A novel bipolar electric fence for excluding white-tailed deer from stored livestock feed

Where cattle (Bos taurus) and free-ranging white-tailed deer (Odocoileus virginianus) coexist, they frequently share space and resources, potentially resulting in damage to stores of livestock feed and risk of interspecies disease transmission. Preventing use of stored feed by deer can be an important objective in farm management, depending on amount of damage experienced and perceived risk of disease transmission. Woven wire fences (2.4 to 3.0 m high) are generally considered to be the most effective means for excluding deer. However, rapidly deployable temporary means of excluding deer could be useful, especially during late winter when deer are most physiologically stressed and motivated to consume feed meant for cattle. Thus, the objective of this study was to evaluate a novel 1.2-m-tall electric fence consisting of 4 strands of bipolar tape (not requiring separate ground wires or animal contact with ground) for excluding deer from artificially established feed piles during late winter 2008 in northwestern Minnesota. To induce deer to pause, investigate the fence, and receive negative stimuli before attempting to jump the fence, the bipolar tape was baited with a viscous fluid attractive to deer. The fence was estimated to be >80% effective at reducing deer presence at feed piles (10 treatment sites and 11 control sites) given the late winter to early spring conditions. Despite the efficacy, using the fence as a primary means of protecting stored feed from deer in areas with known disease transmission risk (e.g., presence of bovine tuberculosis) is not recommended because risk could remain unacceptably high if even low numbers of deer access stored feed. Yet, the fence could be effective as immediate protection of stored feed in winter before a more permanent and effective deterrence strategy, such as woven-wire fencing, could be installed during the subsequent summer. The fence would also be effective for reducing deer depredation of stored feed, as well as gardens, small orchards, or other localized or seasonal resources.

Comparison of magnetic resonance imaging–fluorodeoxy- glucose positron emission tomography fusion with pathological staging in rectal cancer

Background

This study represents an initial experience with combined magnetic resonance imaging (MRI) and [18F]fluorodeoxyglucose positron emission tomography (FDG PET) (MRI–PET fusion) in the primary staging of rectal carcinoma.

Methods

A retrospective analysis of data recorded on patients with rectal cancer was undertaken. Patients requiring long-course radiotherapy were excluded. Chest radiography, abdominal computed tomography and endorectal ultrasonography were performed. In addition, MRI of the pelvis, whole-body FDG PET and MRI–PET fusion were carried out. All patients subsequently underwent anterior resection.

Results

Twenty-three patients with rectal carcinoma (15 men), of median age 60 (range 46–75) years, were enrolled. In tumour (T) assessment, MRI correctly staged 14 of 22 T2/T3 tumours. In lymph node assessment, MRI–PET fusion had a sensitivity of 44 per cent, with a specificity and positive predictive value of 100 per cent. No additional information was acquired from MRI–PET fusion over MRI plus abdominal computed tomography and chest radiography.

Conclusion

MRI–PET fusion adds little to conventional investigations for staging rectal carcinoma.

Use of Elastin Fibres Detected in Non-Directed Low Volume Bronchial Lavage in Ventilated ICU Patients

Elastin fibres in sputum have been described as a more sensitive marker of pulmonary necrosis than plain chest X-rays. This study aimed to determine the prevalence of elastin fibres using non-directed non-protected mini-bronchoalveolarlavage (BM-BAL) in mechanically ventilated patients in the intensive care unit. Patients admitted to the general intensive care unit of a tertiary referral hospital requiring more than 48 hours of mechanical ventilation had surveillance BM-BAL performed on admission and were then examined weekly using potassium hydroxide wet preparations for the presence of elastin fibres. All positive and a random selection of 16 negative preparations from patients with acute respiratory distress syndrome or pneumonia were fixed and examined using Weigert's staining method for elastin. Of 412 patients enrolled, 130 (32%) had pneumonia on admission, 50 (12%) developed 58 episodes of ventilator-associated pneumonia and acute respiratory distress syndrome was diagnosed in 86 patients (21%). No chest X-ray showed cavitating infiltrates. Of 985 specimens examined, only seven had elastin fibres. Elastin fibres are uncommonly found using BM-BAL in general screening, acute respiratory distress syndrome or pneumonia in the intensive care unit, the incidence too low to be a useful indicator of pulmonary necrosis.

