Abstract The present work was carried out with the objective of evaluating the epidemiology of Leptospirosis in companion animals in Paraguay, year 2021 - 2022. For this purpose, samples were taken from a database, granted by a private veterinary laboratory, of laboratory results of positive, negative and serovars of leptospirosis in animals of the canine and feline species of different origins corresponding to the years 2021 and 2022. Of a total of 6506 samples of canines and felines, a prevalence of 80% was obtained in the year 2021 and 69.4% by the year 2022. The presence of anti-leptospiral antibodies in canines being more frequent, between the year 2021 (95.8%) and 2022 (89.5%), and from the feline species 4.1 were obtained. % for the year 2021 and 10.4% in the year 2022. Likewise, in the year 2021 a high prevalence of seropositivity to Leptospirosis was registered in the Central department (90.9%) and in the year 2022 corresponding again to the Central department (92%). Likewise, a survey was carried out on 81 veterinary professionals who had cases of Leptospirosis who attended a veterinary consultation, on the diagnostic methods most used, 35% used the Elisa test, 30.8% stated that they used more than one test as diagnostic method, 24.6% used the microscopic agglutination test (MAT), 4.9% used PCR, and the remaining 3.7% used the dark background microscopy test. Regarding the most frequent symp toms, they were the following: fever (69.1%), paleness of the mucous membranes (53%), dehydration (43.2%), anorexia (41.9%), reddish-brownish urine (40 7%), vomiting (37%), jaundice (33.3%), diarrhea (32%), neuro- logical symptoms (25.9%), uraemic halitosis (24.6%), sublumbar/renal pain (23, 4%), respiratory symptoms (16%), episcleral vascular congestion (12.3%), drowsiness (8.6%), and epistaxis (6.1%). Leptospirosis, being a zoonotic disease, re-emerging and neglected, is currently gaining relevance due to the results obtained in this research showing that it is a disease with high seropositivity in our country.

Resumen La leptospirosis al ser una enfermedad que se transmite a través de los animales se vuelve de gran interés epidemiológico por su implicancia en la salud pública, ya que estos pueden transmitir la bacteria a los seres humanos por la convivencia entre ellos, por lo cual está investigación tuvo como objetivo evaluar la epidemiología de la Leptospirosis en animales de compañía en Paraguay, año 2021 - 2022. Se accedió a una base de datos, otorgado por un laboratorio veterinario privado, con resultados laboratoriales positivos, negativos y serovares de leptospirosis en animales de la especie canina y felina de distintas procedencias correspondiente a los años 2021 y 2022, y se realizó una encuesta a 81 profesionales veterinarios que tuvieron casos clínicos de Leptospirosis. De un total de 6506 muestras de caninos y felinos, se obtuvieron una prevalencia del 80% en el año 2021 y 69,4% para el año 2022. Siendo más frecuente la presencia de anticuerpos anti leptospiras en caninos, entre el año 2021 (95,8%) y 2022 (89,5%), y de la especie felina se obtuvo 4,1% para el año 2021 y 10,4% en el año 2022. Así mismo, en el año 2021 se registró una alta prevalencia de seropositividad a Leptospirosis en el departamento Central (90,9%) y en el año 2022 correspondiendo nuevamente al departamento Central (92%). Mediante la encuesta, se obtuvo que de los métodos de diagnósticos mayormente utilizado es el de Elisa con un empleo del 35%, el 30,8% manifestaron usar más de una prueba como método de diagnóstico, 24,6% utilizaron la prueba de aglutinación microscópica (MAT), 4,9%% usaron PCR, y el 3,7% restante se valieron de la prueba de microscopía de fondo oscuro. En cuanto a los síntomas más frecuentes fueron los siguientes: fiebre (69,1%), palidez de las mucosas (53%), deshidratación (43,2%), anorexia (41,9%), orina rojiza - parduzca (40,7%), vómito (37%), ictericia (33,3%), diarrea (32%), síntomas neurológicos (25,9%), halitosis urémica (24,6%), dolor sublumbar/renal (23,4%), síntomas respiratorios (16%), congestión vascular episcleral (12,3%), somnolencia (8,6%), y epistaxis (6,1%). La Leptospirosis al ser una enfermedad zoonótica, de carácter reemergente y des- cuidada, cobra relevancia en la actualidad debido a los resultados obtenidos en esta investigación demuestran que es una enfermedad de elevada seropositividad en nuestro país.

