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Cellular events in the normal and inflamed cornea.

PURPOSE: Although normal cornea is an avascular transparent structure, bone marrow (BM)-derived cells exist in situ even in noninflamed conditions. We evaluated constitutive cellular trafficking into the cornea in the naive state and investigated how corneal inflammation may be initiated by various stimuli. METHODS: BM chimeric mice were generated using BM from enhanced green fluorescent protein (eGFP) transgenic mice. Corneas of chimeric mice were carefully studied by fluorescent biomicroscopy until 6 months after transplantation. To analyze initiation of cellular events in corneal immune response, we cauterized the center of the cornea or inoculated IL-1 beta into the corneal micropocket. Cellular events were analyzed by flow cytometry. RESULTS: At 2 weeks after BM transplantation, GFP cells gradually migrated into the cornea from the limbal area and were distributed over the entire cornea at 6 months. In both the cauterization and micropocket assays, infiltration of neutrophils and macrophages occurred on days 2 and 4, respectively. Depletion of neutrophils by anti-Gr-1 Ab significantly reduced corneal edema/opacity induced by cauterization. IL-1 beta-induced angiogenesis was markedly reduced in monocyte chemoattractant protein-1 knockout mice. CONCLUSIONS: BM-derived cells are recruited into the normal cornea and may be essential to maintain corneal clarity. In the inflamed cornea, neutrophils might be responsible for acute corneal edema/opacity and macrophages for corneal angiogenesis and chronic inflammation.

Animals↗

Phenol cauterization in the management of ingrowing toenails.

Phenol cauterization has been carried out on 150 toes in 121 patients with an ingrowing toenail. There was no significant morbidity and the procedure was tolerated well by all patients. Overall recurrence rate was found to be 4 per cent after nine months. This figure compares favourably with surgical ablation techniques and when combined with improved patient tolerance indicates that phenol cauterisation may be the ablation procedure of choice in the treatment of an ingrowing toenail.

Cautery↗

Histological quality of polyps resected using the cold versus hot biopsy technique.

BACKGROUND AND STUDY AIMS: The monopolar hot biopsy technique is a widespread method of removing and cauterizing small colonic polyps. Due to the insulated cups of the biopsy forceps, it also allows adequate histological interpretation of the resected specimen. In our experience, polyps removed using the monopolar hot biopsy technique have been less histologically interpretable in comparison with polyps removed using cold biopsy forceps. The aim of this study was to assess and compare the diagnostic quality of polyps obtained using the hot biopsy and cold biopsy techniques. PATIENTS AND METHODS: This was a prospective study of consecutive patients undergoing colonoscopy with removal of polyps using either hot biopsy or cold biopsy techniques. One experienced endoscopist using the same techniques carried out the biopsies. An experienced gastrointestinal pathologist, blinded to the technique used, evaluated the specimens for diameter, artifacts, cautery damage, tissue fragmentation, and general histological and diagnostic quality. Statistical analysis was carried out using the chi-squared test, Fisher's exact test, and Student's t-test. RESULTS: Forty-three consecutive patients (84 % men; mean age 63.8 +/- 15 years) underwent 88 biopsies (45 hot biopsies and 43 cold biopsies). There were no statistically significant differences between the two study groups with regard to demographic data, indications for colonoscopy, endoscopic findings, or polyp size. Cautery damage, architectural distortion, and tissue fragmentation occurred more frequently in polyps resected using the hot biopsy technique ( P < 0.001). CONCLUSIONS: The quality of the specimens removed by cold biopsy was generally better than when using hot biopsy technique. Histological evaluation is more difficult in polyps resected with the hot biopsy technique in comparison with the cold biopsy technique. When the nature of polyps affects the patient's management, a biopsy may be obtained before polyp coagulation.

Aged↗

Creating permanent complete heart block by indirect cauterization without atriotomy.

We created permanent complete heart block (CHB) in 11 dogs without atriotomy by means of indirect cauterization of the atrioventricular (A-V) bundle with a partially insulated wire placed through a small puncture in the atrial wall and guided by palpation. In six acute studies and five chronic studies, all dogs exhibited permanent CHB. To test the block, isoproterenol increased both atrial and ventricular rates 200%-400% without affecting the block. Atropine had no effect on ventricular rate or block.

Animals↗

Endolymphatic hydrops after total dissection or cauterization of the distal portion of the endolymphatic sac.

In this study, a more subtle animal model of Menière's disease is investigated by damaging the distal portion of the endolymphatic sac by dissection or cauterization to produce mild dysfunction of endolymphatic outflow. Cauterization resulted in low degrees of hydrops without any correlation with the inflicted damage. Total dissection of the distal portion of the sac adjacent to the sigmoid sinus produced moderate to severe endolymphatic hydrops with interanimal variation. The consequences of these relatively severe effects, in relation to the mild damage of the endolymphatic sac, and the influence on damaged and undamaged parts of the endolymphatic sac will be discussed.

