Plaque disruption and subsequent thrombotic occlusion is the primary mechanism by which atherosclerosis leads to acute coronary syndromes and ischemic stroke. Platelets are the key component of arterial thrombus formation in response to sudden fissuring or rupture of the atheromatous plaque. Low dose aspirin (100~300 mg/day) rapidly inhibits platelets through permanent inactivation of the key platelet enzyme, cyclooxygenase (COX). The efficacy and safety of aspirin have been extensively studied in several populations, ranging from healthy individuals to highrisk patients with acute myocardial infarction or ischemic stroke. It is well established that aspirin reduces the risk of serious vascular events (death, myocardial infarction, and stroke) by approximately 25% in patients with established vascular diseases. However, long-term therapy with aspirin approximately doubles the risk of major extracranial bleeding (mostly gastrointestinal bleeding) and also increases the risk of hemorrhagic stroke. In contrast to the clear benefit of aspirin in secondary prevention, its benefits in primary prevention are less clear. A meta-analysis of primary prevention trials in men demonstrated that aspirin reduces the risk of myocardial infarction by approximately 30% but has no effects on the risk of stroke. By contrast, the Women's Health Study showed that aspirin reduces the risk of stroke by 17% but has no effects on the risk of myocardial infarction. The reasons for this discrepancy remain unclear, requiring additional studies. Taken together, aspirin is recommended for primary prevention in healthy individuals with an annual risk of vascular events >1.5%. In conclusion, aspirin is recommended for secondary prevention in all patients, but its risk-benefit ratio should be carefully considered for primary prevention.
Acute Coronary Syndrome ; Aspirin* ; Atherosclerosis ; Blood Platelets ; Hemorrhage ; Humans ; Male ; Myocardial Infarction ; Primary Prevention ; Prostaglandin-Endoperoxide Synthases ; Rupture ; Secondary Prevention ; Stroke ; Thrombosis ; Vascular Diseases ; Women's Health

Timely diagnosis and subsequent appropriate intervention is important in respiratory diseases. Chest radiograph is the most commonly performed radiologic examination and is the imaging study that the majority of non-radiologist physicians are most likely to encounter in their clinical practice. Chest radiography, however, can be very complex and difficult to interpret accurately due to abnormalities that might be quite subtle. Failure to detect lung cancer on the chest radiograph, which has become one of the most frequent causes of missed diagnoses in radiology, is a major cause that brings up medicolegal suits. There are no reliable radiographic criteria to distinguish lung cancer from benign diseases. Being knowledgeable about thoracic imaging will help to minimize errors. The diagnosis of lung cancer is commonly delayed because of masking by a tuberculosis lesion. In diagnosing tuberculosis, clinicians should be aware of endobronchial tuberculosis, anthracofibrosis, multidrug resistant tuberculosis, and non-tuberculous mycobacterial diseases. If pneumonia was not resolved, endobronchial lesions such as a foreign body or cancer, bronchioloalveolar cell carcinoma, and atypical pathogens might be considered. In patients with chronic coughing, eosinophilic bronchitis also should be suspected in addition to postnasal drip syndrome, cough variant asthma, and gastroesophageal reflux disease. Most common pitfalls can be avoided by physicians who are familiar with diverse patterns of respiratory disease in diagnosis. Through an increased familiarity with variable manifestations of pulmonary diseases and a high index of suspicion, the diagnosis of respiratory diseases will be improved.
Asthma ; Bronchitis ; Cough ; Diagnosis* ; Eosinophils ; Foreign Bodies ; Gastroesophageal Reflux ; Humans ; Lung Diseases ; Lung Neoplasms ; Masks ; Pneumonia ; Radiography ; Radiography, Thoracic ; Recognition (Psychology) ; Thorax ; Tuberculosis

