OBJECTIVES: The multiple sleep latency test (MSLT) is commonly used as a valid objective measure of sleepiness. The procedure of MSLT is well standardized but the sleep onset criterion is somewhat variable. One epoch of stage 1 sleep is the most commonly used criterion, and the criterion of three epochs of stage 1 sleep is also used. The purpose of this study was to compare the two criteria used to determine sleep onset. METHODS: We retrospectively analyzed 60 consecutive MSLT that were performed according to a standaridized protocol. We scored each test using the two different criteria for sleep onset and then statistically analyed the results. RESULTS: Using the different criteria, 20 patients among 60 showed changes in mean sleep latency (33.3%). The extent of change ranged from 1.3% to 38.5% (mean 15.9%). Non-narcoleptic patients showed a significantly higher incidence of change than other sleep disorder patients. CONCLUSION: Changes in mean sleep latency occurred according to the different criteria of sleep onset. But the difference arising from different criteria was statistically not significant in patients with moderate to severe sleepiness. Considering that 1 epoch criterion for sleep onset is more sensitive in detecting clinically significant sleepiness, the authors suggest that the 1 epoch criterion is more reliable than the 3 epochs criterion.
Humans ; Incidence ; Retrospective Studies

There are widely recognized unusual remote neurological manifestations of internal malignancy. However, as far as the author's knowledge, the generalized myokymia associated with myokymic discharge has not been reported as paraneoplastic syndrome earlier. The patient was a 63-year-old female with generalized myokymia and paresthesia for 4months. The nerve conduction study revealed mild sensorimotor polyneuropathy and EMG study showed the generalized myokymic discharges, which were not changed by sleeping or brachial plexus block. The carbamazepine reduced the amount of myokymia and myokymic discharges but not the benzodiazepine. The diagnosis of lung cancer was confirmed by needle aspiration biopsy, and the cell types of lung cancer were mixed undifferentiated and small cell type. By the administration of anti-cancer drugs including cisplatin, the myokymia and myokymic discharges were completely disappeared. The patient died at 8 months after the diagnosis.
Benzodiazepines ; Biopsy, Needle ; Brachial Plexus ; Carbamazepine ; Cisplatin ; Diagnosis ; Female ; Humans ; Lung Neoplasms* ; Lung* ; Middle Aged ; Myokymia* ; Needles ; Neural Conduction ; Neurologic Manifestations ; Paraneoplastic Syndromes ; Paresthesia ; Polyneuropathies

A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.
Aged ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Echocardiography ; Electrocardiography ; Female ; Hematoma/*diagnosis/*surgery ; Humans ; Magnetic Resonance Imaging ; *Pulmonary Artery ; Thromboembolism/diagnosis ; Tomography, X-Ray Computed

Polycythemia is a condition in which the red blood cell count is increased due to an inherited or acquired mutation, a physiologic response to hypoxia, autonomous erythropoietin production, or deliberate erythropoietin administration. Higher testosterone levels appear to act as a stimulus for erythropoiesis and testosterone replacement therapies have rarely been reported as causes of polycythemia. We report here a case of a 51-year-old man with polycythemia that was caused by long-acting testosterone undecanoate (Nebido(R)).
Anoxia ; Erythrocyte Count ; Erythropoiesis ; Erythropoietin ; Humans ; Middle Aged ; Polycythemia ; Testosterone

