Epistaxis Research Articles

Efficacy and safety of supraglottic jet oxygenation and ventilation to minimize sedation-related hypoxemia: a meta-analysis with GRADE approach.

Hypoxemia is a common complication of sedation. This meta-analysis aimed to evaluate the efficacy and safety of supraglottic jet oxygenation and ventilation (SJOV) in preventing hypoxemia during sedative procedures. Randomized controlled trials (RCTs) that compared SJOV with conventional oxygen therapy in sedated patients were searched in five databases (MEDLINE, EMBASE, Cochrane Library, China National Knowledge Infrastructure [CNKI], and Google Scholar) from their inception to March 2024. The primary outcome was the proportion of patients who developed hypoxia (SpO2 < 90%). The secondary outcomes included subclinical respiratory depression (90% ≤ SpO2 < 95%), severe hypoxemia (SpO2 < 75%), airway interventions, adverse events, hemodynamics, propofol dosage, and procedure time. The certainty of evidence was determined using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twelve trials (n = 3058) were included in the analysis. The evidence suggests that SJOV results in a large reduction in the risk of hypoxemia (risk ratio [RR], 0.26; 95% confidence interval, 0.19-0.36; low certainty) and subclinical respiratory depression (RR, 0.40; low certainty) compared with the control. SJOV likely resulted in a large reduction in the risk of severe hypoxemia (RR, 0.22; moderate certainty). In addition, it may result in a large reduction in the need for jaw lift (RR, 0.22; low certainty) and mask ventilation (RR, 0.13; low certainty). The risk of sore throat probably increases with SJOV (RR, 1.71; moderate certainty), whereas SJOV may result in little to no difference in nasal bleeding (RR, 1.75; low certainty). Evidence is very uncertain regarding the effect of SJOV on hemodynamics (very low certainty) and procedure time (very low certainty). SJOV probably resulted in little to no difference in sedative doses between the groups (moderate certainty). According to the GRADE approach, SJOV likely results in a large reduction in the risk of severe hypoxemia but probably increases the risk of sore throat. Compared with the control, evidence suggests that SJOV results in a large reduction in the risk of hypoxemia, subclinical respiratory depression, and the need for airway manipulation, with little to no difference in nasal bleeding. The integration of SJOV into clinical practice may help minimize hypoxemic events in at-risk patients.

Microbiological comparison of the disinfecting efficacy of small and large cotton swabs in nasotracheal intubation: a randomized trial.

Nasotracheal intubation (NTI) is necessary during surgeries requiring clear access to the surgical field and in patients with respiratory issues. This study investigates the pre-NTI nasal disinfection efficacy of different cotton swab sizes, hypothesizing that smaller swabs could minimize bleeding while maintaining disinfection efficacy. Patients classified as American Society of Anesthesiologists-physical status (ASA-PS) class 1 or 2 scheduled for general anesthesia with NTI were randomly assigned to either a large cotton swabs (LCS) or fine cotton swabs (FCS) group in this randomized controlled trial (RCT)." After anesthesia, a fine cotton swab was inserted into the inferior nasal meatus in both groups to collect bacteria (sample A). Next, the nasal cavity was disinfected with LCS or FCS according to the patient group. Bacteria were collected by inserting a fine cotton swab into the inferior nasal meatus (sample B). After surgery, bacteria were collected from the endotracheal tube tip using a fine cotton swab in both groups (sample C). The samples were cultured for 24 hours, and the colonies from samples A-C were counted. The changes in bacteria count between samples A and B and samples A and C were determined. Nasal bleeding from cotton swab insertion was assessed as a secondary outcome. Student's t-tests, a chi-square independence test, and Mann-Whitney U tests were used for the statistical analysis. The statistical significance level was set at p < 0.05. Between samples A and B, the change in bacteria count was 7.2% (1.4-26.1%) (median[interquartile range]) in the LCS group and 6.9% (0.9-22%) in the FCS group (p = 0.90). Between samples A and C, the change in bacteria count was 7.5% (0.2-44%) in the LCS group and 8.3% (0.3-39%) in the FCS group (p = 0.55). We examined 62 subjects in each group (LCS and FCS), and samples A, B, and C were collected from all participants in both groups. Nasal bleeding occurred in 42/62 in the LCS group and 22/62 in the FCS group (p < 0.01). Cotton swab thickness did not impact disinfection efficacy, but large swabs increased the risk of nasal bleeding. We recommend FCS for nasal disinfection prior to NTI in ASA 1-2 patients, as they reduce bleeding risk without compromising disinfection. UMIN-CTR (registration no. UMIN000051495), June 30, 2023.

