A 66-year-old man with an unknown medical history developed chest pain and a diagnosis of acute myocardial infarction (AMI) was given by his physician. Percutaneous coronary intervention was performed in the left anterior descending artery. Echocardiography revealed ventricular septal perforation (VSP) ; therefore, the patient was transferred to our hospital. After admission, his platelet count dropped rapidly during heparin administration, and left ventricular thrombosis and deep vein thrombosis were noted, raising a suspicion of heparin-induced thrombocytopenia (HIT). To establish cardiopulmonary bypass, argatroban alone was insufficient to prolong the Powered by Editorial Manager^® and ProduXion Manager^® from the Aries Systems Corporation activated clotting time (ACT) ; thus, nafamostat mesilate was also used for coronary artery bypass grafting and surgical repair of VSP. It took many hours to normalize the ACT, requiring re-exploration for excessive bleeding. On the 37th postoperative day, the patient was transferred to another hospital. We performed cardiac surgical procedures using argatroban in a patient who developed HIT during the course of VSP following AMI ; however, we had difficulty in controlling the ACT. Since, to the best of our knowledge, there are no previous studies reporting surgical case of VSP complicated by HIT, we present this case with a review of the relevant literature.

The case was a 27-year-old woman with a history of Turner syndrome. The patient underwent ascending-descending aorta bypass for aortic coarctation 6 years previously and underwent subsequent follow-up on an outpatient basis. She consulted our department because of fever, chest pain and headache as the main complaints. Age-indeterminate type A aortic dissection was found on computed tomography, and she was admitted to the hospital on the same day. Echocardiography also revealed an enlarged aortic root and bicuspid aortic valve. Aortic root replacement and total arch replacement were performed, and her postoperative course was favorable. It is reported that in cases of Turner syndrome with aortic coarctation, aortic aneurysm and aortic dissection are likely to occur due to the vulnerability of the aortic wall. We encountered a patient with Turner syndrome who underwent ascending-descending aorta bypass for adult aortic coarctation and subsequently developed type A aortic dissection, underwent aortic root and total arch replacement, and rehabilitated after surgery, as well as provide bibliographic considerations.

Introduction   Redox state of glutathione as an oxidative stress marker changes by exercise. Therefore, oxidative stress marker has been used to evaluate the physical condition of athletes. In athletics it is important to prevent fatigue for peak performance. Acupuncture has been used for fatigue prevention of athletes. However, there is little scientific evidence to prove the effect. The purpose of this study is to examine the effects of electroacupuncture (EA) on the change in redox state of glutathione as an oxidative stress marker in the blood by ergometer exercise. Methods   In this crossover study, the EA and control (CONT) groups each included 12 healthy male volunteers. EA at 2 Hz and optimum intensity was performed on each subject at both the SP10 (Xuehai) and SP11 (Jimen) locations for 10 min before exercise. Respiratory metabolism was recorded during bicycle ergometer exercise by ramp rate until exhaustion. Blood samples were collected from the fingertip of each subject before and after exercise. Oxidized glutathione (GSSG) and total glutathione (tGSH) concentrations in the blood were biochemically determined as a marker of oxidative stress. The degree of fatigue before and after exercise was evaluated by the visual analogue scale (VAS). Results   The ventilatory threshold (VT) and the respiratory compensation point (RC), parameters of respiratory metabolism during exercise, did not differ significantly between the EA and CONT groups. Between both groups, the significant difference was not recognized to the amount of change in tGSH, GSSG, GSH, GSSG/tGSH by exercise. The GSSG/tGSH values after exercise was significantly lower than that before exercise in the EA group (p<0.05). In contrast, this level did not change significantly in the CONT group. The VAS values increased significantly after exercise in both groups (p<0.05); however, the VAS value in EA group showed a low tendency in comparison with that in CONT group. Discussion   VT and RC did not differ between the two groups, indicating that the level of exercise was nearly the same for both groups. In comparison of both groups, there was no significant difference on the amount of change of each glutathione parameters by exercise. On the other hand, The GSSG/tGSH and the VAS values after exercise were lower than those values before exercise in the EA group. Therefore, it might be possible that the EA affects the change of the glutathione due to the exercise. Our results might suggest that EA-mediated change of GSH bear some related to suppression of fatigue.