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A 51-year-old woman with previously diagnosed situs inversus (SI) totalis was admitted to our hospital with nasal bleeding. Blood tests showed severe thrombocytopenia, with a platelet count of 1.9 × 104/mm(3), and idiopathic thrombocytopenic purpura (ITP) was diagnosed. She was refractory to medical treatment, so we performed laparoscopic splenectomy (LS). The mirrorimage anatomy made the procedure difficult for the right-handed surgeon, so we modified the technique to enable it to be performed via an anterior approach through the subxiphoid area using the right hand, with an ultrasonic dissecting device and an endostapling device. The operation was performed safely, the patient recovered uneventfully, and her platelet count normalized. To our knowledge, there has been no other report of LS in a patient with SI; however, it can be performed safely with careful management.

An extensive craniofacial trauma is often associated with skull basal fractures and severe epistaxis. Such event requires nasal packing, using balloon systems or even arterial embolization or ligation. However, the use of balloon systems may result in an intracranial position. We report here such a case in an 18-year-old man suffering from a severe nasal bleeding.

We describe a patient with bone marrow hemophagocytosis who had classic dengue fever associated with nasal bleeding and pancytopenia. The patient recovered with appropriate supportive care. A literature search shows fewer than 20 case reports of dengue related hemophagocytosis in the English literature. Our patient is an interesting case of dengue related hemophagocytic syndrome and adds an additional case to the literature. Clinicians should consider that the occurrence of hemophagocytosis in the appropriate geographical area could be due to dengue virus infection and present with pancytopenia.

We describe three cases of blood boils of the maxillary sinus that were suspected to be malignant tumors. The patients were a 27-year-old female, a 52-year-old male and a 24-year-old male. The chief complaints in all cases were unilateral nasal obstruction and nasal bleeding. CT examination showed that the tumors occupied the entire unilateral maxillary sinus, and expanded with maxillary bone thinning. Biopsies performed through the nasal cavity revealed the tumorous masses to be benign. Ultimately, the tumorous masses were surgically extirpated without any transfusion, and the histopathological diagnosis turned out not to be the more typical hemangioma, but rather so called blood boil.

Medial protrusion of the lamina papyracea into the ethomoid sinus has been described as a cause of orbital complications during endoscopic sinus surgery (ESS). The reported rate of the abnormal ranges from 0.5-6.5%.We encountered a male patient with nasal bleeding. A nasal tumor in right nasal cavity was found and medial protrusion of the lamina papyracea into the ethmoid sinus was confirmed by preoperative CT examinations. The patient was successfully treated by ESS without orbital complications.We emphasized that appropriate CT examinations before ESS are very important for preoperative evaluation of the anatomical relation among adjacent critical structures.

The aim of this study was to introduce a modified endoscopic lift of the floor of the maxillary sinus in beagles. Twelve operations (bilateral and randomly chosen) were done in 6 beagles each in the test group (modified endoscopic operation), and the control group, in which the operation was done with an osteotome. All operations were evaluated by two indices of safety (perforation of the sinus membrane and nasal bleeding) and 3effective indices (the intraoperative height after lifting, volume of bone grafts, and dislocation of the sinus grafts). The sinus membrane was not perforated and there were no nasal bleeds in either group. The intraoperative height after lifting was 13.7 (0.8) mm in the test group and 9.1 (0.5) mm in the control group, so it was significantly higher in the test group than the control group (p=0.0001). Similarly, the volume of bone graft was 0.9 (0.04) ml in the test group and 0.5 (0.02) ml in the control group (p=0.0001). The volume of the anterior and posterior bone grafts in the implant cavity in the test group did not differ significantly (p=0.102), while there were significant differences in the control group (p=0.002). Endoscopic lifting of the floor of the maxillary sinus is a safe and effective approach based on direct observation in beagles.

