Diode laser versus bipolar diathermy for turbinate reduction in cases of inferior turbinate hypertrophy.

This study was designed to assess the surgical outcomes of two commonly used techniques for turbinate reduction (diode laser and bipolar diathermy) in selected group of patients with chronic nasal obstruction which resulted from inferior turbinate hypertrophy. The current study was conducted on adult patients with a diagnosis of inferior turbinate hypertrophy. 42 patients (21 in each group) with an age range of 21-38 years (mean = 26.0 ± 4.1) were included in this work and were randomly distributed in 2 groups: one group was scheduled for diode laser turbinectomy (DLT) while the other group was managed by bipolar diathermy (BDT). In DLT, the machine was on a continuous mode with intermittent loading, with laser energy level set to 6 W (0.3-s pulse, 0.1-s break). Pre- and postoperative assessments were statistically compared via tests from SPSS 19.0 (IBM, Chicago, Illinois; USA). Percentage of categorical variables were compared using the Chi-square (χ2) test. P < 0.05 was considered significant, P˃0.05 was considered non-significant, and P < 0.001 was considered highly significant. At 6 months postoperatively, in cases of DLT, there was high significant improvement as regards nasal obstruction and headache (χ2 = 64.78 and 39 respectively; P < 0.0001). There was insignificant difference as regards rhinorrhea (χ2 = 5.524; P = 0.137). In comparison to the postoperative data of both groups, significant difference was reported as regards nasal obstruction and headache (P < 0.001) and rhinorrhea (P < 0.05). This study demonstrated that both laser and bipolar cautery are effective in improving nasal obstruction and rhinorrhea. Preservation of the nasal mucociliary function was better in the diode laser group.

Electrocautery, Diathermy, and Surgical Energy Devices: Are Surgical Teams at Risk During the COVID-19 Pandemic?

OBJECTIVE: The aim of the study was to provide a rapid synthesis of available data to identify the risk posed by utilizing surgical energy devices intraoperatively due to the generation of surgical smoke, an aerosol. Secondarily it aims to summarize methods to minimize potential risk to operating room staff. SUMMARY BACKGROUND DATA: Continuing operative practice during the coronavirus disease-19 (COVID-19) pandemic places the health of operating theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled droplets and aerosol particles, thus posing an inhalation threat even at considerable distance. Surgical energy devices generate an aerosol of biological particular matter during use. The risk to healthcare staff through use of surgical energy devices is unknown. METHODS: This review was conducted utilizing a rapid review methodology to enable efficient generation and dissemination of information useful for concurrent clinical practice. RESULTS: There are conflicting stances on the use of energy devices and laparoscopy by different surgical governing bodies and societies. There is no definitive evidence that aerosol generated by energy devices may carry active SARS-CoV2 virus. However, investigations of other viruses have demonstrated aerosolization through energy devise use. Measures to reduce potential transmission include appropriate personal protective equipment, evacuation and filtration of surgical plume, limiting energy device use if appropriate, and adjusting endoscopic and laparoscopic practice (low CO2 pressures, evacuation through ultrafiltration systems). CONCLUSIONS: The risk of transmission of SARS-CoV2 through aerosolized surgical smoke associated with energy device use is not fully understood, however transmission is biologically plausible. Caution and appropriate measures to reduce risk to healthcare staff should be implemented when considering intraoperative use of energy devices.

Short-wave diathermy in the clinical management of musculoskeletal disorders: a pilot observational study.

Musculoskeletal disorders are the most common cause of pain and functional limitation in the general population. The study aim was  to evaluate short-wave diathermy (SWD) effects on pain and quality of life in people with musculoskeletal disorders. Eighty participants (31 men, mean age 56 ± 12.49 years) were enrolled, recruiting from outpatient clinics at the Rehabilitation Unit, University Hospital, Padova. Inclusion criteria were pain lasting more than 15 days, pain visual analog scale (VAS) score higher than 50/100 mm, and a diagnosis of osteoarthritis, neck/back pain, or tendinopathies. All participants underwent ten sessions of percutaneous SWD, 3 times/week. Each session lasted 15-20 min, with frequencies of 4 or 8 MHz and heat intensity between 40 and 60 W. Outcomes were assessed before and after treatment. Primary outcome was pain reduction, evaluated by short form McGill pain questionnaire, which includes VAS and present pain intensity (PPI). Secondary outcome was improvement in social and work-related activity limitations. Participants were grouped based on classification of pain [nociceptive and neuropathic pain (group A) vs nociceptive only (group B)]. VAS and PPI improved significantly (p < 0.01). No difference in pain reduction (VAS and PPI) emerged between the groups. Limitations due to pain in work-related and non-work-related activities decreased (p < 0.01); use of pain medications was reduced at T1 vs T0 (p < 0.01). Our results suggest that SWD is effective in reducing musculoskeletal pain in the short term, providing relief and improving quality of life.

