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1.
Urology ; 135: 171-172, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31589882

RESUMO

OBJECTIVE: To demonstrate how bladder ultrasound can be useful in completing morcellation during difficult Holmium Laser Enucleation of the Prostate (HoLEP). As HoLEP has emerged as a standard of care for the treatment of benign prostatic hyperplasia, multiple studies have reported the potentially catastrophic complication of bladder injury during morcellation. This video aims to assist any urologist performing HoLEP by providing step-by-step instruction for using ultrasound to complete morcellation safely. METHODS: Enucleation is performed using a 26-French continuous flow scope, off-set laser bridge with a laser stabilization catheter, and a 550 µm holmium laser fiber. Once the median and lateral lobes have been enucleated, the outer sheath is removed and the nephroscope is inserted to facilitate morcellation. Under dual inflow irrigation, the Piranha morcellator (Richard Wolf, Knittlingen, Germany) is introduced and set to the manufacturer's recommended settings of 1500 rpm. A 3.5-MHz convex abdominal ultrasound transducer (Hitachi Prosound Alpha 7; Hitachi Aloka Medical America, Wallingford, CT) under B-mode is used to visualize the bladder, predominantly in the sagittal orientation. Morcellation proceeds under simultaneous ultrasound and direct cystoscopic guidance. RESULTS: The distended bladder is visualized concurrently with the ultrasound and via the nephroscope as the Piranha engages the adenoma and begins morcellation. Once the adenoma is engaged, the operator then drops their hands to place the morcellator in the center of the bladder. Ultrasound provides real-time feedback as to the location of the morcellator in relation to the adenoma and bladder. CONCLUSION: This video highlights the use of intraoperative bladder ultrasound as a visual aid to assist during the morcellation portion of HoLEP. This proof of concept demonstrates that ultrasound can be an additional tool to utilize during difficult cases when cystoscopic visualization during morcellation is limited.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Terapia a Laser/métodos , Morcelação/métodos , Prostatectomia/métodos , Bexiga Urinária/diagnóstico por imagem , Humanos , Complicações Intraoperatórias/etiologia , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Masculino , Morcelação/efeitos adversos , Morcelação/instrumentação , Estudo de Prova de Conceito , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/cirurgia , Ultrassonografia , Bexiga Urinária/lesões
2.
J Photochem Photobiol B ; 203: 111740, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887638

RESUMO

PURPOSE: The aims of this ex vivo study were to evaluate the effectiveness of the Nd:YAP laser in the treatment of dentin hypersensitivity, to compare the temperature rise during laser irradiation at three different dentine thicknesses, and to analyse the composition of the dentine-lased surface. METHODS: A total of 33 teeth were used in this study. For scanning electron microscopy (SEM) observation, 24 teeth were transversely sectioned and divided into 4 groups: group A was irrigated with EDTA; group B was irradiated by Nd:YAP laser with 180 mJ energy/per pulse, 0.9 W average power, and 5 Hz frequency (power density [PD] = 229 W/cm2); group C was irradiated by Nd:YAP laser with 280 mJ energy/pulse, 1.4 W average power, and 5 Hz frequency (PD = 356 W/cm2); and group D was irradiated by Nd:YAP with 360 mJ energy/pulse, 1.8 W average power, and 5 Hz frequency (PD = 458 W/cm2). Energy-dispersive spectroscopy (EDS) analysis was performed on the same teeth evaluated for SEM observations. For temperature increase evaluation performed with thermocouples, 9 teeth were transversely sectioned at 3 different thicknesses (3 for each group) of 1, 2, and 3 mm. RESULTS: Statistical analysis showed significant changes in the diameter of the dentinal tubule orifices among all groups; EDS did not show modification of the Ca/P ratio. Temperature increase under irradiation exceeded 5.5 °C only in the group D samples. CONCLUSIONS: This ex vivo study, based on temperature recording, SEM observation, and EDS analysis, demonstrated that Nd:YAP laser at a PD of 356 W/cm2, corresponding to an average power of 1.4 W, defines the best treatment for dentine hypersensitivity in terms of compromise between efficacy of the treatment and safety of the pulp.


