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PubMed1999

Development of open-scope subfascial perforating vein surgery: lessons learned from the first 67 cases.

Although perforating vein surgery in treatment and prevention of venous ulcers remains controversial, minimization of the procedure has allowed its reevaluation. We have chosen to develop the technique using a single port and an open scope using a variety of mostly nondisposable instrumentation. Since our first subfascial endoscopic perforator vein surgical (SEPS) procedure in July 1993, we have operated on 67 limbs in 62 patients (27 women, 35 men) ranging in age from 24 to 85 years. Using CEAP criteria, there were 16 limbs in class 4, 13 in class 5, and 38 in class 6. Preoperative investigations included duplex ultrasound in 35 cases, ascending phlebography in 29 cases, and selective use of physiologic testing with air plethysmography (APG) in 12 patients. A variety of initial explorations using different-diameter scopes has given way to single-port methodology for medial leg exploration. A mean of 3.08 perforators per patient was interrupted using electrocoagulation or metal clips and scissor division. This technique, as developed, allows same-day or short-stay (<24 hr) surgery. A vigorous program of thromboembolism prophylaxis was used in selected cases. From these 67 csaes we conclude that endoscopic perforating vein interruption provides a useful tool for the surgeon interested in treating severe chronic venous insufficiency. The open-scope, single-port technique accomplishes intervention objectives in a simplified manner. Although recurrent chronic venous insufficiency (CVI) is not eliminated, its postoperative treatment is markedly eased.

Adult↗
PubMed2003

Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata.

PURPOSE: Human papilloma virus infections of the anogenital region are very common and cause condylomata acuminata; cervical, penile, vulvar, or perianal intraepithelial neoplasia; and more rarely, invasive cancer. The currently available therapies often result in painful, extensive, slow-healing ulcerations and frequent early relapses. This study was aimed at determining the efficacy of topical application of the antiviral agent cidofovir at 1 percent. METHODS: Twenty patients treated with coagulations were compared with 27 patients treated with cidofovir. Lesions refractory to cidofovir were cleared up with additional coagulations. The number of patients previously treated for condylomata did not differ between the two groups. Significantly more patients treated with cidofovir, however, had an impaired immune status (37 percent) compared with the patients treated with coagulations (5 percent). RESULTS: Cidofovir alone cured the lesions in 32 percent of the patients and induced partial regression in 60 percent. However, in smokers, complete resolution of the condylomata occurred only in 16.6 percent compared with 66 percent of nonsmokers (P = 0.03). The number of coagulation sessions was much lower (P < 0.0005) in the cidofovir treated group (1 +/- 0.8 vs. 2.9 +/- 2). Furthermore, the relapse rate was significantly lower in the cidofovir group (3.7 vs. 55). All recurrences in the electrocoagulation group occurred within four months of confirmed lesion clearance. Topical applications of cidofovir 1 percent were well tolerated. Thirty-three percent of the patients reported only mild pain caused by erosive dermatitis. In contrast, coagulations caused painful ulcerations that necessitated the use of analgesics in all patients treated this way. CONCLUSIONS: Topical applications of cidofovir, an antiviral compound with activity against human papilloma virus, is effective in the majority of patients with perianal condylomata and is a valuable adjuvant to surgical treatment of these lesions.

Administration, Topical↗
PubMed1991

Ablation of the atrioventricular junction with radiofrequency energy using a new electrode catheter.

Percutaneous catheter ablation using radiofrequency energy can be used to interrupt atrioventricular (AV) conduction in patients with supraventricular tachycardia refractory to drugs. Results of radiofrequency ablation of the AV junction using a custom-designed catheter with a large, 3-mm-long distal electrode, 2-mm interelectrode spacing, and a shaft with increased torsional rigidity were compared with those using a standard quadripolar electrode catheter (Bard EP). An electrocoagulator (Microvasive Bicap 4005) supplied unmodulated radiofrequency current at 550 kHz, which was applied between the distal electrode of the ablation catheter and a large skin electrode. With use of the modified catheter, 12 of 13 patients (92%) had persistent complete AV block induced with 7 +/- 5 applications of 18 +/- 6 W of radiofrequency power. In contrast, complete AV block was produced in only 9 of 18 (50%) historical control patients treated with the standard catheter, despite a similar number of applications (7 +/- 5) and power output (16 +/- 4 W). A rise in impedance, due to desiccation of tissue and coagulum formation, occurred earlier (28 +/- 18 vs 52 +/- 24 seconds, p less than 0.001) and more frequently (54 vs 40% of applications, p = 0.047) in patients treated with the standard catheter than in patients treated with the modified catheter. The use of a catheter designed to increase the surface area of electrode-tissue contact allows more radiofrequency energy to be delivered before a rise in impedance occurs and appears to increase the effectiveness of radiofrequency ablation of the AV junction.

