Optimum site for in ovo amino acid injection in broiler breeder eggs

Three experiments were conducted to evaluate the effect of differences in in ovo amino acid (AA) injection sites in broiler breeder eggs on subsequent hatchability and BW of chicks. In Experiment 1, an AA solution was injected into eggs with 13-mm or 19-mm, 27-ga needles. Uninjected eggs served as controls. Hatchability was decreased (P < 0.05) in eggs receiving AA injections with the 19-mm needle in comparison to the control and 13-mm-injected groups. However, BW of chicks increased (P < 0.05) relative to pre-incubational egg weight by AA injection with the 13-mm needle. In order to evaluate the in ovo location of AA injections from Experiment 1, India ink was injected into eggs in Experiment 2 with a 13-or 19-mm needle. Immediately after injection, the air cell end of the egg was windowed in order to observe effects of injection site. Windowing of eggs was accomplished by removing a piece of the eggshell over the air cell and the underlying membrane at Day 7 of incubation. The amount of injected India ink was higher in the extra-embryonic coelom in eggs treated by both needles. However, the occurrence of India ink in the extra embryonic coelom was higher (P < 0.05) in the group injected with AA solution using a 13-mm needle as compared to that after injection using a 19-mm needle. The observation of India ink in the amniotic cavity was higher (P < 0.05) in the group injected with AA solution using a 19-mm needle rather than that using a 13-mm needle. In Experiment 3, treatments consisted of control (uninjected eggs) or windowed eggs. Windowed eggs received AA to the chorioallantoic membrane, the yolk, extra-embryonic coelom, or amniotic cavity at Day 7 of incubation. Hatchability was reduced, but chicks hatched when eggs were windowed and when AA were injected into the yolk sac or extra-embryonic coelom. However, chicks did not hatch when AA were administered to the chorioallantoic membrane or into the amniotic cavity. These results suggest that the best AA injection sites in ovo may be the yolk and extra-embryonic coelom.

Percutaneous liver biopsy in children: impact of ultrasonography and spring-loaded biopsy needles

BACKGROUND

Percutaneous liver biopsy is a valued tool of pediatric hepatology. Recent advances in technology have incorporated spring-loaded biopsy needles and ultrasonography in percutaneous liver biopsy.

METHODS

To determine the frequency of complications after liver biopsy and whether variables such as needle selections (Jamshidi, Monopty, or ASAP) and ultrasound guidance could predict complications, medical records were retrospectively reviewed of all patients who underwent percutaneous liver biopsy during a 7-year period. Available data were collected from 123 patients who had undergone a total of 249 percutaneous liver biopsies. All patients with evidence of mild clotting abnormalities (8.83%) received platelets, cryoprecipitate, or fresh-frozen plasma.

RESULTS

There was a 6.83% incidence of overall complications, and a 2.4% incidence of major complications. The mortality rate was 0.4%. Ultrasound localization did not diminish the risk of bleeding during biopsy. There was no significant difference in the change of hematocrit between the aspiration (Jamshidi) and spring-loaded (Monopty) needles. However, in patients less than 5 years of age, the change of hematocrit was significantly higher (P < 0.05) with the 15- or 18-gauge ASAP needle (Microvasive, Quincy, MA, U.S.A.) than with either the Jamshidi (Allegience Healthcare, Columbia, MD, U.S.A.) or Monopty (Bard Technologies, Covington, GA, U.S.A.) needles.

CONCLUSION

Percutaneous liver biopsy is safe, using either aspiration or spring-loaded needles. Ultrasound guidance may not be helpful except in patients who underwent segmental liver transplantation.

Equipment, technique, quality assurance, and accreditation for imaging-guided breast biopsy procedures

Needle biopsy diagnosis of breast lesions can be performed using fine needle aspiration or large core needle biopsy techniques. Imaging guidance using mammographic stereotactic devices or sonography can accurately guide biopsy probes into suspicious lesions. Choice of the biopsy probe in any individual patient will depend upon equipment availability, lesion characteristics, breast configuration, and cost considerations. Quality control and quality assurance programs should be instituted to maintain a high level of patient care. Facilities performing these biopsies can obtain accreditation to attest to the quality of their biopsy program.