Assuntos
Sensibilidade da Dentina/radioterapia , Lasers de Estado Sólido/uso terapêutico , Dentina/fisiologia , Dentina/efeitos da radiação , Humanos , Microscopia Eletrônica de Varredura , Espectrometria por Raios X , Temperatura Ambiente
3.
Int Braz J Urol ; 45(6): 1161-1166, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808404

RESUMO

PURPOSE: To compare two-shift operation mode and single player mode different impact on surgical results and operator comfort in flexible ureteroscopic holmium laser lithotripsy for renal calculi larger than 1.5cm. MATERIALS AND METHODS: From december 2017 to december 2018, 92 patients with renal calculi admitted to Qilu Hospital and were treated through fl exible ureteroscopy. They were randomized in two-shift group (n=50) and single player group (n=42). The operative time, blood loss, hospitalization stay after operation, residual fragments (≥4mm) rate, fragmentation speed, postoperative complications and operator's fatigue score were compared. RESULTS: There was no significant difference between two groups regarding age, gender, illness side, stone size, blood loss, operative time, postoperative hospitalization stay, complications, etc (p >0.05). The fragmentation speed was 44.5±20.0mm3/min in two-shift group compared with 34.2±17.3mm3/min in single player group (p=0.037). Residual fragments (≥4mm) rate after fi rst surgery was 18% in two-shift group, while the residual fragments (≥4mm) rate was 40.5% after first surgery in single player group (p=0.017). The total fatigue score of two-shift group was 8.4 compared to 29.9 in single player group (p <0.001). CONCLUSION: In flexible ureteroscopic holmium laser lithotripsy for the treatment of renal calculi larger than 1.5cm, two-shift operation mode can raise the fragmentation speed and stone clearance rate, as well as signifi cantly lower operator's fatigue level and improve operator's comfort.


Assuntos
Cálculos Renais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/métodos , Ureteroscopia/métodos , Adulto , Desenho de Equipamento , Ergonomia , Feminino , Humanos , Cálculos Renais/patologia , Tempo de Internação , Litotripsia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Resultado do Tratamento , Ureteroscopia/instrumentação
4.
J Drugs Dermatol ; 18(11): 1090-1096, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31738492

RESUMO

Background: Hypopigmentation is a common cutaneous manifestation that frequently poses a therapeutic challenge for dermatologists. Current treatments have varying efficacies and rarely provide patients with long-term results. However, new treatments are emerging, and head-to-head studies comparing these treatments are warranted. Methods & Materials: In this prospective, Institutional Review Board (IRB)-approved, double-blinded study, 40 subjects with moderate to severe hypopigmentation were randomized into 1 of 4 treatment arms; non-ablative fractional laser, ablative fractional laser, ablative fractional laser with laser-assisted delivered bimatoprost, and an epidermal harvesting system. Results: All patients in this study showed improvement regardless of the treatment modality. The average improvement score was calculated on a 0 to 4 scale, and Group 3 (fractional ablative laser and bimatoprost) was found to have a significantly higher average improvement than all other treatments, with 76% of the patients exhibiting at least a grade 3 (over 50%) improvement over the treatment course. Group 1 (non-ablative fractional) also had a significantly higher average score compared with group 2 (fractional ablative laser). Conclusion: New and emerging therapies have shown promise in helping re-pigmentation of cutaneous hypopigmentation. In this head-to-head trial, it was shown that laser-assisted delivery of bimatoprost had a greater statistically significant improvement compared with 3 possible treatment modalities for stimulation of pigment in medical and cosmetic hypopigmentation. J Drugs Dermatol. 2019;18(11):1090-1096.


Assuntos
Bimatoprost/administração & dosagem , Fármacos Dermatológicos/administração & dosagem , Dermatoses Faciais/cirurgia , Hipopigmentação/cirurgia , Lasers de Estado Sólido/uso terapêutico , Melanócitos , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Coleta de Tecidos e Órgãos , Resultado do Tratamento
5.
J Drugs Dermatol ; 18(11): 1104-1107, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31741350

