Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.255
Filtrar
1.
Lancet ; 395(10219): 212-224, 2020 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31954466

RESUMO

BACKGROUND: Cataract surgery is one of the most common operations in health care. Femtosecond laser-assisted cataract surgery (FLACS) enables more precise ocular incisions and lens fragmentation than does phacoemulsification cataract surgery (PCS). We hypothesised that FLACS might improve outcomes in cataract surgery compared with PCS despite having higher costs. METHODS: We did a participant-masked randomised superiority clinical trial comparing FLACS and PCS in two parallel groups (permuted block randomisation stratified on centres via a centralised web-based application, allocation ratio 1:1, block size of 2 or 4 for unilateral cases and 2 or 6 for bilateral cases). Five French University Hospitals enrolled consecutive patients aged 22 years or older who were eligible for unilateral or bilateral cataract surgery. Participants, outcome assessors, and technicians carrying out examinations were masked to the surgical treatment allocation until the last follow-up visit and a sham laser procedure was set up for participants randomly assigned to the PCS arm. The primary clinical endpoint was the success rate of surgery, defined as a composite of four outcomes at a 3-month postoperative visit: absence of severe perioperative complication, a best-corrected visual acuity (BCVA) of 0·0 LogMAR (logarithm of the minimum angle of resolution) or better, an absolute refractive error of 0·75 dioptres or less, and unchanged postoperative corneal astigmatism power (≤0·5 dioptres) and axis (≤20°). The primary economic endpoint was the incremental cost per additional patient who had treatment success at 3 months. Primary outcomes were assessed in all randomly assigned patients who met all eligibility criteria (missing data considered as failure). We used mixed logistic regression models or mixed linear regression models for statistical comparisons, adjusted on centres and whether cataract surgery was bilateral or unilateral. The study is registered with ClinicalTrials.gov, NCT01982006. FINDINGS: Of the 907 patients (1476 eyes) randomly assigned between Oct 9, 2013, and Oct 30, 2015, 870 (704 eyes in FLACS group and 685 eyes in the PCS group) were analysed. We identified no significant difference in the success rate of surgery between the FLACS and PCS groups (FLACS: 41·1% [289 eyes]; PCS: 43·6% [299 eyes]); adjusted odds ratio 0·85, 95% CI 0·64-1·12, p=0·250). The incremental cost-effectiveness ratio was €10 703 saved per additional patient who had treatment success with PCS compared with FLACS. We observed no severe adverse events during the femtosecond laser procedure, and most of the complications in the FLACS group related to the primary outcome measures occurred during the phacoemulsification phase or postoperatively. INTERPRETATION: Despite its advanced technology, femtosecond laser was not superior to phacoemulsification in cataract surgery and, with higher costs, did not provide an additional benefit over phacoemulsification for patients or health-care systems. FUNDING: French Ministry of Social Affairs and Health.


Assuntos
Extração de Catarata/economia , Extração de Catarata/métodos , Análise Custo-Benefício , Terapia a Laser/economia , Facoemulsificação/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata/efeitos adversos , Estudos de Equivalência como Asunto , Feminino , Humanos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/efeitos adversos , Facoemulsificação/métodos , Resultado do Tratamento
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.
Medicine (Baltimore) ; 98(52): e18340, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876707

