The Adverse Effects of Topical Photodynamic Therapy:a consensus review and approach to management

Background: Topical photodynamic therapy (PDT) is widely used to treat superficial nonmelanoma skin cancer and dysplasia, and is generally well tolerated. However, as with all treatments, adverse effects may occur and awareness may facilitate approaches to prevention and management. Objectives: To review the available evidence relating to the adverse effects of topical PDT, to help inform recommendations in updated clinical guidelines produced by the British Association of Dermatologists and British Photodermatology Group, and the efficacy of preventative and therapeutic approaches.Methods: This review summarizes the published evidence related to the adverse effects of topical PDT and attempts to interpret this evidence in the context of patient risk and management.Results: Pain and discomfort during PDT are acute adverse effects, which can be minimized through the use of modified and low-irradiance PDT regimens and do not therefore usually limit successful treatment delivery. Other adverse effects include the risk of contact allergy to photosensitizer prodrugs, although this is rare but should be kept in mind, particularly for patients who have received multiple PDT treatments to larger areas. There are no other significant documented longer-term risks and, to date, no evidence of cumulative toxicity or photocarcinogenic risk.Conclusions: Topical PDT is usually well tolerated, reinforcing the utility of this important therapeutic option in dermatology practice. The main acute adverse effect of pain can typically be minimized through preventative approaches of modified PDT regimens. Other adverse effects are uncommon and generally do not limit treatment delivery.</p

Simulation of the mechanical interlocking capacity of a rough bone implant surface during healing

Background: When an implant is inserted in the bone the healing process starts to osseointegrate the implant by creating new bone that interlocks with the implant. Biomechanical interlocking capacity is commonly evaluated in in vivo experiments. It would be beneficial to find a numerical method to evaluate the interlocking capacity of different surface structures with bone. In the present study, the theoretical interlocking capacity of three different surfaces after different healing times was evaluated by the means of explicit finite element analysis. Methods: The surface topographies of the three surfaces were measured with interferometry and were used to construct a 3D bone-implant model. The implant was subjected to a displacement until failure of the bone-to-implant interface and the maximum force represents the interlocking capacity. Results: The simulated ratios (test/control) seem to agree with the in vivo ratios of Halldin et al. for longer healing times. However the absolute removal torque values are underestimated and do not reach the biomechanical performance found in the study by Halldin et al. which might be a result of unknown mechanical properties of the interface. Conclusion: Finite element analysis is a promising method that might be used prior to an in vivo study to compare the load bearing capacity of the bone-to-implant interface of two surface topographies at longer healing times

Three-dimensional radiological classification of lumbar disc herniation in relation to surgical outcome

Centrally located lumbar disc herniations have been reported to be of predictive value for poor post-operative clinical outcome. One hundred and fifty patients undergoing lumbar disc herniation surgery were prospectively included. Herniation-related parameters, including the grading of contours, were assessed from pre-operative computed tomography (CT) and magnetic resonance imaging (MRI) images using a new three-dimensional grading system. The radiological findings were compared with outcome parameters two years post-operatively (patient-assessed pain, function/health scores and evaluation by an independent observer). An intra- and inter-observer validation of the classification was performed in a subgroup of patients. High intra-observer and good inter-observer reliability for both CT and MRI was seen. In the study population, no relation between the distribution or size of the herniations and outcome at 2-year follow-up were found. The distribution and size of the lumbar disc herniations with the three-dimensional classification were not found to be of importance for the clinical outcome

Clinical factors of importance for outcome after lumbar disc herniation surgery: long-term follow-up

Factors as age, sex, smoking, duration of leg pain, working status, type/level of disc herniation and psychosocial factors have been demonstrated to be of importance for short-term results after lumbar discectomy. There are few studies with long-term follow-up. In this prospective study of lumbar disc herniation patients undergoing surgery, the result was evaluated at 2 and 5–10 (mean 7.3) years after surgery. Predictive factors for satisfaction with treatment and objective outcome were investigated. Out of the included 171 patients undergoing lumbar discectomy, 154 (90%) patients completed the 2-year follow-up and 140 (81%) completed the long-term follow-up. Baseline data and questionnaires about leg- and back pain intensity (VAS), duration of leg pain, disability (Oswestry Disability Index), depression (Zung Depression Scale), sick leave and employment status were obtained preoperatively, at 2-year- and long-term follow-up. Primary outcome included patient satisfaction with treatment (at both time points) and assessment of an independent observer at the 2-year follow-up. Secondary outcomes at 2-year follow-up were improvement of leg and back pain, working capacity and the need for analgesics or sleeping pills. In about 70% of the patients excellent or good overall result was reported at both follow-ups, with subjective outcome measurements. The objective evaluation after 2 years was in agreement with this result. Time on sick leave was found to be a clinically important predictor of the primary outcomes, with a potential of changing the probability of a satisfactory outcome (both objective and subjective) from around 50% (sick leave >3 months) to 80% (sick leave <2 months). Time on sick leave was also an important predictor for several of the secondary outcomes; e.g. working capacity and the need for analgesics