Port Pocket Infections: Hydrogel Reduces Time to Healing and Clinic Visits Compared with Iodoform Gauze.

Pocket infections are an occasional complication of totally implanted central venous catheters. The purpose of this study was to compare the safety, efficacy, and efficiency of the use of hydrogel after port removal vs the conventional method of packed iodoform gauze. In a cohort of 31 patients, the hydrogel group (n = 13) healed significantly faster than the group treated with the conventional method (15.5 vs 26.8 d; P = .009) and required fewer scheduled clinic visits (1.2 vs 10.8; P < .001). There were no differences in complications. This study suggests that hydrogel effectively promotes healing of port pocket infections, with advantages over the established technique.

Bismuth subnitrate iodoform parafin paste used in the management of inflammatory follicular cyst - Report of two cases.

Dentigerous cyst or follicular cyst is a type of odontogenic cyst which encloses the crown of an unerupted tooth and is attached to the amelocemental junction and is the second most common odontogenic cyst contributing about 16.6% to 21.3% of all odontogenic cysts. Occurrence of Dentigerous cysts according to Shear is usually in 3rd and 4th decade in contrast to this finding Shibata et al showed that the age of discovery of the dentigerous cyst was generally 9-11 years. The treatment indicated for dentigerous cysts are surgical enucleation of the cyst, along with removal of the involved tooth; or the use of a marsupialization technique, which removes the cyst while preserving the developing tooth. The present case report describes the management of dentigerous cysts in children with the use of Bismuth Subnitrate Iodoform Paste.

A pilot randomized controlled trial comparing bismuth iodine paraffin paste external ear pack and no ear pack after middle ear surgery.

To pilot a substantive randomized control trial comparing post-operative external ear canal pack with no ear pack after middle ear surgery, 32 adults undergoing primary posterior bony canal wall preserving middle ear surgery were randomized to have either a bismuth iodoform paraffin paste pack or no ear pack post-operatively. Outcome measures included clinician- and patient-recorded visual analogue scale scores for ear signs and symptoms at 3 weeks and 3 months and audiometric findings at 3 months post-operatively. There was no statistically significant inter-group difference in 3-week clinician and patient cumulative scores for ear signs and symptoms. There was also no significant difference in graft take rate, appearance of ear canals and audiometric results in either group at 3 months. No difference in ear symptoms, clinician findings or hearing was demonstrated between patients with a post-operative pack compared to those without a pack following middle ear surgery in this pilot study.

Treatment of abscessed primary molars utilizing lesion sterilization and tissue repair: literature review and report of three cases.

PURPOSE: The purpose of this report was to review an emerging alternative treatment to pulpectomies and extractions for nonvital primary teeth called lesion sterilization and tissue repair (LSTR) and provide the results of three clinical case applications. LSTR is a noninstrumentation endodontic treatment that involves a triantibiotic mixture in a propylene glycol vehicle, which is used to disinfect root canal systems. This concept was developed by the cariology research unit of the School of Dentistry, Niigata University, Niigata, Niigata Prefecture, Japan. This article reviews the development of the technique, clinical procedures required for the technique, three clinical applications and radiographic documentation and follow-up, and a short literature review of the current evidence supporting its application in clinical practice.

Comparative evaluation of antimicrobial efficacy of various root canal filling materials along with aloevera used in primary teeth: a microbiological study.

AIM: this study was conducted to evaluate the antimicrobial effectiveness of 6 root canal filling materials and a negative control agent against 18 strains of bacteria isolated from infected root canals of primary molar teeth using agar diffusion assay. MATERIALS: Aloevera with sterile water Zinc oxide and Eugenol, Zinc oxide-Eugenol with aloevera, Calcium hydroxide and sterile water, Calcium hydroxide with sterile water and aloevera, Calcium hydroxide and Iodoform (Metapex) and Vaseline (Control). MIC and MBC of aloevera was calculated. RESULTS: All materials except Vaseline showed varied antimicrobial activity against the test bacterias. The zones of inhibition were ranked into 4 inhibition categories based on the proportional distribution of the data. All the 18 bacterial isolates were classified under 2 groups based on Gram positive and Gram negative aerobes. Statistical analysis was carried out to compare the antimicrobial effectiveness between materials tested with each of the bacterial groupings. CONCLUSION: Aloevera + Sterile Water was found to have superior antimicrobial activity against most of the microorganisms followed by ZOE + Aloevera, calcium hydroxide + Aloevera, ZOE, calcium hydroxide, Metapex in the descending order and Vaseline showed no inhibition.

Sutures coated with antiseptic pomade to prevent bacterial colonization: a randomized clinical trial.

