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Subgingival access and artificial plaque removal by a sonic cleaning device.

A sonic subgingival cleaning device (soniPick Sonic Interdental Plaque Remover) has recently been marketed with three bristle tips varying in size lengths and bundle diameters. The purpose of this study was to evaluate the ability of these bristle tips to remove subgingival artificial plaque deposits in a laboratory method used for toothbrushes. The laboratory method has been modified for testing the sonic device, to simulate the directions for using the product at home. The dimensions (length x bundle width) of three tips tested were: 0.007" x 0.040"; 0.007" x 0.062"; and 0.009" x 0.062". The tips used with the sonic device were placed on the tooth surface at a 20 degrees angle according to directions, and inserted 3 mm under simulated gingivae. The device was turned on and the tip was moved in a maximum 10 mm stroke for 15 seconds with the brushing machine. For control purposes, a flat, multi-tufted, ADA-accepted manual toothbrush (Oral-B P35) was also tested. The manual toothbrush was tested using the standard methods for evaluating toothbrushes, i.e., with the bristle tips placed at the gingival margin, then brushed at a 45 degrees angle at 250 g weight, using 15 mm strokes for 60 seconds. The depth of subgingival deposit removal was recorded as the maximum depth of the artificial plaque deposit removed from the pressure-sensitive paper under the simulated gingivae over anterior- or posterior-shaped teeth. In the assays conducted, the three bristle tips on the sonic device removed artificial plaque deposits under the simulated gingival at depths of 1.9-2.7 mm. The manual toothbrush had a mean subgingival cleaning depth of 0.6 mm. Differences between the three bristle tips used with the sonic device and the manual toothbrush were significant (p < 0.001 ANOVA). In this laboratory assay, all 3 bristle tips provided with the sonic cleaning device maintained access into and subsequent removal of artificial plaque from the subgingival space.

Analysis of Variance↗

Detecting bacterial colonization of implanted orthopaedic devices by ultrasonication.

Glycocalyx-producing bacteria have been observed on orthopaedic devices that were removed for reasons other than infection. It has been suggested that the bacteria adhere to foreign surfaces within a biofilm and elude standard culture techniques. The authors adapted previously used ultrasonication protocols that disrupt the surface biofilm before culturing removed orthopaedic devices from patients without clinical evidence of infection. Patients having revision total joint arthroplasty of the hip or knee who lacked current or prior clinical evidence of infection were studied prospectively. During surgery, the femoral component and a corresponding control femoral implant were placed in separate sterile bags of saline. The implant and saline combination was placed in an ultrasonication bath for 30 minutes at 60 Hz. The saline solution was passed through a 0.45-microm pore filter, and the filter residue was cultured on sheep blood agar. None of the 21 implants yielded positive culture on routine microbiologic testing. However, using the ultrasonication protocol, a coagulase-negative Staphylococcus grew from one of the removed implants. Numerous total joint implant failures that are attributed to aseptic loosening may be a result of subclinical infection from bacteria within a biofilm. The current study supports the concept that biofilm-protected bacterial colonization of implants may occur without overt signs of infection and ultrasonication can be used to enhance identification of these bacteria.

Adult↗

Use of the U-clip for microvascular anastomosis.

Microvascular anastomosis is a demanding skill requiring technical excellence and a thorough knowledge of anatomy and physiology. Every suture placed in a microvascular anastomosis should be considered critical as each has the potential to compromise the delicate reconstruction. As such, any device that can facilitate microvascular suture placement deserves thorough evaluation. The U-clip (Coalescent Surgical, Sunnyvale, CA) is such a device in that it eliminates the often time consuming process of tying knots. We evaluated use of the U-clip in microvascular anastomosis of a 1.5 mm artery. We found the U-clip to offer some advantages including ease of use, traditional feel of directed suture placement (as compared to couplers), and elimination of time needed for knot tying. Its shortcomings include size (in diameter, the "pop-off" section of the device appears larger than standard 8-0 suture), the significant force required to "pop-off" the device and difficulty removing the device.

Adult↗

Clinical experience with Scott inflatable penile prosthesis in 150 patients.

The Scott inflatable penile prosthesis was implanted in 150 patients with organic (89%) and psychologic (11%) impotency from 1979 to 1982. The patients were followed up for an average of twenty-five (6-46) months. A satisfactory result was achieved in 133 (89%) patients. Forty-nine major complications occurred in 38 patients. Forty-four surgical procedures were performed in 33 patients to correct mechanical or technical complications (32), replace the device (9), or remove the device (3). Two patients refused corrective surgery, and the complications could not be corrected in 2 patients. Cylinder leaks (15), leaks at tubing/connector junctions (14), and cylinder aneurysms (7) were responsible for most of the mechanical failures. Additional refinements in surgical technique will not eliminate these problems. Device modifications should be made to increase cylinder durability, to eliminate the need for suture ligation of tubing/connector junctions, and to assure symmetrical cylinder expansion.

Adult↗

Management of Peyronie disease by implantation of inflatable penile prosthesis.

Sixty-seven patients with advanced Peyronie disease were treated by implantation of an inflatable penile prosthesis (IPP). Twenty-eight of the 67 patients had documented total erectile failure. The remaining 39 patients had significant penile curvature causing "mechanical impotence" due to inability to achieve adequate vaginal penetration and chose implantation of an inflatable penile prosthesis (in some cases, combined with a straightening procedure) rather than one of the standard penile straightening procedures. Currently, 63 of the 67 patients have functioning prosthetic devices; in 3 other patients the device was removed because of infection, and 1 patient was dissatisfied and had the device removed. For impotent patients with severe Peyronie disease for whom other medical or surgical treatment is neither desirable nor suitable, we recommend implantation of an inflatable penile prosthesis combined with a possible straightening procedure.

