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Inhaltsverzeichnis

Frontmatter

Basic Science

Frontmatter

Laser Hospital — It’s Clinical and Engineering Results

In order to use the multiple lasers simultaneously for better treatment, to save the staff and space more effectively, to perform more reliable safety program, to educate and train laser surgeons, physicians, nurses, and para-medical personnels, the laser hospital v/as planned in 1983.

Kazuhiko Atsumi, Narong Nimsakul, Akio Ihara, Yuichi Shiokawa, Hiroshi Koyama, Norihiro Suenaga

Remotized Laser Beam Distribution System for Surgical Applications

The laser technique is continuously spreading among the medical community, but many institutions are discouraged by the cost of a medical laser, evaluable in about 150.000 US$. Furthermore, during a normal operation, the sum of the durations of the laser shots may be up to a few minutes, because of the “dead times” needed to prepare each patients, to aim the lesion with the endoscope and later to disengage the room. Of course, could the system be shared by several specialists in different rooms, these dead times could be cross-linked so not to interfere with each other, and the equipment could therefore be used much more intensely. The solution of a portable laser has a major drawback in the unavoidable misalignment of the cavity resulting from the vibrations and pushes involved in the moving. Our system consists of a commercial Nd:YAG laser, originally portable and now kept fixed, provided with a fiber distribution system of the laser beam to 6 different rooms of the Endoscopy Department of the INT, Milan. In each room it is possible to control via software the functioning of the laser in each detail.

P. Spinelli, M. Dal Fante, M. Pascucci, N. Ridi

Diffusely Reflecting Surfaces for Laser Surgical Instruments

Makers of surgical instruments are proud of the bright stainless steel surfaces of their products. However used in conjunction with a laser such surfaces are a dangerous source of inadvertently reflected light.

W.-G. Wrobel, U. Fink, M. Reindl, E. Unsöld

Excimer Laser for Medicine — Prospects for Computer Guided Surgery

In contrast to the cutting effect by heat transfer from Argon, Nd:Yag and CO2 laser beams the excimer laser can remove organic tissue without almost any heat transfer to adjacent material. This ablative effect depends strongly on the intensity of the laser beam at the target: The ablation rate is in the μm range per laser shot, therefore many pulses are required to ablate tissue layers.

K. Hohla, H.-W. Henke, J. Pfaff, W. Würth

A New Argon Laser System with Kaleidoscanner and its Clinical Applications

The argon laser has become a well-accepted modality for physicians interested in treating superficial vascular cutaneous lesions. It has become well-established and is the most commonly and successfully used treatment. However, conventional practical argon laser therapy for port wine stains is extremely difficult and often results in uneven and excessive local dosage during the treatment and operator fatigue is common, due to small laser beam size and uneven power distribution curve. We have developed the “Kaleidoscope”(a glass light-guiding rod) to obtain a uniform power distribution over the irradiated area and then applied it to the handpiece for a ruby laser system for treatment of hyperpig-mented skin lesions On the basis of our kaleidoscope system we have developed a new argon laser system incorporating a kaleidoscanner for treatment of vascular cutaneous lesions.

T. Morita, R. Tanino, M. Miyasaka, M. Nishimura, M. Osada, K. Iwasaki, S. Shimizu

The Clinical Potential of the Holmium Laser

The Holmium Laser has a wavelength of 2.1 microns. This falls between the NdYag (1.06) and the CO2 (10.6) both of which are established as lasers which have a clinical application.

I. Kaplan, D. Aravot, S. Giler, Y. Gat, D. Sagie, Y. Kagan

Medical Applications of KrF Excimer Laser

In the laser technology, as new laser it is put great emphasis on development of short wavelength lasers. It is one of the ultraviolet lasers, that is excimer laser, being noticed much lately1,2). We will introduce some example of excimer laser and tissue interactions.

U. Kubo, K. Okada

Comparative Study on Excimer, CO2 and Nd: YAG Laser for Biological Tissue Cutting

The mechanism of biological tissue cutting was investigated using excimer laser compared with CO2 and ND-YAG lasers. Tissue cutting by excimer laser is different from others. Tissues are cut sharply, and bleeding from tissue can not be coagurated by using excimer laser. No or a minimal thermal effect can be observed from the postoperative tissues. Many hypotheses have been published the mechanism of tissue cutting by excimer laser; thermal effect, photochemical effect, photon effect, plasma effect and others. From thermographic analysis and histological studies, we confirmed that biological tissues are destroyed by cutting organelle, especially mitochondria. Cells and tissue blow out following to the organelle explosion. It is true that the generation of heat causes and sometimes makes carbonated layer. But the generation of heat is the result following to tissue explosion, The energy balance, between generated and lost heat, makes defferences of tissue effect.

T. Yonezawa, T. Onomura, K. Motomura, Y. Abe, K. Mabuchi, T. Chinzei, K. Imachi, K. Atsumi

Neodymium-YAG Laser at 1064 and 1320 NM: Laser Tissue Interaction at Varying Irradiation Parameters and Application Techniques

It was the aim of this study to compare the tissue effects of the 1,318 μm with the ones of the 1,064 μm Nd-YAG laser in in vitro tests and in the acute animal experiment under conditions oriented on the gastroenterological endoscopic practice before applying the method in man.

J. Hochberger, Ch. Ell

Photoablation Threshold of Human Aorta as a Function of Wavelength

In Fig. 1 an artist’s view of laser angioplasty is shown. The goal is to transport energy from short pulsed lasers through fibers via a catheter system, probably a balloon-dilatation catheter, to photoablate plaques in coronary and peripheral arteries.

G. Müller, H.-P. Berlien, B. Biamino, K. Dörschel, H. Kar

First Experiences with Disposable Fibre Delivery Systems for the Neodym-YAG-Laser

For a few month sterile packed, for single use designed laserprobes of the british Pilkington company are available.

T. Müller-Schwefe, M. Siemon, M. Thermann

Infrared Plastic Waveguides for Surgical Applications

For successful use of the IR lasers in medicine a good type of waveguide is essential to be devised. The known IR transparent materials, from which fibers might be drawn (1–3) have several disadvantages such as: sensitivity to light, chemicals and humidity, or high toxicity and limited flexibility. In this paper we present a new type of hollow fiber made of plastic tubes which were covered, on the inside walls, with metallic or metallic and dielectric films. The metallic and dielectric films were obtained by depositing successively a metal film followed by a dielectric one. These hollow plastic waveguides are good waveguides and do not suffer from the above shown disadvantages.

J. Dror, D. Mendlovic, E. Goldenberg, N. Croitoru

Hollow Light Guide for Medical CO2Laser

We have developed a flexible CO2 laser beam guide with metal and polymer compound hollow tube1). These previous experimental results reported in the 6th congress at Ilsarem2). In this paper, we will be report improvement experimental results of since the year before last congress.

U. Kubo, Y. Hashiahin

Medical Applications of Silver Halide Optical Fibers

Since the early eighties, when lasers were first used in cardiology, Intensive investigation has been carried on to develop a system consisting of a laser and an optical fiber for percutaneous transluminal laser angioplasty. Argon and Nd:YAG lasers were first used, since quartz fibers capable of transmitting visible light were commercially available (1). A persistent high rate of arterial wall perforation has jeopardized in vivo experiments with these two lasers. This arterial wall perforat ion has been attributed to the thermal mechanism by which the tissue was ablated (2). In the last two years it has been demonstrated that lasers such as dye, excimer, CO2 TEA and Er:YAG -emitting ultrashort, energetic pulses of light, which are strongly absorbed by tissue — should be selected to obtain tissue ablation with minimal thermal damage (3–5). Yet excimer laser pulses shorter than 300 nanometer are poorly transmitted through fused silica optical fibers, while good optical fibers for the transmission of the Er:YAG light at 2.43 micrometer are not yet commercially available. The CO2 laser was also considered a good candidate for cardiovascular applications. As a system, the CO2 laser is extremely well developed, featuring continuous (CW), chopped and pulse modes of energy delivery and almost an unlimited variety of energy profiles in the pulsed mode including ultrashort high energy pulses. The lasers are small, efficient, reliable, easy to operate and thus do not require high technical skills.

Dov Gal, Abraham Katzir

Detection and Analysis of the Ultra-Weak Photon Emission from Various Biological Materials

This paper describes an unique phenomenon of the spontaneous chemiluminescence of human blood samples. An extremely sensitive single photon counter was developed using a carefully selected, highly effective photomultiplier and the very weak light emissions from various biological samples including human blood specimens were measured. As the most representative results obtained, ultra-weak chemiluminescence of human blood plasma samples taken from subjects under certain living conditions and disease states are presented. The intensities of very weak light emission of smokers’ plasma samples reached substantially higher levels than those of nonsmokers’. Chemiluminescence of smokers’ and nonsmokers’ urine samples, cigarette smoke itself, cigarette smoke absorbed into organic solvents were also examined. Effects of cigarette smoke on organ chemiluminescence were experimentally tested in an animal model. Ultra-weak chemiluminescence of blood plasma samples of certain liver diseases also showed higher chemiluminescence levels than those of healthy subjects. Oxygen requirement was generally observed for these light emissions. It is interesting to speculate that this higher chemiluminescent property of the plasma samples might be somehow related to health disorders.

B. Yoda, Y. Goto, Y. Taguchi, T. Miyazawa, A. Saeki, H. Inaba

Miniaturized Optoelectronic Transceiver for Application and Pick-Up of Biological Signals

We present a two-way optoelectronic transmission system for telemetry between a main instrument and a satellite mobile unit to be mounted on a laboratory animal The link employs a pair of LED/photodiode transmitters and receivers operating in regime of diffused infrared radiation from laboratory walls and ceiling.The system offers an accuracy of 0.5% in amplitude and a signal bandwidth of IKHz with a high degree of immunity to electromagnetic noise and ambient illumination.The small size of the mobile unit implemented in surface mount technology (SMT) and the low-voltage, low-power design, make it well-suited for an indoor telemetry link with a freely moving animal of small size. This transceiver system has been routinely utilized for Polarographic in-vivo determination of brain metabolites (DOPAC, 5-HIAA) in rats.

Valerio Annovazzi-Lodi, Silvano Donati

Applications of Optical Phase Conjugation in Medicine

In this paper we introduce optical phase conjugation to the laser-medical community as well as to speculate on several possible applications of this phenomenon.

B. W. Stewart

Potential Applications of Lasers in Diagnosis and Preoperative Assessment of Lesions Using Three Dimensional Imaging

The investigation of disease in a living patient employs many techniques. In diagnostic pathology, one of those most frequently used is the microscopic examination of thin slices of the diseased tissue.

R. A. S. Blackie, J. Drinkwater, S. Hart

Neurosurgery

Frontmatter

Homo Faber Amplificus Lucis — State of the Art

Surgery with lasers constitutes without any doubt one of the most outstanding achievements of civilization in the age of technology. The scientific investigation of brain functions which forms its base and is still being carried on by this discipline has been a consequence of keen observation of nature, which had already started in antiquity, and ingenious nature studies, as manifested by clinical research in the 19th and electrobiology in the 20th centuries. Modern technology has enriched the arsenal of our diagnostic tools by neuroimaging, which permits visualization of nerve structures with a degree of accuracy as achieved by any anatomical atlas, while evoked potentials and their monitoring in vivo safeguard maximum precision in the scanning of neural paths and centers. Neurosurgery thus represents the apex of the application of up-to-date technological tools and highly sophisticated surgical methods, including lasers of varying wavelength, to the human brain. From times immemorial, generations of thinkers and researchers have contributed with industry and tenacity to the exponential development of new means and ways for saving human lives or making them again worth living, thus gradually opening up new perspectives to the knowledge of mankind.

F. Heppner

Lasers in Neurosurgery: State of the Art

When we were first confronted with the laser, in 1975, it was not considered useful for neurosurgery (1,2,3). We were nonetheless fascinated by the potential of a non-touch instrument and attempted to demonstrate its applicability. After theoretical considerations and animal experiments, we performed the first laser operation on a patient on July 28, 1976. Since then we have performed over 1,100 procedures with the CO2 and Nd:YAG lasers (4–8). Our early hopes for the laser have been realized and new indications added.

P. W. Ascher

The Use of Contact Laser in Neurosurgery

Recent technological improvement consents to deliver a laser beam directly in contact with the tissue and to restore that tactile feed-back the operator had lost with usual laser instruments.

V. A. Fasano, R. M. Ponzio

A Review of 500 Cases of Brain Tumors Operated with Multiple Laser Sources in Comparison with Conventional Tools

In this review we have considered the surgical results of the treatment of cerebral gliomas and meningiomas with multiple laser sources, microscope, CUSA and intraoperative echography in comparison with conventional tools. The laser (1, 2, 3, 4, 5) is utilized for cutting, vaporization, hemo stasis. There are different laser sources with peculiar characteristics, CO2 laser is utilized for dissection and vaporization in restricted and hardly approachable areas. It has a limited thermic and hemostatic effect. Nd;YAG laser presents considerable depth of penetration and a better hemostatic effect in comparison with CO2 laser. Recently Nd:YAG laser has been utilized as contact laser coupled with a sapphire tip. (6, 7, 8, 9, 10, 11, 12)

G. F. Lombard, G. Mazzotta, Gallo Lassere, V. A. Fasano

Laser-Assisted Nerve Anastomoses Using a 1,3 µm Nd: YAG Laser with Long-Term Observations

Laser-assisted nerve anastomoses (LANA) of the left sciatic nerve of 30 adult albino rats were carried out with the 1,318 µm Nd:YAG laser in the following way: The nerves are cut through with microscissors. The proximal and the distal nerve stumps are adapted by two lateral epineural sutures. The epineurium, adapted by means of tweezers, is welded together on the upper side and the lower side by a few laser fusion points (12,5 W; 0,1 sec; 0,2 mm diameter) and then the epineural tube is closed.After being removed following several weeks 28 laser-assisted nerve anastomoses showed perfect continuity.

F. Ulrich, T. Sander, R. Schober, W. J. Bock

Time Course of the Blood-Brain Barrier Defect Following Laser Irradiation and Other Injuries of the Rat Forebrain

Laser irradiation of the brain surface of an experimental animal results in a lesion consisting of 3 to 6 discernible zones (1). The outermost zone of the lesion is usually an edematous zone, due to the break down of the blood-brain barrier (4). Similar vasogenic brain edema may be produced by focal freezing of the brain cortex (3) and by local laceration (5). In order to evaluate the time needed for restoration of blood-brain barrier function impaired by the trauma, blood-brain barrier function was investigated at different times after Nd-YAG- and CO2-laser irradiation, cold injury and focal laceration of the rat forebrain using Evansblue as an indicator.

H. R. Eggert, J. May, M. Hornyak, V. Kallmeyer

Effect of Nd: YAG Laser at 1.44 µm on Rabbit Brain

Laser vaporizatior of tissue is highly dependent upon the wavelength of the applied radiation. In the pear infrared, absorption is dominated by the water content of tissue. There is a large variance of the absorption spectrum of water over a relatively small range of radiation wavelength (Fig. 1). Consequently, a small change in the operating wavelength of an infrared laser will dramatically influence tissue response. Several laser emission wavelengths and their corresponding absorption coefficients in water are shown in Fig. 2. The absorption coefficient increases from approximately 2 cm-1 at the Nd:YAG wavelength of 1.32 µm to 30 cm-1 at 1.44 µm. This study was undertaken to quantify some of the differences in laser interaction with brain tissue at 1.06 µm and 1.44 µm.

