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Introduction Spinal anesthesia involves the administration of a dose of local anesthesia into the intrathecal space of the lumbar spine, using spinal needles with varying characteristics and design. When completing the administration of spinal anesthesia, you may check the volume of fluid remaining inside the spinal needle. Objective To measure and compare the volume of residual fluid following the administration of spinal anesthesia using three different brands of 27 gauge spinal needles. Methods This is an observational analytical cross-section trial for which tree types of 27 gauge commercial needles were selected: BD Whitacre pencil point, Spinocan Quincke sharp point, and Disposable spinal needle. Following the administration of spinal anesthesia, the same operator, without detaching the syringe from the needle, deposited the residual volume into a collection tube so that a second operator quantifies the volume using a precision micropipette. Results The residual volume obtained from the 27G spinal needles showed a statistically significant difference in favor of the BD Whitacre needles (P Conclusions The BD Whitacre pencil point proved to lodge less residual volume following spinal anesthesia. No clinical implications can be made from this finding and new studies are required to ratify these results.

Purpose: We present a method for acquiring and correcting upright images using the on board CBCT imager. An upright imaging technique would allow for the introduction of upright radiation therapy treatments, which would benefit a variety of patients including those with thoracic cancers whose lung volumes are increased in an upright position and those who experience substantial discomfort during supine treatment positions.Methods: To acquire upright CBCT images, the linac head was positioned at 0 degrees, the KV imager and detector arms extended to their lateral positions, and the couch placed at 270 degrees. The KV imager was programmed to begin taking continuous fluoroscopic projections as the couch rotated from 270 to 90 degrees. The FOV was extended by performing this procedure twice, once with the detector shifted 14.5 cm towards the gantry and once with it shifted 14.5 cm away from the gantry. The two resulting sets of images were stitched together prior to reconstruction. The imaging parameters were chosen to deliver the some dose as that delivered during a simulation CT. A simulation CT was deformably registered to an upright CBCT reconstruction in order to evaluate the possibility of correcting the HU values via mapping.Results: Both spatial linearity and high contrast resolution were maintained in upright CBCT when compared to a simulation CT. Low contrast resolution and HU linearity decreased. Streaking artifacts were caused by the limited 180 degree arc angle and a sharp point artifact in the center of the axial slices resulted at the site of the stitching. A method for correcting the HUs was shown to be robust against these artifacts.Conclusion: Upright CBCT could be of great benefit to many patients. This study demonstrates its feasibility and presents solutions to some of its first hurdles before clinical implementation.--------------------------Cite this article as:Fave X, Yang J, Balter P, Court L. Upright CBCT: A novel imaging technique. Int J Cancer Ther Oncol 2014; 2(2):020221. DOI: 10.14319/ijcto.0202.21

During compulsory examination of 25 years old soldier in psychiatric clinic, as psychopathy features were observed in him, intracranial foreign metal body - sewing needle was found out. The patient and his parents had no any information about existence of intracranial sewing needle till the examination. Parents of the patient could not give any anamnestic information to the doctor in charge on existence of sewing needle in intracranial region. It is clear that sewing needle can be entered into intracranial region only till the period sinciput became firm. The fact that sharp point of the needle is towards down shows once again that the needle was pricked intentionally. In the result of the research the conclusion was reached that as the patient was the only grandson in the family, near relatives enviousle entered sewing needle into his intracranial region form the sinciput while he was baby in order to murder him. The accident was evaluated as the result of unsuccessful crime. So, in the result of the research we can come to the conclusion that instrumental examinations (rentgenography, of skull in two projections, computer tomography, nuclear magnetic resonance examination, etc.) for psychiatric patients are necessary.

