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At least 1,135 records · Page 63Linked to original sources
PubMed1996

Video-assisted thoracoscopic treatment of spontaneous pneumothorax: technique and results of one hundred cases.

OBJECTIVE: This article describes the technique and results for an initial series of 100 pneumothoraces treated by video-assisted thoracoscopy. METHODS: From May 1991 to November 1994, 97 patients (78 male and 19 female patients) aged 37.2 +/- 17 years (range 14 to 92 years) underwent video-assisted thoracoscopy for treatment of spontaneous pneumothorax (primary in 75 patients, secondary in 22 patients). RESULTS: The procedure was unilateral in 94 patients and bilateral in three patients (total 100 cases). Pleural bullae were resected with an endoscopic linear stapler; a lung biopsy was performed in the absence of any identifiable lesion. Pleurodesis was achieved by electrocoagulation of the pleura (n = 3), "patch" pleurectomy (n = 3), subtotal pleurectomy (n = 20), or pleural abrasion (n = 74), including conversion to standard thoracotomy in five. One of these five patients had primary pneumothorax and four had secondary pneumothorax. There were no postoperative deaths. A complication developed in 10 patients: five patients with a primary pneumothorax (6.6%) and five with a secondary pneumothorax (27.7%). The mean postoperative hospital stay was 8.25 +/- 3.2 days. Mean follow-up is 30 months (range 7 to 49 months). Pneumothorax recurred in 3% of patients, all of whom were operated on at the start of our experience. Three percent of the patients had chronic postoperative chest pain. CONCLUSIONS: Video-assisted thoracoscopy is a valid alternative to open thoracotomy for the treatment of spontaneous primary pneumothorax. Its role for the management of secondary pneumothorax remains to be defined. In the long term, the efficacy of video-assisted thoracoscopic pleurodesis and surgeon experience should yield the same results as standard operative therapy.

Adolescent↗
PubMed2003

Superiority of electrocautery over the suture method for achieving cervical cone bed hemostasis.

OBJECTIVE: To compare the efficacy of electrocautery with that of the suture method for achieving hemostasis of the cervical cone bed. METHODS: We performed a retrospective chart review of all patients who underwent cold-knife conization of the cervix over a 5-year period. Patients were categorized into two groups: the cautery group, in which the cone bed was electrocauterized with a hand-held electrocoagulation device; and the suture group, in which hemostasis was achieved by a continuous locking suture placed circumferentially around the cone bed. Outcome measures evaluated include estimated blood loss, operative time, and incidence of complications, including secondary hemorrhage, cervicitis, and cervical stenosis. Data were analyzed by Student t test, chi(2) test, linear regression, and multiple logistic regression where appropriate. RESULTS: There were 156 women in the cautery group and 35 in the suture group. The cautery group had significantly lower estimated blood loss (27 mL versus 101 mL; P <.01) and shorter operative time (34 versus 43 minutes; P <.01) than the suture group. The procedure-related complication rate was 6.4% in the cautery group, compared with 14.3% in the suture group (P = nonsignificant). A higher use of lateral sutures, vasopressors, and thrombotic agents was seen in the cautery group. However, even after adjusting for these variables, mean estimated blood loss (33 mL, P <.01) and mean operative time (34 minutes, P <.01) were significantly less in the cautery group than in the suture group. CONCLUSIONS: Cauterization of the cone bed is superior to suture as a method of achieving hemostasis, with significantly less blood loss and shorter operative time.

Adult↗
PubMed2002

Local therapy for rectal cancer.

Local procedures for carefully selected distal rectal cancer offer significant advantages such as sphincter preservation and avoidance of radical surgery. However, since preoperative selection criteria including current imaging modalities are unable to definitively stage regional lymph node status, local therapies for rectal cancer have the inherent potential disadvantage of undertreating a fraction of patients due to unresected mesorectal/regional lymph node disease. Current available data suggests that the local approach may be appropriate only for carefully selected T1 tumors with favorable pathologic features. Inferior local control and survival reported for T2 tumors and T1 tumors with unfavorable features, despite the addition of chemoradiation, outweigh the advantages of the local approach. Patients with unfavorable tumors who are unable to tolerate radical resection or who refuse surgery may be treated with local excision with or without adjuvant chemoradiation. Other modalities, such as electrocoagulation and endocavitary radiation, may also be valuable in this setting, as well as preoperative chemoradiation followed by local excision. Regardless of the approach used, all patients undergoing local therapy of a rectal cancer require careful long-term follow-up, because these patients remain at significant risk for local recurrence and distant failure.

