Revolutionary advances in organic foods.

'Organic' is a labelling term that denotes products produced under the authority of the Organic Foods Production Act. Before a product can be labelled 'organic', a government-approved certifier inspects the farm where the food is grown to make sure the farmer is following all the rules necessary to meet the US Department of Agriculture (USDA) organic standards. Companies that handle or process organic food before it gets to your local supermarket or restaurant must be certified, too. Along with the national organic standards, the USDA developed strict labelling rules to help consumers know the exact content of the food they buy. It is important to emphasise that the USDA has not made any health claims for organic foods. It is indeed fortunate that the US Department of Health and Human Services, Centers for Disease Control and Prevention, USDA and the Environmental Protection Agency are now expanding their research to explore the scientific basis for the health benefits of organic foods.

Hazards of powder on surgical and examination gloves: a collective review.

This article reviews information on the hazards associated with dusting powders on latex surgical and examination gloves. Dusting powders were first applied to latex gloves to facilitate donning. After 1980, manufacturers devised innovative techniques to manufacture gloves without dusting powders. It has been well documented that the powders on gloves present a health hazard to patients, as well as to operating-room personnel. First, these powders elicit tissue toxicity in every tissue in the body. Second, these powders serve as carriers of latex allergen and may precipitate a life-threatening allergic reaction in sensitized patients. These well-documented hazards of glove powders have caused a growing number of hospitals in the world to abandon the use of examination and surgical gloves coated with powder, and instead to use only powder-free gloves.

The scientific basis for selecting surgical sutures.

The purpose of this study was to examine the handling properties of synthetic absorbable and monofilament polypropylene sutures made by two different manufacturers and to compare a subjective evaluation by surgeons to the results of standardized biomechanical performance tests. The surgeons' clinical subjective evaluation of the monofilament polypropylene sutures correlated with the results of the biomechanical performance studies, whereas the biomechanical evaluation of the two synthetic absorbable sutures detected notable differences in their performance. These distinct differences in biomechanical performance of the absorbable sutures did not alter their performance in the subjective clinical evaluation.

An innovative absorbable coating for the polybutester suture.

The polybutester (PBE) suture has been coated with an absorbable polytribolate polymer that is composed of glycolide (9%), epsilon-caprolactone (51%), and poloxamer 188 (40%) to reduce its drag forces. It is the purpose of this study to document the influence of this coating on the biomechanical performance of both PBE sutures and polypropylene (PP) sutures. The performance parameters evaluated were breaking strength, elongation, stiffness, knot security, knot run down, and tissue drag. The breaking strength of PP sutures was remarkably similar to that of coated and uncoated PBE sutures. In size 5/0 PP sutures, the sutures exhibited considerably greater elongation at knot break than did comparably sized PBE sutures. The PBE suture elongated under low loads, but returned to its original length when the load was removed. In contrast, the PP suture elongated irreversibly at high loads, exhibiting creep. Coated and uncoated PBE sutures exhibited less stiffness than PP sutures and exhibited limited memory after removal from the suture package. Coating the PBE suture markedly reduced its drag forces in musculoaponeurotic, colonic, and vascular tissue. Knot security with the coated PBE suture was achieved with only one more throw than with comparably sized uncoated PBE sutures. On the basis of the results of this study, coating the PBE suture represents another major advance in suture performance.

Biomechanical performance of new cardiovascular needles.

Cardiovascular needles are now being manufactured from new stainless steel alloys containing high concentrations of nickel, Surgalloy and Ethalloy. The purpose of this study was to compare the biomechanical performance of a cardiovascular needle made of Surgalloy with a comparably sized needle made of Ethalloy. The parameters of biomechanical performance included sharpness, maintenance of sharpness, resistance to bending, and ductility. Because the biomechanical performance of these needles was remarkably similar, cardiovascular needles made of either the Surgalloy or Ethalloy alloys are recommended for cardiovascular surgery.

Revolutionary advances in skin stapling: a collective review.

The purpose of this article is to provide a collective review of the literature on skin staplers. On the basis of this review, the Auto Suture Multifire Premium, with its regular and wide metal staples, is recommended for skin closure. The Auto Suture Multifire Graftac-S is ideally suited for skin-graft fixation, because it delivers an absorbable staple that usually does not have to be removed from the healing graft. Dermal skin closure can now be achieved using the Auto Suture SQS-20, which coapts the cut dermal edges with an absorbable straight pin. Dermal wound approximation can be accomplished in significantly less time than dermal suture closure.

5th Annual David R. Boyd, MD Lecture: Revolutionary advances in wound repair in emergency medicine during the last three decades. A view toward the new millennium.

This lecture provides an overview of advances in wound repair devised by our multidisciplinary team of physicians, scientists, and students. Our collective efforts have devised products, drugs, and concepts that are facilitating wound repair without infection and with the least possible scar. Some of the beneficial products and drugs developed or identified by our laboratory include nitrile examination and surgical gloves, magnification loupes, high pressure syringe irrigation, Shur Clens, as well as a wide variety of different wound closure techniques. In addition, our studies of the mechanism of wound injury, soil infection-potentiating fractions, dynamic and static skin tensions, and microflora of the skin have become important predictors of the outcomes of wound repair. During the new millennium, the computerized clinical information system as well as studies of tissue regeneration should dramatically change our approaches to wound repair.

Denture esophageal impaction refractory to endoscopic removal in a psychiatric patient.

