Chemical Cautery Research Articles

Complications of thyroid surgery

The first recorded thyroid operation is credited to Albucacis in Spain in around the year 1000. About 170 years later, Frugardi attempted to induce atrophy of a goitre by transfixing it with shoelaces. From this surgical technique evolved slowly via methods including mass ligatures, chemical cautery, morcellation and injection of turpentine, to the more familiar concepts of modern thyroidectomy (Hegner, 1932; Dionigi et al, 2008). Today, surgeons continue to refine the technique via new equipment such as Harmonic scalpels and nerve monitors, and novel techniques such as minimally-invasive and non-cervical approaches (e.g. via the axilla or the mouth).

Inhibition of Chemical Cautery–Induced Corneal Neovascularization by Topical Pigment Epithelium–Derived Factor Eyedrops

To evaluate the effect of topically administered pigment epithelium-derived factor (PEDF) on experimentally induced corneal neovascularization (NV) in a rat model. Corneal chemical cauterization was induced in the left eye by using silver nitrate sticks in 160 anesthetized male Sprague-Dawley rats. The rats were randomly assigned to 4 groups with 40 rats each for topical administration of recombinant PEDF, chloramphenicol, chondroitin sulfate, and normal saline (as control). At different intervals (3, 10, 15, and 30 days) of the treatment, rats were euthanized and the corneas removed for immunohistochemistry and Western blot analyses to measure expression levels of PEDF, vascular endothelial growth factor (VEGF), and CD34, an endothelial maker. The right eyes were used as normal control. There were high levels of PEDF expression and low levels of VEGF and CD34 in the normal cornea. VEGF and CD34 levels were significantly induced by chemical cauterization in the groups treated with chloramphenicol, chondroitin sulfate, and normal saline, demonstrating corneal NV. The VEGF and CD34 levels reached a plateau in the cornea on the 10th day after cauterization and remained at high levels thereafter. In contrast, the PEDF treatment prevented the overexpression of VEGF and CD34 induced by the cauterization. PEDF downregulates VEGF expression and inhibits corneal NV induced by chemical cauterization. The results suggested that PEDF has therapeutic potential for corneal neovascular diseases.

Primary aneurysmal bone cyst of patella

Of all the aneurysmal bone cysts (ABC) occurring in the body, less than 1% are seen in the patella. We report here, a 27-year-old woman with Stage III ABC of patella. Curettage, chemical and thermal cautery of the bed followed by autogenous bone grafting of the defect was done. At two-year follow up, there was a suspicion of lucency in the middle of the patella. However a repeat curettage revealed only fibrous tissue. Now at four years of follow up, the bone graft remained well incorporated. Patient has mild anterior knee pain on stair climbing but regained normal knee function.

Suppurative Thyroiditis in Children

To elucidate the etiology of suppurative thyroiditis in children and recommend a management algorithm. Case series of 5 pediatric patients with a diagnosis of suppurative thyroiditis seen between January 1999 and April 2007. All 5 patients primarily presented with left-sided intrathyroidal abscesses. The number of infections from first presentation to the time of definitive diagnosis ranged from 1 to 5. Three patients underwent incision and drainage of the abscess once, and 2 had the procedure performed 3 times. Barium swallows identified a piriform sinus tract on the left side in 2 of the 5 patients. Telescopic hypopharyngoscopy identified the internal opening in all 5. Three were managed with complete excision of their tracts and 2 with cauterization of the internal opening with silver nitrate. All 5 are currently asymptomatic. Suppurative thyroiditis is a very rare infection in children. A left-sided intrathyroidal abscess should immediately arouse suspicion of a piriform sinus tract. Barium swallows may identify the etiology in some cases. Definitive diagnosis requires a hypopharyngoscopy, with detailed telescopic examination of the left piriform fossa apex. Endoscopic chemical cautery of the internal opening is a safe and effective technique, with very low morbidity, and has the potential for cure.