The Packed Epistaxis Patient: Risks of Rebleeding? A Pilot Study to Inform Outpatient Management of Packed Patients.

Current common practice for patients with idiopathic epistaxis which requires nasal packing is to admit as an in-patient for overnight observation. Anecdotally, many patients do not re-bleed, so admissions may be unnecessary. Several factors have been suggested to be associated with an increased risk of re-bleeding, such as hypertension, anticoagulant use, and male gender. We set out to investigate these factors, to create a local guideline to identify patients who may be safe to discharge with a pack in situ. We collected the data on the most recent admissions in our department, who each received a non-absorbable nasal pack for idiopathic epistaxis (n = 100). Data points included age, gender, anticoagulation status, and comorbidities. Data from 100 patients were audited. Of those, 13 were found to have re-bled through their packing (13%). Statistically significant predictors of re-bleed were as follows: Male sex (OR = 9.81, P = .048, 95% CI 1.02-94.11), aspirin use (OR = 8.11, P = .047, 95% CI = 1.03-63.79), hypertension (OR = 8.14, P = .040, 95% CI = 1.10-60.26), and age (OR = 0.93, P = .018 95% CI = 0.88-0.99). Re-bleed in patients managed with non-absorbable packing for idiopathic epistaxis is uncommon. Risk factors may include male sex, hypertension, and aspirin use. ENT departments nationally may consider discharging patients' home with pack in situ, for removal as an outpatient, in the absence of these risk factors.

Post Operative Outcome of Conventional Dacryocystorhinostomy with Mitomycin C and Without Mitomycin C

Background: Dacryocystitis is an inflammatory condition of the lacrimal sac, typically caused by obstruction of the nasolacrimal duct. The purpose of the study compares the results of intra operative Mitomycin C application in DCR surgery compared to external DCR without Mitomycin C. Materials and methods: This was randomized control trial. A total of 80 patients of primary acquired nasolacrimal duct obstruction were divided into 2 groups on the basis of simple random sampling. Group-1 contained 40 patients who received 0.02% solution of MMC at the osteotomy site during surgery and considered as the study group and group-2 contained another 40 patients who did not get MMC during surgery and considered as the control group. Patients were followed on 1st post-operative day, 1st week, 1-, 3-, 6- &amp; 12-months interval. Patency of lacrimal passage was assessed by lacrimal syringing and patient’s symptoms were recorded on each follow up. Results: Data shows that there was statistically significant difference in the study showed 39 (97.50%) patients with patent lacrimal passage, only 1 (2.50%) patient was found blocked in their lacrimal drainage system in 1, 3, 6 Months and finally 1 year follow up time. On the other hand in control, 34 (85%) patients showed patency of the drainage system after 1 year and 6 (15%) patients showed blockage and this results was maintained up to 1 year follow up after treatment. During the follow up period, no complications such as abnormal nasal bleeding, mucosal necrosis or infection were noted in any patients. Conclusion: Distinctly higher success rates were achieved in patients undergoing DCR with intra operative MMC as compared to those undergoing external DCR. IAHS Medical Journal Vol 7(1), June 2024; 22-25

Prospective Comparison of Conventional External Dacryocystorhinostomy and Endonasal Laser Dacryocystorhinostomy

