[Hiccup treated by administration of intranasal vinegar].

A three-year old girl, who had severe cerebral palsy, severe mental retardation, and symptomatic epilepsy, was suffering from intractable hiccup that lasted for more than an hour since she was 2 years and 10 months old when she undertook tracheotomy and laryngotracheal separation. Sometimes this intractable hiccup was followed by respiratory arrest. Although the hiccup was resistant to conventional medications, the nose drops of small amount of vinegar showed a favorable effect on the hiccup. Intranasal vinegar might stimulate dorsal wall of nasopharynx where the pharyngeal branch of the glossopharyngeal nerve, which is thought as an afferent of the reflex arch of hiccup, is distributed. The administration of intranasal vinegar is a safe and handy method to stimulate dorsal wall of nasopharynx. We believe that intranasal vinegar administration could be a useful nonpharmacologic therapy to cease intractable hiccup.

Fatal eosinophilic heart disease in a child with neurofibromatosis-1 complicated by acute lymphoblastic leukemia.

We present a pediatric case of neurofibromatosis-1 (NF-1) complicated by acute lymphoblastic leukemia and hypereosinophilia, which caused multiple end-organ damage. Although clinical symptoms such as fever and coughing were noted only 1 week before admission, the condition deteriorated rapidly with a fatal outcome prior to antileukemic therapy. A postmortem examination demonstrated extensive endomyocardial fibrosis with thrombotic occlusion and recanalization of the coronary arteries. Leukemic cell infiltration was not seen in the cardiac tissue. When eosinophilia is diagnosed in patients with NF-1, eosinophilic end-organ damage, particularly cardiac involvement, in addition to hematological malignancies, should be screened for in order to start medical treatment at the early stage of the disease.