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PubMed1993

Experimentally induced cortical malformations in rats.

Different cortical malformations were produced in rats by a single dose of X-rays (200 cGy) given on different days during gestation. These include large cortical ectopic masses after irradiation on day 14; segmentation of the cerebral cortex following irradiation on days 15, 17, 19; and a four-layered "lissencephalic" cortex following irradiation on day 16. Other types of cortical malformation were produced in rats aged 0-2 days by one of the following procedures: focal cortical freezing, focal electrocoagulation, cortical aspiration, and focal brushing of the meninges with a blunt needle covered with cotton. These latter abnormalities include laminar necrosis of layer V, focal cortical dysplasia reminiscent of microgyria, status verrucosus deformis and porencephaly. Experimentally induced cortical malformations in rats can help to increase our understanding of normal and abnormal neurogenesis and organisation of the human cerebral cortex.

Animals↗
PubMed1991

Use of BICAP in a case of colon angiodysplasia.

This paper reports on a case of colonic bleeding from an angiodysplastic lesion of the ascending colon in a 71-year-old diabetic woman, resulting in severe anemia in the patient, who was treated using the BICAP electrocoagulation system. The present report includes a description of this technique, which involves the use of a 7-F hemostatic probe connected to a 25-W BICAP source.

Aged↗
PubMed1976

Laparoscopic sterilization in the immediate puerperium.

The safety and effectiveness of laparoscopic sterilization with electrocoagulation and separation of the tubes when performed within five days of a normal delivery is evaluated. The majority of patients (53.5%) were sterilized within 36 hours of delivery and were discharged on either the same day or the first post-sterilization day (91.0%). While some form of complications were reported for 9.5 percent of the patients, potentially serious complications occurred for only 2 patients (1.%). Most of the complications were probably unrelated to the laparoscopic procedure. At six months after sterilisation, complications were reported by 2.9 percent of the patients who returned for a follow-up visit. One patient became pregnant 3.5 months after sterilization. The results of this study suggest that performing laparoscopic sterilization in the immediate puerperium does not significantly increase the complication or failure rates of the procedure.

Electrocoagulation↗
PubMed1976

[Neurosurgical treatment of trigeminal neuralgia (author's transl)].

Follow-up studies of 210 cases treated by electrocoagulation and of 146 cases treated by temporal subtotal resection of the posterior root (Frazier) and descriptions of a further 1946 cases in a cooperative study in which different surgical treatments were applied are used as a basis for discussion advantages and disadvantages of the different surgical methods. Selective elimination of pain fibers with protection of tactile sensibility seems the most desirable objective. With this in mind, the new percutaneous method developed by Sweet receives particular attention.

Electrocoagulation↗
PubMed1986

Upper gastrointestinal bleeding caused by gastroduodenal vascular malformations. Incidence, diagnosis, and treatment.

Within a two-year period, 12 patients with upper gastrointestinal bleeding due to gastroduodenal vascular malformations were admitted to a specialized intensive care unit. They represented 2.1% of all admissions for upper gastrointestinal bleeding, and 3.7% of those with severe hemorrhage (greater than or equal to 2 units of blood transfused). Early endoscopy was nondiagnostic during the first bleeding episode in all nine patients with nonhereditary vascular malformations; the diagnosis was eventually made after relapsing hemorrhage by repeat endoscopy in five patients, angiography in two, and histology in another two. These nine patients accounted for 23.6% of all cases of upper gastrointestinal bleeding considered to be of unknown origin after initial work-up. The remaining three patients had Rendu-Osler-Weber disease, and the first endoscopy was diagnostic in all of them. Emergency treatment was required for 11 patients; surgery was undertaken in seven, and transendoscopic therapy (electrocoagulation or endoscopic clipping) in four. There was a 25% mortality rate. No further bleeding has occurred in eight patients after a mean follow-up period of two years. Gastroduodenal vascular malformations are a more frequent cause of upper gastrointestinal bleeding than heretofore recognized, especially in patients whose hemorrhage is deemed to be of unknown origin after an initial work-up. Endoscopy, which may need to be repeated, is the most rewarding diagnostic procedure. Awareness of their possible existence facilitates endoscopic recognition. When available, transendoscopic therapy is a good choice to stop active bleeding from such lesions.