Isolated radial nerve palsy in a newborn: report of two cases

Two newborns with history of difficult birth were diagnosed within 24 hours after birth with isolated radial nerve palsy. Both newborns recovered completely. Awareness and multidisciplinary approach is essential.

Improving cervical cytology screening in a remote, high risk population

OBJECTIVE

To evaluate the use of the ThinPrep method to reduce rates of unsatisfactory Papanicolaou (Pap) smears in women in remote communities.

DESIGN

Prospectively collected samples were split and screened conventionally and by ThinPrep at the Queensland Cytology Service.

PATIENTS

Three hundred women having cervical smears taken by a Mobile Women's Health Service nurse or at the antenatal and sexual health clinics of a remote north Queensland community.

MAIN OUTCOME MEASURE

Number of Pap smears reported as unsatisfactory for evaluation and requiring a repeat smear request.

RESULTS

17.3% of conventionally prepared smears were technically unsatisfactory, compared with 6.3% prepared with ThinPrep. The overall rate of unsatisfactory smears was only 4.3% when both ThinPrep and conventional smears were assessed for a combined report.

CONCLUSION

A significant reduction in the proportion of unsatisfactory Pap smears is possible with the ThinPrep method. Targeted use of ThinPrep in communities with high rates of unsatisfactory smears may prove cost-effective.

Holding the baby: head downwards positioning for physiotherapy does not cause gastro-oesophageal reflux

The head-downwards tipped position for physiotherapy has been claimed to exacerbate gastro-oesophageal reflux (GOR) in infants with cystic fibrosis (CF). This was investigated using lower oesophageal pH monitoring during physiotherapy. Twenty-one infants (age range 1-27 months) with respiratory disorders (CF=11), undergoing lower oesophageal pH monitoring were recruited. Subjects received two physiotherapy episodes in random order, A/B or B/A, 12 h apart. A began the gravity-assisted positioning head downward tip for: right lower lobe, middle lobe, left lower lobe and lingula; then supine with no tip for anterior segments of the upper lobes followed by apical segments of upper lobes in a sitting position. B was in the reverse order. Intermittent chest clapping was carried out for 4 min in each position by a physiotherapist blinded to the pH data. During episode A, the median change in pH from baseline was -0.32 (range -2.07 to +1.0) in non-CF subjects (NS) and -0.52 (range -2.7 to +0.52) in CF subjects (p<0.02). During episode B, the median change in non-CF subjects was -0.1 (NS; range - 1.7 to -0.15) and in CF subjects was -0.05 (NS; range -0.67 to +0.5). There was no order effect for positioning. In the CF subjects the sitting position was twice as likely to have the lowest pH measurement during physiotherapy than the other positions (p<0.04). In conclusion, the head-downward tipped positioning for physiotherapy treatment neither induces nor aggravates gastro-oesophageal reflux. There is no justification for routinely changing the way in which infant physiotherapy is carried out.

Airway response of children with primary ciliary dyskinesia to exercise and beta2-agonist challenge

In primary ciliary dyskinesia (PCD), chest physiotherapy for airway clearance is essential. Exercise and inhaled beta2-agonists can produce bronchodilation thereby augmenting physiotherapy. However, both can also cause bronchoconstriction, and the effects of these stimuli in PCD are not known. In a preliminary study, the mean coefficients of variation for forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) in children with PCD were determined. They were 5.4%, 4.4% and 8.4%, respectively. Twelve children with PCD and 12 normal children performed pulmonary functions under resting conditions; during and after a validated treadmill exercise test; and before and 15 min after 200 microg of inhaled salbutamol. At baseline, FEV1, FVC, forced mid-expiratory flow (FEF25-75%) and PEFR were significantly reduced in the PCD group compared with the control group. Exercise produced a significant increase in PEFR in the PCD group. There was no significant difference between the groups in response to salbutamol. Within the PCD group, exercise produced a significantly greater increase in PEFR than beta2-agonist therapy. In conclusion, in children with primary ciliary dyskinesia there is evidence of obstructive pulmonary disease. In these children, exercise is a more potent stimulus for bronchodilation than by inhaled beta2-agonists. Enhancement of airway clearance may best be achieved by encouraging patients to exercise before physiotherapy rather than by inhaling beta2-agonists, but the effects of each should be assessed for each individual before instigating treatment.

