Two studies were performed to assess the function and longevity of a novel intraosseous (IO) catheter device. For the initial study, nine animals were assigned to three study groups. The first group received a 25 mm intraosseous device within the proximal humerus, the second group within the proximal tibia, and standard jugular catheters were placed in the final control group. Serial aerobic and anaerobic blood cultures were collected from jugular veins at day zero, then every third day while devices remained in use. Radiographs were obtained immediately after placement and again after removal of all IO devices. Goats were observed for overall clinical condition and lameness associated with catheter sites, and catheters were evaluated for patency and proper positioning. IO devices in the tibia remained in for less time than those in the humerus. Blood cultures in this study showed growth of Bacillus, Staphylococcus, and one colony within the genera Brachyacterium or novel Dermabacteraceae. Catheters also showed growth of Bacillus, as well as a single colony of Micromonospora chalcea. No animals in either IO group exhibited radiographic evidence of resulting damage or structural change within surrounding bone. In study two, eighteen goats were assigned to two study groups (25 mm intraosseous device within the wing of the ilium, or 45 mm catheter in the proximal humerus). Blood for serial aerobic and anaerobic blood cultures and CBC were collected from jugular veins at day zero, then every second day thereafter while devices remained in use. All clinical monitoring and removal criteria were identical to study one. Catheters in the ilium remained in significantly less time than those in the humerus. Several animals in the proximal humerus group demonstrated moderate lameness following removal. One goat developed an abscess near the insertion site and showed radiographic evidence of periosteal bone growth. Serial cultures showed growth of Bacillus, Streptococcus, Staphylococcus, and Enterococcus. Bloodwork indicated mild elevations of white blood cells from baseline in some cases. Our study indicated that catheters may remain safely in place for greater than 24 hours, but that animals should be closely monitored for negative side-effects for several days during the post-removal period.

Objectives: Progressive resorption of the alveolar ridge in the posterior maxilla and pneumatization of the maxillary sinus creates a challenging situation for rehabilitation with endosseous dental implants. Lateral wall sinus augmentation technique has proved to be predictable in gaining vertical bone height by the addition of bone graft under the schneiderian membrane. Cone beam computed tomography (CBCT) is essential for planning this bone augmentation technique to identify any concerns such as the presence of bony septae, sinus pathology, an intraosseous vascular canal, etc. that may contribute to potential complications. The purpose of this study is to investigate the prevalence of intraosseous anastomosis of the posterior superior alveolar artery (PSAA) and infraorbital artery (IOA) in the lateral wall of the maxillary sinus in patients of Temple University Kornberg School of Dentistry utilizing cone beam computed tomography (CBCT). Materials and Methods: 821 CBCT scans taken at Temple University Kornberg School of Dentistry Department of Oral Maxillofacial Radiology between January 2009 to December 31, 2015 were analyzed with iCATVisionQ software for the presence of an intraosseous artery in the lateral wall of the maxillary sinus, the most anterior tooth associated with the canal and the vertical distance from the artery to the floor of the sinus. Age, gender, ethnicity, and dentition status were also evaluated. Of the 821 scans reviewed, 447 patients met the inclusion criteria of the study. The 447 patients were subdivided by gender into 249 females and 199 males, and subdivided by ethnicity into 292 Caucasians, 42 Asians, 24 Hispanics, and 90 African Americans. The data was documented in an excel spreadsheet and analyzed. Results: Based on the 447 scans included in this study, there was an anastomosis of the posterior superior alveolar artery and infraorbital artery in the lateral wall of the sinus in 752 (84%) of the sinuses evaluated. The majority of the detected vascular canals were seen bilaterally. There was also a presence of multiple canals in 155 (17%) sinuses, the majority being two canals. The highest number of canals visualized was four canals in four sinuses. The tooth most associated with the vascular canal was the second premolar. The average distance from the vascular canal to the floor of the sinus was 12mm. Conclusions: Based on the results of this retrospective study, the prevalence of an intraosseous anastomosis in the lateral wall of the maxillary sinus is greater than previously reported (30-70%). In some cases, multiple intraosseous vascular canals were identified. With this knowledge, the importance of locating the vascular canals prior to surgery is important to minimize bleeding complications. Cone beam computed tomography (CBCT) should be a diagnostic tool for surgeries involving the lateral wall of the maxillary sinus. / Oral Biology

No description available.

