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Correlations between levels of mite and cat allergens in settled and airborne dust.

Thirty homes in Rochester, Minn., 20 of which housed cats, were studied to compare cat and mite allergen concentrations in airborne and settled dust. With Air Sentinels in the bedroom and living room for airborne collections, and a Sample Vac for collections from living room carpet and bedroom mattress, immunochemical quantifications of each were made with various radiometric assays with polyclonal and monoclonal antibodies. The most significant correlations were found between airborne mite in the bedroom and living room (p less than 0.001) and airborne mite in the bedroom and dust from the bedroom mattress (p less than 0.001). Most houses had specific epitopes of both Dermatophagoides pteronyssinus and D. farinae, but D. farinae was present in greater amounts. In seven houses we found greater than 10 micrograms of group I mite allergen per gram of settled dust, indicating that some houses in Minnesota have concentrations of mite allergens high enough to cause allergic disease, even in the winter. Clinical interpretation of these data on air levels is hampered by uncertainty as to whether symptoms are more closely related to average steady-state exposure, which we measured, or to brief heavy concentrations. Further epidemiologic studies are needed to define the concentration of mite and cat allergens in the air that are risk factors for allergic disease. The concentration of cat allergen correlated with mite allergen in the air, but not in settled dust, presumably reflecting the fact that both are influenced by ventilation rate.

Air↗

A double-blind, placebo controlled trial of solidified benzyl benzoate applied in dwellings of asthmatic patients sensitive to mites: clinical efficacy and effect on mite allergens.

BACKGROUND: The aim of this double-blind, randomized study was to investigate the effectiveness of an acaricidal cleaning product in modifying both clinical symptoms and mite allergen levels over a period of at least 1 year. METHODS: Twenty-six asthmatic patients with proven Dermatophagoides pteronyssinus (Dp) asthma were selected; three were withdrawn from the trial. The patients' homes were divided into two groups; 11 homes were treated with solidified benzyl benzoate and tenside agents (A), and 12 were treated with a placebo (P). Two applications were performed at the beginning of the trial and at least 6 months later. Patients were examined 1 month before the trial, at the beginning of the trial, and every 3 months over a period of 1 year. Indoor mite exposure was evaluated by three methods: semiquantitative guanine determinations, quantitative guanine determinations, and the measurement of Der p I + Der f 1 (antigen P, of Dp + antigen F1 of D. farinae) levels. RESULTS: The symptom scores established at the beginning of the trial and 12 months later showed a statistically significant improvement only in the A group (p < 0.01). The visual analog scale also showed a statistically significant difference both in the A (p < 0.05) and P groups (p < 0.01). No statistical differences were found between medication scores in the A or P groups. A statistically significant increase was also observed for forced expiratory volume in 1 second and maximal expiratory flow rate 25/75 in the two groups (p < 0.05 for P group; p < 0.01 for A group). The mean decreases in Der p I + Der f 1 in patient mattresses between the beginning of the trial and after 12 months were 20% for the acaricide group and 17% for the placebo group, respectively (NS). For house dust samples with origins other than the patients' mattresses we found significant decreases in Der p I+Der f 1 in the A group (p < 0.01 for carpets and p < 0.05 for upholstery elements).

Adolescent↗

Mite asthma in childhood: a study of the relationship between exposure to house dust mites and disease activity.

BACKGROUND: Children with asthma are commonly sensitized to the house dust mite. METHODS: We took monthly measurements from July to December of the amount of mites in the mattresses of asthmatic children and correlated them with symptom score, pulmonary function, and airway hyperreactivity to methacholine. RESULTS: In spite of the high number of Dermatophagoides pteronyssinus throughout this period, symptom and treatment scores, as well as PC20 to methacholine, worsened during the months of September and October. CONCLUSIONS: It is concluded that when asthmatic children allergic to mites are exposed to high levels of mite allergen, the number of mites in the mattress dust no longer correlate with increased symptoms, and that other factors are more likely to be associated with exacerbation.

