Needle Injury Research Articles

Blood donation‐related neurologic needle injury: evaluation of 2 years' worth of data from a large blood center

There is little information in the medical literature on t he clinical spectrum of blood donation-related neurologic needle injury and on its frequency in a blood donor population. Sixty-six cases of blood donation-related neurologic needle injury were identified from nursing reports made during a 2-year collection period involving 419,000 whole blood donations. Telephone follow-up was completed on 56 of the 66 cases to better define clinical symptoms, the donor's desire for physician consultation, recovery times, and residual effects. Symptoms in 66 donors included numbness or tingling (n = 54), excessive or radiating pain (n = 43), and loss of arm or hand strength (n = 8). Of the 56 donors with complete follow-up, 17 (30%) consulted a physician one or more times. Recovery times in these 56 donors were <3 days (n = 22), 4 to 29 days (n = 17), 1 to 3 months (n = 13) 3 to 6 months (n = 2), and >6 months (n = 2). Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. The incidence of blood donation-related neurologic needle injury was 1 of every 6300 donations. While donor recovery may in some cases require a great deal of time and/or physician consultation(s), total recovery appears to be the rule. The incidence of blood donation-related neurologic needle injury is relatively low.

Family variation for fall cold hardiness in two Washington populations of coastal Douglas-fir (Pseudotsuga menziesii var. menziesii (Mirb.) Franco)

In order to assess the genetics of fall cold hardiness in coastal Douglas-fir (Pseudotsuga menziesii var. menziesii (Mirb.) Franco), shoot cuttings were collected in October from saplings (9-year-old trees) of open-pollinated families in two progeny tests in each of two breeding zones in Washington, one in the Coast range (80 families) and one on the west slope of the Cascade Mountains (89 families). Samples from over 5500 trees were subjected to artificial freezing and visually evaluated for needle, stem and bud tissue injury. The extent to which cold injury is genetically related to tree height and shoot phenology (timing of bud burst and bud set) was also evaluated.Significant family variation was found for all cold hardiness traits; however, individual heritability estimates were relatively low (ranging from 0.09 to 0.22). Significant family-by-test site interaction was detected for needle injury in the Cascade breeding zone, but not in the coastal zone. Genetic correlations (rA) among needle, stem and bud tissues for cold damage were weak (0.16 ≤ rA ≤ 0.58) indicating that genes controlling fall hardening are somewhat different for different tissues. Timing of bud burst and bud set were only weakly correlated with cold injury (rA ≤ 0.49). Thus, bud phenology is a poor predictor of fall cold hardiness in this species. There was no consistent relationship between tree height and cold injury in the coastal zone. In the Cascade zone, taller trees appeared to be more susceptible to cold injury, but the association was weak (mean rA = 0.38, range 0.20–0.72).

Risk of hepatitis C seroconversion after occupational exposures in health care workers

Background: To determine the incidence of hepatitis C virus (HCV) seroconversion, health care workers reporting an occupational exposure with blood or other risk-prone body materials from a patient known to be seropositive for HCV antibody were enrolled. Methods: HCV seroconversion within 6 months of a reported exposure was assessed by second-generation enzyme immunoassay and immunoblot assay. Results: From January 1992 through December 1993, 331 (51%) hollow-bore needlesticks, 105 (16.5%) suture needle or sharp object injuries, 85 (13%) mucous membrane contaminations, and 125 (19.5%) skin contaminations were reported. Four HCV seroconversions were observed after hollow-bore needlesticks (1.2%; 95% CI 0.3% to 3.0%); no seroconversions occurred after other routes of exposure. Blood-filled needlesticks and source patient coinfection with HIV appeared to be associated with a higher risk of seroconversion. Conclusions: The risk of HCV seroconversion after occupational exposure appears to be low but is not negligible. Aggressive implementation of universal precautions is important for preventing risk-prone exposure, but safer devices are also needed.

Chronological study of peripheral benzodiazepine binding sites in the rat brain stab wounds using [3H] PK-11195 as a marker for gliosis.

