OBJECTIVES: The purpose of this study was to assess the clinical and polysomnographic characteristics of Korean patients with obstructive sleep apnea syndrome (OSAS), especially in relation to differences due to age and gender. METHODS: All subjects were consecutive patients who were proven to have OSAS with nocturnal polysomnography. They were interviewed with a structured interview format including sociodemographic information, past medical history, medication, and sleep-related history. Simultaneously, they were also given Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) to answer in order to check subjective sleep quality and subjective sleepiness. RESULTS: Mean age of the 308 subjects was 49.5+/-13.3 years, with 77.6% of the subjects being males and 22.4% of the subjects being females. The aging effects on the sleep architecture in Korean OSAS corresponded with normal aging, but with the effect of OSAS itself superimposed, the extent of aging effects was more marked than that of normal aging. The severity of Korean patients of OSAS was not correlated with age. When divided into age subgroups, significant correlation was found between RDI and BMI in patients of each subgroup of those in the 4th to 7th decades. The oldest subgroup (>70 years) described their subjective sleep quality as poorer than any other age subgroups, despite of less subjective drowsiness. The severity of OSAS and the change of sleep architecture of male subjects turned out to be severer than those of female ones. The female/male ratio of the subjects tended to increase with aging. CONCLUSIONS: The aging effect on the sleep architecture in Korean OSAS seems to be a mixture of the changes by normal aging and sleep disorder per se. The severity of OSAS was not correlated with age, but highly correlated with BMI. The severity of OSAS and the change of sleep architecture of male patients were severer than those of female ones.
Aging ; Body Mass Index ; Female ; Humans ; Male ; Polysomnography ; Sleep Apnea, Obstructive ; Sleep Stages

BACKGROUND: Since the endothelin-1 may be implicated in the pathogenesis of peripheral vascular diseases associated with connective tissue diseases (CTDs), we examined the plasma endothelin-1 level in association with quantitative nailfold capillaroscopy in patients with CTDs. METHODS: We investigated 79 patients with connective tissue diseases (54 systemic lupus erythematosus (SLE), 18 systemic sclerosis (SSc), 4 mixed connective tissue disease, 3 polymyositis/dermatomyositis). Plasma samples were obtained and endothelin-1 levels were measured by sandwich enzyme-linked immunosorbent assay. The presence and duration of Raynaud phenomenon as well as nailfold capillaroscopy were evaluated in each patient. To examine the quantitative nailfold capillaroscopy, we measured the length of apical limb width, capillary width and capillary length. RESULTS: According to the presence or absence of Raynaud phenomenon, there was no statistically increased plasma endothelin-1 level between two groups (2.433 +/- 2.259 pg/mL n=33, vs. 1.905 +/- 1.371 pg/mL n=46, p=non specific). All the SSc patients had Raynaud phenomenon and according to the presence of abnormal capillaroscopic findings, there were increased level of endothelin-1 in abnormal capillaroscopy group compared to normal capillaroscopy group (3.940 +/- 3.335 pg/mL (n=12), vs 1.573 1.006 pg/mL (n=6), p<0.05). As compared quantitative examination of nailfold capillaroscopy with plasma endothelin-1 level, in SSc patients the endothelin-1 level correlated well with the length of apical limb width (r(s)=0.577 p<0.05). In SLE patients the endotheliln-1 level correlated well with the length of apical limb width and capillary width (r(s)=0.425 p<0.01, rs=0.278 p<0.05, respectively). CONCLUSION: Our data demonstrate that the presence of abnormal capillaroscopic findings reflect increased plasma endothelin-1 level in patients with connective tissue diseases, and quantitative analysis of nailfold capillaroscopy can be useful to predict the disease activity with the evidence of increased plasma endothelin-1.
Capillaries ; Connective Tissue Diseases* ; Connective Tissue* ; Endothelin-1* ; Enzyme-Linked Immunosorbent Assay ; Extremities ; Humans ; Lupus Erythematosus, Systemic ; Microscopic Angioscopy ; Mixed Connective Tissue Disease ; Peripheral Vascular Diseases ; Plasma* ; Raynaud Disease ; Scleroderma, Systemic

