Nerve welding using CO[2] laser: an experimental study

The ultimate goal of any peripheral nerve repair is maximum sensory and motor recovery of the distal denervated part. Conventional suture repair may result in neuroma formation and a fibrotic reaction that is detrimental to nerve regeneration. Further studies concerning laser and its effect on the peripheral nerves in rats and other species have helped in the development of laser-assisted nerve anastomosis. In the field of otorhinolaryngology, facial nerve anastomosis, particularly in difficult-to-reach sites, may need such a non-contact sutureless laser technique to overcome the difficulties of other conventional methods. The aim of this work is to assess the effect of CO[2] laser as a tool for sciatic nerve welding in rats [with and without solder] and comparing it with the conventional suture repair. Sixty rats were used in this study classifying into 5 Groups: Group A: 12 rats for laser nerve welding without solder. Group B: 12 rats for laser nerve welding with solder. Group C: 12 rats for nerve anastomosis with sutures. Group D: 12 rats for delayed laser nerve welding without solder [one week after cut]. Group E: 12 rats for delayed laser nerve welding without solder [two week after cut]. After follow-up period of 8 weeks the rats of each group were assessed physically for functional recovery [motor and sensory], elecrtophysiologically for nerve conduction and histopathologically for morphological study of nerve fibers. It was found that no significant difference between laser groups and suture group regarding physical, electrophysiological and histopathological results. Only the dehiscence rate was higher in laser groups than in suture group. The soldered laser group was the least one concerning dehiscence. It is concluded that CO[2] laser -assisted nerve welding is as effective as microsuturing technique, but easier, less tedious, less time consuming and easy to reach difficult areas

Hepatic focal lestions: is needle biopsy a must?

With advanced in liver imagin, the results of recent studies have suggested a very high accuracy of preoperative evaluation of hepatic focal lesions, making tumour biopsy unnecessary in most cases. The aim of this study was to evaluate the accuracy of the diagnostic work-up, without needle biopsy, for defining the indications for surgery in patients with focal lesions of liver. Between august 1998 and february 2002. 58 patients with hepatic focal lesions. Were evaluated retrospectively. Preoperative diagnosis was established by means of laboratory parameters, tumor markers, ultrasnongraphy, compared tomography [ct], helical compared tomography, and magnetic resonance imaging [mri]. Fifty-five patients underwent surgery and the results of pathological examination were obtained for all cases. Preoperative clinical/radiological diagnosis were confirmed in 55 lesions. Hepatocellular carcinoma was present in 38 [65%] cases and cavernous hemangioma in 17 [29%] cases. Three patients had inconclusive preoperative clinical/radiological data. Accordingly, ultrasound-guided needle biopsy was performed. Non-Hodgkin lymphoma was present in 2 patients [4%] and one patients [2%] had glaucomatous hepatitis confirmed by pathological examination. The false positive rate for the clinical/radiological evaluation was 3 of 58 [5.2%] with a positive predictive value of 94.8%. Preoperative radiological diagnosis of focal lesions was accurate in lesions >/= 3cm. Tumor biopsy is unnecessary in these patients, however, in a subgroup of lesions< 3cm, there is a higher false positive rate [20%]. Tumor biopsy should be considered if lesions not radiological diagnosed