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.

Use of electrosurgical units in the endoscopic resection of gastrointestinal tumors / Empleo de las unidades electroquirúrgicas en la resección endoscópica de neoplasias digestivas

Electrosurgical units (ESUs) are indispensable devices in our endoscopy units. However, many endoscopists are not well-trained on their use and their physical bases are usually not properly studied or understood. In addition, comparative data concerning the settings that may be applied in different circumstances are scarce in the medical literature. Given that it is important to be aware of their strengths and risks, we conducted a review of the available information and research on this topic

Las unidades electroquirúrgicas (UES) son dispositivos indispensables en nuestras unidades de endoscopia. Sin embargo, muchos endoscopistas no están bien entrenados en su uso y sus bases físicas generalmente no son estudiadas o comprendidas adecuadamente. Además, los datos comparativos sobre los ajustes que pueden aplicarse en diferentes circunstancias son escasos en la literatura médica. Dado que es importante conocer sus fortalezas y riesgos, realizamos una revisión de la información existente y la investigación sobre este tema

Experiencia en el tratamiento de los mucoceles en atención primaria / Experience in treating mucoceles in primary care

En los últimos años en la consulta de atención primaria hemos tratado múltiples casos de mucocele, lesión benigna, relativamente frecuente (2,5/1.000), que se origina por una retención mucosa a nivel de las glándulas salivales menores en la cavidad oral, principalmente a nivel del labio inferior. En este artículo exponemos nuestra experiencia en su tratamiento y realizamos una revisión de la bibliografía para ver si nuestro tratamiento era el correcto (AU)

Several cases of mucocele have been treated in our Primary Health Care centre. These are benign lesions, relatively frequent (2.5/1000), which is caused by a retention of mucous from the minor salivary glands into the oral cavity, mainly at the level of the lower lip. The experience in their treatment in this centre is presented, along with a review of the literature to see if our treatment was correct (AU)

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.

Tratamiento neoadyuvante con acitretino oral e imiquimod tópico en el carcinoma basocelular gigante / Oral Acitretin and Topical Imiquimod as Neoadjuvant Treatment for Giant Basal Cell Carcinoma

El carcinoma basocelular (CBC) gigante se define como aquel que mide 5cm o más. Aunque la cirugía se considera el tratamiento de elección para cualquier tipo de CBC, en los de gran tamaño, puede ser altamente destructiva. Así, utilizamos la combinación de acitretino oral e imiquimod 5% tópico como tratamiento neoadyuvante en dos pacientes afectos de un CBC gigante. El acitretino es un retinoide sistémico que se utiliza en la prevención primaria del cáncer cutáneo no melanoma. El imiquimod es un inmunomodulador aprobado para el tratamiento, entre otros, de CBC superficiales no faciales menores de 2cm. Estudios previos han demostrado una acción sinérgica anticarcinogénica de ambos fármacos, tanto in vivo como in vitro. Dicha combinación produjo en nuestros pacientes una gran reducción de la masa tumoral, lo que nos permitió aplicar posteriormente un tratamiento definitivo con la remisión completa de los CBC (AU)

Giant basal cell carcinoma (BCC) is defined as a tumor with a diameter of 5cm or more. Surgery, the treatment of choice for any type of BCC, can cause considerable anatomical damage in large tumors. In 2 patients with giant BCC we therefore provided neoadjuvant treatment with a combination of oral acitretin and topical 5% imiquimod. Acitretin is a systemic retinoid used for primary prevention of nonmelanoma skin cancer. Imiquimod is an immunomodulator whose approved indications include treatment of non facial superficial BCC less than 2cm in diameter. Previous studies have demonstrated a synergic anticancer effect of both drugs in vitro and in vivo. This combination produced a marked reduction in tumor mass in our patients. Later we were able to provide definitive treatment, which achieved complete remission of the tumors (AU)

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 (AU)

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 (AU)

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.

