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PubMed2006

The utility of bipolar electrocautery in hereditary hemorrhagic telangiectasia.

OBJECTIVE: The surgical treatment of epistaxis associated with hereditary hemorrhagic telangiectasia (HHT) is varied. Laser therapy is often inadequate for larger complex lesions. This study sought to determine if bipolar cautery can be effectively and safely used in treating HHT-associated epistaxis. STUDY DESIGN AND SETTING: Records from all patients with HHT treated surgically over 8 years were reviewed retrospectively. Outcomes or complications were noted in the clinic on follow-up evaluation. RESULTS: Twenty-seven patients with HHT who underwent surgical treatment of epistaxis were evaluated; 18 were treated with bipolar cautery. Forty-two separate bipolar treatments were performed. No new septal perforations or synechiae were noted. Twenty-two of 42 treatments were coupled with ancillary laser treatments. The bipolar was also used as the sole technique in 20 procedures. CONCLUSION: Bipolar electrocautery is a safe and effective tool for the intraoperative control of HHT-related epistaxis. SIGNIFICANCE: Bipolar electrocautery may be used as an adjunct to laser techniques or as a stand-alone technique. EBM RATING: C-4.

Adult↗
PubMed2001

Gross and histologic characteristics of laparoscopic injuries with four different energy sources.

OBJECTIVE: To compare the gross and histologic effects of bipolar and monopolar cautery, ultrasonic scalpel, and CO(2) laser on porcine ureter, bladder, and rectum. DESIGN: Experimental prospective study. SETTING: Cleveland Clinic Foundation Animal Research Laboratory, Cleveland, Ohio. ANIMAL(S): Nonpregnant adult female pigs. INTERVENTION(S): The rectum, bladder, and ureters of 12 female pigs were injured with four different laparoscopic energy sources. MAIN OUTCOME MEASURE(S): Gross measurements of injured tissue and histologic analysis of the depth of the tissue injury. RESULT(S): Gross assessment results were that monopolar injuries of the bowel and bladder were significantly longer than ultrasonic injuries (P<0.01). Injuries were generally manifest as coagulative denaturation of collagen bundles. This resulted in an eosinophilic homogenization of tissue. Nuclei were retained in the injured tissue, although in most cases they had a pyknotic, streamed appearance. The CO(2) laser caused no deep-tissue injury. CONCLUSION(S): Laparoscopic energy sources injure tissue differently. Monopolar cautery appears to have the most lateral spread of thermal energy. The CO(2) laser appears to cause the least deep-tissue injury.

Animals↗
PubMed1984

Complications of female sterilization: immediate and delayed.

Surgical sterilization in women has changed dramatically over the past 20 years. The development of laparoscopy and minilaparotomy have made the procedure readily available even in developing countries. In the United States, changing social values and changes in hospital regulations have done as much as technology to account for the tremendous increases in the number of women undergoing sterilization. Improved sterilization procedures have resulted in lower costs for sterilization and lowered morbidity and mortality rates. Hysterectomy for sterilization alone carries unacceptable morbidity and mortality rates. Originally, laparoscopic techniques utilized unipolar cautery. However, bowel burns, a rare but serious complication, were reported, and this led to newer techniques. These techniques, using bands, clips, and bipolar cautery, have gained increasing popularity and have eliminated many of the serious complications of female sterilization. Historically, there has been concern that tubal sterilization by any method produces, in significant numbers of patients, the subsequent gynecologic and psychologic problems called "post-tubal ligation syndrome." A review of earlier literature indicates that many of these studies have serious methodologic problems, including recall bias, inappropriate control groups, failure to elicit prior history of gynecologic or psychologic problems, and failure to account for the use of oral contraceptives or IUDs. More recent large prospective epidemiologic studies that have controlled for prior gynecologic problems and contraceptive usage have failed to show increased incidence of gynecologic sequelae in large numbers of women. However, there are some data to support the concept that in certain individuals, sterilization may result in disruption of ovarian blood or nerve supply, producing gynecologic sequelae. Additional data from these ongoing large-scale studies and others should help to elucidate this problem in the future. Pregnancy after sterilization (even excluding pregnancies present at the time of the procedure) is more common the first year after the procedure with the risk decreasing in subsequent years.(ABSTRACT TRUNCATED AT 400 WORDS)

Electrocoagulation↗
PubMed2003

Modified transanal rectosigmoidectomy for Hirschsprung's disease: clinical and manometric results in the initial 20 cases.

