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PubMed1983

Anesthesiologic considerations in laser neurosurgery.

The laser has been welcomed to the neurosurgical armamentarium because of the inherent precision and gentleness of the no-touch technique. In order to maximize laser safety and efficacy, however, certain anesthesiologic considerations, specific to neurosurgery, must be realized. Motion of patient (target) during routine anesthesiologic checks or as the result of physiologic excursions during myocardial contraction and respiration must be minimized. Ventilatory parameters, anesthetic agents, and cardio active drugs are considered.

Anesthesia, General↗
PubMedDate not supplied

Adenocarcinoma of the colon and rectum: a review of surgical treatment in 302 patients.

A retrospective study of 302 patients who underwent surgical treatment for colorectal carcinoma from 1952 to 1971 is presented. Resectability rate was 93.7 per cent. Operative mortality rate was 5 per cent. Complications were recorded in 12 per cent of cases. Recurrence at the anastomotic line occurred in 3.31 per cent. The actuarial five-year survival rate was 44.2 per cent for all types of cancer. The "no-touch" technique utilized after 1968 resulted in increased survival of patients who had Dukes' B and C cancers.

Adenocarcinoma↗
PubMed1985

Neodymium:YAG laser irradiation of urinary bladder tumors. Follow-up study of 100 consecutively treated patients.

Advanced laser beam technology has made endoscopic destruction of urinary bladder tumors possible. The neodymium: YAG laser is more suited for this purpose than the other available laser systems because of the higher penetration power into biological tissue. Small superficial tumors are particularly suitable for this treatment, but it is also possible to deal with muscle invasive tumors. The treatment procedure is simple and well tolerated by the patients. Recurrence of tumor in the irradiated area can be avoided by precise irradiation. In spite of being a no-touch technique, however, laser does not appear to prevent the occurrence of new tumors in nonirradiated areas.

Adult↗
PubMed1989

An improved procedure for enzymatic harvesting of highly purified canine venous endothelial cells for experimental small diameter vascular prostheses.

We developed a new device, the vein holder, to improve yield and purity of enzymatic harvests of venous endothelial cells. External jugular veins of mongrel dogs were dissected by a no-touch technique. In vitro length and circumference of the vein segments were decreased to about half of the in situ dimensions. The vein holder enabled mounting of the veins at 80% of their in situ length during endothelial cell harvesting. Trypan blue staining and scanning electron microscopic observations revealed that vein eversion as well as the new vein holder technique successfully removed the endothelium. Endothelial cell harvests by the eversion technique were, however, low and varied in size, viability, and purity. In contrast, the defined handling by the new vein holder technique regularly provided markedly increased amounts of endothelial cells. Most of the cells attached and developed cultures consisting of endothelial cells only, as shown by the uptake of DilAcLDL. Prostacyclin production of confluent cultures was similar to that of native veins. It is concluded that minimal handling, defined mounting, and prevention of overfilling the vein markedly improves endothelial cell harvests, providing greater amounts of viable and purified endothelial cells.

Animals↗
PubMed1989

Allergic contact dermatitis from dental composite resins due to aromatic epoxy acrylates and aliphatic acrylates.

7 patients were occupationally sensitized to dental composite resin products (DCR): 6 dental nurses and 1 dentist. All had a positive patch test to their DCR. 2 independent types of allergy were seen; (a) aromatic epoxy acrylate, and/or (b) aliphatic acrylates. 4 out of 5 patients reacted to BIS-GMA, the most widely used aromatic epoxy acrylate in DCR, but not the dentist. She and 2 dental nurses were allergic to aliphatic acrylates, including triethylene glycol dimethacrylate (TREGDMA) and triethylene diglycol diacrylate (TREGDA). 4 patients were allergic to epoxy resin (ER) (containing mainly MW 340), possibly an impurity in some DCR. 2 patients were also allergic to methyl methacrylate (MMA): the dentist, had been exposed to MMA, but the nurse's exposure was uncertain. 1 patient was also allergic to rubber gloves, 2 to rubber chemicals but not their gloves, and 5 to disinfectants used. diagnosis was delayed as long as 13 years in spite of previous patch testing. Dermatologists need to use the patients' own DCR and the (meth)acrylate series for patch testing. No dental nurses could continue their occupation, but the dentist could occasionally handle DCR if wearing PVC gloves. Dental personnel need to know about the risks of DCR, and use no-touch techniques and protective gloves.