Background:Epiphora, a common manifestation of chronic dacryocystitis, requires definitive treatment through dacryocystorhinostomy (DCR), a surgical procedure aimed at creating an alternative fluid drainage pathway.This study aimed to assess how effective both external dacryocystorhinostomy (Ex-DCR) and endonasal dacryocystorhinostomy (Endo-DCR) are in managing chronic dacryocystitis, with a specific focus on surgical duration, complication rates, and treatment outcomes. Methods: In this study, sixty participants were prospectively enrolled and evenly divided into two groups. Thirty patients were assigned to the first group and underwent En-DCR surgery, while the second group, also comprising thirty patients, underwent Ex-DCR surgery. Both groups were monitored for a duration of 9 months and assessed for surgical duration, perioperative and postoperative complications, and eventual surgical outcomes. Results: The distribution of patients across age groups and sexes was similar between the two groups (p&gt;0.05). Clinical features such as epiphora, epiphora with discharge, and epiphora with swelling were comparable between groups. En-DCR group demonstrated significantly less intraoperative bleeding (mean:13.5 ml vs 50 ml; p&lt;0.0001) and shorter operative durations (mean: 20 mins vs 37.5 mins; p&lt;0.0001) compared to Ex-DCR group. Complications such as nasal bleeding and hematoma were minimal in both groups, with no significant differences noted. The final outcome, categorized as success (En-DCR vs Ex-DCR: 76.7% vs 83.3%) or failure (23.3% vs 16.7%), did not show a statistically significant difference between the two groups (p&gt;0.05). Conclusion:Both surgical techniques offer feasible alternatives for addressing issues related to nasolacrimal obstruction. J Bangladesh Coll Phys Surg 2024; 42: 355-362

Unnoticed freshwater leech as a hidden cause for recurring epistaxis: a case series and review of literature conducted at Tertiary Care Hospital Sikkim, North East India

BackgroundWhile leeches as intranasal foreign bodies are not frequently encountered, they can be one of the causes of epistaxis. The aim of the study is to raise awareness among healthcare professionals about the possibility of patients from leech endemic regions presenting with epistaxis.Case presentationWe present a series of epistaxis cases due to intranasal leech infestation. In our series of 10 cases, there were 7 male and 3 female patients, aged between 2 and 53 years old. The duration of the complaint ranged from 1 to 5 weeks. All patients experienced with blood-stain nasal discharge or frank nasal bleeding at some point and most of them have a history of leech infestation from spring water as a local source. This article presents our approach to managing nasal leech infestation as epistaxis and outlines the precautionary measures taken for the retrieval of this living foreign body.ConclusionDetails of the history must be taken before concluding the diagnosis. Maintain a high index of suspicion of leech infestation as a hidden cause of epistaxis especially in patients coming from endemic areas.

A diagnostic journey: Unraveling von Willebrand disease in a child with inconclusive initial testing

Background: Epistaxis attacks in childhood are an important reason for pediatric emergency visits, most of which are minor and infrequent. However, recurrent epistaxis can be a sign of an underlying bleeding disorder such as von Willebrand disease. This case report highlights controversies and obstacles that may arise during the diagnostic process, hindering a clear confirmation. Case presentation: An eight-year-old boy, who had a history of recurrent epistaxis and easy bruising since infancy, was presented to the Pediatric Emergency Department of Al Khor Hospital for a repeat episode of nosebleed. Local examination showed dilated capillaries in addition to nasal bleeding signs. Family history revealed similar past complaints in both his brother and his father. Previous epistaxis attacks were mostly left-sided. Blood workups were not diagnostic. Later, repeated blood tests led by high clinical suspicion resulted in the diagnosis of von Willebrand disease. The new diagnosis had a direct effect on the patient’s bleeding management. Nose bleeds peaked in frequency and severity over the next two years and decreased remarkably thereafter, the same pattern as before in the father and older brother. Discussion: The heterogeneous nature of von Willebrand disease, overlapping with the healthy population, creates a diagnostic dilemma. Therefore, balanced diagnostic approach is crucial. Bleeding history and family history provide invaluable clues but are not definitive. The blood workups may struggle with the variations in function and fluctuating levels of the von Willebrand factor molecule. Although genetic testing is helpful in some cases, it has its limitations. Conclusion: The diagnosis of von Willebrand’s disease generally follows the traditional approach. It begins with a detailed bleeding history combined with a focused family history that pinpoints potential cases, followed by blood testing. However, interpretation of blood workups can be challenging due to the patient-to-patient and within-patient variability of the disease, the wide panel of investigations, and the different cutoff levels in different guidelines. Despite all this, testing is irreplaceable. Management of bleeding should begin immediately and should not be affected by inconclusive blood workups.

Comprehensive review on ethnomedicinal, phytochemistry and pharmacological profile of.

