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PubMed1986

A comparison of various types of fixation devices for protection of the posterior cruciate ligament against a posterior drawer force.

We compared four different fixation devices to determine which offers the greatest relative protection to the posterior cruciate ligament (PCL) against elongation with an applied posterior drawer force. We designed a system to monitor and record the change in distance between an approximate origin and insertion of the PCL as known forces were applied posteriorly to the tibia with the femur fixed. Six fresh cadaver knees were used in this investigative series. They were first tested with the PCL intact, then with the PCL transected, and then with the various fixation devices applied. After comparing the results with transarticular pins and quadrilateral and anterior half-frame external fixators, we found that transarticular fixation offers significantly greater protection to the PCL. This study may prove to be helpful to the orthopaedist when selecting ancillary fixation for posterior cruciate repair or reconstruction.

Adult↗
PubMed1982

Efficacy of enforcement in an industrial hearing conservation program.

Relative efficacy of various levels of enforcement in the use of personal hearing protective devices was investigated among employees of a large industrial plant. The main variable was that each of four groups of employees worked during a different period of enforcement policy on the use of personal hearing protection. Analysis of variance of mean hearing levels using three different audiometric grading schemes with different levels of sensitivity, namely, the 0.5, 1, 2 kHz Hearing Level Index, the 1, 2, 3 kHz Hearing Level Index, and the 4000 Hz single puretone test indicate that the enforcement policy did have a dramatic effect on the efficacy of the hearing conservation program and should give similar results in other industrial settings. When and where the use of personal hearing protection was left to the employee it was found that hearing loss among the noise-exposed was very much in excess of that among a non-noise-exposed group. Mandatory use of personal protective devices was found to be much more effective in conserving hearing that the voluntary approach. Mandatory use of earmuffs exclusively proved to be less effective than mandatory use of personal hearing protection when the employee was given a choice of earmuffs or earplugs. Enactment of the Occupational Safety and Health Act did not result in greater hearing conservation over the existing company mandatory hearing conservation program which is quite effective.

Adult↗
PubMedDate not supplied

Using a mathematical model to evaluate the efficacy of TB control measures.

We evaluated the efficacy of recommended tuberculosis (TB) infection control measures by using a deterministic mathematical model for airborne contagion. We examined the percentage of purified protein derivative conversions under various exposure conditions, environmental controlstrategies, and respiratory protective devices. We conclude that environmental control cannot eliminate the risk for TB transmission during high-risk procedures; respiratory protective devices, and particularly high-efficiency particulate air masks, may provide nearly complete protection if used with air filtration or ultraviolet irradiation. Nevertheless, the efficiency of these control measures decreases as the infectivity of the source case increases. Therefore, administrative control measures (e.g., indentifying and isolating patients with infectious TB) are the most effective because they substantially reduce the rate of infection.

Cross Infection↗
PubMedDate not supplied

Is acculturation related to use of hearing protection?

Noise-exposed employees with limited English skills may pose a special challenge for hearing conservation programs. This pilot field study assessed knowledge, attitudes, and behavior regarding use of hearing protective devices in a largely Hispanic group of 88 workers exposed to industrial noise. Effectiveness of hearing protection was determined through field measurements of personal attenuation ratings. Individual scores on an acculturation scale (first language learned, language at home, degree of literacy in English, preferred language) demonstrated a correlation between a low degree of acculturation and low personal attenuation rating (R2= 0.49, p=0.0001). Low acculturation was also correlated with high-perceived barriers to use of hearing protection (p=0.006). Although neither self reports of self-efficacy nor perceived benefits of hearing protection correlated with personal attenuation rating, perceived barriers to hearing protector use was a significant predictor of hearing protector fit (p=0.05). These results indicate that less acculturated workers may be underutilizing hearing protection in the workplace partly due to perceived barriers to use of hearing protective devices. To be effective, hearing conservation training programs in work sites with an immigrant work force need to address language and cultural barriers to the use of hearing protection.

Acculturation↗
PubMed2001

[Endovascular treatment for recurrent carotid stenosis].

