Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-yea...Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.展开更多
BACKGROUND Reports of a decrease in hospital admissions during the coronavirus disease 2019(COVID-19)lockdown period have raised concerns about delayed or missed diagnoses and treatments for non-COVID-19-related illne...BACKGROUND Reports of a decrease in hospital admissions during the coronavirus disease 2019(COVID-19)lockdown period have raised concerns about delayed or missed diagnoses and treatments for non-COVID-19-related illnesses.AIM To investigate the impact of the COVID-19 pandemic-induced lockdown and its end on hospital admissions of patients with epistaxis in Germany.METHODS A retrospective analysis based on the national database of the Hospital Remuneration System was used to compare hospital admissions during defined time periods between 2019 and 2022 with the lockdown period as the reference period.This was done on a weekly basis before,during,and after the lockdown.An Interrupted Time Series was used as the analysis method.RESULTS In our analysis,we included 26183 patients.The implementation of the lockdown led to a substantial reduction in the overall occurrence of epistaxis among patients(P<0.05).This effect was most pronounced in the age group of 0-39 years,where the decrease was highly significant(P<0.001).However,there was no change observed in patients aged 80 years and older(not significant).With the end of the lockdown period,the overall number of patients,especially in the youngest age group,increased abruptly and significantly(P<0.01).CONCLUSION During the lockdown period,there was a decrease in hospital admissions for younger patients with epistaxis,possibly due to the fear of COVID-19 exposure.We also conclude that the severity of epistaxis was not underestimated in the elderly during the pandemic.展开更多
Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to ...Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to invasive intranasal device insertion in the absence of on-demand specialist involvement. Aim: The aim of this article is to not only highlight superior outcomes in patients with acute nontraumatic epistaxis that are treated with noninvasive nebulized tranexamic acid instead of more invasive options, but also monetary benefit to the community through reduced costs. Case Presentation: this case report highlights a successful epistaxis resolution with use of tranexamic acid in a 64-year-old female after she was subjected to intranasal device insertion that did not resolve bleeding. Conclusion: Nebulized tranexamic acid is a cost-effective medication that not only reduces rates of recurrence, but it also increases patient satisfaction while minimizing overall healthcare costs, and therefore should be the first choice therapy in uncomplicated epistaxis management.展开更多
AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational s...AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.RESULTS:A total of 1249 patients were registered for severe UGIH in the data basis,461(36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen(75%) subjects required posterior nasal packing and 2(10%) embolization in addition to correction of coagulopathy. Five(25%) patients died in the hospital,12(60%) received orthotopic liver transplantation(OLT),and 3(15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.CONCLUSION:Severe epistaxis in patients with ESLD is(1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH;and(2) associated with a high mortality rate in patients not receiving OLT.展开更多
Emergencies of epistaxis in students caused by environmental pollution have rarely been reported to date.This study aimed to explore the cause of an emergency of epistaxis in elementary students by using a field epide...Emergencies of epistaxis in students caused by environmental pollution have rarely been reported to date.This study aimed to explore the cause of an emergency of epistaxis in elementary students by using a field epidemiological investigation.Twenty-two epistaxis cases from a single school with differences in gender,age,and classroom,were diagnosed within a period of 7 days.The展开更多
Rationale:Cavernous internal carotid artery(ICA)pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis.The sudden onset of epistaxis due to such a fatal aneurysm protruding into the ...Rationale:Cavernous internal carotid artery(ICA)pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis.The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice.The management is often challenging because of anatomical inaccessibility of the bleeding point.Patient's concern:A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis.Diagnosis:A computerized tomography(CT)scan showed a fracture in the sphenoid sinus.CT angiogram revealed cavernous ICA pseudoaneurysm.Interventions:Endovascular coil embolization.Outcomes:The patient recovered well and was discharged without any neurological deficits Lessons:Cavernous ICA pseudoaneurysm may lead to a life-threatening situation.If a patient has a history of head trauma,post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.展开更多
