Barry L. Hainer

Fundamentals of electrosurgery.

Electrosurgery uses electricity to remove tissue, coagulate bleeding, or destroy tumors. Modern units, first developed for application in neurosurgery, are now available in office models that are most commonly used by the family physician for cutaneous surgery. Electrosurgery can accomplish cutting, coagulation, desiccation, and fulguration. Electrosurgical equipment for the office is relatively inexpensive and portable. The main advantage of this surgical modality is rapid completion of the procedure with minimal surgical time, because hemostasis occurs at the time of the incision. After some basic instruction and initial practice on animal tissue, which are provided through the guidance of several excellent texts or continuing education courses, the family physician can readily apply electrosurgery in an office-based practice safely, efficiently, and with satisfying results.

Limulus lysate assay in detection of gonorrhea in women from a low-incidence population

An evaluation of the limulus amebocyte lysate assay for detection of gonococcal endotoxin in cervical secretions was undertaken in 48 women from an ambulatory population with a low incidence of gonococcal infection. When cervical secretions were diluted 1 : 2,000, positive limulus amebocyte lysate assay results were obtained in four women (100%) with culture-proved gonococcal infection, and negative results were obtained in 25 of 44 women (57%) with culture-negative specimens. The limulus amebocyte lysate assay was not sufficiently specific in a low-incidence, largely asymptomatic population to be recommended as a rapid diagnostic procedure (60 minutes) in such a group. Standardization of sampling technique, size, and reagent preparation and elimination of vaginal contamination of cervical secretions may produce a limulus amebocyte lysate test with more consistent performance characteristics in varied populations. Since the predictive value of a test varies with the prevalence of the disease in the populations tested, a test proposed for use in a population with a low likelihood of disease must be tested in such a population.

Gastrointestinal Tract Infections

Gastrointestinal (GI) tract infections are caused by a wide variety of fungi, viruses, and bacteria, and all areas of the GI tract are affected. Infections range from mild, where disease is self-limited and supportive care is the treatment, to severe, where hospitalization and intravenous fluids and antibiotics are required for survival. In recent years, the increasing antibiotic resistance of various bacteria has become an important aspect of GI infection treatment and has resulted in augmentation of therapy.