Potty, Anish G; Khan, Wasim; Tailor, Hitesh D
Diathermy has revolutionised modern surgery and is an important tool for efficient and safe surgical practice. It has evolved to become the modern day scalpel, being used for cutting and coagulating tissues. This article addresses the functioning and safe use of diathermy in the perioperative setting. The various precautionary checks before surgery, which are prerequisite for safe usage, are highlighted along with the necessary safety drills during and after operation. A specific note is included about the use of electrical equipment in specialised surgeries like cardiac and laparoscopic surgery. The issues regarding the maintenance and repair of equipment are acknowledged and finally, the anticipation for a future with precise and safer cutting and coagulation devices is addressed. PMID:21162356
Sudhindra, T V; Joseph, A; Haray, P N; Hacking, B C
Surgical diathermy is an invaluable aid in modern surgery and most contemporary diathermy machines are considered safe. However, diathermy accidents do still occur and a diathermy unit can be potentially lethal if adequate care is not exercised in its use. PMID:10911759
Sudhindra, T V; Joseph, A; Hacking, C J; Haray, P N
Surgical diathermy is an invaluable aid in modern surgery and most contemporary diathermy machines are considered safe. However, diathermy accidents still do occur and a diathermy unit can be potentially lethal if adequate care is not exercised in its use. PMID:10700764
... III (premarket approval). (c) Date PMA or notice of completion of PDP is required. A PMA or notice of... diathermy described in paragraph (b) of this section shall have an approved PMA or declared completed PDP...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Microwave diathermy. 890.5275 Section 890.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5275...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Microwave diathermy. 890.5275 Section 890.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5275...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Ultrasonic diathermy. 890.5300 Section 890.5300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5300...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Ultrasonic diathermy. 890.5300 Section 890.5300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5300...
... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shortwave diathermy. 890.5290 Section 890.5290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5290...
... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shortwave diathermy. 890.5290 Section 890.5290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5290...
... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shortwave diathermy. 890.5290 Section 890.5290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5290...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shortwave diathermy. 890.5290 Section 890.5290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5290...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Ultrasonic diathermy. 890.5300 Section 890.5300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5300...
... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Microwave diathermy. 890.5275 Section 890.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5275...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Ultrasonic diathermy. 890.5300 Section 890.5300 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5300...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Microwave diathermy. 890.5275 Section 890.5275 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5275...
... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shortwave diathermy. 890.5290 Section 890.5290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES PHYSICAL MEDICINE DEVICES Physical Medicine Therapeutic Devices § 890.5290...
Tuli, A; Singh, A
Tongue tie, also known as ankyloglossia or ankyloglossia inferior, is a relatively common finding in pediatric surgical outpatient clinics. It occurs as a result of a short, tight, lingual frenum causing tethering of the tongue tip. It is a common oral finding in infants and children, which is often neglected. Although most cases resolve or are asymptomatic, some patients develop articulation problems and other concerns related to poor tongue-tip mobility. In this article, we report on a 5-year old girl with a tongue tie, who underwent frenectomy using monopolar diathermy under local anesthesia without any postoperative complication. PMID:20660983
Goats, G C
Continuous shortwave diathermy is the technique of choice when uniform marked elevation of temperature is required in the deep tissues. This heating can be targeted accurately by using an appropriate applicator positioned correctly. SWD also allows superficial structures to be heated selectively, although for this the various methods of surface heating are usually preferable. Sub-acute or chronic conditions respond best to continuous shortwave diathermy which, when used properly, can be as effective as ultrasound. Acute lesions are better treated with pulsed shortwave diathermy. Continuous shortwave diathermy can help to relieve pain and muscle spasm, resolve inflammatory states and reduce swelling, promote vasodilation, increase the compliance of connective tissue, increase joint range and decrease joint stiffness. Images Figure 1 Figure 2 PMID:2691003
Sidhu, S. K.; Shaw, S.
We report 2 cases of elicitation of allergic contact dermatitis to acrylates from disposable blue diathermy pads used on patients who underwent routine surgery. Their reactions were severe, and took approximately 5 weeks to resolve. Both patients gave a prior history of finger tip dermatitis following the use of artificial sculptured acrylic nails, which is a common, but poorly reported, cause of acrylate allergy. Patch testing subsequently confirmed allergies to multiple acrylates present in both the conducting gel of disposable blue diathermy pads, and artificial sculptured acrylic nails. We advocate careful history taking prior to surgery to avoid unnecessary exposure to acrylates in patients already sensitized. Images Figure 1 Figure 2 PMID:10364952
Ning, Huaxiu; Wang, Yun; Yuan, Yiwen; Ning, Huaying
This paper aims to discuss the nursing and safety of silver needle diathermy in the treatment for ankylosing spondylitis. We nursed 46 patients with ankylosing spondylitis treated with silver needle diathermy. Specific nursing was focused on physical condition evaluation and mental nursing before treatment, observation during and after treatment, diet nursing, needle eye nursing, functional training and propaganda and education when discharged. The result suggested that all the patients received mental nursing, diet guide, skin care, health education, functional training and follow-up visit from the nurse and all of them could endure silver needle diathermy as discomfort or drug allergy was barely found, so were slight scald and skin infection nearby the needle eye caused by fainting during acupuncture, accidental puncture or overheat. Follow-up visit showed that no patient suffered obvious untoward effect and the pain, joint range of motion and living condition were distinctly improved a week after discharging. In conclusion, during the treatment for ankylosing spondylitis applying silver needle diathermy, the nursing before, during and after the treatment can obviously reduce the complication, accelerate the recovery, which is highly safe. PMID:25796147
Savage, J A; Simmons, R J
Modern ophthalmic microsurgery, particularly cataract extraction, trabeculectomy, and other forms of glaucoma filtration surgery, has been characterized by ever increasing precision. The use of radio frequency (RF) currents for cautery of blood vessels in anterior segment microsurgery has several advantages over other methods widely employed, including the bipolar cautery. A coaxial monopolar underwater diathermy probe, which operates with RF current has been specifically developed for anterior segment microsurgery and has proved vastly superior in cataract surgery, trabeculectomy, and full thickness glaucoma filtration procedures. PMID:4011123
Batista Neto, Simone; Graziano, Kazuko Uchikawa; Padoveze, Maria Clara; Kawagoe, Júlia Yaeko
In Brazil, single use diathermy pencils (SUDP) are among the most common reused devices. This study assesses the sterilization efficacy of reprocessing SUDP using two cleansing methods (manual or automated), followed by one of three of the low-temperature sterilization methods: Hydrogen Peroxide Plasma (HPP), Ethylene Oxide (ETO) or Low-Temperature Steam Formaldehyde (LTSF). The sample was composed of 360 SUDP after their first use. The probability of sterilization failure was estimated considering the number of positive microbiological results obtained by cultures of the studied devices. The overall sterilization failure probability for SUDP was 0.26. The sterilization method, which presented the lowest failure probability was the LTSF (0.01), followed by ETO (0.21) and HPP (0.56). Automated cleansing obtained a better result than manual cleansing. This trial demonstrated that the probability of sterilization in reprocessed SUDP is highly dependent on both the type of cleansing and the sterilization method applied. PMID:20428701
Sriman, Narayanan; Prabhakar, V.; Bhuvaneswaran, J.S.; Subha, N.
Aim: The purpose of this study was to evaluate the effects of three electronic apex locators (EAL), electric pulp tester (EPT) and diathermy on pacemaker function in vitro. Materials and Methods: Three EALs: Root ZX (J. Morita Co., Tustin, CA, U.S.A.), Propex (Dentsply), Mini Apex locator (SybronEndo, Anaheim, CA, USA), EPT (Parkell pulp vitality tester Farmingdale, NY, USA) and Diathermy (Neomed 250 B) were tested for any interference with one pacemaker (A medtronic kappa KVDD901-serial number: PLE734632S). Directly connecting the pacemaker lead with the EAL/EPT/diathermy operating on a flat bench top, the telemetry wand was held directly over the pacemaker to monitor the pacing pattern for a period of 30 s. Pacemaker activity was continuously recorded on the telemetric programmer and electro gram (EGM) readings examined for pacer inhibition, noise reversion or inappropriate pacemaker pulses. Results: All the three apex locators showed no pacing interference or background noise during its function or at rest. The EGM readings of EPT showed varying levels of background noise in between pacing however, this did not affect the normal pacing pattern and the pacing interval remained constant. EGM readings of diathermy showed an increase in the pacing interval (irregular pacing pattern) followed by complete inhibition of the pacing system. Conclusion: The tested EALs do not interfere with cardiac pacemaker function. The tested EPT showed varying levels of background noise but does not interfere with cardiac pacemaker function. Use of Diathermy interfered with the normal pacing, leading to complete inhibition of the pacing system. PMID:25657520
Nalavenkata, Sunny; Winter, Matthew; Kour, Rachel; Kour, Nam-Wee; Ruljancich, Paul
Objectives To present our novel technique and step-by-step approach to bipolar diathermy circumcision and related procedures in adult males. Methods We reviewed our technique of bipolar circumcision and related procedures in 54 cases over a 22-month period at our day procedure center. Bipolar diathermy cutting and hemostasis was performed using bipolar forceps with a Valleylab machine set at 15. Sleeve circumcision was used. A dorsal slit was made, followed by frenulum release and ventral slit, and was completed with bilateral circumferential cutting. Frenuloplasties released the frenulum. Preputioplasties used multiple 2–3 mm longitudinal cuts to release the constriction, with frenulum left intact. All wounds were closed with interrupted 4/0 Vicryl Rapide™. Results A total of 54 nonemergency bipolar circumcision procedures were carried out from November 2010–August 2012 (42 circumcisions, eight frenuloplasties, and four preputioplasties). Patients were aged 18–72 years (mean, 34 years). There was minimal to no intraoperative bleeding in all cases, allowing for precise dissection. All patients were requested to attend outpatient reviews; three frenuloplasty and two circumcision patients failed to return. Of the remaining 49, mean interval to review was 49 days, with a range of 9–121 days. Two circumcision patients reported mild bleeding with nocturnal erections within a week postoperatively, but they did not require medical attention. Two others presented to family practitioners with possible wound infections which resolved with oral antibiotics. All 49 patients had well-healed wounds. Conclusion The bipolar diathermy technique is a simple procedure, easily taught, and reproducible. It is associated with minimal bleeding, is safe and efficient, uses routine operating equipment and is universally applicable to circumcision/frenuloplasty/preputioplasty. In addition, it has minimal postoperative complications, and has associated excellent cosmesis. PMID
Petrou, M.; Kaplan, D.; Goldstraw, P.
BACKGROUND--Major airways obstruction is a distressing cause of morbidity and mortality. For disease that is extensive and recurrent, there is a need for a safe and cost effective technique for palliation. METHODS--The results of 29 patients with tracheobronchial obstruction (24 malignant and five benign) treated by diathermy resection alone or in combination with endobronchial stenting have been reviewed. RESULTS--The major site of obstruction was the trachea in 14, main carina in seven, right main bronchus in six, and left main bronchus in two patients. Fifteen had received other forms of treatment beforehand including external radiotherapy, endoscopic dilatation, and laser resection (Nd:YAG). Five patients required two or more treatment sessions for symptom recurrence. Ten patients also received additional treatment with a stent (nine) or insertion of gold grains (one). There were no intraoperative deaths or complications and the average length of stay was five days (range 2-14). Twenty eight patients reported immediate symptomatic relief, and objective improvement in the results of lung function tests was seen in eight patients whose condition was less acute and where preoperative lung function tests could be undertaken (average improvement in FEV1 of 53.1% and in FVC of 20.6%). CONCLUSIONS--Bronchoscopic diathermy resection is an effective and safe method for relieving the symptoms of tracheobronchial obstruction at appreciably less cost than laser resection. Images PMID:8296261
Ruggera, P. S.; Witters, D. M.; von Maltzahn, G.; Bassen, H. I.
