RESUMO
The Nantucket pine tip moth (NPTM) (Rhyacionia frustrana Comstock) is a native, regeneration pest of young loblolly pines (Pinus taeda L.), causing shoot dieback, tree deformity, and growth and volume declines. Soil applications of systemic insecticides may be an effective strategy to suppress NPTM populations. The study objective was to assess the efficacy of four systemic insecticide treatments (chlorantraniliprole, dinotefuran, fipronil, and imidacloprid) for two growing seasons in outplanted bareroot and containerized seedling trials. Response variables included NPTM infestation rates, along with tree height, groundline diameter, volume index, and stem form. Infestation rates significantly decreased for each systemic insecticide treatment during the first year compared to controls, although dinotefuran and imidacloprid provided season-long control in one trial. Chlorantraniliprole reduced NPTM infestation rates for two growing seasons in both trials. While imidacloprid treatments did not alter growth metrics except for one comparison, fipronil and dinotefuran treatments improved several growth metrics. Chlorantraniliprole consistently improved growth metrics throughout the study.
Assuntos
Inseticidas , Mariposas , Pinus , Animais , Pinus taeda , Mariposas/fisiologia , Benchmarking , Controle de Insetos , ÁrvoresRESUMO
At the blood-brain barrier, overexpression of the drug efflux transporter ABCC2 (also known as MRP2) has been proposed as a mechanism for impaired carbamazepine (CBZ) treatment response in epilepsy. However, investigation of the impact of ABCC2 polymorphisms on CBZ treatment efficacy has produced conflicting and inconclusive results. A series of in vitro cell efflux and plasma membrane vesicle uptake assays were undertaken to investigate whether CBZ was an ABCC2 substrate. In addition, the effect of three common ABCC2 polymorphisms, -24C>T, c.1249G>A and c.3972C>T, on the efficacy of CBZ in epilepsy (assessed using the clinical end points time to first seizure and time to 12-month remission from the SANAD (Standard and New Antiepileptic Drugs) trial) was determined. CBZ was found not to be a substrate for human ABCC2 in vitro. Clinically, no significant association was observed for the ABCC2 genetic variants and CBZ treatment outcomes. This comprehensive analysis does not support a role for ABCC2 in CBZ treatment efficacy.
Assuntos
Carbamazepina/uso terapêutico , Epilepsia/tratamento farmacológico , Epilepsia/genética , Proteínas Associadas à Resistência a Múltiplos Medicamentos/genética , Adulto , Feminino , Humanos , Masculino , Proteína 2 Associada à Farmacorresistência Múltipla , Proteínas Associadas à Resistência a Múltiplos Medicamentos/metabolismo , Polimorfismo Genético/genética , Células Tumorais CultivadasRESUMO
BACKGROUND: When closed reduction of a developmental dislocation of the hip fails, some form of open reduction is required. In recent years, the many advantages of the medial approach open reduction have been emphasized. However, there have been suggestions that the rate of growth disturbance in the proximal femur and the requirement for secondary surgical procedures may be higher with this route than with others. The purpose of this study was to investigate the efficacy and safety of a modified medial approach open reduction, in which the stability of the reduction is enhanced by resection of the redundant ligamentum teres and suturing of the stump of the tendon to the anteromedial capsule. METHODS: The hospital records and radiographs of 92 infants and children with 109 dislocated hips were reviewed retrospectively. Key demographic and pretreatment data were collected by the first author and compared with the outcome at the most recent follow-up. In addition, 69 children returned for a clinical evaluation by the first author. The outcome at the most recent follow-up was graded according to Severin, and associations were sought between pretreatment grade of dislocation according to Tonnis, the presence of ossific nucleus, changes in the acetabular index, the requirements for secondary surgery, associations with previous treatment, and the position of abduction in the postoperative cast. RESULTS: At a mean follow-up of 9 years, 89% of hips were classified as Severin grade 1 or 2. Avascular necrosis (AVN) was classified according to the system of Kalamchi and MacEwen. The incidence of AVN was 41%, but two thirds of these were grade 1 (temporary irregular ossification), and the Severin grading in these hips was not compromised. The presence of ossification in the capital epiphysis and a range of abduction of less than 60 degrees in the hip spica were noted to be protective against the development of AVN. Three hips redislocated and required additional treatment. Thirty-eight hips required a total of 44 additional surgical procedures. CONCLUSIONS: We have demonstrated that it is possible to use a medial approach for open reduction of the congenitally dislocated hip in combination with tenodesis of the ligamentum teres to the anteromedial joint capsule. The incidence of growth disturbance in the proximal femur is high and cumulative with long-term follow-up. However, in this large series, the rate of hip stability, growth disturbance, and need for secondary surgery are comparable to other series. We conclude that the many advantages of open reduction by the medial approach outweigh the disadvantages.