RESUMO

The purpose of our study was to compare the selected parameters of the anterior segment of the eye in patients after femtosecond laser-assisted cataract surgery (FLACS) with the results of microincision cataract surgery (MICS) and conventional phacoemulsification surgery (CPS). This single-center prospective randomized comparative observational study included 87 patients. Patients were randomly selected into group A (FLACS), group B (MICS) and group C (control group). All the surgeries were performed by the same experienced surgeon. Preoperative and postoperative parameters were evaluated: best-corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss percentage (ECL%), central corneal thickness (CCT), central anterior and posterior corneal astigmatism induction, posterior corneal elevation map were measured. Intraoperative parameters: effective phacoemulsification time (EPT), balanced salt solution use (BSS use), total surgical time and suction time were analyzed. Examination was performed preoperatively and on the first, seventh day, one and six months postoperatively. The follow up period was 6 months. There was no statistically significant difference in BCVA, central anterior and posterior astigmatism induction between studied groups. The ECL% was statistically significant lower in the group A on the 7th day, 1 month and 6-months postoperatively (P < .05). The CCT was statistically significant lower in the group A and in the group B than in the group C on the 7th postoperative day (P = .002). However, in the 6 months follow-up there was no statistically significant difference in the CCT between studied groups (P = .133). We observed statistically significant difference in change of the posterior corneal elevation map at the periphery assessed within the 90° to 120°meridian range between group A, group B and group C at every timepoint postoperatively (P < .05). The EPT and BSS use were statistically significant lower whilst total surgery time was statistically significant higher in the FLACS group (P < .05). To conclude in the 6 months follow-up there was statistically significant difference found between eyes undergoing FLACS, MICS and CPS with respect to the posterior corneal elevation map assessed within the studied range, ECL%, EPT, BSS use and total surgery time. Postoperative BCVA, central anterior and posterior astigmatism induction, CCT were comparable between studied groups.


Assuntos
Segmento Anterior do Olho/patologia , Extração de Catarata/métodos , Terapia a Laser/métodos , Facoemulsificação/métodos , Idoso , Segmento Anterior do Olho/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Estudos Prospectivos , Acuidade Visual
4.
Medicine (Baltimore) ; 98(50): e18026, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852065

RESUMO

The purpose of this study is to evaluate the biometric parameters of crystalline lens components and to find effective factors for predicting postoperative intraocular lens (IOL) position. This retrospective study included 97 eyes from 97 patients with a mean age of 63.00 ± 12.38 (SD) years. The biometric measurements were performed by means of a 3-dimensional optical coherence tomography (3D-OCT) device. Specifically, anterior chamber depth (ACD), aqueous depth (AD), lens thickness (LT), lens meridian parameter (LMP), white-to-white diameters (WTW), anterior segment length (ASL), the anterior part of lens (aLT), and the posterior part of lens (pLT) were measured. Additionally, axial length (AL) and corneal radius (CR) were measured by the partial coherence interferometry. Ninety-seven eyes were divided into thin lens group (LT < 4.5 mm) and thick lens group (LT ≥ 4.5 mm). The differences between the above two groups were also analyzed. Postoperative IOL position was measured by 3D-OCT at 3 months postoperatively and regression formulas for predicting postoperative IOL position were developed by various combinations of preoperative factors. As lens thickened, ACD and AD became shallow (all P < .001). AD, ACD, ASL, aLT, and pLT showed statistically significant differences between two subgroups classified on the basis of LT (all P < .001). Meanwhile, the value obtained by subtracting aLT from pLT did not show any association with the other biometric measurements. The combination of ACD, aLT, pLT, AL, CR, and WTW showed the highest correlation with postoperative IOL position (R = 0.536, P < .001). In conclusion, pLT-aLT was an independent factor not affected by any other variables and did not show significant difference between thin lens group and thick lens group. The subdivision of the lens structure using 3D-OCT helps to predict postoperative IOL position.


Assuntos
Segmento Anterior do Olho/diagnóstico por imagem , Biometria/métodos , Extração de Catarata/métodos , Terapia a Laser/métodos , Lentes Intraoculares , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Cristalino/diagnóstico por imagem , Cristalino/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 98(47): e17906, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764789

RESUMO

BACKGROUND: Femtosecond laser (FL) is an effective method to treat patients with myopia, but its relative efficacy and safety is still unclear. Thus, this study will be conducted to assess the efficacy and safety of FL for myopia systematically. METHODS: This study will systematically retrieve the following electronic databases up to the present: Cochrane Library, PubMed, EMBASE, Web of Science, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, Wanfang, VIP, and China National Knowledge Infrastructure. All electronic databases will be searched without any limitations of language and publication status. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: We will summarize the targeted results evaluating the efficacy and safety of FL for patients with myopia. CONCLUSIONS: This study will provide a comprehensive evidence summary on FL for patients with myopia.PROSPERO registration number: PROSPERO CRD42019148659.