Background: Epistaxis is one of the commonest emergencies encountered by ENT physicians as well as to family and emergency physicians. It is common among school children as they are easily injured during different sch...Background: Epistaxis is one of the commonest emergencies encountered by ENT physicians as well as to family and emergency physicians. It is common among school children as they are easily injured during different school activities. Objective: The aim of this study was to assess the level of knowledge and attitude regarding first aid management of epistaxis among school teachers in Al-Ahsa, Saudi Arabia. Method: A cross sectional study was conducted in November 2017 among Saudi school teachers in AlAhssa region, Kingdom of Saudi Arabia. The data were collected by a well-structured online questionnaire which was designed including questions about the biographical data of the teacher, questions about the past knowledge of the emergency management of epistaxis and questions assessing the awareness of the method applied as a management of epistaxis. Result: We received 485 valid responses. 76% of teachers were female, 93% worked in public and 40% were in primary schools. 54% of participants had received information about first aid to stop nose bleeding or hemorrhage. 67% said that their students experienced epistaxis before. Interestingly, 15% said they would not try to stop the bleeding, and only 25% said they would press on the cartilaginous part of nose. However, a higher percentage (57%) knew that they should tilt the head forward.展开更多
Severe epistaxis management remains a challenge to otolaryngologists. Despite the large choice of treatment strategies to control epistaxis, the method of regional haemostasis via edoscopic arterial ligation has becom...Severe epistaxis management remains a challenge to otolaryngologists. Despite the large choice of treatment strategies to control epistaxis, the method of regional haemostasis via edoscopic arterial ligation has become frequently used. Arterial supply occlusion is usually performed by electrocautery or application of titanium clips. After placement of titanium clips, they will remain in place forever and could surprisingly be rediscovered later on CT-scan. Most of otolaryngologists are familiar with this method and are able to identify these clips, however, it could be more difficult for radiologists and other practitioners. In order to draw the attention of other specialists to the existence of this method and to help them correctly interpret such CT-scans, the authors present an example of a case that troubled radiologists. In addition, the authors also discussed the vascular supply of the nasal fossa and methods of severe epistaxis management.展开更多
Middle meningeal artery (MMA) pseudoaneurysms are very rare and are most often traumatic. They may present as an epidural or intraparenchymal hematoma. This study reports a rare case in which a patient suffered from i...Middle meningeal artery (MMA) pseudoaneurysms are very rare and are most often traumatic. They may present as an epidural or intraparenchymal hematoma. This study reports a rare case in which a patient suffered from intractable epistaxis because of a pseudoaneurysm in middle meningeal artery and skull base fracture after craniocerebra trauma. Pseudoaneurysm and the feeding artery were embolized by using Onyx-18 liquid embolic system. Complete cessation of bleeding was achieved in this case immediately after the endovascular therapies. In this study, clinical manifestation, diagnostic imaging and endovascular treatment are described. Formation mechanisms and the treatment of traumatic pseudoaneurysm of middle meningeal artery are discussed.展开更多
Background/Objectives: Epistaxis is a common presentation and may constitute a major challenge to the parents and the health care givers. This study aimed at determining the clinico-epidemiological pattern, presentati...Background/Objectives: Epistaxis is a common presentation and may constitute a major challenge to the parents and the health care givers. This study aimed at determining the clinico-epidemiological pattern, presentation and etiology of epistaxis. Materials and Methods: This prospective study of all patients that presented with epistaxis via the Ear, Nose and Throat department of a tertiary institution in Nigeria. The study was carried out between June 2012 and July 2017. Data were obtained from patients who gave consent by using pre-tested interviewer assisted questionnaire. All the data obtained were analyzed using SPSS version 16.0. Results: The prevalence of epistaxis in this study was 12.2%. The peak age group was 1-10 years with epistaxis prevalence of 36.4%. The male to female ratio was 1.5:1. Anterior epistaxis was more common than posterior epistaxis accounted for 80.1% and 7.4% respectively. Single episode of epistaxis was seen in 78.4% of the patients while recurrent epistaxis occurred in 21.6%. Unilateral epistaxis was 62.5%, bilateral epistaxis was 37.5% while right nasal bleeding accounted for 35.8%. The main local causes of epistaxis were trauma 29.5%, infective rhinosinusitis 18.8% and sinonasal tumours 12.5%. Severe epistaxis requiring blood transfusion was seen in 2.8% of the patients and death was recorded in 2.3%. Majority 110 (62.5%) were managed by observation alone, 20 (11.4%) by conservative therapy and 22 (12.5%) had surgical excision. Blood transfusion was given in 5. The outcome of treatment was good recovery in 79.0% while patients’ satisfaction with treatment was noted in 84.1%. Conclusion: Epistaxis is a common sinonasal presentation with effect on quality of life. In our center commonest site of nose bleeds was local mainly from traumatic, inflammatory and neoplastic aetiology.展开更多
