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Two uncommon cases of left ventricular rupture that occurred during cardiac surgery were treated successfully. These cases may be useful in understanding the etiology of common left ventricular rupture following mitral valve replacement. One case occurred during coronary bypass surgery. The myocardium which is already abnormal seems to be weak to trauma such as bending, traction and torsion. In the other case, who underwent mitral valve replacement with preservation of the posterior leaflet with its attached chordae, the disruption was localized in the epicardial side of the left ventricular posterior wall, though direct injury by some instrument was excluded as a possibility, with a depth of half the thickness of the wall. In experiments using dogs, shape and movement of the mitral annulus were examined. The length of the annulus attached to the posterior leaflet in end-systole was shortened to 89.0 +/- 4.6% of that in late diastole. Furthermore, the annulus was distorted by the elevation of the heart. We approve of Cobbs' "untethered ventricle theory" and consider moreover as follows: In general, whether with or without preservation of the mitral loop, the mitral annulus and the left ventricular posterior wall after mitral valve replacement are severely constricted by the rigid prosthetic ring and become tense, which limits movement in both circular and longitudinal directions. Then even slight stress may cause a primary tear on the posterior wall of the left ventricle, resulting in rupture. In order to treat the rift, the prosthesis must be removed before the apex of the heart is lifted, to avoid excessive ventricular wall tension.

We have used recombinant human erythropoietin (EPO) with an autologous blood predonation in open heart surgery looking forward to preventing patient's blood level of hemoglobin and quick recovery in post-operative period. In our results, patient's value of hemoglobin (Hb) and hematocrit (Ht) decreased due to autologous blood predonation. In group A (autologous blood predonation with EPO administration), however, predonated blood volume were larger than in group B (without EPO administration), decreased value of Hb and Ht were smaller than in group B. The counts of reticulocyte were higher in group A at the operative day. Among six cases phlebotomized with EPO administration, five cases required no homologous blood transfusion for their hospital course. Postoperative recovery of patient's Ht value were earlier in preoperative blood donation group. In particular, patients who administered EPO intravenously have showed fair recovery from anemia. EPO is very effective drug to prevent patients from the developing anemia as a complication of autologous blood predonation. We conclude that autologous blood predonation with EPO administration is beneficial method to reduce homologous blood requirement in open heart surgery.

The authors reviewed the computed tomographic (CT) scans of patients with subarachnoid hemorrhage whose initial angiograms were negative, to investigate the validity of CT scans in predicting the presence of an angiographically missed aneurysm in such patients. During the past 14 years, additional angiograms have been obtained for 38 of the 45 patients with subarachnoid hemorrhage whose initial angiograms disclosed no aneurysm. Aneurysms were found in 8 patients; 7 on the anterior communicating artery and 1 at the junction of the internal carotid and posterior communicating arteries. CT scans were taken within 4 days after subarachnoid hemorrhage in 31 patients. Analysis of these scans showed that the second angiogram revealed 1) an aneurysm in 21% of the patients with a thin layer of subarachnoid blood and in 63% of those with a thick layer; 2) no aneurysm in the patients without subarachnoid blood; and 3) an aneurysm of the anterior communicating artery in 70% of the patients who showed a considerable amount of blood in the basal frontal interhemispheric fissure. These results suggest that if CT scans show thin or thick subarachnoid blood, angiographic study should be repeated early in the course. If a considerable amount of blood is shown in the basal frontal interhemispheric fissure, it is highly probable that an aneurysm is hidden on the anterior communicating artery, even if the angiogram is negative for an aneurysm.

Following results were obtained from intravenous single administration of cefotaxime 2 g by measuring its levels in uterine arterial blood, elbow venous blood, ovary, oviduct, several sites in uterine tissue, and in the fluid excreted in the dead space formed by radical hysterectomy. (1) Uterine artery and elbow vein blood levels revealed marked increase immediately after administration followed by gradual reduction at slow rate. (2) Peak levels in female internal genital organ tissue were achieved 12 approximately 19 minutes after cefotaxime administration, and ranged between 5 to 8 mcg/g independently from measurement site. In cervix uteri, portio vaginalis high concentration of 4.9 approximately 5.7 mcg/g was achieved within ten minutes after drug administration. (3) In the fluid excreted in the dead space formed by radical hysterectomy cefotaxime levels were maintained around 15 mcg/ml level throughout 5 approximately 6 hours following its administration, and gradually decreased at slow rate later.

The authors report a case of a dermoid cyst in the right anterior cranial fossa, which communicated spontaneously with both the subarachnoid space and the lateral ventricle. The communication was demonstrated by metrizamide computed tomographic cisternography before operation and was verified during operation.

A case of ventricular diverticulum causing cerebellar ataxia is presented. Computerized tomography clearly demonstrated the aperture of the diverticulum in the medial wall of the trigone and its extension into the posterior fossa. The diverticulum regressed and the cerebellar ataxia disappeared after placement of a ventriculoperitoneal shunt.

Following results were obtained from intravenous administration of T-1982 (cefbuperazone) 1 g by measuring its concentrations in uterine arterial serum, cubital venous serum, oviduct, ovary and several sites in uterine tissue. Endometrium showed the highest concentration among various uterine tissues by any administration (bolus injection, dripping infusion for 1 or 2 hours). Transfer concentrations about 1 hour after the end of 1 hour drip infusion proved to be almost the same as 2 hours drip infusion. In the field of obstetrics and gynecology, it was considered that T-1982 has good efficacy in infections especially caused by E. coli, Klebsiella and Proteus.