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1.
Rev. ADM ; 77(6): 316-320, nov.-dic. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1151346

ABSTRACT

Se entiende por agrandamiento gingival el incremento en masa y volumen del tejido gingival. Se considera una condición benigna de la cavidad oral, por lo general de manejo rutinario, que logra regularse con medidas simples de control del biofilm microbiano. El agrandamiento gingival puede ser producido por diversas condiciones clínicas, hereditarias, deficiente higiene oral o fármacos. La epilepsia afecta a 1% de la población mundial y requiere el uso de fármacos antiepilépticos o anticonvulsivantes para lograr su control, dentro de éstos la fenitoína actúa como un bloqueador selectivo de los canales de sodio sensibles al voltaje y constituye uno de los fármacos más empleados por su capacidad en el control de crisis focales y generalizadas. La fenitoína se ha relacionado con los agrandamientos gingivales como uno de sus efectos adversos, los cuales se incluyen dentro de las enfermedades por fármaco inducidas en la cavidad oral. El objetivo de este artículo es brindar la información necesaria sobre el manejo correcto de pacientes con agrandamiento gingival producido por fenitoínas y a la vez poder conocer las consecuencias de estos fármacos en la cavidad oral (AU)


Gingival enlargement means the increase in mass and volumen of the gingival tissue. It is considered a benign condition of the oral cavity, usually of routine management, wich can be regulated with simple measures of biofilm control. The gingival enlargement can be produced by diverse clinical conditions, hereditary deficient oral higiene or drugs. Epilepsy affects 1% of the world population and requires the use of antiepileptic or anticonvulsant drugs to achieve its control, within these phenytoin acts as selective blocker or voltage ­ sensitive sodium channels and is one of the most used grugs for its ability to control focal and generalized crises. Phenytoin has been linked to gingival enlargement as one of its adverse effects which is included within the drug diseases induced in the oral cavity. The objective of this article is to provide the necessary information on the correct managment of patients with gingival enlargemen produced by phenytoins and at the same time to know the consequences of these drugs in the oral cavity (AU)


Subject(s)
Humans , Female , Adult , Phenytoin/adverse effects , Gingival Overgrowth/chemically induced , Gingival Hyperplasia/chemically induced , Schools, Dental , Electrosurgery/methods , Gingival Hyperplasia/surgery , Gingivectomy/methods , Membranes, Artificial , Mexico , Anti-Bacterial Agents/therapeutic use
2.
Rev. Assoc. Med. Bras. (1992) ; 66(2): 201-209, Feb. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136173

ABSTRACT

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.


Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Bartholin's Glands/surgery , Cysts/surgery , Electrosurgery/methods , Postoperative Complications , Recurrence , Time Factors , Bartholin's Glands/pathology , Retrospective Studies , Age Factors , Treatment Outcome , Statistics, Nonparametric , Cysts/pathology , Electrosurgery/adverse effects , Intraoperative Complications , Middle Aged
3.
Rev. chil. dermatol ; 35(3): 95-101, 2019. ilus
Article in Spanish | LILACS | ID: biblio-1116407

ABSTRACT

Debido al acelerado envejecimiento de la población, cada vez es mayor la cantidad de usuarios portado-res de dispositivos electrónicos cardíacos implan-tables (DECI). Muchos de estos pacientes se verán enfrentados a procedimientos dermatológicos que con frecuencia utilizan equipos de electrocirugía. Es-tos tienen riesgo potencial de producir interferencias electromagnéticas (IEM), y por lo tanto alterar el fun-cionamiento de estos dispositivos. Si bien no todos los DECI tienen las mismas características, las nuevas tec-nologías de estos dispositivos han disminuido, aunque no eliminado completamente, el riesgo de IEM. Este artículo tiene como propósito revisar el tema y recopilar las recomendaciones generales que todo dermatólogo debe conocer tanto en la fase preoperatoria, intraoperatoria, como postoperatoria al utilizar equipos de electrocirugía en un paciente con DECI.


Due to the accelerated population aging, an increa-sing number of users is carrying cardiac implantable electronic devices (CIEDs). Many of these patients will face dermatological procedures that often use electrosurgical equipment. The latter has the poten-tial to produce electromagnetic interference (EMI), and therefore alter the operation of these devices. While not all CIEDs have the same characteristics, new technologies for these devices have decreased if not eliminated completely the risk of EMI.The purpose of this article is to review CIED topic and compile general recommendations that every dermatologist should be aware of, both in the preoperative, intraoperative, and postoperative phases when using electrosurgery equipment in a patient with CIED.


