Peruvian Man Research Articles

Teaching Video NeuroImages: Slow periodic myoclonus in subacute sclerosing panencephalitis and fulminant Wilson disease

Slow periodic myoclonus is a well-recognized phenotype of fulminant subacute sclerosing panencephalitis (video 1).1 This distinctive phenotype has not been previously recognized in another rapidly progressive disorder, fulminant Wilson disease. We documented slow periodic myoclonus in a 34-year-old Peruvian man who developed paranoid schizophrenia and, 6 months later, levodopa-unresponsive parkinsonism and falls, progressing into akinetic mutism (video 2). Prior to death, the diagnosis of Wilson disease was supported by ocular and neuroimaging features (figure), low ceruloplasmin (5.3 U/L), high urinary copper, and diffuse hepatopathy on echography. Slow periodic flexor myoclonus reflects cortical excitability and bears a poor prognosis.2 The EEG correlates are generalized, high-amplitude, quasiperiodic complexes.

Peritonitis Due to Appendicitis Related to Mercury Sequestration: An Unusual Peruvian Case Report

Elemental mercury ingestion caused by folk practices is rare and usually harmless. Nevertheless, some complications related to mercury ingestion have been reported such as appendicitis related to mercury sequestration and poisoning leading to systemic toxicity. Patients usually present with nausea, vomiting, and abdominal tenderness. Mercury sequestration in the appendix depends on its anatomy and mercury physical properties, both of which may lead to appendicitis, resulting in subsequent peritonitis leading to multiple and severe surgical complications. A 26-year-old Peruvian man complaining of vomiting and abdominal pain after ingestion of elemental mercury as part of a folk practice presented to the emergency department. Physical exam was remarkable for rigid abdomen and diffuse rebound sign. A clinical diagnosis of peritonitis was made. The patient was taken to the operating room where an open appendectomy and peritoneal lavage were performed. On gross inspection, a silver foreign body within the perforated appendix was seen by the surgical team. The patient developed multiple surgical complications leading to multiple organ failure and death. Clinicians should be aware that mercury ingestion is usually benign. However, severe complications may develop. Early surgical and medical intervention should be initiated promptly to achieve better outcomes. We present the first case of peritonitis due to appendicitis related to mercury sequestration in the appendix.

Infected Cavitations, Bullae and Interstitial Lung Disease in a COVID-19 Patient in Lima, Peru.

A 48-year-old Peruvian man was diagnosed with COVID-19 in December 2020. His infection resolved and he was discharged from hospital after 14 days. However, 1 week later he presented with haemoptysis, malaise, pleuritic pain, infected cavitations, bullae, extensive interstitial lung disease and pneumomediastinum. He recovered after antibiotic treatment and was discharged after 8 days. His symptoms may have been due alveolar rupture due to persistent cough during and after diffuse inflammation of the lung parenchyma caused by COVID-19 infection.LEARNING POINTSSARS-CoV-2 infection may be associated with lung bullae and cavitations as COVID-19 sequelae.Patients with respiratory problems after COVID-19 should be monitored closely and undergo pulmonary tests.COVID-19 patients may experience complications for several months due to bacterial infections.