Ficus religiosa L. (F. religiosa) or sacred fig is a large perennial tree belonging to the family Moraceae or mulberry family. Though the tree has pan-tropical distribution but originally it is indigenous to the Indian subcontinent and Indochina region. Popularly the tree is named "Pepal or bodhi tree". Traditionally, it is practiced for the treatment of asthma, nose bleeding, heart disorders, diabetes, wound healing, ear problems, constipation, hyperlipidemia, gonorrhea, ulcers and infectious disorders. Chemical analysis demonstrated the presence of numerous bioactives including tannins, phenols, saponins, sugars, alkaloids, methionine, terpenoids, flavonoids, glycosides, proteins, separated amino acids, essential and volatile oils and steroids etc., which are probably responsible for its diverse pharmacological actions. The present work is an attempt to compile up-to-date comprehensive information on F. religiosa that covers its taxonomy, ethnomedicinal importance, phytochemistry, pharmacological attributes and clinical trials. Keeping in mind the various health attributes of F. religiosa, future research can be aimed at in-depth elucidation of the structure-function relationship and multifactorial signalings pathways.

Prospective Study on Coblation Vs. Cautery in Endoscopic Trans Sphenoidal Surgery for Pituitary Macroadenoma: Impact on Nasal Function.

Endoscopic endonasal Trans-sphenoidal surgery for sellar-suprasellar tumors is considered the preferred route. The ideal instruments in skull base surgery should be able to manipulate adequately through the narrow corridors with effective tissue removal and bleeding control and reduce collateral damage to nearby vital structures. The present study sought to compare the nasal morbidity following transnasal sphenoidal surgery for pituitary macroadenoma using Coblation and Electrocautery. 160 undergoing Endoscopic TSS for non-functioning PAs were enrolled. The patients were randomly allocated into Coblation (n = 80) and electrocautery (n = 80) groups. All operations were performed by the same group of surgeons skilled in their surgical techniques. There were 59 and 53 patients with Knosp grade II tumors in the cautery and coblation group, respectively, while 21 and 27 patients had Knosp grade III tumors. The average duration of surgery using cautery was 96+/-4.5min, while with coblation, the average time was 83+/-3.5min, and the difference was statistically significant. Nasal crusting and granulation severity were observed more in the electrocautery group. The coblation group patients had clear surgical fields with few ooze points; the difference between the two groups was significant. Nasal synechiae and decreased nasal patency were common in the electrocautery group. There were no statistical differences in nasal bleeding, nasal deformity, or sense of smell parameters. Advanced medical tools like coblation are safe and effective for the dissection and ablation of the mucosa. They result in better intra-operative visualization and lesser postoperative nasal morbidity, which will help patients achieve a better quality of life.

Clinical Outcomes of Left Ventricular Assist Device Bleeding Complication.

Bleeding complications have emerged as major causes of morbidity and mortality in patients with implantable left ventricular assist devices (LVAD). We hypothesized that the hemodynamics after LVAD implantation may influence the occurrence of bleeding complications after LVAD implantation. We retrospectively evaluated 78 patients who underwent continuous-flow LVAD implantation and hemodynamic ramp test after LVAD implantation between July 2017 and July 2023 at Osaka University. The bleeding complication occurred in 13 patients. The rates of freedom from bleeding complications at 1, 3, and 5 years were 94%, 85%, and 74%. Gastrointestinal bleeding, nose bleeding, and intraperitoneal hemorrhage occurred in six, three, and two patients, respectively. Preoperative average brachial-ankle pulse wave velocity (baPWV) was positively associated with bleeding complication (1,276 ± 280 vs. 1,098 ± 190 cm/s p = 0.04). In the hemodynamic ramp test, systemic vascular resistance (SVR) in patients with bleeding complications was higher than that in patients without bleeding complications (SVR: 1,359 ± 341 vs. 1,150 ± 217 dyne sec/cm5, p = 0.01). High preoperative baPWV and high SVR in the hemodynamic ramp test were significantly associated with bleeding complications after LVAD implantation. Arteriosclerosis is a risk factor for bleeding complications after LVAD implantation.