Subject(s)
Humans , Pacemaker, Artificial , Defibrillators, Implantable , Electromagnetic Fields/adverse effects , Electrosurgery/methods , Dermatologic Surgical Procedures , Postoperative Care , Preoperative Care , Heart-Assist Devices , Intraoperative Complications/prevention & control
4.
Rev. Fac. Odontol. (B.Aires) ; 34(78): 7-12, 2019. ilus
Article in Spanish | LILACS | ID: biblio-1116033

ABSTRACT

La aplicación del LÁSER (light amplification of stimulation emision of radiation) en las áreas de la medicina y la odontología viene demostrando una constante evolución, brindándonos alternativas a los tratamientos convencionales. Los láseres quirúrgicos de tejidos blandos muestran grandes ventajas comparados a los procedimientos habituales de corte, ya sea con bisturí frío o electrobisturí. La mínima necesidad de anestesia, la analgesia intra y postoperatoria, la coagulación inmediata, la cicatrización por segunda, el efecto bactericida, la ausencia de puntos de sutura, el confort postoperatorio, son algunas de las ventajas que hacen que la cirugía con láser sea una opción indiscutible que está ganando terreno entre los profesionales de la salud (AU)


Subject(s)
Humans , Female , Child , Electrosurgery/methods , Extraoral Traction Appliances , Lasers , Lingual Frenum/surgery , Malocclusion, Angle Class III/therapy , Patient Care Team , Argentina , Schools, Dental , Speech Therapy , Wound Healing , Palatal Expansion Technique , Treatment Outcome , Orthodontic Appliances, Functional
5.
Rev. chil. obstet. ginecol. (En línea) ; 82(5): 539-553, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-899940

ABSTRACT

OBJETIVOS: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado. MATERIALES Y MÉTODOS: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier. RESULTADOS: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %). CONCLUSIONES: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.


GOALS: Currently, there is a high rate of over-treatment of precursor cervical lesions, which, in their causality, depends on the inexperience of the decision-making operator. The objective of the present study was to develop a standardized method of weighting / judgment of diagnostic variables and treatment useful to be used by young specialists in order to minimize the risk of improper handling. MATERIAL AND METHODS: We included 471 patients referred by abnormal cytology and treated by LEEP. Sensitivity, specificity, predictive values and likelihood ratios for the diagnosis of CIN2+ were calculated for each of the diagnostic methods. Each resident was taught a standardized protocol to carry out a LEEP procedure. Once the best predictors were identified, a scoring scale was constructed that weighted the variables and the best cut-off point for the prediction of CIN2+ was defined by ROC curve. Differences between groups were compared using Chi-square, ANOVA or t-test. Failure curves were built up using the 1-Kaplan Meier method. RESULTS: The prevalence of CIN2+ in this cohort was 66%. The agreement between the diagnostic tests was low, with colposcopy having the worst positive predictive value and the highest risk of over-treatment. Age, cytology, colposcopy (stratification based on the extent of compromise by quadrants), punch biopsy, and agreement between diagnostic tests were included for building the scoring scale. A score ≥ 9 in association with the use of a standardized protocol obtained rates of over-treatment <15%, recurrences of CIN2+ <5% at 5-year follow-up and a low rate of suboptimal procedures or complications (<2%). CONCLUSIONS: The UC-CONE method, by combining an integrated scoring system with a standardized excision protocol, minimizes the risk of over-treatment or inadequate treatment of pre-invasive cervical lesions by young specialists, reducing the number of procedures indicated unnecessarily and maintaining a high rate of therapeutic success.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Cervical Intraepithelial Neoplasia/surgery , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/methods , Electrosurgery/methods , Biopsy , Logistic Models , Cervix Uteri/pathology , Predictive Value of Tests , Retrospective Studies , ROC Curve , Analysis of Variance , Sensitivity and Specificity , Cervical Intraepithelial Neoplasia/diagnosis , Conization , Decision Making
6.
Rev. otorrinolaringol. cir. cabeza cuello ; 77(2): 188-192, jun. 2017. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-902761

ABSTRACT

El láser como alternativa a la cirugía abierta de la vía aérea superior ha venido a modificar la forma de abordaje de las patologías en esta área, pero no deja de ser un procedimiento costoso que no está al alcance de todos los servicios. Por este motivo se han reinventado nuevas formas de abordaje que cumplan los mismos requisitos tanto de la cirugía abierta como con láser pero con un menor coste. Presentamos una serie de 30 casos realizados en un período de 6 años por motivos tanto tumorales como no, en los que se realizaron abordajes cerrados a través de microcirugía con disección mediante microelectrodos. Obteniendo pocas complicaciones y una disminución de la estancia hospitalaria significativa. Con lo cual nos parece una técnica eficiente para abordajes de este tipo.


