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Port wine stains correspond to cutaneous congenital capillary dysplasias and are undergoing broad clinical appearances as far as size, colour, and anatomical areas are concerned together with several possible associations to other vascular pathology. Laser treatment started by the end of the 70's with, at that time moderate scientific production, followed by a very "explosive" period till mid 90's, leading to a progressive decrease till today. Therefore, everything has been reported several times and, in some occasions with some kind of artlessness and/or without follow-up. Author will try in this paper to report a 25 years experience, with as much objectivity as possible.

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In order to set up a disinfection protocol, the tip of the optical fibre of an Nd-YAP laser, λ=1.34 µm, was contaminated in vitro with: Mycobacterium smegmatis (CIP 7326), Candida albicans (ATCC 2091), Bacillus stearothermophilus (ATCC 7953) or Streptococcus sanguis (ATCC 10556). It was then treated with various biocidal solutions, Septinol(®) V, glutaraldehyde 2%, ethanol 95° and NaOCl 6%, using one of two protocols: 10 s of contact, or 5 s of contact followed by 5 s of wiping. The latter technique proved to be the most effective. Whatever the biocidal solution used, all the bacteria adhering to the fibre were eliminated. The protocol was checked in vivo in the canals of 10 teeth presenting root canal infections. No bacteria withstood the treatment with Septinol(®) V. This treatment does not alter the qualities and performance of the fibre as far as light transmission is concerned.

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Chronic hypertrophic rhinitis is sometimes refractory to local, as well as general, medical treatment. Before undertaking surgical reduction of the inferior turbinates, there is indisputably a place for cauterization or laser vaporization of the inferior turbinate mucosa. The authors present a study of 46 patients treated by the holmium:YAG laser for chronic hypertrophic rhinitis. The results after only one laser session are satisfactory in 89.1% at 6 months' follow-up and in 52.2% with mean follow-up of 16.2 months. No major secondary effects were observed.

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The authors report their experience in the treatment of portwine stains by means of two recent improvements. The first improvement concerns the use of frequency doubled Nd-YAG laser which emits at 532 nanometres. This wave-length corresponds to an absorption peak of haemoglobin and is therefore more selectively absorbed by haemangiomatous tissue. This helps to explain the better clinical results obtained and the elimination of the other effects classically induced by argon laser, with complete preservation of the healthy, non-angiomatous skin as well as skin and scalp hair. Treatment is consequently facilitated, as illustrated by a series of 79 patients who received a total of 92 treatment sessions over a period of 14 months. The second improvement consists of the addition of an automat which allows the beam to be used continuously with scanning of adjacent bands. This automat not only allows a very homogeneous treatment by eliminating all of the errors associated with manual scanning, but can also be used to treat large portwine stains in a single session instead of the multiple sessions required previously. An interval of 5 to 6 months should be respected before treating the residual part of the portwine stain situated more deeply in the dermis, which should be considered to be a new portwine stain. The combination of these two apparatuses allows fluences (fluence is the product of the power selected by the exposure time per unit area) of only 8 to 15 joules/cm2 due to the dynamics of the treatment in contrast with other static modalities which require higher fluences.(ABSTRACT TRUNCATED AT 250 WORDS)

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The authors report a study of 60 years of French Jurisprudence in relation to the medical contract in cosmetic surgery. Although the obligation can only be in the form of means in the case of surgery of living tissues, a special obligation nevertheless applies when the operation is not performed as a therapeutic procedure but at the patient's wishes. It is an obligation of caution and diligence, respecting the role of proportionality in the indications and the means applied to obtain the desired objective and the safety of the patient. The application of these means will be judged by the magistrate more severely than in therapeutic surgery. A certain degree of laxity in the investigation of a causal relationship in civil law has led to the use of the concept of decreased chance of survival for the compensation of victims of serious complications occurring during cosmetic surgical operations.

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The authors present their experience of the use of carbon dioxide laser for the treatment of angiodysplasias (so-called "cavernous" angiomas). The reduction of operative haemorrhage and the simpler postoperative course resulting from the intraoperative and postoperative use of this technique have ensured very satisfactory results in a series of 76 patients. The limitations of the technique are defined. The authors also discuss the complex classification of "cavernous angiomas" and propose a synthetic clinical approach by combining the embryological, histological, evolutive and radiographic features of these lesions.

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The authors report a case of cutaneous pathomimesis of the hand with severe self-mutilation, contrasting with the minimal nature of the psychiatric illness. They recall several pathogenic and therapeutic elements for this disease which, although difficult, should be managed by a multidisciplinary approach.

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The authors report their experience of the use of the CO2 laser in oral pathology, based on 109 patients treated in 136 sessions. The indications of this type of therapy are reviewed and details of the technic and results are given. The CO2 laser is specially useful in cases of dysplasia and cavernous hemangiomas; it guarantees the quality of the intervention, and avoids post-operative discomfort for the patients. Future prospects of this method are promising.

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The technique of argon laser treatment of port wine hemangiomas has been greatly improved since first used in the medical field. Complications may however occur and the authors report in this paper their experience and special studies performed on hyperpigmentation. This complication is due to an increase in melanic normal production as it has been proved by optical and electron microscope studies on pigmented skin biopsies.

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Using carbon dioxide laser, the authors proved the existence of a new type of wart, localized under the heel. Its considerable extension between the dermis and epidermis, far from the visible excrescence, may explain the absence of positive response to classical treatment in some cases.

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We describe our experience and the problems we encountered organizing an autonomous surgical unit in which the equipment and organization enable three lasers to be used in may different applications in medicine and surgery. The three lasers--CO2, Nd:YAG, and argon--may now be used by all the departments concerned within our teaching hospital. As our unit goes into operation, we have determined that we must now begin an evaluation 1) To assess the clinical value of laser usage via the careful selection of cases for laser treatment, the storage of data for future reference on card and computer records, and the assessment of the vital role of the laser within a range of modern therapeutic aids; 2) to achieve technical improvements, by the optimum use of laser sources and related optical equipment; and 3) to assess the economics of the unit, the profitability of bringing together the three types of laser, and the total cost involved.

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