Abstract: An articulated arm for holding surgical instruments, having elongated arm members; rotational joints connecting the arm members end to end, such that members are pivotable about the joints and at least one of the joints is selectively lockable by fluid pressure; and a plurality of tubes communicating fluid pressure between two adjacent joints. When two adjacent members are pivoted relative to one another, the tubes connecting a particular pair of joints remains substantially stationary with respect to the arm member connecting that pair of joints.

Abstract: A method for inserting an autonomous capsule into the G.I. tract includes use of an endoscope having a clamp and at least one retractable support for retaining the clamp. The capsule is engaged with the clamp and pushed to its desired position within the G.I. tract. The capsule is then disengaged by loosening the hold of the clamp on the capsule. The insertion of the capsule can be observed through an imaging unit placed within the endoscope.

Abstract: An endoscope apparatus having an insertion part which includes an object optical system in order to conduct measurements or stereoscopic-vision observations, using the object optical system with a moderate parallax, a moderate size of an image can be provided without making an endoscope thick in diameter.

Abstract: A device for positioning components within endoscopic systems includes a hermetically sealed housing. An outer ring element is mounted to rotate about the outer side of the housing and carries on its circumference at least one outer magnet. Further, an inner ring element is mounted inside the housing and carries likewise at least one inner magnet, the magnets being aligned in such a way that any rotation of the outer ring element has the effect to move the at least one inner magnet by magnetic coupling, such movement serving the purpose to position the respective components. In order to achieve a simple, relatively small and functionally safe structure it is proposed that both the outer and inner ring elements be configured as axially displaceable rings carrying the oppositely arranged magnets, and that the inner ring be mechanically connected with the component to be positioned.

Abstract: A method for testing and/or training cognitive ability, including the steps of testing a preliminary cognitive level of a user and receiving results representative therefrom. According to the results, the cognitive level may then be broken up into separate discrete cognitive skills, and one or more tasks may be created, each task related to each of the separate discrete cognitive skills. The one or more tasks may then be presented to the user and so that a current cognitive level of the user is re-tested, and results representative therefrom are received. This process may be repeated at least one time.

Abstract: The present invention provides a swallowable data recorder medical device. The swallowable data recorder medical device includes a capsule including a sensing module for sensing a biologic condition within a body. A recording module is provided including an atomic resolution storage device. The recording module is electrically coupled to the sensing module for recording data representative of the sensed biologic condition in the atomic resolution storage device. A power supply is coupled to the recording module.

Abstract: Radioactive sources, preferably radioactive seeds, for use in brachytherapy comprising a radioisotope within a sealed biocompatible container, wherein at least one part of a surface of the container is roughened, shaped or otherwise treated so that it is no longer smooth. The surface treatment may enhance the ultrasound visibility of the source and/or reduce the tendency of the source to migrate once implanted in a patient's body. Preferred radioisotopes are palladium-103 and iodine-125.

Abstract: Methods and systems for detecting contrast agents is provided. Differences between different sized vessels throughout a period of contrast agent enhancement are identified without significantly depleting the available contrast agent. Dual detection paths are used for imaging, such as one path for detecting nonlinear response and another path for detecting differences between the responses to two or more pulses. Where echoes from two or more pulses of acoustic energy are combined to detect the nonlinear response, the nonlinear response may also include signals originating from a loss-of-correlation (LOC) or motion between received pulses. These signals generated from LOC or motion can be produced from agent disruption where a second received echo is different from a first received echo due to a change in a bubble's shape (i.e., destruction), or from simple spatial translation between acoustic pulses as seen from the same spatial location, respectively.

Abstract: An ultrasonic transducer is formed by a plurality of cMUT cells, each comprising a charged diaphragm plate capacitively opposing an oppositely charged base plate. The cMUT cells can be fabricated by conventional semiconductor processes and hence integrated with ancillary transducer circuitry such as a bias charge regulator. The cMUT cells can also be fabricated by micro-stereolithography whereby the cells can be formed using a variety of polymers and other materials.

Abstract: Acoustic imaging systems are provided. A preferred system includes a transducer lens configured to mate with a transducer body. The transducer lens is configured to propagate acoustic energy. Preferably, the transducer lens is formed, at least partially, of an acoustic-matching material, which exhibits acoustic properties corresponding to acoustic properties of a body to be imaged. Methods also are provided.

