First Report of Embellisia hyacinthi Causing a Leaf Spot and Bulb Skin Spot Disease on Scilla peruviana in California.

The genus Scilla (Hyacinthaceae) includes more than 50 species of perennial, flowering bulbs grown in landscapes worldwide. In December 2000 and May 2009, an unknown leaf spot disease on Scilla peruviana was submitted to the California Department of Food and Agriculture Plant Pest Diagnostic Lab. Samples were collected during routine phytosanitary inspections of production fields in Santa Cruz County in 2000 and Monterey County in 2009. The disease was detected before plants flowered in one field at each location each year and appeared to have a scattered distribution. Foliar spots were large, elliptical to oblong with grayish black centers and brown margins. Yellow halos surrounded many of the spots. Examination of the bulb material revealed small necrotic patches on the outer bulb scales. A rapidly growing fungus was isolated on one-half-strength acidified potato dextrose agar (APDA) from the sporulating leaf spots and necrotic patches on the bulbs. The colonies were greenish gray and became dark olivaceous with age. Dictyospores, which formed on simple to branched, geniculate conidiophores, were oblong, fusiform or obclavate and usually had a triangular apical cell. They were initially hyaline, turning olivaceous brown with age. Conidia measured 14 to 39 × 8 to 13 µm (average 24.6 × 9.9 µm) typically with two to four (but up to seven) thick, transverse septa and one to two longitudinal septa. Morphologically, the fungus matched the description of Embellisia hyacinthi de Hoog & Miller (1,3). To confirm pathogenicity, four leaves of four S. peruviana plants were inoculated by taking colonized mycelial plugs from 2-week-old cultures and placing them in a plastic screw-cap lid filled with sterile water. The water plus mycelial plug suspension in the lid was then clipped to the adaxial side of a pushpin-wounded leaf (4). Plants were placed in a dark dew chamber at 20°C for 48 h and then moved to a growth chamber at 20°C with a 12-h photoperiod. After 48 h, the clips, caps, and plugs were removed. An equal number of control plants were wounded and mock inoculated with noncolonized APDA agar plugs and the experiment was repeated. Leaf lesions were visible 3 days after clip removal and expanded to an average of 26 × 10 mm, 14 days after inoculation. Sporulation was observed in the lesions after 5 to 7 days and the fungus was isolated from all inoculated leaves. No symptoms developed on the control leaves. DNA sequencing of the internal transcribed spacer region of the isolate (GenBank Accession No. HQ425562) using primers ITS1 and ITS4 matched the identity of E. hyacinthi (2,4). E. hyacinthi has been reported as a foliar and bulb pathogen on Hyacinthus, Freesia, and Scilla in Japan and Europe including Great Britain. Bulbs infected with E. hyacinthi are generally less sound and less valuable than noninfected bulbs (1). To our knowledge, this is the first report of the disease on S. peruviana in California. References: (1) G. S. de Hoog and P. J. Muller. Neth. J. Plant Pathol. 79:85, 1973. (2) B. Pryor and D. M. Bigelow. Mycologia 95:1141, 2003. (3) E. Simmons. Mycotaxon 17:216, 1983. (4) L. E. Yakabe et al. Plant Dis. 93:883, 2009.

An intermittent foreign body in the airway: a case report.

A case is described of a surgical 'stay' suture which apparently disappeared from the tracheostomy site and took an unusual course before it reappeared in the patient's tracheostomy tube. Our report highlights the importance of documentation of the surgical techniques and procedures used in the performance of a tracheostomy and the importance of daily bedside examinations in the critically ill patient.

Rates of in-hospital arrests, deaths and intensive care admissions: the effect of a medical emergency team.

