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At least 1,243 records · Page 69Linked to original sources
PubMed2005

Assessment of construct validity of the endoscopic sinus surgery simulator.

OBJECTIVE: To study the relationship between performance on an endoscopic sinus surgery simulator (ES3) and fundamental perceptual, visuospatial, and psychomotor abilities. DESIGN: Validation study. SETTING: Tertiary care medical center. PARTICIPANTS: Thirty-four medical students and 4 otolaryngology residents voluntarily enrolled. INTERVENTIONS: Subjects performed tasks on the ES3, minimally invasive surgical trainer virtual reality (MIST-VR), pictorial surface orientation (PicSOr), and 3 visuospatial tests (cube comparison, card rotation, and map planning). MAIN OUTCOME MEASURES: The MIST-VR was scored for time, task error, economy of hand movement, economy of diathermy, and total score. Scores were generated for the PicSOr task and visuospatial tests. Scores were correlated with time, accuracy, and total subscore on navigation, injection, and dissection tasks, as well as hazard score and total trial score on the ES3. RESULTS: The PicSOr score was statistically significantly correlated with the hazard score on the ES3 (r = 0.50, P < .001). Cube comparison (r = 0.43, P < .01) and card rotation (r = 0.45, P < .01) scores correlated significantly with the ES3 trial score, as did the MIST-VR total score and the ES3 trial score (r = 0.57, P < .001). In a multiple regression model, the PicSOr, cube comparison, and MIST-VR total scores were statistically significant predictors of ES3 performance (r = 0.63, P < .01). CONCLUSIONS: Scores on the ES3 correlate strongly with scores on previously validated measures of perceptual, visuospatial, and psychomotor performance. The ES3 provides a reliable assessment of factors that are important to the acquisition of minimally invasive surgical skills, demonstrating construct validity.

Computer Simulation↗
PubMed1990

Subglottic cysts in the premature infant.

Supraglottic cysts in the newborn are a well-recognized entity, but subglottic cysts have been rarely reported. Over the past 6 years we have observed subglottic cysts in nine patients with relatively long intubations from the neonatal intensive care unit of two university hospitals. Most frequently the patients were extubated and did well for weeks or months, but then they had progressive biphasic stridor. On endoscopy the patients had a subglottic stenosis that was irregular but with a smooth mucosal lining. Usually the cysts were apparent, but in two patients the mucosa was thickened and the patients were treated as a subglottic stenosis with tracheostomy. These subglottic cysts were recognized at the time of laryngotracheoplasty. In six patients the cysts were managed either by marsupialization with cup forceps, endoscopic diathermy, or carbon dioxide laser without recurrence. It is our belief that this condition is most likely due to scarring and obstruction of mucus glands of the subglottic area from prolonged intubation. This entity should be recognized and looked for in the neonate who has an acquired subglottic stenosis and should first be treated conservatively with endoscopic marsupialization.

Child, Preschool↗
PubMed1996

Cytomorphologic characteristics of thermal injury related to endocervical brushing following loop electrosurgical excision procedure (LEEP).

Loop electrosurgical excision procedure (LEEP) is gaining popularity in the United States as an alternative to other ablative and cone methods of treatment for preneoplastic conditions of the uterine cervix. The major advantage is that it is an outpatient procedure using local anesthesia. Post-LEEP evaluation of the endocervical canal can be accomplished by either endocervical curettage or cytobrush. We reviewed the immediate post-LEEP cytobrushes from 33 patients. Artifact related to the procedure was seen in all cases and included: 1) elongated endocervical cells with cytoplasmic "tails" and streaming nuclei ("taffy pulled"); 2) loose cellular aggregates with coalesced cytoplasm and "hockey stick" nuclei; 3) sheets of cells with frothy cytoplasm and shrunken thumbprinted nuclei; 4) nuclear enlargement; and 5) smudgy nuclear chromatin. The background ranged from bloody coagulum to watery proteinaceous material. Original diagnoses were negative in 25 cases. Eleven (44%) were considered abnormal on review. Of these, four were interpreted as having squamous intraepithelial lesions (SIL), one was atypical squamous cells of undetermined significance (ASCUS), and six had atypical glandular cells of undetermined significance (AGUS). It was not always possible to grade the degree of dysplasia. There was review agreement with 14 negatives, one SIL, one ASCUS, and one unsatisfactory specimen. Three AGUS were upgraded to SIL, and one unsatisfactory specimen was considered atypical on review. In conclusion it is possible to separate artifact from actual pathology on post-LEEP cytobrush specimens. Recognition of the characteristic changes seen on cytologic specimens obtained immediately following diathermy loop treatment will allow accurate identification of true abnormalities.