ABSTRACT Objectives: To verify the role of adenoid hypertrophy (AH) and otitis media with effusion (OME) in adult patients, in relation to the diagnosis of clinically asymptomatic nasopharyngeal carcinoma (NPC). Methods: One hundred and six adult patients were enrolled in this retrospective study. Of 256 cases who underwent nasopharyngeal biopsy for suspected nasopharyngeal malignancy in our clinic between January 2009 and July 2014, this subset met our criteria. We divided the patients into two groups—patients with AH only and those with synchronous presence of OME, and AH. Results: Two patients out of 68 (2.9%) in the first group (only AH) and one patient out of 38 (2.6%) in the second group had NPC. There was no statistically significant difference. Conclusion: We found that asymmetric AH in adult patients seems an important risk factor for NPC, and we strongly suggest that biopsy be done to rule out nasopharyngeal carcinoma, whether or not they synchronously have OME even in the absence of other clinical symptoms that would arouse suspicion of a nasopharyngeal malignancy, such as neck mass, epistaxis and cranial nerve impairment.

Plasma cell neoplasia has a wide presentation of disease (localised or systemic) according to the International Myeloma Working Group. Radiological imaging identifies plasmacytomas as solitary lesions or part of multiple myeloma. We present a rare case of a 21-year-old female who presented with a skull-base tumour. CONTRIBUTION: A head and neck plasmacytoma with further lytic bone lesions was confirmed on imaging. This article presents and discusses the clinical, CT, MRI, positron emission tomography (PET)-CT, histology and laboratory findings.

Abstract Introduction Angioleiomyoma is a rare neoplasm that represents ∼ 0.2 % of all head and neck benign tumors and ∼ 2% of total cases of tumors of the sinonasal tract. It was once considered a possible subtype of leiomyoma, but, in the 2020 World Health Organization (WHO) classification of soft tissue tumors, it is accepted as a singular entity. Objective To systematically review the existing literature on angioleiomyoma in the light of the new classification of soft tissue tumors. Data Synthesis The present study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search in the PubMed, Cochrane, Scopus, and Google Scholar databases was performed in January 2022. The search items included the following keywords: nasal angioleiomyoma OR sinonasal angioleiomyoma OR nasal vascular leiomyoma OR sinonasal vascular leiomyoma. A total of 87 patients were evaluated. He age of the patients in the studies ranged from 15 to 88 years (mean age at diagnosis: 55.6 years). The most common site of involvement was the nasal septum (28.4 %), followed by the inferior turbinate (22.5%). The most common symptom was nasal obstruction (66.7%), followed by epistaxis (47.1%). Surgical excision represented the main treatment, and there was recurrence of pathology in only 1 case (0.9%). Conclusion To our knowledge, only 87 cases of sinonasal-tract angioleiomyoma have been previously described. The results of the present review seem to confirm the rarity and the benign nature of this neoplasm, and they seem to confirm the necessity to improve the available data about sinonasal-tract angioleiomyoma.

