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Wakasugi R, Sasaki T, Takano S, Kamada H, Yoshioka K, Tochigi K, Ikeda R, Takahashi N, Matsuyama H, Horii A. Plus moist HS-W ®: a new nasal packing material for the middle meatus in endoscopic sinus surgery. Eur Arch Otorhinolaryngol 2024; 281:2985-2991. [PMID: 38219246 PMCID: PMC11065909 DOI: 10.1007/s00405-023-08437-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/22/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Removal of the current calcium alginate packing materials to the middle meatus in endoscopic sinus surgery (ESS) is usually accompanied by discomfort or pain owing to the hard and brittle nature of these materials. Plus moist HS-W® is a new calcium alginate packing material released in 2022 developed to overcome this issue by changing the uronic acid component. We aimed to compare the discomfort/pain during the removal of Plus moist HS-W® with Kaltostat®, as well as their suitability as packing materials in ESS. METHODS Kaltostat® and Plus moist HS-W® were used as packing materials in 22 and 21 patients who underwent ESS in 2021 and 2022, respectively. Patients were asked to rate the pain during the packing removal 10 days after ESS using the Numerical Rating Scale (NRS). The ratio of residual packing materials, number of suctions (insertions/extractions of the suction cannula), and time required to remove packing materials were measured. Postoperative complications such as hemorrhage, local infection, lateralization of the middle turbinate, and synechia of the middle meatus were also evaluated. RESULTS The Plus moist HS-W® group exhibited significantly lower NRS pain scores, a lower ratio of residual packing materials, a reduced number of suctions, and a shorter time required to remove the packing. No obvious postoperative complications occurred in both groups except for one suspicious case of a slight infection in the Kaltostat® group. CONCLUSION Compared with Kaltostat®, Plus moist HS-W®, characterized by better gelatinization than Kaltostat®, benefits patients by minimizing discomfort/pain during removal. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Ryo Wakasugi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan.
| | - Takanobu Sasaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Satoshi Takano
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Hisashi Kamada
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Kuniaki Yoshioka
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Kaori Tochigi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Ryo Ikeda
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Nao Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Hiroshi Matsuyama
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-Ku, Niigata City, 951-8510, Japan
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Weber RK, Sommer F, Heppt W, Hosemann W, Kühnel T, Beule AG, Laudien M, Hoffmann TK, Hoffmann AS, Baumann I, Deitmer T, Löhler J, Hildenbrand T. [Fundamentals and practice of the application of nasal packing in sinonasal surgery]. HNO 2024; 72:3-15. [PMID: 37845539 DOI: 10.1007/s00106-023-01369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND OBJECTIVES This paper presents an overview on nasal packing materials which are available in Germany. The current literature is analyzed whether there are robust criteria regarding use nasal packing after sinonasal surgery, whether there are fundamental and proven advantages or disadvantages of products, and what this means in clinical practice. MATERIALS AND METHODS Selective literature analysis using the PubMed database (key words "nasal packing", "nasal tamponade", "nasal surgery", "sinonasal surgery", or "sinus surgery"), corresponding text books and resulting secondary literature. RESULTS AND CONCLUSIONS Because of systematic methodological shortcomings, the literature does not help in the decision-making about which nasal packing should be used after which kind of sinonasal surgery. In fact, individual approaches for the many different clinical scenarios are recommended. In principle, nasal packing aims in hemostasis, should promote wound healing, and should not result in secondary morbidity. Nasal packing materials should be smooth (non-absorbable materials), inert (absorbable materials), and should not exert excessive pressure. Using non-absorbable packing entails the risk of potentially lethal aspiration and ingestion. For safety reasons inpatient control is recommended as long as this packing is in situ. With other, uncritical packing materials and in patients with special conditions, outpatient control could be justified.
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Affiliation(s)
- Rainer K Weber
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland.
- Sinus Academy, Karlsruhe, Deutschland.
- Sektion Nasennebenhöhlen- und Schädelbasischirurgie, Traumatologie, HNO-Klinik, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.
| | - Fabian Sommer
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Werner Heppt
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Städtisches Klinikum Karlsruhe, Karlsruhe, Deutschland
| | - Werner Hosemann
- Klinik für Hals-Nasen-Ohrenheilkunde, Heliosklinikum Stralsund, Stralsund, Deutschland
| | - Thomas Kühnel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Achim Georg Beule
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Münster, Münster, Deutschland
- Deutsches Zentrum für Erkrankungen der oberen Atemwege, Münster, Deutschland
| | - Martin Laudien
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Kiel, Kiel, Deutschland
| | - Thomas K Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Anna Sophie Hoffmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Ingo Baumann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Thomas Deitmer
- Deutsche Gesellschaft für HNO-Heilkunde, Kopf- und Hals-Chirurgie e. V., Bonn, Deutschland
| | - Jan Löhler
- Deutscher Berufsverband der HNO-Ärzte e. V., Neumünster, Deutschland
| | - Tanja Hildenbrand
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Freiburg, Freiburg, Deutschland
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Lo WL, Yeh CF. Using Surgicel-wrapped Merocel to reduce pain during the removal of nasal packing. Acta Otolaryngol 2023; 143:984-988. [PMID: 38134221 DOI: 10.1080/00016489.2023.2292754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Merocel is a commonly used material for nasal packing; nevertheless, the majority of patients experience pain when the nasal packing is removed.Aims/Objectives: This study aims to introduce a novel technique for nasal packing using Surgicel-wrapped Merocel. MATERIAL AND METHODS Patients who underwent septoplasty received either Merocel or Surgicel-wrapped Merocel as nasal packing. Clinical complications related to bleeding and subjective symptoms associated with the packing materials were assessed. RESULTS Between 2018 and 2021, a total of thirty-three patients with a deviated nasal septum underwent septoplasty. Among them, eight patients received Merocel nasal packing, while twenty-five patients were treated with the new nasal packing technique involving Surgicel-wrapped Merocel. We observed a significant reduction in pain during removal in the Surgicel-wrapped Merocel group compared to the Merocel group (p = .008). However, no significant differences were noted in other discomforts related to packing or bleeding after removal between these two groups.Conclusions and Significance:Using Surgicel-wrapped Merocel as nasal packing following septoplasty is an effective method to alleviate pain during removal.
