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At least 1,117 records · Page 62Linked to original sources
PubMed1996

Complications of 174 laparoscopic hysterectomies.

The case records of 174 patients who underwent laparoscopic hysterectomy between September, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 45.4 (range 17.8-68.5) years, mean weight 70.2 (50-121) kg and mean parity 2.3 (0-4). Laparoscopic hysterectomy (i.e. uterine arteries secured laparoscopically) was performed in 98 patients, laparoscopically assisted vaginal hysterectomy in 70, and laparoscopic subtotal hysterectomy in 6. Bilateral or unilateral oophorectomy were performed in 40 cases. The mean operating time was 131 (45-285) minutes and mean hospitalization 2.6 (1-11) days. Endoscopic stapling devices were used in 135 cases, biopolar diathermy in 117, sutures and ties in 84, and the harmonic scalpel in 29. The overall complication rate was 16%. Seven cases (4%) required conversion to laparotomy. These included 2 inadvertent cystotomies (1 after 2 Caesarean sections), 3 cases of dense uterovesical adhesions following previous surgery and 2 instances of excessive uterine size (> 16 weeks). The mean follow-up period was 2.2 (1-18) months. One patient had a shortened vagina requiring dilatation and another had vault granulations requiring diathermy treatment. Overall 98.3% of patients were satisfied with their surgery.

Adolescent↗
PubMed1992

Randomised clinical trial of manipulative therapy and physiotherapy for persistent back and neck complaints: results of one year follow up.

OBJECTIVE: To compare the effectiveness of manipulative therapy, physiotherapy, treatment by the general practitioner, and placebo therapy in patients with persistent non-specific back and neck complaints. DESIGN: Randomised clinical trial. SETTING: Primary health care in the Netherlands. PATIENTS: 256 patients with non-specific back and neck complaints of at least six weeks' duration who had not received physiotherapy or manipulative therapy in the past two years. INTERVENTIONS: At the discretion of the manipulative therapists, physiotherapists, and general practitioners. Physiotherapy consisted of exercises, massage, and physical therapy (heat, electrotherapy, ultrasound, shortwave diathermy). Manipulative therapy consisted of manipulation and mobilisation of the spine. Treatment by general practitioners consisted of drugs (for example, analgesics), advice about posture, home exercises, and (bed)rest. Placebo treatment consisted of detuned shortwave diathermy (10 minutes) and detuned ultrasound (10 minutes). MAIN OUTCOME MEASURES: Changes in severity of the main complaint and limitation of physical functioning measured on 10 point scales by a blinded research assistant and global perceived effect measured on a 6 point scale by the patients. RESULTS: Many patients in the general practitioner and placebo groups received other treatment during follow up. Improvement in the main complaint was larger with manipulative therapy (4.5) than with physiotherapy (3.8) after 12 months' follow up (difference 0.9; 95% confidence interval 0.1 to 1.7). Manipulative therapy also gave larger improvements in physical functioning (difference 0.6; -0.1 to 1.3). The global perceived effect after six and 12 months' follow up was similar for both treatments. CONCLUSIONS: Manipulative therapy and physiotherapy are better than general practitioner and placebo treatment. Furthermore, manipulative therapy is slightly better than physiotherapy after 12 months.

Adult↗
PubMed1998

A randomised controlled comparison of injection, thermal, and mechanical endoscopic methods of haemostasis on mesenteric vessels.

BACKGROUND AND AIMS: A randomised controlled comparison of haemostatic efficacy of mechanical, injection, and thermal methods of haemostasis was undertaken using canine mesenteric vessels to test the hypothesis that mechanical methods of haemostasis are more effective in controlling haemorrhage than injection or thermal methods. The diameter of arteries in human bleeding ulcers measures up to 3.45 mm; mesenteric vessels up to 5 mm were therefore studied. METHODS: Mesenteric vessels were randomised to treatment with injection sclerotherapy (adrenaline and ethanolamine), bipolar diathermy, or mechanical methods (band, clips, sewing machine, endoloops). The vessels were severed and haemostasis recorded. RESULTS: Injection sclerotherapy and clips failed to stop bleeding from vessels of 1 mm (n = 20) and 2 mm (n = 20). Bipolar diathermy was effective on 8/10 vessels of 2 mm but failed on 3 mm vessels (n = 5). Unstretched elastic bands succeeded on 13/15 vessels of 2 mm but on only 3/10 vessels of 3 mm. The sewing machine achieved haemostasis on 8/10 vessels of 4 mm but failed on 5 mm vessels (n = 5); endoloops were effective on all 5 mm vessels (n = 5). CONCLUSIONS: Only mechanical methods were effective on vessels greater than 2 mm in diameter. Some mechanical methods (banding and clips) were less effective than expected and need modification. Thermal and (effective) mechanical methods were significantly (p < 0.01) more effective than injection sclerotherapy. The most effective mechanical methods were significantly more effective (p < 0.01) than thermal or injection on vessels greater than 2 mm.

