Pantaloon spica cast: an effective method for postoperative immobilization after free graft hypospadias repair

PURPOSE: We used a postoperative dressing of silicone foam in conjunction with a pantaloon spica cast to optimize the chances for successful graft take in hypospadias repairs with grafts. We compared the results to those of inpatient bed restriction. MATERIALS AND METHODS: A total of 15 patients underwent graft urethroplasty, and application of a penile silicone foam dressing and fiberglass pantaloon spica cast. Patients were discharged home the following morning. RESULTS: Two fistulas developed. Results are no different from those of our previously reported cases which required 6 or 7 days of hospitalization. CONCLUSIONS: We believe that the pantaloon spica cast provides necessary immobilization for facilitating imbibition and inosculation, which are required for graft survival. Also, the spica cast allows early discharge home, obviating the need for prolonged hospitalization and bed rest.     

Regulated neurite tension as a mechanism for determination of neuronal arbor geometries in vivo

Transection and displacement experiments on isolated neurons in culture have shown that their neurites are under tension. Such tensile forces might be important in determining the structures of neuronal arbors in vivo. It has also been proposed that tension mechanisms generate the global folding patterns of the brain. It has been difficult to determine whether tension is important in vivo, however, because most neuronal arbors have complex three-dimensional structures that cannot be perturbed in a controlled manner. Here we describe a situation in which tension can be demonstrated and perturbed in an intact central nervous system (CNS). In the embryonic CNS neuropil of the grasshopper Schistocerca americana, the axon of a local serotonergic interneuron known as s1 forms a characteristic bifurcation. The geometry of this bifurcation node is highly conserved between embryos and held constant during development. Current models for the development of such geometries usually propose that they are created and maintained by neurite adhesion to localized substrates. Here we show that the structure of the s1 bifurcation node is likely to be determined by balanced tension between three fixed points. This was revealed by selectively transecting each of the branches that intersect at the node. Transections are followed by a rapid restructuring ('snapping') of the node geometry.     

Clinically significant azole cross-resistance in Candida isolates from HIV-positive patients with oral candidosis

OBJECTIVES: To determine the proportion of fluconazole-resistant Candida albicans isolates that have clinically significant cross-resistance to itraconazole or ketoconazole, that is sufficient to result in failure of these agents at their standard doses (200 and 400 mg daily for 7 days, respectively). METHODS: Seven hundred C. albicans isolates from HIV-positive patients with oral candidosis underwent susceptibility testing using a relative growth method, for which cut-off values corresponding to clinical drug failure have been established. RESULTS: A total of 431 isolates were fully azole-susceptible and three main resistance patterns were detected: isolates resistant to fluconazole alone (n = 100); isolates resistant to fluconazole and ketoconazole but susceptible to itraconazole (n = 94); and isolates resistant to all three drugs (n = 50). No isolates were consistently resistant to ketoconazole without being fluconazole-resistant, and no itraconazole resistance was detected without ketoconazole resistance. Resistance to fluconazole alone was more common in specimens obtained soon after first clinical fluconazole failure, whereas specimens from patients with a longer history of fluconazole-unresponsive candidosis were more likely to be infected with cross-resistant isolates. Median days of prior azole exposure and cumulative fluconazole dose were significantly less for those with isolates resistant to fluconazole alone than for those with ketoconazole cross-resistant isolates, who had received less azole therapy and smaller cumulative fluconazole doses than those with isolates cross-resistant to all three drugs (although not statistically significant). After the diagnosis of fluconazole-unresponsive candidosis, increasing cumulative doses of itraconazole solution were associated with increasing likelihood of cross-resistance. CONCLUSIONS: Clinically significant cross-resistance to other azoles may occur in fluconazole-resistant isolates of C. albicans, although initially most isolates are not cross-resistant and the detection of cross-resistant isolates is associated with a history of greater prior azole exposure. Patients who have been treated for fluconazole-resistant candidosis for longer and with greater cumulative doses of itraconazole solution tend to become infected with increasingly cross-resistant isolates of C. albicans.     

Scattered radiation doses to infants and children during EMI head scans

Scattered radiation doses to the eyes, thyroid and gonads of infants and children undergoing EMI head scans have been measured with thermoluminescent dosimeters. An average skin dose of 1.3 rad per scan was measured. Results are reported relative to incident skin dose and indicate that it is likely that there is no somatic or genetic hazard due to scattered radiation during an EMI head scan.     

The influence of stimulation of the hypothalamus on the choice of food during maintenance of rats on various salt and water diets

Electrical stimulation of the lateral hypothalamus of rats maintained on a normal or salty diet with water deprivation leads to an increase in drinking excitability and to a decrease in the thresholds for salty food consumed. The stimulation promotes attenuation of the effects of the "mental" desalting of food that is achieved by a spatial co-placement of the nonsaltiness signal with salty reinforcement, and accelerates the conversion of the signal significance of the conditional stimuli associated with nonsalty and salty reinforcement as well. Electrical stimulation of the hypothalamus accelerates the formation of conditioned reflex aversion to salty food and the inhibition of conditioned reflexes in the direction of the corresponding food dispenser, and intensifies the existing state of thirst as well, imparting to it characteristics of a dominant motivation.