INTRODUCTION: Excessive daytime sleepiness and cataplexy are key features of narcolepsy. Modafinil is psychostimulant used in the treatment of narcolepsy. In this study, we evaluated effects of modafinil on nocturnal sleep structure and sleep latency in multiple sleep latency test and clinical features. METHODS: Twelve narcoleptic patients (7 male, age: 22.9 +/- 2.6 yrs) were participated in the study. All of them had done nocturnal polysomnography (nPSG), multiple sleep latency test (MSLT), clinical symptoms scales and have repeated same procedure after taking 200 mg of modafinil. We have done linear mixed model analysis to describe effects of group, medication and nap time on these measures. RESULTS: Modafinil did not affect clinical scales except PSQI which had been reduced after medication. In this study, Modafinil reduced total sleep time, sleep efficiency and increased wake after sleep onset and percent of arousal during sleep in nocturnal polysomnography and prolonged mean sleep latency in multiple sleep latency tests in both group. DISCUSSION: Modafinil has stimulant effect of central nervous system but its effect on night sleep is less than other psychostimulants such as methylphenidate. We ascertained that modafinil affected total sleep time, sleep efficiency and percent of wake during sleep but did not effect on sleep structure. Modafinil was effective in the management of day time sleepiness. Modafinil can enhance alertness of control group without day time sleepiness.
Arousal ; Cataplexy ; Central Nervous System ; Humans ; Male ; Methylphenidate ; Narcolepsy* ; Polysomnography ; Weights and Measures

INTRODUCTION: Detrended fluctuation analysis (DFA) is used as a way of studying nonlinearity of EEG. In this study, DFA is applied on sleep EEG of normal subjects to look into its nonlinearity in terms of EEG channels and sleep stages. METHOD: Twelve healthy young subjects (age: 23.8+/-2.5 years old, male:female=7:5) have undergone nocturnal polysomnography (nPSG). EEG from nPSG was classified in terms of its channels and sleep stages and was analyzed by DFA. Scaling exponents (SEs) yielded by DFA were compared using linear mixed model analysis. RESULTS: Scaling exponents (SEs) of sleep EEG were distributed around 1 showing long term temporal correlation and self-similarity. SE of C3 channel was bigger than that of O1 channel. As sleep stage progressed from stage 1 to slow wave sleep, SE increased accordingly. SE of stage REM sleep did not show significant difference when compared with that of stage 1 sleep. CONCLUSION: SEs of Normal sleep EEG showed nonlinear characteristic with scale-free fluctuation, long-range temporal correlation, self-similarity and self-organized criticality. SE from DFA differentiated sleep stages and EEG channels. It can be a useful tool in the research with sleep EEG.
Electroencephalography* ; Polysomnography ; Sleep Stages ; Sleep, REM

Seventeen volunteers with cutaneous dermatophytosis were enrolled in a clinical trial to evaluate the effectiveness of oral ketoconazole. The group included six patients with tinea cruris(6 malcs), four with tinea corporis, including one with tinea faciai, (3 males, 1 female), three with tinea versicolor(3 males) and four with tinea capitis(3 males, 1 female). The oral ketoconazole was taken within 10 minutes after a meal. The patients under the age of 10 received 100mg of ketoconazole per day, whereas those aged over 11 received 200mg of ketoconazole until the skin lesions are cured. Seventeen patients had complete clinical and mycologic cure, one responded clinically. It required one to four weeks to become culturally negative for tinea cruris, four to seven weeks for tinea corporis, three to eight weeks for tinea capitis. For tinea versicolor it required three to five weeks to become negative by scotch tape method. Adverse reactions to ketoconazole were absent and no patients required discontinuation of the drug. The results indicate that ketoconazole is a safe and effective drug for the treatment of dermatophytosis.
Humans ; Ketoconazole* ; Male ; Meals ; Skin ; Tinea Capitis ; Tinea Versicolor ; Tinea* ; Volunteers