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Affiliation(s)
- Wen-Ling Lo
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chien-Fu Yeh
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Otorhinolaryngology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yasli SO, Canpolat DG, Baydan E, Demirbas AE. Effectiveness Of Computed Tomography-Guided Nasotracheal Intubation Procedure On Predicting Tube Advancement Difficulty And Preventing Epistaxis: A Prospective Case-Control Study. J PAK MED ASSOC 2023; 73:1981-1986. [PMID: 37876056 DOI: 10.47391/jpma.8034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Objectives To evaluate the effectiveness of computed tomography-guided nasotracheal intubation procedure in predicting tube advancement difficulty and preventing epistaxis. METHODS The prospective study was conducted at Erciyes University Faculty of Dentistry from April 2018 to June 2019 and comprised maxillofacial surgery patients of either gender aged 18-50 years who were due to undergo bimaxillary orthognathic surgery, which was defined as American Society of Anaesthesiology grade I or II. The space where the tube was to be passed in the internal nasal valve region was measured horizontally and vertically using computed tomography. A single experienced anaesthesiologists intubated all the patients who were later divided into 'easy' group A and 'difficult' group B on the basis of the effort required to advance the tube through the nasal passage. Data was analysed using JASP version 0.14.1.0). RESULTS Of the 60 patients, 42(70%) were females and 18(30%) were males. The overall mean age was 29.0±10.5 years and the mean body mass index value was 23.6±4.0 kg/m 2 (p>0.05). There were 28(46.6%) patients in group A, and 32(53.3%) in group B. Median distances were significantly shorter and epistaxis was significantly higher in group B compared to group A (p<0.001). The cut-off values to reveal the distance at which difficulty may be experienced while advancing the tube, determined through receiver operating characteristic analysis, were 1.09 cm for vertical and 0.39cm for horizontal distances. CONCLUSIONS The nasotracheal intubation procedure under the guidance of computed tomography could help predict the difficulty of tube advancement, and could thus prevent epistaxis and other related nasal intubation complications. Clinical trial number: NCT05525754.
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Affiliation(s)
| | | | - Ebru Baydan
- Department of Dentistry, Erciyes University, Turkey
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Xu P, Liu S, Dong Y, Liang W, Li Z, Liu F. Effects of nasal irrigation after endoscopic transsphenoidal resection in patients with pituitary adenomas: A randomized controlled trial. Medicine (Baltimore) 2021; 100:e28317. [PMID: 34941128 PMCID: PMC8702231 DOI: 10.1097/md.0000000000028317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 01/05/2023] Open
Abstract
PURPOSE We aimed to explore the methods to reduce or prevent nasal complications after endoscopic transsphenoidal pituitary adenoma resection. We also examined the effects of nasal irrigation after this procedure was performed. METHODS A randomized controlled trial was performed. Sixty patients of a tertiary hospital were enrolled in this study. The subjects were randomly divided into a control group and an intervention group. The subjects of the control group were given routine guidance, and 20 mL of normal saline was atomized through inhalation. The gauze was removed 7 days after surgery. The patients of the intervention group were given 50 mL of a 2% saline solution at 37°C to 38°C for bilateral nasal irrigation for 1 week. After that, patients were given 50 mL of a 0.9% normal saline solution at 37°C to 38°C for bilateral nasal irrigations. The complications of the two groups were collected at baseline, 1 week after intervention, 1 month, and 3 months after intervention. The data were analyzed using the chi-square test. RESULTS A 1-month after intervention, there were significant differences in dysosmia, epistaxis, and nasal adhesion between the intervention and control groups. A 3-month after intervention, only olfactory disturbances were significantly different between the two groups. CONCLUSIONS Nasal irrigation helps reduce the incidence of complications such as epistaxis and nasal adhesions in the early postoperative period. It can also promote the elimination or reduction of olfactory disturbances.
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Affiliation(s)
- Peng Xu
- Department of Otolaryngology, Tianjin Huanhu Hospital, Tianjin, China
| | - Shuling Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
- Department of Nursing Management, Tianjin Huanhu Hospital, Tianjin, China
| | - Yahong Dong
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Wei Liang
- Department of Operating Room, Tianjin Huanhu Hospital, Tianjin, China
| | - Zijun Li
- Department of Otolaryngology, Tianjin Huanhu Hospital, Tianjin, China
| | - Fang Liu
- Department of Otolaryngology, Tianjin Huanhu Hospital, Tianjin, China
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Tan YL, Wu ZH, Zhao BJ, Ni YH, Dong YC. For nasotracheal intubation, which nostril results in less epistaxis: right or left?: A systematic review and meta-analysis. Eur J Anaesthesiol 2021; 38:1180-1186. [PMID: 34617919 DOI: 10.1097/eja.0000000000001462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasotracheal intubation is usually required in patients undergoing oromaxillofacial, otolaryngological or plastic surgery to prevent the airway encroaching into the operating field. Epistaxis is the most common complication, but which nostril is associated with a lower incidence and severity of epistaxis is still unclear. OBJECTIVE When both nostrils are patent, to determine the preferred nostril for nasotracheal intubation under general anaesthesia. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). The primary outcome was the incidence of epistaxis and the secondary outcomes included the incidence of severe epistaxis, the time required to pass the tube through the nasal passage and total intubation time. DATA SOURCES PubMed, Embase and the Cochrane Register of Controlled Trials were searched from database inception to 1 March 2020. ELIGIBILITY CRITERIA The only studies included were RCTs comparing epistaxis related to nasotracheal intubation via right or left nostril, in adult surgery patients undergoing general anaesthesia. RESULTS Ten RCTs with 1658 patients were included. Compared with the left nostril, intubation via the right nostril was associated with a significantly lower incidence of epistaxis: risk ratio (RR) and 95% confidence intervals (CI) were 0.78 (0.62 to 0.99), P = 0.04: a lower incidence of severe epistaxis (five studies, n=923), RR 0.40 (0.22 to 0.75), P = 0.004: and a shorter intubation time (three studies, n=345), mean difference -7.28 (-14.40 to -0.16) seconds, P = 0.05. In two studies (n=310), no significant difference between the right and left nostril was observed in the time to pass the tube through the nasal passages, mean difference -0.59 (-1.95 to 0.77) s, P = 0.40. CONCLUSION On the basis of the current available evidence, when both nostrils are patent, the right nostril is more appropriate for nasotracheal intubation, with a lower incidence and severity of epistaxis and faster intubation time. TRIAL REGISTRATION The study protocol has been registered in PROSPERO (CRD42020169949).