In order to investigate the early ultrastructural lesions at the first sign of lameness in the oligofructose (OF) model of laminitis, the disease was induced in four horses, while another four horses were sham-treated controls. Minor lesions were detected in lamellar samples examined by light microscopy. Examination by transmission electron microscopy (TEM) showed excessive waviness, breaks and separation of portions of lamellar basement membrane (BM) in the treated horses. There was also disintegration and disappearance of hemidesmosomes (HD) and epidermal basal cell (EBC) cytoskeleton, and an increase in the distance between the EBC plasmalemma and the centre of the BM. A link was thus established between the first clinical signs of lameness and ultrastructural changes in the lamellar dermo-epidermal interface. This implied that pathogenesis was underway well before clinical signs (24 h) and that successful therapy would need to be instituted earlier than previously considered. Earlier therapy may be facilitated if delivery of efficacious drugs to the foot was achievable. A treatment modality that delivered effective concentrations of anti laminitic drugs to the target organ (the epidermal lamellae) was thus an objective of this study. Hoof lamellar tissue from five ponies treated with prolonged euglycaemic hyperinsulinaemia and four control (sham-treated) ponies were harvested and processed for TEM. Lamellae from treated ponies showed attenuation and elongation of secondary epidermal lamellae (SEL), HD number reduction and infiltration of leukocytes. Unlike carbohydrate induced laminitis in horses, there was no global separation at the lamellar dermal/epidermal interface in ponies. Two unique lamellar lesions found in this induction model was mitosis among EBCs and thickening of the BM, not normally characteristic of acute laminitis. The pathophysiology of hyperinsulinaemic laminitis remains unresolved but if insulin, delivered directly to the foot, induced laminitis several pathophysiological questions would be answered. In particular, it would emphasise the laminitogenic potential of insulin alone in the pathogenesis of laminitis. It also allows the treatment foot to be compared with the remaining three that act as internal controls. A modality that delivered drugs like insulin to the target organ (the epidermal lamellae) was needed and was an objective of this study. A microdialysis (MD) method, based on continuous sampling of the lamellar extracellular fluid (ECF), was developed to monitor lamellar drug concentrations. MD probes were implanted in the hoof lamellar tissue of six normal Standardbred horses under local anaesthesia. A bolus intravenous (IV) dose (5 mg/kg BWT) of gentamicin sulfate was injected into the jugular vein. MD and blood samples were collected at different time points during 24 h, and calibrated and analyzed using an ELISA method for gentamicin. During the first 8 h, the concentration of gentamicin was significantly higher in blood than lamellar ECF, a result that is reversed when lamellar MD is repeated during IO infusion of gentamicin. The results showed that this modestly invasive method was a useful tool to monitor changes in the lamellar ECF during drug delivery or during laminitis development. Knowledge of the anatomy and dynamics of blood circulation in the equine foot is fundamental to understand laminitis pathophysiology. Using histology, decalcification, diaphanization, computed tomography (CT), micro CT and gelatin-India Ink vascular perfusion, the normal anatomy of the dorsal part of distal phalanx (DP) and its vascular relationship to hoof lamellae was characterised. The results showed a close relationship between the distal phalangeal and lamellar circulations and raised the possibility of accessing the lamellar circulation via the DP and the possibility that IO perfusion (IOP) of the DP could deliver drugs to the lamellae. IOP of the DP with methyl methacrylate (MMA) corrosion casting material resulted in filling of the lamellar and sublamellar vascular network and incomplete filling of lamellar capillaries. Perfusion of common digital artery with a suspension of barium sulfate resulted in filling of lamellar arteries but not capillaries. Perfusion of the common digital vein resulted in filling of lamellar veins but not capillaries. Perfusion with barium sulfate partitioned veins from arteries because particle size prevented entry into capillaries. IOP with barium sulfate filled only veins revealing that vascular egress from the DP was venous. This study showed that a retrograde venous connection exists between the DP and lamellar circulations with the potential for lamellar drug delivery. Intra-arterial (IA) and IO infusion results using gelatin-India Ink were markedly improved when cadaver limbs were subjected to cyclic loading within the physiological range. Without loading lamellar capillaries failed to fill no matter what the injection pressure. Cyclic loading cadaver limbs 6 times resulted in complete lamellar capillary filling and suggested that cyclic limb loading contributed to perfusion of lamellar