Acute coronary syndrome (ACS) consists of unstable angina, non-ST segment elevation myocardial infarction (NSTEMI), and STEMI. The pathology underlying ACS is acute thrombosis in a coronary artery, which is usually caused by plaque rupture in a mild stenotic lesion. A rupture-prone plaque is known as a vulnerable plaque (VP), although recently the definition of VP has been expanded to include rapidly progressive plaque. Although no single method can predict future cardiac events in mild stenotic lesions, there have been big advances in detecting VP, such as virtual histology-intravascular ultrasound and optical coherence tomography. These techniques look for thin cap fibroatheromas, which is the most common type of VP, characterized by a thin fibrous cap <65 microm, a large necrotic core, and marked macrophage infiltration of the fibrous cap. The recent concept of VP, the methods for detecting VP, and the treatment of VP are discussed.
Acute Coronary Syndrome ; Angina, Unstable ; Coronary Vessels ; Macrophages ; Myocardial Infarction ; Plaque, Atherosclerotic ; Rupture ; Thrombosis ; Tomography, Optical Coherence

Amyloidosis is a disease complex associated with deposition of insoluble filbrillar protein in various tissues of the body. Cutaneous lesions are present in up to 40 % of patients with primary and myeloma associated systemic amyloidosis. We present a case of systemic amyloidosis associated with multiple myleoma occuring in 54-year-old male who had waxy papules with petechiae on nasola bial fold, postauricular area, and cheek. The diagnosis was confirmed by Congo red stain, electron microscope, immunelectrophoresis, Bence-Jones proteinuria, immunoperoxidase stain, and bone marow biopsy.
Amyloidosis* ; Biopsy ; Cheek ; Congo Red ; Diagnosis ; Humans ; Male ; Middle Aged ; Multiple Myeloma* ; Proteinuria ; Purpura

A patient was admitted for catheter ablation of atrial fibrillation. Cardiac computed tomography and transesophageal echocardiography revealed the absence of the left atrial appendage. However, the right atrial appendage looked normal and the level of pro B-natriuretic peptide was within normal limits. Successful catheter ablation was performed without any procedural complications and the sinus rhythm was appropriately maintained for 10 months with an antiarrhythmic drug.
Atrial Appendage* ; Atrial Fibrillation ; Catheter Ablation ; Echocardiography, Transesophageal ; Humans

Obstructive sleep apnea (OSA), a common comorbidity in patients with stroke, has shown increasing prevalence over the past few decades. OSA is an important risk factor for stroke in addition to other well-known contributors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. Moreover, OSA is an independent predictor of neurological outcomes and mortality. The pathological mechanisms underlying the association between OSA and stroke include autonomic dysfunction, hypertension, cardiac arrhythmia, dyslipidemia, impaired glucose tolerance, hypoxia, and inflammation. Continuous positive airway pressure (CPAP) therapy has proven clinical utility in improvement of neurological symptoms in patients with stroke. Findings from a CPAP withdrawal model have shown increased sympathetic activity in OSA with a consequent significant elevation in blood pressure, relevant cerebral hypoxia, and disturbed cardiac repolarization. In this review, we present an overview of the literature that describes an association between OSA and stroke in addition to the vascular risk factors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. This study highlights the importance of early and accurate diagnosis and management of OSA for stroke prevention and care and will benefit physicians in clinical practice.

A 59-year old man was admitted for drowsiness and stiff neck. CSF examination showed lymphocytic pleocytosis and PCR for herpes simplex virus (HSV)-1 was positive in CSF. Brain MRI revealed enhanced lesions in left temporal lobe. His symptom improved with acyclovir. Follow-up studies showed red blood cells in CSF and a hematoma in the left temporal lobe. There was no additional symptom related to the hematoma. He was discharged after conservative care. Although rare, hematoma can develop in HSV-1 meningoencephalitis.
Acyclovir ; Brain ; Encephalitis, Herpes Simplex* ; Erythrocytes ; Follow-Up Studies ; Hematoma* ; Herpes Simplex* ; Herpesvirus 1, Human ; Leukocytosis ; Magnetic Resonance Imaging ; Meningoencephalitis ; Neck ; Polymerase Chain Reaction ; Simplexvirus ; Sleep Stages ; Temporal Lobe

