Sleep Disorder and Alcohol / 수면정신생리

The use of alcohol is associated with the development and worsening of sleep disorder. Alcohol is generally known to have a sedative effect, but it has an arousal or sedative effect depending on the timing and drinking dose and directly affects REM sleep physiology. Alcohol acts on the central nervous system (CNS) to interfere with the sleep-wake cycle and to affect sleep-related hormone secretion. In addition, the ingestion of alcohol pre-sleep is associated with deterioration and development of sleep related breathing disorders (SBD). The increase in resistance of the upper respiratory tract and the decrease in sensitivity of the CNS respiratory center and the respiratory muscles are major mechanisms of alcohol-induced SBD, and result in snoring or apnea in healthy men or aggravating apnea in patients with OSA. Sleep-related restless leg syndrome and circadian rhythm disorders are common in alcohol use disorder patients. This review provides an assessment of scientific studies that investigated on the impact of alcohol ingestion on nocturnal sleep physiology and sleep disorders.

Primary Granulomatous Hypophysitis Presenting with Panhypopituitarism and Central Diabetes Insipidus / 대한내과학회지

Primary granulomatous hypophysitis is a rare inflammatory disorder of the pituitary gland and patients commonly present with symptoms of sellar compression and hypopituitarism. A 48-year-old woman was admitted due to headache and fatigue. Magnetic resonance imaging showed a 21 x 18 x 13-mm round sellar mass with a thickened pituitary stalk. The endocrinological examination revealed panhypopituitarism and diabetes insipidus. Suspecting hypophysitis, the patient was given steroid and hormone replacement therapy. Six months later, she continued to complain of severe headaches and nausea. Computed tomography showed no significant change in the sellar mass. Subsequently, transsphenoidal surgery was performed. The pathological examination revealed granulomatous changes with multinucleated giant cells and primary granulomatous hypophysitis was diagnosed. Her headache resolved, but the pituitary functions did not improve. This is the first reported case in Korea of primary granulomatous hypophysitis with dysfunction of anterior and posterior pituitary gland, including the stalk, without optic chiasm compression.

Serious Complications after Self-expandable Metallic Stent Insertion in a Patient with Malignant Lymphoma / 결핵및호흡기질환

An 18-year-old woman was evaluated for a chronic productive cough and dyspnea. She was subsequently diagnosed with mediastinal non-Hodgkin lymphoma (NHL). A covered self-expandable metallic stent (SEMS) was implanted to relieve narrowing in for both main bronchi. The NHL went into complete remission after six chemotherapy cycles, but atelectasis developed in the left lower lobe 18 months after SEMS insertion. The left main bronchus was completely occluded by granulation tissue. However, the right main bronchus and intermedius bronchus were patent. Granulation tissue was observed adjacent to the SEMS. The granulation tissue and the SEMS were excised, and a silicone stent was successfully implanted using a rigid bronchoscope. SEMS is advantageous owing to its easy implantation, but there are considerable potential complications such as severe reactive granulation, stent rupture, and ventilation failure in serious cases. Therefore, SEMS should be avoided whenever possible in patients with benign airway disease. This case highlights that SEMS implantation should be avoided even in malignant airway obstruction cases if the underlying malignancy is curable.

Pneumatosis Intestinalis Complicated by Pneumoperitoneum in a Patient with Asthma / 결핵및호흡기질환

Pneumatosis intestinalis (PI) is a very rare condition that is defined as the presence of gas within the subserosal or submucosal layer of the bowel. PI has been described in association with a variety of conditions including gastrointestinal tract disorders, pulmonary diseases, connective tissue disorders, organ transplantation, leukemia, and various immunodeficiency states. We report a rare case of a 74-year-old woman who complained of dyspnea during the management of acute asthma exacerbation and developed PI; but, it improved without any treatment.

Management of Persistent or Recurrent Otorrhea after Open Cavity Tympano-Mastoidectomy: Laser Application / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Persistent and recurrent otorrhea following open cavity tympano-mastoidectomy can be a serious problem for the patient and the otologic surgeon. Frequent post-operative otorrhea hallmarks surgical failure. Medical treatment may often yield resolution, but a significant number of patients would still require re-operation. So we applied CO2 laser cauterization to draining cavity. The objective of the present study was to introduce the CO2 laser cauterization on draining cavity, and to describe the clinical course of the laser treatment. MATERIALS AND METHOD: Twenty-one cases of post-operative persistent or recurrent otorrhea were diagnosed at our hospital from January 1999 to December 2000. Fifteen cases were selected in this study. The selection criteria included chronic ear patient, open cavity tympano-mastoidectomy, absent residual or recurrent cholesteatoma. The minimum duration of follow up was 6 months. All cases were locally anesthetized with 10% xylocaine. The CO2 laser was Shaplan 100 which was connected to a microscope. The interval of CO2 laser cauterization was one week. RESULTS: All of 15 cases were cured completely. There was no recurrence during the follow up period. The locations of granulation tissues were tegmen (10 cases), mastoid tip (6 cases), retro-facial or facial ridge (4 cases), and sino-dural angle (4 cases). The mechanical causes of retention of debris in open cavity procedures included insufficient meatoplasty (3 cases) and high facial ridge (2 cases). The times of CO2 laser coagulation ranged from 2 to 5. CONCLUSION: Based on our research on the effect of CO2 laser among patients with draining cavity, we concluded that : 1) CO2 laser cauterization was an efficient method for the management of draining cavity, 2) CO2 laser cauterization has benefits which reduced the frequency of OPD visits and 3) CO2 laser cauterization provided a delicate, selective removal of granulation tissues.

Age - related Changes of T cells,B cells Distribution in C57BL/6 Mice Thymus,Spleen and Popliteal Lymph Node / 체질인류학회지

The following experiment was performed to clarify distributional changes of the Ly1, L3T4, Ly2 positive T cells and IgM positive B cells 1, 4, 8, 12 and 40 weeks after birth. Thymus, spleen and lymph node were removed and immunohistochemical staining such as avidin -biotin -peroxidase complex method was used. The results obtained from above epxperiment were as follows; 1. Ly1 positive T cells were decreased after 8 weeks in the thymus and spleen. these were decreased after 40 weeks in the lymph node. 2. There was no difference L3T4 positive T cells in the thymus, but in the spleen decrease of cell number was shown after 40 weeks. 3. Ly2 postive T cells were decreased after 4 weeks in the thymus, after 40 weeks in the spleen. There was no change of distribution in the lymph node. 4. There was no difference distribution of IgM positive B cells. The results suggest that the age related decrease of the immunity is caused by decrease of cellular immunity related to T cell depletion.