It has been reported that myocardial bridging may be associated with myocardial ischemia, myocardial infarction, vasospasm, cardiac arrhythmia and sudden death. However, the mechanism whereby ischemia occur as a consequence of myocardial bridging remains unclear. Recently we experienced a case of myocardial infarction in a patient with myocardial bridging and atrial fibrillation. A 66-year-old man presented with severe chest pain. His ECG showed ST elevation in V3-V5 and atrial fibrillation with rapid ventricular response. He underwent coronary angiography, which revealed a thrombus in the distal portion of the myocardial LAD bridge. He was treated with antiplatelet agents, heparin, tirofiban and amiodarone and beta-blocker without percutaneous coronary intervention. Five days later, his clinical condition was recovered and follow-up coronary angiography revealed markedly improved blood flow of the left anterior descending artery. The previous thrombus had disappeared.
Aged ; Amiodarone ; Arrhythmias, Cardiac ; Arteries ; Atrial Fibrillation* ; Chest Pain ; Coronary Angiography ; Death, Sudden ; Electrocardiography ; Follow-Up Studies ; Heparin ; Humans ; Ischemia ; Myocardial Bridging ; Myocardial Infarction* ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors ; Thrombosis

BACKGROUND: During adult general anesthesia, we used 3~5 L/min of fresh gas flow(FGF) but low FGF are employed, the amount of anesthetic consumption and air contamination can be reduced. The aim of this study was to determine the minimal appropriate inflow rate of oxygen and nitrous oxide during semiclosed circle technique. METHODS: We selected 40 patients, ASA group 1 or 2, scheduled for elective, nonabdominal surgery under general anesthesia with semiclosed circle system. Anesthesia was maintained with 50% oxygen, nitrous oxide and enflurane, controlled ventilation was used; rate of 10/min, tidal volume of 10 ml/kg. After induction and vital signs stabilized, FGF was changed to 4 L, 3 L, 2 L and 1L/min at interval of 30 minutes. We observed mean airway pressure and arterial blood gas tensions. RESULTS: The changes of mean airway pressure did not correlated with fresh gas inflow rate. In arterial blood gas analysis, PaO2 showed a decreasing tendency significantly according to decreasing fresh gas inflow rate(p<0.01) but there were no clinical hypoxemia in all patients. There were no significant changes in pH, PaCO2 and base excess. CONCLUSIONS: We consider that FGF of 1~2 L/min is appropriate during adult general anesthesia because of economic and ecological advantages. Also, we consider low flow technique with below 1L/min can be used safely and effectively under proper gas monitoring such as oxygen analyzer, capnometer.
Adult* ; Anesthesia ; Anesthesia, General* ; Anesthetics ; Anoxia ; Blood Gas Analysis ; Enflurane ; Humans ; Hydrogen-Ion Concentration ; Nitrous Oxide* ; Oxygen* ; Tidal Volume ; Ventilation ; Vital Signs

Pancreatoblastoma is a rare tumor, which usually affects infants and young children. We report a case of pancreatoblastoma in a 51-year-old man. To our knowledge, this is the first case of pancreatoblastoma occurred in an adult in Korea. A 2,5 * 3.5 cm sized pancreatic mass was detected on routine examination. An enhanced computed, tamography scan showed a slightly low density solid mass in the body of the pancreas. An abrupt occlusion of the main pancreatic duct and filling defect at the body was noted in the endoscopic retrograde pancreatogram. On operation, a well circumscribed yellowish white mass with whitish capsule was found without adhesion. Histologic examination revealed that the tumor was made up predominantly of medium sized round to polygonal cells having finely granular cytoplaam arranged in solid sheet and acinar structure. Squamoid corpuscles with ovoid to elongated cells were also scattered. The patient is doing well postoperatively. In the review of the literature, the tumor may be biologically different in the older and younger age group.
Adult* ; Child ; Humans ; Infant ; Korea ; Middle Aged ; Pancreas ; Pancreatic Ducts

BACKGROUDN: Docetaxel is a highly effective chemotherapeutic agent with proven efficacy for non-small cell lung cancer (NSCLC). However, myelosuppression can be a substantial concern when docetaxel is administered every 3 weeks. Weekly administration of low-dose docetaxel has demonstrated a comparable efficacy together with a distinct toxicity profile with reduced myelosuppression. We conducted a phase II study of weekly administration of docetaxel and cisplatin or carboplatin in patients with advanced NSCLC to evaluate efficacy and safety. METHODS: Twenty-nine patients with advanced or metastatic NSCLC who had not received prior treatment were enrolled in the study. The patients received intravenous infusions of docetaxel (35 mg/m2 on days 1, 8, 15) and cisplatin (75 mg/m2 on day 1) or carboplatin (AUC 6), followed by a week of rest. RESULTS: Twenty-six patients were assessable for efficacy and all patients were assessable for toxicity determination. The overall response rate of the regimen was 44.8%. The median survival was 11.3 months, and the 1-year survival rate was 37%. Of the hematologic toxicities, grade 3/4 neutropenia were observed in 12.6% of the patients, but there were no episodes of neutropenic fever. Non-hematologic toxicities were mild. CONCLUSIONS: With this weekly dosing regimen, although efficacy is comparable, myelosuppression is substantially less, and the overall tolerability profile is better than with dosing every 3 weeks.
Carboplatin ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Fever ; Humans ; Infusions, Intravenous ; Neutropenia ; Platinum* ; Survival Rate