Assuntos
Necrose da Cabeça do Fêmur/etiologia , Luxação Congênita de Quadril/cirurgia , Tenodese/métodos , Criança , Pré-Escolar , Feminino , Fêmur/crescimento & desenvolvimento , Seguimentos , Luxação Congênita de Quadril/classificação , Luxação Congênita de Quadril/patologia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos , Índice de Gravidade de Doença , Tenodese/efeitos adversos , Resultado do TratamentoRESUMO
Macrophage activation syndrome (MAS), a recognized complication of systemic juvenile rheumatoid arthritis (sJRA), has been associated with significant morbidity and mortality. Dysregulation of macrophage-lymphocyte interactions leading to uncontrolled proliferation of highly activated macrophages and massive release of proinflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha) appears to be central to the pathogenesis of this syndrome. Until now the mainstay of therapy has been corticosteroids and cyclosporin A. We describe a patient with MAS and sJRA successfully treated with the anti-TNF agent etanercept. The outcome in this patient suggests etanercept might be an effective therapeutic agent in MAS.
Assuntos
Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Imunoglobulina G/administração & dosagem , Ativação de Macrófagos/efeitos dos fármacos , Receptores do Fator de Necrose Tumoral/administração & dosagem , Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite Juvenil/complicações , Biópsia por Agulha , Medula Óssea/patologia , Criança , Esquema de Medicação , Quimioterapia Combinada , Etanercepte , Seguimentos , Humanos , Ativação de Macrófagos/fisiologia , Masculino , Medição de Risco , Índice de Gravidade de Doença , Pele/patologia , Síndrome , Resultado do TratamentoRESUMO
CT-2584 HMS, 1-(11-dodecylamino-10-hydroxyundecyl)-3, 7-dimethylxanthine-hydrogen methanesulphonate, is a modulator of intracellular phosphatidic acid. We treated 30 patients as part of a Phase I and pharmacokinetic study to determine the maximum-tolerated dose of CT-2584 HMS, toxicity profiles, pharmacokinetic profile and antitumour effects at escalating dose levels. CT-2584 HMS was given as a continuous infusion for 6 hours for 5 consecutive days every 3 weeks. Plasma samples for pharmacokinetic studies were analysed using a validated high-performance liquid chromatographic assay. Mean C(max)and AUC values for each dose group were similar on days 1 and 5 and increases in plasma concentration (C(max)and AUC) appeared proportional to the dose. CT-2584 HMS had a mean elimination half-life of 7.3 hours. Values of V(d)and clearance were independent of dose and duration of treatment. Dose escalation was halted at 585 mg/m(2)because of malaise and lethargy, which was sometimes accompanied by nausea and headache. 26 patients were evaluable for response, one patient with pleural mesothelioma achieved a partial response to treatment confirmed by CT scanning. A dose level of 520 mg/m(2)daily x 5 days would be suitable for Phase II testing. Alternative schedules of CT-2584 HMS to overcome the limiting toxicity of malaise would be worthy of examination.
Assuntos
Antineoplásicos/farmacocinética , Neoplasias/tratamento farmacológico , Ácidos Fosfatídicos/metabolismo , Xantinas/farmacocinética , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Área Sob a Curva , Arritmias Cardíacas/induzido quimicamente , Relação Dose-Resposta a Droga , Fadiga/induzido quimicamente , Feminino , Hematúria/induzido quimicamente , Humanos , Hipersensibilidade/etiologia , Hipotensão/induzido quimicamente , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/induzido quimicamente , Náusea/induzido quimicamente , Neoplasias/sangue , Proteinúria/induzido quimicamente , Resultado do Tratamento , Vômito/induzido quimicamente , Xantinas/efeitos adversos , Xantinas/uso terapêuticoRESUMO
We reviewed the clinical and radiologic results of 164 proximal femoral osteotomies in 132 children using the AO (ASIF) 90 degree fixed-angle blade plate and the Richards intermediate hip screw to establish the clinical and radiologic outcomes, establish the incidence of complications, and determine the relative indications and contraindications for the two implants. The incidence of complication in this series was 9% (15 complications in 14 osteotomies in 13 patients) including one bursitis, one wound breakdown with exposure of the underlying plate, five infections, two peroneal nerve palsies, one fractured shaft of femur, one fractured neck of femur, two technical errors, one painful nonunion, and one loss of fixation. There were five (3%) revisions in total. Fifty-six osteotomies in 44 patients were performed using the Richards intermediate hip screw, and 108 osteotomies were performed in 88 patients using the AO 90 degree fixed-angle blade plate. We found that both implants were effective with an acceptable rate of complications and revision surgery.
