Cardiac rupture remains a severe complication after acute myocardial infarction (AMI) and its prognosis is poor. Between February 1985 and February 1995, six male patients (age range, 59 to 76 years, average 65.2) underwent repair of heart rupture after AMI at our clinic. The time interval between heart rupture and emergency surgery ranged from one hour to 24 hours (average 11 hours). Two patients did not recover from the initial shock, and were treated by emergency operation under IABP or PCPS. These two patients both had the blow-out type of heart rupture, and were treated by the felt-sandwich method. Neither patient was cured, due to uncontrollable bleeding. The other 4 patients recovered from circulatory catastrophe after pericardial drainage, and surgery was then carried out. One blow-out type patient died of bleeding. Two cases of hemorrhagic dissecting type were successfully treated by the felt-sandwich method. One oozing type case was treated with fibrin-glue and good results were obtained. The hemorrhagic dissecting type or oozing type showed good results but the blow-out type showed poor results. Initial pericardial drainage after establishing the diagnosis and gentle handling of the heart is essential to obtain good results. For the blow-out type of repture, other strategy is needed to control bleeding and facilitate recovery from shock.

Thrombomodulin is an endothelial cell membrane protein that is released into the blood in soluble forms in response to endothelial damage. We evaluated thrombomodulin in blood samples taken from the femoral vein before, during and after elective surgery for abdominal aortic aneurysm in 9 patients. Thrombomodulin was measured using an ETA assay. Thrombomodulin decreased significantly just before aortic declamp from before surgery (p<0.001), and remained unchanged just after and 1 hour after aortic declamp. Three hours after aortic declamp, thrombomodulin increased significantly from 1 hour after aortic declamp (p<0.01), peaked at 6 hours after aortic declamp and then decreased. These data suggest that thrombomodulin did not increase significantly during surgery for abdominal aortic aneurysm.

Anastomotic false aneurysm (AFA) of the aorta or iliac artery is a rare but life-threatening complication of prosthetic grafts. We report a surgical case involving AFA of the right external iliac artery which developed at the site of peripheral anastomosis of the temporary bypass procedure used during prosthetic reconstruction of the descending aorta for dissecting aneurysm (DeBakey IIIb) 15 years previously. A 60-year-old woman was hospitalized with rapidly growing right lower abdominal mass. Computed tomography and angiography revealed that the mass was an anastomotic external iliac artery false aneurysm and surgery was performed. The AFA was exposed transperitoneally and resected with a part of the intact external iliac artery without complication. Anatomical reconstruction was completed with a prosthesis. The postoperative course was uneventful. We conclude that patients with retroperitoneal grafts require lifelong routine periodic follow-up and if an AFA is discovered, it should be resected.

We experienced unusual dilatation of gelatin-impregnated knitted Dacron prostheses after abdominal aortic aneurysm surgery. Therefore, we investigated dilatation of gelatin impregnated knitted Dacron grafts compared with other types of Dacron grafts after abdominal aortic aneurysm surgery. Eighteen grafts inserted after abdominal aortic aneurysm surgery were studied for to evaluate dilatation. Enhance CT was used to determine the external diameter of the most dilated portion of the abdominal aortic grafts and high speed plain CT was used to determine the most dilated internal diameter. The gelatin-impregnated knitted Dacron grafts dilated from 25% to 43.8% (mean 31.8±7.2%), significantly more than collagen impregnated woven Dacron grafts (p=0.0003). Moreover, high fever was frequently noticed after these grafts implantation (66.7%). Therefore, caution must be used concerning these implantation in aortic lesions and careful follow-up study should be performed after implantation.

We encountered an unusual disruption of an expanded polytetrafluoroethylene (EPTFE) axillofemoral bypass graft apart from that anastomoses. We suspected the possible robe of the physical effects of body movement provoking the disruption of the axillofemoral bypass graft and therefore examined the physical effect of body movement on the axillary-to-femoral artery graft in 15 healthy men. At the lower part of the graft, the physical effect was significantly stronger. The disruption of this axillary-to-femoral artery graft was associated with the physical effect of body movement.

The purpose of this study was to determine the effect of intraoperative autologous blood salvage during elective abdominal aortic aneurysm repair with Cell Saver 4 (Heamonetics Inc.). Fifty patients prospectively received intraoperative autologous transfusion (Group CS; n=50, 1991-94) and 25 received no intraoperative autologous transfusion (Group NCS; n=25, 1983-91). Only 7 patients in Group NCS received no homologous blood (28%), while 43 in Group CS received autologous blood transfusion (86%). There was no difference between the groups with respect to postoperative platelets counts or serum concentrations of total protein, albumin, BUN and LDH. We conclude that the use of the Cell Saver 4 reduces perioperative homologous blood during elective aortic aneurysm repair.

AIMTo investigate the associations of autosomal and X-chromosome homologs of the RNA-binding-motif (RNA-binding-motif on the Y chromosome, RBMY) gene with non-obstructive azoospermia (NOA), as genetic factors for NOA may map to chromosomes other than the Y chromosome.

METHODSGenomic DNA was extracted using a salting-out procedure after treatment of peripheral blood leukocytes with proteinase K from Japanese patients with NOA (n=67) and normal fertile volunteers (n=105). The DNA were analyzed for RBMX by expressed sequence tag (EST) deletion and for the like sequence on chromosome 9 (RBMXL9) by microsatellite polymorphism.

RESULTSWe examined six ESTs in and around RBMX and found a deletion of SHGC31764 in one patient with NOA and a deletion of DXS7491 in one other patient with NOA. No deletions were detected in control subjects. The association study with nine microsatellite markers near RBMXL9 revealed that D9S319 was less prevalent in patients than in control subjects, whereas D9S1853 was detected more frequently in patients than that in control subjects.

CONCLUSIONWe provide evidence that deletions in or around RBMX may be involved in NOA. In addition, analyses of markers in the vicinity of RBMXL9 on chromosome 9 suggest the possibility that variants of this gene may be associated with NOA. Although further studies are necessary, this is the first report of the association between RBMX and RBMXL9 with NOA.

Adult ; Chromosomes, Human, Pair 9 ; genetics ; Chromosomes, Human, X ; genetics ; Expressed Sequence Tags ; Heterogeneous-Nuclear Ribonucleoproteins ; genetics ; Humans ; Male ; Microsatellite Repeats ; genetics ; Nuclear Proteins ; genetics ; Oligospermia ; genetics ; Polymorphism, Genetic ; RNA-Binding Proteins ; genetics