A Case of Double Primary Cancer in Stomach and Rectum / 대한소화기내시경학회지

Double primary cancer is defined as the case of primary malignant tumors, which must be arise in different sites and have a different histologic appearences. The number of reported cases of double primary malignant tumors has increased in recent and the occurrence of multiple primary cancers in the same individuals is one of the interesting subjects for investigation and research in relation to the carcinogenic mechanism and/or genetic factors. We have experienced a case with double primary malignant tumors of different site origins such as stomach adenocarcinoma and rectal adenocarcinoma, which were diagnosed by biopsies with gastro and colono fiberscopy. For its great rarity, we report this case with review of literatures.

A Case of Gastric Leiomyoblastma / 대한소화기내시경학회지

A 48 year-old man was admitted with the chief complaint of epigastric pain for 10 days. With upper gastrointetinal series and gastrofiberscopy, there noted a round hemispherical submucosal tumar at lesser curvature side of stomach. Because of continuous epigastric pain and large submucosal mass with mucosal ulceration the patient undewent operation. After subtotal gastrectomy, we found the round well-demarcated tumor with mucosal ulceratian and hemarrhage, which located at muscular layer. Microscopically, dominent cells of tumor are round or polygonal epithelioid cells, which cytoplasm was lightly eosinophilic and was tightly coadenced about nucleus so that the bulk of the cell appeared clear. In the immunohistochemistry with desmin, the tumor cells are positive. Histological diagnosis was leiomyoblastoma of stomach. In 1960 Martin et al. described six cases of unusual round cell myogenic tumor of stomach. In 1962, Stout report a series of 69 similar cases and he proposed the term leiomyoblastoma'. Until recent, leiomyoblastoma are rare and largely misdiagnosed as leiomyoma or leiomyosarcoma. A careful histological study is recommended in case of smooth muscle cell tumor of stomach

Lung Volumes and Alveolorespiratory Function in Mitral Stenosis

Lung Volumes and alveolorespiratory function were studied in 30 cases of pure or predominat mitral stenosis in slightly to moderately compromized state, and the results were compared with those in the normal controls. In patients with mitral stenosis, there was a singnificant reduction in the vital capcity and the total lung capacity, whereas the residual volume and its ratio to the total lung capacity were significantly increased. The distribution of inspired gas was uneven as reflected by increase in the lung clearnace index and in the slope of phase III of the single breath nitrogen washout curve. The alvelolar arterial oxygen tension gradient and the physiological dead space were singinificantly increased despite a singinificant decrease in the arterial carbon dioxide tension. The diffusing capacity was also reduced in some cases.

Echocardiographic Observation in Patients with Mitral Valve Prolapse

Twenty-one cases of mitral valve prolapse (MVP) diagnosed by M-mode echocardiograms were studied in regard to the underlying or associated conditions, types of MVP, and dimensions of the cardiac structures and parameters reflecting cardiac performance determined by echocardiograms. In 9 cases, MVP was thought to be idiopathic origin. Associated conditions in the remainder were 5 cases of congenital heart disease, 2 cases of rheumatic myocarditis, 1 case each of aortic valve disease, ischemic heart disease and hyperthyroidism, and 2 cases of undiagnosed cardiac conditions. There were 2 cases of buckling type of MVP and in the remainder hammock type. In these 2 patients with hammock type of MVP, mitral valve echoes were seen in the left atrium during systole in 1 case, and diastolic anterior displacement of posterior mitral leaflet in the other. In 9 cases of idiopathic MVP, cardiac dimensions and parameters reflecting cardiac performance as determined from echocardiograms showed no significant differences from those of 27 normal controls.

