Mutational Analysis of Triple-Negative Breast Cancer Using Targeted Kinome Sequencing / 한국유방암학회지

Purpose@#Triple-negative breast cancer (TNBC) does not have defined therapeutic targets and is currently treated with chemotherapy only. Kinase dysregulation triggers cancer cell proliferation and metastasis and is a crucial therapeutic target for cancer. In this study, targeted kinome sequencing of TNBC tumors was performed to assess the association between kinome gene alterations and disease outcomes in TNBC. @*Methods@#A kinome gene panel consisting of 612 genes was used for the targeted sequencing of 166 TNBC samples and matched normal tissues. Analyses of the significantly mutated genes were performed. Genomic differences between Asian and non-Asian patients with TNBC were evaluated using two Asian TNBC datasets (from Seoul National University Hospital [SNUH] and Fudan University Shanghai Cancer Center [FUSCC]) and three nonAsian TNBC datasets (The Cancer Genome Atlas [TCGA], METABRIC, and Gustave Roussy).The prognostic value of kinome gene mutations was evaluated using tumor mutational burden (TMB) and oncogenic pathway analyses. Mutational profiles from the TCGA were used for validation. @*Results@#The significantly mutated genes included TP53 (60% of patients), PIK3CA (21%), BRCA2 (8%), and ATM (8%). Compared with data from non-Asian public databases, the mutation rates of PIK3CA p.H1047R/Q were significantly higher in the SNUH cohort (p = 0.003, 0.048, and 0.032, respectively). This was verified using the FUSCC dataset (p = 0.003, 0.078, and 0.05, respectively). The TMB-high group showed a trend toward longer progression-free survival in our cohort and the TCGA TNBC cohort (p = 0.041 and 0.195, respectively). Kinome gene alterations in the Wnt pathway in patients with TNBC were associated with poor survival in both datasets (p = 0.002 and 0.003, respectively). @*Conclusion@#Comprehensive analyses of kinome gene alterations in TNBC revealed genomic alterations that offer therapeutic targets and should help identify high-risk patients more precisely in future studies.

The effects of a single-dose subacromial injection of a nonsteroidal anti-inflammatory drug in geriatric patients with subacromial impingement syndrome: a randomized double-blind study

Background@#As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs. @*Methods@#Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation. @*Results@#Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671). @*Conclusions@#Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up.

The effects of a single-dose subacromial injection of a nonsteroidal anti-inflammatory drug in geriatric patients with subacromial impingement syndrome: a randomized double-blind study

Background@#As nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have similar effects, steroids can be avoided to reduce adverse effects. This study aimed to compare the differences in symptom improvement after subacromial injection of steroids or NSAIDs. @*Methods@#Sixty patients with rotator cuff syndrome for at least 3 months were enrolled and divided into steroid and NSAID groups. The steroid group received a mixture of 1 mL of triamcinolone acetonide (40 mg/mL) and 1 mL of lidocaine hydrochloride 2%, while the NSAID group received a mixture of 1 mL of Ketorolac Tromethamine (30 mg/mL) and 1 mL of lidocaine hydrochloride 2%. The patients were assessed before and at 3, 6, and 12 weeks after the procedure. Shoulder scores from visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and University of California Los Angeles (UCLA) were used for evaluation. @*Results@#Both groups showed improvements in the clinical outcomes. Overall VAS, ASES, and UCLA scores improved from 6.9, 32.7, and 16.0 before the procedure to 2.0, 1.2, and 1.1; 81.5, 87.6, and 88.5; and 29.7, 31.8, and 32.0 at weeks 3, 6, and 12 weeks after the procedure, respectively. Twenty-six patients (86.7%) in the steroid group and 28 (93.3%) in the NSAID group reported satisfactory treatment outcomes. There were no significant differences in the outcomes between the two groups (p=0.671). @*Conclusions@#Subacromial injection of NSAIDs for rotator cuff tendinitis with shoulder pain had equivalent outcomes with those of steroid injection at the 12-week follow-up.

