Appukuttan Aswin; Jagadeesh S
Context: Bipolar cautery forceps are an expensive instrument and especially in Government Medical colleges and Government Hospitals, getting a pair is a very tedious and prolonged task due to official reasons. Aims: To make a cheap and easily obtainable bipolar cautery forceps. Settings and Design: The reason for innovation was that the cautery forceps in the department were out of order and we were not getting replacements. Materials and Methods: Made from condemned and damaged forcep...
E. Liapakis, Ioannis; Englander, Miriam; Sinani, Roven; I. Paschalis, Eleftherios
BACKGROUND Facial telangiectasias are superficial cutaneous vessels that can result in noticeable aesthetical imperfections. This study presents a technique for the removal of facial telangiectasias using hand cautery. METHODS Twenty-five patients with facial telangiectasias were treated using hand cautery (Medicell Inc, Athens, Greece) during 2009-2013. Photo documentation was performed for each patient before and immediately after treatment. Treatment was performed by cauterization at 800°C...
Full Text Available Context: Bipolar cautery forceps are an expensive instrument and especially in Government Medical colleges and Government Hospitals, getting a pair is a very tedious and prolonged task due to official reasons. Aims: To make a cheap and easily obtainable bipolar cautery forceps. Settings and Design: The reason for innovation was that the cautery forceps in the department were out of order and we were not getting replacements. Materials and Methods: Made from condemned and damaged forceps or from stainless steel nonsurgical forceps which are very low-cost, very cheap and easy to get hold of, especially in a Government institution with limited resources. Results: It has been used for the past one and a half years in our Department for plastic surgical procedures, including microvascular surgery. Initially, it was designed when the cautery forceps in the department were out of order and we were not getting replacements and later on, it became part of the routine set as it was found to be equally good. Conclusions: A very cheap and useful alternative to the commercially available bipolar cautery forceps has been made.
Full Text Available Fistula in ano is common condition in perineal region. Anorectal fistulas are divided into four distinct types according to the Parks’ classification: intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric.1 The ultimate goal of fistula surgery is to eradicate it without disturbing or disturbing minimally the anal sphincter mechanism. The radiofrequency scalpel is an innovative instrument, which allows cutting and coagulating tissues in an atraumatic manner and which facilitates in accelerating and improving the surgical procedure conversely to the electric scalpel.2 This prospective study which will be conducted in a single centre and in this study we are comparing use of monopolar cautery and radiofrequency cautery units for the patients with fistula in ano operated during the period of February 2012 to February 2015. All fistulas will be treated by fistulectomy using coring technique. Results will be analyzed on following points like intraoperative bleeding, clearance of visual field, intra- and post-operative odema, and time required for every procedure, recurrence. AIMS AND OBJECTIVES OF STUDY 1. To compare intraoperative bleeding during surgery using both the units (cautery/RF cautery during surgery. 2. To assess clearance of field of vision intraoperatively. 3. To see for intraoperative and post-operative edema. 4. To assess time required for the procedure. 5. Final results in terms of recurrence. CONCLUSION Radiofrequency ablation is better method for fistulectomy compared to monopolar cautery in terms of intraoperative blood loss, post-operative pain, oedema, and healing period. But if procedure is better taken care of recurrence is avoidable. Operative time required for monopolar cautery exceeds radiofrequency cautery.
Full Text Available Hemostasis is a fundamental principle of surgery for which electrocoagulation is universally used. Bipolar electrocautery has an advantage over monopolar electrocautery in terms of the precision of the extent of tissue coagulation and the lateral extent of thermal tissue injury. However, secondary to the thermal changes induced in the tissue due to electric current passage, there is charring of tissue, which adheres to the cautery tip. This, not only decreases its effectiveness, but also, by getting avulsed while removing the cautery tip from the surgical field, causes rebleeding and more trauma to the tissue. Irrigation of the surgical field during application of cautery reduces the charring effect, thereby improving the efficiency and efficacy. Irrigation-coupled electrocautery devices are available but are costly to acquire and maintain. We describe a simple and reliable version of an irrigation-coupled cautery device, which is of immense functional utility in our experience. It decreases the amount of charring of the tissue and its adherence to the bipolar forceps tips, thereby decreasing the frustrating loss of effectiveness and also increases the life of the bipolar forceps as cleaning needs to be less frequent. By virtue of its simplicity and cost-effectiveness, it can be used in almost all hospitals and situations.
Full Text Available The identification of previously captured individuals is essential for a wide variety of ecological and behavioural studies. A lot of different methods are used for marking lizards, however they have many drawbacks. In presented study we used heat-branding method, using pen-like medical cautery units, previously employed to successfully mark other lizard species and snakes. The technique is permanent, readable and harmless for lizards, as well quick and easy. In 2009 we marked 111 individuals of sand lizard, Lacerta agilis. Next year we caught 88 lizards, 17 of them were re-captured. Among these re-captured lizards, five were caught after 26.8 (± 16.3 days (means in the same year and 12 after 308.8 (± 64.3 days (means in the next year. Recaptured individuals were still unambiguously recognisable.
In this paper, I focus on the historical analysis of the process of the introduction and acceptance of modem medical techniques in Japan from the standpoints of medical assessments by Japanese doctors at that time. The "écraseur" and "galvanic cautery" are surgical instruments which were introduced into Japan from Prussia in 1873-74. These two surgical instruments have almost the same utility, such as the removal of tumors, polypi, and other growths without the effusion of the blood. At the beginning of the Meiji era, many social facilities, for example, European style hospitals and medical schools, academic journals, industrial expositions and catalog sales of medical devices, were introduced in Japan. These social facilities were related to the transfer of the medical practices in which these surgical instruments were used. Although this transfer was achieved in a short time, it involved technology assessments by Japanese doctors from many practical standpoints, including economic viewpoints. In particular, the "galvanic cautery" served as a medical device that had significant mutual effects in the surrounding areas. PMID:20509528
Full Text Available ... we are looking at a monitor at the foot of the bed, and we are hand holding ... those are controlling the instrument tips, and the foot movements help control the cautery. The monopolar cautery ...
Full Text Available ... monopolar cautery in my right hand and the bipolar cautery forceps in the left hand. Now, you’ ... generated from both the monopolar scissors and the bipolar forceps. It’s not quite as grand as it ...
Full Text Available ... the instrument tips, and the foot movements help control the cautery. The monopolar cautery and cut. Focus ... you can see the four reels that basically control the movement of that tip. And, there are ...
Full Text Available ... see we've used the cautery to achieve access to the sternum. On the left hand side ... wound, which allows us to get more ready access to the aorta and the aortic valve. The ...
Full Text Available ... the blood supply to this ovary. And we use these scissors with cautery to open up the ... really have to find an excuse not to use laparoscopy or the robot. And I think you ...
Full Text Available ... to about here, and I am going to use the crease. In this area, I am going ... bleeding from the skin edges, which we will use an electric cautery to control the bleeding. So, ...
Full Text Available ... go down through the various levels. Sometimes we use the cautery to help with hemostasis so that ... sewing up the patient's uterus. So we'll use two layers of suture to sew up the ...
Full Text Available ... everything is magnified. But, each of those power sources do create a little bit of smoke. To ... not a flammable mix with the cautery power sources. Not good if you explode the patient on ...
Full Text Available ... cases, I think in large part because the nature of the cautery and the scissors. We're ... think that gives a more secure closure, better healing. I'll have you just hold that, please, ...
Full Text Available ... divide the tissues, the subcutaneous fat and connective issues above the sternum, or the breast bone. John, ... re just using the cautery to divide the issues down to the sternum, or the breast bone, ...
Full Text Available ... natural umbilical defect that everybody has. And we work a little bit here to do this because ... the cylinder such that the operating surgeon alone works there. Handheld cautery, please. Who's a good candidate ...
Full Text Available ... and then the scissors also have monopolar cautery capacity. So in each hand we have the ability ... the robot. But again, if she has bad pulmonary function or maybe horrendous surgical history with adhesions, ...
Full Text Available ... and then the scissors also have monopolar cautery capacity. So in each hand we have the ability ... major centers who have been doing a large volume of cases that they can get equivalent or ...
Full Text Available ... these spaces, which I'll describe as we work in them. Using bipolar cautery here, and then ... develop a program, we go to training, we work on models, we work on animate models, we ...
Full Text Available ... that simulating platform that makes the surgeon more confident and it's safer for the patient. But it's ... with the cautery, do you still feel pretty confident compared to putting suture to the vessels? Does ...
Full Text Available ... as scissors as well. They are actually more efficient scissors if we activate the monopolar cautery, but ... vessels, so on and so forth. It’s more efficient than cutting. You can cut just normal scissors, ...
Full Text Available ... we basically just go down through the various levels. Sometimes we use the cautery to help with ... help. The nurse practitioner has even a higher level of education and experience helping patients who need ...
Full Text Available ... as easy fatigueability, ankle swelling and a decreased energy level. Some more subtle symptoms can include decreased ... amount. As we continue to use the cautery machine, we will divide this pericardium and then use ...
Full Text Available ... to the other staff that's here today to help us. We have Dr. Dan Mitchell, who's the ... various levels. Sometimes we use the cautery to help with hemostasis so that there's minimal blood loss ...
Full Text Available ... ll describe as we work in them. Using bipolar cautery here, and then the scissors also have ... t. There are circumstances where if there's metastatic disease, meaning certainly beyond the uterus, and if it's ...
Full Text Available ... surgical tech is Tawna McLoughlin, who also is working as a bedside assistant this evening. And we ... these spaces, which I'll describe as we work in them. Using bipolar cautery here, and then ...
Full Text Available ... touch right there that I'm going to control with the cautery. But we're having minimal ... give a shot of vitamin K. That helps control bleeding. There's always a risk that babies who ...
Full Text Available ... remember, everything is magnified. But, each of those power sources do create a little bit of smoke. ... is not a flammable mix with the cautery power sources. Not good if you explode the patient ...
Full Text Available ... cetera. We start out, again, with that small skin incision and then we use a cautery device ... anesthetized and we're ready to start the skin incision, the entire time of the operation is ...
Full Text Available ... of it, which is characteristic of what we call the complex masses, again, a mixture of solid ... hand, although we make use of what I call focal point cautery - - we’re taking the peritoneum ...
