|
LASER THERAPY AS A NEW MODALITY
IN THE TREATMENT OF INCOMPLETE PERIPHERAL NERVE INJURIES:
Prospective Clinical Double-Blind Placebo-Controlled
Randomized Study
S. Rochkind, M. Alon, T. Brantwien, M. Nissan, M. Khaigrekht,
VE. Drory Departments of Neurosurgery, Neurology, Rehabilitation
and Physiotherapy, Tel Aviv Sourasky Medical Center, Israel
The research project was an interdisciplinary effort
to evaluate an innovative therapeutic strategy, wherein low power
laser irradiation was applied for the treatment of severe incomplete
peripheral nerve and brachial plexus injuries. The purpose of
this clinical trial was to evaluate the effectiveness of this
treatment as a non-invasive, low-cost method for improving the
functional recovery of patients suffering from incomplete peripheral
nerve and brachial plexus injuries. This study evaluated the functional
improvement of 18 patients suffering from incomplete peripheral
nerve or brachial plexus injuries who received low power irradiation
or placebo treatment for 21 consecutive days in a double-blind,
placebo-controlled, randomized manner. Clinical and electrophysiological
assessments were done at baseline, at the end of the 21 days of
treatment and 3 and 6 months thereafter.
The analysis of the results of the double-blind, placebo-controlled
randomized study showed statistically significant improvement
in motor function (P=0.0001) in the laser- treated group at the
end of the 21 days of treatment and at the 3 and 6 month follow-up
periods, compared to the placebo group. No statistical significance
was found in sensory function in the laser-treated group, compared
to the placebo group. In the laser-treated group, statistically
significant improvement was found in motor (P=0.0001) and sensory
functions (P=0.035) at the end of the six-month follow-up period,
compared to baseline. In the placebo group, no statistically significant
improvement was found in motor and sensory functions at the end
of the six-month follow-up period, compared to baseline. Electrophysiological
analysis of the laser-treated group showed statistically significant
improvement in recruitment of voluntary muscle activity (P=0.006),
as well as a trend toward statistical significance in amplitude
of compound muscle action potentials (CMAP) (P=0.067) at the end
of the 21 days of treatment and at the 3 and 6 month follow-up
periods, compared to the placebo group. In the laser-treated group,
statistically significant improvement in recruitment of voluntary
muscle activity (P=0.0001), as well as CMAP amplitudes (P=0.049)
were found at the end of the six-month follow-up period, compared
to baseline. In the placebo group, no significant change in CMAP
amplitude was found, but a minor improvement in motor unit recruitment
was observed, at the end of the follow-up period compared to baseline.
In conclusion: Our double blind clinical study
indicates that laser therapy enhances the recovery of injured
nerve tissue. The therapeutic results show an objective progressive
improvement in nerve function, leading to a significant functional
recovery. Laser therapy, a non-invasive low-cost method, may be
useful in improving the functional recovery of patients suffering
from incomplete peripheral nerve and brachial plexus injuries.
|
|
HOW DANGEROUS IS LASER LIGHT?
Lars Hode, D.Sc. Spectro Analytic Irradia AB, Stockholm,
Sweden
Strong sounds can be harmful our sound sensitive
ears, strong light can harm our sensitive light detectors - the
eyes. A laser can be a strong light source. Some lasers can be
dangerous - no doubt. But which lasers and why is it so? How dangerous
are for instance therapy lasers? There are examples where the
fear of laser is more dangerous than the laser itself. Low Level
Laser Therapy can be carried out with either weak or strong lasers.
But "Low Level" does not necessarily mean that the light is weak
or that it is harmless. Is a 15 watt defocused CO2-laser more
dangerous than a 500 mW GaAlAs-laser? What about the so-called
laser pointers? Why are invisible wavelengths sometimes more dangerous
than visible and sometimes less dangerous? How dangerous are reflexes?
Are the international rules adequate or should they be more strict?
Are there other light sources that may be even more dangerous
than lasers? Can laser light cause cancer? Can LLLT stimulate
growth of already existing cancer cells? Is it risky to treat
something on an eye-lid with LLLT? These and many other questions
will be answered and some enlightening demonstrations will be
performed.
The best protection against eye injury due to laser light is not
protection goggles! The best protection is knowledge and understanding
of the underlying mechanisms.
|
|
LLLT IN VIVO EFFECTS ON MAST
CELLS
M.A.Trelles, M. Vélez, J. Rigau, E. Mayayo Instituto
Médico Vilafortuny/ANTONI DE GIMBERNAT FOUNDATION; E-43850 CAMBRILS,
SPAIN
Department of Tissue Pathology of the University
Hospital Juan XXIII, Tarragona
Because of their compounds, basically related to
active aminas, Mast Cells (MC) play an important role in inducing
vasodilatation. MC's are particularly concentrated in the perivascular
areas and their reaction to chemical or physical action is well
known, but they can also react to laser stimuli as can be demonstrated
by a series of laboratory in vivo experiments. In fact, vasodilatation
is one of the biological effects that indicates the action of
low level laser therapy (LLLT) on tissues. Based on this premise,
MC reactions were controlled before and after laser irradiation.
Quantitative and morphometric changes were recorded and compared
to control groups, detecting tissue changes in the surrounding
area to that where laser light was irradiated. By using two lasers
of different output, but applying the same energy density, it
was observed that MC's reacted more actively when the total energy
is delivered in a shorter period of time. Substances contained
in MC granules pass into the bloodstream, because of laser irradiation,
and produce vasodilatation. This phenomenon has been gauged and
might help the therapeutical response to LLLT. By means of Radio
Immunology Assay (RIA) irradiated tissue, which was previously
pulverised, was analysed quantitatively and statistically for
its Histamine content, observing that its level changed at the
end of the experiment, compared with the normal level of Histamine
of non-irradiated tissue. For this experiment, the tongue of the
Swiss mouse (rich in MC's) after 2,4 J/cm2 He-Ne 632 nm laser
irradiation on alternative days (5 sessions) was used, and results
obtained confirm the possible non-selective action of LLLT in
the degranulation of mast cells. Moreover, it has been observed
that Histamine levels in blood vary after laser irradiation and
this can occur after just one single laser irradiation of 2,4
J/cm2. A dose of a Helium/Neon (632 nm) laser energy was capable
of producing vasodilatation and active releasing of MC granules
to the interstitial cell medium detected by electron microscopy.
These structural changes have been morphometically evaluated by
optical and electron microscopy noticing special active vasodilatation.
Interstitial oedema was noticed together with the opening of cell
membrane pores between endothelial cells, as well as exocytosis
of MC granules, which passed into the bloodstream.
Since Histamine is a powerful anti-inflammatory agent as well
as having particular effects on blood circulation, creating vasodilatation,
it could be used as an explanatory thesis in the chain of mechanisms
involved in obtaining therapeutic effects when using LLLT.
|
|
LEVEL LASER THERAPY IN TENDON
INJURIES? - A REVIEW OF IN VITRO AND IN VIVO TRIALS
J.M. Bjordal, C. Couppe University of Bergen, Dept.
Physiotherapy Science, Bergen, Norway
Purpose : To investigate the effect of different
laser treatment parametres on fibroblast inflammation and production
of collagen fibres.
Material : Controlled in vitro or in vivo trials with low
level laser therapy (LLLT) Method : Literature search for trials
published after 1980 using LLLT on Medline, Embase, Cochrane Library
and handsearch of physiotherapy journals in English and Scandinavian
languages. Optimal treatment parameters regarding timing, treatment
frequency, dose and power density at target tissue were synthesized.
Results : The literature search identified 31 controlled
trials with LLLT on collagen tissue. Three in vitro trials were
performed on stretch-induced and inflammation in fibroblast cultures
and five in vitro trials were performed on collagen production.
Optimal dose and power density for inhibition of prostaglandin
PGE2 and interleukin 1- beta production was found to be 3.2-6.3
J/cm2 and 5.3 mW/cm2 measured at the target fibroblast cells after
5 days of irradiation. Data on upper range limits for anti-inflammatory
treatment were inconclusive. Optimal dose and power density for
collagen production was found to be in the range 0.2-2.0 J/cm2
and 2 -20 mW/cm2 measured at the target fibroblast cells. Daily
treatment for 2 weeks with optimal parameters yielded a maximum
increase in collagen production of 37%. The results from three
in vivo trials showed similar increase in collagen production.
Doses in excess of 4.5 J/cm2 and power densities higher than 30
mW/cm2 inhibited fibroblast metabolism and decreased collagen
production.
Conclusion : There is evidence of a dose-response pattern
for LLLT in the treatment of tendon injuries during the proliferative
phase of regeneration.
|
|
LOW LEVEL LASER THERAPY CAN BE
EFFECTIVE FOR TENDINITIS: A META-ANALYSIS
J.M. Bjordal, C. Couppe University of Bergen, Dept.
Physiotherapy Science, Bergen, Norway
Purpose: To investigate if low level laser
therapy (LLLT) with previously defined optimal treatment parametres
can be effective for tendinitis. Material : Randomized controlled
trials with LLLT for tendinitis. Method : Literature search
for trials published after 1980 using LLLT on Medline, Embase,
Cochrane Library and handsearch of physiotherapy journals in English
and Scandinavian languages. Only trials that compared laser exposure
of the skin directly over the injured tendon with optimal treatment
parametres with identical placebo treatment were included.
Results: The literature search identified 77 randomized
controlled trials with LLLT, of which 18 included tendinitis.
Three trials were excluded for lack of placebo control, of which
one trial was comparative, another lacked patients with tendinitis
in the treatment group, while the last unwittingly gave the placebo
group active treatment. Four trials used too high power density
or dose, and three trials did not expose the skin directly overlying
the injured tendon. The remaining eight trials were included in
a statistical pooling, where the mean effect of LLLT over placebo
in tendinitis was calculated to 32% [25.0-39.0, 95% CI].
Conclusion: Low level laser therapy with optimal treatment
procedure/parametres can be effective in the treatment of tendinitis.
|
|
TINNITUS AND VERTIGO - A CASE
FOR THE DENTIST?
Jan Tunér DDS Grängesberg, Sweden. E-mail: jan@tuner.nu
The correlation between tinnitus/vertigo and cranomandibular
disorders (CMD) has been known for quite some time, yet few dentists
seem to be aware of this. It is not natural for the dentist to
ask, nor for the patient to inform the dentist about such a situation
since it does not appear to be a dental indication. However, quite
a number of tinnitus/vertigo patients will be releived of their
symptoms if a proper CMD treatment is performed. Low level lasers
have been used to treat tinnitus patients with reasonable success,
if sufficient energy and suitable treatment technique is used.
These lasers have also proved themselves successful in the treatment
of CMD. It is obvious, therefore, that low level laser therapy
is an appropriate treatment modality for the yet undefined subgroup
of tinnitus/vertigo patients with a CMD background. Laser therapy
will reduce pain levels, ease muscular spasms and revert the viscious
circle. In some cases laser therapy alone will produce astonishing
results, in others it has to be combined with traditional occlusal
stabilisation procedures. It is important for doctors to be aware
of this subgroup of tinnitus patients since traditional therapies,
and even laser therapy of the inner ears, will be ineffective
if the CMD is not diagnosed and treated. This presentation will
look at the literature documentation for laser therapy of tinnitus/vertigo.
|
|
IS LLLT A PANACEA IN DENTISTRY?
Jan Tunér DDS Grängesberg, Sweden. E-mail: jan@tuner.nu
In the literature more than 30 different indications
for Low Level Laser Therapy can be found. A casual reader may
get the impression that LLLT is a panacea in dentistry. This is
certainly not the case. It is important that the correct diagnosis
is made, that tissue condition is considered, that a reasonable
dose is applied and that a suitable wavelength is used. As always,
a combined knowledge about dentistry, physics and treatment technique
will be rewarded clinically. If the parameters above are under
reasonable control, LLLT will become a very powerful tool in the
hands of any dentist. For some indications laser therapy will
be a useful additional treatment modality to conventional methods,
for some indications conventional methods may be equal or better
and for yet others laser therapy will be the best, if not the
only available method. This presentation will review some of the
most useful indications for dental LLLT, with suggestions for
optimal treatment parameters
|
|
USE OF LOW-LEVEL LASER THERAPY
(LLLT) FOR TREATMENT OF THE PATIENTS WITH A CANCER OF A ESOPHAGUS
T3N0MX
V.A.Mikhailov,* I.B.Sudakov,** I.N.Denisov,*** V.L.Osin
Moscow scientific-practical center on laser therapy,*Oncologic
hospital, Rjasan, **Moscow medical academy named after Setchenov,***Medical
Center at business management of the President of Russian Federation
In this part of work at 20 patients received the
laser therapy (LLLT) in a combination with external radial therapy
under the radical program (1group), 15 patients (2 groups) received
only one laser therapy , the control group consist of 18 men receiving
only external radial therapy on the radical program (3 groups),
10 patients received only symptomatic therapy (4 groups). The
stage of disease T3N0MX and spent treatment in skilled and control
groups was identical. Radial therapy carried out on kettles "Lutch-1"
and "Agat- ?" on a procedure from three fields (1 parasternal,
2 and 3 - juxtaspinal under an angle of 40 degrees to a backbone)
with a single dose till 90 % on doses by a curve 1,8 Gr and cooperative
dose 64-66 Gr. The irradiation was carried out 5 days per one
week with a break 2 days. A GaAs semiconductor laser (wavelength
890 nm., pulsed mode, pulse power 5-10 W.) was used for laser
therapy. Laser therapy carried out after leading to a tumor of
a dose 15-20 Gr. The sessions LLLT carried out 3 times per one
week in day. A cooperative dose - 5,8 J/cm2 The analysis of lifespan
of the patients in group receiving LLLT with radial therapy and
in control group has shown, that use of laser therapy increases
lifespan of the patients: 1 group - up to 10,28 ±2,03 months,
in 2 groups up to 11,4 ±3,02 months, in 3 groups it makes 7,35
±2,4 months, in 4 groups - 6,3 ± 1,94 months. Use LLLT allows
to reduce quantity of occurrence of complications after radiation
therapy in 2,9 times.
