The effects of packing with ribbon gauze and neuropatties on the nasal mucosa was assessed using sheep as an animal model. Fourteen sheep either underwent ribbon gauze or neuropattie nasal packing. Trauma to nasal mucosa caused by ribbon gauze and neuropatties was compared to mucosa on the lateral aspect of the middle turbinate which was not in contact with any packing. This tissue was used as a control. Ribbon gauze packing resulted in signi cant loss of 68 per cent of the ciliated surface of the mucosa when compared with the control group with a 15 per cent loss of ciliated surface (p<0.005). Neuropattie packing also resulted in signi cant loss of 50 per cent of the ciliated surface of the mucosa when compared with the control group (p<0.005). There was no signi cant difference in loss of ciliated mucosa in the specimens packed with ribbon gauze or neuropatties (p = 0.25).Nasal packing results in a signi cant mucosal injury with loss of cilia. This may in uence the mucociliary clearance of the nose in the post-operative healing phase. Pre-operative nasal packing should be used circumspectly and if possible avoided.Key words: Nose; Nasal mucosa; Occlusive dressings; Sheep Introduction Nasal packing is used as part of the pre-operative preparation for sinus surgery by many rhinologists.

The potential benefits of humidifying insufflation gas during thoracoscopy warrant its evaluation in the clinical setting.

No abstract

Adelaide SUMMARY P.seitdoxanthotna elasticum (PXE) is cm aiito.so/nal recessively inherited defect oj connective lisstte. characterized hy degeneration and calcification of elastic fihres in arterial walls, in the lamina elasticii oj Bruch's ntemhrane of tlie eye, and in elastic jihres of the middle zone oj the reticidar dermis. The cutitneoiis changes become manifest in the second decade oj life. This report describes a difficult diaf^nostic case of widespread vascular di.sease and reno-vascttlar hyperten.sion, in which the diai^nostic skin chani^es later hecante apparent. CASE RCI'ORTThe palicnt was first admiltcd lo hospital at the age of four years with polydipsia, and polyuria manifested by nocturnal enuresis. There was a mild inabilily to concentrate and acidify urine, but other renal function tests were essenlially normal. Tubular function studies revealed no reducing substances or aminoaciduriu. Hypertension was apparent (160/90) with cardiomegaly and a triple rhythm. A hypokaluemic alkalosis .suggested hypcraldosteronism.Intravenous pyelography confirmed satisfactory renal function of both kidneys, and adequate cortex, but showed some culyceal dilatation on the left side, and on this basis an aortogram was performed. This study revealed abnormal circulation of vessels in tbe region of the upper pole of the left kidney, and although both main renal arteries were considered normal, (here was possible stenosis of (he peripheral brandies of the right renal artery with post-stenotic dilatation.In view of the findings at the upper pole of tbe left kidney and the perplexing hypertension, the possibility of phaeochromocytoma was raised, and an adrenalectomy subsequently carried out. However, the adrenal histology was * Dcrmatohislopathologist, The Queen Elizabeth Hospilal.Address for reprints: Dr. R. I). Dymock. Dcparlmenl of Mislopathology, The Queen Elizabeth Hospital, Wood vi Ile. S.A. 5011. normal, and there was no significant postoperative decrease in blood pressure.OifTerential renal vein cathetcrizution was undertaken under radiological control and showed signilicanl dilTerences of renin output between the lefl and right renul veins. A left nephreclomy was performed and hislopathology revealed a normal looking kidney with blui.sh discolouration of the uppermost pyramid, with a large ves.sel 2nim in diameter at the corticomedullary junction, in this region of discolouration. The vessel appeared Io conimunicale with the surface 1cm above the hiluni, but there was no aberrant vessel externally. A few glomeruli were hyalinized and there was some calcification of tubules. On .section the renal arteries showed vascular calcification.Examination of the ocular fundi revealed some tortuosily of ihe retinal ve.ssels. and several small hacmorih;iu.cs ;it one sU\ge. There was no evidence of fully developed angioid streaks.Following nephrectomy tlic blood pressure again continued at a liigh level despite antihypertensive therapy.An intriguing finding when the patient was aged six years was that the femoral arteries an...