capillaries normally in horses. To evaluate IO delivery of drugs to hoof lamellae in the standing, conscious horse, gentamicin solution (25 mg/mL) was slowly infused (20 µL/min) through an IO bone screw. Lamellar ECF was collected via a lamellar MD probe and blood was collected from the jugular vein. Gentamicin was 50-100 times more concentrated in lamellar ECF than in blood. This study introduces a potential method for delivery of drugs into the lamellar tissue in the standing, conscious horse. Laminitis pathology occurs before clinical signs and can be induced by insulin as well as enteric OF overload. Thus therapy delivered to the target of laminitis, the hoof lamellae, has an improved chance of success if delivered promptly, safely and at high concentrations. A validated drug delivery and lamellar analysis system that achieves these criteria, was the discovery of this project and is now available to combat laminitis.

O ultrassom é rotineiramente utilizado para avaliação de tecidos moles, contudo é um método que possui características importantes para avaliação não somente destes tecidos, mas dos ósseos também, além de possuir recursos diferenciais que auxiliariam muito no planejamento do tratamento e do prognóstico; embasados nessa premissa analisamos a possibilidade de avaliação de alterações intra-ósseas, por meio do ultrassom. A amostra foi constituída por cinco mandíbulas de porco, maceradas, e avaliadas nas regiões dos terceiros molares (tanto do lado direito quanto do esquerdo, totalizando 10 avaliações), por possuírem nessa região uma cripta óssea expressiva, o que simularia uma lesão intra-óssea. Para as avaliações ultrassonográficas dois grupos de três observadores foram formados, sendo um de CirurgiõesDentistas (Radiologistas) e outro de Médicos (Ultrassonografistas), os quais avaliaram, individualmente, a facilidade de visualização da imagem obtida por meio da ultrassonografia, bem como também o grau de translucidez do osso. Sendo que 46,6% das avaliações feitas pelos Cirurgiões-Dentistas foram ponderadas como de fácil visualização, 13,3% foram considerados de média dificuldade para avaliação, contra 23,3% que foram classificadas como de difícil localização, contudo 16,6% não foram possíveis de serem observadas. Os médicos classificaram como de fácil visualização 43,3% das ultrassonografias avaliadas, 23,3% como de média dificuldade, 20% de difícil observação e não conseguiram visualizar em 13,3% da amostra. Após avaliar os resultados encontrados e embasados na revisão da literatura foi possível concluir que: é possível se avaliar cavidades intraósseas por meio da ultrassonografia, contudo, para isso é necessário que a cortical óssea, por onde o feixe de ondas ultrassônicas vai penetrar, esteja adelgaçada; o US é um método imaginológico de fácil execução e interpretação, uma vez que os Cirurgiões- Dentistas que não tinham acesso, nem familiaridade, com este recurso imaginológico, conseguiram não só utilizá-lo, mas também compreender suas imagens, contudo em um grau discretamente menor em relação ao grupo formado por Médicos Ultrassonografistas, o que pode ser justificado por uma maior experiência por parte desses profissionais; mais estudos devem ser conduzido a fim de se explorar mais os benefícios e as vantagens que o US pode oferecer na área Odontológica. / Ultrasound (US) is routinely used for evaluation of soft tissues; however it is a method that has important features to evaluate not only these tissues, but also hard tissues that could help in the treatment planning and prognosis. This study analyzed the possibility of evaluation of intra-osseous changes, by means of US; grounded in this premise. The sample consisted of five macerated pig jaws, and the third molars areas (both the right and the left, totaling 10 ratings) were evaluated as these regions have a significant bone crypt, which simulate an intra-osseous lesion. For ultrasound images assessments two groups of three observers were trained, one of dentists (Radiology specialists) and other of physicians (US specialists), which evaluated individually, the visualization of the image obtained by US, and also the translucency degree of the bone. Dentists have been considered 46.6% of the assessments of easy viewing; 13.3% were considered of medium difficulty; 23.3% were classified as very difficult, although 16.6% were not found. Physicians considered 43.3% of images of easy viewing; 23.3% were considered of medium difficulty; 20% were classified as very difficult, although 13,3% were not found. Based on this results and the literature findings, it is possible to conclude that US is a useful tool for assessment of intraosseus cavities, but cortical bone should be thin so the sound waves can penetrate. US is an imaging method easy to perform and interpret, as the dentists, who had no access or familiarity with US, could interpret its images, at a slightly lower level than the US specialists, which can be explained by greater experience by these professionals. More studies should be conducted in order to explore the potential benefits and advantages of US utilization in Dentistry.

