The document provides information on using the Hyfrecator 2000 for electrosurgery. It compares the Hyfrecator to other electrosurgery methods like electrocautery and cryotherapy. It discusses the principles of electrosurgery using the Hyfrecator, describing tissue destruction methods like fulguration, desiccation, and coagulation. It provides guidance on choosing electrodes, adjusting power settings, and using different Hyfrecator configurations for various procedures.
This is to explian the basic Principle of Electrosurgical unit
It includes Principle
Block diagram,types various techniques,front and back panel of the machine,hazards,advantages etc.
This is to explian the basic Principle of Electrosurgical unit
It includes Principle
Block diagram,types various techniques,front and back panel of the machine,hazards,advantages etc.
In operating room the most hazardous devise used in a daily basis is diathermy.
A basic understanding of electricity is needed to safely apply electrosurgical technology for patient care.
As the title mentions, learn how LASER's are useful for cosmetic and non cosmetic purposes. This is a purely medicine based topic. Not described in lay man terms.
Surgical diathermy involves the intra cellular conversion of high frequency alternating current to thermal energy in order to generate a variety of tissue effect during surgery
Presentation describing the modes of diathermy used in modern day surgery, its working principles, complications associated with diathermy use, precautions to be taken while using diathermy. Valuable for undergraduate students and post graduate residents of general surgery.
High intensity focused ultrasound (HIFU) is an early stage medical technology that is in various stages of development worldwide to treat a range of disorders. The mechanism is similar to using a magnifying glass to focus sunlight. Focused ultrasound uses an acoustic lens to concentrate multiple intersecting beams of ultrasound on a target. Each individual beam passes through tissue with little effect but at the focal point where the beams converge, the energy can have useful thermal or mechanical effects. HIFU is typically performed with real-time imaging via ultrasound or MRI to enable treatment targeting and monitoring (including thermal tracking with MRI).
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Cardiology is a branch of medicine that deals with the disorders of the heart as well as some parts of the circulatory system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology.
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Surgical Diathermy the For Way in Modern Open SurgeryBatubo Nimi
The surgical diathermy is one of the most important surgical tool in the operating theatre. It is use to cut tissues, controlling bleeding by coagulation haemostasis and destruction of unwanted cells.
In operating room the most hazardous devise used in a daily basis is diathermy.
A basic understanding of electricity is needed to safely apply electrosurgical technology for patient care.
As the title mentions, learn how LASER's are useful for cosmetic and non cosmetic purposes. This is a purely medicine based topic. Not described in lay man terms.
Surgical diathermy involves the intra cellular conversion of high frequency alternating current to thermal energy in order to generate a variety of tissue effect during surgery
Presentation describing the modes of diathermy used in modern day surgery, its working principles, complications associated with diathermy use, precautions to be taken while using diathermy. Valuable for undergraduate students and post graduate residents of general surgery.
High intensity focused ultrasound (HIFU) is an early stage medical technology that is in various stages of development worldwide to treat a range of disorders. The mechanism is similar to using a magnifying glass to focus sunlight. Focused ultrasound uses an acoustic lens to concentrate multiple intersecting beams of ultrasound on a target. Each individual beam passes through tissue with little effect but at the focal point where the beams converge, the energy can have useful thermal or mechanical effects. HIFU is typically performed with real-time imaging via ultrasound or MRI to enable treatment targeting and monitoring (including thermal tracking with MRI).
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Cardiology is a branch of medicine that deals with the disorders of the heart as well as some parts of the circulatory system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology.
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Surgical Diathermy the For Way in Modern Open SurgeryBatubo Nimi
The surgical diathermy is one of the most important surgical tool in the operating theatre. It is use to cut tissues, controlling bleeding by coagulation haemostasis and destruction of unwanted cells.
Different type of Energy Sources used in Surgery are described In this presentation...
like Radio frequency Electro-surgery
Ultrasound Energy
Laser
Argon beam Coagulation
Alma 2016 Clinical Publication - Legato II Treats Scars Hamutal Gozlan
Clinical and histological results in the treatment of atrophic
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This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.
Instruments that apply energy to cut, coagulate and dissect tissue with minimal bleeding facilitate surgery. The improper use of energy devices may increase patient morbidity and mortality.
If you own a DermLite dermatoscope and are attending this year's BAD (British Association of Dermatologists) visit our stand for a free DermLite health check
The Cryosuccess is a simple and effective handheld cryotherapy device for accurate treatment of skin lesions making it ideal for general practice, dermatology, podiatry and minor surgery applications.