|
|
THE USE OF LASER THERAPY AND
ADDITIONAL THERAPEUTIC MODALITIES AFTER ARTHROSCOPY OF THE KNEE
AT ALPINE SKI TEAM 1
Lilic Alen, physiotherapist; 2Kozlevcar Živec Maja,
dr. med. spec.fiz.reh.med.; 3Marcan Radoslav, dr.med., spec.ortop
1FIZIO, Ilirska Bistrica, Slovenija, 2Iskra Medical, Ljubljana,
Slovenija, 3Ortopedska bolnišnica Valdoltra, Slovenija
In the present article we will review different
kind of injuries in the alpine ski sport and we will concentrate
on the injuries of the ligamentar part of the knees and meniscs
in slovenian ski team. After the description of the injuries follows
detailed presentation of the rehabilitational procedures from
the first day of the injury till the return in to the competition
arena. We will try to explain the modalities of the rehabilitational
procedures and their influence in the tissues, their main and
side effects. Our main attention will be focused to the use of
the biostimulative laser of higher power - 1,2 W and wave lenght
of 830 nm and it's influence on the velocity of recovery in the
patients and their succes in following competitions.
|
|
ROLE OF THE CIRCULATING BLOOD
IN INITIATION OF THERAPEUTIC EFFECTS OF VISIBLE LIGHT
K.A.Samoilova Institute of Cytology of the Russian
Academy of Sciences, St. Petersburg, Russia
The successful use in Russia of the extracorporal
and intravascular irradiation of the patient`s blood with the
laser and non-laser light for the wound healing promotion, immunomodulation,
pain relief, etc. suggests that development of these effect in
the case of the percutaneous light application also is due to
its effect on blood. Such mechanism seems quite possible, as the
visible and IR light penetrating the skin at the depth of 2-4
mm reaches a network of small vessels and can affect the blood
that circulates here at a low rate. Since during the laser treatment
it is possible to irradiate only a small area of the surface body
or wound and, correspondingly, of a very small volume of the circulating
blood, it is necessary to explain how its photomodification can
lead to a wide spectrum of therapeutic effects. For this purpose,
we refer to the data obtained at our Laboratory in studying mechanisms
of the rapidly developing functional changes induced by retransfusions
of a small blood volume (1.5-2.5% of its circulating pool) irradiated
extracorporally with the UV or He-Ne laser light. It has been
found out that the optical radiation induces structural-functional
changes and activation of blood cells, which results in that a
small volume of blood acquires properties of an active preparation
able to modulate the state of cells of the autologous blood and
other tissues. Indeed, when the photomodified blood is added in
vitro to the 10-80-fold volume of the intact autologous blood,
it "translates" to it the light-induced changes that, in spite
of such a pronounced dilution of blood, not only are not reduced
but even are enhanced. As a result, the entire volume of the circulating
blood acquires properties of an active preparation. The chief
"translators" of the light effects are the irradiated mononuclear
leukocytes and platelets, and whereas development of some effects
(improvement of hemorheology, activation of all types of leucocytes,
etc), is necessarily associated with the presence of irradiated
cells, the development of other effects (first of all an enhancement
of the growth promoting activity of blood) is initiated by soluble
factors secreted by these cells. By now we have accumulated an
evidence for that after exposure of a small area of the body to
visible incoherent polarized light, immediate changes occur of
the rheological, transport, gas transport, growth stimulating,
immunomodulating properties of the circulating blood and that
these changes develop mainly as a consequence of the effect of
the transcutaneously photomodified blood.
|
|
EXPOSURE OF THE VOLUNTEERS'
SKIN TO VISIBLE POLARIZED LIGHT IS ACCOMPANIED BY INCREASE IN
GROWTH PROMOTING ACTIVITY OF THE CIRCULATING BLOOD FOR HUMAN CELLS
IN VITRO : DEPENDENCE OF THE EFFECT ON CELL TYPE
K.A.Samoilova, M.I.Blinova, N.M.Yudintzeva, N.V.Kalmykova,
E.V.Kuz'minych *D.I.Sokolov, O.I.Zubanova, K.D.Obolenskaya Institute
of Cytology of the Russian Academy of Sciences, *Institute for
Experimental Medicine of the Russian Academy of Medical Sciences,
St.Petersburg, Russia
In analyzing mechanisms of the visible light-induced
stimulation of wound healing we studied the growth promoting (GP)
activity of the volunteers' blood for cultured human cells after
a single exposure of small area of the body (15x15 cm) to therapeutic
dose of visible incoherent polarized (VIP) light (Swiss BIOPTRON-2
device, 400-2000 nm, 95% of polarization, 12 J/cm2). The exfusion
of blood and its centrifugation were performed before and after
VIP-session; cell-depleted plasma (2.5-10%) was added to the culture
medium instead of fetal calf serum. In the 1st group of the experiments
the following cells were used as targets: two primary cultures
(keratinocytes, KC, of the donor skin, embryonal fibroblasts,
FB) and two continuos lines (endothelial cells ECV304 and epidermoid
carcinoma A-431 cells). The number of cells was determined by
a colorimetric method. In the 2nd group the primary cultures of
the PHA-stimulated blood lymphocytes (Lym) after their damage
with X-ray (0.5 Gy) were tested. The mitotic index (MI) and incidence
of the chromosome breaks (ChrBr) were determined in these cells
after their cultivation in presence of 22% of autologous plasma
derived from the same volunteers before and after VIP-treatment.
It has been established that in 0.5 hr after the VIP-session,
soluble factors appear in the volunteers' blood; they stimulate
proliferation of KC (in 57% of the cases, on average, by 20%),
FB (in 41%, by 10%), ECV304 (in 53%, by 30%), but not of the tumor
cells. The blood drawn from volunteers next day after exposure
has a higher GP activity for KC (frequency of the increments is
70%, by 30%) but not for other cells. It is essential that the
frequency and degree of the stimulation of FB proliferation are
1.5-2 times lower than those of KC and ECV304, which might be
one of the explanations as to why no pronounced hyperproliferation
of the connective tissue is observed after the VIP-treatment of
wounds. A significant individual variability of the blood GP properties
has been revealed, as well as a high degree of dependence of VIP-
effects on the initial level of the blood GP activity: as a rule,
it rises at a low indices, while slightly decreases at the high
ones. Hence, VIP light produces regulatory effect on the GP activity
of the circulating blood for KC, FB, and ECV304. As to X-damaged
Lym, cultivation together with autologous plasma of VIP-exposed
volunteers resulted to the restoration of the cell mitotic activity,
on average, from 82% to the level in non-damaged Lym and simultaneously
reduced the ChrBr frequency, on average, by 17%. According to
our findings the photomodified platelets can be an important source
of factors able to restore the damaged autologous cells. Moreover,
a proof has been obtained that platelet - associated growth factors
(PDGF and EGF) have such activity. The results are discussed in
the connection with VIP-induced changes of the content of some
cytokines and growth factors in blood.
|
|
CHANGES OF THE CONTENT OF SOME
CYTOKINES AND GROWTH FACTORS IN CIRCULATING BLOOD OF VOLUNTEERS
EXPOSED TO VISIBLE POLARIZED LIGHT AT A THERAPEUTIC DOSE
K.A.Samoilova, D.I.Sokolov, K.D.Obolenskaya, N.A.Zhevago
Institute of Cytology of the Russian Academy of Sciences, St.
Petersburg, Russia
The promotion of wound healing and immunomodulation
are the cardinal indications for laser therapy. Since these complex
phenomena involve participation of immunomodulators and growth
factors circulating in blood, it is necessary to study effects
of phototherapy their level. Using an ELISA, we determined the
plasma levels of Il-b, TNF-a, INF-g, Il-10, and transforming growth
factor (TGF-b) in healthy volunteers (n=15-20) in 0, 0.5, and
24 hr after exposures of their back (400 cm2) to a therapeutic
dose of visible incoherent polarized (VIP) light (Swiss BIOPTRON-2
device, 400-2000 nm, 95% polarization, 12 J/cm2). As a control
(Placebo) group, unexposed people were similarly tested after
2 exfusions of blood for study (30-40 ml for 24 hr). There were
no changes of the IL-1b level in 0.5 and 24 hr after the VIP-exposure
of 17 volunteers, however, the TNF-a content in 0.5 hr changed
in 85% of the subjects: a very slight increase was revealed in
persons with a low initial cytokine level (50% of all tested)
and a more marked decrease, in volunteers with a high initial
cytokine level. The inverse dependence of the light-induced effects
on the initial TNF-a levels is confirmed by a negative correlation
coefficient r (-0.67). In other 22 volunteers a statistically
significant increase in the INF-g level was found in 0.5 and 24
hr: its mean amount changed by 44 pg/ml (from 21 to 65 pg/ml),
in some people, by 102-308 pg/ml. Meanwhile, in the Placebo group
(n=7) a decrease in the INF-g content was observed, which presumably
resulted from the hemoexfusion. There also were changes of the
Il-10 and TGF-b levels in 78-85% of volunteers, a high dependence
of these changes being found on the initial level: r=-0.96 (Il-10)
and r=-0.60 (TGF-b). Indeed, in subjects with the low values of
Il-10 (40% of cases) its level increased in 0.5 hr (from 9 to
49 pg/m) and, to a lesser degree, in 24 hr, while in the group
with the high Il-10 content it fell markedly (from 150 to 5 pg/ml);
in the Placebo group a significant increase of Il-10 was observed
(from 67 to 126 pg/ml in 24 h). As to TGF-b, its content within
0.5 hr decreased almost twice in 40% of cases (from 20.4 to 11
ng/ml) and rose in the 40% of volunteers 1.5 times (from 7.9 to
11.8 ng/ml). In the Placebo group there was an elevation of the
TGF-b level in 60% of the people, while a decrease, only in 27%
of the tested persons (by 25%). However, in 24 hr the 2-fold fall
of the TGF-b content was revealed already in 71% of the control
group persons, whereas among the irradiated volunteers, it was
revealed only in 40%. Thus, a single VIP-exposure of healthy people
immediately increases the plasma INF-g level and produces a regulatory
effect on the TNF-b, Il-10, and TGF-b content.
|
|
CHANGES IN SOME FUNCTIONAL AND
BIOCHEMICAL PARAMETERS OF THE CIRCULATING HUMAN BLOOD AFTER PERCUTANEOUS
APPLICATION OF VISIBLE POLARIZED LIGHT AT A THERAPEUTIC DOSE
M.F.Balljuzek, N.Yu.Romanenko, S.I.Morozova, E.A.Manova,
1K.A.Samoilova, 1A.V.Vologdina. Center of Phototherapy and Laser
Surgery of the Russian Academy of Sciences Hospital, 1Institute
of Cytology of the Russian Academy of Sciences, St.Petersburg,
Russia
Three years ago, our clinics started application
of a Swiss phototherapeutic device BIOPTRON that allows an exposure
of a small body area to visible incoherent polarized (VIP) light,
whose spectrum and power density are close to the Sun visible
radiation (400-2000 nm, 95% of polarization, 12 J/cm2). To elucidate
physiological mechanisms and to specify indications for this type
of phototherapy,we analyzed some biochemcal parameters in 26 healthy
volunteers during the course of 10 daily irradiations of a body
area, 400 cm2.In the Placebo group (n=16) the irradiation was
imitated and 5 exfusions of 140 ml blood for 10 days for study
was performed, like in the main group. A rapid statistically significant
decrease of the glucose level in 65% of VIP-exposed volunteers
(on average, by 10%) has been observed in 0.5 hr after VIP-session
but no significant changes in the Placebo group. Subsequently,
strongly depending on the initial level, there was a decrease
or an increase of this parameter in most VIP-irradiated subjects.
The correlation and dispersion analysis has revealed regulatory
and normalizing effect of the VIP-sessions on the glucose content.
In the Placebo group, this regularity was not detected. Deep changes
were in parameters of lipid metabolism: an immediate decrease
of triglyceride content, (from 1.14 to 1.00 mmole/l) and its gradual,
statistically significant decrease by the end of the course. The
analysis indicated both a regulatory and normalizing effect of
the VIP-course on the content of these atherogenic lipids The
increase in b-lypoproteins' level was observed in 24 hr as well
as by the end of course in both groups. Hence, this effect was
due to the hemoexfusion rather than the effect of light.A statistically
significant increase of the level of anti-atherogenic lipid a-cholesterol
(from 1,76 to 1.98 mmol/l), was found out at all periods of the
VIP-course, whereas in the Placebo group this parameter decreased.
