Sympathetic Overactivity Based on Heart-Rate Variability in Patients with Obstructive Sleep Apnea and Cerebral Small-Vessel Disease

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) is associated with cerebral white-matter changes (WMC), but the underlying mechanisms are not completely understood. Our aim was to identify the cardiovascular autonomic characteristics during sleep that are associated with cerebral WMC in OSA patients. METHODS: We recruited subjects from our sleep-center database who underwent both polysomnography and brain MRI within a 1-year period. Sixty patients who had OSA with WMC (OSA+WMC), 44 patients who had OSA without WMC (OSA−WMC), and 31 control subjects who had neither OSA nor WMC were analyzed. Linear and nonlinear indices of heart-rate variability (HRV) were analyzed in each group according to different sleep stages and also over the entire sleeping period. RESULTS: Among the nonlinear HRV indices, the Poincaré ratio (SD12) during the entire sleep period was significantly increased in the OSA+WMC group, even after age adjustment. Meanwhile, detrended fluctuation analysis 1 during non-rapid-eye-movement sleep tended to be lowest in the OSA+WMC group. These indices were altered regardless of the presence of hypertension or diabetes. In the subgroup analysis of middle-aged OSA patients, approximate entropy during rapid-eye-movement sleep was significantly lower in OSA+WMC patients than in OSA−WMC patients. Overall, the nonlinear HRV indices suggest that sympathetic activity was higher in the OSA+WMC group than in the OSA−WMC and control groups. CONCLUSIONS: Our findings suggest that dysregulation of HRV, especially overactivation of sympathetic tone, could be a pathophysiologic mechanism underlying the development of WMC in OSA patients.

Efficacy of Levofloxacin and Rifaximin based Quadruple Therapy in Helicobacter pylori Associated Gastroduodenal Disease: A Double-Blind, Randomized Controlled Trial

The aim of this study was to evaluate the efficacy of levofloxacin and rifaximin based quadruple regimen as first-line treatment for Helicobacter pylori infection. A prospectively randomized, double-blinded, parallel group, comparative study was performed. Three hundred consecutive H. pylori positive patients were randomized to receive: omeprazole, amoxicillin, clarithromycin (OAC); omeprazole, amoxicillin, levofloxacin (OAL); and omeprazole, amoxicillin, levofloxacin, rifaximin (OAL-R). The eradication rates in the intention to treat (ITT) and per protocol (PP) analyses were: OAC, 77.8% and 85.6%; OAL, 65.3% and 73.6%; and OAL-R, 74.5% and 80.2%. The eradication rate achieved with OAC was higher than with OAL on the ITT (P = 0.05) and PP analysis (P = 0.04). OAL-R regimen was not inferior to OAC. The frequency of moderate to severe adverse effects was significantly higher in OAC treatment group. Especially, diarrhea was most common complaint, and there was a significantly low rate of moderate to severe diarrhea with the rifaximin containing regimen. In conclusion, the levofloxacin and rifaximin based regimen comes up to the standard triple therapy, but has a limited efficacy in a Korean cohort. The rifaximin containing regimen has a very high safety profile for H. pylori eradication therapy.

Effect of Acid Pump Antagonist (Revaprazan, Revanex(R)) on Result of 13C Urea Breath Test in Patients with Helicobacter pylori Associated Peptic Ulcer Disease / 대한소화기학회지

BACKGROUND/AIMS: Revaprazan (Revanex(R)) is a novel proton pump inhibitor (PPI) that has a somewhat different effect on proton pump compared with the other PPI's, also (called as 'acid pump antagonist'). We aimed to examine the false negative rate of 13C-urea breath test (UBT) in the patients with Helicobacter pylori (H. pylori) associated peptic ulcer disease who were treated with revaprazan and evaluate the anti-urease activity of revaprazan. METHODS: Total 55 patients were enrolled in this study. They received EGD examination between January 2009 and December 2009 and diagnosed histologically as H. pylori associated peptic ulcer disease. All patients took revaprazan only. Three patients were excluded because of underlying chronic disease and inappropriate breath sampling. The remaining 52 patients had UBT at 0, 2 and 4 weeks of revaprazan use. After 2 weeks of the cessation of revaprazan, they had the fourth UBT. RESULTS: At 2 and 4 weeks, the false negative rates of UBT were 5.8% and 23.1%, respectively (p=0.05). After 2 weeks of the cessation, the cases of the false negative result were five. Four out of five patients had prolonged negative results on two or three successive tests, and baseline 13C difference value did not predict the false negative results. CONCLUSIONS: False negative results of UBT were common and increased with prolonged use of acid pump antagonist. As PPI, it had also anti-urease activity and most patients (47/52, 90.4%) reverted to positive results by 2 weeks after the cessation of taking the medication.