Abstract Objective To analyze variability in the distance between the Anterior Ethmoidal Artery (AEA) and the anterior Skull Base (SB), as well as the frequency of lateral asymmetry in a Latin American population using computed tomography. Methods A total of 250 computed tomography scans of paranasal sinuses in coronal reconstruction (500 AEAs) were analyzed. After determining the image with the best anatomical view of the artery, the distance between its midpoint and the ethmoidal roof was measured, and the images were independently interpreted by 2 physicians. Results Of the 500 AEAs, 279 (55.8%) adhered to or passed through the SB at a distance of 0 mm. A total of 221 AEAs (44.2%) were at some distance from the SB, of which 107 (48.4%) were on the right side, ranging from 1.18 to 6.75 mm, and 114 (51.5%) were on the left side, ranging from 1.15 to 6.04 mm. The overall mean distance between the AEA and SB was 1.22 (SD = 1.57) mm, increasing to 2.77 (SD = 1.14) when the arteries adhered to the SB were excluded. Seventy-six individuals (30.4%) had a lateral distance variation > 1 mm. Conclusion Our study includes the largest sample of AEA analyzed with computed tomography scans of paranasal sinuses. There was some distance between the AEA and SB in almost half the patients, and we found a high rate of lateral variability >1 mm. Level of evidence: Level 3.

Abstract We present the clinical case of a 58-year-old woman who consulted for episodes of self-limited epistaxis in the right nostril associated with hypersensitivity to manipulation of this nostril. Examination revealed a nodular mucosal lesion in the nasal septum, with a hard consistency and purplish appearance. The lesion was excised endonasally, with histopatho-logical result of a glomus tumor (GT) of the nasal septum. The GT is a benign perivascular neoplasm, derived from smooth muscle cells present in the glomus body; structure with thermoregulatory function, formed by a shunt between arterioles and venules, without the presence of capillary network. Glomus bodies are mostly present in the extremities (nail bed). Glomus tumors are truly exceptional in the ENT area, with only about thirty cases published to date at the nasosinusal level. Most cases occur between the 5th and 6th decade of life and more frequently in women. It raises differential diagnosis fundamentally with two entities: paraganglioma (with which it should not be confused from the terminological or histological point of view) and with solitary fibrous tumor (former hemangiopericytoma). The behavior is benign and the treatment is surgery.

Resumen Presentamos el caso clínico de una mujer de 58 años que consulta por episodios de epis-taxis autolimitadas por fosa nasal derecha asociados a hipersensibilidad al manipular dicha fosa nasal. A la exploración se evidenció en el septum nasal una lesión mucosa nodular, de consistencia dura y aspecto violáceo. Se llevó a cabo exéresis de la misma por vía endonasal, con resultado histopatológico de tumor glómico (TG) del septum nasal. El TG es una neoplasia benigna perivascular, derivada de las células musculares lisas presentes en el cuerpo glómico; estructura con función termorreguladora, formada por un shunt entre arteriolas y vénulas, sin presencia de red capilar. Los cuerpos glómicos están presentes, mayoritariamente, en extremidades (lecho ungueal). Los tumores glómicos son, verdaderamente, excepcionales en el área ORL, existiendo sólo una treintena de casos publicados hasta la fecha a nivel nasosinusal. La mayoría de casos se presentan entre la 5ᵃ y 6ᵃ década de la vida y más, frecuentemente, en mujeres. Plantea diagnóstico diferencial, fundamentalmente, con dos entidades: el paraganglioma (con el que no debe ser confundido desde el punto de vista terminológico ni histológico), y con el tumor fibroso solitario (antiguo hemangiopericitoma). El comportamiento es benigno y el tratamiento es la cirugía

Resumo Objetivos: Caracterizar a demografia, apresentação, tipos histológicos, tratamento e sobrevida de doentes com tumores malignos nasossinusais diagnosticados num centro hospitalar terciário em Portugal. Desenho do estudo: Estudo retrospetivo. Materiais e métodos: Revisão de registos clínicos de janeiro de 2012 a dezembro de 2021. Resultados: Foram incluídos 19 pacientes, com predomínio do género masculino (57,9%) e uma idade média ao diagnóstico de 66,7 ± 9,8 anos. Os sintomas de apresentação mais comuns foram a obstrução nasal e a epistáxis (47,4%). O carcinoma pavimentocelular foi o subtipo histológico mais frequente (21,1%). Houve um predomínio do tratamento cirúrgico primário comparativamente ao tratamento não cirúrgico (84,2% VS 15,8%). Nove doentes foram submetidos a uma abordagem externa, enquanto em 7 a abordagem foi endoscópica endonasal. O tempo médio de seguimento dos doentes foi de 26,9 ± 20,6 meses. A sobrevida global aos 5 anos foi de 53,5% e a sobrevida livre de doença foi de 62,8%. Conclusões: Neste estudo o prognóstico foi dependente do estadio da doença e da modalidade terapêutica, e, a abordagem endoscópica endonasal foi segura e eficaz em doentes devidamente selecionados.

