RESUMO
OBJECTIVES: A fast, simple, versatile, and reliable method to record light emission intensity profiles of cylindrical light diffusers (CDFs) in air and transparent liquids has been developed. METHODS: A fluorescent color glass filter (RG695) converts red light emitted by a cylindrical diffuser fiber into near-infrared light in an emission angle-independent manner. The red light was provided from a diode laser system at 635 nm. Near-infrared fluorescence from the RG695 was imaged with a camera. Images from this camera were processed to obtain emission intensity profiles. Cylindrical diffuser fiber profiles of four different manufacturers were compared. RESULTS: The proposed method provides angle-independent intensity profiles of cylindrical diffuser fibers with a single camera shot. It could be demonstrated that dependent on the underlying principle of how the diffuser fiber tips emit light, the emission profile can change significantly in media with different refractive indices. CONCLUSIONS: By converting the light emitted by a diffuser fiber tip into fluorescence light one can eliminate the dependence of the recorded profile on the emission angle from the diffusor. This approach allows for easily taking into account refraction-index (mis)matching by placing the equipment into a suitable liquid. The proposed measurement principle bears potential for quality assurance measurements of CDFs used for interstitial laser thermotherapy or photodynamic therapy.
Assuntos
Desenho de Equipamento , Lasers Semicondutores/uso terapêutico , Fluorescência , Fibras Ópticas , Tecnologia de Fibra Óptica/instrumentaçãoRESUMO
Laser ablation (LA) has been evaluated for the minimally invasive thermal treatment of various cancers, but conventional unidirectional endoscopic ultrasound (EUS)-guided LA has limitations. Therefore, we developed a cylindrical laser diffuser to overcome the limitations of unidirectional EUS-guided LA. The purpose of this study was to compare the efficacies and safeties of EUS-guided LA using a novel cylindrical laser diffuser and radiofrequency ablation (RFA) in vivo in swine pancreas. EUS-guided RFA (15 W, 30 s, 450 J) and cylindrical interstitial LA (CILA) (5 W, 90 s, 450 J) were applied to normal pancreatic tissue in six anesthetized pigs (three per group). Laboratory tests were performed at baseline, immediately after ablation (day 0), and 2 days after procedures (day 2). Two days after procedures, all pigs were sacrificed, and histopathological safety and efficacy assessments were performed. Technically, EUS-guided RFA and CILA were performed successfully in all cases. No major complications, including perforation or acute pancreatitis, occurred during the experiment in either group. All animals remained in excellent condition throughout the experimental period, and laboratory tests provided no evidence of a major complication. Average necrotic volumes in the RFA and CILA groups were 424.2 mm3 and 3747.4 mm3, respectively, and average necrotic volume was significantly larger in CILA group (p < 0.001). EUS-guided RFA and CILA had acceptable safety profiles in the normal swine pancreas model. Our findings indicate EUS-guided CILA has potential for the effective local treatment of pancreatic cancer as an alternative to EUS-guided RFA.
