Curette - an overview | ScienceDirect Topics (2022)

A curette or sterile 15-blade scalpel is then used to collect the debris onto a glass microscope slide, at which point 10%–20% of KOH solution (with or without dimethylsulfoxide) is applied to the collected specimen.

From: Nail Disorders, 2019

Endometrial Biopsy

Grant C. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020

Reusable Stainless Steel Curette (Novak or Randall) and Disposable Endometrial Aspirators with Syringe Suction (Cannula Curette, Uterine Explora, Explora II)

The Novak curette is made of stainless steel and has been available for more than 50 years (Fig. 129.3A). The cannula is rigid and is attached to a 10- to 20-mL disposable plastic syringe. When the syringe plunger is pulled, the negative pressure generated draws endometrial tissue into the cannula. Both the Novak and Randall curettes are reusable after sterilization. A disadvantage of this method is that patients complain of greater pain than with flexible plastic aspirators.

Several disposable methods allow easier use of suction by connecting a locking syringe to the end of the plastic aspirator. The Cannula-Curette, Uterine Explora, and Explora II combine the benefits of a rigid cannula with disposability. Both Explora models are nylon with a sharp Randall-type cutting edge (seeFig. 129.3B). The Explora has one distal port, whereas the Explora II has two distal ports on opposing sides of the aspirator. Tissue is obtained with suction using a scraping and peeling action. In women with large endocervical canals, the Cannula Curette may be a better option (Fig. 129.4). It comes in sizes ranging from 3 to 7 mm, whereas the Explora and Explora II are available only in 3- and 4-mm sizes. When AUB is present, the larger-diameter Cannula Curette is less likely to clog than the smaller curettes. Sensitivity and specificity of these types of endometrial samplers are similar to those for the flexible plastic endometrial aspirators. These type aspirators may be more likely to get tissue in the premenopausal woman or one who is having menstrual bleeding at the time of the procedure.

After completing previous steps 1 through 8, the procedure for the reusable stainless steel curette (Novak or Randall) and disposable endometrial aspirators with syringe suction (Cannula Curette, Uterine Explora, Explora II) is as follows:

9.

Apply a tenaculum to the anterior or posterior tip of the cervix, depending on the direction of flexion of the uterus. Graspthe cervix with the tenaculum teeth in the horizontal position. Grasping the cervix at the 3 or 9 o’clock position with the tenaculum in the vertical plane decreases the diameter of the external os. Local anesthesia (2 mL of 2% lidocaine solution or spray) where the tenaculum teeth are applied decreases patient discomfort (optional).

10.

Insert a uterine sound into the cervix while applying gentle traction to the tenaculum. Halt when the fundus is reached, and note the insertion measurement in centimeters. Remove the sound from the patient. If stenosis is present, cervical dilation may be necessary (seeChapter 126, Cervical Stenosis and Cervical Dilation).

11.

Gently insert the curette into the endometrial cavity while applying traction with the tenaculum. Stop insertion once the curette is at the depth that was sounded.

12.

Before attaching the curette, draw up 1 to 2 cm of air into the syringe. This will be used to evacuate the curette when the procedure is completed.

13.

Attach a 20-mL syringe to the curette hub. Pull the syringe back to the 10- to 15-mL mark to create suction. The Explora models recommend pulling the syringe back to 1 or 2 mL to avoid discomfort.

14.

Apply pressure against the uterine sidewalls, and perform four to six single-strip curettages. Sample from the fundus to the lower uterine segment, and obtain at least one sample from each quadrant. More sampling can be done if the patient is tolerating the procedure well.

15.

Release the pressure on the syringe, withdraw the curette from the uterus, and express the sample into the formalin bottle by pushing the plunger of the syringe toward the curette. Label the formalin bottle.

16.

Remove the speculum from the vagina.

