Lasers in Surgery and Medicine最新文献

Background

Paronychia is a common side effect of anticancer therapies, particularly epidermal growth factor receptor inhibitors (EGFRIs). Standard treatments often provide limited relief. Pulsed dye laser (PDL) therapy at 595 nm, with vascular-targeting and anti-inflammatory effects, may serve as an effective adjunctive treatment.

Objective

To evaluate the clinical efficacy and safety of adjunctive 595-nm PDL therapy in the treatment of paronychia induced by anticancer drugs, particularly EGFRIs.

Materials and Methods

This prospective pre-post study included 70 digits with anticancer drug-induced paronychia, Common Terminology Criteria for Adverse Events [CTCAE] grade 1–2, from ten patients. After a 2-week run-in with standardized treatment, participants received 4 weekly sessions of 595-nm PDL therapy. Outcomes—assessed at baseline, each visit, and 2 weeks posttreatment—included erythema index (EI), modified Severity of Paronychia Assessment Tool (SPOT) score, pain, edema, Physician Global Assessment (PGA), patient satisfaction, and adverse events.

Results

PDL therapy significantly reduced the EI from 1.63 to 1.42 (p < 0.001) and edema from 1.67 to 1.45 (p < 0.001). Modified SPOT scores improved from 3.61 to 1.99 (p < 0.001), with early pain relief observed (4.40–1.25; p < 0.001). PGA improved by Week 3, and patient satisfaction increased from 0 to 100 by Week 5 (p < 0.001).

Conclusion

PDL adjuvant therapy significantly improves both clinical signs and patient-reported outcomes in anticancer drug-induced paronychia.

Objectives

Severe recurrent acute tonsillitis (RAT) is commonly treated by removing the palatine tonsils, namely tonsillectomy (TE). Laser TE has been suggested as an alternative to cold steel dissection, although its efficacy and safety for the surgical treatment of RAT remain unclear. Therefore, we conducted a systematic review and meta-analysis comparing laser TE to cold steel dissection TE in patients with RAT.

Methods

We systematically searched PubMed, Embase, and Cochrane Central for eligible studies. Outcomes of interest were intraoperative blood loss, operation time, quality of life, postoperative pain, and postoperative hemorrhage. Subgroup and sensitivity analyses were performed. RStudio v4.1.0 and Review Manager v5.4 were used for statistical analysis. A prospective protocol was registered in PROSPERO (CRD42024533742).

Results

Nine studies, including six randomized trials, met eligibility criteria, comprising 612 patients with RAT. In total, 1224 tonsils were excised; 612 (50%) were submitted to laser TE, and the remaining to cold steel dissection. Laser was associated with lower intraoperative blood loss (mean difference [MD] −35.89; 95% confidence interval [CI] [−53.08, −18.71]; p < 0.01; I² = 100%) and operation time (MD −10.46; 95% CI [−16.63, −4.29]; p < 0.01; I² = 99%). No significant differences between interventions were found in postoperative pain, quality of life, or postoperative hemorrhage.

Conclusions

In patients with RAT, laser TE yielded reduced intraoperative blood loss and operation time, with comparable hemorrhage risk, postoperative pain, and quality of life to cold steel dissection. Yet, the occurrence of post-surgery sore throat remains uncertain, highlighting the need for further randomized trials reporting long-term outcomes after tonsil surgery.

Objectives

Limited-cutaneous systemic sclerosis (lcSSc), formerly known as CREST syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, scleroderma, and telangiectasias) is an auto-immune connective tissue disease characterized by cutaneous fibrosis and systemic fibrovascular dysfunction. The cutaneous fibrosis of lcSSc is commonly limited to acral sites, with perioral involvement seen in 70%–85% of cases. Patients often seek treatment of lcSSc-associated microstomia for functional and cosmetic purposes. Treatments for the cutaneous sclerosis in systemic sclerosis (SSc) include topical agents, systemic immunosuppressants, phototherapy, and other less commonly used systemic medications. More recently fractional ablative laser therapy with the carbon dioxide (CO₂) laser has been utilized in scarring disorders of the skin with notable improvement in cutaneous fibrosis. Here we report a case of a 54-year-old female with lcSSc-associated microstomia treated with fractional ablative CO₂ laser. The goal of treatment was to improve the objective size of the oral aperture and improve subjective symptoms, including oral mobility, speech, and eating.