Adult↗
PubMedDate not supplied

Management of pre-invasive disease of the cervix.

The management of pre-invasive disease of the cervix is based on local control and prevention of progression to invasive malignancy. Screening continues to be an effective tool for detecting cervical neoplasia in a pre-invasive state due to the long natural history of progression from low-grade dysplasia to invasion. When abnormal cells are detected with a Papanicolaou (Pap) smear, a thorough evaluation should consist of colposcopy, directed biopsy, and cone biopsy, where appropriate. In the absence of invasion, local control may be achieved by excisional or ablative techniques including traditional cold-knife cone, laser cone, loop electrosurgical excision, cryotherapy, laser or electrocoagulation diathermy. The benefit of excisional therapy is the ability for histologic specimen assessment. Ablative therapies are associated with lower complication rates (<2%). Success rates for these modalities are comparable, exceeding 90%. Eradication of human papilloma virus (HPV) from the genitourinary tract [associated with over 90% of condylomas, cervical intraepithelial neoplasia (CIN) and invasive malignancies] is not possible with currently available techniques.

Colposcopy↗
PubMed2001

Pulmonary metastasectomy: might the type of resection affect survival?

BACKGROUND AND OBJECTIVES: Metastasectomy proved to be the choice treatment in the case of pulmonary metastasis. In this study we assessed the impact on survival of three types of resection: minimal by laser or conventional device and lobectomy. METHODS: We considered 85 patients who underwent lung metastasectomy for tumors that originated from various sites. Fifty-two minimal resections were accomplished in 34 patients by conventional (diathermy dissection or stapler suture line) device, 59 resections in 29 by Nd:YAG laser. Lobectomies were 22. Minimum follow up required was 2 years. RESULTS: The 3-year Kaplan-Meier survival rate was 63%, 44%, 53% for laser, conventional resections and lobectomy. The 5-year survival was 40%, 28%, 26% respectively. Among the groups there was no significant difference (P = 0.15). Laser patients showed shorter periods of air leakage and hospital stay. CONCLUSIONS: The type of resection did not disclose statistically significant differences on survival. Minimal surgery, especially by laser device, is recommended for less morbidity.

Bone Neoplasms↗
PubMed1983

The significance of microscopic invasive cancer in endoscopically removed polyps of the large bowel. A clinicopathologic study of 51 cases.

A clinicopathologic study of 51 patients with endoscopically removed large bowel polyps showing histologic evidence of malignancy, either focally, to a massive extent, or comprising the entire polyp, revealed only one absolute finding capable of predicting residual disease, namely, the presence of cancer at the resection line. Of 23 radical resections, only one was justified. This case showed evidence of residual disease in the colectomy specimen that could have been predicted on the basis of involvement of the diathermy margin by carcinoma. Of 28 patients having polypectomy alone, 1 patient developed a Dukes' B carcinoma. The polyp, removed 9 months previously from the same site, had shown involvement of the margin by carcinoma. A conservative approach is thus advocated in the absence of this finding.

Colectomy↗
PubMed2004

Spinal manipulative therapy for low back pain.

