[Use of StyletScope in a patient with airway injury].

A forty-year old man hanged himself and was transported to our hospital. On arrival his consciousness was clear but he showed dyspnea, dysphagia, and oral bleeding. Tracheal intubation was attempted but was failed and emergency tracheostomy was successfully accomplished. Tracheoplasty was soon scheduled under general anesthesia because of subcutaneous emphysema. An ordinary laryngoscope could not give a view of the larynx at all. Orotracheal intubation was accomplished with StyletScope. It worked very well for the destroyed trachea. StyletScope is a useful device for intubation, especially in difficult airway management.

[A case of cardiac myxoma presenting with multiple cerebellar hemorrhages and elevation of interleukin-6 in the cerebrospinal fluid].

We report a 25-year old man with cardiac myxoma presenting with multiple cerebellar hemorrhages and elevation of interleukin-6 (IL-6) in the cerebrospinal fluid (CSF). The patient was first admitted to our hospital because of cerebral infarctions at the age of 23. After systemic exploration he was diagnosed as cardiac myxoma. In this patient, the serum level of IL-6 was elevated. The cardiac myxoma was resected and the serum IL-6 level returned to normal. His neurological symptoms improved almost to normal and he was discharged. The patient had been well for two years until he developed headache at the age of 25. Brain MRI revealed multiple cerebellar hemorrhages that overlaid old infarctions. The hemorrhages enlarged in a three months period and his headache became worse, and then he was admitted again. The IL-6 value was normal in serum at that time, but it was elevated in the CSF. The CSF IgG index was also elevated. Cerebral angiograms showed no abnormal vessel in the infratentorium, while multiple fusiform aneurysms were found in both middle cerebral arteries. A transesophageal echocardiography revealed no recurrence of cardiac myxoma. Craniotomy was performed and intracerebellar hematomas were removed. Histopathological examination showed only old and recent bleedings; no metastatic myxoma tissue was found. Although no myxoma tissue was found in biopsy specimen, it seemed reasonable that an elevated level of IL-6 in the CSF was due to metastasized intracranial myxoma, which caused cerebellar embolism, and then invaded the vessel walls and continued to grow. In reviewing the literature we have found no reported case of cardiac myxoma with analysis of IL-6 value in the CSF. We speculate that the level of IL-6 in the CSF might be a good marker for the neurological manifestations of cardiac myxoma.

Pathological lesions causing pulmonary hypertension after closure of a ventricular septal defect.

A 15-year-old boy with a ventricular septal defect, pulmonary hypertension, Down's syndrome, and extremely thickened media (ETM) of the small pulmonary arteries died of heart failure and pulmonary hypertension 13 years after intracardiac repair. Microscopic examination of lung specimens collected prior to the intracardiac repair and at the time of autopsy revealed that the ETM had remained unchanged and that the arteries connected to the vessels with ETM had become severely thickened. The present case shows that even a small percentage of arteries with ETM can cause pulmonary hypertension, and illustrates one of the mechanisms of how pulmonary hypertension can fail to be resolved after intracardiac repair.

Monostotic fronto-orbital fibrous dysplasia with convulsion--case report.

A 28-year-old man presented with monostotic fronto-orbital fibrous dysplasia associated with convulsions. Signs of meningeal irritation were observed. Computed tomography (CT) showed right frontal sinusitis, and destruction from the inner to outer table with expansion of the diploic space. T1- and T2-weighted magnetic resonance imaging showed an abnormal low-intensity mass, with heterogeneous gadolinium enhancement. Although the meningitis resolved, signs of infection continued for 2 months due to sinusitis. Treatment of the right frontal sinusitis was undertaken, accompanied by open biopsy. The histological diagnosis was fibrous dysplasia. Once the infection had completely resolved, orbitofrontal reconstruction was undertaken. Cranioplasty was carried out using cranial bone cement. Three-dimensional CT was valuable to show the likely postoperative result.