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In many cases deep second degree and third degree burns cause severe scarring. The authors have reported here their experience of the treatment of hypertrophic scarring from burns carried out on 44 children with intralesional injections of a long-acting cortico-steroid (Triamcinolone hexacetonide) using the jet spray technique.
After injecting autologous muscle to induce massive pulmonary embolism, the effects of high-frequency jet ventilation (HFJV) were compared with those of controlled mechanical ventilation (CMV) in anesthetized, paralyzed dogs. HFJV better maintained both alveolar ventilation and oxygenation than did CMV. Moreover, PaO2, cardiac index, and oxygen delivery were greater with HFJV than with CMV when the two modes of ventilation were compared at the same PaCO2.
Plantar and common warts can be cured with great efficacy by the intralesional injection of bleomycin using the jet injector. Traditional keratolytic treatment and electro-desiccation are also still in use. Condyloma acuminata respond to podophyllin combined with cryotherapy. It is advisable to use the CO2 laser in more extensive infections. Interferon injections also may be helpful in these cases. Plane warts can be treated by tretinoin and 5-fluorouracil. In case of diffuse verruca sensitization with diphenylcyclopropenone can be considered.
STUDY OBJECTIVE: To compare the in vitro performance of an ultrasonic nebulizer and a jet nebulizer in producing a respirable aerosol of tobramycin solution for injection. DESIGN: In vitro observational study DEVICES: Ultrasonic and jet nebulizers. INTERVENTION: Output was determined by measuring the difference in nebulizer weight before and after nebulizing 3 ml of tobramycin injection solution. Mass median aerodynamic diameter (MMAD) and respirable mass were determined by sampling tobramycin aerosol into a cascade impactor. MEASUREMENTS AND MAIN RESULTS: Mean (SD) output was 1.14 (0.09) ml/minute for the ultrasonic nebulizer and 0.64 (0.08) ml/minute (p<0.001) for the jet nebulizer. Mean MMAD for the jet nebulizer (2.31 [0.10] microm) was less than that of the ultrasonic nebulizer (2.81 [0.17] microm, p<0.001). The majority of tobramycin aerosol produced was in the respirable range for both the ultrasonic (65.1% [4.10%]) and jet (60.6% [0.73%], p=0.008) nebulizers. CONCLUSION: Despite small, clinically unimportant differences in aerosol size and respirable fraction, either device would be acceptable to administer tobramycin injection solution.
Evidence that interferon-gamma may be a physiologic macrophage-activating factor, and that macrophage activation may be defective in lepromatous leprosy, led us to test the effects of intradermal injection of low doses of recombinant interferon-gamma in six patients with this disease. Interferon-gamma, 1 or 10 micrograms, was administered daily by jet gun for three days into a single cutaneous lesion. A biopsy specimen was taken from the injection site on the sixth study day and compared with specimens obtained previously from a site where no injection had been made or where excipient alone had been injected in the same way as the interferon. Interferon-gamma elicited local effects similar to certain features of delayed-type hypersensitivity reactions or tuberculoid leprosy, including induration, T-cell and monocyte infiltration, keratinocyte proliferation, diminution of epidermal Langerhans cells, and dermal and epidermal cell HLA-DR (Ia) antigen expression. At some of the sites of interferon-gamma injection, there was also an apparent decrease in acid-fast bacilli. Before treatment, monocytes from patients with lepromatous leprosy released 48 percent as much hydrogen peroxide as did monocytes from controls in response to phorbol myristate acetate, and 36 percent as much as those from controls in response to Mycobacterium leprae. When recombinant interferon-gamma was injected, these responses became normal. No toxic effects were observed. These observations suggest that interferon-gamma can mediate certain manifestations of delayed-type hypersensitivity or cell-mediated immunity in vivo, and that recombinant interferon-gamma should be tested for possible therapeutic effects in certain nonviral infectious diseases.