R. Martiniuk, J. D. S. McKean, J. Tulip, B. W. Mielke, J. Bauer

Use of the Nd: YAG Laser in Microsurgery of Intracranial Tumors

The Nd-YAG laser has been introduced to intracranial surgery by Beck in 1978 (1,2). But up to now, it has not been generally accepted as a microsurgical tool (3,5). In order to get an impression of its real value in intracranial microsurgery, records of operations were reevaluated with special regard to the type of tumors, surgical steps and irradiation parameters.

H. R. Eggert, J. May

Surgery and Plastic Surgery

Frontmatter

The CO2 Laser in Clinical Surgery: Past, Present and Future — State of the Art

The CO2 laser has a wavelength of 10.6 microns. This is the only laser beam which is entirely absorbed by water. Since the body tissue comprises between 75% to 90% water, it follows that if the CO2 laser beam is focused on the body tissue it will cause a vaporisation of the tissue while at the same time, due to the release of thermal energy, the small blood vessels and lymphatics will be sealed. This results in a fine haemostatic incision leaving the residual tissue relatively undamanged so that one is not precluded from performing a primary repair of the residual wound, either by suturing or by skin grafting.

I. Kaplan

Operative Treatment of Hemorrhoids with CO2 Laser and Nd: YAG Laser Respektively

Diseased hemorrhoids are usualy regarded as a simple disease and their surgical treatment as minor surgery. This is not true from the patients point of view. For the patient hemorrhoids are inconvenient, often painful, the postoperative course is marked by defecation problems and impaired healing.

Ch. Armbruster, K. Dinstl, H. Greiner, A. Tuchmann

Endobronchial Laser Therapy in Pneumological Emergency

The most frequent emergency situation in which the Neodym-YAG-Laser can be applied is the obstruction of central airways. Not only malignancies but also benign lesions — mostly membranes or granulomata after sugery or long-time intubation — may lead to dyspnea that is further aggravated by bleeding or retention of secretions.

H. D. Becker

Surgery of Breast Cancer with the CO2 Laser — Report on 449 Operations

Since 1975 1600 operations with the CO2-laser (Sharplan 791) have been performed at the first surgical department KA Rudolfstiftung, Vienna. Most operations were done for diseases of the breast.

K. Dinstl, St. Kriwanek, G. Platthy, A. Tuchmann

The Combined 1.06 µm and 1.32 µm Nd: YAG Laser in Surgery

At present our surgical team of the IIIrd Surgical Clinic of Charles University Prague, tests the usage of Nd:YAG laser of Czechoslovak construction. Laser system was developed at the Faculty of Nuclear Science and Physical Engineering of Technical University of Prague.

L. Horak, J. Fanta, J. Kabat, J. Marek

Clinical Experiences in Laser Resection of Liver, Spleen and Kidney in Children — Indications and Morphological Results

Laser has found its application for research fields of medicine during the past years. In case of special indications laser application has already been accepted. Our study does not only reveal indications for laser therapy, and differentiates them from euphorc innovational indications, but shows when laser application is superior to conventional technique.

H. Meier, K. H. Dietl, J. Morcate, E. Unsöld, G. H. Willital

Postoperative Analgesia and Nd: YAG Laser Surgery

Reports of reduced postoperative pain following Nd:YAG laser surgery have, to date, been mostly anecdotal. Following review of some 200 laser cases we have confirmed these reports and established the need for comparative clinical trials involving the use of low power contact Nd:YAG Laser and conventional operative techniques in body surface surgery, intermediate surgery (involving but not transecting muscle layers) and body cavity surgery.

K. C. Moore, A. Steger, N. Hira

Application of the Laser Speckle Method for the Blood Flow Determination at Patients with Arterial Occlusive Disease

The blood flow in capillaries is essential for the nutrition of the tissue and the transport of the waste products. It is very useful to distinguish between micro- and macro-circulation, and therefore it is necessary to measure the microcirculation directly at the site of interest.

B. Ruth, D. Abendroth, L. Sunder-Plassmann, W. Waidelich

Two Step Emergency Treatment of Malignant Tracheal Stenoses

Neodym Yag laser treatment is widely used in urology, neurology, gastroenterology and pulmonology. In Pulmonology, laser therapy is usually limited to endobronchial processes when the perfusion of the afflicted lung is preserved, but there are essentially no restrictions to its use in cases of endotracheal obstructions not amenable to surgery or radiotherapy (1). Since these patients are frequently in a life threatening state with poor lung function and severe hypoxia the safe performance of the procedure usually requires general anesthesia with jet ventilation and the use of a rigid bronchoscope (2). In very rare cases the functional reserves of the patients are limited to such an extent that general anesthesia may be impossible. We would like to report the case histories of two patients whose treatment was particularly difficult due to severe restrictions of lung function testing.

H. Seibold, O. Sigg, D. Bunjes

Morphological Peculiarities in Laser Wound Healing

Biopsies of various organs of 2 000 patients were studied morphologically following operations with the aid of CO2-, Nd-YAG and argon lasers in abdominal, purulent, plastic, hepatic and pancreatic surgery as well as endoscopic laser photocoagulation of acute gastric bleedings. The optimal power density of CO2 laser irradiation for the resection of hollow organs in gastointestional tract and liver, spleen and pancreas is about 3.103 Wt/mm2. In the area of CO2 laser incision of different tissues the coagulative necrosis about 60mcm takes place. The general width of thermal damages in biological tissues was about 132,7 ± 18,3 mcm. The peculiarities in laser wounds healind lies in the absence of leucocytic infiltration or edema of tissues ajaicent to the area of thermal necrosis. The application of CO2 laser for surgical treatment of purulent wounds on soft tissues and in abdominal surgery gives a possibility to get the sterility and absolute hemostasis that results in healing these wounds in a type of an aseptic productive inlammation. This aseptic productive inflammation in healing process of the laser wounds leads to the shortening of treatment, and purulent wounds heal as clean surgical wounds.

V. I. Yeliseenko, V. E. Normansky

Comparative Assessment of Conventional and Laser Treatment for Suppurative Wounds

Modern principles in the treatment of suppurative wounds are the following: (1) incision of devitalized tissues; (2) the primary or postponded suture; (3) utilization of a pulsed jet and a system of active aspiration. These methods are efficient in 85–90%. It satisfies the majority of surgeons. But thre are two things worth attention. First, the described scheme cannot be used in case of extensive flegmons, marked inflammatory changes around the purulent focus and when it has deep location near large vessels and nerves; when there is an extensive tissue necrosis and anaerobic flora. Secondly, the period of invalidity -with traditional methods being used — is unjustified in many cases. More effective therapy in extensive suppurative processes could be possibly reached with better management of a purulent focus and with the ameliorated influence on purufication and regeneration. For the latter one many surgeons are using enzymatic necrolysis. But natural proteinases turned to be not effective enough because of their rapid inactivation and withdrawing from the wound.

O. K. Skobelkin, P. I. Tolstykh, V. I. Ryabov, V. A. Derbenev

12-Year Experience of CO2 Laser Application in Surgeries on Hollow Organs of Gastro-Intestinal Tract

The laser as the surgical instrument has found an especially wide application in surgery on parenchymatous organs, in endoscopy, in pus surgery. The application of the laser scalpel on hollow organs is limited by the coplexity of laser beam manipulation in the depth of the wound, by the danger of damaging adiacent tissues and organs and by the overheating of tissues in the area of the incision. The tissue overheating takes place because the energy of the laser beam is absorbed by the blood flowing into the wound. Boiling blood leads to thermal damage of the surrounding tissue with the formation of large area of coagulation necrosis and with the inhibited regeneration processes. To avoid this we have developed a new and original technique of laser dissection of hollow organ’s wall to which the blood supply is temporaly stopped with the help of special instruments. These latter have two jaws. Lower jaw serves as a screen and the upper onehas a through lengthwise slot for laser beam. The instrument permits an accurate gradual transmission of the light beam and allows to perform quick and bloodless tissue cutting. It causes minimal thermal tissue damage, asepticity and the so-called “the effect of biological tissue welding”. The latter means tissue coagulation along the incision and layers’ adhesion.

O. K. Skobelkin, E. I. Brekhov, G. D. Litvin, M. V. Smoljaninov, V. I. Ryabov

Morphologic Aspects of Nd: YAG Laser Application on Lung Tissue

For nearly 10 years the Nd:YAG laser is used by several medical disciplines such as gastroenterology, urology, neurosurgery and pulmonology (2,8). The normally used wavelength of 1064 nm shows a good coagulation effect due to little absorption and high scattering in tissue. By resonance modification, a second wavelength of 1318 nm, at which water in particular, and highly vascularized tissue as well, demonstrate an absorption rate 10 times higher than that at 1064 nm, can be produced (fig.1,2; 1,3,4,9). Theoretically at this wavelength, one can expect a marked difference in the behaviour of parenchymal tissue, advantageous to clinical application, i.e. more precise tissue ablation and a superior degree of coagulation. Results of initial experimental studies examining use and effects of a Nd:YAG laser on leaver and splenic tissue can be found in the current literature (5,6,8). For the lung however such studies have not been performed, so that informations to application parameters as well as basic characteristics of the two wavelengths are not available. We therefore performed animal experiments evaluating the clinical application of the Nd:YAG laser in lung surgery.

A. Rolle, E. Unsöld, L. Ruprecht, W. Permanetter, F. Frank

Indication and Technique of Laserapplication in Pancreas-Resection in Children — First Results

The most frequent pediatric surgical diseases of the pancreas (8,9) are: nontraumatic, connatal and genetic determined diseases of the pancreas (6%), i.e. cystic alterations and stenosis of the branches of the pancreatic ducts (11,12); blunt abdominal trauma with damage to the pancreas tissue (19%); rupture of the pancreas (42%) (23); pancreas pseudocysts (18%); annular pancreas (8%) (14); alterations of the choledochal duct (4%) (15,22) and insulinomas (3%).

G. H. Willital, H. Meier, M. Maragakis, G. Stöhr

Ultrasonographic Guided Lasertherapy for Liver Cancers — Experimental Temperature Measurements and Clinical Application

Nd:YAG laser has been used for the treatment of tumors on the hollow organ through endoscopy, whereas, due to its property of recti-linear propagation, it has not been thought suitable for the treatment of tumors in parenchymatous organ.

Daijo Hashimoto, Kiyotoshi Yabe, Yushio Uedera, Shyunichi Yumoto, Yasuo Idezuki

Application of the CO2 Laser in Thoracic Surgery

Advances in the management of median sternotomy infections over the past two decades have significantly reduced the morbidity and mortality of this major complication. The technique of open debridement introduced by Spencer1 in 1961 and closed mediastinal irrigation with antimicrobial agents described by Shumacker and Mendelbaum2 in 1963 made salvage of these patients possible. Recently, the use of muscle flaps, omentum, and CO2 laser debridement for the reclosure of infected sternal wounds has improved the clinical outcome.3–6

H. R. Herrera, J. R. Hinshaw, R. J. Lanzafame

Use of Carbon Dioxide Laser in Genital System Corrective or Reconstructive Surgery

The reconstructive and corrective treatment of some congenital or acquired lesions in male and female genital apparatus, derives remarcable advantages from the use of Carbon Dioxide Laser. This instrument, in fact, put us in a position to usefully effect surgery thanks to its characterictics, among which, preminently, that of sealing blood and lymphatic vessels while cutting them: and that of reducing tissue reactivity thus limiting oedema and consequently pain.

R. Pariente

Laser Scalpel in Pancreatic Surgery

At present operative treatment of pancreas gives the the great postoperative mortality rate and postoperative complications. This is due to the operative trauma of pancreatic tissue which gives rise to the acute postoperative pancreatitis and pancreonecrosis with further complications and to the development of specific postoperative purulent complications in the stump margin.

E. I. Brechov, G. D. Litvin, A. G. Kirpitchov, V. V. Kalinnikov, A. N. Severtsev

Experience with the Use of CO2 Laser and Infra Red Low Energy Laser in Aesthetic Plastic Surgery of the Face

In our experience two Lasers were used since 1982 for many lesions, but. the improvement of the technic and the quality of the healing process allowed a more specific utilisation in aesthetic plastic surgery where they became two outstanding tools for better results.

R. E. Amar

Hemorrhoidectomy and Fistulectomy with Nd: YAG Laser

Hemorrhoids and anal fistulas have been the most common diseases among the Chinese. Since October 1985 724 of the number of the patients had received laser hemorrhoidectomy or fistulectomy, 314 had follow-up period of over 6 months: internal hemorrhoids 238, external 24, anal fistulas 52. Treatment parameters: laser working distance 5 mm, spot size ?? = 1 mm, power density 1910–3185 W/cm2, M/F: 207/107, age ranged 9–82. 9 patients had been refused to give a routine surgical operation elsewhere because of being in the serious local infection stage, 12 because of accompanying hypertension, thyroidism, etc. Results: in most patients, 218 (92%) for internal hemorrhoids, 24 (100%) for external hemorrhoids, 52 (100%) for anal fistulas both preoperative symptoms and physical signs disappeared; the symptoms of 20 (8%) of internal hemorrhoids were improved because of various reasons. Complications: rebleeding 6 /1.9%), severe pain 7 (2.2%), dysuria 12 (4.1%), anal sphincter spasm and skin bridge 5 (1.6%), fissure inanal 5 (1.6%).

S. Zhao, Y. Chen

The Effects of Laser Smoke on the Lungs of Rats

Although laser surgery has gained increasing interest in gynecology during the past 10 years and a substantial volume of literature has been published in peer review journals regarding this modality of treatment, little data exists about the effects of the plume (vapor) by-products resulting from this surgery. The purpose of this study was to determine whether harmful effects might result if the vapor products of laser surgery were chronically inhaled.

M. S. Baggish, M. Elbakry

Orthopaedy

Frontmatter

CO2 Laser in Orthopaedic Surgery

Though lasers have been in clinical use for the last twenty five years they have not moved into orthopaedic surgery. There was only one scientific paper in the uses of laser in orthopaedic surgery though a total of 319 scientific papers were presented at the 6th Congress of the International Society for Laser Surgery and Medicine in 1985. Does laser not offer any distinct advantage in orthopaedic surgery for it to have taken so long to get into orthopaedic practice? This paper describes our preliminary experience with CO2 laser in orthopaedic surgery. CO2 laser surgery was started at the National University Hospital, Singapore on 18 December 1985 and Professor Kaplan from Israel stayed with us for one week to start the programme.

P. Balasubramaniam

Laser as an Operative Tool in Endoscopic Operations in Orthopaedic Surgery

Operations by means of endoscopy are nowadays being widely used as they have advantages, not least the minimal trauma they exert. The use of laser-surgery in urological, gynaecological and bronchial procedures has already become a routine procedure. In orthopaedic operations, such as for example meniscectomy or synovectomy, arthroscopic techniques have found an ever increasing use. Also in a spinal surgery, as well as in the operative treatment of a disc pro-Lapse, microsurgical techniques as well as chemonucleolyses are progressively used. The aim of aur experimental investigations was to determine the effect of laser-operations on joints and intervertebral discs. This was done on tissue of corpses by means of exact infra-red thermographic measurements and histological examination of the tissues treated. Initially we investigated the possible means of employment as well as the suitybility of a CO2-laser and a Neodym-Yag-laser (wavelength 1064 nm) for the treatment of disc-tissue, menisci, and synovial tissue. Following this we developed the application techniques and suitable instruments for the planned operations. Special attention was paid to temperature changes that occured. These were varied and optimized with regard to distance as well as timing, depending on the parameters of the instruments used. In our study we focused on the endoscopic treatment of meniscal and synovial tissue of the knee joint, as well as the so-called “nucleus pulposus vaporization”.

