Medical laser application : international journal for laser treatment and research最新文献

Purpose

Thulium:YAG (Tm:YAG) laser vapoenucleation (ThuVEP) has been introduced in the treatment of benign prostatic obstruction (BPO) with promising results. However, with an aging population in the industrialized nations and improved medical therapy, the patients seeking treatment for BPO are getting older. Surgical therapy in this group of patients may not only be less effective due to the overall constitution of the patient but also due to the prolonged time of suffering from BPO. The aim of this study was to evaluate intermediate-term efficacy of ThuVEP in older patients. The outcome and complications of patients were analyzed after a postoperative follow-up period of 12 months and the results of subgroups aged both above and below 75 years were compared.

Material and methods

Laser prostatectomy was performed using a 70 W Tm:YAG 2 μm continuous wave laser (LISA laser, Katlenburg, Germany) in combination with a continuous-flow laser resectoscope and a mechanical tissue morcellator (R. Wolf, Knittlingen, Germany). The condition of patients was followed in terms of improvement of uroflow and post-void residual urine, intra- and postoperative course and the occurrence of complications.

Results

Eighty consecutive patients were included in this prospective observation. Patients were grouped according to age. Subgroup I included patients with an age ≥75 years, subgroup II included patients <75 years. The mean age was 80.2 years in subgroup I and 66.6 years in subgroup II. Preoperative data was comparable in both groups, as well as improvements in postoperative voiding function.

Conclusion

Transurethral ThuVEP is a safe and effective therapy method even in older patients. The patient's age does not influence the functional operative outcome.

Objective

A study was undertaken to assess a technique of 360° ablation of urethral stricture tissue with a 120 W KTP laser in comparison with the results of visual internal urethrotomy.

Materials and methods

Ninety-three men with urethral strictures were treated with 120 W KTP laser vaporization using the circumferential technique to eliminate the entire stricture. The strictures were located at the bladder neck in 14 men, the bulbar urethra in 65 patients and the penile urethra in the remaining 14 patients. The follow-up ranged from 6 months to 2 years with an average of 13 months. All patients had flexible urethroscopy 4 weeks after the laser vaporization and then a follow-up examination at 6 months and 1 year.

The treatment was considered a success when no further therapy was required. Satisfactory results were established if the patient needed only one post-treatment therapy with dilatation using sounds or a catheter. The treatment was designated a failure when patients needed multiple therapies or another operative procedure.

Results

The success rate for strictures at the bladder neck was 92% (13/14 men) with satisfactory in 8% (1/14 man) and there were no failures.

At the bulbar urethral stricture site, vaporization was successful in 80% (52/65 men), satisfactory in 9% (6/65 men), and failed in 11% (7/65 men). Penile urethral strictures had success with 71% (10/14 men) and 29% (4/14 men) were considered failures.

Conclusion

Ninety-three men with urethral strictures were treated with a 120 W KTP laser. The overall success rate was 81%. With improved technique and the advent of the 180 W KTP laser, further improved results are to be expected.

Background

Intercellular adhesion molecule-1 (ICAM-1) is a member of the immunoglobulin super family of adhesion molecules that plays a role in transendothelial migration and adhesion processes involved in the pathogenesis of psoriasis. Previous studies have demonstrated partial and total clearance of psoriasis by selective photothermolysis of dermal vessels with the pulsed dye laser.

Objective

The aim of this study is to assess the efficacy of the pulsed dye laser (PDL) in treatment of chronic psoriatic plaque lesions by measuring changes in ICAM-1 expression in the epidermis and dermis of psoriatic patients before, during and after treatment, with correlation to the clinical improvement.

Patients and methods

Sixty patients with chronic plaque psoriasis were treated with flashlamp-pumped pulsed dye laser (FPDL) with 585 nm wavelength, 450 μs pulse duration, 7–8.5 J/cm² fluence, and 7 mm spot size. Sessions were performed every 2 weeks with each patient receiving a total of 3 sessions. Clinical, histological, and immunohistochemical assessments were carried out. A correlation between plaque severity score (sum score) and changes in the mean of ICAM-1 expression was assessed throughout and after treatment.

Results

Reduction of ICAM-1 expression mean in psoriatic lesion was 1.83 ± 0.29 at week 2, 1.60 ± 0.19 at week 4, and 1.53 ± 0.18 at week 6 from the start of the laser treatment, compared to the baseline which was 2.90 ± 0.40. In the control group, ICAM-1 expression was 0.60 ± 0.07. A significant correlation between clinical improvement and reduction in ICAM-1 expression at weeks 4 and 6 of laser treatment was proven (p < 0.05).

Conclusion

ICAM-1 expression is reduced significantly after treatment of psoriasis with pulsed dye laser, which can be used as an indicator for its efficacy.

