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At least 127 records · Page 7Linked to original sources

Endometrial ablation by rollerball electrocoagulation compared to uterine balloon thermal ablation. Technical and safety aspects.

OBJECTIVE: To compare two methods of endometrial ablation, hysteroscopic rollerball electrocoagulation (RBE) and non-hysteroscopic uterine balloon thermal (UBT) ablation (Thermachoice), regarding intra- and post-operative technical complications and safety aspects. STUDY DESIGN: A randomised controlled study in a teaching hospital, 139 pre-menopausal women with dysfunctional uterine bleeding proved by a validated menstrual score list were enclosed. Endometrial ablation by a hysteroscopic or non-hysteroscopic method was performed. RESULTS: Rollerball electrocoagulation carries a significantly higher risk of intra-operative complications compared to uterine balloon thermal ablation and is a significantly more time consuming procedure. Post-operative complication rates in both groups were low, but post-operative analgesics were prescribed significantly more in the uterine balloon group. CONCLUSION: Endometrial ablation by uterine balloon thermal ablation (Thermachoice) is a safe and simple non-hysteroscopic procedure.

Adult↗

A computer based, temperature controlled bipolar electrocoagulation system: II. Optimal temperature and coagulation time.

OBJECTIVE: A computer based, temperature controlled bipolar coagulation system has been developed. This system was evaluated for its efficiency on electrocoagulation of rabbit uterine horns at a low temperature. STUDY DESIGN: In purpose to find an optimal setting, rabbit uterine horns were coagulated at various temperature and time. They were examined histologically and histochemically up to six weeks after coagulation. RESULTS: Electrocoagulation at 90 degrees C for 30 s induced a total occlusion of the lumen when examined six weeks later. CONCLUSION: This coagulation system with low temperature is sufficient for a total occlusion of uterine lumen in the rabbit.

Animals↗

Electrocoagulation diathermy.

With experience extending over an interval of 25 years, one single application of electrocoagulation diathermy has been substantiated as a most consistent and effective method of eradicating precancerous lesions of the cervix. Although there is a protocol for selection that must be adhered to, the vast majority of patients with CIN lesions are suitable for this method of ablative therapy. Ablation by electrocoagulation diathermy appears to have distinct advantages over other methods because of the following: 1. Very high cure rates (98%) with first-time treatment can be achieved, even for major dysplasia and/or carcinoma in situ. 2. Extensive and deep lesions can be effectively eradicated irrespective of the purported histological severity. 3. Electrodiathermy is capable of eradicating lesions extending into the endocervical canal, providing anatomical limits can be evaluated colposcopically. 4. The technique is simple and rapid. The versatility of the electrodes facilitates eradication of the lesion irrespective of the shape and contour of the cervix. 5. No expensive capital outlay nor costly maintenance of equipment is required. 6. There are no physical hazards for medical personnel. 7. It is cost-effective--the technique is readily adaptable as a true out-patient procedure on a 'walk in, walk out' basis. 8. It has a very low incidence of surgical morbidity and does not jeopardize physiological and reproductive function. 9. For practical purposes, the subsequent risk of development of invasive cancer of the cervix can be effectively eliminated.

Contraindications↗

Bipolar electrocoagulation versus suture of solitary ovary after laparoscopic excision of ovarian endometriomas.

STUDY OBJECTIVE: To compare the functional ovarian damage associated with the use of bipolar coagulation versus ovarian suture after laparoscopic excision of ovarian endometriomas in patients with a solitary ovary. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Tertiary care center. PATIENTS: Forty-seven consecutive women with a single ovary and regular menses who underwent laparoscopic stripping of one or more ovarian endometriomas between June 1996 and June 2001. Intervention. Twenty-one patients had bipolar electrocoagulation (group A), while 26 had suturing of the ovary (group B). Plasma follicle-stimulating hormone (FSH) and estradiol levels were determined before surgery and re-evaluated at 3-, 6-, and 12-month follow-up. MEASUREMENTS AND MAIN RESULTS: At 12-month follow-up, six patients (29%) in group A had oligo-amenorrhea versus three patients (12%) in group B (p = .14). Follicle-stimulating hormone levels between 10 and 20 mlU/mL were found in five patients (24%) in group A and in three patients (12%) in group B, whereas FSH levels above 20 mlU/mL were found in three patients (14%) in group A and in no patient in group B. Eight patients (38%) in group A had FSH levels greater than 10 mlU/mL versus three patients (12%) in group B (p = .042). Overall, repeated analysis of variance showed a marginally significant difference (p = .06) in FSH values between the two groups. CONCLUSION: Our results suggest that bipolar electrocoagulation of the ovarian parenchyma after laparoscopic stripping of an endometriotic ovarian cyst adversely affects ovarian function.

