Effect of Er:YAG Laser for Women with Stress Urinary Incontinence.

PURPOSE: The aim of our study is to assess efficacy of noninvasive erbium-doped yttrium aluminium garnet laser (Er:YAG laser) for female stress urinary incontinence (SUI). MATERIALS AND METHODS: Forty-one women with SUI were included in the study and scheduled for vaginal Er:YAG laser treatment. The procedure was performed with a 2940 nm, Er:YAG laser (Fotona Smooth ™ XS, Fotona, Ljubljana, Slovenia), designed to heat up the vaginal mucosa to around 60°C. All subjects had a baseline and 6 months' posttreatment assessment that included perineal sonography and lower urinary tract symptoms. RESULTS: Significant improvements in both urinary frequency and incontinence were found 6 months after Er:YAG laser treatment when compared to the baseline results (p<0.001). The battery of questionnaires administered to patients, including the UDI-6, IIQ-7, OABSS, and POPDI-6, all showed significant improvement posttreatment (P < 0.001). The treatment efficacy for the vaginal Er:YAG laser for SUI at 6 months posttreatment was 75.5% (31/41). Bladder neck mobility by perineal ultrasonography decreased significantly (16.1 ± 6.4 mm to 10.5 ± 4.6 mm) after treatment (p=0.039). No permanent adverse events were found. CONCLUSIONS: The Er:YAG vaginal laser seems to be a safe and efficacious treatment for women with mild to moderate SUI, this being partly related to the decrease of bladder neck mobility following laser treatment.

Design of multifunctional alkali ion doped CaF2 upconversion nanoparticles for simultaneous bioimaging and therapy.

Herein, alkali ion doped CaF2 upconversion nanoparticles (UCNPs) were first reported as a multifunctional theranostic platform for dual-modal imaging and chemotherapy. Interestingly, we found that the alkali ions doping approach could efficiently enhance the upconversion luminescence (UCL) intensity, whereas slightly affect the phase and morphology of the resulting products. In order to further improve the UCL efficacy for bioimaging, a pristine CaF2 shell was grown on the CaF2:Yb, Er core surface to enhance the UCL intensity. After being transferred into hydrophilic UCNPs, these water-soluble UCNPs could be served as contrast agents for in vitro/in vivo UCL imaging and X-ray computed tomography (CT) imaging. Furthermore, the as-prepared UCNPs could also be employed as nano-carriers for drug delivery. Doxorubicin (DOX) can be easily loaded onto the UCNPs and the DOX-loaded UCNPs exhibit a good cell killing ability. Therefore, the multifunctional core-shell CaF2 UCNPs with UCL/CT imaging and drug carrier properties may find extensive applications in simultaneous imaging diagnosis and therapy.

Efficacy of radiosynovectomy in rheumatoid arthritis.

In this retrospective study, we evaluated the effect of radiosynovectomy of patients with rheumatoid arthritis. Radiosynovectomy was performed in 577 joints of 137 rheumatoid patients. We applied 185 MBq yttrium-90 in knees (n = 58), 74-111 MBq rhenium-186 colloids in ankle (n = 50), wrists (n = 43) and shoulders (n = 35), and 15 to 37 MBq in finger (n = 298) and toe joints (n = 46). The effect of radiosynovectomy was scored in 4 subjective categories: excellent response (no symptoms); good response (significant reduction of symptoms); moderate response (slight decrease); and bad response (no change or worsening), of pain and/or swelling in treated joint 3 months after the procedure. Excellent or good response was observed in 57% of treated knees, 63% of shoulders, 60% of wrists, 64% of ankles, 54% of thumb bases, 55% of MCP's, 54% of PIP's, 53% of DIP's, and 54% of MTP's. Side effects associated to the RSO, i.e., swelling or transient increase of pain, were recorded in 7% of the patients that resolved within 1 month. No patient had any non-reversible skin alteration after treatment, only slight erythema was observed in 5 patients. Radiosynovectomy is effective and safe in the treatment of rheumatoid arthritis.

Clinical effect of radiation synovectomy of the upper extremity joints: a randomised, double-blind, placebo-controlled study.

