The pathogenesis and mechanism of obstructive sleep apnea (OSA) has been under investigation for over 25 years, but its etiology and mechanism remains elusive. Skeletal (maxillary and/or mandibular hypoplasia or retrodisplacement, inferior displacement of hyoid) and soft tissue (increased volume of soft tissue, adenotonsillar hypertrophy, macroglossia, thickened lateral pharyngeal walls) factors, pharyngeal compliance (increased), pharyngeal muscle factors (impaired strength and endurance of pharyngeal dilators and fixators), sensory factors (impaired mechanoreceptor sensitivity, impaired pharyngeal dilator reflexes), respiratory control system factors (unstable respiratory control) and so on facilitate collapse upper airway. Therefore, OSA may be a heterogeneous disorder, rather than a single disease entity and various pathogenic factors contribute to the OSA varies person to person. As a result, patients may respond to different therapeutic approaches based on the predominant abnormality leading to the sleep disordered breathing.
Compliance ; Humans ; Hypertrophy ; Macroglossia ; Mechanoreceptors ; Pharyngeal Muscles ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive*

No abstract available.
Animals ; Cricetinae* ; Macrophage Activation* ; Macrophages* ; Macrophages, Peritoneal* ; Mice* ; Nitric Oxide ; Phagocytosis

No abstract available.
Animals ; Macrophages ; Macrophages, Peritoneal* ; Mice* ; Signal Transduction*

BACKGROUND: Cerebral white matter lesions(WMLs), such as leukoaraiosis, may be related to damage from cerebral ischemia and may also be associated with the degenerative process. The apolipoprotein E (APOE) 4 allele is a risk factor for degenerative diseases, such as Alzheimer`s disease, and ischemic brain damage through acceleration of atherosclerosis. No study has been performed regarding WMLs and APOE genotype in Korea. We investigated the association between WMLs and APOE among Koreans. METHODS: Brain MRI was performed in 225 subjects(ages 61 to 85 years) without neuropsychiatric disease randomly selected from the Ansan Health Cohort Study. WMLs observed on 225 MRI scans were rated in terms of severity by 2 raters. All study subjects underwent APOE genotyping. RESULTS: WMLs were observed in 109(48.4%) of subjects. In the subjects with WMLs, the distribution of APOE genotypes was 0.9% for epsilon 2/epsilon 2, 11.0% for epsilon2/epsilon3, 1.8% for epsilon2/epsilon4, 61.5% for epsilon3/epsilon3, 22.9% for epsilon3/epsilon4, and 1.8% for epsilon4/epsilon4, respectively. The distribution of APOE genotypes did not differ between subjects with and without WMLs. CONCLUSION: These data suggest that there is no association between WMLs and APOE genotypes in Koreans.
Acceleration ; Alleles ; Apolipoproteins E ; Apolipoproteins* ; Atherosclerosis ; Brain ; Brain Ischemia ; Cohort Studies ; Genotype ; Gyeonggi-do ; Korea ; Leukoaraiosis ; Magnetic Resonance Imaging ; Risk Factors

No abstract available.
Constriction, Pathologic* ; Stents*

BACKGROUND: The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to M3 muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal M2 muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these M2 muscarinic receptors act as autoreceptors. Loss of function of these M2 receptors, as it occres in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of M2 muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. METHODS: We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test(PC 20<16mg/ml). Methacholine provocation tests performed twice on separate days allowing for an interval of one week. In the second test, pre-treatment with the M2 muscarinic receptor agonist pilocarpine(180µg) through inhalation was performed before the routine procedures. RESULTS: Eleven subjects with mild asthma and eight aubjects with moderate asthma showed significant increase of PC20 from 5.30±5.23mg/ml(mean±SD) to 20.82±22.56mg/ml(p=0.004) and from 2.79±1.5mg/ml to 4.67±3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of PC20 from 1.76±1.50mg/ml to 3.18±4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. CONCLUSION: In subjects with mild and moderate asthma, function of M2 muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. These results suggest that function of M2 muscarinic receptors is different according to severity of asthma.
Acetylcholine ; Asthma ; Autoreceptors ; Humans ; Inhalation ; Korea ; Methacholine Chloride ; Models, Animal ; Muscle, Smooth ; Neurons* ; Pilocarpine ; Pulmonary Medicine ; Receptors, Muscarinic* ; Respiratory Tract Infections ; Vagus Nerve