W. E. Siebert, D. Kohn, S. Breitner, H. J. Refior

Gastroenterology

Frontmatter

Endoscopic Laser Treatment in the Gastrointestinal Tract — State of the Art

The most suitable laser wavelength for endoscopic use in the GI tract is a Neodymium-YAG laser with the wavelength of 1.06 µm and a power output of 100 W. The other wavelengths of 1.32 µm up to 3.4 µm are still experimental as well as eximer lasers and dye lasers used in tumours dotted with HPD. Pulsed Nd: YAG lasers and pulsed dye lasers have boon tried endoscopically for destruction of biliary stones.

P. Kiefhaber, K. Kiefhaber, G. Nath

Endoscopic Nd: YAG Laserthermia: Experimental Study on Carcinoma-Bearing BDF1 Mice

Clinically laserthermia has proved to be safer and more reliable than conventional contact-laser irradiation in eradicating tumour tissue. Since the differences in the mechanism of tumour destruction are still not fully understood, we compared these methods in an experimental study using BDF1 mice and obtained the following results: 1)There are differences in the process of carcinoma cell destruction between laserthermia (low power, long time) and contact irradiation (high power, short time).2)Laser-light itself has the ability to cause carcinoma cell destruction.3)Changes due to laserthermia become detectable histologically 3 h after irradiation.

N. Kanemaki, H. Tsunekawa, C. Brünger, M. Nishida, H. Nishikawa, H. Kato, K. Hattori, N. Daikuzono

Endoscopic Nd: YAG Laserthermia in Depressed Early Gastric Carcinoma

Laserthermia is a new form of treatment developed for indirect destruction of tumour tissue by applying local hyperthermia (43–44°C) through prolonged low-power laser irradiation. Since 1984 we have investigated this method in experimental and clinical studies. Here we report our clinical experience with 20 cases of depressed early gastric carcinoma (15 pre-operative cases and 5 inoperable cases, where treatment aimed at local cure).In 12 of the 15 pre-operative cases, the bottom of the laserthermia-induced ulcer showed no residual cancer, indicating the efficacy of this treatment. Histo-pathological examination revealed that although laserthermia-induced degeneration was detectable down to the proper muscle layer, surface changes were confined to shallow ulceration. Of the 5 “curative” cases, one patient died after 13 months’ follow-up. Autopsy revealed local cure achieved by laserthermia.We have recently employed endoscopic ultrasonography to evaluate the depth of cancer infiltration and video endoscopy, to determine the extent of the lesion before treatment and to detect any cancer residue during follow-up. We believe, the combination of these techniques makes laserthermia the safest and most effective form of treatment for depressed early gastric carcinoma in inoperable cases.

C. Brünger, H. Tsunekawa, N. Kanemaki, M. Nishida, H. Nishikawa, H. Kato, K. Hattori, N. Daikuzono

Psychological and Quality of Life Analysis of the Palliative Treatment of Oesophageal Cancer

Palliative cancer treatment can not be assessed by using objective or ‘hard’ criteria such as mortality, recurrence of disease, or clinical data on the spread of disease. Emphasis has to be placed on ‘softer’ subjective data. There is little data of this nature on patients with oesophageal tumours treated by laser recannalisation or intubation for the relief of malignant dysphagia. We present a prospective study on the quality of life assessment of patients treated for the palliation of malignant dysphagia

H. Barr, N. Krasner

Nd: YAG Laser Treatment of Malignant Gastrointestinal Tumors

During the last years the treatment of malignant gastrointestinal tumors by Nd-YAG laser became of more importance (3,5). In the palliative treatment of tumors, the Nd-YAG laser has shown advantages that cannot be achieved with other forms of treatment (1,2,3,5). In particular cases according to a special indication and postoperative observation you can use the Nd-YAG laser in curative treatment(4).

K. Dittrich, Ch. Armbruster, K. Dinstl, H. Günter

Clinic Experience in Endoscopic YAG Laser Therapy for Large Intestinal Polyps

an analysis of 60 patients and 159 polyps

YAG laser is characterized by its strong perforative ability and the ability of cutting through human body tissues. Optical glass fiber led into human body by the endoscope can be used to resect the polyps in large intestine and treat them with gasification therapy. Since 1983, we have treated 60 patients suffering from large intestinal polyps with YAG laser made in China. 159 polyps were treated. 70 of them were cut and taken out intact. It was confirmed that the endoscopic laser is a reliable and effective therapy in treating large intestinal polyps.

Wang Rui-zhong, Wang Zhen-he, Wang Shu-shen, Bai Yu-gang

New Vascular Occulusion Method with Lateral Laser Aming Probe

The primary disadvantage of the conventional forward aiming fiberprobe is the need to fire the laser parallel with, or close to the longitudinal axis of the gastrointestinal tract. How, cancers and ulcers appearing on the wall of the gastrointestinal tract can be treated through laser radiation delivered by the lateral-aiming fiberprobe. After several years of study, we have succeeded in developing a lateral-aiming probe which incorporates a truncated quartz fiber tip protected by a micro-cap. Effective treatment of all lesions in hollow organs has become possible endoscopically with the ability to freely rotate the probe. We have successfully treated gastric cancers, bleeding duodenal ulcers and esopageal strictures which could not be effectively treated with conventional laser probes.

Daijo Hashimoto, Hiroto Koyama, Kiyotoshi Yabe, Yushi Uedera, Shyunichi Yumoto, Yasuo Idezuki

Nd: YAG Laser in the Management of Gastrointestinal Bleeding in Relation to Intensity

In 1984 we set up a new organizational programme for treatment of gastrointestinal bleeding at our Department of Internal Medicine, University Hospital Rebro, Zagreb, Yugoslavia. Namely, we opened a new Gastroenterology Interventional Unit. Immediately upon admission to our Unit, patients with upper GI bleeding are submitted to the urgent endoscopy followed by the appropriate endoscopic method, namely, photocoagulation utilized to stop the bleeding. In some cases complications are encountered, the active bleeding cannot be stopped or rebleeding occurs. Such patients are then operated.

B. Jereb, R. Pulanić, V. Šalamon, M. Rosandić-Pilaš, B. Vucelić, N. Hadžić, S. Knežević, V. Borčić, F. Golem

Lasers in Rectosigmoid Tumors

Patients were treated on an outpatient basis, without anesthesia or sedative medication. Patients were prepared with a small enema at the Laser Center and no special diet was required before the treatment. Patients were treated once or twice a week until functional improvement (advanced cancers) or until complete destruction of the tumor (1,2). Then they were followed up every two weeks until complete reepithelialization. Then patients with an advanced cancer were retreated every month, and the other patients were followed up and retreated if a recurrence or new lesions occurred.

J. M. Brunetaud, V. Maunoury, J. P. Ancelin, D. Cochelard, A. Cortot, J. C. Paris

Endoscopic Electric Surgery and Nd: YAG Laser Therapy for Gastrointestinal Cancers

Surgery is the best available choice of treatment for the malignant gastrointestinal tumor. But in later stages of advanced obstructive cancer of the G-I tract most individuals are not good candidates for operation or irradiation. Implantation of endoprotheses for the stenotic G-I tumor has limiting factors that result in adverse conditions for some patients. Laser therapy is a palliative treatment in a lumen narrowing by G-I cancer by correcting obstruction and improving the patient’s nutrition. Nd:YAG laser and electrocoagulation can both arrest G-I bleeding in the earlier years.(1–5) In 1982, Fleischer first tried using the Nd:YAG laser to treat 5 patients with advanced obstructive esophageal cancer and their dysphagia was significantly improved.(6) A 63% effective palliative rate for the malignant tumor by Nd:YAG laser therapy was reported by Kobayashi in 1983.(7)

K. L. Wu, Tung-Chao Cheng

Bleeding Ulcers Results with Nd: YAGLaser Coagulation

For a long time emergency endoscopy has proved to be of high diagnostic efficacy in bleeding of the upper digestive tract, concerning localisation, identification and activity of bleeding.

H. Schönekäs

Nd: YAG Laser Treatment in Early Gastric Cancer in our Institution

From December 1980 to June 1987, a total of 57 cases (63 lesions) of early gastric cancer were received laser treatment in our institution. Of them, 41 cases with 45 lesions were received follow-up examination for more than 3 months, 5 cases (5 lesions) were operated after laser irradiation, 7 cases (8 lesions) recieved follow-up less than 3 months which made impossible to evaluate therapeutic effect, and 4 cases (5 lesions) were drop-out (Table 1). The operated cases were shown in Table 2.

Hiroshi Fujimura, Ichiro Tanabe, Tatsuo Otani, Tsuyoshi Aibe, Takayoshi Noguchi, Yukinori Okazaki, Tadayoshi Takemoto, Susumu Kawamura, Shigemi Ariyama, Tetsuro Sasayama, Mitsuhiko Tanabe, Hiroshi Kawano

Nd: YAG Laser with Water Jet Stream — A New Transmission System with a Water-Guided Laser Beam

The transmission of laser light via flexible transmission systems is the prerequisite for the fiberendoscopic use of lasers in gastroenterology. Among the lasers that meet the necessary conditions, the Neodymium YAG laser has become widely accepted on account of its specific physical properties (1). Recently, changes in pulse quality, wavelength, and transmission system (2–6), have opened up the way to new forms of application. In the case of the Neodymium YAG laser, light is released either in the pulsed or continuous wave mode. For the pulsed laser, the wavelength 1.06 microns is always employed, while for the continuous wave laser (cw), two wavelengths are al present in use: 1.06 microns, and 1.32 microns. Light can be transmitted with or without contact with the tissue. The contact methods are differentiated in accordance with the material of the tip of the light guide. In the case of the non-contact procedures, a differentiation is made between fibers with coaxial CO2 flow, and those with water flow.

R. Sander, H. Poesl, F. Frank, P. Meister, M. Strobel, A. Spuhler, E. Unsoeld

Laser Treatment of Colorectal Tumors — Initial Results of Clinical Studies with the Nd: YAG Laser, Wavelength 1318 NM

The importance of the Nd YAG laser is expanding with its range of indications. New wavelengths have been developed with the goal of achieving more efficient laser treatments for localized tumors. After animal experiments in the rabbit stomach (1) a comparative, randomized and prospective study was initiated. This should help to clarify the effects of the 1.32 µm wavelength of the Nd YAG laser on colorectal tumors in clinical use — in comparison to the 1.06 µm wavelength which is commonly used.

R. Sander, H. Poesl, A. Spuhler, M. Strobel, E. Unsoeld

Laser Treatment of a Stenosis After Continuity Resection of the Colon

The video clip of 12 minutes shows a case report of an 55 year old patient, who showed severe signs of illness in November 1983 and after he had been examined thoroughly was operated in an external hospital because of a tumor in the sigmoidal region, whose origin could not be cleared preoperatively.

T. Müller-Schwefe, P. Dreverhoff

Gynecology

Frontmatter

Laser Diagnostic Cylindrical Excision Versus Cold Knife Conization — A Clinical Experience of 60 Cases

Laser conical excision of the uterine cervix is a much praised procedure in current gynecological practice. From March 1985 to February 1986, cylindrical excision of the uterine cervix by carbon dioxide laser was performed for 30 patients with abnormal papanicolau smears and colposcopic finding. During the same period another 30 patients with the same condition, underwent conventional cold knife conization, used as the control group. A comparison of the data of the clinical parameters between these two groups showed no significant difference. However, the comparison of the pathological parameters was as follows: specimen depth in laser cylindrical excisional specimen vs cold knife conical specimen was 6.43 mm ± 2.29 mm vs 4.68 mm ± 2.13 mm (p < 0.001), while the lesion distance in laser cylindrical excisional specimen vs cold knife conical specimen was 5.08 mm ± 2.65 mm vs 4.20 mm ± 1.67 mm p < 0.01. The aforementioned figures proved that the former procedure can remove a larger volume of tissue and include more definite extension of the lesion. The potential advantages of laser cylindrical excision in detecting a possible invasive lesion in the uterine cervix harboring CIN will be presented and discussed.

Alex C. Wang, T. Z. Chang, Swei Hsueh, M. C. Kao

CO2 Laser-Application in the Lower Female Genitaltract for Treatment of Cervical Intraepithelial Neoplasia, Bartholin Duct Cysts and Condylomata Acuminata

The use of CO2-laser can offer precision, bloodless field and accessibility to poorly visible areas. This report discribes the microsurgical technigues that can be performed by the CO2-laser in the lower femal genital tract.

U. Heckmann

New Methods in Treatment of the Portio Dysplasias by Carbon Dioxide Laser

On the basis several-year subject in connection with the gynaecologiccal control examinations and cancer screenings, according to epithelia lesions of different location and extension as well as seriousness, the authors suggest different laser surgical solutions taking the histological diagnosis of the lesion into consideration that is established from the result of the test-excision prior to the intervention in the cases wherethe screening examination proves an epithelia lesion going forward in the direction of malignancy.

L. Kovacs, A. Bartsch, P. Unk

Immediate, Short- and Long-Term Effects of CO2 Laser Therapy on Cervical Epithelium

The management of benign and premalignant cervical lesions by CO2 laser therapy has been widely discussed in the literature, but until now, few have described it in terms of cytological changes.

J. H. Faktor, E. Avram

Treatment of Condylomata Acuminata by Means of CO2 Laser

The condylomata acuminata is one of the most wide-spread sexual diseases. The pathogen is a DNA virus, the verruca vulgaris virus namely the human papilloma virus counted to the papova viruses (papilloma virus), that is known as the only member of papova viruses that is pathogic for human beings.

A. Bartsch, L. Kovacs

The Use of Contact Laser Probe in Gynecological Endoscopy

Of the many lasers that have been used in surgical fields 4 have been introduced into gynecology: the CO2, the argon, the Nd:YAG and the KTP-laser. Each of these lasers has a specific wavelength and thus different effects on the tissue.

J. Keckstein, A. S. Wolf, R. Steiner

The Nd:YAG Laser Sapphire Tip in Reproductive Surgery, a Preliminary Report

The CO2 laser is used for several indications in operative laparoscopy. Many authors reported the advantages of CO2 laser preparation. The open abdominal surgery with the use of laser is easy and relatively safe. The endoscopic operations-talking about the laser endoscopy we mean laser laparoscopy and laser hysteroskopy — in many cases are technically difficult, especially if rigid instruments are used. The main problem is the danger of damaging the neighbouring organs. It is also important to note the high costs of CO2 laser equipment.

D. Wallwiener, A. Morawski, D. Pollmann, G. Bastert

Sapphire Tip in Treatment of Recurrence of Breast Cancer, of the Vulva and Tumor Reduction

The CO2 laser surgery in primary radical an palliative treatment of breast cancer and cancer of the vulva is recognized, since many years, as established method of treatment in several centres of the world. In the last two years, employing the new developed laser technique, we worked out in our research centre in the University of Saarland, further indications. We are using two surgical laser systems, CO2 laser and Nd:YAG laser, for primary and secondary treatment of breast cancer and cancer of the vulva and, in the last period, for palliative surgery of recurrences of ovarian cancer. The comparison studies on mice (Lewis Loung carcinoma) are very wel1-known, and the results show indisputable superiority of CO2 laser tumor excision over conventional cold knife surgery. In our own studies we compared additionally the results of CO2 laser excision with the excision of the new developed Nd:YAG laser contact technique. We found out that the survival rate in both groups is similar.

