Effectiveness of Rapidrhino® Packing in Patients Who Visited Emergency Room due to Anterior Epistaxis

PURPOSE: Although there are many treatment options for managing epistaxis, little is known about their outcomes in the emergency department (ED). In this study, we evaluated the management of epistaxis, especially comparing the efficacy between Rapidrhino® and Merocel®. METHODS: A retrospective review of patients with epistaxis visiting the ED between January 2010 and June 2016 was performed. Haemostatic properties of packs were initially measured in the ED, and after the removal of packs in the otorhinolaryngology clinic. Subgroup analyses were performed in a similar fashion for patients receiving and not receiving anticoagulants or the antiplatelet. RESULTS: The initial success rates for Rapidrhino® and Merocel® were both high (90.3%, 86.3%, respectively). Rebleeding rates for Rapidrhino® and Merocel® were 41.4% and 56.3%, respectively. Overall, there was a significant difference between the two types of packs in recurrence (p=0.032). Particularly, in patients with anticoagulants, the initial success rates of Rapidrhino® were higher than that of Merocel® (88.6%, 76.2%, respectively, p=0.222). The rebleeding rate of Rapidrhino® was much lower than that of Merocel® (54.3%, 85.7%, respectively, p=0.016). In the Rapidrhino® group, the rebleeding rate varied according to the packing removal date (p=0.001). CONCLUSION: Rapidrhino® and Merocel® are equally effective in the initial arrest of epistaxis in the ED. Rapidrhino® may be more effective in controlling haemorrage on removal, particularly in patients with anticoagulants. Patients with epistaxis could be treated with Rapidrhino® in the ED, which could be removed in the outpatient clinic one day later.

The Usability of p16 Immunohistochemical Staining as a Screening Test of Human Papillomavirus Infection in Head and Neck Squamous Cell Carcinoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although human papillomavirus (HPV) infection has been recognized as having an important role in the pathogenesis of head and neck squamous cell carcinoma (HNSCC), there is no simple and reliable screening test of HPV infection in HNSCC to date. In the present study, we investigated the usability of p16 immunohistochemical staining as a screening test for HPV infection in HNSCC. SUBJECTS AND METHOD: Paraffin blocks were obtained from 45 tonsil SCC patients, who underwent surgery as an initial treatment between 1995 and 2004. Paraffin blocks were also obtained from 20 normal controls. Expression of p16 was investigated immunohistochemically and these results were compared with results of HPV genotyping and the real-time polymerase chain reaction (PCR) assay of viral oncoprotein to validate p16 staining as a reliable diagnostic tool of HPV infection. RESULTS: The expression of p16 was found to be significantly different between tonsil SCC (32/45, 71.1%) and normal control tissues (0/20, 0%)(p<0.05). Among the 45 patients, HPV genotyping and real-time PCR assay were performed in 21 of the 32 p16 (+) patients and in 6 patients of the 13 p16 (-) patients. HPV-16 was detected in 18 (85.7%) out of the 21 p16 (+) patients and in 2 (33.3%) out of the 6 p16 (-) patients. The p16 expression and HPV-16 status was significantly correlated (p<0.05). The two patients who had HPV-16 infection but did not have p16 expression showed an episomal infection or very low viral copy number each. CONCLUSION: The p16 expression may be an useful marker of HPV infection in HNSCC and may be used as a screening test for HPV infection in HNSCC.

The Efficacy of Microvascular Decompression in Disabling Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Disabling positional vertigo (DPV) refers to the cross-compression of the eighth cranial nerve from vessels in the posterior fossa which causes symptoms of vestibular disturbances. The most common symptom is a whirling sensation that is worse when the head is in a specific position and is abated with total bed rest. Many patients with DPV also have symptoms of auditory nerve and/or adjacent cranial nerve involvement, such as tinnitus, hearing disturbance, geniculate neuralgia, facial twitching. To analyze DPV, the authors reviewed patients with DPV who underwent microvascular decompression (MVD) in our institution. SUBJECTS AND METHOD: A retrospective study was performed on 11 patients with DPV who underwent MVD from January 2002 to September 2007. Information was collected on sex, age, symptoms, offending vessels, the success rate, surgical complications. RESULTS: Three patients were male and eight were female. Their mean age was 55.1 years (range 37-70). The most common offending vessel was AICA in 7 cases (64%) and second vessel was PICA in 3 cases (27%). Only one case (9%) had a vein. Patterns of improvement after MVD could be divided into 3 clinical types. There was complete recovery after operation in 8 cases, partial recovery in 2 cases, and recovery failure in 1 case. There were no major complications except hearing impairment in 1 case. CONCLUSION: This study shows that MVD provides a high rate of success with low morbidity, and can be regarded as one effective procedure for DPV.