Enhanced Pulsed Dye Laser for Facial Rejuvenation.

BACKGROUND AND OBJECTIVES: To evaluate the efficacy of an enhanced pulsed dye laser (PDL) for treatment of facial-dyschromia. STUDY DESIGN/MATERIALS AND METHODS: Thirteen patients were enrolled in the study. Nine patients were female, four were male, with a mean age of 61 years. All patients presented with either facial telangiectasia, rosacea, pigment, or a combination thereof. At the initial evaluation, test spots were performed to determine the subject's response to selected treatment parameters. In the study, the enhanced 595 nm PDL deployed a spot size range of 5-12 mm with fluences ranging from 8 to 18 J/cm2 . Pulse duration was 10 milliseconds. Enhancements in this device included the option for contact or cryogen spray cooling, increased maximum pulse energy, increased repetition rate, option for addition of radiofrequency (RF), an option for a 15 mm spot size, and longer dye life. The smaller spots were used only for focal low contrast pigmented lesions that persisted after overall facial treatment with the larger spot. Smaller fluences were applied for general rejuvenation with the 12 mm spot (mean ~9 J/cm2 ). Sapphire contact cooling was applied at 10°C. A smaller area of the skin was reserved (typically pre-auricular area) for addition of RF energy just before the pulse (40-70 J/cm3 ) over 100 milliseconds with a 20 milliseconds delay between the end of the RF pulse and beginning of the laser pulse. The minimum fluence that achieved vessel closure/vessel bluing and/or slight immediate pigment darkening was applied based on test spots performed just before treatment to the entire face. Determinations of improvement were made by evaluation of photographs with standard settings using polarized and nonpolarized images. Up to three treatments were performed approximately 1 month apart with follow-up visits 1 and 3 months after the final treatment. RESULTS: Evaluation by a panel of blind observers determined a mean clearance of at least 50% in all lesions, while 77% of lesions had 50-75% clearance, and 23% of lesions had 76-100% clearance. Pain was approximately 4/10. Subjective lesion improvement and satisfaction rates were 3 out of 4 and 3.6 out 4, respectively. CONCLUSION: An enhanced PDL is effective in one pass treatments for facial rejuvenation with considerably less operative time than previous commercially available systems. A second pass applied to focal challenging lesions results in even more improvement, in a single treatment session. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Medulloblastoma with extensive nodularity undergoing post-therapeutic maturation to a gangliocytoma: a case report and literature review.

We present a report of a 12-year-old boy diagnosed with medulloblastoma at 22 months of age. A gross total resection was performed followed by adjuvant systemic chemotherapy due to his young age; however, the tumor recurred locally in the posterior fossa 7 months later. The recurrent tumor was excised and he received craniospinal radiation with a boost given to the posterior fossa followed by high-dose chemotherapy. He remained disease free for approximately 10 years without major neurologic deficit and only mild cognitive impairment. A routine follow-up MRI of the brain revealed an enhancing mass. The patient underwent surgical debulking and pathological examination revealed no residual immature medulloblastoma cells but instead mature ganglion cells, consistent with a gangliocytoma. The apparent maturation of primitive medulloblastoma cells is a rare phenomenon, which may have ensued from the long-term effects of adjuvant therapies inducing advanced cellular maturation.

Pupil dilation using a standard cataract surgery regimen alone or with atropine 1.0% pretreatment: prospective comparative evaluation.

PURPOSE: To compare the amount of pupil dilation produced by a set of commonly used preoperative mydriatic agents for cataract surgery, with the same regimen preceded by topical administration of atropine 1.0%. SETTING: Department of Ophthalmology, Loma Linda University, Loma Linda, California, USA. METHODS: In this prospective unmasked study, the baseline pupil size in eyes of volunteers was measured. Pupil size was then measured 30 minutes after instillation of the institution's standard dilation regimen for cataract surgery, which included phenylephrine 2.5%, tropicamide 1.0%, and cyclopentolate 1.0%. Several days later, the subjects returned for repeat measurements after pretreating the study eye(s) with atropine 1.0% 3 times a day the day previously and once on the morning of repeat dilation and measurements. Pupil size was again measured after administration of the standard regimen. RESULTS: The study included 72 eyes of 54 patients. A paired t test showed a statistically significant difference in mean pupil dilation between the standard regimen alone and the standard regimen with atropine 1.0% pretreatment. The mean pupil dilation was 7.3 mm +/- 1.2 (SD) with the standard regimen alone and 6.9 +/- 1.2 mm with the standard regimen with atropine pretreatment; the difference was statistically significant (P<.001). CONCLUSION: The addition of atropine 1.0% 1 day before administration of a standard preoperative dilating regimen for cataract surgery resulted in a smaller dilated pupil diameter than administration of the standard set of preoperative mydriatic agents alone. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.