Association between varicose veins anatomical pattern and procedural complications following endovascular laser photothermolysis for chronic venous insufficiency

We sought to assess clinical characteristics and pattern of collateral network involvement associated with development of truncal (systematized) versus diffuse/non-truncal (non-systematized) varicose veins (VVs) in patients undergoing endovascular laser photothermolysis for chronic venous insufficiency (CVI). Secondly, we aimed to assess whether the type of VVs influenced the procedural complications of endovascular laser therapy. A total of 508 patients with hydrostatic VVs of the lower limbs who underwent endovenous laser treatment were included, out of which 84.1% (n=427) had truncal VVs (group 1) and 15.9% (n=81) had diffuse (non-systematized) VVs (group 2). Patients with truncal varices were significantly older (47.50±12.80 vs 43.15±11.75 years, P=0.004) and those with associated connective tissue disorders were more prone to present diffuse VVs (P=0.004). Patients in group 1 presented a significantly higher number of Cockett 1 (P=0.0017), Cockett 2 (P=0.0137), Sherman (P<0.0001), and Hunter (P=0.0011) perforator veins compared to group 2, who presented a higher incidence of Kosinski perforators (P<0.0001). There were no significant differences regarding postoperative complications: thrombophlebitis (P=0.773), local inflammation (P=0.471), pain (P=0.243), paresthesia (P=1.000), or burning sensation (P=0.632). Patients with more advanced CEAP (clinical, etiologic, anatomic, pathophysiologic) classes were older (P<0.0001), more were males (39.05 vs 27.77%, P=0.0084), more were prone to present ulcers (P<0.0001) and local hyperthermia (P=0.019), and presented for endovenous phlebectomy after a longer time from symptom onset. In patients with CVI, systematized VVs were associated with a more severe clinical status and a distinct anatomical pattern of perforators network compared to non-systematized VVs, which is more common in advanced stages.

Percutaneous laser ablation of benign thyroid nodules: a one year follow-up study / Ablação percutânea com laser de nódulos benignos de tireoide: um estudo de acompanhamento de um ano

ABSTRACT Objective To evaluate safety and effectiveness of nodule volume reduction and thyroid function after percutaneous laser ablation treatment in patients with benign nonfunctioning thyroid nodules. Methods Prospective single-center study, from January 2011 to October 2012, which evaluated 30 euthyroid and thyroid antibodies negative patients with benign solitary or dominant nodule with indication of treatment due to compressive symptoms and aesthetic disturbances. The clinical and laboratory (thyroid ultrasound, TSH, FT4, TG, TG-Ab, TPO-Ab and TRAb levels) evaluations were performed before the procedure, and periodically 1 week, 3 months and 6 months after. The ablation technique was performed under local anesthesia and sedation. In each treatment, one to three 21G spinal needle were inserted into the thyroid nodule. The laser fiber was positioned through the needle, which was then withdrawn 10mm to leave the tip in direct contact with the nodule tissue. Patients were treated with a ND: Yag-laser output power of 4W and 1,500 to 2,000J per fiber per treatment. The entire procedure was performed under US guidance. Results Thirty patients, with a total of 31 nodules submitted to laser ablation were evaluated. The median volumetric reduction of the nodule was approximately 60% after 12 months. No statistical significance was observed on thyroid function and antibodies levels. There was a peak on the level of thyroglobulin after the procedure due to tissue destruction (p<0.0001). No adverse effects were observed. Conclusion Percutaneous laser ablation is a promising outpatient minimally invasive treatment of benign thyroid nodule.

RESUMO Objetivo Avaliar a segurança e a efetividade da redução de volume nodular e função tireoidiana após tratamento com ablação percutânea por laser em pacientes com nódulos tireoidianos benignos não funcionantes. Métodos Estudo unicêntrico prospectivo, de janeiro de 2011 a outubro de 2012, que avaliou 30 pacientes eutireoideos (com anticorpos antitireoide negativos), com nódulo solitário ou dominante benigno, com indicação de tratamento devido a sintomas de compressão e distúrbios estéticos. As avaliações clínica e laboratorial (ultrassonografia de tireoide, TSH, FT4, TG, TG-Ab, TPO-Ab e TRAb) foram realizada antes do procedimento e periodicamente − 1 semana, 3 meses e 6 meses depois. A técnica de ablação consistiu em procedimento realizado sob a anestesia local e sedação. Em cada tratamento, uma a três agulhas espinhais 21G foram inseridas no nódulo tireoidiano. A fibra laser foi posicionada através da agulha que foi, então, retirada 10mm, para deixar a ponta em contato direto com o nódulo. Os pacientes foram tratados com uma potência de saída ND: Yag-laser de 4W e 1.500 a 2.000J por fibra por tratamento. Todo o procedimento foi guiado por ultrassonografia. Resultados Foram avaliados 30 pacientes, com total de 31 nódulos submetidos à ablação a laser. A redução média volumétrica do nódulo foi de aproximadamente 60% após 12 meses. Não foi observada significância estatística na função da tireoide e nem nos níveis de anticorpos. Houve pico no nível de tiroglobulina após o procedimento devido à destruição do tecido (p<0,0001). Nenhum efeito adverso foi observado. Conclusão A ablação com laser é um tratamento minimamente invasivo promissor para tratamento do nódulo benigno da tireoide.