BACKGROUND Epistaxis can be an isolated finding or a manifestation of a systemic disease.Some of the potential etiologies are usage of anticoagulants,bleeding disorders,vascular aneurysms,nasal neoplasm,hypertension a...BACKGROUND Epistaxis can be an isolated finding or a manifestation of a systemic disease.Some of the potential etiologies are usage of anticoagulants,bleeding disorders,vascular aneurysms,nasal neoplasm,hypertension and nasal steroids.Hereditary hemorrhagic telangiectasia(HHT)as a cause of recurrent epistaxis is uncommon.CASE SUMMARY In this report,we describe an 18-year-old adolescent with recurrent epistaxis,mucocutaneous telangiectasia and family history of HHT,consistent with HHT.CONCLUSION Timely diagnosis is needed not only to treat the epistaxis but also to be vigilant for other serious manifestations of this condition.展开更多
Epistaxis is a common complaint which is rarely life-threatening, as most cases are self-limited and as such unreported. However, it may be a significant cause for concern if it becomes recurrent. Although a number of...Epistaxis is a common complaint which is rarely life-threatening, as most cases are self-limited and as such unreported. However, it may be a significant cause for concern if it becomes recurrent. Although a number of medications including topical antihistamines and non-steroidal anti-inflammatory drugs are known aetiological factors for epistaxis due to their antiplatelet effects, beta blockers are not being widely reported as a possible cause. This report presents the case of a 34-year-old G2P0+1, who was diagnosed with hyperthyroidism in pregnancy and subsequently reported epistaxis twice at different occasion and different hospital settings when propranolol was introduced for her treatment, with resolution of epistaxis after withdrawal of propranolol. The report aims to highlight and sensitize physicians to the possible risk of bleeding in patients placed on beta blockers especially propranolol for a wide range of medical condition due to its thrombocytopathic effect.展开更多
Background: This study aimed to determine the safety and efficacy of sphenopalatine artery (SPA) surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to ass...Background: This study aimed to determine the safety and efficacy of sphenopalatine artery (SPA) surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to assist clinicians in making prompt and appropriate decisions regarding SPA surgery for refractory epistaxis. Methods: We analyzed 97 consecutive patients with nasal bleeding hospitalized in our institution between April 2009 and March 2018. Clinicopathological characteristics and clinical outcomes were analyzed from retrospective chart reviews. Results: Of the 97 patients, 28 (29 sides) required SPA surgery. There were no differences in sex, anti-coagulant drug or antiplatelet use, hemoglobin concentration, or platelet count between Group A (patients who required surgery) and Group B (patients who did not require surgery). Age (58 vs. 67 years, p = 0.038) and severity of comorbidity (0 vs. 1, p = 0.039) were significantly lower in the surgery group. Patients who were younger and had lower Charlson Comorbidity Index (CCI) scores had more requirements for surgery than those who were older and had higher CCI scores. There was no significant difference between the groups with respect to the proportion of patients receiving blood transfusions;however, the length of hospitalization was significantly longer in Group A than in Group B (8.9 vs. 8 days, p = 0.038). Success rate (non-rebleeding rate) was 89%, comparable to that reported in previous studies. Conclusions: Endoscopic SPA surgery was found safe and effective method with few complications. Younger patients with lower CCI scores were found appropriate for SPA surgery for refractory epistaxis due in part to a lower risk of anesthesia.展开更多
Background: Hereditary hemorrhagic telangiectasia (HHT) is a relatively common, albeit under-recognized autosomal-dominant multisystemic vascular disorder. Epistaxis due to telangiectases in the nasal mucosa is the mo...Background: Hereditary hemorrhagic telangiectasia (HHT) is a relatively common, albeit under-recognized autosomal-dominant multisystemic vascular disorder. Epistaxis due to telangiectases in the nasal mucosa is the most common and often the earliest symptom of HHT. As many as 90% of affected individuals eventually experience recurrent epistaxis, with a mean frequency of 18 episodes per month. Prompted by the limitations of invasive treatment, researchers have directed attention to laser photocoagulation as an alternative nonsurgical treatment modality with promising results. Purpose: The purpose of the present study was to describe our experience with the state-of-the-art 980 nm diode laser for the treatment of bleeding lesions of the skin, nasal and oral mucosa in patients with HHT. Methodology/Principal: We treated 16 HHT patients with intractable bleeding from telangiectasias using the 980-nm diode laser as an office procedure using local anesthesia. We recorded hemoglobin levels before and after treatment and used disability questionnaires. Results: All patients treated had an improvement in hemoglobin levels and disability scores. In patients with multiple lesions hemoglobin levels improved from a mean of 8.4 to 11.2 (p = 0.008). The disability index in this group improved from a mean of 5.3 to 2.8 (p = 0.007). Follow-up ranged between 4 and 12 months. Conclusions: The 980-nm diode laser is a good office based solution for bleeding in HHT.展开更多
