Recent advances in surgical diathermy.
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Among colorectal polyps, those of the sessile and villous type are said to bear a high frequency cancer degeneration. While surgery is considered the cure, alternative choices are to be offered in the presence of contraindications or lack of an informed consent. We analyzed the results of the "combined therapy" that requires the use of the ND-YAG laser following the ablation of the lesion with diathermic snare. We used an EV laser 132 with double wavelength to allow the ablation of flat lesions and minimize the risk of perforation. We included 12 patients with sessile colorectal polyps. In 9/12 complete eradication was obtained over a follow-up 11 months; of the remaining 3, 2 dropped out, 1 did not respond. Owing to the small series, the relationship between the successful eradication and the size of the polyp cannot be evaluated. We conclude that the treatment of sessile colorectal polyps with this combined approach may be a promising one.
In addition to sclerosifying by use of fibroendoscope which acts upon the source of bleeding, to achieve hemostasis and prevent bleeding relapses nowadays other methods have also gained acceptance. Major importance among these is attached to diathermocoagulation. It may principally be assumed that diathermocoagulation is indicated for critically ill patients with serious accompanying diseases of primary or secondary importance, as well as in the event of persistent bleeding during the clinical examination and impending resumption of bleeding soon after the examination. Hemostasis by electrocoagulation should not be attempted in patients in agonal state when endoscopic examination is in its self dangerous. It is contraindicated also when the source of bleeding can not be established, in cases of severe arterial bleeding, blurring the optics, and in severe concave ulcers carrying the risk of perforation. The method was applied on 173 patients; in 96 (55 per cent) electrocoagulation was successful and in 78 (45 per cent) was unsuccessful. Electrocoagulation was considered a success in patients with acute ulcers and cardiovascular disease, in cases of large erosive units of drug origin, in posteriorly located gastric ulcers, in Mallory-Weiss syndrome and in gastric cancer.
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Several failures with postoperative reappearance of a hypertonia after trabeculectomy, determined the authors to bring some improvement. For avoidance the scarring, on practice diathermal clotting of one middle channel of 1.2 mm, using a spatula. Were obtained well outcomes with normal ocular pressure in twenty-three cases.