Systemic iodine absorption associated with the use of preoperative ophthalmic antiseptics containing iodine.

BACKGROUND: Polyvinylpyrrolidone-Iodine (PVP-I) is routinely used as preoperative antiseptic during ophthalmic surgery. Iodine absorption from iodine-containing antiseptics can lead to the development of thyroid disorders. Therefore, a quantitative measurement of iodine absorption from these antiseptics was performed in patients undergoing elective cataract surgery. METHODS: This study enrolled 241 patients to evaluate systemic iodine absorption after exposure to conjunctival and/or periorbital 1.25% and 10% PVP-I compared to an iodine-free antiseptic. RESULTS: All patients who received the 10% PVP-I regardless of the application site showed a 1.2-1.5-fold increase in urinary iodine excretion after 24 h (p = 0.01). In 17 out of 110 (15.5%) patients in whom 10% PVP-I was used, the critical threshold of urinary iodine excretion as defined by WHO (>300 µg/L) was exceeded. In contrast, no significant ioduria was observed with the use of 1.25% PVP-I except in patients after 48 h (p = 0.01) and with a concurrent conjunctival and periorbital application. The proportion of the excreted iodine in urine ranged from 0.24% to 1.77%. No correlation was found between the total applied concentration of iodine and the amount excreted in urine. CONCLUSION: Based on our findings, we believe that the use of 10% PVP-I as preoperative ophthalmic antiseptic should undergo further clinical evaluation in regard to its impact on thyroid function. Conjunctival or periorbital application of 1.25% PVP-I does not result in significant ioduria.

Ductoscopy-based descriptors of intraductal lesions and their histopathologic correlates.

BACKGROUND: In order to elucidate criteria for distinguishing benign from malignant lesions, this study correlated the ductoscopy-based macroscopic description of intraductal lesions with histopathologic results. MATERIALS AND METHODS: Aiming to use diagnostic criteria consistent with previous publications, we analyzed the literature and established a uniform set of diagnostic descriptors. Based on these criteria, we subsequently analyzed and catalogued video and photographic material from 68 patients with nipple discharge, who had undergone ductoscopy followed by open surgery. For all breast lesions, the factors lesion type, number of lesions, lesion color, surface characteristics, and presence of blood or atypical vessels were reported. Based on the frequency distribution and the odds ratio, we were able to evaluate the differential diagnostic value of ductoscopic criteria in comparison with the respective histopathologic results. RESULTS: Among the ductoscopic criteria, a fissured surface, hemorrhage or atypical vessels, and a polypoid appearance were important predictors for malignant lesions. In contrast, a smooth surface, the absence of hemorrhage and atypical vessels and a level appearance of the lesions predicted benign lesions. CONCLUSIONS: For predicting the benign versus malignant character of ductoscopic lesions, the following criteria should be used: presence or absence of blood and atypical vessels, surface type, and level versus polypoid appearance.

Analysis of pressure distribution below the metatarsals with different insoles in combat boots of the German Army for prevention of march fractures.

AIM: The aim of the present study was the assessment of metatarsal head loading in combat boots of the German armed forces. With respect to the prevention of metatarsal stress fractures, we evaluated how cushioning insoles (made of EVA foam or neoprene) achieved a load reduction in comparison with conventional insoles. MATERIAL AND METHODS: Local pressure, force and impulse values were determined with the pedar-m expert in-shoe pressure measurement system applied in 26 volunteers during walking with four different insoles made of synthetic mesh, EVA foam and neoprene. Data analysis was performed with SAS and tested for statistical differences with non-parametric tests (with p<0.05 as a significance level). RESULTS: For the peak pressures under the metatarsal heads (MT) the following order was found: MT-II>MT-III>MT-I>MT-IV>MT-V. A comparison of the insoles indicated that the neoprene insole resulted in the lowest peak pressures with significant load reductions under MT-III to MT-V (p<0.00001). Furthermore, the impulse values under MT-II to MT-V were significantly lower with neoprene insoles (p<0.0002). However, the subjects rated the conventional insoles as more comfortable and better fitting than the newly developed insoles. DISCUSSION/CONCLUSION: The cushioning insoles were superior to the conventional insoles with respect to the plantar pressure distribution. With respect to the load reduction we can conclude that the modified insoles might be able to reduce the incidence of march fractures. The biomechanical advantage does not appear to be related to personal preferences.

