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Vuylsteke M, Van Dorpe J, Roelens J, De Bo T, Mordon S, Fourneau I. Intraluminal Fibre-Tip Centring can Improve Endovenous Laser Ablation: A Histological Study. Eur J Vasc Endovasc Surg 2010; 40:110-6. [DOI: 10.1016/j.ejvs.2009.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 09/20/2009] [Indexed: 10/20/2022]
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Wassmer B, Zemmouri J, Rochon P, Mordon S. Comparative Study of Wavelengths for Laser Lipolysis. Photomed Laser Surg 2010; 28:185-8. [PMID: 19803718 DOI: 10.1089/pho.2008.2480] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leclère FMP, Petropoulos I, Mordon S. Laser-assisted cartilage reshaping (LACR) for treating ear protrusions: a clinical study in 24 patients. Aesthetic Plast Surg 2010; 34:141-6. [PMID: 19484177 DOI: 10.1007/s00266-009-9353-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 04/03/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Protruding ears are the most common congenital ear deformity, with a frequency of 13.5%. Since 1845 and the first works of Dieffenbach, over 170 classical surgical methods have been proposed to correct it. We introduced laser-assisted cartilage reshaping (LACR) in 2004 as an alternative to invasive surgical otoplasty. METHODS Between January 2008 and June 2008, 24 patients underwent LACR for treatment of bilateral ear protrusion. Fourteen adults and ten children were treated (mean age = 16.0 years, range = 6-45 years). No anesthesia was used. Both sides of the entire helix and the concha were irradiated using a 1540-nm laser connected to a 4-mm spot handpiece with integrated cooling. Fluences varying from 70 up to 84 J/cm(2) were applied. Immediately after the irradiation, silicone elastomer was inserted inside the helix to give it the desired shape. After 3 minutes a solid mold was obtained. Patients were asked to keep this mold in place at all times with a bandage wrapped around the head for the first 3 weeks and then for an additional 3 weeks only during the night. A non-steroidal anti-inflammatory drug (NSAID) was prescribed to the patients for 3 days. At 1, 30, 60, and 90 days after the procedure, ears were checked and photographs were taken. Clinical follow-up at 1 year was obtained via direct patient contact or over the telephone. RESULTS The treatment was well tolerated. No hematomas or skin necrosis occurred. Contact dermatitis was observed in four children and two adults as a result of inappropriate mold design. These patients stopped wearing the mold and the shape of their ear did not improve. For the remaining 18 patients (6 children and 9 adults), the expected ear reshaping was obtained (fluence was 84 J/cm(2)). For three other adults, incomplete reshaping of the ears was observed and can be correlated to a lower fluence (70 J/cm(2)). CONCLUSION LACR, performed without any anesthesia, is a safe and less morbid approach to surgical otoplasty.
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Adatto MA, Luc-Levy J, Mordon S. Efficacy of a novel intense pulsed light system for the treatment of port wine stains. J COSMET LASER THER 2010; 12:54-60. [DOI: 10.3109/14764171003706158] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Capon A, Iarmarcovai G, Mordon S. Laser-assisted skin healing (LASH) in hypertrophic scar revision. J COSMET LASER THER 2010; 11:220-3. [PMID: 19951192 DOI: 10.3109/14764170903352878] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laser-Assisted Skin Healing (LASH) is based on the therapeutic effects of controlled thermal post-conditioning. The authors have previously demonstrated on humans that an 810-nm diode-laser system could assist wound closure leading to an improvement of wound healing with a resulting indiscernible scar. A 47-year-old woman (skin type II), who developed systematically hypertrophic scars after surgery, was enrolled for a hypertrophic scar revision. Excess scar tissue was removed. Immediately after the conventional closure of the incision, laser irradiation (120 J/cm(2)) using a 0.8 cm(2) spot size (rectangular spot, length = 20 mm, width = 4 mm) was applied. Topical silicone gel sheeting (Cerederm((R))) was applied for 2 months afterwards to prevent a thick scar from reforming. No complications occurred during the course of this study. No recurrence of hypertrophic scarring was noticed 6 months after scar revision. This study reports, for the first time, the possibility of improving the appearance of hypertrophic scarring in scar revision by altering through thermal stress the wound-healing process. Since the appropriate initial management of wounds is of importance, the LASH technique could be offered as a new approach to prevent hypertrophic scarring.