Bilateral descemet membrane detachment in femtosecond laser-assisted cataract surgery / Descolamento de descemet bilateral em cirurgia de catarata com laser de femtosegundo

Abstract We report an unusual case of a 65-year old patient that developed localized bilateral Descemet membrane detachment during non-simultaneous femtosecond laser-assisted cataract surgery (FLACS). The detachment occurred when the laser was performing the secondary incision. In the operating room, the isolate-and-release technique was used to effectively manage this complication. To the best of our knowledge, this is the first reported case of bilateral Descemet membrane detachment during FLACS.

Resumo Relatamos um caso de uma paciente de 65 anos de idade que evoluiu com descolamento de Descemet localizado bilateral durante cirurgias de catarata não simultâneas com laser de femtosegundo. O descolamento ocorreu durante a realização da paracentese pelo laser. Na sala cirúrgica, foi utilizada a técnica de "isolar e liberar" para conduzir eficazmente esta complicação. De acordo com o nosso conhecimento, esse é o primeiro relato de caso de descolamento bilateral da membrana de Descemet durante cirurgia de catarata com laser de femtosegundo.

Mirror Syndrome after Fetoscopic Laser Treatment - A Case Report / Síndrome do espelho após tratamento laser por fetoscopia - caso clínico

Abstract Mirror syndrome is a rare disease with unknown pathophysiology that can be present in different diseases that can cause fetal hydrops. The prognosis is usually bad with a high perinatal mortality. We report an unusual form of mirror syndrome that manifested itself only after a successful treatment for fetal hydrops (caused by twin-twin transfusion syndrome, in Quinteros stage IV) was performed. This syndrome was controlled by medical treatment, and despite the usually bad prognosis seen in these cases, we could extend the pregnancy from the 23rd to the 34th week of gestation, resulting in the birth of 2 live infants.

Resumo A síndrome do espelho é uma doença rara, de fisiopatologia desconhecida, que se manifesta em situações obstétricas responsáveis pela presença de hidrópsia fetal. Habitualmente o prognóstico é reservado, uma vez que se associa a elevadas taxas de mortalidade perinatal. O presente caso clínico trata de uma situação de síndrome do espelho que se manifestou, atipicamente, após o tratamento eficaz para a hidrópsia fetal associada à síndrome de transfusão feto-fetal. Apesar do mau prognóstico associado a estas situações, conseguiu-se controlar a situação apenas com tratamento médico e, desta forma, prolongar a gravidez durante 12 semanas.

Holmium laser enucleation of the prostate: surgical, functional, and quality-of-life outcomes upon extended follow-up

ABSTRACT Objectives: To evaluate the long-term surgical, functional, and quality-of-life (QoL) outcomes after Holmium laser enucleation of the prostate (HoLEP) in patients with symptomatic benign prostatic hyperplasia (BPH). Materials and Methods: We retrospectively reviewed recorded data on patients who underwent HoLEP between June 2002 and February 2005. Ninety-six patients were enrolled. Demographic, perioperative, and postoperative data were recorded. On follow-up, International Prostate Symptom Scores (IPSSs), prostate-specific antigen (PSA) levels, QoL scores, peak uroflowmetric data (Qmax values), and post-voiding residual urine volumes (PVR volumes), were recorded. Complications were scored using the Clavien system. Statistical significance was set at p<0.05. Results: The mean follow-up time was 41.8±34.6 months and the mean patient age 73.2±8.7 years. The mean prostate volume was 74.6±34.3mL. Significant improvements in Qmax values, QoL, and IPSSs and decreases in PSA levels and PVR volumes were noted during follow-up (all p values=0.001). The most common complication was a requirement for re-catheterisation because of urinary retention. Two patients had concomitant bladder tumours that did not invade the muscles. Eight patients (8.3%) required re-operations; three had residual adenoma, three urethral strictures, and two residual prostate tissue in the bladder. Stress incontinence occurred in one patient (1%). All complications were of Clavien Grade 3a. We noted no Clavien 3b, 4, or 5 complications during follow-up. Conclusions: HoLEP improved IPSSs, Qmax values, PVR volumes, and QoL and was associated with a low complication rate, during extended follow-up. Thus, HoLEP can be a viable option to transurethral resection of the prostate.

A terapia com laser em especialidades odontológicas / Terapia con rayos láser en especialidades dentales / Laser therapy in dental specialties

Introdução: a terapia com laser tem sido utilizada com muito êxito na clínica odontológica e é uma excelente opção para cuidados de saúde. Objetivo: identificar no Norte/Nordeste do Brasil o número de dentistas especializados en raios laser e identificar, dentro do territorio brasileiro, as regiões onde há maior demanda de cursos de capacitação em laserterapia. Métodos: estudo descritivo com base nas consultas de dados secundários disponíveis no site do Conselho Federal de Odontologia, na secção de serviços e consultas, em 2013. Os resultados foram avaliados pelos testes do chi-quadrado e exato de Fisher (nível de significância de 5 porcento). Resultados: a amostra do estudo foi formada por 29 profissionais. Nas regiões analisadas, a maioria dos profissionais que possuiam a especialização em laserterapia eran clínicos gerais (sem especialização). Verificpu-se que a região sudeste se destaca pela maior disponibilidade de cursos certificados laserterapia, seguido pelo sul e pelo norte. O nordeste não apresenta nenhum curso em laserterapia, embora tenha mais profissionais especializados que no norte. O laser não deve representar apenas um dispositivo novo na clínica odontológica, mas sim, como uma nova filosofia terapêutica, que permite una interação biofísica entre a luz e o tecido biológico, o qual favorece um melhor tratamento e uma melhor qualidade de vida dos pacientes. Conclusões: uma maior quantidade de profissionais especializados se encontram na região sul e sudeste do Brasil, porém já é possível notar um aumento deste número no nordeste(AU)