PURPOSE: Surgery of recurrent carotid stenosis (RCS) has higher complication rates than primary carotid endoarterectomy (CEA). Percutaneous transluminal angioplasty (PTA) and stent placement were evaluated retrospectively with a view to proposing then as alternative procedures for RCS. METHODS: In the last 10 years, 19 patients underwent 20 endovascular procedures for RCS at our Department. The mean interval between CEA and PTA was 21 months (range 4-96): 14 patients had PTA within 2 years, 3 patients within 2 and 3 years,and 2 after 3 years. The mean degree of stenosis was 92% (range 80-95%). PTA was performed by balloon catheters (size 4-7 mm) without using cerebral protection device; one self-expanding stent was used to treat RCS after PTA. All patients underwent physical examination and carotid color-coded Doppler sonography in autumn 1999 RESULTS: The procedure was technically successful, with residual stenosis lower than 50%, in 17 of 19 patients; 10 patients showed residual stenosis lower than 30%. Carotid PTA was stopped due to transient neurological deficit in one case. One RCS proved uncompliant even though high-pressure balloon catheters were used. The mean follow-up period in 16 patients was 37.4 months (range 3-99 months). Carotid restenosis after PTA developed in 3 patients, respectively after 29,18 and 7 months. In the last case RCS was successfully treated by stent placement (Wallstent). The primary patency rate was 81%, the secondary patency rate was 88% and the late clinical success rate was of 94%. CONCLUSIONS: In selected cases, PTA without the use of cerebral protection devices and stent placement proved to be a safe and effective alternative treatment for early RCS. When an atherosclerotic lesion is suspected surgery or endovascular treatment with cerebral protection devices are recommended.

Aged↗
PubMed2006

Techniques in cerebral protection.

Carotid angioplasty and stenting is a valid alternative option to conventional carotid endarterectomy in the treatment of carotid artery stenosis. During the stenting process, however, distal embolization can occur with neurological consequences. To avoid this, cerebral protection devices have been introduced. Three principal types of protection system have been developed: distal balloon occlusion, distal filters and proximal protection with or without reversal of flow. As protection devices became the focus of interest by manufactures and physicians, several trials are going on worldwide to analyze the characteristics of each of them and to evaluate their efficacy to reduce the rate of distal embolization.

Blood Vessel Prosthesis↗
PubMedDate not supplied

Stent-protected carotid angioplasty using a membrane stent: a comparative cadaver study.

PURPOSE: To evaluate the performance of a prototype membrane stent, MembraX, in the prevention of acute and late embolization and to quantify particle embolization during carotid stent placement in human carotid explants in a proof of concept study. METHODS: Thirty human carotid cadaveric explants (mild stenoses 0-29%, n = 23; moderate stenoses 30-69%, n = 3; severe stenoses 70-99%, n = 2) that included the common, internal and external carotid arteries were integrated into a pulsatile-flow model. Three groups were formed according to the age of the donors (mean 58.8 years; sample SD 15.99 years) and randomized to three test groups: (I) MembraX, n = 9; (II) Xpert bare stent, n = 10; (III) Xpert bare stent with Emboshield protection device, n = 9. Emboli liberated during stent deployment (step A), post-dilatation (step B), and late embolization (step C) were measured in 100 microm effluent filters. When the Emboshield was used, embolus penetration was measured during placement (step D) and retrieval (step E). Late embolization was simulated by compressing the area of the stented vessel five times. RESULTS: Absolute numbers of particles (median; >100 microm) caught in the effluent filter were: (I) MembraX: A = 7, B = 9, C = 3; (II) bare stent: A = 6.5, B = 6, C = 4.5; (III) bare stent and Emboshield: A = 7, B = 7, C.=.5, D = 8, E = 10. The data showed no statistical differences according to whether embolic load was analyzed by weight or mean particle size. When summing all procedural steps, the Emboshield caused the greatest load by weight (p = 0.011) and the largest number (p = 0.054) of particles. CONCLUSIONS: On the basis of these limited data neither a membrane stent nor a protection device showed significant advantages during ex vivo carotid angioplasty. However, the membrane stent seems to have the potential for reducing the emboli responsible for supposed late embolization, whereas more emboli were observed when using a protection device. Further studies are necessary and warranted.

Adult↗
PubMed2006

European carotid PROCAR Trial: prospective multicenter trial to evaluate the safety and performance of the ev3 Protégé stent in the treatment of carotid artery stenosis--1- and 6-month follow-up.