Evaluation of interventions to prevent needlestick injuries in health care occupations

OBJECTIVE

The objective of this study was to evaluate interventions that reduce or prevent needlestick injuries in health care occupations.

METHODS

Cochrane Collaboration search strategies to locate studies that evaluated interventions to reduce needlestick injuries in health care occupations were used. Studies were selected if they met the following criteria: (1) interventions were evaluated in the defined population; (2) interventions were randomized, with a comparison group(s); (3) outcomes were objectively measured and had interpretable data. Eleven studies met inclusion criteria. The main outcomes of interest were changes in the number of glove or skin perforations and changes in amount of skin contamination.

RESULTS

Three studies found a decrease in glove or skin perforations when double gloves or combinations of gloves were used by surgeons and their assistants. One study found an increase in glove perforations but a decrease in hand contamination. Three studies evaluated the effectiveness of specialized needles in reducing needlestick injuries during surgical wound closure with decreases in glove or skin perforations reported. Protective devices were evaluated in three studies and significant reductions in glove perforations were found with the use of a needleless intravenous system and surgical assist device. One study evaluated a "no-touch" technique used by surgeons during wound closure and found a significant decrease in the number of glove perforations compared to the traditional "hand-in" method of closure.

CONCLUSIONS

Few randomized controlled trials have been employed to evaluate the effectiveness of interventions to reduce needlestick injuries in health care occupations. The majority of the studies evaluated interventions during surgical procedures, rather than during patient care on nursing units, probably because the latter is more difficult to observe.

[Headaches after spinal anesthesia: prospective multicenter study of a young adult population]

OBJECTIVE

We assessed the occurrence of post-dural puncture headache (PDPH) in a group of young adults following spinal anaesthesia using a 24-gauge Sprotte needle.

STUDY DESIGN

Prospective, multicentre, non-randomized study.

PATIENTS

This 9 month-long study, included 1,122 patients less than 50 years-old, consisting of 502 women and 620 men.

METHODS

Assessment of PDPH after 48 hours and 7 days.

RESULTS

PDPH occurred in 0.8 percent of patients. There was no statistically significant difference in terms of age group or gender between the patients. Incidence of PDPH did not depend on type of anaesthetic solution, puncture level or ease of puncture.

DISCUSSION

The use of 24-gauge Sprotte needles was associated with a low rate of puncture difficulties. Usual predisposing factors for PDPH, such as age below 50 years and female gender do no longer apply with this type of needle. The rate of puncture difficulties was low (6.7 percent), in contrast with ultra-fine 27 or 29 gauge needles, which sometimes result in puncture failure. Acceptance of the technique was excellent, as 99.38 percent of patients were satisfied.

CONCLUSION

The indications of spinal anaesthesia could be extended to young patients, whatever their gender, using a non-traumatic 24-gauge Sprotte needle.

Scaling of hemolysis in needles and catheters

Hemolysis in clinical blood samples leads to inaccurate assay results and often to the need for repeated blood draws. In vitro experiments were conducted to determine the influence on hemolysis in phlebotomy needles and catheters of pressure difference, cannula diameter, and cannula material. Fresh blood from five human volunteers was forced from a syringe inside a pressurized chamber through 14, 18, and 22 gauge 304 stainless steel needles and polyurethane and Teflon catheters, all 40 mm long. Hemolysis was measured in the samples by a spectrophotometer. It was found that hemolysis increased with increases in pressure difference and cannula diameter and no consistent trend could be identified with regard to cannula material. The pressure differences required for significant hemolysis were above those typical of clinical venipuncture blood draws. While there was substantial variability among individuals, the hemolysis values scaled with exponent S = (t/t0)[(tau/tau0)-1]2, where t is the characteristic duration of shear, t0 is a time constant, tau is the wall shear stress, and tau0 is the wall shear stress threshold below which no hemolysis occurs. A hemolysis threshold including both time and shear stress was also defined for S = constant. The threshold implies that a threshold shear stress exists below which erythrocytes are not damaged for any length of exposure time, but that red cells may be damaged by an arbitrarily short period of exposure to sufficiently large shear stress.