Assuntos
Placas Ósseas , Parafusos Ósseos , Fêmur/cirurgia , Osteotomia , Adolescente , Adulto , Paralisia Cerebral/cirurgia , Criança , Pré-Escolar , Feminino , Luxação do Quadril/cirurgia , Humanos , Doença de Legg-Calve-Perthes/cirurgia , Masculino , Complicações Pós-OperatóriasRESUMO
Outcomes from observation or cast or surgical treatment of idiopathic toe-walking were determined in 136 children. With patient-determined outcomes, for the observation group, gait was normal in 6%, improved in 45%, and unchanged in 49%. Physician-determined outcomes demonstrated normal gait in 12% of children. Outcomes were similar in the cast group. With patient-determined outcomes in the surgical group, 22% walked normally, 50% had improved, 26% were unchanged, and 2% had deteriorated; with physician-determined outcomes, 37% walked normally. The natural history, determined from the observation group, was for idiopathic toe-walking to persist, albeit with improvement in 50%. Cast treatment did not alter the natural history. Surgical treatment may influence the outcome, but indications for surgery need to be clarified.
Assuntos
Tendão do Calcâneo/anormalidades , Marcha , Dedos do Pé , Tendão do Calcâneo/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Resultado do TratamentoRESUMO
The Health Council of Hawkins County, Tennessee, received a State Tobacco Prevention grant to institute an anti-smoking program in the county schools. The program chosen was called TarWars and encompasses a prohealth tobacco-free program curriculum. The goal was to discourage tobacco use among the nation's youth by focusing on tobacco's short-term ill effects. Because the program encourages community involvement, nursing students from East Tennessee State University, Johnson City, identified volunteers from the Hawkins County Retired Teachers Association to develop a teaching program for use in the first year of the program and as well as in subsequent years of the TarWars curriculum. A pretest and posttest were given to the students to assess the program's success. The objectives of the grant were that 80% of the students would be able to name three negative effects associated with tobacco use and three positive effects of not using tobacco. The goal was met when 91% could identify negative effects and 89% could identify three positive effects of not using tobacco.
Assuntos
Bacharelado em Enfermagem , Serviços de Saúde Escolar/organização & administração , Serviços de Enfermagem Escolar/organização & administração , Prevenção do Hábito de Fumar , Estudantes de Enfermagem , Criança , Humanos , Serviços de Saúde Rural/organização & administração , TennesseeRESUMO
The cause of toe-walking is unknown. Muscle biopsies were taken from a group of 25 toe-walkers who were treated at this hospital to try to identify the pathological cause of the condition. The most common abnormality noted was an increase in the proportion of type I muscle fibers with type grouping; other less common changes included the presence of angulated atrophic fibers and thickened capillaries and cases in which occasional fibers were undergoing active degeneration and regeneration. The combination of these changes suggests that there may be an underlying neuropathic process in idiopathic toe-walkers.
Assuntos
Marcha , Músculo Esquelético/anormalidades , Músculo Esquelético/patologia , Dedos do Pé , Caminhada , Biópsia por Agulha , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , MasculinoRESUMO
The pharmacological properties and signaling of angiotensin IV (ANG IV) receptors were studied in opossum kidney cell line OK7A. Saturation binding experiments with 125I-labeled ANG IV demonstrated the presence of high-affinity ANG IV binding sites in OK7A cell membranes with a dissociation constant (Kd) of 0.40 +/- 0.08 nM and a maximal amount of binding sites (Bmax) of 180 +/- 50 fmol/mg protein. In competition experiments, unlabeled ANG IV inhibited 125I-ANG IV binding biphasically: 20% of binding sites had high affinity [inhibition constant (Ki) = 0.44 +/- 0.04 nM] and 80% had low affinity (Ki = 130 +/- 10 nM). ANG III displaced 125I-ANG IV from binding sites with low affinity (Ki = 205 +/- 10 nM), and ANG II did not compete with 125I-ANG IV at concentrations up to 10 microM. The binding of ANG IV to OK7A cell membranes was significantly enhanced in the presence of 5 mM EDTA and completely blocked by 5 mM dithiothreitol. Guanosine 5'-O-(3-thiotriphosphate) inhibited the binding of 125I-ANG IV, indicating the G protein coupling of ANG IV receptors in OK7A cells. In signaling studies, ANG IV induced transient increase in intracellular calcium concentration ([Ca2+]i) from 49 +/- 3 to 280 +/- 45 nM. ANG IV failed to influence phosphoinositol metabolism, indicating that Ca2+ mobilization is not linked to ANG IV signaling. Ethylene glycol-bis(beta-aminoethylether)-N,N,N',N'-tetraacetic acid completely abolished ANG IV-induced increase in [Ca2+]i, consistent with Ca2+ influx. The voltage-sensitive Ca2+ channel blocking agents verapamil and nifedipine attenuated the effect of ANG IV on [Ca2+]i to 133 +/- 33 and 174 +/- 32 nM, respectively. These data suggest that ANG IV induces Ca2+ influx in OK7A cells, at least partially, through the voltage-sensitive Ca2+ channels.