Acrylic Resins↗
PubMed1992

[Use of the Nd:YAG laser in surgical treatment of intracranial tumors].

The Nd:YAG laser was used between January 1989 and March 1991 in 63 cases of intracranial tumours, including 32 meningiomas, 16 gliomas (including 11 glioblastomas), 8 acoustic neurinomas, 11 metastatic brain tumours. In 76.2% of cases very good results were obtained. The Nd:YAG laser was found to be particular value in the treatment of vascular intracranial tumours, especially meningiomas and metastatic tumours. The ability of the Nd:YAG laser to shrink and devascularize these tumours, was useful in neurosurgical operations. The no-touch technique, minimal or no thermal effect on surrounding tissues, better haemostasis and precision allow for easier removal of acoustic nerve tumours. The Nd:YAG laser is very useful in the operations close to the very important for life areas of the brain. The major advantages of laser include reduction of mechanical trauma, reduction of blood loss, and more radical removal of intracranial tumours.

Adult↗
PubMed1986

Endoscopic applications of laser therapy.

Lasers have provided a new surgical tool that has several distinct advantages: It is effective at a distance ("no-touch" technique). It can cut, coagulate, and vaporize depending on the wavelength, energy, and tissue characteristics. Laser energy can be carried through flexible fibers and so can be used in previously inaccessible sites. Endoscopic laser surgery can now be successfully used for control of bleeding, palliation of obstructing tumors, detection in microscopic stages, and possibly as definitive treatment of small malignant tumors. The indications for the use of lasers and their successful application will undoubtedly increase in the near future.

Aged↗
PubMed1987

Testicular biopsy and vasography in the evaluation of male infertility.

Testicular biopsy is performed mainly to differentiate primary testicular failure from obstructive ductal lesions (usually occurring in the epididymis in azoospermic patients who have normal serum gonadotropins). Testicular biopsy may be performed easily on an outpatient basis with excision of a small piece of seminiferous tissue using a "no-touch" technique. Needle core biopsy and needle aspiration biopsy may become more widely used in the future. The role of flow cytometry for purposes of interpreting testicular specimens may be expanded in the future. Vasography should be performed only at the time of planned definitive correction of obstructive lesions of the genital duct system. Various techniques of performing vasography are discussed. Emphasis is placed on deferring vasography until the time that definitive surgery is performed to correct the patient's ductal obstruction. In that regard, vasography therefore generally is not performed as an isolated outpatient procedure.

Ambulatory Care↗
PubMed1983

Correction of esophageal atresia with distal tracheoesophageal fistula.

Correction of the full spectrum of esophageal atresia with tracheoesophageal fistula (TEF) remains controversial. Circular myotomy and other lengthening procedures have shown promise to reduce tension when a relatively wide gap exists between esophageal segments; nevertheless a relatively high complication rate persists. We believe anastomotic tension is commonly found with repair of this anomaly. Therefore, the construction of the anastomosis will be a primary determinant of success. Twenty-four infants with TEF were admitted, 12 (50%) weighing 2.5 kg, nine (37%) 1.8 to 2.5 kg, and three (13%) 1.8 kg. All underwent gastrostomy and end-to-end single-layer anastomosis. Gaps of up to 4.5 cm were encountered, and in one case a cervical incision was necessary for mobilization of the upper pouch. For eight patients (33%) the gap was at least 2.5 cm and significant anastomotic tension was generated. For the series, there were no anastomotic leaks (all confirmed by barium swallow), reoperations, or surgical complications (there were two late, unrelated deaths). Prophylactic dilation was routinely performed 6 weeks and 3 months postoperatively. Subsequently, seven of the 24 (29%) required additional (one to five) dilatations but are now asymptomatic at least 2 years later. Follow-up for the entire series is 5 months to 5 years. Three infants (13%) required fundoplication for reflux without stricture and two infants (8%) an aortopexy. For successful esophageal anastomosis we consider the following technical points important: (1) no-touch technique to minimize tissue damage, (2) generous (5 to 7 mm) full-thickness suture depth, (3) fine (6/0) monofilament suture to reduce tissue reactivity, and (4) in cases of significant tension, the sutures are preplaced and used to provide traction to eliminate tension during tying. Tension is often unavoidable in TEF, yet a carefully constructed anastomosis will withstand this stress. This approach provides results at least as satisfactory as the reported experience with a variety of techniques.

