Sample records for cautery

  1. Craniosynostosis incision: scalpel or cautery? (United States)

    Wood, Jeyhan S; Kittinger, Benjamin J; Perry, Victor L; Adenola, Adeyemi; van Aalst, John A


    There is an ongoing debate regarding the optimal instrument for scalp incisions: the scalpel or electrocautery. The argument generally focuses on improved healing after an incision made with a knife and decreased bleeding when using electrocautery. This study compares the use of scalpel and electrocautery in making coronal incisions for patients undergoing surgical correction of craniosynostosis. The outcome metric used is wound healing within 6 months after surgery. All patients presenting to the University of North Carolina Children's Hospital with craniosynostosis between July 1, 2007 and January 1, 2010 requiring a coronal incision for surgical correction were prospectively enrolled. In all of these patients, half of the coronal incision was made with knife; the other half, with needle tip cautery. Side of the incision was specified at the time of surgery in the operative report. Patients were excluded from the study if the instrument for incision was not specified or if only 1 modality was used for the entire incision. Sixty-eight patients underwent cranial vault reconstruction, of which 58 met inclusion criteria. Of the 58 matched pairs, 55 were analyzed statistically. The 3 excluded cases were those who had midline complications. There were 17 wound complications (15%): 8 in the knife group, 6 in the cautery group, and 3 at midline (with indeterminate side for the problem). We found no statistically significant difference in wound healing between incisions made with a knife or with electrocautery.

  2. 21 CFR 886.4100 - Radiofrequency electrosurgical cautery apparatus. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Radiofrequency electrosurgical cautery apparatus... SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4100 Radiofrequency electrosurgical cautery apparatus. (a) Identification. A radiofrequency electrosurgical cautery apparatus is an AC...

  3. Unilateral Anterior Epistaxis Electrocautery versus Chemical Cautery

    International Nuclear Information System (INIS)

    Umar, A. S.; Rahat, Z. M.; Hussain, S. S.; Khan, M. Z.; Fareed, G.


    Objective: To evaluate and compare the two methods, electrocautery versus chemical cautery, for controlling unilateral anterior epistaxis and to identify the complications. Design: Randomized control trial. Place and Duration: This study was conducted in ENT Department PNS Shifa Hospital Karachi from August 2009 to June 2011. Patients and Methods: Ninety two cases with unilateral anterior epistaxis were divided using random number trials into two groups i.e. group A and group B containing 46 cases each. In group A electrocautery and in group B chemical cautery with 50% silver nitrate was done and the results were compared. Results: In this study 92 cases were divided randomly into two groups i.e. group A and group B containing 46 cases in each group. In group A 44 (95.6%) out of 46 cases were treated successfully with a single visit as an outpatient by electrocautery, the patients were called for follow up on the fifth day and then fortnightly for three months after the procedure, only 2 (4.3%) cases reported in first five days with mild recurrence of bleeding. In group B 42 (91.3%) cases out of 46 cases were treated successfully in a single visit and recurrence of bleeding occured in 4 (8.7%) cases who required a second visit during the first five days. There were no major complications found in either group except few complaints of post cauterization pain and mucosal inflammation observed slightly more in group B patients. Conclusion: Electrocautery and chemical cautery with 50% silver nitrate both are equally effective procedures to control anterior epistaxis if the bleeding point is visible and small. Both procedures are reliable and there are no major complications. Occasionally if the bleeding point in the anterior nasal septum is large then electrocautery may be a preferred option. (author)

  4. Comparison of electro and chemical cautery in the treatment of anterior epistaxis. (United States)

    Toner, J G; Walby, A P


    In the ENT Department of the Royal Victoria Hospital, Belfast, the impression (supported only by anecdotes) was that electro-cautery was superior to chemical cautery in the treatment of simple anterior epistaxis. Since no evaluation of the relative merits of electro and chemical cautery has been reported, a prospective randomized study was conducted to assess the effectiveness of electro-cautery and cautery with silver nitrate. The results of the study showed that there was no statistically significant difference between the two methods in either controlling the epistaxis or in the incidence of complications. It is concluded that since cautery with a silver nitrate tipped applicator is simpler, and of equal effectiveness, it would appear to be the treatment of choice for simple anterior epistaxis.

  5. Chemical cautery of the inferior turbinates with trichloroacetic acid

    Directory of Open Access Journals (Sweden)

    Azevedo, Alexandre Fernandes de


    Full Text Available Introduction: Chronic secondary nasal obstruction, the hypertrophy of the inferior turbinates is a common symptom of great morbidity in our society. Several surgical techniques are described to cases refractory to medical treatments, however, there are controversy about which one of them is more effective and less subject to complications. Objective: Evaluate the efficacy, security and practicability of using ambulatory trichloroacetic acid to treat the hypertrophy of the inferior turbinates. Method: Prospective study with 29 patients submitted to the ambulatory technique of 30% trichloroacetic acid infiltration in the inferior turbinate's submucosa, under topic anesthesia. The symptoms of rhinorrhea and nasal obstruction were evaluated using the analogical and visual scale (AVS 010 pre-cautery and one year post-procedure. Results: Significant nasal obstruction and rhinorrhea reduction one year post-procedure. The complications were light synechia in two patients and small bleedings in four spontaneous resolution cases. Conclusion: The proposed method showed excellent results concerning nasal obstruction and rhinorrhea, can be conducted in ambulatory environment, and has proved to be a low-complication method.

  6. A Comparison of Bipolar Electrocautery and Chemical Cautery for Control of Pediatric Recurrent Anterior Epistaxis. (United States)

    Johnson, Nathan; Faria, John; Behar, Philomena


    To compare the outcome of children with anterior epistaxis treated intraoperatively with either bipolar electrocautery or silver nitrate chemical cautery. Case series with chart review. Tertiary-care pediatric otolaryngology practice. Children aged 2 to 18 years treated with either intraoperative bipolar electrocautery or silver nitrate chemical cautery of the anterior nasal septum for recurrent anterior epistaxis. Any reported bleeding event after surgery was recorded. The mean time from surgery to recurrent epistaxis was compared between groups. Fifty patients underwent bipolar electrocautery, while 60 patients underwent silver nitrate chemical cautery. Within 2 years, 1 (2%) patient in the bipolar electrocautery group and 13 (22%) patients in the silver nitrate chemical cautery group had recurrent epistaxis (P = .003). Two years after treatment, there was no difference between treatment groups. Overall, 4 patients (8%) had recurrent epistaxis postoperatively in the bipolar electrocautery group at a mean of 4.34 years after treatment, while 17 (28.3%) patients recurred after a mean of 1.53 years of treatment in the silver nitrate chemical cautery group (P = .01). Compared to those treated with chemical cautery, those treated with bipolar electrocautery had a longer nosebleed-free period and a lower incidence of recurrent epistaxis within 2 years of treatment. Beyond 2 years, the treatment methods are equivocal. Bipolar electrocautery may be a superior treatment in children who will not tolerate in-office chemical cautery, in those with a risk of severe bleeding, or when it can be combined with other operative procedures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  7. [Clinical study of treatment of epistaxis of little's area by microwave, anterior nasal packing and trichloroacetic acid cautery]. (United States)

    Zhi, T; Liu, Y; Liu, F


    To study the difference and quality of three different kind of treatment methods for epistaxis of Little's area, such as: microwave, anterior packing of nasal cavity and trichloroacetic acid cautery. The cases were divided into three group. The state of bleeding, reaction of after-treatment and recurrence were recorded and analysed. Comparing with the anterior nasal packing and trichloroacetic acid cautery, the microwave is characteristic by thorough stop-bleeding, light reaction, less recurrence. Microwave is an ideal way to treat epistaxis of Little's area. The patient's reaction is mild and less the clinical effects is obviously better than the anterior packing of nasal cavity and trichloroacetic acid cautery.

  8. Impact of carprofen administration on stress and nociception responses of calves to cautery dehorning. (United States)

    Stock, M L; Barth, L A; Van Engen, N K; Millman, S T; Gehring, R; Wang, C; Voris, E A; Wulf, L W; Labeur, Léa; Hsu, W H; Coetzee, J F


    The objective of this study was to investigate the effects of carprofen administered immediately before cautery dehorning on nociception and stress. Forty Holstein calves aged approximately 6 to 8 wk old were either placebo treated and sham dehorned ( = 10) or cautery dehorned following administration of carprofen (1.4 mg/kg) subcutaneously ( = 10) or orally ( = 10) or a subcutaneous and oral placebo ( = 10) in a randomized, controlled trial. All animals were given a cornual nerve block using lidocaine before dehorning. Response variables including mechanical nociception threshold, ocular temperature, heart rate, and respiratory rate were measured before and following cautery dehorning for 96 h. Blood samples were also collected over 96 h following dehorning and analyzed for plasma cortisol and substance P concentrations by RIA. Plasma carprofen concentration and ex vivo PGE concentrations were also determined for this time period. Average daily gain was calculated for 7 d after dehorning. Data were analyzed using a linear mixed effects model with repeated measures, controlling for baseline values by their inclusion as a covariate in addition to planned contrasts. Dehorning was associated with decreased nociception thresholds throughout the study and a stress response immediately after dehorning, following the loss of local anesthesia, and 48 h after dehorning compared with sham-dehorned calves. Carprofen was well absorbed after administration and reached concentrations that inhibited ex vivo PGE concentrations for 72 h (subcutaneous) and 96 h (oral) compared with placebo-treated calves ( Carprofen-treated calves tended to be less sensitive ( = 0.097) to nociceptive threshold tests. Overall, at the dosing regimen studied, the effect of carprofen on sensitivity and stress following cautery dehorning was minimal. Consideration of route of administration and dose determination studies may be warranted.

  9. Radiofrequency Coblation Versus Intramural Bipolar Cautery for the Treatment of Inferior Turbinate Hypertrophy. (United States)

    Shah, Anil N; Brewster, Douglas; Mitzen, Kelly; Mullin, David


    Compare intramural bipolar electrocautery and radiofrequency coblation in the treatment of inferior turbinate hypertrophy with regards to objective and subjective improvement in nasal obstruction, rate and type of complications, experience during the procedure, and rate of recovery. Prospective, single-blinded study. Single tertiary medical center from 2008 to 2010. Forty-one adult patients with inferior turbinate hypertrophy refractory to medical management were treated with radiofrequency coblation in one nostril and intramural bipolar cautery in the other. Subjective and objective data, including use of a Visual Analog Scale (VAS) for subjective outcomes, acoustic rhinometry, and nasal endoscopy, were then obtained from each patient comparing the 2 techniques. Radiofrequency coblation was significantly less painful than intramural bipolar cautery during the procedure (P = .03) and during the early postoperative period (P measured by acoustic rhinometry and subjective VAS outcomes. Radiofrequency coblation seems to offer an equivalent alternative to bipolar electrocautery for the treatment of inferior turbinate hypertrophy with less discomfort during the procedure and early post-operative period. © The Author(s) 2015.

  10. Medical cautery units as a permanent and non-invasive method of marking lizards

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    Anna Ekner


    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.

  11. Evaluation of alternatives to cautery disbudding of dairy goat kids using physiological measures of immediate and longer-term pain. (United States)

    Hempstead, Melissa N; Waas, Joseph R; Stewart, Mairi; Cave, Vanessa M; Sutherland, Mhairi A


    We evaluated alternatives to cautery disbudding of goat kids using physiological measures of immediate and longer-term pain. Fifty Saanen doe kids were randomly assigned to 1 of 5 treatments (n = 10/treatment): (1) cautery disbudding (CAUT), (2) caustic paste disbudding (CASP), (3) liquid nitrogen disbudding (CRYO), (4) clove oil injected into the horn bud (CLOV), or (5) sham disbudding (SHAM). Serum cortisol and haptoglobin concentrations were measured from blood samples collected immediately before treatment (baseline) and at 15, 30, 60, and 120 min and then again at 6 and 24 h post-treatment. An infrared thermography camera was used to take images of the horn buds 24 h pre- and 24, 48, and 72 h post-treatment to measure skin temperature. Body weight was measured daily for 1 wk to assess weight change post-treatment. Images of the horn buds were taken at d 1, 2, and 7 and at 6 wk post-treatment to assess tissue damage and wound healing. Mean cortisol concentrations were elevated in CASP kids 1 h post-treatment relative to CAUT kids. Cortisol concentrations of CRYO kids were higher than those of CAUT kids 30 min post-treatment; concentrations for CLOV kids were similar to CAUT kids post-treatment. Mean haptoglobin concentrations were similar across treatments over time; however, CLOV kids had higher concentrations at 24 h post-treatment than all other treatments. Skin temperatures of CASP and CLOV kids were elevated relative to CAUT kids at all time points post-treatment, and all disbudded kids had skin temperatures above those of SHAM kids at 72 h post-treatment. Treatment did not influence weight gain. The CAUT kids had large, open wounds exposing bone; small scabs were still evident 6 wk post-treatment. The CASP kids had red and open, raw wounds that generated large eschars, apparent for up to 6 wk. The CRYO kids had closed, dry wounds initially, but over time lesions appeared that caused open wounds; small scabs were present 6 wk post-treatment. The CLOV kids

  12. A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children (United States)

    Ahmed, Ahmed E; Abo El-Magd, Essam A; Hasan, Gamal M; El-Asheer, Osama M


    Background Epistaxis is a common medical problem in pediatric population. Although in most cases it is mild and self-limiting, a proportion of childhood epistaxis is massive, recurrent, or resistant to conventional management. Objective To compare effectiveness of propranolol as a treatment option for childhood epistaxis versus conventional silver nitrate cautery. Study design and methodology This is a prospective interventional comparative study that was carried out during a period of 1 year (January 1, 2013 to December 31, 2013) at Qena University Hospital and Assiut University Children’s Hospital. One hundred children aged 6–12 years who presented with epistaxis to Qena University Hospital and Assiut University Children’s Hospital during the study period and fulfilling the inclusion criteria were included in the study. They were randomly assigned into one of two interventional groups, where 50 children were treated with oral propranolol (propranolol treatment group) and another 50 children were treated with conventional silver nitrate cautery (cauterization treatment group) for their epistaxis. Propranolol was given at a dose of 1.5–2 mg/kg/day (divided into three doses). Patients were followed for 6 months after their discharge for recurrence of epistaxis. Results Both groups of patients showed minimal recurrent epistaxis with rates of 14% for propranolol treated group and 12% for cauterization group, with no statistically significant difference between both groups. Local pain was found to be more in patients treated with silver nitrate cauterization. Conclusion Treatment of primary epistaxis with propranolol or silver nitrate cautery showed equal rates of recurrence, and local nasal pain was slightly more among silver nitrate cauterization treated group. Propranolol could be a favorable treatment option for patients with primary epistaxis. Further studies that include multiple centers and larger number of patients are recommended for more clarification

  13. Advancing optical imaging for breast margin assessment: an analysis of excisional time, cautery, and patent blue dye on underlying sources of contrast.

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    Torre M Bydlon

    Full Text Available Breast conserving surgery (BCS is a recommended treatment for breast cancer patients where the goal is to remove the tumor and a surrounding rim of normal tissue. Unfortunately, a high percentage of patients return for additional surgeries to remove all of the cancer. Post-operative pathology is the gold standard for evaluating BCS margins but is limited due to the amount of tissue that can be sampled. Frozen section analysis and touch-preparation cytology have been proposed to address the surgical needs but also have sampling limitations. These issues represent an unmet clinical need for guidance in resecting malignant tissue intra-operatively and for pathological sampling. We have developed a quantitative spectral imaging device to examine margins intra-operatively. The context in which this technology is applied (intra-operative or post-operative setting is influenced by time after excision and surgical factors including cautery and the presence of patent blue dye (specifically Lymphazurin™, used for sentinel lymph node mapping. Optical endpoints of hemoglobin ([THb], fat ([β-carotene], and fibroglandular content via light scattering ( measurements were quantified from diffuse reflectance spectra of lumpectomy and mastectomy specimens using a Monte Carlo model. A linear longitudinal mixed-effects model was used to fit the optical endpoints for the cautery and kinetics studies. Monte Carlo simulations and tissue mimicking phantoms were used for the patent blue dye experiments. [THb], [β-carotene], and were affected by , and [β-carotene]/ was 40%. [β-carotene] and [β-carotene]/ were the only parameters not affected by cautery. This work demonstrates the importance of understanding the post-excision kinetics of ex-vivo tissue and the presence of cautery and patent blue dye for breast tumor margin assessment, to accurately interpret data and exploit underling sources of contrast.

