Clinical evaluation of enhanced nonablative skin rejuvenation using a combination of a 532 and a 1,064 nm laser

BACKGROUND AND OBJECTIVES: Improvements in the physical signs of photoaging can be achieved by non-invasive laser resurfacing procedures. To evaluate the effectiveness and safety of the Nd:YAG 1,064 nm and KTP 532 nm lasers for non-invasive skin rejuvenation. STUDY DESIGN/PATIENTS AND METHODS: Subjects requesting non-invasive skin rejuvenation underwent two treatments with the 532 nm laser to one side of the face and with both lasers to the other side, followed by three treatments with the 1,064 nm laser to both sides. Skin characteristics were evaluated before, during, and up to 4 months after treatment. RESULTS: A >25% improvement in overall skin condition was observed for >30% of subjects at the 1 month follow-up and >40% of subjects at the 4 month follow-up. The greatest improvements were observed for visual dryness, roughness, and uneven pigmentation. No adverse events were reported. There was a trend for greater improvement in patients who received more 1,064 nm treatments but this was not statistically significant. CONCLUSIONS: The 532 nm KTP and 1,064 nm Nd: YAG lasers can be effectively and safely used for non-invasive skin rejuvenation.     

Clinical evaluation of low-power laser and a desensitizing agent on dentin hypersensitivity

Lasers in Medical Science - The aim of this randomized, longitudinal clinical study was to evaluate different protocols for dentin hypersensitivity treatment with low-power laser at different...     

两种自酸蚀粘结剂修复牙颈部非龋性缺损临床观察

目的：研究自酸蚀粘结剂3MAdper Prompt和Clearfil SE Bond临床应用于牙颈部非龋性缺损修复的疗效比较。方法：选择31名患者（102颗牙）,采用随机自身同名牙配对方法分为两组,一组使用3MAdperPrompt粘结剂,另一组使用Clearfi lSE Bond粘结剂,分别于修复即刻（基线）、修复后6个月、1年、2年以改良的美国公共健康部（United States Public Health Service,USPHS）制定的评定系统标准记录修复效果。结果：采用配对χ2检验,比较两种粘结剂在修复效果上无显著差异（P〉0.05）。结论：通过两年临床观察,两种自酸蚀粘结剂修复牙颈部非龋性缺损具有较好的应用效果。     

Carbon dioxide laser surgery for cervical intraepithelial neoplasia

During 1977–1983, 787 consecutive referred cases of CIN were treated by vaporization of a dome-shaped defect, by excision of a cylindrical specimen, or a combination of procedures where 48% were CIN III. Vaporization was used for 72% of CIN I, 76% of CIN II, and 64% of CIN III cases. Less than 15% of vaporization and all excision cases were done in hospital under anesthesia; 11% had delayed bleeding requiring attention (admission was required in 2%); 100% of CIN I, 96% of CIN II, and 96% of CIN III cases were cured. Persistent disease was diagnosed at the first (96%) or second (4%) visit. Subsequent treatment included laser and less than 1% hysterectomy. Overall cure for laser surgery was 99·5%. Sixty-eight patients subsequently became pregnant; outcomes were normally distributed. Treatment success in related to adequate volume of tissue removed.     

Effects of ArF: Excimer laser irradiation on human enamel and dentin

Round enamel and dentin surfaces of sound and carious extracted human teeth were irradiated by an ArF:excimer laser for up to 180 sec. Thermographic measurements indicated that the temperature rise due to heat accumulation caused by laser irradiation on these enamel and dentin surfaces was up to 19°C (10 HZ with 540 J/cm²), and the temperature returned to the preirradiation value within 10 sec after the irradiation was stopped. Under light microscopy, no carbonization was evident on these surfaces, and a simple recess was formed by abrasion or vaporization in the irradiated regions. In the secondary SEM, uniformly distributed fine pores and prism structures appeared slightly on the enamel surfaces. Between the peritubular and the intertubular dentin, there appeared a distinct difference in the dissolved area. The laser almost completely removed carious regions of the enamel and the dentin, and penetration extended beyond the carious regions. In the backscattered electron SEM, highly mineralized layers were observed on the enamel and dentin surfaces dissolved by the laser. © 1993 Wiley-Liss, Inc.     

