Value of Neonicotinoid Insecticide Seed Treatments in Mid-South Cotton (Gossypium hirsutum [Malvales: Malvaceae]) Production Systems.

Neonicotinoid insecticides are currently one of two classes of chemicals available as a seed treatment for growers to manage early season insect pests of cotton, Gossypium hirsutum L. (Malvales: Malvaceae), and they are used on nearly 100% of cotton hectares in the midsouthern states. An analysis was performed on 100 seed-treatment trials from Arkansas, Louisiana, Mississippi, and Tennessee to determine the value of neonicotinoid seed treatments in cotton production systems. The analysis compared seed treated with neonicotinoid insecticides seed treatments plus a fungicide with seed only treated with fungicide. When analyzed by state, cotton yields were significantly greater when neonicotinoid seed treatments were used compared with fungicide-only treatments. Cotton treated with neonicotinoid seed treatments yielded 123, 142, 95, and 104 kg ha-1, higher than fungicide only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments provided an additional 115 kg lint ha-1 comparedwith fungicide only treated seed. Average net returns from cotton with a neonicotinoid seed treatment were $1,801 per ha-1 compared with $1,660 per ha-1 for cottonseed treated with fungicide only. Economic returns for cotton with neonicotinoid seed treatments were significantly greater than cottonseed treated with fungicide only in 8 out of 15 yr representing every state. These data show that neonicotinoid seed treatments provide significant yield and economic benefits in Mid-South cotton compared with fungicide only treated seed.

Value of Neonicotinoid Insecticide Seed Treatments in Mid-South Corn (Zea mays) Production Systems.

Neonicotinoid seed treatments are one of several effective control options used in corn, Zea mays L., production in the Mid-South for early season insect pests. An analysis was performed on 91 insecticide seed treatment trials from Arkansas, Louisiana, Mississippi, and Tennessee to determine the value of neonicotinoids in corn production systems. The analysis compared neonicotinoid insecticide treated seed plus a fungicide to seed only with the same fungicide. When analyzed by state, corn yields were significantly higher when neonicotinoid seed treatments were used compared to fungicide only treated seed in Louisiana and Mississippi. Corn seed treated with neonicotinoid seed treatments yielded 111, 1,093, 416, and 140 kg/ha, higher than fungicide only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments resulted in a 700 kg/ha advantage compared to fungicide only treated corn seed. Net returns for corn treated with neonicotinoid seed treatment were $1,446/ha compared with $1,390/ha for fungicide only treated corn seed across the Mid-South. Economic returns for neonicotinoid seed treated corn were significantly greater than fungicide-only-treated corn seed in 8 out of 14 yr. When analyzed by state, economic returns for neonicotinoid seed treatments were significantly greater than fungicide-only-treated seed in Louisiana. In some areas, dependent on year, neonicotinoid seed treatments provide significant yield and economic benefits in Mid-South corn.

Value of Neonicotinoid Insecticide Seed Treatments in Mid-South Soybean ( Glycine max ) Production Systems.

Early-season insect management is complex in the Mid-South region of the United States. A complex of multiple pest species generally occurs simultaneously at subthreshold levels in most fields. Neonicotinoids are the only insecticide seed treatment widely used in soybean, Glycine max L., production. An analysis was performed on 170 trials conducted in Arkansas, Louisiana, Mississippi, and Tennessee from 2005 to 2014 to determine the impact of neonicotinoid seed treatments in soybean. The analysis compared soybean seed treated with a neonicotinoid insecticide and a fungicide with soybean seed only treated with the same fungicide. When analyzed by state, soybean yields were significantly greater in all states when neonicotinoid seed treatments were used compared with fungicide-only treatments. Soybean treated with neonicotinoid treatments yielded 112.0 kg ha -1 , 203.0 kg ha -1 , 165.0 kg ha -1 , and 70.0 kg ha -1 , higher than fungicide-only treatments for Arkansas, Louisiana, Mississippi, and Tennessee, respectively. Across all states, neonicotinoid seed treatments yielded 132.0 kg ha -1 more than with fungicide-only treated seed. Net returns from neonicotinoid seed treatment usage were US$1,203 per ha -1 compared with US$1,172 per ha -1 for fungicide-only treated seed across the Mid-South. However, economic returns for neonicotinoid seed treatments were significantly greater than fungicide-only treated seed in 4 out of the 10 yr. When analyzed by state economic returns the neonicotinoid seed treatments were significantly greater than fungicide-only treated seed in Louisiana and Mississippi. These data show that in some areas and years, neonicotinoid seed treatments provide significant economic benefits in Mid-South soybean.