Further observations on histological changes at the ureteroileal junction in ileal conduits

Seventy-two ureteroileal anastomoses taken from ileal conduits removed from 62 patients were examined histologically to characterize the range of mucosal and stromal changes at these sites. All 72 demonstrated variable amounts of subepithelial chronic inflammation and fibrosis. Other histological features included: cystic spaces lined by transitional epithelium (N = 29; 40%; average diameter 1.2 mm); cystic spaces lined by mixed intestinal/transitional epithelium (N = 5; 7%; average diameter 0.77 mm); and cystically dilated intestinal glands (N = 21; 29%; average diameter 0.24 mm). The latter were associated with overgrowth by transitional epithelium, which had prevented mucus drainage. Twenty-one (29%) had mucus pools with no epithelial lining (average diameter 1.2 mm), and polypoidal protrusions into the lumen of the anastomosis were found containing mucus pools (N = 4; 6%; average diameter 1.4 mm), transitional-lined cysts (N = 5; 7%; average diameter 2.2 mm), and mixed intestinal/transitional-lined cysts (N = 2; 3%; average diameter 2.5 mm). Focal rupture of dilated intestinal glands with interstitial pooling of mucus was not uncommon, and marked dystrophic calcification was found in 1 case within a large collection of extracellular mucus. This series confirms that inflammation, fibrosis, and glandular overgrowth by transitional epithelium are common occurrences at ureteroileal anastomosis sites. Subsequent gland rupture may result in sizable accumulations of interstitial mucus, and rarely in marked dystrophic calcification.

Pathologic features of the ureteroileal anastomosis in ileal conduits in childhood

Ileal conduit urinary diversions are associated with a high incidence of late complications often requiring major revision surgery. Although the etiology of the late complications is not always clear, there may be unilateral or bilateral hydroureteronephrosis, with the conduits showing narrowing and stricture formation with villous atrophy, chronic inflammation, and fibrosis. Histologic review of 20 ureteroileal anastomoses from 12 patients showed variable degrees of chronic changes. In addition, cystically dilated intestinal glands were noted in six anastomoses, transitional epithelial-lined cysts were noted in nine, aggregated pools of mucus were noted in four, mixed transitional and intestinal epithelial-lined cysts were noted in two, and polypoid lesions with mucus pools or cysts projecting into the lumen were noted in five. Twelve cysts measured over 1 mm in diameter; six measured over 2 mm. These histologic features may result from overgrowth of intestinal glands by transitional epithelium, with subsequent gland dilatation, rupture, and mucus pooling. It is possible that the larger "cysts" and "polyps" may have contributed to the ureteroileal obstruction, a finding that may have bearing on other types of urinary tract reconstructions using bowel segments.

Leiomyosarcoma of the saphenous vein in a child with 12-year follow-up

Leiomyosarcomas of the vasculature are exceedingly rare tumors in childhood. The case of a 2-year-old girl who underwent three local excisions with two courses of adjuvant chemotherapy over 3 years for a leiomyosarcoma of a saphenous vein tributary is described. Follow-up over the following 9 years has shown no evidence of further recurrence or metastases suggesting that cure has been achieved. Treatment options are discussed and pertinent literature is reviewed.