BACKGROUND AND OBJECTIVES: The purpose of this study was to subculture normal human middle ear epithelial (NHMEE) cells, investigate whether the subcultured NHMEE cells could have ability to differentiate into secretory cells, and establish a method to get cultured NHMEE cells for further study of human middle ear epithelial differentiation and secretion. MATERIALS AND METHOD: Freshly isolated epithelial cells from healthy middle ear mucosa were subcultured repeatedly after enzymatic disaggregation in serum-free medium on plastic tissue culture dishes. The subcultured cells were counted after every passage and tested for secretory differentiation in air-liquid interface (ALI) cultures. The apical secretion of cultured NHMEE cells were characterized by immunoblotting and Western blotting. RESULTS: Attachment rate of subcultured NHMEE cells was over 70% through every passage. Cells proliferated by 22 fold from passage-1 to passage-2 (P-2), but passage-4 cells did not proliferate. P-2 NHMEE cells in ALI cultures was stained with mucin antibody (H6C5) but not b-tubulin antibody. Cultured NHMEE cells secreted mucin and lysozyme. CONCLUSION: P-2 NHMEE cell cultures retained many important features of normal epithelium and were suitable for conducting many studies of human middle ear epithelial cell biology including cell differentiation and secretion.
Biology ; Blotting, Western ; Cell Culture Techniques ; Cell Differentiation ; Ear, Middle* ; Epithelial Cells ; Epithelium ; Humans* ; Immunoblotting ; Mucins ; Mucous Membrane ; Muramidase ; Plastics

BACKGROUND AND OBJECTIVES: Despite many reports about middle ear mucosal epithelial cell culture of experimental animals like rat, gerbil or chinchilla, normal human middle ear epithelial (NHMEE) cells have not been cultured in vitro yet. We attempted to culture NHMEE cells and confirm them to be epithelial cells. MATERIALS AND METHOD: Healthy middle ear mucosa was harvested during the otologic surgery without contamination. Specimen was cultured by primary explant culture method and proliferating cells were subcultured after enzymatic disaggregation. Cultured cells were observed using phase contrast light microscope, scanning electron microscope and transmission electron microscope. Immunocytochemical stain was performed to identify the expression of cytokeratin, vimentin and von Willebrand factor. RESULTS: Cultured cells were of polygonal shape and the cell surfaces were covered by microvilli. The immunocytochemical stain revealed cytokeratin in all the cultured cell, whereas vimentin was co-expressed in some of the cells and von Willebrand factor was not expressed at all. We could observe desmosome or tonofilament in cultured cells by TEM. Although cells proliferated 20 or 30 fold in every passage, the passage-4 cells did not proliferate and many vacuoles were formed. CONCLUSION: The NHMEE culture system using serum free media will provide a good model for the study of human middle ear epithelial differentiation and secretion.
Animals ; Cell Culture Techniques ; Cells, Cultured ; Chinchilla ; Culture Media, Serum-Free* ; Desmosomes ; Ear, Middle* ; Epithelial Cells ; Gerbillinae ; Humans* ; Intermediate Filaments ; Keratins ; Microvilli ; Mucous Membrane ; Rats ; Vacuoles ; Vimentin ; von Willebrand Factor

PURPOSE: To review the results of resections of heterotopic ossification around the hip in patients with central nervous system injuries. MATERIALS AND METHODS: Heterotopic ossification was resected in ten hips of eight patients and followed for at least one year. Average age was 38.1 years (range, 21-56 years). We reviewed the charts and the radiographs for overall patient function, location of the lesion, radiographic evidence of maturation and any recurrence. Heterotopic ossification was resected regardless of the result of bone scan. RESULTS: All patients showed improved function. Three minimal recurrences and one moderate recurrence were identified at the last follow-up radiography, but the range of motion had not decreased due to recurrence. CONCLUSION: Severe heterotopic ossification around the hip in patients with spastic paralysis was resected, and it was found that the range of motion was improved in all patients and that the chance of recurrence was minimal, even though the bone scan showed hot uptake on the bone scan.
Adult* ; Central Nervous System ; Follow-Up Studies ; Hip Joint ; Hip* ; Humans ; Muscle Spasticity* ; Ossification, Heterotopic* ; Paralysis ; Radiography ; Range of Motion, Articular ; Recurrence

