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PubMed1984

Choroidal melanoma associated with rhegmatogenous retinal detachment.

A case of pigmented choroidal lesion coincident with rhegmatogenous retinal detachment was observed. The patient refused enucleation, and the retinal detachment was successfully treated by diathermy without drainage of subretinal fluid. Clinically the lesion was observed to enlarge, and upon enucleation five years after diathermy the tumor was seen to be a spindle-cell choroidal melanoma. The patient died from metastases of melanoma six years after the enucleation.

Choroid Neoplasms↗
PubMed1983

Behavior of some enzymatic activities in the serum of rabbits after tissue damage by CO2 laser radiation.

A comparative evaluation of the biochemical damage observed after tissue injury by high-power CO2 laser, scalpel, and electrical diathermy has been made in rabbits. The tissue injury consisted of surgery performed by making two perpendicular linear cuts on the muscle of the posterior thigh. At different times after surgery, enzymatic levels of creatine kinase, aspartate amino transferase, and lactate dehydrogenase were determined in the serum. Only creatine kinase showed an increase, and it was lower in both extent and dispersion in the animals treated with CO2 laser. The results suggest that CO2 laser radiation caused damage to muscular tissue which was moderately lower compared to that from scalpel or electrical diathermy.

Animals↗
PubMed1978

Goniodiathermy: experimental studies on ab interno filtration.

Goniodiathermy was carried out in rabbit eyes by first performing a goniopuncture with a Barkan knife followed by the introduction of an intraocular diathermy probe into the goniopuncture tract and heating of the cut ends of the scleral fibers. Histologic sections revealed that goniodiathermy produced a gaped wound in the scleral wall of the angle. Goniopuncture alone, without diathermy, resulted in a thin, well healed scar. Goniodiathermy appears to be a safe and feasible technique for creating a tract in the scleral wall of the anterior chamber angle in adult rabbits. This procedure, with modifications, may serve as a model for creating filtering blebs in the treatment of glaucoma in humans.

Adult↗
PubMed1994

Ab-interno sclerostomy using a goniodiathermy instrument.

We describe the use of a new instrument designed to create a simultaneous goniopuncture with diathermy using an ab-interno technique. The goniodiathermy ab-interno procedure was first performed on three eyes of three cynomolgus monkeys. Intraocular pressure (IOP) assessment and histologic examination were performed over a 10-day period. A functioning filtration bleb with a patent sclerostomy was achieved in all of the experimental eyes. A pilot study involving four eyes of four glaucoma patients also was performed. Of these four, successful long-term functioning filtration areas with adequate lowering of IOP were achieved in only two. The remaining two required further surgical intervention. Although combining goniopuncture and diathermy into a one-step ab-interno procedure proved successful in the primates studied, the preliminary use of this new instrument as a method of creating a filter in humans raises questions regarding its clinical usefulness.

Adolescent↗
PubMed2003

Precision and safety of the pulsed electron avalanche knife in vitreoretinal surgery.

BACKGROUND: We have developed a new surgical instrument, called the pulsed electron avalanche knife (PEAK; Carl Zeiss Meditec, Jena, Germany), for precise, "cold," and tractionless dissection of tissue in liquid media. OBJECTIVE: To evaluate the 3-dimensional damage zone induced by the PEAK compared with 2 other standard intraocular surgical instruments, diathermy and retinal scissors. METHODS: Damage zone and minimum safe distance were measured in vitro on chick chorioallantoic membrane and in vivo on rabbit retina with the use of propidium iodide staining. RESULTS: The PEAK produced a paracentral zone of cellular structure disruption surrounding a crater and a peripheral zone of structurally intact but abnormally permeable cells. The instrument induced a damage radius that varied from 55 to 300 micro m for the range of voltages and pulses typically used during surgery. For comparison, damage radius for microsurgical scissors was 50 micro m, and for diathermy, 400 to 850 micro m. The PEAK also damaged tissue up to 1.4 mm away by the creation of water flow that formed at the tip of convex probes during collapse of a cavitation bubble. Concave probes, which prevent formation of the water jet, eliminated this effect. CONCLUSIONS: The PEAK operated well within accept-able safety limits and may greatly facilitate both posterior segment surgeries (eg, membrane dissection and sheathotomy) and anterior segment procedures (eg, capsulotomy, nonpenetrating trabeculectomy, and iridectomy).

Allantois↗
PubMed1986

A simplified method of treating retinal detachment with macular hole. Long-term follow-up.

