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Implant infections and antibiotic-impregnated silicone rubber coating.

A method is described for coating silicone rubber-encapsulated implant devices with an outer layer of silicone rubber impregnated with a mixture of gentamicin sulphate and diethanolamine fusidate. A coating of this sort provides bactericidal activity lasting for a few days in the film of fluid surrounding such an implant. When used for coating our implants, the retrospective rate of implant infections believed to have been introduced at the time of surgery was reduced to 0.7% (coated), compared with 10.0% (uncoated), a highly significant difference (p less than 0.001). Systemic perioperative antibiotic prophylaxis was not shown to confer any such benefit.

Escherichia coli Infections↗

Sensitisation to natural rubber latex: an epidemiological study of workers exposed during tapping and glove manufacture in Thailand.

OBJECTIVES: To estimate the prevalence of sensitisation to natural rubber latex in latex tappers and latex glove factory workers, and to relate this to airborne exposure to latex. METHODS: Five hundred workers employed in three latex glove factories, 314 tappers, and 144 college students (control group) were studied. The workers in the glove factories were classified into three exposure groups; high, moderate, and low. Personal exposures to natural rubber latex aeroallergens were measured by immunoassay. Symptom questionnaires and skin prick tests with latex allergens (Stallergènes 1:200 w/v) and other common environmental allergens were performed. The criterion for positivity was a wheal reaction at least 3 mm in diameter greater than that to a diluent control. RESULTS: The geometric mean (GM) concentration of latex in air was 15.4 microg/m(3) for those employed in glove stripping, glove inspections, and packing of powdered gloves. The moderate exposure glove manufacturing group and the tappers had GM concentrations of 2.3 and 2.4 microg/m(3) respectively, compared with United Kingdom users of latex powdered gloves,who had GM concentrations of 0.5 microg/m(3). The prevalence of sensitisation to latex in the tappers and latex glove factory workers was 1.3% and 1.7% respectively. No positive cases were found among the college students. Workers who showed a positive skin prick test to latex were more likely to be atopic. Work related respiratory and dermatological symptoms were found in about 20% of each population studied, but were not related to the presence of positive latex prick tests. CONCLUSIONS: This study suggests that in the Thai latex industries, latex sensitisation is rare despite high concentrations of airborne exposure and is less prevalent than in the healthcare sector in Europe where skin exposure is greater.

Adult↗

Effect of acupuncture stimulation on peripheral nerve regeneration using silicone rubber chambers.

The purpose of this study was to determine whether acupuncture could affect the regeneration of a 10-mm gap of rat sciatic nerve created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes. Empty silicone rubber tubes with no further treatment were used as controls. Six weeks after implantation, the animals received the acupuncture or the electroneedling treatment exhibited a more mature ultrastructural nerve organization with significantly higher numbers in the axon density, the blood vessel area, and the percentage of blood vessel area occupied in total nerve area than the controls. In addition, the electroneedling could combine both the needling and the electrical stimulation to potentiate the nerve-growth promoting effect of the acupuncture treatment. These results showed that acupuncture treatment could elicit positive effects on regenerated peripheral nerves.

Acupuncture↗

Effects of buyang huanwu decoction on peripheral nerve regeneration using silicone rubber chambers.

This study investigated the effect of buyang huanwu decoction on the regeneration of a 10-mm gap of rat sciatic nerve created between the proximal and distal nerve stumps, which were sutured into silicone rubber tubes. Empty silicone rubber tubes with no further treatment were used as controls. Six weeks after implantation, 89% of the animals orally administered the buyang huanwu decoction exhibited regeneration across the nerve gaps, whereas only 70% had regenerated in the control group. Both qualitative and quantitative histology of the regenerated nerves revealed a more mature ultrastructural organization with significantly higher numbers of myelinated axons, larger endoneurial areas, higher axon densities and a larger percentage of axon area per total nerve area in the buyang huanwu group than in the controls. These results showed that the buyang huanwu decoction had a growth-promoting effect on the regenerated nerves.

Animals↗

A long-term follow-up of silicone-rubber interposition arthroplasty for osteoarthritis of the thumb carpometacarpal joint.

