Clinical benefits of a new multipurpose disinfecting solution in silicone hydrogel and soft contact lens users.

OBJECTIVES: To evaluate the safety and efficacy of a new multipurpose disinfecting solution (MPDS) containing a diblock copolymer, poly(oxyethylene)-poly(oxybutylene), designed to improve the wetting properties of silicone-hydrogel lenses. METHODS: This 90-day, randomized, concurrently controlled, double-masked, multisite study involved 573 subjects at 30 investigational sites in the United states. Existing lens wearers were randomly assigned to either regimen 1 (OPTI-FREE PureMoist, a newly developed formulation, Alcon Laboratories Inc., Fort Worth, TX) or regimen 2 (renu fresh, Bausch and Lomb Inc., Rochester, NY). At baseline, days 7, 30, 60, and 90, the subjects recorded subjective evaluations relating to lens acceptability and comfort, wearing time, and rewetting drop frequency, whereas investigators assessed slitlamp findings (including corneal fluorescein staining), lens deposits (modified Rudko), visual acuity, and adverse events. Group IV lenses were collected for ex vivo measurement of lysozyme deposits. RESULTS: Differences favoring regimen 1 were noted on day 90 for subjective evaluations of lens comfort (insertion, removal, overall); lens moisture and freshness; gentle on eye; clear vision; and lens handling (all P<0.004). Corneal fluorescein staining severity and area and lysozyme deposits (group IV lenses) were lower with regimen 1 (P<0.0001). CONCLUSIONS: This 90-day study shows that the new MPDS designed for silicone-hydrogel lenses is safe and effective when used by both silicone-hydrogel and traditional soft lens wearers. By improving comfort and decreasing lysozyme deposits and corneal fluorescein staining, the new MPDS enhances patients' wearing experience and helps maintain optimal lens performance.

Late infiltration of post-orthodontic white spot lesions.

White spot lesion (WSL) infiltration has been recommended immediately after debonding of orthodontic brackets. It is however not clear if established inactive WSLs can also be masked through infiltration. Orthodontic treatment of a 19-year-old patient had to be terminated prematurely due to development of multiple WSLs of varying severity. Three months after debonding, the patient presented for lesion infiltration. After etching with 15% HCl gel and re-wetting of the dried surfaces it seemed that a good outcome could be expected. Lesion infiltration led to complete masking of less severe WSLs. The visual appearance of moderate and severe WSLs was improved but they were still visible after treatment. Inactive WSLs may not represent an increased caries risk, but patients are often bothered esthetically. Infiltration by repeated etching might be a viable approach even for inactive WSLs. Controlled clinical trials are needed to investigate the long-term performance of this technique.

Use of a mucoadhesive disk for relief of dry mouth: a randomized, double-masked, controlled crossover study.

BACKGROUND: Dry mouth is a frequent complaint of adults worldwide. In those who experience dry mouth, therapeutic options include the use of salivary substitutes and sialogogues. METHODS: The authors compared the efficacy and safety of mucoadhesive disks (OraMoist, Axiomedic, Zurich; distributed by Quantum Health, Eugene, Ore.) applied three times daily with those of placebo mucoadhesive disks in a double-masked, randomized, controlled crossover study. The primary end point of interest was within-participant differences in subjective (visual analog scale) ratings of dry mouth according to the New York University Bluestone Mouthfeel Questionnaire. The secondary end point was within-participant differences in salivary flow rates. RESULTS: Twenty-seven participants completed the single-site study. The results showed no significant difference between the two types of mucoadhesive disks, both of which were associated with a statistically significant improvement in the subjective experience of moistness across the 60-minute period after application and compared with baseline measures after two weeks of use. Furthermore, both disks were associated with a statistically significant improvement in salivary flow rates across the 60-minute period after application and compared with baseline measures after one and two weeks of use. The disks were well tolerated, and participants did not report any adverse events. CONCLUSIONS: The mucoadhesive disks used in this study were safe and provided symptomatic relief from dry mouth. Practice Implications. Patients with dry mouth may benefit from this novel delivery system.

Bleaching: preventing common problems.

So there you have it--a system to guarantee compliance and to eliminate the sensitivity that often accompanies bleaching treatment. Give the patients control so they can see and celebrate their improvement (Figures 8 and 9). Most importantly use a protocol and methods that get the job done faster and better with an absolute minimum of discomfort.

Plastic surgery: understanding abdominoplasty and liposuction.

Requests for plastic surgery procedures that alter one's body image are on the rise. To ensure the best possible outcome, patients who request a combined procedure (eg, abdominoplasty and liposuction) must meet certain criteria to be eligible for surgery. It is critically important for patients to understand that these surgeries are not weight-reduction procedures, and they must be prepared to make lifestyle changes to ensure long-lasting results. These procedures are performed in a variety of facilities (eg, surgeons' offices, surgery centers, hospitals). Perioperative nurses must have a basic knowledge and understanding of abdominoplasty and liposuction and the special requirements and potential complications involved with these procedures.