Assuntos
Ablação por Cateter , Terapia a Laser , Pancreatite , Ablação por Radiofrequência , Animais , Suínos , Doença Aguda , Ablação por Cateter/métodos , Pancreatite/cirurgia , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgiaRESUMO
OBJECTIVE: This systematic review and meta-analysis aimed to compare the perinatal outcomes of complicated monochorionic pregnancies after selective reduction by radiofrequency ablation, bipolar cord coagulation, and interstitial laser. DATA SOURCES: We searched PubMed, Scopus, and Web of Science, from the inception of the database up to April 26, 2021. STUDY ELIGIBILITY CRITERIA: Studies comparing at least 2 selective reduction techniques among complicated monochorionic pregnancies and presenting data on perinatal outcomes, including gestational age at procedure, gestational age at delivery, procedure to delivery interval, preterm premature rupture of membranes, preterm birth, survival rate, and birthweight, were eligible. METHODS: The random-effects model was used to pool the mean differences or odds ratios and corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value. RESULTS: A total of 10 studies with 734 cases of fetal reduction met the inclusion criteria, of which 9 studies with 674 fetuses were eligible for quantitative synthesis. In 8 studies that compared radiofrequency ablation with bipolar cord coagulation, radiofrequency ablation was associated with increased procedure to delivery interval (days) (mean difference, 13.42; 95% confidence interval, 1.90-24.94; P=.02; I2=0.0%), decreased preterm birth (odds ratio, 0.50; 95% confidence interval, 0.29-0.85; P=.01; I2=3.0%), and decreased preterm premature rupture of membranes (odds ratio, 0.45; 95% confidence interval, 0.27-0.73; P=.001; I2=0.0%). Radiofrequency ablation and bipolar cord coagulation had comparable survival rates (odds ratio, 0.85; 95% confidence interval, 0.54-1.35; P=.49; I2=0.0%). In 3 studies that compared radiofrequency ablation with interstitial laser, there was no significant difference in gestational age at delivery (P=.07) or survival (P=.15). In 3 studies that compared bipolar cord coagulation with interstitial laser, bipolar cord coagulation was associated with a higher survival rate (odds ratio, 3.21; 95% confidence interval, 1.13-9.10; P=.03; I2=0.0%), but the gestational age at delivery was comparable between groups (P=.16). CONCLUSION: This study demonstrated that radiofrequency ablation has a greater procedure to delivery interval and decreased preterm premature rupture of membranes and preterm birth than bipolar cord coagulation. Although there was no difference in gestational age at delivery for either bipolar cord coagulation, radiofrequency ablation, or interstitial laser, survival was higher with bipolar cord coagulation than with interstitial laser.
Assuntos
Complicações na Gravidez , Nascimento Prematuro , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Redução de Gravidez Multifetal , Nascimento Prematuro/epidemiologia , Estudos Retrospectivos , Cordão UmbilicalRESUMO
Surgical treatment is standard for the treatment of small breast cancers. Due to the pain and esthetic sequelae that can follow surgery, minimally invasive treatments are under investigation. Our aim was to conduct a dosimetry study of laser interstitial thermotherapy. Turkey tissue was used as an ex vivo model, and mammary glands from ewes were used as in vivo models. We used two different wavelength lasers (805 nm and 980 nm). Two types of fiber from two different manufacturers were used: bare fibers with a diameter of 600 µm and diffusing fiber. The diffusing fibers were 5 mm and 10 mm in length. We also used a computerized model to predict thermal damage and to correlate with the ex vivo and in vivo procedures using a constant and variable coefficient. The mathematical model was based on the finite element method for solving light distribution, bio-heat, and thermal damage equations. Based on our ex vivo and in vivo experiments, we found that the optimal configuration for this treatment was the use of the 980-nm laser at 4 W with bare fibers for a minimum treatment time of 150 s. We also developed a predictive mathematical model that showed good predictability of necrosis in line with the experimental data. Laser treatment is a promising therapy for small breast lesions. However, further development of treatment guidance is necessary to support its use in clinical practice.
Assuntos
Neoplasias da Mama , Hipertermia Induzida , Terapia a Laser , Animais , Neoplasias da Mama/terapia , Simulação por Computador , Feminino , Humanos , Lasers , Modelos Teóricos , OvinosRESUMO
BACKGROUND: The therapeutic capacity of multiple cylindrical interstitial laser ablations (CILAs) of pancreatic tissue was evaluated with 1064 nm laser light in ex vivo and in vivo porcine pancreatic models. METHODS: A diffusing applicator was sequentially employed to deliver 1064 nm laser light in a cylindrical distribution to ablate a large volume of pancreatic tissue. Ex vivo tissue was tested at various power levels (5, 7, and 10 W) under US imaging. An in vivo porcine model was used to evaluate the clinical feasibility of multiple CILAs on pancreatic tissue at 5 W via laparotomy (N = 3). RESULTS: Multiple CILAs symmetrically ablated a range of ex vivo tissue volumes (2.4-6.0 cm3) at various power levels. Multiple CILAs warranted a therapeutic capacity of symmetrically ablating in vivo pancreatic tissue. Both ex vivo and in vivo pancreatic tissues after multiple CILAs at 5 W confirmed the absence of or minimal thermal injury to the peripheral tissue and carbonization. CONCLUSIONS: The current findings suggest that the collective thermal effects from multiple CILAs can help widely ablate pancreatic tissue with minimal thermal injury. Further in vivo studies will investigate the safety of the proposed CILA treatment as well as acute/chronic responses of pancreatic tissue for clinical translations.