Adolescent↗

Control of house dust mite antigen in bedding.

Bedding has been constructed with a vapour-permeable waterproof fabric that is impermeable to house dust mite antigen (Der p1). Der p1 levels per gram of mattress dust after 12 weeks' use of the new covering were 1% of levels in control samples from mattresses cleaned conventionally.

Adolescent↗

Strength and functional recovery following repair of flexor digitorum superficialis in zone 2.

A two-pronged study was designed to evaluate the strength in vitro and functional recovery in vivo of FDS repairs in zone 2. In part I, horizontal mattress or Tajima grasping repairs were performed on fresh-frozen cadaveric digits, using 3/0 or 4/0 braided nylon suture material. The Tajima repair was significantly stronger than the mattress suture, using either 3/0 (P = 0.0001) or 4/0 (P = 0.0027) suture material. The 3/0 Tajima repair appeared strong enough to permit gentle early active motion. Furthermore, the clinical portion of the study (part II) demonstrated restoration of FDS function following repair in relatively isolated injuries in 13 out of 15 digits (86.7%), with PIP flexion averaging 80 degrees and grip strength 89% of that in the uninjured hand.

Cadaver↗

Tensile strength of the end-weave flexor tendon repair. An in vitro biomechanical study.

A study was designed to investigate the tensile strength of the end-weave method of tendon repair. Flexor tendons were removed from 13 fresh-frozen human cadavers, transected and repaired with the end-weave technique varying from one to five weaves, with two suture techniques, the commonly used horizontal mattress suture and a new method we have termed the cross stitch. The repairs were then tested in tension to failure on a Materials Test System (MTS) biomechanical testing device. Comparisons were also made to tensile strengths of intact whole tendons, tendon-bone insertions, and distal reinsertion techniques. Tensile strength increased linearly with the number of weaves for both suture methods. The cross stitch was found to have significantly greater strength per weave compared to the horizontal mattress suture (P < 0.05). Three out of five trials of five weaves done with the cross stitch actually failed at the tendon itself first, rather than through the repair, which was the failure mode for all other trials. The results from this in vitro model suggest that active rehabilitative exercises might safely be performed in the immediate post-operative period after procedures that involve tendon weaving.

Biomechanical Phenomena↗

An oculo-cardiac hypothesis of sudden unexpected death in infants.

The oculo-cardiac hypothesis presented here draws attention to the evidence for links between Sudden Unexpected Death in Infants (SUD) - known in America as the Sudden Infant Death Syndrome, also as "cot death" or "crib death" - and the vagally mediated reflex slowing of the heart beat following pressure on the eye. A brief review is made of epidemiologic findings on SUD, including the fact that around 9000 infant fatalities per year are attributed to SUD in the U.S.A. alone. Evidence for excessive vagal discharge as a likely factor in SUD is discussed. The nature of the oculo-cardiac reflex discovered by Aschner is described, with particular attention to those factors which appear to make specific categories of sleeping infant more vulnerable to cardiac arrest in circumstances where this reflex is elicited. The factors include prematurity and an existing electrical instability of the heart. Regarding the manner in which such an oculo-cardiac reflex might in practice be set off, it is suggested that this could occur if the infant slept in such a position that the weight of the head could press the eye against any irregular surface which might exist on the mattress, or any object which was resting on the mattress. Evidence is cited for SUD infants being in fact more likely than controls to sleep in such a position. Children with exophthalmos would be more at risk in this respect. It is stressed that all this evidence is already published, but has not previously been drawn together to show the likelihood of a link between Sudden Dath and the oculo-cardiac reflex.

Heart↗

Effects of nursery illumination on frequency of eyelid opening and state in preterm neonates.