Eighteen patients with macular hole retinal detachment and no visible posterior vitreoretinal connections were treated by one of two methods. In ten patients with extensive retinal detachment, the subretinal fluid was released in the temporal scleral side, and 1.0 mL or more of air or gas was injected into the vitreous cavity through the pars plana. In eight patients with localized retinal detachment in the posterior pole, 0.7 mL or more of gas was injected into the vitreous cavity after 0.3 to 0.5 mL of aqueous humor was released. Macular buckling, macular diathermy, or vitrectomy was not used. After the operation, the patients were placed in a prone position for at least six hours a day until the air or gas disappeared from the vitreous cavity. In 15 of 18 patients, the retina remained attached during follow-up periods that ranged from four to 32 months (average, 14 months). This operation is easy and safe and requires no sophisticated instruments. In addition, the macula is not damaged, as it can be by diathermy and buckling. This procedure should be the treatment of choice in patients with retinal detachments with macular holes but without other breaks or visible vitreous adhesion.

Aged↗
PubMed2001

Traditional tonsillectomy compared with bipolar radiofrequency thermal ablation tonsillectomy in adults: a pilot study.

OBJECTIVES: To assess the morbidity and efficacy of bipolar radiofrequency thermal ablation tonsillectomy and compare it with traditional cold dissection tonsillectomy with diathermy hemostasis. DESIGN: Prospective, randomized, single-blinded, controlled clinical study. SETTING: Helsinki University Central Hospital, Department of Otorhinolaryngology-Head & Neck Surgery, Helsinki, Finland. PATIENTS: Forty healthy volunteer patients aged 18 to 65 years admitted for elective tonsillectomy with recurrent or chronic tonsillitis, obstructive tonsillar hypertrophy, or history of quinsy. Two patients were excluded from the study and 1 patient cancelled the operation. INTERVENTIONS: Nineteen patients underwent a traditional cold dissection tonsillectomy with diathermy hemostasis, and 18 patients underwent a bipolar radiofrequency thermal ablation tonsillectomy. There was no intergroup difference in age, sex, weight, and indications for tonsillectomy. The subjects were not informed of the type of procedure until the telephone interview 3 weeks after the operation. MAIN OUTCOME MEASURES: Operating time and intraoperative blood loss; need for anesthetics during the operation; different recovery indicators in the recovery room (ie, duration and medications administered), surgical ward (ie, medications administered, use of corticosteroids, general condition, and status of the uvula on the first postoperative day), and in the 2 weeks following surgery (ie, visual analog scale scores on 6 symptoms, medications needed, the day patients returned to work, use of antibiotics, and retreatment acceptance); and complications and certain laboratory parameters. RESULTS: There was a statistically significant but clinically insignificant difference in operating time and intraoperative blood loss in favor of the traditional tonsillectomy group. The other outcome measures showed no statistically significant differences. CONCLUSION: Bipolar radiofrequency thermal ablation and traditional tonsillectomy were associated with similar postoperative morbidity.

Adolescent↗
PubMed2001

Therapeutic ultrasound for osteoarthritis of the knee.

BACKGROUND: Therapeutic ultrasound is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA. OBJECTIVES: To assess the effectiveness of therapeutic ultrasound therapy for treating OA. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to the end of December 2000, using the sensitive search strategy developed by the Cochrane Collaboration. The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles. SELECTION CRITERIA: All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing therapeutic ultrasound against placebo or another active intervention in patients with OA were selected. DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to be included based on inclusion and exclusion criteria (LB, VW). Data were independently abstracted by two reviewers (VW, LB), and checked by a third reviewer (BS) using a pre-developed adapted form for the OA sub-group of the Cochrane Musculoskeletal Group. The same two reviewers, using a validated scale, assessed the methodological quality of the RCTs and CCTs independently. OA outcome measures were extracted from the publications. The pooled analysis was performed using weighted mean differences (WMDs) for joint counts, pain, global and functional assessments. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout and random effects for outcomes showing heterogeneity. MAIN RESULTS: Three trials, including 294 patients with knee OA were included. Only one trial (n=74) compared therapeutic ultrasound to placebo. This trial showed no difference in range of motion, pain or gait velocity after 4 weeks of therapeutic ultrasound. Two trials compared therapeutic ultrasound to an active therapy (n=220). These trials showed no statistical difference between galvanic current or short wave diathermy for the outcomes of pain and patient-assessed improvement. REVIEWER'S CONCLUSIONS: Ultrasound therapy appears to have no benefit over placebo or short wave diathermy for patients with knee OA. These conclusions are limited by the poor reporting of the characteristics of the device, of the population, of the OA,and therapeutic application of the ultrasound and low methodological quality of the trials included. No conclusions can be drawn about the use of ultrasound in smaller joints such as the wrists or hands.

