Seasonal change and its effect on the prevalence of infectious skin disease in a Gambian village.

A longitudinal dermatological study was carried out to determine the effect of seasonal change on the prevalence of skin diseases, particularly infectious skin diseases. This study was performed at the end of the rainy season and at the end of the subsequent dry season at Keneba, The Gambia. The surveys provide a profile of the influence of climate on the prevalence of certain skin diseases, both in terms of the susceptible diseases and who in the community was most affected. These surveys also provided an appreciation of the magnitude of skin disease in the community. The greatest effect of climatic change was on the prevalence of the dermatomycoses and pyoderma in children under 10. No seasonal influences were detected with other forms of skin disease. Some unusual aspects of scabies were noted in the surveys, particularly the low prevalence and the unusual age distribution pattern with no higher prevalence amongst children.

Detection of the tumour suppressor gene p53 in nasopharyngeal carcinoma in Hong Kong Chinese.

This study has investigated the expression of the p53 tumour suppressor gene in 41 cases of primary nasopharyngeal carcinomas (NPC) using the p53 monoclonal antibody BP53-12. Moderate p53 expression was found in 54% and strong expression in 12% of the specimens. There was no correlation between p53 expression and any of the clinicopathological parameters or survival. Surprisingly, three research groups have investigated p53 mutations in NPC and found no fresh tumour specimens to contain p53 mutations in exons 4-8 of the gene. It may be argued that as p53 overexpression has been demonstrated in 70% of the patients investigated in this study, that the mutations lie outside the 4-9 exon region. We are in the process of testing this hypothesis.

The nasal volume of children as measured by Manometric Rhinometry.

A new method of measuring nasal volume has been developed called 'Manometric Rhinometry'. We describe the principle behind its use and present the results of measuring two groups of normal children aged 4-10. The total volume of the nasal cavity, paranasal sinuses and postnasal space in these children averaged 81 ml in 4-year olds and 140 ml in 10-year olds when measured using an open cell foam plug. Where a rigid nasal tip was used the volume averaged 67 ml in 4-year olds rising to 99 ml in 8-year olds. Correlation with age, weight, height and head circumference showed the greatest correlation with height (r = 0.66). Multiple regression analysis did not add further explanatory power.

Manometric rhinometry: a new method of measuring the volume of the air in the nasal cavity.

Almost all the pathological and physiological process that effect the nose will change the volume of the airspace within it. This volume has previously been difficult to measure but a new method that calculates this space has been developed. A mechanical model was built to test the physical parameters involved in making volume measurements. The model demonstrated that a model sinus could be detected if the ostium was only 0.5 mm in diameter. It also showed that a mathematical model which described the volume of the space could be constructed. In vivo experiments showed that nasal volume can be measured in children as young as 4. In children, nasal volume correlates with age, height, and weight. They had a low coefficient of variation (7.1%) and a high test-retest correlation (r = 0.94). Adult nasal volume averaged 138 ml. The method is sensitive enough to detect the decongestant effect of xylometazoline in a group of 17 healthy volunteers (p < 0.01). There is no significant difference in the sensitivity to detect the decongestant effect of xylometazoline when compared with active anterior rhinometry, nasal peak flow, and acoustic rhinometry (range 80-95%).

The detection of the c-myc and ras oncogenes in nasopharyngeal carcinoma by immunohistochemistry.

Forty-one paraffin embedded specimens of primary nasopharyngeal carcinoma (NPC) were examined to investigate the expression of c-myc and ras oncogenes. Sections were stained with the monoclonal antibodies myc 1-9E10 or ras Y13-259 and binding was detected using the ABC method. The intensity of staining for each tumour was assessed as nil, moderate or intense. The results indicated that 9 (22%) had intense staining for the c-myc oncogene, 28 (68%) had moderate staining and only 4 (10%) showed no staining. For the ras oncogene, 8 (19%) had intense staining, 22 (54%) moderate staining and 11 (27%) showed no staining. The patient's clinical data indicated no correlation between the expression of either c-myc or ras p21 and age, sex, smoking, tumour stage, antibody titre to EBV, or family history. No correlation was found between ras p21 expression and survival; however, overexpression of the c-myc oncogene correlated with a poor prognosis (p < 0.05). This study is consistent with investigations demonstrating that c-myc expression correlates with poor survival in head and neck tumours.

A comparison between the effect of ice packs on the forehead and ice cubes in the mouth on nasal submucosal temperature.

The submucosal temperature in the inferior turbinate was measured in 13 subjects. It was found that giving ice cubes to suck produced a significantly greater fall in nasal temperature than did the application of ice packs to the forehead. In only seven out of the 13 subjects did an ice pack reduce nasal temperature.

