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A model approach to laser coagulation of dermal vascular lesions.

The quantitative absorption of light by blood and by human skin is discussed in relation to laser coagulation therapy of dermal vascular lesions. The skin is represented by epidermis and dermis. Both layers are assumed to be planparallel. Absorption and scattering of light by turbid materials was accounted for by the Kubelka theory. Reflection and transmission data of blood and of skin were taken from the literature. This model shows that, firstly, argon-laser coagulation at 488/514.5 nm of dermal vascular lesions is a selective method because vascular absorption exceeds non-vascular dermal absorption by a factor of 10. Secondly, a coagulation depth of about 1 mm is predicted in agreement with the literature. Thirdly, the epidermis absorbs the 488/514.5 nm wavelengths about half as strong as blood and is therefore non-transparent. The consequences of this have been discussed in relations to the final cosmetic result. Fourthly, there is theoretical evidence that better cosmetic results may be expected when coagulation is performed at either 420 nm, 540 nm, or 575 nm. This suggests application of the krypton-laser with lines at 407, 413, and 415 nm (violet), at 531 nm, or at 568 nm. The krypton 647 nm line and the ruby 694 nm line are of little value for this purpose.

Absorption↗

[Interstitial laser coagulation in the treatment of benign prostatic hyperplasia. Preliminary results].

51 patients aged 68 (range 52-81) years with lower urinary tract symptoms compatible with obstruction from benign prostatic hyperplasia were treated with interstitial laser coagulation (ILC). Postoperative urinary retention lasting less than one week was seen in the majority of cases. All patients were followed up for three months and ten cases had further follow-up after one year. Three months after treatment the international prostate symptom score decreased from 23.3 +/- 0.7 to 8.9 +/- 0.8 and was 10.2 +/- 2.1 after one year. Peak urinary flow increased concomitantly from 8.3 +/- 0.4 to 12.2 +/- 0.7 at three months and was 11.5 +/- 1.4 ml/sec after one year. Three patients received other, additional treatment because the ILC-treatment failed. In conclusion, interstitial laser coagulation had marked effects on symptoms, whereas the effects on objective parameters were less pronounced in this selected group of patients. However, more extensive follow-up, is essential for further evaluation of this new treatment procedure.

Aged↗

[Endoscopic laser coagulation of ciliary processes in patients with severe uncompensated glaucoma].

Endoscopic laser coagulation was used in 85 patients with severe uncompensated glaucoma. A manifest hypotensive effect (decrease of intraocular pressure from 44.21 +/- 3.17 to 23.12 +/- 4.58 mm Hg 1 year after the operation) and analgesic effect were attained. As a result of treatment, intraocular pressure normalized in 88.2% patients and the eyeball was preserved in 98.8% patients subjected to surgery.

Adult↗

Randomised prospective trial of contact laser prostatectomy (CLAP) versus visual laser coagulation of the prostate (VLAP) for the treatment of benign prostatic hyperplasia. 2-year follow-up.

OBJECTIVE: To determine the long-term efficacy and complications of visual laser coagulation/ ablation, VLAP (side-firing fibre) and direct contact laser ablation, CLAP (sapphire-tipped fibre) of the prostate in the treatment of benign prostatic hyperplasia (BPH). PATIENTS AND METHODS: Patients with clinical BPH, obstructed at voiding cystometry, were recruited and randomised to undergo either CLAP (21 patients) or VLAP (17 patients). At baseline, 1, 6, 12 and 24 months, patients underwent clinical evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, post-void residual urine volume, and pressure/flow urodynamics. RESULTS: The mean operating time for CLAP was 37.7 min and 24.5 min for VLAP. There was minimal morbidity with only 5 men requiring bladder irrigation after CLAP, 1 of whom had a blood transfusion. No patient required irrigation after VLAP. The mean catheterisation time after CLAP was 4.5 days (range 1-31 days) and 13.2 days (range 7-70 days) after VLAP. IPSS and Qmax improved significantly and maintained at 2 years. After CLAP, the IPSS decreased from 20.9 to 13.5 at 2 years while Qmax rose from 10 to 15.5 ml/s at 2 years. After VLAP, the IPSS decreased from 21.8 to 13.3 at 2 years while Qmax rose from 10 to 15. 9 ml/s. There was no difference between CLAP and VLAP. Pressure/flow urodynamics at 6 months showed reduced bladder outflow obstruction. CONCLUSIONS: CLAP and VLAP offer the same improvement in flow rates and symptoms at 2years. Both procedures lead to minimal morbidity, but the excellent haemostasis that is achieved at VLAP makes it of more use in treating patients at high risk of haemorrhage after surgery.