A Follow-Up Study of Rotator Cuff Tear Using Magnetic Resonance Imaging / 대한정형외과학회잡지

PURPOSE: Rotator cuff disease (RCD) is a common cause of shoulder pain. However little is known about the progression of RCD during conservative management. This study aimed to identify the progression of RCD using magnetic resonance imaging (MRI). MATERIALS AND METHODS: This study was conducted between 2013 and 2015; 48 patients who underwent MRI after at least one year of conservative treatment for RCD were enrolled for follow-up analysis. Rotator cuff tear (RCT) and retraction were measured using an MRI. Tear progression was defined as an increase of 3 mm or more in tear size or retraction. Patients were divided into two groups: Small tear group and medium/large tear group. The progression of tears was analyzed. RESULTS: RCT occurred in 25 cases and tendinosis occurred in 23 cases. The progression was observed in 12 cases (48.0%), and new tears were observed in 2 cases (8.7%). The pre-treatment tear size and retraction were 17.8 mm and 18.9 mm, respectively; while the post treatment tear size and amount of tendon retraction were 20.2 mm and 22.3 mm, respectively. The pre-treatment anteroposterior diameter of tears showed a positive correlation with the pre-treatment tendon retraction (r=0.830, p < 0.001) but a negative correlation with the anteroposterior tear size progression (r=−0.473, p=0.017). Small size tears were found in 5 cases (20.0%) and medium/large size tears were found in 20 cases (80.0%). Among the 5 cases of small size tears, 4 cases (80.0%) showed progression, with a mean anteroposterior diameter of 7.4 mm and a mean amount of retraction of 5.9 mm. Among the 20 cases with medium/large size tears, 8 cases (40.0%) showed progression, with a mean anteroposterior diameter of 4.1 mm and a mean retraction of 6.8 mm. The frequency of tear progression was significantly different between the two groups (p < 0.001). CONCLUSION: The need to use MRI monitoring during the conservative treatment of rotator cuff tears to evaluate the possibility of switching to surgical treatment. This study also suggests that an aggressive surgical treatment should be considered even for small tears, since the size of tear and retraction of tears may progress similarly regardless of the size of tear.

A Ganglion Cyst Formed after Anterior Transposition of the Ulnar Nerve: A Case Report

In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.

A Ganglion Cyst Formed after Anterior Transposition of the Ulnar Nerve: A Case Report

In this report, a case of a 70-year-old man with a large ganglion cyst formed after anterior transposition of the left ulnar nerve is presented. Three months after the index surgery, the patient presented with a painless superficial ovoid, soft mass measuring 5x4x2 cm in size located at the posteromedial aspect of the left elbow, the previously operated site. Magnetic resonance imaging showed a well demarcated cystic mass with a stalk connecting to the elbow joint. Excisional biopsy was performed and pathologic findings showed that the cystic wall had no definite lining cells with myxoid degeneration compatible with findings of ganglion cyst.

External Fixation Under Local Anesthesia in Intertrochanteric Fracture Patients with High Anesthetic Risk: 3 Case Reports / 대한고관절학회지

The goals of surgical treatment are to obtain anatomical reduction, obtain stable fixation, and allow early rehabilitation. Results of conservative management of intertrochanteric fractures are not satisfactory due to the increased risk of cardiopulmonary complications related to immobilization. External fixation has been well-established as an alternative treatment modality for intertrochanteric fractures in elderly and medically-compromised patients. The authors reviewed the related literature and reported on three cases of elderly patients that suffered from intertrochanteric fractures and had severe medical co-morbidities. They were successfully treated by external fixation under local anesthesia.

External Fixation Under Local Anesthesia in Intertrochanteric Fracture Patients with High Anesthetic Risk: 3 Case Reports / 대한고관절학회지

The goals of surgical treatment are to obtain anatomical reduction, obtain stable fixation, and allow early rehabilitation. Results of conservative management of intertrochanteric fractures are not satisfactory due to the increased risk of cardiopulmonary complications related to immobilization. External fixation has been well-established as an alternative treatment modality for intertrochanteric fractures in elderly and medically-compromised patients. The authors reviewed the related literature and reported on three cases of elderly patients that suffered from intertrochanteric fractures and had severe medical co-morbidities. They were successfully treated by external fixation under local anesthesia.

Basal Cell Carcinoma of the Prostate

Basal cell carcinoma (BCC) of the prostate, a rare variant of prostate cancer, is derived from the basal cells of prostatic ducts and acini. BCC generally occurs in elderly men with obstructive voiding symptoms and levels of serum prostate-specific antigen within the normal range. In most cases, diagnosis is made through transurethral resection or simple enucleation. Most cases are indolent, but local recurrence and metastasis have been reported in a few cases. Thus, radical surgery and long-term follow-up are recommended. We report a case of a 54-year-old man who underwent radical retropubic prostatectomy after being diagnosed with BCC during a transurethral resection performed for lower urinary tract symptoms. The patient has remained free of disease for 4 months after surgery.