Animals↗

Drug effects on the neovascularization response to silver nitrate cauterization of the rat cornea.

Neovascular growth into the cornea induced by silver nitrate cauterization is the basis of this experimental model developed to test potential anti-inflammatory drugs for ocular use. Cauterization of the rat cornea with a silver nitrate applicator stick provides the stimulus for neovascularization, which is scored by a "blinded" investigator. Burn stimulus intensity is also scored to substantiate a consistent stimulus among the groups. Compounds showing activity in this model include topical dexamethasone, prednisolone, ticabesone propionate, ketorolac, and phenidone. This model is presented as a practical method for testing anti-inflammatory drugs in the eye.

Administration, Topical↗

Diverticular bleeding and the pigmented protuberance (sentinel clot): clinical implications, histopathological correlation, and results of endoscopic intervention.

UNLABELLED: Over a 3-yr period, we performed colonoscopy on five patients (mean age 71 yr) in whom a specific diverticulum that contained a pigmented protuberance (PiP) was unequivocally identified as the cause for hemorrhage. Four of these individuals had endoscopic bipolar cauterization of the PiP, and two patients had surgery. AIM: To (1) determine the clinical significance of an intradiverticular PiP, (2) correlate endoscopic features of a PiP with histopathological findings and, (3) assess results of endoscopic treatment for affected patients with lower GI bleeding. METHODS: Medical charts were reviewed to garner data and assess outcome for patients. The bleeding diverticulum in one surgical case was detected in the resected specimen, and histological examination was performed. RESULTS: The mean number of transfusions, bleeding days, and lowest hemoglobin concentration before definitive treatment was 4.8, 3.4, and 8.4 gm%, respectively. All patients rebled before treatment. In all instances, the PiP projected through the neck of the diverticulum, which was actively bleeding in two patients. Endoscopic bipolar cautery directed at the PiP achieved permanent hemostasis in three of four subjects (75%) (morbidity 0%). Endoscopic therapy failed in one subject, and a hemicolectomy was performed. Histological evaluation of the resected specimen showed erosion of a medium sized artery into the diverticulum. The PiP represented a sentinel clot (not a visible vessel) adherent to a breach in the vessel wall. A patient who had surgery instead of endoscopic therapy had a prolonged, complicated postoperative course. CONCLUSIONS: (1) The presence of an intradiverticular PiP may identify a subset of patients at risk for severe recurrent diverticular bleeding. (2) Histopathological analysis showed the PiP to be a sentinel clot rather than a visible vessel. (3) In patients with severe recurrent diverticular bleeding, endoscopic treatment of the vessel beneath this lesion may be a viable alternative to surgery.

Aged↗

[An experimental study on congenital foot deformity--with reference to a local disturbance in the limb bud using the exo utero survival method].

Experimental studies on abnormal developments in mammalian embryos have been limited by an inaccessibility to the embryo for surgical manipulations. Here we have developed the exo utero survival method proposed by Muneoka et al. in 1986 to produce models of various hindlimb anomalies by cauterizing a portion of the hindlimb bud of the mouse embryo. A total of 500 mice were used. The treatment was performed on time-pregnant JCL/ICR mice at 10.5 to 12.5 days of gestation (plug day = day 0). Polydactyly occurred in the group treated with pre-axial cauterization at 10.5 to 11.0 days of gestation, and oligodactyly at 10.5 to 12.5 days of gestation. A same insult resulted in different deformities depending on the time of cauterization. Immediately after the cauterization, there was a cloudy area in the limb bud, but at 15 minutes to one hour later, it developed into a necrotic focus surrounded by hemorrhaging and hematoma. The duration of the existence of this hematoma was various. The hematoma occurred just beneath the mesenchymal tissue in the peripheral venous sinus and moved proximally at 24 to 48 hours after the cauterization, in the group treated after 11.5 days of gestation (not seen in the 12.5 days group). This fact was considered to support the progress zone and positional value theory proposed by Summerbell et al. in 1973. From this study, it was concluded that the occurrence of foot deformities such as polydactyly, oligodactyly and cleft foot would have been determined by the site, severity and time of the local insult as well as by the recoverability of the mesenchymal tissue.

Animals↗

Permanent sterilization by hysteroscopic cauterization.

