单用308nm准分子激光与联合他卡西醇治疗白癜风的疗效对比观察

目的 比较单用308nm准分子激光疗法治疗白癜风与联合局部应用维生素D3类似物他卡西醇治疗白癜风的疗效和安全性。方法 用单盲、自身对照的方法对78例稳定期泛发性的白癜风患者的自身对称或相邻的皮损采用308nm准分子激光治疗,实验组联合外用他卡西醇软膏,对照组用安慰剂软膏,1个月观察1次,拍照对比疗效,对78例患者进行治疗后评价。结果 不同治疗部位疗效评价：实验组头面、躯干、四肢皮损的总有效率分别为93．5l％,84．16％,42．35％,对照组总有效率分别为90．90％,77．45％,34．15％（P〈0．05）;不同类型的皮损治疗效果比较：实验组寻常型和节段型皮损总有效率分别为86．80％,93．33％,对照组分别为73．81％,84．00％（P〈0．05）;照光次数和累积照光剂量比较：实验组最初色素再生时照光次数和光累积量分别为（16．15±3．22）次和（4．40±5．03）J／cm＾2,对照组分别为（18．56±3．50）次和（6．60-i-1．01）J／cm。（P〈0．05）,显效的患者实验组为（20．36±1．50）次和（7．50±3．54）J／cm＾2,对照组为（21．68±2．40）次和（8．80±9．24）J／cm＾2（P〈0．05）。结论 308nm准分子激光治疗白癜风有效而且安全,联合他卡西醇外用可以提高白癜风患者的治疗反应,增强308nm准分子激光的疗效,缩短色素再生的时间,减少照光的能量。     

308nm准分子激光治疗眼眶白癜风的疗效观察

目的：评价308nm准分子激光治疗眼眶白癜风的疗效及安全性。方法：采用308nm准分子激光系统治疗83例眼眶稳定期白癜风患者,每周治疗2次,连续治疗10～30次,治疗1.5～3个月后进行疗效评价。结果：治疗10次、20次及30次后眼眶的显效率分别为54.17%、60.6%、88.46%。结论：308nm准分子激光治疗眼眶白癜风是安全有效的。     

Effect of force on ablation depth for a XeCl excimer laser beam delivered by an optical fiber in contact with arterial tissue under saline.

The effect of force applied to a 430 micron single fiber, delivering 60 pulses of 308 nm XeCl laser radiation at 20 Hz, on the ablation depth in porcine aortic tissue under saline has been investigated. Energy densities of 8, 15, 25, 28, 31, 37, and 45 mJ/mm2 were used. Force was applied by adding weights from 0 to 10 grams to the fiber. The fiber penetration was monitored by means of a position transducer. At 0 grams, the ablation depth increased linearly with incident energy density, but the fiber did not penetrate the tissue; with any weight added, the fiber penetrated the tissue at energy densities above 15 mJ/mm2. The fiber did not penetrate during the first several pulses, possibly due to gas trapped under the fiber. After these first pulses, a smooth linear advancement of the fiber began, which lasted until the pulse train stopped. The ablation depth increased with increasing energy densities and weights. This effect was largest above 25 mJ/mm2 where the ablation efficiencies (unit mm3/J), with weights added to the fiber, were substantially larger than values found in 308 nm ablation experiments described in the literature, which were conducted with either a focused laser beam or a fiber without additional force. The results imply that in 308 nm excimer laser angioplasty, force must be applied to the beam delivery catheter for efficient recanalization, and that experiments performed with a focused beam or without actual penetration of the fiber do not represent the situation encountered in excimer laser angioplasty.     

Ultrafast imaging of tissue ablation by a XeCl excimer laser in saline.

To determine the temporal evolution of laser induced tissue ablation, arterial wall specimens with either hard calcified or fatty plaques and normal tissue were irradiated in a 0.9% saline solution using a XeCl excimer laser (wavelength 308 nm, energy fluence 7 J/cm2, pulse width 30 ns) through a 600 microns fused silica fiber pointing perpendicular either at a 0.5 mm distance or in direct contact to the vascular surface. Radiation of a pulsed dye laser (wavelength 580 nm) was used to illuminate the tissue surface. The ablation process and the arising bubble above the tissue surface were recorded with a CCD camera attached to a computer based image-processing system. Spherical cavitation bubbles and small tissue particles emerging from the irradiated area have been recorded. The volume of this bubble increased faster for calcified plaques than for normal tissue.     