Primary Sternoclavicular Septic Arthritis in a Healthy Adult: A Case Report

Sternoclavicular septic arthritis is a rare condition and it is usually related to predisposing conditions like intravenous drug abuse, diabetic mellitus, trauma and so on. A delayed diagnosis of this disease may cause severe complications like mediastinitis and chest wall abscess. Computed tomography or magnetic resonance imaging is needed to evaluate the complications. If the above complications are present, then joint resection should be considered. We report here on a case of a 52-year-old man who was diagnosed with primary sternoclavicular septic arthritis and he had no predisposing conditions. The pathogen on the aspiration-culture was S. aureus and it was susceptible to cefminox. The patient was cured with administering only antibiotic therapy for 6 weeks; intravenous cefminox therapy for 4 weeks followed by oral cefminox therapy for 2 weeks.

Bilateral Elastofibroma Dorsi of the Shoulder: Case Report

We report a case of an 86-year-old man diagnosed with bilateral elastofibroma dorsi who was managed conservatively after a two year follow-up. An elastofibroma dorsi is a benign, slow-growing tumor that is most often located in the inferior periscapular area in elderly patients. It should be considered to differentiate them from other soft tissue tumors located at the inferior periscapular region. Increased awareness of these characteristics will decrease the incidence of a misdiagnosis of elastofibroma dorsi as a malignancy and avoid unnecessary surgery.

Radiologic Result of Treatment of Intertrochanteric Fracture Using Compression Hip Screw: Involvement of Lateral Cortex

PURPOSE: To assess the meaning of the unstable intertrochanteric fracture of femur with involvement of lateral cortex by analysing the radiologic result of the surgical treatment using a compression hip screw. MATERIALS AND METHODS: Classifing patients (who has taken the surgical treatment for intertrochanteric fracture of femur using compression hip screw from January 1999 to June 2002) in our hospital with 24 patients who had not much difference statistically in the compression screw located within the femur, Tip-Apex distance (TAD) the Singh Numerical Value of osteoporosis. The results were divided into two groups, group A (without fracture extends through lateral cortex of femur: 16 cases) and B (fracture extends through lateral cortex of femur: 8 cases), when analyzing it. And then analyzed the final examination in the evaluation of electrical potential level by radiology, change of the inside and outside of neck-shaft angle, descent level of the screw and the change of the neck-shaft angle. RESULTS: In the latest follow up, the sliding amount of the screw in group B, the average was 14.9+/-9.3 mm, and 6.7+/-3.6 mm in group A. There was no difference statistically (p value>0.05). In the varus change in group B, the average was 8.00+/-8.12degrees and in group A it ws 2.75+/-2.63degrees There was statistical difference(p value<0.05). In displacement after operation, it was 7.60+/-2.61 mm in group B and 0.5+/-1.80 mm in group A. There was statistical difference (p value<0.05). CONCLUSION: The intertrochanteric fracture with involvement of lateral cortex of femur have to be considered as unstable fracture having tendency of displacement.

Dietary Ascorbate Supplementation Reduces Oxidative Tissue Damage and Expression of iNOS in the Kidney of Streptozotocin Induced Diabetic Rats

Reactive oxygen species (ROS) have been suggested to be contributory factors in complications of diabetes mellitus. In the present study, we investigated the generation of superoxide, the lipid peroxide level measured as thiobarbituric acid reactive substances, the vasorelaxation of isolated thoracic aorta and the iNOS expression in kidney of streptozotocin induced diabetic rats. Sprague Dawley rats were divided into four groups: control, ascorbate (400 mg/kg rat weight daily in drinking water), diabetic (single dose of 50 mg of STZ/kg i.p.) and diabetic simultaneously fed with ascorbate for 12 wk. Rats in groups were studied at tri-weekly intervals (0 to 12 wk). Diabetic rats were evaluated periodically with changes of plasma glucose levels and body weight. The ascorbate supplimentation attenuated the development of hyperglycemia and weight loss induced by STZ injection in rats. In the present experimental condition, the ascorbate supplimentation had no significant effect on plasma glucose levels and changes in body weight of normal rate. The superoxide generation, formation of thiobarbituric acid reactive substance and iNOS expression in kidney were significantly increased in STZ-treated rats that were decreased by ascorbate supplimentation. The ascorbate supplimentation had no effect on vasorelaxation of isolated thoracic aorta. These results indicate that ascorbate supplimentation may exert an inhibitory effect on STZ-induced oxidative tissue damage through protection of pancreatic islet cells by scavanging reactive oxygen species. The ascorbate supplimentation may possibly attenuate the renal complication of diabetes mellitus.