A patient with bilateral implanted neurostimulators suffered significant brain tissue damage, and subsequently died, following diathermy treatment to hasten recovery from teeth extraction. Subsequent MRI examinations showed acute deterioration of the tissue near the deep brain stimulator (DBS) lead's electrodes which was attributed to excessive tissue heating induced by the diathermy treatment. Though not published in the open literature, a second incident was reported for a patient with implanted neurostimulators for the treatment of Parkinson's disease. During a diathermy treatment for severe kyphosis, the patient had a sudden change in mental status and neurological deficits. The diathermy was implicated in causing damage to the patient's brain tissue. To investigate if diathermy induced excessive heating was possible with other types of implantable lead systems, or metallic implants in general, we conducted a series of in vitro laboratory tests. We obtained a diathermy unit and also assembled a controllable laboratory exposure system. Specific absorption rate (SAR) measurements were performed using fibre optic thermometry in proximity to the implants to determine the rate of temperature rise using typical diathermy treatment power levels. Comparisons were made of the SAR measurements for a spinal cord stimulator (SCS) lead, a pacemaker lead and three types of bone prosthesis (screws, rods and a plate). Findings indicate that temperature changes of 2.54 and 4.88 °C s-1 with corresponding SAR values of 9129 and 17 563 W kg-1 near the SCS and pacemaker electrodes are significantly higher than those found in the proximity of the other metallic implants which ranged from 0.04 to 0.69 °C s-1 (129 to 2471 W kg-1). Since the DBS leads that were implanted in the reported human incidents have one-half the electrode surface area of the tested SCS lead, these results imply that tissue heating at rates at least equal to or up to twice as much as those reported here for
Takahashi, Kenji; Hashimoto, Sanshiro; Kurosaki, Hiromasa; Kato, Kazuo; Majima, Tokifumi; Shindo, Yasuhiro; Watanabe, Hiroshi; Mochizuki, Yusuke; Takai, Shinro
[Purpose] This study aimed to compare the efficacy of radiofrequency diathermy with that of microwave diathermy in combination with intra-articular injection of hyaluronic acid into the knee of patients with osteoarthritis (OA). [Subjects] A total of 17 patients with knee OA were enrolled. The participants were randomly divided into two groups: a radiofrequency diathermy group (RF group, 9 subjects), and a microwave diathermy group (MW group, 8 subjects). [Methods] Subjects received radiofrequency or microwave thermal therapy 3 times at 1-week intervals. Intra-articular injection of hyaluronic acid was administered 10 min before every thermal therapy session. The outcome was evaluated using the Japan Orthopaedic Association (JOA) and the Lequesne Index (LI) at baseline, at weeks 1 (1 week after the first thermal therapy) and 3 (1 week after the last thermal therapy). [Results] The JOA scale increased significantly after three sessions of thermal therapy in the RF group, while no significant increase was observed in the MW group. LI decreased significantly after 3 weeks in the RF group. In the MW group, there was no significant difference in LI between the two time points. [Conclusion] This study revealed that symptom relief in patients with knee OA was greater with radiofrequency diathermy than with microwave diathermy with concurrent use of hyaluronic acid injection, presumably due to the different heating characteristics of the two methods. PMID:27065540
Talpur, Altaf Ahmed; Khaskheli, Abdul Basir; Kella, Nandlal; Jamal, Akmal
Background: Since a long time skin incisions have routinely been made with scalpels. Now a day there is a shift in trend from this method to electrosurgical skin incisions. However, fear of bad scars and improper wound healing has prevented its wide spread use. This Study aimed to compare both methods of skin incisions for different variables. Objectives: The aim of this study was to examine incisional time, blood loss during incision and postoperative wound complications and pain with both methods of skin incision. Patients and Methods: A prospective, comparative and randomized study was conducted at different hospitals of Hyderabad and Nawabshah, Pakistan from 1st of December 2009 to 30th of November 2011. The study included patients of either sex above the age of five years with general surgical pathology who were to undergo surgery. these candidates were randomly put into two groups. In Group A patients incision was made with a scalpel and in group B with diathermy. Data was analyzed for age, sex, comorbid illness, incisional time, blood loss during incision making and postoperative pain and wound complications. Results: A total of 283 patients completed the follow-up and were included in the final analysis. Group A comprised of 143 (50.53%) patients; 83 (58%) males and 60 (42%) females with a mean age of 36.03 years. Amongst the 140 patients of group B, there were 85 (60.7%) males and 55 (39.3%) females with a mean age of 36.52 years. Twenty-five (17.48%) patients of group A and 27 (19.28%) of group B had comorbid illnesses. Mean incision time was 8.9025-sec/cm2 for group A and 7.3057 sec/cm2 for group B patients. Mean blood loss during incision making was 1.8262 mL/cm2 and 1.1346 mL/cm2 for group A and B patients, respectively. Pain was 5.2957 for group A patients on day one and 3.1181 for group B patients. Pain score was 2.1049 and 1.6206 on day two and 0.8191 and 0.7192 on day five, for group A and B patients, respectively. Postoperative wound complications
Sun, Ming-Kuan; Shieh, Jay; Chen, Chuin-Shan; Chiang, Hongsen; Huang, Chang-Wei; Chen, Wen-Shiang
The effects of an implant on temperature distribution in a tissue-mimicking hydrogel phantom during the application of therapeutic ultrasound were investigated. In vitro experiments were conducted to compare the influences of plastic and metal implants on ultrasound diathermy and to calibrate parameters in finite element simulation models. The temperature histories and characteristics of the opaque (denatured) areas in the hydrogel phantoms predicted by the numerical simulations show good correlation with those observed in the in vitro experiments. This study provides an insight into the temperature profile in the vicinity of an implant by therapeutic ultrasound heating typically used for physiotherapy. A parametric study was conducted through numerical simulations to investigate the effects of several factors, such as implant material type, ultrasound operation frequency, implant thickness and tissue thickness on the temperature distribution in the hydrogel phantom. The results indicate that the implant material type and implant thickness are the main parameters influencing the temperature distribution. In addition, once the implant material and ultrasound operation frequency are chosen, an optimal implant thickness can be obtained so as to avoid overheating injuries in tissue. PMID:27150744
Meretoja, Tuomo J; von Smitten, Karl A J; Kuokkanen, Hannu O M; Suominen, Sinikka H H; Jahkola, Tiina A
Skin-sparing mastectomy (SSM) followed by immediate breast reconstruction delivers superior cosmetic and functional outcome. However, SSM is vulnerable to complications of the native skin envelope. This study aims to compare the effects of radiofrequency coagulation and conventional diathermy on complications of SSM. Sixty consecutive patients suitable for SSM were randomized into conventional diathermy and radiosurgery groups. These groups were compared and the risk factors for SSM flap complications were evaluated. The SSM flap complication rate was 23.4%. There was no difference between the study groups regarding the SSM flap complications. Increased SSM flap complication rate was associated with smoking and the type of skin incision used. This study shows that high-frequency radiosurgery is comparable to conventional diathermy in terms of complication rates of SSM. Furthermore, this study reports an association between the tennis-racquet-type incision and an increased SSM flap complication rate compared with the round periareolar type incision. PMID:18281791
Brown-Woodman, P.D.; Hadley, J.A.; Richardson, L.; Bright, D.; Porter, D.
In recent years, there has been increased concern regarding effects of operator exposure to the electromagnetic (EM) field associated with shortwave diathermy devices. The present study was designed to investigate the effects, on rats, of repeated exposure to such an EM field. Following repeated exposure for 5 wk, a reduction in fertility occurred as indicated by a reduced number of matings in exposed rats compared to sham-irradiated rats and a reduction in the number of rats that conceived after mating. The data suggest that female operators could experience reduced fertility, if they remained close to the console for prolonged periods. This has particular significant for the physiotherapy profession.
Anwar, Khurshid; Ahmad, Rafiq; Khan, Muneeb
Objective: To assess and compare the relative efficacy of silk ligation and diathermy coagulation techniques in controlling bleeding during tonsillectomy in the first 24 hours. Methods: This prospective study was conducted at the Department of ENT, Khalifa Gul Nawaz Teaching Hospital, Bannu and this department related consultants’ private clinics from January 1, 2012 to December 31, 2014. The study included 180 cases. All patients included were having history of recurrent, acute tonsillitis, with more than 6–7 episodes in one year, five episodes per year for two years, or three episodes per year for three years. All the surgeries were performed by dissection method. Haemostasis during the procedure was secured by either ligation with silk 1 or using diathermy. The results were analyzed using SPSS 16.0 for windows. Results: A total of180 cases were included in the study. The ages of the patients ranged from 5 to 40 years with the mean age of 15.56 years and a std.deviation of +/- 8.24. The male to female ratio was 1.25:1. The number of hemorrhages occurring was greater in the ‘diathermy coagulation’ group as compared to the ‘silk ligation’ group. However, the observed difference was statistically insignificant (p >.05). Conclusion: Primary haemorrhage occurring during tonsillectomy is a serious threat and control of bleeding during the procedure should therefore be meticulous. Both suture ligation and coagulation diathermy for control of bleeders during the procedure by dissection method are equally effective. PMID:26430438
The Food and Drug Administration (FDA) is issuing a final order to reclassify shortwave diathermy (SWD) for all other uses, a preamendments class III device, into class II (special controls), and to rename the device "nonthermal shortwave therapy'' (SWT). FDA is also making a technical correction in the regulation for the carrier frequency for SWD and SWT devices. PMID:26470404
Vardiman, John P.; Moodie, Nicole; Siedlik, Jacob A.; Kudrna, Rebecca A.; Graham, Zachary; Gallagher, Philip
Context Various modalities have been used to pretreat skeletal muscle to attenuate inflammation. Objective To determine the effects of short-wave diathermy (SWD) preheating treatment on inflammation and stress markers after eccentric exercise. Design Controlled laboratory study. Setting University laboratory setting. Patients or Other Participants Fifteen male (age = 22 ± 4.9 years, height = 179.75 ± 9.56 cm, mass = 82.22 ± 12.67 kg) college-aged students. Intervention(s) Seven participants were selected randomly to receive 40 minutes of SWD heat treatment (HT), and 8 participants served as the control (CON) group and rested without SWD. Both groups completed 7 sets of 10 repetitions of a high-intensity eccentric exercise protocol (EEP) at 120% of the 1-repetition maximum (1-RM) leg extension. Main Outcome Measure(s) We biopsied muscles on days 1, 3 (24 hours post-EEP), and 4 (48 hours post-EEP) and collected blood samples on days 1, 2 (4 hours post-EEP), 3, and 4. We determined 1-RM on day 2 (24 hours post-SWD) and measured 1-RM on days 3 and 4. We analyzed the muscle samples for interleukin 6 (IL-6), tumor necrosis factor α, and heat shock protein 70 and the blood for serum creatine kinase. Results We found a group × time interaction for intramuscular IL-6 levels after SWD (F2,26 = 7.13, P = .003). The IL-6 decreased in HT (F1,6 = 17.8, P = .006), whereas CON showed no change (P > .05). We found a group × time interaction for tumor necrosis factor α levels (F2,26 = 3.71, P = .04), which increased in CON (F2,14 = 7.16, P = .007), but saw no changes for HT (P > .05). No group × time interactions were noted for 1-RM, heat shock protein 70, or creatine kinase (P > .05). Conclusions The SWD preheating treatment provided a treatment effect for intramuscular inflammatory myokines induced through high-intensity eccentric exercise but did not affect other factors associated with intense exercise and inflammation. PMID:25844857
Faramarzi, Abolahassan; Heydari, Seyed Taghi
Objective Post-tonsillectomy hemorrhage remains an important factor in determining the safety of performing tonsillectomy as a day case procedure. The aim of this study was to determine the safety of day case tonsillectomy by using combination method, cold dissection tonsillectomy and bipolar diathermy hemostasis. Methods A prospective randomized clinical study conducted on the patients who had undergone day case tonsillectomy (DCT). There were two groups (DCT and control group) each group consisting of 150 cases. Tonsillectomy was performed by using combination method; cold dissection and hemostasis was achieved by ligation of vessels with bipolar electerocautery. Findings We found 3 cases of post-tonsillectomy bleeding in DCT group and 4 cases in the control group. There was no statistically significant difference in the rate of post-operative hemorrhage between the two groups. Conclusion The findings suggest the safety of the combination of cold dissection tonsillectomy and bipolar diathermy hemostasis as day case tonsillectomy. PMID:23056702
Wang, Chunxiao; Zhang, Xinyu; Tang, Xiangchen; Liu, Jianping; Congdon, Nathan; Chen, Jingjing; Lin, Zhuoling; Liu, Yizhi
Pediatric ophthalmologists increasingly recognize that the ideal site for intraocular lens (IOL) implantation is in the bag for aphakic eyes, but it is always very difficult via conventional technique. We conducted a prospective case series study to investigate the success rate and clinical outcomes of capsular bag reestablishment and in-the-bag IOL implantation via secondary capsulorhexis with radiofrequency diathermy (RFD) in pediatric aphakic eyes, in which twenty-two consecutive aphakic pediatric patients (43 aphakic eyes) enrolled in the Childhood Cataract Program of the Chinese Ministry of Health were included. The included children underwent either our novel technique for secondary IOL implantation (with RFD) or the conventional technique (with a bent needle or forceps), depending on the type of preoperative proliferative capsular bag present. In total, secondary capsulorhexis with RFD was successfully applied in 32 eyes (32/43, 74.4%, age 5.6±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved in 30 eyes (30/43, 70.0%), but in the remaining 2 eyes (2/32, 6.2%) the IOLs were implanted in the sulcus with a capsular bag that was too small. Secondary capsulorhexis with conventional technique was applied in the other 11 eyes (11/43, 25.6%, age 6.9±2.3 years), of which capsular bag reestablishment and in-the-bag IOL implantation were both achieved only in 3 eyes(3/43, 7.0%), and the IOLs were implanted in the sulcus in the remaining 8 eyes. A doughnut-like proliferative capsular bag with an extensive Soemmering ring (32/43, 74.4%) was the main success factor for secondary capsulorhexis with RFD, and a sufficient capsular bag size (33/43, 76.7%) was an additional factor in successful in-the-bag IOL implantation. In conclusion, RFD secondary capsulorhexis technique has 70% success rate in the capsular bag reestablishment and in-the-bag IOL implantation in pediatric aphakic eyes, particularly effective in cases with
It is submitted that the thermal action of short-wave therapy does not account for the therapeutic results obtained. The theory is put forward that many of the results obtained can be better explained by the disruptive and dispersive action of the impact of the electromagnetic vibrations. An analogy, indicating such disruptive effects at high frequency, is drawn from the molecular vibrations—transmitted through transformer oil, and excited by the application of high frequency currents to the layers of quartz in the piezo-electric oscillator of quartz. It is submitted that these disruptive and dispersive effects will be greatest where the conductivity of the tissues is low, such as in bones and fat, and it is shown that it is in these regions that the therapeutic action of these currents is most obvious. It is also pointed out that, if effects, comparable to those obtained in the subcutaneous area, are obtained in the deeper tissues and organs, the application of deep-wave therapy would be attended by serious risk. PMID:19990107
Mid-follicular phase pulses of inhibin B are absent in polycystic ovarian syndrome and are initiated by successful laparoscopic ovarian diathermy: a possible mechanism regulating emergence of the dominant follicle.
Lockwood, G M; Muttukrishna, S; Groome, N P; Matthews, D R; Ledger, W L
. Four women with PCOS whose anovulation was successfully treated with laparoscopic ovarian diathermy (LOD) underwent repeat venous sampling following LOD. Their serum inhibin B levels fell to the upper limit of the normal range (160 +/- 38.5) pg/mL, and pulsatility was initiated. It is possible that inhibin B pulses are being generated directly by the ovary in response to pulses of GnRH in the peripheral circulation, or indirectly in response to FSH pulses arising in the pituitary. The function of inhibin B pulses in the mid-follicular phase of the normal cycle remains to be elucidated, but the absence of the normal pulsatile pattern in women with PCOS, in conjunction with high basal levels of inhibin B arising from the multiple small follicles characteristic of the PCOS ovary, appears to reinforce the development of a large cohort of small, developmentally arrested, and ultimately atretic follicles in these patients. Initiation of normal inhibin B pulsatility by LOD in patients with polycystic ovaries appears to correlate with the post-operative onset of ovular cycles. PMID:9589683
...). (c) Date PMA or notice of completion of PDP is required. A PMA or a notice of completion of a PDP for... paragraph (b) of this section shall have an approved PMA or declared completed PDP in effect before...