THE TALE OF THE TRAVELING CHEESE: SHIGELLA IN A LUNG TRANSPLANT PATIENT

TOPIC: Transplantation TYPE: Fellow Case Reports INTRODUCTION: Shigella is a common cause of gastroenteritis in areas of overcrowding and poor sanitation, but is seen less frequently in the developed world. Infection is mainly acquired through the fecal-oral route, but consumption of unpasteurized dairy remains a high risk for transmission. In this report, we describe a case of a lung transplant patient who presented with septic shock secondary to Shigella gastroenteritis after ingesting unpasteurized cheese brought back from Peru. CASE PRESENTATION: This is a case of a 62-year-old Peruvian man who underwent a bilateral lung transplant for end stage idiopathic pulmonary fibrosis in November 2018, a year prior to this presentation. Pre-transplant the patient status was CMV +/+, EBV +/+. At time of presentation his immunosuppression regimen consisted of Tacrolimus 0.5 mg, Mycophenolate 500mg twice daily and Prednisone 10mg daily.He had been progressing well until he presented to the emergency department with a reported fever of 103 degrees Fahrenheit, around 40 episodes a day of profuse non-bloody, watery diarrhea and abdominal discomfort. He did not complain of nausea or vomiting. He revealed that he had eaten soft, white, unpasteurized cheese that was brought from Peru two days prior.He was hypotensive with a blood pressure of 72/39, a heart rate of 107 beats per minute and SaO2 of 96% while breathing ambient air. A physical exam revealed mild diffuse abdominal tenderness, rest of exam was normal.Laboratory examination revealed a white blood cell count of 18,000 cells/mcl, platelet (PLT) count of 147,000 cells/mcl, creatinine 1.30 mg/dL, lactic acid 3.2 mmol/L. Computerized tomography (CT) of his abdomen showed fluid filled loops of the colon and small bowel, reflecting enteritis and diarrhea. Stool studies were sent. The patient was treated with intravenous fluids, Tacrolimus was held due to new acute kidney injury, Mycophenolate held due to leukopenia and Cefepime and Metronidazole were administered for empiric coverage for abdominal pathogens. On day 4 of admission Shigella flexneri (sensitive to Levofloxacin and Ceftriaxone, resistant to Ampicillin) was isolated and infectious disease consultation obtained. The patient had clinically recovered on Cefepime and he completed the antibiotic course. He was discharged the following day on his routine triple immunosuppressive therapy. DISCUSSION: Solid organ transplant recipients with diarrhea should be tested for shigella. Patients not responding to conventional treatment should undergo repeat culture and sensitivity testing. Bacterial culture is the gold standard for diagnosis of shigella infections. The use of antibiotics depends on the severity of illness, the age of the patient and immune status. CONCLUSIONS: This case highlights the importance of educating transplant patients on how to reduce certain harmful exposures that may be fatal in immunosuppressed individuals. REFERENCE #1: 1. GBD 2016 Diarrhoeal Disease Collaborators. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Infect Dis 2018. REFERENCE #2: 2. Kotloff KL, Winickoff JP, Ivanoff B, et al. Global burden of Shigella infections: implications for vaccine development and implementation of control strategies. Bull World Health Organ 1999; 77:651–66 REFERENCE #3: 3. Livio S, Strockbine NA, Panchalingam S, et al. Shigella isolates from the global enteric multicenter study inform vaccine development. Clin Infect Dis 2014; 59: 933–41. DISCLOSURES: No relevant relationships by Nikhil Madan, source=Web Response No relevant relationships by Vipul Patel, source=Web Response No relevant relationships by Safiyya Quintiliani, source=Web Response

Paracoccidiodomycosis lung reactivation in a patient with signet-ring cell gastric adenocarcinoma after chemotherapy: Case report

Although the relationship between paracoccidioidomycosis (PCM) and solid tumors has been described more than 80 years ago, reports of PCM and gastric cancer are rare. PCM can present before or concomitantly with the diagnosis of cancer, and its clinical presentation may rise the suspicion of malignancies or be part of reactivation by immunosuppression. We present the case of a 52-year-old Peruvian man with a signet-ring cell (SRC) gastric adenocarcinoma who after 6 chemotherapy sessions with FLOT (docetaxel, oxaliplatin, leucovorin, 5-fluorouracil) presented rapidly growing lung nodules. The lung biopsy showed yeasts compatible with Paracoccidioides sp., so he received initial treatment with itraconazole and after gastrectomy maintenance therapy with trimethoprim/sulfamethoxazole accompanied by tomographic resolution of lesions.

