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At least 55 records · Page 3Linked to original sources
PubMed2001

Interstitial laser coagulation for the treatment of benign prostatic hyperplasia: a 3 year-follow-up of 30 cases.

OBJECTIVE: To report the results and 3 year-follow-up of treatment of benign prostatic hyperplasia (BPH) using interstitial laser coagulation. MATERIAL AND METHOD: Thirty men with BPH underwent treatment with interstitial laser coagulation between December 1996 and April 1997. Their average age was 68 years old. All of them were assessed prior to the treatment and post treatment for symptoms score, uroflowmetry and postvoid residual urine. Any complication and consequence were evaluated at each follow-up visit. RESULTS: Up to 36 months follow-up, all parameters showed marked improvement. The symptom score decreased from 20 to 5. Peak flow rate increased from 4 ml/sec to 17 ml/sec. Residual urine decreased from 115 ml to 8 ml. No major complication was detected. Urethral catheter or intermittent catheterization were used for the mean of 9.1 days. All of the patients who were potent prior to the treatment remained potent and 75 per cent still had prograde ejaculation. No re-treatment was needed in the 3 year-follow-up. CONCLUSION: On the basis of these results, we propose that interstitial laser coagulation appears to be a minimally invasive treatment for BPH, with substantial improvement of both objective and subjective parameters.

Aged↗
PubMed2003

Interstitial laser coagulation treatment of benign prostatic hyperplasia: is it to be recommended?

PURPOSE: To update the clinical data on the treatment of benign prostatic hyperplasia (BPH) by interstitial laser coagulation (ILC). MATERIAL AND METHODS: In addition to recent review articles, original papers published during the last 2 years were surveyed. The focus was on prospective, particularly randomized, trials and on those with long-term follow-up. RESULTS: Interstitial laser coagulation is feasible, although considerable variability is observed in the results. Operative complications are minimal, but the postoperative catheterization time is relatively long. Irritative symptoms can last for a long time, and the rate of urinary infections is as high as 35%. There also is significant variability in the urodynamic results. The technique seems to be more effective in patients with mild bladder outlet obstruction at baseline. The retreatment rate at 1 year is as high as 15%, and higher rates, as much as 40%, are described at 3 years. When compared in a randomized fashion with transurethral resection of the prostate (TURP), the postoperative period is shorter after TURP and the retreatment rate (early and late) is higher after ILC. CONCLUSIONS: Interstitial laser coagulation is superior to TURP in terms of operative morbidity, but postoperative morbidity is higher after ILC. Long-term durability has not been properly documented, and randomized studies show a higher retreatment rate after ILC than after TURP. The technique is recommended for those patients with bleeding disorders necessitating an interventional therapy.

Clinical Trials as Topic↗
PubMed1992

Treatment of congenital tracheoesophageal fistula by endoscopic laser coagulation: preliminary report of three cases.

Three newborns with congenital tracheoesophageal fistula were treated by endoscopic laser coagulation. After radiologic and endoscopic diagnosis, laser coagulation of the mucosal layer of the fistula followed using Nd:YAG laser light transferred through an uncovered quartz fiber of 600 microns diameter. The successful and uneventful course in two cases contrasts with the incomplete obliteration in one case caused by inadequate energy application and/or early localized instillation of contrast medium for radiologic control examination. The advantages of this method include elimination of an operative procedure, exclusion of operative complications, and the possibility of repetition in recurrent cases. Care must be taken to prevent esophageal and tracheal damage by use of this method.

Bronchoscopy↗
PubMed1994

Catheter-directed laser coagulation of atrial myocardium in dogs.