Assuntos
Terapia a Laser , Animais , Pâncreas/diagnóstico por imagem , Pâncreas/cirurgia , SuínosRESUMO
PURPOSE: The aim of the present study was to retrospectively evaluate the efficacy of interstitial laser photocoagulation (ILP) ablation of thyroid nodules during a 6-year follow-up period and to identify possible predictors of the final outcome. METHODS: Forty-three outpatients (38 women) were assigned to ILP therapy. The study group included euthyroid patients with benign thyroid nodules. Thyroid size, nodule volume and features, and autoimmune test were collected at baseline. Patients underwent US control after the ILP procedure and 1 month, 6 months, 12 months later and then annually. RESULTS: During the follow-up, two distinct groups of patients emerged: the responders (N = 33) and the non-responder (N = 10) ones to ILP. In the responder group, the nodule volume significantly decreased during the follow-up, but a trend toward a slight increase in nodule volume was recorded up to the end of follow-up. No significant decrease in nodule volume was observed in the non-responder group. Neither baseline clinical nor demographic features were significantly different between responders and non-responders groups. In the whole group of patients, the energy delivered per mL of nodule tissue was significantly correlated with the percent volume decrease at the end of follow-up. CONCLUSIONS: Interstitial laser photocoagulation is a safe technique able to reduce byabout 50% the volume of benign thyroid nodules in the majority of treated patients. However, due to the great variability of results, an active follow-up is required. The only independent predictor of ILP outcome is the energy delivered per mL of nodule tissue.
Assuntos
Terapia a Laser/métodos , Fotocoagulação/métodos , Nódulo da Glândula Tireoide/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Nódulo da Glândula Tireoide/patologia , Resultado do TratamentoRESUMO
INTRODUCTION: Twin reversed arterial perfusion (TRAP) sequence is a phenomenon seen in 1-3% of monochorionic twin pregnancies, where the acardiac fetus is found to have multiple anomalies. The normal pump twin maintains its own perfusion in addition to that of its acardiac co-twin. As a result, if the acardiac twin increases in size, the burden on the pump twin is increased, leading to cardiac failure, hydrops fetalis, polyhydramnios, premature delivery, and perinatal death. The outcome of pregnancy is largely dependent on the growth of the acardiac twin. In view of high perinatal loss, surgical techniques to interrupt the blood flow to the acardiac twin have been evaluated. METHODS: We evaluated interstitial laser therapy, which is the main mode of therapy in our unit, of TRAP pregnancies referred over a 5-year period. Interstitial laser was offered if the blood flow in the acardiac twin was found to be persistent at 2 consecutive examinations or if there were cardiac or hydropic changes in the pump twin at the first examination. RESULTS: A total of 18 cases of TRAP were referred during this period and all were counselled regarding fetal therapy if the situation were to deteriorate; 5 couples (27.7%) opted for termination of pregnancy; of the remaining 13, 7 (53.8%) agreed to perform intervention following confirmation of a normal karyotype. Six (85.7%) and 1 (14.3%) lasers were performed in the second and third trimesters, respectively; all 7 had a normal outcome of the pump twin. There were 6/13 (46.2%) in the expectant group who continued the pregnancy with no intervention, with 2 term live births (33.3%). CONCLUSIONS: Our study confirms that there is a high risk of spontaneous loss in untreated pregnancies with TRAP, primarily due to polyhydramnios and fetal hydrops. In the pregnancies that underwent interstitial laser, there was a more favourable outcome. Interstitial laser is minimally invasive, safe, and feasible in experienced hands.
