Is electrosurgery fulguration a better procedure for Bartholins gland cyst?

SUMMARY OBJECTIVE To evaluate the effectiveness of electrosurgery fulguration as a treatment for Bartholin's gland cysts. DESIGN Retrospective study with a comparative control group performed on Hospital Brigadeiro and in the Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo from February 2005 to March 2009. Patients: Patients with Bartholin's gland cyst were divided into three treatment groups: group 1 electrosurgery (n=169 cases); group 2 - gland excision with the conventional technique using a cold scalpel (n = 51 cases); group 3 - marsupialization (n=11 cases). We reviewed the clinical and surgical history, physical examination, description of the surgical technique, postoperative results (success and complications), and follow-up data. RESULTS There is no difference between groups in relation to intraoperative bleeding, hematoma, and complete healing in a single treatment session. However, electrosurgery shows the lower percentage of recurrences 18 (10,7%) compared to the Marsupialization technique (group 3, p=.031). Recurrences occurred in 18 (10,7%), 3 (5,9%), and 4 (36,4%) cases. After retreatment by the same technique, there was a complete cure rate of 90% (152/169) for group 1, and 98% (50/51) for group 2. The cost of group 1 was lower than that of other groups. CONCLUSION The fulguration with electrosurgery of the capsule of Bartholin's cyst is an effective method of treatment, andthe cost of this technique is lower than the conventional technique and marsupialization.

RESUMO OBJETIVO Avaliar a eficácia da fulguração da eletrocirurgia como tratamento para os cistos da glândula de Bartholin. MÉTODOS Estudo retrospectivo, grupo controle comparativo realizado no Hospital Brigadeiro e disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de fevereiro de 2005 a março de 2009. Pacientes com cisto de glândula de Bartholin foram divididos em três grupos de tratamento: grupo 1 - eletrocirurgia (n = 169 casos); grupo 2 - excisão da glândula com técnica convencional utilizando bisturi frio (n = 51 casos); grupo 3 - marsupialização (n = 11 casos). Revisamos a história clínica e cirúrgica, o exame físico, a descrição da técnica cirúrgica, os resultados pós-operatórios (sucesso e complicações) e os dados de acompanhamento. RESULTADOS Não há diferença entre os grupos em relação ao sangramento intraoperatório, hematoma e cicatrização completa em uma única sessão de tratamento. No entanto, a eletrocirurgia mostrou o percentual mínimo de recidivas, 18 (10,7%), em relação à técnica de marsupialização (grupo 3, p = 0,031). Recorrências ocorreram em 18 (10,7%), três (5,9%) e quatro (36,4%) casos. Após o retratamento pela mesma técnica, houve taxa de cura completa: 90% (152/169) para o grupo 1 e 98% (50/51) para o grupo 2. O custo do grupo 1 foi menor do que os dos outros grupos. CONCLUSÃO A fulguração com eletrocirurgia da cápsula do cisto de Bartholin é um método efetivo de tratamento, mas o custo dessa técnica é menor do que a técnica de convenção e a marsupialização.

Fogo em campo cirúrgico - Medidas preventivas para cirurgia palpebral segura / Operating room fire prevention - preventive measures for safe eyelid surgery

Resumo Fogo em campo cirúrgico durante cirurgia palpebral é uma complicação intra-operatória que é dramática tanto para o paciente quanto para a equipe médica. Relatamos um caso de acidente cirúrgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercílio. Houve interação entre o oxigênio usado para sedação (máscara aberta) e uma fonte de ignição representada pelo cautério monopolar. Embora o paciente tenha apresentado boa evolução clínica com recuperação total da lesão cutânea, este caso é um alerta para se evitar tais tipo de ocorrência. Ressaltamos neste trabalho quais as condições implicadas e o modo de prevenção.