PURPOSE: To compare the clinical efficacy of radiosynoviorthesis (RSO) with intra-articular radionuclide plus glucocorticoid (GC) injection (group A) with that of placebo plus GC injection (group B) for the treatment of persistent synovitis in joints of the upper extremity. METHODS: At baseline and at 6 and 12 months after intra-articular injection, six clinical parameters were scored. Changes in clinical values over time were summed to provide a change composite index (CCI), ranging from 0 (no effect) to 12 (maximal effect). A CCI > or =6 was considered to indicate successful treatment. Differences in response rate and CCI between groups A and B were examined. Regression analyses were performed to explore whether baseline variables could predict therapeutic effect. RESULTS: Sixty-eight joints in 44 patients were treated. Six months after intra-articular injection, response rates (CCI > or =6) were 69% (25/36) in group A and 29% (9/31) in group B (p=0.001). The mean CCIs +/- standard deviation at 6 months were 6.7+/-3.2 for group A and 3.3+/-3.8 for group B (p=0.001). At 12 months the response rates were 69% (25/36) in group A and 32% (8/25) in group B (p=0.004). The mean CCIs at 12 months were 6.8+/-3.3 for group A and 4.2+/-4.7 for group B (p= 0.046). None of the baseline variables predicted the therapeutic effect. CONCLUSION: RSO (radionuclide plus GC) of upper extremity joints with immobilisation for 72 h shows a significantly better response rate than placebo plus GC in patients with persistent synovitis after at least one failed outpatient intra-articular GC injection.

[Unusual digital articular destructions after radio-synovectomy and cortisone injection therapy for Bouchard arthrosis]. / Ungewöhnliche Fingergelenkdestruktionen nach Radiosynoviorthese (RSO) und Cortisoninjektionstherapie bei Bouchard-Arthrose.

UNLABELLED: Starting in 1998, a female patient suffering from activated Bouchard arthrosis was treated with intra-articular steroid injections into digits of both hands. In September 2001, an additional therapy with erbium-169 injections into the same joints was begun. The injections were continued until March 2003. No benefit was observed. Instead, severe destruction of the involved joints with articular necroses and marked periarticular calcifications had occurred. The course of events are documented by plain film examinations. CONCLUSIONS: The indication for alternating steroid injections and radio-synovectomies in patients with activated Bouchard arthrosis has to be reconsidered. In vivo and in vitro experiments are necessary to evaluate the potential harms of this combination of therapies. A close clinical and radiological control of treatment outcome with reevaluation of the indication is necessary.

Erbium:YAG laser as a method of deepithelization in corrective and reductive breast surgery.

Deepithelization of the breast in breast ptosis surgery is important, being associated with risks which could affect the clinical outcome. The role of Er:YAG laser deepithelization was investigated. A total of 12 bilateral mammoplasties were performed, randomly assigned to 2 groups, one of experienced and one of less-experienced surgeons. Results were compared between the 2 groups of surgeons for scalpel deepithelization on one breast and the Er:YAG laser on the contralateral breast. No complications; less edema, pain, and erythema; and quicker wound healing were observed in the laser-deepithelized breasts, with a shorter operation time even for the less-experienced surgeons. The authors do not suggest that the Er:YAG laser should replace the scalpel in the hands of the expert surgeon for breast deepithelization in breast ptosis surgery, but the results of the study suggest that Er:YAG laser ablation is a safe, precise, effective and complication-free method.

Clinical efficacy of radiation synovectomy in digital joint osteoarthritis.

PURPOSE: Radiation synovectomy was developed for local treatment of rheumatoid arthritis. In this study, the long-term efficacy of radiation synovectomy was retrospectively evaluated in patients with osteoarthritis (activated arthrosis) of the digital joints using an algofunctional score. METHODS: Fifty-three digital joints in 29 patients (mean age 64.8 years) were treated by intra-articular injection of 169Er citrate. All joints were painful despite pharmacotherapy and showed an elevated blood pool pattern in a pretherapeutic three-phase bone scan, indicative for local synovitis. The patients were asked to classify their complaints with respect to different daily manual activities on a ten-step pain scale from 1 (total disability) to 10 (lack of any impairment) prior to and after treatment, with a mean follow-up of 41 months. Local signs of osteoarthritis such as joint swelling or pain were additionally evaluated and were scored from progression of complaints to excellent improvement based on patient self-evaluation. RESULTS: All patients reported a pronounced improvement in their manual activities. The mean total score of 4.73+/-0.58 for all activities prior to treatment increased significantly to 6.79+/-0.47 after radiation synovectomy (p<0.05). The best results were obtained in the thumb base joints, whereas distal interphalangeal joints were frequently resistant to therapy. CONCLUSION: Radiation synovectomy is highly effective in digital joint osteoarthritis with concomitant local synovitis.

The gold standard for decortication of rhinophyma: combined erbium-YAG/CO2 laser.

Rhinophyma is a benign condition of the nose that often is severely disfiguring and occasionally causes functional problems. A considerable proportion of the patients, with rhinophyma are elderly with chronic medical problems. Electrocautery, heated scalpel, carbon dioxide (CO(2)) laser, argon laser, Weck blade, dermabrasion, cryotherapy, radiotherapy, full-thickness excision, skin graft, flap reconstruction, and cold scalpel have been used either alone or in combination. All these techniques have disadvantages that are resolved by using the combined erbium:yttrium-aluminum-garnet (YAG)/CO(2) laser. The authors present their technique and the results from decortication of rhinophyma using a combined erbium:YAG/CO(2) laser. The technique requires only local anesthesia with a vasoconstrictor. The combination of an efficient vaporization tool consisting of the erbium:YAG laser and the CO(2) coagulation laser provides a nearly bloodless field for accurate sculpting of the nose and produces cosmetically pleasing results.

