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Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection.

Papillomavirus DNA has been reported recently in the vapor (smoke plume) derived from warts treated with carbon dioxide laser; this raises concerns for operator safety. We therefore have studied a group of human and bovine warts to define further the potential risk of wart therapy and to test whether a surgical mask could reduce exposure. Half of each wart was treated with carbon dioxide laser and the other half with electrocoagulation. The vapor produced by each form of therapy was collected with a dry filter vacuum apparatus and analyzed for the presence of papillomavirus. Vapor from human plantar warts was analyzed for the presence of human papillomavirus DNA, because there is no infectivity assay for human papillomavirus. Of plantar warts treated, five of eight laser-derived vapors and four of seven electrocoagulation-derived vapors were positive for human papillomavirus DNA. Greater amounts of papillomavirus DNA were usually recovered in the laser vapor than in the electrocoagulation vapor from the same wart. Bioassay readily detected infectious bovine papillomavirus in the vapor from bovine warts treated with either modality; more virus was present in laser-derived material. A surgical mask was found capable of removing virtually all laser- or electrocoagulation-derived virus, strongly suggesting that such masks can protect operators from potential inhalation exposure to papillomavirus.

Air Microbiology↗

Computer based, temperature controlled bipolar electrocoagulation system. III. Effect on pregnancy rate in the rat.

OBJECTIVE: A computer based, temperature controlled bipolar coagulation system has been developed. STUDY DESIGN: Endometriosis was induced in 39 mature female rats by means of transplantation of endometrium on the peritoneal wall near the ovary. Three weeks later, all the rats were laparotomized and they were randomized into five groups according to treatment; an untreated group, a group with microsurgical treatment and three groups with electrocoagulation at different temperatures (70, 85 and approximately 300 degrees C). Three weeks after these treatments they made pregnant after daily examinations of vaginal smear. At the ninth day of pregnancy, they were laparotomized again, the number of fetus was recorded and the implants were examined for their size and histology. RESULTS: In the untreated group, the size of implantation was decreased significantly, which suggested a hormone dependent nature for this tissue. No further endometriosis was observed in any of the rats treated with either microsurgical removal or electrocoagulation at any temperatures examined. There was no significant difference in the number of fetus in the treated groups. CONCLUSION: Electrocoagulation at a low temperature is as effective as microsurgery or electrocoagulation at a high temperature for the treatment of endometriosis.

Animals↗

Occlusion of the fallopian tube by selective transcatheter radiofrequency electrocoagulation: an experimental study in rabbits.

PURPOSE: To test the feasibility of performing transcervical fallopian tube occlusion in a rabbit model with use of unipolar radiofrequency (RF) electrocoagulation. MATERIALS AND METHODS: Under fluoroscopic guidance, transvaginal catheterization of the right or left fallopian tube was first performed with use of a coaxial technique in 20 rabbits. With a metal guide wire protruding from the catheter serving as the active electrode, RF electrocoagulation was performed. The power output was set to 200 W and the current was applied for 20 seconds. The fallopian tube on the contralateral side and the uterus were used as controls. Rabbits were randomly designated to be killed either 2 days (group I, n = 10) or 30 days (group II, n = 10) after the procedure, and tubal patency and histologic changes were evaluated. RESULTS: In group I, significant necrosis of the endosalpinx caused by RF electrocoagulation was found in all 10 rabbits. In group II, the occluded fallopian tube showed fibrosis of the wall in all 10 rabbits, but there was no tissue damage to adjacent organs. Histologic findings in the contralateral fallopian tubes were normal in all 20 rabbits. CONCLUSION: Transcatheter RF electrocoagulation proved to be a safe nonsurgical alternative for occlusion of the fallopian tubes in rabbits.

Animals↗

Endoscopic bipolar electrocoagulation in upper gastrointestinal bleeding.