The feasibility of transcatheter laser coagulation of atrial myocardium was tested in a canine model by using a combined electrode-laser catheter. In 17 anaesthetized beagles a total of 264 lesions, 12-19 per dog, and 3-5 in each area were produced in: (1) the lateral walls, (2) the posterior right atrial walls, (3) the inter-atrial septum, and (4) the atrial appendage. The power source was a continuous wave Nd:YAG laser. Irradiance was 1 kW.cm-2, at a wave length of 1064 nm, the irradiated spot diameter was 2.0-2.5 mm, and the pulse duration 5-60 s. Local intra-cardiac atrial potentials recorded from the targeted areas during laser irradiation dwindled after onset of the laser pulse, and their amplitude was reduced persistently by pulses of 15 s or longer. Histopathologically, the acute lesions showed intramural haemorrhage and coagulation necrosis, but there was no tissue vaporization or crater formation. Chronic lesions showed clear-cut oval-shaped areas of transmural fibrosis. Diameters of lesions, dependent on the amount of laser energy applied, measured from 4.6 +/- 0.5 mm (450 J) to 7.8 +/- 1.4 mm (1800 J). Follow-up lasted 6-25 months (average 10.5). All the animals survived the procedure without complications. Transcatheter laser coagulation of atrial myocardium is safe and can be performed in a controllable manner by using the catheter system presented.

Action Potentials↗
PubMed1999

An MRSA outbreak in a urology ward and its association with Nd:YAG coagulation laser treatment of the prostate.

An outbreak of methicillin resistant Staphylococcus aureus (MRSA) involving 88 patients in a general urology ward is described. Symptomatic bacteraemia and epididymo-orchitis occurred in 10 and 8% of patients respectively. Patients had a particularly high risk of acquiring serious MRSA infection after endoscopic neodymium yttrium aluminium garnet (Nd:YAG) laser treatment of the prostate. Appreciation of the mode of transmission of MRSA, a programme of continuing education for all medical and nursing staff, simple changes in ward protocol and advances in surgical laser technique contributed to the control of the outbreak.

Cross Infection↗
PubMed2002

Transient hydropic signs in the donor fetus after fetoscopic laser coagulation in severe twin-twin transfusion syndrome: incidence and clinical relevance.

OBJECTIVE: To evaluate the incidence, characteristics, and impact on perinatal outcome of the development of hydropic signs in the donor fetus after laser coagulation for severe twin-twin transfusion syndrome in the second trimester. METHODS: Forty cases of second-trimester severe twin-twin transfusion underwent fetoscopic laser coagulation of placental anastomoses and were followed up with serial ultrasound up to 14 days after therapy. Ultrasound scans were performed just before, and on days 1, 3, 5 and 14 after therapy, and fetuses were monitored for the presence of hydropic signs (skin edema, pleural effusion, ascites and pericardial effusion). Response to therapy and perinatal outcome in terms of neonatal survival were recorded for all cases. RESULTS: Four recipients (10%) and three donors (7.5%) died over the first 72 h after therapy. During the study period, two recipients (5.5%) developed frank hydrops fetalis, and eventually died in utero. Ten donors (27.0%) developed one or more hydropic signs. In nine (90%), signs were mild or moderate and transient (mean, 3.2 days), while in one case hydrops worsened and the fetus eventually died. No donors with transient hydrops died in utero, and two died postnatally due to extreme prematurity. Gestational age at procedure and deepest amniotic fluid vertical pocket were similar between hydropic and non-hydropic donors. Discrepancy in estimated fetal weight at procedure was significantly lower in donors developing hydrops (9.6 (SD, 6.4) vs. 17.8 (14.4)%,P = 0.018). In pregnancies with hydropic donors, gestational age at delivery (33.1 (3.4) vs. 29.7 (3.5) weeks,P = 0.015) and birth weight for recipient (2392 (423) vs. 1631 (576) g, P < 0.001) and donor (1908 (774) vs. 1281 (583) g,P = 0.021) were significantly higher. The development of transient hydrops had no influence on neonatal survival at 28 days nor on the rate of clinical resolution of intertwin transfusion. CONCLUSIONS: Transient hydropic signs may develop in a proportion of donor fetuses after laser coagulation for severe twin-twin transfusion syndrome. This phenomenon is normally not associated with a poor prognosis, and possibly indicates an hemodynamic adaptation response following interruption of the transfusion process.

Female↗
PubMed1995

[Reflection measurement during retinal laser coagulation in patients. Development of an automatically controlled dosimeter].