Transcription patterns of human papillomavirus type 16 in genital intraepithelial neoplasia: evidence for promoter usage within the E7 open reading frame during epithelial differentiation

Human papillomavirus (HPV) type 16 transcription was analysed by in situ hybridization using 125I-labelled subgenomic riboprobes, from 26 genital intraepithelial neoplastic (IN) lesions, in formalin-fixed biopsies from 18 different cases. Distinct transcription patterns separable by the presence or absence of late gene transcription were detected. In 12 lesions, late gene expression was absent; HPV transcripts corresponding to the E6 and E7 open reading frame (ORF) were detectable in all basal cells and were usually evenly distributed through all layers of the epithelium. Transcripts corresponding to the E1, E2 and E2/E4 ORFs were present in nine of 12 lesions and displayed a similar distribution. In 14 lesions late gene transcripts were present. E6 and E7 transcripts were detectable basally in all but one lesion. The levels of E7 but not E6 transcripts were markedly increased in the superficial cells of differentiating epithelia, with an identical distribution and at similar levels to those of the E2/E4 transcript. We propose that the most abundant transcript in genital IN lesions containing late gene expression is an E7/E1 [symbol: see text] E2/E4 transcript corresponding to that reported in HPV-6/11 condylomata and which is derived from a similar promoter within the E7 ORF.

High prevalence of human papillomavirus transcripts in all grades of cervical intraepithelial glandular neoplasia

Cervical biopsy specimens containing cervical intraepithelial glandular neoplasia (CIGN) were examined for the presence of human papillomavirus (HPV) RNA transcripts by in situ hybridization with iodine 125-labeled riboprobes. HPV RNA was detectable in 95.2% of biopsy specimens. HPV 16 RNA was present in 12, HPV 18 in 27, and both in 1 of the 42 cases examined. Among HPV-positive cases, HPV RNA was detectable in all grades of CIGN and, in three cases, in glands displaying only minimal nuclear abnormality insufficient for a diagnosis of CIGN. Patients with HPV RNA-positive CIGN were younger than those with negative findings for HPV, and patients with less severe grades of CIGN showed a trend toward a younger age of presentation than patients with severe glandular lesions. Increasing grades of CIGN may reflect progressive stages in the development of cervical adenocarcinoma, and this progression may closely involve HPV gene expression from its earliest stages.

Differing prevalence of human papillomavirus RNA in penile dysplasias and carcinomas may reflect differing etiologies

Penile intraepithelial neoplasias grade 3 (PIN 3) and penile carcinomas were examined for the presence of human papillomavirus (HPV) RNA transcripts by in situ hybridization using 125I-labeled RNA probes. Human papillomavirus transcripts were detected in all 10 PIN 3 lesions not associated with invasive malignant conditions but were present in only 29% of penile carcinomas (9 of 26 squamous cell carcinomas and none of 5 verrucous carcinomas). Human papillomavirus RNA-positive penile cancers were significantly more likely to exhibit adjacent PIN 3 lesions than were HPV-negative tumors, and PIN 3 lesions adjacent to tumors always contained the same HPV-RNA type as was present in the invasive tumor. The development of most penile cancers may be unrelated to HPV infection. Future epidemiologic studies of the role of sexually transmitted factors in the development of penile carcinoma should distinguish between HPV-positive and HPV-negative penile cancers.

Increased age and mortality associated with cervical carcinomas negative for human papillomavirus RNA

Attempts to relate presence and type of human papillomavirus in cervical carcinoma with prognosis have yielded conflicting results. To further investigate this relation, the association between survival of cervical cancer patients after diagnosis and the presence of human papillomavirus (HPV) RNA within the tumour was assessed retrospectively. Formalin-fixed biopsy specimens from 212 patients with cervical carcinoma who had been followed for up to 6 years were tested by in-situ hybridisation with 125I-labelled riboprobes. HPV-RNA-positive women were 11.9 years younger than HPV-negative women at diagnosis (p less than 0.001). Case-fatality rates from cervical cancer rose with absence of HPV RNA, age at diagnosis, or FIGO stage. Multivariate analysis confirmed that absence of detectable HPV RNA and advanced FIGO stage were independent risk factors. No differences in survival between HPV types 16, 18, 31, or 33 were seen. These observations suggest that cervical carcinoma patients fall into two groups--a younger, HPV-RNA-positive group, with a better prognosis, and an older, HPV-RNA-negative group with poorer prognosis. Treatment regimens for the two groups may need to differ.