Atrioventricular Node↗
PubMed1982

A comparison of different laparoscopic sterilization occlusion techniques in 24,439 procedures.

This investigation assessed the safety and efficacy of five laparoscopic tubal occlusion techniques for female sterilization: electrocoagulation, the tubal ring via conventional and open laparoscopy, the prototype spring-loaded clip, and the Rocket clip. The 24,439 cases make up a data set collected by collaborating staffs at 64 institutions in 27 countries. The five techniques were compared with respect to six commonly evaluated parameters. Rates of surgical difficulties ranged from 2.4% to 12.5% (5.1% overall); rates of surgical complications, from 0.7% to 2.7% (1.7% overall); and rates of technical failures, from 0.6% to 1.0% (0.8% overall). Twelve-month life-table pregnancy rates were less than one per 100 women years. Prospective data on six menstrual parameters revealed that the menstrual cycles of the majority of women were unchanged after sterilization; for those who reported a change, approximately half experienced a change in one direction and half in the other direction. For example, one half reported an increase in the amount of menstrual flow, and one half reported a decrease in the amount of flow. The reported incidence of subsequent pelvic operations was less than 1% at each long-term follow-up. These data indicate that laparoscopic sterilization is safe and effective and that none of the studied techniques has a distinct advantage.

Actuarial Analysis↗
PubMed1983

Menstrual pattern changes following laparoscopic sterilization with different occlusion techniques: a review of 10,004 cases.

A comparison is made of menstrual pattern changes reported by 10,004 women undergoing interval and postabortion sterilization by the laparoscopic occlusive techniques of unipolar electrocoagulation, the tubal ring, the prototype spring-loaded clip, and the Rocket clip. Controlling for prior contraceptive use, the menstrual patterns in these women sterilized by the four techniques were compared with respect to six parameters: cycle regularity, cycle length, menstrual flow duration, amount of flow, dysmenorrhea, and intermenstrual bleeding. The majority of women reported no menstrual changes subsequent to sterilization. When changes were experienced, they occurred in equal proportions in opposite directions. Depending on the parameter, from 15% to 79% of the menstrual pattern changes seen within 6 months after sterilization in women who were using oral contraceptives or intrauterine contraceptive devices at the time of sterilization could be attributed to the discontinuation of those methods of contraception. There were no significant differences between the several occlusion technique groups with respect to the proportion of women who reported changes in their menstrual patterns after sterilization.

Adult↗
PubMed1983

Previous abdominal surgery as a risk factor in interval laparoscopic sterilization.

Previous abdominal surgery has been termed a relative contraindication for laparoscopic sterilization. This study quantifies the relative risks of surgical difficulties, immediate complications, and early follow-up complications/complaints of interval sterilization in women with versus women without previous abdominal surgery (PAS and NPAS groups, respectively). This multicenter study included women sterilized by electrocoagulation, the tubal ring, and the spring-loaded clip. Within each center the PAS and NPAS women were generally similar with respect to sociodemographic variables and preexisting medical conditions. Stratified analysis determined that the rate of surgical difficulties was significantly higher in PAS women (relative risk = 2.3, P less than 0.05), but most of these difficulties were overcome without resorting to another technique or approach. The rates of complications as well as the mean operation times and mean durations of hospitalization (indices of medical costs) did not differ significantly between the PAS and NPAS groups.

Abdomen↗
PubMed1979

Macroscopic and microscopic studies of fallopian tube after laparoscopic sterilization.

