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We present a new experimental model of Staphylococcus aureus infective endocarditis in guinea pigs. Permanent aortic valve damage was produced by electrocoagulation after catheterization of the right carotid artery, which allowed avoidance of the intracardiac catheter to produce cardiac vegetations. Our model closely mimics pathological mechanisms of native valve endocarditis.
This prospective non-randomised trial of 128 selected patients with unresectable oesophageal or gastrooesophageal junction cancers aims to evaluate the initial relief of malignant obstruction by means of bipolar electrocoagulation for both circumferential and submucosal strictures of Nd:YAG laser for the other patients. A limited dilatation was performed initially if a small calibre endoscope was unable to pass through the stricture. Prompt and significant relief of dysphagia without complications was achieved in 83% of patients. Improved patients were retreated monthly during the follow up period. Radiotherapy was recommended when possible. Symptomatic relief of obstruction lasted 4.2 months on average and 76% of patients remained palliated until death. Monthly retreatment using the most appropriate endoscopic procedure for the tumour configuration and radiotherapy after endoscopic relief of obstruction seems to give the best palliation for patients with unresectable cancers of the oesophagus or gastrooesophageal junction.
An 18-year-old Friesian mare with a large intrauterine cyst was examined by transrectal ultrasonography. There were several small to moderately sized intraluminal endometrial cysts, one of which connected via the myometrium to a large subserosal cyst, thereby effectively forming a 'transmural' cyst complex. During a videohysteroscopy, the intraluminal part of this transmural cyst was removed by electrocoagulation via a polypectomy snare. It was then possible to drain the large subserosal part of the cyst into the uterine lumen by transrectal massage, thereby confirming the presence of the transmural connection.
Several methods of endoscopically controlling acute, nonvariceal upper gastrointestinal bleeding have been developed. Some, such as the laser, heater probe, and bipolar electrocoagulation, have been evaluated in controlled clinical trials. The purpose of this paper is to discuss endoscopic control of nonvariceal gastroduodenal hemorrhage and to consider whether improvement in outcome is likely with any of these devices. Techniques and results of controlled clinical trials are reviewed.
Fifty-one patients with advanced cancer of the esophagus underwent 191 endoscopic palliative procedures, including bouginage, laser therapy, bipolar electrocoagulation, and stent placement. In three patients free perforations developed; these were treated immediately and no sequelae developed. Perforations confined within the tumor mass were diagnosed with CT in two patients and did not require treatment. Methods of endoscopic palliation are discussed with reference to the radiologic studies and techniques. The radiologist must evaluate tumor topography and esophageal wall thickness with computed tomography and esophagography to aid in the choice of palliative therapy. Knowledge of each technique and its risks by the radiologist is essential for useful consultation with the endoscopist before, during, and after the procedure.
Twenty pigs underwent (a) cystic duct occlusion by means of fluoroscopically guided transcatheter endoluminal bipolar radio-frequency (RF) electrocoagulation and (b) gallbladder sclerotherapy with one of two different regimens of ethanol and sodium tetradecyl-sulfate (STS). Serum ethanol levels and hepatic enzyme tests showed no acute toxicity. Postmortem histologic studies showed that the bile ducts beyond the occlusion site remained entirely unaffected in all animals. In three of four animals followed up for 2 weeks, the sclerosants induced necrosis of the gallbladder mucosa, but the adjacent liver, serosa, and blood vessels remained intact. In 13 of 16 animals followed up for 8 weeks, the gallbladder lumen was obliterated by fibrous scar tissue. In the animals treated with 95% ethanol and 3% STS, the gallbladder mucosa was necrotic in all areas after 2 weeks (two of two animals) and eradicated completely after 8 weeks (six of eight animals); the other regimen (70% ethanol plus 1% STS) was somewhat less effective. In this study, the combination of RF-mediated cystic duct occlusion and gallbladder sclerotherapy with ethanol and STS permitted gallbladder ablation in swine without toxic side effects.
Nine hundred and seven polyps (mean size 3.7 mm; range 2-8) from 460 patients (mean age 67 years; range 34-94) were removed with monopolar electrocoagulation forceps ('hot biopsy forceps'). Sixty-three percent of the polyps were adenomatous and 36% were hyperplastic. In this series there were 3 cancers and 1 neurofibroma. About 42% of the polyps were in the sigmoid-rectum region; the rest were evenly distributed in the remaining part of the colon. There were no complications. Specifically there were no cases of perforation or massive bleeding after removal of these polyps. Within the guidelines mentioned, hot biopsy removal of small colonic polyps is safe.
