Fatal gas embolism during ureteroscopic holmium: yttrium‐aluminium‐garnet laser lithotripsy under spinal anesthesia – a case report

Ureteroscopic holmium: yttrium‐aluminium‐garnet (Ho:YAG) laser lithotripsy is an excellent treatment modality, especially for a large impacted ureteral stone. The treatment is efficient and safe. It helps surgeons to carry out a minimally invasive lithotripsy instead of an open surgery in patients with ureteral calculi. Here, we present the first report of a fatal gas embolism that occurred during ureteroscopic Ho:YAG laser lithotripsy under spinal anesthesia. When this complication occurs, the correct crisis resolution protocols, such as prevention of further air entry, reduction in the volume of air entrained, well‐hydration, and rapid initiation of cardiopulmonary resuscitation with administering inotropic drugs, are highly effective in the critical period.     

Faraday Rotation of Dy2O3, CeF3 and Y3Fe5O12 at the Mid-Infrared Wavelengths

The relatively narrow choice of magneto-active materials that could be used to construct Faraday devices (such as rotators or isolators) for the mid-infrared wavelengths arguably represents a pressing issue that is currently limiting the development of the mid-infrared lasers. Furthermore, the knowledge of the magneto-optical properties of the yet-reported mid-infrared magneto-active materials is usually restricted to a single wavelength only. To address this issue, we have dedicated this work to a comprehensive investigation of the magneto-optical properties of both the emerging (Dy2O3 ceramics and CeF3 crystal) and established (Y3Fe5O12 crystal) mid-infrared magneto-active materials. A broadband radiation source was used in a combination with an advanced polarization-stepping method, enabling an in-depth analysis of the wavelength dependence of the investigated materials’ Faraday rotation. We were able to derive approximate models for the examined dependence, which, as we believe, may be conveniently used for designing the needed mid-infrared Faraday devices for lasers with the emission wavelengths in the 2-μm spectral region. In the case of Y3Fe5O12 crystal, the derived model may be used as a rough approximation of the material’s saturated Faraday rotation even beyond the 2-μm wavelengths.     

Congenital plaque‐like glomangioma treated successfully with dual wavelength pulsed‐dye and neodymium:yttrium‐aluminum‐garnet laser

Glomovenous malformations are disseminated variants of cutaneous glomus tumors. These malformations are subdivided into regional or localized, disseminated, and congenital plaque‐like forms. The congenital plaque‐like form is the rarest variant. Most treatment modalities have been disappointing in the treatment of large glomangiomas, leading to high recurrence rates. We report a case of a 34‐year‐old man with a congenital plaque‐like glomangioma on his left arm and forearm treated successfully with sequential pulsed‐dye neodymium yttrium aluminum garnet laser.     

A fractional 2940 nm short-pulsed,erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians

Abstract

Background: Although ablative fractional laser for the facial photodamaged skin was effective and safe, there have been only limited reports regarding the efficacy and safety of fractional Er:YAG laser treatments for photodamaged facial skin in Asians. Objective: Our objective was to assess the efficacy and safety of the Er:YAG laser (2940 nm) using the ‘‘ablative’’ fractional resurfacing mode to treat photodamaged facial skin. Methods: A total of 29 Korean patients were treated for photodamaged facial skin using a fractional Er:YAG laser. The number of treatments was mean 2.3 sessions at two-week intervals. Independent investigators assessed the efficacy using standardized photographs. The patients’ satisfaction rate was also evaluated. Results: For dyspigmentation, 62.5% of the treated patients showed improvement greater than 26%. Regarding wrinkles, 50% of the treated patients showed improvement greater than 26%. All patients showed various degrees of improvement in skin laxity. Assessing the overall features, 62.5% of the study subjects showed improvement greater than 26%, and most of them (91.7%) reported that their subjective satisfaction rate was above ‘slight satisfaction’. Downtime accounted for approximately one week in most patients. Conclusions: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for photodamaged facial skin in Asians.     