Materials and Methods

The Lumenis Ultra Pulse CO₂ laser was used to fractionally ablate the target peri-oral skin. Pulses were performed up to but not crossing the vermillion border circumferentially around the mouth. Measurements in centimeters were taken pretreatment as well as 2 and 5 months posttreatment. Appropriate infectious prophylaxis was provided to the patient.

Results

Notable increases were observed at 2 and 5 months follow-ups in horizontal width (+14.3%), vertical height (+12.1%), and cross-sectional areas (+28.1%) of the oral aperture following a single treatment with CO₂ laser. Subjective improvements in oral mobility, speech, and daily activities such as eating were noted by the patient.

Conclusion

Ablative fractional CO₂ laser is an effective and efficient method for the treatment of microstomia secondary to systemic sclerosis with minimal adverse effects. Utilizing this therapeutic treatment can significantly impact the quality of life in patients with lcSSc-associated microstomia.

Objectives

There have been concerns regarding combining procedural treatments for acne scars concurrently with isotretinoin (ISO) treatment due to risks of delayed healing and adverse events. However, recent studies showed favorable outcomes of several procedures without serious side effects, though evidence in Southeast Asians is lacking. This study aims to demonstrate the safety and efficacy of fractional ablative carbon dioxide laser (AFCL) for acne scars in concurrence with ISO treatment in the population with Fitzpatrick skin type (FST) 3 or higher.

Material and Methods

This prospective study enrolled Thai participants with acne scars of 2 or more based on the Qualitative Global Scarring Grading Score (QGSGS). Twenty-five participants were currently on ISO 30–70 mg/week. Investigators provided whole-face AFCL three times along with assessments of adverse events, edema, crusting, and erythema at baseline, Months 1 and 3. At Months 1, 3, and 6, post-inflammatory hyperpigmentation (PIH) and acne scars were examined by clinical and quantitative evaluations.

Results

Of the 50 participants, 45 completed the study, with most classified as FST 4 and 5. The post-laser edema and erythema showed no significant difference in the severity between both groups. However, participants in the non-ISO group experienced significantly more severe crusting following treatment (p-value = 0.006). The incidence of PIH was 23.81% (ISO) versus 42.23% (non-ISO) (p-value = 0.024). Depression volume and the QGSGS showed significant reduction compared to the baseline; however, there was no significant difference between groups.

Conclusions

Thus, AFCL is a safe and effective treatment for acne scar patients with FST of 3 or higher in Southeast Asians currently undergoing oral ISO.

Sepsis is a systemic inflammatory response syndrome caused by infection, potentially leading to severe organ dysfunction or septic shock.

Objectives

This study aimed to evaluate the effects of vascular photobiomodulation (VPBM), on metabolic parameters in hospitalized patients with sepsis, addressing both efficacy and mechanistic insights.

Methods

Conducted as a randomized, blind, controlled clinical trial with 30 participants, the study divided patients into a Control Group (CG) and an Intervention Group (VPBMG). The VPBMG received a 660 nm red laser, delivering 180 J of energy, applied to the radial artery for 30 min over 5 consecutive days. The sample was predominantly male, averaging 40 years of age and 80 bpm heart rate.

Results

From the third day, the VPBMG group showed significant reductions in WBC, PCO₂, PaO₂, lactate, creatinine, SpO₂, and pH levels (p < 0.001).

Conclusions

These findings suggest VPBM improves sepsis-related clinical and biomarker parameters, offering promise as a therapeutic option for managing this critical condition.