RESUMO

Introduction: Melasma is a common disorder where patients develop hyperpigmented macules and patches on the face and is thought to be the result of sun exposure and hormonal contributions, although the pathogenesis is not completely understood. Lasers have been used for melasma treatment with varying degrees of success. Objectives: The objective of this study was to examine the safety and efficacy of a novel picosecond laser for the treatment of melasma. Materials and Methods: Ten subjects received nine weekly laser treatments with a picosecond laser to a randomized half of their face. A lightening cream was applied to the entire face to serve as a control. The primary outcome measure was clinical efficacy measured by a patient-reported outcome survey, the Melasma Quality of Life (MELASQOL) questionnaire, and physician assessment with the Global Aesthetic Improvement Scale (GAIS). The secondary outcome measure was safety, which was assessed by monitoring for adverse events. Photos were taken before every treatment and at a 1-week follow-up. Results: Ninety percent of subjects rated their melasma as at least slightly better, and 90% percent of subjects would recommend this laser treatment to others with melasma. MELASQoL questionnaire scores improved by an average of 5.7 points after laser treatment. Assessments by two board-certified dermatologists using the GAIS revealed an overall improvement in 80% of patients on the laser treatment side versus 20% on the control side. Side effects, including erythema and discomfort, were minimal and transient post-treatment. Conclusions: This study suggests that picosecond laser treatments are a safe and efficacious way to treat melasma. J Drugs Dermatol. 2019;18(11):1104-1107.


Assuntos
Dermatoses Faciais/cirurgia , Lasers de Estado Sólido/uso terapêutico , Melanose/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
6.
Medicine (Baltimore) ; 98(48): e17948, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770202

RESUMO

BACKGROUND: Laser systems are a common treatment choice for onychomycosis. They exert their effects on inhibiting the growth of the fungus by selective photothermolysis but efficacy is dependent on the specific type of apparatus used. To systematically review the available published literature on the curative effects and safety of laser treatment for onychomycosis. METHODS: Databases including PubMed, web of science, China National Knowledge Internet (CNKI), WanFang Database and VIP were searched systematically to identify relevant articles published up to July 2018. Potentially relevant articles were sourced, assessed against eligibility criteria by 2 researchers independently and data were extracted from included studies. A meta-analysis was performed using R software. RESULTS: Thirty-five articles involving 1723 patients and 4278 infected nails were included. Meta-analysis of data extracted from these studies revealed that: the overall mycological cure rate was 63.0% (95%CI 0.53-0.73); the mycological cure rate associated with the 1064-nm Nd: YAG laser was 63.0% (95%CI 0.51-0.74); and that of CO2 lasers was 74.0% (95%CI 0.37-0.98). The published data indicate that laser treatment is relatively safe, but can cause tolerable pain and occasionally lead to bleeding after treatment. CONCLUSION: Laser treatment of onychomycosis is effective and safe. The cumulative cure rate of laser treatment was significantly higher for CO2 lasers than other types of laser. Laser practitioners should be made aware of potential adverse effects such as pain and bleeding.


Assuntos
Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Onicomicose/radioterapia , Humanos , Unhas/efeitos da radiação , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Niger J Clin Pract ; 22(10): 1441-1447, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31607737

RESUMO

Background: There was no enough data about the appropriate surface cleaning of core composite material after temporary cementation. Aim: To evaluate the effects of surface cleaning techniques on initial shear bond strength (SBS) between core composite material and resin nanoceramic crown materials after temporary cementation. Material and Methods: Cubic specimens were prepared from prosthetic materials, including Lava Ultimate. Cylinder-shaped composites were cemented to glass slides with eugenol-free temporary cement, resulting in a total of 44 cylinders (n = 11). The surfaces of composite cylinders were then cleaned with an Er, Cr:YSGG laser, 37% orthophosphoric acid, yellow tape diamond bur, or dental explorer. Cleaned cylinders were bonded to cubic specimens with resin cement. Initial SBS tests were performed with a universal testing machine at 0.5 mm/min crosshead speed. One-way ANOVA and post hoc Tukey tests were used to analyze the obtained data (P =0.05). Results: Initial SBS values were significantly affected by the different surface cleaning methods (P <.05). The highest SBS value was obtained with the laser group (SBS = 17.14), while the lowest was obtained with dental explorer group (SBS = 5.95). There was no significant difference between the diamond bur group and the laser group (P =0.982). Conclusions: Laser irradiation or yellow tape diamond bur cleaning of the core composite surface could be recommended to strengthen bond strength between the resin luting cement and the core composite. Before adhesive or conventional cementation of prosthetic restoration, the core composite surface should be cleaned.