Assuntos
Rim/metabolismo , Receptores de Angiotensina/metabolismo , Transdução de Sinais , Angiotensina II/análogos & derivados , Angiotensina II/metabolismo , Angiotensina II/farmacologia , Animais , Ligação Competitiva , Cálcio/metabolismo , Linhagem Celular , Rim/citologia , Nucleotídeos Cíclicos/metabolismo , Gambás , Fosfatidilinositóis/metabolismo , Fosfolipases Tipo C/metabolismoRESUMO
We report the results of medial physeal stapling in 16 knees with primary genu valgum and 27 with secondary genu valgum. In the primary group, stapling was undertaken at a mean chronological age of 12 years in girls and 13 years in boys. The medial femoral physis was stapled in ten knees and the medial femoral and tibial physes in six knees. At skeletal maturity, all patients had excellent or good leg alignment. Secondary genu valgum is due to skeletal dysplasia, haematological or endocrine disorders, or to juvenile chronic arthritis. Stapling was at a mean chronological age of 11 years in girls and 14 years in boys. The medial femoral physis was stapled in 13 knees, the medial tibial physis in three and both in 11 knees. At skeletal maturity, 85% had excellent or good leg alignment, and correction had occurred within one year. Two of the poor results were due to staple extrusion from osteoporotic bone, and two to overcorrection. Rebound growth was minimal and unpredictable after the removal of staples. Medial physeal stapling is a suitable method of treatment for both primary and secondary genu valgum in late childhood and in adolescence. At least one year of knee growth is required to achieve correction, and care is needed to avoid overcorrection of the secondary genu valgum.
Assuntos
Mau Alinhamento Ósseo/cirurgia , Fêmur/cirurgia , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho/anormalidades , Grampeamento Cirúrgico , Tíbia/cirurgia , Adolescente , Determinação da Idade pelo Esqueleto , Mau Alinhamento Ósseo/diagnóstico por imagem , Criança , Feminino , Fêmur/anormalidades , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/crescimento & desenvolvimento , Masculino , Amplitude de Movimento Articular , Tíbia/anormalidadesRESUMO
Over a nine-year period, 20 feet with persistently symptomatic talocalcaneal coalition were treated by resection of the bar. The 17 patients were all under 16 years of age. Excellent or good long-term results were achieved in the ten feet in which preoperative coronal CT had shown that the area of coalition measured 50% or less of the area of the posterior facet of the calcaneum. In these feet heel valgus was less than 16 degrees and there were no radiographic signs of arthritis of the posterior talocalcaneal joint. Talar beaking was present in 70% of these feet but it did not impair the clinical result. Fair or poor results were observed in the ten feet in which preoperative CT had shown the area of relative coalition to be greater than 50%. In these feet, heel valgus was greater than 16 degrees and most had narrowing of the posterior talocalcaneal joint and impingement of the lateral process of the talus on the calcaneum.
Assuntos
Articulação Talocalcânea/cirurgia , Adolescente , Calcâneo/anormalidades , Calcâneo/diagnóstico por imagem , Criança , Humanos , Artropatias/diagnóstico por imagem , Artropatias/patologia , Artropatias/cirurgia , Dor/etiologia , Prognóstico , Articulação Talocalcânea/anormalidades , Articulação Talocalcânea/diagnóstico por imagem , Tálus/anormalidades , Tálus/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Suporte de CargaRESUMO
A patient with an accessory right diaphragm discovered during thoracotomy for correction of severe thoracolumbar scoliosis is presented to illustrate the diagnostic difficulties that may occur in children with accessory diaphragm. The patient had presented at an early age with respiratory symptoms which were assumed to be asthmatic in aetiology and complicated by progressive chest deformity. The respiratory symptoms in accessory diaphragm can be improved by surgery.