BACKGROUND/AIMS: To investigate the potential value of the use of the fibrin glue-antibiotic mixture in the treatment of anal fistulae. MATERIALS AND METHODS: This study included 69 patients with idiopathic nonspecific anal fistulae. Patients with IBD (inflammatory bowel disease), TBC, actinomycosis, and cancer were excluded from the study. The microbiological analysis of the discharge of the fistula was done routinely. If there was any doubt about vertical classification of the fistulous tract MR of anal canal was necessary. As regards the vertical disposition, 39 fistulae were classified as intersphincteric and 30 as transsphincteric, and as to the length of the fistulous tract, 24 fistulas had tracts </=3.5 cm long, and 45 fistulas had tracts >3.5 cm long. All fistulae were first treated with the lavage of the fistulous tract with antibiotic solution until a sterile microbiological finding was obtained. This was followed by electrocoagulation of the fistulous tract with a special probe for the eradication of granulomatous tissue. Finally the fibrin glue-antibiotic mixture (Tisseel, Immuno Ltd., Vienna, Austria) was applied. RESULTS: After a follow-up of 18-36 months (median 28) 18 patients (26%) had a recurrence; among these, intersphincteric fistula recurred in 9 patients (23%) and transsphincteric also in 9 (30%). Regarding the length of the fistulous tract, a fistula with a </=3.5 cm long tract recurred in 13 patients (54%) and a fistula with a >3.5 cm long tract in 5 (11%). CONCLUSION: The analysis showed that the success of the treatment of anal fistulae with fibrin glue-antibiotic mixture was independent of the vertical disposition of the fistula, and was dependent on the length of the fistulous tract. Surgical treatment remains a golden standard for simple fistulae with a tract </=3.5 cm. Anal fistulae with a longer tract usually present a more complex problem and are often more difficult to treat surgically, the use of the fibrin glue-antibiotic complex proved to be a feasible method for those cases. It is a safe, cheap, reproducible, pain-free procedure, which eliminates the possibility of anal incontinence and can be performed under local anesthesia.
Chronic nasal obstruction is a common disorder, mostly caused by hypertrophic inferior turbinates. In cases of nonresponse to conservative medical management, the surgical reduction of the inferior turbinates is often required. Surgical techniques for the reduction of hyperplastic nasal turbinates include monopolar or bipolar coagulation, partial or total reduction of the turbinates with a conchotome or scissors and laser surgery with Nd:YAG, CO(2) or KTP. Argon plasma coagulation (APC) is a new, innovative technique in otorhinolaryngology which is based on high-frequency electrocoagulation with an argon gas source. The fast and short surgery times, the absence of hemorrhagic complications and, in rhinosurgery, the complete abstention from any kind of nasal packing are remarkable. Between March and November 2000, a group of 157 patients with symptoms of nasal obstruction due to hypertrophic inferior turbinates were treated using APC, at the Otorhinolaryngology Surgery Department of the Hospital of Dolo (Venice). The follow-up period was 24 months. Rhinomanometry was performed to objectively measure the nasal obstruction and to verify the postoperative improvement. The Student t test was used for statistical data. After 24 months, 87% (p < 0.001) of the patients reported to have a better nasal airflow than before the operation. None of the patients needed a nasal packing after APC surgery. The indication, advantages, complications, controversies and long-term results of the treatment with APC in rhinosurgery are reviewed and discussed.
BACKGROUND/AIM: To compare the changes in uterine and ovarian artery blood flow following laparoscopic sterilization via bipolar cautery with Pomeroy tubal ligation via mini-laparotomy in patients who had voluntary surgical sterilization. METHODS: Ninety consecutive fertile women applying for voluntary tubal ligation were recruited in this prospective study. Patients were allocated for either laparoscopic tubal ligation via bipolar electrocoagulation (group 1) or Pomeroy tubal ligation via mini-laparotomy (group 2) according to their preference. Color Doppler flow analysis of uterine and ovarian arteries were carried out on the 3rd day of the cycle prior to the procedure (D(0)), on the 3rd postoperative day (D(1)) and on the 3rd day of the cycle, 3 months (D(3)) following the surgery. The significance of difference between the three measurements was analyzed by using analysis of variance. RESULTS: Prior to surgery, the mean pulsatility index of the uterine artery, left and right ovarian arteries were 1.9 +/- 0.3, 1.8 +/- 0.3, 1.8 +/- 0.2 in group 1 and 1.8 +/- 0.08, 1.8 +/- 0.08, 1.8 +/- 0.07 in group 2, respectively. There was no statistically significant difference between group 1 and group 2 in terms of D(0) values (p > 0.05). 3rd postoperative day and 3rd month measurements of both uterine and ovarian arteries in group 1 and group 2 did not show any statistically significant difference from that of preoperative values (p > 0.05). CONCLUSION: No alternation in the flow of either ovarian or uterine arteries following tubal sterilization performed by bipolar electrocautery and Pomeroy's technique was determined both in the immediate postoperative period and 3 months after the surgery.