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Mordon S, Plot E. Laser lipolysis versus traditional liposuction for fat removal. Expert Rev Med Devices 2010; 6:677-88. [PMID: 19911878 DOI: 10.1586/erd.09.50] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Liposuction is second only to breast augmentation as the most commonly performed cosmetic procedure in the USA. Liposuction removes fat through very small skin incisions, with atraumatic, blunt-tipped cannulas. Simplicity, quality of results and relatively rare complications are but a few benefits that explain its success. Its main limitation is the minimal skin retraction achieved after the procedure. Laser lipolysis is based on a thermal effect. The laser can vaporize, melt tissues and coagulate blood vessels. More importantly, the laser stimulates the formation of collagen in the region, enhancing skin elasticity and promoting skin contraction in the treated areas. This review aims to describe traditional liposuction and laser lipolysis, and discusses the difference between the two techniques.
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Mordon S, Capon A, Fournier N, Iarmarcovai G. Lasers thermiques et cicatrisation cutanée. Med Sci (Paris) 2010; 26:89-94. [DOI: 10.1051/medsci/201026189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Desmyttère J, Grard C, Stalnikiewicz G, Wassmer B, Mordon S. Endovenous Laser Ablation (980nm) of the Small Saphenous Vein in a Series of 147 Limbs with a 3-Year Follow-up. Eur J Vasc Endovasc Surg 2010; 39:99-103. [DOI: 10.1016/j.ejvs.2009.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 09/20/2009] [Indexed: 10/20/2022]
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Desmyttère J, Grard C, Stalnikiewicz G, Wassmer B, Mordon S. Endovenous Laser Ablation (980nm) of the Small Saphenous Vein in a Series of 147 Limbs with a 3-Year Follow-up. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2009.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vandermeulen L, Makris D, Mordon S, Goossens A, Marquette CH, Haentjens P, Noppen M. Thoracoscopic Findings and Pharmacokinetics of Inhaled Fluorescein in a Pig Model. Respiration 2010; 80:228-35. [DOI: 10.1159/000308463] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 01/25/2010] [Indexed: 11/19/2022] Open
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Leclère FMP, Mordon S, Schoofs M. Acute digital ischemia: A neglected microsurgical emergency. Report of 17 patients and literature review. Microsurgery 2009; 30:207-13. [DOI: 10.1002/micr.20723] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Mordon S, Wassmer B, Servell P, Desmyttère J, Grard C, Stalnikiewicz G. Is a vein filled with blood a good model for studying endovenous laser ablation? Lasers Surg Med 2009; 41:543-4. [DOI: 10.1002/lsm.20809] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Vuylsteke M, Van Dorpe J, Roelens J, De Bo T, Mordon S. Endovenous laser treatment: a morphological study in an animal model. Phlebology 2009; 24:166-75. [DOI: 10.1258/phleb.2009.008070] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives The destruction induced during endovenous laser treatment (ELT) of the saphenous vein and the perivenous tissue in an animal model (goats) was analysed. Differences in vein wall destruction produced by two laser types, the 980 and 1500 nm diode lasers, were evaluated histologically. Methods In 14 goats, 28 lateral saphenous veins were treated with ELT. In 14 veins we used the 980 nm diode laser and in the remnant a 1500 nm laser. Postoperatively the veins were removed at different stages and sent for histological examination. Results Immediately removed veins after ELT show an uneven destruction of the vein wall. Veins harvested one week postoperatively show inflammatory tissue at their periphery. Two and three weeks postoperatively, organization is very extensive. In some cases, recanalization begins in a semi-lunar manner at the contralateral side of the laser hit. Veins treated with a 980 nm laser show deeper ulceration with more perivenous tissue destruction compared with veins treated with a 1500 nm diode laser. Conclusions The ELT of veins produces an unevenly distributed damage. The cell necrosis is far more extensive than expected. Uneven vein wall destruction can lead to recanalization. Using a 1500 nm laser correlates with less penetrating ulcerations and more circumferential damage.