Adolescent↗
PubMed1995

Therapeutic effect of argon plasma coagulation on small malignant gastrointestinal tumors.

In endoscopy, argon plasma coagulation (APC) is a new principle of non-contact electrocoagulation and has proved to be a sufficient tool for palliative endoscopic treatment of gastrointestinal neoplasms, predominantly of the oesophagus and colorectum. In a study of 67 patients suffering from histologically confirmed and endosonographic T1-staged tumours of the gastrointestinum, 10 patients were selected for endoscopic APC treatment because of the impossibility of surgical therapy. Although the application was primarily of a palliative nature, in 9 of 10 cases of minor neoplasms, no further tumour could be detected in biopsies during the observation period (9.45 +/- 2.8 months). One patient was not cured locally. In none of the patients was any serious complication noticed during the outpatient follow-up. The effective results and lack of severe complications suggest this technique as an alternative therapy in selected patients with smaller gastrointestinal tumours.

Aged↗
PubMed1987

Angiodysplasia--an uncommon cause of colonic bleeding: colonoscopic evaluation of 1,050 patients with rectal bleeding and anaemia.

Angiodysplasia of the colon was diagnosed in 31 out of 1,050 patients (3%) presenting with rectal bleeding or anaemia, among 10,000 colonoscoped at St. Mark's Hospital. The lesions were identified in 16 out of 879 (2%) patients with rectal bleeding, in 15 out of 171 (9%) patients with anaemia, and in a further three patients without features of blood loss. The angiodysplasia lesions were predominantly in the right colon (76%) and occurred with a similar frequency (12%) in the transverse and the left colon. Affected patients (59% male and 41% female) were in the older age group (53-89 years; mean age 69.5 years) but only one patient had known aortic valve disease. Angiodysplasia is an important diagnosis to consider in patients presenting with colonic bleeding or anaemia because it can be treated in the majority of cases by endoscopic electrocoagulation. However in our experience it is less common (3%) than previously suggested by other authors (40-67%). Endoscopic over-diagnosis is possible when intramucosal capillaries with no bleeding tendency on local traumatisation or biopsy are included in the diagnosis but these lesions are not true angiodysplasia.

Aged↗
PubMed1994

Mechanical devices for interval laparoscopic tubal sterilization in previous IUD users.

This retrospective analysis was conducted to determine whether IUD users are good candidates for laparoscopic sterilization using the tubal ring and the Filshie clip. The data set used for the analysis came from international multicenter clinical trials involving 1235 women who were sterilized by the tubal ring and 1892 women sterilized by the Filshie clip. Results indicate that former IUD use is not associated with an increased risk of surgical injuries, including uterine perforation, major complications, or postoperative infections, for either of these tubal occlusion techniques. The risk of a sterilization procedure ending in technical failure (defined as switching to laparotomy and/or a tubal occlusion technique not originally planned) among tubal ring cases was greater for former IUD users than for non-IUD users. However, this may be related to a center effect. Nine of the 10 ring cases with technical difficulties were successfully switched to electrocoagulation, and the operator did not have to resort to an unintended laparotomy. The incidence of surgical difficulties among the Filshie clip cases was also higher in former IUD users, but all of these difficulties were safely overcome without changing the tubal occlusion method. These findings lead us to believe that, in general, a woman's IUD use should not generally be a reason for an experienced service provider to hesitate in performing an interval laparoscopic sterilization using a mechanical tubal occlusion technique.

Adult↗
PubMed1996

Subfascial endoscopic perforator vein surgery: a preliminary report.

