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Inhibition of moisture penetration to the skin by a novel incontinence barrier product.

OBJECTIVE: To measure the ability of a multiple-barrier product to inhibit the passage of a highly water-soluble tracer into the skin when compared with products currently available on the market (Peri-Care; Sween Corp., and Double-Guard; C. R. Bard, Inc.) DESIGN: Dye extraction from the skin was measured at specified intervals and a spectrophotometric measurement of the amount of dye was obtained. SETTING AND SUBJECTS: Two groups of light-skinned volunteers, 6 young adults subjects, aged 22 to 31 years, and 6 older subjects, aged 61 to 73 years, were studied in a controlled laboratory setting. INSTRUMENTS: Spectronic 601 spectrophotometer. METHODS: Rectangles (1 inch x 4 inch), inscribed on the ventral forearm skin, were divided into 4 1 inch x 1-inch squares, onto which 50 microL of different barrier products were spread. Band-Aids (Johnson & Johnson), saturated with 70 microL of an FD&C red dye No. 40 solution, were placed over the treated squares and left in place for specified intervals up to 8 hours. Similarly treated Band-Aids placed onto untreated skin comprised the controls. MAIN OUTCOME MEASURE: Amount of dye extracted from the skin as reflected by absorbance spectrophotometry. RESULTS: This multiple-barrier product inhibited the passage of the tracer into the skin significantly better than the other 2 products at all time points, except for 1 point in the elderly group. CONCLUSION: Noninvasive preclinical methods show that this prototype barrier cream inhibits the absorption onto the skin of a solution simulating the density and ionic strength of urine. The advantages and limitations of the methods are clarified and directions for clinical research are suggested.

Adult↗

Management of hyperkeratotic lesions in the elderly patient.

Many factors contribute in the development of hyperkeratotic lesions in the elderly patient. The internal and external causes render the elderly foot more susceptible to limited ambulation, increased incidence of infection, ulceration, and eventual loss of the limb. Once the lesion is classified and the causes identified, a beneficial treatment plan can evolve. Reduction of the lesion(s), appropriate padding, shielding, splinting, accommodative orthoses, insoles, emollients, and mild keratolytics on regular treatment intervals are helpful in maintaining comfort and allowing function of the elderly foot. If the bony abnormalities or abnormal position of the foot do not respond to conservative measures, then surgical intervention should be considered based on the medical and vascular status of the patient. The evaluation of the elderly patient's presenting footwear, and patient education on the need for proper shoe gear size, shape, and materials cannot be overemphasized. Proper footwear and fitting is essential for the elderly in managing hyperkeratotic lesions. When regular footwear is not beneficial special shoes should be considered to accommodate the foot and treatment plan (e.g., accommodative orthoses, and so forth). The Extra Depth Inlay Thermold, Ambulator, Bunion last and Keystone last are options. If special shoes are too heavy for the elderly patient, there is a wide variety of athletic shoes that are shock absorbent and lightweight. Success in management includes a proper identification of the problem, relief of the symptoms, regular follow-up care, and periodic review of footwear to ascertain the need for repair or modification.

Aged↗

Engineered structures for use in disposable incontinence products.

The background and evolution of absorbent disposable hygiene products is discussed. The current technology used to produce disposable hygiene products such as baby diapers, feminine hygiene products and adult incontinence management products is shown to have a number of manufacturing and in-use problems. Alternative technologies, such as multilayer composite webs offer the opportunity to achieve better product weight control, and therefore better control over the other related properties, reduced raw material waste and improved functional characteristics. There are still problems to be resolved when using such composite materials, but the potential of these new technologies has now been established.

Disposable Equipment↗

[Incontinence aids].

Incontinence aids are mechanical devices that help reduce, capture, absorb or channel urinary and stool loss. They can exert a significant positive impact on the quality of life and the social integration of those affected, as well as provide relief to their care-givers. Incontinence aids are used as a bridge until conservative and operative treatments bring continence, as a complement to other therapies or as a long-term course of treatment. The selection of appropriate incontinence aids, such as vaginal pessaries, penis clamps, and tampons, urinals, urine and faecal collectors, absorbing aids, urethral and suprapubic catheter channelling systems--requires a great deal of experience and an extensive assortment of various products in different sizes. In order to provide the patient with optimal treatment and advice where not only the products available are changing rapidly, but the conditions and environment as well (e.g., insurance reimbursement), close-knit teamwork is required among the physician, incontinence nurse, and the care-providers. Likewise to be considered is the fact that incontinence aids and care requirements vary significantly among the specialties of urogynaecology, urology, paraplegic centres, paediatrics and nursing homes; specific competence centres are therefore required for these areas.

Fecal Incontinence↗

Effects of two kinds of underwear on metabolic heat production during 60 min recovery after 30 min severe exercise in the cold.