A new endoscopically deliverable bipolar electrocoagulator has been developed, and employed clinically to treat upper gastrointestinal bleeding in 53 patients on 61 occasions. By direct application of the electrode to the bleeding vessels immediate hemostasis was achieved in 52 out of 53 bleeding vessels. Non-bleeding visible vessels were safely coagulated. Arrest of bleeding was permanent in 44 patients (83%), of whom 20 were candidates for emergency operation because of massive, continued or recurrent bleeding. Rebleeding after hemostasis by bipolar electrocoagulation was noted in 8 patients (15%); however, the majority of rebleeds were those with acute mucosal lesions who had serious underlying medical problems. Emergency operation was performed in 5 patients, and was averted in most patients after successful hemostasis by bipolar electrocoagulation. There were no complications related to the procedure. Bipolar electrocoagulation with our coagulator is a safe and easily applicable technique that is a promising addition to currently available endoscopic hemostatic methods.

Adolescent↗

Periorbital syringoma: a pilot study of the efficacy of low-voltage electrocoagulation.

BACKGROUND: Management of periorbital syringomas is problematic and avoided by many inexperienced physicians. The medical literature presently prefers CO(2) laser resurfacing to many other modalities, but the subject of electrosurgery has not been well explored. OBJECTIVES: To evaluate the clinical efficacy of electrocoagulation at low voltages in treating periorbital syringomas. MATERIALS AND METHODS: Twenty cases were collected during the period of 2002 through 2005. All cases were photographed before treatment with a dual-frequency 4-MHz radiofrequency device (Surgitron, Ellman International, Inc., Hewlett, NY) at a power of 1 to 2 in electrocoagulation mode. Six-week follow-up visits were scheduled to discuss occurrences and expectations, observe treatment effects, and apply further electrosurgery if needed. RESULTS: Clinical improvement increased with each subsequent treatment session. All patients scored either moderate or marked clinical improvement by their final visits, with 60% (11/18) revealing a marked clinical improvement (i.e., >70% clearance). The most common encountered adverse effects consisted of periorbital burning, swelling, redness, and pigmentary changes. CONCLUSION: Low-voltage electrocoagulation is an effective therapy for periorbital syringoma and should be considered when treating this difficult condition. To our knowledge, this is the first study utilizing electrocoagulation for removal of syringomas.

Adolescent↗

Electrocoagulation diathermy for the treatment of cervical dysplasia and carcinoma in situ.

This report presents further experience in the use of electrocoagulation diathermy for the treatment of patients with cervical intraepithelial disease. By means of the colposcope it was possible to select a group of nonpregnant patients, in whom a proven noninvasive lesion was located entirely within range of the colposcope. This group, comprising 450 patients, has been treated by means of electrocoagulation diathermy, and with followup, only 28 patients have shown evidence of a residual lesion; in 8 of these the residual lesion has been eradicated subsequently by repeat diathermy treatment. Significant complications following electrocoagulation diathermy occurred in 13 patients (3%). The overall apparent cure rate for electrocoagulation diathermy was 95.4%.

Biopsy↗

[Palliative therapy of rectal cancer by electrocoagulation].

Palliative therapy for rectal carcinoma is only indicated in selected patients who do not tolerate radical surgery or with very advanced disease. In a retrospective series the results of transanal electrocoagulation are analyzed. In addition patients or their relatives were questioned about the treatment related increase in quality of life and the wish of recurrent coagulation if needed. The main indication for transanal electrocoagulation was rectal stenosis, blood loss, discharge of mucosa and tumor as well as pain. Anal incontinence only gets better when it is due to discharge. However, transanal exposition bears the risk of worsening the incontinence. The electrocoagulation is favored by all continent patients before colostomy. The main indication for a colostomy was incontinence and fistula. Palliative irradiation was concentrated in patients with pain. In 59 operations upon 40 patients there was one rebleeding and one death due to sepsis resulting in a mortality of 1.7%. We conclude from our results that transanal electrocoagulation is a safe procedure in patients with rectal carcinoma who do not qualify for radical surgery.

Aged↗

Controlled trial of liquid monopolar electrocoagulation in bleeding peptic ulcers.

