Use of the Alexandrite Laser for Treatment of Seborrheic Keratoses

BACKGROUND: Seborrheic karatoses are benign lesions that are easily irritated and often cosmetically objectionable. Liquid nitrogen cryotherapy and other surgical methods are useful in treating these lesions, but are difficult to tolerate in patients who have large numbers of lesions requiring treatment. The alexandrite laser was used in one patient to quickly and efficiently destroy hundreds of seborrheic keratoses. The treatment was tolerable and excellent cosmetic results were achieved.     

532-nm Diode Laser Treatment of Seborrheic Keratoses with Color Enhancement

BACKGROUND Seborrheic keratoses (SKs) are benign cutaneous tumors of the epidermis. Localization in the head and neck areas can produce an unsightly appearance. Recurrence after curettage, shave excision, cryoablation, or chemical peel can be common.
OBJECTIVE The objective was to determine if laser ablation with the 532-nm laser and color enhancement is effective in removing SKs.
MATERIALS AND METHODS A total of 326 patients who presented with 1,567 benign SKs were treated with the DioLite (Iridex Corp.) and VersaPulse cosmetic (Coherent Inc.) 532-nm diode lasers with color enhancement using a red marker or ferric subsulfate. The DioLite was set at 27 to 30 J with a 2- to 3-mm spot size, and a 10-ms pulse width was used for ablation. The VersaPulse was set at a lower energy of 9.5 to 12 J/cm² with a 3-mm spot size, 3- to 6-Hz repetition rate, and 10-ms pulse duration for ablation. All patients were Caucasian.
RESULTS Complete resolution of the SKs occurred in 93% of lesions. Seven percent of SKs required a second round of laser treatment for incomplete ablation. There were no cases of hyperpigmentation or hypertrophic scar formation of the skin following laser treatment. Hypopigmentation occurred in 6% of patients and was associated with old, chronic, or recalcitrant lesions.     

False "Melanocytic" Parameters Shown by Pigmented Seborrheic Keratoses: A Finding Which is not Uncommon in Dermoscopy

BACKGROUND: Dermoscopic evaluation of pigmented lesions includes assessment of criteria suggestive of melanocytic proliferation. Dermoscopic diagnosis may be hampered when a nonmelanocytic lesion displays one or more melanocytic features. OBJECTIVE: To evaluate the incidence of misleading dermoscopic features characteristic of melanocytic lesions in pigmented seborrheic keratosis (PSK). METHODS: We evaluated 402 clinically typical PSKs from 138 patients with at least one clinically identifiable PSK. RESULTS: Approximately 10% of PSKs displayed one or more melanocytic features, the most frequent being a "false" pigment network. CONCLUSION: The occurrence of a "false" pigment network in PSK can be misleading in the differential diagnosis of clinically equivocal lesions. A correct diagnosis can only be obtained if all available dermoscopic criteria are appropriately assessed together with the clinical examination.     

Treatment of War Wounds: A Historical Review

The treatment of war wounds is an ancient art, constantly refined to reflect improvements in weapons technology, transportation, antiseptic practices, and surgical techniques. Throughout most of the history of warfare, more soldiers died from disease than combat wounds, and misconceptions regarding the best timing and mode of treatment for injuries often resulted in more harm than good. Since the 19th century, mortality from war wounds steadily decreased as surgeons on all sides of conflicts developed systems for rapidly moving the wounded from the battlefield to frontline hospitals where surgical care is delivered. We review the most important trends in US and Western military trauma management over two centuries, including the shift from primary to delayed closure in wound management, refinement of amputation techniques, advances in evacuation philosophy and technology, the development of antiseptic practices, and the use of antibiotics. We also discuss how the lessons of history are reflected in contemporary US practices in Iraq and Afghanistan. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Disclaimer: The opinions or assertions contained herein are the private views of some of the authors and are not to be construed as official or reflecting the views of the Department of Defense or the US government. This work was prepared as part of their official duties and, as such, there is no copyright to be transferred.     

