Clinical Analysis of Daytime Sleepiness and Insomnia in Patients with Obstructive Sleep Apnea

BACKGROUND AND OBJECTIVES: Sleep disturbances and excessive daytime sleepiness (EDS) are the major symptoms of obstructive sleep apnea (OSA). This study aimed to investigate clinical implications of insomnia and EDS in patients with OSA using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). MATERIALS AND METHOD: We evaluated 131 subjects with suspected OSA who were undergoing polysomnography (PSG) and performing the PSQI and ESS surveys. OSA was diagnosed when the apnea-hypopnea index was five or more. EDS was defined when ESS score was 11 points or higher. Detailed history and questionnaire were used to categorize insomnia. We compared clinical variables and PSG results in subgroups with or without insomnia and EDS. RESULTS: There were no significant differences of PSQI and ESS score between controls and OSA. OSA with insomnia had significantly increased total score (p < 0.001) and decreased total sleep time (p=0.001) and sleep efficiency (p=0.001) on the PSQI compared to those without insomnia. OSA with EDS showed significantly increased PSQI score (p=0.022) and decreased total sleep time (p=0.018) on PSG compared to those without EDS. Neither PSQI nor ESS score had a correlation with respiratory variables such as AHI and oxygen saturation. Total sleep time had a significant effect on both insomnia and EDS in patients with OSA. CONCLUSION: Decreased total sleep time had important effects on subjective symptoms of OSA and comorbid insomnia. Therefore, restoration of decreased sleep time is important in the management of OSA.

A Case of Salivary Gland Choristoma Mimicking Glomus Tympanicum / 대한이비인후과학회지

Salivary gland choristoma is defined as the architecturally normal salivary gland tissues found in abnormal locations. Middle ear salivary gland choristoma usually presents with conductive hearing loss. We present a case of middle ear mass with conductive hearing loss in a 6-year-old boy. A reddish mass was incidentally found behind the normal tympanic membrane. Magnetic resonance image showed the markedly enhancing lesion which was in accordance with glomus tympanicum. Preoperative angiography was performed, but supplying artery and mass was not identified. Surgical exploration was made and the mass was dissected easily without profuse bleeding. Final diagnosis was salivary gland choristoma by histopathology. We discuss the clinical features and management of middle ear salivary choristoma with the review of literature.

p38 MAPK and ERK activation by 9-cis-retinoic acid induces chemokine receptors CCR1 and CCR2 expression in human monocytic THP-1 cells

9-cis-retinoic acid (9CRA) plays an important role in the immune response; this includes cytokine production and cell migration. We have previously demonstrated that 9CRA increases expression of chemokine receptors CCR1 and CCR2 in human monocytes. To better understand how 9CRA induces CCR1 and CCR2 expression, we examined the contribution of signaling proteins in human monocytic THP-1 cells. The mRNA and surface protein up-regulation of CCR1 and CCR2 in 9CRA-stimulated cells were weakly blocked by the pretreatment of SB202190, a p38 MAPK inhibitor, and PD98059, an upstream ERK inhibitor. Activation of p38 MAPK and ERK1/2 was induced in both a time and dose-dependent manner after 9CRA stimulation. Both p38 MAPK and ERK1/2 phosphorylation peaked at 2 h after a 100 nM 9CRA treatment. 9CRA increased calcium influx and chemotactic activity in response to CCR1-dependent chemokines, Lkn-1/CCL15, MIP-1alpha/CCL3, and RANTES/CCL5, and the CCR2-specific chemokine, MCP-1/CCL2. Both SB202190 and PD98059 pretreatment diminished the increased calcium mobilization and chemotactic ability due to 9CRA. SB202190 inhibited the expression and functional activities of CCR1 and CCR2 more effectively than did PD98059. Therefore, our results demonstrate that 9CRA transduces the signal through p38 MAPK and ERK1/2 for CCR1 and CCR2 up-regulation, and may regulate the pro-inflammatory process through the p38 MAPK and ERK-dependent signaling pathways.