193 nm excimer laser ablation of bone

The argon fluoride excimer laser is investigated as a cutting-ablating tool for bone surgery. Quantitative measurements are presented for various fluences of laser energy and number of pulses. Histological data are presented that demonstrate the minimal damage to the surrounding material from the laser interaction. Comparisons are made for non-decalcified and decalcified bone. The differences observed, as a function of decalcification in the fluences required for specified depth penetration, are noted and a possible explanation is suggested.     

Percutaneous transluminal excimer laser angioplasty in total peripheral artery occlusion in man

Laser angioplasty and laser-assisted angioplasty have become a clinical reality. Producing sharply defined borders of the ablated area with minimal adjacent thermal damage, excimer lasers offer several proven and some potential advantages over conventional systems. To evaluate the feasibility of excimer laser angioplasty, we have treated one patient using 308-nm radiation via a bare fiber in direct contact with the total occlusion of a right femoral artery. The lesion was successfully recanalized, thus allowing easy passage of the balloon catheter and subsequent dilatation. This percutaneous laser recanalization of an occluded peripheral artery is one of the first to be done in man using excimer laser radiation, thus demonstrating that the technique is feasible and the system is potentially useful.     

他克莫司软膏联合308nm准分子激光治疗儿童局限性白癜风

目的:本研究旨在评价0.03%他克莫司软膏和308 nm准分子激光治疗儿童局限性白癜风的安全性和有效性。同时研究308nm准分子激光联合外用0.03%他克莫司软膏对疗效的影响。方法:76个患者入组研究,研究采用随机单盲自身对照试验共15周。入组患者均具有两侧对称病变,进行左/右面部、躯干、手足的比较。按患者2至4个靶病变随机分为两组:A组患者外用0.03%他克莫司软膏,每天两次;B组患者外用0.03%他克莫司软膏每日两次,联合308nm准分子激光治疗,每周两次。研究期间对疗效和安全性因素进行评价。结果:76个患者完成了研究,A组91.3%和B组97.4%的皮损观察到复色。与治疗前相比,A组和B组皮损均明显改善。B组72.3%的皮损获得4级复色,与A组比较有显着性差异(P<0.05)。面颈部的复色率(复色75%以上)明显高于躯干、四肢、手足的复色率(P<0.05)。两组患者未见明显的副作用,两组之间的副作用发生率没有显著差异。结论:0.03%的他克莫司软膏和308 nm准分子激光对于治疗儿童局限性白癜风是安全、有效的,且耐受性良好。联合使用他克莫司软膏和308nm准分子激光显著提高疗效。     

308nm准分子激光联合驱虫斑鸠菊肌注治疗白癜风临床观察

目的：观察308nm准分子激光联合驱虫斑鸠菊治疗白癜风的疗效及安全性。方法：将98例白癜风患者随机分为三组,其中对照组31例,治疗A组34例,治疗B组33例。对照组：应用驱虫斑鸠菊注射液2ml肌注,每日一次（早晨8点）;治疗A组：应用308nm准分子激光治疗,2～3次/周;治疗B组：采用308nm准分子激光联合驱虫斑鸠菊治疗。三组疗程均为2个月,由专人评价并记录治疗效果及治疗期间出现的不良反应。结果：①治疗B组总有效率为84.8%,明显高于其他两组（P＜0.01）;②治疗B组面颈部有效率为84.1%,躯干四肢为66.7%;均高于其他两组（P＜0.01）,且以面颈部有效率最高;③三组中肢端关节部位的有效率最低,且组间比较无显著性差异（P＞0.05）。结论：应用308nm准分子激光联合驱虫斑鸠菊治疗局限型的非肢端及非关节突出部位的白癜风,能获得满意疗效,可在临床推广应用。     

