The deposition of talc in patients with silicone gel-filled breast implants.

This study was initiated to understand why talc was found in the entrance wounds and pericapsular scars of patients with silicone breast implants. Twenty-five surgical gloves made between 1977 and 1992 by a major glove manufacturer were evaluated with infrared spectroscopy. Seven gloves manufactured before early 1983 contained talc. Later manufactured gloves contained calcium carbonate instead of talc. Talc-containing gloves were submitted to independent laboratories for scanning electron microscopic examination and x-ray microanalysis to obtain finer detail. Remnants of the mold-release agent talc were found in the matrix of the patient-contact side of the glove. Wetting studies showed that silicone oil (gel bleed) immediately wet the surface of rubber glove. After donning, silicone oil was massaged between the thumb and index finger of each washed, talc-containing glove for 1 minute and then daubed from the glove to a microscopic slide. The slide was viewed with polarized light microscopy for the presence of talc crystals. Transfer of talc occurred using silicone oil, but not saline, in each talc-containing glove. Three factors were likely involved in the greater talc deposition that occurred with patients undergoing silicone gel-filled breast implantation than in patients undergoing other surgical procedures. (1) The wetting of the gloves with silicone gel bleed from implants loosened the talc in the glove matrix. (2) Hand-intensive surgical use freed the talc from the gloves. (3) Loose talc adhered to the silicone elastomer of the breast implants and was deposited with implant placement.     

Nitrile versus Latex for Glove Juice Sampling

The objective of this study was to explore the utility of nitrile gloves as a replacement for latex surgical gloves in recovering bacteria from the hands. Two types of nitrile gloves were compared to latex gloves using the parallel streak method. Streaks of Klebsiella pneumoniae and Staphylococcus aureus were made on tryptic soy agar plates, and the zones of inhibition were measured around pieces of glove material placed on the plates. Latex gloves produced a mean zone of inhibition of 0.28 mm, compared to 0.002 mm for nitrile gloves (p<.001). While the parallel streak method is not intended as a quantitative estimate of antimicrobial properties, these results suggest that nitrile may be a viable alternative to latex in glove juice sampling methods, since nitrile avoids the risk of latex exposure.     

Contact Dermatitis from Penetration of Rubber Gloves by Acrylic Monomer

An orthopaedic surgeon developed dermatitis from acrylic materials. The acrylic monomer was found to penetrate surgical rubber gloves readily. Cases of “rubber glove dermatitis” with negative patch tests may have a similar explanation. Laboratory tests suggest that monomer does not damage rubber sufficiently to allow bacteria to penetrate gloves, but it remains possible that this would happen under theatre conditions.     

Glove powder reduction and alternative approaches

This article addresses the role of glove powder in facilitating allergic reactions to natural rubber latex (NRL) and to the chemical additives in synthetic and NRL gloves as well as its role in eliciting postsurgical complications. Various dusting powders have been used historically to prevent gloves from sticking to each other and to facilitate donning. All have manifested adverse consequences for health care professionals and patients. Manufacturing methods for powder reduction and elimination are presented. The recently developed ASTM methods for the quantitation of powder on powder-free and powdered gloves are reviewed along with the new ASTM maximum powder limits for all medical gloves. Caution must be exercised when methods of protein and powder reduction are implemented to minimize the possibility of creating other adverse consequences.     

