Láser CO2 vaginal, indicaciones y aplicaciones / Vaginal CO2 laser, indications and applications

El síndrome genitourinario es una entidad hoy en día cada vez más frecuente en la mujer posmenopáusica, con signos y síntomas muy característicos que llevan a la pérdida de calidad de vida de las pacientes, generados por la disminución de estrógenos. Su diagnóstico se realiza mediante una buena historia clínica, exámenes hormonales, estudios urodinámicos y de pH vaginal. Su clínica varía desde sequedad vaginal, atrofia de la misma, vaginitis a repetición, pérdida de orina al esfuerzo, nicturia y dispareunia. A los largo de los años se han protocolizado diferentes tratamientos como reemplazos hormonales, lubricantes y cirugías invasivas vaginales. Pero en los últimos años ha aparecido una nueva terapéutica de láser CO2 fraccionado. Materiales y método. Se realizó un estudio retrospectivo de seis años de evolución, entre los años 2017 y 2023, con más de 300 pacientes tratadas con tecnología láser CO2 fraccionado, con criterios de inclusión y exclusión, protocolizando 3 sesiones cada 30 días y controles hasta los 6 meses. Resultados. Para evaluar los resultados se diseñó una encuentra de satisfacción de 5 puntos, la cual fue presentada luego de cada sesión, encontrando un alto grado de satisfacción en la mejoría clínica a medida que transcurrían las sesiones, con un muy bajo índice de complicaciones. También biopsias con mejorías histológicas que demuestran resultados. Discusión. La aplicación de esta nueva tecnología láser nos abre una posibilidad terapéutica segura, rápida y efectiva para mejorar la sintomatología y calidad de vida de nuestras pacientes con síndrome genitourinario, sumando una nueva terapéutica a todo el arsenal de tratamientos médico-quirúrgicos disponibles a la fecha. Conclusiones. El síndrome genitourinario es una entidad prácticamente inevitable, con síntomas desde leves a graves, que afecta la calidad de vida personal, sexual y social. Los tratamientos hasta la fecha hormonales, tópicos o quirúrgicos han dado mediocres resultados sin estar exentos de complicaciones, por lo que la aparición de la tecnología láser CO2 fraccionada nos ha dado el plus necesario para aportar un tratamiento seguro, eficaz, con mínimas complicaciones y una curva de aprendizaje pequeña

Genitourinary syndrome is an increasingly frequent entity in postmenopausal women today, with very characteristic signs and symptoms that lead to a loss of quality of life in patients, generated by estrogen depletion, whose diagnosis is made through a good clinical history, hormonal tests, urodynamic and vaginal pH studies. Its symptoms vary from vaginal dryness, vaginal atrophy, repeated vaginitis, loss of urine on exertion, nocturia and dyspareunia. Over the years, different treatments have been protocolized, such as hormone replacements, lubricants, and invasive vaginal surgeries. But in recent years a new fractionated CO2 laser therapy has appeared. Materials and method. A retrospective study of six years of evolution was carried out, between the years 2017 and 2023, with more than 300 patients treated with fractionated CO2 laser technology, with inclusion and exclusion criteria, protocolizing 3 sessions every 30 days and controls until the 6 months. Results. To evaluate the results, a 5-point satisfaction score was designed, which was presented after each session, finding a high degree of satisfaction in the clinical improvement as the sessions progressed with a very low indication of complications. Also biopsies with histological improvements that demonstrate results. Discussion. The application of this new laser technology opens up a safe, fast and effective therapeutic possibility to improve the symptoms and quality of life of our patients with genitourinary syndrome, adding a new therapeutic option to the arsenal of medical-surgical treatments available to date. Conclusions. Genitourinary syndrome is a practically inevitable entity, with symptoms ranging from mild to severe, affecting the quality of personal, sexual and social life. The hormonal, topical or surgical treatments to date have given mediocre results, not being free of complications, so the appearance of fractionated CO2 laser technology has given us the necessary extra to provide a safe, effective treatment, with minimal complications. and a small learning curve.

Clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars / 中华烧伤杂志

Objective: To explore the clinical effects of fractional carbon dioxide laser combined with minimally invasive scar release in the treatment of post-acne atrophic scars. Methods: A retrospectively observational study was conducted. From January to June 2021, 60 patients with grade 3 and 4 post-acne atrophic scars who met the inclusion criteria were admitted to the First Affiliated Hospital of Henan University of Traditional Chinese Medicine. According to the adopted treatment methods, 30 patients treated with fractional carbon dioxide laser combined with minimally invasive scar release were included in combined treatment group (19 males and 11 females, aged (26±4) years), and 30 patients treated with fractional carbon dioxide laser alone were included in laser alone group (18 males and 12 females, aged (25±6) years). All the patients received the treatment once every two months, totally 3 times. Before the first treatment and 2 months after the last treatment, the scars were assessed by échelle d'évaluation clinique des cicatrices d'acné (ECCA). In 2 months after the last treatment, the curative effect was evaluated and the total effective rate was calculated according to the ECCA score. The adverse reactions of patients during the treatment were recorded. Data were statistically analyzed with independent sample t test, Wilcoxon rank-sum test, Mann-Whitney U test, chi-square test, and Fisher's exact probability test. Results: Before the first treatment, the ECCA scores of patients in the two groups were similar (P>0.05). In 2 months after the last treatment, the ECCA scores of patients in combined treatment group were significantly lower than those of laser alone group (Z=-2.89, P<0.05). The ECCA scores of patients in combined treatment group and laser alone group in 2 months after the last treatment were both significantly lower than those before the first treatment (with Z values of -4.81 and -4.79, respectively, P<0.05). In 2 months after the last treatment, the treatment in laser alone group cured the scars in 2 patients, and were markedly effective in 13 patients, effective in 7 patients, and ineffective in 8 patients; the treatment in combined treatment group cured the scars in 4 patients, and were markedly effective in 22 patients, effective in 3 patients, and ineffective in one patients. The total effective rate of scar treatment in combined treatment group (96.67%, 29/30) was significantly higher than 73.33% (22/30) in laser alone group (P<0.05). During treatment, in combined treatment group, 3 patients had pain, one patient had redness and swelling, and one patient had pigmentation. In laser alone group, one patient had pain, and 2 patients had pigmentation. No infection occurred in the wounds of all the patients in the two groups. Conclusions: Compared with fractional carbon dioxide laser alone, fractional carbon dioxide laser combined with minimally invasive scar release for post-acne atrophic scars can result in a higher total effective rate, with simple operation and good effect, so it is worthy of clinical application.