The aim of this study was to evaluate the efficacy and the safety of liquid monopolar electrocoagulation in the endoscopic control of major haemorrhage from peptic ulcers. During the 24-month period of the trial, emergency endoscopy was performed on 480 patients consecutively admitted with acute upper gastrointestinal tract hemorrhage. Ulcers were seen in 168 cases (35%). Seventy-eight of these were included in the trial. Active bleeding was present in 21 cases and stigmata of recent bleeding were observed in 57. Immediate hemostasis was achieved in nine of 11 patients with active bleeding ulcers. However, active bleeding can stop spontaneously (as in four of 10 control patients), which reemphasizes the importance of randomized studies. There was a trend toward hemostatic benefit for the electrocoagulation-treated patients with actively bleeding ulcers. In the group of 31 patients with visible vessels, the electrocoagulation treatment reduced significantly both the rate of rebleeding and the emergency surgery. In the group of 26 patients with other stigmata of recent bleeding (fresh or altered clot, or black spots), only in two cases allocated to placebo treatment occurred rebleeding. These patients are at minimal risk of further bleeding. The results offer support to the contention that liquid monopolar electrocoagulation is a safe and effective method of reducing the incidence of further bleeding and emergency surgery. This new technique has the advantages of low cost, easy maintenance, durability, and portability.

Adult↗

Electrocoagulation and the risk of cervical neoplasia.

The relationship between electrocoagulation diathermy and the risk of cervical neoplasia was evaluated in a case-control study of 145 women with cervical intraepithelial neoplasia compared with 145 age-matched outpatient control subjects, and 191 cases of invasive cervical cancer compared with 191 control subjects in the hospital for acute conditions unrelated to any of the identified or suspected risk factors for cervical cancer. History of electrocoagulation was associated with an apparently reduced risk of cervical intraepithelial neoplasia (relative risk = 0.50, with 95% confidence interval = 0.29-0.87), and of invasive cancer (relative risk = 0.42, 95% confidence interval = 0.22-0.82). However, this apparent protection could be largely explained in terms of a different frequency of previous Papanicolaou smears in patients and control subjects. When adjustment was made for that variable, the risk estimates of CIN and invasive cancer among women who had undergone electrocoagulation increased to 0.62 and 0.83 and became statistically nonsignificant. Further allowance for other identified potential confounding factors by means of multiple logistic regression raised these estimates to 0.73 and 0.94, respectively. Thus, these data provide evidence against the hypothesis that electrocoagulation may have an important and independent role in the prevention of cervical neoplasia.

Adult↗

Effect of monopolar electrocoagulation on esophagus, stomach and duodenum in dogs.

The effects of electrocoagulation on the esophagus, stomach and duodenum of mongrel dogs were studied. A commercially available electrocoagulator unit and suction electrode were used. Various dial settings and duration times were used. The total number of sites electrocoagulated was 945; histologic section of each site was prepared. A dial setting of 7 and duration of 5 seconds was safe for the canine esophagus and duodenum; for the stomach it is a dial setting of 7 and duration of 3 seconds. This information will be useful in safe application of electrocoagulation to superficial bleeding lesions in the canine esophagus, stomach and duodenum.

Animals↗

Comparison of argon laser photocoagulation and bipolar electrocoagulation for endoscopic hemostasis in the canine colon.

Severe bleeding from the lower gastrointestinal tract commonly occurs from mucosal lesions such as angiodysplasia and less often from acute ulcerations. Endoscopic coagulation of such lesions is now feasible. Our purpose was to compare the efficacy and histologic injury of bipolar electrocoagulation and argon laser photocoagulation applied at laparotomy in the canine colon. After right colotomy and heparinization in adult mongrel dogs, bleeding standard ulcers were randomly assigned to treatment or control. The colonic ulcers randomized to each group were not significantly different in size or bleeding rate. Efficacy of treatment was evaluated acutely. Adjacent normal mucosa was treated with the same modality as the ulcer to simulate treatment of a mucosal lesion. The same total exposure time (argon laser photocoagulation) or number of pulses (bipolar electrocoagulation) was used for these paired treatments. Gross and histologic injury were determined after 7 days. Both argon laser photocoagulation and bipolar electrocoagulation were uniformly effective in controlling bleeding from standard colonic ulcers and the incidence of full thickness injury was similar, 33%-48%. The histologic damage seen with normal mucosa treatment was consistently less than with standard ulcers for all treatment groups. The difference is easily explained by the reduction in colonic wall thickness of about 50% with creation of standard ulcers. In our opinion, argon laser photocoagulation and bipolar electrocoagulation are safe enough to be used in clinical trials for control of colonic bleeding from mucosal lesions but not acute colonic ulcers.