Transdermal delivery of macromolecules by erbium:YAG laser.

The aim of this study was to assess the effect of molecular weight (MW) on the transdermal delivery of macromolecules by erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment. Fluorescein isothiocyanate (FITC)-labeled dextran (FD) of increasing MWs (4.4, 19.4, 38, and 77 kDa) was used as the model macromolecules to investigate the skin permeation in vitro. Fluorescence microscopy and scanning electron microscopic (SEM) images were utilized to examine the transport mechanisms of the macromolecules via the skin after laser treatment. The results indicate a significant increase in the permeation of FITC and FD across skin treated by the laser. The MWs of macromolecules and laser fluences were found to play important roles in controlling macromolecular absorption. Transdermal delivery of FD with a MW of at least 77 kDa could be achieved with laser treatment. Follicular routes were significant for FITC permeation, whereas intercellular pathways played important roles on the delivery of FD. Ablation of the stratum corneum (SC) layer, photomechanical stress on intercellular regions, and alterations of the morphology and arrangement of corneocytes are possible mechanisms of how the Er:YAG laser promotes macromolecular delivery. No alteration of viable skin morphology was observed after laser treatment and the partly ablation of the SC may be reversible. Hexameric insulin showed higher skin permeation than did FD with similar MWs (38 kDa) with laser enhancement. From the study presented herein, it is concluded that the Er:YAG laser can be effective for transdermal delivery of macromolecules and hydrophilic permeants such as peptides and protein-based drugs.

Physical and biological dosimetry in patients undergoing radiosynoviorthesis with erbium-169 and rhenium-186.

Physical and biological dosimetry were investigated in 45 rheumatoid arthritis patients treated by radiosynoviorthesis (RSO) with 186Re-sulphide (medium-sized joints) and 169Er-citrate (digital joints). Biological dosimetry involved scoring dicentrics in lymphocytes, cultured from blood samples withdrawn just before and 6 h, 24 h and 7 days after treatment. Physical methods included repeated blood sample counts and scintigraphy data. For erbium-169 (pure beta emitter), only bremsstrahlung could be measured and solely in the injection area. For rhenium-186 (both beta and gamma emitter), whole body scans and static images of joints and locoregional lymph nodes were performed. Dosimetry calculations were in accordance with the MIRDOSE 3 software and tables. For erbium-169 (21 patients), either metacarpophalangeal (30 MBq) or proximal interphalangeal (20 MBq) joints of the hands were treated (one joint per patient); 18 patients (out of 21) were interpretable for biological dosimetry, 10 (out of 11) for physical dosimetry and six (out of 10) for both. For rhenium-186, 23 wrists, nine elbows, three shoulders and two ankles were injected in 24 patients, with a maximum of three joints per patient (70 MBq per joint); 20 patients (out of 24) and 10 (out of 10) were interpretable for biological and physical dosimetry, respectively, and eight (out of 10) for both methods. Erbium-169 biological dosimetry was negative in all interpretable patients, and physical dosimetry gave a blood dose of 15 +/- 29 microGy and an effective dose lower than 1 mSv/30 MBq. For rhenium-186, biological results were negative in 16 patients (out of 20), but showed a blood irradiation around 200 mGy in the last four. A significant cumulative increase of dicentrics 7 days after injection (16/10,000 instead of 5/10,000 prior to treatment; p < 0.04) was also noted. Gamma counts gave a blood dose of 23.9 +/- 19.8 mGy/70 MBq and the effective dose was found to be 26.7 +/- 5.1 mGy/70 MBq, i.e. about 380 microGy.MBq-1. Erbium-169 RSO is very safe from both physical and biological dosimetry standpoints. Rhenium-186 leak is greater, as demonstrated by the higher blood activity and the measurable, although limited, dicentrics induction in blood lymphocytes. However, the effective dose remains moderate, i.e. 30 times lower than in 131I therapy in benign thyroid diseases.

[Principles of radiosynoviorthesis]. / Grundlagen der Radiosynoviorthese.

Radiosynoviorthesis plays an important role in local treatment of rheumatoid arthritis. Radionuclides with different beta-energy are used according to the size of the joint. 90Y is used for the irradiation of chronic synovitis of the knee, 186Re for shoulder, elbow, wrist, hip and ankle; and 169Er for small finger joints. Side effects of radiosynoviorthesis such as irradiation synovitis can be avoided by synchronous injection of corticosteroids. About 60% of treated joints show good therapeutic results, early radiosynoviorthesis being the most successful. Best results are achieved in the early stages of disease in the treatment of ankle, knee and shoulder. Radiosynoviorthesis represents an alternative treatment for local therapy in rheumatoid patients.

