Needle Syringe Research Articles

Testing the waters: a pilot programme to enhance the opportunities of risk reduction in Needle Syringe Program clients

Currently the Needle Syringe Program (NSP) in Australia collects information on occasions of service rather than number of individuals. The limitations experienced in identifying specific client demographic features and injecting practices impacts on NSP’s ability to implement intervention strategies, refer clients into treatment services and adopt service provision appropriate to the injecting drug user (IDU) client group. A networked, ‘real-time’, computerised information management system was developed to record service information about clients attending five staffed NSP outlets. Service providers and the client group were consulted verbally regarding planning and implementing the project. Key objectives included the ability to profile the client group, increase brief interventions around risk behaviour, develop specifically targeted projects, increase rates of drug treatment referral, enhance skills of NSP workers, establish a client reference group and maintain the confidentiality of the 978 registered clients. This novel client information management model offers the opportunity to create a client history file and is a successful example of a concept that can be incorporated into the service practice of other NSPs.

Citologia aspirativa por agulha fina (CAAF), em testículo de onça pintada (Panthera onca), utilizada como ferramenta no diagnóstico de infertilidade

Several methods of testicular punch biopsy were proposed for obtaining material for histologic or cytologic evaluation, but did not received enough clinical acceptance because it was considered to be too traumatizing. The fine Needle Aspiration (FNA) is considered a useful, simple and fast method to obtain samples from tissues. Regarding the importance of FNA in wild animals, this technique was tried in captive adult jaguar (Panthera onca) aiming the evaluation and possible causes of infertility. Using a needle and disposable syringe, the testis were aspirated. The whole aspirated was smeared onto a microscope slide and stained with Diff-quick method. Semen samples were collected by electroejaculation and analyzed for pH, total volume, motility, status, total spermatozoa count and morphology. Evaluation of sperm volume, pH, motility vigor and morphology were normal. However, was found below concentration. Cytologic quantification revealed germinative cells in all testicles. Among serial types of morphological normal spermatogenesis cells, there were found theratological forms of double final spermatids. These anomalous forms of final spermatids have not been noticed yet in FNA papers. So, we concluded that FNA together with other techniques, provides a useful tool in male infertility diagnostics, mainly when related to endangered species.

Syringe type and drug injector risk for HIV infection: a case study in Texas

Studies of accidental needlestick exposure to blood containing human immunodeficiency virus (HIV) have shown that the volume of blood in an exposure is a strong predictor of subsequent infection. Illicit drug injectors, a group at elevated risk for HIV transmission, use syringes manufactured in two styles, one of which (the integral cannula type) retains substantially less blood after intravenous use than the other (the detachable needle type). In this report, we examine some of the factors associated with use of syringes with detachable needles among drug injectors in San Antonio, Texas using data from epidemiological surveys, ethnographic studies, and historical observations. We compare personal history of syringe type use with HIV serostatus in a sample of 501 active drug injectors interviewed and screened for HIV in 1997–1998. Ninety-nine percent of these respondents reported that they currently used only integral cannula syringes, but 13% had used a syringe with a detachable needle within the past 2 years, and 37% had used one in their lifetime. Only 9% had ever used one ⩾20 times in a year. Hispanic (Mexican American) respondents were significantly less likely than other ethnic groups to have ever used a detachable needle syringe. HIV seroprevalence was <1% among heterosexual injectors who had never used a detachable needle syringe compared to 4% among those who had used one ( p<0.05).

The use of pre-cannulation local anaesthetic and factors affecting pain perception in the emergency department setting

Study objective—To determine whether the use of subcutaneous local anaesthetic (lignocaine) is associated with a reduction in cannulation pain in the emergency department setting. Methods—Patients over 18 with a Glasgow...

