Capillary Malformations Treated With Sequential Pulsed Dye and Nd:YAG Laser Therapy: A Retrospective Study. / Malformaciones capilares tratadas con aplicación secuencial de láser de colorante pulsado y Nd:YAG: estudio retrospectivo.

INTRODUCTION AND OBJECTIVE: Capillary malformations are the most common vascular malformations in childhood. The current treatment of choice is pulsed dye laser (PDL) therapy, but this frequently does not result in complete resolution. The search for alternative treatment strategies thus continues. In this study we describe our experience with the use of sequential dual-wavelength PDL and Nd:YAG laser therapy in patients with capillary malformations. MATERIAL AND METHODS: We conducted a retrospective, descriptive study of patients with capillary malformations treated with dual-wavelength PDL and Nd:YAG laser therapy between 2006 and 2011. Four dermatologists rated the effectiveness of treatment on a scale of 10 to 0. We also investigated the potential value of the following factors as predictors of better treatment response: sex, malformation size and color, and presence of associated hypertrophy. Adverse effects were also analyzed. RESULTS: We studied 71 patients and most of them experienced a statistically significant improvement after treatment. More favorable responses were observed for violaceous malformations, lesions with associated hypertrophy, and smaller lesions. Adverse effects were reported for 26.76% of patients, and the most common effect was the appearance of isolated areas of skin atrophy. CONCLUSIONS: We consider that sequential dual-wavelength PDL and ND:YAG laser therapy is an effective alternative for treating capillary malformations in selected patients.

Correlação da permeabilidade com a resistência de união na dentina humana desproteinizada utilizando tratamentos de laser e fosfato de cálcio / Correlation of permeability with bond strenght in deproteinized human dentin using laser and calcium phosphate treatments

As restaurações a base de materiais resinosos tiveram um grande desenvolvimento, entretanto a durabilidade da interface adesiva ao substrato dental ainda é comprometida pela permeabilidade dentinária e pela degradação da camada hibrida. O objetivo desse estudo foi avaliar, in vitro, tratamentos que reduzem a permeabilidade dentinária, como aplicação de produto dessensibilizante à base de fosfato de cálcio e processo assistido a laser, e correlacionar essa redução de permeabilidade com a resistência de união a dentina. Sessenta discos de dentina de molares humanos com 6 mm de diâmetro e 1,5 mm de altura foram utilizados. Foi realizado desproteinização na superfície dentinária oclusal de todas as amostras. As amostras foram divididas em seis grupos (n=10) conforme os tratamentos sendo: A ­ Adesivo (Single Bond Universal ­ 3M ESPE); LA ­ Laser de Nd:YAG + Adesivo; AL - Adesivo + Laser Nd:YAG; FA ­ Fosfato de Cálcio + Adesivo; FLA ­ Fosfato de Cálcio + Laser Nd:YAG + Adesivo e FAL ­ Fosfato de Cálcio + Adesivo + Laser Nd:YAG. O percentual das permeabilidades inicial e final (após tratamento) foi calculado a partir da permeabilidade máxima. Os grupos foram comparados em cada momento da avalição da permeabilidade (inicial e final). Para o teste de resistência de união (RU) as amostras foram restauradas com resina composta (Z350 ­ 3M ESPE) e submetidas ao envelhecimento termomecânico (5.000 ciclos térmicos e 120.000 mecânicos), posteriormente foram confeccionados palitos para o teste de microtração. Os resultados para a permeabilidade dentinária e desvio padrão foram (médias percentuais %): iniciais A: 63,18 (±15,82); FA: 72,87 (±17,48); LA: 78,42 (±15,92); FLA: 72,64 (±24,28); AL: 74,96 (±16,86) ; FAL: 71,60 (±15,33) e as médias percentuais após os tratamentos: A: 29,99 (±16,38); FA: 34,42 (±18,60); LA: 35,13 (±20,61); FLA: 26,70 (±11,44); AL: 20,20 (±6,32) e FAL: 23,85 (±12,30). Os resultados e o desvio padrão para o teste de RU (em Mpa) foram: A 35,28 (±4,18); FA 32,17(±3,10); LA 39,19 (±4,58); FLA 36,06 (±2,75); AL 34,34 (±3,63) e FAL 35,14 (±2,40). Os dados foram submetidos ao teste de ANOVA, para a permeabilidade, observou-se uma redução estatisticamente significante para todos os tratamentos (p=0), no entanto não foram observadas diferenças na redução da permeabilidade entre os tratamentos (p=0,318125), para a RU a presença de fosfato não demonstrou diferença estatisticamente significante (p>0,05), no entanto para o fator tratamento houve diferença entre os grupos (p<0,05), o teste de Tukey 5% mostrou que os grupos LA e FLA apresentaram valores superiores estatisticamente os demais. No teste de correlação de Pearson foi constado que a correlação entre RU e permeabilidade foi insignificante (r= - 0,0581). O presente estudo concluiu que todos os tratamentos foram efetivos para a redução da permeabilidade. A resistência de união foi afetada pelos tratamentos. A correlação entre RU e permeabilidade foi desprezível(AU)