* BACKGROUND AND OBJECTIVE: Current techniques of laser-assisted dacryocystorhinostomy are mosdy endonasal. In this report, the authors describe their technique of laser-assisted dacryocystorhinostomy performed through the canaliculi and the surgical results they achieved. * PATIENTS AND METHODS: Fourteen patients with nasolacrimal duct obstruction underwent transcanalicular laser-assisted dacryocystorhinostomy. The bony ostium was perforated using a fiber optic-transmitting, giant-pulse Nd: YAG laser, with an energy of 0.5 to 4 J per pulse. The total energy used to create an ostium was 18 to 34 J. A silicone tube was inserted through the canaliculi and the ostium into the nasal cavity and kept in place for 5 to 7 months. Patients were observed for 18 to 22 months. * RESULTS: Nine of the 14 patients 64%) reported the disappearance of epiphora following surgery. In 3 patients, no relief of epiphora was obtained. In 1 patient the operation was not completed because of severe nasal bleeding. In another, tearing began 12 months after surgery (6 months after tube removal). * CONCLUSIONS: Transcanalicular laser-assisted dacryocystorhinostomy is a potentially useful method for performing dacryocystorhinostomy. Technical modifications and improvements are needed to increase the success rate. [Ophthalmic Surg Lasers 1997;28:723-726.]

Nasal packing is a very common procedure in the otolaryngologic service for nasal bleeding and postoperative hemostasis. However, a pyogenic granuloma complicated from nasal packing has not been reported in the literature. A 50-year-old man underwent nasal packing by use of vaseline gauze due to nasal bleeding. Two weeks later, a dark brown nasal tumor was found in his nasal cavity. He underwent partial turbinectomy for removal of the tumor. The pathology demonstrated a pyogenic granuloma. It is the first case of a confirmed pyogenic granuloma complicated from nasal packing in the literature. To prevent complications and decrease the discomfort, we strongly recommend the use of inflatable balloons or nontraumatic materials for nasal packing.

OBJECTIVE To call pediatrician's attention to an infrequent cause of severe repetitive epistaxis. METHODS The authors report a case of Bernard-Soulier Syndrome and also make a review of the literature available in MEDLINE from 1970. RESULTS The authors describe a 3 year-old boy with severe repetitive epistaxis with hemodinamic repercussions, who required many blood and hemoderivates transfusions. Many diagnostic hypotheses had been formulated, until macroplatelets were found. This finding enabled the diagnosis of Bernard-Soulier Syndrome. A maxillary artery embolization was performed, and the bleedings stopped. CONCLUSIONS Pediatricians should have a high index of suspection in children with severe repetitive nasal bleedings to diagnose uncommon causes of epistaxis, like Bernard-Soulier Syndrome and other trombocytopaties.

A epistaxe continua sendo uma das emergências otorrinolaringológicas mais comuns e preocupantes. Apesar do grande interesse no assunto, ainda não há consenso com relação à sua melhor abordagem inicial. OBJETIVO: Avaliar o sítio de sangramento em pacientes com epistaxe ativa ou recorrente. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Trinta pacientes adultos com epistaxe ativa ou recorrente foram avaliados com rinoscopia anterior clássica e endoscopia para identificação do sítio de sangramento na cavidade nasal. RESULTADO: O uso do endoscópio permitiu o diagnóstico do sítio de sangramento em todos os pacientes. CONCLUSÃO: O exame endoscópico cuidadoso da porção posterior da cavidade nasal permite a identificação do sítio de sangramento na maioria dos casos de epistaxe e deve ser considerado um exame de rotina.Epistaxis remains one of the most common otolaryngology emergencies. Despite considerable interest in the subject, there is still no consensus on the most appropriate primary therapeutic modality. AIM: The purpose of this study was to evaluate the bleeding source of acute or recurrent epistaxis in adults. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Thirty adults patients with acute or recurrent epistaxis were evaluated through the use of frontal light and endoscope for identification of the bleeding source in the nasal cavity. RESULTS: Use of the nasal endoscope allowed diagnosis of the bleeding site in all patients. CONCLUSION: A careful examination of the posterior nasal cavity allows identification of the bleeding source in most patients and should be a routine procedure.

Summary Epistaxis remains one of the most common otolaryngology emergencies. Despite considerable interest in the subject, there is still no consensus on the most appropriate primary therapeutic modality. Aim The purpose of this study was to evaluate the bleeding source of acute or recurrent epistaxis in adults. Study design Clinical prospective. Material and Method Thirty adults patients with acute or recurrent epistaxis were evaluated through the use of frontal light and endoscope for identification of the bleeding source in the nasal cavity. Results Use of the nasal endoscope allowed diagnosis of the bleeding site in all patients. Conclusion A careful examination of the posterior nasal cavity allows identification of the bleeding source in most patients and should be a routine procedure.