308nm准分子激光联合哈西奈德溶液治疗头皮银屑病的疗效观察

目的：探讨308nm准分子激光治疗头皮银屑病的临床疗效。方法：将80例头皮银屑病患者分为两组：治疗组40例,给予308nm准分子激光照射治疗,2次／周,期间外用哈西奈德溶液,2次／天;对照组40例,外用哈西奈德溶液,2次／天。两组均治疗4周后观察疗效。结果：治疗组与对照组总有效率分别为97．5％和70％,两组比较有显著性差异（r=11．11,P〈0．01）。结论：308nm准分子激光联合哈西奈德溶液治疗头皮银屑病疗效确切,不良反应少。     

他克莫司软膏联合308nm准分子激光治疗白癜风临床观察

目的:探讨外用0.1%他克莫司软膏联合308nm准分子激光治疗白癜风的疗效及安全性。方法:患者35例,以自身未治疗皮损作为空白对照,每例患者选择两处相近或对称部位的皮损,每周2次以308nm准分子激光进行治疗,共治疗16次。A组皮损同时每天早晚外用0.1%他克莫司软膏,B组单用308nm准分子激光治疗,试验结束时依据治疗前、后皮损的照片进行疗效评价。结果:试验结束时,未治疗的皮损均未出现任何改善,A组有效率为97.1%(34/35),B组为85.7%(30/35),显效率A组为74.3(&/35)、B组为48.6%(17/35),两组间显效率有显著性差(异2χ=4.884,P=0.023),但有效率差异不显著(2χ=2.917,P=0.088)。对18例患者进行随访,3个月内,A组所有治疗皮损均维持稳定或持续好转,而B组有3例皮损出现复发。结论:308nm准分子激光治疗白癜风疗效高、副作用少,联合外用0.1%他克莫司软膏可显著提高其疗效并减少复发。     

308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风疗效观察

目的:探讨308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风的疗效。方法:治疗组儿童面部白癜风患者采用Xt rac颠峰准分子激光联合他卡西醇软膏治疗,对照组仅用Xt rac颠峰准分子激光,为期3月,治疗结束后3天进行疗效评价。结果:治疗组显效率77.3%,对照组显效率52.5%,两组差异有统计学意义(χ2=5.69,P<0.05)。结论:308nm准分子激光联合他卡西醇软膏治疗儿童面部白癜风疗效好、副作用小。     

308 nm Excimer laser ablation of cartilage

This article reports the investigation of the XeCl excimer laser as a cutting-ablating tool for human fibrocartilage and hyaline cartilage. Quantitative measurements were made of tissue ablation rates as a function of fluence in meniscal fibrocartilage and articular hyaline cartilage. A force of 1.47 Newtons was applied to an 800-μm fiber with the laser delivering a range of fluences (40-190 mJ/mm²) firing at a frequency of 5 Hz. To assess the effect of repetition rate on depth per pulse, a set of measurements was made at a constant fluence of 60 mJ/mm², with the repetition rate varying from 10 to 40 Hz. Histologic and morphometric analysis of preserved specimens was performed using light microscopy. The results of these studies revealed that the ablation rate was directly proportional to fluence over the range tested. Fibrocartilage was ablated at a rate 2.56 times faster than hyaline cartilage. Repetition rate had no effect on the penetration per pulse. Adjacent tissue damage was noted to be minimal (10–70 μm). The excimer laser achieved ablation rates adequate for arthroscopic applications. © 1994 Wiley-Liss, Inc.     

Autofluorescence spectroscopy using a XeCl excimer laser system for simultaneous plaque ablation and fluorescence excitation