Preference to have used a medically supervised injecting centre among injecting drug users in Kings Cross, Sydney

ObjectiveTo assess factors affecting preference to have last injected in a medically supervised injecting centre (MSIC) among injecting drug users (IDUs) attending a needle syringe program (NSP) in Kings Cross, Sydney. MethodsAll NSP attenders over a two-day period in August 1999 were asked where they last injected, whether they injected alone and if they would have preferred to use an MSIC. This was in addition to the routine data collected, which included age, gender and last drug injected. ResultsAmong the 178 respondents, 52 (29%) last injected in a public place and 77 (44%) last injected alone. Seventy-one per cent of all respondents would have preferred to use an MSIC. Of those who injected in public, 83% would have preferred to use an MSIC compared to 66% of those who injected in private, which was significant (p=0.03). Age, gender, last drug injected and having injected alone did not affect preference to use an MSIC. ConclusionsRespondents' high preference to use an MSIC suggests that it may well achieve its public order and public health objectives. ImplicationsAn MSIC may significantly shift current patterns of illicit drug use in Kings Cross, the community impact of which should be monitored and managed.

Eight Years of Fat Transplantation Experience

Introduction: I have used fat as a transplantation filler following liposuction approximately 8 years. Six years ago, I began freezing fat to be used later. The results of both frozen and fresh fat as transplant material is dependent on many variables, not the least of which is technique. I describe the background of this procedure, its evolution, my personal techniques, and the results. Materials and Methods: For this study, only 30 randomly chosen patients who could be followed for at least 6 months were considered. Twenty-eight patients received fresh fat transferred at the time of surgery. Fourteen patients received frozen fat. Five patients received a second injection of frozen fat. Three received 3 or more injections. Two patients received frozen fat injected as the initial filler. One patient received a subsequent injection of frozen fat. My technique for harvesting fat either to be used as fresh transplant material or later as frozen transplant material is the same. Tumescent infiltration is carried out using the standard Klein solution, 0.05% lidocaine, in normal saline with 1:1000000 epinephrine. Originally a 2- or 2.5-mm cannula with a 35 mL or 60-mL syringe technique was used; however, recently, the Coleman harvesting needle and 10-mL syringe have been used. The fat is stored in 5- and 10 mL syringes. Conclusion: I have found fat to be an acceptable filler for both congenital and surgical defects as well as a good method for augmentation. I found frozen fat to survive as well as fresh fat.

HIV, hepatitis B and sexual practices in the street-recruited injecting drug users of Calcutta: risk perception versus observed risks.

Injecting drug users (IDUs) were recruited from the streets of Calcutta to obtain a baseline biological and behavioural data on risk practices. One-fifth of them (mostly using buprenorphine) tested positive for hepatitis B surface antigen (HBsAg); 4% were reactive to serologic test for syphilis (VDRL: Venereal Disease Research Laboratory). Condom use was insignificant while 74% reported sex with female sex workers and 15% of male IDUs also reported having sex with men. Although, sharing of injecting equipment ('works') was perceived as dangerous by the IDUs, majority of them (90/103) reportedly shared it; cleaning of works before sharing was a concern for intravenous but not for intramuscular drug injecting. Half of the IDUs reported suffering ever from abscess; a proportion (12%) of which had had superadded attack of maggots in it. They were also found to be infected with HIV (1%, 95% CI 0.028-5.97%) at a low prevalence that prompted subsequent launching of needle syringe exchange programme, establishment of cleaning norms before sharing of works, cleaning of injecting site on the body and condom promotion.

Risk factors for hepatitis C virus infection among injecting drug users in Sydney.

To study risk factors for hepatitis C virus (HCV) infection in injecting drug users (IDUs) from central Sydney. All IDUs attending a primary health care facility in central Sydney between December 1991 and November 1992 who underwent HCV antibody testing. Information was obtained retrospectively from client forms routinely completed at the time of medical consultation. Additional information on injecting history and practice was obtained from the registration forms of subjects who also attended the needle syringe exchange programme at the same health care facility. Of the 201 IDUs tested, 118 (59%) had HCV antibodies, which did not differ significantly between males and females. HCV prevalence increased significantly with age, being highest in IDUs who were aged 35 years or more (93%) and lowest in IDUs aged under 20 years (17%). HCV prevalence increased significantly with time since first injecting, from 26% for IDUs who had injected for less than 3 years to 94% for those who had injected for more than 10 years. HCV prevalence was also significantly higher in heterosexual IDUs as compared with homosexual male IDUs, and in opiate users as compared with stimulant users, even after adjustment for age and duration of injecting. HCV prevalence was strongly associated with exposure to hepatitis B virus, but was not associated with exposure to HIV. Recent HCV transmission indicates ongoing injecting risk behaviour despite HIV prevention efforts, and underlies the potential for increased transmission of HIV through the sharing of injecting equipment. Within the population of IDUs, those who are heterosexual or inject heroin appear to be at increased risk of HCV infection.