A. Morawski, D. Wallwiener, G. Bastert

Nd: YAG Laser Sapphire Tip in Operative Hysteroscopy — A Preliminary Report

The subject of my report is contact laser technique in operative hysteroscopy. It is my opinion that this newly developed laser technique will play a very important role in future operative hysteroscopy. To make my point clear I would like at the beginning to recall the known indications for operative hysteroscopy. They are: septa, synechia, polyps, myopas and, as fifth indication, bleeding, in my opinion, impossible to treat by means of conventional methods. At present we have following methods for intrauterine surgery: for conventional methods we can use sharp cutting instruments often combined with electrocautery. The instruments are: known in urology resecto-scopes and electrosurgical cutting loop. To exclude the danger of insufflation of CO2 in blood vessels we have to use during operative hysteroscopy liquid distension medium, for example, Hyskon or 5% glucose with continuous or interrupted flow. All hysteroscopists know exactly how uncomfortable is this technique. Because of danger of bleeding the conventional operative hysteroscopy requires very often vasoconstrictors; for proper coagulation we need the electro-surgical unit with a power of 50 watts. A possibility of transcervical intrauterine operation eliminates in many cases the need for an extended abdominal operation.

A. Morawski, D. Wallwiener, G. Bastert

Histological Differences in the Tissue Effect; As well as the Healing Process After the Uterotomy Performed on Rats with the Use of CO2 Laser (Sharplan 1060) -Super-Pulsed Wave Versus Continuous Wave

The recently developed CO2 laser technique, the electronically superpulsed CO2 laser beam shows until now unknown abilities of tissue preparation. In this study, we would like to present our first results of experiments performed on rats comparing tissue defect, thermal injury of tissue and healing process after incision of uterine horn by superpulsed and continuous-mode. We used CO2 laser Sharplan 1060.

D. Wallwiener, A. Morawski, R. Damböck, G. Bastert

Complementary Laser Application in Gynaecology

Partially the application of CO2 laser surgical method is of a complementary character, i.e., the application of CO2 laser surgery forms an essential part of the operation process or the spectrum of surgical methods of the type of operation respectively. The reason for the essential nature has to be seen in the special effect of the CO2 laser beam on certain tissue. The complementary character, however, consists in the limitation of the CO2 laser surgical effect as far as the whole complex of methods used in a certain type of operation is concerned. The complementarity of the CO2 laser surgical method consists in its alternating effect with the electro-micro-surgical, micro-surgical and macro-surgical method.

U. Herrmann

Clinical Experience of CO2 Laser Treatment of Vaginal and Vulval Diseases

In recent years the laser has become a very useful tool for the treatment of different gynecological diseases.

W. Albrich, A. Götz, H. Hepp, K. Richter, W. Waidelich

Laser Technique for Non-Surgical Female Sterilization and Reversal of Sterilization by Tissue Welding

An attempt to develop a new, simple, safe and effective non-surgical method of sterilization and a possible way of reversing this procedure was made using the Holmium Laser technique.

E. Lachman, A. Shulman, C. Bahari, D. Aravot, S. Giler, I. Kaplan, D. Sagie, J. Kagan, Y. Kalisky

Urology

Frontmatter

Lasers in Urology — State of the Art

15 years of experimental and clinical use of laser technology have the effect that lasers are not only known in urology but meanwhile firmly established in many sectors of this field (Table 1). Moreover, there are new indications in diagnostics and therapy which have not yet exceeded the experimental state. (Table 2/3).

A. Hofstetter

Laser Assisted Urethrotomia Interna

Unfortunately cold knife urethrotomy of urethral strictures has only a very limited succsess rate. Recurrences are seen in 50 to 70% of the cases.

A. Schilling, A. Friesen, R. Böwering

Contact Nd: YAG Laser Surgery in Urology

The Neodymium:YAG laser produces a 3–5 mm. depth of thermal damage in the bladder due to protein denaturation with preservation of mechanical stability of the bladder wall stroma.1,2,3 Until recently the non-contact method of delivering laser light to the bladder, urethra and, on occasion, the upper urinary tract, has been the primary method of delivery. This non-contact technique may play a role in decreasing the rate of recurrence due to implantation.4,5

Eric J. Sacknoff

Value of the Nd: YAG Laser in the Therapy of Penile Carcinoma

Squamous cell carcinoma of the Penis accounts about 1% of all malignancies in men in Europe in contrary to some countries in Africa where a rate of 10% is found.

K. H. Rothenberger

Induratio Penis Plastica: Laser-Chemo-Therapeutic Treatment

Many therapies have been tried for Induratio penis plastica but many of them have failed.

M. D’Ovidio, G. Leonelli

Transurethral Laser Surgery for Bladder Tumor. With References to Tumor Recurrence

Nd:YAG laser surgery has a lot of advantage propagated as a non-contact destruction and complete necrotization of the tumor tissue1). Therefore, transurethral Nd:YAG laser surgery (abbreviated TULS) would be an ideal method for the treatment of bladder tumor in this point of view. However, the indication of TULS was limited to only a small tumor. The bulky tumor should be applied with standard TUR prior to TULS2).

K. Okada, S. Kiyotaki, H. Asaoka, A. Nakano

Argonlaser-Urethrotomy in Male: Results and Problems

The benign urethra stricture disease in male at all times presents a challenge to the surgeon thus justifying the development of ever new methods of operation. The problem involved is neatly summed up by HELMSTEIN in 1964: “Once a stricture, always a stricture! As early as 1880 the Viennese Leopold von DITTEL had thus characterized the difficulties of therapy: Neither incision nor dilation result in radical cure, whereas urethrotomy solves the problem more quickly and recidivation takes longer.

H. D. Noeske, J. Kraushaar, M. Wolf, C. F. Bothauge

Endoscopic YAG-Laser Therapy for Localised Carcinoma of the Prostate

Carcinoma of the prostate is the commonest urological cancer and is the fifth commonest malignant tumour of males worldwide (Parkin et. al.., 1984). In the United Kingdom it characteristically presents to urologists at a late stage with metastases. The natural history is such that once a patient presents with M1 disease his median life expectancy is approximately two years and this is unaffected by hormonal manipulation (Parker et. al. 1985). Despite the recent interest in new methods of hormonal therapy there is no evidence that they confer improved survival over orchidectomy and they should be regarded as palliative rather than curative. Therefore, if attempts are to be made to improve the outlook for this disease attention must be focused on early disease.

T. A. McNicholas, C. Charig, S. St. C. Carter, J. E. A. Wickham, E. P. N. O’Donoghue

Carcinoma of the Penis Treated with the Nd: YAG Laser

Eighteen males with squamous cell carcinoma of the penis were treated primarily with the Neodymium YAG Laser. Six patients had TIS, 10 patients had T1 tumors, and 2 men had T2 carcinoma. All patients had refused traditional therapy of partial penectomy and received informed consent as to the investigational nature of the Neodymium YAG Laser photoradiation therapy.Circumcisions and deep tissue biopsies were performed on all patients prior to tumorcidal Neodymium photoradiation treatment. The patients were followed from 12 to 36 months.In followup, 6 patients with TIS had no evidence of recurrent cancer. Of the 10 males with T1 squamous cell carcinoma of the penis, 7 patients (70%) were tumor free at a mean followup of 28.6 months. The 2 men with T2 carcinoma of the penis had reduction of the tumor mass but were not cured.The obvious advantage of the Neodymium YAG Laser in treating carcinoma of the penis is preservation of the penis eliminating disfiguring amputation and its psychogenic sequelae.

Terrence R. Malloy, Alan J. Wein, Victor L. Carpiniello

Ultrasound Guided Lasertreatment of Urothelial Tumors

The use of the Neodym-Yag-Laser for the treatment of superficial urothelial tumors alone or in combination with other treatment modalities has proved its value during recent years.

A. Baumüller, R. Vannahme

Histopathological Findings of Biopsies Gained from Urothelial Tumors Following Laser Therapy

The treatment of urothelial tumors with endoscopic application of the Nd: YAG-laser has gained increasing importance during recent years. After laser — radiation biopsies from tumors are altered and thus the question arose if such material is useful for determination of stage and grade in these particular cases. To evalute this problem, biopsies from 89 patients were investigated.

G. E. Schubert, A. Baumüller, R. Sonnenberg

Laser Application in Pediatric Urology

Diseases of the urologenital tract in childhood are very different from these of adults. At adults mostly we have tumors, at children there are in addition to that congenital malformations and also traumatic conditioned diesease. This wide spectrum of diseases in pediatric urology performs a manifold use of different laser systems, where especially the Nd:YAG laser became qualified because its radiation can be transmitted by fiber without any problem (Fig. 1).

H.-P. Berlien, W. Biewald, J. Waldschmidt, G. Müller

Comparative Study of Microvascular Anastomosis Using a CO2 Laser, a Nd: YAG Laser and Conventional Suture Techniques

Application of microsurgical laser techniques have been made in an attempt to minimize tissue trauma and to facilitate and speed up small vascular and vas anastomosis (1,2,4,6). In this study, we will compare laser-assisted microvascular anastomosis (LAMA) performed with a microsurgical CO2-laser1, with a 1.32µ Nd:YAG-laser2, and also with conventional microvascular suture anastomosis (CMSA).

R. A. Bürger, C.-D. Gerharz, P. Küppers, U. Engelmann, R. Hohenfellner

Laser Surgery of the Bladder Neck and Prostate

Sixty patients with proven urologic outlet obstruction were studied. Each patient had cystometric studies, cystoscopy and uroflometry. A total of forty-one males underwent photoirradiation of the bladder neck while 19 patients underwent treatment for prostatic adenoma; some in combination with bladder neck contractures. All patients were screened with transrectal ultrasonography of the prostate and were eliminated from the study with any suggestion of abnormality. Procedures were accomplished using a 100 watt Neodymium;YAG laser with type of delivery source varying from contact probes at low energy to bare fibre in direct contact at watts ranging from 60–80 watts. The procedure that seemed most effective was bare fibre, high energy contact therapy. Patients were followed up from 3–30 months and though early in the observation period, some conclusions appear clear from our results. Patients underwent all procedures under local anesthesia or intravenous sedation with Diazepam or occasional Demerol in the office setting as outpatients. Patient’s ages ranged from 49–88 years. Results can be divided into two groups: laser therapy of the bladder neck for contracture and laser prostatotomy.

Roger S. Warner, Marc S. Cohen

Laser Neodymium-YAG in Urology

From the opening of the LASER Center in the Hospital Espanol of Cordoba, I have made some treatments in several urological pathologies, following the protocols of the International Bibliography and in particular the experiences of Prof. A. Hofstetter.

Raul A. Olmedo, Pedro M. Minuzzi, Pedro G. Minuzzi, Federico G. Minuzzi, Susana I. Minuzzi, Juan A. Saenz

Lithotripsy

Frontmatter

Laser-Induced Shock Wave Lithotripsy (LISL)-Biologic Effects and First Clinical Application

Continuous wave lasers induce thermic lesions in an irradiated tissue by transformation of the laser energy into heat.Laser energy from a pulsed Nd-YAG laser with a pulse duration in the nanosec. range is changed into mechanic energy as Shockwaves by creation of a localized plasma.This procedure-laser induced breakdown-can be used for disintegration of concrements(e.g.urinary calculi)(1).

R. Hofmann, R. Hartung, H. Schmidt-Kloiber, E. Reichel

Laser Lithotripsy: Measurement of Pressure and Shockwaves in Stones

Opto-mechanical effects induced by short pulsed lasers are widely used for disruption or disaggregation of biological structures like e.g. kidney stones and gall stones.

Th. Meier, E. Keckeis, R. Steiner

Laser Induced Shock Waves for Medical Applications

Extracorporal shock wave lithotripsy (ESWL) is by now a well established method to fracture human kidney and gall bladder stones in vivo.One method of generating shock waves in water is to focus a laser beam of short pulse width and high energy to a point.We report on experiments with a Q-switched Nd:YAG laser causing an optical breakdown in the focal region of a lens. It was found that the shock wave formation and dynamic depends not only on the lens performance but also on the laser beam properties. Using a semi-elliptic reflector we measured the temporal and spatial behaviour of the reflected and focused shock wave and studied the pressure distribution at the second focal point of the reflector with an ultra-fast PVDF-transducer and time-resolved Schlieren photographs. First in vitro-experiments on kidney and gall bladder stones gave reasonable results.

E. Steiger, W. Uebelacker

Physical Foundations of the Laser-Induced Shockwave Lithotripsy (LISL)

This paper describes the basic concepts of stone fragmentation by lasers and the possibilities of guiding laser-light through optical fibers. A section about the physics of the laser-induced breakdown (LIB) and the Shockwaves produced thereby is followed. These Shockwaves cause the stone fragmentation in the laser-induced shock-wave lithotripsy (LISL) and the effectiveness of biliary and ureter stone destruction is dealt with in the last chapter.

E. Reichel, H. Schmidt-Kloiber, H. Schöffmann, G. Dohr, R. Hofmann, R. Hartung

Laser Fragmentation of Urinary Calculi: In Vitro Studies

Parameters for effective in vitro laser fragmentation of urinary calculi by the neodymium-YAG (Nd:YAG) laser and the KrF-Excimer laser are examined. The results of reflection measurement of urinary calculi at wavelengths of different laser systems are presented. From λ=1046 nm (Nd:YAG laser) to λ=249 nm (KrF-Excimer laser) a continuous decline of reflection is found. The reflection at λ=1046 nm is above 90% whereas a complete absorption is found in the ultraviolet range. Furthermore a tube which contains as essential parts a water pump and a Nd:YAG laser system is presented. This tube allows by determination of its entrance size and by sucking off the urinary calculi fragmentation to particles which are not larger in diameter than the entrance size. Following these results experimental data with the KrF-Excimer laser are presented.

R. Friedrichs, R. Poprawe, R. Kohnemann, W. Schäfer, H. Rübben

Laser-Induced Shock Wave Lithotripsy (LISL)

By continous Nd: YAG LASER it is possible to vaporize urinary calculi using high power. Because of tissue laceration due to the resulting heat, this is not possible in vivo.

N. Schmeller, A. Hofstetter, J. Pensel, F. Frank, F. Wondrazek

Laser Lithotripsy of Gallstones by Means of Pulsed Nd: YAG Lasers

Laser lithotripsy was performed with a flashlamp pulsed Nd: YAG laser (wave length 1064 nm) (by LASAG, Thun, Switzerland). The following parameters are freely adjustable: pulse frequency (1–20 Hz), pulse energy (0.1–4 Joule), and pulse duration (0.1–10 msec). The laser energy is transmitted via a highly flexible quartz fibre with a diameter of 0.2 mm.

Ch. Ell, J. Hochberger, D. Müller, G. Lux, L. Demling

Gallstone-Lithotripsy by Pulsed Nd: YAG Laser

Nd:YAG-Laser are used in curative and palliative surgery. The development of a pulsed Nd:YAG Laser now also allows the desintegration of concrements. The presupposition for clinical use of such technique is a system that gives necessary energy in very short pulses and high repetition rate to avoid thermic lesion and a flexible transmission system that can be brought through the working channel of flexible endoscopes.

H. Wenk, V. Lange, K. O. Möller, F. W. Schildberg, A. Hofstetter

ENT

Frontmatter

Laser Surgery — ENT (Upper Aero-Digestive Tract)-State of the Art

The possibility of being able to use various laser systems (CO2, Argon or Nd Yag) for endoscopic and microscopic surgery of benign and malignant lesions of the upper aero-digestive tract has opened up a new therapeutic dimension.