Abstract Fire in the surgical field during eyelid surgery is an intra-operative complication that is dramatic for both the patient and the medical staff. It's being reported a case of surgical accident during eyelid surgery where the patient suffered a brow burn. There was interaction between the oxygen used for sedation (open mask) and a source of ignition represented by monopolar cautery. Although the patient presented good clinical evolution with complete recovery of the cutaneous lesion, this case is an alert to avoid such type of occurrence. This work highlights the conditions involved and the way of prevention.

Burns related to electrosurgery - Report of two cases / Queimaduras relacionadas à eletrocirurgia - Relato de dois casos

Abstract Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.

Resumo A eletrocirurgia é uma tecnologia que se desenvolveu muitos nos últimos anos e se tornou um instrumento de grande importância na cirurgia moderna. A maioria dos equipamentos é considerada segura, embora existam riscos relacionados ao seu uso. Várias lesões podem ser causadas por eletrocautérios, as queimaduras são as mais frequentes e temidas. Relatamos dois casos de queimaduras relacionadas ao uso do bisturi elétrico e promovemos uma revisão de literatura, pois o conhecimento dos fundamentos da eletrocirurgia, seu uso correto, a escolha de um equipamento seguro, o monitoramento constante e a investigação imediata diante de quaisquer suspeitas com certeza podem melhorar a experiência operacional para ambos, cirurgião e paciente.

Edema laringotraqueal a causa de una lesión térmica: Complicación tras una tiroidectomía en niños / Laryngotracheal edema due to thermal injury: A complication after thyroidectomy in children

La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomia, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomia que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía.

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.

Exéresis de linfangioma en encía con electrobisturí / Exeresis of gingival lymphangioma with an electric scalpel

El linfagioma es considerado por la mayoría de los autores como una neoplasia benigna de los vasos linfáticos, que se puede presentar en cavidad oral. El 75 por ciento de los casos se presentan mayormente en la cabeza y el cuello. Cuando la boca se ve afectada, la lengua es el principal órgano que muestra alteraciones clínicas. El propósito de esta presentación fue describir un caso clínico de linfangioma en tejido gingival, tratado exitosamente mediante extirpación quirúrgica con electrobisturí. Se trata de una paciente de 13 años de edad, que acudió a consulta por presentar sangrado a nivel de la encía de molares inferiores derechos. Durante la anamnesis no se detectaron antecedentes familiares ni personales de interés. Los resultados de los exámenes de laboratorio se encontraron en los rangos normales. A partir de los hallazgos clínicos y radiográficos observados, se establecieron como diagnósticos presuntivos: granuloma piógeno, hemangioma o linfangioma. Se realizó fase higiénica con posterior escisión quirúrgica de la lesión empleando electrobisturí. Se efectuó análisis histopatológico. Se estableció como diagnóstico: linfangioma en encía a nivel de órganos dentales 46 y 47. Se obtuvo una cicatrización excelente 15 días después de la intervención. La localización inusual de este tipo de lesiones en la encía, y su tratamiento exitoso con electrobisturí, lo constituyen en un caso interesante, debido a los escasos reportes que sobre él existen en la literatura científica(AU)

To most authors, lymphangioma is a benign neoplasm of lymphatic vessels which may occur in the oral cavity. In 75 percent of the cases it presents in the head and neck. When the mouth is affected, the tongue is the main organ showing clinical alterations. The purpose of the study was to describe a clinical case of lymphangioma of gingival tissue successfully treated by surgical removal with an electric scalpel. A 13-year-old female patient attended consultation with bleeding from the gingival tissue next to the lower right molars. No personal or family antecedents of interest were detected during history taking. Laboratory results were within normal ranges. Based on clinical and radiographic findings, the following diagnoses were tentatively established: pyogenic granuloma, hemangioma or lymphangioma. Upon cleaning up the area, surgical removal of the lesion was performed using an electric scalpel. Histopathological examination was conducted. The following diagnosis was established: lymphangioma of the gingiva at the level of dental organs 46 and 47. Excellent scarring was obtained 15 days after the intervention. The singularity of this case lies in the unusual location of this type of gingival lesion, its successful treatment with an electric scalpel, and the fact that very few reports about the subject can be found in the literature(AU)

Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia / Número de fragmentos, status das margens e artefatos térmicos de peças conizadas de cirurgia com alças de ondas de alta frequência no tratamento da neoplasia intraepitelial cervical

CONTEXT AND OBJECTIVE: Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). DESIGN AND SETTING: Cross-sectional study at Universidade Federal de São Paulo (Unifesp). METHODS: The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. RESULTS: The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CONCLUSION: CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.

