Comparative Analysis of Endonasal Lateral Osteotomy and Percutaneous Lateral Osteotomy in Patients with Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#The purpose of this study was to compare the effectiveness of percutaneous and endonasal lateral osteotomy for the correction of deviated nose.SUBJECTS AND METHOD: Medical records of 60 patients who underwent rhinoplasty to correct deviated nose were reviewed retrospectively. Patients with unilateral osteotomy, revision rhinoplasty, spreader graft, or who had no preoperative or postoperative photos were excluded from the study. The patients were categorized into two groups, which either had C-shaped deviation or I-shaped deviation. Preoperative and postoperative deviation angles were measured and their differences were analyzed according to the approach methods.@*RESULTS@#In the percutaneous approach group, 26 patients had C-shaped deviation and 10 patients had I-shaped deviation, whereas in the endonasal approach group, 17 patients had C-shaped deviation and 7 patients had I-shaped deviation. In the percutaneous approach, the deviation angle was statistically improved in the C-shaped deviation, but in the endonasal approach, it was statistically improved in the C-shaped and I-shaped deviation after surgery. In the C-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 5.2°±3.6° and 7.9°±5.3°, respectively, which showed significant difference. However, in the I-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 2.9°±1.3° and 2.9°±1.0°, respectively, with no significant difference.@*CONCLUSION@#The improvement of deviation angle following osteotomy may be different according to the approach methods for deviated nose. Endonasal approach was more suitable than percutaneous approach in the correction of I-shaped deviated nose.

Management of Acquired Cholesteatoma Associated With Patulous Eustachian Tube and Habitual Sniffing

OBJECTIVES: To investigate the effect of surgical treatment with eustachian tube (ET) catheter insertion in patients with acquired cholesteatoma associated with patulous eustachian tube (PET) and habitual sniffing. METHODS: Nine ears of nine patients (two men and seven women; age, 20 to 65 years; average, 37.9±12.0 years) of acquired cholesteatoma associated with PET and habitual sniffing who underwent cholesteatoma surgery with simultaneous additional ET catheter insertion were examined in this study. Successful treatment was defined as stoppage of sniffing, a relief of a PET handicap inventory-10 (PHI-10), an improvement of autophony grade and no cholesteatoma recurrence. RESULTS: ET catheter insertion was performed in all ears. Follow-up duration ranged from 16 to 37 months (average, 25.4 months). Cases consisted of nine pars flaccida type (100%). All patients obtained relief from aural symptoms and stopped sniffing. Postoperative PHI-10 scores were significantly lower than preoperative scores (P<0.001). During an average follow-up of 25.4 months, no cholesteatoma recurrence has occurred to date. One patient developed otitis media with effusion (OME) post-catheterization; OME resolved spontaneously without treatment. Four patients had a consecutive ET catheter insertion on the other side to resolve PET-related aural symptoms. CONCLUSION: In case of acquired cholesteatoma with PET and habitual sniffing, ET catheter insertion performed simultaneously with cholesteatoma surgery could help reduce aural symptoms and stop sniffing. Moreover, the procedure might help in preventing cholesteatoma recurrence.

Comparative Analysis of Endonasal Lateral Osteotomy and Percutaneous Lateral Osteotomy in Patients with Deviated Nose / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study was to compare the effectiveness of percutaneous and endonasal lateral osteotomy for the correction of deviated nose. SUBJECTS AND METHOD: Medical records of 60 patients who underwent rhinoplasty to correct deviated nose were reviewed retrospectively. Patients with unilateral osteotomy, revision rhinoplasty, spreader graft, or who had no preoperative or postoperative photos were excluded from the study. The patients were categorized into two groups, which either had C-shaped deviation or I-shaped deviation. Preoperative and postoperative deviation angles were measured and their differences were analyzed according to the approach methods. RESULTS: In the percutaneous approach group, 26 patients had C-shaped deviation and 10 patients had I-shaped deviation, whereas in the endonasal approach group, 17 patients had C-shaped deviation and 7 patients had I-shaped deviation. In the percutaneous approach, the deviation angle was statistically improved in the C-shaped deviation, but in the endonasal approach, it was statistically improved in the C-shaped and I-shaped deviation after surgery. In the C-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 5.2°±3.6° and 7.9°±5.3°, respectively, which showed significant difference. However, in the I-shaped deviation, the average degrees of improvement of percutaneous and endonasal approach were 2.9°±1.3° and 2.9°±1.0°, respectively, with no significant difference. CONCLUSION: The improvement of deviation angle following osteotomy may be different according to the approach methods for deviated nose. Endonasal approach was more suitable than percutaneous approach in the correction of I-shaped deviated nose.