Abstract: The Laragh Method is a novel method useful for evaluating and treating hypertensive patients. The Laragh Method provides a systematic approach for the physician to use volume vasoconstriction information with entry and induced changes in blood pressure and in ambulatory plasma renin levels for the rational selection of treatment tailored to suit each individual hypertensive patient. The Laragh Method provides a systematic and rational approach to drug selection which greatly improves the therapeutic success rate among hypertensive patients and which for the large majority provides long-term blood pressure control with one drug instead of two or two instead of three with each drug rationally targeted to control the renin and/or volume elements in the blood pressure equation.

Abstract: A blood pressure can be obtained by supplying an external pressure to a portion of an artery. The external pressure is preferably between the systolic and diastolic pressure. An event which occurs at least once a cycle can then be identified. This event can be, for example, a peak in the arterial compliance that occurs at a transmural pressure approximately equal to zero. A pair of signals, one that is an arterial volume-indicating signal, and one that is an arterial pressure-indicating signal can be used to identify this event. Alternately, a small signal high-frequency exciter component can be placed upon the pressure or volume of the artery and detected to determine the time that the transmural pressure is equal to zero.

Abstract: A flexible or rigid endoscope biopsy device provides for the taking of multiple biopsy specimens from different sites, and for separating and storing these specimens in a partitioned container. The distal end of this device consists of a grasper which can bite or cut off a bit of tissue. The proximal end of the inner tubing is connected via the handle end of the device to a multi-chambered specimen storage device, which is itself connected to suction. The storage device has several chambers, each of which may be lined up with the inner tubing, by rotating the top of the storage device. After some or all of the storage subpartitions have been filled with specimens, the storage device can be detached from the inner tubing and handle of the device and labeled and sent directly to the pathology lab.

Abstract: A technique for quantifying perfusion and removing a biopsy sample at a site in a living body wherein an instrument having a perfusion sensor is introduced into the body at a site to be investigated to there interrogate the tissue. The biopsy specimen is collected when the perfusion sensor produces a signal indicative of perfused, viable tissue.

Abstract: A probe deflection device includes an outer tube and an inner tube. The outer tube is fabricated from an magnetic resonance (MR) compatible material. The inner tube is fabricated from a resilient material having a memory. The inner tube is shaped prior to insertion into the outer tube. To use the probe deflection device, the distal end of the outer tube is located in a biological subject near a target area. The shaped inner tube is inserted into the outer tube and extends into the target area. The shaped inner tube allows the inner tube to extend into a target area in the biological subject that is off-axis from the outer tube. A probe is inserted into the inner tube. The inner tube and the outer tube are removed from the biological subject leaving the probe embedded in the target area. Alternatively, the outer tube includes an controllable closure having an off-axis exit hole. The inner tube enters the biological subject through the off axis exit hole. A probe is inserted into the inner tube.

Abstract: A massager has a rotation shaft with arcuate grooves defined in a periphery of the rotation shaft and a guide received in the arcuate grooves so that when the rotation shaft rotates, the guide is able to control the rotation shaft to rotate and extend.

Abstract: A massaging device to eliminate fat on a human body is disclosed. The massaging device comprises a substantially T-shaped hold boy, a rotating motor, a bowl-shaped seat body, a massaging wheel seat, and a netlike cap. The massaging wheel is in contact with the human body so as to massage the body. A controller is provided at an appropriate section of the power source cable of the device, facilitating the user to control the power supply of the massaging device.

Abstract: A pulsator assembly for massaging the plantar and transverse arch regions of a foot. An array of spring loaded pistons extending upward through holes in an upper shell structure forms a topology conforming to the plantar and arch regions of a human foot. The piston tips that making contact with the foot has shapes selected from a choice of nipple shaped ends or inserts made from a permanent magnetic. The pistons are urged up and down in concert with the opposing forces imposed by a walking action, thereafter, massaging while stimulating the plantar arch region of the soles without exerting excessive forces to the transverse arch region.

Abstract: An air foot massaging apparatus for massaging and stimulating tired feet, and thereby creating beneficial physiological effects throughout the body and including a pair of boot shaped structures for adapting to the user's feet or a unitary fluid-tight container for retaining fluid therein and adapting to a user's feet. Each boot shaped structure has a plurality of interior compressible and expandable air nodes which engage with the user's foot, a compressor to inflate or deflate the compressible and expandable air nodes for providing an effective massaging pattern to massage the user's feet, a vibration motor for providing a vibrational massage to further provide an effective massaging pattern to massage the user's feet, and a control mechanism for controlling the inflating and deflating of the plurality of compressible and expandable air nodes.

