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Technology and Health Care is intended to serve as a forum for the presentation of original articles and technical notes, observing rigorous scientific standards. Furthermore, upon invitation, reviews, tutorials, discussion papers and minisymposia are featured.
The following types of contributions and areas are considered:
1. Original articles:
Technology development in medicine: New concepts, procedures and devices associated with the use of technology in medical research and clinical practice are presented to a readership with a widespread background in engineering and/or medicine.
Significance of medical technology and informatics for healthcare: The appropriateness, efficacy and usefulness deriving from the application of engineering methods, devices and informatics in medicine and with respect to public health are discussed.
2. Technical notes:
Short communications on novel technical developments with relevance for clinical medicine.
3. Reviews and tutorials (upon invitation only):
Tutorial and educational articles for persons with a primarily medical background on principles of engineering with particular significance for biomedical applications and vice versa are presented.
4. Minisymposia (upon invitation only):
Under the leadership of a Special Editor, controversial issues relating to healthcare are highlighted and discussed by various authors.
Abstract: Photothermal treatment of tumors of the retina and choroid such as retinoblastomas, malignant melanomas, benign tumors as well as of vascular malformations can be performed by using laser radiation. A number of basic physical laws have to be taken into account in this procedure. Of particular importance thereby are: Arrhenius' law to approximate the kinetics of protein denaturation and photocoagulation, furthermore the electromagnetic radiation field, the distribution of both radiant and thermal energy induced in tumors and vascular structures, the influence of the wavelength and laser pulse duration (exposure time), as well as of the optical properties of the tissue.…Strict confinement of the extent of the photothermal damage is critical since such pathological entities are frequently located close to the macula or optic nerve head. The conditions for tumor destruction are best fulfilled when using radiation in the near-infrared range of the electromagnetic spectrum such as that emitted from the diode (810 nm) and the Nd: YAG (1064 nm) laser, because of the good optical penetration properties of these radiations in tissue. Short wavelength sources of radiation, such as the argon ion (488, 514 nm) or the freqeuency-doubled Nd: YAG (532 nm) laser are less well suited for the irradiation of large vascular structures due to their poor penetration depths. However, for vascular formations with a small thickness (1 mm or less), short wavelength sources appear to be the most appropriate choice. Optical coupling of radiant energy to the eye by means of indirect ophthalmoscopic systems or positive contact lenses is furthermore of importance. Strong positive lenses may lead to severe constrictions of the laser beam within the anterior segment, that leads to high irradiance increasing the probability for structures to be damaged; with negative contact lenses, such as the -64 D Goldmann type lens, this danger is largely absent.
Abstract: Surgical optimization of the cavopulmonary connection and pharmacological therapy for dysfunctional Fontan physiology continue to advance, but these treatment approaches only slow the progression of decline to end-stage heart failure. The development of a mechanical cavopulmonary assist device will provide a viable therapeutic option in the bridging of patients to transplant or to stabilization. We hypothesize that rotational blood flow, delivered by an implantable axial flow blood pump, could effectively assist the venous circulation in Fontan patients by mimicking vortical blood flow patterns in the cardiovascular system. This study investigated seven new models of mechanical cavopulmonary assistance (single and dual-pump…assist), created combinations of pump designs that deliver counter rotating vortical flow conditions, and analyzed pump performance, velocity streamlines, swirling strength, and energy augmentation in the cavopulmonary circuit for each support scenario. The model having an axial clockwise-oriented impeller in the inferior vena cava and an axial counterclockwise-oriented impeller rotating in the superior vena cava outperformed all of the support scenarios by enhancing the energy of the cavopulmonary circulation an average of 10.3% over the entire flow range and a maximum of 27.4% at %the higher flow rates. This research will guide the development of axial flow blood pumps for Fontan patients and demonstrated the high probability of %a cardiovascular benefit using counter rotating pumps in a dual support scenario, but found that this is dependent upon the patient-specific cavopulmonary anatomy.
