Laser and Radiofrequency Ablation Study (LARA study): A Randomised Study Comparing Radiofrequency Ablation and Endovenous Laser Ablation (810 nm)

ObjectivesThere have been few randomised studies comparing Radiofrequency Ablation(RFA) with other endovenous techniques. The primary aim of this study was to determine whether RFA of the great saphenous vein (GSV) was associated with less pain and bruising than endovenous laser ablation (EVLA).Materials and methodsThis trial had two cohorts – patients with bilateral GSV incompetence causing varicose veins (VV) and those with unilateral GSV VVs. In total 87 legs were treated in this study. Limbs in the bilateral group were treated with RFA in one leg and EVLA in the other. In the unilateral group limbs were randomised to RFA or EVLA. RFA was performed using the Celon RFiTT system (Teltow, Germany). EVLA was performed using an 810 nm Laser (Biolitec AG, Germany). Phlebectomies were performed as required. Primary endpoints were patient assessed pain and bruising measured by visual analogue scale (VAS). Secondary endpoints were patency assessed by duplex ultrasound at 6 weeks and 6 months.ResultsIn the bilateral group, RFA resulted in significantly less pain than EVLA on days 2–11 postoperatively. RFA also resulted in significantly less bruising than EVLA on days 3–9. There were no significant differences in mean post operative pain, bruising and activity scores in the unilateral group. Both RFA and EVLA resulted in occlusion rates of 95% at 10 days postoperatively.ConclusionsRFA was less painful for patients than EVLA and produced less bruising in the postoperative period with comparable success rates but there was no difference in the unilateral group.     

Endovenous Treatment of the Great Saphenous Vein Using a 1,320 nm Nd:YAG Laser Causes Fewer Side Effects than Using a 940 nm Diode Laser

BACKGROUND: Limited data are available about treatment-related side effects with respect to laser wavelength in endovenous laser treatment (ELT) of the great saphenous vein (GSV). OBJECTIVE: To compare the results and side effects of a 940 nm diode and a 1,320 nm neodymium:yttium-aluminum-garnet (Nd:YAG) laser. METHODS: Three patient cohorts (A, B, and C) received ELT of the GSV using a 940 nm diode laser at 15 W (group A) or 30 W (group B) or using a 1,320 nm laser at 8 W (group C). In all cases, energy was administered continuously with constant pullback of the laser fiber under perivenous tumescent local anesthesia. RESULTS: The GSVs of group A (n = 113), group B (n = 136), and group C (n = 33) received ELT. An average linear endovenous energy density of 24, 63, and 62 J/cm and an average endovenous fluence equivalent of 12, 30, and 33 J/cm2 were administered to the vein. Occlusion rates were 95% (group A), 100% (group B), and 100% (group C) at day 1 after ELT and 90.3% (group A), 100% (group B), and 97% (group C) at 3 months after ELT. With the 1,320 nm laser ELT (group C), treatment-related pain (50%) and the need for analgesics (36%) were significantly reduced (p < .005) in comparison with treatment-related pain (81%) and the need for analgesics (67%) after the 30 W 940 nm laser ELT (group B). Ecchymosis was also significantly reduced (p < .05) in group C (1,320 nm) compared with group B (30 W, 940 nm). CONCLUSION: ELT of the GSV using a 1,320 nm Nd:YAG laser causes fewer side effects compared with 940 nm diode laser ELT.     

Randomised Controlled Trial Comparing Sapheno-Femoral Ligation and Stripping of the Great Saphenous Vein with Endovenous Laser Ablation (980 nm) Using Local Tumescent Anaesthesia: One Year Results

ObjectivesComparison of sapheno-femoral ligation and stripping (SFL/S) versus endovenous laser ablation (EVLA, 980-nm) in the treatment of great saphenous vein (GSV) insufficiency, using local tumescent anaesthesia.DesignRandomised, single centre trial.Materials and methodsPatients with GSV incompetence and varicose veins were randomised to either SFL/S or EVLA. At days 1, 2, 3, 7, 10, and 14 post-treatment, patients completed questionnaires on pain and quality of life. Recurrent varicose veins were evaluated by Duplex ultrasound (DUS) performed at 1 and 6 weeks, and 6 and 12 months.Results130 legs in 121 patients were treated by SFL/S (n = 68) or EVLA (n = 62). Significantly more post-treatment pain was noted after EVLA at days 7, 10 and 14 (p < 0.01; p < 0.01; p = 0.01), more hindrance in mobility at days 7 (p < 0.01) and 10 (p = 0.01), and in self care (p = 0.03) and daily activities (p = 0.01) at day 7 compared to SFL/S. DUS at 1-year follow-up showed 9% recurrences (5/56) after EVLA and 10% (5/49) after SFL/S.ConclusionBoth SFL/S and EVLA, using local tumescent anaesthesia, were well tolerated, with no difference in short-term recurrence rate. In the second week after EVLA, patients experienced significantly more pain resulting in restricted mobility, self care and daily activity compared to SFL/S.     