Instruments and Materials

Melissa A Bogle MD, Aaron K Joseph MD, in Surgery of the Skin, 2005

Curettes

Curettes are used primarily for the treatment of benign or low-grade malignant tumors and for debulking tumors prior to Mohs micrographic surgery. They come in many handle styles with either round or oval heads of varying sizes from 1 mm to 9 mm (Fig. 4.8). The choice of curette is largely personal preference, but smaller heads should be used for finer procedures. Furthermore, as with any instrument, care must be taken not to dull the sharp edge of the curette. A dull curette will create excessive tissue trauma and a suboptimal outcome.

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Cerumen Impaction Removal

Grant C. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020

Curette or Suction Technique

A curette is usually the fastest way to remove cerumen and may be preferred for small amounts of easily visible and reachable wax. It is also usually the easiest method for children, who may find it difficult to remain still for suction or irrigation. In adults, suction can be used for deeper or slightly more adherent impactions. Suction works best for multiple tiny fragments or for soft cerumen; it often fails when there is a single, hard, irregular, and impacted cerumen plug. Young children are often frightened by the noise suction makes. For children and adults, irrigation will be necessary for dense, adherent, or circumferential impactions.

1.

Seat the patient on the examination table. If available, a neck rest, such as those on a dental or otolaryngology (ears, nose, throat [ENT]) chair, may help adults remain immobile. Children often tolerate the procedure better if held securely or swaddled with a sheet in a parent’s lap or, if supine, with the parent or assistant stabilizing the head. A positional restraint board may be helpful.

2.

Using the otoscope, first visualize the opposite canal to become familiar with the patient’s anatomy. Next, visualize the cerumen in the affected canal by applying traction on the helix as necessary. In adults, traction is usually applied posteriorly and upward on the pinna while simultaneously pulling it slightly out from the head. In the small child, the pinna is pulled down, back, and slightly out from the head. Five to 10 mL of local anesthetic instilled in the ear will usually result in increased patient comfort for the duration of the procedure; however, it may obscure the canal briefly, so sometimes it is better just to remove the cerumen.

3.

Using the selected curette, ear hook, or suction catheter, reach through the partially open magnifying posterior lens of the otoscope and gently remove the impacted cerumen. Take care to avoid traumatizing the bony ear canal. Work either through the scope (Fig. 62.2A) or, after identifying the location of the cerumen, by direct visualization (Fig. 62.2B).

Note: The clinician’s hand should be stabilized by remaining firmly in contact with the patient’s head at all times. This should minimize the risk of scraping the wall of the external canal or perforating the tympanic membrane. Even the most cooperative patient may move involuntarily because of a stimulated vagal nerve cough reflex.

4.

If hard wax is encountered, installation of 8 to 10 drops of ceruminolytic (e.g., 3% hydrogen peroxide, docusate sodium, or 5% to 10% sodium bicarbonate) for at least 15 minutes should facilitate removal. For wax adherent to the tympanic membrane,irrigation or suction may be necessary. Suction catheters (seeFig. 62.1) are quite loud when used in the external canal, so if suction is used, the patient should be warned and instructed not to pull away from the noise.

5.

Firmly adherent cerumen frequently tears epithelium as it is removed. Consider prescribing topical otic antibiotics afterward if epithelium is disrupted.

Principles and Technique of the Colposcopic Exam

Barbara S. Apgar, ... Mary M. Rubin, in Coloscopy: Principles and Practice (Second Edition), 2008

Endocervical Curettes

Endocervical curettes are long, stainless steel rods consisting of a finger-grip handle and a head or tip with a slightly upturned cutting edge (Figure 6-23). Only one edge of the tip is a sharp cutting edge. The other edge is dull and is not used as a cutting surface. The cutting edge of the tip is on the same plane as the finger hold on the handle. The head or tip is made with or without a basket. If a basket is present, the sample collected in the basket may prove difficult to remove.

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Tonsillectomy and Adenoidectomy

Grant C. Fowler MD, in Pfenninger and Fowler's Procedures for Primary Care, 2020

Curette Method

1.

A self-retaining mouth gag is placed in the mouth and suspended from the Mayo stand.

