We have attempted to measure parafoveal retinal acuity directly on the exact retinal locus, while observing the retinal image in real time using the scanning laser ophthalmoscope(SLO 101, Rodenstock, Munish, Germany). By the SLO Visumetry software(Rodenstock v. 3.0), thirty eyes of healthy volunteers were examined in 20degrees image field. Using Snellen E as stimulus, the examination was performed from the fovea by the radial pattern. The maximal retinal distance point, which responded to stimulus, was recorded by the pixel, and the distance(mm) from the fovea was calculated by the Bennett formula. The maximum distance from the fovea at the given stimulus size was achieved as follows: 0.32+/-0.01mmat the 15 x15 arc of minute(0.333), 0.63+/-0.01mm at the 17 x17 arc of minute(0.294), 1.05+/-0.03 mmat 20 x 20 arc of minute(0.25), and 1.44+/-0.0 5 mmat the 23 x23 arc of minute(0.217). It was also revealed that the horizontal maximal distance from fovea at given stimulus size was statistically superior to the vertical maximal distance(p<0.05). In conclusion we were able to establish the normal range of parafoveal retinal acuity in healthy volunteers. It may serve as the baseline for subsequent study of retinal pathology and functional evaluation as well as its treatment.
Healthy Volunteers* ; Pathology ; Reference Values ; Retinaldehyde* ; Visual Acuity*

BACKGROUND: Asthmatic patients frequently suffer cold-weather-associated respiratory symptoms. The sensitivity, specificity, accuracy and diagnostic value of isocapnic hyperventilation of cold air(IHCA) using a multistep method was investigated in patients suspected to have asthma. METHOD: One hundred and 29 adult patients who had an IHCA performed between july 1999 and December 2000, had an methacholine bronchoprovocation test because of a clinical suspicion of asthma. RESULTS: According to strict criteria, 50 were defined as asthmatics and 79 as symptomatic nonashmatics. There were no differences in age, sex and smoking state between the asthmatic and symptomatic nonasthmatic groups. There was a significant decrease in the percentage reduction in the forced expiratory volume in 1 second(FEV1) after the IHCA between the asthmatics(-10.0±6.8%) and the symptomatic nonasthmatics(-2.3±2.5%). The factors associated with a reactivity to IHCA were FEV1/FVC, FEF25-75/FVC and FEV1(% of predicted). The accuracy was highest using a 7% fall in FEV1; the sensitivity was 76% and the specificity 96%. CONCLUSION: IHCA is a specific, although not a sensitive, test for diagnosing asthma in adult patients. Furthermore, the diagnostic cut-off value of the different methods of IHCA need to be determined.
Adult* ; Asthma* ; Forced Expiratory Volume ; Humans ; Hyperventilation* ; Methacholine Chloride ; Sensitivity and Specificity ; Smoke ; Smoking

PURPOSE: To analyze the hyperacuity defects of preferential hyperacuity perimeter (PHP) in myopic CNV and correlate with the other macular anatomical or physiological properties obtained with fluorescein angiography (FA), Optical coherence Tomography (OCT), and central perimeter. METHODS: Seven patients with myopic CNV diagnosed by FA underwent PHP, OCT, central visual field (VF). We examined the locational correlation among FA, central VF and PHP hyperacuity defect and then compared PHP hyperacuity defect with the CNV size by OCT. Also we made a comparison with macular sensitivity change in VF and hyperacuity defects change in PHP after PDT in 4 patients. RESULTS: All the 7 eyes with myopic CNV tested positive for hyperacuity defects. 5 eyes showed locational correlation among PHP and FA, central VF. The size of hyperacuity defect of PHP and CNV size by OCT was positive correlation (p=0.007). Four eyes treated with PDT showed decrease of PHP hyperacuity defect size and changes in location according to decrease of CNV size after PDT. CONCLUSIONS: Our results suggest that the PHP may be used to detect myopic CNV and beneficial for analyzing functional effect following PDT in myopic CNV patients. These results require further validation in a larger population.
Fluorescein Angiography ; Humans ; Photochemotherapy ; Tomography, Optical Coherence ; Visual Fields

