Mite and cockroach sensitisation in patients with allergic rhinitis in the Free State.

BACKGROUND: Studies in patients with allergic rhinitis living in the Free State have showed grass pollens to be the predominant allergens, with house-dust mite sensitisation being less prevalent than in the coastal areas and a low rate of sensitisation to the storage mite Lepidoglyphus destructor. No studies have been conducted on sensitisation to the other storage mites, spider mites or cockroaches. We aimed to determine the prevalence of sensitisation to various house-dust mites, storage mites, spider mites and cockroaches in patients with allergic rhinitis living in the Free State. METHODS: Fifty consecutive patients with allergic rhinitis attending the ear, nose and throat clinic at Universitas Hospital underwent skin-prick testing and/or ImmunoCAP RAST testing for common aero-allergens, house-dust mites, storage mites, spider mites and cockroaches. RESULTS: Forty-six per cent of patients were sensitised to one of the house-dust mites, with house mite sensitisation being significantly more common in patients who had previously lived at the coast. Storage mites were not common aero-allergens, while 46% of patients were sensitised to the spider mite Tetranychus urticae. Blatella germanica was the cockroach species to which patients were most commonly found to be sensitised on ImmunoCAP RAST testing, with 38% of patients being sensitised to this aero-allergen. CONCLUSIONS: House-dust mites, T. urticae and the cockroach B. germanica appear to be important aero-allergens in the Free State. Storage mite sensitisation is not common.

Low dose radiotherapy for adenotonsillar lymphoid hyperplasia in HIV-positive patients.

Lymphoid hyperplasia is common in HIV positive patients. The aim of this study was to determine the response to radiotherapy. Thirty-three adult patients with recurrent tonsillitis or upper airway obstruction due to tonsillar hyperplasia and conformed histology of follicular hyperplasia were included. Thirteen underwent a 24 Gy course of radiotherapy and were followed up for a minimum of 16 weeks post-radiotherapy. There was a statistically significant decrease in the median tonsillar size (95% confidence interval [-3;-2]) and in the median CD4 count (95% CI [3;152]) after 16 weeks. None of the patients had acute tonsillitis or airway obstruction after radiotherapy. Low dose radiotherapy is effective in the management of adenotonsillar hyperplasia in HIV positive patients.

Pulmonary hypertension due to recurrent juvenile laryngeal papillomatosis.

Although pulmonary hypertension secondary to upper airway obstruction caused by adenotonsillar hyperplasia has been well described, the association between laryngeal papillomatosis and pulmonary hypertension has not previously been documented. We report three patients with pulmonary hypertension due to upper airway obstruction caused by laryngeal papillomatosis. Pulmonary hypertension can contribute to significant preoperative and postoperative morbidity and cause intraoperative complications. Preoperative diagnosis and treatment of pulmonary hypertension is therefore essential in these patients.

Use and care of an endotracheal/tracheostomy tube cuff--are intensive care unit staff adequately informed?

BACKGROUND: There is an apparent high incidence of tracheal stenosis in the Bloemfontein area. The aim of this study was to determine intensive care unit (ICU) staff knowledge of the use and care of endotracheal and tracheostomy tube cuffs. METHODS: One hundred and twelve qualified nurses, working in 11 different ICUs, were asked to complete an anonymous questionnaire regarding endotracheal/tracheostomy tube cuffs. RESULTS: The results highlight the following three areas of concern: (i) there was an overall misconception in 38% of the respondents that the function of the cuff was to secure the tube in position in the trachea to prevent self-extubation; (ii) accurate regulation of cuff pressure was not routine practice in any of the ICUs; and (iii) only half of the respondents felt their training regarding cuff care management was sufficient. CONCLUSIONS: ICU staff had misconceptions regarding the function and care of endotracheal/tracheostomy tube cuffs. The concept of a higher cuff pressure for better stabilisation of the tube is probably an important factor that could have caused the increase in tracheal stenosis in the Bloemfontein area. Critical care nursing needs to emphasise the use of current techniques, discourage routine cuff deflation, and encourage collaboration with ICU physicians on standards of care. A protocol that could be used in the ICUs regarding the use and care of an endotracheal/tracheostomy tube cuff is proposed.