82: Severe Hemorrhagic Cystitis (HC) After Allogeneic Hematopoeitic Stem Cell Transplantation (HSCT): Incidence and Risk Factors

HC is a major source of morbidity after HSCT. Severe HC often results in prolonged hospitalizations, increased health care costs, decreased quality of life and, rarely, death. Further elucidating risk factors may lead to preventive strategies and early treatment. We reviewed 208 cases of HC which occurred in 1353 allogeneic HSCT recipients transplanted at the University of Minnesota from 1995–2006. Severe HC was defined as urinary clots and bladder pain requiring bladder irrigation and/or sequelae such as urethral and/or ureteral obstruction, renal failure and or the need for surgical or chemical bladder cautery or coagulation.

Endoscopic chemical cautery of piriform sinus tracts: A safe new technique

Piriform sinus tracts are thought to be of branchial origin and typically present with suppurative thyroiditis or a lateral neck mass. Endoscopic examination with direct visualization of the internal opening usually confirms the diagnosis. Complex external surgery with complete excision of the tract is the current standard of care. We report two cases of piriform sinus tracts which were managed with silver nitrate cautery of the internal opening. Post-operative closure of the opening was confirmed in one patient. This appears to be a safe and effective technique that eliminates the need for surgery and has not been previously reported.

Depression and debulking of mandibular ameloblastoma followed by the definitive surgical excision with peripheral ostectomy and chemical cautery with distilled water—a new concept especially for the growing patients

Depression and debulking of mandibular ameloblastoma followed by the definitive surgical excision with peripheral ostectomy and chemical cautery with distilled water—a new concept especially for the growing patients

An innovative method of nasal chemical cautery in active anterior epistaxis

We present a method to cauterize an actively bleeding source in anterior epistaxis. In our experience, this method is efficient, provides full control of the bleeding, and ensures precise cautery of the bleeding source with minimal usage of chemical cautery sticks.

Silver nitrate cautery in aphthous stomatitis: a randomized controlled trial

Aphthous stomatitis is a painful, recurrent disease of the oral mucous membrane. Silver nitrate sticks have been used for a long time to provide pain relief for the duration of an aphthous ulceration, with only one application. Silver nitrate causes chemical cauterization and increases the depth of injury. To study the effect of chemical cautery with silver nitrate in reducing pain of aphthous ulceration and to determine if this treatment shortens or prolongs healing. In a randomized, patient-blinded, placebo-controlled study, 97 patients with painful minor oral aphthous ulceration were randomized to receive silver nitrate cautery or placebo. The severity of pain was rated on a three-category scale (severe, mild, none) and was recorded each day until the seventh day after the procedure. The lesion size was recorded at the time of the procedure and on the seventh day afterwards. In the treatment group, the ulcer was gently painted with a silver nitrate stick until it turned white. In the placebo group, the ulcer was gently painted with a placebo stick. In the treatment group, 33 of 47 patients (70%) evaluated and in the placebo group, four of 38 patients (11%) evaluated had reduction in severity of pain 1 day after the procedure. The difference was statistically significant (P < 0.001). On the seventh day after the procedure, the ulcers were completely re-epithelialized in 39 patients (83%) in the treatment group and in 34 patients (89%) in the placebo group. The difference was not statistically significant (P = 0.39). The results of our study showed that one application of silver nitrate can decrease the severity of pain in aphthous ulceration without significantly shortening or prolonging healing time. We did not observe any side-effects in our study. The effect is rapid and lasts for the duration of the lesion. The treatment is simple and cost-effective in patients with infrequent recurrences.