Electrocoagulation↗
PubMed1986

Controlled trial of small bipolar probe in bleeding peptic ulcers.

204 of 460 patients with upper gastrointestinal bleeding admitted to a busy district hospital were found to be bleeding from peptic ulcers or to have signs of recent haemorrhage at endoscopy within 24 h of admission. To determine if the small bipolar probe could stop bleeding or rebleeding, patients were allocated to electrocoagulation (101) or not (103); other aspects of treatment were identical. Groups were stratified by ulcer site to give similar numbers in each. To allow for differences in sex, age, initial haemoglobin, presence of other diseases, and shock, data were analysed by logistic regression. Fewer patients in the treated group (17) continued to bleed or rebled compared with controls (34). Rebleeding and mortality rates in the treated group were higher early in the trial, suggesting the need for experience in application of the probe. Further improvements in technology and technique may result in significant reductions in mortality.

Clinical Trials as Topic↗
PubMed1995

Endoscopic transthoracic sympathicotomy for severe angina.

We evaluated the antianginal effects of endoscopic transthoracic sympathicotomy (ETS) in 24 patients not eligible for coronary bypass surgery or angioplasty. In this procedure, the sympathetic chain is electrocoagulated under general anaesthesia. No major surgical complications occurred. The frequency of anginal attacks was significantly reduced (p = 0.001). The mean increase in maximum exercise capacity was 13 (SD 21) W (p = 0.009). ST depression at maximum comparable workload was reduced by 0.052 (0.10) mV (p = 0.005). Global ejection fraction during exercise and metaiodobenzylguanidine uptake were unchanged. Heart rate variability analysis showed a reduction of the ratio between low and high frequencies at tilt test (-1.00 [0.96]; p < 0.001). We conclude that ETS can be done without major complications, alleviates angina, and increases maximum working capacity in patients with advanced coronary disease.

Aged↗
PubMed2001

Endoscopic argon plasma coagulation for palliative treatment of malignant airway obstructions: early results in 47 cases.

Argon plasma coagulation (APC) is a new method of non-contact electrocoagulation, using high frequency current by means of ionized argon gas (argon plasma). Recently, this technique has become available for flexible endoscopic delivery through special probes. Aim of this study is to evaluate the efficacy, indications and the possible side effects of APC use in the palliative treatment of malignant airway obstructions and/or bleeding. Over a 24-month period, 47 patients underwent APC treatment for malignant neoplasms of the tracheobronchial system causing obstruction and/or recurrent bleeding. Immediate airway patency and haemostasis were obtained in 91.5% of cases (43/47). No complications or side effects caused by the treatment were observed. In two patients, the treatment allowed a radical surgical approach after induction chemotherapy. In all cases, APC proved to be highly effective and easy to perform. In our experience, APC has proven to be easy to perform, rapidly effective, safe and well tolerated by the patient, even after repeated application. This study highlights the value of endoscopic APC in the palliative management of tracheobronchial neoplasms.

Adult↗
PubMed1988

The status of electrosurgery in dermatologic practice.

A survey was made of the electrosurgical practices of the members of the American Society of Dermatologic Surgery. Results showed that the majority prefer the traditional electrosurgical units, with the Hyfrecator (Birtcher Corp.) being by far the most popular. The most common forms of high-frequency electrosurgery are electrocoagulation and electrodesiccation. Very few dermatologists use cutting current, although many own machines with this capability. The majority do not use a strict sterile technic when performing electrosurgery. However, there appears to be an increasing awareness of contamination risks, and many dermatologists have started using disposable or sterilizable treatment electrodes. High-frequency electrosurgery is by far the most common method of electrosurgery. Electrocautery and surgical galvanism are very rarely used.

Dermatology↗
PubMedDate not supplied

Pediatric tonsillectomy with bipolar electrosurgical scissors.

