ABSTRACT
Objective: The aim of this study was to evaluate the effect of non-ablative erbium vaginal laser treatment on vaginal mucosa tissue affected by severe atrophy.Methods: Ten patients with severe genitourinary syndrome of menopause were treated with two sessions of the non-ablative erbium-doped yttrium aluminium garnet laser (Er:YAG laser) separated by 4 weeks. Vaginal biopsies were performed before and 3 months after the second treatment. The improvement in vaginal atrophy was assessed using multiple measuring tools before and 6 months after the treatment. The degree of patients' satisfaction was also assessed.Results: Microscopic examination showed significant changes in the main structural components of the vaginal wall mucosa after two non-ablative Er:YAG laser sessions. The epithelial thickness increased from 45 µm (10-106 µm) to 153 µm (97-244 µm) measured 3 months after the final laser treatment. Vaginal atrophy improved in all patients by all measured outcomes. The degree of patient satisfaction was very high (3.6 on the Likert four-point scale). No adverse events or complications were observed in any of the sessions. Conclusion: The non-ablative Er:YAG laser seems to be a safe and effective method to increase epithelial thickness of the vaginal mucosa in patients with severe vaginal atrophy.
Subject(s)
Laser Therapy/methods , Lasers, Solid-State , Menopause , Vagina/pathology , Vagina/surgery , Aged , Atrophy , Biopsy , Epithelium/pathology , Epithelium/surgery , Female , Female Urogenital Diseases/surgery , Humans , Middle Aged , Patient SatisfactionABSTRACT
OBJECTIVE: The aim of this study was to evaluate the efficacy and acceptability of a second generation of vaginal laser treatment, the vaginal erbium laser, as a nonablative photothermal therapy for the management of genitourinary syndrome of menopause in postmenopausal breast cancer survivors. METHODS: The study was performed using an erbium laser crystal yttrium-aluminum-garnet (XS Fotona Smooth, Fotona, Ljubljana, Slovenia) with a wavelength of 2,940ânm. Forty-three postmenopausal breast cancer survivors were treated with three laser applications every 30 days. Symptoms were assessed before the treatment and after 1, 3, 6, 12, and 18 months, using two methods, subjective Visual Analog Scale (VAS) and objective Vaginal Health Index Score (VHIS). The procedures were performed on an outpatient basis without anesthesia or drug use before or after the intervention. RESULTS: From baseline values of 8.5â±â1.0âcm, vaginal dryness VAS scores were 4.4â±â1.2âcm after the third treatment and 5.5â±â1.5âcm 12 months after the treatment (Pâ<â0.01 vs basal values), whereas they were 7.5â±â1.8âcm after 18 months from the last laser application (NS vs basal values). From baseline values of 7.5â±â1.5âcm, dyspareunia VAS values decreased to 4.2â±â0.9âcm after the third treatment and 5.1â±â1.8âcm 12 months from the last laser application (Pâ<â0.01 vs basal values), whereas they were 6.5â±â1.8âcm after 18 months from the last laser application (NS vs basal values). VHIS, from baseline values of 8.1â±â1.3, was 21.0â±â1.4 after the third treatment and 18â±â1.8 12 months from the last laser application (Pâ<â0.01 vs basal values), whereas they were 14.8â±â1.5âcm after 18 months from the last laser application (NS vs basal values). No adverse events were recorded during the study. CONCLUSIONS: This study suggests that the vaginal erbium laser is effective and safe for the treatment of genitourinary syndrome of menopause in breast cancer survivors.
Subject(s)
Female Urogenital Diseases/surgery , Hyperthermia, Induced/methods , Laser Therapy/methods , Lasers, Solid-State/therapeutic use , Postmenopause , Adult , Aged , Breast Neoplasms/complications , Cancer Survivors , Dyspareunia/etiology , Dyspareunia/surgery , Female , Female Urogenital Diseases/etiology , Humans , Middle Aged , Pilot Projects , Syndrome , Treatment Outcome , Vagina/surgery , Vaginal Diseases/etiology , Vaginal Diseases/surgeryABSTRACT
Estudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente.
Recent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.
Subject(s)
Humans , Female , Urologic Diseases/surgery , Female Urogenital Diseases/surgery , Laser Therapy/methods , Lasers, Gas/therapeutic use , Syndrome , MenopauseABSTRACT
OBJECTIVE: To present a case of infantile myofibromatosis of visceral location and a review of the literature. METHOD/RESULTS: We report the case of an 11-year-old Caucasian girl hospitalized for abdominal tumorous mass, weight loss and lack of appetite. Physical examination showed: cutaneous-mucous paleness and a painless, palpable tumorous mass of 8-10cm in the right abdominal flank, of firm consistency with defined edges and extending past the midline. Blood test showed hemoglobin 90 mg/l and erythrocyte sedimentation rate of 130 mm/hour. Chest x-ray and bone study were normal, while abdominal x-ray showed intratumorous calcification, intravenous urographyc showed light displace downwards and outwards of the right kidney. Ultrasound showed a solid echogenic mass with a diameter of 11cm in the right abdominal flank, above and extending towards the lower portion of the right kidney. Surgical treatment for possible neuroblastoma was initiated, during which various tumorous growths were observed in the mesocolon, the largest measuring 7cm, which were removed. Macroscopic examination showed whitish well-defined tumorous growths of firm consistency with focal calcifications. Microscopic examination showed a proliferation of fibroblastic type cells, with some areas having smooth muscle cell characteristics. Diagnosis was myofibromatosis. CONCLUSIONS: Infantile myofibromatosis is the most common fibrous disorder of infancy and childhood, more commonly found between birth and two years of age, may also appear later in life. Etiology is unclear, but certain studies report estrogen involvement in its pathogenesis. Clinical symptoms depend on the location and extension of the lesion and age at presentation. Spontaneous relapse may occur. Prognosis is good in the absence of visceral damage, although generalized congenital myofibromatosis with visceral damage is associated with high mortality especially in the first months of life, due to its destructive capacity, obstruction of vital organs, growth inhibition or infection. Urologic concerns include possible infiltration of genito-urinary organs (kidney, corpus spongiosum) and its association with urologic abnormalities. Ultrastructural and immunohistochemical studies show that the tumor is composed of myofibroblasts, with estrogen receptors, displaying vimentin and smooth muscle actin immunoreactivity. Strict follow up is recommended in patients with congenital myofibromatosis to avoid or detect possible complications that may be life-threatening (Bone survey abdominal-pelvic ultrasound, echocardiogram, chest-abdominal CT and biopsy). The treatment of choice is surgical removal, with extensive excision to avoid possible relapse.
Subject(s)
Colonic Diseases , Female Urogenital Diseases , Myofibromatosis , Child , Colonic Diseases/diagnosis , Colonic Diseases/surgery , Female , Female Urogenital Diseases/diagnosis , Female Urogenital Diseases/surgery , Humans , Myofibromatosis/diagnosis , Myofibromatosis/surgeryABSTRACT
A medical readiness training exercise was conducted in conjunction with Task Force Bravo in Honduras during July and August 2000. Surgical teams from Madigan Army Medical Center performed 46 major pelvic reconstructive surgical procedures and treated more than 300 patients. The mission was an exceptional training opportunity for Army Medical Department personnel, who performed complex surgical procedures with limited logistical support under austere surgical conditions. Team members gained invaluable experience in mobilization preparedness and tested their predeployment training and resourcefulness while providing needed services to the people of the host nation.