摘要
Abstract Objective: To describe Top-hat results and their association with margin status and disease relapse in a referral facility in Brazil. Methods: A retrospective study of 440 women submitted to LEEP to treat HSIL, in which 80 cases were complemented immediately by the top hat procedure (Top-hat Group - TH). TH Group was compared to women not submitted to Top-hat (NTH). The sample by convenience included all women that underwent LEEP from January 2017 to July 2020. The main outcome was the histological result. Other variables were margins, age, transformation zone (TZ), depth, and relapse. The analysis used the Chi-square test and logistic regression. Results: The TH Group was predominantly 40 and older (NTH 23.1% vs. TH 65.0%, p<0.001). No difference was found in having CIN2/CIN3 as the final diagnosis (NTH 17.0% vs. TH 21.3%, p=0.362), or in the prevalence of relapse (NTH 12.0% vs. TH 9.0%, p=0.482). Of the 80 patients submitted to top hat, the histological result was CIN2/CIN3 in eight. A negative top hat result was related to a negative endocervical margin of 83.3%. A CIN2/CIN3 Top-hat result was related to CIN2/CIN3 margin in 62.5% (p=0.009). The chance of obtaining a top hat negative result was 22.4 times higher (2.4-211.0) when the endocervical margin was negative and 14.5 times higher (1.5-140.7) when the ectocervical margin was negative. Conclusion: The top hat procedure did not alter the final diagnosis of LEEP. No impact on relapse was observed. The procedure should be avoided in women of reproductive age.
Subject(s)
Humans , Female , Gynecologic Surgical Procedures , Uterine Cervical Dysplasia , Uterine Cervical Neoplasms , Cervix Uteri , Colposcopy , Conization , Electrosurgery摘要
Objetivo: Analisar as evidências científicas disponíveis na literatura sobre os sinais e sintomas relacionados à exposição à fumaça cirúrgica em trabalhadores do bloco operatório. Método: Revisão integrativa da literatura, com busca nas seguintes bases de dados: Medline, Cumulative Index to Nursing and Allied Health Literature, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Web Of Science e SCOPUS. Resultados: Foram 1.351 estudos pré-selecionados, sendo 4 por busca manual. Ao fim, obtiveram-se cinco artigos para análise. Os sinais e sintomas encontrados foram: tosse, ardência de faringe, espirros, rinite, lesão nasofaringe, sensação de corpo estranho na garganta, congestão nasal, inflamação das vias aéreas, lacrimejamento dos olhos, náuseas, vômitos, dor abdominal, fraqueza, cãibra, cefaleia, sonolência, tonturas, irritabilidade, desconforto (como mau cheiro na roupa). Conclusão: Observaram-se grandes avanços nas pesquisas propostas, estudos que embasam a intensidade dos sinais e sintomas e orientação dos riscos nocivos que proporcionem aos gestores conhecimento e fundamentação científica para futuras intervenções tanto contra a proteção ao trabalhador como para prevenção de risco no ambiente de trabalho.
Objective: To analyze the scientific evidence available in the literature on signs and symptoms related to surgical smoke exposure among surgical block workers. Method: This integrative literature review searched the following databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Health Sciences Literature, Web of Science, and Scopus. Results: A total of 1,351 studies were pre-selected, 4 of which were found by manual search. In the end, five articles were analyzed. The signs and symptoms identified were: cough, burning sensation in the pharynx, sneezing, rhinitis, nasopharyngeal lesion, foreign body sensation in the throat, nasal congestion, airway inflammation, lacrimation, nausea, vomiting, abdominal pain, weakness, muscle cramp, headache, drowsiness, lightheadedness, irritability, discomfort (such as unpleasant smell in clothes). Conclusion: Great advances have been detected in the studies proposed. These investigations lay the foundation for the intensity of signs and symptoms and the orientation regarding harmful risks, providing managers with the knowledge and scientific basis for future interventions, both to protect the team and to prevent risks in the work environment.
Objetivo: Analizar la evidencia científica disponible en la literatura sobre signos y síntomas relacionados con la exposición al humo quirúrgico en trabajadores de quirófano. Método: Revisión integrativa de la literatura, buscando en las siguientes bases de datos: Medline, Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, Web Of Science y SCOPUS. Resultados: Hubo 1.351 estudios preseleccionados, cuatro por búsqueda manual. Al final, se obtuvieron cinco artículos para su análisis. Los signos y síntomas encontrados fueron: tos, ardor faríngeo, estornudos, rinitis, lesión nasofaríngea, sensación de cuerpo extraño en la garganta, congestión nasal, inflamación de las vías respiratorias, lagrimeo de los ojos, náuseas, vómitos, dolor abdominal, debilidad, calambres, dolor de cabeza, somnolencia, mareos, irritabilidad, malestar como mal olor en la ropa. Conclusión: Hubo grandes avances en la investigación propuesta, estudios que apoyan la intensidad de los signos y síntomas y orientaciones sobre riesgos nocivos que brinden a los gestores conocimiento y fundamento científico para futuras intervenciones, tanto contra la protección del trabajador como para la prevención de riesgos en el entorno laboral.
Subject(s)
Humans , Occupational Health , Electrocoagulation , Electrosurgery , Operating Rooms , Smoke摘要
SUMMARY: The studies of the properties of vascular structures and tissues during electric welding, in particular direct morphological changes in the blood vessel walls in the areas of welding processes, are of interest. Perforating veins, femoral veins, abdominal aorta, vena cava and porcine perforating veins of the limbs were used in this study. We performed end-to-end electric welding of the aorta, venous end-to-side electric welding, vein end-to-artery side arterial and venous welding, venous end-to-end electric welding, as well as arterial and venous lumen sealing.The results of histological studies showed the formation of a coagulated acellular protein matrix, represented by unorganized denatured protein fibrous structures. In the area of vascular tissue coagulation, lacunes were formed as a result of water evaporation from the biological tissue. In the perifocal area of the welded junction, cell reduction occurred without necrosis or charring. The data obtained confirm the safety of high frequency electric welding of the main vessels and the prospectfor clinical use of the studied techniques.
