Unexpected vascular response to epinephrine in port wine stains

Success of argon laser therapy as a therapeutic modality for port wine stains has been correlated with the degree of vascular congestion within the lesions. Epinephrine causes vasoconstriction and erythrocyte stasis within normally innervated vessels. We tested the hypothesis that subcutaneous injection of epinephrine would cause vasoconstriction, altered hemodynamics, and increased red cell mass in port wine stains and thus allow more directed and less nonspecific damage and a better cosmetic result. Two clinically similar and adjacent areas within port wine stains were biopsied from 10 patients following subcutaneous injection of either Xylocaine or Xylocaine with epinephrine. Erythrocytes within vessels of the superficial cutaneous vascular plexus were increased in areas pretreated with Xylocaine plus epinephrine (55.3 versus 45.9 percent; p less than 0.09). This increase was seen in 9 of 10 patients studied (p less than 0.05). Epinephrine appears to increase erythrocytes within ectatic vessels of port wine stains and thus would likely improve laser energy absorption and cosmetic results.     

Trichoepithelioma: successful treatment with the argon laser

The cosmetic concern associated with multiple trichoepitheliomas is obvious. Previous modes of therapy have proven to be only temporary. However, multiple trichoepitheliomas appear to respond to the thermocoagulation and epidermal atrophic effects of the argon laser without recurrence over an extended follow-up period. Although these lesions are not as highly vascular as port-wine hemangiomas, their dramatic response to the argon laser is similar. This report documents a case of multiple trichoepitheliomas treated successfully with the argon laser from the face and scalp of a 29-year-old white woman. The benefits of the argon laser in treatment of multiple trichoepitheliomas include eradication of the lesions without apparent recurrence, restriction of spread of solitary trichoepithelioma into adjacent tumors, and prevention of obstruction of the periorbital region and auditory canal. The treatment may be accomplished as a simple outpatient procedure under local anesthesia with minimal pain or disability.     

Argon laser therapy of port-wine stains: effects and limitations

One hundred and one patients (112 parts) with port-wine stains were treated by argon laser therapy. We strictly evaluated all patients according to color shift, scar formation, and pigmentation. We observed good to excellent results in 44 percent of patients, and less satisfactory results in 56 percent. The relationship between the effects of treatment and several factors, such as patients' age, anatomic site, and histologic type of the lesions, were investigated. More satisfactory results tended to be obtained in patients with neck lesions and with histologic type III lesions (dilated type). To date we have not discerned any definite criteria for precisely predicting the response of port-wine stains to argon laser therapy. Consequently, the performance of a test seems to us to be the best way of discovering the response and course of healing of an individual port-wine stain after laser therapy. Thirty-six consecutive patients were studied to determine whether compression and cooling would improve the outcome of argon laser therapy. The use of this method did not produce any noticeable effects.     

Reaction of vessels of the microcirculatory bed of subcutaneous tissue to exposure to an argon laser beam

The effect of argon laser irradiation on the microvessels of the subcutaneous fat tissue of rabbit's ear placed into Clark's transparent chamber was studied. Capillaries and venules were found to be sensitive to argon laser irradiation; functional disturbances of microcirculation were most distinct. Following laser irradiation an active reconstruction of the microcirculatory bed with the redistribution of the blood stream took place along with destruction of the vascular wall and perivascular inflammation.     

Capillary hemangioma (strawberry mark) of infancy: comparison of argon and Nd:YAG laser treatment

Capillary hemangioma of infancy (strawberry mark) is a self-limiting problem, and conservative treatment is recommended. These birthmarks can be associated with a great deal of morbidity. There is definitely a role for a palliative form of treatment without systemic complications or destruction of adjacent tissue. In a 6-year period, 55 patients received 57 Nd:YAG or argon laser treatments. Thirty patients received 31 argon treatments, and 25 patients received 26 Nd:YAG treatments; and 2 received first argon with subsequent Nd:YAG treatments. Although more dramatic successes were noted in the Nd:YAG laser, complications were more frequent and severe. Complications included delayed healing, postoperative bleeding, and some hypertrophic scarring. Complications were seen in 12 percent of all patients, 9 percent of these associated with the Nd:YAG laser.     

