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ond follow-up, 25 patients did not experience mother episode of rebleeding from both sides. Two patients on Problems encountered at home were minimal, the finger-cot and 6 on the medium-strip had minimal Although 2 patients complained of more pain on merecurrence of bleeding which were all transient, hence dium-strip side and equal incidence (one each) of minor did not require special attention, bleeding leak from both types, statistical evaluation is obviously not applicable. One problem intrinsic to the Results from microbiologic studies showed growths standard method of packing, which occurred in 4 pain 46.7% of specimens* coming from the outer surface tients, is the protrusion of the gauze strip into the of the finger-cot, 67.7% from the inner dressing of the oropharynx when the pack loosens up, Tllis cannot finger-cot, and 16.7% from the medium-strip gauze, happen in the other method since the dressing is con- Species of Staphylococcus particularly albus accounted tained within the finger.cot unless the whole pack slips for 85.7% of the microorganisms isolated from the down into the oropharynx. To avoid accidelatal extrufinger-cot surface, 61.9% from the inner dressing, and sion of the packs particularly the finger-cot on sneezing 60% from the medium-strip. The rest of the microor- forexample, patients were advised to cover nose with an ganisms cultured were various species of gram-nega- external dressing at all times. tive bacilli except for one isolate each of Candida sp. from the inner dressing and from the medium-strip In our institution, the conventional anterior nasal gauze, packs are usually removed on the fifth posl-operative day since incidence of rebleeding is said to bo high if the packs are taken out earlier. In this study, both types of DISCUSSION nasal packing were removed on the third post-operative day. Early removal means early patient aelief from Although the finger-cot method has been known to discomfort and decreased likelihood of other eomplicabe less traumatic than the standard gauze dressing, con- tions associated with nasal packing. trolled trials comparing both types are lacking. This study makes use of each patient as his own control, Indeed all sides from wberethemedium-stripgauze enabling the examiners to evaluate both types of ante- was removed showed minimal to profuse mbleeding. rior nasal packing in every aspect at the same instance. When compared to the finger-cot, the form_ is associated with an overwhelmingly significant greater degree The insertion of the medium strip gauze was asso- of rebleeding (Wilcoxon matched-pair rank test, ciated with more pain than that of the finger-cot, which p
With regard to microbiology of nasal packing ma- with saliva particularly to account for the varied flora terials (see Table 7), the most number of isolates were recovered from the inner dressing of the finger-cot, from the inner dressing of the finger-cot. This was Contamination on collection could not be also disexpected because it was not lubricated intentionally counted since all packing materials passed through both with an antibiotic ointment. Colonization was not con- nares. In general, the presence of microbial growth sidereal clinically significant since it was confined within remained academic since all patients did not clinically the finger-cot. Nonetheless, the outer surface of the manifest signs of active infection. finger-cot revealed statistically more isolates regardless of kind than the medium-strip (sign, 19=0.04). This may be due to the fact that the finger-cot is made of latex CONCLUSION which is a non-absorbent and non-porous material, making the antibiotic ointment easily washed away by This study hasestablished thatthe finger-cotmethod the excessive rhinorrhea associated with nasal packing, of nasal packing is equally effective as the standard _iStaphylococcus albus was the most common microor- medium-strip in controlling post-operative bleeding. In ganism cultured from all packing materials. Since it is addition, it offers the following advantages over the non-pathogenic in healthy adults, its exclusion from sta- medium-strip method namely: (1) significant lesser tistical testing will bring about no significant difference pain on insertion and on removal of the pack, (2) aignibetween the outer surface of the finger-cot and the ficant lesser recurrence of bleeding after removal with mediumstrip gauze in terms of potential pathogenic a generally smooth nasal mucosa, (3) relatively costmicrobes recovered (sign test, p= 1.0; see Appendix C). effective since little amount of antibiotic ointment is In normal nasal flora as studied by Slavin et al, Staphy- needed (the surgical gloves may come from those to be lococcus epidermidis (albus) was present in 83%, S. discarded), and (4) early removal i.e., on the third post- Aureus in 23 %, Streptococcus viridans in 17%, and operative day or even earlier. Although it requires extra Enterobacter species in 4% (percentages total over time for proper insertion, this shortcoming can be over- 100% due to mixed growths). All patients in this study, come by familiarity with the method. Microbial isolates however, had chronic sinusitis which might also add to from all nasal packing, though more from the finger-cot, the emergence of gram-negative bacteria. Another were not clinically significant as a whole. contributory source was the possible contamination TABLE 1 : TYPES OF NASAL SURGERY 1. Polypectomy, ethmoidectomy, antrostomy-bilateral withorwithout partialmiddle turbinectomy-bilateral ........................................................................................................................................... 