Abstract: The incidence of Acute Leukemia (AL) subtypes varies according to geographical distribution and more predominant in developing countries. The aim here was to evaluate the usefulness of cost effective diagnostic tools in characterization of Acute Lymphoblastic Leukemia (ALL) in resource poor population. One hundred and two AL cases were diagnosed. For diagnosis, cytochemical analysis and immunohistochemistry were performed. Among the children < 12 years, ALL was 64.3% while AML accounted for 30%. In patients > 12 years, ALL was 59.4% and AML was 31.3%. The B-ALL occurred most frequently than T-ALL in both the age groups while based on immunophenotyping…in AML, CD13 was the most commonly expressed antigen. Hence, cost effective diagnostic tools namely the immunophenotyping and cytochemistry are useful and improve accuracy and rapidly risk-stratify patients that were diagnosed with acute leukemia.
Keywords: Acute leukemia, cytochemistry, immunophenotyping, CD markers
Abstract: BACKGROUND: Radiofrequency ablation (RFA) temperatures reaching 45°C in adjacent tissues are cytotoxic to the spinal cord, nerves and surrounding tissues. OBJECTIVE: This study compares different RFA electrodes with regard to the temperature distribution during ablation of spinal metastases. METHODS: In vitro experimental study in isolated lumbar vertebrae of a human cadaveric spine. The temperature distribution of RFA electrodes was measured during ablation in human cadaveric lumbar vertebrae containing a simulated vertebral body lesion. The analysis compared a novel bipolar RFA electrode with two conventional monopolar RFA electrodes. A vertebral metastasis model was prepared…in eight lumbar vertebrae for each electrode. Differences between the electrodes were evaluated with a one-way ANOVA. RESULTS: The lowest temperature at the thermocouples adjacent to the simulated lesion was achieved when using the bipolar RFA electrode (46.4 ± 3.3°C), but temperature difference to the monopolar RFA electrodes was not significant. In the neural foramen and epidural space of lumbar vertebrae the maximal temperature measured when using the bipolar RFA electrode was 37.0 ± 0°C and 37.3 ± 0.7°C, which was significantly lower than during ablation via either of the monopolar RFA electrodes (p ≤ 0.001). CONCLUSIONS: Temperatures in areas of adjacent tissue during RFA using a specific for spinal ablation designed electrode with integrated thermocouples were significantly lower compared to other electrodes, potentially reducing temperature related risks during ablation.
Abstract: The aim of this study was to investigate the association between metabolic syndrome (MetS) and arm and leg muscle mass to total weight ratios in Korean adults. This was a randomized, controlled, cross-sectional study. Data from 2,383 adults (1,030 men and 1,353 women) were collected from the Korea National Health and Nutrition Examination Survey 2010-2011. Blood lipid profiles, blood pressure, and anthropometric characteristics, including weight, height, waist circumference, and muscle mass on dual energy X-ray absorptiometry (DXA), were evaluated in the participants. MetS was defined according to the criteria of the National Cholesterol Education Program Adult Treatment Panel III. The…average mass of both arms and legs was determined using regional muscle analysis by DXA. Afterwards, the arm and leg muscle mass to total body weight ratio was determined and classified into 4 quartiles (i.e., quartile 1 [highest muscle ratio] to quartile 4 [lowest muscle ratio]). According to the arm muscle and leg muscle ratios, there was a higher prevalence of MetS in quartile 4 than in quartile 1 in both men and women. A low arm and leg muscle mass to body weight ratio was associated with a higher prevalence of MetS after adjusting for age, physical activity, frequency of smoking, and frequency of alcohol consumption. In conclusion, MetS patients demonstrated a lower arm and leg muscle mass to body weight ratio. Strength training for the lower and upper extremities is recommended because it can have a positive effect on MetS prevention.
Abstract: BACKGROUND: Obesity is one of the biggest drivers of preventable chronic diseases and healthcare costs in Worldwide. Different prevention activities are suggested. By monitoring daily energy expenditure (EE) could be possible make personalized diets and programming physical activity. In this, physical inactivity is one of the most important public health problems. Some studies refer the effort of the international community in promoting physical activities. Physical activity can be promoted only by increasing citizens' empowerment on taking care of their health, and it passes from the improving of individual information. Technology can offer solutions and metrics for monitoring and…measuring daily activity by interacting with individuals, sharing information and feedbacks. OBJECTIVE: In this study we review indicators of total energy expenditure and weaknesses of available devices in assessing these parameters. METHODS : Literature review and technology testing EuNetHta core model. RESULTS: For the clinical aspects, it is fundamental to take into account all the factor that can influence the personal energy expenditure as: heart rate, blood pressure and thermoregulation (influenced by the body temperature). DISCUSSION: In this study we focused the attention on the importance of tools to encourage the physical activity. We made an analysis of the factor that can influence the right analysis of energy expenditure and at the same time the energy regime. A punctual monitoring of the exercise regime could be helpful in Telemedicine application as Telemonitorig. More study are needed to value the impact of physical activity tracker in Telemonitorig protocols. CONCLUSION: On the assessment of the energy expenditure, critical issues are related to the physiological data acquisition. Sensors connected with mobile devices could be important tools for disease prevention and interventions affecting health behaviors. New devices applications are potential useful for telemedicine assistance, but security of data and the related communication protocol limits should be taking into account.
