OBJECTIVES: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder that is characterized by repetitive collapse or partial collapse of the upper airway during sleep in spite of ongoing effort to breathe. It is believed that OSA is usually worsened in REM sleep, because muscle tone is suppressed during REM sleep. However, many cases showed a higher apnea-hypopnea index (AHI) during NREM sleep than during REM sleep. We aimed here to determine the characteristics of REM sleep-dependent OSA (REM-OSA) and NREM sleep-dependent OSA (NREM-OSA). METHODS: Five hundred sixty polysomnographically confirmed adult OSA subjects were studied retrospectively. All patients were classified into 3 groups based on the ratio between REM-AHI and NREM-AHI. REM-OSA was defined as REM-AHI/NREM-AHI > 2, NREM-OSA as NREM-AHI/REM-AHI > 2, and the rest as sleep stage-independent OSA (IND-OSA). In addition to polysomnography, questionnaires related to subjective sleep quality, daytime sleepiness, and emotion were completed. Chi-square test, ANOVA, and ANCOVA were performed. RESULTS: There was no age difference among subgroups. The REM-OSA group was comprised of large proportions of mild OSA and female OSA patients. These patients experienced poor sleep and more negative emotions than other two groups. The AHI and oxygen desaturation index (ODI) were lowest in REM-OSA. Sleep efficiency and N3 percentage of REM-OSA were higher than in NREM-OSA. The percentage of patients who slept in a supine position was higher in REM-OSA than other subgroups. IND-OSA showed higher BMI and larger neck circumference and abdominal circumference than REM-OSA. The patients with IND-OSA experienced more sleepiness than the other groups. AHI and ODI were highest in IND-OSA. NREM-OSA presented the shortest total sleep time and the lowest sleep efficiency. NREM-OSA showed shorter sleep latency and REM latency and higher percentage of N1 than those of REM-OSA and the highest proportion of those who slept in a lateral position than other subgroups. NREM-OSA revealed the highest composite score on the Horne and Östberg questionnaire. With increased AHI severity, the numbers of apnea and hypopnea events during REM sleep decreased, and the numbers of apnea and hypopnea events during NREM sleep increased. The results of ANCOVA after controlling age, sex, BMI, NC, AC, and AHI showed the lowest sleep efficiency, the highest AHI in the supine position, and the highest percentage of waking after sleep onset in NREM-OSA. CONCLUSION: REM-OSA was associated with the mild form of OSA, female sex, and negative emotions. IND-OSA was associated with the severe form of OSA. NREM-OSA was most closely related to position and showed the lowest sleep efficiency. Sleep stage-dependent characteristics could provide better understanding of OSA.
Adult ; Animals ; Apnea ; Female ; Horns ; Humans ; Neck ; Oxygen ; Polysomnography ; Respiration ; Retrospective Studies ; Sleep Apnea, Obstructive* ; Sleep, REM ; Supine Position

OBJECTIVE: This study's aim was to develop and standardize a Korean version (SCoRS-K) of the Schizophrenia Cognition Rating Scale (SCoRS), which is used to evaluate the degree of cognitive dysfunction affecting the everyday functioning of people with schizophrenia. METHODS: Eighty-four schizophrenia patients with stable symptoms who were receiving outpatient treatment and rehabilitation therapy, and 29 demographically matched non-patient controls, participated in the study. Demographic data were collected, and clinical symptoms, cognitive function, and social function were evaluated to verify SCoRS-K's reliability and validity. Clinical symptoms were evaluated using the Positive and Negative Syndrome Scale and the Clinical Global Impression-Schizophrenia Scale. Cognitive function was evaluated using a short form of the Korean Wechsler Adult Intelligence Scale and the Wisconsin Card Sorting Test (WCST). Social function was evaluated using the Social and Occupational Functioning Assessment Scale, the Schizophrenia Quality of Life Scale, and the Social Functioning Scale. RESULTS: Data analysis demonstrated SCoRS-K's statistically significant reliability and validity. SCoRS-K has high internal consistency (Cronbach's alpha; patient 0.941, informant 0.905, interviewer 0.964); test-retest reliability [patient 0.428 (p=0.003), informant 0.502 (p<0.001), interviewer 0.602 (p<0.001); and global rating 0.642 (p<0.001)]. The mean scores of subjects were significantly higher than those of the controls (p<0.001), demonstrating SCoRS-K's discriminant validity. Significant correlations between the total scores and global rating score of SCoRS-K and those of the scales and tests listed above (except WCST) support SCoRS-K's concurrent validity. CONCLUSION: SCoRS-K is a useful instrument for evaluating the degree of cognitive dysfunction in Korean schizophrenia patients.
Adult ; Cognition* ; Humans ; Intelligence ; Neurobehavioral Manifestations ; Outpatients ; Quality of Life ; Rehabilitation ; Reproducibility of Results* ; Schizophrenia* ; Statistics as Topic ; Weights and Measures ; Wisconsin

