Evidencia científica actualizada del tratamiento con cannabis medicinal en pacientes con dolor crónico / Current evidence of medical cannabis treatment in patients with chronic pain

El cannabis medicinal ha sido promovido por los medios de comunicación y por la opinión pública en general. La planta del cannabis y los medicamentos a base de cannabis (CbM) han pasado por alto los estudios tradicionales basados en la evidencia, y han sido legalizados en muchos países sin pasar por el camino habitual de aprobación de los medicamentos. La comunidad médica debe conocer la evidencia actual al respecto para poder asesorar de manera competente a los pacientes. Esta revisión explicará brevemente la situación actual de la evidencia, de los obstáculos encontrados y de los posicionamientos de las respectivas sociedades del dolor respecto a la utilización del cannabis medicinal para el tratamiento del dolor.(AU)

Medical cannabis has been promoted by the media and by public opinion. The cannabis herb and cannabis-based medicines have bypassed traditional evidence-based studies, and have been legalized in many countries without going through the usual path of drug approval. The medical community must be aware of the current evidence in this regard in order to appropriately advise patients. This review will explain the current status of the evidence, the obstacles encountered to obtain evidence, and the positions of the respective pain societies regarding the use of medicinal cannabis for the treatment of pain.(AU)

Es útil el cannabis medicinal para el tratamiento de la fibromialgia? / Is medical cannabis useful for the treatment of fibromyalgia?

La fibromialgia es una enfermedad crónica de etiología desconocida hasta la fecha, que asocia una sintomatología muy variada, condicionando severamente la calidad de vida de las personas que la padecen. Clínicamente se caracteriza por presentar dolor musculoesquelético generalizado, cansancio desmesurado para la actividad física realizada, mala higiene del sueño o alteraciones emocionales. Se trata de una patología prevalente, pudiendo llegar a afectar hasta un 2-3 % de la población, en su mayoría mujeres de edad media. El diagnóstico es clínico y habitualmente tardío. Según la literatura, existe una demora de aproximadamente dos años desde el diagnóstico hasta el inicio de un tratamiento adecuado. Durante este tiempo, el consumo de recursos derivados por pruebas innecesarias o pérdida de jornadas laborales la convierte en un problema de salud de primera índole. Condicionado por esa etiología desconocida, el tratamiento disponible para la fibromialgia no es curativo. Existen diversos tratamientos que han demostrado un efecto beneficioso en la evolución de la enfermedad como una educación del paciente, psicoterapia, ejercicio físico y tratamiento farmacológico. A pesar de su variedad, ninguno de estos tratamientos consigue de manera efectiva una mejoría permanente y duradera, lo que va a dar lugar a una búsqueda constante por parte de estos pacientes de tratamientos alternativos que les aporten nuevos resultados. En la actualidad, el cannabis medicinal es uno de esos posibles nuevos tratamientos que goza de una ilusión o esperanza como alternativa del tratamiento analgésico en estos pacientes. Se va a proceder a analizar la situación actual de la enfermedad de la fibromialgia, así como una revisión sistemática sobre la evidencia existente hasta la fecha, entre la fibromialgia y los cannabinoides.(AU)

Fibromyalgia is a chronic disease of unknown etiology that severely conditions the quality of life of people who suffer from it. It is characterized by general musculoskeletal pain, excessive fatigue for the physical activity performed, poor sleep hygiene or emotional disturbances. It is a very prevalent pathology and can affect up to 2-3 % of the population, mostly middle-aged women. Diagnosis is clinical, based on physical examination and usually it is usually carried out late. According to the literature, there is a delay of approximately two years from diagnosis to the initiation of appropriate treatment. During this time, the consumption of resources derived by unnecessary testing or loss of working hours derivate from the fibromyalgia makes it a major health problem. Conditioned by that unknown etiology, the available treatment for fibromyalgia is not curative. There are several treatments that have shown a beneficial effect on the evolution of the disease, such as patient education or psychotherapy, physical exercise and pharmacological treatment. Despite their variety, none of these treatments achieves a permanent and lasting improvement. This will lead to a constant search by these patients for alternative treatments that bring them new results. Currently, medical cannabis is one of those possible new treatments that has a certain illusion or hope as an alternative to these patients. We will proceed to analyze the current situation of fibromyalgia disease, as well as a systematic review of the evidence existing to date between fibromyalgia and cannabinoids.(AU)

