Phytophthora ramorum does not cause physiologically significant systemic injury to California bay laurel, its primary reservoir host.

California bay laurel trees (Umbellularia californica) play a crucial role in the reproduction and survival of Phytophthora ramorum in coastal California forests by supporting sporulation during the rainy season and by providing a means for the pathogen to survive the dry, Mediterranean summer. While bay laurel is thus critical to the epidemiology of sudden oak death and other P. ramorum diseases in California, the relatively minor symptoms observed on this reservoir host suggest that it may not sustain ecologically significant injury itself. The long-term role that P. ramorum will play in California forests will depend in part on the extent to which this pathogen decreases the ecological fitness of bay laurel. Despite the importance of this question, no study has yet investigated in detail the physiological impact that ramorum blight imposes on bay laurel. This experimental study quantifies the impact that P. ramorum has on artificially inoculated bay laurel seedlings with measurements that integrate the full injury that infection with an oomycete may cause: photosynthetic efficiency, total photosynthetic area, and growth. Leaf area and leaf mass were not impacted significantly by infection of P. ramorum. Photosynthetic efficiency was mildly depressed in symptomatic, but not asymptomatic leaves, despite unnaturally high levels of necrosis that were imposed on the seedlings. These results demonstrate that bay laurel trees suffer only minor injury from ramorum blight beyond visible necrotic symptoms. Consequently, it is highly likely that bay laurel will continue to be widely available as a host for P. ramorum in California forests, which has long-term implications for the composition of these forests.

Nasal septal squamous cell carcinoma: a chart review and meta-analysis.

Squamous cell carcinoma of the nasal septum occurs infrequently and is often misdiagnosed because its symptoms are similar to everyday rhinologic complaints. The published series have been too small to determine the best form of treatment for this cancer. The authors of this study retrospectively reviewed nasal septal squamous cell carcinomas treated at three university-affiliated hospitals over a 30-year period. Sixteen primary tumors were identified and reviewed for presentation, staging, treatment, recurrence patterns, and risk factors. The authors then combined their findings with those of suitable literature series and performed a meta-analysis to evaluate predictors of survival. There were too few patients in each stage and treatment group to significantly determine the optimal treatment for nasal septal squamous cell carcinoma. However, based on the present study and the literature series, the authors suggest that small lesions may be confidently treated with either radiation or surgery and that combined therapy may be reserved for more advanced tumors.

Fibrin-glue-reinforced paper patch myringoplasty of large persistent tympanic membrane perforations in the guinea pig.

Investigators have attempted to simplify and improve myringoplasty. However, techniques have not been applied to large, chronic human tympanic membrane perforations. Fibrin glue has been shown to improve wound strength but has not been significantly utilized in myringoplasty. To evaluate the effectiveness of paper patch myringoplasty reinforced with fibrin glue, 15 guinea pigs underwent repeated myringectomy to form persistent (>50%) perforations. The right ears were repaired with a paper patch and fibrin glue (treatment group), and the left ears with a paper patch alone (control group). Of 16 surviving ears (9 right and 7 left), only 1, a left ear, failed to heal. In the control group, histology revealed a larger fibrous layer approaching greater total eardrum thickness than in the treatment group. Neither group was significantly different from a normal, nonoperated tympanic membrane in terms of overall thickness. Fibrin glue failed to demonstrate histologic evidence of increased cellular proliferation and possibly hindered growth. High spontaneous healing rates in guinea pigs undermine myringoplasty modeling.

Hemoptysis and pseudohemoptysis: the patient expectorating blood.

Patients expectorating blood seek evaluation and treatment from a variety of clinicians. Although the bleeding may arise either from the lungs (hemoptysis) or from the upper aerodigestive tract (pseudohemoptysis), the evaluation commonly focuses on exclusion of a pulmonary neoplastic source. Likewise, most literary reviews only focus on hemoptysis as it relates to pulmonary malignancies. The present retrospective review identifies 471 patients with the diagnosis of hemoptysis over a six-year period, and 10% were ultimately found to have UAT etiologies for their bleeding. UAT cancers were identified as the source in 2.1% of all patients, either due to primary lesions or via metastases. The majority of UAT cancers had been previously diagnosed prior to this episode of hemoptysis. This review indicates that a thorough UAT history and exam is warranted in the hemoptysis patient because of the significant occurrence of UAT causes. However, the likelihood of finding an occult UAT cancer in this patient population is very low with the only risk factor being a previous history of a UAT neoplasm.

Disorders of taste and smell.

Chemosensory dysfunction involves deficits in taste or smell. Aberrations in these senses can be quite distressing to the patient and can negatively impact on nutritional well-being. A thorough history and physical examination are important in isolating the etiology of the sensory loss from the numerous causes of taste and smell disorders. The diagnosis can be simplified by the fact that only a few causes (nasal and sinus disease, viral-induced loss, and head trauma) are responsible for the vast majority of chemosensory dysfunctions. Therapy is limited, but one should be aware of the existing medical and surgical treatment modalities.

Diagnosis and management of hemoptysis.

Hemoptysis may present in patients both young and old, and its causes are numerous. The origin of the bleeding can be anywhere from the lips to the lung pleura, and a precise history and physical examination are essential in narrowing the search for the etiology. The chest film can effectively identify or exclude most lung neoplasms, but further evaluation is needed in those patients at high risk for cancer. The etiologies of hemoptysis are reviewed; emphasis is placed on a thorough history; the utility of diagnostic studies are explained; and efficient management is outlined.

Congenital and genetic sensorineural hearing loss.

One in 750 neonates will have a sensorineural hearing loss of which approximately 40% will be due to a genetic defect. The causes of congenital and genetic sensorineural hearing loss are abundant, and their associations with other diseases are quite diverse. The early detection of hearing loss is of the utmost importance because it can affect development even within the first year of life. A familiarity with the numerous causes of sensorineural hearing loss and their associated abnormalities allows for early detection. Rehabilitation of the hearing loss as well as treatment of the associated organic defects and assistance through genetic counseling is often indicated.

Ultrafiltration in the treatment of refractory congestive heart failure.

Artificial subtraction of fluids and solutes was evaluated in the course of acute and chronic heart failure when it became refractory to standard intensive medical treatment. A group of 19 patients (mean age 57 years), 9 with ischemic, 2 amyloidotic, 4 valvular, and 4 idiopathic cardiomyopathy, were treated. In 17 patients extracorporeal ultrafiltration (UF) by means of a polysulfonate ultrafilter was adopted along 125 sessions (105 assisted by a roller pump and 20 as a slow continuous ultrafiltrate). In two patients continuous peritoneal dialysis was adopted. In every case UF was well tolerated. Ultrafiltrate volumes ranged from 1680 to 3500 ml for every session with corresponding Na losses ranging from 194 to 434 mEq/session. Improved clinical and functional status with reduction of edema was observed in 17 of 19 patients. In 12 patients UF could be discontinued due to restored response to diuretics; 5 of these patients could subsequently undergo heart surgery (1 transplant, 3 valve replacement, 1 coronary bypass). The remaining 7 patients survived on medical therapy alone for an average of 228 days. In 7 of 19 cases, UF could not be discontinued, and these patients died after an average of 23 days of treatment. In conclusion, UF proved to be effective in eliminating salt-fluid overload and restoring response to medical treatment. Patients who are potential surgical candidates seem to be the most suitable for UF.