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Affiliation(s)
- Ying-Lun Tan
- From the Medical School of Nantong University, Nantong (YLT), Department of Oral Anesthesiology, Nanjing Stomatological Hospital (ZHW, BJZ, YCD) and Central Laboratory, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China (YHN)
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Seghers N, Ledeghen S, Collet S, Degols JC. Safety of (rhino)septoplasty without nasal packing in routine ENT practice. Eur Arch Otorhinolaryngol 2021; 278:4329-4333. [PMID: 33738566 DOI: 10.1007/s00405-021-06713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This retrospective study assesses the risks and benefits linked to the non-use of nasal packing after a (rhino)septoplasty, compared with post-operative care with anterior nasal packing such as Merocel®. METHODS Complication rates observed during the first week after surgery were compared between groups with and without use of classic nasal packing over a large sample of 534 patients, who had undergone either a closed or open procedure, with bilateral turbinoplasty, and with or without osteotomies. Complications listed include epistaxis, haematoma, impetiginization, septal perforation, hyperalgesia, and dyspnoea. RESULTS No significant difference was observed between the group with and without packing regarding the immediate post-operative complications of epistaxis (4.4% of the cases with nasal packing versus 3% without, p = 0.918) and impetiginization (3% of the cases with nasal packing versus 4.2% without, p = 0.478). The technique used, as well as any osteotomies performed, had no impact on the results. CONCLUSION Non-use of nasal packing after a (rhino)septoplasty is a safe alternative to classic post-operative methods. Provided that there is a rigorous surgical technique and strict clinical control, it should be used as a principal technique in any routine practice due to its safety for patients immediately post-surgery.
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Affiliation(s)
| | - Stéphane Ledeghen
- ENT Department, Clinique Saint-Pierre D'Ottignies (CSPO), Ottignies-Louvain-la-Neuve, Belgium
| | - Stéphanie Collet
- ENT Department, Clinique Saint-Pierre D'Ottignies (CSPO), Ottignies-Louvain-la-Neuve, Belgium
| | - Jean-Christophe Degols
- ENT Department, Clinique Saint-Pierre D'Ottignies (CSPO), Ottignies-Louvain-la-Neuve, Belgium
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Li X. Is prophylactic ablation reasonable for the management of idiopathic recurrent epistaxis? Am J Otolaryngol 2020; 41:102494. [PMID: 32334920 DOI: 10.1016/j.amjoto.2020.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Xiuguo Li
- Department of Otolaryngology, Jining No. 1 People's Hospital, No. 6, JianKang Road, Jining City, 272000, Shandong Province, China.
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Lou ZC. Microwave ablation: A new technique for the prophylactic management of idiopathic recurrent epistaxis. Am J Otolaryngol 2019; 40:696-699. [PMID: 31229366 DOI: 10.1016/j.amjoto.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to compare the re-bleeding of idiopathic recurrent epistaxis with no definite bleeding site treated with either prophylactic microwave ablation (MWA) or continuous observation. STUDY DESIGN Case series with chart review. SUBJECTS AND METHODS 61 patients with idiopathic recurrent epistaxis but no definite bleeding sites in the first operation were assigned to prophylactic MWA group (n = 39) and continuous observation group (n = 22). Patients in prophylactic MWA group were given prophylactic MWA at the common bleeding sites. Patients in continuous observation group were only observed in the ward. The bleeding sites, re-bleeding and complications were evaluated during 3 months follow-up period. RESULTS Rebleeding was experienced by 7 of the patients (17.9%) who were treated with prophylactic MWA whereas, 13 of the patients (59.1%) who used continuous observation had rebleeding. The rebleeding rate for patients undergoing prophylactic MWA group was lower than that for the observation-only group (p < 0.01). All the ablations were completed for the patients with known bleeding site within 1-2 min. These patients only had the complain of slight postoperative pain, no serious complications (including nasal adhesion, crust, septal perforation, etc.) were found in the follow-up period. CONCLUSIONS MWA is a simple, convenient, rapid, and definite hemorrhage control method with minimally invasive therapeutic technique. Prophylactic MWA at the common bleeding sites helps to significantly reduce the rate of rebleeding in patients in whom no definite bleeding sites have been identified.
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Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699, Jiangdong Road, Yiwu City, Zhejiang Province, China.
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Abstract
OBJECTIVES Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method. METHODS We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze. RESULTS Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively. CONCLUSIONS Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia. LEVEL OF EVIDENCE 1B Laryngoscope, 127:1026-1031, 2017.
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Affiliation(s)
- Jong Seung Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sam Hyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chonbuk National University, Jeonju, Korea
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Liu J, Sun X, Guo L, Wang D. Posterior epistaxis: Common bleeding sites and prophylactic electrocoagulation. Ear Nose Throat J 2016; 95:E18-E22. [PMID: 27792828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Posterior epistaxis is a frequent emergency, and the key to efficient management is identification of the bleeding point. We performed a retrospective study of 318 patients with posterior epistaxis treated with endoscopic bipolar electrocautery during a 4-year period. Distribution of the bleeding sites was recorded. Patients with no definite bleeding sites in the first operation were assigned to Group A (n = 39) and Group B (n = 34). Patients in Group A were only observed in the ward. Patients in Group B were given prophylactic electrocoagulation at the common bleeding points. Of the 318 patients, bleeding sites were successfully identified and coagulated in 263 patients. All of them were located posteriorly, with 166 on the lateral nasal wall, 86 on the septum, and 11 on the anterior face of the sphenoid sinus. The rebleeding rate of Group B (8.8%) was lower than that of Group A (38.5%) (p < 0.01).
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Affiliation(s)
- Juan Liu
- Department of Otolaryngology, Eye Ear Nose and Throat Hospital, 83 Fen Yang Rd., Shanghai 200031, PR China
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Abstract
BACKGROUND Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disease characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. METHODOLOGY The genetic basis and pathophysiology of the disease are discussed. Diagnostic criteria and the clinical course of the condition are considered. The current management options, both medical and surgical, are reviewed. CONCLUSIONS Hereditary haemorrhagic telangiectasia requires specialist treatment for the problems it causes, and is best managed in specialist centres. Epistaxis is often the major symptom, significantly affecting patients' quality of life. An understanding of the available treatment options is therefore important for the otorhinolaryngologist.
