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Study Design/Materials (study + material)
Selected AbstractsEyelid Tightening and Improved Eyelid Aperture through Nonablative Fractional ResurfacingDERMATOLOGIC SURGERY, Issue 11 2008SEAN A. SUKAL MD BACKGROUND AND OBJECTIVE The effects of fractional resurfacing on eyelid tightening and aperture are unknown. Our purpose was to retrospectively examine the potential for eyelid tightening and eye-aperture opening in patients treated with nonablative fractional resurfacing for facial photorejuvenation. STUDY DESIGN/MATERIALS AND METHODS Fractional laser treatments using a 1,550-nm erbium-doped fiber laser system on the upper and lower eyelids were given at a pulse energy of 17 to 20 mJ at 125 micro-thermal zones (MTZ)/cm2 to a final density of 500 to 750 MTZ/cm2. Each patient had 3 to 7 treatments. Standard pre- and post-treatment photographs were taken at each visit. Physicians who graded 31 preselected patient photographs using a 4-point scale evaluated eyelid tightening. Increase in eyelid aperture was also evaluated. RESULTS All patients had some degree of eyelid tightening; 19% achieved 1% to 25% tightening, 26% achieved 25% to 50%, 26% achieved 50% to 75%, and 29% achieved 75% to 100%. Increase in eyelid aperture was seen in 55.9% of patients. Postoperative wounding, hypopigmentation, hyperpigmentation, persistent erythema, and scarring were not observed. All patients experienced mild or no edema for a few days after treatment. CONCLUSION Fractional resurfacing tightens and increases eyelid aperture without wounding, downtime, or long-term complications. [source] Magneto-motive detection of tissue-based macrophages by differential phase optical coherence tomographyLASERS IN SURGERY AND MEDICINE, Issue 3 2007Junghwan Oh PhD Abstract Background and Objectives A novel method to detect tissue-based macrophages using a combination of superparamagnetic iron oxide (SPIO) nanoparticles and differential phase optical coherence tomography (DP-OCT) with an external oscillating magnetic field is reported. Study Design/Material and Methods Magnetic force acting on iron-laden tissue-based macrophages was varied by applying a sinusoidal current to a solenoid containing a conical iron core that substantially focused and increased magnetic flux density. Results Nanoparticle motion was detected with DP-OCT, which can detect tissue movement with nanometer resolution. Frequency response of iron-laden tissue movement was twice the modulation frequency since the magnetic force is proportional to the product of magnetic flux density and gradient. Conclusions Results of our experiments indicate that DP-OCT can be used to identify tissue-based macrophage when excited by an external focused oscillating magnetic field. Lasers Surg. Med. 39:266,272, 2007. © 2007 Wiley-Liss, Inc. [source] Removal of amateur blue-black tattoos in Arabic women of skin type (III,IV) with Q-switched alexandrite laserJOURNAL OF COSMETIC DERMATOLOGY, Issue 2 2005Iqbal A Bukhari Summary Background and Objectives, Tattoos in Arabic society used to have a cosmetic importance on the face of females. These were usually amateur tattoos done by non-professional women in the tribe. Because Islam as a religion prohibited its practice and its application, people became concerned about removing the old tattoos by any means. Nowadays, laser is considered an effective method of tattoo removal. Here, we report our experience in the removal of tattoos in Arabic women of skin type III,IV using the Q-switched alexandrite laser. Study Design/Materials and Methods, Twenty female subjects aged 35,50 years from similar racial and ethnic background with amateur tattoos were treated using the Q-switched alexandrite laser. Fluence threshold was determined and a spot test was made. Q-switched alexandrite laser with a fluence range 4.0,7.5 J/cm2 (mean 6.05) was used at 6,12-week intervals. Total treatment numbers ranged from three to six sessions (mean 4.15) with single-pulse technique application. Results, More than 95% lightening was achieved in five patients after three to six sessions at fluence range of 6,7.5 J/cm2 and > 75% lightening in 10 subjects after three to six sessions of treatment at fluence range of 4,7.5 J/cm2. Pinpoint bleeding was observed in one case but no pigmentary alteration or scarring was seen. Conclusion, Tattoo pigment removal by Q-switched alexandrite laser is an effective method in skin type (III,IV) with minimal side effects, which gives high patient satisfaction. [source] Increasing the efficiency of photodynamic therapy by improved light delivery and oxygen supply using an anticoagulant in a solid tumor modelLASERS IN SURGERY AND MEDICINE, Issue 7 2010Liyong Yang MS Abstract Background and Objective The main factors in photodynamic therapy (PDT) are: photosensitizer retention, photon absorption, and oxygen supply. Each factor has its unique set of problems that poses limitation to the treatment. Both light delivery and oxygen supply are significant bottlenecks in PDT. Vascular closure during PDT reduces oxygen supply to the targeted tissue. On the other hand, with the changes in blood perfusion, the tissue optical properties change, and result in variation in irradiation light transmission. For these reasons, it becomes very important to avoid blood coagulation and vascular closure during PDT. Study Design/Materials and Methods The efficiency of PDT combined with the anticoagulant heparin was studied in a BALB/c mouse model with subcutaneous EMT6 mammary carcinomas. Mice were randomized into three groups: control, PDT-only, and PDT with heparin. The photosensitizer Photofrin® was used in our experiments. Light transmission, blood perfusion, and local production of reactive oxygen species (ROS) were monitored during the treatment. The corresponding histological examinations were performed to determine the thrombosis immediately after irradiation and to evaluate tumor necrosis 48,hours after the treatment. Results The results clearly demonstrated that PDT combined with pre-administered heparin can significantly reduce thrombosis during light irradiation. The blood perfusion, oxygen supply, and light delivery are all improved. Improved tumor responses in the combined therapy, as shown with the histological examination and tumor growth assay, are clearly demonstrated and related to an increased local ROS production. Conclusion Transitory anticoagulation treatment significantly enhances the antitumor effect of PDT. It is mainly due to the improvement of the light delivery and oxygen supply in tumor, and ultimately the amount of ROS produced during PDT. Lasers Surg. Med. 42:671,679, 2010. © 2010 Wiley-Liss, Inc. [source] Effect of pulsing in low-level light therapy,LASERS IN SURGERY AND MEDICINE, Issue 6 2010Javad T. Hashmi MD Abstract Background and Objective Low level light (or laser) therapy (LLLT) is a rapidly growing modality used in physical therapy, chiropractic, sports medicine and increasingly in mainstream medicine. LLLT is used to increase wound healing and tissue regeneration, to relieve pain and inflammation, to prevent tissue death, to mitigate degeneration in many neurological indications. While some agreement has emerged on the best wavelengths of light and a range of acceptable dosages to be used (irradiance and fluence), there is no agreement on whether continuous wave or pulsed light is best and on what factors govern the pulse parameters to be chosen. Study Design/Materials and Methods The published peer-reviewed literature was reviewed between 1970 and 2010. Results