Although the open Linton subfascial perforator vein interruption operation succeeded, for the most part, in preventing recurrent venous ulceration, it was associated with morbidity and prolonged hospitalization. We have attempted to obtain the beneficial effects of perforator interruption by the less invasive procedure of subfascial endoscopic perforator vein surgery using laparoscopic instrumentation and limited or no hospitalization. A total of 31 consecutive operations were performed in 30 patients. Sixteen women and 14 men were entered into the study, and all of them had severe chronic venous insufficiency with either open or healed ulcers. Operations were carried out without gas insufflation, in 17 without a hemostatic tourniquet, and in 13 entirely on an outpatient basis. The 18 hospitalizations produced a total of 49 days of inpatient care (mean 2.72 days). One to six perforating veins were encountered in these operations, and veins identified as perforators were electrocoagulated or clipped and sectioned. Sixteen limbs had severe chronic venous insufficiency or healed ulcers, and 15 had open ulcers. In 13 limbs, ulcers were intermittently present for 1 to 5 years. Seven of these healed within 4 weeks of operation and four others within 8 weeks. Two healed more than 8 weeks after surgery. In two limbs with ulcers that were present for 1 to 6 months, healing took place within 4 weeks of the operation in both. Complications included atelectasis in one patient, cellulitis requiring antibiotic therapy in three, wound hematomas not requiring intervention in two, and wound seroma not requiring therapy in one. This preliminary experience suggests that perforator vein interruption can be accomplished using existing instrumentation and a variety of technical modifications to achieve the objectives of the Linton operation without the attendant morbidity. Videoscopic instrumentation obtains benefits of subfascial perforator vein interruption without morbidity of the open operations. This preliminary study suggests that the operative procedure is attended by minimum morbidity without the need for rehospitalization. Long-term observation will be required to assess the procedure definitively, but the short-term objectives can be safely accomplished with minimum use of inpatient facilities.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

Endoscopic management of nonvariceal gastrointestinal bleeding.

Endoscopic management of upper gastrointestinal bleeding has been expanded from a purely diagnostic role to a therapeutic role in many patients. In addition to controlling active bleeding, it is an option in a patient who is clinically at a high risk of rebleeding, or in patients who have peptic ulcers with visible vessels or stigmata indicating high risk. Several methods have been studied, and currently the most useful include thermal cautery with the heater probe or bipolar electrocoagulation, and injection using epinephrine and/or sclerosants. Endoscopic hemostasis can effect permanent control of bleeding in many patients, but should be considered complementary to conventional surgical control in other patients, where temporary control to stabilize the patient is a desired end.

Electrocoagulation↗
PubMed1996

Diagnostic efficacy of push-enteroscopy and long-term follow-up of patients with small bowel angiodysplasias.

Gastrointestinal angiodysplasias are the most common cause of obscure chronic digestive blood loss. Push-enteroscopy is likely to detect and to treat vascular lesions. Push-enteroscopy was performed in 83 patients (mean age 62 years) presenting with iron deficiency anemia of obscure origin. A nonrevealing preliminary evaluation included esophagogastroduodenoscopy, colonoscopy and, in 50% of the patients, small bowel barium studies. We employed a 240-cm Olympus push-enteroscope (XSIF-100), 11.3 mm in diameter. A potential bleeding lesion was observed in 49 patients (59%). Gastrointestinal angiodysplasias were the most common lesion (33 patients). Electrocoagulation (bicap) of angiodysplasias was performed when accessible and not diffuse (<20). If not contraindicated, hormonal treatment was proposed for patients who had at least five AD. Some patients had both treatments. Long-term follow-up (mean, 12.2 months) was obtained in 25 patients with small bowel angiodysplasias. A good outcome (neither recurrence of anemia nor blood transfusion requirements) was observed in 12 patients. The diagnostic efficacy of push-enteroscopy is high. Despite available and recommended therapeutic modalities, the long-term outcome was considered to be good in only 50% of the patients.

Adolescent↗
PubMed1989

Colonic angiodysplasia. Follow-up of patients after endoscopic treatment for bleeding lesions.