A 1470-nm laser combined with foam sclerotherapy in day surgery: a better choice for lower limb varicose veins

Day surgery is being more and more adopted by clinicians. Higher wavelength lasers give patients better experience than lower wavelength lasers, which makes it more suitable for day surgery. This study compares the short- and mid-term efficacy, postoperative morbidity, and patient satisfaction of “1470-nm endovenous laser ablation (EVLA) combining foam sclerotherapy in day surgery” with “810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery” on great saphenous vein (GSV) insufficiency postoperatively. A single-institution historical cohort study of 194 patients was performed in Shanghai Ninth People’s Hospital, China. Ninety-seven patients received 1470-nm EVLA combining foam sclerotherapy in day surgery (“1470-nm group”), and 97 patients received 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery recommended by guidelines (“810-nm group”). No significant difference was found between the 1470-nm group and the 810-nm group in terms of GSV occlusion rate (both 100%), complication rate, and recurrence rate (8.2 vs. 11.3%) during the period of 1–12 months after surgery. Serious complications in the 1470-nm group and 810-nm group were 0 and 1.0%. Minor complications in the 1470-nm group and 810-nm group were ecchymosis at 20.6 and 18.6%, edema at 69.1 and 63.9%, and paresthesia around ankle at 0 and 3.1%, respectively. Advantage of the 1470-nm group over the 810-nm group was statistically significant considering the patient perioperative comfort and economic cost. Treatment of 1470-nm EVLA combining foam sclerotherapy in day surgery has similar efficacy as the 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery in GSV insufficiency and is more comfortable with less incision, hospitalization procedure, and medical costs. It may be a new option for patients who are afraid or unable to be hospitalized.     

Effect of 940 nm laser diode irradiation prior to bonding procedure on postoperative sensitivity following class II composite restorations: a split-mouth randomized clinical trial

The aim of this study was to evaluate the effect of 940 nm laser diode on class II composite cavities prior to bonding and restoration process on the postoperative sensitivity (POS). Thirty patients with two bilateral premolars with mesio or disto-occlusal carious lesions were evaluated. In each patient, the teeth were randomly divided into the control and laser groups. After cavity preparation and isolation and before the bonding process, the laser group was subjected to 940 nm irradiation (Epic 10, Biolase, USA) by 400 μ tip continuously at 100 mW with 398 J/cm² energy density of tip, which was applied for 5 s at a distance of 2 mm on the axial wall of the cavity. In the control group, irradiation was performed by using the aiming beam. Access cavity was then restored with a composite resin. Cold sensitivity was measured using a cold spray application on the middle third of teeth buccal surface at baseline (before the intervention), 1, 14, and 30 days after the restoration by visual analog scale (VAS) criteria. The mean Friedman and Wilcoxon signed-rank tests were used for data analysis. It was shown that in both laser and control groups, the VAS was significantly decreased at all times compared to the baseline (p ≤ 0.05). There was no statistically significant difference between the mean VAS of two groups at baseline and first day (p ≤ 0.05), but at 14 and 30 days after the intervention, it was significantly lower in the laser group (p ≤ 0.05). The results of this study demonstrated that the cavity pretreatment with laser diode (940 nm) effectively reduces the postoperative sensitivity in class II composite restorations.