Assuntos
Diafragma/anormalidades , Insuficiência Respiratória/etiologia , Escoliose/complicações , Criança , Humanos , Masculino , Insuficiência Respiratória/diagnósticoRESUMO
A previously undescribed anomaly of the calcaneus occurred in an otherwise healthy 2-month-old girl. There was marked bilateral hypoplasia of the calcanei, involving approximately the posterior half of each. The child stood at 15 months and walked at 22 months. At age 5 years, the child had a slight in-toed gait that corrected with dorsiflexion. Her only problem has been some difficulty with shoeware. The etiology of this anomaly remains conjectural.
Assuntos
Calcâneo/anormalidades , Calcâneo/embriologia , Feminino , Humanos , LactenteRESUMO
We have evaluated two methods of surgical treatment of adolescent idiopathic double major scoliosis in 59 patients. In group 1, 31 patients were treated by fusion of the upper curve only. In group 2, 28 patients had lumbar fusions also including most of the lower curve. The magnitude of the lower curve and the correction obtained in traction were good indicators of the correction achieved postoperatively. Forty-four patients were reviewed at a minimum of 10 years after operation. Those in group 1 showed sustained improvement of the lower curve with minimal stiffness and pain. Group 2 patients had lumbar curves of similar severity at review, but had significantly more low back pain and stiffness. The number of lumbar segments which remained mobile appeared to be a critical factor in determining the outcome. Selective fusion of the upper curve in double major scoliosis produces satisfactory results if the lumbar curve is less than 50 degrees. It may also be appropriate for flexible lumbar curves of larger angle.
Assuntos
Vértebras Lombares , Escoliose/cirurgia , Fusão Vertebral , Vértebras Torácicas , Adolescente , Fenômenos Biomecânicos , Criança , Feminino , Seguimentos , Humanos , Masculino , Dor/fisiopatologia , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologiaRESUMO
The long-term results following the correction of coxa vara by Pauwels' Y-shaped intertrochanteric osteotomy have been evaluated in 14 children. Ten of the children had unilateral hip disease and were otherwise normal while four had bilateral hip disease due to generalised skeletal dysplasias. In each case, the growth plate was vertical, the femoral head was displaced inferiorly and there were abnormalities in the metaphysis of the femoral neck. The results indicate that this osteotomy provides lasting correction of the deformity, regardless of the cause, as long as the inclination of the growth plate is corrected to 40 degrees or less and adequate support is provided for the metaphyseal defect and the displaced femoral head.
Assuntos
Fêmur/anormalidades , Articulação do Quadril/cirurgia , Osteotomia/métodos , Criança , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Marcha/fisiologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Osteocondrodisplasias/complicações , RadiografiaRESUMO
A descriptive educational needs assessment was conducted at a southwestern military medical center on knowledge, attitudes, beliefs, and self-identification of risk factors for acquired immunodeficiency syndrome (AIDS). A self-report questionnaire was administered to 700 pregnant women. Misinformation and lack of knowledge about AIDS were identified. A small group of women reported that they were at risk for AIDS. The study findings support a need for AIDS educational programs for childbearing women.
Assuntos
Síndrome da Imunodeficiência Adquirida/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Complicações Infecciosas na Gravidez/psicologia , Síndrome da Imunodeficiência Adquirida/enfermagem , Adulto , Coleta de Dados , Feminino , Humanos , Educação de Pacientes como Assunto , Gravidez , Complicações Infecciosas na Gravidez/enfermagem , Risco , Fatores de Risco , AutoimagemRESUMO
Two cases of painful osteochondritis of the basal epiphysis of the first metatarsal are described. Complete resolution without deformity was achieved in both patients. We suggest that this condition be considered in the differential diagnosis of transitory foot pain in childhood.
Assuntos
Epífises , Ossos do Metatarso , Osteocondrite/diagnóstico , Adolescente , Moldes Cirúrgicos , Criança , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Imobilização , Aparelhos Ortopédicos , Osteocondrite/diagnóstico por imagem , Osteocondrite/terapia , Prognóstico , Radiografia , SapatosRESUMO
Spinal deformity was present in 58 (19%) of 302 patients born with oesophageal atresia and fistula when examined at review. This was present in 24 (47%) of 51 patients with vertebral anomalies and 34 (14%) of 251 patients with normal vertebrae. Scoliosis was present in 21 patients with vertebral anomalies, torticollis in two, and lordosis in one. Two thirds of the patients with congenital scoliosis have had or are likely to require operation, compared with five patients with non-congenital scoliosis. Scoliosis associated with mixed vertebral anomalies in the lower thoracic spine had the worst prognosis. The medical records of a further 64 patients who had survived operation but who could not be traced were reviewed, and indicated that four had had congenital vertebral anomalies but none had a spinal deformity. We recommend early detection of vertebral anomalies in this group and careful follow up of patients with these abnormalities.