The behaviour of a group of premature neonates was observed under three conditions of ambient illumination defined as either DARK, LIGHT or BRIGHT (mean intensities: 0.9, 109 and 1370 lux). Trends in the data suggested that increasing the level of illumination resulted in a reduction in the proportion of time spent with eyelids open and of the amount of time spent in awake states. However, these effects were small and in most cases failed to attain statistical significance. Sudden offset of light did however produce a transitory increase in eyelid opening for a period of approximately 60 s that appeared to be unaccompanied by any change of state (P less than 0.001). Irrespective of illumination condition, the infants' behaviour was characterized by prolonged periods of eyelid closure which were significantly greater for the lower eye (in mattress contact, mean lid closure = 96.2%) compared to the upper eye (no mattress contact, mean lid closure = 88.25%). The prolonged occurrences of eyelid closure are discussed in relation to visual development and phototoxicity.

Arousal↗

Arthroscopic outside-in meniscal repair through a needle hole.

This article describes an alternative method for outside-in repair of a longitudinal meniscal tear through a needle hole, which will produce an almost negligible cutaneous scar. The procedure is performed under arthroscopic set-up using an 18-gauge needle preloaded with appropriate suture material. Insert the needle twice through the same cutaneous entry hole to form a mattress loop across the torn meniscal segments. The first insertion penetrates both segments and forms a loop. The second insertion then engages the outer segment and forms another loop. Draw the free end of this second loop into the joint and feed it into the first loop. Pull the first loop out from the joint together with the trapped portion near the free end, until the whole suture becomes a vertical mattress. Finally, tie a slipknot and several half hitches to close the meniscal gap under the stitch. In a large bucket-handle tear, stitches should be started at the middle and then alternating anteriorly and posteriorly 3 to 4 mm apart. To ensure that no significant extracapsular structures are trapped in each stitch, a 13-gauge needle can be used as a cannula sheath. This technique is economical and technically safe and simple for reparable meniscal lesions, including the posterior horn.

Arthroscopy↗

Meniscal repair using the FasT-Fix all-inside meniscal repair device.

PURPOSE: We performed a prospective study of meniscal repair using a new all-inside suture meniscal repair device to evaluate its clinical efficacy. TYPE OF STUDY: Prospective case series. METHODS: The results of 42 meniscal tears in 37 patients who underwent meniscal repair using the FasT-Fix device (Smith & Nephew, Andover, MA) were prospectively evaluated. All cases were performed by 1 surgeon (A.A.S.). Preoperative and follow-up evaluation was performed using the objective and subjective International Knee Documentation Committee (IKDC) criteria as well as Lysholm functional questionnaires. Statistical significance was determined to be P < .05 based on a 2-tailed t test. Relook arthroscopy was performed in 8 patients (9 repairs). Any patient who had a hybrid repair was excluded. RESULTS: The patient population studied, 37 patients comprising 42 meniscal repairs, had an average age of 27 years (range, 13 to 48 years), and an average follow-up of 24.3 months (range, 22 to 27 months). There were 20 male and 18 female patients with 23 medial and 9 lateral repairs; 5 patients had both menisci repaired. All patients had tears in Cooper radial zones 1 and 2 and, thus, had a peripheral meniscal rim of at least 2 mm. All tears were predominantly in the middle and posterior third of the meniscus and 8 tears extended into the posteriormost aspect of the anterior third of the meniscus. An average of 2.8 suture devices was used (range, 1 to 5), predominantly in a vertical or vertical oblique mattress configuration. Forty-two percent were isolated meniscal injuries and 58% had a concurrent anterior cruciate ligament (ACL) reconstruction. Concomitant procedures were ACL reconstruction in 22, excision of loose body in 1, and excision of a large meniscal cyst in 1. Tear length averaged 2.9 cm (range, 1.5 to 4.5 cm). The success rate by objective IKDC score was 86% (73% normal, 13% nearly normal, and 14% abnormal). Of the 5 clinical failures, 3 were in the isolated group (80% success rate), and 2 were in the ACL group (91% success rate). Both the subjective IKDC and the Lysholm scores statistically improved (IKDC average, 59 preoperative and 92 postoperative; Lysholm average, 69 preoperative and 94 postoperative). There were 8 relook arthroscopies; 5 for failures and 3 for other procedures at which time complete healing was noted. In no case was there articular scuffing from the knots. Removal of a device at the time of surgery was necessary in 5 instances for failure of engagement of the T-Fix bar. An additional FasT-Fix device was then inserted without difficulty in each case. No case of postoperative extra-articular or intra-articular complications was encountered. CONCLUSIONS: The FasT-Fix suture device affords an all-inside method of meniscal repair using a strong vertical or horizontal mattress suture configuration and appears to be a safe and effective technique for meniscal repair for tears with at least a 2-mm peripheral rim. It has a high success rate and low complication rate and has results comparable to classic suture repair techniques. LEVEL OF EVIDENCE: Level IV.

