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1.
Medicine (Baltimore) ; 99(41): e22520, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031293

RESUMO

BACKGROUND: There is no consensus in existing literature on the pulse power, application time, frequency and the dose of energy of laser therapy for the patients. Therefore, we conducted this research for the assessment of safety and efficiency of ultrasound and high-intensity laser therapy (HILT) in the lumbar disc herniation (LDH) patients. METHODS: Our present research was approved by the institutional review board in the West China-Guangan Hospital. All the participants would acquire the written informed consent. From December 2020 to December 2021, we will conduct a prospective evaluation via a senior surgeon for 1 hundred LDH patients who plan to undergo the conservative treatment at our hospital. In this research, the inclusion criteria contained: the patients with lumbar disc herniation diagnosed by lumbar MRI; the patients with no history of trauma or congenital abnormalities; and the patients with sufficient psychological ability to understand and then answer the questions raised in assessment scale. The participants were randomly divided into the control group or HILT group after performing the examination of baseline. The main outcome was the pain score of visual analog scale. The other results contained the adverse effects, back range of motion as well as functional scores. CONCLUSIONS: We assumed that the HILT is as effective as the ultrasound therapy in treating pain for LDH. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5975).


Assuntos
Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Humanos , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/fisiopatologia , Deslocamento do Disco Intervertebral/terapia , Terapia a Laser/efeitos adversos , Dor Lombar/etiologia , Vértebras Lombares , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Amplitude de Movimento Articular , Terapia por Ultrassom/efeitos adversos
2.
PLoS One ; 15(9): e0238394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970691

RESUMO

PURPOSE: To investigate the outcome of phacoemulsification in selective laser trabeculoplasty (SLT)-treated eyes. METHODS: This retrospective study included patients who had open angle glaucoma (OAG) with previous SLT who underwent phacoemulsification. We evaluated intraocular pressure (IOP), length of glaucoma control without treatment, and antiglaucoma medication or surgery. SLT-treated eyes that did not receive phacoemulsification were retrospectively chosen as a control. We investigated factors related to outcome of phacoemulsification by multivariate analysis. RESULTS: 42 eyes with previous SLT that underwent phacoemulsification and 40 controls were retrospectively evaluated. Phacoemulsification was performed 52 ± 15 months after SLT. After a mean follow-up of 74 ± 21 months, mean IOP was significantly decreased in the phaco group by 2.2 ± 2.7 mmHg (p < 0.001). In the SLT group, mean IOP was decreased by 0.8 ± 2.8 mmHg (p < 0.001). 9 eyes (16.7%) in the phaco group and 11 eyes (19.0%) of the SLT group needed topical treatment, and no eye needed glaucoma surgery in both groups. The factor related to success was higher baseline IOP (p = 0.002). CONCLUSION: Prior SLT didn't negatively influence phacoemulsification in patients with OAG. Phacoemulsification lowered IOP effectively and safely in OAG patients who were treated with SLT.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Facoemulsificação , Trabeculectomia/métodos , Idoso , Terapia Combinada , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Facoemulsificação/efeitos adversos , Estudos Retrospectivos , Segurança , Resultado do Tratamento
4.
Surgery ; 168(5): 909-914, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32792099

RESUMO

BACKGROUND: This study investigates the clinical outcomes of endovenous microwave ablation and endovenous laser ablation for varicose veins. METHODS: A total of 139 patients who underwent endovenous microwave ablation and 145 patients who underwent endovenous laser ablation were included in this multicenter study. The clinical outcomes and complications were assessed at 1, 6, and 12 months after the procedure. The effect on quality of life was assessed by the Aberdeen Varicose Vein Questionnaire and the EuroQol Group 5-Dimension Self-Report Questionnaire. RESULTS: The endovenous microwave ablation group had a shorter procedure time than the endovenous laser ablation group (42.58 ± 15.62 minutes vs 65.46 ± 24.38 minutes, P < .01), and no significant differences were observed in the other procedure parameters. The incidences of induration (20.26% vs 31.06%) and ecchymosis (13.07% vs 22.98%, P < .05) were lower in the endovenous microwave ablation group. The rates of temporary paresthesia (9.80% vs 18.01%) and residual varicosities (8.61% vs 16.77%, P < .05) were lower in the endovenous microwave ablation group at 1 month. There were no significant differences in paresthesia or saphenous vein closure rates between the groups at 6 and 12 months. Both groups had significant improvements in their Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores post-procedure, and no significant differences in Aberdeen Varicose Vein Questionnaire and EuroQol Group 5-Dimension Self-Report Questionnaire scores were confirmed. However, local recurrence below the knee was lower in the endovenous microwave ablation group (2.34% vs 8.46%, P < .05) after 12 months. CONCLUSION: Our results confirmed that the endovenous microwave ablation procedure demonstrated a shorter procedure time, lower complication, and local recurrence than the endovenous laser ablation procedure.


