Objective Medically refractory angina remains a significant health concern despite major advances in revascularization techniques and emerging medical therapies. We aimed to determine the safety and efficacy of extracorporeal shockwave myocardial therapy (ESMT) in managing angina pectoris. Methods A single-arm multicenter prospective study was designed aiming to determine the safety and efficacy of ESMT. Patients of functional Canadian Cardiovascular Society class 11–IV, despite stable and optimal medical management, with documented myocardial segments with reversible ischemia and/or hibernation on the basis of echocardiography/single-photon emission computerized tomography (SPECT) were enrolled from 2010 to 2012. A total of 111 patients were enrolled, 33 from Indonesia, 21 from Malaysia, and 57 from Philippines. Patients underwent nine cycles of ESMT over 9 weeks. Patients were followed up for 3–6 months after ESMT treatment. During follow-up, patients were subjected to clinical evaluation, the Seattle Angina Questionnaire, assessment of nitrate intake, the 6-min walk test, echocardiography, and SPECT. Results The mean age of the population was 62.9 ± 10.9 years. The summed difference score on pharmacologically induced stress SPECT improved from 9.53 ± 17.87 at baseline to 7.77 ± 11.83 at follow-up (P = 0.0086). Improvement in the total Seattle Angina Questionnaire score was seen in 83% of patients (P < 0.0001). Sublingual nitroglycerin use significantly decreased (1.14 ± 1.01 tablets per week at baseline to 0.52 ± 0.68 tablets per week at follow-up; P = 0.0215). There were no changes in left ventricular function on echocardiography (0.33 ± 9.97, P= 0.93). The Canadian Cardiovascular Society score improved in 74.1% of patients. Conclusion This multicenter prospective trial demonstrated that ESMT is both a safe and an efficacious means of managing medically refractory angina.
Background Pneumatic‐assisted high velocity jet injections are an alternative method for intradermal delivery of hyaluronic acid (HA) and demonstrated efficacy in dermal thickening and scar remodeling with minimal side effects. Aims We aimed to investigate the clinical efficacy comparing non‐crosslinked HA (NCL‐HA) and crosslinked HA (CL‐HA) for aesthetic skin concerns. Methods We retrospectively analyzed charts of 115 patients treated with jet injected NCL‐HA and CL‐HA for skin rejuvenation, age‐related laxity and rhytidosis, hypertrophic and acne scars and striae. Global Aesthetic Improvement Scale (GAIS) and the 5‐grade patient satisfaction scale were used for assessment of the treatment efficacy at the 3‐month follow‐up. Efficacy was separately analyzed between patients receiving NCL‐HA vs. CL‐HA. Longevity of treatment effect was measured by the time to voluntary return for repeat treatment. Results An average of 2.8 treatments was completed per patient with a low incidence of side effects including bruises (7%) and temporary local edema (1%). Patients were highly‐satisfied with the treatment results in all categories with the average satisfaction scores of 3.68 (NCL‐HA) and 3.76 (CL‐HA). An average GAIS score of 1.7 (“much improved”) was calculated for neck, décolleté and perioral areas. An overall GAIS score averaged as 1.78 (NCL‐HA) and 1.6 (CL‐HA). Longevity of the effect averaged 13.1 months for NCL‐HA and 13.2 months for CL‐HA groups. Conclusion Our retrospective data showed similar significant improvement of all aesthetic skin concerns in 115 subjects treated with either NCL‐HA or CL‐HA delivered intradermally by a high velocity jet‐injector device with minimal downtime, pain or side‐effects.
BackgroundKinetic energy of a liquid jet has been demonstrated to achieve clinical efficacy by injecting hyaluronic acid for skin thickening and improving facial sagging. A pneumatically accelerated jet penetrates the epidermis leaving HA particles spherically spread in the dermis and initiating microtraumatic wound healing.MethodWe reported retrospective analysis of our successful experience in improving rhytidosis and skin remodeling in the middle and lower facial regions by pneumatically administered HA filler. Subjects seeking correction of facial wrinkles in middle and lower face were treated in 3 monthly sessions with computerized jet‐injection device and assessed 6 months thereafter for perception of the wrinkles, rhytidosis burden, and treatment satisfaction.ResultsThirty‐four female patients (average age 42 years) with age‐related rhytidosis in perioral, cheek, and neck areas received the treatment. The treatments had short downtime, minimal pain, and no side effects. Mean Lemperle Rating Scale score decreased in all treated areas by one full degree and was maintained for 6 months after the treatments. Patients and investigators independently scored the wrinkles as “improved” per Global Aesthetic Improvement Scale. Mean treatment satisfactory score was 4.0 ± 1.4 (out of 5).ConclusionRetrospective data showed successful implementation of liquid jet injections of HA in correction of aging middle and lower facial regions.
Background Needle‐free jet injection implements kinetic energy of liquid jet for transcutaneous delivery of drugs into soft tissues. Combination therapy of intralesional 5‐fluorouracil and triamcinolone offers efficacious treatment for keloids with a reduced adverse effect of the drug monotherapy. This study evaluates safety and efficacy of the drug combination administered to keloid scars via intralesional jet injections. Methods A retrospective analysis of the keloid treatments was performed. Efficacy was assessed by reviewing pre‐ and post‐treatment scores of the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and by comparing baseline and photographs taken 3 months after the treatments. Safety and tolerability were collected and analyzed. Results Twenty‐one subjects (M/F = 11/10) with 39 keloids received the treatments. Treatments were well‐tolerated by all patients at mean injection pain of 2.0 ± 1.0 per Numeric Pain Rating Scale (NPRS). Self‐resolved lesion ulceration was observed in 4 patients. Post‐treatment evaluation demonstrated a 53% decrease in total VSS score (P < 0.05) and in all sub‐categories. Mean patient score of POSAS decreased in the color, stiffness, thickness, and irregularity components. Pain and pruritus lessened by 69% and 79% (P < 0.05 in both), respectively, among the patients with complaints prior to the treatment. Independent reviewers reported an average 51%‐75% reduction in keloids. Conclusions Improved appearance of keloids and symptomatic relief was achieved by intralesional administration of combined 5‐fluorouracil and corticosteroid through the high‐pressure jet injections. The synergy between the drug combination and the jet physical impact provided clinical effect.
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