RESUMEN: Los estudios de las propiedades de las estructuras y tejidos vasculares durante la soldadura eléctrica son relevantes, en particular los cambios morfológicos directos en las paredes de los vasos sanguíneos en las áreas de los procesos de soldadura. En este estudio se utilizaron venas perforantes, venas femorales, parte abdominal de la aorta, vena cava y venas perforantes porcinas de los miembros. Realizamos soldadura eléctrica de extremo a extremo de la parte abdominal de la aorta, soldadura eléctrica de extremo a lado venosa, soldadura arterial y venosa de extremo a arteria del lado venoso, soldadura eléctrica de extremo a extremo venoso, así como lumen arterial y venoso. Los resultados de los estudios histológicos mostraron la formación de una matriz de proteína acelular coagulada, representada por estructuras fibrosas de proteínas desnaturalizadas no organizadas. Se formaron lagunas como resultado de la evaporación del agua del tejido biológico en el área de la coagulación del tejido vascular, En el área perifocal de la unión soldada, la reducción celular ocurrió sin necrosis ni carbonización. Los datos obtenidos confirman la seguridad de la soldadura eléctrica de alta frecuencia de los vasos principales y la perspectiva de uso clínico de estas técnicas.
Subject(s)
Animals , Vascular Surgical Procedures/methods , Anastomosis, Surgical/methods , Electrosurgery/methods , Swine , Blood Coagulation , Blood Vessels/anatomy & histology摘要
Objetivo: Identificar o conhecimento científico produzido sobre os cuidados de enfermagem relacionados ao uso da eletrocirurgia no período intraoperatório. Método: Revisão integrativa, realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) e na biblioteca virtual Scientific Electronic Library Online (SciELO), por meio dos descritores "eletrocirurgia", "cuidados de enfermagem" e "recuperação pós-cirúrgica melhorada", correlacionados pelo operador booleano and, nos idiomas português, inglês, espanhol e francês. Dos 213 estudos encontrados, sete compuseram a amostra. Utilizou-se o software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ), por meio dos métodos de análise lexical e de similitude. Para a análise da qualidade metodológica, aplicou-se o nível de evidência científica, segundo recomendações da Agency for Healthcare Research and Quality (AHRQ). Resultados: Destacam-se publicações entre 2010 e 2012, com nível de evidência V, indexadas nas bases de dados LILACS e CINAHL. Verificaram-se, na nuvem de palavras, termos com maior frequência relativa: "paciente" (n=14); "risco cirúrgico" (n=12); "eletrocirurgia" (n=10); "enfermeiro" (n=8); "conhecimento" (n=6), "cuidado" (n=6) e "prevenção" (n=5). Feita a análise de similitude, identifica-se um leque semântico de palavras mais frequentes. Conclusão: Evidencia-se escassez de estudos, na literatura, com informações significativas para agregação de conhecimentos e construção de novos trabalhos.
Objective: To identify the scientific knowledge produced under the care of nursing related to the use of electrosurgery in the intraoperative period. Method: Integrative review based on the databases: Latin American and Caribbean Health Sciences Literature (LILACS), PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and in the virtual library Scientific Electronic Library Online (SciELO), using the descriptors "electrosurgery", "nursing care" and "enhanced recovery after surgery", correlated by the Boolean operator and, in Portuguese, English, Spanish and French. Of the 213 studies we found, seven composed the sample. We used the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (IRAMUTEQ) software, through methods of lexical analysis and similitude. For the analysis of methodological quality, we applied the scientific level of evidence, according to recommendations from the Agency for Healthcare Research and Quality (AHRQ). Results: The publications of 2010 to 2012 stand out, with level of evidence V, indexed in LILACS and CINAHL. In the word cloud, we observed the following terms had higher relative frequency: "patient"(n=14); "surgical risk" (n=12); "electrosurgery" (n=10); "nurse" (n=8); "knowledge" (n=6); "care" (n=6); and "prevention" (n=5). After the similitude analysis, we identified the semantic range of more frequent words. Conclusion: There are a few studies in the literature with significant information to aggregate knowledge and build new analyses.
Objetivo: Identificar el conocimiento científico producido sobre la atención de enfermería relacionada con el uso de electrocirugía en el período intraoperatorio. Método: Revisión integradora, realizada en las bases de datos LILACS, PubMed, CINAHL y en la biblioteca virtual SciELO, a través de los descriptores Electrocirugía, Atención de enfermería y Recuperación posquirúrgica mejorada, correlacionados por el operador booleano and, en portugués, inglés, español y francés. Siete de los 213 estudios encontrados compusieron la muestra. Se utilizó el software IRAMUTEQ, mediante los métodos de análisis léxico y de similitud. Para el análisis de la calidad metodológica se aplicó el nivel de evidencia científica, según las recomendaciones de la Agency for Healthcare Research and Quality (AHRQ). Resultados: Destacan las publicaciones entre 2010 y 2012, con nivel de evidencia V, indexadas en las bases de datos LILACS y CINAHL. En la nube de palabras se encontró términos con mayor frecuencia relativa: Paciente (n=14); Riesgo quirúrgico (n=12); Electrocirugía (n=10); Enfermero (N=08); Conocimiento (N=6), Atención (N=6) y Prevención (n=5). Se identifica un rango semántico de palabras más frecuentes a partir del análisis de similitud. Conclusión: Se demostró la escasez de estudios en la literatura, con información significativa para la agregación del conocimiento y la construcción de nuevas obras.