Background:Pediatric epistaxis is one of the most common and frequently occurring diseases,while its pathogenesis is complicated and remains to be fully elucidated.Objective:This work aims to explore the therapeutic e...Background:Pediatric epistaxis is one of the most common and frequently occurring diseases,while its pathogenesis is complicated and remains to be fully elucidated.Objective:This work aims to explore the therapeutic effect and action mechanism of Rhizoma Imperatae in the treatment of pediatric epistaxis in a network pharmacology approach and to provide a practical reference for treating epistaxis in children.Methods:The active ingredients of Chinese herb Rhizoma Imperatae were obtained from the TCMSP database,and the targets of chemical compounds were subsequently predicted using the Swisstargetprediction database;the disease targets of epistaxis were exported from the Genecards database;the obtained overlapped genes were applied for protein-protein interaction(PPI)analysis,Gene Ontology(GO)anlysis and KEGG analysis.Results:There were 128 targets of Rhizoma Imperatae were predicted,and 500 disease targets were collected,with 19 overlapped targets between the drug and the disease.The five genes matrix metallopeptidase 9(MMP9),EGFR,JUN,PTGS1,and ESR1 had the most connections based on the PPI analysis.The GO analysis indicated that positive regulation of vascular smooth muscle cell proliferation and positive regulation of smooth muscle cell proliferation were greatly associated with MMP9,EGFR,and JUN genes in biological processes(BP)and positive regulation of lipid kinase activity and nitric-oxide syntheses activity affected EGFR and ESR1 genes mostly in molecular function(MF).Conclusion:The present research results demonstrated that Rhizoma Imperatae might play a role in alleviating pediatric epistaxis using a network pharmacology technique,hoping to figure out its action mechanism of the drug against the disease.展开更多
Objective:Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population.The objective of this study was to determine whether socioeconomic status influences the presentatio...Objective:Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population.The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population.Methods:Retrospective review of emergency department visits from January 2012 to May 2014.The setting is in an emergency department of a Canadian tertiary care centre.Adult patients with primary diagnosis of anterior epistaxis in the emergency department were included in this study.The main outcome was emergency department visits for anterior epistaxis visits.Results:A total of 351 cases of anterior epistaxis were included.The mean age was 70 years and 51%of patients were male.The patients were stratified into two groups based on whether their age was equal to and above,or below 75 years.Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles(P<0.05).This association did not hold true for those younger than 75 years or for all age groups combined.Conclusion:There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.展开更多
Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective revie...Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included.Anterior epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's perspective.Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.Results:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the analysis.The median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were controlled.Conclusions:Our results show wide difference in the hospital cost of epistaxis across treatment modalities.These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.展开更多
文摘Internal carotid artery (ICA) aneurysms are an unusual but serious cause of epistaxis. This epistaxis is massive and sometimes uncontrollable threatening the vital prognosis of patients. We report the case of a 16-year-old adolescent received in emergency with severe bilateral epistaxis, asthenia and grade-3 left exophthalmos. In his history, the subject had been the victim of an assault six months before consultation. He had received blows on the cephalic extremity with light but repeated epistaxis. The treatment consisted to blood products transfusion and local compression by sterile gazes. An ICA aneurysm in sphenoid sinus has been confirmed in a craniofacial CT scan coupled to vascular opacification. Although the ICA has a variable course in contact with the sphenoid sinus, massive epistaxis would be the consequence of a pronounced dehiscence of the ICA in the sphenoid sinus, particularly in a traumatic context. In front of this type of epistaxis in our context, general practitioners must be able to suspect a ruptured ICA aneurysm in the presence of exophthalmos and a notion of old or recent cranio-encephalic injury. Additionally, due to the high morbidity and mortality of this condition, a monitoring algorithm is necessary for patients with head trauma to facilitate early detection.