PURPOSE: To describe the magnetic resonance (MR) imaging findings of hypertrophic olivary degeneration (HOD). MATERIALS AND METHODS: MR images of seven patients with HOD were retrospectively reviewed. Two were women and five were men, and they were aged between 48 and 65 (mean 58) years. Imaging examinations were performed with a 1.5-T unit, and the findings were used to evaluate the size and signal intensity of olivary lesions. The time interval from hemorrhagic ictus to MR imaging was between two and 30 months. Follow-up examinations were performed in two patients. RESULTS: All four patients with hemorrhages involving the central tegmental tract in the pons or midbrain showed ipsilateral HOD. Among these four, bilateral HOD was seen in one patient with hemorrhage involving the bilateral central tegmental tract, and in another with tegmental hemorrhage extending to the ipsilateral superior cerebellar peduncle. One patient with cerebellar hemorrhage involving the dentate nucleus had contralateral HOD. Two patients with multiple hemorrhages involving both the pons and cerebellum showed bilateral HOD. Axial MR images showed mild enlargement of the involved olivary nucleus, with high signal intensity on both proton density and T2 weighted images. There was no apparent enhancement on postcontrast T1-weighted images. CONCLUSION: MR imaging can clearly distinguish secondary olivary degeneration from underlying pathology involving the central tegmental tract in the pons or midbrain and cerebellum. These olivary abnormalities should not, however, be mistaken for primary medullary lesions.
Cerebellar Nuclei ; Cerebellum ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Male ; Mesencephalon ; Olivary Nucleus ; Pathology ; Pons ; Protons ; Retrospective Studies

OBJECTIVE: The purpose of this paper is to study the possible differences in clinical and polysomnographic findings, depending on the presence or absence of subjective complaints of abnormal sleep behavior, in patients with RWA on polysomnography. METHOD: We reviewed patient records and polysomnographic data of patients referred to the Sleep Laboratory at Seoul National University Hospital from June 1996 through October 2002. We defined the manifest RBD group (n=32) as patients having both complaints of abnormal sleep behavior and RWA on polysomnography. The latent RBD group (n=20) consisted of patients who exhibited RWA on polysomnography but did not complain of abnormal sleep behavior. The clinical characteristics and polysomnographic findings between the two groups were compared and analyzed. RESULTS: Fifty-two subjects had RWA, as detected by polysomnography (42 males and 10 females, mean age of 55.1+/-19.1 years). Subjects in the manifest RBD group were significantly older than those in the latent RBD group (61.59+/-13.5 vs. 44.70+/-2.76 years, independent t-test, p<0.01). More subjects in the manifest RBD group exhibited abnormal REM behavior on polysomnography than did subjects in the latent RBD group (81.3 vs. 50.0%, Fisher's exact test, p<0.05). No significant differences between the groups were found in the prevalence of brain disorders and primary sleep disorders, gender proportion, and sleep architecture. CONCLUSION: No difference in sleep architecture was found between the manifest and the latent RBD groups. Only age and the presence of abnormal sleep behavior on polysomnography differentiated the two groups. We suggest that RWA on polysomnography without complaints of abnormal sleep behavior may be early manifestation of manifest RBD. Attention to RWA on polysomnography is necessary to help prevent full-blown RBD from developing.
Brain Diseases ; Female ; Humans ; Male ; Mental Disorders* ; Polysomnography ; Prevalence ; REM Sleep Behavior Disorder ; Seoul ; Sleep Wake Disorders ; Sleep, REM*

OBJECTIVE: The purpose of this study is to investigate the prevalence rate of OSA in subjects whose main sleep complaint is insomnia and to find differential factors of OSA in these insomniac subjects. METHOD: We reviewed the medical records and polysomnographic findings of patients referred to the Sleep Laboratory at Seoul National University Hospital from January 1996 to December 2002. Four-hundred and seventy subjects complained of insomnia as their main sleep problem (235 males and 235 females, mean age 53.6+/-12.4 years). First, we investigated the prevalence rate of OSA in these insomniac patients. Second, we compared the clinical and demographic characteristics of the OSA-associated group with those of the non-associated group. Third, we examined whether the degree or presence of differential factors within the OSA group correlate with severity of OSA, as determined by the respiratory disturbance index (RDI). RESULTS: Among 470 insomniac subjects, 125 subjects (26.6%) were diagnosed as OSA by nocturnal polysomnography. OSA-associated subjects were significantly older (58.4+/-12.3 years vs. 51.8+/-11.2 years, p<0.01), and had significantly higher body mass index (BMI) (23.4+/-3.3 kg/m2 vs. 22.5+/-3.1 kg/m2, p=0.44) than non-associated subjects. The OSA-associated group had more subjects with male gender (64.0 % vs. 44.9 %, p<0.01), hypertension (20.0 % vs. 9.3 %, p<0.01) or snoring (96.0 % vs. 63.5 %, p<0.01). Within the OSA-associated group, age had a significant positive correlation with RDI (p=0.01). CONCLUSION: We found that a considerable portion of patients complaining of insomnia as their main sleep problem were diagnosed as OSA. Snoring, old age, male gender, obesity, and comorbid hypertension were found to be differential factors of OSA in insomniac patients. We suggest that diagnostic efforts including nocturnal polysomnography are needed for insomniac patients with any of the above risk factors of OSA.
Body Mass Index ; Female ; Humans ; Hypertension ; Male ; Medical Records ; Obesity ; Polysomnography ; Prevalence ; Risk Factors ; Seoul ; Sleep Apnea, Obstructive* ; Sleep Initiation and Maintenance Disorders* ; Snoring

