1/16. Intracranial haemorrhage due to factor v deficiency.factor v deficiency is a rare coagulation disorder which is inherited autosomal recessively. factor v deficiency should be considered in infants with bleeding disorders and prolonged prothrombin and activated partial thromboplastin times if bleeding continues in spite of vitamin k injection. In this article, the case of an infant with an intracranial haemorrhage due to congenital factor v deficiency is reported.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/16. The use of nasal endoscopy to control profuse epistaxis from a fracture of the basi-sphenoid in a seven-year-old child.A seven-year-old child sustained a fracture of her basisphenoid resulting in profuse, life-threatening haemorrhage which could not be controlled with a post-nasal pack. The fracture site was identified using rigid endoscopy and packed with oxidized cellulose, resulting in immediate control of the haemorrhage. The use of the nasal endoscope in the management of posterior epistaxis is discussed.- - - - - - - - - - ranking = 0.4keywords = haemorrhage (Clic here for more details about this article) |
3/16. life-threatening haemorrhage after elevation of a fractured zygoma.A 21-year-old man presented with a fractured left zygoma after an alleged assault. The fracture was elevated four days later, at which time he had a brisk left-sided epistaxis. Recovery was uneventful except for a haematoma that was drained a month later. Two weeks after this, he was admitted after having collapsed. He was shocked and bleeding profusely from his nose. He had a further major bleed in hospital and this was treated by tying off the left external carotid artery. He has made an uneventful recovery and investigations have shown no bleeding diathesis.- - - - - - - - - - ranking = 0.8keywords = haemorrhage (Clic here for more details about this article) |
4/16. Management of severe postnasal haemorrhage: the Kingsley splint revisited.Postnasal haemorrhage accompanying severe craniofacial trauma may have catastrophic consequences if not arrested promptly. The airway has usually been secured and the cervical spine stabilized, but apart from fluid replacement, other attempts to control haemorrhage in the resuscitation room of the accident and emergency department may be to no avail. We wish to draw attention to a simple device that was introduced over 100 years ago and which may rapidly aid haemostasis and prevent the onset of hypovolaemic shock.- - - - - - - - - - ranking = 1.2keywords = haemorrhage (Clic here for more details about this article) |
5/16. An unusual cause of epistaxis: a haemophilic pseudotumour in a non-haemophiliac, arising in a paranasal sinus.Most cases of epistaxis are due to simple causes and are easily treated on an out-patient basis. However, there are some cases where the origin of bleeding is not obvious or arises from an unusual pathological source. The authors describe a case of epistaxis due to a mass in the maxillary antrum that when biopsied showed the histological appearances of a haemophilic pseudotumour. The patient was anticoagulated on warfarin for a cardiac valve replacement and this was thought to be the cause of the ongoing haemorrhage necessary for development of the pseudotumour. Even in haemophiliacs, pseudotumours are rare and we believe this case is unique in that the patient is a non-haemophiliac. The epistaxis was eventually controlled by external beam radiotherapy to the pseudotumour. The management of this case is outlined as well as a review of the literature on haemophilic pseudotumour.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
6/16. Complications with use of the Epistat in the arrest of midfacial haemorrhage.Control of midfacial haemorrhage can be difficult, especially in the multiply injured patient, either at the scene of injury, or in the Accident and Emergency Department. The use of Epistats has proven invaluable in this setting. Potential problems exist with their use and this is illustrated with examples, together with strategies for overcoming them. A summary of the didactic method of safe use of this life saving technique is insert the Epistat, aiming for a fingertip placed at the soft palate;inflate the posterior cuff;withdraw the Epistat slightly, to position the posterior cuff within the nasal choanae;inflate the anterior (intranasal) cuff.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
