Thermocoagulation as a Surgical Approach for the Treatment of Obsessive-Compulsive Disorder in Refractory Patients: Systematic Review

Obsessive-compulsive disorder (OCD), a disabling chronic neuropsychiatric disease, entails high economic costs to society and has high morbidity and mortality rates. The first-line treatments for OCD are selective serotonin reuptake inhibitors and cognitivebehavioral therapy. However, this disorder has the highest refractory index to noninvasive treatment. Alternatively, ablative thermocoagulation neurosurgical techniques have shown efficacy and few adverse effects. The present systematic review aimed to identify validated protocols to observe the effectiveness of ablative procedures in the treatment of severe and refractory OCD, as well as their possible adverse effects and benefits. This review supports the effectiveness of ablative methods by presenting them as a safe non-experimental therapeutic option for cases of highlyrefractory OCD. Additional relevant findings were the improvement in cognitive function, functional capacity, affective orientation, and quality of life, which contribute to the destigmatization of this surgical technique. Further controlled studies may lead to the individualization of recommendations of targets for ablative thermocoagulation.

Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review / Eficacia y seguridad de crioterapia, cono frio o termo-coagulación en comparación con LEEP como terapia para la neoplasia intraepitelial cervical: Revisión sistemática

ABSTRACT OBJECTIVES To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. METHODS Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. RESULTS The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). CONCLUSIONS The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.

RESUMEN OBJETIVOS Evaluar la eficacia y seguridad del uso de crioterapia, cono frio o termo-coagulación en comparación con el procedimiento de escisión electroquirúrgica en asa (LEEP) para el manejo de neoplasias intraepiteliales cervicales. MÉTODOS Revisión sistemática de ensayos controlados aleatorizados en mujeres con neoplasia intraepitelial cervical en tratamiento con crioterapia, cono frio, o termo coagulación y LEEP, para estimar su eficacia y seguridad. La búsqueda se realizó en MEDLINE/PUBMED, Registro Cochrane Central de Ensayos Controlados (CENTRAL) y Scopus, hasta setiembre de 2018. RESULTADOS Se identificaron 72 estudios, ocho cumplieron los criterios de inclusión. Cono frio disminuyó el riesgo de enfermedad residual en comparación con LEEP (RR 0,54; IC del 95%, 0,30-0,96, p = 0,04). Crioterapia en comparación con LEEP incrementó el riesgo de recurrencia de enfermedad en un 86,0% (RR 1,86; IC del 95%, 1,16-2,97, p = 0,01) con un tiempo de seguimiento de seis a 24 meses, y de infecciones (RR, 1,17; IC del 95%, 1,08-1,28, p < 0,001); pero redujo el riesgo de sangrado menor en un 51,0% (RR 0,49; IC del 95%, 0,40-0,59, p ≤ 0,001). CONCLUSIONES Cono frio reduce el riesgo de enfermedad residual. Sin embargo, la crioterapia reduce el riesgo de sangrado menor en las 24 horas posteriores al tratamiento e incrementa el riesgo de recurrencia de enfermedad y de infecciones.

Comparison of sharp dissection, electrocautery, and ultrasonic activated scalpel with regard to endothelial damage, preparation time, and postoperative bleeding during radial artery harvesting

Abstract Objective: To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods: Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results: Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion: Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.

Long-Term Evaluation of Nasal Septoplasty Followed by Inferior Turbinate Cauterization for the Treatment of Nasal Obstruction Using Objective and Subjective Methods

Abstract Introduction Nasal septoplasty is considered the treatment of choice for nasal obstruction due to septal deviation. An ongoing discussion among rhinologists is whether it is reasonable to perform objective measurements of nasal patency pre or postoperatively routinely. Objective The primary aim of this study was to identify the short- and long-term functional benefits for patients undergoing septal surgery, as assessed by acoustic rhinometry (AR). The secondary goal was to evaluate the short- and long-term perception of symptom relief and disease-specific quality of life (QoL) outcomes on the part of the patients. Methods This was a prospective observational study in which AR was utilized for the assessment of nasal patency preoperatively and 1, 6 and 36months after septoplasty. Total 40 patients who underwent septoplasty filled out the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire and the Glasgow Benefit Inventory (GBI) to assess their subjective improvement in nasal obstruction symptoms and the changes in their QoL. Results There were statistically significant improvements in nasal patency, mean postoperative NOSE and GBI scores postoperatively. However, there was no correlation between the mean NOSE and GBI scores and the AR measurements. Furthermore, the GBI scores tended to decrease as the postoperative period increased. Conclusion The present study confirms that septoplasty significantly increases nasal patency and causes a significant subjective improvement in nasal obstruction symptoms. The absence of a statistically significant correlation among the objective measurements, the symptom scores, and the patients' low GBI scores indicates that factors other than the anatomical findings may also contribute to the patients' perception of QoL.

Which mode and potency of electrocoagulation yields the Smallest Unobstructed Area of the Fallopian Tubes? / Qual modo e potência produzem a menor área de nãoobstrução nas tubas de Falópio?

