Complicaciones oculares secundarias a depilación de las cejas con láser diodo / Ocular complications secondary to diode laser-assisted eyebrow epilation

Se describen dos casos clínicos de complicaciones oftalmológicas secundarias a depilación con láser diodo de las cejas.Los dos pacientes incluidos son mujeres que, horas después de someterse a un procedimiento de depilación con láser diodo en la zona de las cejas, presentan fotofobia y visión borrosa. Ambas son diagnosticadas de uveítis anterior aguda y tratadas con corticoides tópicos y midriáticos. En el seguimiento se constata la presencia de secuelas (midriasis y corectopia en ambas pacientes, catarata en la segunda) derivadas del procedimiento láser.El tratamiento con láser depilatorio de las cejas puede inducir daños oculares irreversibles. Es necesario informar a los usuarios de estas técnicas de los riesgos que conllevan y utilizar dispositivos de seguridad.Destacamos la importancia de los efectos secundarios oftalmológicos derivados del uso de estos láseres (AU)

We describe two cases of ocular complications secondary to Diode laser assisted eyebrow epilation.Both included patients were women who underwent an eyebrow epilation procedure with Diode laser. A few hours after the procedure they started complaining with photophobia and blurred vision. They were diagnosed with anterior acute uveitis and treated with topical steroids and mydriatics. During the follow-up the presence of sequelae derived from the laser procedure (mydriasis and corectopia in both patients, cataract in the second one) was confirmed.Laser hair removal of the eyebrows can induce irreversible eye damage. Complete and reliable information regarding the potential side effects of this procedure and proper use of appropriate safety devices is mandatory.We point out the importance of the potential ocular side effects associated with these cosmetic devices (AU)

Photobiomodulation therapy reduces postoperative pain after third molar extractions: A randomized clinical trial / La terapia de fotobiomodulación reduce el dolor posoperatorio después de extracciones de terceros molares: un ensayo clínico aleatorizado

Background: To assess the efficacy of PBMT on reducing postoperative pain scores in patients submitted to thirdmolar extractions.Material and Methods: A randomized controlled trial (ReBEC:RBR-94BCKZ) was designed according to theSPIRIT and followed the CONSORT. Patients were randomly allocated according to control or PBMT groups.PBMT consisted of the application of GaAlAs laser (808nm;50mW) applied in six points (1.23 min;11 J/cm2) afterextraction. Pain scores were assessed using the Visual Analogue Scale (VAS) in millimeters evaluated after 6(T6), 24 (T24), and 48 (T48) hours. The Wilcoxon Mann–Whitney test was used to check for possible associationsbetween VAS scores and treatment groups.Results: A total of 101 third molar extractions were performed in 44 patients. The mean age was 28 yearsold(SD±11.54). Comparing control and intervention, PBMT group showed a significant effect on the reductionof postoperative pain at T6(mean VAS=0.9; C.I:0.63–1.16) compared to control (mean VAS=2.5;C.I:2.1–2.88)(p<0.001). The same statistically significant effect on the reduction of postoperative pain was observed at T24(PBMT mean VAS=0.72;C.I:0.51–0.93; control mean VAS=2.86;C.I:2.40–3.31;p<0.001) and T48 (PBMT meanVAS=0.64;C.I:0.36–0.92; control mean VAS=2.86;C.I:2.37–3.34;p<0.001).Conclusions: PBMT significantly reduce the postoperative pain scores when assessed 6, 24, and 48 hours afterthird molar extractions.(AU)

Tratamiento de fístula enterocutánea combinando láser diodo y embolización / Combined treatment of enterocutaneous fistula with laser diode and embolization

INTRODUCCIÓN: El tratamiento delas fístulas enterocutáneas establecidas en pacientes multioperados es complejo y requiere de soluciones creativas. Presentamos la resolución de un caso con láser diodo y con cianoacrilatos. CASO CLÍNICO: Paciente de 15 años, diagnosticado a los 12 de colitis ulcerosa y sometido a pancolectomía con ileostomía urgente por brote refractario al tratamiento médico. Cinco meses después se realizó un descenso ileoanal con reservorio dejando ileostomía de protección, pero presentó un posoperatorio tórpido con infección pélvica, precisando dos nuevas laparotomías urgentes, para lavado y hemostasia. Seis meses después, se evidenció una estenosis de la anastomosis que se resolvió tras varias dilataciones, neumáticas bajo visión endoscópica y domiciliarias con tallos de Hegar. Un año después se cerró la ileostomía, presentando al mes una distensión abdominal y aparición de fístula en línea media abdominal, que pudo tutorizarse endoscópicamente, observando su origen en la anastomosis ileoanal. Se trató mediante sesiones de láser diodo, con mejoría parcial, aunque persistía la salida de gases. Un año después se embolizó implantando espirales de platino y cianoacrilatos diluidos con lipiodol, resolviéndose totalmente el cuadro. Transcurridos 17 meses de esta última intervención, el paciente se encuentra asintomático, con continencia fecal total diurna y nocturna, tres deposiciones al día y la fístula está totalmente cerrada. CONCLUSIÓN: El tratamiento con láser diodo, combinado con embolización con espirales de platino y cianoacrilatos, puede ser un tratamiento eficaz con baja morbilidad de las fístulas enterocutáneas establecidas

