BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

BACKGROUND: It is known that there is a pronounced circardian periodicity for the time of onset of acute myocardial infarction(AMI), with prominent increase in incidence of onset in the morning hours. However, the characteristic circardian variability in AMI is blunted in patients receiving beta-blockers or aspirin therapy before their presentation with AMI. These findings are attributed to the increase in platelet aggregability, blood coagulability, and plasma catecholamine that change coronary tone and myocardial oxygen demand. We hypothesize that, in addition to above physiologic and biochemical parameters, morphologic patterns of the coronary artery lesions are related to the development of circardian variation in AMI. METHOD: Subjects were 160 patients with AMI(male 92, female 68, mean age 56.9 +/-10.5 years old). Patients were classified by the time of onset of typical chest pain(AMI) by 6-hour interval from mid-night. Circardian variability of onset of AMI was compared with clinical findings and coronary angiographic findings. RESULTS: Incidence of onset of AMI was most frequent in the morning hours(6AM-noon,42.5%). There was no difference in degree of stenosis, lesion length, incidence of intraluminal thrombus, among 3 subgroups of AMI according to time of attack. Morning hour group had more frequent ulceration of coronary lesion than that of other groups(22.4% vs. 5.4%, p<0.01), and less frequent calcified lesion than that of other groups(3.0% vs 5.4%, p<0.05). Normal or minimal coronary artery lesion, that is Iess than 25% stenosis, was more frequent in the morning hour group comparing to that of other groups(11.9% vs. 9.78%). Eccentric stenosis(15.7% vs, 11,1%) and diffuse irregular lesion(25.5% vs. 16.7%) tended to be more frequent in the morning hour group. There were no differences in sex, age, incidence of hypertension, cigarette smoking, diabetes, degree of alcohol ingestion, ejection fraction, maximal CK value, preinfarction angina duration, past history of MI, and in incidence of arrhythmia. CONCLUSIONS: There were more ulcerative coronary atherosclerotic lesions, but fewer calcified coronary lesions in the morning group than in afternoon and night group. These findings indicate that morphology of coronary artery lesions may play a role in causing circardian variation in AMI.
Angina, Unstable ; Arrhythmias, Cardiac ; Aspirin ; Blood Platelets ; Constriction, Pathologic ; Coronary Vessels* ; Eating ; Female ; Humans ; Hypertension ; Incidence ; Myocardial Infarction* ; Oxygen ; Periodicity ; Plasma ; Smoking ; Thorax ; Thrombosis ; Ulcer

No abstract available.
Histiocytosis ; Histiocytosis, Non-Langerhans-Cell ; Stomach* ; Xanthomatosis*

BACKGROUND: Kidney transplant recipients inevitably take a life-long immunosuppressive medication to prevent graft rejection. Non-compliance to immunosuppressive medication is one of the main causes leading to acute and chronic rejection and diminished renal function, resulting in a return to dialysis, increased morbidity, or mortality with an additional health care cost and poor quality of life. The purpose of this study was to investigate actual medication compliance and its related factors. METHODS: A total of 222 functioning kidney transplant recipients were surveyed in a single center, and 25 patients were excluded due to incomplete responses. We reviewed medical records retrospectively, and the data were statistically analyzed with SPSS version 13.0. RESULTS: Among 197 patients, 113 (57.4%) were compliant to the immunosuppressive agents, and 84 (42.6%) recipients were non-compliant. Non-compliant patients were significantly younger (P=0.004), highly educated (P=0.004), employed (P=0.005), more likely to live alone (P=0.035), and drank more (P=0.001) than the compliant patients. Regarding psychosocial factors, more barriers (P=0.015), weak beliefs about the necessity of taking medications (P=0.001), strong beliefs about specific concerns related to medications (P=0.038), and low self efficacy (P=0.003) were identified in the non-compliant group compared with the compliant group. CONCLUSIONS: This study revealed that multiple factors affected medication compliance in patients taking immunosuppressants. It would be helpful to identify potential recipients with a risk for non-compliance based on their general characteristics and psychosocial factors, so they can be provided a specialized education program to promote compliance. This strategy may help produce more favorable long-term outcomes among kidney transplant recipients.
Compliance ; Dialysis ; Graft Rejection ; Health Care Costs ; Humans ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Medical Records ; Medication Adherence ; Quality of Life ; Rejection (Psychology) ; Retrospective Studies ; Self Efficacy