Adult↗
PubMed1980

Non-operative removal of bile duct stones by duodenoscopic sphincterotomy.

Surgical exploration of the common bile duct carries considerable risks in elderly and frail patients. Peroral, fibreoptic duodenoscopy allows access to the papilla of Vater in sedated patients and the opportunity to perform a diathermy sphincterotomy for removal of bile duct stones. We have attempted sphincterotomy in 134 patients, most of whom had previously undergone cholecystectomy and had some contraindication to a further operation. Sphincterotomy was technically successful in 129 patients (96 per cent), and all duct stones were removed in 119 patients (92.5 per cent of successful sphincterotomies). The technique failed only once in 95 patients with stones less than 14 mm diameter. Immediate complications occurred in 10 patients, 3 of whom required emergency surgery; 1 patient died. Endoscopic diathermy sphincterotomy is a major therapeutic advance in the management of elderly and high risk patients with bile duct stones. No significant adverse effects have yet been revealed in follow-up studies. However, the possibility of long term complications dictates the need for caution in offering this procedure to young patients who are fit for reoperation.

Adult↗
PubMed1983

Neural crest ablation and limb morphogenesis.

Left caudal neural crest was ablated by diathermy in 2-day-old chick embryos, to injure the region of sensory sciatic innervation before the appearance of the hind-limb bud. Embryos were fixed immediately, 24 hr and 14 days later, for examination of the effects of the ablation upon neural crest, neural tube, somitic mesoderm, and subsequent limb development. All embryos examined immediately and at 24 hr after ablation showed damage to the left neural crest, but the injury extended deeper into neural fold or tube, across the midline, and into somitic mesoderm. Of 17 chicks which survived to 16 days, 7 had gross deformity of the left leg and 10 had morphologically normal legs. Deformed chicks had a significant reduction in the mass of dorsal root ganglia on the operated side but no reduction in the area of the spinal cord. Operated chicks without limb deformities showed reduction of spinal cord but not of dorsal root ganglia. This suggests that limb morphogenesis may be quantitatively related to neural crest but not to neural tube. This possibility is considered in the light of previous publications. However, the experimental limitation of the diathermy method leaves the final conclusion open to interesting speculation and to future examination by improved experimental design.

Animals↗
PubMedDate not supplied

Glaucoma following retinal detachment operations.

After retinal detachment operations 1-5% of the patients develop glaucoma. If this occurs directly after the operation it is the result of mechanical narrowing of the chamber angle. This can be the result of indentation due to an exoplant or encircling band causing forward displacement of the lens/iris diaphragm. Other causes are torsion of the ciliary body or a ciliary block due to serous detachment of the choroid caused by venous compression or diathermy. Ischaemia of the anterior segment sometimes leads to glaucoma in the long run; this is then the result of rubeosis iridis. Conducive factors are detachment of the recti muscles, arterial and venous compression by the exoplant or encircling band and the use of diathermy. When performing such operations it is advisable to take these risks into account and to keep a check on the intraocular pressure after the operation. A patient is described who, as the result of ischaemia, eventually developed ribeosis iridis with neovascular glaucoma, leading to loss of the eye.

Aged↗
PubMed1986

The microcirculation in neodymium-YAG laser irradiated and in electrocoagulated urinary bladder tumors evaluated with laser Doppler flowmetry.

Neodymium-YAG laser irradiation is a relatively new therapeutic modality for the treatment of urinary bladder tumors which is suggested to produce an instantaneous arrest of the blood circulation and a homogeneous coagulation of the tumor tissue. Utilizing the laser Doppler flowmetry principle the microcirculatory changes in laser irradiated tumors were compared to the changes in tumors coagulated with diathermy. In laser treated tumors the blood cell flux decreased to near baseline levels throughout coagulated area. Vascular stasis was demonstrated in the erythematous zone encircling the necrosis. In tumors coagulated with diathermy a corresponding constant decrease in blood cell flux could not be demonstrated. Thus the neodymium-YAG laser irradiation seems preferable to electrocoagulation in the treatment of urinary bladder tumors as more complete and homogeneous arrest of the blood circulation in the treated area is achieved.

