Efficacy of a 2-mm spot size lens for the treatment of superficial vascular lesions with a flashlamp-pumped dye laser

BACKGROUND: The flashlamp-pumped dye laser, using either a 3 or 5 mm spot size, is an excellent instrument for the treatment of port-wine stains and other superficial cutaneous vascular lesions. Problems exist with patient acceptance due to prominent and prolonged blue-black discoloration and the pain associated with the treatment. OBJECTIVE: To assess the effectiveness of a flashlamp-pumped dye laser equipped with a 2 mm spot size lens in the treatment of superficial vascular lesions. METHODS: Twenty-one patients with telangiectasias, cherry angiomas, and angiokeratomas were treated at a variety of fluences. RESULTS: Three of 21 patients had complete clearing of their superficial vascular lesions. An improvement of greater than 75% was noted by 11 patients, and six patients noted a 50%-75% improvement. One patient had less than 50% improvement. Less post-treatment discoloration and less pain were noted with the 2 mm spot size lens. CONCLUSIONS: The 2 mm spot size lens, used with the flashlamp-pumped dye laser is an effective instrument for the treatment of superficial cutaneous vascular lesions.     

Organization and expression of basement membrane collagen IV genes and their roles in human disorders

PURPOSE: The prevalence of reflux in the deep and superficial venous systems in the Edinburgh population and the relationship between patterns of reflux and the presence of venous disease on clinical examination were studied. METHODS: A cross-sectional survey was done on men and women ranging in age from 18 to 64 years, randomly selected from 12 general practices. The presence of varicose veins and chronic venous insufficiency was noted on clinical examination, as was the duration of venous reflux by means of duplex scanning in 8 vein segments on each leg. Results were compared using cut-off points for reflux duration (RD) of 0.5 seconds or more (RD >/= 0.5) and more than 1.0 second (RD > 1.0) to define reflux. RESULTS: There were 1566 study participants, 867 women and 699 men. The prevalence of reflux was similar in the right and left legs. The proportion of participants with reflux was highest in the lower thigh long saphenous vein (LSV) segment (18.6% in the right leg and 17.5% in the left leg for RD >/= 0.5), followed by the above knee popliteal segments (12.3% in the right leg and 11.0% in the left leg for RD >/= 0.5), the below knee popliteal (11.3% in the right leg and 9.5% in the left leg for RD >/= 0.5), upper LSV (10.0% in the right leg and 10.8% in the left leg for RD >/= 0.5) segments, the common femoral vein segments (7.8% in the right leg and 8.0% in the left leg for RD >/= 0.5), the lower superficial femoral vein (SFV) segments (6.6% in the right leg and 6.4% in the left leg for RD >/= 0.5), and the upper SFV (5.2% in the right leg and 4.7% in the left leg for RD >/= 0.5) and short saphenous vein (SSV) (4.6% in the right leg and 5.6% in the left leg for an RD >/= 0.5) segments. In the superficial vein segments, there was little difference in the occurrence of reflux whether RD >/= 0.5 or RD > 1.0 was used; but in the different deep vein segments, the prevalence of reflux was 2 to 4 times greater for RD >/= 0.5 rather than RD > 1.0. Men had a higher prevalence of reflux in the deep vein segments than women, reaching statistical significance (P /= 0.5. In general, the prevalence of reflux increased with age. Those with "venous disease" had a significantly higher prevalence of reflux in all vein segments than those with "no disease" (P 相似文献   

DNA-based HLA class II postmortem typing: evaluation of different techniques for prospective corneal allografting

