ABSTRACT
An expectant, nontreatment strategy for acoustic neuromas implies an understanding of the natural biologic behavior of these tumors. This study describes the long-term follow-up of a group of unoperated acoustic neuroma patients. Patterns of tumor growth are discussed in light of clinical outcome. Patient selection and a follow-up protocol are recommended for those individuals in whom a nontreatment strategy is contemplated.
Subject(s)
Neuroma, Acoustic/history , History, 20th Century , Humans , Neuroma, Acoustic/pathology , Neuroma, Acoustic/therapySubject(s)
Aneurysm, Ruptured/complications , Aortic Aneurysm, Thoracic/complications , Deglutition Disorders/etiology , Laryngeal Edema/etiology , Aged, 80 and over , Aneurysm, Ruptured/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Deglutition Disorders/diagnosis , Disease Progression , Emergency Service, Hospital , Fatal Outcome , Female , Hemorrhage/complications , Hemorrhage/diagnosis , Humans , Laryngeal Edema/diagnosis , Laryngoscopy/methods , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed/methodsABSTRACT
The case of a 63-year-old woman who presented to the emergency department with epistaxis and haemodynamic instability is reported. Subsequent investigation showed renal failure and multiple pulmonary nodules. A positive proteinase 3 antineutrophil cytoplasmic antibody test supported the diagnosis of fulminant Wegener's granulomatosis, requiring urgent dialysis, plasma exchange and immunosuppression. This is the first report in the emergency literature of Wegener's granulomatosis presenting as acute epistaxis. Emergency physicians should consider Wegener's granulomatosis in patients with atypical epistaxis. In patients presenting with clinically severe, active disease early proteinase 3 antineutrophil cytoplasmic antibody testing is recommended.