Electrocoagulation↗
PubMed1981

[Experimental and clinical examinations of the effect of cryosurgery of intraocular pressure].

Diathermy and cryosurgery have different effects on living tissue. Cell membranes are ruptured by cryosurgery, but the proteins are less affected than by diathermy. A short review of experimental cyclocryosurgery and the clinical results are presented. Data from the literature as well as evaluation of patients confirm that, as yet, the results are not satisfactory. The sequelae of freezing are very different in slow-and fast-freezing procedures. Therefore, the results in rabbits treated with a cryosurgical unit used for retinal detachment surgery (Amoils, -80 degrees C) were compared with the results using a cryoprobe cooled with liquid nitrogen (-180 degrees C). A permanent reduction in intraocular pressure was not achieved using cyclocryotherapy applied with the equipment used for detachment surgery (-80 degrees C). Repeated cryosurgery of this type did not result in a permanent pressure reduction. Histopathology demonstrated that the ciliary epithelium had regenerated and prolongation of the cyclocryotherapy applications did not result in a permanent intraocular pressure reduction. Lens opacities occurred in all rabbits of this series. Application of cryotherapy with a nitrogen-cooled cryoprobe (2.5 mm2 contact area) caused severe damage, resulting in phthisis bulbi. Another nitrogen-cooled probe (contact area of about 1 mm2 diameter) resulted in a permanent reduction in intraocular pressure, but the anterior parts of the lens became opaque. Histopathology revealed total necrosis of the ciliary epithelium and the basal membrane. Three months after cyclocryotherapy of this type the ciliary processes were atrophic and covered with connective tissue and regeneration of epithelial cells was not found in areas of such cryotherapy scars. Further experiments have been commenced including a reduction of application time, in order to find the optimum application technique resulting in permanent intraocular pressure reduction and the fewest possible side effects.

Animals↗
PubMed2002

Congenital posterior urethral obstruction: re-do fulguration.

In patients with congenital posterior urethral obstruction, transurethral fulguration (TUF) is usually the treatment of choice if the patient is in a stable condition. However, few papers have described the proportion of patients who need further fulguration. We reviewed 83 boys with a congenital obstructive posterior urethral membrane (COPUM) to assess the role of re-do fulguration, as judged by prospective video recordings. Between December 1990 and March 2000, 83 boys (aged from newborn to 15 years) underwent cystourethroscopy for investigation of a urethral anomaly and were found to have a COPUM. TUF was performed endoscopically with a hook diathermy electrode. Two to 3 months later boys who had cauterisation had a further urethroscopy and diathermy as required. Of the 83 membranous lesions in the posterior urethra, 38 were considered severe, 20 moderate, and 21 minor. Four patients had inadequate data to be properly classified. Eighteen (47.4%) of the 38 patients who had a severe obstructive membrane equired further endoscopic intervention to obliterate residual membrane elements. As over 45% of patients who had a severe obstructing membrane needed further fulguration, it is important to follow patients carefully and to repeat the cystourethroscopy.

Adolescent↗
PubMed2006

Upper airway surgery: the effect on nasal continuous positive airway pressure titration on obstructive sleep apnea patients.

The objective of this study was to observe the change in CPAP pressure after nasal and/or tonsil surgery in a retrospective study involving 17 patients unable to tolerate CPAP titration. All patients had two polysomnography studies for titration: one before and another subsequent to upper airway surgical treatment. The results showed a mean age of 49 +/- 9 years, a body mass index of 30 +/- 4 kg/m(2) and an apnea-hypopnea index of 38 +/- 19. Surgical procedures were radiofrequency reduction of the inferior turbinate (eight patients), septoplasty (one patient), septoplasty with inferior turbinectomy (two patients), septoplasty with inferior turbinate submucosal diathermy (two patients), septoplasty with tonsillectomy (two patients), septoplasty with inferior turbinate submucosal diathermy and tonsillectomy (one patient) and tonsillectomy (one patient). CPAP titration before and after surgery had respectively a mean pressure of 12.4 +/- 2.5 and 10.2 +/- 2.2 cmH(2)O ( P = 0.001). Maximum CPAP pressure was 16.4 cmH(2)O before and 13 cmH(2)O after surgery. A pressure reduction > or =1 cmH(2)O occurred in 76.5% of the patients and > or =3 cmH(2)O in 41.1%. Upper airway surgical treatment appears to have some benefit by reducing nasal CPAP pressure levels. The effect seems to be greater when the prior pressure was > or =14 cmH(2)O.