Abstract Objectives: To characterize demographics, presentation, histologic types, treatment and survival of patients with sinonasal malignancies diagnosed at a tertiary hospital center in Portugal. Study design: Retrospective study. Material and methods: Review of clinical records from January 2012 to December 2021. Results: Nineteen patients were included, with male predominance (57.9%) and a mean age at diagnosis of 66.7 ± 9.8 years. The most common presenting symptoms were nasal obstruction and epistaxis (47.4%). Squamous cell carcinoma was the most common histologic subtype (21.1%). Primary surgical therapy was preferred comparative to nonsurgical therapy (84.2% VS 15.8%). Nine patients were submitted to external approach, while 7 patients underwent endonasal endoscopic treatment. The mean follow-up time was 26.9 ± 20.6 months. Five-year overall survival was 53.5% and disease-free survival was 62.8%. Conclusion: In this study prognosis was stage and treatment-dependent, and endoscopic approach was safe and effective in carefully selected patients.

RESUMEN Introducción: Las fracturas nasales son las más comunes de la región maxilofacial. Sin embargo, la literatura cubana sobre el tema es escasa y desactualizada, por lo que surgió la motivación para realizar esta investigación. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con fractura nasal atendidos en un hospital universitario cubano. Métodos: Se realizó un estudio observacional, descriptivo y transversal en pacientes atendidos en el Servicio de Cirugía Maxilofacial del Hospital General Universitario “Carlos Manuel de Céspedes” de Bayamo, provincia Granma, Cuba, en el período comprendido entre el 1 de enero y el 31 de diciembre del 2020. Se estudiaron variables clínicas, epidemiológicas y terapéuticas. Resultados: Se incluyeron 99 pacientes, de los cuales 74 (74,75 %) fueron masculinos. En el 44,44 % de los casos las edades estuvieron comprendidas entre los 21 y 40 años. Cincuenta pacientes (50,51 %) tuvieron fracturas producto de la violencia interpersonal. Noventa y siete pacientes (97,98 %) presentaron epistaxis. Cincuenta y nueve pacientes (59,60 %) recibieron reducción cerrada asociada con taponamiento nasal y fijación externa con yeso. Conclusiones: Predominó el sexo masculino y el grupo de edades de 21 a 40 años. La principal etiología fue la violencia interpersonal. En la mayoría de los casos la epistaxis estuvo presente. Prevalecieron las fracturas cerradas, así como las que tuvieron el dorso desviado lateralmente.

ABSTRACT Introduction: Nasal fractures are the most common fractures of the maxillofacial region. However, Cuban literature on the subject is scarce and outdated, so the motivation for this research arose. Objective: To characterize patients with nasal fractures treated in a Cuban university hospital in a clinical and epidemiological manner. Methods: An observational, descriptive and cross-sectional study was carried out in patients treated at the Maxillofacial Surgery Service of the University General Hospital. “Carlos Manuel de Céspedes” of Bayamo, Granma province, Cuba, from January 1 to December 31, 2020. Clinical, epidemiological and therapeutic variables were studied. Results: 99 patients were included, of whom 74 (74.75 %) were male. In 44.44 % of the cases the ages were between 21 and 40 years. Fifty patients (50.51 %) had fractures resulting from interpersonal violence. Ninety-seven patients (97.98 %) presented epistaxis. Fifty-nine patients (59.60 %) received closed reduction associated with nasal packing and external fixation with plaster cast. Conclusions: Male gender and age group 21 to 40 years predominated. The main etiology was interpersonal violence. Epistaxis was present in most cases. Closed fractures prevailed, as well as those with laterally deviated dorsum.