INTRODUCTION: Enterocutaneous fistula treatment in patients undergoing multiple surgeries is complex and requires creative solutions. We present the case of an enterocutaneous fistula managed with laser diode and cyanoacrylates. CLINICAL CASE: 15-year-old patient, diagnosed with ulcerative colitis at 12 years of age, undergoing full colectomy with urgent ileostomy as a result of a flare-up refractory to medical treatment. Five months later, an ileoanal pull-through with pouch was carried out, leaving a protection ileostomy in place. However, postoperative evolution was poor, with pelvic infection, so two further urgent open surgeries were required for lavage and hemostasis purposes. Six months later, anastomotic stricture was noted. It was healed following various pneumatic dilations under ultrasound vision and at-home dilations using Hegar dilators. One year following this, ileostomy was closed, but one month later, abdominal distension occurred. It was associated with a fistula in the abdominal midline, which could be endoscopically guided, with its origin being located at the ileoanal anastomosis. Laser diode sessions were applied for treatment purposes, with partial improvement, but still with gas emission. One year later, embolization was performed by placing platinum coils and lipiodol-diluted cyanoacrylates, and clinical signs disappeared. 17 months following this surgery, the patient has no symptoms, with full day and night fecal continence and 3 daily stools, and the fistula is completely closed. CONCLUSION: Combined treatment with laser diode and platinum coil and cyanoacrylate embolization proves effective in the management of enterocutaneous fistula, with low morbidity

Comparison of diode laser - Oral tissue interaction to different wavelengths. In vitro study of porcine periodontal pockets and oral mucosa

BACKGROUND: The aim of this in vitro study was to evaluate the effect of diode lasers at different wavelengths and power settings in handmade incisions in periodontal pockets and in oral mucosa of porcine tissue considering thermal damage, necrosis and the affected area of the soft tissue. MATERIAL AND METHODS: Combining the following laser wavelengths, 445 nm, 532 nm (KTP), 810 nm, 980 nm, 1064 nm and 1470 nm, and a power range from 0.5W to 2.0W in a continuous wave mode (CW), we made handmade incisions in porcine periodontal pockets and oral mucosa. After histological processing, we measured the area of lost tissue, the area of thermal damage and the area of necrosis. Then, we performed ANOVA to evaluate the difference between groups and two-way ANOVA to identify the influence of the laser-type variables and the power on the results. RESULTS: We applied an ANOVA test to evaluate the results, where statistical analysis showed clear differences between the 1470nm and 810nm laser groups that refer to thermal damage and necrosis in the periodontal pocket surface. Regarding the oral mucosa surface, the 1064 nm laser showed differences in the analysis of lost tissue. According to the applied power, all the variables we studied (lost tissue area, area of thermal damage and necrosis) showed higher values when using a power of 2.0W instead of 0.5W. CONCLUSIONS: According to our results, the 810nm diode laser for oral soft-tissue biopsy using power ranges between 0.5W and 2W would be the best choice to avoid thermal damage in peri-incisional margins

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Eficacia del láser de diodo de arseniuro de galio en el tratamiento de 2 casos de liquen plano oral / Effectiveness of 904 nm Gallium-Arsenide Diode Laser in Treatment of Oral Lichen Planus: Report of 2 Cases

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A histological evaluation of the surgical margins from human oral fibrous-epithelial lesions excised with CO2 laser, Diode laser, Er:YAG laser, Nd: YAG laser, electrosurgical scalpel and cold scalpel

Background: We aim to evaluate the presence of histological artefacts in the surgical margins of human oral fibro-epithelial hyperplasias excised with lasers of different wavelengths, and also electrosurgical scalpel and cold scalpel. Moreover, we aim to determine if some of these instruments could impair the normal histological diagnosis of these lesions. Material and Methods: We included 130 consecutive surgical samples of 80 females and 50 males (mean age of 53.82±16.55) with a histological diagnosis of an oral benign fibrous-epithelial hyperplasias. The samples were categorized into 6 groups according to the type of instrument used: CO2 laser group, diode laser group, Er:YAG laser group, Nd:YAG laser group, electrosurgical scalpel group and cold scalpel group. Histological instrument-induced changes were microscopic evaluated and related with clinical and pathological variables. Results: The instrument with highest tissue damage extension (TDE) was the electrosurgical scalpel (1002.2μm±434.92), followed by diode laser (913.73 μm±322.45), Nd:YAG (899.83μm±327.75), CO2 laser (538.37μm±170.50), Er:YAG laser (166.47μm±123.85), and at last with fewer alterations the cold scalpel group (2.36μm±7.27) (P < 0.001). The most regular incision was observed in CO2 laser group, followed by Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and diode laser group with the less regular incision using cold scalpel as comparison (P < 0.001). A correlation was found between the incision score and TDE (P < 0.001). Regarding histological diagnosis, no case showed any limitation of diagnosis related with the use of any instrument evaluated. Conclusions: Our results suggest that lasers can be used for the excision of oral benign fibrous-epithelial hyperplasias, without hispathological diagnosis limitations, as long as the physical properties of each laser are known and respected. Er:YAG laser have shown to be a laser with few tissue damage extension and with good incision regularity, been a possible instrument of choice for the surgical removal of these lesions

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Eficacia y seguridad de la ciclofotocoagulación transescleral con micropulsos en el tratamiento del glaucoma / Efficacy and Safety of Micropulse(R) Transscleral Cyclophotocoagulation in Glaucoma