O ultrassom é rotineiramente utilizado para avaliação de tecidos moles, contudo é um método que possui características importantes para avaliação não somente destes tecidos, mas dos ósseos também, além de possuir recursos diferenciais que auxiliariam muito no planejamento do tratamento e do prognóstico; embasados nessa premissa analisamos a possibilidade de avaliação de alterações intra-ósseas, por meio do ultrassom. A amostra foi constituída por cinco mandíbulas de porco, maceradas, e avaliadas nas regiões dos terceiros molares (tanto do lado direito quanto do esquerdo, totalizando 10 avaliações), por possuírem nessa região uma cripta óssea expressiva, o que simularia uma lesão intra-óssea. Para as avaliações ultrassonográficas dois grupos de três observadores foram formados, sendo um de CirurgiõesDentistas (Radiologistas) e outro de Médicos (Ultrassonografistas), os quais avaliaram, individualmente, a facilidade de visualização da imagem obtida por meio da ultrassonografia, bem como também o grau de translucidez do osso. Sendo que 46,6% das avaliações feitas pelos Cirurgiões-Dentistas foram ponderadas como de fácil visualização, 13,3% foram considerados de média dificuldade para avaliação, contra 23,3% que foram classificadas como de difícil localização, contudo 16,6% não foram possíveis de serem observadas. Os médicos classificaram como de fácil visualização 43,3% das ultrassonografias avaliadas, 23,3% como de média dificuldade, 20% de difícil observação e não conseguiram visualizar em 13,3% da amostra. Após avaliar os resultados encontrados e embasados na revisão da literatura foi possível concluir que: é possível se avaliar cavidades intraósseas por meio da ultrassonografia, contudo, para isso é necessário que a cortical óssea, por onde o feixe de ondas ultrassônicas vai penetrar, esteja adelgaçada; o US é um método imaginológico de fácil execução e interpretação, uma vez que os Cirurgiões- Dentistas que não tinham acesso, nem familiaridade, com este recurso imaginológico, conseguiram não só utilizá-lo, mas também compreender suas imagens, contudo em um grau discretamente menor em relação ao grupo formado por Médicos Ultrassonografistas, o que pode ser justificado por uma maior experiência por parte desses profissionais; mais estudos devem ser conduzido a fim de se explorar mais os benefícios e as vantagens que o US pode oferecer na área Odontológica. / Ultrasound (US) is routinely used for evaluation of soft tissues; however it is a method that has important features to evaluate not only these tissues, but also hard tissues that could help in the treatment planning and prognosis. This study analyzed the possibility of evaluation of intra-osseous changes, by means of US; grounded in this premise. The sample consisted of five macerated pig jaws, and the third molars areas (both the right and the left, totaling 10 ratings) were evaluated as these regions have a significant bone crypt, which simulate an intra-osseous lesion. For ultrasound images assessments two groups of three observers were trained, one of dentists (Radiology specialists) and other of physicians (US specialists), which evaluated individually, the visualization of the image obtained by US, and also the translucency degree of the bone. Dentists have been considered 46.6% of the assessments of easy viewing; 13.3% were considered of medium difficulty; 23.3% were classified as very difficult, although 16.6% were not found. Physicians considered 43.3% of images of easy viewing; 23.3% were considered of medium difficulty; 20% were classified as very difficult, although 13,3% were not found. Based on this results and the literature findings, it is possible to conclude that US is a useful tool for assessment of intraosseus cavities, but cortical bone should be thin so the sound waves can penetrate. US is an imaging method easy to perform and interpret, as the dentists, who had no access or familiarity with US, could interpret its images, at a slightly lower level than the US specialists, which can be explained by greater experience by these professionals. More studies should be conducted in order to explore the potential benefits and advantages of US utilization in Dentistry.