Endoscopic electrocoagulation or photocoagulation is now the method of choice for treating colonic angiodysplasia. Follow-up of such patients has not been extensive. The authors report 26 patients with typical and symptomatic lesions who have been treated endoscopically. Follow-up (mean duration, 29.3 months) revealed that 21 patients remained symptom-free after a single procedure. Two patients needed a second procedure before being considered cured. In two others, the need for transfusions was lessened considerably after treatment. The last patient died of terminal cardiac failure. No complications occurred during treatment. Endoscopic treatment is a safe and efficient method for treating bleeding colonic angiodysplasia.

Adolescent↗
PubMed1983

Management of perforation due to colonoscopy.

Six patients who underwent emergency laparotomy for perforations secondary to colonoscopy or polypectomy are described. Three patients had the laceration closed primarily, two required colostomy, and one needed resection. When contamination is minimal and the colon is mechanically prepared, primary closure without diversion is the treatment of choice. Colostomy is rarely indicated and may lead to increased morbidity, in view of the need for closure. However, resection should be considered if suspicion of carcinoma is great. Factors that contribute to perforation include sedation, forceful introduction of the colonoscope, inadequate equipment for hemorrhage control, and prolonged application of electrocoagulation to the colonic wall.

Colonoscopy↗
PubMed1999

Experimental studies of thermal therapy for severe nonvariceal bleeding in dogs.

BACKGROUND: There are several methods of achieving endoscopic hemostasis for nonvariceal hemorrhage, including use of a heater probe, bipolar electrocoagulation, use of a Gold probe, and injection therapy with epinephrine or ethyl alcohol. However, due to clinical variations, clinical studies comparing thermal with injection therapy have yielded conflicting results. Therefore, we used a canine model of acute bleeding from gastric serosal vessels to examine the efficacy of the heater probe and the Gold probe in achieving hemostasis and to compare the injurious effects of these methods with injection therapy. METHODS: Seven mongrel dogs were used in the study. Four were assigned to acute experiments in which transected blood vessels were allowed to bleed profusely. Two dogs of this group were treated with either a large or small Gold probe, while the other two were treated with either a large or small heater probe. In the other three dogs, we tested the chronic effects of the heater probe, the Gold probe, and injection therapy with dilute epinephrine. RESULTS: Complete hemostasis was achieved for all four dogs in the acute experiments. Dogs treated with either a large or small heater probe had coagulation necrosis that extended to the serosa and muscularis but not to the mucosa. The large Gold probe had similar results, but the small Gold probe caused tissue damage to the serosa, muscularis, submucosa, and mucosa at several of the application sites. Both probes caused scarring of the gastric wall. In the chronic experiments, we found that the Gold probe caused larger mucosal ulcers than the heater probe. All ulcers healed in 3 weeks. The epinephrine injection caused localized swelling and discoloration, but after 1 week the tissue returned to normal. CONCLUSIONS: Both the heater probe and the Gold probe are effective in achieving hemostasis in a canine model of nonvariceal hemorrhage, and both methods are superior to injection therapy. For active bleeding ulcers, we currently recommend a combination therapy, using first injection therapy and then a heater or Gold probe. However, clinicians should be aware of the potential for tissue damage.

Animals↗
PubMed2003

Prevention of adenocarcinoma by reversing Barrett's esophagus with mucosal ablation.

The ultimate goal of therapy in patients with Barrett's esophagus (BE) is to reduce the risk of developing adenocarcinoma of the esophagus. Neither pharmacologic nor surgical therapy has been documented to reduce this risk. There is preliminary evidence that many forms of mucosal ablation combined with acid reduction therapy result in restitution of normal squamous epithelium in patients with BE. Acid reduction can be accomplished with high-dose proton pump inhibitor therapy or antireflux surgery. Endoscopic ablation can be accomplished with photodynamic therapy, laser, multipolar electrocoagulation, a heater probe, and argon plasma coagulation. These techniques require further study so the complication rates can be compared. The success of reversing BE must be evaluated in a standard way utilizing large-capacity biopsy forceps through a therapeutic endoscope. Ideally, patients at high risk of developing adenocarcinoma of the esophagus can be treated with ablation therapy and followed to document a reduction in the development of adenocarcinoma of the esophagus. A validated biomarker would help select high risk patients appropriate for reversal therapy. Currently, patients who are at prohibitive risk for surgery or who refuse surgery are candidates for combination therapy including mucosal ablation to reverse their BE. This therapy offers the promise of less morbidity and greater quality of life than resection.

