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Biomedical subjects

J M Garden

Publications and source records attributed to J M Garden.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of cutaneous hemangiomas by the flashlamp-pumped pulsed dye laser: prospective analysis.

Thirty-three cutaneous capillary and mixed hemangiomas in 24 patients were treated prospectively with the flashlamp-pumped pulsed dye laser. Patients ranged in age from 2 weeks to 7 months; the follow-up period was up to 22 months. Some patients received therapy until the lesion was almost clear or until the lesion failed to respond; others received treatment only until active capillary lesional proliferation abated. In the first group of patients, 18 of 25 lesions that were 3 mm or less in elevation lightened with therapy (93.9% +/- 4.6% in 4.1 +/- 1.6 treatment sessions) and flattened to 0.3 +/- 0.4 mm in thickness. The seven lesions that were 4 mm or more in thickness lightened 85.7% +/- 7.3% in 7.0 +/- 2.0 treatment sessions but showed less diminution in thickness (to 3.4 +/- 3.6 mm; p less than 0.01). The second group of patients, who received therapy until proliferation ceased, required just one to three therapeutic sessions. Three of the four lesions that showed residual atrophy were 4 mm or greater in thickness; the fourth lesion was ulcerated on presentation. None of the lesions had residual induration or scarring. We conclude that the flashlamp-pumped pulsed dye laser may successfully prevent enlargement and promote involution of capillary hemangiomas with minimal adverse effects. Therapy is most appropriate for patients with hemangiomas at sites of potential functional impairment, of maceration or ulceration, and of significant cosmetic disfigurement. Therapy should be initiated as early as possible, when lesions are relatively flat, for optimal results.

Female↗
PubMed1990

Dermatologic laser surgery.

The laser is becoming an increasingly important surgical and medical instrument in the field of dermatology. Developments in the areas of laser technology and application have significantly broadened its clinical use over the past several years. These rapid changes and advances in the use of the laser for cutaneous processes may make it difficult for the physician to maintain a current base of knowledge in this area. Relevant laser systems and their clinical applications are presented and discussed, as are investigational laser systems, which may be of importance for the future. This will allow the dermatologic surgeon the opportunity to update concepts and evaluate the various laser systems and their cutaneous applications.

Argon↗
PubMed1989

Pearly penile papules: treatment with the carbon dioxide laser.

Pearly penile papules are frequently occurring lesions located over the corona and sulcus of the penis. They are asymptomatic and are considered to be acral angiofibromas. Some individuals, disturbed by their presence, request removal of the lesions. Even after patients are assured of the benign nature of the process and its relatively high incidence, prominent lesional involvement may still cause significant psychological distress. Two patients with pearly penile papules have been successfully treated with the carbon dioxide laser. A review of the literature and description of treated cases are presented.

Carbon Dioxide↗
PubMed1988

Papillomavirus in the vapor of carbon dioxide laser-treated verrucae.

Vapor produced by the carbon dioxide laser during the vaporization of papillomavirus-infected verrucae was analyzed for viral DNA content. Two models were used for evaluation: an in vitro cutaneous bovine fibropapilloma and an in vivo human verruca model. Four bovine fibropapillomas were exposed to various laser parameters with power densities of 38,200 to 130 W/cm2 and energy fluences of 3820 to 130 J/cm2. The generated vapor was collected in a chamber in line with a vacuum system. Hybridization with bovine papillomavirus DNA probes revealed intact bovine papillomavirus DNA for all power densities and energy fluences used. The laser vapor from seven patients undergoing carbon dioxide laser therapy for plantar or mosaic verrucae was also collected. Laser parameter settings were similar to those usually chosen for clinical tissue vaporization. Intact human papillomavirus DNA was present in the vapor from two of seven patients. These studies indicate that intact viral DNA is liberated into the air with the vapor of laser-treated verrucae. It would be prudent for all practitioners who use the laser in treating patients with viral infections or conditions associated with viruses to practice extreme care and safety throughout the laser procedure.

Air Microbiology↗
PubMed1988

Pulsed dye laser (577 nm) treatment of portwine stains: ultrastructural evidence of neovascularization and mast cell degranulation in healed lesions.

Portwine stains were examined before, immediately after, and 1 yr after successful clearance by a pulsed dye laser (577 nm) using ultrastructural techniques. Dilated vascular channels and mast cell hypoplasia characterized lesional skin before treatment. Immediately after treatment, widespread selective vessel necrosis, similar to changes previously described, was observed. One year after laser irradiation, the abnormally ectatic portwine stain vessels had been replaced by small venules and arterioles, similar in number and diameter to blood vessels in normal skin; the only difference noted was that these new vessels were surrounded by easily identifiable mast cells. Many of these mast cells exhibited evidence of activation and degranulation. We conclude that mast cells may play an important role in the neovascularization of portwine stains treated by 577-nm dye laser irradiation.

Adolescent↗
PubMed1988

The treatment of port-wine stains by the pulsed dye laser. Analysis of pulse duration and long-term therapy.

A flashlamp-pumped pulsed dye laser at 577 nm was evaluated in the treatment of port-wine stains. The degree of lesional lightening was compared following laser exposure with pulse durations of 20 and 360 microseconds. In addition, lesional therapy using the 360-microseconds pulse duration was evaluated for lightening and side effects following long-term patient observation and after repeated treatments of the same site. A total of 52 patients with port-wine stain were treated; their average age was 29 years, with eight patients less than 18 years, of whom 29 had comparative test site placement for the different pulse durations. Of these 29 patients, 25 demonstrated greater lightening at the 360-microseconds pulse duration test site. All 52 patients proceeded to receive full treatment placement with the 360-microseconds pulse duration, which resulted in an overall lightening of 42% after the initial treatment and 68% after re-treatment sessions. Forty-four percent of the patients had equal to or greater than 75% lesional lightening. Pretreatment anesthesia was unnecessary and only minimum posttreatment care was required. Mild adverse effects of epidermal change, depression, or pigmentary change appeared in only four cases and was limited to less than a 2% area in each of these lesions. These side effects did not recur when the lesions were re-treated at lower energy dosages. No posttreatment sclerosis or scarring appeared, even after multiple retreatment sessions to the same area, regardless of the anatomic location, color of the lesion, or age of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Treatment of resistant severe psoriasis with systemic cyclosporine.