BACKGROUND: The purpose of the European PROCAR Trial was to evaluate the safety and performance of the Protégé stent in the treatment of common and/or internal carotid artery stenoses with adjunctive use of a filter embolic protection device. METHOD: The Protégé GPS stent is a self-expanding Nitinol stent system mounted on a 6 Fr 0.018'' (6-9 mm stent) or 7 Fr 0.035'' (10 mm stent) over-the-wire delivery system. Study patient assessments were conducted at baseline, periprocedure, discharge, and 1 and 6 months postprocedure. A total of 77 patients have been enrolled in the trial. RESULTS: In the 77 lesions treated (31 symptomatic, 46 asymptomatic), the procedure was technically successful in 76 (99%), with an average residual stenosis of less than 30%. One procedure failed because the embolic protection device could not be retrieved and the patient was sent to surgery. Within 30 days, there were four (5.2%) major adverse neurological events (MANEs). Three of the MANEs were major strokes (3.9%), one a minor stroke. The fifth MANE occurred prior to the 6-month follow-up visit; this patient had a major stroke 75 days after the procedure and died 36 days later. One additional death occurred because of urosepsis. CONCLUSIONS: The PROCAR trial shows that the Protégé stent with adjuvant use of a filter embolic protection device satisfies safety and performance criteria for the treatment of carotid artery stenosis. The incidence of MANEs for the Protégé stent is comparable to the incidence of these events in other recent carotid stent studies and standard carotid endarterectomy (CEA).

Aged↗
PubMed2001

[Embolism prevention during interventional treatment of aortocoronary bypass stenoses].

No-reflow is an unpredictable complication after percutaneous intervention in saphenous vein grafts. Plaque embolism, vasoconstriction and thrombosis are mechanisms that lead to poor distal run-off. Treatments with alternative techniques like DCA, TEC and ELCA as well as phamacological attempts like GP IIb/IIIA inhibitors, vasodilators and calcium-channel blockers do not improve outcome. This is the rationale for the development of mechanical devices to prevent distal embolization. Two concepts of distal protection devices are currently realized: occlusive balloon and filtering devices. The largest experience comes from the PercuSurge GuardWire, an occlusive balloon device. The recently presented data from the SAFER trial showed a significant prevention of distal embolization and improvement in clinical outcome. The second generation of filter devices is under investigation; the advantages of these systems are the preservation of blood flow and precise angiography-guided stent positioning. Another issue of investigation is a broader use of protection devices in carotid stenting, and in interventions in acute MI and acute coronary syndromes.

Aged↗
PubMed1996

[An analysis of 148 outpatient treated occupational accidents].

BACKGROUND: The most common eye injuries are non-perforating. Eye injuries in the workplace are a major cause of socioeconomical damage, morbidity and disability, despite well publicised standards for industrial eye protection. This study investigates the epidemiological and clinical aspects of 148 occupational cases. PATIENTS: At the University Eye Clinic of Tübingen, 709 non-perforating eye injuries were registered as occupational accidents between 1995 and 1996. Of these cases, 148 were analysed retrospectively per random. RESULTS: The 5 most common injuries of 148 patients (m/f = 138/10; mean age 33.4 +/- 12 years) were related to corneal foreign body injuries (35%), chemical burns (15.5%), sub-conjunctival foreign bodies (12%), thermal/ultraviolet injuries (11%) and contusions (7.4%). Of these patients, 22.3% were employed as construction workers and 16.2% as metal workers. At the time of examination the visual acuity of the traumatic eye was 0.9 +/- 0.3. The interval between the beginning of work and accident was 6.2 +/- 6.4 hours in average (0.5-13.5 h). Of all accidents, 8.5% were caused during the first hour of work; in contrast 45.5% of all accidents were caused after 6 hours of work. Another 12.4 +/- 14.5 hours (5min.-72 h; median 7 h) passed by until the patients arrived for eye examination at the Eye Clinic of Tübingen. Only 6% of all patients arrived within the first hour, and 29.7% after 12 hours. Of all cases, 30.4% received first-aid treatment in their company by the factory doctor or by the eye doctor before examination at the Eye Clinic. Only 6.8% of all patients had protective spectacles during work. Incapacity was seen in 30.4%; the average in total was 5.5 +/- 10 days. CONCLUSION: Despite the late examination at the Eye Clinic the functional loss was mostly little except after chemical burns. Nevertheless, most occupational accidents can be avoided with better protective devices in order to reduce the incidence of injuries and socioeconomical damage. Therefore an intense campaign about protective devices at the place of employment should be required. We conclude that education about safety glasses in the workplace by tradespeople and trades assistants during tasks for which goggles are recommended could considerably reduce the rate of occupational eye traumata. The data of the University Eye Clinic of Tübingen are useful to identify strategies to prevent eye injuries such as wider and better use of safety glasses and improvement in engineering controls.

