Ureter Identification In an Inflammatory Pig Model Using a Novel Near-Infrared Fluorescent Dye.

BACKGROUND AND OBJECTIVES: Ureters are at risk of injury in settings of inflammation and distorted anatomy. The use of a fluorescent dye can improve intraoperative ureteral identification without the need for any additional invasive procedures. Our team has previously described the development of a preclinical ureter-specific dye, UL-766, tested in a rat model. Here, we present the use of the fluorescent dye during laparoscopy to assist in ureteral identification in a swine model with an inflamed abdomen; the results of this study serve as proof of feasibility for use in the setting of tissue edema and erythema. STUDY DESIGN/MATERIALS AND METHODS: With institutional approval, two 20-25 kg pigs underwent abdominal surgery with the use of a Food and Drug Administration-approved fluorescence laparoscopic system. Using standard laparoscopy, inflammation was induced with sharp and blunt dissection and irritation was induced with gauze. The animals were allowed to recover and returned to the operating room after 7 days. Images of the inflamed right retroperitoneum, with fluorescence imaging, turned on, were taken before and after intravenous injection of the novel fluorescent dye at 120 µg/kg. The time until fluorescence visualization of the ureters was measured, and the fluorescent signal was measured for up to 4 hours from the time of the initial dye injection. Partial and complete transection of ureteral injuries was made by scissors and monitored under both standard video and fluorescence laparoscopy. RESULTS: Inflammation reduced the certainty of ureter identification by white light alone. Despite surrounding tissue erythema and edema, ureteral visualization under fluorescence laparoscopy was achieved within 5-10 minutes after dye injection. The fluorescent signal remained visible for at least 4 hours after injection, and the fluorescent dye showed a partial ureteral injury that would not have been observed under standard laparoscopy. CONCLUSIONS: UL-766 is a preclinical fluorescent dye useful for the intraoperative identification of the ureters and ureteral injuries in an inflamed abdomen. With the acquisition of additional preclinical data, this novel dye can be a valuable tool during laparoscopic abdominal and pelvic surgeries. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Treatment of erythematotelangiectatic rosacea, facial erythema, and facial telangiectasia with a 577-nm pro-yellow laser: a case series.

Various lasers have been used for the treatment of erythematotelangiectatic rosacea (ETR), facial erythema (FE), and facial telangiectasias (FT). The assessment of the treatments of all of these conditions with a 577-nm pro-yellow laser has not been reported yet. The aim of this work was to assess the efficacy and safety of the 577-nm pro-yellow laser in ETR, FE, and FT. Forty patients suffering from ETR, FE, and FT (25 female and 15 male) were enrolled in this study. All of the patients were treated with 577-nm pro-yellow laser (QuadroStarPRO YELLOW® Asclepion Laser Technologies, Germany) at 4-week intervals, for one to four sessions. The assessment of the treatment was made based on the digital photographs and the percentage of fading of the erythema and telangiectasias in the lesions. Significant clinical improvement (80-100%) was observed in the first or second sessions of the treatment in FE and ETR patients and in second and fourth sessions of the treatment in FT patients. The treatment was very well tolerated. No side effect was observed except for a few patients who had mild to moderate erythema fading away in 12-24 h. This case series has shown that the pro-yellow laser is a very effective, safe, and well-tolerated treatment for ETR, FE, and FT.

Fractional 532-nm KTP diode laser and 595-nm pulsed dye laser in treatment of facial telangiectatic erythema.

