Regional Anesthesia Risks: Going From Lower to Lowest

More steps can be taken to decrease risk even more

Neurologic injury from regional anesthesia is very low

The risk of neurologic injury from regional anesthesia techniques is already low, but some feel it could be even lower. (Photo: Bigstock)

Can the risk of neurologic injury due to regional anesthesia go from very low to extremely low? That was the question on the minds of many anesthesiologists at this year’s International Symposium of Ultrasound for Regional Anesthesia, Pain Medicine and Perioperative Applications in Toronto, Canada.

Already, the risk of neurologic injury is low, but some say there are even more steps anesthesiologists can take to reduce the risk even lower.

“What we do is very safe, but this allows us to spend a lot of time talking about the optimal way to make things even safer,” said Kyle Kirkham, MD, FRCPC, staff anesthesiologist at Toronto Western Hospital, University Health Network and assistant professor to the Department of Anesthesia at the University of Toronto, Ontario, Canada. “Can we step back and find an approach that doesn’t require the needle to be in contact with the nerve at all?”

Ongoing research

Research based on the topic of increasing proximity to the nerve without causing injury has been done in the past, but now experts are calling on more alternative approaches to be looked at, such as maintaining a distance from the nerve while still delivering a sufficient diffusion of anesthetic.

Studies concerning current flow and twitch have shed some light on avoiding nerve damage, but nothing concrete has been set forth yet.

“We have discovered that a lot of studies have shown you can be touching the nerve and have high current and not get a twitch,” said Paul McHardy, MD, FRCPC, an anesthesiologist at Sunnybrook Health Sciences Centre in Toronto. “At the same time, you can be outside the nerve, have low current and have a twitch. The architectural structure of the nerves behaves differently in terms of risk.”

Using pressure as a measurement was thought to be a reliable way to minimize the risk of neurologic injury. However, one animal study showed that high injection pressures may suggest intraneural needle placement and result in persistent neurologic deficits, which led the authors to recommend against excessive injection pressure.

One anesthesiologist, Xavier Sala-Blanch, MD, director of the Orthopedic Anesthesia Section at the University of Barcelona, Spain, looked at retrospective research which determined ultrasound guidance can decrease the risk for local anesthetic systemic toxicity after a peripheral nerve blockade.

“It is important that we try to reduce the percentage of injury,” said Dr. Sala-Blanch. “Ultrasound helps us to do this.”

To read more on the topic of reducing the risks of regional anesthesia techniques, click here: Techniques Can Push Regional Anesthesia Risks Still Lower.

For more than 30 years, Havel’s has offered premium quality anesthesia needles and ultrasound needles for anesthesiologists, pain management specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia Needles and Pain Control Needles.


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Radiology and Your Hospital: Rethink and Regroup

Ohio hospital strikes innovative new partnership with outside imaging practice

radiology MRI scan

Aultman Hospital in Canton, Ohio has formed a unique partnership with Radiology Associates of Canton with a focus on both patient and physician satisfaction. (Photo: Bigstock)

Patient care and satisfaction is a top priority for many hospitals and healthcare networks across the country, and many facilities are trying new approaches to keep their patients, and physicians, happy.

Aultman Hospital in Canton, Ohio is doing just that. Three years ago the nonprofit hospital faced challenges typical to anyone working in modern-day healthcare — financial pressure, increased competition — and when it came time to renew the contract the hospital had with an outside radiology practice, Aultman’s CEO Christopher Remark decided it was time for a new approach.

For years, the relationship between Aultman Hospital and Radiology Associates of Canton was all too common. Separated, uncommunicative and lacking in transparency, the time for change was obvious. The two parties worked together to develop a shared vision with the best interests of the hospital and practice in mind.

“When you summed it all up, it didn’t look really good, from our standpoint, from an imaging standpoint,” said Remark. “We really felt that we had an opportunity to do something different because it was right in the heat of [health care reform].”

A new focus

The end result was a shift in focus for Aultman and Radiology Associates, set around incentives tied to quality, patient satisfaction and most importantly, efficiency. Volume and money took a backseat, and the new goals included growing their outpatient market share, instituting patient-centered imaging services and preparing for new payment models for patients.

