Phytophthora cinnamomi as a Cause of Oak Mortality in the State of Colima, Mexico.

This research identifies the root pathogen Phytophthora cinnamomi as the primary cause of mortality in a 300-ha disease center of mixed oak trees in a native forest in southern Mexico. In increasing order of apparent field resistance to the disease, the major oak species are Quercus glaucoides, Q. peduncularis, and Q. salicifolia. P. cinnamomi was isolated from soil in the affected area from symptomatic trees and was successfully used to perform Koch's postulates on these three oak species. Artificial and natural infections produced vertically elongated discolorations in the outer xylem and distinctive phloem canker lesions with a sharp demarcation line between healthy and affected tissues. In Q. glaucoides there is little evidence that this oak species is able to resist the girdling effects of the phloem lesions, but in Q. peduncularis, and especially in Q. salicifolia, increased production of callus tissue around the phloem canker lesions suggests an active resistance mechanism that may allow these infected trees to survive somewhat longer. This particular incident is unlike other recent reports in other parts of the world of oak mortality caused by P. cinnamomi because the initial appearance of disease in this area is known (just prior to 1987), and it has subsequently expanded to the present area of 300 ha (in 1999) as a distinctive infection locus with periodically advancing infection fronts. This incident is also another dramatic illustration of the potential environmental damage that can result when P. cinnamomi is introduced into a simple forest ecosystem where the major overstory trees are susceptible to infection and are killed.

Severe hypoglycemia as a presenting symptom of carbohydrate-deficient glycoprotein syndrome.

We describe clinical, biochemical, and molecular findings in a 2(1/2)-year-old girl with a phosphomannose isomerase deficiency who presented with severe and persistent hypoglycemia and subsequently developed protein-losing enteropathy, liver disease, and coagulopathy. Six months of therapy with mannose supplementation resulted in clinical improvement and partial correction of biochemical abnormalities.

Antibodies to pneumococcal capsular polysaccharides in children with human immunodeficiency virus infection given polyvalent pneumococcal vaccine.

Antibody to 7 common pneumococcal capsular polysaccharides was measured in 11 children with human immunodeficiency virus (HIV) infection who had been previously vaccinated with 23-valent polysaccharide pneumococcal vaccine, 11 unvaccinated children with HIV infection, and 11 healthy subjects. No differences in capsule-specific IgG levels against serotypes 4, 6B, 8, 12F, 14, 19A, and 19F were observed among the vaccinees with HIV infection compared with unvaccinated children with HIV infection and age-matched control children.

Thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest injury.

PURPOSE: The purpose of this study is to describe our experience with thoracoscopic drainage and decortication as definitive treatment for empyema thoracis following penetrating chest trauma. METHODS: Over a 9-month period, eight patients at two institutions were treated for empyema thoracis that developed following penetrating chest injury. Seven patients sustained gunshot wounds and one a stab wound. All were treated for hemothorax with a closed tube thoracostomy. Associated injuries included six spinal cord injuries, a liver and diaphragmatic injury, a subclavian injury, and a carotid injury. Each patient subsequently developed an empyema. All patients underwent one thoracoscopic drainage and decortication of the empyema. RESULTS: In all patients, complete resolution of the empyema was achieved with the thoracoscopic technique. Chest tubes were removed a median of 8.5 days after the procedure. Median blood loss was 200 mL. The average duration of the operation was 110 minutes. There were two complications, a persistent air leak and a trapped lung, both treated with thoracoscopic intervention. CONCLUSION: Thoracoscopic drainage and decortication offers an alternative to thoracotomy for definitive therapy of empyema thoracis developing after penetrating chest trauma.

Development of valve dysfunction in adolescents and young adults with Down syndrome and no known congenital heart disease.

We performed examinations and echocardiographic studies in 35 patients with Down syndrome (aged 20 +/- 4.2 years) with no known intracardiac disease. Sixteen patients (46%) had mitral valve prolapse; two of these also had tricuspid valve prolapse. Two had aortic regurgitation. Valve regurgitation was present in 4 (17%) of 23 patients more than 18 years of age but in none of the 12 patients 18 years of age or younger. We recommend screening of adolescent and young adult patients with Down syndrome for the development of valve dysfunction, especially before dental or surgical procedures.