Bilateral nasal septal chemical cautery: a safe and effective outpatient procedure for control of recurrent epistaxis, our experience in 134 patients.

PURPOSE: To assess the effectiveness and complications of bilateral nasal septal cautery using silver nitrate in anterior nasal epistaxis. METHODS: This prospective study was carried out on 180 consecutive patients presenting with epistaxis to a general ENT clinic. Local anaesthetic cautery was performed using 5% lidocaine hydrochloride and 0.5% phenylephrine hydrochloride spray in all the patients except eight children that were 4 years or younger that were done under general anaesthetic. Visible vessels in Little's areas were cauterised using two silver nitrate sticks each side. Patients were prescribed naseptin cream and followed-up. We classified re-bleeds as follow: 0-1 episodes: significant improvement, 2-3 episodes: moderate improvement, 4 + episodes: no improvement. RESULTS: We analysed 134 (74%) patients who were seen at follow-up. Age range was 5-88 years (mean 25, median 15), there were 89 (67%) males. Children made up 60% (81) of the study population (aged 16 years and under), of these 56 (69%) were male. Significant improvement was seen in 93% (124) of the study population, but there were relapses in two children (1.5%) and only moderate improvement in eight patients (6%). There was no significant complication in the study population, but 11 patients had crusting at the sites of cautery at follow-up. CONCLUSIONS: Bilateral silver nitrate cauterisation is an effective method of treating recurrent epistaxis with low risk of complications.

Relapsing polychondritis associated with bilateral stapes footplate fixation: a case report.

INTRODUCTION: Relapsing polychondritis is a rare multisystem autoimmune disease of uncertain etiology characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues. Its respiratory, cardiovascular, renal and neurological complications are life-threatening, and it is thus important to recognize the disease and its complications early. Relapsing polychondritis may follow a slowly evolving or rapidly progressive course. CASE PRESENTATION: The case of a 39-years-old Caucasian woman with a three-year history of recurrent bilateral chondritis of the auricles, nasal chondritis, seronegative polyarthritis and dermatitis is reported. She had an associated bilateral stapedial fixation and one side was successfully operated on. She also had a large septal perforation involving both the cartilaginous and bony parts. The patient first presented with severe cutaneous inflammation when she was only one month old, and so this is an illustrative case of relapsing polychondritis that slowly evolved over many years. CONCLUSIONS: Relapsing polychondritis is still a relatively uncommon condition, which explains why there is often a delayed diagnosis of the disease. It is usually difficult to examine tympanic membranes in cases of relapsing polychondritis, and, therefore stapes fixation should also be suspected when there is an associated conductive hearing loss.

Inadvertent insertion of a nasogastric tube into both main bronchi of an awake patient: a case report.

The use of nasogastric tube is desirable for the short-term administration of calories when oral feeding is not possible. Although the insertion of nasogastric tubes has been described as being easy this is not without risks. An unusual case of malpositioning of a fine bore nasogastric tube into both main bronchi in a patient that was awake is reported. Respiratory complications of misplaced nasogastric tubes and the importance of a check chest x-ray following tube placement are discussed.

A simple technique for nasogastric feeding tube insertion.

Nasogastric tubes are increasingly used in the management of a diverse group of patients who generally require short-term enteral feeding. Various techniques of insertion have been described emphasizing the fact that as yet there is no simple and safe method. Nasogastric intubation in head and neck cancer patients may be especially difficult following radiotherapy due to difficulties in swallowing secondary to edema, mucositis, abnormal anatomy and altered sensation. In this paper, we describe a simple technique that evolved from experience of passing enteral feeding tubes in head and neck cancer patients. The feeding tube is inserted through the appropriate nasal cavity, and at 21 cm (8 inches) from the anterior nares in the average adult (corresponding to a few millimeters above the arytenoids), the patient is asked to vocalize by saying 'eeeee' in a high pitched tone. The tube is then advanced into the esophagus while the patient is vocalizing. This technique has been successfully carried out in 22 consecutive patients, thereby avoiding the use of more invasive methods.