BACKGROUND: Two new types of lasers, the pulsed dye laser and the Q-switched ruby laser, have shown good to excellent results in the treatment of vascular malformations and benign pigmented lesions of the skin. A new and very effective alternative to pulsed dye laser is the recently introduced Photoderm VL. This device is based on the use of a wide-band non-coherent intense pulsed light source which emits a continuous spectrum in the range of 515 nm to 1200 nm. PATIENTS AND METHODS: More than a 1000 patients with a variety of lesions of the skin were treated by these new laser systems and the Photoderm VL. The Q-switched ruby laser (wavelength 694 nm, pulse duration 25 ns) is suitable for the treatment of benign lentigines, café-au-lait macules, seborrhoic ceratosis, tattoos, and traumatic tattoos. The pulsed dye laser (585 nm, 0,3-0,45 ms) treats nevi flammei, capillary hemangiomas, telangiectasias, xanthelasma, hypertrophic scarring, and adenoma sebaceum. In addition we present the facilities of the new Photoderm VL (515 nm-1200 nm, 0,5-20 ms) for the treatment of nevi flammei, benign hemangiomatous malformations, telangiectasias, erythrosis interfollicularis colli, hypertrophic scarring, and hypertrichosis. RESULTS AND CONCLUSIONS: the Q-switched ruby laser, the pulsed dye laser, and the Photoderm VL show excellent results in the treatment of lesions of the skin, which otherwise would have been difficult to treat of untreatable. The efficiency of the laser types presented is based on the theory of selective photothermolysis. Scarring is almost never seen and hypo- or hyperpigmentation is in most cases transient.     

The pulsed dye laser--possibilities and limits

The pulsed dye laser (wavelength 585 nm, pulse duration 0.3-0.45 ms) is very effective in the treatment of port-wine stains, beginning hemangiomas, telangiectasias, spider nevi, xanthelasma and red hypertrophic scarring. It is the laser of choice in the therapy of young patients with port-wine stains. The pulsed dye laser is limited by its relatively superficial penetration into the skin with a maximum of 1.5 mm.     

510-nm pigmented lesion dye laser. Its characteristics and clinical uses

BACKGROUND: Benign pigmented lesions are of a cosmetic concern to many individuals. Numerous treatments exist, including several types of lasers. The Candela 510 nm pigmented lesion dye laser has recently been added to this armamentarium. It is designed specifically for the treatment of superficial pigmented lesions while significantly decreasing the risk of scarring and prolonged hypopigmentation. OBJECTIVES: To describe the characteristics of the Candela pigmented lesion dye laser and report on the therapeutic outcome of patients treated for actinic lentigines, café-au-lait macules, melasma and red tattoos by one of the authors (RCG). METHODS: The Candela 510 nm pigmented lesion dye laser was used to treat solar lentigines, café-au-lait macules, melasma and red tattoo. RESULTS: Excellent outcomes resulted on facial and hand lentigines (89% and 88% of patients had greater than 75% clearing, respectively), but often required more than one treatment. Lentigines located on the upper extremities and trunk improved less dramatically. Immediate greying occurred universally. Bruising was often noted. Treatment failures have been observed especially in treating lentigines located on the lower extremities. Café-au-lait macules responded inconsistently, with facial lesions giving the best results. Melasma responded poorly, often with hyperpigmentation. Three red tattoos cleared. Treatment failure may be related to inaccurate clinical assessment of pigment depth or regrowth of the lesion. Several cases are presented to demonstrate clinical and histologic effects of the laser. CONCLUSION: The Candela 510-nm pigmented lesion dye laser is an effective treatment for superficial pigmented lesions. Its associated morbidity is minimal.     

Alcohol Use Disorders Identification Test (AUDIT)]

Laser ablation of acrylic bone cement is an alternative method of cement removal that can be used during revision arthroplasty of cemented implants. This study investigated the feasibility of using a continuous-wave Argon ion laser (wavelength = 514 nm) with the addition of methylene blue or red dye no. 13 to enhance the ablation of two types of bone cements: polymethylmethacrylate and polybutylmethylmethacrylate. Six cement/dye combinations were studied while power (0.5, 0.75, and 1.0 W) and exposure times (30, 45, 60, and 90 seconds) were varied. The Argon laser was unable to ablate undyed polymethylmethacrylate or polybutylmethylmethacrylate. However, ablation was shown for both cements with either dye. The red dye had a stronger absorption peak at 514 nm than did the blue dye. Statistically larger ablation areas were seen for red polymethylmethacrylate than for blue polymethylmethacrylate (p < 0.013) at all levels tested. Ablation areas were larger in red than in blue polybutylmethylmethacrylate cement. Blue polybutylmethylmethacrylate cement produced larger ablation areas than did blue polymethylmethacrylate cements at all energy levels tested, with smaller surrounding damage areas. Red polybutylmethylmethacrylate cement also produced larger ablation areas than did red polymethylmethacrylate cement (at 0.75 and 1.0 W), again with smaller damage areas. Damage zones were smallest in red polybutylmethylmethacrylate cements at all test levels. These results suggest that, by using dyes to selectively alter the absorption characteristics of bone cement, laser ablation can be an effective method for cement removal. Changes in the chemical structure of the cement can also influence the response to laser treatment. Furthermore, the absorption spectra of the bone cement can be altered to maximize energy absorption at a wavelength that is not absorbed by bone tissue; this potentially minimizes damage to bone during revision surgery.     