... for large firms and $59,075 for small firms (75 FR 45641, August 3, 2010). The total cost per PMA is... response to the 515(i) Order (74 FR 16214, April 9, 2009), and any additional information that FDA has... Register: 44 FR 50512 (August 28, 1979), 48 FR 53032 (November 23, 1983), and 52 FR 17732 (May 11,...
Fan, Xu; Wang, Yunguang; Cheng, Haiping; Chong, Xiaochen
The present circuit was designed to apply to human tissue impedance tuning and matching device in ultra-short wave treatment equipment. In order to judge if the optimum status of circuit parameter between energy emitter circuit and accepter circuit is in well syntony, we designed a high frequency envelope detect circuit to coordinate with automatic adjust device of accepter circuit, which would achieve the function of human tissue impedance matching and tuning. Using the sampling coil to receive the signal of amplitude-modulated wave, we compared the voltage signal of envelope detect circuit with electric current of energy emitter circuit. The result of experimental study was that the signal, which was transformed by the envelope detect circuit, was stable and could be recognized by low speed Analog to Digital Converter (ADC) and was proportional to the electric current signal of energy emitter circuit. It could be concluded that the voltage, transformed by envelope detect circuit can mirror the real circuit state of syntony and realize the function of human tissue impedance collecting. PMID:27382746
... electronic products which may emit ultraviolet, visible, infrared, microwaves, radio and low frequency.... Infrared: Alarm systems. Diathermy units. Dryers, ovens, and heaters. Microwave: Alarm systems....
... electronic products which may emit ultraviolet, visible, infrared, microwaves, radio and low frequency.... Infrared: Alarm systems. Diathermy units. Dryers, ovens, and heaters. Microwave: Alarm systems....
... electronic products which may emit ultraviolet, visible, infrared, microwaves, radio and low frequency.... Infrared: Alarm systems. Diathermy units. Dryers, ovens, and heaters. Microwave: Alarm systems....
Hong, Kwang Dae; Lee, Sun Il; Moon, Hong Young
Colonic gas explosion, although rare, is sometimes a fatal iatrogenic complication in endoscopic procedures or laparotomic surgery, but it has not been reported during port incision of laparoscopy. We report a case of gas detonation in a patient with pneumatosis intestinalis and pneumoperitoneum, on opening the peritoneum with a diathermy for umbilical trocar insertion. Based on our experience, in cases of pneumoperitoneum, surgeons need to avoid using a diathermy in opening the peritoneum. PMID:22288881
... is pulsed on and off at a rapid rate. For most patients with a pacemaker, this procedure is a relative contraindication. ● Transcutaneous electrical nerve/muscle stimulators (TENS), a method of pain control. ● Diathermy, which heats body tissues with high-frequency electromagnetic radiation or ...
... body tissues. On July 6, 2012 (77 FR 39953), FDA issued a proposed rule which, if made final, would... diathermy for all other uses has been discussed as part of the proposed rule (77 FR 39953). The discussion... (63 FR 40025), FDA published a final rule classifying certain previously unclassified...
Novotney, L.C.; Gravitis, I.
This research project was initiated to identify potential human populations for future epidemiological studies of the health effects of radio frequency radiation. Through a literature search and contacts with various groups and organizations, numerous occupations and applications of radio frequency radiation (RFR) were identified and evaluated for their suitability for further study. Many populations were eliminated early because their potential exposure to RFR was too limited or data necessary for epidemiological research were unavailable. Eight populations were evaluated in detail and appear to satisfy many of the criteria for epidemiological research and could be useful study groups in an investigation of the health effects of non-ionizing radiation. The eight potential study populations are: RF heat sealer operators, HF (high frequency) tube welder operators, medical diathermy operators in Veterans Administration hospitals, medical diathermy operators in rehabilitation facilities, school children located near broadcasting towers, state policemen, security guards, and radar technicians.
Olmi, R.; Andreoli, S.; Bini, M.; Feroldi, P.; Spiazzi, L.
Tissue hyperaemia is a physiological consequence of the temperature increase that follows, for example, the absorption of electromagnetic or ultrasound power in clinical diathermy. Diathermy, as well as other physical therapies (for example massotherapy), affects the local blood content of tissues through various mechanisms (vasoconstriction/dilatation, opening/closing of precapillary sphincters). A method for evaluating hyperaemia in superficial and medium-depth tissues has been recently proposed, which is based on four-electrode impedance measurements. A microcirculation model has also been developed to describe the hyperaemic effects of local diathermic therapy. This paper describes an electrical model of the tissues in hyperaemic conditions which allows us to correlate electrical impedance measurements to microcirculation modifications.
Sowton, E; Gray, K; Preston, T
Patients with 41 implanted non-competitive pacemakers were investigated. A variety of domestic electrical equipment, a motor-car, and a physiotherapy diathermy apparatus were each operated in turn at various ranges from the patient. Interference effects on pacemaker function were assessed on the electrocardiograph. Medtronic demand 5841 pacemakers were stopped by diathermy while Cordis Ectocor pacemakers developed a fast discharge rate. Cordis triggered pacemakers (both Atricor and Ectocor) were sensitive to interference from many items of domestic equipment and the motor car. The Elema EM153 ran at an increased rate when an electric razor was running close to the pacemaker. The Devices demand 2980 and the Medtronic demand 5841 were not affected by the domestic equipment tested. The significance of interference effects is discussed in relation to pacemaker design. PMID:5470044
Garcia, Larissa Martins; Soares, Alcimar Barbosa; Simieli, Camila; Boratino, Alessandra Vairo Peres; Guirro, Rinaldo Roberto de Jesus
The objective of this study was to assess electromyographic features of the brachial biceps muscle after the application of cryotherapy and short-wave diathermy. Sixty healthy volunteers participated in the study and were equally divided into three groups: cryotherapy - application of ice packs for 30 min; short-wave diathermy for 20 min; and control. The thermal agents were applied to the anterior and posterior regions of the non-dominant arm. The electromyographic (EMG) signal from the brachial biceps was recorded before and after the application of thermal agents during flexion of the elbow joint at 25%, 50%, 75% of a maximum voluntary isometric contraction defined at least two days before the actual experiments (MVICbl). The volunteers also were asked to execute a free MVIC before and after the application of the thermal agents (MVIC free). A linear regression model with mixed effects (random and fixed) was used. Intra-group analysis showed a reduction in root mean square (RMS) at MVIC free, with no change in the median frequency of the EMG signal at any contraction level for the short-wave diathermy group. An increase on RMS values and a decrease on median frequencies were found after the application of cryotherapy for all contraction levels. The results imply that cryotherapy plays an important role on changing neuromuscular responses at various levels of muscle contraction. Therapists should be aware of that and carefully consider its use prior to activities in which neuromuscular precision is required. PMID:25148950
Khan, A; Masood, J; Ghei, M; Kasmani, Z; Ball, A J; Miller, R
Every Urologist, during the course of fulguration treatment of bladder tumours, has at some time or another experienced small intravesical explosions usually manifesting as a "pop". Major intravesical explosions are rare but potentially devastating complications of transurethral endoscopic resections. The damage to the bladder can range from small mucosal tears to bladder rupture, which can either be intraperitoneal (requiring laparotomy and open bladder repair) or extraperitoneal. We review the literature on intravesical explosions to determine the aetiology of these explosions and suggest strategies to prevent these. A comprehensive literature search was performed using Medline and Ovid to obtain information using search terms: intravesical explosions, transurethral procedures, endoscopic procedures, diathermyIntravesical explosions occur due to the production of explosive gases during use of diathermy on human tissues. The most dangerous combination is hydrogen and oxygen. Hydrogen alone is not explosive and it only becomes explosive when admixed with oxygen. Oxygen is not produced in sufficient quantity during diathermy to cause explosions but can enter into the bladder from the atmosphere during endoscopic procedures. Careful operative technique (correct use of the Ellick evacuator bulb and reducing the frequency of manual irrigations of the bladder) with minimisation of the operative time and using the coagulation current at moderate power as well as judicious coagulation of tissues can reduce the risk of this dangerous complication arising. PMID:17171415
Orsi, Franco; Penco, Silvia Matei, Victor; Bonomo, Guido; Vigna, Paolo Della; Monfardini, Lorenzo; Cobelli, Ottavio De
Background. Ureterointestinal anastomotic strictures (UAS) complicate 10-15% of surgeries for urinary diversion and are the main cause of deterioration in renal function. Treatments are surgical revision, management with autostatic stent, balloon dilatation, endoscopic incision, and percutaneous transrenal diathermy (Acucise). A new option is cryoplastic dilatation (Polar-Cath). Purpose. To assess the feasibility, complications, and preliminary results of UAS treatment using the Acucise and Polar-Cath systems. Methods. Nineteen UAS, diagnosed by ultrasonography or computed tomography and sequential renal scintigraphy, occurred in 15 cancer patients after radical cystectomy and urinary diversion. Fifteen were managed with balloon diathermy and 4 by balloon cryoplasty in a three-stage procedure-percutaneous nephrostomy, diathermal or cryoplastic dilatation, and transnephrostomic control with nephrostomy removal-each separated by 15 days. All patients gave written informed consent. Results. Dilatations were successful in all cases. The procedure is simple and rapid (about 45 min) under fluoroscopic control and sedation. Procedural complications occurred in 1 (5%) patient with UAS after Wallace II uretero-ileocutaneostomy: a common iliac artery lesion was induced by diathermal dilatation, evident subsequently, and required surgical repair. Patency with balloon diathermy was good, with two restenoses developing over 12 months (range 1-22) of follow-up. With balloon cryoplastic dilatation, one restenosis developed in the short term; follow-up is too brief to assess the long-term efficacy. Conclusion. Our short-term results with diathermal and cryoplastic dilatation to resolve UAS are good. If supported by longer follow-up, the techniques may be considered as first-choice approaches to UAS. Surgery should be reserved for cases in which this minimally invasive technique fails.
Rawe, Ian M
Pulsed shortwave diathermy, an electromagnetic therapy, has been in clinical use for acute and chronic musculoskeletal pain for many decades. Innovation, miniaturization and advances in technology have allowed for the development of a new generation of shortwave devices that deliver a localized, low fixed dose of shortwave therapy. Clinical research has shown that these novel shortwave devices can be used safely in order to reduce acute and chronic pain, as well as the need for pain medications. Their ease of use and safety profile make low-dose shortwave devices an attractive alternative, or adjunct therapy, to pharmacological-based pain therapies. PMID:24641342
Twigg, V; Carr, S; Peres, C; Mirza, S
Craniometaphyseal dysplasia is a rare genetic condition characterised by hyperostosis of the skull base and sclerosis of craniofacial bones. This can cause nasal obstruction. This paper presents the case of a 14-year old with craniometaphyseal dysplasia presenting with nasal obstruction successfully treated with turbinoplasty. A literature search was conducted using PUBMED and EMBASE. In conclusion, in cases of craniometaphyseal dysplasia with nasal obstruction conventional techniques such as submucosal diathermy and outfracturing of inferior turbinates may not be adequate. Bony turbinoplasties along the whole length of the inferior turbinate may be required. PMID:25890400
Kim, Myung-Su; Lee, Jang-Hoon; Lee, Dong-Hyup; Lee, Young Uk; Jung, Tae-Eun
Tracheostomy is a relatively common surgical procedure that is performed easily in an operating room or intensive care unit. Open tracheostomy is needed in patients requiring prolonged ventilation when percutaneous tracheostomy is inappropriate. Sometimes, it is difficult to achieve bleeding control in the peritracheal soft tissue, and in such cases, we usually use diathermy. However, the possibility of an electrocautery-ignited surgical field fire can be overlooked during the procedure. This case report serves as a reminder that the risk of a surgical field fire during tracheostomy is real, particularly in patients requiring high-oxygen therapy. PMID:25346908
Elinder, Karolina; Söderman, Anne-Charlotte Hessén; Stalfors, Joacim; Knutsson, Johan
The objective of this study was to examine factors affecting morbidity after tonsillectomy in children. Data from the National Tonsil Surgery Register in Sweden on 18,712 patients who underwent tonsillectomy with or without simultaneous adenoidectomy between 1 and 18 years of age were analysed. This register includes data on sex, gender, surgical indication, and the surgical and haemostasis techniques used for each patient, as well as patient-reported outcomes for haemorrhage, analgesic use and antibiotic use. Comparison of patients who underwent surgery for infection versus upper airway obstruction revealed a significant increase in haemorrhage complications in the infection group. However, no significant difference remained after the adjustments for confounders in multivariable regression analysis. Instead, the increased risk among patients who underwent surgery for infection was mainly attributable to the use of bipolar diathermy and increased patient age. Patients who received surgery for infection reported more days of analgesic use, as well as more unplanned contacts with a health care service provider due to pain, compared with those who underwent surgery for upper airway obstruction. These results remained significant in multivariate analysis. The use of bipolar diathermy for haemostasis resulted in an increased risk, while the use of cold steel surgical instruments, a younger patient age and female sex led to a decreased risk. The surgical and haemostasis techniques used are the most important factors that affect morbidity after tonsillectomy in the paediatric age group. The choice of surgical techniques is of utmost importance for decreasing morbidity in these patients. PMID:27020269
Walijee, Hussein; Al-Hussaini, Ali; Harris, Andrew; Owens, David
There are a multitude of techniques to undertake tonsillectomy, with hot techniques such as diathermy and coblation being associated with a higher risk of secondary haemorrhage. The UK National Prospective Tonsillectomy Audit (2004) advocated cold steel dissection and ties to be the gold standard. This prospective observational study investigates the trends in tonsillectomy techniques across Wales in the last decade to establish if surgeons have adhered to this national guidance. Data relating to tonsillectomy were extracted over a 10-year period from 1 January 2003 to 31 December 2012 from the Wales Surgical Instrument Surveillance Programme database. A total of 19,195 patients were included. Time-series analysis using linear regression showed there was an increase in the number of bipolar diathermy tonsillectomies by 84% (Pearson's r = 0.762, p = 0.010) and coblation tonsillectomies by 120% (r = 0.825, p = 0.003). In contrast, there was a fall in the number of cold steel dissection tonsillectomies with ties by 60% (r = −0.939, p < 0.001). This observational study suggests that the use of bipolar and coblation techniques for tonsillectomy has increased. This deviation from national guidance may be due to these techniques being faster with less intraoperative bleeding. Further study for the underlying reasons for the increase in these techniques is warranted. PMID:26693228
Stewart, W.; Ouellet-Hellstrom, R.