The purpose of this study was to evaluate electroless plating as a method of increasing the diameter of an orthodontic wire in comparison with eletroplating. After pretreatment plating of the 0.016 inch stainless steel orthodontic wire, electroless plating was performed at 90 degrees C until the diameter of the wire was increased to 0.018 inch. During the process of electroless plating, the diameter of the wire was measured every 5 minutes to examine the increasing ratio of the wire' diameter per time unit. And to examine the uniformity, the diameter at 3 points on the electroless-plated orthodontic wire was measured. An X-ray diffraction test for analyzing the nature of the plated metal and a 3-point bending test for analyzing the physical property were performed. The electroless-plated wire group showed a increased tendency for stiffness, yield strength, and ultimate strength than the electroplated wire group. And there was a statistically significant difference between the two groups for stiffness and ultimate strength. In the electroless-plated wire group, the increasing ratio of the diameter was 0.00461 +/-.00003 mm/5 min (0.00092 mm/min). In the electroplated wire group, it was 0.00821 +/-.00015 mm/min. The results of the uniformity test showed a tendency for uniformity in both the plating methods. The results of this study suggest that electroless plating of the wire is closer to the ready-made wire than electroplating wire in terms of the physical property. However, the length of plating time needs further consideration for the clinical application of electroless plating.
Electroplating* ; Orthodontic Wires* ; Stainless Steel ; X-Ray Diffraction

BACKGROUND: The cases of Plasmodium vivax malaria in Korea are mixed with long and short incubation periods. This study aims to define clinico-epidemiologic chracteristcs of Plasmodium vivax malaria in Korea. MATERIALS AND METHODS: We selected the civilian cases infected with P. vivax malaria in Korea from the epidemiological investigation data of 2001 to 2010, whose incubation periods could be estimated. The long and short incubation periods were defined by duration of infection and onset time, and the cases were compared by demographic factors and clinical symptom, infection and onset time. The correlation was analyzed between the proportion of cases in the infected region with the long incubation period and meteorological factors along with latitude. RESULTS: The length of the mean short and long incubation periods for the cases were 25.5 days and 329.4 days, respectively. The total number of the study subjects was 897, and the number cases of short and long incubation periods was 575 (64.1%) and 322 (35.9%), respectively. The aspect of incubation period showed a significant difference by region of infection; there was a higher proportion of long incubation period infection cases in Gangwon-do than in Gyeonggi-do and Incheon. The proportion of long incubation period cases showed significant correlation with latitude and temperature of August and September of the infected regions. CONCLUSIONS: Incubation period of P. vivax malaria in Korea showed significant difference by infected region, infection and onset time and the proportion of long incubation period cases showed significant correlation with latitude and meteorological factors of the infected regions.
Demography ; Korea ; Malaria ; Malaria, Vivax ; Meteorological Concepts ; Plasmodium ; Plasmodium vivax

The aim of this study was to determine the effects of polymorphisms in the apolipoprotein E gene (APOE) on lipid levels in Korean adults and to investigate the interactions between these polymorphisms and environmental factors in determining lipid levels. We performed a cross-sectional study of 1,900 subjects (668 men and 1,232 women; 45-74 yr old) in Namwon, Korea, in 2004. APOE polymorphisms were determined by polymerase chain reaction and restriction enzyme analysis. Carriers of the APOE*E2 (E2) allele had significantly lower total cholesterol and low-density lipoprotein cholesterol (LDL-C) concentrations than did carriers of the APOE*E3 (E3) or APOE*E4 (E4) alleles, regardless of gender. The APOE allele type had significant effect on high-density lipoprotein cholesterol (HDL-C) and triglyceride levels in women, but not in men. The effect of APOE allele type on HDL-C levels was modified by age in women. In addition, in men, the effect of APOE allele type on triglyceride levels was modified by smoking. These findings highlight the important effect of gene-environment interactions on lipid levels.
Aged ; Analysis of Variance ; Apolipoproteins E/*genetics ; Comparative Study ; Cross-Sectional Studies ; Female ; Gene Frequency ; Genotype ; Humans ; Korea ; Lipids/*blood ; Lipoproteins, HDL Cholesterol/blood ; Lipoproteins, LDL Cholesterol/blood ; Male ; Middle Aged ; *Polymorphism, Genetic ; Triglycerides/blood