The data obtained have allowed us to apply the VIP-therapy in
10 patients with X-syndrome. For comparison 10 other patients
as well as 12 volunteers were irradiated with therapeutic doses
of He-Ne laser light. A small number of examined subjects allows
only preliminary conclusions. Unlike volunteers no significant
decrease was revealed in the sugar and triglyceride levels, whereas
b-lipoproteins' content decreased soon after the 1st session and
by the end of the course of both VIP-therapy and laser treatment
(by 32%). As to a-cholesterol, it increased in patients with initially
low values and decreased in subjects with high level both after
a single exposure to light and by the end of course. There were
no significant differences in the studied parameters between the
VIP- and laser-treated volunteers.
|
|
RESULTS OF LOW LEVEL LASER THERAPY
(LLLT) IN THE TREATMENT OF INNER EAR DISEASES
L. Wilden* and D. Ellerbrock** *Private Office,
Bad Füssing, Germany ** Laser Evolution-Light Energy Healing,
Passau, Germany
The increase of LLL energy quantities in the treatment
of a large number of patients has proven a very effective biostimulative
result. The energy was transmitted with 3 laser diodes (830nm)
and 3 diodes (635nm) via meatus and mastoid. The examination and
therapy included 348 patients, 251 right and 187 left inner ear
organs (cochlea), 171 patients were female and 231 male Their
average age was 56.9 years. The average duration of the disease
was 5,9 years. In 391 of the cases the patients suffered from
tinnitus. The examination lasted from 24 june 1996 to 9 february
1999, the average treatment phase lasted 61.5 days. The average
duration of the therapy was 11.8 hours, the average quantity of
the transmitted energy was 6732 joule. Before every series of
LLLT the patients hearing capacity (air and bone conduction) was
examined by an audiometry test. After the 9 th therapy the hearing
capacity was again examined by the same method. The resulting
readings were evaluated using all test data over 12 frequencies,
then the frequency intervals (low-middle and high) and the grouping
of patients according to age, duration of the disease, quantity
of the transmitted energy and the results obtained by the therapy.
In cases of deafness 125 db were used as an auxiliary value. Improvements
of the hearing capacity were ascertained in all frequency sectors.
The best results were obtained in the low frequency sector (reduction
of 11.7 db) and in the high frequency sector (reduction of 14,6
db). The therapy results were better when more energy was transmitted.
The correlation of the patients age and the duration of the disease
on one hand, and the therapy results on the other, are biologically
plausible. If LLL is transmitted in suitable energy quantities
to the inner ear (cochlea) biostimulative effects can be well
documented.
|
|
IMPORT OF RADIATION PHENOMENA
OF ELECTRONS AND THERAPEUTIC LOW- LEVEL-LASER IN REGARD TO THE
MITOCHRONDRIAL ENERGY TRANSFER
L. Wilden1, Dr. Rainer Karthein2 1 Private Office,
Bad Füssing, Germany 2 TÜV Rheinland/Berlin Brandenburg, Department
of Radiation Protection, Köln, Germany
Objective: The authors describe a consistent
theoretical model of the cellular energy transfer (respiratory
chain) by taking into consideration the radiation phenomena of
electrons and therapeutic low level laser. Summary Background
Data: Biochemical models of the cellular energy transfer regard
the classical corpuscular aspect of electrons as the responsible
energy carriers thereby ignoring the wave-particle dualism of
the electrons and the import of radiation energy of this process.
Methods: The authors show the influence of radiation phenomena
for the cellular energy transfer explaining consistently some
of the intermediate steps of this complex process.
Results: Because of the inherent wave-particle dualism
of the electrons, it is obvious to regard radiation phenomena
in order to explain the cellular energy transfer. The classical
biochemical models only use the particle part of the electrons
as energy carriers. The connection between the energy transport
by radiation and the order in structures may be understand, if,
for instance, structurally bound energy is released during the
dissolution of structures (Oxidation of foodstuffs) or is again
manifested (finally reduction of oxygen to water). Regarding the
energy values relevant for the respiratory chain , the import
of electromagnetic radiation of characteristic ranges of wavelengths
on the cellular energy transfer becomes evident. Depending on
its wavelength, electromagnetic radiation in the form of light
can stimulate macromolecules, can initiative conformation changes
in proteins or can transfer energy to electrons. Low level laser
from the red and the near infrared region corresponds well with
the characteristic energy and absorption levels of the relevant
components of the respiratory chain. This laser stimulation vitalises
the cell by increasing the mitochondrial ATP (adenosine-tri-phosphate)-production.
Conclusions: With regard to radiation phenomena and its
enhanced electron flow in the cellular energy transfer (respiratory
chain) it is possible to explain the experimentally found increase
of ATP-production by means of low level laser light on a cellular
level. Intense researchs for this iostimulative effect are required.
|
|
CHANGES IN INTRACELLULAR CALCIUM
CONCENTRATION INDUCED BY BIOSTIMULATION OF CARDIAC CELLS GROWN
IN CULTURE USING VISIBLE LIGHT OR HYDROGEN PEROXIDE.
Rachel Lubart, Asher Shainberg, Harry Friedman,
and Ronit Lavie Bar-Ilan University, Ramat-Gan 52900, Israel Reactive
oxygen species (ROS) modulate intracellular calcium ion concentration
([Ca2+]i). In the present study, we have measured the [Ca2+]i
changes in cardiac cells after illuminating the cells with visible
light and compare these changes with those observed in response
to hydrogen peroxide (H2O2) addition to the cell culture. We have
found that low level light (LLL) irradiation mimics the effect
of low concentrations (10 - 35 mM) of H2O2 and both cause an increase
in [Ca2+]i and accelerated muscle contractions. No damage to the
cells was evident 24 hours after the treatment. These results
support the idea that photobiostimulation by LLL, is a consequence
of ROS production in response to visible light absorption. By
comparing changes in [Ca2+]i that we observed in response to LLL
irradiation to those observed, in some cases, in response to irradiation
in the early stage of PDT, one can find that in both cases, there
is elevation in [Ca2+]i after irradiation moreover the elevation
has a transient character. But, while following PDT this elevation
is in the range of 100 %, after LLL irradiation, an increase of
about 20 % in [Ca2+]i is observed.
|
|
LASER THERAPY IN WOUND MANAGEMENT
Mary Dyson, PhD FCSP FAIUM LHD(Hon) Centre for Cardiovascular
Research and Biology, GKT Medical School, KCL, Guy's Hospital
Campus, London SE1 9RT, UK.
The end product of wound management should be a
healed wound. To appreciate how low intensity laser therapy (LILT)
can assist in achieving this it is necessary first to be familiar
with
· the normal structure of the tissues involved in the injury
· the stages involved in the repair of these tissues.
Following a brief description of the above as they apply to skin,
the effects of LILT on the cellular events which occur during
the healing of acute wounds of skin will be examined. Used correctly
these effects can lead to an acceleration of the healing process
in wounds healing suboptimally. This acceleration is due, at least
in part, to reduction in the duration of acute inflammation resulting
in a more rapid entry into the proliferative stage of repair when
granulation tissue is produced. Methods of converting chronic
wounds into acute wounds in which healing can be accelerated will
be suggested. The cellular mechanisms that cause this acceleration
will be described. Reversible membrane permeability changes, for
example to calcium ions, occur. These stimulate cell activity
leading to a range of events including enhanced
· growth factor release by macrophages
· keratinocyte proliferation
· mast cell recruitment and degranulation
· angiogenesis.
The urgent need for controlled, double blind clinical
studies of wound healing in volunteers and patients using calibrated
LILT devices whose output is known and fully reported will be
emphasised. Ideally wound healing should be monitored objectively
and noninvasively throughout the healing process to provide the
data needed for evidence based clinical LILT practice. The potential
role of high resolution (20 MHz) digitised ultrasound B-scans
of wounds in providing this data will be described.
|
|
OPEN WOUND HEALING (BED SORES,
ULCUS CRURIS, BURNS) WITH SYSTEMIC EFFECTS OF LLLT
Adam Mester Semmelweiss University, Budapest, Hungary
I.The wound healing phases and laser effects:1)
subcellular, 2) cellular effects: leukocytes and mediators, fibroblast
proliferation, lymphocyte activation and mediators, endothelial
capillaries regeneration/ revascularisation, epithelial cell regeneration,
mucosal regeneration.
II. Anti-inflammatory laser effects in wound healing: Prostaglandin
synthesis, Immunological reactions, Helper and suppressor T-cell
effects. B-cell effects. IgM/IgG/complement, skin transplantation.
III. Pain relief effect of laser irradiation: direct neurone effects,
neurotransmitter effects, indirect efects. Prostagandin synthesis
related chemical effects. Oedema reduction and vascular effects.
Perfusion and endothel reactions.
IV. Radiation sensitivity influencing laser effects: Dose dependent
stimulation and inhibition. Cell type and status dependent reactions.
T-cells: CD8/CD4 cells, C and A neurons, epithel cells/cuboid
mucosal cells. Human skin types dependent reactions.
V. Side effects of laser irradiation: Carcinogenesis, co-carcinogenesis,
de novo tumour provocation. Effects on groth of already existing
tumours.
VI. Methods of laser irradiation: Laser specific light effects:
Monochromatic High photon density Coherent Linear Polarisation
Divergence Wave length Penetration Absorption Energy density,
power density. Superficial dosis / effective dosis / target volume.
Spot irradiation / moving irradiation forms. Frequency of sessions.
Cumulative effects, synergistic effects, antagonistic effects.
Non- thermal application modalities of high power lasers.
VII. Role of laser and other photostimulative therapies in the
compex wound management. Acknowledgement: The Central Research
Institute of the Hungarian Academy of Sciences and LASOTRONIC
AG (Switzerland) was helping the research.
|
|
LASER THERAPYIN RHEUMATOLOGY
Judit Ortutay M.D., Klara Barabas M.D., Ph.D., *Adam
Mester MD National Institute of Rheumatology and Physiotherapy,
Budapest *Semmelweis University, Faculty of Medicine, Dept. of
Diagnostic Radiology and Oncotherapy, National Laser Therapy Centre,
Peterfy Sandor Teaching Hospital, Budapest
Barabas irradiated first the joints of rheumatoid
arthritis (RA) patients without skin ulcer. In the first open
study objectively the range of motion and circumference of the
treated joints were measured, Ritchie index as semiobjective parameter,
subjective parameters as joint tenderness and pain on a visual
analogous scale (VAS) were registered. The walking time was registered
as a functional disability parameter. Laboratory activity parameters
and the 99mTechnetium index was measured. The second part of the
clinical study was double blinded, Infra Red (10mW and 100 mW)
lasers were used versus dummy devices with the same outlook. The
third part of the study were in vitro experiments. Synovial membranes
of rheumatoid arthritis patients The DNA/RNA ratio of the RA group
was compared to the control group. Significant difference was
detected between the two groups. The fourth phase of clinical
studies was to detect the effects of laser irradiation in other
rheumatic diseases: psoriatic arthritis, sacroileitis, osteoarthritis,
entesopathy, tenosynovitis, bursitis calcarea, fibromyalgia, localised
muscle spasm, periarthritis humeroscapularis etc. The different
wavelengths (604, 630, 660, 670, 690, 750, 780, 790, 820, 830,
904, 1053, 1219 nm,) were compared (30 - 100 mW) with other physiotherapy
modalities, like ultrasound. Acknowledgement: The Central Research
Institute of the Hungarian Academy of Sciences and LASOTRONIC
AG (Switzerland) was helping the research.
|
|
NO-SURGICAL LASER TREATMENT
IN PHLEBOLOGY
L. Longo, MD General Surgery Institute & Phlebology
Center Siena University - Italy
Many Lasers have been used in the treatment of phlebologic
diseases, with wavelengths of 488- 511- 532- 577 - 585 - 595 -
600 - 632 - 810 - 950 - 1064 - 1320 nm. To summarize, Laser therapy
could be the elective treatment for the wound healing, while edema,
haematoma, ulcers are treatable with lasers only after an accurate
diagnosis. The purpose of our study is to review the different
types of laser beams used in these pathologies, underlining their
respective advantages and drawbacks. We can offer some options
on the choice of no-surgical lasers in phlebology, based our 25
years of personal experience and the data reported in the literature.
The treatment procedure is always important, and we must remember
that laser beams can be used also synergically in association
with other treatments. In conclusion, laser therapy has a positive
and specific role in the treatment of various phlebologic diseases,
but it must be used after an exact diagnosis and according to
an appropriate procedure.
|
|
LASERACUPUNCTURE
Pekka J. Pöntinen, M.D, Ph.D, F.I.C.A.E., Tampere
University, Tampere, Kuopio University, Kuopio, Finland E-mail:
pontinen@sci.fi
Traditionally acupuncture means stimulation of specific
points on the surface of the body in order to produce mainly regulatory
effects on the functions of the internal organs. The same points
have been used to increase or decrease the functional state of
different organs. In Traditional Chinese Medicine (TCM) the acupuncture
points (AP) are connected by channels or meridians in and under
the skin and have deep connections to the internal organs. The
selection of the proper points has been as important as the correct
type of stimulation, either reinforcement or sedation. In the
traditional Chinese medicine the human model has been mainly energetic,
physiological, not anatomical. The changes in the energy flow
induced by the blocks in the channels or acceleration of the flow
leading either to the deficit or excess of the vital energy, Chih,
were believed to be the origin of diseases. The APs were the loci
to balance the energy flow through needle stimulation. Modern
acupuncture has a different nature. For the consensus conference
arranged by the National Institutes of Health (NIH) and held in
Bethesda, Maryland in November 1997 the term acupuncture was defined
as stimulation, primarily by the use of solid needles, of traditionally
and clinically defined points on and beneath the skin, in an organized
fashion for therapeutic and/or preventive purposes. Application
of stimulus to the reactive points (by needle, heat, massage,
transcutaneous electric nerve stimulation/TENS, laser, etc.) according
to TCM can influence the pathophysiological function of the affected
organ-meridian systems. In modern Chinese AP therapy, a combination
of local tender points (AHSHI) and classical peripheral APs is
common. Laseracupuncture (LAP) Today LAP provides a noninvasive
and low risk alternative to needle stimulation. A combination
of local reactive (tender) points or Ahshi points and active muscle
TPs form a practical and effective basis for LAP in pain treatment.