PURPOSE: Retinal laser coagulation has limited reproducibility, because every laser exposition is unpredictably affected by pigmentation and media opacities. This can lead to complications. A feedback-controlled dosimeter would make retinal laser treatment a safer, more reproducible and faster procedure. METHOD: A reflectometer was developed that allows monitoring of the reflection of laser light during standard photocoagulation. Hundreds of coagulations in rabbit eyes and about 12,000 coagulations in patients undergoing routine laser treatment were recorded. RESULTS: The results of the first reflectance measurements in humans are presented along with extensive animal studies. A typical reflectance history was found for different lesion intensities. The degree of retinal whitening correlates with reflectance characteristics. These characteristics allow an early prediction of lesion intensity. Motion during laser exposure affects each coagulation in a fashion similar to spot size and exposure time. CONCLUSION: Reflectometry is the currently most effective means of monitoring lesion development. An automatic dosimeter for retinal photocoagulation seems feasible.

Animals↗
PubMed1995

Creation of a volume lesion in the dog prostate using neodymium:YAG laser coagulation: concepts for clinical treatment.

BACKGROUND AND OBJECTIVE: The purpose of this study was to determine the geometrical development of a coagulated zone in the canine prostate during free beam side fire Nd:YAG laser coagulation. STUDY DESIGN/MATERIALS AND METHODS: A series of 10 male dogs underwent endoscopic prostatic Nd:YAG fixed position laser coagulation through a suprapubic cystotomy using a right-angle deflecting delivery catheter (Microvasive, Boston, MA) at times varying from 10 to 120 seconds at 30 watts. In addition, two dogs underwent lasing by pulling the catheter at 1 mm/s in four quadrants. Acute gross and microscopic pathology specimens were prepared and the lesion shape and volume determined. RESULTS: Analysis of the coagulated volume showed that during the initial 15 seconds of lasing, the zone of coagulation approximates a sphere centered on the urothelium opposite the laser fiber. However, as lasing progressed, the lesion changed from a sphere to an expanding ellipse. This changing geometry can be explained by the absorption and scatter characteristics of the laser and the temperature equilibrium that is established within the prostate. CONCLUSION: An understanding of this time-dependent geometrical shift from a sphere to an ellipse allows the surgeon to supplement the fixed protocols for lasing at certain positions for given amounts of time. Specific plans can then be established for tissue at the bladder neck, apex, anterior stroma, floor, and irregular prostatic regrowth.

Absorption↗
PubMed2000

Histological estimation of the efficacy of endoscopic laser coagulation therapy for diffuse antral vascular ectasia.

We present the case of a 72-year-old woman with successful control of repeated episodes of bleeding from diffuse antral vascular ectasia (DAVE) by laser coagulation therapy. In addition to DAVE, the patient also suffered from severe iron deficiency anaemia (due to recurrent bleeding), liver cirrhosis, and huge tumours of hepatocellular carcinoma (HCC). She was referred from another hospital after failure to stop her bleeding episodes. Endoscopic examination revealed diffuse speckled telangiectasia over most of the stomach (from antrum to the upper portion of the body) and large numbers of blood clots. The patient had received repeated blood transfusions, haemostatic drugs, and H2 receptor antagonists at the other hospital, without improvement of the repeated bleeding. She underwent three sessions of endoscopic laser coagulation therapy for the lesions at our hospital after the final diagnosis of DAVE had been made based on the characteristic histological findings of biopsied specimens. This treatment improved her general condition and stopped the bleeding from the gastrointestinal tract even without fasting. Unfortunately, however, her liver function gradually worsened due to HCC and previous massive bleeding, and she finally died of liver failure three months after the last laser session. Autopsied specimens obtained from the patient's stomach revealed that macroscopic diffuse speckled telangiectasia and microscopic typical vasodilatation in mucosal and submucosal layers of gastric tissue had disappeared in the treated areas but not all portions of the DAVE lesion. These histological findings for the treated areas, in addition to the clinical improvement of bleeding, suggest that endoscopic laser coagulation therapy may be useful and one of the first choices in treatment for DAVE.

Aged↗
PubMedDate not supplied

[Clinical experiences with a new method of laser coagulation in gastrointestinal hemorrhages].