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
SURGICAL ANATOMY OF THE RETROPERITONEUM, ADRENALS, KIDNEYS AND URETERS.pptx
Dr motley Guide to the Hyfrecator
1. A Simple Guide to the
Hyfrecator 2000
Edited by
Richard J Motley MA MD MRCP
Consultant in Dermatology and Cutaneous Surgery
University Hospital of Wales
Cardiff
Section on Vasectomy by
Dr Tim Black
Marie Stopes Clinic
London
Sole Importers and UK Service Agents
for the Hyfrecator Since 1962
Page 1 of 13
2. Contents
Page
Introduction 2
The Hyfrecator, Electrocautery, Cryotherapy and Laser compared 2
Principles of Electrosurgery 4
Special Features relating to use of the Hyfrecator 6
Choice of Electrodes 7
Adjusting the Power 8
Configurations 9
Treatment of lesions 9
Using the Hyfrecator for Vasectomy 12
Page 2 of 13
3. INTRODUCTION
Efficiency and Cost-effectiveness are popular terms for the 1990's but have always meant 'getting the job
done' and 'value for money'. In these terms there is little to compare with the Conmed Hyfrecator 2000,
the latest and best model in the long line of Hyfrecators which, for more than half a century, have been
the most popular electrosurgical accessory for outpatient and office-based surgery.
The Hyfrecator allows precise destruction of all types of cutaneous lesion (both superficial and deep) and
controls surgical bleeding simply, quickly and effectively. Bleeding can prolong even minor procedures
and increase the risk of haematoma formation, infection and wound dehiscence that may lead to poor
cosmetic results.
The Hyfrecator is widely used for outpatient procedures that range from epilation to vasectomy
(described later). It is commonly used by Dermatologists in conjunction with curettage for the
destruction of small well-defined skin cancers such as basal cell carcinoma and for the treatment of a
wide variety of cutaneous lesions.
Other applications include: - Vasectomy (p), Chiropody, Maxillofacial, Plastic Surgery,
GU Medicine, Gynaecology, Veterinary.
Cutaneous conditions amenable to treatment with the Hyfrecator include:
Adenoma sebaceum, Angiokeratoma, Benign Moles, Campbell de Morgan Spots, Common viral warts,
Fibromas, Filiform warts, Lymphangiomas, Molluscum contagiosum, Plane warts, Pyogenic granulomas,
Sebaceous gland hyperplasia, Seborrhoeic warts, Skin tags, Solar keratoses, Spider naevi, Syringomas,
Telangiectasias, Venereal warts, Xanthelasmata.
THE HYFRECTOR, ELECTROCAUTERY, CRYOTHERAPY AND LASER COMPARED:
The Hyfrecator is a Surgical Diathermy Unit. It produces a controlled electrical discharge of high
frequency and high voltage, which selectively destroys tissue by the passage of electric current.
Electrocautery by comparison uses an electrically heated metal 'burner' to destroy tissue through heat
conduction. Cryotherapy uses a freezing spray to produce damage to cells, which are then eliminated by
natural processes. All three modalities have a place in outpatient surgery and overlap in their uses.
Page 3 of 13
4. Lasers produce a high power beam of monochromatic light which can be specifically 'targeted' to destroy
one component of body tissue - such as haemoglobin or melanin. They are particularly useful for treating
diffuse cutaneous malformations such as vascular and pigmented birthmarks. The main disadvantage of
lasers is their cost - usually tens of thousands of pounds.
The Hyfrecator, Electrocautery and Cryotherapy units are compared below:
Hyfrecator
Advantages
The Hyfrecator is more versatile and can be used to treat more conditions than any type of electrocautery
or cryotherapy equipment. It delivers rapid, precise destruction of all types of cutaneous malformation,
including telangiectasia and unwanted hair growth. It can provide controlled tissue coagulation and
precise surgical haemostasis using bipolar coagulation. Small lesions can be treated without anaesthesia.
Disadvantages and Hazards
As with electrocautery it can ignite alcoholic skin preparations that should be allowed to evaporate
before commencing treatment. Caution is required in patients with implanted cardiac pacemakers.
Electrocautery
Advantages
Simple, robust equipment. Allows destruction of common cutaneous lesions under local anaesthesia.