Adult↗

Blindness due to electrocoagulation following functional endoscopic sinus surgery.

A case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under conditions of poor visualization, that may be the case in post-operative bleeding following (endoscopic) sinus surgery, is strongly discouraged.

Adult↗

Cathodic dissolution in the electrocoagulation process using aluminium electrodes.

All the authors working with aluminium electrodes in the electrocoagulation process have shown that a dissolution occurs at the cathode. This result cannot be explained by the electrochemical process in which only the anodes should be dissolved. The most probable reaction is a chemical attack by hydroxyl ions (generated during water reduction) on the aluminium cathode but nobody has proved it in the framework of the electrocoagulation process. So we are interested in determining what kind of reactions occurs at the cathode. For that, we have elaborated a batch pilot apparatus divided into two compartments, allowing measurement of gas formation taking place only in one compartment. The gases measurements were performed by mass spectrometry with helium as carrier gas. To validate our experimental protocol, the first experiments have been done with a stainless steel cathode: in this case, the results have indicated that the amount of created hydrogen is in good agreement with the values calculated using the second Faraday's law. The experiments realised with an aluminium cathode have shown that the hydrogen formation, in these conditions, was higher than those observed with the stainless steel cathode. All our investigations enable us to propose that with an aluminium cathode, hydrogen formation can be separated into two phenomena. The first one is due to an electrochemical reaction (water reduction), and the second one arises from a chemical reaction explaining the dissolution observed at the cathode.

Aluminum↗

Modified electrocoagulation and its possibilities in the control of gastrointestinal bleeding.

In acute experiments in the stomach of dogs electrocoagulation with simultaneous instillation of water (EHT-electrode i.e. electro-hydro-thermo-electrode) proved the most effective electrocoagulation method for controlling standardized bleeding: Optimal visibility at the bleeding site, extension of the therapeutic range as well as the avoidance of charring at the bleeding site are its major advantages. Disturbing adhesion of coagulated material on the electrode is also avoided. The electro-hydro-thermo-electrode is a cheap and portable means of controlling bleeding.

Animals↗

Possible mechanism of hemostasis effected by electrocoagulation.

Forty acute gastric ulcers were created in 10 rabbits. The bleeding was controlled by monopolar electrocoagulation in 20 ulcers, the remaining ulcers were left untreated as controls. Spontaneous intravascular thrombosis was precluded by heparinization. A histological assessment in the acute stage revealed significant morphological alterations in electrocoagulated ulcers, with fibrin deposition, decreased tissue stainability and swelling of the vessel walls, indicating heat-induced damage including cells of the vessel walls. An intravascular occlusive fibrin thrombosis demonstrated in all coagulated ulcers is suggested to be the probable mechanism of hemostasis.

Animals↗

Effective and safe endoscopic reversal of nondysplastic Barrett's esophagus with thermal electrocoagulation combined with high-dose acid inhibition: a multicenter study.

BACKGROUND: Barrett's esophagus is a metaplastic change in the esophageal lining with an increased risk for adenocarcinoma. Multiple endoscopic techniques have been applied in an effort to reverse Barrett's. This is a multicenter trial defining the efficacy and safety of multipolar electrocoagulation combined with high-dose acid inhibition. METHODS: Patients with a 2- to 6-cm segment of Barrett's esophagus without dysplasia were enrolled at 3 centers. They were treated with omeprazole 40 mg twice daily and then with up to 6 sessions with electrocoagulation aimed at eliminating all the endoscopically apparent Barrett's. Four quadrant large-capacity biopsies every 2 cm were centrally assessed for residual intestinal metaplasia. RESULTS: Fifty-eight patients reached the endpoint of failure of visual reversal of Barrett's after 6 treatment sessions or a 6-month follow-up after the last session. Eighty-five percent had visual reversal and 78% both visual and histologic reversal. Four patients had histologic evidence of residual intestinal metaplasia. Transient esophageal symptoms were common. One patient developed a stricture requiring dilation and one required overnight hospitalization for chest pain. CONCLUSIONS: The majority of patients with 2 to 6 cm of nondysplastic Barrett's esophagus can be safely reversed with this combination therapy. Long-term follow-up will be necessary to document the durability of the new squamous epithelium.

