A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: a pilot study.

OBJECTIVE: to evaluate the effects of low-level laser therapy for perineal pain and healing after episiotomy. DESIGN: a double-blind, randomised, controlled clinical trial comparing perineal pain scores and episiotomy healing in women treated with low-level laser therapy (LLLT) and with the simulation of the treatment. SETTING: the study was conducted in the Birth Centre and rooming-in units of Amparo Maternal, a maternity service located in the city of São Paulo, Brazil. PARTICIPANTS: fifty-two postpartum women who had had mediolateral episiotomies during their first normal delivery were randomly divided into two groups of 26: an experimental group and a control group. INTERVENTION: in the experimental group, the women were treated with LLLT. Irradiation was applied at three points directly on the episiotomy after the suture and in three postpartum sessions: up to 2 hrs postpartum, between 20 and 24 hrs postpartum and between 40 and 48 hrs postpartum. The LLLT was performed with diode laser, with a wavelength of 660 nm (red light), spot size of 0.04 cm(2), energy density of 3.8 J/cm(2), radiant power of 15 mW and 10s per point, which resulted in an energy of 0.15 J per point and a total energy of 0.45 J per session. The control group participants also underwent three treatment sessions, but without the emission of radiation (simulation group), to assess the possible effects of placebo treatment. MAIN OUTCOMES: perineal pain scores, rated on a scale from 0 to 10, were evaluated before and immediately after the irradiation in the three sessions. The healing process was assessed using the REEDA scale (Redness, Edema, Echymosis, Discharge Aproximation) before each laser therapy session and 15 and 20 days after the women's discharge. FINDINGS: comparing the pain scores before and after the LLLT sessions, the experimental group presented a significant within-group reduction in mean pain scores after the second and third sessions (p=0.003 and p<0.001, respectively), and the control group showed a significant reduction after the first treatment simulation (p=0.043). However, the comparison of the perineal pain scores between the experimental and control groups indicated no statistical difference at any of the evaluated time points. There was no significant difference in perineal healing scores between the groups. All postpartum women approved of the low-level laser therapy. CONCLUSIONS: this pilot study showed that LLLT did not accelerate episiotomy healing. Although there was a reduction in perineal pain mean scores in the experimental group, we cannot conclude that the laser relieved perineal pain. This study led to the suggestion of a new research proposal involving another irradiation protocol to evaluate LLLT's effect on perineal pain relief.

Pityriasis rubra pilaris sensitive to narrow band-ultraviolet B light therapy.

Pityriasis rubra pilaris (PRP) is a rare skin condition which typically presents in adults as red-orange plaques with islands of sparing, perifollicular keratotic papules, waxy palmoplantar keratoderma, and erythema with fine, diffuse scale. Currently, there are no well-established treatment guidelines for this condition. This is party due to a lack of universally effective treatments for PRP, with some cases being resistant to multiple topical and systemic therapies. Systemic retinoids have been used with some success. Several phototherapy regimens have lead to variable results. The authors present a case of PRP, unresponsive to 6 month treatment of isotretinoin, that was subsequently treated with narrow-band ultraviolet B (NB-UVB) light therapy with complete resolution after four months of light treatment. The observed clinical benefit may encourage future phototesting and consideration of NB-UVB light therapy in recalcitrant PRP cases.

Right ventricular mass: a histopathological surprise.

A 33-year-old woman in the postpartum period presented with a mass in the right ventricular outflow tract. She underwent excision of the mass under standard cardiopulmonary bypass. Histopathologic examination of the mass revealed a metastatic lesion from the thyroid, which was follicular carcinoma of the thyroid. Later she underwent total thyroidectomy with lymph node dissection of the neck and radioactive 131I ablation for the residual tumor in the neck. At 1-year follow-up, the patient has no evidence of residual lesion in the heart, neck, or anywhere else in the body. A detailed preoperative workup could have changed the order of interventions and probably avoided a heart operation.

[Acute anal fissures in puerperants]. / Ostrye anal'nye treshchiny u rodil'nits.

The author shares his experiences with treatment of 236 puerperas with anal fissures. Three types of anal fissures are established. The appearance of anal fissures can be caused by precipitated labor, large fetus, episio- and perineotomy. The main attention in cases with postpartum anal fissures was given to local treatment by different means which included arrest of the pain syndrome and formation of the granulation barrier till the appearance of regular stool and prevention of constipation. Long-term results were good.

[Prevention of lactation mastitis by the use of low-intensity laser irradiation]. / Profilaktika laktatsionnogo mastita pri pomoshchi nizkointensivnogo lazernogo izlucheniia.