Nutritional genomics (nutrigenomics) is the application of high-throughput functional genomics technologies to nutritional science lying in the interface between the nutritional environment and genetic process. It seeks to provide a molecular genetic understanding of how common dietary nutrition affects health by altering the expression or structure of an individual's genetic makeup. On the other hand, nutrigenetics is significantly different from nutrigenomics since nutrigenetics has been used for decades in certain rare monogenic diseases such as phenylketonuria, and has the potential to provide a basis for personalized dietary recommendation based on the individual's specific genetic background in order to prevent common multifactorial disorders decades before their clinical manifestation. The human genome maps and SNP databases, together with the rapid development of tools suitable for investigating genetic and epigenetic changes in small tissue biopsies provide the means to begin the test hypothesis about the mechanisms by which diet influences disease risk including cancer directly in human subjects, could be inevitable flatforms for clinical application to achieve targeted therapy in near future.
Biopsy ; Deception ; Diet ; Epigenomics ; Genetic Processes ; Genome ; Genome, Human ; Genomics ; Hand ; Humans ; Molecular Biology ; Nutrigenomics* ; Nutritional Sciences ; Phenylketonurias

Psoriasis is a common, chronic skin disease. The goal of therapy is always to use the appropriate medication to achieve the desired effect while minimizing side effect. The three types of traditional therapies for treatment of psoriasis are topical therapies, phototherapies and systemic therapies. Topical steroid, vit D derivatives are frequently prescribed with other agents. Broad band UVB, PUVA and narrow band UVB therapies are most commonly used phototherapy. Three main systemic agents now used for moderate to severe psoriasis are retinoid, cyclosporine and methotrexate. Psoriasis is recently found to be an T-cell mediated immunologic disease. This lead to the developing new targeted immunobiologic agents.The newer biologic agents appear to combine greater efficacy of treatments with less toxicity by targeting T cell activation or specific mediator, TNF-alpha.
Biological Factors ; Biological Products ; Cyclosporine ; Immune System Diseases ; Methotrexate ; Phototherapy ; Psoriasis* ; Skin Diseases ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

The paper reviews recent advances regarding characteristics and treatment issues of alcohol use disorders in women. Women drink less alcohol but have greater sensitivity of alchol-related problems than men. Recent evidences suggest that women are more likely to have alcohol-related physical problems at smaller amount of drinking than men. Also, they have more alcohol-induced cognitive and emotional disturbances. Alcohol-induced reproductive problems are also specific to women. It may be due to women's unique susceptibility to the toxic effects of alcohol. There are also evidences that women may have more psychiatric problems than men before onset of drinking problems.There was a significantly higher lifetime prevalence of psychiatric comorbidity in women than in men with alcohol use disorders. All of these differences have important treatment implications. But, more research are needed to discover the nature of gender difference of alcohol drinking.
Affective Symptoms ; Alcohol Drinking ; Alcoholism* ; Comorbidity ; Drinking ; Female ; Humans ; Male ; Prevalence

Alcoholism, a major public health problem throughout the world, causes an enormous damage to health and quality of life and undermines the well being of families and society. It is associated with liver disease, cancer, cardiovascular problems, accidental deaths, suicides, and homicides. Over the last 20 years, a significant progress has been made in the pharmacological treatment of alcoholism owing to the better understanding of the neurobiological substrates of alcohol dependence, including adaptive changes in amino acid neurotransmitter systems, stimulation of dopamine and opioid peptide systems, and, possibly, changes in serotonergic activity. Disulfiram, naltrexone and acamprosate are the only pharmacological agents currently approved for the management of alcohol dependence. Data from studies of ondansetron and topiramate in alcohol dependence are somewhat promising, but it appears that the evidence of efficacy of these drugs in large controlled clinical trials are still lacking. Trials with SSRIs and some antipsychotics have shown disappointing results. Because the biological basis of alcohol dependence appears to be multifactorial, the future of management of alcoholism would involve combination therapy, using drugs acting on different neuronal pathways, such as acamprosate and naltrexone. Pharmacotherapy should be used in association with appropriate psychosocial support and specific treatment for any underlying psychiatric comorbidities.
Alcoholism* ; Antipsychotic Agents ; Comorbidity ; Disulfiram ; Dopamine ; Drug Therapy ; Homicide ; Humans ; Liver Diseases ; Naltrexone ; Neurons ; Neurotransmitter Agents ; Ondansetron ; Opioid Peptides ; Public Health ; Quality of Life ; Suicide

No abstract available.