Abstract: A device for supporting and displaying interrelated medical components, such as cardiopulmonary bypass circuit components. The device includes a rigid or flexible chassis having openings therein for receiving the components. A plurality of retainers, such as straps, hooks, or tabs, are provided adjacent the openings for releasably securing the components therein. The chassis may be formed of a thin, flexible polymer sheet having tabs cut therein and adapted to be bent out of the plane of the sheet for securely retaining the various components. The pre-arrangement of the components in close proximity greatly simplifies the task of setting up a particular medical circuit, and reduces the potential for error. For cardiopulmonary bypass circuits, the support device enables the tubing lengths to be reduced, thus reducing the prime volume of the circuit. The chassis is provided with apertures for mounting on rods in the operating room, which rods may extend from the operating table.

Abstract: An intraoperative autotransfusion system and method of use. The system includes an autotransfusion device, a removable cassette, a cardiotomy reservoir, a container for holding washing fluid, and a reservoir for containing processed blood. The removable cassette includes a centrifugal cell, a peristaltic pump, and multiple clamps, each having fixed and sliding elements. The cassette has a housing and multiple ducts for connection to the cardiotomy reservoir.

Abstract: A system for collecting red blood cells (RBCs) and other blood components that reduces the need for human intervention. A disposable set is provided having a port, an RBC container, a centrifuge rotor having a variable total volume, and a filter, along with tubing connecting the port, the container, the rotor and the filter. A control unit is also provided and includes a spinner in which the rotor may be held, a flow-control arrangement for controlling flow among the various components of the disposable set, and an electronic controller. The whole blood is directed by the flow-control arrangement from the port through the tubing to the rotor. The rotor includes an elastic diaphragm, and the control unit's flow-control arrangement includes a pump or other device for applying a positive and negative pressure to the rotor's elastic diaphragm. The spinner rotates the rotor so as to separate the whole blood into plasma and RBCs.

Abstract: Segmental edema is treated by inserting a plasma extraction filter device in a major vein of a body segment or servicing the body segment containing the edemic tissues, and inserting a return catheter in a major artery of the body segment affected or feeding the body segment from which plasma is extracted. Blood plasma and plasma proteins extracted from the edemic body segment through the plasma extraction filter fluids are directed to an ultrafiltration apparatus where plasma water is separated from the plasma proteins. Plasma proteins are returned to the body segment from which the plasma was extracted via the return catheter in the major artery of the subject body segment.

Abstract: Systems and methods are provided for removal (ablation) or modification of soft tissue with high frequency voltage through a capacitive charge process. Specifically, one of the conductors of a capacitor device maybe positioned adjacent to, or in the region of, a body structure. The other conductor is spaced, and electrically insulated from, the first conductor. A high frequency voltage is applied across the conductors to create a potential difference that results in a charge on the conductors and creates an electric field therebetween. High frequency alternating current flows between the conductors to a degree dependent on the capacitance and the current frequency. The charge on the first conductor is sufficient to modify the adjacent tissue. In some variations the charge is sufficient to heat the tissue for tissue coagulation or tissue shrinkage (i.e., collagen contraction). In other variations, the charge is sufficient to ablate or volumetrically remove the tissue.

Abstract: An insufflation apparatus (2) to be connected through a hose (9) to a gas supply device (3), said hose (9) being connectable to the gas supply device (3) by a hose coupling interface including complementary connection elements (11, 12) at or in gas supply device (3) and at the hose end (9) directed towards the gas supply device, and a sterile filter element (10) being provided. The sterile filter element (10) carries connection element (12) of hose (9).

Abstract: An applicator for applying fluid from a squeeze bottle to various parts of the body that may be difficult to reach includes two rigid arms connected by an adjustable angle joint. One end of the first arm screws onto the bottle. The other end of the second arm ends in a tubular connector such as a grease gun fitting. A flexible tube provides a fluid passage between the bottle and the tubular connector. A variety of terminals for different purposes can sealingly snap onto the tubular connector. The terminals preferably have a grease fitting for easy connection. The terminals may include an enema tip, a douche tip, a bidet tip and a suntan lotion spreader. The arms may retract telescopically for compact transport and storage.