In 1989 approximately 42,000 questionnaires were mailed to female physical therapists to assess the risk of adverse reproductive effects among those exposed to electromagnetic radiation at radiofrequencies. From the resulting data, the risk of early recognized fetal loss was assessed using a nested case-control design. The cases (1753 miscarriages) were matched to controls (1753 other pregnancies except ectopics) on mothers age at conception and the number of years elapsed between conception and interview. The results of the study indicate that female physical therapists who work with microwave diathermy 6 months prior to the pregnancy and/or during the first trimester were at increased risk of experiencing a recognized early fetal loss, but female physical therapists who work with shortwave diathermy were not at an increased risk. This association was shown to hold even when the mother's age at conception, the number of years elapsed between conception and interview, the number of prior early fetal losses, mother's conditions ever diagnosed, and use of other modalities were controlled. The data also suggest a possible association between exposure to transcutaneous electrical nerve stimulation with an elevated risk of early recognized fetal loss.
Cristescu, Simona M.; Kiss, Rudolf; te Lintel Hekkert, Sacco; Dalby, Miles; Harren, Frans J. M.; Risby, Terence H.
Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (>30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (>10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene. PMID:25128523
Cristescu, Simona M; Kiss, Rudolf; Hekkert, Sacco te Lintel; Dalby, Miles; Harren, Frans J M; Risby, Terence H; Marczin, Nandor
Pulmonary and systemic organ injury produced by oxidative stress including lipid peroxidation is a fundamental tenet of ischemia-reperfusion injury, inflammatory response to cardiac surgery, and cardiopulmonary bypass (CPB) but is not routinely measured in a surgically relevant time frame. To initiate a paradigm shift toward noninvasive and real-time monitoring of endogenous lipid peroxidation, we have explored pulmonary excretion and dynamism of exhaled breath ethylene during cardiac surgery to test the hypothesis that surgical technique and ischemia-reperfusion triggers lipid peroxidation. We have employed laser photoacoustic spectroscopy to measure real-time trace concentrations of ethylene from the patient breath and from the CPB machine. Patients undergoing aortic or mitral valve surgery-requiring CPB (n = 15) or off-pump coronary artery bypass surgery (OPCAB) (n = 7) were studied. Skin and tissue incision by diathermy caused striking (> 30-fold) increases in exhaled ethylene resulting in elevated levels until CPB. Gaseous ethylene in the CPB circuit was raised upon the establishment of CPB (> 10-fold) and decreased over time. Reperfusion of myocardium and lungs did not appear to enhance ethylene levels significantly. During OPCAB surgery, we have observed increased ethylene in 16 of 30 documented reperfusion events associated with coronary and aortic anastomoses. Therefore, novel real-time monitoring of endogenous lipid peroxidation in the intraoperative setting provides unparalleled detail of endogenous and surgery-triggered production of ethylene. Diathermy and unprotected regional myocardial ischemia and reperfusion are the most significant contributors to increased ethylene. PMID:25128523
Pill, C. F.; Letchworth, A. T.; Noble, A. D.
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. PMID:6462994
Maudgil, A; Wagner, B E; Rundle, P; Rennie, I G; Mudhar, H S
Purpose Malignant melanoma of the eye is an uncommon condition that is important to recognise. We describe three cases in which ocular foreign bodies have masqueraded as ocular malignant melanoma. Methods Interventional case reports. Results Case 1 describes diathermy-induced carbon particle implantation, during plaque therapy for the treatment of uveal melanoma, mimicking recurrence with extra-scleral invasion. Case 2 shows a foreign body called ‘mullite' mimicking conjunctival melanoma. Case 3 demonstrates a conjunctival foreign body called ‘illite' that mimicked a limbal melanocytic lesion, clinically thought to be either melanocytoma or melanoma. Conclusion This report highlights the importance of careful history taking, examination, and appropriate biopsy in cases of suspected malignant melanoma, to prevent unnecessary and potentially radical treatment. PMID:25104745
An increasing number of patients are now treated cardiac pacemakers and implantable cardioverter defibrillators and the technology of these is constantly changing. It is vital to have a good understanding of how they function and what the real risks are. Understanding how the device should work when functioning normally, and the possible effects of electromagnetic interference, is paramount to their safe management in the peri-operative period. Knowing when a device should be disabled or reprogrammed requires careful consideration. Information from the patient's pacemaker clinic should be sought whenever possible and can be invaluable. In addition, the Medicines Healthcare products Regulatory Agency have published the first set of UK guidelines on the management of implantable devices in the presence of surgical diathermy and this will undoubtedly provide a firm foundation on which anaesthetists can base much of their practice. PMID:16922756
Riga, Celia V. Bicknell, Colin D.; Wallace, Daniel; Hamady, Mohamad; Cheshire, Nicholas
To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure.
McCluggage, W G; Allen, D C
AIMS: To determine the causes of ovarian granulomatous inflammation and to discuss the differential diagnoses. METHODS: The pathological features of all ovarian granulomas identified by pathology SNOMED coding in Northern Ireland over a 13 year period were reviewed. Case notes of patients were also reviewed. RESULTS: The most common cause of ovarian granuloma was a foreign body reaction to suture material introduced at a previous operative procedure (15 cases). Other causes were Crohn's disease (four cases), previous diathermy (two cases), tuberculosis (two cases), a necrotising reaction following previous surgery (two cases), endometriosis (one case), and bacterial tubo-ovarian abscess (one case). In five cases, no cause was apparent for the granulomatous inflammation. In these, varying numbers of small, well circumscribed cortical granulomas were present. These cases correspond to so-called "idiopathic" cortical granulomas. CONCLUSION: The study confirms the wide range of conditions which can give rise to ovarian granulomatous inflammation. Images PMID:9215150
Riga, Celia V; Bicknell, Colin D; Wallace, Daniel; Hamady, Mohamad; Cheshire, Nicholas
To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure. PMID:18972158
Möllnitz-Schiert, P; Wiedemann, K
The physical principles of electricity and types of electrical injuries are reviewed. The extent of such injuries depends on the strength of the current: ventricular fibrillations can be induced by a current of 10mA, and even of 10 muA if the current passes directly through the heart. The extent of electrothermal injuries depends on the duration of the current flow and the contact area. Indirect electrical injuries may arise from interferance with cardiac pacemakers or monitoring equipment. Risks attendant on the use of even the "safest" electrical apparatus are discussed, with special reference to the risks arising from interaction between, e.g., high frequency diathermy and monitoring equipment or domestic appliances (beside lamp, razor) and monitoring or electrical therapeutic equipment. A number of safety measures to minimize the risk of electrical injuries are discussed. PMID:1085931
Ellingsrud, S; Johnsson, A
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. PMID:8323575
Reimold, W V
A modified monopolar electrocoagulation probe for endoscopic treatment of gastrointestinal bleedings in special situations is described. The tip of the active electrode may be moved foreward or drawn back into a teflon catheter. Thereby, blood clots are removed from the tip of the probe. The device is easy to use, reliable in emergency endoscopies and can be employed with conventional high-frequency diathermy instruments. The probe is inexpensive. 49 patients with active gastrointestinal bleedings according to Forrest Ib were treated. In 40/49 patients permanent hemostasis could be achieved. In 4/49 patients recurrent bleedings were controlled after repeated electro-coagulation. 4/49 patients needed elective operation, one patient emergency operation. Complications by application of the described monopolar electrocoagulation probe did not occur. The area of necrosis according to electrocoagulation was small. PMID:1926958
Nayak, Lipika; Nayak, Bhagabat; Sinha, Gautam; Khokhar, Sudarshan
An 11-month-old baby girl presented with white reflex in her left eye. On examination, there was a 6.5×5 mm(2)haemangioma present over her face involving on her lower lip. Systemic examinations were within normal limits. The left eye was small, with an axial length of 16.08 mm and had a cataract. Ultrasonography of the left eye was suggestive of the presence of a vascular stalk, persistent hyperplasia of a primary vitreous, or persistent fetal vasculature with vitreous haemorrhage. On MRI, the left eye was small with vitreous haemorrhage. Left eye lens aspiration was performed and the bleeding vascular stalk behind the lens was cauterised with diathermy. The right eye was normal. The patient was diagnosed as having PHACE syndrome (Posterior fossa malformations, Hemangiomas, Arterial anomalies, Coarctation of the aorta and other cardiac defects, and Eye abnormalities syndrome). On follow-up, she was able to follow light with her left eye. PMID:27033295
Misa-Agustiño, Maria J; Jorge-Mora, Teresa; Jorge-Barreiro, Francisco J; Suarez-Quintanilla, Juan; Moreno-Piquero, Eduardo; Ares-Pena, Francisco J; López-Martín, Elena
Non-ionizing radiation at 2.45 GHz may modify the morphology and expression of genes that codify heat shock proteins (HSP) in the thyroid gland. Diathermy is the therapeutic application of non-ionizing radiation to humans for its beneficial effects in rheumatological and musculo-skeletal pain processes. We used a diathermy model on laboratory rats subjected to maximum exposure in the left front leg, in order to study the effects of radiation on the nearby thyroid tissue. Fifty-six rats were individually exposed once or repeatedly (10 times in two weeks) for 30 min to 2.45 GHz radiation in a commercial chamber at different non-thermal specific absorption rates (SARs), which were calculated using the finite difference time domain technique. We used immunohistochemistry methods to study the expression of HSP-90 and morphological changes in thyroid gland tissues. Ninety minutes after radiation with the highest SAR, the central and peripheral follicles presented increased size and the thickness of the peripheral septa had decreased. Twenty-four hours after radiation, only peripheral follicles radiated at 12 W were found to be smaller. Peripheral follicles increased in size with repeated exposure at 3 W power. Morphological changes in the thyroid tissue may indicate a glandular response to acute or repeated stress from radiation in the hypothalamic-pituitary-thyroid axis. Further research is needed to determine if the effect of this physical agent over time may cause disease in the human thyroid gland. PMID:25649190
Hepworth, C; Kadirkamanathan, S; Gong, F; Swain, C
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 2mm. Keywords: endoscopic haemostasis; mesenteric vessels PMID:9616305
Armstrong, Nigel; Vale, Luke; Deverill, Mark; Nabi, Ghulam; McClinton, Samuel; N’Dow, James
Objective To determine which surgical treatment for lower urinary tract symptoms suggestive of benign prostate enlargement is cost effective. Design Care pathways describing credible treatment strategies were decided by consensus. Cost-utility analysis used Markov modelling and Monte Carlo simulation. Data sources Clinical effectiveness data came from a systematic review and an individual level dataset. Utility values came from previous economic evaluations. Costs were calculated from National Health Service (NHS) and commercial sources. Methods The Markov model included parameters with associated measures of uncertainty describing health states between which individuals might move at three monthly intervals over 10 years. Successive annual cohorts of 25 000 men were entered into the model and the probability that treatment strategies were cost effective was assessed with Monte Carlo simulation with 10 000 iterations. Results A treatment strategy of initial diathermy vaporisation of the prostate followed by endoscopic holmium laser enucleation of the prostate in case of failure to benefit or subsequent relapse had an 85% probability of being cost effective at a willingness to pay value of £20 000 (€21 595, $28 686)/quality adjusted life year (QALY) gained. Other strategies with diathermy vaporisation as the initial treatment were generally cheaper and more effective than the current standard of transurethral resection repeated once if necessary. The use of potassium titanyl phosphate laser vaporisation incurred higher costs and was less effective than transurethral resection, and strategies involving initial minimally invasive treatment with microwave thermotherapy were not cost effective. Findings were unchanged by wide ranging sensitivity analyses. Conclusion The outcome of this economic model should be interpreted cautiously because of the limitations of the data used. The finding that initial vaporisation followed by holmium laser enucleation for
van Jonbergen, Hans-Peter W.; Barnaart, Alexander F.W.; Verheyen, Cees C.P.M.
Introduction: Anterior knee pain following total knee arthroplasty is estimated to occur in 4-49% of patients. Some orthopedic surgeons use circumpatellar electrocautery (diathermy) to reduce the prevalence of postsurgical anterior knee pain; however, the extent of its use is unknown. Materials and Methodology: In April 2009, a postal questionnaire was sent to all 98 departments of orthopedic surgery in The Netherlands. The questions focused on the frequency of total knee arthroplasties, patellar resurfacing, and the use of circumpatellar electrocautery. Results: The response rate was 92%. A total of 18,876 TKAs, 2,096 unicompartmental knee arthroplasties, and 215 patellofemoral arthroplasties are performed yearly in The Netherlands by the responding orthopedic surgeons. Of the orthopedic surgeons performing TKA, 13% always use patellar resurfacing in total knee arthroplasty for osteoarthritis, 49% use selective patellar resurfacing, and 38% never use it. Fifty-six percent of orthopedic surgeons use circumpatellar electrocautery when not resurfacing the patella, and 32% use electrocautery when resurfacing the patella. Conclusion: There is no consensus among Dutch orthopedic surgeons on the use of patellar resurfacing or circumpatellar electrocautery in total knee replacement performed for osteoarthritis. A prospective clinical trial is currently underway to fully evaluate the effect of circumpatellar electrocautery on the prevalence of anterior knee pain following total knee arthroplasty. PMID:21228917
Fan, L; Evans, D H; Naylor, A R
Transcranial Doppler ultrasound (US) can be used to detect microemboli in the cerebral circulation, but is still limited because it usually relies on "human experts" (HEs) to identify signals corresponding to embolic events. The purpose of this study was to develop an automatic system that could replace the HE and, thus, make the technique more widely applicable and, potentially, more reliable. An expert system, based around a digital signal-processing board, analysed Doppler signal patterns in both the time domain and frequency domain. The system was trained and tested on Doppler signals recorded during the dissection and recovery phases of carotid endarterectomy. It was tested with 74 separate 2.5-min recordings that contained at least 575 artefacts in addition to 253 s of diathermy interference. The results were compared with the results obtained by three HEs. Using a "gold-standard" that classified any event detected by the majority of HEs as an embolus, the automatic system displayed a sensitivity of 94.7% and a specificity of 95.1% for 1151 candidate events 7 dB or more above the clutter (signal-to-clutter ratio, SCR, > or = 7 dB), and 89.6% and 95.3%, respectively, for 2098 candidate events with SCR > or = 5 dB. The system had a very similar performance to individual HEs for SCR > or = 7dB, and was only marginally worse for SCR > or = 5 dB. PMID:11527593
Gorski, P; Goetz, W
For the development of the therapy using electricity as agent two tracks can be identified. On the one side, the indication for applying this therapy was handled more careful, simultaneously the technical equipment was improved. The Polish noble man Alexander Sapieha (1773-1812), the leading natural scientist of the Granddukedom of Warsaw, cooperated with excellent European scientists in order to improve the galvanic battery technologically. Among these scientists were Alexander Volta (1745-1827), the inventor of the battery, and Johann Bartholomaeus Trommsdorff (1770-1837), who is considered as one of the founders of scientific pharmacy in Europe. A. Sapieha supported the publication of galvanic experiences, e.g. in the case of Alexander of Humboldt (1769-1859) by publishing his paper about electric fishes. Sapiehas connections with the scientific centers in Turin and Bologna, Erfurt, Warszaw and Paris accelerated the exchange of information about galvanism. Later the resulting mini-batteries were employed in diathermie, in defibrillators and pacemakers. Details about these connections are presented in the lecture resp. full paper. PMID:11625095
Benayoun, Y; Petellat, F; Leclerc, O; Dost, L; Dallaudière, B; Reddy, C; Robert, P-Y; Salomon, J-L
The extension of blood vessels into the normally avascular stroma defines corneal neovascularization. Though this phenomenon, pathophysiological and clinical features are well characterized, therapeutic modalities have been hindered by a lack of safe, efficacious and non-controversial treatments. In this literature review, we focus on available therapeutic options in light of recent evidence provided by animal and clinical studies. First, this review will focus on pharmacological treatments that target angiogenesis. The low cost and market availability of bevacizumab make it the first anti-angiogenic therapy choice, and it has demonstrable efficacy in reducing corneal neovascularization when administered topically or subconjunctivally. However, novel anti-angiogenic molecules targeting the intracellular pathways of angiogenesis (siRNA, antisense oligonucleotides) provide a promising alternative. Laser therapy (direct photocoagulation or photo-dynamic therapy) and fine needle diathermy also find a place in the treatment of stabilized corneal neovascularization alone or in association with anti-angiogenic therapy. Additionally, ocular surface reconstruction using amniotic membrane graft or limbal stem cell transplantation is essential when corneal neovascularization is secondary to primary or acquired limbal deficiency. PMID:26522890
Feilden, F. E.