Ultrasound-assisted lipoplasty.

The use of ultrasound-assisted lipoplasty (UAL) to assist in the removal of subcutaneous fat has been practiced in Europe for nearly 15 years and over the last 7 years has gained popularity in the United States. Liposuction is now one of the most commonly performed cosmetic procedures by board-certified plastic surgeons. This article will review the UAL procedure, its history, regulatory issues, instrumentation and equipment needed. It will also review changes and recent updates, clinical protocol, complications, and future considerations.

Bacterial strike-through of re-usable surgical drapes: the effect of different wetting agents.

Wound contamination and the resultant postoperative infection is a major problem in all forms of surgery. Air contamination, gloves, surgical instruments and drapes have all been investigated as sources of wound contamination. We investigated the effect of different wetting agents on strike-through rate of bacteria through re-usable polyester/cotton surgical drapes using a newly described method. Within 30 min bacterial strike-through of dry surgical drapes occurs. Wetting drapes with blood or normal saline enhances the strike-through rate of bacteria. Wetting drapes with iodine or chlorhexidine diminishes, but does not stop, bacterial strike-through. The use of re-usable polyester/cotton drapes is a potential source of wound contamination especially when wetted with blood or normal saline.

Corneal-wetting property of lignocaine 2% jelly.

PURPOSE: To evaluate the corneal-wetting property of lignocaine 2% jelly. SETTING: A district general hospital. METHODS: Fifty patients having cataract surgery were divided into 3 groups. Group 1 comprised 20 patients who had topical eyedrop anesthesia and corneal irrigation with balanced salt solution (BSS(R)) during surgery as necessary. Group 2 comprised 15 patients who received lignocaine jelly on arrival and just before the corneal incision was made as well as corneal moisturizing by BSS during surgery. Group 3 comprised 15 patients who received lignocaine jelly on arrival and additional lignocaine jelly if necessary just before the corneal incision was made to maintain corneal clarity. The duration of efficacy and the frequency of the applications of the 2 agents were recorded. Corneal clarity and reflections were noted intraoperatively. Corneal status was assessed postoperatively in the ward. RESULTS: Preoperative lignocaine 2% jelly maintained corneal clarity longer than BSS (P <.001). A second application of lignocaine was needed when surgery was prolonged. CONCLUSIONS: The corneal-wetting property of lignocaine 2% jelly can be useful during cataract surgery by avoiding repeated corneal irrigation with BSS.

The quality of skin care products and their ingredients.

Several ingredients used in skin products have been criticized as being excessively harsh, allergenic, or otherwise unsuitable for use, especially in the elderly population. Preservatives, in particular, have been condemned, leading to a proliferation of "preservative-free" products. Other descriptive/promotional phrases with negative connotations are "fragrance-free" and "emulsifier-free." Inferences regarding these designations might suggest that preservatives, fragrances, emulsifiers, and a number of other ingredients serve no important function, are superfluous in terms of product quality, and, therefore, should be left out of all skin products. While this is obviously not the case, neither is the obverse. Ingredients used in skin care products should be carefully chosen to support or maintain the overall effectiveness and utility of the product, and the concentration of such ingredients should be given careful consideration. After briefly reviewing skin structure and changes that occur during aging, this article examines the concept of product quality. Major nondrug ingredient categories will be addressed, including the reasons for using such ingredients in skin care products, the products in which they are required, the limitations and choices available within each category, and guidelines for product selection.

In vitro dentin demineralization inhibition effects of an experimental fluoridated HEMA and water wetting agent.

The ability of fluoride-releasing resins to inhibit dentin demineralization remains controversial. The purpose of this study was to evaluate the caries inhibition of resin composite restorations with an experimental fluoridated hydroxyethyl methyl methacrylate (HEMA) and water wetting agent. Standardized Class V preparations were placed in 40 molars, the gingival margin placed below the cementoenamel junction. Two dentin primers (sodium fluoride, HEMA and water; HEMA and water) were placed in equal numbers of 20 preparations, then One-Step Dental Adhesive (Bisco) was applied as recommended by the manufacturer, followed by the placement of a resin composite restoration. Amalgam restorations with no primer/adhesive were placed in 10 preparations and 10 preparations were restored by placing One-Step Dental Adhesive, then resin composite. All teeth were subjected to an artificial caries challenge (pH 4.4) for 5 days. Results demonstrated the mean areas (microm2 +/- s.d.) of demineralization 100 microm from the restoration/dentin margin to be: amalgam 5,570 +/- 873; One-Step 7,038 +/- 2,099; HEMA and water 6,126 +/- 634; fluoridated HEMA and water 3,411 +/-593. ANOVA and Duncan's test (P < 0.05) demonstrated the fluoridated HEMA and water wetting agent to have significantly less adjacent dentin demineralization than the other three groups. Eighty percent of HEMA and water wetting agent, 80% of One-Step Dental Adhesive and 100% of amalgam restorations demonstrated wall lesions. One hundred percent of restorations with fluoridated HEMA and water wetting agent demonstrated inhibition zones in adjacent dentin.