The first year of the new agreement was 2013, and it was a major success. One of the biggest successes was dropping the turnaround rate for an MRI brain observation report from 24 hours to two. Employee and physician satisfaction is up for both, which then leads to stronger patient care and better outcomes for all.

“This is the beauty of co-management because we were talking strategically, and as a hospital we were behind in these areas,” said Remark. “It was neat to forge a relationship between the cardiologists and radiologists to really make this happen.”

“This would not have happened without a visionary CEO of the hospital like Remark,” said Syed Furqan Zaidi, M.D. and CEO of Radiology Associates of Canton.

For more information on the new partnership, click here: The Radiologist’s Role in Shaking Up Your Hospital.

Since 1981, Havel’s has offered premium quality radiology needles and biopsy needles for radiologists, doctors, hospitals and other leading medical professionals. To see Havel’s selection of radiology and biopsy needles, please click here: Havel’s Radiology and Biopsy Needles.


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Before and After: Ultrasound and Anesthesia for Reducing Surgical Pain

Taking advantage of today’s technology

ultrasound and regional anesthesia for pain

Ultrasound can be used to treat patients with surgical pain before, during and after surgery. (Photo: Bigstock)

A few decades ago, the thought of using ultrasound for anesthesia seemed silly and unnecessary. Today, ultrasound has become one of the leading technological innovations for many regional anesthesia procedures. The benefits of using ultrasound for needle injections are incredible, as you’re able to see the needle on the screen as you make your way around internal structures to your target destination. In this case, seeing is truly believing.

Using ultrasound and regional anesthesia to manage pain during surgery is one of its many benefits, but it can also help patients before and after surgery as well. The most important thing a patient wants is to be as pain-free as possible throughout the entire surgical experience, including the pre-op and post-op stages. By using ultrasound, a team of anesthesiologists can provide the patient with exactly that.

Here’s a breakdown of the added advantages to using ultrasound before and after surgery:

Pre-op assessment

When managing pain for surgery, it all starts with the pre-op routines. Ultrasound can come in handy when placing IVs in patients whose veins might be difficult to reach, or even see. By using ultrasound to find hidden or hard to reach veins, it decreases the amount of painful needle sticks a patient might otherwise have to receive. Ultrasound allows even the most inexperienced physician to find the vein quickly and easily, often with the patient fully awake and conscious. With the help of ultrasound, it usually only takes a single needle insertion to get the job done.

Post-op assessment

Some surgeries come with agonizing post-surgical pain, including surgeries on the hips and shoulder. With ultrasound, post-op pain can be significantly reduced. By using it to place blocks for pain relief, it can help visualize the target nerves and surround them with a pain-blocking local anesthetic. Using these techniques also reduces the need for narcotics, which can lessen the amount of nausea and vomiting a patient might experience. It also increases the rate at which it takes the affected joints to become more mobile again.

The advantages of ultrasound use in anesthesia and pain management are clear, but the possibilities shouldn’t end here. As new benefits are discovered over time, it’s only a matter of time until the next breakthrough is realized.

To read more on the benefits of using ultrasound for regional anesthesia, click here: Anesthesia Alert: Are You Using Ultrasound to Its Full Potential?

Since 1981, Havel’s has offered premium quality anesthesia needles and pain control needles for anesthesiologists, pain management specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia and Pain Control Needles.

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Adverse Events With Cosmetic Skin Procedures Rare

Overall incidence was 0.24 percent

Minor cosmetic dermatology procedures safe

A new report shows that the majority of minor cosmetic dermatology procedures are safe and produce little to no adverse events. (Photo: Bigstock)

Some of the most common cosmetic dermatology procedures, including laser, other forms of energy and injection therapy, have been found to have little, if any, adverse events related to them according to a recent analysis of a large prospective database.

The analysis found a total of 48 adverse events that occurred in over 20,000 cosmetic procedures. Out of all the adverse events that did occur, none were found to be serious or life-threatening, and no incidence of hospitalization, mortality, serious illness or permanent injury were reported. The most common events were transient bruising or redness, minor hyper- or hypopigmentation or temporary “bumps” at the injection site for injectable treatments.

