We describe pneumomediastinum in a primigravida with delay in the second stage of labor. The pathophysiology, clinical presentation, and management are reviewed.

Emotional distress in a group of Israeli women who requested legal abortion was compared with that in a group of women on the verge of delivery and in a random group of nonpregnant women on measures of anxiety and depression. Emotional consequences of the abortion were evaluated by before-and-after comparisons of the same measures in a subgroup of the aborting women. Findings indicated significantly greater distress in the aborting women, with lower levels after the abortion. The effects on emotional well-being of personal and contextual factors and their interactions were also examined.

Of 142 patients with Pseudomonas aeruginosa (PSA) ear infections, 88 (62 per cent) had chronic otitis media and 54 (38 per cent) external otitis. Following serotyping and pyocin typing of their bacteria, and relating the type to outcome, patients could be divided into three groups: (1) 120 patients who had no recurrence with isolation of only one PSA strain, (2) 13 patients who had recurrent infections and in whom the same PSA strain was isolated in repeated cultures, and (3) nine patients who had recurrent disease, but who had a change in their PSA strains. Most of the PSA strains isolated from patients in groups (1) and (2) were stable to pyocin, and resistent to gentamicin. Patients in the first group were all cured initially by medical management. Of the nine patients in group (3) who had a different serotype on repeated cultures, medical treatment was successful in eight (89 per cent), but of the 13 patients in group (2) who had the same Pseudomonas aeruginosa serotype cultured, medical therapy failed in six (46 per cent) and mastoid surgery was required. Serotyping of Pseudomonas aeruginosa otitis may be helpful in predicting the type of management in patients who have recurrent infections.

Acute epiglottitis in the child is an emergency, well known to pediatricians, that requires rapid diagnosis and treatment. Aggressive treatment in recent years has markedly decreased mortality (17). Acute epiglottitis in adults has been thought to be rare, but lately numerous studies have shown an increase in the disease. We present 19 older patients, aged 13-72 (mean 44.7 years), with acute epiglottitis. A most important finding was the relatively long time from onset of symptoms until diagnosis, averaging 2.5 days. All the blood and throat cultures were negative, except for a single throat culture which yielded Pseudomonas aeruginosa. The most common presenting symptoms were severe sore-throat and dysphagia; half presented with some respiratory distress. Diagnosis was usually made on indirect laryngoscopy, but lateral X-ray of the soft tissues of the neck was found to be highly reliable. Treatment was usually conservative, including antibiotics, rehydration and steroids to alleviate edema. All patients were under strict observation for the first 48 hours, but only 1 required intubation. There were no deaths.

The cases of two patients with epithelial ovarian carcinoma who had been treated with surgery and cisplatin-containing combination chemotherapy and had developed brain metastases are described. Modern protocols for management of advanced-stage epithelial ovarian carcinoma have resulted in prolonging the lives of the patients sufficiently for central nervous system metastases to become apparent and possible resistence of the 'blood brain' barrier to the currently used chemotherapeutic agents may have left the CNS 'unprotected' from metastases.

The natural history of individuals with acute acoustic trauma who ceased to be exposed to impact noise was examined. Retrospective follow-up was carried out for 4 years on patients who were qualified as disabled following acoustic trauma with permanent threshold shift. Eight hundred forty-one individuals (1682 ears) were examined, of which 1514 ears with acoustic trauma were included in the study group; 150 individuals (300 ears) who continued to be exposed to impact noise even after discovery of acoustic trauma comprised the control group. In the latter, as long as exposure to gunfire continued, the severity of acoustic trauma increased. In the study group, during the first year after injury, changes were observed in hearing, whether improvement or deterioration; after this period, hearing loss appeared to be final. We suggest that, after 1 year following acute acoustic trauma, the associated hearing loss be considered as final, provided there is no further exposure to noise. This finding holds great importance from the medicolegal standpoint, an aspect that is unclear in the literature. It clarifies that beyond the period of 1 year after initial exposure, the pathologic process ceases (as long as there is no additional exposure to noise or gunfire). Further hearing deterioration beyond this period is not related to the initial acoustic trauma but rather to other factors.

This chapter discusses the expression of Ia antigens on different tissues and the possible involvement of Ia antigens in immune reactions. The central part of the mouse H-2 complex, the I-region, is involved in several different immunological phenomena such as genetic control of the immune response, cellular cooperation, mixed lymphocyte reaction, and graft versus host reaction. As many of these reactions are mediated by surface structures of lympoid cells, the recently discovered Ia antigens that are coded for by the I-region are of interest. Recent studies showed that the Ia antigen system is a complex polymorphic system with at least 3 different I-subregions controlling more than 15 different Ia specificities, some of which occur in allelic forms. Knowledge of the involvement of the I-region in immune reactions leads to the assumption that the I-region controlled la antigens participate in these reactions. This hypothesis is examined by attempts to block Ia determinants of lymphocytes participating in in vitro secondary immune responses to sheep red blood cells (SRBC) by inclusion of alloantisera into the cultures in the absence of complement.

A nationwide study of aplastic anemia in Israel revealed a mean yearly incidence of 7.1/1,000,000 in males and 8.7/1,000,000 in females. Twenty-five per cent of the cases reported had an apparent chloramphenicol etiology. Ten patients, five treated with chloramphenicol and five without it, developed acute leukemia. The median survival was 11 months in males and 28 in females. Survival was particularly inferior in chloramphenicol-related cases, suggesting that this group constitutes a specific entity.