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silateral tinnitus and hearing loss. One patient was evaluated at a late stage who also presented with facial nerve weakness. Immunohistochemical analysis in all specimens confirmed overexpression of the HIF-1a protein in tumor cells.Conclusion: ELSTs are likely to be associated with HIF-1a mediated angiogenesis. These lesions are possibly associated with loss of VHL protein due to mutation of the VHL gene.Significance: Elucidation of the pathophysiology of endolymphatic sac tumors may lead to future novel approaches in the management of this unusual tumor associated with von Hippel-Lindau disease.

study was to elucidate the effects of VCAP on sleep and the utility of awake and sleep laryngoscopy in MSA.Methods: We recruited 14 patients with MSA presenting with snoring (4 men and 10 women; mean age, 54.6 years; disease duration, 4.2 years; International Cooperative Ataxia Rating Scale [ICARS], 46.9). After performing arterial blood gas analysis, spirometry, and polysomnography (PSG), awake and sleep laryngoscopy were performed.Results: Sleep laryngoscopy revealed that 7 patients exhibited VCAP and 7 patients did not. Between these 2 groups, there were no significant difference in the following findings: sex, disease duration, ICARS, findings of daytime blood gas analysis and PSG findings (mean SpO2 during sleep, AI, AHI and arousal index). Five of 7 patients who exhibited VCAP also showed bilateral arytenoidal tremor on awake laryngoscopy.Conclusion: These findings suggest that MSA should be followed by sleep laryngoscopy, however, it is difficult to perform sleep laryngoscopy as a routine evaluation. Since early diagnosis of VCAP is difficult to make on awake laryngoscopy, arytenoidal tremor may be useful as a sign to predict VCAP.

Objectives: Toxic shock syndrome (TSS) is a multisystem disease caused by the toxin or superantigen producing strains of streptococci or staphylococci. We report a rare case of toxic shock syndrome presenting as a prevertebral abscess.Methods: A case review of an unusual presentation, clinical course, and management of TSS. We review the incidence, disease course, radiographic appearance, and treatment of TSS. A MEDLINE search of this topic revealed no similar cases of toxic shock syndrome presenting as a prevertebral abscess.Results: A 30-year-old otherwise healthy male presented with a 2-day history of odynophagia, frontal headaches, and subjective fevers. One day prior to admission he was treated with azithromycin for pharyngitis. He returned to the emergency room secondary to a nonpruritic rash on his extremities. On physical exam the patient was found to have posterior pharyngeal wall fullness, tender right lymphadenopathy, and a maculopapular rash on his extremities. Radiographic imaging revealed a cervical prevertebral abscess. The patient underwent incision and drainage of this prevertebral abscess. On postoperative day 2 he became febrile and developed multiple organ failure requiring intubation and intensive care. The patient received intravenous antibiotics and intravenous immunoglobulin. The patient's systemic manifestations gradually resolved and he was extubated 9 days after intubation.Conclusion: This is the first reported case of prevertebral abscess as a possible source of TSS. The onset of TSS can be abrupt and recognition of its symptoms is imperative in quickly diagnosing and treating this multisystem disease.