Effect of Steroid on Impaired Vascular Function Induced by Irradiation

BACKGROUND AND OBJECTIVES: Intracoronary irradiation has been proven to reduce restenosis following percutaneous transluminal coronary angioplasty, however late thrombosis is another recurring problem. We evaluated the sequential changes of vascular dysfunction and morphological changes according to the radiation dosage in rats. The effects of dexamethasone on these changes were also evaluated. MATERICAL AND METHODS: Female Sprague-Dawley rats were randomized into 4 groups (n=20, each group), and were irradiated with 0, 5, 10, 20 Gray (Gy). The rats were sacrificed at 1 hour, 1, 3 and 7 days after irradiation. The physiographic responses and morphologic changes of the arterial rings were evaluated. After the time- and dose-response relationship was determined, an additional 40 rats were pretreated with dexamethasone for 3 days and irradiated with 10 or 20 Gy to evaluate the effects of the dexamethasone. 5 Gy irradiation did not induce endothelial dysfunction. 10 Gy irradiation induced an impairment of endothelium dependent relaxation (EDR) only 7days after irradiation. 20 Gy caused an impairment of EDR from the very time of irradiation, although endothelium independent relaxation (EIDR) was not affected irrespective of dose or time. On immuno-histochemistry of vWF, all irradiated arteries showed mild de-endothelialization in acute phase and subsequent re-endothelialization. However, after 20 Gy irradiation, re-endothelialization did not occur. With dexamethasone treatment, all of these vascular dysfunctions were prevented, and re-endothelialization was promoted. CONCLUSION: Irradiation induced the impairment of EDR as well as de-endothelialization, in a time- and dose-response relationship in rats. Pretreatment with dexamethasone may partly prevent radiation-induced vascular dysfunction and de-endothelialization.

Comparison of efficacy and safety of simvastatin, 10 mg and 20 mg in the treatment of hypercholesterolemia / 대한내과학회지

BACKGROUND: Elevated serum cholesterol level is a major risk factor for cardiovascular morbidity and mortality. Simvastatin is effective for treating hypercholesterolemia. The aim of the study was to evaluate efficacy and safety of 6-month therapy with simvastatin with relatively low dose, 10 mg and 20 mg/day. METHODS: One hundred six patients with hyperlipidemia (triglycerides130 mg/dL) were randomized to receive either simvastatin 10 mg/day (n=43) or 20 mg/day (n=63). Efficacy was determined by measuring changes from baseline in lipid parameters including LDL cholesterol, total cholesterol, triglycerides and high-density lipoprotein (HDL) cholesterol. RESULTS: Of the one hundred six patients randomized to treatment, forty patients were men and sixty-six patients were women. Fifty-five percent of patients had hypertension, nine percent coronary artery disease and thirteen percent type 2 diabetes mellitus. Mean baseline lipid concentrations were 258 (total cholesterol), 201 (triglycerides), 50 (HDL) and 167 mg/dL (LDL). Both 10 mg and 20 mg of simvastatin produced statistically significant improvements in all measured serum lipid parameters (p< 0.001). Compared with 10 mg of simvastatin, 20 mg of simvastatin produced significantly greater (p< 0.001) reductions from baseline LDL cholesterol (34.9 mg/dL vs 20.8 mg/dL). But 10 mg of simvastatin was more effective than 20 mg of simvastatin at reducing triglycerides level (42.7 mg/dL vs 22.3 mg/dL). There was no significant difference in both doses at improving total cholesterol and HDL cholesterol level. Percentage of patients at goal LDL as recommended by NCEP guideline (ATP III) were 81% and 80% for patients in low risk but 35% and 50% for patients in coronary heart disease and its risk equivalents, taking 10 mg and 20 mg/day respectively. Both doses were well tolerated. Only 3 patients (4.8%) in the 20 mg group and one patient (2.3%) in the 10 mg group experienced mild adverse events. Most patients contacted by telephone wanted to take 10 mg of simvastatin. CONCLUSION : In patients with hypercholesterolemia in Korea, both doses (10 mg, 20 mg) of simvastatin were effective in improving serum lipid parameters and well-tolerated. We recommend, considering patients' preference, that 10 mg of simvastatin be intial dosage and in patients with coronary heart disease, higher doses than 20 mg should be prescribed to allow most patients to reach their NCEP target levels.