Assuntos
Terapia a Laser/métodos , Miopia/cirurgia , Projetos de Pesquisa , Revisão Sistemática como Assunto , Humanos , Procedimentos Cirúrgicos Oftalmológicos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
6.
Rom J Ophthalmol ; 63(3): 268-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687630

RESUMO

Purpose. To report a case of malignant glaucoma in a pseudophakic female patient, with no history of glaucoma, resolved through pars plana anterior vitrectomy. Case presentation. An 80-year-old female patient presented in our Emergency Department after a five-day history of pain in her left eye (LE). In the last day, the patient noticed marked visual loss and ocular pain. Visual acuity was light perception and Goldman tonometry was 80 mmHg in her LE. The biomicroscopy revealed absent peripheral and central anterior chamber (AC) and posterior chamber (PC) pseudophakia. Posterior segment ecography showed no vitreous or choroidal abnormalities. A peripheral laser YAG iridotomy was made and the patient was treated with intravenous 20% mannitol, topical timolol, topical brimonidine, and topical cycloplegics. 12 hours later, despite a patent iridotomy in the LE eye, intraocular pressure (IOP) was 55 mmHg, absent AC with severe corneal edema. The diagnosis of pseudophakic malignant glaucoma was made and laser YAG capsulotomy was performed with no resolution of symptoms and signs. 24 hours later, we performed pars plana anterior vitrectomy. Postoperatively, the AC depth increased and the IOP decreased to 20mmHg. After a week, the patient was discharged with hand movement perception visual acuity in her LE, 20 mmHg IOP, reduced corneal edema, normal depth AC. After a month, the corneal edema resolved, the visual acuity was 2/50, IOP was 20mmHg, and the AC had a normal depth. Conclusion. Malignant glaucoma is a sight threatening condition, reported in pseudophakic eyes. Although, literature describes cases solved by cycloplegics and laser YAG capsulotomy, our patient needed pars plana anterior vitrectomy for the resolution of symptoms and signs.


Assuntos
Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Pseudofacia/cirurgia , Acuidade Visual , Vitrectomia/métodos , Idoso de 80 Anos ou mais , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pseudofacia/complicações , Pseudofacia/diagnóstico , Lâmpada de Fenda
7.
Medicine (Baltimore) ; 98(44): e17426, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689746

RESUMO

RATIONALE: Spherophakia is a rare diagnosis which is often associated with a shallow anterior chamber, angle-closure glaucoma, lens subluxation, and lenticular myopia. When cataracts occur with subluxation of the lens, vision is often markedly affected. This often presents surgeons with a unique challenge of maintaining good visual outcomes while minimizing potential complications. PATIENT CONCERNS: A 48-year-old female was referred for ophthalmological assessment due to decreased vision in the left eye. In the left eye, the best-corrected visual acuity at distance was 20/125 with manifest refraction of -6.5D + (-0.75) D × 118°. The slit lamp examination showed iridodonesis and a significant nuclear cataract (C3N3) with tremor in the left eye. After pupil dilation, a subluxated lens, weak zonules, and "fake golden ring" within the lens was noted. DIAGNOSIS: Due to the patient's symptoms, examination results, she was diagnosed with cataract, subluxation of the lens and spherophakia in left eye. INTERVENTIONS: The patient underwent an uneventful femtosecond laser-assisted cataract surgery (Alcon Fort Worth, TX). The laser was able to perform a circular free-floating anterior capsulotomy and easy lens fragmentation. OUTCOMES: There were no postoperative complications. At 3 months postoperatively, the uncorrected visual acuity was 20/25, and the manifest refraction was -0.25 D - 0.75 D × 148° with the corrected distance visual acuity of 20/16. LESSONS: Femtosecond laser-assisted cataract surgery is an effective approach for cataract surgery in patients with subluxated and spherophakic lenses, with the benefits of causing minimal further zonular damage and easy lens fragmentation.


