Cooling efficiency of cryogen spray during laser therapy of skin.

BACKGROUND AND OBJECTIVES: Cryogen spray cooling (CSC) is used extensively for epidermal protection during laser-induced photothermolysis of port wine stains and other vascular skin lesions. The efficacy of CSC depends critically on the heat transfer coefficient (H) at the skin surface for which, however, no reliable values exist. Reported values for H, based on tissue phantoms, vary from 1,600 to 60,000 W/m(2) K. STUDY DESIGN/MATERIALS AND METHODS: A simple experimental model was designed and constructed, consisting of a pure silver-measuring disk (diameter 10 mm, thickness approximately 1 mm), embedded in a thermal insulator. The disk was covered with a 10 microm thick stratum corneum layer, detached from in vivo human skin. The heat transfer coefficient of the stratum corneum/cryogen interface was measured during CSC with short spurts of atomized tetrafluoroethane. RESULTS: H was found to be dependent on the specific design of the cryogen valve and nozzle. With nozzles used in typical clinical settings, H was 11,500 W/m(2) K, when averaged over a 100 ms spurt, and 8,000 W/m(2) K when averaged over a 200 ms spurt. CONCLUSIONS: The presented model enables accurate prediction of H and thus improve control over temperature depth profile and cooling efficiency during laser therapy. Thereby, it may contribute to improvement of therapeutic outcome.

Demonstration of synergistic effects of hyperthermia and photodynamic therapy using the chick chorioallantoic membrane model.

The chick chorioallantoic membrane (CAM) model was used to study vascular effects of photodynamic therapy (PDT) and hyperthermia (HPT) and the synergism of these modalities. The CAM is a convenient medium for monitoring the modifications of the vasculature. It is possible to view the CAM and to examine structural changes of individual blood vessels in real time. Moreover, the CAM is a closed system which lends itself to mathematical modeling of the temporal and spatial temperature profile and in which HPT can be performed quantitatively and to a selected depth, using different lasers. A porphyrin-type photosensitizer solution was applied to areas of the CAM, defined by teflon O-rings placed on the surface. Uptake dynamics of the sensitizer into the CAM was determined by analyzing its fluorescence in vivo. The CAM area was irradiated with a dual-wavelength laser system composed of a dye laser at 644 nm (to induce PDT) and a CO2 laser at 10.6 microns (to bring about HPT). Damage to the CAM vasculature, due to combined PDT+HPT, was compared to the outcome of the separate modalities, and a synergistic effect of about 40% was observed.

Glucose administration combined with photodynamic therapy of cancer improves therapeutic efficacy.

Both the scope and the levels of activity in basic research and in the clinical applications of PDT, have grown enormously during the past few years. Several studies have examined the synergism of hyperthermia and chemotherapeutic agents in combination with PDT to enhance tumor eradication. The present study investigates the synergism of glucose administration combined with phototherapy. The results of this study suggest that glucose administration is simple and well tolerated, and combined with PDT produces a larger percentage of animals cured than using PDT alone. Furthermore, the results indicate that this approach requires lower amounts of light and might enable dosage reduction of photosensitizer for optimal response, with minimal side effects, to the treatment of cancer.

Photochemotherapy of hypervascular dermal lesions: a possible alternative to photothermal therapy?

Continued improvement in the results of laser treatment of port wine stain, with reduction in scarring, will depend on the ability to use lasers to induce selective injury of only the abnormal blood vessels in the dermis while sparing the normal overlying epidermis. Photodynamic therapy, using an exogenous photosensitizing drug specifically activated by certain wavelengths of light, may be used to destroy selectively certain targets in biological systems. The current study demonstrates, in the chicken comb model, that photochemotherapy can be used to treat hypervascular dermal lesions while leaving the normal overlying epidermis completely intact.