Laser treatment for onychomycosis: a review.

It has always been difficult to treat onychomycosis due to decrease ability of topical agents to penetrate the nail and reach the affected nail bed. Oral antifungal have shown good response but due to longer duration course it has potential to cause systemic side effects, leading to patient non-adherence and adverse events. Lasers, therefore, have been suggested for the treatment of onychomycosis due to their minimally invasive nature and the potential for requiring fewer treatment sessions. The aim of writing this article is to review a literature regarding treatment of onychomycosis by laser. This article will discuss about all the available laser treatment options for onychomycosis as well as their currently published, peer-reviewed literature.

[Blood supply of liver metastasis].

OBJECTIVE: To probe the blood supply of liver metastasis by celiac arteriography, proper hepatic arteriogaphy, pure portal vein perfusion CT. METHODS: Fifty patients with liver metastasis were examined prospectively by plain CT scan, multiphase enhanced CT scan, celiac arteriography and proper hepatic arteriography, of whom, 23 were examined by pure portal vein perfusion CT during superior mesenteric arterial portography. The imaging manifestations were observed, and the time attenuation curves (TDC)of tumor center, tumor edge, portal vein and normal liver parenchyma were used to calculate liver perfusion with a software of PhotoShop(used in DSA image analysis)and a deconvolution model (CT perfusion software) designed for the dual blood supply. RESULTS: DSA findings: hypervascular 12 cases, hypovascular 38 cases, and ring tumor stain 36 cases. TDC of proper hepatic arteriography showed: the mean peak concentration (K value) in tumor center (67.48+/-11.56)%, the mean peak concentration (K value) on tumor edge (76.23 +/-14.89)%, the mean peak concentration (K value) in normal liver parenchyma (51.42+/-10.26)%; the mean time to peak concentration in tumor center(9.00+/- 1.03) s, and the mean time to peak concentration on tumor edge (10.69+/-2.82) s; TDC of celiac arteriogaphy showed: the concentration of tumor center and tumor edge increased fastly in early stage, then maintained an increasing plateau slowly, in the meanwhile, the concentration of normal liver parenchyma increased slowly and steadily, after 14 s of acquisition, the concentration of tumor center was lower than that of tumor edge and normal liver parenchyma. Mean time to peak concentration of portal vein was(11.84+/-1.81) s. Multiphase enhanced CT scan findings: ring enhancement in artery phase 11 cases; mild ring enhancement in artery phase,continued thick ring enhancement in portal phase 5 cases; no enhancement in artery phase,ring enhancement in portal phase 25 cases; ring enhancement in equilibrium phase 8 cases; no enhancement in artery phase, portal phase and equilibrium phase 1 case. The mean time to peak enhancement of portal vein was(14.33+/-2.23) s, and the mean enhancement peak value (320.00+/-28.78) HU; the densily of normal liver parenchyma increased slowly after contrast medium administration, the mean time to peak enhancement was (22.25+/-3.44) s, and the mean enhancement peak value (110.75+/-16.31) HU. CONCLUSION: The blood supply of liver metastasis only comes from hepatic artery, and portal vein does not join in the blood supply of liver metastasis.