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PubMed2006

Use of pulsed shortwave diathermy and joint mobilization to increase ankle range of motion in the presence of surgical implanted metal: A case series.

STUDY DESIGN: Case series. BACKGROUND: Traditionally, all forms of diathermy have been contraindicated over metal implants. There is a lack of research-based evidence for harm regarding the use of pulsed shortwave diathermy (PSWD) over orthopedic metal implants. Because PSWD is an effective modality for deep heating, we investigated whether ankle range of motion (ROM) could improve with the cautious use of PSWD and joint mobilizations, despite orthopedic metal implants being in the treatment field. CASE DESCRIPTIONS: Four subjects presented with decreased ankle ROM due to extensive fractures from traumatic injuries. All subjects were postsurgical, with several internal fixation devices. Subjects previously received rehabilitation therapy involving joint mobilizations, therapeutic exercises, moist heat, and ice, but continued to lack 15 degrees to 23 degrees of ankle dorsiflexion. The Human Subjects Review Board of Brigham Young University approved the methods of this case series. Subjects gave written informed consent. Initial dorsiflexion active ROM for each patient was -3 degrees, 0 degrees, 8 degrees, and 5 degrees, respectively. Treatment regime consisted of PSWD to the ankle for 20 minutes at 27.12 MHz, 800 pps, 400 microseconds (48 W). Immediately after PSWD, mobilizations were administered to the joints of the ankle and foot. Ice was applied posttreatment. OUTCOMES: Dorsiflexion improved 15 degrees, 15 degrees, 10 degrees, and 14 degrees, respectively, after 8 or 13 visits. All patients returned to normal activities with functional ROM in all planes. Follow-up 4 to 6 weeks later indicated that the subjects maintained 78% to 100% of their dorsiflexion. No discomfort, pain, or burning was reported during or after treatment. No negative effects were reported during the short-term follow-up. DISCUSSION: When applied with appropriate caution, we propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints, despite implanted metal. We continue to advise caution when applying diathermy with machines other than the Megapulse II. Further research is needed to determine the safety parameters of other diathermy machines. As a final caution, we advise that diathermy not be used in the presence of a cardiac pacemaker or neurostimulator.

Adult↗
PubMed1995

Loop diathermy and cold-knife conization in patients with cervical intraepithelial neoplasia: a comparative study.

One hundred and sixty-eight cases of cervical conization were performed for cervical intraepithelial neoplasia (CIN) in a 32-month study. The indications for conization were unsatisfactory colposcopic finding, abnormal epithelium that extended into the endocervical canal, a microinvasive cervical cancer, and significant discrepancy among cytology, colposcopy, and/or punch biopsy histology. In the early period of the study, conization was done by the cold-knife method (N = 107), whereas loop diathermy was used in the latter part of the study (N = 61). Both groups were similar in terms of age, indications for conization, and size of cervical cone specimens. Loop diathermy conization was done in a significantly shorter time (5.7 +/- 1.8 minute vs 15.2 +/- 6.1 minute)(P < 0.05) than cold-knife conization. However, the difference in the postoperative complications between loop diathermy(3.0%) and cold-knife conization(4.7%) was not significant. The incidence rate of residual CIN III lesions in the subsequent hysterectomy specimens, found by histological documentation on these specimens was 25.0 and 26.1 percent after loop diathermy and cold-knife conization respectively. These results suggest that loop diathermy is much easier to perform and a more time-conserving treatment modality than cold-knife conization in the management of patients with cervical intraepithelial neoplasia.

Adult↗
PubMed1993

Randomized trial comparing diathermy hemorrhoidectomy with the scissor dissection Milligan-Morgan operation.