Abstract: A balloon catheter includes an elongate pliable catheter tubing with a dilatation balloon fixed to the catheter tubing near its distal end. The dilatation balloon includes a first wall for dividing the balloon into a plurality of dilatation compartments adjacent one another and arranged angularly about the catheter tubing. Each dilatation compartment is fluid tight and in fluid isolation from other compartments. The compartments are individually controlled so the pressure within each balloon compartment may be adjusted as determined by the operator. The dilatation balloon includes a second wall means composed of the respective outer wall portions of the dilatation compartments which defines an outer transverse profile of the dilatation balloon and adapted to form surface engagement with the tissue segments surrounding the balloon when the compartments are dilatated.

Abstract: There is disclosed a clear view cannula for use in surgical procedures having a tubular body, a cylindrical sleeve mounted about and slidably secured to the tubular body, and a plurality of shield members secured to the cylindrical sleeve. The cylindrical sleeve is slidably movable relative to the tubular body causing the shield members to expand and deploy such that the shield members retain torn and fragmented soft tissue within an anatomical cavity. Means are provided on the tubular body to co-act with means on the cylindrical sleeve to lock the expanded and deployed shield members and secure the tubular body within an anatomical body.

Abstract: A retracting needle assembly for use with a syringe barrel having a cylindrical collar and a plunger having a release element with a sharp distal end includes an outer hub having a passageway therethrough and an inner hub having a proximal end, a distal end and a conduit therethrough. The proximal end of the inner hub has an inner portion and a dissociable outer portion connected to the inner portion. The dissociable outer portion is further connected to the outer hub. The distal end of the inner hub is smaller than the passageway of the outer hub at the distal end of the outer hub and projects distally outwardly therefrom. A needle cannula having a distal end, a proximal end, and a lumen therethrough is connected to the inner hub so that the lumen is in fluid communication with the conduit. An energized spring is contained between the inner and outer hub. Structure is provided for connecting the outer hub to the collar of the syringe barrel.

Abstract: A syringe assembly includes a plastic cap (20) that has an end wall (22) and a side wall (24). The end wall (22) preferably includes a plug portion (64) that extends away from an inner surface (62) of the end wall (22). The side wall (24) includes an inner surface (28) that has an engaging portion that sealingly engages a corresponding surface on a syringe. The engaging portion preferably includes two generally annular ribs (34) and (36). An interference fit is provided between the engaging portion and a corresponding surface on the syringe to maintain a sterile seal where the engaging portion contacts the syringe. The plug portion is received within an opening in the syringe and maintains a sterile seal at that point while simultaneously maintaining any medicament within the syringe.

Abstract: A hemostasis cannula unit including a valve housing, a cap, and a hemostasis valve, wherein the hemostasis valve includes a proximal valve gasket and a distal valve gasket compressed against the valve gasket by the valve housing, wherein the proximal valve gasket is the same shape as the distal valve gasket.

Abstract: Needle protectors for retaining needles are disclosed. The needle protector includes a housing with an opening at each of a proximal and distal end. The needle protector may include a portion that is depressible to a substantially fixed position over the needle retracted within the housing.

Abstract: An eye dropper bottle 20 is provided which allows a person to instill drops D into an eye E while the bottle 20 is held in a near horizontal orientation 22. The bottle 20 has a reservoir 51 for holding a liquid 59. The reservoir 51 includes a base 52, an upper end 50, and compressible walls 55. The bottle 20 further includes a neck 40 into which a dropper tip 34 fits. The neck 40 has external threads 42 onto which an internally threaded 32 cap 30 fits. The internal surface 56 of the walls 55 of the reservoir 51 maintains a constant slope 58 of a predetermined angle to allow virtually all the liquid 59 of the reservoir 51 to flow toward a dropper tip 34 where it can be discharged in the form of drops D while the bottle is held in a near horizontal orientation 22. The bottle 20 is grasped with a thumb T parallel to the length of the bottle 20 and an index finger F wrapped around a sulcus 48.

Abstract: A sampling port having a mechanical valve for a drainage apparatus is disclosed which permits a practitioner to directly access a collection chamber of the drainage apparatus using a needle-less syringe for withdrawing a sample of fluid therefrom. The sampling port comprises a port in direct communication with the collection chamber and a mechanical valve partially disposed inside the port. The mechanical valve comprises a generally tubular body containing a spring loaded valve that is normally closed to fluid flow communication and operable using a needle-less tip syringe to actuate the valve. In operation, a practitioner engages the needle-less tip syringe to the valve which places the valve in an open position and permits fluid flow into the syringe as the practitioner draws back on the plunger of the syringe.