Comparing ease of intraosseous needle placement: Jamshidi versus cook

In a sample of 34 study subjects, Cook and Jamshidi intraosseous (IO) needles were compared for ease of insertion into turkey bones. The averaged lapsed time of insertion was significantly shorter using the Jamshidi needle (25.5 v 56.2 seconds, P < .0001). The mean difficulty of insertion score was lower using the Jamshidi needle (3.0 v 7.1 on a 10-cm visual analog scale, P < .0001). The less costly Jamshidi needle is easier to use in IO insertion in this turkey bone model.

Intravenous therapy needle choices in ambulatory cancer patients

The purpose of this research utilization project was to evaluate a set of research-based decision rules designed to guide needle choice for peripheral intravenous (i.v.) therapy in ambulatory cancer patients. A consecutive series of 100 patients receiving i.v. therapy for one day were assigned to receive either a plastic catheter or a steel needle using the decision rules based on age, weight, vein condition, solution to be administered, and infusion volume, and were evaluated for phlebitis, local or systemic infection, and extravasation. None of the patients experienced phlebitis or infection, and a 25% cost savings ($6,800 Canadian) was obtained. Two patients (5%) from the "steel needle group" experienced an extravasation of 5FU but neither required treatment nor experienced changes to subsequent peripheral i.v. therapy. Our nursing procedure for initiation of i.v. therapy has been changed to reflect the needle choice decision rules evaluated in this project.

Self-injection devices for intracavernosal pharmacotherapy: operational classification and safety considerations

Several self-injection devices have been recently proposed as an aid to home intracavernosal self-injection treatment for erectile dysfunction, with the purpose of allowing an easier drug administration, decreasing the artificiality of intracavernosal pharmacotheraphy, with the overall goal of increasing the acceptability of this treatment. We propose a classification of these devices according to the type of mechanical impact on the cavernosal tissue: self-injection pens, allowing for manual needle insertion and manual drug delivery; autoinsertors, with automatic needle insertion and manual drug delivery, and autoinjectors, that provide both automatic needle insertion and automatic drug delivery. The use of autoinjectors bears two theoretical risks: extra-corporal drug delivery in cases of wrong injection site, and trabecular damage due to high delivery pressure. In one device pressures 15 times higher the values reached by manual injection, and statistically higher than pressures obtained by maximal strength manual injection, were observed in an in-vitro investigation. Specific studies are needed to define a threshold pressure value for trabecular damage in the flaccid state; accordingly, information on autoinjector developed pressures should be provided by manufacturers. Clinical studies with adequate follow-up are needed as well, to verify the risk of autoinjector-induced extracorporal drug delivery, and the occurrence of intracavernosal nodules or penile curvature, compared to manual self-injection.

Enhancing needle durability by silicone coating of surgical needles

The purpose of this study was to assess the effect of coating surgical needles with silicone on their durability. Needle durability is a measure of needle sharpness after repeated passage through tissue. Needle sharpness was determined by quantitating the energy required to pass a designated needle repeatedly (20 times) through porcine skin, linea alba, colon, and aorta. The results demonstrate that the durability and sharpness of silicone-coated needles were significantly greater than those of comparable uncoated needles in linea alba, colon, and aorta, but not in skin.

Device-specific risk of needlestick injury in Italian health care workers

OBJECTIVES

To identify the types of medical devices causing needlestick injuries among Italian health care workers, to document the device-specific injury rates and time trends for different hollow-bore needles, and to compare injury rates from these devices with those reported in the United States.

DESIGN

Longitudinal survey.

SETTINGS

Twelve Italian acute care public hospitals.

