1. Acta Otorrinolaringol Esp. 2010 January - February;61(1):41-47. Epub 2009 Dec 10. [Epidemiology of epistaxes admitted to a tertiary hospital.] [Article in Spanish] Monjas-Cánovas I, Hernández-García I, Mauri-Barberá J, Sanz-Romero B, Gras-Albert JR. Servicio de Otorrinolaringología, Hospital General Universitario, Alicante, España. INTRODUCTION AND OBJECTIVES: Epistaxis has been known since antiquity. However, we have limited epidemiological data at our disposal. The aim of this study is to know the main epidemiological characteristics of the cases of epistaxis admitted and to determine the factors associated with the recurrence of bleeding. METHODS: A retrospective study was conducted including admissions for epistaxis in the ENT department of our hospital during the period between January, 2003, and December, 2008. We analyzed the distribution by gender, age, location and time of year. The aetiological causes identified included systemic and local factors. We analyzed the variables related to bleeding recurrence. RESULTS: We evaluated 178 cases of epistaxis: 68% of patients were male (121/178), compared to 32% of women (57/178). The median age (p25-p75) was 65 (53-75) years. The epistaxes were most noticeable during the months of January and April. Among the systemic causes, hypertension (56%), anti-platelet treatment (23%) and anti-coagulant therapies (18.5%) predominated. Local factors were much less numerous than general ones (11% v. 68%). Recurrent bleeding was present in 14% of cases (25/178) and only the posterior location was shown to influence this variable (P<.05). CONCLUSIONS: The typical pattern of the patients admitted to our department for epistaxis is a middle-aged or elderly male with underlying co-morbidity and posterior epistaxis. Copyright © 2009 Elsevier España, S.L. All rights reserved. PMID: 20004879 [PubMed - as supplied by publisher] 2. Oral Maxillofac Surg. 2009 Dec 1. [Epub ahead of print] Ischemic necrosis of nose and palate after embolization for epistaxis. A case report. Ntomouchtsis A, Venetis G, Zouloumis L, Lazaridis N. Aristotle University of Thessaloniki, School of Dentistry, Thessaloniki, Greece. This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature. PMID: 19949825 [PubMed - as supplied by publisher] 3. Cas Lek Cesk. 2009;148(8):370-3. [Hypertensive crisis--the present view] [Article in Czech] Janota T. III. interní klinika 1. LF UK a VFN, U Nemocnice 1, 128 08 Praha 2. tomasjanota@atlas.cz Hypertensive crisis is an acute, life-threatening condition associated with a substantial sudden increase in blood pressure. If the increase is accompanied by a damage of brain, cardiovascular system, eye ground or kidneys, it is referred to as an emergent hypertensive situation. In case of complaints comprising chest pain, shortness of breath, headache, epistaxis, weakness, faintness or seizure alone without organ damage, it is referred to as an urgent hypertensive situation. Treatment of emergent situations is parenteral and is conducted under a permanent monitoring in an intensive care unit. Nitrates, urapidil, diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta blockers and clonidin are used with respect to organ damage and accompanying diseases. Rate of blood pressure reduction and target values depend on a type of organ damages. An escalation of per oral medication is used in the treatment of urgent situations. Parenteral medication is indicated only in case of failure of this approach. PMID: 19899722 [PubMed - indexed for MEDLINE] 4. Oncologist. 2009 Nov;14(11):1131-8. Epub 2009 Nov 6. FDA drug approval summary: bevacizumab (Avastin) as treatment of recurrent glioblastoma multiforme. Cohen MH, Shen YL, Keegan P, Pazdur R. Division of Biological Oncology Products, Office of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, Maryland 20993-0002, USA. martin.cohen@fda.hhs.gov On May 5, 2009, the U.S. Food and Drug Administration granted accelerated approval to bevacizumab injection (Avastin; Genentech, Inc., South San Francisco, CA) as a single agent for patients with glioblastoma multiforme (GBM) with progressive disease following prior therapy. The approval was based on durable objective responses (independent radiologic review with stable or decreasing corticosteroid use). Two trials evaluating bevacizumab, 10 mg/kg by i.v. infusion every 2 weeks, were submitted. One trial also randomized patients to