LAP can replace needles in the treatment of functional disorders
and is then directed to classical APs. As a painless modality
of acupuncture LAP is well accepted by children and other sensitive
patients. LAP provides excellent possibilities for clinical studies
on acupuncture. Recently Schlager and coworkers confirmed the
efficacy of AP Neiguan (PC6) in the prevention of postoperative
vomiting in children undergoing strabismus surgery. In another
randomized, double-blind placebo-controlled study low-intensity
laser therapy effectively prevented the recurrence of Herpes simplex
infection. Our study groups at the Universities of Kuopio and
Tampere have studied the analgetic effect of peripheral stimulation
(needle acupuncture, transcutaneous electrical stimulation/TENS,
massage, electric stimulation, low energy laser) applied on APs
or TPs using pressure algometry . We have conducted a series of
experiments using different wavelengths (633-904 nm) and both
coherent and noncoherent irradiation. LEPT was given directly
to TPs (1-2 J/TP) or local tender spots. In blind, cross-over
studies both HeNe- and IR-diode (904 nm) lasers elevated pressure
pain threshold (PTH). In a follow-up study on 54 MPS patients
LEPT (820 nm, 1-2 J/TP) PTH increased from 2.94+1.44 tp 6.56+0.96
kg/cm˛ (p<0.001) and MGF from 0.60+0.28 to 1.03+0.29 bar (p<0.05),
whereas VAS decreased from 44.6+11.3 to 9.3+6.4 (p<0.001). In
this and other series we have found that the effect is greater
on the side where PTH and MGF values are initially lower. As in
our earlier studies with low and high freguency TENS one sided
HeNe-laser irradiation elevated PTH of the corresponding, contralateral
nontreated TPs in addition to the response on the treated side.
More recently the main emphasis has been turned to the central
mechanisms and pathways. In a pilot study LED-light (880 nm, 1J/cm2)
given to TPs in trapezius muscle (TE15) bilaterally and upon proc.
spinosus of C7 (DU14) significantly altered regional cerebral
blood flow e.g. in thalamus, caudate nucleus and prefrontal cortex.
In our experience less than 1 J/point or 100-200 J/cm˛ given in
a contact mode is mainly ineffective in clinical practice when
treating musculoskeletal disorders and myofascial pain through
TPs. In many well controlled, blind and double-blind cross-over
studies showing insignificant results the actual radiant exposure
to the target site has been a mere fraction of the dose normally
used in clinical practice. When treating APs of low resistance
and high sensitivity the irradiation dose should be reduced to
about 0.1-0.2 J/point (10 per cent of the normal dose [1-2 J/point]
used at muscle TPs).
|
|
THE REGENERATING CAPACITY OF
LLLT ON MUSCLE FIBERS AND ON CATILAGE TISSUE
van der Veen Ph, Lievens P Department of Rehabilitation
Research Vrije Universiteit Brussel, Brussels, Belgium
Introduction: This study concerns the influence
of laser treatment on the regeneration process of cartilage tissue
and muscle fibers. It is known that damage of cartilage and muscular
tissue is a serious problem in, for example rheumatic diseases
and sportsinjuries. The lack of blood supply is one of the most
important factors involved. Previous studies have proven the regeneration
capacities of laser in woundhealing and bone repair. Material
and Methods: In the first part of this study we have chosen
to experiment on cartilage tissue of mice. A 0.4 mm hole was drilled
in both ears on 15 mice. The mice were devided into 3 groups,
dependent on the duration of treatment (1, 2 or 4 days). The right
ears were treated with GaAs IR laser (904nm, 10W) for 3 minutes.
The left ears remained untreated and were used as control. Photographs
were taken from the histologic sections and were interpreted by
using the Bentley method. Parameters were: macrophage activity,
fibroblast proliferation, chondrocyte activity, remodeling of
catilage structure and perichondrium activity. The satistical
analyses of the results was done by a Chi square test. During
the second part of our study we made a longitudinal incision in
the anterior muscle of both legs of 20 mice. The injured area
could be traced by black-inkt spots. The right side was irradiated
by means of a GaAs IR laser (904nm) and the left side was used
as control. On the 7th and 18th day post injury, the mice were
controlled. Microscopic photographs were taken of the injured
zone and for histologic interpretation following parameters were
used: mononucleated cells, early myotubes, regenerated fibers
and degenerated fibers. The results were statistically analysed
using Kolmogorov-Smirnov Goodness of fit test and Wilcoxon Matched-Pairs
Singeld-Rank test. Significant level was always chosen at the
5% level.
Results: After 1 day of treatment, no significant differences
were found between the irradiated group and control and there
was no tendency of cell proliferation. After 2 days of treatment,
the drilled hole is filled with cartilage structures and is more
filled than the control ear. No activity of perichondrium and
a differentiation of chondrocytes and fibroblasts is not notable.
A significant activation of the perichondrium is found towards
the drilled hole. There is a significant difference between the
irradiated and non irradiated side; the untreated ear is filled,
but with totally other cell structures than in the treated ear.
In our second experimental set-up, we found that after 7 days
the injured area was populated by mononucleated cells, but not
significant. Laser irradiation did not accelerate early myotubes
proliferation, nor did it accelerate the number of regenerating
fibers, but significant more number of myotubes were found in
comparison with the non-irradiated group. Altough very close to
the significant level, we found no significant increase of mononucleated
cells after 18 days. No acceleration of early myotubes and number
of myotubes, although significant after 7 days, is found. Important
is the significant increase in number of regenerated fibers in
the experimental group.
|
|
WOUND HEALING PROCESS: INFLUENCE
OF LLLT ON THE PROLIFERATION OF FIBROBLASTS AND ON THE LYMPHATIC
REGENERATION
Lievens P, van der Veen Ph Department of Rehabilitation
Research Vrije Universiteit Brussel, Brussels, Belgium
In order to fully understand the positive influence
of LLLT on wound healing, we investigated the infuence that laser
has on proliferation of fibroblasts, one of the basic elements
in the wound healing process, and on the regeneration of the lymphatic
system, which is important for the evacuation of fluids and waste
products out of the wound area.
Material and Method: 1)To do so we cultivated cells coming
from 2 different mice (type NMRI) and divided 4 groups per mouse.
Two were irradiated, two not using a IR (904nm, 3,7mW) laser.
Then we did a BrdU labeling with 4 flasks (2 were irradiated,
2 control) 2)To investigate the regeneration of the lymphatic
system, we made a standardized incision on the ventrolateral side
of 600 mice. In the control group (n=500) as well as the experimental
group the evolution of 4 parameters was studied (adhesion, local
oedema, regeneration of the vein and regeneration of the lymph
vessel) by means of transillumination microscopy. The wounds in
the test group were irradiated twice a day with a combined HeNe
(632nm, 5mW)-IR (904nm 68,8mW) laser.
Results:1) The results show a significant increase (p<0.05)
of fibroblast proliferation. The BrdU labeling showed an increased
DNA activity. There is also a perfect match between number of
fibroblasts and DNA activity. 2) The adhesion of the scar with
the underlaying tissues disappeared after 10 days in the control
group and after 4 days in the experimental group. The local oedema
dissapeared in the test group after 8 days, while in the control
group it lasted untill 10 days.A considerable acceleration of
the regeneration of both vein and lymph vessel was seen in the
test group
|
|
NON-INVASIVELASER THERAPY OF
MORBUS PEYRONIE - INDURATIO PENIS PLASTICA
Miroslav Prochazka, M. D., Karel Koci, M. D.
Rehabilitation Clinic Jarov, Prague; Andrology Clinic Andromeda,
Prague, Czech Republic
Induratio penis plastica is a rare affection of
male penis though occurrence is reported in 6 - 9 per cent of
male population. From clinical, as well as from theoretical point
of view this is very interesting kind of proliferous inflammation.
Thus dual mechanism of effect of non-invasive laser beam can be
employed in implicating overproduction of fibrin (and its resorption)
as well as in direct influence upon inflammatory processes.
In our study 40 patients have been followed for more than a five-year
period. We combine classical medicamentous techniques (colchicine,
E vitamin) together with non-invasive laser of the following parameters:
probes 200 and 300 mW, 50 J/cm2 continuous mode + 50 J/cm2 with
beam modulated in 5 Hz frequency in one therapy bout. The therapy
is applied 20 times in a row, twice a week as introductory series
of procedures, followed by, according to clinical results, maintenance
series of 3 - 5 procedures 2 - 3 times a year. Furthermore, we
have found useful a combination with one more kind of physiotherapy
- ultrasound - presumably due to erosion of syndesmotic conjunctions.
Results:
- 100 per cent of patients without painfull erection (mostly from
second or third procedure on, as it is usually for the pain that
patients are stirred to see a doctor, not for the deformity),
- 60 per cent of patients with significant reduction, or even
fade of palpable resistance,
- less than 30 per cent of patients with marked effect on deformity
of penis in the course of erection. Lesser effect on deformity
during erection can be noticed with patients whose palpable resistance
fade away completely. Theoretically, we are of the opinion that
it is a result of permanent conversion of syndesmotic stroma of
cavernous corpora, persisting even after disposal of overproducted
fibrin. In general, better prognosis can be expected with patients
with a clear causer of the affection (trauma, catheterization)
than with idiopathic forms, or even with forms connected with
other and overall affections (combination with Dupuytren´s contractures)
Conclusions: We consider therapy with non-invasive laser to be
absolutely the most effective component of the whole therapeutical
complement within the scale of possible therapies of Morbus Peyronie
(Induratio Penis Plastica), and therefore we establish it a routine
method for all patients suffering from this affection. Its main
contribution is high clinical efficacy, with negligible possible
rate of theoretical risks (we have not observed any side effects
of this therapy), and unique compliance of a method which is not
connected with any unpleasant feelings for the patient.
|
|
CHEMO-AND RADIATION-INDUCED
MUCOSITIS : RESULTS OF MULTICENTER PHASE III STUDIES.
Rene Jean Bensadoun Centre Antoine-Lacassagne,
Nice, France
Considerable buccal toxicity of radiotherapy and/or
chemotherapy in patients with cancer can cause patients to become
discouraged and can alter their quality of life. In addition,
such toxicity often necessitates alterations of treatment planning,
with grave consequences in term of tumor response and even survival
(concept of dose-intensity). With 5-fluorouracil and head and
neck radiotherapy for example, acute mucosal toxic effect is the
main limiting factor for which no clinically appropriate prophylaxis
or efficacious antidote has been found to date. Management of
oral mucositis is currently primarily directed at palliation of
the symptoms, and prevention of infections. Low Level Laser Therapy
(LLLT) has been reported effective in reducing the severity of
oral mucositis lesions in a non-randomized trial, initiated in
Nice (France) by Ciais et al. (1). The efficacy of this method
in the prevention of chemotherapy induced oral mucositis has been
subsequently confirmed in two prospective, double-blind randomized
trials, in patients undergoing bone marrow transplant (2 ; 3).
These initial findings and the high incidence of radiation-induced
mucositis prompted a randomized multicenter trial to evaluate
LLLT for the prevention of acute radiation-induced oropharyngeal
mucosal lesions. The trial was open to patients with carcinoma
of the oropharynx, hypopharynx and oral cavity being treated by
external radiotherapy, with a total dose of 65 Gy at a rate of
1 fraction of 2 Gy/day, 5 days a week, from cobalt-60 or linear
accelerator photons, without prior surgery or concomitant chemotherapy.
Between September 1994 and March 1998, thirty patients entered
this double-blind randomized study conforming to the Huriet law.
The goal was to determine whether preventive HeNe laser beam applications
could reduce or prevent oropharyngeal mucositis caused by radiotherapy.
Patients characteristics: There were 26 men and
4 women. Mean age was 60.4 years (range 36 - 78). Oral examination
and preventive dental management were performed prior to radiotherapy.
Daily oral hygiene (cleaning of the teeth and dental prosthesis)
during treatment was recommended. Patients were assigned to either
laser treatment (L+) or sham-treatment (L-) by computer blocked
randomization. The protocol called for the inclusion of 30 patients,
15 in each arm. No associated anti-inflammatory or other treatment
was authorized. Analgesics could be prescribed, but not during
the 2 days preceding each week evaluation. Patients received HeNe
laser applications daily for five consecutive days (Monday to
Friday) each week, during the seven weeks of radiotherapy. The
malignant tumor had to be located outside the areas selected for
randomized preventive LLL application. Laser was delivered to
the tissues by a straight optical fiber with a 1.2 mm spot size.
The 9 treatment areas included : posterior third of buccal mucosa,
soft palate and anterior tonsillar pillars. Laser illumination
consisted of a continuous beam (wavelength: 632.8 nm; power: 60
mW), calibrated at the end of the optical fiber every day. The
treatment time (t) for each application point was given by the
equation : t (sec) = energy (J/cm2) x surface (cm2)/ Power (W).
The average energy density delivered to the treatment areas was
2 J/cm2, and was applied on these nine points, equally distributed
on the treated surfaces, for 33 s per point (each specific LLL
session lasted approximately 5 minutes). The 60 mW lasers were
designed and produced by Fradama S.A. (Geneva, Switzerland). All
laser illuminations were performed by the same individual in each
center. This operator was the only person to know whether or not
the patient was sham-treated, and did not participate in the evaluation
and scoring mucositis. During the sessions, patients wore wavelength-specific
dark glasses and were instructed to keep their eyes closed, to
assure that they did not know whether they were sham-treated or
whether they received laser applications. The laser made the same
noises, and the probe was held in the mouth exactly the same way,
when treating control subjects and when treating laser patients.
The whole irradiation field, the oral cavity and the visible oropharynx
were inspected weekly during seven weeks by the same physician
(head and neck surgeon, or radiation oncologist), blinded to the
result of randomization. The evaluation of mucositis and pain
was performed on the oropharyngeal areas (9 points). Criteria
for evaluation were the standard WHO scale for mucositis in the
oropharynx; and a segmented visual analogic scale for pain (patient
self evaluation). In this phase III study, no adverse effect was
noted with the use of a 60-mW HeNe laser, though it is important
to emphasize the importance of preventing retinal damage by the
use of wavelength-specific goggles. This is consistent with previous
reports. Laser applications delayed time of onset, attenuated
the peak severity and shortened the duration of oral mucositis.
