We describe an unusual 30-year-old female patient with a history of refractory hypertension and hypokalemia. She was diagnosed as primary aldosteronoism with bilateral adrenal hyperplasia 8 years age and blood pressure has been controlled with spironolactone 200mg/day, nifedipine 40mg/day, Cardura 4mg/day and oral potassium supplement till these days.

Recently refractory high blood pressure was developed and about 5×4×4.5cm sized left a-drenal mass was observed by abdominal CT. The hypertension and hypokalemia was controlled by left adrenalectomy.

Aortic dissection is caused by a circumferential or transverse tear of the intima by a discrepancy between the strength of the aortic wall and the intraluminal pressure.

Arterial hypertension seems clearly to be a factor in the genesis of aortic dissection.

An elevated blood pressure or evidence of its existence can be found in 70-80 percent of patients. Other factors predisposing to aortic dissection are congenital disorder of connective tissue, vasculitis, etc. But trauma or physical strain is unusual cause of classic dissection.

Diagnosis is confirmed by computed tomography, aortography or echocardiography.

A 62-year-old man without a history of hypertension, emphysema or congestive heart failure visited our hospital because of hoarseness which developed suddenly during the physical strain. A contrast material-enhanced computed tomographic (CT) scan was performed at an other hospital due to hoarseness, mild fever and general weakness. Then he visited to our ENT department and performed laryngeal CT due to hoarseness. The CT shows somewhat mass-like soft tissue, so he was transferred to our internal medical department.

The chest CT scan and simple chest PA was done and we found a dissecting aneurysm.

This case developed by Physical strain and diagnosed by hoarseness is unusual and rare.

Femoral pseudoaneurysm is important complication after diagnostic femoral catheterizationor more complex procedure.

With the increasing use of larger-size percutaneous instruments and periprocedual anticoagulant or antiplatelet agent the incidence of postcatheterization femorl artery injuries ncluding pseudoaneuiysm has increased in the past few years.

Duplex ultrasonography and addition of color- flow Doppler provides an accurate, noninvasive. risk-free diagnosis and faster detection of intraaneurysrnal blood flow and the track betweenthe injured artery and the pseudoaneurysm.

Though early surgical repair of the arterial defect is usually recommended because of severeand life-threatening complication such as rupture, fhrornboembolism, compression neuropathyetc, Ultrasono-Guided Compression Repair(UGCR) is to be first-line treatment for its advantagesuch as high success rate, low morbidity and cost-effectiveness.

The authors report 2 cases of femoral psoudoaneurysrns treated using UGCR with nlanualcompression with C-clamp at the same time as a nonsurgical treatment.

Hypothyroidism may accompany pericardial may accompany pericardial effusion occasionally, in the patient who complains of any symptom of hypothyroidism and dose not receive treatment. We have experienced two cases of hypothyroidism presenting with the symptoms of dyspnea and chest tightness. The cuase of dyspnea and chest tightness was pericardial effusion and congestive heart failure. So we report two cases of primary hypothyroidism presenting with pericardial effusion and review the literature.

To determine the effect of aging on left ventricular filling mitral valve flow was evaluatedwith conventional pulsed Doppler echocardiography in 100 normal subjects, aged 20 to 76 years, who had no evidence of cardiovascular disease. The subjects were classified into the5 groups, according to the age, with 20 subjects in each groups : 20-29 years(group I), 30-39 years(group II), 40-49 years(group III), 50-59 years(group IV) and 60-76 years(group V).

The results were as follows :

1) The LVEDD(Left Ventricular End Diastolic Diameter) and left ventricular mass indexwere significantly increased with aging(r=0.50, r=0.60) and the ejection fraction showed nosignificant differences among these groups.

2) With aging, the peak early velocity(Peak E) was decreased(r=-0.36) and the peak atrialvelocity(Peak A) was increased(r=0.43). The E/A ratio and atrial diastolic velocity were decreased significantly with aging and showed a negative correlation with aging(r=-0.70).

3) The deceleration time of early diastolic flow was increased with aging(r=0.29) but without significance.

4) The isovolumetric relaxation time was significantly increased with aging(r=0.75).

In conclusion, as myocardial stiffness increases with aging, nonuniformity of myocardialrelaxation is frequently associated in older age group. Thus, a certain echocardiographic parameter shows abnormal value with normal aging process : the IVRT and DT are prolonged, Peak E is decreased and E/A ratio increased. For correct evaluation of the left ventricular diastolicfunction, age should be considere, along with the other factors such as loading conditionsof the heant heart rate and the contractile status of the heart.

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• Analysis of the Influence of Doppler Incidence Angle in the Evaluation of Cardiac Diastolic Function
  Yon-Min Kim
  Journal of Radiological Science and Technology.2024; 47(6): 549.     CrossRef

Wilson's disease is an autosomal recessive abnormality in the hepatic excretion of copper that results in toxic accumulation of the metal in liver, brain, and the other organs. Wilson's disease associated with brain lesion was found in 25-year-old woman who had dysarthria, wing-beating tremor, and Kayser-Fleisher ring. Laboratory data revealed hypoceruloplasminemia, hypercuprinuria, hypocupronemia and increased copper deposition in the liver biopsy specimen. The brain CT showed mild cortical atropy and bilateral low attenuation in lentiform nucleus.