Abstract Objective To determine which mode and potency of electrocoagulation, using a modern electrosurgical generator, yields the smallest unobstructed area of the Fallopian tubes. Methods In an experimental study, tubes from 48 hysterectomies or tubal ligation were evaluated. Tubes were randomly allocated to one of the following groups: group A) 25 W x 5 seconds (n = 17); group B) 30 W x 5 seconds (n = 17); group C) 35 W x 5 seconds (n = 18), group D) 40 W x 5 seconds (n = 20); group E) 40 W x 5 seconds with visual inspection (blanch, swells, collapse) (n = 16); group F) 50 W x 5 seconds (n = 8). Bipolar electrocoagulation was performed in groups A to E, and monopolar electrocoagulation was performed in group F. Coagulation mode was used in all groups. Digital photomicrography of the transversal histological sections of the isthmic segment of the Fallopian tube were taken, and themedian percentage of unobstructed luminal area (mm2) was measured with ImageJ software (ImageJ, National Institutes of Health, Bethesda, MD, USA). The Kruskal-Wallis test or analysis of variance (ANOVA) was used for statistical analysis. Results Ninety-six Fallopian tube sections were analyzed. The smallest median occluded area (%; range) of the Fallopian tube was obtained in the group with 40 W with visual inspection (8.3%; 0.9-40%), followed by the groups 25 W (9.1%; 0-35.9%), 40 W (14.2; 0.9-43.2%), 30 W (14.2; 0.9-49.7%), 35 W (15.1; 3-46.4%) and 50 W (38.2; 3.1-51%). No statistically significant difference was found among groups (p = 0.09, Kruskal-Wallis test). Conclusion The smallest unobstructed area was obtained with power setting at 40 W with visual inspection using a modern electrosurgical generator. However, no statistically significant difference in the unobstructed area was observed among the groups using these different modes and potencies.

Resumo Objetivo Determinar em qual modo e potência, usando unidades geradoras modernas de eletrocoagulação, produz a menor área de não-obstrução das tubas de Falópio. Métodos Num estudo experimental, tubas uterinas derivadas de 48 histerectomias ou ligadura tubária foram avaliadas. As tubas foram alocadas aleatoriamente para um dos seguintes grupos: grupo A) 25 W x 5 segundos (n = 17); grupo B) 30 W x 5 segundos (n = 17); grupo C) 35 Wx 5 segundos (n = 18), grupo D) 40 W, 5 segundos (n = 20); grupo E) 40 W x 5 segundos inspeção visual (branqueia, incha e colapsa) (n = 16); grupo F) 50 Wx 5 segundos (n = 8). A eletrocoagulação bipolar foi usada nos grupos de A a E, e a eletrocoagulação monopolar, no grupo F. O modo de coagulação foi utilizado em todos os grupos. Cortes histológicos transversais do segmento ístmico das tubas de Falópio foram corados e fotografados digitalmente, e a percentagem da área luminal (mm2) não-obstruída foi medida com o software ImageJ (ImageJ, National Institutes of Health, Bethesda, MD, USA). O teste de Kruskal-Wallis ou ANOVA foram usados para a análise estatística. Resultados Noventa e seis cortes histológicos de tubas de Falópio foram analisados. A mediana da menor área não-obstruída (%; amplitude) da tuba de Falópio foi obtida no grupo 40 W com inspeção visual (8,3%; 0,9-40%), seguido do grupo 25 W (9,1%; 0- 35,9%), 40W(14,2; 0,9-43,2%), 30 W(14.2; 0,9-49,7%), 35 W(15,1; 3-46,4%) e 50 W (38,2; 3.1-51%). Não houve diferença significativa entre os grupos (p = 0,09, teste de Kruskal-Wallis). Conclusão A menor área não-obstruída foi obtida com a potência de 40 W com inspeção visual usando um gerador moderno de eletrocirurgia. Contudo, nenhuma diferença significativa na área não-obstruída foi observada entre os grupos usando esses modos e potências.

Argon plasma versus electrofulguration in the treatment of anal and perianal condylomata acuminata in patients with acquired immunodeficiency virus

Abstract Purpose: To compare the effectiveness of anal and perianal condylomata treatment using argon plasma and electrofulguration. Methods: From January 2013 to April 2014, 37 patients with anal and perianal condylomata, who had been diagnosed through proctological examination, oncotic cytology, polymerase chain reaction (PCR) and histology, underwent treatment with argon plasma and electrofulguration. The perianal and anal regions were divided into two semicircles. Each semicircle was treated using one of the methods by means of simple randomization. Therapeutic sessions were repeated until all clinical signs of infection by HPV were eliminated. The patients were evaluated according to several variables like the genotype of HPV, HIV infection, oncological potential per genotype, oncotic cytology and histology. Results: Among all the variables studied, only immunosuppression due to HIV influenced the results, specifically when the fulguration method was used. There was no significant difference in effectiveness between argon and fulguration based on lesion relapse (p > 0.05). However, among HIV-positive patients, fulguration presented worse results, with a significant difference (p = 0.01). Conclusion: Regarding treatment of anal and perianal condylomata acuminata, comparison between applying fulguration and argon demonstrated that these methods were equivalent, but use of fulguration presented more relapses among HIV-positive patients.