     

Midterm varicose vein recurrence rates after endovenous laser ablation: comparison of radial fibre and bare fibre tips

Open in a separate window OBJECTIVESWe evaluated and compared midterm recurrence results of our patients with great saphenous vein insufficiency who were treated with a 1470-nm diode laser using 2 different types of fibre catheter kits.METHODSA total of 61 consecutive patients were treated between 2013 and 2014 with a bare fibre (BF) tip (BF group) and 60 consecutive patients were treated with a radial fibre (RF) tip (RF group) from 2014 to 2016. First-year venous clinical severity scores (VCSSs) were compared with VCSS before endovenous laser ablation and at the first-month follow-up. Patients were examined for recurrence and classified according to the system developed by Stonebridge.RESULTSThere was no significant difference between the 2 groups in terms of VCSS. Examination with Doppler ultrasonography showed no recurrence in the RF group, whereas recurrences were detected in 6 patients in the BF group, which was statistically significant (P = 0.028). All of the recurrences were type 1b (incompetent tributaries) varicose vein recurrences. The VCSS of the patients with recurrence were the same as the scores of patients without recurrence (0.5 ± 0.55).CONCLUSIONSVaricose vein recurrence was more often seen in the BF group than in the RF group. Recanalization-induced and neovascularization-induced recurrences were not found in either group. Saphenofemoral side branch-induced recurrence was more significant in the group treated with the BF tip.     

No significant difference between 1940 and 1470 nm in endovenous laser ablation using an in vitro porcine liver model

Lasers in Medical Science - Current endovenous laser ablation (EVLA) practice favours 1470&nbsp;nm, as water is a major chromophore for this wavelength. Water has a greater affinity for...     

Great Saphenous Vein Diameter at the Saphenofemoral Junction and Proximal Thigh as Parameters of Venous Disease Class

BackgroundGreat saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standardised pre-interventional assessment is required to analyse the relative merit of treatment modalities. We weighed GSV diameter measurement at the sapheno-femoral junction (SFJ) against measurement at the proximal thigh 15 cm distal to the groin (PT), established a conversion factor and applied it to selected literature data.MethodsLegs with untreated isolated GSV reflux and varices limited to its territory and control legs were studied clinically, with duplex ultrasound and photoplethysmography. GSV diameters were measured at both the SFJ and the PT. A conversion factor was calculated and used to compare published data.ResultsOf 182 legs, 60 had no GSV reflux (controls; group I), 51 had above-knee GSV reflux only (group II) and 71 had GSV reflux above and below knee (group III). GSV diameters in group I measured 7.5 mm (±1.8) at the SFJ and 3.7 mm (±0.9) at the PT. In groups II and III, they measured 10.9 mm (±3.9) at the SFJ and 6.3 mm (±1.9) at the PT (p < 0.001 each). Measurement at the PT revealed higher sensitivity and specificity to predict reflux and clinical class. Good correlation between sites of measurement (r = 0.77) allowed a conversion factor (SFJ = 1.767 * PT, PT = 0.566*SFJ) to be applied to pre-interventional data of published studies.ConclusionsGSV diameter correlates with clinical class, measurement at the PT being more sensitive and more specific than measurement at the SFJ. Applying the conversion factor to published data suggests that some studies included patients with minor disease.     

Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital: The First 400 Procedures

Endovenous laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our learning curve.MethodsThree hundred and twenty-three patients (403 limbs) with incompetence of the GSV underwent ELA. Patients were assessed by clinical examination and venous duplex ultrasound was performed 6 weeks after operation. Visual analog scale (VAS) pain scores of the first postoperative week were recorded. Operative time and success rate were analysed.ResultsAfter 6 weeks, 301 (74.7%) treated legs were examined by duplex ultrasound imaging. Successful complete occlusion was present in 282 (93.7%) GSVs. Partial occlusion was present in 12 (4.0%) GSVs. In seven (2.3%) limbs the GSV was not occluded. The maximum mean VAS pain score was noted on the 5th postoperative day. From the start of this series, the operation time decreased rapidly for each surgeon, stabilising after 15 limbs.ConclusionELA of the incompetent GSV is effective and safe. ELA is simple to perform, well accepted by patients and relatively atraumatic. In our opinion, ELA can be easily implemented in surgical practice.     

Interstitial laser photocoagulation: Evaluation of a 1320 nm Nd-YAG and an 805 nm diode laser: the significance of charring and the value of precharring the fibre tip