Keywords: Physical activity, motor activities, psychomotor performance, energy expenditure, energy metabolisms, instruments and apparatus, telemedicine, mobile health, Telehealth
Abstract: BACKGROUND: Combined extra- and intracranial carotid artery stenoses, particularly involving multiple lesions, show complex hemodynamic properties and represent a therapeutic dilemma. We used computational fluid dynamics (CFD) to investigate whether insufficient cerebral blood flow (CBF) in a 70-year-old man with tandem stenoses was the cause of aphasia and right hemiparesis after carotid artery stenting (CAS) of the extracranial stenosis. METHOD: Three-dimensional digital subtraction angiography (3D-DSA) was performed before and after balloon angioplasty and CAS in the patient. The geometrical and rheological conditions of the carotid arteries were determined, and computational meshes were generated from the…patient-specific 3D-DSA datasets. CFD analysis was performed, and hemodynamic parameters such as mass flow, pressure, fractional flow reserve, and streamlines were calculated. RESULTS: Post-CAS simulations showed that the percentage of internal carotid artery mass flow from common carotid artery mass flow increased from 9% to 14% and CBF improved by only 5%. CONCLUSIONS: CFD analysis suggested that the neurological complications were caused by insufficient CBF rather than embolic events, and in tandem carotid stenoses, CAS for an extracranial lesion alone may not always sufficiently increase CBF. CFD enabled the noninvasive quantitative estimation of the effects of CAS of each stenotic segment on carotid flow.
Abstract: Human-Body Communication (HBC) is a wireless communication method using the human body tissue as a transmission medium for signals. This paper on the basis of human muscle fiber tissues' characteristics, it is first proposed to establish the analytical model of galvanic coupling human-body communication channel. In this model, the parallel and the transverse electrical characteristics of muscular tissue are fully considered, and the model accurately presents the transmission mechanism of galvanic coupling human-body communication signals in the channel. At last, through compare with the experimental results and calculation results, the maximum error of the model is 22.4% and the average…error is 14.2% within the frequency range.
Keywords: Analytical model, fiber characteristics, galvanic coupling, Human-Body Communication
Abstract: BACKGROUND: Hospital real-time location systems (RTLS) are increasing efficiency and reducing operational costs, but room access tags are necessary. OBJECTVE: We developed three iPhone 5 applications for an RTLS and communications using Bluetooth low energy (BLE). METHODS: The applications were: Peripheral device tags, Central beacons, and a Monitor. A Peripheral communicated with a Central using BLE. The Central communicated with a Monitor using sockets on TCP/IP (Transmission Control Protocol/Internet Protocol) via a WLAN (wireless local area network). To determine a BLE threshold level for the received signal strength indicator (RSSI), relationships between signal…strength and distance were measured in our laboratory and on the terrace. RESULTS: The BLE RSSI threshold was set at -70 dB, about 10 m. While an individual with a Peripheral moved around in a concrete building, the Peripheral was captured in a few 10-sec units at about 10 m from a Central. The Central and Monitor showed and saved the approach events, location, and Peripheral's nickname sequentially in real time. Remote Centrals also interactively communicate with Peripherals by intermediating through Monitors that found the nickname in the event database. CONCLUSIONS: Trial applications using BLE on iPhones worked well for patient tracking, and messaging in indoor environments.