Preanalytical errors on zinc concentrations caused by single-use gloves

Preanalytical errors causing specimen contamination with zinc (Zn) are disastrous for routine medical diagnostics or scientific studies. The aim of the study presented here is to simulate contamination possibilities when using single-use gloves.The ability to release Zn into the specimen was tested using nitril (A), vinyl (B) and latex (C) gloves with 15 (14) replications. In our first approach, a 1 × 1 cm piece of the glove’s fingertip was incubated for 10 min with serum. Our second approach imitated a very short contact of serum to the glove’s material by letting serum run over the glove from a pipette for 3 cm distance into a tube. The effect of gloves’ contact to liver tissue was examined using glove C only: a block of liver tissue was touched once at one side producing an experimental fingerprint. Zn was analyzed in serum and liver wet weight (ww) using ICP-MS; the basal serum/liver Zn concentration was set as zero for calculation. The calculated addition of Zn is given as median (p25 - p75).The first approach led to distinct contamination with Zn (in μg/L) being evident from all three types of gloves, but depended markedly from the type of material: A: 176.5 (129.7–204); B: 975.1 (663.6–1164.3); C: 2112 (1685–2516). Imitating a very short contact of serum to the glove’s surface resulted in an additional Zn concentration of 105.7 (70.4–168.8), 56.2 (-13.5–121.4) and 955.7 (746–1159) μg/L using gloves A, B and C, respectively. A single fingerprint on liver tissue using glove C resulted an addition of 3995 (861–6435) μg Zn/kg liver ww.The data underline that the dimension of preanalytical contamination of blood and tissue samples for Zn analysis via single-use gloves is relevant for routine diagnostics and scientific studies. Critical steps and possibilities to minimize these effects should be considered seriously for specimen handling in routine laboratory diagnostics as well as in scientific studies to avoid preanalytical errors and, finally, misinterpretation of the data.     

Toxicity effects of latex gloves on boar spermatozoa

It is known that several materials used in semen collection have been found to be detrimental to spermatozoal motility. In this study, examinations for toxic effects of latex and vinyl gloves, used with and without talcum powder on boar spermatozoa, were performed. Ten boars of known fertility with >/=80% sperm motility were divided into two groups (n = 5 boars each) for in vitro and in vivo studies. In the in vitro study, semen was collected from each of the five boars and was divided into five separate aliquots (5 ml each). One aliquot from each of the boars remained as the control, while the remaining aliquots were divided into individual treatments exposing the semen to a l cm(2) piece of latex or vinyl glove with or without talcum powder. In the in vivo experiment, semen from each of the five boars was collected using a gloved hand. During collection, the first half of the sperm-rich fraction was collected into a filtered sterile container, while the second half of the fraction was allowed to run through the palm of either a latex or vinyl powdered glove prior to collection in the container. In both experiments, semen sample motility was assessed by two independent observers at 1 minute after exposure. Results of both experiments consistently showed a significant (P<0.05) effect of latex gloves (with or without talcum powder) on boar semen when compared with the control semen. Motility was at or near 0% at 1 min after exposure to latex. No significant difference (P>0.05) in motility was observed between the control semen and the semen exposed to talcum powdered vinyl gloves. These results show that latex gloves are detrimental to boar spermatozoa. Therefore, it is suggested that when collecting boar semen vinyl gloves should be used.     

Permeability of gloves used in nuclear medicine departments to [99mTc]-pertechnetate and [18F]-fluorodeoxyglucose: Radiation protection considerations

In order to evaluate the safety of the individual protection devices, the permeability of four different types of disposable gloves, commonly used in hospitals, was tested in relation to [^99mTc]-pertechnetate and to [¹⁸F]-fluorodeoxyglucose ([¹⁸F]-FDG).From these radiopharmaceutical solutions, a drop was deposited on the external surface of the glove which was opened and stretched with the external surface placed upward. The smear test technique permitted to evaluate the activity onto the inner surface of the glove at different times. The smear tests were measured in a well sodium iodide detector calibrated in efficiency for ^99mTc and ¹⁸F. The permeability was tested on ten samples of each type of gloves and was expressed as the ratio of the activity onto the inner surface at each time interval to the activity deposited on the external surface of the glove. For each type of gloves and for each sampling time, mean value, standard deviation and percentage coefficient of variation of permeability were evaluated.One type of gloves showed a low resistance to permeation of both radiopharmaceuticals, while another one only to pertechnetate. The other gloves were good performers.The results of this study suggest to test permeability for gloves used for handling radiopharmaceuticals, before their adoption in the clinical routine. This practice will provide a more careful service of radiation protection for nuclear medicine department staff.     