Effect of dietary calcium on blood lead concentrations in occupationally exposed and nonexposed workers

PURPOSE: Evaluation of night glare after excimer laser in situ keratomileusis (LASIK) using two different ablation zone diameters. METHODS: One hundred and twenty eyes of 60 consecutive myopic patients received LASIK with the Nidek EC-5000 excimer laser. Eyes were randomized so that every patient had a single ablation zone of 5.5 mm on one eye and an ablation zone of 5.5 mm with a transition zone of 1.0 mm diameter larger on the other eye. Night glare was measured by two methods; a spot light test and a subjective questionnaire. RESULTS: At 6 months, 54 patients (90%) were examined; results of the spot light test showed that 40 patients (74.1%) perceived more glare with the eye with the single ablation zone; the subjective questionnaire indicated that 22 patients (40.7%) had more night glare with the eye with a single ablation zone compared to the other eye. The use of the transition zone increased the required total ablation depth by 20%. CONCLUSION: The use of a peripheral transition 1.0 mm diameter larger than the ablation zone significantly decreased night glare after LASIK with slight increase in the required central ablation depth.     

Pelvic ring injuries: a challenge for the trauma surgeon

Newly available minimally invasive methods have changed established treatment of human sialolithiasis during the past several years. After basic in vitro and in vivo investigations, two systems of shockwave treatment proved to be useful for clinical application: extracorporeal shockwave lithotripsy (piezoelectric system) and intracorporeal laser lithotripsy (using a rhodamine-6G dye laser). Following our clinical experiences with these methods a differential scheme for managing sialolithiasis is recommended depending on localization of the calculi and their maximal diameters. Submandibular stones are best treated by extra-corporeal lithotripsy if the stone is located in intraglandular parts or in the gland hilum. Stones of the hilum can also be treated by laser lithotripsy. In the distal parts and near the duct orifice, papillotomy and stone extraction should be tried independent of the stone size. If the stone is located in the intraglandular parts of the duct system or in the hilum and its diameter is over 12 mm, submandibulectomy is necessary. Calculi of the parotid gland should only be treated by extracorporeal lithotripsy, regardless of size and location.     

Agreement and repeatability of infrared pupillometry and the comparison method

OBJECTIVE: To evaluate the accuracy and repeatability of the widely used comparison method of measuring pupil size. DESIGN: Cross-sectional study. PARTICIPANTS: Fourteen eyes of seven healthy myopic subjects were examined. INTERVENTION: Two examiners made two repeated measures of pupil diameters of 14 eyes using Rosenbaum card comparison pupillometry and infrared pupillometry. Subjects fixated on a distant visual acuity chart, and pupils were measured under three luminance conditions. The agreement and inter-rater repeatability of both methods were determined. MAIN OUTCOME MEASURES: Outcomes were pupil diameters, limits of agreement, and coefficient of repeatability of two examiners. RESULTS: The mean difference between the two techniques ranged from 0.3 to 0.5 mm. The limits of agreement within two standard deviations ranged from 2.4 to 2.8 mm. Coefficient of repeatability ranged from 0.6 to 1.4 mm for infrared pupillometry and 1.0 to 1.2 mm for Rosenbaum pupillometry. Inter-rater repeatability of Rosenbaum pupillometry was consistently pupil diameter biased. Pupil diameters measured with the Rosenbaum method were consistently larger than diameters measured with the infrared technique for both examiners under all luminance conditions. CONCLUSIONS: Results indicate that although the mean difference in techniques was small, the range of the agreement between the Rosenbaum and the infrared techniques was large. The Rosenbaum method consistently overestimated pupil diameters and was subject to inter-rater repeatability bias. Rosenbaum pupillometry may not be appropriate when accurate pupil measurements are required. The results have implications for many clinical trials in ophthalmology, including those evaluating refractive surgery that use Rosenbaum comparison pupillometry.     