2.

The hard and soft palates are inspected visually and manually for occult submucous cleft palate. If there is no cleft palate, the soft palate is then retracted with a red rubber catheter that is placed through the nose and out the mouth, and clamped over the retractor to expose the adenoid bed.

3.

The adenoid bed is inspected with the laryngeal mirror for the presence of adenoid tissue. Adenoid tissue decreases with age and is often gone by the teenage years.

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4.

An adenoid curette is placed on the adenoid tissue extending superior to the soft palate. It is placed high in the nasopharynx, basically abutting the posterior aspect of the nasal septum.

5.

Downward pressure is applied to the curette while the curette is moved along the plane of the posterior pharyngeal muscle (Fig.66.18). Take care not to penetrate deeply into the prevertebral tissue.

6.

The bulk of the adenoid tissue is removed with the first pass.

7.

Occasionally a second pass may be needed with grossly enlarged adenoids. Take care not to venture too far laterally to avoid injuring the torus tubarius or eustachian tube opening.

8.

Redundant tissue around the opening of the eustachian tube can be carefully removed with a punch adenotome.

9.

A nasal suction catheter is inserted, and continuous suction is applied for 2 to 3 more minutes, until bleeding stops. Nasopharyngeal packing may also help.

10.

Rarely does this technique produce enough bleeding for cautery to be required. Persistent postoperative oozing may be controlled somewhat by nasal decongestant drops.

Central Quadriceps Free Tendon for ACL Reconstruction

Stephan V. Yacoubian, John P. Fulkerson, in Textbook of Arthoscopy, 2004

Femoral Tunnel

A small curet is used to identify the proper location for this tunnel. We recommend placing the femoral guide pin 7 to 8 mm anterior to the posterior notch and in the 10:30 o'clock–1:30 o'clock (right knee–left knee) position. The femoral guide pin is placed through the tibial tunnel with the knee at 70 to 90 degrees of flexion. Ideally, the guide pin should exit the anterolateral thigh at an angle of about 45 to 50 degrees from the axis of the femur and anterior to the iliotibial band. The tunnel is reamed to a depth of 35 to 40 mm (Fig. 65-10). Debris is cleared out. Blowing out the back wall is not a critical issue with use of an Endobutton. The Endobutton drill is then placed over the femoral guide pin, and drilling continues completely through the lateral cortex. A depth gauge is then used to measure the tunnel. Using the Endobutton ‘graftmaster,’ the distance from the Endobutton to the femoral tunnel orifice point on the graft (marked in blue) should be determined, and the suture length should be adjusted to match the measured length of the tunnel. Allow at least 2 cm of tendon graft in the tunnel. Be sure to allow room to flip the Endobutton after placement through the femoral tunnel.

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Ulnar Collateral Ligament Reconstruction Using the Modified Jobe Technique

Benton A. Emblom, ... Leonard C. Macrina, in Operative Techniques: shoulder and elbow surgery, 2011

STEP 2

PEARLS

Curved curettes allow straight drill paths to be converted into a curved tunnel.

The native UCL is not reapproximated until after the drilling of the ulnar tunnel in order to facilitate visualization of the ulnohumeral joint.

PITFALLS

Excessive retraction during preparation of the ulnar tunnel can damage the ulnar nerve.

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Utilizing a soft tissue protector also protects the ulnar nerve and any soft tissue in close proximity.

The ulnar tunnel is created.

The sublime tubercle is again identified on the proximal ulna.

A 3.6-mm drill bit is used to create two holes, approximately 5 mm off the joint line, immediately anterior and posterior to the sublime tubercle, and leaving a bone bridge of approximately 1.5 cm (Fig. 15).

Curved curettes (size 0 and 1) are then sequentially used to connect the holes and create a continuous curved tunnel.

A manually curved Hewson suture passer is used to pass the graft through the ulnar tunnel.

The distal two thirds of the incised UCL is reapproximated with a #0 Ticron suture (Fig. 16).

