Endothelin is a 21-residue peptide vasoconstrictor produced by endothelium. The exact role of endothelin in the pathophysiology of renal disease has not yet been extensively demonstrated. Thus, to elucidate the pathophysiological significance of plasma and urinary endothelin-1 (ET-1) in patients with lupus nephritis. we studied 7 patients diagnosed as lupus nephritis by kidney biopsy and 7 healthy volunteers. Serum and urinary biochemical studies including creatinine and ET-1 were done, and urinary excretion of N-acetyl-β-D-glucosaminidase(NAG) was also measured.

The results were as follows ;

1) Patient poop and control group showed no significant differences in their clinical characteristics, basic biochemical studies, serum creatinine, plasma ET-1, urinary excretion of protein. NAG and creatinine and ET-1 clearance. Of 7 lupus nephritis patients, only 2 patients showed abnormal serum complement and anti-dsDNA.

2) In lupus nephritis patients, plasma ET-1 level showed no correlation with serum creatinine, complement and anti-dsDNA(p>0.05).

3) ET-1 clearance showed no significant correlaticn with creatinine clearance rate, complement anti-dsDNA ana urinlary NAG excretion.

Plasma ET-1 level and its clearance rate could not reflect the lupus nephritis activity. But our study included small number of patients and only 2 patients of pathologically proven lupus nephritis showed active disease, biochemically and clinically, ana the majority of patients has alreday been in remission state after treatment. Above factors probably acted as a bias against the results, leading to statistical limitations. In further studies, we should broaden our subject group in number and to other renal diseases than limiting to lupus nephritis and prospective long term follow up study is indicated to further investigate the role of urinary excretion of ET-1 and their mechanism of action on renal disease.

In the past gastric carcinomas composed predominantly of signet ring cells formed only a small percentage of gastric malignancies. However. we have had the impression that in recent years the relative incidence and amount of signet ring cells in biopsy and resection specimens of gastric carcinoma have risen sharply. This report is an analysis of 69 cases of signet ring cell type of gastric adenocarcinoma diagnosed at Ewha Womens University Hospital from January, 1987 to December, 1991. The results obtained were summerized as follows.

1) The male to female ratio was 1:1.2.

2) The peak age incidence was the 6th decade and the 7th decade with 23.9% each other, and the 8th decade with 17.4%, the 5th decade and the 4th decade with 16% each other. Average age of patients was younger than entire gastric adenocarcinoma.

3) The major clinical symptom was epigastric pain, indigestion, vomiting and abdominal fullness in decreasing orders.

4) The macroscopic feature of the signet ring cell type of adenocarcinoma by gastronberscopy showed Borrmann's type III 26 cases(37.6%), type IV 21 cases(30.4%), type II 10 cases(14.5%).

5) The location of signet ring cell type was mainly the gastric antrum 39 cases(56.5%), the body 18 cases(26%), and widespread from body to antrum 9 cases(13%).

6) The size of lesion showed above 3cm with 53%, 1.5~3.0cm with 31.3%, below 1.5cm with 15.7% in frequency.

7) Thirty out of 39 cases(76.9%) involve to the serosa, 3 cases(7.7%) to the muscle layer, 3 cases(7.7%) to the mucosa and the submucosa each other.

8) Distant metastases were relatively frequently occurred in increased CEA group.

9) Five-year survival rate of 49 cases was 62.8%.

Two-dimensional and color doppler echocardiography were performed on 54 newborn infants (20:full-term, 21:premature, 13:asphyxated) three times to estimate tricuspid regurgitation and pulmonary artery flow. The results were as follows :

1) Peak velocity of tricuspid regurgitation was significantly highest in asphyxated newborn, and it was significantly decreased as increasing age in three groups.

2) The percent of duration of tricuspid regurgitation was not significantly different among three groups, but they were significantly decreased as increasing age in three groups.

3) RA/LA area ratio was not significantly different among three groups, but it was signiacantly decreased as increasing age in three groups.

4) Peak flow velocity, acceleration time, acceleration time/ejection time ratio of pulmonary artery were not significantly different among three groups, but they were significantly increased as increasing age in three groups.

5) Preejection poriod/acceleration time ratio of pulmonary artery was not significantly different but it was significantly decreased as increasing age in three groups.

In conclusion, pulmonary artery pressure was normally decreased within 1~2 days by applying the Bernoulli equation to Doppler ultrasound measurement of peak flow velocity of tricuspid regurgitation.

The technique may be useful in prediction of pulmonary hypertension and treatment of persistent fetal circulation or cardiopulmonary distress.

In a prospective study of 59 epileptic patients receiving anticonvulsant drugs, the author evaluated routine screening for hematologic and liver toxicity. CBC, differential, platelets and liver function were obtained within 6 months after anticonvulsant medication.

During this time, the author evaluated the psychiatric symptoms and adverse effects of drugs. In laboratory monitoring, 5.1% of patients had minor abnormalities of blood studies(minimal below level of Hb, Hct, MCV) and 18.6% of patients had abnormalities of liver function(elevation of ALP, ALT & AST) necessitating rechecks. All were the same finding on repeat, but there were no clinical symptoms of hematological abnormalities and liver toxicity. In clinical monitoring, 62.7 of patients had psychiatric symptoms and the most common symptom was depression(15.3%). 71.2% of patients had minor adverse effects of anticonvulsants and the most common symptom was disturbance of school performance(18.6%).