Mohamed Hafez El Saied Hafez; Mona Hossam El Din Abd El Hamid; Sabah Abd El Raouf; Sherif Mohamed Soaida; Mohamed Mahmoud Marie
Background and aim: Transurethral resection of the prostate (TURP) is the standard procedure for treatment of benign prostatic hyperplasia which is the most common non-malignant disorder of the prostate, affecting over 50% of the elderly male population. This randomized study was done to compare the effect of bipolar cautery using saline with monopolar cautery using glycine regarding hemodynamic and biochemical changes in TURP. Methods: After approval from the ethical committee in Kasr Al ...
Vis, Esther; van den Berge, Herbert
We questioned how many patients with epistaxis can be treated by cautery without the use of nasal packing, as cautery is more effective and efficient. To investigate this, we performed a retrospective study of a cohort of 418 patients with epistaxis who presented to one ENT consultant at the ENT department of Medisch Centrum Leeuwarden (the Netherlands) between 1997 and 2007. Main outcomes were the treatment modality (cautery and/or nasal packing), recurrence of epistaxis and need for hospitalization. In 98% of all patients the bleeding site could be found and treated by cautery. The incidence of recurrent bleeding was 6%. Two percent of all patients had to be admitted to the hospital. This is considerably lower compared with recurrence rates and hospitalization after treatment by nasal packing known from the literature. Therefore we concluded that nearly all patients can be effectively treated by cautery with a low recurrence rate. In addition, this method of treatment is very cost effective. Because cautery requires skill and appropriate facilities, we recommend special attention for this in ENT training programs. PMID:22125793
Full Text Available ... cautery. If you’re expecting it to look black when you seal it, it won’t look black. It looks whitish, and you can see above ... t have clamps hanging off the uterus every time we use the LigaSure. We’re using it ...
Full Text Available ... so, one of my first objectives is to open this space, try to find out if that is a ... using. That’s monopolar cautery using there to help open that space. Now, that’s the round ligament that we are ...
Full Text Available ... device. This device is what we call a bipolar cautery unit, and as you can see, there’s -- ... clips on it. So this is called a “bipolar device.” Another device we have here, which is ...
Full Text Available ... appear magnified inside the patient and with the instrumentation, and that’s all pretty much eliminated with the ... oxygen, that’s potentially flammable, and we’re using instrumentation inside the patient with cautery, and so that ...
Full Text Available ... as the planes we're going through, this space of retzius. Here I can see with the structures of the medial and bocal ligament, the urethras ... cautery and the bleeding will stop. Again, the structures here, the 12 ... here we've completed the space of retzius, which means the space that's anterior ...
A double flange lumen apposing FC-SEMS used as a port for necrosectomy significantly improves management of walled-off pancreatic necrosis. Placement of this stents should be considered when multiple necrosectomy sessions are anticipated. Procedure time can be significantly decreased using a catheter that combines a cautery tip and stent delivery system.
Full Text Available ... do with these little blue, essentially tweezers, called “bipolars,” is to cauterize the tissue between the healthy ... of what we’re dissecting here with the bipolars, the little cautery equipment. The hope here is ...
Full Text Available ... home with your own germs taking care of things at home, and you're going to do a lot ... cautery. 00:15:30 CHRISTOPHER STANLEY, MD: One thing for the people at home, those instruments look rather large, but honestly they' ...
Pekin ducks are often bill-trimmed to prevent feather pecking and cannibalism, but this practice has been criticized because of the resulting potential for acute and chronic pain. The goal of this experiment was to compare two different bill-trimming methods, hot blade trimming with cautery (TRIM) a...
Warren, W H
This article discusses the diagnosis and interventional options apart from surgical resection for carcinoma of the esophagus. Other topics discussed are methods of inserting plastic and self-expanding metal stents in conjunction with their complications, and neodymium:yttrium-aluminum-garnet photodynamic therapy, cryoablation, and BICAP (bipolar cautery probe) options. Clinical scenarios illustrate the pros and cons of these approaches. PMID:10967761
Norn, Svend; Permin, Henrik; Kruse, Poul R; Kruse, Edith
. Paré abolished the painful practise of cautery to stop bleeding and used ligatures and dressings instead. A multitude of subjects were included in his writings such as military surgery, aneurysm, hernia, obstetrics and plague, and through his techniques he guided the development of the gentle art of...... surgery. Paré became the founder of modern surgery, a restorative process that heals the body with minimal suffering....
Amjad Alwaal; Azhar, Raed A.; Sero Andonian
Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution whi...
Retinal detachment surgery with silicone oil injection in transconjunctival sutureless 23-gauge vitrectomy Cirurgia de descolamento de retina com injeção de óleo de silicone no sistema de vitrectomia transconjuntival sem sutura de 23-gauge
Rubens Camargo Siqueira; Aline Degasperi Cote Gil; Rodrigo Jorge
PURPOSE: To report a surgical technique for retinal detachment surgery using transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection. METHODS: Thirty-one patients with retinal detachment underwent vitreoretinal surgery using a transconjunctival sutureless 23-gauge vitrectomy system. At the end of the procedure silicone oil was injected into all eyes through a microcannula. After removing the microcannula, a bipolar cautery was used in the conjunctiva over the wound to pre...
Roussel, Bertrand; Rapior, Sylvie; Charlot, Colette; Masson, Christian-Louis; Boutié, Paul
This paper presents the major therapeutic uses of Fomes fomentarius (L. : Fr.) Fr., tinder polypore. The context of this fungus is a wooly and soft material so called amadou (tinder). During the XVIII and XIXth centuries, the fungal material was used as haemostatic dressing and bandage to keep the temperature and compress parts of the body. It was also used as cautery for moxibustion and was reported in several traditional pharmacopoeias (Hungarian, Chinese, Indian). PMID:12712985
Sekins, K Michael; Barnes, Stephen R.; Fan, Liexiang; Hopple, Jerry D.; Hsu, Stephen J.; Kook, John; Lee, Chi-Yin; Maleke, Caroline; Ramachandran, A R; Zeng, Xiaozheng (Jenny); Moreau-Gobard, Romain; Ahiekpor-Dravi, Alexis; Funka-Lea, Gareth; Mitchell, Stuart B.; Dunmire, Barbrina
Background Bleeding from limb injuries is a leading cause of death on the battlefield, with deep wounds being least accessible. High-intensity focused ultrasound (HIFU) has been shown capable of coagulation of bleeding (cautery). This paper describes the development and refereed in vitro evaluation of an ultrasound (US) research prototype deep bleeder acoustic coagulation (DBAC) cuff system for evaluating the potential of DBAC in the battlefield. The device had to meet quantitative performanc...
Lesurtel, Mickael; Belghiti, Jacques
Liver transection is the most challenging part of liver resection due to the risk of massive blood loss which is associated with increased postoperative morbidity and mortality, as well as reduced long-term survival after resection of malignancies. Among the devices used for open parenchyma transection, ultrasonic dissection with bipolar cautery forceps is one of the most widely used technique worldwide. We identified four retrospective comparative studies and three randomized controlled tria...
The purpose of this paper is to consider the legality of decision for medical treatment expenses under Health Insurance Law. The following issues are discussed: The right to health and Connstitution of Japan; The right to health and Medical Social Security Law; History and concept of Health Insurance Law; Health Insurance Law and the right to self-determination and freedom of medical treatment selection; Care of acupuncture and moxa cautery and medical teratment expenses under Health Insuranc...
Gilmour, T K; Rytina, E; O'Connell, P B; Sterling, J C
A 55-year-old male cardiac transplant recipient presented with cutaneous nodules on the limbs caused by Alternaria alternata. Oral fluconazole 200 mg daily for 3 weeks was ineffective. Itraconazole 100 mg oral daily was ceased when hyperglycaemia developed. Individual lesions were successfully treated with either curettage and cautery or double freeze-thaw cryotherapy. Alternaria spp. are ubiquitous fungal saprophytes which may cause cutaneous infections particularly in immunocompromised patients. PMID:11233722
Ramsis F Ghaly
Full Text Available Background: Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs, there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery. Case Descriptions: A 60-year-old female with a permanent St. Jude′s spinal cord stimulator (SCS presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer′s representative was contacted preoperative. Both surgeries proceeded uneventfully. Conclusions: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe.
Ahmad Khosravi Khorashad
Full Text Available Colonic lipomas are benign adipose tumors that do not usually cause symptoms. Giant colonic lipoma (GCL is an uncommon finding at endoscopy which may lead to iron deficiency anemia (IDA with or without macroscopic ulceration. The choice of therapeutic procedure to treat symptomatic GCLs has been controversial. A case of GCL presented with occult bleeding and IDA is reported in this article. IDA resolved following the successful removal of the GCL by a combination of endoloop ligation and snare cautery technique.
Thomsen, Jørn Bo; Gunnarsson, Gudjon Leifur
The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally...... not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been...
Duffield, Todd F.; Heinrich, Anneliese; Millman, Suzanne T; DeHaan, Andrew; James, Shelley; Lissemore, Kerry
This study assessed the efficacy of ketoprofen for mitigating pain following dehorning with an electric cautery iron. Forty Holstein heifer calves, 4 to 8 wk of age, were randomized to receive a lidocaine cornual nerve block and either an injection of ketoprofen (3 mg/kg IM) or physiological saline, 10 min prior to dehorning. Cortisol was measured from serum obtained 10 min prior to dehorning and at 3 and 6 h post-dehorning. Calf behavior was video-recorded between 0 to 2, 3 to 5, and 6 to 8 ...
