Some Laser-Tissue Interactions in 308 nm Excimer Laser Coronary Angioplasty

Some physical concepts of laser-tissue interactions that occur in 308-nm excimer laser angioplasty are addressed. Monte Carlo numerical computations were used to analyze the light fluence rate distributions resulting from finite diameter laser beams incident on tissue, as applied by fiber-optic light delivery catheters. The fluence rate at the inside part of the tissue surface from a 0.2-mm diameter fiber emitting 308-nm light, is increased more than twice relative to the incident power density. The light fluence rate distribution inside the tissue spreads very little outside the incident beam diameter. Therefore, the distributions from different fibers in multifiber catheters will not overlap unless the fibers are very close together. The maximum fluence rate decreases with decreasing beam diameters. Ablation of tissue by a 308-nm excimer laser delivery system in contact with the tissue resulted in a damage zone adjacent to the crater wall, due to expansion of the gaseous debris trapped under the tip of delivery system. In case of contact irradiation, the ablation was more efficient than in case of noncontact irradiation. Direct temperature measurements during excimer laser ablation by an infared (IR) camera showed that temperature accumulation will occur when a sequence of pulses is applied at frequencies of at least 5 Hz. The temperature rise above ambient under circumstances simulating clinical conditions is measured to be 66°± 7°C.     

Ocular Melanoma Metastatic to Skin: The Value of HMB-45 Staining

BACKGROUND: Cutaneous metastatic disease is an important finding that may represent the first sign of systemic cancer, or, if already known, that may change tumor staging and thus dramatically altered therapeutic plans. Although cutaneous metastases are relatively frequent in patients with cutaneous melanoma, they are less so from ocular melanoma. OBJECTIVE: To demonstrate the value of HMB-45, staining in the detection of ocular melanoma metastatic to skin. METHODS: The immunohistochemical stain HMB-45 a monoclonal antibody directed against intact human melanoma cells, was employed on a skin biopsy specimen from a cutaneous tumor. Results: HMB-45 staining was positive in the atypical hyperchromatic cells of the deep dermis. CONCLUSION: HMB-45 may be of value in the detection of ocular melanoma metastatic to skin. Cutaneous metastatic disease is a somewhat common and extremely important diagnosis. Although cutaneous metastases from cutaneous melanoma are relatively frequent, those from ocular melanomas are less so. Use of histochemical staining, especially the HMB-45 stain, allows confirmation of the diagnosis.