Puncture Of Capsule Research Articles

Automated Capsular Decompression to Avoid Argentinian Flag Sign in Intumescent Cataract.

We describe an alternative automated technique that consists of simultaneous anterior capsule puncture and decompression of the capsular bag by using an insulin needle attached to the aspiration tubing of the phacoemulsification device to prevent the occurrence of the "Argentinian Flag sign" during capsulorhexis in intumescent cataract. Instituto de Olhos de Assis and Center of Specialties Hoftalmed, located in the state of São Paulo, Brazil. Prospective interventional study. Eighty-eight eyes of 88 patients with white or intumescent cataracts were included in this study. Routine clear cornea incision, capsule staining with trypan blue, intracameral anesthesia, and ophthalmic viscoelastic device were used before the procedure. A 26-gauge needle was connected to the phacoemulsification aspiration tubing using a double male Luer connector for irrigation, and aspiration was inserted into the anterior chamber through a new paracentesis incision with the bevel facing down. Immediately after insertion, automated aspiration of the liquefied cortex was performed to remove anterior intralenticular material and achieve capsular decompression. Compression of the nucleus with the needle tip was performed to remove any liquefied material trapped between the posterior surface of the nucleus and the posterior capsule. All surgeries were performed using the same phacoemulsification and parameters. The rate of complete continuous capsulorhexis was observed and noted. No complications were observed in any of the cases. A single-stage, continuous, and well-centered capsulorhexis was achieved in 100% of cases. We conclude that a simultaneous puncture and decompression of the capsular bag using an insulin needle attached to the aspiration tubing of the phacoemulsification machine effectively avoided the "Argentinian Flag sign" in intumescent cataract surgery.

The traction force of the pulled limb in hip arthroscopic surgery is determined by stiffness coefficient which is significantly related to muscle volume.

To verify the relationship between muscle volume, lateral centre-edge angle (LCEA), alpha angle (AA), body mass index (BMI) and Beighton score with stiffness coefficient (SC). To analyse the difference of traction force at different physical states of hip joint capsule. Thirty-six patients who underwent hip arthroscopy operation were included. The volumes of some related muscles were measured in MRI images by 3D Slicer. We recorded and tested differences in traction force of five joint capsule physical states, including before (State 1) and after joint capsule puncture (State 2), after the establishment of anterolateral and mid-anterior approaches (State 3) and after incision of the joint capsule through these two approaches (States 4, 5). The correlation between muscle volume, BMI, LCEA, AA and SC was verified by Spearman test. Poisson regression was used to explain confounding variables. The average force at State 1 was 531.8N. There were significant differences in traction force between these five states (p < 0.001). There was a significant positive correlation between muscle volumes and SC (p < 0.001). BMI had no correlation with SC (n.s.). The preoperative LCEA of the affected side was correlated with SC (p = 0.043). AA and SC were not correlated (n.s.). The physical states of the hip joint capsule affected traction force. Muscle volume rather than BMI is an ideal index to estimate preoperative traction force. LCEA affected traction force, whilst AA and Beighton score did not. Measuring the muscle volume can help estimate the most suitable traction force for the patient. IV.

Application of modified anterior capsular reducting capsulorherxis in white cataract surgery

Objective To evaluate the efficacy of application of modified anterior capsular reducting capsulorherxis in white cataract surgery. Methods The anterior chamber was injected with a small amount of viscoelastics. A puncture small triangle flap in the center of the anterior capsule was made with self-made 1 ml syringe. Through the anterior capsule puncture flap, a small amount of viscoelastics was injected slowly under the anterior capsule, and liquefied cortex was replaced from the main incision. Curvilinear capsulorherxis was completed with capsulorherxis forceps. Results Sixty-eight eyes with white cataract received surgery, among them 66 eyes were successfully capsulorherxis, and the success rate was 97.06%. Conclusion Application of modified anterior capsular reducting capsulorherxis in white cataract surgery can not effect the observation of the operation field and the capsulorhexis operation, and reduce the pressure in capsular bag, improve the success rate of the annular capsulorhexis. Key words: Cataract, white; Capsulorherxis, anterior capsule, reducting, modified

Evaluating the sensitivity, reproducibility and flexibility of a method to test hard shell capsules intended for use in dry powder inhalers

