Primary Trabecular Carcinoid of the Ovary / 대한암학회지

Primary trabecular carcinoid of the ovary is very rare and less than 30 cases have been reported. Herein is reported a primary trabecular carcinoid of the ovary which contained an epidermoid cyst in a 80-year-old woman. Gross examination showed 12 x 11 x 7 cm- sized mass in the right ovary. On cut-surface, the mass was composed of multilocular cyst containing serous and keratinized material and of 5 x 3.5 cm-sized solid area with extensive necrosis and hemorrhage. Microscopic examination revealed that the tumor cells are almost arranged in trabeculae and focally in insular pattern. Also, the tumor contained an epidermoid cyst but not other teratomatous elements. Tumor cells were immunoreactive for cytokeratin, neuron specific enolase (NSE) and chromogranin. Electron microscopic tindings revealed characteristic, round-shaped neurosecretory granules and perinuclear microfilaments.

A Case of ST-Segment Elevation in a Patient with Subarachnoid Hemorrhage

There are several EKG changes in cerebrovascular disease(CVD). The wide prominent of inverted T wave is frequently developed in patients with CVD. There were case reports for CVD in patient with ST-segment elevation without myocardial infarction, but the exact mechanism is unknown. EKG abnormalities associated with subarachnoid hemorrhage were first described by Byer et al, in 1947.1 We report the case of 72 years old female patient who developed subarachnoid hemorrhage and intraventricular hemorrhage with ST-segment elevation.

Microalbuminuria as a Predictor of Coronary Artery Disease in Non-Diabetic Subjects

BACKGROUND: Microalbuminuraia is a strong prognostic factor for cardiovascular morbidity and mortality in type I and II diabetics. Recent data suggest that microalbuminuria predicted cardiovascular disease independent of hypertension in one of two large-scale studies performed in non-diabetics. Additional possibilities could be a previously documented association with other major and interconnected cardiovascular risk factors, such as insulin resistance, and elevated cardiac mass, abnormal circulation lipid levels, and overweight. The object of this study os to investigat the incidence of microalbuminuria, and to define the pathophysiologic mechanism of microalbuminuria to contribute coronary heart disease in non-diabetic patients with angiographiclly documented coronary artery disease(CAD). METHODS: The study group comprised 31 patients(M;21, mean age 60+/-30 year) with angiographically documented CAD and 15 normal control(m;9, mean age 62+/-7 year). Urinary albumin excretion, blood pressure, echocardiographic left ventricular mass indes, plasma abdominal/hip circumference ratio, fasting glucose, insulin, and c-peptide were studied. The microalbuminuria was defined urinary albumin more than 20ug/min. RESULTS: 1) Six of 31 patients with CAD(19.4%) and none of 15 normal control had microalbuminuria. Hypertension were documented 13 of 31 patients with CAD, and none of 15 normal control(p<0.01). Five of 6 patients with CAD and microalbuminuria and 8 of 25 patients with non-microalbuminuric aptients had hypertension (p<0.05). 2) In the microalbuminuric subjects with CAD, body mass index(29.0+/-3.2vs 24.8+/-3.5), systolic blood pressure(138+/-31 vs 118+/-15mmHG), lipoprotein(a) (69+/-31vs 32+/-32mg/dl), fastion C-peptide(5.5+/-2.2 vs 2.7+/-1.6ng/ml), and microalbumin(221+/25 vs 9.6+/-7.9mg/day)were significantly greater than in normal control(p<0.05). But no difference in left ventricular mass, lipid profile, and abdominal/hip circumference ratio existed between the microalbminuric patients with CAD and normal control. 3) Between the microalbuminuric patients with CAD and without CAD, no signficant difference were noted excepr lipoprotein(a) lever(69+/-31 vs 29+/-29mg/dl), fasting C-peptide(5.5+/-2.4 vs 2.5+/-1.2ng/ml), and microalbumin(221+/-247 vs 8.6+/-6.7mg/day). CONCLUSION: Microalbuminuria was associated with history of hypertension or concurrent antihypertension therapy and insulin resistance in non-diabetics with CAD. But left ventricular cardiac mass, central obesity inedw, and lipid profile were not related with microalbuminuria. The underlying presence of a major risk factor such as hypertension and insulin resistance might be explain the previously reported predictive value of microalbuminuria for cardiac events.

Exercise-Induced ST-Segment Depression in Patients after Successful Coronary Angioplasty

BACKGROUND: Exercise induced ST-segment depression in patients after coronary angioplasty is frequently observed but the mechanism responsible for exercise induced myocardial ischemia early after successful coronary angioplasty is poorly understoodd. The object of this study is to investigate potential determinants of this phenomenon by analizing the clinical, exercise testing, and angiographic characteristics in patients with exercise induced ST-segment depression. METHODS: The study group comprised 13 patients with exercise induced ST-segment depression(Positive group,M:12, mean age:59+/-9year) and 26 patients without exercise induced ST-segment depression(Negative group, M; 22, mean age; 55+/-13 year) after succeessful coronary angioplasty in single vessel disease. We compared preangioplasty clinical, angiographic, and hemodynamic variables in group with positive and negative results on exercise testing after successful PTCA. RESULTS: 1) Clinical characteristics: The initial diagnosis were acute myocardial infarction in 5, unstable angina in 8 patients at positive group, and 16 and 10 patients at negative group, respectively. There were no significant different in initial diagnosis, risk factor for coronary artery disease, and medication used before exercise test at between two groups. 2) Cornary angiography and PTCA: The maximal ballooning size were significantly smaller in positive group than negative group(2.7+/-0.5 vs 3.1+/-0.4mm, 2.9+/-0.4mm, vs 3.2+/-0.4mm, respectively(p<0.05) but there were no significantly different in ejection fraction, end-diastolic volume, end-systolic volume before PTCA. degree of stenosis of lesion before and after PTCA, total ballooning time, balloon pressure, lesion site and infarction relation of lesion at between two groups. 3) Exercise test: The mean time from angioplasty to the performance of exercise testing were 9.5+/-4.0 days in positive group and 6.1+/-4.5 days in negative group. The mean depression of ST-segment was 1.5+/-0.5mm and was predominantly noted in lateral leads(V4-6)(9/13:69%). There were no significantly different in total exercise time, rate-pressure product, and metabolic equivalents-exercise time at positive and negative group. But positive results at follow up exercise test were significantly higher in positive group(p<0.05). CONCLUSION: There were no definite determinating factors for exercise induced ST-segment depression early after successful coronary angioplasty by analizing the clinical, angiographic, and exercise testing variables. The pathophysiologic mechanism of this findding remain to be elucidated, especially for association of microvascular functional alternation.