[Mistaken grafting to diagonal branch in minimally invasive direct coronary artery bypass: a case required reoperation].

The patient was a 75 year-old male who was admitted with recurrent chest pain during hemodialysis one year after PTCA to the right coronary artery and left circumflex branch (LCX). He had the history of cerebral infarction and chronic renal insufficiency. Coronary angiography showed severe stenosis from the left main trunk to left anterior descending artery (LAD) and restenosis at the PTCA site of LCX. The LCX lesion was dilated with PTCA. Minimally invasive coronary artery bypass (MIDCAB) with left internal thoracic artery (LITA) to LAD was carried out uneventfully. However, chest pain appeared on 1 POD. LITA angiography revealed that LITA was anastomosed to the diagonal branch that had occluded completely in the preoperative angiography. Off-pump CAB to LAD using inferior epigastric artery was carried out through median sternotmy on the same day. He recovered smoothly, and LITA angiography before discharge demonstrated that both grafts to LAD and diagonal branch are patent.

[Ventricular septal defect with pulmonary hypertension and concomitant left atrial myxoma in elder patient: a successful surgical case report].

A 70-year-old man was admitted with syncope attack on exertion. Ventricular septal defect with pulmonary hypertension and left atrial myxoma were confirmed by ultrasonography and cardiac catheterization. Preoperative Pp/Ps was 0.95 and pulmonary vascular resistance was 16 units. Pulmonary vascular resistance decreased to 9.6 units by the administration of Isoproterenol and decreased to 8.5 units with PGE1. Patch closure of VSD and excision of left atrial myxoma were performed simultaneously. The patient recovered completely, although he suffered from pneumonia and jaundice due to liver congestion postoperatively. Cardiac catheterization before discharge revealed Pp/Ps 0.38 and PVR 10.1 units.

[Fundamental and clinical studies of cefpiramide in the field of obstetrics and gynecology].

Cefpiramide (CPM, SM-1652), a new cephem antibiotic, was fundamentally and clinically studied. The following results were obtained. Serum and internal genital tissue levels of CPM were measured following intravenous drip infusion of 1 g. High serum levels of 30 micrograms/ml and tissue levels of more than 4 micrograms/g were at least maintained for 8 hours. Favourable transfer of CPM into the pelvic dead space exudate was observed. The exudate level was 7.25 micrograms/ml on average even at 8 hours after intravenous drip infusion. A total of 6 cases comprising 4 with Bartholin's cyst, 1 with pelvic peritonitis and 1 with lymphocyst was treated with CPM at a dose of 0.5-2 g twice daily by intravenous injection or intravenous drip infusion. The clinical response was excellent in 1 case and good in 5 cases. Side effects and abnormal laboratory findings due to the drug were not noted.

[Clinical trial and basic study on the tissue transfer of cefminox].

Cefminox (CMNX, MT-141) was studied both fundamentally and clinically with following results: In the treatment of 3 cases of Bartholin's abscess, 2 cases of pyometra, and 1 case each of bartholinitis, inflammation of the pelvic dead space, retroperitoneal abscess and pelvic peritonitis, CMNX was administered at a dosage of 1 g. The global clinical results were rated as good in 9 cases. From these findings it is considered that CMNX is promising as an antibiotic with extremely high efficacy for infections of the field of obstetrics and gynecology. Furthermore, since in none of our cases side effects or laboratory abnormalities were observed, CMNX is considered to be a drug with high efficacy and safety. In 5 cases received 1 g of CMNX intravenously, concentrations of the drug in the serum and tissues of internal genital organs were determined. CMNX was maintained at concentrations higher than 20 micrograms/ml for the serum and 10 micrograms/g for each tissue studied. In the pelvic dead space exudate 10 to 20 micrograms/ml of the drug was still detected even at 8 hours after the administration. These results obtained by our fundamental study support the efficacy of CMNX demonstrated in the clinical part of our study.

[Behaviour of uterine muscle calmodulin and contraction during pregnancy and under estrogen, progesterone administration].

The calmodulin levels of human and rat myometrium were measured during pregnancy and under estrogen, progesterone administration, and uterine muscle contraction at the same time was also measured. The calmodulin concentration in the uterine muscle was increased as the stage of pregnancy advanced. This increase also intensified the maximum contractility of the uterine muscle together with the increase of growth during pregnancy. The calmodulin levels were increased by the administration of estrogen and this increase was restricted by progesterone. As a result, the adjustment of the calmodulin level by administration of these steroid hormones was found to be a very interesting mechanism for studying the physiology of uterine muscle contractions.

[Clinical studies on sulbactam/cefoperazone in the field of obstetrics and gynecology].

Sulbactam/cefoperazone (SBT/CPZ), a new developed antibiotic, was clinically studied. The following results were obtained. Total of 5 cases comprising 1 with endometritis, 3 with Bartholin's abscess, 1 with pyometra (due to corpus cancer) were treated with SBT/CPZ at a dose of 1 g twice daily for 4-5 days by intravenous injection or intravenous drip infusion. The clinical response was good in all cases. A case with pyometra did not respond to the therapy in bacteriologically. Side effects and abnormal laboratory findings due to the drug were not noted.

[Fundamental and clinical studies of ceftazidime in the field of obstetrics and gynecology].

Ceftazidime ( CAZ ), a new cephalosporin antibiotic, was fundamentally and clinically studied. The following results were obtained. Serum and internal genital tissue levels of CAZ were measured following intravenous drip infusion of 1 g for 30 minutes. Serum levels of more than 10 micrograms/ml and tissue levels of more than about 7 micrograms/ml were maintained after 2 hours to 2 hours and 30 minutes, respectively. Favourable transfer of CAZ into the pelvic dead space exudate was observed. The exudate level attained its peak of 31.54 micrograms/ml on average at 2 hours and was 16.8 micrograms/ml on average even at 8 hours after intravenous drip infusion. A total of 6 cases comprising 1 of adnexitis, 2 of pyometra, 1 of endometritis and 2 of parametritis was treated with CAZ at a dose of 0.5 approximately 2.0 g twice daily by intravenous injection or intravenous drip infusion. The clinical response was excellent in 1 case, good in 4 cases and poor in 1 case. Abnormal laboratory findings and side effects due to the drug were not noted.

[Clinical trial of carmofur (HCFU) in the treatment of malignant ovarian cancer--The first report: combination therapy with endoxan, mitomycin C, and toyomycin].

A new fluoropyrimidine antitumor agent, carmofur (HCFU, Mifurol) was administered to patients with malignant ovarian tumor. Two of these patients revealed favorable results. The first patient was a 72-year-old female, who was diagnosed as having ovarian serous cystadenocarcinoma with metastatic omental tumor at exploratory laparotomy, its size was newborn child head size. She was started on with a combination chemotherapy of Mifurol (600 mg p.o. daily), Endoxan (4 mg/kg i.v. twice a week), Mitomycin C (0.04 mg/kg i.v. twice a week) and Toyomycin (0.01 mg/kg i.v. twice a week). After four weeks, this combination therapy brought her a complete response with disappearance of pleural effusion, ascites and metastatic tumor. The second case was a 39-year-old female, who underwent adnexectomy elsewhere which led to the discovery of Krukenberg tumor, and was referred to our hospital. After the first course of the same combination chemotherapy, second look operation was performed. Histological examination of the specimen obtained by metastatic tumor of uterosacral ligament showed the degeneration (grade II b-III, Oboshi and Shimozato) of cancer cell. It is suggested that this combination chemotherapy including Mifurol is effective and useful for the patients with ovarian carcinoma.