BACKGROUND: Sleep-related breathing disorders(SRBD) and periodic leg movements disorder(PLMD) are both common, and are considered as separate sleep disorders. However, both disorders show high comorbidity. SRBD and PLMD can result in excessive daytime sleepiness and insomnia due to frequent sleep fragmentation So, it is very important to consider the presence of PLMD, when we are dealing with the diagnosis and management of SRBD. The objectives of this study were to determine the incidence of PLMD in patients with SRBD, and 13 describe any differences between patients with and without PLMD. METHOD: The authors reviewed the sleep recordings of 106 Patients with a final diagnosis of SRBD(obstruclive sleep apnea or upper airway resistance syndrome), who underwent full nocturnal polysomnography, including the monitoring of the anterior tibialis electromyogram. All sleep records were recorded and scored using the standard criteria. The data was analyzed by the student t-test. RESULTS: 106 patients(M=76, F=30) were included in the analysis. Data revealed a mean age of 49.5 +/- 13.6 years, a respiratory disturbance index(RDI) of 22.3 +/- 25.4/hour sleep, a lowest oxygen saturation of 84.9 +/- 11.3%, a mammal esophageal pressure of -41.0 +/- 19.1cm H2O, and PLM index(PLMI) index(PLMI) 13.1 +/- 22.4 movements/ hour sleep. Forty four percent(47 of 106 patients) had a PLMI of greater than 5 on this study. The mean age of the patients with PLMD was significantly higher than that of the patients without PLMD(p < 0.005). Fe-male patients with SRBD accompanied more PLMD(p < 0.05). The apnea index of the patients with PLMD was significantly lower than that of the patients without PLMD(p < 0.01). The percentage of stage 1 sleep in the patients with PLMD was significantly lower than that of the patients without PLMD(p < 0.05). CONCLUSION: The prevalence of PLMD in the patients with SRBD was high at 44.3%. The patients with PLMD were older and had more high RDI in comparison to the patients without PLMD, which was consistent with previous findings. The authors recommend that more careful consideration of PLMD is required when diagnosing and treating SRBD.
Airway Resistance ; Apnea ; Comorbidity* ; Diagnosis ; Extremities* ; Humans ; Incidence ; Leg ; Mammals ; Oxygen ; Polysomnography ; Prevalence ; Respiration* ; Sleep Apnea Syndromes ; Sleep Deprivation ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

BACKGROUND: Measurement of coronary flow velocity in clinical caes contributes to understanding the pathophysiology of coronary circulation. To evaluate the coronary hemodynamics, we analyzed the pattern of coronary flow velocity with a new device consisting of 15Mhz piezoelectric transducer integrated into the tipped 0.018 inch or 0.014 inch flexible, steerable angioplasty guidewire. METHOD: A low profile(0.018 in. or 0.014 in.) Doppler angioplasty guidewire was used to measure the basal blood flow velocity in proximal coronary artery after intracoronary infusion of 200µg nitroglycerine, hyperemic blood flow velocity after intracoronary infusion of adenosine(12µg for LCA, 6µg for RCA). We measured several parameters such as APV (average peak velocity, cm/sec), DSVR(diastolic systolic velocity ratio), MPV(maximal peak velosity, cm/sec), PVI(peak velocity integral, cm), SPVI(systolic peak velocity integral, cm), DSIR(diastolic systolic integral ratio), ASPV(average systolic peak velocity, cm/sec) in basal and hyperemic states. This measurements were made in 17 patients undergoing coronary angiography. RESULTS: 1) APV, ADPV, MPV, in the basal state were higher in LCA than in RCA(32.1±16.6, 40.0±23.6, 57.1±29.0/15.8±9.1, 17.1±10.2, 24.5±20.9cm/sec) and DSVR was also higher in LCA(2.7±2.1/1.4±0.6). But ASPV and SPVI was not different(p>0.05). Significant increases in APV were noted in LCA(32.1±16.6→60.6±17.6cm/sec) and in RCA (15.8±9.1→42.1±15.5cm/sec) after adenosine infusion compared with basal state. DSVR measured in basal state were not statistically different from values in hyperemic state in LCA and RCA(2.7±2.1→2.3±1.7, 1.4±0.6→1.4±0.5, p>0.05). CONCLUSION: The blood flow patterns in both coronary arteries showed different biphasic flow patterns and this finding might be due to the pressure gradient during diastolic phase of both ventricles.
Adenosine ; Angioplasty ; Blood Flow Velocity ; Coronary Angiography ; Coronary Artery Disease ; Coronary Circulation ; Coronary Vessels ; Hemodynamics ; Humans ; Methods ; Nitroglycerin ; Transducers

