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PubMedDate not supplied

A treatment algorithm for the management of epistaxis in hereditary hemorrhagic telangiectasia.

We examined the management options used for epistaxis of varying severity in patients with hereditary hemorrhagic telangiectasia (HHT) to develop a treatment algorithm. Fifty patients with HHT were studied from 1991 to 1997 to consider various treatment options and their relative efficacy. There were 28 females and 22 men; their ages ranged from 15 to 85. Follow-up ranged from 6 months to 6 years. A wide variety of treatments had been used (including various forms of cautery, septal surgery, topical and systemic hormones, antifibrinolytic therapy, arterial ligation, laser therapy, and closure of the nostrils). Treatments used during the follow-up period were argon laser therapy (40), systemic estrogen or progesterone (17), septodermoplasty (12), or closure of the nostrils (14). Patients were divided into those with mild to moderate disease (requiring one or no blood transfusions during the course of their illness) and those with severe disease (requiring more than one blood transfusion). Using this broad categorization, those with mild to moderate disease did well with sequential argon laser therapy with or without the adjunct of septodermoplasty or hormone therapy. Those with severe disease did not find argon laser therapy beneficial but found their epistaxis completely stopped with closure of the nasal cavities. Based on these findings, a simple treatment algorithm defines the optimum treatment options for epistaxis in this difficult-to-treat group of patients.

Adolescent↗
PubMed1975

Adult deficiencies and duplications of head and thoracic structures resulting from microcautery of blastoderm stage Drosophila embryos.

Drosophila embryos were damaged by microcautery at the cellular blastoderm stage at the sites of presumptive imaginal cells, identified from fate maps. The resulting adults were analyzed for abnormal structures. Cautery of any of the presumptive imaginal regions can lead to defects in the adult cuticle, though the majority of adults which hatch are morphologically normal. The abnormal adults had one or more discs either deleted, incompletely formed, or misarranged. Several of the structures which were incomplete had duplicated regions. The results suggest that, from the time fo their initial formation in the cellular blastoderm, a group of cells determined to be an 'adult' structure possesses a gradient of developmental capacity which is expressed by certain regions duplicating and other cells regenerating. The types of duplications found were similar to those resulting from other experimental treatments of imaginal discs at later stages in development, indicating that the presumptive imaginal disc cells, when they are first established in the cellular blastoderm, have a similar organization to mature imaginal discs.

Animals↗
PubMed1976

Iridectomy in rubeosis iridis.

Creating an iridectomy in the face of rubeosis iridis carries a significant risk of hyphema. A technique is described utilizing a bipolar micro-cautery to cauterize iris vessels under direct observation before cutting iris tissue. This allows the iridectomy to be performed with less risk of intraocular bleeding.

Cautery↗
PubMed1992

An experimental model of ectropion uveae and iris neovascularization in the cat.

Neovascularization of the iris (NVI) is one of the most frequently studied intraocular vascular proliferations in animal models. Ectropion uveae has not been a consistent finding in these studies. In this study, a surgical model of ectropion uveae and iris neovascularization was developed that involved lensectomy, vitrectomy, bipolar cautery and transection of all three principal branch veins in the cat eye. Twelve of 14 eyes that received this procedure developed postoperative retinal detachments with a clinical picture of hemorrhagic retinopathy. These eyes progressed to a clinical picture of NVI within 1-7 wk. Eight eyes developed ectropion uveae for as much as 300 degrees. At the light microscopic level, a fibrovascular membrane was apparent on the anterior iris stroma in 9 of 14 eyes and further involved the angle in six eyes.

Animals↗
PubMed1990

The effect of oxygen on corneal neovascularization.

Since tissue oxygen levels are believed to play a pivotal role in new vessel growth in several situations, we studied the effect of several oxygen concentrations (0, 10, 21, 50, 75, or 100%) on corneal vascularization induced in the rat by chemical cautery. We achieved this by perfusing known concentrations of oxygen through goggles fitted over both eyes of the rat after corneal cauterization. Neovascularization was measured in flat corneal preparations with India ink-filled vessels 4 days postcautery using computerized image analysis. The angiogenic response of rats whose eyes were continuously exposed to 0-75% oxygen were not significantly different from each other. The mean response in corneas exposed to 100% oxygen was 10-21% lower than all of the other groups, and this difference was statistically significant when compared to oxygen concentrations of 0, 21 and 75%. The reason for the inhibitory effect of 100% oxygen remains to be determined, but it may represent a toxic effect of oxygen free radicals on the vascular endothelium.