Cannabis medicinal en el tratamiento del dolor crónico visceral / Medical cannabis treatment in patients with visceral chronic pain

El dolor visceral crónico es muy frecuente e incapacitante. El dolor visceral secundario crónico debe distinguirse de los estados de dolor visceral primario crónico, que se consideran enfermedades por derecho propio. El dolor visceral crónico primario es una categoría del dolor de tipo nociplástico, que se caracteriza por una nocicepción alterada sin evidencia clara de daño tisular real o potencial. El manejo del dolor visceral crónico primario es un desafío, ya sea por falta de eficacia farmacológica o por intolerancia de los efectos secundarios. En este contexto, el tratamiento con cannabinoides puede ser una alternativa útil en estos pacientes. En esta revisión, tras explicar brevemente los mecanismos fisiopatológicos implicados en el dolor visceral crónico y su relación con el sistema endocannabinoide, revisaremos la evidencia actual sobre la utilización de cannabinoides en el tratamiento del dolor crónico visceral.(AU)

Chronic visceral pain is very common and disabling. Chronic secondary visceral pain must be distinguished from chronic primary visceral pain states that are considered diseases in their own right. Primary chronic visceral pain is a category of nociplastic-like pain, characterized by impaired nociception without clear evidence of actual or potential tissue damage. Management of primary chronic visceral pain is challenging, either due to lack of pharmacological efficacy or intolerance to side effects. In this context, treatment with cannabinoids can be a useful alternative in these patients. In this review, after briefly explaining the pathophysiological mechanisms involved in chronic visceral pain and its relationship with the endocannabinoid system, we will show the current evidence on the use of cannabinoids in the treatment of chronic visceral pain.(AU)

Actitud y conocimiento actual del especialista español en tratamiento del dolor respecto al cannabis medicinal / Attitudes and current knowledge of the spanish pain treatment specialist regarding medical cannabis

Introducción:En España la prescripción de cannabis medicinal está actualmente en proceso de ser regulada. Hasta la fecha no existen estudios respecto a cuál es la actitud y el conocimiento del especialista español en tratamiento del dolor respecto a la utilización del cannabis medicinal en el tratamiento del dolor.Métodos:Se llevó a cabo una consulta online que estuvo disponible en internet desde julio de 2020 a octubre de 2021. La encuesta constaba de 10 preguntas relacionadas con tres principales áreas de interés: 1) experiencia personal de los especialistas; 2) el papel del cannabis en la medicina del dolor; y 3) la necesidad de formación y legalización del cannabis medicinal.Resultados:94 especialistas en tratamiento del dolor respondieron a la encuesta. El 38 % de los que respondieron tenía experiencia en el tratamiento del dolor con cannabis medicinal y lo consideraban eficaz. El 78 % creía que era seguro recetar cannabis medicinal. Las indicaciones comunes son dolor neuropático (72 %), dolor oncológico (56 %), fibromialgia (39 %), artralgias (30 %) y dolor visceral el 29 %. Las principales contraindicaciones son la esquizofrenia (73 %), el embarazo/lactancia (65 %), enfermedad cardiovascular (32 %) y la edad < 18 años (61 %). Solo el 35 % calificó al cannabis como más peligroso que los opiáceos. El 95 % consideró necesaria más formación específica. El 47 % consideró la necesidad de que la prescripción del cannabis medicinal se realizara a través de una unidad específica, mientras que el 34 %, por el contrario, piensa que la prescripción debería realizarla un especialista con formación específica.Conclusión:A pesar de la falta de experiencia clínica en el tratamiento del dolor con cannabis medicinal en nuestro país, el conocimiento, las actitudes y las creencias de los especialistas en dolor españoles están en línea con el conocimiento médico general actual de países con más experiencia clínica.(AU)