A 52-year-old male complained of left nasal obstruction and frequent nasal bleeding. The first operation performed was intranasal resection of a tumor. Eight years later, a recurrent tumor was found in the nasal vestibulum. An enhanced CT scan revealed low density area with marked contrast. There was no sign of invasion into the maxillary sinus or of bone absorption. Wide surgical excision was performed through a lateral rhinotomy approach. The patient has been followed for 2 years with no evidence of recurrence.

Apasmarari rasa , a unique Ayurvedic preparation having hingulottha shuddha parad (HSP), Shuddha Gandhaka (SG) and S huddha Tuttha (ST) and Bhavana dravya (Trituration) as Tinospora cordifolia (Guduchi) as ingredients. The pharmaceutical processing involved preparation of chakrikas (pellets) by triturating the ingredients and sealing them in Sharava (shallow earthen disc) samputa ( uniform smeared and dried ) and subjecting the apparatus to Agni . After self-cooling (swangasheeta) , the mixture was triturated with kadali kanda swarasa for one day and the final product was subjected to analysis. Apasmarari rasa was subjected to assess the LD 50 and Anti convulsant activity on Male Albino rats was by means of MES (Maximal Electro convulsing Shock) Method. A supra maximal strength was 150mA in rats for 0.2 seconds and stimulus was applied via ear clip electrodes. The animal dose of Phenytoin (7.2mg/kg), Smriti sagar rasa (18mg/kg) and Apasmarari rasa (5.4mg/ kg) was given orally to different groups. The animals were observed for a period of 180 minutes after being subjected to electro convulsions. Experimental study had shown some significant result when compared to other drugs. No doubt, that both standard drugs also shown good results when it comes to HLE (hind limb extension), but other factors such as time duration of flexion, tonus, clonus, recovery time amongst others in test drug group ( Apasmarari rasa ) showed significantly better results. Some other observation such as nasal bleeding and orbital bleeding was also absent in test drug group ( Apasmarari rasa ).

Arthrogryposis multiplex congenita, renal dysfunction, and cholestasis (ARC) syndrome is a rare, fatal, multisystem disorder. Bleeding problems, which occur spontaneously and post organ biopsies, have been reported in these patients. We report the case of an infant who had life-threatening spontaneous nasal bleeding. A detailed assessment of her platelet function and morphology is presented.

Objective To assess the in vivo hemostatic effect of a folkloric medicinal plant extract. Subjects and Methods Wistar rats were randomized into four groups of seven. Group 1, a control group, received no pretreatment and was irrigated with saline. Group 2 received no pretreatment and was irrigated with the plant extract. Group 3, a control group, received pretreatment with heparin and was irrigated with saline. Group 4 received pretreatment with heparin and was irrigated with the plant extract. A standardized skin-bleeding model was created using full-thickness skin defects on the Wistar rats’ dorsal skin. To control bleeding, compressive dressings were placed after inserting 1 mL of the plant extract or saline into the bleeding area. Hemostasis time and amount of nasal bleeding were measured in all groups to compare the treatments without and with the plant extract. Results Without heparin pretreatment, the folkloric medicinal plant extract shortened the hemostasis time by 1.29 minute and reduced the amount of bleeding by 0.63 g. With heparin pretreatment, the plant extract shortened the hemostasis time by 2.29 minutes and reduced the amount of bleeding by 0.70 g. Conclusion The medicinal plant extract irrigation was more effective than saline irrigation for treating hemorrhagic skin defects in animals using a compressive dressing with or without heparin pretreatment.