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Abstract
BACKGROUND Hereditary haemorrhagic telangiectasia is an autosomal dominant vascular disease characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations. METHODOLOGY The genetic basis and pathophysiology of the disease are discussed. Diagnostic criteria and the clinical course of the condition are considered. The current management options, both medical and surgical, are reviewed. CONCLUSIONS Hereditary haemorrhagic telangiectasia requires specialist treatment for the problems it causes, and is best managed in specialist centres. Epistaxis is often the major symptom, significantly affecting patients' quality of life. An understanding of the available treatment options is therefore important for the otorhinolaryngologist.
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Tanner R, Harney MS. The initial management of epistaxis. Ir Med J 2015; 108:123-124. [PMID: 26016308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epistaxis affects up to 60% of people. The basic first aid management of epistaxis is clearly stated in the literature and guidelines. Anecdotal evidence would suggest that these principles are not understood by patients and are not being conveyed to patients by their doctors. The aim was to assess current knowledge of epistaxis first aid management and identify the principle source of education in epistaxis control. This was a single centre cross-sectional study. The study population included those presenting to otolaryngology outpatients with epistaxis. 20 patients participated in this study over a 7 month period. Five (25%) patients did not use compression during an episode of epistaxis. Nine (60%) patients that used the compression technique failed to compress the lower one-third of the nose. Only two (10%) of patients identified their GP as having taught them first aid for epistaxis. Knowledge of epistaxis management is poor. Education regarding the basic principles of first aid for epistaxis may reduce morbidity and unnecessary consultations from health professionals.
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Abstract
A short-cut review was carried out to establish whether topical tranexamic acid can be used to treat spontaneous epistaxis. Thirty-three papers were found, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. The clinical bottom line is that there is insufficient evidence to support the use of topical intranasal tranexamic acid in the management of spontaneous epistaxis in haemodynamically stable patients presenting to the emergency department.
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Sugiyama K, Manabe Y, Kohjitani A. Mechanism of stylet-facilitated nasotracheal intubation. Reply. Can J Anaesth 2014; 61:1058. [PMID: 25436269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Wu J, Su T, Zhang J, Zhang J, Wu Y, Wang D, Bian C. [Angle of titanium clip next turbinate resection without filling in the clinical observation]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 28:1347-1349. [PMID: 25522576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To observe the self-developed horn type of titanium clamp used for inferior turbinate resection from filling effect. METHOD Choose the cases of inferior turbinate resection of 152 cases randomly selected 92 cases (group) in 2-4 angle type titanium clip head-tail closed wound middle turbinate, and therefore more than nasal passages in the surgical wound, just as in the nasal passages above micro tamponade, bare breathing zone, keep the ventilation, 1- 3 days to take out the angle titanium clamp; 60 cases (control group) with vaseline oil gauze or postoperative Merocel hemostatic sponge tamponade nasal bleeding. Observation of 1-3 days after nasal ventilation, headache, nasal bleeding, dry mouth, tolerance is painful, aural fullness tinnitus, a total of 7 indicators of sleep. RESULT The team outside the there was no difference in blood loss and the control group, the rest of the indicators is better than the control group. CONCLUSION The angle of titanium clamp used in inferior turbinate resection from stuffing, patients get better comfort, avoid drawn yarn of pain, improve the quality of perioperative patients with life.
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Jahanshahi J, Hashemian F, Pazira S, Bakhshaei MH, Farahani F, Abasi R, Poorolajal J. Effect of topical tranexamic acid on bleeding and quality of surgical field during functional endoscopic sinus surgery in patients with chronic rhinosinusitis: a triple blind randomized clinical trial. PLoS One 2014; 9:e104477. [PMID: 25133491 PMCID: PMC4136784 DOI: 10.1371/journal.pone.0104477] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/03/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The effect of tranexamic acid (TXA) on bleeding and improvement of surgical field during functional endoscopic sinus surgery (FESS) is not clear yet. This study was conducted to answer this question. METHODS This trial was conducted on 60 patients with chronic sinusitis at Beasat Hospital, Hamadan, Iran, from April to November 2013. Thirty patients in the intervention group received three pledgets soaked with TXA 5% and phenylephrine 0.5% for 10 minutes in each nasal cavity before surgery. Thirty patients in the control group received phenylephrine 0.5% with the same way. The amount of bleeding and the quality of surgical field were evaluated at 15, 30, and 45 minutes after the start of surgery using Boezaart grading. RESULTS The quality of the surgical field in the intervention group compared to the control group was significantly better in the first quarter (P = 0.002) and the second quarter (P = 0.003) but not in the third quarter (P = 0.163). Furthermore, the amount of bleeding was much less during all periods in the intervention group than in the control group (P = 0.001). CONCLUSION Topical TXA can efficiently reduce bleeding and improve the surgical field in FESS in patients with rhinosinusitis. Based on these findings, topical TXA may be a useful method for providing a suitable surgical field during the first 30 minutes after use. TRIAL REGISTRATION Iranian Registry of Clinical Trials IRCT201212139014N15.