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Current Techniques of Adenoidectomy

Mai Thy Truong MD, Peter J. Koltai MD, in Sleep Apnea and Snoring (Second Edition), 2020

3.1 Curette Adenoidectomy

The use of a curette to remove the adenoids dates back to some of the earliest attempts at this procedure and remains an incredibly popular technique worldwide. The original design of Jacob Gottenstein has been modified, and many different lengths, widths, and curvatures are available. The basic principle is that of a sharp horizontal knife edge that is designed to cut through the base of the adenoid bed. The instrument is designed to follow the natural curvature of the nasopharyngeal skull base (Fig. 70.1).

The curette may be passed blindly into the nasopharynx, or the laryngeal mirrors may be used to guide the cutting edge into position. Visualization of the fossa of Rosenmuller helps determine the appropriate curette size. The curette is placed against the vomer and then pushed through the adenoid tissue to the more resistant deeper layers. The handle is pulled toward the head, and the surgeon's other hand acts as a fulcrum at approximately the level of the incisors. The curette is swept in an arc through the adenoid tissue until the level of Passavant ridge, which is the inferior aspect of the dissection. After the initial pass, the adenoid bed is inspected for the completeness of the procedure. If residual adenoid tissue is left behind, it must be removed using a smaller curette or St. Claire-Thompson forceps or Meltzer adenoid punch forceps. A tonsil sponge is then generally placed into the nasopharynx to aid in hemostasis. These sponges may contain medications such as oxymetazoline or can be used alone. It is the author's preference to finalize hemostasis using a suction monopolar cautery using mirror guidance, although other techniques, including pressure packing, bismuth subgallate, and silver nitrate, have been described. Once final hemostasis is achieved, the nasopharynx and oropharynx should be irrigated and the stomach emptied of its contents before extubation.

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Posterior Far Lateral Disk Herniation

Chadi Tannoury, ... Todd J. Albert, in Operative Techniques: spine surgery, 2008

STEP 3

PEARLS

(Video) Systemic Sclerosis part 2 surgical overview by Mr Lindsay Muir

No. 2 curettes and an angled 3-0 curette are extremely helpful in clearing soft tissue off the bony and soft tissue anatomy and especially the intertransverse membrane.

Instrumentation/Implantion

High-speed bone burr: long and angled drill handpiece

Nos. 2 and 3-0 angled curette

Blunt dissector

A microscope is helpful for delineating the anatomy of the area.

The medial half of the intertransverse muscle is incised and reflected laterally, exposing the intertransverse ligament, also known as the “intertransverse membrane.”

Using a binocular loop magnification and a fiberoptic headlight versus a microscope, identification is made, if possible, of the posterior primary ramus as it passes through the medial aspect of the intertransverse membrane and before it distributes its branches to the dorsal musculature.

The posterior primary ramus is used as a reference to locate the spinal nerve and dorsal root ganglion, which are embedded in extraforaminal fat and connective tissue beneath the intertransverse membrane.

Gentle and careful superior and lateral retraction of the spinal nerve allows further access to the disk material.

Alternatively, the pedicle below can be identified, and slipping proximally allows identification of the disk. Sliding dorsally allows delineation of the nerve root, and it can then be protected.

The nerve branches are in close proximity to the accompanying vessels and extruded disk herniation. Branches of the lumbar artery should be dissected carefully and spared whenever possible. However, accompanying veins can be cauterized if they hinder access to the herniated disk fragment.

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Plate/Blade Form Implants

Charles M. Weiss DDS, ADAM WEISS BA, in Principles and Practice of Implant Dentistry, 2001

Check Location Accuracy/Bone Harvesting.

The intermediate osteotomy now is cleansed and checked for dimensional accuracy with the solid titanium channel curette and depth gauge. Gently insert this instrument distally to the base of the preliminary osteotomy, and carry it mesially as it curettes out and harvests a paste of bone chips and blood. If desired, this may be preserved in a sterile dappen dish on the tray setup. Several passes may be needed to clear the channel. Check the depth and evenness of the base of the preliminary osteotomy, and make any necessary corrections to ensure conformity. Place the implant in its preliminary osteotomy to confirm that the mesio-distal length of the osteotomy can accommodate the length of the implant, with an extra 1 to 2 mm of clearance at each end.

