A 67-year-old man who had undergone robot-assisted laparoscopic radical prostatectomy 16 days before suffered from high fever. A screening CT showed an aortic arch aneurysm was 40 mm in diameter, and Bacteroides fragilis was identified from blood culture. A few days after the first CT, the size of the aneurysm increased rapidly to 50 mm in diameter, subsequently an urgent procedure of total arch replacement using rifampicin-soaked Dacron graft was performed. Although the postoperative course was unremarkable, pyrexia recurred on the ninth post operative day. The third CT showed a new aneurysm in the thoraco-abdominal aorta just below the celiac artery. The second urgent procedure of graft replacement of the thoraco-abdominal aorta with the reconstruction of the celiac artery was performed. Preoperative FDG-PET/CT was useful to decide the level of the resection and the suture. The intravenous administration of the antibiotics continued for six weeks after surgery. The patient is doing well without any signs of infection on oral antibiotics at 7 months after the second surgery.

Secretory immunoglobulin A (sIgA) plays an important role in mucosal immunity, and salivary levels change in response to social, psychological and physical stress. However, little is understood about how surgical stress affects salivary sIgA. The results of the present study showed that mouse salivary IgA concentration was significantly elevated immediately after surgery and returned to pre-surgical levels after 24 h. Thus, the surgery did not suppress IgA secretion under our experimental conditions, suggesting that mucosal immunity was not perturbed. Since the role of α-adrenergic receptors involved in IgA secretion has remained unclear under surgical stress, we further examined the effects of either α₁-adrenergic (prazosin) or α₂-adrenergic antagonist (yohimbine) on the salivary sIgA. Yohimbine, but not prazosin, antagonized the surgically induced salivary IgA enhancement, indicating mediation by α₂-receptor stimulation. The mRNA for IgA was not altered in the salivary gland after surgery, suggesting that surgical stress did not stimulate IgA synthesis in the salivary gland cells. In conclusion, it is suggested that the surgical stress does not perturb mucosal immunity in our experimental model, although a transient increase of concentration of salivary IgA was observed immediately after surgical insult.

This report describes a case of localized Langerhans' cell histiocytosis which occurred in the maxilla of a 23-year-old male. The lesion was treated by an injection of corticosteroids. Corticosteroid treatment for Langerhans' cell histiocytosis of the maxilla is considered to be beneficial because no sequelae remain following the treatment.

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

  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.