A prospective randomized controlled study on the effects of compound analgesia in ultra-pulsed fractional carbon dioxide laser treatment of post-burn hypertrophic scars in children / 中华烧伤杂志

Objective: To investigate the effects of compound analgesia on ultra-pulsed fractional carbon dioxide laser (UFCL) treatment of post-burn hypertrophic s in children. Methods: A prospective randomized controlled study was conducted. From April 2018 to March 2020, 169 pediatric patients with post-burn hypertrophic s admitted to the First Affiliated Hospital of Air Force Medical University were randomly divided into general anesthesia alone group (39 cases, 19 males and 20 females, aged 35 (21, 48) months), general anesthesia+lidocaine group (41 cases, 23 males and 18 females, aged 42 (22, 68) months), general anesthesia+ibuprofen suppository group (41 cases, 25 males and 16 females, aged 38 (26, 52) months), and three-drug combination group with general anesthesia + lidocaine+ibuprofen suppository (48 cases, 25 males and 23 females, aged 42 (25, 60) months), and the pediatric patients in each group were treated with corresponding analgesic regimens when UFCL was used to treat s, and the pediatric patients were given comprehensive care throughout the treatment process. The pain degree of pediatric patients scar was evaluated by facial expression,legs,activity,cry,and consolability (FLACC) of children's pain behavior scale at 0 (immediately), 1, 2, and 4 h after awakening from the first anesthesia, respectively. At 4 h after awakening from the first anesthesia of postoperative pain assessment, the self-made analgesia satisfaction questionnaire was used to evaluate the satisfaction for the analgesic effect of the pediatric patients or their families, and the satisfaction rate was calculated. Within 2 h after the first operation, the occurrences of adverse reactions of the pediatric patients, such as nausea and vomiting, headache, dizziness, drowsiness, etc, were observed and recorded. Before the first treatment and 1 month after the last treatment, the Vancouver scar scale (VSS) was used to evaluate the pediatric patients scar, and the difference value between the two was calculated. Data were statistically analyzed with least significant difference test, Kruskal-Wallis H test, chi-square test and Fisher's exact probability test. Results: At 0 h after awakening from the first anesthesia, the FLACC scores of pediatric patients in general anesthesia+lidocaine group, general anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than those in general anesthesia alone group (P<0.01). The FLACC scores of the pediatric patients in anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than that in general anesthesia+lidocaine group (P<0.01), and the FLACC score of the pediatric patients in three-drug combination group was significantly lower than that in general anesthesia+ibuprofen suppository group (P<0.01). At 1 and 2 h after awakening from the first anesthesia, the FLACC scores of pediatric patients in general anesthesia+ibuprofen suppository group and three-drug combination group were both significantly lower than those in general anesthesia alone group and general anesthesia+lidocaine group (P<0.01), and the FLACC score of the pediatric patients in three-drug combination group was significantly lower than that in general anesthesia+ibuprofen suppository group (P<0.01). At 4 h after awakening from the first anesthesia, the FLACC scores of the pediatric patients in general anesthesia+ibuprofen suppository group and three-drug combination group were significantly lower than those in general anesthesia alone group and general anesthesia+lidocaine group (P<0.01). At 4 h after awakening from the first anesthesia, the satisfactions rate with the analgesic effect in the four groups of pediatric patients or their families were 79.49% (31/39), 85.37% (35/41), 87.80% (36/41), and 97.92% (47/48), respectively. The satisfaction rate of the pediatric patients in three-drug combination group was significantly higher than those in general anesthesia alone group, general anesthesia+lidocaine group, general anesthesia+ibuprofen suppository group. Within 2 h after the first operation, there was no significant difference in the overall comparison of adverse reactions such as nausea and vomiting, headache, dizziness, and drowsiness of pediatric patients among the 4 groups (P>0.05). The VSS scores of pediatric patients before the first treatment, 1 month after the last treatment, and and the difference value between the two in the 4 groups were not significantly different (P>0.05). Conclusions: Three-drug combination for analgesia has a good effect in the treatment of hypertrophic scars after burn in pediatric patients with UFCL. Pediatric patients or their families are highly satisfied with the effect, and the treatment effect and incidence of adverse reactions are similar to other analgesic regimens, so it is recommended to be promoted in clinical practice.

Tratamiento del síndrome genitourinario de la menopausia con láser CO2 en pacientes de Clínica Estrella / Treatment for genitourinary syndrome of menopause with CO2 laser in Clinica Estrella patients

El síndrome genitourinario de la menopausia se refiere a los signos y síntomas relacionados a la disminución estrogénica dando como resultado una atrofia vaginal, esto ocasiona un gran impacto negativo en las actividades cotidianas de las mujeres, existen varios tratamientos para aliviar y resolver los síntomas, siendo los más frecuentes la incontinencia urinaria por esfuerzo y resequedad vaginal. Dentro de los distintos tratamientos, el láser tiene como objetivo la restauración de la mucosa vaginal, estimulando los fibroblastos para obtener la neo colagenogenesis y vascularización, recuperando su funcionalidad y obteniendo mejoría de los síntomas junto con la calidad de vida de las pacientes

Genitourinary syndrome of menopause refers to a group of signs and symptoms related to the decreased estrogen and as a result, the vaginal atrophy, this has a great negative impact on the daily activities of women, there are several treatments to alleviate and resolve the symptoms, the most frequent being stress urinary incontinence and vaginal dryness. Among the different treatments, the laser aims to restore the aavaginal mucosa, stimulating fibroblasts to obtain neo-collagen oogenesis and revascularization, recovering their functionality and obtaining an improvement in symptoms along with the quality of life of patients