Histological study was carried out on human fallopian tubes one hour and one month after various methods of laparoscopic sterilization. Ciliated cells were counted and histological lesions were observed. Deciliation is proved at a distance from the site of sterilization. Taking into account these two data, it has been possible to display the substance loss provoked by each of the usual sterilization methods (unipolar electro-coagulation, bipolar electrocoagulation, silicone ring and Hulka-Clements clip) which have to be taken into consideration in case of surgical re-anastomosis.

Fallopian Tubes↗
PubMed1989

Changes in menstrual blood loss after four methods of female tubal sterilization.

One-hundred females requesting tubal sterilization were included in this study. They were enrolled into 4 groups, each n = 25. They were allocated to a particular method of sterilization on a randomized basis. The four modalities used were: laparoscopic Falope ring application, bipolar electrocoagulation, Hulka clip application and Pomeroy tubal ligation via minilaparotomy. The menstrual blood loss (MBL) was quantitatively estimated, using the alkaline hematin method, prior to sterilization and after 3, 6 and 12 months. No significant changes in MBL were observed after the four sterilization techniques. Moreover, they did not differ significantly in this context.

Adult↗
PubMed1985

Reaction of bone marrow after cryo- and thermolesions on internal organs.

Focal thermo- and cryolesions were placed on one kidney and the liver of Wistar rats. The wound healing was investigated histologically and by tritiated thymidine autoradiography. Furthermore, the 3H labeling indices of neutrophilic and eosinophilic promyelocytes and myelocytes as well as that of erythroblasts were determined in bone marrow samples from femur and vertebra. Normal nonoperated rats and rats which underwent sham operation (simple laparotomy) served as controls. The cryonecrosis healed completely after 4 weeks, whereas thermonecrotic areas were still observed 12 weeks after operation. The maximum mesenchymal and epithelial proliferation occurred between the 2nd and 3rd postoperative days. In the bone marrow, the highest labeling indices were estimated in animals with thermonecrosis, with values remaining increased during the 2 weeks after operation. Significant differences between the bone marrow response after cryolesions and sham operation were not observed. Thermolesions of internal organs, for example, after electrocoagulation, evoke a persisting local granulomatous inflammation accompanied by a distinct bone marrow reaction probably because of the pure resorption of carbonized tissue components. Iatrogenic cryolesions, in contrast, are characterized by a quick and uncomplicated wound healing without a significantly increased proliferation of bone marrow cells, thus corresponding to the wound healing after sham operation.

Animals↗
PubMed1989

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

Efficacy and tissue effects of injection therapy for nonvariceal upper gastrointestinal bleeding were studied in 16 mongrel dogs. The results were compared with those obtained by neodymium-yttrium-aluminum-garnet laser, bipolar electrocoagulation, and heater probe. Epinephrine (1:10,000), absolute ethanol, and 1% polidocanol were used as injection solutions. In acute, severely bleeding experimental ulcers as well as in transected submucosal arteries, injection methods were not as effective as thermal methods in achieving complete hemostasis, although injection therapy, especially with large volumes of epinephrine (1:10,000), very quickly decreased the rate of bleeding. Chronic experiments showed that epinephrine (1:10,000) caused almost no tissue injury, but also did not induce vessel thrombosis. In contrast, absolute ethanol and 1% polidocanol caused tissue necrosis, ulceration, and vessel thrombosis, the former by acute dehydration and fixation of the tissue, the latter by acute edema and subsequent inflammation and sclerosis. These data suggest that although epinephrine injection may slow or temporarily stop bleeding, this modality is not as efficacious as injection with 1% polidocanol or absolute ethanol in inducing definitive vessel thrombosis. In the present experimental conditions sclerotherapy was not as effective as thermal methods in achieving hemostasis. These data also show that injection therapy with 1% polidocanol and absolute ethanol is by no means safer than thermal methods.

Animals↗
PubMed1992

Endoscopic therapy for acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis.