Mendenhall, William M; Henderson, Randal H; Costa, Joseph A; Hoppe, Bradford S; Dagan, Roi; Bryant, Curtis M; Nichols, Romaine C; Williams, Christopher R; Harris, Stephanie E; Mendenhall, Nancy P
The optimal management of persistent hemorrhagic radiation cystitis is ill-defined. Various options are available and include oral agents (ie, sodium pentosan polysulfate), intravenous drugs (ie, WF10), topical agents (ie, formalin), hyperbaric oxygen, and endoscopic procedures (ie, electrical cautery, argon plasma coagulation, laser coagulation). In general, it is best to manage patients conservatively and intervene only when necessary with the option least likely to exacerbate the cystitis. More aggressive measures should be employed only when more conservative approaches fail. Bladder biopsies should be avoided, unless findings suggest a bladder tumor, because they may precipitate a complication. PMID:24322335
Hong, J J; Park, W; Ehrenpreis, E D
Radiation proctopathy is a common unfortunate complication following radiation therapy of pelvic malignancies. Symptoms of chronic radiation proctopathy include haematochezia, urgency, constipation, tenesmus, diarrhoea and rectal pain. Currently, a wide variety of pharmacological options, endoscopic cautery techniques and surgical procedures have been proposed for the treatment of chronic radiation proctopathy. Although these have been proposed primarily as treatment for rectal bleeding, the control of other symptoms has been noted with some of these agents. Pharmacological options include 5-aminosalicylic acid preparations, coticosteroid enemas, sucralfate (oral, enemas), formalin, short chain fatty acid enemas, oestrogen/progesterone, hyperbaric oxygen, antioxidants, sodium pentosan polysulphate and misoprostol rectal suppositories. Of these, sucralfate and formalin therapy appear to be effective for bleeding control. Misoprostol rectal suppositories and oral sucralfate may be useful in the prevention of acute and chronic symptoms of radiation proctopathy. Endoscopic cautery techniques have included the use of Nd:YAG laser and argon laser for coagulation of bleeding neovascular telangiectasias. Argon plasma coagulation offers a safe non-contact method of delivering haemostasis which has proven to be particularly useful in targeting difficult to reach lesions tangentially. Surgery is generally reserved for severe refractory cases involving ongoing haemorrhage, obstruction, stricture formation, fistulas and perforation. Given that formal randomized placebo-controlled studies are lacking for most treatments, the management of these patients is often challenging and unclear. Hence, there is a need for more research and education on radiation proctopathy. PMID:11552895
Full Text Available Background: Present study was conducted with a background in mind to compare the efficacy of electrocautery and cryocautery for the management of cervical erosion. Aim of this study was to compare the efficacy of electrocautery and cryocautery for the treatment of cervical erosion and to check cost effectiveness. Methods: A comparative study was conducted at Maharishi Markandeshwar medical college and hospital, Kumarhatti (Solan between July'13 to June'14 among 100 patients of reproductive age group with cervical erosion. They were grouped into 2 groups A (Electrocautery and B (Cryocautery and data obtained was analysed by paired t-test. Results: Though in short- term follow-up at 4-6 weeks after cautery, apparently electrocautery was superior to cryocautery in terms of erosion healing rate 92% vs. 76% as P value (0.4557 is not statistically significant, but in long-term follow-up at 12-14 weeks there was no significant difference in erosion healing but electrocautery was cost effective. Conclusions: Both types of cautery were equally good for treatment of cervical erosion in long-term follow-up. But electrocautery occupies less space and there is no chance of gas leakage in electrocautery, so electrocautery is more cost effective. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 715-719
Lesurtel, Mickael; Belghiti, Jacques
Liver transection is the most challenging part of liver resection due to the risk of massive blood loss which is associated with increased postoperative morbidity and mortality, as well as reduced long-term survival after resection of malignancies. Among the devices used for open parenchyma transection, ultrasonic dissection with bipolar cautery forceps is one of the most widely used technique worldwide. We identified four retrospective comparative studies and three randomized controlled trials dealing with the efficacy of ultrasonic dissector (UD) compared with other techniques including the historical clamp crushing technique. UD is associated with similar blood loss and slower resection time compared with water-jet or clamp crushing technique. However, it seems to be more precise in dissecting vessels. Its use does not impact on morbidity and hospital stay compared with other techniques. From an economic point of view, UD is the most expensive technique and may be a disadvantage for low centre volume. UD with bipolar cautery is one of the safest and the most efficient device for liver transection, even if its superiority over the clamp crushing technique has not been well established. It is considered as a standard technique for liver transection. PMID:18773097
Ramos, Juan A; Brull, Sorin J
The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. After consultation with device manufacturers, the devices with patient programmability were switched off. Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components. PMID:26588030
Kobayashi, Michiya; Okamoto, Ken; Namikawa, Tsutomu; Okabayashi, Takehiro; Sakamoto, Junichi; Hanazaki, Kazuhiro
In this paper we report a technique for laparoscopic lymph node (LN) dissection for descending and proximal sigmoid colon cancer with the preservation of the superior rectal artery (SRA) to maintain the blood supply to the distal sigmoid colon. Five (5) cases were included from November 2004 to March 2005. For D3 LN dissection, the root of inferior mesenteric artery was exposed with ultrasonic cutting and coagulating surgical device to avoid bleeding. The arterial wall was then exposed with a spatula-type electric cautery down to the left colic artery (LCA). The LCA was then clipped and cut while preserving the SRA. The inferior mesenteric vein was divided at the caudal side of the LCA and prior to joining to the splenic vein. All cases underwent a LN dissection laparoscopically. There were no cases of complications originating from the LN dissection. Although long-term outcomes should be investigated, our results indicate that this is a safe, applicable method. PMID:17705727
Kim, Sang Gyun
Endoscopic resection of early gastric cancer is defined as incomplete when tumor cells are found at the resection margin upon histopathological examination. However, a tumor-positive resection margin does not always indicate residual tumor; it can also be caused by tissue contraction during fixation, by the cautery effect during endoscopic resection, or by incorrect histopathological mapping. Cases of highly suspicious residual tumor require additional endoscopic or surgical resection. For inoperable patients, argon plasma coagulation can be used as an alternative endoscopic treatment. Immediately after the incomplete resection or residual tumor has been confirmed by the pathologist, clinicians should also decide upon any additional treatment to be carried out during the follow-up period. PMID:27435699
Alwaal, Amjad; Azhar, Raed A; Andonian, Sero
Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously. PMID:22606636
Full Text Available Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously.
Tajiri, Ryosuke; Ueda, Taeko; Aoyama, Yoko; Sakuragi, Toshihide; Tohyama, Atsushi; Okabe, Keisuke; Nakagawa, Hitomi; Kinjo, Yasuyuki; Hachisuga, Toru
A 31-year-old nulligravid woman with a 3 year history of infertility visited our hospital. After consultation and a transvaginal ultrasound and MR imaging, her uterine anomaly was identified as complete septate uterus: class V (a) by the American Fertility Society (AFS). She had a doubled uterine cervix and a vaginal septum. Hysteroscopic metroplasty was performed with the aid of a laparoscopy. Both tubal patencies were confirmed with indigocarmine in a laparoscopic image. Laparoscopic electronic cautery was also done on the left ovarian endometrioma (stage 1 endometriosis; the revised American Society for Reproductive Medicine (rASRM) classification 4 point minimal). We distrained an intrauterine device in the uterine cavity and removed it after two cycles of menstruation. The patient subsequently became pregnant during her third menstrual cycle and the current progress of her pregnancy is favorable. PMID:25787098
Herskin, Mette S.; Di Giminiani, Pierpaolo; Thodberg, Karen
In many countries, piglets are tail docked to prevent tail biting. The aim of this study was 1) to evaluate the efficacy of a local anaesthetic and/or NSAID to reduce pain caused by tail docking; and 2) to examine interactions with docking length. This was examined in 295 piglets docked by hot iron...... cautery 2–4 days after birth and based on behaviour during docking as well as the following 5 h. The study involved three main factors: local anaesthetic (Lidocain), NSAID (Meloxicam) and docking length. Either 100%, 75%, 50% or 25% of the tails were left on the body of the piglets. Irrespective of the...... tail length, tail docking led to signs of procedural pain, which could be reduced by administration of Lidocain. Preemptive use of Meloxicam did not affect the signs of procedural pain. The results show that tail docking led to behavioural changes throughout the 5 h observation period indicating that...
Manohar S Gundeti
Full Text Available Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis-a-vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs, Agni (thermal cautery and Shastrakarma (surgery for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK, i.e. aqueous solution of Apamarga (Achyranthes aspera Kshara. We observed that all these warts took a minimum of 2-6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases.
Full Text Available Diverticular hemorrhage is the most common reason for lower gastrointestinal bleeding (LGIB with substantial cost of hospitalization and a median length of hospital stay of 3 days. Bleeding usually is self-limited in 70–80% of cases but early rebleeding is not an uncommon problem that can be reduced with proper endoscopic therapies. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed by interventional endotherapy including injection, heat cautery, clip placement, and ligation to achieve endoscopic hemostasis. This review will serve to highlight the various interventions available to endoscopists with specific emphasis on superior modalities in the endoscopic management of diverticular bleeding.
Full Text Available Dieulafoy’s lesions are a rare cause of gastrointestinal hemorrhage. Extragastric Dieulafoy’s lesions are even more uncommon. We report the case of a 75-year-old woman who presented with gastrointestinal bleeding from a transverse colonic Dieulafoy’s lesion. She presented with two episodes of melena followed by one episode of fresh blood per rectum. In addition, there was associated presyncope and anemia (hemoglobin 69 g/L in the setting of supratherapeutic warfarin anticoagulation (INR 6.2 for nonvalvular atrial fibrillation. Esophagogastroduodenoscopy was negative for an upper GI source of bleeding but on colonoscopy an actively oozing Dieulafoy’s lesion was identified in the transverse colon. Bipolar cautery and hemostatic endoclips were applied to achieve hemostasis. Clinicians should consider this rare entity as a potential cause of potentially life-threatening lower gastrointestinal bleeding and we review the endoscopic modalities effective for managing colonic Dieulafoy’s lesions.