Outcome of 1000 liver cancer patients evaluated at the UPMC Liver Cancer Center

We evaluated 1000 consecutive patients with liver tumors at the University of Pittsburgh Medical Center (UPMC) Liver Cancer Center over the 4-year period from August 2000 to August 2004. Of the 1000 patients seen, 573 had primary liver cancer and 427 had metastatic cancer to the liver. The mean age of the patients evaluated was 62.2 years, and 61% were male. Treatment consisted of a liver surgical procedure (resection or radiofrequency ablation) in 369 cases (36.9%), hepatic intra-arterial regional therapy (transarterial chemoembolization or ⁹⁰yttrium microspheres) in 524 cases (52.4%), systemic chemotherapy in 35 cases (3.5%), and palliative care in 72 patients (7.2%). For treated patients, median survival was 884 days for those undergoing resection/radiofrequency ablation, compared to 295 days with regional therapy. These data indicate that over 90% of patients with liver cancer evaluated at a tertiary referral center can be offered some form of therapy. Survival rates are superior with a liver resection or ablation procedure, which is likely consistent with selection bias. Hepatocellular carcinoma was the most common tumor seen due to referral pattern and screening of hepatitis patients at a major liver transplant center. The most common reason for offering palliative care was hepatic insufficiency usually associated with cirrhosis. Presented at the 2005 American Hepato-Pancreato-Biliary Association Congress, Hollywood, Florida, April 14–17, 2005 (oral presentation). Supported by grant NIH R01-GM52021 (DAG).     

Treatment options for unresectable HCC with a focus on SIRT with Yttrium‐90 resin microspheres

Hepatocellular carcinoma (HCC), the predominant form of primary liver cancer, is the second leading cause of cancer‐related deaths across the globe. Only a small percentage of HCC patients (~20%‐30%) are diagnosed at an early stage when first‐line treatment options may be effective. The majority of HCC patients (>70%) are diagnosed with unresectable disease and given a poor overall prognosis. Current treatment guidelines recommend locoregional therapy with transarterial chemoembolisation (TACE) and systemic therapy with sorafenib as first‐line treatment for patients with intermediate and advanced stage HCC. However, multiple factors including contraindications, technical considerations and treatment‐related toxicities pose significant challenges in achieving favourable treatment outcomes, underscoring the need for a paradigm shift in managing these patients. In 2002, yttrium‐90 (Y‐90) resin microspheres was approved by the U.S. Food and Drug Administration (FDA) for the treatment of unresectable metastatic colorectal cancer to the liver with adjuvant floxuridine chemotherapy. However, thousands of patients with unresectable HCC have also been treated with resin Y‐90. For over two decades, several small‐scale prospective trials and retrospective studies have investigated and reported on the efficacy of locoregional selective internal radiation therapy (SIRT) with Y‐90 microspheres in treating unresectable HCC. Although it is currently a treatment option for intermediate‐stage HCC patients, mainstream clinical application of resin Y‐90 has been largely limited because of the lack of sufficient clinical data from a randomised controlled trial. This could change with the imminent announcement of results from the phase 3 Sorafenib vs Radioembolization in Advanced Hepatocellular carcinoma (SARAH) trial. To provide the foundation and context for interpreting results from the SARAH trial, this article provides an overview of treatment modalities and current challenges in managing unresectable HCC. There is also a review of key prospective and retrospective studies evaluating the use of Y‐90 SIRT, specifically Y‐90 resin microspheres in unresectable HCC, which led to the development of the SARAH trial. Methods: To identify relevant publications, the PubMed database was queried using one or more of the following search terms alone or in combination with Boolean operators: epidemiology, hepatocellular, hepatocellular cancer, hepatocellular carcinoma, unresectable, radioembolisation, selective internal radiation therapy, SIR‐Spheres, yttrium 90, TACE, and sorafenib. The results were sorted or filtered by “Author”, “Publication dates” or “Article types” to identify articles relevant to each section of the review. To ensure that information on ongoing clinical trials involving Y‐90 resin was included, we conducted a search on “ClinicalTrials.gov”, by combining the search terms “HCC” OR “hepatocellular carcinoma” with “Y 90” OR “yttrium 90” OR “radioembo”, and screened for studies that involved treatment with Y‐90 resin microspheres.     

硝酸钇对大鼠胃粘膜和胃酸分泌的影响

本文研究硝酸钇对饥饿大鼠和幽门结扎大鼠的胃粘膜和胃酸分泌的影响。硝酸钇ig对饥饿大鼠的胃粘膜有严重损伤,但硝酸钇ip对幽门结扎大鼠胃粘膜的损伤却有预防作用。硝酸钇在8～32mg/kg范围内,无论是ig还是ip对胃酸分泌均有抑制作用,且呈明显的剂量效应关系,但4mg/kg对胃酸分泌影响不大。硝酸钇ig可减少胃壁结合粘液的分泌,ip途径则无影响。