Assuntos
Colagem Dentária/métodos , Cimentos Dentários/química , Corrosão Dentária/métodos , Adesivos Dentinários/química , Vidro/química , Lasers de Estado Sólido/uso terapêutico , Cimentos de Resina/química , Cimentação , Resinas Compostas/química , Cimentos de Ionômeros de Vidro , Humanos , Teste de Materiais , Resistência ao Cisalhamento , Propriedades de Superfície
8.
Urology ; 134: 79-83, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476349

RESUMO

OBJECTIVE: To better understand the impact of laser fiber-tip configuration on lithotripsy performance, we undertook an in vitro study comparing 3 fiber-tip configurations: (1) new (single-use), (2) cleaved (reusable), and (3) coated (cut with scissors). METHODS: Lithotripsy was performed using a Ho:YAG laser utilizing fragmentation (1 J × 10 Hz) and dusting (0.5 J × 20 Hz) settings. BegoStones were fragmented with a laser fiber advancing at a speed of 1 mm/s (220 seconds of activation). Three fiber-tip configurations were tested: new single-use standard (242 µm core) and cleaved (272 µm core), compared to the same fiber-tip coated/cut flush with scissors, respectively. Study outcome was difference in stone mass before and after each experiment. Power output was measured using a power meter. RESULTS: Fragmentation for new or cleaved fibers was greater than the coated/cut flush fiber-tip (P <.05). For 1 J × 10 Hz and 0.5 J × 20 Hz settings, fragmentation was 59% and 75% higher with new fiber-tip compared to the coated/cut flush fiber-tip, respectively. For 1J × 10 Hz and 0.5 J × 20 Hz settings, fragmentation was 51% and 45% higher with cleaved fiber-tip compared to the coated/cut flush fiber-tip, respectively. Power output at the end of laser activation was higher for new and cleaved fiber-tips. CONCLUSION: New and cleaved laser fibers demonstrated superior lithotripsy performance compared to fibers that were coated/cut flush with scissors. Cutting single-use laser fibers risks damaging the fiber-tip which can disperse the energy and reduce lithotripsy efficiency.


Assuntos
Desenho de Equipamento , Lasers de Estado Sólido , Litotripsia a Laser , Cálculos Urinários/terapia , Desenho de Equipamento/efeitos adversos , Desenho de Equipamento/classificação , Análise de Falha de Equipamento/métodos , Humanos , Lasers de Estado Sólido/normas , Lasers de Estado Sólido/uso terapêutico , Litotripsia a Laser/efeitos adversos , Litotripsia a Laser/instrumentação , Litotripsia a Laser/métodos , Teste de Materiais/métodos
9.
Microsc Res Tech ; 82(11): 1869-1877, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31373738

RESUMO

Laser irradiation has been proposed as a preventive method against dental caries since it is capable to inhibit enamel demineralization by reducing carbonate and modifying organic matter, yet it can produce significant morphological changes. The purpose of this study was to evaluate the influence of Er:YAG laser irradiation on superficial roughness of deciduous dental enamel and bacterial adhesion. Fifty-four samples of deciduous enamel were divided into three groups (n = 18 each). G1_control (nonirradiated); G2_100 (7.5 J/cm2 ) and G3_100 (12.7 J/cm2 ) were irradiated with Er:YAG laser at 7.5 and 12.7 J/cm2 , respectively, under water irrigation. Surface roughness was measured before and after irradiation using a profilometer. Afterwards, six samples per group were used to measure bacterial growth by XTT cell viability assay. Adhered bacteria were observed using confocal laser scanning microscopy (CLSM) and a scanning electron microscopy (SEM). Paired t-, one-way analysis of variance (ANOVA), Kruskal-Wallis and pairwise Mann-Whitney U tests were performed to analyze statistical differences (p < .05). Before treatment, samples showed homogenous surface roughness, and after Er:YAG laser irradiation, the surfaces showed a significant increase in roughness values (p < .05). G3_100 (12.7 J/cm2 ) showed the highest amount of Streptococcus mutans adhered (p < .05). The increase in the roughness of the tooth enamel surfaces was proportional to the energy density used; the increase in surface roughness caused by laser irradiation did not augment the adhesion of Streptococcus sanguinis; only the use of the energy density of 12.7 J/cm2 favored significantly the adhesion of S. mutans.


