Biomedical subjects

M S Baggish

Publications and source records attributed to M S Baggish.

At least 19 recordsLinked to original sources

PubMed1992

Comparison of thermal injury zones in loop electrical and laser cervical excisional conization.

Thirty cervical conization specimens obtained by thin-loop electric excision were compared with 30 carbon dioxide laser excisional cone specimens. Zones of thermal artifact were measured with a precise stage micrometer technique calibrated to a Zeiss standard. The mean depth of coagulation at the ectocervical margin measured 0.187 and 0.164 mm for thin loop and laser, respectively. Thermal artifact at the endocervical margin was greater with electric loop (0.295 mm) than with superpulsed carbon dioxide laser (0.137 mm). The zones of thermal injury induced by both electric loop and laser made no significant impact on the interpretation of margin adequacy.

Cervix Uteri↗

PubMed1992

Hysteroscopic treatment of septate uterus with Neodymium-YAG laser.

OBJECTIVE: To determine the effectiveness of Neodymium-YAG (Nd-YAG) laser for hysteroscopic transection of the septate uterus to improve pregnancy outcome. DESIGN: Patients treated for recurrent pregnancy loss and/or infertility were evaluated for before versus after treatment pregnancy outcomes. SETTING: All patients were referred to a University Reproductive Endocrine and Infertility practice from 1986 through 1990. PATIENTS, PARTICIPANTS: Nineteen patients underwent hysteroscopic transection of uterine septa after exclusion of other factors that may cause recurrent fetal wastages and/or infertility. They were allowed to conceive 8 weeks after surgery after a postoperative hysterosalpingogram. Fourteen women attempted conception during a time span of 11 to 42 months; 3 patients declined to conceive, and 2 were lost to follow-up. INTERVENTIONS: Hysteroscopic transection of the uterine septum with a Nd-YAG laser was performed in all patients. The Nd-YAG laser delivered via a 600-microns bare fiber or an 800-microns sculpted fiber through operative hysteroscopy. MAIN OUTCOME MEASURES: To evaluate the success and complications of this new laser technique. RESULTS: (1) Thirteen patients conceived; 10 delivered a live infant at term; (2) 87% of the postoperative pregnancies were considered successful as compared with 11% preoperative; (3) complications included a small perforation of the uterus (no treatment needed) and development of uterine adhesions (1 case only). CONCLUSIONS: Hysteroscopic metroplasty with the Nd-YAG laser is a valuable alternative new technique for the treatment of uterine septum.

Abortion, Spontaneous↗

PubMed1991

Presence of human immunodeficiency virus DNA in laser smoke.

Concentrated tissue culture pellets infected with human immunodeficiency virus (HIV) containing 1 x 10(7) cells/ml were vaporized by means of a carbon dioxide laser. The vaporous debris resulting from the laser's impact were evacuated through sterile silastic tubing, then bubbled through sterile culture medium (RPMI) positioned in series with a commercial smoke evacuator. No HIV DNA was detected in the culture medium flask. Tissue culture studies of the silastic collection tubing revealed p24 HIV gag antigen in 3 of 12 tube segments at the end of 1 week and in 1 of 12 tube segments at 2 weeks. No sustained infection of HIV cultured cells was observed at the 28th day. Polymerase chain reaction (PCR) analysis of particulate debris obtained from the silastic collection tubing was positive from proviral HIV DNA in both immediately sampled and day 14 cultured material.

Culture Techniques↗

PubMed1991

Serum levels of Hyskon during hysteroscopic procedures.

Hyskon hysteroscopy fluid is used with the hysteroscope as an aid in distending the uterine cavity and in visualizing its surfaces. We correlated the amount of Hyskon used during hysteroscopy with both the instillation pressures generated within the uterine cavity and with serum levels of Hyskon in 11 healthy subjects. Serum levels in excess of 1000 mg% were measured at 30 min when an amount of Hyskon greater than 300 mL was used. Intrauterine Hyskon absorption and/or injection during hysteroscopy were found even after volumes of Hyskon as small as 50-100 mL were used. Serum levels were significantly higher with the larger amounts of Hyskon used in ablative procedures (P less than 0.01), as compared with serum levels seen with the smaller amounts of Hyskon used for diagnostic procedures. The injection pressures should be low to minimize the amount of intravascular injection. In cases in which extensive ablative procedures are necessary, we suggest that a two-stage procedure be considered. Because of the hypertonicity of Hyskon, intravascular volume expansion that may be larger than that seen during transurethral prostatectomy occurs.

Absorption↗

PubMed1989

Catastrophic injury secondary to the use of coaxial gas-cooled fibers and artificial sapphire tips for intrauterine surgery: a report of five cases.

Five women undergoing endometrial ablation with the Nd-YAG laser developed sudden gas embolism. In each case laser intrauterine contact surgery was carried out utilizing coaxial fibers with (three cases) and without (two cases) artificial sapphire tips but commonly cooled by air or nitrogen. Four of the five women died in a sequence of sudden cardiovascular collapse followed by irreversible cardiac arrest. One woman was critically ill and following prolonged hospitalization survived with neurological deficits.