Differing characteristics of human papillomavirus RNA-positive and RNA-negative anal carcinomas

Anal carcinomas were tested for the presence of human papillomavirus (HPV) RNA transcripts by in situ hybridization using 125I-labeled RNA probes. The HPV transcripts were detected in 73.2% of 41 nonglandular anal carcinomas but in none of six anal or 11 rectal adenocarcinomas. In anal nonglandular carcinomas, no difference in the percentage of tumors that were HPV RNA positive was observed between tumors classed as basaloid carcinomas or squamous cell carcinomas. Patients with HPV RNA-negative tumors were significantly older (9.2 years) than those with HPV RNA-positive tumors. Anal intraepithelial neoplasia Grade 3 in the surrounding epithelium was seen in 14 of 25 assessable HPV RNA-positive tumors and in none of nine assessable HPV RNA-negative tumors. Anal tumors may include two separate clinical and biologic groups distinguished by their dependence, or lack of dependence, on HPV RNA expression for maintenance of the neoplastic state.

Presence and distribution of human papillomavirus sense and antisense RNA transcripts in genital cancers

RNA transcription in eight human papillomavirus (HPV) type 16-positive genital carcinomas and in two cervical squamous cell carcinoma (SCC)-derived cell lines was analysed by in situ hybridization using 125I-labelled subgenomic riboprobes. Transcripts corresponding to the E6 and E7 open reading frames were always present, except within the keratinizing layers of differentiated SCCs. Intranuclear E1 gene transcripts were detectable in both cell lines and some tumours whereas E2/E4 transcripts were absent from five of seven assessable tumours, suggesting transcription from integrated viral DNA. When mRNA sense riboprobes were used as controls, no signal was seen in the two cell lines; however, three tumours contained a focal, intense nuclear RNase-sensitive signal using mRNA sense riboprobes. This antisense RNA signal mapped across the whole genome including the noncoding region. In one tumour, the presence of antisense RNA was independently confirmed by using E7 and E2/E4 RNA probes of both orientations in RNase protection assays. Transcription of antisense RNA may be a natural feature of some HPV-positive genital tumours and its possible role in modulating cell behaviour in vivo requires further investigation.

Two unusual tumours of the gastrointestinal tract in a patient with tuberous sclerosis

A 16 year old girl with an established diagnosis of tuberous sclerosis presented with a 1 year history of swelling of the left cheek. A 2 cm diameter tumour was excised which showed histological features of a solid variant of a minor salivary gland basal cell adenoma. One year later during laparotomy and excision of multiple renal angiomyolipomas, a 5 cm diameter subserosal tumour was found at the hepatic flexure of the colon. Examination of biopsy material revealed a leiomyoma. This case is presented to demonstrate two tumours that have not to the authors' knowledge been previously described in a young patient with tuberous sclerosis. Although the association may be coincidental, these tumours could represent two rare associations of tuberous sclerosis.

Criteria for the diagnosis of primary endocrine carcinoma of the skin (Merkel cell carcinoma). A histological, immunohistochemical and ultrastructural study of 13 cases

Thirteen cases of primary endocrine carcinoma of the skin (Merkel cell carcinoma) were reviewed with the aim of defining the morphological, immunohistochemical and ultrastructural criteria for diagnosis. The tumour cells were characterized by their scanty cytoplasm, generally small uniform nuclei with finely dispersed chromatin and multiple small nucleoli. Nuclear shapes varied from round to spindle, with larger and pleomorphic forms predominating in 2 tumours. A striking feature seen in 12 tumours was the occurrence of a "ball-in-mitt" pattern represented by 1 or 2 crescentic tumour cells closely wrapped around an oval cell. Staining for neuron-specific enolase was the most consistent marker of the tumour and the characteristic juxtanuclear globular staining for keratin and cytokeratin and the occasional coexpression of neurofilament set this tumour apart from other cutaneous neoplasms, in particular, metastatic carcinoid tumours and oat cell carcinoma from the lung. The fine structural features of note were striking paranuclear or juxtanuclear whorls of intermediate filaments, seen in 7 cases, the presence of variable numbers of membrane-bound dense core granules of 80-150 nm diameter in all cases and cytoplasmic spinous or microvillous projections containing microfilaments in 4 cases. Less consistent characteristics of primary endocrine carcinomas of the skin included cell moulding, argyrophilia and immunohistochemical staining for ACTH, VIP and calcitonin. The high frequency of vessel invasion in this series is in keeping with the high rate of local recurrence, lymph node metastases and visceral dissemination reported. The distinction from other similar appearing tumours in the skin is discussed.