The laser as an alternative to open surgery of the upper airway has come to change the form of approaching the disease in this area, but it is still an expensive procedure that is not available to all services. For this reason a new ways of approach to meet the same requirements both open as laser but at a lower cost surgery. We present a series of 30 cases performed over a period of 6 years for reasons as much tumor, which closed approaches through microsurgical dissection were performed using microelectrodes. Obtaining few complications and significant decreased hospital stay. Our considerations is it seems an efficient technique for such approaches.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Laryngeal Diseases/surgery , Electrosurgery/methods , Laryngectomy/methods , Microsurgery/methods , Laryngeal Neoplasms/surgery , Microdissection , Electrodes
7.
Article in English | WPRIM | ID: wpr-21464

ABSTRACT

OBJECTIVE: This study was conducted using the human papillomavirus (HPV) DNA chip test (HDC), in order to determine whether the HPV genotype is a predictor of residual disease in a subsequent hysterectomy following a loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN) 3. METHODS: Between January 2002 and February 2015, a total of 189 patients who underwent a hysterectomy within 6 months of LEEP caused by CIN 3 were included in this study. We analyzed their epidemiological data, pathological parameters, high-risk HPV (HR-HPV) load as measured by the hybrid capture II assay, and HR-HPV genotype as measured by the HDC. A logistic regression model was used to analyze the relationship between covariates and the probability of residual disease in subsequent hysterectomy specimens. RESULTS: Of the 189 patients, 92 (48.7%) had residual disease in the hysterectomy specimen, CIN 2 in seven patients, CIN 3 in 79 patients, IA1 cancer in five patients, and IA2 cancer in one patient. Using multivariate analysis, the results were as follows: cone margin positivity (odds ratio [OR], 2.43; 95% CI, 1.18 to 5.29; p or =220 relative light unit (OR, 2.98; 95% CI, 1.38 to 6.43; p<0.01), positive endocervical cytology (OR, 8.97; 95% CI, 3.81 to 21.13; p<0.001), and HPV-16 or HPV-18 positivity (OR, 9.07; 95% CI, 3.86 to 21.30; p<0.001). CONCLUSION: The HPV-16 or HPV-18 genotype is a reliable predictive factor of residual disease in a subsequent hysterectomy following a LEEP for CIN 3.


Subject(s)
Adult , Aged , Aged, 80 and over , Cervical Intraepithelial Neoplasia/surgery , Electrosurgery/methods , Female , Genotype , Genotyping Techniques/methods , Human papillomavirus 16/genetics , Human papillomavirus 18/genetics , Humans , Hysterectomy , Middle Aged , Neoplasm, Residual , Papillomavirus Infections/virology , Prognosis , Retrospective Studies , Uterine Cervical Neoplasms/surgery , Viral Load
9.
Säo Paulo med. j ; 131(6): 405-410, 2013. tab, graf
Article in English | LILACS | ID: lil-697417

ABSTRACT

CONTEXT AND OBJECTIVE: Human immunodeficiency virus (HIV)-infected women have higher incidence, prevalence, persistence and recurrence of pre-invasive cervical lesions (CIN II or III). The aim here was to investigate the risk of recurrence of CIN II/III among HIV-infected women (HIV+) and uninfected women in a cohort treated by means of large-loop excision of the transformation zone (LLETZ). DESIGN AND SETTING: Cohort study conducted at Instituto Fernandes Figueira/Fundação Oswaldo Cruz (IFF/Fiocruz). METHODS: 60 HIV+ and 209 HIV-negative patients were included in a cohort for follow-up after undergoing LLETZ to treat CIN II/III. A histopathological diagnosis of CIN II/III during the follow-up was taken to constitute recurrence. The following possible confounding variables were assessed: age at treatment and at end of follow-up; histological grade of intraepithelial disease treated; surgical margin involvement; adequacy of colposcopy during the follow-up; CD4+ lymphocyte count; HIV viral load; and type of antiretroviral therapy. RESULTS: Among the 60 HIV+ women, six showed recurrent disease during the follow-up. However, among the 209 HIV-negative women, seven showed a new precursor lesion. The relative risk of disease recurrence in the HIV+ women was 4.21 (95% CI = 1.42 to 12.43). The Kaplan-Meyer curve showed that the risk of recurrence was significantly higher among HIV+ women (log-rank test: P = 0.0111). CONCLUSION: The HIV+ women in our cohort presented a risk of CIN II/III recurrence at least 42% higher than among the HIV-negative women. These patients should form part of a rigorous screening and follow-up protocol for identification and appropriate treatment of cervical cancer precursor lesions. .