OBJECTIVES: To evaluate the effectiveness of a medical emergency team (MET) in reducing the rates of selected adverse events. DESIGN: Cohort comparison study after casemix adjustment. PATIENTS AND SETTING: All adult (> or = 14 years) patients admitted to three Australian public hospitals from 8 July to 31 December 1996. INTERVENTION STUDIED: At Hospital 1, a medical emergency team (MET) could be called for abnormal physiological parameters or staff concern. Hospitals 2 and 3 had conventional cardiac arrest teams. MAIN OUTCOME MEASURES: Casemix-adjusted rates of cardiac arrest, unanticipated admission to intensive care unit (ICU), death, and the subgroup of deaths where there was no pre-existing "do not resuscitate" (DNR) order documented. RESULTS: There were 1510 adverse events identified among 50 942 admissions. The rate of unanticipated ICU admissions was less at the intervention hospital in total (casemix-adjusted odds ratios: Hospital 1, 1.00; Hospital 2, 1.59 [95% CI, 1.24-2.04]; Hospital 3, 1.73 [95% CI, 1.37-2.16]). There was no significant difference in the rates of cardiac arrest or total deaths between the three hospitals. However, one of the hospitals with a conventional cardiac arrest team had a higher death rate among patients without a DNR order. CONCLUSIONS: The MET hospital had fewer unanticipated ICU/HDU admissions, with no increase in in-hospital arrest rate or total death rate. The non-DNR deaths were lower compared with one of the other hospitals; however, we did not adjust for DNR practices. We suggest that the MET concept is worthy of further study.

Conservative management of a posterior tracheal tear: a case report.

We describe a case of posterior tracheal wall tear managed conservatively with a successful outcome. The presentation of a sudden increase in cuff volume and subcutaneous emphysema presents a challenging management problem requiring careful bronchoscopic and computed tomography delineation and isolation of the injury using a double lumen tube. This case also highlights the vulnerability of the trachea to injury from airway intervention and considers the possible mechanisms of tracheal injuries during the commonly performed intensive care procedure of percutaneous tracheostomy.

Outbreak of Leaf Spot of Saponaria Caused by Alternaria saponariae in California.

Saponaria (Saponaria vaccaria [= Vaccaria hispanica]) is a Caryophyllaceae plant that is grown commercially in California as a cut flower. In 1998, a leaf spot disease devastated the commercially grown saponaria in coastal California. The entire saponaria crop was completely unmarketable because of extensive leaf spotting. Symptoms consisted of circular, brown, necrotic leaf spots with diameters up to 8 mm and concentric zones of lighter and darker tissue. Chlorotic borders developed around the spots. Conidia from leaves were obclavate, usually had 7 transverse and 1 to 4 longitudinal septa, and narrowed gradually toward the apex into a blunt-tipped, unbranched beak cell. The spore body measured 69 to 90 (to 119) × 17 to 21 (to 25) µm, with the distinctive beak cell 17 to 53 µm long. Conidia formed short chains on host tissue. The fungus was identified as Alternaria saponariae (Peck) Neergaard (2). For pathogenicity tests, six representative isolates were grown on V8 juice agar under fluorescent tube lighting. Potted saponaria were sprayed with either conidial concentrations (1 × 10e5 conidia per ml) or water. Plants were incubated in a chamber with a humidifier for 48 h and then maintained in a greenhouse (23 to 25°C). After 14 days, leaf spots similar to the original symptoms developed on all inoculated plants, and the pathogen was reisolated. Plants sprayed with water were symptomless. The experiment was repeated and the results were similar. Using the same isolates and method, we inoculated carnation (Dianthus caryophyllus), sweet William (Dianthus barbatus), and saponaria. However, disease developed only on saponaria. While A. saponariae on saponaria was reported previously in California (1), this is the first report to characterize the pathogen and document that isolates are pathogenic on saponaria but not on other commercial Caryophyllaceae hosts. References: (1) K. F. Baker and L. H. Davis. Plant Dis. Rep. 34:403, 1950. (2) P. Neergaard. Aarsberet. J. E. Ohlsens Enkes Plantepat. Lab. No. 3, 1938.