  14. Effect of isoflurane alone or in combination with meloxicam on the behavior and physiology of goat kids following cautery disbudding. (United States)

    Hempstead, Melissa N; Waas, Joseph R; Stewart, Mairi; Dowling, Suzanne K; Cave, Vanessa M; Lowe, Gemma L; Sutherland, Mhairi A


    Cautery disbudding of goat kids is painful, but may be alleviated with pain mitigation. We therefore evaluated the effect of administering general anesthesia (isoflurane) or a nonsteroidal anti-inflammatory drug (meloxicam) on goat kid behavior and physiology following cautery disbudding. Trial 1 (n = 12/treatment) evaluated behavioral responses in 72 female Saanen dairy goat kids (mean ± standard error of the mean; 3.9 ± 0.15 d old) and trial 2 (n = 10/treatment) evaluated physiological responses in 60 female Saanen dairy goat kids (4.3 ± 0.14 d old). Goat kids were randomly assigned to 1 of 6 treatment groups that were either (1) sham-handled only (simulated disbudding; SHAM) or disbudded with (2) no pain relief (CAUT), (3) isoflurane gas (ISO), (4) isoflurane and s.c. meloxicam combined (ISO+MEL), (5) meloxicam s.c. (0.5 mg/kg of body weight; I-MEL), or (6) oral meloxicam (0.2 mg/kg of body weight; O-MEL). Head shaking, head scratching, self-grooming, feeding, and body shaking were continuously video recorded for 24 h pre- and post-treatment. Lying behavior was recorded continuously for 24 h pre- and post-treatment using accelerometers. Plasma cortisol, glucose, and lactate concentrations were measured from blood samples collected immediately before treatment (baseline) and at 15, 60, and 120 min post-treatment. Body temperature was measured immediately after blood sampling at all blood sampling time points. Head shaking and body shaking frequencies were 50% higher in CAUT than SHAM kids 5 min post-treatment; ISO+MEL and ISO kids performed 25% less body shakes than CAUT kids. Head scratching durations 1 h post-treatment were higher in CAUT than SHAM kids, whereas O-MEL were similar to SHAM kids from 2 h post-treatment. Self-grooming, feeding, and lying did not differ between groups. Cortisol concentrations were higher in CAUT than SHAM kids (156.4 ± 26.41 and 104.1 ± 26.41 nmol/L, respectively), whereas ISO+MEL and ISO kids (88.3 ± 26.41 and 113.2 ± 26

  15. Effects of turbinoplasty versus outfracture and bipolar cautery on the compensatory inferior turbinate hypertrophy in septoplasty patients. (United States)

    Bozan, Aykut; Eriş, Hüseyin Naim; Dizdar, Denizhan; Göde, Sercan; Taşdelen, Bahar; Alpay, Hayrettin Cengiz


    The most common cause of septoplasty failure is inferior turbinate hypertrophy that is not treated properly. Several techniques have been described to date: total or partial turbinectomy, submucosal resection (surgical or with a microdebrider), with turbinate outfracture being some of those. In this study, we compared the pre- and postoperative lower turbinate volumes using computed tomography in patients who had undergone septoplasty and compensatory lower turbinate turbinoplasty with those treated with outfracture and bipolar cauterization. This retrospective study enrolled 66 patients (37 men, 29 women) who were admitted to our otorhinolaryngology clinic between 2010 and 2017 because of nasal obstruction and who were operated on for nasal septum deviation. The patients who underwent turbinoplasty due to compensatory lower turbinate hypertrophy were the turbinoplasty group; Outfracture and bipolar cauterization were separated as the out fracture group. Compensatory lower turbinate volumes of all patients participating in the study (mean age 34.0±12.4 years, range 17-61 years) were assessed by preoperative and postoperative 2 month coronal and axial plane paranasal computed tomography. The transverse and longitudinal dimensions of the postoperative turbinoplasty group were significantly lower than those of the out-fracture group (p=0.004). In both groups the lower turbinate volumes were significantly decreased (p=0.002, p<0.001 in order). The postoperative volume of the turbinate on the deviated side of the patients was significantly increased: tubinoplasty group (p=0.033). Both turbinoplasty and outfracture are effective volume-reduction techniques. However, the turbinoplasty method results in more reduction of the lower turbinate volume than outfracture and bipolar cauterization. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  16. Comparison of online, hands-on, and a combined approach for teaching cautery disbudding technique to dairy producers. (United States)

    Winder, Charlotte B; LeBlanc, Stephen J; Haley, Derek B; Lissemore, Kerry D; Godkin, M Ann; Duffield, Todd F


    The use of pain control for disbudding and dehorning is important from both an animal and industry perspective. Best practices include the use of local anesthetic, commonly given as a cornual nerve block (CNB), and a nonsteroidal anti-inflammatory drug. The proportion is decreasing, but many dairy producers do not use local anesthesia, perhaps in part due to lack of knowledge of the CNB technique. Although this skill is typically learned in person from a veterinarian, alternative methods may be useful. The objective of this trial was to determine if there were differences in the efficacy of online training (n = 23), hands-on training (n = 20), and a combined approach (n = 23) for teaching producers to successfully administer a CNB and disbud a calf. The primary outcome was block efficacy, defined as a lack of established pain behaviors during iron application. Secondary outcomes were background knowledge (assessed by a written quiz), CNB and disbudding technique (evaluated by rubric scoring), time taken, and self-confidence before and after evaluation. Associations between training group and outcome were assessed with logistic regression, ordered logistic regression, and Cox-proportional hazard models, with a random effect for workshop. Block efficacy was not different between training groups, with 91% successful in both combined and online groups, and 75% in the hands-on trained group. Online learners had poorer technical scores than hands-on trainees. The combined group was not different from hands-on. Time to block completion tended to be longer for the online group (62 ± 11 s), whereas time to disbudding completion was not different between hands-on (41 ± 5 s) or combined trainees (41 ± 5 s). The combined group had the highest pre-evaluation confidence score, and remained higher after evaluation than online but was not different than hands-on. Although we saw some statistical differences between groups, absolute differences were small and block efficacy was similar. This suggests online training can be a useful tool for motivated producers who lack access to hands-on training. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  17. Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU). (United States)

    Chertoff, Jason; Khullar, Vikas; Burke, Lucas


    The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  18. Mothers Perception of Teething in Children

    African Journals Online (AJOL)


    includes blistering, bleeding, placing leeches on the gum, applying cautery to the back of the head and lancing- a method where lancet was used to cut the gum in other for the teeth to appear.7 1t was thought that failure of the teeth to appear was due to lack of a pathway and that this was the cause of death from teething,.

  19. Role of trichloroacetic acid and gelfoam in closure of tympanic ...

    African Journals Online (AJOL)

    Results: Patients had relief from various symptoms, such as tinnitus, heaviness, and so on. There was some amount of auditory improvement in almost all the cases. It ranged from 5 to 23 dB. Conclusions: Cautery and patching of tympanic membrane perforation may be considered as the first-line management in the small- ...

  20. Role of Trichloroacetic Acid and Gelfoam in Closure of Tympanic ...

    African Journals Online (AJOL)


    Feb 7, 2018 ... tinnitus, heaviness, and so on. There was some amount of auditory improvement in almost all the cases. It ranged from 5 to 23 dB. Conclusions: Cautery and patching of tympanic membrane perforation may be considered as the first-line management in the small- to medium-sized perforations before ...

  1. Role of Trichloroacetic Acid and Gelfoam in Closure of Tympanic ...

    African Journals Online (AJOL)


    Dec 5, 2017 ... tinnitus, heaviness, and so on. There was some amount of auditory improvement in almost all the cases. It ranged from 5 to 23 dB. Conclusions: Cautery and patching of tympanic membrane perforation may be considered as the first-line management in the small- to medium-sized perforations before ...

  2. Pancreatic Necrosectomy Through a Novel Double-flange Lumen-apposing Covered Metal Stent (Video

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    Andres Sanchez-Yague


    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.

  3. Safety of Monopolar Electrocautery in Patients With Cochlear Implants. (United States)

    Tien, Duc A; Woodson, Erika A; Anne, Samantha


    The outcomes of 2 patients with cochlear implants (CIs) who underwent adenotonsillectomy (AT) with inadvertent use of monopolar cautery are presented. The safety data regarding monopolar cautery use in CI recipients is also reviewed. This is a retrospective case series of 2 CI recipients that underwent AT with monopolar cautery and literature review of electrocautery safety in the setting of CI. Two patients with CIs underwent AT with use of monopolar cautery inadvertently by surgeons that do not routinely perform cochlear implants as part of his or her clinical practice. Patient 1 was a 9-year-old female who had AT for obstructive sleep apnea (OSA) after undergoing unilateral CI for profound congenital sensorineural hearing loss (SNHL) 8 years ago. Patient 2 was a 7-year-old female who underwent AT for OSA 4 months after undergoing unilateral CI for congenital SNHL. Both patients had no immediate signs of complications with their CI use postoperatively. Both patients demonstrated unchanged postoperative neural response telemetry and behavioral audiometric testing. Patient 1 continues to have no CI-related complications 3.5 years after the procedure. Patient 2 has been followed for at least 3 months by audiometric testing and 10 months by otolaryngologist with no CI-related complications. Although animal and cadaveric studies suggest that monopolar cautery may be safely used in patients with cochlear implants, there have been no in vivo human studies that have evaluated the risk to the patient or implant. This is a report of a small, unintended experience with 2 patients, both of whom exhibit no complications or changes to CI function thus far. © The Author(s) 2016.

  4. Electrocautery-induced localized colonic injury elicits increased levels of pro-inflammatory cytokines in small bowel and decreases jejunal alanine absorption. (United States)

    Barada, Kassem; Mourad, Fadi H; Noutsi, Bakiza; Saadé, Nayef E


    Colitis is associated with functional abnormalities in proximal non-inflamed gut areas, but animal models to study small bowel dysfunction in colitis have limitations. This study aims to determine small intestinal alanine absorption and cytokine expression in a novel model of colonic ulceration induced by electro-cautery. A descending colon ulcer was induced in rats by a bipolar electro-cautery probe. Ulcer score was determined using Satoh's criteria. Jejunal alanine absorption was measured immediately and at different time intervals post ulcer induction. Levels of interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) protein and m-RNA were determined in mucosal scrapings obtained from the colon, duodenum, jejunum and ileum at various time intervals after colonic ulcer induction. The mean ulcer score was 3 up to 48h, followed by healing by 96h post ulcer induction. Small bowel histology was normal throughout. Jejunal alanine absorption was reduced by 12-34% immediately and up to 72h after cautery and returned to normal at 96h. IL-1 and TNF-α mRNA increased significantly in the colon, duodenum, jejunum and ileum 3h post electro-cautery and returned to normal at 48h, while that of IL-6 increased significantly at 48h post ulcer induction. Similarly, IL-1, IL-6 and TNF-α protein levels increased in the duodenum, jejunum, ileum and colon up to 48h post ulcer induction. Electrically induced localized colonic injury increased production of pro-inflammatory cytokines in non-inflamed segments of the small intestine and was associated with derangements of jejunal absorptive function. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. [History of the therapeutic uses of the tinder polypore, Fomes fomentarius (L. : Fr]. (United States)

    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).

  6. Changing Trends in the Management of Epistaxis (United States)

    Alam, Elie; Hadi, Usamah


    Epistaxis is a very common complaint seen by many types of physicians including otolaryngologists, family physicians, and others. Management of epistaxis is often challenging and requires many types of intervention. The following review describes the different types of past and current treatment modalities including cautery, nasal packing, maxillary artery ligation, anterior artery ligation, and sphenopalatine artery ligation. The paper also proposes an algorithm for managing such cases. PMID:26351457

  7. Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting (United States)

    Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza


    Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602


    Directory of Open Access Journals (Sweden)

    Tomaž Benedik


    Full Text Available Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries.The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct.Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calot’s triangle must be dissected free of fat and fibrous – tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible – cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct. Low cautery settings should be used in portal dissections to prevent arc.With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.

  9. Endoscopic resection of large colonic lipomas assisted by a prototype single-use endoloop device

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    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.

  10. Modelling cost-effectiveness of different vasectomy methods in India, Kenya, and Mexico

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    Seamans Yancy


    Full Text Available Abstract Background Vasectomy is generally considered a safe and effective method of permanent contraception. The historical effectiveness of vasectomy has been questioned by recent research results indicating that the most commonly used method of vasectomy – simple ligation and excision (L and E – appears to have a relatively high failure rate, with reported pregnancy rates as high as 4%. Updated methods such as fascial interposition (FI and thermal cautery can lower the rate of failure but may require additional financial investments and may not be appropriate for low-resource clinics. In order to better compare the cost-effectiveness of these different vasectomy methods, we modelled the costs of different vasectomy methods using cost data collected in India, Kenya, and Mexico and effectiveness data from the latest published research. Methods The costs associated with providing vasectomies were determined in each country through interviews with clinic staff. Costs collected were economic, direct, programme costs of fixed vasectomy services but did not include large capital expenses or general recurrent costs for the health care facility. Estimates of the time required to provide service were gained through interviews and training costs were based on the total costs of vasectomy training programmes in each country. Effectiveness data were obtained from recent published studies and comparative cost-effectiveness was determined using cost per couple years of protection (CYP. Results In each country, the labour to provide the vasectomy and follow-up services accounts for the greatest portion of the overall cost. Because each country almost exclusively used one vasectomy method at all of the clinics included in the study, we modelled costs based on the additional material, labour, and training costs required in each country. Using a model of a robust vasectomy program, more effective methods such as FI and thermal cautery reduce the cost per

  11. Radiofrequency-assisted body piercing

    Directory of Open Access Journals (Sweden)

    Preethitha Babu


    Full Text Available The art of body piercing is ancient; however, nowadays it has evolved into a fashion statement. In the Indian subcontinent, ear and nose piercing hold religious and cultural significance in addition to being done for aesthetic reasons. Body piercing is routinely performed by railroading technique or by piercing guns; many modifications of the technique have emerged. Irrespective of the technique used, the main complications associated are intraoperative bleeding and postoperative infection. To overcome these problems, we describe a novel and simple technique of ear and nose piercing using the radio frequency cautery.

  12. How to stop a nosebleed. (United States)

    Petruzzelli, G J; Johnson, J T


    Epistaxis is a common emergency usually caused by local trauma to the nasal mucosa. Occasionally, it may result from systemic diseases such as atherosclerosis, hypertension, or coagulopathy. Anterior nosebleed often can be controlled with topical vasoconstriction and cautery. Intranasal packing may be necessary to tamponade bleeding vessels. Occlusion of the sinus ostia by anterior nasal packing may necessitate prophylactic use of antibiotics to prevent sinusitis. Posterior nosebleed requires nasopharyngeal packing. Patients must be closely monitored and given supplemental high-humidity oxygen. Persistent or recurrent nosebleed or failure of posterior nasopharyngeal packing to control bleeding indicates the need for otolaryngologic consultation and perhaps surgical intervention.

