Fluorescence remission spectroscopy of psoriatic lesions and the effect of topical anthralin therapy.

BACKGROUND: Psoriatic lesions are characterized by induration, scaling and erythema. Erythema is a result of inflammation and increased microvascular blood flow. Anthralin is the strongest topical antipsoriatic drug that causes clearing of psoriatic lesions and temporary remission. OBJECTIVE: The objective evaluation of skin perfusion might be a suitable way to gain a better insight in the pathophysiological process of this disease and to evaluate the response to antipsoriatic anthralin therapy. METHODS: We evaluated 21 psoriatic lesions (plaques, patches and pinpoint lesions) including 4 lesions in remission with anthralin induced erythema and 4 controls of healthy, uninvolved skin. We performed the measurements with a combined fluorescence and remission imaging (FRIS). The FRIS sensor is coupled with a touch screen industrial computer. The equipment consists of a white-light halogen lamp (20 W), two VIS-spectrometer modules (Zeiss) for remission detection and references. Imaging is realized by CCD-colour camera module and white light ring-lighting. Fluorescence emission was realized using an ultraviolet LED with a wavelength of 370 nm. The fluorescence detector is a highly sensitive MCS CCD (Zeiss) with an integration time of 2.5 sec. RESULTS: Spectral remission of psoriatic skin is characterized by a pronounced decrease (60-80%) of the haemoglobin double-peak compared to uninvolved skin. The NADH-fluorescence is diminished in lesional psoriatic skin including anthralin-treated areas with clinical remission. CONCLUSIONS: Vascular perfusion is increased in psoriatic lesions as demonstrated by remission spectroscopy. NADH-fluorescence is reduced in lesional psoriatic skin and in anthralin-induced erythema. FRIS is a suitable tool for objective evaluation of the cutaneous response to antipsoriatic treatment.

[Thermal irritation of the organ of equilibrium by means of heat radiation (NIR)]. / Thermische Reizung des Gleichgewichtsorganes mittels Wärmestrahlung (NIR).

BACKGROUND AND OBJECTIVE: Convection and conduction are the main factors involved in caloric response. Heat radiation has also been discussed as an important factor. The present work tests whether heat radiation is an essential part of the caloric response and whether caloric irritation of the semicircular canals is possible using two sources with a different near infrared (NIR) spectrum. In addition, we tested whether it is possible to induce a detectable nystagmus reaction using either NIR-radiation sources. RESULTS: NIR is able to penetrate bone tissue. The temperature elevation in dry and wet bones was almost immediately registered. With high optical power, specific temperature maxima could be seen by focal and selective broad spectrum and monochromatic NIR irritation of the three semicircular canals. Nystagmus could be generated after using both NIR emission sources in five probands. CONCLUSIONS: NIR generates temperature differences and nystagmus. By using a broad scale as well as a monochromatic NIR-emission source, it is possible to generate a nystagmus. The procedure of NIR-irritation occurs without physical contact, is painless and quiet.

[Near infrared stimulation of the equilibrium organ--first clinical experiences]. / Nahinfrarotreizung des Gleichgewichtsorgans--erste klinische Erfahrungen.

BACKGROUND: A new method for the stimulation of the organ of equilibrium by means of a broad-scale and monochromatic near infrared emission was developed. This method should be examined within the framework of a pilot study, evaluated and its clinical possible applications examined. PATIENTS AND METHODS: Healthy probands (n = 15), patients with a radical cave of the ear (n = 5), patients with a defect of the tympanic membrane (n = 5) and spontaneous nystagmus (n = 5) were examined. In healthy probands an irritation with broad-scale as well as monochromatic near infrared (NIR) was performed and compared with a water irrigation (44 degrees, 50 ml in 30 seconds). The subjective, local feelings during the application and the appearance of giddiness according to irritation were recorded and the nystagmus was registered by means of videonystagmography. In patients with radical cave of the ear and tympanic membrane defects, a broad-scale NIR-irritation before a comparative irritation with warm air (44 degrees) was performed exclusively. RESULTS: In all healthy probands, a nystagmus reaction could be seen with broad-scale and monochromatic NIR. Compared to the hot water irritation slow phase velocity (SPV) was decreased however registrable by means of Frenzel glasses and electronystagmography during the culmination stage. In patients with radical cave (n = 4) and tympanic membrane defects (n = 3) showing paradoxical nystagmus reaction during hot air irritation, a nystagmus to the site of stimulation resulted by means of light calorisation. In patients with a spontaneous nystagmus an attenuation (n = 1) or inversion (n = 2) could be achieved by NIR-radiation. CONCLUSIONS: The method of the NIR-radiation is suitable in clinical practice for the caloric test proofing warm reaction. Vaporization cold does not occur. The application of heat charm is better proportionable and steerable than during air irritation. The procedure is sterile, noiseless and non-contact. Difficulties in interpretation of results of vestibular tests because of evaporation coldness do not occur.