Assuntos
Doenças em Gêmeos/cirurgia , Coração Fetal/anormalidades , Transfusão Feto-Fetal/cirurgia , Hidropisia Fetal/cirurgia , Terapia a Laser , Feminino , Humanos , Gravidez , Gravidez de Gêmeos , Resultado do TratamentoRESUMO
The article describes the clinical observation of the patient 84 years old with prostate cancer T2bNxM0, left kidney cancer T1N0M0 and severe comorbidity. Stepwise interstitial laser coagulation was performed using the Russian microsecond Nd: YAG laser surgical complex.
Assuntos
Neoplasias Renais/cirurgia , Fotocoagulação a Laser , Lasers de Estado Sólido/uso terapêutico , Neoplasias da Próstata/cirurgia , Idoso de 80 Anos ou mais , Comorbidade , Humanos , Neoplasias Renais/complicações , Fotocoagulação a Laser/instrumentação , Masculino , Neoplasias da Próstata/complicaçõesRESUMO
This article presents a case of a 59-year-old patient with a primary tumor of the right kidney with bladder and liver metastases. The patient was treated in three-stages. In the first stage, he underwent ureteral stone extraction, laser resection of the tumor with subsequent vaporization. In the second stage, a repeat laser resection and vaporization of the tumor was performed. During the third stage, the patient underwent TUR of the bladder wall with the tumor, followed by laser vaporization of the tumor bed. During a 9-year follow-up, no signs of tumor growth or metastasis were observed.
Assuntos
Carcinoma de Células de Transição , Neoplasias Ureterais , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/cirurgia , Humanos , Neoplasias Renais , Pelve Renal , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Neoplasias Ureterais/cirurgiaRESUMO
Photothermal therapy (PTT) represents a promising modality for tumor control typically using infrared light-responsive nanoparticles illuminated by a wavelength-matched external laser. However, due to the constraints of light penetration, PTT is generally restricted to superficially accessible tumors. With the goal of extending the benefits of PTT to all tumor settings, interstitial PTT (I-PTT) is evaluated by the photothermal activation of intratumorally administered Prussian blue nanoparticles with a laser fiber positioned interstitially within the tumor. This interstitial fiber, which is fitted with a terminal diffuser, distributes light within the tumor microenvironment from the "inside-out" as compared to from the "outside-in" traditionally observed during superficially administered PTT (S-PTT). I-PTT improves the heating efficiency and heat distribution within a target treatment area compared to S-PTT. Additionally, I-PTT generates increased cytotoxicity and thermal damage at equivalent thermal doses, and elicits immunogenic cell death at lower thermal doses in targeted neuroblastoma tumor cells compared to S-PTT. In vivo, I-PTT induces significantly higher long-term tumor regression, lower rates of tumor recurrence, and improved long-term survival in multiple syngeneic murine models of neuroblastoma. This study highlights the significantly enhanced therapeutic benefit of I-PTT compared to traditional S-PTT as a promising treatment modality for solid tumors.
Assuntos
Hipertermia Induzida , Nanopartículas , Neoplasias , Neuroblastoma , Camundongos , Animais , Fototerapia , Terapia Fototérmica , Linhagem Celular Tumoral , Neuroblastoma/terapia , Neuroblastoma/patologia , Neoplasias/tratamento farmacológico , Microambiente TumoralRESUMO
BACKGROUND AND AIMS: Local ablative treatment is another option for improving outcomes and has been evaluated for locally advanced pancreatic cancer. We previously suggested endoscopic ultrasound (EUS)-guided interstitial laser ablation using a cylindrical laser diffuser (CILA) might be a feasible therapeutic option based on experiments performed on pancreatic cancer cell lines and porcine model with a short follow-up (3 days). The aim of this study was to investigate the safety of EUS-CILA performed using optimal settings in porcine pancreas with a long-term follow-up (2 weeks). METHODS: EUS-CILA (laser energy of 450 J; 5 W for 90 s) was applied to normal pancreatic tissue in porcine (n = 5) under EUS guidance. Animals were observed clinically for 2 weeks after EUS-CILA to evaluate complications. Computed tomography and laboratory tests were carried out to evaluate safety. Two weeks after EUS-CILA, all pigs were sacrificed, and histopathological safety and efficacy evaluations were conducted. RESULTS: EUS-CILA was technically successful in all five cases. No major complications occurred during the follow-up period. Body weight of porcine did not change during the study period without any significant change in feed intake. Animals remained in excellent condition throughout the experimental period, and laboratory tests and computed tomography (CT) scans provided no evidence of a major complication. Histopathological evaluation showed complete ablation in the ablated area with clear delineation of surrounding normal pancreatic tissue. Mean ablated volume was 55.5 mm2 × 29.0 mm and mean ablated areas in the pancreatic sections of the five pigs were not significantly different (p = 0.368). CONCLUSIONS: In conclusion, our experimental study suggests that EUS-CILA is safe and has the potential to be an effective local treatment modality. No major morbidity or mortality occurred during the study period. Further evaluations are warranted before clinical application.