US-guided microwave ablation for primary hyperparathyroidism: a safety and efficacy study.

OBJECTIVES: To evaluate the safety and efficacy of microwave ablation (MWA) with the assistance of continuous cool saline injection (CCSI) in patients with primary hyperparathyroidism (PHPT). METHODS: Between November 1, 2014, and February 29, 2016, 22 patients with PHPT were enrolled and treated with ultrasound-guided MWA assisted by CCSI. The levels of parathyroid hormone (PTH) and serum calcium were recorded before and after the MWA. Patients were divided into two groups (normalized and unnormalized groups) according to treatment efficacy. Fisher's exact test and the Mann-Whitney test were used to compare data between the two groups. Timing differences in serum PTH and calcium levels were analyzed with repeated measures analysis of variance. RESULTS: Normalized outcomes for both PTH and calcium levels were achieved in 19 of 22 (86.36%) patients with PHPT. In the normalized group, PTH levels remained normal for 12 months after MWA. PTH levels in the unnormalized group were outside the reference range at six of seven follow-ups within 12 months following MWA. By contrast, serum calcium levels gradually decreased in all patients in both groups. The mean serum PTH and mean calcium levels at 6 months after therapy were significantly lower than those before MWA (both p < 0.05). A transient voice change developed in eight patients. One patient experienced hypocalcaemia, which was corrected by oral calcium supplementation within 2 months. CONCLUSIONS: US-guided MWA assisted by CCSI is safe and effective for destroying parathyroid gland tissue and may serve as a therapeutic alternative for patients with PHPT. KEY POINTS: • Microwave ablation is a new option for patients with hypercalcemic or normocalcemic primary hyperparathyroidism. • Microwave ablation can decrease PTH and calcium levels with sustained efficacy in most patients. • Treatment is safe and causes only transient side effects.

Evaluation of the treatment of chronic chemotherapy-induced peripheral neuropathy using long-wave diathermy and interferential currents: a randomized controlled trial.

PURPOSE: The purpose was to investigate the effects of long-wave diathermy in combination with interferential currents (interferential therapy and long-wave diathermy at high power (ITH)) in comparison with long-wave diathermy at a power below the active treatment dose (long-wave diathermy at low power (LDL), control group) on sensory and motor symptoms in patients with chronic chemotherapy-induced peripheral neuropathy (CIPN) in the lower extremities. METHODS: Sixty-seven patients with chronic CIPN were randomized to 12 weeks of either ITH or LDL. Follow-up assessments were performed after the treatment period and at 37 weeks after randomization. The primary outcome was pain (Numeric Rating Scale (NRS)), and the secondary outcomes were discomfort, nerve symptoms, subjective measurement of dizziness (Dizziness Handicap Inventory), and balance. Differences within and between groups were analyzed. RESULTS: Pain intensity decreased significantly only in the LDL group directly after the treatment period from NRS median 25 to median 12.5 (P = 0.017). At the 37-week follow-up, no changes were detected, irrespective of group (NRS 13 vs. 20, P = 0.885). Discomfort decreased significantly in both groups at both 12 and 37 weeks after the baseline (P < 0.05). Balance disability showed significant declines in both groups at 12 and 37 weeks (P = 0.001/0.025 in the ITH group vs P = 0.001/<0.001 in the LDL group). Balance ability (tightened Romberg test) increased significantly at both 12 and 37 weeks in both groups (P = 0.004/<0.040 in the ITH group) but did not improve in the LDL group at any of the follow-up time points (P = 0.203 vs P = 0.383). The one-legged stance test was unchanged in the ITH group after 12 weeks but improved 37 weeks after baseline (P = 0.03). No significant changes were observed in the LDL group at any of the follow-up time points. CONCLUSION: This study provides no support for the use of a combination of long-wave diathermy and ITH as a treatment option for patients with chronic CIPN. However, the chronic CIPN symptoms decreased with time irrespective of the treatment.

