The optimal surgical management for failed conservative measures in epistaxis remains unclear. Given the growing enthusiasm for endoscopic transnasal sphenopalatine artery ligation, it is prudent and timely to evaluate the evidence base for this technique. This study aims to analyse the current evidence for transnasal endoscopic sphenopalatine artery ligation by reviewing the literature and also by comparing the results with other approaches to the management of epistaxis. A detailed literature search identified 11 publications relating to endoscopic sphenopalatine artery ligation. The total number of patients in the pooled series was 127, of which 98% had control of epistaxis following surgery. These results compared favourably to the results of most other techniques used in the modern treatment of epistaxis. Nonetheless, the total number of patients in the 11 case series is small. It is therefore recommended that all units using this technique audit their results to see if the high success rates achieved in the literature are reproducible. If this is the case, then endoscopic sphenopalatine artery ligation may indeed be the surgical answer to intractable posterior epistaxis.

The present study showed that males have better bimanual coordination when compared to their female counterparts and aging causes decline in efficiency of bimanual coordination.

We present an interesting case of an elderly lady who presented with stridor caused by megaesophagus secondary to an acquired idiopathic dysmotility disorder. We discuss the aetiology and management of megaesophagus secondary to this condition and how it differs from megaesophagus secondary to achalasia.

Background: The role of estrogen on the heart is well known in the normal course of the menstrual cycle. Significant increase in both progesterone (37%) and estradiol (13.5%), whereas no change in plasma FSH & LH was observed in exercising women in previous studies. Therefore this study was intended to see the limitations of the pulmonary system in adaptability to exercise in proliferative phase of menstrual cycle in perimenopausal women. Material and Methods: Healthy adult females between 42-45 years who regularly undergo training and participate in competitive middle distance running events for at least past 3 years were considered in the athlete group whereas the non-athlete group did not have any such regular exercise program. Dynamic heart functions were measured in both groups before exercise was evaluated following standard procedure of treadmill testing. Results: It was observed that exercise per se cause a statistically significant change in dynamic heart function parameters in either of the groups. Summary and Conclusion: This finding supports the hypothesis that the cardiovascular system is normally the most limiting factor in the delivery of oxygen even under the predominant influence of estrogen in proliferative phase which is further accentuated by exercise.

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