Accidents, Occupational↗
PubMed1978

Solar retinopathy: visual prognosis in 20 cases.

A report of 20 cases of solar retinopathy associated with watching an eclipse of the sun is presented. Visual prognosis was generally good and most patients had good vision at the end of six months. Paramacular scotomata, image distortion and macular changes were, however, still present in the majority of patients. Transmission of energy through various protective devices was measured with a fluxmeter. The finding of retinal damage after exposure of even short duration through protective devices that reduce the incident irradiance of the sun up to 5,000 times indicates that the damage observed may be other than thermal in nature. It is concluded that no safe method for directly viewing a solar eclipse is generally available, and that the public, especially schoolchildren and their children, should be better acquainted with this hazard.

Adolescent↗
PubMed1992

[Health effects and personal protection in pest control workers using organophosphorus insecticides].

One hundred and sixteen pest control workers (16 termite control workers (Sprayer I), 46 cockroach or fly-control workers (Sprayer II) and 56 both termite and cockroach or fly-control workers (Sprayer III)) were surveyed by a questionnaire and health examinations. Variety and quantity of pesticide used, personal usage of protective devices (respirator, gloves, work clothes, under wear), and conditions related to bathing were studied by a questionnaire. Relationships between protective devices and blood cholinesterase activity (ChE) were also analyzed. Significant findings were as follows: Most of the pest control operators wore gum gloves and gas masks when involved in termite control. However in the case of cockroach or fly-control, 38% did not wear gloves, and for respiratory protection 44% wore gas masks while 25% of them did not even use any form of respirators. In spite of having better protective practices than sprayers II and III, sprayer I showed significantly lower plasma ChE activity than both sprayer II and III. Plasma ChE activity in sprayers who put on simple respirators tended to be lower than those using gas masks. Plasma ChE activity was also significantly lower in those workers who had less frequent changes of work clothes compared to those with more frequent.

Adult↗
PubMedDate not supplied

A pressure prevention device for burned ears.

Full-thickness burns to the external ear can produce loss of skin and cartilage and can result in severe cosmetic deformity. Even partial-thickness burns render the ear vulnerable to tissue loss if the helix is subjected to pressure from pillows, dressings, or straps that are used to secure endotracheal tubes. Because of the incidence of burned ear deformities and the difficulty in reconstructing the external ear, an ear protection device has been designed. The bilateral ear protection device, referred to as "headgear", is fitted to all patients in the burn center who require intubation for an inhalation injury; it is worn continuously until extubation. During a 15-month period 39 consecutive critically burned patients were fitted with the headgear because of the need for ventilator support and/or for protection of the burned ear(s). Pressure necrosis of ear tissue was prevented in all 33 survivors.

Burns↗
PubMed2000

Hip protectors for preventing hip fractures in the elderly.