PURPOSE: The authors describe a modified technique of primary transanal rectosigmoidectomy for Hirschsprung's disease (HD), using a Swenson like procedure to perform the anastomosis between the colon and the rectum, and the preliminary results from this in children. METHODS: Twenty children, of whom, 90% were boys and 10% girls, 50% white and 50% nonwhite, aged 15 days to 10 years and with HD proven via biopsy, underwent a transanal pull-through procedure over a 29-month period. Postoperative follow-up ranged from 29 to 5 months. The proximal cut edge of the mucosal and submucosal cuff was tagged with multiple polypropylene 4-0 sutures, which were used for traction of the intestinal layers outside. The rectal mucosa was incised circumferentially using cautery, to perform rectal dissection approximately 1.5 cm from the dentate line, except in newborn case, in which the proximal cut edge was 0.5 cm from the dentate line. The dissection extended in an upward direction around the entire rectal circumference as far as the opening of the peritoneal reflection. The full thickness of rectum and sigmoid were mobilized outside through the anus, with division and coagulation of the rectal and sigmoid vessels using cautery or ligatures with cotton 4-0. The dissected colon then was divided above the transition zone, which was confirmed via full-thickness biopsy sections and with frozen section confirmation of ganglion cell presence. The authors performed a modified Swenson anastomosis technique, using a seromuscular polyglactin 4-0 separate-stitch suture. No drains were used. RESULTS: Normal bowel movements were displayed by all patients at the follow-up. All patients underwent a defecogram and anorectal computerized manometry at 3 months after surgery that showed an absence of stenosis and good anorectal sphincter muscle complex function. The incidence of complications in our series was 10%. CONCLUSIONS: During the follow-up period of 29 months, all patients had normal bowel movements and normal anorectal manometric pressure profiles.

Adolescent↗
PubMed2003

Evaluation of palatal snoring surgery in an animal model.

OBJECTIVE: We introduce an animal model to reproduce and measure palatal snoring and to assess the effectiveness of cautery-assisted palatal stiffening operation and injection snoreplasty versus a control (no palatal intervention) on treatment of palatal flutter snoring. Study design and setting An anesthetized laboratory canine model uses 2 simultaneous temporary tracheotomies. An inferior tracheotomy is cannulated with an endotracheal tube for ventilation. A superior tracheotomy is cannulated with a tube passed cephalad and seated in the hypopharynx. Negative pressure applied to the upper tube leads to partial collapse of the upper airway with palatal fluttering, and the anesthetized dog snores. Videostroboscopy records palatal flutter frequency before and after surgical intervention. Preoperative and postoperative palatal assessments are made on 15 beagles. RESULTS: Cautery-assisted palatal stiffening operation and injection snoreplasty objectively stiffen the canine soft palate with diminished snoring compared with controls. Conclusion and significance We provide a reproducible animal model to experimentally measure new interventions to treat palatal flutter snoring.

Animals↗
PubMed1992

Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis.

Whilst it is generally accepted that the standard management for anterior or benign epistaxis is either cautery or anterior nasal packing, that of posterior or intractable epistaxis remains controversial. Various modalities of treatment, ranging from posterior nasal packing to arterial ligation and embolization, have been advocated but none have been unanimously accepted as the treatment of choice. The purpose of this paper was to determine the efficacy of internal maxillary arterial ligation versus combined internal maxillary arterial ligation and anterior ethmoid arterial coagulation in intractable epistaxis. Over a six year period, from 1985 to 1990, 454 patients were admitted and treated for epistaxis. Forty-seven patients were diagnosed as having intractable epistaxis on the basis that the epistaxis failed to settle on anterior nasal packing. They were moved to the next step in management, which was combined anterior and posterior nasal packing. There were 30 failures, one was found to have choriocarcinoma of the maxilla, and was treated with cytotoxics, and the other 29 were moved to the next step, which was arterial ligation. Fifteen patients had internal maxillary arterial ligation, and 14 combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation. Large windows were created in both the anterior and posterior walls of the maxillary sinuses and all identifiable branches of the internal maxillary artery were dissected out carefully and two medium size ligating clips were placed over the main trunk, the sphenopalatine and the descending palatine branches. Single clips were placed on all other identifiable branches. Coagulation of the anterior ethmoidal artery was performed with a bipolar cautery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Controlled radiofrequency endotubal sterilization.

