A case of toxigenicCorynebacterium ulceransinfection is presented. The diagnosis was delayed and no anti-toxin administered. A nasopharyngeal biopsy was complicated by severe haemorrhage necessitating a post nasal pack. A brief review of the pathology and treatment ofCorynebacterium ulceransis given.

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Synovial sarcoma is rarely seen in the head and neck region. A case of synovial sarcoma of the pharynx in a child is presented.

Summary Ten patients with allergic perennial rhinitis completed a 3‐month course of treatment with flunisolide nasal spray†. Biopsy of the nasal mucosa was carried out before the initiation of treatment and at the end of the treatment period. The flunisolide was administered as a 0.025% solution twice daily at a total daily dose of 200μg. No histological abnormalities which could have been attributed to the effects of the drug were found in the post‐treatment biopsies. Comparison of the pre‐ and post‐treatment histological features showed either that there had been no apparent changes or that there had been a reduction in the oedema and/or cellular infiltration which had been present initially. All except one patient improved clinically and in this case the pre‐treatment nasal biopsy demonstrated features of atrophic rhinitis.

SummaryThree consecutive groups of 50 obstetric patients received spinal anaesthesia. The control group received no prophylactic treatment for spinal headache, the second group were treated by the epidural injection of 20-25 ml of normal saline and the third group were treated by abdominal binder.There was no statistically significant difference between the two forms of treatment but the results show that the incidence of post spinal puncture headache can be significantly reduced by applying either of them. Surgery inside the nose is easier when the mucosa is in a shrunken and decongested state. It has therefore been common for many years to use topical cocaine and adrenaline mixtures pre-operatively to produce this effect. The practice has continued despite the widespread use of general anaesthesia for these operations on the grounds that inhalational agents themselves cause peripheral vasodilation and therefore make the nasal mucosa hyperaemic.This use of cocaine and adrenaline has caused the authors concern because of the risk of systemic effects in the presence of halogenated general anaesthetics. There is also the clinical impression that systemic absorption of the cocaine mixture occasionally causes unwanted side-effects which may be severe. The present study was therefore instituted to determine the relative efficacy of three different doses of topical cocaine and to record the incidence of side-effects. The cocaine was administered after the induction of anaesthesia and adrenaline was omitted. Materials and methodsThepatients. The investigation was carried out on forty-five patients aged between 16 and 65 years who were admitted for nasal surgery ( Table 1). No selection of patients either on grounds of nasal pathology or general health was made. Permission was not sought from the patient since the technique hardly differed from normal. The dose of cocaine administered was not known at the time of operation but did not exceed the customary amount.Anaesthetic technique. All patients were seen and examined pre-operatively. Premedication was with papaveretum 20 mg and hyoscine 0.4 mg provided that the body weight was greater than 50 kg; three quarters of this dose was given if the bodyweight was less than 50 kg.