Abstract Bleeding is an important factor in FESS since it increases the rate of complications. The main objective of perioperative management is to achieve good hemostasis. This is a review of the main recommendations of the international literature, that includes preoperative, intraoperative and postoperative measures.

Resumen El manejo del sangrado en CEF es fundamental, ya que aumenta la tasa de complicaciones. El principal objetivo del manejo perioperatorio es lograr una buena hemostasia, es por esto que se realizó una revisión de las principales recomendaciones de la literatura internacional, que incluye medidas preoperatorias, intraoperatorias y postoperatorias.

Resumo A leishmaniose é uma doença infeciosa, causada por protozoários do género Leishmania, cujo vetor de transmissão é a picada de mosquitos (fêmeas) chamados flebótomos. Existem três formas principais - visceral, cutânea e mucocutânea, sendo a afeção da mucosa a manifestação mais rara da doença. A incidência em Portugal é considerada hipoendémica. Apresentamos um caso clínico de uma mulher, com queixas de obstrução nasal, epistáxis e lesões irregulares eritematosas a nível das asas do nariz, columela, vestíbulo e septo nasal. Foram realizadas biópsias das lesões cutâneas e da mucosa nasal que revelaram a presença de corpos de Leishman-Donovan. A doente foi submetida a tratamento com anfotericina B e itraconazol com boa evolução clínica e desaparecimento das lesões. A leishmaniose mucocutânea atinge preferencialmente a mucosa nasal e se não diagnosticada e tratada atempadamente pode levar a destruição da cartilagem e disseminação das lesões para a nasofaringe, faringe e laringe comprometendo a via aérea e provocando desfiguração.

Abstract Leishmaniasis is caused by the protozoan parasite Leishmania which is transmitted through bites of infected female phlebotomine sandflies. There are 3 main forms - visceral, cutaneous and mucocutaneous, with mucosal affection being the rarest manifestation of the disease. The incidence in Portugal is considered hypoendemic. We present a case of a 48 years old female, with complaints of nasal obstruction, epistaxis and irregular erythematous scaly plaques surrounding the nostrils. Histology of the nasal septum and skin revealed the presence of Leishmania-Donovan bodies. She was treated with amphotericin-B and itraconazole with clinical improvement and disappearance of lesions. Mucocutaneous leishmaniasis preferably affects the nasal mucosa and if not diagnosed and treated in time can lead to cartilage destruction and dissemination of mucosal lesions to the nasopharynx, larynx, compromising the airway and even leading to disfigurement.

Abstract Objectives: The aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment. Methods: This is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5–6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting. Results: The participants had significant improvement in the post-test scores in all three scenarios (p < 0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p < 0.05). Conclusion: Simulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill. Level of evidence: II. Objectives lecturebased lecture based simulationbased Methods 6 emergencies 56 5 5– 15days days 15 postings day pretest pre test groups Tracheostomy group, group , Nasogastric Epistaxis done Handson Hands 15days, days, posttest post conducted posting Results p 0.05, 005 0.05 0 05 0.05) handson hands 0.05. . Conclusion Simulationbased Simulation skill evidence II 1 00 0.0 0.

ABSTRACT Glomangiopericytoma is a rare vascular neoplasm of the nasal cavity and paranasal sinuses that occurs during the sixth or seventh decade of life. It is categorized as a borderline tumor with low malignant potential and classified as a distinct entity of sinonasal tumors with perivascular myoid phenotype by the World Health Organization (WHO). We report the case of a 50-year-old woman with nasal obstruction and severe epistaxis. The nasal sinuses computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a 3.1 cm soft tissue mass occupying the upper part of the left nasal cavity invading the left paranasal sinuses and nasal septum, and the left eye medial rectus muscle. A total mass resection was performed by nasal endoscopy. The histological and immunohistochemical examination yielded the diagnosis of glomangiopericytoma. This case report aims to contribute to the knowledge of nasal neoplasms. The need for more data on this entity is the main obstacle to developing standardized treatment guidelines. life WHO. WHO . (WHO) 50yearold yearold 50 year old epistaxis CT, CT , (CT) MRI (MRI 31 3 1 3. septum muscle endoscopy glomangiopericytoma neoplasms guidelines (WHO 5 (CT