We developed novel multifunction vitreous forceps to decrease the frequency of forceps insertion and enable the removal of the internal limiting membrane and other intravitreal membranes for better surgical results. The basic forceps were conventional continuous curvelinear capsulorrhexis (CCC) forceps. The size of the shaft is 23G and its pointed end measures 500 µp? in diameter. Additionally, there is a platform in its tip. The pointed end with platform helps to hold the membrane because the outer sheath can be moved while the tip of the forceps is fixed in position, and its pen hold type grip helps to reduce hand movement. The most advantageous thing is that the sharp point enables us to make an initial flap easily and the desired area of internal limiting membrane can be peeled off by firmly holding the platform. [Ophthalmol Surg Lasers 2002;33:260-261]

In our brevia “Web-Spinning Caterpillar stalks snails” (22 July 2005, p. [575][1]), we reported a new species of cosmopterigid moth, Hyposmocoma molluscivor a. The species description was given in the Supporting Online Material; however, according to the International Code of Zoological Nomenclature, the formal description must appear in print to make the name officially available. The description follows. ![Figure][2] Hyposmocoma molluscivora . Type specimen. ![Figure][2] Male genitalia ventral aspect. Hyposmocoma molluscivora Rubinoff & Haines, new species Male. Length of forewing: 6 mm, ( n = 1). Head. Creamy dull white with scattered fuscous scales. Labial palpi prominent, recurved, mostly black. Antenna uniformly black, unscaled except for small white mark on dorsal side of elongated first basal segment; vertex same color as rest of head. Thorax. Dorsal scaling similar to that of head centrally but with more fuscous scales, abruptly becoming black at periphery where joining at base of costal margin of wing. Underside black toward head, abruptly becoming white with few fuscous scales toward abdomen. Legs. Prothoracic legs mostly black. Mesothoracic legs basally white abruptly becoming black, metathoracic legs same pattern. Tibial spurs prominent, off-white. Forewing: (see left panel of figure) very elongate, narrow, 6 times longer than broad. Ground color a lustrous white overlaid extensively with indistinct pattern of fuscous scales over upper (costal) ⅔ of wing, sometimes dense enough to appear as black spots, posterior ⅓ mostly white, fuscous scales becoming very sparse with distinct, undulating margin, except apical lower ⅓ remaining mostly fuscous like rest of forewing. Hindwing. More lanceolate than forewing, 7 times longer than broad. Subcostal brush (fig. S1) ([1][3]) prominent, dark brown, extending ⅔ the length of hindwing. Lustrous light gray with long concolorous fringe maximum length nearly half as long as hindwing. Abdomen uniformly dark gray. Genitalia as in the right panel of the figure and fig. S2 ([1][3]). Pseuduncus elongate, curved, attenuated distally into sharp point; aedeagus stout, prominent, blunt tipped; anellus lobes ⅓ length of uncus, broadened and setose distally, left lobe with distinctly broader tip; valva broadened distally, with four prominent, broad, uniformly spaced spurs, sequentially longer distally. Male. HOLOTYPE. HAWAII: Maui, Makawao Forest Reserve. Elevation 920 m. GPS coordinates (UTM, NAD83): 04Q 783924, 2305563. Adult emerged III-23-05. (W. Haines, C. King collectors). Deposited in the University of Hawaii Insect Museum, on indefinite loan to the Bishop Museum, Honolulu, Hawaii. Hyposmocoma molluscivora is most similar and may be sympatric with Hyposmocoma lebetella Walsingham in montane wet forest areas of East Maui. The taxa can be easily distinguished by differences in forewing pattern, and the presence of the subcostal brush in H. molluscivora , but absent in male H. lebetella . Hyposmocoma molluscivora larvae form elongate, almost cylindrical cases of silk, algae, and small snail shells. The larvae use silk to attach resting snails to leaves and then force their way out into the snail's shell to feed (fig. S3) ([1][3]). 1. 1.[↵][4]Supporting Online Material is available at [www.sciencemag.org/cgi/content/full/311/5766/1377a/DC1][5]. 2. 2.We thank M. Bryce, F. Starr, and K. Starr for bringing specimens to our attention; B. Holland and R. Cowie of the University of Hawaii for identifying snail specimens; and F. Duvall for access to the Makawao Forest Reserve. J. Powell of UC Berkeley provided very helpful comments. W. Haines was supported by a National Science Foundation GK-12 grant (#DGE-0232016) awarded to the University of Hawaii's Center for Conservation Research and Training, K. Y. Kaneshiro, principal investigator. [1]: /lookup/doi/10.1126/science.1110397 [2]: pending:yes [3]: #ref-1 [4]: #xref-ref-1-1 "View reference 1. in text" [5]: http://www.sciencemag.org/cgi/content/full/311/5766/1377a/DC1

