Surgical treatment of symptomatic subglottic stenosis during the third trimester of pregnancy.

Subglottic stenosis is a narrowing of the airway distal to the glottis. Airway narrowing can be severe and, when coupled with pregnancy, can pose a significant threat to the mother and fetus. There is sparse literature describing treatment of these critical patients, posing a challenge for management. We describe our experience with a 31-year-old woman with idiopathic subglottic stenosis who became symptomatic during her pregnancy, requiring surgical intervention early in her third trimester. The following case report describes this patient's presentation and management, in which an awake dilation technique was used. We also include a literature review on the management of subglottic stenosis in pregnancy.

Adenoid cystic carcinoma of the nasal cavity: a case report.

Adenoid cystic carcinoma (ACC) is the most common malignant tumor of the minor salivary glands. The sinonasal tract is a common site of ACC occurrence, second only to the oral cavity. Of all cases of sinonasal ACC, a minority (22 to 35%) arise in the nasal cavity. Three histologic patterns of ACC have been described: cribriform, tubular, and solid. Compared with the cribriform and tubular forms, predominantly solid-type ACCs have been associated with higher rates of perineural invasion, higher S-phase fractions, and a higher incidence of aneuploidy. The histologic differentiation of solid-pattern ACC from other sinonasal malignancies typically requires the identification of one or both of the other ACC patterns in the same specimen. We present the case of a 39-year-old man with solid-pattern ACC arising in the nasal cavity. The tumor was resected endoscopically. We also discuss the relevant literature regarding the histologic diagnosis, prognosis, and treatment options for solid-pattern ACC.

Acute renal failure following massive mannitol infusion.

Mannitol overuse-induced acute renal failure (ARF) has rarely been described. We report four cases, all male, between the ages of 20 and 42 years, who developed acute renal failure (3 anuric, 1 nonoliguric) after receiving mannitol 1,172 +/- 439 g (mean +/- SD) during a time period of 58 +/- 28 h. The infusion rate was 0.25 +/- 0.02 g/kg/h. The onset of acute renal failure was detected 48 +/- 22 h after infusion. In 2 of the 3 cases in which urinary cytology was evaluated, the presence of vacuole-containing renal tubular cells was observed. All patients had hyponatremia (120 +/- 11 mEq/l), and hyperosmolality (osmolar gap 70 +/- 11 mosm/kg water). No other factors could be pointed to as causing acute renal failure. In the 3 anuric cases in which hemodialysis was performed, immediate recovery of diuresis was observed. Two patients recovered renal function on the fifth and sixth days, and 2 died due to endocranial hypertension - one of them while recovering - on the fourth and sixth days. In the present report, mannitol-induced ARF occurred at clustered doses of 0.25 mg/kg/h.