体表中间型软组织肿瘤的整形外科治疗

目的总结体表中间型软组织肿瘤的手术治疗经验及其疗效。方法33例体表中间型软组织肿瘤,其中25例（75．8％）为术后复发病例,8例为首次病例,均行肿瘤扩大切除术,在足够的深度、广度下切除肿瘤,一期修复创面。结果本组行邻近皮瓣＋皮片移植修复18例,远位皮瓣＋皮片移植修复7例,皮片移植修复8例。3例游离皮片部分坏死,补充植皮后创面修复;1例后斜角肌肌瓣坏死后锁骨外露,行胸大肌肌瓣转移＋皮片移植后创面修复。随访0．5～4年无一例复发。结论对中间型软组织肿瘤手术治疗时需注意切除的深度和广度,以减少复发机率;采用整形外科技术修复创面可获得满意效果。     

Surgical Treatment of Angina Pectoris. A Follow-up Study with Special Reference to Clinical Results after Bypass

A follow-up study of 132 patients with stable angina pectoris, who underwent a bypass operation during the period 1970–1976, is presented. The survival curves and mortality rates for this group and for 180 patients, who had previously undergone indirect revascularization, are given. At the first follow-up after bypass operation, 87% of the patients were subjectively improved, 72% of the vein grafts were patent and 85% of the patients had at least one graft patent. A positive correlation was found between patent grafts and subjective improvement. A similar correlation between subjective and objective improvement (exercise test) was not found.     

Er:YAG Laser for the Treatment of Actinic Keratoses

BACKGROUND: There is no single optimal treatment for multiple facial actinic keratoses. The existing therapies such as topical 5-fluorouracil, chemical peels, cryotherapy, dermabrasion, and CO2 laser resurfacing can produce prolonged recovery time or are often operator dependent. OBJECTIVE: The purpose of this study was to investigate another therapeutic modality which provides a shorter recovery time with uniform results. We performed a prospective pilot study investigating the use of the Er:YAG laser for the treatment of multiple facial actinic keratoses. METHODS: Five patients with multiple facial actinic keratoses were treated with two to three passes of Er:YAG laser. Anesthesia was achieved in all cases by topical application and local infiltration when indicated. All patients were treated with 2.0 J, 5 mm spot size, and a fluence of 10 J/cm2. Clinical and histologic evaluations were performed both pre- and postoperatively. RESULTS: All patients showed a decrease in the total number of clinical actinic keratoses on the face ranging from 86 to 96%. In addition to the reversal of actinic damage in the epidermis, histologic evidence revealed increased fibroplasia and decreased superficial solar elastosis 3 months after the laser resurfacing. Reepithelialization occurred in 5-8 days, and erythema lasted for about 3-6 weeks after the procedure. There was no evidence of scarring or pigmentary changes in any of the patients during the follow-up period. CONCLUSION: Er:YAG laser skin resurfacing is a safe and effective treatment for multiple facial actinic keratoses. Histologic data suggest a new zone of collagen deposition occurs in the superficial papillary dermis. Under our current parameters, Er:YAG laser skin resurfacing has a relatively short recovery period and a low risk of scarring. Unlike the CO2 laser, Er:YAG laser skin resurfacing can be performed with topical anesthesia alone.     

Effect of Topical Mitomycin C on the Healing of Surgical and Laser Wounds: A Hint on Clinical Application

OBJECTIVES: Mitomycin C (MMC) is used in otolaryngological surgery to reduce complications from postoperative scarring. However, the effects of MMC on wound healing at different doses and on different wound types have not been fully described. The aim of this study was to evaluate the effects of topical MMC at 2 different doses on the healing of surgical and laser wounds. STUDY DESIGN AND SETTING: This was a randomized study using 20 rabbits. Six full-thickness wounds were made by excision or laser vaporization on the flank skin. The wounds were randomly treated by topical MMC of 0.4 or 1.0 mg/mL or saline for 5 minutes. RESULTS: Re-epithelialization and contraction of the original wounds were significantly delayed by the use of MMC (P < 0.01). The delayed healing effect of MMC was more prominent in the laser wounds than in the excision wounds. MMC inhibited collagen deposition and fibroblast proliferation of wounds on histological analysis. The 2 different concentrations of MMC showed no difference in gross or histological wound healing characteristics. CONCLUSION: Our results showed that MMC delays the healing of wounds as a result of the inhibition of fibrosis, especially for laser wounds.     