The basic molecular and cellular mechanisms of LLLT are discussed. The type of pulsed light sources available and the parameters that govern their pulse structure are outlined. Studies that have compared continuous wave and pulsed light in both animals and patients are reviewed. Frequencies used in other pulsed modalities used in physical therapy and biomedicine are compared to those used in LLLT. Conclusion There is some evidence that pulsed light does have effects that are different from those of continuous wave light. However further work is needed to define these effects for different disease conditions and pulse structures. Lasers Surg. Med. 42:450,466, 2010. © 2010 Wiley,Liss, Inc. [source] Varying ratios of wavelengths in dual wavelength LED photomodulation alters gene expression profiles in human skin fibroblastsLASERS IN SURGERY AND MEDICINE, Issue 6 2010D.H. McDaniel MD Abstract Background and Objective LED photomodulation has been shown to profoundly influence cellular behavior. A variety of parameters with LED photomodulation can alter cellular response in vitro. The effects of one visible and one infrared wavelength were evaluated to determine the optimal ratio to produce a net increase in dermal collagen by altering the ratio of total energy output of each wavelength. The ratio between the two wavelengths (590 and 870,nm) was shifted in 25% increments. Study Design/Materials and Methods Human skin fibroblasts in culture were exposed to a 590/870,nm LED array with total combined energy density fixed at 4.0,mW/cm.. The ratio of 590/870,nm tested parameters were: 100/0%, 75/25%, 50/50%, 25/75%, and 0/100%. These ratios were delivered using pulsed duty cycle of exposure (250,milliseconds "on" time/100,milliseconds "off" time/100,pulses) for a total energy fluence of 0.1,J/cm.. Gene expression was examined using commercially available extra cellular matrix and adhesion molecule RT PCR Arrays (SA Biosciences, Fredrick, MD) at 24,hours post-exposure. Results Different expression profiles were noticed for each of the ratios studied. Overall, there was an average (in an 80 gene array) of 6% expression difference in up or downregulation between the arrays. The greatest increase in collagen I and decrease in collagenase (MMP-1) was observed with 75/25% ratio of 590/870,nm. The addition of increasing proportions of IR wavelengths causes alteration in gene expression profile. The ratios of the wavelengths caused variation in magnitude of expression. Conclusions Cell metabolism and gene expression can be altered by simultaneous exposure to multiple wavelengths of low energy light. Varying the ratios of specific wavelength intensity in both visible and near infrared light therapy can strongly influence resulting fibroblast gene expression patterns. Lasers Surg. Med. 42:540,545, 2010. © 2010 Wiley,Liss, Inc. [source] Hyperthermic injury to adipocyte cells by selective heating of subcutaneous fat with a novel radiofrequency device: Feasibility studiesLASERS IN SURGERY AND MEDICINE, Issue 5 2010Walfre Franco PhD Abstract Background and Objective The main objective of the present study is to demonstrate the feasibility of utilizing a novel non-invasive radiofrequency (RF) device to induce lethal thermal damage to subcutaneous adipose tissue only by establishing a controlled electric field that heats up fat preferentially. Study Design/Materials and Methods Adipocyte cells in six-well plates were subjected to hyperthermic conditions: 45, 50, 55, 60, and 65°C during 1, 2, and 3,minutes. Cell viability was assessed 72,hours after exposure. Two groups of abdominoplasty patients were treated with the RF device during and days before their surgical procedure. Temperatures of cutaneous and subcutaneous tissues were measured during treatment (3,minutes) of the first group. The immediate tissue response to heating was assessed by acute histology. The delayed tissue response was assessed by histology analysis of the second group, 4, 9, 10, 17, and 24 days after treatment (22,minutes). A mathematical model was used to estimate treatment temperatures of the second group. The model uses patient-based diagnostic measurements as input and was validated with in vivo clinical temperature measurements. Results Cell viability dropped from 89% to 20% when temperature increased from 45 to 50°C during 1,minute exposures. Three minutes at 45°C resulted in 40% viability. In vivo, the temperature of adipose tissue at 7,12,mm depth from the surface increased to 50°C while the temperature of cutaneous tissues was <30°C during RF exposure. Acute and longitudinal histology evaluations show normal epidermal and dermal layers. Subcutaneous tissues were also normal acutely. Subcutaneous vascular alterations, starting at day 4, and fat necrosis, starting at day 9, were consistently observed within 4.5,19,mm depth from the skin surface. Subcutaneous tissue temperatures were estimated to be 43,45°C for 15,minutes. Conclusions A controlled internal electric field perpendicular to the skin,fat interface is selective in heating up fat and, consequently, has the ability to induce lethal thermal damage to subcutaneous adipose tissues while sparing overlying and underlying tissues. In vitro adipocyte cells are heat sensitive to thermal exposures of 50 and 45°C on the order of minutes, 1 and 3,minutes, respectively. In vivo, 15,minutes thermal exposures to 43,45°C result in a delayed adipocyte cellular death response,in this study, 9 days. The novel RF device presented herein effectively delivers therapeutic thermal exposures to subcutaneous adipose tissues while protecting epidermal and dermal layers. Lasers Surg. Med. 42:361,370, 2010. © 2010 Wiley,Liss, Inc. [source] Diode laser hair removal does not interfere with botulinum toxin A treatment against axillary hyperhidrosisLASERS IN SURGERY AND MEDICINE, Issue 3 2010Anna Paul MD Abstract Background and Objective The possible interference of combined laser hair removal and Botulinum toxin A (BoNT/A) injections in the treatment of axillary hyperhidrosis has not previously been explored. In order to examine this potential interference, we assessed the effect of BoNT/A on axillary hyperhidrosis with and without concomitant diode laser axillary hair removal. Study Design/Materials and Methods In a prospective, double blind, randomized cross over trial, nine patients suffering from primary axillary hyperhidrosis were laser-treated on one randomly assigned axilla. One week later, both axillas were injected intradermally with BoNT/A (100,MU per axilla). During the same session, the previously untreated axilla was lasered. Axillary sweat rates (in g/5,minutes.) were determined by gravimetry and compared at rest, during mental exercise, and during physical exercise. Additionally, subjective outcome measures were assessed by a visual analogue scale, Dermatology Life Quality Index, and Global Clinical Impression score. Results No differences were found regarding the effect of BoNT/A on previously laser-treated and laser co-treated sides over time course for any of the outcome parameters. Sweat production was reduced 3 weeks after BoNT/A treatment by 93.5% at rest, 96.5% during mental exercise, and 67% during physical exercise. Conclusions Concomitant laser hair removal does not interfere with BoNT/A treatment on axillary hyperhidrosis. Lasers Surg. Med. 42:211,214, 2010. © 2010 Wiley-Liss, Inc. [source] Long-term efficacy of a fractional resurfacing device,,§LASERS IN SURGERY AND MEDICINE, Issue 2 2010Arisa E. Ortiz MD Abstract Background and Objective Recently, there has been much debate regarding