W. Steiner

Endoscopic Therapy of Laryngeal Carcinomas with the CO2 Laser

In many countries small vocal cord carcinomas are not treated primarily surgically, but radiologically because of voice impairment after surgery.

H. Rudert

Vaporization of ORO-Pharyngeal Lymphoid Tissues — Indications, Techniques and Results in 40 Cases

The role of the carbon dioxide laser has become established in the management of various congenital and acquired lesions of the airway. The method has proven to be efficient, safe, with minimal operative morbidity and bleeding. About 150 cases have been managed at our institution during the past 4 years.

M. Remacle, M. Hamoir, P. Van Heule, Y. Frederickx, B. Bertrand

Benefit and Risks of Laser Surgery in Carcinomas of the Larynx and Pharynx

The incidence of laryngeal and pharyngeal cancer increased tremendously over the last 30 years in Europe (4). Several new concepts of therapy were developed 1n the last 10 years. Especially CO2-laser surgery has gained much Interest. The possibility of endoscopic surgery seems to be a major advantage over conventional surgery which requires a wide exposure of the operating field. However, the limited two dimensional view through the operating microscope can be deleterious as radical excision is required. Another objection was raised due to carbonization at the cutting borders which can hinder a true histological evaluation (2, 4, 5). In our present study we evaluated the benefits and risks of endolaryngeal and endopharyngeal CO2-laser surgery in the management of carcinomas in these regions.

T. Lenarz, J. Haels

Laser Turbinectomy

The laser turbinectomy was popularized in the U.S. by Harry Mittelman and Stuart Selkin. At the International Society for Lasers in Medicine and Surgery Meeting that was held in Detroit, we presented a paper dealing with new instrumentation that facilitated the use of the carbon dioxide laser in intranasal surgery. To this instrumenation we have added the Nd:YAG laser as part of an FDA protocol that we have written for Cooper LaserSonics. This protocol covers a wide spectrum of Head and Neck Applications of the Nd:YAG laser.

Ronald Allen Kirschner

CO2 Laser Microsurgery in Choanal Atresia — How to Protect the Alar Skin from Burning?

The use of CO2 Laser beam combined with a surgical microscope has been, in our two years short experience, the best way for treating choanal atresia. The surgical tool is easy to move in the strenght field of the nasal fossa, there is less postsurgical pain for the young patient, and it is not necessary to leave in place a calibration tube for cicatrisation around. But some rules must absolutely be followed in order to avoid complications linked to the CO2 Laser microsurgery: 1)recurrence of the nasal stenosis, especially in case of a wide bony stenosis,2)burning of alar skin that may lead to disaesthetic scars, and disfonctionnai stenosis.

B. Bertrand, Ph. Eloy, M. Remacle

Use of a Microspot Micromanipulator for CO2 Laser Surgery in Otolaryncology

A new microspot micromanipulator for the CO2 laser has been developed and utilized in both laboratory setting and in clinical practice. Eight patients with various benign vocal cord pathologies and one patient with early dysplasia of the vocal cords were treated with the new microspot micromanipulator utilizing the operating microscope with a 400 mm lens. This new micromanipulator has the following unique features: a virtual image, utilizing a fiberoptic bundle with a green aiming light, and a spot size of.4 mm utilizing the 400 mm lens on the operating microscope. Elimination of a helium neon aiming laser obviates the problems with coincidence and a glaring effect of the laser upon the tissue. The spot size can be changed from.4 mm up to 3 mm in size.

S. M. Shapshay, R. Wallace, J. F. Kveton, R. Hybels, R. K. Bohigian, S. Setzer

Role of Laser Surgery in the Management of Recurrent Malignancies at the Base of Skull

Laser has at present gained a foothold in the management of recurrent malignancies of the base of skull. Though this treatment modality is essentially palliative, it is gaining ground in many centres. In Singapore the use of laser is being increasingly used in the palliative management of recurrent Nasopharyngeal Carcinoma where other modes of treatment have gained, namely radiotherapy and chemotherapy. The incidence of new cases of NPC is in the region of 200 per year in Singapore hence there is increasing availability of such cases here.

N. Kunaratnam

Reform of Traditional Treatment of Nasal Polyps by Using Laser

This paper presents the use of laser for the treatment of nasal polyps instead of the traditional method. Traditionally, they are removed by snaring method. After operation, profused bleeding, possibility to recur, unsatisfactory result and so on may be the problems. Anterior nasal packing with gauze for hemostasis may make patient very distressing. To solve these problems, the authors used YAG Laser through optic fiber condition to treat 150 cases of nasal polyps recently with satisfactory results. This method might also be used in nasal polyp patients who are contradicted to the traditional treatment or complicated with blood and cardiovascular diseases.

Min De Liu, Hong Deng, Pei Zhong Wang

Oral Surgery

Frontmatter

Progress Report on Laser Therapy in Oral and Maxillo-Facial Surgery

In oral and maxillo-facial surgery, the application of the Nd-YAG laser may be considered as a standard method in the treatment of patient suffering from hemorrhagic diathesis. ACKERMANN (1984) re-portet his experiences of more than 1000 treatments in oral surgery during the last 10 years, executed in cooperation with the Munich Centre of Haemophilia. In his studies, the indication of laser-coagulation diseases (Haemophilia A and B), infirmity of thrombocytes (Thrombastenia, Thrombocytopenia, disorders of the function of thrombocytes) and the more exceptional vascular bleeding diseases. Postoperative bleeding was reported in 10% of the cases and therefore lies within the known limit. In most cases an ambulant treatment with local anaesthesia was possible. Only for patients with severe Haemophilia A with a remaining activity of factor VIII below 1% as well as in cases of inhibitors against factor VIII a stay in hospital for 1 or 2 days was necessary. Also the laser coagulation in anticoa-gulated patients has been successfully used. Ackerraann’s clinical studies show that the Nd-YAG-laser is a remarkable alternative to the classical methods of treatment, considering especially the possibility to avoid the problem of transferred plasma proteins during surgical treatment.

Hans.-Henning Horch, Michael Herzog

The Carbon Dioxide Laser in Oral Surgery

The CO2 laser has a definite advantage in surgery of the oral cavity. This is related to the ability to perform accurate hemostatic surgery, while at the same time, sterilizing the operative area. Lesions of various kinds can be treated either by excision or vaporization. In the latter case, anesthesia can be avoided by using the pulsed mode. Minimal postoperative pain and edema with rapid healing results in speedy recovery without significant discomfort. We are presenting some demonstrative cases to support this assertion. Gingival Hyperplasia: In the treatment of gingival hyperplasia, the laser has an advantage because of its hemostatic potential and sterilizing capability. We also noted, in these cases, that postoperative discomfort is minimal, and the use of peripack after the operation is unnecessary. Epulis of the Gingiva: A case of epulis of the gingiva treated by vaporization without local anesthesia. Leukoplakia of the Residual Ridges and Palate: A case of a 64-year-old female with leukoplakia of the lower residual ridges and the palate. Treatment was by vaporization of the lesions with pulsed rnode without anesthesia. Leukoplakia of the Tongue: The ability to treat lesions of the tongue occupying extensive surfaces without anesthesia and without bleeding while leaving the patient free of postoperative pain, is an impressive application of the CO2 laser.

S. Barak, I. Kaplan, I. Rosenblum

Socio-Economic Appraisal of Dental Treatment Using CO2 Laser

Dental decay is the third minor scourge in developed countries. The cost of curative dental treatment is very high.

F. Melcer, J. Melcer, J. Dejardin

The Advantages of the CO2 Laser Beam in Intentional Replantation, Implantation

Since 1981 we have pointed out the benefits of the CO2 laser beam in Dentistry.

J. Melcer, F. Melcer, Ph. Tardieu, J. P. Brun

Conventional and Nd: YAG Laser Hyperthermia (Laserthermia): Effects on Rabbit Tongue Tissue

To use laser hyperthermia (laserthermia) as a form of cancer therapy in the field of oral surgery, we have conducted several basic studies. Using rabbits, we recently investigated the differences between hyperthermia by laser light and by other means. More specifically, we experimentally compared the effects of the artificial sapphire probe commonly used for laserthermia and a new titanium probe of the same form which transmits heat but not laser light.Results: 1)Ultrasonography showed that laserthermia penetrates deeper into the tissue than conventional hyperthermia.2)Histo-pathological examination revealed that in identical conditions laserthermia has greater invasiveness in normal tissue than conventional hyperthermia.

Y. Watanabe, H. Tsunekawa, K. Takeuchi, H. Okumura, K. Fujitsuka, S. Kitayama, T. Toyoda, Y. Kameyama, K. Hiranuma, C. Brünger

Nd: YAG Laser in Oral Cavity Cancer Report of 200 Cases — Minimum Follow up of one Year

Oral cavity cancers are one of the commonest cancers in our country. These cancers are treated by surgery, radiotherapy and chemotherapy either simultaneously or successively. Treatment of oral cancers by Nd:YAG Laser is an additional modality of treatment. Treatment by YAG Laser is simple, involves very little morbidity and no mortality and is cost effective. This treatment has special attraction for aged patients with cancers which otherwise need major ablative surgery and reconstructive procedures. It also permits adjuvant use of chemotherapy or radiotherapy if needed.

D. D. Patel

Thermal Combination of Dental Alloys with a Commercial Nd: Glass Compact-Laser

In dental laboratories soldering is used almost exclusively for thermal combination in dental alloys. Despite careful techniques soldered joints always show low tensile strength with a wide range of values (1). The causes of this are: 1st) incomplete filling of soldering gap, 2nd) many partially connected shrinkholes, 3rd) small diffusion zones, 4th) oxide-and flux inclusions, 5th) microcracks in the connecting zone (2). These problems become apparent especially if alloys with extremely diverse expansion coefficients like, for instance, precious alloy DegulorR M with non-precious alloy WironiumR have to be soldered. Etched cross sections of this combination show that the edges of the WironiumR sample do not differ from their original form. The bonding is achieved almost exclusively by adhesion, since diffusion of solder components hardly occurs and under the most favourable conditions only extends to a few micrometers. This is confirmed by distribution of the element gold recorded by wavelength dispersive x-ray spectroscopy (WDS). In order to obtain strong joints for clinical use, however, the connection planes have to be enlarged in dental laboratory and this hinders appearance, cleaning properties and parodontal hygiene.

A. Kasenbacher, E. Dielert

Cardiology/Angiology

Frontmatter

Applicability of 10 Watt Argon-Laser to Recanalisation of Obliterated Arterial Segments

The aim of our study was to demonstrate the effect of Argon-Laser light on atherosclerotic obliterations of postmortal human vessels. The structure of the experiment was the following: 12 postmortal segments of the human A. femoral is with al length of 15 mm and atherosclerotic alterations were positioned in a basin containing physiological solution. The friction resistance between the vessel segment and the bottom of the basin was low. The distal fiber tip was directed into the obliterated vessel lumen. A steady velocity of 0.18 or 0.29 mm/s of the fiber was obtained by linear feeding. The proximal fiber tip was coupled to a 10-W-Argon-Laser. The initial distance between the distal fiber tip and the obliteration was 5 mm. With the beginning of irradiation the motor of the linear feeding was switched on. The laser process was observed through a stereo microscope and was interrupted either by the distal fiber tip appearing at the distal end of the vessel or the location of the vessel segment was changed. The diameter and depth of the channel and the level of fiber soiling were analysed.

C. Norden, F. Dähne, St. Müller, H. Heine, W. Ebert

Cardiovascular Stability During Contact Nd: YAG Laser Surgery in the Abdominal Cavity

The introduction of contact tips and probes for use with low power Nd:YAG laser energy has been particularly beneficial to the specialty of General Surgery. The operative use of the Nd:YAG laser, formerly limited to endoscopic therapy, has now been extended to a wide range of open surgical procedures. The technological benefits of the low power contact method of applying laser energy have been well documented (1). For the patient, the operative advantages include reduced tissue trauma and greatly decreased blood loss. Postoperatively, reduced morbidity and improved recovery lead in many cases to early hospital discharge (2). The potential uses of low power contact Nd:YAG laser energy within the abdominal cavity have been detailed by Joffe (3).

K. C. Moore, A. Steger, N. Hira

Fundamental Research in Laser Angioplasty (1): Effects of Nd:YAG, Argon-Ion and Excimer Lasers on Human Aortic Wall with or Without Atheromatous Plaque

As the number of patients who have occlusive peripheral arterial disease grows, the clinical need of non-surgical treatments for this disorder is becoming stronger. In recent years, it has been reported that laser irradiation has the capability to vaporize and re-canalize occlusive lesions of a blood vessel [1–3]. Thus, angioplasty by laser has attracted considerable attention also in many countries, including ours.

Masaru Iwasaki, Kihachirou Kamiya, Akira Ueno

Morphological Basis for Laser Isolation of the Ectopic Foci in Atria

Surgical treatment of the supraventricular tachycardias caused by ectopic activity in the focus of the atrium is based on its excision, isolation or destruction applying electro- or cryotechnique (1, 2,3,4). If the localization of the focus is not precisely identified, surgical methods are proposed for the isolation of the right atriun, including the sinus node, complete electrical isolation of the left atriun etc. (5, 6, 7, 8).

V. A. Obelienius, A. J. Knepa, E. J. Burneckis

Energy Threshold for Argon Laser Ablation of Arterial Plaque

Argon ion laser energy has been used for the removal of atheromatous plaque in vitro and in vivo and is a promising technique in recanalizing arterial channels for the surgical treatment of atherosclerotic cardiovascular disease.1–4 It is important to understand the mechanism of tissue removal and laser tissue interaction to optimize the most efficient and safest method to deliver argon ion energy intravascularly, as well as the most appropriate wavelength, and dosage, optical geometry and methods to limit the laser activity to the intraluminal occlusion without danaging other tissues, including the vessel wall.

Robert W. Gammon, K. R. Fox, A. A. Coster

An Evaluation of Prostaglandin Activity and Pathologic Changes Following Carbon Dioxide Laser Endarterectomy

Laser endarterectomy has been proposed as a method to recanalize narrowed or occluded arteries, especially coronarles. Since a substantial number of patients with anterior cerebral circulation ischemic symptoms have evidence of obstructive carotid lesions, laser angioplasty may perhaps be a useful technigue for the treatment of cerebrovascular disease. Most of the endarterectomy studies performed to date have been performed using argon lasers (1). Alterations in clotting have been associated with argon laser angioplasty (2,3). Such alterations would have considerable impact on cerebro-vascular circulation where thrombosis and embolism are poorly tolerated. Very little basic science data has been published regarding carbon dioxide laser irradiation of vessel surfaces. CO2 lasers generally induce more superficial lesions in tissue than argon or YAG so as to make them perhaps more useful in the performance of laser angioplasty. McVicker et al have recently published results from CO2 laser treatments of canine carotid and femoral vessels studying the acute thrombotic conseguences of laser irradiation (4). The current study set out to attempt to reproduce those data as well as to evaluate the delayed effects, observed after several hours of recirculation of CO2 laser endarterectomy.

Francis W. Gamache, Babette Weksler, Daniel Alonso

Laser Application in the Fields of Cardiovascular Surgery; Experimental and Clinical Studies

Recently, several kinds of lasers have been widely employed in the fields of medicine and surgery. However, laser applications are very rare in the field of cardiovascular surgery throughout the world. By the way, surgical treatment for ischemic heart disease has been widely performed in Japan. Especially aortocoronary bypass (A-C bypass) for these patients has been down as a popular surgical intervention.

