Outcome of low level lasers versus ultrasonic therapy in de Quervain's tenosynovitis

Background:

de Quervain''s tenosynovitis is an inflammation of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) muscle tendon sheaths at the level of radial styloid process. Its conservative management includes nonsteroidal anti-inflammatory drugs, wrist and thumb immobilization, ultrasonic therapy (US Th.) and low level laser therapy (LLLT). Literature is scanty on comparative efficacy of US Th. and LLLT for its management. This prospective study evaluates outcome of US Th. versus LLLT in de Quervain''s disease.

Materials and Methods:

Thirty patients clinically diagnosed de Quervains tenosynovitis were included in the study and randomly assigned to two groups. The average age was 36 years (range: 21-45 years). One group was given LLLT and the other US Th. for a total of 7 exposures on alternate days. The clinical criteria used were Finkelstein''s test, tenderness over radial styloid (Ritchie''s tenderness scale), grip strength, pain (visual analog scale [VAS]) and radiological criteria was ultrasonographic assessment of change in thickness of APL and EPB tendon sheath. They were measured before commencement and at the end of seven sessions of therapy, as per standard procedure.

Results:

Significant improvement was seen within both groups in the following outcome measures assessed: Ritchie''s tenderness scale, grip strength and VAS. Finkelstein''s test was not significantly improved in either groups. Ultrasonographic measurement of tendon sheath diameters, the mediolateral (ML), and anteroposterior (AP) diameters was not found to be significantly different in the US Th. group and the laser therapy group after treatment. On comparing both the groups, no statistically significant difference was found. However, looking at the mean values, the grip strength and VAS showed better improvement in the US Th. group as compared to the laser therapy group.     

经尿道钬激光前列腺剜除术与前列腺电切术近期疗效的对比分析

目的比较前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)和前列腺电切术(transurethral resection of the prostate,TURP)治疗良性前列腺增生(benign prostatic hyplasia,BPH)的疗效及安全性。方法将2012年6月至2013年7月90例行腔内手术治疗的BPH患者随机分为2组,分别行前列腺钬激光剜除术(HoLEP)和经尿道前列腺电切术(TURP)。监测、记录2组患者围手术期和术后1、3、6个月复查指标,比较最大尿流率(maximum flow rate,Qmax)、国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life score,QOL)等变化并进行统计学分析,比较两种术式近期临床疗效。结果术前两组患者一般情况和国际前列腺症状评分、生活质量评分、最大尿流率、残余尿量测量以及前列腺重量比较差异无统计学意义(P0.05);HoLEP组较TURP组术中出血量、手术时间、低钠血症的发生率、膀胱冲洗时间、留管时间都较低(P0.01);术后1个月、3个月及6个月2组IPSS、QOL和Qmax均比术前有明显改善(P0.01);但2组间比较并无显著统计学意义(P0.05)。结论 HoLEP术与TURP术相比,近期手术效果相似,且手术安全性更好,可视为治疗BPH的较好新方法。     

Pyogenic granuloma complicating pulsed-dye laser therapy for cherry angioma

A 37 year-old-woman presented for cosmetic removal of a 7-mm (diameter) cherry angioma on her right anterior thigh. Various treatment options were discussed and removal of the lesion using pulsed-dye laser was carried out. The patient returned 5 weeks later complaining of bleeding from the treatment site, which on examination showed a 23 × 23-mm friable nodular lesion with the typical appearance of a pyogenic granuloma. This lesion was removed by shave excision, curettage and electrodessication. Histopathological examination confirmed the diagnosis of pyogenic granuloma. This is a rare occurrence post pulsed-dye laser therapy that physicians may choose to discuss with patients prior to performing this procedure.     

Micro-island damage with a nonablative 1540-nm Er:Glass fractional laser device in human skin

Background and objectives  Fractional photothermolysis produces micro-islands of thermal injury to the skin while preserving areas among treated tissue sites in order to promote wound healing. Histological changes associated with single and multiple passes of the 1540-nm Er:Glass fractional laser were examined using in vivo human skin.
Methods and materials  Panni of five abdominoplasty patients were treated intraoperatively with a Fractional Lux1540 erbium glass laser system at various laser parameters, with single and multiple passes. Biopsies were removed and examined using standard histological stains.
Results  Deep coagulated columns of collagen separated by regions of unaffected tissue were observed at variable fluence parameters. A direct correlation between the depth of penetration of the coagulated microcolumns and increasing energies was observed. Micro-islands of coagulation were ∼250 μm in diameter and separated by ∼800 μm of unaffected tissue. With multiple passes, significantly more disruption of the dermal–epidermal junction (DEJ) occurred at higher fluences. In contrast to the controlled fractional columns observed with single-pass treatments, nonuniform coagulated columns were distributed randomly throughout the tissue when instituting multiple passes over the same treatment region.
Conclusion  Micro-islands of thermal damage were observed at variable energy parameters. Pathological changes within the skin were clearly dependent on amount of energy and number of passes of the laser treatment. Significantly more superficial damage, accompanied by disruption of the DEJ was observed with multiple passes when compared with single pass at similar fluences. However, with multiple passes, depth of thermal injury did not increase with increasing energies but did disrupt the micro-island array observed with single-pass fractional treatments.     

点阵激光的临床应用进展

由于点阵激光具有疗效肯定,安全性高和停工期短等优点,已成功用于治疗痤疮瘢痕和光老化等.与传统的剥脱性和非剥脱性激光不同,点阵激光仅作用部分皮肤,保留周围正常皮肤,从而有利于快速愈合和减少停工期.点阵激光通过微治疗孔传递高能量到达真皮层,从而保证疗效,而避免传统剥脱性激光容易出现的风险为持续性色素减退和瘢痕.概述近几年剥脱性和非剥脱性点阵激光在瘢痕、光老化、萎缩纹、色素性疾病、脱发和点阵激光经皮给药等的临床应用、机制和疗效.     