Assuntos
Técnicas de Ablação/métodos , Terapia a Laser/métodos , Micro-Ondas/uso terapêutico , Varizes/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Varizes/psicologia
5.
Medicine (Baltimore) ; 99(34): e21814, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846820

RESUMO

BACKGROUND: Various techniques have been applied in facial rejuvenation and lattice laser is the most accepted. However, the application effect of lattice laser in facial rejuvenation is unclear. This study aims to evaluate the application effect of lattice laser in facial rejuvenation. METHODS: Randomized controlled trials of lattice laser in facial rejuvenation will be searched in PubMed, EMbase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang, the Chongqing VIP Chinese Science and Technology Periodical Database, and China biomedical literature database from inception to July 2020. And Baidu Scholar, International Clinical Trials Registry Platform, Google Scholar, and Chinese Clinical Trials Registry will be searched to obtain more relevant studies comprehensively. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS: This study will sum up the present evidence so far by exploring the application effect of lattice laser in facial rejuvenation. CONCLUSIONS: The findings of the study will provide helpful evidence for the application effect of lattice laser in facial rejuvenation, promoting clinical practice, and further scientific research. ETHICS AND DISSEMINATION: The private information from individuals will not publish. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/QF6H5.


Assuntos
Face , Lasers de Estado Sólido/uso terapêutico , Rejuvenescimento , Envelhecimento da Pele , Humanos , Terapia a Laser/métodos , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto
6.
Cancer Radiother ; 24(6-7): 744-750, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32861611

RESUMO

Advances in physical, technological and biological fields have made radiation oncology a discipline in continual evolution. New current research areas could be implemented in the clinic in the near future. In this review in the form of several interviews, various promising themes for our specialty are described such as the gut microbiota, tumor organoids (or avatar), artificial intelligence, connected therapies, nanotechnologies and plasma laser. The individual prediction of the best therapeutic index combined with the integration of new technologies will ideally allow highly personalized treatment of patients receiving radiation therapy.


Assuntos
Microbioma Gastrointestinal , Neoplasias Intestinais/radioterapia , Radioterapia (Especialidade)/tendências , Inteligência Artificial , Previsões , Humanos , Terapia a Laser/métodos
7.
J Vis Exp ; (161)2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32744528

RESUMO

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium. A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20‒2 5W in continuous mode. Each cyst is punctured until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed. This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.


Assuntos
Cistos/diagnóstico , Endométrio/diagnóstico por imagem , Endoscopia/métodos , Doenças dos Cavalos/diagnóstico , Terapia a Laser/métodos , Ultrassonografia/métodos , Animais , Cistos/patologia , Endométrio/patologia , Feminino , Doenças dos Cavalos/patologia , Cavalos
8.
Pain Res Manag ; 2020: 1537875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32566059

RESUMO

Objective: Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods: Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom's criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results: Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). According to Odom's criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion: Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.


Assuntos
Descompressão Cirúrgica/métodos , Deslocamento do Disco Intervertebral/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Neuroendoscopia/métodos , Adulto , Descompressão Cirúrgica/instrumentação , Feminino , Humanos , Terapia a Laser/instrumentação , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
9.
J Neurol Surg A Cent Eur Neurosurg ; 81(4): 348-354, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32361984