Safety and effectiveness of a drug-loaded haemostatic sponge in chronic rhinosinusitis: a randomized, controlled, double-blind study

Some cases of chronic rhinosinusitis (CRS) require surgical treatment and postoperative nasal packing, but bleeding and adhesion are common complications after nasal surgery. Biodegradable drug-loaded implants hold great therapeutic options for the treatment of CRS, but little data are available regarding the safety and efficacy of a novel drug-loaded haemostatic sponge (DLHS) in the sinus. The aim of this study was to investigate the safety and efficacy of DLHS in the sinus. We conducted a prospective, randomized, controlled, double-blind clinical trial. In this clinical trial, 49 patients were enrolled and randomly divided into 2 groups: group A (n = 25) had the DLHS containing 1 mg budesonide and 0.67 mg sodium hyaluronate placed into the sinus, and group B (n = 24) had the Nasopore placed after ESS. Endoscopic follow-up was performed for 12 weeks, and the findings were classified using the discharge, inflammation, polyps/oedema (DIP) endoscopic appearance scores. All patients completed questionnaires to evaluate their sinonasal symptoms by using the sinonasal outcome test-22 (SNOT-22) Chinese version and visual analogue scale (VAS). Serum cortisol concentration in group A was measured prior to surgery and at days 1, 3, 7, and 14 after nasal surgery. Comparing group A and group B, at 2 weeks, no significant differences were observed in either objective or subjective parameters. The mean value of VAS for rhinorrhoea and DIP for oedema and the mean value of nasal adhesion were significantly lower in Group A than in Group B at 6 and 12 weeks, but a significant difference did not occur in SNOT-22 and VAS for dysosmia between the two groups at 6 and 12 weeks. The mean serum cortisol concentrations in group A at the follow-up were within normal limits without remarkable fluctuations. This study demonstrates the safety and efficacy of a novel biodegradable DLHS with the possibility of being used in CRS patients, and this sponge may reduce inflammation and minimize adhesions via controlled local drug delivery without measurable systemic exposure.

Nasal hemorrhage - risk factors and management in 707 outpatient and inpatient patients

Epistaxis is one of the most common emergencies in otorhinolaryngology. The spectrum ranges from mild, self-limiting cases to life-threatening hemorrhages. Depending on the severity and course of the condition, management can be either outpatient or involve inpatient monitoring, possibly with surgical treatment.A retrospective systematic evaluation was conducted on all outpatient and inpatient patient data diagnosed with epistaxis from January to December 2021. Epistaxis associated with tumors, trauma, and postoperative epistaxis were excluded.A total of 707 patients were included. Seasonally, the highest number of patients presented in January. Outpatient management was possible for 80.8% of the cases, while 19.2% required inpatient admission. Among the inpatients, 15.4% required surgical intervention. Within the entire study cohort, 61.1% of the patients were male. Among the inpatients who underwent surgical treatment, the proportion of male patients was even higher (81.0%). The majority (73.1%) of the inpatients were on at least one anticoagulant medication. Advanced age (p=0.044) and the presence of posterior epistaxis (p<0.001) were significantly associated with the need for inpatient treatment. No children required inpatient care.Epistaxis is a common condition in otorhinolaryngology, predominantly affecting older male patients and those on anticoagulant therapy in severe cases within the studied cohort. Surgical intervention under general anesthesia was infrequently necessary for the treatment of epistaxis in the overall study population (3%).

PVC membrane bulk optode incorporating 4-nitrobenzo-15-crown-5 and sodium tetrakis(1-imidazolyl) borate for the pico-molar determination of silver ion in pharmaceutical formulation