Adult↗

Randomized trial of normal saline solution injection versus bipolar electrocoagulation for treatment of patients with high-risk bleeding ulcers: is local tamponade enough?

BACKGROUND: Endoscopic injection of normal saline solution is reportedly an effective treatment for bleeding ulcers. If it is as effective as standard therapy, low cost, wide availability, and lack of injury would make saline solution injection an attractive option. METHODS: Patients with clinical evidence of major bleeding from an ulcer with active bleeding or a nonbleeding visible vessel were randomly assigned to injection with normal saline solution (1-2 mL boluses; mean volume 30 mL) or bipolar electrocoagulation (20 W, 10-sec applications; mean time 100 sec). Patients, those caring for patients, and those collecting data were blinded to therapy. RESULTS: Further bleeding occurred in 14 (29%) of 48 patients in the saline solution group versus 6 (12%) of 52 patients in the bipolar group (95% CI [2%, 33%]; p = 0.04). Significantly more units of blood were transfused in the saline solution group (median 2 units vs. 0 units; p = 0.01). Hospital days (median 4 vs. 3) and mortality (6% vs. 2%) were not significantly different in the 2 groups. Independent risk factors for further bleeding were saline solution injection (p = 0.02), units transfused before therapy (p = 0.02), and ulcer size (p = 0.03). CONCLUSION: Local tamponade with saline solution injection is less effective than bipolar electrocoagulation for the treatment of bleeding ulcers.

Double-Blind Method↗

Predictive factors for rebleeding in patients with peptic ulcer bleeding after multipolar electrocoagulation: a retrospective analysis.

The role of endoscopic therapy for peptic ulcer bleeding is well-documented. Nevertheless, rebleeding occurs in 10% to 30% of patients, and such patients are at high risk for death without early retreatment or definitive surgery. The aim of our study was to predict which patients would rebleed within 1 month after successful multipolar electrocoagulation of 100 patients with active peptic ulcer bleeding (spurting, oozing, or nonbleeding visible vessel). We had achieved initial hemostasis in 97 patients and carried out univariate and multivariate analyses to predict which patients would rebleed. Rebleeding occurred within 1 month in 17 (17.5%) patients. we correlated 20 clinical and endoscopic factors with rebleeding episodes. With univariate analysis, blood transfusion of 500 ml or more at entry (p < 0.0001) and use of cimetidine (p = 0.01) were statistically significant for rebleeding. With multivariate analysis, use of omeprazole was an independent factor for preventing rebleeding (odds ratio, 7.68; 95% confidence interval, 1.642-35.929). We suggest that omeprazole may help to prevent rebleeding in patients who have had hemostasis with multipolar electrocoagulation.

Anti-Ulcer Agents↗

Treatment of cervical intraepithelial neoplasia (CIN) by radical electrocoagulation diathermy: 5 years' experience.

During the first 5 years of a colposcopy clinic established in a London teaching hospital 653 new patients were seen, usually referred because they had had an abnormal cervical smear report suggesting cervical intraepithelial neoplasia (CIN). Of 490 women treated within the district for CIN, 361 (73.7%) underwent radical electrocoagulation diathermy, 91 (18.6%) were treated by cone biopsy, 34 (6.9%) underwent hysterectomy and the other four patients were treated by cryocautery. Of the 245 women treated by radical electrocoagulation diathermy who have been followed for at least 12 months, persistent or recurrent disease has been found in only 15, a first time treatment success rate of 93.9%.

Colposcopy↗

Treatment of trigeminal neuralgia in the aged by a simplified surgical approach (percutaneous electrocoagulation).