RESUMO

BACKGROUND: Glioblastoma multiforme (GBM) is an aggressive intracranial malignancy that confers a poor prognosis despite maximum surgical resection and chemoradiotherapy. Survival decreases further with deep-seated lesions. Laser interstitial thermal therapy (LITT) is an emerging minimally invasive technique for tumor ablation shown to reduce tumor burden effectively, particularly in deep-seated locations less amenable to gross total resection. We describe our initial technical experience of using the combination of LITT followed by surgical resection in patients with GBMs that exhibit both an easily accessible and deep-seated component. MATERIALS AND METHODS: Patients with GBM who received concurrent LITT and surgical resection at our institution were identified. Patient demographic and clinical information was procured from the University of Texas MD Anderson Cancer Center electronic medical record along with preoperative, postoperative, and 1-month follow-up magnetic resonance imaging (MRI). RESULTS: Four patients (n = 2 male, n = 2 female) with IDH-wild type GBM who received combined LITT and surgical resection were identified and analyzed retrospectively. All patients received chemoradiotherapy before presentation. All but one patient (75%) received resection before presentation. Median age was 54 years (range: 44-56 years). Median length of hospital stay was 6.5 days (range: 2-47 days). Median extent of combined ablation/resection was 90.4%. One of the four patients experienced complications in the perioperative or immediate follow-up periods. Local recurrence was observed in one patient during the follow-up period. CONCLUSION: Malignant gliomas in deep-seated locations or in close proximity to white matter structures are challenging to manage. LITT followed by surgical resection may provide an alternative for tumor debulking that minimizes potential morbidities and extent of residual tumor. Further studies comparing this approach with standard resection techniques are warranted.


Assuntos
Neoplasias Encefálicas/terapia , Glioblastoma/terapia , Terapia a Laser/métodos , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Terapia Combinada , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
10.
J Laparoendosc Adv Surg Tech A ; 30(6): 695-700, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32352856

RESUMO

Background: Congenital high airway obstruction syndrome (CHAOS) is a rare condition characterized by complete obstruction of the upper fetal airways. Left untreated, it is uniformly fatal. Ex utero intrapartum treatment (EXIT) has been used to establish a surgical airway in affected fetuses during delivery. While this procedure benefits those fetuses that survive to delivery, high mortality in the prenatal period necessitates earlier innovative strategies. Herein, we report a novel technique for in utero intervention. Methods: A fetoscopic intervention was performed at 28 weeks on a 35-year-old G1P0 woman with fetal CHAOS from a laryngeal obstruction measuring 11 mm in length on prenatal imaging. Under ultrasound guidance, a 3.3-mm curved fetoscope was used to access the uterine cavity through a single subcentimeter maternal skin incision. The scope was driven through the fetal oral cavity and manipulated to attain a view of the vocal cords. A subglottic obstruction was observed. A 600-micron laser fiber was passed through the working channel of the scope and used to ablate the obstructed airway. Using the laser fiber and a guidewire, the ablated opening was traversed with the fetoscope to the level of the carina. Results: Postoperatively, the lungs became less hyperinflated. There was improvement in ascites and diaphragmatic eversion. At 31 1/7 weeks' gestation, the mother experienced preterm premature rupture of membranes with active labor and the fetus was delivered through EXIT to tracheostomy. The infant was managed on mechanical ventilation and is currently thriving at home with a tracheostomy at 2 years of age. Conclusion: Fetoscopy with laser ablation of the airway obstruction is an effective prenatal management strategy that offers the potential to alter the devastating natural course of CHAOS.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Doenças Fetais/cirurgia , Fetoscopia/métodos , Terapia a Laser/métodos , Traqueia/cirurgia , Ultrassonografia Pré-Natal/métodos , Adulto , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/diagnóstico , Feminino , Doenças Fetais/diagnóstico , Idade Gestacional , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Gravidez , Síndrome
11.
World Neurosurg ; 139: 583-587, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360672

RESUMO

BACKGROUND: Thermal coagulation is a central principle in surgery, particularly regarding hemostasis, as well as being an integral part of intracranial tumor removal. Traditionally, surgical hemostasis is achieved through application of unipolar or bipolar electrocautery. This method has been contemporized and specialized to treat intracranial tumors through a technique called stereotactic laser ablation (SLA), also known as laser interstitial thermal therapy. CASE DESCRIPTION: In this article, we present this technique as an additional option in the treatment of difficult intracranial tumors. Specifically, we report here a highly vascular and hemorrhagic pineocytoma found in a fragile, elderly patient who underwent a novel combination of procedures: SLA mediated devascularization followed by resection via an endoscopic approach. CONCLUSIONS: SLA-mediated thermal-coagulation is a potential strategy for minimizing hemorrhagic risks in brain tumor resection and may be used in conjunction with other approaches tailored to the patient and their disease.