1. The antherozoid of the Characeae studied is composed of about three to four coils. Its body is a somewhat flattened band which consists of an anterior cytoplasmic portion, a posterior vesicle, a cytoplasmic envelope, and an elongated nucleus which tapers to a sharp point at each end. 2. The anterior cytoplasmic portion consists of an outer and an inner bandlike part. The outer band bears the two cilia of unequal length and a small nearly spherical body at its forward end. In the inner portion a delicate thread can be seen. 3. The swimming motion of the antherozoids of Chara and Nitella is rotary, either clockwise or counter-clockwise. 4. The antherozoids of the different species of Chara studied are similar in every respect. The antherozoid of the Nitella species resembles that of Chara, but is considerably smaller.

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Many techniques and forms of equipment have been evolved for performing sialography and each has its adherents. The suction cannula made in recent weeks by the author for sialography has some unique advantages to commend it. This cannula can be made readily by anyone with a modicum of manual dexterity. Two disposable Yale injection needles (as manufactured by Becton, Dickenson & Co.) and one of their protective polythene packing sheaths are required (Fig. 1). The size of the resulting cannula can be altered by choice of needle but the one originally made used a needle of 21 G and 1¾ in. length. By also varying the lengths of thec annula can be made of quite small dimensions to suit the requirements of any particular case. First one of the needles has its sharp point ground flat and the blunted end smoothed on a fine carborundum stone. The plastic packing sheath has its closed end cut off at right angles to the length, so that the blunted needle, when inserted, will project about ¼ in. (more or less, as de...

A scalpel has been designed to reduce the risk of inadvertent inoculation of a member of the surgical team during open surgical procedures by blood infected with the human immunodeficiency virus (HIV) related to acquired immunodeficiency syndrome (AIDS). The sharp point at the end of the blade has been removed, and a rounded section substituted (Fig. 1). Except for such procedures as lancing a boil, the traditional point on a standard scalpel no longer serves a real purpose, since surgeons are taught to dissect and divide tissue with the belly of the blade. In fact, it may well be that the more curved surface that is available for cutting, the more useful and versatile the knifeblade. Until such a blade is manufactured, surgeons operating in areas of high risk may, in addition to having the scrub nurse pass the knife on a tray, be well-advised to grind off the very sharp point on a sterile whetstone on the nurse’s table before starting any surgical procedure. FIGURE 1. Rounded blade of scalpel.

pin to the midpoint. The loop was then closed slowly until the free ends of the pin were approximated. Reopening the snare loop permitted the sharp point to be secured within the safety catch. The snare was withdrawn, the grasping forceps was inserted, and the closed pin was secured at the spring end. Once the pin was pulled close to the tip of the endoscope, the entire apparatus was removed. The endoscope was reinserted a final time, and no residual mucosal injury was noted in the stomach or esophagus. The patient's subsequent course was uncomplicated. DISCUSSION To assess the reproducibility of this procedure, the following experiment was performed. Several open safety pins of varying sizes (3.5, 5.0, 6.0 cm) were immersed in gastric juice to approximate intragastric conditions and snared in the manner described above. In almost every instance, the pin, once completely closed by the snare so that the point was past the safety catch, snapped shut as the snare wire slackened (Figure I). The failures occurred with a semicircular polypectomy snare (Olympus SD-1 U) that had been used many times and which was not capable of generating the tension necessary to close the large pin. With the crescent shaped snare

ASCLEROTOMY knife is here presented. 1 The need for this knife is based on the fact that the scleral incision for iridectomy ab externo, iridencleisis, cyclodialysis, scleral resection or incision for removal of a foreign body through the posterior route is a delicate and careful procedure. If the incision is done too rapidly and too deeply, the uveal tract may be incised and vitreous may prolapse. The blade itself forms an obtuse angle of approximately 135 degrees with the handle. The widest portion near the handle is 1.25 mm.; it then narrows to a sharp point. The entire blade is about 1.2 cm. in length. The lower surface is sharp and bevels upward. The upper surface has a cutting edge which extends from the point for a distance of 3 mm. This knife has the following advantages: 1. Because of its angle, it facilitates the incision and makes it easier