A preliminary comparison of the effects of halothane and isoflurane on nasal mucosal blood flow.

The differing effects of halothane and isoflurane on nasal mucosal blood-flow was investigated by means of laser-doppler flowmetry in a total of fourteen patients who received one of these inhalational agents during anaesthesia. A trend towards lower nasal flux was seen in the halothane group but, due to insufficient numbers, significance could not be demonstrated. These changes in flux appeared not to be related to the falls in perfusion pressure which were seen in both groups of patients and were thought to be due to locally vasoactive effects.

Temporal arteritis presenting as a submandibular swelling.

Temporal arteritis (giant cell arteritis) is a disease of protean manifestation. A case which presented as a submandibular swelling is reported.

Comparison of cocaine alone or with adrenaline on nasal mucosal blood flow.

Cocaine is commonly used in ENT practice for its vasoconstrictor and anaesthetic properties. It is sometimes combined with adrenaline. The laser Doppler Flowmeter was used to compare the effect of 5 per cent cocaine alone or with adrenaline (1 in 1,000) on nasal mucosal blood flow. The results show an average fall in blood flow of 76.7 per cent for cocaine with adrenaline, compared to 61.2 per cent with cocaine alone. The difference is significant (P less than 0.05). The time taken for the blood flow to fall was an average of 131 s and 160 s respectively. These differences are not significant.

Beware bleeding from the ear.

We present the case of a 55-year-old man who presented with intermittent, profuse bleeding from the ear five years following radiotherapy for a nasopharyngeal carcinoma. He had developed osteoradionecrosis of the temporal bone, and the bleeding was shown to originate from an aneurysm of the internal carotid artery within his temporal bone. This has not previously been reported as a complication of radiotherapy for nasopharyngeal cancer.

Use of protein electrophoresis in the diagnosis of cerebrospinal fluid rhinorrhoea.

The diagnosis of CSF rhinorrhoea on clinical grounds alone can be difficult. We describe how the use of non-invasive electrophoretic analysis of nasal secretions for tau protein (asialotransferrin) helped in the management of cases where the existence of a CSF leak was in doubt. Patients were thus saved unnecessary invasive investigations or surgery. A modification of the method of analysis, which improves diagnostic accuracy, is described.

Fibromatosis of the parapharyngeal space.

Tumours of the parapharyngeal space are not common. The majority arise from the deep lobe of the parotid gland or neurovascular structures. We describe a case of fibromatosis, which has not previously been reported at this site.

Abnormalities of the paranasal sinuses in patients with nasopharyngeal carcinoma: a computed tomographic study.

A retrospective study of computed tomography scans of the paranasal sinuses of 131 control subjects in Hong Kong revealed minor mucosal abnormalities in more than half of the ethmoid sinuses. Major abnormalities were present in seven per cent of maxillary, five per cent of anterior ethmoid and four per cent of posterior ethmoid sinus. In 85 patients with nasopharyngeal carcinoma the prevalence of minor mucosal abnormalities in the sinuses was similar to that of the control group but major mucosal abnormalities were significantly more common in the anterior and posterior ethmoids at 15 per cent and 21 per cent of the respective sinuses (p < 0.001).

The paranasal sinuses before and after radiotherapy for nasopharyngeal carcinoma: a computed tomographic study.

A study comparing the pre- and post-radiotherapy computed tomographic scans of patients treated for nasopharyngeal carcinoma revealed that the incidence of major mucosal abnormality was significantly increased and approximately doubled after radiotherapy. The most significant factor predicting major mucosal abnormality after radiotherapy was the presence of tumour in the sinus before treatment. In the maxillary sinus there was significant association of major mucosal abnormality before and after radiotherapy although this was not so for the other sinuses. The mucosal changes observed were evident as early as six months after radiotherapy.

Career development: our professional responsibility.

Literature indicates that nurses' contributions to the health care profession are misunderstood by the general public. Of equal importance is how nurses perceive themselves. The present study attempted to describe the self-image of nurses working in a hospital setting and to determine whether there are differences in self-image between beginning and expert nurses, between caregivers and noncaregivers, between nurses with different levels of education, and between full-time and part-time nurses. Using the Porter Nursing Image Scale, a sample of 363 nurses perceived themselves positively on the three factors: Interpersonal Power, Interpersonal Relations, and Intrapersonal Ability. Significant differences were found between beginning and expert nurses, between caregivers and noncaregivers, between those with BSN and MSN education, and between full-time and part-time nurses. The data suggest the importance of graduate-level education for nurses and the need for career advancement and career counseling.