The use of electrocutting and electrocoagulation in surgery.
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The previous paradigm that Barrett's is an irreversible premalignant lesion has recently been challenged by a proliferation of reports documenting elimination of Barrett's by a variety of endoscopic techniques. Whether Barrett's is entirely eliminated is unknown as endoscopic biopsy samples the surface of the epithelium only. Numerous reports document underlying specialised columnar epithelium in many of these trials. Until now there have been no reports of pathological examination of the entire oesophagus as a specimen. This case documents complete elimination of intestinal metaplasia from the oesophagus and supports the biological plausibility of these research techniques.
Introduction of a small electric current by way of a catheter-placed electrode can completely occlude experimentally produced arteriovenous fistula. The occlusion appears permanent and without morbidity in experimental animals. This technique might be clinically useful in obliterating an arteriovenous fistula and controlling gastrointestinal hemorrhage.
A method of producing complete heart block (CHB) in open-chest dogs is described. Having found previous methods unreliable in our hands or excessively complex for the acute open-chest setting, we constructed an electrocautery pinch-clamp device that functions in both locating and destroying the area of the atrial septum that contains the atrioventricular node and His bundle. Fifteen male mongrel dogs were anesthetized with alpha-chloralose, intubated, and ventilated (Harvard 607). Through a left thoracotomy at the fifth intercostal space, the two arms of the clamp are introduced into the left and right atria, respectively, via the atrial appendages. The correct site for electrocautery is located by gently squeezing the atrial septum between the arms of the clamp. Systematic testing of the region of the septum that lies, roughly, between the coronary sinus ostium and the anterior portion of the septal leaflet of the tricuspid valve will result in a rhythm disturbance when the correct site is squeezed. Sustained pressure will yield overt dissociation of the atrial and ventricular contractions. The electrocautery current is then activated for 10-15 s. Lead II of the electrocardiogram is monitored, and if CHB is not sustained after 5 min, the procedure is repeated. Once CHB is established, the clamp is removed and the atrial defects are ligated. By application of this method with no prior use of the technique, 12 of 15 attempts produced stable CHB lasting at least 3-4 h. Examination of the hearts of eight of the animals revealed no septal defects or damage to the tricuspid valve. We conclude that this method offers significant advantages for the production of CHB in acute studies in the dog.
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Intra-arterial electrolysis was performed in the renal arteries of 10 pigs with platinum electrodes. Direct current was used and with correct technique firmly adherent thromboses in the arteries could regularly be made. The method is somewhat time-consuming and with unsuitable electrodes, too much current or too high current strength, vessel perforations occurred. Further experiments are under way to improve the method.
A new coaxial electrode catheter design has been tested in 19 renal arteries of pigs with excellent results, i.e. 100 per cent thrombosis. One vessel ruptured. The electrode (anode) is situated on a thin inner catheter and after electrolysis it is pulled back into a shielding outer catheter. This should reduce downstream embolization. Usual currents have been 8 to 10 mA at 10 V and doses of 16 to 36 C have been used depending on the size of the artery. In the single case of rupture of the vessel a current of 20 mA was used. The method appears to be ready for clinical testing.
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