We have experienced a case of malignant melanoma of choroid in 60-year-old female who had decreased visual acuity in her right eye for 4 months. She was examined with slit-lamp, direct and indirect ophthalmoscope, ultrasonography, fluor escein angiography, computerized tomography, and then diagnosed as malignant melanoma of choroid. So enucleation was performed and the tumor was confirmed to be a choroidal malignant melanoma composed of spindle cells and epithelioid cells by light microscope.
Angiography ; Choroid* ; Epithelioid Cells ; Female ; Humans ; Melanoma* ; Middle Aged ; Ophthalmoscopes ; Ultrasonography ; Visual Acuity

We have experienced a case of malignant melanoma of choroid in 60-year-old female who had decreased visual acuity in her right eye for 4 months. She was examined with slit-lamp, direct and indirect ophthalmoscope, ultrasonography, fluor escein angiography, computerized tomography, and then diagnosed as malignant melanoma of choroid. So enucleation was performed and the tumor was confirmed to be a choroidal malignant melanoma composed of spindle cells and epithelioid cells by light microscope.
Angiography ; Choroid* ; Epithelioid Cells ; Female ; Humans ; Melanoma* ; Middle Aged ; Ophthalmoscopes ; Ultrasonography ; Visual Acuity

To evaluate the clinical usefulness of new handheld air impulse tonometer(Pulsair, Keeler), the intraocular pressures of 147 eyes of 80 men and women at the age range of 9 to 82 year without corneal opacity or corneal edema were measured with the Goldmann applanation tonometer as well as noncontact air impulse tonometer. The IOPs measured with both tonometer were compared to evaluate the correlation coefficiency. The correlation coefficiency between two instruments is 0.89. Therefore, the new type of noncontact tonometer could be useful for clinical applications due to its accuracy, simplicity, painlessness, portability, and repeatability-especially at glaucoma screening programs.
Corneal Edema ; Corneal Opacity ; Female ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Mass Screening

We report here on a case of a neurogenic tumor of the neck with an uncertain origin on the preoperative evaluation. A 67-year-old woman with a palpable mass in the left side of the neck was referred to our hospital. The mass had slowly grown over 7 years and her dyspnea had gradually become more severe over the recent 6 months. Computerized tomography and magnetic resonance imaging showed an 8 cm sized solid mass that abutted the trachea and the esophagus without invasion, but the origin of the mass was not clearly identified. During surgical exploration, we identified that the tumor was located in the esophageal muscle layer. Immunohistochemical staining revealed that the tumor cells were positive for S-100 protein, which confirmed a diagnosis of schwannoma.
Aged ; Diagnosis ; Diagnosis, Differential* ; Dyspnea ; Esophagus ; Female ; Humans ; Magnetic Resonance Imaging ; Neck ; Neurilemmoma ; S100 Proteins ; Thyroid Gland ; Trachea

BACKGROUND AND OBJECTIVES: Endothelial dysfunction and increased vascular inflammation may be associated with variant angina (VA). However, their exact roles remain to be clarified. The aim of the presents study is to investigate whether the level of inflammation markers and the flow-mediated dilation (FMD) are related to VA. SUBJECTS AND METHODS: The study included 46 patients (VA group: 53.9+/-12.0 years, 20 males) with positive spasm provocation tests and they were without significant coronary stenosis, and 14 patients (control group: 46.6+/-13.5 years, 7 males) with negative spasm provocation tests and they were without significant coronary stenosis. The clinical characteristics and inflammatory markers, including the high sensitive C-reactive protein (hsCRP) level, the monocyte count and the von Willebrand factor (vWF) level, and the FMD were compared between the two groups. The FMD and inflammatory markers were measured in the morning before performing the ergonovine provocation coronary angiogram. RESULTS: The level of vWF was significantly higher in the VA group than in the control group (166.5+/-41.9% vs. 118.0+/-65.3%, respectively, p=0.029). The FMD was significantly decreased in the VA group compared with the control group (9.2+/-4.3% vs. 12.4+/-4.2%, respectively, p=0.021). Nitrate-mediated dilation did not differ between the two groups. The levels of the monocyte count, hs-CRP and homocysteine were higher in the VA group than in the control group (554.7+/-261.0/mm3 vs. 440.7+/-136.0/mm3, respectively, p=0.039; 0.3+/-0.4 mg/dL vs. 0.1+/-0.1 mg/dL, respectively, p=0.029; 7.54+/-4.0micronmol/L vs. 5.92+/-1.6micronmol/L, respectively, p=0.033). CONCLUSION: The results of this study suggested that increased inflammatory markers and endothelial dysfunction may be associated with variant angina.
Angina Pectoris ; C-Reactive Protein ; Coronary Stenosis ; Endothelium ; Ergonovine ; Homocysteine ; Humans ; Inflammation ; Monocytes ; Spasm ; von Willebrand Factor