Pharmaceutical tests for hard shell capsules are designed for orally administered capsules. The use of capsules in dry powder inhalers is widespread and increasing and therefore more appropriate tests are required to ensure quality and determine if these capsules are fit for purpose. This study aims to determine the flexibility, reproducibility and sensitivity of a quantitative method that is designed to evaluate the puncture characteristics of different capsule shell formulations under different climatic conditions. A puncture testing method was used to generate force displacement curves for five capsule formulations that were stored and tested at two different temperatures (5°C and 19°C). Force-displacement puncture profiles were reproducible for individual capsule shell formulations. The methodology was able to discriminate between capsules produced using different primary materials i.e. gelatin versus hypromellose, as well as more minor changes to capsule formulation i.e. different material grades and excipients. Reduced temperature increased the forces required for capsule puncture however further work is required to confirm its significance. Results indicate the method provides a reproducible and sensitive means of evaluating capsule puncture. Future studies should validate the methodology at different test sites, using different operators and with different capsule shell formulations.

52 VITRIFICATION OF DAY-8 EQUINE EXPANDED BLASTOCYST: AN IN VITRO COMPARISON OF DIRECT VERSUS INDIRECT MECHANICAL INTRODUCTION OF CRYOPROTECTANT

The cryopreservation of equine expanded blastocysts (&gt;300 μm) has been largely unsuccessful primarily due to the low permeability of the embryo to cryoprotectants. This low permeability has been attributed to the acellular glycoprotein capsule that develops when an embryo approaches approximately 300 μm in diameter. Mechanical alternatives may provide a means to overcome the capsule barrier and the relative large embryo size to successfully cryopreserve equine embryos. The objective of this experiment was to compare re-expansion rates of vitrified equine expanded blastocysts following either direct or indirect mechanical introduction of cryoprotectants using a coaxial microinjection system (Dracula pipette). Twenty-six Day-8 expanded blastocysts were subjected to capsule puncture, cryoprotectant injection, and blastocoele fluid extraction (direct treatment) or capsule puncture and blastocoele fluid extraction (indirect treatment) before cryopreservation. The Dracula pipette incorporates the injection pipette within the holding pipette, facilitating aspiration of blastocoele fluid or injection of cryoprotectant in a single unit. A standard vitrification protocol using a final concentration of 3.4 M glycerol and 4.6 M ethylene glycol at cryopreservation was used. Vitrified embryo re-expansion was assessed following in vitro culture at 24, 48, and 72 h post-warming. Differences across treatments were analysed using the Student's t-test for re-expansion and the chi-squared test of independence for capsule loss. Pre-vitrification embryo mean diameter (mean ± standard error) for direct and indirect treatment groups were not different, 979 ± 85.6 μm and 912 ± 101.4 μm, respectively (P = 0.62). Post-vitrification embryo mean diameters were not different for the direct and indirect treatments (688 ± 63 and 662 ± 75 μm, respectively; P = 0.79). Following 72 h of in vitro culture, there was no difference in mean embryo diameter (1813.16 ± 209 μm v. 1383.88 ± 198 μm; P = 0.21), or re-expansion rates (69 v. 69%) for direct and indirect treatment groups, respectively. However, partial or total capsule loss was 69% (9/13) for direct treatment embryos compared with 30% (4/13) for indirect treatment embryos (P = 0.049). Results from this experiment demonstrate that capsule puncture and blastocoele fluid extraction before vitrification resulted in high re-expansion rates of Day-8 equine expanded blastocysts after warming. More importantly, the relatively large percentage of capsule failure when directly introducing cryoprotectant into the embryo may interfere with maternal recognition of pregnancy following embryo transfer. Nonetheless, based on the embryonic re-expansion rate of vitrified equine embryos following the indirect technique, we anticipate that a relatively high pregnancy rate can be obtained if this technique is used.