Hydroxyapatite is commonly used as a filler to replace amputated bone or as a coating to promote bone ingrowth into prosthetic implants. Many modern implants, such as hip replacements and dental implants, are coated with hydroxyapatite. We report a patient with occupational asthma due to hydroxyapatite, proven by a specific inhalation challenge, who experienced an early asthmatic reaction after exposure to hydroxyapatite, without increased airway responsiveness to methacholine despite an increased eosinophil count in the peripheral blood. A 38-year-old male dental implant worker visited our allergy department for the evaluation of occupational asthma. He had treated dental implant titanium surfaces with hydroxyapatite for 1.5 years. One year after starting his employment, he noticed symptoms of rhinorrhea, paroxysmal cough, and chest tightness. His symptoms were aggravated during and shortly after work and subsided several hours after work. When he stopped working for 2 months because of his chest symptoms, he became asymptomatic. After restarting his work, his symptoms reappeared and were aggravated. A methacholine bronchial challenge test had a negative response. The following day, a specific bronchial provocation test with wheat powder was negative. On the third day, a specific bronchial provocation test with hydroxyapatite powder produced an early asthmatic response. On the fourth day, a methacholine bronchial challenge test was negative. Further studies are needed to evaluate the exact pathogenetic mechanism of hydroxyapatite-induced occupational asthma.
Adult ; Asthma ; Asthma, Occupational ; Bronchial Provocation Tests ; Cough ; Dental Implants ; Durapatite ; Employment ; Eosinophils ; Hip ; Humans ; Hypersensitivity ; Inhalation ; Male ; Methacholine Chloride ; Occupations ; Thorax ; Titanium ; Triticum

The genetically determined CYP2D6 activity is considered to be associated with cancer susceptibility with inter-individual variation. Genetic polymorphism of CYP2D6(B) and CYP2D6(T) was determined by the two polymerase chain reaction(PCR) and BstN1 and EcoN1 restriction fragment length polymorphisms(RFLP) for 67 lung cancer cases and 95 healthy volunteer controls. The cases were composed of 26 squamous cell carcinoma, 14 small cell carcinoma, 10 adenocarcinoma, 3 large cell undifferentiated carcinoma, and 14 not histologically diagnosed. The results were gained from the 142 subjects (57 cases and 85 controls) who observed successfully in two PCR and BstN1/EcoN1 RFLP. Only one and no mutant allele of the CYP2D6(B) and CYP2D6(T) gene was detected, that is, the frequency of mutant allele was very low; 0.7%(1/142) and 0%(0/142), respectively. Detected mutant allele of the CYP2D6(B) was heterozygous type(WM). The odds ratios for lung cancer susceptibility with CYP2D6(B) and CYP2D6(T) genotype were not calculated. These results are similar to the previous understanding that the mutant allele is very rare in Orientals compared to Caucasians, therefore, it considered that CYP2D6(B) and CYP2D6(T) genotypes have maybe no association with lung cancer susceptibility in Koreans. This is the basic data of CYP2D6(B) and CYP2D6(T) genotypes for Koreans. It would be hepful for further study to determine lung cancer susceptibility of Koreans with the data about CYP1A1, CYP2E1, GSTM1 from future study.
Adenocarcinoma ; Alleles ; Carcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Cytochrome P-450 CYP1A1 ; Cytochrome P-450 CYP2D6 ; Cytochrome P-450 CYP2E1 ; Genotype ; Healthy Volunteers ; Lung Neoplasms* ; Lung* ; Odds Ratio ; Polymerase Chain Reaction* ; Polymorphism, Genetic ; Polymorphism, Restriction Fragment Length

To know the diagnostic efficacy of erectile perineal ultrasonography in stress urinary incontinence, We compared erectile perineal ultrasonography with chain cystourethrography in 16 women (mean age: 54 years old) with genuine stress urinary incontinence. We measured the posterior urethrovesical angle (PUVA) at rest and during straining in both tests. The average value of PUVA at rest state was 143.4 in chain cystourethrography and 150.9 in perineal ultrasonography (p<0.001). During straining state, PUVA was 172.4 in chain cystourethrography and 177.2 in perineal ultrasonography (p<0.001). The difference between PUVAs at rest and during straining were 29.0 in chain cystourethrography and 26.3 in perineal ultrasonography U)<0.05). In conclusion, erectile perineal ultrasonography is non-invasive, simple, comfortable and useful diagnostic method in stress urinary incontinence. So we think that erectile perineal ultrasonography can replace the chain cystourethrography to diagnose the stress urinary incontinence.
Female ; Humans ; Ultrasonography* ; Urinary Incontinence*

