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

BACKGROUND: An appropriate level of sedation and pharmacological assist are essential during percutaneous transluminal balloon angioplasty (PTA). Ketamine provides good analgesia while preserving airway patency, ventilation, and cardiovascular stability with an opioid sparing effect suggesting that it would be ideal in combination with remifentanil and midazolam in spontaneously breathing patients. We evaluated the effect of a small dose of ketamine added to midazolam and remifentanil on analgesia/sedation for PTA procedures. METHODS: Sixty-four patients receiving PTA were enrolled. The Control group received midazolam 1.0 mg i.v. and continuous infusion of remifentanil 0.05 microg/kg/min. The Ketamine group received, in addition, an intravenous bolus of 0.5 mg/kg ketamine. Patients' haemodynamic data were monitored before remifentanil infusion, 5 min after remifentanil infusion, at 1, 3, 5, 30 min after incision, and at admission to the recovery room. Verbal numerical rating scales (VNRS) and sedation [OAA/S (Observer's Assessment of Alertness/Sedation)] scores were also recorded. RESULTS: The VNRS values at 1, 3, and 5 min after incision and OAA/S scores at 5 min after remifentanil infusion, and 1, 3, and 5 min after incision were lower in the Ketamine group than in the Control group. In the Control group, the VNRS value at 1 min after incision significantly increased and OAA/S values at 3, 5, and 30 min after incision significantly decreased compared to baseline values, while there were no significant changes in the ketamine group. CONCLUSIONS: A small dose of ketamine as an adjunct sedative to the combination of midazolam and remifentanil produced a better quality of sedation and analgesia than without ketamine and provided stable respiration without cardiopulmonary deterioration.
Analgesia ; Angioplasty, Balloon ; Humans ; Ketamine ; Midazolam ; Piperidines ; Recovery Room ; Respiration ; Ventilation ; Weights and Measures

BACKGROUND: Despite the development of a new class of antiemetics, postoperative nausea and vomiting (PONV) still remains a frequent and distressing complication. We compared the prophylactic antiemetic effect of administering dexamethasone 5 mg as an adjunct to ramosetron and ondansetron in patients at high-risk for PONV following lumbar spinal surgery. METHODS: In this randomized, double-blind study, 120 female non-smoking patients with intravenous patient-controlled analgesia (PCA) received ramosetron 0.3 mg plus dexamethasone 5 mg (group R + D) or ondansetron 4 mg plus dexamethasone 5 mg (group O + D) intravenously. Fentanyl-based PCA was administered for 48 hr postoperatively; ramosetron 0.3 mg or ondansetron 12 mg was added to the PCA regimen according to the allocated group. The incidence of PONV and rescue antiemetic were assessed for 48 hr postoperatively at 0-6, 6-24, and 24-48 hr. RESULTS: The overall incidence of PONV did not differ between the groups (50% vs. 60%, in groups R + D and O + D, respectively). The overall incidence of nausea was similar between groups (47% vs. 60%, in groups R + D and O + D, respectively). The overall frequency of vomiting was also similar between groups (8% vs. 12%, in groups R + D and O + D, respectively). The severity of nausea and the overall use of rescue antiemetic were not different between groups. CONCLUSIONS: The antiemetic efficacy of ramosetron plus dexamethasone was similar to that of ondansetron plus dexamethasone on preventing PONV in high-risk patients undergoing lumbar spinal surgery.
Analgesia, Patient-Controlled ; Antiemetics ; Benzimidazoles ; Dexamethasone ; Double-Blind Method ; Female ; Humans ; Incidence ; Nausea ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Spine ; Vomiting

BACKGROUND: Despite the development of a new class of antiemetics, postoperative nausea and vomiting (PONV) still remains a frequent and distressing complication. We compared the prophylactic antiemetic effect of administering dexamethasone 5 mg as an adjunct to ramosetron and ondansetron in patients at high-risk for PONV following lumbar spinal surgery. METHODS: In this randomized, double-blind study, 120 female non-smoking patients with intravenous patient-controlled analgesia (PCA) received ramosetron 0.3 mg plus dexamethasone 5 mg (group R + D) or ondansetron 4 mg plus dexamethasone 5 mg (group O + D) intravenously. Fentanyl-based PCA was administered for 48 hr postoperatively; ramosetron 0.3 mg or ondansetron 12 mg was added to the PCA regimen according to the allocated group. The incidence of PONV and rescue antiemetic were assessed for 48 hr postoperatively at 0-6, 6-24, and 24-48 hr. RESULTS: The overall incidence of PONV did not differ between the groups (50% vs. 60%, in groups R + D and O + D, respectively). The overall incidence of nausea was similar between groups (47% vs. 60%, in groups R + D and O + D, respectively). The overall frequency of vomiting was also similar between groups (8% vs. 12%, in groups R + D and O + D, respectively). The severity of nausea and the overall use of rescue antiemetic were not different between groups. CONCLUSIONS: The antiemetic efficacy of ramosetron plus dexamethasone was similar to that of ondansetron plus dexamethasone on preventing PONV in high-risk patients undergoing lumbar spinal surgery.
Analgesia, Patient-Controlled ; Antiemetics ; Benzimidazoles ; Dexamethasone ; Double-Blind Method ; Female ; Humans ; Incidence ; Nausea ; Ondansetron ; Passive Cutaneous Anaphylaxis ; Postoperative Nausea and Vomiting ; Spine ; Vomiting

A 56-year old female who had an atrial septal defect with tricuspid regurgitation received a patch repair and tricuspid annuloplasty. During weaning from cardiopulmonary bypass (CPB), bright red blood filled the endotracheal tube and breathing circuit. We suctioned the blood through the endotracheal tube. The bleeding was massive (about 400 ml) but the airway could be cleared with endotracheal suction. We irrigated endotracheal tube with normal saline with phenylephrine. The weaning of CPB was done and protamine was administered. The bleeding ceased when protamine was administered. Weaning from CPB was accomplished uneventfully. We found a little bleeding in the right main stem bronchus by flexible bronchoscopy but did not do any more procedures. In the intensive care unit, the patient had stable vital signs and good respiratory function. The patient was extubated without any problems at postoperative 1 day and transferred to ward without any complications.
Bronchi ; Bronchoscopy ; Cardiopulmonary Bypass* ; Female ; Heart Septal Defects, Atrial ; Hemoptysis* ; Hemorrhage ; Humans ; Intensive Care Units ; Middle Aged ; Phenylephrine ; Respiration ; Suction ; Tricuspid Valve Insufficiency ; Vital Signs ; Weaning

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