Acute Cartilage Injury Induced by Trans-Articular Sutures

Objective To determine the extent of acute cartilage injury by using trans-articular sutures. Methods Five different absorbable sutures, monofilament polydioxanone (PDS) and braided polyglactin (Vicryl), were compared on viable human osteochondral explants. An atraumatic needle with 30 cm of thread was advanced through the cartilage with the final thread left in the tissue. A representative 300 μm transversal slice from the cartilage midportion was stained with Live/Dead probes, scanned under the confocal laser microscope, and analyzed for the diameters of (a) central “Black zone” without any cells, representing in situ thread thickness and (b) “Green zone,” including the closest Live cells, representing the maximum injury to the tissue. The exact diameters of suture needles and threads were separately measured under an optical microscope. Results The diameters of the Black (from 144 to 219 µm) and the Green zones (from 282 to 487 µm) varied between the different sutures ( P < 0.001). The Green/Black zone ratio remained relatively constant (from 1.9 to 2.2; P = 0.767). A positive correlation between thread diameters and PDS suturing material, toward the Black and Green zone, was established, but needle diameters did not reveal any influence on the zones. Conclusions The width of acute cartilage injury induced by the trans-articular sutures is about twice the thread thickness inside of the tissue. Less compressible monofilament PDS induced wider tissue injury in comparison to a softer braided Vicryl. Needle diameter did not correlate to the extent of acute cartilage injury.

Comparing the Incidence of Postdural Puncture Headache After Diagnostic Lumbar Puncture due to 22 Gauge Standard Versus 25 Gauge Atraumatic Needle : A Randomized Controlled Trial

Background: There is growing evidence that the incidence of Postdural Puncture Headache (PDPH) after Lumber Puncture (LP) with the smaller, non-cutting needle is less. Nevertheless, larger, cutting needles are still widely used for this procedure in Bangladesh. The aim of this study was to compare the incidence and severity of PDPH between 22 G standard needle and 25 G atraumatic needle for diagnostic LP in patients with neurological symptoms. Methods and materials: This single-blind, randomized, controlled trial was carried out in Department of Neurology, Chittagong Medical College Hospital, during February 2017 to January 2018. One hundred consecutive patients admitted in Neurology ward fulfilled the set inclusion and exclusion criteria were enrolled in the study and randomly divided into two equal groups: Group A (LP was done with 22 G standard needle) and Group B (LP was done with 25 G atraumatic needle). The incidence and severity of PDPH was interviewed on day 5 following LP. Results: Effective sample size was 99 (50 in Group A and 49 in Group B) as one patient was dropped out. Both groups were similar in terms of baseline sociodemographic and clinical characteristics. LP was successful in first attempt in 25 (50%) and 28 (57.8%) patients in Group A and Group B respectively. Incidence of PDPH was significantly higher in Group A than Group B. Severity of PDPH was also significantly higher in Group A than in Group B with regards to presence of moderate degree of PDPH. Analgesics use was significantly less in Group B in comparison to Group A. Absolute adjusted risk of mild to moderate PDPH with 25G atraumatic needles was reduced by 3.74 times (95% CI: 1.22-11.44) compared to 22 G standard needle. Conclusion: 25 G atraumatic needles significantly reduced the incidence and severity of PDPH as compared to 22G standard needle. So, using 25 G atraumatic needle would be beneficial for diagnostic LP procedure. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 67-71

Closing a longitudinal defect on a caudal hollow vein by using the technique for connecting paravasal tissues with adventitia of parallel going artery

This article describes the use of the tech-nique for connection of paravasal tissues with adventitia of a parallel-going artery to close a longitudinal defect up to 2 millime-ters long in the caudal vena cava. The study was conducted on 6 male white rats. The goal of our work was to evaluate the effec-tiveness of haemostasis by using the method of connecting paravasal tissues of the caudal vena cava with adventitia of a parallel-running artery. All surgical interventions were performed under general anesthesia, in compliance with the rules of aseptics and antiseptics. A vessel defect was created by dissecting its paravasal tissue and the vein wall in the longitudinal direction with the tip of a 21G injection needle, then it was removed by connecting the paravasal tissue of the caudal vena cava and the aorta adventitia. For this, 2 sutures were applied by using Nylon USP 9-0 with a pricking atraumatic needle. The time taken to close the defect and the effec-tiveness of haemostasis were evaluated. As a result of the studies, we came to the follow-ing conclusions: the average time taken to close the defect was 3.3 ± 0.34 minutes. Un-like the classical method, we do not waste time isolating the vessel from surrounding tissues and the parallel artery, and also the suture is not placed through all layers of the vessel, causing a traumatic effect on the inti-ma. This technique is effective for haemo-stasis, in five out of six cases, the blood stopped 4 minutes after the closure of the defect on the vessel. And in one of six cases, blood stopped 6 minutes after the closure of the defect.