Conclusively, severe toxic reaction was not in the patients with abnormal hematologic & liver function, but psychiatric symptoms and adverse effects of drugs were sufficiently evaluated from clinical observation. So, the author believes that clinical monitoring is more important than laboratory monitoring and routine blood & liver function is not necessary.

A clinical study was carried out on 227 cases of gastric cancer managed at Department of General Surgery of EWHA Woman's University Hospital, from January 1986 to December 1992.

The results were as follows :

1) The age were 27 years to 92 years, and the most freguent age group was 6th decade.

2) The sex ratio of male to female was 1.8:1.

3) The duration of symptom were less than 6 months in 62.5% and more than 6 months in 37.5%.

4) The most common subjective symptoms were epigastric pain & discomfort(79.2%), indigestion(33%), weight loss(13.2%) and nausea & vomiting(11.8%) respectively.

5) The proportion of blood group A among all cases was 37% which was slight higher than that of general population 32.6%.

6) Epigastric tenderness was most common physical finding(44.9%), but 14.5% of all cases had no physical findings.

7) The most common lesion location were antrum & pylorus in 69%, body and fundus were 27% and 4% respectively.

8) 99.6% of all acse were adenocarcinoma.

9) Early gastric cancer were found in 21.1% of cases.

10) The operability was 92.5%, and resectability was 85.9%.

11) Postoperative morbidity was 18%, Wound infection and enterocutaneous fistula were most common complications.

A series of 21 cases with traumatic intraventricular homorrhage diagnosed by computed tomography is described.

Most were victims of traffic accident and suffered from severe head injuries. Cerebral contusions and subarachnoid hemorhage were the most common associated findings. Blood was present in one or both lateral ventricles in 13 cases ; the 3rd or 4th ventricles in 2 and all ventricles in 6 cases.

The presence of IVH indicated a poor outcome. Poor outcome was associated with increasing age, low admission Glasgow Coma Scale, the presence of space occupying lesions and hemorrahge in all four ventricles.

IVH after blunt head trauma is uncommon and reflects the severity of the head injury.

Ultrasound has been found to be accurate, reliable and comfortable method in the measurement of spleen. Also ultrasound offers the rapid and simple method of estimating volume of spleen in vivo against the computed tomography.

The study was undertaken to obtain standard values of size in three dimensions and normal range of splenic volume by the use of splenic volumetric index(SVI) in normal korean adults.

The author analyzed 100 cases of abdominal ultrasonography of normal korean adults.

The results were as fallows :

1) The average size of spleen in adult male was 6.85±1.31cm in breadth, 4.93±1.27cm in thickness, 6.33±1.46cm in height ; in adult fermales, 6.61±1.23cm, 5.17±1.25cm, 6.33±1.42cm respectively ; total average, 6.73±1.27cm, 5.05±1.27cm, 6.33±1.39cm, respectively.

2) The average splenic volumetric index in adult male was 8.20±3.95 : in adult females, 8.41±4.08 : total average, 8.31±4.00 : upper limit, 20.65 : lower limit 2.24.

3) There were no statistical differences of SVI and size between sex and age.

Magnetic resonance(MR) is the most widely used diagnostic tool for the meniscal tears. 160 images of menisci of 30 patients and 10 normal subjects were photographed with coronal and sagittal planes and with narrow and conventional wide window settings. To access the diagnostic efficacy of imaging planes and the window settings, MR images of two window settings with coronal and sagittal planes of menisci were interpreted by four experienced observers. Images were graded on a five-point scale to enable receiver operating characteristic (ROC) curve analysis. The ROC curves constructed from the coronal plane were similar to those of the sagittal images. The area of under ROC curve constructed from the narrow window setting was inferior to one from the wide window settings. There was no difference of diagnostic performance between four observer to detect meniscal abnormality. This suggests that there is no globally significant improvement in the detection of meniscal tear when narrow window setting are used for interpretation, and there is probable improvement when both coronal and sagittal images are used for meniscal MRI.

We experienced a case of venous hemangioma, which was clinically suspected as a granuloma pyogenicum but confirmed histopatholoically. The patient was a 27-year-old woman, who showed erythematous bluish nontender nodules on the right nostril and ala nasi. Histopathologic examination showed blood vessels with thick fibromusclar wall and thin wall in the dermis. The blood vessel with thick wall was lined by a single layer of endothelial cells and lacked elastic fibers on Verhoeff van Gieson stain.

She was treated with surgical excision, laser therapy(SPTL-1) and intralesional triamcinolone acetonide injection.

The author reports the experiences of the transcondylar approaches to five meningiomas in the low clivus and foramen magnum, two aneurysms of the posterior inferior cerebellar artery and one cavernous angioma in the pontomedullary area. The results show that there, was no operative mortality and minimal operative morbidity was noted ; one patient has temporary oropharyngeal dysfunction. The main advantage of this approach of offers the best direct view of the ventral structures to low clivus and foramen magnum without additinal retraction or manipulation of the brain stem.