The etiology of carotid abnormalities is both congenital than acquired. The aim of this study was to clarify the role of aging and atherosclerosis in the acquired cases, and the role of these abnormalities in hemodynamic alterations and neurologic symptoms. Over a 1-year period the authors studied all the subjects undergoing carotid examination by continuous-wave and color-coded Doppler sonography at an Angiology Unit. They evaluated neurologic symptoms; risk factors for atherosclerosis; number, sites, and kinds of carotid abnormalities; atherosclerotic lesions; stenosis; hemodynamic alterations of the carotid; and other localizations of atherosclerotic diseases. There were 469 subjects: 272 (58%) with abnormalities (group 1) and 197 (42%) without abnormalities (group 2). The total number of abnormalities was 479 (104 tortuosities, 262 kinkings, and 113 coilings). The abnormalities were more prevalent in the elderly (P<0.001) and in women (P<0.001). In group 1 they found significant prevalences of hyperlipemia (P<0.001), hypertension (P<0.01), chronic cigarette smoking (P<0.01), and ischemic heart disease (P<0.05). Carotid atherosclerotic lesions were more prevalent in group 1 than in group 2 (P<0.001); among the patients with atherosclerotic carotid lesions, those in group 1 were older than those in group 2 (P<0.001). Tortuosity seemed to be associated with fewer hemodynamic alterations. The authors conclude that atherosclerosis, hypertension, and aging may play an important role in producing carotid abnormalities. The aging seemed more important than atherosclerosis. Only a prospective study of patients with carotid abnormalities and no atherosclerotic lesion will clarify the role of hemodynamics and neurologic symptomatology.

The species-level identification of sterile and/or arthroconidium-forming filamentous fungi presumed to be basidiomycetes based upon morphological or physiological features alone is usually not possible due to the limited amount of hyphal differentiation. Therefore, a reliable molecular approach capable of the unambiguous identification of clinical isolates is needed. One hundred sixty-eight presumptive basidiomycetes were screened by sequence analysis of the internal transcribed spacer (ITS) and D1/D2 ribosomal DNA regions in an effort to obtain a species identification. Through the use of this approach, identification of a basidiomycetous fungus to the species level was obtained for 167/168 of the isolates. However, comparison of the BLAST results for each isolate for both regions revealed that only 28.6% (48/168) of the isolates had the same species identification by use of both the ITS and the D1/D2 regions, regardless of the percent identity. At the less stringent genus-only level, the identities for only 48.8% (82/168) of the isolates agreed for both regions. Investigation of the causes for this low level of agreement revealed that 14% of the species lacked an ITS region deposit and 16% lacked a D1/D2 region deposit. Few GenBank deposits were found to be complete for either region, with only 8% of the isolates having a complete ITS region and 10% having a complete D1/D2 region. This study demonstrates that while sequence-based identification is a powerful tool for many fungi, sequence data derived from filamentous basidiomycetes should be interpreted carefully, particularly in the context of missing or incomplete GenBank data, and, whenever possible, should be evaluated in light of compatible morphological features.

Isolation and characterization of the new species Chrysosporium ophiodiicola from a mycotic granuloma of a black rat snake (Elaphe obsoleta obsoleta) are reported. Analysis of the sequences of different fragments of the ribosomal genes demonstrated that this species belongs to the Onygenales and that this species is genetically different from other morphologically similar species of Chrysosporium. This new species is unique in having both narrow and cylindrical-to-slightly clavate conidia and a strong, pungent odor. CASE REPORTA black, male rat snake (Elaphe obsoleta obsoleta) of undetermined age was presented with a history of prolonged anorexia and slow-growing facial masses. The snake was found as an adult at an old home site in an old barn near Sparta, GA, by the current owner, a wildlife educator. The snake had been in his possession for 4 years and was frequently used in public educational performances in the southeast. Upon presentation, the snake had a 1-cm by 1.5-cm subcutaneous, longitudinally ovoid swelling overlying his right ventral mandible area (Fig. 1A). He also had a 1-cm swelling overlying his right eye and extending down into the orbit, displacing the eyeball laterally and displacing the palate and dorsal limit of the choana ventrally. The masses were lobular, whitish in appearance, and enclosed in a thin capsule. The submandibular mass was removed in its entirety, as its capsule was very discrete. The other mass was very friable and locally extensive. Both masses were surgically removed and submitted for histopathological examination and culture. Not all portions of the second mass could be completely removed, due to the location of this mass, but the area enclosing it was debrided. At the time of surgery, the snake was treated with meloxicam (Metacam; Boehringer Ingelheim Vetmedica, Inc., St. Joseph, MO) at a dose of 0.2 mg/kg of body weight once a day and enrofloxacin (Baytril; Bayer HealthCare, LLC, Animal Health Division, Shawnee Mission, KS) at a dose of 5 mg/kg twice a day. This was continued until the histopathology report indicating a fungal infection was received. Enrofloxacin was discontinued, and ketoconazole was initiated. A single oral administration of ketoconazole (Apotex, Inc., Toronto, Ontario, Canada) at 50 mg/kg was administered daily. The snake was kept at 29.5°C and was tube fed Hill's a/d prescription diet (Hill's Pet Nutrition, Inc., Topeka, KS) A/D at 25 ml every 3 days. There was a moderate amount of postoperative swelling at the incision over the orbit. This was treated with warm wet compresses daily, and the swelling decreased. The snake passed away 2 months after surgery.The histopathological evaluation and primary culture were performed at the University of Georgia, Veterinary Diagnostic and Investigational Laboratory, Tifton, GA. Both masses consisted of multifocal-to-coalescing granulomas. The granulomas had central regions of amorphous eosinophilic and occasional cellular debris, surrounded by an inflammatory cell infiltrate consisting of histiocytes, lymphocyt...

We report a systemic mycosis in a German Shepherd dog caused by Geosmithia argillacea. Although this etiologic agent microscopically resembles a Penicillium species, and is histopathologically compatible with members of the genus Aspergillus, morphologic features and molecular characterization clearly separate it from these genera. This appears to be the first report of disseminated disease by this species in humans or animals. In vitro antifungal susceptibility testing suggests resistance to amphotericin B and voriconazole and susceptibility to caspofungin, itraconazole, and posaconazole.

Abdominal hypertension is frequent after liver transplantation and may be associated with a complicated post-operative course.