The Rotating Total Knee Arthroplasty: 67 Cases Reports

Total knee arthroplasty of Sledge type is difficult to perform successfully in severely damaged knee that has poor bone-stock and ligament instability. High rate of loosening has be.en found in total hinge type and kinematic rotating hinge type, so we considered use of tibia rotating prosthe,,is that allows motion with stability would be a good option. The indications of this type are severe varus deformity, bone loss, incompetent ligament, or revision. We studied 67 cases of total knee arthroplasty using Endo Model rotating total knee arthroplasty (WALDEMAR LINK GmbH & Co. Germany), which had been performed from January, 1991 to June, 1994. Thirty knees out of 67 cases were degenerative osteoarthritis, 15 posttraumatic arthritis, 11 rheumatoid arthritis, 5 revision arthroplasty, 2 sequelae of pyogenic arthritis, etc. Thirteen knees out of 67 cases had patellar resurfacement. Twenty-six out of 67 cases had bone graft. Using the Knee Rating Score of Hospital for Special Surgery, 3S were excellent and 2 l good.

Clinical Study of Potential Embolic Sources in Patients with Ischemic Cerebrovascular Diseases

BACKGROUND: The etiologies of ischemic cerebrovascular diseases are various-thrombosis or artery to artery embolism, cardiogenic embolism and lipohyalinosis. In the past embolic cerebral infarct was thought to occur uncommonly. But these days substantial portion of patients have been found to have potential embolic sources by transesophageal echo cardiography and carotid duplex doppler. As transesophageal echocardiography has a high yield for identification of potential sources of cardiac embolism in patients with ischemic cerbrovascular diseases, its use has been increasing. In Korea an increasing number of patients with ischemic cerebrovascular diseases have been examined by transesophageal echocardiography since 1990. But in all the previous studies transesophageal echocardiographic evaluation has been confined to the patients with high probability of embolic cerebral infarct. All kinds of ischemic cerebrovascular diseases patients have never been examined by transesophageal echocardiography and carotid duplex doppler and the prevalence of potential embolic sources in Korean ischemic cerebrovascular disease patients is not known. The aim of this study was to evaluate the prevalence of potential cardiovascular embolic sources by transesophageal echocardiography and carotid duplex doppler in unselected patients with ischemic cerebrovascular diseases. METHODS: We evaluated all kinds of ischemic cerebrovascular diseases patients admitted from 1994. 9. 1. until 1995 9. 31. to the Departments of Neurology and Internal Medicine of Kangnam General Hospital. We evaluated them by transesophageal echocardiography, carotid doppler, brain CT(or brain MRI). A significant carotid stenosis was defined as a duplex scandetected lesion producing at least 50% vessel narrowing. The following echocardiographic findings were defined prospectively as potential cardiac sources of embolism : atrial appendage or left atrial cavity thrombus, spontaneous echocardiographic contrast, atrial septal aneurysm, interatrial shunt, ventricular aneurysm, ventricular thrombus, myxomatous mitral valve and protruding atherosclerotic plaque in the ascending aorta or transverse aortic arch. RESULTS: Of 64 patients admitted during the study period, 30 were excluded(Three patients were critically ill, and twenty seven patients refused diagnostic work-up.). Thorough diagnostic work-up was performed in 34 patients. Transesophageal echocardiographic positive findings were present in six patients(17.6%). Of them four(4/34, 11.7%) had spontaneous echo contrast, two(2/34, 5.8%) had left atrial thrombi, one(1/34, 2.9%) had ascending aorta atheroma. Eleven patients(11/34, 32.3%) had abnormalities in carotid doppler study. Five patients(5/34, 14.7%) had abnormalities both in transesophageal echocardiography and carotid doppler study. CONCLUSIONS: The results suggest that among ischemic cerebrovascular diseases patients substantial portion of patients have potential embolic sources. The prevalence of potential embolic sources in Korea may be higher than previously expected. Because the relative small number of the patients studied make it difficult to generalize the results, further studies with a large number of patients are needed.