bevacizumab plus irinotecan treatment. All patients had received prior surgery, radiotherapy, and temozolomide. Patients with active brain hemorrhage were excluded. One trial enrolled 78 independently confirmed GBM patients. Partial responses were observed in 25.9% (95% confidence interval [CI], 17.0%-36.1%) of the patients. The median response duration was 4.2 months (95% CI, 3.0-5.7 months). The second trial enrolled 56 GBM patients. Partial responses were observed in 19.6% (95% CI, 10.9%-31.3%) of the patients. The median response duration was 3.9 months (95% CI, 2.4-17.4 months). Safety data were provided for the first study. The most frequently reported bevacizumab adverse events of any grade were infection, fatigue, headache, hypertension, epistaxis, and diarrhea. Grade 3-5 bevacizumab-related adverse events included bleeding/hemorrhage, central nervous system (CNS) hemorrhage, hypertension, venous and arterial thromboembolic events, wound-healing complications, proteinuria, gastrointestinal perforation, and reversible posterior leukoencephalopathy. The attribution of certain adverse events (e.g., CNS hemorrhage, wound-healing complications, and thromboembolic events) to either bevacizumab, underlying disease, or both could not be determined because of the single-arm, noncomparative study design. PMID: 19897538 [PubMed - indexed for MEDLINE] 5. J Clin Oncol. 2009 Nov 20;27(33):5499-505. Epub 2009 Oct 26. Dose finding and early efficacy study of gemcitabine plus capecitabine in combination with bevacizumab plus erlotinib in advanced pancreatic cancer. Starling N, Watkins D, Cunningham D, Thomas J, Webb J, Brown G, Thomas K, Oates J, Chau I. Department of Medicine, Royal Marsden Hospital, Downs Rd, Sutton, Surrey SM2 5PT, United Kingdom. Comment in: J Clin Oncol. 2009 Nov 20;27(33):5487-91. PURPOSE: This study evaluated safety and efficacy of chemotherapy (gemcitabine plus capecitabine) plus bevacizumab/erlotinib in advanced pancreatic cancer because dual epidermal growth factor receptor/vascular endothelial growth factor blockade has a rational biologic basis in this malignancy. PATIENTS AND METHODS: Patients with untreated, unresectable, locally advanced or metastatic pancreatic carcinoma were enrolled onto one of the following four sequential dose levels (DLs) of escalating capecitabine doses (days 1 to 21): DL1, 910 mg/m(2); DL2, 1,160 mg/m(2); DL3, 1,400 mg/m(2); or DL4, 1,660 mg/m(2). Doses of coadministered gemcitabine (1,000 mg/m(2) on days 1, 8, and 15), bevacizumab (5 mg/kg on days 1 and 15), and erlotinib (100 mg/d) every 28 days (up to six cycles) were fixed. Using a 3+3 study design, dose-limiting toxicity (DLT) was assessed in cycle 1. Results Twenty assessable patients were enrolled (DL1, n = 8; DL2, n = 3; DL3, n = 6; and DL4, n = 3); 97 cycles were administered. Median age was 63 years (range, 33 to 77 years), and male-to-female ratio was 10:10. Performance status was 0 and 1 in two and 17 patients, respectively; and nine and 11 patients had locally advanced and metastatic disease, respectively. DLT occurred in one patient at DL1 (grade 3 epistaxis) and two patients at DL4 (grade 3 diarrhea and grade 3 skin rash > 7 days). Common grade 3 and 4 toxicities (10% to 20%) were diarrhea, hand-foot syndrome, stomatitis, and skin rash. Grade 3 lethargy and grade 3 or 4 neutropenia occurred in 40% and 45% of patients, respectively. No GI perforation, grade 3 GI hemorrhage/hypertension, or pneumonitis occurred. Ten partial responses were observed. Median overall and progression-survival times (all patients) were 12.5 and 9.0 months, respectively. CONCLUSION: The maximum-tolerated dose of capecitabine was 1,660 mg/m(2). The recommended capecitabine dose in this cytotoxic doublet/biologic doublet regimen is 1,440 mg/m(2); this regimen is under evaluation in an ongoing phase II study. PMID: 19858399 [PubMed - indexed for MEDLINE] 6. Rhinology. 