Objectives: Glanzmann thrombasthenia is a rare disorder of platelet function that may result in life-threatening hemorrhage, particularly from the nasal vaults. Various medical therapies (such as recombinant factor VII, antifibrinolytic agents, and blood transfusions) and surgical therapies (such as nasal packing, electrocautery, laser coagulation, septoplasty, and embolization) have been described with various degrees of success. Methods: We present a unique case report of a 4-year-old child with known Glanzmann thrombasthenia and two separate episodes of life-threatening epistaxis that were treated successfully by nasal packing with strips of cured pork because of special circumstances. Results: Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae. In both applications, the patient had complete cessation of nasal bleeding within 24 hours, and was discharged within 72 hours after treatment. Conclusions: To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.

The YAMIK sinus catheter, which was developed in Russia, is less difficult to use and causes fewer complications than the Proetz displacement method, the standard physical therapy procedure for chronic sinusitis. This method was used once a week for 3 consecutive weeks to treat 132 patients with chronic sinusitis. The only complication was slight nasal bleeding found during receiving negative pressure. An evaluation of subjective symptoms and objective findings showed that headache and nasal secretion were significantly diminished during and after treatment. Its remarkable effectiveness in reducing sinus pressure supports the “hydrops ex vacuo” theory as the mechanism of frontal sinusitis.

So-called pleomorphic adenoma is frequently found in the major salivary glands, but it very rarely originales in the nasal septum.We treated two patients with pleomorphic adenoma arising from the nasal septum.The first case was a 34-year-old female who complained of nasal bleeding, and the second was a 56-year-old female who complained of nasal obstruction and nasal bleeding.The tumors were removed by the intranasal approach. The histopathological diagnosis was pleomorphic adenoma.In Japan, The rate of recurrence and the rate of malignant change of pleomorphic adenoma of the nasal septum are 2.2% and 4.4% respectively.We think it is necessary to extirpate completely pleomorphic adenoma of the nasal septum and to make careful long term follow up survey.

A 33-year-old female complaining of sudden nasal bleeding, left buccal pain and maxillary swelling was sent to our hospital for further examination. CT scans showed a cystic lesion with bone formation in the left maxillary sinus. The patient underwent en bloc removal of this cystic lesion by Denker's operation.Histological examination revealed that the ossification originated in scar tissue in the cystic wall. The origin of this cystic lesion was presumed to be a polypoid growth from the maxillary sinus mucosa which elongated and folded to form a cyst. Fibrous ossification probably developed in the process following scar formation due to chronic inflammation in the cystic wall.

Objectives: Purified plant polysaccharide (HemoStase) is a plant-derived hemostatic agent that has not previously been used in sinus surgery. This study was conducted to evaluate the effectiveness of this novel agent in the control of nasal bleeding during endoscopic sinus surgery. The volume of bleeding during endoscopic sinus surgery was hypothesized to not be statistically significantly different between a control group (gelatin-thrombin matrix; FloSeal) and an experimental group (purified plant polysaccharide; HemoStase). Methods: Eighteen patients with a history of chronic rhinosinusitis in whom maximal medical therapy failed who underwent endoscopic sinus surgery were randomized into one of two groups (control FloSeal group or experimental HemoStase group). In the control group, sites in the nose that were actively bleeding during the operation were controlled with FloSeal. In the experimental group, sites in the nose that were actively bleeding during the operation were controlled with HemoStase. The main outcome measure was total operative blood loss. Blood loss was the sum of blood removed by suction during the surgery (recorded in milliliters) and blood on surgical sponges (weighed and converted to milliliters). Statistical analysis was performed with the t-test and the Mann-Whitney U test. Results: The amounts of blood loss (mean ± SEM) were not significantly different between the FloSeal (262 ± 15 mL) and HemoStase (265 ± 33 mL) groups (p = 0.93). Conclusions: The results of this study demonstrate the use of a novel product for the control of intraoperative bleeding during endoscopic sinus surgery.

Objective: Sorbsan (calcium alginate) is an absorbent packing that shows a potent hemostatic effect and can maintain moist wound surfaces. The aim of this study was to evaluate the early symptoms and QOL with Sorbsan versus Beschitin-F (chitin-coated gauze) for middle meatus packing after endoscopic sinus surgery (ESS).Method: We performed a cohort study of 40 patients who underwent ESS. The patients were randomly allocated into 2 groups who underwent insertion of either Sorbsan or Beschitin-F into the middle meatus. A daily diary was used to record the symptoms and QOL, measured using visual analogue scales.Results: The scores for each of the symptoms of nasal pain, headache, nasal bleeding, and postnasal drip were statistically significantly lower in the Sorbsan group. The scores for each of the QOL parameters, including the effect on their stay in the hospital and sleep disturbance, were also significantly lower in the Sorbsan group. There were no findings of postoperative hemorrhage or local infection...