[Use of polydimethylsiloxane in the endoscopic treatment of urinary incontinence of neurologic origin in children]. / Utilisation du polydiméthylsiloxane dans le traitement endoscopique de l'incontinence urinaire d'origine neurologique chez l'enfant.

AIM: We report the use of polydimethylsiloxane (PDS-Macroplastique) in endoscopic treatment of urinary incontinence in children with neurogenic bladder and try to determine optimal criteria for patient selection. METHODS: Forty four children (19 males, 25 females) have been treated since 1995. Aetiology was mainly spina bifida (n = 36). Previous surgery had been performed in 26 patients, including bladder neck reconstruction in 21 cases and bladder augmentation in 15 cases. Mean age at injection was 13 years (7 to 17). Only one injection was performed in 27 patients, two injections in 4 cases, and three and more injections in 3 cases. Mean volume at each injection was 3.6 cc. Mean interval between two injections was 6 months (3-15 m). All injections were performed transurethrally. RESULTS: Follow-up ranged from 6 to 41 months (median: 23). Fifteen patients (34%) are dry (continence > 4 hours, no urinary pad during the day) and 11 (25%) are improved (continence from 2 to 3 hours, minimal pad). Eighteen patients obtained poor results. In the entire series previous bladder neck surgery or preoperative detrusor hyperactivity did not interfere with the results. The only difference concerns the sex-ratio: the good results were mainly seen in females: 44% of girls are cured versus 21% of boys. CONCLUSION: Injection of PDS in the bladder neck achieve the goal of continence in 34% of the cases in neurogenic bladder. Better results are seen in girls. Injection does not compromise other surgical procedures. The use of PDS seems more suitable than bovine collagen in view of the potential problems of prions.

Lidocaine in ultrasound-assisted lipoplasty.

The doses of lidocaine used for lipoplasty often exceed what is commonly recommended for other surgical procedures. When using these high volumes of lidocaine and wetting solutions, a variety of safety issues must be considered. The author knows of no other plastic surgery operation in which the safety of the procedure is so influenced by the medications administered. Each component of the wetting solution--the alkalized fluid, the epinephrine, and the lidocaine--has an individual and interrelated role. The absorption of lidocaine with epinephrine after subcutaneous installation for lipoplasty probably represents a unique situation, and the concepts presented should not necessarily be extrapolated to other types of procedures.

Sjögren's syndrome.

Sjögren's syndrome (SS) is a progressive autoimmune rheumatic disorder. Its precise etiology is unknown, although several contributing factors have been identified. One theory is that the condition results from complications related to infection with the Epstein-Barr virus. Primary exposure to or reactivation of Epstein-Barr virus elicits expression of the human leukocyte antigen complex. This is recognized by T lymphocytes (CD 4+) resulting in the release of cytokines (tumor necrosis factor, interleukin-2, interferon-gamma, and others). A genetic marker specific for Sjögren's syndrome, HLA-DR4, has been identified. According to the World Health Organization, the prevalence of Sjögren's syndrome is unknown. A recent epidemiologic study in Sweden estimated the prevalence in the adult population to be 2.7%. In the United States, 10 years ago, the number of patients with Sjögren's syndrome was thought to be fewer than 100,000. This number today is estimated to be more than 1 million. Sjögren's syndrome has been reported in nearly every major country of the world, and the geographic distribution of cases appears to be relatively uniform. Sjögren's syndrome typically affects women (90%) during the fourth or fifth decade of life. Isolated cases of Sjögren's syndrome in children have been reported.

Betaine-containing toothpaste relieves subjective symptoms of dry mouth.