Laser–induced fluorescence may be used to guide laser ablation of atherosclerotic lesions. This study was performed to evaluate arterial autofluorescence spectroscopy in vitro using a single XeCl excimer laser (308 nm) for simultaneous tissue ablation and fluorescence excitation. The laser beam was coupled to a 600-μm silica fiber transmitting 40–50 mJ/mm² per pulse. The fluorescence radiation emanating retrogradely from the fiber was collected by a concave mirror for spectroscopic analysis over a range of 321–657 nm. The arterial media (n = 26), lipid plaques (n = 26), and calcified lesions (n = 27) of aortic specimens from ten human cadavers were investigated in air, saline, and blood. Whereas the spectrum of calcified lesions changed with the surrounding optical medium, the other spectra remained constant. In air and blood, the spectra of arterial media, lipid plaques, and calcified lesions could be differentiated qualitatively and quantitatively (P < 0.0001). In saline, there was no clearcut spectroscopic difference between lipid plaques and calcified lesions. However, normal arterial media and atherosclerotic lesions (lipid plaques plus calcified lesions) could still be discriminated. Thus spectroscopy and plaque ablation can be combined using a single XeCl excimer laser. These encouraging results should stimulate further studies to determine the potential use of this approach to guide laser angioplasty in humans. © 1994 Wiley-Liss, Inc.     

Rate-dependent,nonlinear photoablation of ocular tissue at 308 nm

To quantify the dependence on pulse repetition rate of 308 nm laser ablation in ocular tissue and elucidate the photoablation mechanisms involved, 85 full-thickness ab interno sclerostomies were created in six human donor eyes using an 800-μm-diameter quartz optical fiber. A laser pulse duration of 135 ns, fluence of 31 mJ/mm², and a fixed repetition rate between 5 and 40 Hz were used for 38 sclerostomies; the remaining 47 sclerostomies were completed at various laser settings during initial experimentation. Surprisingly, the numbers of pulses required for complete penetration of the optical fiber through the fixed tissue thickness were not constant as expected but decreased nonlinearly with increasing repetition rate. This demonstrates that the 308 nm excimer laser cuts ocular tissue significantly more rapidly per pulse at higher repetition rates. To explain this nonlinearity, we propose a composite ablation mechanism composed of photochemical, thermal, mechanical, and optical effects in varying proportions. © 1994 Wiley-Liss, Inc.     

308nm准分子激光联合胸腺肽治疗成人头面部白癜风临床观察

目的:探讨口服胸腺肽联合308nm准分子激光治疗白癜风的疗效及安全性。方法:85例患者随机分成两组。实验组44例,308nm准分子激光(2次/周)联合胸腺肽(10mg 2/日)治疗;对照组41例,单纯予308nm准分子激光治疗(2次/周),两组疗程25次。于治疗25次3天后进行疗效评价。结果:治疗结束后,实验组有效率为95.45%(42/44),对照组为87.8%(36/41),显效率实验组为72.73%(32/44),对照组为51.22%(21/41),两组间显效率有显著性差异(χ2=4.182,P=0.041),但有效率差异不显著(χ2=3.316,P=0.375)。对两组各30例患者随访6个月,实验组患者所有治疗皮损均维持稳定或持续好转,而对照组有2例皮损出现复发。结论:308nm准分子激光治疗白癜风疗效高、副作用少,联合口服胸腺肽可显著提高其疗效并减少复发。     

Fragmentation of biliary stones with a 308 nm excimer laser

The use of a XeCl excimer laser (308 nm) for biliary stone fragmentation is reported. Laser energy is delivered via UV grade fused silica fibers to the target stones immersed in normal saline solution. Sixty biliary calculi--pigment (n = 40), and cholesterol (n = 20)--were fragmented in vitro. The total energy delivered per unit mass of the stone is kept constant. Two energy fluences (80 and 110 mJ/mm2) at two repetition rates (5 and 20 Hz) delivered through fibers of two core sizes (300 and 600 microns) are utilized to study the effect of different laser parameters on the fragmentation process. Although both pigment and cholesterol stones are susceptible to excimer laser fragmentation, higher fragmentation efficiency is obtained for the pigment stones than for the cholesterol stones. Our study suggests that higher energy fluence and larger fiber core size result in higher fragmentation efficiency for pigment stones. Fragmentation thresholds at stone surface for a variety of biliary calculi of known composition were measured. The threshold energy fluence is approximately 3 mJ/mm2 and 17 mJ/mm2 for pigment and cholesterol stones, respectively. Our study indicates that the 308 nm excimer laser may be effective as a laser lithotriptor with low threshold and good efficiency for biliary stone fragmentation.     

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.