RESUMO Esta revisão teve como objetivo fornecer uma visão geral das malformações arteriovenosas pulmonares, incluindo as principais apresentações clínicas e radiológicas, investigação e algoritmo de tratamento da condição. A principal etiologia das malformações arteriovenosas pulmonares é a telangiectasia hemorrágica hereditária (THH), também conhecida como síndrome de Rendu-Osler-Weber, com mutações no gene ENG no cromossomo 9 (THH tipo 1) ou no complexo ACVRL1/ALK1 (THH tipo 2). A epistaxe sempre deve ser avaliada quando repetida, quando associada à anemia e em alguns casos de hipoxemia. Na investigação, a ecocardiografia e TC de tórax com contraste são essenciais para avaliar essa condição. A embolização é a melhor escolha terapêutica, especialmente para correção em casos de hipoxemia ou para evitar infecções sistêmicas. Por fim, o manejo da doença foi abordado em condições especiais, como a gravidez. O acompanhamento por TC deve ser feito a cada 3-5 anos, dependendo do tamanho dos vasos aferentes e eferentes, e a antibioticoprofilaxia deve sempre ser orientada. Em última análise, o conhecimento da doença pelos profissionais de saúde é um ponto crucial para o diagnóstico precoce desses pacientes na prática clínica, o que pode potencialmente modificar o curso natural da doença. radiológicas condição THH, THH , (THH) RenduOslerWeber, RenduOslerWeber Rendu Osler Weber, Weber Rendu-Osler-Weber 1 ACVRL1ALK1 ACVRLALK ACVRL1 ALK1 ACVRL ALK ACVRL1/ALK 2. 2 . 2) repetida terapêutica sistêmicas fim especiais gravidez 35 3 5 3- anos eferentes orientada análise clínica ACVRL1ALK

ABSTRACT This review aimed to provide an overview of pulmonary arteriovenous malformations, including the major clinical and radiological presentations, investigation, and treatment algorithm of the condition. The primary etiology of pulmonary arteriovenous malformations is hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, with mutations in the ENG gene on chromosome 9 (HHT type 1) or in the ACVRL1/ALK1 complex (HHT type 2). Epistaxis should always be evaluated when repeated, when associated with anemia, and in some cases of hypoxemia. In the investigation, contrast echocardiography and chest CT are essential for evaluating this condition. Embolization is the best treatment choice, especially for correction in cases of hypoxemia or to avoid systemic infections. Finally, disease management was addressed in special conditions such as pregnancy. CT follow-up should be performed every 3-5 years, depending on the size of the afferent and efferent vessels, and antibiotic prophylactic care should always be oriented. Ultimately, knowledge of the disease by health professionals is a crucial point for the early diagnosis of these patients in clinical practice, which can potentially modify the natural course of the disease. presentations investigation condition HHT, HHT , (HHT) RenduOslerWeber Rendu Osler Weber syndrome 1 ACVRL1ALK1 ACVRLALK ACVRL1 ALK1 ACVRL ALK ACVRL1/ALK 2. 2 . 2) repeated anemia choice infections Finally pregnancy followup follow up 35 3 5 3- years vessels oriented Ultimately practice ACVRL1ALK

