Meningitis is a life-threatening complication of otitis media. The appropriate management and the role of surgical intervention are still controversial, and there are no evidence-based guidelines in this regard.

We report three cases of otogenic meningitis, initially treated with parenteral antibiotics and myringotomy, followed by surgery. Two patients had an emergency mastoidectomy and one patient underwent surgery one month post-recovery due to the suspicion of bone erosion on a computed tomography scan. In two cases, a canal wall up procedure was performed, and one patient underwent revision of a radical mastoidectomy. In all cases, no pus or granulations were seen in the mastoid. Two patients fully recovered and one patient died.

We review the literature and critically discuss the role, timing and preferred type of surgery for otogenic meningitis.

Kimura's disease (KD) is an uncommon condition once thought to affect only Orientals. The patients present with swelling of the major salivary glands associated with cervical lymphadenopathy. The clinical, histopathological and radiological findings of a young Caucasian female with KD will be presented and discussed.

This study investigates the influence of hypertensive disorders on twin pregnancies for an unselected, population-based series. Between 1986 and 1991, out of a total of 56,381, 766 (1.3%) were twin deliveries at our institution, the only tertiary care hospital serving a population of about 400, 000 inhabitants. The incidence of hypertensive disorders was significantly higher in twin gestations than in singleton pregnancies, at 3437/55,615 (6.2%) vs 85/766 (11.1%) (p<0.001, OR=1.8, 95% CI =1.4-2.3). Hypertensive disorders were significantly higher in twin as compared to singleton pregnancies, regardless of parity, and even after adjusting for maternal age. More instrumentai or surgical deliveries were needed when pregnancies were complicated by hypertension, in twin as well as singleton gestations. Despite the association between prematurity and hypertensive disorders, and prematurity and perinatal mortality, no significant difference was found in perinatal mortality between hypertensive and nor-motensive twin pregnancies. The neonatal death-rate in normotensive and hypertensive twin pregnancies (3.7% and 3.5% respectively) was higher than that of stillbirths (respectively 2.3% and 0%).

An unusual case of synergistic infection caused by Salmonella paratyphi and anaerobic streptococcus resulting in necrotizing cervical infection associated with deep neck abscess and internal jugular vein thrombosis, is presented. Salmonella acting as an oxygen consumer in the infected tissues, facilitates the growth of anaerobic cocci, hence the development of a devastating soft tissue infection. The precipitating cause was a tonsillar infection developing due to ‘post-anginal sepsis’. The aetiopathogenesis of the cervical infection is discussed.

A case of Burkitt's lymphoma involving the tonsil in a 10-year-old Bedouin boy, is presented. The biological behaviour and the clinical presentation of this unusual neoplasm are discussed and the English language literature is reviewed.

The diagnosis was made by histological examination, electron microscopy and confirmed by immunohistochemistry. The patient showed an excellent symptomatic response to surgery and chemotherapy.

Seventy-nine children have been followed with persistent middle ear effusion (MEE). They were scheduled for myringotomy and insertion of ventilating tubes (VT). Several factors delayed elective surgery for two-and-a-half years in a closed population. After that period, the children were again examined otomicroscopically and hearing tests were performed. MEE persisted in 69 per cent of the ears, but was absent in 31 per cent. Atelectasis appeared in 26 per cent of the ears; in only a very few cases did severe atelectasis develop. Complications following delay of myringotomy and introduction of VT are minor.

Osteomas of the frontal sinus are usually symptomless. When they enlarge they may produce pressure symptoms such as headaches. Small osteomas developing near the fronto-ethmoidal duct may interfere with the patency of the duct and impair the aeration of the sinus. This is a report of a case in which a small osteoma was found to be the cause of severe chronic headaches.

The observation of a higher incidence of sex-chromosome abnormalities amongst patients in mental deficiency and subnormality institutions than in the general population (Maclean et al., 1962; Court Brown et al., 1964) suggested that a sex chromatin survey of a theoretically related chronic psychotic population might be of interest. Mott (1919) observed a high frequency of testicular atrophy in dementia praecox, particularly in patients dying in early adolescence, and Forster (quoted by Mott, 1919) reported on the ovarian findings in similarly affected women. Hemphill et al. (1944) found a high incidence of testicular atrophy in a series of ninety male schizophrenic patients.

The diagnostic classificatory system in use in modern psychiatry appears to be the product of countless acts of “subjective factor analysis”. Psychiatrists have observed that particular symptoms tend to occur in clusters, and these clusters have been labelled and given a status akin to that of disease entities in general medicine. It is a continually developing empirical system, and it is customary to reexamine such systems periodically to assess the state of current practice and its validity.

The last five years have seen the beginning of a remarkable new development in the pharmacological approach to psychiatry. Pharmacological treatment for mental disorder is not, of course, new; drugs like hellebore, opium, camphor, bromides, paraldehyde and the barbiturates cover a large part of the history of psychiatric therapy. Since 1951 a number of new drugs with the generic title of tranquillizers have been introduced, of which the two best known are chlorpromazine and reserpine. They have the characteristic effect of producing sedation without producing sleep.