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In this study from the Czech Republic, the authors looked at the effectiveness of argon plasma coagulation (a non-contact form of monopolar electrocoagulation) in treating recurrent epistaxis in patients with hereditary haemorrhagic telangiectasia (HHT). The advantage of argon plasma coagulation is the limited penetration depth and better ability to control intraoperative bleeding than laser coagulation. The study was conducted over a nine-year period and involved 36 patients with a median age of 59.5 years. Most of the patients also had topical estriol ointment treatment in conjunction with the argon plasma coagulation. All the patients had a history of heavy epistaxis prior to the treatment and some even had repeated blood transfusions. Recurrent epistaxis in these patients can usually be very difficult to manage, so any effective management solutions are important. All of the patients had telangiectasias in the nasal cavity, and most had oral mucosa and skin telangiectasias. Two patients had telangiectasias in other organs. In terms of number of procedures, out of the 36 patients 22 (61%) had more than one procedure, with the maximum number of procedures being 16. The intervals between interventions ranged from one month to eight years. All of the included patients in the study were satisfied with the effects of the treatment in terms of reduction in severity and frequency of epistaxis. There were no significant complications, but there were two small septal perforations. The study suggests that argon plasma coagulation is a safe and effective method for managing the troublesome condition of recurrent epistaxis in HHT, with the advantage of being minimally invasive.

Experience with argon plasma coagulation in treatment of recurrent epistaxis in patients with hereditary haemorrhagic telangiectasia.
Alzbeta F, Dostalova L, Plzak J.
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Sunil Sharma

Alder Hey Children's Hospital, UK.

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