BACKGROUND: A 595-nm pulsed dye laser (PDL) and the fractional 532-nm potassium titanyl phosphate (KTP) laser have also been demonstrated to be effective for facial telangiectasias. OBJECTIVE: To compare the clinical therapeutic effects of a fractional 532-nm KTP laser with those of a 595-nm pulsed dye laser (PDL) for treating facial erythematous skin lesions. METHODS: Twenty healthy adults with facial erythematous skin lesions were treated using a fractional 532-nm KTP laser on one side of the face and a 595-nm PDL on the other cheek. Three treatments were administered at 4-week intervals. The degree of improvement in facial telangiectasias was evaluated by colorimeter analysis, a physician's assessment using clinical photographs, and the subject's self-assessment. RESULTS: In the physician's assessment with clinical photography, a significant improvement was observed from baseline to posttreatment in both groups. As measured by a colorimeter, the a* value decreased from 16.23 (±2.81) to 12.22 (±2.75) in the 595-nm PDL group and from 16.02 (±2.93) to 12.77 (±2.77) in the fractional 532-nm KTP laser group. The a* value showed a significant reduction in both groups (P < .0001). There was no significant difference in efficacy between the two groups. In the subjective self-assessment, scores improved by 1.68 (±0.95) in the fractional 532-nm KTP laser group and by 1.78 (±0.92) in the 595-nm PDL group. CONCLUSION: A fractional 532-nm KTP laser is a valid option for the treatment of facial erythematous skin lesions with telangiectasia.

Acral angioosteoma cutis: A rare case.

Acral angioosteoma cutis is a rare and benign cutaneous lesion clinically characterized by an exophytic growth resembling pyogenic granuloma on the acral skin; first described in 2006. Its pathogenesis is still unclear while well-formed capillaries, pale stroma, bland fibroblast-like cells, and multiple tiny spicules of woven bone constitute the histological hallmarks. Here, we present a case of acral angioosteoma cutis in a 34-year-old man to increase awareness regarding this rare condition.

Treatment of erythemato-telangiectatic rosacea with brimonidine alone or combined with vascular laser based on preliminary instrumental evaluation of the vascular component.

The purpose of this study is to evaluate the outcome of a series of patients with erythematotelangiectatic rosacea (ETR) affected by persistent erythema and varying degree of telangiectasias being treated with brimonidine alone or combined with a vascular laser based on the type of vascular components preliminarily evaluated by clinical and instrumental observation. Ten patients affected by ETR were enrolled in a pilot, open study. Instrumental evaluation included erythema-directed digital photography by VISIA-CR™ system and X10 dermoscopy. Those patients showing marked background erythema and minimal telangiectasias (group A) were treated with a single application of brimonidine 0.33% gel, while patients showing both marked background erythema and marked telangiectasias (group B) were treated with a session of Nd:YAG laser and reevaluated 1 month later after a single application of brimonidine. An Investigator Global Assessment (IGA) of treatment outcome was performed at the end of treatment in both groups. In group A, 6 h after brimonidine application, a marked reduction of the background erythema was observed in all patients, and IGA was rated as excellent. In group B, 6 h following the application of brimonidine, a marked reduction of the background erythema was observed in all cases, while telangiectasias remained unchanged. A further treatment with brimonidine 1 month after the Nd:YAG laser session determined complete clearing of facial erythema, and IGA was rated as excellent. In conclusion, a preliminary evaluation of the vascular component by erythema-directed digital photography and dermoscopy in ETR may be helpful to select the most appropriate therapeutic strategy.

[Exceptional pacemaker complication in Still's disease]. / Ungewöhnliche Schrittmacherkomplikation bei Morbus Still.

CASE REPORT: A 49-year-old man with Still's disease presented with a rash above his pacemaker scar. In 2012, there was a replacement of the generator in which the position was changed from subpectoral to subcutaneous. A revision operation was performed after the local finding became worse, turning from a granuloma to a macula. THERAPY: During surgery, a superficial position of the leads was revealed. Both leads and generator were removed with great effort from the granulation tissue. The new material was again implanted into a subpectoral position. The postoperative examination of the wound showed unremarkable signs of healing. CONCLUSION: After repositioning of the generator to a subcutaneous location, the skin was exposed to greater mechanical stress, which caused erythema and hypergranulation in a patient with Still's disease. A superficial position of a pacemaker should be avoided in patients affected by Still's disease.

An exploratory split-face study of a dual-wavelength laser system on erythromelanosis follicularis faciei in Chinese population.