Animals↗
PubMed1985

Angiogenic activity in injured rat corneas as assayed on the chick chorioallantoic membrane.

The temporal appearance of an angiogenic effect in chemically cauterized rat corneas was determined by studying the responses that they induced in the vessels of the chick chorioallantoic membrane (CAM). Injured rat corneas were grafted to the CAM from 90 minutes to 7 days after cautery. As controls, uninjured rat corneas and corneas of healthy rats cauterized immediately after death were also grafted. The vascular responses to the grafts were graded in a masked fashion by stereoscopic biomicroscopy on a five-tiered scale, by evaluations of projected colored photographs on the same scale, and by histologic examination of the grafts. Separate coefficients of angiogenesis were determined for the stereoscopic and photographic evaluations. We detected significant differences between corneas of healthy rats that were uninjured or cauterized chemically immediately after death and those that were cauterized in the living rat. Uninjured corneas and corneas cauterized postmortem elicited a mild vascular response in the CAM, as reflected by low coefficients of angiogenesis. Whereas blood vessels were not detected in corneas injured postmortem, some normal corneas vascularized but only after being on the CAM for at least 7 days. The coefficients of angiogenesis of corneas that were cauterized during life were significantly higher than those of both control groups prior to grafting after comparable times on the CAM. Corneas vascularized on the CAM included those that were cauterized as soon as 90 minutes prior to grafting. The strongest vascular responses, as reflected by coefficient of angiogenesis and the frequency of histologically confirmed nucleated avian erythrocytes within intracorneal blood vessels, were found with corneas that were grafted to the CAM 3 days after chemical cauterization. Corneas that vascularized on the CAM were associated with a prominent leukocytic infiltrate suggestively derived from the chick embryo. The results suggest that chemically cauterized rat corneas contain a chemoattractant for polymorphonuclear leukocytes within 90 minutes of injury and that such polymorphonuclear leukocytes or other components of the injured corneas possess the ability to stimulate angiogenesis on the CAM.

Allantois↗
PubMed1988

Thrombin as an adjuvant to reanastomosis of the fallopian tubes reduces implantations in the rabbit.

To study the efficacy of topically administered thrombin as an adjuvant in tubal microsurgery, 24 rabbits underwent a 1-cm resection and microsurgical anastomosis of both fallopian tubes and were randomized to either thrombin or cautery for hemostasis. Ovarian wedge biopsies were done on the left ovary. The animals were mated 4 to 5 weeks postoperatively with a buck of proven fertility. They were killed at 2 to 3 weeks' gestation to note the number of fetuses per patent tube and presence or absence of pelvic adhesions. There was no effect of topical thrombin on the crude pregnancy rate but it was associated with a marked reduction in the number of fetuses per patent tube, despite similar rates of pelvic adhesions between groups. Topically administered thrombin appeared to reduce fertility in this experimental model by an undefined mechanism.

Administration, Topical↗
PubMed1987

Immunobiology of Langerhans cells on the ocular surface. I. Langerhans cells within the central cornea interfere with induction of anterior chamber associated immune deviation.

Inoculation of P815 tumor cells into the anterior chamber of eyes of BALB/c mice produces Anterior Chamber Associated Immune Deviation (ACAID) whereby delayed hypersensitivity responses to the minor H antigens of the tumor cells are suppressed. In our laboratory, impaired delayed hypersensitivity is obtained in the majority, but not all normal BALB/c recipients. In the minority, typcial delayed hypersensitivity responses, similar to those induced by subcutaneous immunization with tumor cells, are observed. Retrospective examination of eyes of animals that develop delayed hypersensitivity following intracameral tumor cell injection revealed a high incidence of a corneal disorder in which significant numbers of Langerhans cells are found within the corneal epithelium. BALB/c mice with corneal lesions characterized by opacity and calcium deposition, or whose corneas had become infiltrated with Langerhans cells induced to emigrate by a superficial cautery wound, received intracameral injections of P815 cells. Minimal or no significant suppression of delayed hypersensitivity was obtained, suggesting that ACAID induction had not taken place. These results suggest that the presence of Langerhans cells in the central corneal epithelium mitigates against ACAID induction.

Animals↗
PubMed1984

Flammability of silicone rubber: an unrecognized hazard.

