[Perioperative management of total laryngectomy for a patient with cold agglutinin disease].

Cold agglutinin disease is possible to cause thromboembolism of various organs due to changes in red blood cells by exposure to low temperature. Safety standards for perioperative management of patients with cold agglutinin have not been established. A patient with cold agglutinin disease was scheduled to undergo total laryngectomy and greater pectoral muscle flap. We thought it important to perform intensive temperature control to prevent a decrease in temperature below the thermal amplitude, which induces agglutinin in the vessel. We tried to keep the temperature of the patient with the warming equipment aggressively and monitored the shift of temperature in detail. It was also important to shorten the surgery with less hemorrhage and anesthetic management which can avoid a large shift in body temperature. We could keep peripheral and deep temperature above the critical point causing agglomeration. We did not find any symptoms of microembolism due to cold agglutination during the operation.

[Case of subcutaneous and mesenteric acute panniculitis with Sjögren's syndrome].

We report a case of a 27-year-old Japanese female with Sjogren's syndrome (SS), who suffered from several episodes of subcutaneous and mesenteric panniculitis with a recurrence within one year. After a history of fever and skin rash, the patient underwent surgery at a local hospital with a diagnosis of acute appendicitis complicated with an ileocecal abscess. She was also diagnosed as having SS. After the operation, the fever and skin rash persisted. She was treated with prednisolone (PSL), and her symptoms resolved. A recurrent bout of abdominal pain with fever, annular erythema on the trunk and a nodular erythematous rash on the lower extremities occurred six months after the operation. A skin biopsy from the lower extremities showed findings that were compatible with panniculitis. Abdominal computer tomography (CT) showed a diffuse swelling with soft tissue density in the intestinal mesenterium and para aortic area. A retrospective examination of the operative specimen obtained from the local hospital revealed centrilobular infiltration of neutrophils in the mesenteric adipose tissue with fat necrosis, which is compatible with mesenteric panniculitis. Twenty mg/day of PSL was successful in treating the systemic panniculitis, and the abnormal diffuse soft tissue density on the abdominal CT disappeared after three weeks of PSL administration. Systemic panniculitis is a rare complication in SS, and the pathogenesis is unclear.