Influenza Vaccines toward Universality through Nanoplatforms and Given by Microneedle Patches

Influenza is one of the top threats to public health. The best strategy to prevent influenza is vaccination. Because of the antigenic changes in the major surface antigens of influenza viruses, current seasonal influenza vaccines need to be updated every year to match the circulating strains and are suboptimal for protection. Furthermore, seasonal vaccines do not protect against potential influenza pandemics. A universal influenza vaccine will eliminate the threat of both influenza epidemics and pandemics. Due to the massive challenge in realizing influenza vaccine universality, a single vaccine strategy cannot meet the need. A comprehensive approach that integrates advances in immunogen designs, vaccine and adjuvant nanoplatforms, and vaccine delivery and controlled release has the potential to achieve an effective universal influenza vaccine. This review will summarize the advances in the research and development of an affordable universal influenza vaccine.

Gelatin Methacryloyl Microneedle Patches for Minimally Invasive Extraction of Skin Interstitial Fluid

The extraction of interstitial fluid (ISF) from skin using microneedles (MNs) has attracted growing interest in recent years due to its potential for minimally invasive diagnostics and biosensors. ISF collection by absorption into a hydrogel MN patch is a promising way that requires the materials to have outstanding swelling ability. Here, a gelatin methacryloyl (GelMA) patch is developed with an 11 × 11 array of MNs for minimally invasive sampling of ISF. The properties of the patch can be tuned by altering the concentration of the GelMA prepolymer and the crosslinking time; patches are created with swelling ratios between 293% and 423% and compressive moduli between 3.34 MPa and 7.23 MPa. The optimized GelMA MN patch demonstrates efficient extraction of ISF. Furthermore, it efficiently and quantitatively detects glucose and vancomycin in ISF in an in vivo study. This minimally invasive approach of extracting ISF with a GelMA MN patch has the potential to complement blood sampling for the monitoring of target molecules from patients.

Quantitative Evaluation of Bleeding during Blood Vessel Puncture Caused by Fine Needle in Lower Abdomen

Inserting a fine needle presents a trade-off problem between safety and accuracy. As one of the serious complications due to tissue damages during needle insertion, severe bleeding often occurs owing to blood vessel puncture. However, there are few researches to evaluate the safety quantitatively regarding bleeding during the fine needle insertion. Therefore, the purpose of this study was the quantitative evaluation of the amount of bleeding due the artery and vein puncture depending on the needle size. We developed a blood circulation system for measuring the amount of bleeding due to blood vessel puncture. Using the system, the amount of bleeding due to different needle sizes was evaluated. The results suggested that the amount of bleeding per unit time increased depending on the needle radius. According to ordinal safety standards, the 22-gauge needle is appropriate for insertion into the lower abdomen.

Medical Devices; General and Plastic Surgery Devices; Classification of the Microneedling Device for Aesthetic Use. Final order

The Food and Drug Administration (FDA or we) is classifying the microneedling device for aesthetic use into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the microneedling device for aesthetic use’s classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients’ access to beneficial innovative devices, in part by reducing regulatory burdens.

Comparison of 22-gauge standard fine needle versus core biopsy needle for endoscopic ultrasound-guided sampling of suspected pancreatic cancer: a randomized crossover trial

BACKGROUND

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is effective for tissue diagnosis of pancreatic mass. To improve diagnostic yield and drawbacks, 22-gauge (G) core biopsy (FNB) needle has been developed. This study aims to compare 22G FNA and FNB needles for EUS-guided sampling of suspected pancreatic cancer.

METHODS

This is a randomized controlled crossover trial. A total of 60 patients with suspected unresectable pancreatic cancer referred for EUS-guided sampling were randomly assigned to two groups. Both groups had 22G FNA and FNB needles performed in a randomized order. The primary endpoint was the cytological, histological and overall diagnostic accuracy of pancreatic cancer.

RESULTS

FNA and FNB needles reported similar level of diagnostic accuracy (FNA needle 95% vs. FNB needle 93.3%; p = .564), and it was not statistically different. However, cytological cellularity was significantly higher in the FNB needles compared to FNA needles (odds ratio 2.75, 95% confidence interval (CI)). There were no procedure-related complications in both needles.

CONCLUSIONS

The diagnostic accuracy of EUS-guided sampling for pancreatic cancer using 22G FNA is comparable to FNB needles. The cytological quality of specimen is better in the FNB needle.