A special stereotactic frame (Radionics) is dedicated to percutaneous electrocoagulation of the trigeminal ganglion. It permits a selection of the first, second or third rootlet according to the territory involved with pain. The penetration of the foramen ovale may be achieved by a jugal or a submaxillary approach, with a common fluoroscopic survey.
Understanding of the electrophysiologic principles of radiofrequency lesion making is necessary to ensure reliable results in surgical procedures using this technique. A radiofrequency lesion is produced by tissue electrocoagulation. Its method of formation and factors affecting heat generation and loss are discussed. Guidelines for making radiofrequency lesions, based on electrophysiologic principles are outlined.
Indications, technical procedures, and complications are discussed for the performance of thermal electrocoagulation of the trigeminal preganglionic rootlets and gasserian ganglion. Specific steps in preoperative evaluation, premedication, anesthetic management, and technical performance of graded lesion-making utilizing radiographic control, physiologic stimulation and intraoperative patient monitoring are discussed. A survey of complications is presented.
The influence of oxygen-derived free radicals on survival in advanced colonic cancer was assessed in a prospective randomized controlled double-blind trial using the radical scavengers dimethyl sulphoxide (DMSO) and allopurinol. Following palliative sigmoid colectomy for carcinoma at Dukes' stage D, 306 patients were randomized to the control group or to electrocoagulation of liver secondaries alone or with allopurinol (50 mg by mouth 4 times a day) or DMSO (500 mg by mouth 4 times a day). In 193 fully evaluable patients who were studied for 5 years, allopurinol and DMSO incurred a significant (p < 0.05) survival advantage over the whole period of study. The similarity in efficacy between allopurinol and DMSO and the fact that the only action they share is scavenging oxyradicals, suggest that these radicals mediate the detrimental effects of malignancy and that removing them incurs a survival advantage for patients with advanced colonic cancer.
Carbon dioxide insufflation of the uterine cavity in sheep enables electrocautery to the surface and superficial tissues of the fetal lamb, using minimally invasive surgery. Absorption of the CO2, however, causes a potentially lethal acidosis. To enable the use of electrocautery dissection of the fetal sheep, without using gas, we have partially replaced the amniotic fluid with 0.5% glycine. To determine whether glycine would have any short- or long-term deleterious effects on the developing fetus, we replaced amniotic fluid with 0.5% glycine in 10 normal fetuses at 101 days of gestation (normal gestation 145-149 days), without later replacing it with the removed amniotic fluid. Histological changes were then sought in the skin, gastrointestinal tract, and pulmonary tree, at 2 ('early', n = 5) or 6 weeks ('late', n = 5) after the introduction of the glycine. There were no histological differences between these and normal sheep at either time point. The use of glycine as a replacement for amniotic fluid subsequently enabled us to carry out electrocautery dissection of the sheep fetus and electrocoagulation of any bleeding vessel. Its use was not associated with any apparent untoward effects. Therefore, it has the potential to be used in minimally invasive surgery on the fetal trachea or on an enlarged fetal bladder.
In a retrospective study of women who had undergone pelviscopic hysterectomies in the last 2 years, we focused on postoperative cyclic spotting. Preoperatively, a regular, cyclic menstruation and a premenopausal sexual hormone constellation were common to all patients. In the first group (n = 29), spotting occurred only in association with two uterine anatomical varieties: uterine hyperflexion and cervical elongation. The second group (n = 18), in which intraoperative internal electrocoagulation of the residual cervical envelope was performed, no spotting occurred despite the presence of uterine hyperflexion and cervical elongation. This procedure prevents the occurrence of postoperative spotting in cases of uterine anatomical varieties.
Thirty-one patients complaining of unexplained infertility for at least 36 months and diagnosed elsewhere were reassessed laparoscopically. After staining their pelvic peritoneum with concentrated methylene blue, they presented with extensive areas of dark blue discoloration, and were diagnosed as suffering from 'diseased pelvic peritoneum'. The levels of peritoneal CA 125 were assessed. At the end of the diagnostic procedure, bipolar electrocoagulation or defocalized laser beam therapy was performed to destroy the affected peritoneal areas, and to allow peritoneal regeneration. Twenty-five pregnancies were obtained following this treatment. A detailed description is given of the diagnosis and treatment procedures.
The treatment of 101 male patients with venereal warts is described. Prior to the study 33 patients had been treated unsuccessfully with podophyllin. 57 of the patients showed urethral lesions while 2 also showed venereal warts in the bladder. The primary treatment was electrocoagulation in 100 patients, 58 of these being cured. Chemical agents such as ethoglucid, Verruxin and thiotepa seemed to be effective in the treatment of resistant, especially intraurethral condylomas. In 8 patients autogenous vaccination was used, 6 responding completely to the vaccination alone while the remaining 2 were cured after vaccination and excision.