Liver transplantation resolves the hyperdynamic circulation in hereditary hemorrhagic telangiectasia with hepatic involvement

BACKGROUND & AIMS: Hepatic involvement in hereditary hemorrhagic telangiectasia is common but often asymptomatic. However, in some cases, the vascular lesions that involve the liver may lead to high-output cardiac failure and pulmonary hypertension that is predominant over hepatobiliary manifestations. Liver transplantation and treatment of these complications are described and discussed in this article. METHODS: Three patients with hereditary hemorrhagic telangiectasia and hepatic involvement received transplants. They had pulmonary hypertension and chronic right-sided heart failure caused by disseminated intrahepatic telangiectasias with shunts between the hepatic artery and hepatic veins or portal vein. Left-to-right intrahepatic shunt output was estimated to range between 51% and 57.5% of cardiac output. RESULTS: Hyperdynamic circulation disappeared after liver transplantation in all patients. Results of computed tomography and right-sided heart catheterization performed 6 months later were normal. Follow-up periods currently are 65, 53, and 29 months, and each patient continues to be asymptomatic. CONCLUSIONS: This report suggests that liver transplantation can be considered as an alternative and successful curative treatment that may prevent the irreversible evolution of cardiopulmonary disease.     

Dexmedetomidine failed to block the acute hyperdynamic response to electroconvulsive therapy

BACKGROUND: Orally administered clonidine (0.2-0.3 mg) has been reported to decrease the acute hypertensive response to electroconvulsive therapy (ECT) without prolonging early recovery. This preliminary study was designed to evaluate the acute hemodynamic effects of the investigational alpha2-adrenergic agonist, dexmedetomidine, in patients undergoing a series of ECT treatments. METHODS: Six patients undergoing a series of three to six consecutive ECT treatments were studied according to a randomized, double-blind, placebo-controlled protocol All patients received either saline or dexmedetomidine, 0.5 or 1.0 microg/kg intravenously, 10-30 min before induction of anesthesia for ECT using a standardized anesthesia protocol. In addition to assessing the cardiovascular variables, the duration of seizure activity, degree of sedation, and time to discharge from the Phase I recovery unit were assessed. RESULTS: Although dexmedetomidine produced dose-related increases in the level of sedation before the ECT procedure, it failed to decrease the peak blood pressure and heart rate responses after the ECT treatment. The 0.5 and 1.0 microg/kg doses of dexmedetomidine prolonged the times to orientation and to discharge from the Phase I unit. CONCLUSIONS: The results of this pilot study suggest that dexmedetomidine (0.5-1.0 microg/kg given intravenously) is not beneficial in controlling the acute hyperdynamic response after ECT.     

Effects of octreotide treatment on restenosis after coronary angioplasty: results of the VERAS study. VErringerung der Restenoserate nach Angioplastie durch ein Somatostatin-analogon

BACKGROUND: The VERAS study (VErringerung der Restenoserate nach Angioplastie durch ein Somatostatin-analogon [Prevention of Restenosis Following Angioplasty With a Somatostatin Analogue]) was a placebo-controlled trial to evaluate the effects of octreotide for the prevention of restenosis after coronary angioplasty. Octreotide is a somatostatin analogue with antiproliferative properties on smooth muscle cell growth in vitro that limits myointimal thickening of arteries in balloon injury models. METHODS AND RESULTS: Patients received either octreotide or placebo, starting 1 hour before angioplasty and continued for 3 weeks. The minimal luminal diameters before and after angioplasty and at 6-month follow-up were analyzed with a digital quantitative algorithm. Of the initial 274 patients recruited, 217 (108 in the octreotide group and 109 in the placebo group) could be analyzed after a complete 6-month evaluation: the minimal luminal diameters were 1.67+/-0.57 mm in the octreotide-treated group and 1.66+/-0.64 mm in the placebo group (two-paired P=.70), and the relative losses were 0.16+/-0.22 and 0.13+/-0.21 (two-paired P=.27). The restenosis rates were also identical in both treatment groups: final diameter stenosis > or =50% (34.3% versus 33.9%, two-paired P=1.0), loss of > or =50% of the initial gain (34.3% versus 33.9%, two-paired P=1.0), and absolute reduction of minimal luminal diameter >0.72 mm (29.6% versus 24.8%, two-paired P=.45). Likewise, there was no difference with regard to the incidence of clinical events (death, myocardial infarction, bypass operations, reintervention). Octreotide was well tolerated, with the exception of gastrointestinal side effects, which were three times more common than in the placebo group. CONCLUSIONS: Octreotide did not reduce the angiographically determined restenosis rate or the incidence of major clinical events after coronary angioplasty.     