The difference between L+ and L- patients was statistically significant
from week 4 to week 7. With the total delivered dose of 65Gy,
conventionally fractionated, all L- patients developed mucositis
at week 2, with a peak at week 5 (13 with grade 3 mucositis, and
2 with grade 2 mucositis). All L+ patients also had mucositis
at week 2, with a peak at week 5 (5 with grade 3 mucositis, 9
with grade 2, 1 with grade 1). During the 7 weeks of treatment,
the mean grade of mucositis in L+ patients was significantly lower
(p=0.01) than the mean grade in L- patients. Results on decrease
in pain intensity were also quite convincing. Laser applications
reduced the incidence and duration of morphine administration.
Ability to swallow was also improved. These results confirm previous
data collected with this method, especially for patients undergoing
bone marrow transplant (BMT). In a prospective study, Barasch
et al. (2) used a 25- mW laser on one side of the mouth only and
reported a statistically significant reduction in oral mucositis
on that side, according to the scoring system they used. In the
Barasch study, each patient was his or her own control, which
could be of importance, since mucosal damage on the sham-treated
side could have benefited also from a distant systemic laser effect.
Cowen et al. (3), using a 60 mW HeNe laser, performed a double-blind
randomized phase III trial, in which laser was administered to
the treatment group during conditioning, prior to the day of transplant.
This study showed a 33% reduction of grades 3 and 4 mucositis
in L+ patients. In this trial, mucositis was scored according
to an oral examination guide, with a 16 items scale, of which
4 were assessed by the patients themselves. Daily mucositis index
was significantly lower in L+ patients (p < 0.05) from d+2 to
d+7 after BMT. The duration of grade 3 stomatitis was also reduced
in L+ patients (p = 0.01). Oral pain was lower (p = 0.05), and
L+ patients required less morphinomimetics (p = 0.05). Finally,
xerostomia and ability to swallow were improved among L+ patients
(p = 0.05, and p = 0.01, respectively). All these results were
in keeping with previous observations, suggesting the efficacy
of the method (1, 4). Schubert et al. for example (4), identified
a trend towards lower oral mucositis scores, on all examination
days, in an interim results report of a phase I/II study, in which
laser application was performed prophylactically during conditioning
before BMT.
In conclusion, LLLT seems to be a safe and efficient
method for the prevention of chemo- and radiation-induced mucositis,
with a tremendous potential interest for combined modality treatment.
The concomitant use of chemo- and radiotherapy is becoming the
new standard of care in advanced head and neck cancer, with very
encouraging results, even in nonresectable cases. Since the main
limiting factor of these combined protocols is the acute mucositis,
this complementary treatment option with low level HeNe laser
could be important in enhancing the feasibility of such regimens,
and especially in the conservation of dose-intensity effect. At
Nice, where the method is now used routinely during head and neck
radiation, we project a new study testing LLL in patients being
treated with concomitant chemo- and radiotherapy for advanced
head and neck cancer. Even more than the improvement of patient
comfort, the therapeutic index of combined specific treatment
should be increased by the use of LLLT, besides standard supportive
care, oral care and enteral nutrition (5). During this study,
other laser wavelengths and powers could be tested, and compared
to 60-mW HeNe laser.
Ref :
1. CIAIS G., NAMER M., SCHNEIDER M., DEMARD F., POURREAU-SCHNEIDER
N., MARTIN P.M., SOUDRY M., FRANQUIN J.C., ZATTARA H. La laserthérapie
dans la prévention et le traitement des mucites liées ŕ la chimiothérapie
anticancéreuse. Bull. Cancer 79 : 183-191, 1992.
2. BARASCH A., PETERSON D., TANZER J.M., D'AMBROSIO J.A., NUKI
K., SCHUBERT M., FRANQUIN J.C., CLIVE J., TUTSCHKA P. Helium-Neon
laser effects on conditioning-induced oral mucositis in bone marrow
transplantation patients. Cancer 76:2550-2556, 1995.
3. COWEN D., TARDIEU C., SCHUBERT M., PETERSON D., RESBEUT M.,
FAUCHER C., FRANQUIN J.C. Low energy helium-neon laser in the
prevention of oral mucositis in patients undergoing bone marrow
transplant : results of a double blind randomized trial. Int.
J. Radiat Oncology Biol. Phys. 38 (4):697-703, 1997.
4 . SCHUBERT M.M., FRANQUIN J.C., NICCOLI-FILHO F., MARCIAL F.,
LLOID M., KELLY J. Effects of low-energy laser on oral mucositis
: a phase I/II pilot study. Cancer Researcher Weekly 7:14, 1997.
5 . R. J. BENSADOUN, J. C. FRANQUIN, G. CIAIS, V. DARCOURT, M.
M. SCHUBERT, M. VIOT, J. DEJOU, C. TARDIEU, K. BENEZERY, T. D.
NGUYEN, Y. LAUDOYER, O. DASSONVILLE, G. POISSONNET, J. VALLICIONI,
A. THYSS, M. HAMDI, P. CHAUVEL, F. DEMARD. Low-energy He/Ne laser
in the prevention of radiation-induced mucositis. A multicenter
phase III randomized study in patients with head and neck cancer.
Support Care Cancer 7(4):244-252, 1999.
|
|
MECHANISMS OF LOW-POWER LASER
LIGHT ACTION ON CELLULAR LEVEL
Tiina Karu Institute of Laser and Informatic Technologies
of Russian Acad. Sci., 142092 Troitsk, Moscow Region, Russian
Federation
Cytochrome c oxidase is discussed as a possible
photoacceptor when cells are irradiated with monochromatic red
to near-IR radiation. Four primary action mechanisms are reviewed:
changes in the redox properties of the respiratory chain components
following photoexcitation of their electronic states, generation
of singlet oxygen, localized transient heating of absorbing chromophores,
and increased superoxide anion production with subsequent increase
in concentration of the product of its dismutation, H2O2. A cascade
of reactions connected with alteration in cellular homeostasis
parameters (pHi, [Cai], cAMP, Eh, [ATP] and some others) is considered
as a photosignal transduction and amplification chain in a cell
(secondary mechanisms).
|
|
SEMICONDUCTOR LASER RAYS THERAPY
FOR THE TREATMENT OF CHRONIC PROSTATITIS
Prof. Guido Strada, Dr med. Franco Gadda, Dr med.
Paolo Dell'Orto, Dr med. Marilena Casu, Dr med. Andrea Baccalin
Department of Urology, San Gerardo Hospital, Monza (Milan-Italy)
Introduction: Chronic prostatitis (ACP) hasn't
a universally successful therapy yet. A lot of studies demonstrated
that LASER therapy has an anti-inflammatory effect on tissues
and can increase lymphatic and venous drainage reducing inflammatory
swelling. For this reasons in the early 90s we proposed a new
therapeutic system for ACP using semiconductor LASER rays consisting
of a gallium-arsenide diode. At the beginning an endorectal probe
was used; then we invented a particular endourethral probe for
laser therapy. This is a brief abstract of what we achieved during
these years.
Histological preliminary studies: Many authors studied
biological effects of LASER on animal tissues (1). Before clinical
practice LASER therapy was tested on a cancer cell line (SW 626)
in order to evaluate if laser stimulation could increase mitosis
cell rate (2) and therefore have a carcinogenic-like effect. We
didn't observe any change in mitosis cell rate. Another study
(3) was made on rabbits to test in vivo any immediate histopathological
damages and temperature rising in rectal ampulla using transrectal
probe. Temperature rising was about 2/10th of a degree centigrade.
No histopathological alterations of rectal wall and the prostate
were observed with particular care of signs of swellig, flogosis
or fibrosis.
Materials and methods: The gallium-arsenide diode in use
has a wave lenght of 904 nm and a frequency of 3000 Hz. The Laser
beam reaches the prostate with a special optic probe. This is
divided in two sections: one contains the laser generator, the
other has five optic fibers and it is screwed onto the first creating
a single body of reduced dimensions. It can be sterilized and
it is atoxic. We experimented 2 different approaches to the prostate:
the first was an endorectal approach and the second was an endourethral
approach. At the beginning we used a "Laser Super Sonic" machine
with endorectal probe according to Strada. The treatment schedule
was 1 treatment every two days (treatment's time of 12 minutes,wave
lenght 3000 Hz)) for a total of 12 applications. Transrectal laser
therapy was not indicated in prostate larger than 4 cm because
this is the maximum depth of the laser beam's efficacy. Then we
experimented an urethral probe (Med 130 Lasotronic â Wave lenght
820 nm, power 30 mW) in order to reduce energy leakage and increase
patient's tolerability. In this case patients underwent 1 treatment
every 3 days for a total of 8 applications (treatment's time of
4 minutes). From 1990 to 1999 more than 200 patients underwent
this kind of treatment. We pubblished results in previous studies
(4-5).
Clinical results: More than 65% of the patients obtained
a symptoms' relief even at 6 months after treatment. We observed
a decrease in IPSS score and an improvement in maximum and mean
urinary flow rate. We analyzed spermatic fluid before and after
treatment (6) and we found that there was an increase in total
germinal cells count, improvement in motility and in morphology.
Concentration of zinc, fructose and citric acid was higher after
treatment (Zinc:9.5 mg% vs 5.5 mg%; Fructose: 64.5 mg% vs 58 mg%;
Citric acid: 360 mg% vs 305 mg%). Prostate ultrasuonds allowed
to appreciate a consistent reduction of prostate volume (21.9
cc vs 29.9 cc), probably due to resolution of oedema. Conclusion:
In our experience laser therapy for chronic prostatitis can be
an effective treatment in improving symptoms and modifying clinical
and sonographyc parameters.
|
|
BIOPHYSICAL ASPECTS OF LOW LEVEL
LASER THERAPY
Herbert Klima Atomic Institute of the Austrian
Universities, Vienna, Austria
Biophysical aspects of low level laser therapy
will be discussed from two points of view: from the electromagnetic
and the thermodynamical point of view. From electromagnetic point
of view, living systems are mainly governed by he electromagnetic
interaction whose interacting particles are called photons. Each
interaction beween molecules, macromolecules or living cells is
basically electromagnetic and governed by photons. For this reason,
we must expect that electromagnetic influences like laser light
of proper wavelength will have remarkable impact on the regulation
of living processes. An impressive example of this regulating
function of various wavelengths of light is found in the realm
of botany, where photons of 660 nm are able to trigger the growth
of plants which leads among other things to the formation of buds.
On the other hand, irradiation of plants by 730 nm photons may
stopp the growth and the flowering. Human phagocyting cells are
natively emitting light which can be detected by single photon
counting methods. Singlet oxygen molecules are the main sources
of this light emitted at 480, 570, 633, 760, 1060 and 1270 nm
wavelengths. On the other hand, human cells (leukocytes, lymphocytes,
stem cells, fibroblasts, etc) can be stimulated by low power laser
light of just these wavelengths. From thermodynamical point of
view, living systems - in contrast to dead organisms - are open
systems which need metabolism in order to maintain their highly
ordered state of life. Such states can only exist far from thermodynamical
equilibrium thus dissipating heat in order to maintain their high
order and complexity. Such nonequilibrium systems are called dissipative
structures proposed by the Nobel laureat I. Prigogine. One of
the main feature of dissipative structures is their ability to
react very sensibly on weak influences, e.g. they are able to
amplify even very small stimuli. Therefore, we must expect that
even weak laser light of proper wavelength and proper irradiation
should be able to influence the dynamics of regulation in living
systems. For example, the transition from a cell at rest to a
dividing one will occur during a phase transition allready influenced
by the tinest fluctuations. External stimuli can induce these
phase transitions which would otherwise not even take place. These
phase transitions induced by light can be impressively illustrated
by various chemical and physiological reactions as special kinds
of dissipative systems. One of he most important biochemical reaction
localized in mitochondria is the oxidation of NADH in the respiatory
chain of aerobic cells. A similar reaction has been found to be
a dissipative process showing oscillating and chaotic behaviour
capable to absorb and amplify photons of proper wavelength. A
great variety of experimental and clinical results in the field
of low level laser therapy supports these two biophysical points
of view concerning the interaction beween life and laser light.
Our former, but also our recent experimental results on the effects
of low level laser light on human cells are steps in this direction.
By using cytometric, photometric and radiochemical methods it
is shown that the increase or decrease of cells growth depends
on the applied wavelenghts (480, 570, 633, 700, 760, 904, 1060,
1270 nm), on the irradiance (100 - 5000 J/m2), on the pulse sequence
modulated to laser beams (constant, periodic, chaotic pulses),
on the type of cells (leukocytes, lymphocytes, fibroblasts, normal
and cancer cells) and on the density of the cells in tissue cultures.
Our experimental results support our hypothesis
which states that triplet oxygen molecules are able to absorb
proper laser light at wavelenght at wavelenghts 480, 570, 633,
700, 760, 904, 1060, 1270 nm thus producing singlet oxygen molecules.
Singlet oxygen takes part in many metabolic processes, e.g. catalytic
oxydation of NADH which has been shown to be a dissipative system
far from thermodynamical equilibrium and sensitive even to small
stimuli. Therfore, laser light of proper wavelenght and irradiance
in low level laser therapy is assumed to be able to exicte oxygen
molecules thus influencing or amplifying metabolism and consequently
influencing and supporting fundamental healing processes.
|
|
LOW INTENSITY LASER THERAPY
(LILT) IN THE MAXILLOFACIAL REGION
Paul Bradley The Royal London School of Medicine
and Dentistry, London, England
The region of the face and mouth is well suited
to Low Intensity Laser Therapy (LILT) in view of ease of access.