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Levy JL, Mordon S, Pizzi-Anselme M. Treatment of individual café au lait macules with the Q-switched Nd:YAG: A clinicopathologic correlation. ACTA ACUST UNITED AC 2009; 1:217-23. [PMID: 11360463 DOI: 10.1080/14628839950516706] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Café au lait macules (CALMs) respond variably to treatment with lasers. This study was carried out to identify which individual features of CALMs could predict a good clinical response to treatment. METHODS Twenty-two patients aged 3-43 years were treated with the frequency-doubled Q-switched Nd:YAG (10 ns, Ø = 3 mm, 2.0 to 3.0 J/cm2). Biopsy specimens of the CALMs were obtained before treatment in 11 patients to achieve the diagnosis of CALMs. Treatment of CALMs usually requires several laser sessions, so the treatment was carried out at 2-month intervals. Clinical follow-up was done 3 and 12 months after the final treatment to observe results and recurrences. RESULTS The analysis shows that the only statistically significant criteria was the jagged aspects of the edges of the CALMs. Consequently, this criteria should be evaluated in further studies in relation with the laser treatment of CALMs.
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Fournier N, Lagarde JM, Turlier V, Courrech L, Mordon S. A 35-month profilometric and clinical evaluation of non-ablative remodeling using a 1540-nm Er:glass laser. J COSMET LASER THER 2009; 6:126-30. [PMID: 15545095 DOI: 10.1080/147641704100021624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND/OBJECTIVE As remodeling is getting more popular with patients, long-term studies are becoming necessary. The aim of this 35-month clinical study was to evaluate the long-term benefits obtained using a 1540-nm Er:glass laser for non-ablative remodeling of perioral and periorbital rhytids. The role of maintenance treatments was also investigated. STUDY DESIGN/METHODS Eleven women with periorbital and perioral rhytids underwent a series of five treatments at 6-week intervals with an Er:glass laser. Five patients subsequently received two maintenance retreatments and six did not. The maintenance treatments were performed at 14 and 20 months. Silicone imprints were performed to measure anisotropy before treatment, at 6 months, at 14 months and at 35 months. Patient self-evaluation/questionnaire was also done to assess adverse effects and subjective clinical improvement. RESULTS For all 11 patients, the percentage of anisotropy reduction was 41.21% at 6 months, 51.76% at 14 months and 29.87% at 35 months. No adverse effects were noted. Patient satisfaction was high at the end of the evaluation. Retreated patients were more satisfied than non-retreated ones. However, there was no difference in the anisotropy factor between the two groups. CONCLUSION Treatment of facial rhytids with a non-ablative 1540-nm Er:glass laser system can produce benefits that persist over 2 years after the last treatment.
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Trelles MA, Mordon S. Cutaneous effects compared between higher fluence with fewer treatments and lower fluence with more treatments in a combined IR laser/radio frequency system. J COSMET LASER THER 2009; 8:177-83. [DOI: 10.1080/14764170601009614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Trelles M, Allones I, Vélez M, Mordon S. Nd:YAG laser combined with IPL treatment improves clinical results in non‐ablative photorejuvenation. J COSMET LASER THER 2009; 6:69-78. [PMID: 15203996 DOI: 10.1080/14764170410032398] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Intense pulsed light (IPL) sources have been reported in non-ablative photorejuvenation, but the excellent histological findings do not always coincide with the clinical results and patient satisfaction index (SI). METHODS Ten female patients (two forehead, four periocular and four perioral), ages ranging from 28 to 46 years, skin types II-IV, wrinkle types I-III, participated in the study. The IPL system was applied with the yellow (570 nm) cut-off filter, 30 J/cm(2), single pulse, followed by the Nd:YAG at 120 J/cm(2), double pulse (7 ms per shot with 20 ms between pulses) on the wrinkled areas only. Three sessions were given at monthly intervals, and an assessment was made 1 and 6 months after the third session. Biopsies were taken from four consenting patients as a cross-section before the first treatment and then 1 and 6 months after the third session. For clinical control and contrast of tissue results, a group of 10 patients (two forehead, four periocular and four perioral; ages ranging from 27 to 47 years, skin types II-IV, wrinkle types I-III) was treated only with IPL, using the same parameters and sessions. Histologies were taken from four consenting patients. RESULTS The histology showed thickening of the epidermis with good dermal collagen organization in both groups. However, the combined treatment showed more dramatic changes in histological tissue condition, and ectatic blood vessels were seen in the deeper dermis. The patient SI values, related to the results, were lower when IPL was used alone. All patients completed the study. In the combined treatment group, overall SIs of 8 (80%) and 8 (80%) were obtained at the control points of 1 and 6 months, respectively, after session 3, compared with SIs of 6 (60%) and 4 (40%) scored by patients in the IPL group at the same points. Discomfort and side effects were minimal in both groups. CONCLUSIONS The addition of the Nd:YAG laser to the IPL regimen in non-ablative skin rejuvenation gave very good histological results, which were echoed by stronger patient satisfaction than in the control group treated only with IPL. Visible improvement in the skin condition of both groups was achieved, but was better in the combined treatment group.