2411 Acute Liver Injury in a Patient Treated With Rosuvastatin: A Rare Adverse Effect

INTRODUCTION: As recently as 2014, Rosuvastatin was the most prescribed brand name drug in the US, with 22.3 million prescriptions filled and $5.8 billion in sales. Its use is associated with mild, asymptomatic, and usually transient, serum aminotransferase elevations, occurring in 1-3% of patients. However, levels above 3 times the ULN occur no more frequently among rosuvastatin-treated [0.2%] as placebo-treated [0.3%] recipients. Rarely, patients can present with clinically apparent acute liver injury, occurring in 1/10,000 patients. CASE DESCRIPTION/METHODS: A 47 y/o Peruvian man was told by his PCP that he had high cholesterol, and he was started on rosuvastatin 5 mg daily. At the time, his LFTs showed AST 17 and ALT 19. However, labs performed a month later showed AST 1282, ALT 2245, ALP 295, total bilirubin (TB) 7.1 (direct 5.5). He was advised to visit his local ER. He was admitted, the rosuvastatin was stopped, he received mainly supportive care, his LFTs continued to rise, and he underwent a liver biopsy. He was then transferred to a tertiary care hospital. His labs upon arrival showed AST 1400, ALT 2253, ALP 277, TB 9.9, and INR 1.1. He was admitted for acute liver failure due to drug-induced liver injury from rosuvastatin. Despite IV NAC therapy for five days and initiation of Ursodiol, his LFTs showed no recovery. His liver biopsy showed acute severe hepatitis with a mixed inflammatory infiltrate with many plasma cells. There was interface activity and bile duct damage. The histopathology was consistent with an immune-mediated drug reaction. He was approved to be listed for liver transplantation due to a high MELD score of 21. Before discharge, his labs improved to AST 942, ALT 1312, and ALP 167, but the TB rose to 17.2. He remained hemodynamically stable with no mental status changes during the hospital course. Afterward, repeated labs showed improvement in the LFTs, except for increasing hyperbilirubinemia. He was re-admitted and given a trial course of IV methylprednisolone after which the TB proceeded to decrease. Ultimately, his liver enzymes improved, he remained asymptomatic, and he was removed from the liver transplantation waitlist. DISCUSSION: The acute liver failure attributed to rosuvastatin is often accompanied by autoimmune features and may be caused by immune mechanisms. Corticosteroids have been used when recovery does not occur promptly. If used, the dose and duration of treatment should be kept to a minimum, and careful follow up after discontinuation is essential.

Teaching Video NeuroImages: Slow periodic myoclonus in subacute sclerosing panencephalitis and fulminant Wilson disease

Slow periodic myoclonus is a well-recognized phenotype of fulminant subacute sclerosing panencephalitis (video 1).1 This distinctive phenotype has not been previously recognized in another rapidly progressive disorder, fulminant Wilson disease. We documented slow periodic myoclonus in a 34-year-old Peruvian man who developed paranoid schizophrenia and, 6 months later, levodopa-unresponsive parkinsonism and falls, progressing into akinetic mutism (video 2). Prior to death, the diagnosis of Wilson disease was supported by ocular and neuroimaging features (figure), low ceruloplasmin (5.3 U/L), high urinary copper, and diffuse hepatopathy on echography. Slow periodic flexor myoclonus reflects cortical excitability and bears a poor prognosis.2 The EEG correlates are generalized, high-amplitude, quasiperiodic complexes.

Ordinary Litigants: Women and Men, Slavery and the Enlightenment in Latin America

