Biomedical subjects
Publications and source records attributed to J H Bellina.
The clip appendectomy is an alternative to the classical suture appendectomy. The use of a new polymer clip facilitates this technique. During pelvic reconstructive surgery an appendectomy may be indicated when suspected appendiceal pathology (such as endometriosis) could adversely affect the surgical outcome. Clip appendectomy can reduce the operative time without increasing morbidity.
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In this study we sought to compare laser tissue interaction in both the quasi-continuous waveform and electronically pulsed waveform of the carbon dioxide laser. An intramode analysis of the electronically pulsed form (at 350 and 650 pulses per second) was also undertaken. Intraperitoneal laser incisions were made on New Zealand white female virginal rabbits and tested at days 0, 5, 15, and 20. Testing involved proximal and midsection analysis of the laser sites to evaluate total area of vaporization, total area of tissue thermal damage, maximum diameter of injury at epithelial surface, maximum depth of laser penetration, angle of vaporization crater edges, and angle of tissue thermal injury of the three modes. Analysis of proximal versus midsection preparation revealed different zones of vaporization and injury within the same laser site. The zone of injury with respect to time was nonuniform, suggesting that the laser output in the electronically pulsed mode was not constant. An in vivo tissue lens phenomenon was also detected, resulting in a compound thermal vaporization and injury pattern.
This study was designed to compare the effect of wound healing after the use of the carbon dioxide laser and the electrosurgical unit on the peritoneal mesothelium of the New Zealand white rabbit. The biophysical parameters were held constant and identical in both groups. The effects were compared in terms of tissue damage, adhesion formation, and healing time. The animals were killed on days 0, 5, 10, 15, 20, and 25. Gross anatomic and histologic findings were recorded. The laser, when compared to the electrosurgical unit in this study, produced no adhesion formation and less tissue injury, immediately and throughout the healing phase (p less than 0.0039).
This study was designed to evaluate the efficacy of reconstructive microsurgery with the carbon dioxide laser for the treatment of infertile women suffering from endometriosis. One hundred and eight women evaluated for infertility and endometriosis underwent reconstructive microsurgery with the carbon dioxide laser. All cases were classified in accordance with the American Fertility Society's classification. Postoperatively, conception rates for the mild-to-moderate and the severe-to-extensive groups were estimated by life table methods for analysis. Estimates of the cumulative pregnancy rate were 55% for the mild-to-moderate group and 88% for the severe-to-extensive group. The abortion rate was 17% and the ectopic pregnancy rate was 3%.
In addition to use of the CO2 laser in gynecologic surgery for the treatment of pelvic, vaginal and vulvar neoplasms, it has been more recently applied to the treatment of infertility. The advantages afforded by the laser over conventional techniques are discussed. The authors' clinical experience in the surgical treatment of infertility, with emphasis on endometriosis and microtubal surgery, are described, and use of the new electro-pulsed laser in infertility surgery is evaluated.
Two light sources used in laparoscopy, both in the photo mode, proved capable of burning a hole in a standard paper surgical drape in less than five seconds. The relationship between power (in watts) and dial settings is not linear. Both of these sources have a maximum power density of 5.6 w/cm2, which far exceeds the 1.8 w/cm2 power density of the other light sources tested. Today, with the demand for increased illumination for photodocumentation , the physician must be cognizant of its potential hazards. Light sources will vary according to the type of source--tungsten, halogen or mercury arc. Each increase in wattage output will transmit a greater cable power density. Equipment should be checked for its potential to produce burns in routine use and, if defective, should be replaced.
This paper relates our comprehensive treatment and follow-up of 242 women with condyloma acuminatum over an 8-year period. Laser treatments were carried out at an average power density of 800 W/cm2. Thirty-five patients received a general anesthetic prior to treatment. All other patients were treated in the outpatient clinic. The majority of patients had multiple involvements: 38% had condyloma acuminatum located on the cervix, vulva, and vagina. All of the patients had at least 1 disease-free year following treatment(s) with the carbon dioxide laser; 65% of those treated had at least 2 disease-free years. In many cases, the men were found to have small papillary excrescences on the penis that were not readily diagnosed with the naked eye and were detected only after colposcopic magnification was used. Once the male partner was treated and the female partner was re-treated, the effective cure rate for 1 year was 97%.