The solid titanium channel curette and depth gauge is narrower bucco-lingually than the preliminary osteotomy, to prevent injury to its lateral walls during curettage. The instrument has the same horizontal Tru-Grip markings, 2 mm apart, that are on the surface of the implant. As the instrument is passed along the base of the preliminary osteotomy, direct depth readings can be made at every point mesio-distally along the site. Corrections are made if and as required to bring the intermediate osteotomy to its proper depth at every point.

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Chapter 21. The Circulatory System

The Circulatory System. In a closed circulatory system , blood is contained inside blood vessels and circulates unidirectionally from the heart around the systemic circulatory route, then returns to the heart again, as illustrated in Figure 21.2 a .. In amphibians, reptiles, birds, and mammals, blood flow is directed in two circuits: one through the lungs and back to the heart, which is called pulmonary circulation , and the other throughout the rest of the body and its organs including the brain (systemic circulation).. Systemic circulation flows through the systems of the body.. atrium (plural: atria) chamber of the heart that receives blood from the veins and sends blood to the ventricles closed circulatory system system in which the blood is separated from the bodily interstitial fluid and contained in blood vessels double circulation flow of blood in two circuits: the pulmonary circuit through the lungs and the systemic circuit through the organs and body gill circulation circulatory system that is specific to animals with gills for gas exchange; the blood flows through the gills for oxygenation hemocoel cavity into which blood is pumped in an open circulatory system hemolymph mixture of blood and interstitial fluid that is found in insects and other arthropods as well as most mollusks interstitial fluid fluid between cells ostium (plural: ostia) holes between blood vessels that allow the movement of hemolymph through the body of insects, arthropods, and mollusks with open circulatory systems pulmonary circulation flow of blood away from the heart through the lungs where oxygenation occurs and then returns to the heart again systemic circulation flow of blood away from the heart to the brain, liver, kidneys, stomach, and other organs, the limbs, and the muscles of the body, and then the return of this blood to the heart unidirectional circulation flow of blood in a single circuit; occurs in fish where the blood flows through the gills, then past the organs and the rest of the body, before returning to the heart ventricle (heart) large inferior chamber of the heart that pumps blood into arteries

Learn about vital capacity, an important part of pulmonary function testing, and how it impacts your asthma diagnosis and treatment.

Vital capacity (VC) is a measurement of the maximum amount of air you can fully inhale into or exhale out of your lungs.. If you have asthma , you may need to have your vital capacity measured periodically to help guide your treatment and assess the severity of your condition.. This test is used in asthma to assess breathing ability and lung condition.. Forced vital capacity (FVC) : Your FVC is the maximum amount of air you can breathe out with maximal effort after taking a full inspiration.. Your VC is likely to be slightly greater than your FEV1 because you have more time to expire when your VC is being measured than when your FEV1 is being measured.. Before you have your VC measured, your healthcare provider may ask you to take your asthma medication at a certain time or to bring it with you.. You might need to have your vital capacity measured before and after using an asthma inhaler to see if and how the medication changes your results.. Your VC is the sum of your tidal volume, inspiratory reserve volume (the amount of additional air you can breathe in with maximal effort), and expiratory reserve volume (the amount of additional air you could breathe out with maximal effort).. A person who is taller than average would be expected to have a VC on the higher side, while a person who has a higher body mass index (BMI) would be expected to have a VC on the lower side.. Obstructive lung diseases may cause a slightly reduced VC. Asthma is an obstructive lung disease because the narrow airways make it difficult to get air out of the lungs; severe asthma may cause a more notable decrease in your VC.. Additionally, if you experience a major difference (typically an improvement) in your VC shortly after taking your asthma inhaler, this could signify that you need better maintenance of your asthma.. If you've been diagnosed with asthma, a significant decline in your VC could mean your disease is progressing or that you are also developing restrictive lung disease in addition to your asthma.. A substantially low vital capacity with asthma is an indication it's time to adjust treatment or that there needs to be further evaluation of the cause of your low VC.

