Do patients with epistaxis have drug-induced platelet dysfunction?

Aspirin and other non-steroidal anti-inflammatory drugs (NSAID) are being used increasingly. A positive correlation has been shown between epistaxis and the use of NSAID in the over 50s. This prospective study compared the NSAID intake and platelet function in 50 patients with epistaxis and 50 controls. Standard haematological parameters and the platelet response to collagen and arachidonic acid aggregation and adenosine triphosphate release were measured. The patients showed a significant increase in NSAID intake (P < 0.01, 95% confidence for the difference in the medians = 4-36%) and hypertension (for diastolic blood pressure > 100 mmHg, P < 0.01, 95% confidence for the difference in the medians = 5.9-16.1). The patients showed a significant reduction in platelet aggregation to collagen (P = 0.025). Non-steroidal anti-inflammatory drugs produce a significant platelet dysfunction which should be considered in the multifactorial aetiology of epistaxis.

An analysis of vocal cord paralysis before and after Teflon injection using combined glottography.

Combined glottography shows clinical potential but has only had limited use in monitoring laryngeal function before and after surgery. Eight patients undergoing Polytetrafluoroethylene (Teflon) injection for unilateral vocal cord palsies had pre- and post-operative combined glottography performed. Grossly abnormal waveforms pre-operatively confirmed poor glottic closure and irregular vibratory cycles. Analysis was difficult. Post-operatively all patients had a marked improvement in voice. Combined glottography showed a clear recovery of the waveforms towards normal with resumption of the two-mass model of glottal movement. Analysis was greatly simplified. Objective records were produced.

An assessment of the reproducibility of combined glottography in a clinical setting.

Although combined glottography has potential as a clinical tool, it has had limited use in the monitoring of laryngeal function before and after treatment. There is no data about the standardization nor reproducibility of the procedure. An indication of the reproducibility of combined glottography is paramount if changes in laryngeal function are to be measured accurately. Using a standardized technique, two complimentary studies examined the reproducibility of combined glottography within one sitting (Study 1) and over time (Study 2). The components of variance were analysed (ANOVA). In Study 1 the variance under controlled conditions for Open Quotient (OQ) and Speed Quotient (SQ) was only 13% and 18% respectively of the total, whilst in Study 2 the variance over time for OQ and SQ was 55% and 58% respectively. Under controlled conditions combined glottography is a reproducible technique.

A comparison of combined glottography in men and women.

Out-patient combined glottography has shown potential in the assessment of the vocal cord cycle in laryngeal abnormality. We compared this technique in men and women with normal laryngeal function, to evaluate the influence of patient sex on the results. Ten adult men were compared with 10 age matched women. The open quotient was significantly greater in women. This indicates the woman's glottis is open for a greater proportion of the glottic cycle, as a result of the anatomical and physiological differences of the larynx between the sexes. Analyses are made of the glottic cycle differences which may account, in part, for the different quality of the female voice. Interpretation of results using this technique must take account of the patient's sex.

Are haematological tests warranted prior to tonsillectomy?

The use of phlebotomy for a full blood count (FBC) and group and serum storage (G&S) prior to tonsillectomy with or without adenoidectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists within the South West Thames region. This was compared with 'countrywide' practice assessed by means of questions to attenders at an otolaryngology course. A postal response rate of 86 per cent was obtained with 67 per cent within the region requesting a FBC prior to tonsillectomy and 50 per cent to adenoidectomy alone. This was much greater than for the 'countrywide' group with 24 per cent and 6 per cent respectively. Requests for pre-operative G&S were 17 per cent and 6 per cent respectively. This large difference in practice suggests that in the clinically healthy patient with no specific indications, pre-operative haematological investigations may be non-contributory, which has important financial implications. The maintenance of post-operative intravenous access is considered to be much safer, less traumatic and cheaper.

Cystic lymphangioma in the adult parotid.

Cystic lymphangioma is a congenital lesion which rarely presents in adult life and even less commonly arises within salivary tissue. We report the sudden appearance of a large cystic lymphangioma within the parotid gland of a young man and discuss the management of this rare condition.

Emergency adenotonsillectomy for acute postoperative upper airway obstruction.

Peri-operative acute upper airway obstruction may be life-threatening. A case is reported of a child with severe adenotonsillar hypertrophy who developed acute upper airway obstruction after a routine surgical procedure and required emergency adenotonsillectomy. The importance of pre-operative assessment is stressed.

Acute upper airway obstruction following Teflon injection of a vocal cord; the value of nebulized adrenaline and a helium/oxygen mixture in its management.

A 67-year-old man presented with a 45-year history of a week voice. This was result of polio which had left him with a right vocal cord palsy. The patient underwent a Teflon injection of the right vocal cord under general anaesthesia to improve the quality of his voice. In the immediate post-operative period, he suffered acute upper airway obstruction. The problem of acute upper airway obstruction following Teflon injection is considered and its management with nebulized adrenaline and a helium/oxygen mixture is discussed.

Intermittent axillary vein obstruction in a competitive canoeist.

The case is reported of a competitive canoeist with intermittent axillary vein obstruction secondary to shoulder girdle muscle hypertrophy. The anatomy of the axilla, pathology of the axillary vein, and reported cases of sports injuries involving the axillary vein are discussed. This would appear to be the first report of such an occurrence in a canoeist.

Typhoid masquerading as Japanese encephalitis.

We describe a variant of typhoid which was clinically indistinguishable from Japanese Encephalitis (JE). The strongly encephalitic presentation led to a potentially serious delay in starting specific antibiotic therapy. Awareness of the usual form of typhoid is of great importance to Army doctors because of the presence of British soldiers and families in the Dharan area of southern Nepal where both typhoid and JE are endemic.

Chloroquine resistant malignant subtertian malaria unmasked by systematic steroid therapy.

We report a case of a Nepalese who developed a recrudescence of malignant falciparum malaria whilst taking systemic corticosteroids. The malaria was resistant to chloroquine at the RI level, the first such case reported from BMH Dharan.