Acquired epidermodysplasia verruciformis: a comprehensive review and a proposal for treatment.

BACKGROUND: Epidermodysplasia verruciformis (EV) is a rare genodermatosis characterized by immunologic abnormalities, disseminated human papilloma virus infection, and early development of skin cancers. Acquired forms have been rarely reported and usually occur with immunosuppression. The therapeutic management of the acquired forms is not standardized, and several therapies have been tried, with variable outcomes. OBJECTIVES: To provide updated clinical and experimental information on the treatment of acquired EV. METHODS: A Medline literature search was performed for relevant Medical Subject Heading terms, reviewing publications on strategies for management of acquired EV. We also report a case successfully treated using a combination of photodynamic therapy and oral retinoids. CONCLUSION: Data from the literature show that a standardized approach to this condition is lacking; the combination treatment chosen in our case may be proposed because it led to an excellent clinical outcome and a long-lasting remission.

Comparison of the efficacy of ketoprofen phonophoresis, ultrasound, and short-wave diathermy in knee osteoarthritis.

The present study aimed to compare the efficacy of three different deep heating modalities: phonophoresis (PH), short-wave diathermy (SWD), and ultrasound (US), in knee osteoarthritis. Patients who consented to participate in the study were randomly divided into the following three groups. Group 1 (n = 33) received PH, Group 2 (n = 33) received US, and Group 3 (n = 35) received SWD. These deep heating therapies were applied by the same therapist. Each therapy began with 20-min hot pack application. Each of the three physical therapy modalities was applied 5 days a week for 2 weeks (a total of 10 sessions). The patients were evaluated using visual analogue scale (VAS) at rest, 15-m walking time, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) both before and after the treatment. Moreover, at the end of the treatment, both the physician and the patient made an overall evaluation, by rating the treatment efficacy. The results of the study showed that VAS, 15-m walking time, and WOMAC parameters were improved with all three deep heating modalities, and all the three modalities were effective. However, there was no significant difference between the three modalities in terms of efficacy. There was also no significant difference between the three groups in terms of post-treatment general evaluation of the physician and the patient. The present study is the first to suggest that choosing one of PH/US/SWD therapy options would provide effective results and none of them are superior to the others, and we believe that these findings will be a basis for further studies.

Effectiveness of thermal and athermal short-wave diathermy for the management of knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: To assess the effectiveness of short-wave diathermy (SWD) treatment in the management of knee osteoarthritis (KOA) and to assess whether the effects are related to the induction of a thermal effect. METHODS: A systematic literature search was conducted in PubMed, CINAHL, PEDro, EMBASE, SPORTdiscus and Scholar Google. Included were trials that compared the use of SWD treatment in patients diagnosed with KOA with a control group (placebo SWD treatment or no intervention) and studies that used high-frequency electromagnetic energy (i.e., 27.12 MHz) with sufficient information regarding treatment dosage. Methodological quality of the included studies was assessed in accordance with the PEDro classification scale. A minimum of a 6/10 score was required for inclusion. RESULTS: Seven studies were included in the final analysis. Treatment protocols (dosage, duration, number of treatments) varied extensively between studies. The meta-analysis of the studies with low mean power did not favour SWD treatment for pain reduction, while the results of studies employing some thermal effect were significant. No treatment effect on functional performance measures was determined. CONCLUSION: This meta-analysis found small, significant effects on pain and muscle performance only when SWD evoked a local thermal sensation. However, the variability in the treatment protocols makes it difficult to draw definitive conclusions about the factors determining the effectiveness of SWD treatment. More research (using comparable protocols and outcome measurements) is needed to evaluate possible long-term effects of thermal SWD treatment and its cost effectiveness in patients with KOA.