It is thought that valuable data should be obtained from a correlation of the clinical and histological features, when dealing with a large number of cases of carcinoma of the prostate. As a result it should be possible to elaborate a system of grouping, each group being characterized by a definite clinical syndrome, pathological features and individual prognosis. To be of value, a record of the end-results of treatment should be on this basis. Malignant disease of the prostate is not infrequently associated with benign hypertrophy, and not infrequently arises in a lateral or median lobe. Cystoscopy may be of definite value in the diagnosis of carcinoma of the prostate. The perineal method of approach is the operation of choice in the small fibrous type of prostate, especially that which is suspected of being malignant. The results so far recorded in this country, in the treatment of carcinoma of the prostate by radium, are not encouraging. As a palliative method of treatment, trans-urethral diathermy should seldom be employed. The most satisfactory palliative method of treatment is a suprapubic cystostomy. Under certain circumstances, a radical perineal excision is justifiable and satisfactory results may be anticipated. PMID:19989820
Roy, Lisa A.; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S.; Cash, Diana; Moon, Lawrence
Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet’s equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments. PMID:26967269
Carmignani, Luca; Macchi, Alberto; Ratti, Dario; Finkelberg, Elisabetta; Casellato, Stefano; Bozzini, Giorgio; Maruccia, Serena; Marenghi, Carlo; Picozzi, Stefano
We investigated if an adequate histological diagnosis can be made from tissue after Thulium laser vapo-enucleation of the prostate (ThuVEP) and whether it is comparable to transurethral prostate resection (TURP) tissue findings in patients with symptomatic benign prostatic hyperplasia. We analyzed 350 ThuLEP and 100 matched TURP tissue specimens from patients who underwent one of the two procedures between January 2009 and June 2014. Thulium Laser Enucleation of Prostate (ThuVEP) was combined with mechanical morcellation of the resected lobe. Each histological specimen was reviewed by two pathologists. Preoperative prostate ultrasound volume, total serum prostatic specific antigen and postoperative tissue weight were evaluated. Microscopic histological diagnosis was assessed by standard histological techniques and immunohistochemical evaluation. Patients were comparable in terms of age and preoperative total serum prostate specific antigen. Incidental adenocarcinoma and high grade PIN of the prostate were diagnosed in a comparable percent of specimens in the 2 groups (2.5 % in the ThuVEP group versus 3 % in the TURP group). Tissue thermal artifacts induced by the Thulium laser are mostly due to coagulation as that of the conventional monopolar diathermy in TURP. Tissue quality was maintained in the ThuVEP histological specimens. Tissue maintain histological characteristics and proprieties without modification for successive immunoistochemical analysis. The pathologist ability to detect incidental prostate cancer and PIN was maintained even if there is a quoted of vaporized tissue. PMID:25862670
Bacelar, Tércio Souto; de Arruda, Pedro Carlos Loureiro; Ferraz, Álvaro Antonio Bandeira; Ferraz, Edmundo Machado
The accumulation of chylous fluid in the abdominal cavity is an infrequent, yet alarming, complication in abdominal surgery. Laparoscopic fundoplication has assumed a central role in the surgical treatment of gastroesophageal reflux disease and is significantly altering the balance of therapy toward more common and earlier surgical intervention. We report the case of a 67-year-old woman with gastroesophageal reflux disease and intense esophagitis who underwent a laparoscopic Nissen fundoplication in February 2000. The procedure was performed without apparent complications. Twenty days later, the patient complained of abdominal pain and distension. Ultrasonography showed ascites, whereas endoscopic and radiological exploration of the fundoplication demonstrated no abnormalities. A paracentesis was performed, which showed a milky fluid with high concentrations of triglycerides (1024 ng/dL) and cholesterol (241 ng/dL). The patient was treated successfully with total parenteral nutrition for 3 weeks, followed by a low-fat diet. To our knowledge, this is the third reported case of chylous ascites after a Nissen fundoplication and the second case after laparoscopic fundoplication. The development of chylous ascites seems to be related to the injury of lymphatic vessels, including the thoracic duct, during the retroesophageal window dissection. The careful dissection and judicious use of diathermy is proposed to prevent this rare complication. PMID:14558719
Introduction The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a year; symptoms for at least 1 year; and episodes that are disabling and prevent normal functioning. Diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results. Bacteria are cultured from few people with tonsillitis. Other causes include infectious mononucleosis from Epstein-Barr virus infection, cytomegalovirus, toxoplasmosis, HIV, hepatitis A, and rubella. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of tonsillectomy in children and adults with acute recurrent or chronic throat infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2014 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 15 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: cold-steel tonsillectomy and diathermy tonsillectomy. PMID:25051184
Borrell, R M; Parker, R; Henley, E J; Masley, D; Repinecz, M
The effectiveness of a new heat modality, Fluidotherapy, was compared with other superficial heat modalities by in vivo temperature measurements. The joint capsule and muscle temperatures in the hands and feet were measured in subjects treated with hydrotherapy, paraffin wax, and Fluidotherapy. Fluidotherapy is a dry heat modality consisting of finely divided solids suspended in an air stream. The dry heat modality, applied at 118 degrees F (47.78 degrees C), resulted in maximum joint capsule and muscle temperature rises of 16.2 degrees F (9 degrees C) and 9.5 degrees F (5.27 degrees C), respectively, compared to 13.5 degrees F (7.5 degrees C) and 8.1 degrees F (4.5 degrees C) for paraffin wax treatment and 10.8 degrees F (6.0 degrees C) and 7.7 degrees F (4.3 degrees C) for a 102 degrees F (38.89 degrees C) water bath, at a depth of about 0.5 cm beneath the skin. At depths down to 1.2 cm, superficial heat modalities are more effective than diathermy and much more effective than ultrasound in elevating temperature. PMID:7443789
Wayman, Christina; Duricki, Denise A; Roy, Lisa A; Haenzi, Barbara; Tsai, Shi-Yen; Kartje, Gwendolyn; Beech, John S; Cash, Diana; Moon, Lawrence
Stroke typically occurs in elderly people with a range of comorbidities including carotid (or other arterial) atherosclerosis, high blood pressure, obesity and diabetes. Accordingly, when evaluating therapies for stroke in animals, it is important to select a model with excellent face validity. Ischemic stroke accounts for 80% of all strokes, and the majority of these occur in the territory of the middle cerebral artery (MCA), often inducing infarcts that affect the sensorimotor cortex, causing persistent plegia or paresis on the contralateral side of the body. We demonstrate in this video a method for producing ischemic stroke in elderly rats, which causes sustained sensorimotor disability and substantial cortical infarcts. Specifically, we induce permanent distal middle cerebral artery occlusion (MCAO) in elderly female rats by using diathermy forceps to occlude a short segment of this artery. The carotid artery on the ipsilateral side to the lesion was then permanently occluded and the contralateral carotid artery was transiently occluded for 60 min. We measure the infarct size using structural T2-weighted magnetic resonance imaging (MRI) at 24 hr and 8 weeks after stroke. In this study, the mean infarct volume was 4.5% ± 2.0% (standard deviation) of the ipsilateral hemisphere at 24 hr (corrected for brain swelling using Gerriet's equation, n = 5). This model is feasible and clinically relevant as it permits the induction of sustained sensorimotor deficits, which is important for the elucidation of pathophysiological mechanisms and novel treatments. PMID:26967269
For manufacturers of electronic products other than those for which a specific guide has been issued, the guide replaces the Guide for the Filing of Annual Reports (21 CFR Subchapter J, Section 1002.11), HHS Publication FDA 82-8127. The electronic product (general) annual reporting guide is applicable to the following products: products intended to produce x radiation (accelerators, analytical devices, therapy x-ray machines); microwave diathermy machines; cold-cathode discharge tubes; and vacuum switches and tubes operating at or above 15,000 volts. To carry out its responsibilities under Public Law 90-602, the Food and Drug Administration's Center for Devices and Radiological Health (CDRH) has issued a series of regulations contained in Title 21 of the Code of Federal Regulations (CFR). Part 1002 of 21 CFR deals with records and reports. Section 1002.61 categorizes electronic products into Groups A through C. Section 1002.30 requires manufacturers of products in Groups B and C to establish and maintain certain records, while Section 1002.11 requires such manufacturers to submit an Annual Report summarizing the contents of the required records. Section 1002.7 requires that reports conform to reporting guides issued by CDRH unless an acceptable justification for an alternate format is provided.
An Assessment of Hazards Caused by Electromagnetic Interaction on Humans Present near Short-Wave Physiotherapeutic Devices of Various Types Including Hazards for Users of Electronic Active Implantable Medical Devices (AIMD)
Leakage of electromagnetic fields (EMF) from short-wave radiofrequency physiotherapeutic diathermies (SWDs) may cause health and safety hazards affecting unintentionally exposed workers (W) or general public (GP) members (assisting patient exposed during treatment or presenting there for other reasons). Increasing use of electronic active implantable medical devices (AIMDs), by patients, attendants, and workers, needs attention because dysfunctions of these devices may be caused by electromagnetic interactions. EMF emitted by 12 SWDs (with capacitive or inductive applicators) were assessed following international guidelines on protection against EMF exposure (International Commission on Nonionizing Radiation Protection for GP and W, new European directive 2013/35/EU for W, European Recommendation for GP, and European Standard EN 50527-1 for AIMD users). Direct EMF hazards for humans near inductive applicators were identified at a distance not exceeding 45 cm for W or 62 cm for GP, but for AIMD users up to 90 cm (twice longer than that for W and 50% longer than that for GP because EMF is pulsed modulated). Near capacitive applicators emitting continuous wave, the corresponding distances were: 120 cm for W or 150 cm for both—GP or AIMD users. This assessment does not cover patients who undergo SWD treatment (but it is usually recommended for AIMD users to be careful with EMF treatment). PMID:24089662
An assessment of hazards caused by electromagnetic interaction on humans present near short-wave physiotherapeutic devices of various types including hazards for users of electronic active implantable medical devices (AIMD).