the long-term efficacy of fractional resurfacing devices. While pulsed CO2 laser resurfacing is considered a highly effective treatment, fractionated resurfacing is a newer modality and its long-term efficacy has yet to be assessed. We report the long-term outcomes of subjects previously treated with fractional CO2 resurfacing for photodamaged skin and acne scars. Study Design/Materials and Methods Ten subjects from our previous studies who received fractional resurfacing for the treatment of acne scarring and photodamage returned for long-term follow-up visits at 1 and 2 years, respectively. Investigators graded maintenance of improvement on a quartile scale based on clinical photography. Results Subjects maintained 74% of their overall improvement at their long-term visits compared to 3-month follow-up visits. While clinical improvement was maintained long-term, the results were not as remarkable as those seen at 3-month visits. The authors speculate that results seen at 3 months may be enhanced by persistent inflammatory changes, as evidenced by heat shock protein 47 activity and ongoing collagen remodeling seen in previous histologic studies. Relaxation of tightening is to be expected with any procedure along with the natural progression of aging. However, patient satisfaction was upheld long-term. Conclusion Fractional CO2 laser resurfacing does have long-term efficacy and persistence of improvement of acne scarring and photodamage compared to baseline. However, additional treatments may be necessary to enhance long-term results. Lasers Surg. Med. 42:168,170, 2010. © 2010 Wiley-Liss, Inc. [source] Optical touch pointer for fluorescence guided glioblastoma resection using 5-aminolevulinic acid,LASERS IN SURGERY AND MEDICINE, Issue 1 2010Neda Haj-Hosseini MS Abstract Background and Objective Total tumor resection in patients with glioblastoma multiforme (GBM) is difficult to achieve due to the tumor's infiltrative way of growing and morphological similarity to the surrounding functioning brain tissue. The diagnosis is usually subjectively performed using a surgical microscope. The objective of this study was to develop and evaluate a hand-held optical touch pointer using a fluorescence spectroscopy system to quantitatively distinguish healthy from malignant brain tissue intraoperatively. Study Design/Materials and Methods A fluorescence spectroscopy system with pulsed modulation was designed considering optimum energy delivery to the tissue, minimal photobleaching of PpIX and omission of the ambient light background in the operating room (OR). 5-Aminolevulinic acid (5-ALA) of 5,mg/kg body weight was given to the patients with a presumed GBM prior to surgery. During the surgery a laser pulse at 405,nm was delivered to the tissue. PpIX in glioblastoma tumor cells assigned with peaks at 635 and 704,nm was detected using a fiber optical probe. Results/Conclusion By using the pulsed fluorescence spectroscopy, PpIX fluorescence is quantitatively detected in the GBM. An effective suppression of low power lamp background from the recorded spectra in addition to a significant reduction of high power surgical lights is achieved. Lasers Surg. Med. 42:9,14, 2010. © 2010 Wiley-Liss, Inc. [source] Non-invasive cryolipolysisÔ for subcutaneous fat reduction does not affect serum lipid levels or liver function tests,LASERS IN SURGERY AND MEDICINE, Issue 10 2009Kenneth B. Klein MD Abstract Background and Objective Cryolipolysis provides a method of non-invasive fat reduction that significantly reduces subcutaneous fat without injury to adjacent tissues. Preliminary animal and human data have suggested that cryolipolysis has no effect on serum lipid profiles or liver tests. This study was intended to more fully document any effect of this procedure on lipid and liver-related blood tests. Study Design/Materials and Methods Forty subjects with fat bulges on their flanks ("love handles") were treated bilaterally with a non-invasive device (Zeltiq Aesthetics, Pleasanton, CA) that precisely cools tissue to achieve a reduction in the fat layer. Serum lipid levels and liver tests were measured prior to treatment, and at 1 day and 1, 4, 8, and 12 weeks post-treatment. Results No meaningful changes in mean values were observed for any blood lipid level or liver test at any point over the 12-week follow-up period. Conclusion Cryolipolysis, when used for reduction of subcutaneous flank fat, is not associated with changes in serum lipids or liver test results. Lasers Surg. Med. 41:785,790, 2009. © 2009 Wiley-Liss, Inc. [source] Comparison of a 1,550,nm Erbium:Glass fractional laser and a chemical reconstruction of skin scars (CROSS) method in the treatment of acne scars: A simultaneous split-face trialLASERS IN SURGERY AND MEDICINE, Issue 8 2009Hee Jung Kim MD Abstract Background and Objective Acne scarring is a common complication of acne but no effective single treatment modality has been developed. To compare the efficacy of 1,550,nm Er:Glass fractional laser and chemical reconstruction of skin scar (CROSS) method in the treatment of acne scars. Study Design/Materials and Methods A split-face trial was conducted in 20 patients (10 rolling, 10 icepick types) with acne scars. One side was treated with the 1,550,nm Er:Glass fractional laser three times with a 6-week interval. And the other side was treated with CROSS method two times every 12 weeks. Results Significant improvement was observed in both sides of the face. In rolling type, the objective and subjective improvement rates were significantly higher in the sides treated with laser than CROSS method. However, in icepick type, there were no statistically significant differences between the two treatment sides. In the laser sides, grades of pain were significantly higher than that of treated with CROSS method. However, downtimes and lasting days of erythema were significantly longer in the sides treated with CROSS method. Conclusion A 1,550,nm Er:Glass fractional laser and CROSS method are both well-tolerated and effective treatment options in the acne scars. However, there was a relatively small difference between the two treatment modalities. Therefore, dermatologists should consider the acne scar type to select the treatment options. Lasers Surg. Med. 41:545,549, 2009. © 2009 Wiley-Liss, Inc. [source] Clinical evaluation of a single-wavelength fractional laser and a novel multi-wavelength fractional laser in the treatment of photodamaged skin,LASERS IN SURGERY AND MEDICINE, Issue 6 2009Laurel Naversen Geraghty BA Abstract Background and Objectives Nonablative fractional lasers are well recognized for rejuvenating photoaged skin. We previously reported favorable outcomes with short follow-up after the use of 1,440-nm Nd:YAG laser energy used alone or in combination with a 1,320-nm laser to effect rejuvenation and wrinkle reduction. We now report longer follow-up data. Study Design/Materials and Methods Nineteen Caucasian subjects (average age 47±8.4; range 33,62) exhibiting mild-to-moderate photoaging of the face and neck were treated four times (average interval 18.1± 4.1 days; range 11,37 days) with the 1,440-nm Nd:YAG fractional laser (average fluence 3.7±0.3,J/cm2) or the 1,320/1,440-nm multiplex Nd:YAG fractional laser (1,320-nm average fluence 8.4±0.4,J/cm2; 1,440-nm average fluence 2.3±0.2,J/cm2). Outcomes were assessed by subjects and the treating physician using a quartile scale to evaluate skin tightening, surface texture, rhytids, dyschromia, erythema, and global appearance after 1, 3, and 6 months. Retroauricular punch biopsies from three patients were