Sever posterior epistaxis is one of the serious clinical problems. Nasal bleeding usually occurs in the anterior septal region, where it can be seen easily and controlled with topical cautery or localized packing. When the bleeding occurs in the posterior nose, it becomes a more serious problem. Many methods have been used to control posterior epistaxis. Some of these are electrocautery, posterior nasal packing, vascular ligation and therapeutic percutaneous embolization. Between 1997 and 2000, nineteen patients were admitted to our hospital because of intractable epistaxis. There were 16 male and 3 female patients whose average age was 55 years. Ten of 19 patients were hypertensive, and none of these had undergoing treatment. Five of 19 patients received maxillary artery ligation. Clinical applications of 3D imaging of the internal maxillary artery using helical CT scan were done for 5 patients. These images were helpful for planning of ligation of the internal maxillary artery. (author)
Full Text Available PURPOSE: To establish an experimental model of laparoscopic partial nephrectomy (LPN in rats and to analyze morphological alterations in the renal parenchyma utilizing an electric cautery and harmonic scalpel. METHODS: Forty Wistar rats were used, divided in 2 experiments with 20 rats each: experiment I, LPN was performed with an electric cautery and the rats were subdivided into groups A and B; experiment II, LPN was performed with a harmonic scalpel and they were subdivided into groups C and D. The animals in groups A and C were sacrificed shortly after surgery and the remnant kidney was removed to study the following variables: necroses and degeneration. In groups B and D a laparatomy was performed for retrieval of the remnant kidney on the 14th day after surgery to analyze fibrous scarring. RESULTS: For the variables necroses and fibrous scarring, the electric cautery creates, on average, greater width than that produced by the harmonic scalpel (p=0.0002 and p=0.0068 respectively. Regarding the variable of degeneration, we found no significant difference between the two types of scalpels (p=0.1267. CONCLUSIONS: LPN in rats is an adequate and feasible experimental model. The electric cautery caused greater damage to remnant renal tissue when compared to harmonic scalpel.OBJETIVO: Estabelecer um modelo experimental de nefrectomia parcial laparoscópica (NPL em ratos e analisar as alterações morfológicas no parênquima renal utilizando-se bisturi elétrico e harmônico. MÉTODOS: Foram utilizados 40 ratos Wistar, distribuídos em dois experimentos com 20 ratos cada: experimento I, NPL utilizando-se de bisturi elétrico e subdividindo-se os ratos em grupos A e B; experimento II, NPL realizada com bisturi harmônico e subdividindo-se os ratos em grupos C e D. Os animais dos grupos A e C foram sacrificados após a cirurgia para a remoção do rim operado e estudo das seguintes variáveis: necrose e degeneração. Nos grupos B e D a laparotomia
Griffin, Liezel L; Ali, Faisal Rehman; Lear, John T
Non-melanoma skin cancer (NMSC) comprises basal cell carcinoma (BCC) and squamous cell carcinoma, together with a host of rare tumours. NMSC is the commonest malignancy among Caucasians and its incidence continues to rise annually. Exposure to UV radiation initiates approximately 90% of NMSC, causing malignant transformation of keratinocytes and suppression of the inflammatory response. Risk factors include sun exposure and immunosuppression. There are several subtypes of BCC, although histological overlap is common. Surgery has traditionally been regarded as the 'gold-standard' treatment, offering excellent cure rates and cosmetic results. Other treatment modalities include physical destruction (radiotherapy, curettage and cautery, and cryotherapy), chemical destruction (photodynamic therapy and topical 5-flurouracil) and immunomodulatory therapy (topical imiquimod). The recent development of novel hedgehog pathway inhibitors for high-risk BCC (including oral vismodegib and sonidegib) may represent a paradigm shift towards medical management of NMSC. PMID:26833519
Sutherland, M A; Bryer, P J; Krebs, N; McGlone, J J
Tail docking of piglets is a routine procedure on farms to control tail-biting behaviour; however, docking can cause an acute stress response. The objectives of this research were to determine the stress responses to tail docking in piglets and to compare two methods of tail docking; cautery iron (CAUT) and the more commonly used blunt trauma cutters (BT). At approximately 6 days of age, piglets were tail docked using CAUT (n = 20), BT (n = 20) or sham tail docked with their tails remaining intact (CON; n = 40). Blood samples were taken prior to tail docking and at 30, 60 and 90 min after tail docking to evaluate the effect of tail docking on white blood cell (WBC) measures and cortisol concentrations. The above experiment was repeated to observe behaviour without the periodic blood sampling, so as not to confound the effects of blood sampling on piglet behaviour. Piglet behaviour was recorded in the farrowing crate using 1 min scan-samples via live observations for 60 min prior to and 90 min after tail docking. Total WBC counts were reduced (P > 0.05) among BT and CAUT compared with CON piglets 30 min after tail docking. Cortisol concentrations were higher (P tail docking. Cautery and BT-docked piglets spent more (P tail docking. Piglets tail docked using CAUT and BT tended to spend more (P tail docking. Elevated blood cortisol can be reduced by the use of the CAUT rather than the BT method of tail docking. Although the tail docking-induced rise in cortisol was prevented by using CAUT, the behavioural response to BT and CAUT docking methods was similar. PMID:22445023
Full Text Available Abstract Background The polyherbal eye drop (Itone™ is a mixture of aqueous distillates of nineteen traditionally used ingredients that sum up to impart potency to the formulation and make it a useful adjunct in various ocular pathologies. However, as there have been no controlled experimental studies accounting to the above claim, therefore, the present study was designed to evaluate the polyherbal formulation (PHF for antiangiogenic, anti-inflammatory, anticataract, antioxidant and cytotoxicity in addition to the evaluation of intraocular penetration of PHF in rabbit eyes using LC-MS/MS. Materials and methods Antiangiogenic activity of the PHF was evaluated using in ovo chick chorio-allantoic membrane (CAM assay and in vivo cautery induced corneal neovascularization assay in rats. Anticataract potential was evaluated using steroid induced cataract in developing chick embryos, sodium selenite induced cataract in rat pups and galactose induced cataract in rats. The antioxidant activity was evaluated using di-phenyl picryl hydrazyl (DPPH radical scavenging assay. Anti-inflammatory activity was evaluated in vitro using inhibition of LTB4 formation in human WBCs and in vivo using carrageenan induced paw edema assay in rats. The cytotoxicity was evaluated against HeLa cancer cell lines using (3-(4,5-Dimethylthiazol-2-yl-2,5-diphenyltetrazolium bromide (MTT assay. Furthermore evaluation of the intraocular penetration of the PHF was carried out in rabbit eyes via aqueous humor paracentesis and further analysis using LC-MS/MS. Results PHF significantly inhibited VEGF induced proliferation of new blood vessels in CAM assay and inhibited the cautery induced corneal neovascularization in rats. Additionally, PHF showed noticeable delay in the progression of cataract in the selenite and galactose induced cataract models whereby the PHF treated lenses were graded for stages II and III respectively. However, the PHF did not show any anticataract activity in
Full Text Available The report by Nuss et al., in 1998 of their 10-year experience with minimally invasive repair of pectus excavatum introduced the possibility of a less invasive approach for the correction of chest wall abnormalities. This procedure is now well-accepted around the world, although serious complications such as intraoperative cardiac perforation and postoperative bar displacement have been reported. The Nuss procedure has been performed concurrently with sternotomy for cardiac operations. However, there have been no reports of minimally invasive pectus excavatum correction in a child with a remote history of a median sternotomy. With IRB approval (Protocol #1308002283 we report the successful completion of a Nuss procedure in an adolescent with a history of a median sternotomy in infancy. During the procedure, thoracoscopy on the right side revealed significant adhesions of the lung and pericardium to the posterior sternum. Additional trocars were placed bilaterally to facilitate visualization and to allow for lysis of the adhesions with bipolar cautery. Passage of the bar was accomplished uneventfully and the patient has an excellent cosmetic outcome 28 months following the operation. We believe that a previous median sternotomy should not be viewed as a contraindication to the minimally invasive repair of pectus excavatum.
Full Text Available Background : Intraoperative somatosensory evoked potential (SSEP monitoring during cervical spine surgery is not a universally accepted standard of care. Our retrospective study evaluated the efficacy and cost-effectiveness of intraoperative SSEP in a single surgeon′s practice. Materials and Methods : Intraoperative SSEP monitoring was performed on 210 consecutive patients who had cervical spine surgery: anterior cervical approach 140 and posterior approach 70. They were screened for degradation or loss of SSEP data. A cost analysis included annual medical costs for health and human services, durable goods and expendable commodities. Results : Temporary loss of the electrical wave during cauterization resolved upon discontinuation of the cautery. We had no loss of cortical wave with preservation of the popliteal potential. A drop in the amplitude of the cortical wave was observed in three patients. This drop was resolved after hemodynamic stabilization in the first patient, readjusting the bone graft in the second patient, and interrupting the surgery in the third patient. The additional cost for SSEP monitoring was $835 per case and the total cost of the surgery was $13,835 per case. By spending $31,546 per year on SSEP, our institution is saving a total cost ranging from $64,074 to $102,192 per patient injured per year. Conclusion : Intraoperative SSEP monitoring is a reliable and cost-effective method for preventing postoperative neurological deficit by the early detection of vascular or mechanical compromise, and the immediate alteration of the anesthetic or surgical technique.
Richards, Lisa M.; Weber, Erica L.; Parthasarathy, Ashwin B.; Kappeler, Kaelyn L.; Fox, Douglas J.; Dunn, Andrew K.
Monitoring cerebral blood flow (CBF) during neurosurgery can provide important physiological information for a variety of surgical procedures. Although multiple intraoperative vascular monitoring technologies are currently available, a quantitative method that allows for continuous monitoring is still needed. Laser speckle contrast imaging (LSCI) is an optical imaging method with high spatial and temporal resolution that has been widely used to image CBF in animal models in vivo. In this pilot clinical study, we adapted a Zeiss OPMI Pentero neurosurgical microscope to obtain LSCI images by attaching a camera and a laser diode. This LSCI adapted instrument has been used to acquire full field flow images from 10 patients during tumor resection procedures. The patient's ECG was recorded during acquisition and image registration was performed in post-processing to account for pulsatile motion artifacts. Digital photographs confirmed alignment of vasculature and flow images in four cases, and a relative change in blood flow was observed in two patients after bipolar cautery. The LSCI adapted instrument has the capability to produce real-time, full field CBF image maps with excellent spatial resolution and minimal intervention to the surgical procedure. Results from this study demonstrate the feasibility of using LSCI to monitor blood flow during neurosurgery.
Parthasarathy, Ashwin B.; Weber, Erica L.; Richards, Lisa M.; Fox, Douglas J.; Dunn, Andrew K.