Masayoshi Okada, Yoshihiko Tsuji, Masato Yoshida, Kazuta Shimizu, Hiroshi Ikuta, Hiroyuki Horii, Kazuo Nakamura

Laser Angioplasty by Means of Sapphire Contract Probe

The first experimental studies on. the ablation of thrombi and atheromatous plaques by laser energy have been done in the early 1980s (1, 2). The feasibility of percutaneous transluminal laser angioplasty (PTLA) in men in peripheral (3, 4), coronary (5), and carotid arteries (6) were demonstrated by clinical pilot studies. At the Department of Radiology of the Karl-Franzens-University Graz, Austria, a research program on PTLA is underway since 1984. In the present study we report our clinical experience with PTLA of peripheral arterial occlusions.

Johannes Lammer, E. Pilger, H. Schreyer, P. W. Ascher

Ophthalmology

Frontmatter

The Use of Nd: YAG Laser in the Treatment of Hyperplastic Persistent Pupillary Membrane

Hyperplastic persistence of the pupillary membrane is a rare but devastating congenital anomaly. Extensive and thick membrane arised from the collarette of iris covering the whole or most of the pupil and sometimes adhering to the anterior surface of the lens forming anterior capsular cataract. Victims of this anomaly often suffered from clinical significant intractable organic amblyopia. Few early medical or surgical management to prevent visual disturbance wore reported in the literature(1,2,3,4). However, only certain cases with less extensive persistent pupillary membrane and at least pupillary aperture of 1.5mm in diameter could achieve successful medical treatment by mydriatics and occlusion therapy(2). Available surgical methods such as sector iridectomy & coreoplasty(1) are often complicated with severe iritis, hyphema and cataract. Using the Nd-YAG laser as a new therapeutic tool, we have successfully treated 7 patients of persistent pupillary membrane. The detached membranes were easily removed from pupillary margin with only Limited complications.

Charles Chia Lee Lin, J. K. Wu, J. H. Liu

Intraocular Microsurgery by Short Pulsed Nd: YAG Laser Effects Clinical Application and its Microsurgical Alternatives

Advocates and sceptics stand opposite sides of the fence at the beginning regarding almost every new procedure which is introduced in medicine. While the one side accepts a new procedure opens up previously unattainable possibilities. The situation is not different regarding the use of short-pulsed lasers on the eye. Inasmuch as comparative prospective studies of this laser application and the microsurgical methods alternative to it are still lacking today, 5 years after the first clinical use, we wish in the following to juxtapose contrary aspects of laser application and microsurgery in some clinically common operations — especially those in which we ourselves have practical experience of both methods.

V.-P. Gabel, R. Birngruber

Infrared Versus Visible Laser Photocoagulation in the Treatment of Specific Eye Diseases

In the visible and near infrared wavelength region melanin is the main absorbing chro-mophore of the fundus. As melanin absorption decreases with increasing wavelength (8), an increased penetration depth into the choroid can be expected for longer wavelengths (10,15,21), and is indicated by some experimental results (1,3,13,17), though quantification is still lacking.

B. Lorenz, R. Birngruber

The Role of Heat Dissipation in Living Tissue During and After Laser Exposure

Heat convection and heat conduction are the two types for the spread of heat in tissue. Heat convection means transport of heat due to mass transport whereas heat conduction is characterized by heat diffusion without mass transport. In tissue with dense vascularity, e.g.parenchymal tissue or the choroid of the eye, heat convection should contribute essentially to heat dissipation.

R. Birngruber, V.-P. Gabel, B. Lorenz

Our Clinical Experience with the new Scanning Laser Ophthalmoscope — A Preliminary Report

Since the days of Helmholtz (2) in the middle of the last century, the inner surface of the living eye can be observed: by ophthalmoscopy. The hand hold ophthalmoscope therefore is the instrument most frequently used by the ophthalmologist, whereas for documentation with film or video bigger and stationary equipments are necessary, called “fundus cameras”. Due to their high technical standard the pictures gained with the aid of modern fundus cameras are of the utmost quality. On the other hand, there are some limitations of the method. Pupils must be widened arteficially (by eye drops), and even small opacifications of the transparent media of the eye (localized in cornea, aqueous humour, lens or vitreous body) can disturb the image by glare.

M. Mertz, E. Fabian, Chr. Foos

Interaction of Q-Switched and Mode-Locked Nd: YAG Laser Pulsed with Ocular Media: An Experimental Analysis

We report on a wide series of experiments performed with the aim of clarifying basic aspects of the interaction between short and ultrashort laser pulses and ocular media which occur in the photodisruption of ocular membranes. We performed, on a simple eye model i)the determination of the threshold intensities required for optical breakdown, and their dependence on pulse duration and geometrical conditions, with pulses ranging from the nanosecond to the picosecond regine;ii)measurements on the shielding properties of single pulses, to evaluate the intrapulse shielding, and of plasma lifetime as a means of determining possible inter-pulse shielding effect;iii)experiments to investigate the occurrence of non-linear effects like Brillouin scattering in the nanosecond regime.

C. A. Sacchi, F. Docchio

Intraocular Pressure Changes After Nd: YAG Laser Capsulotomy

3 mJ Q-Switched Nd:YAG laser anterior capsulotomies with 30 burns in circular arrangement were performed on 10 rabbits 20 eyes. Intraocular pressure measurements, anterior segment fluorescent angiography, aqueous humour protein amount determination, optic microscopy and electron microscopy observation were examined at different intervals after operation. Discussion on the relationship between intraoccular pressure and other measurement and observation mentioned above were presented.

Kang-Sun Wang, Ling Wang

Corneal Laser Trauma

In ophthalmology laser surgery is a well established method of therapy. It had been one of the first laser applications in medicine which has been introduced into routinly used clinical therapy. Nowadays in ophthalmology a variety of different lasers are used for: photo-coagulationargon laser (blue, green),krypton laser (yellow, red),dye laser (blue, green, yellow, orange, red),CO2-laserphoto-disruptionNd:YAG-laser (Q-switched. mode-locked).

E. Fabian

Dermatology

Frontmatter

Laser Dermatology — State of the Art

The use of the laser in dermatology has one of the longest histories in the medical application of the laser. Despite a period where dermatologists moved away from the use of the laser because of unwanted side effects such as scarring and hyperpigmentation, the past three years have seen a resurgence of interest in the use of this still-new modality. A better understanding of basic laser physics, biophysics, laser-tissue interaction and beam manipulation has led to good results, consistently achieved. The emergence of new wavelengths with highly specific tissue interactions has added to this growth phenomenon. Basic scientific studies and solid clinical data on photobiosti-mulation have added Low Level Laser Therapy (LLLT) to the growing list of both new and tried and tested High Level Laser (HLL) modalities which form the armamentarium of the laser dermatologist. This paper will examine the basics of HLLT and LLLT, and look at the state-of-the-art applications of the laser in dermatology from both a theoretical and practical standpoint. It will become clear that, as Professor Leon Goldman has long said; “If you don’t need the laser, don’t use it”. However, if you have need of it, then do use it, always provided the user has the multidisciplinary background so necessary for successful application of the laser in any of the medical specialties, especially dermatology.

Toshio Ohshiro, R. Glen Calderhead

Argon Laser Treatment of Portwine Stain, its Application and Limitations

Application of argon laser (Ar) treatment to portwine stain (PS) and other superficial lesions of the skin was studied for an 8-year period in about 800 cases. Results of the treatment and some of its limitations were reported.

T. Matsumoto, T. Ohura

Laser Treatment of Cutan and Deep Vessel Anomalies

Haemangioms are the most often occuring malformations in childhood and their treatment is controversial. Most haemangioms heal spontaneously before the age of 8, and it is advisable to wait till then. If located at an exposed position, e.g. on the face or on functionally important structures, further growth can result in significant functional disorders or disfigurations. This requires early treatment in infancy and childhood. Until now all treatment methods have been radical and have caused further injury. One prominent example is X-ray therapy. Treatment can result after a period of 20–30 years can result in a development of malignomas (Fig. 1 + 2).

H.-P. Berlien, J. Waldschmidt, G. Müller

Argon Laser Photodermoabration for Cicatrical Acne Sequella Treatment

Scarring constitutes one of the most frequent unaesthetic acne complications (1). For its correction there have beer-several methods of treatment proposed of which chemical peeling (2), which produces destruction of first cutaneous layers, is the most common. Nevertheless, this method doesn’t always achieve satisfactory results, especially if lesion is too deep or when peeling complicates with haemorrhages (3), infections (4), etc.

M. A. Trelles, Morillo M. Martinez, E. Mayayo, J. Rigau, J. Sanchez, Francino P. Sala

Possibilities for the Increase of the Coagulation Depth in Skin with the Argonlaser

The depth, to which tissue will be coagulated by irradiation with laser light of defined wavelength, cannot be increased arbitrarily by simply raising the laser power. The surface of the tissue carbonizes and evaporates above a certain power density. Therefore, the optical absorption becomes larger and the laser beam now is absorbed to a higher amount on the surface and the depth of coagulation decreases. For every type of laser there exists a maximum coagulation depth (MCD), which cannot be exceeded by increasing the laser power /1/.

D. Haina, M. Landthaler, W. Waidelich

Improvement of Therapy Results in Treatment of Port Wine Stains with the Argonlaser

The report in “Possibilities for the increase of the coagulation depth in skin with the argonlaser” by D. Haina, M. Landthaler, W. Waidelich describes the technical and physical means of water cooling which helps to improve the results in treatment of Portwine stains with the argonlaser /1/.

D. Haina, W. Seipp, M. Landthaler, W. Waidelich

New Light Guide with a Sapphire Tip for the Argon Laser

The argon laser is well established for treatment of vascular lesions like port wine stains (3). But the argon laser does not work vessel specific since coagulation of epidermis and superficial dermis occurs. With the usually used parameters of irradiation depth of coagulation is limited to about 1 mm (1, 2, 4).

Michael Landthaler, Diether Haina, Erich Weimel, Wilhelm Waidelich, Otto Braun-Falco

A Comparative Study of the Wavelength Dependent Effect of the Argon, Nd: YAG and CO2 Lasers in ddY Mouse Skin

The argon, Nd:YAG and CO2 lasers are the lasers used most in medicine and surgery. The biological tissue reaction to each laser is primarily wavelength dependent, but basically similar early histologic changes can be achieved by all three laser types despite their wavelength difference. This study was designed to find the irradiation time needed to achieve a similar repeatable biologic reaction for each laser type, and to correlate the findings. Positive Evans blue exudation (EBE) from the laser-irradiated dorsum skin of the ddY mouse was used as the indicator. The correlation of the irradiation times to achieve EBE with the argon laser standardised at 1 was 47.5 for the Nd:YAG and 0.1 for the CO2. The possible use of these figures in the medical application of the laser is explored.

Toshio Ohshiro

Effects of Laserlight of Low Power Density on Sebaceous Glands

In contrast to laserlight of high power density therapeutical application of laserlight of low power density remains still questionable (1, 2). At least in Europe the so called soft lasers and MID lasers are recommended for treatment of various conditions and in dermatology especially for the treatment of acne vulgaris. But up to now no scientific data are available. We therefore decided to examine the effect of laserlight of low power density on sebaceous glands, since these glands play an important role in the pathogenesis of acne vulgaris. Sebum output is an absolute prerequisite of acne and all measures which reduce sebum production improve the disease (3).

Michael Landthaler, Diether Haina, Christoph Ohngemach, Wilhelm Waidelich, O. Braun-Falco

Large Scale Treatment of Dermatoses Using He Ne- and IR-Laser Radiation

The apparatus 1 used by us has been developed for external treatment of large size skin areas. It is equipped with a He-Ne-Laser (632.8 nm wavelength, 10 mW peak power) and a GaAs-Laserdiode (904 nm wavelength in the infra red) emitting pulses with a peak power of 72 W, 200 ns pulse duration and 600 – 1400 Hz repetition frequency. The visible He-Ne laser beam also provides a guiding aid for the infrared application. The area of irradiation can be varied at different oscillation frequencies by means of a vibrating electrodynamical scanner.

S. Chlebarov

Tunable Lasers in Dermatology: Determination of Action Spectra

Tunable lasers are ideal light sources for photodermatological research because of their monochromaticity, high spectral intensity and tunability of the wavelength. Thus action spectra e.g. of erythema and pigmentation can be determined with high accuracy. An improved knowledge of erythema and pigmentation reactions is of great interest concerning the photo- and photochemotherapy of special skin diseases like psoriasis with UV light or the use of intense UVA irradiation for cosmetic tanning.

A. Anders, M. Knälmann, E.-G. Niemann, H. Tronnier

Morphologic Effects of Short Argon and Dye Laser Pulses

The goal of the present study was to characterize the effect of different durations of dye laser pulses in comparison to the changes following short argon laser pulses.

K. Klepzig, M. Landthaler, D. Haina, W. Waidelich, O. Braun-Falco

CO2 Laser Microsurgery for Skin Lesions

A series of 52 malignant and 310 benign skin lesions was selected for laser microsurgery from Jan. 1982 to Dec. 1985. Epithelial (13.3%), pigmented (17.2%) soft tissue (32.1%), pseudotumoral (33.1%) and inflammatory lesions (4.4%) were located on the face (58%), scalp (5%), extremities (10.2%), trunk or limbs (16%) and perianal area (10.5%). CO2 laser models used were Valfivre LSS 25, Coherent 450, and Cooper 250 Z coupled with the ZEISS OPMI-6 operating microscope (focal lens 200 mm). Laser systems were used at 10 to 15 W, CW and superpulsed emission spot size was 0.5 to 1.5 mm. Resection was used in 58% of cases, vaporization or combined procedure were used in the remaining cases. Of the 52 malignant lesions, 4 (7.7%) had unevaluable radicality for thermal damage, 7 (13.5%) persisted, and 1 (1.9%) recurred in a follow up ranging from 6 to 36 months. Of the 310 benign lesions, 96.4% had good to excellent cosmetic results without complications, 3 cases (1%) had prolonged pain and edema, 5 cases (1.6%) had hyperplastic scars and 8 cases (2.6%) recurred. CO2 laser microsurgery appears to be a precise and effective alternative treatment modality especially for benign exophytic and critically located lesions.

G. Bandieramonte, O. Santoro, P. Lepera, G. Fava, G. De Palo

CO2 Laser and Cavernous Haemangiomas

During our five year’s experience of the CO2 laser, we have been able to pick out a certain number of indications where this laser is particularly useful. Cavernous haemangiomas are among them.

F. Laffeitte, J. P. Chavotn, D. Rouge, M. Costagliola

Dermabrasion Versus CO2 Laser in the Removal of Tattoos — A Comparative Study

Since the first days of laser application in dermatology the removal of tattoos was of special intrest and different lasers have been employed (Ruby, Argon, CO2, Nd:YAG) (3).

U. Hohenleutner, M. Landthaler, Diether Haina, W. Waidelich, O. Braun-Falco

Nd: YAG Laser Ablation of Superficial Varices

Superficial Varices or spider veins comprise a long standing problem for a large number of women. A number of procedures have been utilized in the past for eradication of these vessels.

Ronald Allen Kirschner

Possibility of Treating Hyperpigmented Skin Lesions Using the Nd: YAG Laser

The authors have developed a ruby laser system having a device to provide uniform output, the “Kaleidoscope” handpiece. This equipment can be used for the treatment of a hyperpigmented skin lesions, such as nevus spilus and nevus cell nevus. As a result, acceptable clinical results have been obtained*. However, the ruby laser was not effective for the treatment of deeply located intra-dermal hyper-melanoses.