CONTEXTO E OBJETIVOS: Mulheres infectadas pelo vírus da imunodeficiência humana (HIV) apresentam maior incidência, prevalência, persistência e recorrência após tratamentos de lesões pré-invasivas do colo uterino (NIC II ou III). O objetivo foi verificar o risco de recorrência de NIC II/III em mulheres infectadas pelo HIV (HIV+) e não infectadas (HIV-) em uma coorte tratada pela exérese eletrocirúrgica da zona de transformação do colo uterino (EZT). TIPO DE ESTUDO E LOCAL: Estudo de tipo coorte realizado no Instituto Fernandes Figueira/Fundação Oswaldo Cruz (IFF/Fiocruz). MÉTODOS: 60 HIV+ e 209 HIV- foram incluídas em uma coorte após terem sido submetidas à EZT para tratamento de NIC II/III. Foi considerado como recorrência o diagnóstico histopatológico de NIC II/III. Foram estudadas as seguintes variáveis possivelmente confundidoras: idade no tratamento e ao final do seguimento, grau histológico da doença intra-epitelial tratada, comprometimento de margens, adequação da colposcopia no seguimento, contagem de linfócitos CD4+, carga viral de HIV e tipo de terapia antiretroviral. RESULTADOS: Dentre as 60 mulheres HIV+, 6 apresentaram doença recorrente durante o seguimento. De 209 HIV-, 7 apresentaram uma nova lesão precursora. O risco relativo de recorrência de doença nas HIV+ foi de 4,21 (IC 95% 1,42-12,43). Uma curva de Kaplan-Meyer mostra que o risco de recorrência é significativamente maior em mulheres HIV+ (teste de log-rank: P = 0,0111). CONCLUSÃO: Mulheres HIV+ em nossa coorte apresentaram risco de recorrência pelo menos 42% maior do que mulheres HIV-. Essas pacientes devem fazer parte de um protocolo de rastreio e acompanhamento rigoroso para identificação e tratamento adequado das lesões precursoras do câncer ...


Subject(s)
Adult , Female , Humans , Acquired Immunodeficiency Syndrome/complications , Cervical Intraepithelial Neoplasia/surgery , Electrosurgery/methods , Neoplasm Recurrence, Local , Uterine Cervical Neoplasms/surgery , Antiretroviral Therapy, Highly Active , Acquired Immunodeficiency Syndrome/drug therapy , Brazil/epidemiology , Cohort Studies , Colposcopy/methods , Follow-Up Studies , Incidence , Kaplan-Meier Estimate , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
10.
Rev. Asoc. Odontol. Argent ; 100(4): 143-146, dic. 2012. ilus
Article in Spanish | LILACS | ID: lil-684955

ABSTRACT

Objetivo: describir el uso extraoral del bisturí piezoeléctrico en la obtención de hueso autólogo de cresta ilíaca. Caso clínico: una mujer de 35 años de edad, que sufrió traumatismo facial en su adolescencia, presenta como secuela una gran atrofia del sector anterior del maxilar superior. Se le programó la realización de un injerto en bloque de hueso autólogo de la cresta ilíaca, utizando para su obtención el bisturí piezoeléctrico. Conclusión: el bisturí piezoeléctrico es una herramienta de gran utilidad en la obtención de materiales para la realización de injertos óseo, ya que minimiza la pérdida ósea, asegura un mayor porcentaje de éxito y produce menor calentamiento en el corte del bloque óseo, lo que favorece una mayor supervivencia de osteoblastos


Subject(s)
Humans , Adult , Female , Electrosurgery/methods , Ilium , Transplantation, Autologous/methods , Bone Transplantation/methods , Alveolar Ridge Augmentation/methods , Wound Healing/physiology , Dental Implants , Guided Tissue Regeneration , Osteotomy/methods
11.
Assiut Medical Journal. 2012; 36 (1): 21-26
in English | IMEMR | ID: emr-126260