Twenty consecutive patients (12 male and 8 female) with second-degree, third-degree, or thrombosed hemorrhoids were randomly allocated to undergo either diathermy hemorrhoidectomy (n = 10) or a scissor dissection Milligan-Morgan hemorrhoidectomy (n = 10). No significant difference was found in the postoperative pain score between the groups. On a scale of 0 to 10, the mean daily pain score in the diathermy group was 4.0, and it was 4.1 in the scissor dissection group. Nor was there any significant difference in the length of inpatient stay (diathermy group, 3.5 days; scissor dissection group, 4.0 days) or in the time between the operation and the first bowel action (diathermy group, 2.0 days; scissor dissection group, 3.0 days). Diathermy hemorrhoidectomy has no significant advantage over the scissor dissection classical Milligan-Morgan hemorrhoidectomy.

Adult↗
PubMed2001

Randomized clinical trial of diathermy versus scalpel incision in elective midline laparotomy.

BACKGROUND: Electrocautery is used increasingly for tissue dissection, although fears of excessive scarring and poor wound healing have curtailed its widespread use for skin incision. This study compared electrosurgical incision with traditional scalpel incision. METHODS: One hundred patients requiring elective midline laparotomy were randomized prospectively to either scalpel or diathermy incision. Parameters measured included incision time, wound size, wound blood loss, total intraoperative blood loss and postoperative wound pain. All wound complications were recorded. RESULTS: The two groups did not differ significantly in relation to patient or wound characteristics. Laparotomy incisions using diathermy were significantly quicker than scalpel incisions (mean(s. e.m.) 6.1(0.4) versus 7.5(0.5) s/cm2; P < 0.04). There was significantly less blood loss in the diathermy group compared with the scalpel group (0.8(0.1) versus 1.7(0.3) ml/cm2; P = 0.002). Postoperative pain scores were significantly lower in the diathermy group for the first 48 h after operation (P < 0.05). Morphine requirements were also significantly lower over the first 5 postoperative days in the diathermy incision group (P < 0.04). There was no difference between groups in wound complications before discharge and at the 1-month follow-up. CONCLUSION: Electrosurgical midline incision in elective surgery has significant advantages over scalpel use on the basis of incision time, blood loss, early postoperative pain and analgesia requirements.

Adolescent↗
PubMedDate not supplied

Effect of submucosal diathermy in chronic nasal obstruction due to turbinate enlargement.

Nasal obstruction is one of the most common chronic presenting symptoms encountered by otolaryngologists. In most patients, the cause of nasal obstruction is either nasal septal deviation or turbinate hypertrophy owing to vasomotor or perennial allergic rhinitis. Most cases of hypertrophic turbinate are usually mild and respond to antihistamine therapy, local decongestions, or allergy desensitization; however, surgery is required in some cases. Surgical treatment is controversial, and many surgical methods of treatment have been proposed. We have recently evaluated the results of our experience with submucosal diathermy (SMD) on 51 patients suffering from chronic nasal obstruction. We have found that diathermy demonstrated good results in 78% of the cases at 2 weeks postoperatively and in 76% of the cases 2 months following the procedure. Patients who had no complaints and had good nasal airflow were not followed-up after 2 months. In the present study, we have carried out a long-term follow-up of another group of patients who had undergone SMD diathermy because of hypertrophy of the inferior turbinates. Patients were examined at 2 months postoperatively and after 1 year, with both subjective and objective assessments of nasal breathing. Two months postoperatively 64 of 91 patients (70.3%) experienced subjective improvement in nasal breathing, where as 73 patients (80.2%) had good nasal breathing as indicated with the Gertner-Podoshin plate. During the follow-up year, secondary operations were deemed necessary for 16 patients because of unsatisfactory results of the original procedure. Of these secondary procedures 4 were revision SMD, 9 patients underwent a septoplasty, in 2 patients functional endoscopic sinus surgery was conducted, and 1 patient had a submucosal turbinectomy. This group of patients was excluded from the 1 year follow-up evaluation. At the 1-year follow-up visit, 65 patients (of the 75) were symptom-free with respect to nasal breathing (86.7%), and 67 patients (89.3%) had good nasal breathing as examined with the Gertner-Podoshin plate. No means were apparent for predicting preoperatively which patients would benefit most from submucosal diathermy. Submucosal diathermy is carried out under local anesthesia and can be implemented as an office procedure. It does not require expensive instrumentation and is a safe, effective procedure for improving nasal breathing in patients with chronic obstructive inferior turbinates, both on a short-term and long-term basis.

