Characteristics of Advanced Gastric Cancer Undetected on Gastroscopy / 대한소화기학회지

BACKGROUND/AIMS: Stomach cancer can be easily diagnosed via endoscopy, but also possible to be missed. The aim of this study was to investigate the clinical and endoscopic characteristics of advanced gastric cancers that were not diagnosed based on endoscopic examination. METHODS: We evaluated patients who had newly diagnosed advanced gastric cancer that was undetected via endoscopy within the last six months. RESULTS: Sixteen patients were included in this study. The locations of the cancers were the cardia in six cases, the greater curvature side of the body in eight cases and the antrum in two cases. The histological findings were tubular type adenocarcinoma in 11 cases, with ten cases of moderately to poorly differentiated adenocarcinoma and five cases of signet ring cell type adenocarcinoma. CONCLUSIONS: Even advanced gastric cancer lesions may not be detected during endoscopy. If a patient continues to complain of upper gastrointestinal symptoms, even though endoscopy does not find abnormal findings, repeated endoscopy and/or additional diagnostic studies should be considered.

The Study on the Na(+), K(+)-ATPase Activities of the Spontaneously Hypertensive Rats

Although the mechanism of the development of hypertension has not been fully elucidated, abnormal ion transport across the cardiovascular musle membrance may play some role in this mechanism. The elevation of intraceular sodium by inhibition of the Na(+), K(+)-ATPase diminshes the sodium gradient for calcium extrusion and/or increase Na(+)/Ca(++) exchange across the cell membrance. In any event, contractility and vascular tone of cardiovascular system can be incresed as reslut of an increase of intracellular calcium. Recently it is reported that the defects of Na(+), K(+)-ATPase occur in spontaneously hypertensive rat(SHR) hearts, compared to control normotensive Spargue Dawley(SD) rat hearts. However, one missing, unresolved question arose in the previous reports in whether the reduced Na(+)-pump activity in the heart of SHR is associated with the development of hypertension itself in these animals or is a consequence of inhertied pathological features that later reslut in a reduced pump activity. In order to clearify this question it is attempted to measured to measure the change of the Na(+), K(+)-ATPase activities in cardiac sarcolemma purified from both the normotensive SD rats and SHR rats during growth ; Simultaneously the charge of cation concentration in both intracellular space(RBC) and extracelluar space(ECF) are measured to the erythrocyte test(Garay and Meyer) applied to the clinical investiation of hypertension. The results obtained are summarized as follows ; 1) The systolic blood pressure of 7 week old SHR was 120-130mmHg, which was not significantly different from that of the age-matched SD rats. However, the blood pressure was elevated to 160-170mmHg in 13-15 week old SHR, even elevated to 190mmHg in one of 19 week old SHR. On the other hand, SHR, in which hypertension was well established had pronounced cardiac hypertrophy. 2) The Na(+), K(+)-ATPase activities in cardiac sarcolemma of the SHR rats were decreased gradually as hypertension established.The decrease of Na(+), K(+)-ATPase was well associated with the increase of intracellular potassium concentration.By contrast, thr Na(+), K(+)-ATPase activities and cation transports og the normotensive SD rats were not significanlty chaged during growth. 3) The charges of Na(+), K(+)-ATPase activities in SHR were specific because the activities of Ca(++)-ATPase which is one of the membrance bound enzyme were not changed during growth appeared to be a major fator which generated hypertension in SHR rats. However, question on how the Na(+), K(+)-ATPase activities are decreased and which event is initiative between reduction of Na(+), K(+)-ATPase and development of hypertension are still remained unclear. Recent literature suggests the there might be a genetic factor, so-called Na(+)-pump inhibitor, involved in the meachanism.

A Clinical Review on Cor Pulmonale

A clinical review was made on 48 cases with cor pulmonale who were admitted to medical department, National Medical Center, between 1973 and 1982, and the results were as follows : 1) Teh age of subjects ranged from 26 to 88, and their mean was 51. male to female ratio was 1.6:1 and majority of them were in their 6th and 7th decade. 2) COPD was the most common cause of cor pulmonale but pulmonary tuberculosis had also a considerable portion. Less commonly it was caused by chest deformity which was mainly from spine tuberculosis and kyphoscoliosis. 3) Almost all patients were admitted with over heart failure. 4) Laboratory features showed indirect evidence of heart failure and pulmonary hypertension in chest X-ray films, RVH patterns in EKG and hypoxia and hypertcapnea with metabolic compensation in arterial gas analysis. 5) The case fatality rate was one-forth and that from kyphoscoliosis was especially high(80%).

Clinical Observation on Poor R-Wave Progression

Poor R-Wave Progression(PRWP) of precordial leads is frequently encountered electrocardiographic findings of uncertain significance and has simply been deemed as suggestion of anterior myocardial infarction without concrete ground. 217 cases with poor R-Wave Progression have been analyzed on clinical records and results are as follows. 1) PRWP was most frequently found in fifties and sixities, comprising 63.9% of the subjects. 2) Co-existent disease entities with PRWP were classified into three categories, cardiovascular diseases, chronic lung diseases and normal variants. 3) The cardiovascular diseases related with PRWP were mainly hypertensive diseases, comprising 59.8% of cardiovascular diseases, followed by ischemic heart disease, valvular heart disease and cardiomyopathies. 4) PRWP may be an early sign of acute myocardial infarction in a certain part of cases, which was endorsed by typical clinical symptoms and enzyme studies. 5) As the criterion of PRWP, V3R equal to or less than 3 mm was thought more adequate for higher specificity rather than 4 mm.