Insulin syringe for anesthesia in ptosis surgery: a randomized, fellow eye-controlled clinical study.

PURPOSE: Unlike ordinary 30-gauge needles, insulin syringe needles are thinner and shorter and have a comparatively blunt tip. Therefore, insulin syringes may reduce injection discomfort, bleeding, and edema by minimizing tissue damage and vascular penetration. This study aimed to evaluate the potential benefits of using insulin syringes for local anesthesia in ptosis surgery. METHODS: This randomized, fellow eye-controlled study included 60 patients (120 eyelids), conducted at a university-based hospital. An insulin syringe was used on one eyelid, and a conventional 30-gauge needle was used on the other. Patients were instructed to score pain in both eyelids using a visual analog scale (VAS) ranging from 0 (no pain) to 10 (unbearable pain). Ten minutes after the injection, two observers scored degrees of hemorrhage and edema in both eyelids on five- and four-pointing grading scales (0-4 and 0-3) for each value, and the average score between the two observers was calculated and compared. RESULTS: The VAS score was 5.17 in the insulin syringe group and 5.35 in the 30-gauge needle group (p = 0.282). Ten minutes after the anesthesia, the median hemorrhage scores were 1.00 and 1.75 (p = 0.010), and the median eyelid edema scores were 1.25 and 2.00 (p = 0.007) in the insulin syringe and 30-gauge needle groups, respectively (Fig. 1). CONCLUSION: Injecting local anesthesia using an insulin syringe significantly reduces hemorrhage and eyelid edema, but not injection pain, before skin incision. Insulin syringes are useful in patients at high risk of bleeding because they can reduce the penetrative tissue damage caused by needle insertion.

Transfer of metallic debris from the metal surface of an acetabular cup to artificial femoral heads by scraping: comparison between alumina and cobalt-chrome heads.

We aimed to investigate the transfer of metal to both ceramic (alumina) and metal (cobalt-chrome) heads that were scraped by a titanium alloy surface under different load conditions. The ceramic and metal heads for total hip arthroplasties were scraped by an acetabular metal shell under various loads using a creep tester. Microstructural changes in the scraped area were visualized with a scanning electron microscope, and chemical element changes were assessed using an energy dispersive X-ray spectrometry. Changes in the roughness of the scraped surface were evaluated by a three-dimensional surface profiling system. Metal transfer to the ceramic and metal heads began to be detectable at a 10 kg load, which could be exerted by one-handed force. The surface roughness values significantly increased with increasing test loads in both heads. When the contact force increased, scratching of the head surface occurred in addition to the transfer of metal. The results documented that metallic debris was transferred from the titanium alloy acetabular shell to both ceramic and metal heads by minor scraping. This study suggests that the greatest possible effort should be made to protect femoral heads, regardless of material, from contact with metallic surfaces during total hip arthroplasty.

The effects of a bioabsorbable barrier membrane containing safflower seed extracts on periodontal healing of 1-wall intrabony defects in beagle dogs.

BACKGROUND: Recently, there has been much research done into the regenerative potential of materials used in oriental medicine. In several studies, evidence was found that these materials have an effect on bone regeneration. Among these materials, safflower seeds are of particular interest as they have been used for the treatment of blood stasis, bone fracture, and osteoporosis in traditional Korean medicine. In addition, they are known to have anti-inflammatory effects. The objective of this study is to evaluate the periodontal tissue regenerative effects of a bioabsorbable barrier membrane (polylactide glycolic acid electro-spun non-woven membrane) containing safflower seed extracts applied to surgically created 1-wall intrabony defects in beagle dogs. METHODS: One-wall intrabony defects were surgically created bilaterally at the mesial and distal sides of the mandibular second premolars and mesial side of the fourth premolars. These defects were randomly assigned either to the surgical control group which received a flap operation only or to one of two experimental groups consisting of defects which received a guided tissue regenerative procedure with either a bioabsorbable membrane (PLGA) or a bioabsorbable membrane containing safflower seed extracts (SSE/PLGA). The dogs were sacrificed 8 weeks after the operation, and a comparative histological examination was done. RESULTS: The new cementum formation was 2.49+/-0.41 mm in the surgical control group, 3.22+/-0.35 mm in the PLGA group, and 3.67+/-0.82 mm in the SSE/PLGA group. The extent of new cementum formation in barrier groups was significantly different from the surgical control group (P <0.05). The amount of intrabony cementum was 1.75+/-0.06 mm, 2.40+/-0.33 mm, and 2.70+/-0.81 mm for the surgical control group, the PLGA group, and the SSE/PLGA group, respectively; the amount of infrabony cementum in the barrier groups was significantly different from the surgical control group (P<0.05). The value of the suprabony cementum was 0.73+/-0.48 mm, 0.82+/-0.21 mm, and 0.97+/-0.09 mm for the surgical control group, the PLGA group, and the SSE/PLGA group, respectively, with no significant differences being observed among the treatments. The amount of new alveolar bone formation was 1.74+/-0.25 mm, 2.36+/-0.30 mm, and 2.64+/-0.74 mm for the surgical control group, the PLGA group, and the SSE/PLGA group, respectively, with a significant difference exhibited between the surgical control group and other groups (P <0.05). Superficial root resorption was often observed, but ankylosis was not present. CONCLUSION: Our results suggest that surgical application of polylactide glycolic acid non-woven membrane with or without safflower seed extract could promote the regeneration of alveolar bone and cementum in intrabony periodontal defects.

Alumina-on-alumina total hip arthroplasty. A five-year minimum follow-up study.

BACKGROUND: Ceramic-on-ceramic couplings are attractive alternative bearing surfaces that have been reported to eliminate or reduce problems related to polyethylene wear debris. Disappointing experiences with alumina ceramic bearings in the past have led to many improvements in the manufacture and design of ceramic implants. The purpose of the present study was to report the results of contemporary alumina-on-alumina total hip arthroplasties with regard to wear, osteolysis, and fracture of the ceramic after a minimum duration of follow-up of five years. METHODS: We evaluated the results of a consecutive series of 100 primary alumina-on-alumina total hip arthroplasties that had been performed with use of a metal-backed socket and a cementless stem in eighty-four patients. All of the patients were sixty-five years of age or younger (mean age, forty-one years), and a single surgeon performed all of the procedures. After a minimum duration of follow-up of sixty months, one patient (one hip) had died and four patients (six hips) had been lost to follow-up, leaving a total of seventy-nine patients (ninety-three hips) available for study. All of these patients were evaluated clinically and radiographically with special attention to wear, periprosthetic osteolysis, and ceramic failure. RESULTS: The mean Harris hip score was 97 points at the time of the latest follow-up evaluation. All prostheses demonstrated radiographic evidence of bone ingrowth. No implant was loose radiographically, and no implant was revised. Ceramic wear was not detectable in the thirty-seven hips in which the femoral head could be differentiated from the cup on radiographs. Periprosthetic osteolysis was not observed in any hip. A fracture of the alumina femoral head and a peripheral chip fracture of the alumina insert occurred in one hip following a motor-vehicle accident. CONCLUSIONS: The results of contemporary alumina-on-alumina total hip arthroplasty with a metal-backed socket and a cementless stem were encouraging after a minimum duration of follow-up of five years. We believe that these improved alumina-on-alumina bearing implants offer a promising option for younger, active patients.