PURPOSE: The optimal technique for pediatric tonsillectomy remains a hotly debated topic. The speed and superior hemostatic properties of electrosurgical dissection must be weighed against the greater tissue preservation and more rapid healing of cold dissection techniques. MATERIALS AND METHODS: We have used a new surgical device, bipolar electrosurgical scissors, in 30 consecutive pediatric tonsillectomies. This instrument provides mechanical cutting with or without simultaneous bipolar electrocoagulation. RESULTS: The average surgical time was 6 minutes. There was no intraoperative blood loss. There were no immediate or late post-tonsillectomy hemorrhages. All tonsillar fossae were completely healed at 2-week follow-up. CONCLUSION: Bipolar electrosurgical scissors provide the best properties of both cold dissection and electrosurgical tonsillectomy without increasing surgical time or cost.

Child↗
PubMed2006

[Palliative endoscopic treatments for esophageal cancers].

Esophageal cancer five-year survival has slightly increased during past 20 years (from 5 to 9%), but remains low. At time of diagnosis, 60% of the patients are only relevant for palliative therapy. Recent advances in therapeutic endoscopy have allowed improving dysphagia and quality of life. Endoscopic techniques are chosen according to tumor characteristics. According to French societies guidelines (FFCD, "Standards-Options-Recommandations" from FNCLCC, SNFGE) endoscopic treatment is a "gold standard" for metastatic patients with poor performance status, as well as oesophago-tracheal fistula. Expandable metal stent are efficient for malignant stenosis with lower morbidity and mortality than plastic prosthesis. Endoscopic placement of a covered self-expanding metal stent is the treatment of choice of an esophago-respiratory fistula. Dilatation is often the first step before other endoscopic therapies or medical treatment such as radiochemotherapy. Single dose brachytherapy could provide better long-term relief of dysphagia and fewer complications than stent placement, but is less widespread. Other techniques like bipolar electrocoagulation have restricted indications especially for circonferential stenosis of cervical esophagus. However, the main problem remains the dysphagia relapse after treatment.

Antineoplastic Agents↗
PubMed1995

Nerval influences on liver cytochrome P450.

In male young adult Wistar rats the influences of nucleus raphe electrocoagulation, spinal cord dissection (cordotomy between C7 and Th1), vagotomy and denervation of liver hilus by phenol on liver cytochrome P450-system (cytochrome P450 concentration, ethylmorphine N-demethylation and ethoxycoumarin O-deethylation activities, hexobarbitone sleeping time) were investigated. In general the influences were small or negligible when compared with sham operated controls, only after vagotomy the depressing effect of sham operation was abolished. In all cases sham operation had a depressing effect until up to five weeks after operation.

7-Alkoxycoumarin O-Dealkylase↗
PubMed2002

Long-term results of endometrial ablation-resection.

STUDY OBJECTIVE: To estimate long-term (>5 yrs) results of endometrial ablation-resection performed in women with abnormal uterine bleeding (AUB). DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Fifty-five women. INTERVENTION: Endometrial ablation-resection by electrocoagulation with a rollerball of the uterine fundus and zone of tubal ostia, followed by electrodissection with a cutting loop of the rest of the uterine cavity. MEASUREMENTS AND MAIN RESULTS: At 5 years after the procedure the success rate was 81.8%. Of 10 women in whom the procedure failed, hysterectomy had to be performed in 6 (10.9%) for recurrent AUB. Of 55 patients, 47 were followed for 6 years for a success rate of 85.1%, 36 were followed for 7 years with a success rate of 83.3%, and 20 were followed for 8 or more years with a success rate of 80.0%. CONCLUSION: Endometrial ablation-resection achieved a success rate of 81.8% at 5 years, and this percentage remained fairly stable throughout the following 4 years. Taking into account only cases of AUB without other organic pathology, the rate was close to 90%. In women with a relatively large uterus (=10 cm), those with myomas or polyps, and patients with dysmenorrhea, the success rate tends to be lower.

Adult↗
PubMed2001

A new portal for gynecologic laparoscopy.

