No abstract

Recent studies have suggested a link between antiplatelet medications and alcohol in the aetiology of acute adult epistaxis. The possibility that adult epistaxis may be associated with alcohol induced platelet dysfunction has not previously been investigated. This study evaluated primary haemostasis in 50 adult patients with idiopathic epistaxis. A detailed alcohol history was recorded and the Simplate bleeding time device was used to test haemostatic function. Forty-six per cent of patients were found to have an abnormality of primary haemostasis. Prolongation of the bleeding time was significantly associated with a history of alcohol use. The effect of alcohol on the bleeding time duration was significant (P < 0.001) even at low levels of intake of between 1 and 10 units per week. Although prevalent in the study group (42%) the use of non-steroidal anti-inflammatory drugs did not confer a significant additional risk of increased bleeding time. These findings support the importance of alcohol induced haemostatic abnormalities in the aetiology of adult epistaxis.

The reported benefits of endoscopic versus open scoliosis surgery include improved visualization, a muscle sparing approach, reduced pulmonary morbidity, reduced pain, and improved cosmesis. Some aspects of the surgical learning curve for this technically demanding method have been previously reported; however, improvements in other factors with increasing experience have not been quantified. This paper presents a series of 100 consecutive endoscopic anterior scoliosis corrections performed between April 2000 and February 2006. We report changes in the following perioperative factors with increasing experience; operative set-up time, operative time, x-ray irradiation time, number of instrumented levels, blood loss, intercostal catheter drainage, chest drain removal time, days in intensive care, days to mobilize, days in hospital, and early complications. Statistical comparisons were made between the first 20 (1 to 20), middle 20 (41 to 60), and last 20 (81 to 100) cases. Results showed statistically significant improvements and increased consistency in operative time, operative set-up time, x-ray irradiation time, blood loss, hospital stay, and mobilization time with experience. The complication rate was comparable to other recently published endoscopic studies. In the last 20 cases of the series, operative times had reduced to 35 minutes per level, x-ray irradiation times to 15 seconds per level, and blood loss to 38 mL per level. Most perioperative surgical factors therefore improve significantly with increasing experience in endoscopic anterior scoliosis correction.