Interstitial laser photocoagulation (ILP) is a new percutaneous technique of thermal destruction (necrosis) of deep-seated tumours, using low power laser energy. Our purpose was to investigate: (i) the effects of different laser wavelengths on the extent of thermal damage produced; and (ii) the role of charring around the fibre tip during ILP. Forty-five normal Wistar rats (250–300 g) had ILP to their liver (exposed at laparotomy) by inserting a 400 μm optical fibre into the liver, and activating the laser at 1, 2 or 3W. This was performed at three laser wavelengths (1064 nm Nd-YAG, 1320 nm Nd-YAG, 805 nm diode) using a clean plane-cleaved fibre, and at two wavelengths (1064 nm and 1320 nm Nd-YAG) using a fibre with pre-charring at its tip. The 805 nm and 1320 nm laser wavelengths produced significantly greater necrosis than the 1064 nm, using a clean fibre tip (mean diameters at 2 W were 21.7 mm, 18.3 mm, 8 mm respectively). Pre-charring the fibre significantly increased the necrotic lesion size at 1064 nm (mean diameter at 2 W was 14.7 mm). Using more strongly absorbed wavelengths (805 nm and 1320 nm) and pre-charring the fibre tip give greater thermal damage during ILP, contrary to previously held views that the optimal wavelength for ILP was 1064 nm in the absence of charring.     

The Effect of Isolated Phlebectomy on Reflux and Diameter of the Great Saphenous Vein: A Prospective Study

ObjectivesTo evaluate the effect of phlebectomy on venous reflux and diameter of the great saphenous vein (GSV).DesignProspective cohort study.MethodPatients presenting with reflux in the GSV resulting in varicose veins were included in this series. Patients were treated by phlebectomy for dilated and incompetent tributaries of the GSV with conservation of the incompetent GSV. We measured reflux duration (RD), peak reflux velocity (PRV) and the diameter of the GSV using duplex ultrasound imaging at inclusion and 1 month after surgery.PatientsWe included 55 limbs in 54 patients (30 women and 24 men) aged from 37 to 83 (mean age 63) years.ResultsFollowing treatment we observed a significant reduction of the mean RD (0.81s vs. 1.5 s p < 0.01, t-test), mean PRV (120 mm s^?1 vs. 249 mm s^?1 p < 0.01, t-test) and mean diameter of the GSV (SFJ = 5.6 mm vs. 6.7 mm, p < 0.01, sub-terminal valve 4.8 mm vs. 4.4 mm p < 0.05, mid-thigh 5.0 mm vs. 4.2 mm, p < 0.01, knee 4.0 mm vs. 5.3 mm p < 0.01, mid-calf 2.7 mm vs. 4.0 mm, p < 0.01, t-test).ConclusionsWe noted reduced reflux in the GSV after phlebectomy with a significant reduction in RD and PRV. Phlebectomy also led to a significant reduction in GSV diameter. These data suggest that the haemodynamics and the diameter of the SV can be improved by using a treatment focussing on the saphenous tributaries.     

Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results

BACKGROUND: Endovenous laser (EVL) ablation of the great saphenous vein (GSV) is thought to minimize postoperative morbidity and reduce work loss compared with high ligation and stripping (HL/S). However, the procedures have not previously been compared in a randomized trial with parallel groups where both treatments were performed in tumescent anesthesia on an out-patient basis. METHODS: Patients with varicose veins due to GSV insufficiency were randomized to either EVL (980 nm) or HL/S in tumescent anesthesia. Miniphlebectomies were also performed. Patients were examined preoperatively and at 12 days, and 1, 3, and 6 months postoperatively. Sick leave, time to normal physical activity, pain score, use of analgesics, Aberdeen score, Medical Outcomes Study Short Form-36 quality-of-life score, Venous Clinical Severity Score (VCSS), and complication rates were investigated. The total cost of the procedures, including lost wages and equipment, was calculated. Cost calculations were based on the standard fee for HL/S with the addition of laser equipment and the standard salary and productivity level in Denmark. RESULTS: A follow-up of 6 months was achieved in 121 patients (137 legs). The groups were well matched for patient and GSV characteristics. Two HL/S procedures failed, and three GSVs recanalized in the EVL group. The groups experienced similar improvement in quality-of-life scores and VCSS score at 3 months. Only one patient in the HL/S group had a major complication, a wound infection that was treated successfully with antibiotics. The HL/S and EVL groups did not differ in mean time to resume normal physical activity (7.7 vs 6.9 calendar days) and work (7.6 vs 7.0 calendar days). Postoperative pain and bruising was higher in the HL/S group, but no difference in the use of analgesics was recorded. The total cost of the procedures, including lost wages, was euro 3084 ($3948 US) in the HL/S and euro 3396 ($4347 US) in the EVL group. CONCLUSIONS: This study suggests that the short-term efficacy and safety of EVL and HL/S are similar. Except for slightly increased postoperative pain and bruising in the HL/S group, no differences were found between the two treatment modalities. The treatments were equally safe and efficient in eliminating GSV reflux, alleviating symptoms and signs of GSV varicosities, and improving quality of life. Long-term outcomes, particularly with respect to recurrence rates, shall be investigated in future studies, including the continuation of the present.     

