Systemic capillary leak syndrome (SCLS) is characterized by recurrent hypovolemic shock attributable to increased systemic capillary leakage. A 46-year-old man was admitted to our hospital because of recurrent episodes of generalized edemawith hypovolemicshock. Blood laboratory data revealed severe hypoproteinemia with a small monoclonal IgG-K protein. These findings suggested strongly the diagnosis of SCLS. A regimen with steroid pulse therapy was tried; however, intravascular overloading accompanied by the recruitment of the initially extravasated fluids resulted in acute pulmonaryedema. Intensive care and careful monitoring of fluid volume are required in SCLS. (Internal Medicine 41: 953-956, 2002)

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ercutaneous coronary intervention (PCI) is the most common and effective strategy for treating acute coronary syndrome (ACS), but it is not always successful, mainly because of the no-reflow phenomenon, 1,2 which is associated with poor functional and clinical outcomes, even when Thrombolysis In Myocardial Infarction (TIMI) flow of grade 3 is acquired at the end of the procedure. [2][3][4] To elucidate the mechanisms underlying the no-reflow phenomenon and to predict its occurrence, differences in the culprit plaque morphology in patients with and without the no-reflow phenomenon have been investigated by grayscale intravascular ultrasound (IVUS) studies. Previous studies have demonstrated that a large plaque burden, positive remodeling, and lipid pool-like images increase the risk for the no-reflow phenomenon. [5][6][7][8][9] However, the detailed differences in the plaque composition between patients with and without the no-reflow phenomenon have been difficult to assess with gray-scale IVUS.Recently, spectral analysis of IVUS radiofrequency (RF) data has been shown to provide detailed quantitative and Circulation Journal Vol.72, August 2008 qualitative information on the composition of coronary plaques in vivo. 10-14 A study by Nasu et al found that in vivo characterization of coronary plaques by 'virtual histology' (VH) correlated favorably with the results of in vitro histopathological examination of tissue samples obtained by directional coronary atherectomy. 15 In the present study, we used VH to assess the differences in culprit plaque composition between ACS patients with and without the no-reflow phenomenon. Methods Patients and LesionsBetween June 2005 and April 2006, 103 consecutive individuals were admitted with ACS. They had either acute myocardial infarction within 24 h of onset or unstable angina of Braunwald's class IIIB (angina at rest without increased creatine kinase (CK)-MB activity within 24 h before coronary angiography). For these patients, coronary angiography was performed to identify culprit lesions, and then PCI was carried out. If thrombi were angiographically detected, percutaneous aspiration thrombectomy with TVAC™ (Nipro Corporation, Osaka, Japan) was performed to minimize the influence of thrombi on subsequent IVUS examinations, 16 which were carried out to assess the morphology of the culprit plaques. If a mobile mass with homogenous echo density, suggestive of thrombus, was also found on IVUS examination, percutaneous aspiration thrombectomy was repeated until the mass was not detected on IVUS examination. However, IVUS examination was not attempted Hiroyoshi Nakajima, MD; Kazuhiro Hara, MD Background The difference in the culprit plaque composition of acute coronary syndrome (ACS) patients with and without the no-reflow phenomenon has not been fully evaluated. Methods and ResultsIntravascular ultrasound radiofrequency data of culprit plaques were obtained and analyzed in 49 ACS patients. The no-reflow phenomenon was defined as a decrease of at least 1 grade in 'Thrombolysi...

Prospective CCTA reduces the radiation dose and allows diagnostic imaging in most cases but shows more nonevaluable artifacts than retrospective CCTA. Use of 50-ms instead of 200-ms PT appears to maintain image quality in patients with a mean HR < 65 beats/min and HR instability of <5 beats/min.

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