Middle ear air injection after chronic ear surgery

In the early period after chronic ear surgery, the reasons for conductive hearing loss may be difficult to determine. Patients who cannot autoinflate the middle ear after 3 weeks, or who have a negative Rinne test result with the 512 Hz tuning fork, are treated with a transtympanic injection of 0.5 cc of air with a 27-gauge needle and tuberculin syringe. This represents 20% of patients who had chronic ear surgery. Results show that hearing may be immediately improved, the sensation of pressure in the ear may be reduced, and fluid may be cleared from the middle ear. Other benefits may include the release of adhesions. The surgeon is better able to assess the thickness of the graft, and the status of the ossicular chain reconstruction can be determined. There have been no complications of middle ear infection or failure of the micropuncture site to heal. In our practice, middle ear air injection is a routine procedure in patients with inadequate eustachian tube function after chronic ear surgery. This report describes the results of 100 patients over 14 years who received middle ear air injections after chronic ear surgery compared with a control group of 100 patients who did not meet the criteria for requiring air injection. Hearing was immediately improved in 74% of patients as determined by Rinne testing. Audiograms were performed in 25 of these patients, documenting a mean improvement in pure-tone average of 16 dB. The long-term hearing results in patients undergoing air injection, who by definition had evidence of poor eustachian tube function, are similar to the results in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Processing of needle rinse material from fine-needle aspirations rarely detects malignancy not identified in smears.

When preparing FNA smears, we recover material left in the needle hub by forcefully striking the open hub against a slide. Material in the syringe tip is expressed by repeated forceful blasts of air (needle unattached). We investigated the utility of recovering additional material by rinsing the needle and syringe. Saline was used to flush the needle and syringe tip repeatedly. All material was processed by cytocentrifugation. We studied 159 needle rinse (NR) specimens from 152 patients (breast = 70, lymph node = 30, lung = 15, soft tissue = 14, salivary gland = 12, thyroid = 12, liver = 5, branchial cleft cyst = 1). Malignancy was identified in 21 FNAs (13%) from 21 patients (14%). All were diagnosed in smears (9 lung, 5 liver, 4 lymph node, 2 breast, 1 soft tissue). NR material identified 16 of these (76%). No case with benign smears (n = 138) showed malignancy in NR material. We conclude that if good technique is applied to preparation of smears and recovery of material from the needle hub and syringe tip, NR material will rarely identify additional malignancies. It thus represents an inefficient allocation of technical and human resources within the laboratory. However, NR may provide additional slides for special stains and may be useful for clinicians who do not always prepare high quality smears. Furthermore, the ease with which FNA of palpable masses can be repeated suggests that in the small number of cases requiring special stains, additional material can be readily obtained.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of procedures and instruments for intracordal injection: Evaluation of the syringe for periodontal ligament anesthesia (CITO JECT).

The intracordal injection technique was first introduced by Brünings in 1911. This technique has been accepted as vocal rehabilitation for dysphonia caused by deficiencies of glottal closure. Although various injection materials have been evaluated, the injection procedure itself has not been studied. In this study, we measured the mechanical force required to perform intracordal injection by using a certain amount of substance, when varying the needle size and syringe type. Although a large needle can reduce the mechanical force for injection, leakage from the pinhole can not be prevented. We modified this technique by introducing a CITO JECT, a syringe, which is used for the anesthesia of the periodontal ligament, to perform the collagen injection. With this technique, the mechanical force required for the injection can be reduced to 1/2 to 1/4 of the force by the conventional technique. We conclude that the introduction of this syringe enable us to use the needle with smaller diameter to facilitate the intracordal injection.