Silver ion (Ag+) is of harmful effects to both environment and human health. Ag+ soluble compounds and salts is used in treating mental illness, epilepsy, nicotine addiction, gastroenteritis, and infectious diseases, including syphilis and gonorrhea, and as anti-infective dermatological agent for controlling nose bleeding. However, high Ag+ doses cause several harmful effects to human health such as irreversible pigmentation of skin and eye, and problems to liver and kidney. A bulk membrane Optode is proposed in this work to measure the Ag+ concentration in the pharmaceutical formulations. The membrane optode is prepared from the ionophore 4-nitobenzo-15-crown-5, the ion-exchanger sodium tetrakis (imidazolyl) borate, the plasticizer o-nitrophenyl octyl ether, and the chromoionophore ETH 5294; these components are dissolved in the PVC/THF slurry to form the membrane. The optode is studied by atomic force microscope and UV–visible spectrophotometer, and its spectrum exhibits two maximum wavelengths of 550 and 665 nm, and response for Ag+ at these maximum wavelengths is reproducible in the concentration range of 10–11 to 10–8 M using acetate buffer of pH 5.0, with very low detection limit of 8.8 × 10–12 M. The most important feature in this work is the selectivity improvement for Ag+ over all interfering ions; the selectivity coefficient logarithm logKAg+,cationopt\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${logK}_{Ag+, cation}^{opt}$$\\end{document} is found to be − 4.3 for Cu2+, − 5.6 for Ni2+ and − 5.0 for Cd2+. The response mechanism is studied by FTIR, and it depends on ion-exchange of Ag+ and sodium imidazolyl borate, followed by the host–guest complexation between Ag+ and the crown ionophore, which is accompanied by concomitant deprotonation of the chromoionphore. The optode has a response time of 2–3 min within lifetime of 10 days with the same response. The optode can be applied successfully for Ag+ determination in the pharmaceutical formulation, PinkEye Relief® eye drop, which is used for treating inflammation, redness and water discharge of the eye; the high recovery and low standard deviation of the results using calibration curve method confirm the accuracy and precision of the proposed optode for its application in real samples.

Evaluation of sodium hyaluronate-based composite hydrogels for prevention of nasal adhesions.

During the healing process after intra-nasal surgery, the growth and repair of damaged tissues can result in the development of postoperative adhesions. Various techniques have been devised to minimize the occurrence of postoperative adhesions which include insertion of stents in the middle meatus, application of removable nasal packing, and utilizing biodegradable materials with antiadhesive properties. This study assesses the efficacy of two sodium hyaluronate (SH)-based freeze-dried hydrogel composites in preventing postoperative nasal adhesions, comparing them with commonly used biodegradable materials in nasal surgery. The freeze-dried hydrogels, sodium hyaluronate and collagen 1(SH-COL1) and sodium hyaluronate, carboxymethyl cellulose, and collagen 1 (SH-CMC-COL1), were evaluated for their ability to reduce bleeding time, promote wound healing, and minimize fibrous tissue formation. Results showed that SH-CMC-COL1 significantly reduced bleeding time compared to both biodegradable polyurethane foam and SH-COL1. Both SH-COL1 and SH-CMC-COL1 exhibited enhanced wound healing effects, as indicated by significantly greater wound size reduction after two weeks compared to the control. Histological analyses revealed significant differences in re-epithelialization and blood vessel count among all tested materials, suggesting variable initial wound tissue response. Although all treatment groups had more epithelial growth, with X-SCC having higher blood vessel count at 7 d post treatment, all treatment groups did not differ in all histomorphometric parameters by day 14. However, the long-term application of SH-COL1 demonstrated a notable advantage in reducing nasal adhesion formation compared to all other tested materials. This indicates the potential of SH-based hydrogels, particularly SH-COL1, in mitigating postoperative complications associated with nasal surgery. These findings underscore the versatility and efficacy of SH-based freeze-dried hydrogel composites for the management of short-term and long-term nasal bleeding with an anti-adhesion effect. Further research is warranted to optimize their clinical use, particularly in understanding the inflammatory factors influencing tissue adhesions and assessing material performance under conditions mimicking clinical settings. Such insights will be crucial for refining therapeutic approaches and optimizing biomaterial design, ultimately improving patient outcomes in nasal surgery.

A rare case of glanzmann thrombasthenia with concomitant factor VII deficiency.

Glanzmann thrombasthenia and clotting factor VII deficiency are rare autosomal recessive bleeding disorders. But the occurrence of both in the same person is an extremely rare phenomenon. Here, we present the case of a young female from Sindh, Pakistan that got diagnosed with Glanzmann thrombasthenia and concomitant moderate factor VII deficiency, a combination not previously reported in the country. The patient exhibited typical clinical manifestations including menorrhagia, nasal bleeds, and prolonged bleeding after minor injuries, compounded by a positive family history and consanguinity. Laboratory investigations revealed marked anemia, prolonged bleeding time, and abnormal platelet aggregation studies consistent with Glanzmann thrombasthenia. The identification of this rare combination relied on comprehensive clinical evaluation, emphasizing the importance of family history in suspected cases. Management involved platelet transfusions, tranexamic acid, and Factor VII replacement, resulting in clinical improvement.