ABSTRACT

The aim of this study is to compare in random manner the intraoperative feasibility, effectiveness and safety of monopolar and bipolar electrosurgery in hysteroscopic polypectomy. 36 Symptomatic patients attending at outpatient clinics and diagnosed to have intrauterine polyps by HSG, transvaginal sonography or Diagnostic hysteroscopy were included. Patients were randomly assigned to two groups to have hysteroscopic polypectomy using either bipolar [Group A] or monopolar [Group B] electrosurgery under general anesthesia. Intraoperatively, the following parameters were noted and recorded: time of start of anesthesia, time of introduction of the resectoscope, time of end of the procedures, time of recovery, amount of fluid used, amount of fluid Collected in the graduated suction, postoperative serum sodium was measured. Sociodemographic data for patients in both groups were comparable. The mean duration of operation was comparable in both group [14.76 +/- 2.95 minutes in bipolar group versus 14.79 +/- 2.94 minutes in monopolar group]. Fluid inflow, fluid outflow and fluid deficit were significantly higher in the monopolar group than in bipolar group. Bipolar electrosurgery seems effective, feasible and safe alternative to conventional monopolar system in hysteroscopic management of intrauterine pathologies


Subject(s)
Humans , Female , Polyps/surgery , Electrosurgery/methods , Treatment Outcome
12.
Säo Paulo med. j ; 130(2): 92-96, 2012. tab
Article in English | LILACS | ID: lil-625335

ABSTRACT

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.


Subject(s)
Adolescent , Adult , Female , Humans , Middle Aged , Young Adult , Artifacts , Conization , Cervical Intraepithelial Neoplasia/surgery , Cervix Uteri/pathology , Uterine Cervical Neoplasms/surgery , Age Factors , Cross-Sectional Studies , Cervical Intraepithelial Neoplasia/pathology , Colposcopy/methods , Electrosurgery/adverse effects , Electrosurgery/methods , Retrospective Studies , Treatment Outcome , Uterine Cervical Neoplasms/pathology
13.
Femina ; 39(4): 183-188, abr. 2011. ilus
Article in Portuguese | LILACS | ID: lil-605509

ABSTRACT

A neoplasia intraepitelial cervical é frequente, e seu diagnóstico e tratamento são importantes na prevenção do carcinoma invasor do colo. O manuseio desta patologia implica em avaliação citológica, colposcópica e histopatológica. A cirurgia de alta frequência está estabelecida na prática clínica como eficaz e de primeira escolha no tratamento, inicialmente, a técnica utilizada consistia na retirada da zona de transformação com apenas uma alça; a seguir, foi introduzido o uso da segunda alça (alça de canal) com o objetivo de retirar o canal cervical, buscando os mesmos resultados da conização a bisturi. Mesmo com tratamento adequado podem ocorrer recidivas, retiradas incompletas ou exageradas de lesão. O objetivo desta revisão consiste em discutir um fluxograma para tratamento de neoplasia intraepitelial cervical, levando-se em consideração: idade da paciente, grau da lesão, desejo de fertilidade e indicação pré-operatória, visando adequação do tratamento da neoplasia intraepitelial cervical. Analisar esse fluxograma pode ser útil para evitar supertratamentos que possam comprometer o futuro reprodutor das nossas pacientes.


Cervical intraepithelial neoplasia is very frequent, and both diagnosis and treatment are important to avoid invasive carcinoma. In order to control this pathology, it is important to conduct cytology, colposcopy and histopathologic analyses. The loop electrosurgical excision procedure (LEEP) is a first-line therapy for high grade CIN treatment. Initially, this technique consisted of removing the transformation zone only. Later, LEEP-CONE was used in order to remove the cervical tissue, which included a second pass or "top hat". A "top hat" procedure removes the endocervical canal, mimicking a cold-knife cone biopsy. Despite LEEP effectiveness, recurrent dysplasia, incomplete excision and overtreatment can occur. This paper aims at discussing an algorithm for cervical dysplasia mangement based on age, lesion grade, desire for fertility and preoperative indications. Looking at this algorithm before performing a LEEP may be useful so clinicians can avoid overtreatment and missteps which could put a patient's reproductive future at risk.