Adult↗
PubMed2005

Harmonic scalpel tonsillectomy: a prospective study.

The harmonic scalpel has been in use for tonsillectomy for the last 5-6 years in western Europe and North America. Although some studies have found this technique to be superior to other conventional methods, its use is still not very popular. In this single-blinded prospective study, the intraoperative events and postoperative morbidity after the use of harmonic scalpel in tonsillectomy (HST) was evaluated in 180 cases in two hospitals and compared with conventional steel tonsillectomy (CST) and hemostasis secured by bipolar diathermy or ligatures in 100 cases. Both bipolar diathermy and ligatures were used to control the intraoperative bleeding in all cases of CST and some cases (n =9) of HST. The study was done in two hospitals. Patients were randomized irrespectively of their age, sex, past history or indication for surgery. The total number of patients operated on was 180 for HST and 100 for CST. The surgical duration, intraoperative blood loss and postoperative pain were compared between the patients who only had tonsillectomy done in either group (n =120 in HST and n = 70 in CST). The mean operative time in the HST group was not longer than the CST group, but the intraoperative blood loss was significantly less in the HST group. Postoperative pain was present in all patients in the HST group, but to a lesser extent than in the CST group. There was no major postoperative hemorrhage in the HST group that required surgical attention. HST has the advantage over CST when secondary hemorrhage after tonsillectomy is considered. Thus, following the results of the National Prospective Tonsillectomy Audit (NPTA), it may be safe to say that HST is superior to most other conventional methods in reducing secondary hemorrhage. The use of disposable blades in CST certainly reduces the risk of the transmission of Cruetzfield-Jacob disease (CJD).

Adolescent↗
PubMed2005

The laparoscopic performance of novice surgical trainees: testing for acquisition, loss, and reacquisition of psychomotor skills.

BACKGROUND: It has been suggested that virtual reality (VR) might be useful for the selection of surgical trainees and the measurement of technical performance during preoperative training and retraining. This study was designed to determine whether it is possible to define and measure the acquisition, loss, and reacquisition of psychomotor skills in novice surgical trainees. METHODS: Novice surgical trainees (NSTs n = 10, junior surgical registrars with little or no prior experience with laparoscopic surgery) were tested and retested after 1 month using the Minimally Invasive Surgical Trainer-Virtual Reality. Two tasks were used: the simple task [stretch diathermy (SD)] and the more complex task [manipulation diathermy (MD)]. The score was derived from the time taken to complete the task and the number of errors that occurred. Acquisition is the difference between the first and last score of the first training session, loss is the difference in score that occurs between the last score of the first training session and the first score of the second training session, and reacquisition is the difference in the first and last scores of the second training session. A performance criterion level was defined for each task by testing a group of experienced laparoscopic surgeons (n = 10). Groups were compared using the nonparametric Wilcoxon signed rank test, with p < 0.05 considered to be significant. RESULTS: Acquisition of skill was found for five of 10 NSTs with the SD task and 10/10 for the MD task. As a group the NSTs achieved the criterion level from the outset with the SD task and exceeded it by the eighth attempt for the MD task. The best score was achieved with fewer attempts during the second training session for the SD but not the MD task. The defined parameters are expressed as mean percentage score +/- SD for the 10 NSTs and for each task. There was a 36% (+/- 26) acquisition for the SD task compared with 50% (+/- 4) for the MD task (Wilcoxon p = 0.241). There was a 23% (+/- 19) loss for the SD task compared with 81% (+/- 16) for the MD task (p < 0.005). There was a 20% (+/- 10) reacquisition for the SD task compared with 54% (+/- 7) for the MD task (p < 0.005). The mean scores were greater for the more complex task (MD), which was more useful in discriminating between the individual trainees and the two training sessions. CONCLUSIONS: It is possible to use VR to define the acquisition, loss, and reacquisition of psychomotor skills in individual NSTs and to compare them with a predefined performance criterion level. This study defines parameters that will be useful in repeated training sessions of NSTs in the preoperative phase of training and during retraining.

Clinical Competence↗
PubMed2006

Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents.

BACKGROUND: In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance. METHODS: A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual-spatial ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A). RESULTS: After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better (p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test). CONCLUSION: The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training.

Abdomen↗