No abstract

The incidence of epistaxis admissions to hospital and their relationship to ambient temperature is examined. A retrospective analysis of 1211 patients with epistaxis sufficiently severe to warrant hospital admission was performed over a period of 1836 consecutive days. Daily average temperature data for this time-period were examined and compared with admission rates. A marked increase in hospital attendance was apparent during colder days. Patients were admitted at a rate of 0.829 patients per day for temperatures less than 5 degrees C, (95% Confidence Interval: 0.737-0.928), compared with 0.645 patients per day for temperatures between 5.1 and 10 degrees C, (95% 0.586-0.708). On average the population of epistaxis patients attended on days that were 0.6 degree C colder (95% Confidence Interval: 0.2 degree C-0.9 degree C) than the average temperature for the time examined (P < 0.005, student's t-test).

A normal range of NPR may prove useful in assessing patients complaining of nasal obstruction. A case may be made that patients on the waiting list that fall within the normal range of NPR are unlikely to benefit from septal surgery because their nasal passages are not greatly asymmetrical.

The significance of post-operative vomiting as a risk factor in the development of a pharyngocutaneous fistula was examined. The case records of 50 consecutive patients undergoing laryngectomies (39 men, 11 women, average age 64 years) were examined, 17 also underwent a simultaneous radical neck dissection. A fistula developed in eight patients (16%) and the median time to its diagnosis was 11 days (range 3-15 days). Several potential risk factors were examined including age, gender, previous radiotherapy, TNM stage, differentiation of tumour, simultaneous radical neck dissection and also the occurrence of vomiting post-operatively. In this series of patients only vomiting in the early post-operative period appeared to be related to the development of a fistula (regression summary: R2 = 0.6, t-value 5.6, P < 0.0001). An episode of vomiting was recorded in eight patients and of these six (75%) subsequently developed a fistula. The median time of post-operative vomiting was 7.5 days (range 1-10 days) and the diagnosis of a fistula occurred at a mean of 1.2 +/- 0.4 days after the episode of vomiting. In a study of this nature it is not possible to conclude that a causal relationship exists between vomiting and fistula development. However, if this is the case a potential means of decreasing the incidence of fistulae following laryngectomy may be available.

Two cases of migration of totally implanted catheter systems are described. The complication is potentially life threatening. (Thorax 1994;49:281-282)