[Effects of different techniques on removal of vapor lock in the apical region of curved canals: a cone-beam computed tomography study]

OBJECTIVE

To compare the effect of four different techniques on removal of vapor lock in the apical region of curved root canals.

METHODS

Forty simulated resin root canals with 45° curvature were prepared using WaveOne Primary, then the apical foramen were sealed with soft wax. The teeth were divided randomly into 4 groups thereafter (n=10). Contract solution was injected into the canals using a 30 G side-vented needle and scanned with cone-beam CT (CBCT) to identify the volume of the vapor lock. Four different techniques including photon-induced photoacoustic streaming (PIPS) laser-activated irrigation, gutta-percha cone technique, ultrasonic irrigation, and sonic irrigation were used to remove the vapor locks in the root canals. The residual volume of the vapor lock was identified again using CBCT scanning data. Accordingly, the reduction rates of the vapor lock were calculated. Furthermore, the initial and residual vapor lock length was calculated. The data were analyzed by using the One-way ANOVA analysis and Kruskal-Wallis H test at a significance level of P<0.05.

RESULTS

There was no significant difference in the initial vapor lock volume (P>0.05). Residual volume of the vapor lock for PIPS laser-activated irrigation was 0 mm(3), and that for gutta-percha cone technique was (0.02±0.07) mm3, significantly lower than those of ultrasonic and sonic irrigation, the values being (0.20±0.09) mm(3) and (0.23±0.06) mm(3) (P<0.001), respectively. The reduction rates of the vapor lock of PIPS laser-activated irrigation and gutta-percha cone technique were 100.00% (100.00%, 100.00%) and 100.00% (77.66%, 100.00%), respectively, significantly higher than those of ultrasonic irrigation [70.37% (56.41%, 91.43%)] and sonic irrigation [63.54% (51.47%, 74.00%), P<0.001]. The length of the residual vapor lock for PIPS laser-activated irrigation was 0 mm, and that for gutta-percha cone technique was (0.15±0.47) mm, significantly lower than those of ultrasonic and sonic irrigation, values being (2.21±0.09) mm and (2.34±0.08) mm (P<0.001), respectively. The length of the residual vapor locks in the ultrasonic and sonic group remained approximately the same as the distance between the working tip and the apical foramen.

CONCLUSION

PIPS laser activated irrigation and gutta-percha cone technique could remove the vapor lock from the apical region of curved canals effectively.

Impact of needle gauge on characterization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) histology samples

BACKGROUND AND OBJECTIVE

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive mediastinal node sampling technique used for lung cancer staging and diagnosis of mediastinal lesions. The four published studies assessing sampling with 21-G or 22-G needles conflict. The study objective is to evaluate the diagnostic utility of 21-G versus 22-G EBUS-TBNA needles, and the ability to subcharacterize both benign and malignant lesions using histopathological assessment only.

METHODS

A retrospective analysis was performed from 303 patients referred for EBUS-TBNA between January 2011 and July 2013. Sampling needle gauge was selected at the discretion of the operator. Samples were assessed by histopathologists blinded to the needle gauge without rapid on-site evaluation for cytology. Contingency table analysis was performed to compare diagnostic utility and ability to subcharacterize malignant and benign lesions.

RESULTS

No difference in diagnostic ability was seen for malignancy (96.6% vs. 95.3% accuracy, 21-G vs. 22-G). Subgroup analysis of benign 21-G tissue samples revealed superior characterization compared with 22-G samples (63/76, 83%, vs. 31/52, 60%, P < 0.01). Characterization of non-small cell lung cancer (NSCLC) was also significantly better with samples obtained with 21-G needles versus 22-G needles (57/65, 88% vs. 34/52, 65%, P < 0.01).

CONCLUSIONS

This large UK single-centre study suggests 21-G EBUS-TBNA needles are superior to 22-G in characterizing benign lesions (especially sarcoidosis) and NSCLC when using histopathological assessment. Making a positive benign diagnosis may avoid the need to perform mediastinoscopy. Obtaining sufficient histological material to subcharacterize NSCLC and particularly lung adenocarcinoma allows appropriate testing for genetic mutations facilitating targeted oncological therapy.

Popularity of suture materials among residents and faculty members of a postdoctoral periodontology program

AIM

The aim of the present study was to determine the favoritism of suture materials among a group of clinicians at a teaching institution.

METHODS

The surveys included 11 absorbable and nine non-absorbable sutures. The surveyor was asked to select his or her suture preferences when it comes to using it in 13 different, commonly-performed surgical procedures.