La biocirugía ayuda a la granulacióny desbridamiento de las heridas crónicas: datos clínicos y medidas de espectroscopia de remisión / Biosurgery supports granulation and debridement in chronic wounds-clinical data and remittance spectroscopy measurement

Objetivo: El tratamiento con larvas está aumentando en interés para el desbridamiento de las heridas crónicas y para la mejoría de la cicatrización de la herida. El objetivo de este estudio fue investigar los efectos clínicos, efectos secundarios y posibles mecanismos de la acción de la biocirugía. Métodos: Se usó biocirugía para el desbridamiento de 30 pacientes con úlceras crónicas en la pierna de origen mixto. El efecto de una sola aplicación de larvas se evaluó por una puntuación clínica de la herida y por espectroscopia sin contacto. Se analizaron los efectos secundarios. Resultados: El desbridamiento fue rápido y selectivo. La supuración de la herida aumentó temporalmente. Observamos una mejoría significativa en la puntuación de la herida con un descenso desde 13,5 ñ 1,8 a 6,3 ñ 2,7 (p<0,001). La mayoría de los pacientes toleraron bien el tratamiento. Doce de 30 pacientes manifestaron un dolor temporal, pero sólo dos necesitaron tratamiento analgésico. Otro efecto secundario fue hemorragia venosa en un paciente. Los espectros de remisión mostraron una mejoría de la oxigenación tisular revelada por el pico doble de oxígeno característico (548 y 575 nm).Conclusiones: La biocirugía es un tratamiento eficaz y rápido para el desbridamiento de las heridas crónicas y para la mejoría de la cicatrización de la herida. Un modo posible de acción es el aumento de la oxigenación tisular. Son necesarios más estudios (AU)

Response of spider leg veins to pulsed diode laser (810 nm): a clinical, histological and remission spectroscopy study.

BACKGROUND: Spider leg veins are common. Their treatment with laser or intensed light therapy shows generally variable success rates and often adverse side effects such as hyper- or hypopigmentation. This study was performed to investigate whether pulsed diode laser (810 nm) treatment is effective and safe. METHODS: Thirty-five female patients with spider leg veins were included in this prospective trial. They were treated twice with a pulsed diode laser (810 nm; spot size 12 mm, frequency 2-4 Hz, pulse width 60 msec, fluence 80-100 Jcm(-2)). Laser therapy was performed on day 0 and day 14. Clinical assessments were carried out before and immediately after the first laser therapy, after 2 weeks, 8 weeks, and one year. Skin biopsies were taken before and immediately after the first laser treatment, and after 10 weeks. Contact-free remittance spectroscopy was performed before laser treatment, immediately after the first treatment, after 2 weeks and 8 weeks. RESULTS: After the first treatment 15 patients showed a complete disappearance (CR) of spider leg veins; in the remaining 20 patients a remarkable improvement (RI) was noted (n=35). After six months of follow-up CR was seen in 6 patients, RI in 6, a stable situation in 9, and scar formation in 1 patient (n=21). The effect was almost completely stable during one year of follow-up. The examination of histological specimens before and after laser treatment showed no cellular inflammatory reaction. The mean vascular area was significantly reduced after the first (p<0.05) and after the second (p<0.05) laser treatment. Spectral analysis showed a marked decrease of peaks for oxygenized haemoglobin immediately after laser treatment and during the follow-up. Safety profile was excellent without purpuric reaction or pigmentary changes. Mild scarring was observed in two patients at the end of follow-up. CONCLUSIONS: Pulsed diode laser therapy (810 nm) is an effective and safe treatment option for spider leg veins. The effects can be seen immediately. Objective monitoring by non-invasive remission spectroscopy and histology of biopsy specimens demonstrates selectivity of the laser action.

Laser therapy of spider leg veins.

