A Case of Primary Duodenal Bulb Carcinoma Combined with Early Gastric Cancer / 대한소화기내시경학회지

The occurence of multiple primary malignant tumor is cansidered infrequent and the primary adenocarcinoma of the duodenal bulb is a rare conditian. The autopsy incidence of duodenal adenocarcinoma is between 0.019 and 0.5%. The first documented case of duodenal carcinoma was described by Hamburger in 1746. Increased awareness of the condition, improvement in diagnostic technics and a more aggressive surgical approach have changed this disease from a postmortem curiosity to a condition that can be treated with satisfactory results. There are several reports on the high incidence of second additinoal cancer in patients with small intestinal cancer. Recently, we have experienced a case of primary duodenal bulb adenocarcinoma with early gastric cancer in a 68 year old male patient with complaints of epigastric pain, diarrhea and body weight loss. So we report the case of primary duodenal bulb adenocarcinoma combined with early gastric cancer with a brief review of literature.

Clinical Observation on Cerebrovascular Acidents

Clinical observation was done on 302 cases of cerebrovascular accidents admitted at Sung-Sim hospital, Chung-Ang University from January, 1968 to August, 1976. 1) Of 302 cases of cerebrovascular accidents, the incidence of cerebral hemorrhage was 28.8, cerebral thrombosis 47,7 Subarachnoid hemorrhage 20.2% and cerebral embolism 3.3%. 2) The peak age incidence was in the fifth decade in cerebral hemorrhage, subarachnoid hemorrhage, whereas in cerebral thrombosis, it was in the sixth decade. 3) The most frequent predisposing factor in cerebral hemorrhage and subarachnoid hemorrhage were physical activity and emotional stress, whereas in thrombosis and embolism, it was rest. 4) Among disease preceding the onset of cerebrovascular accidents, hypertension were presented 65.4% in cerebral hemorrhage, 63.6% in cerebral thrombosis, 56.6% in subarachnoid hemorrhage and valvular heart disease was presented 40.0% in cerebral embolism. 5) Serum cholesterol level over 200mg% was seen in 33.0% of cerebrovascular accidents. 6) Leukocytosis was seen 58.6% of cerebrovascular accidents which was predominantly found in the hemorrhagic group. 7) The pressure of cerebrospinal fluid was elevated in 61.7% of cerebrovascular accidents, predominantliny the hemorrhagic group. 8) The peak duration of admission was present in 51.7% of cerebrovascular accidents within 7 days and mortality rate during hospitalization was 38.0% in cerebral hemorrhage, 10.4% in cerebral thrombosis and 27.8% in subarachnoid hemorrhage. 9)The mortality rate during hospitalization was 35.3% in all cerebrlavascular accidents within 24 hours.

Studies on Hypertension in Korea: I. Clinical Study

An analytical observation was carried out on clinical features manifested by 435 patients admitted to Sacred Heart Hospital under a diagnosis of hypertension for a period of June 1968 to August 1972. The following results were obtained: 1. The occurence rate of hypertension was like to be higher in males than in females, showing a ratio of 3:2. The group of the 6th decade of age showed the densest distribution followed the groups in the 5th and the 7th decades, in either sex. 2. The average measurement of blood pressure in patients with hypertension for less than 2 years of duration was 174.8+/-25.14/114.0+/-18.72 mmHg. One who had suffered for over 10 years showed 189.7+/-32.02/126.6+/-23.95mmHg. The value had a tendency to increase as the ailment duration prolonged. 3. In eye fundus findings,hypertensive retinopathy of K-W stage II was the most frequent, observed in 39.0% of all. The appearing rate of hypertensive retinopathy increased and the change in the eye ground was accentuated as the ailment lingered longer. There was no noticeable correlative evidence between serum cholesterol and retinopathy by K-W classification, while the appearing rate of arteriosclerosis in the eye ground by Scheie's classification somewhat increased as serum cholesterol elevated. 4. Albuminuria was observed in 62.9% of all cases, a tendency of a higher appearing rate in parallel with the protraction of illness and a higher measurement of blood pressure. 5. The appearing rate of albuminuria increased as the change of eye fundus deepened. 6. The mean value of serum cholesterol was 192.0mg%, and there was no difference in cholesterol determination by age. 7. The ECG revealed an abnormal tracing in 78.0% of all cases, of which LVH was the most common abnormality appearing in 62.3%. The abnormalities in ECG were found more frequently as the illness protracted longer and blood pressure measured higher. 8. The chest X-ray showed abnormal findings in 55.6% of all cases, of which cardiomegaly was the most common change evidenced in 43.9%. 9. The cerebrovascular accident(22.9%), cardiac failure(8.6%) and renal insufficiency(7.9%) were the major complications of hypertension. The cerebrovascular accident was also found in higher occurence in the cases of longer duration of ailment with hypertension.