文摘BACKGROUND Reports of a decrease in hospital admissions during the coronavirus disease 2019(COVID-19)lockdown period have raised concerns about delayed or missed diagnoses and treatments for non-COVID-19-related illnesses.AIM To investigate the impact of the COVID-19 pandemic-induced lockdown and its end on hospital admissions of patients with epistaxis in Germany.METHODS A retrospective analysis based on the national database of the Hospital Remuneration System was used to compare hospital admissions during defined time periods between 2019 and 2022 with the lockdown period as the reference period.This was done on a weekly basis before,during,and after the lockdown.An Interrupted Time Series was used as the analysis method.RESULTS In our analysis,we included 26183 patients.The implementation of the lockdown led to a substantial reduction in the overall occurrence of epistaxis among patients(P<0.05).This effect was most pronounced in the age group of 0-39 years,where the decrease was highly significant(P<0.001).However,there was no change observed in patients aged 80 years and older(not significant).With the end of the lockdown period,the overall number of patients,especially in the youngest age group,increased abruptly and significantly(P<0.01).CONCLUSION During the lockdown period,there was a decrease in hospital admissions for younger patients with epistaxis,possibly due to the fear of COVID-19 exposure.We also conclude that the severity of epistaxis was not underestimated in the elderly during the pandemic.
文摘Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to invasive intranasal device insertion in the absence of on-demand specialist involvement. Aim: The aim of this article is to not only highlight superior outcomes in patients with acute nontraumatic epistaxis that are treated with noninvasive nebulized tranexamic acid instead of more invasive options, but also monetary benefit to the community through reduced costs. Case Presentation: this case report highlights a successful epistaxis resolution with use of tranexamic acid in a 64-year-old female after she was subjected to intranasal device insertion that did not resolve bleeding. Conclusion: Nebulized tranexamic acid is a cost-effective medication that not only reduces rates of recurrence, but it also increases patient satisfaction while minimizing overall healthcare costs, and therefore should be the first choice therapy in uncomplicated epistaxis management.
基金Supported by National Institutes of Health,No.41301Veteran Administration Clinical Merit Review Grant,to Dr Dennis M JensenPhilippe Foundation Grant,to Dr.Marine Camus
文摘AIM:To describe the prevalence,diagnosis,treatment,and outcomes of end stage liver disease(ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage(UGIH).METHODS:This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.RESULTS:A total of 1249 patients were registered for severe UGIH in the data basis,461(36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen(75%) subjects required posterior nasal packing and 2(10%) embolization in addition to correction of coagulopathy. Five(25%) patients died in the hospital,12(60%) received orthotopic liver transplantation(OLT),and 3(15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.CONCLUSION:Severe epistaxis in patients with ESLD is(1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH;and(2) associated with a high mortality rate in patients not receiving OLT.