RESULTS

The surveys showed overall preferences for non-absorbable versus absorbable sutures. Chromic Gut with a 4-0 diameter thread reverse cutting FS2 needle was the most favored suture. For periodontal bone grafts and hard tissue ridge augmentation, polytetrafluoroethylene with a 4-0 thread and FS2 needle was preferred. For autogenous gingival grafts, gingival allografts, connective tissue grafts, frenectomy and frenoplasty, Chromic Gut with 5-0 diameter thread reverse cutting P3 needle was favored. For extraction socket preservation, soft tissue canine exposure, ridge augmentation, and dental implants, Chromic Gut with 4-0 diameter thread reverse cutting FS2 needle was preferred, and for sinus augmentation, Vicryl with a 4-0 diameter thread reverse cutting FS2 needle was favored.

CONCLUSION

Absorbable sutures were preferred in the majority of periodontal procedures; however, non-absorbable sutures were favored in procedures that required longer healing or better stability of the flap edges in cases of periodontal and ridge augmentation.

Comparison between the classical and a modified trans-septal technique of alar cinching for Le Fort I osteotomies: a prospective randomized controlled trial

The aim of this prospective randomized control trial was to analyse the efficacy of a new trans-septal alar base cinch suture in controlling alar width in patients undergoing maxillary intrusion and setback by comparing it with the traditional cinch suture. Statistical evaluation was carried out in 62 of 76 patients. Group I (31 patients) received the traditional alar base cinch suture, and group II (31 patients) received the alar base cinch suture with an anchoring bite taken through the nasal septum 10mm behind its anterior edge. In both groups the accurate identification of alar fibroareolar tissue was facilitated by an 18 gauge green needle passed extra orally. Alar base width was measured before and 6 months after surgery using Vernier callipers. Preoperative alar base width for group I was 29.76 mm (1.901SD) and for group II 29.79 mm (3.141SD); the postoperative values were 32.42 mm (1.858SD) and 29.94 mm (2.568SD), respectively. Mean alar base widening was 2.661 mm (0.800SD) in group I and 0.145 mm (2.050) in group II. The difference in alar widening was statistically significant (p<0.001). In conclusion, the trans-septal modified alar cinch suture offers better control of alar base architecture in maxillary intrusion and setback.

Device-specific rates of needlestick injury at a large military teaching hospital

The device-specific needlestick injury (NSI) rate provides a means of comparing rates of injury between work sites and institutions over time. We performed a retrospective study of intravenous and percutaneous injection NSI at a large military teaching hospital using electronic purchase records and occupational NSI exposure forms to define action levels for process improvements. A rate of 2.25 NSI per 100,000 intravenous needles and 2.21 NSI per 100,000 percutaneous needles was found.

Occupational blood and body fluid exposure of university health care workers

BACKGROUND

Occupational exposure to bloodborne pathogens caused by percutaneous injuries or mucosal contamination is common in hospital settings.

METHODS

Reports of exposures to human blood and body fluids from Padua university health care workers since 2004 to 2006 and compliance with follow-up after injury according to the patients' source were analyzed.

RESULTS

The injury reports were 497. The residents in surgery and anesthesiology were significantly more injured than others, and the compliance with follow-up was low: from 26.3% (hepatitis B virus) to 40% (hepatitis C virus) with a positive source, less than 30% with a negative source, as far as 40% with an unknown source. No seroconversion was observed in subjects completing the follow-up.

CONCLUSION

We suspect underestimation of injury reports and low compliance with the follow-up requests that health care workers adhere to the protocols and follow the standard procedures to prevent exposures to bloodborne pathogens.

[The comparison of reactions in skin prick test performed with the standardized lancet and the injection needle]

Achieving reproducible results with the skin prick test method depends on a certain amount of experience, the depth of skin penetration by the device which is used and reducing the number of false positive reactions caused by contamination of the device by allergen extract previously pricked. The aim of the study was to compare the results of SPT performed with "single puncture device" using lancet or injection needle with "multiple puncture device" using the same needle wiped in alcohol between pricks.

MATERIAL AND METHODS

Twenty adult patients with seasonal allergic rhinitis with known sensitivity to grass pollen allergen and ten control subjects entered the study. SPT were applied to the volar surface of both forearms on two separate visits during which fixed sequence of pricking histamine, allergen and saline solutions (Allergopharma, Reinbeck, Germany) was maintained. On the first visit new device was used for each prick: injection needles on one forearm and lancets on the other. On a second visit (after a wash-out period of 4 weeks) injection needle changed between each prick on one forearm was compared with using the same needle wiped in alcohol between pricks on the other forearm.