Murad Alam, MD, of Northwestern University in Chicago, and colleagues reported their findings online in JAMA Dermatology.

“The principal finding was what we had expected; basically, that the adverse event rate after minor cosmetic procedures is very low,” Alam said. “But it was a surprise at just how low the rate was. Not only was the rate very low, but the types of events we found were very innocuous.”

First of its kind

This is good news for the growing number of cosmetic procedures dermatologists perform every year. Even with the large numbers, adverse events had not been well documented up to this point. This is largely due to a lack of data on the subject. In order to avoid this, Alam and his colleagues approached the study from a unique standpoint. The main focus was to select a specific subset of patients – those treated with noninvasive and minimally invasive procedures involving lasers energy devices and injectable neurotoxins and fillers – and look at how frequent adverse events occurred in those patients.

“We included certain kinds of cosmetic procedures that are quite common,” said Alam. “Among those procedures would be filler procedures – injectable, prepackaged fillers for facial augmentation – neurotoxins and a number of laser and energy devices.” Laser and energy devices can include procedures such as hair removal, tattoo treatment and removal and wrinkle and fine line treatments.

By the numbers

The new study involved 23 cosmetic dermatologists across eight different locations. Researchers looked at data from procedures of interest performed between March 28 and December 30, 2011. This data included initial observations by participating dermatologists, patient-reported events and follow-up contact with patients via telephone. If an adverse event was suspected but not observed by a dermatologist, patients were asked to return for a follow-up exam within 24 hours.

In total the data was made up from 20,399 procedures, and the total incidence of adverse events was 0.24 percent. Adverse events were most commonly associated with procedures involving the cheeks, eyelids and nasolabial, or “laugh lines.”

“This multicenter prospective study of a large cohort of consecutively performed cosmetic procedures demonstrates that adverse events are uncommon after minimally invasive and noninvasive laser, energy device, filler and neurotoxin procedures,” the authors wrote. “Most adverse events were types that would be expected to resolve with treatment over weeks or months.”

“Patients seeking such procedures can be reassured that, at least in the hands of trained, board-certified dermatologists, [these procedures] pose minimal risk.”

For more information on the large scale study, click here: Few Adverse Events With Cosmetic Skin Procedures.

Since 1981, Havel’s has offered premium quality sutures and surgical scalpel blades for dermatologists, doctors, hospitals and other leading medical professionals. To see Havel’s selection of sutures and surgical scalpel blades, please click here: Havel’s Sutures and Surgical Scalpel Blades.

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5 Tips for Overcoming Continuous Nerve Block Obstacles

Helpful hints for better, more successful blocks

Using ultrasound for continuous nerve blocks

Continuous nerve blocks have many distinct advantages that outweigh any drawbacks.

Continuous nerve blocks have a number of advantages for both the surgeon and the patient, but what exactly are they?

Continuous peripheral nerve blocks (CPNBs) are used in a number of surgeries that before would necessitate an overnight stay in a hospital for postoperative pain control. A surgeon places a pain catheter in the vicinity of the target nerve which acts as a conduit for the continuous flow of anesthetic. The technique provides target-specific analgesia for a variety of surgeries and gets patients through the first 48 hours after surgery with little or no pain medication.

Continuous nerve blocks decrease the time it takes for a patient to be cleared for discharge from the hospital, giving many patients the chance to return home on the same day of surgery. There’s also very little hospital readmission related to pain control associated with the procedure.