Histerectomía por vía laparoscópica: experiencia de diez años en hospitales de la zona norte de Honduras / Laparoscopic hysterectomy: experience of ten years in hospitals in the northern region of honduras

Antecedentes: La histerectomía, es uno de los procedimientos quirúrgicos ginecológicos que más se realizan es Estados Unidos; la histerectomía laparoscópica, introducida en 1989, se ha convertido en un procedimiento diseminado dado su baja morbi - lidad y pronta recuperación comparada a la histerectomía abdominal. Objetivo: Caracterizar la evolución de pacientes sometidas a histerectomía laparoscópica en centros hospitalarios de la zona norte de Honduras. Metodología: Estudio descriptivo, transversal, multicéntrico, se revisó la casuística de 10 años en 8 centros hospitalarios de la zona norte de Honduras caracterizando la evolución de pacientes sometidas a histerectomía con o sin ooforectomia por vía laparoscópica. Resultados: Se realizaron en el periodo de estudio, 569 procedimientos, 551 casos en pacientes menores de 50 años, el tiempo quirúrgico promedio fue 62 minutos, el sangrado oscilo entre 50 y 150 ml en 557 pacientes, tiempo promedio de hospitalización 30 horas, las complicaciones observadas fueron san- grado importante en 6 pacientes, lesión vesical 5 pacientes y tromboembolia 1 paciente. Discusión: La histerectomía laparoscópica en los centros incluidos en el estudio se inicio en 2006; el procedimiento y la mejora en los resultados de la evolución de las pacientes se observo después de capacitar personal de enfermería, y médico, y realizar protocolos para la realización de los procedimientos...(AU)

Electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies: experimental study / Técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever: estudo experimental

There are few studies about the treatment options for cranial cruciate ligament rupture in growing dogs, especially with epiphysiodesis techniques. The aim of this study was to evaluate the electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies. The novel electrocautery technique was compared with the screw technique regarding the efficacy for tibial plateau leveling in growing dogs. Six healthy Labrador retriever puppies were divided into two groups. The screw technique was used in one group and the electrocautery technique was used in the other group. Both proximal tibial epiphysiodesis techniques for tibial plateau leveling were effective in achieving reduced tibial plateau angle and did not cause significant joint changes. The screw technique was more invasive and caused slightly greater morbidity than the electrocautery technique. The electrocautery technique seems to be a good alternative for proximal tibial epiphysiodesis in young dogs.(AU)

São descritos poucos estudos sobre as opções de tratamento para a ruptura do ligamento cruzado cranial em cães na fase de crescimento, especialmente em relação às técnicas de epifisiodese. O objetivo deste estudo foi avaliar a técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever. A nova técnica de eletrocauterização foi comparada com a do parafuso em relação à eficácia para nivelamento do platô tibial em cães na fase de crescimento. Seis filhotes saudáveis da raça Labrador foram selecionados e divididos aleatoriamente em dois grupos. A técnica do parafuso foi usada em um grupo, enquanto no outro foi usada a da eletrocauterização. Ambas as técnicas de epifisiodese proximal da tíbia para nivelamento do platô tibial foram eficazes na redução do ângulo do platô tibial e não causaram alterações articulares importantes. A técnica do parafuso foi considerada mais invasiva e causou morbidade um pouco mais acentuada do que a da eletrocauterização. Assim, a técnica da eletrocauterização parece ser uma boa alternativa para a epifisiodese proximal da tíbia em cães jovens.(AU)

Electrocauterio y broncoscopia flexible como primera medida en la obstrucción central de la vía aérea y hemoptisis asociada / Electrocautery and bronchoscopy as a first step for the management of central airway obstruction and associated hemoptysis

Background: Central airway obstruction caused by malignant or benign lesions, associated in some cases with hemoptysis, is a condition with high morbidity and mortality. The use of electrocautery by flexible bronchoscopy is an initial treatment option with immediate improvement of obstruction symptoms. It is as effective as Nd: YAG laser. Aim: To describe the usefulness of electrocautery in the management of central obstruction of the airway and hemoptysis. Material and Methods: A retrospective, descriptive study of patients referred for management of central airway obstruction or associated hemoptysis. Diagnoses, symptoms (dyspnea, cough, and hemoptysis) and radiology before and after the procedures were analyzed. Results: Eighteen patients aged 59 ± 12 years (66% males) were evaluated, registering 25 endoscopic procedures. Three conditions were found: partial or complete airway obstruction, hemoptysis and post lung transplant bronchial stenosis. Seventy two percent presented with dyspnea, 61% with cough and 33% with hemoptysis. Sixty six percent of patients had airway obstruction caused by malignant metastatic lesions. After electrocautery, 17 patients (94.4%) improved their symptoms and achieved complete airway clearing. Three patients had significant bronchial stenosis after lung transplant achieving subsequent clearing after electrocautery. Conclusions: Electrocautery during flexible bronchoscopy is an effective and safe procedure for the management of central airway obstruction and associated hemoptysis.

