Ki-Hwan Ji

Increased Circulating Endothelial Microparticles and Carotid Atherosclerosis in Obstructive Sleep Apnea

Background and Purpose Endothelial impairment is a linking mechanism between obstructive sleep apnea (OSA) and cardiovascular diseases. Profiles of endothelial microparticles (EMPs) and endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. The aims of this study were to measure the levels of EMPs and progenitor cells in OSA, determine the correlations between these factors and OSA severity and the degree of atherosclerosis, and document any changes in these factors after therapy. Methods Subjects with (n=82) and without (n=22) OSA were recruited prospectively. We measured the number of colony-forming units (CFU) in cell culture as the endothelial progenitor cell index, and the number of EMPs using flow cytometry with CD31 [platelet endothelial cell adhesion molecule (PECAM)], CD42 (platelet glycoprotein), annexin V, and CD62E (E-selectin) antibodies at baseline and after 4-6 weeks of continuous positive airway pressure (CPAP) therapy. Carotid intima-media thickness (IMT) was regarded as a marker of atherosclerosis. Results The levels of PECAM+CD42- (p<0.001), PECAM+annexin V+ (p<0.001), and E-selectin+ microparticles (p=0.001) were higher in OSA subjects than in non-OSA subjects. The number of CFU did not differ between the two groups. OSA severity independently predicted the levels of PECAM+CD42- (p=0.02) and PECAM+annexin V+ (p=0.004). Carotid IMT was correlated with OSA severity (p<0.001), PECAM+CD42- (p=0.03), and PECAM+annexin V+ (p=0.01). Neither OSA severity nor carotid IMT was correlated with either the number of CFU or E-selectin+. CPAP therapy decreased the occurrence of E-selectin+ (p<0.001) in 21 of the OSA subjects, but had no effect on the other microparticles of the number of CFU. Conclusions OSA led to the overproduction of EMPs, which moderately correlated with OSA severity and the degree of atherosclerosis, and partly responded to therapy. The endothelial impairment might contribute to future cardiovascular events.

Zolpidem-induced sleep-related eating disorder

An association between zolpidem administration and sleep-related eating disorder (SRED) has been suggested. The authors observed zolpidem-induced SRED in restless legs syndrome (RLS). With the review of previous reports, we identified a common occurrence of RLS in zolpidem-induced SRED.

PO15.21 Right-To-Left Shunt Degree by Transcranial Doppler in the Patent Foramen Ovale on the Stroke Mechanism

nystagmus induced by lying down were analyzed. Twenty two patients also underwent bithermal caloric tests before treatment and the followup test was done after treatment in 8 patients. Results: The patients included 18 (60.0%) women and 12 (40.0%) men. Mean age of the patients was 64.4±11.1. Horizontal nystagmus was induced by lying down from sitting to supine position in 26 patients (86.7%), which was ipsilesional in 23 (88.4%). The horizontal nystagmus after head shaking was present in 18 patients (60.0%) and was contralesional in all the patients. The caloric weakness (CP>30%) was present in 7 patients (31.8%, 7/22) before treatment and became normal in every patients after treatment. The caloric paresis was ipsilesional in 6 patients (85.7%, 6/7). Conclusions: In Apo HC-BPV, the direction of head-shaking nystagmus was uniformly contralesional and the caloric paresis was mostly ipsilesional. The head shaking nystagmus and caloric paresis observed in our patients with Apo HC-BPV may be explained by mechanical interference of the endolymphatic flow by the otolithic debris. Head-shaking nystagmus may have lateralizing value in Apo HC-BPV.

PO15.5 Effect of Antiplatelet Agent on the Progression of Leukoaraiosis

Background: Leukoaraiosis is bilateral patchy or diffuse hyperintensity lesion in the cerebral white matter on T2-weighted or FLAIR imaging. It is thought to be caused by ischemia, but clinical relevance is uncertain. Asymptomatic elderly commonly show the incidental leukoaraiosis on MRI. However, there is no consensus on the treatment of these patients, including the usage of antiplatelet. We performed this study to assess the effects of antiplatelet treatment on the progression of asymptomatic leukoaraiosis. Methods: We recruited subjects who were more than 50 years-old and had two MRI scans separated by at least three years interval. The patients with brain lesion such as stroke, brain tumor, systemic malignancy, and infection were excluded. Subjects were categorized into antiplatelet and non-antiplatelet group, which were decided by the attending physician’s preference. White matter change was assessed in FLAIR image based on the Schelten’s scale without clinical information of the subjects, and the progression of scale was compared between the two groups. Wilcoxon signed rank sum test was used for the statistical comparison. Results: From 2002 to 2008 in Inha University Hospital, 34 patients were followed up and analyzed. Fifteen subjects were included in antiplatelet group and nineteen in non-antiplatelet group. Median Schelten scale of initial MRI were 6.9±2.5 in the antiplatelet group and 4.8±2.9 in the nonantiplatelet group (p = 0.04). The scale of follow-up MRI were 7.1±2.6 and 4.9±2.9 (p = 0.029), respectively. Worsening of scale more than 1 grade was evident in eight subjects (23.5%). There was no significant difference in the change of white matter grade between the antiplatelet group and the non-antiplatelet group (0.20±0.41, p = 0.082 vs. 0.05±0.02, p = 0.33). Conclusions: Subjects with higher white matter grade on MRI were more likely to take antiplatelet, but there was no effect on the progression of leukoaraiosis.

