The hallmarks of sleep apnea syndrome include daytime hypersomnolence, snoring, obesity, disturbed nocturnal sleep, and apneic episodes. Thyroid deficiency states are now a well recognized cause of sleep apnea. Central, obstructive, and mixed patterns of sleep apnea may be observed in hypothyroidism. A 33-yr-old man was admitted complaining of daytime hypersomnolence, snoring, sleep apnea and obesity. A polysomnogram showed obstructive pattern of sleep apnea syndrome. Physical examination and hormonal study revealed a narrowing of the upper airway and primary hypothyroidism. Dilated cardiomyopathy was diagnosed by echocardiogram. The poctients was treated for obstructive sleep apnea syndrome with nasal continuous positive airway pressure(CPAP) for 2 months and the underlying hypothyroidism with thyroid hormone therapy. This successfully controlled the snoring, sleep apnea, and other apnea-related symptoms. Here, we describe our experience of nasal CPAP and thyroid hormone therapy in a patient with primary hypothyroidism associated with obstructive sleep apnea syndrome and dilated cardimyopathy with review of the relevant literature.
Cardiomyopathies ; Cardiomyopathy, Dilated* ; Disorders of Excessive Somnolence ; Humans ; Hypothyroidism* ; Obesity ; Physical Examination ; Polysomnography ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive* ; Snoring ; Thyroid Gland

BACKGROUND: Sex specific cross sectional reference values for the lung function indices usually employ a linear model with a term for age and height. The purpose of this study was to determine the effects of the body mass index (BMI), the fat percentage of the body mass and the fat-free mass index (FFMI) on the forced expiratory volume curve. METHOD: Between January 2000 and December 2001, a total of 300 subjects, 150 men and 150 women (mean age : 45+/-13 years), with a normal lung function were enrolled in the study sample. This study measured the FEV1, FVC and FEF25-75% from the forced expiratory volume curve by a spirometer and the body composition by a bioelectrical impedance method in all subjects. Multiple regression analysis was used in order to examine the effects of the body composition on the parameters derived from the forced expiratory volume curve. RESULT: After adjusting for age, the BMI and Fat percentage improved the descriptions of the FVC (p<0.05, r2=0.491) and FEV1 (p<0.05, r2=0.654) in women. In contrast, the FFMI contributed significantly to the FVC (p<0.05, r2=0.432) and FEV1 (p<0.05, r2=0.567) in men. The FEF25-75% correlated with the fat percentage in women (p<0.05, r2=0.337). CONCLUSION: These results suggest that the BMI, the fat percentage and the FFMI are significant determinants of the forced expiratory volume curve. The pulmonary function test, when considering the BMI, the fat percentage and the FFMI, might be useful in clinical applications.
Body Composition ; Body Mass Index* ; Electric Impedance ; Female ; Forced Expiratory Volume* ; Humans ; Linear Models ; Lung ; Male ; Reference Values ; Respiratory Function Tests*

BACKGROUND: Unexplained weight loss, which commonly occurs in patients with chronic obstructive pulmonary disease(COPD), is important because weight loss is an independent risk factor of mortality and morbidity in these patients. Leptin is known to play an important role in regulating body weight. In addition, the tumor necrosis factor(TNF-α) might also play a potential role in the weight loss experienced in chronic wasting disease. The aim of this study was to determine the influence of plasma leptin and the circulating TNF-α system to the difference in the body compositions in patients with COPD. METHODS: Spirometry, body composition analysis and the plasma concentrations of leptin, TNF-α and a soluble TNF receptor 55, 75 were measured in 31 patients with chronic bronchitis and 10 patients with emphysema. The COPD subtype was classified by the transfer coefficient of carbon monoxide, DLco/VA. RESULTS: The circulating levels of leptin were significantly lower in those patients with emphysema(108.5±39.37 pg/ml) than those with chronic bronchitis(180.9±57.7 pg/ml). The circulating levels of sTNF-R55 were significantly higher in the emphysema patients(920.4±116.4 pg/ml) than in those with chronic bronchitis(803.2±80.8 pg/ml). There was no relationship between the circulating leptin levels and the activated TNF system in patients with chronic bronchitis and emphysema. However, the circulating leptin levels correlated well with the BMI and fat mass in both patient groups. CONCLUSION: These results suggest that the weight loss noted in emphysema patients may be associated with the activation of the TNF-α system rather than the plasma leptin level.
Body Composition ; Body Weight ; Bronchitis, Chronic* ; Carbon Monoxide ; Emphysema* ; Humans ; Leptin* ; Mortality ; Necrosis ; Plasma* ; Pulmonary Disease, Chronic Obstructive ; Receptors, Tumor Necrosis Factor ; Risk Factors ; Spirometry ; Tumor Necrosis Factor-alpha* ; Wasting Disease, Chronic ; Weight Loss*

Paraneoplastic nephrotic syndrome can be diagnosed from its clinical and immunological features. The development of several types of glomerular injury in patients with cancer have been recognized, and are considered as paraneoplastic syndrome. Most prominent are the occurrence of membranous glomerulonephritis in patients with carcinomas. We report a case of a 60-year-old-man with small cell lung cancer presenting as nephrotic syndrome. A renal biopsy revealed membranous glomerulonephritis. Six lots of chemotherapy were administerd, which led to a complete tumor response with total resolution of the nephrotic syndrome following treatment.
Biopsy ; Drug Therapy* ; Glomerulonephritis, Membranous* ; Humans ; Nephrotic Syndrome ; Paraneoplastic Syndromes ; Small Cell Lung Carcinoma*

BACKGROUND/AIMS: The caudal-related homeobox transcription factor, Cdx2, plays an important role in proliferation and differentiation of intestinal epithelial cells. Its expression is confined to normal and neoplastic intestinal epithelium. We evaluated Cdx2 expression in advanced colorectal cancers to determine the correlation between Cdx2 expression and clinicopathologic characteristics. METHODS: Four hundreds twenty consecutive colorectal cancers were included in the study. Cdx2 expression was investigated by immunohistochemistry using tissue microarrays constructed from surgically resected specimens. 145 invasive breast cancers, normal tissues from gastric mucosa, liver, lung, kidney and ovary were used as control. Nuclear staining was considered to be positive and the result was divided into 3 categories. RESULTS: In the colorectal cancers, Cdx2 was expressed in 380 of 420 (90.5%) cases, and 349 of 380 (83%) cases showed strong and diffuse staining and 31 of 420 (7.5%) cases showed weakly positive staining. Forty patients (9.5%) of colorectal cancer were negative for Cdx2. All of the invasive breast cancers and all non-neoplastic control tissues except the regions of intestinal metaplasia in gastric mucosa, which showed strong Cdx2 expression, were negative for Cdx2. Loss of Cdx2 expression was observed more frequently in cases with deeper invasion (p<0.05), lymph node metastasis (p<0.05), poor histologic differentiation (p<0.001), and distant metastasis (p<0.05). CONCLUSIONS: Cdx2 could be a highly sensitive marker to detect metastasis from intestine and might be useful as a novel prognostic marker in colorectal cancers.
Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/*metabolism/pathology ; Female ; Homeodomain Proteins/*metabolism ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Tumor Markers, Biological/analysis