Contraindications to tissue plasminogen activator thrombolysis for acute lower extremity ischemia.

Previous randomized prospective trials have demonstrated the effectiveness of transcatheter tissue plasminogen activator (tPA) thrombolysis in treating acute limb ischemia (ALI) compared to conventional surgery. These pivotal trials have also highlighted contraindications for these procedures. Given recent advancements in techniques and technology, our aim is to reassess the relevance of these contraindications in contemporary practice. A retrospective chart analysis was performed utilizing the inpatient medical records of consecutive individuals who underwent tPA treatment for acute limb ischemia (ALI) from September 2016 to April 2022. Inclusion criteria encompassed patients aged 18 and above displaying clinical symptoms and imaging evidence of ALI within 14 days. All patients received tPA with suction thrombectomy following the fast-track thrombolysis protocol. In cases where a persistent thrombus or stenosis was detected, catheter-directed thrombolysis was considered overnight, and patients underwent angiography and reassessment in the operating room subsequently. Patients were classified into two groups based on the STILE trial's established contraindications for endovascular treatment in acute limb ischemia (ALI). If a patient had any of these contraindications, they were placed in the contraindicated group. This resulted in 24 patients (32%) in the contraindicated group and 52 patients (68%) in the non-contraindicated group. No statistically significant demographic variations were observed between these groups. Contraindications in our study included uncontrolled hypertension (12/24, 50%), recent invasive procedures (7/27, 29%), history of cerebrovascular accident (CVA) within 6 months (3/24, 12%), and intracranial malformation/neoplasms (2/24, 8%). Three patients within the non-contraindicated group experienced bleeding complications: two with puncture site bleeds and one with nasal bleeding. In contrast, one patient in the contraindicated group had transient postoperative hematuria. There were no significant differences in bleeding complications observed between the two groups (p = .771). Additionally, no amputations were observed within our population. In light of our study results and advancements in endovascular therapies, we can now safely and efficiently treat patients who were previously considered contraindicated for such treatments. It is essential to individualize treatments and carefully balance the risks and benefits of endovascular versus open surgical revascularization for these patients. Additionally, we believe that the nearly 30-year-old guidelines for endovascular therapies need to be revisited and updated to align with modern technology.

Application of articaine in endoscopic endonasal dacryocystorhinostomy: a retrospective study.

To investigate the comparative effects of local anesthesia using lidocaine with adrenaline vs. articaine with adrenaline in endoscopic endonasal dacryocystorhinostomy (EN-DCR). This retrospective study included a total of 180 patients. These patients were categorized into two groups: the lidocaine group, which received 2% lidocaine (1:100,000 adrenaline), and the articaine group, which received 4% articaine (1:100,000 adrenaline) for local anesthesia. The study compared anesthesia efficacy, intraoperative pain levels, intraoperative bleeding, as well as differences in heart rate and blood pressure between the two groups. The articaine group demonstrated a significantly lower visual analog scale (VAS) pain score when compared to the lidocaine group, measuring at 4.4 ± 0.6 cm vs. 5.0 ± 1.0 cm, respectively (P < 0.0001). Additionally, the articaine group exhibited a higher anesthesia efficacy compared to the lidocaine group (89.0% vs. 76.6%, p = 0.0487). Notably, the articaine group experienced less nasal mucosal bleeding during the surgery in contrast to the lidocaine group (p = 0.004). However, there were no statistically significant differences in changes in blood pressure and heart rate between the two groups (p > 0.05). This study demonstrated that 4% articaine (1:100,000 adrenaline) has superior clinical effectiveness in comparison to 2% lidocaine (1:100,000 adrenaline) in EN-DCR.

Comparison of Short-term Outcomes Between Schneiderian Membrane Perforation and Non-perforation Patients after Simultaneous External Elevation and Implantation.

