Chronically Elevated Myeloperoxidase Antineutrophil Cytoplasmic Antibody Levels in an Asymptomatic 91-year-old Patient / General Medicine

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) associated glomerulonephritis is commonly diagnosed in elderly patients with acute kidney injury (AKI). Prompt diagnosis and rapid initiation of appropriate therapy are essential to avoid the development of ANCA-associated vasculitis, which can be a life- and organ-threatening disease. We report a rare case of a 91-year-old male with a high MPO-ANCA titer, who took allopurinol, and showed no symptoms for >20 months, following which sudden AKI and severe bronchial asthma necessitated hemodialysis and steroid administration. Chronically elevated ANCA titers should be examined for causes and followed up to limit the risk of subsequent disease development.

A Case of Sigmoid Colon to Skin Fistula Following Surgery for Abdominal Aortic Aneurysm / 日本心臓血管外科学会雑誌

We present a case of sigmoid colon to skin fistula following surgery for abdominal aortic aneurysm that was believed to have resulted from nonocclusive mesenteric ischemia involved in low cardiac output syndrome. A 65-year-old man underwent surgical treatment for an abdominal aortic aneurysm. Although the patient had operative risks of renal dysfunction and left ventricular dysfunction due to an old myocardial infarction, the abdominal aortic aneurysm was 6cm in diameter and threatened to rupture, thus prompting surgical removal. For the operation, the abdominal aorta was clamped above the renal arteries and the aneurysm was replaced with a Y-shaped prosthetic graft following the aneurysmectomy. Among the vessels supplying the sigmoid colon, both the inferior mesenteric artery and the left internal iliac artery had become obstructed and thus only the right internal iliac artery could be successfully reconstructed. The patient suffered from low cardiac output syndrome after surgery and subsequently experienced renal dysfunction, liver dysfunction and a disturbance of the peripheral circulation. On postoperative day number 7, the patient complained of watery diarrhea occurring several times a day and abdominal distension as a result of the ischemic colitis. On day number 16, the sigmoid colon to skin fistula developed. Oral intake was discontinued and nutritional support thereafter consisted of intravenous hyperalimentation. In addition, enteral nutrition using an elemental diet was begun. The fistula was successfully closed two weeks later and the patient recovered with no further complications.

A Case of Post-Transfusion Graft-versus-host Disease / 日本心臓血管外科学会雑誌

A 78-year-old man with obstruction of the right common femoral artery due to arteriosclerosis obliterans underwent successful amputation of his leg. On the first postoperative day he received transfusion of three units of preserved blood. He continued to recover until postoperative day 7, when he developed a high fever, erythroderma and diarrhea. His condition gradually deteriorated and on postoperative day 15 he demonstrated severe and progressive leukopenia and thrombocytopenia. Although he underwent intensive treatment he died on postoperative day 20. A skin biopsy specimen revealed evidence of post-transfusion graft-versus-host disease.