The recent discovery of plasmid derived beta-lactamase production by N. gonorrhoeae has changed the outlook of treatment of gonococcal infections and may well become the single most important factor in gonorrhoea control. Penicillinase is a beta-lactamase that splits the beta-lactam ring of penicillin hetween the C and N atoms to form penicilloic acids. We have been trying to assess the prevalence of PPNG in Korea since May 1980. We report here 7 strains of beta-lactamase producing N. gonorrhoae detected by chrornogenic cephalosporin method from Jan. 1981 to Mar. 1981 at the Joong Ku puhlic health center in Seoul. In January, I strain (l.3%); February, 2 strains (5.0%); and March, 4 strains .(6 4%) have been isolated. All restrains were confirmed by sugar feriventation test. Previously only one strain of PPNG had been reported among Korean laymen. The sudden appearance of PPNG among Korean laymen in 1981 may mean the barruer between U.S. Army enc1aves and Korean public has been broken recently and/or direct irnport of PPNG frorn abroad especially from South East Asia.

Hemorrhagic shock is one of the most common causes of death in patients with multiple trauma and therefore rapid control of bleeding is the main strategy to save these patients. Resuscitative balloon occlusion of the aorta (REBOA) has been applied in several trauma cases and because of the effectiveness of this procedure it has been adopted in the trauma field. Herein, we report the first successful case of REBOA in Korea performed on a 46-year-old man with hemorrhagic shock after a fall from a height of 14-stories. The patient visited our hospital emergency room with hypovolemic shock, we performed Resuscitative Endovascular Balloon Occlusion of the Aorta under bed side blind technique. His vital sign was stabilized after procedure, then we could performed endovascular bleeding control. The patient was discharged on his 33rd in-hospital day without invasive procedure and major scar.
Aorta* ; Balloon Occlusion* ; Cause of Death ; Cicatrix ; Emergency Service, Hospital ; Hemorrhage ; Humans ; Korea ; Middle Aged ; Multiple Trauma ; Shock* ; Shock, Hemorrhagic ; Vital Signs

Latex allergy is a known cause of allergic contact dermatitis. It produces mild symptoms, including skin rash and itching, which usually subside in a few days. However, latex allergy can also induce anaphylaxis, a severe type I hypersensitivity reaction that can cause urticaria, angioedema, hypotension, tachycardia, and bronchospasm. We report a case of anaphylactic shock during gastric cancer surgery in a patient with no previous allergic history. Surgery was suspended when hypotension, tachycardia, and wheezing developed. A thorough workup revealed that the patient had a latex allergy. The patient subsequently underwent curative gastrectomy performed with latex-free procedures.
Anaphylaxis ; Angioedema ; Bronchial Spasm ; Dermatitis, Allergic Contact ; Exanthema ; Gastrectomy ; Humans ; Hypersensitivity, Immediate ; Hypotension ; Latex ; Latex Hypersensitivity ; Pruritus ; Respiratory Sounds ; Stomach Neoplasms ; Tachycardia ; Urticaria

Pyogenic liver abscess (PLA) can be caused by bacteria entering the liver via the portal vein or primary bacteremia, or it can be cryptogenic. Recently, Klebsiella pneumoniae has been increasingly found as a PLA pathogen. PLA due to this bacterium often leads to formation of extrahepatic abscesses. The treatment of choice is dual therapy with insertion of percutaneous catheter drainage and antibiotic therapy. We report 2 cases of PLA due to K. pneumoniae in immunocompetent children. We successfully treated patient 1 with percutaneous catheter drainage for 18 days and 6-week course of antibiotic therapy. Patient 2 was treated with percutaneous needle aspiration and antibiotic therapy for the same period. In both patients, the PLAs showed the ultrasound-confirmed resolutions after the dual therapy.
Abscess ; Anti-Bacterial Agents ; Bacteremia ; Bacteria ; Catheters ; Child ; Drainage ; Humans ; Immunocompetence ; Klebsiella pneumoniae ; Klebsiella ; Liver ; Liver Abscess, Pyogenic ; Needles ; Pneumonia ; Portal Vein