used to evaluate wound healing. Three patients withdrew from the study prior to evaluation, one missed the 1-month evaluation, and one missed the 6-month evaluation. Results Assessment by subjects and the treating physician revealed clinical improvement for all outcomes after 1, 3, and 6 months. The differences between the treatment groups were not statistically significant. Subjects demonstrated the greatest average 6-month improvements in surface texture and global skin appearance. Subjects treated with the multiplex laser reported more skin tightening than the group treated only with the 1,440-nm laser. Histological evaluation revealed wound healing within 10 days and significant neocollagenesis at 3 months. No adverse events were reported in any subject. Conclusion The 1,440-nm Nd:YAG and 1,320/1,440-nm multiplex Nd:YAG lasers safely and effectively produced improved surface texture, rhytids, dyschromia, erythema, global skin appearance, and skin tightening. Histopathologic findings correlated with clinical observations. Lasers Surg. Med. 41:408,426, 2009. © 2009 Wiley-Liss, Inc. [source] The effect of 595,nm pulsed dye laser on superficial and nodular basal cell carcinomasLASERS IN SURGERY AND MEDICINE, Issue 6 2009Sonali M. Shah MD Abstract Background and Objective Basal cell carcinomas (BCCs) have supporting vasculature that could serve as a target for 595,nm pulsed dye laser (PDL). The objective of this study was to determine the effect of repeated PDL treatments on BCCs of superficial and nodular subtypes and of varying diameters. Study Design/Materials and Methods Twenty biopsy-proven BCCs received four 595,nm PDL treatments at 2-week intervals. The tumor and 4,mm of peripheral skin were treated using a set of previously optimized laser parameters: one pass, 15,J/cm2 energy, 3,ms pulse length, no cooling, and 7,mm spot size with 10% overlap. The treated area was excised and evaluated histologically for residual tumor. Histologic response rates of the PDL treated BCCs were compared with that of non-PDL treated, matched control tumors. Results Nearly all BCCs <1.5,cm in diameter (n,=,12) showed complete response to four PDL treatments (91.7%; n,=,11/12) versus 16.7% of controls (n,=,2/12, P -value,= 0.0003). BCCs ,1.5,cm in diameter (n,=,8) showed a complete response rate of 25% (n,=,2/8) versus 0% of controls (n,=,0/8, P -value,=,0.2). Mean clinical tumor diameter of the complete responders was 1.1,cm (n,=,13) versus 2.2,cm (n,=,7) for incomplete responders (P -value,=,0.005). Tumor histologic types among the complete responders included superficial, nodular, micronodular, and keratinizing. Incompletely responding BCCs showed a significant reduction in tumor burden after PDL treatment, with residual histologic tumor burden ranging from <1% to 29% of the original clinical tumor diameter, compared to 13,68% residual tumor burden for the corresponding controls (P -value,=,0.05). Conclusions PDL is an effective means of reducing tumor burden in patients with large BCCs and may be an alternative therapy in BCCs <1.5,cm in diameter. Lasers Surg. Med. 41:417,422, 2009. © 2009 Wiley-Liss, Inc. [source] Treatment of Helicobacter pylori infection with intra-gastric violet light phototherapy: A pilot clinical trial,LASERS IN SURGERY AND MEDICINE, Issue 5 2009Anthony J. Lembo MD Abstract Background and Objective Helicobacter pylori infects the mucus layer of the human stomach and causes peptic ulcers and adenocarcinoma. We have previously shown that H. pylori accumulates photoactive porphyrins making the organism susceptible to inactivation by light, and that small spot endoscopic illumination with violet light reduced bacterial load in human stomachs. This study assessed the feasibility and safety of whole-stomach intra-gastric violet phototherapy for the treatment of H. pylori infection. Study Design/Materials and Methods A controlled, prospective pilot trial was conducted using a novel light source consisting of laser diodes and diffusing fibers to deliver 408-nm illumination at escalating total fluences to the whole stomach. Eighteen adults (10 female) with H. pylori infection were treated at three U.S. academic endoscopy centers. Quantitative bacterial counts were obtained from biopsies taken from the antrum, body, and fundus, and serial urea breath tests. Results The largest reduction in bacterial load was in the antrum (>97%), followed by body (>95%) and fundus (>86%). There was a correlation between log reduction and initial bacterial load in the antrum. There was no dose,response seen with increasing illumination times. The urea breath test results indicated that the bacteria repopulated in days following illumination. Conclusion Intra-gastric violet light phototherapy is feasible and safe and may represent a novel approach to eradication of H. pylori, particularly in patients who have failed standard antibiotic treatment. This was a pilot study involving a small number of patients. Further research is needed to determine if phototherapy can be effective for eradicating H. pylori. Lasers Surg. Med. 41:337,344, 2009. © 2009 Wiley-Liss, Inc. [source] Pulpal effects of enamel ablation with a microsecond pulsed ,,=,9.3-µm CO2 laserLASERS IN SURGERY AND MEDICINE, Issue 4 2009Michal Staninec DDS Abstract Background and Objectives In vitro studies have shown that CO2 lasers operating at the highly absorbed 9.3 and 9.6-µm wavelengths with a pulse duration in the range of 10,20-microsecond are well suited for the efficient ablation of enamel and dentin with minimal peripheral thermal damage. Even though these CO2 lasers are highly promising, they have yet to receive FDA approval. Clinical studies are necessary to determine if excessive heat deposition in the tooth may have any detrimental pulpal effects, particularly at higher ablative fluencies. The purpose of this study was to evaluate the pulpal safety of laser irradiation of tooth occlusal surfaces under the conditions required for small conservative preparations confined to enamel. Study Design/Materials and Methods Test subjects requiring removal of third molar teeth were recruited and teeth scheduled for extraction were irradiated using a pulsed CO2 laser at a wavelength of 9.3 µm operating at 25 or 50 Hz using a incident fluence of 20 J/cm2 for a total of 3,000 laser pulses (36 J) for both rates with water cooling. Two control groups were used, one with no treatment and one with a small cut made with a conventional high-speed hand-piece. No anesthetic was used for any of the procedures and tooth vitality was evaluated prior to treatment by heat, cold and electrical testing. Short term effects were observed on teeth extracted within 72 hours after treatment and long term effects were observed on teeth extracted 90 days after treatment. The pulps of the teeth were fixed with formalin immediately after extraction and subjected to histological examination. Additionally, micro-thermocouple measurements were used to estimate the potential temperature rise in the pulp chamber of extracted teeth employing the same irradiation conditions used in vivo. Results Pulpal thermocouple measurements showed the internal temperature rise in the tooth was within safe limits, 3.3±1.4°C without water cooling versus 1.7±1.6°C with water-cooling, n,=,25, P<0.05. None of the control or treatment groups showed any deleterious effects on pulpal tissues and none of the 29 test-subjects felt pain or discomfort after the procedure. Only two test-subjects felt discomfort from "cold sensitivity" during the procedure caused by the water-spray. Conclusion It appears that