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1.
Urology ; 136: 196-201, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31790785

RESUMO

OBJECTIVE: To compare outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) for lower urinary tract symptoms secondary to benign prostate hyperplasia using 3 different laser fibers and 2 different laser energy modes. MATERIALS AND METHODS: This is a review of a clinic registry of men with lower urinary tract symptoms secondary to benign prostate hyperplasia who underwent HoLEP between August 2018 and January 2019. Patients were assigned to group 1 (50 patients), group 2 (50 patients), and group 3 (50 patients) based on the HoLEP being completed with either a Slimline 550µm, Slimline 1000µm, or MOSES 550 µm laser, respectively. The groups were compared using SSPS for ANOVA comparison of means and multivariate logistic regression. RESULTS: Ten patients who underwent concomitant stone surgery (2 PCNL, 8 ureteroscopy , 3 bilateral cases) and 11 patients had bladder stones removed; ancillary procedures did not significantly differ between groups(P = .2). Prostate enucleation times differed significantly (22.5 + 7.3, 16.4 + 6.9, 18.1 + 8.6 minutes P ≤.001) between groups. However, statistical significance was lost once enucleation time was indexed against enucleated tissue weight. Time to achieve hemostasis (minutes) was statistically different between groups (10.6 + 6.1, 7.7 + 5.2, 6.3 + 4.8 P <.001). This difference in hemostatic time was maintained on multilogistic regression demonstrating that MOSES laser enucleation was associated with a 3.9-minute decrease time to achieve hemostasis after enucleation compared to Slimline 550 HoLEP (P <.001). CONCLUSION: Our findings suggest that modulated pulsed laser energy can improve hemostasis during the enucleation phase of a HoLEP resulting in shorter Operating Room times.


Assuntos
Terapia a Laser/instrumentação , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Idoso de 80 Anos ou mais , Humanos , Sintomas do Trato Urinário Inferior/etiologia , Masculino , Pessoa de Meia-Idade , Hiperplasia Prostática/complicações , Estudos Retrospectivos
2.
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
3.
Angiol Sosud Khir ; 25(4): 116-122, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855208

RESUMO

The purpose of the study was to work out a Russian-made, simple-to-manufacture, safe, inexpensive and efficient device for performing endovasal laser obliteration (EVLO) of varicose veins, with the underlying principle of endoluminal distribution of the total laser energy into several flows. The development of this device was based on the principle of dividing the total laser radiation into two energy flows. One flow has a shape of circularly formed, continuous field of laser radiation of specified width within the angular range from 50 to 90°, which ensures the main energetic contribution to thermal impact on the vascular wall. The second energetic flow is formed in the part of the tip having a shape of a truncated cone, along the axis of the optical fibre within the angular range from 10 to 50°, which ensures additional thermal effect of radiation on the narrowing walls of the venous channel. Starting from 2016, EVLO with the use of the developed device was performed in a total of 50 patients with class C2-C3 varicose veins. The morphogenesis of the occurring restructuring of the venous wall was studied intraoperatively and in various time periods. Tissue specimens obtained intraoperatively demonstrated in the majority of cases complete or partial intimal detachment, swelling, disorganization of the middle membrane, adventitial loosening with thrombosis of the elements of the vasa vasorum in the majority of portions. The histological specimens harvested at 10 to 14 days were found to contain in the venous wall clear-cut distinct evidence of actively commensing connective-tissue proliferation. At 1 month of follow up the specimens of the veins treated with EVLO using the developed device showed the beginning of collagenisation of the wall, with finally fibrous restructuring and wall hyalinosis by month 3 after EVLO. The proposed device for EVLO of varicose veins makes it possible to act upon the venous wall simultaneously with two energy flows which excludes negative thermal action of excess energy of laser radiation on the vascular wall while using unidirectional radiation in the form of one or even two, but thin rings and, thus, dramatically decreasing reducing the risk for the development of complications. Implementation of the new device into the phlebological practice in Russia in conditions of complete import substitution has significant economic benefit.


Assuntos
Terapia a Laser/instrumentação , Varizes/cirurgia , Veias/cirurgia , Humanos , Varizes/patologia , Veias/patologia
4.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(5): 372-374, 2019 Sep 30.
Artigo em Chinês | MEDLINE | ID: mdl-31625340

RESUMO

By introducing the unqualified cases of radiation emission test of medical laser equipment, this paper analyses the causes of the problems and the corrective measures adopted, and analyses the effectiveness of the corrective measures. It is proposed that the design rules and rules related to radiation emission should be mastered from the input stage of product design and development, and the radiation emission problem should be considered and solved as soon as possible.