Adolescent↗
PubMed1993

Laparoscopic ovarian diathermy: an effective treatment for anti-oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome.

OBJECTIVE: To determine the long term efficacy of laparoscopic ovarian diathermy in the management of refractory anovulatory infertility in women with the polycystic ovary syndrome. DESIGN: Open study of 50 women treated over a period of 3 years and 3 months, with follow up until 18 months after the last woman was treated. SETTING: Teaching Hospital. SUBJECTS: Fifty consecutive women with refractory anovulatory infertility (mean duration 5.3 (SD 3.5) years). All had been treated unsuccessfully with anti-oestrogens and more than half with gonadotrophins. INTERVENTIONS: Laparoscopic ovarian diathermy. MAIN OUTCOME MEASURES: Ovulatory cycles and pregnancies. RESULTS: Forty-three women (86%) ovulated following ovarian diathermy; the mean time to ovulation was 23 (SD 6.2) days. Three nonresponders ovulated following anti-oestrogen treatment to which they were previously resistant. Thirty-three women have conceived 58 pregnancies; 22 had no treatment other than ovarian diathermy prior to their first post-operative conception; in seven an anti-oestrogen was given because of lengthening cycles; two were treated elsewhere with gonadotrophins without prior postdiathermy anti-oestrogen therapy and conceived; four had the operation repeated and two of these conceived. Twenty-six women conceived within the first 8 post-operative months. Forty-two pregnancies ended in the birth of normal live healthy babies, eight are ongoing and eight miscarried. Of the 22 women who had no pelvic abnormality other than polycystic ovaries, 19 (86%) have had one or more successful pregnancies. CONCLUSION: Laparoscopic ovarian diathermy is a very effective treatment for anti-oestrogen resistant anovulatory infertility in women with the polycystic ovary syndrome and should be considered as the next step in those who fail to respond to anti-oestrogen treatment.

Adult↗
PubMed1989

Evidence against diathermy as a beneficial treatment for human papillomavirus infection of the cervix.

An observational study of the influence of diathermy on the rate of subsequent cytological evidence of cervical intraepithelial neoplasia and/or human papillomavirus infection among women with a histological diagnosis of cervical human papillomavirus infection is presented. After the histological diagnosis of human papillomavirus infection, 35% (23/65) of women who were not diathermied had persistence/recurrence of cytological abnormalities compared with 30% (60/203) of the women who were diathermied at the time of the biopsy. The rate ratio for further abnormality among women who did not have a diathermy relative to those who did was not significantly different at 1.25 (95% confidence interval 0.77-2.03). This study had a power of 77% to detect a true rate ratio of 2 at the 0.05 level of significance. This data does not provide strong evidence that diathermy is appropriate management for women with cervical human papillomavirus infection without evidence of dysplasia.

Adolescent↗
PubMed1976

Electrocoagulation diathermy for the treatment of cervical dysplasia and carcinoma in situ.

This report presents further experience in the use of electrocoagulation diathermy for the treatment of patients with cervical intraepithelial disease. By means of the colposcope it was possible to select a group of nonpregnant patients, in whom a proven noninvasive lesion was located entirely within range of the colposcope. This group, comprising 450 patients, has been treated by means of electrocoagulation diathermy, and with followup, only 28 patients have shown evidence of a residual lesion; in 8 of these the residual lesion has been eradicated subsequently by repeat diathermy treatment. Significant complications following electrocoagulation diathermy occurred in 13 patients (3%). The overall apparent cure rate for electrocoagulation diathermy was 95.4%.