A Case of Simple Ulcer of the Terminal Ileum Successfully Treated by Monoclonal Antibody to Tumor Necrosis Factor-alpha (Infliximab) / 대한소화기내시경학회지

Nonspecific and idiopathic ulcer of the small bowel or colon is a rare condition, and it is the so called "simple ulcer" when the patients do not have systemic symptoms of Behcet's syndrome. Differentiation of simple ulcer from intestinal Behcet's disease according to the endoscopic and pathologic findings is often impossible and the clinical course of the 2 maladies is similar. A 51-year-old man presented with low abdominal pain, and colonoscopy revealed a huge deep ulceration with an entero-enteric fistula in the terminal ileum. He was diagnosed with simple ulcer without the constitutional symptoms of Behcet's syndrome. He was refractory to conventional therapy with corticosteroids and antibiotics, and so he required surgical resection. Monoclonal antibody against tumor necrosis factor-alpha (Infliximab) was administered at 0, 2 and 6 weeks. His symptoms were relieved after the therapy and the ulceration had completely resolved after 1 year. He was entirely asymptomatic at the 36 month follow up.

A Case of Cowden Disease Associated with Lhermitte-Duclos Disease / 대한소화기내시경학회지

Cowden disease (CD), also known as 'multiple hamartoma syndrome', is a rare autosomal dominant disorder with a high risk of breast, thyroid, or genitourinary malignancies. Lhermitte-Duclos Disease (LDD) is believed to be a hamartomatous overgrowth of cerebellar ganglion cells and currently is considered to be a part of CD. However, the report of the association between LDD and CD has been very unusual. We have recently experienced a 53-year-old man with LDD who had acral keratosis of extremities, gastrointestinal polyposis, and multinodular goiter. To our knowledge, it is the second case of CD associated with LDD in Korea. We report it with a review of the literatures.

A Case of Ischemic Colitis due to Falling Down / 대한소화기내시경학회지

Ischemic colitis, the most common form of acute mesenteric ischemia, is encountered primarily in elderly patients, and frequently presents with abdominal cramping pain and hematochezia. Both occlusive and nonocclusive underlying mechanisms have been proposed, but the precise pathophysiology remains unknown. On colonoscopy, the earlier signs of ischemic colitis are mucosal hyperemia, edema, and hemorrhagic nodules representing submucosal bleeding. It is followed by well-demarcated elongated ulcerations covered with exudate. In most cases, the clinical course is transient and self-limiting. After conservative treatment with hydration, cessation of food, and broad-spectrum antibiotics, clinical symptoms improve within several days. Recently, we have experienced a case of ischemic colitis following falling down and report this case with a review of the literature.

Polymyositis Associated with Bronchiolitis Obliterans Organizing Pneumonia

Bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathologic syndrome of pulmonary inflammatory responses which has become increasingly recognized and has been described in association with a variety of disorders. We present a case of polymyositis associated with BOOP that responded to a corticosteroid therapy. The patient had a nonproductive cough, increasing dyspnea, fatigue, mild proximal limb weakness, and bilateral basal interstitial infiltrates on chest X-ray. This case will add further strength to the association of BOOP with polymyositis. (J Korean Neurol Assoc 19(5):547~549, 2001)