RESULTS

There was no statistical difference between the three tested methods for the size of wheel to histamine (p = 0.5), saline (p = 1) and allergen (p = 0.54) in group of SAR patients as well as for the size of wheel to histamine (p = 0.41) and saline (p = 1) in control subjects. Analysis of wheel diameters for histamine and allergen in group of SAR patients demonstrated comparable degrees of precision for all tested methods (CV%): there was no statistical difference between CV% achieved for the size of histamine (p = 0.73); as well as for allergen wheal (p = 0.32).

CONCLUSIONS

The results of SPT achieved by using only one injection needle rinsed in alcohol for multiple pricks seem to have similar quality, being more economical than standard techniques in which puncture device is changed between each test.

Retractable-needle catheters: an update on local drug delivery in coronary interventions

In the treatment of coronary artery disease, local delivery of pharmaceutical substances has long been a goal, yet the technology is still evolving. Coronary stents have become the predominant means of treating obstructive lesions, and the need for additional pharmacologic treatment is evidenced by the popularity of drug-eluting stents. Moreover, stents have residual limitations, in particular in-stent thrombosis and late restenosis. Investigators have recently proposed delivering coronary drugs by means of local injection devices. These innovative devices, which incorporate retractable needles at the tip of a catheter, appear to be ready for clinical testing. In addition to solving many of the limitations of drug-eluting stents, local injection devices may eventually enable interventional cardiologists to treat vulnerable plaques. Herein, we review the evolution and current status of local drug delivery in the coronary arteries, with an emphasis on novel catheters that have retractable needles.

Optimizing Renal Cortical Neoplasm Tissue Sampling Through a Modified Biopsy Technique: Laboratory Experience and Initial Clinical Experience

OBJECTIVES

We evaluated 11 currently available biopsy devices using a standard and a novel renal biopsy technique in a porcine model. We then applied our laboratory findings to clinical practice to improve our biopsy results during laparoscopic renal cryoablation procedures.

METHODS

A total of 11 biopsy devices were applied to live porcine renal tissue using two different techniques. In groups 1 and 2, the biopsy devices were deployed external to the renal tissue and in a standard manner after insertion into the renal tissue, respectively. Ten biopsies were performed for each condition and with each device. The biopsy quality metrics included sample core length and width and number of glomeruli and vessels in each sample. Subsequently, we confirmed our laboratory finding regarding the optimal biopsy technique during 10 sequential laparoscopic renal cryoablation procedures. During these procedures, each renal mass underwent the standard and modified biopsy techniques.

RESULTS

In the animal investigation, a total of 220 biopsies were performed. Regarding the biopsy technique, the mean core length for groups 1 and 2 was 7.32 and 4.91 mm (P <0.01) and the mean number of glomeruli was 7.6 and 4.2 (P <0.01), respectively. Clinically, 10 patients successfully underwent renal cryoablation in conjunction with the two renal biopsy groups. In all 10 cases, between the two biopsies, a histopathologic diagnosis was successfully obtained. The preablation standard and preablation modified biopsy technique established a diagnosis 7 of 10 and 9 of 10 times, respectively.

CONCLUSIONS

Our preliminary laboratory and clinical data have demonstrated the effectiveness and safety of the modified biopsy technique.

Preliminary Results of a New Temporary Vocal Fold Injection Material

Temporary vocal fold injection is a valuable procedure for vocal fold paralysis or paresis of uncertain permanency and as a trial augmentation to decide the value of vocal fold augmentation. A new material made from glycerin, carboxymethylcellulose, and water has recently been developed for temporary vocal fold augmentation. Eleven patients underwent vocal fold injection for the treatment of glottal incompetence with this material. The duration of effectiveness of this injection material was 2 to 3 months depending on the injection amount. This new material satisfies several requirements for an ideal temporary vocal fold injection material in terms of injectability, convenience, duration of effectiveness, and safety. The authors conclude that this new material is a good option for temporary vocal fold augmentation.

Ultrasonography-guided core-needle biopsy of parotid gland masses

BACKGROUND AND PURPOSE

An accurate diagnosis of a parotid gland mass is essential for adequate management. We determined the clinical efficacy of USCNB in diagnosing parotid gland masses by using cutting needles of different bores.