Treatment of Inflammatory Facial Acne with the 1,450 nm Diode Laser Alone versus Microdermabrasion Plus the 1,450 nm Laser: A Randomized, Split-Face Trial

BACKGROUND: The 1,450 nm laser has been effective in treating acne. Microdermabrasion may help treat acne and reduce skin barriers to increase the delivery rate of topical anesthetics. OBJECTIVES: To evaluate the efficacy, safety, and pain associated with the treatment of inflammatory facial acne with the 1,450 nm laser alone versus microdermabrasion plus the 1,450 nm laser. METHODS: Twenty patients with facial acne were treated with the 1,450 nm laser alone and microdermabrasion plus the 1,450 nm laser in a randomized, split-face trial. RESULTS: Laser alone and microdermabrasion plus laser significantly reduced the total number of acne lesions. Mean reductions of 53.5% and 55.6% were found after three treatments for laser alone and microdermabrasion plus laser, respectively. Clinical improvement was maintained 12 weeks after the last treatment. Mean pain scores were 5.3 6 1.5 for microdermabrasion plus laser and 5.2 6 1.5 for laser alone. There was no statistical difference between treatment levels for efficacy or pain. There was an average 10% increase in sequential pain as the laser treatment progressed. CONCLUSION: The 1,450 nm laser is effective, well tolerated, and safe for treating facial acne. This small pilot study did not demonstrate increased clinical efficacy or decreased associated pain with the addition of microdermabrasion to treatment with the 1,450 nm laser. A larger study may be needed to demonstrate any additional benefit.     

经尿道前列腺电切术与1470 nm半导体激光汽化术治疗前列腺增生的疗效比较

【摘要】 目的 对经尿道前列腺电切术和1470 nm半导体激光汽化术治疗前列腺增生的临床疗效的比较。方法〓收集2014~2015年采用不同方法治疗前列腺增生患者的临床资料,选择1470 nm半导体激光汽化术治疗和TURP治疗的BPH患者各50例,分治疗组和对照组,2组术前临床参数比较无统计学意义(P>0.05)。对两组手术情况、随访情况及并发症发生率进行比较。结果〓采用1470 nm半导体激光汽化术治疗组显示良好临床效果,两组在手术时间、术中出血量、术后留置导尿管时间和术后住院时间的差异均有统计学学意义(P<0.05)。术后3个月随访,2组IPSS、Qmax、RUV与术前相比及组间术后相比差异均有显著性意义(P<0.05);治疗组与对照组并发症发生率分别为6%和26%,差异有统计学意义(P<0.05)。结论〓TUPR和1470 nm半导体激光汽化术均能有效的治疗前列腺增生,但1470 nm半导体激光汽化术术中出血量少,导尿管留置时间短,并发症少,安全性高,效果更好。     

High-Energy 595 nm Pulsed Dye Laser Improves Refractory Port-Wine Stains

BACKGROUND: Port-wine stains respond quite well to 585 nm pulsed dye laser treatment, but often clearance is not complete. We investigated a prototype, a high-energy 595 nm pulsed dye laser capable of delivering up to 9.5 J/cm2 using a 10 mm circular spot, with a 1.5 ms pulse duration. OBJECTIVE: This study was undertaken to determine if the high-energy, 595 nm, variable-pulse duration pulsed dye laser could improve port-wine stains that had become refractory to conventional treatment. METHODS: Twenty patients were entered into the study and treated with the high-energy, 595 nm, variable-pulse duration pulsed dye laser using fluences ranging from 7.5 to 9.5 J/cm2, a 1.5 ms pulse duration, and a 10 mm spot size. RESULTS: Average improvement was rated as 40% prior to the initiation of the study after an average of 8.8 treatments at an average energy of 7.9 J/cm2 with the 585 nm pulsed dye laser and 76% following an average of 3.1 treatments with the high-energy 595 nm pulsed dye laser using an average fluence of 7.9 J/cm2. Dermal spectrometer erythema measurements improved from 2.2-fold that of normal skin to 1.5-fold that of unaffected skin. CONCLUSIONS: The high-energy 595 nm pulsed dye laser improves port-wine stains that have become refractory to the conventional 585 nm pulsed dye laser.     