Tip of the cautery can be sterilised by heating to red heat before use. Needle points available for treating
spider naevi. Can be used to control skin surface bleeding (and operative bleeding - with some
difficulty).
Page 4 of 13
5. Disadvantages and Hazards
Not a very precise method of treatment. Battery powered equipment often 'runs out' at the time you need
it most, more powerful mains powered equipment is bulky and unwieldy. Hot cautery tip can ignite any
inflammable material - including dry cotton dressings and alcoholic skin preparations. Treatments
always require local anaesthesia.
Cryotherapy
Advantages
Modern cryosprays allow precise delivery of refrigerant with reproducible results. Many treatments can
be administered without local anaesthesia as cooling the skin has an anaesthetic effect.
Disadvantages
Liquid nitrogen has to be obtained shortly prior to treatment, or stored in specialised vessels. Unused
nitrogen evaporates rapidly. The inflammatory response to cryotherapy is unpredictable and often
intense. Injury takes several weeks to resolve and only then can the extent and adequacy of treatment be
assessed. Incorrectly handled nitrogen can cause burns. Cryotherapy destroys melanocytes producing an
unacceptably white scar in coloured skin.
PRINCIPLES OF ELECTROSURGERY
A technical description of electrosurgical generators requires a vocabulary unfamiliar to most physicians.
Voltage, frequency, power, current, current density, capacitative-coupling, dispersive patient return
electrode, alternative return pathways, earthing, grounding, modulation, spark-gaps, are but a few of the
terms used to describe the functions of electrosurgical generators. The following section is designed to
teach the clinician the important principles of electrosurgery and to impart an understanding of the risks
and benefits of the technique.
Diathermy (from the Greek Dia - through and thermy- heat) is the heating of tissue by the passage of high
frequency current.
Simple batteries produce a direct current that flows from one pole to the other. Mains electricity
alternates, with the polarity reversing 50 times per second. The size of current flow is determined by
Page 5 of 13
6. voltage (the 'push' from behind) and resistance (of the tissue) through which it is trying to flow. The
higher the resistance the higher the voltage required to allow current to flow. Direct currents and low
frequency alternating currents stimulate muscles including cardiac muscle, which may fibrillate with
fatal results. At higher frequencies, however, muscles are not stimulated and the current can be put to
therapeutic effect.
The flow of current through tissue causes heating, the higher the current flowing through an area of
tissue the greater the heat generated. This heating effect depends on current density i.e. the current flow
per unit area of tissue and has important implications in the use of electrosurgery. Medical diathermy, as
used by physiotherapists, employs two large electrode plates, which are applied to either side of an
injured muscle. A high frequency current then passes between the plates gently warming the intervening
tissue. The current density at each plate is very low and the plates remain cool.
Surgical diathermy, however, uses a small active electrode and a large dispersive patient return electrode,
(not required with the Hyfrecator). Current density at the tip of the surgical electrode is very high
leading to heat generation in the immediately adjacent tissue. This method of using surgical diathermy is
referred to as 'monopolar' - because the electrosurgical effect is confined to one electrode. 'Bipolar'
electrosurgery uses two small electrodes, as the insulated tips of bipolar forceps, which are applied either
side of the tissue to be coagulated. High current density is generated between the forceps tips
coagulating the intervening tissue.
The Hyfrecator is a low power surgical diathermy unit designed specifically for outpatient surgery. In
comparison with a conventional surgical diathermy machine, it produces a higher voltage output (which
matches the high impedance of dry skin) and because of its limited power can be safely used without a
dispersive patient return electrode. It also provides a bipolar output for precise tissue coagulation with
bipolar forceps.
When using the Hyfrecator three different forms of tissue destruction are possible: 'fulguration',
'desiccation' and 'coagulation'. Fulguration occurs when the electrode is held just above the skin and a
shower of sparks play over its surface. This causes carbonisation or charring and the charred tissue acts
as an insulator preventing deeper tissue damage. Although it looks more dramatic in use, the tissue
destruction produced by fulguration is more superficial than that of desiccation or coagulation.
Page 6 of 13
7. Desiccation is achieved by placing the electrode in good electrical contact with the skin surface so that
no sparks are generated during treatment. This achieves a deeper level of tissue damage but not as deep
as coagulation. Coagulation occurs when two electrodes are brought to the tissue with bipolar forceps.
The concentrated flow of current precisely coagulates the intervening tissue sealing small blood vessels.
