Acute spontaneous coronary artery rupture is rare and the diagnosis might be missed due to high risk of mors subita. We present three patients hospitalized with signs of cardiac tamponade due to acute spontaneous coronary artery rupture. All the three were successfully operated with evacuation of the pericardial hematoma, identification of the bleeding site, and hemostasis. The patients were examined with coronary angiography and computer tomography, and no underlying cause of the rupture was detected. In patients presenting with cardiac tamponade, acute spontaneous coronary artery rupture is a possible diagnosis.

Background-The treatment of recurrent pleural effusion in advanced malignant disease should be efficient and with tolerable side effects. Since 1983 intrathoracic instillation of the antimalaria drug mepacrine has been used to achieve pleurodesis. The cytotoxic drug bleomycin has been claimed to be equally effective and with fewer side effects. The present study was designed to compare these two agents. Methods-Forty patients with carcinoma and pleural effusions refractory to repeated pleural aspirations over the previous 12 weeks were randomised to receive treatment with intrathoracic instillation of mepacrine or bleomycin. Fluid volumes before and after pleurodesis, drainage time, and side effects were registered and analysed, and the response to treatment was evaluated by clinical examination and chest radiography.

In the 18 months up to July 1983, 120 Björk-Shiley convexo-concave prostheses with 70 degrees opening angle were implanted in 47 women and 61 men aged 19-78 (mean 58.6) years. The prosthetic valves were aortic in 65 cases, mitral in 23 and both aortic and mitral in 20 cases. Emergency operation was required in ten cases, and concomitant surgery was performed in 43 (39.8%). The early mortality was 5.5%. A follow-up study, comprising 498 patient years, revealed 73.1% 5-year survival. There were three mechanical failures of prosthesis, in one of which re-replacement was successful. Elective prosthesis replacement was performed in four other cases judged to be at high risk of strut fracture.