Assuntos
Aderência Bacteriana/efeitos da radiação , Cárie Dentária/prevenção & controle , Esmalte Dentário/efeitos da radiação , Lasers de Estado Sólido/uso terapêutico , Streptococcus mutans/fisiologia , Streptococcus/fisiologia , Aderência Bacteriana/fisiologia , Humanos , Microscopia Eletrônica de Varredura , Streptococcus/crescimento & desenvolvimento , Streptococcus/efeitos da radiação , Streptococcus mutans/crescimento & desenvolvimento , Streptococcus mutans/efeitos da radiação , Propriedades de Superfície/efeitos da radiação
10.
J Dermatol ; 46(10): 843-848, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31389056

RESUMO

Phakomatosis pigmentovascularis is a rare syndrome characterized by widespread capillary malformation and pigmented nevus. The objective of this study was to evaluate its characteristics and treatment. Fifty-two patients presenting between 2003 and 2017 were retrospectively reviewed. Type IIa (port-wine stain and dermal melanocytosis with oculocutaneous involvement) was most common. Systemic involvement was observed in 17.3% and it was not significantly correlated to extent of capillary malformation or pigmented nevus. However, systemic involvement was significantly frequent in patients with nevus of Ota and in patients with pigmented nevus located on the head and neck (P = 0.004 and 0.035, respectively). Capillary malformation was almost cleared in 28.6% of patients using pulsed dye laser, whereas pigmented nevus was almost cleared in 23.7% and completely cleared in 42.1% of patients using Q-switched neodymium:yttrium-aluminum-garnet laser. Treatment outcome score showed significant inverse correlation with the extent of port-wine stain or pigmented nevus (P = 0.047, ρ = -0.308 and P = 0.011, ρ = -0.410, respectively). Pigmented nevus demonstrated better treatment response to lasers than did capillary malformation. Smaller lesions tended to show better treatment outcomes for both capillary malformation and pigmented nevus.


Assuntos
Terapia com Luz de Baixa Intensidade/métodos , Síndromes Neurocutâneas/diagnóstico , Nevo de Ota/diagnóstico , Mancha Vinho do Porto/diagnóstico , Neoplasias Cutâneas/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Lasers de Corante/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Terapia com Luz de Baixa Intensidade/instrumentação , Masculino , Pessoa de Meia-Idade , Síndromes Neurocutâneas/complicações , Síndromes Neurocutâneas/radioterapia , Nevo de Ota/etiologia , Nevo de Ota/radioterapia , Mancha Vinho do Porto/etiologia , Mancha Vinho do Porto/radioterapia , Estudos Retrospectivos , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/radioterapia , Resultado do Tratamento , Adulto Jovem
11.
Arch. Soc. Esp. Oftalmol ; 94(8): 409-412, ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185629

RESUMO

Mujer de 20 años de edad con disminución brusca de visión en el ojo izquierdo. En la exploración de fondo de ojo, se observó una hemorragia prerretiniana focal en la arcada temporal superior con hemovítreo acompañante. La evolución espontánea fue favorable. A los 18 meses presentó una nueva pérdida visual en ese ojo, objetivándose una hemorragia premacular subhialoidea que fue drenada satisfactoriamente mediante una hialoidotomía con láser Nd-YAG. La paciente había presentado además, una hemorragia digestiva alta y menorragia. Se le realizó un estudio de la hemostasia que demostró un déficit del factor VII de la coagulación. Se trata de un trastorno muy infrecuente que, con anterioridad, no se había descrito en asociación a la aparición de hemorragias prerretinianas


The case concerns a 20 year-old woman with a sudden visual loss in her left eye. In the fundus examination, a focal pre-retinal haemorrhage was observed in the superior temporal vascular branch with accompanying vitreous haemorrhage. There was a favourable spontaneous outcome. Eighteen months later, she presented with a new visual loss in the same eye, showing a sub-hyaloid pre-macular haemorrhage that was satisfactorily drained by hyaloidotomy using a Nd-YAG laser. The patient had also presented with an upper digestive tract haemorrhage and menorrhagia. A haemostasis study was performed that showed a coagulation factor VII deficiency. This is a very uncommon disorder that has not been previously described in association with the appearance of pre-retinal haemorrhages