Animals↗

Comparison of endoscopic electrocoagulation and laser photocoagulation of bleeding canine gastric ulcers.

The most promising endoscopic hemostatic techniques all depend upon heat to coagulate. Four thermally active techniques under similar controlled conditions in this endoscopic study were compared. The study was undertaken to compare the efficacy and histologic damage of monopolar electrocoagulation (MPEC), bipolar electrocoagulation (BPEC), argon laser photocoagulation (ALP) and neodymium-yytrium-aluminum-garnet (YAG) laser photocoagulation applied endoscopically to control bleeding from standard canine gastric ulcers. An open-closed model utilizing a nontraumatic intestinal clamp in heparinized adult mongrel dogs was used. Bleeding ulcers were randomly assigned to an endoscopic treatment modality or control. The endoscopic techniques and parameters of treatment for this study were established from a previous experience with each modality and from endoscopic treatment in pilot studies. Quantitative efficacy and subjective ease of endoscopic treatment were evaluated acutely; gross and histologic injury were determined after 7 days. Our conclusions were that more energy or greater power was required with each method to treat bleeding standard ulcers efficiently through the endoscope than at laparotomy. It was also concluded that each method was 93% or more effective in halting bleeding in this canine ulcer model but there were differences in ease of endoscopic use. Both lasers were much easier to apply than electrocoagulation. The order of decreasing ease of application was YAG, ALP, MPEC, BPEC. Argon laser and BPEC caused significantly less tissue injury than either MPEC or YAG. The order of increasing injury or decreasing margin of safety was ALP, BPEC, YAG and MPEC. In contrast to electrocoagulation, especially monopolar, laser related tissue injury was generally predictable and correlated with total treatment energy, animal weight or gastric overdistension, or both. The limitations, advantages, and disadvantages of each hemostatic technique are discussed and compared.

Animals↗

Computer-assisted electrocoagulation: bipolar vs. monopolar in the treatment of experimental canine gastric ulcer bleeding.

A prospective, randomized, controlled experiment using a canine model of severely bleeding gastric ulcer was performed to compare the hemostatic efficacy and tissue damage produced by one bipolar and two monopolar electrodes. Both monopolar electrodes were insulated to their tips; they differed with respect to their surface area (3 mm2 vs. 4 mm2). The force of electrode application was controlled. An analog computer monitored the energy per electrode application and predetermined the duration of each application. Fifty-nine standard acute bleeding ulcers were made and treated one at a time in six heparinized foxhounds at sterile laparotomy. Treatment was randomized to the bipolar or to one of the monopolar electrodes within each of three bleeding strata. No significant difference was observed in hemostatic efficacy among the three electrodes. Treated ulcers were examined histologically after 5 to 7 days to determine the maximum tissue damage produced: Bipolar electrocoagulation caused significantly less damage than electrocoagulation with either monopolar electrode. We conclude that with these electrodes, bipolar electrocoagulation is equally effective for stopping bleeding but results in less tissue injury than monopolar electrocoagulation in this experimental model.

Animals↗

[Local treatment of "small cancers" of the rectum: excision is preferable to electrocoagulation].

From 1973 to 1990, 50 patients with a "small cancer" of the rectum were treated locally either by electrocoagulation or by local excision using an electrical scalpel. 20 patients were treated by electrocoagulation. Their 5-year actuarial survival was 78.3% and the local recurrence rate was 16.5%. 4 treated patients by local excision had a lesion which invaded the serosa and should have been amputated as primary procedure. Three of them relapsed. 26 patients were treated by local excision for a lesion confined to the rectal wall. Their 5-year actuarial survival was 94.4% and the local recurrence rate was 4.5%. The difference in survival and recurrence was significant between electrocoagulation and excision of a lesion confined to the rectal wall. These results suggest that excision is preferable to electrocoagulation as it allows prediction of the result by pathological examination of the operative specimen.

