Sleep disturbances are commonly encountered problems in cancer patients. Sleep has a role in maintenance of immunity, metabolism, and quality of life but little has been known about the prevalence, risk factors, and effects on prognosis of sleep disturbances in patients with cancer. Also little attention has been made on proper assessment and management of sleep disorders in these patients. Recently, there have been some reports that sleep disorders are related with development of many cancers such as breast, colorectal, prostate, and endometrial cancers. An intermittent hypoxia and a disruption of circadian rhythm are considered as one of the possible mechanisms of cancer developments. More aggressive evaluation and meticulous management of sleep disturbances in cancer patients are essential to improve quality of life as well as prognosis.
Anoxia ; Breast ; Circadian Rhythm ; Endometrial Neoplasms ; Female ; Humans ; Prevalence ; Prognosis ; Prostate ; Quality of Life ; Risk Factors ; Sleep Wake Disorders

BACKGROUND: Laryngoscopy and tracheal intubation are associated with hemodynamic pressor responses, which lead to adverse effect. Opioids have been used to reduce the hemodynamic change. The purpose of this study was to investigate an optimal dosage of remifentanil for attenuating hemodynamic change. METHODS: 120 ASA class 1-2 patients, scheduled for elective surgery, were divided randomly into 4 groups. Anesthesia was induced with vecuronium priming dose (0.01 mg/kg) and TCI of propofol target concentration 8 microgram/ml. This was reduced to 4 microgram/ml when the effect-site concentration had been 3 microgram/ml. After the effect-site concentration had reached 4 microgram/ml, vecuronium (0.09 mg/kg) was given. At the same time, control group received normal saline, group R0.25 received remifentanil 0.25 microgram/kg, group R0.5 received remifentanil 0.5 microgram/kg, group R1 received remifentanil 1 microgram/kg over 60s and an infusion 0.2 microgram/kg/min. Intubation was performed after maximum depression of the single twitch was shown by single twitch stimulation test. Sytolic blood pressure, mean arterial pressure, diastolic blood pressure, heart rate and BIS value were measured preinduction, after propofol induction, immediately before and after intubation and 1, 2, 3, 4 minutes after intubation, respectively. RESULTS: Post-intubation mean arterial pressure decreased significantly from pre-intubation value in group R0.5 and R1 (P < 0.05). In group R0.5 and R1, hypotension and bradycardia occurred but there were no significant differences in their incidence between two groups. CONCLUSIONS: We suggest that remifentanil 0.5 microgram/kg bolus and an infusion of 0.2 microgram/kg/min attenuate the pressor response to tracheal intubation in patients anesthetized with propofol TCI.
Analgesics, Opioid ; Anesthesia ; Arterial Pressure ; Blood Pressure ; Bradycardia ; Depression ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Incidence ; Intubation* ; Laryngoscopy ; Propofol* ; Vecuronium Bromide

Brugada syndrome is an arrhythmogenic disease that is manifested by specific patterns of right bundle branch block with ST elevation in right precordial (V1-V3) ECG leads causing ventricular fibrillation, leads to a sudden death without organic heart problems. It is an incomplete penetrating autosomal dominant disease that is due to mutation in SCN5A gene, coding for Na+ channel of cardiac muscles. This syndrome is more common and may be endemic in southeast Asia. Although it is a highly risky disease, it's preventive treatment for arrhythmia has not been established yet. We experienced a case of 28 year old man who had wedge resection of lung because of spontaneous pneumothorax under general anesthesia and who was suspected Brugada syndrome based on specific ECG patterns and a family history of his father's sudden death after syncope.
Adult ; Anesthesia, General ; Arrhythmias, Cardiac ; Asia, Southeastern ; Brugada Syndrome* ; Bundle-Branch Block ; Clinical Coding ; Death, Sudden ; Electrocardiography ; Heart ; Heart Arrest ; Humans ; Lung ; Myocardium ; Pneumothorax ; Syncope ; Ventricular Fibrillation