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Affiliation(s)
- Javaneh Jahanshahi
- Department of Ear-Nose-Throat Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farnaz Hashemian
- Department of Ear-Nose-Throat Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sara Pazira
- Department of Ear-Nose-Throat Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | | | - Farhad Farahani
- Department of Ear-Nose-Throat Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ruholah Abasi
- Department of Ear-Nose-Throat Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Jalal Poorolajal
- Modeling of Noncommunicable Diseases Research Center, Department of Epidemiology & Biostatistics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Griffiths CF, Cutler AR, Duong HT, Bardo G, Karimi K, Barkhoudarian G, Carrau R, Kelly DF. Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note. Acta Neurochir (Wien) 2014; 156:1393-401. [PMID: 24809531 DOI: 10.1007/s00701-014-2107-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 04/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Most endoscopic transsphenoidal approaches jeopardize the sphenopalatine artery and septal olfactory strip (SOS), increasing the risk of postoperative anosmia and epistaxis while precluding the ability to raise pedicled nasoseptal flaps (NSF). We describe a bilateral "rescue flap" technique that preserves the mucosa containing the nasal-septal vascular pedicles and the SOS. This approach can reduce the risk of postoperative complications, including epistaxis and anosmia. METHODS A retrospective analysis was conducted of all patients who underwent endoscopic transsphenoidal surgery with preservation of both sphenopalatine vascular pedicles and SOS. In a recent subset of patients, olfactory assessment was performed. RESULTS Of 174 consecutive operations performed in 161 patients, bilateral preservation of the sphenopalatine vascular pedicle and SOS was achieved in 139 (80 %) operations, including 31 (22 %) with prior transsphenoidal surgery. Of the remaining 35 operations, 18 had a planned formal NSF and 17 had prior surgery or extensive lesions precluding use of this technique. Of pituitary adenomas, RCCs or sellar arachnoid cysts, 118 (94 %) underwent this approach, including 91 % of patients who had prior surgery. Preoperative olfaction function was maintained in 97 % of patients that were tested. None of the patients had postoperative arterial epistaxis. CONCLUSION Preservation of bilateral sphenopalatine vascular pedicles and the SOS is feasible in over 90 % of patients undergoing endonasal endoscopic surgery for pituitary adenomas and RCCs. This approach, while not hindering exposure or limiting instrument maneuverability, preserves the nasoseptal vasculature for future NSF use if needed and appears to minimize the risks of postoperative arterial epistaxis and anosmia.
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Affiliation(s)
- Chester F Griffiths
- Saint Johns Medical Center, John Wayne Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA
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Nosebleeds: how serious are they? Johns Hopkins Med Lett Health After 50 2014; 25:3. [PMID: 24809120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Dupuis-Girod S, Ginon I, Saurin JC, Marion D, Guillot E, Decullier E, Roux A, Carette MF, Gilbert-Dussardier B, Hatron PY, Lacombe P, Lorcerie B, Rivière S, Corre R, Giraud S, Bailly S, Paintaud G, Ternant D, Valette PJ, Plauchu H, Faure F. Bevacizumab in patients with hereditary hemorrhagic telangiectasia and severe hepatic vascular malformations and high cardiac output. JAMA 2012; 307:948-55. [PMID: 22396517 DOI: 10.1001/jama.2012.250] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT The only treatment available to restore normal cardiac output in patients with hereditary hemorrhagic telangiectasia (HHT) and cardiac failure is liver transplant. Anti-vascular endothelial growth factor treatments such as bevacizumab may be an effective treatment. OBJECTIVES To test the efficacy of bevacizumab in reducing high cardiac output in severe hepatic forms of HHT and to assess improvement in epistaxis duration and quality of life. DESIGN, SETTING, AND PATIENTS Single-center, phase 2 trial with national recruitment from the French HHT Network. Patients were 18 to 70 years old and had confirmed HHT, severe liver involvement, and a high cardiac index related to HHT. INTERVENTION Bevacizumab, 5 mg per kg, every 14 days for a total of 6 injections. The total duration of the treatment was 2.5 months; patients were followed up for 6 months after the beginning of the treatment. MAIN OUTCOME MEASURE Decrease in cardiac output at 3 months after the first injection, evaluated by echocardiography. RESULTS A total of 25 patients were included between March 2009 and November 2010. Of the 24 patients who had echocardiograms available for reread, there was a response in 20 of 24 patients with normalization of cardiac index (complete response [CR]) in 3 of 24, partial response (PR) in 17 of 24, and no response in 4 cases. Median cardiac index at beginning of the treatment was 5.05 L/min/m(2) (range, 4.1-6.2) and significantly decreased at 3 months after the beginning of the treatment with a median cardiac index of 4.2 L/min/m(2) (range, 2.9-5.2; P < .001). Median cardiac index at 6 months was significantly lower than before treatment (4.1 L/min/m(2); range, 3.0-5.1). Among 23 patients with available data at 6 months, we observed CR in 5 cases, PR in 15 cases, and no response in 3 cases. Mean duration of epistaxis, which was 221 minutes per month (range, 0-947) at inclusion, had significantly decreased at 3 months (134 minutes; range, 0-656) and 6 months (43 minutes; range, 0-310) (P = .008). Quality of life had significantly improved. The most severe adverse events were 2 cases of grade 3 systemic hypertension, which were successfully treated. CONCLUSION In this preliminary study of patients with HHT associated with severe hepatic vascular malformations and high cardiac output, administration of bevacizumab was associated with a decrease in cardiac output and reduced duration and number of episodes of epistaxis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00843440.
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Affiliation(s)
- Sophie Dupuis-Girod
- Hospices Civils de Lyon, Hôpital Louis Pradel, Genetic Department and National Reference Center for Rendu-Osler Disease, Bron, France.
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Fischer KD. [When no doctor is on call. Medical works for lay persons in late antiquity]. Med Secoli 2012; 24:379-401. [PMID: 25807743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article offers a survey of the chief medical texts for lay persons in Latin, followed by a more detailed discussion of two examples, hare's brain for teething troubles and remedies for nosebleed.
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Affiliation(s)
- Klaus-dietrich Fischer
- Institut für Geschichte, Theorie und Ethik der Medizin der Universitätsmedizin der Johannes-Gutenberg Universität Mainz, D.
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Lazaraki G, Akriviadis E, Pilpilidis I, Parisi I, Tzilves D, Tarpangos A. Low dose of bevacizumab is safe and effective in preventing bleeding episodes in hereditary hemorrhagic telangiectasia. Am J Gastroenterol 2011; 106:2204-6. [PMID: 22138950 DOI: 10.1038/ajg.2011.287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Tong JL. Xylometazoline pretreatment reduces nasotracheal intubation-related epistaxis in paediatric dental surgery. Br J Anaesth 2011; 106:279; author reply 279-80. [PMID: 21233119 DOI: 10.1093/bja/aeq395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
CONCLUSION The present findings indicate that conventional nasal packing is not required for endoscopic endonasal surgery. OBJECTIVES To evaluate the routine use of packing in endoscopic endonasal surgery. METHODS From January 2006 through January 2009, 146 consecutive patients who underwent endoscopic endonasal surgery performed by the same surgeon in Kyoto University Hospital were evaluated. The surgical procedure was ended with conventional gauze packing in 70 consecutive patients from January 2006 through August 2007 (Packing group), and placing of oxidized cellulose on operative sites was performed in 76 consecutive patients from September 2007 to January 2009 (Non-packing group). We analyzed demographic characteristics, comorbidities, surgical procedures, incidence of packing the nose after excessive postoperative bleeding, and occurrence of postoperative adhesion. RESULTS No significant differences in the demographic characteristics, except for gender, and in comorbidities were found between the two groups. The number of endoscopic sinus surgery procedures with septoplasty and/or turbinoplasty, or tumor extirpation in the Non-packing group was significantly larger than that in the Packing group. There was no significant difference in the incidence of postoperative bleeding or postoperative adhesion between the two groups.