For all the advantages continuous nerve blocks have, they aren’t without obstacles. Here are five tips for surgeons to help overcome the hurdles and place successful blocks:

  1. Prepare ahead of time by placing single-shot blocks – there’s no denying it takes a lot of skill and training to place pain catheters successfully. One way to overcome the difficulty is by practicing with single-shot blocks for several months beforehand. Pain catheters are like an extension of single-shot blocks, except they’re more advanced and complex. For one, you’re using a bigger needle, most often an 18-gauge instead of a 22-gauge that’s commonly used for single-shot blocks. Practicing with single-shot blocks first will ultimately help once you’re ready for CPNBs.
  2. Use technology to your advantage – the use of continuous nerve blocks and pain catheters has become more common because ultrasound guidance has improved and become more affordable over time. Without ultrasound, catheters are very hard to place. Ultrasound makes it easier to see nerves and blood vessels, which helps to guide your needle through. Above all else, being able to see the needle at all times is essential. As you advance, you should always be able to see the tip of the needle on the ultrasound screen. This kind of visibility will help make certain you’re not damaging anything else in the process.
  3. Reimbursement comes in patient care, not monetary value – continuous nerve blocks are a huge investment for good patient outcomes. Most patients would prefer them because they allow them to leave on the same day of their surgery. With more attention on patient quality and satisfaction than ever before, CPNBs are a value-added service that can help boost those measures for your hospital.
  4. Remember: pain catheters take more time to place – even the most experienced doctor can take about 15 minutes to place the pain catheter. New practitioners may require even more time, around 30 to 40 minutes. For time efficiency, be sure to place the catheter somewhere other than the OR so you’re not wasting valuable turnover time, or worse making surgeons wait for you to begin.
  5. Manage your patient’s expectations – be sure to remind your patients that take-home pain catheters will bring their pain down significantly, but not fully. It helps with reducing postoperative pain to a more manageable level, about a four or five out of 10. By combining it with oral pain medication, pain can be reduced to around a two or three. Also remind them that the biggest problem with the catheter is not taking it out, but keeping it in. Getting one caught on something is no laughing matter. By managing patient expectations, you’ll get better results for everyone.

For more information on the advantages of using continuous nerve blocks, click here: Are Continuous Nerve Blocks Worth the Trouble?

For over 30 years, Havel’s has offered premium quality anesthesia needles and pain control needles for anesthesiologists, pain management specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia and Pain Control Needles.

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New PTSD Treatment Offers Relief With Neck Injections

Researchers say technique relieved symptoms in 70 percent of combat veterans

SGB treatment for combat troops and veterans suffering from PTSD

A new treatment option for PTSD called a stellate ganglion block, or SGB, could provide relief for combat troops and veterans suffering from the disorder.

A new report published in the October issue of Military Medicine found that an anesthesia technique called a stellate ganglion block, or SGB, could provide much needed relief for soldiers suffering from post-traumatic stress disorder. The report showed that over 70 percent of combat veterans who received the treatment once or more said it relieved symptoms of PTSD such as sleep disturbances, anxiety and depression, as measured by a checklist in nearly 100 service members.

SGB works by injecting an anesthetic into a bundle of nerves located near the base of the neck. These nerves, called the stellate ganglion, are targeted using ultrasound guidance along with general anesthesia. After a one-week follow-up after their first injection, the study said that “78.6 percent of responders had an average reduction of their PTSD checklist score of 22 points.”

Game-changing relief

Dr. Eugene Lipov, a Chicago-based pain management specialist, has been using SGB to treat PTSD since 2008. Lipov knew of the nerve block’s relief for menopause-related hot flashes, and came to the conclusion that since the technique seems to restart the body’s temperature-regulating mechanism, it might also restart a PTSD patient’s overreaction to stimulus by way of interrupting the connections between the sympathetic nervous system and central nervous system.

“As a pain management specialist, I knew SGB relieved problems related to the sympathetic nerve system and thought it could work to relieve the hyperarousal characteristic of PTSD,” said Dr. Lipov.

Acceptance in the medical community

Although the procedure is showing signs of relief, it is not widely accepted as a treatment for PTSD. This is due to the fact that the disorder itself is still not fully understood. Currently, PTSD is classified as a psychiatric disorder, and physicians are reluctant to embrace a physical treatment like SGB for relief in what’s thought of as a mental health disorder.

“Pharmacotherapy and psychotherapy are only moderately helpful, at best,” said Dr. Maryam Navaie, a San Diego-based consultant. “We need more effective treatment options.”