The distinction between fulguration and desiccation is largely artificial - for the purposes of treatment,
but the physician should be aware that sparks are associated with more superficial tissue destruction and
that good electrical contact is required for deeper tissue destruction. Furthermore, higher power settings
are required for desiccation and coagulation and the effect on tissue is less immediately apparent than
with fulguration.
Finally, the Hyfrecator may be used in conjunction with a dispersive patient return electrode plate.
Under these circumstances the dispersive plate is connected to the dispersive plate connector on the
Hyfrecator and the plate held in maximum contact with the patient’s skin. The use of the plate increases
the efficiency of the system, and until experience is gained the settings of the machine should be reduced.
With the use of the return plate it is possible to produce deep monoterminal tissue coagulation.
SPECIAL FEATURES RELATING TO USE OF THE HYFRECATOR 2000
When an electrosurgery generator produces a current it flows from one pole of the machine to the other.
Unlike the Hyfrecator most electrosurgery generators are radio frequency-isolated machines which
require a dispersive patient return electrode held firmly against the patient's skin to complete the
conductive pathway. (The use of a patient return electrode is mandatory for safety when procedures are
performed under general anaesthesia).
The Hyfrecator, however, is a ground-referenced machine and does not require a patient return electrode.
The active electrode is held to the skin and current returns to the machine by capacitative-coupling with
the patient's environment to ground (earth). This is quite acceptable for low-power electrosurgery but
can lead to unusual effects as the current seeks the path of least resistance back to the machine. This
path includes all that the patient is in contact with -i.e. the couch, attending physician, any other medical
equipment etc. If a very good pathway to ground is established then most of the current will take this
Page 7 of 13
8. route. Furthermore, if this route is established by only a small point of contact then current density at
this point may be high enough to produce a spark - leading to swift protestation but little harm in the
conscious patient.
In order to prevent this effect grounded devices should not be brought into contact with the patient during
operation of the Hyfrecator and the Physician should maintain good contact by resting a hand on the
patient's skin (or alternatively not make contact with the patient during the procedure).
Monopolar electrosurgery may interfere with implanted cardiac pacemakers and normally should not be
used in their presence. Bipolar coagulation with bipolar forceps is free of this risk.
The Hyfrecator 2000 performs internal self-diagnostic tests when it is first switched on - this is indicated
by visual and auditory warnings.
CHOICE OF ELECTRODES
The development of 'Electrolase' disposable electrodes and sterile sheaths for the Hyfrecator handle has
eliminated the risk of cross-contamination between patients and many physicians exclusively use
Electrolase tips. These are available with a sharp point - for pinpoint procedures such as the treatment of
spider naevi and telangiectasias, and with blunt points for most other procedures. They are available
sterile for use within surgical wounds, or non-sterile for use on the skin surface.
A range of non-disposable electrodes is available including needle, ball and blade-shaped electrodes,
which may be required occasionally for specialised procedures. Hair growth can be treated with fine
epilation needles, (disposable epilation needles are also available and require a lightweight handle.
Metal hypodermic needles can also be used with an adapter but are too sharp for many applications.
ADJUSTING THE POWER
The effect of surgical diathermy is dependent upon current density, this in turn depends on the output of
the machine, the area of contact between the electrode tip and the tissue and the resistance of the return
pathway.
Page 8 of 13
9. The physician must constantly evaluate the electrosurgical effect and position of the electrode and adjust
the power settings accordingly. It is useful to experiment with a piece of meat to see the various effects
that can be achieved.
Remember that if the length of electrode in contact with tissue is doubled, the area of tissue contact is
quadrupled and the power setting must be increased fourfold to achieve the same effect. Much more
power is required for desiccation -where the electrode is held in good contact with the tissue, than for
fulguration where the tip of the electrode is held above the surface producing a stream of sparks and a
much more superficial destruction of tissue.
In order to accommodate the full range of power outputs required for procedures the Hyfrecator 2000 has
two output ranges. The low output now delivers up to 20 Watts at 3000 volts; adjustable in increments
of 0.1 Watts up to 10 Watts, which allows precise control when working with fine, tipped electrodes.
The higher output delivers up to 35 Watts at 8000 volts, adjustable in increments of 1 Watt, and is used
for larger procedures and deeper tissue destruction. The bipolar output delivers up to 35 Watts at 3000
volts, in increments of 1 Watt, and is used with bipolar forceps.
A very useful feature, which is new to the Hyfrecator 2000, is the memory for the ‘last used’ power
setting in each mode. When the machine is switched on, or switched between modes, the most recent
power setting in that mode is selected for the operator’s convenience.