Assuntos
Extração de Catarata/métodos , Catarata/complicações , Terapia a Laser/métodos , Subluxação do Cristalino/complicações , Cristalino/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Acuidade Visual
8.
Braz J Med Biol Res ; 52(12): e8474, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31778436

RESUMO

The management of nonspecific lumbar pain (NSLP) using laser irradiation remains controversial. A systematic review of recently published studies indicates that the effects of laser therapy are commonly assessed using only imperfect methods in terms of measurement error. The main objective of this study was to assess static postural stability using an objective tool in patients with chronic NSLP after laser irradiation at different doses and wavelengths. In total, 68 patients were included in the laser sessions and were randomly assigned into four groups: high-intensity laser therapy at 1064 nm and 60 J/cm2 for 10 min (HILT), sham (HILT placebo), low-level laser therapy at 785 nm and 8 J/cm2 for 8 min (LLLT), and sham (LLLT placebo). In addition, all patients were supplemented with physical exercises (standard stabilization training). To assess postural stability, a double-plate stabilometric platform was used. All measurements were performed pre- and post-laser sessions (three weeks) and at follow-up time points (one and three months). Laser procedures led to more balanced posture stability in patients, although these positive changes were significant mainly for short-term observation (after 4-week therapy). In the follow-up analysis, the parameters were gradually impaired. Kruskal-Wallis analysis of variance (ANOVA) for independent variables did not show any difference between the studied groups. Low- and high-intensity laser therapy does not lead to a significant improvement in postural sway in patients with NSLP compared with standard stabilization training based on short- and long-term observations.


Assuntos
Terapia a Laser/métodos , Dor Lombar/radioterapia , Equilíbrio Postural/efeitos da radiação , Adulto , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Resultado do Tratamento
9.
Cancer Imaging ; 19(1): 65, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615562

RESUMO

MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Terapia a Laser/métodos , Imagem por Ressonância Magnética/métodos , Neuronavegação/métodos , Humanos
10.
Medicine (Baltimore) ; 98(38): e17201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567969

RESUMO

BACKGROUND: Laser therapy is widely used for exercise-induced fatigue, while the effect among different studies remains controversial. The present study was to summary available randomized controlled trials (RCTs) to evaluate the effect of laser therapy in subjects with exercise-induced fatigue. METHODS: PubMed, Embase, and Cochrane Library were searched to identify the potential RCTs from inception to October 2017. The weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated using a random-effects model. RESULTS: Twenty RCTs involving a total of 394 individuals were included in final analysis. No significant differences were observed between the laser therapy and control for the outcomes of lactate (WMD: -0.19; 95%CI: -0.52 to 0.13; P = .244), repetitions (WMD: 4.44; 95%CI: -1.43 to 10.32; P = .138), work load (WMD: 3.38; 95%CI: -1.15 to 7.91; P = .144), time taken to perform the exercise tests (WMD: 4.42; 95%CI: -2.33 to 11.17; P = .199), creatine kinase (WMD: -41.80; 95%CI: -168.78 to 85.17; P = .519), maximum voluntary contraction (WMD: 23.83; 95%CI: -7.41 to 55.07; P = .135), mean peak forces (WMD: 2.87; 95%CI: -1.01 to 6.76; P = = .147), and visual analog scale (VAS) (WMD: -1.91; 95%CI: -42.89 to 39.08; P = = .927). The results of sensitivity analysis suggested that laser therapy might play an important role on the levels of lactate (WMD: -0.30; 95%CI: -0.59 to -0.01; P = = .040), maximum voluntary contraction (WMD: 33.54; 95%CI: 1.95 to 65.12; P = = .037), and VAS (WMD: -21.00; 95%CI: -40.78 to -1.22; P = = .037). The results of subgroup analyses indicated no significant differences between the laser therapy and placebo for lactate and repetitions when stratified by study design, mean age, gender, and study quality. CONCLUSIONS: The findings of this meta-analysis did not indicate any significant differences between the laser therapy and placebo.


