In defense of long-term treatment: on the vanishing holding environment.

There are compelling similarities in the caregiving functions of good clinicians and good parents. Both clinicians and parents function best in a supportive environment. Yet many clinicians do not feel supported. They are under relentless pressure to find ever-briefer forms of treatment for all individuals, regardless of the individual's symptoms or circumstances. This pressure is especially distressing for the clinical social worker who, by tradition, has provided therapeutic services for the most-troubled individuals. This article is intended as a supportive gesture for the clinician who is struggling with questions about long-term treatment. Health care trends and contraindications for short-term therapy are addressed. A clinical case is presented.

Diving-related inner ear injuries.

Diving-related inner ear barotrauma (IEB) and inner ear decompression sickness (IEDS) most often result in permanent severe cochleovestibular deficits, unless immediate diagnosis is reached and the correct treatment is commenced early. Nine cases of sport-diving-induced inner ear injuries that were referred to the Israeli Naval Hyperbaric Institute between October 1987 and September 1989 are presented with regard to evaluation, treatment, and follow-up. The diagnosis was IEB in five divers and IEDS in four. Explorative tympanotomy was carried out with remarkable results in two patients with IEB, while the remaining three were relieved by bed rest alone. Three of the four IEDS patients were recompressed according to the extended US Navy Table 6 with good short-term results. The role of complete otoneurological evaluation in the decision-making process leading to the correct diagnosis and treatment is emphasized.

Hyperbaric oxygenation for necrotizing (malignant) otitis externa.

Two patients with extensive necrotizing otitis externa have been treated by hyperbaric oxygenation. One patient had facial nerve palsy and the other suffered from skull base involvement. Due to severe side effects, the preferred combined intravenous antibiotic therapy was changed to monotherapy in one case and completely withdrawn in the second. This was done before the commencement of hyperbaric oxygenation, while the necrotizing infection was still active. Hyperbaric oxygenation therapy was followed by complete resolution of the necrotizing otitis externa, which did not recur. The pathogenesis of the disease and mechanisms by which hyperbaric oxygenation might be of benefit are described. We conclude that hyperbaric oxygenation should be considered as adjuvant therapy for necrotizing otitis externa whenever a therapeutic pressure chamber is available.

Tonsillar leiomyoma.

Tumors of smooth muscle origin are rare in the oral cavity. To date, only eighty-three cases of oral leiomyomas have been reported. A first case of tonsillar leiomyoma in a 73-year-old male is presented. The theories of origin and the various histologic types of oral leiomyomas are discussed. Leiomyoma can easily be confused with other spindle-cell tumours. Special stains are necessary to reach a correct diagnosis. It is sometimes difficult to differentiate benign leiomyoma from malignant leiomyosarcoma. The use of mitotic figure count to indicate malignant behaviour is not always reliable. The need for wide surgical excision of the tumour, complete sectioning and examination of the specimen and meticulous follow-up of the patient for evidence of recurrence are emphasized.

Resistance to water flow in the sorghum plant.

Knowledge of the location and magnitude of the resistance to water flow in a plant is fundamental for describing whole plant response to water stress. The reported magnitudes of these resistances vary widely, principally because of the difficulty of measuring water potential within the plant. A number of interrelated experiments are described in which the water potential of a covered, nontranspiring leaf attached to a transpiring sorghum plant (Sorghum bicolor [L.] Moench) was used as a measure of the potential at the root-shoot junction. This allowed a descriptive evaluation of plant resistance to be made.The water potentials of a covered, nontranspiring leaf and a nonabsorbing root in solution, both attached to an otherwise actively transpiring and absorbing plant, were found to be similar. This supported the hypothesis that covered leaf water potential was equilibrating at a point shared by the vascular connections of both leaves and roots, i.e. the nodal complex of the root-shoot junction or crown. The difference in potential between a covered and exposed leaf together with calculated individual leaf transpiration rates were used to evaluate the resistance between the plant crown and the exposed leaf lamina called the connection resistance. There was an apparent decrease in the connection resistance as the transpiration rate increased; this is qualitatively explained as plant capacitance.Assuming that the covered leaf water potential was equal to that in the root xylem at the point of water absorption in the experimental plants with relatively short root axes, calculated radial root resistances were strongly dependent on the transpiration rate. For plants with moderate to high transpiration rates the roots had a slightly larger resistance than the shoots.