PROPÓSITO: Comunicar nuestros resultados con la ciclofotocoagulación transescleral con el láser diodo Micropulse(R) (Iridex) en el tratamiento del glaucoma. MÉTODOS: Estudio retrospectivo en pacientes adultos con glaucoma con al menos 6 meses de seguimiento y solo una sesión de Micropulse(R). Se utilizó la misma técnica quirúrgica, el único parámetro de láser que podía variar fue el tiempo total de tratamiento (en segundos). Los parámetros restantes se mantuvieron fijos en 2 W de potencia y 0,5 ms (31,3%) de ciclo activo. RESULTADOS: Se obtuvo un total de 22 ojos de 17 pacientes con glaucoma de diversos tipos y estadios (en su mayoría congénitos y pseudoexfoliativos). El tiempo medio de seguimiento fue 7,9 meses. La duración total del tratamiento varió de 100 a 180 segundos. Definición de éxito: 5 mmHg < presión intraocular (PIO) < 21 mmHg, y una reducción ≥ 20% del valor basal y no adición de inhibidores orales de la anhidrasa carbónica y no reoperación. La tasa de éxito global fue del 72,7% en el primer mes, del 54% a los 4 meses, del 41% a los 6 meses y del 27,3% en el seguimiento final. Los pacientes tratados con duraciones de tratamiento más prolongadas (180 s) lograron mejores resultados. La reducción promedio de la PIO en ojos exitosos fue del 36% (de 26,3 a 16,7 mmHg, DE: 4,58, p = 0,028). No se informaron complicaciones. CONCLUSIONES: En una población heterogénea de glaucoma (principalmente de tipo congénito y pseudoexfoliativo) obtuvimos una baja tasa de éxito (27,3%) en el mediano plazo con una sola sesión de Micropulse(R)

OBJECTIVE: To report the results using Micropulse(R) transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. METHODS: Retrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse (R). The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5 ms (31.3%) of active cycle. RESULTS: A total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180 seconds. Definition of success: 5 mmHg < Intraocular pressure (IOP) < 21mmHg and a reduction of ≥ 20% of the baseline value and no addition of oral carbonic anhydrase inhibitors, and no re-operation. The overall success rate was 72.7% in the first month, 54% at 4 months, 41% at 6 months, and 27.3% at final follow-up. Patients with longer treatment durations (180 s) achieved better results. The mean reduction in IOP in successful eyes was 36% (from 26.3 to 16.7 mmHg, SD 4.58, P = .028). No complications were reported. CONCLUSIONS: In a heterogeneous population of glaucoma (mostly congenital and pseudoexfoliation types), a low success rate (27.3%) was obtained in the medium-term with a single session of Micropulse(R)

Tratamiento primario con láser diodo en malformación venosa cervical de gran tamaño / Laser diode treatment of a giant lateral-neck venous malformation

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Queratitis neurotrófica posciclofotocoagulación transescleral con láser diodo / Neurotrophic keratitis after transscleral diode laser cyclophotocoagulation

OBJETIVO: Estudiar la relación existente entre el tratamiento con ciclofotocoagulación transescleral con láser de diodo y el desarrollo de queratitis neurotróficas por lesión de la inervación sensitiva corneal. MÉTODOS: Se han estudiado 5 ojos de 5 pacientes que fueron tratados con ciclofotocoagulación transescleral con láser de diodo y al poco tiempo desarrollaron úlceras neurotróficas. Se han recogido las diferentes características personales de los pacientes, incluyendo refracción y factores de riesgo de hipoestesia corneal, así como los parámetros de láser empleados en el tratamiento. RESULTADOS: Se comprobó que los 5 pacientes presentaban factores predisponentes de hipoestesia corneal previos a la cirugía (uso de betabloqueantes tópicos crónicos, cirugías corneales, diabetes mellitus o distrofias corneales). Sin embargo, ninguno había desarrollado queratitis neurotróficas hasta el momento de la ciclofotocoagulación. Se evidenció, además, que 4 de ellos eran altos miopes y que todos ellos fueron tratados con parámetros elevados de láser (2.880 mW por 3 s, en una superficie de 275° de media), y se desencadenaron úlceras neurotróficas entre los 10 y los 35 días después de la cirugía. CONCLUSIONES: La queratopatía neurotrófica es una complicación poco frecuente que puede aparecer tras la ciclofotocoagulación transescleral con láser de diodo, debido a la lesión secundaria de los nervios ciliares largos. La aparición de esta se puede ver favorecida por la existencia de factores de riesgo previos, entre los que hay que incluir la alta miopía. Es crucial respetar los parámetros de tratamiento recomendados, para evitar la aparición de esta dolencia