STUDY OBJECTIVE: A safe, effective, inexpensive method of transcervical tubal sterilization could have a major impact on women's health. In this study, we evaluated the efficacy of a new radiofrequency catheter prototype designed for endotubal sterilization using animal models. SETTING: Animal research laboratory. DESIGN: Prospective observational study. METHOD: The optimal energy delivery to create a complete circumferential transmural thermal lesion in the tube was determined in 114 in vitro acute studies using porcine and bovine fallopian tubes. A study was then initiated with eight mini-pigs. Thirty-four lesions were made in the fallopian tubes using computer-controlled power delivery. Three weeks later the animals were euthanized and evaluated. MEASUREMENTS AND MAIN RESULTS: A hydrosalpinx was evident in 8/11 of the tubes with separate proximal and distal cautery, implying occlusion at each of these sites. Complete occlusion of the tubes was seen at 12/22 sites evaluated by histology. Narrowing was seen in 9/22, and 1/22 was open. CONCLUSION: The endotubal cautery prototype creates a reproducible lesion, but did not always cause complete closure of the tube in this preliminary study. However, based on our results, we hypothesize that a radiofrequency catheter can be developed for minimally invasive transcervical sterilization.

Animals↗
PubMed2001

Review article: current therapeutic options for radiation proctopathy.

Radiation proctopathy is a common unfortunate complication following radiation therapy of pelvic malignancies. Symptoms of chronic radiation proctopathy include haematochezia, urgency, constipation, tenesmus, diarrhoea and rectal pain. Currently, a wide variety of pharmacological options, endoscopic cautery techniques and surgical procedures have been proposed for the treatment of chronic radiation proctopathy. Although these have been proposed primarily as treatment for rectal bleeding, the control of other symptoms has been noted with some of these agents. Pharmacological options include 5-aminosalicylic acid preparations, coticosteroid enemas, sucralfate (oral, enemas), formalin, short chain fatty acid enemas, oestrogen/progesterone, hyperbaric oxygen, antioxidants, sodium pentosan polysulphate and misoprostol rectal suppositories. Of these, sucralfate and formalin therapy appear to be effective for bleeding control. Misoprostol rectal suppositories and oral sucralfate may be useful in the prevention of acute and chronic symptoms of radiation proctopathy. Endoscopic cautery techniques have included the use of Nd:YAG laser and argon laser for coagulation of bleeding neovascular telangiectasias. Argon plasma coagulation offers a safe non-contact method of delivering haemostasis which has proven to be particularly useful in targeting difficult to reach lesions tangentially. Surgery is generally reserved for severe refractory cases involving ongoing haemorrhage, obstruction, stricture formation, fistulas and perforation. Given that formal randomized placebo-controlled studies are lacking for most treatments, the management of these patients is often challenging and unclear. Hence, there is a need for more research and education on radiation proctopathy.

Adrenal Cortex Hormones↗
PubMed2000

Removal of adherent ventricular catheters by a modified sheath introducer system: technical note.

BACKGROUND/PURPOSE: A series of technical notes has been dedicated to the removal of retained intracranial shunt catheters, among which the intraluminal cautery proved to be the most accepted technique. However, several reports showed that these techniques still harbor potentially serious complications. METHODS: In this technique, a modified plastic sheath introducer system is passed over the retained ventricular catheter. While advancing the tube along the longitudinal axis of the catheter, circular movements of the tube around the longitudinal axis of the catheter are performed, allowing the tube to act as a spherical knife cutting the ingrown choroid plexus or ependymal adhesions. RESULTS: There were no procedure-related complications in any of the 9 patients treated by the technique described. The procedure proved to be easy and effective in all cases. In addition, in case a new ventricular catheter was needed at the same site, it could be placed via the same tube. CONCLUSIONS: The technique described seems to be an easy, safe, and effective alternative to other techniques for removal of retained ventricular catheters. However, considering the limited number of patients treated with the technique described and the great number of patients treated by the widely accepted intraluminal cautery, one cannot claim the one technique as superior to the other at this stage.