CONTEXTO E OBJETIVO: Cirurgia de alta frequência (CAF) é um método não traumático de corte e coagulação com muitas vantagens, porém induz a artefatos térmicos na região do corte. O objetivo foi avaliar a relação entre idade, número de fragmentos, grau da lesão e grau de artefatos térmicos e a qualidade das margens das peças cirúrgicas resultantes da CAF para neoplasia intraepitelial cervical (NIC). TIPO DE ESTUDO E LOCAL: Estudo transversal na Universidade Federal de São Paulo (Unifesp). MÉTODOS: Foram revisados prontuários e laudos histopatológicos de 118 mulheres que foram submetidas a conização por cirurgia de alta frequência no período de 1999 a 2007. Idade, número de fragmentos, grau da lesão, grau de artefatos térmicos e qualidade das margens foram avaliados. RESULTADOS: A idade média das pacientes foi de 27,14 anos; 63,6% tinham diagnóstico de NIC II e 36,4% de NIC III. A lesão foi retirada com um fragmento em 79,6%. As margens estavam livres de neoplasia em 85,6% e comprometidas na margem endocervical em 6,8%. Fragmentos prejudicados por artefatos ocorreram em 2,5%. Artefatos de grau severo ocorreram em 22,8%. Mulheres com idade igual ou superior a 30 anos apresentaram mais casos de NIC III (P < 0,0004). O comprometimento neoplásico de margens cirúrgicas e artefatos de grau severo ocorreram mais vezes nos casos em que foram retirados dois ou mais fragmentos e em pacientes com idade igual ou superior a 30 anos. CONCLUSÃO: NIC III em mulheres com idade superior a 30 anos, quando retiradas em dois ou mais fragmentos na CAF, apresentaram maior número de margens comprometidas e grau severo de artefatos térmicos.

Procedimiento de escisión electro-quirúrgica por asa térmica y riesgo de parto prematuro: una revisión sistemática de la literatura / Loop electrosurgical excision procedure and risk of preterm delivery: a literature review

Antecedentes: A diferencia de la conización cervical por cono frío, no se ha podido demostrar una clara asociación entre el procedimiento de escisión electro-quirúrgica por asa térmica (LEEP) y el riesgo de parto prematuro. Objetivo: Análisis crítico de la literatura científica, en relación al riesgo de presentar un parto prematuro en pacientes que han sido sometidas a LEEP, y los resultados materno-perinatales asociados. Búsqueda sistemática en múltiples bases de datos. Resultados: Se encontraron sólo tres artículos que cumplían los criterios de inclusión, los cuales son incluidos en esta revisión. De éstos, el primero muestra que el LEEP no aumenta el riesgo de parto prematuro ni de recién nacidos de bajo peso. El segundo evidencia un aumento del riesgo de rotura prematura de membranas y parto prematuro secundario a esto, pero no de parto prematuro espontáneo. Sin embargo, el tercero, señala que el LEEP se asocia en forma significativa a riesgo aumentado de parto prematuro, parto prematuro secundario a rotura prematura de membranas y recién nacidos de bajo peso. Los tres estudios son de cohortes retrospectivas, lo cual les otorga un nivel de evidencia de tipo 2b. Conclusión: La evidencia indica que la excisión de la zona de transformación a través del uso de LEEP está asociada a un pequeño, pero real incremento del riesgo de presentar un parto de pretérmino.