As a general rule the output should be set as low as possible to achieve the effect desired. The output
mode is selected - either monopolar low or high outputs or the bipolar mode for use with insulated
forceps. The power can be adjusted either on the machine using the rotary digital power dial, or using
the switching handle which makes it possible for the physician to adjust the power settings without
assistance. The simple universal handle and footswitch may be preferable for very fine procedures - such
as epilation and the treatment of telangiectasia where the slightest movement may dislodge the electrode
from the area to be treated. The footswitch is also required when using bipolar forceps.
A sticker on the machine refers to its 30s/30s 'Duty Cycle'. This is a licensing requirement. In effect the
machine can be run at full output for 30 seconds and then should be allowed to rest for 30 seconds. It
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10. should not be run continuously at maximum output otherwise it will overheat. In practice most
procedures use less than half maximum output for 1-3 seconds at a time.
CONFIGURATIONS
The standard Hyfrecator is provided with a switching handle that allows control over the equipment from
the handpiece. Sterile plastic sheaths can be placed over the handle and lead for open surgery.
The blunt sterile Electrolase electrode tips are probably most useful, although the sharp tips are best for
treating telangiectases.
For very fine work it may be preferable to use a footswitch to activate the machine, eliminating any
minor tremor associated with operating the switching handle. Please note that you shouldn’t use the
footswitch to control the switching handle as this can result in unexpected current leaks - use the simple
universal (non-switching) handle with the footswitch. A lightweight handle is also available which takes
standard disposable epilation needles.
For precise coagulation of bleeding vessels a pair of bipolar forceps and leads is invaluable, these must
be used in conjunction with the footswitch.
Other accessories are available for specialised procedures if you need them.
The Hyfrecator is supplied complete and ready for use and includes a comprehensive operating
manual and video to guide new users.
THE TREATMENT OF CUTANEOUS LESIONS WITH THE HYFRECATOR
Don't forget before destroying cutaneous lesions that tissue diagnosis is straightforward and whenever
there is any clinical uncertainty of diagnosis a shave or curette biopsy should be taken for histological
examination.
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11. General Principles:
Following treatment with the Hyfrecator the skin should be kept clean and moist with white soft paraffin
or an antibiotic ointment such as ‘Polyfax’. The treated area should be washed twice daily and the
ointment applied regularly. This will produce optimal healing of the skin but, as would be expected, the
amount of scarring will vary from site to site and person to person and so there is no substitute for
treating a small test area initially and assessing the final results before proceeding to a full treatment.
Try to be aware of the effects of the electric current during treatment and remember that although a lot of
sparks look dramatic they create a superficial charring which is insulating to heat and electric current and
tends to minimise the depth of treatment. For deeper and more effective treatment the electrode tip
should remain in good contact with the tissue throughout treatment. The intensity of treatment is greatly
increased by the use of the dispersive, patient return electrode. Very superficial treatments can be given
without anaesthesia, but the majority requires local or topical anaesthesia.
The following lesions respond well to treatment with the Hyfrecator:
Benign moles.
Under local anaesthesia shave excise the bulk of the lesion. Use light electrofulguration to produce
haemostasis and to destroy any remaining protuberant tissue.
Dermatosis Papulosis nigra.
These small warty lesions typically develop on the face of patients of Caribbean descent. Light
electrofulguration will destroy them. Plane (flat) warts can be treated in a similar manner.
Epilation.
The fine epilation needle electrode is placed gently down the hair follicle until resistance is met. A light
current is passed into the tissue whilst the operator gently pulls at the hair. When sufficient current has
been applied the hair becomes loose and is effortlessly plucked from the follicle. This technique can be
useful for hair-bearing intradermal naevi.
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12. Facial Telangiectasias.
The blunt electrolase tip is placed directly over the telangiectatic blood vessel and a brief current passed
to desiccate and blanch the skin and vessel. A further segment is then treated and so forth until the entire
vessel is destroyed. A white streak may be left after healing - and this is particularly visibly if patients
have background facial erythema - patients should be warned of this.
Milia, Comedones, Small Cysts.
The skin overlying milia or other inclusion cysts is lightly desiccated which leads to discharge of the
contents after a few days. This technique is useful for patients with multiple closed comedones in acne.
Molluscum Contagiosum.
Lightly electrodesiccate the surface of the lesion which will then involute.