Cardiac Catheterization↗
PubMed2004

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↗
PubMed1992

Preliminary experience using an ultrasonic aspirator for laparoscopic cholecystectomy.

An ultrasonic aspirator (Olympus) specially designed for laparoscopic surgery, which also includes cautery and suction-irrigation systems, was evaluated in 40 patients undergoing laparoscopic cholecystectomy. The generating power of each system is controlled by hand or foot switches, and most operating procedures could easily be performed through a 10 mm trocar inserted through the abdominal wall. The ultrasonic aspirator successfully fragmented and aspirated soft tissue, allowing a precise differentiation between the cystic duct and artery, small vessels, lymphatics and fibrous tissue. Removal of the gallbladder could be performed successfully using the cautery and ultrasonic aspirator, whereby parts of cauterization or division could easily be identified. Identification of the cystic duct and artery, course of the cystic duct and Hartmann's pouch in the same field of vision was possible which is important for avoiding major complications such as injury of the common bile duct. No complications were seen during or after surgery in any of the patients.

Cholecystectomy, Laparoscopic↗
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↗
PubMed2002

Formation of vesicovaginal fistulas in laparoscopic hysterectomy with electrosurgically induced cystotomy in female mongrel dogs.

OBJECTIVE: The aim of this pilot study was to investigate the relationship between various types of laparoscopic bladder injuries and vesicovaginal fistula formation in an animal model. STUDY DESIGN: Sixteen female mongrel dogs were divided into four groups. All animals underwent a laparoscopic hysterectomy. Those assigned to group 1 sustained a 1-cm bipolar cautery injury to the bladder base without perforation of the bladder mucosa. Animals in group 2 had two sutures of 2-0 polyglactin placed to incorporate the full thickness of the bladder wall and the vaginal cuff. The bladder injury to group 3 was a 1-cm bladder base laceration induced with monopolar cautery, repaired with two interrupted 2-0 polyglactin sutures. Group 4 underwent a bladder base cystotomy similar to those in group 3, with the closure incorporating the anterior vaginal wall. Animals were killed and necropsy was performed at least 28 days after surgery. The bladder and vagina of each animal were harvested en bloc. Evidence of a vesicovaginal fistula was determined by two methods: transurethral injection of indigo carmine solution under direct visualization and air injection during underwater submersion. RESULTS: The four groups were comparable with regard to postoperative weight changes. No mongrels showed signs of infection or sepsis. Inspection of the harvested bladder and vagina revealed no fistulas in groups 1 and 2. One mongrel from group 3 and one from group 4 had evidence of a vesicovaginal fistula. With 95% CIs, the fistula rate would be at least 2% and as high as 38% if a larger study had been undertaken. CONCLUSION: The female mongrel is the first identified animal model of vesicovaginal fistula formation. In this setting, an electrosurgically induced cystotomy and repair of the bladder during the performance of a laparoscopic hysterectomy is associated with the formation of postoperative vesicovaginal fistulas.

Animals↗
PubMed2001

Quantitative evaluation of intact peripheral nerve structures after utilization of CO2 laser, electrocautery, and scalpel.

OBJECTIVE: This study aimed to evaluate quantitatively the integrity of nerve structures near CO2 laser incisions. BACKGROUND DATA: There are some hypotheses that try to explain the analgesia reported after CO2 laser surgery. One of them is based upon the observation of the destruction of nerve endings after use of this technique. METHODS: A comparative study was carried out using 25 animals (Rattus norvegicus) divided into five groups of 5 animals each. Standard incisions were carried on the dorsum of the tongue of each animal using the cautery (group 2), scalpel (group 3), CW CO2 laser (group 4), and SPS CO2 (group 5); group I served as control. The animals were killed immediately after the experiment, and specimens were taken and routinely processed to wax. Three-micrometer sections were cut and stained using S-100 protein antibody. The stained sections were analyzed under light microscopy using a calibrated graticule, and the number of intact nerves was counted in five standard areas around the incision. RESULTS: The results of this study showed that there were no statistically significant differences in the numbers of intact peripheral nerve structures in both laser groups and other groups. No statistically significant difference was found between nonoperated and scalpel groups. The number of intact peripheral structures in cautery wounds was significantly smaller than in non-operated and scalpel wounds. CONCLUSIONS: Therefore, it is unlikely that immediate destruction of peripheral nerve structures is the cause of post-operative analgesia following CO2 laser surgery.