Monitoring cerebral blood flow (CBF) during neurosurgery can provide important physiological information for a variety of surgical procedures. CBF measurements are important for assessing whether blood flow has returned to presurgical baseline levels and for assessing postsurgical tissue viability. Existing techniques for intraoperative monitoring of CBF based on magnetic resonance imaging are expensive and often impractical, while techniques such as indocyanine green angiography cannot produce quantitative measures of blood flow. Laser speckle contrast imaging (LSCI) is an optical technique that has been widely used to quantitatively image relative CBF in animal models in vivo. In a pilot clinical study, we adapted an existing neurosurgical operating microscope to obtain LSCI images in humans in real time during neurosurgery under baseline conditions and after bipolar cautery. Simultaneously recorded ECG waveforms from the patient were used to develop a filter that helped reduce measurement variabilities due to motion artifacts. Results from this study demonstrate the feasibility of using LSCI to obtain blood flow images during neurosurgeries and its capability to produce full field CBF image maps with excellent spatial resolution in real-time with minimal disruption to the surgical procedure.
Herskin, M S; Thodberg, K; Jensen, H E
In pig production, piglets are tail docked at birth in order to prevent tail biting later in life. In order to examine the effects of tail docking and docking length on the formation of neuromas, we used 65 pigs and the following four treatments: intact tails (n=18); leaving 75% (n=17); leaving 50% (n=19); or leaving 25% (n=11) of the tail length on the pigs. The piglets were docked between day 2 and 4 after birth using a gas-heated apparatus, and were kept under conventional conditions until slaughter at 22 weeks of age, where tails were removed and examined macroscopically and histologically. The tail lengths and diameters differed at slaughter (lengths: 30.6±0.6; 24.9±0.4; 19.8±0.6; 8.7±0.6 cm; Ptail diameter: 0.5±0.03; 0.8±0.02; 1.0±0.03; 1.4±0.04 cm; Ptails with neuromas (64 v. 0%; Ptail (1.0±0.2 v. 0; Ptail docking piglets using hot-iron cautery causes formation of neuromas in the outermost part of the tail tip. The presence of neuromas might lead to altered nociceptive thresholds, which need to be confirmed in future studies. PMID:25482535
To evaluate the technical aspects, results and complications of the percutaneous radiologic placement of peritoneal dialysis catheters. Between December 1999 and April 2001, 26 peritoneal dialysis catheters were placed percutaneously in 26 consecutive patients by interventional radiologists. The patient group consisted of 16 men and ten women with a mean age of 55 (range, 30-77) years. The results and complications arising were reviewed, and the expected patency of the catheters was determined by means of Kaplan-Meier survival analysis. The technical success rate for catheter placement was 100% (26/26 patients). Severe local bleeding occurred in one patient due to by inferior epigastric artery puncture, and was treated by compression and electronic cautery. The duration of catheter implantation ranged from 1 to 510 days and the patency rate was 416±45 days. Catheter malfunction occurred in four patients. In two, this was restored by manipulation in the intervention room, and in one, through the use of urokinase. In three patients, peritonitis occurred. Catheters were removed from four patients due to malfunction (n=2), peritonitis (n=1), and death (n=1). Percutaneous radiologic placement of a peritoneal dialysis catheter is a relatively simple procedure that reduces the complication rate and improves catheter patency
Shimizu, H; Seki, S; Mizuguchi, A; Tsuchida, H; Watanabe, H; Namiki, A
The cardiac output monitoring by impedance cardiography, NCCOM3, was evaluated in adult patients (n = 12) who were subjected to coronary artery bypass grafting. Values of cardiac output measured by impedance cardiography were compared to those by the thermodilution method. Changes of base impedance level used as an index of thoracic fluid volume were also investigated before and after cardiopulmonary bypass (CPB). Correlation coefficient (r) of the values obtained by thermodilution with impedance cardiography was 0.79 and the mean difference was 1.29 +/- 16.9 (SD)% during induction of anesthesia. During the operation, r was 0.83 and the mean difference was -14.6 +/- 18.7%. The measurement by impedance cardiography could be carried out through the operation except when electro-cautery was used. Base impedance level before CPB was significantly lower as compared with that after CPB. There was a negative correlation between the base impedance level and central venous pressure (CVP). No patients showed any signs suggesting lung edema and all the values of CVP, pulmonary artery pressure and blood gas analysis were within normal ranges. From the result of this study, it was concluded that cardiac output monitoring by impedance cardiography was useful in cardiac surgery, but further detailed examinations will be necessary on the relationship between the numerical values of base impedance and the clinical state of the patients. PMID:2362347
Anuradha, S; Bharathi, K; Khalique, Abdul
Oculosporidiosis caused by Rhinosporidium seeberi is a common infectious disease of south India. Here we are reporting a rare case of oculosporidial polyp containing another parasite Enterobius vermicularis as a co infection. This is the first report of its kind in literature. A nine year old school going girl from a rural area presented with a reddish polypoidal lesion from conjunctiva along with complaints of severe itching over it. On examination, the polyp measured 5 mm × 5 mm in size, reddish, granular with a tendency to bleed on touch. Her vision was normal. All the basic investigations were within normal limits. A differential diagnosis of conjunctival papilloma, foreign body granuloma and oculosporidiosis were considered clinically. The polyp was removed completely using electro cautery with healthy margins around the lesion. To our surprise histopathological examination of the swelling revealed the presence of two different parasites in the conjunctival polyp. Sections showed sporangia of Rhinosporidium seeberi, fragments of Enterobius vermicularis and its eggs. She was then treated with anti helminthic drugs. Two months of follow up till now showed no recurrence of the lesion. PMID:25337525
Patil, Jawahar G; Purser, G J; Nicholson, A M
Use of 'Judas' fish to betray the locations of conspecifics is a powerful tool in management of invasive pest fish but poses a risk of contributing to recruitment. Our aim therefore was to generate surgically sterilised male common carp (Cyprinus carpio) and test whether they readily assimilate into wild populations, retain sexual behaviour and successfully betray the locations of feral carp. Male common carp were surgically sterilised (n=44) adopting a two-point nip technique, using either a haemoclip, suture or electro cautery to tie each of the testicular ducts about 2.5 cm cranial to urogenital sinus-retaining all of the glandular testis tissue. Observed survival (95%) and success (>70%) rates were relatively high. Plasma steroids (11-keto testosterone and 17β-estradiol) were quantified by immunoassay. A subset of sterile and control male fish (n=7 each) were implanted with radio-transmitters and released into Lake Sorell (50 km(2)) and their ability to betray the location of feral carp was assessed by radio tracking and targeted fishing. There was a statistically significant difference in 11-keto testosterone and 17β-estradiol levels over time (P0.05), implying that surgery did not compromise the animals physiologically. The sterile Judas fish integrated well into the population-behaving similarly to control Judas males and assisted in the capture of feral carp. The study marks a significant breakthrough in the management of this pest fish with potential adoption to the management of other pest fish globally. PMID:25776462
Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.
Full Text Available Objective: algae isolates obtained from fresh and marine resources could be one of the richest sources of novel bioactive secondary metabolites expected to have pharmaceutical significance for new drug development. This study was conducted to evaluate the antiangiogenic and antiproliferative activity of Chlorella pyrenoidosa in experimental models of angiogenesis and by MTT assay. Materials and Methods: lyophilized extract of C. pyrenoidosa was extracted using dichloromethane/methanol (2:1, concentrated and vacuum evaporated to obtain the dried extract. The crude extract was evaluated in the vascular endothelial growth factor (VEGF-induced angiogenesis in in ovo chick chorioallantoic membrane assay (CAM at various concentrations (n = 8 using thalidomide and normal saline as positive and untreated control groups, respectively. The crude extract was also subjected to the antiangiogenic activity in the silver nitrate/potassium nitrate cautery model of corneal neovascularization (CN in rats where topical bevacizumab was used as a positive control. The vasculature was photographed and blood vessel density was quantified using Aphelion imaging software. The extract was also evaluated for its anti proliferative activity by microculture tetrazolium test (MTT assay using HeLa cancer cell line (ATCC. Results: VEGF increased the blood vessel density by 220% as compared to normal and thalidomide treatment decreased it to 67.2% in in ovo assay. In the in-vivo CN model, the mean neovascular density in the control group, the C. pyrenoidosa extract and bevacizumab group were found to be 100%, 59.02%, and 32.20%, respectively. The Chlorella pyrenoidosa extract negatively affected the viability of HeLa cells. An IC 50 value of the extract was 570 μg/ml, respectively. Conclusion: a significant antiangiogenic activity was observed against VEGF-induced neovascularization and antiproliferative activity by MTT assay. In this study, it could be attributed that the
Full Text Available Abstract Background Monopolar cautery is the most commonly used surgical cutting and hemostatic tool for head and neck surgery. There are newer technologies that are being utilized with the goal of precise cutting, decreasing blood loss, reducing thermal damage, and allowing faster wound healing. Our study compares thermal damage caused by Harmonic scalpel and CO2 laser to cadaveric tongue. Methods Two fresh human cadaver heads were enrolled for the study. Oral tongue was exposed and incisions were made in the tongue akin to a tongue tumor resection using the harmonic scalpel and flexible C02 laser fiber at various settings recommended for surgery. The margins of resection were sampled, labeled, and sent for pathological analysis to assess depth of thermal damage calculated in millimeters. The pathologist was blinded to the surgical tool used. Control tongue tissue was also sent for comparison as a baseline for comparison. Results Three tongue samples were studied to assess depth of thermal damage by harmonic scalpel. The mean depth of thermal damage was 0.69 (range, 0.51 - 0.82. Five tongue samples were studied to assess depth of thermal damage by CO2 laser. The mean depth of thermal damage was 0.3 (range, 0.22 to 0.43. As expected, control samples showed 0 mm of thermal damage. There was a statistically significant difference between the depth of thermal injury to tongue resection margins by harmonic scalpel as compared to CO2 laser, (p = 0.003. Conclusion In a cadaveric model, flexible CO2 laser fiber causes less depth of thermal damage when compared with harmonic scalpel at settings utilized in our study. However, the relevance of this information in terms of wound healing, hemostasis, safety, cost-effectiveness, and surgical outcomes needs to be further studied in clinical settings.