Ordinary Litigants:Women and Men, Slavery and the Enlightenment in Latin America Camilla Townsend (bio) Michelle A. McKinley. Fractional Freedoms: Slavery, Intimacy, and Legal Mobilization in Colonial Lima, 1600–1700. New York: Cambridge University Press, 2016. x+ 294 pp.; ISBN 978-1-1071-6898-5 (cl); 978-1-3166-2010-6 (pb); 978-1-3167-3191-8 (epub). Bianca Premo. The Enlightenment on Trial: Ordinary Litigants and Colonialism in the Spanish Empire. New York: Oxford University Press, 2017. xiii+ 384 pp.; ISBN 978-0-1906-3872-6 (cl); 978-0-1906-3873-3 (pb); 978-0-1906-3874-0 (epub). Two colonial Latin Americanists have recently made landmark contributions to the study of the history of law. Michelle McKinley's Fractional Freedoms and Bianca Premo's Enlightenment on Trial both study the uses to which disempowered people put the court system, focusing on gender and race as intertwined categories of analysis. Their studies yield particularly rich results even for scholars outside the realm of legal history. McKinley frankly acknowledges that in the past generation there has been "a veritable boom in studies examining slaves' entanglement with the law" (7). Like many who study Latin America, she has found herself responding to the historian Frank Tannenbaum's thesis in Slave and Citizen (1947) that the enslaved in that region found themselves in dramatically different circumstances than those in North America because of their access to the court system (thanks to the Siete Partidas) and the existence of an alternate set of authority figures (the Catholic Church).1 She does not quarrel with his insight, but her focus is on the slaves themselves: "A study that takes as its subject slaves' use of courts implicitly differs from a study of the laws of slavery, although both approaches ultimately are shaped by the issue of agency and structure" (28). She wishes to underscore that if we move beyond the bounds of fully slave societies like Brazil and the southern United States, we find enslaved people with a much higher likelihood of having experienced intimate ties with slaveholders, and not just in a sexual sense. It thus becomes imperative that gender take a lead role in our analysis (10–11). Furthermore, she argues that "contingent liberty (or fractional freedom) was the reality that all—whether enslaved, freed, or free—accepted and to which they accommodated their lives" (11). [End Page 165] McKinley's book is so thorough that it can and undoubtedly will serve as a veritable encyclopedia on the ways in which slaves pursued "fractional freedom"—a somewhat increased liberty for themselves or their loved ones—in a mid-colonial society with slaves. Chapter one demonstrates how actively the enslaved were involved in shaping their own legal cases, no matter how much help they received from a procurador (attorney). It also documents the practice of the censura (public censure), about which very little has been previously known. At the request even of a slave, the church would send out announcements to be made from every pulpit in the region, calling for people to step forward as witnesses; "Does anyone here know if it is true that don Alonso freed the baby Inés at her birth?" Chapter two explores the tensions between the sacrament of marriage (the authority of the church) and enslavement (the authority of the state), demonstrating in fascinating detail how effectively the enslaved used these tensions—for instance, when an enslaved Peruvian man married in haste in Lima to avoid being sent by his master out to Arica (97). Chapter three, on affective intimacy, moves beyond the expected stories of masters forcing enslaved women into relationships. Here, McKinley looks at ways in which some people were able to hide their enslaved status in order to contract marriage with a free person, to the benefit of the children. Chapter four considers the question of relations between enslaved mothers and their children who were freed by their fathers at baptism. It demonstrates how vulnerable such freedom was and how necessary it was for the enslaved mothers to keep the fathers in the public eye, first in order to gain freedom for the children and then to protect them from re-enslavement. Chapter...

Gastroduodenal involvement in disseminated strongyloidiasis.

Here, we report the case of a 57-year-old Peruvian man on long-term corticosteroid therapy for a drug allergy and proton pump inhibitors for chronic dyspepsia symptoms. Upper gastrointestinal endoscopy showed multiple white granular lesions and widespread erosions in the stomach. Our findings indicate that gastric strongyloidiasis should be carefully considered in high-risk patients even if endoscopic findings are nonspecific.

An Unusual Case of Anaphylaxis after Blunt Abdominal Trauma

BackgroundDue to current human migratory patterns, emergency physicians in developed countries are facing emergent clinical presentations of neglected tropical diseases with increasing frequency. In those situations, the clinician's diagnosis is often delayed due to a lack of familiarity with the disease. Case ReportWe present the case of a 25-year-old Peruvian man who presented to the Emergency Department complaining of dyspnea and abdominal pain after upper abdominal trauma. His physical examination revealed mouth and eyelid edema in association with epigastric pain. An abdominal computed tomography scan revealed a liver hydatid cyst. Emergent surgical evacuation of the cyst was required to control the anaphylactic reaction. Why Should an Emergency Physician Be Aware of This?Anaphylaxis in the setting of a complicated hydatid cyst is a life-threatening disease. Critical care management and emergent surgical evacuation of the cyst are indicated.

