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Pregnant women with respiratory symptoms of pleuritic pain and productive cough should undergo evaluation for coccidioidomycosis. This should include a history of travel or residency in endemic areas and careful assessment for toxic erythema, erythema nodosum, or erythema multiforme. To confirm a diagnosis of this disease, a sputum culture, wet mount, and serological tests should be performed. The risk of dissemination, which is highest in the second and third trimesters, can be estimated by a complement-fixation titer. In disseminated cases aggressive treatment with amphotericin B has improved the previously reported high maternal and neonatal mortality rate. Fortunately, case reports do not indicate that transplacental spread occurs. Reactivation or exacerbation of a chronic low-grade infection during pregnancy may occur in patients treated for prior disseminated disease (32, 34). Interestingly, both of the reported cases of reactivation or exacerbation occurred in insulin-dependent diabetics.

We describe a simple technique to facilitate the removal of difficult-to-remove Norplant implants. Through a standard skin incision for Norplant removal, the fibrous capsule surrounding the implant is secured using either a dermatologic skin hook or a 25-gauge hypodermic needle fashioned into a hook with a hemostat. Traction is applied to bring the fibrous sheath into the incision site, where the implant tip is dissected free using a scalpel. The precisely localized countertraction afforded by this technique provides increased accuracy and speed for the removal of difficult-to-extract implants. Tissue trauma is minimized and the need to extend the skin incision is reduced.

The aim of this study has been to develop a test system for attachment of pneumococci to pharyngeal cells. Cells scraped from a healthy person were washed and quantitated, bacteria added and after incubation the suspension was washed and the number of adhering bacteria counted. Among strains from different infectious foci the highest number of strains with adhesive capacity was found in the otitis media group. Capacity to attach to the pharyngeal mucosa might be a virulence factor of pneumococci causing otitis media. There was a lack of distinct relation between capsular serotype and adhesive capacity indicating that the polysaccharide is not primarily responsible for the binding to epithelial cells. If attachment to the pharyngeal mucosa is a first step necessary for colonization and subsequent invasion of the tissues, then antibiotics in the secretions preventing such colonization might be of protective value in otitis-prone children.