Introduction:In Spain, the prescription of medical cannabis is currently in the process of being regulated. To date, there are no studies regarding the attitude and knowledge of the Spanish pain treatment specialists regarding the use of medical cannabis in the field of pain treatment.Methods:An online survey was carried out and was available on internet from July 2020 to October 2021. The survey consisted of 10 questions related to three main areas of interest: 1) personal experience of the specialists; 2; the role of cannabis in pain medicine; and 3) need for training and legalization of medicinal cannabis.Results:94 pain treatment specialists responded to the survey. 38 % of those who responded had experience in treating pain with medical cannabis and considered it effective. 78 % believed that it was safe to prescribe medical cannabis. Common indications are neuropathic pain (72 %), cancer pain (56 %), fibromyalgia (39 %), arthralgia (30 %) and visceral pain 29 %. The main contraindications are schizophrenia (73 %), pregnancy/lactation (65 %), cardiovascular disease (32 %), and age < 18 years (61 %). Only 35 % rated cannabis as more dangerous than opioids. 95 % considered more specific training necessary. 47 % considered the need of an specific unit for the prescription of medical cannabis, while 34 %, on the contrary, think that the prescription should be carried out by an specialist with specific training.Conclusion:Despite the lack of clinical experience in the treatment of pain with medical cannabis in our country, the knowledge, attitudes and beliefs of Spanish pain specialists are in line with current general medical knowledge in countries with more clinical experience.(AU)

Perceptions from nurses, surgeons, and anesthetists about the use and benefits of the surgical checklist in a teaching hospital.

OBJECTIVE: To assess attitudes and perceptions from nursing staff, surgeons and anesthetists about compliance, utility, and impact on patient's safety of the surgical checklist in a teaching hospital. We also aimed to identify improvement opportunities for strengthening the usefulness of the checklist in the operating theater. METHODS: We carried out a questionnaire-based an observational cross-sectional study. A questionnaire was distributed to operating room staff, including nursing staff, surgeons, and anesthetists. In addition to the information about surgical checklist, We also collected information regarding years of experience in the operating theater. Fisher's exact was used to compare proportions in each statement. Group discussion meetings with key professionals were held to jointly assess the results, propose improvement actions, and evaluate their feasibility. RESULTS: The overall response rate was 36.2% (131/362). Nursing staff was perceived as the most supportive group in the use of surgical checklist. A 64.3% of surgeons considered that using the checklist prevented adverse events vs 84.2% and 85.7% among anesthetists and nurses, respectively; p=0.028. Junior staff showed a supportive attitude toward the use of surgical checklist, considering it as a tool that gives them confidence. We ended up with a list of improvement actions aiming at strengthening the surgical checklist reliability and compliance. CONCLUSIONS: The perception of the surgical checklist usefulness as a tool to prevent adverse events was moderate among surgeons, but well appreciated by junior staff. Nursing staff were especially critical regarding compliance and support by other professionals. To reinforce the usefulness perception of the surgical checklist it is needed to increase the involvement of all professionals, especially senior staff and surgical leaders.

Properties of polidocanol foam in view of its use in sclerotherapy.

Foam sclerotherapy is a widely used method to treat varicose veins disease. It is easy to use and apply, affordable, and has high efficiency that depends on foam stability upon injection. Since sclerotherapy is usually applied in a medical doctor's office, one of the most employed methods to generate foam is based on the Tessari technique which uses pumping cycles of liquid and air in-and-out of a double syringe system. Finally, the produced foam exits through a small orifice (∼2mm) at the output of a three-way valve. The present work shows results regarding the factors that may influence foam stability (liquid to air ratio, type of connector, syringe diameter, number of pumping cycles, etc.) of a commonly used sclerosing agent (polidocanol). Furthermore, an effort is made to evaluate the effect of adding different substances on the stability of polidocanol foams (0.5% w/w) by altering the surface tension or/and the bulk and interfacial rheological properties of the fluids. It is shown that adding small concentrations of nonionic surfactants can increase foam stability with just a very small variation of the mean bubbles size.