龙珠软膏在肛裂术后的临床应用

观察龙珠软膏住肛裂术后廊用促进创面愈合的疗效,寻求一种更为有效的促进肛肠病术后创面愈合的治疗方法。选择肛裂术后患者60例,其中治疗组和对照组各30例,术后分别给予龙珠软膏和九华膏换药,1次／d。换药期间详细观察创面的宽度、深度、疼痛程度、水肿程度、肉芽生长指标,并进行评分。比较两组创面平均愈合时间。换药前后症状体征疗效和临床总疗效。结果显示,治疗组和对照组创面平均愈合时例分别为（19．80±2．78）d和（21．90±3．24）d,治疗组愈合速度明显快于对照组（P〈0．01）;水后第7天治疗疼痛的有效率分别为93．3％和80．0％,治疗水肿的有效率分别为96．2％和96．0％,治疗组减轻疼痛的疗效优于对照组（P〈0．05）,换药20d后创面疗效治疗组明显优于埘照组（P〈0．05）。结果表明,龙珠软膏能够加快创面愈合,减缓疼痛、水肿等早期不适症状体征,特别是在上皮爬行瘢痕形成时期具有明显疗效。     

妊娠期嵌顿痔手术治疗91例临床观察

目的:探讨妊娠期嵌顿痔手术治疗的可行性和安全性。方法:采用手术方法治疗妊娠期嵌顿痔91例,观察疗效。结果全部治愈,均能及时解除痛苦,恢复排便功能。结论:手术方法治疗妊娠期嵌顿痔基本安全可靠。     

The Effect of Multiple Sequential Light Sources to Activate Aminolevulinic Acid in the Treatment of Actinic Keratoses: A Retrospective Study

There is a lack of research regarding the sequential use of multiple light sources for topical 5-aminolevulinic acid activation in photodynamic therapy for actinic keratosis. This study evaluated 5-aminolevulinic acid-photodynamic therapy for actinic keratosis using blue light combined with red light, pulsed dye laser, and/or intense pulsed light in a retrospective fashion. Field-directed 5-aminolevulinic acid-photodynamic therapy was performed with blue light only, blue light + pulsed dye laser, blue light + intense pulsed light, blue light + pulsed dye laser + intense pulsed light, or blue light + red light + pulsed dye laser + intense pulsed light for nonhyperkeratotic actinic keratoses of face, scalp, or upper trunk. Blue light + intense pulsed light + pulsed dye laser produced greater patient-reported improvement in actinic keratoses than blue light or blue light + intense pulsed light and greater subject-reported improvement in overall skin quality than blue light + intense pulsed light. The addition of red light led to no further benefit in either outcome measure. Photodynamic therapy with multiple, sequential laser and light sources led to greater patient-graded improvement in actinic keratoses than that with a single light source (blue light), without significant differences in post-treatment adverse events. However, the small, widely disparate number of patients between groups and follow-up times between patients, as well as retrospective assessments based on subjective patient recall, severely limit the significance of these findings. Nevertheless, the results raise interesting questions regarding the use of multiple light and laser sources for photodynamic therapy of actinic keratoses and warrant further research with a prospective, randomized, controlled study.Actinic keratoses (AKs) are dysplastic epidermal neoplasms resulting from chronic cutaneous exposure to ultraviolet radiation, commonly found within photodamaged areas of the face, bald scalp, posterior neck, upper trunk, and dorsal upper extremities.1 Risk factors for the development of AKs include older age, male gender, Fitzpatrick I and II skin types, proximity to the equator, immunosuppression, and cumulative exposure to sunlight, tanning beds, and/or psoralen + ultraviolet A light (PUVA).1-3 The fact that 65 to 97 percent of squamous cell carcinomas develop from AKs or areas of field cancerization highlights the need for effective treatment of these lesions.2Numerous options exist for the management of AKs (4 PDT may also have the potential to decrease expression of early markers of cutaneous neoplasia (e.g., Ki-67 and p53), as demonstrated in multiple studies following methyl aminolevulinate PDT (MAL-PDT) using incoherent red light.5,6 Complete response rates with PDT vary based on the area treated, number of sessions required, and the type of exogenous photosensitizer and light or laser source used, ranging from 50 to 90 percent.6-14