Trigeminal neuralgia can be excruciatingly painful. For aged patients, among whom trigeminal neuralgia most commonly occurs, medical therapy may often afford relief of pain. However, since this disorder is likely to become worse with increasing age, medical therapy eventually may fail because of increasing drug requirements and intolerable side effects. Major forms of surgical treatment requiring craniotomy may afford longstanding relief but are associated with significant side effects in 3-5 per cent of cases. For these reasons the authors began to test a new surgical approach, i.e., stereotaxic percutaneous electrocoagulation of the trigeminal nerve. More than 300 patients have been treated by this technique in the past five years. Successive radiofrequency lesions allow the production of a graded sensory deficit sufficient to relieve pain while preserving touch and motor function in the face. Unnecessary suffering from the severe pain of trigeminal neuralgia need not occur because of age or a debilitated condition which might ordinarily preclude surgical treatment. More than 100 patients over 65 years of age (4 of them older than 90) have been treated. Of this group, 93 per cent reported good to excellent results. Seven per cent have had some recurrent pain during the follow-up period; however, recoagulation has been required in only 5 per cent of these patients. Recoagulation may be readily performed in any patient who shows evidence of fading of the sensory deficit. The electrocoagulation technique and the results in elderly patients are discussed.

Aged↗

Local treatment (electrocoagulation) for carcinoma of the rectum in the elderly.

For more than 70 years, surgical excision with permanent colostomy has been the most common operation for adenocarcinoma of the rectum. Local treatment has been advocated by some surgeons, but most prefer radical surgery. Abdominoperitoneal resection often diminishes the risk of local recurrence, but mortality and morbidity rates are very high, especially in the elderly. Although local treatment for rectal cancer remains controversial, the author believes that the elderly constitute a separate category of patients because their mortality and morbidity rates are high and because they usually are unable to care for a colostomy. Local treatment seems a much more desirable form of therapy. A series of 6 elderly patients (average age, 77) were treated by local electrocoagulation followed by radiation therapy, for biopsy-proven adenocarcinoma of the rectum; one died after nine months from liver metastases (present at the time of diagnosis), and one had to undergo a colostomy after 19 months. For the 4 remaining patients, follow-up has ranged from three years to nine months. To date there has been no recurrence, no evidence of metastases, and no mortality or morbidity. In the author's opinion, the results of electrocoagulation-radiation treatment of small rectal adenocarcinomas are superior to the results of radical surgery in elderly patients.

Adenocarcinoma↗

Neodymium:yttrium aluminum garnet surgical laser versus bipolar electrocoagulation for laparoscopic ovariectomy in dogs.

OBJECTIVE: To compare use of neodymium:yttrium aluminum garnet (Nd:YAG) surgical laser and bipolar electrocoagulation (BEC) for laparoscopic ovariectomy (OVE) in dogs. STUDY DESIGN: Prospective clinical trial. ANIMALS: Female dogs (n=72). METHODS: Laparoscopic OVE by Nd:YAG laser (600 microm optical fiber, contact mode) in 36 dogs was compared with laparoscopic OVE by bipolar electro-coagulating grasping forceps. Dogs were paired (laser, electrocoagulation) matched for breed, age, body weight, obesity, and number of heat cycles. Duration of predetermined surgery times and total surgical time were compared between groups. Occurrence of intra- and postoperative complications and their effect on surgical duration were evaluated. RESULTS: Laser surgery resulted in a higher incidence of intraoperative mesovarial bleeding (12 times; 9 dogs) compared with electrosurgery (4 times; 3 dogs). Use of laser caused a 2 minute delay for transection of the left ovary compared with electrosurgery. Postoperative complication rates and convalescence were similar for both groups. CONCLUSIONS: BEC reduced surgical time and intraoperative mesovarial bleeding compared with laser resection. CLINICAL RELEVANCE: Although the laser was effective for laparoscopic OVE, bipolar electrosurgical laparoscopic OVE remained the method of choice.

Animals↗

Ultrasound guided electrocoagulation in patients with chronic non-insertional Achilles tendinopathy: a pilot study.