The principle of antituberculosis therapy is to apply a combination regimen of at least two bactericidal drugs to which the bacteria are susceptible for sufficient duration, thus improving the efficacy of the therapy and preventing the development of resistant strains. If a certain side effect develops during the therapeutic trial, the next step includes identifying the causative drug, estimating the type and magnitude of the side effect, and finally deciding whether the regimen should be discontinued. In a clinical setting, however, these decisions cannot be made easily. Many antituberculosis drugs causes similar side effects, and even if the causative drug is identified, the decision to discontinue the drug must be based on its relative importance in the current antituberculosis regimen. Effective application of antituberculosis medication requires the physician to fully understand what adverse effects each drug is associated with, which side effect necessitates withdrawal of the drug, and how to rechallenge the drug with side effects when it is absolutely required in the regimen.
Bacteria

The hemolytic uremic syndrome consists of microangiopathic hemolytic anemia, acute renal failure, and thrombocytopenia following a prodromal illness of gastroenteritis or upper respiratory infection. Sometimes, the syndrome can present in a dramatic fashion with severe abdominal pain and signs of intestinal obstruction, suggesting an intussusception or acute surgical crisis. A 2-year-old girl with a 3-day history of several episodes of bloody-mucoid diarrhea and severe abdominal pain was admitted under suspicion of intussusception. Her symptoms started 4 days after eating a pork and X-ray revealed the distended small bowel without a large bowel gas pattern. Colitis without perforation was found by abdominal ultrasonogram and sigmoidoscope. Unfortunately, she became pallor, puffy, and oliguric 7 days later. Clues to the diagnosis of hemolytic uremic syndrome in the early stages of the acute illness were oliguria, abnormal peripheral blood smear, anemia despite dehydration, and proteinuria. The onset is usually preceded by symptoms of gastroenteritis, such as fever, vomiting, abdominal pain, and bloody diarrhea. This is followed in 5 to 10 days by a sudden onset of pallor, irritability, weakness, lethargy, and oliguria. The majority of patients recover normal renal function with aggressive management of the acute renal failure. Careful medical management of the hematologic and renal manifestations, in conjunction with early and frequent peritoneal dialysis, offers the best chance of recovery from the acute phase. The present patient was recovered by apropriate fluid and electrolyte management, transfusions of packed RBCs, fresh frozen plasma, and early application of peritoneal dialysis.
Abdominal Pain ; Acute Kidney Injury ; Anemia ; Anemia, Hemolytic ; Child, Preschool ; Colitis* ; Dehydration ; Diagnosis ; Diarrhea ; Eating ; Female ; Fever ; Gastroenteritis ; Hemolytic-Uremic Syndrome* ; Humans ; Intestinal Obstruction ; Intussusception ; Lethargy ; Oliguria ; Pallor ; Peritoneal Dialysis ; Plasma ; Proteinuria ; Red Meat ; Sigmoidoscopes ; Thrombocytopenia ; Ultrasonography ; Vomiting

Surgical techniques for facial rejuvenation have become highly progressed in the last decade. Until recently, little attention has been paid to the intrinsic mechanisms of skin changes, such as wrinkling, surface irregularities, and alterations of pigmentation, and other various aging phenomena. Superficial facial wrinkling was not embraced seriously. This attitude has changed for the better, and among the many methods and techniques now available are Trichlor Acetic Acid(TCA), Phenol, Alpha Hydroxy Acid, and several different types of laser peeling methods. Skin resurfacing has undergone many changes and still is in the process of evolution. My personal experience with Phenol, TCA, and dermabrasion began in 1990. In this article, I tried to explain the basic methods of skin resurfacing for physicians and surgeons who are not in the esthetic fields. Chemical peeling, laser peeling, and dermabrasion share common characteristics of would healing. For compiling the subtopic that relates to the resurfacing, I rather concentrated my writing on chemical peeling due to the short life-cycle of laser peeling technique with ever-developing new laser machines. New techniques and procedures continue to evolve rapidly. I have no doubt that what is written in this article will be improved or become obsolete, or even be discarded in the future. Since the ideas and techniques are not static, but incessantly moving forward toward perfection.
Aging ; Dermabrasion ; Humans ; Phenol ; Pigmentation ; Rejuvenation ; Skin* ; Surgeons ; Writing