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Affiliation(s)
- Chiaki Suzuki
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University, Kyoto, Japan
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No more nosebleeds. Consum Rep 2010; 75:12. [PMID: 20361413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
REASONS FOR PERFORMING STUDY There have been no previously published large case series describing short- and long-term outcome of transarterial coil embolisation (TCE) in horses with guttural pouch mycosis (GPM). OBJECTIVES To describe the clinical and surgical features of horses with GPM presented at the Veterinary School of Lyon during a 28 month period; and to evaluate immediate to long-term results of TCE as a treatment. METHODS Medical records of all horses with GPM treated with TCE between February 1999 and July 2002 were analysed. To be included in the study, no other surgical or medical treatment for the mycosis was administered. Subject details, case history and results of initial clinical examination and endoscopy were reviewed. For all individuals, evaluation of long-term complications and case evolution was based on owner or trainer interviews between 24 and 41 months after surgery. RESULTS Thirty-one horses were identified with unilateral (n = 25) or bilateral (n = 6) GPM affecting only the medial (n = 28), only the lateral (n = 2) or both compartments simultaneously (n = 7). Of the 23 individuals presented with epistaxis, 20 showed complete resolution of the problem. Of the 19 horses presented with neurological signs, 2 were subjected to euthanasia for persistence of severe dysphagia. Prognosis for survival was excellent (84%) and prognosis for return at the level expected by the owner or trainer was good (71%). CONCLUSIONS AND POTENTIAL RELEVANCE TCE of horses affected with GPM is an effective method of preventing haemorrhage and resolving the majority of mycotic lesions without further specific treatment. Treated horses did not present relapse of mycosis during the follow-up period.
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Affiliation(s)
- O M Lepage
- Départment Hippique, Ecole Nationale Vétérinaire de Lyon, F-69280 Marcy l'Etoile, France
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Affiliation(s)
- Jill Rushing
- University of Southern Mississippi in Hattiesburg, USA
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Abstract
OBJECTIVE Septoplasty is one of the most common operations performed by otorhinolaryngologists. Nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty is the pain and discomfort during removal of the nasal packs. The objective of this study was to evaluate the results of septoplasty without postoperative nasal packing. METHODS Septoplasty was performed by standard technique. No nasal packing was used in these cases. RESULTS Seventy-eight patients were included in the study. The majority of the patients (64.1%; 50/78) on a morning list were operated. Sixty-two patients were discharged home the same day, the remaining others were discharged the next day. Our postoperative haemorrhage rate was 7.7% (6/78) and only 3.8% (3/78) patients required nasal packing. Majority (84.6%) of the patients were satisfied with the operation at the postoperative follow up 3 months later. CONCLUSIONS Septoplasty can be safely performed without postoperative nasal packing. Only 3.8% patients required nasal packing in this study.
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Affiliation(s)
- Y Bajaj
- Department of ENT, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Javed A, Ayyub M, Abrar S, Mansoor M, Khan B, Hussain T. Control of severe bleeding episode in case of Glanzmann's thrombasthenia refractory to platelet transfusion therapy by administering recombinant factor VIIa. J Ayub Med Coll Abbottabad 2009; 21:171-173. [PMID: 20524499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Glanzmann's thrombasthenia is an autosomal recessive inherited platelet function defect. Though, quantitatively normal, the aggregation ability of platelets is reduced leading to bleeding episodes requiring transfusion of platelet concentrates. We describe a case of 13-year-old girl who had recurrent episodes of epistaxis since birth and was managed with multiple platelet concentrate transfusions and recently admitted with severe epistaxis refractory to platelet transfusion. At this stage administration of recombinant activated factor VII (fVIIa) was considered, which was initially given at 90 microg/kg dose with little control of bleeding but subsequent second dose of 120 microg/kg was administered with excellent response and immediate control of bleeding.
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Affiliation(s)
- Asim Javed
- Combined Military Hospital, Rawalpindi, Pakistan
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de Gussem EM, Snijder RJ, Disch FJ, Zanen P, Westermann CJJ, Mager JJ. The effect of N-acetylcysteine on epistaxis and quality of life in patients with HHT: a pilot study. Rhinology 2009; 47:85-88. [PMID: 19382502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Free O2- radicals may cause precapillary sphincter abnormalities, resulting in epistaxis in hemizygous knockout mice for Endoglin. The objective of this study was to test if antioxidants, like N-acetylcysteine (NAC), are have a role in the treatment of epistaxis in hereditary hemorrhagic telangiectasia (HHT). METHODS Forty-three patients participated in this study taking NAC 600 mg t.i.d for 12 weeks. Patients registered frequency, severity and duration of epistaxis and private and work-related quality of life (QOL), using a diary for two 6 weeks periods. The first period was prior to starting treatment and the second started after 6 weeks using NAC. RESULTS There was a decrease infrequency (p < 0.01) and severity (p < 0.01) of epistaxis during the day. The improvement was most remarkable in male patients and patients with an ENDOGLIN mutation. In women and patients with an ALK-1 mutation, only a trend for improvement was found. Nocturnal epistaxis did not improve. The effect of epistaxis on the ability to work (p = 0.02) was reduced. CONCLUSION This pilot study was conducted to investigate whether animal experiments can be translated to humans with HHT regarding epistaxis. The positive results with NAC are promising and justify a randomised clinical trial.