Criterios en la selección de pacientes para optimizar resultados en liposucción asistida por láser de abdomen y flancos: análisis de 340 cirugías / Patient selection criteria to optimize results in laser-assisted liposuction of the abdomen and flanks: analysis of 340 surgeries

El objetivo de nuestro estudio es valorar mediante ecografía y análisis estadístico la respuesta a la liposucción asistida por láser en abdomen y flancos. Para ello, se tuvo en cuenta la disminución del tejido adiposo, la retracción cutánea y el grado de satisfacción de las pacientes con los resultados. Realizamos un estudio retrospectivo sobre 340 cirugías en pacientes multíparas mayores de 40 años, con o sin diástasis de rectos, que rechazaron la abdominoplastia con lipectomía. Las intervenciones se efectuaron mediante liposucción a respectivamente en 924 y 9/5 11111, bajo sedo-analgesia y con anestesia tumescente. Los láseres se programaron para emisión en modo continuo, actuando al unísono con potencia de 20 W hasta alcanzar un promedio de entre 10 a 12 kJ de energía acumulada para los flancos, y de entre 12 a 18 kJ para el abdomen. La valoración subjetiva y objetiva se realizó mediante escala GAIS (Global Aesthetic Improvement Scale). Se tomaron fotografías antes, 1 y 6 meses después de la intervención. En abdomen se realizaron ecografías antes y 6 meses después de la cirugía, y se empleó t de Student como test de contraste para el estudio analítico. En 60 pacientes seleccionados aleatoriamente como muestra representativa se realizaron fotografías digitales de la superficie de la piel a fin de valorar comparativamente por programa de ordenador la textura-flacidez de la condición del tejido antes, 1 y 6 meses después de la cirugía. En ninguno de los resultados se observó isquemia y/o quemaduras. La disminución del tejido adiposo, según las ecografías, fue estadísticamente significativa (p<0,05) comparativamente a los 6 meses del tratamiento. La valoración de las fotografías antes y 6 meses después de la cirugía por un médico ajeno al estudio, al igual que la textura-flacidez cutánea, fue Buena o Muy Buena. La valoración subjetiva por cuestionarios de escala GAIS alcanzó un 57,1% (194 pacientes) al sumar los resultados Buenos y Muy Buenos. En cambio, la valoración objetiva por el médico fue sensiblemente superior, un 74% (252 pacientes). En conclusión, según los estudios realizados creemos que la liposucción asistida por láser es una técnica eficaz y reproducible, que obtiene notables resultados cuando las pacientes presentan depósitos de grasa localizada y no sudominales como consecuencia de partos múlti-sufren diástasis de los rectos abdominales como consecuencia de partos múltiples. También es importante que, de forma ideal, las pacientes no presenten un índice de masa grasa corporal (BMI) superior a 26 para predecir y obtener óptimos resultados (AU)

Ultrasound and statistical analysis of results of laser-assisted liposuction of the abdomen and flanks have been evaluated. Decrease in fat tissue, skin retraction and patient satisfaction with results have all been taken into consideration. This retrospective study corresponds to 340 surgeries, done on multiparous patients over 40 years age, with and without abdominal recti muscle diastasis that rejected going through abdominal lipectomy. Surgeries were carried out by laser assisted liposuction with two Diode lasers emitting at 924 and 975 nm, operating simultaneously, performed under sedation and analgesia, and injecting tumescent anaesthesia. Lasers were programmed for emission in continuous mode with both systems operating at a power of 20W, reaching a total mean accumulated energy of between 10 and 12 kJ for flanks, and between 12 and 18 kJ for the abdomen. Subjective and objective evaluation was carried out using a GAIS scale (Global Aesthetic Improvement Scale). Photographs were taken before, 1 and 6 months after procedures. For the abdomen ultrasound examination were done before and 6 months after surgery, and Student's t-test was implemented for the statistical analysis. In 60 patients, randomly chosen as a representative sample, digital photographs of the skin surface were taken in order to comparatively evaluate skin texture-laxity condition, before, 1 and 6 months after surgery with the aid of a computer programme. No ischemia or burns were observed in any patient. According to ultrasound exam, decrease in fat tissue was statistically significant (p<0,05) when compared to 6 months after surgery. Evaluation by an independent doctor to the study, before and 6 months after photographs as well as the skin texture-laxity, were Good and Very Good. Subjective results obtained through questionnaires using GAIS scale reached 57,1% (194 patients) satisfied with results, totalling the Good and Very Good results. However, the objective evaluation, done by the Doctor, was significantly better regarding results obtained, 74% (252 patients). In conclusion, laser assisted liposuction is an effective and reproducible technique that obtains notable results when patients presented localized fat deposits and did not suffer diastasis due to multiple pregnancies. It is also important that, ideally, patients selected should not have a BMI of over 26 in order to obtain optimal results (AU)

