We experienced a case of multiple injuries in an illegal alien, in which particular considerations for treatment were needed. The patient was a 24-year-old Japanese-Brazilian man. He received multiple injuries in a motor vehicle accident, including lacerations to the face and the oral cavity, multiple maxillofacial fractures, fractures in the pelvis, and fractures within the left knee joint. Treatment was very difficult, firstly because of language problems and mainly because he was an illegal alien. Problems in the treatment of illegal aliens are discussed.

In a 1-year retrospective study (April 1, 2002, to March 31, 2003), I reviewed the medical records of 22 hospitalized epistaxis patients at Aizawa Hospital. I evaluated multiple factors associated with epistaxis : age, gender, month of hospital admission, length of stay, underlying medical diseases, blood pressure, hemoglobin level, site of bleeding and treatment. Visualization of the bleeding vessel is key to efficient management of epistaxis. All patients had their nasal cavity examined by endoscopy. Seven patients (31.8%) had bleeding at the posterior portion of the inferior nasal meatus, and three of them required a nasopharyngeal pack (Bellocq's Tampon). No patient underwent surgical arterial ligation or arterial embolization. Endoscopically guided treatment was useful in all patients.

A 53-year-old woman was admitted for evaluation of a solitary pulmonary nodule on the chest radiograph. She was asymptomatic and had no past history or familial history. Physical and laboratory findings revealed no abnormality. Computed tomography (CT) of the chest showed a solitary nodule in the right S3 area with a size of 12mm. The patient underwent partial pulmonary resection by video-assisted thoracoscopic surgery. Pathological examination of the resected specimen revealed epitheloid cell granulomas with caseous necrosis. The final diagnosis of pulmonary Mycobacterium avium complex (MAC) infection was made by PCR. The radiographic appearance of a solitary nodule in pulmonary MAC diseases is extremely rare. The radiographic findings were difficult to distinguish from other tumors, including lung cancer. This infection should be added to the list of possible causes of solitary pulmonary nodule.