Kenji Iwasaki, Susumu Shimizu, Mitsuhiro Osada, Ryuzaburo Tanino, Muneo Miyasaka

Nd: YAG Laser Treatment of Tattoos

There are a variety of techniques tht are currently employed for the eradication of tattoos. Each one of the techniques has its own distinctive advantages and disadvantages.

Ronald Allen Kirschner

The Percutaneous and Subcutaneous Application of the Nd: YAG Laser for Animal Experiments

In the ease of a percutaneous laser application the laser beam at first hits the superficial layers of the epidermis which are also the first to coaqulate. The layers of the skin that follow, which are deeper are less and less hit by the laser coagulation cone. The tip of this cone marks the limit of the so-called depth of penetration (in the case of the CO 2 laser 0.1 mm, in the case of the Argon Laser 1–2 mm, in the case of the Nd-Yag-laser 3–5 mm).

Dimtrije Katalinic

New Diode Laser for Immediate Pain Attenuation Following Snowy Dry Ice Treatment for Naevus of Ohta

Snowy dry ice application followed by epithelial peeling is an effective treatment for Ohta’s naevus. However, it is quite painful. The GaAlAs diode laser has been found to be effective in pain attenuation. A retrospective study of 452 patients is presented, using the diode laser for immediate pain attenuation following snowy dry ice application and epithelial peeling. One group of 100 patients participated in an additional separate study to determine the time course for pain recovery after dry ice application alone without laser or peeling. A second group of 100 patients participated in a second study to evaluate recovery and determine the time course following peeling without laser irradiation. In all cases the laser proved effective in attenuating the perceived pain by 60%, and shortening the overall recovery time by 37%, with minimal (0.7%) and controllable side effects.

Toshio Ohshiro, J. Kubota, K. Iwahira, I. Tanaka

Abnormal Skin Microcirculatory Reflex in Diabetic Patients with Autonomic Neuropathy Detected by the Use of Laser Doppler Flowmeter

Autonomic neuropathy (DAN) is a well-recognized complication of diabetes. Because it is often aymptomatic1 in the early stage and has a higher mortality risk2,3, it is very important clinically. Since the first introduction of cardiovascular reflex (CVR) tests on 19734,5, they have been widely used for detecting DAN. With increasing understanding of the pathophysiology of DAN, more aspects of autonomic dysfunction have been explored.6 In the present study, we wanted to characterize the skin microvascular reflex (MVR) changes in diabetes using newly available technology — The laser Doppler flowmeter,7,8 and compare the MVR between patients with and without cardiac autonomic dysfunction, as determined by CVR tests.

L. T. Ho, Kam-Tsun Tang, Jeng-Tao Wang, Hing-Chung Lam, Shing-Hung Li, Li-Chuan Hsiao, Jing-Cherng Perng, Yueh-Fen Liu

PDT

Frontmatter

PDT — State of the Art

Photodynamic therapy is an experimental treatment for solid tumors. Photodynamic therapy (PDT) consists of the activation of a photosensitizing agent by light. This photodynamic reaction produces damage to the tissue containing the photosensitizer and exposed to light and in presence of oxygen. The idea of treating tumors by photosensitizers is as old as the early ’900; already in the 1903 topic application of eosin and esposition to sunlight was known to produce response by skin tumors (1). On the other hand Policard, 1924, observed reddish fluorescence in animal and human tumors observed under Wood lamp. The presence of fluorescence was attributed to endogenous porphyrins accumulated after infection of the observed tissue by hemolytic bacteria (2). In 1942 Auler and Banzer (3) reported animal tumor fluorescence after systemic administration of Hematoporphyrin (HP) and in 1960 Lipson and coworkers prepared the Hematoporphyrine derivative (HPD), a mixture of porphyrins obtained treating HP with acetic and sulphuric acids (4). They demonstrated that HPD was selectively accumulated by malignant as well as by actively proliferating tissues and realized the first demonstration of endoscopic diagnosis of malignant tissues by detection of fluorescence in the respiratory and in the upper digestive tract (5). After the development of laser, fluorescence diagnosis and particularly PDT have been furtherly studied and the advantage of laser on filtered lamp light has been demonstrated by the possibility of obtaining the necessary power of light with a very narrow band (630 nm wavelength).

P. Spinelli, M. Dal Fante

Endoscopic Nd: YAG Laser Photocoagulation in Oncology: A 5 Year Experience

Actually the best we can do for patients with non-curable cancers is to improve their life expectancy and to give them a better quality of life by treating the most distressing symptoms. Lasers allow palliation of bleeding and obstruction in the respiratory, digestive, and urinary tracts, applied as unic therapeutic resource or in combination with radio- and chemo-therapy or with other endoscopic procedures. Besides palliation Endoscopic Laser Therapy (ELT), has curative indications, firstly in high risk patients with cancers at early stages and then in accurately selected cases, as an alternative to traditional therapeutic methods. Also sessile adenomas of the digestive tube can be treated by laser.

P. Spinelli, M. Dal Fante

The Effects of Photoradiation Therapy and Hyperthermia on Mice Bearing Subcutaneous Tumor

Hematoporphyrin derivativo (HPD) is a photosonsitizer and has strong affinity to quickly growing tissues and tumors (1). After HPD is excited by light, the energy can transfer to oxygen which may cause the tumor cells lysed (2). Photoradiation therapy, the application of HPD and light irradiation, is a good modality for cancer therapy. The therapeutic effect of photoradiation therapy in subcutaneous tumor for BALB/C strain mice had been studied in this laboratory (3).

D. M. Hau, H. Chang, M. C. Kao, H. Y. Hsu

Laser Inactivation of Blast Lymphocytes by Photodynamic Effect with Hematoporphyrin Species

Photodynamic effect caused by combination of hematoporphyrin (Hp) and photo-radiation on malignant cells, which is cytocidal, has been used as a new therapeutic modality of malignant disease. We found that cytotoxic T-cells (CTL), which play a prominent role in rejection episode in clinical organ transplantation, also possess an affinity for Hp like malignant cells. Therefore, photoradiation after administration of Hp can destroy CTL, and if we can destroy the activated CTL selectively, it has a possibility to become a new rejection therapy. We report here for the first time the photodynamic effect of Hp on human Concanavarin A (Con A) activated blast lymphocytes and mouse CTL.

S. Satomi, T. Taguchi, H. Inaba, S. Mashiko, S. Sato

Two-Photon Excited Visible Fluorescence and Photodynamical Effect of Pheophorbide a on Cultured Tumor Cells Using a Nd: YAG Laser

Photodynamic therapy (PDT) represents a new approach to treatment of a variety of malignant tumors in man and animals1). A nontoxic, photosensitizing drug with fluorescent properties, such as the hematoporphyrin derivative (IIpD), is first injected systemically. After 2–3 days, this drug exhibits a higher retention in the cancerious region than in the surrounding normal tissue. Subsequent irradiation at a proper optical wavelength, mainly red light around 630 nm, results in rapid necrosis of the neoplastic tissue.

S. Mashiko, H. Inaba, S. Sato, Y. Taguchi, S. Kimura

Intracellular and in vivo Composition of Hematoporphyrin Derivative by Various Fluorescent Components

Due to a coincidence of tumor-localizing, fluorescent and photosensitizing properties, hematoporphyrin derivative (Hpd) and a purified version Photofrin II (containing mainly dihematoporphyrin ether or ester, DHE, with a large amount of aggregated compounds) are used for detection and photodynamic therapy of cancer /1/. Tumor localization and photo-sensitization, however, are attributed to different components of the porphyrin mixtures Hpd or Photofrin II. Dimeric and aggregated species were reported to be the main tumor localizers /1,2/, whereas the monomeric and dimeric components have the best photosensitizing properties /3/. Fluorescence is most pronounced for the monomeric species hematoporphyrin, hydroxyethyl-vinyldeutero-porphyrin and protoporphyrin /4/, less efficient by one order of magnitude for DHE, and very low for aggregated compounds.

H. Schneckenburger, M. Frenz, J. Feyh, A. Götz

Dynamical Processes Associated with Singlet Oxygen Generations in Porphyrin Solutions

Photoradiative therapy(PRT) has become one of attractive reliable method for cancer therapy nowadays. Since early work by Dougherty and his group1) in the 1970’s, a lot of medical and fundamental investigaters have been reported about it. Most of cases, the singlet oxygen has been postulated to play important role in PRT because of its powerful capacity to react on cell organerals chemically and this resulting in cell destruction. The energy transfer model from porphyrin to oxygen molecule is shown in Figure 1.

Ichiro Tanabe, Hiroshi Fujimura, Yukinori Okazaki, Tadayoshi Takemoto, Yoshihiko Kanemitsu, Yuichi Tanaka, Hiroto Kuroda

An in vitro Comparison of Laser Parameters for Photodynamic Therapy

Although the use of Photodynamic Therapy (PDT) as a mode for the treatment of cancer is in an experimental stage, very little is known about the fundamental mechanism(s) behind the effect itself. The purpose of this study was to further characterize the light and/or heat induced destruction of cancerous cell in vitro. Comparisons were made of the effects of average irradiance, peak irradiance and energy fluence on cell kill.

B. W. Stewart, M. LaPlant, S. B. Kim, C. Distler

Histological Analysis of Cottontail Rabbit Papilloma Virus-Induced Papillomas Treated with Hematoporphyrin Photodynamic Therapy

Our findings of papilloma regression following treatment with HPD-PDT have been reported recently (Shikowitz et.al., 1986). HPD has been shown to localize selectively in rapidly growing tissue such as malignancies and papillomas. Henderson et.al. (1980) demonstrated the ability of HPD to localize in both squamous cell carcinomas and chemically induced papillomas raised on the shaved backs of Swiss white mice by painting with 9,10-dimethyl-1,2-benzanthracene and croton oil. This prompted our initial investigation into the possible efficacy of HPD-PDT for the treatment of virally induced papilloma disease, utilizing CRPV as a model system. We successfully treated large cutaneous rabbit papillomas with intravenous administration of HPD followed by activation with light at 630 nm from an Argon pump dye laser. Two animals were maintained for 18 months following treatment. The animals were sacrificed and biopsies were taken from totally regressed papillomas, partially regressed papillomas, untreated papillomas and normal skin. The histological analysis with molecular analysis confirmation form the basis of this report.

Mark J. Shikowitz, Bettie M. Steinberg, Rachel L. Galli, Allan L. Abramson

Biodistribution of Indium-III Dihematoporphyrin Ether in Papillomas and Body Tissues and its Relevance to Photodynamic Therapy

Hematoporphyrin derivative (HPD) and its newly purified form, dihematoporphyrin ether (DUE) have been shown to selectively localize in malignant tissues and virally induced papillomas (Sliikowitz et.al.). Its use as a probe to distinguish tumors from normal tissues has been largely based on its fluorescence when activated by ultraviolet light. These findings are largely subjective, and a direct correlation to its use as a photosensitizing agent to selectively kill transformed cells when activated by an appropriate wavelength of tight (630 nm) could not be made. We labeled DUE with Indium-Ill and tracked its biodistribution through CRPV induced papillomas and normal body tissues.

Mark J. Shikowitz, Rachel Galli, Dibyendu Bandyopadhyay, Schlomo Hoory

Photodynamic Therapy (PDT) of Superficial Bladder Tumor

The PDT is mainly suitable for the treatment of relatively superficial tumors.

H. D. Nöske, J. Kraushaar, C. F. Rothauge

HPD Mediated Photochemotherapy for Selective Treatment of Leukemic Cells VS Normal Cells

As photochemotherapy of solid tumors is rapidly develloping recent studies suggested that in-vitro photochemotherapy mediated by HPD could be more efficient on leukemic cells than normal cells (1), (2) and this represent a way of cell selection. In order to demonstrate this phenomenon we studied the phototoxicity on both leukemic cells (L1210) and normal syngeneic hemoprogenitors. We varied three culture parameters: time incubation of the cells with HPD, temperature of the medium during incubation and treatment of the cells, laser dose fractionation in 2 or 3. For each condition 3 separates experiments in triplicate have been performed, and each experiment involved simultaneously both cell types for 2 or 3 laser energy levels.

T. Patrice, M. T. Foultier, V. Praloran, D. Cloarec, L. Le Bodic

Indirect Appreciation of the PDT Effect on the Tumor Vasculature

Some authors recently published papers evidencing the rôle of PDT on neovasculature of tumors. In order to appreciate the exact role of PDT on vasculature versus the tumor mass itself we realized 3 different vitro-vivo comparisons on our tumor model HT 29 grafted on nude swiss mice: HPD injection, tumor excision, in vitro laser irradiation, tumor “re-graft”, VS tumor excision, in vitro delay (20’ at 370C), tumor“re-graft”HPD injection, tumor excision, in-vitro irradiation, tumor graft on a new nude mouse VS tumor excision, in-vitro delay, tumor graft on a new nude mouseHPD injection, tumor excision, laser irradiation of the tumor site of implantation, tumor “re-g raft” VS tumor excision, delay, laser irradiation, tumor “re-graft”.

T. Patrice, M. T. Foultier, M. F. Le Bodic, L. Le Bodic

“Rosette” Argon Laser Phototherapy with Rhodamine 123: A new Method for Eradication of Melanoma Tumors in Nude Mice

Rhodamine 123 (Rh-123) is a mitochondrial specific dye that can be successfully used as a photochemosensitizing agent for the argon laser treatment of human melanoma in vitro. In this study a new technique of “Rosette” treatment with the argon laser was developed to completely eradicate human melanoma (M24) tumor transplants in nude mice after “sensitization” with a nontoxic dose of Rh-123. Each experimental group included 4 nu/nu mice injected subcutaneously with 10 millions cells/site for a total of 48 sites. Tumor take was >95% at one week with >10 mm3 tumor volume at each site. Control groups of untreated M24 tumors and M24 tumors sensitized with lug/ml of Rh-123 demonstrated significant growth during the 10 weeks follow-up. Test groups were sensitized with Rh-123 (1ug/ml for one hour) by intratumor injection at one week then treated with the argon laser at 514.5 nm. To allow uniform delivery of energies to the tumors and its edges, a new “Rosette” technique was developed. The tumors were then exposed to non-thermal levels of 700J/cm2 (36°C) or 950J/cm2 (40°C) as determined by a reproducible method of dosimetry. All 16 tumors in this test group showed complete regression with excellent healing and no recurrences even after ten weeks follow-up. Control tumors treated with the argon laser alone, exhibited regrowth at 4 weeks after treatment.

D. J. Castro, R. E. Saxton, H. R. Fetterma, P. H. Ward

Photodynamic Therapy of Oral Cancer in Hamsters

Oral cancer can arise from a primary multiple dysplastic epithelium. Therefore oral cancer can be surrounded by normal mucosa, but also by leucoplakial or sources of a carcinoma in situ. The multifocal origin is one of the reasons for the high recurrence rate and the bad prognosis of oral cancer. According to the statistics the 5-years-healing rate amounts to only 30%–40%. (FRIES 1978, NOLTENIUS 1987, PAPE 1985)

M. Herzog, H.-H. Horch, Th. Meier, S. Enders

Low Power Laser/Biostimulation

Frontmatter

Low Power Laser in Medicine and Surgery — State of the Art

Laser applications in medicine and surgery have been started by using high power to coagulate, to vaporarize the biological tissues — it means by use of thermal effect. Next application of laser is considered to be using pressure effect to destruct biological stone by application of short pulse laser. Recently, the use of low power is becoming one of the topics of laser applications in medicine.