Thermography as a predictive tool for laser treatment of port-wine stains

The argon laser, which has been proven both useful and safe for port-wine stain therapy, interacts with the hemoglobin of the vessels. In a percentage of cases, this treatment is still inefficient, and there is a lack of correlation between these bad results and clinical or histologic criteria. Thermography, which explores the vascularization of the port-wine stain, leads us to consider port-wine stains from a physical point of view. This very simple test shows no correlation with the clinical parameters of port-wine stain but is closely related to the results obtained with laser therapy. It seems to be a good criterion to estimate the argon laser treatment prognosis.     

Photoradiation therapy of cutaneous angiosarcomas in mice

Cutaneous angiosarcoma is a relatively rare but devastating malignant vascular tumor. It has a high incidence of recurrence following conventional therapeutic modalities applied either singly or in combination. The increased vascularity of cutaneous angiosarcomas, facilitating selective uptake and retention of a photosensitizing agent, such as hematoporphyrin derivative (HPD), suggests that these tumors would respond well to photoradiation therapy. To study the feasibility of this treatment modality, transplantable hemangiosarcomas were implanted in B6C3F1 female mice. Within 2.5 to 3.5 hours after intraperitoneal administration of HPD, fluorescence was recorded in the tumor as compared with surrounding normal skin. When these photosensitized tumors were exposed to 70 J/cm2 of laser energy from an argon-pumped dye laser at 630 nm, the tumors showed marked necrosis within 24 hours. In another series, the tumors were initially photosensitized with HPD for 3 hours and then treated with laser energy ranging from 0 to 96 J/cm2. A dual labeling procedure demonstrated a dose-related decrease in DNA synthesis rate in tumors that were exposed to 0 to 30 J/cm2 at 24 hours after treatment. Furthermore, tumor tissue exposed to laser energy in excess of 30 J/cm2 showed no significant cellular DNA synthesis. These data, supported by histologic evidence of tissue destruction, suggest that photoradiation therapy has a great potential as a therapeutic modality for cutaneous angiosarcomas.     

Preliminary study of the vascular dynamics of port-wine hemangioma with therapeutic implications for argon laser treatment

The vascular dynamics of port-wine hemangioma have been studied in several ways in order to better understand blood flow factors. Utilizing a laser Doppler velocimeter, differential perfusion/blood flow was studied and contrasted to normal skin, compared to heat and cold challenges, and finally measured in relationship to argon laser treatment. Results indicate that port-wine hemangiomas do not necessarily have different perfusion than normal skin but respond less vigorously to heat challenges. Cooling showed no uniform response by port-wine hemangioma vessels, while injection with Xylocaine plus epinephrine resulted in a markedly decreased perfusion and vasoconstriction contrary to previously held theories. Argon laser treatment did not uniformly alter laser Doppler perfusion to a predictable degree. Laser Doppler velocimeter flow studies were not able to predict future good versus bad results of laser treatment.     

Ulcerated anogenital hemangioma of infancy

Ten female infants were referred for symptomatic hemangiomas in the anogenital area. (One had had steroid treatment prior to consultation.) The natural history of these lesions is well known. Virtually all will spontaneously involute over a period of years. However, the lesions reported were particularly troublesome because of repeated ulcerations and subsequent pain. Prior treatment had been local wound care with antibiotic ointment and Telfa-type dressings. After referral from a family practitioner or pediatrician, argon laser treatment was performed in an outpatient setting. Eight of the 10 patients were treated with local anesthesia, and 2 had general anesthesia. All lesions healed in 1 to 5 weeks. No patients referred during this period were excluded from this series. All who received treatment were included. All the lesions involuted following treatment. In our estimation, the final result is identical to what may be expected after spontaneous involution of an ulcerated or infected hemangioma. The major difference is that involution occurred in a few weeks in laser-treated patients rather than a period of months or years. Ulcerated hemangiomas of the anogenital area have significant morbidity that can be efficiently avoided with the use of argon laser therapy. Lesions of the anogenital area have a strong predilection for females.     