Assuntos
Neoplasias Encefálicas/cirurgia , Hemorragia Cerebral/cirurgia , Terapia a Laser/métodos , Neuroendoscopia/métodos , Glândula Pineal/cirurgia , Pinealoma/cirurgia , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Glândula Pineal/diagnóstico por imagem , Pinealoma/diagnóstico por imagem , Estudo de Prova de Conceito
12.
World Neurosurg ; 139: 603, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360676

RESUMO

Cavernous malformations of the midbrain require careful consideration of the risks and benefits of intervention as well as the optimal surgical approach for these challenging lesions. Excellent results can be achieved with careful surgical planning and technique. We demonstrate a contralateral left pterional craniotomy for a translamina terminalis approach to carbon dioxide laser-assisted microsurgical resection of a thalamomesencephalic cavernoma in a 59-year-old woman with progressive debilitating diplopia secondary to partial third nerve palsy (Video 1). We performed a contralateral left modified pterional craniotomy in which we limited dissection of the temporalis muscle to approximately one third rather than extending the muscle split down to the zygoma. The cavernous malformation was resected with no complications, and the patient was discharged from the hospital on postoperative day 3. She noted immediate improvement and nearly complete resolution of symptoms over ensuing weeks. This approach offers a direct route to the lesion with minimal brain transgression, while avoiding the critical structures within the interpeduncular cistern, including the basilar artery and thalamomesencephalic perforating arteries, as well as bordering neural structures, including cerebral peduncles, oculomotor nerves, and mamillary bodies. Use of the carbon dioxide laser with its 0.55-mm tip offers a low surgical profile and allows for precise cutting, thus minimizing thermal damage to surrounding tissues. The translamina terminalis approach through a pterional craniotomy offers a safe and potentially less morbid alternative to select thalamomesencephalic lesions compared with exposure through the mesencephalic surface, which in our experience often necessitates an orbitozygomatic craniotomy.


Assuntos
Craniotomia/métodos , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Terapia a Laser/métodos , Tálamo/cirurgia , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Tálamo/diagnóstico por imagem
13.
Int J Surg ; 79: 217-221, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32447004

RESUMO

BACKGROUND: To compare the diagnostic value of prostate cancer (PCa) between holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP). METHODS: We retrospectively analyzed the clinical data of 2909 patients who underwent surgery for benign prostatic hyperplasia (BPH) from January 2008 to June 2018. A total of 1362 patients received HoLEP, and 1547 patients received TURP. The baseline patient characteristics were collected. We then compared the perioperative outcomes of these patients who diagnosed with incidentally diagnosed prostatic carcinoma (IDPC) or PCa after BPH surgeries. RESULTS: The total detection rate of PCa in HoLEP group was higher than that in TURP group (85/6.24% vs. 61/3.94%, p = 0.005). Specifically, 55(4.6%) patients were diagnosed with IDPC in HoLEP group with prostate-specific antigen (PSA) less than 4 ng/ml, and 37(2.7%) patients in TURP group (p = 0.014). For the patients with PSA between 4 and 10 ng/ml, 15(13.9%) patients were diagnosed with PCa after HoLEP, and 6(5.0%) patients after TURP (p = 0.023). But the detection rate of PCa was not significantly different between the two groups when PSA was over 10 ng/ml. On the other hand, 57 in 1215 patients with no prostate biopsy preoperatively were diagnosed with PCa after HoLEP, while 42 in 1370 patients after TURP (4.7% vs. 3.1%, p = 0.040), respectively. Twenty-six patients received once biopsy and diagnosed with PCa in HoLEP group, while 15 patients in TURP group (18.4% vs. 8.9%, p = 0.018), respectively. However, no significant difference was observed for patients who received twice prostate biopsy in the two groups. CONCLUSIONS: The present study showed that HoLEP can provide a higher total detection rate of PCa when compared with TURP. Besides, this superiority was especially embodied in patients with PSA less than 10 ng/ml.