The management of cervical intraepithelial neoplasia: the use of the carbon dioxide laser

This report concerns the experience of an abnormal Pap smear clinic in treating cervical intraepithelial neoplasia (CIN). The CO2 laser was the primary treatment method in 283 consecutive cases during 1977-1981, which fulfilled the criteria for conservative management. Seven percent of cases were performed in hospital as out-patients; the remainder were performed in the clinic without anesthesia. The location and shape of the defect was individualized in each case to conform to the topography of the cervix. The basic configuration, however, was the same for all cases; a dome-shaped defect with a curved apex and straight sides of at least 6 mm in height. Laser surgery was well tolerated; few post-operative complications arose. The squamocolumnar junction reappeared in each case at the level of the external os, facilitating follow-up. Eleven cases (3.9%) exhibited persistent disease within 3 months of primary treatment. Thereafter no primary laser failures occurred. Follow-up in this series ranged from 18 to 36 months. Failure rates for CIN grades are as follows: CIN I, 1.3%; CIN II, 2.0%; CIN III, 7.3%. No case of persistent disease was of greater severity than was originally diagnosed. Ten of the 11 cases were successfully managed with repeat laser surgery, yielding an overall therapeutic success rate of 99.6%. These data indicate that laser surgery is the most efficacious conservative method for eradicating this disease.     

Repetitive Er:YAG laser irradiation of human skin: a histological evaluation

BACKGROUND AND OBJECTIVE: Deep coagulation of skin collagen by Er:YAG laser repetitive pulses has been predicted by previous theoretical models and later demonstrated on animal skin. The goal of this study was to determine the effect of repetitive Er:YAG laser pulses on human skin and its response to this treatment. STUDY DESIGN/MATERIALS AND METHODS: Lid skin of six female volunteers with blepharochalasis has been treated with laser at day 0, 7, and 21 before elective surgery-blepharoplasty. The treated skin was excised as part of the procedure and prepared for further histological examination. We used a 2,940 nm Er:YAG laser (Fidelis M320A by Fotona) with 'smooth' mode parameters: fluence from 0.50 to 2.00 J/cm2; six pulses per packet; 550 microsecond/pulse, 250 millisecond/packet; single pass, no overlapping; spot size 5 mm; repetition rate 20 Hz. RESULTS: We observed deep collagen denaturation at laser fluences of 1.25 J/cm2 and over; epidermal damage was proportional to fluence with total coagulation of the epidermal layer at fluences of 1.75 J/cm2 and over. At day 7 after laser treatment we observed a complete regeneration of the epidermal layer and a regeneration zone within the dermis with prominent infiltration of CD68+ monocytes/macrophages. At day 21 after laser treatment we observed collagen remodeling and (myo-)fibroblast proliferation at tissue depths of up to 240 microm. CONCLUSIONS: Repetitive Er:YAG laser irradiation is effective in deep denaturation and remodeling of human skin collagen in vivo, with less epidermal damage compared to standard Er:YAG laser skin resurfacing.     

A novel method for removing the collagen network from acid-etched dentin by neodymium:yttrium-aluminum-garnet laser

This study proposes a new application for the neodymium:yttrium-aluminum-garnet (Nd:YAG) laser in conservative dentistry, which is represented by the removal of collagen network from acid-etched dentin. Thirty extracted human upper premolars were selected to be given standardized buccal and lingual class V cavities. The teeth were randomly divided into three groups, each consisting of ten teeth: group 1, acid etch/Nd:YAG laser; group 2, acid etch/10% sodium hypochlorite (NaOCl); group 3, acid etch only. Five teeth from each group were prepared for the Masson trichrome technique, and the other five teeth were prepared for examination by scanning electron microscope. The results showed that the Nd:YAG laser can be used successfully as a novel method for removing collagen network from acid-etched dentin and can remove the collagen network more thoroughly than 10% NaOCl.     

Management of 633 cervical intraepithelial neoplasias by CO2 laser: persistent diseases and recurrences

During the past 6 years, we have managed 633 cervical intraepithelial neoplasias with the CO2 laser. If the lesion is located on the ectocervix, the CO2 laser is used to vaporize it under the microscope. If the lesion is located in the endocervical canal, the CO2 laser is used to excise a cylinder-shaped tissue with a handpiece. Colposcopic examination is performed 21 days after treatment. Persistent disease is recognized at this examination; healing is obtained spontaneously in 66% of those with persistent disease without second treatment. There were eight with recurrent disease with abnormal Pap tests and abnormal colposcopic findings, and 12 with recurrent disease with abnormal Pap tests and normal colposcopic findings (recurrent koilocytis cells). After laser treatment cervical function was good and pregnancies were normal.     