Isolated Dorsal Dislocation of Intermediate Cuneiform: A Case Report / 대한족부족관절학회지

An isolated dislocation of the intermediate cuneiform bone is a rare midfoot injury. This paper reports a case of a 60 year old man who fell from a height with his foot in the plantar flexed position. An isolated dorsal dislocation of the intermediated cuneiform was confirmed. Good results were obtained after an open reduction and internal fixation with a Lisfranc screw and Kirschner wire.

Effectiveness of Polyvinyl Acetate Sheeted with Carboxymethyl Cellulose as a Packing Material after Septoplasty

BACKGROUND AND OBJECTIVES: Although polyvinyl acetate (Merocel®) has been widely used as a packing material after septoplasty, removable nasal packing can increase patient discomfort, local pain, and pressure. Furthermore, the removal of nasal packing has been described as the most uncomfortable and distressing feature associated with septoplasty. The purpose of this study was to investigate the efficacy of polyvinyl acetate with carboxymethyl cellulose sheet (Rhinocel®) nasal packing on patient subjective symptoms, degree of bleeding, hemostasis, and wound healing following septoplasty. SUBJECTS AND METHOD: Forty patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with Rhinocel® and the other one with Merocel®. Patient subjective symptoms while the packing was in situ, hemostatic properties, pain on removal, degree of bleeding on removal, duration of hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. RESULTS: Although the two types of packing materials were equally effective in controlling postoperative bleeding after septoplasty, Rhinocel® was significantly more comfortable while in situ and less painful on removal than Merocel®, which was associated with significantly more bleeding on removal and so more time was needed to control hemorrhage. There was no significant difference in postoperative wound healing or pack cost. CONCLUSIONS: The use of Rhinocel® after septoplasty has less discomfort, greater patient satisfaction, and less bleeding on removal with no adverse reactions compared to Merocel® packing. Therefore, Rhinocel® may be a useful packing material after septoplasty.

Sural Nerve Entrapment and Tenosynovitis of Peroneus Longus by Hypertrophied Peroneal Tubercle: A Case Report / 대한족부족관절학회지

A hypertrophied peroneal tubercle can present as a bony prominence at the lateral aspect of the foot and a peroneal tenosynovitis or tear. We report a case of a 52-year-old man complaining of lateral foot tingling pain and numbness. The sural nerve entrapment and peroneus longus tenosynovitis by hypertrophied peroneal tubercle were confirmed. Good results were obtained after excision of the hypertrophied peroneal tubercle and sural nerve release.

Macroaggregates in the packed red blood cell unit during transfusion / 대한마취과학회지

No abstract available.

Closely Sequential Carotid Endarterectomies in Patients with Bilateral Internal Carotid Artery Stenosis / 대한혈관외과학회지

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of closely sequential carotid endarterectomies (CEAs) for bilateral internal carotid artery stenosis. METHODS: From September 1995 to December 2011, 953 CEAs were performed for internal carotid artery occlusive disease in Asan Medical Center. Seven hundreds eighty-five patients received unilateral CEA, and 84 patients received bilateral CEAs. Of the 84 patients with bilateral CEAs, 15 who underwent closely sequential CEAs with an intersurgical period of 7 days were included in this study. Retrospectively, surgical outcomes were evaluated and compared, regarding CEA-related parameters, and early and late mortality and morbidity rates between patients with closely sequential bilateral CEAs and unilateral CEA. RESULTS: With this strategy, initial CEA was performed for the symptomatic side in symptomatic patients, or for the higher-grade carotid stenosis in asymptomatic patients. All 15 patients received contralateral CEA 7 days after initial CEA, and sufficient revascularization was obtained in all procedures. With a mean follow-up of 11.7 months, there were no perioperative neurological complications or strokes. During the follow-up period, early and late complications, except for transient cranial nerve injury, occurred without statistically significant difference between unilateral CEA and closely sequential bilateral CEAs. CONCLUSION: Closely sequential bilateral CEAs showed excellent early and late clinical outcomes. Although the number of patients included in the study was few, our results demonstrated that closely sequential bilateral CEAs were safe and effective strategies for bilateral internal carotid artery stenosis. In addition, future clinical studies will be needed, with a greater number of patients.