Objectives

Sjögren's syndrome (SS) is an autoimmune disorder that affects multiple systems, including hypofunction of salivary and lacrimal glands, associated with xerostomia and keratoconjunctivitis sicca. Current treatments for SS aim to alleviate symptoms and prevent complications by providing therapeutic support to patients. In this context, photobiomodulation therapy (PBMT) with low-level laser has demonstrated efficacy in managing conditions associated with reduced salivary flow, including SS.

Methods

This study reports a case of a 17-year-old female patient diagnosed with SS who underwent PBMT targeting the major salivary glands to alleviate symptoms of xerostomia. Fifteen sessions of PBMT were conducted using an infrared low-level semiconductor diode laser.

Results

A significant improvement in salivary flow was observed, increasing from 0.4 to 1.64 mL/min post-therapy, with results maintained 6 months after the final application. In addition, the patient's initial moderate xerostomia was reduced to mild, as assessed by a questionnaire using a numerical visual scale.

Conclusions

PBMT with a low-level laser proved to be an effective nonpharmacological therapeutic option for conditions of xerostomia in SS, particularly in young patients. Further studies with larger patient samples are necessary to validate the effectiveness of this promising therapy for this patient population.

Introduction

Diabetic foot ulcers affect approximately 15% of individuals with diabetes, compromising their quality of life and placing an additional burden on the public health system.

Objectives

This study aims to evaluate the effects of the antimicrobial photodynamic therapy (aPDT) in tissue repair through the analysis of two case studies involving individuals with diabetes-related foot lesions.

Methods

aPDT was performed using 1% methylene blue, a cluster of four red lasers (660 nm) with an average radiant power of 100 mW, and radiant energy per emitter of 6 J. The exposure time was 1 min, resulting in a total radiant energy per session of 24 J. Patients were evaluated on sessions 1, 3, 5, 10, and 30 days after the completion of treatment.

Results

Using the Bates-Jensen Wound Assessment Tool (BWAT) scale as a tool to assess wound progression, Patient 1 had an initial score of 37 points, which reduced to 24 points by the end of treatment, resulting in a decrease of 13 points on the scale. Patient 2 started with 36 points and finished with 14 points, achieving complete healing.

Conclusions

Treatment led to improved wound quality, evidenced by a reduction in BWAT scores, a 74.9% decrease in wound area in patient 1 with consistent healing progress, and complete wound closure in patient 2. Although limited by its case-series design, this study contributes preliminary clinical evidence suggesting the potential benefits of antimicrobial photodynamic therapy (aPDT) in the management of diabetic foot ulcers and highlights the need for larger, controlled trials to validate its efficacy. In conclusion, aPDT was effective across all evaluated outcomes in these two reported cases.

Trial Registration

NCT06416462 (initial release: 09/23).

Background

Current treatment options for facial erythema associated with acne and rosacea include oral and topical treatments. Physical modalities are also commonly used recently. Combination therapy usually works better than a single therapy. There are few studies on the therapeutic effect of IPL combined with TXA on facial erythema.

Objective

To study the efficacy of intense pulsed light combined with 3% tranexamic acid in the treatment of facial erythema associated with acne and rosacea.

Methods

A total of 56 patients were included in the study. They were randomly divided into the observation group and the control group, with 28 cases in each group. The observation group was treated with intense pulsed light combined with 3% tranexamic acid for external use, while the control group was treated with intense pulsed light only. The clinical efficacy, erythema degree, and skin disease quality of life index score before and after treatment were observed in the two groups, and the results were compared.

Results

After treatment, both groups showed improvement; the observation group exhibited a significantly higher overall effective rate than the control group (p < 0.05). The scores of erythema index and skin quality of life index in the observation group were lower than those in the control group, and the differences were statistically significant (p < 0.05). There were no obvious adverse reactions in both groups.

Conclusion

Intense pulsed light combined with 3% tranexamic acid can effectively improve the degree of acne and rosacea erythema without serious adverse effects.