BACKGROUND: Lambert-Eton myasthenic syndrome(LEMS) is characterized by the clinical triad of muscle weakness, hyporeflexia, and autonomic dysfunction. In contrast to myasthenia gravis.LEMS is not commonly associated with respiratory failure. Any case of respiratory failure in LEMS has not been reported in Korea. CASE DESCRIPTION: The first case is a 61-tear-old male complained of proximal muscle weakness and dysarthria associated with severe dry mouth for 3 month and developed respiratory failure. The second case is a 65-tear-old male who began complaining of muscle weakness, weight loss, dry mouth, and recurrent respiratory difficulty for 14 months. Repetitive nerve stimulation(RNS) test for ulnar nerve showed CMAP with low amplitude, a significant decremental response at the low rate stimulation and a marked incremental response at the high rate stimulation in the left abductor digiti muscles in both cases. The first case had small cell carcinoma of the lung, but the second case presented with respiratory failure in the absence of malignancy. CONCLUSION:We experienced two cases of LEMS presenting respiratory failure. To our knowledge, this is the first report of respiratory failure in LEMS in Korea.
Carcinoma, Small Cell ; Dysarthria ; Humans ; Korea ; Lambert-Eaton Myasthenic Syndrome* ; Lung ; Male ; Mouth ; Muscle Weakness ; Muscles ; Reflex, Abnormal ; Respiratory Insufficiency* ; Ulnar Nerve ; Weight Loss

BACKGROUND: Lambert-Eton myasthenic syndrome(LEMS) is characterized by the clinical triad of muscle weakness, hyporeflexia, and autonomic dysfunction. In contrast to myasthenia gravis.LEMS is not commonly associated with respiratory failure. Any case of respiratory failure in LEMS has not been reported in Korea. CASE DESCRIPTION: The first case is a 61-tear-old male complained of proximal muscle weakness and dysarthria associated with severe dry mouth for 3 month and developed respiratory failure. The second case is a 65-tear-old male who began complaining of muscle weakness, weight loss, dry mouth, and recurrent respiratory difficulty for 14 months. Repetitive nerve stimulation(RNS) test for ulnar nerve showed CMAP with low amplitude, a significant decremental response at the low rate stimulation and a marked incremental response at the high rate stimulation in the left abductor digiti muscles in both cases. The first case had small cell carcinoma of the lung, but the second case presented with respiratory failure in the absence of malignancy. CONCLUSION:We experienced two cases of LEMS presenting respiratory failure. To our knowledge, this is the first report of respiratory failure in LEMS in Korea.
Carcinoma, Small Cell ; Dysarthria ; Humans ; Korea ; Lambert-Eaton Myasthenic Syndrome* ; Lung ; Male ; Mouth ; Muscle Weakness ; Muscles ; Reflex, Abnormal ; Respiratory Insufficiency* ; Ulnar Nerve ; Weight Loss

Theoretically one might suggest the abdominoplasty can cause respiratory decompensation resulting from musculofascial plication, which reduces the respiratory reserve by decreasing intra-abdominal volume and diaphragmatic excursion. This prospective study was perfomed to evaluate the effect of abdominoplasty and the change of intraoperative Paw on the pulmonary function of 20 consecutive otherwise healthy subjects. The pulmonary function test was performed preoperatively, and repeated 2 months after the operation. Additionally, we monitored intraoperative Paw. Comparison of the pulmonary function test showed a significant decrease(p<0.001) in the mean forced vital capacity(FVC) and the mean forced expiratory volume in one second(FEV1) throughout the study period. Postoperatively, the mean FVC decreased by 11.65% and the mean FEV1 decreased by 16.15%. The mean Paw increased by 6.6cmH2O(3-12cmH2O) by musculofascial plication. And we found that the decrease in FVC and FEV1 was significantly correlated with intraoperative changing of Paw in abdominoplasty(p<0.001). FVC and FEV1 could be decreased by abdominoplasty due to decreasing intra-abdominal volume and diaphragmatic excursion, but there was no respiratory symptom clinically in all patients 2 months after the operation. In conclusion, We found that the decrease in FVC and FEV1 after 2 months of abdominoplasty was significantly correlated with intraoperative Paw change during operation. The intraoperative Paw was increased to 12 cmH2O without any respiratory symptom in this study. We suggested that the increase in intraoperative Paw less than about 10cmH2O can not affect on respiratory function clinically.
Abdominoplasty* ; Forced Expiratory Volume ; Humans ; Prospective Studies ; Respiratory Function Tests