Abstract: An external urinary catheter for the relief of male urinary incontinence is provided. The catheter comprises a contact member which is adapted to be engaged with at least the extreme portion of a penis, said contact member being connected to a discharge conduit via an opening in the distal end section of the contact member. The catheter is provided with an aperture. A membrane, which is capable of selectively passing gases but retaining urine, is fastened to the surface surrounding the aperture. The membrane is at least partly protected by a shield. At least one vent for allowing gases to be in substantially unhindered contact with the external surface of the membrane is arranged in the catheter.

Abstract: A personal care absorbent article, such as an infant diaper, a training pant, an incontinence garment and the like, having a structure for opening a support channel adjacent a gluteal fold when the wearer is in a sitting position. The structure having an expandable element hingedly connected to a compressible element whereby the expandable element forms the support channel upon compression of the compressible element.

Abstract: A disposable diaper is locally formed with a protuberance in a transversely middle zone of the diaper between urethral meatus and anus of a diaper wearer, and the diaper thus formed is capable of preventing loose passage discharged thereon form flowing toward the front side of the wearer.

Abstract: An intimate napkin for use with an undergarment, having: a substantially planar and elongated frame (3, 3′) comprising a first face having a liquid pervious material layer, and a second face, opposite to the first face, having a liquid impervious material layer; an absorbing core (2) inserted in the frame (3,3′) between the liquid pervious material layer and the liquid impervious material layer, the liquid impervious material layer having a first inner surface faced to the core (2), and a second outer surface, opposite to the first surface, faced outwardly, which constitutes the outer face of the napkin (1,1′); and an adhesive layer applied to the second outer surface, the napkin (1,1′), wherein the adhesive layer is comprised of at least five lines of adhesive (4) substantially spaced apart, the adhesive ratio ranges from 8 to 25 g/m2, and the adhesive has a shear value of at least 2.0 Kgf is disclosed.

Abstract: A sanitary napkin having a napkin body comprising a topsheet, a backsheet and an absorbent core disposed therebetween and a pair of wings at both side edges of the napkin body. The wings comprise a portion of the backsheet extending transversely outward from a middle zone of the side edge of the napkin body and a reinforcing member bonded to an upper surface of the backsheet's portion. Elastically stretchable and contractable cover sheets are bonded to an upper surface of the napkin body.

Abstract: A disposable absorbent garment comprising a topsheet, a back-sheet and an absorbent core disposed between the topsheet and backsheet is disclosed. The absorbent core is formed from a folded laminated comprising three layers, including an upper layer, a lower layer and a central fibrous layer including from about 50 to about 95 percent by weight superabsorbent polymer and about 5 to about 50 percent by weight stabilization additives. The upper and lower layers comprise tissue, airlaid fluff pulp synthetic non-woven fibrous layers. The central fibrous layers is adhesively bonded to both the upper and lower layers, all layers together assisting to maintain the dry and wet integrity of the absorbent core. Folding of the thin absorbent laminate provides an absorbent core that can handle large doses of urine.

Abstract: A sanitary napkin has a strip that extends rearwardly to reside in the intergluteal crevice. The pad fits snugly against the body without penetrating. Because the strip provides improved body contact, similar protection is achieved with a smaller pad, thus providing a discretion benefit to the wearer.

Abstract: A disposable diaper that includes a briefs-shaped cover member having an elastic stretchability in a vertical direction of the diaper, and an absorbent member that includes a topsheet and a backsheet both of which are not elastically stretchable at least in the vertical direction, and a liquid-absorbent core disposed therebetween. The absorbent member is suspended inside the cover member by suspender sheets that are elastically non-stretchable sheets, at least in the vertical direction, and have pleats which can be flattened out in a vertical direction of the diaper.

Abstract: A breathable, substantially liquid impermeable laminate is provided that is permanently conformable to the contours of a wearer's body when used in a personal care absorbent article or a medical article. The laminate includes a breathable (preferably microporous) film and a fibrous nonwoven web. Both the film and the web are extendible in a cross direction to a width at least 25% greater than an original, unstretched width upon application of a stretching force. The web and the film, and the overall laminate, exhibit little or no retractive force once they have been stretched. A diaper or other garment can be constructed in undersized fashion using the laminate, permitting material savings. When the garment is worn, the laminate stretches only where needed to provide a substantially perfect fit on the wearer. The minimal retractive force avoids the skin marks, rashes, etc. that can result from elastic garments.