It is also an area associated with a variety of painful conditions
and intractable ulcers which have proved amenable to LILT in a
total of around 500 cases. Our practise is based on several postgraduate
research projects:
1. Studies of depth penetration of 820nm. These have been undertaken
using a CCD camera to demonstrate penetration depths in non vital
tissue specimens augmented by observations in the living subject
with isotropic detectors.
2. Investigation of vascular response. A thermographic camera
has been used for local heating effects while laser doppler has
been employed to measure microcirculatory flux. Ultrasound doppler
allowed monitoring of arterial status. A variety of wavelengths
and fluxes have been investigated.
3. Double blind clinical trial in temporomandibular joint disorder
pain. Methods have included algometry for pressure point thresholds,
electromyography for muscular activity and sensor tracking for
mandibular movement.
4. Study of effect on osseointegration of implants in jaw and
femur. Research methods have involved mechanical push out testing,
radiovisiography, x-ray microtomography and histomorphometry in
the rabbit experimental model. On the basis of the data acquired
clinical practise has been undertaken particularly in the following
conditions:
1. Post Herpetic Neuralgia,
2. Temporomandibular Joint Disorder Pain
3. Trigeminal Neuralgia
4. Atypical Facial Pain,
5. Pain from Acute Maxillofacial Trauma
6. Palliation of Pain from Unresectable Orofacial Cancer,
7. Intractable Oral Ulcerations,
8. Nerve Lesions,
9. Cavernous Haemangiomas Of the Facial Region in Infants
The results of this clinical practise are described
and analysed.
|
|
ACTION OF 904 NM DIODE LASER
IN ORTHOPAEDICS AND TRAUMATOLOGY
Giuseppe Tam, M. D. Specialist in Legal/Insurance
Medicine, Laser Center Tolmezzo - Italy
Objective: The semiconductor or laser diode
(GaAs, 904 nm) is the most appropriate choice in pain-reduction
therapy.
Summary Background Data: Low power density laser acts on
the Prostaglandins synthesis, increasing the change of PGG2 and
PGH2 Periossidos into PGI2 (also called Prostaciclyn or Endoprostol).
The last one is the main product of the Arachidonic acid into
the endothelial cells and into the smooth muscular cells of the
vessel walls having a vasodilating and anti-inflammatory action.
Methods: Treatment was carried out on 447 cases and 435
patients (250 women and 185 men) in the period between 20.05.1987
and 31.12.1999. The patients, whose age ranged from 25 to 70,
with a mean age of 45 years, were suffering from rheumatic, degenerative
and traumatic pathologies as well as cutaneous ulcers. The majority
of the patients had been seen by orthopaedists and rheumatologists
and had undergone x-ray examination. All patients had received
drug-based treatment and/or physiotherapy, with poor results.
Two thirds were experiencing acute symptomatic pain, while the
others presented a chronic pathology with recurrent crises. We
used a pulsed diode laser, GaAs 904 nm wavelength. Frequency of
treatment: 1 application per day for 5 consecutive days, followed
by a 2-day interval. In the evaluation of the results the following
parameters have been considered: disappearance of spontaneous
and induced pain, anatomic and functional evaluation of the joints,
muscular growth, verbal rating scales, hand dinamometer, patient's
pain diary.
Results: Very good results were achieved especially with
cases of symptomatic osteoarthritis of the cervical vertebrae,
with sport-related injuries, with epicondylitis, and with cutaneous
ulcers; also, last but not of least importance, with cases of
osteoarthritis of the coxa.
Conclusions: Treatment with 904 nm diode laser has substantially
reduced the symptoms as well as improved the quality of life of
the patient, thus postponing the need for surgery
|
|
ACTION OF 904 NM DIODE LASER
IN ORTHOPAEDICS AND TRAUMATOLOGY
Giuseppe Tam, M. D. Specialist in Legal/Insurance
Medicine, Laser Center Tolmezzo - Italy
Objective: The semiconductor or laser diode
(GaAs, 904 nm) is the most appropriate choice in pain-reduction
therapy.
Summary Background Data: Low power density laser acts on
the Prostaglandins synthesis, increasing the change of PGG2 and
PGH2 Periossidos into PGI2 (also called Prostaciclyn or Endoprostol).
The last one is the main product of the Arachidonic acid into
the endothelial cells and into the smooth muscular cells of the
vessel walls having a vasodilating and anti-inflammatory action.
Methods: Treatment was carried out on 447 cases and 435
patients (250 women and 185 men) in the period between 20.05.1987
and 31.12.1999. The patients, whose age ranged from 25 to 70,
with a mean age of 45 years, were suffering from rheumatic, degenerative
and traumatic pathologies as well as cutaneous ulcers. The majority
of the patients had been seen by orthopaedists and rheumatologists
and had undergone x-ray examination. All patients had received
drug-based treatment and/or physiotherapy, with poor results.
Two thirds were experiencing acute symptomatic pain, while the
others presented a chronic pathology with recurrent crises. We
used a pulsed diode laser, GaAs 904 nm wavelength. Frequency of
treatment: 1 application per day for 5 consecutive days, followed
by a 2-day interval. In the evaluation of the results the following
parameters have been considered: disappearance of spontaneous
and induced pain, anatomic and functional evaluation of the joints,
muscular growth, verbal rating scales, hand dinamometer, patient's
pain diary.
Results: Very good results were achieved especially with
cases of symptomatic osteoarthritis of the cervical vertebrae,
with sport-related injuries, with epicondylitis, and with cutaneous
ulcers; also, last but not of least importance, with cases of
osteoarthritis of the coxa.
Conclusions: Treatment with 904 nm diode laser has substantially
reduced the symptoms as well as improved the quality of life of
the patient, thus postponing the need for surgery.
|
|
METHODS OF MEASUREMENT OF SELECTED
OPTICAL PARAMETERS OF HUMAN TISSUES USING OPTICAL FIBER PROBE
A.Kukwa2), Z.Jankiewicz1), D.Podniesinski1), M.Skórczakowski1),
M.Tulibacki2), A.Zajac1) 1) Institute of Optoelectronics, Military
University of Technology, 2 Kaliski St., 00-908 Warsaw, POLAND,
tel. (48#22) 685- 93-28, fax (48#22) 666-89-50, e-mail masteer@sec.polbox.pl
2) Medical University, 30 Filtrowa St., 00-908 Warsaw, POLAND,
tel. (48#22) 841-05-05,
The data available in literature concerning optical
properties of tissues are for the linear absorption range, i.e.,
the absorption characteristics are determined for low intensity
and for dead tissues sample using various measuring methods 1,2.
The new optical methods of real time measurements the actual values
of absorption coefficient or scattering coefficient in tissues
are presented in this paper. The changes of scattering coefficient
caused by laser heating of the tissue resulting in its coagulation
have been measured by the method illustrated in Fig.1.
In this method the moment of stabilization of the tissue transmittance
is detected (Fig.2) what corresponds with the moment of coagulation.
Table 1. Measurements results of real absorption coefficient for
the chosen tissues Laser type Tissue kind Threshold energy[mJ]
Defect area[mm2] Absorption coefficient ???cm-1] CTH:YAG liver
78 3.46 112.1 muscle 80 5.72 180.7 Er:YAG liver 10 0.82 2072 muscle
7 0.34 1228 Another method consists in detection of the moment
of ablation the irradiated tissue surface - Fig.3. At the moment
the backscattered light distribution is rapidly disturbed because
of the vaporization of the tissue. For the vaporization process
the energy is necessary the value of which can be calculated from
relationship: , where S is an interaction area, x is the light
penetration depth of the tissue, r and c is the specific density
and specific heat of the tissue, Epf is the energy of tissue vaporisation.
From the other side for exposition with radiation beam in the
medium of volume of the energy will be absorbed the value of which
depends on the value of absorption coefficient. It is expressed
by: , where E0 is the energy incident on the surface S, a is the
medium absorption coefficient. Due to it for limiting (boundary)
transition for x® 0 we have peak density of energy causing destruction
of tissue surface , where the value 2527.2 ([J/cm3]) is results
from energy balance of a phase change (from temperature 36.60C
to temperature of total vaporisation). The exemplary results of
the measurement are presented in Table1.
Fig.3. Scheme of a measuring system used for analysis of
values of absorption coefficient during a laser treatment
and for measurement of indicative beam.
|
 |
REFERENCES 1. S.A.Prahl, M.J.C.van Germet, A.J.Welch; Determining
the optical properties of turbid media by using the adding-doubling
method, Appl. Opt. vol.32, pp.559-568, 1993 2. J.W.Pickering,
at all: Double-integrating-sphere system for measuring the optical
properties of tissue, Appl. Opt. vol.32, pp.399-410, 1993
|
|
NEW METHOD OF CHARACTERISATION
OF LASER BEAM INTERACTION EFFECT WITH TISSUES
A.Kukwa2), D.Podniesinski1), M.Skórczakowski1),
M.Tulibacki2), A.Zajac1) 1) Institute of Optoelectronics, Military
University of Technology, 2 Kaliski St., 00-908 Warsaw, POLAND,
tel. (48#22) 685- 93-28, fax (48#22) 666-89-50, e-mail masteer@sec.polbox.pl
2) Warsaw Medical University, 30 Filtrowa St., 00-130 Warsaw,
POLAND, tel. (48#22) 841-05-05,
There are many laser sources emitting in the spectral
range from 200 nm to 10,6mm, which are applied in medical equipment.
In such a wide spectral range biological tissues change their
optical parameters significantly especially the value of absorption
coefficient of radiation varies considerably. In last years the
scientific researches have been started in order to apply laser
sources of near infrared radiation (NIR) (of wavelengths from
2000nm to 3000nm) in medical equipment. The main representatives
of laser sources in this range are the following lasers: CTH:YAG
(l=2080nm), Tm:YAG (l=2010nm), Er:YAG (l = 2940nm). These lasers
are characterized by extremely high values of absorption coefficient
in tissues (especially Er:YAG laser radiation). The typical method
of classifications laser radiation interaction with tissues which
is used up to now is based on well known Ledukhov's diagram [1].
In this approach the value of intensity [W/m2] or energy density
[J/cm2] is the base to categorize the mechanism talking place
during the interaction of radiation with biological tissues -
fig.1.
[2]. Fig.2. The volumetric energy density vs. tissue absorption
coefficient for different fluence of laser radiation In the spectral
range from 800nm to 3000nm the value of absorption coefficient
a changes from 0.174 cm-1 to 13245 cm-1 respectively and is extremely
high or low in all optical range [3]. It is obvious that for such
a huge variation of absorption coefficient we can not use the
only one model of interaction of radiation with the tissue - even
in the cases when the physical mechanism of absorption are identical
for any sources. As the result the certain diagrams proper for
the specific radiation sources are constructed. These models may
be proper also for the sources characterized by comparable depth
of light penetration in tissues. To characterize the processes
of laser radiation interaction with tissues more precisely the
new diagram has been constructed assuming that the volumetric
energy density absorbed in tissues is the objective parameter,
which determines the process of the interaction. In this approach
it is possible to take into account the phase conversion processes
such as coagulation and vaporization of biological tissues. The
diagram presented on fig.2. allows to predict the results of interaction
of laser radiation with tissue precisely taking into consideration
the actual value of absorption coefficient characteristic for
real levels of beam's fluence not as in hitherto approaches where
only value of linear absorption coefficient has been considered.
References:
1. V.V.Tuchin, S.R.Utz, A.Yu.Barabanow et al.; Laser Phototherapy
of Psoriasis, Proc. SPIE, vol.1422, s.85-96, 1991r 2. S.J.Gitomer,
R.D.Jones; Laser - produced plasmas in medicine, Proc. SPIE, vol.1202,
s. 118-132, 1990r 3. A.Oreavski, S.Jacques, et al.; Laser-tissue
interaction studied by time-resolved stress detection, CLEO'94,
ref. CWN4, 1994r
|
|
WOUND HEALING IN ANIMALS AND
HUMANS WITH USE OF LOW LEVEL LASER THERAPY-TREATMENT OF OPERATED
SPORT AND TRAFFIC ACCIDENT INJURIES:
A Randomized Clinical Study. 1Zlatko Simunovic,
M.D., F.M.H., 2Anthony D. Ivankovich, M.D., 3Arsen Depolo, M.D.,
Ph.D 1Department of Anesthesiology and Intensive Care Unit, La
Caritá Medical Center, Laser Center, Locarno, Switzerland 2Department
of Anesthesiology, Rush Presbyterian St. Luke's Medical Center,
Chicago, Illinois, USA 3Department of Surgery, Medical School,
University of Rijeka, Rijeka, Croatia
Background and Objective: The main objective
of current animal and clinical studies was to assess the efficacy
of Low Level Laser Therapy (LLLT) on wound healing in rabbits
and humans.
Study Design/Materials and Methods: A randomized controlled
study in rabbits initially evaluated the effects of laser irradiation
on the healing of surgical wounds. The application of LLLT to
human tissues is comparable to animal tissues of similar physiological
structure, so a clinical evaluation was subsequently conducted.
After surgical therapy for injuries involving the ankle and knee
bilaterally, Achilles tendon, epicondylus, shoulder, wrist, or
interphalangeal joints of hands unilaterally, LLLT was used in
74 patients for 18 days. Infrared diode laser (GaAlAs) 830 nm
continuos wave was used for treatment of Trigger Point (TP) and
HeNe 632.8 nm combined with diode laser 904 nm pulsed wave laser
for scanning procedures, both applied as monotherapy during the
current clinical study. The presence of redness, heat, pain, swelling
and loss of function were assessed.
Results: Wound healing was significantly accelerated (25-35%)
in the group of patients treated with LLLT. Pain relief and functional
recovery of patients treated with LLLT were significantly improved
comparing to untreated patients.
