Multinucleate Cell Angiohistiocytoma: A Case Report and Unique Treatment Consideration

Introduction: Multinucleate cell angiohistiocytoma (MCAH) is a benign, yet exceedingly rare vascular and firbiohistiocytic proliferation. The lesions are typically asymptomatic and are commonly cosmetically displeasing to patients. 1 Previous reports have demonstrated success in treating MCAH with fractional ablative CO2 laser, argon laser, pulsed dye laser, and KTP lasers. 3 The scarcity of reported cases may suggest that the lesion is commonly misdiagnosed, and we report this case to highlight the characteristic features of MCAH with successful treatment with Neodymium YAG laser. Case Presentation: A 64-year- old female presented to our clinic with a 1- month history of multiple erythematous to violaceous lesions on her bilateral hands. The lesions were asymptomatic, but cosmetically displeasing for the patient. Past medical history and family history was noncontributory. Examination revealed several 2-6 mm well- circumscribed, erythematous, indurated smooth papules on the bilateral dorsal and in the second web space of the left hand. Shave biopsy of the lesions were consistent with MCAH. She was initially treated with topical steroids twice daily for 2 weeks, with no improvement. The patient received 3 treatments with Neodymium YAG, 4 weeks apart. This treatment was discontinued after 3 sessions due to the dramatic visible improvements in regards to induration and discoloration of the lesions. Discussion: MCAH is an extremely uncommon lesion, diagnosis is made on the basis of clinical examination, histopathologic and immunohistochemical analysis of the lesions. This case illustrates diagnosis and successful treatment of MCAH with Neodymium YAG and offers a unique treatment consideration for patients.

The first experience of tracheal recanalization by tumor resection with Nd-YAG-laser

Actuality. Tracheal cancer is a rare disease which amounts up to 0.2% of the total number of cancers. Currently, there is an increase in the number of patients with impaired tracheal patency. Endoscopic procedures are most commonly used to restore and maintain the tracheal lumen. The key treatment for primary cancer is a surgical one; however, due to late diagnostics, the tumor is often inoperable. Chemotherapy for tracheal cancer is ineffective, and practically is not used. At present, endoscopic tracheal recanalization with laser vaporization is a method of choice in patients with inoperable tracheal tumors.Objective: to improve outcomes in patients with inoperable primary tracheal cancer using Nd-YAG laser either as the fi rst component of staged treatment strategy, or as the fi nal volume treatment.Methods. Patient K., 75 years old, was admitted to the hospital with complaints of dyspnea at rest, weakness and hemoptysis. As anamnesis showed, the patient had noticed a deterioration in her breathing during the last 6 months. CT scan revealed a volumetric formation (tumor) of the cervicothoracic trachea (8.0 cm above the bifurcation) with 90% stenosing in the lumen. When performing tracheobronchoscopy in the cervicothoracic trachea, a broad-based lumpy tumor, 5 cm long, stenosing the tracheal lumen by 2/3 was found on the posterior wall. Morphological examination of biopsy material revealed adenocystic carcinoma.Results. The performed endoscopic examination with neodymium YAG laser recanalization demonstrated the advantage of this technique in patients with inoperable tracheal tumors.Conclusion. Endoscopic recanalization of the trachea with neodymium YAG laser has been proven to be effective in patients with inoperable tracheal cancer. It improves their quality of life as well.

Effect of Anterior Capsule Polishing on the Rate of Neodymium: YAG Laser Capsulotomy in Multifocal Intraocular Lens

