Penetration of different kinds of peptides or collagen peptide through the intestinal membrane was studied in two experiments using anin vitrorat everted intestine penetration model. In Study 1, twelve 11-wk-old rats (Wistar strain) were randomly divided into two groups and penetration of whey peptide (n=6) and soy peptide (n=6) through the intestinal membrane was compared. In Study 2, fourteen 11-wk-old rats (Wistar strain) were divided into a control group (n=7) and a training group (treadmill running at a speed of 20-35 m/min for 15 mm day, 5 days wk for 4 wk n=7), and penetration of collagen peptide through the intestinal membrane was investigated in the two groups. In Study 1, the quantity of whey peptide that penetrated through the intestinal membrane was significantly greater than that of soy peptide (P<0.01) . In Study 2, body weight was significantly lower in the training group than in the control group except during 12 and 12.5 wk of age (13.5 wk ; P<0.01, others; P<0.05) . The weights of heart, kidney, and spleen were significantly increased, and the weight of fat was significantly decreased in the training group compared to the control group (P<0.05, P<0.05, P<0.01, P<0.05, respectively) . In both groups, a portion of collagen peptide penetrated through the intestinal membrane; but there was no significant difference in quantity between the two groups. In conclusion, the inhibition of weight gain in the training group was possibly caused by decreased feeding from lack of appetite with enforced exercise. These findings suggest that whey peptide penetrated through the intestinal membrane in greater quantities than soy peptide, and collagen peptide is not affected by enforced exercise.

A 74-year-old male who had a medical history of thoracic endovascular aortic repair (TEVAR) was referred to us for endoleakage. A total of 21 years ago, he underwent emergent descending aortic grafting for aortic aneurysm rupture at his age of 53. After that, 19 years ago, he underwent TEVAR with Matsui-Kitamura stent graft (MKSG) due to pseudoaneurysm formation at the proximal anastomotic site at the age of 55. CT revealed type III endoleakage due to fracture of MKSG and graft. We proceeded to perform TEVAR with Relay Plus successfully, and his endoleakage disappeared. His postoperative course was uneventful. He was discharged from our hospital on the 9th day after the operation, and is now doing well.

A 70-year-old woman diagnosed with angina pectoris was scheduled to undergo off-pump coronary artery bypass grafting (OPCAB) using the left internal thoracic artery and the saphenous vein (SVG). We performed a proximal anastomosis of the SVG to the ascending aorta using a clampless proximal anastomotic device. When this device was removed from the ascending aorta after completion of the SVG proximal anastomosis, we noticed the extensive appearance of an ascending aortic adventitial hematoma. Transesophageal echocardiography revealed a flap in the ascending aorta, which was diagnosed as an iatrogenic aortic dissection. The decision was made to immediately perform an additional aortic replacement. There was an intimal tear consistent with the device insertion site, which was identified as the site for the development of aortic dissection. After performing an ascending aortic replacement, coronary artery bypass grafting was performed. Her postoperative course was uneventful, and enhanced CT on postoperative day 12 showed aortic dissection up to the level of the abdominal aorta, but the false lumen was completely thrombosed. Iatrogenic aortic dissection caused by proximal anastomotic device during OPCAB is a very rare but serious complication, and early intraoperative diagnosis and prompt additional surgical treatment were considered necessary to save the patient's life.

A 66-year-old woman attended our hospital for ascending aortic aneurysm. She was admitted with sudden back pain and acute aortic dissection of Stanford type B was revealed by computed tomography. We performed replacement of the ascending aorta and aortic arch with the frozen elephant trunk technique. The left pleural drainage fluid turned cloudy white after diet initiation on postoperative day 2. We diagnosed chylothorax with biochemical analysis and stopped oral intake completely, but the drainage increased to 3,700 ml/day. On postoperative day 8, completely thoracoscopic ligation of thoracic duct was performed. The drainage decreased immediately after the procedure. She could start meals on postoperative day 12 and was discharged on postoperative day 22. We conclude that a completely thoracoscopic ligation of thoracic duct for persistent chylothorax after aortic surgery can lead to early resolution.