Subject(s)
Humans , Electrosurgery , Intraoperative Care , Nursing Care , Disease Prevention , Enhanced Recovery After Surgery , Nurses摘要
Abstract Introduction: The objective of this study is to compare the effects of conventional monopolar electrosurgery (CMES) and low-thermal plasma kinetic cautery (PKC) on complications such as bleeding, abnormal wound healing, pain, and drainage in patients who underwent on-pump coronary artery bypass grafting (CABG). Methods: This retrospective clinical study included 258 patients undergoing CABG; the patients were randomized to PKC (PEAK PlasmaBlade, n=153) and CMES (n=105) groups. The patients' clinical data were examined retrospectively for biochemical variables, postoperative drainage, post-surgery erythrocyte suspension transfusion count, surgical site pain examined with visual analogue scale (VAS), and wound healing. Two-sided P-value > 0.05 was considered as statistically significant. Results: The median post-surgery erythrocyte suspension transfusion number was significantly lower with PKC compared to CMES (0 [0-1] vs. 1 [1-4], respectively, P<0.001). Mean postoperative drain output and time until removal of drain tubes were significantly lower with PKC compared to CMES (300±113 vs. 547±192 and 1.95±1.5 vs. 2.44±1.8; P<0.001 and P=0.025, respectively). Mean VAS score for spontaneous and cough-induced pain were significantly lower with PKC compared to CMES (1.98±1.51 vs. 3.94± 2.09 and 3.76±1.46 vs. 5.6±1.92; P<0.001 for both comparisons). Reoperation due to bleeding was significantly higher with CMES compared to PKC (0 vs. 11 [7.2%], P=0.001). Conclusion: Use of PKC during CABG considerably reduces postoperative drainage, need for blood transfusion, reoperation due to bleeding, and postoperative pain. PCK appears to be a good alternative to CMES for CABG.
Subject(s)
Humans , Coronary Artery Bypass, Off-Pump , Plasma Gases , Coronary Artery Bypass , Retrospective Studies , Dissection , Electrosurgery摘要
La percepción hacia el alcance de la excelencia estética se traduce especialmente en saber interpretar y satisfacer los deseos del paciente, empleándose para eso, todos los conocimientos disponibles en la literatura científica. La utilización de carillas, coronas cerámicas o de Circonio pueden representar un tratamiento, predecible y confiable, cuando las condiciones, básicas de salud se encuentran ya resueltas. Una de estas condiciones, se refiere a un marco de salud Periodontal, con contornos gingivales estéticos y naturales. En algunos casos, donde esto no sucede, la microcirugía estética puede ser un recurso práctico y predecible. A su vez la evidencia científica nos ofrece parámetros para guiarnos y así alcanzar un correcto diagnóstico, planeamiento seguro, técnica adecuada y la utilización del material más indicado para cada situación clínica. La subjetividad estética puede estar escondida entre líneas en la ciencia. Con ésta recopilación acompañado con la ejemplificación de los casos clínicos desarrollados, intentaremos aproximarnos a la excelencia (AU)
Subject(s)
Humans , Male , Female , Zirconium , Ceramics , Crowns , Esthetics, Dental , Microsurgery , Patient Care Planning , Electrosurgery , Evidence-Based Dentistry , Gingival Recession/therapy摘要
Se entiende por agrandamiento gingival el incremento en masa y volumen del tejido gingival. Se considera una condición benigna de la cavidad oral, por lo general de manejo rutinario, que logra regularse con medidas simples de control del biofilm microbiano. El agrandamiento gingival puede ser producido por diversas condiciones clínicas, hereditarias, deficiente higiene oral o fármacos. La epilepsia afecta a 1% de la población mundial y requiere el uso de fármacos antiepilépticos o anticonvulsivantes para lograr su control, dentro de éstos la fenitoína actúa como un bloqueador selectivo de los canales de sodio sensibles al voltaje y constituye uno de los fármacos más empleados por su capacidad en el control de crisis focales y generalizadas. La fenitoína se ha relacionado con los agrandamientos gingivales como uno de sus efectos adversos, los cuales se incluyen dentro de las enfermedades por fármaco inducidas en la cavidad oral. El objetivo de este artículo es brindar la información necesaria sobre el manejo correcto de pacientes con agrandamiento gingival producido por fenitoínas y a la vez poder conocer las consecuencias de estos fármacos en la cavidad oral (AU)
Gingival enlargement means the increase in mass and volumen of the gingival tissue. It is considered a benign condition of the oral cavity, usually of routine management, wich can be regulated with simple measures of biofilm control. The gingival enlargement can be produced by diverse clinical conditions, hereditary deficient oral higiene or drugs. Epilepsy affects 1% of the world population and requires the use of antiepileptic or anticonvulsant drugs to achieve its control, within these phenytoin acts as selective blocker or voltage sensitive sodium channels and is one of the most used grugs for its ability to control focal and generalized crises. Phenytoin has been linked to gingival enlargement as one of its adverse effects which is included within the drug diseases induced in the oral cavity. The objective of this article is to provide the necessary information on the correct managment of patients with gingival enlargemen produced by phenytoins and at the same time to know the consequences of these drugs in the oral cavity (AU)
Subject(s)
Humans , Female , Adult , Phenytoin/adverse effects , Gingival Overgrowth/chemically induced , Gingival Hyperplasia/chemically induced , Schools, Dental , Electrosurgery/methods , Gingival Hyperplasia/surgery , Gingivectomy/methods , Membranes, Artificial , Mexico , Anti-Bacterial Agents/therapeutic use摘要
El póntico E es una alternativa de tratamiento para la pérdida prematura dental, este tipo de póntico fue publicado por primera vez en 2014 por Robert P. Korman. El diseño del póntico permite ofrecer predictibilidad en cuanto a soporte y mantenimiento de la arquitectura gingival, también promueve que el tejido vestibular migre coronalmente sobre el póntico, creando un surco gingival. Se recibió a una paciente que presentaba fragmento radicular del diente 21 y ausencia del diente 12, reborde residual atrófico (clase I según Seibert). Como plan de tratamiento, se realizó la extracción atraumática del fragmento radicular del diente 21 para retardar el colapso del reborde alveolar y se colocó injerto de tejido conectivo en la zona del diente 12 para corregir el defecto clase I de Seibert, se realizó la conformación de los nichos gingivales con electrobisturí en conjunto con la prótesis provisional y la preparación de los dientes pilares para la recepción y rehabilitación con pónticos E. Se colocó una prótesis fija de cinco unidades (dientes 13 al 23) en material núcleo de Zr y estratificada con cerámica (AU)
