Transdermal monosialoganglioside with laser in the treatment of spinal cord lesion in rats

OBJECTIVES:

To evaluate the effects of monosialoganglioside (GM1) administered transdermally with laser in the recovery of spinal cord injury in rats.

METHODS:

Forty male Wistar rats underwent spinal cord contusion using the NYU Impactor. In Group 1, the rats received 0,2 ml of saline intraperitoneally daily; in Group 2, GM1 was administered intraperitoneally at a concentration of 30 mg/kg per day; in Group 3, rats were treated daily with laser at low temperature on the skin, and in Group 4, the daily laser session also contained GM1. All the groups were treated for 42 days. The animals were evaluated by the Basso, Baettie and Bresnahan (BBB) functional scale on days 7, 14, 21, 28, 35 and 42 after the injury, and by histopathology and motor evoked potential after 42 days of injury.

RESULTS:

The animals in Group 4 had higher BBB scores compared with the other groups. There were no differences between the groups, or in the comparisons over time. Histological evaluation showed no differences, and no differences were found in the motor evoked potential tests either.

CONCLUSION:

GM1 associated with the use of low-temperature laser shows no superior functional, neurological or histological results in the treatment of spinal cord lesions in rats. Evidence Level I, Experimental, Controlled, Animal Study.

Periodontal Bone Regeneration and the Er,Cr:YSGG Laser: A Case Report

BACKGROUND

Traditional methods of regenerating bone in periodontal bone defects have been partially successful and have involved numerous protocols and materials. More recently, it has been proposed that Er,Cr:YSGG laser energy may also be beneficial in the treatment of periodontal pockets, particularly in the regeneration of bone lost due to periodontal disease.

CASE DESCRIPTION

The purpose of this paper is to present a case report of the Er,Cr:YSGG laser being used to conservatively treat a recalcitrant periodontal pocket in the presence of a periodontal bone defect and that resulted in successful resolution of the pocket and significant radiographic bone fill at the 1 year recall visit.

CLINICAL IMPLICATIONS

This protocol using the Er,Cr:YSGG laser for the treatment of periodontal loss of attachment and periodontal bone loss may represent a less invasive alternative than traditional open-flap periodontal surgery or the intrasulcular use of other more penetrating laser wavelengths.

Effect of photoselective vaporization prostatectomy on lower urinary tract symptoms in benign prostatic hyperplasia with or without intravesical prostatic protrusion

PURPOSE

Intravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP.

MATERIALS AND METHODS

This prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6.

RESULTS

The patients' mean age was 66.6±7.8 years. Mean serum PSA and prostate volume were 1.7±1.5 ng/mL and 42.9±16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2±1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group.

CONCLUSIONS

Among patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.

Mechanisms of Laser-Tissue Interaction: II. Tissue Thermal Properties

Laser-tissue interaction is of great interest due to its significant application in biomedical optics in both diagnostic and treatment purposes. Major aspects of the laser-tissue interaction which has to be considered in biomedical studies are the thermal properties of the tissue and the thermal changes caused by the interaction of light and tissue. In this review paper the effects of light on the tissue at different temperatures are discussed. Then, due to the noticeable importance of studying the heat transfer quantitatively, the equations governing this phenomenon are presented. Finally a method of medical diagnosis called thermography and some of its applications are explained.

Holmium laser enucleation of the prostate: modified morcellation technique and results

PURPOSE

We developed an inverse technique for tissue morcellation by modifying the conventional upward technique and then examined its safety and efficiency.

MATERIALS AND METHODS

From July 2008 to December 2010, a total of 389 consecutive patients treated with holmium laser enucleation of the prostate (HoLEP) were enrolled in this study. For tissue morcellation, we used an upward technique for an initial series of 84 patients and an inverse technique for a consecutive series of 305 patients. We compared efficiency and safety between the inverse technique and the upward technique.

RESULTS

There were no significant differences in mean age or prostate volume between the two groups. The mean morcellation efficiency was higher in the inverse technique group. The incidence of severe bladder injury was significantly higher in the upward technique group. Regarding the site of bladder injury, 7 and 4 cases of bladder injury occurred in the bladder dome and posterior wall, respectively, in the upward technique group. In the inverse technique group, however, the site of bladder injury was limited to the trigone. We divided our clinical series of patients into the upward technique group and three inverse technique groups on the basis of the timing. The mean morcellation efficiency was significantly higher in all three inverse technique groups than in the upward technique group. However, there was no significant difference in mean morcellation efficiency between the three inverse technique groups.

