In Utero Bipolar Diathermy to Salvage a Phenotypically Normal Fetus in 45,X/46,XY Heterokaryotypic Monochorionic Twins

Heterokaryotypic monozygotic twins are rare. We report a set of monochorionic diamniotic twins complicated with lethal malformations and hydrops in one fetus at menstrual age of 16 weeks’. Sonographic appearances and genetic am-niocentesis result suggested for 45,X and 46,XY heterokaryotypic twins. Coexisting polyhydramnios found in the sac of severely malformed 45,X fetus threatened miscarriage and premature delivery. To salvage the phenotypically normal male fetus, the hydropic 45,X co-twin was selectively terminated by occlusion of its umbilical cord with bipolar dia-thermy. Complete cessation of funicular flow was achieved, resulting in normalization of total amniotic fluid volume. A healthy 2200-gram baby boy was born at 38 weeks’. His neurodevelopment was intact at 2 years of age. His physical examination was significant for slight growth delay (15 percentiles), with 6% of 45,X mosaicism found in his peripheral blood. Owing to the rarity of the cases, limited data is available regarding an optimal treatment for heterokaryotypic monochorionic twins with discordant lethal malformation. Intrauterine intervention may be offered should demise or permanent disabilities are imminent to the apparently normal fetus.

A Comparative Study between Sub Mucous Diathermy with or without Inferior Partial Turbinectomy

Objective: In this study we aimed to compare the effects of submucosal cauterization of the inferior turbinate with or without inferior partial turbinectomy. Materials and methods: In this prospective cohort study, 60 patients with inferior turbinate hypertrophy were randomized and divided into two groups. The first one was submitted to submucosal cauterization associated with partial turbinectomy, and the second one only submucous cauterization. Five items were assessed to compare both methods: pain, nasal bleeding, scarring, crustation and nasal air way patency. Follow-up was performed on days 1, 14, 30 and 3 months later. Results: In both groups crusting formation was similar. Reactionary hemorrhage was more common in turbinectomy group. Scarring showed better results in the turbinectomy group in the first month postoperative, airway patency showed good results in 80% of the patients with turbinectomy. Conclusion: Submucosal cauterization with inferior partial turbinectomy has yielded better nasal patency when compared to submucosal electrocautery ablation alone.

Examining the life-cycle of the Coblator II device:Increases in paediatric post-tonsillectomy haemorrhage after six years of use

All paediatric tonsillectomies were examined from 2012–2019 at a single tertiaryreferral institution,and all were performed by one of two paediatric otolaryngologists.One exclusively used the diathermy,the other exclusively used the Coblator II.Two Coblator units were purchased simultaneously in 2012 and not replaced.There was no significant difference in number of tonsillectomies performed(1298 via diathermy,1221 via Coblator),nor in postoperative day of bleed,patient age,indication for procedure,and no patient had an underlying coagulopathy.The most common indication for tonsillectomy in both groups was sleep-disordered breathing.There was no significant difference in postoperative haemorrhage rates between groups for the first six years of the study(0%-1.4%/year).Years 7 and 8 saw the Coblator group haemorrhage rate significantly increase(0%-0.6%diathermy group vs 2%-3%Coblator group),though still fell within accepted rate of postoperative haemorrhage.The devices were then replaced,and the differences in haemorrhage disappeared.There appears to be a significant increase in paediatric post-tonsillectomy haemorrhage when using a Coblator device greater than six years old.This may suggest a useful lifespan for the Coblator II device.

Effects of Tecartherapy on Body Tissue: A Systematic Review

Electrophysical devices based on diathermy are one of the modalities used by many professionals to treat pain. The objective of this study was to identify the effects of Tecartherapy on healthy and unhealthy tissues. A systematic review of Tecartherapy technology was carried out. Articles published up to the year 2023 were investigated. The search argument used was “Capacitive-resistive electrical transfer” OR “Tecar” OR “Therapy Tecar” OR “CRET” in the BVS, Cochrane, PEDro, PubMed, IEEE Explore databases, Scielo and Web of Science. As for the main results of using Tecartherapy, there is an increase in temperature. In healthy tissues there is an increase in local blood flow, a decrease in muscle fatigue and an increase in muscle flexibility. In addition to the effects observed on healthy tissues, pain reduction and improved joint function were also observed. It was concluded that this technology has similar effects to other diathermy, but Tecartherapy proved to be safer and more comfortable. .

Effect of hyperthermia in combination with cryotherapy on sarcoma 180 in mice

The significant decrease in tumor recurrence caused by combined hyperthermia (local water bath) with cryotherapy has previously been shown. This study demonstrated an in vivo additive interaction of local microwave diathermy (hyperthermia, 42±0.5℃, 20 min. ) and liquid nitrogen treatment (cryotherapy,-180℃, 3 min. ) against intraperitoneally implanted sarcoma 180 in ICR mice. Local hyperthermia was produced by applicating 2450 MHz microwave to the region of the tumor without induction of significant whole body hyperthermia.Both hyperthermia and cryotherapy were delivered as a single dose individually on day 1 and day 2. The analysis of the tumor size curves showed that all of the treatments had more significant effect on sarcoma 180 than on the control group (P < 0. 0001 ). The optimal sequence of the combined therapies found in the experiment was cryotherapy→hyperthermia (CH) (P<0. 0001). Weights of the tumors excised from the mice on day 11 showed that the combined therapies (cryotherapy→hyperthermia or hyperthermia→cryotherapy) were more effective on sarcoma 180 than hyperthermia or cryotherapy used alone(P<0.01).

New Technique of Clipless Laparoscopic Cholecystectomy

Background: In laparoscopic cholecystectomy (LC), application of clips is the standard method for controlling the cystic duct and artery. However, this is not without problems. We propose a modified technique for management of cystic duct and artery in LC. Methods: Since 2007, 328 patients presented with symptomatic gallstones were included. In those patients, the cystic artery was divided by monopolar cautery and the cystic duct was ligated intracorporeally using nonabsorbable suture. Results: Three patients (0.9%) have bleeding from cauterized cystic artery;bleeding was controlled by diathermy in two of them and application of metal clip was necessary in the remaining patient. Cystic duct leak was detected in only one patient (0.3%), and it was managed by percutaneous drainage. At follow up we did not encounter abnormalities suggestive of bile duct stricture. Conclusion: The proposed modification of LC is feasible, practical, safe and economic as well. It is associated with reduced risk of postoperative morbidity.

Patellar Tendinopathy: A Physiotherapist’s Perspective

The pathology of patellar tendinopathy and the mechanisms of pain are poorly understood. The most popular treatment modality is the Eccentric overload Exercise. However, there is insufficient evidence to recommend a specific protocol and yet it is the most commonly used treatment modality. The aim of this case study is to present the possible mechanisms of pain and a treatment approach on a patient who was diagnosed as having patellar tendinopathy. It is suggested that hyper extension of the knee might be the source of patellar tendon pain in this patient. Following a course of pulsed short wave diathermy the patient was symptom free and remained so at 6 month review. Further studies to evaluate effectiveness of pulsed short wave diathermy is suggested.