OBJECTIVE: To study the relationship between treatment with diode laser transscleral cyclophotocoagulation and development a neurotrophic keratitis due to the damage of the sensitive corneal innervation. METHODS: A study was conducted on 5 eyes of 5 patients who were treated with diode laser transscleral cyclophotocoagulation and soon developed neurotrophic ulcers. Personal characteristics of the patients were collected, as well as refraction and risk factors for corneal hypoesthesia, and the parameters of the laser used in the surgery. RESULTS: It was found that the 5 patients had predisposing factors of corneal hypoesthesia prior to surgery (chronic use of topical beta blockers, surgery with corneal incisions, diabetes mellitus, or corneal dystrophies); however none had developed neurotrophic keratitis until the cyclophotocoagulation was performed. It also showed that 4 of them were highly myopic, and they all were treated with high laser parameters (with an average of 2880 mW for 3 s at an average surface of 275°), triggering neurotrophic ulcers between 10 and 35 days after surgery. CONCLUSION: Neurotrophic keratitis is a rare complication that can occur after diode laser transscleral cyclophotocoagulation, secondary to the damage of the long ciliary nerves. The emergence of this disorder can be triggered by the existence of previous risk factors, including high myopia, thus it is important to respect the recommended treatment parameters to prevent the development of this disorder

The effect of laser photobiomodulation diode laser (Ga-As) 100 mW on temporomandibular joint anterior disc displacement: preliminary study

Background: Superpulsed low-level laser therapy (LLLT) seems to be a good choice as a non-invasive treatment for temporomandibular joint (TMJ) disorders and pain. Objectives. The purpose of this study is to clinically evaluate the effectiveness of splint for treatment of anterior disc displacement with reduction of the TMJ with or without LLLT. Material and methods. This was a prospective experimental study that included 20 female patients with anterior disc displacement with reduction of the TMJ. Patients were randomly assigned into two groups of 10 each. Patients of Group I were subjected to LLLT during four weeks, together with stabilization appliance splint for treatment of anterior disc displacement with reduction of the TMJ. Patients were evaluated before treatment, after six sessions of laser therapy, after 12 sessions of laser therapy, and 1 month after the last session. Patients of Group II were subjected to only stabilization appliance splint. Results. Follow up of maximum mouth opening in mm before and after treatment in Group I showed statistically significant difference with p value<0.001. In concordance, Follow up of visual analog scale (VAS) for pain before and after treatment in Group I showed statistically significant difference with p value<0.001. Comparisons between both groups before and after treatment showed significant improvements in the maximum mouth opening in mm and VAS for pain in Group I. Conclusions. Splint and LLLT in patients with anterior disc displacement with reduction of the TMJ are more effective than splint alone. The application of LLLT is proved to be safe and improves the results of the splint

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Los diferentes tipos de láser y sus aplicaciones en podología / Diferents tipes of laser and podiatry applications

Los diferentes tipos de láseres, sobre todo el láser de diodo, irrumpen en la terapéutica podológica para proporcionar una alternativa más de tratamiento en muchas patologías que son el día a día de las consultas. El buen manejo y el conocimiento de sus características son requisitos imprescindibles para no tener efectos secundarios indeseados y poder llevar a cabo tratamientos poco dolorosos, minimizando el tiempo total, y muchas veces proporcionando una solución a diversas patologías (AU)

Diferent tipes of laser, like diode laser, are a good option of podiatry treatment in many patologies that appears in ours clinics. This option needs from the podiatrist a correct management and a deep knowledge of his use for not have secundary efects and could carry out treatments that are not painful, minimizing total time and providing a solution for many patologies (AU)

Pseudoepitheliomatous hyperplasia after diode laser oral surgery. An experimental study

BACKGROUND: to examine the process of epithelial reparation in a surgical wound caused by diode laser. MATERIAL AND METHODS: An experimental study with 27 Sprage-Dawley rats was undertaken. The animals were randomly allocated to two experimental groups, whose individuals underwent glossectomy by means of a diode laser at different wattages, and a control group treated using a number 15 scalpel blade. The animals were slaughtered at the 2nd, 7th, and 14th day after glossectomy. The specimens were independently studied by two pathologists (blinded for the specimens' group). RESULTS: at the 7th day, re-epithelisation was slightly faster for the control group (conventional scalpel) (p = 0.011). At the 14th day, complete re-epithelization was observed for all groups. The experimental groups displayed a pseudoepitheliomatous hyperplasia. CONCLUSIONS: it is concluded that, considering the limitations of this kind of experimental studies, early re-epithelisation occurs slightly faster when a conventional scalpel is used for incision, although re-epithelisation is completed in two weeks no matter the instrument used. In addition, pseudoepitheliomatous hyperplasia is a potential event after oral mucosa surgery with diode laser. Knowledge about this phenomenon (not previously described) may prevent diagnostic mistakes and inadequate treatment approaches, particularly when dealing with potentially malignant oral lesions

Láser resección transuretral prostática: estudio de seguridad con un nuevo sistema de fotovaporización selectiva con láser de diodo de alta intensidad en próstatas mayores de 80 ml / Laser transurethral resection of the prostate: Safety study of a novel system of photoselective vaporization with high power diode laser in prostates larger than 80 mL