Adult↗

PubMed1989

Appraising a clinical journal article in obstetrics and gynecology.

Although some physicians have the opportunity to participate in a journal club during residency, many infrequently receive formal instruction on how to critically evaluate a journal article. Systematic guidelines for appraising a clinical journal article are presented and illustrated with examples. Considering each guideline in its respective order may lead to a better understanding of what the literature may offer one's practice.

Female↗

PubMed1989

A ten-year experience treating cervical intraepithelial neoplasia with the CO2 laser.

Between 1977 and 1987, the CO2 laser was used to treat 4024 women who were diagnosed by cytology studies, colposcopy, and biopsy examination to have cervical intraepithelial neoplasia. On the basis of specific indications, these women were treated by vaporization, excisional conization, or combination conization procedure. The evolution of methodology for each laser technique was based on specific pathophysiology and long-term observation of results. A total of 3070 patients underwent vaporization, 2881 of whom had no evidence of disease after one laser exposure (93.8%). Of the 954 patients who had laser excisional procedures, 925 (97%) had no evidence of disease. The most common complications observed were intraoperative and postoperative bleeding; however, sutures were required in only 1.34% of the latter. The risks of cervical stenosis (1.1%), incompetent cervix (0%), and pelvic infection (0.05%) were very low. This 10-year study demonstrated that the CO2 laser was a highly effective method for treating cervical epithelial neoplasia and had the added benefit of preserving reproductive function and anatomic integrity.

Carbon Dioxide↗

PubMed1989

Death caused by air embolism associated with neodymium:yttrium-aluminum-garnet laser surgery and artificial sapphire tips.

Two women undergoing intrauterine surgery with the neodymium:yttrium-aluminum-garnet laser delivered by the artificial sapphire tip had catastrophic cardiovascular collapse during operation. In each case the evolution of clinical events was consistent with the diagnosis of air embolus. Investigation of causative factors links the use of the sapphire tip and the gaseous cooling of the tip to the calamitous outcomes. Both women died.

Adult↗

PubMed1989

Evaluation of tissue healing and adhesion formation after an intraabdominal amniotic membrane graft in the rat.

The amniotic membrane was used as a graft intraabdominally in the rat to study the healing process and the graft's efficacy in preventing postoperative adhesions. We observed the gradual invasion of the graft with fibroblasts and plasma cells and increased vascularity. By the tenth postoperative day the graft had taken completely. There was no evidence of infection at the graft site or rejection of the graft. Application of the graft after lysis of adhesions was followed by adhesion formation at the graft site. The graft did not show evidence of necrosis but failed to prevent adhesion formation.

Abdomen↗

PubMed1989

Quantitative evaluation of the skin and accessory appendages in vulvar carcinoma in situ.

Fifty cases of vulvar carcinoma in situ comprising over 1000 histologic sections were studied. Each case was evaluated to determine the thickness of the neoplastic epidermis and the depth of involved skin appendages. Two precise techniques were used to perform the microscopic measurements. The areas most frequently afflicted with neoplasia were: one or both labia (45%), interlabial folds (27%), perineum-fourchette (15%), and perianal skin (10%). Multicentric disease was observed in 68% of the cases. The epidermal thickness ranged between 0.35-1.66 mm. The mean depth (+/- SD) of the epidermis was 0.93 +/- 0.37 mm. Eighteen of the 50 patients demonstrated involvement of the skin appendages to a mean depth of 1.53 +/- 0.77 mm, suggesting that laser vaporization to a depth of 2.5 mm will, with the anticipated additional thermal necrosis, eliminate appendages involved with carcinoma in situ in 95% of instances. The most common sites of skin appendage involvement were the labia majora or minora and the interlabial folds.

Adult↗

PubMed1988

New laser hysteroscope for neodymium-YAG endometrial ablation.

A multichannel operating hysteroscope was developed for use with the Nd-YAG laser. The telescopes measure 350 mm in length, with a 4 mm outer diameter (OD), and are available with 0 degree or 30 degrees objectives. The operating sheath incorporates two isolated operating channels (2 mm OD) through which an Nd-YAG quartz fiber and an aspiratory cannula can be inserted simultaneously. The design of this instrument permits constant or intermittent aspiration of debris from the intrauterine milieu and very clear vision throughout the operative procedure. The entire cavity of the uterus may be flushed with the distending medium by injecting the liquid through the instillation channel and opening one of the two operating channels.

Endometrium↗

PubMed1988

Protection of the rat lung from the harmful effects of laser smoke.

Fourteen Sprague-Dawley rats were exposed to CO2 laser exhaust that had first passed through smoke-evacuator filters. Six rats breathed laser vapors that were filtered through commercially available, standard production model smoke-evacuator systems. These animals demonstrated pulmonary lesions identical to but qualitatively less severe than those observed in animals breathing unfiltered vapor. Six additional rats were protected by the interposition of a cartridge filter plus an ultra-low penetration air filter, which trapped 0.1 micron particles; the microscopic sections of the lungs of these experimental rats and two control rats were similar in appearance, i.e., no pathological changes were observed.

Animals↗

PubMed1988

Combined tubal and molar pregnancy: case report.

