RESUMEN
According to photothermolysis, the FPDL(flashlamp-pumped pulsed dye laser) treatment theoretically causes no epidermal damage, however, we have observed blister, crust and scars in clinical experiences, and we have also found that FPDL has limited effect on adults, specially, thick-skinned Asian people with rich melanin pigment. In order to explain these effects, we took biopsies and made a histologic observation and analyzed the results statistically. The biopsies were taken from 15 patients who received first treatment and stained with H&E and NBTC(nitroblue tetrazolium chloride). We measured epidermal melanin content, epidermal damage, vessel wall coagulation depth, RBC coagulation depth, mean vessel diameter and evaluated clinical results at post-treatment 6 weeks. The vessel diameter and darkness of lesion color were increased with ages. Complete vessel coagulation was restricted to small vessels. With increasing epidermal melanin content, epidermal damage increased accordingly. The clinincal results were enhanced with increasing coagulation depth of vessel walls, and deteriorated with increasing epidermal melanin content. The clinical result was not significantly correlated with RBC-coagulation depth or energy used. We observed that melanin pigments have an adverse effect on clinical results. The FPDL treatment can be a choice of treatment to children with light colored lesion, but has a limitation to Asian adults with rich melanin pigment. Therefore, repetitive treatment is necessary for improvement of clinical results.
Asunto(s)
Adulto , Niño , Humanos , Pueblo Asiatico , Biopsia , Vesícula , Cicatriz , Oscuridad , Láseres de Colorantes , MelaninasRESUMEN
It has been well documented that dysfunction of the Eustachian tube if the main cause of middle ear disease in most cleft palate patients. The middle ear disease is refractory to medical treatment and has frequent recurrences; the final results may end up with chronic otitis media and/or hearing loss. Currently, myringotomy with placement of ventilation tube in early infant stage have been widely accepted for treatment of otitis media in cleft palate patients. We calculated the frequency of the occurrence of otitis media in cleft palate patients who have received palatoplasty in our clinic. Preoperative otoscopic examination and tympanometric test were taken in all patients. We performed tympanostomy and ventilation tube insertion at the time of palatal repair on every patients who had evidence of otitis media in the preoperative otologic examinations. Since November 1996, 79 patients received palatoplasty and among these 63 patients(79.7%) received bilateral ventilation tube insertion simultaneously. We confirmed the previously documented high prevalence of otitis media in cleft palate patients and understood the importance of preoperative otologic examinations in the managements of cleft palate.
Asunto(s)
Humanos , Lactante , Fisura del Paladar , Oído Medio , Trompa Auditiva , Pérdida Auditiva , Ventilación del Oído Medio , Otitis Media , Prevalencia , Recurrencia , VentilaciónRESUMEN
The use of a tissue expander and implant is the simplest option for breast reconstruction after mastectomy. Use of a round dome-shaped prosthesis and the commonly used one-stage technique with a Becker type prosthesis, however, often produces an undesirable upper pole fullness. To overcome this and to achieve improved aesthetic results, we started using an anatomically-shaped expander and implant, as described by Maxwell, as a two-stage breast reconstruction. We reviewed the results of our 21 reconstructed breasts in 22 patients who were deemed suitable for reconstruction using this technique since January 1995. The most commonly used expander was 350cc (range 350-550cc) and an average of 4.2 inflations were required before replacing the expander with a permanent implant. All the expanders were placed in submuscular pockets and implant volume. The longest follow-up was 36 months. Few complications developed and most patients were satisfied with the results. We found that the anatomically-shaped expander and implant produced better aesthetic results compared to a done-shaped prosthesis.