Infection of the temporomandibular joint: a report of three cases

An intracapsular and pericapsular infection of the temporomandibular joint (TMJ) is rare. The invasion of bacteria into the joint space can occur through several routes. Among them, hematogenous spread is most common. This report describes three cases of abscess formation in the TMJ (intracapsular and pericapsular infection). The patients were treated with supportive care and surgical intervention (incision and drainage) under hospitalization, and their symptoms had improved. Pain of the TMJ is a typical symptom of temporomandibular joint disorders (TMD). On the other hand, an infection of the TMJ can also cause pain on the affected side, and can be misdiagnosed as routine TMD. Therefore, the possibility of an infection of the TMJ cavity should be considered when treating TMD.

Total Knee Replacement Arthroplasty with NexGen(R)-LPS: Minimum 5 Year Follow-up Results / 대한정형외과학회잡지

PURPOSE: One hundred and thirty-six patients who underwent total knee replacement arthroplasty (TKRA) with NexGen(R)-LPS were analyzed for the clinical and radiologic results after a minimum follow-up of 5-years. MATERIALS AND METHODS: This study included 136 patients (209 knees) who underwent TKRA with NexGen(R)-LPS between August 1998 and February 2005 and had a minimum follow-up of 5 years. We evaluated the range of motion (ROM), American Knee Society knee functional scores, radiographic results and complication rates in the study subjects with an average 8.3 years of follow-up (range: 5-11.5 years). We also compared the results of the degenerative arthritis group (195 knees in 129 patients) with those of the rheumatoid arthritis group (14 knees in 7 patients). RESULTS: The mean ROM increased from 107.3degrees to 122degrees at the final follow-up. The flexion contracture also improved from 8.3degrees to 1.2degrees at final follow-up. The knee score improved from 51 to 94.7 at the final follow-up. The functional score improved from 38 to 84.2 (p0.05). Valgus (alpha), varus (beta), flexion (gamma) and the posterior slope angle (delta) of the tibial components were well maintained both during the immediate postoperative period and at the final follow-up. There was no significant difference in the tibiofemoral angle and alpha, beta, gamma and delta angle (p>0.05) between the degenerative arthritis and rheumatoid arthritis groups. The alignment of the alternative substance was also relatively well maintained. Radiolucent lines were observed in 39 knees (18.7%), and in 42 zones out of 209 knees. The most common site of radiolucent lines was the medial side of the tibia in 21 knees. The overall incidence of radiolucent lines was 15% for the femur, 61% for the tibia and 24% for the patella. There was no statistically significant difference between the presence of radiolucent lines and the clinical results (p>0.05). There was 1 case of revision surgery due to loosening of implants at 8 years after surgery, but no early loosening was observed in the study subjects. Complications were found in 6 patients. Two patients with early postoperative infection were treated with revision surgery. Two patients with acute hematogenous infection 4 years after the initial operation were treated with revision surgery. Two patients with superficial infection were treated with antibiotics and regular dressing. CONCLUSION: The patients treated with the NexGen(R)-LPS TKRA had a decreased level of postoperative pain and an improved knee joint ROM. A lower rate of complications was also found with this type of implant.