Chronological studies of the development of the peripheral benzodiazepine receptor sites were undertaken with the goal of evaluating the sensitivity of this marker for the study of the gliosis development in the injured brain. No significant increase in [3H] PK-11195 binding occurred in the rat brain stab wound one day following the puncture. A significant increase in the receptor density (Bmax) from the second day onward was observed. The Bmax reached its highest levels in the grey matter on the sixth day after a 23-gauge needle wound (8.75 +/- 0.09; pmol mg-tissue-1) and on the seventh day after an 18-gauge needle wound (8.98 +/- 0.31 pmol mg-tissue-1). In the white matter, the Bmax was greatest seven days after the wound (3.42 +/- 0.07; pmol mg-tissue-1; 23-gauge needle and 3.56 +/- 0.1 pmol mg-tissue-1 in the 18-gauge needle injury). Between 30 and 60 days after the wound, the Bmax was significantly lower than the Bmax observed between 6 and 14 days. The Bmax in the wound produced with needles was seven to eight times greater than the Bmax in the grey matter of the ipsilateral and contralateral cortices. Histological examination showed that there were no astrocytes or macrophages in the stab wound one day after the lesion. However, the glial fibrillary acidic protein positive cells and macrophages appeared on D3 after an injury. Gliosis, as measured by the PK-11195 binding, was also observed in the remote contralateral cortex. Data shows that PK-11195 binding is a very sensitive method of evaluating brain injury and could be of great value in studying progressive injuries in the living human brain in conjunction with positron emission tomography.

Induction of Fos protein in a model of closed head injury in rats

The induction of Fos immunoreactivity in the pyriform cortex and the hippocampal formation after closed head injury was determined and compared to that seen following cortical needle injury in pentobarbital anaesthetized male rats. Robust Fos expression was observed in the ipsilateral pyriform cortex following both types of injury but was observed in the ipsilateral dentate gyrus only following closed head injury. Pretreatment with the NMDA receptor blocker MK-801 eliminated closed head injury induced Fos expression in the pyriform cortex and attenuated that seen in the hippocampus. Similar amounts of Fos expression were observed in urethane anaesthetized lactating and nonlactating rats following closed head injury. No gross behavioural impairments as reflected in body weight gain and locomotor activity were seen in animals subjected to closed head injury. These results demonstrate that as with other forms of brain damage, closed head injury at levels that produce no overt brain lesion nor gross behavioural impairment induce Fos expression in the pyriform cortex and the dentate gyrus which is dependent on the activation of NMDA receptors. Further, this response to brain injury is not modulated by lactation.

Thermal injury of the posterior duodenum during laparoscopic cholecystectomy

While complications of laparoscopic cholecystectomy occur in 3-7% of cases, bowel injuries are uncommonly reported. Bowel injuries appear to be of two types: penetrating bowel injury from either the Veress needle or trocar, and thermal bowel injury from either contact or conductive burn. The duodenum is usually spared from Veress needle or trocar injury because of its posterior location. However, during dissection in the triangle of Calot, the duodenum is at risk for direct contact burn or energy conduction burn. In this report we describe a presumed conductive burn injury of the posterior second portion of the duodenum which followed laparoscopic cholecystectomy. This unrecognized injury resulted in full-thickness necrosis of the duodenal wall with delayed perforation. This injury was successfully managed with pyloric exclusion. The diagnosis and management of this previously unreported injury are described.

Response of Mouse Lens to Central Needle Injury

We examined the difference in response to different degrees of injury in the mouse lens. The anterior side of the lens was pricked through the cornea by a microsyringe with a 31-gauge needle or an ordinary needle. The location of the needle tip was mostly marked with Evans' blue (EB) stain. At least three types of responses were recognizable. The first was a recovery type in which the wound was healed by an epithelial reaction. EB was localized at the superficial zone of the anterior cortex. The second was a type in which the change within the lens was stationary after forming a spherical body with a slightly smaller diameter than that of the entire lens. EB was observed in the intermediate zone of the anterior cortex. The third was a rapid progressive type of cataract which caused lens opacity within 3 days. The trace of the needle tip was observed around the perinuclear zone. These results suggest that the cortex of the mouse lens consists of three zones which may be functionally different around the lens nucleus: superficial, intermediate and perinuclear zones.