Purpose Herein, we elucidated the effect of anterior capsule polishing (ACP) during cataract surgery on the rate of neodymium: YAG (Nd: YAG) laser capsulotomy in multifocal intraocular lens (MIOL). Methods We extracted the medical records of patients who underwent phacoemulsification with MIOL between May 2016 and April 2017 from the files of the patients, and the follow-ups of fewer than 3 years were excluded. The participants were divided into the ACP group and the non- ACP group based on whether the anterior capsule was polished. The primary outcome was whether to perform Nd: YAG capsulotomy during the follow-up. We analyzed the time from IOL implantation to Nd: YAG laser capsulotomy using the Kaplan-Meier survival curves. Results The ACP group comprised 70 eyes and non-ACP group, 60 eyes. One year postoperatively, 7.14% of the eyes in the ACP group and 8.33% in the non-ACP group required Nd: YAG laser capsulotomy (P > 0.99). After 2 years, it was 24.29% and 18.33%, respectively (P = 0.52). After 3 years, it was 30.0% and 28.33% respectively (P = 0.85). There was no distinct difference in the probability for Nd: YAG laser between the ACP group and the non-ACP group evaluated using Kaplan-Meier survival curves (P = 0.81). Patients with implantation of diffractive MIOL (AT LISA tri 839MP) had a high probability of requiring Nd: YAG laser capsulotomy. Conclusion Polishing the anterior capsule had no remarkable effect on reducing the rate of Nd: YAG laser capsulotomy after phacoemulsification in MIOL.

Comparative study between the efficacy of long-pulsed Neodymium- YAG laser and Fractional CO2 laser in the treatment of striae distensae

Background: Striae Distansae (SD) are a disfiguring dermal lesion, characterized by lines of dermal atrophy, occurring at sites of dermal damage caused by stretching. They affect adolescents and more than 70% of pregnant females due to stretching of the skin.Objectives: To assess and to compare the effect of 1, 064 nm Long Pulsed (LP) Nd: YAG laser and Fractional CO2 laser clinically and histologically in treating SD.Materials/Methods: Thirty female patients with bilateral symmetrical SD were treated with Fractional CO2 laser on one side and long-pulsed Nd: YAG laser on the other side. All patients treated with 3 laser sessions at 3 weeks interval. Global Aesthetic improvement scale (GAIS) and the score of patient satisfaction were used to evaluate improvement 3 months post treatment. Four mm punch biopsies were taken from each side before treatment and 3 months after the last session to measure epidermal and collagen thickness.Results: More significant clinical improvement was noted with the Nd:YAG laser than Fractional CO2 laser. Both GAIS and satisfaction score were significantly higher in the Nd:YAG laser treated side epidermal and collagen thickness were evidently increased in the lesions treatd by Nd: YAG laser than those treated by Fractional CO2 laser with no significant difference.Conclusions: Long pulsed Nd-YAG laser is clinically more effective than the Fractional CO2 laser in treating SD without serious adverse effects, although there was no significant difference between them histopathologically.

Frequency of Raised Intraocular Pressure and its Correlations to the energy used following Neodymium YAG Laser Posterior Capsulotomy in Pseudophakes

Objective: To determine the frequency of raised intraocular pressure in pseudophakic undergoing Nd YAG laser posterior capsulotomy. To compare the frequency of raised intraocular pressure in pseudophakic undergoing high and low energy Nd YAG laser posterior capsulotomy Methods: This Descriptive case series included 140 patients with pseudophakic posterior capsular opacity. After dilating the pupils with tropicamide Nd YAG laser posterior capsulotomy was performed and the total amount of energy used was noted. The frequency of raised IOP in post-laser patients and comparison of frequencies of raised IOP undergoing high and low energy Nd YAG laser posterior capsulotomies (≤ 50 MJ labeled as low energy and > 50 MJ labeled as high energy) were calculated Results: The mean age was 57.37 ±8.74. Mean pre laser IOP was 15.15 and post-laser IOP was 17.50. The rise in IOP was normal in 82.9% and raised in 17.1%. In lower energy group normal IOP was found in 35.7% and raised in 2.9%. In a higher energy group, normal IOP was found in 47.1%, and raised IOP was found to be 14.3%. Conclusion: Higher the energy used during the Nd YAG laser posterior capsulotomy procedure, more is the chance of a rise in post-laser intraocular pressure as compared to those in which lesser energy was being used.