this CO2 laser can ablate enamel safely without harming the pulp under the rate of energy deposition employed in this study. Lasers Surg. Med. 41:256,263, 2009. © 2009 Wiley-Liss, Inc. [source] Complications of fractional CO2 laser resurfacing: Four casesLASERS IN SURGERY AND MEDICINE, Issue 3 2009Douglas J. Fife MD Abstract Background and Objective Fractional ablative laser therapy is a new modality which will likely be widely used due to its efficacy and limited side-effect profile. It is critical to recognize, characterize, and report complications in order to acknowledge the limits of therapeutic efficacy and to improve the safety of these devices. Study Design/Materials and Methods The photographs, treatment parameters, and clinical files of four female patients aged 54,67 who had scarring or ectropion after fractional CO2 laser resurfacing on the face or neck were carefully reviewed to search for any possible linking factors. Results Patient 1 developed erosions and swelling of the right lower eyelid 2 days postoperatively, which developed into scarring and an ectropion. Patient 2 developed linear erosions and beefy red swelling on the right side of the neck which developed into a tender, band-like scar over 1-month. Patient 3 developed stinging and yellow exudate in multiple areas of the neck 3 days postoperatively. Cultures grew methicillin-resistant Staphylococcus aureus. Despite appropriate treatment, she developed multiple areas of irregular texture and linear streaking which developed into scars. Patient 4 developed an asymptomatic patchy, soft eschar with yellowish change on the left side of the neck. Azithromycin was started, however at 2-week follow-up she had fibrotic streaking which developed into horizontal scars and a vertical platysmal band. The treatment and final outcome of each patient are described. Conclusion Scarring after fractional CO2 laser therapy may be due to overly aggressive treatments in sensitive areas (including excessive energy, density, or both), lack of technical finesse, associated infection, or idiopathic. Care should be taken when treating sensitive areas such as the eyelids, upper neck, and especially the lower neck and chest by using lower energy and density. Postoperative infections may lead to scarring and may be prevented by careful taking of history, vigilant postoperative monitoring and/or prophylactic antibiotics. Lasers Surg. Med. 41:179,184, 2009. © 2009 Wiley-Liss, Inc. [source] Fractional deep dermal ablation induces tissue tightening,LASERS IN SURGERY AND MEDICINE, Issue 2 2009Zakia Rahman MD Abstract Background and Objective Due to the significant risk profile associated with traditional ablative resurfacing, a safer and less invasive treatment approach known as fractional deep dermal ablation (FDDAÔ) was recently developed. We report the results of the first clinical investigation of this modality for treatment of photodamaged skin. Study Design/Materials and Methods Twenty-four subjects received treatments on the inner forearm with a prototype fractional CO2 laser device (Reliant Technologies Inc., Mountain View, CA) at settings of 5,40 mJ/MTZ and 400 MTZ/cm2. Clinical and histological effects were assessed by study investigators 1 week, 1 month, and 3 months following treatment. Thirty subjects were then enrolled in a multi-center study for treatment of photodamage using the same device. Subjects received 1,2 treatments on the face and neck, with energies ranging from 10 to 40 mJ/MTZ and densities ranging from 400 to 1,200 MTZ/cm2. Study investigators assessed severity of post-treatment responses during follow-up visits 48 hours, 1 week, 1 month, and 3 months following treatment. Using a standard quartile improvement scale (0,4), subjects and investigators assessed improvement in rhytides, pigmentation, texture, laxity and overall appearance 1 and 3 months post-treatment. Results Clinical and histologic results demonstrated that fractional delivery of a 10,600 nm CO2 laser source offers an improved safety profile with respect to traditional ablative resurfacing, while still effectively resurfacing epidermal and dermal tissue. Forearm and facial treatments were well-tolerated with no serious adverse events observed. Eighty-three percent of subjects exhibited moderate or better overall improvement (50,100%), according to study investigator quartile scoring. Conclusions FDDAÔ treatment is a safe and promising new approach for resurfacing of epidermal and deep dermal tissue targets. Lasers Surg. Med. 41:78,86, 2009. © 2009 Wiley-Liss, Inc. [source] Pilot clinical study of a novel minimally invasive bipolar microneedle radiofrequency device,LASERS IN SURGERY AND MEDICINE, Issue 2 2009Basil M. Hantash MD Abstract Background and Objectives Noninvasive bipolar and monopolar radiofrequency (RF) deep dermal heating devices have previously been described. A novel minimally invasive RF device employing a bipolar microneedle electrode system is introduced and its resultant thermal effects on human skin in vivo were characterized for the first time. Study Design/Materials and Methods An investigational 35 W RF device was configured to operate in bipolar mode delivering energy directly within the dermis using 5 microneedle electrode pairs with real-time feedback of tissue temperature for treatment control. Superficial cooling was achieved using a Peltier device. A range of pulse durations between 1 and 25 seconds, and lesion temperatures between 60 and 80°C were tested in vivo on 15 human subjects. Thermal effects were assessed histologically using either hematoxylin & eosin (H&E) or nitroblue-tetrazoliumchloride (NBTC) staining. Treatment effects and adverse events were also monitored clinically. Results The investigational bipolar RF device delivered controlled heating within dermal tissue. Histological staining with H&E revealed the presence of zones of denatured collagen within the reticular dermis. Lesions were generated at preselected temperatures between 60 and 80°C. Fractional lesions separated by zones of sparing as well as contiguous lesion patterns were demonstrated. Histological staining with H&E and NBTC revealed sparing of adnexal structures and adipose tissue. No major adverse events were observed. Conclusions A novel fractional RF device utilizing a minimally invasive bipolar microneedle delivery system for the treatment of human tissue was developed. Treatment of 15 human subjects illustrated the controlled creation of dermally located thermal coagulation zones, herein known as radiofrequency thermal zones. We discovered that varying the pulse length allowed for fractional sparing of dermal tissue. To our knowledge, this is the first report to describe use of a direct real-time temperature and impedance feedback system to control energy delivery during deep dermal heating. Lasers Surg. Med. 41:87,95, 2009. © 2009 Wiley-Liss, Inc. [source] Porphyrin distribution after topical aminolevulinic acid in a novel porcine model of sebaceous skin,,LASERS IN SURGERY AND MEDICINE, Issue 2 2009Fernanda H. Sakamoto MD Abstract Background and Objective Aminolevulinic acid photodynamic therapy (ALA-PDT) depends on drug metabolism into porphyrins. Clinically, ALA-PDT has been used with a wide range of protocols for treating both epidermal and dermal targets, despite limited understanding of porphyrin biodistribution over time. We studied porphyrin accumulation after topical application of ALA in vivo, and also describe the porcine ear as a new animal model to study adnexal glands. Study Design/Materials and Methods The microanatomy of anterior ear