Animals↗
PubMed1984

Effect of introduction of colposcopy into a district general hospital.

Management of cervical intra-epithelial neoplasia, in a district general hospital, was examined for two 22-month periods before and after the introduction of colposcopy. This technique enables the clinician to evaluate the extent and severity of pre-malignant change, and makes treatment, using less radical destructive techniques, possible. The method of conservative treatment in this hospital was diathermy, and the cure rate of cases so treated was 97%. The use of diathermy treatment resulted in a 75% reduction in the incidence of cone biopsy in women below the age of 40 years. A further advantage of colposcopy has been recognized, which is that some women with "mild or moderate changes" are discovered to have more severe lesions, and receive appropriate treatment without delay. It follows that all patients with an abnormal smear should be referred for colposcopy, unless there is an obvious local cause of the abnormality, such as easily treatable infection, and that the post-treatment smear reverts to normal. In this hospital the cost of establishing a colposcopic service was low, and the cost benefits, as well as the improved management of cervical intraepithelial neoplasia suggests that the service should be introduced in all district general hospitals.

Adolescent↗
PubMed2003

Long-term outcomes of intragastric endoscopic mucosal resection using a modified buess technique for early gastric cancer.

BACKGROUND/AIMS: The aim of this study was to clarify long-term outcomes of endoscopic mucosal resection (EMR) using a modified Buess technique for mucosal gastric cancer. METHODS: The procedure included en bloc mucosal resection using a Buess-type rectoscope into the gastric lumen via a temporary gastrostomy under video camera guidance. We reviewed 5 patients who underwent this procedure between 1995 and 1997 with a single mucosal cancer of the stomach that was unsuitable for en bloc excision by endoscopic snare diathermy. RESULTS: All tumors were superficial elevated types (type 0-IIa) located in the middle third and posterior wall of the stomach. Median maximum tumor diameter was 2.2 (range 1.1-3.5) cm. There was no operative mortality. One patient developed a hemorrhagic gastric ulcer postoperatively. All tumors histologically showed curative potential of the mucosal resection without margin involvement. During a median follow-up period of 64 (50-77) months, none of the patients developed local recurrence. One patient had an early gastric cancer that metachronously developed at another stomach site. CONCLUSION: Intragastric EMR using a modified Buess technique appears to be a useful treatment for cure of mucosal gastric cancer for a limited group of patients unsuitable for complete en bloc excision by endoscopic snare diathermy.

Adenocarcinoma↗
PubMed2004

Ultrasonically activated scalpel compared with electrocautery in tonsillectomy.

The occurrence of postoperative bleeding, the quantity of operative bleeding and the duration of operation were retrospectively evaluated in 407 patients who underwent tonsillectomy within a 32-month period. They were operated on with either an ultrasonically activated scalpel (UAS), bipolar diathermy (BPD) or blunt dissection with monopolar diathermy (MPD) with the following results. (1) Primary bleeding was more common with MPD: MPD 7.1% vs. BPD 2.4% (p < 0.01) vs. UAS 1.0% (p < 0.001). Secondary bleeding was more common with UAS: UAS 19.6% vs. MPD 14.5% (p < 0.001) vs. BPD 14.5% (p < 0.01). There was no statistical significance in the differences between overall postoperative bleeding rates. (2) There was statistically significantly less operative bleeding with UAS:UAS 24.8 ml vs. MPD 58.7 ml vs. BPD 43.8 ml. (3) On the other hand, the operation time was on average longer with UAS: UAS 32.3 min vs. MPD 18.4 min vs. BPD 22.1 min. Our results suggest that UAS offers no significant advantage over MPD or BPD in tonsillectomy other than minimal operative bleeding possibly due to longer duration of operation.

Adolescent↗
PubMed1977

The encircling Silastic 3 mm band without cautery in retinal detachment surgery.

