Tratamento de neurofibromatose NF-1 com laser de CO2 - Relato de caso / Treatment of neurofibromatosis NF-1 with CO2 laser - case report

neurofibromatose tipo 1 apresenta lesões cutâneas múltiplas e limitadas opções terapêuticas. O laser de CO2 é ferramenta útil na remoção de neurofibromas, a principal fonte de desfiguração cosmética nesses pacientes. Apresentamos o tratamento de neurofibromas com laser de CO2 em uma paciente ao longo de quatro anos e meio. A paciente apresentava lesões de diâmetro variável, distribuídas difusamente. Após 16 sessões com laser de CO2 constatou-se melhora clínica. Apesar de ser tratamento paliativo, a melhora estética obtida justifica o esforço e tempo demandados, tendo em vista os ganhos na esfera psicológica do paciente.

Type 1 neurofibromatosis has multiple cutaneous lesions and limited treatment options. CO2 laser is a useful tool for the removal of neurofibromas, the main source of cosmetic disfiguration for these patients. We present the treatment of neurofibromas with CO2 laser in a patient over 4.5 years. The patient had lesions with variable diameter, diffusely distributed. After 16 sessions of CO2 laser, we observed clinical improvement. Although it is a palliative treatment, the cosmetic improvement achieved substantiates the demanded effort and time in view of the psychological gains for the patient.

Bartholin's gland cysts: management with carbon-dioxide laser vaporization / Cistos da glândula de Bartholin: tratamento com vaporização laser com CO2

PURPOSE: To evaluate the effectiveness, recurrence rate, and complications of carbon-dioxide laser vaporization in the treatment of Bartholin's gland cysts. METHODS: A retrospective study including 127 patients with symptomatic Bartholin' gland cysts submitted to carbon-dioxide laser vaporization at our institution from January 2005 to June 2011. Patients with Bartholin's gland abscesses and those suspected of having neoplasia were excluded. All procedures were performed in an outpatient setting under local anaesthesia. Clinical records were reviewed for demographic characteristics, anatomic parameters, intraoperative and postoperative complications, and follow-up data. Data were stored and analyzed in Microsoft Excel® 2007 software. A descriptive statistical analysis was performed, and its results were expressed as frequency (percentage) or mean±standard deviation. Complication, recurrence, and cure rates were calculated. RESULTS: The mean age of the patients was 37.3±9.5 years-old (range from 18 to 61 years-old). Seventy percent (n=85) of them were multiparous. The most common symptom was pain and 47.2% (n=60) of patients had a history of previous medical and/or surgical treatment for Bartholin's gland abscesses. Mean cyst size was 2.7±0.9 cm. There were three (2.4%) cases of minor intraoperative bleeding. Overall, there were 17 (13.4%) recurrences within a mean of 14.6 months (range from 1 to 56 months): ten Bartholin's gland abscesses and seven recurrent cysts requiring reintervention. The cure rate after single laser treatment was 86.6%. Among the five patients with recurrent disease that had a second laser procedure, the cure rate was 100%. CONCLUSIONS: At this institution, carbon-dioxide laser vaporization seems to be a safe and effective procedure for the treatment of Bartholin's gland cysts.