Adolescent↗

Arthroscopic transosseous suture anchor technique for rotator cuff repairs.

The skin is incised 1 to 2 cm distal to the lateral portal. A transosseous tunnel is created through the greater tuberosity by a sharp penetrator, entering 1.5 to 2 cm distal to the top of the greater tuberosity. The penetrator exits medially, between the tip of the greater tuberosity and the articular surface of the humeral head, in the middle of the footprint. The first anchor, a 5-mm Spiralok (DePuy Mitek, Norwood, MA) is placed at the penetrator's exit site on the footprint. Using a specially designed suture leader, the lateral limb of the suture in the anchor, which passes through the previously created transosseous tunnel, is taken from the anchor and pulled out. The other suture end is passed through the supraspinatus tendon. The second suture, placed superficially in the anchor, is passed from the anchor through the supraspinatus tendon, as a mattress suture. If more anchors are required, the procedure should be repeated. The transosseous suture limb and the suture limb that is passed through the supraspinatus tendon are tied through the lateral portal. The knot tying is then performed with a sliding Delimar knot. The mattress suture, passing through the supraspinatus tendon, is tied through the anterior lateral portal. The knot tying procedure is repeated depending on the number of anchors.

Arthroscopy↗

Arthroscopic technique for patch augmentation of rotator cuff repairs.

The patient is placed in the lateral position, and an arthroscopic cuff repair is performed according to standard techniques. The line of repair is usually in the shape of a "T" or an "L." The repair is viewed through the lateral portal, with fluid inflow through the scope. Mattress sutures are placed in the anterior and posterior portions of the cuff, with respect to the line of repair, just medial to the most medial point of the tear. The sutures are placed in accordance with margin convergence suture passing methods. Next, 2 double-stranded suture anchors are placed into the lateral aspect of the greater tuberosity, which can be used to secure the anterior and posterior portions of the rotator cuff as well as the patch. The cuff sutures are tied first; then, the patch is addressed. The graft is sized by placement of a ruled probe or similar device into the subacromial space. The length of each side of the "rectangle" is measured to obtain the dimensions of the patch. The patch is then cut to fit the measurements. If the patch material is elastic, a slightly smaller than measured graft is cut to provide tension on the repair. The arthroscope is then moved to the posterior portal, and a large (8 mm) cannula, with a dam, is placed into the lateral portal. All sutures are brought out of the lateral cannula, and corresponding ends of each suture are held together in a clamp. The sutures are placed in their respective orientations once outside the cannula (e.g., anterior-medial, anterior-lateral), covering all 4 quadrants. Care is taken to ensure that the sutures have no twists and are not wrapped around one another. The sutures are passed through the graft, in mattress fashion, with a free needle, in their respective corners and clamped again. The graft is then grasped with a small locking grasper on its medial edge and is passed through the cannula into the subacromial space. The clamps holding the sutures are then gently pulled to remove the slack. A smaller (5 mm) cannula is placed through 1 of the anchor incisions into the subacromial space. The medial 2 sutures are retrieved, a pair at a time, through the small cannula and are tied according to standard arthroscopic techniques; then, the lateral 2 sutures are retrieved from the anchor. The graft should cover the area of repair completely and should be under slight tension. Additional sutures may be placed to further secure or tension the graft as necessary, with the use of standard suture passing techniques, similar to those used when margin convergence is performed. Passive shoulder motion, pendulum exercises, and active elbow and wrist motion begin 2 days after surgery when the dressing is removed. Active assisted motion and active motion begin at 6 weeks, with integrated periscapular stabilization exercises. Formal cuff strengthening begins no sooner than 12 weeks after surgery for large and massive tears.

