Tratamento do cisto colóide do terceiro ventrículo por neuroendoscopia estereotática com laser Nd: YAG

OBJECTIVE: Colloid cysts (IIIVT CC) are benign neuroepithelial cysts located in the anterior third ventricle. The authors propose the use of Nd:YAG laser stereotactic neuroendoscopic for guided resection of the third ventricle colloid cysts. METHOD: Eleven patients presented third ventricle colloid cysts and were treated by Nd:YAG laser guided with stereotactic endoscopy (n=7) , stereotactic endoscopy (n=3) or stereotactly guided puncture (n=1). The patients were followed prospectively (average 33 months, range 19-64 months). The clinical data, neuroimaging findings, hospitalization stay, outcomes and complications of the method were evaluated. RESULTS: All patients presented headache; six had papilledema, one had gait disturbance and one had third-nerve palsy. Neuroimaging showed hydrocephalus and a IIIVT CC with 14.4-mm mean diameter. After surgery all patients presented clinical and image improvement. Only two patients presented transient morbidities that were easily treated: One had diabetes insipidus that lasted for two days and was treated with a single dose of DDAVP, and another had chemical aseptic meningitis, probably due to the contact of the cyst content with the CSF. This patient was treated with antibiotics and corticosteroids with complete resolution of the problem without sequels. The other patients were discharged from the hospital 48 h after surgery. CONCLUSION: The stereotactic neuroendoscopy-guided procedure with Nd:YAG laser allowed the complete removal of the third ventricle colloid cysts, without definitive morbidities, sequels or recurrence of the lesion.OBJETIVO: Os cistos colóides (CC IIIVT) são lesões neuroepiteliais benignas localizadas anteriormente no terceiro ventrículo. Nós propomos a ressecção neuroendoscópica com o uso do Nd:YAG laser guiada por estereotaxia. MÉTODO: Onze pacientes portadores de cisto colóide do terceiro ventrículo foram tratados por neuroendoscopia estereotática com laser Nd:YAG (n=7), neuroendoscopia estereotática (n=3) ou punção estereotática (n=1) e foram seguidos prospectivamente (média 33 meses, variação 19-64 meses). Os dados clínicos, achados de neuroimagem, tempo de hospitalização, evolução e complicações referentes à técnica foram avaliadas. RESULTADOS: Todos pacientes apresentaram cefaléia; seis tiveram papiledema, um apresentou distúrbio de marcha e um apresentou paresia do terceiro nervo. Os exames de neuroimagem evidenciaram hidrocefalia e CC IIIVT com diâmetro médio de 14,4 mm. Depois da cirurgia todos os pacientes apresentaram melhora clínica e de imagem. Apenas dois pacientes apresentaram morbidades transitórias que foram facilmente tratadas: um apresentou diabetes insipidus que durou dois dias e foi tratada com uma única dose de DDAVP, o outro apresentou meningite química asséptica, provavelmente pelo contato do conteúdo do cisto com o líquor. Este paciente recebeu antibióticos e corticóide com resolução completa do problema. Os outros pacientes receberam alta hospitalar após 48 h. CONCLUSÃO: A ressecção neuroendoscópica com o uso do Nd:YAG laser guiada por estereotaxia possibilitou a remoção completa do cisto colóide sem morbidades definitivas, seqüelas ou recorrência da lesão

Laser de baixa intensidade em deiscência aguda de safenectomia: proposta terapêutica Low level laser therapy in acute dehiscence saphenectomy: therapeutic proposal

Abstract Dehiscence is a feared complication after major surgeries. Patient who had undergone coronary artery bypass grafting developed saphenectomy's dehiscence on lower limb with edema and pain on the 15 th postoperative day. Conventional treatment had been initially performed without clinical improvement. On the 30 th postoperative day only Low Level Laser Therapy (LLLT) was applied punctually around surgical wounds edge. The results revealed granulated tissue, reduction of inflammatory process and analgesic effect since the first application. In this pilot study, LLLT has shown a considerable role as a wound healing agent, through a new proposal for efficient, safe and noninvasive therapy. Descriptors: Laser therapy, low-level. Surgical wound dehiscence. Wound healing. Resumo Deiscência é uma complicação temida em cirurgias de grande porte. Paciente submetida a revascularização miocárdica evoluiu com deiscência de safenectomia em membro inferior, edema e dor no 15º dia pós-operatório (PO), tendo sido realizado inicialmente o tratamento convencional no ambulatório sem melhora clínica. No 30º PO, aplicou-se somente Laser de Baixa Intensidade (LBI) ao redor da borda da ferida, pontualmente. A lesão respondeu com tecido de granulação, diminuição do processo inflamatório e analgesia desde a primeira aplicação. Neste estudo piloto, a laserterapia mostrou ter um papel importante como agente facilitador de cicatrização, por meio de uma terapia não-invasiva, eficaz e segura. Descritores: Terapia a laser de baixa intensidade. Deiscência da ferida operatória. Cicatrização de feridas

Photobiomodulation Therapy Restores IL-10 Secretion in a Murine Model of Chronic Asthma: Relevance to the Population of CD4+CD25+Foxp3+ Cells in Lung.