BACKGROUND: Low-back pain is a costly illness for which spinal manipulative therapy is commonly recommended. Previous systematic reviews and practice guidelines have reached discordant results on the effectiveness of this therapy for low-back pain. OBJECTIVES: To resolve the discrepancies related to the use of spinal manipulative therapy and to update previous estimates of effectiveness, by comparing spinal manipulative therapy with other therapies and then incorporating data from recent high-quality randomized, controlled trials (RCTs) into the analysis. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL were electronically searched from their respective beginning to January 2000, using the Back Group search strategy; references from previous systematic reviews were also screened. SELECTION CRITERIA: Randomized, controlled trials (RCT) that evaluated spinal manipulative therapy for patients with low-back pain, with at least one day of follow-up, and at least one clinically-relevant outcome measure. DATA COLLECTION AND ANALYSIS: Two authors, who served as the reviewers for all stages of the meta-analysis, independently extracted data from unmasked articles. Comparison treatments were classified into the following seven categories: sham, conventional general practitioner care, analgesics, physical therapy, exercises, back school, or a collection of therapies judged to be ineffective or even harmful (traction, corset, bed rest, home care, topical gel, no treatment, diathermy, and minimal massage). MAIN RESULTS: Thirty-nine RCTs were identified. Meta-regression models were developed for acute or chronic pain and short-term and long-term pain and function. For patients with acute low-back pain, spinal manipulative therapy was superior only to sham therapy (10-mm difference [95% CI, 2 to 17 mm] on a 100-mm visual analogue scale) or therapies judged to be ineffective or even harmful. Spinal manipulative therapy had no statistically or clinically significant advantage over general practitioner care, analgesics, physical therapy, exercises, or back school. Results for patients with chronic low-back pain were similar. Radiation of pain, study quality, profession of manipulator, and use of manipulation alone or in combination with other therapies did not affect these results. REVIEWER'S CONCLUSIONS: There is no evidence that spinal manipulative therapy is superior to other standard treatments for patients with acute or chronic low-back pain.

Humans↗
PubMed2003

Thermotherapy for treatment of osteoarthritis.

BACKGROUND: Osteoarthritis is a degenerative joint disease that affects mostly the weight-bearing joints in the knees and hips. As the affected joint degenerates pain and restriction of movement often occur. Inflammation can also occur sometimes resulting in edema of the joint with OA. Treatment focuses on decreasing pain and improving movement. OBJECTIVES: To determine the effectiveness of thermotherapy in the treatment of OA of the knee. The outcomes of interest were relief of pain, reduction of edema, and improvement of flexion or range of motion (ROM) and function. SEARCH STRATEGY: Two independent reviewers selected randomized and controlled clinical trials with participants with clinical and/or radiological confirmation of OA of the knee; and interventions using heat or cold therapy compared with standard treatment and/or placebo. Trials comparing head to head therapies, such as two different types of diathermy, were excluded. SELECTION CRITERIA: Randomized and controlled clinical trials including participants with clinical or radiographical confirmation of OA of the knee; and interventions using heat or cold compared to standard treatment or placebo were considered for inclusion. DATA COLLECTION AND ANALYSIS: Study results were extracted by two independent reviewers. Outcomes were continuous in nature (pain, strength, improvement) and were analyzed by weighted mean difference using a fixed effects model. Graphical data were used when table data were not available. MAIN RESULTS: Three randomized controlled trials, involving 179 patients, were included in this review. The included trials varied in terms of design, outcomes measured, cryotherapy or thermotherapy treatments and overall methodological quality. In one trial, administration of 20 minutes of ice massage, 5 days per week, for 3 weeks, compared to control demonstrated a clinically important benefit for knee OA on increasing quadriceps strength (29% relative difference). There was also a statistically significant improvement, but no clinical benefit in improving knee flexion ROM (8% relative difference) and functional status (11% relative difference). Another trial showed that cold packs decreased knee edema. REVIEWER'S CONCLUSIONS: Ice massage compared to control had a statistically beneficial effect on ROM, function and knee strength. Cold packs decreased swelling. Hot packs had no beneficial effect on edema compared with placebo or cold application. Ice packs did not effect pain significantly compared to control in patients with OA. More well designed studies with a standardized protocol and adequate number of subjects are needed to evaluate the effect of thermotherapy in the treatment of OA of the knee.

Cryotherapy↗
PubMed1994

Effects of local heat and cold treatment on surface and articular temperature of arthritic knees.

OBJECTIVE: To evaluate and compare the effects of locally applied heat and cold treatments on skin and intraarticular temperature in patients with arthritis. METHODS: Thirty-nine patients with arthritis of the knee were divided at random into 4 treatment groups (ice chips, nitrogen cold air, ligno-paraffin, and placebo short wave). A temperature probe was inserted into the knee joint cavity and another placed on the overlying skin, and changes in temperature over 3 hours were recorded for each treatment group. RESULTS: The mean temperature of the surface of the skin dropped from 32.2 degrees C to 16.0 degrees C after application of ice chips and from 32.6 degrees C to 9.8 degrees C after application of nitrogen cold air; the mean intraarticular temperature decreased from 35.5 degrees C to 29.1 degrees C and from 35.8 degrees C to 32.5 degrees C, respectively, after these treatments. Treatment with ligno-paraffin increased the surface temperature by 7.5 degrees C and the temperature in the joint cavity by 1.7 degrees C. No significant changes were observed with placebo short wave diathermy. CONCLUSION: The traditional model, that intraarticular temperature is decreased by superficial heat and increased by superficial cold, must be discarded. In arthritis patients, intraarticular temperature is increased by superficial heat and decreased by superficial cold. This has clear consequences for treatment policy.