Histological effects of ozone on slash pine ( Pinus elliotti var. Densa)

Ozone is present in much of the United States and has been shown to reduce growth and development of some coniferous tree species. Slash pine ( Pinus elliotti) is a unique species which occurs naturally only in southern Florida and several of the Lower Keys. The purpose of this research was to determine if mesophyll cells of slash pine needles respond to ozone in a manner similar to that of other conifers, to determine exposure—response relationships of mesophyll cell injury and ozone exposure level, and if needles of native trees that exhibit chlorotic mottle have more mesophyll cell death than asymptomatic needles. Fumigations were performed at four ozone levels with 7-hr mean values of 0, 55, 67, and 71 ppb for 84 days. Results show that ozone injury symptoms occur to mesophyll cells of needles before visible needle injury (chlorotic mottle). The predominant injury to needles was cell necrosis. Ozone exposure—response relationships of exposure (ppm-hr) percentage of dead cells showed a highly statistically significant ( P < 0.0001) linear relationship of y = 3.56+0.58 ( x) with a correlation coefficient of 0.86. These results support the conclusion that mesophyll cells of needles of slash pine are very sensitive to ozone. Results presented also indicate that needles from native slash pine trees at Everglades National Park show chlorotic mottle, similar to that exhibited by many conifers, and that such visible injury was generally related to a higher percentage of cell necrosis compared with needles without symptoms.

Physiological response to controlled freezing of attached red spruce branches

Previous studies of foliar cold tolerance in red spruce ( Picea rubens Sarg.) have been conducted on isolated shoots or needles. These studies therefore could not show either the type or amount of visible injury to attached foliage in a natural environment after controlled freezing stress, or the physiological response, if any, of visibly undamaged foliage. It was hypothesized that even when visible injury did not develop, foliage on frozen, attached branches would show long-term alterations in electrolyte leakage, water balance, and gas exchange capacity as a result of severe freezing stress. In mid-December 1990, intact, attached branches of red spruce saplings which had been exposed to controlled ozone levels (1 × or 2 × ambient) and precipitation acidity (pH 3.1 or 5.1) were frozen to −48 or −54°C. Neither ozone nor precipitation acidity affected any measure of freezing injury at P ⩽ 0.1. During the 3 months following freezing, current-year shoots developed either a brown needle discoloration, needle abscission without visible discoloration, or no obvious needle discoloration or abscission. This is the first experiment to show that severe freezing stress can lead to abscission of visibly undamaged needles from an attached branch. All frozen current-year needles had elevated relative electrolyte loss ( REL) with 24 hr after freezing, but REL subsequently declined for needles without visible discoloration. One day after freezing, average relative water content ( RWC) of needles on frozen and unfrozen shoots was about 85%, and RWC remained above 80% throughout the winter for unfrozen shoots. By mid-January, needle RWC on visibly injured shoots averaged about 50%. RWC of experimentally frozen needles without visible injury feel more slowly to between 65 and 76% by late February. Across all shoot types, REL just after freezing was negatively correlated with needle RWC 1 month later, and also with maximum dark respiration ( R), conductance to water vapor ( g), and light-saturated net photosynthesis ( A) measured on detached shoots at 12–20°C in late January to February. In unfrozen shoots, net photosynthesis reached a maximum of about 5 μmol m −2 s −1. Shoots with visible needle injury and shoots from branches which later showed needle abs cission had very large reductions in mean maximum gas exchange (> 50% for R, > 60% for g, and > 90% for A) compared to unfrozen shoots. On frozen branches which retained needles, non-visibly injured shoots had declining dark respiration rates and reductions of about 40% in maximum conductance and net photosynthesis, suggesting physiological damage from the freezing stress despite a lack of visible needle injury. Net photosynthesis and conductance remained lower in non-visibly injured frozen shoots compared to unfrozen shoots in late March and early April, more than 3 months after freezing. Initial net photosynthesis of frozen shoots placed in the growth chamber in late January was strongly correlated with maximum net photosynthesis. Initial net photosynthesis divided by initial conductance ( A i/ g i) was even more strongly correlated with maximum net photosynthesis ( r =0.95. A i/ g i was also negatively correlated with visible needle injury estimated in late March. A i/ g i measured on detached shoots, under favorable conditions for photosynthesis, may therefore be an early indicator of either latent visible needle injury or reduced photosynthetic capacity for freeze-damaged trees.

