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ABOUT LASER AND LASER MEDICINE
"Photo Laser Medicine/LLLT has for some people an aura of magic due to its ability to heal longstanding medical problems. To others it has the aura of "alternative" medicine.
Both categories find that they are wrong. Laser therapy is no magic, and the rich scientific documentation will certainly surprise the unbelieving." (Lars Hode, physicist and chairman of the Swedish Laser medical Society)
ABOUT RADIATION:
UNDERSTANDING THE BASICS:
Energy (heat, movement, radiation and matter) is the most fundamental property of universe and can never be destroyed or created. Energy can only be converted from one form to another.
Amount of energy is measured in joule, named after the English physicist James Joule (an older unit used in the past is the calorie (1 calorie is 4.18 joules).
The laser is the most advanced of our light sources.
Light
Amplification by
Stimulated
Emission of
Radiation
(the first name ever suggested hat the word "Oscillation" instead of "Amplification" and would therefore being named LOSER :-)
Each and every laser includes the following parts:
Energy source (power supply)
Lasing (amplifying) medium (solid, liquid or gas)
Resonating cavity (mirrors)
Surgical Lasers
In order for a laser to be suitable for use as a surgical laser, it must be powerful enough to heat up the tissues to temperatures over 50 degrees C. It can be used either in continous wave or pulsed mode. These lasers are divided into three categories
- Vaporising
- Light cutting
- Deep cutting
Therapeutic Lasers
(used in our clinics)
There are three main types:
HeNe (InGaAIP)
GaA
GaAIA
What happens and how it works:
IN SHORT:
MECHANISM:
When cells are stressed or in hypoxic tissues, Nitric Oxide (NO) competitively displaces oxygen in Cytochrome C Oxidase, reducing ATP and changes in Reactive Oxygen Species (ROS) production that lead to increased oxidative stress and inflammation.
PRIMARY EFFECT:
ATP - Increased cellular energy
NO - unbound from Cytochrome C Oxidase
ROS - Reduced oxidative stress
SECONDARY EFFECT:
The primary effects leads to a cascade or indirect secondary effects on cell signalling such as exchange of calcium ions, secretion of growth factors, activation of enzymes and other seconday messengers.
TERTIARY EFFECT:
Neutrophils, macrophages, mast cells, fibroblasts, endothelial cells, keratinocytes and leukocytes have all been shown to be influenced by laser in vitro and in vivo. This is true for all cells with mitrochondria, but results depend on the local environment. Healthy cells show little or no response whereas cwlls in hypoxic or other stressed states are more likely to show changes. There are also measurable changes in blood flow, a reduction in apoptosis and protection of cells after ischemic injury.
CLINICAL BENEFITS:
TISSUE REPAIR: Improved speed and quality of regeneration of skin, muscle, tendon, ligament, bone and neural tissue.
INFLAMMATION: Resolution of inflammation better or at least equal than NSAIDS (Non-steroidal anti-inflammatory drugs) but without the side effects
ANALGESIA: Temporary reversible, inhibition of nerve conduction in small and medium diameter peripheral nerve fibers.
More Details?
Treatment with laser therapy is NOT based on heat development but on photochemical and photobiological effects in cells and tissue.
When the light hits, certain cell functions are stimulated and this is particularly evident, if the cell has an impaired function.
Clinical and experimental experience shows that laser therapy has its greatest effects on cells/tissue/organs affected by a generally deteriorated condition, such as in patients suffering from some type of functional disorder, infection or injury in tissue. The light energy seems to produce the greatest benefit where it is mostly needed.
It is known that chromophores, in the form of e.g. porphyrins, play an important role. It is known that small amounts of singlet oxygen build up when tissue is irradiated with laser light. Rochkind's and Lubart's group in Israel (see references) has demonstrated this. Singlet oxygen is a free radical which itself influences the formation of ATP (adenosine triphosphate) which constitutes the cells' fuel and energy store.
Another photoreceptor is NADPH oxidase which has been found in non-blood cells. It possesses a flavoprotein which can be the target of light. Several chromophores are photosensitizers and generate Reactive Oxygen Species (ROS) following irradiation.
In order for the light to be absorbed, there must be receptors. To date many reactive proteins, capable of harvesting low light energy, have been identified in procaryotic and eucaryotic organisms and many more are being dicovered yearly. The most common photochemically active receptors in humans are rod and cone pigments in the eye.
Recent discovery are encephalopsins in the brain and pinopsin in the pineal gland.
ABOUT LASER BLOOD IRRADIATION
Laser Blood Irradiation (LBI) is not a recent treatment modality. In 1923 the US scientist Knott began to experiment with ways to irradiate the blood in order to destroy infectious organisms. The works of Nobel Prize winner Ryberg Finsen spurred the idea.
The first treatment of a human subject was a woman who suffered from haemolytic streptococcus septicaemia after a septic abortion. Treatment with UV blood irradiation rapidly returned her to normal health. Knott waited five years to make sure that the woman did not suffer from any subtle long term effects, before further treatment of a human subject was undertaken.
In Russia, Samailova and Snopov investigated Laser Blood Irradiation extensively in laboratories and clinics. They called the treatment “photo-haemotherapy” and there are studies, research papers and reports of general effects on the immune system, including decrease of blood viscosity, improvement of microcirculation (cellular), detoxification, oxygenation, normalisation of haemostasis, and activation of immune and proliferative processes.
Indications reported in the literatrure are:
Occlusive vascular diseases in the extremities, unstable angina, acute myocardial infarction, diabetic angiopathies, acute pneumonia, lung abscess, bronchial obstructive diseases, drug resistant forms of schizophrenia, rheumatoid arthritis, ischemic heart diseases, haemorrhagic shock.
Three ways of Laser Blood Irradiation (LBI) are used:
a) irradiation with HeNe laser via a thin light-guide and an IV needle;
b) irradiation of the blood outside of the body in plastic or quartz tubes
or c), the method which is used nowadays: Transcutaneous irradiation (the light source is put on the skin) is non-invasive and has several advantages, such as better patients acceptance, ease of application and lack of cross infections. 1 mW intravenous HeNe irradiation equals 20-30 mW transcutaneous irradiation.
THE USE OF DIFFERENT LASERS:
We use biostimulation lasers:
Semiconductor lasers:
InGaAIP 630 – 700 nm biostimulation, healing
GaAIA 780-820-870 nm biostimulation, healing
GaAs 904, 905 nm biostimulation, healing
Gas laser:
HeNe 633, 3390 nm biostimulation, healing
We do not use:
Crystalline lasers KTP/532 532 nm leg vein treatment
Ruby 694 nm tattoo and hair removal
Alexandrite 755 nm bone cut, hair removal
Nd: Yag 1064 nm coagulation of tumours
Ho: Yag 2130 nm surgery, root canal
Er: Yag 2940 nm dental drill, laser peeling
Ti: sapphire tuneable two-photon PDT
Liquid lasers Dry laser tuneable kidney stones
Rhodamine 560-650 nm PDT, dermatology
Gas lasers: Eximer 193, 248, 308 nm eye, vascular surgery
Argon 350 – 514 nm dermatology, retinopathy
Copper 578 nm dermatology
CO2 10600 nm dermatology, surgery
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