RESUMO: Mineralização dos tecidos moles e ulceração epitelial são achados comuns em cães com uremia, sendo geralmente observados no trato gastrointestinal, pulmões e pleura. O objetivo desse relato é reportar um caso de mineralização e ulceração da mucosa nasal contribuindo para epistaxe recorrente em um cão com insuficiência renal crônica e uremia. Um cão com epistaxe recorrente e aumento da ureia e creatinina foi hospitalizado. A contagem plaquetária e os testes de coagulação não tinham alterações. Foi diagnosticado insuficiência renal crônica, e o cão foi submetido a eutanásia. Na necropsia, o cão tinha os rins diminuídos, com superfície irregular. As conchas nasais estavam levemente avermelhadas. Histologicamente, foi diagnosticada uma glomerulonefrite crônica com mineralização gástrica e hiperplasia das paratireoides. As conchas nasais tinham mineralização da parede de vasos e membrana basal, úlceras e hemorragia. Os achados histopatológicos indicam que a mineralização e ulceração nasal foram causadas pela uremia. A severidade das lesões histológicas sugere que a mineralização/ulceração nasal pode ter causado, ou pelo menos contribuído, para a epistaxe deste cão. Espera-se, com esse relato, estimular futuros estudos que investiguem uma possível associação entre uremia, mineralização/ulceração nasal e epistaxe em cães.

ABSTRACT: Soft tissue mineralization and epithelial ulceration are common findings in dogs with uremia, being commonly reported in the gastrointestinal tract, lungs and pleura. This report described a case of nasal mucosal mineralization and ulceration contributing to recurrent epistaxis in a dog with chronic renal failure and uremia. A dog with recurrent epistaxis accompanied by elevated urea and creatinine was hospitalized. Platelet count and coagulation tests were within normal limits. Chronic renal failure was diagnosed, and the dog was euthanized. On necropsy, the kidneys were small, with an irregular capsular surface. The nasal conchae were slightly reddish. Histopathology revealed chronic glomerulonephritis, with gastric mineralization and bilateral parathyroid hyperplasia. Vascular and basal lamina mineralization, epithelial ulceration and hemorrhage were seen in the nasal conchae. The observed findings indicated that nasal mineralization and ulceration were caused by uremia. The severity of histopathological findings suggested that nasal mineralization/ulceration may have caused or at least contributed to epistaxis in this dog. We hope to stimulate further investigations into possible association between uremia, nasal mucosa mineralization/ulceration and epistaxis in dogs.

Abstract Introduction Choanal polyps are benign lesions arising from the sinonasal mucosa, extending through the choana into the nasopharynx. Though polyps arising from the maxillary sinus and extending to the choana are common, polyps arising from the sphenoid sinus ostium, posterior part of middle turbinate, and inferior and middle meatus are quite uncommon. Objective To document the site of origin of choanal polyps arising from unusual sites; their clinical, radiological, and histopathological characteristics, as well as diagnostic challenges and management. Methods This retrospective, single-center study included 14 patients aged 16 to 75-years-old with choanal polyps. After obtaining informed consent, their clinical, radiological and surgical details and histopathology reports were reviewed. Patients were followed for at least 6 months after surgery. Results The predominant symptoms were unilateral nasal obstruction (n = 9), snoring, rhinorrhea, and epistaxis. Though anterior rhinoscopy was unremarkable, a mass could be visualized during posterior rhinoscopy in the nasopharynx in 11 patients, and a mass could be directly visualized in the oropharynx in 2 patients. After diagnostic by nasal endoscopy, these polyps were noted to arise from the posterior aspect of the middle meatus (n = 6), middle turbinate (n = 3), posterior septum (n = 3), sphenoid sinus ostium (n = 1), and inferior meatus (n = 1). All patients were managed surgically. The histopathological examination revealed inflammatory polyp (n = 12), actinomycosis (n = 1), and rhinosporidiosis (n = 1). Patients were followed up for 6 to 22 months. We observed no complications or recurrence. Conclusion Diagnostic nasal endoscopy should be performed in all patients presenting with nasal obstruction, to rule out choanal polyps arising from unusual sites. Complete polyp removal and appropriate treatment based on histopathology prevents recurrence. mucosa common uncommon sites clinical characteristics management retrospective singlecenter single center 1 75yearsold yearsold 75 years old consent reviewed surgery n 9, 9 , 9) snoring rhinorrhea epistaxis unremarkable 6, 6) 3, 3 3) 1, 1) 1. . surgically 12, 12 12) recurrence 7