Bladder exstrophy closure in the newborn period with external pelvic fixation performed without osteotomy: A preliminary report.

BACKGROUND: Successful primary bladder closure is the most crucial element for urinary continence in patients with classic bladder exstrophy (CBE). In the newborn period, bladder closure can be performed in the first 48 h without pelvic osteotomy or external fixation, but requires postoperative lower extremity immobilization (i.e., spica cast, Bryant's or Buck's traction). OBJECTIVE: To present a novel surgical approach for primary bladder closure for CBE using two-pin external fixation without pelvic osteotomy, and without postoperative lower extremity immobilization. STUDY DESIGN: A retrospective chart review of patients with CBE was performed at the current institution from 2000 to 2016, including all primary bladder closures with external fixation and without osteotomy or lower extremity immobilization. Patients were discharged with the external fixator in place, which was later removed in clinic. Baseline clinical and demographic variables, and follow-up data were recorded. RESULTS: Thirteen patients were analyzed; eight (61.5%) were male. Pre-operative intersymphysial distance was 3.68 ± 1.0 cm (2.0-5.0). Mean follow-up was 56.8 ± 40.3 months (10-131). One patient had a partial bladder neck dehiscence, due to pin displacement on postoperative day 1: he had the lowest gestational age of 34 weeks (Summary table). DISCUSSION: This approach used external fixation to bring the pubic bones together intra-operatively, and to decrease the tension in closing the pelvic ring and abdominal wall without osteotomy. External fixation with osteotomy and long-term immobilization, or using a spica cast without osteotomy offered the added advantage of improved wound care, due to lack of lower limb immobilization, less patient discomfort, and facilitation of mother/caregiver and newborn bonding. CONCLUSION: The two-pin external fixator without osteotomy as an adjunct to primary bladder closure in CBE patients was technically feasible. At the current institution this approach had an equivalent success rate to previous reports in the literature for primary bladder closure, decreased the length of hospital stay, and precluded the need for lower extremity immobilization. Early data for bladder capacity were encouraging.

Botulinum toxin type A as an adjunct to the surgical treatment of the medial rotation deformity of the shoulder in birth injuries of the brachial plexus.

We retrospectively reviewed 26 patients who underwent reconstruction of the shoulder for a medial rotation contracture after birth injury of the brachial plexus. Of these, 13 patients with a mean age of 5.8 years (2.8 to 12.9) received an injection of botulinum toxin type A into the pectoralis major as a surgical adjunct. They were matched with 13 patients with a mean age of 4.0 years (1.9 to 7.2) who underwent an identical operation before the introduction of botulinum toxin therapy to our unit. Pre-operatively, there was no significant difference (p = 0.093) in the modified Gilbert shoulder scores for the two groups. Post-operatively, the patients who received the botulinum toxin had significantly better Gilbert shoulder scores (p = 0.012) at a mean follow-up of three years (1.5 to 9.8). It appears that botulinum toxin type A produces benefits which are sustained beyond the period for which the toxin is recognised to be active. We suggest that by temporarily weakening some of the power of medial rotation, afferent signals to the brain are reduced and cortical recruitment for the injured nerves is improved.

Outcome after later combined brachial plexus and shoulder surgery after birth trauma.

Of 22 infants aged between 11 and 29 months who underwent a combined reconstruction of the upper brachial plexus and shoulder for the sequelae of a birth injury, 19 were followed up for two or more years. The results were evaluated using a modified Gilbert scale. Three patients required a secondary procedure before follow-up. Three patients had a persistent minor internal rotation contracture. All improved by at least two grades on a modified Gilbert scale.

Isolation of stable hemolysin and catalase variants of Staphylococcus aureus S6C includes one with an exoprotein-deficient phenotype.

Previous studies suggested that the exoprotein-deficient phenotype of a Delta 1058::Tn551 insertion/deletion mutant of Staphylococcus aureus S6C was not owing to the insertion/deletion event, but instead was owing to the inherent instability of the agrC gene during transduction of the Delta 1058::Tn551 region into S6C. The purpose of the following study was to examine S6C as a potential source of exoprotein-deficient mutants that would account for their appearance after transposition and transduction. Four stable variants of S6C were isolated that differed in their hemolysin and catalase activities. Surprisingly, the agr regulatory molecule, RNAIII, was undetectable in one of these variants, which most likely accounted for the exoprotein-deficient phenotype of this variant. When the original Delta 1058::Tn551 mutation was transduced into the hemolytic, catalase-positive variant of S6C, none of the transductants exhibited an exoprotein-deficient phenotype. These data suggest that, while the exoprotein-deficient phenotype of the S6C variant is most likely due to mutations in the agr regulatory system, these mutations are not caused by the transduction of the Delta 1058::Tn551 region into S6C, but instead already exist in an exoprotein-deficient variant of S6C.