Effects of Thoracentesis on Thoracic Impedance and Cardiac Performance

Effects of thoracentesis on thoracic impedance and cardiac performance were studied in patients with uncomplicated unilateral tuberculous pleural effusion. The speed of the removal of the pleural effusion in thoracentesis was essentially similar to that of a generally used for therapeutic purpose in daily practice. Thoracic impedance was measured in 23 cases before, 4 and 10 minutes after thoracentesis to the amount of pleural effusion aspirated was observed. In 11 cases out of 23, the changes in cardiac performance as assessed by stroke volume, cardiac output, heart rate, heather index and ratio of pre-ejection period to left ventricular ejection time(PEP/LVET) were observed 4 minutes after 150 ml to 1,000 ml of thoracentesis. In these cases, stroke volume, cardiac output, and Heather index were determined from impedance cardiograms, and PEP/LVET from mechanocardiograms recorded simultaneously with the former. A significant increase in thoracic impedance was observed both 4 and 10 minutes after thoracentesis. There was a slight but a significant correlation between the changes in thoracic impedance and the amount of pleural fluid aspirated only 4 minutes after thoracentesis. Thoracentesis showed no consistent influence on cardiac performance as reflected to stroke volume, cardiac output, heart rate, heart index and PEP/LVET. These facts suggest that measurement of thoracic impedance may be a useful method reflecting alterations in pleural fluid volumes, particularly when it occurs in a relatively short period of time, and the effects of thoracentesis of less than one liter on the cardiac functions as determined by the above-mentioned parameters were variable.

Studies on Apexcardiogram in Hypertension

Fractional time intervals during cardiac cycle were determined by means of the analyses of mechanocardiograms in 100 male patients with hypertension and 100 healthy males, which served as controls. The mechanocardiograms anyalyzed in this study were simultaneously recorded electrocardiograms, phoocardiograms, apexcardiograms and carotid pulse tracings. Of various time intervals during systolic in patients with hypertension, the mechanical systole(both C-D and C-A2 intervals), the isovolumic contraction time, the initial phase of ventricular contraction and the ventricular pressure elevation time were significantly prolonged, whereas the protodiastole was significantly shortened. The prolongation of the mechanical systole was caused primarily by the lengthening of the isovolumic contraction time, which resulted from the prolongation of the components of the latter, namely the initial phase of ventricular contraction and the ventricular pressure elevation time. During diastole, there were significant prolongation of the isovolumic relaxation time and the rapid ventricular filling period, and a significant shortening of the slow ventricular filling period. Among these time intervals, the mechanical systole(C-A2 inlerval), the isovolumic contraction time, the ventricular pressure elevation time and the isovolumic relaxation time showed significant positive correlation with blood pressure. On the other hand, the slow ventricular filling period was significantly negatively correlated with blood pressure. These facts suggested that the changes in these time intervals were related to increased afterload and/or resultant myocardial or hemodynamic alterations.

Studies on Apexcardiogram in Hypertension

Fractional time intervals during cardiac cycle were determined by means of the analyses of mechanocardiograms in 100 male patients with hypertension and 100 healthy males, which served as controls. The mechanocardiograms anyalyzed in this study were simultaneously recorded electrocardiograms, phoocardiograms, apexcardiograms and carotid pulse tracings. Of various time intervals during systolic in patients with hypertension, the mechanical systole(both C-D and C-A2 intervals), the isovolumic contraction time, the initial phase of ventricular contraction and the ventricular pressure elevation time were significantly prolonged, whereas the protodiastole was significantly shortened. The prolongation of the mechanical systole was caused primarily by the lengthening of the isovolumic contraction time, which resulted from the prolongation of the components of the latter, namely the initial phase of ventricular contraction and the ventricular pressure elevation time. During diastole, there were significant prolongation of the isovolumic relaxation time and the rapid ventricular filling period, and a significant shortening of the slow ventricular filling period. Among these time intervals, the mechanical systole(C-A2 inlerval), the isovolumic contraction time, the ventricular pressure elevation time and the isovolumic relaxation time showed significant positive correlation with blood pressure. On the other hand, the slow ventricular filling period was significantly negatively correlated with blood pressure. These facts suggested that the changes in these time intervals were related to increased afterload and/or resultant myocardial or hemodynamic alterations.