New device for visual neodymium:YAG laser prostate ablation: Acute and chronic canine evaluation

This canine study (n = 6) evaluated the acute and chronic effects of Nd:YAG laser prostatectomy using a Prolase II fiber. The Prolase II device consists of a 1,000 μm quartz fiber which directs a cone of Nd:YAG laser energy, at 45° to the axis of the fiber, into the prostatic urethra under direct visual guidance [visual laser ablation of prostate, (VLAP)]. Under visual guidance and saline irrigation, 60 seconds of 60 watts of laser power was delivered at 3, 6, 9, and 12 o'clock positions (14,400 J). One canine was instrumented but received no laser energy (control). One prostate was harvested acutely. The remaining four laser-treated dogs were evaluated at 6 to 16 weeks. The histopathology of acute laser effects shows areas of necrosis with loss of glandular structures and stromal edema. Surrounding this area was a zone of degenerative glandular structures extending up to 12.6 mm into the prostate. Two of the four dogs developed urinary retention at 6.5 and 9 weeks. On examination, both were found to have fibrotic strictures at the distal prostatic urethra with markedly dilated proximal prostatic urethral lumens (1.98 and 2.8 cm). Two other dogs showed no signs of urinary retention at sacrifice. Histopathology, both the 6 and 16 week laser-treated animals without urinary retention demonstrated dilated prostatic urethras with maximum cross-sectional diameters of 1.52 and 1.50 cm, respectively. However, the 16 week dog demonstrated mild distal urethral narrowing by urethrogram. The control dog demonstrated normal histology of the prostate at 16 weeks. This study demonstrates the safety and initial results of a delivery device for trans-urethral laser prostate ablation in a canine model. Further studies are needed to evaluate the cause of the fibrotic urethral strictures in this model and determine its clinical relevance. © 1994 Wiley-Liss, Inc.     

经皮激光椎间盘减压术联合HANS疗法治疗颈椎间盘突出症

目的探讨经皮激光椎间盘减压术（percutaneous laser disc decompression,PLDD）联合经皮电刺激（HANS）治疗颈椎间盘突出症的临床早期疗效。方法选68例符合PLDD治疗适应证的颈椎间盘突出症患者,随机分为两组,分别采用PLDD联合HANS（A组）和单纯PLDD（B组）,在治疗前和治疗后1个月、6个月进行疗效评定。结果 （1）A组与B组术后1个月、6个月的优良率分别为77%和56%（P〈0.05）,86%和62%（P〈0.05）。结论 PLDD围手术期须重视颈椎旁软组织及神经功能障碍的治疗。PLDD术联合HANS疗法可明显提高治疗颈椎间盘突出症的早期疗效。     

Three-year follow-up of oral leukoplakia after neodymium:yttrium aluminum garnet (Nd:YAG) laser surgery

Oral leukoplakia is a relatively common lesion with a significant proportion of cases changing into cancer. Since most leukoplakias are asymptomatic, the primary objective of treatment must aim at the prevention of such malignant transformation. The main objectives of the study are to observe (1) the efficacy, safety and acceptability of the neodymium:yttrium aluminum garnet (Nd:YAG) laser in the management of oral leukoplakia; (2) the nature of postoperative complications, if any, associated with laser ablation, and (3) the 3-year prognosis of oral leukoplakia treated with laser. Twenty-eight patients with histologically proven leukoplakia were treated with Nd:YAG laser. From this study, we observed that the patients treated with Nd:YAG laser had only mild to moderate pain, swelling and restricted mouth opening, which peaked between 72 h and 1 week. In a majority of the patients the healing was prolonged, to a maximum of 5 weeks, and there was no clinical evidence of scarring in 26 out of 28 cases. In this study we achieved a cure rate of 92.86% in a 6-month period. Further follow-up after 3 years yielded almost the same result, except that one patient was not available for follow-up. We concluded that Nd:YAG laser is an effective device in the management of oral leukoplakia, which is one of the major pre-cancerous lesions in our country.     

Treatment of vitiligo by 308-nm excimer laser: an evaluation of variables affecting treatment response

BACKGROUND AND OBJECTIVES: To determine the true efficacy of the 308-nm excimer laser for the treatment of vitiligo, while taking into account confounding factors such as anatomic site of treatment, age, sex, skin type, MED, and duration of evolution of the vitiligo. STUDY DESIGN/MATERIALS AND METHODS: Thirty-five patients with vitiligo were included. Each lesion was treated twice a week by the 308-nm excimer laser for a maximum of 24 sessions. Efficacy was blindly evaluated by two independent physicians. RESULTS: Repigmentation was noted in 46 plaques/52 (88.5%). Repigmentation rate (75%) was obtained in 14 (26.9%). In "UV sensitive" areas (face, neck, trunk), 8/14 lesions (57.1%) had a repigmentation rate, 75% versus 6/38 (15.8%) in "UV resistant" areas (bony prominences and extremities) (P = 0.031). No relationship could be established between response to the treatment and the following variables: age, sex, skin type, MED, and duration of evolution of the vitiligo (respectively, P = 1, 0.666, 0.566, 0.628, 0.521). CONCLUSIONS: An aesthetically reasonable result is achieved essentially in "UV sensitive" areas, thus appearing to be the appropriate places of choice for this treatment.     