Introducción: la terapia con rayos láser se ha utilizado con mucho éxito en la clínica dental, actualmente constituye una excelente opción para la asistencia sanitaria. Objetivo: identificar en el norte/noreste de Brasil el número de dentistas especializados en rayos láser y identificar, dentro del territorio brasileño, las regiones donde hay mayor demanda de cursos de capacitación de terapia con rayos. Métodos: estudio descriptivo basado en las consultas de datos secundarios disponibles en el Consejo Federal de Odontología del sitio, la sección de servicios y consultas, en 2013. Los resultados se evaluaron mediante la prueba de chi cuadrado y la prueba exacta de Fisher (nivel de significación del 5 por ciento). Resultados: la muestra estuvo conformada por 29 profesionales. En las regiones analizadas, la mayoría de los profesionales que poseen la especialización en terapia con rayos láser son médicos generales (no especializados). Se encontró que la región sureste destaca por una mayor disponibilidad de cursos certificados en la terapia con rayos láser, seguido por el sur y el norte. El noreste no muestra ningún curso en la terapia con rayos laser, aunque hay más profesionales cualificados que en el norte. El rayo láser no debe definirse solo como un dispositivo nuevo en la clínica dental, sino como una nueva filosofía terapéutica, que permite una interacción biofísica entre la luz y el tejido biológico, lo cual favorece un mejor tratamiento y una mejor calidad de vida de los pacientes. Conclusiones: una mayor cantidad de profesionales especializados se encuentra en la región sur y sureste de Brasil pero ya es posible notar una ampliación de este número en el noreste(AU)

Introduction: laser therapy has been used with great success in dental clinics, and constitutes an excellent option in current health care. Objective: determine the number of dentists specializing in laser therapy in the north / northeast of Brazil and identify the regions in the Brazilian territory where there is a greater demand for courses on laser therapy. Methods: adescriptive study was conducted based on the examination of secondary data available from the Brazilian Federal Council of Dentistry of the area, the services section and consultations, in the year 2013. Results were evaluated with the chi-square test and Fisher's exact test (significance level of 5 percent). Results: the sample was composed of 29 professionals. In the regions analyzed, most professionals with specialization in laser therapy are general, non-specialized practitioners. It was found that the southeast stands out for its greater availability of certified courses on laser therapy, followed by the south and the north. No course about laser therapy was found in the northeast, despite the fact that there are more qualified professionals in that region than in the north. Laser therapy should not be defined as a new device in dental practice, but as a new therapeutic philosophy allowing biophysical interaction between light and biological tissue, thus providing better treatment and improving the quality of life of patients. Conclusions: alarger number of specialized professionals may be found in the south and southeast of Brazil, but an increase in their number is already noticeable in the northeast(AU)

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

PURPOSE: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates. MATERIALS AND METHODS: Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV or =200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery. RESULTS: A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, +/-7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7+/-36.9 mL and 4.15+/-4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture. CONCLUSIONS: HoLEP in patients with an extremely large prostate can be performed efficiently and safely.

Evaluación endoscópica de la deglución. Resultados en pacientes con tumores benignos y malignos de laringe y hipofaringe, tratados con cirugía transoral con láser de CO2 / Functional endoscopic evaluation of swallowing. Results inpatients with benign and malignant tumors of the larynx and hypopharynx treated with transoral CO2 laser surgery / A avaliação endoscópica da deglutição. Os resultados em pacientes com tumores benignos e malignos da laringe e hipofaringe tratados com cirurgia transoral laser de CO2

La utilización del LASER de CO2 en laringología comenzó en la década del ‘80, permitiendo la exéresis de tumores por vía transoral. Su indicación se basa en los excelentes resultados oncológicos. La función deglutoria postquirúrgica es un factor importante en la calidad de vida de los pacientes con cáncer del tracto aerodigestivo superior. Los resultados de la deglución son relevantes para elegir la modalidad terapéutica, la cual debe ser no sólo efectiva en controlar el cáncer sino también en preservar la función del órgano. El grado y el tipo de alteración deglutoria deben ser determinados en forma precisa, para establecer el tratamiento postoperatorio adecuado. Esto es posible mediante estudios como la videodeglución y la evaluación endoscópica de la deglución (FEESST)...

The CO2 laser have been used for treatment of laryngeal cancers since 1980, with excellent oncological results. The swallowing plays an important roll in superior aerodigestive cáncer patient. Swallowing results are relevant to choose the therapeutic modality, which must be effective in controlling not only cancer but also in preserving organ function. The degree and type of swallowing impairment must be determined precisely, to establish the appropriate postoperative treatment. This is possible through studies like videodeglucion and endoscopic evaluation of swallowing (FEESST)...