BACKGROUND AND OBJECTIVES: We hypothesized that patients with nitroglycerin-induced headache had preserved systemic vasomotion and there might be an increased nitroglycerin-mediated dilation (NMD) response in the brachial artery. The aim of this study is to evaluate whether nitroglycerin (NTG)-induced headache is associated with the level of the NMD and flow-mediated dilation (FMD) or the severity of coronary artery disease (CAD). SUBJECTS AND METHODS: The study included 87 patients (Group I: mean age: 54.8+/-9.5 years, 46 males) with headache and new onset chest pain, and 109 patients (Group II: mean age: 57.4+/-8.9 years, 67 males) without headache and with new onset of chest pain. Patients were excluded from this study if they had a history of chronic headache, long term nitrates use and coronary artery procedures. Coronary angiography was performed within one month after administering nitroglycerin for the usual clinical indications. RESULTS: The clinical characteristics did not differ between the two groups. The NMD was significantly higher in Group I than in Group II (23.0+/-7.5% vs. 18.5+/-8.6%, respectively, p<0.001). The FMD was significantly higher in Group I than in Group II (9.0+/-4.1% vs. 7.5+/-4.3%, respectively, p=0.007). On multiple regression analysis, NTG-induced headache was a predictor of CAD {oddsratio (OR), 0.04, 95% confidence interval (CI), 0.02-0.11: p<0.001, respectively}. CONCLUSION: We have shown that the vasodilator response to NTG and FMD are increased in the patients with NTG-induced headache. More NTGinduced headache developed in the patients with normal coronary arteries or minimal CAD than in the patients with obstructive CAD. This finding might be helpful as additional information for evaluating the patients with chest pain syndrome.
Brachial Artery ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Headache ; Headache Disorders ; Humans ; Nitrates ; Nitroglycerin ; Thorax

The aim of this study was to evaluate whether the clinical outcomes were associated with socioeconomic status (SES) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). The author analyzed 2,358 patients (64.9 +/- 12.3 yr old, 71.5% male) hospitalized with AMI between November 2005 and June 2010. SES was measured by the self-reported education (years of schooling), the residential address (social deprivation index), and the national health insurance status (medical aid beneficiaries). Sequential multivariable modeling assessed the relationship of SES factors with 3-yr major adverse cardiovascular events (MACEs) and mortality after the adjustment for demographic and clinical factors. During the 3-yr follow-up, 630 (26.7%) MACEs and 322 (13.7%) all-cause deaths occurred in 2,358 patients. In multivariate Cox proportional hazards regression modeling, the only lower education of SES variables was associated with MACEs (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.04-1.91) and mortality (HR, 1.93; 95% CI, 1.16-3.20) in the patients with AMI who underwent PCI. The study results indicate that the lower education is a significant associated factor to increased poor clinical outcomes in patients with AMI who underwent PCI.
Acute Disease ; Age Factors ; Aged ; *Angioplasty, Balloon, Coronary ; Cohort Studies ; Demography ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocardial Infarction/economics/mortality/*therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sex Factors ; Social Class ; Socioeconomic Factors ; Treatment Outcome

BACKGROUND/AIMS: Delay in symptom-to-door time (SDT) in patients with acute ST-segment elevation myocardial infarction (STEMI) is the most important factor in the prediction of short and long-term mortality. The purpose of this study was to investigate the social and clinical factors affecting SDT in patients with STEMI. METHODS: We analyzed 784 patients (61.0 +/- 13.2 years, 603 male) diagnosed with STEMI from November 2005 to February 2012. The patients were divided into four groups according to SDT: Group I (n = 163, < or = 1 h), Group II (n = 183, 1-2 h), Group III (n = 142, 2-3 h) and Group IV (n = 296, > 3 h). RESULTS: Delay in SDT increased with age (Group I, 58.4 +/- 12.0; Group II, 59.4 +/- 13.3; Group III, 62.0 +/- 12.8; Group IV, 63.0 +/- 13.8 years, p = 0.001). In 119 patients, transportation was less frequently used as the delay in SDT (41.7% vs. 29.0% vs. 26.1% vs. 9.8%, p < 0.001). By multiple logistic regression analysis, family history [OR, 0.488; CI, 0.248-0.959; p = 0.037], previous ischemic heart disease [OR, 0.572; CI, 0.331-0.989; p = 0.045], no occupation [OR, 1.600; CI, 1.076-2.380; p = 0.020] and method of transportation [OR, 0.353; CI, 0.239-0.520; p < 0.001] were independent predictors of delay in SDT. CONCLUSIONS: Our study shows that general education about cardiovascular symptoms and a prompt emergency call could be important to reduce SDT in STEMI.
Education ; Emergencies ; Humans ; Logistic Models ; Mortality ; Myocardial Infarction* ; Myocardial Ischemia ; Occupations ; Transportation

