Uso do laser de 1. 470 nm para o tratamento de insuficiência venosa superficial / Use of 1, 470 nm laser for treatment of superficial venous insufficiency

Resumo Contexto Existem diversas formas de tratamento de varizes de membros inferiores. Entre elas, destaca-se o uso do laser diodo de 1.470 nm. Essa técnica proporciona aos pacientes uma cirurgia em regime ambulatorial, com retorno precoce à atividade ocupacional, bom resultado estético e baixo índice de complicações. No entanto, ainda se discute exaustivamente variáveis como comprimento de onda do laser, potência aplicada em cada área, tipo de fibra, necessidade ou não de tumescência e densidade de energia endovenosa linear. Objetivos Analisar os resultados do tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm. Métodos Estudo retrospectivo, realizado em uma clínica privada de um hospital privado em Florianópolis a partir de dados colhidos prospectivamente. As amostras eram de 287 pacientes submetidos à cirurgia para tratamento da insuficiência venosa superficial com laser diodo de 1.470 nm, de janeiro de 2016 a dezembro de 2018, totalizando 358 veias safenas magnas e 84 veias safenas parvas tratadas. Resultados A taxa de oclusão total após 12 meses de cirurgia foi de 94,4%, com densidade de energia endovenosa linear média de 45,90 J/cm nas veias safenas magnas e de 96,4% com densidade de energia endovenosa linear média de 44,07 J/cm nas veias safenas parvas. Conclusões No período acompanhado, o laser diodo de 1.470 nm mostrou-se um tratamento seguro, muito efetivo e com baixas taxas de complicações (dor, edema, equimose, trombose venosa profunda e trombose induzida pelo calor endovenoso).

Abstract Background There are several ways to treat varicose veins of the lower limbs, among which use of 1470nm diode lasers stands out. This technique can be used to treat patients in outpatient settings, with early return to work, good esthetic results, and low rates of complications. However, variables such as the laser wavelength, the power administered in each area, the type of fiber, and the linear intravenous energy density (LEED) are still extensively discussed. Objectives To analyze the results of superficial venous insufficiency treatment with a 1470nm diode laser. Methods Retrospective study conducted at a private clinic in a private hospital in Florianopolis, based on a database collected prospectively. The sample comprised 287 patients who underwent surgery to treat superficial venous insufficiency with 1470nm diode laser, from January 2016 to December 2018, totaling 358 great saphenous veins (GSVs) and 84 small saphenous veins (SSVs) treated. Results The total occlusion rates after 12 months of surgery were 94.4% in the GSVs, with an average LEED of 45.90 J/cm, and 96.4% in the SSVs, with an average LEED of 44.07 J/cm. Conclusions During the follow-up period, the 1470nm diode laser proved to be a safe treatment, with great efficacy and low rates of complications (pain, edema, bruising, deep vein thrombosis, and endothermal heat-induced thrombosis - EHIT).

Xylometazoline hydrochloride nasal spray combined with laser artificial nasolacrimal duct implantation for nasolacrimal duct obstruction / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the role of xylometazoline hydrochloride nasal spray in combination therapy of nasolacrimal duct obstruction and to investigate the effect of nasal inflammation on nasolacrimal duct obstruction. <p>METHODS: Totally 279 patients with nasolacrimal duct obstruction were collected, who received lacrimal passage irrigation, CT angiography for lacrimal passage and nasal endoscope before treated by lacrimal laser forming and artificial nasolacrimal duct implantation combined with xylometazoline hydrochloride nasal spray. In group A, 137 patients were treated with antibiotic eye drop and non-steroidal anti-inflammatory drugs after operations. In group B, 142 patients were treated with xylometazoline hydrochloride nasal spray besides the same treatment for group A. <p>RESULTS:In the 279 patients 217(77.8%), in which 105 cases(76.6%)were in group A and 112 cases(78.9%)were in group B, were suffered with nasal inflammation, including nasal mucosal hyperemia, inferior turbinate hypertrophy, middle turbinate hypertrophy. At 3mo after the ducts were drawn, efficacy of group B was 95.8%, which was significant better than that of group A(86.1%, <i>P</i><0.05).<p>CONCLUSION: Nasal inflammation was an important factor in the incidence of nasolacrimal duct obstruction, which shoud pay more attention in the process of diagnosis and treatment. Combination therapy could improve the cure rate of nasolacrimal duct obstruction.

Laser application as a modern treatment in the cardiovascular surgery / 日本心臓血管外科学会雑誌

Recently, laser has been widely applied in the field of medicine and surgery. However, laser application is very rare in the cardiovascular surgery through world. Among the patients with ischemic heart disease there are some cases for whom aortocoronary bypass could not be carried out, because of small branches and diffuse stenoses of the coronary arteries. Besides, there are some problems in keeping long-term patency after vascular anastomosis especially for small-caliber vessels. For resolving these problems we have performed and continued to achieve laser works concerning, 1) myocardial revascularization by laser, 2) laser vascular anastomosis, 3) laser angioplasty. Subsequently, myocardial revascularization by high energy CO₂ laser could be successfully carried out experimentally. It was microscopically clarified that transventricular laser channels newly created in the ischemic myocardium were patent even 3 years after surgery. On the basis of excellent results of experimental studies laser was successfully employed in a 55 year-old male patient who had severe anginal attack and 90% stenosis of the left anterior descending coronary artery. On the other hand, vascular anastomosis by low energy CO₂ laser (out put 20-40mW, irradiation time 6-12s/mm) was satisfactorily utilized in 83 patients with intermittent claudication, chronic renal insufficiency and angina pectoris after a feasibility of the procedure was clearly confirmed by hemodynamic and histological examinations. Finally, laser angioplasty using Argon laser was fundamentally studied in the mongrel dogs and human cadaver. Based on the successful results of these studies, laser angioplasty was clinically applied in the 17 patients with multiple coronary stenoses or severe stenoses of the peripheral arteries. From these excellent results, laser application was inevitable for treatment in the field of cardiovascular surgery. Clinical experience of 101 patients treated by laser was reported in detail.