A patient sustained a burn when silicone rubber tubing was ignited by a pencil cautery unit. Unlike polyethylene, silicone rubber does not melt prior to reaching its ignition temperature. The application of heat near or to silicone rubber is to be avoided.

Burns↗
PubMed1980

Experimental induction of intrinsic valve stenosis.

True pulmonic and aortic valvular stenoses were produced in dogs by chemical cautery of valve cusps during cardiopulmonary bypass. The intrinsic valve stenoses were confirmed by phonocardiography, gradient measurements, angiography, and pathologic examination. The lesion were similar to clinical valvular stenosis in several respects, including the presence of dystrophic calcification. Unlike the hitherto available models of supravalvular stenosis, the present preparation is amenable to a greater variety and spectrum of experimental studies.

Animals↗
PubMed1996

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↗
PubMed1996

Prevalence of HBsAg among the non cauterized groups of blood donors.

One thousand two hundred and seventeen (1217) blood specimens from non-cauterized blood donors were tested for HBsAg by counterimmunoelectrophoresis technique: 48 specimens were positive giving an incidence of 3.95%; specimens from 99 blood donors with cautery marks were tested side by side using the same technique, 3 specimens were positive giving an incidence of 3.05%. These results show that Sudan can be considered among the countries with very high prevalence of HBsAg. This emphasizes the importance of testing every unit of blood or blood product before transfusion. This high prevalence is mainly attributable to the use of common improperly sterilized water-boiled syringes, needles and surgical instruments. The results also show that the incidence of HBsAg among cauterized donors is not higher than among non-cauterized; thus routine rejection of cauterized citizens from giving blood at the reception stage is unjustified as it adds to the problem of shortage of blood in Sudan.

Adolescent↗
PubMed1997

Effect of push enteroscopy on transfusion requirements and quality of life in patients with unexplained gastrointestinal bleeding.

AIM: The aim of our study was to determine whether push enteroscopy altered transfusion requirements or quality of life in patients with unexplained gastrointestinal bleeding. METHODS: Twenty-nine patients with gastrointestinal bleeding unexplained by upper endoscopy and colonoscopy or persistent despite appropriate therapy after these procedures, underwent enteroscopy. Transfusion records in the year preceding and after the procedure were obtained from blood bank records and from telephone interviews every 6 months. RESULTS: Of 29 patients, 20 had received a transfusion (mean 8 +/- 3 units per patient) in the year preceding enteroscopy. In the year after the enteroscopy, 11 patients required transfusion (p = 0.034), and the mean transfusion requirement fell to 4 +/- 2 units, (p = 0.007). Angiodysplasia, the most frequent lesion found at enteroscopy (13 patients, 45%) were treated by endoscopic cautery. These patients had received an average of 13 +/- 6 units of packed cells per patient in the year preceding the procedure. In the year after enteroscopy, there was a significant reduction in transfusions (6 +/- 3 units per patient; p = 0.021). Of the 13 patients, 4 (31%) no longer required transfusions. Median functional status improved from 60 to 90 (p = 0.005). CONCLUSIONS: Enteroscopy alters the outcome of some patients with obscure gastrointestinal bleeding by reducing or eliminating bleeding and improving functional status.

Angiodysplasia↗
PubMed1997

Use of harmonic scalpel at laparoscopic cardiomyotomy. A new method.

The laparoscopic cardiomyotomy with anterior fundoplication (Heller-Dor procedure) is accepted for treatment of esophageal achalasia. The crucial point of the procedure is proper myotomy and avoid perforation of the esophagus. Hook cautery is widely accepted to dissect the oesophageal muscle. We'd like to demonstrate our experiences with a new device--Ultrasonically Activated Harmonic Scalpel-, witch was used at our operation for achalasia to make the cardiomyotomy. Between December 1993 and December 1996, 11 patients with esophageal achalasia underwent laparoscopic Heller's operation with Dor's antireflux procedures. In one patient we applied the Ultrasonically Activated Harmonic Scalpel (HS) to make the cardiomyotomy. The use of HS and results were evaluated. Application of the Harmonic Scalpel is effective for cardiomyotomy. It can be used more safe than electrocoagulation, because it cause less thermic lesion. It's easy to use at laparoscopic way. A perforation of the esophagus didn't occur. There was no intra-, or postoperative complications. After the operation the patient is free of complains. After our first operation, we have found, that Ultrasonically Activated Scalpel can be applied with safe and good results for the cardiomyotomy at laparoscopic operations for esophageal achalasia.

