title: Plasma surgery and topical estriol: effects on the nasal mucosa and long-term results in patients with Osler's disease.
abstract: OBJECTIVE
  The study goal was to report on the long-term results and effect of argon plasma coagulation (APC) surgery and topical estriol in patients with Osler's disease who had recurrent epistaxis. Study design In a prospective clinical study, 52 patients underwent APC and estriol application and were followed for 18 months regarding their bleeding frequency and intensity. Patient blood samples were obtained to determine the serum estriol levels. Scanning electron microscopy of the nasal mucosa enabled a better understanding concerning the effect of estriol on the nasal mucosa.
  
  
  RESULTS
  Eighteen months after treatment, 96% of the patients stated a significantly reduced bleeding frequency and intensity. Under estriol influence, former berry-like telangiectasia of the nasal mucosa was flatter. The serum estriol levels did not increase significantly in any of the patients. No side effects from the use of topical estriol were observed.
  
  
  CONCLUSIONS
  The combined treatment approach with APC and topical estriol significantly reduces epistaxis in Osler's disease.
  
  
  CONCLUSIONS
  APC and topical estriol have proved to be a promising alternative in the treatment of Osler's disease.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University, Hospital Mannheim, Mannheim, Germany. haneen.sadick@hno.ma.uni-heidelberg.de
authors.forename: Haneen
authors.initials: H
authors.lastname: Sadick
authors.forename: Ramin
authors.initials: R
authors.lastname: Naim
authors.forename: Naim
authors.initials: N
authors.lastname: Ramin
authors.forename: Jasmina
authors.initials: J
authors.lastname: Oulmi
authors.forename: Karl
authors.initials: K
authors.lastname: Hörmann
authors.forename: Hörmann
authors.initials: H
authors.lastname: Karl
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bergler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003131:Combined Modality Therapy; D004844:Epistaxis / Q000601:surgery; D004964:Estriol / Q000097:blood / Q000494:pharmacology* / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000187:drug effects* / Q000601:surgery* / Q000648:ultrastructure; D011446:Prospective Studies; D012008:Recurrence; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000175:diagnosis / Q000601:surgery*; D013684:Telangiectasis / Q000175:diagnosis / Q000601:surgery
chemical_list: D004964:Estriol