BACKGROUND: The past. studies on prediction formulas of pulmonary function parameters in healthy nonsmoking Korean adults have been performed in relatively small number of subjects and the reported results were restricted on a few parameters. Also there was no systematic investigation into the effect of smoking on pulmonary function parameters in smokers who have no respiratory symptoms. Therefore we attempted to establish prediction formulas of pulmonary function parameters and examined the effect of smoking on pulmonary function parameters. METHODS: We analyzed the result of parameters derived from the forced expiratory spirogram in 1,067 nonsmoking subjects from June in 1990 to December in 1991. They consisted of 306 males and 761 females and had neither respiratory symptoms nor history of respiratory disease. We derived prediction formulas by multiple linear regression method from their age, heights, and weights in each sex. To examine the effect of smoking on pulmonary function parameters, we classified 383 smoking men into three groups according to the past amount of smoking as follows : i.e. group of smokers who have smoked below 10 pack-years, 10-20 pack-years and above 20 pack-years. Regarding each group of past smoking as an independent dummy variable, we analyzed pulmonary function parameters including nonsmoking men as a baseline by multiple linear regression. We evaluated the smoking effect on pulmonary function parameters according to estimated p-value. RESULT: 1) Prediction formulas for pulmonary function parameters in each sex were derived. 2) The past smoking less than 10 pack-years does not give any effect on pulmonary function parameters. The past smoking of 10~20 pack-years showed significant negative correlation with FEV1/FVC and FEF 25~75%, and the smoking above 20 pack years showed negative correlation with FEV1 and FEV1/FVC. CONCLUSION: We have got prediction formulas of pulmonary function parameters which is driven from forced expiratory spirogram in nonsmoking Korean adults by multiple linear regression from age, heights and weights of subjects. The past smoking more than 10 pack-years showed negative correlation with some pulmonary function parameters of airflow obstruction.
Adult* ; Female ; Humans ; Linear Models ; Male ; Smoke* ; Smoking* ; Weights and Measures

Pulmonary lymphangioleiomyomatosis is a disease involving the proliferation of atypical smooth muscle cells trom the perilymphatics, peribronchial and perivascular region of the lung and the retroperitneum. The disease usually affects women of child-bearing age. We recently experienced a case of pulmonary lymphangioleiomyomatosis in a 31-year-old women who had suffered from a chylous pleural effusion. Histologic confirmation of lymphangioleiomyomatosis was made upon a video-associated thoracoscopic lung biopsy. Here we report this case with a brief review of the literature.
Adult ; Biopsy ; Female ; Humans ; Lung ; Lymphangioleiomyomatosis* ; Myocytes, Smooth Muscle ; Pleural Effusion*