BACKGROUND: High resolution colour Doppler ultrasound shows intratendinous Doppler activity in patients with chronic Achilles tendinopathy. Treatment of this neovascularisation with sclerosing therapy seems to relieve the pain. However, the procedure often has to be repeated. OBJECTIVE: To investigate the effect of electrocoagulation of the neovessels on tendon pain and tendon vascularity in patients with chronic Achilles tendinopathy. METHODS: Colour Doppler ultrasound guided electrocoagulation was used on vessels in the ventral portion of the Achilles tendon in 11 patients (seven men, four women, mean age 41 years) with painful chronic mid-portion Achilles tendinosis. A unipolar coagulation device was used. RESULTS: One patient dropped out after two months (dissatisfied with the results). The remaining 10 patients (91%) were satisfied. These 10 patients were still satisfied at six months of follow up and had returned to their previous level of activity. All 10 patients were "cured" after one treatment. The patient who dropped out received two treatments because of lack of progress. There was significantly reduced pain (Likert pain scale, 0-10) during activity, from a median of 7 (range 4 to 10) at baseline to 0 (0 to 8) at six months' follow up (p<0.005); and at rest, from 1.5 (1 to 5) to 0 (0 to 8) (p = 0.005). In all patients, vascularisation was unchanged at the six months follow up, with no significant change in semiquantitative or quantitative colour scoring. CONCLUSIONS: Coagulation in the area with vessels entering the tendon appears to be effective treatment for painful chronic mid-tendinous Achilles tendinopathy. No effect on the intratendinous Doppler activity could be detected, suggesting that the effect is independent of changes in blood flow. Localisation of hyperaemia appears to be the key to the pathology and for targeting the treatment. One explanation could be that the effect is obtained by destruction of nerves accompanying the vessels.

Achilles Tendon↗

Lidocaine/prilocaine cream (EMLA(R)) versus infiltration anaesthesia: a comparison of the analgesic efficacy for punch biopsy and electrocoagulation of genital warts in men.

OBJECTIVES: To compare analgesic efficacy and pain caused by administration of lidocaine/prilocaine cream (EMLA(R)) versus xylocaine 1% local infiltration for punch biopsy and electrocoagulation of genital warts in men. DESIGN: Open randomised comparative parallel-group study. SETTING: Department of Dermatovenereology, University Hospital Rotterdam/Dijkzigt, the Netherlands. PATIENTS: 63 males with warts on the genital mucosa and/or perianal area. METHODS: EMLA(R) cream (2.5-5 g) was applied during 13-45 minutes before surgery. Xylocaine 1% (0.1-4 ml) was infiltrated 0.5-4 minutes before surgery. Pain during administration and surgery was assessed by the patient on a verbal rating scale and on a visual analogue scale. RESULTS: EMLA(R) application was painless in all patients (n = 31) whereas xylocaine infiltration was slightly painful in 17/29 patients and moderately painful in 10/29 patients. EMLA(R) analgesia was satisfactory for 94% of biopsies and 62% of electrocoagulations. Xylocaine infiltration was satisfactory in all procedures. CONCLUSIONS: EMLA(R) application on the male genital mucosa is painless but it has a lower analgesic efficacy than xylocaine infiltration. However EMLA is a useful anaesthetic for taking biopsies in this area and may be used as premedication for local infiltration.

Adolescent↗

Surgical treatment of intractable epilepsy combined with bipolar electrocoagulation on functional cortex.

OBJECTIVE: Resecting epileptogenic foci combined with bipolar electrocoagulation of functional cortex has been successfully used to treat intractable epilepsy. METHOD: 124 cases with intractable epilepsy have been treated from 1996 to 1999, 75 cases with temporal lobe epilepsy and 48 cases with extra-temporal lobe epilepsy, and one case with infantile hemiplegia. Electrocorticography (ECoG) was used pre- and postoperatively. 108 cases were followed-up from one to three years. RESULTS: The general efficiency of bipolar electrocoagulation on functional cortex (BCFC) for epilepsy is 91.7%. The pathological features indicate that the damage by coagulation of the cortex is only in the supra- and infra-granular layers, similar to multiple subpial transection (MST). CONCLUSION: When the epileptogenic foci are located in functional cortex, the method of resecting the foci combined with BCFC has been effective and improves the results greatly. BCFC is safe and easy to use.

Adolescent↗