Four patients with severe psoriasis have been treated with oral cyclosporine for 6 months. Two had generalized erythroderma and two had extensive plaque-type psoriasis; all had either become unresponsive to or were unable to use other accepted treatments. All four patients responded rapidly and were completely clear of psoriasis within 3 weeks of beginning therapy. Initial doses ranged from 7.5 to 8.5 mg/kg/day. Mild reversible nephrotoxicity occurred in the one patient whose cyclosporine trough level briefly exceeded 200 ng/ml. Cyclosporine may offer an alternative therapeutic modality in the management of erythrodermic or severe resistant plaque-type psoriasis. The effectiveness of cyclosporine in psoriasis underscores the putative role of cell-mediated immune factors in the pathogenesis of psoriasis.

Administration, Oral↗
PubMed1987

Wound healing in porcine skin following low-output carbon dioxide laser irradiation of the incision.

Wound healing of scalpel incisions to the depth of adipose tissue closed with conventional methods was compared with closure by low-output carbon dioxide laser irradiation. In 3 Pitman-Moore minipigs wound healing was evaluated at intervals from 1 to 90 days by the following methods: clinical variables of wound healing; formation of the basement membrane components bullous pemphigoid antigen, laminin, and fibronectin; and histological evaluation of the regeneration of the epidermis, neovascularization, and elastin and collagen formation. There was no significant difference in healing between wounds closed by the various conventional methods and by the low-output carbon dioxide laser.

Animals↗
PubMed1987

The pulsed dye laser: its use at 577 nm wavelength.

The ability to increase laser-induced cutaneous blood vessel damage selectivity is dependent upon optimizing various intrinsic laser parameters. Varying the laser emission wavelength, pulse duration, and/or incident energy dosage allows the clinician potential improvement in the laser treatment of cutaneous small blood vessel processes such as port-wine hemangioma and telangiectasia. The pulsed dye laser at 577 nm and a pulse duration of 300 to 400 microseconds, incorporates desired laser parameters into its design. Clinical evaluation of the therapeutic outcome with this laser reveals favorable results while significantly minimizing potential adverse side effects.

Hemangioma↗
PubMed1987

Tunable pulsed dye laser for the treatment of benign cutaneous vascular ectasia.

A tunable pulsed dye laser emitting at 577 nm and 360 microseconds pulse width was used to treat benign cutaneous vascular ectasias other than port wine stain in 77 patients. Except for leg telangiectasias (34 patients), the overall response was excellent. Forty-two of forty-five patients with hemangiomas, spider nevi, angioma serpiginosum, venous lakes or facial telangiectasias showed excellent results after 1-4 consecutive treatments. Scarring was observed in none of the patients. These results confirm previous data on the use of the tunable dye laser in the treatment of port wine stain, and suggest that 577 nm wavelength and 360 microseconds pulse width allow the selective photothermolysis of vascular cutaneous ectasias with better clinical results than previously reported.

Adult↗
PubMed1986

Hydroa vacciniforme. Diagnosis by repetitive ultraviolet-A phototesting.

Hydroa vacciniforme is a rare disorder manifested in early childhood by recurrent photoinduced vesicles that heal with scarring. We report a case in which repetitive exposures to artificial ultraviolet light in the A range reproduced the clinical findings induced by natural sunlight. Phototesting may be viewed as an important diagnostic aid, as the induction of lesions clinically identical to hydroa vacciniforme can provide a reliable criterion for the diagnosis.

Child↗
PubMed1986

The low-output carbon dioxide laser for cutaneous wound closure of scalpel incisions: comparative tensile strength studies of the laser to the suture and staple for wound closure.

The low-output carbon dioxide (CO2) laser was used for cutaneous wound closure of scalpel incisions. Cutaneous scalpel incisions were placed over the dorsum of three minipigs and were then closed by either the laser, sutures, or staples. At multiple time points after wound closure, up to day 90, the tensile strengths of these wounds were comparatively evaluated. All wounds, including those closed with the laser, clinically appeared to heal similarly with no evidence of wound dehiscence or infection. Tensile strength studies revealed similar sigmoid curves for all wound closure modalities with low initial tensile strengths up to days 14 to 21, which afterwards increased rapidly, with a plateau toward day 90. From our study, it appears that the CO2 laser, in the low-output mode, can be used for cutaneous wound closure and that similar clinical healing and tensile strength measurements are obtained relative to the conventional cutaneous wound closure modalities of the suture or staple.

Animals↗
PubMed1986

Nodular primary localized cutaneous amyloidosis: immunohistochemical evaluation and treatment with the carbon dioxide laser.

Nodular primary localized cutaneous amyloidosis is an uncommon disorder for which there is no consistently satisfactory treatment. The amyloid fibrils are thought to have an immunoglobulin light chain derivation and systemic involvement must be excluded in all cases. We report a patient with a large scalp lesion of nodular primary localized cutaneous amyloidosis whose immunohistochemical evaluation revealed lambda light chain deposits and who thus far has no apparent systemic involvement. The lesion was treated by the carbon dioxide (CO2) laser with excellent cosmetic results and minimal morbidity.

Adult↗