Allergic contact dermatitis to acrylates in disposable blue diathermy pads.
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We report 2 cases of elicitation of allergic contact dermatitis to acrylates from disposable blue diathermy pads used on patients who underwent routine surgery. Their reactions were severe, and took approximately 5 weeks to resolve. Both patients gave a prior history of finger tip dermatitis following the use of artificial sculptured acrylic nails, which is a common, but poorly reported, cause of acrylate allergy. Patch testing subsequently confirmed allergies to multiple acrylates present in both the conducting gel of disposable blue diathermy pads, and artificial sculptured acrylic nails. We advocate careful history taking prior to surgery to avoid unnecessary exposure to acrylates in patients already sensitized. (+info)
Radiofrequency ablation of unresectable primary and metastatic hepatic malignancies: results in 123 patients.
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OBJECTIVE: To describe the safety and efficacy of radiofrequency ablation (RFA) to treat unresectable malignant hepatic tumors in 123 patients. BACKGROUND: The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, or multifocality or inadequate functional hepatic reserve. Local application of heat is tumoricidal; therefore, the authors investigated a novel RFA system to treat patients with unresectable hepatic cancer. PATIENTS AND METHODS: Patients with hepatic malignancies were entered into a prospective, nonrandomized trial. The liver tumors were treated percutaneously or during surgery under ultrasound guidance using a novel LeVeen monopolar array needle electrode and an RF 2000 generator. All patients were followed to assess complications, treatment response, and recurrence of malignant disease. RESULTS: RFA was used to treat 169 tumors (median diameter 3.4 cm, range 0.5 to 12 cm) in 123 patients. Primary liver cancer was treated in 48 patients (39.1%), and metastatic liver tumors were treated in 75 patients (60.9%). Percutaneous and intraoperative RFA was performed in 31 patients (35.2%) and 92 patients (74.8%), respectively. There were no treatment-related deaths, and the complication rate after RFA was 2.4%. All treated tumors were completely necrotic on imaging studies after completion of RFA treatments. With a median follow-up of 15 months, tumor has recurred in 3 of 169 treated lesions (1.8%), but metastatic disease has developed at other sites in 34 patients (27.6%). CONCLUSIONS: RFA is a safe, well-tolerated, and effective treatment to achieve tumor destruction in patients with unresectable hepatic malignancies. Because patients are at risk for the development of new metastatic disease after RFA, multimodality treatment approaches that include RFA should be investigated. (+info)
An evaluation of radio frequency exposure from therapeutic diathermy equipment.
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To assess the physiotherapist's exposure to radio frequency electromagnetic fields (RF) leaking from short wave diathermy equipment, we conducted on-site measurements of stray electric and magnetic fields (27.12 MHz) close to continuous wave (CW) short wave equipment. The results show that the operator's knees may have the highest exposure level for both electric field (E-field) and magnetic field (H-field) in the normal operating position, i.e., behind the device console. The whole-body E-field exposure normally does not exceed the 1992 IEEE recommended limit during a normal treatment session. On the other hand, the operator's whole-body exposure to H-field was barely below the recommended limit. Our data suggest little chance of immediate harmful effects of RF leakage from the diathermy. Nonetheless, physiotherapists should still be advised to remain at a distance of at least 20 cm from the electrodes and cables to avoid possible overexposure. (+info)
Evaluation of the relative cost-effectiveness of treatments for infertility in the UK.
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This paper aims to complement existing clinical guidelines by providing evidence of the relative cost-effectiveness of treatments for infertility in the UK. A series of decision-analytical models have been developed to reflect current diagnostic and treatment pathways for the five main causes of infertility. Data to populate the models are derived from a systematic review and routine National Health Service activity data, and are augmented with expert opinion. Costs are derived from an analysis of extra-contractual referral tariffs and private sector data. Sensitivity analysis has been carried out to take account of the uncertainty of model parameters and to allow results to be interpreted in the light of local circumstances. Results of the modelling exercise suggest in-vitro fertilization is the most cost-effective treatment option for severe tubal factors and endometriosis, with surgery the most cost-effective in the case of mild or moderate disease. Ovulatory factors should be treated medically with the addition of laparoscopic ovarian diathermy in the presence of polycystic ovarian syndrome. For other causes, stimulated intrauterine insemination (unexplained and moderate male factor) and stimulated donor intrauterine insemination (severe male) are cost-effective. (+info)
Fine needle diathermy occlusion of corneal vessels.
