A Systematic Review on the Treatment of Dermatosis Papulosa Nigra.

Dermatosis papulosa nigra (DPN) is a benign skin condition that is primarily reported in skin of color patients. While prevalent, treatment options are limited and the benign course of DPNs may cause them to be overlooked by clinicians. However, large and multiple lesions in cosmetically sensitive areas may be emotionally and socially distressful to patients. There are few literature reviews examining treatment options for this condition. A literature search was performed using PubMed, Medline, Embase, and Web of Science databases. 67 articles were identified and 15 studies met the inclusion criteria. Our findings demonstrate that laser therapy is becoming increasingly utilized as a safe and efficacious treatment for DPNs in skin of color patients. J Drugs Dermatol. 20(4):467-472. doi:10.36849/JDD.2021.5555.

Transcatheter Electrosurgery: JACC State-of-the-Art Review.

Transcatheter electrosurgery refers to a family of procedures using radiofrequency energy to vaporize and traverse or lacerate tissue despite flowing blood. The authors review theory, simulations, and benchtop demonstrations of how guidewires, insulation, adjunctive catheters, and dielectric medium interact. For tissue traversal, all but the tip of traversing guidewires is insulated to concentrate current. For leaflet laceration, the "Flying V" configuration concentrates current at the inner lacerating surface of a kinked guidewire. Flooding the field with non-ionic dextrose eliminates alternative current paths. Clinical applications include traversing occlusions (pulmonary atresia, arterial and venous occlusion, and iatrogenic graft occlusion), traversing tissue planes (atrial and ventricular septal puncture, radiofrequency valve repair, transcaval access, Potts and Glenn shunts), and leaflet laceration (BASILICA, LAMPOON, ELASTA-Clip, and others). Tips are provided for optimizing these techniques. Transcatheter electrosurgery already enables a range of novel therapeutic procedures for structural heart disease, and represents a promising advance toward transcatheter surgery.

New and traditional surgical approaches to hidradenitis suppurativa.

When the prevention of new lesions fails and when medical therapy of established and growing lesions is ineffective, surgery is the accepted method of dealing with hidradenitis suppurativa/acne inversa. The rationale and preferred techniques of mini-unroofing using a biopsy punch, deroofing using scissors, electrosurgery or laser, and classical wide excision and closure are discussed. The situation in which incision and drainage is considered for temporary pain relief would be best considered an opportunity for deroofing, as illustrated in the accompanying online videos.

Bipolar transurethral resection of the prostate: Darwinian evolution of an instrumental technique.

Bipolar transurethral resection of the prostate (B-TURP) represents a Darwinian evolution of an instrumental technique that has been justified by reinforcing the leading position of monopolar transurethral resection of the prostate. Notwithstanding limitations, the best available evidence recommends B-TURP as an attractive alternative. It may serve as a reliable training platform for modern residents. High-quality evidence is lacking to definitely define its position in treating special subpopulations (anticoagulation dependence, comorbidities, and large adenomas). Regarding economic issues, preliminary evidence supports B-TURP, warranting further investigation. Future perspectives include attempts toward improvements of the existing technology, combining advantages with those of other new techniques, and evolution to novel, potentially safer, or more efficient techniques to address remaining challenges.

Electrosurgery in urology: recent advances.

Inadequate hemostasis is one of the most important causes of morbidity and mortality following urological surgery. Despite the long-term usage of coagulation, there is an ongoing development of new devices, including bipolar transurethral resection of the prostate or new vessel-sealing devices. A thorough understanding of the advantages and disadvantages of these new instruments can improve the operative experience for both the urologist and patient. The optimal coagulation system should be small, efficient, easy to handle and with low heat spread. In this article, we analyze different electrothermal coagulation systems and modern tissue-sealing devices in urological applications with the aim to substantiate the advantages and disadvantages of each technique in terms of efficacy and safety.