Prospective randomised comparative study of visual foam sclerotherapy alone or in combination with ultrasound-guided foam sclerotherapy for treatment of superficial venous insufficiency: preliminary report

ObjectiveThe aim of the study is to compare ultrasound-guided foam sclerotherapy (UGFS: injection of foam sclerosant under ultrasound guidance) of the great saphenous vein (GSV) combined with visual foam sclerotherapy (VFS: injection of foam sclerosant under visual control) for varicose tributary veins and VFS alone in the treatment of GSV reflux.Design and methodsA total of 133 limbs in 97 patients with GSV reflux were randomised to receive either VFS alone or VFS combined with UGFS. In both groups, 1% polidocanol foam was used. Assessments included duplex ultrasonography, evaluation of Venous Clinical Severity Scores (VCSS) and CEAP (clinical, etiologic, anatomic, and pathophysiologic) scores. Ultrasonographic inspection of the foam in the GSV was carried out during 5 min before compression was applied. The primary ‘end’ point of the study was obliteration of the GSV at 6 months.ResultsA total of 51 limbs in 48 patients were treated with UGFS + VFS and the remaining 52 limbs in 49 patients were treated with VFS alone. There were no significant inter-group differences in patient age, male: female ratio, height, weight, body mass index, CEAP clinical scores or VCSS. The GSV diameter was 6.0 ± 1.7 mm (median ± interquartile range) in the UGFS + VFS group and 5.7 ± 1.6 mm in the VFS group (p = 0.419). The mean injected volume of foam for varicose tributary veins was 4 ± 2 ml in the UGFS + VFS group and 6 ± 2 ml in the VFS group, a significantly higher amount of foam being used in the latter (p < 0.001). However, the mean total amount of foam was greater in limbs treated with UFGS + VFS than in those treated with VFS alone (p = 0.017). Ultrasonographic inspection revealed complete vasospasm of the GSV in 37 (72.5%) limbs in the UGFS + VFS group and 29 (55.8%) in the VFS group during sclerotherapy (p = 0.097). At 6-month follow-up, complete occlusion was found in 23 limbs (45.1%) treated with UGFS + VFS and in 22 limbs (42.3%) treated with VFS. The difference between the two groups was not significant (p = 0.775). Reflux was absent in 30 limbs (58.8%) treated with UGFS + VFS and in 37 (71.2%) treated with VFS (p = 0.190). There was no inter-group difference in post-treatment VCSS (p = 0.223).ConclusionsThese results show that UGFS + VFS and VFS are equally effective for the treatment of GSV reflux, despite the lower volume of foam used for VFS alone.     

Comparison of short-pulsed and long-pulsed 532 nm lasers in the removal of freckles

The purpose of this study was to compare the efficacy and safety of the 532 nm long-pulsed laser (10 ms) with that of the 532 nm short-pulsed laser (10 ns) for freckle removal. Currently, the gold standard for treatment is the short-pulsed laser. Recently, several long-pulsed lasers have been introduced for both hair removal and the treatment of freckles. To our investigative team’s knowledge, no controlled experiments have been performed to compare the safety and efficacy of long-pulsed versus short-pulsed lasers for the treatment of freckles. This was a 4-week trial, and all patients had three freckles that were randomly allocated to be treated with short-pulse laser, long-pulse laser, or to receive no treatment (control). All patients had three freckles that were randomly selected to be treated with short-pulse 532 nm Medlite IV laser (10 n, 1 J/cm²), or long-pulse 532 nm Aura laser (10 ms, 1 J/cm²) or to remain as a control (no treatment). The laser treatment was only performed once, followed by a 1-day and a 1-month follow-up visit. Freckle size was determined by a novel surface area measurement technique that was created by our research staff. The study included 17 sets of freckles (three in each set). All of the lesions which received the short-pulsed laser treatment had immediate whitening of the lesions, which turned into dry scabs the next day. None of the freckles treated in the long-pulsed group or control group developed immediate whitening or scabs. No blisters or ulcers developed. The average pain score in the short-pulsed laser group was 2–3 out of 10, while it was 0 out of 10 in the long-pulsed laser group. All scabs that developed in the short-pulsed laser group fell off between days 6 and 12 (average 8 days). The outcome of this study verified the appropriate treatment of freckles. The study confirmed that when the same energy settings, short-pulsed laser is the more effective laser treatment regimen (when compared with the long-pulsed laser), with high tolerability and minimal side effects for patients with skin types I to IV.     