7/16. moyamoya disease complicated by life-threatening epistaxis: first report of a case.OBJECTIVE: Subacute haemorrhage is a common emergency in otorhinolaryngology. Rapid evaluation of the aetiology and localization is a precondition for suitable treatment. We demonstrate a rare case of primarily intractable epistaxis associated with occlusion of the circle of willis (moyamoya disease). PATIENT: A 38-year-old man presented with a 24-h history of recurrent epistaxis. Anamnesis revealed long-term anticoagulation after heart valve transplantation and arterial hypertension. RESULTS: As a result of several re-bleedings after anterior nasal packing, a re-packing was followed by surgical treatment under general anaesthesia. Four days after discharge the patient presented to the intensive care unit with severe re-bleeding. After removal of a temporary Bellocq packing, interdisciplinary treatment was necessary. Emergency angiography revealed advanced moyamoya disease, with occlusion of both internal carotid arteries. The cerebral blood supply was sustained by an excessive collateral network originating from external carotid anastomoses. This complicated the endovascular treatment, which consisted of embolization of the infraorbital and maxillar arteries with liquid material and coils flanked by Bellocq packing. The patient was doing well at follow-up after 12 months. CONCLUSION: epistaxis complicating moyamoya disease is rare, and endovascular treatment is difficult due to the high risk of cerebral embolism. Malformations of the cerebral arteries should be considered in the differential diagnosis of intractable epistaxis.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
8/16. Nasotracheal intubation: look before you leap.Nasotracheal intubation is frequently used for airway management during maxillofacial surgery. Complications such as haemorrhage occur more frequently with this route of intubation than with the orotracheal route. This case report describes a male patient aged 51 yr who developed severe epistaxis after the tube had passed the nares. As an additional complication laryngoscopy and endotracheal intubation failed because of difficult airway (Cormack-Lehane grade 4). Attempts using an intubating laryngeal mask airway and a Bonfils intubating fibrescope did not succeed. The airway was finally managed by cricothyroidotomy. A modified sequence of nasotracheal intubation is proposed to avoid similar life-threatening complications.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
9/16. An unusual presentation of tuberculous lymphadenitis.A 43 years male presented with recurrent epistaxis and had generalised lymphadenopathy on examination. No haematological disorder could be established even after bone marrow aspiration and biopsy but the patient was found to have tuberculosis of the lymph node on histopathology, with severe thrombocytopenia in the peripheral blood and increased platelet precursor in the marrow suggesting peripheral platelet destruction. Anti-tuberculous therapy was started but the patient died due to subarachnoid haemorrhage.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
10/16. Use of recombinant factor viia in the management of severe bleeding episodes in patients with bernard-soulier syndrome.bernard-soulier syndrome (BSS) is a rare congenital platelet disorder characterized by defective platelet adhesion and manifested by spontaneous and often profuse bleeding. Recombinant factor viia (rFVIIa) is a haemostatic agent licensed for the treatment of bleeding episodes in patients with haemophilia and inhibitors, which may represent a low-risk alternative to existing therapies in the management of patients with BSS. Here, we describe the use of rFVIIa for the treatment of three severe bleeding episodes in two patients with BSS. Data were extracted by automated searching of the international, internet-based registry http://www.haemostasis.com . Patient 1, a 24-year-old woman, was admitted with severe epistaxis and hypotension. The diagnosis of BSS was confirmed by macrothrombocytopenia, absence of ristocetin-induced platelet agglutination (RIPA) and absence of glycoprotein (GP) Ibalpha and IX on the platelet surface. Epsilon aminocaproic acid (EACA; two 50-mg/kg doses), packed red blood cells (PRBCs, 2 U) and platelets (30 U) failed to control the bleeding and, after 13 h, three bolus doses of rFVIIa (90 microg/kg body weight) and a third dose of EACA were administered; bleeding stopped after the third dose of rFVIIa. Patient 2, a 15-year-old girl, initially presented with severe menorrhagia. A lack of RIPA and severe deficiency of GPIbalpha on the platelet surface confirmed the diagnosis of BSS. EACA and fresh-frozen plasma did not control the haemorrhage, but two bolus doses of rFVIIa (98 microg/kg body weight) resulted in a marked decrease in bleeding. On second admission, patient 2 had severe epistaxis and mild menorrhagia. Two rFVIIa doses (98 and 122.5 microg/kg body weight) were given, and the bleeding stopped. No adverse events were reported in these cases. These three admissions highlight the potential of rFVIIa for the treatment of severe bleeds in patients with BSS.- - - - - - - - - - ranking = 0.2keywords = haemorrhage (Clic here for more details about this article) |
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