The utility of bipolar electrocautery in hereditary hemorrhagic telangiectasia

OBJECTIVE: The surgical treatment of epistaxis associated with hereditary hemorrhagic telangiectasia (HHT) is varied. Laser therapy is often inadequate for larger complex lesions. This study sought to determine if bipolar cautery can be effectively and safely used in treating HHT-associated epistaxis. STUDY DESIGN AND SETTING: Records from all patients with HHT treated surgically over 8 years were reviewed retrospectively. Outcomes or complications were noted in the clinic on follow-up evaluation. RESULTS: Twenty-seven patients with HHT who underwent surgical treatment of epistaxis were evaluated; 18 were treated with bipolar cautery. Forty-two separate bipolar treatments were performed. No new septal perforations or synechiae were noted. Twenty-two of 42 treatments were coupled with ancillary laser treatments. The bipolar was also used as the sole technique in 20 procedures. CONCLUSION: Bipolar electrocautery is a safe and effective tool for the intraoperative control of HHT-related epistaxis. SIGNIFICANCE: Bipolar electrocautery may be used as an adjunct to laser techniques or as a stand-alone technique. EBM RATING: C-4.     

Cavernous sinus thrombosis following odontogenic and cervicofacial infection

Summary Cavernous sinus thrombosis (CST) is rarely seen clinically as a complication of infectious processes since the discovery of penicillin. At the present time, dental abscess is an uncommon cause of CST. We now report our experiences with a 60-year-old diabetic male, who developed CST 38 days after extraction of an infected upper third molar tooth. The importance of eradicating regional cervicofacial foci of infection is stressed.     

Occurrence of tetrodotoxin and paralytic shellfish poison in the Taiwanese crab Lophozozymus pictor

Paralytic toxicity was detected by tetrodotoxin (TTX) bioassay in all 15 specimens of the xanthid crab Lophozozymus pictor collected from northern Taiwan in 1993. The average toxicity of crab specimens was 921 ± 231 (mean ± S.E.) mouse units. The toxin of crab was partially purified and then identified. It was found that the crab toxin contained TTX and gonyautoxin. The ratio of TTX to gonyautoxin for crab toxin was about 9:1.     

Effects of finite angular steps and extent of profile data on the calculation of rotational x-ray dose distributions

Computer algorithms for rotational therapy beams, in most cases, perform dose calculations by summing stored fixed beam data at finite angular steps. Such an algorithm, based on the Bentley beam model, was evaluated by comparing calculations with measured data for an 18-MV x-ray beam. Measurements were made in a specially constructed cylindrical water phantom of 15-cm radius using a 0.1-cm3 ionization chamber for an arc of 180 degrees and for a field size of 7.2 X 7.2 cm2 at 100-cm source-axis distance. This study revealed that the Bentley beam model, with fixed beams summed every 10 degrees, predicts the dose in the treatment volume, centered about the isocenter, with an accuracy of approximately 2%. However, dose at depths between the phantom surface and the treatment volume could be underestimated by as much as 10% (3% of isocenter). This was shown to be partially due to the truncated tails of the off-axis profiles in the Bentley model, which extend only 8 mm outside the edge of the radiation field, and the large angular increment of integration (10 degrees). Using beam profiles extending to 4 cm outside the edge of the radiation field and angular steps of 5 degrees or less for summation of fixed beams reduced errors to less than 5%. Therefore, extended beam profiles and smaller angular steps for summing fixed beams are recommended for photon rotation calculation when increased accuracy is required.     

Multiple Malignant Melanomas at Different Burn Scar Areas: A Case Report

Background. Malignant changes in burn scars occasionally develop, the majority being squamous cell carcinoma. Malignant melanomas (MMs) arising in burn scars occur rarely.
Objective. To present the case of a patient with a multiple MM developed at different burn scar areas.
Methods. A case report and review of literature are given.
Results. One was a large pigmented nodular lesion with central ulceration on right flank. It was widely excised and revealed lentigo MM. After that, we took notice another small pigmented lesion on right arm. It was also reported lentigo MM.
Conclusion. This case provided a valuable lesson. Another kind of tumor may be present even if one tumor is found by pathologic observation, especially in burn scar patients. Clinicians should carefully observe burn scars, chronic ulcers, and other pigmented lesions.     

INDICATIONS FOR ENDOSCOPIC MUCOSAL RESECTION FOR EARLY COLORECTAL CANCER: SHOULD THEY BE STRICT OR SHOULD THEY BE EXPANDED?

Endoscopic technologies have been developed greatly. As for early gastric cancer, the indications for endoscopic mucosal resection for early colorectal cancer have been widened recently. Technological advances can support wider and deeper resections using endoscopy but the remaining problem for the endoscopic management of cancer is lymph node metastasis. I discuss here the indication for endoscopic mucosal resection for early colorectal cancer to bring into focus the risk factors for metastasis to lymph nodes.