A Case of Primary Mediastinal Embryonal Carcinoma Arising in the Posterior Mediastinum / 결핵

Primary germ cell tumors of the mediastinum are rare, accounting 1-5% among all germ cell tumors and 10% of all neoplasms in this area. Approximately 85% of these tumors occur in men with a mean age 29 years. These tumors are mainly found in the anterior mediastinum and appear grossly as large lobulated masses. They are frequently invasive at the time of diagnosis and almost 90% of patients are symptomatic. Primary nonseminomatous germ cell tumor arising in the posterior mediastinum is very rare. We report a case of 37- year old male arising from the posterior mediastinum. Serum tumors markers including alpha-fetoprotein and beta-hCG which are usually elevated in germ cell tumor were not elevated. He was found to have a primary mediastinal embryonal carcinoma with pulmonary metastasis at open exploration. He was treated with debulking surgery and cisplatin-based chemotherapy, died of sepsis after 15 months postoperatively.

Study of 24 Hour Ambulatory Blood Pressure Monitoring in Acute Stroke Patients

OBJECTIVE: Appropriate evaluation of hypertension is important in the patients with a stroke because hypertension is a major cause of a stroke. Blood pressure may be falsely elevated or depressed immediately after a stroke, depending on the severity of neurological deficit, mobility, and physical activity, and the level of consciousness. To overcome this problem, ambulatory blood pressure monitoring (ABPM) has been proposed as a method of obtaining a more accurate clinical assessment. SUBJECTS AND METHODS: The present study was performed in an acute stage of stroke patients to assess the manifestation of 24 hour ambulatory blood pressure, to observe the nocturnal blood pressure fall and to evaluate the relationship of blood pressure degree on admission and nocturnal blood pressure dip. Thirty four patients admitted within 24 hours after onset of acute stroke were involved in this study. 24 Hour blood pressure monitoring device was installed on an independent arm by oscillometric method as soon as brain imaging study was performed. ABPM readings were obtained each 30 minutes during daytime and each 1 hour during nighttime with electrocardiography. Each patients were classified as the presence or absence of hypertension. We examined nocturnal blood pressure dip and mean pressure of 24 hour ambulatory blood pressure. RESULTS: 1)This study demonstrated that comparing daytime with nighttime 24 hour ambulatory blood pressure, 20 of 24 patients (83%) with acute stroke with hypertension, did not show nocturnal blood pressure dip, and there was sustained high nocturnal blood pressure in patients with acute stroke with hypertension. 2)There were significant differences between 24 hour ambulatory mean daytime blood pressure and mean nighttime blood pressure in patients with acute stroke without hypertension, so was lower in nighttime (p<0.05). 3)It is likely that in acute stroke patients with hypertension, patients with higher blood pressure on admission had more abnormality of nocturnal blood pressure dip. CONCLUSION: These results suggest that in patients with acute stroke, 24 hour ABPM is useful method to assess diurnal variation and evaluate hypertension in acute stage of stroke patients, and suggest that patients with acute stroke with hypertension trend to loss of nocturnal blood pressure dip.

A Case of Atypical Ulcerative Colitis Initially Presented as the Appendiceal Lesion / 대한소화기내시경학회지

Ulcerative colitis (UC) is an inflammatory disease primarily involving the colonic mucosa. The extension of classic UC is uniform and continuous with no intervening areas of normal mucosa. The rectum is usually involved and the inflammation extends proximally in a continuous fashion for a variable distance. However, as more patients get colonoscoped, it had been reported that there is a wide spectrum to what is called UC. There appear to be a few patients with otherwise typical UC but with rectal sparing. And also there are patients with classic distal UC who have an isolated area of cecal disease and segmental UC with skipped area. We have experienced a case of atypical UC initially presented as a isolated lesion around the appendiceal orifice with the segmental distribution of inflammatory change without an active inflammatory lesion in the rectum. It was considered that understanding of the significance of an isolated lesion in the appendix would contribute to the elucidation of the pathogenesis of UC.

