The broken needle: report of case.

After any patient who is to receive a local anesthetic has given informed consent about the possibility of broken instruments, the practitioner should carefully prepare the patient and instrumentation for a successful anesthetic. If a needle does break and cannot be immediately removed, the practitioner should not try to retrieve it. The patient should be referred to a knowledgeable specialist familiar with the detailed anatomy of the head and neck and the surgical removal of foreign bodies from the same.

A double-blind crossover comparison of topical anesthetics.

Three topical anesthetics and a placebo were compared in 102 separate trials. The degree of anesthesia produced with each agent was determined by placing a needle in the palate near the palatal foramen. Pain produced was rated by the participants on a scale from 1 to 5.

Management and treatment of a mandible fracture in an athlete.

The purpose of this paper is to demonstrate a treatment program that may permit a student-athlete who has a mandible fracture to continue participation in a sport without further jeopardizing his or her health. This article is based on an actual case in which a student-athlete sustained a mandible fracture during an intercollegiate basketball game. Within 24 hours, the injured athlete resumed basketball practice. Three days following the injury, he was permitted to compete in a game. In addition to recommendations regarding acute care, we discuss protective equipment, follow-up guidelines, and nutritional considerations. These guidelines may assist the sports medicine team in determining when an athlete with a mandible fracture can return to competitive and contact sports.

The degradation of paracetamol (4-hydroxyacetanilide) and other substituted acetanilides by a Penicillium species.

A mould which was isolated from a solution of paracetamol was identified as a Penicillium species and was found to possess the ability to utilise a series of substituted acetanilides, including paracetamol (4-hydroxyacetanilide), phenacetin (4-ethoxyacetanilide) and metacetamol (3-hydroxyacetanilide) as sole carbon sources for growth. Studies with washed-cell suspensions indicated that growth of the Penicillium isolate in the presence of paracetamol induced the respective enzyme systems for the degradation of this compound. Manometric studies measuring oxygen uptake rates, indicated that the mould was capable of degrading paracetamol to acetate and 4-aminophenol. Acetate was further metabolised whilst 4-aminophenol accumulated in the growth medium and was subsequently i-entified by UV spectroscopy and thin-layer chromatography. Similar experiments with phenacetin indicated metabolism by the mould to acetate and 4-ethoxyaniline which was isolated and identified by subsequent analysis of the growth medium. However, unlike 4-aminophenol and 4-ethoxyaniline, the degradation product (3-aminophenol) from metacetamol metabolism was further degraded by the mould.

Vascular penetration following intraligamental injection.

The potential for inadvertant intravascular injection of a local anesthetic solution with the intraligament injection syringe is described. The spread of solution is radiographically demonstrated, and precautions during the use of the procedure are suggested.

Conversion phenomenon following general anesthesia.

Two cases have been presented that demonstrate a previously undescribed complication of general anesthesia, i.e., altered recovery of consciousness secondary to hysterical conversion reactions. This potential complication must be considered when an organic cause for the symptoms cannot be found in a psychologically unstable individual. A helpful diagnostic sign is described. Consultation with a psychiatrist is mandatory if immediate alleviation of the symptoms is not obtained by the anesthesiologist and/or the surgeon.