Kazuhiko Atsumi

Effects of Low Dose Laser Radiation on Bacterial Growth

Two years ago, we demonstrated inhibitory effects of sublethal doses of laser radiation on bacterial growth (1). In the range of laser radiant exposures below 4 J/cm2 our results were inconclusive. As this range is of a great importance for laser application in biostimulative medicine, we repeated our investigation using a more sensitive experimental model.

M. Džinić, N. Nanušević, O. Nanušević

Preliminary Observation and Approach of the Laser Biological Effect of the Immune Liver RNA in the Action of Malignant Tumor

The methods now being used in the treatment of tumors may be basically classified into two broad categories: One is the direct killing of cancer cells and the other is the inhibiting of the cancer cells growth by strengthening the function of immunity surveillance to cancer cells. But in this paper, we try to probe into the technology of laser treatment of cancer by both the two main methods mentioned above and the way in which the “reversion” of the cancer cells takes place.

Fu-Shou Yang, Da-Wen Xu

Low Power CO2-Laser Treatment of the Facial Neoplasm — 3,000 Cases

Since 1985 we have been using a small size portable (gross weight 5Kgs) low power CO2 laser treatment apparatus, its wave length 10.6 μm, output power O — 3 W, controllable. The surgical operation apparatus is in revolver form, the trigger controls the laser beam output, its operation is easy and safe. We have treated 3,000 cases of facial neoplasm with this apparatus, the curative effect has been satisfactory.

Fu-Shou Yang

Studies of Laser-Induced Cell Growth with Yeast in Continuous Culture

Most of the studies concerned with biostimulation are subject to large statistical uncertainties. Thus it was our aim to develop a very precise and reproducible method to measure the multiplication rates of two simultaneous growing cultures, one of them being irradiated with laser, the other one kept in the dark.

A. Gfrörer, J. Spahn, W.-D. Wagner, W. Waidelich

The Concept of ”Biologon” and the Influence of Laser Light on Vital Activities

The purpose of this study is to present a theory with some new features for the analysis of the behavior of the living matter in the case when one ore more parameters of its environment change. The first part deals with the fundamental problem of what the precondition is that turns any change into a signal, into a stimulus which, when processed, becomes “vital” information provoking responses which manifest themselves either in an attempt to preserve the structure status quo existing before the change in the environment, or in creating a new type of dynamic structure status quo. It will be followed by application to clear up confusion in the interpretation and comparison of the responses of living matter to laser light.

P. Greguss

Low Energy Laser Irradiation Prevents the Early Morphological and Electrophysiological Effects of Optic Nerve Injury

The present study provides evidence that low-energy laser irradiation causes, at least temporary prevention of degeneration of mammalian central nervous system (CNS) axons after moderate compression injury.

M. Rosner, M. Belkin, M. Erlich, J. Friedman, M. Schwartz

Application of the CO2 Laser in the Rheumatoid Hand

One of the major goals in tendon reconstruction is the restoration of the gliding motion of the tendon. This is particularly difficult in the complexity of the healing process in the rheumatoid hand.

H. R. Herrera, J. R. Hinshaw, R. J. Lanzafame

Na+-K+ Transport, Cotransport and Cell Volume of Rats Erythrocytes Submitted to Helium-Neon Laser Radiation

It has been studied the Na+-K+ transport, cotransport, and cell volume in erythrocytes of rats irradiated with Helium-Neon laser. It has been observed an increase in the passive diffusion of Na+ and K+ compensated by higher Na+-K+ pump activity. There was not observed alterations in Na+ and K+ cotransport, cell volume, as well as in the Na+ and K+ intracellular content.

Hugo Juri, Jose Palma, Frank Frank, Ron Lapin, Jose Lillo, Sham Yung

Biological Effects of Low Laser Irradiation on Cultivated Rat Brain Cells

A well-established neuroglial cell line obtained from the dissociated culture of normal neonatal rat (JAR-2 F-51) brain tissue was used as a model to investigate its biological effects resulted from the irradiation of low power lasers. These lasers are conventionally used for “bioregulation” or “acupuncture”. This culture shows a relatively constant morphological characteristics of the cell and presents a steady growth and proliferation in the monolayer system. The monolayer culture was exposed to the irradiation of various lasers in low power density of various situations. The effects on cellular morphology, proliferation and other functional activities after various conditions of irradiation will be studied.

Ming-Chien Kao, Jui-Chang Tsai, Teh-Cheng Jou

Immunological Aspects of Laser Therapy

Human polymorphonuclear leukocytes and macrophages emit light of low intensity during phagocytosis with maxima near 630 nm and near 760 nm. Singlet oxygen is one of the toxic agents, which are released from phagocytes in order to destroy strange particles or cells. In addition to that, singlet oxygen produces or mediates the photon emission of phagocytes during immune defense. Typical emission bands of singlet-oxygen are at 1060 nm and 1270 nm, but also at 480, 570, 634 and 760 nm steming from dimolar oxygen transitions. The wavelengths of 633 nm and 760 nm seem to be mainly involved in immune reaction of phagocytes.On the other hand, laser light of specific wavelengths (e.g.633 nm He-Ne-lasers light), of relatively low emission intensity (mWatt range) and of low dose (Joule/cm2 range) has been successfully applied in various medical laser therapies during the last 15 years. Experimental investigations on the effects of low dose laser light and monochromatic light support these photomedical observations. Recent studies on cell division of low level light result in favorite wavelength near 630 nm and 760 nm.Comparing these two immunological aspects of light in biological systems, the following hypothesis is formulated and discussed: Photon emission of phagocytes might play an important role in immune system regulation and, on the other hand, appropriate laser light supports the natural immune reaction by simulating phagocytosis, thus leading to healing or improvement of deseases.This hypothesis is in agreement with our recent knowledge in nonequilibrium thermodynamics of open systems: even weak stimuli (e.g. some photons) can create new order in cases of weak instabilities of the system. This can be examined by various methods. By using thermocouples, the kinetics of the heat production of rabbits after the injection of pyrogenic substances changed by the additional influence of weak 633 nm laser light. By using radiochemical methods and by counting white blood cells, immune suppressive effects of 633 nm laser light on lymphocytes and an immune stimulating effect on neutrophils have been found.

H. Klima, L. Schindl, D. Adamiker

Low Power Laser Radiation Acts on Mast Cells Degranulation

In a previous work (1) we reported that low power laser irradiation produce vasodilation and that this phenomenon could be associated to its direct or indirect action on mast cells (MC).

E. Mayayo, M. A. Trelles, L. Miro, J. Rigau, G. Baudin

Data for Laser Biostimulation in Wound-Healing

Since the first ruby laser was made in 1960, multiple applications of lasers have been identified. The special burning, coagulating, and vaporizing effects of high output lasers, together with their easy manipulation using optical systems, have resulted in extensive medical use. Additionally, there is much interest in the nonthermic effects of lasers in photodynamic tumor therapy and in biostimulation.

Adam Mester, Andrew F. Mester

Clincial Experience on Mix HeNe and I R Low Energy Laser — A Review of 404 Cases

Since 1971 Mester(31) had reported that he observed biostimulative effect of low energy laser beam. Thereafter, plenty of studies had been performed which included experimental studies on animals(7,14,16-,20,21,22,23,25,26,28,35,39,40,42,43), experimental invitro and invivo studies on human cells culture(l,24,25) and clinical studies(2,5,6,8,-9,11,13,15,17,19,2 7,29,31,32,33,34,35,36,37,38,41,44,45,4 7,48,49). All these studies comfirmed that the low energy laser had a nonthermal effect so called BIOSTIMULATION. Though studies on intracellular changes with electron microscope as well as studies on biochemical reaction and cellular enzymatic activity showed significant changes after low energy laser beam irradiation, the mechanism of this biostimulative effects remain unclear.

Peter Hasan, Agus Rijadi, Santoso Purnomo, Hendrik Kainama

Laser Treatment of Backpain and Enthesiopathy in Ankylosing Spondylarthritis

Ankylosing spondylarthritis is one of the diseases which cause chronic pain , not only during the day, but often more severe during the night and in some cases nearly intolerable in the very early morning. Depending on stage and extension pain is localized at back, at the tendons (as enthesiopathy) and in about 30 % at joints because of peripheral arthritis. Common treatment uses NSAIDs and daily physiotherapy. The outcome with this concept of management for most patients is fair. Still not solved problems include: 1. loss of range of motion 2. management of iridocyclitis 3. side-effects of NSAIDs and 4. in some cases ineffectiveness of pain releaving drugs. Two years ago we reported our study with therpy-resistant tendonitis which we treated with low-power-laser. The immediate effect (87 %) and the long-term-outcome (80 %) of these patients has been as convincingly that we performed another preliminary study on 16 patients (10 male/ 6 female) with enthesiopathies (8 x achillestendon, 5 x Periarthropathia coxae, 3 x plantar fasciitis) as manifestations of ankylosing spondylarthritis (12 x) or psoriasisarthritis (4 x). Treatment was performed with infirared-laser. 904 nm (IR CEB Space) or IR mixed with He-Ne 632.8 nm (M 3 UP Space), the energy-density varied between 600 and 960 Joule/m2, irradiations were daily up to 20 times as monotherapy.

Christian Gärtner, M. Becker

A Double Blind Study of Low Power He-Ne Laser Therapy in Rheumatoid Arthritis

We have studied the effectiveness of He-Ne laser (8.5mW) in treatment of RA, OA, and cervical spondylosis of totally 92 patients. Placebo irradiation was applied to 37 patients, and He-Ne laser to 55 patients. The irradiation was performed 20 times in 10 weeks on each subject. The length of irradiation was 15 minutes per each treatment. During the experiment period, the assessment to tenderness, pain on motion, circumference, range of motion, grip strength, duration of morning-stiffness, hydrops, and ESR was performed. Urine 5-HIAA, thermograph, and other laboratory tests were also assessed. The general assessment by the doctors showed significant clinical difference (P<0.01) in the intergroup comparison. In the assessment of the patients’ personal impression, significant improvement was recorded too (P<0.01).

Y. Oyamada, R. Satodate, J. Nishida, S. Izu, Y. Aoki

Postoperative Helium-Neon-Laser Irradiation in the Face and Neck Region

Soft lasers (i.e. He-Ne lasers of 2 mW and 5mW output respectively, lent by the firm of Silberbauer ) have been in use at this clinic for the last six years. Beside our own animal experiments (Strassl et al. 1983) and electron microscopy studies (Schenk et al. 1986, Porteder et al. 1986) and on the basis both of relevant literature (Kovacs et al. 1974, Mester et al. 1974, Ilaina et al. 1981, Silberbauer 1984, Mester A.F. and Mester A. 1986, Hubacek et al. 1986, Kövy et al. 1986, Benodicenti 1986) and of initial clinical results (Porteder et al. 1983), which would seem to indicate that healing is promoted, we have been using the low-power laser to an increasing extent in clinical praetice.

Hubert Porteder, E. Rausch, U. Jaskulka, K. Vinzenz, P. Schenk

Laser Stimulation Therapy Using a Diod Laser

For more than 3 years, we have been continuing pain-alleviating therapy using a low-power diode laser and made a clinical estimation of the efficacy of this method. We have presented the results at several conferences and meetings, either domestic or international.

Chiyuki Shiroto, Keiichi Ono, Toshio Ohshiro

Treatment of Peripheral and Central Nervous Systems After Injury Using Low Energy Laser Irradiation: Experimental Results

Our group has been working on various aspects of Low Energy Laser Irradiation — LELI — and its effects on the Peripheral Nervous System — PNS — during the last 8 years. In this work we used HeNe lasers to irradiate, directly or transcutaneously, the sciatic nerve of rats in vivo.

S. Rochkind, M. Nissan, L. Barr-Nea, R. Lubart, N. Brusovalnic, N. Razon, Y. D. Heilbronn, A. Bartal

Investigations on Different Laser Wavelengths and Power in Peripheral and Central Nervous System

In recent publications (1,2,3,4) we have reported the effect of Low Energy Laser Irradiation -LELI- on the regeneration of peripheral nerves in rats following a crush injury and using a He-Ne laser (632,8nm). We were looking into various parameters affecting the efficacy of so-called soft lasers on the biological material in vivo. In the work presented here we report our results comparing 3 wavelengths: 465nm, 520nm and 588nm. According to Olson (5) and others, the wavelength is probably one of the most critical factors.

R. Lubart, S. Rochkind, M. Nissan, L. Barr-Nea

Effect of Low Power Laser Radiation on Experimental Burns and Their Application in Clinics

A number of different procedures are currently used with the aim of accelerating the healing of burns, as one of the direct consequences of the frequent complications accompanying burns is the need for xenografting, artificial skin grafting and other costly modes of therapy. A safe and secure therapeutic procedure which would avoid the need for such treatments would constitute a marked advance in the management of lesions resulting from burns (1).

M. A. Trelles, E. Mayayo, F. Dalmases, C. Romero

Effects of Laser Radiation over Zusanli Point on Egg of the Aged

For exploring the effects of laser radiation over ZuSanli point on the e EGG of the healthy aged, fourty-three subjects were selected for the study. The result as follows:

Fourty-three healthy ageds, aged above 45, free of disease and having not received medication for two weeks prior were selected for the study. 20 males and 23 females in the laser group, 2 males and 23 females in the control group. No drugs were administered during the course of this study.

Peng Yue, He Gao-Hui, Zhang Dong

Preliminary Study on the Biostimulation of Low Power Laser Therapy

Pain relief by low power laser is acknowledged as one of the biophysical laser applications. Generally He-Ne and diode lasers are used in pain clinics and YAG laser is used in some clinics. It is hard to find a standard for the practice of laser therapy of pain, becuase so many varieties of technical procedures and irradiation modalities have been reported. The thermographic findings during YAG and diode laser therapy of pain revealed more or less thermal effect on the lased region. The local circulatory increment produced by laser stimulation was influenced by the irradiation dose, however the therapeutic results were not always consistent with the irradiation dose and were not differentiated by continuous and pulsed irradiations. Absorption of these lasers in a milk showed similar patterns of energy distribution and the increased frequency of the pulsed laser resulted in an increment of average power in the pictures taken with infrared camera. It was interesting to find the interference fringe in the picture of the finger transilluminated with diode laser. These findings were reported in the Third International Nd:YAG Laser Symposium in 1986. The author hypothesized that coherency of laser beam may influence the structural water in the tissue and initiate a chemical process to produce the biostimulation.

K. Kamikawa

Histological Evaluation of Effect of Low Power Laser on the Synovial Membrane of Rheumatoid Arthritis

Only a few studies have been carried out on the effects of low power laser irradiation on the joints affected by rheumatoid arthritis 1) 2)3) (RA). Goldman et al.1) and Oyamada et al.2)3) reported the improvement of symptoms and signs of RA by laser irradiation. We have histologically examined the effects of low power helium-neon laser irradiation on the synovial membrane of the RA-affected knee joints.

Jun Nishida, Takuya Iwasaki, Ryoichi Satodate, Masataka Abe, Yoshinori Oyamada

Cont.Wave Infrared Low Power Application Significantly Accelerates Chronic Pain Relief Rehabilitation of Professional Athletes. A Double Blind Study

Unlike other patients, professional athletes demand from their therapists the quickest return into their games. The purpose of our study was to confirm that cont. wave infrared low power laser therapy accelerates their complete rehabilitation.

C. Diamantopoulos, O. Emmanouilidis

Backmatter

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