Talon cusp is an uncommon anomaly, whose etiology may be disturbances in the morphodifferentiation stage. Dens in dente is also a rare anomaly that is challenging in clinic as it may cause pulp necrosis or periapical lesions due to the communication with the oral cavity. This article reports multiple talon cusps on permanent maxillary and mandibular incisors and molars in 3 siblings. A 9-year-old boy presented with structures like nodules, shaped as cylindrical cones with a sharp point or a raindrop with deep developmental fissures on the palatal aspect of the maxillary central incisors, lingual aspect of the mandibular central incisors and labial aspect of both mandibular first molars. The buccal surface of the maxillary right central incisor was also affected. Some of them exhibited dens in dente. His 15-year-old sister had prominent talon cusps on the palatal surface of maxillary central incisors and buccal surface of the mandibular first molars and mandibular left second molar. His 7-year-old brother had only one trace talon on the maxillary left central incisor. No syndrome was identified in the patients. In conclusion, genetic inheritance may be a causative factor in talon cusp. Cúspide em garra (talon cusp) é uma anomalia incomum, cuja etiologia pode estar relacionada a distúrbios no estágio de morfo-diferenciação. Dens in dente é também uma anomalia rara que impõe desafios na prática clínica, uma vez que pode causar necrose pulpar ou lesões periapicais devido à comunicação com a cavidade oral. Este artigo relata múltiplos casos de cúspide em garra em incisivos e molares superiores e inferiores permanentes em 3 irmãos. Um menino de 9 anos apresentou-se com estruturas nodulares em formato de cone cilíndrico com uma ponta aguda ou de "gota de chuva", com fissuras de desenvolvimento profundas na face palatina dos incisivos centrais superiores, e face lingual dos incisivos centrais e vestibular de ambos os primeiros molares inferiores. A face vestibular do incisivo central superior esquerdo também foi afetada. Alguns dentes apresentavam dens in dente. Sua irmã de 15 anos apresentava cúspides em garra proeminentes na face palatina dos incisivos centrais superiores e face lingual dos primeiros molares inferiores e segundo molar inferior esquerdo. Seu irmão de 7 anos apresentava apenas uma cúspide em garra vestigial no incisivo central superior esquerdo. Nenhuma síndrome foi identificada nos pacientes. Conclui-se que a herança genética pode ser um fator causativo da cúspide em garra.

Customary hypnotizing techniques entail an element of risk. This applies both to the methods of verbal suggestion and to those of sensory stimulation (haptic, optical, acoustic, thermic, vestibular stimuli). The risk in question is specially inherent in the fascination method; in some cases the hypnotist may get tired before the patient does! When the hypnotist looks into the patient’s eyes or makes him stare at some brilliant object (e.g., a reflex hammer) while assuring him that he will fall asleep, there will be a double disappointment for the physician if the patient persists in remaining awake. In the first place he loses the confidence of the patient, who, rightly or wrongly, will think that he cannot hypnotize, and secondly, what is worse still, the hypnotist will lose the confidence in his own ability, which will adversely affect his self-assured attitude toward the patient with the well-known result: hypnosis is abandoned as a therapeutic aid. There is, however, a fixation method that is an exception to this, i.e., the “color-contrast” method, the basic principle of whioh was laid down by Levy-Suhl in 1908. Here follows a description of the technique of the method that we have applied for many years in the Leyden Psychiatric Clinic. The patient is asked to lie on a couch and is handed a piece of cardboard 14 x 23 cm, plain grey in color, on which 2 strips of paper, each measuring 3.2 x 8 cm and respectively light yellow and blue (not shiny), have been neatly pasted without any fold, in such a way that a space of 5 mm remains between the 2 colored strips. (The writer usually rounds off the bottom-right-hand corner of the piece of cardboard to prevent the sharp point from irritating the patient who holds it in his right hand.) The patient with normal eyesight is told to hold the card at arm’s length. The couch is placed in such a way that the light falls on the complementary colors. While the patient, in accordance with the instructions given him, fixes without inter

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Accurate measurement from the line of insertion of any rectus muscle to the point on the sclera where it is desired to recede or advance that muscle is necessary. For this purpose a number of calipers have been designed. I have not been satisfied with any so far placed on the market. One type, designed on the principle of a slide rule, measures accurately the desired distance, but the projecting bars are dull and do not give an opportunity to indicate by a delicate scratch mark the position on the sclera for the insertion of the sutures. Another type is a small caliper with dull points neither of which serves the particular purpose desired. I have had an instrument maker construct a caliper one shank of which carries a thin shaft of steel which terminates in a very fine sharp point. This point cannot penetrate the sclera, as it is