Starch Granulomatosis of the Peritoneum

Starch glove powder is used extensively by surgeons in Britain and is generally considered innocuous so that precautions to prevent granuloma formation, previously taken when talc glove powder was in use, are now neglected. Reported here are five cases of starch granulomatosis of the peritoneum occurring over a period of a few months. This condition requires reoperation within a limited time for its diagnosis and may be confused macroscopically with disseminated malignant disease or tuberculosis or may simply cause adhesions. Recognition is dependent on a high degree of suspicion by both surgeon and histopathologist, as special histological techniques may be necessary. Consequently, it is only in a minority of the florid cases that a diagnosis is made, and the condition would appear to be much more common than is generally realized. A plea is made for scrupulous care to avoid starch powder contamination of the operative field.     

Effectiveness of handwashing agents in eliminating Staphylococcus aureus from gloved hands.

The recent emphasis on gloving has resulted in accounts of healthcare workers washing gloves instead of changing them. This study evaluated the efficacy of soap and three germicidal agents in decontaminating latex and vinyl medical gloves that were experimentally contaminated with Staphylococcus aureus. Gloves were tested for perforations before and after the glove-washing procedure. Results of this study demonstrated that contamination was reduced from the glove surfaces. Although the routine washing of gloved hands cannot be recommended, it may be carried out under limited circumstances.     

Effectiveness of handwashing agents in eliminating Staphylococcus aureus from gloved hands

The recent emphasis on gloving has resulted in accounts of healthcare workers washing gloves instead of changing them. This study evaluated the efficacy of soap and three germicidal agents in decontaminating latex and vinyl medical gloves that were experimentally contaminated with Staphylococcus aureus. Gloves were tested for perforations before and after the glovewashing procedure. Results of this study demonstrated that contamination was reduced from the glove surfaces. Although the routine washing of gloved hands cannot be recommended, it may be carried out under limited circumstances.     

The transfer of bacteria to, and survival on, dental records

The purpose of this study was to ascertain whether viable bacteria could be transferred from gloves to laboratory cards in dental records and, if so, to determine whether bacteria could survive on the paper. The thumbs and forefingers of two types of glove (Biogel D and Microtouch) were inoculated with Streptococcus sanguis and left for various periods of time. A sterile dental laboratory card was then held with the gloves and the number of bacteria surviving on the card determined after various periods of incubation of the card at room temperature. Bacteria were transferred to the laboratory cards and remained viable for up to 72 h. More viable bacteria were transferred from the Microtouch gloves than from the Biogel D gloves, and this was attributable, in part, to the latter gloves exerting a bactericidal effect. The results demonstrated that bacteria can be transferred from gloves to laboratory cards and that these organisms can remain viable for long periods of time. Dental records may, therefore, represent a possible route of cross-infection.     

Muscular responses to handle perturbation with different glove condition

Effect of wearing gloves on timely muscle reaction to stabilize handle perturbation was investigated. Thirteen adults gripped a horizontal overhead handle to which an upward force was applied at a random time. Muscle reaction time, integrated EMGs for eight muscles, and handle displacement were compared among three glove conditions affecting the coefficient of friction (COF = 0.32, 0.50, and 0.74 for the polyester glove, bare hand, and latex glove, respectively). Lower COF increased the integrated EMGs and handle displacement until stabilization of the perturbed handle. The low-friction glove resulted in 16% (p = .01) greater muscular effort and 20% (p = .002) greater handle displacement, compared to the high-friction glove. Muscle reaction time was not influenced by glove condition. Cutaneous sensation and reflex eliciting forearm muscle activity appear to play an important role in detecting and responding to the perturbation initially, while the forearm and latissimus dorsi muscles primarily contribute to stabilizing the perturbed handle compared to other shoulder and upper arm muscles. Therefore, low-friction gloves, cutaneous sensory dysfunction, and weakened forearm and latissimus dorsi muscles may jeopardize persons’ ability to stabilize a grip of a handle after perturbation.     