Retinal detachment with tears can be cured by scleral buckling by synthetic material pressure retino-choroidopathy without cautery (diathermy, cryo- or photocoagulation) to tear edges on conditions: (1) To use the encircling Silastic 3-mm band (equatorial or oblique according to tear site) giving a permanent buckle. The segmental buckle may recede reopening the tear and its retino-choroidopathy effect may not be sufficient to seal the tear. (2) Not to evacuate the subretinal fluid leaving the ocular tension at end of operation a bit high [about 25 mm Hg in the first operation and 5 mm Hg (Schøtz) in the recent reoperation above the preoperative level]. The synthetic material pressure retino-choroidopathy seals the tear and lowers the ocular tension in subsequent days with beter buckling. (3) As these conditions may not be attained, it is wiser to use minimal diathermy or cryo-therapy to seal the tear.

Follow-Up Studies↗
PubMed1978

Long-term results of retinal detachment surgery.

Patients treated successfully with retinal detachment surgery 11-39 years earlier were called back and examined. The average age was 35 years at the time of surgery and the average interval between the operation and this follow-up examination was 16 years. The visual acuity had decreased in many patients. The most frequent causes of this fall in visual acuity after surgery were cataract and macular degeneration. Chorioretinal atrophy with blackish pigment spots developed in the reattached retina a long time after surgery and caused defects in the visual fields. This atrophy seems to be related to the long duration of retinal detachment before and after operation, which may cause malnutrition of the detached retina and result in incomplete recovery of visual cells, leading to chorioretinal atrophy. Macular degeneration was caused or accelerated by detachment of the macula. There was no difference in postoperative ocular findings between only diathermy and combination of diathermy with segmental scleral-buckling procedures. However, Arruga's ring suture method induced cataract more frequently than did other surgical procedures.

Adolescent↗
PubMed2005

Acquired subglottic cysts in preterm infants.

OBJECTIVES: Acquired subglottic cysts (SGCs) are a recognized complication of intubation in preterm infants. A brief window of our experience is reviewed to determine the demographics and outcomes of therapy. DESIGN: A retrospective review encompassing patients diagnosed and treated from 2001 to 2002 inclusively. SETTING/METHODS: A case series of 11 patients evaluated at a tertiary care pediatric institution over a 2-year period is presented. RESULTS: Eleven patients evaluated for symptoms of severe airway distress were diagnosed with SGC by microlaryngoscopy and bronchoscopy. All had a history of prematurity with intubation in the perinatal period. All but one became symptomatic many months following intubation. Two patients presented for assessment with tracheotomies, whereas a third received a tracheotomy during therapy owing to a large obstructive bilateral SGC. Large unilateral SGCs were the most common finding on endoscopy. Treatment consisted of cyst marsupialization or direct excision on laryngotracheoplasty. Twenty-six procedures were performed. Four patients required single procedures for complete resolution of symptoms. Two patients had staged procedures with the use of endoscopic diathermy. An element of subglottic stenosis was present in 10 of the 11 patients; however, only 3 patients required laryngotracheoplasty for definitive treatment. CONCLUSION: SGCs are associated with intubation in premature infants and may develop many months following extubation. The duration of intubation does not appear to be a predictive risk factor. Subglottic stenosis is commonly an underlying finding in patients with SGC. Staging procedures with endoscopic diathermy is a highly effective modality, minimizing the need for more invasive procedures.

Cysts↗
PubMed1979

Reflex suppression of gastric motility during laparotomy and gastroduodenal nociceptive stimulation.

The effects on gastric motility of laparotomy or of nociceptive stimuli directed to the antro-duodenal area were studied in anaesthetized cats. A diathermic lesion of the duodenal or gastric antral wall induced pronounced gastric relaxation, which could either fade off within 0.5--1.5 h or persist for several hours. This gastric relaxatory response persisted after administration of antiadrenergic and anticholinergic drugs but was eliminated by vagotomy or cold blockade of the vagi. Vagotomy performed during the relaxed gastric state after diathermy immediately resulted in a more or less complete recovery of gastric tone. Blunt mechanical stimulation of the duodenum also caused a prompt gastric relaxation, which showed the same characteristics as the response to diathermy as regards the effects of nerve-blocking drugs and vagotomy. The laparotomy incision per se caused temporary inhibition of rhythmic gastric contraction, but this effect was largely abolished if atropine or guanethidine had been given. It is concluded that nociceptive stimuli against the gastric or duodenal wall induce, besides a sympathoadrenergic reflex inhibition of gastric motility, a profound long-lasting gastric relaxation via a reflex activation of the vagal nonadrenergic inhibitory fibres. This vagally mediated relaxation of the stomach is likely to contribute to the suppression of gastric motility seen in 'paralytic ileus'.