Comparison of lateral thermal damage of the human peritoneum using monopolar diathermy, Harmonic scalpel and LigaSure.

BACKGROUND: New hemostatic technologies are often employed in open and laparoscopic surgery to reduce duration of surgery and complications. Monopolar diathermy, Harmonic scalpel and LigaSure are routinely used in open and laparoscopic surgery for tissue cutting and hemostasis. We compared lateral thermal damage following in vivo application of 3 commonly used instruments. METHODS: We used monopolar diathermy, Harmonic scalpel and LigaSure to coagulate and divide the peritoneum of patients who underwent median laparotomy. After anesthesia, median supraumbilical laparotomy was performed, and the peritoneum of each patient was coagulated using different devices. Using light microscopy and morphometric imaging analysis, the width of tissue lateral thermal damage was measured from the point of the peritoneal incision. RESULTS: We included 100 patients in our study. After a peritoneal incision, the mean lateral thermal damage of monopolar diathermy, Harmonic scalpel (output power 3), Harmonic scalpel (output power 5) and LigaSure were 215.79 µm, 90.42 µm, 127.48 µm and 144.18 µm, respectively. CONCLUSION: The degree of lateral thermal spread varied by instrument type, power setting and application time. LigaSure and Harmonic scalpel were the safest and most efficient methods of tissue coagulation. Monopolar diathermy resulted in the greatest degree of thermal damage in tissues.

[Haemorrhoidal disease: role of conservative outpatient treatments]. / La malattia emorroidaria: ruolo dei trattamenti ambulatoriali conservativi.

AIM: This study is a critical review of conservative office treatments of haemorrhoidal disease. MATERIAL OF STUDY: Many are outpatient techniques proposed in current literature; several with small series, anecdotal ones or some ones yet abandoned for excessive morbidity (for example anal divulsion, dilatation and so on); among most used we describe procedure, indications, contraindications, results and limits about rubber band ligation, sclerotherapy, cryotherapy, infrared photocoagulation, bipolar diathermy and direct current therapy. RESULTS: Each method has its supporters, indications and limits; therefore in literature there are discordant opinions even when randomized studies are compared. Indeed each technique is been compared with one or more other ones but there is not a randomized trial which compares all these treatments. CONCLUSIONS: Conservative office techniques, and rubber band ligation in particular, have an important role in second degree haemorrhoidal disease, in non-responsive to medical treatment first degree and also in third degree haemorrhoids in elderly patients with comorbidity or with sectorial or moderate prolapse.

[Optimization of methods for measurement and assessment of occupational exposure to electromagnetic fields in physiotherapy (SW diathermy)]. / Optymalizacja metod pomiarowych i oceniajacych ekspozycje zawodowa na pola elektromagnetyczne stosowane w fizykoterapii krótkofalowej.

BACKGROUND: Physiotherapists commonly use high-frequency (HF) electromagnetic field (EMF) units for therapeutic heating, whereas they are a source of strong EM fields. High EMF intensity values in places, where physiotherapists perform their occupational duties, require frequent measurements and their exposure must be monitored. Such procedures are obligatory and expensive, but they do not improve working conditions of physiotherapists. The aim of the study was to update the knowledge of actual exposure of physiotherapists to EMF and optimize methodical and decisive procedures. MATERIAL AND METHODS: EMF strength was measured in close proximity of twenty diathermy (SW) units, and in places usually occupied by physiotherapists. Modern digital-readout equipment was used for the measurements. It allowed us to identify the resultant EMF spectrum and to manage the measurement results. Values of the induced current, I(L), in the limbs of 16 physiotherapists were measured. RESULTS: The highest values of EMF strengths were measured for the whole body of the physiotherapist at the console, to 200 V/m and 0.20 A/m, and at the electrodes, to 180 V/m and 0.40 A/m. During intervention procedures, the physiotherapist's hands were exposed to 900 V/m and 2.0 A/m EMF. The maximum value of the exposure W indicator for routine operations was as high as 0.32, and for intervention procedures as high as 1.67. The maximum intensities of induced currents measured in the physioterapist's upper limbs during intervention procedures were up to 120 mA, depending on individual person. CONCLUSIONS: The results have confirmed the high EMF strength values occurring in the real conditions of the work environment of physiotherapists performing routine procedures. High intensity values of currents induced in the limbs of the physiotherapist performing intervention procedures represent a real threat in 25% of cases. The existing obligatory annual monitoring procedures are expensive and completely fail to offer any protection against EMF. The authors of this paper propose to implement a two-stage (obligatory and facultative) monitoring and measurement system.

