Combined CO 2-Nd:YAG radiation in liver and anorectal diseases.

A 1986 report of the authors' experience in human liver surgery emphasized the promise of a combined delivery of CO 2 and Nd:YAG wavelengths, using an artificial procedure of linking two separate handpieces. A newer machine is available now which emits simultaneous CO 2 and Nd:YAG radiations in a single, coherent, coaxial beam (Combolaser, Lasermatic). This study compares the effects of the combined coaxial delivery in such fields as benign proctology, vaporizations of anorectal and liver tumors, and laser liver resections, where clinical experience with wavelengths used separately or successively have been reported. Between September 1989 and October 1991, 104 patients have had such operations. The results demonstrate a reduction of energy densities when combined delivery is compared with single laser irradiation for the same purpose. The necrotic zone is reduced with better hemostasis. Finally, a significant reduction of operative time for tumoral vaporizations has been noted. In conclusion, the combined beam modifies the laser-tissue interaction, and allows the surgeon to work with suitable power ratios, according to the tissues' stroma, and vascularity.

[Endoscopic treatment of oesophageal sténosis using Celestin prosthesis (author's transl)]. / Traitement endoscopique des sténoses oesophagiennes par prothèse de Célestin.

The Celestin pulsion tube introduced by endoscopy seems to constitute a satisfactory method of dealing with oesophageal strictures, both malignant and benign. The site and histology of the tumour, as well as the diameter of the remaining lumen are determined by an initial endoscopic examination. The Eder-Puestow guide wire, essential to safe dilatation and intubation, may be introduced in various ways depending upon the size, length and nature of the stenosis: it may be threaded through the lumen with a fiberoscope under radiological control, or after drilling with laser. Subsequent dilatation may be carried out with olive-shaped metal dialtors, stepped plastic dilators of laminaria, depending upon the degree of fibrosis and the risks of fissuration. A final diameter of 17 mm is advisable. The pulsion tube, with its soft anti-migration skirt, is positioned using an introducer mounted on a semi-rigid mandrin or sliding over a fiberoscope. Its position must be checked at three-monthly intervals. The authors have used this method in 115 patients, 24 of whom had benign lesions and 91 malignant lesions. Among the latter, 23 had been irradiated, 7 were post-anatomotic and 61 had never been treated. There were 5 cases of mediatinitis and one of haemorrhage. Eleven tight strictures, wich had resisted dilatation with metal olive yieled laminaria. The longest follow-ups are of 19 months for malignant stenose and 40 months for benign stenoses. The main indications are malignant stenoses, irrespective of whether they have been irradiated or not, and peptic stenoses in inopereable patients. The procedure restores normal oral feeding, thereby avoiding the need for gastrostomy or jejunostomy.