Tensile strength of wound closure with cyanoacrylate glue.

2-Octyl cyanoacrylate tissue adhesive is increasingly being used for closure of traumatic lacerations. Data regarding the strength of incisions closed with 2-octyl cyanoacrylate are limited. We compared the strength of disruption of closure with glue with that of more conventional methods of wound closure. Segments of fresh porcine skin measuring 3.5 x 10 cm were approximated by one of four methods: 1) 2-octyl cyanoacrylate glue, 2) surgical staples, 3) 0.5 inch Steri-Strips, and 4) interrupted 4-0 poliglecaprone 25 sutures in a subcuticular fashion. Fifteen specimens were used to test each type of closure. The strength of closure was tested on an Instron 4502 tensionometer. The peak force required for disruption of the closure was recorded and the strength of the closure was compared. Staples provided the strongest closure. Skin glue proved superior to Steri-Strips but inferior to stapled closure. The difference between skin glue and suture closure was not statistically significant (P = 0.12). Patterns of failure differed between the groups. Skin glue failed because of disruption of the skin-glue interface. 2-Octyl cyanoacrylate glue provides a wound closure that is similar to closure with an interrupted subcuticular absorbable suture. This study validates the clinical use of skin glue for closure of surgical incisions. The technique should be used with caution in areas of the body that are subject to tension.

Diaphragmatic hernia after Ivor-Lewis esophagectomy manifested as lower gastrointestinal bleeding.

Diaphragmatic hernia after esophageal resection is a recognized but rare complication. Parahiatal hernias may result from manipulation and extension of the crura during surgery. This can lead to a wide array of symptoms depending on the extent and organ that is herniated. A high index of suspicion is required because there is no one symptom that is specific for herniation. This report represents the first case of a patient presenting with lower gastrointestinal bleed from a parahiatal hernia after esophageal resection.

Basic skin flaps for the general surgeon: a teaching method.

BACKGROUND: Teaching residents the design and creation of skin flaps is challenging because the use of skin flaps is not common enough during the course of a typical residency to provide a broad experience base. METHODS: A 12 x 12-inch board with a 1/8-inch foam rubber covering was designed to provide for the creation of four flaps and one Z-plasty. A lecture and practical exercise were used to teach basic techniques. Performance was measured by preexamination and postexamination, as well as by a resident satisfaction survey. RESULTS: Mean scores improved by 45%. The resident survey revealed an average subjective rating was 4.7 on a scale of 1 to 5. All residents rated this format superior to traditional lecture instruction. Total cost to provide laboratory experience for 16 residents was $50. Materials can be recovered and reused at a cost of $0.40 each. CONCLUSIONS: The materials developed provided an effective, inexpensive nonbiologic model for teaching preoperative skills.

Malignant peripheral nerve sheath tumors of the head and neck: analysis of prognostic factors.

Malignant peripheral nerve sheath tumors of the head and neck region are uncommon and may be associated with neurofibromatosis or occur in a sporadic manner. This is a retrospective review of 17 patients with these tumors who were treated at a single institution. Analysis of clinical and pathologic factors that influenced outcome was performed. There were 9 men and 8 women. Seven patients had a history of neurofibromatosis. Radiotherapy was implicated as a possible etiologic factor in 4 patients. The neck was the most frequently involved site. Overall survival at 5 years was 52%. Survival was improved for women and for patients with low-grade tumors. Age, tumor site, and size had no impact on survival. Survival was worse for patients with neurofibromatosis than for those with the sporadic form of the disease (P = 0.02). Survival was calculated by the method of Kaplan and Meier. The significance of such results was based on results of the log rank test. Local recurrence correlated with tumor size and resection margin status. No local recurrences occurred in those patients who had negative margins of resection and received adjuvant radiotherapy. Tumor grade was predictive of the development of distant metastases. Negative margins of resection are essential for obtaining local control, and the addition of adjuvant radiotherapy may be beneficial in this group. Salvage surgery for local recurrence is possible in some patients.

Managing the nondeflating urethral catheter.