BACKGROUND: Erythromelanosis follicularis faciei (EFF) is clinically characterized by well-demarcated erythema, hyperpigmentation and follicular papules. No satisfactory therapy has been widely accepted. OBJECTIVE: This study was aimed to evaluate the efficiency and complications of a dual-wavelength laser system in the treatment of EFF in Chinese population. METHODS: Twelve Chinese patients with EFF were enrolled in this study. One side of the face was randomized to receive five successions of treatments at intervals of 6-8 weeks, with the other side spared as control. The parameters were set as follows: energy densities of 6.5-7.5 J/cm(2) with pulsed dye laser (PDL) and 35-50 J/cm(2) with Nd:YAG; pulse duration of 0.5 ms with PDL and 15 ms with Nd:YAG; a delay time of 100 ms between delivery of the two wavelengths. The efficacy was evaluated using subjective assessment and non-invasive measurement. RESULTS: After five sessions of treatment, over 40% patients achieved more than 50% (moderate or significant) improvement. The efficacy maintained at 3-month follow-up. The values of erythema index and melanin index on treated side were significantly less than those on untreated side after sessions of treatments. Adverse effects of treated side were limited. CONCLUSION: Using this split-face module, dual-wavelength laser system treatment is proved to be suitable for Chinese EFF. Adverse effects were minimal.

Neodymium-yttrium aluminum garnet laser versus pulsed dye laser in erythemato-telangiectatic rosacea: comparison of clinical efficacy and effect on cutaneous substance (P) expression.

BACKGROUND: Different laser systems are reported to be effective in treatment of telangiectasia and erythema, but comparative studies on 1064-nm neodymium-yttrium aluminum garnet (Nd-YAG) laser and pulsed dye laser (PDL) in treatment of erythemato-telangiectatic rosacea are lacking. Substance (P) is implicated in rosacea pathogenesis. OBJECTIVES: To compare the effect of Nd-YAG laser and PDL on erythemato-telangiectatic rosacea, both clinically and immunohistochemically on cutaneous substance (P) expression. METHODS: This split-face comparative study included 15 patients with erythemato-telangiectatic rosacea treated on the right side with Nd-YAG laser and on the left side with PDL: three sessions, 4 weeks apart. Evaluation of the patients was done using erythema and telangiectasia grading scores, patient's self-assessment, physicians' clinical assessment of the patient, and immunohistochemical assessment of substance (P). RESULTS: One month after the three laser sessions, excellent response was achieved in 73.3% of patients after Nd-YAG and in 53.3% of patients after PDL with significantly lower substance (P) concentration after Nd-YAG laser than after PDL. Positive correlations were found between the decrease in erythema and telangiectasia grading scores and the decrease in substance (P) concentration. CONCLUSIONS: The use of Nd-YAG laser and PDL appears to be safe and effective measures in treatment of erythemato-telangiectatic rosacea. Both types of laser decrease the concentration of substance (P) in the skin. This effect is more pronounced with Nd-YAG laser.

Rapid healing and reduced erythema after ablative fractional carbon dioxide laser resurfacing combined with the application of autologous platelet-rich plasma.

BACKGROUND: Fractional carbon dioxide laser resurfacing (FxCR) has shown considerable efficacy in reducing wrinkles, although complications such as scarring and prolonged erythema are more common and down-time is longer than with nonablative laser treatment. Platelet-rich plasma (PRP), a high concentration of platelets in a small volume of plasma, is known to enhance tissue healing. OBJECTIVE: To evaluate the benefits of PRP in the wound healing process after FxCR. MATERIALS AND METHODS: Twenty-five subjects were treated with FxCR on the bilateral inner arms. PRP was prepared from 10 mL of whole blood and applied on a randomly allocated side, with normal saline being used as the contralateral control. Transepidermal water loss (TEWL) and skin color were measured on both sides. Skin biopsies were also taken from five subjects on day 28. RESULTS: Significantly faster recovery of TEWL was seen on the PRP-treated side. The erythema index and melanin index on the PRP-treated side were lower than on the control side. Biopsy specimens from the PRP-treated side showed thicker collagen bundles than those from the control side. CONCLUSION: Application of autologous PRP is an effective method for enhancing wound healing and reducing transient adverse effects after FxCR treatment.