skin of swine was measured. Topical 20% ALA in water/ethanol was applied under occlusion. Biopsies taken after 5, 10, 15, and then every 15 minutes for a total of 3 hours were examined by fluorescence microscopy of frozen sections to assess accumulation and distribution of porphyrins. Results Porphyrin fluorescence of digital photomicrograph images was not visually apparent until 30,45 minutes after application, although quantitative pixel analysis showed a statistically significant increase in epidermal fluorescence only 15 minutes after ALA application. From 30 to 120 minutes, epidermis, hair follicles (HF), and sebaceous glands (SG) became progressively more fluorescent. Eccrine gland fluorescence began to be detected after 30 minutes; SG showed fluorescence starting at 45,75 minutes. Fluorescence in all sites reached maximum intensity from 75 to 180 minutes of incubation. There was a trend for HF and SG to express stronger fluorescence compared with epidermis and eccrine glands. Conclusion Anterior pig ear skin is microanatomically similar to human sebaceous skin. The time-dependent accumulation of porphyrins in pilosebaceous units and eccrine glands in this model suggests other routes of uptake of topical ALA in addition to the trans-epidermal route. Apparently, time interval between ALA application and light exposure could be optimized for different uses of ALA-PDT. Lasers Surg. Med. 41:154,160, 2009. © 2009 Wiley-Liss, Inc. [source] Ultrasound guidance and monitoring of laser-based fat removalLASERS IN SURGERY AND MEDICINE, Issue 10 2008Jignesh Shah MS Abstract Background and Objectives We report on a study to investigate feasibility of utilizing ultrasound imaging to guide laser removal of subcutaneous fat. Ultrasound imaging can be used to identify the tissue composition and to monitor the temperature increase in response to laser irradiation. Study Design/Materials and Methods Laser heating was performed on ex vivo porcine subcutaneous fat through the overlying skin using a continuous wave laser operating at 1,210 nm optical wavelength. Ultrasound images were recorded using a 10 MHz linear array-based ultrasound imaging system. Results Ultrasound imaging was utilized to differentiate between water-based and lipid-based regions within the porcine tissue and to identify the dermis-fat junction. Temperature maps during the laser exposure in the skin and fatty tissue layers were computed. Conclusions Results of our study demonstrate the potential of using ultrasound imaging to guide laser fat removal. Lasers Surg. Med. 40:680,687, 2008. © 2008 Wiley-Liss, Inc. [source] Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone for treatment of port wine stain birthmarksLASERS IN SURGERY AND MEDICINE, Issue 9 2008Cheng-Jen Chang MD Abstract Background and Objective The objective of this study was to improve port wine stain (PWS) therapeutic outcome in response to laser therapy. Our specific aim was to determine whether the combined use of pulsed dye laser (PDL) therapy and topical Imiquimod versus PDL alone can improve PWS therapeutic outcome. Study Design/Materials and Methods This pilot study involved a retrospective review of 20 subjects, all Asian, with PWS. Subject ages ranged between 3 and 56 years. Upon enrollment, three test sites were prospectively identified on each subject for treatment assignments to the following regimens: (A) PDL+Imiquimod; (B) PDL alone; and (C) Imiquimod alone. PDL test sites received a single treatment with a 585 nm wavelength; 1.5 milliseconds pulse duration; spot size 7 mm using a light dosage of 10 J/cm2 with cryogen spray cooling. For the PDL+Imiquimod and Imiquimod alone test sites, subjects were instructed to apply Imiquimod topically to the sites once daily for 1 month after PDL exposure. Subjects were followed-up at 1, 3, 6, and 12 months after PDL exposure to evaluate each of the three test sites. The primary efficacy measurement was the quantitative assessment of blanching responses as measured by a DermoSpectrometer to calculate the hemoglobin-index of each site at 1, 3, 6, and 12 months after PDL exposure. Subjects were also closely monitored for any adverse effects. Results Based on paired sample test analysis, there were clinically, and statistically significant, differences in blanching responses over time favoring PWS receiving PDL+Imiquimod as compared to either PDL or Imiquimod alone (P<0.05). At 12 months, it should be noted that there was some evidence of redarkening of PWS test sites treated by PDL+Imiquimod and PDL alone, presumably due to revascularization of blood vessels. However, based on comparison of the hemoglobin-indices determined at 1 and 12 months after PDL exposure, there was less revascularization of PWS test sites treated with PDL+Imiquimod as compared to PDL alone (P<0.05). Transient hyperpigmentation was noted in 10% (n,=,2) and 40% (n,=,8) of subjects on the PDL+Imiquimod and PDL alone test sites, respectively. On all sites, hyperpigmentation resolved spontaneously without medical intervention within 6 months. Permanent hypopigmentation or scarring was not observed on any test site. Conclusion Based on the results of this pilot study, PDL+Imiquimod resulted in superior blanching responses over time as compared to PDL alone for treatment of test sites on PWS lesions. Although the PDL+Imiquimod approach is intriguing, clinical validation in large PWS patient samples is required. Lesers Surg. Med. 40:605,610, 2008. © 2008 Wiley-Liss, Inc. [source] Photodynamic therapy of cervical intraepithelial neoplasia with hexaminolevulinate,LASERS IN SURGERY AND MEDICINE, Issue 9 2008Philipp Soergel MD Abstract Background and Objective CIN is a disease of women in their reproductive years, and treatment includes excisional techniques with increased risk of preterm deliveries. Photodynamic therapy (PDT) using topical precursor of photoactive porphyrins may be a non-invasive alternative with minimal side effects. This study assessed the feasibility and response rate of PDT with hexaminolevulinate (HAL) in cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) infection. Study Design/Materials and Methods Twenty four patients with a CIN 2 or 3 or a persistent CIN 1 and a positive high-risk HPV-DNA test were included. Each patient had gynaecologic examination including cervical cytology, HPV DNA testing, colposcopy and biopsy. Ten milliliters of HAL-thermogel (10 mM) were topically applied to the cervix for 3,5 hours, followed by 1,000 seconds of illumination of both ecto- and endocervical canal with red coherent light (wave length 633 nm) using a PDT laser and a special light catheter. Follow-up examinations were carried out after 3 (cytology, colposcopy, HPV DNA testing, and if needed re-PDT) and 6 months. Results Seven, 10, and 7 patients had a CIN 1, 2, or 3, respectively. Treatment could be accomplished in all cases and no severe side effects were encountered. Fifteen out of the 24 patients had a complete response (15/24,=,63%) and a HPV remission 6 months after 1,3 treatments. The remission rates were 71%, 50%, and 71% for CIN 1, 2 and 3. Conclusion HAL PDT seems to be a non-invasive, repeatable procedure for CIN and cervical HPV infection with minimal side effects which can be easily performed on outpatient basis. Lesers Surg. Med. 40:611,615, 2008. © 2008 Wiley-Liss, Inc. [source] Temporary hair removal by low fluence photoepilation: Histological study on biopsies and cultured human hair folliclesLASERS IN SURGERY AND MEDICINE, Issue 8 2008Guido F. Roosen MSc Abstract Background and Objectives We have recently shown that repeated