PO15.2 Comparison of Lacunar Infarct with Branch Atheromatous Occlusion

Background: Increasing efficiency of intensive care of preeclampsia. Methods: We examined 100 pregnant women with preeclampsia. In the main group, we assessed preeclampsia severity, taking into account changes in hemodynamics system and in vegetative tonus following the method of aminazine test, developed by the author. We also determined plasma osmolality, considering growth in fluid volume during application of infusion solutions. The control group received conventional complex preeclampsia therapy. Aminazine test consisted of intravenous titrated administration of up to 12.5 mg of aminazine with control of arterial blood pressure, hands skin temperature, and blood-filling of nail beds. Results: We diagnosed compensated preeclampsia stage in case of positive aminazine test (decrease in systolic blood pressure by 20 25 mm Hg, in diastolic blood pressure by 10 15 mm Hg, temperature increase by 1oC comparing with the primary improvement in blood-filling of nail beds. In the absence of the described reaction, we diagnosed decompensated stage. After aminazine test we introduced 5 mg of aminazine every 4 hours for both stages, which produced decrease in the amount of prescribed medications. The effect of developed method induced the shortening of treatment period, decrease in the number of surgical operations during delivery. It also pushed up the number of independent deliveries. Conclusions: For differentiated diagnostics of preeclampsia’s stage severity, and for creation of the background for correction of pathophysiological disturbances, it is necessary to include into complex intensive care aminazine test.

PO15.3 Intima-Media Thickness According to TOAST Classificaton and Risk Factors in Ischemic Stroke

Background: Increasing efficiency of intensive care of preeclampsia. Methods: We examined 100 pregnant women with preeclampsia. In the main group, we assessed preeclampsia severity, taking into account changes in hemodynamics system and in vegetative tonus following the method of aminazine test, developed by the author. We also determined plasma osmolality, considering growth in fluid volume during application of infusion solutions. The control group received conventional complex preeclampsia therapy. Aminazine test consisted of intravenous titrated administration of up to 12.5 mg of aminazine with control of arterial blood pressure, hands skin temperature, and blood-filling of nail beds. Results: We diagnosed compensated preeclampsia stage in case of positive aminazine test (decrease in systolic blood pressure by 20 25 mm Hg, in diastolic blood pressure by 10 15 mm Hg, temperature increase by 1oC comparing with the primary improvement in blood-filling of nail beds. In the absence of the described reaction, we diagnosed decompensated stage. After aminazine test we introduced 5 mg of aminazine every 4 hours for both stages, which produced decrease in the amount of prescribed medications. The effect of developed method induced the shortening of treatment period, decrease in the number of surgical operations during delivery. It also pushed up the number of independent deliveries. Conclusions: For differentiated diagnostics of preeclampsia’s stage severity, and for creation of the background for correction of pathophysiological disturbances, it is necessary to include into complex intensive care aminazine test.

Typical Kleine-Levin syndrome

각삽화사이에는정상적인수면및행동양상을보이는것이 특징이다 삽화 시 환각 정신착란 . (hallucination), (confu등 인지장애와 과식증 과다성욕증 sion) (hyperphagia), 과민성 등 행동장애도 동 (hypersexuality), (irritability) 반될 수 있다. 1-3 현재 원인과 병리는 확실히 밝혀지지 않았 지만 뇌 단일광자방출단층촬영술 , (brain single photon 이하 에서 양측 emission computed tomography, SPECT) 측두엽 및 비우성 전두엽 특히 시상하부에서관류 감소를 , 보였다는 검사 결과들이 보고된바 있고, 1-4 뇌척수액 내의 이 감소를 보인다는 결과가 보고 되었 hypocretin-1 다. 1-3,5 저자들은 환시와 과식증을 동반한 반복적 수면과다 증 을 보인 환자를 예로 반복적인 수면과다 (hypersomnia) , 증과 동반될 수 있는 증상들 임상적인 접근 및 감별 진단 , 에 대하여 알아보고자 한다.