O uso do laser de CO2 laringologia começou nos anos 80, permitindo a excisão tumor transoral. A indicação baseia-se nos excelentes resultados oncológicos. Função de deglutição pós-cirúrgico é uma importante qualidade de vida de pacientes com câncer do fator trato aerodigestivo superior. Engolindo resultados são relevantes para escolher a modalidade terapêutica, que deve ser eficaz no controle não só do câncer, mas também em preservar a função do órgão. O grau e tipo de comprometimento da deglutição deve ser determinada com precisão, para estabelecer o tratamento pós-operatório adequado. Isso é possível através de estudos como videodeglucion e avaliação endoscópica da deglutição (FEESST)...

One day surgery in the treatment of benign prostatic enlargement with thulium laser: A single institution experience

PURPOSE: Various articles have previously addressed the introduction of new surgical laser therapies for an enlarged prostate gland causing obstructive symptoms. The objective of this study was to report the feasibility of performing the thulium laser vapo-enucleation of the prostate (ThuVEP) procedure for benign prostatic obstruction in a 1-day surgery. MATERIALS AND METHODS: From September 2011 to September 2013, we conducted a prospective study on patients who underwent ThuVEP in a 1-day surgery. The primary outcomes measured perioperatively included operative time, resected tissue weight, hemoglobin decrease, transfusion rate, postoperative irrigation and catheterization time, and postoperative hospital stay. Also, the preoperative and postoperative International Prostate Symptom Score (IPSS) and results of uroflowmetry performed on the 7th and 30th postoperative days were recorded. All perioperative and postoperative complications were monitored. RESULTS: A total of 53 patients underwent the surgical treatment in a 1-day surgery. Seven patients continued antiaggregant therapy with aspirin. Mean preoperative prostatic adenoma volume was 56.6 mL. Mean operative time was 71 minutes. The average catheter time was 14.8 hours. The peak urinary flow rate on day 7 improved from 9.3 to 17.42 mL/s (p<0.001) and the IPSS improved from 18 to 10.2 (p<0.01). Patients were routinely discharged on the day of catheter removal. No complications were recorded. CONCLUSIONS: ThuVEP can be safely conducted as a 1-day surgical procedure. This strategy results in cost savings. ThuVEP shows good standardized outcomes with respect to improvement in flow parameters and length of bladder catheterization.

Vaporización fotoselectiva prostática con láser greenlight: ¿existen más complicaciones en pacientes octogenarios? / Photoselective prostatic vaporization with greenlight laser: are there more complications in octogenarians?

Durante décadas la resección transuretral de próstata (RTU) se ha considerado el tratamiento de elección para la hiperplasia prostática benigna (HPB) sintomática. Los efectos adversos se reportan entre un 7 a 14 por ciento de los pacientes. Desde la introducción de la vaporización fotoselectiva prostática (VFSP) con láser GreenLight® su uso se ha propagado extensamente reportándose similar efectividad y mayor seguridad. Por otra parte, en los últimos años ha aumentado importantemente el número de procedimientos en octogenarios. Hoy se operan pacientes más añosos y con más comorbilidades. El objetivo de nuestro estudio fue evaluar si los pacientes octogenarios sometidos a VFSP con láser GreenLight® presentan más complicaciones que los menores de 80 años. Material y métodos: Estudio retrospectivo, de casos y controles. Se incluyeron pacientes con HPB sintomática sometidos a VFSP con láser GreenLight® entre los años 2005 y 2012. Se registró número de comorbilidades, número de fármacos, riesgo ASA y tiempo quirúrgico. Como complicaciones se consideró fiebre, requerimiento de transfusión, retención aguda de orina, estenosis de cuello, síntomas irritativos vesicales y otras. Se utilizó t-student y chi-cuadrado para comparar los grupos. Se obtuvo Odds ratio (OR) para las complicaciones. Resultados: Se incluyeron en el estudio 104 pacientes, 33 de ellos tenían 80 años o más. No existieron diferencias significativas entre los grupos. La estadía hospitalaria fue mayor en los pacientes octogenarios (60h vs 26h, p<0,001, IC 95 por ciento 14,9-54,2). No se encontraron diferencias significativas en cuanto a las complicaciones (36,4 por ciento vs 23,9 por ciento, p=0,24) con un OR de 1,82 (IC 95 por ciento 0,74 - 4.44).Conclusiones: Los octogenarios sometidos a VFSP con láser GreenLight® no presentan más complicaciones que aquellos de menor edad por lo que éste tratamiento podría considerarse como una alternativa segura y razonable para este grupo de pacientes...

For decades, transurethral resection of prostate (TURP) has been considered the treatment of choice for symptomatic benign prostatic hyperplasia (BPH). Adverse effects were reported between 7-14 percent of patients. Since the introduction Photoselective vaporization of the prostate (VFSP) with GreenLight ® laser its use has spread widely with similar effectiveness and increased safety being reported. Moreover, in recent years the number of procedures in octogenarians have significantly increased. Today more elderly patients with comorbidities are operated. The aim of our study was to evaluate whether octogenarians undergoing VFSP with GreenLight ® laser present more complications than those under 80.Methods: A retrospective, case-control study. Patients with symptomatic BPH that underwent GreenLight ® laser VFSP between 2005 and 2012 were included. Number of comorbidities, number of medications, ASA risk and operative time were recorded. As complications we considered: fever, transfusion requirements, acute urinary retention, bladder neck stenosis, bladder irritative symptoms and others. T-student and chi-square test were used to compare the groups. Odds ratio (OR) was obtained for complications. Results: The study included 104 patients, 33 of them were 80 years or older. There were no significant differences between groups. The hospital stay was higher in octogenarians (60h vs 26h, p <0.001, 95 percent CI 14.9 to 54.2). No significant differences were found in terms of complications (36.4 percent vs 23.9 percent, p = 0.24) with an OR of 1.82 (95 percent CI 0.74 - 4.44).Conclusions: Octogenarians undergoing VFSP with GreenLight ® laser did not have more complications than those younger patients, so this treatment could be considered as a safe and reasonable alternative for this group of patients...