Assuntos
Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Próstata/patologia , Hiperplasia Prostática/cirurgia , Neoplasias da Próstata/diagnóstico , Ressecção Transuretral da Próstata/métodos , Idoso , Idoso de 80 Anos ou mais , Hólmio , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Int J Hyperthermia ; 37(1): 366-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32308070

RESUMO

Objective: To determine the clinical efficacy of laser ablation for the tredatment of primary hyperparathyroidism (pHPT).Materials and methods: Twelve patients with pHPT were treated with laser ablation. Energy was administered by means of 1.5 m optical fibers percutaneously placed into the target via 21 G needles. A laser ablation unit (EchoLaser X4, Esaote) applied 3 W power for 400-600 s/fiber/insertion to a total 3600-9000 Joules of energy. Patient serum parathyroid hormone (PTH) and calcium levels were checked at baseline and thereafter every 6 months. Patients were followed-up for 2 years with serologic and contrast-enhanced ultrasound. Therapeutic success was defined as normal PTH and calcium levels together with disappearance of nodule-related symptoms.Results: All procedures were performed in single session. Immediately following ablation, contrast enhanced ultrasound confirmed that all but one target had become avascular (technical success rate 11/12; 92%), remaining avascular at all follow-up ultrasound examinations, thereafter. The mean volume of parathyroid nodules decreased from 0.54 cc to 0.36 cc (72.0%). Serum PTH and calcium levels were significantly lower at 1, 12 and 24 m compared to baseline (p < 0.01). By 6 m, PTH and calcium returned to normal and were stable until 24 m in all successfully treated patients. All cases of hyperparathyroid-related symptoms resolved by 6 m (ostealgia [n = 5], repeated renal colic [n = 5], vomiting [n = 3]). Only one patient (8%) reported transient dysphonia as a minor complication.Conclusion: Laser ablation of enlarged, symptomatic parathyroid glands is safe and well-tolerated and can produce long-term, sustained reduction of serum PTH and calcium levels.


Assuntos
Adenoma/diagnóstico por imagem , Terapia a Laser/métodos , Neoplasias das Paratireoides/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
World Neurosurg ; 138: e892-e897, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32272272

RESUMO

OBJECTIVE: Epilepsy with periventricular nodular heterotopia (PVNH) lacks a conclusive surgical treatment strategy as eloquent cortex and important white matter tracts frequently overlay the deep periventricular nodules. Our goal was to evaluate the safety and efficacy of laser interstitial thermal therapy (LITT) for the treatment of epilepsy in PVNH. METHODS: Data on demographic characteristics, complications, visual outcomes, Engel classification at last follow-up, antiepileptic drug use, morbidity, and mortality among patients who underwent this procedure were retrospectively reviewed. RESULTS: Between May 2015 and January 2019, 5 patients underwent 6 LITT procedures for epilepsy with PVNH. One patient had residual nodules after their first procedure and underwent a second ablation. The average follow-up time was 12 months. Three patients were Engel class Ia, 1 patient was Engel class II, and 1 patient was Engel class III at last follow-up. Two patients were able to reduce their antiepileptic drugs postoperatively. Three patients had no changes in vision, 1 patient experienced a quadrantanopsia, and 1 patient had subjective blurry vision after their procedures. No patients experienced motor deficits, dysphasia, infection, or mortality. CONCLUSIONS: LITT appears to be a safe and promising option to provide seizure relief for patients with refractory epilepsy and PVNH that otherwise may not be surgical candidates. Some appropriately determined patients with refractory epilepsy may benefit from LITT before proceeding with an invasive intracranial evaluation. A larger sample size and long-term follow-up is necessary to further elucidate safety and efficacy.