Biopsy↗
PubMedDate not supplied

An 18-day stretching regimen, with or without pulsed, shortwave diathermy, and ankle dorsiflexion after 3 weeks.

CONTEXT: The amount of retained ankle flexibility gains and the effects of diathermy on those gains are unclear. OBJECTIVE: To determine the retention of flexibility 3 weeks after an 18-day stretching regime and the effect of pulsed, shortwave diathermy on that retention. DESIGN: We used a 2x4 factorial with repeated measures on day (1, 19, 24, and 39). The other independent variable was treatment (stretch only versus diathermy and stretch). The dependent variable was ankle-dorsiflexion angular displacement as measured on a digital inclinometer. SETTING: Therapeutic Modality Research Laboratory. PATIENTS OR OTHER PARTICIPANTS: 23 healthy college-aged volunteers (8 males, 15 females; age = 22.7 +/- 2.1 years, height = 171.1 +/- 8.8 cm, mass = 70.4 +/- 13.5 kg). INTERVENTIONS: All subjects performed 3 weeks (not including weekends) of low-load, prolonged, long-duration stretching. One group performed stretching only; the other group also received diathermy. MAIN OUTCOME MEASURE(S): After an 18-day stretching regime and 7-day retention study, subjects returned 14 days later for the 3-week retention measure. The angle of inclination from the posterior Achilles tendon to the sole of the shoe near the heel was measured on each treatment and test day. RESULTS: Regardless of group (F(1,21) = 0.74, P = 0.40), the flexibility gained between days 1 (99.7 +/- 4.0 degrees), 19 (102.9 +/- 5.8 degrees), and 24 (105.0 +/- 6.2 degrees) were maintained at day 39 (104.8+/- 7.2 degrees) (P < .05). CONCLUSIONS: Flexibility gains in normal ankles with 3 weeks of training were retained for at least 3 weeks after training ceased. The application of pulsed, shortwave diathermy during stretching did not appear to influence the chronic retention of flexibility gains in normal subjects.

Journal Article↗
PubMed1989

Bipolar diathermy treatment of long saphenous vein varicosities.

A new technique of endoluminal diathermy of the long saphenous vein using a bipolar electrode is described. This is safer than conventional unipolar diathermy and histological examination of the diathermied veins shows similar appearances using unipolar and bipolar diathermy. Clinical assessment of both techniques yields similar results. Endoluminal bipolar diathermy is simple and relatively painless compared with conventional stripping of the long saphenous vein and can be recommended.

Electrocoagulation↗
PubMed1983

Electrocoagulation diathermy for cervical dysplasia and carcinoma in situ: a 15-year survey.

The present report assesses 15 years' experience with electrocoagulation diathermy in the treatment of cervical intraepithelial neoplasia (CIN). Selection is based on the ability to visualize the boundaries of the lesion colposcopically. Visualization, together with cytology and target biopsy, should exclude invasive carcinoma. Histologically confirmed CIN of varying severity (almost two thirds were CIN III) was treated by diathermy in 1864 patients. The size of the lesion varied, and at times the lesion extended into the endocervical canal. Cervical intraepithelial neoplasia was eradicated in 97.3% of patients by a single diathermy treatment. Ninety-three percent of all patients under the age of 30 with CIN were treated by this method. Progression to invasive carcinoma after diathermy has not been demonstrated. A single treatment with electrocoagulation diathermy has proved consistently to be the most effective superficial ablative method for primary eradication of CIN whether deep, extensive, or of major severity.

Adult↗
PubMed1995

Comparison of scleral tensile strength after transscleral retinal cryopexy, diathermy, and diode laser photocoagulation.