2009 Sep;47(3):260-3. Epistaxis of patients admitted in the emergency department is not indicative of underlying arterial hypertension. Theodosis P, Mouktaroudi M, Papadogiannis D, Ladas S, Papaspyrou S. ENT Department, General Hospital of Athens O Evagelismos, Athens, Greece. P.Theodosis@yahoo.gr OBJECTIVE: To assess the association between epistaxis and arterial hypertension. METHODS: A prospective study was conducted in 80 patients admitted in the emergency department, 42 with epistaxis and 38 well-matched controls. Blood pressure was measured upon admission and by continuous 24-hour ambulatory monitoring on the following days. RESULTS: Estimated values upon admission did not differ between groups. A definitive diagnosis of hypertension was set in 18 patients admitted for epistaxis (42.9%) and in 11 controls (28.9%, p = NS). Systolic pressures during the 24-hour recording period, systolic pressures during day and diastolic pressures during night were significantly higher among patients admitted for epistaxis than among controls. CONCLUSIONS: Although studies with larger series of patients are mandatory, epistaxis does not seem to result from underlying arterial hypertension. PMID: 19839247 [PubMed - indexed for MEDLINE] 7. Med J Malaysia. 2008 Dec;63(5):377-8. Endoscopic cauterization of the sphenopalatine artery in persistent epistaxis. Harvinder S, Rosalind S, Gurdeep S. Department of ENT, Hospital Ipoh, Jalan Hospital, 30990, Ipoh, Perak, Malaysia. harvindersran@hotmail.com The management of epistaxis remains to be a challenging problem for most ENT surgeon especially posterior epistaxis. Most cases are managed by placement of posterior nasal packs or balloons and failure leads to more invasive techniques, involving ligation of the internal maxillary artery. The above management is associated with significant patient complication and morbidity. Endoscopic ligation or cauterization of the sphenopalatine artery has emerged as a viable and minimally invasive alternative. We have performed endoscopic cauterization of nine sphenopalatine arteries in eight patients with no further episodes of epistaxis and complications, with an average follow-up of 25 months. The mean age of the patients was 52.75 years. Fifty percent of the patients had a history of hypertension. PMID: 19803294 [PubMed - indexed for MEDLINE] 8. BMC Cancer. 2009 Sep 28;9:347. Bevacizumab plus FOLFIRI or FOLFOX in chemotherapy-refractory patients with metastatic colorectal cancer: a retrospective study. Lièvre A, Samalin E, Mitry E, Assenat E, Boyer-Gestin C, Lepère C, Bachet JB, Portales F, Vaillant JN, Ychou M, Rougier P. Gastroenterology and Digestive Oncology Unit, Assistance Publique Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne Billancourt, France. astrid.lievre@wanadoo.fr BACKGROUND: The anti-VEGF antibody bevacizumab associated with an irinotecan or oxaliplatin-based chemotherapy was proved to be superior to the chemotherapy alone in first or second line treatment of metastatic colorectal cancer (mCRC). However, it was reported to have no efficacy in 3rd or later-line, alone or with 5FU. The aim of this study was to evaluate the activity of bevacizumab combined with FOLFIRI or FOLFOX in mCRC who have failed prior chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin. METHODS: Thirty one consecutive patients treated between May 2005 and October 2006 were included in this retrospective study. All of them have progressed under a chemotherapy with fluoropyrimidine plus irinotecan and/or oxaliplatin and received bevacizumab (5 mg/kg) in combination with FOLFIRI or simplified FOLFOX4 every 14 days. RESULTS: Ten patients (32.2%) had an objective response (1 CR, 9 PR) and 12 (38.8%) were stabilized. The response and disease control rates were 45.4% and 100% when bevacizumab was administered in 2nd or 3rd line and 25% and 55% in 4th or later line respectively (p = 0.024 and p = 0.008). Among the patients who had previously received the same chemotherapy than that associated with bevacizumab (n = 28) the overall response rate was 35.7% and 39.3% were stabilized. Median progression free survival (PFS) and overall survival (OS) were of 9.7 and 18.4 months respectively. Except a patient who presented a hypertension associated reversible posterior leukoencephalopathy syndrome, tolerance of bevacizumab was acceptable. A rectal bleeding occurred in one patient, an epistaxis in five. Grade 1/2 hypertension occurred in five patients. CONCLUSION: This study suggests that bevacizumab combined with FOLFOX or FOLFIRI may have the possibility to be active in chemorefractory and selected mCRC patients who did not receive it previously. PMCID: PMC2761407 PMID: 19785749 [PubMed - indexed for MEDLINE] 9. Med Hypotheses. 