OBJECTIVE: The aim of this study was to assess if an antiseptic pomade could reduce the bacterial colonization on multifilament sutures. STUDY DESIGN: A randomized clinical trial was conducted with 40 volunteer patients of both sexes aged 18-70, randomly separated into experimental (n = 20) and control (n = 20) groups. The experimental group received pomade-coated sutures (iodoform + calendula) and the control group uncoated sutures. Two millimeters of the suture was harvested from each patient from the 1st to the 15th postoperative day. The bacteria that had adhered to them were cultured. The number of colony-forming units per milliliter (CFU/mL) was determined and the groups were compared using the Mann-Whitney statistical test (P < .05). RESULTS: The experimental group showed a significant reduction in bacterial growth compared with the control group (P = .002). CONCLUSIONS: In this experimental model, the antiseptic pomade was effective in reducing bacterial colonization on silk braided sutures.

Cytotoxicity and proliferative effects of Iodoform-containing root canal-filling material on RAW 264.7 macrophage and RKO epithelial cell lines.

OBJECTIVE: The present study investigated the effect of the Iodoform-containing root canal filling material on the viability of cultured macrophages and epithelial cells, and on cytokine secretion. DESIGN: The effect of Endoflas F.S. on the proliferation of a RAW 264.7 macrophage cell line and on a RKO epithelial cell line, and on the production of tumour necrosis factor alpha (TNFα) from macrophages was examined. Cell vitality was evaluated using a colourimetric XTT (sodium 2,3-bis(2-methoxy-4-nitro-5-sulfophenyl)-5-[(phenylamino)-carbonyl]-2H-tetrazolium inner salt) assay. The presence of cytokines was determined by two-site enzyme-linked immunosorbent assay (ELISA). RESULTS: Direct exposure of Endoflas F.S. and its media, up to a dilution of 1/8, decreased the viability of macrophages and epithelial cells by ∼70% compared to control media (P<0.05). Media dilution from 1/16 to 1/1024 demonstrated a proliferative effect, increasing cell viability by about 60% compared to media without Iodoform-containing root canal filling material. CONCLUSIONS: Direct and indirect exposure to high concentrations of iodoform-containing root canal filling material showed a cytotoxic effect on macrophages and epithelial cells, while low concentrations induced cell proliferation.

Prenatal developmental toxicity studies of inhaled methyl iodide vapor in rabbits reveal a susceptible window of exposure inducing late gestational fetotoxicity.

Methyl iodide (MeI), an intermediate used in the manufacture of some insecticides and pharmaceuticals, is under review for U.S. registration as a non-ozone-depleting alternative to methyl bromide in the pre-plant soil fumigation market. Guideline (OPPTS 870.3700) developmental toxicity studies in New Zealand White (NZW) rabbits showed dose-dependent increases in the litter proportions of late fetal deaths and postimplantation loss and/or decreased fetal body weight following inhalation exposure of pregnant rabbits to MeI during gestation days (GD) 6-28. A subsequent phased-exposure study was performed to pinpoint the critical window of gestational exposure that produced the rabbit fetotoxicity. Artificially inseminated NZW female rabbits were exposed to 20 ppm MeI vapors by whole-body inhalation (6 h/day) throughout major organogenesis and fetal development (GD 6-28), during early gestation (GD 6-14) or mid-gestation (GD 15-22) only, or during 2-day intervals late in gestation (GD 23-24, 25-26, or 27-28). No maternal or developmental toxicity was elicited from maternal exposure during GD 6-14, 15-22, or 27-28. However, MeI-related fetotoxicity, including increased litter proportions of late fetal deaths with or without corresponding decreases in fetal body weight, were observed for females exposed during GD 6-28 (p < .01), 23-24 and 25-26. Although the increase in late-stage fetal death for each of the 2-day exposures on GD 23-24 and GD 25-26 was not statistically significant, as noted for the combined total of fetal deaths during the GD 6-28 exposure, it can be deduced that the gestational window of GD 23-26 was the most susceptible window of exposure for eliciting developmental toxicity in rabbits exposed to MeI vapors.

Two-day inhalation toxicity study of methyl iodide in the rat.

The effects of inhaled methyl iodide (MeI) on clinical pathology parameters, glutathione (GSH) tissue levels, serum thyroid hormone and inorganic iodide concentrations, S-methylcysteine hemoglobin concentrations, and liver UDP-glucuronyltransferase activity were studied in the rat. Male rats were exposed by whole-body inhalation to 0, 25, or 100 ppm MeI, 6 h/day for up to 2 days. Serum cholesterol concentrations (both high-density lipoprotein [HDL] and low-density lipoprotein [LDL] fractions) were increased and triglycerides were decreased at both exposure levels. Serum thyroid-stimulating hormone (TSH) concentrations were increased at 25 and 100 ppm, and serum triiodothyronine (T(3)) and thyroxine (T(4)) concentrations were decreased at 100 ppm. There was no change in either reverse triiodothyronine (rT(3)) or UDP-glucuronyltransferase activity at either exposure level. A dose- and time-dependent reduction in GSH levels in blood, kidney, liver, and nasal tissue was observed, with the greatest reduction in nasal tissue (olfactory and respiratory epithelium). MeI exposure also resulted in a substantial dose- and time-dependent increase in both serum inorganic iodide and red blood cell S-methylcysteine hemoglobin adducts. These results indicate that following inhalation exposure, MeI is rapidly metabolized in blood and tissue of rats, resulting in methylation products and release of inorganic iodide.