RESUMO
OBJECTIVE: To estimate the neonatal survival rate after intra-fetal laser (IFL) treatment for twin reversed arterial perfusion (TRAP) sequence, and to investigate the effect of gestational age at the time of procedure. METHODS: Retrospective cohort study of TRAP sequences followed at our institution from 2013-2020. Systematic review and meta-analysis of the neonatal survival rate after IFL was conducted. Both diamniotic and monoamniotic monochorionic pregnancies were included. A subgroup analysis to compare outcomes according to gestational age at procedure (<16+0 weeks or ≥16+0 weeks) was planned. RESULTS: Thirteen pregnancies were followed at our center and seven were treated with IFL: the survival rate was 57%. Ten studies published between 2008 and 2020 for a total of 156 cases were included in the meta-analysis. The overall neonatal survival after IFL was 79% (95% CI 0.72-0.86, I2 22%). A random-effects model comparing neonatal survival for IFL performed <16+0 weeks versus ≥16+0 weeks showed no significant difference between the two groups (OR = 0.93; 95% CI 0.37-2.33). CONCLUSION: IFL is a safe and minimally invasive technique for the treatment of TRAP sequence, with a survival rate of 79%. Gestational age at treatment (before or after 16 weeks) does not seem to affect neonatal survival rate.
Assuntos
Transfusão Feto-Fetal , Terapia a Laser , Gravidez , Recém-Nascido , Feminino , Humanos , Lactente , Transfusão Feto-Fetal/cirurgia , Estudos Retrospectivos , Resultado da Gravidez , Idade Gestacional , Lasers , Perfusão , Gravidez de GêmeosRESUMO
BACKGROUND: In the algorithm of treatment of benign prostatic obstruction (BPO), the shift from medical therapy to surgery is steep in terms of invasiveness. Recently, a lively interest has developed on alternative micro-invasive options. Transperineal interstitial laser ablation (TPLA) was recently proposed for BPO treatment. OBJECTIVE: This work aims to illustrate feasibility, efficacy and safety profile of TPLA in BPO treatment. DESIGN, SETTING, AND PARTICIPANTS: We prospectively analyzed the results of TPLA performed between September 2018 and March 2019 for LUTS due to BPO, in men with prostate volume <100 ml. SURGICAL PROCEDURE: TPLA was performed in OR, under local anesthesia, using Soracte Lite-EchoLaserX4. Diode laser light is conveyed through 300 µm optical fibers introduced transperineally by 21 Ga needles and placed at a security distance from urethra and bladder neck. EchoLaser Smart Interface eases needle positioning and increases the safety. MEASUREMENTS: The primary endpoint was the variation of Qmax and IPSS at 1, 3 and 6 months. We also assessed the ejaculatory function and recorded complications. These outcomes were further investigated at 12 months by phone call. RESULTS AND LIMITATIONS: 21 men with prostate volume of 43.5 ± 8.5 ml underwent TPLA. All were discharged after 24 h, keeping the transurethral catheter for 8.7 ± 2.5d. At one month all patients but one discontinued medical therapy, showing significant advantage in Qmax (+3.4 ± 5.7 ml/s; p < 0.01) and IPSS (-5.6 ± 7.0; p < 0.01). Functional results were still progressing at 6 months, with Qmax (+4.7 ± 6.0 ml/s; p < 0.01) and IPSS improvement (-13.1 ± 4.7; p < 0.01). The ejaculatory function was preserved as the MSHQ-EjD increased (p < 0.05). The only complication was a prostatic abscess, treated with transperineal drainage and antibiotic. CONCLUSIONS: TPLA is a micro-invasive treatment for BPO showing good functional and safety outcomes. PATIENT SUMMARY: This work illustrates the results of TPLA to treat LUTS due to BPO, showing high efficacy, preservation of the ejaculation, and low complication rate.