LPS levels in root canals after the use of ozone gas and high frequency electrical pulses

Abstract The present study aims to verify the effect of ozone gas (OZY® System) and high frequency electric pulse (Endox® System) systems on human root canals previously contaminated with Escherichia colilipopolysaccharide (LPS). Fifty single-rooted teeth had their dental crowns removed and root lengths standardized to 16 mm. The root canals were prepared up to #60 hand K-files and sterilized using gamma radiation with cobalt 60. The specimens were divided into the following five groups (n = 10) based on the disinfection protocol used: OZY® System, one 120-second-pulse (OZY 1p); OZY® System, four 24-second-pulses (OZY 4p); and Endox® System (ENDOX). Contaminated and non-contaminated canals were exposed only to apyrogenic water and used as positive (C+) and negative (C-) controls, respectively. LPS (O55:B55) was administered in all root canals except those belonging to group C-. After performing disinfection, LPS samples were collected from the canals using apyrogenic paper tips. Limulus Amoebocyte Lysate (LAL) was used to quantify the LPS levels, and the data obtained was analyzed using one-way ANOVA. The disinfection protocols used were unable to reduce the LPS levels significantly (p = 0.019). The use of ozone gas and high frequency electric pulses was not effective in eliminating LPS from the root canals.

Hiperqueratosis nevoide bilateral de areola y pezón. presentación de un caso / Hyperkeratosis of the nipple and areola

La hiperqueratosis nevoide de areola y pezón es una entidad patológica de la dermatología escasamente presentada en la literatura. Descrita por primera vez en 1938 por Levy – Frankel,2 quien además establece una clasificación etiológica de la misma. En este trabajo se presenta un caso de hiperqueratosis nevoide bilateral de areola y pezón, y su tratamiento con galvanocauterio que da muy buenos resultados no solo estéticos sino primordialmente por la nula recidiva.

Hyperkeratosis of the nipple and the areola is a pathological entity of dermatology sparsely reported, first described in 1938 by Levy - Frankel, who established an etiological classification of that entity. In this paper a case of bilateral hyperkeratosis of the nipple and the areola and its successful treatment with galvanocautery surgery with no long-term recurrence is reported.

Fulguración con láser de la recidiva de tumores vesicales superficiales bajo anestesia local: diseño de procesos / Laser fulguration of superficial bladder tumor recurrence under local anesthesia. design process

Introduction: The process design is one of the most interesting tools to ensure the quality of health care before the start of an activity. Although the gold standard treatment of superficial bladder tumors remains transurethral resection (TUR), the onset of laser energy source with better endourological systems allows us to adopt alternative therapies. The aim of this pilot study is to describe the design and protocol in 37 patients with a novel process consisting of outpatient treatment under local anesthesia of bladder tumors with holmium laser. Material and Methods: Pilot study includes 37 patients between January 2012 and December 2013, for the development of a process of holmium laser bladder fulguration without anesthetic infiltration in outpatient study. It analyzes and studies the procedure tolerance, development of immediate complications, visual analog scale (VAS) of pain, patient satisfaction, hospital stays avoided, problems during the application process and development. Results: The mean age of the patients was 69.2 +/- 10.3 years, 100 percent of patients prefer this procedure instead conventional transurethral resection and VAS rating presenting ≤ 3. There were no important complications. Only one patient was admitted at hospital due to hematuria resolved without surgical treatment. Conclusions: The development and implementation of fulguration of superficial papillary bladder tumors with holmium laser process is simple, well tolerated, ambulatory and without complications, with no need of hospital stay.

Introducción: El diseño de procesos es una de las herramientas de mayor interés para asegurar la calidad de la asistencia sanitaria antes del comienzo de una determinada actividad. Aunque el gold standard del tratamiento de los tumores vesicales superficiales sigue siendo la resección transuretral (RTU), la aparición de la fuente de energía láser con mejores medios endourológicos nos permite adoptar otras alternativas terapéuticas. El objetivo de este estudio piloto es describir el diseño y protocolo en 37 pacientes de un proceso novedoso consistente en el tratamiento en régimen ambulatorio y bajo anestesia local intravesical de los tumores de vejiga con láser de holmium. Material y Métodos: Estudio piloto que incluye 37 pacientes entre enero de 2012 y diciembre de 2013, para la elaboración de un proceso de fulguración vesical con láser de holmium sin infiltración anestésica en régimen ambulatorio. Se analiza y estudia tolerancia al procedimiento, desarrollo de complicaciones inmediatas, escala visual analógica (EVA) del dolor, satisfacción del paciente, estancias hospitalarias evitadas, problemas durante la aplicación del proceso y desarrollo del mismo. Resultados: La edad media de los pacientes fue 69,2 +/- 10,3 años, presentando puntuación EVA ≤ 3. No existieron complicaciones importantes. Hubo un ingreso por hematuria tardía que se resolvió de forma conservadora. Conclusiones: La elaboración y aplicación del proceso de fulguración de tumores vesicales papilares superficiales con láser holmium es una técnica sencilla, con buena tolerancia, ambulatoria y sin complicaciones de interés, con eliminación de estancias hospitalarias.