Adenocarcinoma↗
PubMedDate not supplied

Prevention of intraventricular hemorrhage during CSF shunt revisions by means of a flexible coagulating electrode. A preliminary report.

We report the preliminary results of a prospective study in 19 patients (22 procedures) undergoing ventricular catheter replacement at the time of CSF shunt revision to determine the value of intraluminal coagulation by means of a flexible monopolar coagulating electrode in preventing ventricular hemorrhage following catheter removal. These patients had their first shunt implanted during infancy, and underwent shunt revision during the 1-year period between October 1996 and October 1997. Sixteen patients were found to have adherent ventricular catheters, that necessitated the use of diathermy for their removal. In 10 procedures electrocoagulation was applied to the stylet of the ventricular catheter thus permitting tube extraction. In the remaining 8 shunt revisions catheter removal was readily accomplished by coagulation applied to a flexible monopolar endoscopic electrode introduced into the lumen of the tube. Two patients developed mild intraventricular hemorrhage following the use of each of the two methods described above. Both coagulation techniques used during the routine withdrawal of ventricular catheters seem to be equally effective. The flexible coagulating electrode has the additional advantage over the stylet of being moldable, allowing its use in cases in which the catheter does not follow a straight course within the ventricular cavity.

Adolescent↗
PubMed2006

Laparoscopic treatment of blunt splenic injuries: initial experience with 11 patients.

BACKGROUND: Nonoperative treatment of splenic injuries is the current standard of care for hemodynamically stable patients. However, uncertainty exists about its efficacy for patients with major polytrauma, a high Injury Severity Score (ISS), a high grade of splenic injury, a low Glasgow Coma Score (GCS), and important hemoperitoneum. In these cases, the videolaparoscopic approach could allow full abdominal cavity investigation, hemoperitoneum evacuation with autotransfusion, and spleen removal or repair. METHODS: This study investigated 11 hemodynamically stable patients with severe polytrauma who underwent emergency laparoscopy. The mean ISS was 29.0 +/- 3.9, and the mean GCS was 12.1 +/- 1.6. A laparoscopic splenectomy was performed for six patients, whereas splenic hemostasis was achieved for five patients, involving one electrocoagulation, one polar resection, and three polyglycolic mesh wrappings. RESULTS: The average length of the operation was 121.4 +/- 41.6 min. There were two complications (18.2%), with one conversion to open surgery (9.1%), and no mortality. CONCLUSIONS: Laparoscopy is a safe, feasible, and effective procedure for evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial.

Adolescent↗
PubMed2000

Early experiences of haemostasis on brain tumour surgery with Argon Plasma Coagulation (APC).

OBJECTIVE: We first applied a novel haemostatic strategy involving Argon Plasma Coagulation (APC), an innovative no-touch electrocoagulation technique in which a high-frequency alternating current is delivered to the tissue through ionized argon gas, to brain tumour surgery, and report its usefulness and limitations. METHODS: The APC system we used comprised an APC 300 developed by ERBE Elektromedizin GmbH, Germany. We applied APC to 13 brain tumours in 12 patients (5 meningiomas, 4 sarcomas, 2 glioblastomas, and 2 pituitary adenomas). To avoid unnecessary thermal injury to the tissue as much as possible, power/gas flow settings of 20 and 40 W were used. The impact time was varied individually but was around several seconds per one impact. The argon jet (1.5-4.5 L/min) clears a field of pooled blood and evenly conducts electrical energy to the target tissue. A thin and flexible probe particularly increased the usefulness of APC for haemostasis on deep-seated skull base tumour operations under a microscope. CONCLUSION: All patients were successfully treated and satisfied with the surgical results without any complications due to APC. APC appears to be an excellent alternative strategy for achieving haemostasis on vascular-rich brain tumour surgery, and may be valuable for the management of patients with coagulation defects.

Adenoma↗