A comparison between endoscopic CO2 laser cauterization and open neck surgery in the treatment of congenital piriform fistula / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the efficacy, advantages and disadvantages of endoscopic CO2 laser cauterization (ECLC) and open neck surgery in the treatment of congenital pyriform sinus fistula (CPSF). Methods: From September 2014 to March 2017, 80 cases with confirmed diagnosis of CPSF received initial treatment at Guangdong Provincial People's Hospital were prospectively analyzed, including 34 males and 46 females, aged 18 to 672 (194.17±141.18) months. They were consecutively divided into endoscopic group and open-surgery group, with 40 cases in each group. Both groups of patients received surgical treatment under general anesthesia. The endoscopic group was treated by endoscopic CO2 laser cauterization, and the open-surgery group underwent the following surgery: first, we performed suspension laryngoscopy examination to confirm the presence of fistula in the bottom of the piriform fossa, then open-neck resection of congenital piriform sinus fistula with recurrent laryngeal nerve and/or lateral branch of superior laryngeal nerve anatomy plus partial thyroidectomy were performed. The data between the two groups were compared, including the operative time, intraoperative blood loss, postoperative pain, average length of stay, neck cosmetic scores, complications and cure rates. All patients were followed up in outpatient clinics. Statistical analysis was performed using SPSS 20.0 software. P<0.05 indicates that the difference is statistically significant. Results: All patients were successfully completed the operation. The operative time, intraoperative blood loss, postoperative pain and average length of hospital stay in the endoscopic group were significantly less than those in the open group [(27.4±5.5) min to (105.8±52.5) min, (0.6±0.5) ml to (33.6±41.5) ml, (1.7±0.9) points to (4.6±0.7) points, (5.9±2.9)d to(8.9±3.3)d, t values were-9.400, -5.031, -16.199, -4.293, P values were all<0.01]; The neck cosmetic score in the endoscopy group was significantly greater than that of the open group [(9.9±0.4) against (5.8±0.9) points, t=25.847, P<0.01]. Compared with the open group (15.0%, 6/40), the complication rate of the endoscopic group (7.5%, 3/40) was not statistically significant (χ²=0.50, P>0.05). Three months after the first treatment, the cure rate in the endoscopic group (82.5%, 33/40) was significantly lower than that in the open-neck group (100.0%, 40/40), χ²=5.64, P<0.05. The follow-up time was 12 months after the last treatment. Eighty cases were followed up and none was lost to follow-up. During the follow-up period, the cure rate of the endoscopy group (97.5%, 39/40) was compared with that of the open group (100.0%, 40/40), and the difference was not statistically significant. Conclusions: In the treatment of CPSF, the two-surgical method each has their advantages. Compared with open-neck surgery, ECLC is simpler, repeatable. ECLC has shorter time in operation and hospital stay, less complications, and less postoperative pain and more precise cosmetic results. It could be preferred for the initial treatment of CPSF and relapsed cases after cauterization. But subject to relatively low cure rate of one-time cauterization and uncertain long-term efficacy, it cannot completely replace the open-neck surgery at present.

O Laser e o tratamento da flacidez e atrofia vulvo-vaginal: uma revisão integrativa da literatura / Laser and the treatment of vulvo-vaginal laxity and atrophy: an integrative review of literature

A atrofia vulvo-vaginal (VVA) é uma condição progressiva e crônica que se manifesta como involução das mucosas vulvo-vaginais e tecidosdevido à diminuição dos níveis de estrogênio. O uso do laser com papel terapêutico ganhou interesse como um tratamento não hormonal para a VVA. Esse estudo objetivou avaliar os efeitos dos lasers de CO2 e Erbium: YAG na flacideze atrofia vulvo-vaginal em mulheres menopausadas. Trata-se de uma revisão integrativa, realizada na base de dados PubMed, utilizando os descritores: vagina, postmenopause, vulvovaginal atrophy, vulvovaginal laxity e laser. Ambos os tipos de lasers aumentam a espessura do epitélio pavimentoso estratificado, estimulam a produção de fibras colágenas, elásticas e outros componentes da matriz extracelular, melhoram a irrigação vascular da vagina e aliviam os sintomas de secura, ardor e dispareunia. No entanto, a duração dos efeitos terapêuticos e a segurança de aplicações repetidas ainda precisam ser mais bem estudados.(AU)

Vulvo-vaginal atrophy (VVA) is a progressive and chronic condition that manifests as involution of the vulvovaginal mucosa and tissues due to decreased levels of estrogen. The use of laser with therapeutic paper gained interest as a non-hormonal treatment for VVA. This study aimed to evaluate the effects of CO2 and Erbium: YAG lasers on vulvovaginal laxity and atrophy in menopausal women. It is an integrative review, carried out in the PubMed database, using the descriptors: vagina, postmenopause, vulvovaginal atrophy, vulvovaginal laxity and laser. Both types of lasers increase the thickness of the stratified squamous epithelium, stimulate the production of collagen, elastic fibers, and other components of the extracellular matrix, improve vascular irrigation of the vagina, and relieve symptoms of dryness, burning, and dyspareunia. However, the duration of therapeutic effects and the safety of repeated applications still need to be better studied.(AU)

Cirugía transoral en hemangiomas de laringe e hipofaringe en adultos / Transoral surgery in laryngeal hemangiomas e hypopharynx in adults

Los hemangiomas son tumores benignos infrecuentes en la laringe. El tratamiento está indicado cuando el tumor produce síntomas (disnea, hemoptisis, odinofagia) y también cuando el riesgo de hemorragia severa por traumatismo es alto. Tres hemangiomas de laringe e hipofaringe fueron tratados con éxito por vía transoral con láser de C02 y radiofrecuencia. Todos los pacientes se alimentaron por vía oral a las 24/48 horas y ninguno tuvo traqueostomía. La tasa de resección completa de los hemangiomas tratados por vía transoral fue 100%. (AU)

Hemangiomas are a rare type of benign tumors of the larynx. The treatment is indicated when the tumor produces symptoms (dyspnea, hemoptysis, odynophagia) and also when the risk of severe bleeding from trauma is high. Three hemangiomas of the larynx and hypopharynx were successfully treated transorally with C02 laser and radiofrequency. All were orally fed at 24/48 hours, and none had a tracheostomy The complete resection rate of hemangiomas treated transorally was 100%. (AU)