Pontic E is an alternative treatment for premature dental loss, this type of pontic was published for the first time in 2014 by Robert P. Korman. The design of the pontic allows to offer predictability in terms of support and maintenance of the gingival architecture, it also promotes that the vestibular tissue migrates coronally over the pontic, creating a gingival groove. A patient was received who presented a radicular fragment of tooth 21 and absence of tooth 12, atrophic residual ridge (class I according to Seibert). As a treatment plan, atraumatic extraction of the root fragment of tooth 21 was performed to delay the collapse of the alveolar ridge and connective tissue graft was placed in the area of tooth 12 to correct Seibert's class I defect, conformation was performed of the gingival niches with electrocautery in conjunction with the provisional prosthesis and the preparation of the abutment teeth for the reception and rehabilitation with pontics E. A fixed prosthesis of five units was placed (teeth from 13 to 23) of Zr core material and stratified with ceramic (AU)
Subject(s)
Humans , Female , Adult , Denture, Partial, Fixed , Esthetics, Dental , Alveolar Ridge Augmentation , Patient Care Planning , Tooth Extraction , Ceramics , Connective Tissue/transplantation , Electrosurgery , Mexico摘要
SUMMARY OBJECTIVE To evaluate the effectiveness of electrosurgery fulguration as a treatment for Bartholin's gland cysts. DESIGN Retrospective study with a comparative control group performed on Hospital Brigadeiro and in the Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo from February 2005 to March 2009. Patients: Patients with Bartholin's gland cyst were divided into three treatment groups: group 1 electrosurgery (n=169 cases); group 2 - gland excision with the conventional technique using a cold scalpel (n = 51 cases); group 3 - marsupialization (n=11 cases). We reviewed the clinical and surgical history, physical examination, description of the surgical technique, postoperative results (success and complications), and follow-up data. RESULTS There is no difference between groups in relation to intraoperative bleeding, hematoma, and complete healing in a single treatment session. However, electrosurgery shows the lower percentage of recurrences 18 (10,7%) compared to the Marsupialization technique (group 3, p=.031). Recurrences occurred in 18 (10,7%), 3 (5,9%), and 4 (36,4%) cases. After retreatment by the same technique, there was a complete cure rate of 90% (152/169) for group 1, and 98% (50/51) for group 2. The cost of group 1 was lower than that of other groups. CONCLUSION The fulguration with electrosurgery of the capsule of Bartholin's cyst is an effective method of treatment, andthe cost of this technique is lower than the conventional technique and marsupialization.
RESUMO OBJETIVO Avaliar a eficácia da fulguração da eletrocirurgia como tratamento para os cistos da glândula de Bartholin. MÉTODOS Estudo retrospectivo, grupo controle comparativo realizado no Hospital Brigadeiro e disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, de fevereiro de 2005 a março de 2009. Pacientes com cisto de glândula de Bartholin foram divididos em três grupos de tratamento: grupo 1 - eletrocirurgia (n = 169 casos); grupo 2 - excisão da glândula com técnica convencional utilizando bisturi frio (n = 51 casos); grupo 3 - marsupialização (n = 11 casos). Revisamos a história clínica e cirúrgica, o exame físico, a descrição da técnica cirúrgica, os resultados pós-operatórios (sucesso e complicações) e os dados de acompanhamento. RESULTADOS Não há diferença entre os grupos em relação ao sangramento intraoperatório, hematoma e cicatrização completa em uma única sessão de tratamento. No entanto, a eletrocirurgia mostrou o percentual mínimo de recidivas, 18 (10,7%), em relação à técnica de marsupialização (grupo 3, p = 0,031). Recorrências ocorreram em 18 (10,7%), três (5,9%) e quatro (36,4%) casos. Após o retratamento pela mesma técnica, houve taxa de cura completa: 90% (152/169) para o grupo 1 e 98% (50/51) para o grupo 2. O custo do grupo 1 foi menor do que os dos outros grupos. CONCLUSÃO A fulguração com eletrocirurgia da cápsula do cisto de Bartholin é um método efetivo de tratamento, mas o custo dessa técnica é menor do que a técnica de convenção e a marsupialização.
Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Bartholin's Glands/surgery , Cysts/surgery , Electrosurgery/methods , Postoperative Complications , Recurrence , Time Factors , Bartholin's Glands/pathology , Retrospective Studies , Age Factors , Treatment Outcome , Statistics, Nonparametric , Cysts/pathology , Electrosurgery/adverse effects , Intraoperative Complications , Middle Aged摘要
Resumo Fogo em campo cirúrgico durante cirurgia palpebral é uma complicação intra-operatória que é dramática tanto para o paciente quanto para a equipe médica. Relatamos um caso de acidente cirúrgico durante cirurgia palpebral onde o paciente sofreu queimadura de supercílio. Houve interação entre o oxigênio usado para sedação (máscara aberta) e uma fonte de ignição representada pelo cautério monopolar. Embora o paciente tenha apresentado boa evolução clínica com recuperação total da lesão cutânea, este caso é um alerta para se evitar tais tipo de ocorrência. Ressaltamos neste trabalho quais as condições implicadas e o modo de prevenção.
Abstract Fire in the surgical field during eyelid surgery is an intra-operative complication that is dramatic for both the patient and the medical staff. It's being reported a case of surgical accident during eyelid surgery where the patient suffered a brow burn. There was interaction between the oxygen used for sedation (open mask) and a source of ignition represented by monopolar cautery. Although the patient presented good clinical evolution with complete recovery of the cutaneous lesion, this case is an alert to avoid such type of occurrence. This work highlights the conditions involved and the way of prevention.