Tratamiento provisional de una fractura coronoradicular complicada / Provisional treatment of a complicated crown-root fracture

Las consultas de carácter urgente portraumatismos dentales son cada vez mas frecuentes en la práctica clínica. Los pacientes no suelen aceptar tener una sonrisa no estética durante el tiempo en que se realiza el tratamiento. Se presenta un caso fractura coronoradicular complicada y su rehabilitación cuasi inmediata provisional (AU)

Emergency consultations for dental injuries are increasingly common in clinical practice. Generally patients do not accept having a non esthetic smile throughout the course of the treatment. Presented is a complicated crown-root fracture and its quasi immediate provisional rehabilitation (AU)

[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.

Intradiscal electrothermal therapy used to manage chronic discogenic low back pain: new directions and interventions.

STUDY DESIGN: Retrospective literature review. OBJECTIVES: To review the data on the clinical efficacy of intradiscal electrothermal annuloplasty found at this writing in the peer-reviewed literature to date, to discuss the methodologic strengths and flaws of the studies, to discuss the pitfalls of clinical study designs, to emphasize the need for prospective randomized studies and for increased basic science investigation. SUMMARY OF BACKGROUND DATA: Studies published or presented at peer-reviewed societies concerning the clinical efficacy of intradiscal electrothermal annuloplasty are reviewed, including background studies on deafferentation and application of thermal energy to alter biomechanical and structural properties. A proposal for future investigations is presented. METHODS: Background data from intracapsular annuloplasty highlighting the safety and efficacy of intradiscal electrothermal annuloplasty are presented. Current studies on this procedure, including those in the National Registry are reviewed. All the studies share a common study design: prospective cohort with historical or noninterventional groups used as controls. The patients reviewed are similar. All have nonradicular low back pain of at least 3 months duration, failed conservative care, normal neurologic examination, and MRI showing only nondegenerative disc disease and positive concordant discography. All the patients underwent intradiscal electrothermal annuloplasty lesion at one or two levels according to standard protocols. Follow-up evaluation was performed at various intervals up to 2 years. All the studies used data from a visual analog scale, with most using the Short Form 36 (SF-36) as outcome instruments. RESULTS: The reported follow-up periods for the studies ranged from 6 months to 2 years. Three published studies, one with a 6-month follow-up period and two with a 1-year follow-up period, were published in the peer-reviewed literature. Two recent reports presented to the North American Spine Society were reviewed: a study of patients on a manufacturer-sponsored registry with a 1-year follow-up period and a multicenter prospective cohort study of 75 patients in an intent-to-treat group, with a 1-year follow-up period. Using the 7-point criteria of Deyo et al, all the studies suggested a positive effect of treatment, with a decrease in visual analog scale ratings and improvement in SF-36 scales, particularly those for physical function and bodily pain. CONCLUSIONS: The studies published so far suggest that the pain resulting from lumbar disc disease may be diminished by intradiscal electrothermal annuloplasty. All these studies project a positive therapeutic effect. However, all the studies suffer from the same methodologic flaws. A prospective cohort design or a nonrandomized prospective design is used with a biased control. The scientific validity of various study designs is discussed, and a randomized prospective study is recommended. Additionally, more investigation into the basic science of the action of intradiscal electrothermal annuloplasty is required.

Are engineers unsung heroes of medical progress?: the historic bond between physics, engineering, and medicine.

This review traces the heretofore unsung hero role of engineering in the evolution of today's healthcare and the growing bond between physics, engineering, and medicine. It recognizes the debt owed to the various specialties of healthcare engineering, especially the bioengineers who contribute not only to a better understanding of basic physiologic and pathologic processes but also to the development and application of technology and the adaptation of new engineering discoveries to medicine. In the past half-millennium, the fields of physics, engineering, and medicine have made a large number of seminal contributions to each other, resulting in ever-advancing healthcare methodologies, although only a precious few remain identified by the originators' names. In this review, 3 engineers are cited in detail for their milestone contributions to medical progress: Roentgen in radiology, Bovie in electrosurgery, and, more recently, Greatbatch in implantable cardiac pacemakers. Future horizons in medicine appear to be ever more attainable because of the synergism between the physical and biological sciences.

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)