Keywords: Real-time location system, Bluetooth low energy, iPhone application
Abstract: BACKGROUND: Demineralization can be arrested or reversed when remineralization agents are applied to incipient carious or non-cavitated carious lesions. A large number of therapeutic agents including non-fluoridated products have been developed to promote enamel remineralization. OBJECTIVE: This study aims to evaluate the efficacy of different bioactive elements containing toothpastes in remineralization of artificial enamel lesions. METHODS: Artificial carious lesions were created on 40 human enamel slabs, and were randomly divided into four groups: (1) control group (no treatment), (2) casein phosphopeptide-amorphous calcium phosphate group (CPP-ACP, GC Tooth Mousse), (3) 8% arginine…and calcium carbonate group (ACC, Colgate Sensitive Pro-Relief), (4) calcium sodium phosphosilicate group (CSP, NovaMin® ). All samples were subjected to 15 days of pH-cycling. Subsequently, a one-hour acid resistance test was carried out. Surface hardness of the samples was assessed using the Knoop hardness test, and surface morphology and roughness were assessed by scanning electron microscopy (SEM) and atomic force microscopy (AFM). Data were analyzed using one-way ANOVA, Tukey's test and paired t test. RESULTS: The three tested toothpastes exhibited a significantly higher remineralization efficacy compared with the control group (P< 0.05 for all). After pH-cycling, the specimens treated with Colgate Sensitive Pro-Relief and NovaMin® showed a significant higher surface hardness (P< 0.001 and P= 0.03, respectively) and lower surface roughness (P< 0.05 for both) compared those treated with GC Tooth Mousse. While after the acid resistance test, all groups showed a significant loss of surface hardness (P< 0.001 for all) and significant increase of surface roughness (P< 0.05). The specimens treated with Colgate Sensitive Pro-Relief and NovaMin® still showed a significant higher surface hardness and lower surface roughness in comparison with those treated with GC Tooth Mousse (P< 0.05 for all). No significant difference was found in surface hardness and roughness between Colgate Sensitive Pro-Relief and NovaMin® during the pH-cycling test and acid resistance test (P= 0.45 and P= 0.83, respectively). CONCLUSIONS: Colgate Sensitive Pro-Relief and NovaMin® present an advantage in enhancing remineralization and inhibiting demineralization for early enamel carious lesions in comparison with GC Tooth Mousse.
Abstract: BACKGROUND: Patients with lumbar degenerative disk disease (DDD) often require an interbody fusion. Several spacer systems have been developed to achieve an adequate fusion. The newly developed flexible interbody spacer system (Luna® , Benvenue Medical Inc.) expands to the disk space and is adjustable to the patient's anatomy. OBJECTIVE: Prospective monocentric evaluation of interbody fusions performed with the new system in patients with DDD to assess the device's efficacy and safety. METHODS: The study includes patients with DDD of one or two contiguous lumbar levels. All patients were treated with the new flexible…cage system. To evaluate the clinical outcome, examinations were conducted preoperatively, 6 weeks, 6 months and 12 months postoperatively. At each study visit possible implant loosening was assessed by plain radiography and any adverse events were documented. Furthermore, back pain was evaluated using the visual analogue scale (VAS), functional impairment using the Oswestry-Disability-Index (ODI) and quality of life using the SF36. RESULTS: A total of 30 patients (age: 52.8 ± 11 years, gender: 53% male) were included. None of the patients showed signs of implant loosening and the total number of adverse events was low (3%). The VAS improved significantly from 81.2 ± 9.5 mm at baseline to 28 ± 26.2 mm after 12-months (p ≤ 0.0001). The ODI also improved significantly from 57.9 ± 9.6% at baseline to 20 ± 15.6% after 12-months (p ≤ 0.0001). The physical component score (PCS) of the SF36 improved significantly ongoing from 29.2 ± 9.3 at baseline to 56.1 ± 14.9 after 12-months (p = 0.0079) and the mental component score (MCS) improved significantly from 49.2 ± 20.7 at baseline to 62.8 ± 18.9 after 12 months (p = 0.013). CONCLUSIONS: Minimal-invasive lumbar interbody fusion with the new flexible system is a safe and effective treatment method for patients with DDD. Complication rates are low and treatment leads to an improvement of pain, functional impairment and quality of life.