Temperature distribution simulation of the human eye exposed to laser radiation

Human eye is a sensitive part of human body with no direct protection and due to its lack of protection against the external heat waves, studying the temperature distribution of heat waves on the human eye is of utmost importance. Various lasers are widely used in medical applications such as eye surgeries. The most significant issue in the eye surgeries with laser is estimation of temperature distribution and its increase in eye tissues due to the laser radiation intensity. Experimental and invasive methods to measure the eye temperature usually have high risks. In this paper, human eye has been modeled through studying the temperature distribution of three different laser radiations, using the finite element method. We simulated human eye under 1064 nm Neodymium-Doped Yttrium Aluminium Garnet [Nd: YAG] laser, 193 nm argon fluoride [ArF] excimer laser, and 1340 nm Neodymium doped Yttrium Aluminum Perovskite [Nd: YAP] laser radiation. The results show that these radiations cause temperature rise in retina, lens and cornea region, which will in turn causes serious damages to the eye tissues. This simulation can be a useful tool to study and predict the temperature distribution in laser radiation on the human eye and evaluate the risk involved in using laser to perform surgery.

Bartholin's gland cysts: management with carbon-dioxide laser vaporization / Cistos da glândula de Bartholin: tratamento com vaporização laser com CO2

PURPOSE: To evaluate the effectiveness, recurrence rate, and complications of carbon-dioxide laser vaporization in the treatment of Bartholin's gland cysts. METHODS: A retrospective study including 127 patients with symptomatic Bartholin' gland cysts submitted to carbon-dioxide laser vaporization at our institution from January 2005 to June 2011. Patients with Bartholin's gland abscesses and those suspected of having neoplasia were excluded. All procedures were performed in an outpatient setting under local anaesthesia. Clinical records were reviewed for demographic characteristics, anatomic parameters, intraoperative and postoperative complications, and follow-up data. Data were stored and analyzed in Microsoft Excel® 2007 software. A descriptive statistical analysis was performed, and its results were expressed as frequency (percentage) or mean±standard deviation. Complication, recurrence, and cure rates were calculated. RESULTS: The mean age of the patients was 37.3±9.5 years-old (range from 18 to 61 years-old). Seventy percent (n=85) of them were multiparous. The most common symptom was pain and 47.2% (n=60) of patients had a history of previous medical and/or surgical treatment for Bartholin's gland abscesses. Mean cyst size was 2.7±0.9 cm. There were three (2.4%) cases of minor intraoperative bleeding. Overall, there were 17 (13.4%) recurrences within a mean of 14.6 months (range from 1 to 56 months): ten Bartholin's gland abscesses and seven recurrent cysts requiring reintervention. The cure rate after single laser treatment was 86.6%. Among the five patients with recurrent disease that had a second laser procedure, the cure rate was 100%. CONCLUSIONS: At this institution, carbon-dioxide laser vaporization seems to be a safe and effective procedure for the treatment of Bartholin's gland cysts.

OBJETIVO: Avaliar a eficácia, a taxa de recorrência e as complicações da vaporização laser com CO2 no tratamento dos cistos da glândula de Bartholin. MÉTODOS: Estudo retrospectivo com 127 pacientes que apresentavam cistos sintomáticos da glândula de Bartholin submetidas à vaporização laser CO2 na nossa instituição de janeiro de 2005 a junho de 2011. Foram excluídas todas as pacientes com abcessos da glândula de Bartholin ou com suspeita de câncer. Todos os procedimentos foram realizados em regime ambulatorial, sob anestesia local. A coleta dos dados foi feita com base na consulta do processo clínico, tendo-se procedido à análise das características demográficas, dos parâmetros anatômicos, das complicações intra e pós-operatórias e dos dados de acompanhamento. Os dados foram armazenados e analisados no software Microsoft Excel® 2007, e os resultados foram apresentados como frequência (porcentagem) ou média±desvio padrão. As taxas de complicações, recorrência e cura foram calculadas. RESULTADOS: A idade média das pacientes foi de 37,3±9,5 anos (variando entre 18 e 61 anos). Setenta por cento (n=85) delas eram multíparas. A queixa mais frequente foi dor e 47,2% (n=60) das pacientes tinham antecedentes de tratamento médico e/ou cirúrgico por abcesso da glândula de Bartholin. A dimensão média dos cistos foi de 2,7±0,9 cm. Foram verificados três (2,4%) casos de hemorragia intraoperatória ligeira e 17 (13,4%) recorrências durante um período médio de 14,6 meses (variando entre 1 e 56 meses): dez abscessos da glândula de Bartholin e sete cistos recorrentes, que precisavam de uma nova intervenção cirúrgica. A taxa de cura após um único tratamento à laser foi de 86,6%. Dentre as cinco pacientes com doença recorrente que foram submetidas a um segundo procedimento com laser, a taxa de cura foi de 100%. CONCLUSÕES: Na presente instituição, a vaporização laser com CO2 parece ser uma opção terapêutica segura e eficaz no tratamento dos cistos da glândula de Bartholin.