Assuntos
Terapia a Laser , Lasers , Luz , Desenho de Equipamento , Terapia a Laser/instrumentação
5.
Vet Clin North Am Exot Anim Pract ; 22(3): 471-487, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31395326

RESUMO

Surgery can be challenging in exotic pets owing to their small size and blood volume, and their increased anesthetic risk compared with small animals. Various devices are available to facilitate suturing, cutting, and hemostasis in the human and veterinary fields. These surgical equipment improve the simplicity, rapidity, and effectiveness of surgery. Vessel-sealing devices, radiosurgery, lasers, and ultrasound devices are commonly used because of their ease of use and increase in surgical efficiency. Other surgical devices are available (eg, stapling devices) but are not discussed in this article.


Assuntos
Animais Exóticos , Equipamentos Cirúrgicos/veterinária , Animais , Biópsia/instrumentação , Biópsia/veterinária , Castração/instrumentação , Castração/veterinária , Desenho de Equipamento , Hemostasia Cirúrgica/instrumentação , Hemostasia Cirúrgica/veterinária , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/veterinária , Lasers/normas , Fígado/patologia , Fígado/cirurgia , Pancreatectomia/instrumentação , Pancreatectomia/veterinária , Radiocirurgia/instrumentação , Radiocirurgia/veterinária , Esplenectomia/instrumentação , Esplenectomia/veterinária , Equipamentos Cirúrgicos/tendências , Procedimentos Cirúrgicos Ultrassônicos/instrumentação , Procedimentos Cirúrgicos Ultrassônicos/veterinária , Procedimentos Cirúrgicos Vasculares/instrumentação
6.
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
7.
J Cosmet Dermatol ; 18(4): 1020-1024, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169354

RESUMO

BACKGROUND: There are many postprocedure skin care options, but no consensus on the best formulation to optimize healing. Silicone gels have only been used to treat keloids and hypertrophic scars and typically applied after the wound has healed. This study compared the healing response after fractional ablative erbium laser resurfacing with a petrolatum-based ointment and a silicone gel. METHODS: A randomized, open-label, split-face study was performed. Ten subjects underwent Erbium:YAG (Sciton) fractional laser resurfacing. Patients were randomized to apply a petrolatum-based gel or a silicone gel (Stratacel® ; Stratpharma) on either the right or left side of the face. Subjects applied the products twice a day for 7 days and were evaluated in person 7, 30, and 60 days postprocedure. Subjects reported on the overall general aesthetic outcome, perceived pain, itch, and tightness via questionnaires using the Global Aesthetic Improvement Scale and the Wrinkle Severity Rating Scale (WSRS). RESULTS: All subjects healed without complications. By day 60, there was no difference in signs and symptoms of healing between the two different dressing approaches. However, patients treated with the silicone gel had less post-treatment erythema and hyperpigmentation. CONCLUSIONS: A novel silicone gel resulted in reduced signs of erythema and hyperpigmentation postprocedure, without an increase in adverse events. Additionally, the silicone gel dries to form a thin, full contact film and can be covered with sunscreen or cosmetics once dry. This new silicone gel presents a good option for postprocedure care after ablative fractional laser resurfacing.


Assuntos
Técnicas Cosméticas/efeitos adversos , Terapia a Laser/efeitos adversos , Vaselina/administração & dosagem , Géis de Silicone/administração & dosagem , Cicatrização/efeitos dos fármacos , Administração Cutânea , Adulto , Idoso , Bandagens , Eritema/tratamento farmacológico , Eritema/etiologia , Estética , Face , Feminino , Humanos , Hiperpigmentação/tratamento farmacológico , Hiperpigmentação/etiologia , Terapia a Laser/instrumentação , Lasers de Estado Sólido/efeitos adversos , Pessoa de Meia-Idade , Rejuvenescimento , Envelhecimento da Pele , Resultado do Tratamento
8.
J Am Acad Dermatol ; 81(4): 984-988, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31202871

RESUMO

BACKGROUND: Basal cell carcinoma (BCC) treatment modalities can be stratified by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic confirmation. Reflectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images. OBJECTIVE: To evaluate the feasibility and efficacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs. METHODS: Prospective study with biopsy specimen-proven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM. RESULTS: Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 ± 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identified in 5 of 22 cases (22.7%) under RCM on immediate first-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found. CONCLUSIONS: Addition of RCM to laser ablation workflow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the efficacy of laser ablation.


