A definite association between blood pressure and history of adult epistaxis in hypertensive patients was not found. The evidence for an association of duration of hypertension and left ventricular hypertrophy with epistaxis suggests that epistaxis might be a consequence of long-lasting hypertension. The association between the presence of enlarged vessels at rhinoscopy with history of epistaxis in hypertensive patients is a novel observation that needs to be addressed in future observations.

There is disagreement on the role of bacteria in the genesis and maintenance of chronic secretory otitis media (CSOM). Extensive studies from other countries report up to 40% of middle ear cultures with bacterial growth. For the present study, material was collected from 94 ears of children with both clinical and tympanometric diagnoses of CSOM. The samples were sent for bacteriological analysis, in there it was stained according to Gram's method and put into growing media: MacConkey (for gram-negative bacteria) and blood agar (for gram-positive bacteria) for 24 h, at 37 degrees C. If germs were identified by Gram's method, antibiograms would be carried out as well, with the Mueller Hington medium. No cultures were made for anaerobes. Only one ear had grown bacteria (Staphylococcus epidermidis), which was deemed contamination. No other ear studied bore bacteria. The possible causes for this disagreement between our study and the literature are discussed.

Chamar a atenção dos pediatras para uma causa rara de epistaxes severas de repetição. Métodos: Os autores descrevem um caso de criança com Síndrome de Bernard-Soulieur e fazem uma revisão de relatos da Síndrome em língua inglesa existentes no MEDLINE desde 1970. Resultados: É descrito um menino de 3 anos e 3 meses, com quadro de epistaxes volumosas de repetição, com importante repercussão hemodinâmica, no qual foram necessárias várias transfusões de sangue e hemoderivados. Foram estabelecidas diversas suspeitas diagnósticas até que, pelo exame de sangue periférico, idendificaram-se macroplaquetas. O diagnóstico final foi de Síndrome de Bernard-Soulieur, e procedeu-se à embolização da artéria maxilar para solucionar as epistaxes de repetição. Conclusões: Embora salientando a raridade da síndrome de Bernard-Soulier e de outras trombocitopatias como causa de epistaxe em crianças, sempre se deve estar atento para essa possibilidade, principalmente quando o quadro de sangramentos for repetitivo e severo.

Avaliação do poder diagnóstico dos sinais e sintomas na otite média aguda Evaluation of the diagnostic power of symptoms and signs in acute otitis media