Evaluation of argon laser surgery in children under 13 years of age

Argon laser surgery is an effective treatment for ectasias and congenital port-wine stains; however, its use in children under the age of 13 is controversial. This paper reviews 202 children under the age of 13 who underwent argon laser treatments for congenital port-wine stains, spider angiomas, epidermal nevi, and lentigines. The clinical characteristics of port-wine stains in 170 children are discussed. Good to excellent results (moderate to complete clearing) in port-wine stains were obtained in 60 percent of patients and seemed to correlate best with lack of blanchability on pressure. Hypertrophic scarring was seen in only 7 children, all of whom had undressed wounds; no significant scarring has been seen in any subsequent child who had maintained a dressed wound postoperatively.     

Study of dynamic microcirculatory problems in ‘blackfoot disease’ -emphasizing its differences from arteriosclerosis

The cutaneous microcirculation can be divided into thermoregulatory shunt vessels and nutritive skin capillaries. Flux in nonnutritional shunt vessels dominates the signal recorded by the laser Doppler flowmeter. Computerized videophotometric capillaroscopy is a sensitive method for assessing cutaneous nutritive microcirculation. Using patients with blackfoot disease and arteriosclerosis as disease models, we evaluated the sensitivity and clinical usefulness of these relatively new techniques for peripheral vascular disorders. In blackfoot disease, blood flux measured by the laser Doppler flowmeter in the affected toe was lower than that in the nonaffected toe. In symptom-free fingers, blood flow was not significantly different between blackfoot disease and arteriosclerosis. However, blood flow in both diseases was lower than that of the control group. Patients who had the same status of thermoregulatory flow and eyeground arteriosclerotic classification underwent a 1-min arterial occlusion of the digits. The postocclusive reactive hyperemia response (PRH) of nailfold capillary loops was evaluated. All parameters for PRH for the cutaneous nutrient microcirculation including resting capillary blood cell velocity (rCBV), peak capillary blood cell velocity (pCBV) and time to pCBV were more significantly disturbed in the blackfoot disease group than in the arteriosclerotic group. On the basis of the results of this study, dynamic capillaroscopy provides a new approach for the early detection of circulatory disturbances resulting from different mechanisms.     

Skin closure with dye-enhanced laser welding and fibrinogen

The topical application of wavelength-specific dye and fibrinogen has been used to enhance laser closure of vascular anastomoses. We compared the closure of skin incisions by two different dye-enhanced, fibrinogen-based laser welding systems [argon laser (power density 4.78 W/cm2) with fluorescein isothiocyanate dye (n = 32) and diode laser (power density 9.55 W/cm2) with indocyanine green dye (n = 32)] with closure by interrupted 5-0 nylon suture (n = 64) and examined tensile strength, hydroxyproline production, histology, and cosmesis. Two 3-cm full-thickness incisions were made on the shaved backs of 64 rats. One incision was closed with suture, whereas the other, after treatment with the appropriate dye, was welded with either argon- or diode-lasered fibrinogen. At postoperative days 5, 10, 15, and 28, the closure sites were harvested and sectioned for analysis. Initially, wounds closed with argon-lasered fibrinogen showed less inflammatory response, greater collagen production (34.61 +/- 0.74 mg/gm), and greater mean peak stress at rupture (64.85 lbs/in2) than those closed with suture (16.42 +/- 3.20 mg/gm, 26.68 lbs/in2) (p less than 0.05). By 15 days, both argon and diode laser closures are superior in strength and collagen production to suture closure (p less than 0.05). At 28 days, diode laser closures (1315.60 lbs/in2) are stronger than suture closures (998.09 lbs/in2), whereas both are stronger than argon laser closures (813.16 lbs/in2) (p less than 0.05). Cosmetically, argon-welded wounds consistently appeared finer and lacked cross-hatched suture scars.(ABSTRACT TRUNCATED AT 250 WORDS)     

Demonstration of elevated type I and type III procollagen mRNA levels in cutaneous wounds treated with helium-neon laser. Proposed mechanism for enhanced wound healing

