HOSPITALNI TRETMAN EPISTAKSE

ANGIOGRAPHIC EMBOLISATION FOR THE TREATMENT OF EPISTAXIS: A REVIEW OF 108 CASES, Elden, Montanera, Terbrugge, Willinsky, Lasjaunias, Charles

Otolaryngol head neck surg 1994, Toronto/Le Kremlin Bicetre, France

• MENAGMENT OF EPISTAXIS IN THE ORAL AND MAXILLOFACIAL SURGERY SETTING: AN UPDATE ON CURRENT PRACTICE

Mahmood, Lowe Oral Surg Oral Med

Oral Pathol Oral Endod 2003

Glasgow Scotland

UVOD

• PREDNJA EPISTAKSA• STRAŽNJA EPISTAKSA:

stražnja tamponada• 26 – 52% neuspjeha• Komplikacije: alarna i

septalna nekroza, tamponadom inducirana hipoksija, aspiracija, otitis, sinuitis, diskomfort

• Infarkt miokarda, moždani udar, iznenadna smrt, toxic shock sy, sleep apnea

ANGIOGRAFSKA EMBOLIZACIJA

• Embolizirati što distalnije

• Pitanje anastomoze između arterije karotis eksterne i arterije karotis interne

• Slijepoća i moždani udar

METODE

• 1984-1992• 97 hosp.

Pacijenata• 108 embolizacija• 2:1 muški/žene• 53 godine• 12 do 91

• Većina pacijenata po prednjoj/stražnjoj tamponadi

• Po uklanjanju ili nezaustavljivo unatoč

• 3 pacijenta samo s prednjom; stari i nemoćni

• 1 podvezivanje a. ethmoidalis ant• 1 septoplastika• Nekoliko pacijenata s Osler Weber Rendu

imalo je u neimedijatnoj anamnezi podvezivanje maksilarne ili karotis externe

• 16 pacijenata elektivno, zbog rekurirajućih epistaksi

• 5,8 : bolnički dani pred embolizaciju

• Mutiple transfuzije krvi• 20% pacijenata s hemoglobinom

ispod 10 gm/ml• 50% potencirana anestezija• 50% opća

• 2,7 f: superselektivna• A. Maxillaris int. bilaterlano,

transfemoralni pristup• 1/3 pac. a. facialis, kolaterale• A. pharyngica asc. u jednom slučaju• U angiografskoj sali odstranjena

tamponada

NIJE BILO LOŠIJE

ZAKLJUČAK

• Osler Rendu Weber- samo u hitnosti

• Embolizacija je visokoučinkovita metoda po neuspjeloj tamponadi

• može zamijeniti kirurgiju

• elektivno u selektiranim slučajevima

____________________________________

Rodos: tamponadu izbaciti kod iole ozbiljnijeg krvarenja:

kirugija/endoskopija ( a sphenopalatina, a. ethmoidalis ant, a. maxillaris)

Arch Otolaryngol Head Neck Surg. 1999 Jun;125(6):686-90. New modification of hot-water irrigation in the treatment of posterior epistaxis. Stangerup SE, Dommerby H, Siim C, Kemp L, Stage J.

KooperabilnostAspiracija2 minute

55/44 % 2,9/4 dana

1. Ann Otol Rhinol Laryngol. 2003 May;112(5):410-4. Effect of modern fibrin glue on bleeding after tonsillectomy and adenoidectomy.Vaiman M, Eviatar E, Shlamkovich N, Segal S.2.Oral Surg Oral Med Oral Pathol. 1993 Mar;75(3):280-2. Dental extractions in patients with bleeding disorders. The use of fibrin glue.Rakocz M, Mazar A, Varon D, Spierer S, Blinder D, Martinowitz U.3.Otolaryngol Head Neck Surg. 2002 Apr;126(4):388-91. Effectiveness of second-generation fibrin glue in endonasal operations.Vaiman M, Eviatar E, Segal S.4.Rhinology. 2002 Dec;40(4):185-8. The use of fibrin glue as hemostatic in endonasal operations: a prospective, randomized study.Vaiman M, Eviatar E, Segal S.5.Clin Otolaryngol. 2001 Aug;26(4):284-5. The use of fibrin glue in refractory coagulopathic epistaxis.Walshe P, Harkin C, Murphy S, Shah C, Curran A, McShane D.Tallaght Hospital, Dublin, Ireland.6. Rhinology. 2002 Jun;40(2):88-91.

Fibrin glue treatment for epistaxis.Vaiman M, Segal S, Eviatar E.

• 1912 Dr. W.G.Jefferson, Portland Me. wrote the "Declaration at Principles"

• A 81 EPISTAXIS.Catarrhal patients are subject to postnasal ulceration which results in local hyperemia and hemorrhage, and thefollowing has never failed to control it: Ammonium Carbonate one dram, Sp. Bella. Gtt 5. Water 4 ounces, Giveone dram every 2 or 3 hours

• B 24 VICARIOUS MENSTRUATION.For epistaxis as vicarious menstruation, if not caused from catching cold during menses, give Tr. Bryonia tenminims in four ounces of water, teaspoonful every hour

• Sigmund Freud's relationship with Wilhelm Fliess, the nose and throat physician who was his closest friend during the years Freud was formulating his new theories.

• Fliess sent Freud a paper entitled "Die nasale Reflexneurose" ("The Nasal Reflex Neurosis"), which he intended to deliver at the 12th Congress for Internal Medicine, in Wiesbaden, in June of 1893

• Fliess went on to say that masturbation altered the left middle turbinate bone in its frontal third, and that therefore he had decided to call this spot the "stomach-ache spot." He added that hemorrhages from the nose were well known among women who masturbated (die Epistaxis der Onanisten ist ganz bekannt).

TORQUEMADA

• “ ISTODOBNO ČIŠĆENJE SPOLNE I

TJELESNE NEČISTI KROZ NOS MOŽE

BITI SAMO DIJELO NEČASTIVOG”

TOMAS TORQUEMADA

INKVIZITOR

Dr. MIRKO IVKIĆ

MENTOR

Mr. Dražen Shejbal

SPECIJALIZANT