Assuntos
Córtex Cerebral/cirurgia , Epilepsia/cirurgia , Terapia a Laser/métodos , Heterotopia Nodular Periventricular/complicações , Adulto , Epilepsia/complicações , Feminino , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
16.
Invest Ophthalmol Vis Sci ; 61(4): 25, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32305043

RESUMO

Purpose: Severing corneal nerves during orthotopic corneal transplantation elicits the elaboration of the neuropeptide substance P (SP), which induces the generation of CD11c+ contrasuppressor (CS) cells. CS cells disable T regulatory cells (Tregs) that are induced when antigens enter the anterior chamber (AC), either by direct injection or by orthotopic corneal transplantation. This study examined the crucial cell surface molecules on Tregs that are adversely affected by CS cells that are generated by severing corneal nerves. Methods: CS cells were induced by producing shallow 2.0-mm circular incisions in the corneal epithelium in BALB/c mice. CD8+ Tregs were generated by injecting ovalbumin into the AC. The effects of CS cells and SP on the expression and function of two cell surface molecules (CD103 and the receptor of interferon-γ) that are crucial for the induction and function of CD8+ Tregs were analyzed. Results: SP converted CD11c+, but not CD11c- , dendritic cells (DCs) to CS cells. Severing corneal nerves resulted in a 66% reduction in the expression of CD103 on CD8+ AC-associated immune deviation (ACAID) Tregs, and a 50% reduction in the interferon-γ receptor (IFN-γR). These effects could be mimicked in vitro by coculturing CS cells with CD8+ ACAID Tregs. Conclusions: The elaboration of SP in response to corneal nerve ablation converts CD11c+ DCs to CS cells. CS cells disable CD8+ ACAID Tregs by downregulating two crucial cell surface molecules, CD103 and IFN-γR, by an SP-dependent pathway. Blocking this pathway may provide a means of restoring ocular immune privilege in corneas subjected to corneal nerve injury.


Assuntos
Antígenos CD/imunologia , Córnea/inervação , Transplante de Córnea/métodos , Privilégio Imunológico , Cadeias alfa de Integrinas/imunologia , Interferon gama/metabolismo , Animais , Câmara Anterior/imunologia , Células Cultivadas , Córnea/citologia , Córnea/cirurgia , Modelos Animais de Doenças , Rejeição de Enxerto , Sobrevivência de Enxerto , Tolerância Imunológica , Terapia a Laser/métodos , Camundongos , Camundongos Endogâmicos BALB C , Substância P/metabolismo , Linfócitos T Reguladores/imunologia
17.
PLoS One ; 15(4): e0223229, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32271751

RESUMO

To explore the shape characteristics of ablation lesions created via laser ablation (LA), radiofrequency ablation (RFA) and microwave ablation (MWA) in canine prostates and the clinical significance of these characteristics, six adult male beagles were randomly assigned to the LA, RFA, and MWA groups. These ablations were performed with common parameters applied in clinical practice (LA, 3 W/1200 J; RFA and MWA, 30 W/120 s). One ablation lesion was created in each lobe of the prostate via the ablation technique, resulting in a total of twelve ablation lesions. Transrectal ultrasound (TRUS) was used as guidance during puncture and to monitor changes in the ablation lesions. Finally, the ablation efficacy was assessed using transrectal contrast-enhanced ultrasonography (CEUS), and the transverse diameter (TRD), anteroposterior diameter (APD) and longitudinal diameter (LD) of each ablation lesion were measured. The volume (V) and the ratio (R) value were calculated. R reflects the shape characteristic of the ablation lesion (the R value close to 1.0 indicates a more spherical shape). The R values of the ablation lesions were 0.89 ± 0.02, 0.72 ± 0.01, and 0.65 ± 0.03 for RFA, MWA and LA, respectively, and they were significantly different (P = 0.027). The volumes of the ablation lesions were 2.17 ± 0.10 ml, 1.51 ± 0.20 ml, and 0.79 ± 0.07 ml for MWA, LA and RFA, respectively, and they were also significantly different (P = 0.001). The three abovementioned thermal ablation techniques with common parameters in clinical practice can be used for ablation in the prostate. The shapes and volumes of the ablation lesions of the three techniques were varied: The RFA-created lesions had the lowest volumes and were more spherical in shape, demonstrating that RFA could be used for the treatment of relatively small lesions or tumours adjacent to vital organs. The MWA lesions had the largest size with a spherical shape, which could be advantageous for the ablation of tumours with relatively large sizes. The sizes of the ablation lesions created via LA were between those of RFA and MWA but presented more oval in shape, suggesting that this method is highly appropriate for the ablation of benign prostatic hyperplasia (BPH).