OBJETIVO: Avaliar a eficácia, a taxa de recorrência e as complicações da vaporização laser com CO2 no tratamento dos cistos da glândula de Bartholin. MÉTODOS: Estudo retrospectivo com 127 pacientes que apresentavam cistos sintomáticos da glândula de Bartholin submetidas à vaporização laser CO2 na nossa instituição de janeiro de 2005 a junho de 2011. Foram excluídas todas as pacientes com abcessos da glândula de Bartholin ou com suspeita de câncer. Todos os procedimentos foram realizados em regime ambulatorial, sob anestesia local. A coleta dos dados foi feita com base na consulta do processo clínico, tendo-se procedido à análise das características demográficas, dos parâmetros anatômicos, das complicações intra e pós-operatórias e dos dados de acompanhamento. Os dados foram armazenados e analisados no software Microsoft Excel® 2007, e os resultados foram apresentados como frequência (porcentagem) ou média±desvio padrão. As taxas de complicações, recorrência e cura foram calculadas. RESULTADOS: A idade média das pacientes foi de 37,3±9,5 anos (variando entre 18 e 61 anos). Setenta por cento (n=85) delas eram multíparas. A queixa mais frequente foi dor e 47,2% (n=60) das pacientes tinham antecedentes de tratamento médico e/ou cirúrgico por abcesso da glândula de Bartholin. A dimensão média dos cistos foi de 2,7±0,9 cm. Foram verificados três (2,4%) casos de hemorragia intraoperatória ligeira e 17 (13,4%) recorrências durante um período médio de 14,6 meses (variando entre 1 e 56 meses): dez abscessos da glândula de Bartholin e sete cistos recorrentes, que precisavam de uma nova intervenção cirúrgica. A taxa de cura após um único tratamento à laser foi de 86,6%. Dentre as cinco pacientes com doença recorrente que foram submetidas a um segundo procedimento com laser, a taxa de cura foi de 100%. CONCLUSÕES: Na presente instituição, a vaporização laser com CO2 parece ser uma opção terapêutica segura e eficaz no tratamento dos cistos da glândula de Bartholin.

Efeitos da aplicação do L.A.S.E.R. HeNe e do ultravioleta B no vitiligo / Application purposes of HeNe L.A.S.E.R. and ultraviolet B in vitiligo

INTRODUÇÃO: O vitiligo é uma doença crônica despigmentante da pele, ocasionada pela perda funcional dos melanócitos da epiderme. Este estudo teve como objetivo comparar os efeitos da aplicação do L.A.S.E.R. HeNe e do ultravioleta B em pacientes com vitiligo. MÉTODO: Foram selecionados 22 pacientes (11 mulheres e 11 homens), com idade entre 12 e 60 anos (31,68 ± 16,29). Os pacientes foram distribuídos aleatoriamente, de acordo com a ordem de comparecimento no serviço e foram divididos randomicamente em dois grupos: o grupo A (n = 12), submetido à aplicação do L.A.S.E.R. HeNe, para o qual a técnica utilizada foi a pontual com aproximadamente 3 cm de distância entre cada ponto, perpendicularmente à pele, e o grupo B (n = 10), exposto ao Ultravioleta B, aplicado de forma perpendicular com 10 cm de afastamento da pele do paciente. Para mensuração da área tratada, utilizou-se o programa AUTOCAD 2002, no qual foi delimitada a borda da mácula em fotos tiradas no início e no fim do tratamento. RESULTADOS: Inicialmente, no grupo A, a área era de 4,87 cm² ± 3,70 e, após a aplicação, foi de 4,15 cm² ± 2,89, com diferença média de 0,72 cm² (1,89). No grupo B, verificou-se que antes da aplicação a média era de 5,36 cm² ± 6,36 e, a após a aplicação, foi de 4,43 cm² ± 5,17, com diferença média de 0,92 cm² ± 1,29. CONCLUSÃO: Ambos os aparelhos obtiveram resultados significativos na redução da mácula, com maior redução no grupo da ultravioleta.

INTRODUCTION: The Vitiligo is a chronic depigmentation illness of the skin caused by loss of functional melanocytes in the epidermis. This study's objective was to compare the effects of applying L.A.S.E.R. HeNe and ultraviolet B in patients with vitiligo. METHOD: 22 patients (11 women and 11 men) aged 12-60 years (31,68 ± 16,29) were selected. Patients were randomly assigned, according to the order of attendance at the service and were divided randomly into two groups: group A (n = 12) subjected to the application of L.A.S.E.R. HeNe, where the technique used was punctual with about 3 cm distance between each point, perpendicular to the skin, and group B (n = 10) exposed to Ultraviolet B applied perpendicular 10 cm away from the patient's skin. For measurement of the treated area it was used the AUTOCAD program, which was bounded to the edge of the stain on photos taken at the beginning and at the end of treatment. RESULTS: Initially, in group A the area was 4,87 cm² ± 3,70, and after application it was 4,15 cm² ± 2,89, with an average difference of 0,72 cm² ± 1,89. In group B it was noted that before applying the average was 5,36 cm² ± 6,36, and after application it was 4,43 cm² ± 5,17, with average difference of 0,92 cm² ± 1,29. CONCLUSION: Both devices achieved significant results in reducing the stain, with a greater reduction in the group of ultraviolet.

