Tympanoplasty surgery: a retrospective audit of surgical outcomes at a regional hospital.

BACKGROUND: Chronic Suppurative Otitis Media (CSOM) is a common condition in our setting, resulting in tympanoplasty surgery being one of the common surgical procedures performed. Little is published regarding outcomes of tympanoplasty surgery in patients living with Human Immunodeficiency Virus (HIV), which has a high prevalence in South Africa. METHODS: A retrospective review of all tympanoplasty surgeries performed at our institute. Outcomes of surgery according to patient demographics, documented HIV status, seniority of surgeon, type and techniques of graft placement and hearing outcomes were reviewed. RESULTS: Successful closure of perforations was 84.4%. Closure rates in the 10 patients known to be HIV positive were 100%. The number of patients meeting the criteria for The Belfast Rule of Thumb (BROT) increased from 26.3% (n = 20) preoperatively to 68.4% (n = 52) postoperatively. CONCLUSION: The results are comparable to both the results obtained at a tertiary hospital and those published internationally. Successful outcomes are obtainable in patients infected with HIV; however, as to the optimal timing of this surgery, this would require further investigation.

Tympanoplasty surgery: a retrospective audit of surgical outcomes at a regional hospital

Background: Chronic Suppurative Otitis Media (CSOM) is a common condition in our setting, resulting in tympanoplasty surgery being one of the common surgical procedures performed. Little is published regarding outcomes of tympanoplasty surgery in patients living with Human Immunodeficiency Virus (HIV), which has a high prevalence in South Africa.Aims:To audit the outcomes of tympanoplasty surgeries performed, including outcomes in patients with HIV.Methods:A retrospective review of all tympanoplasty surgeries performed at our institute. Outcomes of surgery according to patient demographics, documented HIV status, seniority of surgeon, type and techniques of graft placement and hearing outcomes were reviewed.Results:Successful closure of perforations was 84.4%. Closure rates in the 10 patients known to be HIV positive were 100%. The number of patients meeting the criteria for The Belfast Rule of Thumb (BROT) increased from 26.3% (n = 20) preoperatively to 68.4% (n = 52) postoperatively.Conclusions:The results are comparable to both the results obtained at a tertiary hospital and those published internationally. Successful outcomes are obtainable in patients infected with HIV; however, as to the optimal timing of this surgery, this would require further investigation

Buccal fat pad - a simple, underutilised flap.

The pedicled buccal fat pad is a reliable flap for the repair of small oral defects. It is durable, easy to harvest and should be considered in settings where access to free flaps is limited and in cases where previous flaps have failed. We discuss a case where this flap was used successfully for closure of an oro-antral fistula. The indications, anatomy and techniques of successful harvest are discussed.

Endoscopic transnasal removal of migrated dental implants.

We report a case of migration of a dental implant into the maxillary sinus and discuss the benefits of endoscopic transnasal removal of such implants. As the sole approach, this technique has rarely been described. The most commonly used technique for retrieval of dental implants is the Caldwell-Luc procedure. This, however, has certain morbidity associated with it and may compromise subsequent implant insertion.

Clinical chemistry reference values in two breeds of swine and their changes during percutaneous exposure to soman.

Clinical chemistry reference values in blood from 48 nonfasting Chester White/Yorkshire and 48 Hanford Miniature swine were determined. Subsequently, 40 animals of each breed were restrained in a cloth sling and fasted for 24 hours while exposed percutaneously to pinacolyl methylphosphonofluoridate (soman). The range of dosages for the Hanford Miniature swine was 2.0 to 15.8 mg/kg, and for the Chester White/Yorkshire swine, the range was 4.0 to 25.0 mg/kg. Sham-exposed groups, consisting of 8 animals of each breed, were treated in an identical manner, except no anticholinesterase agent was administered. Samples of blood were drawn at 1, 7, 14, and 28 days after soman or sham exposure. In the sham-exposed groups, significant changes from the reference values were observed as a result of the 24-hour restraint. In both breeds, skeletal muscle enzyme activities were increased, plasma cholinesterase activity (ChEPL) was decreased, calcium concentration was decreased, and phosphorus concentration was increased. Percutaneous exposure to soman resulted in decreases of ChEPL and erythrocyte cholinesterase activities (ChERBC). The ChEPL recovered more quickly than the ChERBC in both breeds. Even in asymptomatic swine, the decrease of ChERBC was greater than 60% after 24 hours. In the swine of each breed given the largest dosage, hyperglycemia was apparent in blood samples taken at the onset of apnea, especially when the animal survived for greater than 2 hours. We conclude that both breeds of swine, on the basis of dispersion in clinical chemistry reference values, were equally suited for this type of dermatotoxicity study. The sling method of restraint, however, caused some undesirable changes in biochemical values.