WOS: 000295101200010 PubMed: 21949584 Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.

In our experience, the technique described can be applied independently according to the specific patient's anatomy and disease, allowing simple, easy, and safe identification of the anterior ethmoidal artery (AEA).The aim of this study was to provide the anatomic rationale for endoscopic cauterization of the AEA and to present our surgical approach to AEA in the treatment of severe nasal bleeding.A retrospective study reviewed 300 endoscopic transnasal AEA cauterizations, over a 20-year period from 1991 to July 2010, at the Instituto Felippu, Sao Paolo, Brazil. All surgeries were carried out under general anesthesia and with the help of a rigid 30° endoscope.The AEA was identified in all the patients treated. In 299 patients we found the AEA located at the level of the horizontal portion of the frontal bone into the anterior ethmoidal canal; in 88 (29.4%) of these patients the canal bone was partially open and in 211 (70.6%) it was completely closed. In only one patient, we found a dehiscent AEA. No patients presented short-term failure and/or long-term failure.

Nasal bleeding is one of the commonest emergencies that place medical staff at risk of blood contamination during management. A sizeable proportion of incidents have been reported where blood splashes in the facial area caused such contamination, and the exposed conjunctivae are potential sites for transmission of human immunodeficiency viruses (HIV). We present a simple self-made device named the ‘Double Bag’, which is highly effective in preventing blood spraying during the management of epistaxis. It was designed to be used while treating epistaxis or removing nasal packing after surgery, when transient bleeding is expected.

The rhinologist and the general practitioner will find many uses for oxidized cellulose gauze packing. In November 1945 Frantz and Lattes described this preparation and their initial experiences with it in various types of wounds. It is particularly valuable in securing hemostasis in certain nasal conditions. Spontaneous nasal hemorrhages that cannot be controlled by cauterization and therefore require packing are much more easily managed when this type of packing is used. Quite often when nonabsorbable gauze packing is used, even though the bleeding is controlled there is recurrence shortly after the packing is removed, mainly because of the adherence of this packing to the hemorrhagic mucosa. With ½ inch oxidized cellulose gauze packing this does not occur. It is inserted in sufficient quantity and with sufficient pressure to control the bleeding but is never removed. In about thirty-six hours too much disintegration has occurred to permit removal with forceps, and

The aim of this pilot study is to evaluate office-based sclerotherapy using sodium tetradecyl sulfate (STS) for epistaxis due to hereditary hemorrhagic telangiectasias (HHT). Patients with HHT suffer from unpredictable, recurrent, severe nasal bleeding necessitating emergency care, nasal packing, blood transfusions, and invasive procedures.In this retrospective study 7 patients with a history of treatment for recurrent epistaxis due to HHT were treated in an office-based setting with intralesional injection of STS. Treatment results were evaluated using a questionnaire. All patients had undergone multiple prior procedures attempting to control epistaxis.Patients had an average of 5 sclerotherapy treatments for HHT. Patients were treated using topical and/or local anesthesia with no reports of discomfort. Bleeding requiring intervention did not occur during the procedures. After the procedure all patients (100%) reported significantly less frequent and less severe nasal bleeding. A total of 83% reported that their need for nasal packing was reduced. All patients were willing to undergo the same treatment again. No complications such as perforation, crusting, or foul smell were reported.This is the first clinical experience demonstrating that office-based sclerotherapy with STS is a safe, tolerable, and useful alternative for the treatment of epistaxis due to HHT.

Angiofibroma of the inferior turbinate is very rare.Our patient was a 27-year-old male who complained of nasal bleeding. The tumor was removed through a palatine approach. There has been no recurence.