Background: Unlike cold-knife conization, studies have shown conflicting results on the outcome of pregnancy following loop electrosurgical excision procedure (LEEP). Objective: Critical analysis of the literature to establish if the LEEP treatments increase risk of preterm delivery and its influence in maternal-perinatal results. Results: Only three studies were filling the inclusion criteria. The first study does not show that LEEP treatment increase risk of preterm delivery and low birth weight. The second study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, but not spontaneous preterm delivery. Nevertheless, the third study shows increased risk of premature rupture of membranes and the subsequent preterm delivery, spontaneous preterm delivery and low birth weight. The three studies are based in retrospective cohorts, which grant them a level of evidence of type 2b. Conclusion: The evidence indicates that loop excision of the transformation zone by LEEP is associated with a small but real increase the risk of preterm delivery.

Estudio de las complicaciones en cirugía dermatológica en el Hospital Clínico de la Universidad de Chile / Complications in dermatological surgery at the Clinical Hospital of Universidad de Chile

La información acerca de las complicaciones en cirugía dermatológica es escasa en la literatura latinoamericana. El presente estudio determina la incidencia de complicaciones global, intra y postoperatoria en cirugía dermatológica y correlaciona los valores obtenidos con variables como sexo y edad del paciente, técnica quirúrgica, diagnóstico clínico y ejecutor del procedimiento quirúrgico. De 283 procedimientos quirúrgicos analizados, un 7,4 por ciento presentó complicaciones. Se registraron un 1,8 por ciento y un 5,7 por ciento de complicaciones en el intraoperatorio y postoperatorio, respectivamente. La complicación quirúrgica más frecuente fue la hemorragia (2,1 por ciento). Se detectó sólo un 0,7 por ciento de infecciones. El promedio de edad de los pacientes con complicaciones intraoperatorias fue mayor que el de los pacientes sin estas complicaciones (62,2 vs 45,0 años; p < 0,05). El grupo de pacientes operados por médicos residentes presentó más complicaciones postoperatorias que el grupo operado por médicos del staff (9,4 vs 0,8 por ciento; p < 0,01). La incidencia demostrada de complicaciones es baja. Variables como sexo, diagnóstico clínico y técnica quirúrgica no modifican la incidencia de complicaciones. Factores como la edad del paciente y el ejecutor del procedimiento quirúrgico guardan correlación con la incidencia de complicaciones.

Little information is available about complications in dermatological surgery in Latin-American literature.This study determines the global, intraoperatory and postoperatory incidence of complications in dermatological surgery, and correlates the obtained values with variables such as sex and age of the patient, surgical technique, clinical diagnosis and the performance surgical procedure.Out of 283 analyzed surgical procedures, 7.4 percent presented complications: 1.8 percent intraoperatory and 5.7 percent postoperatory. The most frequent surgical complication was hemorrhage (2.1 percent). Infections accounted for only 0.7 percent. The mean age of patients with intraoperatory complications was higher than that of patients without any complications (62.2 v/s 45.0 years; p < 0.05). The group of patients operated by residents had more postoperatory complications than the group operated by staff dermatologists (9.4 vs 0,8 percent; p < 0.01). The demonstrated incidence of complications is low. Variables such as sex, clinical diagnosis and surgical technique do not modify the incidence of complications. Factors such as age of the patient and performance surgical procedure do have a correlation with the incidence of complications.

Cervical stenosis following electrosurgical conization / Estenose cervical após conização eletrocirúrgica

CONTEXT AND OBJECTIVE: Cervical stenosis is a postoperative complication of procedures for treating preinvasive lesions of the cervix and takes on particular importance due to the clinical repercussions associated with it. Furthermore, it causes limitations in relation to cytological and colposcopic follow-up. The aim here was to assess the incidence of cervical stenosis among a cohort of patients who underwent electrosurgical conization and to identify possible prognostic factors associated with its occurrence. DESIGN AND SETTING: Retrospective study at Gynecology and Obstetrics Department, Instituto Fernandes Figueira, Rio de Janeiro. METHODS:This was an observational study among a cohort of patients who underwent electrosurgical conization of the uterine cervix. The possible predictive variables were analyzed as bivariate means between the groups with and without stenosis. We also calculated the incidence density rate ratio for cervical stenosis in relation to each possible predictive variable and the respective confidence intervals (95 percent). Levels of 5 percent were considered significant. RESULTS: 274 patients who underwent electrosurgical conization of the uterine cervix with a minimum follow-up period of six months were included. The crude incidence of cervical stenosis was 7.66 percent and the incidence density was 3.3/1,000 patients-month. CONCLUSIONS: We did not find associations between the variables for stenosis. However, we observed borderline significance levels relating to hemorrhagic complications before and after the operation (p = 0.089).