Three Cases of Descemet's Membrane Detachment after Cataract Surgery

Descemet's membrane detachment (DMD) is an uncommon condition with a wide range of etiologies. More than likely, the most common cause is a localized detachment occurring after cataract surgery. We report three cases of Descemet's membrane detachment that occurred after uncomplicated phacoemulsification cataract surgeries. The first patient was managed without surgical intervention, the second patient was treated using an intracameral air injection, and the last patient was treated with an intracameral perfluoropropane (C3F8) gas injection. All three patients recovered their vision following the reattachment of Descemet's membrane. The three patients were treated according to the extent of the detachment.

Classification of Ptosis in Korea

PURPOSE: To classify blepharoptosis in Korean patients, investigate the type of surgery used, and to compare the results with the data from Western countries. METHODS: A total of 913 patients (1147 eyes) who underwent surgery for blepharoptosis from 1991 to 2003 were classified as either being congenital or acquired blepharoptosis, and then further subclassified into myogenic, aponeurotic, mechanical, or neurogenic ptosis according to Freuh's mechanistic classification. The type of surgery for each type of blepharoptosis was investigated. RESULTS: Of the 913 patients, 695 (76.1%) were congenital type, and 218 (23.9%) were acquired type. Freuh's mechanistic classification by type was 84.7% myogenic type, 10.5% aponeurotic, 3.4% neurogenic, and 1.6% mechanical. By order of frequency, the type of surgery used was 60% frontalis suspension, 26.4% levator resection, 12.2% aponeurosis repair, and 1.4% conjunctivomullerectomy. CONCLUSIONS: Congenital type was more common than acquired type. The proportion of congenital type was higher than the results reported from Western countries, but lower than those of previous Korean studies. This is probably due to the increased number of adults undergoing surgery for blepharoptosis compared to the past, and is a reflection of influence of socio-economic levels.

Comparison of Short-term Surgical Outcomes of Ahmed Glaucoma Valve Implant between 96 mm2 and 184 mm2 of the Surface Area

PURPOSE: To compare the short-term surgical outcomes of Ahmed glaucoma valve implant with a surface area between 96 mm2 and 184 mm2. METHODS: The outcomes of thirteen eyes of 13 patients with refractory glaucoma who had undergone 96 mm2-sized Ahmed glaucoma valve implantation were compared with those of 13 eyes of 13 patients with 184 mm2-sized Ahmed glaucoma valve implantation. RESULTS: Average age and preoperative intraocular pressure (IOP) were statistically indistinguishable between the two groups (p=0.54 and 0.40, respectively). Average follow-up period and final IOP were also statistically similar (p=0.15 and 1.00, respectively). Comparing the overall IOPs and the numbers of antiglaucoma medications, the IOP of postoperative day 1 with the 184 mm2-group was only relatively lower (p=0.07). The 2-year success rates were 18.0% for the 96 mm2-group and 69.2% for the 184 mm2-group (Ed-there is no respective comparison here) with Kaplan-Meier survival analysis (p=0.0018). The rates of complications and re-operation were similar between the two groups. CONCLUSIONS: The average postoperative IOPs were not statistically different between the two groups. However, the success rate was better in the 184 mm2-group than in the 96 mm2-group.

Aluminum Clearance by Hemodialysis in Chronic Renal Failure / 대한산업의학회지

OBJECTIVES: This study was carried out to investigate aluminum levels in blood and the factors affecting aluminum concentration; we also presented findings on aluminum clearance during hemodialysis in chronic renal failure patients. METHODS: We selected 56 patients with case of chronic renal failure and 144 healthy examinees as a control group. We analysed aluminum concentrations in their blood, water and dialysis fluid. RESULTS: The blood aluminum concentration in the 56 patients was 2.38+/-0.27 microgram/ dL , about 4 times higher than that of the control group (p < 0.01). Blood aluminum concentrations were not affected by factors such as creatinine, BUN, hemodialysis duration, iron, and drinking water. After hemodialysis, blood aluminum level were decreased by about 15% and the aluminum concentration in the dialysis fluid was increased. CONCLUSIONS: Blood aluminum levels were significantly high in the chronic renal failure patients; and hemodialysis helped the patients to excrete aluminum. Authors suggest that a purified dialysis fluid containing a lower aluminum concentration would facilitate aluminum excretion in hemodialysis patients.