2009 Dec;73(6):955-7. Epub 2009 Aug 12. Is recurrent epistaxis from Kiesselbach's area (REKAS) in any relationship to the hemorrhoidal disease? Mladina R, Skitarelić NB, Skitarelić NP. Department of Otolaryngology Head and Neck Surgery, University Hospital Rebro-KBC, Zagreb, Croatia. Vascular diseases are a major threat to human health nowadays. Hypertension, cardiovascular disease and varicose vain disease including hemorrhoids, are now increasingly recognized as inflammatory diseases. The role of inflammation cytokines in the pathogenesis of these diseases is very important. The lamina propria in the nasal mucosa is rich in blood vessels and humoral mediators. Recurrent epistaxis from Kiesselbach's area syndrome (REKAS) was first mentioned as early as 1985. It has been found that 90% of patients suffering from recurrent epistaxis from Kiesselbach area syndrome simultaneously suffered from hemorrhoids. Clinical observations suggest a possible mutual pathophysiologic relationship between Kiesselbach's and anorectal venous plexus. This relationship is also suggested in the reverse direction: significantly more than two thirds of primarily hemorrhoidal patients (83.01%) showed simultaneous vascular dilatations within their Kiesselbach plexuses, but none of these patients had ever have recurrent nose bleeds. There is one more thing they did not have (contrary to REKAS group)--anterior septal deformity. Furthermore, REKAS and hemorrhoidal disease, despite being different clinical entities, frequently appear in the primarily REKAS patients or their closest relatives (more than 90% out of all!). At the same time, all of REKAS patients did have a certain degree of the anterior septal deformity, which primarily hemorrhoidal patients did not have at all. Therefore we presume that Kiesselbach's vascular plexus in the Little's area of the nasal septum belongs to the same group as anorectal venous plexus does (others of this group are brain, esophagus, and lower leg venous system). We also presume that the anterior septal deformity is a crucial factor for the onset of the inflammation of the nasal vestibule skin (vestibulitis nasi), while vestibulitis nasi precipitates the onset of typical recurrent nose bleeds from the Kiesselbach's plexus. PMID: 19679399 [PubMed - in process] 10. Optometry. 2009 Jul;80(7):350-3. Case report: bilateral simultaneous central retinal vein occlusion in Waldenström's macroglobulinemia. Chanana B, Gupta N, Azad RV. All India Institute of Medical Sciences, New Delhi, India. bhuvan_chanana@rediffmail.com BACKGROUND: We report a case of bilateral simultaneous central retinal vein occlusion (CRVO) in Waldenström's macroglobulinemia. METHODS: We report the case of a 60-year-old woman who presented with decreased vision in both eyes. RESULTS: Ophthalmoscopic examination showed scattered retinal hemorrhages and venous tortuosity with macular edema bilaterally. The patient had a history of hypertension and was under investigation for lethargy, recurrent epistaxis, and fainting episodes. Serum protein electrophoresis showed an M-spike in the gamma region. Bone marrow trephine biopsy confirmed the diagnosis of Waldenström's macroglobulinemia. The patient was treated with plasmapheresis and subsequent chemotherapy, resulting in improvement of ocular and systemic symptoms. CONCLUSIONS: We report this case to emphasize that in any case of bilateral CRVO, hyperviscosity should be suspected. Serum electrophoresis along with coagulation profiles should be performed as a standard practice in patients with bilateral simultaneous CRVO. PMID: 19545847 [PubMed - indexed for MEDLINE] 11. Clin Otolaryngol. 2009 Jun;34(3):232-5. Clopidogrel versus low-dose aspirin as risk factors for epistaxis. Rainsbury JW, Molony NC. ENT Department, Russells Hall Hospital, Dudley, West Midlands, UK. j_rainsbury@yahoo.co.uk OBJECTIVES: To quantify the relative risk of epistaxis for patients taking low-dose aspirin or clopidogrel compared to patients taking neither drug. DESIGN: Case-control study. SETTING: Primary care. PARTICIPANTS: 10,241 patients from three GP practices in the West Midlands. MAIN OUTCOME MEASURES: Epistaxis resulting in presentation to the GP, attendance at Accident & Emergency, or referral to ENT outpatients. RESULTS: There was a significant difference in the proportion of patients with epistaxis across the three groups (chi(2) = 84.1; 2 degrees of freedom; P < 0.000001). Relative risk of epistaxis was increased in both the aspirin (RR = 9.04; 95% CI = 5.13-15.96) and clopidogrel (RR = 6.40; 95% CI = 2.33-17.56) groups compared to the no drug group. There was no increased risk of epistaxis with aspirin compared to clopidogrel (RR = 1.4; 95% CI = 0.6-3.4). CONCLUSION: There is an increased risk of troublesome epistaxis in patients taking aspirin or clopidogrel. There is no significant difference in risk of epistaxis between the two drug groups. PMID: 19531172 [PubMed - indexed for MEDLINE] 12. J Eur Acad Dermatol Venereol. 