Limitations in the use of the dermo-jet.
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A self-contained jet injector, the Syrjet Mk II, can be used for needleless injection of anesthetic agents into the skin and subcutaneous tissues. Although designed for dental use, its compact size, simplicity, and versatility make it suited for many medical applications where a relatively small anesthetic field is desired, especially in children. It provides an anesthetic area for the introduction of standard hypodermic needles for more extensive tissue infiltration, or for definitive anesthesia for procedures such as marrow aspiration, biopsies, small lesion excision, and in certain field blocks such as digital or facial sensory. It is significantly free of side effects and complications.
10 women allergic to nickel developed skin reactions at injection sites with a Dermo-Jet (Krantz model) of (a) 2% lidocaine solution and (b) 0.9% saline solution. 10 women (age-matched) not allergic to nickel were selected as controls and submitted to the same injections; they had no positive reactions. Various controls (including injections with a needle and patch tests) were made in both groups. Nickel was leached into fluids from the metallic internal parts of the Dermo-Jet. The positive reactions were allergic and due to nickel. Histology showed changes of an allergic contact dermatitis with particular features, probably due to the intradermal injection of nickel. Some practical implications regarding the quality of medical instruments are discussed.
BACKGROUND: The measles, mumps and rubella (MMR) vaccine confers trivalent immunity in >90% of subjects immunized. Alternatives to the use of needles for vaccine administration have recently been made available. We report the safety and efficacy of MMR vaccine delivered by a new needle-free jet injector (Injex) compared with needle syringe administration. METHODS: Forty adolescent subjects were injected bilaterally via needle syringe and jet injector with MMR vaccine and reconstitution buffer. Subjects were blinded as to which device contained the vaccine. Subjects were followed longitudinally for 12 weeks postimmunization, and titers to measles, mumps and rubella immunogens were determined by enzyme immunoassays. Injection pain was quantified using the visual analog pain scale. RESULTS: Adverse events were mild and included injection site soreness (jet injector, 2.5% of subjects; needle, 12.5%), injection site bleeding (jet injector, 0%; needle, 7.5%), malaise (jet injector, 0%; needle, 5%) and fever (jet injector, 0%; needle, 2.5%). All subjects displayed measles titers significantly above baseline during the follow-up. Ninety-five percent of subjects displayed titers above baseline for the mumps antigen vs. 97.5% for rubella. No significant differences in immunogenicity were found between groups receiving the vaccine via the jet injector or the needle syringe at any time during the follow-up (P > 0.05). Injection pain scores were not significantly different between injector types (P > 0.05). CONCLUSIONS: We conclude that the measles, mumps and rubella vaccine can be safely and effectively delivered by the Injex jet injector. This device therefore provides an alternative to standard needle injection and a methodology that might reduce the risk of needle stick accidents.
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Anesthesia for microlaryngeal surgery creates many obstacles for the anesthesiologist and otolaryngologist. Anesthetic techniques developed to improve surgical exposure have been met with significant limitations and are difficult for the anesthesiologist to monitor. A new subglottic jet ventilation anesthesia system is introduced that meets the needs of the otolaryngologist and the anesthesiologist. This new system is made up of two components: (1) The Hunsaker Mon-Jet tube is a laser-safe, subglottic jet ventilation tube constructed of a nonflammable fluoroplastic material. It allows monitoring of tracheal pressure and end tidal carbon dioxide, and it is designed with a basket-shaped distal extension to align the jet port away from the tracheal mucosa and to prevent trauma and submucosal injection of jetted gas. (2) An automatic jet ventilator, which has an adjustable respiratory rate, inspiratory/expiratory ratio, and flow rate, also monitors expiratory end peak airway pressures and has an automatic shutdown feature if either of these pressures are exceeded. This system was successfully used in 36 patients undergoing microlaryngeal surgery.
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71 patients with knee joint osteoarthritis deformans in exacerbation with weak exudative component have received outpatient treatment: intrajoint injections of kenalog with novocaine, jet intra- and periarticular injections of the above drugs, magnetolaser therapy (groups 1, 2 and 3, respectively). The response was obtained in 85, 90 and 75%, respectively. Neither toxicity nor complications were recorded. The above methods are recommended for use in outpatient departments and clinics.
A cell-free crude extract of Erysipelothrix rhusiopathiae injected by high pressure jet into the knee-joint of rabbits stimulated an acute, mild inflammatory reaction. Additional injections at 3-day intervals induced a chronic condition characterized by hyperplasia of the synovial cells and hypertrophy of the villi, due to infiltration by lymphocytes and plasma cells which formed aggregates resembling Allison-Ghormley bodies. There was also extensive proliferation of stroma vasculature and fibrous tissue. A similar jet injection of the diluent produced an early, transient, acute, and mild inflammation. A mechanism is postulated for fixation of one or more of the chemically characterized antigens in or near the synovium as a means of inducing the localized inflammatory response that predisposes the joint to infection.
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Eighty patients (34 with lung abscess, 39 with lingering pneumonia associated with chronic bronchitis) were examined for the activity of the proteinase inhibitory system in bronchial washing off as well as for the level of alpha 1-proteinase inhibitor in blood serum. The system of proteinases inhibitors was found to be unbalanced with the predominance of proteinases. The proteinase inhibitor contrycal was included into the multimodality treatment of patients. The patients of the main group were administered contrycal and antibiotics intrapulmonarily with the aid of a needle jet injector (NJI-1) and endobronchially, whereas the control group patients were given intravenous injections in the identical daily and total dose. The local (intrapulmonary and endobronchial) administration of proteinase inhibitors and antibiotics turned out to compare very favourably with intravenous injection of the same remedies.
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