Objetivo: Presentar la viabilidad de la vaporización fotoselectiva de la próstata (VFP) con un nuevo sistema de resección de láser de diodo. El tratamiento quirúrgico de la hiperplasia prostática benigna (HPB) está en constante evolución. Las técnicas de láser se utilizan cada vez más en próstatas de gran tamaño. Métodos: Se realizó un estudio prospectivo para evaluar los datos operativos y los resultados de los pacientes con VFP utilizando láser de diodo de alta potencia (DAP) y una innovadora fibra con cabeza de cuarzo en forma de pala en los pacientes con próstata > 80 ml. Se describen los datos demográficos, tiempo quirúrgico, pérdida de hemoglobina, resultados operatorios (IPSS, calidad de vida [CdV], Qmáx, residuo posmiccional [RPM], IIEF-5 y micción diaria) y las complicaciones de la clasificación Clavien-Dindo. Resultados: Treinta y un pacientes fueron incluidos en el estudio. Dieciséis (51,6%) estaban en tratamiento antiplaquetario activo y 12 (38,7%) habían recibido anticoagulantes antes de la cirugía. Todos los casos fueron seguidos al menos 6 meses. No se produjeron complicaciones graves intraoperatorias ni postoperatorias. Tres pacientes (9,7%) tuvieron complicaciones leves según la clasificación Clavien-Dindo. Veintisiete (87,1%) fueron dados de alta en el primer día del postoperatorio sin catéter. Hubo mejoras significativas en el IPSS, CdV, Qmáx y RPM, tanto a los 3 como a los 6 meses (p < 0,0001), pero la función sexual según el IIEF-5 no mostró diferencias. La urgencia (de cualquier grado) aumentó a los 3 meses (48,4%; p = 0,002) y se redujo considerablemente a los 6 meses (9,7%, p < 0,0001). Conclusión: Esta experiencia piloto con fibra en forma de pala y DAP es alentadora. Esto demuestra que la resección con láser es un procedimiento seguro, logrando excelentes resultados en cuanto a IPSS, CdV y Qmáx en próstatas grandes, incluso en pacientes de alto riesgo. Se necesita un seguimiento más prolongado, estudios controlados comparativos y aleatorios para generalizar estos resultados

Objective: To present the feasibility of photoselective vaporization of the prostate (PVP) with of a new diode laser-resection system. Surgical treatment of benign prostatic hyperplasia (BPH) is constantly evolving. Laser techniques are increasingly used in prostates of large size. Methods: A prospective study was performed to evaluate operative data and patient outcomes with PVP using high-power diode laser (HPD) and a novel quartz-head fiber with shovel shape in patients with prostate > 80 mL. Demographic data, operative time, hemoglobin loss, operative results (IPSS, quality of life (QoL), Qmax, post void residue (PVR), IIEF-5 and micturition diary) and complications following Clavien-Dindo classification are described. Results: Thirty-one patients were included in the study. Sixteen (51.6%) were on active antiplatelet treatment and 12 (38.7%) had received anticoagulants before surgery. All cases were followed at least 6 mo. No intraoperative or postoperative major complications occurred. Three patients (9.7%) had minor complications according to Clavien-Dindo classification. Twenty-seven (87.1%) were discharged on postoperative day one without catheter. There were significant improvements in IPSS, QoL, Qmax and PVR, both at 3 and 6 mo (P < .0001), but sexual function according to IIEF-5 showed no differences. Urgency (any grade) increased at 3 mo (48.4%; P = .002) and considerably decreased at 6 mo (9.7%;P < .0001). Conclusion: This pilot experience with shovel shape fiber and HPD is encouraging. It shows that laser-resection is a safe procedure, achieving excellent results in terms of IPSS, QoL and Qmax in large prostates even in high-risk patients. Longer follow-up, comparative and randomized controlled studies are needed to widespread these results

Atomic force microscopy visualization of injuries in Enterococcus faecalis surface caused by Er, Cr: YSGG and diode lasers

AIM: To visualize by Atomic Force Microscopy the alterations induced on Enterococcus. faecalis surface after treatment with 2 types of laser: Erbium chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser and Diode laser. MATERIAL AND METHODS: Bacterial suspensions from overnight cultures of E. faecalis were irradiated during 30 seconds with the laser-lights at 1 W and 2 W of power, leaving one untreated sample as control. Surface alterations on treated E. faecalis were visualized by Atomic Force Microscopy (AFM) and its surface roughness determined. RESULTS: AFM imaging showed that at high potency of laser both cell morphology and surface roughness resulted altered, and that several cell lysis signs were easily visualized. Surface roughness clearly increase after the treatment with Er,Cr:YSGG at 2W of power, while the other treatments gave similar values of surface roughness. The effect of lasers on bacterial surfaces visualized by AFM revealed drastic alterations. CONCLUSIONS: AFM is a good tool to evaluate surface injuries after laser treatment; and could constitute a measure of antimicrobial effect that can complete data obtained by determination of microbial viability

Eficacia antimicrobiana de la terapia fotodinámica en la desinfección de los conductos radiculares: estudio ex vivo / Antimicrobial efficacy of photodynamic therapy in the disinfection of root canal: ex vivo study