We used the middle upper abdomen as a primary port insertion as an alternative portal for laparoscopy and multiport operative pelviscopy in 188 women who were at high risk for subumbilical adhesions because of previous abdominal surgeries or history of gynecologic cancer. Primary cannula insertion was in the middle upper abdomen between xyphoid process and umbilicus (Lee-Huang point). This was the single entry site for the Veress needle and primary laparoscopy port. In 184 (98.4%) of 188 women surgery was performed without complications. No procedure was converted to laparotomy due to visceral or vascular injuries. Two omentum injuries from primary port insertion were repaired with bipolar electrocoagulation; a colon injury was repaired with laparoscopic sutures. In our experience, this laparoscopic port is effective in women who have had abdominal surgery or gynecologic malignancy. (J Am Assoc Gynecol Laparosc 8(1):147-150, 2001)

Adult↗
PubMed1995

Suture placement for hemostasis during laparoscopy using the Stamey needle.

Bleeding at cannula insertion sites during laparoscopic procedures often is difficult to manage. The few published techniques for controlling abdominal wall bleeding include suturing under direct observation, electrocoagulation, and placement of a Foley catheter. These methods may provide less than adequate hemostasis, however. We developed a technique of direct suture placement under laparoscopic guidance using an absorbable monofilament suture and the Stamey needle as a ligature carrier.

Abdominal Muscles↗
PubMed1996

The classic intrafascial Semm hysterectomy as an alternative to abdominal hysterectomy.

STUDY OBJECTIVE: To compare the classic intrafascial Semm hysterectomy (CISH) with abdominal hysterectomy. DESIGN: Retrospective analysis. SETTING: Community hospital. PATIENTS: The first 100 women with intractable uterine bleeding, leiomyomata, and chronic pelvic pain. INTERVENTIONS: The CISH procedure, initially with the Endo GIA stapler, but later, electrocoagulation and suture to lower costs and eliminate automatic staple complications. MEASUREMENTS AND MAIN RESULTS: Operating time for CISH decreased and our ability to remove larger uteri increased as we became more proficient. Complications were limited to one cystotomy and four transfusions. The average hospital stay was 36 hours and most patients were back to normal activity in 3 weeks. CONCLUSION: Our experience suggests that the CISH is organ preserving, is minimally invasive, decreases recovery time, and can be performed in women in whom an open abdominal approach once would have been the only option.

Adult↗
PubMed1996

Experience with 800 hysteroscopic endometrial ablations.

STUDY OBJECTIVE: To determine the safety and efficacy of hysteroscopic endometrial ablation in women with menometrorrhagia. DESIGN: Retrospective record review. SETTING: A credentialing program in teaching and nonteaching hospitals. PATIENTS: Eight hundred women who underwent endometrial ablation in 54 hospitals, with indications of abnormal uterine bleeding disrupting lifestyle, postmenopausal bleeding during hormone replacement therapy, poor surgical risk for hysterectomy, or desire to preserve the uterus. INTERVENTIONS: Seventy percent of the patients were treated with danazol 100 to 600 mg/day for 6 to 12 weeks, 8% received gonadotropin-releasing hormone analogs, 7% received progestins, and 15% were given no preoperative treatment. Under appropriate anesthesia the cervix was dilated to 10 mm and the uterine cavity was distended with 1.5% glycine solution under gravity inflow of 80 to 100 cm water and outflow suction of 80 to 100 mm Hg pressure. Electrocoagulation with or without resection was completed using 100 and 125 W, respectively. MEASUREMENTS AND RESULTS: At 12 months 60% of patients reported amenorrhea, 29% hypomenorrhea, 6% eumenorrhea, and 5% no change. Repeat ablation was performed in 4% of patients. An additional 2% had hysterectomy for malignancy (endometrium 2, sarcoma 1, atypical hyperplasia 1), pelvic pain (4), fibroids (4), persistent bleeding (3), and endometritis (2). The complication rate was 3.9%: false passage during cervical dilatation (6), uterine perforation (dilator 4, resectoscope 2, Laminaria 1), fluid absorption greater than 1500 ml (8), minor bleeding (5), endomyometritis (4), and intrauterine pregnancy (1). CONCLUSIONS: Hysteroscopic endometrial ablation is a safe and effective treatment for women with menometrorrhagia.