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Mordon S, Wassmer B, Rochon P, Desmyttere J, Grard C, Stalnikiewicz G, Reynaud JP. Serum lipid changes following laser lipolysis. J COSMET LASER THER 2009; 11:74-7. [DOI: 10.1080/14764170902792173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fournier N, Aghajan-Nouri N, Barneon G, Mordon S. Hair removal with an Athos Nd:YAG 3.5 ms pulse laser: a 3-month clinical study. ACTA ACUST UNITED AC 2009; 2:125-30. [PMID: 11360328 DOI: 10.1080/14628830050516362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION/OBJECTIVE This study aimed to evaluate the safety and efficacy of a 3.5 ms Nd:YAG laser for the removal of hair in subjects with Fitzpatrick skin types I-IV. Thanks to a pulse shorter than the hair Thermal Relaxation time (TRT), photothermolysis was thus achieved. METHODS This study assessed the percentage of hair reduction at 1 month and at 3 months after a single Nd:YAG laser treatment (Athos; Quantel Médical, France); 3.5 ms pulse, single shot to 3 Hz, a maximum fluence of 80 J/cm2, 4 mm spot, no cooling system, no anaesthesia. The treatment sites consisted of three adjacent squares (optimum fluence, no treatment, -20% optimum fluence). Computerized hair counting was realized on digital pictures. The phototype, pain, side effects and patient's satisfaction were noted. Biopsies were performed 15 min after treatment. The enrolment consisted of 17 women, 22-60 years old, phototypes I-IV, with a follow-up at 1 month and 3 months of 25 sites. RESULTS Counting at 1 month and at 3 months revealed a significant hair reduction compared with the control sites: 60% at 1 month (P < 0.001) and 24% at 3 months (P < 0.05) for optimal fluence (25-80 J/cm2), compared with 31% and 0% on the control sites; values similar to those published for Nd:YAG or diode lasers. There were no adverse effects at all. Biopsies showed lesions from necrosis coagulation of the root sheaths and hair disruption to isolated apoptotic cells in the outer root sheath, depending on the fluence applied. CONCLUSION Results from this study show that the Athos Nd:YAG is efficient and safe for removing pigmented hair in phototypes I-IV.
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Angel S, Boineau D, Dahan S, Mordon S. Treatment of active acne with an Er:Glass (1.54 µm) laser: A 2‐year follow‐up study. J COSMET LASER THER 2009; 8:171-6. [DOI: 10.1080/14764170600915985] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Trelles MA, Mordon S, Allones I, Rigau J. Effects of skin cleaning modes on the condition of collagen and elastin after laser resurfacing. ACTA ACUST UNITED AC 2009; 2:169-76. [PMID: 11350672 DOI: 10.1080/146288300750163736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Laser resurfacing is now widely used for the treatment of facial wrinkles, photoaging and acne scars and is usually combined with comparatively aggressive methods of cleaning detritus off the treated area after each laser pass. OBJECTIVE This study aims to evaluate two different cleaning methods (damp gauze or damp large-tip cotton buds) in order to elucidate their influence on the healing process, if any. The left or right preauricular area, chosen at random on 10 patients undergoing periocular and perioral resurfacing with the same laser system, was cleaned after each laser pass with damp gauze (Group G) and the contralateral side with the large-tip cotton buds (Group C). Post-resurfacing oedema and erythema were observed in the preauricular areas and rated by the same experienced observer immediately after treatment and at 14, 30, 45, 60 and 90 days. RESULTS Oedema was slightly more noticeable initially in Group G patients, but the erythema was more intense and lasted longer in the gauze-cleaned tissue. The sites were biopsied at 90 days and the samples sent for blinded histological evaluation to assess the degree of collagen and elastin fibre compaction. The histology demonstrated that the tissue from Group G achieved, at 90 days, better compaction of collagen and elastin fibres than that from Group C. CONCLUSIONS It is suggested that the abrasive action caused by the gauze adds to the existing stimulative inflammatory reaction following CO2 laser resurfacing, which augments the collagen and fibre compaction response in the tissue. Comparatively aggressive cleaning with damp gauze may therefore be preferable to other methods when performing laser resurfacing.