CONTEXTO E OBJETIVO: A estenose cervical é uma complicação pós-operatória dos procedimentos para tratamento das lesões pré-invasivas do colo uterino e assume importância particular tanto pelas repercussões clínicas associadas como pela limitação causada nos acompanhamentos citológico e colposcópico. O objetivo foi verificar a incidência da estenose cervical em uma coorte de pacientes submetidas a conização eletrocirúrgica do colo uterino e apontar possíveis fatores prognósticos associados. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, observacional realizado no Instituto Fernandes Figueira, Departamento de Ginecologia, Rio de Janeiro, Brasil. MÉTODOS: Estudo observacional em uma coorte de pacientes submetidas à conização eletrocirúrgica do colo uterino. As variáveis possivelmente preditoras foram analisadas de forma bivariada entre os grupos com e sem estenose. Calculou-se também a razão de taxas de incidência-densidade da estenose cervical para cada variável possivelmente preditora e os respectivos intervalos de confiança (95 por cento). O nível de significância considerado foi de 5 por cento. RESULTADOS: Foram incluídas 274 pacientes submetidas a conização eletrocirúrgica do colo uterino com um tempo mínimo de seis meses de acompanhamento após o procedimento. A incidência bruta de estenose cervical foi de 7,66 por cento e a incidência-densidade foi de 3,3/1000 pacientes-mês. Não houve diferença estatisticamente significativa entre as características clínico-demográficas dos grupos. CONCLUSÃO: Não se encontrou associação entre as variáveis e a estenose, porém observou-se um nível de significância limítrofe em relação às complicações hemorrágicas do peri e pós-operatório (p = 0,089).

Appropriate interval for repeat excision in women undergoing prior loop electrosurgical excision procedure for cervical neoplasia.

The objective of the present study was to evaluate the impact of intervals on complications and pathological examination in women undergoing a repeat loop electrosurgical excision procedure (LEEP) for cervical neoplasia. During October 2004 and January 2007, 78 women who had undergone repeat LEEP at Chiang Mai University Hospital, were prospectively evaluated. The mean age was 47.5 years (range; 27-69 years). The mean duration of uncomplicated vaginal bleeding was 4.4 days (range; 1-20 days). The occurrence of persistent vaginal bleeding was noted in 9 women. Among 78 women, 2 (2.56%) and 7 (8.97%) experienced intraoperative and postoperative hemorrhage, respectively. Six (7.69%) had postoperative infection. These complications were not significantly different from those observed in women undergoing first LEEP in the same period (P=0.56). There was no significant difference in the incidence of perioperative complications and the incidence of non-evaluable cone margins among women who undergoing repeat LEEP within 4-6 weeks, between 6-8 weeks, and more than 8 weeks after first LEEP. In conclusion, repeat LEEP could be safely performed 4-12 weeks after the first procedure without any impact on pathological specimen examination.

