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Percutaneous mitral balloon valvotomy (PMV) introduced by Dr. Inoue in 1984 has been modified and developed in its methodology. PMV is now considered as a therapeutic alternative to surgical mitral commissurotomy in selected cases, but its long-term follow-up data are still needed. In order to evaluate the value of PMV as a therapeutic modality the 26 patients with severe mitral stenosis undergone PMV since October 1988 in Chonnam University Hopsital were analysed and the results were as follows. The procedure was technically successful in relieving mitral stenosis in 21 patients(80.8%), 18 with two monofoil balloon catheters and 3 with one bifoil balloon catheter. They were 13 male and 8 female patients, aging from 25 to 56 years, average 39.8±9.5 years. Immediately after successful PMV, mitral valve area by Gorlin's formula was significantly increased from 0.68±0.23 to 1.68±0.77(p<0.01), mean transmitral pressure gradient significantly decreased from 12.3±6.0 to 4.5±2.2㎜Hg(p<0.01), and cardiac output measured by thermodilution method increased from 3.2±1.6 to 3.7±1.3 L/min but statistically of no significance(p= 0.14). Thirteen(50%) of 26 patients experienced one or more complications. Mitral regurgitation newly developed or increased in its degree of severity in 6 patients, creation of atrial septal defect(Qp/Qs ratio more than 1. 3) 3, atrial perforation 2, significant bleeding from puncture site 2. Less frequent complications were acute myocardial infarction, chordae tendinae rupture, and protracted hypotension, one for each. There was no death and emergency surgery needed. PMV was failed in 5 patients, 4 failures were experienced during first 10 trials of PMV. The above results suggested that PMV could be an alternative to surgical mitral commissurotomy at least in selected cases.
Primary adrenocortical carcinoma (ACC) is a rare tumor and its usual sites of meta-stasis are the lung (71%), lymph node (68%), liver (42%), and bone (26%). How-ever, intracaval invasion extending into the right atrium is very rare and spontaneous regression of tumor burden in adrenal carcinoma is also rare. We report a case of ACC with direct invasion of the inferior vena cava and right atrium. A 34-yr-old male patient presented with progressive dyspnea, weight loss, and poor oral intake over 3 months. Non-functioning ACC with direct invasion of the inferior vena cava and right atrium was confirmed by imaging, pathologic, and hormonal study. Chemo-radio-therapy was attempted. However, tumor burden was not changed, but rather toxic hepatitis and thrombocytopenia were developed. His subjective symptoms and gen-eral conditions were improved after 1 month of conservative management and the patient was discharged. During clinical follow-up, this tumor showed spontaneous regression.
N/A An elevated serum alphafetoprotein (AFP) concentration in a nonpregnant adult is the most discriminating laboratory test indicative of malignant disease now available. AFP is found on low concentration in the serum of normal adults, but it appears in high concentration in fetal serum at 12 weeks gestation. Elevations in adults are associated with pregnancy, a variety of nonneoplastic liver diseases, primary hepatocellular carcinoma and teratocarcinoma containing yolk sac elements. Extensive evaluation of the serum AFP concentration as a diagnostic marker for primary hepatocellular carcinoma has been carried out over the last 10 years. The measurement of serum AFP concentration is very useful in the diagnosis of hepatocellular carcinoma. Hepatitis B virus has been linked to hepatocarcinogenesis and recent evidence suggests incorporation of the hepatitis B virus genome into the cancer cell chromosome. Serum AFP was measured quantitatively by radioimmunoassay technique in 296 patients, who visited the out-clinic or were hospitalized at Chonnam University Hospital during the period from June 1981 to July 1983. Those who were tested included 33 cases of normal population as control group, 133, hepatic diseases(46, primary hepatocelluar carcinoma; 11, hepatic metastatic tumor; 76, cirrhosis of liver; 13, acute viral hepatitis; 24, chronic hepatitis), 70 cases of nonhepatic malignant diseases, and 23 cases of the other nonhepatic diseases as the disease group. HBsAg was measured by enzyme immunoassay technique in 35 out of 46 cases of primary hepatocellular carcinoma. The results obtained were as follows; 1) The serum AFP concentration in 33 cases of normal control subjects was 4+-3 ng/ml (Mean+-S.D., Range: 0-12 ng/ml). Upper limit of serum AFP concentration in the normal adult was considered 10 ng/ml, which was derived from mean+-1.96 S.D. 2) In hepatic diseases, the serum AFP concentration was 30+-67 ng/ml(2-248 ng/ml) in acute viral hepatitis, 34+-57 ng/ml(1-260 ng/ml) in chronic active hepatitis, 10+-17 ng/ml (1-35 ng/ml) in chronic persistent hepatitis, 46+-74 ng/ml(0-350 ng/ml) in cirrhosis, 1,590+-2,245 ng/ml(0-8,000 ng/ml) in primary hepatocellular carcinoma and 86+-132 ng/ml(0-360ng/ml) in metastatic tumor of the liver. 3) Serum AFP concentration was exceeded the 400ng/ml only in hepatocellular carcinoma, which was revealed in 26 cases out of 46 cases of primary hepatocellular carcinoma. 4) HBsAg was positive in 21 cases out of 35 cases of primary hepatocellular carcinoma. In 16 out of 21 HBsAg positive cases, AFP was exceeded 400 ng/ml. 5) There were no significant changes of serum AFP concentration in the process of disease. Follow-up examination had been done at 2 to 6 weeks later the initial examination.