Karpowicz, Jolanta; Gryz, Krzysztof
Leakage of electromagnetic fields (EMF) from short-wave radiofrequency physiotherapeutic diathermies (SWDs) may cause health and safety hazards affecting unintentionally exposed workers (W) or general public (GP) members (assisting patient exposed during treatment or presenting there for other reasons). Increasing use of electronic active implantable medical devices (AIMDs), by patients, attendants, and workers, needs attention because dysfunctions of these devices may be caused by electromagnetic interactions. EMF emitted by 12 SWDs (with capacitive or inductive applicators) were assessed following international guidelines on protection against EMF exposure (International Commission on Nonionizing Radiation Protection for GP and W, new European directive 2013/35/EU for W, European Recommendation for GP, and European Standard EN 50527-1 for AIMD users). Direct EMF hazards for humans near inductive applicators were identified at a distance not exceeding 45 cm for W or 62 cm for GP, but for AIMD users up to 90 cm (twice longer than that for W and 50% longer than that for GP because EMF is pulsed modulated). Near capacitive applicators emitting continuous wave, the corresponding distances were: 120 cm for W or 150 cm for both-GP or AIMD users. This assessment does not cover patients who undergo SWD treatment (but it is usually recommended for AIMD users to be careful with EMF treatment). PMID:24089662
Kachewar, Sushil G; Kulkarni, Devidas S
Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non - operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non - steroidal anti - inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non - operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short - wave, and radiation therapy. Rest, immobilization with a sling, and oral non - steroidal and steroid anti - inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102
Kachewar, Sushil G; Kulkarni, Devidas S
Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences. PMID:23998102
Shields, M B
When surgical attempts to control glaucoma by improving aqueous outflow are not successful, the alternative approach is usually to reduce aqueous inflow by a cyclodestructive procedure. Cyclodestructive elements that have been tried in the past include diathermy, electrolysis, and beta irradiation. Cyclocryotherapy is presently the most commonly used cyclodestructive procedure, although this operation has significant limitations, and newer techniques are being evaluated utilizing laser energy or ultrasonic radiation. Each of these procedures uses a transcleral approach, which has the disadvantages of (1) the inability to precisely quantitate the destruction of the ciliary processes, and (2) damage to adjacent tissue. Transpupillary cyclophotocoagulation minimizes these problems, but is limited to the small number of eyes in which adequate gonioscopic visualization of the ciliary processes can be achieved. An alternative approach for aphakic eyes is intraocular cyclophotocoagulation, utilizing an endophotocoagulator through a pars plana incision. Depending on the status of the eye, visualization for this technique can be accomplished either by the transpupillary route or with an endoscope. Images FIGURE 1 FIGURE 2 FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 PMID:3832531
Atef, Ahmed; Fawaz, Ahmed Aly
Tonsillectomy in adults is associated with significant postoperative pain. Intravenous paracetamol injection (Perfalgan) is marketed for the management of acute pain. This prospective placebo-controlled study was performed to evaluate the analgesic efficacy and safety of intravenous paracetamol in 76 adult patients undergoing elective standard bipolar diathermy tonsillectomy. After tonsillectomy was performed under general anesthesia, the patients were randomized to receive either intravenous paracetamol 1 g (Perfalgan) (n = 38) or 0.9% normal saline as a placebo (n = 38) at 6-h intervals. No other analgesic medication was permitted for postoperative pain during the study. Need for rescue analgesic during the first 24 h after surgery as well as all adverse events were recorded. The intravenous paracetamol group differed significantly from the placebo group regarding pain relief and median time to pethidine rescue. Intravenous paracetamol significantly reduced pethidine consumption over the 24-h period. The worst pain after surgery was also more severe in the placebo group than that in the paracetamol group. There was no significant difference between groups in the incidence of adverse events. Intravenous paracetamol administered regularly in adult patients with moderate to severe pain after tonsillectomy provided rapid and effective analgesia and was well tolerated. PMID:17891409
Creatsas, George; Deligeoroglou, Efthimios
Vaginal aplasia is an uncommon congenital anomaly which is usually diagnosed as part of the Mayer-Rokitansky-Kuster-Hauser syndrome. The appropriate management of the anomaly includes the creation of a neovagina, and various surgical or non-surgical techniques have been described. Among them the Creatsas modification of Williams vaginoplasty is an operative technique which involves the following surgical steps: Under general anesthesia, and after cutting the hymen with the use of diathermy, a U-shaped incision is made in the vulva extending across the perineum and up to the medial side of the labia to the level of the external urethral meatus, being 4cm lateral to it. The tissues are mobilized and a first layer of interrupted sutures is put between the inner skin margins using absorbable material with the knots lying inside the creating neovagina. A second layer of the same material is used to approximate the subcutaneous fat and the perineal muscles and finally, the external skin is sutured with absorbable interrupted stitches. The Creatsas vaginoplasty is simple, safe and highly effective, as its application in a large number of patients has been followed by excellent results, with the creation of a satisfactory neovagina (length 10-12 cm, width 5 cm) in 98% of patients. PMID:17350745
Diathermy is used widely in neurosurgical procedures, mainly for subcutaneous and deeper layers dissection. The use on scalp and skin of other body parts has been precluded by the fear of scar formation and wound dehiscence. One-hundred-and-seventy-seven skin incisions for neurosurgical procedures have been performed using the micro-needle electrocautery scalpel (MES) and the steel scalpel. The elements in this study included: electrocautery generator unit, cutting mode, power, waveform, size and shape of the MES, depth of the incision, the speed of the electrode movement through tissue, amount of blood loss, physical inspection of the wound edges and wound complication. Patients tolerated the procedures well, with no increased risk from the use of the MES. Only two incisions had wound infection and dehiscence. All other patients had usual wound healing. Time taken during skin opening was significantly shorter when using the MES. Blood loss during skin opening was three to five times less when the micro-needle electrocautery scalpel was used. The MES is both safe and useful in neurosurgical procedures. The findings of this study recommend the use of the MES in all neurosurgical procedures, especially when blood loss has significant importance, such as in paediatric cases. PMID:15327229
Reidenbach, H D
In order to perform endoscopic haemostasis there exist several different mechanical, biochemical and thermal methods, which may be applied together with rigid or fully flexible endoscopes in different situations. The technological fundamentals of convective, conductive and radiative heat transfer, the irradiation with coherent electromagnetic waves like microwaves and laser radiation and the resistive heating by RF-current are described. A review of the state of the art of haemostatic coagulation by laser radiation (photocoagulation) and radio-frequency currents (surgical diathermy, high-frequency coagulation) is given. The wavelength-dependent interactions of coherent light waves are compared especially for the three mainly different laser types, i.e., carbon-dioxide-, neodymium-YAG- and argon-ion-laser. The well-known disadvantages of the conventional RF-coagulation are overcome by the so-called electrohydrothermosation (EHT), i.e. the liquid-assisted application of resistive heating of biological tissues to perform haemostasis. Different technological solutions for bipolar RF-coagulation probes including ball-tips and forceps are shown and the first experimental results are discussed in comparison. PMID:1595405
Dua, Rajan; Chakraborty, Suman
Knowledge of heat transfer in biological bodies has many therapeutic applications involving either raising or lowering of temperature, and often requires precise monitoring of the spatial distribution of thermal histories that are produced during a treatment protocol. Extremes of temperature into the freezing and burning ranges are useful in surgical procedures for selective killing and/or removal of target tissues. For example, the primary objective of hyperthermia is to raise the temperature of the diseased tissue to a therapeutic value, typically 41- 44 degrees C, and then thermally destroy it. The present paper therefore aims to develop a mathematical model for effective simulation of photo--thermal interactions between laser rays and biological tissues. In particular, damage of biological tissues when subjected to single point laser diathermy is numerically investigated using a unique enthalpy-based approach for modeling multiple phase change, (namely, melting of fat and vaporization of water content of the tissues) and the associated release/absorption of latent heat in conjunction with unsteady state heat conduction mechanisms. The governing equations of bio-heat transfer coupled with initial and boundary conditions are solved using a finite volume approach in conjunction with line by a line tri-diagonal matrix algorithm (TDMA) solver. Temperature responses of tissues subject to laser heating are quantitatively investigated in detail using the present model, and the resultant solutions are expected to be immensely useful in a variety of Bio-thermal practices in medicine and surgery. PMID:15767117
De Angelis, Paola; Romeo, Erminia; Rea, Francesca; Torroni, Filippo; Caldaro, Tamara; Federici di Abriola, Giovanni; Foschia, Francesca; Caloisi, Claudia; Lucidi, Vincenzina; Dall'Oglio, Luigi
Pancreatic pseudocysts (PP) arise from trauma and pancreatitis; endoscopic gastro-cyst drainage (EGCD) under endoscopic ultrasonography (EUS) in symptomatic PP is the treatment of choice. Miniprobe EUS (MEUS) allows EGCD in children. We report our experience on MEUS-EGCD in PP, reviewing 13 patients (12 children; male:female = 9:3; mean age: 10 years, 4 mo; one 27 years, malnourished male Belardinelli-syndrome; PP: 10 post-pancreatitis, 3 post-traumatic). All patients underwent ultrasonography, computed tomography and magnetic resonance imaging. Conservative treatment was the first option. MEUS EGCD was indicated for retrogastric cysts larger than 5 cm, diameter increase, symptoms or infection. EGCD (stent and/or nasogastrocystic tube) was performed after MEUS (20-MHz-miniprobe) identification of place for diathermy puncture and wire insertion. In 8 cases (61.5%), there was PP disappearance; one, surgical duodenotomy and marsupialization of retro-duodenal PP. In 4 cases (31%), there was successful MEUS-EGCD; stent removal after 3 mo. No complications and no PP relapse in 4 years of mean follow-up. MEUS EGCD represents an option for PP, allowing a safe and effective procedure. PMID:23678380
Scott, Jonathan B.; Parker, Anthony E.
The evolution of wide-bandgap semiconductor transistor technology is placed in historical context with other active device technologies. The relative rapidity of GaN transistor development is noted and is attributed to the great parallel activity in the lighting sector and the historical experience and business model from the III-V compound semiconductor sector. The physical performance expectations for wide-bandgap technologies such as Gallium-Nitride Field-Effect Transistors (GaN FETs) are reviewed. We present some device characteristics. Challenges met in characterising, and prospects for modeling GaN FETs are described. Reliability is identified as the final remaining hurdle facing would-be foundries. Evolutionary and unsurprising applications as well as novel and revolutionary applications are suggested. Novel applications include wholly monolithic switchmode power supplies, simplified tools for ablation and diathermy in tissue, and very wide dynamic range circuits for audio or low phase noise signal generation. We conclude that now is the time to embark on circuit design of MMICs in wide-bandgap technology. The potential for fabless design groups to capitalise upon design IP without strong geopraphic advantage is noted.
Hareuveny, R; Kavet, R; Shachar, A; Margaliot, M; Kheifets, L
Relatively high exposures to radiofrequency (RF) fields can occur in the broadcast, medical, and communications industries, as well in occupations that use RF emitting equipment (e.g. law enforcement). Information on exposure to workers employed in these industries and occupations is limited. We present results of an Israeli National Survey of occupational RF field levels at frequencies between ~100 kHz and 40 GHz, representing Industrial Heating, Communications, Radar, Research, and Medicine. Almost 4300 measurements from 900 sources across 25 occupations were recorded and categorised as 'routine', 'incidental', or 'unintended'. The occupation-specific geometric means (GMs) of the percentage of the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit values (TLVs) for each of the three exposure scenarios are presented together with the geometric standard deviation (GSD). Additionally, we present estimates of occupation-specific annual personal exposures and collective exposures. The vast majority of the GM of routine exposures ranged from a fraction to less than 1% of ACGIH TLVs, except for Walkie-Talkie (GM 94% of ACGIH), Induction Heating (17%), Plastic Welding (11%), Industrial Heating (6%) and Diathermy (6%). The GM of incidental and unintended exposures exceeded the TLV for one and 14 occupations, respectively. In many cases, the within-occupation GSD was very large, and though the medians remained below TLV, variable fractions of these occupations were projected to exceed the TLV. In rank order, Walkie-Talkie, Plastic Welding, and Induction Heating workers had the highest annual cumulative personal exposure. For cumulative collective exposures within an occupation, Walkie-Talkie dominated with 96.3% of the total, reflecting both large population and high personal exposure. A brief exceedance of the TLV does not automatically translate to hazard as RF exposure limits (issued by various bodies, including ACGIH) include a 10
Rosario, Jose Luis; Foletto, Álexis
A lack of muscle flexibility affects the functionality of the human body, making it difficult to carry out certain activities of daily living. The aim of the present study was to compare the technique of passive static stretching on hamstring muscles in isolation, or combined with heating techniques and different application times. Fifty women were randomly assigned to 5 groups (n = 10 each): The Microwave Diathermy Group had the hamstrings heated by microwave before stretching; Treadmill Group, in which warm-up walking was performed before stretching; 30-Second Group, in which 30 s of stretching was performed; 10-Minute Group, which involved stretching for 10 min and Control Group. In all groups, the leg extension range of motion was assessed, and the flexibility by the third finger-ground test was performed before and after application. The individuals in the experimental groups performed three stretching sessions on three consecutive days. All statistical analysis was performed with p ≤ 0.05. The results showed that all treatments were effective compared to the control group. The Treadmill Group and the 10-Minute group were superior for an acute effect (soon after the stretch--related to a decreased muscular viscoelasticity). The 10-Minute Group was the most effective for the chronic effect (long lasting--related to increased numbers of sarcomeres). A 10-minute stretch, when performed over four subsequent days, is suggested for faster increase in flexibility. The results could suggest a systemic warming (such as the one provided by a treadmill workout) before stretching for an acute gain of flexibility in the same day. It was possible to identify the inefficiencies associated with the use of microwaves in terms of stretching to gain flexibility. In fact, the values recorded were similar to stretching without any heat at all. PMID:25603738
Black, SA; Taylor, FGM; Russell, MH; Ariga, R; Thomas, MH
INTRODUCTION Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis. PATIENTS AND METHODS Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter's Hospital between 1987 and 2006. Patients were followed up by telephone interview. RESULTS A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9–71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner's syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem. CONCLUSIONS Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome. PMID:18325216
Mantiply, E D; Pohl, K R; Poppell, S W; Murphy, J A