2009 Sep;23(9):1026-34. Epub 2009 May 4. Mucosal leishmaniasis: description of case management approaches and analysis of risk factors for treatment failure in a cohort of 140 patients in Brazil. Amato VS, Tuon FF, Imamura R, Abegão de Camargo R, Duarte MI, Neto VA. Infectious and Parasitic Diseases Clinic, Hospital das Clinicas, Medical School, University of Sao Paulo, Sao Paulo, Brazil. valdirsa@netpoint.com.br BACKGROUND: Mucosal leishmaniasis is caused mainly by Leishmania braziliensis and it occurs months or years after cutaneous lesions. This progressive disease destroys cartilages and osseous structures from face, pharynx and larynx. OBJECTIVE AND METHODS: The aim of this study was to analyse the significance of clinical and epidemiological findings, diagnosis and treatment with the outcome and recurrence of mucosal leishmaniasis through binary logistic regression model from 140 patients with mucosal leishmaniasis from a Brazilian centre. RESULTS: The median age of patients was 57.5 and systemic arterial hypertension was the most prevalent secondary disease found in patients with mucosal leishmaniasis (43%). Diabetes, chronic nephropathy and viral hepatitis, allergy and coagulopathy were found in less than 10% of patients. Human immunodeficiency virus (HIV) infection was found in 7 of 140 patients (5%). Rhinorrhea (47%) and epistaxis (75%) were the most common symptoms. N-methyl-glucamine showed a cure rate of 91% and recurrence of 22%. Pentamidine showed a similar rate of cure (91%) and recurrence (25%). Fifteen patients received itraconazole with a cure rate of 73% and recurrence of 18%. Amphotericin B was the drug used in 30 patients with 82% of response with a recurrence rate of 7%. The binary logistic regression analysis demonstrated that systemic arterial hypertension and HIV infection were associated with failure of the treatment (P < 0.05). CONCLUSION: The current first-line mucosal leishmaniasis therapy shows an adequate cure but later recurrence. HIV infection and systemic arterial hypertension should be investigated before start the treatment of mucosal leishmaniasis. Conflicts of interest The authors are not part of any associations or commercial relationships that might represent conflicts of interest in the writing of this study (e.g. pharmaceutical stock ownership, consultancy, advisory board membership, relevant patents, or research funding). PMID: 19453817 [PubMed - indexed for MEDLINE] 13. Niger J Clin Pract. 2008 Dec;11(4):379-82. Relationship between epistaxis and hypertension: a study of patients seen in the emergency units of two tertiary health institutions in Nigeria. Isezuo SA, Segun-Busari S, Ezunu E, Yakubu A, Iseh K, Legbo J, Alabi BS, Dunmade AE, Ologe FE. Department of Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. simeonisezuo@yahoo.com BACKGROUND: Both epistaxis and hypertension are common in the general population. OBJECTIVE: This study aimed at determining the prevalence of hypertension among epistaxics, and the relationship between epistaxis and hypertension. METHODS: Retrospective analysis of 62 adults comprising 31 each of males and females with a mean age of 41.4 +/- 16.6 years (range: 18-90 years) that presented in the emergency units of two tertiary health institutions seen over 11 years was done. Main outcome measure was the prevalence of hypertension amongst epistaxics. Seventy-six age and sex-matched patients with bleeding from sites other than the nostrils with no record of epistaxis were selected by simple random sampling as controls. RESULTS: Peak prevalence of epistaxis occurred during the months of January and March. Compared to the controls, the epistaxics had significantly higher blood pressures: (146.1 +/- 40.7 mmHg versus 123.2 +/- 16.3 mmHg systolic, P=0.001), and (91.3 +/- 24.8 mmHg versus 78.2 +/- 12.8 mmHg diastolic, P=0.001), and higher proportions of patients with previous history of hypertension (32.3% versus 7.9%; p<0.001) and family history of hypertension (12.9% versus 