The Wiskott-Aldrich syndrome is a rare disease characterized by thrombocytopenia, recurrent eczema and a marked vulnerability to recurrent infection. Patients with Wiskott-Aldrich syndrome have frequent infections by bacteria which have polysaccharide capsules such as Pneumococcus, Hemophilus influenzae and Neisseria meningitidis due to poor antibody response to polysaccharide antigens. We experienced a 21 years old man with septic arthritis combined with Pneumococcal pneumonia, multifocal abscesses in back and iliacus muscle. After treatment with antibiotics for one month, he was treated successfully.
Abscess ; Anti-Bacterial Agents ; Antibody Formation ; Arthritis, Infectious* ; Bacteria ; Capsules ; Eczema ; Haemophilus influenzae ; Humans ; Neisseria meningitidis ; Pneumonia, Pneumococcal ; Rare Diseases ; Streptococcus pneumoniae ; Thrombocytopenia ; Wiskott-Aldrich Syndrome* ; Young Adult

Sacrococcygeal chordoma is a rare malignant tumor which is believed to take its origin from remnants of the fetal notochord, and presents in the sacral hollow or occasionally posteriorly. The growth is leisurely and it is invasive rather than metastatic. In treatment, there is evidence that early diagnosis of sacrococcygeal chordoma followed by radical resection c palliative radiotherapy does provide the opportunity for cure. We have experienced two cases of sacrococcygeal chordoma, which were treated with one case of a complete surgical resection and the other case of only biopsy.
Biopsy ; Chordoma ; Early Diagnosis ; Notochord ; Radiotherapy

Sulfasalazine, one of disease modifying anti-rheumatic drugs, is widely used in various rheumatic diseases. Very rarely, sulfasalazine causes drug-associated hypersensitivity syndrome that resembles infectious mononucleosis. Clinical signs include fever, lymphadenopathy, maculopapular skin rash and multivisceral involvement which appear 2 to 5 weeks after administration of drug. Atypical lymphocytosis, liver dysfunction and splenomegaly are also frequently observed. Severe infectious mononucleosis-like syndrome in sulfasalazine treated patients can be caused by reactivation of viruses such as human herpes virus-6, that often result in hypersensitivity syndrome. We report a case of patient who developed infectious mononucleosis-like syndrome after administration of sulfasalazine for the treatment of rheumatoid arthritis. This case warrents careful observation for infectious mononucleosis-like syndrome after sulfasalazine treatment.
Antirheumatic Agents ; Arthritis, Rheumatoid ; Exanthema ; Fever ; Humans ; Hypersensitivity ; Infectious Mononucleosis ; Liver Diseases ; Lymphatic Diseases ; Lymphocytosis ; Rheumatic Diseases ; Splenomegaly ; Sulfasalazine*

A severe adverse reaction to certain drug could be associated with hypersensitivity syndrome, showing the clinical features of infectious mononucleosis including maculopapular rash, fever, lymphadenopathy, leukocytosis, atypical lymphocytes, liver dysfunction, and renal disturbance. We report a systemic lupus erythematosus patient who developed infectious mononucleosis-like syndrome with administration of ceftriaxone/isepamicin for the treatment of pneumonia. This case warrants careful attention to infectious mononucleosis-like syndrome associated with antibiotics administration, especially in febrile patients with known autoimmune diseases such as systemic lupus erythematosus.

Discrimination (Psychology) ; Humans ; Methods ; Odors ; Precision Medicine ; Prevalence ; Prospective Studies ; Smell

There were many studies to investigate the pathogenesis and prevention of infection in artificial joint replacement due to the difficulty in management of infected arthroplasty in spite of using large amounts of antibiotics. Biomaterials play a major role in the development of infection because of the way the body responds to their chemical and physical characteristics. Exopolysaccharide glycocalyx or biofilm(slime) which is produced by organisms adhered to the biomaterials has been detected and regarded as an important factor in pathogenesis. The production of slime on the biomaterials in turn makes the pathogens resistant to the antibiotics and therefore they survive. The objects of this study are to evaluate which materials are more susceptible to the adherence by Staphylococcus epidermidis, to evaluate the amount of antibiotics needed to kill the S. epidermidis adhered to the biomaterials(Polymethymethacrylate, Titanium-6Aluminum-4Vanadium alloy, Ultrahigh molecular weight polyethylene), and to evaluate the timing of administration of the antibiotics(cephradine, gentamicin) and potadine for prevention of postoperative infection. The results are as follows. 1. The materials in order of greatest adherence due to the number of organisms colonized are poly- methylmethacrylate(PMMA), ultrahigh molecular weight polyethylene(UHMWPE), and titanium alloy(Ti-6A1-4V alloy) being the least adherent. 2. With the production of biofilm the S. epidermidis becomes resistant to even that of 4 times the minimum bactericidal concentration(MBC) of antibiotics. 3. For prevention of postoperative infection, the prophylactic administration of cephradine if effective when used within 4 hours after contamination and the gentamicin and potadine are effective when used within 8 hours after the contamination with S. epidermidis.
Alloys ; Anti-Bacterial Agents ; Arthroplasty ; Biocompatible Materials ; Biofilms ; Cephradine ; Colon ; Gentamicins ; Glycocalyx ; Joints ; Molecular Weight ; Staphylococcus epidermidis ; Titanium