low fluence photoepilation (LFP) with intense pulsed light (IPL) leads to effective hair removal, which is fully reversible. Contrary to permanent hair removal treatments, LFP does not induce severe damage to the hair follicle. The purpose of the current study is to investigate the impact of LFP on the structure and the physiology of the hair follicle. Study Design/Materials and Methods Single pulses of IPL with a fluence of 9 J/cm2 and duration of 15 milliseconds were applied to one lower leg of 12 female subjects, followed by taking a single biopsy per person, either immediately, or after 3 or 7 days. Additionally, we present a novel approach to examine the effects of LFP, in which ex vivo hairy human scalp skin was exposed to IPL pulses with the same parameters as above, followed by isolation and culturing of the hair follicles over several days. Samples were examined histologically and morphologically. Results The majority of the cultured follicles that had been exposed to LFP treatment showed a marked treatment effect. The melanin containing part of the hair follicle bulb was the target and a catagen-like transformation was observed demonstrating that hair formation had ceased. The other follicles that had been exposed to LFP showed a less strong or no response. The skin biopsies also revealed that the melanin-rich region of the hair follicle bulb matrix was targeted; other parts of the follicle and the skin remained unaffected. Catagen/telogen hair follicles were visible with unusual melanin clumping, indicating this cycle phase was induced by the IPL treatment. Conclusions Low fluence photoepilation targets the pigmented matrix area of the anagen hair follicle bulb, causing a highly localized but mild trauma that interrupts the hair cycle, induces a catagen-like state and eventually leads to temporary loss of the hair. Lesers Surg. Med. 40:520,528, 2008. © 2008 Wiley-Liss, Inc. [source] Effect of fluence on efficacy using the 1440 nm laser with CAP technology for the treatment of rhytids,LASERS IN SURGERY AND MEDICINE, Issue 6 2008Jenifer R. Lloyd D.O. Abstract Background and Objective The objective of this study was to evaluate the effect of fluence on the treatment of rhytids using a 1440 nm laser with CAPSM technology and the T350 tip. Study Design/Materials and Methods Twelve subjects with rhytids were enrolled in an IRB approved study. The AffirmÔ laser with CAP technology (Cynosure, Inc., Westford, MA) 1440 nm, 10 mm T350, 2 milliseconds, 1.5 Hz was used at fluences ranging from 3.0 to 5.5 J/cm2 in a split face study. At each treatment visit, fluences on the right side of the face were held constant at 3.0 J/cm2, while the left side of the face started at 3.0 J/cm2 and increased 0.5 J/cm2 with each treatment to a maximum of 5.5 J/cm2. Five treatments were given at 2-week intervals using the SmartCoolÔ (Cynosure, Inc.). Photographic comparisons at baseline and 3 months were used to compare fluence results as well as to evaluate for efficacy in the treatment of rhytids. The following standard scale was employed: Poor (0,25%), Fair (26,50%), Good (51,75%), and Excellent (76,100%). In addition, following the study, a few subjects received a series of laser pulses at increasing fluences on their buttocks to further evaluate the effect of fluence on tissue reaction. Results Comparing the right and left photographic results, no clinically observable differences were noted. Both sides received the same grade in all cases. Five subjects (42%) were noted to have Good results, three (25%) were given a rating of Fair, and four (33%) were given a Poor result with little or no improvement observed. The follow-up buttock fluence study demonstrated an effect threshold at 3.0 J/cm2. Conclusion The 1440 nm laser with CAP technology can provide overall improvement in patients with rhytids at moderate fluences. Increasing the fluence does not appear to increase efficacy. Lesers Surg. Med. 40:387,389, 2008. © 2008 Wiley-Liss, Inc. [source] Optimization of treatment parameters for Foscan®-PDT of basal cell carcinomasLASERS IN SURGERY AND MEDICINE, Issue 5 2008Christian S. Betz MD Abstract Background and Objective Basal cell carcinomas (BCCs) are the most common form of skin cancers with high and increasing incidence rates. Photodynamic therapy (PDT) with mTHPC (Foscan®) has shown to be a promising treatment alternative with good cosmetic results. The current study was aimed to determine optimal treatment parameters for this indication. Study Design/Materials and Methods mTHPC-PDT was performed in 117 patients with a total of 460 BCCs with diagnosis confirmed by scratch cytology. Treatment parameters were altered as follows: Foscan® dose 0.03,0.15 mg/kg, drug-light interval (DLI) 1,96 hours, total energy density 20,120 J/cm2. Outcomes were assessed 8 weeks post-PDT following WHO guidelines. Results The overall rate of complete remissions (CR) was 96.7% and the cosmetic outcome was very good. In the largest subgroup (n,=,80) where low-dose Foscan® was applied (0.05 mg/kg mTHPC; 48 hours DLI; 50 J/cm2 total energy density), a CR rate of 100% with a high and narrow 95% Confidence Interval of 0.955,1.000 was achieved. Smaller variations of the treatment parameters (i.e., reducing the photosensitizer dose to 0.04 mg/kg or shortening the DLI to 24 hours) yielded similarly good results. Side effects were encountered in 52 out of 133 PDT sessions. They were more common in patients who had received high drug doses (0.06,0.15 mg/kg) and comprised mostly pain and phototoxic reactions. Three patients developed severe sunburns with subsequent scarring at the injection site following bright sunlight exposure 15,19 days after photosensitizer administration. Conclusions The presented data suggest that mTHPC-PDT with the treatment parameters mentioned above seems to be an effective treatment option for BCCs. If sensibly applied, it is well tolerated and provides mostly excellent cosmetic results. Long-term results are yet to be evaluated. Lesers Surg. Med. 40:300,311, 2008. © 2008 Wiley-Liss, Inc. [source] Noninvasive blood flow imaging for real-time feedback during laser therapy of port wine stain birthmarksLASERS IN SURGERY AND MEDICINE, Issue 3 2008Yu-Chih Huang MS Abstract Background and Objectives During laser therapy of port wine stain (PWS) birthmarks, regions of persistent perfusion may exist. Immediate retreatment of such regions may improve PWS laser therapeutic outcome. To address this need, we propose use of laser speckle imaging (LSI) to provide real-time, quantitative feedback during laser surgery. Herein, we present in vitro and in vivo data collected with a clinic-based LSI instrument. Study Design/Materials and Methods Prior to clinical implementation, we first investigated three aspects of LSI deemed important for clinical imaging: (1) instrument depth of field (DOF); (2) effects of laser irradiance on speckle flow index (SFI) values; and (3) measurement repeatability. Clinical measurements were acquired from the lesions of PWS patients immediately prior to and after laser therapy at the Beckman Laser Institute. Results Our preclinical data suggest the following: (1) instrument DOF was ,1 cm; (2) quantitative flow characterization with LSI was practically unaffected at normalized irradiance values between 0.06 and 0.5; and (3) our LSI instrument was capable of highly reproducible SFI values. From our clinical measurements, we found that the relative difference between blood perfusion in PWS lesions and adjacent normal skin was highly variable. Based on SFI images, the perfusion of PWS skin is sometimes