Biomedical subjects

L Reinisch

Publications and source records attributed to L Reinisch.

At least 55 records · Page 3Linked to original sources

PubMed1997

Laser ablation as a function of the primary absorber in dentin.

BACKGROUND AND OBJECTIVE: Infrared transmission spectra of dentin reveal a broad absorption band between 6.0 and 7.0 microns composed of absorption peaks of water, collagen and carbonated hydroxyapatite. The nearly constant absorption and the existence of absorption peaks of different tissue components were used to investigate ablation as a function of the primary absorber. STUDY DESIGN/MATERIALS AND METHODS: Laser ablation of dentin as a function of fluence was studied in the wavelength range between 6.0 and 7.5 microns using the Vanderbilt Free-Electron Laser (FEL). Depth and volume of the ablation crater were determined with a silicon replica method and subsequent confocal laser topometry. SEM investigations were performed on the irradiated surfaces. For the description of the experimental data an ablation model is developed. RESULTS: At all applied wavelengths we found a linear increase of ablation depth as a function of fluence above a threshold fluence. The lower absorption of dentin at 7.5 microns compared to the absorption at 6.0, 6.5 and 7.0 microns results in a greater ablation threshold. At 6.0, 6.5 and 7.0 microns wavelengths the ablation thresholds are comparable. The experimental data are in good agreement with an ablation model using a mean absorption coefficient of the target material. No thermal cracking is observed after ablation in dentin. The post ablative surface structure at 6.0 and 7.0 microns looks similar whereas at 7.5 microns the surface reveals a greater roughness. CONCLUSION: The ablation efficiency and threshold depend on the mean absorption but do not depend upon the chemical identity of the primary absorber in dentin. Calculations show that heat conduction during the laser pulse leads to a thermal equalization between the heated microstructures and surrounding tissue resulting in an ablation with little dependence on the primary absorber.

Absorption↗

PubMed1996

Laser safety features of eye shields.

BACKGROUND AND OBJECTIVE: A number of lasers are available for cutaneous periorbital surgery, yet not all eye shields are appropriate for all applications. We tested a variety of commercially available eye shields to assess their safety features. STUDY DESIGN/MATERIALS AND METHODS: Six commercially available eye protectors were studied. A focused laser was incident upon the shield, and the intensity and exposure duration required for visible damage to the shield were measured. We then measured the temperature on the underside of the eye shield during exposure from the laser. Time-dependent temperature measurements were made with a type-T thermocouple fixed to the eye shield with silicon grease. RESULTS: Thermal response curves and rates of warming for each of the six eye shields were generated. Plastic shields showed significant thermal damage with most of the lasers tested. The metallic shields warmed more slowly and to a lesser degree. CONCLUSION: Overall, the metallic eye shields had the most acceptable safety profile. Many of the plastic shields exhibited significant thermal damage, and therefore we discourage their use in periorbital laser surgery.

Equipment Design↗

PubMed1996

In vitro changes in non-facial human skin following CO2 laser resurfacing: a comparison study.

BACKGROUND AND OBJECTIVE: We evaluated the physical changes in human skin following CO2 laser cutaneous resurfacing with either the Sharplan SilkTouch handpiece or the Coherent UltraPulse laser. STUDY DESIGN/MATERIALS AND METHODS: Three-hundred five human tissue samples and matched controls were used. Up to five laser passes were performed per specimen. Parameters evaluated included: lateral skin shrinkage, transient temperature change, isometric tension development, elasticity change, and histologic change. RESULTS: Skin shrinkage increased in direct proportion to laser pass number. Isometric tension exponentially increased and elasticity exponentially decreased with successive laser passes. The zone of thermal denaturation for the SilkTouch handpiece was 115 +/- 15 microns, and was independent of laser pass number. The zone of thermal denaturation was patchy for the UltraPulse laser treatments, regardless of pass number. A greater temperature increase was also measured for SilkTouch irradiation than with the UltraPulse laser. CONCLUSION: The observed alterations in tissue length, tension development, and elasticity obtained with SilkTouch or UltraPulse treatment may contribute to the changes in clinical appearance associated with laser cutaneous resurfacing. Our findings support a role for extracellular matrix contraction in the mechanism of action for CO2 lasers in cutaneous resurfacing.

Elasticity↗

PubMed1996

Thermal injury patterns and tensile strength of canine oral mucosa after carbon dioxide laser incisions.