Vasovagal syncope is elicited by the Bezold-Jarisch reflex, triggered by anxiety, emotional stress or pain. It is the result of reflexively increasing parasympathetic tone and decreasing sympathetic tone sensed by chemoreceptor in vagus nerve and mechanoreceptor of ventricle, which causes bradycardia, systemic vasodilatation and profound hypotension. Although it is a transient episode in many cases, it could give rise to cardiac arrest. Diabetic autonomic neuropathy can lead to significant change in blood pressure and pulse rate, bradycardia, hypotension, and even cardiac arrest by increasing the risk of hemodynamic instability under general or regional anesthesia. We have experienced a patient who had once cardiac arrest following after positional change and recovered in a few minutes. The patient was supposed to have diabetic autonomic neuropathy under the emotional stress and anxiety before spinal anesthesia was done. We believe that this is the result of combination between paradoxical Bezold-Jarisch reflex caused by overactivation of parasympathetic nerve system and autonomic nervous system instability precipitated by diabetic autonomic neuropathy.
Anesthesia, Conduction ; Anesthesia, Spinal* ; Anxiety ; Autonomic Nervous System ; Blood Pressure ; Bradycardia ; Death, Sudden, Cardiac* ; Diabetic Neuropathies ; Heart Arrest ; Heart Rate ; Hemodynamics ; Humans ; Hypotension ; Mechanoreceptors ; Reflex ; Stress, Psychological ; Syncope, Vasovagal ; Vagus Nerve ; Vasodilation

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation due to chronic airway inflammation and destruction of the alveolar structure from persistent exposure to oxidative stress. The body has various antioxidant mechanisms for efficiently coping with such oxidative stress. The nuclear factor erythroid 2-related factor 2 (Nrf2)–antioxidant response element (ARE) is a representative system. Dysregulation of the Nrf2-ARE pathway is responsible for the development and promotion of COPD. Furthermore, COPD severity is also closely related to this pathway. There has been a clinical impetus to use Nrf2 for diagnostic and therapeutic purposes. Therefore, in this work, we systematically reviewed the clinical significance of Nrf2 in COPD patients, and discuss the value of Nrf2 as a potential COPD biomarker.

BACKGROUND AND OBJECTIVES: The ethmoidal infundibulum is a cleft-like space situated like a funnel before the maxillary ostium. In this cleft, unilateral inflammations and benign diseases occur sometimes. In this study, we are trying to evaluate benign diseases widening the unilateral ethmoidal infundibulum and their chief complaints, and to identify the radiologic patterns of them in contrast-enhanced computerized tomography (CT) and magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Sixty eight cases with unilateral ethmoidal infundibular widening on contrast enhanced CT were evaluated with MRI between Jan, 1995 and Dec, 1999. Fifty- six cases of pathologically proved inflammatory or benign diseases were analyzed prospectively by medical records, CT and MRI. RESULTS: Benign diseases widening the unilateral ethmoidal infundibulum included antrochoanal polyp, maxillary sinus mucocele, prolapsed antral mucosa (a variant of maxillary sinus mucocele), noninvasive fungal sinusitis, nasal polyp with sinusitis and inverted papilloma. They showed soft tissue density in the unilateral maxillary sinus and infundibulum with uncinate process erosion on CT. They were differentiated by the signal intensity on T2 weighted MRI and enhancement patterns on T1 weighted MRI. CONCLUSION: The preoperative diagnosis of benign diseases widening the unilateral ethmoidal infundibulum depends on endoscopic biopsy generally, but MR imaging may be helpful for differential diagnosis of them.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Inflammation ; Magnetic Resonance Imaging ; Maxillary Sinus ; Medical Records ; Mucocele ; Mucous Membrane ; Nasal Polyps ; Papilloma, Inverted ; Polyps ; Prospective Studies ; Sinusitis

BACKGROUND AND OBJECTIVES: The ethmoidal infundibulum is a cleft-like space situated like a funnel before the maxillary ostium. In this cleft, unilateral inflammations and benign diseases occur sometimes. In this study, we are trying to evaluate benign diseases widening the unilateral ethmoidal infundibulum and their chief complaints, and to identify the radiologic patterns of them in contrast-enhanced computerized tomography (CT) and magnetic resonance imaging (MRI). SUBJECTS AND METHODS: Sixty eight cases with unilateral ethmoidal infundibular widening on contrast enhanced CT were evaluated with MRI between Jan, 1995 and Dec, 1999. Fifty- six cases of pathologically proved inflammatory or benign diseases were analyzed prospectively by medical records, CT and MRI. RESULTS: Benign diseases widening the unilateral ethmoidal infundibulum included antrochoanal polyp, maxillary sinus mucocele, prolapsed antral mucosa (a variant of maxillary sinus mucocele), noninvasive fungal sinusitis, nasal polyp with sinusitis and inverted papilloma. They showed soft tissue density in the unilateral maxillary sinus and infundibulum with uncinate process erosion on CT. They were differentiated by the signal intensity on T2 weighted MRI and enhancement patterns on T1 weighted MRI. CONCLUSION: The preoperative diagnosis of benign diseases widening the unilateral ethmoidal infundibulum depends on endoscopic biopsy generally, but MR imaging may be helpful for differential diagnosis of them.
Biopsy ; Diagnosis ; Diagnosis, Differential ; Inflammation ; Magnetic Resonance Imaging ; Maxillary Sinus ; Medical Records ; Mucocele ; Mucous Membrane ; Nasal Polyps ; Papilloma, Inverted ; Polyps ; Prospective Studies ; Sinusitis