基金sponsored by Zhejiang Provincial Program for the Cultivation of High-Level Innovative Health Talentsin part supported by the Natural Science Foundation of China(81472961)the Co-constructed Projects by the National Health and Family Planning Commission of China,and the Health Bureau of Zhejiang Province(No.WSK2014-2-004)
文摘Emergencies of epistaxis in students caused by environmental pollution have rarely been reported to date.This study aimed to explore the cause of an emergency of epistaxis in elementary students by using a field epidemiological investigation.Twenty-two epistaxis cases from a single school with differences in gender,age,and classroom,were diagnosed within a period of 7 days.The
文摘Rationale:Cavernous internal carotid artery(ICA)pseudoaneurysm caused by non-penetrating head trauma is a rare cause of massive epistaxis.The sudden onset of epistaxis due to such a fatal aneurysm protruding into the sphenoid sinus is extremely rare in clinical practice.The management is often challenging because of anatomical inaccessibility of the bleeding point.Patient's concern:A 42-year-old man with a history of head trauma showing an ICA aneurysm eroding the sphenoid sinus followed by massive epistaxis.Diagnosis:A computerized tomography(CT)scan showed a fracture in the sphenoid sinus.CT angiogram revealed cavernous ICA pseudoaneurysm.Interventions:Endovascular coil embolization.Outcomes:The patient recovered well and was discharged without any neurological deficits Lessons:Cavernous ICA pseudoaneurysm may lead to a life-threatening situation.If a patient has a history of head trauma,post-traumatic cavernous ICA pseudoaneurysm should be considered a differential diagnosis of massive epistaxis.
文摘Background: Epistaxis is one of the commonest emergencies encountered by ENT physicians as well as to family and emergency physicians. It is common among school children as they are easily injured during different school activities. Objective: The aim of this study was to assess the level of knowledge and attitude regarding first aid management of epistaxis among school teachers in Al-Ahsa, Saudi Arabia. Method: A cross sectional study was conducted in November 2017 among Saudi school teachers in AlAhssa region, Kingdom of Saudi Arabia. The data were collected by a well-structured online questionnaire which was designed including questions about the biographical data of the teacher, questions about the past knowledge of the emergency management of epistaxis and questions assessing the awareness of the method applied as a management of epistaxis. Result: We received 485 valid responses. 76% of teachers were female, 93% worked in public and 40% were in primary schools. 54% of participants had received information about first aid to stop nose bleeding or hemorrhage. 67% said that their students experienced epistaxis before. Interestingly, 15% said they would not try to stop the bleeding, and only 25% said they would press on the cartilaginous part of nose. However, a higher percentage (57%) knew that they should tilt the head forward.
文摘Severe epistaxis management remains a challenge to otolaryngologists. Despite the large choice of treatment strategies to control epistaxis, the method of regional haemostasis via edoscopic arterial ligation has become frequently used. Arterial supply occlusion is usually performed by electrocautery or application of titanium clips. After placement of titanium clips, they will remain in place forever and could surprisingly be rediscovered later on CT-scan. Most of otolaryngologists are familiar with this method and are able to identify these clips, however, it could be more difficult for radiologists and other practitioners. In order to draw the attention of other specialists to the existence of this method and to help them correctly interpret such CT-scans, the authors present an example of a case that troubled radiologists. In addition, the authors also discussed the vascular supply of the nasal fossa and methods of severe epistaxis management.
文摘Middle meningeal artery (MMA) pseudoaneurysms are very rare and are most often traumatic. They may present as an epidural or intraparenchymal hematoma. This study reports a rare case in which a patient suffered from intractable epistaxis because of a pseudoaneurysm in middle meningeal artery and skull base fracture after craniocerebra trauma. Pseudoaneurysm and the feeding artery were embolized by using Onyx-18 liquid embolic system. Complete cessation of bleeding was achieved in this case immediately after the endovascular therapies. In this study, clinical manifestation, diagnostic imaging and endovascular treatment are described. Formation mechanisms and the treatment of traumatic pseudoaneurysm of middle meningeal artery are discussed.
