A case of a 77-year-old man is reported, who developed late rupture of the knitted Darcon velour graft by blunt trauma 8 years after implantation for axillo-femoral bypass. Dacron fiber deterioration, which led the graft to fragility, might have played a main role in the clinical setting. This case clearly emphasizes that with its possibility to be deteriorated life-long care and follow up should be taken for the patients who undergo arterial reconstructive surgery using Dacron prostheses.

We performed surgery for atrial fibrillation and mitral valve disease on 3 patients along with atrial mapping. Macroreentrant circuits were found in 2 patients and the other patient showed a preexcitation ectopic focus in the left atrium. Right atrial excitation was chaotic in all three patients. Of the two patients with reentry circuits, one patient underwent biatrial incisions and the other patient had only a left atrial incision. In the patient with a preexcitation ectopic focus, we performed cryoablation of that focus and made a left atrial incision in order to prevent the reoccurrence of atrial fibrillation after surgery. Following surgery, one patient experienced transient atrial fibrillation, however, continuous atrial fibrillation was resolved by this procedure and all patients returned to a normal sinus rhythm.

From March 1981 to March 1990, 61 patients with Stanford type B acute aortic dissection were initially treated by conservative therapy. Among these 61 patients, the dissected lumen became occluded due to thrombosis early after diagnosis in 25 patients (Group T) and remained patent in 36 patients (Group P). Twentythree patients in Group T (92%) and 22 patients in Group P (61%) were discharged without major complications related to acute aortic dissection. However, 2 patients in Group T (8%) and 14 patients in Group P (39%) required additional surgical therapy or died during hospitalization. The mean aortic diameter at the time of admission in Group T was smaller than that of Group P (38±3mm vs 43±7mm, p<0.05). During the observation period, there was a tendency for the diameter of the dissected aorta in Group T to decrease, but to increase in Group P. Long-term survival appeared to be better in Group T than in Group P, but there was no significant difference in the overall survival curve. Large aortic diameter at the time of admission and the presence of a true thoracic aortic aneurysm were major contributing factors influencing the prognosis. A long-term follow-up study showed that the dissected lumen reduced or disappeared in 14 of 23 patients in Group T (61%) but only 2 of 16 patients in Group P (12.5%). We concluded that the patients with small dissected aortas and thrombosed dissected lumens (Group T) can recuperate only with conservative therapy. However, patients with large dissected aortas and patent dissected lumen (Group P) may require surgical therapy even in Stanford type B aortic dissection.

Pregnancy and childbearing are important issues for female survivors of childhood, adolescent, and young adult (CAYA) cancer. Here, we report the case of a 38-year-old primiparous woman who had been treated with multimodal therapy for ovarian dysgerminoma in childhood. During junior high school, she had been admitted to our hospital complaining of abdominal distension, fever, and dyspnea. A massive abdominal tumor was found, and she was referred to a university hospital for treatment. Ovarian tumors suspected to be ovarian dysgerminoma were diagnosed, and right oophorectomy with lymph node dissection was performed. The left ovary was preserved. Postoperative histologic examination revealed ovarian dysgerminoma with class V ascites cytology, indicating Stage IIIc disease. The postoperative course was uneventful. Following surgery, she received bleomycin, etoposide phosphate, and cisplatin chemotherapy. Menarche occurred 12 years after surgery. She visited a gynecology clinic 24 years and 9 months after surgery because of suspected pregnancy. Pregnancy was confirmed, and she gave birth by vaginal delivery at a gestational age of 35 weeks + 1 day. Both the patient and child are now in good health. Fertility is an important consideration for CAYA cancer survivors. In cases of CAYA cancer, it is important to make treatment decisions together with patients with due consideration given to survival and fertility.