Ecommerce is a business model that enables the buying and selling of goods and services over the Internet.

Electronic Commerce As noted above, ecommerce is the process of buying and selling tangible products and services online.. Ecommerce has helped businesses (especially those with a narrow reach like small businesses ) gain access to and establish a wider market presence by providing cheaper and more efficient distribution channels for their products or services.. International sales: As long as an ecommerce store can ship to the customer, an ecommerce company can sell to anyone in the world and isn't limited by physical geography.. White label ecommerce companies leverage already successful products sold by another company.. After a customer places an order, the ecommerce company receives the existing product, repackages the product with their own package and label, and distributes the product to the customer.. Although the ecommerce company has little to no say in the product they receive, the company usually faces little to no in-house manufacturing constraints.. An ecommerce website is any site that allows you to buy and sell products and services online.. An ecommerce company can sell to customers (B2C), businesses (B2B), or agencies such as the government (B2G).. While the latter involves the entire process of running a business online, ecommerce simply refers to the sale of goods and services via the internet.. Ecommerce companies like Amazon, Alibaba, and eBay have changed the way the retail industry works, forcing major, traditional retailers to change the way they do business.

What is the pain gate control theory and how is it used to control or eliminate acute or chronic pain?

Scientists have many different theories about pain and the best ways to get control of your pain.. The pain gate control theory states that "gates" allow certain stimuli to pass through neural pathways to your brain.. Non-noxious stimuli, the ones that don't make you feel pain, pass through the "pain gate" and then help close the gate so painful stimuli cannot reach your brain.. Therefore, you may be able to decrease or eliminate pain that you are feeling by allowing only "safe" and non-noxious stimuli through the gate to your brain.. But pain can be tricky, because pain may be sensed by your brain when there is no actual emergency or potential harm to your body.. These psychological factors, along with actual noxious stimuli from your body to your brain, shape how you feel pain and how your body reacts to it.. That is how the pain gate theory works: Apply a non-noxious stimulus to your body that closes the gate and does not allow the painful stimulus to enter your brain.. When this happens, the "gate" in the neural pathway closes, and painful stimuli are prevented from reaching the brain and being felt.. The pain gate control theory is just that—a theory.. Other research has found that while the gate theory may help control some pain, a more global bio-psycho-social model of pain sensation is more accurate.. Some studies show good pain control with TENS, while others show very little improvement in pain with TENS.. Controlling pain is a billion-dollar healthcare industry, and it is estimated that over 20% of American adults are living with chronic pain.. The pain gate control theory is a simple way to understand how you feel pain and how to control acute and chronic pain .. Simply put: non-noxious stimuli can get through the gate to your brain while preventing painful feelings from getting to your brain.. This model of pain control can help you find the best approach to eliminating your pain.

Stainless steel is one of the most common materials when a combination of strength and corrosion resistance is necessary.

Stainless steels are a group of steels that are resistant to corrosion through the addition of alloying elements .. The term stainless steel is used to describe a family of about 200 alloys of steel with remarkable heat and corrosion resistance properties.. Stainless steel contains a minimum of 10.5% of chromium that improves its corrosion resistance and strength.. Martensitic stainless steel will have lower corrosion resistance when compared with austenitic and ferritic grades with the same chromium and alloy content.. Hot food in stainless steel containers300 series stainless steel applications include:. Manganese also promotes the solution of nitrogen in stainless steel and may, therefore, be added to replace nickel in stainless steel with nitrogen.. Stainless steel brings along corrosion and heat resistance besides the conventional properties of steel.

Eyeq is the leading questionbank for ophthalmology exam revision with 5 000 questions and counting you can fully prepare for

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