  13. Clinical Factors of Delayed Perforation after Endoscopic Submucosal Dissection for Gastric Neoplasms

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    Yoshinobu Yamamoto


    Full Text Available Background. Delayed perforation is a rare but severe complication of endoscopic submucosal dissection (ESD for early gastric neoplasm (EGN. The aim of this study was to clarify clinical factors related to delayed perforation after ESD. Methods. A total of 1158 consecutive patients with 1199 EGNs underwent ESD at our hospital between January 2000 and December 2015. Univariate analysis was used to identify clinicopathological factors related to delayed perforation. Moreover, duration of cautery needed for hemostasis was measured by comparison between perforated and nonperforated points in patients with delayed perforation. Results. Delayed perforation occurred in 5 of 1158 consecutive patients with 1199 EGNs who underwent ESD (0.42%. All cases were diagnosed within 24 h after ESD and recovered with conservative management. On univariate analysis, location in the upper stomach was the factor most significantly associated with delayed perforation (P<0.01. Duration of cautery needed for hemostasis was significantly longer at perforated points (9 s than at nonperforated points (3.5 s in five patients. Conclusions. Location in the upper stomach was the risk factor most prominently associated with delayed perforation after ESD for EGNs. In addition, delayed perforation appears associated with excessive electrocautery for hemostasis.

  14. Use of potassium titanyl phosphate (KTP) laser Dermastat in the treatment of recurrent anterior epistaxis - a new technique. (United States)

    Jain, A; Frampton, S J; Sachidananda, R; Jain, P K


    To evaluate the short- to medium-term effectiveness of potassium titanyl phosphate (KTP) laser Dermastat in patients with recurrent anterior epistaxis. Fifty-eight patients presenting with recurrent anterior epistaxis were treated using potassium titanyl phosphate laser Dermastat. Those with recurrent epistaxis arising from prominent vessels in Little's area, and/or those for whom treatment with silver nitrate cautery failed, were included. The main outcome measure was resolution of epistaxis at two months. Fifty-eight patients were treated; 27 were under 18 years old. Thirty patients had prominent vessels. Thirty-one patients had undergone previous cautery treatment. Thirty-eight patients had treatment to the left side, 19 to the right and 1 to both. At two months, 74 per cent reported resolution of epistaxis with no complications. This increased to 78 per cent at further follow up. Our technique is a successful, safe treatment for recurrent anterior epistaxis in an otherwise treatment-resistant group. A single procedure is effective. The handpiece and tip are reusable and sterilisable, resulting in cost-effectiveness.

  15. Transcatheter Embolization in the Management of Epistaxis (United States)

    Dubel, Gregory J.; Ahn, Sun Ho; Soares, Gregory M.


    A majority of the population will experience epistaxis at some time in their life. Most cases will be from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and may require endoscopic cautery, posterior packing, surgical ligation, or embolization. Embolization has been used to treat epistaxis for more than 30 years and success can be achieved in approximately 90% of patients, with major complications occurring in approximately 2%. These excellent results require thorough knowledge of the regional anatomy, familiarity with the equipment and various agents used to achieve this type of embolization, as well as attention to detail and meticulous technique. There remains debate on several aspects of embolization, including the agent of choice, preferred size of the embolic, and the number of vessels to embolize. Advances in endoscopic surgery have evolved to the point that similar success rates for embolization and modern surgical techniques in treating epistaxis may be expected. This detailed review of pertinent vascular anatomy, embolization technique, and surgical alternatives should allow practitioners to formulate treatment algorithms that result in optimal outcomes at their institutions. PMID:24436547

  16. Treatment for trichiasis through a combination of eyelash trephination and electrocautery. (United States)

    Han, Jae-Hyung; Doh, Sang-Hee


    This article introduces 3-mm-deep eyelash trephination combined with electrocautery as a way to increase the success rate for treatment for trichiasis. We have modified surgical instruments, ready-made ophthalmic microtrephine and cautery tip for a 3-mm-deep eyelash trephination and electrocautery. After eyelash trephination with microtrephine, electrocautery was added with a bended cautery tip after embedding in the trephination site. The trephined eyelids were photographed biweekly and checked for recurrence until 8 weeks after operation. Eyelash trephination combined with electrocautery was carried out on 20 Korean patients. The number of removed cilia was 109. Of these, the number of successfully removed hair follicles was 89. During 8 weeks, the total recurring rate of eyelash trephination combined with electrocautery was 17%. In the case of hair follicle removal success with electrocautery, the recurring rate was as low as 11%, but in the case of hair follicle removal failure with electrocautery, recurring rate is 45%. We checked the depth of removed eyelash follicles, and the mean depth was 2.03 ± 0.085 mm in this study. No serious complication was found during the period of this study. The eyelash trephination combined with electrocautery for trichiasis is a method with a low recurrence rate and few complications. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

  17. Comparative evaluation of two techniques of hemostasis in neonatal circumcision using the Plastibell device. (United States)

    Kazem, Moslemi Mohammad; Mehdi, Abedin Zadeh; Golrasteh, Kholaseh Zadeh; Behzad, Feis Zadeh


    To evaluate the safety of the Plastibell neonatal circumcision technique and the incidence of complications in Iranian neonates. In this study, 7510 term neonates born between 2001 and 2006 in Rafsanjan medical centers, with age range of 3-36h, were randomized into two groups. In group A (3760 cases), an incision was made in the dorsal surface of the prepuce and then 3min frenular manual compression was performed with a sponge. In group B (3750 cases), frenular hemostasis was achieved using ophthalmologic thermal cautery. The two groups were compared in terms of complications of hemorrhage, wound infection, urine retention and delayed wound healing. In group A, bleeding occurred in 15 cases (0.4%), and in group B in two cases (0.05%). The bleeding rate in group A was significantly higher (P=0.002). In group A, urinary retention was seen in 12 cases (0.03%), in comparison to 35 cases (0.9%) in group B. This complication rate was significantly higher in group B (P=0.001). Local or systemic infection was not seen in either group. Although using thermal cautery we have less bleeding, the total complication rate is increased significantly. Copyright (c) 2010 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

  18. Applied Research on Laparoscopic Simulator in the Resident Surgical Laparoscopic Operation Technical Training. (United States)

    Fu, Shangxi; Liu, Xiao; Zhou, Li; Zhou, Meisheng; Wang, Liming


    The purpose of this study was to estimate the effects of surgical laparoscopic operation course on laparoscopic operation skills after the simulated training for medical students with relatively objective results via data gained before and after the practice course of laparoscopic simulator of the resident standardized trainees. Experiment 1: 20 resident standardized trainees with no experience in laparoscopic surgery were included in the inexperienced group and finished simulated cholecystectomy according to simulator videos. Simulator data was collected (total operation time, path length, average speed of instrument movement, movement efficiency, number of perforations, the time cautery is applied without appropriate contact with adhesions, number of serious complications). Ten attending doctors were included in the experienced group and conducted the operation of simulated cholecystectomy directly. Data was collected with simulator. Data of two groups was compared. Experiment 2: Participants in inexperienced group were assigned to basic group (receiving 8 items of basic operation training) and special group (receiving 8 items of basic operation training and 4 items of specialized training), and 10 persons for each group. They received training course designed by us respectively. After training level had reached the expected target, simulated cholecystectomy was performed, and data was collected. Experimental data between basic group and special group was compared and then data between special group and experienced group was compared. Results of experiment 1 showed that there is significant difference between data in inexperienced group in which participants operated simulated cholecystectomy only according to instructors' teaching and operation video and data in experienced group. Result of experiment 2 suggested that, total operation time, number of perforations, number of serious complications, number of non-cauterized bleeding and the time cautery is applied

  19. Ambroise Paré (1510-1590) and His Innovative Work on the Treatment of War Injuries. (United States)

    Markatos, Konstantinos; Tzivra, Anna; Tsoutsos, Spyridon; Tsourouflis, Gerasimos; Karamanou, Marianna; Androutsos, Georgios


    The purpose of this study is to summarize the innovations of Ambroise Paré (1510-1590) on the treatment of war wounds and improving amputation technique through ligature in arteries and veins. Ambroise Paré debunked the widely accepted idea that gun powder was poisonous for wounds. He also minimized the use of cautery of wounds by his dressing methods and the application of ligature during amputations. All these innovative rationales revolutionized the practice of war surgery during the Renaissance and paved the way for the introduction of modern surgery. Nevertheless, although his wound dressing innovations became widely accepted, the same did not happen with ligature and amputation; those techniques could become widely applicable if one could somehow control bleeding until the blood vessels had been tied. This became possible much later in the 18th century when Jean Louis Petit invented the first useful and efficient tourniquet.

  20. Fournier′s gangrene due to perioperative iatrogenic colon perforation in a renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Georgios Papadimitriou


    Full Text Available Fournier′s gangrene is not a common cause of morbidity in renal transplant recipients, but, if it occurs, it is difficult to treat because of the immunosuppression and associated increased mortality rate. We describe the case of a male patient who underwent renal transplantation with complicated post-operative course, resulting in cecum perforation (thermal injury due to cautery use during transplantation requiring exploratory laparotomy and cecostomy. A few days later, he developed Fournier′s gangrene and urgent radical surgical debridement of the scrotum was performed, along with aggressive antibiotic regimen and the immunosuppressive treatment was modified. Subsequently, the patient underwent scheduled cecostomy closure (right hemicolectomy, while the scrotum trauma healed with tertiary intention. Epidemiologic characteristics, clinical presentation, diagnostic workup, therapeutic options and morbidity-mortality rates of Fournier′s gangrene are reviewed, emphasizing the role of immunosuppression in renal transplant recipients to disease development.

  1. The evolving breast reconstruction

    DEFF Research Database (Denmark)

    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 criticized...... for oncoplastic and reconstructive breast surgery and will certainly become an invaluable addition to breast reconstructive methods....

  2. Laparoscopic partial nephrectomy in rats Nefrectomia parcial laparoscópica em ratos

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    Fernando Meyer


    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

  3. Vessel cauterization as a therapeutic adjunct in persistent disciform corneal stromal edema

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    Lasisi Akinola Muideen


    Full Text Available This is a case report of a symptomatic non-clearing, vascularized, disciform, corneal stromal edema with a feeder vessel that has remained refractory to medical therapy of antiviral, steroid, and antibiotics, for a period of three weeks, but showed a rapid improvement in visual acuity of 0.1 Log mar within five days of feeder vessel cauterization, together with improvement of two psychometric scales in corneal cloudiness on a scale range of 0 to 3, clinical evidence of resolution of corneal edema, and subjective resolution of the patient′s symptoms. Cauterization was done under magnification with a ball cautery point warmed in a spirit lamp following topical anesthesia. This intervention may become handy in difficult non-clearing corneal edema and prevent blinding consequences, in a low-resource facility, in selected applicable cases.

  4. Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series

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    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.

  5. Leiomyosarcoma of the inferior turbinate

    Directory of Open Access Journals (Sweden)

    Christopher W. Harper, Jr., MD


    Full Text Available We report a case of leiomyosarcoma of the inferior nasal turbinate. The patient, a 68-year-old Caucasian male, presented with 4–6 weeks of epistaxis that was resistant to nasal packing and septal cautery. Upon inspection in the operating room, a small mass was excised from the inferior turbinate. High-power H&E-stained microscopy demonstrated bundles of malignant smooth muscle cells, and immunohistochemical stains were strongly positive for desmin, smooth muscle actin and vimentin, while negative for pankeratin EA1/EA3 and CaM 5.2, suggesting leiomyosarcoma as the diagnosis. Clear margins were obtained at a second surgery. At the time of this writing it is 8 months since his last surgery and he has remained symptom free.

  6. Effects of administration of a local anaesthetic and/or an NSAID and of docking length on the behaviour of piglets during 5 h after tail docking

    DEFF Research Database (Denmark)

    Herskin, Mette S.; Di Giminiani, Pierpaolo; Thodberg, Karen


    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...... that effects of this management routine are more persistent than earlier suggested, and suggesting that docking length may influence the post-surgical behaviour of piglets. By use of the present sites of injection and dosages, neither local anaesthetic nor NSAID had marked effects on post-surgical behavioural......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...

  7. An update on epistaxis. (United States)

    Yau, Stephanie


    Epistaxis is one of the most common ear, nose and throat (ENT) emergencies to present to general practitioners (GPs). The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. Successful treatment requires knowledge of nasal anatomy, and potential risks and complications of treatment. Epistaxis is often a simple and readily treatable condition. However, given the potential consequences of a significant bleed, GPs should have an understanding of the causes, potential risks and emergency management. Epistaxis can be classified into anterior or posterior bleeds, the former being the most common. Anterior bleeds can often be treated with cauterisation with silver nitrate sticks, provided there is good preparation, correct equipment and assistance close at hand. If there is a lack in any of these aspects, prompt use of nasal packing and referral to an emergency department or a specialist ENT service is recommended.

  8. Management of intractable spontaneous epistaxis (United States)

    Rudmik, Luke


    Background: Epistaxis is a common otolaryngology emergency and is often controlled with first-line interventions such as cautery, hemostatic agents, or anterior nasal packing. A subset of patients will continue to bleed and require more aggressive therapy. Methods: Intractable spontaneous epistaxis was traditionally managed with posterior nasal packing and prolonged hospital admission. In an effort to reduce patient morbidity and shorten hospital stay, surgical and endovascular techniques have gained popularity. A literature review was conducted. Results: Transnasal endoscopic sphenopalatine artery ligation and arterial embolization provide excellent control rates but the decision to choose one over the other can be challenging. The role of transnasal endoscopic anterior ethmoid artery ligation is unclear but may be considered in certain cases when bleeding localizes to the ethmoid region. Conclusion: This article will focus on the management of intractable spontaneous epistaxis and discuss the role of endoscopic arterial ligation and embolization as it pertains to this challenging clinical scenario. PMID:22391084

  9. In vivo demonstration of surgical task assistance using miniature robots. (United States)

    Hawks, Jeff A; Kunowski, Jacob; Platt, Stephen R


    Laparoscopy is beneficial to patients as measured by less painful recovery and an earlier return to functional health compared to conventional open surgery. However, laparoscopy requires the manipulation of long, slender tools from outside the patient's body. As a result, laparoscopy generally benefits only patients undergoing relatively simple procedures. An innovative approach to laparoscopy uses miniature in vivo robots that fit entirely inside the abdominal cavity. Our previous work demonstrated that a mobile, wireless robot platform can be successfully operated inside the abdominal cavity with different payloads (biopsy, camera, and physiological sensors). We hope that these robots are a step toward reducing the invasiveness of laparoscopy. The current study presents design details and results of laboratory and in vivo demonstrations of several new payload designs (clamping, cautery, and liquid delivery). Laboratory and in vivo cooperation demonstrations between multiple robots are also presented.

  10. New maneuver in robotic single-port cholecystectomy

    International Nuclear Information System (INIS)

    Ege, B.; Gulen, M.