Subject(s)
Humans , Male , Aged , Operating Rooms , Electrocoagulation/adverse effects , Electrosurgery/adverse effects , Eyelids/surgery , Patient Safety , Fires/prevention & control , Blepharoptosis/surgery , Burns/etiology , Risk Factors , Blepharoplasty/methods , Electricity/adverse effects , Electrocoagulation/instrumentation , Electrosurgery/instrumentation , Intraoperative Complications摘要
Objective:to analyze the capacity of the bioaerosol retention filters with the use of a surgical smoke aspirator in procedures of cauterization of venereal warts. Method:field, descriptive, cross-sectional and quantitative research. The study was developedat a referral center for sexually transmitted infections in the northern state of Paraná, in the urology outpatient clinic. Data collection was collected from April to July 2016, with a sample obtained from 72 cauterization procedures. A descriptive statistical analysis was performed. Results:24 filters attached in two equipment, used to vacuum the smoke were analyzed. The conventional Polymerase Chain Reaction method was used to read the filters, using specific primers to search for Simple Herpes, HerpesZoster, Hepatitis C, Human Immunodeficiency Virus, Hepatitis B and Human Virus Papilloma. From the analyzed samples were found Viral Deoxyribonucleic Acid from Herpes Simplex, Hepatitis B and Human Virus Papilloma in the analyzed filters. Conclusion:the use of surgical vacuum aspiration equipment with Ultra-low Particulate Air filters during the cauterization of venereal warts was able to retain bioaerosols when the filter replacement time was respected.
Objetivo:analisar a capacidade dos filtros de retenção de bioaerossóis com o uso de aspirador de fumaça cirúrgica em procedimentos de cauterização de verrugas venéreas. Método: pesquisa de campo, descritiva, transversal e quantitativa. O estudo foi desenvolvido em um centro de referência para infecções sexualmente transmissíveis no Norte do estado do Paraná, no ambulatório de urologia. A coleta de dados foi realizada no período de abril a julho de 2016, com uma amostra obtida a partir de 72 procedimentosde cauterização. Realizou-se análise estatística descritiva. Resultados:foram analisados 24 filtros acoplados em dois equipamentos, utilizados para aspiração da fumaça. O método da Reação em Cadeia da Polimerase convencional foi utilizado para a leitura dos filtros, sendo utilizados primersespecíficos para a pesquisa de Herpes Simples, Herpes Zoster, Hepatite C, Vírus da Imunodeficiência Humana, Hepatite B e Papiloma Vírus Humano. A partir das amostras analisadas foram encontrados Ácido Desoxirribonucleico viral do Herpes Simples, Hepatite B e Papiloma Vírus Humano nos filtros analisados. Conclusão: O uso de um equipamento de aspiração de fumaça cirúrgica, com filtros Ultra-low Particulate Air, durante as cauterizações de verrugas venéreas mostrou-se capaz de reter bioaerossóis quando respeitado o tempo de troca dos filtros.
Subject(s)
Humans , Male , Female , Smoke , Condylomata Acuminata , Cautery , Outpatients , Papilloma , Referral and Consultation , Viruses , Biological Factors , Sexually Transmitted Diseases , Filters , Occupational Exposure , HIV , Health Personnel , Hepatitis C , Electrosurgery , Alphapapillomavirus , Air Filters , Hepatitis , Hepatitis B , Herpes Simplex , Herpes Zoster摘要
PURPOSE: To investigate the clinical manifestations and properties of remnant particles in the subconjunctival space after high-frequency radio-wave electrosurgery for conjunctivochalasis. METHODS: We performed a retrospective, observational case series with in vitro experimental imaging in nine eyes from eight patients who presented with small dark-gray lesions during follow-up after high-frequency radio-wave electrosurgery for conjunctivochalasis. General examination including slit-lamp examination and visual acuity testing was performed preoperatively and postoperatively. During follow-up, we evaluated remnant particles and any other complications including granuloma or conjunctival injection with slit-lamp photography and anterior optical coherence tomography. Coagulation tips were investigated with scanning electron microscope and energy dispersive X-ray spectroscopy to analyze the insulating electrode and assess changes to tips after repeated use. RESULTS: None of the patients included in this study experienced any change in visual acuity or major complications postoperatively. Small dark-gray lesions (0.3 to 0.5 mm in size) were observed in the inferior bulbar sub-conjunctival space in the location where high-frequency radio-wave electrosurgery had been performed. Cirrus high-definition optical coherence tomography images revealed focal hyper-reflection with a posterior shadow, suggesting foreign particles. Scanning electron microscopy and energy dispersive X-ray spectroscopy imaging analysis revealed peaks of carbon and fluorine complexes, consistent with the polytetrafluoroethylene coating on the electrode. CONCLUSIONS: There were no instances of inflammatory reaction, particle migration, or major complications due to particles. Physicians should be aware of the possibility of remnant polytetrafluoroethylene particles in subconjunctival tissue when using insulated coagulation tips subjected to repeat sterilization.