Assuntos
Fadiga/terapia , Terapia a Laser , Exercício , Humanos , Terapia a Laser/métodos , Resultado do Tratamento
11.
Artigo em Russo | MEDLINE | ID: mdl-31513165

RESUMO

BACKGROUND: The inflammatory process in the hepatobiliary system contributes to the development and progression of pathological changes in the adjacent digestive organs. The data available in the literature suggest that laser radiation and magnetic therapy are effective in treating hepatobiliary diseases. AIM: To evaluate the effects of magnetic laser radiation on the status of gastroduodenal organs in patients with chronic acalculous cholecystitis. SUBJECTS AND METHODS: Fifty patients with chronic acalculous cholecystitis, mostly women, were followed up; their mean age was 44±8 years (36 to 56 years); the disease duration was 6±1.5 years. The patients were randomized into 2 groups: 1) a comparison group (n=20) and 2) a study group (n=30). Both groups were homogeneous for sex, age, disease duration and severity. The basic treatment included the oral intake of Jermuk mineral water according to the generally accepted scheme, acupuncture, iodine-bromine baths, massage of the collar area, exercise therapy, and, if indicated, therapeutic enemas. During the basic treatment, the patients in the study group were prescribed magnetic laser radiation to the right subcostal area. Results were assessed at 20-22 days after treatment. RESULTS: The performed treatment resulted in positive clinical changes and improvement in the indicators characterizing the status of gastroduodenal organs. CONCLUSION: The studies have established that rehabilitation in patients with chronic acalculous cholecystitis along with laser radiation contributes to positive clinical changes and improvement in the status of the gastroduodenal system. There is a tendency to normalize acid-forming function and morphological state of the gastric and duodenal mucosa.


Assuntos
Colecistite Acalculosa/terapia , Terapia a Laser/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
12.
World Neurosurg ; 132: e124-e132, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518744

RESUMO

BACKGROUND: Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with laser interstitial thermal therapy (LITT) for the management of brain metastases and radiation necrosis of the posterior fossa. METHODS: We retrospectively analyzed 13 patients with metastases and radiation necrosis of the posterior fossa managed with LITT. RESULTS: Thirteen patients with histopathologically confirmed radiation necrosis (n = 5) and metastases (n = 8) of the posterior fossa underwent LITT. The median preoperative tumor was 4.66 cm3, and median postoperative ablation cavity volume was 6.29 cm3. The median volume of the ablation cavity was decreased to 2.90 cm3 at a 9-month follow-up. The median volume of peritumoral edema was 12.25 cm3, which fell to a median of 5.77 cm3 at 1-month follow-up. The median progression-free survival was 7 months (range, 3-14 months) and the mean overall survival was 40 months (range, 2-49 months) after LITT. There were no intraoperative complications. One patient experienced palsy of the seventh and eighth cranial nerves on follow-up, attributable to LITT. CONCLUSIONS: Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. Our findings demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.


Assuntos
Fossa Craniana Posterior/cirurgia , Hipertermia Induzida/métodos , Neoplasias Infratentoriais/terapia , Terapia a Laser/métodos , Adulto , Idoso , Edema Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Fossa Craniana Posterior/patologia , Feminino , Seguimentos , Humanos , Neoplasias Infratentoriais/secundário , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico por imagem , Necrose/etiologia , Complicações Pós-Operatórias/epidemiologia , Intervalo Livre de Progressão , Radiocirurgia , Estudos Retrospectivos , Análise de Sobrevida
13.
Ophthalmologica ; 242(4): 234-238, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31480058

