Six surgical cases of localized abdominal aortic dissections experienced from 1977 to August, 1992 comprised 1.1% of all true aneurysms of the abdominal aorta (563 cases) and 2.5% of all aortic dissections (242 cases) for the same period. The mean age of the 6 patients at operation was 70 years (range from 62 to 74 years, 2 males, 4 females). All dissections were localized at the infrarenal abdominal aorta and one case showed three-channeled dissection. All cases were diagnosed preoperatively and prosthetic graft replacement was performed. Localized abdominal aortic dissection was reported in only 30 cases, including our cases, in the Japanese literature. Compared to thoracic aortic dissection, the development of symptoms is slow, age is high and the condition is often accompanied by hypertension and atherosclerosis.

This multicenter study was designed to clarify the positive effects of recombinant human erythropoietin (EPO; epoetin alfa) by subcutaneous administration on anemia after autologous blood donation in cardiac surgery. A total of 55 patients undergoing elective heart surgery were enrolled in this study and subcutaneously given EPO at a dose of 200IU/kg (200IU group, n=23), 400IU/kg (400IU group, n=16) or 600IU/kg (600IU group, n=16) once a week for 3 weeks prior to surgery. Autologous blood (400g) was drawn twice from each patient, at 14 days and 7 days before surgery. Oral iron was given daily throughout this study. The mean reticulocyte counts increased significantly 2 weeks after the first administration of EPO in the 200IU group or 1 week after the first administration in the 400IU and 600IU groups. There was an increase in mean hemoglobin (Hb) levels 1 week after the initiation of EPO by 1.7, 2.8 and 2.1% in the 200IU, 400IU and 600IU groups, respectively. After the first drawing of autologous blood, the Hb levels decreased gradually in all groups despite the second administration of EPO. The change in Hb level immediately before surgery however, was a 4.2% decrease (p<0.05) in the 200IU group and 0.8% decrease (N. S.) in the 400IU group and 0.7% increase (N. S.) in the 600IU group in comparison with the initial Hb level. In conclusion, subcutaneous administration of EPO was effective in improving anemia after autologous blood donation in cardiac surgery.

Between 1988 and 1991, 231 patients underwent surgical repair for abdominal aortic aneurysm. Among them 132 patients underwent isolated Y graft replacement electively. They were divided into two groups, according to the operative procedure; transperitoneal approach (n=51) and retroperitoneal approach (n=81), and the surgical results were compared retrospectively. There was no significant difference in operative time, amount of operative bleeding, operative transfusion, total transfusion, autotransfusion, duration of intubation, total use of analgesia or length of postoperative stay in the two groups. The amount of fluid drained from the nasogastric tube was significantly greater in the transperitoneal group. The initiation of drinking and eating were both significantly prolonged in the transperitoneal group. The transperitoneal approach is indicated for cases with thoracic or thoracoabdominal aneurysm which may be operated on in the future, cases of bilateral common iliac aneurysms and cases with heart disease. Otherwise it is preferable to select the retroperitoneal approach as the first choice for elective surgical treatment of abdominal aortic aneurysm, because the retroperitoneal approach is superior in terms of the recovery of gastro-intestinal movement.