Aged↗

Interstitial laser coagulation in benign prostatic hyperplasia: A critical evaluation after 2 years of follow-Up.

Since 1993 we have prospectively followed a cumulative cohort of males with benign prostatic hyperplasia and symptomatic bladder outlet obstruction who underwent interstitial laser coagulation (ILC) of the prostate. We evaluated the safety and efficacy of ILC with respect to relief of symptoms and bladder outlet obstruction. In addition to the critical evaluation of our clinical results, the perineal and transurethral approaches were investigated as they may make a substantial impact on the overall success rate, including prostate size, number of sticks per prostate volume and type of application. A total of 59 patients were treated with the Nd-YAG laser (mediLas fibertom) between April 1993 and December 1996. At the time of reevaluation, 47 patients had completed a follow-up of up to 24 months. A perineal approach was used in 34%, transurethral in 23%, and a combined approach in 43% of the patients, depending on the preoperative volume of the prostate. 75% were high-risk patients in accordance with the ASA score (ASA III). The efficacy of treatment was assessed 6, 12, 24 and 52 weeks postoperatively in accordance with the International Prostate Symptom Score (IPS/quality of life), cystomanometric studies, peak urinary flow rate, residual volume and volume reduction of the prostate. Reduction of prostatic volume and sticks used per prostate volume were correlated to the overall success rate. A significant improvement in all voiding parameters (flow rate, residual volume), including the symptom score, was observed. P(det) decreased from an average of 90 cm H(2)O preoperatively to 42 cm H(2)O postoperatively after 24 weeks and the mean reduction in prostate volume was 14 cm(3). Interestingly, it was noted that the overall success rate was not size-related. A distinct positive correlation was found in the number of sticks performed and the improvement in objective and subjective parameters. In view of the low morbidity outcome, especially in high-risk patients, we proclaim Nd-YAG interstitial laser coagulation of the prostate to be an effective and safe alternative method of treatment for symptomatic benign prostatic hyperplasia.

Aged↗

Comparison of histological effect of electrocoagulation and Nd-YAG laser coagulation in intact and tumorous rat tissue.

In our animal experiments we used a chemical agent (dibutylnitrosamine) to induce urinary bladder tumor in rats, then this was implanted under the dorsal skin of rats of the same strain to gain a standard tumor preparation. The histological effects of electrocoagulation and Nd-Yag laser coagulation were compared in rat striated muscle, liver, intact rat urinary bladder and in our standard tumor preparation. The histological changes suggested that laser coagulation has advantages over electrocoagulation for inducing deep and homogenous necrosis in intact and tumorous tissues.

Animals↗

Investigations on laser coagulated rat eyes by fluorescence angiography and microscopy.

Laser coagulation using 50 and 100 mW of power, a spot of 50 microns and an exposure time of 0, 2 seconds were performed on rat eye fundi. We observed the effects which were produced in the retina and choroid utilizing both fluorescence photomicroscopy with incident excitation light and fluorescence angiography. No distinct differences were noticed between the effects produced by 50 and by 100 mW. Both energies damaged choroid and retina, especially the outer part of the retina. Moreover, fluorescein angiography within 24 hours gave us effective information for estimating the applied laser effect.

Animals↗

[Interstitial laser coagulation of benign prostatic hyperplasia].

We report on the new method of interstitial laser coagulation for the treatment of benign prostatic hyperplasia (BPH). The procedure is based on the interstitial application of Nd:YAG laser irradiation, delivered through a new light guide system. Such light applicators coagulate constant tissue volumes in a homogeneous manner, as proven by in vitro studies in different tissues, including surgically removed prostate adenoma. The extent of the coagulation is determined by laser power and irradiation time. At 5 W, for example, and during a 10-min period, this zone reached a diameter of up to 20 mm. Temperatures generated in the process were over 100 degrees C, as measured by time/space resolution. These results were confirmed by in vivo studies in canine prostates. In the course of 7 weeks, the coagulated areas formed scars with degeneration and fibrosis, accompanied by marked shrinking. Neighbouring organs were not affected. The method was successfully transferred to clinical practice. The application of the light guides to the lateral lobes was performed percutaneously from the perineum under transrectal ultrasound guidance. The median lobe was punctured transurethrally under direct vision. Twenty-seven patients with an average age of 67.7 years were treated between July 1991 and March 1992. At the time of evaluation 15 patients had a follow-up of more than 2 months. They experienced a mean increase of peak flow rate from 6.6 to 15.2 ml/s and a mean decrease of residual volume from 206 to 38 ml. This was accompanied by a marked lessening of symptoms. The average prostate weight decreased from 63 to 44 g. Sexually active patients did not experience retrograde ejaculation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

Intertwin anastomoses in monochorionic placentas after fetoscopic laser coagulation for twin-to-twin transfusion syndrome: is there more than meets the eye?