Assuntos
Carcinoma Basocelular/cirurgia , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Recidiva Local de Neoplasia/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Biópsia , Carcinoma Basocelular/diagnóstico por imagem , Carcinoma Basocelular/patologia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Terapia a Laser/instrumentação , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasia Residual , Estudos Prospectivos , Medição de Risco , Pele/diagnóstico por imagem , Pele/patologia , Pele/efeitos da radiação , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologia , Resultado do Tratamento
9.
J Cosmet Dermatol ; 18(3): 773-777, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31116009

RESUMO

INTRODUCTION: Visible leg veins are a common cosmetic concern treated mostly by 1064 nm Nd:YAG laser that has become the chosen laser therapy for treating all leg veins up to 3 mm in size. The objective of the current prospective study was to evaluate the safety and efficacy of a new 1064 nm diode laser for leg veins and spider veins on the lower extremities. METHODS: A total of 15 female subjects seeking leg veins and spider veins treatment were recruited to this study. The treatment protocol included two treatment sessions 6 weeks apart and two follow-up visits at three and 6 months after the last diode laser treatment. Results were evaluated by photographs and an investigator classification of the treated vascular lesions appearance on five scores scale from 0 (normal) to 4 (severe). RESULTS: Treatment area photos demonstrated improvement in vascular lesions appearance. Average vascular lesions classification was reduced by approximately one score from baseline score of 2.9 (score 3 is moderate) to an average score 2 (mild) at the 3-month follow-up visit. This improved classification sustained also at 6-month follow-up visit, indicating the long-term effect of the treatment impact. No significant or unexpected adverse events were detected in any of the patients as a result of the treatments. CONCLUSIONS: This study has demonstrated that the new 1064 nm diode laser is safe and effective for the treatment of leg vascular lesions on the lower extremities.


Assuntos
Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Telangiectasia/cirurgia , Adulto , Feminino , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Perna (Membro) , Extremidade Inferior , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
11.
Skin Res Technol ; 25(5): 683-692, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31056804

RESUMO

BACKGROUND: Long-pulsed (LP) lasers at pulse durations of 1-300 ms have been used to destroy nests of nevi cells by selectively targeting pigment chromophores. OBJECTIVE: To evaluate dual-wavelength LP laser-induced tissue reactions. METHODS: The patterns of LP 755-nm alexandrite (Alex) and/or 1064-nm neodymium (Nd):yttrium-aluminum-garnet (YAG) laser-induced tissue reactions were macroscopically evaluated using a tattoo-embedded phantom. Additionally, a pilot in vivo human study was performed for common acquired melanocytic nevus, of which dermoscopic images and high-speed cinematographs were obtained. RESULTS: Combinations of Nd:YAG and Alex laser treatments at interpulse intervals of 10 or 20 ms generated round to oval zones of photothermal and photoacoustic injury in two distinctive areas containing disintegrated tattoo particles. Treatment at interpulse intervals of 10 or 20 ms between Alex and Nd:YAG pulses elicited lesser degrees of thermal damage to surrounding tissues, compared to treatment at 100 or 200 ms. Immediately after combined LP laser treatment of human nevus lesions in vivo, Nd:YAG-Alex treatment at a 20-ms interpulse interval exhibited more remarkable crusting and erosive appearances than Alex-Nd:YAG treatment. CONCLUSION: For treating pigmented disorders, sequential delivery of LP Nd:YAG and Alex pulses at short interpulse intervals of 10-20 ms can effectively destroy nests of pigment chromophores.


