Ministry of Health clinical practice guidelines: Management of Rhinosinusitis and Allergic Rhinitis.

The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on Management of Rhinosinusitis and Allergic Rhinitis, for the information of readers of the Singapore Medical Journal. Chapters, page and figure numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=24046). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Effects of a hot environment on simulated cycling and running performance in triathletes.

AIM: This study examined the effects of a hot environment on metabolic responses, thermoregulation, and performance during simulated cycling and running in triathletes. METHODS: Seven male triathletes completed two trials in moderate (22+/-0.2 degrees C, 76+/-2% relative humidity, M) and hot (31.2+/-0.2 degrees C, 76.4+/-1.6% relative humidity, H) environmental conditions separated by at least 7 days. The subjects were required to complete a self-paced 40 km simulated cycling, followed by a 10 km run on a treadmill for as fast as possible in both trials. RESULTS: The overall performance time was faster in M than H (M vs H, 119+/-6 min vs 127+/-6 min, P<0.01). Moreover, there were no differences in the cycling time between the two trials, but the run time was faster in M (M vs H, 51+/-4 min vs 59+/-5 min, P<0.05) than in H. Ad libitum water consumption was higher in H than in M (H vs M, 970+/-231 mL min(-1) vs 547+/-131 mL min(-1) P<0.05), and the mean skin temperature was also higher in H than in M throughout the exercise (H vs M, 35.3+/-0.1 vs 33.3+/-0.1 degrees C, P<0.05). However, there were no differences in rectal temperature, blood lactate, blood glucose, body mass change, plasma volume change, osmolality, carbohydrate oxidation, and fat oxidation between the trials. CONCLUSION: The results suggested that triathletes reduced their running performance after a 40 km simulated cycling when the ambient temperature was high.

Acute epiglottitis in the tropics: is it an adult disease?

Acute epiglottitis has traditionally been described as a paediatric disease in reports from temperate countries. There have been very few reports from tropical countries. This is a retrospective review of 32 cases of acute epiglottitis from Singapore over an eight-year period from 1992 to 1999. There were 31 adults and only one child. In Singapore, Haemophilus influenzae Type b (Hib) immunization in not routine, and thus the increased prevalence in adults cannot be attributed to Hib immunization. Eleven patients required airway intervention, of whom nine had endotracheal intubation and two had a surgical airway. Significant predictors for airway intervention included the sex of the patient, stridor, presence of airway compromise on examination and a "thumb sign" on the lateral neck radiograph. In adults, selective airway intervention is recommended as those without airway compromise at presentation recover very well with medical treatment alone.

Multiple tumour presentation of trichilemmal carcinoma.

Trichilemmal carcinoma is a rare skin tumour occurring in the sun-exposed areas of the elderly. It originates from the external root sheath of the hair follicle and is the malignant form of the trichilemmoma. Clinically, it may be mistaken for a squamous cell carcinoma, basal cell carcinoma, nodular melanoma or keratoacanthoma. It is distinct from the proliferating trichilemmal tumour. Trichilemmal carcinoma is usually a solitary lesion and an extensive literature search revealed no previously reported cases of multiple tumour presentation. We describe a case of trichilemmal carcinoma arising from three distinct sites in the same patient and discuss the differential diagnoses, histological features and probable aetiology of this rare tumour.

Clinical audit on tonsils and adenoid surgery. Is day surgery a reasonable option?

Four hundred and five patients who underwent tonsillectomy and/or adenoidectomy over a 27-month period were reviewed retrospectively to determine local patient characteristics and complication rates. The predominance of adult patients (mean age of 23.8 years), male subjects (male to female ratio of 2:1), and tonsillectomy cases (85.4%) were in contrast to studies reported in Western countries. Chronic tonsillitis or adenoiditis was the most common indication for surgery and the most frequent complications encountered were fever (20.0%) and haemorrhage (5.2%). Three patients (0.7%) had significant haemorrhage requiring a return to the operating theatre for haemostasis. Bleeding occurred within 6 hours in 2 patients and on the third postoperative day in 1 patient. The rate of haemorrhage was significantly higher in male patients (P = 0.038). The average duration of hospitalisation was 3.6 days. The main reasons for delayed discharge from hospital were retention for observation of pain and fever or for social or administrative purposes. Based on the results of the survey, day surgery for tonsillectomy and adenoidectomy would be feasible in Singapore provided patients are carefully selected and actively monitored for at least 6 hours after the operation.