BACKGROUNDS: In the absence of distant metastasis, small cell lung cancer (SCLC) patients presenting with supraclavicular lymph node (SCLN) involvement and pleural effusion can benefit from thoracic radiotherapy. But there are some debate as to the prognostic significance of both SCLN involvement and pleural effusion. The purpose of this study was to determine the prognostic significance of SCLN involvement and pleural effusion in SCLC. METHODS: Two Hundred and fifteen patients with histologically confirmed small cell lung cancer, who were treated either at the Keimyung university Dongsan hospital and Kyungpook national university hospital from January 1994 to June 1998, were evaluated retrospectively. The patients were classified as having either limited or extensive stage using the Veterans Administration staging system. RESULTS: SCLN was presented in 10.5% of patients(n=21). The median survival was 247 days for patients with SCLN(n=21) and 264 days for patients without(n=194) (p=0.52). After treatment, the median survival was 298 days for patients with SCLN(n=13) and 348 days for patients without(n=115) (p=0.52). SCLN involvement was not correlated with the presence of distant metastases. Medican survival was 459 days for patients with a limited stage without SCLN(n=66), 650 days for those with a limited stage with SCLN (n=7) (p=0.96). Pleural effusion was presented in 24.7% of patients(n=52). The median survival was 198 days for patients with pleural effusion(n=52) and 275 days for patients without(n=163) (p<0.05). After treatment, the median survival was 294 days for patients with a pleural effusion(n=25) and 286 days for patients without(n=103) (p=0.39). The presence of pleural effusion was not correlated with that of distant metastases. The median survival was 395 days for patients with a limited stage without a pleural effusion(n=63), 451 days for those with a limited stage with pleural effusion(n=10) (p=0.92). CONCLUSIONS: In this study, SCLN involvement does not explain the poor survival rate and the relevance to extensive staged disease. Furthermore, the existence of a pleural effusion did not correlated with the presence of distant metastases. However, the presence of a pleural effusion appears to be a minor prognostic factor in our study. Therefore supraclavicular lymph node justify any amendment to the staging system currently used.
Gyeongsangbuk-do ; Humans ; Lymph Nodes* ; Neoplasm Metastasis ; Pleural Effusion* ; Radiotherapy ; Retrospective Studies ; Small Cell Lung Carcinoma* ; Survival Rate ; United States Department of Veterans Affairs

Kawasaki disease (KD) is an acute, self-limiting, small-vessel vasculitis with an unknown cause that affects children between the ages of 6 months and 5 years. Its important acute complication is coronary artery aneurysm. Myocardial infarction caused by thrombus formation inside the aneurysm or by organic obstructive lesion following the regression of aneurysm is the principal cause of death in KD. However, coronary artery aneurysms and stenosis requiring surgery are rare in KD. We report an our experience about anesthetic management of child undergone off-pump coronary artery bypass grafting surgery because of coronary artery aneurysm associated with KD.
Anesthesia ; Aneurysm ; Cause of Death ; Child ; Constriction, Pathologic ; Coronary Artery Bypass, Off-Pump ; Coronary Disease ; Coronary Vessels ; Humans ; Infarction ; Mucocutaneous Lymph Node Syndrome ; Myocardial Infarction ; Thrombosis ; Transplants ; Vasculitis

BACKGROUND: The purpose of this study was to report findings of exploratory arthroscopic assessment performed in conjunction with removal of internal fixation device placed in the initial surgery for rotational ankle fracture. METHODS: A total of 53 patients (33 male, 20 female) who underwent surgery for rotational ankle fracture between November 2002 and February 2008 were retrospectively reviewed. All patients gave consent to the exploratory arthroscopic surgery for the removal of internal fixation devices placed in the initial surgery. Lauge-Hansen classification system of ankle fractures was assessed for all patients. Intra-articular lesions (osteochondral lesion, loose body, and fibrosis) were evaluated via ankle arthroscopy. Comparative analysis was then performed between radiological classification of ankle fracture/patient's symptoms and arthroscopic findings. RESULTS: Lauge-Hansen classification system of ankle fractures included supination-external rotation type (n = 35), pronation-external rotation type (n = 9), and pronation-abduction type (n = 9). A total of 33 patients exhibited symptoms of pain or discomfort while walking whereas 20 exhibited no symptoms. Arthroscopic findings included abnormal findings around the syndesmosis area (n = 35), intra-articular fibrosis (n = 51), osteochondral lesions of the talus (n = 33), loose bodies (n = 6), synovitis (n = 13), and anterior bony impingement syndrome (n = 3). Intra-articular fibrosis was seen in 31 of symptomatic patients (93.9%). Pain or discomfort with activity caused by soft tissue impingement with meniscus-like intra-articular fibrosis were found in 19 patients. There was statistical significance (p = 0.02) between symptoms (pain and discomfort) and the findings of meniscus-like fibrosis compared to the group without any symptom. CONCLUSIONS: Arthroscopic examination combined with treatment of intra-articular fibrosis arising from ankle fracture surgery may help improve surgical outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Ankle/*pathology/radiography/*surgery ; Ankle Fractures/*pathology/radiography/*surgery ; Arthralgia ; Arthroscopy/*methods ; Female ; Fibrosis ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