Adolescent↗
PubMed1997

Efficacy of isotopic 13CO2 laser laparoscopic evaporation in the treatment of infertile patients with minimal and mild endometriosis: a life table cumulative pregnancy rates study.

STUDY OBJECTIVE: To assess the efficacy of 13CO2 laser laparoscopy in treating infertile women with minimal to mild endometriosis according the American Fertility Society classification in terms of pregnancy rates. DESIGN: Prospective study. SETTING: Medical school-affiliated hospital. PATIENTS: One hundred seventy-six women whose infertility was associated with minimal or mild endometriosis diagnosed by laparoscopy. INTERVENTIONS: The patients were treated with one of four methods: 49 underwent operative laparoscopy with newly developed 13CO2 laser vaporization and/or resection; 45 were treated by operative laparoscopy with simple monopolar electrocoagulation; 43 who had undergone only diagnostic laparoscopy did not receive any treatment; and 39 received danazol 800 mg/day for 3 months after diagnostic laparoscopy. MEASUREMENTS AND MAIN RESULTS: Estimated cumulative pregnancy rates using life table analyses were indicators of treatment of success and compared among the treatments. A subgroup of 111 patients considered to have endometriosis as the only major infertility factor were also evaluated and compared among treatment options. Pregnancy rates in the CO2 laser laparoscopy group were significantly higher than in the other three groups and in endometriosis-only subset. CONCLUSIONS: Advanced laparoscopic surgery with the CO2 laser can be more efficient than other modalities in treating infertile women with minimal to mild endometriosis in terms of pregnancy rates. It appears that in experienced hands, laser laparoscopy has more favorable results than the other treatments.

Adult↗
PubMed2000

Transient hemifacial sensory loss with xerophthalmia following temporal lobectomy.

OBJECTIVE AND IMPORTANCE: The occurrence of a unilateral sensory loss in the second trigeminal distribution and the inability to tear following an ipsilateral temporal lobectomy has not been noted despite a number of reports of cranial nerve compromise under similar situations. CLINICAL PRESENTATION: A 48-year-old woman experienced complex partial seizures over three years attributable to the presence of cavernous malformations of the right temporal lobe. INTERVENTION: An anterior temporal extrahippocampal resection was performed. The surgery was marked by the need for electrocoagulation of the dural base of the temporal lobe where numerous bleeding points were encountered. Postoperatively, the patient experienced an ipsilateral maxillary division sensory loss, absence of tearing, and diminished nasal congestion for an eight-month period until resolution. CONCLUSION: Injury of the fibers of the maxillary division of the trigeminal nerve and the adjacent greater superficial petrosal nerve appears to be the cause. No prior account of such an occurrence has been published.

Electrocoagulation↗
PubMed1997

Increased esophageal chemoreceptor sensitivity to acid in patients after successful reversal of Barrett's esophagus.

When compared to patients with erosive esophagitis, patients with Barrett's esophagus have demonstrated reduced chemo- and mechanoreceptor sensitivity to acid infusion and balloon distension, respectively. However, anecdotal clinical experience suggested an increase in symptom perception in patients after successful elimination of Barrett's epithelium, using multipolar electrocoagulation (MPEC) and high-dose proton pump inhibitor (PPI). To determine perception thresholds to acid infusion, we evaluated eight consecutive patients after a series of MPEC treatments resulted in complete elimination of Barrett's mucosa and compared them to 10 age-matched patients with nonreversed Barrett's esophagus and 10 patients with symptomatic, endoscopy-documented erosive esophagitis (Hetzel-Dent grade 2 or greater). Chemosensitivity was determined by a modified acid perfusion test, where acid perception thresholds were quantified by the lag time to initial typical symptom perception, sensory intensity rating, and an acid perfusion sensory score (APSS). While patients after successful elimination of Barrett's esophagus had similar sensory intensity ratings and APSS as patients with erosive esophagitis, the lag times differed significantly between the groups, and both groups had significantly higher sensory intensity ratings and APSS than patients with nonreversed Barrett's esophagus. In conclusion, patients after complete reversal of Barrett's mucosa are unexpectedly as sensitive to acid as symptomatic patients with erosive esophagitis.

Anti-Ulcer Agents↗