Subject(s)
Humans , Male , Female , Cervical Intraepithelial Neoplasia , Colposcopy , Conization , Electrosurgery/methods , Uterine Cervical Neoplasms/surgery , Uterine Cervical Neoplasms/prevention & control , Neoplasm, Residual , Unnecessary Procedures
14.
Rev. bras. cir. plást ; 24(4): 504-508, out.-dez. 2009. ilus
Article in Portuguese | LILACS | ID: lil-545144

ABSTRACT

Introdução: O rinofima, também chamado de elefantíase nasal ou acne hiperplásica, temsido descrito desde o tempo de Hipócrates. Está associado, na maioria das vezes, ao hábitode ingestão de álcool (alcoolismo). É caracterizado histologicamente por hipertrofiae hiperplasia das glândulas sebáceas, proliferação fibrovascular da derme e acantose doepitélio. Método: Esse trabalho apresentar casos de rinofima tratados com equipamentode alta frequência (erroneamente denominado de radiofrequência, considerando suas característicasde alto grau de precisão de corte, assim como coagulação simultânea e possibilidadede isolamento oncológico da área tratada, pelas características de vaporizaçãocelular, ocorrida no local de ação do eletrodo). Seu mecanismo de ação é bastante similaràquele verificado no Laser de CO2. Resultados: Foram operados 8 pacientes portadoresde rinofima, com idades que variavam de 55 a 63 anos, dos quais 3 eram de sexo femininoe 5 eram do sexo masculino, entre os anos de 1990 a 2007. Os resultados foram naturais,com período de recuperação bastante curto. Nossa experiência há mais de 10 anos comeste tipo de equipamento levou-nos a somente utilizar esse método, em decorrência de suamaior facilidade e excelência dos resultados.


Introduction: Rhinophyma, also called nasal elephantiasis or acne hyperplasic, has beendescribed since Hipócrates. It is associated, in most times, to the continuous ingestion ofalcohol (alcoholism). histologicaly is characterized by hypertrophy and hyperplasia of thegreasy glands, fibrovascular proliferation of the dermis and acantosis of the epithelium.Method: This article presents cases of rinophy treated with equipment of high-frequency(also denominated of radio-frequency, due to their characteristics of high degree of cutprecision, as well as the simultaneous coagulation and possibility of oncologic isolationof the treated area, because of cellular vaporization, in the site of action of the electrode).His action mechanism is similar to that verified in the CO2 laser. Results: Eight patientspresenting Rhinophyma were operated, with ages that varied from 55 to 63 years, of which3 were female and 5 were male, among the years from 1990 to 2007. The results werequite natural, with quite short recovery period. Conclusion: Our experience has more than10 years with this equipment type only took us the to use this method, due to his largesteasiness and excellence of the results.


Subject(s)
Humans , Male , Female , Adult , Nose Deformities, Acquired/surgery , Electrosurgery/methods , Nose/surgery , Radio Waves , Radiosurgery , Rhinophyma , Surgical Procedures, Operative , Equipment and Supplies/methods , Methods , Radiation , Diagnostic Techniques and Procedures
15.
Femina ; 37(4): 209-212, abr. 2009. ilus
Article in Portuguese | LILACS | ID: lil-541987

ABSTRACT

A cirurgia ginecológica teve um avanço muito significativo nos últimos anos, sobretudo com o surgimento de novas técnicas cirúrgicas minimamente invasivas. A histerectomia vaginal sem prolapso com sistema de selamento de vasos de baixo custo baseia-se na técnica descrita por Heaney, modificada com a utilização de um clamp autoclavável (Marclamp) conectado a um sistema gerador de energia bipolar de selamento de vasos (Maxium - KLS Martin). As vantagens da histerectomia vaginal com sistema de selamento de vasos de baixo custo são: menor tempo cirúrgico, pós-operatório menos doloroso, menor tempo de internação e retorno mais rápido às atividades habituais. A histerectomia vaginal pode ser realizada em regime ambulatorial.


The gynecological surgery had a very significant advance in recent years, over all with the new minimally invasive surgical techniques. The vaginal hysterectomy in nonprolapsed uterus using economic vessel sealer system is based on Heaney modified technique using the Marclamp connected to Maxium (Martin's bipolar vessel sealing system). The advantages of the vaginal hysterectomy with economic vessel sealer system are: less operative time, less post-operative pain, lesser time of internment and faster return to the habitual activities. The vaginal hysterectomy can be realized in ambulatorial hospital care.