13 2. Ethmoidectomy, antrostomy-bilateral withorwithout partialmiddle turbinectomy-bilateral ............................................................................................................................................ 7 3. Polypectomy, ethmoidectomy, antrostomy/ ethmoidectomy, antrostomy withorwithout partialmiddle turbinectomy-bilateral ............................................................................................................................................ 6 4. Submucous resection-septurn polypectomy, ethmoidectomy, antrostomy-bilateral withorwithout partialmiddle turbinectomy-bilateral ............................................................................................................................................ 5 5. Submucous resection-septum Ethmoidectomy, antrostomy-bilateral ..................................................................................................................... 1 TOTAL .................................................................................................................................. 32.................... 90 t
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Iq4LIPl:qut=S TABLE OF CONTENTS NEC
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HEAD AND NECK SURGERY - TO ADD OR N
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PRESIDENT'S PAGE The years 1989-90
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RIZAL MEDICAL CENTER DEPARTMENT OF
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muscles. Again it is likely possibl
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area measuring 4.8 x 3.7 cm extendi
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tend to recur locally, even after p
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UNIVERSITY OF THE PHILIPPINES PHILI
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The majority of patients with hyper
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mass wa uttrasonograImy. Neck explo
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Figure 2 : Parathyroid Adcnoma vs.
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E.wa_ileMassonLe_Maxilla "salt& pep
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of some clinical features as well a
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MCU HOSPITAL DEPARTMENT OF OTOLARYN
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JOSE REYES MEMORIAL MEDICAL CENTER
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nonetheless stated: "We have the im
Page 41 and 42: to the diagnostic know-how of the c
Page 43 and 44: PATIENTS & METHODS: These signs and
Page 45 and 46: Most patients in group 1 complained
Page 47 and 48: DISCUSSION: and septal deviation mi
Page 49 and 50: OSPITAL NG MAYNILA DEPARTMENT OF OT
Page 51 and 52: ..temporary relief. According to Ha
Page 53 and 54: CASE REPORT phonuclear cells. The r
Page 55 and 56: TITLE:Cleft Lip Surgeryfor Rural Fi
Page 57 and 58: After intubation and the endoctrach
Page 59 and 60: BIBLIOGRAPHY Converse, J.M., Recons
Page 61 and 62: UNIVERSITY PHILIPPINE DEPARTMENT OF
Page 63 and 64: Table 3. Distribution of Organism b
Page 65 and 66: J BIBLIOGRAPHY Y MACKOWIAK, P.A., J
Page 67 and 68: Figure 3. SENSITIVITY PATTERN OF Pr
Page 69 and 70: Figure 3. Percent SENSITIVITY PATTE
Page 71 and 72: loradatine 10 mg/tabletgiven once a
Page 73 and 74: 1. Severity of Symptoms 3. Comparis
Page 75 and 76: -J;r,ceiving 40 mg of loratadine da
Page 79 and 80: : ' : _ : ::::::: : : i : ::
Page 81 and 82: These patients are new patients see
Page 83 and 84: - Table Vl Baseline Signs and Sympt
Page 85 and 86: The following Table VII will show t
Page 87 and 88: • 14.Drowsiness: None 30 2 4 10 2
Page 89 and 90: Actifed's side effect of drowsiness
Page 91: " to be packed with one type of pac
Page 95 and 96: TABLE 6: MANNER OF CONTROL OF REBLE
Page 97 and 98: APPENDIX C MICROBIALGROWTH POTENTIA
Page 99 and 100: EAST AVENUE MEDICAL CENTER DEPARTME
Page 101 and 102: type (20%-30% of cases) varies from
Page 103 and 104: TABLE Ii HistologicalClassification
Page 105 and 106: THE LATERAL NASAL WALL IN FILIPINOS
Page 107 and 108: MIDDLE MEATUS: Diameter of ostium:
Page 109 and 110: .;4".,..:'.-" ............. '---.",
Page 111 and 112: Figure 4. Variation in the location
Page 113 and 114: This study presents variations with
Page 115: ACKNOWLEDGMENT The authors would li
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