Cervical cordotomy for the treatment of oncological pain / Cordotomia cervical para tratamento da dor oncológica: revisâo de literatura

Cordotomy consists in the discontinuation of the spinothalamic tract in the anterolateral quadrant of the spinal cord and aims to reduce the transference of nociceptive information in the dorsal horn of the grey matter of the spinal cord (CPME) for rostral units at the neural axis. Many modalities of cordotomy may be employed: anterior transdiscal between C4-C5; endoscopic infra mastoid tip between C1-C2; percutaneous guided by fluoroscopy infra mastoid tip between C1-C2; percutaneous guided by CT infra mastoid tip between C1-C2; open cordotomy by means of laminectomy. The main indication is for patients in advanced cancer disease with severe neuropathic pain bellow the neck in whom the period of survival due to cancer disease is inferior to 3-4 months. The results for immediate pain relieve ranges from 69% to 100% of the cases, while preoperative Karnofsky scores were 20 and 70, respectively versus post operative Karnofsky scores of 20 and 100 respectively; the difference was determined to be highly significant (p < 0.001).

A cordotomia consiste na discontinuação do trato espinotâmico no quadrante ântero-lateral da medula espinal e visa reduzir a transferência de informação nociceptiva no corno dorsal da substância cinzenta da medula espinal (CPME) para as unidades rostrais no neuroeixo. Muitas modalidades de cordotomia podem ser empregadas: transdiscal anterior entre C4-C5; endoscópica inframastoidea entre C1-C2; Percutânea inframastoidea entre C1-C2 guiada por fluoroscopia; percutânea inframastoidea entre C1-C2 guiada por TC; cordotomia aberta por laminectomia. A principal indicação é para pacientes com câncer avançado com dor neuropática severa abaixo do pescoço nos quais a sobrevida devido ao câncer é inferior a 3-4 meses. Os resultados para alívio imediato da dor varia de 69% a 100% dos casos, enquanto os escores de Karnofsky foram de 20 e 70 no período pré-operatório, para 20 e 100 no período pós-opertaório; a diferença foi estatisticamente significativa (p < 0.001).

Effect of Electrocauterization on the Inflammation of the Conjunctiva in Experimental Animal Model

PURPOSE: Recently, conjunctivochalasis repair surgery using electrocauterization has been gaining popularity. However, patients with electrocauterized conjunctivoplasty tend to complain of more postoperative pain than patients undergoing simple excision with suturing. Therefore, we investigated the effects of electrocauterization on inflammation of the conjunctiva using an experimental animal model and compared these with the effects of simple excision with suturing. METHODS: Ten New Zealand white rabbits underwent cauterization in the right eyes and excision and suturing in the left eyes. For each eye, we excised or electrocauterized the inferior bulbar conjunctiva, 1 mm in width and 6 mm in length, 2 mm from the limbus. A fine-needle electrode was inserted subconjunctivally, and electrocauterization was performed. In the contralateral eye, the corresponding area was excised and re-approximated with 10-0 nylon sutures. Sutures were removed after 14 days. Tissue samples were obtained at 21 days post-procedure, and inflammatory cells were counted in five randomly selected fields (x200) on hematoxylin-eosin stained slides. Tumor necrosis factor (TNF)-alpha and interleukin (IL)-1beta concentrations in tears were measured using enzyme linked immunosorbent assays. RESULTS: All cauterized eyes demonstrated smooth surface healing without scarring after 5 days, whereas sutured eyes presented with mild edema with some scarring until the suture was removed. The number of inflammatory cells was significantly greater in sutured eyes compared with cauterized eyes (p = 0.035, Mann-Whitney U-test) at 21 days post-procedure. Tear TNF-alpha and IL-1beta concentrations at 21 days were similar in both groups. CONCLUSIONS: Electrocauterization for conjunctivoplasty seems to be advantageous in terms of inflammation compared with simple suturing and excision.