Animals↗
PubMed1996

Comparison of acucise endopyelotomy and endoballoon rupture for management of secondary proximal ureteral stricture in the porcine model.

At this point in time, endopyelotomy is first-line therapy for both primary and secondary adult ureteropelvic junction obstruction (UPJO) in many medical centers. However, the potential, albeit small, for significant bleeding with any endoincision of the UPJ has sparked interest in the simple, less morbid technique of endoballoon rupture. To date, no comparative data are available on the effectiveness of these two techniques. Thirty female minipigs were randomized to cutting balloon (Acucise) endopyelotomy (AEP) (N = 13), endoballoon rupture (EBR) (N = 13), or a control arm (N = 4). Following baseline retrograde pyelogram (RPG) and diuretic renogram (DRG), a secondary proximal ureteral stricture was created by laparoscopic ligation of the UPJ. After 8 weeks, AEP or EBR was performed in each of the study pigs. In 16 pigs (8 AEP, 8 EBR), a 7F 22-cm ureteral stent was placed (chronic arm). After 6 weeks, the stent was removed, and a second RPG and DRG were performed. Three months post-treatment, after RPG and DRG, the renal units were harvested, and histologic sections of the affected UPJ, contralateral normal ureter, and ipsilateral kidney were examined. Ten pigs (5 AEP, 5 EBR) underwent harvest immediately after treatment (acute arm). The four control animals remained untreated. At 8 weeks, all minipigs had obstructive findings on RPG and DRG. All UPJs could be treated but one, which had an impassable stricture; there were no perioperative complications. In the acute arm, all UPJs were patent. All five AEP ureters had evidence of an uneven cut and cautery effect. Of the EBR ureters, two had smooth tears and three had ragged tears, and none had evidence of cautery effect. In the chronic arm, 3 months after either AEP or EBR, all minipigs had a patent UPJ, yet only 5 of 16 had an improved 1 1/2 by DRG. Histologic sections of the affected UPJs from 20 minipigs in the chronic arm (8 AEP, 8 EBR, 4 controls) were indistinguishable among the three groups; each revealed significant periureteral fibrosis and chronic inflammation with a mainly unremarkable muscular layer. However, histologic sections of 25 treated kidneys, including both acute and chronic animals (13 AEP, 12 EBR), revealed endstage renal disease (N = 10), chronic inflammatory changes (N = 7), or normal tissue (N = 8). Again, there was no trend favoring either AEP and EBR. In summary, in this laboratory study, we could detect no difference in outcome between an incisional endopyelotomy and an endoballoon rupture for treating secondary UPJO.

Animals↗
PubMed2006

Ureteroscopy for symptomatic hydrocalices: a case series.

BACKGROUND: Hydrocalix is an uncommon condition that typically is treated with percutaneous dilation of the stenotic infundibulum. Ureteroscopy has the advantage of minimizing invasiveness. METHODS: We reviewed our experience with 12 retrograde ureteroscopies for hydrocalix in 10 patients. RESULTS: Access to the hydrocalix could not be achieved in one. Of the remaining 11, the original infundibulum was dilated in all but one, in whom neoinfundibulotomy was performed with a laser. The laser was used in eight cases, balloon dilation with cautery in two, and cautery alone in one. Of the seven hydrocalices bearing stones, four were rendered stone free. Immediate symptomatic success was achieved after 6 of the 11 evaluable procedures (one patient was lost to follow-up after a technically successful procedure). Of the five symptomatic failures, three went on to additional treatment (one ureteroscopy and two percutaneous), one elected against treatment despite recurrence of stenosis, and one had persistent pain owing to stones even though the hydrocalix was cured. Of the six symptomatic successes, three were without symptoms at a mean 25 months of follow-up, two have had recurrences necessitating additional treatment (both percutaneous) a mean of 51 months later, and one did not have adequate imaging follow-up. CONCLUSION: Ureteroscopy for hydrocalix achieved technical success in most patients, but relief of symptoms followed only about half of the procedures. A trial of ureteroscopy does not preclude subsequent success with a percutaneous approach. Ureteroscopy is a reasonable option for hydrocalix for patients who wish to avoid percutaneous surgery.