Abdomen↗
PubMed1976

Experimental cleavage of chorioretinal scars by traction and subretinal fluid.

The resistance to separation by localized traction and exudative retinal detachment of experimental chorioretinal scars produced with argon laser photocoagulation, cryothermy and diathermy was tested in rabbits. In vivo, the area of retinal separation over the scar was similar to that obtained by traction on normal retina. Moreover, the retinal cleavage occurred at the level of the scar regardless of the scar inducing modality, indicating that the scar is the weakest point in the retina-pigment epithelium joint. However, spaced and dense chorioretinal scars produced by argon laser photocoagulation, diathermy and cryothermy usually remained attached after experimental production of exudative retinal detachments with penicillin G intravitreal injections. This study indicates that the resistance to detachment of the normal retina by traction may be as strong as that of the scarred tissue and that the chorioretinal scars' effect is related to lesser fluid penetration into the treated area.

Animals↗
PubMed2000

Methods of haemostasis in tonsillectomy assessed by pain scores and consultation rates. The Roskilde County Tonsillectomy Study.

OBJECTIVES: To compare four methods of haemostasis after tonsillectomy assessed by pain scores and consultation rates. STUDY DESIGN AND METHODS: A prospective study. The method of sole compression of the tonsillar fossae with gauze tampons was compared to ligation, bipolar diathermy and ligation/diathermy in combination. RESULTS: Highly significantly lower pain scores after discharge were found in the compression group compared to the other three groups (p < 0.025). The consultation rate in person after discharge of the compression group was significantly lower than in the diathermy group (p < 0.01) and the ligation/diathermy group (p < 0.05). CONCLUSION: Sole compression was associated with considerably less morbidity and no higher risk of postoperative haemorrhage. Sole compression should therefore be preferred in tonsillectomy whenever the surgeon considers it to be justified.

Adolescent↗
PubMed2001

Hope for clomiphene citrate resistant ovaries.

OBJECTIVE: To assess the presentation, different surgical modalities and their outcome in the treatment of polycystic ovarian disease. METHODS: A retrospective study was carried out on 66 patients with polycystic ovarian disease. The majority of the cases had a history of infertility for at least 2 years and were known to be clomiphene citrate resistant in the Saudi German Hospital, Jeddah between 1994 and 1998 undergoing laparoscopic ovarian drilling. RESULTS: More than 80% of the patients were below 30 years of age. The majority of cases below 30 years had primary infertility. Irregular cycle was the main clinical presentation in 75% of cases; ovarian volume was more than 5.5cm3 in all of the cases. Diathermy drilling was carried out for 50 patients, laser for 12 patients and wedge resection for 4 patients. The follow-up treatment showed that pregnancy rate was 23%, 38% and 0% in the 3 groups. Cases that failed to conceive had significantly higher luteinizing hormone level. CONCLUSION: Laparoscopic ovarian drilling using diathermy or laser is effective during the induction of ovulation and increases the pregnancy rate in cases of polycystic ovarian disease resistant to clomiphene citrate.

Adult↗
PubMedDate not supplied

Treatment update: nonallergic rhinitis.

Chronic nonallergic rhinitis is a diagnosis of exclusion. The pathophysiology underlying this disorder is unknown. There probably are several mechanisms involved and several different variations of this condition. Therapies which have been approved for use in the treatment of chronic nonallergic rhinitis include topical corticosteroids and azelastine. Topical corticosteroid preparations that have received approval are fluticasone, budesonide, and beclomethasone. Topical nasal saline also has been established as a beneficial adjunct to therapy in some instances. Other therapies have included capsaicin, silver nitrate, botulin toxin, and various surgical procedures. These procedures include turbinate reduction, which has been performed by a number of techniques including submucosal diathermy, cryosurgery, laser cautery, and classic resection. Ethmoidal and vidian neurectomies have been performed by excision, diathermy, and cryotherapy. These procedures have met with varying degrees of success.

Anti-Allergic Agents↗
PubMed1975

Drainage of subretinal fluid: why, when, where and how.