    The need to integrate aspects of functional, psychosocial and cosmetic impairment into medical care is increasingly accepted among the physicians and the patients. For these reasons, single-port robotic surgery emerges as the most advanced approach using the technology. In this study, authors used a new robotic dissector with monopolar electrocautery feature in order to determine the device's safety and efficacy. Between January 2015 and February 2016, 10 out of 11 consecutive cholecystectomies were included in the study. There was no significant differences in port placement and docking time between two groups (p=0.382, p=0.789). The time spent by surgeon was significantly shorter in group 2 (p=0.005). Using robotic dissector with monopolar cautery significantly shortened the console time. This new instrument (Maryland monopolar dissector) provides more feasible and faster dissection of the Calot's triangle, supporting further the advantages of robotic single-site cholecystectomy. (author)

  11. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    International Nuclear Information System (INIS)

    Handa, Toru; Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu


    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)

  12. Ligation of the internal maxillary artery for intractable epistaxis. 3D imaging of internal maxillary artery using helical CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Handa, Toru [Akitsu Prefectual Hospital, Hiroshima (Japan); Yazin, Koji; Hirakawa, Katsuhiro; Fukushima, Noriyuki; Takumida, Masaya; Hirata, Shitau; Iguchi, Tetsuhiko; Amano, Yoshiharu


    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)

  13. Principles of physics in surgery: the laws of mechanics and vectors physics for surgeons-part 2. (United States)

    Srivastava, Anurag; Sood, Akshay; Joy, Parijat S; Mandal, Shubhyan; Panwar, Rajesh; Ravichandran, Suresh; Sarangi, Sasmit; Woodcock, John


    In this sequel, to an earlier article, we discuss the laws of Mechanics, Thermodynamics and Vectors as they apply to soft and bony tissues. These include the Laplace's Law as applied to colonic perforation, compression therapy, parturition, variceal rupture, disc herniations etc. The Pascal's Law finds use in hernia repair and the Heimlich maneuver. Trigonometrically derived components of forces, acting after suturing, show ways to reduce cut-through; the thickness and the bite of suture determines the extent of tissue reaction. The heating effect of current explains the optimum gap between the prongs of a bipolar cautery and the use of law of transfer of heat in determining relation between healthy wound healing and ambient temperature.

  14. Segmental irradiation of the bladder with neodymium YAG laser irradiation

    International Nuclear Information System (INIS)

    McPhee, M.S.; Mador, D.R.; Tulip, J.; Ritchie, B.; Moore, R.; Lakey, W.H.


    The Neodymium YAG laser energy source can be readily adapted for cystoscopic use by some simple modifications of existing urologic equipment. Both the fiberoptic resectoscope and a deflecting cystourethroscope have been adapted for this purpose. Fixation of the fiber tip 1 cm. from the target and use of a divergent beam of 36 degrees allows the delivery of standardized dosage to a relatively large bladder tissue volume. Animal experiments involving 35 mongrel dogs established that repetitive overlapping doses of 200 joules ech can successfully treat a large area of bladder resulting in a full thickness bladder wall injury. This technique has been used in 4 high risk patients with infiltrating bladder cancer without adverse sequelae. The ability to reliably produce a full thickness lesion may give this modality a therapeutic advantage over conventional cautery techniques especially for the treatment of residual infiltrative carcinoma

  15. The laparoscopic ovarian electrocautery versus gonadotropin therapy in infertile women with clomiphene citrate-resistant polycystic ovary syndrome; a randomized controlled trial. (United States)

    Mehrabian, Ferdous; Eessaei, Fatemeh


    This study aimed to compare two methods of treatment of infertility with gonadotropin with laparoscopic ovarian electrocauterization in patients with clomiphene citrate-resistant polycystic ovary syndrome (PCOS). A number of 104 nulipara patients with polycystic ovary syndrome, who were resistant to clomiphene citrate were randomly assigned to two groups. One group received gonadotropin; after the bleeding withdrawal and from the third day of the cycle, the injection of human menopausal gonadotropin (HMG) was started with 10 mg medroxy progesterone. The patients were followed with serial trans-vaginal sonographies. When the diameter of follicles reached to 18 mm, human chorionic gonadotropin (HCG) was prescribed. The other group was treated with laparoscopic ovarian electrocauterization under general anesthesia. If after 3 cycles, the anovulation was established with progesterone measurement, the clomiphene citrate was prescribed. Gonadotropin was administered, if the lack of ovulation persisted. No significant difference was documented between the two groups in terms of the obesity indexes, duration of infertility, age, sonographic and laboratory findings. In the gonadotropin group, 37 cases (71%) of pregnancy occurred. The rate of pregnancy was the same in the other group consisting of 18 cases treated by electrocautery, 9 cases with cautery + clomiphene, and 10 cases with clomiphene + cautery + gonadotropin. In the group treated with gonadotropin, there were 1 triple and 4 twins pregnancies. In the group treated with ovarian electrocautery, one twin pregnancy was observed. In the group treated with gonadotropin, 2 cases of ovarian hyperstimulation syndrome, 1 case of ectopic pregnancy and 6 cases of miscarriage occurred; the corresponding figure in the ovarian electrocautery group consisted of 5 cases of miscarriage. Our findings suggest that ovarian electrocauterization is an appropriate method with good efficacy and low complication rate for infertility

  16. The use of FloSeal haemostatic sealant in the management of epistaxis: a prospective clinical study and literature review. (United States)

    Wakelam, O C; Dimitriadis, P A; Stephens, J


    INTRODUCTION It is standard practice in the UK that if conservative measures or chemical cautery fail to control epistaxis, patients receive nasal packing which is often uncomfortable, requires admission and has well documented associated morbidity. Our study aims to evaluate the use of FloSeal haemostatic sealant in managing patients with epistaxis. MATERIALS AND METHODS Patients were identified from those referred with active epistaxis. A successful outcome was defined as complete haemostasis with FloSeal alone, with no further significant bleeding requiring admission or further interventions in the subsequent 7 days. Patients reported satisfaction using a ten-point visual analogue scale. Ear, nose and throat doctors recorded patient demographics, time to prepare FloSeal, length of stay, need for further treatment and adverse events on an electronic database. RESULTS 30 patients were enrolled in the study. The mean time to prepare FloSeal was 5 minutes. The success rate of FloSeal was 90%. The mean length of stay was 2.75 hours. The mean patient satisfaction with FloSeal was 8.4/10. No adverse events occurred. DISCUSSION FloSeal was found to be effective in controlling anterior epistaxis. There was a single case of posterior epistaxis which required operative management. The literature largely supports FloSeal in anterior epistaxis, but indicates sphenopalatine artery ligation as the definitive management of posterior epistaxis. CONCLUSIONS Our data support the use of FloSeal in patients with anterior epistaxis not controlled with conservative measures or chemical cautery. It was found to be easy to use, is well tolerated by patients and is efficient in financial terms.

  17. Comprehensive approach to ocular consequences of Stevens Johnson Syndrome - the aftermath of a systemic condition. (United States)

    Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Kamala Muralidharan, Seema; Arumugam, Sumathi


    Stevens Johnson Syndrome (SJS) can lead to end stage corneal blindness. This study describes the comprehensive treatment measures and their outcomes in the management of ocular sequelae and complications of SJS. Four hundred sixty-four eyes of 232 patients of SJS who underwent surgical intervention (punctal cautery, mucus membrane grafting for lid margin keratinisation, fornix reconstructive procedures, tectonic procedures, keratoplasty and keratoprosthesis) were studied. It was a non-comparative, retrospective, interventional case series. The primary outcome was the change in the best corrected visual acuity (BCVA). Secondary outcome measures included an improvement in the ocular surface status as indicated by corneal epithelial fluorescein staining and Schirmer's I strip wetting. The BCVA and the ocular surface status improved and/or stabilized in > 70 % of eyes following punctal cautery (n = 160) and > 80 % of eyes following lid margin mucus membrane grafting (n = 238). BCVA improved in 50 % of eyes following fornix reconstructive procedures (n = 24) with COMET (n = 6), in 63.9 % eyes with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) lens (n = 36), in 81.8 % of eyes after cataract surgery (n = 22). A BCVA of ≥20/200 was achieved in 72.34 % of eyes following keratoprostheses procedures (n = 47). The mean duration of follow up was 53.3 ± 15.2 months. The ocular sequelae of Stevens Johnson Syndrome can be blinding. They need to be identified and addressed early to retard the continued deterioration of the ocular surface. Our study aims to highlight the problem as well as the importance of comprehensive measures in the management of this potentially blinding disorder.

  18. Operating room fires in periocular surgery. (United States)

    Connor, Michael A; Menke, Anne M; Vrcek, Ivan; Shore, John W


    A survey of ophthalmic plastic and reconstructive surgeons as well as seven-year data regarding claims made to the Ophthalmic Mutual Insurance Company (OMIC) is used to discuss operating room fires in periocular surgery. A retrospective review of all closed claim operating room fires submitted to OMIC was performed. A survey soliciting personal experiences with operating room fires was distributed to all American Society of Oculoplastic and Reconstructive Surgeons. Over the last 2 decades, OMIC managed 7 lawsuits resulting from an operating room fire during periocular surgery. The mean settlement per lawsuit was $145,285 (range $10,000-474,994). All six patients suffered burns to the face, and three required admission to a burn unit. One hundred and sixty-eight surgeons participated in the online survey. Approximately 44% of survey respondents have experienced at least one operating room fire. Supplemental oxygen was administered in 88% of these cases. Most surgical fires reported occurred in a hospital-based operating room (59%) under monitored anesthesia care (79%). Monopolar cautery (41%) and thermal, high-temperature cautery (41%) were most commonly reported as the inciting agents. Almost half of the patients involved in a surgical fire experienced a complication from the fire (48%). Sixty-nine percent of hospital operating rooms and 66% of ambulatory surgery centers maintain an operating room fire prevention policy. An intraoperative fire can be costly for both the patient and the surgeon. Ophthalmic surgeons operate in an oxygen rich and therefore flammable environment. Proactive measures can be undertaken to reduce the incidence of surgical fires periocular surgery; however, a fire can occur at any time and the entire operating room team must be constantly vigilant to prevent and manage operating room fires.

  19. Evaluation of pharmacological activities and assessment of intraocular penetration of an ayurvedic polyherbal eye drop (Itone™ in experimental models

    Directory of Open Access Journals (Sweden)

    Velpandian Thirumurthy


    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

  20. Para-axillary subcutaneous endoscopic approach in torticollis: tips and tricks in the surgical technique. (United States)

    Tokar, Baran; Karacay, Safak; Arda, Surhan; Alici, Umut


    An obvious scar on the neck may appear following the open surgery for congenital muscular torticollis (CMT). The cosmetic result may displease the patient and the family. In this study, we describe a minimally invasive technique, para-axillary subcutaneous endoscopic approach (PASEA) in CMT. A total of 11 children (seven girls and four boys with the age range between 1 and 15 years) were operated for torticollis by PASEA. All patients had facial asymmetry and head and neck postural abnormality. Following an incision at the ipsilateral para-axillary region, a subcutaneous cavernous working space is formed toward sternocleidomastoid (SCM) muscle. The muscle and fascia are cut by cautery under endoscopic vision. The patients had postoperative 2nd-week and 3rd-month visits. The incision scar, inspection, and palpation findings of the region, head posture, and shoulder position of the affected side were considered in evaluation of the cosmetic outcome. Preoperative and postoperative range of motion of the head and neck were compared for functional outcome. We preferred single incision surgery in our last two patients; the rest had double para-axillary incision for port insertion. Incomplete transection of the muscle was not observed. There was no serious complication. Postoperatively, head posture and shoulder elevation were corrected significantly. Range of motion of the head was improved. Postoperatively, all the patients had rotation capacity with more than 30 degrees. The range of postoperative flexion and extension movements was between 45 and 60 degrees. The open surgery techniques of CMT causes visible lifelong incision scar on the neck. PASEA leaves a cosmetically hidden scar in the axillary region. A single incision surgery is also possible. A well-formed cavernous working space is needed. External manual palpation, delicate dissection, and cutting of SCM muscle with cautery are the important components of the procedure. Surgeons having experience in pediatric

  1. Laparoscopic female sterilization. (United States)

    Filshie, G M


    An overview of laparoscopic sterilization techniques from a historical and practical viewpoint includes instrumentation, operative techniques, mechanical occlusive devices, anesthesia, failure rates, morbidity and mortality. Laparoscope was first reported in 1893, but was developed simultaneously in France, Great Britain, Canada and the US in the 1960s. There are smaller laparoscopes for double-puncture procedures, and larger, single-puncture laparoscopes. To use a ring or clip, a much larger operating channel, up to 8 mm is needed. Insufflating gas may be CO2, which does not support combustion, but is more uncomfortable, NO2, which is also an anesthetic, and room air often used in developing countries. Unipolar electrocautery is now rarely used, in fact most third party payers do not allow it. Bipolar cautery, thermal coagulation and laser photocoagulation are safer methods. Falope rings, Hulka-Clemens, Filshie, Bleier, Weck and Tupla clips are described and illustrated. General anesthesia, usually a short acting agent with a muscle relaxant, causes 33% of the mortality of laparoscope, often due to cardiac arrest and arrhythmias, preventable with atropine. Local anesthesia is safer and cheaper and often used in developing countries. Failure rates of the various laparoscopic tubal sterilization methods are reviewed: most result from fistula formation. Mortality and morbidity can be caused by bowel damage, injury or infection, pre- existing pelvic infection, hemorrhage, gas embolism (avoidable by the saline drip test), and other rare events.

  2. Minimally invasive repair of pectus excavatum in an adolescent with a history of a median sternotomy as an infant

    Directory of Open Access Journals (Sweden)

    Lauren Huckaby


    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.

  3. A randomized controlled study of the efficacy of misoprostol and hyaluronic acid in preventing adhesion formation after gynecological surgery: a rat uterine horn model. (United States)

    Kaya, Cihan; Sever, Nurten; Cengiz, Hüseyin; Yıldız, Şükrü; Ekin, Murat; Yaşar, Levent


    To investigate the effect of misoprostol in the reduction of adhesion formation after gynecological surgery. A double blind, randomized controlled experimental study was designed. Twenty-one female Wistar Hannover rats were divided into three groups as control, misoprostol and Hyalobarrier(®) groups. A uterine horn adhesion model was created. After anesthesia induction, 1.5-2cm injuries were made to the each uterine horn by cautery. The control group received no special medications except for the standard surgical procedure. The misoprostol group received 10μcg/kg misoprostol in addition to the standard surgical procedure, and the Hyalobarrier(®) group received 1cm(3) ready-for-use Hyalobarrier(®) gel intraperitoneally in addition to the standard surgical procedure. After 14 days from the first surgical procedure, adhesion scores were evaluated. The extent (p<0.001), severity (p<0.001), degree (p<0.001) and total adhesion score (p<0.001) values of the control group were statistically higher than the values of misoprostol and Hyalobarrier(®) groups. The inflammation score value of misoprostol group was statistically lower than control and Hyalobarrier(®) groups (p<0.001). In this study, we have found a new therapeutic potential of misoprostol that may be useful in preventing pelvic adhesion and reducing inflammation scores. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Management of Epistaxis – A Single Centre Experience and Economic Considerations

    LENUS (Irish Health Repository)

    Keane, E


    Epistaxis represents the most common ENT emergency and its management has been a focus of audit recently, with consideration given to the associated economic burden. The aim of our study is to evaluate the management of epistaxis in terms of treatments used, duration of stay, recurrence and cost. A retrospective review of hospital inpatient enquiry (HIPE) data from a single secondary referral centre was undertaken during a four year period. Four hundrefd and thirty-four patients were identified. The majority (n= 262, 60.3%) were male and the average age was 64.2 years. The vast majority (n=362, 83.4%) were managed non-operatively. Only 15 patients (3.4%) were managed surgically. The average length of stay was 2.5 days and did not vary greatly between the treatment groups. The recurrence rate was 8.2% (n=36). Approximate costs of packing vs EUA and cautery suggest that packing alone is more economical but more data is needed to fully compare the options.