Differences in stress reactivity of laboratory macaques measured by heart period and respiratory sinus arrhythmia

Some laboratory primates are more likely than others to react to anxiety-provoking stressors. Individuals that overreact to stressors may experience diminished psychological well-being and would be inappropriate for some experiments. The differences between reactive and nonreactive individuals may be reflected in heart period and respiratory sinus arrhythmia (RSA). Using surface electrodes and radio telemetry, we measured these two cardiac variables in seven male and ten female singly caged longtailed macaques (Macaca fascicularis) when they were exposed to two stressors, a sudden noise (whistle test) and an unfamiliar technician wearing capture gloves (glove test). Behavior was videotaped during both tests. For the whistle test, cardiac data were recorded before, during, and after two 1 min whistle blasts separated by 90 min. For the glove test, data were recorded in 1 min blocks every 8 min over 96 min before, during, and after 1 min exposure to the gloved technician. Heart period was decreased and RSA was suppressed during both the whistle and glove exposures. After the whistle test, the cardiac activity of most subjects returned to baseline levels within 10 min. The glove test produced more extended suppression, with greater individual differences, than the whistle test. There were greater individual differences in RSA than in heart period. These enhanced individual differences were used to define stress reactors that differed from nonreactors in their cardiac data profiles. Of 16 subjects that completed the glove test, five were identified as reactors. Am. J. Primatol. 45:245–261, 1998. © 1998 Wiley-Liss, Inc.     

Effect of dental tool surface texture and material on static friction with a wet gloved fingertip

Hand injuries are an important cause of pain and disability among dentists and dental hygienists and may be due to the high pinch forces involved in periodontal work. The pinch forces required to perform scaling may be reduced by increasing the friction between the tool and fingers. The purpose of this study was to determine whether modifying the tool material, surface texture, or glove type altered the coefficient of static friction for a wet gloved finger. Seven tools with varying surface topography were machined from 13 mm diameter stainless steel and Delrin and mounted to a 6-component force plate. The textures tested were a fine, medium and coarse diamond knurled pattern and a medium and fine annular pattern (concentric rings). Thirteen subjects pulled their gloved, wet thumb pad along the long axis of the tool while maintaining a normal force of 40 N. Latex and nitrile gloves were tested. The coefficient of static friction was calculated from the shear force history. The mean coefficients of static friction ranged from 0.20 to 0.65. The coefficient of static friction was higher for a smooth tool of Delrin than one of stainless steel. Differences in the coefficient of static friction were observed between the coarse and medium knurled patterns and the fine knurled and annular patterns. Coefficients of static friction were higher for the nitrile glove than the latex glove for tools with texture. These findings may be applied to the design of hand tools that require fine motor control with a wet, gloved hand.     

Natural rubber latex allergy in the occupational setting

Over the last decade, the prevalence of natural rubber latex (NRL) allergy has reached epidemic proportions among workers who use or who are exposed to powdered latex products. NRL-associated occupational asthma is confined largely to those exposed to powdered latex glove use or other latex aerosols. The most frequent presenting symptom of NRL allergy is contact urticaria; inhalation may cause symptoms of allergic rhinitis and asthma. Skin prick testing is the most accurate tool for diagnosis of NRL allergy. The cornerstone of management is cessation of exposure; substitution with non-NRL or nonpowdered NRL gloves results in predictable rapid disappearance of latex aeroallergen.     

Operations on the pancreas; some technical considerations

Many diseases of the pancreas formerly universally considered fatal, now are known to be amenable to surgical therapy. Pancreatic cysts, pseudocysts, calculi, inflammation, and benign and malignant tumors all can be dealt with effectively by operation. In this presentation various surgical techniques which have proved to be of therapeutic importance are considered.     

OPERATIONS ON THE PANCREAS—Some Technical Considerations

Many diseases of the pancreas formerly universally considered fatal, now are known to be amenable to surgical therapy. Pancreatic cysts, pseudocysts, calculi, inflammation, and benign and malignant tumors all can be dealt with effectively by operation. In this presentation various surgical techniques which have proved to be of therapeutic importance are considered.     