Efeitos imediatos do eletrocautério endovascular em varizes de membros inferiores / Immediate effects of endovascular electrocauterization in lower limb varicose veins

OBJETIVOS: Determinar a importância das variáveis: Intensidade de Energia (I), Potência (P) e Tempo de Aplicação (T) nas alterações histológicas ocorridas em varizes de membros inferiores submetidas à eletrocauterização endovascular. MÉTODO: Estudo prospectivo experimental realizado em pacientes submetidos à eletrocauterização endovenosa de fragmento proximal da veia safena magna, de acordo com uma tabela de aleatorização - GI: I=0J, P=0W, T=15s; GII: I=300J, P=60W, T=5s; GIII: I=600J, P=60W, T=10s; GIV: I=900J, P=60W, T=15s; GV: I=450J, P=90W, T=5s; GVI: I=900J, P=90W, T=10s; GVII: I=1350J, P=90W, T=15s; GVIII: I=600J, P=120W, T=5s; GIX: I=1200J, P=120W, T=10s; GX: I=1800J, P=120W, T=15s. Os fragmentos foram submetidos a estudo anatomopatológico com o objetivo de analisar a profundidade das alterações tissulares, assim classificadas: Grupo A - endotélio e média, Grupo B - endotélio, média e adventícia. RESULTADOS: A intensidade das alterações histológicas - Grupo A e B - ocorridas nos fragmentos foram proporcionais à Intensidade de Energia de eletrocauterização (p=0,0001). Essa associação linear também pode ser verificada para as variáveis Potência (p=0,017) e Tempo de Aplicação (p=0,0001). O índice de correlação de Spearman foi maior para variável Tempo de Aplicação: 0,42269 (p=0,002) quando comparada com a variável Potência de Energia: 0,3542 (p=0,005). CONCLUSÃO: O Tempo de Aplicação de Energia é mais importante do que a Potência de Energia utilizada para uma mesma energia de eletrocauterização, na determinação da profundidade dos efeitos histológicos observados na parede das varizes de membros inferiores.

OBJECTIVE: To determine the importance of the variables: Energy Intensity (I), Power (P) and Time of Application (T) in the histological changes occurring in lower limb varicose vein submitted to endovascular electrocauterization. METHOD: Prospective experimental study conducted in patients undergoing great saphenous vein electrocauterization according to a randomization table - GI: I=0J, P=0W, T=15s; GII: I=300J, P=60W, T=5s; GIII: I=600, P=60W, T=10s; GIV: I=900J, P=60W, T=15s; GV: I=450J, P=90W, T=5s; GVI: I=900J, P=90W, T=10s; GVII: I=1350W, P=90W, T=15s; GVIII: I=600, P=120W, T=5s; GIX: I=1200J, P=120W, T=10s; GX: I=1800J, P=120W, T=15s. The fragments were submitted to histopathological examination in order to analyze the depth of tissue changes, classified as follows: Group A - endothelium and media; Group B - endothelium, media and adventitia. RESULTS: The intensity of histological changes - Groups A and B - that occur in the fragments were proportional to Energy Intensity of electrocauterization (p=0.0001), Power (p=0.017) and Time of Application (p=0.0001). The Spearman correlation coefficient was more powerful for the variable Time of Application: 0.42269 (p=0.002) when compared with the variable Power of Energy (P): 0.3542 (p=0.005). CONCLUSION: Time of Application of Energy is a stronger predictor than the Power of Energy in determining the depth of the histological effects observed in the wall of the varicose vein submitted to electrocauterization.

Application of high frequency bipolar electrocoagulation LigaSureTM in appendix vermiformis of rabbits with or without acute inflammatory process / Aplicação do eletrocoagulador bipolar de alta frequência LigaSureTM no apêndice vermiforme na vigência ou não de processo inflamatório agudo

PURPOSE: To evaluate the efficacy of the use of LigaSureTM in appendectomy, with or without acute inflammatory process, and to compare with simple ligature and conventional therapy. METHODS: A total of 30 rabbits (Oryctolagus cuniculus) randomly allocated in two groups, group A and B, of 15 animals each were used. The group A without acute appendicitis and the group B with acute appendicitis were submitted to appendectomy. After, the groups were subdivided into three groups, each group containing five rabbits submitted to simple ligature, conventional therapy and application of LigaSureTM. We assessed macroscopic and microscopy parameters of appendiceal stump and operative wound. RESULTS: The group with acute appendicitis that LigaSureTM was applied had fibrosis in 100% of animals, as well as in the other operative techniques used. It suggested that application of LigaSureTM is efficient as other techniques used in healing of appendiceal stump. CONCLUSIONS: The application of LigaSureTM induces the formation of fibrosis in the appendiceal stump. The technique proved efficacy to induce enough fibrous tissue to obstruct leakage of enteric content.

OBJETIVO: Avaliar a eficácia da utilização do LigaSureTM na apendicectomia, com ou sem a presença de processo inflamatório agudo, comparando com ligadura simples ou técnica tradicional. MÉTODOS: Um total de 30 coelhos (Oryctolagus cuniculus) foi alocado em dois grupos, grupos A e B, cada um composto por 15 animais. O grupo A não apresentava apendicite aguda e o grupo B com apendicite aguda, sendo os animais submetidos à apendicitectomia. Cada grupo foi divido em três subgrupos, cada um com cinco animais onde foram então submetidos à ligadura simples, técnica tradicional ou utilização do LigaSureTM. Foram avaliados parâmetros macroscópicos assim como microscópicos do coto apendicular assim como da ferida operatória. RESULTADOS: No grupo que apresentava apendicite aguda onde foi utilizado o LigaSureTM, foi observado fibrose em 100% dos animais, assim como nos outros dois grupos. Com isto mostrou-se que a aplicação do LigaSureTM é tão eficiente quanto as outras técnicas utilizadas na cicatrizaçãoo do coto apendicular. CONCLUSÕES: A utilização do LigaSureTM induz a formação de fibrose na região do coto apencicular. A técnica foi eficaz quanto à formação de tecido fibrótico evitando o extravassamento de conteúdo entérico.