Purpose: The purpose of this study is to investigate the prevalence of intraosseous vascular canals in the lateral wall of the maxillary sinus by utilizing high quality Cone Beam Computerized tomography (CBCT) scans. Material and Methods: 111 CBCTs that were obtained in a private practice were randomly selected from 500 CBCTs. The CBCTs were obtained from 2007 to 2011 with an iCAT CBCT unit. Then were reconstructed and imported into Simplant pro 15 software. Among the 111 selected CBCT images 13 scans that were not covering the sinus cavity entirely or had poor quality (e.g. scattering) were excluded from the study. All the CT scans were examined for presence or absence of intraosseous anastomosis by a single investigator. All the para-axial sections were carefully observed on both left and right side. The focus was on the area that most commonly the lateral window is prepared. In other words, the main area that was evaluated was from Distal of canine to distal of second molar on each side. Result: From initial 111 selected CBCTs, 13 were excluded due to either quality or the range of coverage. 52 (53%) were female and the rest 46 (47%) were male. 54 (55.1%) anastomosis noted among the 98 CBCTs that were evaluated. In other words, in 196 sinuses that were evaluated 27.5% of them had intraosseous anastomosis. Conclusion: the presence of intraosseous vascular canals in the lateral wall of the maxillary sinus is not a prevalent finding. Learning of the presence of intraosseous anastomosis in the lateral wall of the maxillary sinus would help with minimizing bleeding complications associated with the lateral wall approach sinus augmentation technique. Therefore, evaluation of the CBCT for anatomical variations is recommended prior to sinus augmentation surgeries. / Oral Biology

Reliable access to the circulation is paramount in most medical and surgical emergencies. When venous access cannot be expediently established, intraosseous (IO) access is indicated. This method has a high success rate even in relatively inexperienced hands and there is considerable clinical experience of IO administration of drugs and fluids. There is however limited evidence on the use of IO samples for laboratory analysis. Also, uptake of drugs during shock has not been extensively studied. Further, there have been concerns that analysis of IO samples may damage laboratory equipment. We have studied, in a porcine model, the use of IO samples for point of care analysis of blood gases, acid base parameters and blood chemistries in stable circulation, in experimental septic shock, and in hypovolemia after major hemorrhage, comparing IO samples with arterial and venous samples, and comparing IO samples from different sites. We have also studied coagulation assays on IO samples in stable circulation and after major hemorrhage. Furthermore, we have compared IO and intravenous administration of antibiotics in experimental sepsis. Average differences between IO and arterial/venous samples varied between the studied analytes. During stable circulation, average IO levels of blood gases, acid-base parameters, hemoglobin/hematocrit and several blood chemistries approximated venous levels relatively well. Differences in acid-base and blood gas parameters, and lactate, were more pronounced in hypovolemia, as well as in sepsis. The dispersion of the differences was often relatively large, indicating limited precision. Average differences between two intraosseous sites were small. Intraosseous samples were clinically hypercoagulable with a strong tendency to clot in vitro, and thromboelastography demonstrated shortened reaction times compared with venous samples. Major bleeding and hemodilution moderately affected the studied coagulation parameters. In endotoxemic animals with circulatory instability, concentrations of cefotaxime and gentamicin in samples from the pulmonary artery were comparable at 5 minutes after intraosseous and intravenous administration, and during a 3 hour observation period. In summary, agreement between analytes in intraosseous and conventional blood samples was variable and often unpredictable, especially during circulatory compromise. Intraosseous samples clinically appeared hypercoagulable, and thromboelastography confirmed this. High and comparable concentrations of cefotaxime and gentamicin were found after intraosseous and intravenous administration of equivalent doses, suggesting that uptake is acceptable during septic instability.