Plasma D-dimer Determination in the Diagnosis of Pulmonary Embolism / 결핵

BACKGROUND: The diagnosis of pulmonary embolism(PE) based on clinical findings is often elusive and therefore requires confirmative diagnostic method. Pulmonary angiography, though the gold standard for the diagnosis of pulmonary embolism, is an invasive method and requires trained personnel and special equipment. Lung V/Q scan, on the other hand, is a noninvasive method but the diagnostic specificity and sensitivity are not satisfactory in case that the results are either intermediate or low probability scan. Plasma D-dimer is generated when a thrombus is fibrinolysed by plasmin and is known to be increased in various thrombotic disorders. The aim of this study was to investigate the value of the determination of plasma D-dimer level in the diagnosis of pulmonary embolism. METHODS: Pulmonary angiography was performed in 17 patients who were clinically suspected to have pulmonary embolism. 9 patients(PE, 56+/-13.4 yrs, M:F=8:1) were diagnosed to have pulmonary embolism by pulmonary angiography. The control group were the 8 patients with negative pulmonary angiography and 13 orthopedic patients with no evidence of pulmonary embolism on scintigraphic and impedance plethysmographic studies(n=21) (non-PE, 54.5 +/-11.1 yrs, M:F=11:10). Plasma D-dimer was measured by latex agglutination method in study subjects and the results were alnalyzed according to the presence or absence of pulmonary embolism. RESULTS: 1) The increased level of plasma D-dimer was more frequently observed in the patients with pulmonary embolism than in the controls(>0.5 mg/L, 8 in PE, 10 in non-PE; <0.5 mg/L, 1 in PE, 11 in non-PE, p=0.049). 2) The diagnostic value of plasma D-dimer level higher than 0.5 mg/L were as follows: sensitivity 88.9%(8/9), specificity 52.4%(11/21), positive predictive value 44.4%(8/18), and negative predictive value 91.7%(11/12). CONCLUSION: Plasma D-dimer determination showed high sensitivity and negative predictive value in the diagnosis of pulmonary embolism and is therefore thought to be useful in excluding the possibility of pulmonary embolism.

The Expression of Adhesion Molecules on Alveolar Macrophages and Lymphocytes and Soluble ICAM-1 Level in Serum and Bronchoalveolar Lavge(BAL) Fluid of Patients with Diffuse Interstitial Lung Diseases(DILD) / 결핵

BACKGROUND: The expression of the adhesion molecules on the cell surface is important in the movement of cells and the modulation of immune response. DILD starts as an alveolitis and progresses to pulmonary fibrosis. So adhesion molecules in these patients is expected to be increased. There are several reports about adhesion molecules in DILD in terms of the percentage of positive cells in immuno-stain, in which the interpretation is subjective and the data were variable. METHODS: So we measured the relative median fluorescence intensity(RMFI) which is the ratio of the FI emitted by bound primary monoclonal antibody to FI emitted by isotypic control antibody of the cells in BALF of 28 patients with DILD(IPF:10, collagen disease:7, sarcoidosis:9, hypersensitivity pneumonitis:2) and 9 healthy control. RESULTS: RMFI of the ICAM-1 on AM(3.30+/-1.16) and lymphocyte(5.39+/-.70) of DILD were increased significantly than normal control(0.93+/-0.18, 1.06+/-0.21, respectively, p=0.001, P=0.003). RMFI of the CD18 on lymphocyte was also higher(24.9+/-14.9) than normal(4.59+/-3.77, p=0.0023). And there was a correlation between RMFI of ICAM on AM and the % of AM(r=-0.66, p=0.0001) and lymphocyte(r=0.447, p=0.0116) in BALF. Also RMFI of ICAM on lymphocyte had a significant (r=0.593, p=0.075) correlation with the % of IL-2R(+) lymphocyte in BALF. The soluble ICAM(sICAM) in serum was also significantly elevated in DILD(499.7 +/-222.2 ng/ml) compred to normal(199.0+/-38.9) (p=0.00097) and sICAM in BAL fluid was also significantly higher than normal control group(41.8+/-23.0 ng/ml vs 20.1 +/-13.6 ng/ml). There was a Significant correlation between sICAM level in serum and the expression of ICAM-1 on AM(r=0.554, p=0.0259). CONCLUSION: These data suggest that in DILD the expression of adhesion molecules is increased in the AM and BAL lymphocytes with elevated serum sICAM, and these parameter may be useful in determining disease activity.

Clinical efficacy of teicoplanin in gram-positive bacterial infection / 감염

No abstract available.

Usefulness of glomerular filtration rate using 31Cr-EDTA clearance to evaluate glomerular hyperfiltration / 대한신장학회잡지

No abstract available.