The factors influencing nocturnal blood pressure drop in essential hypertensives

BACKGROUND: Blood pressure is normally lower during night times than in day times. But in some people, this nocturnal blood pressure drop is decreased or absent. In essential hypertensives, absence of nocturnal blood pressure drop (the 'nondipping' pattern) has been associated with increased target organ damage and cardiovascular morbidity. Present study was intended to describe the proportion of 'nondippers' among untreated essential hypertensives in Korea and to investigate the influences of independent clinical factors on the nocturnal fall of blood pressure. METHODS: We studied 50 untreated Korean essential hypertensives who underwent 24-hour ambulatory blood pressure monitoring. Subjects with a nocturnal drop in systolic or diastolic blood pressure, or both, 10% were defined as 'dippers', the others as 'nondippers'. Their demographic and clinical characteristics were obtained through medical record and questionnaire. Above characteristics were considered to be independent variables and the dipping status, dependent. RESULTS: Thirty four percent of essential hypertensives were 'nondippers'. Nocturnal bloGd pressure drop decreased with reporting of family history of hypertension and higher 24-hour ambulatory mean b1ood pressure. Previous studies insisted on the influence of age on the dipping status, but in our study, age showed no impact on nocturnal blood pressure drop. CONCLUSION: About one third of untreated subjects with essential hypertension were observed to be nondippers. Family history of hypertension and high 24-hour ambulatory mean blood pressure significantly decreased nocturnal blood pressure drop in our study. According to the previous studies, above factors might work through affecting the normally decreased sympathetic activity during sleep time. Longitudinal studies of the influence of nondipping on the long term prognosis of hypertension and large scale studies to establish the factors influencing nocturnal blood pressure drop and their mechanisms are further needed.

Magnetic motor evoked potential in non-insulin dependent diabetic patients

Diabetes mellitus is the most common cause of the peripheral neuropathy and an important risk factor of the cerebrovascular disease. There are also several case reports of the diabetic myelopathy, and it has been known that the incidence of cord involvement is not rare on autopsy and somatosensory evoked potential studies. To determine the functional derangement of central descending motor pathway in diabetes, 59 cases of diabetes were studied with the magnetic motor evoked potential (MMEP) study. The diabetic patients were divided into two groups according to the nerve conduction study (23 with normal and 36 with abnormal nerve conduction studies) and compared with the results of 31 normal control cases. The results are as follows. 1. At each stimulated point, there are statistically significant differences in latencies of MMEPs between normal control and diabetic groups. 2. Compared to the control group, the peripheral conduction time is also significantly prolonged in diabetic patients. 3. However, there is no difference in the calculated central motor conduction time among three groups. In conclusion, this result means that prolonged latencies of MMEPs in diabetes may be due to peripheral neuropathy rather than dysfunction of central motor pathway. Therefore the clinical significance of MMEP has to be decided segmentally rather than by simple determination of the vertex latency.

A Case of Pure Trigeminal Motor Neuropathy

Trigeminal motor neuropathy is a rare disorder which involves only motor fiber in trigeminal nerve. We experienced a 58-year-old man with muscle weakness and wasting of left masticatory muscles for 3 weeks. He had suffered from the same event on the right side 13 years ago. He had no sensory dysfunction and Brain CT revealed no gross abnormality. All the laboratory findings were negative and the EMG revealed chronic denervating process in bilateral masseter and temporalis muscles. He has improved after steroid therapy.

A Case of Inclusion Body Myositis

Here we report a case of the classical inclusion body myositis. The muscle pathology in a 61-year-old male patient with slowly progressive proximal muscle weakness and atrophy revealed basophilic rimmed vacuoles on light microscope and intracytoplasmic filamentous inclusions with membranous whorls through electron microscope. He did not respond to steroid therapy.

The Factors Influencing the Clinical Course of Acute Cerebral Infarctions: Cortical Versus Lacunar Infarction

We think that the clinical courses of lacurlar infarctions are somewhat different from those of cortical ones, because the ischemic penumbra, a keystone of acute infarct recovery, of the former is rnore limitted than that of the latter. Therefore, we analyzed the selected data, 38 cortical and 33 lacunar infarct patients, from Severance Stroke Registry which were recorded from May, 1989 to April, 1990, to demonstrate and compare the differences of the clinical courses and its influencing factors between the cortical and lacunar infarcts. Our results suggested as follows first, the initial neurologic deficits of cortical infarctions are rnore serious than those of lacunar infarctions, but with the better short-term improvements of tbe former, the short-term motor outcome between the two types of infarcts are not significantly different second, whiIe the short-term improvernent of cortical infarcs is influenced by initial hematocrit level, the short-term motor outcome and the degree of improvement of lacunar infarcts are influenced by the patient's age.