Endobronchial involvement in non-Hodgkin's lymphoma is rare. We experienced 36-year-old woman with endobronchial non-Hodgkin's lymphoma whose first presentation was breathless ness due to the total atelectasis of the left lung. The patient underwent fiberoptic bronchoscopy and the histologic finding with immunohistochemical staining confirmed CD30(+), EMA(+) anaplastic large cell lymphoma. Although the patient showed dramatic response to radiation therapy and combination chemotherapy, subsequently she died of disease progression.
Adult ; Bronchoscopy ; Disease Progression ; Drug Therapy, Combination ; Female ; Humans ; Lung ; Lymphoma, Large-Cell, Anaplastic ; Lymphoma, Non-Hodgkin* ; Pulmonary Atelectasis

BACKGROUND: The detection of collapsible airways has important therapeutic implications in chronic airway disease and bronchial asthma. The distinction of a purely collapsible airways disease from that of asthma is important because the treatment of the former may include the use of pursed lip breathing or nasal positive pressure ventilation whereas in the latter, pharmacologic approaches are used. One form of irreversible airflow limitation is collapsible airways, which has been shown to be a component of asthma or to emphysema, it can be assessed by the volume difference between what exits the lung as determined by a spirometer and the volume compressed as measured by the plethysmography. METHOD: To investigate whether volume difference between slow and forced vital capacity(SVC-FVC) by spirometry may be used as a surrogate index of airway collapse, we examined pulmonary function parameters before and after bronchodilator agent inhalation by spirometry and body plethysmography in 20 cases of patients with evidence of airflow limitation(chronic obstructive pulmonary disease 12 cases, stable bronchial asthma 7 cases, combined chronic obstructive pulmonary disease with asthma 1 case) and 20 cases of normal subjects without evidence of airflow limitation referred to the Pusan National University Hospital pulmonary function laboratory from January 1995 to July 1995 prospectively. RESULTS: 1) Average and standard deviation of age, height, weight of patients with airflow limitation was 58.3+/-7.24(yr), 166+/-8.0(cm), 59.0+/-9.9(kg) and those of normal subjects was 56.3+/-12.47(yr), 165.9+/-6.9(cm), 64.4+/-10.4(kg), respectively. The differences of physical characteristics of both group were not significant statistically and male to female ratio was 14:6 in both groups. 2) The difference between slow vital capacity and forced vital capacity was 395+/-317ml in patients group and 154+/-176ml in normal group and there was statistically significance between two groups(p<0.05). Sensitivity and specificity were most higher when the cut-off value was 208ml. 3) After bronchodilator inhalation, reversible airway obstructions were shown in 16 cases of patients group, 7 cases of control group(p<0.05) by spirometry or body plethysmography and the differences of slow vital capacity and forced vital capacity in bronchodilator response group and nonresponse group were 300.4+/-306ml, 144.7+/- 180ml and this difference was statistically significant. 4) The difference between slow vital capacity and forced vital capacity before bronchodilator inhalation was correlated with airway resistance before bronchodilator(r=0.307 p=0.05), and the difference between slow vital capacity and forced vital capacity after bronchodilator was correlated with difference between slow vital capacity and forced vital capacity(r=0.559 p=0.0002), thracic gas volume(r=0.488 p=0.002) before bronchodilator and airway resistance(r=0.583 p=0.0001), thoracic gas volume(r=0.375 p=0.0170) after bronchodilator, respectively. 5) The difference between slow vital capacity and forced vital capacity in smokers and nonsmokers was 267.5+/-303ml, 277.5+/-276ml, respectively and this difference did not reach statistical significance(p>0.05). CONCLUSION: The difference between slow vital capacity and forced vital capacity by spirometry may be useful for the detection of collapsible airway and may help decision making of therapeutic plans.
Airway Obstruction ; Airway Resistance ; Asthma ; Bronchodilator Agents ; Busan ; Decision Making ; Emphysema ; Female ; Humans ; Inhalation ; Lip ; Lung ; Lung Diseases, Obstructive ; Male ; Plethysmography ; Positive-Pressure Respiration ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive ; Respiration ; Sensitivity and Specificity ; Spirometry ; Vital Capacity