Assuntos
Terapia a Laser/métodos , Nevo Pigmentado/cirurgia , Transtornos da Pigmentação/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Dermoscopia/métodos , Humanos , Terapia a Laser/instrumentação , Lasers de Estado Sólido , Masculino , Imagens de Fantasmas , Pele/efeitos da radiação , Tatuagem
13.
Nat Commun ; 10(1): 1926, 2019 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-31028250

RESUMO

Recently, surface-enhanced Raman scattering nanoprobes have shown tremendous potential in oncological imaging owing to the high sensitivity and specificity of their fingerprint-like spectra. As current Raman scanners rely on a slow, point-by-point spectrum acquisition, there is an unmet need for faster imaging to cover a clinically relevant area in real-time. Herein, we report the rational design and optimization of fluorescence-Raman bimodal nanoparticles (FRNPs) that synergistically combine the specificity of Raman spectroscopy with the versatility and speed of fluorescence imaging. DNA-enabled molecular engineering allows the rational design of FRNPs with a detection limit as low as 5 × 10-15 M. FRNPs selectively accumulate in tumor tissue mouse cancer models and enable real-time fluorescence imaging for tumor detection, resection, and subsequent Raman-based verification of clean margins. Furthermore, FRNPs enable highly efficient image-guided photothermal ablation of tumors, widening the scope of the NPs into the therapeutic realm.


Assuntos
Neoplasias Encefálicas/terapia , DNA/química , Nanopartículas Metálicas/química , Imagem Óptica/métodos , Neoplasias Ovarianas/terapia , Análise Espectral Raman/métodos , Animais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirurgia , Linhagem Celular Tumoral , DNA/metabolismo , Portadores de Fármacos/síntese química , Portadores de Fármacos/farmacocinética , Feminino , Corantes Fluorescentes/química , Engenharia Genética , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Limite de Detecção , Terapia com Luz de Baixa Intensidade/instrumentação , Terapia com Luz de Baixa Intensidade/métodos , Nanopartículas Metálicas/administração & dosagem , Camundongos , Imagem Óptica/instrumentação , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/cirurgia , Imagens de Fantasmas , Prata/química , Análise Espectral Raman/instrumentação , Ensaios Antitumorais Modelo de Xenoenxerto
15.
Urol Clin North Am ; 46(2): 303-313, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30961862

RESUMO

Diagnosis, treatment, and follow-up are all influential in determining the overall cost to the health care system for kidney stones. New innovations in the field of nephrolithiasis have been abundant, including disposable ureteroscopes, ultrasound-guided approaches to percutaneous nephrolithotomy, and advanced laser lithotripters. Identifying cost-effective treatment strategies encourages practitioners to be thoughtful about providing value-based high-quality care and remains on important principle in the treatment of urinary stone disease.


Assuntos
Análise Custo-Benefício , Cálculos Renais/economia , Cálculos Renais/cirurgia , Efeitos Psicossociais da Doença , Assistência à Saúde/economia , Diagnóstico por Imagem/economia , Equipamentos Descartáveis/economia , Custos de Cuidados de Saúde , Humanos , Invenções/economia , Cálculos Renais/epidemiologia , Cálculos Renais/prevenção & controle , Terapia a Laser/economia , Terapia a Laser/instrumentação , Litotripsia/economia , Nefrolitíase/economia , Nefrolitíase/epidemiologia , Nefrolitíase/prevenção & controle , Nefrolitíase/cirurgia , Nefrolitotomia Percutânea/economia , Nefrolitotomia Percutânea/instrumentação , Nefrolitotomia Percutânea/métodos , Fibras Ópticas/economia , Ureteroscopia/economia , Ureteroscopia/instrumentação
16.
World Neurosurg ; 127: 436-441, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30974271

RESUMO

BACKGROUND: Clearpoint Smartframe is a magnetic resonance imaging-compatible stereotactic system often used to perform magnetic resonance imaging-guided biopsies. The system is typically mounted on the scalp through screws that pierce the skin and penetrate the outer table of the cranium. However, the frame can also be configured to be mounted directly onto the skull. CASE DESCRIPTION: Here, we describe the clinical context well suited for a skull-mount Clearpoint Smartframe surgery. The patient suffered from a subcentimeter right parafourth ventricular contrast-enhancing lesion with hydrocephalus and underwent a right suboccipital needle biopsy followed by an occipital ventriculoperitoneal shunt. Although the hydrocephalus resolved with the ventriculoperitoneal shunt, the biopsy sample proved nondiagnostic. The patient underwent a second procedure during which the Clearpoint Smartframe was mounted onto the skull through space dissected free during the previous surgery. Diagnostic biopsy (H3K27 glioma) was performed followed by stereotactic laser ablation of the lesion. CONCLUSIONS: We describe a case in which the skull mount Clearpoint Smartframe was used to biopsy and ablate a midline H3K27 glioma.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Terapia a Laser/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Crânio/cirurgia , Técnicas Estereotáxicas/instrumentação , Adulto , Neoplasias Encefálicas/patologia , Desenho de Equipamento , Glioma/patologia , Humanos , Hidrocefalia/patologia , Hidrocefalia/cirurgia , Biópsia Guiada por Imagem/instrumentação , Imagem por Ressonância Magnética Intervencionista/instrumentação , Masculino , Imagem Multimodal , Tomografia Computadorizada por Raios X , Derivação Ventriculoperitoneal/instrumentação , Derivação Ventriculoperitoneal/métodos
17.
J Urol ; 202(4): 795-800, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31009288