We have plotted data from a number of studies on the range of radiofrequency (RF) field levels associated with a variety of environmental and occupational sources. Field intensity is shown in units of volts/meter (V/m) for electric field strength and amps/meter (A/m) for magnetic field strength. Duty factors, modulation frequencies, and modulation indices are also reported for some sources. This paper is organized into seven sections, each cataloging sources into appropriate RF frequency bands from very-low frequency (VLF) to super-high frequency (SHF), and covers frequencies from 10 kHz to 30 GHz. Sources included in this summary are the following: Coast Guard navigational transmitters, a Navy VLF transmitter, computer visual display terminals (VDTs), induction stoves or range tops, industrial induction and dielectric heaters, radio and television broadcast transmitters, amateur and citizens band (CB) transmitters, medical diathermy and electrosurgical units, mobile and handheld transmitters, cordless and cellular telephones, microwave ovens, microwave terrestrial relay and satellite uplinks, and police, air traffic, and aircraft onboard radars. For the sources included in this summary, the strongest fields are found near industrial induction and dielectric heaters, and close to the radiating elements or transmitter leads of high power antenna systems. Handheld transmitters can produce near fields of about 500 V/m at the antenna. Fields in the general urban environment are principally associated with radio and TV broadcast services and measure about 0.1 V/m root-mean-square (rms). Peak fields from air traffic radars sampled in one urban environment were about 10 V/m, 300 times greater than the rms value of 0.03 V/m when the duty factor associated with antenna rotation and pulsing are factored in. PMID:9383245
Motta, Alicia Beatriz
Polycystic Ovary Syndrome (PCOS) is one of the common endocrine diseases that affects women in their reproductive age. PCOS has diverse clinical implications that include reproductive (infertility, hyperandrogenism, hirsutism), metabolic (insulin resistance, impaired glucose tolerance, type 2 diabetes mellitus, cardiovascular diseases) and psychological features (increased anxiety, depression and worsened quality of life). The exact patho-physiology of PCOS is complex and remains largely unclear. The prevalence of PCOS is estimated at 4-18%, depending on diverse factors discussed ahead. The phenotype varies widely depending on life stage, genotype, ethnicity and environmental factors including lifestyle and body weight. During the last decades, obesity and excess weight are major chronic diseases all around the word. Obesity increases some features of PCOS such as hyperandrogenism, hirsutism, infertility and pregnancy complications. Both obesity and insulin resistance increase diabetes mellitus type 2 and cardiovascular diseases. Moreover, obesity impairs insulin resistance and exacerbates reproductive and metabolic features of PCOS. It is well known that obesity is associated with anovulation, pregnancy loss and late pregnancy complications (pre-eclampsia, gestational diabetes). Obesity in PCOS is also linked to failure or delayed response to the various treatments including clomiphene citrate, gonadotropins and laparoscopic ovarian diathermy. It has been reported that, after losing as little as 5 % of initial body weight obese women with PCOS improved spontaneous ovulation rates and spontaneous pregnancy. Therefore, the weight loss prior to conception improves live birth rate in obese women with or without PCOS. The treatment of obesity may include lifestyle therapy (diet and exercise), pharmacological treatment and bariatric surgery. In summary, weight loss is considered the first-line therapy in obese women with PCOS. In the present review, the consequence and
Dall’Oglio, Luigi; Caldaro, Tamara; Foschia, Francesca; Faraci, Simona; Federici di Abriola, Giovanni; Rea, Francesca; Romeo, Erminia; Torroni, Filippo; Angelino, Giulia; De Angelis, Paola
Post-esophageal atresia anastomotic strictures and post-corrosive esophagitis are the most frequent types of cicatricial esophageal stricture. Congenital esophageal stenosis has been reported to be a rare but typical disease in children; other pediatric conditions are peptic, eosinophilic esophagitis and dystrophic recessive epidermolysis bullosa strictures. The conservative treatment of esophageal stenosis and strictures (ES) rather than surgery is a well-known strategy for children. Before planning esophageal dilation, the esophageal morphology should be assessed in detail for its length, aspect, number and level, and different conservative strategies should be chosen accordingly. Endoscopic dilators and techniques that involve different adjuvant treatment strategies have been reported and depend on the stricture’s etiology, the availability of different tools and the operator’s experience and preferences. Balloon and semirigid dilators are the most frequently used tools. No high-quality studies have reported on the differences in the efficacies and rates of complications associated with these two types of dilators. There is no consensus in the literature regarding the frequency of dilations or the diameter that should be achieved. The use of adjuvant treatments has been reported in cases of recalcitrant stenosis or strictures with evidence of dysphagic symptoms. Corticosteroids (either systemically or locally injected), the local application of mitomycin C, diathermy and laser ES sectioning have been reported. Some authors have suggested that stenting can reduce both the number of dilations and the treatment length. In many cases, this strategy is effective when either metallic or plastic stents are utilized. Treatment complications, such esophageal perforations, can be conservatively managed, considering surgery only in cases with severe pleural cavity involvement. In cases of stricture relapse, even if such relapses occur following the execution of well
Kumar, Suraj; Sharma, Vijai P; Negi, Mahendra P S
Low back pain (LBP) is a common health problems. Although it is multifactorial, its treatment varies considerably, including medication, physical therapy modalities, and exercise therapy, and each have several interventions. Despite their effectiveness, their head-to-head comparisons are limited. This study was aimed at 1 such comparison. A total of 30 hockey players, 18 to 28 years of age, with subacute or chronic LBP were randomly assigned equally in 2 groups. One group was treated with conventional treatment--a combination of 2 electrotherapies (ultrasound and short-wave diathermy) and 1 exercise therapy (lumbar strengthening exercises)--and the other group was treated with dynamic muscular stabilization techniques (DMST), an active approach of stabilizing training. The results showed that both the treatments are effective in the management of LBP, but DMST was found to be more effective than conventional treatment. The walking, stand ups, climbing, and pain improved 4.7, 2.0, 1.4, and 2.1 times, respectively, more with DMST than with conventional treatment. With time (days), walking, stand ups, climbing, and pain improved (correlation) significantly (p < 0.01) higher in DMST (r = 0.83 to 0.92) than in conventional treatment (r = 0.40 to 0.75), and their rate of improvement (regression beta coefficients) were also significantly (p < 0.01) higher in DMST (beta = -0.16 to 0.73) than in conventional treatment (beta = -0.07 to 0.15). Subjects matching were perfect (p < 0.01) and test-retest reliability of all dependent variables was significantly (p < 0.01) high (intraclass correlation coefficient approximately 1). No major adverse effects were recorded in any of the patients in either group. This study concluded that for early recovery, DMST is more suitable than conventional treatment. PMID:19858754
Kessler, T M; Wöllner, J; Kozomara, M; Mordasini, L; Mehnert, U
Sacral neuromodulation (SNM) represents a promising option for managing treatment-refractory neurogenic bladder dysfunction. It remains to be seen, however, which types of neurogenic bladder dysfunction and which underlying neurological disorders best respond to SNM. Constant improvements in SNM have been achieved and it is now a minimally invasive approach performed under local anesthesia which should be considered before undertaking larger reconstructive procedures. An electrode is implanted in the S3 or S4 sacral foramen and during a test phase lasting for days to weeks the patient keeps a bladder diary to determine whether SNM has provided a relevant benefit. If the results of the test phase are positive, a neuromodulator is implanted in the gluteal area (or more rarely in the abdominal wall).The mechanism of action of SNM has not been completely clarified, but the afferent nerves most likely play a key role. It appears that SNM produces a modulation of medullary reflexes and brain centers by peripheral afferents. The implanted neuromodulation system does not lead to limitation of the patient's activities. However, it should be noted that high-frequency diathermy and unipolar electrocauterization are contraindicated in patients with neuromodulators, that during extracorporeal shock wave lithotripsy the focal point should not be in the direct vicinity of the neuromodulator or the electrode, that ultrasound and radiotherapy in the region of the implanted components should be avoided, that the neuromodulation should be discontinued in pregnancy, and that MRI examinations should only be conducted when urgently indicated and the neuromodulator is turned off. PMID:22269992
Bosteels, Jan; Van Herendael, Bruno; Weyers, Steven; D'Hooghe, Thomas
In everyday clinical practice, it is not always clear if and when exactly in the fertility work-up a diagnostic laparoscopy should be offered. The aim of this review is to analyse the available evidence with respect to alternative diagnostic methods for detecting tuboperitoneal infertility and with respect to the position of diagnostic laparoscopy in women with infertility. A literature search of the National Library of Medicine and the National Institutes of Health (PubMed) was performed using the key words 'diagnostic laparoscopy and infertility'. The study methodology was carefully considered in an effort to present conclusions preferably based on randomized controlled trials (RCTs). The routine use of diagnostic laparoscopy for the evaluation of all cases of female infertility is currently under debate. According to data published in retrospective non-controlled studies, diagnostic laparoscopy after several failed cycles of ovulation induction enables the detection of a significant proportion of pelvic pathology amenable to treatment. A Cochrane review has shown that laparoscopic ovarian diathermy in clomiphene-resistant polycystic ovarian syndrome is at least as effective as gonadotrophin treatment, and results in a lower multiple pregnancy rate. The role of laparoscopy before the start of treatment with intrauterine insemination is controversial, according to one RCT. In women with bilateral ultrasonically visible hydrosalpinges, two RCTs have demonstrated increased implantation and pregnancy rates in IVF cycles after salpingectomy. Although RCTs which have studied the benefit of laparoscopic surgery in moderate or severe endometriosis are still lacking, its value has generally been accepted. In conclusion, some specific clinical settings, solid evidence is available to recommend the use of diagnostic laparoscopy in current fertility practice. There is however a need for more RCTs to answer remaining questions regarding its value in the diagnosis and
Rathinam, Sridhar; Nanjaiah, Prakash; Sivalingam, Sivakumar; Rajesh, Pala B
Background Video-Assisted Thoracoscopic Sympathectomy (VATS) is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes. Methods We evaluated 200 procedures in 100 consecutive patients, who underwent Video Assisted Thoracoscopic Sympathectomy by a single surgeon in our centre between September 1996 to March 2007. All patients had maximum medical therapy prior to surgery and were divided into 3 groups based on indications, Group 1(hyperhidrosis: 48 patients), Group 2 (facial flushing: 26 patients) and Group 3(intractable angina: 26 patients). The demography and severity of symptoms for each group were analysed. The endpoints were success rate, 30 day mortality, complications and patient's satisfaction. Results 99 patients had bilateral VATS sympathectomy and 1 had unilateral sympathectomy. The conversion rate to open was 1(1%). All patients had successful removal of ganglia proven histologically with no perioperative mortality in our series. The complications included pneumothorax (5%), acute coronary syndrome (2%), transient Horner's syndrome (1%), transient paraesthesia (1%), wound infection (4%), compensatory hyperhidrosis (18%), residual flushing (3%) and wound pain (5%). There were five late deaths in the intractable angina group at a mean follow up of 36.7 months. Overall success rates of abolishing the symptoms were 96.3%, 87.5% and 95.2% for Group 1, 2 and 3 respectively. Conclusion Excision of the sympathetic chain with histological confirmation during VATS sympathectomy is a safe and effective method in treating hyperhidrosis, facial flushing and intractable angina with good long term results and satisfaction. PMID:18700966
Kuzma, Scott A.; Doberstein, Scott T.; Rushlow, David R.
Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1–T2 disc herniation. Background: A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Differential Diagnosis: Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. Treatment: The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1–T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Uniqueness: Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. Conclusions: The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1–T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for
Dall'Oglio, Luigi; Caldaro, Tamara; Foschia, Francesca; Faraci, Simona; Federici di Abriola, Giovanni; Rea, Francesca; Romeo, Erminia; Torroni, Filippo; Angelino, Giulia; De Angelis, Paola
Post-esophageal atresia anastomotic strictures and post-corrosive esophagitis are the most frequent types of cicatricial esophageal stricture. Congenital esophageal stenosis has been reported to be a rare but typical disease in children; other pediatric conditions are peptic, eosinophilic esophagitis and dystrophic recessive epidermolysis bullosa strictures. The conservative treatment of esophageal stenosis and strictures (ES) rather than surgery is a well-known strategy for children. Before planning esophageal dilation, the esophageal morphology should be assessed in detail for its length, aspect, number and level, and different conservative strategies should be chosen accordingly. Endoscopic dilators and techniques that involve different adjuvant treatment strategies have been reported and depend on the stricture's etiology, the availability of different tools and the operator's experience and preferences. Balloon and semirigid dilators are the most frequently used tools. No high-quality studies have reported on the differences in the efficacies and rates of complications associated with these two types of dilators. There is no consensus in the literature regarding the frequency of dilations or the diameter that should be achieved. The use of adjuvant treatments has been reported in cases of recalcitrant stenosis or strictures with evidence of dysphagic symptoms. Corticosteroids (either systemically or locally injected), the local application of mitomycin C, diathermy and laser ES sectioning have been reported. Some authors have suggested that stenting can reduce both the number of dilations and the treatment length. In many cases, this strategy is effective when either metallic or plastic stents are utilized. Treatment complications, such esophageal perforations, can be conservatively managed, considering surgery only in cases with severe pleural cavity involvement. In cases of stricture relapse, even if such relapses occur following the execution of well
Ghaly, Ramsis F.; Tverdohleb, Tatiana; Candido, Kenneth D.; Knezevic, Nebojsa Nick
Background: Spinal cord stimulation is currently approved to treat chronic intractable pain of the trunk and limbs. However, such implantable electronic devices are vulnerable to external electrical currents and magnetic fields. Within the hospitals and modern operating rooms (ORs), there is an abundance of electrical devices and other types of equipment that could interfere with such devices. Despite the increasing number of patients with neuromodulation implantable devices, there are no written guidelines available or consensus of cautions for such patients undergoing unrelated surgery. Case Descriptions: A 60-year-old female with a permanent St. Jude's spinal cord stimulator (SCS) presented for open total abdominal hysterectomy. Both the anesthesia and gynecology staffs were aware of the device presence, but were unaware of any precautions regarding intraoperative management. The device was found to be nonmagnetic resonance imaging compatible, and bipolar cautery was used instead of monopolar cautery. A 59-year-old female with a 9-year-old permanent Medtronic SCS, presented for right total hip arthroplasty. The device was switched off prior to entering the OR, bipolar cautery was used, and grounding pads were placed away from her battery site. In each case, the manufacturer's representative was contacted preoperative. Both surgeries proceeded uneventfully. Conclusions: The Food and Drug Administration safety information manual warns about the use of diathermy, concomitant implanted stimulation devices, lithotripsy, external defibrillation, radiation therapy, ultrasonic scanning, and high-output ultrasound, all of which can lead to permanent implant damage if not turned off prior to undertaking procedures. Lack of uniform guidelines makes intraoperative management, as well as remote anesthesia care of patients with previously implanted SCSs unsafe. PMID:26958424