文摘Background/Objectives: Epistaxis is a common presentation and may constitute a major challenge to the parents and the health care givers. This study aimed at determining the clinico-epidemiological pattern, presentation and etiology of epistaxis. Materials and Methods: This prospective study of all patients that presented with epistaxis via the Ear, Nose and Throat department of a tertiary institution in Nigeria. The study was carried out between June 2012 and July 2017. Data were obtained from patients who gave consent by using pre-tested interviewer assisted questionnaire. All the data obtained were analyzed using SPSS version 16.0. Results: The prevalence of epistaxis in this study was 12.2%. The peak age group was 1-10 years with epistaxis prevalence of 36.4%. The male to female ratio was 1.5:1. Anterior epistaxis was more common than posterior epistaxis accounted for 80.1% and 7.4% respectively. Single episode of epistaxis was seen in 78.4% of the patients while recurrent epistaxis occurred in 21.6%. Unilateral epistaxis was 62.5%, bilateral epistaxis was 37.5% while right nasal bleeding accounted for 35.8%. The main local causes of epistaxis were trauma 29.5%, infective rhinosinusitis 18.8% and sinonasal tumours 12.5%. Severe epistaxis requiring blood transfusion was seen in 2.8% of the patients and death was recorded in 2.3%. Majority 110 (62.5%) were managed by observation alone, 20 (11.4%) by conservative therapy and 22 (12.5%) had surgical excision. Blood transfusion was given in 5. The outcome of treatment was good recovery in 79.0% while patients’ satisfaction with treatment was noted in 84.1%. Conclusion: Epistaxis is a common sinonasal presentation with effect on quality of life. In our center commonest site of nose bleeds was local mainly from traumatic, inflammatory and neoplastic aetiology.
文摘BACKGROUND Epistaxis can be an isolated finding or a manifestation of a systemic disease.Some of the potential etiologies are usage of anticoagulants,bleeding disorders,vascular aneurysms,nasal neoplasm,hypertension and nasal steroids.Hereditary hemorrhagic telangiectasia(HHT)as a cause of recurrent epistaxis is uncommon.CASE SUMMARY In this report,we describe an 18-year-old adolescent with recurrent epistaxis,mucocutaneous telangiectasia and family history of HHT,consistent with HHT.CONCLUSION Timely diagnosis is needed not only to treat the epistaxis but also to be vigilant for other serious manifestations of this condition.
文摘Epistaxis is a common complaint which is rarely life-threatening, as most cases are self-limited and as such unreported. However, it may be a significant cause for concern if it becomes recurrent. Although a number of medications including topical antihistamines and non-steroidal anti-inflammatory drugs are known aetiological factors for epistaxis due to their antiplatelet effects, beta blockers are not being widely reported as a possible cause. This report presents the case of a 34-year-old G2P0+1, who was diagnosed with hyperthyroidism in pregnancy and subsequently reported epistaxis twice at different occasion and different hospital settings when propranolol was introduced for her treatment, with resolution of epistaxis after withdrawal of propranolol. The report aims to highlight and sensitize physicians to the possible risk of bleeding in patients placed on beta blockers especially propranolol for a wide range of medical condition due to its thrombocytopathic effect.
文摘Background: This study aimed to determine the safety and efficacy of sphenopalatine artery (SPA) surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to assist clinicians in making prompt and appropriate decisions regarding SPA surgery for refractory epistaxis. Methods: We analyzed 97 consecutive patients with nasal bleeding hospitalized in our institution between April 2009 and March 2018. Clinicopathological characteristics and clinical outcomes were analyzed from retrospective chart reviews. Results: Of the 97 patients, 28 (29 sides) required SPA surgery. There were no differences in sex, anti-coagulant drug or antiplatelet use, hemoglobin concentration, or platelet count between Group A (patients who required surgery) and Group B (patients who did not require surgery). Age (58 vs. 67 years, p = 0.038) and severity of comorbidity (0 vs. 1, p = 0.039) were significantly lower in the surgery group. Patients who were younger and had lower Charlson Comorbidity Index (CCI) scores had more requirements for surgery than those who were older and had higher CCI scores. There was no significant difference between the groups with respect to the proportion of patients receiving blood transfusions;however, the length of hospitalization was significantly longer in Group A than in Group B (8.9 vs. 8 days, p = 0.038). Success rate (non-rebleeding rate) was 89%, comparable to that reported in previous studies. Conclusions: Endoscopic SPA surgery was found safe and effective method with few complications. Younger patients with lower CCI scores were found appropriate for SPA surgery for refractory epistaxis due in part to a lower risk of anesthesia.