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PURPOSE: To develop a novel technique, fine needle diathermy (FND), for the occlusion of corneal vessels and to evaluate its safety and efficacy in a series of patients. METHODS: Fourteen patients were treated with FND to occlude corneal vessels. Patients were categorized into four groups: group 1 (n = 4), high risk patients with stromal vascularization before keratoplasty; group 2 (n = 2), patients with progressive lipid keratopathy; group 3 (n = 4), post keratoplasty patients with active rejection episodes associated with vessels; and group 4 (n = 4), patients with disciform vascularized scars with recurrent inflammation. The success of the treatment in terms of vessel occlusion and the clinical outcome were monitored. RESULTS: All patients in group 1 had successful corneal transplantation, and the grafts remained clear without graft rejection. Patients in group 2 with lipid keratopathy had 100% obliteration of vessels with stabilization of corneal scar. All four patients in group 3 had complete regression of vessels with reversal of graft rejection. Patients with vascularized disciform scar had resolution of the inflammation without recurrence. Average follow-up was 10.3 months (minimum, 6 months; maximum, 24 months). No serious complications were observed with FND. CONCLUSIONS: FND is a useful and inexpensive technique that can serve as an adjunct or alternative to laser occlusion for the treatment of established corneal vessels. It is fairly safe and effective, although complications such as intrastromal bleeding and crystalline deposits can occur and at times it may have to be repeated once or twice to achieve the desired result. (+info)
Laparoscopic myolysis.
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This review will focus on the different techniques and the long-term effects of the technique called myolysis on myoma growth. Indications for myolysis are essentially pelvic pain, compression symptoms and global uterine volume in order to avoid hysterectomy. In the late 1980s, myolysis was performed laparoscopically with the help of the neodynium: yttrium aluminium garnet (Nd:YAG) laser. Later, bipolar needles were developed as an alternative to the Nd:YAG laser. Diathermy and cryomyolysis were also proposed but series are small in the literature. Very recently, myoma interstitial thermo-therapy (MITT) was performed using the diode laser and a specific optical light diffuser that is designed to transmit laser light in all directions. Laparoscopic myolysis was proved to be effective in provoking myoma shrinkage, with a dramatic decrease in size and a marked devascularization of the myoma and this technique can be proposed as an alternative to myomectomy in selected patients: only those aged >40 years or those not desiring to bear any more children. (+info)
Does laparoscopic ovarian diathermy affect the outcome of IVF-embryo transfer in women with polycystic ovarian syndrome? A retrospective comparative study.
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Controlled ovarian stimulation for IVF and embryo transfer and outcome parameters were compared retrospectively in 31 women with clomiphene-resistant polycystic ovarian syndrome (PCOS). Of these women, 15 had previously undergone laparoscopic ovarian diathermy before IVF (group A, total 22 cycles) and 16 had not had surgical treatment (group B, total 24 cycles). No statistically significant differences were observed in the number of oocytes retrieved, although the number of embryos available for transfer was significantly higher in group B (7.1 +/- 3.8 versus 4.6 +/- 2.7, P < 0.01). The clinical pregnancy rate per embryo transfer appeared to be higher in group B (63.2 versus 41.2%), as did the miscarriage rate (66.7 versus 28.6%), giving an apparent improved ongoing pregnancy rate per embryo transfer in group A (29.4 versus 10.5%), but this was not statistically significantly different. The incidence of severe ovarian hyperstimulation syndrome (OHSS) was apparently higher in group B (4.2 versus 0%), but this difference was not statistically significant. No cases of severe OHSS were seen in group A. Ovarian diathermy does not appear to have a deleterious effect on controlled ovarian stimulation, and the outcome of IVF-embryo transfer may be beneficial in decreasing the risk of severe OHSS and improving the ongoing clinical pregnancy rate. (+info)
Gynaecology and general surgery.
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The gynaecological disorders most likely to be met by the general surgeon are those that present with acute abdominal symptoms and those unexpectedly encountered at laparotomy. The former group includes ectopic pregnancy, acute salpingitis, and complications of ovarian cysts and abortion and the latter endometriosis, ovarian tumours, and myomatosis. The characteristics and treatment of these various conditions are described and principles outlined for the guidance of the general surgeon in dealing with gynaecological problem. (+info)