2.6%; p<0.02). The proportion of subjects with blood pressure elevation at presentation that remained sustained was significantly higher among the epistaxics than the nonepistaxics (87.5% versus 47.6%, chi2=8.1, P=0.005). The epistaxics had significantly higher prevalence of hypertension than the non-epistaxics (45.2% versus 13.2%, chi2=17.5, p=0.001). Univariate analysis demonstrated association between epistaxis and hypertension (OR=5.4, 95% CI=2.4-12.5, P=0.001), and between epistaxis and age (OR=0.9, 95% CI=1.3-12.5, P=0.02). On multivariate analysis using logistic regression the association between epistaxis and hypertension persisted, after adjusting for age, sex, season and causes of epistaxis (OR=5.6, 95% CI=1.7-15.6, P=0.01). CONCLUSIONS: Our findings support an association between epistaxis and hypertension in the study population. PMID: 19320416 [PubMed - indexed for MEDLINE] 14. Ann Afr Med. 2008 Sep;7(3):107-11. Pattern of epistaxis in Sokoto, Nigeria: a review of 72 cases. Iseh KR, Muhammad Z. Department of Ear, Nose and Throat, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. frobih@yahoo.com BACKGROUND: Epistaxis remains a common otorhinolaryngological emergency in most hospital emergency departments with varied manifestations. The pattern as seen in a tertiary health institution in Sokoto, Nigeria is the subject of this paper. METHOD: This is a 5 year retrospective study (January 1995-December 1999) of all cases of epistaxis presenting at or referred to the Ear, Nose and Throat (ENT) Department of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria whose data were analyzed. RESULTS: A total number of 72 cases were seen with epistaxis out of 3,706 new cases seen at the ENT clinic. The incidence of epistaxis amongst UDUTH ENT patients was 19/1000. There were 45 males (62.5%) and 27 Females (37.5%) with a male to female ratio of 1.7:1. Their ages ranged between land 70 years with the 0-10 age range recording the highest number (26.4%). The commonest cause of epistaxis was idiopathic (29.2%), followed by trauma (27.8%) and hypertension (18.0%). Non surgical methods (97.2%) such as observation alone (34.7%) without active intervention to arrest bleeding, and nasal packing (34.7%), being the commonest intervention measures used to actively arrest bleeding followed by cauterization of the bleeding points (11.1%) were the frequent treatment measures. Surgical extirpation was carried out in 2 cases (2.8%) to arrest the epistaxis. CONCLUSION: Although epistaxis is a common otorhinolaryngological emergency and varied in its manifestation, it affects mainly the young people (<30 years (62.5%)) in this environment with idiopathic, trauma, and hypertension being the common causes which are amendable to treatment with excellent results. PMID: 19253519 [PubMed - indexed for MEDLINE] 15. Int J Cardiol. 2009 Jan 11. [Epub ahead of print] A new evidence of end-organ damage in the patients with arterial hypertension: Epistaxis? Celik T, Iyisoy A, Yuksel UC, Karahatay S, Tan Y, Isik E. Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik-Ankara, Turkey. PMID: 19138805 [PubMed - as supplied by publisher] 16. Clin Cancer Res. 2008 Dec 1;14(23):7871-7. VEGF as a marker for outcome among advanced breast cancer patients receiving anti-VEGF therapy with bevacizumab and vinorelbine chemotherapy. Burstein HJ, Chen YH, Parker LM, Savoie J, Younger J, Kuter I, Ryan PD, Garber JE, Chen H, Campos SM, Shulman LN, Harris LN, Gelman R, Winer EP. Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. hburstein@partners.org BACKGROUND: Anti-vascular endothelial growth factor therapy (VEGF) is an important new treatment modality in oncology. We sought to determine the efficacy and safety of the humanized monoclonal anti-VEGF antibody, bevacizumab, and vinorelbine as treatment for refractory breast cancer and to explore the role of plasma VEGF as a predictor of treatment outcome. EXPERIMENTAL DESIGN: Eligible patients had received one or two prior chemotherapy regimens for metastatic breast cancer or recurred within 12 months of adjuvant therapy and had measurable disease and adequate end-organ function. Patients received bevacizumab 10 mg/kg every 2 weeks, and vinorelbine each week, until tumor progression or prohibitive toxicity. Plasma VEGF was measured at baseline. RESULTS: Among 56 women treated on protocol, bevacizumab and vinorelbine yielded a 34% response