Guidelines in Practice: Electrosurgical Safety.

Surgeons routinely use electrosurgical devices to cut and coagulate tissue during surgical procedures. However, hazards associated with electrosurgery (eg, burns, electrical shock, fire) can place patients or personnel at risk. Perioperative nurses should standardize processes, preoperatively assess the risks for electrosurgical injuries, and participate in education activities on electrosurgical safety to help prevent injuries from occurring. The AORN "Guideline for electrosurgical safety" provides guidance to perioperative personnel for safe use of electrosurgical units, electrocautery devices, and argon-enhanced coagulators. This article discusses prevention of electrosurgical unit injuries, including those that can be caused by electrosurgical accessories. A scenario describes how a team investigating two incidents related to use of electrosurgery uses an assessment tool to identify risks for injury and includes a report of these risks in the surgical briefing. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for electrosurgical safety.

The Effect of Short-Wave Diathermy and Exercise on Depressive Affect in Chronic Low Back Pain Patients.

OBJECTIVE: The aim of this study was to compare exercise, continuous short-wave diathermy (SWD) and intermittent SWD treatment modalities and to evaluate the effects of these treatments on chronic back pain and depression. METHODS: This study is an intervention trial which evaluated patients who applied to our clinic due to chronic low back pain between 2008-2009. The study group consisted of 90 patients between the ages of 40-65 who had had low back pain for more than 6 months. The patients were randomized into three groups. The first group received placebo short-wave diathermy, the second group received continuous short-wave diathermy, and the third group received pulsed short-wave diathermy. Pain was evaluated by Visual Analog Scale (VAS) and the Pain Disability Index (PDI).The Modified Oswestry Low Back Pain Disability Questionnaire Form was used for the measurement of functional deficiency and the Beck Depression Inventory (BDI) was used for the evaluation of depression.All scales were performed before the treatment, immediately after treatment and 3 months after treatment. RESULTS: Significant decreases in PDI and VAS scores were found in all groups (p<0.05 for each). Similarly, there was a significant improvement in all groups in terms of functional deficiency(p<0.001 for each), while no differences were found between groups (p = 0.895). In terms of BDI scores, there was no improvement in those receiving only exercise, while Group 2 and 3 had significant improvements (p <0.05). When groups were compared for BDI scores, no differences were found between any of the groups (p = 0.189). CONCLUSION: Continuous SWD treatment with exercise was found to be more effective in reducing pain in patients with chronic low back pain than other treatment modalities used in our study. Although there was no significant difference between the groups in terms of depressive mood, it was found that those receiving continuous and pulsed SWD treatment had significant improvements in depression as measured by the BDI.

Cutting Edge: Novel Treatment Options Targeting Corneal Neovascularization to Improve High-Risk Corneal Graft Survival.

PURPOSE: Corneal neovascularization is an important risk factor for graft rejection after keratoplasty, although its role in posterior lamellar keratoplasty is not yet well defined. The aim of this work was to describe clinically available approaches that target corneal neovascularization preoperatively to improve graft survival after subsequent penetrating keratoplasty (PK) and to present findings on Descemet membrane endothelial keratoplasty (DMEK) in eyes with neovascularization. METHODS: Recent work on the use of anti-vascular endothelial growth factor agents, fine needle diathermy (FND), and corneal collagen crosslinking (CXL) to regress corneal neovascularization before PK is summarized. Furthermore, studies that have investigated the outcome of DMEK in vascularized eyes are presented. RESULTS: Pretreatment of recipient corneas with FND combined with anti-vascular endothelial growth factor agents is an effective method to reduce long-standing corneal neovascularization and results in relatively low rejection rates after subsequent high-risk PK. Peripheral CXL also seems to be a potent method to regress corneal neovascularization, although data on the impact of pretransplant CXL on long-term graft survival are not yet available. There are only limited data on graft rejection rates after DMEK in vascularized eyes, but initial studies indicate that DMEK seems to be a viable therapeutic option when no stromal scars are present. Furthermore, preexisting stromal neovascularization seems to regress after high-risk DMEK. CONCLUSIONS: Several angioregressive strategies to treat corneal neovascularization before PK have entered the clinic with promising initial results, which warrants larger trials with longer follow-up. Studies will also have to define the precise role of preexisting corneal neovascularization in high-risk DMEK.