Evaluation of respiratory parameters in rats and rabbits exposed to methyl iodide.

Laboratory animals exposed to methyl iodide (MeI) have previously demonstrated lesions of the olfactory epithelium that were associated with local metabolism in the nasal tissues. Interactions of MeI in the nasal passage may, therefore, alter systemic toxicokinetics. The current study used unrestrained plethysmographs to determine the MeI effect on the breathing frequency and minute volume (MV) in rats and rabbits. Groups of 4 rats each were exposed to 0, 25, or 100 ppm and groups of 4 rabbits each were exposed to 0 and 20 ppm MeI for 6 h. Breathing frequency and MV were measured and recorded during the exposure. Blood samples were collected for inorganic serum iodide and the globin adduct S-methylcysteine (SMC) as biomarkers of systemic kinetics immediately following exposure. No significant reductions in breathing frequency were observed for either rats or rabbits. Significant changes in minute volume were demonstrated by both rats and rabbits; however, the changes observed in rats were not concentration dependent. The MeI-induced changes in MV resulted in significant differences in the total volume of test substance atmosphere inhaled over the 6-h period. Rats demonstrated a concentration-dependent increase in both inorganic serum iodide and SMC. Rabbits exposed to 20 ppm MeI demonstrated a significant increase of inorganic serum iodide; SMC was also increased but was not statistically significant. The results of this study are consistent with previous kinetic studies with MeI, and the data presented here can be integrated into a computational fluid dynamics physiologically based pharmacokinetic model for both rats and rabbits.

Evaluation of possible modes of action for acute effects of methyl iodide in laboratory animals.

Recent studies have indicated that exposures to methyl iodide (MeI) produce a number of effects in laboratory animals, including fetal toxicity, neurotoxicity, and degeneration of the nasal epithelium. An understanding of the mode of action by which the effects of MeI are produced is useful in guiding critical decisions used in risk assessment. These decisions include the selection of the appropriate internal dose measure(s) calculated using physiologically based pharmacokinetic (PBPK) modeling, and evaluating the relevance of the observations in animals to human health. Modified Hill criteria were used to evaluate several possible mode(s) of action through which MeI produces toxicity in animals. For each endpoint, the key studies were summarized and several possible modes of action were compared to the modified Hill criteria. The available data best support the hypothesis that the fetal effects were likely associated with modulation of the thyroid hormones by iodide during development. This mode of action dictates the use of an internal dose measure in the risk assessment that is indicative of fetal iodide status, such as cumulative iodide concentration (area-under-the-curve or AUC) for iodide in fetal blood. The acute transient neurotoxicity observed in rats exposed to MeI is best supported by a mode of action involving modification of ion currents by the parent chemical in nerve cells. In the case of assessing the potential acute neurotoxicity of MeI, the peak concentration of MeI in the brain would be the appropriate internal dose measure. Finally, the nasal lesions associated with exposure to high concentrations of MeI in rats are best supported by a mode of action that involves glutathione (GSH) depletion in the nasal epithelial tissue. The daily minimum GSH level in olfactory epithelium is the most appropriate internal dose measure for use in risk assessment for this endpoint. Confidence in these modes of action is considered low for the neurotoxic effects, medium for the nasal effects, and high for the fetal effects.

A real-time methodology to evaluate the nasal absorption of volatile compounds in anesthetized animals.

Nasal dosimetry models that combine computational fluid dynamics and physiologically based pharmacokinetic modeling incorporate information on species-specific anatomical differences, including nasal airflow, mucosal diffusion, clearance-extraction, and metabolism specific to different epithelial layers. As such, these hybrid models have the potential to improve interspecies dosimetric comparisons, and may ultimately reduce uncertainty associated with calculation of reference concentrations. Validation of these models, however, will require unique experimental data. To this end, a method for evaluating the uptake of a prototypical compound, methyl iodide (MeI), in the nasal cavity of the intact animal was developed. The procedure involved insertion of a small-diameter air-sampling probe in the depth of the nasal cavity to the nasopharynx region in anesthetized animals. The exterior portion of the probe was connected directly to a mass spectrometer to provide a continual real-time analysis of concentrations of MeI in the nasal cavity. A plethysmography system was used to monitor breathing parameters, including frequency and tidal volume for each animal. Animals were placed in a sealed glass chamber and exposed to MeI at initial chamber concentrations ranging from 1 to 50 ppm. Studies were conducted on n = 3 rabbits per exposure concentration for a total of nine animals and n = 6 rats at a single exposure concentration of 1 ppm. In the rabbit, the percent of MeI absorbed in the nasal cavity ranged from 57 to 92% (average 72 +/- 11) regardless of exposure concentration. Similarly, the percent of MeI absorbed in the nasal cavity of the rat ranged from 51 to 71% (average 63 +/- 8).