Assuntos
Humanos , Feminino , Adulto Jovem , Cegueira/etiologia , Deficiência do Fator VII/complicações , Hemorragia Retiniana/etiologia , Hemorragia Vítrea/etiologia , Deficiência do Fator VII/diagnóstico , Fundo de Olho , Lasers de Estado Sólido/uso terapêutico , Recidiva , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/cirurgia , Hemorragia Vítrea/diagnóstico por imagem
12.
J Drugs Dermatol ; 18(7): 663-665, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31334626

RESUMO

Recalcitrant plantar warts pose a therapeutic challenge. Cidofovir is a viral DNA polymerase inhibitor that has been used in treatment of verrucae with greater success than traditional treatments in some cases. Laser-assisted drug delivery enhances drug penetration beyond the epidermis and is particularly well-suited, though under-utilized, to target palmoplantar verrucae. We report the use of an erbium:yttrium-aluminum-garnet (Er:YAG) ablative fractional laser (AFL) followed by topical cidofovir in treating recalcitrant plantar warts. Two patients were treated with a 2940-nm Er:YAG laser at depths of 1.2-1.5 mm followed by topical application of cidofovir 75 mg/mL. Both patients exhibited a significant reduction in lesion size and improvement in symptoms. AFL-assisted delivery of topical cidofovir represents a promising therapeutic option for recalcitrant plantar warts. J Drugs Dermatol. 2019;18(7):663-665.


Assuntos
Cidofovir/administração & dosagem , Sistemas de Liberação de Medicamentos/instrumentação , Dermatoses do Pé/tratamento farmacológico , Verrugas/tratamento farmacológico , Administração Cutânea , Adulto , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Pessoa de Meia-Idade , Absorção Cutânea/efeitos da radiação , Soluções , Resultado do Tratamento
13.
BMJ Case Rep ; 12(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31302623

RESUMO

Female-to-male transsexual patient, 22 years old, with neophallus from radial forearm free flap (phalloplasty in March 2014), history of urethral fistula and urethral stricture 1 year later treated with surgical correction (fistulectomy) and suprapubic urinary diversion. Subsequently, he developed a new urethral stenosis located in the urethral anastomosis. Immediately proximal to the stenosis, there was a urethral dilatation (pseudodiverticulum) with a fibrous septum and several retracted stones. The stones were fragmented, the fibrous septum destroyed and the urethral stricture corrected, all with holmium laser. After 40 months of follow-up the patient shows satisfactory urinary flow with no signs of residual lithiasis or stricture.


Assuntos
Terapia a Laser/instrumentação , Litíase/cirurgia , Doenças Uretrais/cirurgia , Feminino , Hólmio , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Complicações Pós-Operatórias/cirurgia , Cirurgia de Readequação Sexual/efeitos adversos , Adulto Jovem
14.
Stomatologiia (Mosk) ; 98(3): 52-55, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31322595

RESUMO

Research objective - an assessment of morphological and element composition various as surfaces of implants, with the diagnosis periimplantitis, subjected to processing by the Er laser; Cr; YSGG wave of 2780 nanometers long in comparison with not subjected. Used implants of three producers: (1 - Nobel Biocare (Sweden), TiUnite surface; 2 - XIVE Dentsplay (Germany), SLA surface; 3 - BioHorizons (USA), RBM surface). Electronic and microscopic methods investigated surfaces of the control (new) implants removed with the diagnosis periimplantit, with the diagnosis periimplantit and processed by the laser. It is revealed that the surface of new sterile implants isn't ideal, on it there are traces of impregnation by inorganic connections, a large amount of foreign chemical elements, especially on a surface of SLA of an implant of XIVE Dentsplay is revealed. The surface of skilled implants with the diagnosis periimplantit is very strongly polluted by carbon (C), phosphorus (P), sulfur (S), silicon (Si), etc., being formed on a surface during an inflammation. After processing of the same surface by the Er laser; Cr; YSGG wave of 2780 nanometers long occurs surface clarification, and the element structure almost completely corresponds to the control.