RESUMO

PURPOSE: We report our experience with long-term outcomes of holmium laser enucleation of the prostate during a period of 18 years. MATERIALS AND METHODS: We reviewed a prospectively collected database from March 1998 through June 2016 for patients who underwent holmium laser enucleation of the prostate for symptomatic benign prostatic hyperplasia as performed or supervised by a single expert surgeon. Demographic and perioperative data were collected, including scores on the I-PSS (International Prostate Symptom Score), quality of life, peak flow rate, post-void residual urine and prostate specific antigen. Perioperative and late adverse events were also assessed. RESULTS: At a median followup of 9.1 years 1,476 patients with a mean age of 70.7 years were included in study. Mean catheter time and hospital stay were 1.2 and 1.3 days, respectively. Mean ± SD I-PSS and quality of life scores (15.9 ± 6.5 vs 6.8 ± 5.6 and 3.1 ± 1.4 vs 1.5 ± 1.4, respectively, each p <0.001) were significantly improved after holmium laser enucleation of the prostate compared to preoperative values. Likewise the mean peak flow rate and post-void residual urine were significantly improved (mean 7.2 ± 4.0 vs 17.7 ± 10.4 ml per second and 204 ± 258 vs 43 ± 73 ml, respectively, each p <0.001) in the 132 patients who could be followed more than 10 years. Perioperative blood transfusion was required in 0.8% of patients. Prostate specific antigen was significantly reduced by 66.7% at the most recent followup (p <0.001). Postoperative complications included urethral stricture and bladder neck contracture in 21 (1.4%) and 30 patients (2.1%), respectively. Repeat holmium laser enucleation of the prostate was required in 21 patients (1.4%). CONCLUSIONS: Holmium laser enucleation of the prostate is a safe, effective and durable procedure to treat benign prostatic hyperplasia during long-term followup.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Retenção Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Próstata/efeitos da radiação , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/instrumentação , Hiperplasia Prostática/complicações , Qualidade de Vida , Estudos Retrospectivos , Fatores de Tempo , Retenção Urinária/diagnóstico , Retenção Urinária/etiologia
18.
Med Oral Patol Oral Cir Bucal ; 24(2): e271-e280, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30818322

RESUMO

BACKGROUND: We aim to evaluate the presence of histological artefacts in the surgical margins of human oral fibro-epithelial hyperplasias excised with lasers of different wavelengths, and also electrosurgical scalpel and cold scalpel. Moreover, we aim to determine if some of these instruments could impair the normal histological diagnosis of these lesions. MATERIAL AND METHODS: We included 130 consecutive surgical samples of 80 females and 50 males (mean age of 53.82±16.55) with a histological diagnosis of an oral benign fibrous-epithelial hyperplasias. The samples were categorized into 6 groups according to the type of instrument used: CO2 laser group, diode laser group, Er:YAG laser group, Nd:YAG laser group, electrosurgical scalpel group and cold scalpel group. Histological instrument-induced changes were microscopic evaluated and related with clinical and pathological variables. RESULTS: The instrument with highest tissue damage extension (TDE) was the electrosurgical scalpel (1002.2µm±434.92), followed by diode laser (913.73 µm±322.45), Nd:YAG (899.83µm±327.75), CO2 laser (538.37µm±170.50), Er:YAG laser (166.47µm±123.85), and at last with fewer alterations the cold scalpel group (2.36µm±7.27) (P < 0.001). The most regular incision was observed in CO2 laser group, followed by Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and diode laser group with the less regular incision using cold scalpel as comparison (P < 0.001). A correlation was found between the incision score and TDE (P < 0.001). Regarding histological diagnosis, no case showed any limitation of diagnosis related with the use of any instrument evaluated. CONCLUSIONS: Our results suggest that lasers can be used for the excision of oral benign fibrous-epithelial hyperplasias, without hispathological diagnosis limitations, as long as the physical properties of each laser are known and respected. Er:YAG laser have shown to be a laser with few tissue damage extension and with good incision regularity, been a possible instrument of choice for the surgical removal of these lesions.