Therapeutic assessment of vulvar squamous intraepithelial lesions with CO2 laser vaporization in immunosuppressed patients / Avaliação terapêutica das lesões intraepiteliais escamosas da vulva com vaporização a laser CO2 em pacientes com imunossupressão

Abstract Objective A vulvar squamous intraepithelial lesion is deemed to be a preceding lesion to vulvar cancer, especially in women aged under 40 years, holders of an acquired or idiopathic immunosuppression. Several treatments have been used to treat these lesions. One of the aesthetically acceptable therapeutic methods is the CO2 laser vaporization. Methods In a transversal study, 46 records of immunosuppressed women bearing a vulvar low grade and/or high grade squamous intraepithelial lesion were selected out of the retrospective analysis, computing age, date of record, date of vulvar lesion treatment with CO2 laser, the time elapsed between the first and the last visit (in months), the number of visits, the presence or absence of condylomatous lesions in other female lower genital tract sites and whether or not recurrences and persistence of intraepithelial lesions have been noticed during the follow-up. Results Patients bearing vulvar high-grade squamous intraepithelial lesion and immunosuppressed (serumpositive forhumanimmunodeficiency virus [HIV] or with solid organs transplantation) have shown a higher level of persistence of lesions and a higher chance of having other areas of the female lower genital tract involved. Conclusion While the CO2 laser vaporization is the most conservative method for the treatment of vulvar high-grade intraepithelial lesions, it is far frombeing the ideal method, dueto the intrinsic infection features considered. The possibility of persistence, recurrences and spontaneous limited regression indicates that a closer surveillance in the long-term treated cases should be considered, in special for immunosuppressed patients.

Resumo Objetivo A lesão intraepitelial escamosa da vulva é considerada uma lesão precursora do câncer vulvar, emespecial emmulheres com idade inferior a 40 anos, portadoras de imunossupressão adquirida ou idiopática. Vários tratamentos têm sido utilizados para tratar esse tipo de lesão. Um dos métodos terapêuticos esteticamente aceitáveis é a vaporização a laser CO2. Métodos Em um estudo transversal, foram selecionados da análise retrospectiva de prontuários arquivados no setor de patologia do trato genital inferior 46 prontuários de mulheres comimunossupressão e portadoras de lesão intraepitelial escamosa de baixo grau e/ou alto grau computando-se: idade, data de registro, data do tratamento da lesão vulvar com laser CO2, tempo entre a primeira e a última consulta (em meses), número de consultas, presença ou ausência de lesões condilomatosas em outros locais do aparelho reprodutor feminino e a ocorrência ou não de recidivas e persistência de lesões intraepiteliais durante o período de acompanhamento. Resultados Pacientes com lesão intraepitelial de alto grau vulvar e imunocomprometidas (soropositivas para HIV ou com transplante de órgãos sólidos) mostraram maior índice de persistência das lesões e maior chance de ter outras áreas do órgão genital feminino comprometidas. Conclusão Embora a vaporização a laser CO2 seja o método mais conservador para o tratamento das lesões intraepiteliais vulvares de alto grau, está longe de ser o método ideal pelas características intrínsecas da afecção em foco. A possibilidade de persistência, recidivas e regressão espontânea limitada recomenda maior vigilância para os casos tratados a longo prazo, em especial para as pacientes com imunossupressão.

effectiveness of fractional CO[2] LASER in treatment of striae rubra and striae alba: a comparative study

Background: Striae distensae are a well-recognized, common skin condition that rarely causes any significant medical problems but are often a significant source of distress to those affected. The natural evolution of striae is from red or purple, raised wavy lesions [striae rubra] to white atrophic lesions with wrinkly surface [striae alba]

Aim of the Work: was to compare the efficacy of the fractional CO2 laser in the treatment of striae rubra versus striae alba

Patients and Methods: The present study included 20 patients above the age of 18 of both sexes; 10 patients had striae rubra and 10 patients had striae alba. They were recruited from Dermatology outpatient clinic in Ain Shams University Hospital from June 2017 to January 2018. 4 sessions of Fractional CO2 Laser for each patient were performed one month apart. The treated striae were randomly selected from each patient [Striae rubra and alba] and were assessed before starting treatment, at the beginning of every session and one month after the last session as regards length, width, texture, color of striae and any complications encountered

Results: No significant difference was found on comparing the clinical response [improvement of color P= 0.653], [improvement of atrophy P= 0.606], side effects [Hyperpigmentation P= 0.531], [Pain P=0.606], [Hypopigmentation P=0.305], [Erythema P= 0.060], of both striae alba and rubra to the laser treatment

Conclusion: The present study showed significant clinical improvement in both types of striae distensae treated by Fractional CO2 Laser with non-significant difference between the 2 groups except the development of erythema in striae rubra group. Furthermore, the histological improvement was significant for both groups with low incidence of the side effects

Recommendations: Larger scale studies with longer follow up period are recommended to further clarify the role of fractional CO2 laser in treatment of striae distensae

New therapeutic option in genitourinary syndrome of menopause: pilot study using microablative fractional radiofrequency / Nova opção terapêutica na síndrome geniturinária da menopausa: estudo piloto utilizando radiofrequência fracionada microablativa

ABSTRACT Objective: To evaluate the clinical response of patients with symptoms of genitourinary syndrome of menopause after application of microablative fractional radiofrequency in the vagina and vaginal introitus. Methods: Fourteen patients with symptoms of genitourinary syndrome of menopause underwent three applications of microablative fractional radiofrequency with a 30-day interval, using the Wavetronic 6000HF-FRAXX device and a fractional vaginal electrode. The questionnaires World Health Organization Quality of Life (for quality of life evaluation), Female Sexual Function Index and Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (for sexual function and satisfaction evaluation) were administered before and after the applications (30 to 60 days after the last procedure), in addition to the satisfaction questionnaire after procedure. Results: There was an increase in almost all dimensions on average in quality of life, with statistical significance only in the health domain. There was a significant improvement in the sexual domains in almost all dimensions. All patients stopped using lubricant during intercourse after treatment. In the satisfaction questionnaire after treatment, we observed that the vast majority felt cured or much better (29% and 64%, respectively, total of 92.6%) and were very satisfied or satisfied (43 and 57%, respectively, total of 100%). The only patient who reported little improvement had an 18-year postmenopausal history and was treatment naïve. Conclusion: Microablative fractional radiofrequency was effective in treating symptoms of vaginal dryness and dyspareunia, and eliminated the use of vaginal lubricant during the period observed. Since this is a pilot study with a small number of patients, further studies are required to corroborate our findings and evaluate the long-term effects of microablative fractional radiofrequency on the vaginal tissue.