METHODS

Data were obtained from a multihospital surveillance database on the number of total injuries reported in each device category. Hospitals provided the corresponding number of devices used annually for each needle type.

MAIN OUTCOME MEASURE

Number of needlestick injuries by type of hollow-bore needle per 100,000 devices used per year.

RESULTS

A total of 2524 injuries from hollow-bore needles were reported. Disposable syringes/hypodermic needles accounted for 59.3% of injuries, followed by winged steel needles (33.1%), intravenous catheter stylets (5.4%), and vacuum-tube phlebotomy needles (2.2%). Intravenous catheter stylets had the highest needlestick injury rate (15.7/100,000 devices used), and disposable syringes had the lowest needlestick injury rate (3.8/100,000). In contrast to the other devices, the injury rate from winged steel needles increased from 6.2 per 100,000 in 1990 to 13.9 per 100,000 in 1992.

CONCLUSIONS

The device-specific needlestick injury rates in Italy are similar to those reported in the United States, suggesting similar exposure experience in two countries. However, in contrast to the United States, needleless intravenous access is standard practice in Italy and thus eliminates one potential risk to Italian health workers. Implementation of safer equipment, such as shielded or retracting needles, and continuing training programs are needed to further reduce the hazards that health care workers face.

The role of transthoracic needle biopsy for the diagnosis and staging of lung cancer

Percutaneous transthoracic needle biopsy (TNB) is a simple and safe procedure with high diagnostic accuracy for the diagnosis and staging of cancer in the lung, hilum, and mediastinum. The complication rate is low and consists primarily of pneumothorax, with only a small percentage of these requiring chest tube reexpansion. Major complications are rare. Computed tomographically guided biopsy is a powerful adjunct to fluoroscopic biopsy and expands the application of TNB to include most thoracic lesions. TNB is the initial diagnostic procedure of choice in peripheral lung lesions, suspected focal metastases, and most hilar and mediastinal masses. Its proper role in the diagnosis and staging of lung cancer requires the close collaboration of the radiologist, cytopathologist, and the patient's primary physician.

[Diagnostic study of pulmonary mass under ultrasonography guided aspiration biopsy by four types of needle]

One hundred and thirty patients with pulmonary mass were studied under ultrasonography guided aspiration biopsy by four types of needle. The cytological positive cases were 57.1% in fine needle (22G), 79.6% in large needle (18G), 90.9% in canaliculated needle (18G) and 80.9% in cutting needle (14G), and the pathological positive cases were 0, 64.4%, 86.3% and 92.8% respectively. These data showed that the positive rate of fine needle puncture was the lowest one. Based on the pathological finding, canaliculated and cutting needle seem to be better than large one and it is the best choice to perform the pulmonary aspiration biopsy.

Cryosurgery of basal cell carcinoma

Cryosurgery is now a widely accepted modality for the treatment of basal cell carcinomas. This article presents a practical approach to using cryosurgery for this purpose in the dermatologist's office. Understanding the cryobiologic basis of cryosurgery is a prerequisite. Aspects of treatment covered include selection and use of appropriate equipment, indications and contraindications for specific tumors, preoperative preparation, various treatment technics with clinical and instrumental depth-dose monitoring, postoperative care, cure rate, and cosmetic and functional end results. The overall results obtained by cryosurgery compare favorably with those obtained by other modalities. Cryosurgery is the treatment of choice for some basal cell carcinomas and a satisfactory alternate treatment for others.

[Experience with percutaneous needle muscle biopsy in pediatrics: alternatives to open biopsy?]

Over 14 months the authors have performed 22 needle muscle biopsies using the Bergström needle. Sufficient material was obtained for histological, histochemical and electron microscopic examination. The biopsies can be done as an outpatient procedure under local anesthetic, and with sedation in infants and young children. The technique is safe, quick and well tolerated and leaves only a very small scar. It provides adequate information for almost all diagnostic purposes in neuromuscular disease. The few indications for open muscle biopsy are discussed.