Prevalencia de Lengua Geográfica en Niños Chilenos de 7 a 10 Años de Edad / Prevalence of Geographic Tongue in Chilean Children between 7 and 10 Years of Age

El objetivo del estudio fue determinar la prevalencia de lengua geográfica y evaluar su asociación con el estrés emocional, irritación crónica, lengua fisurada y tipo de establecimiento educacional, en niños de 7 a 10 años de edad en la ciudad de Viña del Mar, Chile. De un total de 27.234 escolares, cursando 2 a 5 año básico, pertenecientes a colegios de la ciudad de Viña del Mar, Chile, se examinaron 436 niños.Se realizó un estudio descriptivo transversal de alumnos provenientes de tres tipos de establecimientos educacionales diferentes: particular, particular con subvención del estado de Chile y municipalizado. Las variables estudiadas fueron edad, sexo y establecimiento educacional. Adicionalmente, en los alumnos con lengua geográfica y 23 alumnos sin este diagnóstico se evaluó la presencia de lengua fisurada, irritación lingual crónica y estrés emocional. Se determinó la prevalencia mediante el cálculo de una proporción, las variables discretas se analizaron mediante Chi-cuadrado de Pearson o la prueba de Fisher y para determinar medidas de asociación con lengua geográfica se realizó regresión logística binaria, considerándose significativo un p<0,05. De los 436 niños, 23 presentaron lengua geográfica, evidenciando una prevalencia de 5,28%, con un IC 95% de 3,37% a 7,81%. No se evidenciaron diferencias respecto al sexo, edad ni tipo de establecimiento educacional. No se determinaron factores asociados a lengua geográfica. La prevalencia de LG determinada es similar a otros estudios que abarcan la misma población de rangos etarios. Al igual que en otros estudios no se pudo demostrar que el estrés emocional, irritación crónica, lengua fisurada y tipo de establecimiento educacional constituyeron factores asociados a la presencia de lengua geográfica.

The aim of this study was to determine the prevalence of geographic tongue and evaluate its association with emotional stress, chronic irritation, fissured tongue and type of educational establishment, in children between 7 and 10 years of age, in the city of Viña del Mar, Chile. From a total of 27,234 students attending 2nd through 5th grade, we examined 436 children. A descriptive study of students was carried out from three different educational institutions: private, private with state funding and public schools. The variables studied were age, sex and the educational establishment the children attended. Additionally in the students with geographic tongue and in 23 students without this diagnosis, we evaluated the presence of fissured tongue, tongue irritation and chronic emotional stress. Prevalence was determined by calculating ratio, discrete variables were analyzed using Pearson Chi-square test or Fisher, and in order to determine association measures with geographic tongue, binary logistic regression was considered significant at p <0.05. Of the 436 children, 23 had geographic tongue, showing a prevalence of 5.28% with a 95% CI 3.37% to 7.81%. No differences regarding sex, age and type of educational establishment were found. No factors associated with geographic tongue were determined. The prevalence of the LG is similar to other studies covering the same age ranges. Furthermore, and as in other works, our study did not to show that emotional stress, chronic irritation, fissured tongue and the type of educational establishment constituted factors associated with the presence of geographic tongue.