OBJECTIVE: This study was undertaken to detect missed anastomoses on the chorionic surface as well as hidden connections in the depth of the cotyledons in placentas after laser coagulation for twin-to-twin transfusion syndrome (TTTS) and to correlate these findings to clinical outcome. STUDY DESIGN: All cord vessels were injected with dyed barium sulphate. A digital photograph of the chorionic surface angioarchitecture and single-shot digital X-ray (Rx) angiograms were made. The presence and diameter of any missed anastomoses on the chorionic surface and of any hidden angiographic connections were determined. RESULTS: Fifty placentas were analyzed, 7 of double intrauterine fetal death (IUFD) and 43 of double survivors. In 9 of 43 (21%) cases with double survival and in all 7 cases of double IUFD, missed anastomoses were identified that should have been ablated by laser coagulation (P < .001). There appeared to be a correlation between the type and diameter of missed anastomoses on the chorionic surface and the clinical outcome. Placentas with missed large arteriovenous/venoarterial anastomoses (AV/VA) (N = 8) were from cases with recurrent TTTS or double IUFD (unless compensated by a large arterioarterial anastomosis [AA]). Next, missed small AV/VA (N = 4) without AA resulted in isolated (ie, without TTTS) discordant hemoglobin levels requiring intrauterine transfusion. Finally, when there were no missed anastomoses (N = 34), TTTS had resolved in all cases and outcome was good, although 1 case had discordant hemoglobin values treated with a single intrauterine transfusion and 4 others had discordant hemoglobin at birth. On Rx angiography, potential hidden connections were present, all but 1 case. CONCLUSION: Coagulation of all anastomoses visible on the chorionic surface seems adequate to treat TTTS. However, hidden connections in the depth of the cotyledon could not be excluded and may be involved in lesser degrees of intertwin transfusion.

Chorion↗

Magnetic resonance imaging of the feto-placentar unit after fetoscopic laser coagulation for twin-to-twin transfusion syndrome.

Twin-to-twin transfusion syndrome (TTTS) is a severe complication in monochorionic twin pregnancies that results from a hemodynamical imbalance of placentar vascular anstomoses that connect the circulation of both fetuses. In TTTS, a poly/oligohydramnios sequence with high fetal morbidity and mortality rates occurs. Fetoscopic laser coagulation of the placentar anastomoses can limit or prevent fetal injury. The purpose of this report is to present and discuss fetal magnetic resonance imaging as a postoperative imaging tool after fetoscopic laser coagulation.

Adult↗

[Argon laser coagulation in the treatment of active chorioretinitis (author's transl)].

Three cases of active chorioretinitis due to toxoplasmosis, which in the past had shown numerous recurrences, were subjected to argon laser coagulation after the preceding treatment with drugs had proved ineffective. Our procedure with the argon laser beam aimed not only at covering the entire area of the active chorioretinitis, but also at encircling and covering the old focus. In our case 2, in which in one phase of the condition argon laser coverage was confined merely to the active focus, there was a recurrence originating from another point of the same lesion. Argon laser coagulation appears to be effective, given the fact that no recurrence was observed after its application in any of our three cases over a follow-up period ranging from 2-4 years.

Adolescent↗

[Repeat laser coagulation of subretinal neovascularization in age-related macular degeneration].

INTRODUCTION: Retinal laser coagulation (LC) of extrafoveal subretinal neovascularization (SRN) due to age-related macular degeneration (AMD) is the only sure therapy. Diagnostics, therapy and follow-up are presented in a case report. CASE REPORT: A 55-year-old woman had suffered from progressive reduction of visual acuity (with metamorphopsia) in both eyes (LE > RE) for 3 years. In the RE the visual acuity was 0.32 and in the LE 0.05. Funduscopy and fluorescein angiography revealed in both eyes the wet form of AMD. The extrafovealy located SRN of the RE was photocoagulated and had to be retreated three-times in 6 weeks due to persistence. For 8 months the findings in the RE have been stable. VA has been improved to 0.4 and no metamorphopsia has been found. CONCLUSION: Extrafoveal SRN should be treated by LC. Short-term follow-up (including FA) and in most cases several LCs are necessary to close the SRN and save the patients' reading vision.