The amount of collateral damage in laser surgery is affected by the precision of the beam delivery. To test a new control system, the authors of this study produced surgical incisions in the canine oral mucosa and then documented histologic and tensile strength changes during the wound healing process. The incisions were made by three different methods: scalpel, manually controlled carbon dioxide (CO2) laser, and computer-controlled C02 laser. Both types of laser incisions took longer to heal than the scalpel incisions. The laser incisions were accompanied by a zone of thermal damage lateral to the incision. With the computer-controlled laser incision, the area of thermal damage was reduced, the laser-induced delay in wound healing was less, and tensile strength was relatively greater. The data indicate that surgical performance is improved by critical beam control.

Animals↗

PubMed1996

Laser applications in otolaryngology.

The perception of the laser has changed as lasers have moved from the laboratory into everyday conventional surgery. The physician's perception of the laser has expanded from the simple light scalpel to a tool with a variety of applications. This issue of Otolaryngologic Clinics of North America is designed to explain how lasers are used today in otolaryngology-head and neck surgery and to indicate new directions for the laser tomorrow.

Endoscopy↗

PubMed1996

Laser physics and tissue interactions.

This article explains the basic principles of lasers from their historical beginnings to their use specifically in otolaryngology. The operation of the laser is shown in clear, easy-to-understand steps with the basics of laser delivery, laser optics, and laser-tissue interactions also presented. This article aims to give the surgeon enough information and understanding to help in deciding which laser to use for which purpose.

Animals↗

PubMed1996

Laser applications in otolaryngology. Conclusion and future outlook.

The field of medicine has embraced and utilized many advanced technologies. The use of the laser will continue to be important as computer assisted surgery and robotics are used in conjunction with lasers to improve patient care. This concluding article reviews the laser and present scenarios for possible future surgical procedures with the laser.

Ear Diseases↗

PubMed1995

Prevention of pharyngocutaneous fistulas by means of laser-weld techniques.

Although much has been written on methods of dealing with pharyngocutaneous fistulas once they have formed, there are few reports of methods of preventing fistula formation from occurring. We examined the use of laser-weld techniques with the neodymium:yttrium aluminum garnet (Nd:YAG) and diode lasers to seal pharyngotomy closures. Laser-weld techniques have been used successfully in many other tissues, but reports documenting use in the upper aerodigestive tract are minimal. Indocyanine-green dye-enhanced collagen and fibrinogen were studied as laser solder materials for the diode laser. Twenty-nine experimental animals were studied. Neither the Nd:YAG nor the diode laser was successful in preventing fistula formation. Tensiometric studies documented significant strength of the laser welds ex vivo, but this finding was not clinically significant.

Anastomosis, Surgical↗

PubMed1994

Tissue ablation by a free-electron laser tuned to the amide II band.

Efforts to ablate soft tissue with conventional lasers have been limited by collateral damage and by concern over potential photochemical effects. Motivated by the thermal-confinement model, past infrared investigations targeted the OH-stretch mode of water with fast pulses from lasers emitting near 3,000 nm (refs 1, 7-9). What does a free-electron laser offer for the investigation of tissue ablation? Operating at non-photochemical single-photon energies, these infrared sources can produce trains of picosecond pulses tunable to the vibrational modes of proteins, lipids and/or water. We report here that targeting free-electron laser radiation to the amide II band of proteins leads to tissue ablation characterized by minimal collateral damage while maintaining a substantial ablation rate. To account for these observations we propose a novel ablation mechanism based on compromising tissue through resonant denaturation of structural proteins.

Amides↗

PubMed1994

Bacteria identification of otitis media with fluorescence spectroscopy.

We have investigated the fluorescence profiles of four common pathogens: S. pneumoniae, S. aureus, M. catarrhalis, and H. influenzae. The steady-state auto fluorescence spectra of bacteria are measured as a function of the incident light from 200 to 700 nm. The spectra for each bacterium are combined into a fluorescence profile or fluorescence finger print. Each bacterium produces a unique in vitro fluorescence profile when measured in a saline suspension. The profiles are reproducible. Suspensions of a bacterial strain, where the identification is not known, can be correctly matched to a small library of previously measured fluorescence profiles using a linear least-squares fitting algorithm. In addition, we have measured the fluorescence and absorption spectrum of the tympanic membrane removed from a chinchilla. The optical properties of the tympanic membrane and the least-squares identification process form precept for a non-invasive, fluorescence based bacterial diagnosis technique to be used in otitis media.

Algorithms↗

PubMed1994

Clinical applications of lasers in otolaryngology--head and neck surgery.