Adult↗
PubMed1983

Electrical discontinuity of tissue substitute models at 27.12 MHz.

Tissue-substitute models consisting of layers of synthetic, electrically equivalent subcutaneous fat, muscle, and bone shaped in conformation with the normal anatomy are used for rapid determination of distribution of temperature and specific absorption rate throughout the tissues when exposed to electromagnetic radiation. The surfaces of the bisected models are approximated during a short exposure period, then separated and scanned with a thermograph. A method was developed to eliminate the electrical discontinuity at the bisected surfaces while allowing separation and subsequent thermographic scanning. A thin layer of silk screen wetted with propylene glycol saturated with sodium chloride was used at the fat interface and a 0.9% sodium chloride solution was used to wet the screen at the muscle interface to eliminate electrical discontinuity during exposure to 27.12-MHz diathermy. Tests showed that in the presence of an electrical discontinuity the heating pattern was grossly distorted. With the method used, the electrical discontinuity is minimized and the subsequent thermographic scanning reveals that the heating pattern is equivalent to that of an intact model.

Adipose Tissue↗
PubMed1986

Effects of in vivo ultrasound hyperthermia on natural killer cell cytotoxicity in the hamster.

The effects of in vivo ultrasound irradiation of the spleen on immunological functions were assessed with an in vitro natural killer (NK) cell cytotoxic assay. Anesthetized hamsters were exposed to 1 MHz ultrasound at intensity levels currently being used clinically for therapeutic diathermy and hyperthermia (1-5 W/cm2, for 500 sec with constant beam scanning). Hyperthermic levels in the spleen ranged from 38-43 degrees C. Significant depression of natural killer (NK) cell activity was seen 4 h after spleen irradiation as compared to sham irradiated and normal animals. A return towards normal levels was observed in experimental groups at 24 h after exposure. Sham and normal animals were not significantly different in NK activity, indicating no significant stress-related immunosuppressive effects due to handling. Differential leukocyte counts taken for each exposure condition showed significant lymphopenia at 4, 8, and 16 h after exposure, near normal levels at 24 h, and complete recovery by 48 h. The number of circulating mononuclear cells at 4 h showed a dose-related suppression as the exposure intensities were increased.

Animals↗
PubMed1989

Thresholds of cat cochlear nucleus neurons to microwave pulses.

Action potentials of neurons in cat dorsal and posteroventral cochlear nuclei were recorded extracellularly with glass microelectrodes while the head of the cat was exposed to microwave pulses at 915 MHz using a diathermy applicator. Response thresholds to acoustic tones, acoustic clicks, and microwave pulses were determined for auditory units with characteristic frequencies (CFs) from 278 Hz to 39.2 kHz. Tests with pulsatile stimuli were performed for durations of 20-700 mus, principally 20, 70, and 200 mus. Brainstem midline specific absorption rate (SAR) threshold was as small as 11.1 mW/g per pulse, and specific absorption (SA) threshold was a small as 0.6 muJ/g per pulse. Microwave thresholds were generally lower for CF less than 9 kHz, as were most acoustic thresholds. However, microwave threshold was only weakly related to click threshold and CF-tone threshold of each unit.

Animals↗
PubMed1993

Perturbations of plant leaflet rhythms caused by electromagnetic radio-frequency radiation.

The minute-range up and down rhythms of the lateral leaflets of Desmodium gyrans has been studied when exposed to electromagnetic radiation in the radio-frequency (RF) range. The RF radiation was applied as homogeneous 27.12 MHz fields in specially-designed exposure cells(and in some cases as non-homogeneous radiation of 27 MHz, amplitude modulated by 50 Hz, in front of commercial diathermy equipment). All fields were applied as pulses. We report effects in the leaflet rhythms such as temporary changes in the amplitude, period, and phase. The radiation could also cause temporary or complete cessations of the rhythms. The lowest dose (8 W/cm2) used was still effective.