BACKGROUND: Spider leg veins are a common aesthetic problem in females. The standard treatment is sclerotherapy but lasers have been used for decades to solve this problem as well. AIM: To review recent advances in laser physics and its tissue interactions with skin vessels. The different laser types used to treat spider leg veins are discussed, including their advantages, limitations and possible adverse effects. METHOD: The international literature on laser therapy for spider leg veins has been reviewed with particular emphasis on the last decade. RESULTS: Recent developments in laser technology allow a more selective and well-tolerated therapy. Efficacy has also improved. Most studies report a greater than 75% improvement in spider leg veins as a realistic goal for laser therapy. Clinic response depends upon wavelength, fluence, pulse width and pulse duration, cooling and the diameter and colour of spider leg veins. CONCLUSIONS: Sclerotherapy remains the gold standard treatment for spider leg veins. Nevertheless, laser therapy has become increasingly efficacious and convenient. Laser selectivity has been improved by technological progress. The ideal laser, however, has yet to be invented.

Contact-free spectroscopy of leg ulcers: principle, technique, and calculation of spectroscopic wound scores.

Objective wound monitoring is an essential tool for evidence-based medicine in leg ulcers and other chronic wounds. Non-invasive and contact-free optical remittance spectroscopy seems to be a useful approach as it can provide additional information with respect to more traditional techniques of wound scoring. Twenty-three patients with chronic venous, arterial, and mixed leg ulcers were enrolled in this study. The clinical state of the ulcers was documented by a clinical wound score (quantity, color, and consistency of granulation tissue). The spectroscopic readings were performed with a novel diode-array spectrometer system in the visible and near-infrared range of the spectrum (400-1600 nm) with a resolution of 5 nm. The wound spectra mainly depend on the absorption of hemoglobin and water. The maximum correlation coefficients of mean remittance spectra with the clinical wound scores did not exceed +/- 0.5. Discriminant and cluster analysis were applied for spectral classification of wound scores. By using cross-validation the percentage of correct predicted wound scores was about 69%. Our results indicate that the application of optical visible and near-infrared spectroscopy could be a valuable remedy for the clinician.

In vivo spectroscopy in dermatology: methods and new fields of application.

BACKGROUND: The human skin is an easily accessible organ on which non-invasive examination methods can be applied. Remittance spectroscopy uses registration of the proportion of reflected light from the skin surface. Optical characteristics of skin are determined by scattering, reflection and absorption. The remittance is influenced by various test conditions and topography. Spectroscopic methods are applied for determination of microcirculation, measuring of erythema and pigmentation and in pharmacology and toxicology of applied drugs. CONCLUSION: The standardization of spectroscopic measurement of human skin is essential to reduce error sources. In future a better investigation of skin structures and molecules, which are responsible for optical characteristics of skin and a more precise evaluation of spectroscopic signals are necessary to get more information about the state of skin and to develop new fields of applications, such as early diagnosis of skin diseases or monitoring of metabolic processes.

A national survey on the use of seclusion in the psychiatric treatment of children.

Officials in 36 states responded to a survey of state policies, procedures, and regulations for the use of seclusion in the psychiatric treatment of children. Thirty-five of the states permit its use in emergencies, and 18 allow its use as part of a therapeutic treatment program. Only six states responding have regulations specifically addressing the use of seclusion with children. The authors summarize state regulations, including duration and frequency of seclusion episodes; orders required to implement seclusion and who may authorize it; rules about observation, documentation, and termination of episodes and breaks during episodes; design of seclusion rooms; and staff training. The authors present a model policy and procedure statement based on clinical and developmental considerations.

Children's perceptions of AIDS.

Knowledge and attitudes about AIDS were surveyed in 147 children between the ages of 6 and 12. Awareness of and accurate information about AIDS increased steadily through the early school years. From third grade on, over 90% of children had heard of AIDS, with the majority capable of providing additional accurate information. Significant misconceptions were also identified in all age groups. Television was found to be the major source of information about AIDS for most children.

Computer technology in psychiatric practice: the automated interview in perspective.

Computer technology is becoming an integral aspect of many medical specialties. Current applications range from the collection and interpretation of patient data to hospital billing and inventory control. Within the field of psychiatry, the role of computers continues to evolve. One area of considerable interest and attention has been the automated patient interview. This article describes the development, present status, and future potential of this technology. Implications for psychiatric practice are examined.

Reducing preoperative anxiety in children: information versus emotional support.

Many different programs are now being used to help children cope with the emotional trauma of hospitalization. This paper presents the results of a study that explored the relative effectiveness of the major components in these programs. Comprehensive intervention, which incorporates both emotional support and information about hospitalization, was found to be the most effective program in reducing preoperative anxiety. An intervention that consists only of emotional support was also found to be capable of reducing anxiety. Application of these findings to the care of hospitalized children and the design of future research methodologies are examined.