  5. Novel Therapeutic Strategies in the Management of Non-Variceal Upper Gastrointestinal Bleeding

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    Ari Garber


    Full Text Available Non-variceal upper gastrointestinal bleeding, the most common etiology of which is peptic ulcer disease, remains a persistent challenge despite a reduction in both its incidence and mortality. Both pharmacologic and endoscopic techniques have been developed to achieve hemostasis, with varying degrees of success. Among the pharmacologic therapies, proton pump inhibitors remain the mainstay of treatment, as they reduce the risk of rebleeding and requirement for recurrent endoscopic evaluation. Tranexamic acid, a derivative of the amino acid lysine, is an antifibrinolytic agent whose role requires further investigation before application. Endoscopically delivered pharmacotherapy, including Hemospray (Cook Medical, EndoClot (EndoClot Plus Inc., and Ankaferd Blood Stopper (Ankaferd Health Products, in addition to standard epinephrine, show promise in this regard, although their mechanisms of action require further investigation. Non-pharmacologic endoscopic techniques use one of the following two methods to achieve hemostasis: ablation or mechanical tamponade, which may involve using endoscopic clips, cautery, argon plasma coagulation, over-the-scope clipping devices, radiofrequency ablation, and cryotherapy. This review aimed to highlight these novel and fundamental hemostatic strategies and the research supporting their efficacy.

  6. Lateral skull base approaches in the management of benign parapharyngeal space tumors. (United States)

    Prasad, Sampath Chandra; Piccirillo, Enrico; Chovanec, Martin; La Melia, Claudio; De Donato, Giuseppe; Sanna, Mario


    To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach. Retrospective study of patients with benign parapharyngeal space tumors. The clinical features, radiology and preoperative management of skull base neurovasculature, the surgical approaches and overall results were recorded. 46 patients presented with 48 tumors. 12 were prestyloid and 36 poststyloid. 19 (39.6%) tumors were paragangliomas, 15 (31.25%) were schwannomas and 11 (23%) were pleomorphic adenomas. Preoperative embolization was performed in 19, stenting of the internal carotid artery in 4 and permanent balloon occlusion in 2 patients. 19 tumors were approached by the transcervical, 13 by transcervical-transparotid, 5 by transcervical-transmastoid, 6, 1 and 2 tumors by the infratemporal fossa approach types A, B and D, respectively. Total radical tumor removal was achieved in 46 (96%) of the cases. Lateral skull base approaches have an advantage over other approaches in the management of benign tumors of the parapharyngeal space due to the fact that they provide excellent exposure with less morbidity. The use of microscope combined with bipolar cautery reduces morbidity. Stenting of internal carotid artery gives a chance for complete tumor removal with arterial preservation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Intraoperative laser speckle contrast imaging for monitoring cerebral blood flow: results from a 10-patient pilot study (United States)

    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.

  8. Do radio frequencies of medical instruments common in the operating room interfere with near-infrared spectroscopy signals? (United States)

    Shadgan, Babak; Molavi, Behnam; Reid, W. D.; Dumont, Guy; Macnab, Andrew J.


    Background: Medical and diagnostic applications of near infrared spectroscopy (NIRS) are increasing, especially in operating rooms (OR). Since NIRS is an optical technique, radio frequency (RF) interference from other instruments is unlikely to affect the raw optical data, however, NIRS data processing and signal output could be affected. Methods: We investigated the potential for three common OR instruments: an electrical cautery, an orthopaedic drill and an imaging system, to generate electromagnetic interference (EMI) that could potentially influence NIRS signals. The time of onset and duration of every operation of each device was recorded during surgery. To remove the effects of slow changing physiological variables, we first used a lowpass filter and then selected 2 windows with variable lengths around the moment of device onset. For each instant, variances (energy) and means of the signals in the 2 windows were compared. Results: Twenty patients were studied during ankle surgery. Analysis shows no statistically significant difference in the means and variance of the NIRS signals (p < 0.01) during operation of any of the three devices for all surgeries. Conclusion: This method confirms the instruments evaluated caused no significant interference. NIRS can potentially be used without EMI in clinical environments such as the OR.

  9. Chromaticity based smoke removal in endoscopic images (United States)

    Tchaka, Kevin; Pawar, Vijay M.; Stoyanov, Danail


    In minimally invasive surgery, image quality is a critical pre-requisite to ensure a surgeons ability to perform a procedure. In endoscopic procedures, image quality can deteriorate for a number of reasons such as fogging due to the temperature gradient after intra-corporeal insertion, lack of focus and due to smoke generated when using electro-cautery to dissect tissues without bleeding. In this paper we investigate the use of vision processing techniques to remove surgical smoke and improve the clarity of the image. We model the image formation process by introducing a haze medium to account for the degradation of visibility. For simplicity and computational efficiency we use an adapted dark-channel prior method combined with histogram equalization to remove smoke artifacts to recover the radiance image and enhance the contrast and brightness of the final result. Our initial results on images from robotic assisted procedures are promising and show that the proposed approach may be used to enhance image quality during surgery without additional suction devices. In addition, the processing pipeline may be used as an important part of a robust surgical vision pipeline that can continue working in the presence of smoke.

  10. Ovarian size and response to laparoscopic ovarian electro-cauterization in polycystic ovarian disease. (United States)

    Alborzi, S; Khodaee, R; Parsanejad, M E


    To evaluate endocrine and ovulatory changes in polycystic ovarian disease (PCOD) in relation to patients' ovarian size. Three hundred and seventy-one women with clomiphene citrate-resistant PCOD underwent laparoscopic ovarian cauterization [type I or typical with ovarian volume >8 cm(3) or cross-sectional area >10 cm(2) (n=211), type II with normal size ovary (n=160)]. Serum levels of LH, FSH, DHEAS, PRL, and T before and 10 days after ovarian cautery, spontaneous and induced ovulation and pregnancy rates were compared. Both groups responded to therapy in a similar manner, with a marked decrease in LH, FSH, DHEAS and T levels, with ovulation rates in type I 90.99%, type II 88.75% and pregnancy rates, 73.45% and 71.25%, respectively, with no statistical differences. Hormonal changes, ovulation and pregnancy rates were similar in the two types of PCOD, therefore it can be concluded that ovarian size is not a prognostic factor for response of PCOD patients to laparoscopic ovarian electro-cauterization.

  11. The outcome of laparoscopic cholecystectomy by ultrasonic dissection.

    LENUS (Irish Health Repository)

    Sasi, Walid


    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.

  12. Cervical cancer screening in women referred to healthcare centres in Tabriz, Iran. (United States)

    Farshbaf-Khalili, Azizeh; Salehi-Pourmehr, Hanieh; Shahnazi, Mahnaz; Yaghoubi, Sina; Gahremani-Nasab, Parvaneh


    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. 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 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. 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.

  13. Topical application of Mitomycin C in the treatment of granulation tissue after Canal Wall Down mastoidectomy

    Directory of Open Access Journals (Sweden)

    Alireza Karimi-Yazdi


    Full Text Available Introduction: Otorrhea and granulation tissue in Canal Wall Down mastoidectomy (CWD is the common problem in cholesteatoma removal and leads to many discomfort for both the patient and the physician. The main objective in CWD is creating the dry cavity, so the topical antibiotic and acetic acid in variable saturations are used for this purpose. In this study we evaluate the effectiveness of topical MMC and chemical cautery by acetic acid.   Materials and Methods: Study population consists of 50 patients with cholesteatoma whom underwent CWD. All patient allocated randomly in two study groups, MMC and acetic acid. After 3 weeks, the first visit is planned, extension of granulation tissue and dryness of cavity are evaluated and topical drugs are used in blind fashion. MMC in 4% and acetic acid in 12.5% saturation are applied. Other visits are completed at next month and 3 months later.   Results: Both methods are effective in treatment of granulation tissue. In each group both treatment were effective too but MMC was more effective than acid acetic in the treatment of granulation tissue after 4 weeks.   Conclusion: Based on our findings, it is clear that topical MMC is very effective in the treatment of granulation tissue and in CWD. It results in dry cavity much better than acetic acid without any complication. 

  14. Permanent pace maker implantation through axillary vein approach

    International Nuclear Information System (INIS)

    Shah, B.; Hussain, C.; Awan, Z.A.


    Device implantation is an integral part of interventional cardiology particularly electrophysiology. In this study, we are going to share our experience of device implantation technique at electrophysiology department Hayatabad Medical Complex, Peshawar. Methods: the study was conducted from June 2011 to December 2015. Axillary vein was used to implant the devices but in some cases when this rout was not convenient due to any reason then subclavian vein was entered through the Seldinger technique. Fluoroscopy time was less than 10 minutes and total procedure time was not more than 45 minutes. Electric cautery was used only in two cases. Pressure dressing was used in a few cases. Results: Total numbers of permanent pacemakers (PPM) remain 800 during the study period. There were 450 single chamber pacemakers and 350 dual chambers pacemakers. No case of any major bleeding was documented and in very few cases there was mild ooze from the procedure site after the operation which was tackled with pressure dressing. Four cases of pneumothorax were noted during the study period and in three cases chest intubation were done and one patient was kept on conservative management. Patient were followed after one month of discharge from the hospital and then yearly. Eight cases of lead dislodgment were documented during the study period. Conclusion: Axillary vein approach for implantation of permanent pacemakers is a safe and less time-consuming technique. (author)

  15. Quantum computing: a prime modality in neurosurgery's future. (United States)

    Lee, Brian; Liu, Charles Y; Apuzzo, Michael L J


    With each significant development in the field of neurosurgery, our dependence on computers, small and large, has continuously increased. From something as mundane as bipolar cautery to sophisticated intraoperative navigation with real-time magnetic resonance imaging-assisted surgical guidance, both technologies, however simple or complex, require computational processing power to function. The next frontier for neurosurgery involves developing a greater understanding of the brain and furthering our capabilities as surgeons to directly affect brain circuitry and function. This has come in the form of implantable devices that can electronically and nondestructively influence the cortex and nuclei with the purpose of restoring neuronal function and improving quality of life. We are now transitioning from devices that are turned on and left alone, such as vagus nerve stimulators and deep brain stimulators, to "smart" devices that can listen and react to the body as the situation may dictate. The development of quantum computers and their potential to be thousands, if not millions, of times faster than current "classical" computers, will significantly affect the neurosciences, especially the field of neurorehabilitation and neuromodulation. Quantum computers may advance our understanding of the neural code and, in turn, better develop and program implantable neural devices. When quantum computers reach the point where we can actually implant such devices in patients, the possibilities of what can be done to interface and restore neural function will be limitless. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Evaluation of percutaneous radiologic placement of peritoneal dialysis catheters: technical aspects, results, and complications

    International Nuclear Information System (INIS)

    Hong, Hyun Pyo; Oh, Joo Hyeong; Yoon, Yub; Lee, Tae Won; Ihm, Chun Gyoo


    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

  17. Evaluation of percutaneous radiologic placement of peritoneal dialysis catheters: technical aspects, results, and complications

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo; Oh, Joo Hyeong; Yoon, Yub; Lee, Tae Won; Ihm, Chun Gyoo [Kyunghee University Hospital, seoul (Korea, Republic of)


    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.

  18. Surgical and interventional radiological management of adult epistaxis: systematic review. (United States)

    Swords, C; Patel, A; Smith, M E; Williams, R J; Kuhn, I; Hopkins, C


    There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery. A systematic review of the literature was performed using a standardised published methodology and custom database search strategy. Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73-100 per cent and 75-92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1-1.5 per cent). No articles directly compared the two techniques. Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

  19. Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia. (United States)

    Boyer, Holly; Fernandes, Patricia; Le, Chap; Yueh, Bevan


    Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (-0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT. © 2015 ARS-AAOA, LLC.

  20. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal (United States)


    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients. PMID:26346242

  1. Effect of cochlear nerve electrocautery on the adult cochlear nucleus. (United States)

    Iseli, Claire E; Merwin, William H; Klatt-Cromwell, Cristine; Hutson, Kendall A; Ewend, Matthew G; Adunka, Oliver F; Fitzpatrick, Douglas C; Buchman, Craig A


    Electrocauterization and subsequent transection of the cochlear nerve induce greater injury to the cochlear nucleus than sharp transection alone. Some studies show that neurofibromatosis Type 2 (NF2) patients fit with auditory brainstem implants (ABIs) fail to achieve speech perception abilities similar to ABI recipients without NF2. Reasons for these differences remain speculative. One hypothesis posits poorer performance to surgically induced trauma to the cochlear nucleus from electrocautery. Sustained electrosurgical depolarization of the cochlear nerve may cause excitotoxic-induced postsynaptic nuclear injury. Equally plausible is that cautery in the vicinity of the cochlear nucleus induces necrosis. The cochlear nerve was transected in anesthetized adult gerbils sharply with or without bipolar electrocautery at varying intensities. Gerbils were perfused at 1, 3, 5, and 7 days postoperatively; their brainstem and cochleas were embedded in paraffin and sectioned at 10 μm. Alternate sections were stained with flourescent markers for neuronal injury or Nissl substance. In additional experiments, anterograde tracers were applied directly to a sectioned eighth nerve to verify that fluorescent-labeled profiles seen were terminating auditory nerve fibers. Cochlear nerve injury was observed from 72 hours postoperatively and was identical across cases regardless of surgical technique. Postsynaptic cochlear nucleus injury was not seen after distal transection of the nerve. By contrast, proximal transection was associated with trauma to the cochlear nucleus. Distal application of bipolar electrocautery seems safe for the cochlear nucleus. Application near the root entry zone must be used cautiously because this may compromise nuclear viability needed to support ABI stimulation.

  2. Comparing the outcomes of incisions made by colorado microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery: A randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Rampalli Viswa Chandra


    Full Text Available Context: Electrosurgery offers many unique advantages such as hemostasis and precise tissue cutting; however, there are a number of disadvantages including thermal injury and delayed wound healing. Aims: The aim of the present study was to compare the outcomes of incisions made by Colorado® microdissection needle, electrosurgery tip, and surgical blade during periodontal surgery. Settings and Design: Twenty-two individuals participated in this study. Three quadrants in each individual were randomly assigned into each of the following experimental groups: Colorado® microdissection needle (CMD, electrosurgery tip (EC and surgical blade (BP, in which, incisions were given with Colorado® microdissection needle, straight electrocautery tip, and a scalpel blade, respectively. Materials and Methods: Blood loss (BL was measured immediately after surgery, and changes in interdental papilla dimensions were recorded at baseline, 7, 30, 120, and 180 days after surgery. Measures of periodontal disease were recorded at baseline, 120, and 180 days after surgery. Postoperative pain and wound healing were recorded at 1, 7, and 15 days after surgery. Results: The use of CMD for periodontal surgery showed better results over EC in all parameters. CMD resulted in lesser bleeding and less postoperative pain and attained similar results to that of BP in clinical parameters of periodontal disease. Conclusions: Colorado® microdissection needle may be a better choice for incisions as it seems to show less tissue damage than cautery and offers tissue healing comparable to scalpel blade.

  3. Incidence of tissue coring during transseptal catheterization when using electrocautery and a standard transseptal needle. (United States)

    Greenstein, Eugene; Passman, Rod; Lin, Albert C; Knight, Bradley P


    The application of radiofrequency electrocautery to a standard, open-ended transseptal needle has been used to facilitate transseptal puncture (TSP). The purpose of this study was to determine the incidence of cardiac tissue coring when this technique is used. A model using excised swine hearts submerged in a saline-filled basin was developed to simulate TSP with electrocautery and a standard transseptal needle. Punctures were performed without the use of electrocautery and by delivering radiofrequency energy to the transseptal needle using a standard electrocautery pen at 3 target sites (fossa ovalis, non-fossa ovalis septum, and aorta). The tissue of the submerged heart was gently tented, and the needle was advanced on delivery of radiofrequency. The devices were retracted, and the needle was flushed in a collection basin. None of the TSPs without cautery caused tissue coring. For TSPs using electrocautery, the frequency of coring was at least 21% for any puncture permutation used in the study and averaged 37% at septal sites (Pelectrocautery and a standard open-ended Brockenbrough needle resulted in coring of the septal tissue in 35% of cases (33 of 96 punctures).

