119 874 2016 : 0 1cc : : : : : :WBC3 640/μl RBC 247 10 /μl PLT 22 9 10 /μl Hb 7 9g/dl PT APTT : : : 1ml 30G absolute ethanol Et 0 1 0 2ml 2mm
119 875 1 000mg/day Et 0 3ml Al Deen endoglin ALK1 1 3 a b 2 : :
119 876 2016 a b 4 : : 5 6 Aethoxysklerol AS Ethanolamine oleate EO Et in vivo 0 1 1ml Et AS EO ml Et Et AS
119 877 1 I : intensity F : frequency T: transfusion Al Dean 7 Et
119 878 2016 Al Deen S, Bachmann Harildstad G : A grading scale for epistaxis in hereditary haemorrhagic teleangectasia. Rhinology 2008 ; 46 : 281 284. Dakeishi M, Shioya T, Wada Y, et al : Genetic epidemiology of hereditary hemorrhagic telangiectasia in a local community in the northern part of Japan. Hum Mutat 2002 ; 19 : 140 148. :. JOHNS 2005 ; 21 : 1041 1045. Mahoney EJ, Shapshay SM : Nd YAG laser photocoagulation for epistaxis associated with hereditary hemorrhagic telangiectasia. Laryngoscope 2005 ; 115 : 373 375.,,, :Osler NBI. ; :.,,, : :. ; :. :. Vasc Lab 2007 ; 4 : 647 649. :. ; :. :. ; :. Morais D, Millás T, Zarrabeitia R, et al : Local sclerotherapy with polydocanol Aethoxysklerol for the treatment of Epistaxis in Rendu Osler Weber or Hereditary Hemorrhagic Telangiectasia HHT : 15 years of experience. Rhinology 2012 ; 50 : 80 86.,, :. ; :.,, :. ; :.,, :. ; :.,, :. JOHNS 2006 ; 22 : 1417 1421.,, :. ; :.,, :. ; :.,, :Dieulafoy. ; :. : ethanolamine oleate, Aethoxysklerol. ; :.,,, :. ; :.,,, :Osler. ; :. :. ; :., :. ; :. Fernandez LA, Garrido Martin EM, Sanz Rodriguez F, et al : Therapeutic action of tranexamic acid in hereditary haemorrhagic telangiectasia HHT : regulation of ALK 1/endoglin pathway in endothelial cells. Thromb Haemost 2007 ; 97 : 254 262. Geisthoff UW, Seyfert UT, Kübler M, et al : Treatment of epistaxis in hereditary hemorrhagic telangiectasia with tranexamic acid a double blind placebo controlled cross over phase IIIB study. Thromb Res 2014 ; 134 : 565 571.
119 879 A Case of Absolute Ethanol Sclerotherapy and an Adhesion Maneuver for Refractory Epistaxis Associated with Osler s Disease Tetsuro Uchida, M.D. and Hiroyuki Nagai, M.D. Department of Otorhinolaryngology, Matsunami General Hospital Case Report : We report herein on the case of a 75 years old woman with refractory epistaxis associated with Osler s disease. Anemia and recurrent epistaxis occurred 10 years previously, and anemia was treated by a physician near the patient s home. Because she had gradually become unable to control her epistaxis, she visited our hospital. We diagnosed Osler s disease based on her family history, past history, and dilatory changes in the peripheral and nasal mucosa vessels. A skin graft failed and ultrasonic coagulation was not so effective. The refractory epistaxis was due to a connected arteriovenous fistula of the right upper nasal valve. Following ethanol injection sclerotherapy and an adhesion maneuver, the epistaxis was well controlled. Keywords : Osler s disease, refractory epistaxis, absolute ethanol, adhesion maneuver Nippon Jibiinkoka Gakkai Kaiho Tokyo 119 : 874 879, 2016