No abstract available.
Pulmonary Artery*

BACKGROUND: Succinylcholine (Sch) has been considered to be the neuromuscular blockade (NMB) of choice in clinical anesthesia due to its rapid onset and short duration of action. Despite these clinical advantages, the use of Sch has decreased recently on account of its potentially fatal adverse effects such as cardiac arrest and malignant hyperthermia. The aim of this report was to analyze the frequency and the indications of Sch as well as to discover an alternative to decreasing the frequency of Sch use. METHODS: The medical records of a total of 33,972 cases under general anesthesia were collected retrospectively, and the frequency of Sch use and the reason for choosing Sch was analyzed. The side effects and other complications of Sch were also analyzed. RESULTS: A muscle relaxant was administered in 32,724 cases (96.3%) out of 33,972 cases, and Sch was used in 647 of these cases (1.9%). The reasons for choosing Sch were the rapid sequence induction (291 cases), short operation time (220 cases), recent food intake (51 cases), habitual use (78 cases) and reintubation (7 cases). There were 211 cases of the single administration of Sch and 13 cases in whom Sch was injected repeatedly. A non-depolarizing muscle relaxant (NDMR) was used after Sch administration in 423 cases. Precurarization was carried out in 434 cases (67%) and no severe complications were observed. CONCLUSIONS: The frequency of using Sch use can be decreased by reducing the habitual use and choosing the intubating dose of the intermediate acting NDMR as an alternative.
Anesthesia ; Anesthesia, General ; Anesthesia, Inhalation* ; Eating ; Heart Arrest ; Inhalation* ; Malignant Hyperthermia ; Medical Records ; Neuromuscular Blockade ; Retrospective Studies ; Succinylcholine*

BACKGROUND: The primitive reflexes such as palmomental, glabella, snout, nuchocephalic reflexes may appear in a variety of diseases of the central nervous system. In this study, we investigated the frequencies of these primitive reflexes in the healthy elderly Korean population that have never been studied before. METHODS: Randomly selected 103 vol-unteers aged older than 60 years were examined by neurologists with a systemic neurological examination which included primitive reflexes and by radiologists with neuroimaging. Seven subjects were excluded from the study due to abnormal findings in the MRI of one subject and unusual neurological signs in 6 subjects. RESULTS: The overall mean age of the subjects was 66.5 years. One or more of the primitive reflexes were seen in 26 (24.9%) subjects. Eighteen (17.2%) subjects showed the palmomental reflex; eleven (10.5%) subjects showed the glabella reflex; five (4.8%) sub-jects showed the snout reflex; and one (1.0%) subject showed the nuchocephalic reflex. One subject had palmomental, glabella as well as snout reflexes, and five subjects had two primitive reflexes at the same time. CONCLUSIONS: Despite the normal findings from the neurological examinations and neuroimaging, 24.9% of healthy aged people had one or more primitive reflexes. The presence of these primitive reflexes as an isolated phenomenon may not imply brain lesions. (J Korean Neurol Assoc 19(4):380~383, 2001)
Aged* ; Brain ; Central Nervous System ; Humans ; Magnetic Resonance Imaging ; Neuroimaging ; Neurologic Examination ; Reflex*

BACKGROUND: Limited information about the effects of stroke on sexual functioning is available. The purpose of this study was to assess the influences of ischemic stroke on sexual functioning and to evaluate the clinical and psychological factors related to poststroke sexual dysfunctions. METHODS:Sixty-six male post-ischemic stroke patients and fifty-one age-matched healthy controls completed a self-administered questionnaire on sexual functioning. The localization of ischemic stroke was determined by neuroimaging findings as well as focal neurological signs. The degree of disability and the degree of depression were also assessed. RESULTS: All domains of sexual functioning, including erectile functions, orgas-mic functions, sexual desire, intercourse satisfaction, and overall satisfaction were decreased in poststroke patients. Patients with occipital lesions had a lesser degree of sexual dysfunctions than those with lesions affecting other areas (p<0.05). Also, sexual dysfunctions in stroke patients were related to the degree of physical disability and the presence of depression (p<0.05). CONCLUSIONS Sexual dysfunctions are common in stroke patients. The reasons for sexual dysfunc-tions after stroke are multifaceted, which include stroke lesion site, physiological factors, and psychosocial factors. (J Korean Neurol Assoc 19(4):342~348, 2001)
Depression ; Humans ; Male ; Neuroimaging ; Psychology ; Surveys and Questionnaires ; Stroke*