BACKGROUND: Nevus of Ota (NO) is a relatively common pigmentary disorder in Asians. Tanino's classification is an old but tacit consensus to delineate the disease. Various treatment options have been presented. However, a few studies have been conducted on available laser options and current treatment strategies or the classification of NO. OBJECTIVE: To investigate current laser options and their effectiveness for the treatment of NO, contributing factors to clinical outcomes, and verification of classification. METHODS: A retrospective study of NO was conducted by reviewing medical charts and photographs of sixty-seven patients. Statistical analysis was used to compare excellent and poor outcomes and determine contributing factors. RESULTS: The median age of onset was below the age of 1 (interquartile range [IQR], 0~1). Tanino's and PUMCH classification systems failed to classify patients in 24 (35.8%) and 6 (9.0%) of patients, respectively. A 1,064 nm Q-switched Nd:YAG laser without additional lasers was used most frequently in 42 patients (62.7%). The frequency of treatment was 19.0 (IQR, 10.0~23.0) in the cured group defined as subjects showing 95% improvement or above, compared to 10.0 (IQR, 6.25~13.75) in the unattained group defined as subjects showing less than 95% improvement (p=0.001). CONCLUSION: A 1,064 nm Q-switched Nd:YAG laser is a reliable treatment armamentarium, functioning as a single infallible modality as well as a combination treatment modality for NO. Repetitive laser treatments without interruption seems to be the most suitable in clearing NO. The current classification systems of NO are defective. Thus, a new classification should be developed.
Age of Onset ; Asian Continental Ancestry Group ; Classification* ; Consensus ; Humans ; Laser Therapy ; Nevus of Ota* ; Nevus* ; Pigmentation ; Retrospective Studies

In the originally published version of this article, the last line of footnotes was omitted in Table 2.

PURPOSE: To evaluate the 1-year results of Descemet's membrane endothelial keratoplasty (DMEK) in Korea. METHODS: The medical records of 9 patients (10 eyes) with endothelial disease who underwent DMEK from January 2012 to December 2013, and were followed up for more than 12 months were reviewed retrospectively. RESULTS: In 8 eyes with successful results after surgery, best corrective visual acuity (BCVA) was significantly improved from 1.64 +/- 0.21 (log MAR, mean) to 0.35 +/- 0.22 at 1 month and was maintained at 12 months (p = 0.012, Wilcoxon signed ranks test). BCVA at postoperative 3, 6 and 12 months were gradually increased (0.25 +/- 0.23, 0.20 +/- 0.17 and 0.16 +/- 0.17 log MAR). Endothelial cell counts were 1,996 +/- 528/mm2, 1,564 +/- 174/mm2 and 1,463 +/- 541/mm2, 1,205 +/- 358/mm2 at 1, 3, 6, and 12 months after surgery, tended to decrease but showed no statistical significance. There was no statistical difference in astigmatism before and 3 months after the operation (3.32 +/- 2.36 diopter and 2.57+/- 1.44 diopter). Primary graft failure occurred in 2 eyes and 1 received reoperation. Total detachment was found in 1 eye. CONCLUSIONS: The 1-year results of DMEK showed fast visual recovery which was maintained for 12 months. DMEK may be a very efficient option for the surgical management of corneal endothelial disease.
Astigmatism ; Cornea ; Corneal Transplantation* ; Descemet Membrane* ; Endothelial Cells ; Humans ; Korea ; Medical Records ; Reoperation ; Retrospective Studies* ; Transplants ; Visual Acuity