Endoscopic hemostatic therapy for upper gastrointestinal bleeding is gaining widespread acceptance despite often conflicting results of randomized controlled trials. To examine the effect of endoscopic therapy in acute nonvariceal upper gastrointestinal hemorrhage, a meta-analysis was performed using a computerized search of the English-language literature and a bibliographic review. The methodology, population, intervention, and outcomes of each relevant trial were evaluated by duplicate independent review. Thirty randomized controlled trials evaluating hemostatic endoscopic treatment were identified. Endoscopic therapy significantly reduced rates of further bleeding (odds ratio, 0.38; 95% confidence interval, 0.32-0.45), surgery (odds ratio, 0.36; 95% confidence interval, 0.28-0.45), and mortality (odds ratio, 0.55; 95% confidence interval, 0.40-0.76). When analyzed separately, thermal-contact devices (monopolar and bipolar electrocoagulation and heater probe), laser treatment, and injection therapy all significantly decreased further bleeding and surgery rates. The reductions in mortality were comparable for all three forms of therapy, but the decrease reached statistical significance only for laser therapy. Further examination of subgroups indicated that endoscopic treatment decreased rates of further bleeding, surgery, and mortality in patients with high-risk endoscopic features of active bleeding or nonbleeding visible vessels. Rebleeding was not reduced by endoscopic therapy in patients with ulcers containing flat pigmented spots or adherent clots. Endoscopic hemostatic therapy provides a clinically important reduction in morbidity and mortality in patients with acute nonvariceal upper gastrointestinal hemorrhage.

Acute Disease↗
PubMed1991

Sutureless hemisplenectomy.

Splenic salvage following blunt injury can fail when parenchymal bleeding is uncontrollable. To define the usefulness of an argon beam coagulator for hemostasis, we used the instrument in a laboratory trial of partial splenic resection. New Zealand white rabbits, weighing 4 to 5 kg, had sharp excision of the lower half of the spleen. No sutures were used to control hemorrhage from the cut splenic surface or the hilar vessels. Hemostasis was achieved with 2 to 4 seconds of electrocoagulation delivered by a beam of argon gas. All animals survived the procedure and were in good health when killed between the fourth and sixth week following the procedure. At necropsy, the spleen was viable in all animals with no abscess or hematoma. Minimal adhesions from the treated splenic surface to the omentum were found. The scar at the cut surface was 1 mm in depth, and the histology of the remainder of the spleen was normal. In this simulated splenic injury model, argon beam coagulation was uniformly successful in achieving hemostasis. Minimal tissue destruction and lack of infection were noted. The argon beam coagulator may be useful in patients with severe splenic injuries and other situations requiring partial splenectomy.

Animals↗
PubMed1980

Laparoscopic sterilization with electrocautery, silastic bands and spring-loaded clips: report of our experience with 790 patients.

A comparative study was carried out in 790 women undergoing one of the 3 most frequently used laparoscopic sterlization techniques: high-frequency unipolar electrocoagulation of the tubes, application of silastic rings or spring-loaded clips to the tubes. The technical problems and per- and postoperative (early) complications are assessed. The use of high-frequency unipolar current has been superseded by today's mechanical and non-electrical sterilization methods. The spring-loaded clip method appears to be a sterilization technique with a minimum of severe complications, and theoretically the greatest chances for possible refertilization.

Electrocoagulation↗
PubMedDate not supplied

Regional effects of apomorphine on rat brain cholecystokinin-8 like immunoreactivity following electrolytic lesions of the ventral tegmental area.

After bilateral electrocoagulation of the ventral tegmental area (VTA) of rats, apomorphine (APO) was administered intraperitoneally to study the effect on the cholecystokinin-8 like immunoreactivity (CCK-8 IR) in the medial prefrontal cortex, the anterior and posterior part of the nucleus accumbens and the corpus striatum. In the medial prefrontal cortex and the posterior part of the nucleus accumbens, CCK-8 IR was markedly decreased by lesioning of the VTA. Then recovery of CCK-8 IR was noted in the APO treated rats following electrolytic lesioning of the VTA. This recovery corresponds to the response of CCK neurons not originating in the VTA or CCK interneurons to APO via DA receptors. In the anterior part of the nucleus accumbens and the corpus striatum, no significant decrease in CCK-8 IR was noted even following lesioning of the VTA. APO administration following the lesioning, however, resulted in a marked increase in CCK-8 IR in the anterior part of the nucleus accumbens and the corpus striatum. According to this result, in these sites, very few CCK neurons originating in the VTA exist and CCK neurons originating in sites other than the VTA or CCK interneurons react on APO via DA receptors.