Clinical Investigation of P Wave Amplitude and Atrial Synchronous Ventricular Pacing in Different Body Position and Physical Activity with a Single-Pass Lead VDD Pacing

BACKGROUND: Single pass lead VDD pacing preserves atrioventricular synchrony with a single lead system which incorporates floating atrial electrodes. The objectives of this study were to measure whether different body postures and physical activities cause significant changes of the atrial electrogram amplitudes and to evaluate the effectiveness of its atrial sensing, ventricular sensing and pacing. METHOD: Prospective study was done in 7 patients with high degree AV block and normal sinus node function in whom a single lead VDD pacing system was implanted. The P wave amplitude was been measured in different condition during follow-up period. RESULTS: 1) During follow-up period, the P wave amplitude showed variation with changes in posture and respiration, but there was no consistent increase or decrease in amplitude. The lowest P wave amplitude was above the minimal atrial sensing value of 0.2 mV. 2) The percentage of atrial synchronous ventricular pacing recorded in Holter ECG and during Treadmill exercise test was more than 99%. 3) Atrial oversensing or VA cross sensing were not observed in any of the patients. CONCLUSIONS: Despite floating atrial electrode, the single pass lead VDD pacing maintains reliable atrial sensing and ventricular pacing in different body position and physical activity, so it may offer an excellent alternative in patients with high grade AV block and intact sinus node function.

Clinical Investigation of P Wave Amplitude and Atrial Synchronous Ventricular Pacing in Different Body Position and Physical Activity with a Single-Pass Lead VDD Pacing

BACKGROUND: Single pass lead VDD pacing preserves atrioventricular synchrony with a single lead system which incorporates floating atrial electrodes. The objectives of this study were to measure whether different body postures and physical activities cause significant changes of the atrial electrogram amplitudes and to evaluate the effectiveness of its atrial sensing, ventricular sensing and pacing. METHOD: Prospective study was done in 7 patients with high degree AV block and normal sinus node function in whom a single lead VDD pacing system was implanted. The P wave amplitude was been measured in different condition during follow-up period. RESULTS: 1) During follow-up period, the P wave amplitude showed variation with changes in posture and respiration, but there was no consistent increase or decrease in amplitude. The lowest P wave amplitude was above the minimal atrial sensing value of 0.2 mV. 2) The percentage of atrial synchronous ventricular pacing recorded in Holter ECG and during Treadmill exercise test was more than 99%. 3) Atrial oversensing or VA cross sensing were not observed in any of the patients. CONCLUSIONS: Despite floating atrial electrode, the single pass lead VDD pacing maintains reliable atrial sensing and ventricular pacing in different body position and physical activity, so it may offer an excellent alternative in patients with high grade AV block and intact sinus node function.

A Case of an Dilated Cardiomyopathy Combined with Guillain-Barre Syndrome

Many neuromuscular disorders involve the heart and may produce dilated or hypertrophic cardiomyopathy. Guillain-Barre Syndrome is an inflammatory polyradiculoneuropathy in which the autonomic nervous system is sometimes involved. ST-segment and T-wave abnormalities have been reported in which the autonomic nervous system is involved, and sudden death can be attributed to fatal arrhythmic or malignant hypertension, but cardiomypathy have been reported rare. 58-year-old woman who complained of pitting edema and exertional dyspnea was admitted. Dilated cardiomyopathy was diagnosed by transthoracic echocardiography. Guillain-Barre syndrome was diagnosed by clinical manifestation, EMG, and CSF tapping. T-wave inversion in electrocardiogram was noted, and left ventricular end-diastolic diameter and ejection fraction were 69.2mm and 37.5% respectively in transthoracic echocardiography. Coronary angiograms were normal and ergonovine test was negative. Plasmapheresis has been used as mainstay of treatment in patient with Guillain-Barre syndrome. She was treated with diuretics and digoxin. Motor paralysis improved gradually by plasmapheresis and left ventricular dysfunction improved after 8 months.