Performance of disposable needle syringe systems for local anesthesia

The performance of different disposable needle syringe systems was determined by measuring needle-puncture pain, needle-bending forces, and the fluid dynamics of the systems. Thirty-gauge needles cause less needle-puncture pain than any other needle. The force required to bend the 30-gauge needle irreversibly was lower than that for the other needles. Studies of the fluid dynamics of different needle syringe assemblies demonstrated that the flow rate can be limited by using large-size syringes (30 mL) and needles with the smallest internal diameter. On the basis of the results of this study, 30-gauge needles attached to 10-mL, syringes are recommended for infiltration anesthesia, and 25-gauge needles with 10-mL syringes are advocated for regional nerve blocks. In infiltration anesthesia, the local anesthetic agent should be injected slowly into the subdermal tissue over a 10-second period. When performing regional nerve blocks, it is also advisable to inject the local anesthetic agent over a 10-second time interval.

A percutaneously adjustable device for banding of the pulmonary trunk

An optimal result is often difficult to obtain with conventional banding of the pulmonary trunk. Furthermore, this procedure has a significant surgical morbidity and mortality. An inflatable device has therefore been developed which consists of an inflatable band and a valve. The band is made of a silicone balloon which is covered with reinforced braid. The band is applied loosely around the pulmonary trunk through a left lateral thoracotomy. The valve is implanted subcutaneously in an intercostal space. The size of the band can be adjusted postoperatively using a needle and fluid-filled syringe percutaneously to inflate or deflate the balloon. Experiments were conducted in 5 animals and follow-up evaluation by cardiac catheterization and angiocardiography was made up to 4 months after implantation of the device. The band could be effectively and reliably adjusted and no malfunction or complication occurred. This preliminary study suggests that this new technique may make binding of the pulmonary trunk a more reliable and effective procedure and may reduce surgical morbidity and mortality. It also may avoid or delay subsequent additional surgery for revision of a band which is too tight or too loose.

An improved method for the determination of human blood kinin levels by sensitive kinin radioimmunoassay.

A highly sensitive and specific radioimmunoassay for kinin (minimal detectable amount, 0.5 pg/tube) was applied to measure the blood kinin level. A five ml blood sample was collected with a siliconized needle and plastic syringe which contained 2.5 ml of 0.8 N-HCl. The blood kinin was extracted with butanol, following reextraction with water. According to this procedure, the mean recovery (mean +/- SE) calculated from added 125I-bradykinin (500 CPM) and the known amounts of cold bradykinin were 50.4 +/- 0.8% and 51.1 +/- 2.2%, respectively. In comparison with other sampling methods in 6 normal subjects, the blood samples taken without HCl in syringes showed a higher level (24.4 +/- 10.1 pg/ml) than the samples with HCl (5.3 +/- 1.3 pg/ml). And very high levels were obtained in the plasma samples collected by the method of Talamo or Vinci (0.53 +/- 0.24 ng/ml and 3.5 +/- 1.3 ng/ml, respectively). The kinin content in blood samples taken with HCl was stable at -20 degrees C for at least one month, but increased significantly at room temperature or 4 degrees C for 48 hours. Blood samples were obtained from 17 normal subjects, and 3 patients with acute myocardial infarction. Blood kinin levels in the patient with acute myocardial infarction, 121 +/- 20.9 pg/ml, were significantly higher than those in normal subjects (3.8 +/- 0.5 pg/ml). From these results, it was concluded that high levels of blood kinin reported previously may have resulted from inadequate sampling procedures. Thus, in order to measure blood kinin accurately, inactivation of the kinin generating and destroying enzymes must be done immediately after the sampling. In addition, this radioimmunoassay method should be very useful in investigating the pathophysiological role of blood kinin in various diseases.

A micromethod for clotting tests and coagulation factor assays.