OBJECTIVES: To determine the effect of transscleral diode photocoagulation on the tensile strength of sclera in an experimental rabbit model and to compare it with that of transscleral cryotherapy and diathermy. METHODS: Twenty-four Dutch-belted rabbits received one of the following three treatment modalities in one eye: (1) transscleral cryotherapy, (2) transscleral diathermy, or (3) transscleral diode laser photocoagulation. The opposite eye served as a paired control. Tensile strength measurements of scleral strips excised from areas of treatment were obtained 6 weeks later. RESULTS: No statistically significant difference in mean tensile strength was observed between eyes receiving transscleral cryopexy (n = 7) or transscleral diode photocoagulation (n = 8) and their corresponding, paired, control eyes. In contrast, transscleral diathermy reduced mean scleral tensile strength to 26% of that of the paired control eyes (n = 8, P = .0001). CONCLUSIONS: In this rabbit model, scleral weakening is significant following transscleral diathermy while transscleral cryopexy or transscleral diode photocoagulation produces no significant weakening relative to paired, untreated controls.

Animals↗
PubMed2001

Dissection versus diathermy for tonsillectomy.

BACKGROUND: Tonsillectomy is a commonly performed surgical procedure. There are several operative methods currently in use, but the superiority of one over another has not been clearly demonstrated. OBJECTIVES: To compare the morbidity associated with tonsillectomy by two different techniques - dissection and diathermy. SEARCH STRATEGY: Cochrane Controlled Trials Register, Medline (1966-2000), Embase (1974-2000). Reference lists were scanned for additional material. SELECTION CRITERIA: Randomised controlled trials of children and adults undergoing tonsillectomy or adenotonsillectomy by dissection or diathermy techniques. Trials were assessed for methodological quality according to the method outlined in the Cochrane Reviewers Handbook. DATA COLLECTION AND ANALYSIS: The reviewers assessed each trial and extracted data independently. MAIN RESULTS: Twenty-two potential studies were identified for further assessment. Twenty trials were not included because they did not meet the inclusion criteria for randomisation methods, controls or outcome criteria. Two trials met the inclusion criteria, one comparing monopolar dissection diathermy with conventional cold dissection in children, and the other comparing microscopic bipolar dissection with cold dissection in children and adults. These studies demonstrate reduced intraoperative bleeding, but increased pain in the diathermy group. There was no difference in the rate of secondary bleeding overall, although the power of both studies to detect a small difference was insufficient. REVIEWER'S CONCLUSIONS: There are insufficient data to show that one method of tonsillectomy is superior. There is evidence that pain may be greater after monopolar dissection. Large, well designed randomised controlled trials are necessary to determine the optimum method for tonsillectomy.

Adult↗
PubMed1997

Diathermy capsulotomy to remove fibrotic anterior capsules in pseudophakic eyes.

OBJECTIVE: To evaluate a technique for removing fibrotic tissue of a shrunken opening of the anterior capsule. SETTING: Augenklinik der Städtischen Kliniken, Frankfurt, Germany. METHODS: Intraocular diathermy was used to enlarge the anterior capsule in nine patients with intraocular lenses (IOLs) (eight poly[methyl methacrylate], one silicone). In five patients, the diathermy was done to improve the intraoperative fundus view just before vitreoretinal surgery. The other four patients had visual field impairment or IOL dislocation resulting from capsular opening contraction. A 1.1 mm paracentesis was made and a viscoelastic injected beneath the anterior capsule. The diathermy probe was then introduced into the anterior chamber and the capsule opening cut to the desired size. The excised material was removed with a forceps. RESULTS: The procedure was free of complications. No eye developed a postoperative inflammatory reaction. CONCLUSION: Diathermy was easy to perform and according to these preliminary results, highly effective.

Adult↗
PubMed1996

Microwave diathermy treatment for primary dysmenorrhea.

This case report documents the use of microwave diathermy in a 31-year-old woman who had had primary dysmenorrhea since menarche began at age 13 years. For 18 years, she had severe monthly pain, frequently resulting in emergency department admissions and 1 to 3 days lost from work. Conventional treatments, including pain-relieving drugs, anti-inflammatory drugs, muscle relaxants, superficial heat, and oral contraceptives, had all been unsuccessful in relieving or abating the intense and debilitating pain. Microwave diathermy (45 W total power) was administered for 20 minutes each month on the day symptoms began (usually the first day of menstruation). Over a 7-month interval, diathermy was followed by almost-immediate and long-lasting relief of symptoms. During the 7 months of treatment, the patient lost no workdays due to severe pain. This case demonstrates the potential use of microwave diathermy as an effective treatment for women with this condition.