Fractal characteristics of tumor vascular architecture during tumor growth and regression

BACKGROUND AND OBJECTIVE: Class III periodontal furcations still represent a challenge for the periodontist. Aim of this study was to test the effect of CO2 laser on the treatment of class III furcation defects. STUDY DESIGN/MATERIALS AND METHOD: Class III furcation defects 3 mm deep were surgically induced on mandibular premolars on six male Beagle dogs, for a total of 36 defects. After 6-8 weeks of plaque accumulation, the mean depth was 6.8 mm. Quadrants were randomly assigned to a) CO2 laser therapy (laser), b) Guided Tissue Regeneration (GTR) procedure using Gore-Tex Membranes, (Gore Tex, Flagstaff, Arizona, USA) and c) Scaling and Root planing (Sc/Rp). CO2 laser beam (El.En, Florence, Italy) was applied to the root surfaces in defocused pulsed mode at 2W, 1 Hz and a duty cycle of 6%, and on periodontal soft tissues at 13W, 40 Hz, and a duty cycle of 40%. Control quadrants received either GTR procedure or Sc/Rp. Mechanical oral hygiene was provided. At 6 months the animals were sacrificed. RESULTS: The laser group showed new attachment formation averaging 1.9 mm (sd +/- 0.5), whereas GTR and Sc/Rp showed 0.2 mm (sd +/- 0.4) and 0.2 mm (sd +/- 0.5) respectively, being the differences statistically significant between the laser group and both GTR and Sc/Rp groups (p < 0.005). CONCLUSION: CO2 laser treatment of class III furcation induced formation of new periodontal ligament, cementum and bone.     

Comparison of the efficacy and safety of 2% dorzolamide and 0.5% betaxolol in the treatment of elevated intraocular pressure. Dorzolamide Comparison Study Group

A multicenter, parallel-design, randomized, double-masked study was conducted to compare the efficacy and safety of 2% dorzolamide with those of 0.5% betaxolol in the treatment of elevated intraocular pressure (i.o.p). A total of 311 adults with ocular hypertension or open-angle glaucoma were randomly allocated to receive either 2% dorzolamide administered topically TID or 0.5% betaxolol administered topically BID plus placebo administered topically QD for 12 weeks. After the washout of previous ocular hypotensive drugs, patients with IOP > or = 23 mm Hg in at least one eye at 10 AM or 4 PM on study day 1 were randomly allocated to receive one of the study treatments. Throughout the study, IOP was measured 2 and 8 hours after instillation of study medication for the morning peak effect (hour 2) and afternoon trough effect (hour 8). After 12 weeks of therapy, the mean change in IOP was not significantly different between the dorzolamide and betaxolol treatment groups at hour 8 (-3.6 mm Hg in both groups) or hour 2 (-5.4 vs -5.3 mm Hg, respectively). The differences between treatments (and 95% CIs associated with these differences) in mean IOP changes from baseline were 0.02 mm Hg (-0.870 to 0.901) for hour 8 and -0.14 mm Hg (-0.959 to 0.685) for hour 2. The ocular adverse experience (AE) most frequently reported by patients was ocular burning and/or stinging, and the most frequently reported nonocular AEs were taste perversion, upper respiratory infection, and headache. Only the incidence of taste perversion was significantly different between treatment groups (14.6% for the dorzolamide group and 0.0% for the betaxolol group). Two percent of patients in each treatment group discontinued the study due to AEs. This study confirmed the similar IOP-lowering effect of 2% dorzolamide and 0.5% betaxolol. Both treatments were generally well tolerated, and their safety profiles were similar.     