Objetivo: Evaluar la eficacia antimicrobiana de la terapia fotodinámica (TFD) mediante el empleo de una solución colorante azul de ortotoluidina (AOT) y una luz emitida por un diodo (LED), en dientes humanos ex vivo, inoculados con Enterococcus faecalis. Meterial y método: Se utilizaron 34 piezas dentarias humanas unirradiculares que fueron preparadas biomecánicamente y esterilizadas. Las muestras fueron divididas al azar en cinco grupos experimentales: I (n = 2) control positivo, II (n = 10) NaOCL 2,5% + NaOCL 2,5%, III (n = 10) NaOCL 2,5% + AOT + LED, IV (n = 10) NaCOL 2,5% + AOT y V (n = 2) control negativo. Todos los grupos, excepto el grupo V (control de esterilidad), fueron inoculados con 30 μl de Enterococcus faecalis e incubados por 24 horas, previo sellado de la superficie externa. Luego de realizar los tratamientos correspondientes se tomaron muestras, por duplicado, para ser procesadas microbiológicamente y efectuar el recuento de unidades formadoras de colonias (UFC). Los resultados fueron evaluados mediante la prueba de Chi cuadrado (X2). Resultados: En el grupo I hubo desarrollo de UFC/ml (2,85 x 107) y se empleó para comparar los otros grupos. Los grupos II, III y V no presentaron desarrollo bacteriano, sin diferencias significativas en sus resultados (p > 0,05). Sin embargo, hubo diferencias entre estos y los grupos I y IV (1,25 x 107). Conclusión: En las condiciones de este estudio la terapia fotodinámica (TFD) con AOT y LED demostró tener potencial antimicrobiano para su uso como coadyuvante en la preparación biomecánica de los conductos radiculares

Aim: To evaluate the antimicrobial efficacy of photodynamic therapy by employing a solution of ortho toluidine blue dye (AOT) and a light emitting-diode (LED), human teeth ex vivo, were inoculated with Enterococcus faecalis. Materials and methods: We used 34 single-rooted human teeth, which were biomechanically prepared and sterilized. Samples were divided randomly into 5 experimental groups: I (n = 2) positive control, II (n = 10) 2.5% NaOCl + 2.5% NaOCl, III (n = 10) 2.5% NaOCl + AOT + LED, IV (n = 10) 2.5% NACOL + AOT and V (n = 2) negative control. All groups except group V (sterility control) were inoculated with 30 μl of Enterococcus faecalis, and incubated for 24 hours before sealing the outer surface. After performing appropriate treatments, samples were taken, in duplicate, to be processed microbiologically and for the determination of colony forming units (CFU). The Chi-square test was used to evaluate the results of this study. Results: The results showed the development of UFC/ml (2.85 x 107) in Group I and served to compare the other groups. Groups II and III showed no statistically significant differences in the results (p > 0.05) between them and respect to Group V (negative control). However, there were differences between them and Groups I and IV (1.25 x 107). Conclusion: Under the conditions of this study, photodynamic therapy with AOT/LED shown to have antimicrobial potential for use as an adjunct in the biomechanical preparation of root Canals

Simulador de realidad virtual para el entrenamiento en vaporización fotoselectiva de la próstata con láser de diodo 980 nm y curva de aprendizaje de la técnica / Virtual reality simulator for training on photoselective vaporization of the prostate with 980 nm diode laser and learning curve of the technique

Objetivo: Se investiga la utilidad de un simulador de realidad virtual para el entrenamiento de la vaporización fotoselectiva de la próstata con láser de diodo. Material y método: Se han practicado 2 experimentos con un simulador (VirtaMed AG, Zürich, Suiza) con software para entrenamiento específico en vaporización prostática modo de contacto con fibra Twister (Biolitec AG, Jena, Alemania). Dieciocho cirujanos realizaron ablación prostática (55 cc) por duplicado y se comparó la puntuación obtenida (190 puntos eficacia y 80 seguridad) en la segunda de ellas por grupos de experiencia (alumnos médicos, residentes, especialistas). También realizaron prueba de orientación espacial con puntuaciones de 0 a 6. Posteriormente 6 de estos cirujanos repitieron 15 ablaciones prostáticas (55 y 70 ml). Se evalúa la mejora de los parámetros obtenidos para definir la curva de aprendizaje y cómo influye la experiencia, las habilidades de orientación espacial y el tipo de secuencia realizada. Resultados: La puntuación global de eficacia y seguridad fue diferente según el grado de experiencia (p = 0,005). Al comparar por pares se detectaron diferencias especialista-alumno (p = 0,004), pero no especialista-residente (p = 0,12) o residente-alumno (p = 0,2). Con respecto a la eficacia del procedimiento se detectan diferencias especialista-alumno (p = 0,0026) y residente-alumno (p = 0,08). Los indicadores parciales diferentes en términos de eficacia fueron tasa de ablación (p = 0,01), tiempo de procedimiento (p = 0,03) y cantidad de cápsula no expuesta (p = 0,03). No se observaron diferencias entre grupos en seguridad (p = 0,5). Con respecto a la curva de aprendizaje la mediana del porcentaje sobre la puntuación total superó el 90% tras realizar 4 procedimientos para próstatas de 55 ml y 10 para glándulas de 70 ml. Esta evolución no se modificó por experiencia previa (residente-especialista; p = 0,6), pero sí según la secuencia de repetición (progresiva-aleatoria; p = 0,007). Los cirujanos con orientación espacial inferior a la mediana del grupo (valor 2,5) no superaron el 90% de puntuación a pesar de la repetición del procedimiento. Conclusión: La simulación para la ablación prostática con láser de diodo de contacto es un buen modelo de aprendizaje con validez discriminativa, al correlacionar resultados métricos con niveles de experiencia y habilidades. La repetición secuencial del procedimiento en niveles crecientes de dificultad favorece el aprendizaje