BACKGROUND/AIMS: Accurate risk stratification is important in the management of patients with acute myocardial infarction (AMI). This study aimed to develop a new assessment tool for the prediction of 1-year mortality in patients with AMI, including biochemical markers. The author developed a new assessment tool (new risk score) that takes biochemical markers into account for 1-year mortality in patients with non-ST elevation myocardial infarction (NSTEMI) and identifies the risk factors related to 1-year mortality. METHODS: A total of 1,427 patients (65 +/- 11.8 years of age, 985 males) who were admitted to the Chonnam National University Hospital with NSTEMI from November 2005 to March 2012 were retrospectively analyzed for score derivation. Multivariable Cox-regression analysis was used to select correlates of 1-year mortality that were subsequently weighted and integrated into an integer scoring system. RESULTS: Seven variables selected from the initial multivariate model were weighted proportionally to their respective hazard ratio for 1-year mortality; age > or = 65 years (2 points), N-terminal pro-brain natriuretic peptide (NT pro-BNP) > 991 pg/mL (1 point), baseline left ventricular ejection fraction < 40% (1 point), high sensitivity C-reactive protein (hs-CRP) > 3 mg/dL (1 point), glomerular filtration rate (GFR) < 60 mL/min/1.73 m2 (1 point), heart rate > 82 beats/min (2 points), and final thrombolysis In myocardial infarction flow < 3 (2 points). CONCLUSIONS: In NSTEMI patients, our new score that incorporates seven risk factors accurately predicts the 1-year mortality. Additionally, the biochemical markers hs-CRP, NT pro-BNP, and GFR are reliable predictors of 1-year mortality.
Biomarkers ; C-Reactive Protein ; Glomerular Filtration Rate ; Heart Rate ; Humans ; Jeollanam-do ; Mortality* ; Myocardial Infarction* ; Prognosis ; Retrospective Studies ; Risk Factors ; Stroke Volume

BACKGROUND/AIMS: It is well known that the menopause is related to interference in lipid metabolism, obesity, and a hypercoagulable state. The aim of the present study was to examine the impact of the menopause in middle-aged Korean females with acute myocardial infarction (AMI). METHODS: A total of 1,781 middle-aged females (aged < 65 years) in the Korean Acute Myocardial Infarction registry were enrolled into this study between November 2005 and December 2013. The patients were divided into two groups; the pre-menopause group (≤ 55 years old) and the menopause group (56-64 years old). Major adverse cardiac events (MACE) were analyzed over a one-year follow-up period. RESULTS: The pre-menopause and menopause groups comprised 669 patients (mean age, 49.1 ± 5.6 years) and 1,112 patients (mean age, 60.6 ± 2.6 years), respectively. The incidence of hypertension (42.2% vs. 59.4%, p < 0.001), diabetes mellitus (DM) (27.4% vs. 35.7%, p < 0.001), and dyslipidemia (12.9% vs. 17.7%, p = 0.008) were more frequent in menopausal patients. Additionally, the rates of smoking (20% vs. 12.7%, p < 0.001) and familial history (12% vs. 6.8%, p < 0.001) were higher in the pre-menopause group. The cumulative rates of MACE did not show any differences between the two groups. A history of atrial fibrillation, previous AMI and DM, higher Killip class, and multi-vessel disease were independent risk factors for predicting one-year MACE. CONCLUSIONS: The survival analysis demonstrated that there was no significant difference in MACE rates between the pre-menopause and menopause groups during the one-year follow-up. Therefore, middle-aged pre-menopausal women should be treated more intensively, regardless of whether they are menopausal.
Atrial Fibrillation ; Diabetes Mellitus ; Dyslipidemias ; Female* ; Follow-Up Studies ; Humans ; Hypertension ; Incidence ; Lipid Metabolism ; Menopause ; Myocardial Infarction* ; Obesity ; Premenopause ; Prognosis ; Risk Factors ; Smoke ; Smoking