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Affiliation(s)
- E M de Gussem
- Department of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands
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Ozcan C, Vayisoglu Y, Kiliç S, Görür K. Comparison of rapid rhino and merocel nasal packs in endonasal septal surgery. J Otolaryngol Head Neck Surg 2008; 37:826-831. [PMID: 19128711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE Our study compared Rapid Rhino (RR; Applied Therapeutic Ltd, Leicestershire, UK) and Merocel (Medtronic Xomed, Jacksonville, FL) nasal packing materials in endonasal septoplasty surgery in terms of postoperative patient comfort and reactionary bleeding. PATIENTS AND METHODS Fifty-one patients underwent endonasal septoplasty. One nasal cavity was packed with Merocel packs and the RR pack was used for the other side. The pain and nasal fullness levels on each side were studied at 1 and 6 hours postoperatively. Pain level was also studied during the removal of the nasal packs on the second day. These levels were scored on the basis of a visual analogue scale (VAS) between 0 and 10. Reactionary bleeding after nasal pack removal was also recorded. The Wilcoxon test was used for statistical analysis of the VAS scores, and the McNemar test was used for comparison of bleeding levels after pack removal. A p value<.05 was considered to be statistically significant. RESULTS Minimal bleeding was noted in 15 patients following Merocel pack removal; however, no bleeding was seen following RR pack removal. Comparison of the VAS scores of pain and nasal fullness of each nasal pack at 1 and 6 hours postoperatively showed a statistically significant difference (p<.05). Similarly, comparison of the pain level for pack removal and bleeding after removal on the second postoperative day demonstrated a statistically significant difference (p<.05 and p=.001, respectively). CONCLUSION RR is more tolerable by patients than Merocel after septoplasty surgery. RR also has some advantages, namely, easy pack removal and less reactionary bleeding.
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Affiliation(s)
- Cengiz Ozcan
- Department of Otorhinolaryngology, Mersin University, and Tarsus State Hospital, Mersin, Turkey.
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Harvinder S, Rosalind S, Gurdeep S. Endoscopic cauterization of the sphenopalatine artery in persistent epistaxis. Med J Malaysia 2008; 63:377-378. [PMID: 19803294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The management of epistaxis remains to be a challenging problem for most ENT surgeon especially posterior epistaxis. Most cases are managed by placement of posterior nasal packs or balloons and failure leads to more invasive techniques, involving ligation of the internal maxillary artery. The above management is associated with significant patient complication and morbidity. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. We have performed endoscopic cauterization of nine sphenopalatine arteries in eight patients with no further episodes of epistaxis and complications, with an average follow-up of 25 months. The mean age of the patients was 52.75 years. Fifty percent of the patients had a history of hypertension.
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Affiliation(s)
- S Harvinder
- Department of ENT, Hospital Ipoh, Jalan Hospital, 30990, Ipoh, Perak, Malaysia.
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Awan MS, Iqbal M. Nasal packing after septoplasty: a randomized comparison of packing versus no packing in 88 patients. Ear Nose Throat J 2008; 87:624-627. [PMID: 19006062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.
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Affiliation(s)
- Mohammad Sohail Awan
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Affiliation(s)
- Michael Weindling
- School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool, UK.
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Abstract
Patients with severe forms of von Willebrand's disease (VWD) may have frequent haemarthroses, especially when factor VIII (FVIII) levels are below 10 U/dL, so that some of them develop target joints like patients with severe haemophilia A. Some patients have recurrent gastrointestinal bleeding, often without lesions in the gastrointestinal tract, and need treatment every day or every other day. Finally, there are children who have epistaxis frequently and severely enough to cause anaemia. In these frequent and severe bleeders, the optimal therapy may be secondary long-term prophylaxis with von Willebrand factor (VWF)/FVIII concentrates rather than on-demand treatment on the occasion of bleeding episodes. The largest experience on such prophylaxis in VWD has been in Sweden in 35 patients with severe forms of VWD. Long-term prophylaxis was also implemented in a cohort of Italian patients with VWD: prophylaxis was used in seven patients with types 3 (n = 1 ), 2A (n = 4), 2M (n = 1) and type 1 (n = 1) VWD because of recurrent gastrointestinal bleeds and in four patients with type 3 VWD because of joint bleeds. Prophylaxis prevented bleeding completely in eight patients and largely reduced hospitalisation for blood transfusions in the remaining three. The cost-effectiveness of these prophylaxis regimens versus on-demand therapy will now be investigated in one large international study
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Affiliation(s)
- Augusto B Federici
- Centro Emofilia e Trombosi Angelo Bianchi Bonomi, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Università degli Studi di Milano, Milano, Italia.
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Eng CY, Yew TA, Ng WS, El-Hawrani AS. Management of recurrent epistaxis in an anticoagulated patient by temporarily closing the nares with sutures. Ear Nose Throat J 2008; 87:221-222. [PMID: 18478797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform,fairly well tolerated, easily reversible, and highly effective.
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Başer M, Coban S, Taşci S, Sungur G, Bayat M. Evaluating First-aid Knowledge and Attitudes of a Sample of Turkish Primary School Teachers. J Emerg Nurs 2007; 33:428-32. [PMID: 17884471 DOI: 10.1016/j.jen.2006.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 10/30/2006] [Accepted: 11/09/2006] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Knowledge of first aid, which constitutes life-saving treatments for injuries or unexpected illnesses, is important for every individual at every age. First aid and basic life support are so important that teaching basic first aid should be compulsory in all schools. The goal of this study was to determine the knowledge and attitudes of a sample of Turkish teachers regarding the administration of first aid. METHODS Three hundred twelve teachers took part in this study to evaluate knowledge and attitudes of teachers in primary schools about first aid. Data were obtained using a questionnaire. It included 30 questions that help identify the teachers and determine their knowledge and attitudes about first aid. Data were analyzed by chi-square test. RESULTS In this study, it was determined that most of the teachers do not have correct knowledge and attitudes about first aid. For example, 65.1% of teachers gave incorrect answers regarding epistaxis, 63.5% for bee stings, and 88.5% for abrasion. It was found out that as the age of the teachers increases, appropriate first-aid practice becomes more and more unlikely. DISCUSSION The results of this study showed that teachers did not have enough knowledge about first aid.
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Affiliation(s)
- Mürüvvet Başer
- Department Gynaecology and Obstetric Nursing, Erciyes Universitesi Atatürk Sağlik Yüksek Okulu, Kayseri, Turkey.
