[Surgical treatment for ascending aortic aneurysm using a transthoracic left ventricular venting].

Three patients with ascending aortic aneurysms underwent graft replacement using deep hypothermic circulatory arrest with continuous retrograde cerebral perfusion. In all three cases, preoperative radiographic examination revealed that the aneurysm was large, thin, and adherent to the back of the sternum. For this reason, left ventricular venting was performed through a left thoracotomy before median sternotomy, to decrease both the risk of rupture of the aneurysm and the difficulty of cannulation. This new method, called transthoracic left ventricular venting, was very useful for performing a median sternotomy under hypotensive and hypothermic conditions adequate to reduce the risk of rupture and to manage any rupture immediately through deep hypothermic circulatory arrest.

[Surgical treatment of incomplete endocardial cushion defect in adult patients].

Seven adult patients (> or = 40 years old) and six pediatric patients with incomplete endocardial cushion defect (ECD) underwent corrective surgery in our institution. Preoperative catheterization study showed that the left-to-right shunting rate and the pulmonary-to-systemic flow ratio were greater in adult patients than those in pediatric patients, but systolic pulmonary arterial pressure was not high and similar in the two groups. The degree of mitral regurgitation by left ventriculography was mild or moderate in both groups. However, in adult patients, a variety of arrhythmias were observed. Postoperatively, NYHA grades and arrhythmia improved markedly in the adult patients. Surgical correction for ECD is recommended even in adult patients before aggravation of cardiac failure and arrhythmia.

[Pharmacokinetic and clinical evaluations of ceftriaxone in perinatal infections in obstetrics and gynecology].

Ceftriaxone (CTRX), an injectable cephem antibiotic agent, was studied for its pharmacokinetic properties and clinical usefulness in perinatal infections in obstetrics and gynecology on a multicenter basis. The study results are summarized below. 1. Following the one-shot intravenous injection of CTRX 1 g to pregnant women before labor, the maternal serum level of CTRX reached a peak at 131.8 micrograms/ml soon after the injection then it began to decrease gradually. T 1/2 was 6.7 hours. The umbilical serum level reached a peak at 16.0 micrograms/ml at 4.9 hours post-dose and decreased gradually with a half-life of 8.1 hours. The umbilical serum level was higher than the maternal serum level at about 12 hours post-dose. The amniotic fluid level reached a peak of 9.6 micrograms/ml at 12.8 hours post-dose. T 1/2 was 15.2 hours. The amniotic fluid level at about 15 hours post-dose or later exceeded the maternal serum level and was almost equal to the umbilical serum level at 24 hours post-dose. 2. Clinical usefulness was evaluated in 79 evaluable cases out of 89 treated for various infections at puerperium or for prophylaxis of infections at cesarean section or premature rupture of membranes (PROM). The efficacy rate was 100% in 7 cases of prenatal infections such as urinary tract infection and 30 cases of postnatal infections such as puerperal intrauterine infections. In 42 cases treated for prophylaxis in cases of cesarean section or PROM, the efficacy rate was 92.9%. Bacteriologically, 29 strains of pathogens were isolated from 26 cases. The disappearance rate of the pathogens was 96.0% as 23 strains were eradicated, 1 strain was substituted and no change was observed in 1 strain with unknown results in 4 strain. Skin rash and itching appeared in 1 patient as an adverse effect (1.1%). There were 10 cases of abnormal clinical laboratory test results such as elevated transaminase level were observed in 7 patients (7.9%). From the results, CTRX was considered to be a useful drug for the perinatal infection in the obstetrics and gynecology fields.

[Clinical studies on cefuzonam in the field of obstetrics and gynecology].

Cefuzonam (CZON, L-105), a cephem type antibiotic, was clinically studied in the field of obstetrics and gynecology. The results are summarized as follows: CZON 1-2 g was administered by injection twice daily to 11 cases of infections (4 of endometritis, 2 of pyometra, 3 of adnexitis and peritonitis, 1 of abdominal abscess, and 1 of puerperal fever). Clinical efficacy was excellent in 2 cases and good in 9 cases, with a very high overall efficacy rate of 100%. Slight elevations of GOT and GPT in 1 case were noted in clinical laboratory tests. No side effects attributable to the drug were noted. CZON is considered to be a useful drug for obstetric and gynecological infections.