rate (95% confidence interval, 22-48%) and median time to progression of 5.5 months. Activity was observed regardless of tumor hormone receptor status or type or extent of prior chemotherapy. Side effects included uncomplicated neutropenia, hypertension, nasal congestion/epistaxis, and neuropathy, consistent with well-described side effects of the respective agents. Three patients had impaired wound healing following surgical procedures. There were only rare instances of thrombosis or clinically significant proteinuria. Lower levels of baseline VEGF were associated with longer time to progression. CONCLUSIONS: Bevacizumab and vinorelbine are well tolerated and effective as treatment for refractory breast cancer. Plasma VEGF warrants further evaluation as a prognostic marker for treatment outcome in advanced breast cancer patients receiving anti-VEGF therapy. PMID: 19047116 [PubMed - indexed for MEDLINE] 17. Ann Fr Anesth Reanim. 2008 Oct;27(10):843-5. Epub 2008 Sep 27. [Brain placement of a double balloon catheter after extensive craniofacial trauma] [Article in French] Blasco V, Heng Ban L, Velly L, Leone M, Gouin F. Département d'anesthésie-réanimation, hôpital Nord, Assistance publique-Hôpitaux de Marseille, faculté de médecine de Marseille, chemin des Bourrely, 13915 Marseille cedex 20, France. valeryblasco@lavache.com An extensive craniofacial trauma is often associated with skull basal fractures and severe epistaxis. Such event requires nasal packing, using balloon systems or even arterial embolization or ligation. However, the use of balloon systems may result in an intracranial position. We report here such a case in an 18-year-old man suffering from a severe nasal bleeding. PMID: 18824320 [PubMed - indexed for MEDLINE] 18. Am J Med Genet A. 2008 Oct 1;146A(19):2551-6. BMPR2 mutation in a patient with pulmonary arterial hypertension and suspected hereditary hemorrhagic telangiectasia. Rigelsky CM, Jennings C, Lehtonen R, Minai OA, Eng C, Aldred MA. Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. Pulmonary arterial hypertension (PAH) and hereditary hemorrhagic telangiectasia (HHT) are distinct clinical entities caused by germline mutations in genes encoding members of the TGFbeta/BMP superfamily: BMPR2 in PAH and ACVRL1, ENG, or SMAD4 in HHT. When PAH and HHT occasionally co-exist within the same family, ACVRL1 mutations predominate. We report a 36-year-old woman initially diagnosed with PAH at age 24. At 35, following massive hemoptysis, multiple pulmonary arteriovenous malformations were discovered, prompting evaluation for HHT. She met the Curaçao diagnostic criteria for suspected HHT based on additional findings of nasal telangiectases and epistaxis. Mutation analysis of ACVRL1, ENG, and SMAD4 was normal, but a germline nonsense mutation in BMPR2 was identified. This is the first known report of HHT features, particularly pulmonary AVMs, associated with a BMPR2 mutation. It adds further weight to a common molecular pathogenesis in PAH and HHT, and highlights that BMPR2 gene analysis is indicated in patients affected with both HHT and PAH. Copyright 2008 Wiley-Liss, Inc. PMID: 18792970 [PubMed - indexed for MEDLINE] 19. Invest New Drugs. 2009 Jun;27(3):285-6. Epub 2008 Aug 27. Rhinitis and epistaxis in patients treated by anti-angiogenic therapy. Prulière-Escabasse V, Escudier E, Balheda R, Soria JC, Coste A, Massard C. Service d'ORL et de Chirurgie Cervico-Faciale, Hôpitaux H. Mondor (Assistance Publique Hôpitaux de Paris) et Centre Hospitalier Intercommunal de Créteil, Paris, France. Anti-angiogenic therapies have a particular drug-related toxicity profile including hypertension, thrombosis, haemorrhages, and proteinuria. Moreover, patients treated by angiogenesis inhibitors present nasal symptoms including symptomatic rhinitis and epistaxis. For the first time, a new entity of "atrophic rhinitis" induced by angiogenesis inhibitors is described and revealed that angiogenesis inhibitors alter the differentiation of nasal epithelium. VEGF may act on epithelial cell proliferation and differentiation in nasal epithelium. PMID: 18754078 [PubMed - indexed for MEDLINE] 20. MMW Fortschr Med. 2008 May 22;150(21):11. [Hypertensive crisis: collapse after using nitro spray. For the elderly a low dose chew capsule is better!] [Article in German] Wittig T. Pohl Boskamp, Leitung Medizin & Zulassung. PMID: 18575246 [PubMed - indexed for MEDLINE]