A small series of 22 patients who underwent hysteroscopy cauterization is reported. The uterus was distended with CO2 and dextran. Cauterization was done with a 6 mm. long, active-tip, No. 4 electrode: There was a 27 per cent failure rate for the controlled cases, this dropping to 11 per cent after recauterization. A significant complication, small bowel perforation, was treated by resection and anastomosis with complete recovery. The uterine distention with CO2 is safe but ostium visualization is not very good; Dextran distention is more cumbersone but gives excellent visualization and exposure of the ostium because higher intrauterine pressures are developed.

Anesthesia↗

Argyremia in septal cauterization with silver nitrate.

OBJECTIVE: The purpose of this study was to demonstrate silver absorption in blood and hair specimens after septal cauterization with silver nitrate and to discuss the potential toxicity of silver. METHOD: A prospective study of 11 volunteers without any known occupational exposure to silver products or past history of septal cauterization with silver nitrate was undertaken. Subjects were recruited in an academic tertiary care centre from October 1996 to September 1997. The study population consisted of five patients with anterior epistaxis and six healthy volunteers without any bleeding problem. Cauterization was done with one or two silver nitrate applicators directly on the bleeding vessel or Kiesselbach's area. Blood was sampled before cauterization and at specified times after application, while hair strands were sampled only 3 months later. Measurements of silver concentration in whole blood and in hair segments were obtained by inductively coupled plasma mass spectrometry. RESULTS: Silver concentrations in whole blood increased significantly after cauterization (p = .02). The measured peak level seemed to correlate with the number of applicators used. No significant increase in silver concentration was observed in hair samples. CONCLUSIONS: Effective silver absorption occurs with only one or two silver nitrate applicators. Hair has not been as reliable as whole blood to document an acute and fragmentary exposure. The indiscriminate use of silver nitrate is a potential source of silver intoxication.

Absorption↗

Long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy: how suitable and useful are conventional surgical instruments?

PURPOSE: To investigate the long-term follow-up outcomes of nonlaser intranasal endoscopic dacryocystorhinostomy (IEDCR) using a nasal endoscope and conventional surgical instruments available in all operating rooms, the advantages of this technique, and the usability and suitability of conventional instruments. METHODS: Twenty-seven IEDCRs were performed in combination with bicanalicular silicone intubation on 24 patients with primary nasolacrimal sac or duct obstruction who had undergone no previous procedures. Ablation of the nasal mucosa was performed with a sickle blade (12 operations) or insulated sickle blade allowing simultaneous intranasal monopolar cauterization (15 operations); a bony window was opened with a drill; and ablation of the medial wall of the lacrimal sac was performed with a sickle blade, Blakesley forceps, and Bellucci ear microscissors. Revision intranasal endoscopic surgery was performed in unsuccessful cases. RESULTS: Patients were followed up for 35 to 71 months (average 49.3 months). In 7 (25.9%) of the 27 IEDCRs, nasolacrimal obstruction recurred within 3 months. Success rates were as follows: 66.7% (8 operations) for the first 12 operations; 80% (12 operations) for the second 15 operations; and 74.1% overall. There were seven cases of surgical failure; revision surgery was successful in four, increasing the overall success rate to 88.9%. CONCLUSIONS: IEDCR can be performed with acceptable facility with standard conventional surgical instruments (sickle blade, endoscopic forceps, and scissors) and surgical tools (drill, monopolar cautery) found in all operating rooms, and the nonlaser intranasal endoscopic approach may be a reasonable alternative to the laser assisted surgery approach.

Adult↗

Confirmation of the rat model of chronic, moderately elevated intraocular pressure.

We have confirmed the usefulness of the rat model of chronic, moderately elevated intraocular pressure (IOP) for studying loss of retinal ganglion cells, and as a model for pharmacological neuroprotection studies that may be relevant to treating human glaucoma. By unilaterally cauterizing three episcleral vessels, as described previously in the literature by another laboratory, we observed an approximately 1.6-fold increase in IOP compared to the contralateral eye (18.6 vs 11.5 mm Hg, respectively). Elevated IOP persisted for 6 months without re-treatment. Cupping of the optic disk was observable by examination, in vivo. In 6 months, there was an approximately 40% loss of retinal ganglion cells in the peripheral retina. This model provides a reproducible and quantitative model for pharmacological experiments using neuroprotective agents.

Animals↗

Laparoscopic management of a gastric perforation after snare removal of a gastric leiomyoma.

A 67-year-old man with a history of myocardial infarction, who had been suffering intermittent epigastric pain and tarry stool for nine months, was referred to our hospital with a suspected gastric tumor. The panendoscopy showed a round, hard submucosal tumor at the greater curvature of the upper gastric body, near the fundus. An ulcer scar was observed on the surface of the tumor. Polypectomy using snare cauterization was carried out. However, severe abdominal pain and abdominal distension developed. A chest radiograph revealed bilateral subphrenic free air. Due to the high risk in this patient, laparoscopic repair of the gastric perforation was carried out using an Endo-GIA instrument. The postoperative course was uneventful. Feeding started on the third postoperative day, and the patient was discharged on the eighth day. A follow-up panendoscopy two months later showed a well-healed scar.