Background and objectives

Ablative fractional carbon dioxide (CO₂) laser treatment has gained popularity for several clinical indications due to its superiority in the treatment of rhytides, scars and photodamaged skin. The concept of ablative fractional photothermolysis (AFP) enables the induction of dermal coagulative injury without confluent epidermal damage, reduces side effects and shortens downtime. To date, less is known about its safety and efficacy on Asian skin where dyspigmentation is suspected to be one of the most challenging adverse events.

Materials and methods

78 Asian and 7 Caucasian subjects underwent 1–3 AFP treatments using a scanned 250 μm CO₂ laser beam for the indications of scar reduction (n = 42), skin tightening (n = 32), enlarged pores (n = 6) and others (n = 5). Two patients were treated for both acneiform scars of the face and atrophic scars on the neck so that in summary, 87 treatment sites received laser therapy. Post-treatment erythema (redness) and edema (swelling) as well as overall satisfaction were graded on a quartile scale with scores from 0 to 3. All designated and observed side effects were noted by blinded observers.

Results

The patient satisfaction (scored by a blinded observer) after AFP for scar reduction, skin tightening, and enlarged pores ranged from minimal to marked clinical improvement with a tendency for a better outcome after repeated treatments. Erythema and edema lasted for 1–4 days in all patients and only one patient developed post inflammatory hyperpigmentation (PIH) after the first treatment.

Conclusion

The presented results allow the conclusion that AFP performed by a scanned CO₂ laser is a safe and effective treatment modality for the improvement of rhytides and photodamaged skin, scarring, enlarged pores and hyperpigmentation in both Asian and Caucasian people, with a minor risk of dyspigmentation. Potential refinement of the number of sessions and treatment parameters need further evaluation to maximize the therapeutic efficacy for the different indications.

Background

Periodontitis is an inflammatory disease of the supportive tissue of teeth caused by specific microorganisms. Periodontitis is a typical example of a chronic inflammatory reaction which cannot develop without an associated inflammation, since it is always attended by gingivitis with marked inflammation. The aim of the paper is to show the anti-inflammatory effects on gingiva by combined therapy (conservative therapy complemented with laser therapy).

Material and methods

A total of 34 patients were examined who had been diagnosed with chronic periodontitis. In the experimental group 17 patients were treated using conservative methods (scaling and root planing) followed by a low level laser therapy (LLLT) with a Scorpion-SM-405-7A system (OPTIKA-LASER; Sofia, Bulgaria), and the patients of the control group (n = 17) were treated only with scaling and root planing (SRP).

Clinical measurements included probing pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), as well as supragingival plaque measurements (PL) and gingival crevicular fluid (GCF) measurements in pockets and were undertaken before therapy (baseline), and three and six months, respectively after the therapy had been completed.

Results

All the subjects in each group completed all phases of the study. Six months after the therapy, the average PPD, CAL and CGF reduction in the experimental group with LLLT was significantly greater (p < 0.05) than for the patients receiving only conservative therapy. The reduction in CAL and GCF at the treated sites was greater than at the SRP sites, although the difference was statistically significant for the six month visit only (p < 0.05).

In the group using only conservative therapy, histological findings of gingivae showed a reduction in the number of inflammatory cells and partial stroma collagenization, while histological findings in gingivae after the laser therapy indicated completely regenerated gingival tissue with few inflammatory cells as well as marked collagen tissue homogenization.

Conclusion

Based on the results obtained, it can be concluded that the use of LLLT as an adjunct procedure in the conservative treatment of periodontitis is very successful in reducing gingival tissue inflammation.

Introduction

Hypertrophic scars and keloid formation are common problems which are not only the result of surgical procedures. Many treatment protocols exist without standardization. The aim of our study was to compare various treatment protocols using a 2940 nm Er:YAG laser with and without additional silicone gel application.

Patients and methods

Twenty-one patients suffering from keloids or hypertrophic scars were treated in four groups with the Burane XL Er:YAG laser (Quantel Derma GmbH; Erlangen, Germany) either in thermal or combined thermoablative mode with or without additional silicone gel application under non-blinded conditions. The appearance of the scars (redness, hardness and elevation) before therapy, and 12 months after therapy was evaluated by therapists based on a scaling system from 0 to 3 (0 = minimum, 3 = maximum).

Results

The patient group was made up of 21 people, 16 females and five males, ranging in age from 16 to 79 years. All patients had a mean reduction of redness, hardness and scar elevation by 51.3% (p = 0.0012), 48.9% (p = 0.0015) and 50.0% (p = 0.0015), respectively. There was no significant difference between groups with or without additional silicone gel application (p > 0.05).

Conclusion

Our pilot study proved the effectiveness of Er:YAG laser treatments (thermal and combined thermoablative mode) for the reduction of hypertrophic scars and keloids. However, the additional application of silicone gel was not as effective as postulated. Larger randomized double-blinded studies are needed to further evaluate treatment protocols for hypertrophic scars and keloids.