During the past few years, I have needed a suitable meatotomy knife for the proper performance of meatotomy in male babies, young children, and even in adults with pin-point or very fine meatus. I have hitherto employed a sharp-pointed urethral knife with a very narrow blade and with a long handle made for use with the endoscope. This was just a makeshift to accomplish the purpose and its use was objectionable because of the sharp point which had to be passed within the urethra. A few cases of retention of urine in babies could be relieved only by the passage of a small ureteral catheter, and would usually recur until I used the urethral knife just mentioned. To my knowledge, the only small knife on the market is the Otis, with a belly-like blade and with a metal bulb at the tip. This cannot be passed

Thirty-four years ago, during my senior year in medical school, one of my professors published a book. It was calledMedicine at the Crossroads.1One needs to read only to the second page of the "Foreword" to learn that it concerns the "crisis" in medical care, and that if the profession does not voluntarily mend its ways the government will take over. Apparently, in the view of some, my contemporaries and I have lived our entire professional careers, either stalled at the same crossroads, or impaled on the sharp point of a crisis, depending on one's choice of metaphors. Somehow or other, it hasn't really seemed that way. A 34-year-old volume on the socioeconomics of medicine is scarcely a source for currently valid statistics. How quaint it may seem is apparent from the fact that the high cost of medical care is equated to $4-a-day hospital rooms and to

The inability to keep a fine sharp point on the usual type of acne stilet in use prompted me to devise the instrument shown in the accompanying photograph. The handle consists of a small vise, manufactured by a large wholesale jewelry supply house. 1 It has a chuck at each end. The needle, which is inserted in one end, is a regular Hagedorn straight surgical needle, with a fine sharp point and a cutting edge on one side. In the other end of the vise is fixed a portion of the usual acne stilet, which has been cut off and rounded to fit the chuck. The vise has approximately the same dimensions as a pocket fountain pen and is large enough to give the operator control of the instrument. The main advantage of this stilet is the Hagedorn needle. These needles are inexpensive and can be replaced. Resharpening is unnecessary.

In seeking a hemostat some years ago which was suitable for goiter surgery, the one marked "old style" in the accompanying illustration was designed and manufactured for our use. It was necessary to have this type of hemostat especially manufactured, as there was no snap on the market with a sufficiently sharp point for plunging them into the thyroid gland and at the same time possessing transverse stamping extending from the top to the heel of the jaws of the clamps. These hemostats have been employed in the clinic for years with great satisfaction, with the exception that catgut ties as they are passed about the handle of the hemostat and pulled downward toward its tip frequently catch in the fissure made by the open joint where the two limbs of the forceps are locked with a screw. To overcome this difficulty, the forceps shown in the illustration

A married woman, aged 55, a patient at the Rochester State Hospital, had made several attempts at suicide during depressive phases of a manic depressive psychosis. On April 1, 1934, she attempted to commit suicide by thrusting a number 12 crochet needle from the right temporal region through both orbits (fig. 1). The sharp point of the hook entered the right temple and was pushed through the left orbit until the point struck the left temporal orbital wall. She could not push the hook farther with her hand. She removed her slipper and, using the heel as a hammer, drove the hook farther into her head until the handle was entirely buried under the skin on the right temporal side. When she was discovered a few minutes later, blood was oozing from her nose and the conjunctiva of both eyes was edematous. Her vision, however, was apparently not impaired.

The following case is of interest on account of the extent of the carcinomatous invasion and the clinical history, which gives another instance of the origin of carcinoma from post-natal embryonic tissue. The clinical examination revealed much evidence in favor of blastomycetes, and it was only after a most painstaking pathologic study by Professor Hektoen that a positive diagnosis of carcinoma was made. Mr. W. P. R., age 23, American, had good health until 9 years of age, when he became the victim of a severe accident. While hanging on a train, he was struck on the inner side of the thigh by the sharp point of a diamond-shaped switch that caused a gaping wound of the thigh, extending below the knee. There was considerable hemorrhage at the time and the wound is said to have been closed by sixty-three stitches. After the injury there was a denuded surface on