The use of lasers in otolaryngology--head and neck surgery is described from the invention of the laser in 1960, through the current uses of the laser, and concludes with a summary for the future directions of laser surgery. The various lasers, including the argon, the KTP, and the carbon dioxide lasers used in otolaryngology, are briefly described. The applications of lasers in the larynx, sinuses, and the ear are separately covered, as well as pediatric otolaryngology. In addition to a brief description of the procedure, the complications and limitations are given. Anesthetic considerations are also covered.

Head and Neck Neoplasms↗

PubMed1994

Intercellular communication between epithelial and fiber cells of the eye lens.

Results of electrical, dye-coupling and morphological studies have previously suggested that gap junctions mediate communication between the anterior epithelium of the lens and the underlying lens fiber cells. This connection is believed to permit 'metabolic cooperation' between these dissimilar cell types and may be of particular importance to the fiber cells, which are thought incapable of autonomous ionic homeostasis. We reinvestigated the nature of the connection between epithelial and fiber cells of the embryonic chicken lens using fluorescence confocal microscopy and freeze-fracture analysis. In contrast to earlier studies, our data provided no support for gap-junction-mediated transport from the lens epithelium to the fibers. Fluorescent dyes loaded biochemically into the lens epithelium were retained there for more than one hour. There was a decrease in epithelial fluorescence over this period, but this was not accompanied by an increase in fiber cell fluorescence. Diffusional modeling suggested that these data were inconsistent with the presence of extensive epithelium-fiber cell coupling, even if the observed decrease in epithelial fluorescence was attributed exclusively to the diffusion of dye into the fiber mass via gap junctions. Furthermore, the rate of loss of fluorescence from isolated epithelia was indistinguishable from that measured in whole lenses, suggesting that decreased epithelial fluorescence resulted from photobleaching and leakage of dye rather than diffusion, via gap junctions, into the fibers. Analysis of freeze-fracture replicas of plasma membranes at the epithelial-fiber cell interface failed to reveal evidence of gap-junction plaques, although evidence of endocytosis was abundant. These studies were done under conditions where the location of the fracture plane was unambiguous and where gap junctions could be observed in the lateral membranes of neighboring epithelial and fiber cells. Paradoxically, tracer molecules injected into the fiber mass were able to pass into the epithelium via a pathway that was not blocked by incubation at 4 degrees C or by treatment with octanol and which excluded large (approximately 10 kDa) molecular mass tracers. Together with previous measurements of electrical coupling between fiber cells and epithelial cells, these data indicate the presence of a low-resistance pathway connecting these cell types that is not mediated by classical gap junctions.

Animals↗

PubMed1994

Noninvasive optical diagnosis of bacteria causing otitis media.

Currently, the identification of the bacteria responsible for acute otitis media requires a painful invasive procedure: tympanocentesis. To develop a rapid and noninvasive technique for bacterial diagnosis, the fluorescence profiles of four common pathogens and the optical characteristics of the tympanic membrane have been investigated. Each bacterium produces a unique in vitro fluorescence profile when measured in a saline suspension. Also, spectrally resolved transmission measurements from the chinchilla tympanic membrane demonstrate an optical window that will transmit sufficient light for in vivo measurement of the fluorescence profiles. Thus, we have established the precept for a fluorescence-based bacterial diagnosis technique to be used in otitis media. This paper presents the theory, optical data, and a discussion of the device engineering involved in the technique.

Animals↗

PubMed1994

Computer-assisted surgical techniques using the Vanderbilt Free Electron Laser.

The Vanderbilt Free Electron Laser (FEL) is capable of lasing between 2.0 and 8.0 microns with a high peak intensity pulsed structure. The FEL is used to investigate potential applications in otolaryngology. Charring of temporal bones and thermal stress patterns in Plexiglas indicate thermal buildup at 20 and 10 Hz repetition rates of the laser. Also, transient temperature changes measured with thermocouples in a gelatin model reveal that significant heat production occurs at these laser repetition rates. To utilize the fastest laser repetition rates and maintain minimal lateral thermal damage, a computer-controlled scanning system was devised. The authors have also used the computer control with the carbon dioxide laser and experienced improved ablation.

Animals↗

PubMed1994

Computer-assisted surgical techniques: a vision for the future of otolaryngology-head and neck surgery.