Instrucciones para la utilización de la escala mincir para valorar calidad metodológica de estudios de terapia / Instructions for the use of mincir scale to assess methodological quality in therapy studies

La calidad metodológica (CM) es un constructo multidimensional complejo que evalúa diferentes variables. Una aproximación al tema fue la generación de escalas para valorar CM de estudios de terapia, diagnóstico y pronóstico por parte de nuestro grupo de trabajo; todas ellas validadas. El objetivo de este artículo es entregar una pauta para estandarizar la aplicación para la escala MINCir, para valorar CM de estudios de terapia. Se realiza una descripción detallada de cada ítem y dominio que conforman la escala MINCir Terapia, junto con una guía de cómo dar respuesta a cada uno de ellos. Se generó una guía de usuario para aplicar la escala MINCir Terapia.

Methodological quality (MQ) is a complex multidimensional construct that tests different types of variables. An approach to this issue was the potential to generate a group of valid scales to assess MQ in therapy, diagnosis and prognosis studies. The aim of this article is to provide a guideline to standardize the implementation of a MinCir scale to assess MQ in therapy studies. A detailed description of each item and discipline of the therapy MinCir scale is provided, along with guidelines on how to respond each query. A user guide for applying the therapy MinCir scale was generated.

Liposucción láser-asistida en ginecomastia: seguimiento ecográfico y estadístico de los efectos observados de retracción cutánea / Laser assisted liposuction for gynecomastia: statistical and ultrasound follow-up of the effects observed in skin retraction

Valoramos por ecografía y estadísticamente la eficacia de la liposucción láser-asistida en casos de ginecomastia, teniendo en cuenta la respuesta de retracción de la piel, la rapidez de la recuperación del paciente, y el grado de satisfacción que originan los resultados. Presentamos un estudio prospectivo de 28 pacientes con ginecomastia de diferente grado, tratados mediante liposucción asistida por láser de Diodo de 1470 nm, previa sedación y con anestesia tumescente. El láser se programó a 15 Watios (W) en emisión continua y se administraron 8 a 12 kilojulios (kJ) por cada mama. No se realizaron escisiones de piel ni se emplearon drenajes. Se realizó valoración objetiva y subjetiva empleando la misma escala visual analógica (VAS) completada por médicos y pacientes. Se tomaron fotografías antes y 6 meses después de la intervención, y se realizaron mediciones del perímetro torácico y del diámetro de las areolas. El seguimiento ecográfico de las áreas tratadas fue comparativo antes y 6 meses después del tratamiento. Para el estudio estadístico se empleó t de Student como test de contraste. No observamos complicaciones, como signos de isquemia o quemaduras cutáneas. La disminución del perímetro torácico y del diámetro de las areolas fue estadísticamente significativa. Tanto la valoración objetiva como la subjetiva alcanzaron resultados superiores al 90 %. Mediante la ecografía también se demostró disminución, estadísticamente significativa, de la banda de tejido graso subcutáneo (p < 0,05) al comparar las imágenes de antes y 6 meses después del tratamiento. La recuperación laboral se realizó en un promedio de 3 días. En conclusión, creemos que la liposucción láser-asistida es un método eficaz y reproducible, comprobado ecográfica y estadísticamente, que alcanza buenos resultados con menos trauma quirúrgico, lo que conlleva un alto grado de satisfacción por parte de los pacientes (AU)

We evaluate efficacy of laser-assisted liposuction in gynecomastia by means of ultrasonography and statistical study, taking into account skin retraction, patients time recovery and satisfaction index with results of surgery. A prospective study on 28 patients suffering from gynecomastia, were treated by means of liposuction assisted by 1470 nm Diode laser lipolysis. Surgery was carried out under sedation and tumescent anesthesia. Laser was programmed at 15 W, 8 a 12 kJ total cumulative energy per breast. Neither skin resection nor drainages were used. Doctors and patients evaluated results objective and subjectively with the same Visual Analogue Scale. For scoring results, pictures took before and 6 months after were used. Measures of chest and areola diameter of before and after surgery were taken for comparative statistical analysis. Ultrasonography follow up was done to determine the width of subcutaneous fat layer eliminated. T Student was use as contrast test to examine results achieved. No complications were observed such ischemia or skin burns. Chest and areolas diameter decrease in dimension were statically significant. Objective and subjective evaluations gave results greater than 90 %. Ultrasonography demonstrated decreasing, statically significant, in subcutaneous fatty tissue (p < 0,05), by comparing images before and 6 months after treatment. Laser-assisted liposuction is an efficacious procedure and reproducible. Ultrasonography controls and the statically study demonstrated good results and limited surgical trauma that imply patients' high satisfaction with the surgery outcome (AU)

