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.

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%).

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.