Full Text Available Background: Cervical cancer is the second most common cancer among Iranian women and among the few cancers that could be easily diagnosed in the pre-malignant stage. We aimed to assess the status of cervical cancer screening in women referred to health care centres in Tabriz, northwest Iran. Materials and Methods: This descriptive-analytical study was done on 441 women referred to health care centres of Tabriz, northwest Iran. The centres were selected using the multi-stage cluster sampling method. The participants were selected from the active records of those centres. A questionnaire regarding the socio-demographic characteristics and cervical cancer screening and reasons for referring or not referring for screening was completed by the participants A P < 0.05 was considered as significant. Results: Out of the participants 49.4% of women had done the Pap smear test while 50.6% had never done this test. The main reason why women had not performed cervical cancer screening was being unaware of the importance of it (46.1%. Logistic regression analysis with adjustment showed a significant relationship between screening and awareness scores (OR = 1.17, CI = 95%:1.12-1.23, when the effect of other confounding factors [total awareness scores, risk factors (marriage or having sexual intercourse at a young age, history of obvious cervical infection, cautery, cryotherapy or repeated curettage, age and type of family planning] in screening was controlled. Conclusion: Suitable and continuous educational programmes especially for high risk women should be implemented through the health care services. Preparing educational brochures and pamphlets and providing adequate training on the necessity of early referral and marriage counseling could also be effective in improving woman′s awareness and performance.
Full Text Available The earliest documented history of cleft lip is based on a combination of religion, superstition, invention and charlatanism. While Greeks ignored their existence, Spartans and Romans would kill these children as they were considered to harbour evil spirits. When saner senses prevailed Fabricius ab Aquapendente (1537-1619 was the first to suggest the embryological basis of these clefts. The knowledge of cleft lip and the surgical correction received a big boost during the period between the Renaissance and the 19th century with the publication of Pierre Franco′s Petit Traite and Traite des Hernies in which he described the condition as "lievre fendu de nativite" (cleft lip present from birth. The first documented Cleft lip surgery is from China in 390 BC in an 18 year old would be soldier, Wey Young-Chi. Albucasis of Arabia and his fellow surgeons used the cautery instead of the scalpel and Yperman in 1854 recommended scarifying the margins with a scalpel before suturing them with a triangular needle dipped in wax. The repair was reinforced by passing a long needle through the two sides of the lip and fixing the shaft of the needle with a figure-of-eight thread over the lip. Germanicus Mirault can be credited to be the originator of the triangular flap which was later modified by C.W. Tennison in 1952 and Peter Randall in 1959. In the late 50s, Ralph Millard gave us his legendary ′cut as you go′ technique. The protruding premaxilla of a bilateral cleft lip too has seen many changes throughout the ages - from being discarded totally to being pushed back by wedge resection of vomer to finally being left to the orthodontists.
AIM: To identify the risk factors for, and to report the microbiological findings and clinical outcomes of, severe microbial keratitis (MK). METHODS: This was a retrospective study of all cases of presumed MK admitted to a tertiary referral center over a 2-year period (September 2001 to August 2003). Data recorded included demographic data, details relating to possible risk factors, results of microbiological studies, clinical findings at presentation, and clinical and visual outcomes. RESULTS: Ninety patients were admitted with a diagnosis of presumed MK during the study period. The mean age of patients was 45 +\\/- 32 years, and the male to female ratio was 47:43 (52.2%:47.7%). Predisposing risk factors for MK included contact lens wear (37; 41.1%), anterior segment disease (19; 21.1%), ocular trauma (13; 14.4%), systemic disease (5; 5.6%), and previous ocular surgery (1; 1.1%). Cultured organisms included gram-negative bacteria (17; 51.5%), gram-positive bacteria (11, 33.3%), acanthamoeba (2; 6.1%), and fungi (1; 3%). Visual acuity improved significantly after treatment [mean best-corrected visual acuity (+\\/-standard deviation) at presentation: 0.76 (+\\/-0.11); mean best-corrected visual acuity at last follow-up: 0.24 (+\\/-0.07); P < 0.001]. Secondary surgical procedures were required in 18 (20%) cases, and these included punctal cautery (1; 1.1%), tissue glue repair of corneal perforation (2; 2.2%), tarsorrhaphy (9; 9.9%), Botulinum toxin-induced ptosis (1; 1.1%), penetrating keratoplasty (3; 3.3%), and evisceration (2; 2.2%). CONCLUSIONS: Contact lens wear remains a significant risk factor for severe MK. MK remains a threat to vision and to the eye, but the majority of cases respond to prompt and appropriate antimicrobial therapy.
Ross, Dara S; Liu, Yi-Fang; Pipa, Jennifer; Shin, Sandra J
Pathologists are expected to accurately diagnose increasingly smaller breast carcinomas. Correct classification (ie, lobular vs ductal or in situ vs invasive) directly affects subsequent management, especially when the focus is near a surgical margin or present in a needle core biopsy and is further challenging if the lesion is morphologically ambiguous. We assessed the diagnostic utility of a multiplex, trichromogen immunostain of 3 commonly employed antibodies (CK7, p63, and E-cadherin) developed in our laboratory to evaluate these small lesions. Of the 147 specimens containing minimal (defined as ≤3 mm in size) invasive carcinoma, 81 also contained in situ carcinoma. In each case, the Minimal Carcinoma Triple Stain was prepared with a parallel H&E-stained slide. Observations of staining characteristics in the focus of interest were recorded. The Minimal Carcinoma Triple Stain was diagnostically useful in all but 1 case. In a case of invasive lobular carcinoma in an excisional biopsy, the Minimal Carcinoma Triple Stain stained only the surrounding breast tissue (appropriately) and not the focus of interest. Also, a subset of 29 of 81 excisional biopsies had minimal invasive carcinoma located 2 mm or less from the inked surgical margin, in which in all cases the Minimal Carcinoma Triple Stain was fully interpretable despite morphologic distortion due to concomitant cautery artifact and tissue disruption in some cases. The Minimal Carcinoma Triple Stain offers an accurate and tissue-conserving method to diagnose small, morphologically problematic foci of breast carcinoma while ideally leaving more tissue for additional adjunctive studies. PMID:23270900
N P Trivedi
Full Text Available Background: Multimodality treatment of head and neck cancer in rural India is not always feasible due to lack of infrastructure and logistics. Aim: To demonstrate the feasibility of multimodality treatment for head and neck cancer in a community setting in rural India. Setting and Design: Community cancer center, retrospective review. Materials and Methods: This article focuses on practice environment in a cancer clinic in rural India. We evaluated patient profile, treatment protocols, infrastructure availability, factors impacting treatment decisions, cost estimations, completion of treatment, and major treatment-related complications for the patient population treated in our clinic for a 2-year period. Results: A total of 230 head and neck cancer patients were treated with curative intent. Infrastructure support included basic operating room facility (cautery machine, suction, drill system, microscope, and anesthesia machine without ventilator support, blood bank, histopathology laboratory, and computerized tomography machine. Radiation therapy (RT facility was available in a nearby city, about 75 km away. One hundred and fifty-four (67% patients presented at an advanced stage, with 138 (60% receiving multimodality treatment. One hundred and eighty-four (80% patients underwent primary surgery and 167 (73% received radiotherapy. Two hundred and twelve (92% patients completed the treatment, 60 (26% were lost to follow-up at 18-month median follow-up (range 12-26 months, with 112 patients (66% being alive, disease free. Totally 142 were major head neck surgeries with 25 free flap reconstructions and 41 regional flaps. There were 15 (6% major post-op complications and two perioperative mortalities. Average cost of treatment for single modality treatment was approximately 40,000 INR and for multimodality treatment was 80,000 INR. Conclusions: This study demonstrates that it is feasible to provide basic multimodality treatment to head and neck
Hesham A. Abdesallam, Ali K. Mahrous, & Abdelsalam H. Hashim
Full Text Available Introduction: Epistaxis is common and has been reported to occur in up to 60 percent of the general population. The affected person usually does not seek medical attention, particularly if the bleeding is minor or self-limited. In rare cases, however, massive nasal bleeding can lead to death. The nose has an abundant blood supply. The arterial supply to the nose comes from carotid arteries. Nasal bleeding usually responds to first-aid measures. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated appropriately. There is no unanimity amongst Otorhinolaryngologists in terms of the sequence of different treatment methods in Epistaxis patients. We aimed in this study to examine our existing practice in terms of management of epistaxis, and to try to come up with suggestions of sequential treatment steps. This is a retrospective study conducted from November 2004 to January 2005 in the Otolaryngology Department in Midway Maritime Hospital. Subjects and Methods: The study group consisted of 100 case notes requested. The demographic data of the patients were collected and the history of epistaxis in each patient. Results: The study showed the peak of incidence of epistaxis (66% was in adults (51 91 years old. No sex predilection. It was mostly spontaneous. 60% of the patients presented for the first time. 63% of the patients have co-morbid conditions. 60% of the patients needed hospital admission. The patients were treated with different measures. Conclusion: We concluded that the cases of epistaxis caused by trauma in our series is far less than expected. Co-morbidity plays a major role in the causation of epistaxis according to this study. We recommend the use of chemical cautery, merocele or both as the first line of local treatment of epistaxis. If it does not work, Rapid Rhino with or without anterior packing should be considered. If this does not work, then sphenopalatine artery ligation
Full Text Available Cauterisation of 144 ear perforations ( R ight and L eft with 20 percent TCA ( T richloracetic acid was tried in patients having 2 to 6mm perforations . Per forations were dry for 3 weeks - 3 months or more. 30 patients were having traumatic perforations such as slap on face, blast injuries or associated with head injuries. Most of the patients were having perforations due to inflammation. Few of them had recent attack of otitis media which were effectively treated by suitable antibiotics, anti - histamines and subs equently taken for cauterization of perforation. Site of perforation was mostly on the anteroinferior quadrant, next the inferior quadrants. Still less number in the entire four quadrant, least no. in P. S. quadrant. Traumatic perforations were irr egular i n shape varying from 2 - 6 mm in size and were elliptical in shape. Hearing loss ranged from 15dB - 45dB ( D epending upon size and site of perforation. Main presenting symptoms in inflammation cases were intermittent discharge as well as deafness. In traumatic case history of pain and deafness was the main symptom. We did wait for 1 month in traumatic cases to achieve spontaneous closure. In inflammatory cases cautery was considered first line of treatment. It has to be done several times at 10 days interval. Mo st of the times closure of perforation was achieved with 3 attempts, inflammatory cases 5 th or 6 th attempt. In one case as many as 23 attempts. In 6 cases of perforation after partial take of graft in myringoplasty occurred after 3 months cauterization was attempted and we got closure in 5 of them. In one case re myringoplasty had to be done.
