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Biomedical subjects

M S Baggish

Publications and source records attributed to M S Baggish.

At least 37 records · Page 2Linked to original sources
PubMed1989

Death caused by air embolism associated with neodymium:yttrium-aluminum-garnet laser surgery and artificial sapphire tips.

Two women undergoing intrauterine surgery with the neodymium:yttrium-aluminum-garnet laser delivered by the artificial sapphire tip had catastrophic cardiovascular collapse during operation. In each case the evolution of clinical events was consistent with the diagnosis of air embolus. Investigation of causative factors links the use of the sapphire tip and the gaseous cooling of the tip to the calamitous outcomes. Both women died.

Adult↗
PubMed1989

Evaluation of tissue healing and adhesion formation after an intraabdominal amniotic membrane graft in the rat.

The amniotic membrane was used as a graft intraabdominally in the rat to study the healing process and the graft's efficacy in preventing postoperative adhesions. We observed the gradual invasion of the graft with fibroblasts and plasma cells and increased vascularity. By the tenth postoperative day the graft had taken completely. There was no evidence of infection at the graft site or rejection of the graft. Application of the graft after lysis of adhesions was followed by adhesion formation at the graft site. The graft did not show evidence of necrosis but failed to prevent adhesion formation.

Abdomen↗
PubMed1989

Quantitative evaluation of the skin and accessory appendages in vulvar carcinoma in situ.

Fifty cases of vulvar carcinoma in situ comprising over 1000 histologic sections were studied. Each case was evaluated to determine the thickness of the neoplastic epidermis and the depth of involved skin appendages. Two precise techniques were used to perform the microscopic measurements. The areas most frequently afflicted with neoplasia were: one or both labia (45%), interlabial folds (27%), perineum-fourchette (15%), and perianal skin (10%). Multicentric disease was observed in 68% of the cases. The epidermal thickness ranged between 0.35-1.66 mm. The mean depth (+/- SD) of the epidermis was 0.93 +/- 0.37 mm. Eighteen of the 50 patients demonstrated involvement of the skin appendages to a mean depth of 1.53 +/- 0.77 mm, suggesting that laser vaporization to a depth of 2.5 mm will, with the anticipated additional thermal necrosis, eliminate appendages involved with carcinoma in situ in 95% of instances. The most common sites of skin appendage involvement were the labia majora or minora and the interlabial folds.

Adult↗
PubMed1988

New laser hysteroscope for neodymium-YAG endometrial ablation.

A multichannel operating hysteroscope was developed for use with the Nd-YAG laser. The telescopes measure 350 mm in length, with a 4 mm outer diameter (OD), and are available with 0 degree or 30 degrees objectives. The operating sheath incorporates two isolated operating channels (2 mm OD) through which an Nd-YAG quartz fiber and an aspiratory cannula can be inserted simultaneously. The design of this instrument permits constant or intermittent aspiration of debris from the intrauterine milieu and very clear vision throughout the operative procedure. The entire cavity of the uterus may be flushed with the distending medium by injecting the liquid through the instillation channel and opening one of the two operating channels.

Endometrium↗
PubMed1988

Protection of the rat lung from the harmful effects of laser smoke.

Fourteen Sprague-Dawley rats were exposed to CO2 laser exhaust that had first passed through smoke-evacuator filters. Six rats breathed laser vapors that were filtered through commercially available, standard production model smoke-evacuator systems. These animals demonstrated pulmonary lesions identical to but qualitatively less severe than those observed in animals breathing unfiltered vapor. Six additional rats were protected by the interposition of a cartridge filter plus an ultra-low penetration air filter, which trapped 0.1 micron particles; the microscopic sections of the lungs of these experimental rats and two control rats were similar in appearance, i.e., no pathological changes were observed.

Animals↗
PubMed1988

Combined tubal and molar pregnancy: case report.

A patient with combined pregnancy developed an acute condition in the abdomen 9 weeks after surgical removal of a tubal pregnancy. At laparotomy she was found to have bilateral theca-lutein cysts. After operation, the patient went into preterm labor and was delivered of a male fetus. Pathologic examination of the placenta revealed hydropic change and trophoblastic hyperplasia.

Adult↗
PubMed1988

New techniques for laser ablation of the endometrium in high-risk patients.

Fourteen women underwent endometrial ablation by use of the Nd:YAG laser. All patients had significant risk factors that precluded safe hysterectomy for intractable bleeding. All patients had demonstrated anemia, menorrhagia, and metrorrhagia uncontrolled by hormonal therapy or curettage. Specifically, seven (50%) women in this group had proved major clotting abnormalities as their principal diagnosis. Three new techniques are described as modifications of the original Nd:YAG ablation methodology and include: (1) the use of Hyskon as the uterine distending medium; (2) the attachment of a high-resolution endoscopic television camera to the eyepiece of the hysteroscope, which permits the surgeon to view the endometrial cavity and operate via a video monitor; and (3) the application of a specially designed dual-channel operating hysteroscope that allows simultaneous laser ablation and aspiration of debris. Although this operation is a valuable alternative to hysterectomy in selected clinical situations, its major deficiencies are the lack of long-term follow-up data and the absence of a surgical specimen for pathologic analysis.

Adult↗
PubMed1988

Carbon dioxide laser laparoscopy by means of a 3.0-mm diameter rigid wave guide.

Rigid carbon dioxide wave guides measuring 300 to 500 mm in length and 3.0 mm in diameter were evaluated in rabbits and humans. The wave guide provided an effective laser delivery system for operative laparoscopy. The tested guide was introduced into the abdominal cavity alternatively via the operating channel of a 9-mm operating laparoscope, through the central channel of a smoke evacuation/irrigation cannula, or via a 3.25-mm second puncture trocar. In contrast to previously tested flexible guides, the rigid device transmitted a visible helium-neon aiming beam, power up to 50 watts, and a beam diameter of less than 1 mm. The hollow guide was kept free of smoke by-products by continuous purging with carbon dioxide gas flowing at 800 to 1000 cc per minute. All wave guides could be sterilized by ethylene oxide gas or Cidex (Surgikos, Arlington, TX) soaking. Fourteen women with a variety of reproductive disorders underwent laser laparoscopy. The rigid wave guide was fired at distances ranging from less than 1 mm to 30 mm from the target and performed with maximal impact at distances of 3 to 5 mm. Perhaps the greatest advantage of this system is its ability to focus-defocus while directly coupling to the handpiece of standard lasers and requiring no special alignment procedures.

Animals↗
PubMed1988

Cytoreduction of ovarian cancer with the Cavitron ultrasonic surgical aspirator.

The Cavitron ultrasonic surgical aspirator was used for cytoreduction in ten patients with intra-abdominal malignancy (nine ovarian and one fallopian tube). The mean age was 65 years, and eight patients had stage IIIC disease. Standard surgical techniques were used to resect the adnexa, uterus, and omentum. The Cavitron was used to remove disease from the diaphragm, spleen, stomach, and small bowel without resection or injury. These nongenital viscera would have required resection using surgical techniques for cytoreduction. The mean Cavitron surgical time was 49 minutes. Cytoreduction by the Cavitron facilitates tumor removal and reduces the requirement for nongenital visceral resection.

Aged↗
PubMed1987

The effects of laser smoke on the lungs of rats.

The sequelae of long-term inhalation of carbon dioxide laser smoke on 10 white rats were studied in a three-phase experiment. The fine particulate matter resulting from tissue vaporization was deposited in the animals' alveoli, which produced congestive interstitial pneumonia, bronchiolitis, and emphysema. The pathologic findings induced by laser plume are not dissimilar to those resulting from the long-term inhalation of other types of particulate matter. Use of an efficient smoke evacuator should offer substantial protection against these normal effects.

Animals↗
PubMed1987

Carbon dioxide laser laparoscopy performed with a flexible fiber in humans.

A flexible carbon dioxide laser fiber delivery system was used in conjunction with the laparoscope to treat 12 women. The 77 by 2 mm hollow fiber could subtend an arc of 90 degrees without significant loss of power or unfavorably affecting the delivery mode. As many as 20 W of power was transmitted through the fiber; however, carbon dioxide gas flow rates as high as 2000 cc/min reduced power by approximately 25%. Replaceable tips preserved fiber integrity to the extent that a single fiber could be reused repeatedly and gas sterilized without jeopardizing laser transmission. Of the 12 cases, endometriotic implants were vaporized in eight women, adhesiolysis was performed in four women, endometrial cysts were drained in two women, and vaporization of myomata was accomplished in two patients. The fiber was also used as a manipulating instrument and could be internally bent with a grasping forceps to better site the laser beam on a lesion. No complications related to the use of the carbon dioxide laser fiber were observed. The safety aspects of carbon dioxide laser fiber technology are not inconsiderable and could provide laser laparoscopy with an extra margin of security.

Beryllium↗
PubMed1987

Comparative study of continuous and pulsed CO2 laser on tissue healing and fertility outcome in tubal anastomosis.

Continuous wave (CW) CO2 laser using a power of 20 W and a spot size of 0.2 mm was used to cut the left uterine horn in 15 rats. Pulsed CO2 laser using a power of 14 W, pulse repetition rate of 400 pps, and a spot size of 0.2 mm was used to cut the left uterine horn in 16 rats. The right uterine horn was sham-operated and used as a control in each group. Microsurgical anastomosis of the cut horn was performed. The effect on fertility showed a pregnancy rate of 66.6% and 81.25% for the CW and pulsed CO2 laser, respectively. Histopathology studies of the anastomotic site revealed thinning of muscularis with fibrosis of both muscularis and subserosal layers in the CW CO2 laser-treated group. There was no thinning, disruption, or fibrosis of muscularis in pulsed laser-treated group. Adhesion score was not different in the two groups.

Animals↗
PubMed1987

Carbon dioxide laser treatment of cervical stenosis.

Fifteen women diagnosed with cervical stenosis were treated by vaporization of scar tissue using the carbon dioxide laser. Ninety-three percent of the cases demonstrated binding constriction of the cervical os to a 2-mm diameter or less and 40% of the cases had either a pinpoint opening or total endocervical obliteration. The technique for laser treatment and the success of the method depend on precise variations of mode, power, beam diameter, and "buttoning" the endocervical mucosal remnant. Twelve of the 15 patients were relieved of stenosis and 9 achieved pregnancy within 2 years of the operative procedure. Critical analysis of possible causative factors in this study revealed that virtually every case of stenosis had been iatrogenic.

Adult↗
PubMed1986

A comparison between laser excisional conization and laser vaporization for the treatment of cervical intraepithelial neoplasia.

One hundred twenty patients with cervical intraepithelial neoplasia who were treated by laser excisional conization were compared with a group of 100 women who had similar diagnoses and were treated by laser vaporization. Every operation in the series was performed in the outpatient surgical unit or in the office. In two thirds of the cases the procedures were carried out with the patients under local anesthesia. The parameters studied included time required to perform the procedure, immediate and delayed bleeding, postlaser stenosis, healing time, patient discomfort, persistence or recurrence of disease, and risk of invasion. The results of this study revealed few disadvantages to performing a laser excisional procedure. Immediate and delayed complications were less frequent with laser excisional conization. The time required to perform an excisional conization was on the average only 4 minutes longer than that for a vaporization. Most significantly, the laser excisional cone provides a large and excellent specimen for the pathologist to review.

Constriction, Pathologic↗
PubMed1986

Comparison of electronically superpulsed and continuous-wave CO2 laser on the rat uterine horn.

Forty-three rats underwent a series of operations with the CO2 laser to incise the uterine horn. Electronically pulsed laser light was compared with the continuous-wave (CW) mode on alternative horns, with each animal serving as its own control. Five variations of the superpulsed mode were compared with the same number of CW settings. Three experiments were performed: acute evaluation after partial uterine horn transection, acute observation after complete transection, and chronic studies after partial transection. The sectioned uterine horns were grossly observed and photographed, then sampled, histologically fixed, and studied by light and scanning electron microscopy. Zones of thermal necrosis were measured by an imaging tube and quantified by a computer-linked digitizing tablet. The results of this study demonstrated 2.5 times less thermal necrosis by electronically pulsed, versus the CW, laser beam. Four-and-one-half times less necrosis was also observed when the pulsed laser was employed for complete transection experiments. Adhesions were provoked in every animal that underwent chronic investigation. Inflammatory response, adhesion progression, and hydrosalpinx formation were significantly diminished in the pulsed-treated group. Qualitatively, wounds inflicted by pulsing showed different geometric patterns, compared with CW incisions. Electronic pulsing offers the surgeon the combined advantages of knife-like incisions and the precision and hemostatic properties of the CO2 laser.

Animals↗
PubMed1986

A flexible CO2 laser fiber for operative laparoscopy.

A flexible, hollow fiber measuring 1.5 mm diameter was used in conjunction with the laparoscope to deliver a CO2 laser beam to the rabbit uterine horn. The fibers tested consistently transmitted 5 to 15 W of laser power without loss of input mode. Several fiber-to-target distances were evaluated from the standpoint of crater characteristics. Microscopic sections were studied, and crater heights and widths were quantified. All lesions produced by the CO2 laser fiber closely mimicked those delivered by the free-hand piece or micromanipulator. In two chronic experiments, rapid fibrosis and "filling in" of the craters was evident at 5 days. No adhesions were observed. The CO2 laser fiber has several advantages over current techniques for the performance of laser laparoscopy as well as over alternative systems, e.g., neodymium:yttrium-aluminum-garnet(ND:YAG) and argon-coupled fibers. The CO2 laser fiber will further increase the options available to the gynecologist for operative endoscopy.

Animals↗
PubMed1986

Pulsed CO2 laser versus conventional microsurgical anastomosis of the rat uterine horn.

The effect of pulsed CO2 laser treatment on tissue reaction and fertility was evaluated. The left uterine horn was cut with a pulsed CO2 laser in 16 rats. In eight other rats, the left uterine horn was cut with microscissors. The anastomosis in both groups was accomplished by microsurgical techniques. The adhesions were mostly filmy after laser treatment, as compared with thick adhesions in the conventional group. Absence of adhesions was found in 62.5% and 50% of the laser and conventional surgery group, respectively. Histologically, some degree of fibrosis in the muscularis layer of the uterine horn was seen in the conventional group, whereas proper muscle continuity was seen in the laser-treated group. The pregnancy rates were 81% and 87.5% in the laser and conventional groups, respectively.

Animals↗