Subject(s)
Humans , Carbon , Electrodes , Electrosurgery , Fluorine , Follow-Up Studies , Granuloma , In Vitro Techniques , Microscopy, Electron, Scanning , Photography , Polytetrafluoroethylene , Retrospective Studies , Spectrometry, X-Ray Emission , Sterilization , Tomography, Optical Coherence , Visual Acuity摘要
Os gestores públicos ou privados são frequentemente pressionados para que tecnologias novas e emergentes na saúde sejam adquiridas, porém, para isso, processos de avaliação para sua incorporação, baseados em evidências científicas, tem sido cada vez mais essenciais, apesar do consenso sobre os inúmeros benefícios proporcionados. O Centro Cirúrgico representa uma unidade vital nas organizações de saúde, diferenciada no ambiente hospitalar, que concentra recursos humanos e tecnológicos altamente especializados, possibilitando uma assistência complexa e sofisticada. Porém, tal cenário demanda formação adequada dos profissionais de saúde, frente às habilidades e conhecimentos requeridos para utilização segura de tal parque tecnológico. A unidade de eletrocirurgia se constitui numa prática rotineira no período intraoperatório, requerendo conhecimento técnico-científico do equipamento e dos procedimentos, uma vez que eventos adversos relacionados a seu uso, como queimaduras, têm sido relatados. O treinamento e a capacitação dos profissionais, enquanto uma premissa na prevenção de acidentes, tem sido apontada como parte das boas práticas adotadas. Este estudo teve por objetivo avaliar o impacto de intervenções educativas no conhecimento e aplicabilidade de eletrocirurgia da equipe médicos residentes e de enfermagem. Trata-se de um quase experimento, com pré e pós-testes em um único grupo, num hospital de ensino de médio porte do interior de São Paulo. Participaram do estudo 4 médicos residentes da especialidade cirúrgica, 4 enfermeiros e 28 técnicos de enfermagem que atuavam com regularidade e frequência no centro cirúrgico. O estudo foi desenvolvido em sete etapas, com duração de 24 meses, sendo elaborado um questionário semi-estruturado para avaliação do conhecimento dos participantes em cada fase e um roteiro tipo check list para observação das práticas em sala cirúrgica, contendo indicadores relativos ao uso de eletrocirurgia. Os participantes foram expostos a duas intervenções educativas, sendo uma aula didática com disponibilização de um manual informativo e uma vídeoaula. Após cada intervenção, foram avaliados quanto a retenção do conhecimento, com intervalos de tempo programados previamente. Os resultados evidenciaram que os médicos residentes e enfermeiros apresentaram conhecimento prévio do tema em alguns tópicos específicos, não ocorrendo alteração de padrão de respostas. Entre os técnicos de enfermagem, observou-se melhora nos percentuais alcançados, com destaque para os itens checagem do equipamento e posicionamento da placa eletrodispersiva. Entretanto verificou-se que apesar do bom rendimento teórico, na prática os profissionais não apresentaram melhora da adesão de todos os indicadores. O posicionamento da placa adequado, ou seja, o mais próximo do sítio cirúrgico, porém distante o suficiente para evitar queimaduras, apresentou índices de conformidade inferiores a 50% em todas as fases do estudo. Pesquisas dessa natureza são oportunas pois proporcionam aos gestores uma possibilidade de propor projetos de melhoria continua da assistência perioperatória, que envolvam toda a equipe de profissionais, uma vez que a qualidade em saúde deve ser entendida como uma somatória de esforços conjuntos na busca por resultados eficazes, seguros e humanizados
Public or private managers are often pressured to acquire new and emerging health technologies; however, for this, evaluation processes for their incorporation based on scientific evidence have been increasingly essential, despite the consensus on the many benefits provided. The Surgical Center represents a vital unit in healthcare organizations, differentiated in the hospital environment, which concentrates highly specialized human and technological resources, allowing complex and sophisticated assistance. Nevertheless, this scenario requires adequate training of health professionals, facing the skills and knowledge required for safe use of such technology park. The electrosurgery unit is a routine practice in the intraoperative period, requiring technical-scientific knowledge of the equipment and procedures, since adverse events related to its use, such as burns, have been reported. The training and qualification of professionals, as a premise in the prevention of accidents, has been pointed out as part of the good practices adopted. This study aimed evaluate the impact of educational interventions on the knowledge and applicability of electrosurgery of the resident and nursing physicians. It is a quasi-experiment, with pre and post-tests in a single group, in a medium-sized teaching hospital in the interior of São Paulo state. Four resident physicians with surgical specialty, 4 nurses and 28 nursing technicians who worked regularly and frequently in the surgical center participated in the study. The study was developed in seven stages, with duration of 24 months, being developed a semi-structured questionnaire to evaluate the participants' knowledge in each phase and a check list type script to observe the practices in a surgical room, containing indicators related to the use of electrosurgery. The participants were exposed to two educational interventions, being one of them a didactic class with the provision of an informative manual and a video-class. After each intervention, the retention of knowledge was evaluated, with previously scheduled time intervals. The results showed that the resident physicians and nurses presented previous knowledge of the subject on some specific topics, and there was no change in the pattern of responses. Among nursing technicians, there was an improvement in the percentages reached, with emphasis on the items checking the equipment and positioning of the electrodispersive plate. However, it was verified that despite the good theoretical performance, in practice, the professionals did not show improvement of the adherence of all the indicators. The appropriate positioning of the plaque, i.e., the one closest to the surgical site, but far enough away to avoid burns, presented compliance rates lower than 50% in all phases of the study. Researches of this nature are necessary because it provides managers with the possibility of proposing projects for continuous improvement of perioperative care, involving the whole team of professionals, since health quality should be understood as a sum of joint efforts in the search for effective, safe and humanized results
Subject(s)
Humans , Surgicenters , Biomedical Technology , Electrosurgery , Health Workforce/organization & administration摘要
La aplicación del LÁSER (light amplification of stimulation emision of radiation) en las áreas de la medicina y la odontología viene demostrando una constante evolución, brindándonos alternativas a los tratamientos convencionales. Los láseres quirúrgicos de tejidos blandos muestran grandes ventajas comparados a los procedimientos habituales de corte, ya sea con bisturí frío o electrobisturí. La mínima necesidad de anestesia, la analgesia intra y postoperatoria, la coagulación inmediata, la cicatrización por segunda, el efecto bactericida, la ausencia de puntos de sutura, el confort postoperatorio, son algunas de las ventajas que hacen que la cirugía con láser sea una opción indiscutible que está ganando terreno entre los profesionales de la salud (AU)
Subject(s)
Humans , Female , Child , Electrosurgery/methods , Extraoral Traction Appliances , Lasers , Lingual Frenum/surgery , Malocclusion, Angle Class III/therapy , Patient Care Team , Argentina , Schools, Dental , Speech Therapy , Wound Healing , Palatal Expansion Technique , Treatment Outcome , Orthodontic Appliances, Functional摘要
Debido al acelerado envejecimiento de la población, cada vez es mayor la cantidad de usuarios portado-res de dispositivos electrónicos cardíacos implan-tables (DECI). Muchos de estos pacientes se verán enfrentados a procedimientos dermatológicos que con frecuencia utilizan equipos de electrocirugía. Es-tos tienen riesgo potencial de producir interferencias electromagnéticas (IEM), y por lo tanto alterar el fun-cionamiento de estos dispositivos. Si bien no todos los DECI tienen las mismas características, las nuevas tec-nologías de estos dispositivos han disminuido, aunque no eliminado completamente, el riesgo de IEM. Este artículo tiene como propósito revisar el tema y recopilar las recomendaciones generales que todo dermatólogo debe conocer tanto en la fase preoperatoria, intraoperatoria, como postoperatoria al utilizar equipos de electrocirugía en un paciente con DECI.