Iodomethane human health risk characterization.

Iodomethane is a new pre-plant soil fumigant approved in the United States. Human exposure may occur via inhalation due to the high vapor pressure of iodomethane. A quantitative human health risk assessment was conducted for inhalation exposure. The critical effects of acute duration iodomethane exposure are: (1) fetal losses in rabbits, (2) lesions in rat nasal epithelium, and (3) transient neurotoxicity in rats. Chronic exposure of rats resulted in increased thyroid follicular cell tumors from sustained perturbation of thyroid hormone homeostasis. A physiologically based pharmacokinetic (PBPK) model for iodomethane was developed to characterize potential human health effects from iodomethane exposure. The model enabled calculation of human equivalent concentrations (HECs) to the animal no-observed-adverse-effect levels (NOAELs) using chemical-specific parameters to determine the internal dose instead of default assumptions. Iodomethane HECs for workers and bystanders were derived using the PBPK model and NOAELs for acute exposure endpoints of concern. The developmental endpoint NOAEL was 10 ppm and corresponding bystander HEC was 7.4 ppm. The nasal endpoint NOAEL was 21 ppm and the HEC was 4.5 ppm. The transient neurotoxicity endpoint NOAEL was 27 ppm and the HEC was10 ppm. Data demonstrated that humans are less sensitive to the effect that causes developmental toxicity in rabbits and the PBPK model incorporated this information, resulting in a higher HEC for the developmental endpoint than for the nasal endpoint. Nasal olfactory degeneration is the primary endpoint for risk assessment of acute exposure to iodomethane.

A survey of postoperative nasal packing among UK ENT surgeons.

Packing of the nasal cavity following routine nasal surgery is a common but controversial practice. We aimed to evaluate nasal packing practices among UK ENT consultants for common nasal operations. A questionnaire was sent to 648 consultant ENT surgeons regarding their packing practice in patients undergoing nasal surgery. Data were collected regarding rhinology subspecialty interest, number of nasal operations performed per year, likelihood of packing for six common nasal procedures, and types of pack used. In all, 282 (43.5%) replies were received. Fifty-four (78.3%) rhinologists claimed to perform >100 nasal operations per year versus 64 (31.8%) non-rhinologists (P < 0.005). For specific operations, there was a universal trend towards less routine packing (>70% frequency) in the rhinologist group (P < 0.005). Surgeons who specified a subspecialty interest in rhinology packed significantly less often than the non-rhinologists for common nasal operations. There was great variation in the type of pack favoured by different surgeons.

Technical tutorial: How to pack a nose with bismuth iodoform paraffin paste gauze safely and effectively.

The current primary treatment for epistaxis in accident and emergency departments is the insertion of Merocel packs. If these are properly inserted, but fail to control bleeding, it is necessary to insert a bismuth iodoform paraffin paste (BIPP) pack. A BIPP pack, when properly inserted, has the potential to stop most bleeds, but books and journals suggest a method of insertion that limits its effectiveness. A safer and more effective way of packing a nose with BIPP than the traditional method is described.

Antimicrobial effect and pH of chlorhexidine gel and calcium hydroxide alone and associated with other materials.

The purposes of this study were to evaluate the effectiveness of 2% chlorhexidine (CHX) gluconate gel, calcium hydroxide [Ca(OH)2] and their combination with iodoform and zinc oxide powder as intracanal medications against select microorganisms, and to measure the pH changes caused by these medications. Antimicrobial activity was determined by the agar diffusion method. The zones of growth inhibition were measured and the results were analyzed statistically by Kruskal-Wallis test (p<0.05). The pH of the pastes was measured right after preparation, after 24 h and 1 week later. The largest mean zones of microbial inhibition were produced by 2% CHX gel, followed by Ca(OH)2 + 2% CHX gel + iodoform, Ca(OH)2 + 2% CHX gel, Ca(OH)2 + 2% CHX gel + zinc oxide, and Ca(OH)2 + water. The mean pH of all medications stayed above 12.0 during the whole experiment, except for CHX gel (pH=7.0). The results of this study showed that all medications had antimicrobial activity, but the most effective against the tested microorganisms were 2% CHX gel, followed by its combination with Ca(OH)2 and iodoform.