Rereading Ventura García Calderón

Ventura García Calderón (1886–1959) was a Peruvian man of letters and a diplomat who was at the center of the hispanophone community in Paris in the first half of the twentieth century. Known as a proponent of Spanish American literature, García Calderón achieved a global celebrity for his dramatic, colorful, and ironic short stories. These stories, published in both Spanish and French, feature a raw depiction of reality, a strong sense of retributive justice, and a sympathy for the marginalized people that characterize European Naturalism. García Calderón adapted this style to advance his goal of providing European readers with an authentic understanding of Peru and Spanish America, thus replacing the voyeuristic and patronizing notion of the “exotic” inherited from literary romanticism and nineteenth-century travel writers. The construction of García Calderón’s stories was subversive and destabilized the widespread notion of Peru held by European critics and readers. While international critics during the author’s lifetime unanimously praised García Calderón’s fiction as well as his essays that theorize the transformation and renaissance of Spanish language and literature by americano writers, scholars since the 1960s have largely misunderstood his reformative project. This essay argues that García Calderón’s originality, vibrancy, and idealism merit a major place for his works in Spanish American literary history.

Cystic Echinococcosis: Late Rupture and Complication of a Stable Pulmonary Cyst

Cystic echinococcosis is observed worldwide. Traditional management includes an invasive surgical approach with adjunctive chemotherapy. It has been suggested that observation alone may be appropriate in asymptomatic individuals with stable cysts. A case involving a 38-year-old Peruvian man with an asymptomatic bronchogenic cyst (suspected to be due to echinococcus, but never definitely diagnosed) is presented. The cyst was first noted in 1998, and was followed for 10 years during which time he remained asymptomatic with minimal radiographic change. One year later, in 2009, he presented with acute rupture of the cyst causing empyema. The patient required thoracotomy, decortication and resection of the ruptured cyst. Final pathology showed Echinococcus organisms. The patient responded well to treatment with albendazole and praziquantel, and became completely asymptomatic within six months. The present case demonstrates that echinococcal cysts may be at risk of spontaneous rupture, even after many years of clinical stability, thus supporting the case for resection of asymptomatic cysts suspected of being echinococcal at the time of diagnosis. In addition, the case illustrates that medical therapy with albendazole and praziquantel, in conjunction with surgical drainage, can be successful in the treatment of echinococcal empyema.

Multiple myeloma presenting as spinal cord compression: a case report

IntroductionSpinal cord compression is a potentially devastating condition that demands immediate attention. Efforts must be divided between addressing the symptoms of cord compression and identifying the precise etiology of the condition.Case presentationA 76-year-old Peruvian man presented to our emergency department for evaluation of the gradual onset of lower extremity weakness over one month, resulting in falls and a two day history of bladder and bowel incontinence. Surprisingly, the etiology of this case of spinal cord compression was found to be multiple myeloma presenting as a solid tumor.ConclusionWe report a case of a spinal cord mass resulting in symptoms of cord compression that was diagnosed when aspects of our patient's initial magnetic resonance imaging scan did not correlate with disc herniation, which was the diagnosis with the greatest pretest probability.

Detection and treatment of Strongyloides hyperinfection syndrome following lung transplantation

Abstract: Strongyloides hyperinfection syndrome has not been reported in lung transplant recipients. We describe the case of a 61‐year‐old Peruvian man, who received bilateral lung transplants for idiopathic pulmonary fibrosis, and subsequently developed persistent fever with pulmonary infiltrates, ventilator dependence, and pneumothoraces. Bronchoalveolar lavage (BAL) cultures for bacteria, viruses, and fungi were negative, but testing for ova and parasites from BAL fluid revealed Strongyloides stercoralis larvae on day 16 post transplant. He was successfully treated with albendazole and ivermectin, and immunosuppression was reduced. BAL fluid also grew Mycobacterium kansasii, for which he received combination anti‐mycobacterial therapy. This case illustrates the importance of screening for parasitic infections before transplantation in the appropriate clinical setting, and demonstrates the utility of direct diagnostic evaluation for parasitic infections in at‐risk post‐transplant patients with unexplained illnesses.

