Selective embolization in the treatment of intractable epistaxis.

CONCLUSIONS: In skilled hands, selective embolization is a safe procedure and represents an effective treatment for prolonged epistaxis. Embolization therapy can be repeated if necessary. OBJECTIVE: Severe posterior epistaxis is a common clinical problem in an ENT department and controlling the bleeding may present difficulties. Several methods are used to control posterior epistaxis, one of the latest treatment strategies being selective embolization of the nasal arteries. The aim of this study was to describe the effect of selective embolization in 22 patients treated with a total of 30 procedures at the ENT Department of Odense University Hospital between January 1995 and March 2004. To our knowledge this is the first Nordic work in which selective embolization has been used as a treatment strategy for patients with hereditary hemorrhagic telangiectasia (HHT). MATERIAL AND METHODS: This was a retrospective review. Post-treatment effects and complications were evaluated by means of a questionnaire and a telephone interview. Owing to the different treatment strategies used, the results were evaluated for 2 groups of patients: Group A, 9 patients with HHT; and Group B, 13 patients with causes of epistaxis other than HHT. RESULTS: In Group A, 15 procedures were performed, 12 of which were beneficial as the duration and number of episodes of epistaxis were reduced. In Group B, 15 procedures were performed and the success rate was 87%. One patient suffered from skin necrosis at the tip of the nose. No other serious side-effects of the treatment were observed.

[Diagnosis and treatment of cerebral venous sinus thrombosis]. / Diagnose og behandling af cerebral venøs sinustrombose.

Thrombosis of the cerebral sinuses most often affects younger adults. Headache is a common complaint and can be accom­panied by vomiting and papilloedema. The diagnosis rests on magnetic resonance imaging and the treatment consists of heparin or low-molecular weight heparin followed by vitamin K antagonists for three months or more. In fulminant cases local thrombolysis is administered, while symptomatic treatment for increased intracranial pressure is given. In retrospective analyses this approach has been associated with a good outcome ­ even in cases treated by decompressive craniectomy.

[Diagnosis and treatment of cerebral venous sinus thrombosis]. / Diagnose og behandling af cerebral venøs sinustrombose.

Thrombosis of the cerebral sinuses most often affects younger adults. Headache is a common complaint and can be accompanied by vomiting and papilloedema. The diagnosis rests on magnetic resonance imaging and the treatment consists of heparin or low-molecular weight heparin followed by vitamin K antagonists for three months or more. In fulminant cases local thrombolysis is administered, while symptomatic treatment for increased intracranial pressure is given. In retrospective analyses this approach has been associated with a good outcome - even in cases treated by decompressive craniectomy.

Admission criteria to the Danish Brain Cancer Program are moderately associated with magnetic resonance imaging findings.

INTRODUCTION: The objective of this study was to evaluate the Danish Brain Cancer Program by examining the criteria for admission to the program and the results of magnetic resonance imaging (MRI) of the brain in 359 patients referred to the program at the Odense University Hospital during one year. The admission criteria given by the Danish Health and Medicines Authority are as follows: 1. Prior computed tomography or MRI indicating tumour. 2. Progressive focal neurological deficits. 3. Epileptic seizure in adults. 4. Change in behaviour or cognition showing progression. 5. Headache with progression over 3-4 weeks. MATERIAL AND METHODS: This was a retrospective analysis of the cerebral MRI of 359 patients. The patients were categorized by admission criteria and MRI outcome. The findings were grouped into four main outcomes: 1. Primary malignant intracerebral tumour. 2. Intracranial tumour -(including meningeoma and metastasis). 3. Acute pathology in total (including tumours and other acute pathologies). 4. Findings of no consequence. RESULTS: We found 46 acute/subacute pathologies including 21 tumours of which eight were primary intracerebral malignant tumours and 313 scans did not have findings of any consequence. In the group with monosymptomatic headache, we found significantly fewer tumours (p = 0.0066, Fisher's exact test) and acute pathologies (p = 0.0008) than in the remaining groups. In the group with change in behaviour or cognition, we found significantly more primary intracerebral malignant tumours (p = 0.0002), tumours in all (p = 0.0001) and acute pathologies (p = 0.0002) than in the other groups. CONCLUSION: Fewer tumours than expected were found. Significantly fewer pathologies were found in the group with monosymptomatic headache than in the remaining groups. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[Local thrombolysis of sinus thrombosis]. / Lokal trombolyse af sinustrombose.

A 16-year-old girl was diagnosed with widely distributed dural sinus thrombosis (DST) and a haemorrhagic infarct in the left parietal lobe. Despite of heparin treatment, pronounced aggravation of symptoms was observed. Through a femoral vein approach a micro-catheter was advanced into the superior sagittal sinus and rt-PA was infused slowly, directly into the thrombus over 24 hours. A follow up angiogram showed recanalisation of sinus. The patient recovered almost completely, with only few remaining cognitive symptoms. This treatment remains experimental, but should be kept in mind for DST-patients unresponsive to heparin treatment.

[Diagnosis and treatment of subarachnoid hemorrhage]. / Diagnostik og behandling ved subaraknoidalblødning.

The rupture of an intracranial aneurysm causing subarachnoid hemorrhage (SAH) has an incidence of 10 per 100,000 in Denmark. The diagnosis is confirmed on CT-scan which shows blood in the subarachnoid space. Formerly, rebleeding was prevented by surgical application of clips. However, at present endovascular embolisation with coils has become the standard treatment. The endovascular methods have improved so much during the last 10 years that some 90% of all aneurysms can currently be secured by using endovascular methods. Vasospasms which are often a most serious complication to SAH can be treated effectively with endovascular methods.

[Juvenile angiofibroma]. / Juvenile angiofibromer.

Juvenile angiofibroma is a rare, benign, rich vascular tumor, and approximately one new case is diagnosed in Denmark each year. It sits in the foramen sphenopalatinum and occurs in boys from 14 to 25 years of age. The most frequent initial symptoms are nasal obstruction and epistaxis. Through the years, the treatment of juvenile angiofibroma has included many methods, including surgical excision, electrocoagulation, interstitial or external radiation therapy, cryosurgery, hormone administration and chemotherapy. Radiation, chemotherapy and surgery have proven to be the most effective treatments. The most serious complication has been preoperative bleeding, but since the introduction of preoperative particle embolization the blood loss has been greatly reduced. Today, surgery preceded by embolization is the primary standard treatment. It is important to diagnose the tumor early, when radical surgery is easier and the frequency of recurrence is lower.

[Treatment of juvenile angiofibroma with particle embolization and endoscopic surgery]. / Behandling af juvenile angiofibromer med partikelembolisering og endoskopisk kirurgi.

INTRODUCTION: Juvenile angiofibroma is a benign, rich vascular nasal tumor, and the biggest complication in surgery is the great loss of blood. Since 1997, Odense University Hospital (OUH) has used preoperative particle embolization and endoscopic surgery to combat this problem. MATERIALS AND METHODS: A retrospective review of the eight patients who have been treated since 1997 was done. The embolization, which was carried out in the radiotherapy department, was done with polyvinyl alcohol particles in the vessels that supply the tumor. The operation was then performed in the ear, nose and throat department of OUH. The tumor was removed endoscopically in all cases in which it was possible. RESULTS: All eight patients were embolized preoperatively. The average preoperative bleeding was 375 ml, a little less when endoscopic access was possible. This is in agreement with the literature and may be considered to be satisfactory. DISCUSSION: Endovascular embolization of juvenile angiofibromas followed by endoscopic surgery is considered to be the preferred treatment method today.