A simple microtechnique for carrying out partial thromboplastin time with kaolin tests with 2 microliter or less of test plasma is described. For single stage factor assays, less than 1 microliter of test solution may be used. Reagents and test plasma are loaded in sequence into a 10 microliter, long needle syringe and introduced into a micro test-tube immobilized in a water bath. The end-point is taken as a positive clearing of kaolin turbidity from the mixture while stirring. Correlation with normal techniques has been excellent.

Intraocular penetration of local hydrocortisone and cortisone.

THE EXPERIMENTS to be reported in this paper were undertaken for the purpose of determining steroid levels in the aqueous humor following subconjunctival injections or topical applications of cortisone acetate or hydrocortisone acetate.* The results of such studies were reported earlier from this laboratory t and by others.‡ The results were similar, but because of certain difficulties and inadequacies of the methods employed, discussed in a later paper from this laboratory, 5 it was deemed of importance to reinvestigate this problem, using certain essential modifications in the analytical methods. METHODS Adult rabbits, approximately 4 lb. (1.8 kg.) in weight, were used. The aqueous humor was removed with a 26-gauge needle and tuberculin syringe by means of an oblique corneal puncture The eyes were previously anesthetized by the instillation of two drops of 0.5% tetracaine hydrochloride and were thoroughly flushed with isotonic saline before the aqueous humor specimens were removed for

Influence of Vascular Impairment on Absorption of Bacteria into Blood from Upper Intestinal Tract

Vercellano found that there was absorption of bacteria during 24 hours, following ligation of the superior mesenteric vessels to the duodenum. His technic consisted of ligating both the superior mesenteric artery and vein, and withdrawing specimens of blood directly from the rabbit's heart at time of ligation and after 1, 4, 12, 18, and 24 hour intervals culturing this blood in broth for 24 hours. His conclusions were that the bacteremia present was due to the lack of blood supply. However, he failed to test absorption of bacteria within intervals of less than one hour. Twenty-five dogs were used for this experiment under nembutal anesthesia (3% solution, using 1 cc. per kilo). In the control series (8 dogs) a 3-inch midline incision was made in the abdomen. Fifty cubic cm. of a suspension of B. prodigiosus (24 hour agar culture using 50 cc. of saline) was injected into the duodenum with a fine needle syringe. At 5 minute intervals, 2 drops of blood were taken from femoral vein and plated on agar. In the second series (8 dogs) used the above technic and ligated 3 large rami of the superior mesenteric artery to the duodenum before injecting the B. prodigiosus suspension. Blood was withdrawn every 5 minutes for one hour and plated on agar. In the third series (9 dogs) used the above technic with the exception that the blood was withdrawn at intervals for a 2-hour period. (See chart.) The abscissa represents the time in minutes. The ordinate represents the number of colonies per cc. of blood. Our results show that in the control series we have some slight absorption from the intestine immediately, while in the other 2 series, there is a marked increase in the rate of absorption.

A NEW MECHANICAL METHOD FOR ARTIFICIALLY TRANSMITTING SUGAR-CANE MOSAIC

1. A new mechanical method for artificially transmitting sugar cane mosaic has been developed and used at the Insular Experiment Station of Porto Rico during the years 1925-1929. 2. The method is very simple and easy to operate and produces constant high percentage of infection. 3. Former investigators had sought to transmit sugar-cane mosaic artificially by extracting the virulent juices and injecting them into the healthy plant by means of a hypodermic needle syringe or by pricking them in after smearing the leaves. The extraction and injection of the virulent juices is always troublesome and the "virus" is quickly rendered non-infectious possibly by exposure to the air. Such methods besides being laborious and troublesome do not produce constantly high percentages of infection. 4. Bruner obtained a few infections by pricking in the virulent juices directly from the mosaic into the healthy tissues without previous extraction. The percentages of infection obtained were quite low. This was possibly due to the use of too coarse a needle. 5. The spindle of tightly rolled tender leaves has been the traditional source of the inoculum in artificial transmission experiments. Our new method (spindle-to-spindle) originally consisted in pricking in the inoculum from a mosaic into a healthy spindle held tightly together. This arrangement, though producing a constant high percentage of infection was somewhat cumbersome. 6. In its final form the leaf-slip method consists in pricking in the inoculum from a slip of mosaic cane leaf held tightly as a band around the exposed spindle of a healthy cane plant. To inoculate small cane plants, corn and other grasses, the band is held around the stem. 7. Black No. 0 and white No. 2 Asta insect pins have been used with equally good results. Ordinary pins do not produce the desired results. 8. The number of pin pricks necessary to produce infection has not been determined. Experiments in which groups of cane plants were pricked one, two and three times each, failed to develop mosaic. Ordinarily, about a hundred pin pricks are sufficient to insure infection. 9. The limiting factor seems to be exposure of the "virus" to the air. By thrusting the pin in and out rapidly in a slanting position a large number of times if there are any other requirements for infection, they will be fulfilled mechanically. The larger the number of pricks made, the larger the number of chances for infection. 10. Using a bunch of pins tied up into a brush makes the inoculation work more rapid, especially when inoculating plants with a thick spindle. Equally good results have been obtained with a bunch as with only one pin at a time. 11. Success depends on the care taken to shorten the exposure to the air, of the "virus" that is carried on the pin and on the rate at which the inoculated plant is growing. In resistant or immune cane varieties, other factors are involved, of which we as yet do not know much about. 12. When the inoculated cane plant is growing vigorously, the tissues are turgid and the sap is flowing freely. This seems to favor infection because (1) the wound made by the pin closes up on it thus excluding the air and (2) possibly because the "virus" is carried and distributed rapidly through the plant. 13. Inoculated cane plants of susceptible varieties, when growing rapidly show the first symptoms of secondary infection usually fifteen days after the inoculation. The symptoms appear and are in every respect identical with those shown by plants that have been inoculated through the agency of the insect vector of the disease, the corn aphid, Aphis maidis Fitch. The course of the disease is the same in sugar-cane plants inoculated artificially as it is in plants inoculated in nature through the agency of the insect vector.

Spectrographic Examination of Pellagrins' Sera

That exposure to direct sunlight produces or intensifies the erythematous eruptions on the exposed parts of the bodies of pellagrins is an opinion of many observers; the underlying cause of this apparent photo-sensitization is, however, entirely obscure. The auto-experiment of Meyer-Betz with hematoporphyrin and the skin manifestations of hydroa-aestivalis, buckwheat disease, and other forms of apparent sensitization among the lower animals at least justify the suspicion that some toxic substance is circulating in the blood stream. With the object of determining whether or not the spectrum of pellagrous differed materially from that of non-pellagrous serum, a series of 13 sera was examined with a Hilger quartz spectrograph. Each case had been admitted to the New Orleans Charity Hospital and all were in the acute stage with characteristic eruption, usually with marked oral and gastro-intestinal symptoms. The serum was obtained in the following manner: After a 12 hour fast blood was drawn from the median basilic vein, using a dry needle and glass syringe. Coagulation was allowed to take place in a paraffin coated tube. The serum was pipetted off and centrifuged at 3000 R.P.M. for 10 minutes and again pipetted off.

LOCAL ANÆSTHESIA WITH THE PHARYNGEAL COCAINE SYRINGE.Read by Title in the Section of Laryngology and Otology, at the Forty-second Annual Meeting of the American Medical Association, held at Washington, D. C., May, 1891.

Mr. Chairman and Gentlemen: —I had occasion to report last year, at Nashville, a method of effectually anaesthetizing the tissue of the vault of the pharynx before operating upon adenoid vegetations, by the interstitial injection of cocaine with a suitably constructed and guarded needle syringe. I wish to-day to make a brief report of observations with the instrument during the past year, and as it was incomplete when exhibited, and has since been somewhat modified, I take the liberty of producing it again. An objection raised to the use of the instrument, which was otherwise kindly criticized at the time, was the danger of calling forth alarming or even fatal symptoms by subcutaneous injections of cocaine. Dangerous and disastrous results from the use of cocaine as a local anaesthetic was, from the start, the bugbear that stalked at the heels of this brilliant and most happy innovation, as it was upon