Management of epistaxis and complications associated with anterior nasal packing

Study objectives: Epistaxis is a common illness, with 6% of the US population requiring medical attention at least once in their lifetime. Divergence exists in the clinical management of epistaxis patients with regard to prophylactic antibiotic use after nasal packing placement. However, there is no clear evidence in the literature to support this practice. The purpose of this study is to review the clinical practice of anterior epistaxis in an academic emergency department (ED) and describe the complications attributed to placement of packing in the anterior nare(s). Methods: This is a retrospective explicit chart review approved by the institutional review board and conducted in an ED with an annual census of 52,000 visits. Study dates were November 1, 2000, to October 31, 2001. Patients were identified using ED admission chief complaint. All patients recognized as having anterior epistaxis were included in the study. Posterior or postoperative epistaxis patients were excluded. A trained abstractor used a standardized sequential medical-record review to extract predefined variables including age, use of packing or cautery, the use of antibiotics, and the presence of subsequent complications. A complication was defined as a return to the ED for any reason. Results: The study cohort included 234 patients with anterior epistaxis. Eighty patients (34%) received anterior nasal packing; 154 patients (66%) did not. Seventy-nine (34%) patients received chemical cautery. Forty-nine (61%) of the patients who underwent nasal packing were placed on antibiotics. Of the 80 nasal packing patients who underwent nasal packing, 22 (28%) developed complications. In all instances, the complication was a recurrence of bleeding. Twenty-seven of the 154 (18%) patients who did not receive packing also returned with recurrence of bleeding. There was no significant difference in complication rates between patients who were packed, cauterized, or received no intervention. No patient returned to the ED with an infectious complication. Conclusion: Approximately one third of anterior epistaxis patients presenting to this ED received nasal packing. A high percentage of return ED visits was noted in patients discharged with and without packing, all for recurrence of anterior epistaxis. Regardless of antibiotic use, no infectious complications were cited in this cohort.

Radiofrequency surgery-a safe, effective technique for sensitive areas of body

∗Object of Study: To evaluate the efficacy & safety of patented 4 MHz Radiofrequency Surgery for treating skin lesions over the most sensitive & delicate areas of body. ∗Materials & Methods: Ultrahigh radiofrequency waves in the range of 3.8 to 4 MHz are known to cause least lateral tissue damage. These properties along with the cold ablation (due to cold electrodes) make it an ideal equipment for sensitive areas of body. In addition, the electrodes being thin & bendable make it easier for penetrating the body folds & cavities when required. The patented 4 MHz radiofrequency equipment was used for this study. The four electrodes selected for treatment were 1) varitip 2) straight needle 3) smallest round loop & 4) round surgipen. 204 patients were selected & treated over the past one & half years. Out of these 73 patients were earlier treated with electrocautery, cryotherapy, chemical cautery or scalpel surgery giving partial result or some side effects. Rest of the patients presented for the first time. Sensitive areas of body treated were: eyelids, periorbital, nosetip, nostrils, lips, perioral, tongue, oral mucosa, cheeks, external auditory meatus, pinna of ear, male & female genitalia, groins, perianal, periungual. Conditions treated on above areas were Verrucae, Seborrhoeic & Actinic Keratoses, Dermatitis Papulosa Nigra, Milia, Moles, Molluscum Contagiosum, Granuloma Pyogenicum, Capillary Haemangioma, Condyloma Acuminata, Xanthelasma, ear Keloids, Scars of Acne & Trauma. Areas treated had single or multiple close lesions. Preoperatively all routine investigations were done. Electrodessication with or without local anaesthesia (Inj. Lignocaine 2% with Adrenaline) was used for all small lesions. Electrosection with or without Electrocoagulation under effect of Inj. Lignocaine with Adrenaline was used in the rest of patients. Varitip & straight needle electrodes were used for Electrodessication. Smallest round loop & round surgipen were used for Electrosection. Postoperatively, non-steroidal anti-inflammatory medicines were given along with oral or topical antibiotic. Sunscreens were advised in relevant patients. Followup with serial photography was done. ∗Results: 4 MHz Radiofrequency Surgery was found to be very suitable technique for lesions on the most sensitive & delicate portions of body because: Least intra & post operative pain & bleeding; minimal scarring; easy penetration of body folds & cavities for safe lesion removal due to the thin bendable electrodes; rapid healing & negligible recurrence; no charring & complications; no dyschromia. ∗Conclusion: Patented 4 MHz Radiofrequency Surgery is a very safe & effective technique for skin lesions on the sensitive & delicate portions of body.

The Formation and Management of Middle Ear Granulation Tissue in Chronic Ear Disease

Granulation tissue is an important pathogenic feature of all types of chronic ear disease, and it can be controlled and treated with good aural toilet, appropriate antibiotic therapy, topical steroids, and chemical cautery or surgical debridement.