Assuntos
Implantes Dentários , Lasers de Estado Sólido , Peri-Implantite , Humanos , Lasers de Estado Sólido/uso terapêutico , Microscopia Eletrônica de Varredura , Peri-Implantite/terapia , Propriedades de Superfície
15.
Optom Vis Sci ; 96(7): 492-499, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31274737

RESUMO

SIGNIFICANCE: Determining risk factors for posterior capsule opacification will allow for further interventions to reduce the risk of development and thus additional procedures. PURPOSE: The purpose of this study was to investigate risk factors associated with development of clinically significant posterior capsule opacification requiring yttrium aluminum garnet (YAG) capsulotomy. METHODS: Medical records of patients (≥18 years) who underwent cataract surgery between January 1, 2011, and March 31, 2014, at Kresge Eye Institute were reviewed. Three hundred eyes requiring YAG capsulotomy up to 3 years after cataract surgery were included in the YAG capsulotomy group. Three hundred eyes not requiring YAG capsulotomy up to 3 years after cataract surgery were selected via age-matched simple randomization (control group). RESULTS: The YAG capsulotomy group included patients with younger age (65.8 ± 11.3 vs. 70.1 ± 10.6 years, P < .001), more men (42.67 vs. 34.67%, P = .04), fewer patients with hypertension (73.00 vs. 83.00%, P < .001), and more patients with hydrophilic intraocular lenses (74.67 vs. 47.00%, P < .001). Logistic regression analysis demonstrated a negative association between YAG capsulotomy and age (coefficient, -0.04; 95% confidence interval [CI], 0.95 to 0.98; P < .001) and hydrophobic intraocular lenses (coefficient, -1.50; 95% CI, 0.15 to 0.33; P < .001), and a positive association with presence of glaucoma (coefficient, 0.88; 95% CI, 1.39 to 4.17; P = .002). Elapsed time to YAG capsulotomy was sooner in patients with a history of uveitis (95% CI, 5.10 to 9.70 months; P = .02) and insertion of hydrophilic intraocular lenses (95% CI, 18.67 to 21.57 months; P < .001). CONCLUSIONS: Results of this study suggest that development of visually significant posterior capsule opacification is associated with younger age, glaucoma, and hydrophilic intraocular lenses, and it occurs earlier among those with hydrophilic intraocular lenses and a history of uveitis.


Assuntos
Opacificação da Cápsula/cirurgia , Lasers de Estado Sólido/uso terapêutico , Cápsula Posterior do Cristalino/cirurgia , Capsulotomia Posterior/métodos , Fatores Etários , Idoso , Opacificação da Cápsula/etiologia , Extração de Catarata , Feminino , Humanos , Lentes Intraoculares/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
Urology ; 132: 212, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271781

RESUMO

OBJECTIVE: To demonstrate the surgical considerations for managing retained UroLift implants when performing HOLEP. Prostatic Urethral Lift via the UroLift System has become a common treatment modality to manage symptoms associated with benign prostatic hyperplasia. The UroLift procedure uses nonabsorbable implants to retract obstructing prostate lobes. Retreatment rates following UroLift have been reported at 13.6% over 5 years.1 We anticipate an increasing number of men seeking definitive surgical management after failed UroLift. There have been reports in the literature of UroLift implants causing morcellator device jams when attempting holmium laser enucleation of the prostate (HOLEP).2 METHODS: From August 2018 to April 2019, we reviewed 118 consecutive patients who underwent HOLEP by a single surgeon. Three men were identified who had previously undergone UroLift. Video footage was obtained. As demonstrated in the video, during enucleation, the metallic clip of the UroLift implants were incorporated in the adenoma specimen. For morcellation, we use the Piranha morcellator (Richard Wolf, Knittlingen, Germany). Morcellation was carried out in a slow and controlled manner. When the metal clip comes into contact with the morcellator, a catch and release is performed by releasing the morcellator pedal and withdrawing the morcellator into the nephroscope to release the adenoma. Remnant clips and sutures can be retrieved with a grasper. We perform a 3 month follow-up cystoscopy in the office to exclude any remnant implant material in the prostatic urethra or bladder. RESULTS: Procedures were completed uneventfully. In developing this technique, we experienced jamming of the morcellator blades in 2 cases requiring replacement of the disposable blades. Follow up in-office cystoscopy did not reveal any remnant implant material that needed to be removed. CONCLUSION: HOLEP can be performed safely in the UroLift failure patient population. Careful morcellation techniques can decrease the risk of costly morcellator blade replacement.