The release of subretinal fluid is only required in certain complicated types of retinal detachment and should be avoided when possible. An important consideration in releasing subretinal fluid is the timing of this step in relation to the application of diathermy or cryotherapy as the primary treatment modality. Drainage should precede application of cryotherapy but follow the use of diathermy. The most satisfactory site for drainage is either immediately above or below the medial or lateral long ciliary nerve, just posterior to the equator of the globe. A technique for drainage of subretinal fluid has been developed and evaluated. An 'L'-shaped scleral flap is dissected to produce a relatively staphylomatous zone and the choroid is perforated near its center.

Choroid↗
PubMed2001

The electrocautery maze - how I do it.

BACKGROUND: The Cox Maze III procedure is the standard operation for the surgical cure of atrial fibrillation. Its wide spread use is limited by the extensive nature of the procedure. The surgical diathermy device is a radio frequency generator and can be used to create surgical lesions, which cause interruption of the basic flutter cycle that initiates/maintains atrial fibrillation. METHODS: We describe the initial results in 25 cases where we used an ordinary surgical diathermy unit to create bi-atrial lesions creating an electrocautery maze during concomitant mitral valve surgery. RESULTS: There was a 96% conversion to sinus rhythm. This has remained stable over a follow-up of a mean of 3.5 years. There has been an associated return of left atrial transport function and a significant reduction in left atrial size. CONCLUSION: The electrocautery maze appears to be a simple, effective, and quick method to cure atrial fibrillation.

Atrial Fibrillation↗
PubMed2002

[Cancer prevention with the endoscope. Search not only for polyps!].

Through the rigorous application of polypectomy, the colon carcinoma rate can be clearly reduced (66%). The term "polyp" comprises epithelial (hyperplastic or neoplastic) and nonepithelial causes. The majority of carcinomas in the colon develop from adenomatous tissue (adenoma-carcinoma sequence). Pedunculated adenomas (90% of all polyps) are removed with the high-frequency diathermy snare. In some cases, flat (sessile) polyps can be elevated by injections placed below them, and then removed with the diathermy snare (strip biopsy). In the event of larger or large-area flat polyps that cannot be removed with the snare, piecemeal resection is applied. The excision alone of adenomas with a stage I carcinoma is carried out only in so-called low-risk situations. Flat neoplasms make particular demands of the endoscopist, since they often appear merely as a reddish area, but may already have invaded the submucosa when diagnosed. For classification and, where indicated, endoscopic resection, the recommendations of the Japanese Society of Gastroenterological Endoscopy are applied.

Colonic Polyps↗
PubMed2004

[New surgical methods for punctal occlusion of severe tear-deficient dry eye and its outcome].

PURPOSE: Although several surgical methods for punctal occlusion have been reported, it is difficult to obtain complete punctal occlusion in all cases since recanalization of the punctum often occurs after the operation. In this report, new surgical procedures to obtain sufficient occlusion of punctum are introduced and the outcome of the present method is compared with that of previous methods. SUBJECTS AND METHODS: Subjects were 33 severe tear-deficient dry eye patients (4 males and 29 females; mean age: 54.3 yrs.) and they were considered as candidates for punctal occlusion of both upper and lower puncta. The previous surgical punctal occlusion method had been performed in 12 cases (group A: 10 females and 2 males) and the newly-developed method was applied to 21 cases (group B : 19 females and 2 males). Corneal epithelial damage(scored with AD classification; A : area, D : density, scored from 0 to 3) was compared before and after the treatment and the control-lability of dry eye with only an artificial tear preparation was compared between the previous and the new methods. The newly-developed surgical procedures include the following steps: (1) diathermy of the epithelium of the canaliculus using a newly-designed electric needle for diathermy, (2) full removal of the epithelium of the canaliculus using a hand motor drill, (3) cutting the punctum at two opposite points parallel to the lid margin, (4) suturing the punctum to close the cut punctum with 10-0 nylon or 8-0 absorbable sutures. RESULTS: In group A, corneal epithelial damage improved a little from A, D : 2.4, 2.1 to A, D: 1.8, 1.9 during an average of 7.2 months of alone follow-up, and only 2 of the 12 cases obtained control with eye drops. In group B, the corneal epithelial damage improved significantly from A, D : 2.1, 2.2 to A, D : 1.0, 1.3 during an average of 8.2 months of follow-up, and all cases obtained control with eye drops alone. CONCLUSION: The new surgical methods are regarded as a more complete way of performing surgical punctal occlusion compared to previous methods.

Dry Eye Syndromes↗