A blind area of origins of epistaxis: technical or cognitive?

PURPOSE: To investigate common origins and features of anterior epistaxis. METHODS: Patients (168) with anterior nose bleed were studied from May to October 2013. Endoscopic examination with angled endoscope and then subsequent management (radiofrequency, selective packing,) was performed. RESULTS: Under thorough nasal endoscopy, anterior nasal bleeding origin was ranked in turn as follows: the anterior nasal septum (NS 83.3%), the small area of anterior lateral wall of nasal cavity corresponding to the nasal back (NB 7.1%), the anterior end of the inferior turbinate (IT 5.4%), and the nasal part of the nasal cavity roof (NR 4.2%). Arterial lesion and hypertension led to large instant quantity of bleeding; hypertension and negligible bleeding origin prolonged bleeding duration. Bleeding was successfully controlled with nasal endoscopy and radiofrequency or selective packing. CONCLUSIONS: The arterial bleeding small area of anterior lateral wall of nasal cavity corresponding to the nasal back and the nasal part of the nasal cavity roof accounted for more than 10% of anterior epistaxis and a thorough endoscopic examination should include these area with angled endoscope. Then radiofrequency and selective packing will sharply reduce the bleeding duration.

Extranodal sinonasal Rosai-Dorfman disease: a clinical study of 10 cases.

Sinonasal Rosai-Dorfman disease (S-RDD) is a rare form of RDD limited to the sinonasal cavity. Multipatient studies of Chinese S-RDD and documentation of its clinical spectrum are rare. This study aimed to identify the clinical profiles of Chinese S-RDD. Medical records of and tissue sections from 10 patients diagnosed with S-RDD between 2007 and 2014 were reviewed. Data on clinical presentations, endoscopy signs, imageological change, treatment and outcome were analyzed. The mean age of five male and five female patients at the first visit was 40.3 years and the mean follow-up period was 58.6 months. Based on the lesion sites, five cases were divided into an anterior sinonasal group, accompanied by symptoms of epistaxis, nasal obstruction and nasal dorsal deformity. Five other cases were divided into a posterior sinonasal group, accompanied by symptoms of hyposmia, epistaxis and nasal obstruction. Endoscopy signs and imageological changes in the anterior group showed diffuse infiltration of the RDD lesion under the septum mucosa, but in the posterior group the RDD lesions often showed as formations on polyps. At the end of follow-up, only one case spontaneously resolved without surgery; two cases in the anterior sinonasal group and three cases in the posterior sinonasal group recurred after endoscopic surgery, but surgery can result in short-term symptomatic control and restoration of function in all cases. S-RDD of the anterior and posterior sinonasal cavity may have different clinical characteristics; endoscopic surgery is effective for short-term symptomatic control and restoration of function for S-RDD.

[Study on correlation between HPV57 infection and the etiology of IP].

OBJECTIVE: To study correlation between HPV infection and the etiology of human papilloma and uncover the effects of HPV57 infection on IP, in order to provide a new way for IP precaution and treatment. METHOD: Sixty formalin-fixed, paraffin-embedded specimens of IP were definitely diagnosed by pathologists. They were examined by the polymerase chain reaction (PCR) technique to amplify HPV DNA with HPV L1 consensus primer and HPV57 type-specific primer. Ten specimens of chronic sinusitis were taken as control group. RESULT: All of the sixty IP specimens showed negative after amplification by HPV 1.1 consensus primer MY09/11. There were forty-seven specimens(47/60, 78.3%) showed positive for HPV type 57 after amplification by HPV57 type-specific primer. CONCLUSION: Our findings suggest a possible role for HPV type 57 in the pathogenesis of nasal inverted papilloma.

[Sorbalgon strips for nasal packing used in 2013 cases of endoscopic sinus surgery].

OBJECTIVE: To summarize the efficacy of Sorbalgon strips used in endoscopic sinus surgery (ESS), to explore a better nasal packing materials. METHOD: From Jan. 2000 to Apr. 2003., 2013 cases with Sorbalgon strips for nasal packing of nasal chronic sinusitis and polyps after endoscopic sinus surgery, and compared with packing of Aureomycin ointment gauze. The hemostasia effect and nasal cavity response were observed. RESULT: Sorbalgon strips had effectiveness at controlling hemorrhage in ESS. Comparing with aureomycin ointment gauze, Sorbalgon strips had less bleeding when being removed (P < 0.01), and the nasal cavity response was gentle (P < 0.01). The packing time with Sorbalgon strip was no more than 24 hour. No any adverse event was observed. CONCLUSION: Sorbalgon strips are a better nasal packing material used in ESS.

[The value of nasal endoscopy in the surgery of the nasal inverted papillomas].

OBJECTIVE: To investigate the value of nasal endoscopy in the surgery of the nasal inverted papillomas. METHOD: 29 patients with nasal inverted papilloma, 15 cases of them were applied nasal endoscopic surgery (nasal endoscopic surgery group), 14 cases were applied nasal lateral incision surgery(nasal lateral incision group), and compared the results of the two surgery. RESULT: Follow-up 1.8 years. COMPLICATIONS: nasal endoscopic surgery group(1 case) was obviously lower than nasal lateral incision group(5 cases), P < 0.01; The hospitalization time: nasal endoscopic surgery group(13.1 d) was obviously short than nasal lateral incision group(20.4 d), P < 0.01; The volume of blood during surgery(I-II stage): nasal endoscopic surgery group(175 ml) was obviously lower than nasal lateral incision group(525 ml), P < 0.01; CONCLUSION: The nasal endoscopy was a better method for treating I-II stage nasal inverted papilloma, and the major advantage is an incision of the face can be avoided. As to III-IV stage disease, should be carefully selected endoscopic surgery. Nasal lateral incision surgery still was a safe and reliable therapeutic method.