It is largely known that photobiomodulation (PBM) has beneficial effects on allergic pulmonary inflammation. Our previous study showed an anti-inflammatory effect of the PBM in an acute experimental model of asthma, and we see that this mechanism is partly dependent on IL-10. However, it remains unclear whether the activation of regulatory T cells is mediated by PBM in a chronic experimental model of asthma. In this sense, the objective of this study was to verify the anti-inflammatory role of the PBM in the pulmonary inflammatory response in a chronic experimental asthma model. The protocol used for asthma induction was the administration of OVA subcutaneously (days 0 and 14) and intranasally (3 times/week, for 5 weeks). On day 50, the animals were sacrificed for the evaluation of the different parameters. The PBM used was the diode, with a wavelength of 660 nm, a power of 100 mW, and 5 J for 50 s/point, in three different application points. Our results showed that PBM decreases macrophages, neutrophils, and lymphocytes in the bronchoalveolar lavage fluid (BALF). Moreover, PBM decreased the release of cytokines by the lung, mucus, and collagen in the airways and pulmonary mechanics. When we analyzed the percentage of Treg cells in the group irradiated with laser, we verified an increase in these cells, as well as the release of IL-10 in the BALF. Therefore, we conclude that the use of PBM therapy in chronic airway inflammation attenuated the inflammatory process, as well as the pulmonary functional and structural parameters, probably due to an increase in Treg cells.post-print1951 K

Avaliação do efeito clínico da terapia de fotobiomodulação com uso do laser de baixa intensidade em rosácea eritêmato-telangiectásica: Estudo piloto / Evaluation of the clinical effect of photobiomodulation therapy using low intensity laser in erythemato-telangiectatic rosacea: Pilot study

Introdução: Rosácea acomete, mundialmente, 45 milhões de pessoas, com evolução crônica, certa predisposição familiar e períodos de recrudescência. Esta é uma enfermidade auto-inflamatória incurável, envolvendo vasos cutâneos e unidade pilossebácea, acometendo principalmente a face. Os sintomas, como: queimação, dor, prurido e rubor, levam ao desenvolvimento de eritema e flushing, devendo ser tratada, evitando sequelas físicas e psíquicas. Esta é uma doença sem cura espontânea e evolução progressiva séria. Considerada um flagelo para os pacientes, muitos desencadeiam quadros de ansiedade, depressão, frustração, isolamento, baixa autoestima, dentre outros problemas emocionais e psicológicos. Todavia, praticamente, todos esses casos podem ser controlados com drogas tópicas e orais, principalmente, tetraciclina com efeitos colaterais e, também, uso de Luz Intensa Pulsada. Deve-se evitar os fatores estimulantes de surtos, tratar agravamento e sequelas, bem como prevenir recidivas, que só acarretam grave estresse psíquico. Objetivo: Analisar a resposta clínica da Terapia de Fotobiomodulação com uso do Laser de Baixa Intensidade (LBI) em portadores de rosácea. Metodologia: Aprovação do Projeto - CAAE 51675115.9.0000.5511. Estudo piloto, transversal, controlado, com 5 pacientes adultas com rosácea, relatando 3,5 anos [2-7anos] de diagnóstico, recidivas constantes e depressão profunda. Uma semana, minimamente antes do início da fotobiomodulação, todas as medicações foram suspensas. Colhidos exames pré e pós LBI, seguidos de questionários (percepção da doença e tratamentos). As pacientes foram submetidas a 10 sessões semanais consecutivas, com CW Diodo Laser (Twin-MMOptics®, Brasil), através dos seguintes parâmetros: ? = 660 nm, P = 15 mW, T = 10 seg., Fluência = 3,8J/cm², ø = 0,025 cm², ?pt = 0,15 J/ponto e ?T = 5,8 - 9,4 J, Densidade de P = 0,6 W/cm2 . A região do facis foi avaliada, pré e pós LBI, mensurado pH cutâneo e temperatura local (termômetro digital). A evolução clínica dos sinais de inflamação local (eritema, prurido e aspecto da lesão cutânea), foram avaliados e realizados registros fotográficos. Resultados: Após 10 sessões de LBI, todas as pacientes relataram redução do rubor (flushing), ardência, coceira e sensibilidade da pele tratada; 2 outras referiram melhora na ardência e coceira nos olhos. Todas telangiectasias maiores regrediram acentuadamente. O grau de satisfação aferido pelos questionários é máximo, com relatos de melhora substancial na qualidade de vida. Conclusão: Terapia com Fotobiomodulação com uso do LBI em rosácea revelou ser eficaz, sem efeitos adversos, segura e cost-effectiveness.