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disease. Polycystic liver disease is commonly observed in ADPKD but rarely has it been associated with a choledochal cyst. We report a case of a choledochal cyst with ADPKD in a 60-year-old female patient with ADPKD and concomitant chronic renal failure who was admitted because of acute deterioration of kidney function due to poor oral intake. There was no history of a biliary disorder and her kidney function recovered promptly after fluid replacement. Non-enhanced computed tomography was performed to evaluate ADPKD and revealed numerous cysts in both kidneys and liver. It also showed fusiform dilatation of the extrahepatic bile ducts, a finding indicative of a choledochal cyst. Liver function was within the normal range and there was no evidence of extrahepatic biliary obstruction. Magnetic resonance cholangiopancreatography confirmed the diagnosis of a type I choledochal cyst combined with ADPKD.
Bile Ducts, Extrahepatic ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst ; Cysts ; Dilatation ; Female ; Humans ; Kidney ; Kidney Failure, Chronic ; Liver ; Liver Diseases ; Polycystic Kidney, Autosomal Dominant ; Reference Values

BACKGROUND/AIMS: The smoking rates and patterns in the North Korean population are not well known. More than 20,000 North Korean defectors have settled in South Korea; thus, we can estimate the current North Korean smoking situation using this group. METHODS: All North Korean defectors spend their first 3 months in a South Korean facility learning to adapt to their new home. We retrospectively analyzed the results from a questionnaire conducted among North Korean male defectors in this facility from August 2012 to February 2014. RESULTS: Of 272 men, 84.2% were current smokers, 12.5% were ex-smokers, and 3.3% were non-smokers. The mean age of this group was 35.9 ± 11.3 years, and smoking initiation occurred at a mean age of 18.2 ± 4.7 years. Among the subjects, 78.1% had a family member who smoked. Of the 221 current smokers, 67.4% responded that they intended to quit smoking. Fagerström test and Kano test for social nicotine dependence (KTSND) results for current smokers were 3.35 ± 2.26 and 13.76 ± 4.87, respectively. Question 9 on the KTSND (doctors exaggerate the ill effects of smoking) earned a significantly higher score relative to the other questions and a significantly higher score in current smokers compared with non-smokers. CONCLUSIONS: The smoking rate in North Korean male defectors was higher than that indicated previously. However, interest in smoking cessation was high and nicotine dependence was less severe than expected. Further investigation is needed to identify an efficient method for North Korean smokers to stop smoking.
Humans ; Korea ; Learning ; Male* ; Methods ; Nicotine* ; Retrospective Studies ; Smoke* ; Smoking Cessation ; Smoking* ; Tobacco Use Disorder*

Miliary brain metastasis from the lung is uncommon and has a poor therapeutic response. We report a case of pulmonary adenocarcinoma combined with multiple brain cystic lesions that were initially misdiagnosed as neurocysticercosis. A 53-year-old male who never smoked was admitted to our hospital with complaints of agitation and cognitive impairment. Brain magnetic resonance imaging showed innumerable, small nodular lesions with a central, low signal intensity in whole brain parenchyma. His symptoms were not improved by the empirical praziquantel medication for disseminated neurocysticercosis. After a transbronchial biopsy from the right middle lobe, we could diagnose the primary lung adenocarcinoma with a single nucleotide polymorphism in the epidermal growth factor receptor exon 20 at codon 787 (Q787Q). His neurologic symptoms and imaging findings have been gradually improving with a first-line Gefitinib treatment for five months. We recommend a more active diagnostic approach including biopsy in case of atypical imaging findings.
Adenocarcinoma ; Biopsy ; Brain ; Codon ; Dihydroergotamine ; Exons ; Humans ; Lung ; Lung Neoplasms ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neurocysticercosis ; Neurologic Manifestations ; Polymorphism, Single Nucleotide ; Praziquantel ; Quinazolines ; Receptor, Epidermal Growth Factor ; Smoke