Differential Findings of Color M-mode Doppler Echocardiography according to the In-hospital Congestive Heart Failure Following Actue Myocardial Infarction

BACKGROUND: Abnormalities of the left ventricular diastolic function can be classified by pulsed Doppler echocardiography, but sometimes it may be difficult to differentiate normal diastolic function from pseudonormalization. Heart failure caused by increased left ventricular filling pressure is rather associated with pseudonormalization or restrictive pattern than normal pattem or relaxation abnormality. We investigated the usefulness of color M-mode Doppler echocardiographic indexes in differentiating normal relaxation from pseudonormalization after acute myocardial infarction. METHOD: Echocardiographic examination including color M-mode Doppler was performed in 44 patients with acute myocardial infarction between 10 and 14 days after attack. 34 patients without in-hospital congestive heart failure(CHF) were assigned as group I, and 10 patients with in-hospital CHF as group II. Flow propagation slope(FPS), time difference(TD) between the occurrence of peak flow velocity in the apical region and at the mitral tip, and normalized time difference(nTD) by mitral and apical distance were measured with color M-mode Doppler echocardiography. RESULTS: FPS was lower in group II(group I, 42.0+/-20.6cm/sec vs group II, 27.8+/-8.0cm/ sec , p=0.065). Both groups had similar TD and nTD. FPS was compared in patients with E/ A ratio of mitral inflow greater than 1(22 patients of group I and 7 patients of group II). Patients with E/A) 1 in group II had significantly lower FPS(group I, 52.1+/-17.5cm/sec vs group II, 31.0+/-7.4cm/sec ; p(0.01). CONCLUSION: FPS was significantly decreased after acute myocardial infarction in patients with in-hospital CHF compared with patients without in-hospital CHF, even when E/A ratio of mitral inflow was greater than 1. Therefore, FPS was an useful index in differentiating normal relaxation from pseudonormalization.

A Case of Primary Malignant Melanoma in the Mediastinum / 결핵

Malignant melanoma develops from the melanocyte and the most common primary site is skin, followed by mucosa and retina. Even though any other tissue where melanocytes reside could be the primary site of the malignant melanoma, the one developed in the mediastinum is rarely reported. We experienced a patients of 54 years old woman whose initial symptom was progressive dyspnea for one month, and proved to have the anterior mediastinal mass with pleural effusion and the small mass in the abdominal soft tissue. The needle aspiration biopsy from the mediastinal mass showed the consistent findings with malignant melanoma. We concluded the mediastinum was the primary site of the malignant melanoma of this patient because we couldn't find any other evidence of primary tumor in skin, oral and gastrointestinal mucosa, and retina. She has been treated with combined chemotherapy with dacarbazine, cisplatin and vinblastine. Her symptom was improved after chemotherapy and follow up chest CT after three cycles of chemotherapy showed the decreased tumor size in the mediastinum.

A Case of Isolated-organ Tuberculosis Causing Common Bile Duct Obstruction: Tuberculous periductal lymphadenitis / 대한소화기내시경학회지

The explanation of isolated-organ tuberculosis rests on the assumption that in the course of the lymphatic or hematogenous dissemination of bacilli, organisms may be rapidly destroyed in all other sites save for the particular tissue involved in the isolated tuberculous process. Tuberculosis can arise in all tissues having lymphatics or blood supply, but the disease causing biliary tract obstruction has been known to be rare. Recently, we experi-enced a case of isolated-organ tuberculosis causing common bile duct obstruction and periductal lymph node enlargement in a 46-year-old Korean male. An ultrasonography-guided percutaneous needle biopsy revealed a granulomatous inflammation of the lymph node. After 7 months of anti-tuberculous medication, the common bile duct obstruction and periductal lymph node enlargement disappeared completely in a follow up abdominal CT and ERCP.

Papillary Carcinoma of Thyroid in Association with Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) includes early development of up to thousands of colorectal adenoma and of colonic adenocarcinoma in all untreated cases. Moreover, a variety of extracolonic manifestation are seen. Several reports have demontrated a high incidence of papillry carcinoma of thyroid. We experienced a case of familial adenomatous polyposis, presenting with thyoid papillry carcinoma, and reported with a brief review of literatures.