OBJECTIVE: This study was conducted to elucidate neuroprotective effect of carnosine in early stage of stroke. METHODS: Early stage of rodent stroke model and neuroblastoma chemical hypoxia model was established by middle cerebral artery occlusion and antimycin A. Neuroprotective effect of carnosine was investigated with 100, 250, and 500 mg of carnosine treatment. And antioxidant expression was analyzed by enzyme linked immunosorbent assay (ELISA) and western blot in brain and blood. RESULTS: Intraperitoneal injection of 500 mg carnosine induced significant decrease of infarct volume and expansion of penumbra (p<0.05). The expression of superoxide dismutase (SOD) showed significant increase than in saline group in blood and brain (p<0.05). In the analysis of chemical hypoxia, carnosine induced increase of neuronal cell viability and decrease of reactive oxygen species (ROS) production. CONCLUSION: Carnosine has neuroprotective property which was related to antioxidant capacity in early stage of stroke. And, the oxidative stress should be considered one of major factor in early ischemic stroke.
Anoxia ; Antimycin A ; Blotting, Western ; Brain ; Carnosine* ; Cell Survival ; Enzyme-Linked Immunosorbent Assay ; Infarction, Middle Cerebral Artery ; Injections, Intraperitoneal ; Ischemia* ; Neuroblastoma ; Neurons ; Neuroprotective Agents* ; Oxidative Stress ; Reactive Oxygen Species ; Rodentia* ; Stroke ; Superoxide Dismutase

Purpose: To report two cases of treatment using high-frequency radio wave electrosurgery for corneal neovascularization that recurred after medication and laser photocoagulation attempts.Case summary: (Case 1) A 53-year-old man visited our hospital complaining of corneal opacity. The best-corrected visual acuity in the left eye was 0.6. Lipid keratopathy indicated new inferior vessels. There was no significant change in corneal opacity after medication and laser photocoagulation; however, the recurrence of feeder vessels was observed. Therefore, electrocautery was performed via high-frequency radio wave electrosurgery. Visual acuity, measured 1 month later, improved to 0.9. Over the subsequent 4-year observation period, new vessels did not recur and the corneal opacity decreased gradually. (Case 2) A 23-year-old woman visited complaining of left eye pain. She had undergone laser photocoagulation three times for corneal new vessels. Visual acuity in her left eye was 0.4. Recurrence of new vessels at the upper cornea was observed, and electrocautery was performed. After 2 months, corneal opacity decreased without revascularization, and visual acuity improved to 0.5. Conclusions In patients with corneal neovascularization, electrocautery using high-frequency radio wave electrosurgery is simple and effective and can reduce corneal opacity and improve vision without complications.

Purpose: To evaluate the long-term outcomes of inverted internal limiting membrane (ILM) flap and ILM insertion in idiopathic macular hole (MH) and to compare the outcomes between the two techniques. Methods: We retrospectively reviewed the medical records of 17 eyes that underwent an inverted ILM flap procedure (flap group, n = 9) or ILM insertion procedure (insertion group, n = 8) for idiopathic MH. Within each group, best-corrected visual acuity (BCVA) before surgery was compared with that at the final follow-up. The BCVA at the final follow-up was compared between the two groups. In addition, the incidence of restoration of the external limiting membrane (ELM) and ellipsoid zone was evaluated. Results: The mean follow-up period was 25.1 ± 13.7 months after surgery. All MHs were closed after the surgery. In all 17 eyes, the logarithm of minimal angle of resolution BCVA had improved significantly from a mean value of 0.88 ± 0.23 before surgery to 0.42 ± 0.23 at the final follow-up (p < 0.001). The BCVA was significantly improved in both the flap group (from 0.92 ± 0.25 to 0.37 ± 0.29, p = 0.007) and the insertion group (from 0.83 ± 0.19 to 0.48 ± 0.15, p = 0.018). There was no significant difference in BCVA at the final follow-up between the two groups (p = 0.075). The incidence of restoration of the ELM and ellipsoid zone was significantly higher in the flap group (seven eyes, 77.8%) than in the insertion group (one eye, 12.5%). Conclusions Both inverted ILM flap and ILM insertion are effective in MH treatment. The restoration of retinal outer layers was better in the flap group. Further studies with a larger study population are needed to evaluate the long-term visual outcomes of the two methods.