PURPOSE: It is difficult to make the standard ischemic RPE culture model which is still not established. In ischemic model, oxygen and glucose are very important. To improve experimental model, we evaluate the effect of glucose on anoxia-induced human RPE cell damage. METHODS: Human RPE cells were incubated with 95% N2/5% CO2 and standard conditions (95% air/5% CO2) at 37degrees C, and various concentation of glucose were added to a glucose-free medium : no glucose, 0.2 mg/ml, 0.4 mg/ml, -2.0 mg/ml. On a daily basis, morphological and proliferation analysis was conducted using the inverted phase contrast microscope. The extent of cell damage was estimated through cell viability analysis. Cell viability was examined using PMS(phenazinemethosulphate)-MTS(3-(4.5 -dimethyl-thiazol-2-yl)-5-(3-caboxymethoxyphenyl)-2-(4-sulfo phenyl)-2H-tetrazolium, inner salt)assay after 24, 48, 72, and 96 hours. Single-stranded DNAs were detected with monoclonal antibody to prove cell apoptosis in cell damage. RESULTS: At slightly low glucose concentration(0.4 mg/ml), the cell viability of human RPE cells cultured at room air was maintained up to 96 hours, whereas that cultured at 95% N2 decreased after 48 hours. At the anoxic condition. the cell viability of human RPE cells cultured with the low glucose concentration (0.2 mg/ml) decreased after 24 hours, but those done with higher glucose concentrations (more than 0.8 mg/ml) were maintained up to 96 hours. In the cell death caused by the anoxic culture, apoptosis was not suggested by single-stranded DNA detection. CONCLUSIONS: Properly higher glucose concentration on culture medium improve cell viability and reduce the cell damage in human RPE culture in anoxic condition. This result helps to improve experimental ischemic model of RPE cell.
Anoxia ; Apoptosis ; Cell Death ; Cell Survival ; DNA, Single-Stranded ; Glucose* ; Humans* ; Models, Theoretical ; Oxygen ; Retinaldehyde*

PURPOSE: To evaluate the outcome of a second intravitreal injection of triamcinolone acetonide for the treatment of diabetic macular edema. METHODS: This clinical series study was carried out on 12 eyes with diabetic macular edema. All patients had shown VA (visual acuity) improvement after the first intravitreal injection of triamcinolone acetonide (4 mg). Following the exhibition of decreased VA and increased foveal thickness, the eyes received a second intravitreal injection. We analyzed the visual acuity and foveal thickness at post-treatment 1, 3, and 6 months by ETDRS (LogMar) and optical coherence tomography (OCT). RESULTS: The mean improvement of visual acuity was 0.24, 0.11, and 0.00 at the 1-, 3-, and 6-month follow-up after the first injection, and was 0.09, 0.00, and -0.20 at the 1-, 3-, 6-month follow-up after the second injection. The mean decrease of foveal thickness was 400, 243, and 109 micrometer at the 1-, 3-, 6-month follow-up after the first injection and 298, 78, and -53 micrometer at the 1-, 3-, and 6-month follow-up after the second injection. The differences of change in foveal thickness after the first and second injections were significant (P=0.02, 0.04, 0.02) but the differences of change in visual acuity were not significant (P=0.14, 0.41, 0.28). CONCLUSIONS: Intravitreal injection of 4 mg of triamcinolone acetonide may increase the visual acuity and may decrease the foveal thickness in the short term, postoperative period, but the second intravitreal injection was less effective than the first injection.
Follow-Up Studies ; Humans ; Intravitreal Injections ; Macular Edema* ; Postoperative Period ; Tomography, Optical Coherence ; Triamcinolone Acetonide* ; Triamcinolone* ; Visual Acuity