The Therapeutic Effects of the Q-Switched Nd:YAG Laser on Pigmented Lesions

The Q-switched lasers which was introduced under the concept of selective photothermolysis. Q-switched Nd:YAG laser, which targets dark pigments in a longer wave length (1064 nm) that has less absorption by melanin, can effectively treat deep tattoos with less pigmentary alterations. We report our experience over the past 3 years in treating 565 patients with tattoos and cutaneous pigmented lesions using the Q-switched Nd:YAG laser. Patients were exposed with a pulse duration of 10 ns and fluences of 6, 7 J/cm2(1064 nm) or 12, 14 J/cm2(532 nm), in exposure spots of 2 mm or 3 mm, at intervals of 4 weeks. Q-switched Nd:YAG laser was effective in removing deep pigmented lesion with 1064 nm, and colored inks with 532 nm. Seventy-three percent of amateur black pigmented lesion were > 75% clear after four to ten treatment. Ninty-eight percent of professional black pigmented lesion were > 75% clear after two on eyebrow, six to eight on extremity and trunk. No significant side effects, including pigmentary changes or scarring, were noted.

One-Stage Reconstruction with Pericraniosubgaleal Flap after Removal of Skin Involved Severe Paraffinoma

Paraffinoma on nose from injection of paraffin by the quack doctor for the purpose of augmentation rhinoplasty has so many problem, especially when invaded overlying nasal skin. 6 cases of skin involved severe paraffinoma were treated by one step reconstruction with pericraniosubgaleal flap and follow up periods was 2 to 17 months. All patients were successfully treated without any complications and had satisfactory results. In cases of three telangiectasis among six patients, the severity of telangiectasis was improved, but not completely. We believe that the advantages of this method are one step reconstruction and good vascularity, which prevent infection and enable easy to make variable shape. When the overlying skin loss was developed, the flap became tolerable graft bed. The authors conclude that the pericraniosubgaleal flap is one of the reliable surgical options for treatment of the skin involved severe nasal paraffinoma.

A Case Report of Pseudoxama Elasticum of the Neck: Surgical Excision and The Effect of Laserbrasion

Pseudoxanthoma elasticum (PXE) is an uncommon heritable disorder of elastin characterized by cutaneous, ocular and vascular abnormalities. Typical skin lesion shows yellowish papules and redundant skin folds on the neck, axilla and groin due to degeneration and calcification of elastic fibers in deep dermis. As in all heritable disorders of connective tissue, no curative therapy is presently know. Redundant and unsightly skin folds about the neck can be improved by surgery, but irregular papular lesion on skin does not improved by surgery. A-44-year-old female who had a skin lesion and angioid streak was treated as follows: Skin folds on the neck were excised successfully without any significant problem such as intraoperative bleeding, wound dehiscence or hypertrophic scar formation. To evaluate whether we could smooth the irregular skin surface due to multiple papules, laserbrasion with a SLT contack Nd:YAG laser system was performed experimentally on a limited area which was located on the right supracla-vicular area about 2 x 3cm in size. An acceptable aesthetic appearance was achieved with surgical excision 12 months after the operation. Biopsy of the laserbrasion site revealed disappearance of the calcium deposit. This study emphasizes the possibility of using laserbrasion in solving troblesome skin lesion of the PXE.

Effects of Acetyl-L Carnitine on Recovery from Sciatic Nerve Injury in Rats

A possible therapeutic effect of acetyl-L carnitine (ALCAR) on peripheral nerve injuries and the expression of Jun, the protein products of immediate-early genes(IEGs), in the spinal cord were investigated after sciatic nerve injury in Sprague-Dawley rats. Experimental animals were divided into 3 groups: intact sciatic nerve as a control group, surgical repair alone, and surgical repair with ALCAR treatment. Toe-spreading response, pinprick response, and compound action potential were measured to evaluate the recovery of sciatic nerve injury. Recovery of behavioral function and electrophysiological function both improved in the surgical repair with ALCAR treatment group. Weak basal expression of Jun was shown in the ventral horn the of spinal cord in the control group. In the surgical repair alone group or the surgical repair with ALCAR treatment group, Jun expression persisted until 28 days after injury in the ventral horn of the spinal cord. Moreover, the surgical repair with ALCAR treatment group showed more increased expression of Jun than the surgical repair alone group. These results suggest that ALCAR facilitates the functional recovery after peripheral nerve injury.

Lacrimal canalicular repairing using silicone intubation

Repairing of lacrimal canalicular laceration has some controversies on the golden time of surgery, the suture method, and the materials for stent. Recently, intubation of silicone tubes has become popular for repair of lacrimal canalicular injuries. Thirty-two cases of injured lacrimal canaliculi were repaired with use of silicone tube stents. The surgery can be done with monocanalicular(10 patients) or bicanalicular(22 patient) methods. The follow-up period was from two to eighteen months(mean ten months). Seven cases using the monocanalicular method and nineteen cases using the bicanalicular method were successful. Three cases of monocanalicular method had epiphora with canalicular obstruction due to early loss of the silicone tube. In monocanalicular method, postoperative complications were punctal granuloma(1 case), punctal slits(2 cases), and early loss of the silicone tube(3 cases). In bicanalicular method, postoperative complications were persistent epiphora during the period of intubaion(4 cases), conjunctival irritation sign(3 cases) and loop retraction(1 case). In conclusion, the success rate of bicanalicular stents were higher than that of monocanalicular stents for canalicular laceration. But the bicanalicular stent had some complications including cosmetic problem, possibility of injuries to the normal canaliculus during intubation, conjuntival irritation sign, and loop retraction.