There are several surgical options for osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint. This paper presents our long-term clinical and radiographic review of 12 thumbs in ten patients treated by partial trapezial excision and silicone-rubber interposition arthroplasty. The follow-up period averaged 15; three years with a ten-year minimum. Although the procedure provided early pain relief in most thumbs, all but two had mild to severe pain at follow-up. The average range of post-operative palmar abduction was 23 degrees. The average post-operative grip strength was 9.5 kg. Both tip and key pinch between thumb and index finger averaged about 50% that of normal subjects. Dislocation of the implant occurred in two joints and breakages in five. Bony erosions around the implant, which we attributed silicone synovitis, were found in four thumbs. The indications for silicone-rubber interposition arthroplasty for OA of the thumb CMC joint should be severely restricted as these produced unsatisfactory long-term results.

Activities of Daily Living↗

Confirmation of the diagnosis of natural rubber latex allergy by the Basotest method.

BACKGROUND: The flow cytometry CD63-based basophil activation test (Basotest has already been validated for the diagnosis of immediate-type allergy such as venom, house dust mite or cypress pollen allergies. The aim of this study was to evaluate the performance (specificity and sensitivity) of Basotest in the diagnosis of natural rubber latex allergy. METHODS: We included 46 latex allergic patients (clinical symptoms of latex allergy, positive latex skin prick tests and/or latex specific IgE) and 33 control subjects and performed Basotest on all subjects. RESULTS: The sensitivity and specificity of Basotest were 84.8 and 87.9%, respectively, when we considered the theoretic cut-off at 15% of CD63-positive cells. Using ROC curves, the optimal cut-off was evaluated at 22%, for which sensitivity and specificity were 79.3 and 96.7%, respectively. CONCLUSION: The Basotest is a reliable test in addition to clinical history and tests already validated (such as skin prick tests and specific IgE) to confirm the diagnosis of natural rubber latex allergy.

Adult↗

Purification and partial amino acid sequencing of a 27-kD natural rubber allergen recognized by latex-allergic children with spina bifida.

We purified from natural rubber latex (NRL) by means of high-performance liquid chromatography a 27-kD protein, recognized characteristically by IgE in sera from latex-allergic children with spina bifida or other congenital anomalies and histories of multiple surgeries. N-terminal sequence analysis of the purified 27-kD protein was unsuccessful suggesting that its N-terminus is blocked. To obtain internal sequence information from the protein it was digested with trypsin and the purified tryptic peptides were subjected to sequence analysis. Thirteen of the 14 sequenced peptides revealed no significant homology to any of the published protein sequences indicating that the 27-kD protein is previously undescribed at the primary structure level. However, one of the 14 sequenced peptides showed significant homology to the rubber elongation factor, a 14.6-kD NRL protein. For the time being, the 27-kD NRL protein is the first molecularly characterized NRL allergen associated with defined clinical manifestations of latex allergy.

Adolescent↗

Pseudoaneurysm of the saphenous vein graft related to artificial rubber pericardium--a case report.

Pseudoaneurysm is an unusual complication of coronary artery bypass grafting. Such aneurysms are caused by technical surgical failures, or inflammation of the sternum and mediastinum following sternotomy observed as an early or mid-term complication of cardiac surgery. This case was an 80-year-old man with a piece of artificial rubber pericardium used for complete closure of the pericardium. A large pseudoaneurysm developed in the body of the saphenous vein graft 15 years after surgery. The old rubber synthetic pericardium was severely degenerative, which induced inflammation and disrupted the saphenous vein graft.

Aged↗

Blue rubber bleb nevus syndrome: immunohistochemical study.

Blue rubber bleb nevus is a rare entity consisting of distinctive angiomas in the skin and gastrointestinal tract, leading to occult or profound gastrointestinal bleeding and chronic anemia. The efficacy has been documented of systemic treatment with corticoids, interferon, vincristine, and, more recently, subcutaneous octreotide in the presence of active lesion proliferation or disseminated intravascular coagulation. A case of blue rubber bleb nevus syndrome with oral hemangiomas in a 24-year-old woman is reported. The surgical specimens were subjected to immunohistochemical study, which showed all of the hemangiomas to be in an inactive phase.

Adult↗

An accidental suffocation by a rubber balloon.

This report presents an autopsy case of a 10-year-old child, who was accidentally suffocated by a rubber balloon that adhered tightly to the epiglottis, occluding air entry. Suffocation by rubber balloon is not uncommon, but the mechanism in this case was unique. The post-mortem findings are given and the conclusion is drawn that such death could have been avoided.

Airway Obstruction↗

Rubber ring clamping of the umbilical cord: a randomized trial.

A randomized trial to compare two methods of umbilical cord tying in neonates, immediately after birth, was undertaken from February to April 1997 in the Department of Obstetrics & Gynaecology, Zewditu Memorial Hospital, Addis Ababa, Ethiopia. In less than 3 months, we investigated 300 neonates, of whom 150 infants were randomly assigned to the traditional ligation of the umbilical cord (using a piece of thread) and the rest to a rubber ring clamping method. Among the former group, 13.3% (20/150) of the neonates bled from their umbilical cords which necessitated re-tying, whereas in the later group, there was no sign of haemorrhage or infection within 12 h of clamping. We suggest that the rubber ring method described is a superior procedure and can easily replace the traditional, cumbersome and time-consuming umbilical cord ligation.

Ethiopia↗

Subjective distress during continuous enteral alimentation: superiority of silicone rubber to polyurethane.

A small-bore feeding tube of silicone rubber was developed in order to improve the acceptance of enteral feeding. The insertion procedure was facilitated by providing a double guidewire which allows continuous adjustment of tip rigidity. The usefulness of this tube was tested in a short-term and a long-term volunteer study as well as in a prospective follow-up of patients receiving enteral nutrition. The volunteer study showed that the newly developed tube significantly reduced subjective distress (rank value 14) when compared to a conventional tube made of polyurethane (rank value 20). In the patient study, 131 silicone rubber tubes were used in 85 patients who received enteral nutrition for a total period of 2080 days and complained about foreign-body feeling and rhinorrhea in only 3.7% and 0.5% of the days, respectively. The rate of inadvertent removals was relatively low (32%), mainly due to restricted mental status of the patients.

Enteral Nutrition↗

Ginsenoside Rb1 enhances peripheral nerve regeneration across wide gaps in silicone rubber chambers.

Silicone rubber chambers filled with collagen containing ginsenoside Rb1 (GRb1) were used to repair lesioned rat sciatic nerves with 15-mm gaps between stumps. Six weeks after implantation, histology of the nerve regenerated in the chambers filled with GRb1 and collagen contained larger axons than those in the chambers with collagen only. This study showed that the GRb1 could exert a positive influence on nerve regeneration when using silicone rubber tubes.

Animals↗

Structural changes in silicon rubber peritoneal dialysis catheters in patients using mupirocin at the exit site.

Structural damage to polyurethane PD (peritoneal dialysis) catheters in patients using mupirocin ointment is widely appreciated, but damage to silicon rubber PD catheters is less well described. Ten catheters (6.6%) out of 152 were found to have structural alterations such as opacification, ballooning, thinning, and rupture. The duration of PD in these 10 patients ranged from 23 months to 80 months (mean duration 51.1 months). The frequency of mupirocin application varied from daily (2 cases) to 2-3 times per week (7 cases). In eight catheters opacification occurred at the exit site whereas one catheter showed opacification midway between the exit site and the titanium adaptor. One catheter showed opacification, ballooning, and thinning at the exit site ruptured in the form of two slit-like openings. In conclusion, various structural changes such as opacification, ballooning or thinning were seen in 6.6% of silicon rubber PD catheters in patients using mupirocin at the exit site. Although the mechanism remains elusive, mupirocin or the antiseptic solution alone or in combination may be contributory. We believe that this is an under-reported complication and encourage other health care givers to incorporate a search for such changes during clinic visits.

Adult↗

Epileptic disorder as the first neurologic manifestation of blue rubber bleb nevus syndrome.

Blue rubber bleb nevus syndrome is an uncommon neurocutaneous disorder characterized by distinctive vascular malformations on the body surface. Vascular malformations of internal organs (typically the gastrointestinal tract) are also frequently present. However, malformations of the central nervous system have only rarely been described. We report a case of blue rubber bleb nevus syndrome in a 5-month-old boy with cutaneous manifestations characteristic of this process present from birth and multiple cerebral angiomas detected by magnetic resonance imaging. At age 1(1/2) months, the patient showed myoclonic seizures and complex partial seizures that were refractory to various antiepileptic regimens. At age 5 months, electroencephalograms (EEGs) showed continuous generalized slow spike-waves, predominantly in the right temporal region; however, EEGs normalized after induction of coma with intravenous midazolam. At age 13 months, the patient suffered from occasional seizures and slightly retarded psychomotor development. Epilepsy is rare in this syndrome but as in other neurocutaneous syndromes (e.g., Sturge-Weber syndrome) can compromise psychomotor development; thus, every effort should be made to control seizures.

Blister↗

Blue rubber bleb nevus syndrome in a patient with ataxia and dementia.

Blue rubber bleb nevus syndrome (BRBNS), an uncommon disorder characterized by cavernous hemangiomas, most often of the skin and gastrointestinal tract, is usually diagnosed during childhood and young adulthood. We made this diagnosis in an octogenarian referred to a geriatric medicine clinic because of concerns about his ability to live independently. Ataxia, dementia, focal neurologic signs, and bluish/purplish vascular nodules on his lips, buccal mucosa, tongue, chest, and neck were noted on physical examination. Magnetic resonance imaging (MRI) revealed an old left parietal infarction, multiple cavernous hemangiomas most densely concentrated in the subcortical structures and cerebellum, and areas of hemosiderin deposition. Skin biopsy findings were consistent with hemangioma. The physical examination, MRI, and skin biopsy made a diagnosis of BRBNS likely. The patient's ataxia, dementia, and other neurologic signs can be explained by previous hemorrhage from the vascular malformations in his brain. Blue rubber bleb nevus syndrome is an uncommon cause of a relatively common geriatric syndrome presentation.

Aged↗

Silicone rubber microangiography of acute spinal cord injury in the rat.

The purpose of this study was to investigate the acute changes in the large vessels and microvasculature of the spinal cord after acute clip compression injury in the rat. Nineteen female Wistar rats underwent acute compression of the spinal cord at C8-T1 at 53 g for 1 min. Silicone rubber was injected into the ascending aorta at 15 minutes, 1, 4, or 24 hours after injury. An additional nine rats served as normal controls. The perfused spinal cords were cleared by the alcohol-methylsalicylate technique. The results showed that, in the normal rat, the centrifugal arterial system from the sulcal arteries provided the major blood supply to the gray matter and the lateral and ventral white matter extending all the way to the pial surface. In the normal rat, there were large veins in the posterior columns coursing longitudinally in the parasagittal plane at the base of the posterior columns. The injured spinal cords displayed marked ischemia and hemorrhage at the injury site. The hemorrhage predominated in the gray matter and posterior white columns and extended rostrally and caudally for 2 to 7 mm in each direction from the injury site. Remote hemorrhages originated from damage to the large parasagittal veins in the posterior columns. Extravasations of silicone rubber were frequently seen at the earlier posttraumatic times and often originated from the sulcal arteries or their branches at the injury site. Occluded sulcal arteries were identified at the injury site at 4 and 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗

157 nm F2-laser writing of silica optical waveguides in silicone rubber.

Silica (SiO2) optical waveguides have been fabricated on the surface of silicone [(SiO(CH3)2)n] rubber by photochemical modification of silicone rubber into silica with 157 nm F2-laser radiation. The 2 mm thick silicone was exposed through a thin (approximately 0.2 mm) air layer to generate oxygen radicals that chemically assisted in the silica transformation. Silica waveguides were defined in 8-16 microm wide exposure strips by a proximity Cr-on-CaF2 photomask. Optimum laser processing conditions are presented for generating crack-free waveguides with good optical transparency at red (635 nm) and infrared (1550 nm) wavelengths. A propagation loss of approximately 6 dB/cm is reported at the 1550 nm wavelength.

Journal Article↗