Neonatal necrotizing enterocolitis: a cause of gastric metaplasia in the mid-ileum

Following neonatal necrotizing enterocolitis in a premature Aboriginal baby, a stricture developed in the distal small intestine. At laparotomy a 1.0 cm stricture was found in a 25 cm thick-walled, oedematous segment of the mid-ileum. Biopsy demonstrated antropyloric-type ectopic mucosa and, therefore, the oedematous segment was removed. The resected specimen contained several distinct areas of flat antropyloric gastric mucosa as well as ileal mucosa. Although no acid-producing cells could be demonstrated, mucosal ulceration was prominent in several areas. Scanning electron microscopy demonstrated gastric pits. Immunoperoxidase technique for gastrin failed to demonstrate gastrin-containing cells. It is believed that this mucosa represents a metaplasia that has been induced in response to mucosal damage, which in turn was initiated by necrotizing enterocolitis. It is believed this would represent the first reported case.

Neoplastic cerebral aneurysm from metastatic gestational choriocarcinoma. Case report

This case of metastatic gestational choriocarcinoma presented as intracerebral hemorrhage from an atypical distal middle cerebral artery aneurysm. Operative evacuation of the intracerebral hematoma was undertaken and histopathological examination revealed choriocarcinoma invading the vessel wall. Neoplastic cerebral aneurysms are unusual, being reported in metastatic choriocarcinoma, cardiac myxoma, bronchogenic carcinoma, and undifferentiated carcinoma. Metastatic choriocarcinoma should be considered in the differential diagnosis of intracerebral hemorrhage in women of child-bearing age. Recent advances in treatment have resulted in a 75% cure rate for metastatic choriocarcinoma.

Hepatosplenic schistosomiasis in a South-East Asian refugee child in South Australia

This report documents a case of hepatosplenic schistosomiasis in a South-East Asian refugee boy who presented with malaise, abdominal distension, and was found to have massive splenomegaly and esophageal varices. The diagnosis was confirmed by liver biopsy and he was treated with a highly efficacious schistosomicide, Praziquantel. The case highlights the possible occurrence in Australia of non-endemic tropical diseases in immigrants.

The contaminated skin-knife. A surgical myth

The scalpel blades used during 187 operations were cultured. At each procedure the knife used to incise the skin was discarded immediately and a fresh knife was used to complete the operation. The results showed that there was no difference in the bacterial growth between the two knives. From these results it would appear that the practice of changing blades after incising the skin is an unnecessary precaution in the prevention of bacterial contamination of clean wounds.

A review of elongation of os calcis for flat feet

Between 1959 and 1974 the late Dillwyn Evans treated severe symptomatic flat feet by elongating the os calcis. The long-term follow-up of 20 of these patients with a total of 23 feet is presented 7 to 20 years after the operation. At review 17 of the 23 feet showed very good or good results and it was concluded that this is a useful procedure for severe cases of flat feet which appears to stand the test of time.

Acute spinal epidural abscess. Observations from fourteen cases

Fourteen cases of acute spinal epidural abscess are analysed. Postoperatively 6 recovered completely, 4 patients recovered enough to allow unaided walking, 2 died and 2 who were paraplegic pre-operatively remained so. The purpose of this paper is to remind readers of the existence of this condition and to plead for early diagnosis and prompt surgical treatment.

Apparatus for Recording X-ray Doses

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