Ryan, Thomas P.; Stalder, Kenneth R.; Woloszko, Jean
Plasma Medicine is a growing field that is having an impact in several important areas in therapeutic patient care, combining plasma physics, biology, and clinical medicine. Historically, plasmas in medicine were used in electrosurgery for cautery and non-contact hemostasis. Presently, non-thermal plasmas have attained widespread use in medicine due to their effectiveness and compatibility with biological systems. The paper will give a general overview of how low temperature, non-equilibrium, gas plasmas operate, both from physics and biology perspectives. Plasma is commonly described as the fourth state of matter and is typically comprised of charged species, active molecules and atoms, as well as a source of UV and photons. The most active areas of plasma technology applications are in wound treatment; tissue regeneration; inactivation of pathogens, including biofilms; treating skin diseases; and sterilization. There are several means of generating plasmas for use in medical applications, including plasma jets, dielectric barrier discharges, capacitively or inductively coupled discharges, or microplasmas. These systems overcome the former constraints of high vacuum, high power requirements and bulky systems, into systems that use room air and other gases and liquids at low temperature, low power, and hand-held operation at atmospheric pressure. Systems will be discussed using a variety of energy sources: pulsed DC, AC, microwave and radiofrequency, as well as the range of frequency, pulse duration, and gas combinations in an air environment. The ionic clouds and reactive species will be covered in terms of effects on biological systems. Lastly, several commercial products will be overviewed in light of the technology utilized, health care problems being solved, and clinical trial results.
Objective was to evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital. The data of 461 patients who underwent interval tubal ligation ITL at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or had a complication and/or an unplanned laparotomy were analyzed. The mean age of patients was 35.1 range: 21-51, gravidity was 4.6 range: 2-9, parity was 3.2 range: 2-7 and number of living children was 3.1 range 2-6. Out of 461 patients, only 20.4% had complications related with general anesthesia. Two cases 0.4% had bleeding from the port-site, 3 cases 0.6% had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding 0.2% from vagina wall. There was only one 0.2% intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1% and all the complications were encountered in patients who had laparoscopic surgery. Outpatient tubal ligation is a convenient and safe procedure and implementing endoscopic surgical techniques is necessary for correction of the complications. (author)
Pankaj Gupta; Muthuvel Arumugam; Raj Vardhan Azad; Rohit Saxena; Supriyo Ghose; Nihar Ranjan Biswas; Thirumurthy Velpandian
Objective: To evaluate the antiangiogenic potential of twenty two marine invertebrate species of Phylum Mollusca from south east coast of India.Methods:Live specimens of molluscan species were collected and their methanolic extracts were evaluated for preliminary antiangiogenic activity using the in ovo chick chorio-allantoic membrane assay. The extracts were further evaluated for in vivo antiangiogenic activity using chemical cautery induced corneal neovascularization assay in rats and oxygen induced retinopathy assay in rat pups.Results:In the chick chorio-allantoic membrane assay, four methanolic extracts of marine molluscan species viz. Meretrix meretrix, Meretrix casta, Telescopium telescopium and Bursacrumena methanolic extracts exhibited noticeable antiangiogenic activity at the tested concentration of 200 µg whereby they significantly inhibited the VEGF induced proliferation of new blood vessels. Among these four extracts, the methanolic extract of Meretrix casta exhibited relatively higher degree of antiangiogenic activity with an inhibitiory percentage (64.63%) of the VEGF induced neovascularization followed by the methanolic extracts of Telescopium telescopium (62.02%), Bursa crumena (60.48%) and Meretrix meretrix (47.01%). These four methanolic extracts were further evaluated for in vivo antiangiogenic activity whereby the methanolic extract of Telescopium telescopium exhibited most noticeable inhibition (42.58%) of the corneal neovascularization in rats in comparison to the sham treated group, and also exhibited most noticeable inhibition (31.31%) of the oxygen induced retinal neovascularization in rat pups in comparison to the hyperoxia group that was observed for considerable retinal neovascularization.Conclusions:The significant antiangiogenic activity evinced by the extract of Telescopium telescopium merits further investigation for ocular neovascular diseases.
Daphnée Beaulieu; Alan Barkun; Myriam Martel
AIM:To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable.METHtODS:Consecutive colonoscopy reports of patients at average/high risk screening,or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly,using a commercial computerized endoscopic report generator.A separate institutional database providing pathological results.Required documentation included patient demographics,history,procedure indications,technical descriptions,colonoscopy findings,interventions,unplanned events,follow-up plans,and pathology results.Reports abstraction employed a standardized glossary with 10％ independent data validation.Sample size calculations determined the number of reports needed.RESULTS:Two hundreds and fifty patients (63.2 ±10.5 years,female:42.8％,average risk:38.5％,personal/family history of CRN:43.3％/20.2％) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice:17.1 ± 8.5 years).Procedural indication and informed consent were always documented.14％ provided a previous colonoscopy date (past polypremoval information in 25％,but insufficient in most to determine surveillance intervals appropriateness).Most procedural indicators were recorded (exam date:98.4％,medications:99.2％,difficulty level:98.8％,prep quality:99.6％).All reports noted extent of visualization (cecum:94.4％,with landmarks noted in 78.8％-photodocumentation:67.2％).No procedural times were recorded.One hundred and eleven had polyps (44.4％) with anatomic location noted in 99.1％,size in 65.8％,morphology in 62.2％; removal was by cold biopsy in 25.2％ (cold snare:18％,snare cautery:31.5％,unrecorded:20.7％),84.7％ were retrieved.Adenomas were noted in 24.8％(advanced adenomas:7.6％,cancer:0.4％) in this population with varying previous colonic investigations.CONCLUSION:This audit reveals lacking reported items
Full Text Available The abdominoperineal resection is a procedure that combine a low anterior resection and the complete perineal excision of the anus and rectum. The paper discuss the surgical anatomy of the rectum, the history, the indications and complications of the procedure. It is also described the technique of the abdominoperineal resection: the abdominal approach is through a lower midline incision, and then, the small bowell is packed into the upper side of the abdomen. The sigmoid colon is mobilized by the incising the posterior and lateral peritoneum. The peritoneal dissection is continued distally parallel to the rectum. The inferior mesenteric artery is identified and ligated just distal to the take off of the left colic artery or higher. The next step is the total mesorectal excision, performed by entering in the retrorectal space, in the avascular space of areolar tissue, above the promontory of the sacrum and anteriorly the presacral nerves. This plane should be continued by sharp disection laterally and caudally till the pelvic floor. Anterior dissection of the rectum is achived by incision the recto-vesical reflection and dissection of the Denonvilliers fascia (in men and in women the mobilization of the rectum is finished by the incision and the dissection of the recto-vaginal reflection. The colon can be now divided proximally. The next step is the perineal resection: an eliptical incision is made to encompass the anus with an adequate margin of tissue. The skin edges are then grasped and the subcutaneous tissue is divided with cautery; the dissection is continued into the fat of the ischio-anal fossa and the inferior rectal vessels are divided. The levator ani is than divided. After the complete posterior dissection of the rectum, the specimen may be delivered into the perineal wound and then, the anteriorly final dissection can be achived. In men the dissection plane is between the rectum and the prostate / urethra, and in women between the
Hanak, Brian W; Ross, Emily F; Harris, Carolyn A; Browd, Samuel R; Shain, William
OBJECTIVE Shunt obstruction by cells and/or tissue is the most common cause of shunt failure. Ventricular catheter obstruction alone accounts for more than 50% of shunt failures in pediatric patients. The authors sought to systematically collect explanted ventricular catheters from the Seattle Children's Hospital with a focus on elucidating the cellular mechanisms underlying obstruction. METHODS In the operating room, explanted hardware was placed in 4% paraformaldehyde. Weekly, samples were transferred to buffer solution and stored at 4°C. After consent was obtained for their use, catheters were labeled using cell-specific markers for astrocytes (glial fibrillary acidic protein), microglia (ionized calcium-binding adapter molecule 1), and choroid plexus (transthyretin) in conjunction with a nuclear stain (Hoechst). Catheters were mounted in custom polycarbonate imaging chambers. Three-dimensional, multispectral, spinning-disk confocal microscopy was used to image catheter cerebrospinal fluid-intake holes (10× objective, 499.2-μm-thick z-stack, 2.4-μm step size, Olympus IX81 inverted microscope with motorized stage and charge-coupled device camera). Values are reported as the mean ± standard error of the mean and were compared using a 2-tailed Mann-Whitney U-test. Significance was defined at p < 0.05. RESULTS Thirty-six ventricular catheters have been imaged to date, resulting in the following observations: 1) Astrocytes and microglia are the dominant cell types bound directly to catheter surfaces; 2) cellular binding to catheters is ubiquitous even if no grossly visible tissue is apparent; and 3) immunohistochemical techniques are of limited utility when a catheter has been exposed to Bugbee wire electrocautery. Statistical analysis of 24 catheters was performed, after excluding 7 catheters exposed to Bugbee wire cautery, 3 that were poorly fixed, and 2 that demonstrated pronounced autofluorescence. This analysis revealed that catheters with a microglia
Purpose: Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5½ weeks. Methods and Materials: Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. Results: The median follow-up time was 25.4 months (range, 4.2–57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose–volume descriptors correlated with GU toxicity, and only the volume of bowel receiving ≥30 Gy correlated with early GI toxicity (p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 ± 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. Conclusions: Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose escalation may be an
Full Text Available Abstract Background Bleeding severity, anatomic location, tissue characteristics, and visibility are common challenges encountered while managing intraoperative bleeding, and conventional hemostatic measures (suture, ligature, and cautery may sometimes be ineffective or impractical. While topical absorbable hemostats (TAH are useful hemostatic adjuvants, each TAH has associated disadvantages. Methods We evaluated the safety and hemostatic efficacy of a new advanced biologic combination product―fibrin pad―to potentially address some gaps associated with TAHs. Fibrin pad was assessed as adjunctive hemostat in open partial nephrectomy in single-center, open-label, Phase I study (N = 10, and as primary hemostat in multicenter, single-blind, randomized, standard-of-care (SOC-controlled Phase I/II study (N = 7 in Israel. It was used to control mild-to-moderate bleeding in Phase I and also spurting arterial bleeding in Phase I/II study. Phase I study assessed safety and Phase I/II study, proportion of successes at 10 min following randomization, analyzed by Fisher exact tests at 5% significance level. Results Phase I (N = 10: All patients completed the study. Hemostasis was achieved within 3–4 min (average = 3.1 min of a single application in all patients. Fibrin pad was found to be safe for human use, with no product-related adverse events reported. Phase I/II (N = 7: Hemostatic success at 10 min (primary endpoint was achieved in 3/4 patients treated with fibrin pad versus 0/3 patients treated with SOC. No clinically significant change in laboratory or coagulation parameters was recorded, except a case of post-procedural hemorrhage with fibrin pad, which was considered serious and related to the fibrin pad treatment, and required re-operation. Although Data Safety Monitoring Board authorized trial continuation, the sponsor decided against proceeding toward an indication for primary treatment of severe arterial
Lippert, Burkard M.; Folz, Benedikt J.; Werner, Jochen A.