SGB was first developed as a treatment for shoulder, neck and face pain caused by the shingles virus and complex regional pain syndrome. As far as a treatment for PTSD, the procedure usually lasts less than an hour for most patients. The complication rate is very rare, occurring in about 1.7 out of 1,000 procedures.

Current and future research

Even though the procedure isn’t a widely accepted form of treatment, SGB has been the focus of several recent studies. In October, a group of researchers from the Long Beach Veterans Affairs Healthcare System, California published results of an SGB treatment study on a group of 12 combat troops. Their results found that the procedure worked extremely well, with five out of the 12 patients feeling better afterwards and four describing SGB as a “miracle cure.”

To read more about SGB treatment for PTSD, click here: Neck Injections a Viable Treatment for PTSD, Researchers Say.

Since 1981, Havel’s has offered premium quality anesthesia needles and pain control needles for anesthesiologists, pain management specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia and Pain Control Needles.

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A Century of Innovation: Radiological Society of North America’s 2014 Annual Meeting

RSNA celebrates historical anniversary with president’s address on Sunday

RSNA President speaks to crowd at RSNA annual meeting

RSNA President N. Reed Dunnick, M.D., speaks to the crowd Sunday night at the RSNA 2014 Annual Meeting.

The Radiological Society of North America‘s 2014 Annual Meeting is currently underway in Chicago, Illinois, and this year marks a special milestone for the organization. The RSNA is celebrating their 100th annual meeting, with a focus on the past, present and future of both the organization and radiology.

RSNA President N. Reed Dunnick, M.D., addressed the crowd on Sunday and touched upon a number of topics, including the organization’s historical past and what it needs to do now in order to push radiology even further for the future.

“If we couple our historical strength in research and discovery with our new focus on delivering patient-centered care, I believe the RSNA and radiology will be well positioned for the next 100 years of service to the world,” said Dr. Dunnick.

He pointed out six distinct elements that are key to helping the field evolve and adapt for the future, but also noted that they only add up to half of the solution. The other half, he said, would come from a mix of new scientific advances with true patient-centered care.

To read more about the president’s address, click here: Innovation, Patient Focus Will Help Radiology Thrive for Next 100 Years.

Since 1981, Havel’s has offered premium quality radiology needles and biopsy needles to radiologists, doctors, hospitals and other leading medical professionals. To see Havel’s selection radiology and biopsy needles, please click here: Havel’s Radiology and Biopsy Needles.


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Cloud Computing: Why Your Dental Practice Should Make the Switch

Cloud-based storage systems are becoming the norm for healthcare

Cloud computing for your dental practice

Cloud computing is changing the way healthcare organizations around the world store data.

These days, it seems like the cloud is everywhere. That’s because, quite literally, it is.

Already, the cloud has made sweeping changes across the medical field, as hospitals and practices make the change from paper-based and hardware storage systems to cloud-based systems. Now, it’s time for dentistry to do the same.

The cloud is a revolutionary advancement, and it can be a valuable tool for dentistry. When you’re “in the cloud,” it essentially means you’re using an Internet-based space to store all of your data. Patient records, X-rays, images – all of your electronic data can be stored in the cloud. By using the cloud, you get a data-storage solution that is flexible and responsive to your practice’s needs.

One of the best advantages of moving to the cloud is the ability to access the most up-to-date information anywhere, anytime. It’s always there to see no matter where you’re at or what device you’re using, as long as that device supports the cloud. It used to be hard to know whether you had the most updated version of your patient’s records, and outdated information can be harmful to both the patient and your practice. By using the cloud, all changes made to a patient’s file are updated automatically, and these changes can be seen by all users across multiple teams or offices, as long as they have authorization to do so. Anyone viewing a patient’s file through the cloud can rest assured that they’re looking at the most recent information on their patient.

Another advantage to the cloud is its flexibility. Making the switch is relatively simple, and storage space is practically unlimited. In addition, using the cloud is highly cost-effective. Most cloud service providers also provide IT support, which can save your dental practice a lot of money in the long run.