A patient with combined pregnancy developed an acute condition in the abdomen 9 weeks after surgical removal of a tubal pregnancy. At laparotomy she was found to have bilateral theca-lutein cysts. After operation, the patient went into preterm labor and was delivered of a male fetus. Pathologic examination of the placenta revealed hydropic change and trophoblastic hyperplasia.

Adult↗

PubMed1988

New techniques for laser ablation of the endometrium in high-risk patients.

Fourteen women underwent endometrial ablation by use of the Nd:YAG laser. All patients had significant risk factors that precluded safe hysterectomy for intractable bleeding. All patients had demonstrated anemia, menorrhagia, and metrorrhagia uncontrolled by hormonal therapy or curettage. Specifically, seven (50%) women in this group had proved major clotting abnormalities as their principal diagnosis. Three new techniques are described as modifications of the original Nd:YAG ablation methodology and include: (1) the use of Hyskon as the uterine distending medium; (2) the attachment of a high-resolution endoscopic television camera to the eyepiece of the hysteroscope, which permits the surgeon to view the endometrial cavity and operate via a video monitor; and (3) the application of a specially designed dual-channel operating hysteroscope that allows simultaneous laser ablation and aspiration of debris. Although this operation is a valuable alternative to hysterectomy in selected clinical situations, its major deficiencies are the lack of long-term follow-up data and the absence of a surgical specimen for pathologic analysis.

Adult↗

PubMed1988

Carbon dioxide laser laparoscopy by means of a 3.0-mm diameter rigid wave guide.

Rigid carbon dioxide wave guides measuring 300 to 500 mm in length and 3.0 mm in diameter were evaluated in rabbits and humans. The wave guide provided an effective laser delivery system for operative laparoscopy. The tested guide was introduced into the abdominal cavity alternatively via the operating channel of a 9-mm operating laparoscope, through the central channel of a smoke evacuation/irrigation cannula, or via a 3.25-mm second puncture trocar. In contrast to previously tested flexible guides, the rigid device transmitted a visible helium-neon aiming beam, power up to 50 watts, and a beam diameter of less than 1 mm. The hollow guide was kept free of smoke by-products by continuous purging with carbon dioxide gas flowing at 800 to 1000 cc per minute. All wave guides could be sterilized by ethylene oxide gas or Cidex (Surgikos, Arlington, TX) soaking. Fourteen women with a variety of reproductive disorders underwent laser laparoscopy. The rigid wave guide was fired at distances ranging from less than 1 mm to 30 mm from the target and performed with maximal impact at distances of 3 to 5 mm. Perhaps the greatest advantage of this system is its ability to focus-defocus while directly coupling to the handpiece of standard lasers and requiring no special alignment procedures.

Animals↗

PubMed1988

Cytoreduction of ovarian cancer with the Cavitron ultrasonic surgical aspirator.

The Cavitron ultrasonic surgical aspirator was used for cytoreduction in ten patients with intra-abdominal malignancy (nine ovarian and one fallopian tube). The mean age was 65 years, and eight patients had stage IIIC disease. Standard surgical techniques were used to resect the adnexa, uterus, and omentum. The Cavitron was used to remove disease from the diaphragm, spleen, stomach, and small bowel without resection or injury. These nongenital viscera would have required resection using surgical techniques for cytoreduction. The mean Cavitron surgical time was 49 minutes. Cytoreduction by the Cavitron facilitates tumor removal and reduces the requirement for nongenital visceral resection.

Aged↗

PubMed1987

The effects of laser smoke on the lungs of rats.

The sequelae of long-term inhalation of carbon dioxide laser smoke on 10 white rats were studied in a three-phase experiment. The fine particulate matter resulting from tissue vaporization was deposited in the animals' alveoli, which produced congestive interstitial pneumonia, bronchiolitis, and emphysema. The pathologic findings induced by laser plume are not dissimilar to those resulting from the long-term inhalation of other types of particulate matter. Use of an efficient smoke evacuator should offer substantial protection against these normal effects.

Animals↗

PubMed1987

Carbon dioxide laser laparoscopy performed with a flexible fiber in humans.

A flexible carbon dioxide laser fiber delivery system was used in conjunction with the laparoscope to treat 12 women. The 77 by 2 mm hollow fiber could subtend an arc of 90 degrees without significant loss of power or unfavorably affecting the delivery mode. As many as 20 W of power was transmitted through the fiber; however, carbon dioxide gas flow rates as high as 2000 cc/min reduced power by approximately 25%. Replaceable tips preserved fiber integrity to the extent that a single fiber could be reused repeatedly and gas sterilized without jeopardizing laser transmission. Of the 12 cases, endometriotic implants were vaporized in eight women, adhesiolysis was performed in four women, endometrial cysts were drained in two women, and vaporization of myomata was accomplished in two patients. The fiber was also used as a manipulating instrument and could be internally bent with a grasping forceps to better site the laser beam on a lesion. No complications related to the use of the carbon dioxide laser fiber were observed. The safety aspects of carbon dioxide laser fiber technology are not inconsiderable and could provide laser laparoscopy with an extra margin of security.

Beryllium↗