Influence of material properties on gloves' bacterial barrier efficacy in the presence of microperforation.

BACKGROUND: Medical examination gloves and surgical gloves protect the wearer directly and the patient indirectly from the risk of contamination. Because of concerns related to latex allergy, an increasing trend toward the use of synthetic gloves made of materials other than latex is observable. However, currently it is unknown if the physical properties of different materials may influence bacterial passage in case of a glove puncture. METHODS: We examined 9 different medical examination gloves from various manufacturers made of nitrile (n = 4), latex (n = 3), or neoprene (n = 2). Additionally, 1 latex surgical glove each with and without antibacterial chlorhexidine gluconate coating and 1 synthetic surgical glove made of thermoplastic elastomer were included in the experiments. The studied materials were perforated following a standardized procedure, and direct bacterial passage was measured under dynamic conditions. Glove elasticity at 1 cm up to 2.5 cm elongation was measured following EN 455-2. RESULTS: Nitrile gloves demonstrated higher material stiffness compared with latex gloves. Medical examination gloves made of nitrile and neoprene showed a 10-fold higher bacterial passage through a standardized puncture compared with latex gloves. All surgical gloves showed a lower bacterial passage compared with the tested examination gloves. CONCLUSION: Bacterial passage through punctures is correlated with the stiffness or elasticity of the glove material. Therefore, gloves made of latex may have an increased protective effect in case of a glove breach. Whenever gloves are purchased and selected, a risk-benefit assessment should be conducted, balancing the risk of allergy against the degree of required protection in case of a glove puncture.

Different risk factors in basaloid and common squamous head and neck cancer.

OBJECTIVES/HYPOTHESIS: The prevalence of human papillomavirus (HPV), herpes simplex virus (HSV), cigarette smoking and alcohol abuse was compared between two histological subgroups of head and neck cancer. STUDY DESIGN: Retrospective review. METHODS: Paraffin-embedded, histologically confirmed surgical specimens from the oropharynx, hypopharynx and larynx, comprising 67 conventional squamous cell carcinomas (SCC) and 10 basaloid squamous cell carcinomas (BSCC), were analyzed for the presence of HPV and HSV DNA using polymerase chain reaction (PCR) techniques. The PCR products were verified by direct sequencing. Patient charts were reviewed for clinical data and risk factors. RESULTS: Given an overall HPV DNA detection rate of 32.5%, a basaloid morphology of the carcinomas correlated significantly with occurrence of HPV DNA (P =.0001). An association could also be demonstrated between basaloid appearance and evidence of HSV DNA (single and combined with HPV DNA; P =.014 and 0.0429, respectively), even if this result based on a low overall HSV DNA detection rate (6.5%). Demonstration of viral DNA in the BSCC specimens was not related to tobacco or alcohol consumption. In contrast, cigarette smoking proved as significant characteristic of SCC (P =.0087). Alcohol abuse occurred also predominately in patients with SCC, but without statistical significance. CONCLUSION: These results hint at differences in the etiology of two distinct histological entities of head and neck cancer. Further research in this field could complete these preliminary data and provide the background for specific preventive strategies.

Crystal chemistry and electronic structure of the metallic lithium ion conductor, LiNiN.

The layered ternary nitride LiNiN shows an interesting combination of fast Li+ ion diffusion and metallic behavior, properties which suggest potential applications as an electrode material in lithium ion batteries. A detailed investigation of the structure and properties of LiNiN using powder neutron diffraction, ab initio calculations, SQUID magnetometry, and solid-state NMR is described. Variable-temperature neutron diffraction demonstrates that LiNiN forms a variant of the parent Li3N structure in which Li+ ion vacancies are ordered within the [LiN] planes and with Ni exclusively occupying interlayer positions (at 280 K: hexagonal space group Pm2, a = 3.74304(5) A, c = 3.52542(6) A, Z = 1). Calculations suggest that LiNiN is a one-dimensional metal, as a result of the mixed pi- and sigma-bonding interactions between Ni and N along the c-axis. Solid-state 7Li NMR spectra are consistent with both fast Li+ motion and metallic behavior.