indistinguishable from that of adjacent normal skin. With laser therapy, we measured a global decrease in blood perfusion, and we frequently observed distinct regions of persistent perfusion. Conclusions Our results demonstrate the potential role of image-guided laser therapy of PWS birthmarks. LSI is a promising tool for noninvasive blood flow characterization during laser therapy due to its relative simplicity and low cost. Laser Surg. Med. 40:167,173, 2008. © 2008 Wiley-Liss, Inc. [source] Combination of Er:YAG laser and photodynamic therapy in the treatment of nodular basal cell carcinomaLASERS IN SURGERY AND MEDICINE, Issue 2 2008Roman, mucler PhD Abstract Backgrounds and Objectives Photodynamic therapy (PDT), via topical aminolevulinic acid (ALA) is an effective treatment for basal cell carcinomas not exceeding a depth of 2 mm. This limits the treatment of basal cell carcinoma (non-melanoma skin cancer) to superficial forms and nodular therapy (only in aesthetically desired locations). This paper addresses the effectiveness of reducing tumor mass via initial Er:YAG laser ablation to depths that are therapeutically responsive to PDT with ALA. Study Design/Materials and Methods This study compared three methods for the treatment of recurring nodular basal cell carcinomas (r nBCC). Method A utilized PDT with topical application of ALA methyl ester, method B with solitary Er:YAG laser ablation, and method C combined Er:YAG laser ablation reducing tumor size below 2 mm (method B) with subsequent ALA methyl ester PDT (method A). All three methods were used to treat to each patient, all subjects presenting with three or more basal cell carcinomas in order to eliminate differences in patient responsiveness to treatment. Patients were monitored and interviewed at 3, 6, and 12 month intervals to examine the progress of tumor elimination, aesthetic results as well as the patient's preference of treatment method. In all, 286 patients were treated, of whom 194 were checked at the prescribed intervals and then evaluated. Results Statistically, the combination therapy demonstrated the most effective treatment at all time intervals, with a final efficacy of 98.97% versus 94.85% (PDT only) and 91.75% (Er:YAG laser only). The combined method also provided the best aesthetic results (scale: 1,best; 4,worst) of 1.23±1.23, compared to 1.67±0.76 (PDT only) and 1.83±0.95 (Er:YAG laser only). Conclusions Although 67% patients preferred solitary Er:YAG laser treatment over the PDT method (20%) and the combined treatment (13%), because of the simplicity of the treatment, the combination therapy has proven to be both clinically and aesthetically superior. Solitary Er:YAG laser ablation will remain however a fast, effective, and economical treatment alternative for simple manifestations of superficial basal cell carcinoma and has replaced PDT for uncomplicated cases at our facility. The combination of Er:YAG laser ablation and ALA,PDT aspires to be therapy of choice for BCC. Lesers Surg. Med. 40:153,158, 2008. © 2008 Wiley-Liss, Inc. [source] The anti-inflammatory mechanism of 635 nm light-emitting-diode irradiation compared with existing COX inhibitorsLASERS IN SURGERY AND MEDICINE, Issue 7 2007Wonbong Lim PhD Abstract Background and Objectives Inhibition of cyclooxygenase (COX) and prostaglandin E2 (PGE2) protects cells against cell injury in specific pathophysiological situations: inflammation and oxidative stress. Although the anti-inflammatory effects have been reported in clinical fields for specific wavelength irradiation during wound healing, the physiological mechanism has not been clarified yet. The aim of the present study is to investigate the anti-inflammatory mechanism of 635 nm light-emitting-diode (LED) irradiation compared with existing COX inhibitors. Study Design/Materials and Methods The present study investigated anti-inflammatory effects of 635 nm irradiation on PGE2 release, COX and phospholipase A2 (PLA2) expression, and reactive oxygen species (ROS) dissociation in arachidonic acid (AA)-treated human gingival fibroblast (hGF). These results were compared with their existing COX inhibitors: indomethacin and ibuprofen. The PGE2 release was measured by enzyme immunoassay, the COX expression was measured by western blot and reverse transcriptase polymerase chain reaction (RT-PCR), and ROS level was measured by flow cytometry, laser scanning confocal microscope and RT-PCR. Results Results showed that 635 nm irradiation and existing COX inhibitors inhibit expression of COX and PGE2 release. Unlike indomethacin and ibuprofen, 635 nm irradiation leads to a decrease of ROS levels and mRNA expression of cytosolic phospholipase A2 (cPLA2) and secretary phospholipase A2 (sPLA2). Conclusion Taken together, 635 nm irradiation, unlike indomethacin and ibuprofen, can directly dissociate the ROS. This inhibits cPLA2, sPLA2, and COX expression, and results in the inhibition of PGE2 release. Thus, we suggest that 635 nm irradiation inhibits PGE2 synthesis like COX inhibitor and appears to be useful as an anti-inflammatory tool. Lesers Surg. Med. 39:614,621, 2007. © 2007 Wiley-Liss, Inc. [source] Photothermal antimicrobial nanotherapy and nanodiagnostics with self-assembling carbon nanotube clustersLASERS IN SURGERY AND MEDICINE, Issue 7 2007Jin-Woo Kim PhD Abstract Background and Objectives Unique properties of carbon nanotubes (CNTs) would open new avenues for addressing challenges to realize rapid and sensitive antimicrobial diagnostics and therapy for human pathogens. In this study, new CNTs' capabilities for photothermal (PT) antimicrobial nanotherapy were explored in vitro using Escherichia coli as a model bacterium. Study Design/Materials and Methods Single-walled carbon nanotubes (SWNTs) and multi-walled carbon nanotubes (MWNTs) were incubated with E. coli K12 strain. CNTs' locations in bacteria and laser-induced thermal and accompanied effects around CNTs were estimated with TEM and PT microscopy, respectively. Multi-pulse lasers at 532 and 1064 nm with 12-ns pulse duration were used for irradiating sample mixtures at different laser fluences. Cell viability was evaluated using a bacterial viability test kit and epi-fluorescence microscopy. Results This study revealed CNTs' high binding affinity to bacteria, their capability to self-assemble as clusters at bacteria surfaces, and their inherent near-infrared (NIR) laser responsiveness. Cell viability was affected neither by CNTs alone nor by NIR irradiations alone. Notable changes in bacteria viability, caused by local thermal and accompanied bubble-formation phenomena, were observed starting at laser fluences of 0.1,0.5 J/cm2 with complete bacteria disintegration at 2,3 J/cm2 at both wavelengths. Furthermore, ethanol in reaction mixtures significantly (more than one order) enhanced bubble formation phenomena. Conclusion This first application of laser-activated CNTs as PT contrast antimicrobial agents demonstrated its great potential to cause irreparable damages to disease-causing pathogens as well as to detect the pathogens at single bacterium level. This unique integration of laser and nanotechnology may also be used for drinking water treatment, food processing, disinfection of medical instrumentation, and purification of grafts and implants. Furthermore, the significant ethanol-induced enhancement of bubble formation provides another unique possibility to improve the efficiency of selective nanophotothermolysis for treating cancers, wounds, and vascular legions. Lesers Surg. Med. 39:622,634, 2007. © 2007 Wiley-Liss, Inc. [source] | ||||||||||||||||