To evaluate factors influencing the structure and shape of stenotic and regurgitant jets, Doppler color flow mapping and optical flow visualization studies were performed with use of a syringe model with a constant rate of ejection to simulate jets of valvular regurgitation and a pulsatile flow model of the right heart chambers to simulate jets of mild, moderate and severe valvular pulmonary stenosis. Ink-(0 to 40%) glycerol-water jets (viscosity 1 to 3.5 centiPoise) were produced by injecting the fluid at a constant rate into a 10 gallon rectangular reservoir of the same still fluid through 1.4 and 3.4 mm needles. The Doppler color flow scanners imaged the laminar jet length within 3 mm of actual jet length (2 to 6 cm) and the jet width within 2 to 3 mm of the actual jet width. Jet flows with Reynolds numbers ranging from 230 to 1,200 injected into still fluid yielded jet length/width ratios that decreased with increasing Reynolds numbers and leveled off to a length/width ratio of 5-6:1 at a Reynolds number near 600. When the fluid reservoir was swirled to better mimic the effect of flow entering the same cardiac chamber from a second source, the jets showed diminution of the jet length/width ratio and a clearly defined zone of turbulence. Studies of the pulsatile flow model were performed at cardiac outputs of 1 to 6 liters/min for the normal and each stenotic valve. Mild stenosis had an orifice area of 2.8 cm2, moderate stenosis an area of 1.0 cm2 and severe stenosis an area of 0.5 cm2. Laminar jet length represented the length of the total jet, which had a symmetric width and was measured from the valve opening to a region where the jet exhibited a spray effect. Laminar jet lengths (0.2 to 1.1 cm) were imaged by Doppler color flow mapping and optical visualization only in the moderate and severely stenotic valves and only at flows less than or equal to 3 liters/min (mean Reynolds numbers less than or equal to 3,470). Beyond this flow rate the jets exhibited a spray effect. Laminar jet length/width ratio approached unity with an increased amount of valvular stenosis and higher flow volumes (cardiac output). Proximal aliasing was present in each valve studied. the length of aliasing (0 to 3.2 cm) proximal to the valve was longer with increased flow rates and increased amounts of stenosis.(ABSTRACT TRUNCATED AT 400 WORDS)
Jet ventilation initially described by Sanders has been modified and improved for use with the Storz bronchoscope. Theoretical and technical performance are discussed and the mechanical and physiological properties are dealt with e.g. FiO2, driving and endotracheal pressure, expiratory CO2 concentrations, blood gas analysis, pulmonary artery pressure and electrocardiographic changes. Using this method prolonged diagnostic and surgical procedures, such as cauterisation of bronchial adenoma, removal of foreign bodies from the airways especially of small children and bronchial toilet in status asthmaticus, are rendered free from problems for the anaesthetist. We believe that the inject ventilator is a very useful addition to endotracheal surgery.
An in vitro technique using color flow imaging and continuous wave Doppler was developed to measure the initial regurgitant flow jet diameter and velocity integral to yield the parameters for a volume calculation. Jets were produced by volume-controlled injection through tubes of various diameters (1.3, 1.9, 2.8, and 3.5 mm) to deliver volumes from 1 to 7 ml over 100 to 300 msec at pressures from 40 to 200 mm Hg. One hundred forty-five samples were obtained. Flow jet diameter consistently overestimated tube diameter by 2 mm when injected volume was 1.5 to 7 ml and by 1.5 mm when injected volume was less than 1.5 ml. This offset was stable with various transducers (2.5, 3.5, 5.0 MHz) at normal gain setting (just under noise). Therefore, corrected flow jet diameter (FJD) = FJD - 2 mm, and Doppler volume = corrected flow jet area x velocity integral. A range of injectates from 1.1 to 7 ml generated Doppler volume of 1.0 to 8.2 ml. The relation between Doppler volume (DV) and injected volume (IV) was DV = 1.079 IV - 0.22, r2 = 0.945, p less than 0.01. This relation was not altered by tube diameter. Thus a method combining color flow imaging and continuous wave Doppler provides a reliable and accurate measure of in vitro flow volume.
The development of a frozen vaccine against cutaneous leishmaniasis offers the possibility of controlling the quality, efficiency and sterility of the promastigotes used for inoculation. Thirty-nine soldiers in a settlement in a hyperendemic area were inoculated with a fresh isolate of Leishmania tropica that was stored at the temperature of liquid nitrogen. Thirty of the soldiers were injected by conventional syringe while the rest were inoculated by an intradermal jet injector. The infective material was transported either in ice or at liquid nitrogen temperature. All the subjects developed lesions at the site of inoculation, without unwarranted reactions. One month after inoculation 31 subjects were examined by a physician. All the reactions were positive--12 ulcers and 19 nodules. After four months, all 39 soldiers were examined: 25 (64%) had ulcers; eight (21%) had nodules; and six (15%) were without visible reaction. The different methods of transporting the vaccine, as well as the different responses of men and women, are discussed.