改良式后囊膜切开术治疗人工晶状体眼晶状体后囊膜混浊

目的：探讨改良式的Nd:YAG激光后囊膜切开术（张力线法）治疗人工晶状体（IOL）眼晶状体后囊膜混浊（PCO）的临床疗效并和传统的十字切开法进行对比。方法：前瞻性对照研究。选取2014 年12月至2015 年12 月在温州医科大学附属眼视光医院因单纯白内障摘除联合IOL植入术后伴发PCO需要行Nd:YAG激光后囊膜切开的患者57 例（60 眼）,按手术方式不同随机分为张力线法组和十字切开法组,每组各30眼。在术后第1天、1周和1个月复查。记录激光单次最小切开能量、点数、总能量、 手术时间以及患眼裸眼视力（UCVA）、最佳矫正视力（BCVA）、球镜度、柱镜度、等效球镜度（SE）、眼压（IOP）以及是否有眼前黑影症状。数据采用独立样本t 检验、卡方检验、重复测量的方差分析等进行分析。结果：十字切开法组和张力线法组术后UCVA（LogMAR）（ F =82.23、67.60,P < 0.001）、BCVA（LogMAR）（ F =40.08、34.78,P < 0.001）较术前均有明显提高,但2组间比较差异无统计学意义（P > 0.05）。张力线法组的激光单次最小切开能量、点数、总能量、手术时间均明显低于十字切开法组（t =3.55、5.79、6.19、8.26,P < 0.01）。张力线法组术后IOP较术前降低（F =3.48,P =0.031）,十字切开法组术后IOP无明显改变（P > 0.05）,2 组间比较差异无统计学意义。张力线法组和十字切开法组在术后出现黑影症状眼所占比例差异无统计学意义。2组术后柱镜度较术前均明显降低（F =9.54、 4.78,P < 0.05）,2 组间比较差异无统计学意义。2 组术后球镜度、SE较术前均无明显改变,2 组间比较差异无统计学意义。结论：改良的Nd:YAG激光后囊膜切开法（张力线法）治疗IOL眼晶状体后囊膜混浊安全有效。该方法相比传统的十字切开法所使用的激光能量小,手术时间短。     

Photo-induced cytomorphologic changes in an advanced cancer phase I clinical trial

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate whether the application of an Infrared Pulsed Laser Device (IPLD) photo-induced significant cytomorphologic changes during the monitoring of advanced cancer patients participating in a phase I clinical trial. MATERIALS AND METHODS: Patients were irradiated with an IPLD (904 nm pulsed at 3 MHz) under a one-dose, one-schedule, and one-procedure design. Total daily dose consisted of a Radiant Exposure of 4.5x10(5) J/m(2). Thirty-one tissue samples from eleven patients with progressive solid neoplastic diseases (TNM IV, UICC) were obtained at three intervals: Time 0 (15-90 days pre-treatment, n=11); Time I (2-5 months post-treatment; n=11); Time II (6-12 months post-treatment, n=09). Three blinded pathologists evaluated samples; scores were determined by consensus. Data were evaluated by using the Wilcoxon matched-pairs signed-rank test and Spearman rank correlation coefficient. The level of statistical significance was alpha=0.05. RESULTS: Increased apoptosis (Time I, P<0.003; Time II, P<0.007), necrosis (Time I, NS; Time II, P<0.01), cytoplasmic vacuoles (Time I, P<0.03; Time II, P<0.02), and nuclear vacuoles (Time I, NS; Time II, P<0.01), reduced cell size (Time I, P<0.007; Time II, P<0.01) and intercellular adhesion (Time I, P<0.01; Time II, P<0.02) were present in neoplastic cells after IPLD treatment. No apparent changes were noted in non-neoplastic cells. The Spearman rank correlation coefficient between apoptosis, necrosis, nuclear vacuoles, cytoplasmatic vacuoles, intercellular adhesion, and cell size was positive and highly significant (P<0.006). CONCLUSIONS: Although further research is necessary, our preliminary results support the novel possibility that the IPLD photo-induces chaotic dynamics that modulate complex physiologically reparative bioeffects.     

Effect of low-power laser irradiation on cell growth and procollagen synthesis of cultured fibroblasts

BACKGROUND AND OBJECTIVES: In dentistry, low-power lasers have been used in the treatment of dentin hypersensitivity, gingivitis, periodontitis, and different forms of oral ulcers. This in vitro study focuses on the biostimulation of NIH-3T3 fibroblasts by a low-power Ga-As-pulsed laser. STUDY DESIGN/MATERIALS AND METHODS: We have studied cell growth and procollagen synthesis of cultured fibroblasts submitted to low-power laser irradiation with energy densities varying from 3 to 5 J/cm(2) over a period of 1-6 days. The light source was a 120 mW Ga-As diode laser (lambda = 904 nm). Growth curves and procollagen immunoprecipitation were obtained. RESULTS: Irradiation of 3 and 4 J/cm(2) increased the cell numbers about threefold to sixfold comparing to control cultures. However, this effect was restricted to a small range of energy densities since 5 J/cm(2) had no effect on cell growth. The energy density of 3 J/cm(2) remarkably increased cell growth, with no effect on procollagen synthesis, as demonstrated by the immunoprecipitation analysis. CONCLUSIONS: Our results showed that a particular laser irradiation stimulates fibroblast proliferation, without impairing procollagen synthesis.