The purpose of this study is to investigate the thermophysiological significance of hydrophilic and hydrophobic properties of underwear materials under the influences of profuse sweating produced during severe exercise in the cold. Two kinds of underwear were used: two layers of cotton underwear with two-piece long-sleeved shirt and full-trousers (C), and two layers of polypropylene underwear with two-piece long-sleeved shirt and full-trousers (P). In addition, the subject put on a two-piece ski suit of 100% polyester including 100% polyester padding. Eight adult females volunteered as subjects in this study. The test was performed in a climatic chamber at an ambient air temperature of 2 degrees C and an air velocity of 0.26 m.s-1. The subject exercised on a cycle ergometer at an intensity of 65% maximal oxygen uptake for 30 min and followed by 60 min recovery. The major findings are summarized as follows: 1) The fall of rectal temperature tended to be greater in P during the recovery. 2) The absolute humidity of innermost layer and middle layer was significantly higher in C than in P during the recovery, but the absolute humidity of middle layer and outermost layer was significantly higher in P than in C during the exercise. 3) Clothing microclimate temperature of innermost at back was significantly higher in C during the exercise and recovery. 4) Metabolic heat production for last 30 min during recovery was significantly higher in P. 5) The degree of skin wettedness sensation and sweating sensation for whole body was significantly higher in P during the exercise. It was concluded that the slower evaporation behavior by absorbing of underwear material in the clothing system has a beneficial influence on thermophysiological responses during severe exercise and its recovery in the cold, although the differences were very small.

Adult↗

[Inhibitory effects of Siamese Tinospora crispa extracts on the carrageenin-induced foot pad edema in rats (the 1st report)].

The naturally occurring Tinospora crispa (T.c.) at Chiang Mai in Thailand has been found to inhibit carrageenin-induced foot pad edema. Compared with the control group, oral administration of the 50% methanol extract (10 mg/kg) from its stems inhibited the edema by 38% in volume, which was induced 4 hr after stimulation by carrageenin in rats. This inhibitory effect on edema formation has been most significant in the n-butanol soluble fraction compared with the ethyl ether- or water-soluble ones, and the action of the n-butanol fraction has been observed in a dose-dependent manner in the range of 1 to 30 mg/kg, p.o. Administration of this fraction by the s.c., or i.p. route also inhibited the carrageenin-induced edema formation to the same degree as that by the oral route. The 3 mg/kg, s.c. dosage of the fraction corresponds roughly to 250 mg/kg sulpyrine and 10 mg/kg diphenhydramine, s.c. Moreover, the fraction administered i.v. also reduced LPS-induced fever in rabbits, and had an antagonistic effect equivalent to 100 mg/kg sulpyrine and 1 mg/kg morphine hydrochloride (in i.p.-administration). The comprehensive anti-inflammatory substance(s) contained in T.c. stems are moderately non-polar compounds soluble in n-butanol and absorbable from both walls of the gut and vessels. The usefulness of a modified dosage of this plant extract for clinical treatment of various types of inflammation is highly suggested.

Analgesics↗

Stapedectomy: gelfoam compared with tissue grafts.

The commonest causes of failure with the prefabricated wire loop-gel foam pad technique are inferior displacement of the loop in the window, high membrane formation and window fibrosis. As a result of these problems some members of the Otologic Medical Group have abandoned the use of gelfoam in favor of tissue grafts. A comparison of the results with gelfoam, fat grafts, and fascia grafts in 573 primary cases is made. Tissue grafts yielded a lower incidence of postoperative vertigo, of temporary and permanent sensori-neural hearing impairment, of fistulas and of long-term hearing regression. The conclusion is that a tissue graft is preferable to gelfoam as an oval window covering in stapedectomy.

Adipose Tissue↗

Systematic review of the effectiveness of urinary continence products.

Urinary incontinence is common, and considerable advances have been made in treatments and therapies for this distressing and socially unacceptable condition. Most people with incontinence use continence products to conceal their loss in the short term or long term. A huge range of products is available, including absorbent products, collection devices, catheters, and accessories. However, little guidance is available to aid consumers and health professionals in product selection. Therefore, a systematic review of research literature from 1982 to 2000 concerning the effectiveness of continence products was conducted. More than 350 articles were retrieved, of which 75 met the selection criteria for this review. It is apparent that there is a lack of high-quality research into the effectiveness of continence products. A recurrent theme in the literature is the importance of individual assessment to find products to suit the particular needs of each consumer. This review indicates that the absence of research information about the effectiveness of continence aids and appliances makes selection difficult.

Equipment Design↗

The structure of the cushions in the feet of African elephants (Loxodonta africana).