Thirty-seven patients with psoriatic nail dystrophy were treated with intradermal nail-fold injections of either triamcinolone acetonide or triamcinolone hexacetonide, using the Port-O-Jet needleless injector. Mild nail-matrix changes showed a very good response to treatment, whilst nail-bed and/or hyponychial changes causing onycholysis and the more severe types of dystrophy usually showed little improvement. Although in occasional cases this may be a useful form of treatment, we would not recommend its general use in patients with psoriatic nail dystrophy.
Acute aortic regurgitation was created experimentally in 21 mongrel dogs to examine the relationship of the regurgitant jet to observed echocardiographic findings. The direction of the regurgitant jet was studied by echo contrast injections in the aortic root. Diastolic fluttering of the anterior mitral leaflet (AML) was noted in all 21 dogs irrespective of direction of the jet. Diastolic fluttering of the interventricular septum (IVS) was noted in six of the seven dogs with a tear of the noncoronary cusp and in one of seven dogs with lesions in the left coronary cusp. In all seven dogs with echocardiographically demonstrated IVS fluttering, a regurgitant jet impinged on the anterior part of the IVS. Amplitude of the AML excursion was not significantly different from control when the lesions involved the noncoronary or the left coronary cusps. However, all seven dogs that had a lesion in the right coronary cusp demonstrated a significant reduction in the amplitude of the AML excursion. The regurgitant jet in these dogs impinged uniformly on the AML. We conclude that diastolic fluttering of the AML is uniformly observed and unrelated to the direction of the regurgitant jet, diastolic fluttering of the IVS is caused by the regurgitant jet impinging upon the IVS, and amplitude of the AML may be reduced as a result of a jet impingement of the AML.
Jets emanating from the exit holes of cardiac catheters during angiographic injections are theoretically capable of producing severe localized cardiovascular trauma. We adopted a fluid mechanical model of an axially symmetric jet to define these energy forces quantitatively, especially as they would occur in the clinical setting. During angiographic injection at all catheter flow rates used clinically, the jet emanating from the exit hole was always turbulent. The physical characteristics of the turbulent jet penetration into the intravascular blood fell upon a universal curve independent of the jet Reynolds number. This curve, never previously described, allows ready calculation of hydraulic energy dissipation for any catheter of known length and lumen size. The diameter of the catheter exit orifice has a greater effect than injection flow rate on decreasing jet penetration. These results provide useful guidelines for reducing trauma during routine angiography.
The usefulness and safety of water jet angioplasty was studied in vitro, using agar phantom and autopsied aorta, and in vivo in acute and chronic arterial occlusions in mongrel dogs. At an injection rate of 1.0 ml/s, the water jet produced erosion of the agar surface when the distance between the catheter and the agar was 1 mm. With an injection rate of 1.5 ml/s, erosion was produced at a distance of 15 mm from the catheter tip. When the water jet was directed at an arterial wall, intimal ablation and ruptured elastic fibers were found histopathologically. A smaller angle between the vascular wall and the catheter was associated with less vascular damage. In vivo, water jet angioplasty was effective against acute obstructions, but not against chronic obstructions. These results suggest that water jet angioplasty may be effective against arterial obstruction due to acute thrombus.
Visual estimates of the intensity of the continuous wave (CW) Doppler regurgitant jet signal have been used to estimate the severity of valvular regurgitation. Theoretically, the strength of the reflected Doppler signal is a function of the number of scatterers. To test this approach quantitatively, free jets were produced in 27 experiments using a power injector and cornstarch suspension varying in concentration from 1% to 3%. Flow volume was varied from 5 to 15 ml, and orifice diameter varied from 2.5 to 10 mm. Machine settings were kept constant. Also, 22 patients with mitral regurgitation (MR)--5 mild, 11 moderate, and 6 severe by angiography--were studied. Average signal intensity under the CW Doppler flow curve was calculated using a computer image processor. In MR patients, average regurgitant flow (RF) intensity was compared with average mitral forward flow (FF) signal intensity. (1) The intensity under the CW flow signal in the free jet experiments correlated well with injection volume (r greater than 0.98). (2) RF average signal intensity did not correlate with angiographic MR severity (r = 0.21), but the ratio of RF to FF average signal intensity did correlate with MR severity (r = 0.73). (3) The sensitivity and the specificity of an RF/FF ratio greater than 0.65 for angiographically severe mitral regurgitation were both 83%. (4) The sensitivity and specificity of an RF/FF ratio less than 0.50 for angiographic mild mitral regurgitation were both 80%. The ratio of regurgitant to forward mitral flow CW Doppler signal intensity appears to be an accurate and clinically applicable method for estimating the severity of mitral regurgitation.