Objective: The utility of a virtual reality simulator for training of the photoselective vaporization of the prostate with diode laser was studied. Materials and methods: Two experiments were performed with a simulator (VirtaMed AG, Zürich, Switzerland) with software for specific training in prostate vaporization in contact mode with Twister fiber (Biolitec AG, Jena, German). Eighteen surgeons performed ablation of the prostate (55 cc) twice and compared the score obtained (190 points efficacy and 80 safety) in the second one of them by experience groups (medical students, residents, specialists). They also performed a spatial orientation test with scores of 0-6. After, six of these surgeons repeated 15 ablations of the prostate (55 and 70 ml). Improvement of the parameters obtained was evaluated to define the learning curve and how experience, spatial orientation skills and type of sequences performed affects them. Results: Global efficacy and safety score were different according to the grade of experience (P = 0.005). When compared by pairs, specialist-student differences were detected (p = 0.004), but not specialist-resident (P = 0.12) or resident-student (P = 0.2). Regarding efficacy of the procedure, specialist-student (p = 0.0026) and resident-student (P = 0.08) differences were detected. The different partial indicators in terms of efficacy were rate of ablation (P = 0.01), procedure time (P = 0.03) and amount of unexposed capsule (p = 0.03). Differences were not observed between groups in safety (P = 0.5). Regarding the learning curve, percentage median on the total score exceeded 90% after performing four procedures for prostates of 55 ml and 10 procedures for prostate glands of 70 ml. This course was not modified by previous experience (resident-specialist; P = 0.6). However, it was modified according to the repetition sequence (progressive-random; P = 0.007). Surgeons whose spatial orientation was less than the median of the group (value 2.5) did not surpass 90% of the score in spite of repetition of the procedure. Conclusion: Simulation for ablation of the prostate with contact diode laser is a good learning model with discriminative validity, as it correlates the metric results with levels of experience and skills. The sequential repetition of the procedure on growing levels of difficulty favors learning

Liposucción láser-asistida en ginecomastia: seguimiento ecográfico y estadístico de los efectos observados de retracción cutánea / Laser assisted liposuction for gynecomastia: statistical and ultrasound follow-up of the effects observed in skin retraction

Valoramos por ecografía y estadísticamente la eficacia de la liposucción láser-asistida en casos de ginecomastia, teniendo en cuenta la respuesta de retracción de la piel, la rapidez de la recuperación del paciente, y el grado de satisfacción que originan los resultados. Presentamos un estudio prospectivo de 28 pacientes con ginecomastia de diferente grado, tratados mediante liposucción asistida por láser de Diodo de 1470 nm, previa sedación y con anestesia tumescente. El láser se programó a 15 Watios (W) en emisión continua y se administraron 8 a 12 kilojulios (kJ) por cada mama. No se realizaron escisiones de piel ni se emplearon drenajes. Se realizó valoración objetiva y subjetiva empleando la misma escala visual analógica (VAS) completada por médicos y pacientes. Se tomaron fotografías antes y 6 meses después de la intervención, y se realizaron mediciones del perímetro torácico y del diámetro de las areolas. El seguimiento ecográfico de las áreas tratadas fue comparativo antes y 6 meses después del tratamiento. Para el estudio estadístico se empleó t de Student como test de contraste. No observamos complicaciones, como signos de isquemia o quemaduras cutáneas. La disminución del perímetro torácico y del diámetro de las areolas fue estadísticamente significativa. Tanto la valoración objetiva como la subjetiva alcanzaron resultados superiores al 90 %. Mediante la ecografía también se demostró disminución, estadísticamente significativa, de la banda de tejido graso subcutáneo (p < 0,05) al comparar las imágenes de antes y 6 meses después del tratamiento. La recuperación laboral se realizó en un promedio de 3 días. En conclusión, creemos que la liposucción láser-asistida es un método eficaz y reproducible, comprobado ecográfica y estadísticamente, que alcanza buenos resultados con menos trauma quirúrgico, lo que conlleva un alto grado de satisfacción por parte de los pacientes (AU)

We evaluate efficacy of laser-assisted liposuction in gynecomastia by means of ultrasonography and statistical study, taking into account skin retraction, patients time recovery and satisfaction index with results of surgery. A prospective study on 28 patients suffering from gynecomastia, were treated by means of liposuction assisted by 1470 nm Diode laser lipolysis. Surgery was carried out under sedation and tumescent anesthesia. Laser was programmed at 15 W, 8 a 12 kJ total cumulative energy per breast. Neither skin resection nor drainages were used. Doctors and patients evaluated results objective and subjectively with the same Visual Analogue Scale. For scoring results, pictures took before and 6 months after were used. Measures of chest and areola diameter of before and after surgery were taken for comparative statistical analysis. Ultrasonography follow up was done to determine the width of subcutaneous fat layer eliminated. T Student was use as contrast test to examine results achieved. No complications were observed such ischemia or skin burns. Chest and areolas diameter decrease in dimension were statically significant. Objective and subjective evaluations gave results greater than 90 %. Ultrasonography demonstrated decreasing, statically significant, in subcutaneous fatty tissue (p < 0,05), by comparing images before and 6 months after treatment. Laser-assisted liposuction is an efficacious procedure and reproducible. Ultrasonography controls and the statically study demonstrated good results and limited surgical trauma that imply patients' high satisfaction with the surgery outcome (AU)

Tratamiento con láser de dióxido de carbono de una papulosis bowenoide vulvar extensa en paciente con sida / Extensive Bowenoid Papulosis of the Vulva Treated by Carbon Dioxide Laser in a Patient With AIDS