Abstract: An absorbent garment having a pant-like configuration is constructed with strategically placed leg elastic, resulting in an aesthetically pleasing, finished look at the leg openings. Such strategic placements include securing the leg elastic to an outer cover and folding the outer cover over the elastic; or placing the elastic between a liquid-permneable body side liner and the outer cover and folding the outer cover over the elastic and securing the outer cover to the body side liner; or folding the outer cover more than once around the elastic. In any case, the distance between the leg elastic is nearly equal to the width dimension of the outer cover of the finished product. In addition to being aesthetically pleasing, the finished product eliminates the chance of exposing the leg elastic to the user. In an alternate embodiment, portions of the outer cover can extend laterally beyond an absorbent layer, thereby serving as seamless leak guards.

Abstract: A surgical system having a cassette with an aspirant collection chamber and an aspiration vent line that draws fluid from the aspirant collection chamber. The pressure within the collection chamber is maintained near ambient so that when the aspiration vent line is open, fluid flows from the collection chamber and into the aspiration line. Such a system does not require a second source of irrigation fluid, minimizes pressure surges into the irrigation fluid line and does not affect the fluidic performance of the aspiration system. In addition, various vent pressures can be achieved by varying the vertical position of the reservoir relative to the aspiration line.

Abstract: The present invention concerns a novel drug delivery unit. The drug delivery unit comprises a medical material and a quantity of gel. Also provided is a permeable membrane. The permeable membrane surrounds the gel. In addition, the present invention also includes an electrical transmission mechanism. The electrical transmission mechanism is operably coupled to the gel to cause the gel to controllably change in shape in response to a voltage applied to the electrical transmission mechanism.

Abstract: An ingestible device for delivering a substance to a chosen location in the GI tract of a mammal includes a receiver of electromagnetic radiation for powering an openable part of the device to an opened position for dispensing of the substance. The receiver includes a coiled wire that couples the energy field, the wire having an air or ferrite core. In a further embodiment the invention includes an apparatus for generating the electromagnetic radiation, the apparatus including one or more pairs of field coils supported in a housing. The device optionally includes a latch defined by a heating resistor and a fusible restraint. The device may also include a flexible member that may serve one or both the functions of activating a transmitter circuit to indicate dispensing of the substance; and restraining of a piston used for expelling the substance.

Abstract: An implantable osmotic pump for delivering a pharmaceutical agent to a patient includes an osmotic engine, a substantially toroidal compartment disposed at least partially around the osmotic engine and a piston disposed within the compartment. The osmotic engine is configured to cause the piston to travel within the compartment and deliver a dose pharmaceutical agent contained within the compartment when the pump is implanted in an aqueous environment. A dose escalation assembly may be fitted to the pump, the dose escalation assembly being adapted to selectively increase the rate at which the pharmaceutical agent is delivered from the pump.

Abstract: A long pulse alexandrite laser hair removal system is disclosed using light pulses of greater than 1 msec and fluences between 10 and 50 J/cm2. The use of an alexandrite laser allows good penetration while still achieving an acceptable combination of hemoglobin and melanin absorption. The use an index-matching application on the skin sections to be treated is also described. This substance will be absorbed into the epidermal layer to provide better coupling of the laser light into the skin. Also, and most advantageously, it will reduce reflections at the epidermal-dermal junction, which can lead to the damage of the skin. Also a topical thermal or photochromic indicator is suggested since skin irradiation in the near-infrared generally does not produce any characteristic skin color change as is found when using pulsed dye lasers, for example.

Abstract: A laser treatment device and process with controlled cooling. The device contains a cooling element with high heat conduction properties, which is transparent to the laser beam. A surface of the cooling element is held in contact with the tissue being treated while at least one other surface of the cooling element is cooled by the evaporation of a cryogenic fluid. The cooling is coordinated with the application of the laser beam so as to control the temperatures of all affected layers of tissues. In a preferred embodiment useful for removal of wrinkles and spider veins, the cooling element is a sapphire plate. A cryogenic spray cools the top surface of the plate and the bottom surface of the plate is in contact with the skin. In preferred embodiments the wavelength of the laser beam is chosen so that absorption in targeted tissue is low enough so that substantial absorption occurs throughout the targeted tissue. In a preferred embodiment for treating large spider veins with diameters in the range of 1.