Late recurrent iris synechia following laser goniopuncture for deep sclerectomy enhancement: case report / Sinéquia iriana tardia após goniopunctura a laser para esclerectomia profunda não penetrante: relato de caso

We report a case of recurrent iris synechiae one year after Nd:YAG laser goniopuncture for deep sclerectomy enhancement in the only functional eye of a patient with end-stage glaucoma. The possible pathophysiology of this uncommon complication and laser treatment aspects are discussed.

A ocorrência de sinéquias irianas após goniopunctura a laser com finalidade de aumentar a filtração após esclerectomia não penetrante é evento raro e que pode levar à crise glaucomatosa aguda e suas consequências. Relatamos a ocorrência deste evento em olho único de paciente portadora de glaucoma em estágio final, um ano após a realização de goniopunctura. Os possíveis mecanismos fisiopatológicos desta complicação incomum, assim como aspectos do tratamento a laser para reverter o quadro são discutidos.

long term follow-up of laser peripheral iridotomy in acute primary angle closure

To determine the success rate and complications of YAG laser peripheral iridotomy during a long term follow up in patients of acute primary angle closure glaucoma. Descriptive prospective case series using a combination of quantitative and qualitative analysis. Study was conducted at the Department of Ophthalmology Dow University of Health Sciences; Eye Unit 1, Civil Hospital Karachi between October 2005 and September 2010. Patients were recruited from the outpatient department with a diagnosis of acute primary angle closure. After medical control of intraocular pressure forty eight patients underwent YAG laser peripheral iridotomy with pulse energies ranging from 5-8 mJ. Patients were examined at 1 hour, 1 day, one week, two weeks and 1, 3, 6, months, one year and after two to three years. Findings were recorded on proforma and statistically analyzed. Mean age was 54.6 [ +/- 6.7, range = 45 -74] years. Mean duration of attack was 2.65 [ +/- 1.4, range 1-6] days. The commonest intra-operative complication was bleeding from the iris in 33.3% eyes. Mean follow-up period was 48.81[ +/- 9.03, range 32-65] months. Thirty six [75%] eyes developed significant cataract. Iridotomy was closed in six [12.6%] eyes. Complete success was observed in 12 [24.5%] eyes. Twenty two [44.9%] eyes required additional anti-glaucoma medication [partial success] while complete failure was observed in 14 [28.6%] eyes. YAG laser peripheral iridotomy is associated with a significant number of short term and long term complications in Asian eyes. Other alternative methods should be taken into consideration to prevent blindness in this part of the world

Complicaciones tardías de la terapia láser como tratamiento de la transfusión feto-fetal: caso clínico / Late complications of laser therapy as a treatment for feto-fetal transfusion: clinical case

Presentamos la descripción del diagnóstico y manejo de una secuencia anemia-policitemia (SAP) que se presenta como complicación de una terapia láser exitosa en un embarazo gemelar monocorial cursando una transfusión feto-fetal (TFF) severa. Describimos la manifestación de esta complicación tardía de la terapia láser de la TFF severa y realizamos una revisión de la literatura internacional al respecto. A pesar del éxito de la introducción de la terapia láser en cuanto a la sobrevida y secuelas neonatales, recientemente se han descrito una serie de complicaciones de presentación tempranas o tardías. Entre las tardías, destacan la muerte de uno o ambos gemelos, recidiva de la TFF, y aparición de una SAP. Varios autores han descrito que la SAP sería secundaria a la presencia, o persistencia, de comunicaciones vasculares extremadamente pequeñas de flujo lento, las cuales llevan a una discordancia en los niveles de hemoglobina entre ambos gemelos, sin diferencias en sus volúmenes sanguíneos.

We describe the diagnosis and management of twin anemia-polycythemia sequence (TAPS), which occurs as a late complication of successful laser therapy in twin monochorionic pregnancies developing severetwin to twin transfusion syndrome (TTTS). We offer a description of this late complication of laser therapy in this condition and a review of the related medical literature. Despite the successful introduction of laser therapy on the survival and neonatal sequelae, various early and late complications related to this procedure have been recently described. Among the late, stands out the death of one or both twins, recurrence of TTTS, and the appearance of TAPS. With regards TAPS, several authors have reported that it would be secondary to the presence, o persistence, of extremely small slow flow vascular communications, which lead to discre-pancies in the hemoglobin levéis between the twins, with no differences in blood volume.