Effect of Photobiomodulation Combined with Physiotherapy on Functional Performance in Children with Myelomeningo-Cele-Randomized, Blind, Clinical Trial.

peer reviewed[en] BACKGROUND: This study aimed to evaluate the electrical activity of the rectus femoris, tibialis anterior, and lateral gastrocnemius muscles during the sit-to-stand task and functional mobility after a neurofunctional physiotherapy protocol associated with PBM. METHODS: Twenty-five children were randomly allocated to either Active PBM + physiotherapy (n = 13) or PBM sham + physiotherapy (n = 12). PBM was carried out with a LED device (850 nm, 25 J, 50 s per point and 200 mW) at four points over the area with absence of a spiny process. Both groups completed a twelve-week supervised program with two weekly 45-60 min sessions. Pre-training and post-training assessments involved the Pediatric Evaluation of Disability Inventory (PEDI). Muscle activity was assessed using portable electromyography (BTS Engineering) and the electrodes were positioned on the lateral gastrocnemius, anterior tibialis, and rectus femoris muscles. The RMS data were recorded and analyzed. RESULTS: After 24 sessions of the treatment protocol, improvements were found in the PEDI score. The participants presented greater independence in performing the tasks, requiring less assistance from their caregivers. More significant electrical activity was found in the three muscles evaluated between the rest period and execution of the sit-to-stand tasks, both in the more compromised or less compromised lower limbs. CONCLUSION: Neurofunctional physiotherapy with or without PBM improved functional mobility and electrical muscle activity in children with myelomeningocele

Low-Level Laser Therapy in Chronic Autoimmune Thyroiditis: A Pilot Study

Background and Objectives: Chronic autoimmune thyroiditis (CAT) remains the most common cause of acquired hypothyroidism There is currently no therapy that is capable of regenerating CAT-damaged thyroid tissue The objective of this study was to gauge the value of applying low-level laser therapy (LLLT) in CAT patients based on both ultrasound studies (USs) and evaluations of thyroid function and thyroid autoantibodies. Study Design/Materials and Methods: Fifteen patients who had hypothyroidism caused by CAT and were undergoing levothyroxine (LT4) treatment were selected to participate in the study Patients received 10 applications of LLLT (830 nm, output power 50 mW) in continuous mode, twice a week, using either the punctual technique (8 patients) or the sweep technique (7 patients), with fluence in the range of 38-108 J/cm(2) USs were performed prior to and 30 days after LLLT USs included a quantitative analysis of echogenicity through a gray-scale computerized histogram index (El). Following the second ultrasound (30 days after LLLT), LT4 was discontinued in all patients and, if required, reintroduced Truodothyronine, thyroxine (T4), free T4, thyrotropin, thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) antibodies levels were assessed before LLLT and then 1, 2, 3, 6, and 9 months after LT4 withdrawal. Results: We noted all patients` reduced LT4 dosage needs, including 7 (47%) who did not require any LT4 through the 9-month follow-up The LT4 dosage used pre-LLLT (96 +/- 22 mu g/day) decreased in the 9th month of follow-up (38 23 mu g/day; P<0.0001) TPOAb levels also decreased (pre-LLLT = 982 +/- 530 U/ml, post-LLLT = 579 454 U/ml, P = 0 016) TgAb levels were not reduced, though we did observe a post-LLLT increase in the EI (pre-LLLT = 0 99 +/- 0.09, post-LLLT= 1.21 +/- 0.19, P=0.001) Conclusion: The preliminary results indicate that LLLT promotes the improvement of thyroid function, as patients experienced a decreased need for LT4, a reduction in TPOAb levels, and an increase in parenchymal echogenicity Lasers Surg. Med. 42:589-596, 2010. (C) 2010 Wiley-Liss, IncFundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq)Coordenacao de Aperfercoamento de Pessoal de Nivel Superior (CAPES

Safety and Efficacy of Low-Level Laser Therapy in Autoimmune Thyroiditis: Long-Term Follow-Up Study

Introduction. A randomized clinical trial (RCT) was performed to evaluate the efficacy of low-level laser therapy (LLLT) for hypothyroidism induced by chronic autoimmune thyroiditis (CAT). Objective. The objective was to assess the safety and actions of LLLT 6 years after completion of the RCT. Materials and Methods. Forty-three participants were invited to participate in this study 6 years after completion of the RCT. Twenty-five were subjected to LLLT (group L), and 18 were subjected to placebo (group P). Primary outcome measure: frequency of thyroid nodules, which were subjected to fine-needle aspiration biopsy. Secondary outcome measures: dose of levothyroxine required to treat hypothyroidism, thyroid peroxidase antibodies (anti-TPO), and anti-thyroglobulin antibodies (anti-Tg). Results. In group L, a nodule was observed in three patients, who all had a Bethesda II classification. In group P, a nodule was also observed in three patients, with two classified as Bethesda II and one as Bethesda III. The levothyroxine dose required by group L was significantly lower than that required by group P (P=0.002). The anti-TPO and anti-Tg levels did not differ between the groups. Conclusion. LLLT, by the methods described, has been shown to be safe for the treatment of hypothyroidism resulting from CAT. This trial is registered with ClinicalTrials.gov Identifier: NCT02240563