Subject(s)
Female , Electrosurgery/methods , Hemostasis, Surgical/instrumentation , Hysterectomy, Vaginal/instrumentation , Hysterectomy, Vaginal/methods , Length of Stay , Blood Loss, Surgical/prevention & control , Minimally Invasive Surgical Procedures/methods , Gynecologic Surgical Procedures/methods , Hospital Costs/trends
16.
Rev. chil. obstet. ginecol ; 74(4): 259-262, 2009. tab
Article in Spanish | LILACS | ID: lil-551382

ABSTRACT

Antecedentes: La conización cervical del cuello uterino es considerada el tratamiento de elección de las neoplasias intraepiteliales de alto grado. Objetivo: Analizar los resultados del tratamiento de esta patología mediante conización Leep. Método: Se revisan los antecedentes y biopsias de 145 pacientes con diagnóstico histológico de neoplasia intraepitelial II y III tratadas con conización cervical por asa Leep en la Unidad de Patología del Tracto Genital Inferior de Clínica Dávila desde el 1 de junio de 2002 al 31 de mayo de 2008. Resultados: Hubo una correlación colpo-biópsica de 80 por ciento (116/145) para Lie de alto grado. Hubo borde positivo en 75 pacientes (51,7 por ciento) y negativo en 70 (48,3 por ciento). Fue necesario un segundo tratamiento en 5 pacientes (3,4 por ciento); en 3 casos por recidivas y en 2 por lesiones invasoras. El 89 por ciento permanece en seguimiento, comprobándose que la totalidad de estas ha tenido un tratamiento considerado satisfactorio. Conclusión: Nuestros resultados confirman que las lesiones cervicales de alto grado deben ser tratadas por métodos escisionales preferentemente, siendo la conización con asa Leep el método de elección por su facilidad de realización, bajo costo de insumos y puede ser realizado sin grandes requerimientos de infraestructura.


Background: The cervical conización of the uterine cervix is considered the treatment of election of high degree intraepithelial neoplasias. Objective: To analyze the results of treatment of this pathology by Leep Conization. Method: The antecedents and biopsies of 145 patients with histological diagnosis of intraepithelial II and III neoplasia, treated with cervix Conization Leep at Lower Genital Tract Unit of Davila Clinic from June first 2002 to May 31 2008 are reviewed. Results: There was a colpo-biopsy correlation of 80 percent (116/145) for high degree CIN. There was positive edge in 75 patients (51.7 percent) and negative in 70 (48.3 percent). A second treatment in 5 patients were necessary (3.4 percent); in 3 cases by recurrences and 2 by invasive lesions. 89 percent remain in control, verifying itself that the totality of these has had a satisfactory considered treatment. Conclusion: Our results confirm that the high degree cervical lesions must preferably be treated by excision methods, being the Leep Conization the method of election by their facility of accomplishment, low cost and can be made without great infrastructure requirements.


Subject(s)
Humans , Adult , Female , Middle Aged , Conization/methods , Electrosurgery/methods , Cervical Intraepithelial Neoplasia/surgery , Uterine Cervical Neoplasms/surgery , Biopsy , Colposcopy , Follow-Up Studies , Cervical Intraepithelial Neoplasia/pathology , Uterine Cervical Neoplasms/pathology
17.
Article in English | WPRIM | ID: wpr-112916

ABSTRACT

The aim of this study was to compare the rate of incomplete resection and treatment outcome of the second-pass technique with those of single-pass technique in loop electrosurgical excisional procedure (LEEP). From 1997 to 2002, 683 women were diagnosed as squamous dysplasia via LEEP in our institution. Age, parity, LEEP technique, grade of lesion, glandular extension, margin status, residual tumor and recurrence were obtained by reviewing medical records. Positive margin was defined as mild dysplasia or higher grade lesions at resection margin of the LEEP specimen. In women who underwent hysterectomy, residual tumor was defined as mild dysplasia or higher grade lesions in hysterectomy specimen. In women who did not underwent hysterectomy, Pap smear more than atypical squamous cells of undetermined significance or biopsy result more than mild dysplasia within two years after LEEP were regarded as cytologic or histologic recurrences, respectively. Treatment failure of LEEP was defined as residual tumor or histologic recurrence. The second-pass technique significantly reduced the endocervical margin positivity (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.63). However, the second-pass technique did not reduce the treatment failure (OR, 0.62; 95% CI, 0.29-1.32). In conclusion, the second-pass technique markedly reduced the endocervical margin positivity, but did not reduce the treatment failure rate of LEEP.


Subject(s)
Adult , Cervical Intraepithelial Neoplasia/pathology , Electrosurgery/methods , Female , Humans , Hysterectomy , Medical Records , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm, Residual/diagnosis , Odds Ratio , Recurrence , Retrospective Studies , Risk Factors , Severity of Illness Index , Uterine Cervical Neoplasms/pathology
18.
Rev. chil. obstet. ginecol ; 74(6): 339-344, 2009. tab
Article in Spanish | LILACS | ID: lil-561847

ABSTRACT

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.