Cold acclimation of Pinus contorta and Pinus sylvestris assessed by chlorophyll fluorescence.

Needle samples of six provenances each of lodgepole pine (Pinus contorta Dougl. var. latifolia) and Scots pine (Pinus sylvestris L.), originating from latitudes 55 to 68 degrees N in western Canada and northern Sweden, were collected during the autumn and subjected to freezing temperatures in the range of -8 to -29 degrees C on three occasions in September and October. Needle injury was assessed by two different methods: visual assessment and chlorophyll a fluorescence. Chlorophyll a fluorescence data showed a highly significant correlation with the visual assessments of injury, indicating that the technique can be used as a simple, non-destructive and objective measure for rapid detection of freezing injury and for ranking of needle materials with respect to development of cold acclimation. The analyses showed that, during the autumn, lodgepole pine needles were more hardy and acclimated to low temperatures earlier than Scots pine needles.

Healing response of the epithelium after lateral needle injury of mouse lens.

Characteristic changes of the epithelial healing process in germinative and equatorial zones of the ddY mouse lens were studied morphologically. After germinative zone injury, the wound was covered by proliferating epithelial cells which increased and migrated posteriorly as a function of time after injury. Epithelial posterior migration from the lens equator was mild. By contrast, with equatorial injury, the wound was covered by proliferated epithelial cells. Moreover, the equatorial area was characterized by disconfiguration of the lens bow and posterior epithelial migration. The results suggest that the larger capsulectomy in IOL operation, which damages the peripheral part of the lens epithelium, might contribute to secondary cataract.

Acidic mist and nitrogen fertilization effects on growth, nitrate reductase activity, gas exchange, and frost hardiness of red spruce seedlings

summaryAcidic deposition may contribute to the decline of red spruce (Picea rubens Sarg.) in eastern North America; response to acidic mist may depend on mist content and plant nutrient status. We grew red spruce seedlings with high or low nitrogen fertilization to roots (other elements in constant proportion to N), exposed only shoots to pH 3.0, high sulphate (10:1, S:N) or high nitrate (1:10, S:N) mist for 5 wk, then moved seedlings outdoors for cold acclimation. Effects of mist content were found until the third week of cold acclimation. Foliar necrosis was higher after exposure to sulphate than to nitrate mist and greater in older than new needles. Sulphate‐misted seedlings had lower new‐shoot biomass, shoot water content, and nitrate reductase activity, and higher foliar sulphur levels than nitrate‐misted seedlings. They also had greater needle frost hardiness (estimated by electrolyte leakage) at the start of cold acclimation. Effects of fertilization were found throughout the experiment. High‐N fertilization increased biomass, tissue N level, and shoot water content, and decreased foliar necrosis from mist. During cold acclimation, high‐N seedlings had lower transpiration and photosynthetic rates and higher water use efficiency than low‐N seedlings. High‐N fertilization increased needle frost hardiness after 5 wk of acclimation and decreased visible needle injury after an outdoor frost. However, high‐N seedlings had fewer needle primordia in terminal buds and more bud frost‐damage than low‐N seedlings. Fertilization, mist content, and their interaction strongly affected seedlings, showing that nutrient status can influence the response of red spruce to acidic deposition and frost.