The evaluation of hyaluronic acid, with and without lidocaine, in the filling of nasolabial folds as measured by ultrastructural changes and pain management.

BACKGROUND: Pain management is an important objective in procedures involving dermal fillers composed of hyaluronic acid (HA). OBJECTIVE: To compare the 1-year clinical results of filling the nasolabial fold with 2 types of filler: large-gel particle HA and large-gel particle HA plus 0.3% lidocaine (HA+L). We compared the level of pain during treatment and 10 minutes after treatment and assessed the safety and efficacy profile, satisfaction, and histological findings (using reflectance confocal microscopy [RCM]). MATERIALS AND METHODS: We performed a comparative, parallel-group, double-blind trial with an external observer (blinded to the type of treatment administered). The filler was applied to the nasolabial fold in 119 patients (HA in 62 patients and HA+L in 57). Patients were followed at months 3, 9, and 12. Pain was evaluated using a visual analog scale. Efficacy and satisfaction were evaluated using the Wrinkle Severity Rating Scale and the Global Aesthetic Improvement Scale. RCM images (n=32) were taken at baseline and at months 3 and 12. RESULTS: Pain: The severity of pain was decreased in patients treated with HA+L on application (P <.001) and 10 minutes later ( P=.008). Efficacy and satisfaction: No significant differences existed between the 2 groups at months 3, 9, and 12. RCM: Skin rejuvenation occurred with a 32% increase in the height of the dermoepidermal junction at month 12 (P <.001), which was similar in both groups. Adverse events: At month 3, the most common adverse events (AEs) were erythema (68%) and hematoma (11%). No AEs were recorded at months 9 or 12. CONCLUSION: The use of HA+L provides pain relief without affecting efficacy, satisfaction, safety, or the duration of results. RCM showed that the changes in the dermoepidermal junction represented a histological improvement in the skin with similar results in both groups.

Laser-assisted lipolysis in the treatment of gynecomastia: a prospective study in 28 patients.

Gynecomastia is the most common breast pathology. Numerous excisions and liposuction techniques have been described to correct bilateral male breast enlargement. Recently, there has been a shift from the open approach to minimally invasive techniques. This article reports a 5-year experience using laser-assisted lipolysis (LAL) to treat gynecomastia, and describes the surgical technique. Between January 2006 and December 2010, a total of 28 patients with bilateral gynecomastia were treated with LAL. Patients had a mean age of 36.5 years (range 24 to 56 years). LAL was performed with a 980-nm diode laser (continuous emission, 15 W power, 8-12 kJ total energy per breast) after tumescent anesthetic infiltration. The breast was evaluated objectively by two physicians who compared chest circumference and photographs. Patients were also asked to score the results using a visual analogue scale: 75 to 100 (very good), 50-74 (good), 25 to 49 (fair) and 0 to 24 (poor). The postoperative period for all patients was incident-free. After 6 months, 18 patients (64.3%) scored the results as "very good", 6 as "good" (21.4%), 3 as "fair" (10.7%) and 1 "poor" (3.6%). Mean chest circumferences pre- and postoperatively were, respectively, 117.4 ± 11.1 cm and 103.3 ± 7.5 cm (p < 0.001), corresponding to a mean difference of 14.1 cm. Physicians scored the photographs as "very good" in 22 patients (78.6%), as "good" in five patients (17.9%), and as "fair" in one patient (3.6%). LAL in gynecomastia is safe and produces significant effects on fatty tissue, with a reduction in breast volume, together with significant skin tightening. Provided an appropriate amount of energy is delivered by an experienced operator, the results are both significant and consistent.