The laser surgical treatment of carcinomas of the upper aerodigestive tract has become an established treatment modality at many otolaryngology departments throughout the laser years. The oncologic results that can be achieved with this surgical technique are quite as good as the results that can be achieved by conventional surgery, the functional results on the other hand often seem to be superior to conventional surgery. The Nd:YAG laser has so far rarely been used as a cutting device in the head and neck region. The fibertom mode is a new technique, which has been developed to make the employment of the Nd:YAG laser as a laser scalpel feasible. Between December 1995 and May 1997 thirty-five patients with squamous cell carinomas of the oral cavity were treated at the Department of Otolaryngology, Head and Neck Surgery of the University of Kiel with the Nd:YAG laser in fibertom mode (30 - 50 Watt, cw-mode, 600 m bare fiber). The operative approach, intra- and postoperative complications, duration of the operation and of the healing process, as well as functional and oncologic results were documented and compared to the retrospectively raised data of a group of patients (n equals 25), that was treated by CO2 laser surgery. When working with the Nd:YAG laser in fibertom mode fewer hemorrhages during the actual dissection could be observed as opposed to dissection with the CO2 laser. By laser dissection with the Nd:YAG laser in fibertom mode the operation had to be interrupted to a much lesser extent for bipolar cautery, thus resulting in a reduced operation time. Until a complete reepithelialization of the laser wound was achieved an interval of 3 - 4 weeks went by. Following Nd:YAG laser excision the healing process was 7 - 10 days delayed when compared to CO2 laser surgery. The functional and oncologic results were quite satisfactory in both groups and no major difference between the two laser systems could be observed. The fibertom mode renders the use of the Nd
[Peculiar history to formation of 'Freely recuperate zone' in the National Sanatorium Kuryu Rakusen-en, Gunma, Japan (relation between the 'Old Yunosawa-ward' and 'Freely recuperate zone' in the National Sanatorium Kuryu Rakusen-en)].
Hansen's disease sufferers had been visiting the hot spring, Kusatsu-Spa, in Gunma, Japan, for Toji (which means 'hot springs treatment' in Japanese) since the middle ages, as it was known reportedly for a long time to be effective in curing the disease. In 1869, Kusatsu-Spa was hit by a massive fire. The innkeepers, who suffered devastating damages, were trying to reconstruct the economy quickly by promoting the medical benefits of the hot spring. This made many Hansen's disease patients to visit and of which many stayed on a long term bases. They would use the hot spring with ordinary visitors. And, they had received the treatment of the spotted moxa cautery with the hot-spring treatment. Later on, Kusatsu- Spa became well known throughout Japan and as the numbers of ordinary visitors increased, they voiced their concerns in sharing the hot spring with the Hansen's disease patients. Therefore, the innkeepers decided to move the patients to another district called Yunosawa and suggested to make a special village of just the patients. In 1887, the representative of the patients came to an agreement with the mayor of Yunosawa to establish a treatment centre there. Yunosawa became part of an administrative area of Kusatsu Town. The area seemed to become a local-governing area mainly shaped by Hansen's disease sufferers and the first legal residential area where Hansen's disease sufferers were given citizenships and may convalesce freely. However, in 1931, leprosy prevention law was passed, and the Japanese government built a new medical treatment centre of Hansen's disease, 4km away from Kusatsu- Spa, which is called National Sanatorium Kuryu Rakusen-en. After deliberations with the representative of the Hansen's disease patients living in the Yunosawa area and the governor of Gunma Prefecture, who received the order from the Japanese government to move them, had agreed to the mass relocation in 1941. This is how Yunosawa had closed its 55 years history and many
Retinal detachment surgery with silicone oil injection in transconjunctival sutureless 23-gauge vitrectomy Cirurgia de descolamento de retina com injeção de óleo de silicone no sistema de vitrectomia transconjuntival sem sutura de 23-gauge
Rubens Camargo Siqueira
Full Text Available PURPOSE: To report a surgical technique for retinal detachment surgery using transconjunctival sutureless 23-gauge vitrectomy with silicone oil injection. METHODS: Thirty-one patients with retinal detachment underwent vitreoretinal surgery using a transconjunctival sutureless 23-gauge vitrectomy system. At the end of the procedure silicone oil was injected into all eyes through a microcannula. After removing the microcannula, a bipolar cautery was used in the conjunctiva over the wound to prevent silicone oil reflux. RESULTS: In all patients retinal reattachment and injection of silicone oil through transconjunctival sutureless 23-gauge vitrectomy system was possible. Retinal re-detachment occurred in 8 patients (25.80% who were submitted to a new vitreoretinal surgery by the technique described above, however, more extensive retinotomy was necessary in all cases, specially inferiorly. Three patients (9.67% presented silicone oil leakage in subconjuntival compartment. Another surgical procedure was necessary to remove the subconjuntival silicone oil. CONCLUSIONS: The retinal detachment surgery with silicone oil injection in transconjunctival sutureless 23-gauge vitrectomy is a safe and efficient technique to repair retinal detachment and it has the advantage of being minimally invasive.OBJETIVOS: Relatar técnica cirúrgica para descolamento de retina utilizando sistema de 23-gauge com injeção de óleo de silicone. MÉTODOS: Trinta e um pacientes com descolamento da retina foram submetidos a cirurgia vitreorretiniana usando o sistema 23-gauge de vitrectomia transconjuntival sem sutura. Ao final do procedimento o óleo de silicone foi injetado em todos os olhos através de uma microcânula. Após a retirada da microcânula, foi utilizado cautério bipolar na incisão conjuntival para prevenir o vazamento do óleo de silicone. RESULTADOS: Em todos os pacientes foi possível reaplicar a retina e injetar o óleo de silicone através do sistema 23
Rafael A. Maioli
Full Text Available ABSTRACT Objective: The purpose of this video is to present the laparoscopic repair of a VUF in a 42-year-old woman, with gross hematuria, in the immediate postoperative phase following a cesarean delivery. The obstetric team implemented conservative management, including Foley catheter insertion, for 2 weeks. She subsequently developed intermittent hematuria and cystitis. The urology team was consulted 15 days after cesarean delivery. Cystoscopy indicated an ulcerated lesion in the bladder dome of approximately 1.0cm in size. Hysterosalpingography and a pelvic computed tomography scan indicated a fistula. Materials and Methods: Laparoscopic repair was performed 30 days after the cesarean delivery. The patient was placed in the lithotomy position while also in an extreme Trendelenburg position. Pneumoperitoneum was established using a Veress needle in the midline infra-umbilical region, and a primary 11-mm port was inserted. Another 11-mm port was inserted exactly between the left superior iliac spine and the umbilicus. Two other 5-mm ports were established under laparoscopic guidance in the iliac fossa on both sides. The omental adhesions in the pelvis were carefully released and the peritoneum between the bladder and uterus was incised via cautery. Limited cystotomy was performed, and the specific sites of the fistula and the ureteral meatus were identified; thereafter, the posterior bladder wall was adequately mobilized away from the uterus. The uterine rent was then closed using single 3/0Vicryl sutures and two-layer watertight closure of the urinary bladder was achieved by using 3/0Vicryl sutures. An omental flap was mobilized and inserted between the uterus and the urinary bladder, and was fixed using two 3/0Vicryl sutures, followed by tube drain insertion. Results: The operative time was 140 min, whereas the blood loss was 100ml. The patient was discharged 3 days after surgery, and the catheter was removed 12 days after surgery
郑叶滨; 杜凡; 杨军
BACKGROUND: In recent years, percutaneous laser disc decompression (PLDD) has been developed gradually in China. But there have been fewer further studies on the indications and contraindications for the use of the therapy.OBJECTIVE: To analyze the therapeutic effect after the choice of the indications for PLDD.DESIGN: A case-paired observational analysis with the patients as the subjects.SETTING: The Department of Radiology and Department of Soft Injuries of the 474 Hospital of Chinese PLA.PARTICIPANTS: We recruited inpatients of the 474 Hospital of Chinese PLA after PLDD between August 1998 and December 2004 as subjects for this research. Totally 68 cases were involved. According to the same gender, the closeness in age, the cases were matched and divided into 2 groups (eg. If there were 2 or more than 2 cases with the same age, the case whose disease course is the closest one was chosen): poor indication group (n=34) and good indication group (n=34).METHODS: A pillow was put under the belly of the patient who lay face down on the angiographic bed with the side with serious symptoms near the outside of the bed (the side where doctor operated). Symbols were marked on the body surface under the fluoroscopy. The waist was subjected to conventional sterilization and was paved with a piece of sterile cloth. 5 Ml of lydocaine was used for anesthesia. 8-12 cm to the posterior central midline of the diseased side, an incision was made to insert the needle according to the fat and thinness of the patients, and attention to the angle adjustment was needed to enter the intervertebral disc through "the secure triangle"beneath the nerve root so that 5 mm of the exposed front segment covered the needle end completely. Cautery was made with 15 W laser for every 1s after an interval of 4 s. The total output power of laser was adjusted according to the area of intervertebral disc, which was usually 1 200-1 700joules. The gas produced should be drawn out during the cautery, and