Adult↗
PubMed1989

Continuous short-wave (radio-frequency) diathermy.

Continuous shortwave diathermy is the technique of choice when uniform marked elevation of temperature is required in the deep tissues. This heating can be targeted accurately by using an appropriate applicator positioned correctly. SWD also allows superficial structures to be heated selectively, although for this the various methods of surface heating are usually preferable. Sub-acute or chronic conditions respond best to continuous shortwave diathermy which, when used properly, can be as effective as ultrasound. Acute lesions are better treated with pulsed shortwave diathermy. Continuous shortwave diathermy can help to relieve pain and muscle spasm, resolve inflammatory states and reduce swelling, promote vasodilation, increase the compliance of connective tissue, increase joint range and decrease joint stiffness.

Biophysical Phenomena↗
PubMed1991

Diathermy-induced inflammation does not affect suture holding capacity of intestinal anastomoses.

We compared the suture holding capacity of rat intestinal anastomoses after division of the bowel with scissors or diathermy. Two sets of experiments differing in suture technique were done. In one set the amount and solubility of anastomotic collagen were measured, and neutrophil accumulation quantified with a myeloperoxidase (MPO) assay. MPO activity 24 h after surgery was 60% higher (p less than 0.05) after division with diathermy than after division with scissors. Suture holding capacity (breaking strength) decreased by approximately 70% (p less than 0.001) in both groups when sutures were inserted near the bowel edges, while no decrease was noted when sutures were inserted at a farther distance, regardless of the mode of bowel division. After 7 days MPO levels approached baseline values in both groups and the bowel always ruptured outside the anastomosis. Collagen content was not adversely affected by diathermy. Although the reduction in early anastomotic strength may be mediated by local neutrophil activity, suture holding capacity was not influenced by the increased neutrophil accumulation elicited by diathermy.

Anastomosis, Surgical↗
PubMed2005

Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: a placebo-controlled double-blind clinical trial.

OBJECTIVE: To examine the effects of pulsed short-wave diathermy (PSWD), delivered at an intensity sufficient to induce a thermal sensation and at an athermal intensity, in comparison with a placebo short-wave diathermy treatment, on reported pain, stiffness and functional ability and on mobility performance of patients with osteoarthritis of the knee. DESIGN: A placebo-controlled double-blind trial with sequential allocation of patients to different treatment groups. SETTING: Outpatient physiotherapy department. SUBJECTS: One hundred and three consecutive patients, mean age 73.7 (+/-6.6) years with osteoarthritis of one or both knees for at least three months. INTERVENTIONS: All participants received three 20-min-long treatments per week for three weeks. One group received PSWD with mean power of 18 W (thermal effect), one group received PSWD with mean power of 1.8 W (athermal effect), and one group received sham short-wave diathermy treatment. Patients were assessed before the initial treatment, immediately following the last treatment, and at a three-month follow-up. MAIN MEASURES: Outcome measures included the WOMAC Osteoarthritis Index, which assessed reported pain, stiffness, and functional ability, and four measures of mobility performance: Timed Get Up and Go test (TGUG), stair-climbing, stair, descending and a 3-min walk. RESULTS: A difference across time was observed for the pain and stiffness categories of the WOMAC Osteoarthritis Index (p = 0.033 and p = 0.008, respectively), with no differences between groups. No other significant differences across time or between groups were observed in any of the other measures. CONCLUSION: The findings do not demonstrate pulsed short-wave diathermy, as it is utilized in clinical settings, to be effective in the treatment of osteoarthritis of the knee.

Activities of Daily Living↗