Subclinical keratoconus among patients visiting laser unit - Hilla Teaching Hospital in Iraq

Subclinical Keratoconus is a term used to indicate a patient with inferior or central steepening of cornea on topography where the clinician suspects that it may progress to keratoconus. Diagnosis of sub-clinical keratoconus among myopic patients seeking for correction of their refractive errors by excimer laser, to avoid surgery for those patients and consider them at risk of developing post operative corneal ectasia which is the most severe post operative complication in photorefractive surgery. One thousand and two hundred myopic patients who attended laser unit/ Hilla Teaching Hospital, during a 1.5 year duration, seeking for correction of their refractive errors. Many investigations were done including visual acuity, slit lamp examination, corneal topography, keratometry and pachymetry. The present results indicating that 49 [4%] of patients diagnosed as having subclinical keratoconus. Out of these cases, 27 [55%] were males and 22 [45%] were females. Forty one of them [83.6%] were less than 25 years old. Sub-clinical keratoconus is one of the challenging problems facing refractive surgeons and is one of the most important and preventable causes of corneal ectasia following photorefractive surgeries

Complicações na dacriocistorrinostomia transcanalicular com laser diodo: complications / Transcanalicular dacryocystorhinostomy with diode laser: complications

OBJETIVO: Analisar as complicações da aplicação do laser de diodo para o tratamento da obstrução nasolacrimal adquirida. MÉTODOS: Foram realizados 44 procedimentos (dacriocistorrinostomia transcanalicular com laser de diodo com intubação bicanalicular de silicone sob anestesia local) entre fevereiro de 2002 a novembro de 2007 em 41 pacientes (3 bilateralmente), sendo 32 mulheres e 9 homens. RESULTADOS: As complicações mais frequentes no intraoperatório foram: dificuldade de passar a sonda de Crawford (13,6 por cento) e passagem da fibra óptica dificultada (11,3 por cento). No pós-operatório, a epífora foi a ocorrência mais frequente (15,9 por cento), seguida pela retirada acidental do silastic (11,3 por cento). CONCLUSÃO: Os índices de complicações intra e pós-operatórias se equivalem aos artigos publicados com a mesma técnica cirúrgica (e mesmo tipo de laser).

PURPOSE: To evaluate the complications of the use of diode laser in the treatment of acquired nasolacrimal obstruction. METHODS: Forty four procedures (transcanalicular dacryocystorhinostomy with diode laser with bicanalicular silicone tube intubation and local anesthesia) where performed from February 2002 to November 2007 in 41 patients (3 bilaterally), 32 women and 9 men. RESULTS: The most common intraoperative complications were disability to pass the Crawford probe (13.6 percent) and the laser probe (11.3 percent). Regarding postoperative complications, epiphora was the event of higher frequency (15.9 percent) followed by the non-intentional silastic extrusion by the patient (11.3 percent). CONCLUSION: Intraoperative and postoperative complications rate were similar of others articles that demonstrated the same surgical technique (with same laser).

Estudo preliminar da influência do laser de baixa intensidade (GaAlAs) na proliferação de células derivadas de polpa dental decídua humana / Preliminary analysis of the influence of low intensity laser (GaAlAs) in proliferation of human deciduous dental pulp derived cells

O objetivo deste trabalho foi verificar in vitro a influência da fototerapia a laser na biomodulação da proliferação de células derivadas de polpa dental decídua humana. Células derivadas de polpa dental decídua humana (densidade = 8,5x103 células/cm2, passagem 13) foram divididas em dois grupos experimentais: Laser (irradiação diária de laser de GaAlAs na dose de 2,5 J/cm2) e Controle (sem irradiação). O ensaio de proliferação multiparamétrico foi realizado com três técnicas consecutivas de avaliação da viabilidade celular: XTT (atividade mitocondrial), vermelho neutro (integridade lisossomal) e cristal violeta (inclusão em DNA), nos períodos de 12 horas, 1, 3, 5 e 7 dias. Os resultados mostraram aumento significativo (p < 0,001) da redução de XTT no grupo Laser (0,929 ± 0,224) em comparação com o grupo Controle (0,495 ± 0,204) em 7 dias; pico máximo da captação de vermelho neutro no grupo Controle aos 3 dias (p < 0,05) e do grupo Laser em 5 dias; a proliferação celular foi constante e progressiva até o período de 7 dias, semelhante em ambos os grupos. Considerando os resultados obtidos concluiu-se que o laser de baixa intensidade biomodula positivamente a atividade mitocondrial de células derivadas de polpa dental decídua humana, porém sem afetar a taxa de proliferação celular.

The aim of this study was to evaluate, in vitro, the influence of laser phototherapy in biomodulation of proliferation for human deciduous dental pulp derived cells. Human deciduous dental pulp derived cells (density = 8,5x103 cells/cm2, passage 13) were separated in two experimental groups: Laser (daily GaAlAs laser irradiation with a 2,5 J/cm2 dose) and Control (without irradiation). The multiparametric proliferation assay was effectuated with three successive techniques for cell viability evaluation: XTT (mitochondrial activity), neutral red (lisossome integrity) and crystal violet (DNA inclusion), during 12 hours, 1, 3, 5 and 7 days. Our results showed a significant increase of mean absorbance of XTT of Laser (0.929 ± 0.224) in comparison with Control (0.495 ± 0.204) in 7 days; maximal uptake of neutral red at 3 days (p < 0.05) for Control and 5 days for Laser group; a constant and progressive cell growth up to 7 days, similar in both groups. On the basis of these findings, it is possible to conclude that the low intensity laser biomodulates positively the mitochondrial activity of human deciduous dental pulp derived cells without, however, significant effects on cell proliferation rates.

