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Compression force rupture experiments were conducted in dog eyes at varying time intervals after scleral diathermy to determine the time variable of scleral weakening and recovery. The sclera was weakened immediately after the diathermy, and there was progressive further weakening for three weeks and then gradual partial recovery to 60% of control eye strength at eight months, at which point the experiment was terminated.
Perforating diathermy coagulation can be used efficiently to destroy large angiomas of the retina. Five patients who had developed large angiomas (greater than 5 disc diameters) in association with various retinal diseases were treated with this technique. The follow-up period ranged from 1 1/2 to 7 years, except for one case in which the patient died five days after the surgical procedure. Several techniques of perforating diathermy are described, and the indications, surgical precautions, and complications of each method are discussed.
A thin, conical diathermy electrode with a smooth-surfaced bent, insulated tip was designed for use in narrow incisions, corners, and angles of dissected scleral flaps. It permits precise delivery of focal diathermy and avoids undesirable parafocal tissue damage. This electrode is especially valuable for preventing uveal bleeding from a sclerochoroidal incision over the pars plana ciliaris and for treating small posterior retinal breaks.
We present a new 22-gauge transvitreal bipolar diathermy microprobe. With the use of the coaxial principle, the current flows only at the probe's end surfaces. Because of its small size and end-on coagulation effect, and when used in conjunction with a low-frequency diathermy unit, the probe can be used safely on vessels lying directly on the retinal surface and close to the optic nerve head. We report three cases to demonstrate the usefulness of this instrument.
BACKGROUND AND PURPOSE: Short-wave diathermy (SWD) is widely available, yet a comprehensive examination of current clinical practice remains absent from the literature. The present paper aims to assess clinical and safety issues in continuous (CSWD) and pulsed (PSWD) short-wave diathermy application and subsequently indicate areas for future research. METHOD: A postal survey was carried out among 116 senior physiotherapists in 41 Irish hospital-based physiotherapy departments. RESULTS: The response rate to the study was 75%. Analysis found that PSWD was the preferred mode of treatment with 27% of respondents using it more than once daily. Respondents considered both modes of treatment indicated for a variety of conditions. CSWD was rated as an effective treatment for chronic osteoarthritis, polyarthritis, non-specific arthrosis and haematomas. PSWD was reported an effective modality for acute soft tissue injury, haematomas, acute osteoarthritis, sinusitis and rheumatoid arthritis. Dose selection varied greatly but tended to be based on the type, nature and duration of the condition. Analysis of safety practices uncovered concerning findings. Although a high level of agreement was found on measures for patient safety, 30% of respondents reported that no measures for operator safety were taken and only five respondents stated they remained a specified distance from SWD equipment. Measures to ensure the safety of other personnel in the physiotherapy department were also lacking. CONCLUSIONS: Given the availability of SWD equipment and its apparent efficacy in certain conditions, future research should aim to establish this by means of controlled clinical trials. The findings on safety practices underline the urgent need for comprehensive guidelines to ensure the safety of operators, patients and the general public during SWD application.
We examined the histopathologic appearance of both cryopexy and diathermy lesions, ten to 60 minutes after application in the rabbit retina. Both lesions showed immediate subretinal fluid accumulation. Thus we would not substantiate the speculation that a diathermy lesion might have greater immediate adhesive strength than a cryotherapy lesion. This explains the clinical experience that retina tends to slip with either modality when trying to treat giant retinal tears.
In the endoscopic treatment of bladder cancer, especially for stages beyond T2, transurethral resection does not seem to be sufficient. The risk of bladder wall perforation, the possibility of incomplete resection, seeding of tumor cells and high recurrence rates support the former statement [6]. Results of a multicentre prospective randomised study have exemplified that irradiation with the Neodymium-YAG Laser has been a reasonable alternative in the therapeutic approach to bladder cancer [2]. Diathermy coagulation must produce a sufficiently deep, homogeneous and well demarcated tissue necrosis. The coagulation depth has to be adjustable and heat production during coagulation should not lead to bladder wall perforation and consequent damage to the bowel. These criteria were investigated using regulated bipolar high frequency diathermy. The innovation in this method is, that thermal side effects on the tissue, e.g. vaporisation and carbonisation are prevented by a protective relay with constant current flow. Animal experimental studies have shown that this method meets all postulated requirements and therefore clinical trials can proceed.