Radiocirugía en el tratamiento conservador de las lesiones preinvasoras del cuello uterino / Radiosurgery in the conservative treatment of the preinvader lesions of the uterine cervix

Se realizó un estudio descriptivo prospectivo y analítico con el objetivo de evaluar el comportamiento del Procedimiento de Extirpación con Asa Electroquirúrgica, como tratamiento conservador de lesiones preinvasoras del cuello uterino en la consultas de patología de cuello del Hospital General Docente de Morón en el periodo comprendido entre el primero de Enero de 2005 al 31 de Diciembre de 2006. El universo estuvo constituido por todas las mujeres portadoras de lesiones preinvasoras del cuello uterino a las que se le efectuó biopsia escisional con electrocirugía. Obteniendo como resultado que la frecuencia de utilización del Asa Electro quirúrgica fue de un 73,4 por ciento; la edad más frecuentes fue de 35-39 años; el motivo de consulta más frecuente fue la citología alterada, iniciaron las relaciones sexuales con menos de 17 años, tuvieron antecedentes de dos partos y de tener tres o más parejas sexuales.

A prospective, descriptive and analytical study was carried out with the objective to evaluate the behaviour of the Loop Electrosurgical Excision Procedure (LEEP), as conservative treatment of the preinvader lesions of the uterine cervix in the pathology office at The General Provincial Docent Hospital of Morón during the period among January 1st, 2005 to December 30th, 2006. The universe was constituted for all the women carrier of the preinvader lesions of the uterine cervix which the excisional biopsy had been carried out with electro surgery. The more frequent age was from 35 to 39 years, obtaining as a result that the utilization frequency of the loop electrosurgical was of a 73, 4 percent. The reason more frequent of the consultation was the alter cytology, they started their sexual relation before the 17 years, and they also had more than three sexual relationships.

[Electrosurgical concepts in ENT medicine. History, fundamentals and practice]. / Elektrochirurgische Konzepte in der HNO-Heilkunde. Geschichte, Grundlagen und Praxis.

The beneficial use of heat in the context of medical treatments was documented even in ancient times. The development of high-frequency alternating current generators led to actual electrosurgery, in which primary heating of the tissue takes place. In day-to-day clinical practice electrosurgery is used for coagulation and for electrotomies. There are both unipolar and bipolar techniques for these procedures. When a unipolar technique is used the active electrode is in the tip of the instrument and the patient plate is usually affixed to the patient's skin at a site outside the operating field. The bipolar technique differs in that there are no electrodes that need to be attached externally; both poles are contained inside the operating instrument, e.g. in the two prongs of a forceps. In radiofrequency surgery high-frequency electrical energy is applied directly into the tissue by a unipolar or bipolar technique. In this way it is possible to cause interstitial tissue lesions while sparing the superficial mucous membranes.

[Transurethral resection for benign prostatic hyperplasia. current developments]. / Transurethrale Resektion bei benigner Prostatahyperplasie. Aktuelle Entwicklungen.

Transurethral resection of the prostate still represents the "gold standard" in surgical treatment of symptomatic benign prostatic enlargement (BPE). New demands were made on transurethral electrosurgery with the appearance of alternative, minimal invasive procedures. Bleeding complications had to be reduced. Different attempts were made to improve the conventional TURP. Band loops and roller bars were developed in order to gain a more effective coagulation during the cutting process by a larger tissue contact. Major advances could be achieved by modifications of the high-frequency generator. Improved procedures like the "Coagulating-Intermittent-Cutting" (CIC), the "Instant-Response-", as well as the "Dry-Cut-Technology" combine cutting and coagulating effects to realize lowered bleeding and an efficient resection process. The introduction of bipolar currency flow opens the possibility of conventional TUR-P with saline solutions and thus to the theoretical avoidance of the TUR-syndrome. By the neoadjuvant use of 5alpha-reductase-inhibitors before planned TUR-P, bleeding- and irrigation fluid absorption should be reduced by lowering perfusion and the size of the prostate. Regarding these innovative approaches which improve the surgical standard and minimize the risk of perioperative complications, transurethral electrosurgery remains the method of choice in instrumental therapy of symptomatic BPE. In the future efficacy and costs will be comparable to those of the transurethral laser-resection or laser-vaporisation.