The Role of Nitric Oxide on Cataractogenesis in Uveitis Model Induced by Concanavalin A and Lipopolysaccharide

Nitric oxide[NO]plays a diverse role in many biological systems such as vascular, nervous and respiratory system. Recently, many studies have been performed to define the relationship between NO and physiological and pathophysiological processes. This study was conducted to evaluate the role of NO on cataractogenesis in uveitis model induced by Con A and LPS. Forty-five white male rabbits were divided into five experimental groups[ten rabbits for each group I, II, III, IV;five rabbits for group V, control]. The rabbits were received intravitreal injection of Con A[I], Con A &L-NAME [II], LPS[III], LPS &L-NAME[IV], BSS[Vfor control], respectively. After injection, the author evaluated the inflammatory grade, cataractous lens changes, NO[nitrite+nitrate]concentration in response to each material in aqueous humor and vitreous cavity and MDA concentration of lens with time interval. Other 7 rabbits 'eyes were enucleated and 14 fresh lenses were extracted to investigate the correlation with in vivo study via lens culture in 12-well plate. These results suggested that NO was closely related to Con A and LPS induced cataractogenesis in uveitis model and Con A was a more reliable candidate due to its prolonged effect. NOS inhibitors could suppress both inflammation and cataract formation. Potent oxidant, peroxynitrite played an important role on NO related cataractogenesis. So, on the clinical basis, NOS inhibitors may be useful in prevention of cataract in inflammatory condition of the eyes but further studies are needed for the confirmation of stability and selectivity of the NOS inhibitors.

The Role of Nitric Oxide on Cataractogenesis in Uveitis Model Induced by Concanavalin A and Lipopolysaccharide

Nitric oxide[NO]plays a diverse role in many biological systems such as vascular, nervous and respiratory system. Recently, many studies have been performed to define the relationship between NO and physiological and pathophysiological processes. This study was conducted to evaluate the role of NO on cataractogenesis in uveitis model induced by Con A and LPS. Forty-five white male rabbits were divided into five experimental groups[ten rabbits for each group I, II, III, IV;five rabbits for group V, control]. The rabbits were received intravitreal injection of Con A[I], Con A &L-NAME [II], LPS[III], LPS &L-NAME[IV], BSS[Vfor control], respectively. After injection, the author evaluated the inflammatory grade, cataractous lens changes, NO[nitrite+nitrate]concentration in response to each material in aqueous humor and vitreous cavity and MDA concentration of lens with time interval. Other 7 rabbits 'eyes were enucleated and 14 fresh lenses were extracted to investigate the correlation with in vivo study via lens culture in 12-well plate. These results suggested that NO was closely related to Con A and LPS induced cataractogenesis in uveitis model and Con A was a more reliable candidate due to its prolonged effect. NOS inhibitors could suppress both inflammation and cataract formation. Potent oxidant, peroxynitrite played an important role on NO related cataractogenesis. So, on the clinical basis, NOS inhibitors may be useful in prevention of cataract in inflammatory condition of the eyes but further studies are needed for the confirmation of stability and selectivity of the NOS inhibitors.

Studies on the Seasonal Changes in Epithelium of the Seminiferous Tubules and Serum Concentration of Testosterone , LH and FSH in the Korean Pheasant Phasianus colchicus / 대한해부학회지