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Persaud RAP, Awad Z, Trinidade A, Kalan A. Use of systemic prophylactic antibiotics with anterior nasal packing in England, UK. Clin Otolaryngol 2007; 32:399; author reply 399-400. [PMID: 17883566 DOI: 10.1111/j.1749-4486.2007.01457.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Li YC, Zhang L, Li GH, Li DK, Li C. [Establishment of artificial airway with a thermal-softened nasotracheal tube guided by fiberoptic bronchoscope]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2007; 19:549-51. [PMID: 17767826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To assess superiority and safety of nasotracheal intubation with a thermal-softened tube guided by fiberoptic bronchoscope to establish an artificial airway for the institution of mechanical ventilation. METHODS A total of 209 patients were randomly allocated to two groups: "treated tube" group (52 centigrade treated tube group, n=105), common tube group (the tube was prepared at room temperature 23-26 centigrade, n=104). Nasotracheal intubation was guided by a fiberoptic bronchoscope to establish an artificial airway. RESULTS (1)The required time of the first successful nasotracheal intubation in the "treated tube" group [(14.48+/-8.31) seconds, 99 cases] was significantly shorter than in the common tube group [(23.85+/-11.97) seconds, 96 cases, P<0.01]. (2)Ratio of successful intubation in the "treated tube" group under conscious condition was higher than that of the common tube group [100% (28/28 cases) vs. 87.5% (21/24 cases), P<0.05]. (3) Ratio of successful intubation in 30 seconds in the "treated tube" group was significantly higher than that of the common tube group [93.9% (93/99 cases) vs. 68.6% (66/96 cases), P<0.01]. (4)The incidence of difficult intubation in the "treated tube" group [5.05% (5/99 cases)] was significantly lower than that of the common tube group [32.29%, (31/96 cases), P<0.01]. (5)The incidence of epistaxis in the first successful nasotracheal intubation in the "treated tube" group [4.0% (4/99 cases)] was significantly lower than that of the common tube group [15.6%,(15/96 cases), P<0.01]. (6)The incidence of epistaxis during nasotracheal intubation in conscious patients was lower in the "treated tube" (3.6%, 1/28 cases) group than that of the common tube group [28.6%, (6/21 cases), P<0.05]. CONCLUSION The use of a thermal-softened nasotracheal tube to intubate guided by a fiberoptic bronchoscope to establish an artificial airway shortened preparation time before intubation. It is not necessary to use a vasoconstrictor for nasal mucosa before intubation, therefore cardiovascular effects due to the drugs can be avoided. It increases the willingness of conscious patients to accept the procedure and successful rate of the first intubation.
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Affiliation(s)
- Yue-Chuan Li
- Department of Pulmonary, Tianjin Chest Hospital, Tianjin, China.
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Watt S, Pickhardt D, Lerman J, Armstrong J, Creighton PR, Feldman L. Telescoping tracheal tubes into catheters minimizes epistaxis during nasotracheal intubation in children. Anesthesiology 2007; 106:238-42. [PMID: 17264716 DOI: 10.1097/00000542-200702000-00010] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters. METHODS Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted. RESULTS The demographics of the three groups were similar. The estimated median area of the gauze in the catheter group that was covered with blood (0%) was significantly less than the areas in the control (40%) and warm (20%) groups. The incidence of clinically relevant bleeding (>or= 40% of the gauze area covered in blood) in the catheter group (5%) was significantly less than in the control (56%) and warm (39%) groups. The incidence of no detectable blood in the catheter group (59%) was significantly greater than in the control (21%) and warm (26%) groups. CONCLUSIONS Telescoping the endotracheal tube into a catheter significantly reduces epistaxis in children undergoing nasotracheal intubation.
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Affiliation(s)
- Stacey Watt
- Department of Anesthesia, Buffalo General Hospital, SUNY at Buffalo, USA
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Palomeque JCG, Ruiz HG. Efficacy of polidocanol in teleangiectasic vascular alterations in Rendu-Osler's disease. Clin Exp Pharmacol Physiol 2007; 34:254. [PMID: 17250648 DOI: 10.1111/j.1440-1681.2007.04525.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abdelkader M, Leong SC, White PS. Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol 2007; 121:759-62. [PMID: 17201991 DOI: 10.1017/s0022215106003379] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/14/2006] [Indexed: 11/06/2022]
Abstract
AbstractThe aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.
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Affiliation(s)
- M Abdelkader
- Department of Otolaryngology, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
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Whitehead DEJ. Nasal catheter insertion for suction diathermy adenoidectomy: tip profile. Clin Otolaryngol 2006; 31:457-8; author reply 458. [PMID: 17014463 DOI: 10.1111/j.1749-4486.2006.01296.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morimoto Y, Sugimura M, Hirose Y, Taki K, Niwa H. Nasotracheal intubation under curve-tipped suction catheter guidance reduces epistaxis. Can J Anaesth 2006; 53:295-8. [PMID: 16527796 DOI: 10.1007/bf03022218] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Nasotracheal intubation (NTI) has greater potential for trauma of nasopharyngeal mucosa than orotracheal intubation. The present study investigated the success rate of NTI and frequency of nasal bleeding using a curve-tipped suction catheter (CTSC) to guide nasotracheal tube advancement. METHODS Subjects comprised 131 adult patients who under-went NTI. Subjects were randomly divided into two groups: a) NTI under CTSC guidance (G[+] group). The CTSC (14 Fr) was first inserted through the tracheal tube, with the tip of the CTSC emerging from the distal end of the tube. The curved tip was directed ventrally. Both tracheal tube and CTSC were advanced together through the nasopharynx; b) NTI without CTSC guidance (G[-] group). The tracheal tube was advanced into the nasal cavity and passed into the pharynx without CTSC guidance. The time required to pass the endotracheal tube through the nasal cavity (nasal passage time), success rate of nasal passage with nasotracheal tube, and the incidence and severity of nasal bleeding were compared. RESULTS Success rate for nasal passage was 100% in the G(+) group (62/62) and 82.6% in the G(-) group (57/69; P = 0.0006). Frequency of nasal bleeding was significantly lower in the G(+) group (21/62, 33.9%) than in the G(-) group (37/69, 53.6%; P = 0.023). Severity of nasal bleeding was also significantly lower in the G(+) group than in the G(-) group (P = 0.030). CONCLUSIONS Nasotracheal intubation under CTSC guidance increases the success rate of airway instrumentation, and also reduces the incidence and severity of epistaxis.
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Affiliation(s)
- Yoshinari Morimoto
- Department of Dental Anesthesiology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka 565-0871, Japan.
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