Metastatic tumors to the nose and paranasal sinuses are relatively rare. We report a case of renal cell carcinoma metastatic to the maxillary sinus. The patient was a 55-year-old male with left nasal bleeding. Several ultrasonic and radiographic examinations revealed right renal cell carcinoma. Total nephrectomy was performed, followed by total maxillectomy.An analysis of 394 previously published cases showed that about 30% of metastases to the head and neck were from renal cell carcinomas, and the most common sites of matastases were the nose and paranasal sinuses. When we see frequent nasal bleeding and rare pathological findings, the possibility of metastatic tumor should be considered.The metastatic pathways to the head and neck are discussed briefly.

A rare case of pleomorphic adenoma of the nasal septum is reported. A 48-year-old man complaining of nasal obstruction and nasal bleeding was referred to our hospital for treatment of a left nasal tumor. The tumor, including the nasal septum, was resected by the modified Denker operation and lateral rhinotomy. The tumor was firm, parenchymatous, pedunculated, and 24 x 22 x 14 mm in size. Pathological examination revealed pleomorphic adenoma with slight cellular atypism. Immunohistochemical observations suggested that characterization of this tumor might be similar to pleomorphic adenoma of the parotid gland.

A statistical review was made of the 2914 emergency patients observed at the Maeda ENT Hospital between January 1, 1988 and December 31, 1990.1. The patients showed a wide age range, but 55.9% were children under ten years of age.2. 66.4% of the patients were seen on weekends and national holidays.3. 71.4% of the patients were seen in or near our city, but about 10% were seen in areas requiring more than 1 hour of travel by car.4. The most frequent emergency disease was acute otitis media (51.5%), followed by acute upper respiratory inflammation (13.2%), foreign body (12.0%), nasal bleeding (7.6%) and injury (5.6%).

The authors present two case studies on pediatric nasal obstruction that highlight the consequences of a delayed diagnosis and the complexities of managing obstructed lesions in children.

Background:Epistaxis is a common condition presenting to emergency and ENT clinics. Most epistaxis bleeding originates from Little's area of the nasal septum. Some cases of refractory epistaxis cannot be resolved with packing or electrocoagulation.Method:The suturing technique applied is widely used in surgery. When faced with pulsatile, recurrent bleeding from Little's area of the nasal septum, all rhinologists should possess the skills to be able to suture the bleeding site, especially after failure of local cautery or packing.Case report:The authors have successfully treated four difficult cases of nasal bleeding from Little's area by suturing.Conclusion:This technique could eliminate the discomfort and complications of nasal packing. To the best of our knowledge, this report probably represents the first published case series of suturing of Little's area to treat recurrent nasal bleeding. More cases need to be treated in this way to enable further evaluation of the technique.

A 59-year-old man complained of swelling of the cheek, nasal obstruction and nasal bleeding. Radiographic examination showed massive bone destruction of the left maxillary sinus. The tentative diagnosis was malignant tumor of the maxillary sinus. The patient was treated with maxillotomy. Histopathological examination revealed no evidence of malignancy, but hematoma and necrotic tissue with pseudostratified columnar ciliated epithelium.Blood boil is a clinical term and the etiology is indefinite. It is possible for several causative factors to exist. It is difficult to distinguish such a lesion from malignant tumor and careful examination with long term follow-up is necessary.

A total of 1, 091 patients consulted our night emergency ear nose and throat clinic during the 3-year period from 1987 through 1989.1) Between 5p.m. and 10p.m., 812 (about 74%) patients came to the clinic.2) About 62% of these patients were under 10 years of age. Small children between 3 and 6 years of age accounted for most of them.3) About 78% of the patients lived in the district in which our clinic was located, covered by the Shibukawa District Medical Association.4) Common diseases included i) acute otitis media (47.0%), ii) acute upper respiratory tract infection (13.6%), iii) foreign body ingestion (11.5%) and nasal bleeding (10.4%).The main problems were: 1) non-emergency cases, 2) some patitents with ENT emergencies, such as epistaxis or vertigo, were taken to general emergency hospitals.