Vascular access in pediatric emergency patients is essential with no doubt. This thesis is based on many scientific publications and studies focused on intravenous and intraoseal access and their aplication in pediatric emergency patients undergoing pre-hospital or hospital treatment. First part is theoretical and is concerned about technique of insertion and post-procedure care. The next part is about comparing different techniques and their successful inserting for the first attempt. The last part is aimed at research with predefined goals. The main goal of this thesis is to give a summary of available knowledge about the peripheral intravenous access and intraoseal access in pediatric emergency patients. The research is aimed at selected group of respondents and their knowledge of techniques and treating of intravenous and intraoseal access. The last goal is to find out which access is preferable in sudden cardiac arrest in children. Data obtained from different groups of respondents approved that none of the groups have sufficient knowledge in inserting and carrying the intravenous and intraoseal access in pediatric emergency patients. In an analysis of data the best results gain paramedics. The majority of respondents would prefer intravenous access in case of sudden cardiac arrest. As a...

Ambulanssjukvården har utvecklats från att tidigare varit en transportorganisation till att vara en enhet som utför specialiserad sjukvård. Vid ett hjärtstopp där patienten behöver snabb access av läkemedel är det idag vanligast att applicera en intravenös infart. För nästan 100 år sedan började den intraosseösa infarten att användas. Vid intraosseös access ges möjlighet att direkt in i benmärgskanalen tillföra läkemedel eller vätska. Det har visat sig i olika studier att intraosseös infart är både säkert och effektivt. I akuta situationer där det misslyckats med intravenös infart kan den intraosseösa infarten utgöra skillnaden mellan liv och död. Efter att användandet minskat har den nu åter börjat tillämpas i större utsträckning. Syftet med studien var att belysa ambulanssjuksköterskors upplevelse av att applicera intraosseös infart. Metoden var kvalitativ med intervjuer som datainsamlingsmetod. Totalt intervjuades tio sjuksköterskor med specialistutbildning inom ambulanssjukvård. Materialet spelades in och transkriberades för att sedan avidentifieras genom att namnet istället fick en siffra. Materialet analyserades med en kvalitativ innehållsanalys. Resultatet redovisas i följande kategorier: kunskapsnivå, medicinteknisk kompetens, prehospitala miljön, stöd av kollegor och erfarenhet. Dessa kategorier baseras på sex underkategorier: utbildning, praktiska färdigheter, osäkerhet, trygghet i arbetsmiljön, trygghet och tidigare erfarenhet. Resultatet visade att ambulanssjuksköterskorna upplevde blandade känslor och tankar om upplevelsen av att applicera intraosseös infart. Det framkom att med erfarenhet kommer trygghet i handhavandet av intraosseös infart. Det framkom under intervjuerna även känslan av osäkerhet och betydelsen av att ha en mer erfaren kollega att ta hjälp av. Vissa ambulanssjuksköterskor upplevde ett behov av mer utbildning. Slutsatsen av denna studie är att de flesta ambulanssjuksköterskor inte upplevde applicering av intraosseös infart som något svårt. Det var några ambulanssjuksköterskor som upplevde osäkerhet och brist på kontinuerlig utbildning och därför ansåg att utbildningen i hantering av intraosseös infart skulle uppdateras kontinuerligt. Arbetsgivaren bör överväga att ha kontinuerliga och för arbetet väsentliga utbildningar vad gäller applicering av intraosseös infart. Huvudmannen skulle också återkommande kunna följa upp ambulanssjuksköterskornas kompetens i detta sällan förekommande moment, som kan vara livsavgörande för patienten.