A Case of Leptomeningeal Carcinomatosis with Bilateral Hearing Loss and Dizziness / 대한이비인후과학회지

Leptomeningeal carcinomatosis is defined as the diffuse infiltration of the leptomeninges by malignant cells metastasized from systemic cancer. We report a case of leptomeningeal carcinomatosis presenting bilateral sensorineural hearing loss and dizziness. A 51-year-old woman who was diagnosed with non-small cell lung cancer with leptomeningeal carcinomatosis was referred to our department because of progressive hearing loss and dizziness. Magnetic resonance imaging revealed an abnormal enhancement of the vestibulocochlear nerves within the internal auditory canals bilaterally. The patient received chemotherapy concurrently with an intrathecal methotrexate injection. Leptomeningeal carcinomatosis must be considered in the differential diagnosis of cancer patients with bilateral progressive sensorineural hearing loss.

A Case of Self-Induced Pneumoparotitis / 대한이비인후과학회지

Self-induced pneumoparotitis is a rare cause of swelling of the parotid gland. It has been reported to be a result of psychosomatic disorder, unintentional habit, and it is sometimes self-induced by patients to achieve secondary gain. We report a case of a 18-year-old man who had a self-induced pneumoparotitis complicated by recurrent parotitis, subcutaneous emphysema and pneumomediastinum. With repeated behavior of insufflation, parotid acini may rupture and air may extend into the retropharyngeal space, causing pneumomediastinum or pneumothorax. In self-induced cases, treatment should necessitate psychologic therapy for behavior modification.

A Case of Angioleiomyoma of the Oropharyngeal Wall / 대한이비인후과학회지

We report a recently encountered case of angioleiomyoma in oropharynx. The patient was a 26-year-old woman. The main symptoms were feeling of narrowing down of the pharynx and difficulty in breathing in the left supine position. Laryngoscopy revealed a 3.5cm-sized, spherical mass with a smooth surface, originating in the right oropharyngeal wall. The tumor was successfully removed using suspension microlaryngoscopy under general anesthesia. Histopathologically, it was well circumscribed and composed of proliferating smooth muscle fibers and dilated blood vessels. The tumor is a benign nature and recurrence is rare. Complete removal is the treatment of choice with care taken to avoid profuse bleeding.

Angiomatous Nasal Polyp with Maxillary Wall Erosion

An angiomatous polyp originates from a sinochoanal polyp, and may be confused with a vascular neoplasm. Compromise of their vascular supply may occasionally lead to infarction, resulting in clinical, radiological and pathological features that simulate a neoplastic process. Recently, we experienced a case of angiomatous nasal polyp that eroded the anterior wall of maxilla at the time of its presentation in a 15-year-old boy. Angiomatous nasal polyps are poorly documented in clinical literature. Although entirely benign, they may simulate neoplastic processes. Thus, awareness of their existence is of considerable importance.

A Case of Pericardial Tamponade in a Korean Man with Pericardial Abscess due to Bacteroides fragilis / 감염과화학요법

Purulent pericarditis is a rare, life-threatening condition and usually involves the whole pericardium. However only few cases have been reported in which a loculated pericardial abscess occurred from purulent pericarditis. The prevalence of acute pericarditis due to bacteria was 6%. Purulent pericarditis due to anaerobic bacteria has been reported less frequently than aerobic bacteria. There was no report about purulent pericarditis due to Bacteroides fragilis in Korea until now. So we report the first case of pericardial abscess due to B. fragilis in 59 year old Korean male with history of chronic renal failure and hemodialysis, that was complicated with pericardial tamponade.

A Case of Pericardial Tamponade in a Korean Man with Pericardial Abscess due to Bacteroides fragilis / 감염과화학요법

Purulent pericarditis is a rare, life-threatening condition and usually involves the whole pericardium. However only few cases have been reported in which a loculated pericardial abscess occurred from purulent pericarditis. The prevalence of acute pericarditis due to bacteria was 6%. Purulent pericarditis due to anaerobic bacteria has been reported less frequently than aerobic bacteria. There was no report about purulent pericarditis due to Bacteroides fragilis in Korea until now. So we report the first case of pericardial abscess due to B. fragilis in 59 year old Korean male with history of chronic renal failure and hemodialysis, that was complicated with pericardial tamponade.