Adult↗

A new temporary catheter (ContiCath) for the treatment of temporary, reversible, postoperative urinary retention.

OBJECTIVES: To describe the initial experience of a newly designed temporary urethral catheter, ContiCath, as an aid in the management of postoperative or temporary outflow obstruction. In patients with normal detrusor and sphincter function, this catheter allows volitional voiding while maintaining an open prostatic urethra. METHODS: In a pilot study, 64 nonconsecutive patients with postoperative or temporary urinary retention, at eight clinical trial sites, were enrolled for the placement of this temporary catheter. Three patients did not have the catheter placed because of placement failure because of either a large median lobe or a urethral stricture. The remaining 61 patients were divided into three groups: those with non-neuropathic causes of retention and retention for 1 week or less (37 patients), those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), and those with neuropathic causes of retention and retention for longer than 1 week (5 patients). The ContiCath is placed in the office setting, in the same fashion as a Foley catheter. A blue prolene tether extends from the bulbar urethra to the meatus to assist in the removal of the device. Patients were then reassessed at 3 hours, and at 7, 14, 21, and 28 days, at which point the device was removed. RESULTS: In patients with a neuropathic cause for their retention (5 patients) and those with non-neuropathic causes of retention and retention for longer than 1 week (19 patients), only 3 patients were able to void after the catheter was placed. Of the 37 patients with a non-neuropathic cause and retention 1 week or less, controlled voiding was seen in 33 patients (89%). Controlled voiding was defined as the patient's volitional ability to initiate and stop his urinary stream. There were no complications with catheter placement; however, 8 patients (24.2%) had minor adverse experiences of frequency/urgency (n = 3), incontinence (n = 3), migration of the catheter (n = 1), and pain (n = 1). CONCLUSIONS: ContiCath offers an alternative to an indwelling Foley catheter in men with temporary bladder outlet obstruction and urinary retention.

Aged↗

Extraocular compression prior to cataract surgery: time course of reduction and subsequent recovery of intraocular pressure.

This study investigated the rate and degree of reduction in intraocular pressure (IOP) obtained with an external ocular compression device. Following removal of the device, the subsequent recovery in IOP was monitored. We aimed to establish the time course of IOP changes, and thereby to optimise our use of such devices prior to cataract surgery. A rapid initial reduction over the first 10 minutes of compression was followed by a more gradual reduction to a mean reduction of 6.97 mmHg at 40 minutes. Recovery of IOP was rapid and complete by 20 minutes. We conclude that compression of up to 40 minutes duration is beneficial, and suggest such devices should be left on until immediately prior to surgery to preserve the reduction achieved.

Adult↗

Muscle atrophy after treatment with Halovest.

STUDY DESIGN: A prospective study was conducted on the sequential changes in the muscles around the cervical spine following external fixation for an extended period. OBJECTIVE: Muscular atrophy around the cervical spine following prolonged external fixation with a Halovest and subsequent recovery from the atrophy were examined. SUMMARY OF BACKGROUND DATA: There are a number of reports on the usefulness of the Halovest. However, there have been no descriptions about muscular atrophy following fixation by the Halovest. METHODS: The study participants were 10 patients who were conservatively treated by the Halovest. Imaging by CT was performed periodically following fixation by the Halovest. The cross sections of the sternocleidomastoid muscle and the nuchal muscle group at C5-C6 were computed by using NIH Image Software. The results were used to evaluate muscular atrophy following fixation by the Halovest and the subsequent recovery after removal of the fixation. RESULTS: Following fixation by the Halovest, atrophy of the muscles around cervical spine sequentially progressed. Three months after fixation, muscular atrophy was about 15% at the sternocleidomastoid muscle and 22% for the nuchal muscle group, but the patients recovered from the atrophic state following the removal of the device. CONCLUSION: Following fixation by the Halovest, muscular atrophy around the cervical spine sequentially progressed. After the device was removed, however, the muscles recovered from the atrophic state. Muscular atrophy caused by prolonged fixation by the Halovest was a reversible change.

Adolescent↗

Our experience with Wisebands: a new skin and soft-tissue stretch device.

Complex wounds that involve skin and soft-tissue defects that are unsuitable for primary closure by conventional suturing are common in the field of surgery. Among the many surgical options available to overcome these problems are various mechanical devices that have recently been proposed for delayed primary closure of such wounds. The authors present their experience with a new complex wound closure device, Wisebands, a device uniquely designed for skin and soft-tissue stretching. During the last 2 years, the authors have treated 20 patients with 22 skin and soft-tissue wounds for which primary closure was not feasible. The Wisebands devices were applied to the wounds, stretching the skin and underlying soft tissue, gradually closing the defects until the edges were sufficiently approximated for primary closure. Successful wound closure was achieved in 18 patients (90 percent). The Wisebands devices were removed in two patients (10 percent) because of major wound complications. In two other patients (10 percent), minor wound complications had occurred that did not necessitate removal of the device. At a mean follow-up of 1 year (range, 10 months to 2 years), stable scarring with no functional or significant aesthetic deficit was achieved. The authors conclude that the Wisebands device facilitates closure of complex skin and soft-tissue wounds, with low morbidity and complication rates, and can provide the surgeon with another important tool for closing complex wounds. Nevertheless, appropriate patient selection, intraoperative judgment, and close postoperative care are essential to ensure closure and avoid undue complications.

Adolescent↗