Endoscopic laser-coagulation was used 94 times in 14 patients to stop gastro-intestinal bleeding or coagulate potential bleeding sources during non-bleeding intervals. Lasting haemostasis was achieved in three cases of incomplete gastric erosion, one of gastric ulcer, one of duodenal ulcer and one of bleeding after antral rugectomy. It failed to stop severe arterial bleeding in a case of gastric carcinoma. Lasting haemostasis was achieved in six haemangiomas of the colon, one case of angiomatosis of the antrum with 62 individual sites, two of angiodysplasia of the colon, 17 lesions in Osler's disease of the oesophagus (2 cases), stomach (10) and duodenum (5). The procedure was performed in the course of diagnostic endoscopy with an argon-ion laser developed by the authors, which has a density of 0.7-1.3 W/mm2. No complications have been observed so far.

Angiomatosis↗
PubMedDate not supplied

[Laser coagulation in the treatment of different-type retinopathy of prematures].

Laser coagulation of the retina was made in 126 children (238 eyes) with retinopathy of prematures (RP) by an 810 nm diode laser ophthalmocoagulator. The methods of transscleral, transpapillary and combined coagulation were applied. As for children who needed coagulation, 39.9% of them had classical RP and 60.1%--fulminant RP (plus-disease). Stabilization in CRP was registered in 97.9% (the threshold process stage was an indication for surgery), and in FRP (plus disease) it was registered in 56.6%. The best effect from surgery in FRP was observed, when patient were operated on in FRP, stage 1 (process localization in zone 1) and stage 2 (process localization in zone 2), whereas, when the procedure was made at stage 3, the process was stabilized only in 37%. The authors elaborated a combined method of laser coagulation (including transscleral and transpupillary techniques), which brought up the rate of stabilization in FRP (plus-disease) to 75.8%. The results did not depend on a coagulation technique in CRP.

Humans↗
PubMed1997

[Treatment of retinal venous occlusion with hemodilution and laser coagulation. Prevention of secondary glaucoma].

BACKGROUND: Neovascular glaucoma is similarly as other ocular neovascularizations, a complication of retinal venous occlusions. The objective of the present work was to assess whether it is possible to prevent this complication by isovolaemic haemodilution and laser coagulation of the retina. METHODS AND RESULTS: Between 1991 and 1996 we used in 10 patients with occlusion of the central retinal vein and in 25 patients with occlusion of the branch of the central retinal vein repeated haemodilution with reduction of the haematocrit to 0.36. In case of soft retinal exudates the retina was treated by laser coagulation. The whole group comprised 28 men and 7 women. The patients' age was 42 to 76 years, 14% of the patients were under 50 years. The mean follow-up period was 29.5 months. During the investigation period so far none of the patients developed neovascular glaucoma. After treatment venous collaterals developed in the retina in 48.5%, in the disc of the optic nerve in 16% of the patients. Improved visual acuity was recorded in 90% of the patients after occlusion of the trunk and in 44% patients after occlusion of the branch of the central retinal vein. CONCLUSIONS: Adjustment of rheological conditions by haemodilution improved for three months the haemodynamic conditions in the affected retina, promote recanalization of the occluded vessels and the development of a collateral circulation and prevented neovascularization. Based on their experience the authors assume that haemodilution combined with laser coagulation has a positive impact on the visual prognosis, but in particular on prevention of neovascular glaucoma, which so far did not develop in the thus treated patients.

Adult↗
PubMed1996

Fetoscopic Nd:YAG Laser Coagulation for Twin-Twin Transfusion Syndrome in Cases of Anterior Placenta

Laser coagulation of anastomosing placental chorionic plate vessels was suggested as a treatment of severe twin-twin transfusion syndrome in midtrimester. An anteriorly located placenta may hamper access and visualization of the vessels involved. We treated six women with completely anterior placenta at 18 to 22 weeks' gestation. Through a 2- to 3-cm minilaparotomy the uterus was accessed after retraction of the viscera. A flexible cannula was inserted through the uterine fundus, and a 35-degree, 0.20-mm minifibroscope and 400-mm fiber were introduced. All vessels crossing the intertwining membrane were coagulated in a continuous mode and a maximum output of 45 W. All fetuses survived the operation. One fetus died in utero 6 weeks postoperatively from cardiac failure, and its receptor twin was born alive. All other pregnancies are either continuing, or the women delivered two healthy babies. Thus far, total fetal survival is 91.6%, compared with results with posterior-sided placentas. Neodymium:yttrium-aluminum-garnet laser coagulation is also possible in case of anterior placenta, but requires a minimal maternal incision and general anesthesia to allow safe cannula placement. A bent scope allows for a larger placental surface to be treated.