Snyder, J D
In an interview with Family Planning World, Helen Axby of the Marie Stopes Clinics explains that the organization's growth at a time when the number of abortions in Great Britain has begun to decline is due to successful management and marketing. Although the British government provides from abortion services, the Marie Stopes Clinics performs over 25,000 abortions a year. According to Axby, the main reason for this is that government restrictions have created a cumbersome process where women often wait 3-4 weeks to receive an abortion. At the Stopes clinics, women receive prompt treatment in a comfortable setting. A consultation is scheduled within a day or two following the initial phone call, and the operation is scheduled at the woman's convenience. Axby explains that the organization conducts extensive advertisement in the Yellow Pages, local newspapers, and women's magazines. Though the clinic operates for profit, its services are far less expensive than what it would cost to obtain them at other private offices. In 1990, the organization grossed about 6.2 million pounds (profits were around 1 million pounds). The profits are used to fund overseas projects. Because of the decline in the number of abortions in Britain, Axby expects the organization to earn less this year. However, Marie Stopes clinics plans to fight to increase its market share of family planning services. Its fastest growing service is vasectomy. Relying on the noninvasive bipolar diathermy technique, the Stopes Clinics have made vasectomy a more simple and comfortable experience for men. Other services include employee screening (for pap smears, breast checks, etc.). Finally, Axby says that the organization might also increase its market share by acquiring its competitors. PMID:12284512
Wilson, M. Edward
ABSTRACT Purpose To describe and analyze pediatric anterior capsulotomy techniques and make recommendations. Methods Five anterior capsulotomy techniques were compared using a porcine model. Extensibility was measured by calculating the mean stretch-to-rupture circumference of each capsulotomy (20 eyes per technique) as a percentage of its circumference at rest. Edge characteristics were reviewed using scanning electron microscopy. A 10-year review of consecutive pediatric cataract surgeries performed by the author focused on the anterior capsulotomy results. A worldwide survey was used to determine current practice patterns. Results Manual continuous curvilinear capsulorrhexis (CCC) produced the most extensible porcine capsulotomy (185%) with the most regular edge and is preferred by surgeons for patients aged 2 years and older. In the pseudophakic clinical cases reviewed, a radial tear developed in 3 (6.5%) of 46 manual CCC cases. Vitrectorhexis (porcine extensibility, 161%) is preferred by surgeons during the first 2 years of life. A radial tear developed in 16 (7.7%) of 208 vitrectorhexis pseudophakic eyes (29 tears in 284 pseudophakic eyes [10.2%] overall). The Kloti diathermy unit, Fugo plasma blade, and “can-opener” technique produced porcine capsulotomies of 145%, 170%, and 149% extensibility, respectively, and radial tears numbering 4 (21%) of 19, 5 of 8, and 1 of 2, respectively, in the clinical series. Conclusions All five capsulotomy techniques are recommendable for children. Only the vitrectorhexis and manual CCC are commonly used today. Vitrectorhexis is well suited for use in infants and young children; manual CCC is best used beyond infancy, and it produces the most stable edge. PMID:15747769
Singal, Rajinder Pal; Sandhu, Karamjot; Singh, Bir; Bhatia, Gaurav; Khatri, Abhishek; Sharma, Bhanu Pratap
bilirubin, AST and ALT occurs after LC or after OC. The alteration in the liver enzymes can be attributed to CO2 pneumoperitoneum, surgical manipulations, diathermy, patient position, and arterial injury may also other factors. These changes return to normal in 3-4 days after procedure and they have no clinical consequences in patients with normal hepatic function but they may still cause worry to the surgeon regarding the integrity of biliary tree. PMID:26487940
Oak, SN; Dave, NM; Garasia, MB; Parelkar, SV
the patients was suboptimal, which led to displacement of diathermy grounding pad. In 54 (1.8%) patients, the checklist was not used at all. In 76 (2.5%) patients the checklist was found to be incompletely filled. Conclusions: Our study supports the use of the checklist as an essential safety tool and reinforcement of the same. The checklist may act as a valuable prompt to focus the team, to ensure that even the simple things have been cared for. PMID:25766340
Castellani, John W; Zambraski, Edward J; Sawka, Michael N; Urso, Maria L
Hyperthermia is suspected of accentuating skeletal muscle injury from novel exercise, but this has not been well studied. This study examined if high muscle temperatures alters skeletal muscle injury induced by eccentric exercise (ECC). Eight volunteers (age, 22.5 ± 4.1 year; height, 169.5 ± 10.8 cm; body mass, 76.2 ± 12.6 kg), serving as their own control, and who were not heat acclimatized, completed two elbow flexor ECC trials; in one trial the biceps were heated >40°C (HEAT) and in the other trial there was no heating (NON). HEAT was applied with shortwave diathermy (100 W) for 15 min immediately before the first ECC bout and for 2 min in between each bout. Individuals were followed for 10 days after each ECC session, with a 6-week washout period between arms. The maximal voluntary isometric contraction decreased by 41 ± 17% and 46 ± 20% in the NON and HEAT trials, respectively. Bicep circumference increased by 0.07 ± 0.08 mm (4%, P = 0.04) and relaxed range of motion decreased by 11.5 ± 8.2° (30%, P < 0.001) in both trials. Serum creatine kinase peaked 72-h following ECC (NON: 6289 ± 10407; HEAT: 5486 ± 6229 IU L(-1), 38-fold increase, P < 0.01) as did serum myoglobin (NON: 362 ± 483; HEAT: 355 ± 373 μg L(-1), 13-fold increase, P < 0.03). Plasma HSP 70 was higher (P < 0.02) in HEAT after 120-h of recovery. There were no differences between treatments for plasma HSP27 and interleukins 1β, 6, and 10. The results indicate that >40°C muscle temperature does not alter skeletal muscle injury or functional impairments induced by novel ECC. PMID:27185904
Gabriel, W. B.
The analysis is of 55 cases admitted into St. Mark's Hospital from 1922 to 1940. The incidence was 3.35% of all cases of cancer of the rectum, anal canal and anus admitted during this period. Sex distribution—27 males and 28 females. The average age (61.7 years) is higher than that of columnar-cell carcinoma of the rectum (57.4 years). Histology.—The cases have been graded into three grades of malignancy—low grade, medium grade, and high grade. Low grade squamous carcinoma is twice as frequent in men as in women, and generally originates at the anal margin. Medium grade squamous carcinoma is equally distributed between men and women; it may arise at the anus or in the anal canal. High grade squamous carcinoma is much more common in the female sex and is almost entirely limited to the anal canal. Quadrant affected—about one-third of the anal margin growths and one-half of the anal canal growths were situated anteriorly. Differential diagnosis from simple papilloma, simple ulcer, chronic inflammation, tuberculous ulcer, tuberculide, primary chancre, amœbic ulcer, basal-cell carcinoma, columnar-cell carcinoma. Biopsy and grading essential before treatment is decided upon. The results of treatment in the three grades of malignancy are described. The best results were obtained in the early low-grade cases treated by interstitial radium needling. In the medium and high grades only three five-year survivals can be reported and these followed excision of the rectum. The management of the inguinal glands is discussed and the importance of a very close post-operative supervision emphasized. Squamous carcinoma of the anal canal may cause lymphatic metastases in the superior hæmorrhoidal glands; there have been four such cases in this series. Diathermy perineal excision is indicated in these cases. ImagesFig. 1Fig. 2Fig. 3Fig. 5Fig. 6aFig. 6bFig. 7Fig. 1Fig. 2Fig. 3Fig. 4 PMID:19992316
Cunha-Vaz, J. G.; Maurice, D. M.
1. The movement of fluorescein across the retinal surface of the rabbit's eye was estimated by measuring the concentration gradient of the dye in the vitreous body. These measurements were made in vivo by means of a slit-lamp fluorophotometer, or were taken from frozen sections of enucleated eyes. 2. In the normal eye, fluorescein does not pass from the blood to the vitreous body across any part of the retina. When injected into the vitreous body it passes rapidly out across the entire retinal surface, even against a very large concentration gradient. 3. A variety of metabolic and competitive inhibitors, effective in blocking organic anion transport in the kidney and liver, tend to abolish this unidirectional movement of fluorescein across the retina. 4. The region occupied by the retinal vessels is more sensitive to inhibition than other areas of the retina. Occlusion of the vessels by diathermy prevents the exchange of fluorescein in this region. 5. It appears, then, that there is an active transport of organic anions out of the vitreous body, both by the retinal capillaries and by the retina itself. The latter system is probably located in the pigment epithelium and seems to be carried forward to the rear surface of the iris. 6. Since the walls of the retinal vessels of the rabbit are freely in contact with the vitreous body, the active transport must take place across the capillary endothelial cells themselves. These vessels have structural and permeability characteristics found only in the central nervous system and it is to be presumed that the anion transport system is shared by the capillaries of the brain. 7. The function of the transport in the retina may be to protect the nervous tissue from toxic materials by preventing their entry from the blood or by removing products of metabolism conjugated as organic anions. Alternatively, the mechanism may be concerned in maintaining the normal adhesion of the retina to the choroid, since retinal detachment was
Zindel, Joel; Inglin, Roman; Brügger, Lukas
Up to one third of the general population suffers from symptoms caused by hemorrhoids. Conservative treatment comes first unless the patient presents with an acute hemorrhoidal prolapse or a thrombosis. A fiber enriched diet is the primary treatment option, recommended in the perioperative period as well as a long-term prophylaxis. A timely limited application of topical ointments or suppositories and/or flavonoids are further treatment options. When symptoms persist interventional procedures for grade I-II hemorrhoids, and surgery for grade III-IV hemorrhoids should be considered. Rubber band ligation is the interventional treatment of choice. A comparable efficacy using sclerosing or infrared therapy has not yet been demonstrated. We therefore do not recommend these treatment options for the cure of hemorrhoids. Self-treatment by anal insertion of bougies is of lowrisk and may be successful, particularly in the setting of an elevated sphincter pressure. Anal dilation, sphincterotomy, cryosurgery, bipolar diathermy, galvanic electrotherapy, and heat therapy should be regarded as obsolete given the poor or missing data reported for these methods. For a long time, the classic excisional hemorrhoidectomy was considered to be the gold standard as far as surgical procedures are concerned. Primary closure (Ferguson) seems to be superior compared to the "open" version (Milligan Morgan) with respect to postoperative pain and wound healing. The more recently proposed stapled hemorrhoidopexy (Longo) is particularly advisable for circular hemorrhoids. Compared to excisional hemorrhoidectomy the Longo-operation is associated with reduced postoperative pain, shorter operation time and hospital stay as well as a faster recovery, with the disadvantage though of a higher recurrence rate. Data from Hemorrhoidal Artery Ligation (HAL)-, if appropriate in combination with a Recto-Anal Repair (HAL/RAR)-, demonstrates a similar trend towards a better tolerance of the procedure at the
ba-bai-ke-re, Ma-Mu-Ti-Jiang A; Huang, Hong-Guo; Re, Wen-Ni; Fan, Kai; Chu, Hui; Ai, Er-Ha-Ti; Li-Mu, Mai-Mai-Ti-Tu-Er-Xun KE; Wang, Yi-Rui; Wen, Hao
AIM: To demonstrate the value of Diosmin (flavonidic fraction) in the management of post-haemorhoidectomic symptoms. METHODS: Eighty-six consecutive patients with grades III and IV acute mixed hemorrhoids admitted to the Anorectal Surgical Department of First Affiliated Hospital, Xinjiang Medical University from April 2009 to April 2010, were enrolled in this study. An observer-blinded, randomized trial was conducted to compare post-haemorhoidectomic symptoms with use of Diosmin flavonidic fraction vs placebo. Eighty-six patients were randomly allocated to receive Diosmin flavonidic fraction 500 mg for 1 wk (n = 43) or placebo (n = 43). The Milligan-Morgan open haemorrhoidectomy was performed by a standardized diathermy excision method. Pain, bleeding, heaviness, pruritus, wound edema and mucosal discharge were observed after surgery. The postoperative symptoms and hospitalization time were recorded. RESULTS: The mean age of the Diosmin group and controls was 53.2 and 51.3 years, respectively. In Diosmin group, haemorrhoid piles were of the third degree in 33 patients and the fourth degree in 10; and in the control group, 29 were of the third degree and 14 were of the fourth degree. There was no statistically significance in age, gender distribution, degree and number of excised haemorrhoid piles, and the mean duration of haemorrhoidal disease between the two groups. There was a statistically significant improvement in pain, heaviness, bleeding, pruritus from baseline to the 8th week after operation (P < 0.05). Patients taking Diosmin had a shorter hospitalization stay after surgery (P < 0.05). There was also a significant improvement on the proctoscopic appearance (P < 0.001). However, there was no statistical difference between the two groups in terms of wound mucosal discharge. Two patients experienced minor bleeding at the 8th week in Diosmin group, and underwent surgery. CONCLUSION: Diosmin is effective in alleviating postoperational symptoms of haemorrhoids
Orumuah, Agbugui Jude; Oduagbon, Obarisiagbon Edwin
Background: Posterior urethral valves (PUV) remain the most common cause of bladder outlet obstruction and renal insufficiency in male children. The aim of this study was to evaluate the presentation, management, challenges, and outcome of the disease in a Nigerian tertiary health institution. Patients and Methods: Retrospectively, medical records of male children with a diagnosis of PUVs over a 10 year period (2003-2012) were retrieved. All data in relation to the study objectives were recorded and analyzed. Results: A total of 44 patients was managed for PUV within the period. The mean age of presentation was 3.95 years with 56.8% of the patients presenting after the age of 1 year. Voiding dysfunction noted in 40 (91.0%) patients was the most common mode of presentation. The most common finding on physical examination was a palpable bladder while urinary tract infection noted in 23 (52.3%) patients was the most common complication noted. Abdominal ultrasonography revealed dilated posterior urethra in 16 (36.4%) cases, while micturating cystourethrogram revealed a dilated proximal urethra in all 35 cases in which it was done, diverticulum in 6 and vesicoureteric reflux in 9. The creatinine value at presentation ranged between 0.4 mg/dl and 4.0 mg/dl with a mean of 1.02 ± 0.93 mg/dl. Urethroscopy in 37 patients confirmed type I and type III PUV in 35 and 2 patients, respectively. Valve ablation with a diathermy bugbee electrode provided relief of obstructions in the 37 patients who underwent the procedure without any significant immediate complication. The period of follow-up ranged between 2 weeks and 3 years with a mean of 10.2 months. There was sustained improvement in urine stream, reduction in the mean creatinine concentration and incidence of UTI during follow-up. However, patients with significantly impaired renal function had a poorer outcome. Conclusion: Many patients with PUV presented late within the reviewed period. Valve ablation provided relief of
Karamanou, M; Liappas, I; Antoniou, Ch; Androutsos, G; Lykouras, E
sulfate to terminate the malaria infection. It is worth mentioning that the above treatment was followed in hospital under strict monitoring of patients' vital signs and regular laboratory tests. In the following years of his discovery, artificial fever was induced by any one of the following methods: the introduction into the patient of a parasitic disease; the injection of a foreign protein; injections of chemical substances such as sulphur; electrical means such as the administration of diathermy or radiotherapy, or placing the patient in an electromagnetic field; and simple immersion of the individual in a hot bath, or placing him in a heat cabinet. Wagner Jauregg's therapy was highly admired and was used on neurosyphilis cases well onto the 1950's. However, with the introduction of penicillin in syphilis' treatment, fever therapy effectively ended. Wagner Jauregg's study led to all the methods of stress therapy used in psychiatry, as electric shock, and insulin. PMID:24185088