Geriatric demographics and the practice of otolaryngology.

Changing demographic trends in our country will have a profound influence on the future practice of otolaryngology. As a result of declining birth rates and increasing lifespans, the geriatric population has already become the fastest-growing segment of our society, and it will continue to be so for decades to come. A larger percentage of patients treated by otolaryngologists will be in the over-65 age group. It will become important to confront not only the medical treatment of this segment of the population, but also the socioeconomic effects of these demographic changes. Familiarity with the terminology, concepts, and statistics of demography is key to understanding the influence that the aging of the population will have on the practice of otolaryngology.

Ethical issues for otolaryngology and surgery in the elderly.

Clinical ethics is an intrinsic aspect of medical practice. Concerns for ethical conduct arise in the management of medical benefits, patient preferences, quality of life, and the relationship between patient care and its attendant familial, social, economic, and legal circumstances. Ethical concerns in surgical practice are central to the essence of the Hippocratic doctrine, "First do no harm." In caring for our patients, particularly in light of the modern practice of medicine, we often use the risk-benefit calculus. The range of ethical concerns for the otolaryngologist who deals with the elderly and infirm covers many diverse situations. Superimposed over this spectrum is the idea of patient autonomy, which is considered to be a cardinal issue in any ethical discussion. Furthermore, increasing medical care costs have created a debate regarding the rationing of healthcare. Ethicists continue the discussion as to whether age should be a decisive factor in the rationing of this care. Definitions of "heroic" and "extraordinary" assume greater significance, and controversies of language become pivotal when the comprehension and cognitive orientation of the patient are compromised by disease and senescence.

An atypical strain of Pasteurella gallinarum: pathogenic, phenotypic, and genotypic characteristics.

The pathogenicity of a strain of Pasteurella gallinarum isolated in Fresno County, Calif., was compared with the American Type Culture Collection (ATCC) strain. Broiler chickens were inoculated intranasally with 10(7) colony-forming units (CFU) and intramuscularly with 10(5) CFU of each strain. The only notable lesions were in chickens inoculated intramuscularly with 10(5) CFU of the Fresno strain, which developed severe myositis at the inoculation site, pericarditis, perihepatitis, airsacculitis, and synovitis. P. gallinarum was reisolated from these lesions. Phenotypic characteristics of the two strains were identical except in reactions in ONPG broth and fermentation of xylose. Protein-banding patterns for the two strains were identical except for a single band difference in the 35-kilodalton region. Restriction endonuclease analysis confirmed that the Fresno strain was a distinct one. Plasmid analysis revealed that the ATCC strain had two plasmids and the Fresno strain had none.

Severe mortality in broiler chickens associated with Mycoplasma synoviae and Pasteurella gallinarum.

Severe economic loss due to high mortality and condemnation rates occurred on two commercial broiler facilities. Chickens had moderate-to-severe airsacculitis, pericarditis, perihepatitis, tracheitis, and synovitis. Pasteurella gallinarum was isolated from 16 of 18 pericardia, four of 14 livers, 11 of 16 air sacs, six of seven joints and one of 28 tracheas in pure culture. In addition, Mycoplasma synoviae was isolated from trachea and air sac. Lesions were suggestive of an Escherichia coli septicemia, but E. coli was isolated from only four of 28 tracheas and one of 14 livers in pure culture. A coronavirus was isolated from trachea and lung. Whether this coronavirus represented a vaccine or field strain of infectious bronchitis was not determined. These findings suggested that the severe lesions were due to a concomitant infection with an atypical strain of P. gallinarum.

Pathogenesis of H13 nephropathogenic infectious bronchitis virus.

A nephropathogenic Massachusetts strain of infectious bronchitis virus (IBV) designated H13-IBV was isolated from the kidneys of commercial broilers. H13-IBV caused respiratory distress, depression, and diarrhea in specific-pathogen-free chickens. Gross renal lesions included pale coloration, swelling, and urate deposition. Histologic renal changes were interstitial mononuclear cell infiltration and degeneration and necrosis of tubular epithelial cells. Lesions in respiratory tissues included thickening and edema of the air sacs, congestion of the tracheal mucosa, and frothy serous exudate. Histologic tracheal lesions were deciliation, mucous gland distortion, inflammatory cell infiltration, and squamous metaplasia. Clinically, H13-IBV was highly pathogenic in birds infected at 1 day of age and mildly pathogenic in birds infected at 4 weeks of age. Kidney lesions were of marked severity only in birds infected at 1 day of age. Tracheal lesions were similar in severity in both age groups.

An outbreak of nephropathogenic H13 infectious bronchitis in commercial broilers.

A nephropathogenic Massachusetts strain of infectious bronchitis virus, designated H13-IB virus, was isolated from the kidneys of broilers in a commercial flock. Respiratory distress, diarrhea, depression, and high mortality were present. Gross renal lesions consisted of pale coloration, mottling, urate deposition, and swelling. The trachea contained a serous to catarrhal exudate. Microscopically, renal changes were primarily associated with the medullary region. Lesions included an interstitial mononuclear cell infiltration, urate deposition, edema, and degenerative and necrotic tubular changes. Tracheal changes included marked thickening of the mucosa, desquamation of ciliated and glandular epithelia and replacement with a stratified undifferentiated epithelium, and inflammatory cell infiltration.