Biomedical subjects
Publications and source records attributed to D B Apfelberg.
The use of the carbon dioxide laser for minor hand problems is reviewed, and the physiological effects of laser treatment are discussed. Forty-one patients have been treated during a one-year period for warts, nail disorders, and a variety of benign neoplasms. Results of CO2 laser treatment are equivalent to those of other methods with less pain and disability. Future applications of the CO2 laser are discussed.
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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 photocoagulation of angiokeratomas of Fordyce, or scrotal angiomas, has been described. The benefits of the argon laser in treatment of these lesions include permanent eradication of the lesions and alleviation of the symptoms of pruritus and episodic bleeding. This method of treatment is safe, does not produce iatrogenic malignant neoplasms, is noninvasive, and is accomplished as an outpatient procedure under local anesthesia with minimal discomfort or disability.
Three patients with granuloma faciale were successfully treated by argon laser therapy. The intense blue-green laser light is readily absorbed by these inflammatory lesions, resulting in resolution of the clinical and microscopic abnormalities. There were no recurrences during follow-up periods of 23, 21, and 5 months, respectively. Argon laser therapy appears to be an important addition to the treatment armamentarium for this uncommon, but difficult to treat, entity.
Argon laser treatment of port wine hemangiomas has evolved greatly in technique. Since 1979, we have treated 150 patients with the "zebra strike" technique in order to enhance fading and lessen the incidence of complications or side effects. Eighty-one such patients are studied in depth with at least an 18-month follow-up on all patients. The "zebra stripe" technique is described in detail. Analysis of fading shows a 64% excellent or good result in all patients and analysis of sponginess shows that a marked reduction of sponginess is possible by the laser. Side effects and complications including hypopigmentation, texture change, and indentation are discussed in detail. Analysis of scarring shows an overall scar rate of 15% with a general scar rate of 7.4% if you exclude the lip and nasolabial area. Residual striping was present to a slight degree in 34% of the patients and to a major degree in 7% of the patients. All factors are discussed as far as age, complexion, sex, color or port wine stain and related to stripe technique.
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Three cases of giant perineal condyloma are detailed and the spectrum of condylomas and verrucous carcinoma is reviewed. The benefits of the CO2 laser in treatment of these lesions include hemostatic incision, wound sterilization, and restriction of lymphatic spread.
Safety of laser exposure and tissue interaction and possible future carcinogenic effects of laser energy are investigated in this study. Mouse fibroblasts of the BALB/3T3 strain have now become the standard in science for the investigation of carcinogenic effects of a variety of physical and chemical/toxic agents. BALB/3T3 fibroblasts were grown in tissue culture and then exposed to x-ray irradiation and argon laser energy. The cells were then grown nine generations and scored for malignant type III foci in a randomized double-blind manner. Argon laser-treated cell groups were then compared with normal untreated controls and known carcinogenic x-ray controls. The results demonstrated that exposure of mouse fibroblasts in vitro tissue culture to argon laser energy did not produce a statistically significant transformation frequency as compared with that of known carcinogenic agents such as x-ray or untreated controls.
It has been proven that intense argon laser light is very useful in the treatment of port-wine hemangiomas and tattoos. However, lasers can successfully treat many other benign cutaneous lesions. This article reports the first use of the argon laser for granuloma faciale and hereditary hemorrhagic telangiectasia. In addition, we have also successfully treated venous lakes, senile angiomas, pyogenic granulomas, acne rosacea, and nevus of Ota.
Increasing clinical use of the CO2 laser in gynecology has been valuable for both external genital and internal reproductive problems. Long-term safety effects of the CO2 laser are investigated in the present study. Fibroblasts grown in tissue culture were exposed to the CO2 laser. They were then grown for nine future generations and scored for possible malignant transformation. Results of the study show that the CO2 laser does not produce a greater incidence of malignant transformation than normal controls. Therefore, in laboratory cells, the CO2 laser appears to be noncarcinogenic.
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Custom-fabricated silicone implants were used in 17 patients to reconstruct thoracic deformities associated with pectus excavatum, hypoplasia of the thorax, and radical mastectomy. The implants have been in place an average of 2 1/2 years. Custom implants have been permanently removed in only two of these patients. These implants can provide accurate, complex contour restoration without creating donor defects. However, problems of extrusion, capsule formation, slippage, and infection requiring implant removal are characteristic of nonautogenous materials. Because these are foreign bodies, well-vascularized soft-tissue coverage is especially essential to retain these implants.
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An analysis of the benefits of submuscular versus subcutaneous implantation was made on mastectomy patients. Ninety-one breast were reconstructed following mastectomy. In 30 breasts, the implants were placed subcutaneously; in 19, subpectorally, and in 42, beneath both the pectoralis and the serratus. The follow-up averaged 2 to 3 years, and recent cases included postoperative tonometry measurements to quantitate the degree of capsular contraction. In addition, 12 cadaver dissections were done to delineate muscle insertion and origins. Results indicate that (1) submuscular implants are clearly superior to subcutaneous ones; (2) subpectoral implantation requires complete detachment of the muscular origin from the ribs; (3) subserratus implantation provides extra muscular coverage, but dissection is more difficult owing to its firm rib attachment; and (4) the subserratus technique provided the lowest incidence of capsular contracture, although the breast was slightly flatter initially, but improved with time.
New concepts in the control of breast cancer and improvements in plastic surgery techniques have facilitated subsequent breast reconstruction. In a six-year period 72 breast reconstructions were carried out in 57 women after surgical treatment for premalignant or malignant breast disease and, in some cases, radiation therapy. The average age of the patients was 48 years and the average interval between the primary cancer operation and breast reconstruction was 42 months. Our experience in these cases has been free of serious complications.