Clinical application of helium neon (632 nm) plus infrared diode laser GaAIAs (830 nm) and CO2laser in treatment of onychomycotic nails

Onychomycosis (fungal infection of the toe nail) is difficult to cure. The aim of this study was to evaluate the method of surgical avulsion using a CO₂laser (7W, 0.1 mm) and using a new protocol of low level laser therapy Helium Neon (632 nm, 1.5 mW, 2 J cm^–2) plus infrared diode laser GaAIAs (830 nm, 50 mW, 4 J cm^–2) every other day to improve the recurrence rate, pain score and healing time. Seventy-eight patients were divided into three groups (A, B and C). The ANOVA statistical tests showed that there was a significant difference between the group A, B and B, C (P<0.005) in the measured mean healing time and pain score but no statistical difference between the group A and C (P<0.01). It was concluded that low level laser therapy reduced pain, improved the healing time and had a lower recurrence rate.     

755nm翠绿宝石激光联合800nm半导体激光治疗腰骶部多毛疗效分析

目的:回顾性分析755nm翠绿宝石激光联合800nm半导体激光治疗腰骶部多毛的临床疗效和安全性。方法:收集笔者医院2017年1月1日-2018年6月30日收治的100例腰骶部多毛患者病例资料,其中50例患者为单纯755nm翠绿宝石激光治疗;50例患者为755nm翠绿宝石激光联合800nm半导体激光治疗。分析两组患者的治疗效果、不良反应发生情况及对治疗效果的满意度。结果:相较于单纯755nm激光治疗,755nm翠绿宝石激光联合800nm半导体激光脱毛的有效率和治愈率显著高于755nm治疗组,两组比较有统计学意义(P<0.05);组间的VAS(视觉模拟评分法)疼痛评分比较,差异无统计学意义(P>0.05),但联合治疗组发生疼痛的次数显著低于单一治疗组(P<0.05);单纯治疗组出现2例色素沉着斑,联合治疗组无色素沉着斑出现,两组比较差异无统计学意义(P>0.05),两组均未出现色素减退斑及瘢痕;联合治疗组患者的总满意率显著高于单一治疗组(P<0.05)。结论:755nm翠绿宝石激光联合800nm半导体激光治疗腰骶部多毛临床疗效明显,安全性良好,疼痛感轻,值得广泛应用。     

Treatment of Surgical Scars with the Cryogen-Cooled 595 nm Pulsed Dye Laser Starting on the Day of Suture Removal

BACKGROUND: Cosmetic results after skin surgery are a key component of patient satisfaction and self-image. Various lasers have been used to attempt scar improvement, without consistent results. The optimal time to initiate laser treatment has not been determined. A recent study using a noncooled 585 nm pulsed dye laser starting on the day of suture removal demonstrated substantial improvement in scar appearance. OBJECTIVE: To determine the efficacy of the 595 nm cryogen-cooled pulsed dye laser in the treatment of surgical scars starting on the day of suture removal. METHODS: Sixteen patients with postoperative linear scars of greater than 2 cm were treated three times at 4- to 8-week intervals with a 595 nm cryogen-cooled pulsed dye laser. All patients had Fitzpatrick skin types I to IV. Each scar was divided at the midline into two fields, with half receiving treatment using a 7 mm spot size at 1.5 ms with 8 J/cm2 and a 30 ms spray duration with a 10 ms delay. The other half was not treated. Scars were evaluated for pigmentation, vascularity, pliability, and height by a blinded examiner using the Vancouver Scar Scale (VSS). In addition, the same blinded examiner evaluated the cosmetic appearance using a scale from 0 (worst) to 10 (best) prior to the second treatment and 1 month after the final treatment. RESULT: SThe average sum of all parameters in the VSS showed significant improvement from 1-month post-treatment to the final evaluation of 60% compared with the control of -3%. Also, scars in the treated portions scored an average of 2 points higher in the overall cosmetic appearance by the same blinded examiner based on a scale of 0 (worst) to 10 (best). Among the individual parameters in the VSS, the most significant improvements were found in vascularity and pliability. CONCLUSION: The cryogen-cooled 595 nm pulsed dye laser is a safe and effective option to improve the cosmetic appearance of surgical scars in skin types I to IV starting on the day of suture removal.