Desenvolvimento de um equipamento eletrocirúrgico com saída não chaveada / Development of an Electrosurgical Unit designed to study the electrosurgery parameters

Neste trabalho são discutidos os resultados do desenvolvimento de um protótipo de um equipamento adequado para certificação de acordo com as normas brasileiras. O equipamento foi implementado com eletrônica analógica e circuitos digitais de processamento discreto. O protótipo obedece ao mais rígido critério de regulação de potência aplicada ao paciente (10 por cento ou 5 W de erro máximo, o que for menor) da norma brasileira. Uma etapa de potência com saída senoidal, utilizando transistores bipolares em região ativa, foi utilizada em oposição às saídas chaveadas tradicionais (moduladas, geralmente, por largura de pulso - PWM). Estes tipos de saídas são discutidos comparativamente, tanto os aspectos de projeto quanto aspectos referentes às características espectrais e de transferência de potência útil para o paciente. Os problemas encontrados na tecnologia adotada para o estágio de saída são apresentados e suas vantagens e desvantagens discutidas na seção final. Um método inédito de regulação de potência ativa em altas freqüências, que responde às modificações da impedância do tecido sob intervenção eletrocirúrgica em menos de 1 ms também é discutivo em detalhes. Outro aspecto de peculiar dificuldade é o transformador de saída dos equipamentos eletrocirúrgicos, que opera em freqüências acima de 300 kHz, o que faz com que o comportamento de sua impedância intrínseca exija cuidados especiais, sendo apresentadas algumas técnicas e soluções de projeto para o mesmo.

Gas plasma treatment: a new approach to surgery?

In this survey we analyse the status quo of gas plasma applications in medical sciences. Plasma is a partly ionized gas, which contains free charge carriers (electrons and ions), active radicals, and excited molecules. So-called nonthermal plasmas are particularly interesting, because they operate at relatively low temperatures and do not inflict thermal damage to nearby objects. In the past two decades nonthermal plasmas have made a revolutionary appearance in solid state processing technology. The recent trends focus on using plasmas in health care, for "processing" of medical equipment and even living tissues. The major goal of tissue treatment with plasmas is nondestructive surgery: controlled, high-precision removal of diseased sections with minimum damage to the organism. Furthermore, plasmas allow fast and efficient bacterial inactivation, which makes them suitable for sterilization of surgical tools and local disinfection of tissues. Much research effort must be undertaken before these techniques will become common in medicine, but it is expected that a novel approach to surgery will emerge from plasma science.

Radio-frequency catheter ablation of cardiac arrhythmias: appraisal of an evolving therapeutic modality.

Since its introduction in 1985, there have been numerous reports of the use of radio-frequency (RF) current as an alternative energy source for catheter ablation. RF current (frequency range 150 kHz to 1 MHz), when delivered in bipolar mode, causes desiccation of tissue by creating a localized area of heat that results in discrete coagulation necrosis. An equivalent energy source such as direct current (DC) shock can be delivered at lower power (5 to 30 W) and lower voltage (30 to 80 V) for a longer pulse duration (10 to 60 seconds), thus eliminating barotraumatic effects. Because of its high frequency, RF current does not stimulate neuromuscular fibers, and general anesthesia during ablation is not needed. Studies in animals have shown that catheter-delivered RF energy can safely produce permanent complete or partial AV block, necrosis of atrial and ventricular myocardium adjacent to the mitral and tricuspid anuli potentially suitable for ablation of accessory pathways, and discrete lesions in the left and right ventricular myocardium. Recently, investigators from several centers have reported successful ablation of the AV junction (either complete or partial AV block) in patients with refractory supraventricular tachyarrhythmias, ablation of accessory pathways, and ablation of focal ventricular myocardium or a segment of a bundle branch in patients with drug-resistant ventricular tachycardia. Specific modification of AV conduction to cure AV nodal reentrant tachycardia has been successfully attempted. In all studies the application of RF current has not caused any serious complications.(ABSTRACT TRUNCATED AT 250 WORDS)