980-nm laser lipolysis (LAL): About 674 procedures in 359 patients.

BACKGROUND: Since the first studies by Apfelberg in 1994, laser lipolysis (LAL) has been on the rise. Laser lipolysis leads to reduced operator fatigue, excellent patient tolerance, quick recovery time, as well as the additional benefit of dermal tightening. This article reports a 5-year experience of LAL and underlines the potential evolutions of the technique. METHODS: Between January 2006 and December 2010, 674 LAL procedures in 359 patients were performed at the Antoni De Gimbernat Foundation in collaboration with the French National Institute of Health and Medical Research (INSERM) U703. LAL was performed with a 980-nm diode laser after tumescent anaesthesia. The following laser settings were used: 600-µm optical fiber, continuous mode, power depending on individual body areas (18-40 W). The cumulative energy used for each area was recorded. Early and late complications were defined and reviewed for the whole series. Satisfaction was assessed by the patients using a visual analogue scale from 0 (unsatisfied) to 10 (highly satisfied). RESULTS: Mean cumulative energy ranged from 12 to 60 kJ. Ecchymoses were observed in all patients but resolved in less than 10 days. A touch up was needed in four patients to remove small cushions of fat missed. Mean patient satisfaction ranged from 6/10 to 9.5/10 depending on the treated area. Moreover, all patients reported they would be willing to undergo the procedure again, if needed. CONCLUSION: 980-nm LAL appears to be a safe, effective and reproducible alternative to conventional lipoplasty. However, refinements in dosimetry should be developed in order to optimise outcomes.

Body contouring by non-invasive transdermal focused ultrasound.

BACKGROUND AND OBJECTIVES: The risks of currently available invasive procedures in body contouring motivate a need for safer, non-invasive technologies for improving the appearance of body silhouette. A new device has been developed that uses focused therapeutic ultrasound to reduce adipose tissue non-invasively. The aim of this study was to assess the efficacy and safety of a novel non-invasive focused ultrasound system (UltraShape Ltd, Tel Aviv, Israel) in reducing localized fat deposits to improve body contours. STUDY DESIGN/PATIENTS AND METHODS: A prospective study was conducted on 30 healthy patients. All patients underwent three treatments, at 1-month intervals, and were followed for 1 month after the last treatment. Areas treated were the abdomen, inner and outer thighs, flanks, inner knees, and breasts (males only). No other body contouring procedure was used during the study. Efficacy was determined by change in fat thickness, assessed by ultrasound measurements, and by circumference measurements. Weight change was monitored to assess whether reduction in fat thickness or circumference was dependent on or independent of weight loss. Safety was determined by clinical findings, assays of serum triglycerides, and liver ultrasound evaluation for the presence of steatosis. RESULTS: All patients showed significant reduction in subcutaneous fat thickness within the treated area. The mean reduction in fat thickness after three treatments was 2.28+/-0.80 cm. Circumference was reduced by a mean of 3.95+/-1.99 cm. Weight was unchanged during the treatment and follow-up period. No adverse effects were observed. CONCLUSIONS: This study shows the efficacy and safety of focused ultrasound, using the UltraShape Contour I, as a non-invasive transdermal method for reducing unwanted fat deposits in the body. Multiple treatments combined with appropriate patient and treatment area selection can produce dramatic improvements in body contour.

[Therapeutic value of colchicine in Behçhet's disease (author's transl)]. / Valor terapéutico de la colchicina en la enfermedad de Behçet.

Four patients affected with Behçet's disease were studied during the past year. Clinical manifestations were varied; besides the classical triad, they included axillary-subclavian thrombophlebitis, electrocardiographic changes, sacroillitis and polyarthritis. The HLA was determined in all patients and it was possible to demonstrate the relationship between HLA-B27 antigen and articular manifestations, HLA-B12 and urogenital ulcers and HLA-B5 with ocular lesions. Treatment with colchicine induced total remission within one month in all four patients, and was longer lasting than remissions which were either spontaneous or induced with other therapies. Pathogenic theories on which treatment was based are discussed.