[Synoviorthese]. / Die Synoviorthese.

Among the various possibilities for local treatment of rheumatoid synovitis, intra-articular injection of corticosteroids has only a very temporary effect. The same can be said of local treatment with cytostatics, though the effect is somewhat longer-lived. After intra-articular treatment with 1% osmic acid, joint effusions in particular remain under control over a lengthy period of time. The most effective conservative local treatment appears to be radionuclide therapy, and in older patients it may be a true alternative to surgical synovectomy. Radionuclides with varying physical properties are administered according to the size of the joint. The dosage of these substances also depends on the size of the joint. If precautions are taken, side effects are rare.

Erbium--169 versus triamcinolone hexacetonide in the treatment of rheumatoid finger joints.

Erbium--169 was compared with triamcinolone hexacetonide in the topical treatment of 32 patients suffering from rheumatoid arthritis. Erbium--169 was injected into 83 and triamcinolone hexacetonide into 54 proximal interphalangeal or metacarpophalangeal joints. Both treatments produced alleviation of joint pain and swelling and improvement of grip strength. At every check-up (1--18 months) the percentage of remissions was higher after triamcinolone hexacetonide injection than after erbium--169. The difference was significant at 1, 3, and 6 months.

[Synoviorthesis of finger joints using erbium-169. Parameters influencing the clinical results at middle-term]. / La synoviothése des articulations digitales de la main à l'erbium 169. Paramètres influençant les résultats cliniques à moyen terme.

Synoviorthesis of the finger joint with erbium-169 is a beneficial therapeutic procedure which produces reduction of articular pain and swelling in 2/3 of cases. The effect is lasting and shows only slight regression during the first 24 months. However, if the rheumatoid disease is very active, or if the articular lesions are primarily erosive, the results are poorer. No correlation was found between therapeutic results and the radiological findings prior to 169E treatment. Erbium-169 reduces inflammation and leads to progressive articular fibrosis. Any chronic synovitis of interdigital joints resistant to appropriate conventional anti-inflammatory treatment may benefit from radio-synoviorthesis with erbium-169. Erbium-169 synoviorthesis is is technically easy to perform and free of side effects. It is a palliative measure which the authors consider a valuable complement to the classical treatment of rheumatoid arthritis.

Double-blind study of erbium 169 injection (synoviorthesis) in rheumatoid digital joints.

A double-blind study of erbium 169 injection into rheumatoid digital joints was carried out with saline as control. 201 joints in 36 patients were studied (137 metacarpophalalangeal, 64 proximal interphalangeal). Erbium 169 was injected into 121 joints and saline water into 80 joints. Local injection of corticosteroids was given to both groups. A definite improvement was observed in 55% to 58% of cases with erbium 169 (+prednisolone acetate) and in 26% to 28% of cases with saline (+prednisolone acetate). The difference was highly significant.

[Early isotopic synoviorthesis during rheumatoid polyarthritis (RP)]. / A propos des synoviorthèses isotopiques précoces au cours de la polyarthrite rhumatoïde (PR)

The authors report the results of 1258 chemical synovectomies carried out in subjects with rheumatoid polyarthritis on joints at Steinbrocker stage I and of 470 chemical synovectomies carried out during the first year of evolution of rheumatoid polyarthritis. Comparison with the results of chemical synovectomy carried out later demonstrate the superiority of early chemical synovectomy.

[Treatment of hemophilic arthropathies by medical synoviorthesis]. / Le traitement des arthropathies hémophiliques par la synoviorthèse médicale

The effects of medical synoviorthesis were studied by the authors in the haemophiliac. The use of radioisotopes was limited in view of the young age of the patients but a good result was achieved for the 5 elbows treated and for the 4 knees (yttrium 90) the results were 2 good, 1 fair and 1 failure. Osmic acid was injected in 44 knees. The results were good and fair in 51% of 39 knees. The results can be improved by a second injection. Synoviorthesis should be kept for joints with very few destructions because of the danger of worsening the osteocartilaginous lesions, specially with osmic acid.

Effect of intra-articular inj-ction of radioactive colloids of erbium and yttrium on the growth of rabbit legs.

The effect of the intra-articular injection of radioactive erbium 169 and yttrium 90 on the growth of the leg in rabbits has been studied. I colloid state these isotopes are used clinically for synovial ablation. These beta emitters slow down bone growth in proportion to the amount of radioactivity injected. If the joint has previously been damaged by an inflammatory arthritis the effect of the radiation on the bone growth is reduced.