Conclusion: In addition to accelerated wound healing, main
advantages of LLLT of postoperative sport- and traffic- related
injuries are reduced exposure to side effects of drugs, significantly
accelerated functional recovery, earlier return to work, training
and sport competition, with cost benefit compared to control patients.
|
|
LOW LEVEL LASER THERAPY IN DENTISTRY
1 Kresimir Simunovic, D.M.D., 2Zlatko Simunovic,
M.D., F.M.H. 1Private dental practice, Locarno-Zürich, Switzerland
2Pain Clinic-Laser Center, Locarno, Switzerland
In recent years there has been increasing number
of dentists using laser technology, either low or high-energy
level lasers. There is no laser yet developed that totally replaces
the conventional rotary instruments, but some routine work in
dental practice can now be done with use of lasers This lecture
will give a brief overview of dental disorders, where LLLT proved
to be an efficient therapeutic procedure, whether applied as monotherapy
or complementary treatment modality LLLT is mainly used for the
treatment of soft tissues inside oral cavity, in order to relieve
the pain or to induce wound healing, or as a diagnostic device
for dental diseases like early detection of caries. Effects of
LLLT are based upon biostimulative-regenerative effect, anti-inflammatory
and analgesic effect
Here are some of pathological changes, which can
successfully be treated with LLLT:
- Wounds after extractions
- Recovery after dental and periodontal surgical procedures
- Open and closed wound healing after minor and major oral surgery
- Lip wounds and combustions
- Abscess
- Scar tissue
- Alveolitis sicca
- Haemathoma
- Herpes labialis
- Aphtae
- Ragadae
- Mucositis
- Dentitio difficilis
- Damages of the mucosa due to the incorrectly sitting prosthesis
- Crown preparation
- Nerve lesions
- Acute and chronic disease of periodontal tissue
- Neuralgia n. trigemini
- Temporo
-mandibular joint disorders
- Trismus
This lecture will bring you exact irradiation techniques and efficient
energy densities, which are determined after many years spent
in the clinical application of LLLT in dentistry.
|
|
PAIN AND PRACTICAL ASPECTS OF
ITS MANAGEMENT
Zlatko Simunovic, M.D., F.M.H. Pain Clinic-Laser
Center, Locarno, Switzerland
It took more than 2000 years to understand what
does the pain mean. Modern technology enabled detailed investigation
of pain, facilitating its better comprehension and helping us
to understand that the pain, especially acute one, is a useful
information. The most frequent aches are back pain and headache,
followed by the neck pain, toothache and stomachache. Back pain
is wide-spread condition, especially in the industrially developed
countries, where it has become almost an epidemic. 30-40% of population
between 10 and 65 years of age visits their physician at least
once a month due to the back pain. But, as much as pain is an
unpleasant sign, it is very useful and essential for the preservation
of life. Pain is a warning signal, which clearly demonstrate that
something goes wrong with that particular part of the body. Simply,
pain is an emergency call. There are two types of pain: acute
pain, which has an identifiable source and is limited in duration,
and chronic pain, which develops when certain diseases associated
with pain become chronic from unknown reasons or when pain mechanism
goes awry. Acute pain is a symptom, while chronic pain is a disease
itself. There are also different types of pain according to its
origin: stress induced pain, neuropathic, nociceptive, reflected,
referred, transferred, visceral, psychosomatic pain, etc. Graphic
presentations of each type of pain will be discussed during the
lecture. This lecture will also bring you an overview about the
physiology of pain, standardised medical approaches to the patient
with pain, current approaches to the treatment of pain and dysfunction,
as well as different modalities currently in use for pain intensity
measurement (Visual Analogue Scale-VAS, Verbal Rating Scale-VRS,
101 rating scale, McGill's Pain Questionnaire, etc). Low Level
Laser Therapy (LLLT) has been used for decades in order to relieve
the pain, as monotherapy or complementary treatment modality.
One of its main mechanisms of action on the human body refers
to the analgesic effects of laser beam. This effect can easily
be achieved if proper application methods and technique are used,
with adequate and optimal energy densities applied on human body.
LLLT acts on cellular and histological level when applied on human
body, where mechanisms of analgesic effect will be discussed in
details. Optimal and individual range of energy densities and
irradiation techniques recommended for the treatment of the musculosceletal
system will be presented in this lecture.
|
|
LASER THERAPY - A NEW MODALITY
IN THE TREATMENT OF PERIPHERAL NERVE INJURIES (Twenty-five
years experience from basic science to clinical studies)
S. Rochkind, MD Department of Neurosurgery, Tel
Aviv Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel,
E-mail: rochkind@zahav.net.il
Since our first publication (Rochkind 1978), we
have been studying and testing low power laser irradiation as
a means to treat peripheral nerves, using both in vitro and in
vivo methods. We have reached the clinical stage and are treating
a variety of peripheral nerve injuries. This study is a review
of my personal experience over the last twenty-five years in the
use of laser therapy in treating these conditions.
I. Influence of Low Power Laser Irradiation on Nerve Cells
A study was done using direct 632.8nm HeNe laser irradiation to
determine the effect of focused laser beams on aggregates of rat
fetal brain cells and rat adult brain. The direct HeNe laser irradiation
3.6J/cm2 caused a significant amount of sprouting of cellular
processes outgrowth in aggregates, compared to small amounts produced
by non-irradiated controls. This observation suggests that low
power laser irradiation applied to the area of an experimentally
injured nerve may induce axonal processes sprouting, thereby improving
nerve tissue recovery. The mechanism of low power laser on nerve
tissue is not completely understood, but some studies partially
explain the photochemical effect of laser irradiation on the biological
system. Cytochromes are affected, thereby stimulating redox activity
in the cellular respiratory chain, thereby causing increases in
ATP production which activates Na+, K+ -ATPase and other ion carriers,
thereby increasing cell activation.
II. Animal Studies - influence of laser therapy on the severely
injured peripheral nerve
A radiation method for treating lesions in both the peripheral
and central nervous systems was proposed in 1978 by Rochkind and
modified over the years. The model used in this work was the rat
sciatic nerve. Low power laser irradiation then was delivered
to the crushed nerve either transcutaneously or directly. The
effects of this laser therapy were measured both in the short-term,
i.e. minutes and in the long-term, i.e. days and months. Short-term
model: direct irradiation of the nerve was done through the open
wound directly to the crushed injured nerve and the compound nerve
action potential was measured. A variety of wavelengths and powers
were applied and 540nm, 632.8nm and 780nm were found most effective
(p=0.01). Long-term model: We found electrophysiolgical activity
dropped as expected in the non-irradiated nerves following the
crush injury, but the use of low power laser irradiation prevented
or decreased this phenomenon (p=0.001), both immediately after
the crush and in the long term. Furthermore, this investigation
showed that when laser treatment was delivered to both the crushed
nerve and the corresponding segments of the spinal cord, the recovery
time and the quality of regeneration of the crushed sciatic nerve
improved, compared to the application of irradiation to the nerve
alone. Histological studies supported the electrophysiological
findings: low power laser irradiation was found to prevent or
decrease scar tissue formation in the injured area. Laser irradiation
enhanced axonal sprouting in the crush-injured sciatic nerve,
thus accelerating recovery of the severely injured peripheral
nerve. In addition, a beneficial effect of low power laser irradiation
was found not only in the laser-treated nerve, but in the corresponding
segments of the spinal cord as well. Such laser treatment has
been found to decrease significantly the degenerative changes
in the corresponding neurons of the spinal cord and induce proliferation
of neuroglia, both in astrocytes and oligodendrocytes. This suggests
a higher metabolism in neurons and a better ability to produce
myelin under the influence of laser treatment. Also, low power
laser irradiation exerts pronounced systemic effects on severely
injured peripheral nerves and corresponding regions of the spinal
cord.
III. Double-Blind Randomized Study Evaluating Regeneration
of the Rat Sciatic Nerve after Suturing and Post-Operative Laser
Therapy
The therapeutic effect of low power laser irradiation on peripheral
nerve regeneration after complete transection and direct anastomosis
of the rat sciatic nerve was studied recently. A 780nm laser wavelength
was applied transcutaneously 30 minutes daily for 21 consecutive
days to corresponding segments of the spinal cord and to the injured
sciatic nerve immediately after closing the wound. Positive somato-sensory
evoked responses were found in 55% of the irradiated rats and
in 11% of the non-irradiated rats. Immuno-histochemical staining
in the laser-treated group showed more intensive axonal growth
and better quality of the regenerative process due to an increased
number of large and medium diameter axons. IV. Clinical Pilot
Studies The group of patients who were treated in the Department
of Neurosurgery at Tel Aviv Sourasky Medical Center had been suffering
from severe peripheral nerve and brachial plexus injuries for
more than two years. Each of the 59 patients received laser treatment
CW, 780nm, five hours daily for 21 consecutive days with the use
of a laser system specially developed for our treatment method.
Criterion for laser treatment in these cases was as follows: patients
who suffered from partial motor and sensory disturbances and where
surgery was not indicated. Fifty-six percent of the laser-treated
patients showed good to excellent results in their motor function.
V. Clinical Double-Blind Placebo-Controlled, Randomized Study
of Low Power Laser in the Treatment of Peripheral Nerve Injures
Since our previous pilot clinical results were positive, a final
evaluation of the response to treatment was in order. Therefore,
we performed a double-blind, placebo-controlled randomized study
of patients who had been suffering from incomplete peripheral
nerve and brachial plexus injuries from 6 months up to several
years after injury. The protocol of this study was done with the
permission of the Helsinki Committee of the Tel Aviv Sourasky
Medical Center and with the approval of the Ministry of Health
of Israel and by a grant from the Rehabilitation Department of
the Ministry of Defence of Israel. The study evaluated the functional
recovery of these patients after undergoing low power laser or
placebo treatment. Recovery was classified by comparing each of
the deficits present before and after surgery. The post-laser
or post-placebo grade was determined by the change in strength
compared to the pretreatment levels. In almost all cases, the
level of motor function was minimal to poor pre-treatment. In
the laser-treated group, statistically significant improvement
was found in motor functional activity P=0.0001, compared to the
placebo group). The electrophysiological findings also showed
statistically significant improvement in the laser-treated group.
Our twenty-five years of experience indicates that Laser Therapy
is a low-cost, non-invasive method and will be recognized as standard
additional treatment for improving the functional recovery of
patients with peripheral nerve and brachial plexus injuries. According
to our clinical experience, the main advantages of Laser Therapy
are the enhancement and acceleration of the recovery of injured
nerve tissue. The therapeutic results show that an objective progressive
improvement appears in nerve function, leading to a significant
and earlier recovery.
|
|
TREATMENT OF MEDIAL AND LATERAL
EPICONYLITIS - TENNIS AND GOLFER'S ELBOW-WITH LOW LEVEL LASER
THERAPY: A MULTICENTER DOUBLE BLIND, PLACEBO CONTROLLED CLINICAL
STUDY ON 324 PATIENTS
1Zlatko Simunovic, M.D., F.M.H., 2Tatjana Trobonjaca,
M.D. and 3Zlatko Trobonjaca, M.D. 1Pain Clinic-Laser Center, Locarno,
Switzerland 2Laser Center, Opatija, Croatia 3Department of Physiology
and Immunology, Faculty of Medicine, University of Rijeka, Croatia
Among the other treatment modalities of medial and
lateral epicondylitis, Low Level Laser Therapy (LLLT) has been
promoted as a highly successful method. The aim of this clinical
study was to assess the efficacy of LLLT using trigger points
(TPs) and scanning application techniques under placebo controlled
conditions The current clinical study was completed at two laser
centers (Locarno, Switzerland and Opatija, Croatia) as a double-blind,
placebo controlled, crossover clinical study. The patient population
(n=324), with either medial epicondylitis (Golfer's elbow; n=50)
or lateral epicondylitis (Tennis elbow; n=274), was recruited.
Unilateral cases of either type of epicondylitis (n=283) were
randomly allocated to one of three treatment groups according
to the LLLT technique applied: (1) TPs; (2) scanning, and (3)
Combination treatment (i.e., TPs and scanning technique). Bilateral
cases of either type of epicondylitis (n=41) were subject to crossover,
placebo controlled conditions. Laser devices used to perform these
treatments were infrared (IR) diode laser (GaAlAs) 830nm continuous
wave for treatment of TPs and HeNe 632.8nm combined with IR diode
laser 904nm pulsed wave for scanning technique. Energy doses were
equally controlled and measured in Joules/cm2 either during TPs
or scanning technique sessions in all groups of patients. The
treatment outcome (pain relief and functional ability) was observed
and measured according to the following methods: (1) short form
of McGill's Pain Questionnaire (SF-MPQ); (2) Visual analogue scale
(VAS); (3) Verbal Rating Scale (VRS); (4) Patient's pain diary;
and (5) hand dynamometer. Total relief of the pain with consequently
improved functional ability was achieved in 82% of acute and 66%
of chronic cases, all of which were treated by combination of
TPs and scanning technique.
This clinical study has demonstrated that the best results are
obtained using combination treatment (i.e., TPs and scanning technique).
Good results are obtained from adequate treatment technique correctly
applied, individual energy doses, adequate medical education,
clinical experience and correct approach of laser therapists.