Due to the accelerated population aging, an increa-sing number of users is carrying cardiac implantable electronic devices (CIEDs). Many of these patients will face dermatological procedures that often use electrosurgical equipment. The latter has the poten-tial to produce electromagnetic interference (EMI), and therefore alter the operation of these devices. While not all CIEDs have the same characteristics, new technologies for these devices have decreased if not eliminated completely the risk of EMI.The purpose of this article is to review CIED topic and compile general recommendations that every dermatologist should be aware of, both in the preoperative, intraoperative, and postoperative phases when using electrosurgery equipment in a patient with CIED.
Subject(s)
Humans , Pacemaker, Artificial , Defibrillators, Implantable , Electromagnetic Fields/adverse effects , Electrosurgery/methods , Dermatologic Surgical Procedures , Postoperative Care , Preoperative Care , Heart-Assist Devices , Intraoperative Complications/prevention & control摘要
PURPOSE: PEAK PlasmaBlade is a recent and distinctive type of electrosurgical device. Previous studies have already documented some meaningful advantages of this device over conventional electrosurgery. This study compared the use of PEAK PlasmaBlade to standard electrosurgery in mastectomy and breast conservative surgery. The purpose was to test the impact of PEAK PlasmaBlade on the wound-healing process and on postsurgical complications in breast cancer surgery. METHODS: Sixty patients undergoing breast cancer surgery were enrolled. The PEAK PlasmaBlade was used for 20 of those. A standard electrosurgical device was used for the other 40 patients. The 2 groups were homogenous in age, body mass index, comorbidities and type of surgery. We recorded wound complications, serum drainage amount and duration of stay, blood loss, time of surgery, length of hospital stay, and total number of medications required. RESULTS: The 2 groups were not significantly different in terms of patient characteristics. A statistically significant reduction in incidence of seroma was observed in the PEAK group: only 10% versus 37.5% of the patients in the conventional electrosurgery group developed this complication (Fisher exact test, P = 0.034). CONCLUSION: Seroma is the most important wound complication in breast surgery. The research of new instruments that might reduce its incidence is desirable. In order to validate or deny the results of this study, it is necessary to enroll more subjects and to consider the impact of this device on axillary lymph node dissection.
Subject(s)
Humans , Body Mass Index , Breast Neoplasms , Breast , Comorbidity , Drainage , Electrosurgery , Equipment and Supplies , Incidence , Intraoperative Complications , Length of Stay , Lymph Node Excision , Mastectomy , Seroma , Surgical Procedures, Operative , Wound Healing , Wound Infection , Wounds and Injuries摘要
OBJETIVOS: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado. MATERIALES Y MÉTODOS: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier. RESULTADOS: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %). CONCLUSIONES: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.
GOALS: Currently, there is a high rate of over-treatment of precursor cervical lesions, which, in their causality, depends on the inexperience of the decision-making operator. The objective of the present study was to develop a standardized method of weighting / judgment of diagnostic variables and treatment useful to be used by young specialists in order to minimize the risk of improper handling. MATERIAL AND METHODS: We included 471 patients referred by abnormal cytology and treated by LEEP. Sensitivity, specificity, predictive values and likelihood ratios for the diagnosis of CIN2+ were calculated for each of the diagnostic methods. Each resident was taught a standardized protocol to carry out a LEEP procedure. Once the best predictors were identified, a scoring scale was constructed that weighted the variables and the best cut-off point for the prediction of CIN2+ was defined by ROC curve. Differences between groups were compared using Chi-square, ANOVA or t-test. Failure curves were built up using the 1-Kaplan Meier method. RESULTS: The prevalence of CIN2+ in this cohort was 66%. The agreement between the diagnostic tests was low, with colposcopy having the worst positive predictive value and the highest risk of over-treatment. Age, cytology, colposcopy (stratification based on the extent of compromise by quadrants), punch biopsy, and agreement between diagnostic tests were included for building the scoring scale. A score ≥ 9 in association with the use of a standardized protocol obtained rates of over-treatment <15%, recurrences of CIN2+ <5% at 5-year follow-up and a low rate of suboptimal procedures or complications (<2%). CONCLUSIONS: The UC-CONE method, by combining an integrated scoring system with a standardized excision protocol, minimizes the risk of over-treatment or inadequate treatment of pre-invasive cervical lesions by young specialists, reducing the number of procedures indicated unnecessarily and maintaining a high rate of therapeutic success.