Adult↗
PubMed2004

Paraganglioma of the urinary bladder: a lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens.

Paraganglioma of the urinary bladder is a rare tumor with characteristic histologic and immunohistochemical features. However, in our experience, it may be misdiagnosed as urothelial cancer because of 1) its frequent involvement of the muscularis propria; 2) morphology that may suggest urothelial cancer in transurethral resection specimens, particularly if there are artifactual changes induced by that procedure; 3) failure of pathologists to include it in their differential diagnosis when evaluating a bladder tumor; and 4) only a minority of the cases are associated with symptoms that might prompt consideration of the diagnosis. Distinction between paraganglioma and urothelial cancer is important because of likely different therapeutic options. In this report, we describe our experience with the histopathology of paragangliomas of the urinary bladder with emphasis on the histologic features that have led to their being misdiagnosed as conventional urothelial cancer and, most importantly, those that will help pathologists recognize this rare tumor of the bladder. Fifteen cases of paraganglioma of the urinary bladder were studied, 11 of them consult cases. They affected patients (8 male, 7 female) with a mean age of 49.5 years; only two had symptoms suggestive of the diagnosis, including hypertension during cystoscopy and episodic headache. Three consult cases were submitted with a diagnosis of "transitional cell carcinoma" and 4 with a diagnosis only of "bladder tumor." Histologically, "zellballen" and diffuse patterns were present in 12 (80%) and 3 (20%) of the cases. A delicate fibrovascular stroma was obvious in 14 (93%) cases. Other patterns included irregular nests and pseudorosette formation. Tumor necrosis, significant cautery artifact, and muscularis propria invasion were present in 1 (7%), 3 (20%) cases, and 10 (67%) cases, respectively. All 15 tumors were composed of large polygonal cells with abundant granular cytoplasm. Focal clear cells were present in 3 (20%). The nuclei were mostly uniform, although occasional pleomorphic nuclei were seen in 6 (40%) cases, and 2 (13%) had frequent pleomorphic nuclei. Mitoses were rare overall, and no abnormal mitotic figures were found. The major histologic features that led to misdiagnosis included a diffuse growth pattern, focal clear cells, necrosis, and muscularis propria invasion, with significant cautery artifact compounding the diagnostic problems. Immunohistochemically, 2 of 2 tumors were positive for neuron-specific enolase, 9 of 10 tumors for chromogranin, and 2 of 3 tumors for synaptophysin; 3 of 3 tumors were negative for cytokeratin and 1 of 1 tumor negative for HMB-45. Paraganglioma of the urinary bladder may be misdiagnosed as urothelial cancer, but a careful search for the characteristic histologic features and, if necessary, supportive immunohistochemical studies, should lead to a correct diagnosis.

Adolescent↗
PubMed1984

Experimental and clinical use of the YAG laser in the management of pulmonary neoplasms.

Animal experiments were performed with evaluation of the use of the neodymium-YAG (yttrium-aluminum-garnet) laser in the trachea, bronchi, and pulmonary parenchyma. Histologic evaluation of incisions into the lung was assessed by multiple sections over a 5-week period and comparisons were made of incisions closed with chronic catgut or coagulated with electric cautery or by the laser. These studies indicated that the laser is more effective in controlling parenchymal bleeding and air leaks than either the cautery or chromic catgut and produces less local tissue reaction. The Nd-YAG laser has been used clinically to treat patients with inoperable obstructing and bleeding carcinomas of the trachea and main bronchi to open the involved airway and to restore pulmonary function. Fifteen patients have had 26 treatments using the Nd-YAG laser. Total laser time was limited to 15 minutes with 0.5-second pulses of 50 to 80 watts being delivered via the fiberoptic and straight bronchoscope as indicated. It is extremely effective in controlling hemoptysis from recurrent endobronchial lesions, and obstructing lesions in the trachea and main stem bronchus can be treated quite successfully with excellent palliation. It is apparent that continued clinical use of the Nd-YAG laser as palliative therapy for bleeding and obstructing tumors of the tracheobronchial tree is indicated and expanded use at the time of thoracotomy to control lung parenchymal bleeding and air leaks should be considered in the future.

Adenocarcinoma, Bronchiolo-Alveolar↗