We report a case of chronic localized thoracoabdominal aortic dissection with an entry located just above the celiac artery which was successfully treated by patch aortoplasty. The patient was a 55-year-old man who complained of abdominal and back pain. CT scan and angiography showed a localized thoracoabdominal aortic dissection the entry of which was located just above the celiac artery. The patient underwent resection of the aneurysm and patch aortoplasty with the aid of a femoro-femoral bypass. The postoperative course was uneventful. Localized thoracoabdominal aortic dissection has been reported in only 5 cases, including our case, in the Japanese literature.

  A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.

Eosinophillic glanuromatosis with polyangitis (EGPA) usually occurs in patients with a recent history (usually less than 10 years) of uncontrolled bronchial asthma. Here we describe a case of EGPA that occurred in a 68-year-old female who had well-controlled bronchial asthma for 17 years. A leukotriene receptor antagonist that had been prescribed one week before onset might have triggered the disease. Our case shows that there is a wide spectrum of clinical characteristics of EGPA, making diagnosis difficult in a primary care setting.

Two patients, a 32-year-old man and a 23-year-old woman, underwent successful reoperations 22 and 18 years after radical repair of the tetralogy of Fallot (TOF). The former patient had a diagnosis of pulmonary stenosis and aortic regurgitation due to infective endocarditis. Patch reconstruction of the right ventricular outflow tract (RVOT) and aortic valve replacement were performed. The latter patient was diagnosed as having pulmonary stenosis and a recanalized ventricular septal defect (VSD), followed by patch reconstruction of the RVOT and direct closure of a residual VSD. Reoperation 15 years or more after radical repair of TOF is rare. Only 15 such cases including the present two have been reported in Japan.

A follow-up study of 98 patients undergoing abdominal aortic aneurysm (AAA) repair for 44 months, ranging 2 to 113 months, revealed no difference in 5-year actuarial survival between patients aged 75 or older and patients aged less than 75. The 5-year actuarial survival of ruptured and nonruptured AAA cases was 469% and 71.2%, respectively (p<0.01). Late deaths after the repair of ruptured AAA were all due to atherosclerotic diseases. During a follow-up period after AAA repair, 9 patients were diagnosed as having malignant diseases with a fatal outcome in 6. Careful attention to atherosclerotic and malignant diseases is indispensable for follow-up management after AAA repair.

A 55-year-old man visited his neighborhood general practitioner complaining of headache, fever and wet cough on July 7, 2003, but there were no sigins that his symptoms would subside. Since an abnormal shadow was found on chest X-ray on July 11, he was referred to our department and hospitalized on the same day. We started to treat him on the assumption that he had community-acquired pneumonia due-to common pathogens. However, he developed severe hypoxemia, and abnormal shadows rapidly progressed to affect both lungs, which led us to suspect that he had acute respiratory distress syndrome (ARDS). We identified the pathogen by examining urinary antigens and serum antibodies and diagnosed of his case as Legionella pneumonia. Although he suffered complications of acute renal failure and shock, the respirator was withdrawn after 11 days of controlled mechanical ventilation, as he was steadily recovering from his illness. The patient was discharged from the hospital on September 9. Although the mortality of legionella pneumonia, when complicated by ARDS, acute renal failure and shock as in the present case, has been reported to be as high as 50 to 80%, we consider that the administration of neutrophil elastase inhibitors and steroids was effective against this disorder.
Shock ; Respiratory Distress Syndrome, Adult ; Pneumonia ; Kidney Failure, Acute ; Complicated

Objective: The present study was done to examine the effect of dietary supplement containing Kurozu concentrate on human visceral fat accumulation. Material and Methods: Sixteen subjects(BMI≧25) were orally administrated Kurozu concentrate for 8 weeks(low dose group: 500 mg/day, high dose group 1000 mg/day). Before and at weeks 8, hematological analysis, urinalysis and CT-scan to estimate the visceral fat accumulation were conducted. Results: In high dose group, following results were obtained; visceral fat decreased significantly(p=0.033), HDL-cholesterol level elevated significantly (p=0.034) and systolic blood pressure decreased significantly(p=0.004). In addition, no serious symptoms or abnormal hematological values were observed in both group.Conclusions: The dietary supplement containing Kurozu concentrate may be useful to prevent a metabolic syndrome.