Adult↗
PubMed1992

Bile leak after laparoscopic cholecystectomy. Diagnostic and therapeutic application of endoscopic retrograde cholangiopancreatography.

BACKGROUND: Laparoscopic cholecystectomy, introduced less than 2 years ago, is widely accepted by patients and physicians despite the lack of controlled trials comparing this technology with conventional cholecystectomy. Recent series have described a variable incidence of biliary tract injury with laparoscopic gallbladder removal. The primary interaction of endoscopic retrograde cholangiopancreatography with this technology is usually in the preoperative or postoperative diagnosis and treatment of common bile duct stones. METHODS: During a 12-month period, 597 patients underwent laparoscopic cholecystectomy by 20 general surgeons at six Puget Sound (Wash) hospitals. All patients with symptomatic postoperative biloma diagnosed by abdominal ultrasound or computed tomography with or without endoscopic retrograde cholangiopancreatography, as well as those who had acute bile duct injury diagnosed and repaired at the time of cholecystectomy, were retrospectively reviewed. RESULTS: Three bile duct transections were acutely recognized and treated with hepaticojejunostomy. Fourteen additional patients presented within 7 days with biloma, three of whom were treated with percutaneous drainage alone. Of the remaining 11 patients who underwent endoscopic retrograde cholangiopancreatography, six were noted to have common bile duct injuries; two, bile duct transections; and 3, cystic duct leaks that required a variety of endoscopic or surgical therapies. In all, 17 (2.9%) of 597 patients sustained a bile duct injury and, to date, seven (1.2%) of 597 patients required surgery for such injury. CONCLUSIONS: In a regional setting, laparoscopic cholecystectomy appears to be associated with a higher incidence of bile duct injury than previous reports of open cholecystectomy. Possible explanations include variant anatomy plus failure to obtain an operative cholangiogram, inadequate dissection, injudicious use of cautery or clip placement, inherent limitations of the procedure, or the learning curve associated with a new technology.

Bile↗
PubMed1979

Coaxial bipolar probe.

A coaxial electrode probe that uses the principle of bipolar coagulation is introduced to ophthalmic microsurgery. The central, or axial, electrode is insulated with silicone from the surrounding outer, or coaxial, diameter electrode. The probe uses available bipolar electrode cautery power and control sources. The distance between the electrode is fixed. Therefore, uniform and repeatable coagulations are attained under controlled power settings. Unwanted microscopic scleral shrinkage is eliminated, while desired scleral shrinkage is controlled. Precise pinpoint coagulations of individual capillaries are routine, especially at corneoscleral incision sites. Higher power settings produce a desired scleral marker in retinal surgery.

Electricity↗
PubMed1979

Intraocular carbon dioxide laser photocautery. I. Animal experimentation.

Intraocular carbon dioxide laser photocautery is used to produce localized closure of vascular channels and chorioretinal adhesion in the albino rabbit. The retinal lesion is sharply demarcated because of the high tissue absorption of CO2 laser radiation. Varying degrees of chorioretinal adhesion can be achieved. The CO2 laser photocautery technique may provide a suitable method of closing vessels and sealing retinal tears at the time of vitrectomy. Accurate placement of the cautery tip on the target area can be accomplished under stereoscopic magnified viewing with the operating microscope and contact lens. Electrical shock hazard is completely eliminated with the CO2 laser energy modality.

Animals↗
PubMed1980

Traumatic episcleritis following phosphorus 32 testing.

Five eyes containing choroidal melanomas were found, on histopathologic examination, to have traumatic episcleritis with foreign-body granulomas and scleral edema underlying the area of tumor. This reaction was clearly correlated with phosphorus 32 testing that had been performed one to four weeks earlier. In all cases, enucleation had been delayed for logistic reasons. Invasion of the sclera or intrascleral canals was found in each case, with extension to the episclera in two of three small melanomas. Although the cases are few, this degree of invasion was greater than that seen in our other small melanomas or in reported series. The possibility that manipulation and inflammation of this type might have an adverse stimulatory influence on some melanomas should be considered when planning delayed enucleation after 32P testing. The juxtaposition of cautery marks and intrascleral tumor in a further case of melanoma demonstrates another possible complication of 32P testing.

Aged↗