Electromagnetic Fields↗
PubMed1975

Surgical management and problems of heart pacing.

Experience with 40 patients and 150 pacemakersss is reviewed. In 13 patients the initial pacing was by epicardial electrodes and in 27 by transvenous catheter electrodes. When epicardial systems were used, two electrodes were always fixed to the heart, the additional electrode being provided for temporary pacing and as a spare in case of future need. The battery unit was usually buried behind the rectus abdominis muscle. Vacuum drainage of the pacemaker pocket was used and was considered helpful in avoiding some complications. The right cephalic vein was preferred for transvenous pacing but existing venous abnormalities sometimes required use of the external jugular vein. Five patients had epicardial systems changed to transvenous ones, and in 5 the reverse procedure was needed. Pacemaker battery problems included inadequate soft tissue protection for the unit, epoxy resion fracture, titanium case leak and problems relating to design change and the special needs for overseas travel. While the danger from diathermy and radiofrequency is now recognized, similar dangers exist for those paced by 'demand' units in large electromagnetic fields.

Abdominal Injuries↗
PubMed1975

A controlled clinical trial of three different methods of perineal wound management following excision of the rectum.

Three methods of perineal wound closure were studied in a randomized prospective clinical trial in 106 patients undergoing excision of the rectum for inflammatory or malignant disease. In method 2 the perineal wound was managed by open drainage. In both methods 2 and 3 the perineal wound was closed by primary suture, suprapubic suction drains being left down to the presacral space, but in method 2 the pelvic peritoneal floor was reconstituted, whilst in method 3 it was left unsutured. Topical and systemic antibiotics were administered to all patients submitted to primary closure of the perineal wound but not routinely to those whose perineal wound was left open. The overall operative mortality was 8-5 per cent but no deaths could be definitely attributed to perineal wound complications. The incidence of primary wound healing after methods 2 and 3 was 45-2 and 42-9 per cent respectively. Operative contamination of the perineal wound had an adverse effect on perineal wound healing. The incidence of persistent wound sinuses and unhealed wounds at 3 and 6 months after primary wound closure was rather less than that encountered after open drainage. It was concluded that primary closure of the perineal wound is the treatment of choice following excision of the rectum, except in cases in which contamination of the perineal wound has occurred during operation or the final state of haemostasis in the pelvis with diathermy and suture at the conclusion of the dissection was deemed to be unsatisfactory.

Ampicillin↗
PubMed1976

Duodenoscopic papillotomy and gallstone removal.

Using an experimental insulated duodenoscope and a diathermy wire, papillotomy has been performed on 10 patients under diazepam sedation. Seven patients had common bile duct stones (6 following cholecystectomy) and 3 had papillary stenosis. Nine of the patients had severe medical or surgical contraindications to further operative treatment. Papillotomy was successful in all patients, with no significant bleeding or other complications. Repeat endoscopy 6-14 days after papillotomy demonstrated a healed biliary orifice of 7-10 mm diameter. Stones had already passed in 3 of the 7 patients; in 2 others, stones were extracted using balloon catheters or Dormia type baskets. Two larger stones could not be removed; in one of these patients the stone and basket became impacted at the papilla and had to be removed surgically 2 days later. Endoscopic papillotomy is an acceptable alternative to surgery in high risk patients, particularly in the treatment of retained common bile duct stones. If long term results prove satisfactory, the technique will have wider application.

Adult↗
PubMed1977

Partial hepatectomies with a hand-held laser knife: An experimental study.

Fifteen mongrel dogs underwent a left lateral non-anatomical partial hepatectomy using a carbon dioxide laser, diathermy or a surgical scalpel. An original prototype of a compact hand-held laser was used and its effects were compared with those of the other two instruments. An improved dry cat surface was achieved by placing a rubber snare proximal to the planned incision. While no significant differences in the blood loss or in the operating time were found among the experimental groups, the laser beam sealed vessels of up to about 6 mm in diameter without any complementary suture ligatures, which were needed in the other groups. Histological studies revealed less tissue trauma in the sections performed by the laser and only slight secondary inflammatory reaction.

Animals↗