CONCLUSIONS

In conclusion, the inverse technique might be a more effective, safer, and more excellent method of morcellation than the conventional upward technique.

Efficacy of holmium laser urethrotomy in combination with intralesional triamcinolone in the treatment of anterior urethral stricture

Purpose

To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection.

Materials and Methods

Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months.

Results

The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture.

Conclusions

Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length.

Treatment of Axillary Osmidrosis Using a Subcutaneous Pulsed Nd-YAG Laser

Background

Axillary osmidrosis is characterized by an unpleasant odor, profuse sweating, and in some instances, staining of clothes that may socially and psychologically impair affected individuals. Various types of surgical procedures have been developed for the treatment of axillary osmidrosis. This study was undertaken to evaluate the effectiveness of subcutaneous pulsed neodymium: yttrium-aluminum-garnet (Nd-YAG) laser treatment for the treatment of axillary osmidrosis.

Methods

Twenty-nine patients with axillary osmidrosis were included in this study. Patients were categorized according to the results of an axillary malodor grading system, and a subcutaneous pulsed Nd-YAG laser was applied to all patients. The treatment area for the appropriate distribution of laser energy was determined using the iodine starch test (Minor's test) against a grid pattern composed of 2×2 cm squares. The endpoint of exposure was 300 to 500 J for each grid, depending on the preoperative evaluation results. The results were evaluated by measurement of axillary malodor both pre- and postoperatively using the grading system and iodine starch test.

Results

The average follow-up period was 12.8 months. Nineteen patients had a fair-to-good result and ten patients had poor results. The postoperative Minor's test demonstrated that there were remarkable improvements for patients with mild to moderate symptoms. Complications including superficial second degree burns (n=3) were treated in a conservative manner. A deep second degree burn (n=1) was treated by a surgical procedure.

Conclusions

Subcutaneous pulsed Nd-YAG laser has many advantages and is an effective noninvasive treatment for mild to moderate axillary osmidrosis.

Serial Changes in Sexual Function Following Holmium Laser Enucleation of the Prostate: A Short-term Follow-up Study

Purpose

To evaluate the serial changes in sexual function in the short-term period after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia (BPH) and to investigate whether a change in each domain of the International Index of Erectile Function (IIEF) is associated with improvement of micturition.

Materials and Methods

Thirty-eight potent men who underwent HoLEP and in whom complete 12-month follow-up data on the IIEF were available were included in this retrospective study. All patients underwent a baseline evaluation for BPH. The surgical outcome was evaluated at 1, 3, 6, and 12 months postoperatively by use of the International Prostate Symptom Score, IIEF, and uroflowmetry.

Results

The mean age and body mass index of the patients was 64.5±6.2 years and 24.2±2.6 kg/m², respectively. Mean total prostate volume and transitional zone volume were 48.8±18.8 ml and 24.2±16.1 ml, respectively. Most IIEF domain scores showed a slight decrease at 1, 3, and 6 months after surgery but recovered to the baseline or showed a marginal but nonsignificant increase at 12 months postoperatively compared with baseline. Orgasmic function and the overall sexual satisfaction domain score remained slightly reduced up to 12 months postoperatively. There was no significant correlation between improvement of micturition and change in sexual function throughout the follow-up period after surgery.

Conclusions

Although HoLEP achieves significant improvements in micturition, overall sexual function decreases slightly in the early postoperative period, but recovers to the baseline at 12 months postoperatively. Our data suggest that changes in sexual function after HoLEP are not associated with improvement of micturition.

Initial Experiences with a 980 nm Diode Laser for Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia

Purpose

This study was conducted to analyze the efficacy of photoselective vaporization of the prostate (PVP) with the use of a 980 nm diode laser for benign prostatic hyperplasia (BPH) according to postoperative period.

Materials and Methods

Data were collected from 96 patients who were diagnosed with BPH and who underwent PVP with the 980 nm K2 diode laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual volume (PVR), were assessed and compared with preoperative baseline values.