Myxoma of the left atrium is known to mimic the clinical and hemodynamic features of mitral valvular disease. The tumor was diagnosed by using the Echophonocardiography, CAT-scanning, and hemodynamic studies including left heart catheterization and angiography. The diagnosis was confirmed at operation. An electrocardiographic timing signal permitted correlation of heart sounds and pressure waves with movement of the tumor between the left atrium and the left ventricle. In early systole, the tumor suddenly moved from left ventricle to the left atrium, and a notch in the rising left ventricular pressure, a prominant c-wave, and loud, late element of the first heart sound were noted. In early diastole, the tumor moved rapidly through the mitral valve, causing an abrupt diminution in the left atrial volume, thus-causing rapid y-descent despite severe obstruction of the mitral valve. An early diastolic sound, thought to be an opening snap, appeared to be related to the checking of the tumor in the left ventricle.(Tumor plop). The unusual left atrial pressure pulse permits accurate preoperative diagnosis in left atrial myxoma. In this respect we evaluated the accuracy of the preoperative noninvasive studies for the diagnosis of intra-cardiac myxoma.

Serum calcium, magnesium and plasma renin activity were studied in the groups of 20 controls and 20 hypertensives. All patients were admitted to Ewha Womans University Hospital between March 1984 and August 1984. The following results were obtained : 1) The plasma renin activity in normal controls were 1.40±1.48mg/ml/hr, and 1.59±1.97 ng/ml/hr in hypertensives. Most of the hypertensives were normal renin hypetension. 2) The serum calcium in normal controls were 8.85±0.84mg/dl and 9.14±0.49mg/dl in hypertensives and had no correlationship between plasma renin activity and serum ca-lcium in controls, byt had positive correlationship in hypertensives (P<0.025). 4) The serum magnesium in normal controls were 2.85±0.82mg/dl and 2.63±0.34mg/dl in hypertensives and had no correlationship to mean blood pressure. 5) There were no correlationship between plasma renin activity and serum magnesium in both controls and hypertensives.

A case of lead poisoning is presented and recent litures are reviewed. A 47-year old male had been admitted to Ewha Womans University Hospital in March 1983 with chief complaints of abdominal colic & distention, nausea and tingling sensation of lower extremities after ingestion of herb pills(HAE GU SIN). Laboratory examinations are as follows; anemia with hypocromic, microcytic, basophilic stippling of erythrocytes in peripheral blood and bone marrow. Blood level of lead was 34.6mcg/dl, urine level of lead was 128.4mcg/L, coproporphyrine and ▵-ALA in 24hours urine were 270.8mcg/L, 19.9mg/L respectively. After treatment with BAL for 1 day, blood level of lead was 30.4mcg/dl, urine level of lead was 2988.6mcg/L, coproporphyrine and ▵-ALA in 24hours urine were increased to 667.2mcg/L, 5.5mg/L respectively and quantitative analysis of herb pills revealed 10% of containing lead.

Thirteen patients with a variety heart diseases were underwent operation for total correction of their defect successfully at Ewha Womans University Hospital from March, 1982 to February, 1983. Among 13 patients, three had patent ductus arteriosus, two tetralogy of Fallot, one ventricular septal defect, two constrictive pericarditis and five rheumatic valvular heart diseases. There was no surgical mortality. Their functional improvement was excellent until 6 to 12 months' postoperative period. Although they were a few patients, we report these cases because we thought they might be a good experience for us in performing coming cardiovascular work.

Intermittent or transient left branch blook is a transient intraventricular conduction defect which was reported by many authors. Although variable etiologic and predisposing causes were considered, myocardial ischemia and hypertension were most important pathogenic factors of intermittent left bundle branch block. We had experienced one case of intermittent LBBB with hypertension and unstable angina and it was evoked by tachycardia, so we reported this case of 50-year old man with brief review of literatrue.

We experienced the left lower lobe pneumonia simulating myocardial infarction in the eletrocardiogram. Eletrocardiographic changes were return to normal after the pneumonic infiltration had subsided. The finding in our case simply reconfirm the well-established principle that the surface electrocardiogram mirros the electrical phenomena of the heart, and it is important to draw attention to noncoronary syndrome that mimic ischemic heart disease.

Tuberculous lesions in the liver are a common finding at autopsy in patients with pulmonary tuberculosis. However upto 1956, only 33 cases of tuberculosis the liver have been reported by exploratory lapartory or autopsy in all the world, but recently diagnosis is more easy with development of liver yet. Recently we had the opportunity to observe 31-year-old male patient who had pulmonary tuberculosis and developed clinical course of F.U.O. In this paper we report a case of tuberculous hepatitis which confirmed by liver biopsy and briefly review the literatures.