Idiopathic Flushing with Dysesthesia: Treatment with the 585nm Pulsed Dye Laser

Objective: The purpose of this study was to analyze the efficacy and safety of the 585nm pulsed dye laser for the treatment of idiopathic flushing with dysesthesia. Design: This was a retrospective study of patients treated with a 585nm pulsed dye laser with fluences ranging from 3.5 to 7.5J/cm² (purpura threshold fluences), a pulse duration of 450μsec, and a spot size of 5 or 10mm. Setting: The Ronald 0. Perelman Department of Dermatology at New York University Medical Center. Participants: Ten adult subjects who presented with flushing with dysesthesia. Measurements: Participants subjectively evaluated the decrease in dysesthesia and the number of flushing episodes. The objective response to treatment was evaluated by a single physician using pre- and postoperative photographs. The severity of postoperative erythema was compared with baseline using an ordinal scale ranging from zero (resolution of erythema) to four (76-100% of baseline erythema). Results: The mean number of treatments received by the subjects was seven. The mean fluence was 6.66J/cm². Subjectively, 100 percent of subjects reported a decrease in dysethesia and the number of flushing episodes. Objectively, subjects demonstrated at least a 62.5-percent reduction in erythema. Conclusion: Laser surgery provided subjective relief of dysesthesia and decreased the number of flushing episodes with a greater than 62-percent objective reduction in the severity of erythema. The 585nm pulsed dye laser is a safe, efficacious treatment for the signs and symptoms of idiopathic flushing with dysesthesia.Flushing is a transient, episodic redness of the face, neck, upper chest, and/or epigastric area that is associated with certain diseases, ingestion of certain drugs or other substances, heat, emotional factors, or physical exertion.1 Blushing is flushing exclusively provoked by an emotional stimulus.2,3 Dysesthesia is defined as an unpleasant, abnormal sensation that is produced by normal stimuli.4Idiopathic flushing is a diagnosis of exclusion.3,5-8 In a subset of patients with idiopathic flushing, dysesthesia may be noted, and patients describe this symptom as a warm, unpleasant, burning sensation. Patients with this constellation of signs and symptoms, which is henceforth referred to as idiopathic flushing with dysesthesia, consistently deny concomitant pruritus. Furthermore, associated signs and symptoms, such as bronchospasm, abdominal cramps, diarrhea, headache, hypotension, or tachycardia, are rare in these patients.The objectives of this study were to define the characteristics of a poorly defined disorder, idiopathic flushing with dysesthesia, and to evaluate the treatment of subjects with this disorder using the 585nm pulsed dye laser.     

SpinoBot: An MRI-Guided Needle Positioning System for Spinal Cellular Therapeutics

The neurodegenerative disease amyotrophic lateral sclerosis (ALS) results in the death of motor neurons in voluntary muscles. There are no cures for ALS and few available treatments. In studies with small animal models, injection of cellular therapeutics into the anterior horn of the spinal cord has been shown to inhibit the progression of ALS. It was hypothesized that spinal injection could be made faster and less invasive with the aid of a robot. The robotic system presented—SpinoBot—uses MRI guidance to position a needle for percutaneous injection into the spinal cord. With four degrees of freedom (DOF) provided by two translation stages and two rotational axes, SpinoBot proved capable of advanced targeting with a mean error of 1.12 mm and standard deviation of 0.97 mm in bench tests, and a mean error of 2.2 mm and standard deviation of 0.85 mm in swine cadaver tests. SpinoBot has shown less than 3% signal-to-noise ratio reduction in 3T MR imaging quality, demonstrating its compliance to the MRI environment. With the aid of SpinoBot, the length of the percutaneous injection procedure is reduced to less than 60 min with 10 min for each additional insertion. Although SpinoBot is designed for ALS treatment, it could potentially be used for other procedures that require precise access to the spine.