Assuntos
Terapia a Laser , Sintomas do Trato Urinário Inferior , Hiperplasia Prostática , Ejaculação , Humanos , Sintomas do Trato Urinário Inferior/cirurgia , Masculino , Próstata , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Resultado do Tratamento , UretraRESUMO
Interventional MR imaging procedures are rapidly growing in number owing to the excellent soft tissue resolution of MR imaging, lack of ionizing radiation, hardware and software advancements, and technical developments in MR imaging-compatible robots, lasers, and ultrasound equipment. The safe operation of an interventional MR imaging system is a complex undertaking, which is only possible with multidisciplinary planning, training, operations and oversight. Safety for both patients and operators is essential for successful operations. Herein, we review the safety concerns, solutions and challenges associated with the operation of a modern interventional MR imaging system.
Assuntos
Cuidados Intraoperatórios/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Segurança do Paciente , Cirurgia Assistida por Computador/métodos , Humanos , Imagem por Ressonância Magnética Intervencionista/efeitos adversos , Guias de Prática Clínica como AssuntoRESUMO
Objective: In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cord coagulation with lasers are the methods proposed for selective fetal reduction. This study brings forth preliminary data of selective fetal reduction procedures at a tertiary care center in India. Material and Methods: This was a prospective observational study of 31 patients with complicated mono-chorionic twin pregnancies. Methods used were ILA, RFA and BPCC. Outcome measures included overall co-twin survival after selective feticide, survival rates with each method, miscarriage (defined as all fetal loss before 24 weeks), early fetal death (<24 hours after procedure) and late fetal death (>24 hours after the procedure) of co-twin. Results: Technical success was achieved in 30/31 (96.8%) of pregnancies. Over all take home baby rate was 63.3%. Live birth rates were 50%, 71.4% and 75% with ILA, RFA and BPCC respectively. Conclusion: Data from initial cases of selective fetal reduction in complicated mono-chorionic twins suggests that these procedures are feasible but are associated with high adverse perinatal outcome.
RESUMO
Monochorionic (MC) twin pregnancies are known to carry a high risk of twin-to-twin transfusion syndrome (TTTS) that could lead to miscarriage and perinatal death. Demise of one fetus is frequently associated with co-fetal death. Fetal reduction by interstitial laser therapy is an effective procedure to prevent this outcome, but it may be associated with significant risks for both mother and fetus. Aplasia Cutis Congenita (ACC) may occur in up to 8% cases of fetal reduction by laser therapy. We report ACC in a preterm infant, a survivor of interstitial laser therapy for fetal reduction in MC pregnancy. Despite of massive skin lesions we were able to manage this case conservatively. Follow-up at 5 years of age revealed minimal scarring and no motor function limitations.
RESUMO
BACKGROUND: Surgery for bromhidrosis has a high risk of complications such as hematoma and necrosis. New nonsurgical methods may reduce the burden on surgery and the risks for the patient. OBJECTIVE: This study was performed to evaluate the efficacy and side-effects of the 1,444 nm Nd:YAG interstitial laser for treating axillary bromhidrosis. METHODS: Eighteen bromhidrosis patients were treated with a 1,444 nm Nd:YAG laser at Korea University Ansan Hospital. The post-treatment follow-up was 6 months. After the procedure, we confirmed apocrine gland destruction through histopathological examination. At each follow-up, we measured the severity of the remaining odor, postoperative pain, degree of mobility restriction, and overall satisfaction. RESULTS: After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands. CONCLUSION: Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis.