BACKGROUND: Urethral catheterization is a routinely performed procedure in hospitalized patients. Numerous complications have been reported secondary to urethral catheter placement. METHODS: The medical literature was searched using the following key words: "urethral catheter," "complications," and "management." A case report is described and a review of the literature is provided to assist in managing the nondeflating urethral catheter balloon. RESULTS AND CONCLUSIONS: All physicians who order urethral catheters must be aware of the possibility of a nondeflating catheter balloon and be comfortable with its initial management. The literature has an abundance of techniques for managing the nondeflating urethral catheter balloon. The approach and algorithm provided serve as a guide for the management of this complication by the family physician.

Malignant tumors of the small intestine: a review of 144 cases.

Cancer of the small intestine represents less than two per cent of all the malignant tumors of the gastrointestinal tract. Because they are infrequent tumors, a review of a tumor registry was performed to analyze response to treatment of the disease and prognostic factors. A retrospective review of patients with primary cancer of the small intestine was performed using the Department of Defense Tumor Registry. The registry was accessed to determine stage, types of cancer, intervention, and patient outcomes. TNM staging and follow-up were available on 144 patients from 1970 to 1996. Median follow-up was 38.9 months. There were 92 (64%) males and 52 (38%) females. The median age was 55.7 years. The types of small intestinal cancer included 68 patients (47%) with adenocarcinoma, 41 patients (28%) with carcinoid, 18 patients (13%) with leiomyosarcoma, and 17 patients (12%) with lymphoma. The overall 5-year survival was 57 per cent and the median survival was 52 months. Survival of patients with adenocarcinoma was not dependent on location within the small bowel. Survival was best for early-stage tumors and when lesions could be completely resected.

Predicting conversion of laparoscopic cholecystectomy for acute cholecystitis.

BACKGROUND AND OBJECTIVES: Laparoscopic cholecystectomy can be safely performed in patients with acute cholecystitis. However, the rate of conversion to open cholecystectomy remains higher when compared with patients with chronic cholecystitis. Preoperative clinical or laboratory parameters that could predict the need for conversion may assist the surgeon in preoperative or intraoperative decision making. This could have cost-saving implications. METHODS: A retrospective review of 46 patients undergoing laparoscopic cholecystectomy for acute cholecystitis was performed. Records were assessed for preoperative clinical, laboratory and radiographic parameters on admission. Temperature and laboratory parameters were also recorded prior to surgery after an initial period of hospitalization that included intravenous antibiotics. The effect of admission and preoperative parameters as well as the trend in these parameters prior to surgery upon the rate of conversion to open cholecystectomy was assessed. RESULTS: Ten patients (22%) required conversion to open cholecystectomy. Conversion was required more often in males (43%) when compared with females (4%) (p=0.003). Conversion rate was 30% in patients with increased wall thickness by ultrasound compared with 12% for patients without wall thickening (p=ns). No admission or preoperative laboratory values predicted conversion. The trend in the patient's temperature (p=0.0003) and serum LDH value (p=0.043) predicted the need for conversion to open surgery. CONCLUSIONS: Preoperative prediction of the need for open cholecystectomy remains elusive. Male patients and patients with rising temperature and LDH levels while on intravenous antibiotics require conversion at increased frequency. However, the benefits of laparoscopic cholecystectomy warrant an attempt at laparoscopic removal in most patients with acute cholecystitis.

Head and neck mucosal melanoma: a 32-year review.

Because mucosal melanoma of the head or neck is uncommon, retrospective data are of value in defining its natural history, response to treatment, and patterns of recurrence. We analyzed the medical records of 28 patients who had been treated for a mucosal melanoma of the head or neck between 1961 and 1993. We found that their cumulative 5-year survival rate was 20%. Patients who had primary tumors of the nasal cavity had significantly better 5-year survival than other patients. Early stage at presentation was another predictor of a more favorable outcome. Only 2 of the 17 patients (12%) who underwent surgery died with local disease. However, 13 of these 17 surgical patients (76%) eventually died of distant metastases. There were 3 long-term (> 5 yr) survivors: 2 who were treated by surgery alone, and 1 who was treated with surgery and radiation therapy. We found that aggressive resection of the primary tumor and of any local recurrence can achieve local control in most patients with mucosal melanoma of the head or neck. Distant metastasis is the limiting factor for long-term survival.

The effects of preperitoneal carbon dioxide insufflation on cardiopulmonary function in pigs.