Our specialty relies increasingly on technologic advancements and increased knowledge of pathophysiology at the cellular and molecular level; these trends will continue. The consequences in the laryngologic, otologic, and rhinologic surgery are presented. Envision the surgeon positioned at a computer workstation to perform surgery. Following endoscopy and the placement of the microlaryngoscope, the only contact he or she will have with the patient is through robotic "hands" on the end of thin rods. These hands thread through the laryngoscope and hold tissue without any tremor. Multiple-wavelength lasers are available, each tuned to optimally incise particular tissue types. The laser beam will be delivered under computer control with active feed-back systems involving ultrasonic imaging, infrared thermography, and photoacoustic monitoring. Similar visions are presented in otology and rhinology with microinstrumentation and virtual reality.

Acoustics↗

PubMed1993

Sub ablation effects of the KTP laser on wound healing.

The KTP laser (wavelength 532 nm) was used in a sub ablative format to determine the effect of low energy density irradiation on the normal healing by primary intention of scalpel skin incisions in rats. Two longitudinal lased strips were created by a 1 cm diameter defocused beam on the shaved, cleaned dorsal epidermis of 32 Sprague-Dawley rates; one strip was produced with a 2.0 W beam (54 J, or 18 J/cm2 total dose), and the other with a 3.5 W beam (94.5 J or 31.5 J/cm2, total dose). Scalpel incisions were made longitudinally within the irradiated zones, using contra lateral scalpel incisions on unirradiated skin as controls. Tensiometric analysis of wound strength was performed at 3, 7, 14, and 23 days following surgery. The data from fresh tissue tensiometry indicate that KTP laser irradiation of skin incisions results in a lower tensile strength for the wound at 7 and 14 days. The decrease in tensile strength is proportional to the total energy density of the exposure. At day 3 and 23, the tensile strength of the wound was independent of the sub ablative laser exposure. The results are in general agreement with studies of the healing process of laser incisions and may help us to understand the details of the healing process from laser incisions.

Animals↗

PubMed1992

Bone ablation with Er:YAG and CO2 laser: study of thermal and acoustic effects.

A pulsed Er:YAG laser at 2.94 microns and a superpulsed CO2 laser at 10.6 microns are used to investigate bone ablation applications in otolaryngology. Quantitative measurements of mass removal and the ablation depth of cat skull bone and rat femur are presented with the Er:YAG laser at fluences of 9-117 J/cm2. Histological results show that the minimal thermal injury zone from the edge of the lesion is 5-10 microns. Comparison of the photoacoustic and thermal effects during the ablation process indicates that the temperature rise from the 10.6-microns light was higher than that from the 2.94-microns light but that the photoacoustic wave amplitude produced with the Er:YAG laser was higher than that with the CO2 laser. The fluence used for the efficient ablation of bone tissues produces a photoacoustic wave ranging from 100 to 120 dB. The ear can tolerate this level for a short time period. Results of this study suggest that the Er:YAG laser can be an important surgical tool in otolaryngology.

Aluminum Silicates↗

PubMed1991

Investigation of laser-induced long-lived states of photolyzed MbCO.

We present evidence from resonance Raman and absorption measurements that the extended exposure of MbCO to CW laser light at low temperatures alters the CO rebinding kinetics and leads to a significantly increased population of very long lived states of photolyzed MbCO. This optical "pumping" process is observed for samples frozen in both aqueous buffer and glycerol/buffer and exhibits power law behavior with a very weak temperature dependence. A comparison of the nonexponential rebinding kinetics of CO molecules from the pumped states with the rebinding observed in flash photolysis experiments suggests that the pumped states are distinct geminate states, not observed in flash photolysis experiments. Thus, a four-state model, with two geminate states, is implicated for MbCO. Pumped states may represent "separated geminate pair" states with the CO molecule still in the heme pocket or possibly trapped within a cavity on its way through the protein matrix, consistent with molecular dynamics simulations. The possibility of significant deoxyheme relaxation from a less domed to a more domed configuration, as a result of the multiple photolysis events associated with the pumping process, is also explored. However, the small changes observed in the Soret band line shape and position subsequent to pumping at T less than 180 K tend to rule out this explanation for the pumping process. Since the yield for creating a pumped state is small (e.g., less than 10(-7) for T greater than 100 K), pumping can be observed only after extended illumination and is absent in flash photolysis measurements, even after multiple flashes. At higher temperatures (T greater than 180 K), the escape of the CO molecule to the solvent is observed. Our data are consistent with a "phase transition" of the protein that is coupled to the surrounding matrix. The protein fluctuations are quenched below approximately 185 K for a solvent composed of 70% glycerol and below approximately 260 K for aqueous buffer. We also present the first large amplitude measurements of CO rebinding from the protein exterior, observed below 200 K after freezing the sample under laser illumination.

Animals↗