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PubMed2006

[Surgical versus non-surgical treatment of posterior epistaxis].

A study was performed in order to compare the efficiency of surgical versus non-surgical treatment in patients hospitalized for epistaxis regarding the source of bleeding, and to identify failure-predicting factors related to specific treatments. 62 patients were included in the study, 36 (58%) of whom suffered from posterior epistaxis and 26 (42%) experienced anterior bleeding. The single factor associated with failure of the non-surgical treatment was the posterior source of the bleeding (p = 0.001). These patients were also hospitalized for a longer period (8, 17 days) than those with anterior epistaxis (4, 62 days) (p = 0.001). The percentage of success for the primary non-surgical treatment in patients with posterior epistaxis was 45% (14/31), significantly smaller (p = 0.0001) than the successful reached in the primary surgical procedure, 87% (13/15); endoscopic cauterization of the sphenopalatine artery. These results support endoscopic cauterization of the sphenopalatine artery as primary care in posterior epistaxis.

Adolescent↗
PubMed2004

Devastating complications from alcohol cauterization of recurrent Rathke cleft cyst. Case report.

Rathke cleft cysts are commonly found on autopsy but are seldom symptomatic. Conventional treatment of these lesions consists of transsphenoidal drainage with partial excision of the cyst, and recurrence is rare. Alternatively, the instillation of absolute alcohol into the cyst has been described in several reports, with no complications. The authors report on a woman with Rathke cleft cyst that recurred three times after the initial treatment; the lesion was treated with alcohol cauterization on the final recurrence with devastating complications. This 51-year-old woman presented in 1992 with headaches and visual disturbances. Admission magnetic resonance imaging revealed a sellar/suprasellar lesion that was treated with conventional surgery and was subsequently confirmed to be a Rathke cleft cyst. The patient again presented with recurrence of the cyst at 22, 26, and 31 months after the initial presentation. On the final recurrence the cyst was treated with alcohol cauterization. Postoperatively, the patient awoke blind and suffered a seizure from leakage of the alcohol. The patient remains completely blind in both eyes and is also anosmic and has left lid ptosis and exotropia, which signify damage to the first through third cranial nerves. Rathke cleft cysts have been known to recur after primary surgery; however, this is the first report of a single cyst recurring three times despite conventional surgical treatment. Additionally, this is the first report in which devastating complications from alcohol cauterization of the cyst have been described. The authors therefore advocate caution when attempting alcohol cauterization and advise that meticulous care be taken to ensure the patency of the cyst.

Blepharoptosis↗
PubMed2005

Dehorning and disbudding distress and its alleviation in calves.

Dehorning and disbudding are routine painful procedures carried out on cattle to facilitate management. The pain caused by these procedures and its alleviation may be evaluated by monitoring behaviour and physiological responses, and by measuring their effects on weight gain. The cortisol response to cautery disbudding is significantly smaller than that to amputation dehorning which infers that the latter is more painful. Amputation dehorning stimulates a defined cortisol response with a rapid rise to a peak value within 30 min followed by a decline to a plateau which then declines to pre-treatment values after about 8 h. A cornual nerve blockade using lignocaine virtually eliminates the escape behaviour seen during disbudding and dehorning and reduces the plasma cortisol response to dehorning for about 2 h. Thereafter there is an increase in the plasma cortisol concentration, a delayed response, which lasts for about 6 h. A cornual nerve blockade, using lignocaine combined with cauterizing the wound caused by amputation dehorning, virtually eliminates the cortisol response as does combining a lignocaine blockade with the non-steroidal anti-inflammatory drug (NSAID) ketoprofen. When xylazine is combined with a cornual nerve blockade using lignocaine before dehorning, the cortisol response is virtually eliminated for about 3 h. When this regime is used before cautery disbudding and includes a NSAID given before and after disbudding the behaviour of calves so treated suggests that pain may be alleviated for 24 h. Cautery disbudding is preferable to amputation dehorning, but for optimal pain relief xylazine sedation, local anaesthesia and a NSAID should be used with both procedures.

