The feasibility of a fiber optic laser approach to relieving lymphedematous syndrome: a case report

Here we report a case of successful fber optic laser treatment of lymphedema in a swollen arm post mastectomy. At the moment, this procedure has only anecdotal evidence to justify its use, but in our experience is a feasible, minimally invasive day-stay procedure which has been demonstrated to be safe and effective. Further nonhomogeneous case pooling and follow-up would enable guidelines and defnite surgical protocols for its use to be implemented.  

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The “Swiss-cheese Doppler-guided laser tonsillectomy”: a new safe cribriform approach to intracapsular tonsillectomy

Outpatient laser ablation of palatine tonsils is a very interesting procedure that has been recently introduced as a routine in head and neck surgery departments. The aim of this study was to describe a new strategy using a Doppler-guided fibre optic neodymium-yttrium–aluminium–garnet (YAG) laser to remove up to 80 % of tonsillar tissue, as assessed in the long-term postoperative clinical evaluation of the volume of the tonsils at the follow-up, and leaving the capsule in place, thus avoiding any haemorrhagic complication and minimize pain. A total of 20 patients (men, n013; women, n07), aged between 6 and 63, were recruited for the procedure. They were affected by chronic hypertrophic tonsillitis with a recurrent fever and other symptoms that were related to oral inflammation. Among the 20 patients, no serious adverse events, including haemorrhagerelated complications, were observed. Treatment was well tolerated, even in patients displaying an overall low pain threshold. No dropout or uncompleted procedure occurred in the present study. Minor complications included sore throat, moderate oedema, mild acute pharynx inflammation, slight peritonsillar exudate and local burning. The postoperative pain, measured by Scott–Huskisson visual analogue scale, was between 5 and 40 mm and was easily counteracted by means of external ice packages and nonsteroidal anti-inflammatory drugs, according to the individual patient’s need. During the 12–36- month follow-up patients showed improved symptoms (n=7) and complete recovery (n=13). A relapse episode was observed in two patients. This study supports fibre optic laser neodymium-YAG tonsil surgery, named “cribriform intracapsular tonsillectomy” or “Swiss-cheese laser tonsillectomy”, as an effective alternative to the traditional cold knife approach or electrosurgery. This approach could become the gold standard for tonsil surgery in the third millennium for safety reasons, acceptable cost–benefit ratio, the precise targeting of the beam across the affected tissues and the short- and long-term recovery.  

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A preliminary study to assess the efficacy of a new UVA1 laser for treatment of psoriasis

Objective: The aim of the present study was to assess the effectiveness of an UVA1 355 nm laser (Alba 355) for treatment of mild, moderate, and severe psoriasis. Background data: Psoriasis is an immune-inflammatory and proliferative skin disease. During the past few years, the instrumental treatment by UV radiation has been successfully described, either alone or in combination with topical and/or systemic drug administration to treat several skin-related diseases. Materials and methods: Fourteen patients, aged between 25 and 50 years, affected by mild-to-severe psoriatic plaques, were included in this study. Patients were treated with a new instrument, laser Alba 355, which administers energy in the UVA1 spectrum. This instrument is based on a 1064 wavelength neodymiumdoped yttrium orthovanadate (Nd:YVO4) laser optically pumped using a 808nm infrared beam able to achieve a third harmonic 355nm wave delivery. The fluences administered were 80–140J/cm2 four times a week for a total of up to 12 sessions over selected psoriatic plaques in different areas of the patients’ bodies. The patients rated their satisfaction with the outcome of the procedure as 1 not satisfied, 2 quite satisfied, 3 very satisfied. Results: Overall, laser treatment of psoriatic plaques produced a significant improvement in Psoriasis Area and Severity Index (PASI) score (F [3, 55] =57.86; p <0.001). The mean PASI score decreased from a baseline value of 24.5 –2.9 to a value of 15.6 –1.9 at 1 week ( p <0.001), 9.1 –1.2 at 2 weeks ( p <0.001), and 5.8 –1.2 at 3 weeks ( p <0.001) (all data reported as mean –standard error of the mean). All the patients were very satisfied with the outcome of procedure. No side effects were observed in this study. Conclusions: The present study outlines an original approach based on UVA1 355 nm laser therapy for treatment of mild, moderate, and severe psoriasis. In the present study, the high success rate was coupled with safety. Larger clinical trials are needed to definitely support the role of this medical device not only for treatment of psoriasis, but also for other skin-related diseases that share a similar pathophysiology. We speculatethat in the near future, the use of this laser will grow in the dermatological field.

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Neodymium:YAG laser treatment of lower leg telangiectasia: a new minimally invasive approach

The aim of this study was to validate the safety and effectiveness of a new therapeutic procedure for the treatment of lower leg telangiectasia without clinical vein insufficiency. A group of 20 healthy women aged between 24 and 47 years (mean±sem 37.05±1.47) with lower leg telangiectasia without clinical vein insufficiency, previously investigated by echo colour Doppler sonography, wererecruited and were treated with neodymium:YAG laser (mean±sem 2.5±0.11 sessions). Good or excellent results were obtained in 16 patients and the improvements were statistically significant (p<0.01). Out of the 20 patients, 16 were satisfied with the procedure. We strongly support laser treatment of lower leg telangiectasia since it allows injection of chemicals to be avoided, and changes the stromal microarchitecture rearranging the fibroblast network into a more resistant pattern reducing the likelihood of relapse.  

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