The uniquely designed limbs of the African elephant, Loxodonta africana, support the weight of the largest terrestrial animal. Besides other morphological peculiarities, the feet are equipped with large subcutaneous cushions which play an important role in distributing forces during weight bearing and in storing or absorbing mechanical forces. Although the cushions have been discussed in the literature and captive elephants, in particular, are frequently affected by foot disorders, precise morphological data are sparse. The cushions in the feet of African elephants were examined by means of standard anatomical and histological techniques, computed tomography (CT) and magnetic resonance imaging (MRI). In both the forelimb and the hindlimb a 6th ray, the prepollex or prehallux, is present. These cartilaginous rods support the metacarpal or metatarsal compartment of the cushions. None of the rays touches the ground directly. The cushions consist of sheets or strands of fibrous connective tissue forming larger metacarpal/metatarsal and digital compartments and smaller chambers which were filled with adipose tissue. The compartments are situated between tarsal, metatarsal, metacarpal bones, proximal phalanges or other structures of the locomotor apparatus covering the bones palmarly/plantarly and the thick sole skin. Within the cushions, collagen, reticulin and elastic fibres are found. In the main parts, vascular supply is good and numerous nerves course within the entire cushion. Vater-Pacinian corpuscles are embedded within the collagenous tissue of the cushions and within the dermis. Meissner corpuscles are found in the dermal papillae of the foot skin. The micromorphology of elephant feet cushions resembles that of digital cushions in cattle or of the foot pads in humans but not that of digital cushions in horses. Besides their important mechanical properties, foot cushions in elephants seem to be very sensitive structures.

Adipose Tissue↗

Quantitative estimates of uptake and internal cycling of (14)N-labeled fertilizer in mature walnut trees.

Uptake and internal cycling of nitrogen (N) in mature walnut trees was studied over a period of 6 years using (15)N-depleted fertilizer and full-canopied walnut (Juglans regia L. cv Hartley) trees. The magnitude of internal N cycling, i.e., the availability of N for new growth from internal N pools, was quantified using both the percent annual depletion (PAD) and the N balance budget approaches. There was good agreement between the two measures, and about 60% of annual N demand was derived from N redistribution from internal pools. The remaining 40% of annual tree N demand was met by an influx of N from the soil/fertilizer pool. Trees were excavated, processed and analyzed after 6 years to determine total tree N content and labeled N recovery. Trees recovered 29.4% of the labeled N applied and, based on previous evidence, we assumed that tree accumulation of labeled N occurred entirely in the first year. Labeled N in the fruits and leaves harvested in the first year represented 26% of the total labeled N accumulated, and the remaining 74% of the labeled N accumulated that year was stored and used to support development of annual organs in subsequent years. In the first year, the early maturing catkins did not accumulate labeled N, indicating their exclusive reliance on internal N. Using the atom% (14)N excess values of catkins and an exponential decline equation to determine turnover rate, the Mean Residence Time (MRT) of storage N in the tree was estimated to be 2.0 years. The size of the cycling pool of storage N in the tree was estimated to be about 50% of the total N content of perennial tree parts. Our data support the hypotheses that: (1) in any given year, mature walnut trees store the majority of soil and fertilizer N absorbed and within 2 years following uptake the N is remobilized and used for new growth, and (2) about half of the total N content of the perennial parts of mature walnut trees is present as nonstructural N and is available for recycling.

Journal Article↗

Prevention of postsurgery-induced abdominal adhesions by electrospun bioabsorbable nanofibrous poly(lactide-co-glycolide)-based membranes.

OBJECTIVES: The objective of this study was to evaluate the efficacy of nonwoven bioabsorbable nanofibrous membranes of poly(lactideco-glycolide) for prevention of postsurgery-induced abdominal adhesions. SUMMARY BACKGROUND DATA: Recent reports indicated that current materials used for adhesion prevention have only limited success. Studies on other bioabsorbable materials using a new fabrication technique demonstrated the promising potential of generating an improved and inexpensive product that is suitable for a variety of surgical applications. METHODS: All rats underwent a midline celiotomy. The cecum was identified and scored using an abrasive pad until serosal bleeding was noted on the anterior surface. A 1 x 1 cm of abdominal wall muscle was excised directly over the cecal wound. The celiotomy was then closed in 2 layers immediately (control) after a barrier was laid in between the cecum and the abdominal wall. All rats underwent a second celiotomy after 28 days to evaluate the extent of abdominal adhesions qualitatively and quantitatively. RESULTS: Cecal adhesions were reduced from 78% in the control group to 50% in the group using biodegradable poly(lactide-co-glycolide) (PLGA) nonwoven nanofibrous membranes (n = 10, P = 0.2) and to 22% in the group using membranes containing PLGA and poly(ethylene glycol)/poly(D,L-lactide) (PEG-PLA) blends (n = 9, P = 0.03). Electrospinning method also enabled us to load an antibiotic drug Cefoxitin sodium (Mefoxin; Merck Inc., West Point, PA) with high efficacy. The electrospun PLGA/PEG-PLA membranes impregnated with 5 wt% cefoxitin sodium, which amounts to approximately 10% of the systemic daily dose typically taken after surgery in humans, completely prevented cecal adhesions (0%) in rats. CONCLUSIONS: Electrospun nonwoven bioabsorbable nanofibrous membranes of poly(lactide-co-glycolide) were effective to reduce adhesions at the site of injury using an objective rat model. The membrane acted as a physical barrier but with drug-delivery capability. The combined advantages of composition adjustment, drug-loading capability, and easy placement handling (relatively hydrophobic) make these membranes potentially successful candidates for further clinical evaluations.

Abdomen↗