To compare short-term outcomes between membrane perforation and non-perforation patients after simultaneous external elevation with implantation. In this retrospective observational study, 60 maxillary posterior tooth-loss patients with an insufficient amount of residual bone for direct implantation were enrolled. All patients underwent simultaneous external elevation and implantation, and were divided into perforation and non-perforation groups according to the postoperative Schneiderian membrane status. Of the 60 patients, 30 cases (35 implants) were assigned to the membrane perforation group, and 30 (44 implants) were allocated to the non-perforation group. There were no statistically significant differences in baseline data (p>0.05). In the perforation group, the mean vertical bone gain (VBG) at 6 and 12 months was 6.02±2.14 mm and 5.37±2.22 mm, resp., compared to 6.78±2.59 mm and 6.42±2.64 mm in the non-perforation group, resp. (both p>0.05). Preoperative median Schneiderian membrane thickness (SMT) in the perforation group was 0.77 mm, which was statistically significantly thinner than the 1.24 mm measure in the non-perforation group (p< 0.05); however, there was no statistically significant difference between two groups at 12 months postoperatively (0.80 mm vs 1.25 mm, p>0.05). The marginal bone loss at 1 year after implant restoration in the perforation and non-perforation groups was 0.16±0.10 mm and 0.22±0.12 mm, resp. During postoperative follow-up, the implant survival rate was 100% in the two groups. The incidence of postoperative nasal bleeding in the perforation group was statistically significantly higher compared with that in the non-perforation group (50% vs 16.7%, p<0.05), whereas no statistically significant differences were observed in the incidence of facial swelling, intraoral bleeding, wound dehiscence and acute/chronic sinusitis between the two groups (p>0.05). Schneiderian membrane perforation after simultaneous external elevation and implantation do not adversely affect short-term clinical and radiographic outcomes.

Intelligent and biocompatible cellulose aerogels featured with high-elastic and fast-hemostatic for epistaxis and wound healing

Nasal tamponade is a commonly employed and highly effective treatment method for preventing nasal bleeding. However, the current nasal packing hemostatic materials exhibit some limitations, such as low hemostatic efficiency, the potential for causing secondary injury when removed from the nasal cavity, limited intelligence in their design, and an inability to promote the healing of nasal mucosa wounds. Herein, we report the fabrication of a smart cellulose aerogel through the covalent cross-linking of carboxymethyl cellulose (CMC) macromolecules, while incorporating one-dimensional cellulose nanofibers (CNF) and two-dimensional MXene as reinforcing network scaffolds and conductive fillers. The abundant hydrogen and ether bonds in aerogels make them possess high elasticity in both dry and wet states, which can be compressed 100 times at 90 % deformation with a stress loss of <10 % under water. The highly elastic aerogels can be filled into the narrow nasal passages, pressuring the capillaries and reducing the amount of bleeding. Moreover, the strong interface between aerogels and blood can promote red blood cell aggregation, platelet adhesion and activation, activate intrinsic coagulation pathway and accelerate blood coagulation, resulting in excellent hemostatic ability. Furthermore, the aerogels exhibit excellent hemocompatibility and cytocompatibility, making them suitable for wound healing and capable of fully healing wounds within 15 days. Notably, the presence of MXene causes the aerogels to form a conductive network when exposed to blood, enabling them to perform real-time hemostatic monitoring without removing the dressing. This innovative biomedical aerogel, prepared from natural materials, shows excellent potential for applications in rapid nasal hemostasis.

Solitary fibrous tumor of nasal cavity: A case report

Solitary fibrous tumor is fibroblastic tumor, located mostly in deep soft tissue as well as extrapulmonary sites. In the present case, a 27-year female presented with complain of bilateral nasal blockage (right &amp;#62;left) with history of nasal bleed. The CT scan report revealed p/o hypervascular nasal polyp and sinusitis. Patient underwent excision of granulomatous mass arising from lateral nasal wall in right nasal cavity. The pathological report stated nasal tumor with hemangiopericytoma like pattern with differential diagnosis of 1) Solitary fibrous tumor – right nasal cavity 2) Glomangiopericytoma; further Immunohistochemistry was positive for CD34 (membranous) and STAT6 (nuclear) which leads to final diagnosis of Solitary fibrous tumor – right nasal cavity. Histopathological characteristics serve as the primary criteria for differentiating this condition from other entities.