Emergency control of Aedes aegypti in the Dominican Republic using the Scorpion 20 ULV forced-air generator.

In an effort to develop a more effective measure for use in emergency control of the dengue vector Aedes aegypti. applications of a combination of a larvicide (Bacillus thuringiensis israelensis [B.t.i.]) and an adulticide (permethrin) were made using a truck-mounted forced-air generator (Scorpion 20) and evaluated in the Dominican Republic. This method has the potential to simultaneously control adults and larvae. In bioassay cages placed in household water containers at the time of application, larval mortalities were 95.1 and 100% for 2 application rates of permethrin mixed with B.t.i. Adult mortalities were not as impressive, probably because of resistance to permethrin. Higher adult mortality in caged specimens (78.5%) and a substantial reduction in the natural population (68.4%) of Ae. aegypti were obtained following a 2.1-g AI/ha application of deltamethrin alone.

Langenskiöld classification of tibia vara: an assessment of interobserver variability.

Six pediatric orthopaedic specialists and six senior orthopaedic residents independently classified 60 radiographs of infantile tibia vara according to the six-stage Langenskiöld classification. Correlation coefficients and percentage agreement were similar in both groups. Interobserver agreement was good for early and late stages, but was poor for intermediate stages. We caution clinicians that small but frequent discrepancies in radiographic staging impart a dubious prognostic value to the Langenskiöld classification.

Barrier spraying to control the malaria vector Anopheles albimanus: laboratory and field evaluation in the Dominican Republic.

To develop a new strategy for control of exophilic/exophagic malaria vectors which rest on peridomestic foliage, Anopheles albimanus was used for laboratory bioassays of mosquito adulticides applied to various vegetation types. Of the three classes of insecticide tested, the pyrethroid (permethrin at 112 g/ha) showed greater foliar persistence than either the carbamate (bendiocarb at 340 g/ha) or the organophosphorus compound (malathion at 277 g/ha). Field evaluation of barrier spraying against An.albimanus was evaluated in rural villages of southwest Dominican Republic during 1989. The pyrethroid deltamethrin was sprayed aerially for ultra-low volume application at treatment rates of 17-19 g a.i./ha in a radius of 500 m around two villages. An.albimanus were monitored by light-traps and human bait collections at both treated villages, compared with two similar untreated villages, up to 9 nights posttreatment. Densities of female An.albimanus were significantly reduced in the sprayed villages for at least 8 or 9 nights. Further evaluation of barrier spraying is recommended to determine optimal pyrethroid formulations and applications rates, their impact on non-target fauna and efficacy against malaria transmission.

Field evaluations in malaise and canopy traps of selected targets as attractants for tabanid species (Diptera: Tabanidae).

Various configurations of an inflated vinyl beach ball covered with black fabric were evaluated in Malaise and canopy (modified Manitoba) traps for possible use as an insecticide-impregnated visual target (T) for Tabanidae. In Malaise traps, T attracted 2x more flies than no T. When inflated with carbon dioxide, T was not significantly different from T filled with air, no matter which type of trap it was in. In canopy traps, 2 or 4 white spots applied to T did not increase its attractiveness to tabanids. When treated with octenol, T was 2-5x more attractive than an untreated T in canopy traps. However, when an octenol treatment was aged for 48 h, it was less effective than a fresh treatment. Overall, the 3 most frequently collected species, in order of abundance, were: Tabanus lineola hinellus, Hybomitra vicina and Chrysops atlanticus. Significantly more T. l. hinellus and H. vicina were collected at T with octenol than at T without octenol. Attempts to detect an insecticidal effect on flies captured in both types of trap that had been baited with Ts treated with permethrin were unsuccessful.

Penetration of ultra-low volume applied insecticide into dwellings for dengue vector control.

Determinations on the penetration of ultra-low volume applied insecticide into dwellings was accomplished with a model house in Frederick, MD, USA, and native houses in Santo Domingo, Dominican Republic. Results from the model house tests show that aerosol droplets, with a volume median diameter of 4 microns, penetrated and remained suspended in low recesses of the building during the first 2 min after spraying. Similar results were found with tests in Santo Domingo, where man-made or natural obstructions were determined to be critical factors in aerosol penetration.