Onychoblastoma – Hamartoma of the Nail Unit: A New Entity?

A 50‐year‐old Peruvian man presented with a 4–5 years history of a 1,2 × 0,7 cm subungual verrucous mass that extended from the proximal nail fold to the hyponychium of the 2nd left toe. Histology of the nail bed showed a nodular tumour with multiple structures, similar to the infundibulum of the follicles, and germ like aggregations often joined to a follicular papilla. Few scattered neoplastic cells were necrotic. The stroma surrounding the nodular aggregations was made up of delicate fibrillary bundles of collagen associated with numerous oval fibrocytes. The histological findings remind us a neoplasm with follicular differentiation: trichoblastoma. A tumor with these histological aspects on the nail unit has never been reported. We name this benign neoplasm, which probably represents an hamartoma, onychoblastoma. Differential diagnosis of this case includes basal cell carcinoma (BCC) of the nail unit which is rare and mostly localised in the nail folds. The main histopathologic findings of nodular BCC are asymmetry, ulceration and its poorly circumscription. The hair follicle and the nail share similar embryological and anatomical features and the occurrence of a tumor with follicular differentiation in the nail further demonstrates the common origin of these adnexal structures.

Primary Meningeal Epstein-Barr Virus-related Leiomyosarcoma in a Man Infected With Human Immunodeficiency Virus

We describe the clinical, radiologic, surgical, and pathologic findings of a 29-year-old Peruvian human immunodeficiency virus-infected man with a primary parasellar meningeal leiomyosarcoma involving the left lesser esphenoidal wing and the cavernous sinus. Over a period of 13 months, he developed headache, vomiting, insomnia, and diplopia. Magnetic resonance imaging revealed a left parasellar extra-axial mass that was isointense in T1, hypointense in T2, and gadolinium-enhanced. The patient underwent subtotal resection of the tumor. The neoplasm was composed of spindle cells with smooth-muscle features. It showed moderate atypia, inconspicuous nucleoli, and scanty mitosis. No tumor necrosis was detected. The immunohistochemistry revealed strong positivity for vimentin, desmin, and smooth-muscle alpha-actin. A low-grade leiomyosarcoma was diagnosed. The in situ hybridization showed positive nuclear reactivity for Epstein-Barr virus-encoded RNA. The immunohistochemistry was negative for Epstein-Barr virus latent membrane protein 1. The main differential diagnosis of primary meningeal smooth-muscle tumors includes meningioma and peripheral nerve sheath tumors. Epstein-Barr virus has been demonstrated in most smooth-muscle tumors associated with acquired immune deficiency syndrome (AIDS). Primary meningeal smooth-muscle tumors, exceedingly rare neoplasms, remarkably affect young adults with AIDS. Comparatively, most AIDS-related visceral (nonmeningeal) smooth-muscle tumors have been reported in children. The permissiveness and tumorigenesis associated with Epstein-Barr virus may depend on the age of human immunodeficiency virus infection.

Nasal Tumor in a Peruvian Man

Nasal Tumor in a Peruvian Man

Nasal Tumor in a Peruvian Man

The American Journal of Dermatopathology offers outstanding coverage of the latest diagnostic approaches and laboratory techniques, as well as insights into contemporary social, legal, and ethical concerns. Each issue features review articles on clinical, technical, and basic science advances and illuminating, detailed case reports. With the The American Journal of Dermatopathology you'll be able to: Incorporate step-by-step coverage of new or difficult-to-diagnose conditions from their earliest histopathologic signs to confirmatory immunohistochemical and molecular studies. Apply the latest basic science findings and clinical approaches to your work right away. Tap into the skills and expertise of your peers and colleagues the world over peer-reviewed original articles, "Extraordinary cases reports", coverage of practical guidelines, and graphic presentations. Expand your horizons through the Journal's idea-generating forum for debating controversial issues and learning from preeminent researchers and clinicians. Official Journal of the International Society of Dermatopathology (ISDP)

First Report of Basal Stem Rot of Golden Barrel Cactus Caused by Fusarium oxysporum f. sp. opuntiarum in Italy.

