Toxic shock syndrome after anterior-posterior nasal packing.

Toxic shock syndrome (TSS) is a severe, potentially life-threatening multisystem disease. It is rather rare with the incidence estimated to be 16.5/100,000 of nasal surgery performed in the United States. A milder degree of TSS may be more common. Surgeons who perform sino-nasal surgery should be aware of this disease, although certain criteria for definite TSS are absent. Early recognition and prompt intervention is important to minimize the morbidity and mortality associated with this disease. This paper presents the first reported case of a milder degree of TSS after anterior-posterior nasal packing in Thailand. The criteria for diagnosis, the pathogenesis, and the management of TSS were reviewed.

Head and neck mycetoma.

Two cases of eumycotic mycetomas in the head and neck region are reported. The first case is the localized mycetoma which involved only the soft tissue of the neck. It was completely excised and the patient needed no further treatment. In the second case, the lesion extensively involved the structures in the parapharyngeal space, submandibular space and carotid sheath. The upper limit is the skull base. The patient was treated by combination of wide excision with radial forearm flap and antifungal agents, however, the prognosis is fair.

Lymphomatoid granulomatosis with upper airway obstruction: a case report.

A case of lymphomatoid granulomatosis in a previously healthy 13-year-old Thai girl presenting with right sixth cranial nerve palsy and severe upper airway obstruction was reported. Cranial nerve palsy later disappeared spontaneously but the patient developed multiple pulmonary nodules and cavity leading to pulmonary insufficiency. Her course was complicated with septicemia which limited the use of corticosteroid and cytotoxic drugs. She finally expired with pseudomonas sepsis in addition to pulmonary and liver involvement. This is the first case of lymphomatoid granulomatosis in a child ever reported in Thailand. Lymphomatoid granulomatosis should be included in the differential diagnosis of upper airway obstruction with pulmonary nodules and cavity and multi-organ involvement in children.

Eosinophilic lymphofollicular hyperplasia with eosinophilia: report of cases.

Two patients with lesions involving the parotid and submandibular region are presented. Clinical pictures and microscopic findings were suggestive of Kimura's disease with coexistent parasitic infestation. Possible parasitic etiological factors were discussed without confirmation.

Parapharyngeal malignant ectomesenchymoma: combined malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation.

A parapharyngeal ectomesenchymoma consisting of mixed malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation occurred in a 36-year-old woman. Immunohistochemical and electron microscopic studies verified the combined mesenchymal and neuroectodermal components within the tumour. Only 9 similar cases, including the present one, are on record. The patients ranged in age from 6 months to 49 years, with an average age of 18 years. The male:female ratio was 4:5. The tumour location was widespread. All reported ectomesenchymomas were histopathologically malignant. Recurrence and/or metastasis was/were common. The neural crest has been suggested as the origin of the ectomesenchymomas.

A case of aural gnathostomiasis.

A young Thai woman was afflicted with aural gnathostomiasis. The only symptom she had was sudden intermittent otalgia without apparent hearing loss, tinnitus, vertigo or otorrhea. Presumptive diagnosis was made from the recent history of ingesting raw fish with subsequent migratory swellings. Definite diagnosis rested on identification of the worms, pertinent eosinophilia and positive skin test. This case was different from those previously reported because it was a primary aural gnathostomiasis without neurological involvement.