Primary Sjögren's syndrome is an autoimmune disorder characterized by lymphocytic infiltrates and destruction of the salivary and lacrimal glands, and systemic production of autoantibodies to the ribonucleoprotein (RNP) particles SS-A/Ro and SS-B/La, leading to clinical symptoms of dryness of the mouth and eyes (sicca syndrome). Autoreactive T cells bearing the CD4 molecule may recognize an unknown self antigen, triggering autoimmunity in the salivary and lacrimal glands. Although several candidate autoantigens including α-fodrin have been reported in Sjögren's syndrome, the pathogenic roles of the autoantigens in initiation and progression of SS are still unclear. It is possible that individual T cells activated by an appropriate self antigen can proliferate and form a restricted clone. Recent evidence suggests that the apoptotic pathway plays a central role in making T cells tolerant to tissue-specific self antigen, and may drive the autoimmune phenomenon. We recently reported that tissue-specific apoptosis in estrogen-deficient mice may contribute to autoantigen cleavage, leading to the development of autoimmune exocrinopathy. The studies reviewed imply that tissue-specific apoptosis and caspase-mediated α-fodrin proteolysis are involved in the progression of autoimmune lesions in Sjögren's syndrome. Moreover, Fas ligand (FasL) and its receptor Fas are essential in the homeostasis of the peripheral immune system. It is considered that a defect in activation-induced cell death (AICD) of effector T cells may result in the development of autoimmune exocrinopathy in Sjögren's syndrome.

A 58-year-old diabetic man underwent emergency coronary artery bypass grafting for ischemic heart failure. Although postoperative cardiac function was good but acute renal failure developed. We started continuous hemodiafiltration (CHDF) from 5 hours after the operation and continued it for 7 days without any undue influence on hemodynamics or bleeding side effects. The renal function gradually improved and CHDF was halted. It is reported that CHDF can prevent renal failure caused by inflammatory cytokines produced after cardiac surgery. CHDF appears to be useful for the management of acute renal failure in the early postoperative period after cardiac surgery.

A 71-year-old woman was admitted with sudden onset of abdominal pain. CT scan image and symptoms showed an impending ruptured suprarenal abdominal aortic aneurysm therefore we performed an emergency operation. The abdominal aorta was replaced with a trunk prosthetic graft with four branches for visceral and lumbar arteries. The post-operative course was uneventful. Pathological examination showed that the aorta had severe atherosclerotic changes. The fibrous tissues increased in the aneurysmal wall which was not consistent with the normal aorta. Intima and media of the aorta everted into the aneurysm. These findings suggested that aneurysm was caused by a penetrating atherosclerotic ulcer.