[A case of eosinophilic esophagitis caused by a cedar ball].

A 65-year-old woman presented to our hospital with chief complaints of a strange sensation in her pharynx, dysphagia, and odynophagia. Upper gastrointestinal endoscopy showed multiple aphthae in the esophagus and she was diagnosed with eosinophilic esophagitis based on the results of biopsy. Swallowing therapy with fluticasone was scheduled; however, she subsequently developed urticaria. She was treated with systemic steroid therapy at another hospital, which improved her symptoms and endoscopic images. A detailed history revealed that she had experienced significant facial edema after making a cedar ball. It was considered that the eosinophilic esophagitis was possibly caused by cedar pollen.

Labour analgesia guided by echocardiography in a parturient with primary dilated cardiomyopathy.

PURPOSE: To evaluate the effects of intrathecal analgesics on cardiac function during labour analgesia using echocardiography in a parturient with idiopathic dilated cardiomyopathy (DCM). CLINICAL FEATURES: Induction of labour was planned in a 35-yr-old primiparous woman suffering from DCM. In order to stabilize hemodynamics in this patient, we induced continuous spinal analgesia with an infusion of fentanyl and epinephrine. Although her analgesia was well maintained for three hours during the first stage of labour, the patient complained of pain towards the second stage of labour. At this point, we administered bupivacaine intrathecally to alleviate her pain. Transthoracic echocardiography showed that the left ventricular end-diastolic and systolic dimensions, as well as the ejection fraction were not impaired by use of these analgesic medications. CONCLUSION: Measurement of left ventricular dimensions by echocardiography allowed us to monitor the patient's response to intrathecal analgesic medications. In this patient with DCM, analgesia with intrathecal fentanyl and bupivacaine was well tolerated.

Primary squamous cell carcinoma of the brain. A rare autopsy case.

In the present study, a rare autopsy case of primary squamous cell carcinoma of the brain is described. The patient was a 49-year-old man who showed brainstem symptoms and signs. These included oculomotor, abducens and facial palsies, dysphagia, dysarthria, and long tract signs such as quadriplegia with Babinski's signs during the 3-year and 6-month course of his illness. Neuropathologically, poorly differentiated squamous cell carcinoma was seen in the pons, medulla oblongata, part of the midbrain and spinal cord, the base of the cerebellum, the hypothalamus, the optic chiasm, and the left parahippocampal gyrus. The base of the pons and medulla oblongata were extensively destroyed by tumor cells. The relevant literature regarding primary squamous cell carcinomas of the brain was reviewed, and the characteristic features of this rare condition were discussed.