Many dentists new to the cloud worry about its reliability. With the cloud, the loss of data is nearly impossible. As far as security, the chance of someone accessing your data without permission or hacking into your cloud is low. Protection is offered through your cloud service provider, and it’s actually more secure than a traditional desktop program. You can be certain that only the people you want seeing your information will have access to it.

More than anything, the biggest reason for dentists to move to the cloud is simply because it’s the wave of the future. More and more health care organizations are implementing the cloud for their data storage, and nobody wants to be standing in the dust while their competition stays ahead of the times.

For more in-depth information on using the cloud for your dental practice, click here: Why You Need to Move Your Dental Practice to the Cloud.

For over 30 years, Havel’s has offered premium quality surgical scalpel blades, miniature blades and sutures to dentists, doctors, hospitals and other leading medical professionals. To learn more about Havel’s selection of surgical blades and sutures, please click here: Havel’s Surgical Scalpel Blades, Miniature Blades and Sutures.

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Fine Needle Aspiration and Mesothelioma: A Better Method for Diagnosis

Italian researchers conclude it as their “preferred technique”

Fine needle aspiration biopsy might be better for diagnosing mesothelioma

Researchers have found that a fine needle aspiration biopsy might be a better way to diagnose mesothelioma because it is less painful for patients.

A group of Italian researchers from the University of Catania say they have found a better way to make tissue sampling for mesothelioma easier and less painful on patients.

The technique, called a thoracic ultrasound-guided fine needle aspiration biopsy, relies on a specialized ultrasound technique designed specifically for chest imaging. Unlike a standard cutting-needle biopsy, a fine needle aspiration biopsy uses a finer needle to collect a small amount of tissue for examination. Researchers say that although samples collected from this technique are small, they are still suitable for evaluation, and the procedure itself is less traumatic for patients.

To learn more about the new research, click here: Fine Needle Biopsy: An Easier Way to Diagnose Mesothelioma?

Since 1981, Havel’s has offered premium quality radiology needles and biopsy needles for radiologists, surgeons, doctors, hospitals and other leading medical professionals. To see Havel’s selection of radiology and biopsy needles, please click here: Havel’s Radiology and Biopsy Needles.


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Spotlight: The Best Hospitals to Work For in Northeast America

Eight out of 10 of the best rely on Havel’s

Johns Hopkins Hospital is the best hospital to work for in northeast America

Johns Hopkins Hospital in Baltimore, Maryland leads the list of the top 10 best hospitals to work for in northeast America.

As healthcare continues to evolve, hospitals and medical centers across the country have evolved as well, adapting to the needs of 21st medical care. Recently, Healthcare Global released a top 10 list of the best hospitals to work for in northeast America. All of the hospitals represent facilities that are leading the way not only in employee satisfaction, but patient satisfaction too. They signify the best in strong credentials and a rich history of innovation, all while furthering the quality of healthcare in this country.

Topping the list was Johns Hopkins Hospital in Baltimore, Maryland, who also ranked number one on U.S. News & World Report’s list of the best hospitals in the country for 2013-14. Mount Sinai Hospital in New York City came in second, followed by Christiana Care Health System in Newark, Delaware, which currently performs in the top five percent nationwide. Rounding out the top five was Geisinger Medical Center in Danville, Pennsylvania and Lehigh Valley Hospital in Allentown, Pennsylvania at number four and five, respectively.

From the list, eight out of 10 rely on Havel’s medical products, which include our superior quality procedure needles and surgical scalpel blades. Havel’s is proud to serve some of the leading hospitals and medical centers not only in the northeast United States, but across the country as well.

To read the full list of hospitals, click here: Top 10: Best Hospitals to Work For in the Northeast United States.

Since 1981, Havel’s has offered premium quality ultrasound and procedure needles for anesthesia, pain control, radiology and biopsy, as well as sutures and surgical scalpel blades, for doctors, hospitals, veterinarians, dentists, dermatologists and other leading medical professionals. To see Havel’s selection of procedure needles, sutures and surgical scalpel blades, please click here: Havel’s Procedure Needles, Sutures and Surgical Scalpel Blades.


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