Forty-nine consecutive patients with symptomatic prolapsed hemorrhoids were prospectively randomized for conventional scissors excision with ligation (Group A; n = 16) or diathermy excision without ligation (Group B; n = 33). The median time taken to complete the procedure was 20 minutes (range, 10-40 minutes) and 10 minutes (range, 5-35 minutes) in Groups A and B, respectively (P < 0.05). Length of hospital stay was similar in both groups, with a median of three days and a range of two to five days. The median length of follow-up was 35 weeks (range, 20-50 weeks) and 35 weeks (range, 20-51 weeks) for Groups A and B, respectively. There was no statistical difference in the severity of postoperative pain between the two groups. The use of postoperative oral analgesics was significantly lower in Group B (P < 0.02), but there was no significant difference in the demand for intramuscular or topical analgesics. Diathermy excision of hemorrhoids is significantly faster than scissors excision, there is less bleeding, the vascular pedicles need not be ligated, and there is significant reduction in the requirement for oral analgesics postoperatively without any increase in early or late postoperative complications.
Cultures generated from tissues consisting of multiple types of cells are often heterogeneous. Unless the cell type of interest has or can be given some selective growth advantage it may be overgrown by other cells. While developing techniques for the tissue culture of microvascular endothelial cells we evaluated an electrosurgical generator (diathermy) to selectively kill nonendothelial cells. Primary cell cultures were observed at X 100 magnification under phase contrast microscopy and a needle electrode apposed to the cell to be destroyed. A return electrode was constructed by placing a sterile clip in contact with the culture medium. The diathermy power setting controlled the area of lysis. Use of this technique allowed weeding of unwanted cells without damage to endothelial cells, which were able to grow to confluence in pure culture.
BACKGROUND: Initially, treatment for anastomotic strictures was surgical. Currently. however, endoscopic techniques are preferred. This study aimed to investigate the efficiency and safety of endoscopic treatment using argon plasma coagulation in combination with diathermy. METHODS: From 1995 to 2000, 49 patients with postsurgical anastomotic strictures of the esophagus or colon were referred for endoscopic treatment. In all cases, radiologic and endoscopic examination showed membranous or short strictures (diameter, 3-8 mm). Under direct endoscopic control, the scar tissue at the anastomotic line was incised radially with a polypectomy snare. The scar tissue between the incisions then was reduced carefully by argon plasma coagulation. RESULTS: All 49 patients were treated successfully with this combined endoscopic technique. Only for four patients was more than one endoscopic session (mean, 3.5; range, 2-6) needed to guarantee long-term success. No complications were encountered. CONCLUSIONS: Endoscopic argon plasma coagulation in combination with diathermy is a safe and effective technique for the treatment of short postsurgical gastrointestinal anastomotic strictures.
This study reports our experience of using thoracoscopic cervicodorsal sympathectomy with diathermy. From December 1994 to September 1998, we performed 53 thoracoscopic sympathectomies in 35 patients. There were 15 men and 20 women, ages 18 to 61 years. Ten surgeries were performed on the right side, 7 were the left, and 18 were bilateral. Indications for surgery were causalgia/reflex sympathetic dystrophy in 8 patients, Raynaud's/vasculitis in 6, intractable Raynaud's disease in 4, and hyperhydrosis in 17 (bilateral procedure). Operating time ranged from 10 to 50 min for unilateral procedures and from 45 to 80 min for bilateral procedures. Patients stayed in the hospital 1 to 4 days. From favorable immediate and follow-up results we conclude that thoracoscopic cervicodorsal sympathectomy using diathermy is feasible, safe, and effective.
We performed bimanual, bipolar intraocular diathermy by using a No. 22 disposable needle and a vitrectomy instrument. The technique required a smaller wound than unimanual bipolar cautery and was combined with membrane peeling techniques. The bipolar technique limited the extent of coagulation effects better than unipolar diathermy methods.
We used a modified bimanual bipolar diathermy technique to treat bleeding vessels in the anterior chamber angle in two patients. We attached one lead of a Mentor Wet Field coagulator to an instrument positioned in the anterior chamber angle at the bleeding site, and attached the second lead to a needle positioned externally at the corneoscleral limbus in the same meridian. Diathermy current passed between the instrument tips to coagulate the bleeding vessels.