BACKGROUND AND OBJECTIVES: Although considerable experimental and clinical knowledge exists on the physiology of pneumoperitoneum, insufflation of the preperitoneal space has not been extensively studied. The purpose of this study is to evaluate the physiology associated with preperitoneal carbon dioxide (CO2) insufflation in a porcine model. METHODS: Eleven pigs weighing 35 to 45 kg were anesthetized and placed on mechanical ventilation. A pulmonary artery catheter and an arterial line were inserted. Balloon dissection of the preperitoneal space and insufflation to 10 mm Hg for 1.5 hours, followed by an increase to 15 mm Hg for an additional 1.5 hours, was performed. Hemodynamic and arterial blood gas values were determined every 15 minutes throughout the stabilization and three-hour insufflation period. Hemodynamic parameters and blood gas values were analyzed using one-way analysis of variance with respect to insufflation time and pressure. RESULTS: Analysis of hemodynamics (CO, CVP, PAD, PAS, PCWP) did not demonstrate statistical significance with respect to time. However, there was a statistical difference in CO (p=.01), CVP (p<.01), and PCWP (p=.034) when comparing a pressure of 15 mm Hg to a pressure of 10 or 0 mm Hg. The other parameters did not demonstrate significant differences among the three pressure groups. Arterial PCO2 and pH were highly significant with respect to time (p<.01 and P<.01, respectively) and among the pressure groups (p<.01 and P<.01, respectively). CONCLUSIONS: Insufflation of the preperitoneal space with CO2 gas does not cause significant alterations in hemodynamics and blood gas changes at a pressure of 10 mm Hg. However, when a pressure of 15 mm Hg is used to insufflate this space, there is evidence of decreased pH and cardiac output, with elevated CVP and CO2 retention. This correlates with greater pneumodissection of the gas within the layers of the abdominal wall when elevated pressures are used.

Sarcoma of the breast: implications of the extent of local therapy.

Although the majority of breast neoplasms will be of epithelial origin, tumors of the stromal elements of the breast may occur. A retrospective review of the medical records and tumor registry data of 25 patients with breast sarcoma treated at Roswell Park Cancer Institute from 1964 to 1995 was performed. There were 24 females and 1 male, with a median age of 55 years. Delay in seeking medical attention was common. Angiosarcoma was the most common histologic type of breast sarcoma (n = 10). Mastectomy was the predominant form of local therapy (21 patients). Overall survival was 61 per cent at 5 years and 36 per cent at 10 years. There was no difference in survival or local control rates for those patients treated with local excision when compared with patients treated with mastectomy. Sarcoma is an unusual form of breast tumor. Survival and local control are similar when comparing local excision and mastectomy. When local excision is performed, attention must be directed to achieving clear margins of resection. The benefit of adjuvant therapy remains undefined.

Intrathyroid cysts of thyroglossal duct origin.

Thyroglossal duct cysts develop from a persistent portion of the thyroglossal tract and have been described as occurring anywhere from the base of the tongue to the manubrium. We present two patients who presented with a cystic thyroid nodule due to an intrathyroid thyroglossal duct cyst. A fine-needle aspiration biopsy was performed, which revealed benign squamous cells. Upon exploration, the first patient was found to have a 2-cm cyst within the thyroid isthmus, and in the second patient, a 1-cm cyst was found in the right thyroid lobe. Pathologic analysis revealed the cyst to be lined by a squamous epithelium consistent with a thyroglossal duct cyst. The lesions were completely surrounded by normal thyroid tissue. There was no evidence of a remnant of the thyroglossal duct extending from the thyroid in the region of the cyst. Both patients were treated by thyroid lobectomy and isthmusectomy and have remained without evidence of recurrence. Intrathyroid thyroglossal duct cysts should be included in the differential of patients with cystic thyroid lesions. Fine-needle aspiration revealing benign squamous cells is usually diagnostic and may detect an occult carcinoma arising within the cyst. Surgical resection is curative and should include a Sistrunk procedure if a thyroglossal duct tract is present.

Prognostic factors for adenocarcinoma of the gallbladder: an analysis of 162 cases.