To assess laser modulation of wound healing, full-thickness cutaneous wounds were produced in the backs of pigs, and subjected to treatment with helium-neon laser. For comparison, some wounds were treated with non-laser energy source (a tungsten light) or left untreated as controls. Type I and type III procollagen mRNA levels were determined in the wounds by molecular hybridization with cDNA probes. The results indicated that type I and type III mRNA levels were markedly increased at days 17 and 28 of the healing in wounds treated with He-Ne laser, when compared to control or tungsten light-treated wounds. The results suggest that helium-neon laser stimulates wound healing by enhancing procollagen gene expression. These observations may have relevance to previous clinical studies suggesting that helium-neon laser stimulates wound healing.     

Experimental aspects of in vitro and in vivo photochemotherapy

The selectivity of in vitro photodynamic reactions and the in vivo effects induced by PRT, whether the irradiation is applied interstitially or externally, still remains unclear. In vitro studies were performed using leukemic cell lines and syngeneic normal hemopoietic progenitors. For these, cells incubated with hematoporphyrin derivative (HPD) and non-incubated cells were irradiated with an argon laser. Data were obtained as the count of cell colonies found after a 7-day incubation period on semi-solid collagen gel medium. In vivo studies employed the HT 29 tumor model grafted into nude mice. Both animals injected with HPD and non-infected controls were irradiated with a dye laser pumped by an argon laser (Coherent) using a 400 micron optic fiber located either at a distance of 65 mm from the skin or inserted into the tumor. The temperature increase occurring during PRT was measured using non-absorbing thermocouples. In vitro, after HPD treatment and argon irradiation leukemic cells showed a greater phototoxicity (greater than 2 log10) than did the normal cells (0.25 log10). In vivo, when the heat rise is very similar (less than 4 degrees C) in both the tissues irradiated externally and those irradiated interstitially after HPD injection, histological examination of these did not reveal any quantitative differences (90% of tumor mass). These results are discussed.     

激光联合康柏西普治疗糖尿病视网膜病变伴黄斑水肿的临床效果及机制研究

目的:探讨激光联合康柏西普治疗糖尿病视网膜病变伴黄斑水肿的临床效果及可能机制。方法:选取2017年1月至2017年12月我院收治的糖尿病视网膜病变伴黄斑水肿患者92例作为研究对象,随机分为观察组46例(46眼)及对照组46例(46眼)。对照组患者实施激光治疗,观察组在注射康柏西普1周后再进行激光治疗。比较两组患者治疗后的临床疗效,治疗前后最佳矫正视力(BCVA)、黄斑中心厚度(CMT)、血管内皮生长因子(VEGF)、胰岛素样生长因子-1(IGF-1)及红细胞生成素(EPO)水平的变化。结果:治疗后,观察组的总有效率为91.30%,显著高于对照组(69.57%,P0.05);两组患者的BCVA均较治疗前明显提高(P0.05),CMT均低于治疗前(P0.05),但观察组BCVA较对照组更高(P0.05);CMT较对照组更低(P0.05)。治疗后,两组患者的VEGF、IGF-1、EPO均较治疗前明显降低,且观察组的VEGF、IGF-1、EPO均显著低于对照组(P0.05)。结论:激光联合康柏西普治疗糖尿病视网膜病变伴黄斑水肿的临床疗效显著优于单用激光治疗,并可有效改善VEGF、IGF-1、EPO水平,这可能对抑制血管新生产生积极作用。     

Transscleral diode photocoagulation of large retinal and choroidal vascular lesions

BACKGROUND: Transscleral retinal photocoagulation with a diode laser is used in glaucoma refractory to medical and surgical treatment. Our main research question was how the technique performed in large vascular lesions associated with hemangiomas of the retina and choroid. METHODOLOGY/CLINICAL FINDINGS: Patient charts were retrieved from the hospital files for patients who underwent the procedure and were followed for at least 24 months. Five patients (6 eyes) fit the criteria. Cases included Von Hippel's disease (2 eyes), Coats' disease (1 eye) and choroidal hemangioma (3 cases). Transscleral diode laser treatment was performed under retrobulbar and topical anesthesia with a retinopexy probe (IRIS DioPexy, IRIS Medical Instruments, Mountain View, CA) applied transsclerally under indirect ophthalmoscope visualization. We found an improvement in best-corrected visual acuity at 24 months postoperatively. CONCLUSIONS/SIGNIFICANCE: Transscleral photocoagulation may have a clinical application in these diseases as an alternate to the high cost of photodynamic therapy with photosensitizing agents.     