Subject(s)
Humans , Female , Pregnancy , Electrosurgery/adverse effects , Electrosurgery/methods , Cervical Intraepithelial Neoplasia/surgery , Uterine Cervical Neoplasms/surgery , Obstetric Labor, Premature/etiology , Pregnancy Complications, Neoplastic/surgery , Conization/adverse effects , Pregnancy Outcome , Probability , Risk Assessment , Fetal Membranes, Premature Rupture/etiology
19.
Int. braz. j. urol ; 34(5): 577-586, Sept.-Oct. 2008. ilus, tab
Article in English | LILACS | ID: lil-500393

ABSTRACT

OBJECTIVE: We evaluated the outcome of bipolar energy by using PlasmaKinetic™ cystoscope instruments in the treatment of urethral stricture and bladder neck contracture. MATERIALS AND METHODS: Twenty-two male patients with urethral stricture and five with bladder neck contracture were treated by endoscopic bipolar vaporization. The most common etiology for stricture formation was iatrogenic (85.2 percent) and the mean stricture length was 12.2 mm. All patients were evaluated with urethrography and uroflowmetry one month and 3 months after surgery. Urethroscopy was routinely performed at the end of the first year. Preoperative mean maximum flow rate (Q max) was 4.9 mL/s for urethral stricture and mean Q max was 3.4 mL/s for bladder neck contracture. The results were considered as "successful” in patients where re-stenosis was not identified with both urethrography and urethroscopy. Minimum follow-up was 13.8 months (range 12 to 20). RESULTS: Tissue removal was rapid, bleeding was negligible and excellent visualization was maintained throughout the vaporization of the fibrotic tissue. Postoperative mean Q max was 14.9 mL/s and the success rate was 77.3 percent for urethral stricture at mean follow-up time of 14.2 months. The success rate was 60 percent with a mean follow-up time of 12.2 months for bladder neck contracture and the mean Q max was 16.2 mL/s, postoperatively. CONCLUSIONS: The study suggests that bipolar vaporization is a safe, inexpensive and reliable procedure with good results, minimal surgical morbidity, negligible blood loss, and thus, it could be considered as a new therapeutic option for the endoscopic treatment of urethral stricture and bladder neck contracture.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Cystoscopy/methods , Electrosurgery/methods , Urethral Stricture/surgery , Urinary Bladder Neck Obstruction/surgery , Follow-Up Studies , Pilot Projects , Prospective Studies , Treatment Outcome
20.
Article in English | IMSEAR | ID: sea-51716

ABSTRACT

BACKGROUND: Vital pulpotomy is a single-stage procedure defined as the surgical amputation of the coronal portion of exposed vital pulp, usually as a means of preserving the vitality and function of the remaining radicular portion. OBJECTIVES : The aim of this study was to compare the clinical and radiographic success rates for electrosurgical vs formocresol pulpotomy in human primary molar teeth. SETTINGS AND DESIGN: This was a prospective, randomized clinical trial. MATERIALS AND METHODS: In this randomized clinical trial, pulpotomies were performed on 70 primary molars in children aged 5-10 years. The teeth were treated using either a conventional formocresol (35 teeth) or electrosurgical technique (35 teeth). Following the pulpotomy procedure, the teeth were evaluated for clinical and radiographic success for three, six and nine months. The teeth were evaluated for the presence of pain, abscess, fistula, mobility, internal and external resorption, and radiolucency. STATISTICAL ANALYSIS: The data were assessed with Fishers' Exact test. RESULTS: After nine months of follow-up, the clinical and radiographic success rates were 96 and 84% respectively in the electrosurgical group and 100 and 96.8% respectively in the formocresol group. There was no statistically significant difference between the success rates in the two groups ( P > 0.05). CONCLUSIONS: Our results showed the failure rates for electrosurgical pulpotomy to be equal to those for formocresol pulpotomy. Although electrosurgical pulpotomy is a nonpharmacological technique giving favorable results, it is still a preservative technique. Further studies using larger samples and longer evaluation periods are recommended.


Subject(s)
Child , Child, Preschool , Dental Amalgam , Dental Fistula/etiology , Dental Pulp Capping/methods , Dental Pulp Exposure/therapy , Dental Restoration, Permanent , Electrosurgery/methods , Follow-Up Studies , Formocresols/therapeutic use , Humans , Molar/drug effects , Periapical Abscess/etiology , Prospective Studies , Pulpotomy/methods , Tooth Mobility/etiology , Tooth Resorption/etiology , Tooth, Deciduous/drug effects , Toothache/etiology , Treatment Outcome , Zinc Oxide-Eugenol Cement/therapeutic use
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