Pulsed dye laser treatment of hypertrophic burn scars

Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. Sixteen patients with 40 hypertrophic burn scars resulting from chemical peels, carbon dioxide laser procedures, and accidental thermal injury were treated with a 585-nm pulsed dye laser. Sequential photographic and clinical assessments were recorded in all patients. Histologic evaluations of skin punch biopsies before and after laser irradiation were performed when possible. Symptomatic improvement of scars was reported after one treatment. Decreased scar erythema with improved texture and pliability was observed after an average of 2.5 treatments. No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.     

Correction of low-grade and mild myopia using Schwind Excimer laser

PURPOSE: To examine the results of Excimer laser photorefractive keratectomy on myopic eyes. To demonstrate the efficacy, safety, predictability and stability of the Schwind Keratom laser. METHODS: Two hundred and fifty three patients were operated, with myopia from -0.75 to -8 D and cylinder of less than 1.50 D. Ablation zone diameters were from 5.3 mm to 6.5 m. The follow-up was one year. RESULTS: One year after the operation, 92% of myopic eyes have uncorrected visual acuity above 20/40, 90% have best corrected visual acuity at least equal to that evaluated before treatment, 94% were within (1 D without correction. Between 6 months and one year, the spherical equivalent varied in only 4% the patients. CONCLUSIONS: The results with the Schwind Keratom laser are excellent and at least comparable with the other lasers. The best results are obtained with low myopia. At the end of this study, the Schwind Keratom laser was certified in France.     

In vitro effects of holmium. YAG laser on caprine stifle retinacular restraints

This study was designed to evaluate the efficacy of the Holmium:YAG laser for performing lateral release and medial joint capsular tightening intracapsularly and to compare the efficacy of the laser versus a scalpel blade for performing a lateral release by performing arthroscopic surgery on 29 caprine patellofemoral joints. Specimens were divided into six treatment groups and treatments consisted of lateral release alone, medial capsular tightening alone, or both treatments, and the effect of each treatment on patellar tracking was evaluated using video analysis of optical markers. Each treatment caused significantly different magnitudes of medial patellar displacement throughout a 75 degrees range of motion: medial tightening followed by lateral release (1.5 +/- 0.10 mm, mean +/- standard error of the mean); lateral release followed by medial tightening (1.1 +/- 0.11 mm); medial tightening alone (0.73 +/- 0.10 mm); lateral release alone (0.36 +/- 0.09 mm); and sham (-0.15 +/- 0.05 mm). There were no significant differences between performing the lateral release using the laser (1.5 +/- 0.10 mm) versus a scalpel (1.4 +/- 0.11 mm). This study shows that lateral release can be performed as effectively with the laser as with a scalpel and that the laser is an effective tool for performing lateral release and medial joint capsular tightening procedures intracapsularly in this caprine model.     

Laser therapy of eyelid and conjunctival tumors, especially in AIDS patients

We treated patients with Kaposi's sarcoma of the lid or conjunctiva, molluscum contagiosum and papilloma of the lid with dye laser photocoagulation. This therapeutic device is extremely efficient as the chosen wavelength of 577 nm is absorbed selectively by haemoglobin. Since Kaposi's sarcoma is a haemoglobin-containing tumour composed of endothelial cells and papilloma is a benign tumour composed of connective tissue and branching vessels, dye laser photocoagulation causes selective damage to abnormal vessels and surrounding connective tissue. After local anaesthesia a small incision was made at the margin of the lesion five patients each with papilloma and with molluscum contagiosum. In six patients with Kaposi's sarcoma no incision had to be done. Starting from the incision or the margin of the Kaposi's sarcoma 50-100 shots of 0.3-0.5 mm diameter and 1 s duration were applied until the lesion was completely gone. We used a dye laser with 577 nm wavelength and 1 W energy. In patients with papilloma, the tumour basis was coagulated and the tumour itself underwent histological examination. There was a marked decrease of the size of the lesion or even complete disappearance. Since Kaposi's sarcoma in AIDS patients can be relatively fast growing, resulting in cosmetically irritating manifestations and, rarely, haemorrhages, treatment may become necessary. AIDS patients with molluscum contagiosum may also benefit from treatment, as spreading of DNA virus particles may result in viral follicular conjunctivitis. Dye laser photocoagulation, however, cannot protect against relapse.     