RESUMO

BACKGROUND: Surgical intervention for dense vitreous hemorrhage (DVH) with unclear etiology is often delayed in favor of conservative follow-up despite possible disease progression and the availability of safe minimally invasive vitrectomy. OBJECTIVES: The aim of this study is to investigate the efficacy of early surgical intervention for DVH with unknown etiology. METHODS: Eighty-eight cases (88 eyes) of DVH with unknown origin were retrospectively reviewed. Inclusion criteria were as follows: (1) measured visual acuity (VA) of 20/200 or worse and (2) fundus invisibility requiring B-scan ultrasonography. Eyes with a history of diabetic retinopathy, recent trauma, or likely retinal detachment (RD) as revealed by B-scan ultrasonography were excluded. Outcome measures were a cause of vitreous hemorrhage and final VA following early (≤2 weeks after symptom onset) or delayed vitrectomy. RESULTS: The most frequently occurring causes of DVH were central or branch retinal vein occlusion (30 eyes, 34%) and retinal tear or RD (29 eyes, 33%). logMAR VA significantly improved after treatment (p < 0.001). Final VA was significantly higher for eyes treated within 2 weeks compared with eyes treated later than 2 weeks after symptom onset (p = 0.020). CONCLUSIONS: Surgical intervention within 2 weeks after symptom onset may prevent a lower visual outcome.


Assuntos
Terapia a Laser/métodos , Acuidade Visual , Vitrectomia/métodos , Corpo Vítreo/diagnóstico por imagem , Hemorragia Vítrea/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia , Hemorragia Vítrea/diagnóstico , Adulto Jovem
14.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 354-359, July-Sept. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1040017

RESUMO

Abstract Introduction Schwannomas are benign, solitary, encapsulated tumors that may originate at any site of the peripheral nervous system, with the exception of the olfactory and optic nerves. Schwannomas of the base of tongue are very rare, and only sporadic cases are documented. The tongue base represents a challenge for surgeons. Carbon dioxide (CO2) laser might provide an effective surgical option for such lesions because of the easy access to the lesion, the bloodless surgical field and optimum epithelization of wounds. Objective We present an unusual case of pedunculated schwannoma of the tongue base treated via transoral CO2-assisted excision. We also provide a review of the available literature, in English language, on humans. Data synthesis The authors searched the PubMed database and Google up to July 2018. The following search terms were applied: tongue and lingual, combined with schwannoma and neurilemmoma. Titles and abstracts were screened, and, then, only supraglottic (hypopharyngeal) tongue base masses were considered. Fourteen articles were included in this review, reporting 17 cases. The age of the patients ranged from 9 to 39 years, affecting predominantly females. Dysphagia and lump sensations were the most common presenting symptoms, and the mean follow-up period range was 1.5 to 60 months (mean = 13 months). There was no evidence of recurrence in any of the cases. Conclusion We could conclude that tongue base schwannomas are rare. Transoral complete excision of the tumor is the treatment of choice. CO2 laser surgery is a minimally invasive treatment option that has been performed in few reports with no recurrence and with favorable outcomes.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Língua/cirurgia , Dióxido de Carbono/uso terapêutico , Terapia a Laser/métodos , Neurilemoma/cirurgia , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Neurilemoma/diagnóstico , Neurilemoma/patologia
15.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401580

RESUMO

Scleral buckle (SB) is a well-established modality to treat retinal detachment (RD). The surgery can fail because of various reasons. This case highlights the role of secondary pneumatic retinopexy (PR) for dealing with recurrent RD after SB surgery. This modality of treatment could be explored before taking up patients for vitrectomy, especially in cases of retinal break without proliferative vitreoretinopathy. In the case presented, secondary PR could save another major surgery and good outcome was achieved with less invasive option.