经皮激光椎间盘减压术治疗颈性眩晕

目的探讨经皮激光椎间盘减压术（PLDD）治疗颈性眩晕的机制和适应证。方法对58例颈性眩晕患者88个突出间盘行PLDD。结果随访6个月-2年,术后眩晕立即消除48例（82.8%）,明显改善5例（8.6%）,无效5例（8.6%）,无神经损害、感染等并发症发生。结论PLDD使椎间盘内压骤然降低,局部直接热疗可消除椎动脉痉挛,同时减少椎间盘内的炎性因子和化学介质的含量,对治疗颈性眩晕有明显疗效。     

上颈椎原发肿瘤的治疗———附21例报告

目的:探讨上颈椎原发肿瘤的合理治疗方法.方法:2001年1月至2006年11月共收治上颈椎原发肿瘤患者21例,男12例,女9例,年龄12～64岁,平均37.2岁.其中脊索瘤12例,骨巨细胞瘤7例,软骨肉瘤1例,恶性神经鞘瘤1例.表现为颈部疼痛不适12例,活动受限11例,脊髓损害10例,咽部肿物伴疼痛1例.就诊时肿瘤已突破骨间室者19例,肿瘤累及前中后三柱者14例.3例因无法负担手术费用而仅行保守治疗,18例行手术治疗,1例肿瘤仅累及后柱及附件背侧软组织,选择后方正中入路手术;17例肿瘤累及三柱或侧柱和/或侧块周围软组织,选择前后方联合入路.均为经瘤切除.9例患者在手术期前后行放射治疗(放疗),1例骨巨细胞瘤使用干扰素免疫治疗.随访观察治疗效果.结果:3例行保守治疗患者确诊后平均3个月死亡.手术病例中,术中结扎一侧椎动脉4例,术后无明显症状.1例术后死于围手术期气道阻塞,另17例平稳度过围手术期,其中13例症状(疼痛或脊髓损害)较术前明显缓解;2例术后出现一过性的四肢瘫,术后3个月后渐恢复;另2例脊髓功能无改善.术后1例咽后壁伤口裂开,再次缝合;另1例咽后壁伤口不愈合、内固定外露,无感染,未处理.2例失访,15例随访4～82个月,平均37.2个月.4例无瘤存活;11例复发,其中8例死亡,3例带瘤存活.结论:上颈椎原发肿瘤确诊时往往浸润广泛,需根据肿瘤位置合理选择手术入路,切除不易彻底,术后易复发.     

关节松动术联合星状神经节超激光照射在颈源性眩晕中的临床研究

目的观察关节松动术联合星状神经节超激光照射治疗颈源性眩晕的临床疗效及安全性。方法颈源性眩晕患者120例随机分三组,每组各40例。Ⅰ组(治疗组):关节松动术加星状神经节超激光照射治疗;Ⅱ组(对照组1):关节松动术加星状神经节阻滞治疗;Ⅲ组(对照组2):牵引加星状神经节超激光照射治疗。治疗前后采用颈性眩晕评估量表(Evaluation Scale for Cervical Vertigo,ESCV)及经颅多普勒超声(TCD)测评。结果治疗后三组患者ESCV评分均有显著提高(P0.01),左、右椎动脉和基底动脉的平均血流速度均较治疗前有提高(P0.05);Ⅰ、Ⅱ组优于Ⅲ组(P0.05)。Ⅰ组未出现Ⅱ、Ⅲ组发生的治疗并发症。结论关节松动术联合星状神经节超激光照射是颈源性眩晕一种较有效的治疗方法。     

Endoscopic neodymium: YAG laser treatment of radiation-induced hemorrhagic cystitis

Hemorrhagic cystitis is a debilitating complication of radiation therapy for pelvic malignancy. Forty-two such patients with intractable hematuria underwent endoscopic Nd:YAG laser coagulation under local anesthesia between January 1990 and July 1992. The laser power was kept at ? 30 W and the pulse duration ? 3 s. Control of bleeding was achieved in 39 patients after one sitting and in 2 patients after two sittings of laser treatment. There were no complications of the procedure and recurrence of bleeding was not seen in any of the patients achieving CR at a mean follow-up period of 14 months. With modifications in the safety guidelines, we recommend laser treatment as the initial procedure of choice in patients with hemorrhagic radiation Cystitis. © 1994 Wiley-Liss, Inc.