Nitric oxide synthase inhibition by N(G)-nitro- l-arginine methyl ester retards vascular sprouting in angiogenesis

The present study was designed to evaluate the role of nitric oxide (NO) for angiogenesis. Angiogenesis was elicited upon mouse cornea by chemical cautery with silver nitrate. Angiogenic activity was evaluated by measuring the length of vascular sprout with or without administration of NO synthase (NOS) inhibitor, N((G))-nitro-L-arginine-methyl ester (L-NAME). In the pericorneal plexus, a circulatory loop situated in the same topological situation for all individuals was selected to observe vascular sprouting. At 72 h after cauterization, the length of the longest vascular sprout was measured using the perfused whole-mount cornea. The length of nontreated mice (83 +/- 83 microm) was significantly longer than that of L-NAME treated mice (33 +/- 24.6 microm). To address the possible contribution of production of vascular endothelial growth factor (VEGF) and NO, we measured mRNAs of VEGF and inducible NOS. The mRNA level of VEGF increased to 170% of the nontreated level at 12 h after cauterization and returned to the nontreated level by 24 h after cauterization. mRNA of inducible NOS remained elevated 24 h after cauterization. These results suggest that the response of preexisting vessels to angiogenic stimulus via NO is of importance in the process of angiogenesis, i.e., vascular sprouting is promoted by NO production. This might be attributable to enhancement of an increase in vascular permeability and /or vasodilation via NO.

Paediatric epistaxis: Alder Hey experience.

Referrals for epistaxis management constitute a significant proportion of paediatric ENT consultations. A prospective audit of all new referrals to our paediatric ENT department for epistaxis management yielded 88 patients over four months. Parents completed a questionnaire with particular reference to the duration of history and frequency of epistaxis. After assessment some patients were given topical chlorhexidine and neomycin cream (Naseptin), in addition some children also underwent chemical cautery (silver nitrate). Of the 64 children in whom out-patient nasal cautery was attempted it was tolerated by 63 (98 per cent). In response to a follow-up postal questionnaire returned by 65 per cent, most parents (74 per cent) felt that Naseptin was useful. A telephone survey of the patients' general practitioners found that 91 per cent of the children did not consult their general practitioner regarding epistaxis again. We conclude that paediatric epistaxis can be effectively managed with a single out-patient consultation.

Laser ablation of granulation tissue at the tracheoesophageal puncture site.

Tracheoesophageal fistula speech may be complicated by granulation tissue around the puncture site. Treatment includes antibiotics, antifungals, chemical or electrocautery, and surgical excision of the granulation tissue. Chemical cautery generally requires repeated treatment sessions. We report our technique and results of CO(2) laser ablation of granulation tissue at the tracheoesophageal puncture site performed as an outpatient office procedure. Seven of 9 patients (78%) were cured with a single treatment. The prosthesis was replaced immediately after laser ablation of granulation tissue. Of the remaining 2 patients, 1 had a recurrence a year later, requiring repeated laser. The second patient had a large mass requiring 4 laser ablations. There were no complications. CO(2) laser has the following advantages compared with other methods of treating stomal granulation tissue: office procedure; 78% cured with single treatment; and the extent of tissue necrosis is predictable.

The effect of selective cyclooxygenase-2 inhibitor on corneal angiogenesis in the rat

PURPOSE. Eicosanoids that are present in inflamed tissues are thought to play a significant role in angiogenesis. Cyclooxygenase, a key enzyme in eicosanoid synthesis, has recently been shown to exist in two isoforms: the constitutive COX-1 and the inducible COX-2. This study was undertaken to determine the role of COX-2 in the corneal angiogenic response. METHODS. Angiogenesis in the rat cornea was provoked by chemical cautery. Either NS-398, a selective COX-2 inhibitor, or indomethacin, a non-selective COX inhibitor, was applied topically 3 times daily for 4 days. Neovascularization was quantitated by digital image analysis in corneal flat preparations. To test their inhibitory effects on eicosanoid synthesis, normal or cauterized corneas were incubated in the culture medium with the inhibitor. Prostaglandin E2 in the medium was assayed using an enzyme-linked immunosorbent assay. RESULTS. Both NS-398 and indomethacin significantly inhibited corneal neovascularization with the % inhibition of 36.4 ± 9.6%, and 38.5 ± 9.0%, respectively, when applied topically at a concentration of 0.1% (p <. 001). Neither reduced the angiogenic response at a concentration of 0.01% or below. PGE 2 production in the cauterized cornea was 2.0 times higher than that in the controls. In normal corneas, indomethacin inhibited PGE 2 synthesis by 80%, whereas NS-398 inhibited it by no more than 20%. In contrast, in injured corneas, both indomethacin and NS-398 inhibited PGE 2 synthesis in a similar fashion, with a maximal inhibition rate of 75 to 80%. CONCLUSIONS. Our results suggest that COX-2 induction in cauterized corneas increases the level of eicosanoids, which result in corneal angiogenesis.

Closure of tympanic membrane perforations by chemical cautery.

Fifty cases of dry, central, tympanic membrane perforation were studied for closure by application of saturated solution of trichloracetic acid. Aetiologically 17 cases belonged to traumatic and 33 to the inflammatory group. Eustachian tube patency and good air-bone gap on audiometry were the pre-requisites. Study concluded with 78% success with average of 2.8 applications. The patients had definite improvement in the hearing acuity and relief from other symptoms. The study highlights the achievements by using this old method.

Epistaxis in children

Most epistaxis in children come from the anterior part of the nasal septum. The bleeding is usually under control by manual compression or vestibular packing with a piece of cotton or calcium alginate. In case of severe or recurrent epistaxis, one must look for a bleeding disorder or a nasal/nasopharyngeal tumour, especially juvenile nasopharyngeal angiofibroma in adolescent males. Chemical or electrical cautery of the septum should be suggested in case of recurrent idiopathic epistaxis. When bleeding continues despite such treatments, anterior nasal packing is recommended; life-threatening epistaxis usually requires posterior packing. Embolisation can be used to reduce blood supply before surgery in case of haemorragic tumours or vascular malformations.

Contamination with blood during management of epistaxis

The management of medical emergencies is known to expose medical staff to the risks of blood contamination,1 including infection with HIV and hepatitis B virus.2 Epistaxis is one of the commonest otolaryngological emergencies, requiring treatment that may range from simple chemical cautery to major arterial ligation. We assessed the risk of blood contamination to junior medical staff during the treatment of acute epistaxis and determined patient opinion regarding the junior doctors' use of protective clothing. Fifty consecutive cases of acute epistaxis treated by two junior medical staff were prospectively studied. Clean protective theatre clothing with gloves, mask, full face visor, hat, and apron was worn during …

Laser Surgery for Cervical Intraepithelial Neoplasia

The laser has provided a relatively easy and safe method for treating all types of CIN. The advantages of lasers include great conservatism due to tissue sparing, great precision because of microsurgical method, combination of excisions and vaporization possible, suitable for therapy of multifocal disease, uncluttered field, and good hemostasis. Although other modalities have also been used successfully in the therapy of this disease, it appears that none are so versatile as CO2 laser or possess its ability to accurately treat the multifocal disease that may involve large surface areas of the lower reproductive tract. It seems unlikely that any of the cervical ablation methods--chemical destruction, hot cautery, diathermy electrode, cryoprobe, laser, and diathermy loop--will completely disappear from use in the near future. Ablation is an attractive alternative to cold-knife excision in properly triaged patients, since it is almost always an outpatient procedure done without anesthesia or with only local anesthesia. Most importantly, a large number of patients have completely visible lesions of a severity less than that of in situ cancer; they really do not need excisional conization by any technique and benefit by quick ablation of the transformation zone. A conization, to be diagnostic and therapeutic, must remove the entire transformation zone to the proper depth. This procedure is almost always attended by a higher morbidity rate than is simple ablation. Laser excisional conization and the large loop excision of the transformation zone procedure are similar in a number of respects, because the operator must have certain capabilities and a through understanding of the disease to be treated to perform the operation correctly.