Assuntos
Insuflação/métodos , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/efeitos adversos , Humanos , Terapia a Laser/métodos , Masculino , Reoperação , Adulto Jovem
16.
Cardiovasc Intervent Radiol ; 42(11): 1571-1578, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410534

RESUMO

PURPOSE: To retrospectively assess safety and efficacy of laser ablation (LA) of multiple liver metastases (LM) from neuroendocrine neoplasms (NEN). METHODS: Twenty-one patients with NEN and at least 3 LM ≤ 4 cm in diameter underwent ultrasonography-guided LA. Up to seven LM were ablated in a single session; if the number of LM exceeded seven, the remaining LM were ablated in further LA sessions with a time interval of 3-4 weeks. LA was performed according to the multifiber technique. The patients underwent contrast-enhanced CT 1 month after LA, and were subsequently monitored every 3 months for the first 2 years and then every 6 months. RESULTS: In total, 189 LM were treated in 21 patients (mean 9 ± 8.2, median 6) in 41 LA sessions (range 1-5). The diameter of LM ranged from 5 to 35 mm (median 19 mm, mean 17.9 ± 6.4 mm). One grade 4 complication occurred (0.53%): a bowel perforation managed by surgery. Technical efficacy was 100%, primary efficacy rate 94.7%, and secondary efficacy rate 100%. Complete relief of hormone-related symptoms was obtained in all the 13 symptomatic patients. Median follow-up was 39 months (range 12-99). 1-, 2-, 3-, and 5-year survival rates were 95%, 86%, 66%, and 40%, respectively. Overall survival resulted higher for patients with Ki-67 expression ≤ 7% than for those with Ki-67 > 7% (p = 0.0347). CONCLUSIONS: LA is a promising and safe technique to treat LM from NEN. A longer follow-up should provide definitive information on the long-term efficacy of this liver-directed therapy. LEVEL OF EVIDENCE: Retrospective study, local non-random sample, level 3.


Assuntos
Terapia a Laser/métodos , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Tumores Neuroendócrinos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico por imagem , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos
17.
Jpn J Ophthalmol ; 63(5): 365-373, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31428900

RESUMO

PURPOSE: To elucidate the current clinical practice patterns of branch retinal vein occlusion (BRVO) management by retina specialists in Japan in the era of anti-vascular endothelial growth factor (VEGF) therapy. STUDY DESIGN: A voting survey using an answer pad system. METHODS: On May 28, 2017, forty-one retina specialists were surveyed on the pathology and clinical practice of BRVO management. RESULTS: Most specialists (77.5%) use fundus examination and optical coherence tomography (OCT) for diagnosis of macular edema (ME) secondary to BRVO. All assess the condition of the ellipsoid zone (EZ) and external limiting membrane (ELM) and consider this a visual prognostic factor. For ME secondary to BRVO, anti-VEGF therapy is the first choice, and most specialists (82.4%) select initial injection followed by a pro re nata (PRN) regimen. For switching to other treatment options for persistent cases, combination therapy of anti-VEGF injections and laser therapy is the most common choice (35.9%), whereas 25.6% select vitreous surgery and 15.4% select adding steroid injections. CONCLUSIONS: Our survey presents the current opinions on the diagnosis and treatment of BRVO by retina specialists in Japan, and reveals the common views about damage to the EZ/ELM as a factor of poor prognosis and anti-VEGF therapy as the first line treatment, highlighting various opinions on initiation and switching of therapy.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Gerenciamento Clínico , Terapia a Laser/métodos , Oftalmologistas/normas , Oclusão da Veia Retiniana/diagnóstico , Inquéritos e Questionários , Tomografia de Coerência Óptica/métodos , Competência Clínica , Humanos , Japão , Oclusão da Veia Retiniana/terapia , Estudos Retrospectivos , Especialização , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
18.
Life Sci ; 233: 116685, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31348947