Bone damage induced by different cutting instruments: an in vitro study

The aim of this study was to compare the peripheral bone damage induced by different cutting systems. Four devices were tested: Er:YAG laser (2.94 mm), Piezosurgery, high-speed drill and low-speed drill. Forty-five bone sections, divided into 9 groups according to different parameters, were taken from pig mandibles within 1 h post mortem. Specimens were fixed in 10 percent buffered formalin, decalcified and cut in thin sections. Four different parameters were analyzed: cut precision, depth of incision, peripheral carbonization and presence of bone fragments. For statistical analysis, the Kruskal-Wallis test was applied to assess equality of sample medians among groups. All sections obtained with the Er:YAG laser showed poor peripheral carbonization. The edges of the incisions were always well-shaped and regular, no melting was observed. Piezosurgery specimens revealed superficial incisions without thermal damage but with irregular edges. The sections obtained by traditional drilling showed poor peripheral carbonization, especially if obtained at lower speed. There was statistically significant differences (p<0.01) among the cutting systems for all analyzed parameters. Er:YAG laser, gave poor peripheral carbonization, and may be considered an effective method in oral bone biopsies and permits to obtain clear and readable tissue specimens.

O objetivo deste estudo foi comparar o dano ósseo periférico produzido por diversos sistemas de corte. Foram avaliados 4 dispositivos: laser Er:YAG (2,94 mm), Piezo-cirurgia, broca em alta rotação e broca em baixa rotação. Para isto, foram utilizadas 45 seções ósseas retiradas de mandíbulas de suínos, até 1 h post-mortem, divididas em 9 grupos de acordo com diversos parâmetros. As amostras foram fixadas em formalina a 10 por cento tamponada, descalcificadas e cortadas em lâminas finas. Foram analisados 4 parâmetros diferentes: a precisão do corte, a profundidade da incisão, a carbonização periférica e presença de fragmentos ósseos. A análise estatística empregou o teste de Kruskal-Wallis para avaliar a similaridade das medianas entre os grupos. Todas as seções feitas com o laser Er:YAG exibiram pouca carbonização. As margens das incisões foram todas bem acabadas e regulares, sem apresentar pontos de fusão. As amostras obtidas por piezo-cirurgia apresentaram incisões superficiais sem danos térmicos, mas com margens irregulares. As seções obtidas pelas brocas convencionais apresentaram pouca carbonização marginal, particularmente as feitas em baixa rotação. Foram observadas diferenças estatisticamente significantes (p<0,01) entre todos os sistemas de corte para cada um dos parâmetros analisados. O laser Er:YAG apresentou pouca carbonização e pode ser considerado como um método eficaz para biópsias de ossos bucais, produzindo amostras de tecido limpas e fáceis de analisar.

Tratamiento endovascular de la insuficiencia de los ejes safenos mediante laser diodo 980 NM / Great saphenous vein endoablation using diode 980 NM laser

Introducción: La enfermedad venosa crónica de las extremidades inferiores presenta una alta frecuencia en la población. El reflujo de la vena safena interna constituye la principal causa de insuficiencia venosa superficial correspondiendo al 70-80% de éstas. El tratamiento ablativo endoluminal de los ejes sáfenos surge como la necesidad de desarrollar un tratamiento mínimamente invasivo. Objetivo: Evaluar los resultados obtenidos mediante la endoablación de la vena safena interna con laser Diodo 980. Material y método: Se realizó un estudio prospectivo que incluyó 146 extremidades inferiores en las cuales se realizó endoablación de la vena safena interna con laser Diodo 980 nm por un período de 15 meses entre los años 2005 y 2007. Se evaluó la permeabilidad inmediata de la vena safena tratada con ecodoppler color y la aparición de complicaciones secundarias al procedimiento. Resultados: De los 90 pacientes tratados, el 76,6% fueron mujeres y el 23,4%, hombres. El promedio de edad fue 58 años. La oclusión de la vena safena interna después de la endoablación con laser fue de 99,32% a la semana y de 97,3% a los 3 meses. Las complicaciones observadas fueron: cordón en relación a la vena safena interna tratada en 5,4%, eritema en 5,4%, dolor en 5,4% y equimosis en 9,4%, Todas las complicaciones se resolvieron completamente sin secuelas. El 100% de los pacientes relató mejoría de sus síntomas y estar satisfecho con el procedimiento. Conclusión: En relación a las técnicas de tratamiento convencionales para el manejo del reflujo de la vena safena interna, los métodos endovasculares presentan baja frecuencia de complicaciones, rápida recuperación y reintegro a las actividades laborales. No presentan el alto grado de neovascularización de la safenectomía quirúrgica.

Background: Great Saphenous Vein reflux is the main cause of superficial vein insufficiency. Endoluminal ablation of this vein is a minimally invasive treatment for varices. Aim: To evalúate the results of Great Saphenous Vein endoablation using Diode 980 nm laser. Material and Methods: A prospective study in 146 lower extremities of 90 patients aged 25 to 91 years (69 females), subjected to Great Saphenous Vein endoablation with Diode 980 nm laser, between 2005 and 2007. Immediate permeability of the treated Saphenous Vein was evaluated with Dúplex ultrasound. Complications related to the procedure were also recorded. Results: Great Saphenous Vein occlusion after endoablation with Diode 980 nm laser was 99% at the end of first week and 97% at 3 months. Recorded complications were induration in relation to the treated Great Saphenous Vein in 5.4%, erythema in 5.4%, pain in 5.4% and ecchymosis in 9.4%. All these complications resolved. All patients reported and improvement of symptoms and were satisfied with the procedure. Conclusions: This Endovascular method for the treatment of Great Saphenous Vein reflux has a low incidence of complications, fast recovery and return to normal activities.