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.

The effects of exercise and dietary therapy on the prevention of diabetic nephropathy (DN) were compared. Thirty-two male OLETF rats were divided into four groups (Ex, Diet, Sed, Pre) . Fourteen LETO rats served as the normal controls. Therapy was conducted for 10 weeks from age 22 to 31 weeks. The Ex group was trained by voluntary exercise, and the Diet group had a restricted food intake resulting in the same BW as that of the Ex group. The Ex developed a significant increase in urinary albumin excretion compared to the Diet group, although significantly less than the Sed group. Blood pressure in the Ex group showed a tendency to be higher during therapy. BW and serum lipids were significantly reduced, and glucose intolerance was improved in both the Ex and Diet groups. There were no differences in the metabolic indices between the Ex and Diet groups. The Ex group showed a significantly heavier kidney weight and a tendency for enlargement of the glomerular area and volume. The protective effect of DN through improvement of the metabolic dis-order by exercise might be offset by exercise-induced renal loads. Control of exercise intensity and blood pressure appear to be important as well as the improvement of glucose intolerance and lipid metabolisms in exercise therapy to prevent an occurrence and development of DN.

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.