Arthroscopy↗

The strength of suture configurations in arthroscopic rotator cuff repair.

PURPOSE: This study evaluated the strength of different suture configurations with the use of a recently introduced arthroscopic suture passer (ExpressSew; Surgical Solutions, Valencia, CA). METHODS: The ultimate tensile strength and mode of failure of each suture configuration were repeatedly tested on a validated porcine rotator cuff tendon model, with the use of standard suture material (No. 2 FiberWire [Arthrex, Naples, FL]) passed with ExpressSew and tested on a Hounsfield digital tensiometer type H20K-W (Tinius Olsen, Hersham, PA). RESULTS: The strongest construct was 2 mattress sutures (mean, 169 N; standard deviation, 56.1 N); this was followed in strength by a single modified Kessler suture (mean, 161 N; standard deviation, 16.9 N), 4 simple sutures (mean, 155 N; standard deviation, 27.3 N), and finally, a single Mason-Allen suture (mean, 140 N; standard deviation, 28.6 N). CONCLUSIONS: Study results show little difference in strength for varying complexities of suture configurations. In simple terms, no demonstrable difference was seen in the strength of construct, whether the surgeon used 4 simple sutures, 2 mattress sutures, or 1 grasping suture. CLINICAL RELEVANCE: This study allows the surgeon to justify use of the simplest configuration of suture passage that works in his hands, for the purpose of attaining a reliable and repeatable repair of the rotator cuff through arthroscopic methods.

Animals↗

Effect of positioning on the incidence of abnormalities of muscle tone in low-risk, preterm infants.

UNLABELLED: BACKGROUND. The preterm infant is subject to the force of gravity: when its body lies pressed against the mattress on which it is placed. AIMS: The purpose of this study was to investigate short-term effects of varied post-natal lying positions in order to prevent neuromuscular and postural abnormalities. METHODS: 60 low risk preterm infants of 31-36 weeks gestational age were enrolled for this randomised clinical trial. Initially each child underwent neurological and psychomotor assessments which included tonus and reflex protocols as well as behavioral, sensory motor and postural examinations. The lying positions of the treated group were varied (back, prone, and side) using a specially designed moldable mattress that maintained the functional position of the infant's body. The control group was placed on their stomachs, (the standard lying position used in 1994) with a standard orthopaedic bolster support under their hips. All infants underwent a second round of examinations upon discharge to assess any changes in neurological and psychomotor outcomes. RESULTS: The sensory-motor skills examinations showed significant abnormalities in the control group: (1) dominance of the extensor muscles due to muscle shortening, (2) hyper abduction and flexion of the arms, and (3) global neuromuscular rigidity. Psychomotor and neurological exams of the control and treatment groups showed delayed developmental muscular acquisitions for infants in the control group. CONCLUSION: Regular changes in posture, while retaining correct functional positions, allowed maintenance of normal neuromuscular and osteo-articular function and permitted the development of spontaneous and functional motor activity in low-risk perterm infants.

Female↗

Tissue-interface pressures on three different support-surfaces for trauma patients.