Coronary Artery Disease in Patients with Atherosclerotic Peripheral Vascular Disease of Lower Extremities

BACKGROUND: Prevalence of the coronary artery disease(CAD) has been reported to be high in patients with the atherosclerotic peripheral vascular disease of lower extremities(PVD). However, the evaluation of the coexisting coronary artery disease(CAD) in patients with the PVD was often difficult due to limitation of the exercise capacity in these patients. This prespective study was designed to determine the prevalence, clinical characteristics of the associated CAD in patioents with PVDd, and to determine the value of the preoperative coronary angiogram as a predictor of the perioperative cardiovascular complications. METHODS: Eighty-two patients with PVD(78 male, age 62+/-7.8) were included from February 1991 to May 1993. Coronary angiogram was performed on the day of periperal angiogram in all patients and patients were divided into two group ; patients with CAD and patients without CAD. Clinical characteristics were compared, and among patients in whom revascularization surgery were undertaken, the incidences of the perioperative cardiovascular complications were compared between two groups. RESULTS: Coronary artery disease(CAD) was present in 50 patients(61%) of 82 PVD patients. In patients with CAD(N=50), only 72% of the patients were suspected for having coexisting CAD on the basis of chest pain and resting electrocardiogram. Revascularization surgery were performed in 46 patients and significantly high incidence of the perioperative acute myocardial infarction was observed in patients with coexisting CAD(4/25, 16% vs. 0/21, 0%). CONCLUSION: Considering the high prevalence of the CAD in patients with PVD and frequent occurrence of perioperative revascularization surgery in patients with PVD, we recommend that simultaneous coronary angiogram with aortography and peripheral angiogram should be considered in patients with PVD.

Clinical and morphological features of hypertrophic cardiomyopathy in Korean patients

Thirty three cases of hypertrophic cardiomyopathy (HCMP) were reviewed to estimate the relative frequencies of the subtypes of HCMP and to clarify whether there is any racial difference in clinical and morphological features of HCMP. The diagnosis was made by echocardiography, cardiac catheterization and left ventriculography. Twenty four patients underwent coronary angiogram. Numbers of cases by the types of HCMP were 20 (61%) with asymmetrical septal hypertrophy (ASH), 11 (33%) with apical hypertrophy (APH) and 2 (6%) with midventricular hypertrophy (MVH). Mean ages of the patients with APH, ASH and MVH were 54, 46 and 31 years respectively, and the differences were statistically significant (p less than 0.05). The giant negative T wave on electrocardiogram was seen in 4 patients (20%) of ASH and 5 patients (45%) of APH. On echocardiogram mean ratio of interventricular septal to left ventricular posterior wall thickness was 1.9 in ASH, 1.2 in APH and 1.6 in MVH, and the differences were statistically significant (p less than 0.05). All patients with APH showed "spade of ace" deformity in left ventriculography. Coronary angiograms were normal in all patients who had the procedure. Our study showed high frequency of APH of which characteristics were similar to those of the Japanese type APH.

Ebstein's Anomaly in Adults

Clinical features, laboratory and operative findings were reviewed in 17 cases adult Ebstein's anomaly admitted to Seoul National University Hospital from Feburary,1979 to October, 1987. 1) Mean age of first diagnosis was 28.6 tears old(range ; 14-57 years old). 2) Exertional duspnea(88.2%) and palpitation(64.7%) were the predominant symptoms, and PSVT was documented in 4 cases among 11 patoents with palpitation. 3) Echocardiogram showed displacement or delayed closure of the tricuspid valve in 13 cases. 4) On similtaneous recording of the intracardiac ECG and pressure, right ventricular electrogram with atrial pressure in atrialized right ventricle was observed in all cases. 5) Right ventriculogram revealed displacement of the tricuspid valve in 9 cases and tricuspid regurgitation in 10 cases. 6) Interatrial communication via ASD(8) and PFO(3) was present in 11 cases(64.7%). 7) Operative finding of 9 cases showed abnormalities of septal leaflet in 9(100%), posterior leaflet in 8(88.8%), and anterior leaflet in 2 cases(22.2%).