In vitro ruminal metabolism of larkspur alkaloids.

Larkspur (Delphinium sp) poisoning of range cattle is a serious, recurring problem in the western United States. Numerous stratagems have been recommended to ameliorate larkspur intoxication, but none are completely effective. Previous studies in this laboratory indicated bovine ruminal microflora are capable of chemically modifying Delphinium alkaloids. Research reported herein was undertaken to further evaluate whether differences in ovine and bovine rumen metabolism might explain differences in susceptibility to larkspur intoxication and whether existing metabolic activity can be enhanced by sustained exposure to Delphinium alkaloids. Comparison of ovine and bovine rumen metabolism of Delphinium geyeri alkaloids in vitro failed to demonstrate differences in the rate of alkaloid metabolism. Rumen liquor collected sequentially from a fistulated cow dosed with dried Delphinium geyeri did not vary in ability to metabolize larkspur alkaloids.

Malaria transmission potential by Anopheles mosquitoes of Dajabon, Dominican Republic.

A field and laboratory study was conducted to determine some of the parameters relevant to malaria transmission by Anopheles mosquitoes in Dajabon Province, Dominican Republic. Although all 4 species occurring in the area, i.e., An. albimanus, An. crucians, An. grabhamii and An. vestitipennis, were included in the investigations, most of the work focused on the first and last named species because of their abundance. Gonotrophic cycles were determined to be 2.6 and 3.2 days for An. albimanus and An. vestitipennis, respectively. Mean parity rates for the 2 species were 37.3 and 20.7%, respectively, in outdoor samples. The human blood index, as determined by ELISA, was 0.08 for An. albimanus and 0.12 for An. vestitipennis. Only An. albimanus was confirmed positive for Plasmodium falciparum circumsporozoite protein, using ELISA. The vectorial capacity of An. albimanus was determined to be 0.019 and that of An. vestitipennis 0.005.

Insecticide susceptibility of Aedes aegypti from Santo Domingo, Dominican Republic.

The insecticide susceptibility of Aedes aegypti adults and larvae from Santo Domingo, Dominican Republic, was investigated using World Health Organization standard procedures. A field strain was more resistant to insecticides than a colony strain that originated from the same place. Larvae produced from ovitrap-collected eggs were resistant to temephos (78.2% mortality on exposure to 0.025 mg/liter). Mortality rates after exposure of adults to discriminating concentrations showed that wild populations were resistant to DDT, malathion, propoxur, permethrin and deltamethrin. The problem of resistance was considered serious enough to warrant consideration of control measures other than the use of chemicals.

Studies of the susceptibility of Anopheles albimanus and Anopheles vestitipennis from Dajabon, Dominican Republic, to insecticides.

Insecticide susceptibility of Anopheles albimanus and An. vestitipennis in Dajabon Province, Dominican Republic, was investigated. Only 74.3% of An. albimanus exposed to 4% DDT for 1 h died. The mortality in this species following exposure for 1 h to 0.25% permethrin was also 74.3%. However, this species was susceptible to malathion, fenitrothion and propoxur. The mortality obtained following exposure of An. vestitipennis to 4% DDT and 0.1% propoxur, both for 1 h, was 71% and 100%, respectively. However, the number of specimens exposed to propoxur was small.

Bionomic studies of the Anopheles mosquitoes of Dajabon, Dominican Republic.

Field studies of Dajabon Province, Dominican Republic, revealed that Anopheles albimanus and An. vestitipennis were the most abundant anopheline species followed by An. crucians and An. grabhamii. Three of the species were collected as adults and larvae whereas An. grabhamii was found only in the adult stage. Perennial ponds and rice fields were the most important larval habitats. The anophelines were predominantly exophilic and exophagic; however, outdoor resting sites could not be identified. Large numbers of mosquitoes were collected from corrals at night and also by using an animal-baited net trap and UV light traps. Man-biting collections showed an early evening peak of biting activity by An. albimanus and An. vestitipennis. Only 23% and 13% of the bites by the 2 species, respectively, occurred indoors.

Baseline data on Aedes aegypti populations in Santo Domingo, Dominican Republic.