Carcinoma of the gallbladder is a rare neoplasm and is associated with a dismal prognosis. To analyze the natural history of this disease and prognostic factors, a large tumor registry database was accessed. During the period 1972 to 1995, 214 patients were entered. Adequate follow-up was available on 162 patients, and this group forms the basis of this review. There were 54 males and 108 females with a median age of 62 years. Median follow-up was 7 months. Right upper quadrant abdominal pain was the most frequent presenting symptom. Fifteen patients had an incidental finding of carcinoma after cholecystectomy. Overall, 5-year survival was 25 per cent, with a median survival time of 9.7 months. Survival was improved for patients with local disease compared with those with regional or metastatic disease. One hundred nine patients underwent surgical therapy. Complete resection was possible in 36 patients, whereas 44 patients had residual disease. Median survival time for patients with no residual disease was 67.2 months, whereas those for patients with microscopic residual tumor and gross residual tumor were 8.9 and 3.8 months, respectively (P < 0.000001). Gallbladder cancer is often diagnosed at an advanced stage and is associated with a poor prognosis. In patients with localized disease, surgical treatment provides the opportunity for long-term survival only when a complete resection can be performed. Prognosis for patients with microscopic residual and gross residual disease is similar.

Intraoperative endoscopy in the management of patients with colorectal disease.

Preoperative colonoscopy is recommended in the evaluation of patients with lower gastrointestinal malignancies. The purpose of this study was to investigate the indications and impact on patient management in patients undergoing intraoperative endoscopy. This is a retrospective review of patient charts from February 1972 to July 1994 of 69 intraoperative endoscopic procedures performed in 54 patients during 54 operative sessions. The results of intraoperative endoscopy affected patient management in 29 of the 54 operative sessions (54%). This included 9 cases (17%) in which the planned surgical procedure was altered. There were no complications related to the endoscopies and 99% were completed successfully. Intraoperative endoscopy can provide important information that can alter the surgical management of patients with colorectal disease. This technique should be considered when intraoperative palpation fails to identify synchronous lesions identified on preoperative studies or in cases where the preoperative study is suboptimal.

Surgery as a single modality therapy for squamous cell carcinoma of the oral tongue.

PURPOSE: The treatment of squamous cell cancer of the oral tongue remains a challenging clinical problem. The efficacy of primary treatment with surgery versus radiation therapy for early stage disease and an adequate treatment paradigm for the clinically negative neck continues to be the subject of clinical debate. We have reviewed our experience in the treatment of oral tongue cancer with surgery as a single definitive treatment modality. PATIENTS AND METHODS: From 1971 to 1993, 79 patients with squamous cell carcinoma of the oral tongue were treated with surgery alone at Roswell Park Cancer Institute. RESULTS: Clinically, 69% of the patients presented with stage I/II disease and 31% presented with stage III/IV. Survival by pathological stage I to IV was 89%, 95%, 76%, and 65%, respectively. Surgical therapy ranged from partial to total glossectomy. There were no patients with positive margins. Local recurrence was observed in 15% of patients with close margins (< 1 cm) and 9% of patients with adequate margins (> or = 1 cm). The incidence of pathological node positive (N+) disease was 6%, 36%, 50%, and 67% for T1, T2, T3, and T4 tumors, respectively. Twenty-five percent of patients undergoing elective neck dissection were pathological N+. All pathological confirmed nodal disease was at level I or II. Of the 43 patients with clinical N0 disease, 16% subsequently developed regional recurrence, all of which were surgically salvaged. CONCLUSION: Locoregional control in patients with squamous cell carcinoma of the oral tongue can be achieved with primary surgical therapy. Adequate margins are crucial to local control. Salvage neck dissection may result in long-term survival for patients with regional relapse. Because of the high rate of occult disease (41%), we currently recommend prophylactic treatment of regional lymphatics for primary clinical disease of T2 or greater.

The utility of ultrasonography in the evaluation of groin masses: a case report.

Surgeons are often faced with the evaluation and management of groin masses. In most cases, an accurate history and physical examination will establish a diagnosis. Ultrasonography is being increasingly used in the evaluation of surgical problems. A case is presented in which bedside ultrasound was utilized in the evaluation of a large, symptomatic left inguinal mass found to be a synovial cyst on exploration. The differential diagnosis of cystic groin lesions and the impact of ultrasonography on diagnosis is reviewed with emphasis on synovial cysts. Surgeon-directed ultrasonography is an asset in the diagnosis of some patients with groin masses and may assist in the identification of those lesions requiring prompt operative intervention.

Occult thyroid carcinoma manifested as a cystic neck mass.

Papillary carcinoma of the thyroid is occasionally manifested by palpable cervical adenopathy and an occult primary lesion. Isolated cystic metastases as the presenting sign are an uncommon finding. In the case reported, a cystic lesion in the patient's neck laterally proved to be an occult papillary carcinoma.