Upper airway tract and upper gastrointestinal tract involvement in patients with pemphigus vulgaris.

Pemphigus vulgaris (PV) is an autoimmune disease involving the skin and mucous membranes. The frequency of upper airway tract (UAT) and upper gastrointestinal tract (UGIT) involvement in PV is not clearly known. Our aim was to determine the incidence of UAT and UGIT involvement in patients with PV. Thirty-seven patients who were diagnosed with PV and treated between March 2008 and April 2009 at the Dermatology Department of the Vakif Gureba Teaching and Research Hospital were included. All patients were evaluated for UAT manifestations by endoscopic examination, and 22 of 37 patients were investigated for UGIT involvement by gastrointestinal endoscopy. Mucosal biopsies were obtained by UGIT endoscopy for direct immunofluorescence (DIF) examination, and a histopathological examination was conducted in patients with active UGIT mucosal lesions. Thirty-five of 37 patients (94.6%) had active pharyngeal, laryngeal, or nasal PV lesions on endoscopic evaluation. Oral symptoms (83.8%) and active oral PV lesions were the most frequent findings (100%). Pharyngeal lesions (64.9%) were the most commonly present lesions on UAT examination. The frequency for laryngeal and nasal lesions was 51.4% and 21.6%, respectively. Five of 22 patients (22.7%) presented with active laryngeal and esophageal lesions. Twenty-one of 22 (95.4%) patients had positive DIF results. We believe that UAT and UGIT endoscopies are useful and necessary diagnostic methods in patients with PV with or without UAT and UGIT symptoms. UAT and UGIT endoscopies should be performed as standard diagnostic procedures in all patients with PV.

Prospective, randomized, controlled clinical trial of Ankaferd Blood Stopper in patients with acute anterior epistaxis.

This is a study evaluating the efficacy of Ankaferd Blood Stopper (ABS) as a hemostatic agent compared to hemostasis by phenylephrine in patients with anterior epistaxis. The study design is a prospective, randomized, controlled, nonblinded, clinical trial. In total, 49 patients were randomly seperated to receive hemostasis technique by means of either ABS wet tampon or phenylephrine impregnated gauze tampon for anterior epistaxis control. Patients were crossed over to the other technique after two unsuccessful attempts of the first technique. Measured outcomes such as number of applications, relationship of number of applications with bleeding intensity (1 = stains on napkin, 2 = soaked napkin, 3 = bowl needed), patient discomfort during hemostasis (0 = none, 9 = unbearable), and complications were assessed. Additional data were recorded for rebleeding within 7 days. 24 of the 49 patients were assigned to the new ABS group (group I) and remaining 25 were included in the standard phenylephrine group (group II). ABS was more effective than phenylephrine at control of anterior epistaxis (79.2 vs. 64%, p < 0.05). For the patients who crossed over from phenylephrine to ABS, 44.4% achieved hemostasis by ABS. ABS successfully treated all bleeding intensity 1 and 2 patients with one application (5 min). ABS patients experienced fewer rebleeding rates within 7 days compared to phenylephrine patients (8.3 vs. 20%, p < 0.05). The patients for which ABS was applied, significant differences in effective control of anterior epistaxis were observed compared to phenylephrine. ABS is effective, safe, quick, and easy alternative to the phenylephrine in patients with anterior epistaxis.