The restorations based on aesthetic materials had a great development, however the durability of the adhesive interface to the dental substrate is still compromised by the dentin permeability and the degradation of the hybrid layer. The aim of this study was to evaluate, in vitro, treatments that reduce dentin permeability, such as the application of desensitizing product based on calcium phosphate and laser assisted process, and to correlate this reduction of permeability with bond strength to dentin. Sixty discs of dentin from human molars 6 mm in diameter and 1.5 mm in height were used. Deproteinization was performed on the occlusal dentin surface of all samples. The samples were divided into six groups (n = 10) according to the treatments: A ­ Adhesive (Single Bond Universal ­ 3M ESPE); LA - Nd: YAG Laser + Adhesive; AL - Adhesive + Laser Nd: YAG; FA - Calcium Phosphate + Adhesive; FLA - Calcium Phosphate + Nd: YAG Laser + Adhesive and FAL - Calcium Phosphate + Adhesive + Nd: YAG Laser. The percentage of the initial and final permeabilities (after treatment) was calculated from the maximum permeability. The groups were compared to each other at each moment of the permeability assessment (initial and final). For the bond strength test the samples were restored with composite resin (Z350 - 3M ESPE) and subjected to thermomechanical aging (5,000 thermal cycles and 120,000 mechanical), later sticks were made for the microtensile test. The results for dentin permeability were: (means % and sd): initial A: 63.18 (± 15.82); FA: 72.87 (± 17.48); LA: 78.42 (± 15.92); FLA: 72.64 (± 24.28); AL: 74.96 (± 16.86); FAL: 71.60 (± 15.33) and the mean percentages after treatments: A: 29.99 (± 16.38); FA: 34.42 (ñ 18.60); LA: 35.13 (± 20.61); FLA: 26.70 (± 11.44); AL: 20.20 (± 6.32) and FAL: 23.85 (± 12.30). The results and standard deviation for the bond strength test (in Mpa) were: A 35.28 (± 4.18); FA 32.17 (± 3.10); LA 39.19 (± 4.58); FLA 36.06 (± 2.75); AL 34.34 (± 3.63) and FAL 35.14 (± 2.40). The results were submitted to ANOVA, a statistically significant reduction in permeability was observed for all treatments (p = 0), however, no differences were observed in the reduction of permeability between treatments (p = 0.318125), the presence of phosphate did not show a statistically significant difference (p> 0.05), however for the treatment factor there was difference between the groups (p <0.05), so Tukey 5% was applied, the LA and FLA groups presented values statistically superior to the others. Pearson's correlation test showed that there was a insignificant correlation (r=- 0,0581). The present study concluded that all treatments were effective for the reduction of permeability. The bond strength was affected by the treatments. A correlation between the permeability and the bond strength can not be observed(AU)

Efeito da associação de fosfato de cálcio, laser Nd: YAG e adesivo na permeabilidade dentinária e na resistência de união / Effect of the association of calcium phosphate, Nd: YAG laser and adhesive on dentin permeability and bond strength