Actuarial Analysis↗

Electrocoagulation combined with the use of an intermittently aerating bioreactor to enhance phosphorus removal.

Biological Oxygen Demand (BOD), nitrogen, and phosphorus were treated with the use of an intermittently aerating bioreactor combined with electrocoagulation. Experiments consisting of batch reactor tests were conducted to identify the most efficient electrode material and the best condition for electrolysis so that the current density would not impede the biological treatment. The operating conditions needed when using an intermittently aerating bioreactor combined with electrocoagulation to enhance phosphorus removal were also identified. Iron was found to be more efficient than aluminum as an electrode material in terms of electricity requirement. When electrocoagulation was conducted and an intermittently aerating bioreactor was used, the electrolysis of the iron electrode in the aerobic stage was observed to be more favorable compared to continuous electrolysis. Sludge rise occurred at the current density of 5.7 mA cm(-2), and lysis of cell at 11.2 mA cm(-2). The applicable current density was found to be less than 4 mA cm(-2). Based on the results of this study, it can be concluded that the use of an intermittently aerating bioreactor combined with electrocoagulation enhances phosphorus removal in sewage treatment plants.

Aluminum↗

A controlled trial of bipolar electrocoagulation in patients with upper gastrointestinal bleeding.

We have assessed the value of the BICAP electrocoagulation probe in reducing the incidence of further bleeding in patients with upper gastrointestinal haemorrhage. One hundred and twenty-nine patients were studied in a prospective randomized controlled trial. There were 85 male and 44 female patients, age range 16-92 years. Forty-five patients had stigmata of recent haemorrhage (visible vessel or spot) and were randomized during endoscopy to 24 control and 21 treatment patients. Seven control patients rebled compared with nine treated patients (Fisher's exact probability test P = 0.44). The transfusion requirements of control patients (3.9 +/- 3.2 units) was not different from that of treated patients (5.7 +/- 3.7 units): Mann Whitney U test, P = 0.06. In the treatment group there was no difference in the operation rate. Also, the number of probe applications between patients with further bleeding and those with no further bleeding was similar (11.6 +/- 5.5 and 11.0 +/- 5.75 respectively). Access with the probe was considered inadequate in 50 per cent of lesions, but this did not correlate with the incidence of rebleeding. Stigmata of recent haemorrhage were significant in predicting rebleeding (P = 0.0019 Fisher's exact probability test). Overall mortality rate of 3.2 per cent was low and was not influenced by electrocoagulation or presence of stigmata of recent haemorrhage. We have not shown that BICAP bipolar electrocoagulation reduces the incidence of rebleeding in upper gastrointestinal haemorrhage.

Adult↗

Laparoscopic electrocoagulation and tubal ring techniques for sterilization: a comparative study.

From August 1975 through May 1976, a comparative study was made of the effects of sterilization by standard electrocoagulation and tubal ring application techniques. The two techniques were randomly assigned to 300 patients. Results show that standard electrocoagulation and tubal ring procedures can easily and safely be performed on an outpatient basis, using local anesthetics and analgesics. Rates of surgical complications for both techniques were clinically acceptable, although tubal risk patients had a higher rate. Pain during the procedure and during the immediate recovery period was more severe for tubal ring patients. Despite the higher incidence of surgical complications and pain associated with the ring, many physicians prefer this method of sterilization because it eliminates the possibility, inherent in electrocoagulation, of inadvertent serious electrical burns.

Adult↗

Laparoscopic tubal electrocoagulation for sterilization: 5000 cases.

Five thousand cases of laparoscopic tubal electrocoagulation were performed for voluntary interval sterilization in outpatient Thai women from January 1974 through June 1978. Immediate complications occurring during surgery resulted from mesosalpingeal hemorrhage, which was successfully managed by omental packing with or without repeated electrocoagulation. The overall failure rate was 0.40%. The authors find this method of tubal electrocoagulation for fertility management to be reliable and safe as an outpatient procedure and to provide rapid convalescence.

Electrocoagulation↗