Dilatation↗
PubMed1992

Operative treatment of colorectal cancer.

Principles of radical surgery for curative treatment of colon and rectal cancer are based on 5-year survival and 2-year local recurrence rates. Depth of invasion, cellular differentiation, vascular invasion, and the location and number of lymph node metastasis influence the 5-year survival rate. Age, type of resection, obstruction or perforation of the primary tumor, and the surgeon's technique influence the 2-year local recurrence rate. Accordingly, high ligation of major vascular pedicle, tumor-free margins, resection of contiguous organs, and oophorectomy should improve survival and an additional benefit may be derived from complete excision of distal mesorectum and the "no-touch isolation technique."

Colorectal Neoplasms↗
PubMed1992

Glove perforation during surgery: what are the risks?

Surgical gloves are important in protecting medical staff from exposure to pathogens during surgery, especially viruses such as hepatitis B and the human immunodeficiency virus. We have studied the incidence and circumstances of surgical glove perforation using a sensitive electronic device. The glove perforation rate during elective general surgery was compared with that seen during an anastomosis workshop, where surgical trainees operated in a laboratory setting. A total of 220 gloves were tested for perforations pre- and postoperatively during general elective surgical procedures. During the surgical training workshop 72 gloves were tested. Fifty-two gloves (24%) were perforated during surgical procedures. Among surgeons, consultants had a significantly lower perforation rate than trainees (26% vs 46%, P < 0.05, chi 2), that for assistants was much lower (9%). The perforation rate for scrub nurses was surprisingly high at 22%. Glove perforation among trainees was significantly lower during workshop procedures than at elective surgery (17% vs 46%, P < 0.05, chi 2), probably because glove perforation occurs commonly at wound closure. Glove perforation remains very common, particularly among surgical trainees. Glove perforation should be reduced by teaching better techniques, especially 'no-touch', particularly for wound closure.

Gloves, Surgical↗
PubMed1978

Cancer of the large bowel with special reference to incidence and etiology.

1. Cancer of the large bowel is second in cancer incidence to lung cancer in Kentucky and in the United States. It is second only to breast cancer in women. 2. It is far more common in the United States and countries with people in the higher socio-economic levels. 3. In addition to the well known associated or premalignant disease, diets high in fats and proteins are thought to increase the risk of the disease. 4. Much research is being carried on to determine other factors in the etiology of this condition. 5. The treatment of choice is still surgical removal of the lesion and all node-bearing and neighboring tissue, including the no-touch isolation technique with early ligation of the section of bowel to be removed. 6. Chemotherapy and radiation therapy are of proven value in more advanced disease. 7. Carcinoembryonic antigen is of value in the prognosis of colorectal cancer.

Carcinoembryonic Antigen↗
PubMed1985

Midtrimester abortion with Laminaria and vacuum evacuation on a teaching service.

Midtrimester abortion by the dilatation and evacuation (D&E) method has generated controversy among health-care providers; many authorities insist that this procedure should be performed only by a small group of experts. Our institution has been providing abortions for patients who were at 13-16 1/2 menstrual weeks on a teaching service with Laminaria and vacuum evacuation (midtrimester D&E). The procedures were performed under local anesthesia in a separate, specially staffed, in-hospital pregnancy termination unit on an ambulatory basis. Twelve resident physicians at different training levels performed 87% of the procedures under the direct, hands-on supervision of a small but experienced faculty group. Records of 1,392 consecutive patients who underwent midtrimester D&E at Brigham and Women's Hospital between January 1, 1979, and December 31, 1980, were analyzed. There were no maternal deaths or life-threatening complications. Immediate and late morbidity was minimal. There were no major complications that necessitated laparotomy. Despite the use of Laminaria overnight, a "no-touch" rather than full sterile technique and no prophylactic antibiotics, infectious complications were minimal. We conclude that midtrimester D&E can be performed safely and efficiently by resident physicians in an appropriate teaching facility under close supervision. That ultimately can increase accessibility to the D&E procedure by increasing the number of physicians trained in this modality.