The development of a sensitive methodology to characterise hard shell capsule puncture by dry powder inhaler pins

In order for hard-shell capsules to function effectively as drug reservoirs in dry powder inhalers, the capsule must be punctured with sharpened pins to release the powdered medicament upon inspiration. Capsule performance in this setting is poorly understood. This study aims to develop a methodology to characterise hard shell capsule penetration by needles from commercial dry powder inhalers, to determine whether changes to capsule materials impact on their performance. Two pin types from two commercial dry powder inhalers were mounted in a material-testing machine, equipped with a 500 N load cell. A stainless steel bush was used to secure a capsule directly below the steel pin. Hypromellose (n=10) and gelatin capsules (n=10) were conditioned in 'normal' or low humidity conditions and were subsequently punctured with both types of pin. Each puncture event was recorded on a load-displacement curve. The force required for puncture was 2.82±0.26 N for hypromellose capsules and 4.54±0.26 N for gelatin capsules, stored in normal humidity. Different capsule materials possessed distinguishable signature profiles but repeated force-displacement profiles were highly reproducible i.e. intra-individual variability was minimal. A rapid, robust yet sensitive methodology has therefore been developed that is able to characterise hard shell capsule materials based on the puncture performance.

A Comparison of the Puncturing Properties of Gelatin and Hypromellose Capsules for Use in Dry Powder Inhalers

This study investigates capsule puncture in dry powder inhalers. Gelatin and hydroxypropylmethyl cellulose (HPMC) capsules (stored at 11 and 33% relative humidities) were punctured using a pin from a Foradil® inhaler, with insertion force measurement via an Instron tester. In HPMC capsules, the force after capsule puncture reduced by half and then increased to a second maximum as the pin shaft entered the hole. In gelatin capsules, the postpuncture force reduced to zero, indicating shell flaps losing contact with the pin. At lower moisture contents, both capsules were less flexible. This provides a tool to measure the shell properties of inhalation capsules.

Posttraumatic Aspergillus terreus endophthalmitis masquerading as dispersed lens fragments

A 20-year-old man developed increasing inflammation with a hypopyon 3 weeks after primary repair of a corneal laceration. An occult anterior capsule puncture was suspected as the stimulus for the inflammation. When aspiration of the suspected hydrated lens material was not curative, a vitrectomy with injection of intravitreal antibiotic agents including amphotericin (0.0125 mg) was done the following day; the culture failed to grow fungal organisms. A repeat vitrectomy was performed 1 week later, and the culture grew Aspergillus terreus. This was determined to be resistant to amphotericin so voriconazole was injected intravitreally. The inflammation recurred, and the eye required enucleation because of blindness and intractable pain. Fungal endophthalmitis should be considered in cases of delayed-onset inflammation after trauma and may be due to organisms resistant to amphotericin.

Glenohumeral movement patterns after puncture of the joint capsule: An experimental study

In on experimental series comprising 22 shoulder specimens obtained at autopsy, we investigated the influence of an intact capsule on glenohumeral stability. Puncture of the capsule resulted in significant glenohumeral translation in unloaded and loaded specimens during shoulder abduction. A maximum of 16.6 mm of distal translation was observed at 20° of abduction. Concomitant with this translation the humerus spontaneously rotated externally, with a maximum rotation of 15.8° at 50° of abduction. After venting the capsule, anterior and posterior translation and external rotation were increased significantly. Maximum total increase in anteroposterior translation was 14 mm at 30° of abduction. The external rotation was increased up to 7.1° at 40° of abduction. These findings indicate that studies evaluating glenohumeral instability are compromised unless the translations resulting from capsular venting ore corrected. Evaluation of shoulder stability should be performed before violation of the intraarticular pressure mechanisms.

TEMPORARY CLEARING OF A CATARACTOUS LENS.

The writings of Risley, Jackson, de Schweinitz, Weeks, Knapp, Pyle and others, have introduced into the management of partial lens opacities considerations which make the old and easy classification of incipient and ripe cataracts unsatisfactory to the observer, and unjust or cruel to the patient. A few clinical truths seem to have been firmly established. We know that the situation of early opacities is of prognostic importance; that senility is neither the only nor the most important factor in etiology of so-called primary senile cataract; that the uveal tract, especially the choroid, should be minutely studied; that "spontaneous cures" now and then occur from absorption, with or without capsule puncture, or from luxation; that hygienic, optical and medicinal care are of importance, and seem to retard progress of lens-clouding: that ripening operations are unreliable, and probably entirely unnecessary; that if the opacity interferes with vision to a great degree, and

Fluid Cataract—Puncture of Capsule, and immediate removal of the fluid from the anterior chamber

Fluid Cataract—Puncture of Capsule, and immediate removal of the fluid from the anterior chamber