No disponible

Endoluminal sclerosis with diode laser in the treatment of orofacial venous malformations

Introduction: The appearance of vascular anomalies in the orofacial area is a common condition, which represents about 50% of these malformations. Traditional treatment approach, such as surgery and chemical sclerosis has been given way to a few less-invasive options, as the use of the 810nm diode laser to induce the sclerosis of the venous malformation by intralesional photocoagulation. Objectives: The objective of this study was to determine the efficacy of the diode laser in the intralesional treatment of the orofacial venous malformations (OFVM), describing the recommended surgical approach, as well as to report the main associated complications. Patients and Methods: 10 cases of OFVM, diagnosed and treated at the Oral Surgery Department of the Dental Clinic of the University of Barcelona, between January, 2009 and April, 2011. Every case was treated under local anesthesia, performing at least one intralesional session of diode laser, applying an 1W active optic fiber, in continuous mode, inserted into the interior of the lesion through an intramuscular needle, from the deepest portion (..) (AU)

Guía clínica de la Asociación Europea de Urología sobre tecnologías láser / European Association of Urology Guidelines on Laser Technologies

Contexto: La Oficina de Guías Clínicas de la Asociación Europea de Urología (EAU) ha establecido un panel de trabajo de guías clínicas para analizar la evidencia científica publicada en la literatura mundial sobre láseres en la práctica urológica. Objetivo: Revisar el origen físico y los aspectos fisiológicos y técnicos de la utilización de los láseres en Urología, así como los actuales resultados clínicos de estas nuevas tecnologías en evolución, junto con recomendaciones para la aplicación de los láseres en Urología. El objetivo principal de esta presentación estructurada de la base de la evidencia actual en esta área es ayudar a los médicos a tomar decisiones informadas con respecto al uso de los láseres en su práctica clínica. Adquisición de la evidencia: Se diseñaron búsquedas estructuradas de la literatura que utilizan un consultor experto para cada sección de este documento. Se realizaron búsquedas en la base de datos Cochrane de Revisiones Sistemáticas, el registro Cochrane Central de Ensayos Controlados y Medline y Embase en la plataforma Dialog/DataStar. Se utilizó la terminología controlada de las respectivas bases de datos y se analizaron tanto Medical Subject Headings como EMTREE para conocer los términos de entrada relevantes. Se identificó una revisión Cochrane. Síntesis de la evidencia: Dependiendo de la fecha de publicación la evidencia de los diferentes tratamientos con láser es heterogénea. La evidencia disponible permite clasificar los tratamientos como alternativas seguras para la terapia de la obstrucción del tracto urinario inferior en diferentes escenarios clínicos, tales como la retención urinaria refractaria, la anticoagulación y la medicación antiplaquetaria. El tratamiento con láser para el cáncer de vejiga solo se debe utilizar en un ensayo clínico o para pacientes que no son adecuados para el tratamiento convencional, debido a comorbilidades u otras complicaciones. Para el tratamiento de la litiasis urinaria y la endoureterotomía retrógrada los láseres proporcionan una herramienta estándar para aumentar el procedimiento endourológico. Conclusiones: En la obstrucción prostática benigna (OPB) la vaporización por láser, la resección o la enucleación son opciones de tratamiento alternativas. El tratamiento estándar para la OPB sigue siendo la resección transuretral de la próstata para próstatas de tamaño pequeño a moderado y la prostatectomía abierta para próstatas grandes. La energía láser es un método de tratamiento óptimo para la desintegración de cálculos urinarios. El uso de láseres para el tratamiento de los tumores de vejiga y en la laparoscopia sigue en investigación (AU)

Context: The European Association of Urology (EAU) Guidelines Office has set up a guideline working panel to analyse the scientific evidence published in the world literature on lasers in urologic practice. Objective: Review the physical background and physiologic and technical aspects of the use of lasers in urology, as well as current clinical results from these new and evolving technologies, together with recommendations for the application of lasers in urology. The primary objective of this structured presentation of the current evidence base in this area is to assist clinicians in making informed choices regarding the use of lasers in their practice. Evidence acquisition: Structured literature searches using an expert consultant were designed for each section of this document. Searches were carried out in the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Medline and Embase on the Dialog/DataStar platform. The controlled terminology of the respective databases was used, and both Medical Subject Headings and EMTREE were analysed for relevant entry terms. One Cochrane review was identified. Evidence synthesis: Depending on the date of publication, the evidence for different laser treatments is heterogeneous. The available evidence allows treatments to be classified as safe alternatives for the treatment of bladder outlet obstruction in different clinical scenarios, such as refractory urinary retention, anticoagulation, and antiplatelet medication. Laser treatment for bladder cancer should only be used in a clinical trial setting or for patients who are not suitable for conventional treatment due to comorbidities or other complications. For the treatment of urinary stones and retrograde endoureterotomy, lasers provide a standard tool to augment the endourologic procedure.Conclusions: In benign prostatic obstruction (BPO), laser vaporisation, resection, or enucleation are alternative treatment options. The standard treatment for BPO remains transurethral resection of the prostate for small to moderate size prostates and open prostatectomy for large prostates. Laser energy is an optimal treatment method for disintegrating urinary stones. The use of lasers to treat bladder tumours and in laparoscopy remains investigational (AU)