SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.
We present our experiences in the surgical management of 21 snorers, utilizing a new approach designed to stiffen the palatal musculature, without compromising its function. This was achieved by using a punctate pattern of intrapalatal diathermy to achieve fibrosis within the palate and hence the requisite stiffening. The initial results of this procedure are encouraging showing a subjective improvement in snoring in 85.7 per cent of patients and an increase in sleeping in the same room as their partner every night, from 14.3 per cent pre-operatively to 57.1 per cent post-operatively.
Conventional methods of arterial ligation in persistent epistaxis often involve significant surgical morbidity, as well as failure due to arterial anastomosis. We have performed endoscopic intranasal end ligation or diathermy of 11 sphenopalatine arteries in 10 patients with no complications and with no further episodes of epistaxis, with an average follow-up period of nine months.
Submucosal diathermy (SMD) is a common surgical procedure carried out to improve the nasal airway. A case is presented in which it was followed by profuse epistaxis which required transfusion of 28 units of blood, eight units of fresh frozen plasma (FFP) and four units of platelets within 14 days.
We report a case of unusually severe, scrotal lymphangiomas that have been treated successfully with the novel combination of cutting diathermy and carbon dioxide laser.
Large loop excision of the transformation zone (LLETZ) allows complete histologic assessment of cervical neoplasia. However, selective colposcopically directed punch biopsy followed by local ablation allows the possibility of inappropriate local ablation of early invasive lesions missed at punch biopsy. The onus of accurate diagnosis lies on the colposcopist. We have studied 1143 patients managed with loop diathermy and identified 35 invasive squamous carcinomas and 9 invasive adenocarcinomas. The data show that the cut-off for accurate colposcopic detection of invasive squamous lesions is not breach of the basement membrane but invasion up to a depth of 1 mm. On the other hand, colposcopy is an unreliable guide for the diagnosis of early adenocarcinoma. Diagnosis based on loop excision allows accurate, rational individualization of management for the unexpected diagnosis of colposcopically occult early invasive disease whilst retaining the logistic benefits of a 'see and treat' policy.
Whether or not thermal artefact precludes accurate histopathologic assessment of excision biopsies of the uterine cervix is currently controversial. Some authors state that margins cannot be assessed at all while others feel that the pathologist can 'see through' the artefact in the majority of cases. Over a 7-month period, 164 patients had loop excision and 84 patients had laser cone biopsy. The zone of coagulation at the specimen periphery was measured and the adequacy of excision assessed. The average width for this zone of coagulation in diathermy loop was 0.32 mm and for laser cone biopsies was 0.31 mm. In 12% of the loop specimens the line of excision was compromised by dysplasia or its assessment was rendered uncertain by thermal artefact. This was far more common in fragmented specimens (20%) compared to those removed as a single specimen (6%). In this study, 40% of patients had fragmented loop specimens. Thus, in attempting to replace cone biopsy with loop excision, we are asking pathologists to reassemble a pathologic jigsaw, then look through the thermal artefact for a decision on margins. We believe that this fragmentation should preclude the use of loop excision for lesions which would previously have been managed by cone biopsy.
OBJECTIVES: To investigate the influence of pulsed short-wave diathermy (PSWD) on fibroblast and chondrocyte cell proliferation rates and to establish the influences of different dosages applied. DESIGN: Four single-blind trials. SETTING: Laboratory, in vitro study. SPECIMENS: Human adult dermal fibroblast and chondrocyte cells were plated at known concentrations and incubated for 5 days. INTERVENTION: Exposure to PSWD, twice daily, on days 2, 3, and 4. MAIN OUTCOME MEASURE: After crystal violet staining (day 5), optical density (cell number) was determined spectrophotometrically. RESULTS: PSWD, given at mean power of 48W for 10 minutes, increased fibroblast proliferation compared with control groups (P<.001). There was a relationship between cell proliferation and the amount of energy given (P<0.001). The optimal mean power for proliferation was estimated to be 13.8W. While keeping mean power constant at 6W, altering pulse duration and pulse repetition rate dosage parameters did not have a significant effect on proliferation (P=.519). Chondrocyte proliferation also increased with PSWD exposure of 6W at 10 minutes duration (P=.015). In addition, treatment time was significantly associated with chondrocyte proliferation (P<.001). CONCLUSION: PSWD is associated with increased rates of fibroblast and chondrocyte proliferation in vitro, which is dose dependent. These results contribute to an understanding of the physiologic mechanisms underlying the therapeutic effects of PSWD.
The incidence of stomal obstruction following gastric restrictive procedures varies with the different methods in use. This complication may cause prolonged hospitalization and even reoperation. The objective of this clinical study was to develop a safe and efficient non-operative alternative for treating stomal obstruction. We transferred current techniques and experience from endoscopic papillotomy to the field of bariatric surgery, and during the past four years we have performed fourteen endoscopic diathermy incisions in eleven patients with resistant stoma obstruction after gastroplasty. The results have been good and there have been no complications. Neither has failure to lose weight due to widening of the stoma occurred. Since we took up the procedure, there have been no relaparotomies due to stoma obstruction in our department. In conclusion, endoscopic incision of an obstructed stoma after gastroplasty is an easily-performed and highly effective alternative to other non-operative procedures for the treatment of serious complications in bariatric surgery.
In experimental studies a new method for anterior capsulotomy of the crystalline lens was developed. The anterior lens capsule can be cut by diathermy in such a manner that this action can be reproduced. The effects of current are illustrated by means of light-microscopic sections, which are also helpful in estimating the degree of surgical trauma. Advantages of the new method are outlined and discussed, with references to other publications.