Keywords: Degenerative disk disease, flexible interbody fusion
Abstract: BACKGROUND: Periprosthetic Joint Infection (PJI) poses a great challenge to patients, surgeons and health care systems. Comorbid diseases and patient-related risk factors are poorly understood. OBJECTIVE: The purpose of this study was to evaluate patient-related risk factors for PJI after primary and after revision Total Hip Arthroplasty (THA). METHODS: In the present study, data was collected from 566 patients who underwent primary or revision THA between July 2011 and June 2012 in an established arthroplasty center (Endocert certified endoprosthesis center, EPZmax). The effects of demographic data and comorbid diseases on revision operations within…18 months following THA were analyzed using descriptive and explorative statistics. RESULTS: It was shown, that alcohol abuse, depression, preoperative ESBL (Extended Spectrum ß-Lactamase bacteria) infection, elevated preoperative serum-CRP (C-reactive protein), extended operation-time, extended length of hospital-stay, intraoperative complications, perioperative urinary tract infections and postoperative antibiotic therapy are significantly related to PJI in primary THA. CONCLUSIONS: Comorbid diseases seem to influence outcome after THA. They are important for predicting revision operations and implant survival. In severe high-risk cases, they can lead to perform the operation under precaution or to avoid performing the operation entirely. This should reduce PJI occurrences in future.
Keywords: Risk factors, periprosthetic joint infection, PJI, Total Hip Arthroplasty
Abstract: Treatment of fractures associated with fibrous dysplasia is difficult because of poor bone quality. In a brief report we present a case in which a hip prosthesis is connected with the distal part of a broken cannulated intramedullary femur nail. Postoperatively, the patient was mobilized with full weight bearing. Radiographs proved the correct position of the implant and a favorable clinical function could be achieved.
Abstract: BACKGROUND: Smoking is a risk factor in the process of bone healing after lumbar spondylodesis, often associated with complications that occur intraoperatively or during follow-up periods. OBJECTIVE: To assess if smokers yield worse results concerning lumbar interbody fusion than non-smokers in a clinical comparative setting. METHODS: Spondylodesis outcomes in 50 patients, 34 non-smokers (mean 58 years; (range 29-81) and 16 smokers (mean 47 years; range 29-75) were compared preoperatively and one year after spondylodesis surgery using Oswestry-Disability-Index (ODI), visual analogue scale (VAS) and radiological outcome analysis of fusion-success. RESULTS: Smokers…showed a comparable ODI-improvement (p = 0.9343) and pain reduction to non-smokers (p = 0.5451). The intake of opioids was only reduced in non-smokers one year after surgery. Fusion success was significantly better in non-smokers (p = 0.01). CONCLUSIONS: The results indicate that smoking adversely effects spinal fusion. Particularly re-operations caused by pseudarthrosis occur at a higher rate in smokers than in non-smokers.
Abstract: BACKGROUND: Myeloma patients often suffer from painful vertebral fractures (VCF) which impair their quality of life. Common methods for augmentation of the vertebrae are vertebroplasty, kyphoplasty and radiofrequency-targeted vertebral augmentation (RF-TVA). OBJECTIVE: This study evaluates the long-term effectiveness and safety of RF-TVA in the treatment of myeloma associated VCF. METHODS: Eighty-seven myeloma patients (mean age: 64.7 ± 9.5 years) with VCF were treated with RF-TVA. Patient data were assessed preoperatively and in five postoperative examinations up to 12 months. Pain was measured with the visual analogue scale (VAS) and the…impairment was evaluated with the Oswestry-Disability-Index (ODI) at each examination. In addition, the mid vertebral height, kyphosis angle, and additional fractures were evaluated by x-rays. Furthermore, cement leakage was documented. RESULTS: The VAS values were significantly improved in comparison to the preoperative values (p≤ 0.001), but slightly fluctuating during the follow-up period. The ODI was also significantly improved (p≤ 0.001), but it showed a worsening from the 12 months evaluation to the 24 months evaluation. The kyphosis angle and the vertebral height were significantly improved after surgery (p = 0.03, p ≤ 0.001), but worsened steadily to the last follow up examination. Cement leakage was asymptomatic and occurred in 18% of the patients. In 10% of the patients additional fractures were detected in the 24 months evaluation. CONCLUSIONS: The results of our study show that RF-TVA is a safe treatment for myeloma associated vertebral compression fractures, which achieves an acceptable improvement of patient's pain and quality of life.