Optic characteristics of breast tissues have been examined in mothers. An internation was designed to prevent and treat nipple fissures using individualized laser therapy regimens. Individualized laser therapy of 329 mothers at risk of mastitis and 68 mothers with a normal postpartum course reduced five-fold the incidence of mastitis in the risk group (from 18.6% to 3.7%, or to values characteristic of a normal puerperium). The wave length of 0.63 micron was found to be of a higher preventive and therapeutic efficacy, compared to the wave length of 0.89 micron. Laser rays activated the immune system, as reflected by rising serum levels of immunoglobulins A, M, G and lactoferrin. It is suggested that mothers with high trophoblastic beta-glycoprotein concentrations are at high risk of puerperal septic complications.

The treatment of retroperitoneal fibromatosis with medroxyprogesterone acetate.

Wide excision is the recommended primary therapy for retroperitoneal fibromatosis. Radiation therapy and a variety of medications have been used to treat patients with recurrent tumors, but the response to these agents has not been uniform. The patient presented was successfully treated with medroxyprogesterone acetate for recurrent retroperitoneal fibromatosis that was refractory to multiple operative resections and radiation therapy.

Breast cancer among women given X-ray therapy for acute postpartum mastitis.

Acute postpartum mastitis (APM) is an inflammatory-infectious condition of the breast, occurring commonly at childbirth or during lactation. A series of 601 women who received x-ray therapy for APM during the 1940's or 1950's have been followed up by mail questionnaire, with medical verification of pertinent conditions, to ascertain their incidences of breast cancer. Control subjects consisted of a series with APM who did not receive irradiation, plus the female siblings of both the APM groups, for a total of 1,239 controls. The groups have been followed up to 45 years; the average was 29 years. The relative risk (RR) for breast cancer, adjusted for age and interval since irradiation (or an equivalent entry definition for controls), was 3.2 for the irradiated breasts; the 90% confidence interval (CI) was 2.3-4.3. For a linear multiplicative model, the risk increased by 0.4% per rad (90% Cl of 0.2-0.7). The dose-response curve appeared to be essentially linear, except for a diminution of risk at high doses (greater than or equal to 700 rad). The fact that there were no treated breasts with doses between 0 and 60 rad, however, means that it was not possible to evaluate the curvature with the maximum contrast between low and high doses. The dose fractionation analyses showed that neither the number of dose fractions, the number of days between fractions, nor the dose per fraction had any apparent effect on breast cancer risk when the variables were analyzed separately. Similarly, when the fractionation variables were considered jointly in a Cox regression analysis, none was significant once total breast dose was controlled for. Analyses of age at irradiation did not show appreciable differences between age groups, although the numbers were too small to be clear-cut (only 64 women greater than 34 yr old at irradiation). Other studies have shown diminished risk associated with an older age at irradiation. The lack of diminished risk in this study may occur because during pregnancy and lactation the breasts are under increased proliferative stimulation by hormones, by comparison with the normal condition of breasts at older ages. An analysis of the temporal relationship of radiation to breast cancer showed that the RR did not vary systematically with interval since irradiation, but the absolute risk increased over time. This finding agrees with other studies that have also suggested a better fit for the multiplicative model.

The influence of potential biases on the risk of breast tumors among women who received radiotherapy for acute postpartum mastitis.

Data from a 30-year follow-up study of 606 women given radiotherapy for acute postpartum mastitis and two non-irradiated control groups were reanalyzed to determine whether bias could account for the reported increased risk of benign and malignant breast tumors in the irradiated population. The biases examined were comparison group selection (i.e. selection bias); differential medical verification of breast tumors between exposed and unexposed groups; differential detection of breast tumors; and confounding. Overall age-adjusted relative risk (RR) estimates for breast cancer (RR = 2.0; 95% CL:1.3-3.1) and for benign neoplastic (RR = 3.5; 95% CL:1.8-6.8) and non-neoplastic breast tumors (RR = 1.5; 95% CL: 1.2-2.1) were compared to those obtained after adjustment for the above biases. The increased risk for breast cancer among the irradiated women could not be accounted for by any of the biases examined, supporting previous reports based on this cohort. However, the suggested association of radiation with benign breast tumors may represent a selection bias since the RR estimate for non-neoplastic breast tumors was no longer statistically significant (RR = 1.2; 95% CL:0.8-1.6) while that for neoplastic breast lesions declined to 2.0 (95% CL:1.1-1-4.0) when non-irradiated women with acute postpartum mastitis were used as the comparison group instead of the non-irradiated female siblings of the exposed. This finding suggests that acute postpartum mastitis may predispose a woman to later developing a benign breast tumor irrespective of whether or not radiotherapy was used to treat this condition.(ABSTRACT TRUNCATED AT 250 WORDS)