Results

The mean prostate volume was 45.3±15.6 g, the mean operative time (lasing time) was 22.9±18.3 minutes, the total amount of energy was 126±84 kJ, and the Foley catheter maintenance period after PVP was 24.8±5.6 hours. At 1 month, significant improvements were noted in IPSS (11.7±6.6), QoL score (2.3±1.1), Qmax (12.7±6.1 ml/sec), and PVR (41.9±30.5 ml). After 3 months, all follow-up parameters showed significant improvements that were sustained throughout a period of 6 months after PVP.

Conclusions

PVP using a K2 diode laser is a minimally invasive and effective surgical method for improvement of BPH and is associated with minimal morbidity.

The effect of erbium-doped: yttrium, aluminium and garnet laser irradiation on the surface microstructure and roughness of double acid-etched implants

Purpose

One of the most frequent complications related to dental implants is peri-implantitis, and the characteristics of implant surfaces are closely related to the progression and resolution of inflammation. Therefore, a technical modality that can effectively detoxify the implant surface without modification to the surface is needed. The purpose of this study was to evaluate the effect of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser irradiation on the microstructural changes in double acid-etched implant surfaces according to the laser energy and the application duration.

Methods

The implant surface was irradiated using an Er:YAG laser with different application energy levels (100 mJ/pulse, 140 mJ/pulse, and 180 mJ/pulse) and time periods (1 minute, 1.5 minutes, and 2 minutes). We then examined the change in surface roughness value and microstructure.

Results

In a scanning electron microscopy evaluation, the double acid-etched implant surface was not altered by Er:YAG laser irradiation under the condition of 100 mJ/pulse at 10 Hz for any of the irradiation times. However, we investigated the reduced sharpness of the specific ridge microstructure that resulted under the 140 mJ/pulse and 180 mJ/pulse conditions. The reduction in sharpness became more severe as laser energy and application duration increased. In the roughness measurement, the double acid-etched implants showed a low roughness value on the valley area before the laser irradiation. Under all experimental conditions, Er:YAG laser irradiation led to a minor decrease in surface roughness, which was not statistically significant.

Conclusions

The recommended application settings for Er:YAG laser irradiation on double acid-etched implant surface is less than a 100 mJ/pulse at 10 Hz, and for less than two minutes in order to detoxify the implant surface without causing surface modification.

A comparison of different gingival depigmentation techniques: ablation by erbium:yttrium-aluminum-garnet laser and abrasion by rotary instruments

PURPOSE

The aim of this study is to compare two different gingival depigmentation techniques using an erbium:yttrium-aluminum-garnet (Er:YAG) laser and rotary instruments.

METHODS

Two patients with melanin pigmentation of gingiva were treated with different gingival depigmentation techniques. Ablation of the gingiva by Er:YAG laser was performed on the right side, and abrasion with a rotary round bur on the opposite side.

RESULTS

The patients were satisfied with the esthetically significant improvement with each method. However, some pigment still remained on the marginal gingival and papilla. The visual analog scale did not yield much difference between the two methods, with slightly more pain on the Er:YAG laser treated site.

CONCLUSIONS

The results of these cases suggest that ablation of the gingiva by an Er:YAG laser and abrasion with a rotary round bur is good enough to achieve esthetic satisfaction and fair wound healing without infection or severe pain. Prudent care about the gingival condition, such as the gingival thickness and degree of pigmentation along with appropriate assessment is needed in ablation by the Er:YAG laser procedure.

Effect of erbium-doped: yttrium, aluminium and garnet laser irradiation on the surface microstructure and roughness of sand-blasted, large grit, acid-etched implants

PURPOSE

The present study was performed to evaluate the effect of erbium-doped: yttrium, aluminium and garnet (Er:YAG) laser irradiation on sand-blasted, large grit, acid-etched (SLA) implant surface microstructure according to varying energy levels and application times of the laser.

METHODS

The implant surface was irradiated by the Er:YAG laser under combined conditions of 100, 140, or 180 mJ/pulse and an application time of 1 minute, 1.5 minutes, or 2 minutes. Scanning electron microscopy (SEM) was used to examine the surface roughness of the specimens.

RESULTS

All experimental conditions of Er:YAG laser irradiation, except the power setting of 100 mJ/pulse for 1 minute and 1.5 minutes, led to an alteration in the implant surface. SEM evaluation showed a decrease in the surface roughness of the implants. However, the difference was not statistically significant. Alterations of implant surfaces included meltdown and flattening. More extensive alterations were present with increasing laser energy and application time.

CONCLUSIONS

To ensure no damage to their surfaces, it is recommended that SLA implants be irradiated with an Er:YAG laser below 100 mJ/pulse and 1.5 minutes for detoxifying the implant surfaces.

