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Objective: A myocardial bridge is an anatomic arrangement in which an epicardial coronary artery becomes engulfed for a limited segment by myocardial fibers from birth. It is recognized angiographyically by systolic compression of coronary artery. A large discrepancy exist between pathological series, in which the incidence has varied from 15% to 85%, and angiographic seires, in which it is reported as being between 0.51% and 2.5%. A myocardial bridge has been associated with myocardial ischemia, infarction and sudden death, but its clinical significance is controversial, The aim of this study was to assess the clinical characteristics and significance of myocardial bridge based on our exerience. Method: We reviewed the consecutive 1554 cinean-giograms performed in the cardiac laboratory of the Keimyung University Hospital from Nov, 1992 to May 1996. Two groups were constituted according to percentage of systolic reduction of the arterial lumen assessed visually or by computerized digital caliper. We differentiated them between below 50% and above 50% in the systolic reduction. Comparison between variables in two groups were made. Results: 1) Myocardial bridges were present in 36 patients (2.3%). 2) Among these patients, 21 had angina (58.3%), 8 had myocardial infarction (22.2%), 6 had hypertension (16.7%) and 4 had hypertrophic cardiomyopthy, primary pulmonary hypertension, mitral regurgitation and aortic regurgitation, respectively. 3) The highest prevalance was found in the mid-left anterior descending (LAD) artery (80.5%), next in the distal LAD artery (11.1%). Two cases had myocardial bridges in two sites. 4) Isolated myocardial bridges which excludes those associated with concomitant cardiovascular diseases were present in 19 patients (1.22%). Initiol symptoms in patients with myocardial bridge are exercise induced angina in 10, atypical chest pain in 3, resting onset chest pain in 3 and palpitation in 1 at admission. Two patients had no specific symptoms except electrocardiographic abnormality. 5) Clinical diagnosis of patients with isolated myocardial bridges were anginal pectaris in 13, myocardial infarction in 2 and nonspecific in 4. Myocardial infarction was present in the group of above 50% of systolic reduction. Conclusion: A myocardial bridge may induce myocardial ischemia and myocardial infarction, but prognosis may be good if patients should avoid precipitating factors i,e. condition induce tachycardia or administered β-blocker etc.
Primary mediastinal seminoma is a rare germ cell tumor histologically identical to testicular seminoma. We experienced one case of Primary mediastinal seminoma recently. He was 51-year old, and complained of progressively severe anterior chest pain and dyspnea for 3 weeks before the time of diagnosis. Echo-cardiogram showed massive pericardial effusion in anterior portion of the right ventricle and posterior portion of the left ventricle with thickened pericardium, During admission, cardiac tamponade was developed, and pericardiectomy was performed. But we couldn`t excised totally because of severe adhesion of anterior mediastinal structures. Pathological findings were pure seminoma developed in thymus with fibrosis and organized hemorrhage in pericardium and pericardial peel. In our case seminoma is associated with possibly tuberculous constrictive effusive pericarditis. We treated with combination chemotherapy followed by irradiation with favorable results.
Background/Aims: We carried out this study to adapt various positive parameters of 24 hour pHmetry for diagnosis of gastroesophageal reflux disease and to determine a correlation between Bernstein test and 24 hour pHmetry. Methods: Sixty-six patients who complained of non-cardiac chest pain underwent Bernstein test and 24 hour pHrnetry. We defined the positive parameters of 24 hour pHmetry as the time percentage of esophageal pH below 4, above 5.78% or 11%, DeMeester score ahove 14,7, symptom index, above 25% or 50%, symptom sensitivity index above 5%. We compared the results of Bernstein test with those of 24 hour pHmetry. Results: On esophageal 24 hour pHmetry, the number of the patients who showed the time percentage of esophageal pH below 4 above 5.78% was 9 (13.6%), above 11% was 4 (6.1%). DeMeester score above 14.7 was seen in 10 (15.2%). Symptom index above 25% was seen in 9 (13.6%), above 50% in 4 (6.1%). Symptom sensitivity index above 5% was observed in 5 (7.6%). Total positive rate was 24.2%-27.2%. On Bemstein test, positive rate was 50%. Ten to twelve patients (30.3%-36.4%) out of 33 patients who were positive for Bernstein test showed positive esophageal 24 hour pHmetry. Six patients out of 33 patients who were negative for Bernstein test showed positive esophageal 24 hour pHmetry. There was no conelation between 24 hour pHmetry and Bernstein test using a kappa index. Conclusions: The positive rate of 24 hour pHmetry for Korean people was lower than that of western people and there was no correlation between Bernstein test and 24 hour pHmetry, We think further investigation should be conducted to confirm the positive parameters of 24 hour pHmetry.