Although many improvements have been made in surgical technique, as well as preoperative and postoperative care, the pancreaticoduodenectomy remains a technically difficult procedure attended by relatively high morbidity and mortality rates. This study concerns a total of 43 patients that underwent a pancreaticojejunostomy using a polyethylene stent by the Dunking method in a pancreaticoduodenectomy at Soon Chun Hyang University Hospital from January 1990 to December 1996. The results obtained are as follows:1) In our study, there were 13 patients with pancreatic head cancer, 11 patients with ampulla of Vater cancer, 5 patients with distal common bile duct cancer, 4 patients with duodenal cancer, 3 patients with chronic pancreatitis, 3 patients with trauma, 3 patients with a choledochal cyst, 1 patient with stomach cancer. 2) There were 23 men (53.5%) and 20 women (46.5%). 3) Postoperative complications developed in 25 patients (58.1%). Of the complications, bleeding was the most commonly observed, after which, in order of frequency, wound infection, leakage at the anastomotic site, intestinal obstruction, and intraabdominal abscess were also observed. 4) The overall operative mortality was 13.9% (excluding emergency cases, mortality was 7.5 %). Four patients died of intraabdominal or gastrointestinal bleeding, one patient died of pancreatic leakage, and one of hepatic failure. 5) Transfusion during the operation (above 5 pints) was significantly correlated with operative morbidity. Preoperative percutaneous transhepatic biliary drainage (PTBD) with serum bilirubin greater than 10 mg/dl significantly decreased the operative morbidity. 6) A prothrombin time more than 13.9 second, serum albumin less than 3.0 g/dl, and an emergency operation were significantly correlated with operative mortality.
Abscess ; Ampulla of Vater ; Bilirubin ; Choledochal Cyst ; Common Bile Duct ; Drainage ; Duodenal Neoplasms ; Emergencies ; Female ; Head and Neck Neoplasms ; Hemorrhage ; Humans ; Intestinal Obstruction ; Liver Failure ; Male ; Mortality* ; Pancreaticoduodenectomy* ; Pancreaticojejunostomy* ; Pancreatitis, Chronic ; Polyethylene ; Postoperative Care ; Postoperative Complications ; Prothrombin Time ; Serum Albumin ; Stents* ; Stomach Neoplasms ; Wound Infection

Lupus miliaris disseminatus faciei (LMDF) is a chronic inflammatory disorder primarily affecting the face. A 22-year-old man presented with facial skin lesions. Physical examination revealed scattered pin-head sized erythematous to yellowish papules. Skin biopsy from the erythematous papule showed keratinous material in the layers of the thin epithelium and caseous necrosis with adjacent epitheloid granuloma and giant cells. After mechanical extractions of milium-like inflamed papules, skin lesions improved leaving an atrophic scar. LMDF was initially thought to be associated with tuberculosis infection but today it is considered a variant of rosacea. However, there have been reports of LMDF in association with epidermal cysts or milium, suggesting an abnormal immune response to the pilosebaceous unit may play a role. Damage to the pilosebaceous unit that is further complicated by milium rupture may induce inflammation resulting in LMDF. We suggest that milium or epidermal cysts may also attribute to the pathogenesis of LMDF although further studies are needed.
Biopsy ; Cicatrix ; Epidermal Cyst ; Epithelium ; Giant Cells ; Granuloma ; Humans ; Inflammation ; Necrosis ; Physical Examination ; Rosacea ; Rupture ; Skin ; Tuberculosis ; Young Adult