Systemic Infection by the Gasric Candidiasis

Candida albicans is a saprophytic organism that frequently resides in the mouth, skin, gastrointestinal and vaginal mucosa. It is also an opportunistic pathogen in immune compromised individuals, diabetics, alcoholics, and where drugs have reduced gastric acid production, and in debilitated subjects treated with antibiotics, steroids, and immunosuppressive or antineoplastic drugs. Although the most common site of gastrointestinal involvement is the esophagus, gastric candidiais may occur in immunosuppressed patients, but is rarely apparent in healthy individuals. Systemic infection by gastric candidiasis is extremely rare. A case of gastric candidiasis, presenting with sepsis, was experienced in a 46-year-old male with diabetes mellitus. He underwent orthopedic surgery because of an intertrochanteric fracture of his femur. On day 6 of the postoperative period, the patient began suffering from an intermittent fever, epigastric pain, and vomiting. Day by day the patient's condition became debilitating and sepsis developed. An endoscopic examination revealed multiple whitish, or central necrotic, plaques in the body and antrum of the stomach. An endoscopic biopsy revealed budding yeast and pseudohyphae infiltrating through the ulcerated gastric wall. After the patient was treated with the fluconazole alternative, liposomal amphotericin B, the patient's condition and endoscopic finding improved. Here, a case of gastric candidiasis presenting with sepsis, in reported along with a review of the corresponding literature.

Lymphoepithelial Cyst by the Pancreas

Cystic lesions of the pancreas are relatively rare, but constitute an important category with a challenging differential diagnosis at the clinical, radiological, and pathological levels. A lymphoepithelial cyst of the pancreas is a rare, but distinctive cystic lesion, lined by a mature, keratinizing squamous epithelium, surrounded by lymphoid tissue. This type of lesion was first described by Luchtrath and Schriefers, in 1985. Although the histogenesis of this lesion is not known, it is benign. It can be successfully managed by local excision, with a "wait and watch" approach, in selected cases. A 52-year-old female presented with a history of intermittent epigastric pain of 3 months duration. A physical examination and laboratory studies showed no abnormal findings. Computed tomography of the abdomen revealed a 4.5x2.5 cm well circumscribed, thin rim enhanced, unilobulated cystic lesion closely attached to the uncinate process of the pancreas. Endoscopic retrograde chloangiopancreaticography showed no abnormalities in the duct system. A local mass excision was performed, due to the suspected diagnosis of a benign cystic lymphangioma. The histopathological diagnosis was a lymphoepithelial cyst of the pancreas. The patient was discharged with no complications, on the 8th postoperative day Here, this case is reported with a review of the relevant literature.

Non-Traumatic Colon Perforation

PURPOSE: Despite advances in surgery, antimicrobial therapy and postoperative intensive care, severe secondary peritonitis, caused by colonic perforation, remains a potentially fatal affliction. The appropriate surgical management of colonic perforation has always been a controversial issue, and one that continues to evolve. The differences in patient's characteristics, due to their medical problems, general conditions, peritonitis grade, or causes of perforation, influence both the surgical decision and the outcome. The aim of this study was to evaluate and compare the incidence, management and outcome of patients with different causes of non-traumatic colon perforation. METHODS: Between February 1993 and February 2002, 42 patients underwent emergency operations for non-traumatic colon perforations. We compared the morbidity and mortality with age, cause, perforation site, extents of peritonitis and surgical procedure. In patients with colorectal-cancer, we assessed the outcomes as perforation types; the perforation of the tumor itself, diastatic perforations proximal to an obstructing tumor and tumor stages. RESULTS: The causes of perforation were cancerous in 17 (40.5%), idiopathic in 7 (16.7%), diverticular in 5 (11.9%), colitis in 4 (9.5%), adhesion and strangulation in 4 (9.5%), stercoral in 3 (7%) and enema induced in 2 (4.8%). The morbidity and mortality in this study was high 76.2 and 26.2%, respectively. The morbidity and mortality was increased as the intra-abdominal fecal contamination increased (P<0.05). but there were no correlations between the complication rate, age, cause, perforation site or operation procedure. In patients with colorectal cancer, there were no correlations between the morbidity and mortality, perforation type or tumor stages. CONCLUSION: A non-traumatic colon perforation is associated with high morbidity and mortality. The prognosis of patients is determined by the grade of their peritonitis. Early diagnosis and prompt surgical management will result in better outcomes for patients with non-traumatic colon perforations.