Satoru Fukami

A Case of Hyperosmolar Nonketotic Coma (HONKC) after Surgery for Laryngeal Carcinoma.

We report a case of hyperosmolar nonketotic coma that developed postoperatively in a patient with cancer of the larynx.The patient was a 69-year-old man, who underwent frontolateral laryngectomy.He suddenly became comatose on the 17th day after surgery and examination revealed HONKC. A low rate of continuous intravenous drip infusion of insulin and fluid replacement were initiated.Despite subsequent acute renal failure, sepsis, disseminated intravascular coaglation and rhabdomyolysis, the patient is still alive to date. HONKC is rare as a postoperative complication, but can be fatal.Careful postoperative care is needed for patients with diabetes mellitus.

Primary Frontal Sinus Carcinoma Found after Injury. A Case Report.

Compared to the maxillary sinus, a carcinoma of the frontal sinus is very rare and difficult to detect early. We report a case of a frontal sinus carcinoma that was not diagnosed in the early stage. A 75-year-old male fell down in his home garden and bruised his forehead. He visited the Shimotsuga General Hospital complaining of swelling of the central part of the forehead. CT showed a defect of the frontal bone and an abnormal shadow of the left frontal sinus. A pathological examination was carried out using a specimen of the ulcer lesion of the forehead, and he was diagnosed with an inflammatory granulation tissue. Antibiotics were admitted for 3 weeks but without improvement. Then, an extranasal frontal sinusectomy was performed. The final pathological diagnosis was a squamous cell carcinoma. Radiotherapy was performed immediately, but unfortunately, he died of bronchopneumonia. Generally speaking, a frontal sinus carcinoma has a very poor prognosis. We emphasize that frontal sinus carcinomas have to be detected at an early stage, and treatment must be started immediately.