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    Wart cryotherapy

    Three years ago I reviewed the Cry-Ac Tracker liquid nitrogen spray system from Brymill Cryogenic Systems. The device uses an infrared sensor to record and display the temperature of the lesion being frozen, providing greater control of the freeze.

    This year, Brymill has introduced the Cry-Ac Tracker Cam that uses an integrated camera to help target the lesion, program the freeze temperature, and record the entire cryotherapy process. Indicators on the video display show the tissue temperature and change color when the targeted freeze temperature has been achieved.

    The device can be used to help train others to learn how to effectively treat warts and to show patients the progress made at subsequent visits when treatment requires multiple return visits, as it often does in the case of treating plantar warts. It produces a narrow, consistent spray and is very easy to use.

    I have also been treating more children with filiform warts, and I like the Brymill Cryo Tweezers to treat these. One simply fills a cup with liquid nitrogen, immerses the special broad-tipped tweezers for 30 seconds, and then grasps the wart with the tweezers, making sure that the wart freezes but not the surrounding tissue. Usually these warts can be eliminated with 1 treatment session, unless they are particularly large.

    Cerumen again, and the ShotBlocker is back

    Most pediatricians are familiar with Bionix, a company that has been around for as long as I can remember and sells a variety of products (curettes, lighted and unlighted; ear wash systems) that help us remove cerumen that obscures our view of the tympanic membrane, causes discomfort, or reduces a child's hearing acuity. This year several new Bionix products are worth consideration.

    First, for those pediatricians who suture, staple, or glue lacerations as part of their routine practice, the Igloo Wound Irrigation System is a sterile device that attaches to a sterile saline bottle and enables a small laceration to be irrigated while minimizing the mess. A length of tubing connects the irrigation saline to a pump handle attached to a clear plastic dome with exit holes. The dome is placed over the laceration and the pump handle squeezed to initiate irrigation. A box of 10 sets sells for $98 dollars.

    Several years ago, pediatricians began using a product from Bionix called the ShotBlocker, an oval plastic device with nubs on 1 side and a notch for injection.

    The ShotBlocker is firmly pressed against the skin at the injection site, and the injection is given in the notch between the device's wings. The nubs saturate sensory nerves in the skin and muscle tissue, thereby reducing or eliminating injection pain.

    Many pediatricians and office nurses found that the ShotBlocker worked as promised and became extremely fond of this simple device. Unfortunately, several years ago the US Food and Drug Administration (FDA) asked Bionix to perform clinical studies showing that the ShotBlocker was safe and effective, and the device was removed from the market. This year, FDA dropped this requirement, and the ShotBlocker is again available. A box of 50 ShotBlockers is only $35, and a box of 100 sells for $50.

    Last, most pediatricians remove impacted cerumen with curettes or by using an ear irrigation system. This year, Bionix has introduced a lighted magnification system that attaches to a low-pressure suction pump that facilitates cerumen removal using negative pressure.

    Because the pump is a low-pressure device, there is no danger of damaging the tympanic membrane or the ear canal. Additionally, a small suction cup attaches to the device, which can be used for extracting foreign bodies.

    The suction pump costs $250, and a box of 25 suction handles is $125. Replacement tubing for the pump is only $5 each. I've been using the system for several weeks and have been impressed by the ease of operation and how effective it is compared to curetting cerumen or using an irrigation system.

    Andrew J Schuman, MD, FAAP
    Dr Schuman, section editor for Peds v2.0, is clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth, ...


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