LLLT, lllt, laser therapy - biostimulation
The Low Level Laser Therapy -
LLLT Internet Guide


This page presents new research
within the field of lllt -
Low Level Laser Therapy
.

Click for latest abstracts

Quick jump index on this page

 

auricular laser acupuncture references 2000


  Selected abstracts from the 7th International Congress
of European Medical Laser Association, Dubrovnik, Croatia, June 2000.
  WOUND HEALING PROCESS: INFLUENCE OF LLLT ON THE PROLIFERATION OF FIBROBLASTS AND ON THE LYMPHATIC REGENERATION LASER THERAPY AS A NEW MODALITY IN THE TREATMENT OF INCOMPLETE PERIPHERAL NERVE INJURIES: Prospective Clinical Double-Blind Placebo-Controlled Randomized Study
  NON-INVASIVE LASER THERAPY OF MORBUS PEYRONIE - INDURATIO PENIS PLASTICA HOW DANGEROUS IS LASER LIGHT?
  CHEMO-AND RADIATION-INDUCED MUCOSITIS : RESULTS OF MULTICENTER PHASE III STUDIES. LLLT IN VIVO EFFECTS ON MAST CELLS
  MECHANISMS OF LOW-POWER LASER LIGHT ACTION ON CELLULAR LEVEL WHAT IS OPTIMAL DOSE, POWER DENSITY AND TIMING FOR LOW LEVEL LASER THERAPY IN TENDON INJURIES?
  SEMICONDUCTOR LASER RAYS THERAPY FOR THE TREATMENT OF CHRONIC PROSTATITIS LOW LEVEL LASER THERAPY CAN BE EFFECTIVE FOR TENDINITIS: A META-ANALYSIS
  BIOPHYSICAL ASPECTS OF LOW LEVEL LASER THERAPY TINNITUS AND VERTIGO - A CASE FOR THE DENTIST?
  LOW INTENSITY LASER THERAPY (LILT) IN THE MAXILLOFACIAL REGION IS LLLT A PANACEA IN DENTISTRY?
  ACTION OF 904 NM DIODE LASER IN ORTHOPAEDICS AND TRAUMATOLOGY USE OF LOW-LEVEL LASER THERAPY (LLLT) FOR TREATMENT OF THE PATIENTS WITH A CANCER OF A ESOPHAGUS T3N0MX
  ACTION OF 904 NM DIODE LASER IN ORTHOPAEDICS AND TRAUMATOLOGY THE USE OF LASER THERAPY AND ADDITIONAL THERAPEUTIC MODALITIES AFTER ARTHROSCOPY OF THE KNEE AT ALPINE SKI TEAM 1
  METHODS OF MEASUREMENT OF SELECTED OPTICAL PARAMETERS OF HUMAN TISSUES USING OPTICAL FIBER PROBE ROLE OF THE CIRCULATING BLOOD IN INITIATION OF THERAPEUTIC EFFECTS OF VISIBLE LIGHT
  NEW METHOD OF CHARACTERISATION OF LASER BEAM INTERACTION EFFECT WITH TISSUES 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
  WOUND HEALING IN ANIMALS AND HUMANS WITH USE OF LOW LEVEL LASER THERAPY-TREATMENT OF OPERATED SPORT AND TRAFFIC ACCIDENT INJURIES: CHANGES OF THE CONTENT OF SOME CYTOKINES AND GROWTH FACTORS IN CIRCULATING BLOOD OF VOLUNTEERS EXPOSED TO VISIBLE POLARIZED LIGHT AT A THERAPEUTIC DOSE
  LOW LEVEL LASER THERAPY IN DENTISTRY CHANGES IN SOME FUNCTIONAL AND BIOCHEMICAL PARAMETERS OF THE CIRCULATING HUMAN BLOOD AFTER PERCUTANEOUS APPLICATION OF VISIBLE POLARIZED LIGHT AT A THERAPEUTIC DOSE
  PAIN AND PRACTICAL ASPECTS OF ITS MANAGEMENT RESULTS OF LOW LEVEL LASER THERAPY (LLLT) IN THE TREATMENT OF INNER EAR DISEASES
  LASER THERAPY - A NEW MODALITY IN THE TREATMENT OF PERIPHERAL NERVE INJURIES IMPORT OF RADIATION PHENOMENA OF ELECTRONS AND THERAPEUTIC LOW- LEVEL-LASER IN REGARD TO THE MITOCHRONDRIAL ENERGY TRANSFER
  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 CHANGES IN INTRACELLULAR CALCIUM CONCENTRATION INDUCED BY BIOSTIMULATION OF CARDIAC CELLS GROWN IN CULTURE USING VISIBLE LIGHT OR HYDROGEN PEROXIDE
  LOW LEVEL LASER THERAPY IN DERMATOLOGY: AN OVERVIEW OF THERAPEUTIC POSSIBILITIES LASER THERAPY IN WOUND MANAGEMENT
  AESTHETIC TREATMENTS WITH LOW LEVEL LASER THERAPY OPEN WOUND HEALING (BED SORES, ULCUS CRURIS, BURNS) WITH SYSTEMIC EFFECTS OF LLLT
  LOW LEVEL LASER THERAPY WITH TRIGGER POINTS TECHNIQUE: A CLINICAL STUDY ON 243 PATIENTS LASER THERAPY IN RHEUMATOLOGY
  WHAT ARE THE THERAPEUTIC POSSIBILITIES OF LOW LEVEL LASER THERAPY IN GYNAECOLOGY, UROLOGY, AND NEUROLOGY? NO-SURGICAL LASER TREATMENT IN PHLEBOLOGY
  APPLICATION OF LOW LEVEL LASER THERAPY ON CHILDREN LASERACUPUNCTURE
  Poster Session TREATMENT OF EPISIOTOMY USING DIFFERENT FORMS OF PHOTOTHERAPY THE REGENERATING CAPACITY OF LLLT ON MUSCLE FIBERS AND ON CATILAGE TISSUE

 

 

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.


Navigation to Laserworlds other abstracts pages (+ 400 abstract)
 Abstracts
2003
 Abstracts
2002-2003
Abstracts from 2001 Abstracts from 2000 June Abstracts from
2000 May
Abstracts
from 99
Abstracts
from 98
Read the abstracts of the Laser Therapy Millennium edition:  
New reports will be added every months. If you have published a scientific report  recently or have it in the pipeline, why not make a personal abstract and mail it to us? SLMS (Swedish Laser-Medical Society) has 1500 lllt - laser therapy studies in its library, but we certainly don’t have everything.


This page was last updated on :

email

1998-2001 copyright © Swedish Laser-Medical Society -All rights reserved



Laserworld homepage LLLT photo gallery LLLT manufactures and distributators LLLT organisation Laser therapy links LLLT search LLLT magazines LLLT Books LLLT - frequently asked questions
webmaster