Subjects with dry mouth often experience irritation of the oral mucosa when using sodium lauryl sulfate containing products for oral hygiene. Betaine, or trimethylglycine, reduces skin-irritating effects of ingredients of cosmetics such as sodium lauryl sulfate. The aim of the present study was to compare the effects of a betaine-containing toothpaste with a regular toothpaste on the oral microbial flora, the condition of the oral mucosa, and subjective symptoms of dry mouth in subjects with chronic dry mouth symptoms. Thirteen subjects with chronic dry mouth symptoms and with a paraffin-stimulated salivary flow rate < or = 1 mL/min participated in the double-blind crossover study. Ten subjects had a very low salivary flow rate (< or = 0.6 mL/min). The subjects used both experimental toothpastes (with or without 4% betaine) twice a day for 2 weeks. Oral examinations and microbiologic sample collections were made at the base lines preceding the two experimental periods and at the end. Standardized questions on subjective symptoms of dry mouth were used when the subjects were interviewed at the end of the two experimental periods. No study-induced significant changes were observed in the microbiologic variables (plaque index, mutans streptococci, lactobacilli, Candida species) or in the appearance of the oral mucosa. The use of the betaine-containing toothpaste was, however, associated with a significant relief of several subjective symptoms of dry mouth. Betaine appears thus to be a promising ingredient of toothpastes in general and especially of toothpastes designed for patients with dry mouth.

Clinical evaluation of the effect of a hydrogen peroxide mouth rinse, sodium bicarbonate dentifrice, and mouth moisturizer on oral health.

The objective of this 60-day single-blind, parallel trial, using 150 subjects, was to evaluate the effect of a 20% sodium bicarbonate dentifrice, a 1.5% hydrogen peroxide solution and a mouth moisturizer on oral tissues and microflora. Subjects were randomly assigned to one of five groups. The treatments were: 1) Sage dentifrice (sodium bicarbonate). Toothette Plus containing baking soda saturated with the hydrogen peroxide solution and use of a mouth moisturizer, 2) Crest dentifrice, Toothette Plus containing baking soda saturated with the hydrogen peroxide solution and use of a mouth moisturizer, 3) Crest dentifrice, Toothette Plus containing baking soda with a control solution and no mouth moisturizer, 4) Crest dentifrice, Toothette (without baking soda), saturated with a control solution and no mouth moisturizer, and 5) Crest dentifrice, Toothette saturated with 1.5% flavored H2O2 and no mouth moisturizer. From a subgroup of 35 patients (seven from each group) buccal smears for exfoliative cytology were taken as were supragingival microbiological samples from the mesial aspect of first molars (pooled). Buccal smears were evaluated for signs of histopathological changes. Microbiological samples from supra- and subgingival plaque for P. gingivalis, P. intermedia, A. actinomycetemcomitans. A viscosus, F. nucleatum, F. sanguis and C. albicans were evaluated. Clinical parameters measured were a stain index (SI), the modified gingival index (MGI), and a plaque index (PI). There were no adverse changes in the oral microflora and no anaplastic or other pathological changes in any subjects. Clinical parameters showed a statistically significant reduction in the MGI ranging from 26.7-29.9% with no significant differences among the groups (p > 0.05). The PI showed small reductions in all groups except group 2, but the differences were not statistically significant from each other or baseline (p > 0.05). The SI revealed slight increases in all groups and no differences among the groups. It can be concluded that use of Sage dentifrice, Toothette Plus saturated with Perox-A-Mint and Sage Mouth Moisturizer are safe to oral tissues. Using these components did not result in clinically noticeable stain formation, promote plaque formation, or produce any significant adverse changes in the oral microflora.

The use of polydimethylsiloxane in the treatment of incontinence after radical prostatectomy.

OBJECTIVE: To report the results of transurethral submucosal injection therapy of polydimethylsiloxane (PDS) to treat incontinence after radical prostatectomy (RP). PATIENTS AND METHODS: Since 1993, about 80 retropubic RPs have been carried out at our institution each year. Severe post-operative incontinence occurred in six patients, with a mean duration of incontinence after RP of 28 months. The pre-operative evaluation consisted of cysto-urethroscopy and urodynamics. Because we have no experience with artificial sphincter implantation, transurethral injection therapy was used to treat the post-operative incontinence, using PDS (vulcanized silicone rubber particles). This material has a mean particle size of 188 microns, providing stability of the material at the injection site. The six patients with severe post-operative incontinence were treated using injection therapy with PDS. RESULTS: After a mean follow up of 15.5 months, five patients, who suffered from day and night incontinence and required at least five pads per day, were dry after injection therapy. One patient improved significantly but still required two pads during the day, but was continent during the night; three patients required a second injection. A mean of 7.5 mL of PDS was used per patient and the side-effects of therapy (dysuria and urinary retention) were minimal. CONCLUSION: Because PDS has excellent biocompatibility, few side-effects or complications, transurethral injection therapy using silicone particles is a justifiable procedure for treating incontinence after RP.

Treatment for radiation-induced xerostomia. An innovative remedy.

Xerostomia continues to be a major complaint of patients who have had radiation therapy of the salivary glands and neck. This article describes the advantages and disadvantages of conventional treatment methods and introduces an innovative, yet inexpensive remedy that has produced favorable results for those afflicted with this chronic complication of therapy.