O objetivo deste estudo foi avaliar in vitro o efeito do tratamento com a associação de fosfato de cálcio, laser de Nd:YAG e sistema adesivo na permeabilidade dentinária e na resistência de união. Foram utilizados 60 discos de dentina com aproximadamente 6 mm de diâmetro e 1,5 mm de altura, obtidos de molares humanos hígidos. Os espécimes foram divididos em dois grupos de acordo com a prévia aplicação ou não do fosfato de cálcio (TeethMate Desensitizer - Kuraray Notitake Dental Inc.). Cada grupo foi dividido em três subgrupos conforme o tratamento realizado (n=10): A- Adesivo (Single Bond Universal - 3M-ESPE), AL- Adesivo + Laser (Nd: YAG 60 mJ) , LALLaser + Adesivo + Laser. A permeabilidade foi mensurada em três momentos: com smear layer presente (inicial), após a abertura dos túbulos (máxima) e depois do tratamento (final). O percentual da permeabilidade inicial e final foi calculada em relação a permeabilidade máxima. Após a fotopolimerização do adesivo foi aplicado uma camada de 3 mm com a resina composta Filtek Z350 XT (3M-ESPE) com técnica incremental. Os espécimes foram submetidos a 5000 ciclos térmicos e 120.000 ciclos mecânicos, e posteriormente foi utilizado o teste de microtração. Adicionalmente foram observados em microscopia eletrônica de varredura (MEV) e microscopia confocal de varredura a laser (MCVL). Os grupos foram analisados pelo teste da analise de variância (ANOVA), teste t pareado e teste Tukey, adotando o nível de significância de 5%. Não foram observadas diferenças significativas entre os grupos na permeabilidade inicial (p=0,48) e após o tratamento (p=0,70). O percentual de permeabilidade após o tratamento foram (A: 42,11; AL: 39,09; LAL: 35,78; FA: 40,38; FAL: 34,23; FLAL: 30,25). O teste t pareado mostrou que o tratamento LAL promoveu uma redução significativa da permeabilidade em relação à inicial, tendo o fosfato de cálcio sido (p=30,25) ou não aplicado (p=35,78). Os tratamentos tiveram diferenças significativas na resistência de união, foi observado que os grupos FAL(31,53MPa), FLAL(31,37MPa) e AL(29,72MPa) apresentaram as maiores médias, que diferiram estatisticamente dos grupos restaurados só com Adesivo. Os demais grupos não apresentaram diferenças significantes (A: 24,34MPa; FA: 26,40MPa; LAL: 29,68MPa). Podemos concluir que o laser Nd:YAG aplicado antes e depois do sistema adesivo (Com e sem Fosfato de Cálcio), influenciou na redução da permeabilidade dentinária e os diferentes tratamentos na dentina influenciam significativamente a resistência de união entre a dentina e a resina, os grupos FAL, FLAL e AL apresentaram os melhores resultados. A correlação entre os parâmetros não teve influencia(AU)

The objective of this study was to evaluate in vitro effect the association of calcium phosphate, Nd:YAG laser and adhesive system on dentin permeability and bond strength. Sixty dentin discs, approximately 6 mm in diameter and 1,5 mm high, were obtained from healthy human molars. The specimens were divided into two groups according to the prior application of calcium phosphate (TeethMate Desensitizer - Kuraray Noritake Dental Inc.). Each group was divided into three subgroups according to the treatment performed: A-Adhesive (Single Bond Universal - 3M-ESPE), AL- Adhesive + Laser (Nd: YAG 60 mJ) and LAL- Laser + Adhesive + Laser. The dentin permeability was measured in three moments: with smear layer present (initial), after opened tubules (maximum) and after treatment (final). The percentage of the initial and final permeability was calculated in relation to the maximum permeability. After adhesive photopolymerization, was applied the composite resin Filtek Z350 XT (3M-ESPE) with incremental technique. The specimens were cycled to 5000 thermal cycles and 120,000 mechanical cycles, and microtensile bond strength test was applied. Additionally they were observed in scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM). The groups were analyzed by ANOVA, paired t test and Tukey test (5%). No significant differences were observed between the groups on initial permeability (p=0.48) and after treatment (p=0.70). Permeability percentage after treatment was (A: 42.11, AL: 39.09, LAL: 35.78, FA: 40.38, FAL: 34.23, FLAL: 30.25). The paired t-test showed that LAL treatment promoted a significant reduction of the permeability in relation to the initial one, with calcium phosphate (p=30.25) or not applied (p=35.78). The treatments had significant differences in bond strength; FAL (31,53 MPa), FLAL (31,37 MPa) and AL (29,72 MPa) groups presented the highest averages, which differed statistically from the groups restored with only Adhesive. The other groups did not present statistically significant differences (A: 24.34 MPa, AF: 26.40 MPa, LAL: 29.68 MPa). It can be concluded that when the Nd:YAG laser was applied before and after the adhesive system (with and without Calcium Phosphate), it influenced the reduction of dentin permeability and the different treatments in dentin significantly influenced the bond strength between dentin and resin , the groups AL, LAL with application of Phosphate and AL without the use of Phosphate showed the best results. The correlation between the parameters had no influence(AU)