RESUMO Objetivo: Avaliar resposta clínica de pacientes com sintomas da síndrome geniturinária da menopausa após aplicação de radiofrequência fracionada microablativa na vagina e no introito vaginal. Métodos: Quatorze pacientes com sintomas de síndrome geniturinária da menopausa foram submetidas a três aplicações de radiofrequência fracionada microablativa com intervalo de 30 dias, utilizando aparelho Wavetronic 6000HF-FRAXX e eletrodo vaginal fracionado. Foram aplicados os questionários World Health Organization Quality of Life (para avaliar qualidade de vida), Female Sexual Function Index e Quality of Life Adapted Questionnaire in the Domain of Sexual Satisfaction (para verificar função sexual e satisfação) antes e depois das aplicações (30 a 60 dias após último procedimento), além do questionário de satisfação após procedimento. Resultados: Na qualidade de vida, houve aumento na média em geral, com significância estatística apenas no quesito saúde. No domínio sexual, houve melhora significativa em quase todas as dimensões. Todas as pacientes cessaram o uso de lubrificante na relação sexual após o tratamento. No questionário de satisfação após tratamento, a maioria se sentiu curada ou muito melhor (29 e 64%, respectivamente; total de 92,6%) e estava muito satisfeita ou satisfeita (43 e 57%, respectivamente; total de 100%). A única paciente que relatou pouca melhora tinha história de 18 anos de pós-menopausa e era virgem de tratamento. Conclusão: Radiofrequência fracionada microablativa foi efetiva em tratar sintomas de ressecamento vaginal e dispareunia, e eliminou o uso de lubrificante vaginal durante o período observado. Por se tratar de estudo piloto com pequena quantidade de pacientes, mais estudos são necessários para corroborar estes achados e avaliar os efeitos a longo prazo da radiofrequência fracionada microablativa no tecido vaginal.

Blefaroplastia: resultados del empleo de dos técnicas en el Centro Oftalmológico de Santiago de Cuba / Blepharoplasty: results of using two techniques in the Ophthalmologic Center from Santiago de Cuba

Introducción: La blefaroplastia produce resultados clínicos y estéticos favorables en los pacientes aquejados por dermatocalasis. Objetivo: Evaluar los resultados de los procedimientos quirúrgicos convencional y con láser de CO2 en estos afectados. Métodos: Se realizó un estudio descriptivo, prospectivo y trasversal de 300 pacientes con dermatocalasis, atendidos en el Servicio de Oculoplastia del Centro Oftalmológico del Hospital General Docente Dr Juan Bruno Zayas Alfonso de Santiago de Cuba, desde enero de 2015 hasta diciembre de 2016. Resultados: Predominaron el grupo etario de 40 a 59 años, el sexo femenino y la afectación en los párpados superiores, sin diferencias significativas en cuanto a las técnicas quirúrgicas empleadas; se observó un mayor número de complicaciones en los pacientes operados de manera convencional, con más frecuencia del sangrado. En general los pacientes evolucionaron satisfactoriamente y los que presentaron limitaciones del campo visual superior se recuperaron sin dificultad luego de la intervención quirúrgica. Conclusiones: La blefaroplastia con láser de CO2 constituye una mejor y más calificada opción terapéutica para la corrección de la dermatocalasis

Introduction: Blepharoplasty produces favorable clinical and cosmetic results in the patients that are suffering from dermatochalasis. Objective: To evaluate the results of the conventional and CO2 laser surgical procedures in these affected patients. Methods: A descriptive, prospective and cross-sectional study of 300 patients with dermatochalasis, assisted in the Oculoplasty Service of Dr Juan Bruno Zayas Alfonso Teaching General Hospital Ophthalmologic Center was carried out in Santiago de Cuba, from January, 2015 to December, 2016. Results: There was a prevalence of the 40 to 59 age group, female sex and upper lids disorder, without significant differences concerning the surgical techniques that were used; a higher number of complications in patients operated with a conventional way was observed, with more frequency of bleeding. In general the patients had a favorable clinical course and those that presented limitations of the upper visual field recovered without difficulty after the surgical intervention. Conclusions: Blepharoplasty with CO2 laser constitutes a better and more qualified therapeutic option for the correction of dermatochalasis

Relieving pain in oral lesions of pemphigus vulgaris using the non-ablative, non-thermal, co2 laser therapy [NTCLT]: preliminary results of a novel approach

Introduction: Pemphigus vulgaris [PV] is a chronic, serious autoimmune mucocutaneous bullous disease. Oral lesions in PV may be extremely painful. This pain may adversely affect the patients' oral intake and quality of life. This before-after clinical trial was designed to assess the pain relieving effects of single session of non-ablative, non-thermal CO2 laser therapy [NTCLT] in oral lesions of PV

Methods: Fifty painful oral lesions of fourteen patients with PV were illuminated by CO2 laser [power: 1 W, scanning the lesions with rapid circular motion of the handpiece] passing through a thick layer of transparent gel with high water content. The pain severity of the oral lesions was reported by the patients up to the fourth postoperative day. They were also asked to continue their existing systemic treatment during the course of this study as a precondition for the participation

Results: The severity of contact and non-stimulate [non-contact] pain declined immediately and significantly after NTCLT [P < 0.001]. The pain relieving effect was sustained during the four successive days of follow-up. The procedure was pain free and no kind of analgesics was required. Following NTCLT, there were no visible thermal complications such as destruction, ablation or irritation of the oral lesions