BACKGROUND: Hip fracture in the elderly is usually the result of a simple fall and hip protectors have been advocated as a means to reduce impact and consequences of such falls. OBJECTIVES: To determine if external hip protectors reduce the incidence of hip fractures in elderly persons following a fall. SEARCH STRATEGY: The Cochrane Musculoskeletal Injuries Group trials register, MEDLINE, and reference lists of relevant articles were searched, and identified trialists contacted. Date of the most recent search: August 1998. SELECTION CRITERIA: All randomised or quasi-randomised controlled trials comparing the use of hip protectors with a control group. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality, using a ten item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. MAIN RESULTS: Five randomised trials involving 1681 participants were included within the review. All studies involved elderly people in nursing homes or residential care, three within the Scandinavian countries, one in Japan and one in the United Kingdom. The two largest studies involving 1409 participants randomised by nursing home or nursing home ward rather than by the individual (cluster randomisation). One study of 141 individuals was primarily a compliance study. Summation of results from four of these studies gave an occurrence of hip fractures of 13/620 (2.1%) for those allocated to wear hip protectors, against 57/920 (6.2%) to those not allocated to wear protectors. However due to the large number of participants allocated by cluster randomisation it was not possible to demonstrate conclusively that this difference between groups was statistically significant. Only one of the 13 hip fractures that occurred in the individuals allocated to wear hip protectors occurred whilst the protector was worn. No significant adverse effects of the hip protectors were reported but compliance, particularly in the long term, was poor. REVIEWER'S CONCLUSIONS: Hip protectors appear to reduce the risk of hip fracture within a selected population at high risk of sustaining a hip fracture. However, this conclusion is based on four trials of low to moderate quality. As two used cluster randomisation, pooling of data was not possible. The generalisability of the results is unknown beyond high-risk populations. Results from six ongoing trials may clarify this situation. Acceptability by users of the protectors remains a problem, due to discomfort and practicality.

Aged↗
PubMed2006

Distal protection in cardiovascular medicine: current status.

Iatrogenic and spontaneous downstream microembolization of atheromatous material is increasingly recognized as a source of cardiovascular morbidity and mortality. Devising ways of reducing this distal embolization using a variety of mechanical means--distal protection--is currently under intense and diverse investigation. This review therefore summarizes the present status of distal protection. It examines the problem of distal embolization, describes the available distal protection devices, reviews those areas of cardiovascular medicine where distal protection devices are being investigated, and discusses potential future developments.

Angioplasty, Balloon↗
PubMed2003

Auditory localization in the horizontal plane with single and double hearing protection.

INTRODUCTION: Although single hearing protection devices such as earplugs or earmuffs are known to degrade sound localization, little is known about localization accuracy in double-hearing-protection conditions where both earplugs and earmuffs are worn at the same time. METHODS: Listeners wearing earplugs, earmuffs, or a combination of earplugs and earmuffs were asked to localize short (250 ms) or long (continuous) pink noise signals originating from one of 24 loudspeaker locations in the horizontal plane. RESULTS: When single hearing protection was worn, localization was reasonably accurate in the left-right dimension even when the stimuli were short in duration. When double hearing protection was worn, however, left-right localization accuracy was poor even when the stimuli were on continuously. A second experiment showed that localization accuracy with double hearing protection varied substantially across different listeners, but that it varied only slightly across refittings of the same earplugs and earmuffs on the same listener. A third experiment showed that double hearing protection impaired localization in the left-right dimension much more for narrow-band sounds at frequencies above 500 Hz than it did for narrowband sounds at frequencies at or below 250 Hz. DISCUSSION: The severe disruptions in performance that occurred when earmuffs and earplugs were worn simultaneously suggest the influence of a mechanism such as bone conduction that does not normally interfere with localization when only a single hearing protection device is used.

Adult↗
PubMed2001

Ocular paintball injuries.

Paintball sport-related ocular injuries represent an increasing problem as the popularity of the sport increases and the number of participants grows. Although eye protective devices designed specifically for paintball sports are extremely effective in preventing such injuries, the failure to properly wear these devices has resulted in an alarming number of severe ocular injuries. Recent trends have indicated that an increasing percentage of paintball sport-related ocular injuries have occurred in unsupervised, noncommercial settings (i.e., backyard games) where the use of eye protective devices is not required. Paintball industry standards for eye protection have recently been developed and should be implemented for all participants.

Athletic Injuries↗
PubMed1990

[Use of contact lenses during general anesthesia].

In 1987-8 the authors investigated changes of the cornea in patients during prolonged operations under general anaesthesia in IMV Brno. They analyzed the causes of corneal damage during prolonged unconsciousness and assessed the relationship of cornea changes on the decrease of lacrimation, change of BUT and period of unconsciousness during general anaesthesia. For the protection of the cornea of anaesthetized patients soft contact lenses were used and the sequelae of their application were compared with the application of other hitherto used protective devices (covering the cornea by an occlusion bandage, viscous drops eye jelly or eye ointment). Hydrophil contact lenses proved useful as a satisfactory protective device to cover the cornea during long-term anaesthesia.

Anesthesia, General↗