Assuntos
Terapia a Laser/veterinária , Complicações Pós-Operatórias/veterinária , Hiperplasia Prostática/veterinária , Ultrassom Focalizado Transretal de Alta Intensidade/veterinária , Animais , Cães , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Masculino , Micro-Ondas/uso terapêutico , Projetos Piloto , Complicações Pós-Operatórias/epidemiologia , Hiperplasia Prostática/cirurgia , Ultrassom Focalizado Transretal de Alta Intensidade/efeitos adversos , Ultrassom Focalizado Transretal de Alta Intensidade/métodos
19.
J Clin Neurosci ; 76: 67-73, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32305273

RESUMO

Corpus callosotomy is a palliative surgical option for patients with refractory epilepsy and frequent drop attacks, decreasing seizure frequency and severity by disconnecting the cerebral hemispheres. Though often successful, open surgery is not without risk. Corpus callosotomy by MRI-guided laser interstitial thermal therapy (MRgLITT) is a minimally invasive alternative to the standard open procedure. This report aims to present an illustrative case and systematically review the current literature on the surgical technique. A systematic review of the English literature through January 2019 was performed. Articles were searched by title utilizing the following key word combinations: "laser" and "callosotomy", "callosotomy" and "ablation", "laser" and "corpus", "callosotomy" and "thermal", and "stereotactic" and callosotomy". The articles recovered were then classified by level of evidence and summarized. Fifteen papers were reviewed, of which 6 met inclusion and exclusion criteria. All included studies were classified as level IV evidence. There was a total of 13 patients ranging from 13 months to 44 years old (mean 23.5 years old). The number of laser fibers utilized ranged from 1 to 3. Engel class I was achieved in 5 patients, II in 4, III in 2, IV in 1. Reported patient follow up was 4-39.7 months (mean 15.43). Corpus callosotomy utilizing MRI-guided laser interstitial thermal therapy results in improvement in seizure frequency and severity with minimal complications. Prospective trials are needed to compare its seizure control and long-term outcomes to that of standard open callosotomy.


Assuntos
Corpo Caloso/cirurgia , Epilepsia Resistente a Medicamentos/cirurgia , Hemisferectomia/métodos , Terapia a Laser/métodos , Radiografia Intervencionista/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética/métodos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
20.
J Mycol Med ; 30(2): 100949, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32234349

RESUMO

Onychomycosis is one of the most prevalent and severe nail fungal infections, which is affecting a wide population across the globe. It leads to variations like nail thickening, disintegration and hardening. Oral and topical drug delivery systems are the most desirable in treating onychomycosis, but the efficacy of the results is low, resulting in a relapse rate of 25-30%. Due to systemic toxicity and various other disadvantages associated with oral therapy like gastrointestinal, hepatotoxicity, topical therapy is commonly used. Topical therapy improves patient compliance and reduces the cost of treatment. However, due to poor penetration of topical therapy across the nail plate, research is focused on different chemical, mechanical and physical methods to improve drug delivery. Penetration enhancers like Thioglycolic acid, Hydroxypropyl-ß-cyclodextrin (HP-ß-CD), Sodium lauryl sulfate (SLS), carbocysteine, N-acetylcysteine etc. have shown results enhancing the drug penetration across the nail plate. Results with physical techniques such as iontophoresis, laser and Photodynamic therapy are quite promising, but the long-term suitability of these devices is in need to be determined. In this article, a brief analysis of the treatment procedures, factors affecting drug permeation across nail plate, chemical, mechanical and physical devices used to increase the drug delivery through nails for the onychomycosis management has been achieved.


Assuntos
Onicomicose/terapia , Administração Oral , Administração Tópica , Antifúngicos/administração & dosagem , Antifúngicos/farmacocinética , Química Farmacêutica/métodos , Terapia Combinada , Portadores de Fármacos/química , Portadores de Fármacos/farmacologia , Sistemas de Liberação de Medicamentos , Humanos , Iontoforese/métodos , Iontoforese/tendências , Terapia a Laser/métodos , Terapia a Laser/tendências , Unhas/efeitos dos fármacos , Unhas/metabolismo , Unhas/efeitos da radiação , Onicomicose/tratamento farmacológico , Onicomicose/epidemiologia , Onicomicose/microbiologia , Permeabilidade/efeitos dos fármacos , Permeabilidade/efeitos da radiação , Fotoquimioterapia/métodos , Fotoquimioterapia/tendências
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