Holmium laser enucleation of prostate for benign prostatic hyperplasia: seoul national university hospital experience

PURPOSE

The objective of this study was to report the experience acquired at the Seoul National University Hospital with Holmium Laser Enucleation of Prostate (HoLEP), combined with mechanical morcellation for symptomatic benign prostatic hyperplasia (BPH).

METHODS

A retrospective review was performed on the clinical data of 309 consecutive patients who underwent HoLEP at our institution between July 2008 and June 2010. All patients were evaluated preoperatively for prostate volume by transrectal ultrasound, maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS) and quality of life (QoL) score. Peri- and postoperative parameters were evaluated and patients were followed-up at 1-, 3-, 6-, and 12- months with the aforementioned investigations.

RESULTS

The patients' mean age was 68.3 (±6.5) years and mean prostate volume was 55.6 (±23.6) mL. Mean enucleation time was 56.2 (±25.1) minutes, mean morcellation time was 11.3 (±9.5) minutes, and the mean resected weight of the prostate was 20.8 (±16.9) g. The mean catheter indwelling period was 1.9 (±1.7) days and mean hospital stay was 2.9 (±1.5) days. Significant improvement was noted in Qmax, IPSS, and QoL at the 1-year follow-up compared with baseline (P<0.01). At 1 month 17.2% of patients complained of irritative urinary symptoms, which were typically self-limiting within 3 months. Transient stress incontinence was reported in 15.2% of patients. No patient experienced persistent obstructive symptoms that required reoperation.

CONCLUSIONS

Our study showed that HoLEP is a safe and effective therapeutic modality for BPH.

The effect of Er:YAG laser irradiation on the surface microstructure and roughness of hydroxyapatite-coated implant

Purpose

The present study was performed to evaluate the effect of erbium:yttrium-aluminium-garnet (Er:YAG) laser irradiation on the change of hydroxyapatite (HA)-coated implant surface microstructure according to the laser energy and the application time.

Methods

The implant surface was irradiated by Er:YAG laser under combination condition using the laser energy of 100 mJ/pulse, 140 mJ/pulse and 180 mJ/pulse and application time of 1 minute, 1.5 minutes and 2 minutes. The specimens were examined by surface roughness evaluation and scanning electron microscopic observation.

Results

In scanning electron microscope, HA-coated implant surface was not altered by Er:YAG laser irradiation under experimental condition on 100 mJ/pulse, 1 minute. Local areas with surface melting and cracks were founded on 100 mJ/pulse, 1.5 minutes and 2 minutes. One hundred forty mJ/pulse and 180 mJ/pulse group had surface melting and peeling area of HA particles, which condition was more severe depending on the increase of application time. Under all experimental condition, the difference of surface roughness value on implant surface was not statistically significant.

Conclusions

Er:YAG laser on HA-coated implant surface is recommended to be irradiated below 100 mJ/pulse, 1 minute for detoxification of implant surface without surface alteration.

Antegrade flexible ureteroscopy for bilateral ureteral stones in a patient with severe hip joint ankylosis

In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.

The learning curve for holmium laser enucleation of the prostate: a single-center experience

Purpose

Holmium laser enucleation of the prostate (HoLEP) is known to have a steep learning curve and, as a result, its clinical usage has limitations. The purpose of this study was to analyze the learning curve and early complications following the HoLEP procedure.

Materials and Methods

A retrospective analysis was performed on 161 patients who had undergone the HoLEP procedure for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) from July 2008 to September 2009. The procedure was done by two surgeons. Perioperatively, enucleated tissue weight, enucleation time, morcellation time, enucleation ratio (enucleation weight/transitional zone volume), and enucleation efficiency (enucleated weight/enucleation time) were analyzed, and early complications were assessed.

Results

Mean enucleation time, morcellation time, and enucleation ratio were 61.3 min (range, 10-180 min), 12.3 min (range, 2-60 min), and 0.66 (range, 0.07-2.51), respectively. In terms of efficiency, enucleation efficiency was 0.32 g/min (range, 0.02-1.25 g/min) and morcellation efficiency was 1.73 g/min (range, 0.1-7.7 g/min). Concerning the learning curve, enucleation efficiency was stationary after 30 cases (p<0.001), morcellation efficiency reached a learning curve at 20 cases (p=0.032), and enucleation ratio had no learning curve in this study. There were several cases of surgery-related complications, including bladder mucosal injury by the morcellator (13%), capsular injury during enucleation (7%), and conversion to a conventional resectoscopy procedure (15%), which showed a reduction in incidence with time.