METHODS

We reviewed records for 40 benign and 13 malignant parotid lesions. USCNB was performed by using 14-20-gauge needles (mean, 16.6 gauge) with one to five (mean, 2.43) passes and a 15-mm throw or specimen notch. Final diagnoses were established on the basis of surgicopathologic results in 31 cases, and on the basis of histopathologic analysis of biopsy specimens, clinical data, and/or imaging studies in 22, with a follow-up of 12.2-77.5 months (mean, 33.6 months).

RESULTS

Compared with surgicopathology, USCNB had a sensitivity of 83%, a specificity of 100%, and an accuracy of 97% in providing specific tissue diagnoses and in differentiating malignant from benign masses. Its positive and negative predictive values were 100% and 96%, respectively, in diagnosing malignancy. One patient (2%) had a local hematoma without sequela after surgical removal of a Warthin tumor. Core biopsy results were completely concordant with surgical findings in 30 (97%) of 31 cases.

CONCLUSION

USCNB is a safe and efficient diagnostic procedure with an accuracy of 97% in the pathologic diagnosis of parotid masses. It can be performed in an outpatient clinic and enables specific tissue diagnosis to obviate intraoperative frozen biopsy and unnecessary surgery. An 18-gauge needle is sufficient for accurate and specific tissue diagnosis of parotid masses.

Dura-arachnoid lesions produced by 22 gauge Quincke spinal needles during a lumbar puncture

AIMS

The dural and arachnoid hole caused by lumbar puncture needles is a determining factor in triggering headaches. The aim of this study is to assess the dimensions and morphological features of the dura mater and arachnoids when they are punctured by a 22 gauge Quincke needle having its bevel either in the parallel or in the transverse position.

METHODS

Fifty punctures were made with 22 gauge Quincke needles in the dural sac of four fresh cadavers using an "in vitro" model especially designed for this purpose. The punctures were performed by needles with bevels parallel or perpendicular to the spinal axis and studied under scanning electron microscopy.

RESULTS

Thirty five of the 50 punctures done by Quincke needles (19 in the external surface and 16 in the internal) were used for evaluation. When the needle was inserted with its bevel parallel to the axis of the dural sac (17 of 35), the size of the dura-arachnoid lesion was 0.032 mm(2) in the epidural surface and 0.037 mm(2) in the subarachnoid surface of the dural sac. When the needle's bevel was perpendicular to the axis (18 of 35) the measurement of the lesion size was 0.042 mm(2) for the external surface and 0.033 mm(2) for the internal. There were no statistical significant differences between these results.

CONCLUSIONS

It is believed that the reported lower frequency of postdural puncture headache when the needle is inserted parallel to the cord axis should be explained by some other factors besides the size of the dura-arachnoid injury.

Resource guide 2004. Insulin delivery

Syringes...pumps...jet infectors...pens...infusers...they all do the same basic thing--deliver insulin. These items carry insulin through the outermost layer of skin and into fatty tissue so it can be used by the body. This section will also cover injection aids, products designed to make infecting easier.

Irreversible damage to the spinal cord following spinal anesthesia

The authors report five patients with damage to the distal spinal cord following spinal anesthesia. The patients developed leg weakness and sensory disturbance. MRI of the lumbosacral spine showed an abnormal area of high signal within the conus medullaris in all patients. Symptoms and signs persisted at 1- to 2.5-year follow-ups. Incorrect needle placement and type of needle used are possible factors leading to spinal cord injury.

Preoperative histologic assessment of head and neck lesions using cutting needle biopsy

OBJECTIVE

This study assessed the clinical utility of cutting needle biopsy in which a newly developed Monopty biopsy instrument (MBI) (Monopty, Bard Urologic Division; Covington, Ga) was used in the preoperative assessment of head and neck lesions.

STUDY DESIGN

Needle biopsies were performed with the MBI in 16 cases of head and neck lesions that included lesions in lymph nodes, salivary glands, palate, and soft tissue.

RESULTS

High-quality histopathologic specimens were obtained without complications in all biopsies performed, and the diagnostic target tissue was obtained in 15 of 16 cases. Diagnoses made from MBI needle biopsy specimens were consistent with the final diagnoses made from subsequent surgical materials in 14 cases, and the accuracy rate was 88%. None of the samples demonstrated significant rush artifacts or obscuring blood, both of which are problems commonly associated with manual biopsy techniques.

CONCLUSIONS

This technique offers a safe and effective means of obtaining adequate tissue for the histological assessment of head and neck lesions.

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.