Effects of radiational heating at low air temperature on water balance, cold tolerance, and visible injury of red spruce foliage

Recent studies have shown that winter needle mortality in red spruce (Picea rubens Sarg.) is increased by exposure to direct solar radiation, possibly as a result of photo-oxidative damage, accelerated winter desiccation, or reduced cold tolerance due to heating of sun-exposed needles. In an experiment at controlled subfreezing air temperatures of -10 to -20 degrees C, visible radiation was less effective than infrared radiation in producing needle desiccation and visible injury during freeze-thaw cycles. However, visible radiation produced a red-brown color in injured needles, similar to natural winter injury, whereas injured needles exposed to infrared radiation were yellow and injured needles kept in darkness were dark brown. Thus, visible radiation was necessary to produce the red-brown color of damaged needles, but not the injury itself. Needle desiccation was not strongly correlated with visible injury, but the pattern of variation in visible injury among trees and the positive correlation between electrolyte leakage and visible injury suggested that freezing damage following freeze-thaw cycles might cause the visible injury. This was confirmed by a second experiment that showed loss of cold hardiness in needles thawed by radiational heating for six consecutive days. Even with a constant nighttime temperature of -10 degrees C, six days of radiational heating of needles to above freezing caused a small (2.8 degrees C) mean decrease in needle cold tolerance, as measured by electrolyte leakage. Continuous darkness at -10 degrees C for six days resulted in an estimated 5.6 degrees C mean increase in needle cold tolerance. Freezing injury stimulated desiccation: cooling at 4 degrees C h(-1) to -43 or -48 degrees C increased the dehydration rate of isolated shoots by a factor of two to three during the first day after thawing. Within three days at 15 to 22 degrees C and 50% relative humidity, the mean water content of these shoots fell to 60% or lower, compared to 90% or greater for unfrozen controls or shoots subject to less severe freezing stress. In some but not all severely freeze-stressed shoots, accelerated needle desiccation and abscission were accompanied by a red-brown color typical of red spruce winter needle injury. We conclude that severe winter desiccation in red spruce may often be due to prior freezing injury, increased as a result of exposure to direct solar radiation. Furthermore, freezing injury in red spruce may sometimes cause desiccation and abscission of green needles.

HIV-Infected Surgeons

To the Editor. —Dr Orentlicher 1 effectively underscored the need to address many issues surrounding the intraoperative transmission of the human immunodeficiency virus (HIV). Little dialogue has surfaced regarding the possibility of virtual elimination of risk through modification of surgical technique. The transfer of body fluids in the operating room can occur when a sharp instrument, usually a solid surgical needle, penetrates both the patient's skin and the surgeon's gloved hand. During an operation, the surgeon's dominant hand holds a scalpel, needle holder, or scissors and therefore makes no contact with the surgical needle, while the nondominant hand (1) exerts counterpressure to propel the needle through the tissues, (2) extracts the needle from the wound, (3) pulls the suture through the tissues, and (4) positions the needle in the jaws of the needle holder. It is in the performance of these four maneuvers that percutaneous needle injuries occur. A surgical

HIV-infected surgeons

To the Editor. —Dr Orentlicher 1 effectively underscored the need to address many issues surrounding the intraoperative transmission of the human immunodeficiency virus (HIV). Little dialogue has surfaced regarding the possibility of virtual elimination of risk through modification of surgical technique. The transfer of body fluids in the operating room can occur when a sharp instrument, usually a solid surgical needle, penetrates both the patient's skin and the surgeon's gloved hand. During an operation, the surgeon's dominant hand holds a scalpel, needle holder, or scissors and therefore makes no contact with the surgical needle, while the nondominant hand (1) exerts counterpressure to propel the needle through the tissues, (2) extracts the needle from the wound, (3) pulls the suture through the tissues, and (4) positions the needle in the jaws of the needle holder. It is in the performance of these four maneuvers that percutaneous needle injuries occur. A surgical

Cold acclimation ofPinus sylvestrisandPinus contortaprovenances as measured by freezing tolerance of detached needles

Differences in cold acclimation were evaluated for detached needles of six Pinus contorta Dougl. and six Pinus sylvestris (L.) provenances originating from latitudes 55° to 68° N in western Canada and northern Sweden. The needles were collected in a Swedish field trial and freeze tested at various temperatures in the range of ‐ 6°C to ‐ 29°C on four occasions from August to October. Temperatures causing 50% discolored (dead) needle tissue were considered a measure of the level of cold acclimation. Provenance variation in needle injury was evident during the whole test period. Variation within species may largely be explained by the latitude of provenance origin, the more northern, the better the frost tolerance. The cold acclimation of lodgepole pine was comparable to that of Scots pine of approximately eight to five latitudes more northern origin from August to October.