Assuntos
Terapia a Laser , Lasers de Estado Sólido/uso terapêutico , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Próteses e Implantes , Humanos , Masculino , Falha de Tratamento , Procedimentos Cirúrgicos Urológicos
17.
Arch. Soc. Esp. Oftalmol ; 94(7): 343-346, jul. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185189

RESUMO

El objetivo es describir un caso de persistencia de membrana de Descemet tras una queratoplastia penetrante, así como la importancia de la tomografía de coherencia óptica de segmento anterior para su diagnóstico y las posibles opciones terapéuticas. Se presenta un caso clínico y se hace una revisión bibliográfica. Se trata de un varón de 88 años que se sometió a una queratoplastia penetrante debido a una queratopatía bullosa avanzada, tras la cual se produjo una persistencia de la membrana de Descemet receptora. La persistencia pasó inadvertida hasta que el paciente comenzó con disminución de su agudeza visual, y en la exploración oftalmológica se observó la presencia de una membrana opalescente posicionada debajo del endotelio, que fue identificada como la membrana de Descemet del receptor. El tratamiento se llevó a cabo mediante membranotomía Nd:YAG, acorde a lo consultado en la literatura con éxito. Como conclusión se establece que la persistencia inadvertida de la membrana de Descemet es una complicación muy poco frecuente de la queratoplastia penetrante. La tomografía de coherencia óptica de segmento anterior permite un diagnóstico de certeza, y la membranotomía con láser Nd:YAG es uno de los tratamientos indicados


A case is presented of a retained Descemet's membrane after penetrating keratoplasty, highlighting the importance of the anterior segment optical coherence tomography (OCT) in the diagnosis and treatment planning of keratoplasty complications. A review of literature is also presented. An 88 year-old man underwent penetrating keratoplasty for bullous keratopathy. A retained host Descemet's membrane was detected. The retained membrane went unnoticed until the visual acuity decreased. The ophthalmological examination showed the presence of an opalescent membrane located below the endothelium, and was identified as the Descemet membrane of the receptor. Nd:YAG laser membranotomy was performed after the diagnosis. To conclude, it is noted that the inadvertent retention of the host Descemet membrane is a rare complication in penetrating keratoplasty. The anterior segment OCT was used to determine the diagnosis, and Nd:YAG laser membranotomy is an indicated treatment in these cases


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Doenças da Córnea/cirurgia , Lâmina Limitante Posterior/cirurgia , Epitélio Posterior/cirurgia , Ceratoplastia Penetrante , Lasers de Estado Sólido/uso terapêutico , Complicações Pós-Operatórias/cirurgia , Lâmina Limitante Posterior/diagnóstico por imagem , Epitélio Posterior/diagnóstico por imagem , Epitélio Posterior/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Lâmpada de Fenda , Tomografia de Coerência Óptica
19.
Urologiia ; (2): 55-58, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31162902

RESUMO

The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.


Assuntos
Neoplasias Renais/cirurgia , Fotocoagulação a Laser , Lasers de Estado Sólido/uso terapêutico , Neoplasias da Próstata/cirurgia , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Neoplasias Renais/complicações , Fotocoagulação a Laser/instrumentação , Masculino , Neoplasias da Próstata/complicações
20.
Ann Otol Rhinol Laryngol ; 128(11): 1073-1077, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31161772

RESUMO

OBJECTIVES: To review the natural history of type I posterior glottic stenosis (PGS-I) and its treatment outcomes through a case presentation and demonstrate the feasibility of in-office management of PGS-I. METHODS: The case of a middle-aged woman who developed PGS-I after prolonged intubation is presented. A review of the literature on management and treatment outcomes of PGS-I is also performed. RESULTS: Initially presenting with a large granuloma that failed conservative management, the patient deferred surgical intervention and developed unilateral vocal fold hypomobility with posterior glottic synechia. The adhesion was successfully ablated in the office with potassium-titanyl-phosphate (KTP) laser; however, vocal fold hypomobility persisted after treatment. CONCLUSIONS: This case illustrates the natural history of the development of PGS-I, demonstrates the feasibility of office-based management of this condition, and provides further evidence that lysis of PGS-I synechia does not uniformly lead to restoration of normal laryngeal function and mobility.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/métodos , Glote/diagnóstico por imagem , Glote/cirurgia , Laringoscopia/métodos , Laringoestenose/cirurgia , Terapia a Laser/métodos , Qualidade da Voz , Feminino , Humanos , Laringoestenose/diagnóstico , Laringoestenose/fisiopatologia , Lasers de Estado Sólido/uso terapêutico , Pessoa de Meia-Idade
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