Conclusion: The results of the trial proposed that single session of NTCLT could immediately and significantly relieve pain in oral lesions of PV, without any visible thermal complications

Uso de Láser diodo de 1470 nm en el tratamiento del carcinoma escamoso de laringe (Tis, T1 y T2) en adultos mayores / 4170 nm diode Laser use in the treatment of laringeal squamous carcinoma (Tis, T1 and T2) in elderly adults / Usando diodo laser 1470 nm, no tratamento do carcinoma de celulas escamosas da laringe (Tis, T1 y T2) em idosos

Introducción: entre las diferentes modalidades terapéuticas para el carcinoma escamoso de laringe en estadios iniciales, la cirugía transoral láser (CTL) constituye el tratamiento de elección. El láser de CO2 es aceptado universalmente como la mejor herramienta terapéutica en este sentido. En situaciones de no poder acceder a esa tecnología, es posible utilizar otros instrumentos para resección en CTL (radiofrecuencia, electrobisturí). Entre estas, nuestro equipo de trabajo ha implementado el uso del láser de diodo de 1470 nm. En el presente trabajo describimos los resultados preliminares en el tratamiento de estadios tempranos del carcinoma escamoso de laringe con CTL. Materiales y métodos: Se utilizó el láser de diodo de 1470 nm en pacientes adultos mayores realizados entre enero de 2012 y diciembre de 2015 en el Servicio de Otorrinolaringología del Hospital Dr. C. Milstein. Resultados: Se trataron 32 pacientes con cáncer de laringe, de los cuales se incluyeron 21, todos mayores de 65 años, con carcinoma escamoso de laringe estadio Tis T1 y T2 sin compromiso cervical ni metastásico y sin tratamiento oncológico previo. De los 21 pacientes incluidos, a 19 se les realizó una única intervención y dos fueron reintervenidos con la misma técnica. Conclusiones: El uso del láser diodo de 1470 nm para el tratamiento del carcinoma escamoso de laringe en estadios iniciales ha permitido controlar la enfermedad en los 21 pacientes intervenidos con esta tecnología, en un tiempo medio de seguimiento de 21 meses. La CTL con láser de diodo se presenta como una opción válida para el tratamiento del cáncer de laringe en estadios iniciales.

Introduction: among the different therapeutic modalities for squamous carcinoma of the larynx in early stages, transoral laser surgery (CTL) is the treatment of choice. Materials and methods: CO2 laser is universally accepted as the best therapeutic tool in this regard. In situations of not being able to access that technology, it is possible to use other CTL resection instruments (radiofrequency, electro-scalpel). Among these, our work team has implemented the use of 1470 nm diode laser. In the present work we describe the preliminary results in the treatment of early stages of squamous carcinoma of the larynx with CTL using 1470 nm diode laser in elderly patients performed between January 2012 and December 2015 at the Otorhinolaryngology Service of Dr. Hospital C. Milstein. Results: Thirty-two patients with laryngeal cancer were treated, including 21, all over 65 years old, with squamous carcinoma of the Tis T1 and T2 larynx without cervical or metastatic involvement and without prior cancer treatment. Of the 21 patients included, 19 were given a single intervention and two were retreated with the same techniqu Conclusions: The use of laser 1470 nm diode for the treatment of squamous carcinoma of the larynx in early stages has allowed the control of the disease in the 21 patients operated with this technology, in an average follow-up time of 21 months. The CTL with diode laser is presented as a valid option for the treatment of laryngeal cancer in initial stages.

Introdução: entre os vários tratamentos para o carcinoma de células escamosas da laringe em modalidades estágios iniciais, laser cirurgia transoral (CTL) é o tratamento de escolha. O laser de CO2 é universalmente aceito como a melhor ferramenta terapêutica a este respeito. Em situações de não ter acesso a essa tecnologia, é possível usar outros instrumentos para CTL ressecção (radiofreqüência, eletrocautério). Materiais e métodos: Entre estes, a nossa equipa implementou o uso de diodo laser 1470 nm. Neste artigo descrevemos os resultados preliminares no tratamento do carcinoma de células escamosas da laringe, com CTL estágios iniciais utilizando o laser de diodo 1470 nm em pacientes idosos realizadas entre Janeiro de 2012 e Dezembro de 2015, Otorrinolaringologia do Hospital Dr. C. Milstein. Resultados: 32 pacientes com câncer de laringe, das quais 21 foram incluídos, todos com mais de 65 anos com carcinoma epidermóide de laringe Tis T1 e T2 sem ou compromisso de cancro cervical metastático e sem tratamento foram tratados. Dos 21 pacientes incluídos, 19 pacientes foram submetidos a uma única intervenção e dois eram reintevenidos com a mesma técnica. Conclusão: O uso de 1.470 nm diodo laser para o tratamento de carcinoma de células escamosas da laringe em estágios iniciais ajudou a controlar a doença em 21 pacientes tratados com esta tecnologia, em um seguimento médio de 21 meses. CTL diodo laser é apresentado como uma opção válida para o tratamento de carcinoma da laringe, em fases iniciais.

Uso del láser CO2 en la cirugía de la disfagia cricofaríngea: caso clínico / CO2 Laser use in the surgery of the cricopharyngeal muscle dysfunction: case report

La miotomía cricofaríngea es una técnica quirúrgica introducida hace años para el tratamiento de la disfagia asociada a disfunción del músculo cricofaríngeo con o sin divertículo de Zenker, mostrando resultados exitosos que revierten la sintomatologta y mejoran la calidad de vida del paciente. Con los avances científicos surge la cirugía láser endoscópica que permite ser una alternativa quirúrgica segura, viable y efectiva respecto a la miotomía clásica abierta, según diferentes series publicadas, mostrando disminuir los tiempos de anestesia, quirúrgico y de recuperación. En este artículo describimos un caso clínico, la técnica quirúrgica utilizada y los resultados en un paciente con disfagia por disfunción cricofaríngea con buen resultado posoperatorio.