It is highly desirable to achieve optimal reproductive performance, reliable morphological and physiological basic data of the reproductive organs. Therefore, seasonal changes in serum testosterone, LH, and FSH concentrations, and morphological changes in testicular epithelial cells were studied in the Korean native pheasant throughout the annual cycle. Mature male pheasants[14-16 months after hatching] were used in this study. The general morphological changes of the epithelia of the seminiferous tubules were observed by dibasic stain, and semithin section from Epon blocks with a phase contrast microscopy. The ultrastructural changes of the the epithelia of the seminiferous tubules were investigated by ultrathin section with transmission electron microscope. The changes in the profiles of the serum FSH, LH, and testosterone concentratioins were measured by RIA[radioimmunoassay]. The results obtained are summarized as follows : 1. There was little variation in the average diameter of the seminiferous tubules from autumn[67.13+/-5.95micrometer] to winter[68.59+/-6.07micrometer], but the highest levels were reached in spring[192.78+/-41.58micrometer]. Thereafter, the diameter decreased slowly in summer[146.57+/-43.68micrometer], then decreased significantly in autumn[67.13+/-5.95micrometer]. 2. Serum testosterne concentration was low from autumn[13.+/-7.21ng/100ml] to winter[17.39+/-13.75ng/100ml], but the highest levels were reached in spring[127.72+/-66.47 ng/100ml]. Thereafter, the concentration was lowest in autumn[13.+/-7.21ng/100ml]. 3. Serum LH concentration increased slowly and linealy from autumn[5.04+/-1.04ng/100ml] to winter[6.23+/-1.08ng/100ml], but the highest levels were reached in spring[11.3+/-3.6 ng/100ml]. Thereafter, the concentration reached the lowest level in autumn[5.04+/-1.04 ng/100ml]. 4. Serum FSH concentration was low from autumn[4.65+/-0.63ng/100ml] to winter[4.2+/-0.98ng/100ml], but the highest levels were reached in spring[17.41+/-8.35ng/100ml]. Thereafter, concentration was the lowest in autumn[4.65+/-0.63ng/100ml]. 5. The seminiferous tubules showed the onset of the spermatongenic cycle in spring but the seminiferous tubules collected in summer exhibited partially degenerative changes. 6. The cytoplasmic process of Sertoli cells of the seminiferous tubules of the pheasant were collected in summer. Many vesicles and degeneratiye changes were included but many number of spermatozoa were embedded partially in the multivesicular bodies in these processes. 7. The diameter of the seminiferous tubules of the pheasant narrowed markedly in autumn, and atrophied in winter. The spermatogonia and Sertoli cells were arranged in monolayer. 8. The myelin figures in the cytoplasmic process of Sertoli cells of the seminiferous tubules of the pheasant in autumn. The nucleus of the Sertoli cells were of a round configuration elongated and oriented perpendicularly to the basement membrane. The results obtained provide basic data for reproductive physiology and are useful for studying the male genital organs of the Korean native pheasant. Structural changes of the seminiferous epithelial cells significantly and postively correlated with serum FSH, LH. The correlation of changes in the hormonal status with alterations of Sertoli cell organells precedes the breeding season.

Prevalence of Hepatitis C Virus Genotype in Pusan, Korea / 한국역학회지

The authors investigated the distribution of Hepatitis C virus (HCV) genotype in blood donors with positive for anti-HCV (n=34), health check-up examiness with positive for anti-HCV (n=29), and in patients with various chronic liver disases positive for anti-HCV (n=63) in Pusan, Korea. HCV genotype was determined by using the molecular typing method through the reverse transcription - polymerase chain reaction (RT - PCR) with four type specific primers. Among 116 anti-HCV positive study subjects, 66.4% were positive HCV RNA by RT-PCR. The major HCV genotype was type II (31.9%) and it was followed by type III (27.6%). Two cases were type IV (1.7%). Double infection with two different HCV genotypes (mixed type) was found in three cases (2.6%). Three cases (2.6%) were not determined by the four type specific primers, it may have different subtype. Type II was more prevalent than type III in the blood donors and health check-up examinees, but the reverse was true in the chronic liver disease patients including hepatocellular carcinoma patients. Type II was more prevalent than type III among the anti-HCV positive subjects with risk factors such as acupuncture history, surgical operation history, and trans-fusion history. In contrast type III was more prevalent than type II among the subjects without the above risk factors. It is supposed that the pathogenicity of different kind of HCV genotype might be different. The results of this study suggest that the type II and type III may be the major CV genotype in Korea. The differences of HCV genotype distribution between the study groups support that the clinical significance according to the HCV genotype may be different.