  4. Torsion of the fallopian tube--a late complication of sterilisation. (United States)

    Sivanesaratnam, V


    Torsion of an intact fallopian tube, unaccompanied by torsion of the ipsilateral ovary, was noted as a complication of bilateral tubal occlusion by the Pomeroy method in a 45-year old Indian woman. The sterilization was performed 5 years previously, at the time of Cesarean section delivery. The patient presented with a history of pain in the right iliac fossa. Laparotomy showed that the distal segment of the right fallopian tube was twisted 3 times on the distal mesosalpinx and appeared tense and gangrenous. The right ovary was normal and a 2 cm gap was noted between the proximal and distal segments of the tube. As a rare complication of the Pomeroy method, the gap in the tube can allow the distal mesosalpinx to act as a pedicle, and with a long mesosalpinx, the fimbriated segment of the tube lies free and may swing and twist to produce torsion. The occurrence of torsion is further promoted by a vascular disturbance leading to venous congestion, edema, and increased weight of the free fimbrial end of the tube. In those patients with a history of sterilization, torsion of the fallopian tube should be considered in the differential diagnosis of acute lower abdominal pain. Torsion of the fallopian tube has also been reported following other methods of tubal occlusion, including cautery and clips.

  5. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal. (United States)

    Parajuli, Ramesh


    Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients.

  6. The effect of bevacizumab (Avastin) treatment on epistaxis in hereditary hemorrhagic telangiectasia. (United States)

    Simonds, Jana; Miller, Frank; Mandel, Jess; Davidson, Terence M


    Determine the effectiveness of treating epistaxis in hereditary hemorrhagic telangiectasia (HHT) with potassium titanyl phosphate (KTP) laser cautery combined with submucosal injection of 100 mg of bevacizumab. Retrospective pilot study. Bevacizumab was injected throughout the nasal cavity following KTP laser treatment in 10 patients (bevacizumab/KTP group) and compared to nine patients previously treated with KTP laser alone (KTP group). Epistaxis frequency and severity, blood transfusion requirement, intravenous iron supplementation, emergency department visit frequency, and quality of life within 1 month and 1 year pre- and postsurgery were analyzed. Benefit was defined as less than three nosebleeds per week, with less than 10 minutes to stop each nosebleed, and no blood transfusions. The pre- and postsurgery data were analyzed within and between the two groups. The groups were comparable in age and gender. Significant benefit was found in frequency of epistaxis (P epistaxis is superior to KTP laser treatment alone. It significantly decreases frequency and severity of nosebleeds and blood transfusion requirements, and significantly improves work ability and quality of life.

  7. Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal

    Directory of Open Access Journals (Sweden)

    Ramesh Parajuli


    Full Text Available Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology. It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of 84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic (38.09% followed by hypertension (27.38%, trauma (15.47%, and coagulopathy (8.33%. Regarding treatment methods, most (52.38% of our patients required anterior nasal packing. Chemical cautery was sufficient to stop bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66% patients, respectively. Two (2.38% patients required endoscopic sphenopalatine arterial ligation. Conclusion. Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied to these patients.

  8. Pulsed dye laser application in ablation of vascular ectasias of the larynx: a preliminary animal study (United States)

    Woo, Peak; Wang, Zhi; Perrault, Donald F., Jr.; McMillan, Kathleen; Pankratov, Michail M.


    Vascular ectasias (dilatation) and vascular lesions of the larynx are difficult to treat with exciting modalities. Varix (enlarged vessel) of the vocal folds, vocal fold hemorrhage, vascular polyp, hemangioma, intubation or contact granuloma are common problems which disturb voice. Current applications of CO2 laser and cautery often damage the delicate vocal fold cover. The 585 nm dermatologic pulsed dye laser may be an ideal substitute. Two adult canines were examined under anesthesia via microlaryngoscopy technique. Pulsed dye laser (SPTL-1a, Candela Laser Corp., Wayland, MA) energy was delivered via the micromanipulator with the 3.1-mm spot size in single pulses of 6, 8, and 10 Joules/cm2 and applied to the vessels of the vocal folds, epiglottis, and arytenoid cartilage. Endoscopic examination was carried out immediately after the treatment and at 4 weeks postoperatively. The animals were sacrificed at 3 weeks, larynges excised, and whole organ laryngeal section were prepared for histology. Pulsed dye laser thrombosed vessels of the vocal fold using 6 or 8 Joules/cm2. Vascular break and leakage occurred at 10 Joules/cm2. Follow up examination showed excellent vessel obliteration or thrombosis without scarring or injury to the overlying tissues. Histologic examination shows vascular thrombosis without inflammation and fibrosis in the vocal fold cover. Pulsed dye laser may have promise in treatment of vascular lesions of the larynx and upper airway.

  9. Laparoscopy hepatic biopsy through cauterization Biópsia hepática laparoscopica por cauterização

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    Alexandra Pinheiro Fantinatti


    Full Text Available Hepatic biopsy was realized through laparoscopy with simultaneous cauterization in the present study, whose principal aim was to evaluate the efficacy of the applied method and to study its effects in the liver of healthy dogs. Furthermore, we tried to verify the main hematological and chemistry profile alterations related to the hepatic function, and to investigate the viability of the fragments collected by histopathology. To attain this objective, 21 clinically healthy dogs, weighing between 10 and 15kg were submitted to hepatic biopsy with forceps connected to the cautery. Cautery was performed by applying radiofrequency energy at 45 watts. Forty-two hepatic biopsies through laparoscopy were conducted in the animals. At group I one hepatic fragment per animal was collected, at group II two hepatic fragments per animal were collected, and at group III three fragments were collected. Hematocrit and alanine-aminotransferase measurements were employed to evaluate the animals at the pre-operative period, at four and six hour post-operative, and at day 30 post-operative. The results revealed that the procedure was safe and effective for hepatic biopsy in dogs. There were no clinical alterations related to the technique. The fragments collected were viable for histopathology. Hepatic biopsy through laparoscopy with simultaneous cauterization is an effective and usefull method in dogs.Este estudo visou avaliar a eficácia do método de biópsia hepática laparoscópica por cauterização e estudar os seus efeitos no fígado de cães sadios. Além disso, procurou-se verificar as principais alterações hematológicas e bioquímicas-séricas relacionadas às funções hepáticas e averiguar a viabilidade dos fragmentos colhidos por exame de histopatologia. Para tanto, 21 cães clinicamente sadios pesando entre 10 e 15kg, foram separados em três grupos de sete animais cada grupo. As amostras foram retiradas da borda no lobo lateral esquerdo

  10. Neuroprotective effects of andrographolide in a rat model of permanent cerebral ischaemia (United States)

    Chan, Su Jing; Wong, WS Fred; Wong, Peter TH; Bian, Jin-Song


    BACKGROUND AND PURPOSE Andrographolide is a diterpenoid lactone isolated from a traditional medicinal herb, Andrographis paniculata. It possesses potent anti-inflammatory activity. The present study examined potential therapeutic effects of andrographolide on cerebral ischaemia using a rat model with permanent middle cerebral artery occlusion (pMCAO). EXPERIMENTAL APPROACH The MCA in rats was permanently occluded (by cautery), and 24 h later neurological effects were assessed with behavioural scores. Infarct volume and microglial activation were determined histologically. The p65 form of the transcription factor, nuclear factor-κB (NF-κB), was measured by Western blot, and cytokines by immunoassay of brain extracts. KEY RESULTS Andrographolide, given i.p. 1 h after pMCAO, reduced infarct volume with a maximum reduction of approximately 50% obtained at 0.1 mg·kg−1. Neurological deficits were also reduced by andrographolide, reflecting a correlation between infarct volume and neurological deficits. pMCAO was found to induce activation of microglia and elevate tumour necrosis factor (TNF)-α, interleukin (IL)-1β and prostaglandin (PG)E2 in the ischaemic brain areas. Andrographolide (0.1 mg·kg−1) significantly attenuated or abolished these effects. In addition, andrographolide suppressed the translocation of p65 from cytosol to nucleus, indicating reduced NF-κB activation. CONCLUSIONS AND IMPLICATIONS Andrographolide exhibited neuroprotective effects, with accompanying suppression of NF-κB and microglial activation, and reduction in the production of cytokines including TNF-α and IL-1β, and pro-inflammatory factors such as PGE2. Our findings suggest that andrographolide may have therapeutic value in the treatment of stroke. PMID:20880404

  11. The role of intraoperative ultrasound in small renal mass robotic enucleation

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    Roberta Gunelli


    Full Text Available Introduction: As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. Materials and methods: A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8 using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826. Results: Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2, the exact position of the lesion could be easily identified in all cases (22/22, even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13 and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22. No complications due to the use of the ultrasound probe were observed. Conclusions: The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during

  12. Pathology outcomes in patients with transurethral bladder tumour resection in a Turkish population: A retrospective analysis

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    Salih Budak


    Full Text Available Objectives: Transurethral bladder tumour resection (TURBT is the common surgical method used in the diagnosis, staging and treatment of patients with bladder tumour. Most of the rare tumours other than the urothelial carcinomas of the bladder are in advanced stage on diagnosis and necessitate aggressive treatment. In our study, we aimed to the histologic types of bladder cancer and to determine the regional incidence of rare bladder cancer types in our region. Materials and methods: We retrospectively evaluated 815 patients who underwent TURBT surgery between January 2010 and March 2016 in our clinic with a diagnosis of bladder cancer and at least 1 year follow-up. Patients with tumour histopathological examination including histological tumour type, grade and were reported. Thirty-nine patients with an unclear pathology report (neighboring organ invasion, cautery artifact, etc and 17 patients whose data could not be accessed were excluded from the study. The patients who had received chemotherapy or radiotherapy due to any type of malignancy (23 were also excluded from the study. Results: The outcomes of 736 patients operated in our clinics due to bladder tumour were evaluated. The mean age was 65.2 ± 8.4; 135 were female and 601 were male. Among them 711 patients with urothelial carcinoma were reported (94.2%. According to TNM classification, stage Ta was observed in 270 patients (37.9%, stage T1 in 297 (41.7%, and stage T2 in 144 (20.3%. Non-urothelial cancers were reported in 25 cases (3.3%. Conclusion: The incidence of bladder carcinoma varies between regions. The results of our study are similar to those of the western countries. Increased smoking and exposure to environmental carcinogenetic agents may lead to altered incidences and histological types of bladder tumours. Revision of regional tumour records may be useful to develop and evaluate future treatment strategies.

  13. Parallel pocket incision: Less invasive surgical intervention for the treatment of intractable pressure ulcer with wound edge undermining. (United States)

    Yamamoto, Takumi; Yoshimatsu, Hidehiko; Hayashi, Akitatsu; Koshima, Isao


    The treatment of deep pressure ulcer with a wide wound edge undermining (pocket) is challenging, especially when conservative treatments are ineffective. As most patients with a pressure ulcer suffer from systemic comorbidities, invasive surgery cannot be performed on all patients, and less invasive treatment is required. Less invasive surgical intervention to a deep pressure ulcer, parallel pocket incision (PPI), was performed on 10 patients with intractable pressure ulcers with a pocket formation. In PPI procedures, two parallel skin incisions were made to open up the deepest fold of the pocket and to preserve the skin overlying the pocket lesion; through the created incisions, the necrotic tissues around the deepest fold of the undermining could be easily removed, which facilitated spontaneous wound healing. Postoperative results and complications were evaluated. All PPI procedures were safely performed under local infiltration anesthesia without major postoperative complication; minor bleeding was seen intraoperatively in three patients, which could be easily controlled with electric cautery coagulation. Nine of 10 ulcers were cured after PPI, and one could not be followed up due to the patient's death non-related to the pressure ulcer. For the nine cured patients, the average time for cure was 14.9 weeks, and no recurrence was observed at postoperative 6 months. PPI is a simple, technically easy, and less invasive surgical intervention to an intractable pressure ulcer with a pocket, which can be safely performed under local infiltration anesthesia even on a patient with severe systemic comorbidities. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Management of third branchial pouch anomalies - an evolution of a minimally invasive technique. (United States)

    Wong, Phui Yee; Moore, Andrew; Daya, Hamid


    The management of third branchial pouch anomalies has evolved in recent times with the popularisation of the endoscopic diathermy technique to sclerose the pyriform fossa sinus opening. We present our experience in managing 3 children with third branchial pouch anomalies and propose a minimally invasive management algorithm avoiding open neck surgery. Retrospective case review of 3 patients including demographics, mode of presentation, investigations, management and complications. Three children, two male and one female of mean age 9.6 years presented with painful left anterior neck swelling. Axial neck imaging showed a superficial abscess with air locules and a sinus tract leading towards the left pharynx. Diagnosis was confirmed by endoscopic examination of the pyriform fossa revealing a sinus opening. Two patients underwent open excision; one combined with diathermy to the sinus opening. The last patient was diagnosed at his initial presentation and managed with endoscopic diathermy of the sinus opening combined with percutaneous needle aspiration of the neck abscess at the same sitting. One patient had two recurrences, the first after initial open surgery and the second after the first cautery. Two patients developed temporary hoarseness after the procedure, which resolved within two weeks. All patients were free from recurrences at follow-up. Introduction of the technique of endoscopic diathermy to the pyriform fossa sinus opening in children with third branchial pouch anomalies has revolutionised their management avoiding open and potentially morbid surgery. Our algorithm takes this further by advocating percutaneous needle aspiration of the infective component and performing diathermy to the sinus opening at the first presentation. Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.

  15. Graphic and haptic simulation for transvaginal cholecystectomy training in NOTES. (United States)

    Pan, Jun J; Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Li, Bai C; Sankaranarayanan, Ganesh; Roberts, Kurt; Schwaitzberg, Steven; De, Suvranu


    Natural Orifice Transluminal Endoscopic Surgery (NOTES) provides an emerging surgical technique which usually needs a long learning curve for surgeons. Virtual reality (VR) medical simulators with vision and haptic feedback can usually offer an efficient and cost-effective alternative without risk to the traditional training approaches. Under this motivation, we developed the first virtual reality simulator for transvaginal cholecystectomy in NOTES (VTEST™). This VR-based surgical simulator aims to simulate the hybrid NOTES of cholecystectomy. We use a 6DOF haptic device and a tracking sensor to construct the core hardware component of simulator. For software, an innovative approach based on the inner-spheres is presented to deform the organs in real time. To handle the frequent collision between soft tissue and surgical instruments, an adaptive collision detection method based on GPU is designed and implemented. To give a realistic visual performance of gallbladder fat tissue removal by cautery hook, a multi-layer hexahedral model is presented to simulate the electric dissection of fat tissue. From the experimental results, trainees can operate in real time with high degree of stability and fidelity. A preliminary study was also performed to evaluate the realism and the usefulness of this hybrid NOTES simulator. This prototyped simulation system has been verified by surgeons through a pilot study. Some items of its visual performance and the utility were rated fairly high by the participants during testing. It exhibits the potential to improve the surgical skills of trainee and effectively shorten their learning curve. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Risk factors, microbiological findings, and clinical outcomes in cases of microbial keratitis admitted to a tertiary referral center in ireland.

    LENUS (Irish Health Repository)

    Saeed, Ayman


    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.

  17. Evaluation of antiangiogenic and antiproliferative potential of the organic extract of green algae chlorella pyrenoidosa (United States)

    Kyadari, Mahender; Fatma, Tasneem; Azad, Rajvardhan; Velpandian, Thirumurthy


    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 IC50 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 activity may be

  18. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication. (United States)

    Moore, John B; Hasenboehler, Erik A


    Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Ischemic orchitis typically presents 2-3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.