A 56-year-old female patient presented with history of nasal blockage, nasal bleeding, headache, since one month. On admission the patient developed severe headache, decreased vision of eyes and blindness. Clinical diagnosis of rhino-orbital involvement was confirmed by computerized tomography of the paranasal sinuses. The diagnosis of fungal infection was confirmed by KOH examination, haematoxylin and eosin examination and Gomori's methanamine silver stain of the biopsy material. Diagnosis was confirmed by culture on Sabouraud Dextrose agar, slide culture on Czapek Dox medium and the isolate was identified as Saksenaea vasiformis. The patient was started on intravenous amphotericin B (received only one dose before succumbing), but she did not respond to the treatment, developed hemiparesis, slurred speech, diminished reflexes and ultimately died. The involvement of the brain was confirmed by computerised tomographic scan. We believe this case to be the first case of rhino-orbito-cerebral infection due to Saksenaea vasiformis and that of second case in an immunocompetent patient in the world.

Objective To show the result of this surgical technique for the treatment of nasal bleeding in Rendu-Osler-Weber disease. Method After great efforts to obtain informed consent for the procedure, considered as a final therapeutic attempt, we present here the surgical technique used in a severe long-standing case with frequent symptoms that required a large number of admissions to our hospital and caused our patient considerable social, family and work-related psychological problems. Results The surgical procedure was performed 14 months ago, with no further epistaxis since then, thus bringing to an end the emergency admissions, rated at 7 per year, and reducing consultations at the digestive and psychological clinics. The laboratory studies (haematocrit, complete blood count, bleeding time) have improved greatly. Conclusions This is a safe technique, well tolerated by the patient, that avoids additional pathologies and reduces costs.

A 55-year-old man was referred to our dermatology department with a 5-month history of nasal bleeding, crusted erosions on the lips (figure 1) and painful oral mucosal ulcerations unresponsive to systemic acyclovir therapy prescribed by a family physician. He was unable to swallow due to agonising pain, and lost 20 kg. The patient was initially suspected of paraneoplastic pemphigus (PNP). Histological examination of the lip and oral mucosa showed non-specific mixed cellular infiltrates without predominance …

Osler's disease (=hereditary hemorrhagic telangiectasia) is an autosomal dominant genetically transmitted disease characterized by abnormal peripheral blood vessels. Intranasal dermoplasty and estrogen therapy have proved to be successful for nasal bleeding. However, these therapies have several complications and sometimes fail to control bleeding. Recently, Nd-YAG laser therapy has been reported to be effective in Osler's disease. We describe here a patient with Osler's disease who has had repeated nasal bleeding for about 10 years. We treated him with laser photocoagulation using a contact Nd-YAG laser at low power settings (30-35W, 0.5 sec). Laser therapy diminished the frequency and severity of hemorrhage without complications. Nasal mucosal tissue of the inferior turbinate showed massive fibroblastic infiltrations and capillary vessel clots with fibrin after laser operation. The Nd-YAG laser appears to be a useful therapeutic procedure for this disease.

A rare case of a penetrating injury extending from the hard palate to the pituitary gland is reported. A 9-month-old infant was referred to our hospital because of a chopstick stuck in his mouth. He had severe oral and nasal bleeding after we removed it and was given a blood transfusion. CT examination revealed circular low-density areas in the subarachnoid cistern.α-Streptococcus was detected in the cerebrospinal fluid. Antibiotics were given, and he was discharged on the 18th day with no complications.

Objective While generally considered an effective treatment for moderate to severe epistaxis in hereditary hemorrhagic telangiectasia (HHT), nasal dermoplasty (ND) has not been well established in Japan. This prompted the present Japanese assessment of clinical efficacy and patient satisfaction following this procedure. Methods Retrospective analysis of clinical records of 15 patients with HHT undergoing ND between August 1991 and May 2004 and survey of these patients as to postsurgical conditions. Main outcome measures were skin graft “take” frequency after surgery (all patients), reported patient satisfaction (eight recent patients), and reported volume and frequency of epistaxis after versus before surgery (eight recent patients). Results Graft take rate was 100%. Most patients experienced reduced frequency and volume of bleeding. One patient required an additional operation, total closure of the external nares, 2 years later. Overall patients felt satisfied with ND, experiencing less nasal obstruction than expected. Conclusions ND is effective in Japanese patients with moderate and severe nasal bleeding from HHT, reducing their risk of bleeding.