Pyogenic Granuloma.
Remove the main bulk of the lesion by curettage or shave excision and electrodesiccate the base.
Seborrhoeic keratoses.
Use high power electrofulguration to soften the surface of the seborrhoeic keratoses, then remove the
tissue either by firm rubbing with a cotton gauze swab, or with light curettage. Solar keratoses may be
treated in a similar manner.
Skin tags.
Small tags up to 1mm in diameter can be easily treated without local anaesthesia. Larger tags require
local or topical anaesthesia. Use a short burst of either electrofulguration or electrodesiccation current to
destroy the tag. The treated skin will separate naturally in a few days.
Spider Naevi / Angiomas
Press the electrode tip over the central vessel and pass an electrodesiccating current sufficient to blanch
the tissue. Beware that over treatment may leave a small depressed scar.
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13. Syringomas.
These lesions typically occur around the eyelids. Light fulguration followed by curettage or pinpoint
electrodesiccation may treat these successfully. Sebaceous gland hyperplasia can be treated in a similar
manner.
Viral Warts.
Electrofulguration or electrodesiccation is used to soften the wart prior to light curettage.
Xanthelasma.
Xanthelasma can be surprisingly deeply situated within the skin and it may be preferable to treat them
with light electrodesiccation on a number of occasions, rather than attempting to remove the entire lesion
in one session.
Vasectomy
Marie Stopes International, a non-profit family planning organisation working in 24 countries has been
using the Schuco Hyfrecator since 1976. In Britain (where there are 24 Stopes vasectomy centres) over
60,000 vasectomies have been performed using the Hyfrecator alone to occlude the vas deferens. This
technique, pioneered in the early seventies by Schmidt, in the States, is quick, reliable and has fewer
complications than traditional ligation techniques with comparable failure rates in the hands of trained
and experienced doctors. This method of contraception is over 99% effective. Electrodes to be used are
the 716 or 7-221-S.
♦♦♦♦♦♦♦♦♦♦♦♦
Finally, enjoy using your new electrosurgical companion and don't
hesitate to seek advice from more experienced colleagues.
Most Hyfrecator owners are enthusiastic about their machine and
will readily swap advice on treatments with you.
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14. Advice on the use of the Hyfrecator and other electrosurgical equipment in patients with
implanted cardiac pacemakers.
Richard J Motley
Consultant in Dermatology and Cutaneous Surgery
Welsh Institute of Dermatology
University Hospital of Wales
Cardiff CF14 4XW
st
21 April 2011
Modern implanted cardiac pacemakers are designed to reject electrical interference through the use of bipolar
intraventricular electrodes and interference-rejecting circuits. The risk of interference from using
electrosurgical equipment is low, but it would be unwise to do so in patients fitted with an implanted cardiac
pacemaker without further advice from their Cardiologist or Cardiac Device Physiologist.
The electrical components of an implanted pacemaker may be damaged by electrosurgery in the vicinity of the
unit. It is also possible that electrical pulses generated close to a pacemaker unit may re-programme its
function.
Patients may be 'Pacemaker-dependent' i.e. their heart beat is entirely dependent upon a pacing signal from
the implanted pacemaker. Unwanted electrosurgical interference may suppress the required pacemaker signal
leading to asystole and collapse - for the duration of the interference.
Some patients are not dependent upon the pacemaker - it only triggers if the natural heart beat stops: they
are at less risk from pacemaker interference.
Finally and most importantly, increasing numbers of patients are now being fitted with combined pacemaker
and implantable cardioversion defibrillator devices (ICD's). These devices not only function as pacemakers but
are capable of detecting and treating various cardiac arrythmias and, if necessary, of defibrillating the heart
should ventricular fibrillation be detected. There is a real risk that a signal generated by electrosurgery may be
mistaken by the ICD for ventricular fibrillation and result in unwanted discharge of the defibrillating current
with undesirable consequences.
Many patients with pacemakers are elderly and most are unaware of the precise nature of their implanted
device, for this reason it is essential that they contact their cardiology service for advice prior to electrosurgical
treatment. The Cardiologist or Cardiac Device Physiologist will usually make the device safe for the duration of
surgery and check that it has not been damaged afterwards.
For simple procedures in clinic, in patients with pacemakers, electrocautery may be used with complete safety.
Acknowledgement:
I am most grateful to Mr Andrew Penney, Chief Cardiac Physiologist, University Hospital of Wales, Cardiff, for
his helpful comments.