Factors affecting Reduction of Slippage in Posterolateral Fusion for Spondylolytic Spondylolisthesis / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVES: The purpose of this study was to analyze the reduction of spondylolisthesis after postural reduction and pedicle screw instrumentation for low-grade spondylolytic spondylolisthesis, and to determine the factors affecting reduction. MATERIALS AND METHODS: Twenty patients (mean age 52.5 years old; range, 30-71 years old), who underwent pedicle screw instrumentation and posterolateral fusion after wide laminectomy and facetectomy, were reviewed. The minimum follow-up period was 2 years. The percentage of slippage was measured on lateral radiographs by the Taillard method. We measured the slip angle, sacral inclination, lumbar lordosis, disc height, and angulation and translation on flexion-extension stress views. These radiological parameters were analyzed statistically for correlation with the reduction of slippage. RESULTS: In these passive reduction surgeries, no forceful reduction was attempted. The average percentage of slippage was 20.6% preoperatively, 13.0% after instrumentation, and 19.5% at the last visit. The reduction of slippage had a correlation with hypermobile angulation on flexion-extension radiographs (p=0.02). There were no significant correlations between the amount of reduction and translation on flexion-extension radiographs (P=0.99), slip angle (P=0.79), disc space height (P=0.6), lumbar lordosis (P=0.68), and sacral inclination (P=0.35). CONCLUSION: Loss of reduction that was achieved by postural reduction with pedicle screw instrumentation for spondylolytic spondylolisthesis occurred at the final follow-up. There was a negative correlation between the reduction of slippage and hypermobile angulation on flexion-extension dynamic radiographs.

Hip Hemiarthroplasty Using Extensively Porous Coated Femoral Stem in Femoral Neck Fracture Aged 70 Years or Older / 대한정형외과학회잡지

PURPOSE: The aim of this study was to determine the utility of cementless extensively porous coated femoral stem in the patients older than 70 years, who had received a bipolar hemiarthroplasty. MATERIALS AND METHODS: From June 1996 to June 2001, this study reviewed the clinical and radiographic results of 31 femoral neck fracture patients (31 hips, 9 men and 22 women), who underwent a bipolar hemiarthroplasty using a cementless extensively porous coated femoral stem, were 70 years or older and were followed up more than 2 years. The mean age at surgery was 79.3 (70-84). The mean follow up period was 31.2 months (range, 24 to 52). The clinical and radiological results were evaluated by the Harris Hip Score (HHS) and the serial X-ray findings, respectively. RESULTS: Clinically, the mean HHS at the last follow up was 84.1 (69-92). Radiographically, there was no evidence of subsidence, pedestal and osteolysis of the femoral stem. A radiolucent line was observed in 11 cases, but there was no evidence of progression. Therefore, all femoral stems were confirmed to be stable. Stress shielding was observed in 22 cases, mild in 20 cases and moderate in 2 cases. CONCLUSION: Bipolar hemiarthroplasty using a cementless extensively porous coated femoral stem inpatients 70 years or older showed good clinical and radiological results. Therefore it is a useful prosthesis for bipolar hemiarthroplasty in patients 70 years or older.

A Comparative Study of the in vivo Wear of Zirconia and Metal Heads Articulating with Polyethylene Liners in Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purposes of this paper was to determine the wear rates and volumetric wears of ceramic (Zirconia) and metal (Cobalt-chrome) femoral heads, and to differentiate creep from true wear. Another purpose was to determine the extent of wear and volumetric wear per annum. MATERIALS AND METHODS: We examined 86 patients (111 hips) who were continuously followed up from 180 patients (225 hips) who received THRA with AVN of stage III or above at our hospital. Patients were followed until December 1999 for more than a minimum of 3 years from June for 1996. The hip joint AP radiographs that had been taken immediately after the operations, six weeks postoperatively and annually thereafter were compared. We used the computer assisted vector wear analysis program of Martell to measure the wear rate, volumetric wear and vector wear. RESULTS: The wear rate and the volumetric wear in the zirconia ceramic head group (1.443 mm/year, 665.433 mm3/year) and metal head group (2.161 mm/year, 1271.831 mm3/year) were high immediately after operation and six weeks postoperatively, and this was significantly more than during all for other periods, giving a wear rate and volumetric wear in the ceramic head group of 0.180 mm/year and 81.101 mm3/year, and in the metal head group of 0.219 mm/year and 124.149 mm3/year. Moreover, the average wear rates and volumetric wear rates of these two groups were significantly different, and annual wear and volumetric wears showed a trend to decrease with time. CONCLUSION: Wear rate and volumetric wear six weeks after operation were remarkably high compared with the other periods. This is interpreted as the result of a creep phenomenon, which occurred mainly during the six weeks following the operation. The Zirconia ceramic head group showed little wear, which confirms the theoretical advantage of the zirconia ceramic head in vivo.