Comparison of superficial surgical site infection following use of diathermy and scalpel for making skin incision in inguinal hernioplasty.

BACKGROUND: The method of making surgical incision remains a complex problem. Although controversial, the use of diathermy instead of scalpel for skin incision and underlying tissue dissection is gradually gaining wide acceptance. This is due to the observation that no change in wound complication rate or postoperative pain is reported with the use ofDiathermy. However, the fear ofexcessive scarring and poor wound healing has curtailed its widespread use for skin incision. OBJECTIVE: The objective of the study is to compare superficial surgical site infection (SSSI) in diathermy and scalpel skin incision in inguinal hernioplasty. STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: Study was conducted at Surgical Unit II, Holy Family Hospital. Rawalpindi from 1st Jan. 2008 to 30th September 2008. PATIENTS AND METHODS: A total of 80 patients who presented with inguinal hernias were included in the study. Patients were divided in two groups. Group1: In 40 patients skin incision was made with Diathermy, Group 2: The other 40 had skin incision with scalpel. RESULTS: The mean age of patients in the intervention group (Group 1) was 50 years while in the control group (Group 2) it was 46 years. 48% patients in Group 1 and 55% in the Group 2 had indirect inguinal hernias. SSSI was noted in 12.5% cases in Group 1 whereas in Group 2 it was 17.5% but this difference was not found to be statistically significant (p value=0.378). CONCLUSION: The use of diathermy for making skin incisions is as safe as scalpel and there is no significant difference amongst both regarding wound infection.

Reducing blood loss in synostosis surgery: the Liverpool experience.

Correction of craniosynostosis represents much of the workload in the pediatric designated UK craniofacial units. We reviewed recent operations as part of an ongoing unit audit cycle with outcome determined as blood use and complications or readmissions within 6 weeks of surgery. A pro forma was designed, and information from a chart search was collated on a Microsoft Excel (Microsoft, Seattle, WA) spreadsheet. Thirty-four patients were treated between March 2005 and December 2006, including 13 who underwent scaphocephaly correction (SC) and 21 who underwent fronto-orbital advancement and remodeling (FOAR). In the FOAR group, 13 patients received continuous autologous transfusion, and 8 patients did not. Continuous autologous transfusion system was not used in any of the patients who underwent SC. The results showed that allogeneic transfusion rates were 46 +/- 36% red cell volume (RCV) in FOAR when a cell saver was used and 50 +/- 21% RCV when it was not. There was no significant difference between each group; however, 25% of patients received no transfusion in the cell saver group, whereas all patients undergoing FOAR were transfused in the non-cell saver group. Transfusion in SC was calculated as 26 +/- 25% RCV, and 33% of patients underwent SC without transfusion. In conclusion, we show that significant reductions in blood transfusion are possible in correction of craniosynostosis both with and without the use of cell savers by application of a simple protocol. Our findings support the recommendation that all of these cases be carried out in multidisciplinary units where high patient throughput allows both maintenance of skills and completion of audit cycles.

Patulous nasolacrimal duct with air reflux: a complication of submucosal diathermy of the inferior turbinate.

BACKGROUND: Submucosal diathermy to the inferior turbinate is a widely practised procedure to improve the nasal airway when nasal obstruction is due to hypertrophy of the inferior turbinate. This paper reports a case of an unusual nasolacrimal complication following submucosal diathermy to the inferior turbinate, and reviews the relevant literature.Case reportA 33-year-old male patient developed a patulous nasolacrimal duct opening following submucosal diathermy of the inferior turbinate. This resulted in spontaneous reflux of air and nasal mucus on to the ocular surface. CONCLUSION: This newly recognised complication of submucosal diathermy to the inferior turbinate indicates the need to be aware of the potential risk to the nasolacrimal system with this technique.