Anesthetics, Local↗
PubMed2003

Silver nitrate: histological effects of cautery on epithelial surfaces with varying contact times.

Silver nitrate is used extensively in rhinological practice for the treatment of recurrent epistaxis. There are currently no recommendations in the literature regarding the optimum application time of this chemical for effective treatment. We assessed the histological effects of silver nitrate on mucosal tissue at varying contact times and made recommendations based on our findings. Silver nitrate was applied at predetermined contact times to tonsillar mucosa, immediately before tonsillectomy in subjects undergoing routine surgery. The cauterized areas were subsequently analysed histologically. The depth of tissue penetration by the silver nitrate was measured. The means for 5, 10 and 20 s were 0.44, 0.30 and 0.38, respectively, P = 0.3. Overall, there was no deeper penetration of the tissues with contact times over 5 s. We conclude that it is not necessary to apply silver nitrate for greater than 5 s to achieve maximal tissue penetration.

Anti-Infective Agents, Local↗
PubMed2003

Silver nitrate cauterization: characterization of a new model of corneal inflammation and hyperalgesia in rat.

Chemical cauterization of the central cornea with silver nitrate was assessed as a superficial injury model of tissue sensitization accompanying acute inflammation. Adult male Sprague-Dawley rats were anesthetized with halothane gas, and the centers of their right corneas treated with a silver nitrate applicator stick (75% silver nitrate, 25% potassium nitrate) to produce a discrete lesion 1 mm in diameter. Edema of the corneal stroma and elevated immune cell counts became significant 4 h after cauterization, and were still evident after 48 h. Behavioral sensitization to chemical stimuli was determined by counting the number of blinks following application of 1 microM capsaicin directly to the corneal surface. A significant increase in stimulus-induced blinking was evident 2 h after cauterization. Chemical sensitization peaked at 6 h, and was no longer significant at 12 h. We conclude that silver nitrate cauterization produces acute corneal inflammation and hyperalgesia, and may prove a useful model for the study of primary afferent nociceptors.

Animals↗
PubMed1987

The effects of hypertonic salicylate on neutrophil migration and vascularization in the rat cornea.

Thermal cauterization of the center of the rat cornea results in emigration of neutrophils into the extravascular limbal tissue and blood vessel growth into the cornea. In this study, 1.0 M sodium salicylate, 1.0 M sodium chloride, and ointment vehicle were administered to normal and cauterized rat corneas for periods of 6, 48, and 144 h. When applied to the normal cornea, salicylate resulted in a marked increase in neutrophils in the limbal tissue at 6 h, but an inhibition at 48 h. Similarly, for the cauterized corneas, administration of salicylate increased the extent of neutrophil emigration at 6 h, but this effect was not sustained at 48 h. Neither vehicle nor sodium chloride had any effect on the extravascular neutrophil population. After 6 days, administration of the vehicle resulted in a slight increase in vascular growth into the cornea, whereas sodium salicylate caused a decrease. These findings indicate that hypertonic (1 M) sodium salicylate does not inhibit the emigration of neutrophils from limbal vessels of cauterized rat corneas, but does appear to have a cytotoxic effect on the tissues and on blood vessel endothelial cells.

Animals↗
PubMed2006

Amniotic membrane transplantation with cauterization for keratoconus complicated by persistent hydrops in mentally retarded patients.

PURPOSE: Vigorous eye rubbing is a cause of extensive hydrops in mentally retarded patients with keratoconus. We describe a new management approach for this condition. DESIGN: Prospective, noncomparative, consecutive case series. PARTICIPANTS: Ten eyes of 10 mentally retarded patients aged 18 to 37 years (8 with Down syndrome and 2 with oligophrenia not associated with Down syndrome). All patients had extensive and persistent hydrops in the course of keratoconus that was refractory to traditional therapy. INTERVENTION: The patients underwent multifocal cauterization of the cornea combined with amniotic membrane transplantation. MAIN OUTCOME MEASURES: Corneal protuberance, final corneal thickness, time to hydrops resolution, and postoperative complications were assessed. RESULTS: Hydrops was successfully resolved in all eyes. The mean initial corneal protuberance (7.6+/-4.2 mm) resolved after 21.4+/-9.5 days in all eyes. Mean final central corneal thickness was 0.47+/-0.11 mm. Extent of initial corneal protuberance, final corneal thickness, and time to resolution were positively correlated with each other. CONCLUSIONS: Amniotic membrane transplantation with cauterization in this series of mentally retarded patients was a highly effective treatment for persistent hydrops related to keratoconus.

Adolescent↗
PubMed1998

Intraoperative cauterization of the cornea can reduce postkeratoplasty refractive error in patients with keratoconus.

OBJECTIVE: This study aimed to evaluate the effect of intraoperative corneal cauterization on the postkeratoplasty refraction of patients with keratoconus. DESIGN: A randomized clinical trial. PARTICIPANTS: Thirty eyes of 29 patients with keratoconus undergoing standard penetrating keratoplasty by the same surgeon were evaluated (MB). INTERVENTION: Standard penetrating keratoplasty included the use of an 8.0-mm donor button sutured into a 7.5-mm recipient bed by means of two running 10-0 nylon sutures with 16 bites each. Before trephination of the recipient bed, superficial cauterization causing tissue shrinkage was applied to a 6-mm central area of the cornea of only 15 eyes (group A). The remaining 15 eyes (group B) did not undergo intraoperative cauterization. Before surgery, 6 months, and 13 months after surgery, a complete ophthalmologic examination was performed on each patient, including uncorrected and best-corrected visual acuity, refraction, keratometry, computerized corneal topography, as well as A-scan contact ultrasonography. MAIN OUTCOME MEASURES: Postkeratoplasty refractive error was measured. RESULTS: Both 6 months (sutures still in place) and 13 months (suture removal performed in all patients) after surgery, the average spherical equivalent was significantly less myopic in the patients undergoing cauterization. At 6 months, it was +1.72 diopters (D) +/- 1.13 D in group A and -3.16 D +/- 2.84 D in group B; at 13 months, it was +0.09 D 1.52 D in group A and -3.89 D +/- 3.01 D in group B. The average keratometric astigmatism also was significantly lower in group A than in group B both at 6 (2.5 D +/- 1.6 D vs. 4.1 D +/- 2.3 D) and 13 months (2.7 D +/- 1.5 D vs. 4.4 D +/- 2.4 D) after surgery. CONCLUSION: Cauterization of the central cornea improves the postkeratoplasty refractive results of patients with keratoconus.

Adolescent↗
PubMed1987

Epistaxis and the flexible nasopharyngoscope.

Posterior epistaxis differs from anterior epistaxis only by its position in the nose, which makes direct access to the bleeding vessel difficult. With the aid of a flexible nasopharyngoscope, however, the bleeding point may be identified and cauterized directly. In this preliminary report, 12 consecutive patients admitted for posterior epistaxis were successfully treated by the technique described.

Aged↗
PubMed1990

CO2 laser cauterization of giant-cell tumor margins.

The CO2 laser was evaluated to determine its effectiveness for marginal cauterization of giant-cell tumors after resectional curettage. Average power densities of 11-53 W/cm2 for corresponding application times of 120 and 60 seconds were found to produce 30 degrees temperature rises in fresh human femoral heads. This temperature was adequate to achieve thermal necrosis of the tumor margins to a depth of 5 mm. CO2 laser resection was found to be accurate and reproducible. No damage to underlying hyaline cartilage and soft tissues was evident histologically at one and four weeks after experimental local laser cauterization of distal femoral condyles in rabbits.

Animals↗
PubMed2003

Proteome analysis of the rat cornea during angiogenesis.

Angiogenesis is the formation of new blood vessels from the pre-existing vasculature. However, the study of this complex process is often hampered by the lack of a suitable cell-based model and the tools to study the biochemical events that lead to new blood vessel growth. The most widely accepted model for angiogenesis is the in vivo rat corneal model. In this model, the cornea, which is normally an avascular tissue, is stimulated to undergo angiogenesis in response to silver nitrate cauterization or to the implantation of an exogenous angiogenic agent. The physical changes associated with the new vessel growth can be readily monitored visually, but the regulated biochemical events that result in the growth and remodeling of the new vessels are much more challenging to decipher. In this report, a proteomics approach is evaluated for its utility in deciphering the biochemical events during a time course of angiogenic stimulation. At various time points post-silver nitrate cautery, corneas were harvested, solubilized, and analyzed by two-dimensional gel electrophoresis. Protein expression profiles at the various stages of angiogenesis were compared to those of control corneas. One hundred and eleven differentially-expressed proteins were identified by either matrix-assisted laser desorption/ionization-time of flight mass spectrometry or liquid chromatography-coupled electrospray ionization tandem mass spectrometry. Many of the proteins up-regulated during the angiogenesis process were identified as blood-related proteins, thus validating the development of functional blood vessels in the normally avascular tissue of the cornea. Furthermore, detection of differentially-regulated proteins in cauterized versus control tissue clearly validated the utility of a proteomics approach to study this model of angiogenesis. However, in order to get at the key regulatory proteins in the angiogenesis process, it is clear that additional scale-up and enrichment approaches will be required.

Animals↗
PubMed2001

Thermal cautery as a treatment for conjunctival inclusion cyst after strabismus surgery.

Conjunctival cysts may be congenital or acquired. A common cause of acquired conjunctival inclusion cysts is the implantation of conjunctival epithelium after surgery or trauma. These cysts often form at the site of muscle reattachment after strabismus surgery. They may disappear spontaneously, but persistent cases often require surgical excision. We report a new technique using cauterization under slit-lamp visualization to treat conjunctival inclusion cysts that can form after strabismus surgery. This procedure is fast, effective, and well tolerated by patients.

Adolescent↗
PubMed2003

Experience with flexible video cystoscope equipped with built-in high-frequency cauterizing element for transurethral resection of the bladder.

We successfully treated three patients using the flexible video cystoscope (CYF-240A, Olympus, Japan) for superficial bladder cancer under local anesthesia and/or spinal anesthesia. The major advantage of this new technique is that surgeons can use digital pictures and high frequency cauterization. This new system provides good quality of life for bladder cancer patients experiencing frequent recurrences.

Aged↗
PubMedDate not supplied

Chemical matricectomy with phenol for the treatment of ingrowing toenail: a review of the literature and follow-up of 172 treated patients.

There are many options for the treatment of ingrowing toenail, ranging from simple conservative approaches to extensive surgical procedures. Although conservative treatment modalities are helpful in patients with stage 1 disease, stage 2 and 3 ingrowing toenails are best treated surgically. The aim of this study was to evaluate the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenail. A total of 350 phenol ablations were performed on 172 patients with stage 2 and 3 disease. Each patient was reviewed weekly until full wound healing was achieved and afterwards, to assess the long-term efficacy of the treatment, they were followed up for a mean period of 25 months. The healing period after the operation ranged from 2 to 4 weeks and no postoperative complications were seen. Only two recurrences (0.57%) were observed, after 9 and 17 months, respectively, and nail spikes had developed in only two toes (0.57%). The success rate was found to be 98.8%. We conclude that phenol cauterization is an excellent surgical method for the treatment of ingrowing toenail because of its simplicity, low morbidity and high success rate.

Adolescent↗
PubMed1999

The effect of selective cyclooxygenase-2 inhibitor on corneal angiogenesis in the rat.

PURPOSE: Eicosanoids that are present in inflamed tissues are thought to play a significant role in angiogenesis. Cyclooxygenase, a key enzyme in eicosanoid synthesis, has recently been shown to exist in two isoforms: the constitutive COX-1 and the inducible COX-2. This study was undertaken to determine the role of COX-2 in the corneal angiogenic response. METHODS: Angiogenesis in the rat cornea was provoked by chemical cautery. Either NS-398, a selective COX-2 inhibitor, or indomethacin, a non-selective COX inhibitor, was applied topically 3 times daily for 4 days. Neovascularization was quantitated by digital image analysis in corneal flat preparations. To test their inhibitory effects on eicosanoid synthesis, normal or cauterized corneas were incubated in the culture medium with the inhibitor. Prostaglandin E2 in the medium was assayed using an enzyme-linked immunosorbent assay. RESULTS: Both NS-398 and indomethacin significantly inhibited corneal neovascularization with the % inhibition of 36.4 +/- 9.6%, and 38.5 +/- 9.0%, respectively, when applied topically at a concentration of 0.1% (p <.001). Neither reduced the angiogenic response at a concentration of 0.01% or below. PGE(2) production in the cauterized cornea was 2.0 times higher than that in the controls. In normal corneas, indomethacin inhibited PGE(2) synthesis by 80%, whereas NS-398 inhibited it by no more than 20%. In contrast, in injured corneas, both indomethacin and NS-398 inhibited PGE(2) synthesis in a similar fashion, with a maximal inhibition rate of 75 to 80%. CONCLUSIONS: Our results suggest that COX-2 induction in cauterized corneas increases the level of eicosanoids, which result in corneal angiogenesis.

Administration, Topical↗
PubMed2002

Silver nitrate injury in the rat sciatic nerve: a model of facial nerve injury.

BACKGROUND: An unpublished communication of a permanent facial paralysis secondary to silver nitrate application in a postoperative mastoid cavity with a dehiscent facial nerve raises concern regarding its neurotoxicity. This study was performed to examine functional neural injury and the morphology of nerve injury due to silver nitrate contact with a peripheral motor nerve. METHODS: Sprague-Dawley male rats were assigned to a sham surgery group or to a group where silver nitrate was applied directly to a surgically exposed sciatic nerve for 1, 5, or 10 seconds. Individual walking track data were collected on postoperative days (POD) 1, 4, 7, and 14, and the Sciatic Functional Index (SFI) was calculated to assess neural function. On POD 14, the cauterized nerve was harvested, and the histologic axon loss of each specimen was graded. RESULTS: In all experimental groups, the most severe functional loss was noted on POD 1. At POD 14 the greatest neural recovery was observed in the 1-second group, whereas the 5- and 10-second cautery groups demonstrated a significantly worse deficit. A moderate or greater degree of axon loss was observed in 50% of animals injured for 1 second and nearly all animals injured for 5 or 10 seconds. CONCLUSION: Functional and neuropathologic data demonstrate that silver nitrate causes significant injury to the rat sciatic nerve. A 5-second cautery causes greater functional impairment and more severe axonal loss than a 1-second injury.

Animals↗
PubMed2001

[Fistula of the fourth branchial pouch: apropos of a case treated by endoscopic cauterization].

Fistula of the fourth branchial pouch is a rare congenital cervical malformation. It typically affects child and occurs in the left side of the neck. Surgical removal of the entire fistulous tract through an external cervical approach is the treatment traditionally performed. We report a case of a right 4th branchial pouch in an adult managed through an endoscopic approach. Endoscopic cauterization of 4th branchial pouch may be considered as an attractive alternative procedure for the management of this congenital anomaly.

Adult↗
PubMed1994

Evaluation of a tapered, blunt, bipolar cautery tip for trabeculectomy.

A bipolar cautery instrument with a tapered, blunt tip has been developed for glaucoma filtering surgery. Evaluated in 30 consecutive trabeculectomy procedures, the instrument proved suitable for all aspects of the operation. The narrow, 23-gauge shaft and tapered, blunt tip allowed gentle, pin-point coagulation of individual bleeders, as well as cauterization of tracks of tissue in a continuous motion. The unit was effective for external cauterization of conjunctival and scleral vessels, as well as for internal cauterization of anterior uveal tissue.

Conjunctiva↗