Regional growth changes in ozone-stressed ponderosa pine (Pinus ponderosa) in the Sierra Nevada, California, USA

Basal area growth trends were determined for ponderosa pine (Pinus ponderosa) in the Sierra Nevada, California, USA, to: (1) evaluate long term growth patterns, and (2) determine if there has been any recent change in the frequency of growth changes outside the expected range of natural variability. Ponderosa pine was sampled in 56 stands with the sample divided equally between sites with and without documentation of symptomatic ozone injury. Basal area increment growth was calculated, temporal growth patterns were evaluated for each tree using time series analysis techniques, and changes in growth trends were summarized for each site by decade. There were several regional growth trends during this century, including a large number of growth decreases in the 1920s and a large number of increases in the 1930s. Many trends were synchronous within stands but were less frequently synchronous between stands. There were significant growth reductions since 1950 in some stands in the southern Sierra. These growth reductions occurred in areas with the highest levels of ozone exposure and needle injury. There was no evidence, however, of significant numbers of recent growth reductions for the entire Sierra Nevada region. Some sites had growth changes possibly associated with stand dynamics, management practices, and pathogens.

Which physicians are at high risk for needlestick injuries?

One thousand fifty-three incidents of needlestick injuries (from hypodermic and suture needles) were reported to the workmen’s compensation insurance at the University of Texas Medical Branch Hospitals in Galveston, Tex., from Nov. 1, 1984, to Jan. 31, 1989 (Table1). The nursing staff was involved in 61.6% of injuries, whereas physicians were involved in 6.7%. The resident staff had 78.9% and the faculty had 21 .l% of the injuries involving physicians. The average annual incidence rate of needleprick injuries per person for residents was 3.1 times that for faculty members. The distribution of needle injuries to physicians, according to department and site of occurrence, was analyzed (Tables 2 and 3). The Department of Anesthesiology reported 22.5% of the cases, followed by the departments of internal medicine (19.2%), surgery (13.7%), radiology (9.6%), and ophthalmology (9.6%). The highest incidence of needle injuries relative to the number of employees was found in the Department of Ophthalmol-

Black Stain Root Disease in Ozone-Stressed Ponderosa Pine

Needle injury was greater and stem growth was less in seedlings inoculated with L. wageneri var. ponderosum than in noninoculated seedlings. The length of the black stain in roots of inoculated seedlings increased as the ozone exposure increased; 43% of the seedlings exposed to charcoal-filtered air (with an ozone concentration of 0.26 ppm-hr/day) had visible black staining, whereas 79% of those exposed to ozone at 2.84 ppm-hr/day were stained

Effects of ozone on three open-pollinated families of Pinus taeda L. grown in two substrates

Seedlings from three open-pollinated loblolly pine ( Pinus taeda L.) families grown in a mixture of commercial peat moss and grade 3 vermiculite (1:3 by volume) or a mixture of mineral soil and peat (1:1 by volume) were exposed to 0, 160 or 320 ppb ozone (O 3 ) for 6h/day, 4 days/week for 8 weeks beginning 12 weeks after transplanting. Before exposures began, seedlings grown in the vermiculite-peat substrate were taller but smaller in diameter than those grown in the mineral soil-peat substrate. After 8 weeks of exposure, seedlings grown in the mineral soil-peat substrate were significantly larger in diameter and total biomass than those grown in the vermiculite-peat substrate. Primary needle and secondary needle injury increased with increasing O 3 concentrations. Suppression of diameter growth, shoot weight and root weight was linear as O 3 concentration increased. The effect of O 3 on height or diameter growth or shoot biomass was not influenced by substrate type; but the suppression of root biomass due to O 3 was dependent on substrate, with greater suppression in biomass occurring in the vermiculite-peat substrate. Foliar injury due to O 3 was slightly greater in family 8–103, but growth suppression due to O 3 was not significantly different among the families. Based on root biomass, response of seedlings to O 3 was substrate-dependent.