THUR 264 Multimodal intervention to improve lumbar puncture

IntroductionLumbar puncture (LP) is a routine procedure performed for diagnostic and therapeutic indications for more than 120 years.1 For as long, post-dural puncture headache (PDPH) has been a complication that can be persistent and severe.2 Finer gauge needles and ‘atraumatic’ needle designs3 significantly reduce the incidence of PDPH.4–6MethodsA multimodal intervention consisting of teaching session on atraumatic needle usage, simulation training with 25G Sprotte needles, and electronic LP proforma was introduced in October 2017.Records for all patients having LP in the Neurology day-case unit at the John Radcliffe Hospital, Oxford, in the months of November 2016 and Nov/Dec 2017 were retrospectively reviewed for documentation and atraumatic needle usage.Results39 records were reviewed from Nov/Dec 2017 and 16 from November 2016. Documentation was significantly improved across all criteria assessed except for documentation of informed consent. Atraumatic needle usage increased from none documented pre-intervention to 38% (n=11 out of 29 where atraumatic needle indicated) post intervention.ConclusionProforma use was associated with improved LP documentation. Atraumatic needle usage increased significantly post-intervention. These results are consistent with previous studies on changing behaviour in LP technique in neurology.7 Large scope for further improvement exists.Abstract THUR 264 Figure 1References1. Quincke H. Die Lumbalpunction des Hydrocephalus -Heinrich Quincke -Google Books 1891. Klin. Wochenschrist. pp. 929–965.2. Greene HM. Lumbar puncture and the prevention of postpuncture headache. JAMA J. Am. Med. Assoc 1926;86:391.3. Hart JR, Whitacre RJ. Pencil-point needle in prevention of postspinal headache. J. Am. Med. Assoc 1951;147:657.4. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: A randomized comparison of five spinal needles in obstetric patients. Anesth. Analg 2000;91:916–20.5. Thomas SR, Jamieson DR, Muir KW. Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture. BMJ 2000;321:986–90.6. Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses. Anesthesiology 1994;81:1376–83.7. Davis A, et al. Change practice now! Using atraumatic needles to prevent post lumbar puncture headache. Eur. J. Neurol 2014;21:305–11.

Application of keratoxenoimplant in the cases of experimental chemical burn of the cornea associated with hypothyroidism

<p>The article analyzes the efficacy of keratoimplant of pigs in rabbits with corneal chemical burns with underlying<br />merkazolil-induced hypothyroidism. Hypothyroidism in rabbits was caused by injection of merkazolil at a dose of<br />10 mg/kg during 60 days. Chemical burn of the cornea was simulated by applications on the cornea of experimental<br />animals filter paper of 5 mm in diameter soaked in a solution of 1 N sodium hydroxide (NaOH) during 30 seconds.<br />With the purpose of surgical correction the place of burn injuries was covered with keratoxenoimplant which was sewn<br />in 4 places (after 12, 15, 18 and 21 hours) to the sclera through the conjunctiva with the help of atraumatic needle<br />8/0 nylon. It was established that corneal burn injury in rabbits with hypothyroidism ran against the background of<br />oppression of nonspecific factors of protection, more expressive growth of endogenous intoxication, depression of<br />antioxidant protection as compared to euthyroid animals with simulated chemical burn of the cornea. Application of<br />keratoxenoimplant contributed to the normalization of the studied parameters and faster healing of burn wounds. It<br />was concluded that the application of keratoxenoimplant under conditions of chemical burn of the cornea positively<br />affected the course of the burn process and promoted more rapid restoration of the integrity of the cornea.</p>

DESIGNING AN INFORMATION RESOURCE TO EXPLAIN DIAGNOSTIC LUMBAR PUNCTURE AND PROMOTE BEST PRACTICE

IntroductionThe lumbar puncture (LP) procedure is an important test in neurological practice. Appropriate information is key to both preparing patients for this invasive procedure and facilitating use of atraumatic LP needles to minimize adverse effects such as local pain and post-LP headache.MethodsA cross-disciplinary team (designers, clinicians and people with multiple sclerosis (pwMS)) developed a website to explain the LP procedure at The Royal London Hospital (Barts Health NHS Trust, UK). User testing was carried out to review both the visual design and functionality of the resource for people with visual and cognitive limitations.ResultsAfter successful testing www.clinicspeak.com/LumbarPuncture is being used in the informed consent process for clinical trials involving pwMS at our institution and is being piloted in our day unit and A&E departments. The website includes what to expect, how to deal with adverse effects, why cerebrospinal fluid is examined and information on the atraumatic needle.ConclusionThe resource provides an appropriate way of communicating sensitive, yet important information to patients. It also demonstrates an innovative way of spreading best practice and encourages the widespread adoption of atraumatic needles for LP in both clinical and research settings. The resource will be demonstrated at the meeting.