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Desmons S, Heger M, Delfosse C, Falgayrac G, Sarrazin T, Delattre C, Catros S, Mordon S, Penel G. A preliminary investigation into the effects of X-ray radiation on superficial cranial vascularization. Calcif Tissue Int 2009; 84:379-87. [PMID: 19190840 DOI: 10.1007/s00223-009-9217-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
Radiation therapy (RT) is an established treatment modality for malignant neoplasms. RT induces tissue damage that may lead to osteoradionecrosis in more severe cases. Suitable animal models to study RT-induced changes in membranous craniofacial bone are currently not available. The aim of this study was therefore to quantify RT-induced changes in cranial microcirculation using a newly developed calvaria chamber model and to relate these changes to RT-induced histological damage. New Zealand white rabbits received a total radiation dose of 18.75 Gy through the calvaria chamber, and the number of vessels, the vessel length density (VLD), and angiogenic sprouting were quantified on a weekly basis during a 12-week period. At the end of 12 weeks, the RT-treated (n = 5) or control (n = 5) calvarias were biopsied for histopathological analysis. RT resulted in a steep reduction in the number of vessels and the VLD during the first 3 weeks, particularly in larger-diameter vessels, followed by a flat stabilization/remodeling phase in the subsequent 9 weeks that never restored to baseline values. Histomorphometric analysis revealed a high degree of osteocytic depletion, prominent hypocellularity in the lacunae and intraosseous vasculature, enlarged and nonconcentric Haversian systems, and a severely disorganized bone matrix in the RT-treated calvarias. Despite the prevalence of some angiogenic potential, the RT-induced effects in the early phase persisted in the intermediate to late phase, which may have contributed to the poor recovery of the RT-treated bone.
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Mordon S. [Thermal lasers and wound healing]. REVUE MEDICALE SUISSE 2009; 5:890-894. [PMID: 19438089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The wound healing is a complex biological process, which induces a dermal remodelling leading at minimum to a visible scar to an hypertrophic scar. In opposition, regeneration of a tissue or organ is the reconstitution ad integro of this organ. Recent studies suggest that by using laser, which generates a precisely defined thermal effect in the skin, it became possible to improve the wound healing process to become closer to tissue regeneration.
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Collinet P, Estevez JP, Ascencio M, Farine MO, Vinatier D, Cosson M, Mordon S. [Diagnosis of cervical squamous intraepithelial lesions by fluorescence imaging: clinical feasibility study]. ACTA ACUST UNITED AC 2009; 37:307-12. [PMID: 19359207 DOI: 10.1016/j.gyobfe.2009.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 01/23/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fluorescence diagnosis is still undeveloped in gynaecology. In order to diagnose and localize squamous intraepithelial lesion (SIL) of the cervix, a new method improving the low specificity of colposcopy would be useful. The goal of this study was to assess the feasibility and safety of colposcopic fluorescence diagnosis of SIL after topically application of methyl aminolevulinate (MAL). PATIENTS AND METHODS Patients with histologic proved cervical intraepithelial neoplasia (CIN) and planned for loop electrosurgical excision procedure (LEEP) under general anesthesia were included in a prospective study. Before general anesthesia, a thick layer of MAL (Metvix-160 mg/mL cream) was applied on the cervix for 35-150 min. Fluorescent colposcopic inspection of the cervix was performed using a rigid 10-mm laparoscope inserted in the vaginal cavity and connected to D-light AF system (Karl Storz Endoskope, Tuttlingen Germany). In order to confirm neoplasic status, fluorescent foci underwent directed punch biopsy(ies). RESULTS Fourteen patients were included in the study. Colposcopic fluorescence imaging revealed red fluorescent foci in 71.4% of cases (10/14) (neoplasic status of fluorescent foci was confirmed in 80%). Concerning MAL, the mean of application time was 73 min (35-150). Two cases presented a false-positive fluorescence and four cases of false-negative fluorescence. For all cases of false-negative fluorescence, application time of MAL was less than 60 min. We observed no systemic or local toxicity of MAL application in any group. DISCUSSION AND CONCLUSION Using topical application of MAL to the cervix, we demonstrated that fluorescence diagnosis of SIL is feasible. This study justifies the further development of fluorescence imaging that combines classical white light colposcopy with the use of a photosensitizer.
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