Frenectomia lingual em bebê utilizando eletrocautério e tetracaína: relato de caso / Electrocautery and tetracaine in baby lingual frenectomy: case report

O artigo relata o caso clínico de frenectomia lingual em bebê, utilizando eletrocautério e anestesia tópica oftálmica (cloridrato de tetracaína). O uso de eletrocautério proporciona diminuição do tempo de trabalho, maior conforto e segurança do procedimento cirúrgico para o bebê e para o profissional. Já a utilização de anestesia tópica oftálmica, é recomendada para procedimentos de controle da dor, tendo melhor absorção em mucosa umedecida, maior profundidade e maior tempo de ação. Esta técnica segue os princípios da odontologia minimamente invasiva.

The article reports a case of lingual baby frenectomy, using electrocautery and topical ophthalmic anesthetic (tetracaine hydrochloride). The use of electrocautery provides reduction of working time, increased comfort and safety of surgery for the baby and the professional. And the use of topical ophthalmic anesthetic is recommended for pain control procedures, and better absorption in the mucosa, deeper and longe r action. This technique follows the principies of minimally invasive dentistry.

Electrocoagulación monopolar de la arteria cística en colecistectomía laparoscópica: experiencia en el Hospital Central de Maracay / Monopolar electrocoagulation of cystic artery during laparoscopic cholecystectomy

Exponer la experiencia del uso de electrocoagulación monopolar de la arteria cística en la colescistectomia laparoscopia en el Servicio de Cirugía General Hospital Central de Maracay. Se realizó un estudio cuantitativo, prospectivo, descriptivo, transversal, basado en electrocoagulación monopolar de la arteria cìstica en colecistectomia laparoscópica electiva a 64 pacientes con arteria cística menor o igual a 2 mm, en un período de tiempo comprendido entre enero 2010 y abril 2011. Se evaluaron variables: edad, sexo, estadio clínico, presencia de sangrado de arteria cistica, presencia de lesiones de vías biliares, tiempo quirúrgico, conversión a colecistectomía abierta, estancia hospitalaria. 86% correspondio al sexo femenino. La edad promedio fue 39 años (rango de 13 a 73 años), siendo la patología litiasis vesicular, con tiempo quirúrgico de 46 a 60 minutos (rango 25 a 95 minutos), sin casos de sangrado de arteria cística, lesión de vía biliar ni conversión a cirugía abierta. Morbilidad en 27% de los casos, conformada por dolor en heridas operatorias, abdominal y nauseas, con estancia hospitaria de 24 horas en 97%, de 48 horas en 3%. La electrocoagulación monopolar de la arteria cística es un método seguro, efectivo que brinda una alternativa diferente en manejo de la misma.

To describe the experience of using monopolar electrocoagulation of the cystic artery in laparoscopy cholecystectomy in partients attending the outpatient minimally invasive laparoscopic surgery at the Hospital Central de Maracay. It was performed a quantitative prospective, cross sectional study, based on monopolar electrocoagulation of the cystic artery during laparoscopic cholecystectomy of 64 elective patients whose cystic artery was less than or equal to 2 mm over a period of time between January 2010 and april 2011. Variables were evaluated: age, sex, clinical stage, presence of cystic artery bleeding, presence of the bile duct injuries durat0ion of surgery, conversión to open cholecystectomy, hospital stay. 86% were females. The average age was 39 years (range 13 to 73 years), with gallstone disease with a surgical time of 46 to 60 minutes (range 25 to 95 minutes), no cases of bleeding from the cystic artery, injury bile duct or conversion to open surgery were reported, morbidity comprised of abdominal pain at the surgical wounds, nausea in 27% of the patients and hospital stay was 24 hours at 97% 48 hours on 3%. The monopolar electrocoagulation of the cystic artery is a sale, effective supplement that provides an alternative in the management of it.

Cirugía endoscópica por monopuerto: reporte de nuestra experiencia en los primeros 175 casos por sils port en Venezuela / Endoscopic surgery by singleport: report of our experience in the first 175 cases by sils port in Venezuela