Contracción capsular poscirugía de catarata en paciente con pseudoexfoliación / Capsular contraction after cataract surgery in a patient with pseudoexfoliation

La pseudoexfoliación es una alteración de la matriz extracelular fuertemente asociada a catarata y glaucoma secundario de ángulo abierto. Relacionada con la edad avanzada y más común en mujeres, es una enfermedad sistémica con típicas alteraciones en el ojo que hacen más difícil la cirugía, especialmente la debilidad zonular y la poca dilatación pupilar. Los pacientes con pseudoexfoliación operados de catarata, requieren un seguimiento posoperatorio más cuidadoso para detectar y tratar tempranamente las complicaciones posoperatorias como es la contracción capsular del caso que presentamos y que resolvió con tratamiento de Yag Láser en los bordes de la capsulorrexis(AU)

Pseudoexfoliation is an extracelular matrix alteration closely associated with cataract and secondary open angle glaucoma. Older age-related and more common in women, it is a systemic illness with typical alterations in the eye such as zonular weakness and little pupil dilation, which makes the surgery more difficult. The patients with pseudoexfoliation and caratact surgery require a more careful postoperative follow-up to early detect and to treat the postoperative complications such as the capsular contraction of the case reported in this paper, which was treated with Yag Laser in the capsulorhexis borders(AU)

Contracción capsular poscirugía de catarata en paciente con pseudoexfoliación / Capsular contraction after cataract surgery in a patient with pseudoexfoliation

La pseudoexfoliación es una alteración de la matriz extracelular fuertemente asociada a catarata y glaucoma secundario de ángulo abierto. Relacionada con la edad avanzada y más común en mujeres, es una enfermedad sistémica con típicas alteraciones en el ojo que hacen más difícil la cirugía, especialmente la debilidad zonular y la poca dilatación pupilar. Los pacientes con pseudoexfoliación operados de catarata, requieren un seguimiento posoperatorio más cuidadoso para detectar y tratar tempranamente las complicaciones posoperatorias como es la contracción capsular del caso que presentamos y que resolvió con tratamiento de Yag Láser en los bordes de la capsulorrexis(AU)

Pseudoexfoliation is an extracelular matrix alteration closely associated with cataract and secondary open angle glaucoma. Older age-related and more common in women, it is a systemic illness with typical alterations in the eye such as zonular weakness and little pupil dilation, which makes the surgery more difficult. The patients with pseudoexfoliation and caratact surgery require a more careful postoperative follow-up to early detect and to treat the postoperative complications such as the capsular contraction of the case reported in this paper, which was treated with Yag Laser in the capsulorhexis borders(AU)

Complicaciones de la capsulotomía posterior por láser de Nd-Yag en el Centro Oftalmológico "Enrique Cabrera" de La Habana / Complications of posterior capsulotomy due to Nd-Yag laser in "Enrique Cabrera" Ophthalmological Center from Havana

