Molten metal burns: further evidence of industrial foundries' failure to comply with Occupational Safety and Health Administration regulations.

The purpose of this report is to describe another case of a molten metal burn to the foot of a foundry worker. The foundry in which he worked failed to comply with Occupational Safety and Health Administration regulations with regard to protective apparel. This injury could have been prevented with annual, unscheduled inspections by the Occupational Safety and Health Administration and with enforcement of additional regulations regarding protective apparel.

Biomechanical performance of cutting edge surgical needles.

The purpose of this study was to compare the biomechanical performance of cutting edge needles made of S45500 stainless steel alloy to Surgalloy stainless steel. The new high-nickel stainless steel alloy, Surgalloy, has superior performance characteristics over that of the other high-nickel stainless steel alloy, S45500. The Surgalloy needle is produced from a stronger stainless steel alloy than the S45500 needle. The Surgalloy needle has considerably greater resistance to bending than the needle produced from S45500 alloy. In addition, Surgalloy stainless steel has almost a twofold greater resistance to fracture than the S45500 stainless steel alloy.

Metacarpophalangeal joint dislocation: indications for open surgical reduction.

In complex dislocations of the metacarpophalangeal joint, the volar plate is separated from the proximal phalanx and the metacarpal head is entrapped within surrounding tissue structures. These complex dislocations must be managed by open surgical reduction to reduce the dislocation and realign the volar plate. A 58-year-old male presented to the emergency department with a complex dislocation of the metacarpophalangeal joint of the left little finger, which was successfully treated by open reduction in the operating room. The indications for open reduction of metacarpophalangeal joint dislocations are reviewed.

Technical considerations in knot construction. Part II. Interrupted dermal suture closure.

The purpose of this study was to identify the optimal knot construction for interrupted dermal sutures. A synthetic braided absorbable suture, sizes 3-0 and 5-0, was selected for this evaluation. With reproducible mechanical performance tests, we determined that the construction of secure knots without ears required one additional throw as compared with secure knots with 3-mm ears. The direction of applied tension did not alter knot security, with the exception of granny knots, which required an extra throw when tension was applied parallel to the suture loop. Because interrupted dermal knot construction is accomplished without knot ears and with an applied tension parallel to the wound, one additional throw must be added to the knot to ensure knot security.

Surgical glove lubricants: from toxicity to opportunity.

In most emergency departments, surgical gloves are coated with surface powders that act as lubricants to facilitate donning. Cornstarch powder is an absorbable powder employed as a donning agent on most powdered gloves. Talcum powder, a nonabsorbable powder, is used as a mold release agent in glove manufacture and is still commonly found on the surfaces of modern surgical gloves. These powders are foreign bodies that elicit inflammatory responses, leading to a wide number of symptoms and complications. The best method of preventing clinical complications from glove powder is to use powder-free gloves.

A new computerized control unit for small bone surgical instruments.

The SmartDrive console represents an important advance in small bone surgery because it monitors and coordinates the operation of its handpieces. The SmartDrive console has the following unique features: 1) a handpiece recognition system; 2) an instrument speed display; 3) a handpiece display and monitoring system; 4) a torque instrument control system; 5) a temperature monitoring system; 6) and an irrigation system. Mechanical performance studies have been undertaken that have validated the accuracy of the monitoring systems of the consoles. The consoles provided reliable recordings of the rotational speeds of their hi-speed drills. The MicroAire console automatically shuts off its power as the temperature increased to 110 degrees F (43 degrees C). In contrast, the Stryker Command 2 console has a limited monitoring system that can not alter the operation of the handpieces.

Peritoneal healing with adhesion formation: current comment.

Intra-abdominal adhesions are fibrotic structures, which lie in the form of a string or attachment between the abdominal organs and connect these together. They are responsible for serious clinical complications that include intestinal obstruction, infertility, and pelvic pain. During the last century, surgeons' comprehensive understanding of the biology of peritoneal healing and wound repair has allowed them to identify a variety of new therapeutic techniques that limit the development of adhesion formation. New drugs, dextran 70 and poloxamer 407, have been developed to prevent adhesion formation. In addition, three new biomaterials (oxidized regenerated cellulose, hyaluronate membrane, and polytetrafluoroethylene) are synthetic barriers being used to prevent adhesions.

Biomechanical performance of a braided absorbable suture.

Lactomer and Polyglactin 910 sutures are both made of copolymers of lactide and glycolide. Biomechanical performance tests demonstrated superior handling characteristics of the Lactomer sutures. Using sutures comparable in size and knot construction, the Lactomer sutures exhibited knot holding force superior to the Polyglactin 910. Moreover, the low knot rundown forces encountered by the Lactomer sutures facilitated construction of secure knots that failed by breakage rather than by slippage.

Evolution of hydrogel polymers as contact lenses, surface coatings, dressings, and drug delivery systems.

Hydrogel polymers are hydrophilic resins that display excellent biocompatibility, which has allowed their application in diverse fields of surgery and medicine. The original hydrogel polymer, a copolymer of 2-hydroxyethyl methacrylate and ethylene dimethacrylate, was developed by Wichterle and Lim in 1954. The development of the first soft hydrogel contact lenses by Wichterle in 1961 represented the first successful clinical application of hydrogel polymers and remains one of the most important uses of hydrogels today. The biocompatibility of hydrogel polymers may be adapted to diverse tissue types by small variations in the makeup of the polymer, including varying the type and amount of monomers and differing the amounts and characteristics of the cross-linking agents used to create the polymer chains. Hydrogels have been successfully developed for use as coatings, soft contact lenses, wound dressings, and drug delivery systems.

Characterization of GABAergic neurons in hippocampal cell cultures.

The morphological characteristics of GABAergic neurons and the distribution of GABAergic synaptic terminals were examined in cultures of hippocampal neurons from 4-35 days in vitro. Neurons expressing GABA immunoreactivity represented about 6% of the total number of cultured neurons at all time points. Although the morphological characteristics of GABAergic cells suggested a heterogeneous population, GABAergic cells as a class were notably different from the non-GABAergic, presumably pyramidal cells. Most GABAergic cells had more fusiform or polygonal shaped somata, non-spiny and less tapering dendrites and appeared more phase-dense than nonGABAergic cells. Quantitative analysis revealed that GABAergic cells had fewer primary dendrites, more elongated dendritic arbors, and longer dendritic segments than non-GABAergic neurons-characteristics that are similar to GABAergic cells in situ. Double immunostaining revealed that GAD65-positive varicosities were also immunopositive for synapsin I, suggesting that GAD65-positive varicosities that contacted somata and dendrites represented presynaptic specializations. Confocal microscopy revealed the proportion of the synaptic specializations on the cell soma that were GAD65-positive was greater than on the dendrites, suggesting that somata and dendrites differ in their ability to induce the formation of presynaptic specializations by GABAergic axons. These data indicate that the GABAergic cells that develop in culture exhibit distinctive morphological characteristics and participate in different synaptic interactions that nonGABA cells. Thus many of the features that distinguish GABAergic neurons in culture are reminiscent of the characteristics that distinguish GABAergic neurons in situ.