Nystagmus at the Onset of Vertiginous Attack in Ménière's Disease.

OBJECTIVE: To clarify the direction and characteristics of nystagmus at the onset of a vertiginous attack in Ménière's disease. PATIENTS: Two patients with Ménière's disease, whose nystagmus at the onset of a vertiginous attack was recorded using electronystagmography. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURES: Electronystagmographic recordings of nystagmus. RESULTS: In both patients, nystagmus was directed toward the affected side over the entire course of the vertiginous attack. One patient experienced a severe sensation of vertigo and exhibited strong nystagmus from the onset of the attack. The other patient reported a mild sensation of vertigo, which was accompanied by intermittent nystagmus. CONCLUSIONS: Vertiginous attacks in Ménière's disease are accompanied by irritative nystagmus. The intensity and characteristics (e.g., continuous or intermittent expression) of the nystagmus may be associated with pathophysiological severity.

[A case of rapidly progressive glomerulonephritis with anti-glomerular basement membrane antibody in the course of MPO-ANCA positive interstitial pneumonia].

A 78-year-old man developed rapidly progressive glomerulonephritis (RPGN) in the course of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-positive UIP that had been found four years previously. When UIP was diagnosed, the MPO-ANCA titer was low and urine was negative for proteinuria and hematuria. On admission, his serum creatinine increased to 16.89 mg/dL and hemoglobin decreased to 5.2 g/dL. Urinalysis revealed that urinary protein excretion was 0.423 g/day and hematuria (30-40/HPF). The MPO-ANCA titer increased to 95.6 U/mL and anti-glomerular basement membrane (GBM) antibody titer elevated to 140 EU. Renal pathology revealed cellular crescents in 10 out of 11 glomeruli excluding two global sclerotic glomeruli. Immunofluorescence showed heavy linear deposits of IgG and C3 along the GBM. Treatments were begun after admission with hemodialysis and intravenous methylprednisolone pulse therapy, oral prednisolone at the dose 30 mg/day. Both MPO-ANCA and anti-GBM antibody were within the normal range after four months. However, the renal function was not restored despite treatment and he died of pulmonary infectious disease after six months from the onset of RPGN. Recently, many cases of RPGN with both MPO-ANCA and anti-GBM antibody have been reported. In this case, persistent UIP-associated MPO-ANCA appeared to have triggered RPGN by anti-GBM antibody.

A Case of Descending Necrotizing MediastinitisPenetrating to the Esophagus.

Here, we present the case of a 78-year-old man with a deep neck infection that caused descending necrotizing mediastinitis that extended from the pharynx to the stomach and was accompanied by two large esophageal fistulas and multiple gastric ulcers. We believe that the series of lesions were the signs of a hidden carcinoma.