康柏西普联合视网膜激光光凝对缺血型视网膜中央静脉阻塞患者球结膜微循环指标和血管内皮功能的影响

摘要 目的：探讨康柏西普联合视网膜激光光凝对缺血型视网膜中央静脉阻塞患者球结膜微循环指标和血管内皮功能的影响。方法：选取2016年8月到2019年9月我院收治的缺血型CRVO患者90例,按信封抽签法分为对照组（n=45,视网膜激光光凝治疗）和研究组（n=45,视网膜激光光凝联合康柏西普治疗）,比较两组患者黄斑中心视网膜厚度(CMT)、球结膜微循环指标、最佳矫正视力(BCVA)、疗效、血清血管内皮生长因子（VEGF）、内皮素-1（ET-1）、一氧化氮（NO）水平以及不良反应。结果：治疗后6个月研究组临床总有效率高于对照组（P<0.05）。治疗后6个月,研究组的BCVA升高程度以及细动脉管径、细静脉管径扩大程度均大于对照组（P<0.05）,CMT以及红细胞聚集积分降低程度大于对照组（P<0.05）。治疗后3 d,研究组的VEGF、ET-1降低程度大于对照组（P<0.05）,NO升高程度大于对照组（P<0.05）。两组不良反应发生率对比未见差异（P>0.05）。结论：康柏西普联合视网膜激光光凝治疗缺血型CRVO疗效较好,可有效改善患者视力及球结膜微循环,同时还可改善血管内皮功能,安全可靠。     

Clinical and Laboratory Double-blind Investigation on Effect of Fibrinolytic Therapy in Patients with Cutaneous Vasculitis

The effects of phenformin and ethyloestrenol and phenformin and stanozolol on the clinical state, plasma fibrinolytic activity, and fibrinogen-fibrin-related antigen (F.R.-antigen) were compared with placebo in 13 patients with cutaneous vasculitis. Eight patients showed considerable clinical improvement when taking phenformin and an anabolic steroid; an impaired fibrinolytic activity before treatment favoured clinical improvement.     

Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery: anatomical basis and clinical applications

The cutaneous perforators of the radial artery adjacent to the superficial branch of the radial nerve and the lateral antebrachial cutaneous nerve were investigated, and the vascular anatomical features of the reversed forearm island flap supplied by those accompanying perforators were documented. Ten fresh cadavers were systemically injected with lead oxide, gelatin, and water. Twenty forearms were then dissected, and an overall map of the cutaneous vasculature and source vessels was constructed. The accompanying arteries were observed to lie along the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve and to nourish the skin through cutaneous branches. Vascular communication among these cutaneous vessels was evaluated, to determine the cutaneous vascular territory of the radial forearm flap. This anatomical information facilitates flap design in the forearm region. Clinical experience regarding the usefulness of the reversed forearm island flap for hand reconstruction for a series of five patients is presented.     

低功率氩离子激光治疗口腔癌前病变的临床研究

目的对氩离子激光治疗口腔癌前病变的治疗机理、照射功率、方法及疗效差异进行探讨。方法 对５３例口腔白斑和扁平苔藓患者应用Ａｒ＾＋激光治疗,检查比较患者治疗前后的临床变化。结果 口腔白斑３１例全部治愈,治愈率１００％;口腔扁平苔藓２２例治愈１３例,显效７例,无效２例,治疗有效率９０．９％,总有效率达９６．２％。结论 氩离子激光治疗口腔白斑和扁平苔藓等清表的口腔慢性病损,不仅疗效显著,操作简便,并发症少