Introducción: La opacidad capsular posterior es la complicación más frecuente de la cirugía de catarata y, aunque la capsulotomía con láser de Nd-Yag es un procedimiento muy efectivo para solucionarla, no está exenta de complicaciones.Objetivo: Describir las complicaciones en pacientes expuestos a capsulotomía con láser de Nd-Yag.Métodos: Se realizó un estudio descriptivo y prospectivo de 104 pacientes con opacidad capsular posterior, atendidos en el Centro Oftalmológico "Enrique Cabrera" de la Habana, durante el 2010. Se analizaron las variables frecuencia y tipo de complicaciones, edad, sexo, antecedentes patológicos personales oculares y sistémicos, clasificación de la opacidad capsular, energía utilizada, así como agudeza visual antes y después del tratamiento.Resultados: En la casuística predominaron el aumento de la presión intraocular y el edema macular quístico como las complicaciones más comunes, los pacientes de 56-75 años, el sexo femenino, así como la opacidad capsular fibrótica y la capsulotomía con más de 8,0 MJ.Conclusiones: Más de la mitad de los afectados presentaron complicaciones de carácter transitorio y reversible, las cuales no estuvieron relacionadas con la cantidad de energía empleada; la mejoría visual después del proceder fue notable.

Introduction: The posterior capsular opacity is the most frequent complication in the cataract surgery and, although capsulotomy with Nd-Yag laser is a very effective procedure to solve it, it is not free of complications. Objective: To describe the complications in patients exposed to capsulotomy with Nd-Yag laser.Methods: A descriptive and prospective study of 104 patients with posterior capsular opacity, assisted in "Enrique Cabrera" Ophthalmological Center from Havana, was carried out during the 2010. Variables of frequency and type of complication, age, sex, pathological ocular and systemic medical history, classification of the capsular opacity, energy used, as well as visual acuity before and after the treatment were analyzed.Results: The increase of the intraocular pressure and the cystic macular edema as the most common complications, the 56-75 year-old patients, female sex, as well as the capsular fibrotic opacity and the capsulotomy with more than 8,0 MJ prevailed in the case material.Conclusions: More than half of the patients presented complications of transitory and reversible type, which were not related to the quantity of energy used; the visual improvement after the procedure was remarkable.

Complicaciones de la capsulotomía posterior por láser de Nd-Yag en el Centro Oftalmológico Enrique Cabrera de La Habana / Complications of posterior capsulotomy due to Nd-Yag laser in Enrique Cabrera Ophthalmological Center from Havana

Introducción: la opacidad capsular posterior es la complicación más frecuente de la cirugía de catarata y, aunque la capsulotomía con láser de Nd-Yag es un procedimiento muy efectivo para solucionarla, no está exenta de complicaciones. Objetivo: describir las complicaciones en pacientes expuestos a capsulotomía con láser de Nd-Yag. Métodos: se realizó un estudio descriptivo y prospectivo de 104 pacientes con opacidad capsular posterior, atendidos en el Centro Oftalmológico Enrique Cabrera de la Habana, durante el 2010. Se analizaron las variables frecuencia y tipo de complicaciones, edad, sexo, antecedentes patológicos personales oculares y sistémicos, clasificación de la opacidad capsular, energía utilizada, así como agudeza visual antes y después del tratamiento. Resultados: en la casuística predominaron el aumento de la presión intraocular y el edema macular quístico como las complicaciones más comunes, los pacientes de 56-75 años, el sexo femenino, así como la opacidad capsular fibrótica y la capsulotomía con más de 8,0 MJ. Conclusiones: más de la mitad de los afectados presentaron complicaciones de carácter transitorio y reversible, las cuales no estuvieron relacionadas con la cantidad de energía empleada; la mejoría visual después del proceder fue notable(AU)

Introduction: the posterior capsular opacity is the most frequent complication in the cataract surgery and, although capsulotomy with Nd-Yag laser is a very effective procedure to solve it, it is not free of complications.Objective: to describe the complications in patients exposed to capsulotomy with Nd-Yag laser. Methods: a descriptive and prospective study of 104 patients with posterior capsular opacity, assisted in Enrique Cabrera Ophthalmological Center from Havana, was carried out during the 2010. Variables of frequency and type of complication, age, sex, pathological ocular and systemic medical history, classification of the capsular opacity, energy used, as well as visual acuity before and after the treatment were analyzed. Results: the increase of the intraocular pressure and the cystic macular edema as the most common complications, the 56-75 year-old patients, female sex, as well as the capsular fibrotic opacity and the capsulotomy with more than 8,0 MJ prevailed in the case material.Conclusions: more than half of the patients presented complications of transitory and reversible type, which were not related to the quantity of energy used; the visual improvement after the procedure was remarkable(AU)