Conclusions

The learning curve of HoLEP is steep; however, it can be overcome gradually. Further study is necessary with respect to long-term postoperative follow-up.

Alcohol-assisted versus Mechanical Epithelium Removal in Photorefractive Keratectomy

PURPOSE

To compare the outcomes and complications of alcohol-assisted versus mechanical corneal epithelial debridement for photorefractive keratectomy (PRK).

METHODS

This randomized controlled trial included 1,250 eyes of 625 patients undergoing PRK for correction of myopia and myopic astigmatism. Each patient was randomly assigned to alcohol-assisted or mechanical epithelial removal.

RESULTS

A total of 658 eyes underwent alcohol-assisted epithelial removal while the epithelium was removed mechanically in 592 eyes. Mean spherical equivalent was -4.37±2.3 D in the alcohol group and -3.8±1.3 D in the mechanical group (P = 0.78). There was no significant difference in postoperative pain between the study groups (P = 0.22). Uncorrected visual acuity ≥ 20/20 and ≥ 20/40 was achieved in 90.9% versus 93.4% (P = 0.08), and 98.9% versus 99.5% (P = 0.36) of eyes in the alcohol and mechanical groups, respectively. Final refractive error within 1D of emmetropia was achieved in 90% versus 92.2% of eyes in the alcohol and mechanical groups, respectively (P = 0.23). Alcohol-assisted debridement required less time than mechanical debridement (96±18 vs. 118±26 seconds, P=0.035). There was no significant difference between the two groups in terms of early and late postoperative complications.

CONCLUSION

Alcohol-assisted and mechanical epithelium removal are comparable in terms of efficacy and side effects. The method of epithelial debridement in PRK may be left to the surgeon's choice.

Holmium laser enucleation of the prostate for benign prostatic hyperplasia: effectiveness, safety, and overcoming of the learning curve

Purpose

To examine the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the surgical treatment of benign prostatic hyperplasia and to estimate the time to overcome the learning curve.

Materials and Methods

From May 2008 to October 2009, 164 consecutive patients treated with HoLEP were enrolled in this study. International Prostate Symptom Score (IPSS), peak urinary flow rate (Qmax), and postvoid residual urine (PVR) were documented preoperatively and at 6 weeks and 3, 6, 12, and 18 months postoperatively. The 164 study subjects were divided into 3 groups (group 1 the first 50 patients treated, group 2 the second 50, and group 3 the third 64), and perioperative data and complications were analyzed in these groups to determine the learning curve. In addition, the inverse and upward techniques were compared in terms of the effects and the stability of morcellation.

Results

The mean patient age was 69 years, and the average operation time was 62 minutes (range, 20-208 minutes). Mean prostate volume was 54.2 ml and mean resected tissue weight was 18.6 g. Postoperatively, IPSS and PVR decreased and Qmax increased significantly. Postoperative complications were transient incontinence (8.5%), urinary retention (4.3%), hematuria (3.0%), urinary tract infection (1.2%), and urethral stricture (0.6%), and intraoperative complications were minor capsular perforation (4%) and bladder injury (8%).

Conclusions

HoLEP was found to be effective and safe regardless of prostate size. We recommend that a systematic educational program be established to reduce the learning curve.

Long-pulsed Nd:YAG laser treatment of warts: report on a series of 369 cases

Various treatment methods have been adopted in the management of warts; however, there is still no consensus on first-line treatment. This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used: spot size, 5 mm; pulse duration, 20 msec; and fluence, 200 J/cm(2). No concomitant topical treatment was used. In all, 21 patients were lost during follow up; hence, the data for 348 patients were evaluated. The clearance rate was 96% (336 of the 348 treated warts were eradicated). The clearance rate of verruca vulgaris after the first treatment was very high (72.6%), whereas the clearance rate of deep palmopantar warts after the first treatment was low (44.1%). During a median follow-up period of 2.24 months (range, 2-10 months), 11 relapses were seen (recurrence rate, 3.27%). In conclusion, long-pulsed Nd:YAG laser is safe and effective for the removal or reduction of warts and is less dependent on patient compliance than are other treatment options.