About 8-hour variation of circulating human endothelin-1

In this study we examined the rate of decrease in size of facial port wine stains (PWS) as a function of number of treatments, lesion size, lesion location and patients' age. This study was performed at the University of Colorado Hospital Outpatient Dermatology Center, Denver, U.S.A. A consecutive sample of 91 patients 18 years of age or younger with facial PWS in which the entire lesion was treated at each visit were studied. Included were all patients who had a minimum of five treatments or complete clearance of their lesion in fewer than five treatments. Patients were evaluated following one, five and 10 treatments with the pulsed (450 s) dye (585 nm) laser. Improvement was defined as the percentage decrease in the size of the PWS. For all patients, the first five treatments resulted in a mean decrease in size of 55% while the second five treatments (38 patients) only improved the mean decrease in size by 18%. Grouped by location, the mean decreases in size from the first five and the second five treatments were as follows: central forehead = 100%, 0%; peripheral face = 58%, 28%; central face = 48%, 14%; and mixed (combination of peripheral and central face) = 21%, 9%. All central forehead PWS completely cleared within five treatments while none of the mixed PWS did so even with an average of 14 treatments. Grouped by size, mean decrease in size was highest for small lesions; < 20 cm2 = 67%, 21%; 20 to < 40 cm2 = 45%, 8%; and > 40 cm2 = 23%, 29%. Grouped by age, mean decrease in size was highest for young children: < 1-year-old = 63%, 33%; 1 to < 6 years = 48%, 15%; and older than 6 years = 54%, 10%. For all patients studied, maximal improvement was obtained in the first five treatments. Major determinants of treatment response in order of decreasing importance are PWS location, size and patients' age. The most successful responses are seen in young patients (less than 1 year old) with small PWS (under 20 cm2) that are located over bony areas of the face such as the central forehead. These three determinants may be useful tools to guide patient expectations and to predict the rate of improvement of PWS to pulsed dye laser treatment.     

Levobunolol 0.5% and timolol 0.5% to prevent intraocular pressure elevation after neodymium:YAG laser posterior capsulotomy

PURPOSE: To evaluate the prophylactic effect of levobunolol 0.5%, timolol 0.5%, or vehicle in reducing the incidence of postoperative intraocular pressure (IOP) spikes of 5 and 10 mm Hg or more in patients having neodymium:YAG (Nd:YAG) laser posterior capsulotomy. SETTING: Miami Vision Center, Coral Gables, Florida; Cullen Eye Institute, Baylor College of Medicine, Houston, Texas; Cincinnati Eye Institute, Cincinnati, Ohio; South Texas Cataract and Glaucoma Center, San Antonio, Texas; Mid-South Eye Foundation, Memphis, Tennessee, USA. METHODS: This prospective, double-masked, randomized study comprised 144 patients having Nd:YAG laser posterior capsulotomy in one eye. One drop of the test medication was administered preoperatively and one drop on the evening after surgery; IOP was measured preoperatively and 1,2,3 and 24 hours postoperatively. RESULTS: Intraocular pressure elevations of 5 mm Hg or more were seen in 1 of 60 patients (2%) in the levobunolol group, 4 of 54 (7%) in the timolol group, and 10 of 28 (36%) in the vehicle group. These elevations occurred significantly more frequently in the vehicle group than in the levobunolol (P < .001) or timolol (P < .004) groups. Elevations of 10 mm Hg or more were found in 2 of 28 patients (7%) treated with vehicle but were not observed in the patients treated with levobunolol or timolol. CONCLUSIONS: Levobunolol 0.5% or timolol 0.5% administered preoperatively and again in the evening after Nd:YAG laser capsulotomy effectively blunted the IOP rise that frequently follows laser surgery.