Female↗

Gamma-aminobutyric acid (GABA) immunocytochemistry of laser coagulations in the rabbit retina.

Rabbit retinas were treated with laser coagulations of low intensity, using five different wavelengths. After coagulation (1, 4 and 28 days), the retinas were stained for GABA, using a direct biotin-avidin-horseradish peroxidase immunocytochemical method. These time intervals were chosen with regard to the existing knowledge of retinal repair. The staining for GABA was increased in the inner plexiform layer at the centre of the lesions at days 1 and 4 after coagulation. At the margins of the lesions, cells in the ganglion cell layer showed strong staining and cells in the amacrine cell layer showed cuffing, independent of the wavelength used. On day 28, a regression of the hyperstaining was noted. Some possible pathophysiological mechanisms are discussed.

Animals↗

Effect of laser coagulation on placental vessels: histological aspects.

In order to evaluate the effect of laser coagulation on placental vessels and to define the optimal power density that should be used for this procedure, coagulation of placental vessels and histological examination were performed on freshly delivered placentae. This study suggests that 45- to 55-watt (6,000-7,666 J/cm2) shots can cause adequate placental injury. The extent of vascular lesions depends upon incident beam energy, fiber diameter, distance and angle to the vessel.

Arteries↗

Magnetic resonance thermometry for predicting thermal damage: an application of interstitial laser coagulation in an in vivo canine prostate model.

Magnetic resonance image-guidance for interstitial thermal therapy has proven to be a valuable tool in its traditional role in device localization and, more recently, in monitoring heat deposition within tissue. However, a quantitative understanding of how temperature-time exposure relates to thermal damage is crucial if the predictive value of real-time MR thermal-monitoring is to be fully realized. Results are presented on interstitial laser coagulation of two canine prostate models which are shown to provide an opportunity to evaluate three models of thermal damage based on a threshold maximum temperature, an Arrhenius damage integral, and a temperature-time product. These models were compared to the resultant lesion margin as derived from post-treatment T(1)- and T(2)-weighted MR images, as well as from direct histological evaluation of the excised canine prostate. Histological evaluation shows that the thermal-injury boundary can be predicted from a threshold-maximum temperature of approximately 51 degrees C or an equivalent Arrhenius t(43) period of 200 minutes, but it is not reliably predicted using the temperature-time product. The methods described in this study are expected to have implications for the treatment of benign prostatic hyperplasia and prostate cancer with interstitial laser coagulation, which will be the focus of future human studies.

Animals↗

Durability of probes for interstitial laser coagulation: impact of power setting and probe design.

BACKGROUND AND PURPOSE: Interstitial laser coagulation (ILC) is a well-established treatment option for patients suffering from benign prostatic hyperplasia (BPH). The vulnerability of the current fibers adds to the high cost of the procedure. The objective was to study the impact of different time-power modes and novel probe designs on tissue effects and fiber durability. MATERIALS AND METHODS: Standardized interstitial laser (Nd:YAG) applications utilizing different fiber types and power settings were performed in vitro on fresh bovine liver in a fluid medium. The resulting effects on tissue coagulation were evaluated. Additionally, the durability of contemporary probes as well as novel designs was examined. RESULTS: High-intensity application protocols of 1750 J within 60 seconds were significantly (p < 0.001) more effective in coagulating tissue (4.22 cm3) than the 90 seconds (3.68 cm3) and 120 seconds (3.06 cm3) time-power modes but significantly (p < 0.001) decreased the durability of fibers. Prototype probes significantly improved durability (p < 0.001), whereas efficacy remained unchanged (p > 0.5). CONCLUSIONS: Using a laboratory model, we could demonstrate that high-intensity time-power settings are more effective in creating tissue coagulation in ILC. The resulting deterioration of the probes can be reduced by applying new fiber designs.

Animals↗

[Nyctometric studies in argon laser coagulation in patients with diabetic retinopathy].

Forty-two patients (57 eyes) with diabetic retinopathy at various stages have been examined by nyctometry before and over the course of the follow-up period after argon laser coagulation of the retina. The findings evidence a marked reduction of the adaptation ability of the central retinal area even in high vision acuity in the patients with diabetic retinopathy vs. normal subjects. A stable rise of the nyctometric parameters has been observed after argon laser coagulation; these parameters characterize the function of the pigmented epithelium and of the retinal cone, and these data may be considered as an evidence of the improved trophics of these tissues, resultant from such therapy.

Adult↗