Rabbit fallopian tubes were used as models to demonstrate the delayed effects of the argon laser wavelength on tissue. Power density, energy density, and velocity were all variables in the experiment. Three groups of ten rabbits were sacrificed two at a time, on days 0, 5, 10, 15, and 20. The results clearly showed delayed tissue changes associated with fibrosis. Mathematical and theoretical comparisons of the argon laser to the carbon dioxide laser help express the advantages and disadvantages of the use of the argon laser in fallopian tube surgery. The return of organ function with respect to time has possible significance to studies of human fallopian tube surgeries.
This study concerns the gross histological effects of scalpel, electric knife, and carbon dioxide laser incisions on skin and uterine tissue in dogs. Tissue studies comparing the carbon dioxide laser with the scalpel and electric knife have frequented the literature. However, a gross and histological comparison specifically involving uterine tissue is not presently known to have been reported. The evaluation on this series of animals considers both the skin and the uterus in an abdominal approach to evaluate the carbon dioxide laser for potential intrauterine surgery. Tissue sampling of both skin and uterus at 2, 6, and 8 weeks postoperatively were histologically examined to evaluate healing rates and degree of scar formation.
Seventy-nine patients with history and physical findings characteristic of antenatal DES exposure were randomly divided into two groups. Fourty-four DES-exposed offspring had their vaginal adenosis treated with the carbon dioxide laser (group I), and the remaining 35 DES-exposed offspring (group II) did not receive any specific treatment for this condition. Additionally, the 79 DES-exposed offspring were compared to an age-matched control population (group III). Treatment of vaginal adenosis with the carbon dioxide laser did not significantly reduce the incidence of development of new dysplasia in the DES-exposed offspring. This study also showed no statistical difference (p less than or equal to 0.05) in the incidence of dysplasia in DES-exposed offspring as compared to a control population.
Between September 1979 and December 1982, 230 cases of tubal reconstructive surgery were followed for 2 years. An analysis of these cases showed 75% to have had more than one procedure performed. There were 91 pregnancies in this group. In the bipolar disease population, 36% achieved an intrauterine pregnancy. Tubal reversal procedure resulted in comparable rates when compared to conventional surgery (71%). The ectopic pregnancy rate was 4.4%, and spontaneous abortion rate was 6.6%. The carbon dioxide laser appears to have a place in the armamentarium of the microsurgeon.
We performed a study to determine the efficacy of laser therapy for the three grades of cervical intraepithelial neoplasia. Two hundred ninety-two patients were studied. Over 90% of the cases occurred in women between 20 and 30 years of age. Among the 21 patients (7%) with persistent disease, 12 (86%) of the cases were diagnosed within the first six months after laser treatment. Those patients were retreated. The overall cure rate in the study population was 96%.
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In 1974 the carbon dioxide laser was adapted to the operating microscope for reconstructive pelvic surgery and the first 15 cases of laser tubal microsurgery were performed. The instrumentation and techniques were refined. A protocol was designed to test the efficacy of this surgical modality, and a new study was begun in 1980. Complete documentation of laparoscopic findings, surgical techniques, and pre- and postoperative hysterosalpingograms are kept on videotapes. Detailed descriptions of the surgical techniques employed in these cases are presented in this paper. Preliminary results are reported in terms of patency and pregnancy rates experienced to date. Eighty-two women experienced fertility enhancement laser microsurgery at the Reproductive Biology Center at F. Edward Hebert Memorial Hospital in New Orleans. Bilateral patency or patency of the only existing fallopian tube was demonstrated postoperatively in 93% of the cases. Eliminating the women practicing contraception, those on postoperative Danazol therapy for endometriosis, male factors, or other reasons for women or their partners being not at risk, conception has occurred 21 times among 20 of 42 patients at risk. Many of the women were referral cases who had had unsuccessful microsurgery or were rejected for microsurgery by their physicians due to extensive disease. These results indicate that the carbon dioxide surgical laser may be a useful adjunct in reconstructive microsurgery for fertility dysfunction.
A study was designed to measure the inter-pathologist consistency of histopathologic diagnosis of cervical intraepithelial neoplasia (CIN) among four pathologists. Intra-pathologist reliability over time was also determined. Between-pathologist comparisons resulted in agreement only 50% of the time; however, 81% of pairs were within one CIN grade of each other. Seventy-one percent of first and second diagnoses of the same pathologist were identical and 93% of pairs were within one CIN grade. In seven cases, however, pairs of evaluations of the same slide were remarkably disparate, two considered normal and CIN III by the same pathologist at different times. The findings of this study, using the CIN grading system, are consistent with other studies using different classification schemes. Inconsistency of diagnoses and discrepancies between pathologists must be considered when conservative therapy is elected for a patient with cervical intraepithelial neoplasia.