Aplicación del láser de CO2 en la blefaroplastia / Application of the CO2 laser in blepharoplasty

Fundamento: la cirugía estética oftalmológica tiene como finalidad el tratamiento de la mayoría de las lesiones de cambios relacionados con el envejecimiento y la exposición solar Objetivo: determinar los resultados que se obtienen con la aplicación del láser de CO2 en la blefaroplastia superior transcutánea en los pacientes con diagnóstico de dermatochalasis. Método: se realizó un estudio descriptivo prospectivo en cuarenta y cinco pacientes mayores de cuarenta años que asistieron a consulta de Oculoplastia con diagnóstico de dermatochalasis. El universo se constituyó por cuarenta y ocho adultos mayores evaluados en dicha consulta. La información se recogió mediante planillas de recolección de datos previamente elaboradas. Se aplicó una encuesta a los participantes en la investigación y al cirujano, que incluyeron las siguientes variables: objeto de estudio, grupos de edades, sexo, causas de la cirugía, mejoría estética y funcional, expectativo del paciente, complicaciones transoperatoria y postoperatorio y grado de satisfacción del paciente y del cirujano. Se utilizó el paquete de programas estadístico SPSS v-11.5 para Windows para el procesamiento estadístico de la información. Resultados: se observó un rango muy similar entre lo estético y lo terapéutico correspondiendo el mayor número de cirugías al sexo femenino en ambas categorías. La mejoría estética y funcional es satisfactoria en la mayoría de los pacientes. Conclusiones: la blefaroplastia con láser de CO2 es una cirugía de mayor estética en el sexo femenino, alcanza una notable mejoría estética y funcional con un mínimo de complicaciones en pacientes con una buena expectativa.

Background: the ophthalmological esthetic surgery has as purpose the treatment of most of the change lesions related with the aging and solar exposure. Objective: to determine the results obtained with the application of the CO2 laser in transcutaneous superior blepharoplasty in patients with dermatochalasis diagnostic. Method: a prospective descriptive study was carried out in forty-five patients older than forty years attended at the Oculoplasty consultation with dermatochalasis diagnostic. The universe was constituted by forty-eight adults evaluated in this consultation. The information was gathered by means of data collecting schedules previously elaborated. A survey was applied to the participants in the investigation and to the surgeon that included the following variables: study purpose, age groups, sex, causes of surgery, esthetic and functional improvement, patient's expectation, transoperative and postoperative complications and patient's and surgeon’s grade of satisfaction. The statistical programs SPSS v-11.5 for Windows was used for the information statistical processing. Results: a very similar rank between esthetics and therapeutics was observed corresponding the biggest number of surgeries to the female sex in both categories. The esthetic and functional improvement is satisfactory in most of the patients. Conclusions: blepharoplasty with CO2 laser is a most esthetics surgery for the female sex; it reaches a remarkable esthetic and functional improvement with a minimum of complications in patients with a good expectation.

Láser en odontología / Laser in dentistry

The term Laser means light amplifed by stimulated emmiting radiation. It has been used for the last 30 years in different medical areas, including dentistry. Basically it transfers an external energy in lightning or luminic energy. There are two types of laser: surgical and therapeutic. The biological reactions of the different tissues, depend on their optical cualities. In dentistry, it has been used in endodontics to clean seal accesory canals; in operative dentistry: as analgesic antiinflamatory in surgical procedures. Taking into account the cautions recommended, it offers a good choise of treatment for our patients.