Epistaxis is a common otolaryngologic problem. A 2.5 years retrospective study (June 1998 December 2000) of patients attending outdoor or indoor services of Department of ENT with complaint of nasal bleeding was done. The study was conducted on 88 patients for the incidence, age and sex relation, etiological factors, clinical findings, and treatment methods for epistaxis.

espanolObjetivo: Analizar los resultados de la implantacion de stents lacrimonasales de poliuretano y las caracteristicas de los pacientes y las intervenciones realizadas. Material y metodos: Estudio de 125 casos de obstruccion del conducto lacrimonasal en 115 pacientes, 30 varones y 85 mujeres. Obstrucciones del lado derecho 51 (40,8%) y del lado izquierdo 74 (59,2%). Edad media de los enfermos: 65 DE 14,61 anos. La clinica de los pacientes fue epifora 65 casos (52%), dacriocistitis aguda 33 (26,4%), mucocele 6 (4,8%), conjuntivitis de repeticion 4 casos (3,2%). Un total de 17 pacientes nos fueron remitidos con el diagnostico de obstruccion de via lagrimal. El tiempo de seguimiento fue de 1 ano. Resultados: Implante realizado con exito en 120 casos (96%). Las complicaciones intraoperatorias mas importantes fueron dolor 5,83%, inflamacion palpebral 5%, falsa via y epistaxis, 0,83% cada una. La epifora desaparecio en 82 casos (68,3%) y persistio en 38 (31,7%). Tiempo medio de fallo del stent en este ultimo grupo 178 dias. En los stents que fallaron se encontro tejido de granulacion en un 63,15% y material mucoide en 36,85%. La principal complicacion postoperatoria fue mucocele en el 7,5% de los casos. Conclusiones: Consideramos esta tecnica una buena alternativa para el tratamiento de la obstruccion de la via lagrimal, aunque sin alcanzar los resultados de la dacriocistorrinostomia externa o endonasal. EnglishObjective: To analyze a series of patients with lacrimal duct obstruction treated with polyurethane stents. Material and Methods: We studied 125 cases of lacrimal duct obstruction corresponding to 115 patients, of whom 30 were males (26.08%) and 85 females (73.91%). The obstruction involved the right side in 51 cases (40.8%) and the left side in 74 (59.2%). Mean age was 65 ± 14.64 years. Symptoms included chronic epiphora in 65 patients (52%), acute lacrimal sac inflammation in 33 (26.4%), mucocele in 6 (4.8%) and recurrent conjunctivitis in 4 (3.2%). Seventeen patients came to us diagnosed with lacrimal duct obstruction. Time of follow up was one year. Results: Stents were successfully implanted in 120 cases (96%). Surgical complications included pain in 5.83%, eyelid inflammation in 5%, nasal bleeding in 0.83% and false duct in 0.83%. Functional success was achieved in 82 patients (68.3%), and surgical failure occurred in 38 patients (31.7%). Mean time of stent failure was 178 days. In these cases, inner granulation tissue was found in 63.15% of the cases and mucoid material in 36.85%. The most common postoperative complication was mucocele formation, which ocurred in 7.5% of the patients. Conclusions: In our experience, polyurethane stent implantation is a good alternative for treating nasolacrimal obstruction, but not as effective as endonasal or external dacryocystorhinostomy.

37 patients with intractable idiopathic epistaxis were treated with superselective embolisation between 1995 and 1999. A total of 40 embolisations was performed, including three procedures for recurrence. The embolic material was gelatin sponge in 27 procedures, microcoils in 9 and both gelatin sponge and microcoils in 4. Immediate cessation of nasal bleeding was obtained in all patients after embolisation. Recurrent epistaxis occurred in 2 (5.4%) of the 37 patients within 7 days after initial embolisation, giving a short-term success rate of 94.6%. The long-term follow-up ranged from 1-51 months (mean 21.6 months). Late re-bleeding occurred in two patients, giving a long-term success rate of 94.6%. Two patients underwent re-embolisation; it was necessary to embolise the ipsilateral facial artery and/or the contralateral internal maxillary as well as the ipsilateral maxillary artery. Although the overall complication rate was 45.0%, no major complications occurred. Superselective embolisation with gelatin sponge is an effective and safe treatment technique for intractable idiopathic epistaxis.