  19. The role of intraoperative ultrasound in small renal mass robotic enucleation. (United States)

    Gunelli, Roberta; Fiori, Massimo; Salaris, Cristiano; Salomone, Umberto; Urbinati, Marco; Vici, Alexia; Zenico, Teo; Bertocco, Mauro


    As a result of the growing evidence on tumor radical resection in literature, simple enucleation has become one of the best techniques associated to robotic surgery in the treatment of renal neoplasia, as it guarantees minimal invasiveness and the maximum sparing of renal tissue, facilitating the use of reduced or zero ischemia techniques during resection. The use of a robotic ultrasound probe represents a useful tool to detect and define tumor location, especially in poorly exophytic small renal mass. A total of 22 robotic enucleations were performed on < 3 cm renal neoplasias (PADUA score 18 Pz 6/7 e 4 Pz 8) using a 12-5 MHz robotic ultrasound probe (BK Drop-In 8826). Once kidney had been isolated from the adipose capsule at the site of the neoplasia (2), the exact position of the lesion could be easily identified in all cases (22/22), even for mostly endophytic lesions, thanks to the insertion of the ultrasound probe through the assistant port. Images were produced and visualized by the surgeon using the TilePro feature of the DaVinci surgical system for producing a picture-in-picture image on the console screen. The margins of resection were then marked with cautery, thus allowing for speedy anatomical dissection. This reduced the time of ischemia to 8 min (6-13) and facilitated the enucleation technique when performed without clamping the renal peduncle (6/22). No complications due to the use of the ultrasound probe were observed. The use of an intraoperative robotic ultrasound probe has allowed for easier identification of small, mostly endophytic neoplasias, better anatomical approach, shorter ischemic time, reduced risk of pseudocapsule rupture during dissection, and easier enucleation in cases performed without clamping. It is noteworthy that the use of intraoperative ultrasound probe allows mental reconstruction of the tumor through an accurate 3D vision of the hidden field during surgical dissection.

  20. Comparison of the effects of ovarian cauterization and gonadotropin-releasing hormone agonist and oral contraceptive therapy combination on endocrine changes in women with polycystic ovary disease. (United States)

    Taskin, O; Yalcinoglu, A I; Kafkasli, A; Burak, F; Ozekici, U


    To study the effects of laparoscopic ovarian cauterization and combination of long-acting GnRH agonist (GnRH-a) and oral contraceptive (OC) therapy on endocrine changes in women with clomiphene citrate (CC)- resistant polycystic ovary disease (PCOD). Prospective, randomized. University-based infertility clinic. Seventeen women with CC-resistant PCOD were included randomly in the study to either laparoscopic ovarian cautery or GnRH-a and OC therapy for 3 months. Serum concentrations of LH, FSH, androstenedione (A), T, and sex hormone-binding globulin (SHBG) were determined before each therapeutic approach and during the follicular phase of first menstrual cycle after the cessation of each treatment. The mean serum concentrations and the clinical profiles were similar in both groups. Both groups showed significant changes in LH, FSH, A, T, and SHBG compared with pretreatment levels. There were no significant differences in the final concentrations of LH, FSH, and A between the two study groups after each treatment, whereas T and SHBG levels were significantly different in the goserelin and OC group. The decrease in LH and increase in SHBG serum concentrations were greater in the goserelin and OC-treated women [-59% and + 5.9% versus - 70% and + 13.5%, respectively]. Although the SHBG concentration increased in both groups, the serum SHBG concentration of the goserelin and OC group was significantly higher than the other group. Both therapeutic modalities revealed similar effects on the endocrine profiles in women with CC-resistant PCOD. Considering the invasiveness, cost, and potential complications of laparoscopic ovarian cauterization, noninvasive medical treatment with GnRH-a and OC combination may be more effective in restoring the optimal follicular environment in women with PCOD.

  1. Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia. (United States)

    Beaulieu, Daphnée; Barkun, Alan; Martel, Myriam


    To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. 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. 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 polyp removal 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. This audit reveals lacking reported items, justifying additional research to

  2. Harmonic scalpel versus flexible CO2 laser for tongue resection: A histopathological analysis of thermal damage in human cadavers

    Directory of Open Access Journals (Sweden)

    Wolf Tamir


    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.

  3. A challenge-response endoscopic sinus surgery specific checklist as an add-on to standard surgical checklist: an evaluation of potential safety and quality improvement issues. (United States)

    Sommer, Doron D; Arbab-Tafti, Sadaf; Farrokhyar, Forough; Tewfik, Marc; Vescan, Allan; Witterick, Ian J; Rotenberg, Brian; Chandra, Rakesh; Weitzel, Erik K; Wright, Erin; Ramakrishna, Jayant


    The goal of this study was to develop and evaluate the impact of an aviation-style challenge and response sinus surgery-specific checklist on potential safety and equipment issues during sinus surgery at a tertiary academic health center. The secondary goal was to assess the potential impact of use of the checklist on surgical times during, before, and after surgery. This initiative is designed to be utilized in conjunction with the "standard" World Health Organization (WHO) surgical checklist. Although endoscopic sinus surgery is generally considered a safe procedure, avoidable complications and potential safety concerns continue to occur. The WHO surgical checklist does not directly address certain surgery-specific issues, which may be of particular relevance for endoscopic sinus surgery. This prospective observational pilot study monitored compliance with and compared the occurrence of safety and equipment issues before and after implementation of the checklist. Forty-seven consecutive endoscopic surgeries were audited; the first 8 without the checklist and the following 39 with the checklist. The checklist was compiled by evaluating the patient journey, utilizing the available literature, expert consensus, and finally reevaluation with audit type cases. The final checklist was developed with all relevant stakeholders involved in a Delphi method. Implementing this specific surgical checklist in 39 cases at our institution, allowed us to identify and rectify 35 separate instances of potentially unsafe, improper or inefficient preoperative setup. These incidents included issues with labeling of topical vasoconstrictor or injectable anesthetics (3, 7.7%) and availability, function and/or position of video monitors (2, 5.1%), endoscope (6, 15.4%), microdebrider (6, 15.4%), bipolar cautery (6, 15.4%), and suctions (12, 30.8%). The design and integration of this checklist for endoscopic sinus surgery, has helped improve efficiency and patient safety in the operating

  4. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication

    Directory of Open Access Journals (Sweden)

    Moore John B


    Full Text Available Abstract Background Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. Case presentation The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Conclusion Ischemic orchitis typically presents 2–3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.

  5. Cost-effectiveness analysis comparing the essure tubal sterilization procedure and laparoscopic tubal sterilization. (United States)

    Thiel, John A; Carson, George D


    To analyze the financial implications of establishing a hysteroscopic sterilization program using the Essure micro-insert tubal sterilization system in an ambulatory clinic. A retrospective cohort study (Canadian Task Force classification Type II-2), in an ambulatory women's health clinic in a tertiary hospital, of 108 women undergoing Essure coil insertion between 2005 and 2006, and 104 women undergoing laparoscopic tubal sterilization for permanent sterilization between 2001 and 2004. The Essure procedures used a 4 mm single channel operative hysteroscope and conscious sedation (fentanyl and midazolam); the laparoscopic tubal sterilizations were completed under general anaesthesia with a 7 mm laparoscope and either bipolar cautery or Filshie clips. Costs associated with the procedure, follow-up, and management of any complications (including nursing, hospital charges, equipment, and disposables) were tabulated. The Essure coils were successfully placed on the first attempt in 103 of 108 women (95%). Three patients required a second attempt to complete placement and two patients required laparoscopic tubal sterilization after an unsuccessful Essure. All 104 laparoscopic tubals were completed on the first attempt with no complications reported. The total cost for the 108 Essure procedures, including follow-up evaluation, was $138,996 or $1287 per case. The total cost associated with the 104 laparoscopic tubal sterilization procedures was $148,227 or $1398 per case. The incremental cost-effectiveness ratio was $111. The Essure procedure in an ambulatory setting resulted in a statistically significant cost saving of $111 per sterilization procedure. Carrying out the Essure procedure in an ambulatory setting frees space in the operating room for other types of cases, improving access to care for more patients.

  6. Paraganglioma of the urinary bladder: a clinicopathologic spectrum of a series of 14 cases emphasizing diagnostic dilemmas. (United States)

    Menon, Santosh; Goyal, Pankaj; Suryawanshi, Pallavi; Tongaonkar, Hemant; Joshi, Amit; Bakshi, Ganesh; Desai, Sangeeta


    Paraganglioma (PG) of the urinary bladder is a rare neuroendocrine neoplasm, accounting for bladder tumours. Distinction from urothelial carcinoma is imperative as management and prognosis vary markedly. In this report, we describe our experience with the histopathology of paragangliomas of the urinary bladder with emphasis on the histologic features that have led to their being misdiagnosed as conventional urothelial cancer and, most importantly, those that will help pathologists recognize this rare tumor of the bladder. All cases of PG of urinary bladder diagnosed at our institute from 2002-2012 were retrieved and diagnosis confirmed in accordance with WHO classification. Clinical and treatment details were obtained from hospital medical records. Fourteen cases of PG of urinary bladder including 5 consult cases were analysed. These included 11 transurethral resections ± partial cystectomies, 2 partial cystectomies and 1 radical cystectomy. Two out of the 5 consult cases had been submitted with a diagnosis of urothelial carcinoma and 1 with that of a rhabdomyosarcoma. Age ranged from 15-84 years (median, 43 years) with a male to female ratio of 1:2.5. Presenting symptoms were haematuria, dysuria and flank pain; only 1 case had antecedent hypertension. Histologically, typical 'zellballen' (72%), diffuse (21%) and ribbon-like (7%) growth patterns amidst a richly vascularised stroma were seen. Muscularis propria invasion and necrosis was present in 72% and 21%, respectively. Substantial cautery artifacts led to misdiagnosis in the 3 erroneous cases. Tumour cells were positive for chromogranin, synaptophysin; sustentacular cells were S-100 positive. Follow up was available in 6 patients; median follow-up was 29 months (8-120 months). One patient developed distant metastasis in cervical lymph node 10 years after diagnosis; remaining were alive without evidence of disease. Paraganglioma of the urinary bladder is a rare tumor and may be misdiagnosed as urothelial cancer

  7. Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method (United States)

    Timmins, Benjamin H.; Hunter, Benjamin N.; Wilson, Kevin F.; Ward, P. Daniel


    Background Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized due to its surgical complexity and flap breakdown. Methods Retrospective review of thirteen HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, pre- and post-procedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional three-flap closure and a simplified two-flap nasal closure procedure. Results The average candidate for nasal closure in this series had an ESS of 7.88, Hgb of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the two flap method is 0.92 and mean GBI score is 56.3. Comparison of five patients who underwent the traditional three-flap nasal closure procedure and eight patients receiving the two flap nasal closure showed no significant difference in post-op ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p=0.0001). Mean time to first revision for eight nasal closure patients is 21.5 months. Conclusion In short-term follow-up, the two-flap procedure has shown comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method. PMID:26751606

  8. Intraoperative complications of outpatient interval tubal sterilization at a teaching hospital in Turkey

    International Nuclear Information System (INIS)

    Dilbaz, B.; Akdag, D.; Cengiz, H.; Akyunak, A.; Dilbaz, S.; Haberal, A.


    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)

  9. Contemporary Management of Achalasia by Pediatric Surgeons: A Survey of the International Pediatric Endosurgical Group. (United States)

    Gould, Joanna L; Rentea, Rebecca M; St Peter, Shawn D


    Achalasia is a rare neurodegenerative disorder of the esophagus. Surgical repair consists of esophagomyotomy, often in conjunction with an antireflux procedure. We sought to determine practice patterns in surgical treatment of pediatric achalasia. Data regarding preferences were collected as part of a comprehensive online-based survey sent to members of the International Pediatric Endosurgery Group (IPEG) completed by 191 surgeons of which 141 performed esophagomyotomies for achalasia. Procedures performed per surgeon were 1-2 (n = 21, 15%); 3-5 (n = 49, 34%); 6-10 (n = 39, 28%); 11-20 (n = 21, 15%); >20 (n = 11, 8%). Most approached the operation laparoscopically (n = 127, 90%). Workup before esophageal myotomy consisted of a diagnostic esophagram (n = 133, 94%) or manometry (n = 102, 73%). Only 60% of surgeons (n = 84) required an EGD. No preference observed in division location of the phrenoesophageal ligament for mobilization of the esophagus. There was a predominant preference for hook cautery (n = 82, 58%) over harmonic shears (n = 30, 21%), heated sealing device LigaSure™ (n = 18, 13%), and other devices (n = 11, 8%) for muscle division. Intraoperatively, 57% (n = 80) had endoscopy and 50% (n = 71) had postoperative esophagram before initiation of enteral feeding. For antireflux procedure, Thal/Dor approach was performed most frequently (n = 111, 79%) followed by the Toupet (n = 18, 13%) and Nissen (n = 4, 3%) and none (n = 7, 5%). Diet restrictions were provided in 76% (n = 107) of postoperative patients. Given the infrequency of achalasia in children, there are a range of treatment plans among pediatric surgeons. We have identified current practices as a first step in developing more standard treatment pathways.

  10. The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection. (United States)

    Dadgarnia, Mohammad Hossein; Aghaei, Mohammad Ali; Atighechi, Saeid; Behniafard, Nasim; Vahidi, Mohammad Reza; Meybodian, Mojtaba; Zand, Vahid; Vajihinejad, Maryam; Ansari, Abdollah


    Although tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection. This double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study. In both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001). patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups. Moreover, Compared pain scores in all times across two groups, no significant difference was found. In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up. Our study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Histopathological and Postoperative Behavioral Comparison of Rodent Oral Tongue Resection: Fiber-Enabled CO2 Laser versus Electrocautery (United States)

    Shires, Courtney Brooke; Saputra, Jennifer Marie; King, Lauren; Thompson, Jerome W.; Heck, Detlef H.; Sebelik, Merry Ellen; Boughter, John Dudley


    Objective To compare operative time and hemostasis of fiber-enabled CO2 laser (FECL) energy to that of the electrocautery (EC) technique for oral tongue resection, to compare return to oral intake and preoperative weight after FECL and EC resection, and to compare histologic changes in adjacent tissue after FECL and EC resection. Study Design Prospective animal study. Setting Research laboratory. Subjects and Methods The CO2 laser fiber and the Bovie cautery were each used to resect the anterior tongue in 15 adult rats. Fixative perfusion and killing were performed on postoperative day 0 (n = 10), 3 (n = 10), or 7 (n = 10). Body weight, food intake, and water intake were recorded daily for 3- and 7-day survival rats. After preparation for histologic analysis, the tongue tissue was graded with a mucosal wound-healing scale (MWHS). Results A higher incidence of intraoperative bleeding and shorter operative times were noted in the EC group. No statistically significant difference in postoperative food or water intake between the EC and FECL groups was noted. The FECL group returned to baseline weight by postoperative day 6. MWHS scores were lower in the EC group by postoperative day 3 and lower in the FECL group by postoperative day 7. Conclusions Both EC and FECL are effective for resection of the tongue in rats. EC has the advantage of shorter operative time and lower MWHS scores by postoperative day 3; FECL has the advantages of less intraoperative bleeding, faster return to baseline body weight, and lower MWHS score by postoperative day 7. PMID:22535916

  12. Endoscopic cubital tunnel release using the Hoffmann technique. (United States)

    Hoffmann, Reimer; Lubahn, John


    Endoscopic cubital tunnel release was originally described in 1989 by Tsai, and his technique has been modified by other surgeons including Mirza and Cobb. In 2006, Hoffmann and Siemionow described an endoscopic technique quite different from Tsai's original description. Instead of working from the "inside out," Hoffmann's technique is performed through an incision similar to that which would be used for an in situ release of the ulnar nerve. The main difference being that the nerve can be explored and decompressed 10 cm proximal and distal to the arcuate ligament as the surgeon looks down on the nerve and the surrounding tissues while viewing the anatomy through a camera attached to a soft tissue endoscope that is inserted in the wound. The arcuate (Osborne's) ligament is released under direct vision much like a standard in situ decompression. Using a blunt dissection instrument, a workspace is created proximally and distally to the cubital tunnel. Next an illuminated speculum is introduced, the nerve is directly visualized between 4 and 5 cm proximal and distal to the cubital tunnel, and potential compressive forearm fasciae or fibrous bands are released. Finally, a 15-cm, 30° soft tissue endoscope is introduced into the incision, and viewing the internal anatomy on a video monitor, the decompression continues using longer scissors. Any potential bleeding is controlled with a long bayonet bipolar cautery. The authors discuss indications, contraindications, and the surgical technique. Postoperative management and associated complications are also discussed. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Overview of plasma technology used in medicine (United States)

    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.