Comparison of chemical cautery (AgNo3) and steroid spray against SMD (submucosal diathermy) in the treatment of symptomatic inferior turbinate hypertrophy (ITH).

OBJECTIVE: To compare the efficacy of chemical cautery (AgNo3) and steroid nasal spray against SMD (submucosal diathermy) in the treatment of symptomatic Inferior Turbinate Hypertrophy (ITH). MATERIALS AND METHODS: Patients attending OPD in the department of ENT &HNS at KMCTH with symptomatic Inferior turbinate Hypertrophy were taken with their approval included for the study. Patients were divided into 2 Groups: in the first Group 25 patients were included and treated with chemical cautery (AgNo3) under Local Anaesthesia (LA), followed by steroid nasal spray for 3 months; in the second Group 25 patients were included and were treated with SMD (submucosal diathermy) under General Anaesthesia (GA).They all had history of use of topical nasal decongestant for different time period. Patients were followed up for 6 months. RESULTS: In Group 1, 16 patients complain of burning sensation for first week and 8 patients complain of continuous nasal blockage for 6 weeks.1 patient complain about inosmia for 2 weeks. In Group 2, nasal pain was complained by 17 patient for 2 weeks. 3 patients complain of persistent nasal blockage for 4 weeks. 3 patients complain of anosmia for 4 weeks. After completion of 6 months in Group 1, 20 patient has recurrent nasal blockage, whereas in Group 2, 10 patient has recurrent nasal blockage. Besides these, other symptoms noticed during initial phase did not appear. CONCLUSION: Chemical cautery (AgNo3) and steroid nasal spray is easy to follow, has less complication ,but failure rate is high, whereas SMD is procedure with less failure rate, but has to carried out under GA and has more discomfort postoperatively. For symptomatic inferior turbinate hypertrophy, where topical nasal decongestant has little role SMD is the choice of treatment for longer relief.

Guideline Implementation: Energy-Generating Devices, Part 1-Electrosurgery.

Energy-generating devices are standard equipment in the surgical suite, with electrosurgical units being the most common type of electrical device used in the OR. Prevention of injuries to patients and personnel related to the use of energy-generating devices is a key component of the perioperative nurse's role. The AORN "Guideline for safe use of energy-generating devices" provides guidance on the use and maintenance of devices that deliver energy in the forms of radiofrequency waves, ultrasound waves, or lasers. This article focuses on key points of the guideline, which address precautions specific to electrosurgical units, patients with implanted electronic devices, and minimally invasive surgery, and documentation of the use of energy-generating devices. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

Ligasure, Harmonic Scalpel versus conventional diathermy in excisional haemorrhoidectomy: a randomized controlled trial.

BACKGROUND: This study was designed to compare the surgical outcomes of haemorrhoidectomy performed by the Ligasure, Harmonic Scalpel with that performed by the conventional diathermy. METHODS: A total of 180 patients were randomized to Ligasure, Harmonic Scalpel and diathermy haemorrhoidectomy, 60 patients for each group. The operative time, post-operative pain scores, parenteral analgesic requirements in the first 24 h, post-operative complications and wound healing rates were documented. RESULTS: The median operative time was 8 min (range, 7-18) for the Ligasure and Harmonic Scalpel groups and 18 min (range, 15-21) for the diathermy group (P < 0.001). Throughout the first post-operative week, the daily median pain score was lower in the Ligasure and Harmonic Scalpel groups than in the diathermy group (P < 0.001). The median number of analgesic ampoules during the first 24 h post-operatively was lower in the Ligasure and Harmonic Scalpel groups (P < 0.001). There was no statistically significant difference in the incidence of post-operative complications. At 6 weeks post-operation, more patients in the Ligasure and Harmonic Scalpel groups had complete healing of wounds (P = 0 < 0.001). CONCLUSION: Ligasure and Harmonic Scalpel provide a superior alternative to conventional diathermy in haemorrhoidectomy with no difference between them in reducing the operative time, post-operative pain, analgesic requirements during the first 24 h and time to complete healing of wounds.