Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

There are several treatment options for rigid fixation at C1–C2 including Brooks and Gallie type wired fusions and C1–2 transarticular screws. The use of a Goel–Harms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel–Harms-type constructs during a 3-year period (2005–2007). Six patients were treated using Goel–Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3–4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7–29). The results demonstrated that Goel–Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.     

Outbreak-specific monovalent/bivalent vaccination to control and eradicate virulent ovine footrot

Footrot is a contagious disease of small ruminants which is caused by the bacterium Dichelobacter nodosus. In its virulent form there are severe economic losses and a very significant animal welfare issue. Sheep and goats can be vaccinated for treatment and prevention of the disease. There are 10 different serogroups of D. nodosus (A–I and M) and immunity is serogroup-specific. When all 10 serogroups are presented together in a vaccine, protection persists for only a few months due to “antigenic competition”. Consequently we evaluated the use of sequential monovalent or bivalent vaccines to control/eliminate/eradicate virulent footrot in a longitudinal intervention study on 12 commercial farms in southeast Australia with flock sizes of approximately 1200–4200 sheep. Overall, virulent footrot was eradicated from 4 of the flocks, 2 of which had 2 serogroups, and the others 4 or 5 serogroups. Where there were only 1 or 2 serogroups (3 farms) the clinical response was rapid and dramatic; prevalence was reduced from 45 to 50% before vaccination to 0% (2 farms) or 0.4% (1 farm) after one round of vaccination. In the remaining 9 flocks there were more than 2 serogroups and successive bivalent vaccines were administered leading to eradication of virulent footrot on 2 farms over 4 years and control of the disease on all but 3 of the others. Of the latter farms, 1 discontinued, and 2 initially had poor response to vaccine due to misdiagnosis of serogroup ‘M’, which was previously unknown in Australia. Control was achieved after administration of a serogroup M vaccine. These results provide clear evidence for control, elimination and eradication of virulent footrot by outbreak-specific vaccination in Australia.     

A Comparison of Interventional Approaches for Increasing Power Take-off Shielding on New York Farms

Objective: Power take-off (PTO) driveline entanglements are a primary source of injury on US farms. As with many farm injury concerns, hazard control technology is widely available for mitigating the risk of these entanglements. Despite the availability of hazard control technology, PTO shields are damaged or missing on approximately 57% of PTO driveline implements in New York. Given the catastrophic nature of entanglements and the ready access to safety technology, a better understanding of what motivates farmers to install or replace PTO shields is warranted. Methods: To examine this question, agricultural health and safety researchers in New York State conducted an initial comparison of PTO shield sales on farms receiving one of three different interventional approaches. These included PTO shield audits, a social marketing campaign, and on-farm safety services. PTO shield purchases were tracked from January 2011 through June 2016 on farms receiving these interventions and on other farms that were not exposed to interventional strategies. Results: Results indicate that a significantly higher number of PTO shields were purchased on farms that requested and received on-farm safety services versus farms that were exposed to PTO shield audits, the social marketing campaign, or the control group. PTO shield sales were slightly elevated on farms receiving driveline audits, as compared with control farms (although these differences were not significant). Conclusions: No marked differences in sales were noted between control farms and farms exposed to the social marketing campaign. Only one of the three interventional strategies (on-farm safety services) approached the number of PTO shield sales necessary to prevent an entanglement.     

Histological quantification of the tissue damage caused by PlasmaJet™ coagulator

The purpose of this study was to evaluate tissue damage caused by the PlasmaJet^TM coagulator in the uterus, ovary, and fallopian tube at different power settings in vitro and then to examine the damage caused in vivo. In vitro evaluation included prospective recruitment of six subjects undergoing hysterectomy with or without salpingo-oophorectomy. Tissue damage was evaluated histologically for power levels at 10%, 15%, and 20%, and for duration of 2 and 5 s at a clinically acceptable distance of 0.5 to 1 cm between the tip of probe and tissue. In vivo evaluation included 15 subjects undergoing hysterectomy with or without salpingo-oophorectomy. The most suitable power setting and duration of diathermy was decided from in vitro examination and applied on in vivo setting. Tissue damage was evaluated histologically. There was no significant difference seen in the depth and width of tissue damage in the in vitro specimens at different low power levels and duration of diathermy (P > 0.05). A setting of 20% power and duration of 5 s of diathermy was used therefore for in vivo setting. Mean ± SD depth (millimetres) of tissue damage in uterus, ovary, and fallopian tube were 0.63 ± 0.19, 0.61 ± 0.14, and 0.63 ± 0.18, respectively. Mean ± SD width (millimetres) of tissue damage in uterus, ovary, and fallopian tube were 4.66 ± 0.05, 4.05 ± 0.61, and 4.51 ± 0.77, respectively. Irrespective of tissue type, the average depth and width of tissue damage with application of Plasmajet^TM coagulator for 5 s at low power is 0.62 and 4.24 mm, respectively. It therefore appears to be a safe method of coagulation in vitro and in vivo at 20% power on gynaecological tissues.     

Otolaryngological manifestations of ‘Muckle-Wells syndrome’

We present a follow-up of a cohort of three cases of Muckle-Wells syndrome (MWS). The aim of this report is to characterise the symptoms of this rare autosomal dominant condition with respect to the ENT practice. A retrospective analysis of the clinical features of MWS from our outpatient follow-up record of the three patients diagnosed with MWS. An extensive literature search was performed, using Medline through Pub Med (1950-2010), EMBASE (1980-2009) and Ovid (1958-2009). Retrospective case note study. In the present cohort, progressive sensorineural hearing loss was the main presentation and has been followed up over 10 years (median). The spectrum of head and neck presentation from the world literature was reviewed and includes hypothyroidism, amyloid goitre, cervical lymphadenopathy, and facial rash. This is the first documented report of the Otolaryngological features of the MWS in the English ENT literature. An awareness of this rare syndrome is essential in order to diagnose this uncommon syndrome and thus to plan for a long-term follow-up.