The purpose of this study was to evaluate and compare tissue-interface pressures on three different support-surfaces for trauma patients. The support-surfaces were a semi soft overlay mattress, a vacuum mattress and a spine board. Tissue-interface pressures were measured in a standardised way between the scapulae, the sacrum, the heels and the different support-surfaces in 20 healthy volunteers. Appreciation of comfort of the support-surface was assessed using a 10-point visual analog scale. High and potentially ischaemic interface pressures were found on all three support-surfaces, with the highest pressures (exceeding 170 mmHg) measured on the spine board. The spine board got the worst comfort score. It was also noted that no support was given to the normal lumbar lordosis by the spine board. There is a need for new support-surfaces for trauma patients, which reduce interface pressures and are comfortable.

Adult↗

Clinical effectiveness of a mite allergen-impermeable bed-covering system in asthmatic mite-sensitive patients.

BACKGROUND: Exposure to allergens plays a role in the development of bronchial hyperresponsiveness and in the chronic inflammatory response seen in asthmatic patients. House dust mites (HDMs) are an important source of allergen. Reduction of these allergens might lead to better lung function and reduction of asthma symptoms. OBJECTIVE: The effect of HDM-impermeable covers on HDM allergen levels, peak flow values, and asthma symptoms were measured. Therefore a randomized clinical trial was carried out. METHODS: Fifty-two allergic asthmatic patients were randomly allocated to use the HDM-impermeable or placebo covers. During the study period, daily peak flow and asthma symptom scores were recorded. Dust samples were taken from the mattresses. RESULTS: We observed a significant reduction in HDM allergen levels on the mattresses after encasing them with HDM-impermeable covers (reduction of 87% of Der p 1 in micrograms per gram of dust; P <.001). Baseline symptoms were so low that no improvement could be established. Morning peak expiratory flow is significantly higher in the intervention group compared with that seen in the placebo group during the study period (beta=20.2; P <.01). CONCLUSIONS: HDM-impermeable covers significantly decreased the level of HDM allergens. Furthermore, morning peak flow was significantly increased during the intervention period. This study indicates that HDM allergen-avoidance measures might have beneficial effects on allergen reduction and asthma outcome.

Adult↗

A biomechanical comparison of the Mitek RapidLoc, Mitek Meniscal repair system, clearfix screws and vertical PDS and Ti-Cron sutures.

The aim of this in vitro study was to measure and compare the biomechanical properties and mode of failure of the five different methods of meniscal repair. Reproducible tears were created in 50 bovine medial menisci and repaired in a standardized fashion with one of the following devices: the RapidLoc meniscal repair device (Mitek Products, Westwood, MA), an 8 mm Mitek meniscal repair system (Mitek Products, Westwood, MA), Clearfix screw (Innovasive Devices, Marlborough, MA), a single vertical mattress suture of 2-0 Ti-Cron (Ethicon, Massachusetts) and a vertical mattress suture of No. 1 PDS II (Johnson and Johnson Int.). The repairs were tested by single cycle load to failure in a materials testing machine. The mean loads to failure for each of the repair groups were as follows: Mitek RapidLoc 44.9 N, Mitek meniscal repair system 20.3 N, Clearfix screw 37.4 N, vertical Ti-Cron 66.1 N and vertical PDS suture 103.0 N. The mean load to failure was significantly greater with PDS vertical sutures than with other techniques (P<0.05). The Mitek RapidLoc had the least extension at failure (14.8 mm) (P<0.05). This study confirms meniscal repair with vertical PDS sutures confers the highest biomechanical stability and that the new Mitek RapidLoc device offers improved load to failure than the previous generations.

Absorbable Implants↗

The Belsey Mark V procedure.

A potential weak link in the Belsey Mark IV partial fundoplication operation is the placement of the plicating mattress sutures in the esophageal muscle. During or after repair, if these sutures are tied too tightly, if the esophagus is pulled taut beneath the diaphragm, or if the diaphragm moves forcibly, the sutures can pull out. This causes partial or complete disruption of the repair. The use of Teflon felt pledgets with the mattress sutures is described (Mark V procedure). This modification seems to give better purchase of the sutures in the muscle of the esophagus and may help to lower the incidence of recurrence.

Adult↗