Journal Article↗
PubMed1999

Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology.

Interstitial laser coagulation (ILC) treatment is a recent technique in the treatment of BPH that is evolving rapidly. The results of a prospective randomised study vs transurethral resection of the prostate (TURP) is presented as well as results of patients treated with a temperature sensing laser system. The first study included 44 patients treated in a prospective randomised study (randomisation ILC vs TURP=2:1) comparing changes in objective and subjective parameters. In the second part of the study the outcome of the treatment of 34 patients with BPH using ILC performed with a temperature-sensing laser system are presented. The clinical outcome at 12, 26, 52 and 104 weeks was evaluated with symptom scores, quality of life measures, changes in voided volume, post void residual, and peak flow rate. In addition changes in prostate volume and urodynamic parameters at half a year follow-up are presented. In this randomised study patients improved markedly at any time during follow-up. In the ILC group there was a significant and persisting subjective improvement whereas the improvements in the TURP group were even more significant. The changes in voiding parameters, including changes in pressure-flow parameters, are superior in the TURP group compared to the changes in the ILC group. The retreatment rate for the ILC group is 21% compared to 7% in the TURP group, no patient with incontinence was documented in either group, while only one patients in the TURP group developed a urethral stricture. In the second part of the study, the clinical improvements following laser therapy using the temperature sensing treatment mode were more pronounced in voiding parameters when compared to those of the randomised laser group. Lower energy interstitial laser treatment of the prostate results in a significant improvement of all clinical parameters that are inferior to improvement following transurethral resection of the prostate. When using a temperature sensing system, the objective results of laser treatment improved and seem to be more durable.

Journal Article↗
PubMed1995

[Central serous chorioretinitis. Therapy experience over 20 years with and without laser coagulation].

Since 1969, 1,179 eyes with central serous chorioretinopathy have been examined with fluorescein fundus angiography. The classic form with fluorescein leakage (type I) decreased in incidence from 86.4% to 55.4%, while an atypical form with frequent serous pigment epithelial detachment (type II) increased from 12.6% to 33.0%, and the mixed form (type I + II) increased from 1 to 11.6%. In type I with delayed healing laser coagulation of the leakage was performed, which improved the visual acuity from 0.64 to 0.92 an average (n = 122), while in cases without laser coagulation the percentage improved only from 0.66 to 0.84 on average (n = 34) with a statistically significant difference (t = 2.64, P < 0.01). Laser coagulation was especially beneficial in the mixed form (n = 16), in which the visual acuity improved from 0.42 to 0.86 on average. The proportion of women increased from 10.7 to 17.9%. The patient age tended to be higher in women more than in men.

Adult↗
PubMed1993

Endoscopic laser coagulation of radiation-induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon.

UNLABELLED: Endoscopic laser coagulation effectively controls bleeding from radiation-induced rectal vascular lesions. OBJECTIVE: To assess the outcome of endoscopic treatment of radiation-induced bleeding due to vascular lesions located proximal to the sigmoid colon. METHODS: We identified 15 consecutive patients with such proximal radiation enteropathy treated at our Institution with Nd:YAG laser between 1984 and 1991. Ten patients (66%) had gastric and/or small bowel involvement, and five (33%) had colonic involvement with or without more proximal lesions. Bleeding first appeared at a mean of 21.2 +/- 12.5 months after completion of radiotherapy. Mean duration of gastrointestinal bleeding before laser treatment was 7.6 +/- 4.6 months. RESULTS: After completion of laser therapy, bleeding ceased in nine (60%) patients, decreased in three (20%), and persisted in three (20%). The mean hemoglobin level increased from 8.4 +/- 0.5 g/dl to 10.4 +/- 0.6 g/dl after completion of laser treatments (p < 0.02). The mean number of transfusions per patient per year decreased from 10.5 +/- 2.8 to 0.9 +/- 0.7 (p < 0.01). No treatment-related complications or deaths occurred. CONCLUSIONS: Endoscopic laser coagulation of radiation-induced mucosal vascular lesions in the upper gastrointestinal tract and proximal colon appears to be safe and, in most cases, effective.

Colonic Diseases↗