Anterior Cruciate Ligament Reconstruction using an Allo-Cortical Bone Interference Screw and a Bone-Patella Tendon-Bone Autograft / 대한정형외과학회잡지

PURPOSE: We report the results of arthroscopic ACL reconstruction using an allo-cortical bone interference screw and a bone-patellar tendonbone (BPTB) autograft. MATERIALS AND METHODS: A preoperative average KT-2000 tests was 6.8 mm (+/-1.3 SD), Lysholm score 71.8 (+/-8.4 SD), Tegner score 3.2 (+/-0.6 SD) and IKDC score was below C in all cases. At the final follow-up, the average KT-2000 test score was 2.3 mm (+/-0.8 SD), Lysholm score 91.2 (+/-5.3 SD), Tegner score 6.8 (+/-1.4 SD) and the IKDC score was above B in all except two cases. The MRI findings of 3 and 6 months after operation showed diffuse bony edema around an allo-cortical bone interference screw. The shape of screw was well demarcated. At 12 months after operation, the bony edema was markedly decreased and the shape of screw was poorly demarcated. RESULTS: A preoperative average KT-2000 tests was 6.8 mm (+/-1.3 SD), Lysholm score 71.8 (+/-8.4 SD), Tegner score 3.2 (+/-0.6 SD) and IKDC score was below C in all cases. At the final follow-up, the average KT-2000 test score was 2.3 mm (+/-0.8 SD), Lysholm score 91.2 (+/-5.3 SD), Tegner score 6.8 (+/-1.4 SD) and the IKDC score was above B in all except two cases. The MRI findings of 3 and 6 months after operation showed diffuse bony edema around an allo-cortical bone interference screw. The shape of screw was well demarcated.At 12 months after operation, the bony edema was markedly decreased and the shape of screw was poorly demarcated. CONCLUSION: The allo-cortical bone interference screw is one of a fixation materials in ACL reconstruction using a BPTB autograft, if does not seen to have the disadvantages of metallic or bioabsorbable interference screws.

A Case of Emphysematous Pyelonephritis in a Diabetic Patients: Radiographic Demonstration of Gas Shadow in Renal Pelvis Experiance of Successful Management by Medical Treatment / 대한신장학회잡지

Emphysematous pyelonephritis is an uncommon and, but life-threatening necrotizing inflammation of renal parenchyme and perinephric tissue by gas-forming organisms. This disease is encountered mainly in patients with uncontrolled diabetes mellitus and/or urinary tract obstruction etc. Clinically, it appears as an acute severe clinical pyelonephritis that needs emergency care with poor prognosis. Though the pathogenesis of this disease is still pooly understood, radiographic demonstration of gas shadow in renal parenchyme and peri- nephritic tissue establishes the diagnosis of emphysematous pyelonephritis. The identification of this finding has been believed to consider incision and drainage or nephrectomy in addition to medical treatment, because of high mortality rate of this disease in spite of vigorous medical management. We herein present 1 diabetic patient with emphysematous pyelonephritis who responded to medical treatment alone. The patient was treated with antibiotics alone, the clinical signs and laboratory findings were improved, CT scan 1 month after medical treatment revealed absence of gas in the renal pelvis.

The effects of chronic lead exposure on norepinephrinergic neurons of the nucleus locus ceruleus of the rat / 대한해부학회지