El último paso hacia el menor grado de invasión después del surgimiento de la cirugía laparoscópica ocurre cuando los cirujanos del mundo se inician en técnicas emergentes, que entre otras, utilizan el ombligo como único puerto de entrada al abdomen quedando camufladas en la cicatriz umbilical, Presentamos la experiencia inicial de nuestro grupo, entre julio de 2009 hasta enero 2011 en variados procedimientos laparoscópicos por monopuerto con el uso del dispositivo SILS® port. Fueron intervenidos 175 pacientes, 163 adultos (93%), 12 niños (7%), todos abordados por un sólo puerto y a través del SILS® port. Se realizaron 102 colecistectomías (58%), 37 apendicectomías (21%), 8 histerectomías (4,6%), 7 ooforectomías (4%), 7 biopsias hepáticas (4%), 6 liberación de bridas y adherencias (3,4%), 4 salpingoclasias (2,3%), 2 esplenectomías (1%), 1 miotomía de Heller con funduplicatura de Dor (0,6%) 1 hiatoplasia esofágica (0.6%). Los procedimientos complejos se efectuaron después de realizados los primeros 50 casos. Todos los procedimientos en niños se completaron por incisión única de manera satisfactoria. En los adultos, 6 requirieron un puerto un adicional, en un paciente fue necesario dos puertos con posterior conversión a laparotomía (hiatoplastia esofágica). Los tiempos promedios resultaron para colecistectomías 42 min (12-72 min), apendicectomía 37,5 min (13-62 min), histerectomías 95 min (65-125 min), ooforectomías 32,5 min (15-50 min), salpingoclasia 18,5 min (12-25 min), miotomía de Heller 182 min, hiatoplastia esofágica 155 min. La cirugía laparoscópica por incisión única es una técnica emergente en franco desarrollo, en niños ha demostrado ser un procedimiento seguro y eficaz, al igual que en adultos. El desarrollo y perfeccionamiento del instrumento hará ampliar el horizonte y abarcar cirugía más complejas y considerarse como alternativa a la cirugía laparoscópica tradicional otorgando el beneficio de menos dolor y mejores resultados estéticos...

We present the initial experience of our work group, between July 2009 and January 2011 in several laparoscopic procedures by monoport with device SILS port. Patients and method: 175 patients underwent surgery, 163 adults (93%), 12 children (7%), all boarded through a single port with SILS port device, 102 cholecystectomies were made (58%), 37 appendectomies (21%) 8 hysterectomies (4.6%), 7 oophorectomies (4%). 7 hepatic biopsies (4%), 6 liberation of bridles and adhesions (3,4%), 4 segmental resection of fallopian tube (2.3%), 2 splenectomies (1%), 1 Heller miotomy with Dor funduplication (0.6%) and 1 hiatal repair (0.6%). The complex procedures were carried out alter made the first 50 cases. All the procedures in children were completed through unique incision. In the adults. 6 required an additional port; in a patient was necessary two port with later conversion to laparotomy (hiatal hernia repair). The operative times averages were for cholecystectomies 42 min (12-72 min), Appendectomies 37,5 min. (13-62 min). Hysterectomies 95 min (65-125 min), Oophorectomies 32.5 min (15-50 min), segmental resection of fallopian tube 18.5 min (12-25 min), Heller miotomy 182 min. Hiatal hernia repair 155 min. The laparoscopic surgery through unique incision is an emergent technique in frank development, in children has demonstrated to be a safe and effective procedure, like in adults. The development and improvement of instruments will make extend the horizon and include more complex surgeries and consider themselves like alternative to the traditional laparoscopic surgery, granting the benefit of less pain and better aesthetic results. The development of skills and abilities to move in a NEW ATMOSPHERE represent a main concern.

Electrocoagulación monopolar del meso apendicular en apendicectomía laparoscópica: experiencia en el Hospital Central de Maracay / Monopolar electrocoagulation of the meso appendix in laparoscopic appendectomy: experience in the Hospital Central of Maracay

Evaluar la electrocoagulación monopolar del meso apendicular como una herramienta útil en apendicectomía laparoscópica en pacientes con apendicitis aguda, ingresados al servicio de Cirugía General del Hospitla Central de maracay. Diseño no experimental de corte transversal, donde la población estuvo conformada por los pacientes que acudieron a la emergencia del Hospital Central de Maracay durante el período enero-julio de 2010. Para la recolección de datos se utilizó: libro de registro, historia clínica y encuesta postoperatoria. Se analizaron por estadística descriptiva, donde se obtuvo que el tiempo quirúrgico promedio fue de 60 minutos, no se presentaron complicaciones tardias, el tiempo de hospitalización fue 2 días y los pacientes se incorporaron a sus actividades físicas en 10 días. La electrocoagulación monopolar del meso apendicular es una herramienta útil en pacientes con apendicitis aguda, ya que abarata costos, y es segura.

Assess the monopolar electrocoagulatión of the meso appendix as a useful tool in laparoscopic appendectomy in patients with acute appendicitis, admitted at service of General Surgery of the Hospital Central de Maracay. This is a non-experimental design of cross section, where the population was formed by patients attending the Hospital Central de Maracay emergency during the period between January and July 2010. Usted for data collection: clinic record and postoperative surgery. They were analyted by descriptive statistics, founding that average surgical time was 60 minutes, there were not late complications, hospitalization time was 2 days, and patients were incorporated into their physical activities in 10 days. Monopolar electrocoagulation of the meso appendicular is a useful tool in patients with acute appendicitis, as it cheaper cost, and is safe.