Use and care of an endotracheal / tracheostomy tube cuff - are intensive care unit staff adequately informed? : intensive care

Background. There is an apparent high incidence of tracheal stenosis in the Bloemfontein area. The aim of this study was to determine intensive care unit (ICU) staff knowledge of the use and care of endotracheal and tracheostomy tube cuffs. Methods. One hundred and twelve qualified nurses; working in 11 different ICUs; were asked to complete an anonymous questionnaire regarding endotracheal / tracheostomy tube cuffs. Results. The results highlight the following three areas of concern: (i) there was an overall misconception in 38of the respondents that the function of the cuff was to secure the tube in position in the trachea to prevent selfextubation; (ii) accurate regulation of cuff pressure was not routine practice in any of the ICUs; and (iii) only half of the respondents felt their training regarding cuff care management was sufficient. Conclusions. ICU staff had misconceptions regarding the function and care of endotracheal / tracheostomy tube cuffs. The concept of a higher cuff pressure for better stabilisation of the tube is probably an important factor that could have caused the increase in tracheal stenosis in the Bloemfontein area. Critical care nursing needs to emphasise the use of current techniques; discourage routine cuff deflation; and encourage collaboration with ICU physicians on standards of care. A protocol that could be used in the ICUs regarding the use and care of an endotracheal / tracheostomy tube cuff is proposed

Incidence and management of acoustic neuromas in South Africa.

OBJECTIVES: To determine the extent to which the various treatment modalities are used in the management of acoustic neuromas treated in South Africa and to estimate the incidence of acoustic neuromas in South Africa. METHODS: A telephonic survey was conducted of all otorhinolaryngologists, neurosurgeons, and radiotherapy centers in South Africa to determine whether they had treated any patients with acoustic neuromas during the calendar year 2000. RESULTS: One hundred and fifteen patients with acoustic neuromas were treated in South Africa during the calendar year 2000, and 8 patients were referred to other countries for treatment. This resulted in an incidence of approximately 0.3 per 100,000 population per year. There was a marked difference in the incidence between the various racial groups: the incidence was at least 1.76 per 100,000 population per year among whites and at least 0.01 per 100,000 population per year among blacks. Of the 115 patients, 78 (68%) were treated surgically and 24 (21%) by stereotactic radiotherapy. Fourteen (12%) patients had newly diagnosed acoustic neuromas that were managed conservatively in the year concerned. The surgical approach used was middle fossa in 8 (7%) patients, retrosigmoid in 61 (53%) patients, and translabyrinthine in 9 (8%) patients. CONCLUSIONS: The majority of acoustic neuromas in South Africa were treated surgically, mainly by a retrosigmoid approach. The incidence of acoustic neuromas in South Africa was approximately 0.3 per 100000 population per year. There were significant racial differences in the incidence.

Swallowed fish bones--is radiography justified? A case report.

A case report is presented of a swallowed fish bone that migrated submucosally into the retropharyngeal tissue. This experience prompted us to investigate the detectability of fish bones by standard radiological examination. Nine different species of fish were examined. A single rib from each specie was taken and taped to the neck of one of us. A lateral soft-tissue radiograph was taken. All of the fish bones were quite readily detected. We fell that the results once more justify the place of this particular examination in confirming both the presence and the location of a swallowed fish bone. However, failure to detect the foreign body in this way can by no means exclude its presence.

A microbiological study of acute maxillary sinusitis in Bloemfontein.

Microbiological analyses and antibiotic sensitivity tests were done on 26 patients with acute maxillary sinusitis during the first 9 months of 1986. Positive cultures were obtained in 23 of the patients, with anaerobes cultured in 13 (50%). Haemophilus influenzae was cultured in all non-producers of beta-lactamase. Therapy with erythromycin and chloromycetin appeared to be equally effective in aerobic cases and metronidazole was effective in all anaerobic cases.

A microbiological study of acute otitis media in Bloemfontein.

Tympanocentesis was done on 36 patients (57 ears) with acute otitis media. Positive cultures were obtained in 65% of cases. Streptococcus pneumoniae was the most commonly isolated organism (25% of ears). There was a high incidence of Staphylococcus epidermidis infection (14% of ears); these organisms are considered to be true pathogens. Haemophilus influenzae seemed to be less common than in other series and in all our cases were non-producers of beta-lactamase. Penicillin and amoxycillin appeared to be equally effective and there seemed to be little difference between responses to cefaclor, erythromycin and co-trimoxazole.

Lateral nasopharyngeal cysts. A case report.

A case of congenital lateral pharyngeal cyst is reported and a classification of pharyngeal cysts is given.