Seven patients underwent surgical repair of the distal aortic arch aneurysm from January 1990 to October 1997. They were 5 men and 2 women ranging from 63 to 78 years of age (mean, 72.7 years). All patients were operated with a median sternotomy only. There was one operative death, which was ruptured case. However, there were no major complications in non-ruptured cases. This retrospective study suggests that it is possible to repair the distal aortic arch aneurysm through a median sternotomy approach alone, when 1) descending aorta originates with normal size just distal to sacciform aneurysm, 2) the maximum diameter of the aneurysm is over 70mm and 3) distal involvement of the aneurysm does not extend beyond the bifurcation of the trachea. It is useful to retract descending aorta proximally by three threads with pledget for distal anastomosis in inclusion technique.

Direct coronary artery reimplantation to the aorta and mitral valve repair were successfully performed in a 29-year-old female with Bland-White-Garland syndrome (BWG syndrome). Under cardiopulmonary bypass, the main pulmonary artery was completely transected and the left coronary artery was excised with a cuff of pulmonary artery wall. Then the left coronary artery was directly anastomosed to the ascending aorta. Mitral regurgitation was repaired with valvulo-annuloplasty. The post operative course was excellent.

The effect of daily physical activity on oxidative stress is still an unknown issue, especially in middle-aged and elderly individuals. In this study, we examined the relationships of oxidative stress and antioxidant capacity with daily physical activity, taking into consideration the dietary antioxidant vitamin intake (vitamin B₂, C and E) of middle-aged and elderly people (66.0±7.0 years, n= 21; 10 males and 11 females, including 5 male trained runners) . Daily physical activity was measured using both a calorie counter and a questionnaire over a period of two weeks. The plasma concentration of thiobarbituric acid reactive substance ( [TBARS] ) and both oxidized and reduced glutathione concentrations ( [GSSG] and [GSH] ) in whole blood were determined in blood samples obtained at rest and immediately after two periods of acute exercise: maximal cycle ergometric exercise and steady state cycle exercise at 80% of ventilatory threshold (VT) for 30 minutes. At a given statistically controlled dietary antioxidant vitamin intake level (vitamin B₂, C and E), the amount of daily physical activity was associated with neither [TBARS], [GSH] and the ratio of [GSSG] / [GSH] at rest, nor changes in levels of these substances after both exercise tests. These data suggest that the amount of daily physical activity may have little influence on oxidative stress or antioxidant capacity at rest and after acute cycle ergometric exercise. Further investigation would be necessary to clarify how much volume or intensity of physical activity induces increased oxidative stress, from the aspect of habitual physical training and nutrition.

The patient was a 52-year-old man with a history of antiphospholipid syndrome (APS), renal dysfunction and myasthenia gravis (MG). On May 2, 1998, he had sudden chest pain while sleeping. Enhanced computed tomography revealed acute aortic dissection (DeBakey type I). We performed emergency graft replacement of the ascending aorta and the aortic arch under extracorporeal circulation. Because of perioperative anuria, we used peritoneal dialysis (PD) just after the operation. Two days after the operation, we performed re-intubation nine hours after the extubation of the tracheal tube, and performed re-extubation three days later. For a while, his postoperative course was uneventful, but because of gradual worsening of APS, we administered more prednisolone, but 74 days after the operation, he died of multiple organ failure caused by an opportunistic infection, sepsis, and disseminated intravascular coagulation. This was very rare case of acute aortic dissection with MG and APS. After administration of more glucocorticoids, it is important to be wary of opportunistic infections.