  14. Squamous cell dysplasia in the proximal rectum of three patients treated for ulcerative colitis on immunomodulators. (United States)

    Connolly, James G; Goldstone, Stephen E


    Anal canal high-grade squamous intraepithelial lesion (HSIL) is the precursor to anal cancer. Immunocompromised patients are at increased risk and disease is usually within 3 cm from the anal verge. High-resolution anoscopy (HRA) with an 8-cm anoscope is used to identify and guide cautery treatment of HSIL. We report three patients with a long-term history of ulcerative colitis (UC) treated with systemic immunomodulators who developed proximally located rectal HSIL. Two patients were HIV-negative women, 63 and 48 years old, and the third was a 51-year-old HIV-positive man with underlying UC for 10, 16, and 3 years, respectively. They each presented with a HPV-positive HSIL visibly extending above the limits of the anoscope used for HRA. None developed cancer. All had episodes of active UC. It is unclear what causative role systemic immunomodulators play in predisposing UC patients to proximal HSIL. HSIL probably developed on a tongue of HPV-infected squamous epithelium growing proximally over the inflamed rectum. Islands developed when areas of squamous epithelium degenerated, creating skip areas. This study highlights the potential for HSIL to extend into the rectum either as a contiguous patch or isolated islands and the need for heightened surveillance in patients with extensive anal canal HSIL treated with immunodulator therapy. HSIL identified at the limit of the anoscope should be investigated further with colonoscopy, and argon plasma coagulation (APC) ablation can serve as an effective treatment option. Patients are at risk for stricture, but it is unclear what role the UC or the ablation played in stricture formation.

  15. Behavioral and histological outcomes following neonatal HI injury in a preterm (P3) and term (P7) rodent model. (United States)

    Alexander, M; Garbus, H; Smith, A L; Rosenkrantz, T S; Fitch, R H


    Hypoxia-ischemia (HI) occurs when blood and/or oxygen delivery to the brain is compromised. HI injuries can occur in infants born prematurely (HI populations, brain injury is associated with subsequent behavioral deficits. Neonatal HI injury can be modeled in rodents (e.g., the Rice-Vannucci method, via cautery of right carotid followed by hypoxia). When this injury is induced early in life (between postnatal day (P)1-5), neuropathologies typical of human preterm HI are modeled. When injury is induced later (P7-12), neuropathologies typical of those seen in HI term infants are modeled. The current study sought to characterize the similarities/differences between outcomes following early (P3) and late (P7) HI injury in rats. Male rats with HI injury on P3 or P7, as well as sham controls, were tested on a variety of behavioral tasks in both juvenile and adult periods. Results showed that P7 HI rats displayed deficits on motor learning, rapid auditory processing (RAP), and other learning/memory tasks, as well as a reduction in volume in various neuroanatomical structures. P3 HI animals showed only transient deficits on RAP tasks in the juvenile period (but not in adulthood), yet robust deficits on a visual attention task in adulthood. P3 HI animals did not show any significant reductions in brain volume that we could detect. These data suggest that: (1) behavioral deficits following neonatal HI are task-specific depending on timing of injury; (2) P3 HI rats showed transient deficits on RAP tasks; (3) the more pervasive behavioral deficits seen following P7 HI injury were associated with substantial global tissue loss; and (4) persistent deficits in attention in P3 HI subjects might be linked to neural connectivity disturbances rather than a global loss of brain volume, given that no such pathology was found. These combined findings can be applied to our understanding of differing long-term outcomes following neonatal HI injury in premature versus term infants

  16. Toward a better understanding of the cellular basis for cerebrospinal fluid shunt obstruction: report on the construction of a bank of explanted hydrocephalus devices. (United States)

    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 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-dominant cellular response tended to be implanted for shorter

  17. Real-time continuous image-guided surgery: Preclinical investigation in glossectomy. (United States)

    Tabanfar, Reza; Qiu, Jimmy; Chan, Harley; Aflatouni, Niousha; Weersink, Robert; Hasan, Wael; Irish, Jonathan C


    To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy. Prospective study. We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections. The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16). We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy. NA Laryngoscope, 127:E347-E353, 2017. © 2017 The American Laryngological

  18. Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

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    Adkison, Jarrod B.; McHaffie, Derek R.; Bentzen, Soren M.; Patel, Rakesh R.; Khuntia, Deepak [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Petereit, Daniel G. [Department of Radiation Oncology, John T. Vucurevich Regional Cancer Care Institute, Rapid City Regional Hospital, Rapid City, SD (United States); Hong, Theodore S.; Tome, Wolfgang [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Ritter, Mark A., E-mail: [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States)


    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 5 Vulgar-Fraction-One-Half 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

  19. The role of extensionists in Santa Catarina, Brazil, in the adoption and rejection of providing pain relief to calves for dehorning. (United States)

    Hötzel, M J; Sneddon, J N


    The majority of dairy calves around the world are dehorned with methods that cause them pain and distress. In some dairy production systems, extensionists may influence dehorning practices used on farm through their advisory and knowledge-transfer role. The aims of this study were to investigate Brazilian extensionists' knowledge, beliefs, and behavior regarding dehorning dairy calves. As little research has addressed this question, a qualitative, theory-building approach was used and the theory of planned behavior was used as a conceptual framework to guide data collection and analysis. In-depth, semi-structured interviews were undertaken with 15 extensionists working in Santa Catarina, Brazil, to examine their role in the adoption and rejection of pain-mitigation strategies at dehorning. The interview transcripts were free coded, identifying 9 major themes within and across interviews. Transcribed interview responses were then coded to constructs in the theory of planned behavior. The themes and constructs that emerged through analysis of the interview responses were combined to develop a conceptual model of extensionists' beliefs, attitudes, and behavior toward recommending protocols for dehorning aimed at minimizing pain. The extensionists interviewed believed that it was necessary to dehorn all dairy replacement heifers. Despite being aware of methods to minimize pain during and after dehorning, all of the interviewees recommended or used the hot cautery method, with no pain control. This method was described as the most effective, cheapest, safest, and fastest method of dehorning. The majority (12) of interviewees rejected the caustic paste method, citing negative past experiences or unfamiliarity with the method and the belief that the method is less practical and riskier for farmers. More than half of the interviewees did not recognize dehorning as painful or expressed the belief that the pain associated with the procedure did not justify the use of pain

  20. Therapeutic Endoscopy for the Control of Nonvariceal Upper Gastrointestinal Bleeding in Children: A Case Series. (United States)

    Banc-Husu, Anna M; Ahmad, Nuzhat A; Chandrasekhara, Vinay; Ginsberg, Gregory G; Jaffe, David L; Kochman, Michael L; Rajala, Michael W; Mamula, Petar


    Gastrointestinal bleeding is one of the most common indications for urgent endoscopy in the pediatric setting. The majority of these procedures are performed for control of variceal bleeding, with few performed for nonvariceal upper gastrointestinal (NVUGI) bleeding. The data on therapeutic endoscopy for NVUGI are sparse. The aims of our study were to review our experience with NVUGI bleeding, describe technical aspects and outcomes of therapeutic endoscopy, and determine gastroenterology fellows' training opportunities according to the national training guidelines. We performed a retrospective review of endoscopy database (Endoworks, Olympus Inc, Center Valley, PA) from January 2009 to December 2014. The search used the following keywords: bleeding, hematemesis, melena, injection, epinephrine, cautery, clip, and argon plasma coagulation. The collected data included demographics, description of bleeding lesion and medical/endoscopic therapy, rate of rebleeding, relevant laboratories, physical examination, and need for transfusion and surgery. The study was approved by the institutional review board. During the study period 12,737 upper endoscopies (esophagogastroduodenoscopies) were performed. A total of 15 patients underwent 17 esophagogastroduodenoscopies that required therapeutic intervention to control bleeding (1:750 procedures). The mean ± standard deviation (median) age of patients who required endoscopic intervention was 11.6 ± 6.0 years (14.0 years). Seven out of 17 patients received dual therapy to control the bleeding lesions. All but 3 patients received medical therapy with intravenous proton pump inhibitor, and 3 received octreotide infusions. Six of the patients experienced rebleeding (40%), with 4 out of 6 initially only receiving single modality therapy. Two of these patients eventually required surgical intervention to control bleeding and both patients presented with bleeding duodenal ulcers. There were no cases of aspiration

  1. Safety and hemostatic efficacy of fibrin pad in partial nephrectomy: Results of an open-label Phase I and a randomized, standard-of-care-controlled Phase I/II study

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    Nativ Ofer


    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

  2. [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)]. (United States)

    Kitahara, Makoto


    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

  3. Enhanced electroscalpel incisional wound healing potential of honey in wistar rats

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    David O. Eyarefe


    Full Text Available Electrosurgery reduces surgical bleeding, and delayed wound healing. This study evaluated comparative incisional wound healing potential of honey in wound created with electroscalpel and cold scalpel. The study used twelve (12 adult male albino rats (130 ± 20 g, randomly grouped into Electro-cautery (n = 6 and Cold scalpel (n = 6. Each rat had three full thickness (6 mm diameter skin wounds (a, b and c created on its dorsum with either Electroscalpel (ES or Cold blade scalpel (CS, and treated topically with Silver sulphadiazine (SSD, wound a, untreated (control, wound b and Bee honey (H, wound c. The wounds were evaluated for gross (exudation, edema, hyperemia, contraction, histologic (granulation, angiogenesis, fibroplasia, epithelialization and immunologic healing indices using standard techniques. Data were analyzed with Chi-square, Two-way Analysis of Variance (ANOVA and Duncan Multiple Range tests (DMRT at α = 0.05. Wound hyperemia and edge edema were prominent in the ES group from day 4 to 6 (P = .000. Percentage wound contraction was higher in the CS than ES group from days 5 to 7 (P = .006 and in the CS treated with honey than ES treated with honey from days 7 to 14 (P = .000. Granulation tissue reduced in ES group treated with SSD than in honey and control wounds. Fibroelastic tissue increased in SSD and honey treated wounds of ES group, and higher in honey treated wounds of CS group (P < .05. Fibroplasia was sustained in honey and SSD treated wounds than control. Honey can be applied to electroscalpel surgical wound to facilitate rapid healing during surgical management of tumours having vascular network. Keywords: Incisional methods, Honey, Silver sulphadiazide, Wound management

  4. Laparoscopic repair for vesicouterine fistulae

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    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

  5. Experimental evaluation of clinical colon anastomotic leakage. (United States)

    Pommergaard, Hans-Christian


    model. In the final experiment, the four-suture anastomoses resulted in a 40% leakage rate in the intervention groups, whereas the eight-suture control anastomoses had a 0% leakage rate. Furthermore, the use of absorbable suture together with voluntarily ingested Temgesic in chocolate spread as analgesic regimen were feasible. This model may be used to test the leakage reducing potential of coating materials. STUDY 3: This experimental study used 53 C57BL/6 mice, in which sufficient eight-suture anastomoses were created. By using bipolar electro-cautery, blood supply was reduced in a stepwise manner to create anastomotic leakage as a result of ischemia. The study showed that reduced blood supply led to large bowel obstruction instead of clinical leakage. However, anastomotic breaking strength was reduced in the ischemic anastomoses. STUDY 4: In this systematic review MEDLINE, Embase and Cinahl were searched up to September 2011 to identify studies evaluating external coating of colonic anastomoses. Most studies were experimental, in which designs were not comparable and many results were contradictory. In a clinical study, a non-significant benefit of fibrin sealant was found. Based on the available clinical and experimental data it was concluded that the fibrin-based sealants, such as Tisseel and Tachosil, and polyethylene glycols may be beneficial. However, further experimental and clinical studies are needed before routine clinical use can be recommended. The studies in this thesis may be valuable for the experimental research field of clinical anastomotic leakage. The model of technical insufficiency has been improved and is now thoroughly validated. If used by researchers worldwide, comparison of results is possible. Pure ischemia/anoxia may be too simple an approach to create a clinical leakage model. Thus, future models could focus on multiple risk factors. Conclusively, large-scale clinical multicenter studies are needed to definitively evaluate whether coating

  6. Incidence of and factors related to late complications in conformal and conventional radiation treatment of cancer of the prostate

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    Schultheiss, Timothy E; Hanks, Gerald E; Hunt, Margie A; Lee, W Robert


    Purpose: The fundament hypothesis of conformal radiation therapy is that tumor control can be increased by using conformal treatment techniques that allow a higher tumor dose while maintaining an acceptable level of complications. To test this hypothesis, it is necessary first to estimate the incidence of morbidity for both standard and conformal fields. In this study, we examine factors that influence the incidence of late Grade 3 and 4 morbidity in patients treated with conformal and standard radiation treatment for prostate cancer. Methods and Materials: Six hundred sixteen consecutive patients treated with conformal or standard techniques between 1986 and 1994 to doses greater than 65 Gy and with more than 3 months follow-up were analyzed. No patients treated with prostatectomies were included in the analysis. The conformal technique includes special immobilization by a cast, careful identification of the target volume in three dimensions, localization of the inferior border of the prostate using a retrograde urethrogram, and individually shaped portals that conform to the Planning Target Volume (PTV). Multivariate analysis using a proportional hazards model compares differences in the incidence of Radiation Therapy Oncology Group/European Organization for Research and Center Treatment (RTOG/EORTC) Grade 3 and 4 late gastrointestinal (GI) and genitourinary (GU) morbidity by technique, T-stage, grade, age, hormonal treatment, irradiated volume, dose, and comorbid conditions. Grade 3 rectal bleeding was defined as requiring three or more cautery procedures. Results: The overall actuarial incidence of genitourinary (GU) toxicities at 5 years was 3.4%, with the crude incidence being six cases in 616 patients satisfying the selection criteria; for gastrointestinal (GI) toxicities, the overall actuarial incidence was 2.7%, with the crude incidence being 13 cases out of 616 patients. The average time to complication for our patients was 12.8 months for GI toxicity and

  7. Técnica de revascularização miocárdica com uso de toracoscopia Coronary artery surgery with thoracoscopy

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    Leonardo Esteves Lima


    surgery, however its use has not been well defined. In our approach, we harvested the left or the right IMA thoracoscopically. Following this the left IMA-LAD or right IMA-right coronary artery anastomoses were fashioned, by means of a left or right small anterior thoracotomy on the beating heart without CPB. A double lumen endotracheal tube was used so the lung could be collapsed. Three left or right lateral chest ports of 1.5 cm were made, and the thoracoscope was placed through the initial port, permitting inspection of the thorax. The other ports were used for IMA dissection, using endoscopic instruments (electrocautery, grasping, forceps,..., the side branches were controlled by either cautery or endoscopic clips. When it was possible, the anterior port was extended doing a small left or right anterior thoracotomy, the pericardium was exposed, the IMA was divided and exteriorized through the thoracotomy. After coronary artery control, the bypass graft was carried out on the beating heart without CPB. In certain cases, when myocardial protection was considered to be essential, this was achieved by means of an intracoronary shunt. We have operated on more than 20 patients using this technique with good results in all cases. We believe that with increasing operator experience, this minimally invasive approach will have a major impact on the management of the coronary artery disease patients, with a faster recovery, shorter hospitalization, and certainly less cost.