Irrigating solutions used in arthroscopy and their effect on articular cartilage. An in vivo study.

The effect of arthroscopic irrigating solutions on articular cartilage was determined by the use of an animal model. Rabbit knee joints were irrigated continuously for two hours with either normal saline, Ringer's lactate, or sterile water. Subsequently, the rate of incorporation of 35SO4 by articular cartilage was used to measure the effect of the irrigants on chondrocyte metabolism. In addition, the irrigated groups were compared to an unirrigated control group. There was no significant difference in 35SO4 incorporation between the groups. This suggested that none of the irrigating solutions used in this study adversely affected articular cartilage function. On the basis of these findings, it appears that normal saline, Ringer's lactate, and sterile water can be safely used as irrigating solutions during most arthroscopic procedures.

Disseminated nocardiosis in three macaque monkeys.

Extrapulmonary nocardiosis was diagnosed at necropsy in two rhesus monkeys (Macaca mulatta) and one pigtailed monkey (M. nemestrina) over a four-year period in a large primate center. Typical lesions were multiple pyogranulomatous foci in the liver, intestines, peritoneum, lung and brain. Partially acid-fast, branching, filamentous organisms were seen in all lesions. Nocardia sp. was isolated from two cases. We postulate that two of the monkeys were infected by the oral route because of the distribution of lesions.

Bone marrow depletion as a coincidental finding to hypothermia in Macaca mulatta.

Three of 16 juvenile rhesus monkeys (Macaca mulatta) and 1 rhesus of 79 adult rhesus and cynomolgus monkeys (Macaca fascicularis) were found comatose in a state of profound hypothermia after a heating failure occurred in the room in which they were housed. One juvenile monkey died shortly thereafter. The three other monkeys were revived with gradual warming and supportive therapy but later experienced separate acute clinical crises manifesting shock and died at 19, 31, and 51 days after the initial episode. Histopathologic findings of severe bone marrow depletion were observed in each of the three monkeys that died after the initial episode.

A new technique for restraint of mice.

One hundred ninety-five mice were restrained for an ear punching and toe clipping identification procedure using a new technique. The unique feature of the restraint method was that the mouse's head was immobilized within a finger loop of surgical scissors.

Seasonal and sexual influences on rabbit atropinesterase.

Atropinesterase was found in 61.17% of 6686 New Zealand White rabbits of both sexes studied over 2.5 years. Significantly more males possessed the enzyme, there was a significant difference in atropinesterase frequencies in males versus females in the winter and summer seasons, and a significant decrease in the frequency of atropinesterase-positive females during the winter.

In vivo detection of rabbit atropinesterase.

The comparability of an in vivo rapid screening test for the presence of atropinesterase with an in vitro standard colorimetric test was assessed using 410 male and female New Zealand white rabbits. The results from both tests were in agreement in 405 of the 410 (98.8%) rabbits compared. One false negative and four false positive results occurred with the rapid screening test.

A comparison of bacterial flora isolated by transtracheal aspiration and pharyngeal swabs in Macaca fascicularis.

The pulmonary flora of 30 monkeys (Macaca fascicularis) was sampled by the transtracheal aspiration technique and the pharyngeal swab method, and the results were compared. The transtracheal aspiration technique yielded lower numbers of bacteria in both aerobic and anaerobic cultures. The bacteria isolated by transtracheal aspiration were predominately pure culture, thereby lowering the possibility of contamination from commensal flora. Bordetella bronchiseptica was isolated from 23.3% of the monkeys by transtracheal aspiration, but this organism was not isolated when samples were collected with pharyngeal swabs.