Medical devices manufactured from latex: European regulatory initiatives

In Europe the marketing of medical devices manufactured from latex is regulated by directives describing the essential (safety) requirements that products have to fulfill to obtain marketing approval. This paper describes the general requirements for marketing medical devices in Europe and, more specifically, the requirements for products manufactured from natural rubber latex. The requirements for marketing medical devices can be fulfilled by using the relevant harmonized European standards. These standards are regularly under revision to incorporate the latest scientific developments. For certain devices, for example, latex medical (examination and surgical) gloves, specific standards have been published. Medical devices manufactured from latex pose a serious problem because of the risk of induction of allergy both against the latex proteins inherently present (type I or immediate type allergy) and against chemicals added during processing (type IV or delayed type hypersensitivity) present as residues in the latex products. So, besides requirements for product quality in terms of barrier properties, strength, and sterility, the main focus consists of the allergy-inducing properties of the latex products. Recent developments have reopened the discussion on the value of total protein versus allergen determination in latex medical gloves. However, as long as minimal levels needed for both sensitization and elicitation have not been established, a safe maximum level for leachable proteins/allergens in latex products cannot be determined. A European Commission guidance document on the latex allergy problem is currently being drafted by experts from Competent Authorities.     

Accounting for movement increases sensitivity in detecting brain activity in Parkinson's disease

Parkinson's disease (PD) is manifested by motor impairment, which may impede the ability to accurately perform motor tasks during functional magnetic resonance imaging (fMRI). Both temporal and amplitude deviations of movement performance affect the blood oxygenation level-dependent (BOLD) response. We present a general approach for assessing PD patients' movement control employing simultaneously recorded fMRI time series and behavioral data of the patients' kinematics using MR-compatible gloves. Twelve male patients with advanced PD were examined with fMRI at 1.5T during epoch-based visually paced finger tapping. MR-compatible gloves were utilized online to quantify motor outcome in two conditions with or without dopaminergic medication. Modeling of individual-level brain activity included (i) a predictor consisting of a condition-specific, constant-amplitude boxcar function convolved with the canonical hemodynamic response function (HRF) as commonly used in fMRI statistics (standard model), or (ii) a custom-made predictor computed from glove time series convolved with the HRF (kinematic model). Factorial statistics yielded a parametric map for each modeling technique, showing the medication effect on the group level. Patients showed bilateral response to levodopa in putamen and globus pallidus during the motor experiment. Interestingly, kinematic modeling produced significantly higher activation in terms of both the extent and amplitude of activity. Our results appear to account for movement performance in fMRI motor experiments with PD and increase sensitivity in detecting brain response to levodopa. We strongly advocate quantitatively controlling for motor performance to reach more reliable and robust analyses in fMRI with PD patients.     

Management of necrotizing pancreatitis.

A comprehensive management plan is presented for patients with severe acute pancreatitis. These patients may have pancreatic or peripancreatic necrosis or pancreatic fluid collections. Multiple organ failure often develops in patients with severe pancreatitis. We therefore recommend that all patients with acute pancreatitis be evaluated for pancreatic anatomy and function. If a patient is seriously ill, a computed tomographic (CT) scan with vascular enhancement should be done. Meanwhile, vigorous fluid replacement is necessary using Swan-Ganz monitoring. Patients with necrosis do not need surgical intervention unless the clinical course or CT scan-guided aspiration shows infection. The objective of an operation should be to remove all infected tissue and fluid. A preoperative CT scan with vascular enhancement should be used as a guide during the operation to ensure that all foci of infected necrosis or fluid are eliminated. We have found that open packing and irrigation with sodium oxychlorosene are helpful in patients with extensive necrosis or those who become infected early after the onset of symptoms. In all, 40% to 50% of patients treated by closed drainage will require reoperation because of incomplete debridement. Persistent sepsis is an indication for reoperation.