Intraoperative Perfluorophenanthrene Use in Complicated Retinal Detachment

23 eyes of 23 patients who underwent conventional vitreoretinal surgery with high specific gravity perfluorocarbon liquid, perfluorophenanthrene, for complicated retinal detachment were evaluated retrospectively. Preoperative vitreoretinal findings showed grade C2 PVR in 4 eyes and C3 in 1 eye and C4 in 10 eyes and C5 in 8 eyes. As a result, 17 eyes(74%) showed anatomical success, completely reattached in 15 eyes, partially reattached in 2 eyes, and 12 eyes(52%) showed functional success (corrected visual acuity 5/200 or better). Follow-up period was over 6 months in all cases. Postoperative complications includes keratopathy in 6 eyes, hypotony in 5 eyes, cataract in 2 eyes, transient vitreous hemorrhage in 1 eye, acute increased IOP in 1 eye, posterior synechiae in 1 eye, cystoid macular edema in 1 eye, and pupillary membrane in 1 eye. Consequently, perfluorophenanthrene can be used beneficially in yield of surgical field and mechanical stabilization of retina in complicated retinal detachment surgery.

Community-based eye health survey in areas of Buan-Kun and Dobong-Ku in Korea

This survey comparing the primary causes of eye disease and visual impairment between rural and urban areas was conducted from the beginning of February through May of 1989. The outcome of that research on 686 residents (1372 eyes) of Buan-Kun, Chunbuk, and 997 residents (1994 eyes) of Dobong-Ku, Seoul, is as follows: 1. Of the basic ocular affections, pterygium was the most prevalent in Baun-Kun with 178 eyes (13.0%), while allergic and chronic conjunctivitis were in the majority in Dobong-Ku with 170 eyes (8.5%). 2. In causes of visual impairment, refractive error showed to be the main one in both Buan-Kun with 135 eyes (9.8%) and Dobong-Ku with 132 eyes (6.6%). 3. In rate of blindness, Buan-Kun had 7.0% monocular blindness and 3.2% of binocular blindness, while 4.1% of monocular blindness and 1.7% of binocular blindness were found in Dobong-Ku. 4. In causes of blindness, cataract (51.1%) was followed by macular degeneration (17.4%), corneal opacity (13.0%), and vascular retinopathy (9.8%) in Buan-Kun, while cataract (56.0%), macular degeneration (6.7%), corneal opacity (6.7%), and phthisis (6.7%) were recorded in that order in Dobong-Ku.

Morphological Classification of the Lens Opacity of Age-Related Cataract in One Area of Seoul

The epidemiological study to evaluate the prevalence rate and the morphological classification was performed in Do Bong-Gu, Seoul from May 9, 1989 to May 25, 1989. However, this report was a part of preliminary data to make a further population based epidemiological study to evaluate the prevalence rate and morphological classification of the age-related cataract in Korea. The results of this study are as follow: 1. The total examinees were 100;39 male and 61 female, and they were over 40 years of age who complained of recent visual acuity decrement. 2. 91 persons had lens opacity in different decement. 3. The prevalence rate of cataract was 89.7% in male and 93.4% in female and the sexual difference shows that the female had more higher frequency of lens opacity. 4. The classification of lens opacity according to the stage showed that the immature cataract was the most frequent type. The cortical cataract was the most frequent type and the mixed type was second in order by the morphological classification. 5. The prevalence rate of cataract in age had strong tendency to increase in older age and in 80s the rate was in 100%.

Morphological Classification of the Lens Opacity of Age-Related Cataract in One Area of Seoul

The epidemiological study to evaluate the prevalence rate and the morphological classification was performed in Do Bong-Gu, Seoul from May 9, 1989 to May 25, 1989. However, this report was a part of preliminary data to make a further population based epidemiological study to evaluate the prevalence rate and morphological classification of the age-related cataract in Korea. The results of this study are as follow: 1. The total examinees were 100;39 male and 61 female, and they were over 40 years of age who complained of recent visual acuity decrement. 2. 91 persons had lens opacity in different decement. 3. The prevalence rate of cataract was 89.7% in male and 93.4% in female and the sexual difference shows that the female had more higher frequency of lens opacity. 4. The classification of lens opacity according to the stage showed that the immature cataract was the most frequent type. The cortical cataract was the most frequent type and the mixed type was second in order by the morphological classification. 5. The prevalence rate of cataract in age had strong tendency to increase in older age and in 80s the rate was in 100%.