BACKGROUND/AIMS: Nasogastric administration of cola for dissolution of phytobezoar was reported but the mechanism is not well understood. We aimed to evaluate the efficacy of cola ingestion for upper gastrointestinal endoscopy in patients who have had distal gastrectomy. MATERIALS AND METHODS: Patients were enrolled from July 2007 to October 2007 and all previously received subtotal gastrectomy. We conducted a randomized case-control study which the patients were randomly assigned to two groups. Group A had preparation with cola and group B had no preparation. Cola preparation group ingested about 1,500 mL of cola between 7 PM to 10 PM in the evening before the procedure. Two examiners who were blinded to the type of preparation performed the endoscopy. We assessed the degree of food residue and bile reflux by Japanese classification. RESULTS: A total of 70 patients were included. The comparison of clinical and laboratory characteristics between the two groups showed no statistically significant difference. During endoscopy, food residue was less found in group A than B, but without statistically significance (group A=12.1%, group B=21.6%, P=0.087). However, bile reflux was significantly less found in group A than B (group A=36.4%, group B=67.6%, P=0.015). Multivariate analysis, cola preparation significantly reduced food residue (OR, 0.032; P=0.001) and bile reflux (OR, 0.102; P=0.001). CONCLUSIONS: Preparation with cola in the evening before endoscopic examination may provide a good quality of preparation in patient with remnant stomach after distal gastrectomy.
Asian Continental Ancestry Group ; Bile Reflux ; Case-Control Studies* ; Classification ; Cola* ; Eating* ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrectomy ; Gastric Stump* ; Humans ; Multivariate Analysis

Pregnancy outcomes for women uncontrolled diabetes mellitus are poor. Women with chronic kidney disease and end-stage renal disease, if pregnant, will develop pregnancy-related complications. In the case of severe renal failure and diabetes mellitus, the incidence of prematurity, low birth weight, and neonatal death increases. Despite these risks, there have been few reported cases of successful pregnancy outcomes for these women. Adherence to a schedule of strict glucose monitoring, blood pressure and volume control, correction of anemia, and intensive hemodialysis may play important roles in the management of these women. Successful pregnancy and childbirth in a patient with diabetic kidney disease receiving hemodialysis have not been previously reported in Korea, to our knowledge. Herein, we report a case of a successful pregnancy outcome in a patient with diabetic end-stage renal disease undergoing hemodialysis.
Anemia ; Appointments and Schedules ; Blood Pressure ; Diabetes Mellitus ; Diabetic Nephropathies ; Female ; Glucose ; Humans ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Kidney Failure, Chronic ; Korea ; Parturition ; Pregnancy ; Pregnancy Outcome ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic

BACKGROUND: Diamond Blackfan anemia (DBA), characterized by impaired red cell production, is a rare condition that is usually symptomatic in early infancy. The purpose of this study was to assess nationwide experiences of DBA encountered over a period of 20 years. METHODS: The medical records of 56 patients diagnosed with DBA were retrospectively reviewed from November 1984 to July 2010. Fifteen institutions, including 13 university hospitals, participated in this study. RESULTS: The male-to-female ratio of patients with DBA was 1.67:1. The median age of diagnosis was 4 months, and 74.1% were diagnosed before 1 year of age. From 2000 to 2009, annual incidence was 6.6 cases per million. Excluding growth retardation, 38.2% showed congenital defects: thumb deformities, ptosis, coarctation of aorta, ventricular septal defect, strabismus, etc. The mean hemoglobin concentration was 5.1+/-1.9 g/dL, mean corpuscular volume was 93.4+/-11.6 fL, and mean number of reticulocytes was 19,700/mm3. The mean cellularity of bone marrow was 75%, with myeloid:erythroid ratio of 20.4:1. After remission, 48.9% of patients did not need further steroids. Five patients with DBA who received hematopoietic transplantation have survived. Cancer developed in 2 cases (3.6%). CONCLUSION: The incidence of DBA is similar to data already published, but our study had a male predilection. Although all patients responded to initial treatment with steroids, about half needed further steroids after remission. It is necessary to collect further data, including information regarding management pathways, from nationwide DBA registries, along with data on molecular analyses.
Anemia ; Anemia, Diamond-Blackfan ; Aortic Coarctation ; Bone Marrow ; Congenital Abnormalities ; Diamond ; Erythrocyte Indices ; Heart Septal Defects, Ventricular ; Hemoglobins ; Hospitals, University ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Registries ; Reticulocytes ; Retrospective Studies ; Steroids ; Strabismus ; Thumb ; Transplants

Rapid serodiagnostic methods for Toxoplasma gondii infection in cats are urgently needed for effective control of transmission routes toward human infections. In this work, 4 recombinant T. gondii antigens (SAG1, SAG2, GRA3, and GRA6) were produced and tested for the development of rapid diagnostic test (RDT). The proteins were expressed in Escherichia coli, affinity-purified, and applied onto the nitrocellulose membrane of the test strip. The recombinant SAG1 (rSAG1) showed the strongest antigenic activity and highest specificity among them. We also performed clinical evaluation of the rSAG1-loaded RDT in 182 cat sera (55 household and 127 stray cats). The kit showed 0.88 of kappa value comparing with a commercialized ELISA kit, which indicated a significant correlation between rSAG1-loaded RDT and the ELISA kit. The overall sensitivity and specificity of the RDT were 100% (23/23) and 99.4% (158/159), respectively. The rSAG1-loaded RDT is rapid, easy to use, and highly accurate. Thus, it would be a suitable diagnostic tool for rapid detection of antibodies in T. gondii-infected cats under field conditions.
Animals ; Antigens, Protozoan/*diagnostic use/genetics ; Cat Diseases/*diagnosis ; Cats ; Chromatography, Affinity ; Escherichia coli/genetics ; *Point-of-Care Systems ; Protozoan Proteins/*diagnostic use/genetics ; Recombinant Proteins/diagnostic use/genetics ; Sensitivity and Specificity ; Serologic Tests/methods ; Toxoplasma/genetics ; Toxoplasmosis, Animal/*diagnosis ; Veterinary Medicine/*methods

Dysphagia aortica is a rare etiology of dysphagia resulting from extrinsic compression of esophagus by thoracic aortic aneurysm or tortuosity and elongation of thoracic aorta. The clinical findings resemble those of esophageal malignancy or esophageal motility disorders. Therefore, primary diagnosis of dysphagia aortica is very difficult. We, herein, report a case of dysphagia aortica aggravated by wearing the abdominal binder in a 70-year-old woman and review the literature pertaining to this condition. Dysphagia aortica should be considered in the differential diagnosis of dysphagia.
Abdomen ; Aged ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Deglutition Disorders ; Diagnosis, Differential ; Esophageal Motility Disorders ; Esophagus ; Female ; Humans ; Manometry