RESUMO

AIMS: The present study aimed to investigate the effects of laser irradiation on the growth factors and cell apoptosis of in vitro cultured infant hemangioma endothelial cells. MAIN METHODS: Endothelial cells of infant hemangioma were cultured in vitro and irradiated using a variable pulse width 1064 nm Nd:YAG laser and intense pulsed light (IPL), the expression of VEGF, VEGFR-2, bFGF and their mRNAs before and after irradiation were measured by ELISA, western blot, RT-PCR and flow cytometry, and changes in the apoptotic rate of endothelial cells in hemangioma were monitored. KEY FINDINGS: The mRNA and protein expressions of VEGF, VEGFR-2, bFGF in hemangioma endothelial cells were inhibited by both Nd:YAG laser and ILP compared to the control cells. The apoptotic rates of hemangioma endothelial cells were also decreased after both laser irradiation treatments in comparison to the blank group. The differences were statistically significant. SIGNIFICANCE: Laser irradiation treats hemangioma not only through a selective photothermal mechanism, but also through cytokine signaling pathways.


Assuntos
Apoptose/efeitos da radiação , Células Endoteliais/efeitos da radiação , Regulação Neoplásica da Expressão Gênica/efeitos da radiação , Hemangioma/metabolismo , Hemangioma/patologia , Terapia a Laser/métodos , Proliferação de Células , Citocinas/genética , Citocinas/metabolismo , Fator 2 de Crescimento de Fibroblastos/genética , Fator 2 de Crescimento de Fibroblastos/metabolismo , Hemangioma/radioterapia , Humanos , Técnicas In Vitro , Lactente , Células Tumorais Cultivadas , Fator A de Crescimento do Endotélio Vascular/genética , Fator A de Crescimento do Endotélio Vascular/metabolismo , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/genética , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/metabolismo
19.
BMJ ; 366: l4235, 2019 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-31292128

RESUMO

The studyGazzard G, Konstantakopoulou G, Garway-Heath E, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet 2019; doi:10.1016/S0140-6736(18)32213-XThis project was funded by the NIHR Health Technology Assessment Programme (project number 09/104/40) and was sponsored by the Moorfields Eye Hospital NHS Foundation Trust.To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000774/early-glaucoma-laser-eye-treatment-trabeculoplasty.


Assuntos
Glaucoma de Ângulo Aberto/cirurgia , Terapia a Laser/métodos , Hipertensão Ocular/cirurgia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Humanos , Terapia a Laser/efeitos adversos , Hipertensão Ocular/tratamento farmacológico , Soluções Oftálmicas , Complicações Pós-Operatórias , Prostaglandinas Sintéticas/efeitos adversos , Prostaglandinas Sintéticas/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Resultado do Tratamento
20.
Artigo em Russo | MEDLINE | ID: mdl-31329190

RESUMO

BACKGROUND: Granuloma annulare is a benign inflammatory dermatosis of unknown etiology, which is characterized by the development of flesh-colored or red papules often arranged in rings on the skin. Currently there are no effective treatments for granuloma annulare. Topical and intradermal applications of glucocorticosteroids produce a short-term and insufficient therapeutic effect. The method cannot be used in extensive rashes. Fractional photothermolysis is a physical method for ablative exposure of tissues to an erbium laser via their local heating with light energy in certain areas. AIM: To investigate the efficiency of fractional photothermolysis in the therapy of patients with granuloma annulare. MATERIAL AND METHODS: Twenty-eight patients diagnosed with granuloma annulare were followed up. All the patients were treated with fractional Fotona Fidelis XS erbium laser at a wavelength of 2940 nm using a FS01 maniple. The treatment cycle consisted of 5 sessions. RESULT: After the treatment, the GASI index was decreased by 50, 75, and 100% in 5 (17.9%), 15 (53.6%), and 8 (28.6%) patients, respectively. The median GASI index was decreased by a total of 2.8 times (p<0.05). CONCLUSION: The study showed the high efficiency of fractional photothermolysis in the treatment of patients with granuloma annulare. This method can be recommended for the treatment of common forms of granuloma annulare.


Assuntos
Granuloma Anular/terapia , Terapia a Laser/métodos , Humanos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA