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Biomedical subjects

M S Baggish

Publications and source records attributed to M S Baggish.

At least 55 records · Page 3Linked to original sources
PubMed1985

Improved laser techniques for the elimination of genital and extragenital warts.

Two series of patients with genital warts were compared for effectiveness of treatment by means of the carbon dioxide laser. In the earlier series (1977 to 1981) laser vaporization was used to remove overt warts while surrounding normal skin was spared. Examination of anal, urethral, and other extragenital sites for possible involvement was done only when warts persisted or recurred. In the later series (1983 to 1985), patients were similarly treated by carbon dioxide laser techniques; however, two additional measures supplemented laser vaporization of gross condyloma acuminatum. The brush technique superficially coagulated skin and mucosal surfaces contiguous to warts. This methodology was hypothesized to eliminate subclinical human papillomavirus infection within normal-appearing epithelium. Compulsive examination and treatment of extragenital sites at the time of the initial laser surgical procedure eliminated the most likely locations for persistence or recurrence. The primary cure rate for the earlier series was 65.8% compared to 91% for the later series. This difference was highly significant (p less than 0.005).

Adult↗
PubMed1985

Carbon dioxide laser for combination excisional-vaporization conization.

Extensive cervical intraepithelial neoplasia may simultaneously involve large areas of the ectocervix, even extending to the vaginal fornices, as well as the endocervical canal. In such instances conventional sharp knife conization would result in virtual removal of the cervix if the surgeon wished to completely circumscribe the entire lesion. By combining a narrow carbon dioxide laser excisional conization with ectocervical vaporization, cervical intraepithelial neoplasia may be eradicated by a virtually bloodless surgical procedure and fertility may be preserved. Sixty-one combination conizations with 6 months to 4 years of follow-up are reported. In 95% of the cases biopsy demonstrated cervical intraepithelial neoplasia in three or more ectocervical quadrants, and 16% had extension of disease into the vagina. The technique of combination conization uses 20 to 30 W of power and 1/2 to 1 mm spots for excision and 10 to 15 W and 1 to 1.5 mm spots for vaporization. The average time to complete the entire procedure was 21 minutes. In three of 61 cases endocervical margins were positive; there were no instances of persistence of neoplasia at either the ectocervical or the vaginal margins. Four complications were observed, all related to delayed bleeding; however, only two patients required the placement of a suture. The volume of tissue removed by a large excisional conization is more than two times greater than that of a laser combination conization.

Adolescent↗
PubMed1984

Management of pelvic endometriosis by means of intraabdominal carbon dioxide laser.

A significant number of patients with severe pelvic endometriosis are at risk of developing pelvic adhesions and/or loss of ovarian function. Although numerous surgical techniques have been advocated, none has any clear advantage over the others. This article presents a new surgical method for conservative management of pelvic endometriosis. The CO2 laser, directed via the microscope or the freehand piece of the articulated arm, was utilized to vaporize focal endometrial implants, to excise endometrial cysts, and to lyse pelvic adhesions in 54 patients. Fourteen of 23 patients (60.8%) attempting pregnancy have conceived at the time of this report. The observed advantages of laser surgery for endometriosis are a bloodless field, precision destruction (vaporization), precision cutting, and the ability to treat poorly accessible areas.

Adult↗
PubMed1983

Intraabdominal surgery with the CO2 laser.

The CO2 laser produces a highly directional and collimated light beam that may be precisely focused to a fine point. Because the laser beam physically removes tissue by vaporization, causes little damage to neighboring cells and seals small vessels, a minimum amount of suture material is required and scar formation is reduced. Although the laser has been utilized commonly in recent years to treat lower genital tract pathology, its application to intraabdominal surgery is in the early developmental phase. Special adaptations of the operative microscope and special accessory instruments are necessary before the laser can be used within the abdominal cavity. One hundred twenty-one cases are described to illustrate the technique and use of the laser for infertility surgery and for the treatment of pelvic endometriosis.

Abdomen↗
PubMed1982

Management of cervical intraepithelial neoplasia by carbon dioxide laser.

Between 1976 and 1981, 412 women with biopsy-proven cervical intraepithelial neoplasia (CIN) were treated by means of the carbon dioxide laser. A previous publication reported the author's initial therapeutic results with laser surgery for CIN, carried out between 1976 and 1978. This report includes data on 297 patients who were followed for 6 months to 5 years after laser vaporization and on 55 women treated by laser excisional cone. Major improvements in the technique of carbon dioxide laser vaporization evolved as experience was gained, and related to elimination of the entire squamocolumnar junction, to destruction of neoplastic tissue to a depth of 5 to 7 mm, and to utilization of power densities greater than 1000 watts/cm2. Cures were achieved in 285 of the 297 patients treated by vaporization, ie, the failure rate was 4% (52 of 55 women treated by excisional cone). Complications during this study were minor and usually correlated with delayed bleeding. One patient developed cervical stenosis following laser excisional cone. No patient was found to have invasive carcinoma after laser surgery to the cervix. Because laser vaporization and laser excisional cone are best adapted for the outpatient setting, financial savings accruing to the patient are considerable. Rapid healing, minimal pain, and a general absence of noxious symptomatology also promote early return to work and daily routines.

Adolescent↗
PubMed1982

Treating viral venereal infections with the CO2 laser.

Viral venereal infections caused by herpes simplex virus 2 and papillomavirus (wart) are epidemic diseases in the United States. Unfortunately, these two infections have eluded conventional therapy to date. Therefore, 306 women were treated for viral venereal diseases with the CO2 laser. Two hundred twenty-eight patients were treated for condyloma acuminatum and 78 for genital herpes. All the patients who underwent treatment for herpes were enrolled in an investigative protocol. Since the viral organisms of both diseases replicate in either the basal or prickle cell layers of the epithelium, deep laser treatment is not necessary; treatment to a depth of 1 to 2 mm is adequate. The average power densities ranged from 311 to 660 w/cm2. Herpes patients responded with relief of pain and elimination of viral infectivity for that cycle. Patients with primary herpes were "cured" in 83% of cases. C. acuminatum could be eliminated with the CO2 laser in virtually every woman.

Carbon Dioxide↗
PubMed1982

Contact hysteroscopic evaluation of the endocervix as an adjunct to colposcopy.

A total of 66 women with cervical intraepithelial neoplasia extending into the endocervical canal were investigated by endocervical curettage, contact endoscopy, and conization biopsy of the cervix. Although atypical epithelium was obtained in only 8 women by blind endocervical curettage, contact endoscopy identified 42 instances of disease of equal or greater magnitude than determined by the original ectocervical colposcopic evaluation. These findings were subsequently confirmed by conization biopsy. As the 6-mm contact hysteroscope may easily be inserted into the pregnant cervix, sufficient reassurance may be gained to avoid endocervical curettage or cone biopsy and thus to avoid the hazard of major hemorrhage and/or pregnancy interruption.

Biopsy↗
PubMed1981

Complications associated with carbon dioxide laser surgery in gynecology.

Complications associated with the use of the carbon dioxide laser in 624 gynecologic patients are presented. Bleeding and pain were the most common side effects of this new modality. Although bleeding occurred in 63 patients, it was considered minor, i.e., requiring no treatment in 56 women. Pain was rather mild and could be dealt with easily by allowing heat buildup to dissipate. Only one laser accident was observed in the entire series. Interestingly, scar formation, e.g., cervical stenosis, was essentially nonexistent. Similarly, no infections were reported. The carbon dioxide laser compares favorably to conventional treatment methods insofar as complications are concerned; however, if future complications are to be avoided, careful training in CO2 laser technology must precede clinical use of the instrument.

Adolescent↗
PubMed1981

CO2 laser for the treatment of vulvar carcinoma in situ.

A new conservative method for treating carcinoma in situ of the vulva is presented. The carbon dioxide laser offers the advantage of a microsurgical technique combined with the benefits of sharp local excision. As one third of the 35 patients treated in this series are under 30 years of age, preservation of the anatomic and functional integrity of the vulva is of paramount importance. Laser therapy has proved to be precise and has resulted in rapid healing without scar formation. The laser regimen conveniently unifies the therapeutic program directed against multicentric squamous neoplasia of the lower genital canal.

Adult↗
PubMed1981

Carbon dioxide laser microsurgery of the uterine tube.

The carbon dioxide (CO2) laser was used to perform microsurgical excision of obstructed tubal segments in rabbit and human subjects. Approximation of the freshly severed tubes by means of laser "welding" was evaluated in both groups investigated. More important, the laser beam cuts accurately and atraumatically while sealing small vascular channels. Scanning electron microscopic studies of the human fallopian tube following laser surgery were done to determine the extent of tissue injury. At a distance of 1 mm distal to the vaporization and necrotic impact zone, normal tubal anatomy was observed. Follow-up data are presented for 7 women who underwent laser beam tuboplasty between 1979 and 1980. The principle advantages of the CO2 laser are its precise control, minimal tissue injury, and hemostatic properties.

Animals↗
PubMed1981

Cystourethroscopy with the direct view contact endoscope.

A new instrument originally designed for hysteroscopy can also be used for cystourethroscopy. The advantages of the instrument are: 1) it uses available room light; 2) it does not require any viewing medium such as water or gas; 3) it gives an excellent direct view of the urethra, bladder neck, and trigone; 4) it is easily included on the instrument table to be used as an adjunct to surgery; and 5) cystourethroscopy with the contact endoscope is an easy office procedure. Although this instrument does not give a panoramic view, limitations are readily recognized by the experienced operator; thus, errors resulting from its use can be avoided.

Cystoscopes↗