Candida albicans frequently inhabits the gastrointestinal tract of humans and this can lead to gastrointestinal candidiasis. Candida albicans infection of the gastrointestinal tract in normal or immunocompromised patients invariably involves the esophagus, with the typical finding of mucosal plaques. In contrast, gastric candidiasis is an uncommon phenomenon that usually occurs in immunocompromised hosts, andonly such eight cases have currently been documented in Korea. We report here on an additional case of gastric candidiasis in a 39-year old woman who had undergone craniotomy and chemotherapy for glioblastoma, and we review the medical literature related to this condition.
Candida albicans ; Candidiasis ; Craniotomy ; Esophagus ; Female ; Gastrointestinal Tract ; Glioblastoma ; Humans ; Immunocompromised Host ; Korea ; Stomach

BACKGROUND/AIMS: Fabry disease is an X-linked recessive and progressive disease caused by alpha-galactosidase A (alpha-GaL A) deficiency. We sought to assess the prevalence of unrecognized Fabry disease in dialysis-dependent patients and the efficacy of serum globotriaosylceramide (GL3) screening. METHODS: A total of 480 patients of 1,230 patients among 17 clinics were enrolled. Serum GL3 levels were measured by tandem mass spectrometry. Additionally, we studied the association between increased GL3 levels and cardiovascular disease, cerebrovascular disease, or left ventricular hypertrophy. RESULTS: Twenty-nine patients had elevated serum GL3 levels. The alpha-GaL A activity was determined for the 26 patients with high GL3 levels. The mean alpha-GaL A activity was 64.6 nmol/hr/mg (reference range, 45 to 85), and no patient was identified with decreased alpha-GaL A activity. Among the group with high GL3 levels, 15 women had a alpha-GaL A genetics analysis. No point mutations were discovered among the women with high GL3 levels. No correlation was observed between serum GL3 levels and alpha-GaL A activity; the Pearson correlation coefficient was 0.01352 (p = 0.9478). No significant correlation was observed between increased GL3 levels and the frequency of cardiovascular disease or cerebrovascular disease. CONCLUSIONS: Fabry disease is very rare disease in patients with end-stage renal disease. Serum GL3 measurements as a screening method for Fabry disease showed a high false-positive rate. Thus, serum GL3 levels determined by tandem mass spectrometry may not be useful as a screening method for Fabry disease in patients with end stage renal disease.
Adult ; Aged ; Fabry Disease/blood/*diagnosis ; Female ; Humans ; Kidney Failure, Chronic/blood/*therapy ; Male ; Middle Aged ; *Renal Dialysis ; Trihexosylceramides/*blood ; alpha-Galactosidase/genetics/metabolism

Schinzel-Giedion syndrome is a rare, distinct dysmorphic syndrome characterized by congenital hydronephrosis, skeletal dysplasia, and severe developmental retardation, likely to be inherited as an autosomal recessive trait, but not yet confirmed. This syndrome is characterized by coarse facial features such as midfacial retraction, bulging forehead, short nose with anteverted nostrils, low-set malformed ears, protruding large tongue, and hypertelorism. Skeletal and limb defects, choanal stenosis, simian creases, hypospadias, microphallus, hypertrichosis, and intractable seizures are the frequently associated clinical findings. Urogenital involvement is a major component of the syndrome, and this problem sometimes is associated with nephrocalcinosis and urinary tract infection in the clinical course of the disease. We report a 22 month-old girl with Schinzel-Giedion syndrome complicated by medullary nephrocalcinosis and urinary tract infection due to Klebsiella pneumoniae. This patient had also been suffering from postnatal growth deficiency, intractable seizure, spastic tetraplegia, delayed development and severe mental retardation.
Constriction, Pathologic ; Ear ; Extremities ; Female ; Forehead ; Humans ; Hydronephrosis ; Hypertelorism ; Hypertrichosis ; Hypospadias ; Infant ; Intellectual Disability ; Klebsiella pneumoniae ; Male ; Nephrocalcinosis ; Nose ; Quadriplegia ; Seizures ; Tongue ; Urinary Tract Infections