Baseline field studies were conducted from April 1987 to July 1988 on Aedes aegypti in Santo Domingo, an endemic area for dengue fever. Premise, container and Breteau indices were measured in one treated area and 2 nearby control areas. These indices averaged 69.6, 46.3 and 142.1, respectively. The principal larval habitats of Ae. aegypti were 208-liter (55-gal) concrete-lined drums. The estimated daily adult production was approximately 60 per house. Adult mosquito populations were monitored using oviposition traps and by sweep net collections. There was no correlation between adult abundance and the larval indices. Monitoring the natural adult densities was more efficient for evaluating the impact of ULV malathion application than the use of standard bioassay procedures.

Effects of controlled burning on Aedes taeniorhynchus eggs in an abandoned rice impoundment in South Carolina.

Controlled burning reduced the number of viable eggs in an Aedes population. The effectiveness of the burn was related to the amount of rainfall, surface moisture and dry vegetation. A greater reduction in viable eggs occurred when the burn was close to the ground. Variable results were achieved if the surface was moist but there was a significant reduction in the number of viable eggs, due to a heavy amount of dry vegetation accompanied by low rainfall.

Comparison of ground and aerial ultra-low volume applications of malathion against Aedes aegypti in Santo Domingo, Dominican Republic.

Efficacy of ground and aerial ultra-low volume (ULV) applications of 91% malathion at 438 ml/ha against Aedes aegypti in the Dominican Republic was evaluated using indoor collections, oviposition trapping and adult sentinel mortality rates. Ground compared to aerial ULV applications in this study were found to have a greater effect on Ae. aegypti when measured by the described sampling techniques. Neither application method provided the level of Ae. aegypti suppression believed necessary for control in the event of a dengue virus epidemic.

Development of Mansonella ozzardi in Simulium amazonicum, S. argentiscutum, and Culicoides insinuatus from Amazonas, Colombia.

Simulium amazonicum, S. argentiscutum and Culicoides insinuatus were collected from the Amazon region of Colombia after having blood-fed on volunteers naturally infected with Mansonella ozzardi. Dissection of the specimens revealed that these species supported the development of the microfilaria of M. ozzardi to the infective stage. Infective larvae were obtained from Simulium within 7 days at temperatures ranging from 23-30 degrees C. S. argentiscutum ingested more microfilariae and had a correspondingly higher experimental infection rate. Three of 31 C. insinuatus dissected beyond day 5 postfeeding contained one advanced second-stage and two third-stage larvae. The current investigation indicates that Culicoides, as well as Simulium, may serve as vectors of mansonelliasis in the Comisaría of Amazonas.

Susceptibility of laboratory primates to infection with Mansonella ozzardi from man.

The study was undertaken to determine primates were susceptible to infection with Caribbean and/or Amazon strains of Mansonella ozzardi of man. Twenty-three animals including three chimpanzees, four squirrel monkeys, one capuchin, five rhesus and 10 patas monkeys each received, by subcutaneous or intraperitoneal injection, 25-170 infective larvae of M. ozzardi harvested either from infected Culicoides furens collected in Haiti or Simulium sp. (sanguineum complex) collected in the Colombian Amazon and transported to our laboratories in Louisiana. Patent infections were obtained in seven of 10 patas monkeys but not in any other species of primates. The prepatent period ranged in duration from 149-186 days with a mean of 168 days. All of the patas monkeys developed modest microfilaremias that persisted for as long as 1 year, the duration of our observations. Adult worms were obtained at necropsy from three of four patas monkeys. The worms were recovered from soakings of the carcass and skin rather than from the abdominal cavity and mesenteries. However, their precise habitat was not determined.

Notas y claves preliminares de los jejenes neotropicales pertenecientes a los grupos Simulium amazonicum y S. sanguineum (Diptera: Simuliidae) incluyendo los vectores de Onchocerca volvunus y Mansonella ozzardi. / Preliminary key of new tropical Diptera pertaining to the groups Simulium amazonicum and S. sanguineum (Diptera: Simuliidae including the vectors of Onchocerca volvulus and Manzonella ozzardi

Los autores estudiaron ocho especies de jejenes de importancia medica pertenecientes a los grupos Simulium amazonicum y S. sanguineum obtenidos en Bolivia, Brasil, Colombia, Guyana y Venezuela. Se acompana una clave preliminar para identificar algunos miembros del grupo y se proporciona algunos datos referentes a la taxonomia y biologia de la mayor parte de las especies estudiadas. Cuatro jejenes han sido incriminados en la transmision de la oncocercosis y/o la mansonelliasis