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Uterine Cervical Dysplasia/surgery , Uterine Cervical Dysplasia/pathology , Colposcopy/methods , Electrosurgery/methods , Biopsy , Logistic Models , Cervix Uteri/pathology , Predictive Value of Tests , Retrospective Studies , ROC Curve , Analysis of Variance , Sensitivity and Specificity , Uterine Cervical Dysplasia/diagnosis , Conization , Decision Making摘要
Abstract Electrosurgery is a technology developed over the last few years and has become a very important tool in modern surgery. Most of the equipment is considered safe, although there are risks related to its use. Several lesions may be caused by electrocautery, and burns are the most common and feared. We report two cases of burns related to use of electrocautery and promote a literature review, because knowledge of electrosurgery fundamentals, its correct use, the choice of a safety device, constant monitoring, and immediate investigation before any suspicions surely can improve the operational experience for both surgeon and patient.
Resumo A eletrocirurgia é uma tecnologia que se desenvolveu muitos nos últimos anos e se tornou um instrumento de grande importância na cirurgia moderna. A maioria dos equipamentos é considerada segura, embora existam riscos relacionados ao seu uso. Várias lesões podem ser causadas por eletrocautérios, as queimaduras são as mais frequentes e temidas. Relatamos dois casos de queimaduras relacionadas ao uso do bisturi elétrico e promovemos uma revisão de literatura, pois o conhecimento dos fundamentos da eletrocirurgia, seu uso correto, a escolha de um equipamento seguro, o monitoramento constante e a investigação imediata diante de quaisquer suspeitas com certeza podem melhorar a experiência operacional para ambos, cirurgião e paciente.
Subject(s)
Humans , Male , Infant, Newborn , Adult , Postoperative Complications/etiology , Burns, Electric/etiology , Electrosurgery/adverse effects摘要
Objetivou-se identificar concentrações de hidrocarbonetos policíclicos aromáticos provenientes da fumaça do eletrocautério nas salas operatórias, correlacionando estas concentrações com o tempo de uso do eletrocautério e cirúrgico. Trata-se de um estudo de campo, transversal e quantitativo, realizado em 50 atos cirúrgicos do aparelho digestivo, entre abril e julho de 2015, em hospital universitário no estado do Paraná. Foram coletados hidrocarbonetos por meio de uma bomba de sucção e determinados por cromatografia liquida. Estes compostos foram encontrados com média de 0,0058 mg.m-³ e mediana de 0,0049 mg.m-³. O tempo médio cirúrgico e de uso do eletrocautério foram de 136 minutos e 220,5 segundos, respectivamente. O teste de correlação de Spearman foi de -0,512 entre as variáveis concentrações e tempo cirúrgico e de -0,183 entre as concentrações e tempo de uso do eletrocautério. Conclui-se que existem hidrocarbonetos e há baixa correlação entre a produção destes compostos e tempo de uso do eletrocautério (AU).
The objective was to identify concentrations of polycyclic aromatic hydrocarbons produced by electrocautery smoke in operating rooms, correlating these concentrations with time of electrocautery and surgical use. This is a cross-sectional and quantitative field study carried out in 50 gastrointestinal surgical procedures, between April and July 2015, in a university hospital in the state of Paraná. Hydrocarbons were collected using a suction pump and measurements were determined through liquid chromatography. These compounds were found to have an average of 0.0058 mg.m-3 and a mean of 0.0049 mg.m-3. The mean surgical time and electrocautery use were 136 minutes and 220.5 seconds, respectively. The Spearman correlation test was -0.512 between concentration variables and surgical time, and -0.183 between the concentrations and electrocautery use. The conclusion was the presence of hydrocarbons and a low correlation between the production of these compounds and the electrocautery usage time (AU).
Se objetivó identificar concentraciones de hidrocarburos policíclicos aromáticos derivados del humo del electrocauterio en quirófanos, correlacionando las concentraciones con el tiempo de uso del electrocauterio y quirúrgico. Estudio de campo, transversal, cuantitativo, realizado en 50 actos quirúrgicos del aparato digestivo, entre abril y julio de 2015, en hospital universitario del estado de Paraná. Fueron recolectados hidrocarburos mediante una bomba de succión, y determinados por cromatografía líquida. Los compuestos fueron encontrados con promedio de 0,0058 mg.m3 y mediana de 0,0049 mg.m3. El tiempo promedio quirúrgico y de uso del electrocauterio fue de 136 minutos y 220,5 segundos respectivamente. El test de correlación de Spearman fue de -0,512 entre variables concentraciones y tiempo quirúrgico, y de -0,183 entre las concentraciones y tiempo de uso del electrocauterio. Se concluye en que existen hidrocarburos y hay baja correlación entre la producción de tales compuestos y tiempo de uso del electrocauterio (AU).
Subject(s)
Humans , Operating Rooms , Occupational Exposure , Air Pollutants, Occupational , Electrosurgery摘要
El láser como alternativa a la cirugía abierta de la vía aérea superior ha venido a modificar la forma de abordaje de las patologías en esta área, pero no deja de ser un procedimiento costoso que no está al alcance de todos los servicios. Por este motivo se han reinventado nuevas formas de abordaje que cumplan los mismos requisitos tanto de la cirugía abierta como con láser pero con un menor coste. Presentamos una serie de 30 casos realizados en un período de 6 años por motivos tanto tumorales como no, en los que se realizaron abordajes cerrados a través de microcirugía con disección mediante microelectrodos. Obteniendo pocas complicaciones y una disminución de la estancia hospitalaria significativa. Con lo cual nos parece una técnica eficiente para abordajes de este tipo.
The laser as an alternative to open surgery of the upper airway has come to change the form of approaching the disease in this area, but it is still an expensive procedure that is not available to all services. For this reason a new ways of approach to meet the same requirements both open as laser but at a lower cost surgery. We present a series of 30 cases performed over a period of 6 years for reasons as much tumor, which closed approaches through microsurgical dissection were performed using microelectrodes. Obtaining few complications and significant decreased hospital stay. Our considerations is it seems an efficient technique for such approaches.