A sandwich amperometric enzyme immunoassay with flow injection for alpha-fetoprotein in human serum has been developed with alkaline phosphatase as the enzyme label. p-Hydroxyphenyl phosphate was used as the substrate for alkaline phosphatase. The hydrolysis product, hydroquinone, was detected by oxidative amperometry in a flow injection system. The amperometric wall jet detector was fitted with a glassy carbon working electrode held at 350 mV vs. Ag/AgCl. The detection limit of hydroquinone in 30 mM borate buffer pH 9.5 was 1.2 x 10(-10) M (linearity range: 10(-9)-5.12 x 10(-6 M). A detection limit for free alkaline phosphatase of 1.2 x 10(-15) M (linearity range: 10(-15)-10(-13) M), or about 36 000 molecules, was observed (same borate buffer and incubations of 10 min at 25 degrees C). These conditions were maintained for the amperometric alpha-fetoprotein immunoassay. For comparison purposes, a photometric detection system was set up, with p-nitrophenyl phosphate as enzyme substrate and the same pair of antibodies and incubation conditions. The detection limit for alpha-fetoprotein obtained by amperometry, 0.07 ng/ml (linearity range = 5-500 ng/ml), was 14 times lower than by photometry. The amperometric enzyme immunoassay correlates well with a commercial colorimetric immunoassay (r = 0.986, slope = 0.967, n = 240).
In Bautzen Reservoir (Germany), a technique of internally dosing iron compounds in combination with a local water column destratification was developed in order to control Microcystis blooms. In this paper, experimental results concerning the phosphorus (P) precipitation by iron application are reported. First, preliminary studies were conducted serving the choice of an appropriate precipitant. Subsequently, a whole-lake experiment was carried out. Fe2+ salts displayed a delayed oxidation and flocculation behaviour when injected into an ascending water jet. Nevertheless, the efficiency of soluble reactive phosphorus (SRP) elimination was equal to experiments with Fe3 + compounds both in laboratory and field experiments. During Fe2+ application, a large P-binding potential remained during the horizontal spreading of the treated water, since the proportion of the dissolved iron fraction near the dosage point was still high. Thus, measurements at a greater distance from the dosage point revealed higher amounts of P eliminated by Fe2+ than by Fe3+ dosage. Compared to the preceding year 1995, during the treatment periods in May-August 1996 and 1997 the SRP contents in the whole water body dropped by 72% and 54%, respectively, while the total phosphorus contents dropped by 45% at each period. We conclude that in-lake dosage of Fe2+ is an appropriate method to reduce the P loading of hypereutrophic reservoirs.
With brilliant synchrotron X-ray sources, microsecond time-resolved synchrotron X-ray radiography and tomography have been used to elucidate the detailed three-dimensional structure and dynamics of high-pressure high-speed fuel sprays in the near-nozzle region. The measurement allows quantitative determination of the fuel distribution in the optically impenetrable region owing to the multiple scattering of visible light by small atomized fuel droplets surrounding the jet. X-radiographs of the jet-induced shock waves prove that the fuel jets become supersonic under appropriate injection conditions and that the quantitative analysis of the thermodynamic properties of the shock waves can also be derived from the most direct measurement. In other situations where extremely axial-asymmetric sprays are encountered, mass deconvolution and cross-sectional fuel distribution models can be computed based on the monochromatic and time-resolved X-radiographic images collected from various rotational orientations of the sprays. Such quantitative analysis reveals the never-before-reported characteristics and most detailed near-nozzle mass distribution of highly transient fuel sprays.