Cricopharyngeal myotomy is a surgical technique introduced years ago for the treatment of dysphagia associated with cricopharyngeal muscle dysfunction with or without Zenker’s diverticulum, showing successful results that reverse the symptoms and improve the quality of life of patients. With scientific advances endoscopic laser surgery allows to be an open safe, feasible and effective for classical surgical myotomy alternative, according to various published series showing decreasing times anesthesia, surgical and recovery emerges. In this article we describe a case, the surgical technique used and results in a patient with dysphagia by cricopharyngeal dysfunction with good postoperative outcome.

CO2 laser and/or fluoride enamel treatment against in situ/ex vivo erosive challenge

ABSTRACT Objective This in situ/ex vivo study investigated the effect of CO2 laser irradiation and acidulated phosphate fluoride gel (APF) application, separately and in combination, on enamel resistance to erosion. Material and Methods During 2 experimental 5-day crossover phases, 8 volunteers wore intraoral appliances containing bovine enamel blocks which were submitted to four groups: 1st phase - control, untreated and CO2 laser irradiation, 2nd phase - fluoride application and fluoride application before CO2 laser irradiation. Laser irradiation was performed at 10.6 µm wavelength, 5 µs pulse duration and 50 Hz frequency, with average power input and output of 2.3 W and 2.0 W, respectively (28.6 J/cm2). APF gel (1.23%F, pH 3.5) was applied on enamel surface with a microbrush and left on for 4 minutes. Then, the enamel blocks were fixed at the intraoral appliance level. The erosion was performed extraorally 4 times daily for 5 min in 150 mL of cola drink. Enamel loss was measured profilometrically after treatment and after the in situ phase. The data were tested using one-way Repeated Measures Anova and Tukey's test (p<0.05). Results CO2 laser alone (2.00±0.39 µm) did not show any significantly preventive effect against enamel erosion when compared with the control group (2.41±1.20 µm). Fluoride treated enamel, associated (1.50±0.30 µm) or not (1.47±0.63 µm) with laser irradiation, significantly differed from the control. Conclusion The APF application decreased enamel wear; however, CO2 laser irradiation did not enhance fluoride ability to reduce enamel wear.

Tratamiento del síndrome genitourinario de la menopausia mediante láser fraccionado CO2: una opción terapéutica emergente / Treatment of genitourinary syndrome of menopause by CO2 fractional laser: an emerging therapeutic option

Estudios recientes han demostrado que el láser fraccionado es una opción terapéutica no hormonal efectiva, sencilla, bien tolerada y sin efectos adversos, para el tratamiento del Síndrome Genitourinario de la Menopausia. La reacción térmica originada produce la restauración del epitelio vaginal, un proceso de neocolagénesis y una mayor vascularización que favorece la llegada de nutrientes, reestableciéndose la estructura de la mucosa, su grosor y trofismo funcional, mejorando por tanto la sintomatología. No obstante, se precisan estudios a largo plazo, controlados, frente a estrógenos locales y otros tratamientos no hormonales para validar la duración de los efectos y la seguridad de las sucesivas aplicaciones. El objetivo de este trabajo es revisar la evidencia relacionada con esta terapia emergente.

Recent reported studies have demonstrated that non-invasive fractional laser is a valid, safe, effective and well tolerated therapeutic option, without adverse events to treat the Menopause Genitourinary Syndrome. The heat shock effect induces the increase of vaginal epithelium thickness, the new glycogen content and the vascular changes, improving the vaginal epithelium structure, functionality and menopausal symptoms. Nevertheless, duration of treatment effects and safety of repeated session are not clear enough. Further controlled long-term follow-up research on laser versus local estrogens and other non-hormonal therapies are needed. The objective of this paper is to review the scientific evidence related to this emergent treatment.

Treatment of Bartholin gland cyst with CO2laser / Tratamento do cisto da glândula de Bartholin comlaser de CO2

ABSTRACT Objective To describe the results of treatment with CO2 laser for Bartholin gland cysts. Methods Thirty-one women with Bartholin gland cysts were treated with CO2laser at an outpatient´s setting. Skin incision was performed with focused laser beam, the capsule was opened to drain mucoid content, followed by internal vaporization of impaired capsule. Results There were no complications. Five patients had recurrence of the cyst and were submitted to a second and successful session. Conclusion CO2 laser surgery was effective to treat Bartholin gland cysts with minimal or no complications, and can be performed at an outpatient´s setting.

RESUMO Objetivo Descrever os resultados do tratamento com laser de CO2 para o cisto da glândula de Bartholin. Métodos Foram tratadas 31 mulheres com cisto da glândula de Bartholin em regime ambulatorial com o laser de CO2. Foram realizados: incisão da pele com feixe de laser focalizado, abertura da cápsula com drenagem do conteúdo mucoide e vaporização interna da cápsula doente. Resultados Não ocorreram complicações. Cinco pacientes apresentaram recidiva do cisto, sendo submetidas à segunda sessão, com sucesso em todas. Conclusão A cirurgia com laser de CO2 foi efetiva para o tratamento do cisto da glândula de Bartholin, com mínima ou nenhuma complicação, podendo ser realizada em ambiente ambulatorial.

A fast, easy circumcision procedure combining a CO2 laser and cyanoacrylate adhesive: a non-randomized comparative trial

ABSTRACT Background Circumcision is performed as a routine operation in many countries, more commonly for religious and cultural reasons than for indicated conditions, such as phimosis and balanitis. There are many techniques available, and recently electrocautery and both Nd:YAG and CO2 lasers, instead of blades, have been used for skin and mucosal incisions. However, the infection risk in circumcisions performed using a CO2 laser was 10% higher. There are also reports of sutureless procedures using cyanoacrylate, but these have higher risks of hematoma and hemorrhage. We combined a CO2 laser and cyanoacrylate to shorten the operation time and to decrease bleeding complications. Materials and Methods : Circumcisions were performed under general anesthesia with CO2 laser and cyanoacrylate combination in 75 6–9-year-old boys between May 2013 and August 2014 only for religious reasons. As a control, we compared them retrospectively with 75 age-matched patients who were circumcised using the conventional guillotine method in our clinic. Results No hematomas, bleeding, or wound infections were observed. One wound dehiscence (1.33%) occurred during the early postoperative period and healed without any additional procedures. The median operating time was 7 (range 6–9) minutes. The conventional guillotine group comprised one hematoma (1.3%), two wound dehiscences (2.6%), and two hemorrhages (2.6%), and the median operating time was 22 (range 20–26) minutes. The difference in surgical time was significant (p<0.001), with no significant difference in the rate of complications between the two groups. Conclusion The combined CO2 laser and cyanoacrylate procedure not only decreased the operating time markedly, but also eliminated the disadvantages associated with each individual procedure alone.