No abstract available.
Polymerase Chain Reaction*

Anticoagulation treatment, including novel or non-vitamin K-dependent antagonist oral anticoagulants (NOACs), is essential to prevent thromboembolic events in high-risk atrial fibrillation patients. There are not enough studies on the effect and safety of NOACs in Asians. Due to the low body surface area, genetic polymorphism, and herbal diet of Asians, it is difficult to attain optimal anticoagulation with traditional anticoagulation treatment using vitamin K antagonists, and more bleeding complications are reported with this treatment. In several recent studies, the use of NOACs in Asians resulted in lower thrombo- embolic events and fewer bleeding complications than those with a vitamin K antagonist. Given the race-related differences of Asians, NOACs have sufficient efficacy and safety for the prevention of thromboembolic events in patients with atrial fibrillation.
Anticoagulants ; Asian Continental Ancestry Group* ; Atrial Fibrillation ; Body Surface Area ; Diet ; Embolism ; Hemorrhage ; Humans ; Polymorphism, Genetic ; Stroke ; Vitamin K

PURPOSE: To find out the effect and proper indications, we studied the effect and complications of anteriorization of the inferior oblique muscle in each type of strabismus. METHODS: We retrospectively studied 33 cases (50 eyes) of primary inferior oblique overaction (IOOA), 17 cases (17 eyes) of superior oblique muscle palsy, and 20 cases (27 eyes) of dissociated vertical deviation (DVD), who received inferior oblique anterior transposition at Chonnam National University Ophthalmology Department from January 1996 to December 2001. RESULTS: In the cases of primary IOOA, the success rate for IOOA of +3~4 was 88%. In the cases of superior oblique palsy, the mean correction of vertical deviation was 14.4 delta. In superior oblique palsy of preoperative vertical deviation less than 15 delta, the success rate was 83%. In DVD, the mean correction of vertical deviation was 9.6 delta and the success rate of preoperative deviation less than 10 delta was 80%. In 11 eyes of 11cases out of 70 cases, complications, including like elevation limitation, IOOA of opposite eye, and hypotropia at primary position, occurred. CONCLUSIONS: In cases of IOOA of +3~4, with superior oblique palsy of preoperative vertical deviation about 15 delta, and DVD of preoperative deviation less than 10 delta, good results were obtained by inferior oblique anteriorization.
Jeollanam-do ; Ophthalmology ; Paralysis ; Retrospective Studies ; Strabismus

No abstract available.
Atrial Natriuretic Factor* ; Humans* ; Lymph Nodes* ; Polymerase Chain Reaction*

Purpose: Antiplatelet drugs are essential in patients with cardiovascular disease who undergo stent placement. We hypothesized that risks of mortality would differ according to adherence to antiplatelet agents, number of antiplatelet agents, and antiplatelet regimens in patients undergoing stent placement or angioplasty. Materials and Methods: Between 2002 and 2013, we initially enrolled 8671 subjects who underwent stent placement or angioplasty in the National Health Insurance Service-National Sample Cohort in Korea. Using the International Classification of Diseases, 10th revision, the incidence of all-cause death, including cardiovascular disease, cerebrovascular disease, and cancer, was defined. Using a nested case-control study design, controls were matched to cases at a ratio of 4:1, and a total of 5415 subjects were eligible for this study. Results: During a median follow-up period of 3.51 years, the incidence rate of all-cause death was 40 per 1000 person-years. We found that adherence to antiplatelet monotherapy significantly decreased risk of death by cerebro-cardiovascular disease, compared with discontinuation of antiplatelets [adjusted odds ratio (OR) 0.62, 95% confidence interval (CI) (0.41–0.96)]. Compared with dual antiplatelet therapy (DAPT), aspirin and clopidogrel monotherapy significantly reduced death by cerebro-cardiovascular disease [adjusted OR 0.65, 95% CI (0.44–0.95) and adjusted OR 0.58, 95% CI (0.35–0.96), respectively]. There was no significant difference of mortality between aspirin monotherapy and clopidogrel monotherapy. Conclusion Our study demonstrated that adherence to antiplatelet therapy and antiplatelet monotherapy, compared with DAPT, in patients with stent placement or angioplasty may have a beneficial effect on mortality in cerebro-cardiovascular disease.