文摘Background: Hereditary hemorrhagic telangiectasia (HHT) is a relatively common, albeit under-recognized autosomal-dominant multisystemic vascular disorder. Epistaxis due to telangiectases in the nasal mucosa is the most common and often the earliest symptom of HHT. As many as 90% of affected individuals eventually experience recurrent epistaxis, with a mean frequency of 18 episodes per month. Prompted by the limitations of invasive treatment, researchers have directed attention to laser photocoagulation as an alternative nonsurgical treatment modality with promising results. Purpose: The purpose of the present study was to describe our experience with the state-of-the-art 980 nm diode laser for the treatment of bleeding lesions of the skin, nasal and oral mucosa in patients with HHT. Methodology/Principal: We treated 16 HHT patients with intractable bleeding from telangiectasias using the 980-nm diode laser as an office procedure using local anesthesia. We recorded hemoglobin levels before and after treatment and used disability questionnaires. Results: All patients treated had an improvement in hemoglobin levels and disability scores. In patients with multiple lesions hemoglobin levels improved from a mean of 8.4 to 11.2 (p = 0.008). The disability index in this group improved from a mean of 5.3 to 2.8 (p = 0.007). Follow-up ranged between 4 and 12 months. Conclusions: The 980-nm diode laser is a good office based solution for bleeding in HHT.
文摘Background:Pediatric epistaxis is one of the most common and frequently occurring diseases,while its pathogenesis is complicated and remains to be fully elucidated.Objective:This work aims to explore the therapeutic effect and action mechanism of Rhizoma Imperatae in the treatment of pediatric epistaxis in a network pharmacology approach and to provide a practical reference for treating epistaxis in children.Methods:The active ingredients of Chinese herb Rhizoma Imperatae were obtained from the TCMSP database,and the targets of chemical compounds were subsequently predicted using the Swisstargetprediction database;the disease targets of epistaxis were exported from the Genecards database;the obtained overlapped genes were applied for protein-protein interaction(PPI)analysis,Gene Ontology(GO)anlysis and KEGG analysis.Results:There were 128 targets of Rhizoma Imperatae were predicted,and 500 disease targets were collected,with 19 overlapped targets between the drug and the disease.The five genes matrix metallopeptidase 9(MMP9),EGFR,JUN,PTGS1,and ESR1 had the most connections based on the PPI analysis.The GO analysis indicated that positive regulation of vascular smooth muscle cell proliferation and positive regulation of smooth muscle cell proliferation were greatly associated with MMP9,EGFR,and JUN genes in biological processes(BP)and positive regulation of lipid kinase activity and nitric-oxide syntheses activity affected EGFR and ESR1 genes mostly in molecular function(MF).Conclusion:The present research results demonstrated that Rhizoma Imperatae might play a role in alleviating pediatric epistaxis using a network pharmacology technique,hoping to figure out its action mechanism of the drug against the disease.
文摘Objective:Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population.The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population.Methods:Retrospective review of emergency department visits from January 2012 to May 2014.The setting is in an emergency department of a Canadian tertiary care centre.Adult patients with primary diagnosis of anterior epistaxis in the emergency department were included in this study.The main outcome was emergency department visits for anterior epistaxis visits.Results:A total of 351 cases of anterior epistaxis were included.The mean age was 70 years and 51%of patients were male.The patients were stratified into two groups based on whether their age was equal to and above,or below 75 years.Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles(P<0.05).This association did not hold true for those younger than 75 years or for all age groups combined.Conclusion:There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.
文摘Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included.Anterior epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's perspective.Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.Results:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the analysis.The median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were controlled.Conclusions:Our results show wide difference in the hospital cost of epistaxis across treatment modalities.These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.
