Nota: These guidelines are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient.

Background: The consequences and risks of prolonged physical exercise are not well established.

We aimed to evaluate the effects of a 24-h ultramarathon, an aerobic test of high physical load, on lipid profile and apolipoproteins B (ApoB) and A1 (ApoA1) levels, minimally modified low-density lipoprotein (LDL), and oxidised LDL. Prospective evaluation of 16 male athletes who participated in an ultramarathon run, where the objective was to run the greatest distance possible in 24 h. Fourteen participants completed the run. The mean distance achieved was 133.1 km (maximum of 169.6 km). There was a trend in reduction of triglycerides and total cholesterol (P = 0.06 and 0.05, respectively), without significant modifications in high-density lipoprotein, LDL and ApoA1 levels (P = 0.16; 0.55 and 0.67). There was a marked reduction in ApoB levels (P < 0.001), correlated directly to the distance covered (Pearson R = 0.68). Accordingly, an increase in the LDL/ApoB ratio was observed. The stress of this physical activity was not associated to an increase in minimally modified LDL or oxidised LDL. Lipid profile levels were not acutely altered by prolonged physical activity. Similarly, there was no evidence of greater oxidation of LDL over a 24-h period of physical activity. The reduction in ApoB was directly proportional to the distance covered, suggesting an acute positive change in phenotype of LDL molecules.

ObjectiveTo assess the immediate results of myocardial revascularization surgery without extracorporeal circulation in a group of patients over 75 years of age. December 2003, 193 (121 men and 72 women) Methods From January 2001 to ConclusionThe surgery adopted for myocardial revascularization was associated with a low mortality rate, a low complication index, and a short length of stay at the hospital. Keywords elderly, myocardial revascularization surgery, extracorporeal circulationThe increase in the elderly population in Brazil in recent years has led to a greater number of patients over the age of 70 years requiring myocardial revascularization surgery. However, over the years, advanced age has been considered a risk factor for morbidity and mortality in coronary artery surgeries 1,2 . The recent advances in myocardial revascularization surgeries without extracorporeal circulation, the technique recommended by Buffolo et al 3 and Benetti 4 at the beginning of the 1980s, has aroused interest in this type of surgery, especially in high-risk patients [5][6][7] .We retrospectively analyzed the immediate results of the myocardial revascularization surgery without extracorporeal circulation in patients over the age of 75 years.

We report the cases of 2 female patients with Takayasu's arteritis referred to our service with lesions affecting the descending thoracic aorta and great vessels. One of the patients had a critical obstructive lesion in the left coronary ostium. Both patients underwent surgery without extracorporeal circulation, with full heparinization and autotransfusion.Takayasu's arteritis is a chronic vasculitis of unknown etiology, whose first case report dates back to 1908 1 . Women account for 80 to 90% of the cases, and the ages of the affected patients range from 10 and 40 years 2,3 . Takayasu's arteritis affects initially the aorta and its primary 4 . The inflammation may be restricted to the thoracic or abdominal aorta, or both, and its, and, sometimes, the manifestations are related to impairment of the coronary ostia. As the disease progresses, all great vessels are commonly affected, and the impairment may range from local lesions to extensive segmentary stenoses. The abdominal aorta and pulmonary arteries are involved in approximately 50% of the patients. The degree of activity of the inflammatory process varies with time, with apparent exacerbations and reductions or remissions.The indication for surgical treatment is often related to severe circulatory complications, such as refractory hypertension and decompensated heart failure, in addition to signs of myocardial ischemia in cases with lesions involving the coronary ostia.The surgical technique varies from case to case, because the number of vessels affected and the extent of the impairment vary, which requires the use of all surgical resources developed for cardiac surgery. Case ReportCase 1 -A 32-year-old white female, who sought our service due to arterial hypertension of difficult control, headache, and claudication of the left lower limb. The patient reported that she began to experience intense headache approximately 8 months before, being then referred to the cardiologist, who diagnosed severe hypertension. Clinical treatment was initiated, and the symptoms improved slightly. Forty-five days before admission, she reported pain in the lower limbs, mainly in the left side, triggered by physical activity, which evolved to pain at rest. On admission, the physical examination revealed arterial hypertension and a significant decrease in the pulses in the lower limbs. Transthoracic echocardiography showed a significant myocardial hypertrophy. Thoracoabdominal tomography showed extensive segmentary stenosis of the descending aorta, with a critical point (95%) at the level of the thoracoabdominal transition ( fig. 1). The patient underwent angiography of the ascending aorta, aortic arch, and descending and abdominal aorta. Not only were the tomographic findings confirmed, but a critical obstructive lesion was detected in the celiac trunk, as was an extensive segmentary lesion in the left carotid artery. Neither the pulmonary artery, nor its branches had any lesion.The tests of inflammatory activity were within the normal range. Only VHS was slightly altered. On...

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