[Patient who developed acute myocardial infarction after total-gastrectomy].

We report a case of a man who underwent coronary artery stent placement, and developed acute myocardial infarction immediately after total-gastrectomy. Thirty-seven days before surgery, he developed an AMI due to 90% stenosis of #1 of the right coronary artery, for which a bare-metal stent was inserted. After the procedure, the patient took aspirin and ticlopidine, which were discontinued preoperatively. Even though the surgery progressed uneventfully, the patient developed ST-T segment elevation in II, III, aVF and complete A-V block soon after surgery. Emergency coronary angiography demonstrated 100% stenosis and clotting of the stent part, for which emergency thrombectomy was required. In conclusion, the risk is very high in the operation early after the insertion of BMS. Therefore, it is better to wait as long as possible and to avoid the easy stopping of the anticoagulant-drugs. It may be also better to give epidural-anesthesia.

Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality.

Background. Optimal treatment practices and factors associated with in-hospital mortality in spontaneous pneumothorax (SP) are not fully understood. We evaluated prevalence, clinical characteristics, and in-hospital mortality among Japanese patients with primary or secondary SP (PSP/SSP). Methods. We retrospectively reviewed and stratified 938 instances of pneumothorax in 751 consecutive patients diagnosed with SP into the PSP and SSP groups. Factors associated with in-hospital mortality in SSP were identified by multiple logistic regression analysis. Results. In the SSP group (n = 327; 34.9%), patient age, requirement for emergency transport, and length of stay were greater (all, p < 0.001), while the prevalence of smoking (p = 0.023) and number of surgical interventions (p < 0.001) were lower compared to those in the PSP group (n = 611; 65.1%). Among the 16 in-hospital deceased patients, 12 (75.0%) received emergency transportation and 10 (62.5%) exhibited performance status (PS) of 3-4. In the SSP group, emergency transportation was an independent factor for in-hospital mortality (odds ratio 16.37; 95% confidence interval, 4.85-55.20; p < 0.001). Conclusions. The prevalence and clinical characteristics of PSP and SSP differ considerably. Patients with SSP receiving emergency transportation should receive careful attention.