Impaction of dental prostheses is frequently encountered in psychiatric patients. These patients may present an especially challenging problem because the diagnosis may be delayed, resulting in increased morbidity and mortality. Delay in diagnosis in such patients has been attributed to their inability to give a reliable clinical history. In addition, radiolucent dentures cannot be easily detected by radiographic examination. The purpose of this report is to describe a psychiatric patient with an impacted radiopaque dental prosthesis that was refractory to endoscopic intervention. An esophagotomy was needed to successfully remove the foreign body.

A global inventory of hospitals using powder-free gloves: a search for principled medical leadership.

Scientific experimental and clinical studies have demonstrated that cornstarch on surgical and examination gloves promotes disease by acting as a reactive foreign body in tissue and serving as a vector for latex allergy. Consequently, hospitals have selected an innovative glove selection program utilizing only powder-free gloves. Healthcare workers in emergency medical systems are now wearing powder-free, latex-free gloves to care for the growing number of patients sensitized to latex. A global Internet search has now identified 70 hospitals in the United States and three hospitals in Europe that use only powder-free gloves.

Global epidemic of human T-cell lymphotropic virus type-I (HTLV-I).

Infection with human T-cell lymphotrophic virus-I (HTLV-I) is now a global epidemic, affecting 10 million to 20 million people. This virus has been linked to life-threatening, incurable diseases: adult T-cell leukemia/lymphoma (ATLL) and HTLV-I-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The cumulative lifetime risk of developing these incurable diseases is approximately 5% in asymptomatic patients. For the emergency physician practicing among patients from high-risk groups, HTLV-I and its associated diseases are presenting an increasing challenge. This report describes its transmission, seroprevalence, treatment, and methods of controlling spread of this retrovirus. Coinfection with HTLV-I and HIV has been shown to accelerate the progression of acquired immune deficiency syndrome (AIDS).

Biomechanical performance of silicone and latex external condom catheters.

Standard in vivo biomechanical performance tests and a pilot clinical study of latex external condom catheters (ECCs) and silicone ECCs demonstrated the superior performance of the silicone ECC over that of the latex ECC. The silicone ECC has a self-adhesive that binds more securely to human skin than the self-adhesive of latex ECC. In addition, the moisture vapor transmission through silicone is significantly greater than through latex. The aggressive self-adhesive of the silicone ECC significantly reduced ECC catheter pop-off compared to that of latex ECC. Silicone ECC removal can be facilitated by the application of a warm, wet cloth to the exterior surface of the silicone ECC, which significantly reduces its self-adhesive force. Constant, gentle traction is then applied to the silicone catheter outlet end to achieve atraumatic silicone ECC removal. On the basis of the results of these standardized tests and pilot study, the silicone ECC is recommended for incontinent men without obstructive uropathy.

Biomechanical performance of powder-free examination gloves.

Biomechanical performance studies were undertaken for powder-free, latex and nitrile examination gloves. Using standardized tests, examination glove performance was judged by measuring glove thickness, glove puncture force, glove tape adhesion force, glove donning force, glove stiffness, and immediate unrecovered stretch. Even though the nitrile examination gloves were thinner than the latex examination gloves, they exhibited a greater puncture resistance. In addition, tape adherence to the N-Dex nitrile glove was the lowest. Moreover, measurements of the handling characteristics of the nitrile examination gloves demonstrated that they are an acceptable alternative to latex examination gloves. While these biomechanical studies demonstrate the superiority of the nitrile examination gloves, clinical glove evaluation is still needed to determine their performance in the health care setting.

Biomechanical performance of latex and non-latex double-glove systems.

The purpose of this study was to evaluate ten commercially available latex, powder-free surgical gloves and four commercially available non-latex, powder-free surgical gloves using standardized, reproducible biomechanical parameters that included glove thickness, puncture resistance, and glove donning force. For all gloves tested, with one exception (Neolontrade mark PF), puncture resistance increased for double-gloves as compared to single-gloves. In addition, single-glove thickness was not a reliable determinant of puncture resistance for either latex or non-latex gloves. For the latex gloves, the Ultrafree double and single-gloves exhibited the highest puncture resistance. The glove donning forces for the Biogeltrade mark M and Biogel Sensortrade mark single-gloves were the lowest. In contrast, the Biogel Revealtrade mark and Encoretrade mark Ultra-Thick exhibited the lowest double-glove donning forces. On the basis of these performance tests of latex gloves, the surgeon should consider the Biogel Reveal as well as the Ultrafree gloves for their latex double-glove system. For the non-latex gloves, the Pure Advantage Nitriletrade mark glove had the highest puncture resistance for one layer and two layers of glove material. The thin Pure Advantage Nitrile glove was the most resistant to glove puncture. The Pure Advantage Nitrile glove had low glove donning forces for both single-glove donning configurations and double-glove donning configurations. Consequently, we recommend the Pure Advantage Nitrile glove as the powder-free, non-latex, double-glove system.

Trigeminal neuralgia: a diagnostic challenge.

A 38-year-old white woman came to the emergency department complaining of severe, unilateral jaw pain. She had consulted her primary care physician and dentist without achieving the correct diagnosis or significant relief of her symptoms. The emergency physician made the diagnosis of trigeminal neuralgia by obtaining a history of severe paroxysmal ipsilateral facial pain activated by numerous facial stimuli. A light stimulation of the trigger point precipitated the pain. Her pain relief from carbamazepine lent further credence to the diagnosis of trigeminal neuralgia and appropriate referral to a neurosurgeon. Pain relief was ultimately achieved for the last 8 months by a neurectomy of the right infraorbital nerve.