We observed that under-and over-irradiation dosage can result
in the absence of positive therapy effects or even opposite, negative
(i.e. inhibitory) effects. The current clinical study provides
further evidence of the efficacy of LLLT in the management of
lateral and medial epicondylitis.
|
|
LOW LEVEL LASER THERAPY IN DERMATOLOGY:
AN OVERVIEW OF THERAPEUTIC POSSIBILITIES
1Zlatko Simunovic, M.D., F.M.H., 2Tatjana Trobonjaca,
M.D. 1Pain Clinic-Laser Center, Locarno, Switzerland 2Laser Center,
Opatija, Croatia
The first application of Low Level Laser Therapy
(LLLT) was completed on dermatological disorders like skin ulcers,
in early sixties. In the meantime, dermatological indications
for LLLT have increased. Particular effects of LLLT are observed
when laser beam is applied on the open wound, which healing can
be significantly accelerated especially in patients with delayed
or impeded wound healing like patients with circulatory disorders,
diabetic patients, etc. LLLT triggers biostimulative-regenerative
processes inside the cell and subsequently causes revitalisation
of the issue as well. Second effect of LLLT refers to the vasodilatation
and neovascularisation of local blood and lymph vessels, thus
causing a better removal of waste products and, on the other hand,
improved oxygenation and nutrition of damaged tissue. Analgesic
and anti-inflammatory effects of LLLT are also significant when
irradiating certain dermatological changes. All effects mentioned
before will be discussed in details during the lecture. Therefore,
LLLT is used today in dermatology in the treatment of the following
conditions: - Ulcus cruris - Burns - Herpers infections - Scar
tissue - Keliod - Sclerodermia - Rosacea - Neurodermitis - Eczema
- Lichen ruber planus and scrofulosus - Psoriasis - Haemathoma
- Etc. Each pathological condition will be explained, and optimal
and individual energy densities will be presented in this lecture.
|
|
AESTHETIC TREATMENTS WITH LOW
LEVEL LASER THERAPY
1Tatjana Trobonjaca, M.D., 2Zlatko Simunovic, M.D.,
F.M.H. 1Laser Center, Opatija , Croatia 2Pain Clinic-Laser Center,
Locarno, Switzerland
If taking into the consideration the list of aesthetic
disorders which can be treated with either Low Level Laser Therapy
(LLLT) or surgical lasers, it is justified to say that laser is
also the light of beauty. Although its first applications were
focussed on serious diseases like skin ulcers and painful conditions,
employment of LLLT in aesthetics has initiated in mid seventies.
Aesthetic changes are mainly benign and they won't seriously damage
the health state of patient's body, but aesthetic problems are
strictly subjective and the same problem causes different psychological
reaction in different persons. Development in modern medicine
and technology brought many new techniques and devices, which
are successfully used in aesthetics today. Laser is one of the
highlights in aesthetics today where it is applied mostly for
facial rejuvenation, because the face is psychologically the most
sensitive aesthetic area of each person. Facial rejuvenation can
be achieved with surgical lasers, which remove superficial layer
of atrophic skin, leaving that area to be self- regenerated. It
is an invasive method, while the process of regeneration can last
few weeks even months, with a prohibition of disposing to the
sunlight. On the other hand, skin rejuvenation can be completed
with use of LLLT or athermal lasers like HeliumNeon (HeNe) or
infrared (IR). The first one is mostly applied in the treatment
of superficial changes, while the IR laser is used for irradiation
of deeper structures. LLLT obtains good results in aesthetics
due to its three main effects: biostimulative-regenerative, analgesic
and anti-inflammatory effect, which will be presented in this
lecture. LLLT can be applied in aesthetics like monotherapy or
complementary treatment modality to the topic medications. Frequent
indications for LLLT in aesthetics are as follows: - Acne - Cellulite
- Striae - Alopecia - Wrinkles - Lentigo senile This lecture will
cover all relevant details related to LLLT and each condition,
with application techniques and recommended individual optimal
energy densities.
|
|
LOW LEVEL LASER THERAPY WITH
TRIGGER POINTS TECHNIQUE: A CLINICAL STUDY ON 243 PATIENTS
Zlatko Simunovic, M.D., F.M.H. Pain Clinic-Laser
Center, Locarno, Switzerland
Among various methods of application techniques
in Low Level Laser Therapy (LLLT), there is also very promising
trigger points (TPs) technique. Trigger points are myofascial
zones of particular sensibility and of highest projection of focal
pain points due to ischaemic conditions. The effect of LLLT and
the result obtained after clinical treatment of more than 200
patients turn out to better that we have ever expected. The pathological
conditions treated in this study comprised: headaches, facial
pain, musculoskeletal ailments, myogenic neck pain, shoulder-arm
pain, epicondylitis humeri, tenosynovitis, low back pain and radicular
pain and Achilles tendinitis. According to clinical parameters,
it has been observed that the rigidity decreases, the mobility
is restored (functional recovery) and that the spontaneous or
induced pain decreases or even disappears by movement, too. LLLT
improves local microcirculation and it can also improve oxygen
supply to hypoxic cells in the TPs area, while at the same time
it can remove collected waste products. The normalisation of the
microcirculation obtained thanks to laser application, interrupts
the circulus vitiosus of the origin of the pain and its development
(Melzack: muscular tension>pain>increased tension>increased pain>etc.).
Results (measured according to the VAS/VRS/PTM): by acute pain-diminishment
more than 70% and by chronic pain more than 60%. Clinical effectiveness
(success of failure) depends upon the correctly applied energy
dose - over/under dosage produces opposite, negative effects on
cellular metabolism. We haven't observed any negative effects
on human body and the use of analgesic drugs could be reduced
or completely excluded. LLLT showed us that the laser beam could
be used in the form of monotherapy or as a complementary treatment
to other therapeutic procedures, above all by chronic pain treatment.
|
|
WHAT ARE THE THERAPEUTIC POSSIBILITIES
OF LOW LEVEL LASER THERAPY IN GYNAECOLOGY, UROLOGY, AND NEUROLOGY?
Zlatko Simunovic, M.D., F.M.H. Pain Clinic-Laser
Center, Locarno, Switzerland
This lecture is based upon more than twenty years
of clinical experience in Low Level Laser Therapy (LLLT) of its
author. LLLT can be successfully applied in gynaecology and urology
due to the specific histologic characteristics of the mucus membrane.
Laser beam easily passes through the mucus membrane, thus achieving
good results in the therapy of genital herpes, various types of
inflammatory diseases especially in vagina and portio uteri, accelerated
wound healing, etc. Particularity related to each of those fields
of medicine as well as optimal energy densities and therapeutic
techniques will be discussed in this lecture. Neurology is a field
of medicine where LLLT can be applied either on inflammatory or
degenerative (painful) disorders. The application of LLLT on the
nerve system disorders is mainly due to its analgesic and anti-inflammatory
effect. Here is the list of neurological diseases, which can be
treated with LLLT: - Carpal tunnel syndrome - Trigeminal neuralgia
- Headache - Paresis n. facialis - Radiculopathy of the spinal
cord - Neuralgia post herpes zoster - Ischialgia - Paresis of
various nerve branches - Peripheral nerve injury This lecture
will bring you scientific explanations of LLLT treatments as well
as optimal, individual energy densities and treatment techniques.
|
|
APPLICATION OF LOW LEVEL LASER
THERAPY ON CHILDREN
1Zlatko Simunovic, M.D., F.M.H., 2Tatjana Trobonjaca,
M.D. 1Pain Clinic-Laser Center, Locarno, Switzerland 2Laser Center,
Opatija, Croatia
The specificity of paediatric patients lies within
their psychological and physiological differences from adults.
Physiologically there is a difference in their metabolic process,
hormone balance, the thickness of the skin, etc. Psychologically,
children in general "see things with their own eyes" and are afraid
of the physician, while the visit to the medical office represents
a stress to the small patient. Children can be treated with Low
Level Laser Therapy (LLLT) without causing any damage to the tissue.
They accept this treatment modality very well because it is a
painless and non-invasive therapeutic procedure. Indications are
the same as those for adults. The only difference in the treatment
of an adult and a child is in applied energy densities. This lecture
will present special approach to the child and conditions, which
have to be fulfilled prior to the treatment itself. Recommended
energy densities will be discussed in details, with the explanation
of particular contraindications in children.
|
|
Poster Session TREATMENT OF
EPISIOTOMY USING DIFFERENT FORMS OF PHOTOTHERAPY
Kymplova, J., Skopek, J., Navratil, L., Knizek
J. Laser Centrum THERAP-TILIA, Prague, Czech Republic
Clinical section of the Department of Biophysics,
1st Medical Faculty, Charles University, Prague, VLA Hradec Kralove,
Czech Republic E-mails: kymplova@atlas.cz; skopek@cesnet.cz; leos.navratil@atlas.cz
Recently, we can see an increasing interest in the use of light
therapy as a medical tool. It is a therapy with only minimal side
effects and therefore it could be widely recommended. The problem
is, that well developed and generally accepted medical protocols
are not available. Broad variety of medical centers and private
physicians use their own protocols, differentiate one from the
other, based on more or less scientifically verified information.
Gynecology and Obstetrix is one of the fields in which phototherapy
is being used and the goal of our study was to make an objective
review of the possible effectiveness of different types of fototherapy
in this field. Episiotomy has been chosen as the most common surgery
in Obstetrix (as reported within almost 90 % of deliveries). Women
giving birth were divided into four groups as follows: 1st group,
as a control group, 2nd group, where polarized light of 400 -
2000 nm was used, 3rd group, in which monochromatic light (660
nm) and pulse magnetic field (8 mT, 100 Hz) were applied simultaneously,
and 4th group with application of therapeutic laser (685 nm).
Results of the study are summarized in the table :
Acknowledgements: This study has been financially supported by
Ministry of Education, grant No.: FJ MSM 111100005 (New technologies
and approaches in diagnostic, prevention and treatment).
|
|
Laser acupuncture references 2000 Selected
references Sources:
- Library of the Swedish Laser Medical Society.
- National Library of Medicine, http://www.nlm.nih.gov/pubs/cbm/acupuncture.html.
Cheng ZY, Zhao CX, Zhang YH, Yao SY. Superficial acupuncture combined
with He-Ne laser radiation in the treatment of facial spasm. Int
J Clin Acupunct 1991;2(1):95-7.
Danhof S. Laser treatment and smoking cessation. Dissertation.
Dutch Medical Acupuncture Assn. 2000. Fong K. Bronchial-asthma
treated by He-Ne laser radiation on ear points. Chin J Acupunct
Moxibustion 1990;3(4):272-3.
Hirsch D, Leupold W. [Placebo-controlled study on the effect of
laser acupuncture in childhood asthma]. Atemwegs Lungenkr 1994;20(12):701-5.
(Ger).
Hoffmann B, Bar T. [The reactions of the skin surface temperature
- a comparison between real and placebo laser acupuncture stimulation
of LI 4.]. Dtsch Z Akupunkt 1994;37(2):28-32. (Ger).
Jia YK, Luo HC, Zhan L, Jia TZ, Yan M. A study on the treatment
of schizophrenia with He-Ne laser irradiation of acupoint. J Tradit
Chin Med 1987 Dec;7(4):269-72.
King CE, Clelland JA, Knowles CJ, Jackson JR. Effect of helium-neon
laser auriculotherapy on experimental pain threshold. Phys Ther
1990;70(1):24-30.
King CE, Clelland JA, Knowles CJ, Jackson JR. Effect of helium-neon
laser auriculotherapy on experimental pain threshold. Phys Ther
1990;70(1):24-30.
Litscher G, Wang L, Wiesner-Zechmeister G: Specific effects of
laserpuncture on the cerebral circulation Lasers Med Sci 15 (2000)
1, 57-62
Mester E. [Biostimulative effect of laser beams]. Z Exp Chir 1982;15(2):67-74.
(Ger)
Mikhailova RI, Terekhova NV, Zemskaia EA, Melkadze N. [The laser
therapy and laser acupunture of patients with chronic recurrent
aphthous stomatitis]. Stomatologiia (Mosk) 1992 May-Dec;(3-6):27-8.
(Rus). Morton AR, Fazio SM, Miller D. Efficacy of laser-acupuncture
in the prevention of exercise-induced asthma.
Ann Allergy 1993 Apr;70(4):295-8.
Morton AR, Fazio SM, Miller D. Efficacy of laser-acupuncture in
the prevention of exercise-induced asthma. Ann Allergy 1993 Apr;70(4):295-8.
Odud AM, Potapenko PI. [The effectiveness of laser puncture in
hypertension patients]. Vrach Delo 1990 Jun;(6):19-21. (Rus)
Odud AM, Potapenko PI. [The use of laser puncture for managing
hypertensive crises]. Vrach Delo 1991 Jul;(7):34-6. (Rus).
Pothman R, Yeh HL. The effects of treatment with antibiotics,
laser and acupuncture upon chronic maxillary sinusitis in children.
Am J Chin Med 1982;10(1-4):55-8
. Shen Ching Ching Shen Ko Tsa Chih 1991 Apr;24(2):81-3, 124.
(Chi).
Tan C H, Sin Y M. The use of laser acupuncture point for smoking
cesssation. American J Acupuncture. 1987; 15: 137-141.
Wang F, Wang Z. Observation on clinical effect of 70 cases of
acute otitis media treated by He-Ne laser radiation on acupoints.
Chin J Acupunct Moxibustion 1991;4(1):30-3.
Wu XB. 100 cases of facial paralysis treated with He-Ne laser
irradiation on acupoints. J Tradit Chin Med 1990;10(4):300-1.
Zalesskiy VN, Belousova IA, Frolov GV. Laser-acupuncture reduces
cigarette smoking: a preliminary report. Acupunct Electrother
Res 1983;8(3-4):297-302.
Zhang B. [A controlled study of clinical therapeutic effects of
laser acupuncture for schizophrenia]. Chung Hua Zhang D, Gao Q.
Treatment of facial paralysis with laser and acupuncture; report
of 76 cases. Int J Clin Acupunct 1993;4(3):327-9.
Zhou YC. An advanced clinical trial with laser acupuncture anesthesia
for minor operations in the oro-maxillofacial region. Lasers Surg
Med 1984;4(3):297-303.
|
webmaster 