The neurotoxic effects of inorganic lead, a common environmental toxic substance, include peripheral neuropathy in adults and encephalopathy in children. Behavioral changes including hyperactivity, short attention span, easy distractibility and impulsiveness have also been noted in patients with chronic lead exposure in childhood. The level of norepinephrine in brain may relate to hyperactivity and chronic lead exposure. The purpose of this study was to determine the effect of inorganic lead (PbCl(2)) administration in neonatal rats using immunocytochemical and electron microscopical analysis of norepinephrinergic neurons of the locus ceruleus. Lead chloride were dissolved in distilled water at the concentration of 0.05%, 0.1% and 0.2% and the solution was administered orally via drinking water. After 4, 8 or 12 weeks of continuous administration, all rats were sacrificed and the brain was processed and immunostained with antibody against tyrosine hydroxylase, a rate limiting enzyme of norepinephrine synthesis antibody. The number of tyrosine hydroxylase immunostained cell bodies in locus ceruleus was estimated. Densitometric analysis of tyrosine hydroxylase immunoreactive profiles in electron microscopic photographs were done by using image analyzer. The number of tyrosine hydroxylase immunoreactive neurons in the locus ceruleus had increased statistically after lead administration. Density of tyrosine hydroxylase immunoreactive profiles in the electron microscopy had also increased. Degenerative changes, such as intra-axonal vacuolar space formation, were found within tyrosine hydroxylase immunoreactive axons. Somewhat widened intercellular spaces and retracted processes were also found in the region of the locus ceruleus. Increased tyrosine hydroxylase immunoreactivity may correlate with hyperreactivity of lead intoxicated children. Degenerative changes may be responsible for the short attention span, easy distractibility and impulsiveness observed in case of mild lead poisoning.

A Case of Glomus Tumor of the Stomach: Role of Endoscopic Ultrasonography / 대한소화기내시경학회지

A glomus tumor of the stomach is a rare submucosal lesion that was first described by De Busscher in 1948. Submucosal tumors of the stomach are mostly leiomyoma, leiomyosarcoma, and malignant lymphoma. It is difficult to diagnose this kind of tumor preoperatively. We present a patient with a gastric glomus tumor which showed the characteristic endoscopic ultrasonographic (EUS) finding. Our case was also diagnosed by pathology after surgery. The major EUS findings in the present case are circumscribed low echoic mass in the forth submucosal layer and an internal heterogenous echo mixed with high echoic spots. The EUS seems to be useful in distinguishing between glomus tumor and other submucosal tumors.

A Case of Hypereosinophilic Syndrome with Hepatic and Gastrointestinal Involvement / 대한간학회지

Hypereosinophilic syndrome is characterized by prolonged eosinophilia of blood and tissue without an identifiable underlying cause and multiorgan system dysfunction by eosinophil-related tissue damage to variable organs: liver, heart, lung, kidney, gastrointestinal tract, skin, nerve. Some case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement have been reported, but not much. We are reporting a case of hypereosinophilic syndrome with hepatic and gastrointestinal involvement in 56-year-old man who presented general weakness and epigastric discomfort. In abdominal US, CT and MRI, intrahepatic multifocal ill-defined lesions were detected. The patient was treated with prednisolone for 16 weeks and recovered from eosinophilia and gastric involvement. A gastric biopsy was taken to confirm recovery. Also, the ill-defined lesions in US and CT disappeared after treatment.

A Case of Complete Remission in Ruptured Hepatocellular Carcinoma after One -time Transcatheter Arterial Chemoembolization / 대한간학회지

There are many kinds of treatments for hepatocellular carcinoma (HCC) such as surgical resection, liver transplantation, chemotherapy, interventional therapy [TACE, ethanol embolization, Immuno -chemoembolization, I131 -lipiodol embolization], thermal therapy, cryotherapy, and radiation therapy. Generally spontaneous remission is not common in HCC, however underlying mechanism of spontaneous remission is uncertain. We report a case of complete remission after one time TACE in ruptured HCC with review of literature about the effect of TACE and spontaneous remission. We conclude that arterial embolization is an effective alternative to surgery for hepatic hemostasis in patients with spontaneous rupture of hepatocellular carcinoma.

Tracheobronchial Aspergillosis An autopsy case report

Tracheobronchial aspergillosis is an unusual form of invasive aspergillosis characterized by noninvasive or only superficially invasive tracheobronchitis with a propensity for dissemination. We report a two-year-old male who suddenly died of respiratory failure. Postmortem examination revealed a pseudomembrane covering the mucosa of larynx, trachea and bronchial tree of both lungs. This pseudomembrane was composed predominantly of Aspergillus hyphae. There was transmural necrotizing bronchitis with fungal invasion to the narrow zone of peribronchial tissue, and dissemination to the stomach and kidney. This form of pulmonary aspergillosis had not been reported in this country.