1/6. Recurrent haemoperitoneum in a mild von Willebrand's disease combined with a storage pool deficit.Haemoperitoneum secondary to haemorrhagic corpus luteum has been described in severe bleeding disorders such as afibrinogenaemia, type 3 von Willebrand's disease and patients under oral anticoagulation. We have studied one patient who presented three episodes of severe bleeding at ovulation, requiring surgery twice, with the diagnosis of mild von Willebrand's disease and mild storage pool deficiency. Mild von Willebrand's disease (associated with other thrombopathies or coagulopathies) should be considered in this pathology, although physicians would prefer to find a severe haemorrhagic disorder as the underlying condition in these cases.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Unusual paranasal sinus tumors in two patients with common nasal complaints.Common nasal complaints are managed by both the otolaryngologist and the primary care physician. We describe the cases of two patients with nasal obstruction who were referred to us for evaluation--one with severe headache and the other with profuse epistaxis. Their histories prior to referral included long-term, common rhinologic complaints of low-grade headache and mild epistaxis. Neither patient had been referred to us until their symptoms had become severe. Our examination revealed that both patients had rare paranasal sinus pathology. One patient had a fibroxanthoma of the frontal sinus, and the other had extramedullary hematopoiesis of the maxillary sinus. Fibroxanthoma of the frontal sinus is rare, and extramedullary hematopoiesis of the maxillary sinus has not been previously reported. These two unique cases serve as a reminder that long-term common rhinologic complaints can occasionally be a sign of life-threatening pathology and require a full evaluation by an otolaryngologist.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Management pitfalls in the use of embolization for the treatment of severe epistaxis.Angiographic embolization for the treatment of severe recurrent epistaxis was added to the traditional treatment options--nasal packing, cauterization, and surgical vessel ligation--in 1974. Since then, clinical experience has shown that this procedure is safe and effective. When epistaxis cannot be controlled with cautery, nasal packing is the most common next step. As such, it is often performed by emergency physicians and other clinicians who are not otolaryngologists. We report two cases in which intranasal neoplasms were obscured as a result of a significant distortion of the normal anatomy. This distortion was secondary to emergency-room treatment of severe epistaxis by repeated nasal packing followed by angiographic embolization. Pre-embolization angiographic studies and subsequent postembolization endoscopic evaluations did not reveal the presence of the occult neoplasms because of the presence of inflammation and edema after treatment. Clinicians should be aware that nasal packing and embolization can obscure the underlying source of epistaxis, and follow-up radiologic studies and endoscopic evaluations are essential to avoid delays in diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Hemotympanums secondary to spontaneous epistaxis.Three cases of hemotympanum that resulted from spontaneous, atraumatic epistaxis are presented. Hemotympanum is a well known physical finding associated with traumatic basilar skull fractures but has not been reported to follow spontaneous nose bleeds that have not been previously treated with nasal packing. A discussion of epistaxis and hemotympanum is presented, and their implication for emergency physicians is discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Fatal epistaxis in craniofacial trauma.Facial trauma often results in minor and infrequently results in major bleeding in the structures of the face. We have recently observed two patients who suffered fatal hemorrhages which could have been controlled using relatively simple measures. Treating physicians often overlook this serious and potentially life-threatening source of hemorrhage until the patient has been in shock for long periods of time and irreversible ischemic brain damage and renal failure have occurred. With careful attention to examination of the face and oropharynx, hemorrhage from these sites can be identified early and the appropriate measures taken to control epistaxis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Severe epistaxis from rhinosporidiosis: a case report.rhinosporidiosis is quite rare in thailand, but the actual incidence may be higher than the numbers reflect. This is thought to be due to misdiagnosis by physicians who are unfamiliar with this disease entity or physicians who found a case but did not describe its presence. The authors report a case in a 17 year old male with the lesion involving both nasal cavities, nasopharynx and left maxillary sinus presenting with severe epistaxis, which was treated by complete surgical removal with electric cauterization of its base. We warn physicians who face this problem to be aware of this disease entity.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |