Safe and minimally invasive laminoplastic laminotomy using an ultrasonic bone curette for spinal surgery: technical note

Background: Ultrasonic surgical aspirators have been used mainly for removing brain tumors. Because of their longitudinal and torsional tip, they are used for cutting the bone structures in spinal surgery installing a scalpel-type tip. The purpose of this report is to describe the effectiveness and surgical pitfalls of an ultrasonic bone curette in laminoplastic laminotomy and hemilaminotomy. Methods: We present 12 patients who underwent laminoplastic laminotomy and hemilaminotomy. We used a SONOPET UST-2001 ultrasonic bone curette with HB-05S handpieces (M and M Co, Ltd, Tokyo, Japan). After a tumor was removed, titanium plates were used for the laminoplastic laminotomy and hemilaminotomy. The technical advantage of an ultrasonic bone curette and procedure-related complication were examined. Results: There were no major procedure-related complications such as cord injury. Wound infection and subcutaneous fluid collection caused by cerebrospinal fluid leakage did not occur for reconstruction of posterior bony structure. In 1 patient with calcified dura mater associated with tumor, dural tear occurred. The width of the tip was narrow enough for resected laminae to be fused postoperatively, and spinal instability did not occur in all cases. Conclusion: The scalpel-type ultrasonic bone curette is useful for cutting bone and effective for reconstruction of the laminae. Laminotomy with an ultrasonic bone curette is safe and minimally invasive. To prevent dural tear, we recommend drilling laminae to make the bone thin as the first step, followed by cutting the remaining laminae using a bone curette especially in cases with calcified or tense dura mater.ArticleSURGICAL NEUROLOGY. 72(5):470-475 (2009)journal articl

Some clinical aspects of rheumatoid arthritis

In our department we have been placing a special emphasis on the treatment and study of rheumatoid arthritis, and during the last four years we have handled about 1,600 cases visiting our outpatient clinic and approximately 100 hospitalized cases. Our experiences with these patients are only what might be called an introductory phase in the study and treatment of rheumatoid arthritis when compared with those in Europe and America. In estimating the incidence of rheumatoid arthritis in Japan from various available data, although it would not reach the level of England and U.S.A., it will be about 100 cases per 100,000 population, matching more or less the incidence in the northern Europe. As regards sex and the predisposing age we find no great difference from those in Europe and America. One striking difference that we find is the fact that patients in our country have very little resistance against salicylic acid drug used in treatment. Therefore, it is unreasonable to expect a good anti-inflammatory action by administering a large dosage of 5-10g of such a drug as aspirin per day. It must be limited within a comparatively small dosage of 1.0 to 2.0 g or with concomitant administration of prednisolone and aspirin in the hope of utilizing its analgesic effect. Furthermore, it is not feasible to introduce the results of studies made in Europe and America on the salicylic drug and its prescription all of them showing the concentration in blood 35 mg%, which is on the borderline of intoxicating dosage. This is only one example, and with some more experiences we shall undoubtedly encounter many dissimilar points. Therefore, it is essential that rheumatology specific to Japan needs to be established.</p

Topical agents or dressings for pain in venous leg ulcers.

Venous leg ulcers affect up to 1% of people at some time in their lives and are often painful. The main treatments are compression bandages and dressings. Topical treatments to reduce pain during and between dressing changes are sometimes used

Lighted Ear Curette

The ear canal is a sensitive and small part of the human body that is prone to accumulate cerumen or lodge foreign bodies. In order to clean the ear canal or remove foreign bodies, three hands are required: one to brace the patient\u27s head, one to maneuver the curette that is used to clean the ear, and one to hold a light source in order to make the small, dark area visible. Therefore, a design is needed that can allow a doctor to safely clean an ear with an instrument that only requires two hands. Furthermore, the design must have disposable curette tip attachments in the form of both a scoop (used to clean the ear) and tweezers (used to remove foreign bodies), while remaining affordable. To make this possible, a design was created that has both a tweezer and scoop disposable attachment that connect onto a reusable handle. A small lighted camera snaps onto the disposable curettes a few centimeters from the end of the tip. When the curette is inserted into the ear, the camera displays a video of the inner ear onto a screen, allowing the user complete visualization as they work, decreasing procedure time and increasing comfort. This report outlines the background, design strategies and results of the ear curette design created. The resulting product is a prototype created using a 3D printer to demonstrate how the curette assembles and functions. Further development of this prototype and the creation of a complete manufacturing plan is necessary before it is ready to be used in a medical setting

Volume Analysis of the Proximal Tibial Metaphysis

Purpose The Vitrea 2 imaging software (Vital Images Inc, Minnetonka, MN) was used for the volume analysis of the proximal tibial metaphysis. Materials and Methods Eighteen computed tomography scans of the proximal tibia were processed through the software, and 3-dimensional imaging of the proximal tibia was reconstructed. Results The volume and area of the proximal tibia that were generated resulted in a mean area of 127 cm2 and a mean volume of 77.2 cm2. Conclusion This study supports the use of the proximal tibial metaphysis as a source of low to moderate volume of autologous bone. When compared with the accepted average volume of 25 cm2, the computed results showed that there could be up to 3 times the amount of bone available in the proximal tibial metaphysis. The reported volume of bone harvested from previous studies was based on need and not the total amount available; subsequently, the results showed the possibility of a larger resource of bone, which provides the surgeon with the volumetrical limits of the proximal tibia metaphysis

Endoscopic ultrasonic curette-assisted removal of frontal osteomas

Indications for endoscopic resection of fronto-ethmoidal osteomas have been progressively expanded thanks to optimization of surgical exposure and the development of dedicated instruments. Curved cutting drills are still suboptimal to treat hard osseous neoplasms of the frontal sinus. We present two patients affected by frontal osteoma treated with an endoscopic procedure using an ultrasonic bone curette. The ultrasonic bone curette may be considered an effective tool to reduce soft tissue manipulation, optimize surgical time and accelerate the healing process. However, the technique requires significant shape innovations to reach the lateral recesses and to manage pure intrasinusal lesions

In vitro evaluation of surface roughness, adhesion of periodontal ligament fibroblasts, and Streptococcus gordonii following root instrumentation with Gracey curettes and subsequent polishing with diamond-coated curettes

Objectives: The objective of the study was to evaluate the efficacy of an additional usage of a diamond-coated curette on surface roughness, adhesion of periodontal ligament (PDL) fibroblasts, and of Streptococcus gordonii in vitro. Materials and methods: Test specimens were prepared from extracted teeth and exposed to instrumentation with conventional Gracey curettes with or without additional use of diamond-coated curettes. Surface roughness (Ra and Rz) was measured before and following treatment. In addition, the adhesion of PDL fibroblasts for 72h and adhesion of S. gordonii ATCC 10558 for 2h have been determined. Results: Instrumentation with conventional Gracey curettes reduced surface roughness (median Ra before: 0.36μm/after: 0.25μm; p < 0.001; median Rz before: 2.34μm/after: 1.61μm; p < 0.001). The subsequent instrumentation with the diamond-coated curettes resulted in a median Ra of 0.31μm/Rz of 2.06μm (no significance in comparison to controls). The number of attached PDL fibroblasts did not change following scaling with Gracey curettes. The additional instrumentation with the diamond-coated curettes resulted in a two-fold increase in the number of attached PDL fibroblasts but not in the numbers of adhered bacteria. Conclusions: Treatment of root surfaces with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may result in a root surface which provides favorable conditions for the attachment of PDL fibroblasts without enhancing microbial adhesion. Clinical relevance: The improved attachment of PDL fibroblasts and the limited microbial adhesion on root surfaces treated with scaling with conventional Gracey curettes followed by subsequent polishing with diamond-coated curettes may favor periodontal wound healin