Phacoemulsificatıon in eyes wıth cataract and high myopia / Facoemulsificação em olhos com catarata e alta miopia

ABSTRACTPurpose:To evaluate the outcomes and complications following phacoemulsification surgery in eyes with cataract and high myopia.Methods:We retrospectively evaluated the data of 43 eyes of 28 consecutive patients (12 males, 16 females) with cataract and high myopia who had undergone phacoemulsification and intraocular lens (IOL) implantation. The mean [± standard deviation (range)] age of the patients was 59.20 ± 11.08 (39-77) years.Results:The frequency of nuclear cataract was significantly higher than that of other cataract types (P=0.003). The mean axial length was 28.97 ± 1.99 (26-33) mm and the mean IOL power was 5.09 ± 4.78 (-3.0 to +14.0) diopters (D). The mean preoperative spherical equivalent (SE) was -16.48 ± 5.23 (-8.00 to -25.00) D and the mean postoperative SE was -1.46 ± 0.93 (0.00 to -3.00) D (P=0.00). The mean preoperative best-corrected visual acuity (BCVA) was 0.91 ± 0.37 (0.30 to -1.50) logMAR and the mean postoperative BCVA was 0.29 ± 0.25 (0.00-1.00) logMAR (P=0.00). Twenty-two eyes (51.2%) achieved the target postoperative refraction (±1.0 D). The eyes were divided into 3 groups according to the axial length. The mean biometric error was significantly higher in the group with the greatest axial length than in the other groups (P=0.007). Preoperative argon laser photocoagulation was performed in 7 eyes (16%) on account of retinal tears, retinal holes, or lattice degeneration. Postoperatively, retinal tears developed in 2 eyes (4%) and were treated with photocoagulation. One eye (2%) developed retinal detachment postoperatively, with the patient consequently referred for retinal surgery. Postoperatively, posterior capsule opacities developed in 11 eyes (25%), with all cases treated by laser capsulotomy.Conclusions:Good postoperative outcomes following phacoemulsification surgery were observed in patients with cataract and high myopia. However, clinicians should be aware of the risk of postoperative retinal tears and rhegmatogenous retinal detachment. Preoperative prophylactic argon laser photocoagulation treatment should be considered where necessary.

RESUMOObjetivo:Avaliação dos resultados e complicações associadas à cirurgia de facoemulsificação em olhos com catarata e miopia alta.Método:Quarenta e três olhos de 28 pacientes (12 homens, 16 mulheres) consecutivos com catarata e alta miopia, que haviam sido submetidos a facoemulsificação e implante de lentes intraoculares (LIO), foram avaliados retrospectivamente. A idade foi de 59,20 ± 11,08, (39-77) anos [média ± desvio padrão, (variação)].Resultados:A frequência de catarata nuclear foi significativamente maior do que os outros tipos (p=0,003). O comprimento axial foi 28,97 ± 1,99, (26-33) mm e o poder da LIO foi 5,09 ± 4,78, (-3,0 a 14,0) dioptrias (D). O equivalente esférico pré-operatório (SE) foi de -16,48 ± 5,23, (-25,00 a -8,00) D e o SE pós-operatório foi -1,46 ± 0,93, (0,00 a -3,00) D, (P=0,00). A melhor acuidade visual corrigida pré-operatória (BCVA) foi de 0,91 ± 0,37, (0,30 -1,50) logMAR e a BCVA pós-operatória foi de 0,29 ± 0,25, (0,00-1,00) logMAR, (P=0,00). Vinte e dois olhos (51,2%) estavam dentro de refração alvo pós-operatória (± 1,0 D). Os olhos foram divididos em três grupos, de acordo com o comprimento axial. O erro biométrico foi significativamente maior no terceiro grupo, em comparação com os outros grupos (p=0,007). Fotocoagulação pré-operatória por laser de argônio foi realizada em 7 olhos (16%) devido a roturas retinianas, buracos de retina ou degeneração látice. No pós-operatório, as roturas da retina ocorreram em dois olhos (4%); tratados com fotocoagulação. Um olho (2%) desenvolveu descolamento de retina no pós-operatório e foi encaminhado para cirurgia de retina. No pós-operatório, opacidades da cápsula posterior ocorreram em 11 olhos (25%) e estes foram tratados com capsulotomia a laser.Conclusões:A cirurgia de facoemulsificação permite bons resultados em pacientes com catarata e miopia alta. No entanto, devemos estar atentos para a possibilidade de roturas da retina pós-operatórias e para o descolamento de retina regmatogênico. Se necessário, devemos usar o tratamento profilático de fotocoagulação a laser antes da cirurgia.

The association of fractional CO2 laser 10.600nm and photodynamic therapy in the treatment of onychomycosis

AbstractBACKGROUND:Onychomycosis is a fungal infection of the nails caused in most cases by dermatophytes Trichophyton rubrum and Trichophyton mentagrophytes. Despite numerous available antifungal drugs for therapy of this infection, the cure rate is low, with high rates of relapse after treatment and side effects.OBJECTIVES:To present a new option for the treatment of onychomycosis, in search of a more effective and rapid method than conventional ones.METHODS:Patients underwent two sessions of CO2 fractional laser 10.600nm associated with photodynamic therapy. Mycological and digital photography were performed before and after the treatment.RESULTS:McNemar test with continuity correction and degrees of freedom = 1: for clinical cure rate, 13.06, with p=0.00005; for mycological cure, 17.05, with p=0.00005; 72% felt fully satisfied with the procedure.CONCLUSIONS:The use of fractional CO2 laser 10.600nm associated with photodynamic therapy can be effective in the treatment of onychomycosis, decreasing the risk of systemic lesions that may be triggered with prolonged use of oral antifungals.