Abstract: BACKGROUND: Urinary incontinence is a common problem among the elderly and patients with neurologic disability. The conventional urinary incontinence aids, such as urine-absorbing diapers, pads, and indwelling catheters, frequently cause hygienic problems. OBJECTIVE: To study the safety and efficacy of a new automatic urine disposal system that can suction and store the urine in a separate container for future disposal. METHODS: An electromechanical urine disposal system that can collect and transport the urine and cleanse and air-dry the external genitalia was developed. The hygienic effects of using this system were studied in 8…participants after 3 months of use. RESULTS: The caregivers of all 8 patients reported improved hygiene of their patients. None of the patients suffered from decubitus ulcers, and skin erythema was absent in 4 patients, while markedly decreased in the other 4 patients when compared with the use of urine-absorbing diapers. Four patients experienced minor urine leakage that was manageable with concurrent use of either diapers or bed pads. CONCLUSIONS: The use of an electromechanical urine disposal system relieves the caregiver from night care, as the urine is automatically collected and stored for disposal the next day. The system improves the hygiene of the patient, as the urine is immediately suctioned and the external genitalia is cleansed and dried after urination.
Keywords: Urinary incontinence, automatic urine disposal, skin erythema, continence aids
Abstract: BACKGROUND: At the emergency triage center, assessment of the present of the danger signs and measurement of vital signs are measured according to the guidelines. The respiration rate is still posing a challenge to the doctor as it is impractical to use conventional devices. Attaching measurement devices to the patient will induce artificial measurements (self-awareness stress effects) besides being time-consuming. Currently, the medical officers visually count the number of times the chest movement in a minute, sometimes poses cultural challenges especially for female patients. OBJECTIVE: The main objective of this paper is to develop a robust…algorithm to extract respiration rate using the contactless displacement sensor. METHODS: In this study, chest movements were used as an indicative of inspiration and expiration to measure respiratory rate using the contactless displacement sensor. The contactless optical signals were recorded from 32 healthy subjects in four different controlled breathing conditions: rest, coughing, talking and hand movement to obtain the motion artifacts that the patients may have in the emergency department. The Empirical mode decomposition (EMD) algorithm was used to derive continuous RR signal from the contactless optical signal. RESULTS: The analysis showed that there is a good correlation (0.9702) with RMSE of 0.33 breaths per minutes between the contact respiration rate and contactless respiration rate using empirical mode decomposition method. CONCLUSION: It can be concluded that the empirical mode decomposition method can extract the respiration rate of the contactless optical signal from chest movement.
Abstract: Recent statistics released by Alzheimer's Disease International has highlighted how prevalent dementia will become in the next couple of years. Along with the increased incidence of individuals being diagnosed with dementia, there has also been an increment in the number of informal carers for people living with dementia. A recent report highlighted that in Australia, there are an estimated of 200,000 informal carers as of 2011. Caring for people who are living with dementia is not an easy task. Previous studies have highlighted that as much as 65% of caregivers do experience symptoms suggestive of depressive symptoms in the process…of care. With the rapid advances in technology, it is of no surprise that information technology and its related innovations have been used in dementia care. A review of the existing literature shows that much of these innovations are focused on the care of patients affiliated with dementia. However, clearly interventions focusing on the needs of the dementia cohort of patient are limited. There are currently more emerging studies demonstrating the efficacy of web-based interventional toolkits for carers who are caring for individuals with dementia. Whilst there are previous studies demonstrating the effectiveness of smartphone interventions for dementia patients, there remains a paucity of smartphone based interventions for caregivers who are living with people with dementia. This technical note describes the conceptualization of an evidence based smartphone intervention for patients living with dementia, as well as for carers of these patients.
Keywords: Smartphone, mobile phone, applications, dementia, caregiving, caregivers burden
Abstract: To evaluate the feasibility and effectiveness of using endoscopic low-temperature plasma radiofrequency ablation (RFA) for treatment of laryngeal plexiform neurofibromatosis-1 (NF-1). An infant diagnosed as laryngeal plexiform NF-1 based on a detailed medical history, as well as physical, laboratory, and pathological examinations, was treated under general anesthesia with low-temperature plasma RFA in combination with a self-retaining laryngoscope and high definition camera system. The laryngeal plexiform NF-1 tumor was successfully excised using endoscopic low-temperature plasma RFA without complications. Following surgery, the infant displayed an uneventful recovery and no disease recurrence during a 2-year follow-up period. low-temperature plasma RFA is a…feasible and effective method for treating laryngeal plexiform NF-1, and has advantages of producing minimal bleeding, providing complete removal of the tumor, and causing only slight degrees of trauma and postoperative tissue reaction.