Assuntos
Eletrocirurgia/métodos , Hiperplasia/patologia , Lasers de Gás/uso terapêutico , Lasers Semicondutores/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Margens de Excisão , Doenças da Boca/patologia , Procedimentos Cirúrgicos Bucais/métodos , Adulto , Idoso , Feminino , Humanos , Hiperplasia/cirurgia , Terapia a Laser/instrumentação , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Boca/patologia , Boca/cirurgia , Doenças da Boca/cirurgia , Mucosa Bucal/patologia , Mucosa Bucal/cirurgia , Procedimentos Cirúrgicos Bucais/instrumentação , Palato Duro/patologia , Palato Duro/cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Língua/patologia , Língua/cirurgia
19.
J Cosmet Dermatol ; 18(2): 464-468, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30723997

RESUMO

Nevus of ota is a dermal melanocytosis common among Asian patients, mottled, blue-gray macule that is usually located unilaterally within the distribution of the first and second branches of the trigeminal nerve and almost always responds well to treatment with Q-switched lasers (eg, ruby, alexandrite, and Nd: YAG). In spite of the plethora of science behind laser-tissue interactions, the objective evaluation of nevus of ota response to laser is not on firm footing and most studies report subjective percentile scoring improvement. A knowledge of the variations in morphology of nevus of ota can help predict an optimal dose response and help to counsel patients appropriately.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Nevo de Ota/cirurgia , Neoplasias Cutâneas/cirurgia , Grupo com Ancestrais do Continente Asiático , Face , Humanos , Terapia a Laser/instrumentação , Pele/inervação , Resultado do Tratamento , Nervo Trigêmeo
20.
Ann Vasc Surg ; 58: 302-308, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769060

RESUMO

BACKGROUND: The aim of this study is to compare 2 groups of patients treated for great saphenous vein (GSV) reflux with open surgical saphenofemoral ligation (SFL) and endovenous laser ablation (EVLA). METHODS: Consecutive patients with primary unilateral GSV reflux undergoing EVLA treatment since 2014 were enrolled, and another series of patients treated with SFL was considered. The patients were stratified according to treatment and the results were compared using the propensity score (1:1). The covariables were age, gender, body mass index, CEAP (Clinical class, Etiology, Anatomy and Pathophysiology) staging, and GSV and saphenofemoral junction diameters. Primary outcomes were GSV occlusion or recurrent groin varicose veins at 1 year after treatment. Secondary outcomes included vein thrombosis, hyperpigmentation, paresthesia, postoperative pain, analgesic requirement, and ecchymosis assessed at discharge and CEAP stage and quality of life (QoL) assessment 1 month after surgery. RESULTS: A total of 123 patients were included in the study: 59 were treated with EVLA and 64 with SFL. At 12 months, we observed 10 recurrent groin varicose veins after SFL (15.6%) and 6 GSV recanalization after EVLA (10.2%, P = 0.369). Extra-saphenous recurrent varicose veins were observed in 36 patients (29.3%): 20 in the open group (31.2%) and 16 in EVLA group (27.1%, P = 0.615). After matching procedure 74 patients were analyzed (37 patients by group), logistic regression model showed that the risk of outcome was not associated with the surgical treatment (odds ratio 1.76, 95% confidence interval 0.52-6.01). CONCLUSIONS: Both techniques to treat saphenous impairment have demonstrated to be safe, with good results in terms of efficacy and symptomatic improvement at follow-up. EVLA with 1,470 nm seems to have lower rates of recurrence and good perceived QoL. Tumescent anesthesia is a good option with good results and may be extended to open surgical ligation.


Assuntos
Anestesia Local , Procedimentos Endovasculares/instrumentação , Veia Femoral/cirurgia , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Anestesia Local/efeitos adversos , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Feminino , Veia Femoral/diagnóstico por imagem , Veia Femoral/fisiopatologia , Humanos , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Ligadura , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia
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