TABLE 1

Available treatment options for actinic keratoses NSAIDs, nonsteroidal anti-inflammatory drugs

退行性腰椎滑脱后路手术临床分析

目的 探讨退行性腰椎滑脱的后路手术治疗,比较后路腰椎管减压内固定并后外侧植骨及椎体间联合后外侧植骨术的临床疗效.方法 37例退行性腰椎滑脱患者采用后路减压、后外侧植骨内固定(A组21例)和椎体间联合后外侧植骨内固定(B组16例)手术,对两组术后植骨融合率及临床症状改善情况进行分析比较.根据术前、术后X线片和JOA评分评价植骨融合率及临床症状改善程度.结果 平均随访42个月.A组骨融合率为86%,B组为94%,两组无显著性差异.A组JOA评分优良率为90%,B组为94%,两组无显著性差异.结论 后路后外侧植骨内固定和椎间联合后外侧植骨内固定术均是有效的手术方法,但椎间联合后外侧植骨融合术的骨融合率较高.     

3种不同药物治疗浅Ⅱ度烧伤感染创面效果观察

目的筛选最佳浅Ⅱ度烧伤感染创面换药配方.方法将120例浅Ⅱ度烧伤感染创面病人随机分为A、B、C 3组各40例.A组采用紫花烧伤膏、紫草油加庆大霉素联合配方换药;B组用庆大霉素纱条湿敷;C组将紫花烧伤膏直接涂于创面.结果A组疗效明显优于B组(P＜0.05),与C组比较差异无显著性意义;换药,更换敷料时病人的疼痛感A、C两组优于B组(均P＜0.01);伤口换药次数及愈合时间A组明显少于B、C组(P＜0.05,P＜0.01).结论选用A组药物配方治疗浅Ⅱ度烧伤感染创面既可减少换药次数,减轻病人的疼痛,又可明显缩短伤口愈合时间,有助于烧伤感染创面的恢复,具有临床应用及推广价值.     

Surgical Treatment of Aortoiliac Occlusive Disease with Concomitant Superficial Femoral Artery Occlusion

Introduction: Aortofemoral bypass is a standard method for the surgical treatment of aortoiliac occlusive disease. Most of the patients with aortoiliac occlusive disease have multisegment arterial occlusions extending to the popliteal or distal arterial system. In this research early and long term results of aortobifemoral bypass and aortobifemo-ral bypass with combined femoropopliteal bypass were assessed.

Patients and Methods: From March 2002 to October 2011, 833 patients underwent bypass procedures for aortoiliac occlusive disease with concomitant superficial femoral artery occlusion. The patients and surgical procedures were studied prospectively. The patients were divided into 2 groups. Group I (n: 632) consisted of patients who only recevied aortobifemoral bypass. Group II (n: 201) comprised of patients in whom aortobifemoral bypass was combined with femoro-popliteal bypass.

Results: In the early (30 days) and late (42 months) follow up periods, the rate of amputation (8 patients in Group I vs. 16 patients in Group II in the early period; p < 0.05 and 8 patients in Group I vs. 11patients in Group II in the late follow-up; p < 0.05) and mortality (2 patients in Group I and 5 patients in Group II in the early period and 8 patients in Group I vs. 11 patients in Group II in the late follow-up; p < 0.05) were higher in Group II. Moreover, graft patency (0.4% thrombosis rate in Group I vs. 5.4% thrombosis rate in Group II in the long run; p < 0.05), freedom from symptoms (claudication, rest pain and necrosis, 3 patients vs. 9 patients, 9 patients vs. 27 patients and 8 patients vs. 17 patients in Group I and Group II, respectively in the longterm follow-up; p < 0.05) and consequences (mortality, amputation, graft infection and graft extraction rates in the longterm, all p < 0.05) were significantly lower in Group II. Conclusion: Aortobifemoral bypass procedure is an efficient, safe and durable technique for the surgical management of aortoiliac occlusive disease (AIOD) combined with superficial femoral artery occlusion. In this circumstance profunda femoris artery plays the major role for the perfusion of limb.