RESUMO
BACKGROUND: Surgery for bromhidrosis has a high risk of complications such as hematoma and necrosis. New nonsurgical methods may reduce the burden on surgery and the risks for the patient. OBJECTIVE: This study was performed to evaluate the efficacy and side-effects of the 1,444 nm Nd:YAG interstitial laser for treating axillary bromhidrosis. METHODS: Eighteen bromhidrosis patients were treated with a 1,444 nm Nd:YAG laser at Korea University Ansan Hospital. The post-treatment follow-up was 6 months. After the procedure, we confirmed apocrine gland destruction through histopathological examination. At each follow-up, we measured the severity of the remaining odor, postoperative pain, degree of mobility restriction, and overall satisfaction. RESULTS: After 180 days of follow-up, malodor elimination was good in 20 axillae, fair in 12 axillae, and poor in four axillae. At the end point of the study, 14 patients were totally satisfied with the laser treatment, three patients were partially satisfied, and one patient was disatisfied. Pain and limitation of mobility were significantly reduced within 1 week post-operatively, and were almost resolved within 4 weeks post-operatively. A histopathological examination revealed decreased density and significant alterations to the apocrine glands. CONCLUSION: Subdermal coagulation treatment with a 1,444 nm Nd:YAG interstitial laser may be a less invasive and effective therapy for axillary bromhidrosis.
Assuntos
Humanos , Glândulas Apócrinas , Axila , Seguimentos , Hematoma , Coreia (Geográfico) , Lasers de Estado Sólido , Necrose , Odorantes , Dor Pós-Operatória , Estudos ProspectivosRESUMO
Background: Interstitial Laser Coagulation (ILC) Indigo 830e system is the first technique that is used in Viet Nam for the treatment of Benign Prostatic Hyperplasia (BPH) patients. Objectives: (1) To evaluate the effects of treatment of benign prostatic hyperplasia by ILC Indigo 830e system. (2) To describe peri- and post-proceduce complications. Subjects and method: The study consisted of 106 BPH patients who treated by ILC Indigo 830e system. This was a cross-section, descriptive study. Results: Overally, good and moderate outcomes was 94.8%, unsatisfactory was 5.2%. The peri- and post-proceduce complications were: urethral irritability 20.8%, prolonged catheterization 4.7%, urinary tract infections 4.7% and hematuria 0.94%. Conclusion: The treatment for benign prostatic hyperplasia patients by ILC Indigo 830e system was an effective and safe therapy, especially in elderly patient group who had multiple diseases.
Assuntos
Hiperplasia ProstáticaRESUMO
Non-vascular interventional diagnostic methods of thyroid nodules include ultrasonography-guided fine-needle aspiration cytology(USgFNAC)and ultrasonography-guided core-needle biopsy(USgCNB).USgFNAC is a practical method used to select and to guide the treatment of various thyroid nodules, however, it is difficult to make a differentiation between benign and malignant lesions simply to rely on the findings of a small number of cells.USgCNB has the advantage of being able to obtain satisfactory specimen enough for making a histological diagnosis, although this procedure is contraindicated in some patients.Non-vascular interventional treatments of thyroid nodules include percutaneous ethanol injection(PEI) and ultrasonography-guided interstitial laser photocoagulation(USgILP).Both PEI and USgILP have fine effect on the benign thyroid nodules.Compared with PEI, laser-induced necrosis can be well controlled, thus, the adverse reactions, such as the formation of fibrosis adjacent to the nodule, vocal cord paralysis, etc.can be avoided.Non-vascular interventional treatments may cause some untoward effects.For the diagnosis and treatment of thyroid nodules, the non-vascular interventional procedure is simple, safe, effective and economic with less complications, therefore, this technique is worth being popularized in clinical practice.