The author describes a miniature bipolar diathermy unit which can be used for several microsurgical purposes. It was developed from a standard endodiathermy instrument which has been in use for pars plana vitrectomy since 1973. It features bipolar forceps which can be used for welding conjunctival flaps and macrohemostasis in strabismus, orbital and lid surgery; bipolar electrodes with and without infusion, for extraocular hemostasis and intraocular microhemostasis in the anterior and posterior segments; bipolar electrodes with infusion for special purposes (still at the experimental stage), for capsulotomy of the anterior lens capsule for extracapsular cataract extraction, section of intraocular strands and membranes and sector iridectomy for tumors or rubeosis of the iris.
The use of Ligasure, a computer-controlled bipolar diathermy system is proven beneficial in a wide range of surgical procedures. This study was to evaluate its application to vaginal hysterectomy. Over forty patients underwent vaginal hysterectomy with (n = 32) or without (n = 12) Ligasure using standard surgical techniques. The main diagnoses, the age of patients, time for surgery, hospital stay and estimated blood loss during operation were compared. The average operating time was shorter in the Ligasure vaginal hysterectomy group (30 mins (24-48) P < 0.05), the estimated blood loss was less in the Ligasure hysterectomy group (39 mins (25-60) P < 0.05), and the hospital stay was shorter in the Ligasure hysterectomy group (1.2 days (1-2) vs 3 days (3-5) P < 0.05). There were no postoperative complications or re-admissions in either group. Vaginal hysterectomy using Ligasure reduced operating time and blood loss, and therefore shortened hospital stay.
A prospective study of 48 women was carried out to estimate the incidence of common genital pathogens in women referred to colposcopy clinic requiring diathermy loop excision and to compare patient morbidity in the subgroups with and without genital pathogens. Of the 43 women included in the analysis, genital pathogens were present in 24 cases (56%) and absent in 19 (44%) of the 24 positive cases, 19 (79%) women had pathogen(s) on the cervical swab, 24 (100%) had pathogen(s) on the high vaginal swab and 15 (63%) had both a positive cervical and high vaginal swab (HVS). The most frequently isolated groups of organisms were mixed anaerobes, alone (four HVS and four cervical) or in combination with Gardnerella vaginalis (four HVS and three cervical) or coliforms (two HVS and two cervical). The mean duration of bleeding and vaginal discharge in the two study groups was not statistically significant (t value 1.97, P 0.05; and t value 0.48, P 0.5, respectively). However, the mean duration of bleeding graded by the patient as being moderate to severe was significantly different in the two groups (t value 3.18 P 0.01). Fifty-six per cent of the women in the study had confirmed genital pathogens, predominantly anaerobes, and the prolonged moderate-to-severe bleeding in this group suggests a potential role for prophylactic bacteriocides, although the study size was unable to implicate a single pathogen.
BACKGROUND: This prospective dose-finding study was undertaken to determine the optimal amount of thermal energy required for laparoscopic ovarian diathermy (LOD) in women with polycystic ovary syndrome (PCOS). METHODS: Thirty women with clomiphene-resistant PCOS were included in the study. All women underwent LOD. A modified Monte Carlo up-and-down design was utilized. Women were treated in groups of three (10 groups). The amount of energy applied was standardized at 150 J/puncture. The number of punctures in each group was decreased/increased according to the number of responders in the previous group. The main outcome was ovulation as defined by a serum progesterone concentration of > or =30 nmol/l. RESULTS: Four groups (n=12) were treated with four punctures/ovary, three groups (n=9) with three punctures, two groups (n=6) with two punctures and one group (n=3) with one puncture. Ovulation occurred in 67, 44, 33 and 33% of women treated with four, three, two and one puncture/ovary respectively. The corresponding pregnancy rates were 67, 56, 17 and 0%. The reductions in the free androgen index and the serum concentrations of testosterone and androstenedione after LOD were observed only in women treated with three and four punctures/ovary. CONCLUSION: The clinical response to LOD seems to be dose-dependent, with an increase in the frequency of ovulation and conception with an increasing dose of thermal energy up to 600 J/ovary.
Although there are other physical methods of destruction which may be effective for small areas of dysplastic change, the author believes that D&C and electrocoagulation diathermy under general anesthesia is a more reliable and more effective method of destruction of abnormal T-Zone. It has the distinct advantage of being able to eliminate large areas, and in particular, changes of major atypia extending into the gland crypts. To date, no patient treated in this fashion has developed invasive carcinoma of the cervix.
Twenty-one patients with nasal obstruction due to allergic or vasomotor rhinitis were assessed rhinomanometrically before and after the operation of submucosal diathermy to the inferior turbinates. It was found that the operation significantly improved the nasal airway. Most patients with an objective improvement reported a corresponding reduction in nasal obstruction. There was no tendency for patients with allergic rhinitis to be dissatisfied with the operation.
For many years it has been suggested that the subjective outcome of the operation of submucosal diathermy to the inferior turbinates (SMD) may be predicted by pre-operatively testing the ability of the nasal mucosa to decongest with topical vasoconstrictor agents. This study of 22 patients undergoing SMD, confirms that the pre-operative decongestion produced by xylometazoline is both a good subjective (P less than 0.001) and objective (P less than 0.002) predictor of outcome. If a significant reduction in nasal resistance is achieved by the application of topical decongestants, then the operation of SMD is likely to be effective.
Tonsillectomy is an operation performed by various techniques. We have developed a bipolar diathermy dissection technique that allows a low intra-operative blood loss without an increase in complications. The average blood loss was less than 4 ml in 100 patients. Most were able to drink and eat by 4 and 10 hours respectively. There was no increase in analgesic requirements. No primary haemorrhage was recorded; three patients had a secondary haemorrhage. The technique allows accurate coagulation of blood vessel and is an easy procedure to learn.