Golden barrel cactus (Echinocactus grusonii Hildm.) is the most common landscape cactus in southern Italy. During 2000, 2001, and 2002, a basal stem rot of golden barrel cactus was observed in several plastichouses located in eastern Sicily with disease levels of nearly 100% on young plants (up to 15 cm in diameter). On the basal crown area, the plants showed pale brown or yellow-orange, sunken lesions bordered by a reddish orange strip up to 1 mm wide. A water-soaked rot or white mycelium at the soil line was also observed. Thirty pieces (0.5 to 1 cm) from the edge of symptomatic tissues were surface disinfected for 2 min in 0.8% (wt/vol) NaOCl, washed with sterile distilled water (SDW), and placed on potato dextrose agar (PDA). In addition, 20 pieces of affected tissue were ground in 400 μl of SDW (1:3, wt/wt), and the resulting suspensions were streaked by loops on PDA supplemented with 1.1 μl/ml of lactic acid (pH 4.4). A Fusarium sp. was consistently isolated from affected tissue pieces and streaks. Koch's postulates were performed at 25°C by inoculating 24 golden barrel cactus plants in 12-cm-diameter pots (12 plants previously sterile needle wounded) with 10 ml per plant of three suspensions (106 CFU/ml) of three isolates sprayed onto the basal stem. One milliliter per ten g of soil of each suspension was also added in the crown portion of golden barrel cacti. Twelve control cacti (six wounded) were sprayed only with SDW. Further pathogenicity tests were carried out on Thanksgiving cactus (Schlumbergera truncata (Haw.) Moran), devil's tongue barrel cactus (Ferocactus latispinus (Haw.) Britton & Rose), peruvian old man cactus (Espostoa lanata (Kunth) Britton & Rose), and Parodia spp. by inoculating eight plants for each host (four wounded) by placing 9-day-old 6-mm mycelial plugs at the base of the healthy cacti. An equal number of plants (four wounded) was inoculated only with a PDA plug. All cacti were maintained in polyethylene bags (90 to 95% for 72 hr) at 25°C. After 12 to 15 days, all wounded inoculated golden barrel, devil's tongue barrel, and peruvian old man cacti exhibited similar symptoms observed in the plastichouses. Typical symptoms were visible also in nonwounded and inoculated cacti 15 days later. Yellow-orange, tan, sunken, and roughly circular lesions were observed on the wounded and inoculated Thanksgiving and Parodia sp. cacti. Control plants were symptomless. The causal fungus was always reisolated from infected cacti. On the basis of 3-septate macroconidia (27 to 35 μm long × 3 to 4 μm wide [average 31.45 × 3.18 μm]), microconidia aseptate, single or double chlamydospores, and monophialide conidiophores observed on carnation leaf agar, and considering the susceptibility of all other inoculated hosts, the fungus was identified as F. oxysporum Schlechtend. f. sp. opuntiarum (Speg.) (1). To our knowledge, this is the first report of basal stem rot of golden barrel cactus in Italy. Reference: (1) W. Gerlach. Phytopathol. Z. 74, 197, 1972.

Ectopic Hair Growth After Flap Reconstruction of the Head and Neck

A 53-year-old Peruvian man underwent total laryngopharyngectomy with tubed radial forearm free flap reconstruction for chondronecrosis of the larynx and pharynx that developed as a complication of radiation therapy. A tracheoesophageal fistula was created for speech rehabilitation. Two years later, he returned with complaints related to frequent trapping of small food particles in his hypopharyngeal segment, causing frequent food regurgitation, halitosis, and mild but bothersome intermittent dysphagia. He also complained of the frequent dysfunction of his tracheoesophageal voice prosthesis, which was caused by clogging of the valve mechanism by hair. Topical nystatin therapy provided no relief. Endoscopic examination of the reconstructed hypopharyngeal segment revealed prominent hair growth without evidence of stricture for