Gas-Liquid Chromamgraphic Analysis of Residual Ethylene Oxide and MMA Monomer in Various lntraocular Lenses

Recently, we performed an ezperi nlent to detect residual ethylene oxide(EO) gas and methylmethacrylate(MMA) monomer in the intraocular lenses from eleven different makers using gas-liquid chromatography. The residual EO gas over 25ppm was seen in 2 makers and also the MMA monomer over 2% was present in two makers. As a result, we recommend that the precise product quality-control of the IOLes is necessary especially for the lenses from foreign manufacturers.

Gas-Liquid Chromamgraphic Analysis of Residual Ethylene Oxide and MMA Monomer in Various lntraocular Lenses

Recently, we performed an ezperi nlent to detect residual ethylene oxide(EO) gas and methylmethacrylate(MMA) monomer in the intraocular lenses from eleven different makers using gas-liquid chromatography. The residual EO gas over 25ppm was seen in 2 makers and also the MMA monomer over 2% was present in two makers. As a result, we recommend that the precise product quality-control of the IOLes is necessary especially for the lenses from foreign manufacturers.

The Study of the Preparation of Purified Fibronectin from the Human Plasma

Fibronectin(FN), a glycoprotein present in plasma and extracellular matrix, has been reported to be effective on various corneal disorders such as persistent epithelial defect, corneal trophic ulcer, herpetic keratitis, etc. We performed the study of the preparation of purified FN from 35 persons' plasma(male: 19, female: 16)by the use of Sepharose 48 Affinity Chromatography and Gel filtration. The prepared FN was pure electrophoretically, and no other plasma proteins were contaminated, and confirmed as pure by multiple methods such as SDS-P AGE, Ouchterlony double gel diffusion and immunoelectro phoresis. Only 40 minutes was taken for preparation. The result showed that FN concentrations in plasma and in prepared solution were 288.9 +/- 72.8 microgram/ml and 294.3 +/- 41.4 microgram/ml respectively. FN concentrations in plasma and FN eyedrops showed no difference between sex, but increased their level with age(p<0.05). The biological activity was better preserved at 4 degrees C(in the refrigerator) than at room temperature till about 4 weeks after preparation. Applicability of this method as a useful preparation of purified FN is recommendable.

A Case of Wegener's Granulomatosis with Ocular Involvement

Wegener's granulomatosis is characterized by necrotizing vasculitis and granuloma formation in both upper and lower respiratory tracts and in kidney. Other organs are also involved frequently. Ocular manifestations are Ehown in about 50% of patients with it. We experienced a case of Wegener's granulomatcsis developed prcgressive paranasal sinusitis and rhinitis combined with orbital and ocular involvement shown proptosis of both eyes, necrotic change of cornea and anterior portion of sclera in left eye and so forth. The diagnosis was confirmed by clinical findings and histopathologic features of tissue biopsy. The histopathology from periccular area of left eye had the typical findings of Wegener's granulomatosis with necrotizing vasculitis and granuloma formation. We had treated with oral cyclophosphamide(30~120mg/day) and corticosteroid(betamethaEcne 3mg 1M) and performed the enucleation of left eye due to widespread necrosis. The general condition and ocular findings were moderately improved with medical treatment but the eventual visual acuity was zero in right eye.

A Case of Wegener's Granulomatosis with Ocular Involvement

Wegener's granulomatosis is characterized by necrotizing vasculitis and granuloma formation in both upper and lower respiratory tracts and in kidney. Other organs are also involved frequently. Ocular manifestations are Ehown in about 50% of patients with it. We experienced a case of Wegener's granulomatcsis developed prcgressive paranasal sinusitis and rhinitis combined with orbital and ocular involvement shown proptosis of both eyes, necrotic change of cornea and anterior portion of sclera in left eye and so forth. The diagnosis was confirmed by clinical findings and histopathologic features of tissue biopsy. The histopathology from periccular area of left eye had the typical findings of Wegener's granulomatosis with necrotizing vasculitis and granuloma formation. We had treated with oral cyclophosphamide(30~120mg/day) and corticosteroid(betamethaEcne 3mg 1M) and performed the enucleation of left eye due to widespread necrosis. The general condition and ocular findings were moderately improved with medical treatment but the eventual visual acuity was zero in right eye.