Laparoscopic partial nephrectomy in rats

PURPOSE: To establish an experimental model of laparoscopic partial nephrectomy (LPN) in rats and to analyze morphological alterations in the renal parenchyma utilizing an electric cautery and harmonic scalpel. METHODS: Forty Wistar rats were used, divided in 2 experiments with 20 rats each: experiment I, LPN was performed with an electric cautery and the rats were subdivided into groups A and B; experiment II, LPN was performed with a harmonic scalpel and they were subdivided into groups C and D. The animals in groups A and C were sacrificed shortly after surgery and the remnant kidney was removed to study the following variables: necroses and degeneration. In groups B and D a laparatomy was performed for retrieval of the remnant kidney on the 14th day after surgery to analyze fibrous scarring. RESULTS: For the variables necroses and fibrous scarring, the electric cautery creates, on average, greater width than that produced by the harmonic scalpel (p=0.0002 and p=0.0068 respectively). Regarding the variable of degeneration, we found no significant difference between the two types of scalpels (p=0.1267). CONCLUSIONS: LPN in rats is an adequate and feasible experimental model. The electric cautery caused greater damage to remnant renal tissue when compared to harmonic scalpel.

OBJETIVO: Estabelecer um modelo experimental de nefrectomia parcial laparoscópica (NPL) em ratos e analisar as alterações morfológicas no parênquima renal utilizando-se bisturi elétrico e harmônico. MÉTODOS: Foram utilizados 40 ratos Wistar, distribuídos em dois experimentos com 20 ratos cada: experimento I, NPL utilizando-se de bisturi elétrico e subdividindo-se os ratos em grupos A e B; experimento II, NPL realizada com bisturi harmônico e subdividindo-se os ratos em grupos C e D. Os animais dos grupos A e C foram sacrificados após a cirurgia para a remoção do rim operado e estudo das seguintes variáveis: necrose e degeneração. Nos grupos B e D a laparotomia para a retirada do rim operado foi após o décimo quarto dia de pós-operatório para a análise da cicatriz fibrosa. RESULTADOS: O bisturi elétrico provocou uma necrose e cicatriz fibrosa mais extensas em relação ao bisturi harmônico (p=0.0002 e p=0.0068 respectivamente). Em relação a variável degeneração, não houve diferença entre os tipos de bisturis (p=0.1267). CONCLUSÕES: NPL em ratos é um modelo experimental adequado e factível. O bisturi elétrico causa danos teciduais mais intensos no rim operado quando comparado com o bisturi harmônico.

Complications of loop electrosurgical excision procedure for cervical neoplasia: a prospective study.

OBJECTIVES: To evaluate the complications following loop electrosurgical excision procedure (LEEP) for diagnosis and treatment of cervical neoplasia. MATERIAL AND METHOD: Descriptive cross sectional study in patients with abnormal cervical cytology who underwent LEEP at Chiang Mai University Hospital between November 2004 and July 2005 were prospectively evaluated for complications. RESULTS: During the study periods, 206 patients underwent cervical loop excision for a total of 226 procedures. The mean age of the patients was 41 years (range, 26-72 years). Sixty (29.1%) women were menopausal. The most common abnormal cervical cytology was HSIL (56.3%) followed by LSIL (12.1%). Twenty-five (11.1%) patients received re-excision for positive margin after the first procedure. Intraoperative hemorrhage occurred in 7.9% of the procedures. Early and late postoperative hemorrhage occurred in 0.4% and 2.6% of the procedures, respectively. Eight (3.5%) had postoperative infections and were cured with oral antibiotics. By logistic regression analysis, there was no significant correlation between age, menopausal status, HIV status, re-excision procedure, final histopathology, cone dimension and the complications of LEEP. CONCLUSION: Loop electrosurgical excision procedure is safe for evaluation and treatment of cervical neoplasia with an acceptable and manageable surgical morbidity.

Tratamiento con láser para telangiectasias faciales / Laser treatment of facial telangectases

Las telangiestasias faciales representan un problema frecuente en la consulta dermatológica. Variadas modalidades terapéuticas se han descrito para tratarlas, siendo la electrocirugía la más clásica y de mayor disponibilidad en la actualidad. Sin embargo, deja como secuela cicatrices y alteraciones pigmentarias. Una alternativa terapéutica son los equipos láser, como el de Argón, de CO2 y de Nd-YAG. Se revisan los fundamentos para el uso de cada láser, las ventajas y limitaciones de cada uno de ellos