Animals↗
PubMed1985

Respiratory tract tumors in hamsters after severe focal injury to the trachea and intratracheal instillation of benzo[a]pyrene.

Two groups of male and female Syrian golden hamsters, of which the trachea was severely injured by electrocoagulation, received 6 weekly intratracheal instillations of benzo[a]pyrene (BaP) + ferric oxide in saline or saline alone. Two comparable groups of hamsters were similarly treated but had an undamaged trachea. The experiment was terminated in week 82. Treatment with BaP resulted in hyper- and metaplastic lesions and tumours of the laryngeal, tracheal, bronchial and pulmonary epithelium. There was no evidence of an increased incidence of BaP-induced tumours in the injured trachea.

Animals↗
PubMed1979

Pain-induced alterations in the individual non-esterified fatty acids in serum.

Changes of individual non-esterified fatty acids in serum were studied in 7 metabolically healthy patients, suffering from idiopathic trigeminal neuralgia, who underwent electrocoagulation of gasserian ganglion under neurolepthypalgesia. The mean concentration of fatty acids increased by about 40% during the strong surgical pain stimulus. The increased lipolysis affected all individual fatty acids in proportion to the ratio of their presence in adipose tissue. The mechanism of pain-induced activation of lipase and possible consequences of alterations in individual non-esterified fatty acids are discussed.

Adult↗
PubMed1993

Local excision and post-operative radiation therapy for rectal carcinoma.

PURPOSE: To assess the patterns of failure and outcome following conservative surgery and post-operative radiation therapy for rectal cancer. METHODS AND MATERIALS: Twenty-five patients underwent post-operative radiation therapy (50 Gy in 20 fractions over 4 weeks) following local excision or electrocoagulation for carcinoma of the rectum. None of the patients had palpable residual disease following surgery. Selection factors for post-operative radiation therapy were refusal of a permanent colostomy, excessive operative risk of an abdominal perineal resection and concern regarding local control with conservative surgery alone. RESULTS: Six of 25 patients developed failure at the primary site. There was no lymph node failure. All five patients with primary failure alone underwent abdominal perineal resection and 2 remained free of recurrence. With a median follow-up of 6 years, 20 of 25 patients remained alive and free of disease. There was no apparent influence of age, sex, type of surgery, tumor size, distance of tumor from anal verge, tumor configuration, resection margins, integrity of the resected tissue, depth of invasion, differentiation, presence of lymphatic or vascular channel invasion, radiation dose or field size on local control and survival. One of 15 patients failed locally when the overall treatment time was 30 days or less, whereas 5 of 10 patients developed local failure when the overall treatment time exceeded 30 days. Sixteen of 20 patients in whom cancer did not recur retained normal anorectal function. All four patients with grade 3 early morbidity and the only patient with Grade 3 late morbidity were amongst the group of 13 patients treated with large AP-PA fields (mean: 15 x 19 cm2). CONCLUSION: In selected patients who are at high risk of local recurrence following local excision alone, and who refuse a colostomy or are at high operative risk from radical surgery, post-operative radiation therapy is an alternative to radical surgery.

Aged↗
PubMed1993

The pathway responsible for EEG synchronization and effect of histamine on this system.

Electrical stimulation (3 Hz, 0.5 volts) to the midbrain reticular formation of conscious rats induced significant increase of EEG power densities (synchronization) recorded at the frontal cortex (FCOR), nucleus ventralis thalami (VE), or nucleus medialis centralis thalami (CM). Significant synchronization was also observed in the FCOR when electrical stimulation was applied to the VE and CM. When ipsilateral and bilateral VEs were electrocoagulated, no EEG synchronization was observed in the FCOR and CM. Intracerebroventricular administration of histamine (Hi) caused a marked suppression of FCOR EEG synchronization in both CM-lesioned and normal rats through H1 receptors. EEG synchronization in FCOR was not induced in ipsilateral or bilateral VE-lesioned rats after RF stimulation. When Hi (1 microgram) was injected into the VE of normal rats, EEG synchronization of FCOR was markedly reduced after RF or VE stimulation. No such changes were induced when Hi was injected into the CM.

Animals↗