Aged↗

Flexible video cystoscope with built-in high-frequency cauterizing element for transurethral resection of bladder tumor.

The major advantage of the flexible video cystoscope is that a digital signal can be obtained while high frequency cauterization is carried out. Cauterization while observing a digital signal picture was not possible before this new model was developed. We decided to use this new cystoscope to resect a bladder tumor and coagulate the bleeding because the patient could tolerate only local anesthesia due to severe heart disease complications. We successfully treated the patient with this technique and no complications were noted. This new flexible video cystoscope was found to be safe for resecting bladder tumor under local anesthesia.

Aged↗

Intracranial haemostasis with a neurosurgical CO2-laser unit.

The authors have been using CO2-laser radiation routinely for more than 2 years. After having recalled the basic thermal properties of this beam, they present their experience. The goal of this work is to point out the particular benefit of CO2-laser cautery to perform tumoral haemostasis. The technical data of this CO2-laser haemostasis are detailed for 3 main indications: In cases of a precise origin of the haemorrhage, the coagulation of small intratumoural vessel necessitates a low output power: 2-4 watts in continued emission; 10-15 watts in the pulsed mode. The beam must be defocussed so as to be as large as the aimed vessel. A micro-manipulatotor is necessary for deeply located tumours. Basal meningiomas, neurinomas, giant adenomas are the best indications. If a diffuse bleeding is encountered in the operative cavity the output must be a little higher: 3-8 watts in continuous mode or 15-30 watts in the pulsed mode; first the cavity is swept with a defocussed CO2-laser ray; then the few larger vessels which have not been cauterized are coagulated one by one either by laser or by bipolar coagulation. The insertion zone of a meningioma can be efficiently coagulated by CO2-laser: a 150-200 watts output in the pulsed mode is necessary if the attachment is dural, a 300-400 watts pulsed output in the case of bony infiltration.

Adolescent↗

Choanal atresia: an unusual serious complication of complementary and alternative medical treatment.

The use of complementary and alternative medicine (CAM) is common among patients with chronic, long-standing nasal disease. Complications resulting from inappropriate CAM practices are sometimes reported, but serious complications such as choanal atresia and stenosis are rare. We report a case of choanal atresia and stenosis due to herbal drug (ie, chemical) cauterization of the nasal cavity in a 39-year-old man. We reviewed the literature on why patients previously given conventional treatment seek alternative therapies. The patient underwent surgical intervention to relieve choanal atresia and stenosis. The postoperative course was unremarkable, and follow-up for 1 year revealed no evidence of restenosis. Choanal atresia and stenosis resulting from CAM treatment are rare. Otolaryngologists should be aware of possible complications occurring in patients receiving such treatments.

Adult↗

Endodontics 1776-1976: a bicentennial history against the background of general dentistry.

During 200 years of progress in endodontics, various sciences have contributed to our understanding of the physiology and pathology of the dental pulp. Early treatment included cauterization of the pulp, the use of poultices or leeches, and tooth transplantation or replantation. Various methods of pulp devitalization are reviewed. Near the turn of the century, the discovery of X rays made diagnosis more accurate and the discovery of local anesthetics eliminated pain during endodontic treatment. Although the focal infection theory slowed the acceptance of endodontic treatment in this century, the biomechanical concept of treatment and research have recently opened new avenues for treatment and have initiated improvements in medicaments and filling materials.

Abscess↗

Mercury water and cauterizing stones: Nicolas André and tic douloureux.

In his 1756 text, Observations pratiques sur les maladies de l'urèthre et sur plusiers faits convulsifs, Nicolas André coined the term "tic douloureux." He believed that this pain originated from compression of facial sensory peripheral nerves. Using scientific observation and experimentation to confirm this hypothesis, he reproduced the tic pain and treated it by using careful efforts to remove adhesions from the nerve with a caustic solution of mercury water. Believing that recurrence of the pain was a result of early closure of the wound, with recompression of the nerve being the direct cause, André prevented recompression by ensuring open wound drainage. André's surgical technique of using cauterizing stones ensured that there was minimal blood loss and little danger of rebleeding and recompression of the nerve by an accumulated blood clot. His case reports include lengthy follow-up periods that documented the benefits of his procedures, which were confirmed by testimonials from uninvolved colleagues. Although remembered for the two words, "tic douloureux," Nicolas André has long been ignored for his prescient treatment and scientific analysis of a disease for which the modern standard of care has only been defined during the last generation.

Cautery↗