Abortion, Induced↗
PubMed1988

Minimal trauma cholecystectomy (a "no-touch" procedure in a "well").

Salient features of an operative technique designed to reduce to a minimum the iatrogenic trauma of cholecystectomy include a limited incision, muscle retraction (instead of division), specific packing and retraction, and distant manipulations by long instruments. Eighty two unselected consecutive patients with primary gallbladder disease underwent operation by this technique. Two permanently bed-confined patients were excluded from study. Acute cholecystitis was documented by histopathology review in 23 cases and chronic cholecystitis in 57 cases. Case material included usual pre-existing concomitant medical problems; five patients meeting formal criteria for the diagnosis of morbid obesity; 15 patients exceeding 199 pounds and one weighing 315 pounds; ambulatory (outpatient) cholecystectomy; 17 patients over 70 and four patients over 80 years of age; five gangrenous and one perforated gallbladders, and perigallbladder abscesses without gangrene in one case; and conspicuous absence of respiratory complications. Median and average incision length was 5.5 cm. There were no major and five minor complications. Recent experience demonstrated safe performance of elective cholecystectomy for chronic disease, regardless of degree of patient obesity, with median incision length 5 cm, median operative time 65 minutes and median post-operative hospital stay 2 days.

Adolescent↗
PubMed1983

[Lasers in neurosurgery].

In recent years neurosurgeons have shown an increasing interest in lasers. An understanding of the basic laser mechanism and tissue effects is important. CO2 laser is an excellent no-touch tool for excising and evaporating brain tumors. It has several other uses in neurosurgery both with free hand technique and with microscope attachment and micromanipulator. Nd: YAG and Argon lasers are more effective for coagulation of blood vessels and dealing with vascular neoplasms. Advantages and disadvantages of this technique are discussed and compared with other methods like bipolar coagulation and CUSA. Indications for the use of the different laser types in neurosurgery are summarized and a prospect of laser in neurosurgery is given.

Brain Diseases↗
PubMed1983

Lasers in neurosurgery: a review.

In recent years neurosurgeons have shown an increasing interest in lasers. An understanding of the basic laser mechanism and tissue effects is important. CO2 laser is an excellent no-touch tool for excising and evaporating brain tumors. It has several other uses in neurosurgery both with free-hand technique and with microscope attachment and a micromanipulator. It is easier and more precise to manipulate a laser beam than any of the conventional instruments. Nd:YAG and argon lasers are more effective for coagulation of blood vessels and for dealing with vascular neoplasms. Microvascular anastamosis has been achieved with the use of Nd:YAG laser in experimental animals and has potential for practical application in extra-intracranial bypass operations. There are many advantages and some disadvantages to the use of lasers in neurosurgery.

Argon↗
PubMed1983

The outpatient-procedure effectiveness of laser treatments in oncology.

The outpatient procedure of CO2 laser surgery has been recently integrated into the routine activity of the National Cancer Institute, Milan. Specific operative protocols that are codified for laser outpatient selection after adequate staging by pathology are presented. Specific indications for gynecologic disease (preneoplastic disorders, CIN, VAIN, and VIN), and general-surgery neoplastic disorders (soft tissue sarcomas, lip and oral cavity lesions, breast lesions) are described. Details of the safety procedures, rules of application, laser instrumentation accessories and wattages, both with vaporization and excisional technique, are reported. An overall rate of 30% out of the 4,000 cases treated yearly are selected for laser treatment procedures on the basis of the evaluation of real advantages. The general advantages of laser surgical applications such as reduction of bleeding and postoperative pain, early and late complications; no-touch method; and patient acceptability--have been emphasized in the routine outpatient procedures. Reduction of the total costs and of the waiting list for hospitalization by the new procedures are finally considered.

Ambulatory Surgical Procedures↗