Twenty-one nulliparous oligomenorrheic women with polycystic ovaries, complaining of infertility (mean duration 6 years) refractory to medical treatment, underwent laparoscopic ovarian diathermy. Eleven had adhesions and/or endometriosis. Regular ovulatory cycles ensued in 17 women (81%). In 9 responders there was a transient rise in mean follicle-stimulating hormone from 5.0 +/- 0.4 (standard error of the mean [SEM]) to 6.7 +/- 0.5 mIU/mL on postoperative day 1 and a fall in testosterone from 2.6 +/- 0.2 to 1.9 +/- 0.2 nmol/L by day 8. Luteinizing hormone fell from 19 +/- 1.2 to 10.4 +/- 1.2 mIU/mL by the follicular phase of the next cycle. Eleven women have conceived 13 pregnancies; 3 miscarried, 7 were delivered at term and 3 are ongoing. Ovarian diathermy is a useful option in women with polycystic ovaries complaining of refractory anovulatory infertility.
With experience extending over an interval of 25 years, one single application of electrocoagulation diathermy has been substantiated as a most consistent and effective method of eradicating precancerous lesions of the cervix. Although there is a protocol for selection that must be adhered to, the vast majority of patients with CIN lesions are suitable for this method of ablative therapy. Ablation by electrocoagulation diathermy appears to have distinct advantages over other methods because of the following: 1. Very high cure rates (98%) with first-time treatment can be achieved, even for major dysplasia and/or carcinoma in situ. 2. Extensive and deep lesions can be effectively eradicated irrespective of the purported histological severity. 3. Electrodiathermy is capable of eradicating lesions extending into the endocervical canal, providing anatomical limits can be evaluated colposcopically. 4. The technique is simple and rapid. The versatility of the electrodes facilitates eradication of the lesion irrespective of the shape and contour of the cervix. 5. No expensive capital outlay nor costly maintenance of equipment is required. 6. There are no physical hazards for medical personnel. 7. It is cost-effective--the technique is readily adaptable as a true out-patient procedure on a 'walk in, walk out' basis. 8. It has a very low incidence of surgical morbidity and does not jeopardize physiological and reproductive function. 9. For practical purposes, the subsequent risk of development of invasive cancer of the cervix can be effectively eliminated.
Twenty patients, 10 allergic and 10 non-allergic, with chronic hypertrophic rhinitis and presenting mainly with bilateral nasal obstruction were subjected to submucosal diathermy of their inferior turbinates. There was significant post-operative improvement clinically, histopathologically and histochemically in the non-allergic group, while the improvement was less obvious in the allergic cases. The post-operative clinical improvement as regards rhinorrhea and sneezing was not as marked as that for nasal obstruction. Evaluation of the results showed that submucous diathermy of inferior turbinates is a good line of treatment for cases of chronic hypertrophic rhinitis, with better results in the non-allergic group of patients.
The patulous Eustachian tube syndrome has previously been regarded as a troublesome but benign condition. Nine out of 13 patients reported here had evidence of cochlear damage similar to that caused by acoustic trauma. These patients also had vestibular symptoms which improved with treatment of the patulous tube. It is postulated that abnormal patency of the Eustachian tube may allow excessive middle ear pressure changes to occur which may be transmitted by abnormal ossicular movement to the cochlea. Eustachian tube diathermy using a ureteric diathermy probe is a safe and effective method of treating this condition.
The findings of a prospective evaluation of the use of a newly-designed bipolar diathermy probe in the outpatient management of adult acute epistaxis are presented. Forty-four adult patients with acute epistaxis were treated with bipolar diathermy after identification of the bleeding point using a rod lens endoscope. The use of the nasal endoscope allowed diagnosis of the source of the bleeding point in all patients. In all 44 patients immediate control of the bleeding was achieved. The use of the bipolar probe obviated the need for hospital admission in 31 patients (70%). Three patients had recurrence of their epistaxis after treatment (7%). The number of patients requiring admission to hospital with epistaxis was significantly reduced using the new bipolar strategy. (4.4/month versus 1.2/month, P < 0.002)