SUMMARY:The age-group-specific incidence and etiological patterns of community-acquired pneumonia (CAP) have not been fully established in Japan. A 2-year prospective surveillance was conducted in Kochi city, Western Japan. All CAP patients aged AE15 years who visited a community-based hospital were enrolled in the study. Clinical samples were examined by conventional bacterial culture and urinary antigen tests, and 6 bacterial pathogens and 16 respiratory viruses were identified from sputum samples by multiplex polymerase chain reaction assays. The age-group-specific incidence of CAP was estimated using a population-based data set of the total number of outpatients in the whole city.

A case of Schönlein-Henoch Purpura (SHP) in a 32 year-old female, showing gastrointestinal manifestations including acute vasculitic cholecystitis was reported. In the course of hospitalization urgent laparotomy was performed because of the severe abdominal pain. The gallbladder was inflamed with a brownish-red edematous wall and subserosal hemorrhage, and was resected. Histological examination of the resected gallbladder specimen revealed leucocytoclastic vasculitis. The patient was treated with prednisolone postoperatively, and symptoms abated over two weeks. Acute cholecystitis with SHP is extremely rare, and as far as the authors know this is the second case of this disorder documented by histological examination. Patients with acute abdomen associated with SHP should be managed with consideration of the complications of acute cholecystitis.

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A microvascular replantation of an amputated large facial segment, using a segment of the descending branch of the lateral circumflex femoral artery and its venae comitantes instead of interpositional vein grafts, is presented, and the advantages of this procedure are discussed.Q 1995 Wiley-Liss, Inc. MICROSURGERY 16:594-597 1995Replantation of amputated segments of the face is a challenging problem. Although the best cosmetic and functional results are obtained with replantation of severed tissue using microsurgical arterial and venous anastomoses, only a few successful cases have been reported so far.'p6 This is due mainly to the small size of the vessels to be anastomosed. We report a case of successful replantation of a completely amputated large facial segment using the vascular tree of the descending branch of the lateral circumflex femoral artery and its venae comitantes instead of interpositional vein grafts. CASE REPORTA 79-year-old man sustained a complete amputation of the whole nose, upper lip, and cheek skin when the blade of a grass cutting machine hit a rock on the ground and rebounded on his face. He was immediately transferred to the hospital, together with the amputated facial segment. The piece measured approximately 10 x 8 cm and was composed of the entire nose, full thickness of the upper lip, and the skin of the right cheek. The septa1 cartilage and part of the nasal bone were also included in the segment, as well as the vestibular skin and the mucous membrane (Figs. 1, 2 ) . After hemostasis of the facial wound was achieved, replantation of the amputated facial segment was attempted by a young plastic surgeon who is unfamiliar with microsurgery. Six hours after injury, the superior labial artery was anas- tomosed and the segment turned pink in color. However, veins suitable for anastomosis could not be found in the segment and complete obstruction of the arterial anastomosis developed soon after. Surgery was stopped then to evaluate the patient's general condition and the plastic surgeon asked our department for help.On our arrival, 11 hr after injury, replantation was started again with the consent of the patient's family. During the induction of general anesthesia, bench microdissection of the segment was performed to identify vessels suitable for anastomosis. The segment was irrigated with saline solution containing heparin and urokinase through the superior labial artery (1.0 mm in diameter), located at the right lateral aspect of the upper lip, and two veins, which were believed to be the right and left angular veins (0.6 to 0.8 mm in diameter), were identified at the root of the nose. The ischemic time was more than 12 hr. Therefore, arterial inflow was established first by anastomosing the superior labial artery of the amputated segment to the descending branch of the lateral circumflex femoral artery. After releasing the vascular clamp, the segment immediately turned pink and brisk bleeding from the edge was noted. Subsequently, venous anastomoses were performed between the two angu...

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