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Biomedical subjects

M Motamedi

Publications and source records attributed to M Motamedi.

At least 55 records · Page 3Linked to original sources
PubMed1995

Laser photocoagulation of prostate: influence of dosimetry.

BACKGROUND AND OBJECTIVE: Recently, increasing enthusiasm has been shown for application of lasers for the treatment of benign prostate hyperplasia (BPH). However, little is known about the thermodynamics of prostatic tissue response during laser irradiation and how the treatment outcome can be optimized. Our objective was to conduct a systematic study of the influence of exposure parameters on the extent of tissue coagulation and to determine the effects of rate of tissue heating on lesion size by comparing the tissue response to high laser power rapid heating vs. low laser power slow heating. STUDY DESIGN/MATERIALS AND METHODS: Nd:YAG laser irradiation of prostate was performed in 15 mongrel canines, using an incident power of 15, 30, or 50 Watts (at the fiber tip) and an exposure time varying from 30 to 300 seconds. The laser beam was delivered via a Urolase side-emitting catheter. The tissue response was compared based on gross as well as histological evaluations of thermal lesions. RESULTS: The depth of coagulation necrosis increased as the laser power was reduced from 50 W to 30 W and further to 15 W while the total delivered energy was kept constant at 2,700 J by adjusting the exposure time. The difference between the three heating rates was more dramatic when the estimated volume of coagulated tissue was considered. Increasing the irradiation time for the low power (15 W) from 180 to 300 seconds resulted in enlarging the coagulated volume by a factor of 1.6. However, for high power (50 W), increasing the exposure time from 54 to 90 seconds resulted in increasing the coagulated volume by a factor of 1.2. CONCLUSION: This study suggests that a slow heating regimen yields larger volumes of coagulation necrosis than the currently used rapid heating approach.

Aluminum Silicates↗
PubMed1995

Randomized clinical trial comparing low power-slow heating versus high power-rapid heating noncontact neodymium:yttrium-aluminum-garnet laser regimens for the treatment of benign prostatic hyperplasia.

OBJECTIVES: To evaluate and compare the safety and effectiveness of two noncontact laser regimens for the treatment of human benign prostatic hyperplasia (BPH), and to assess the impact of the spatial distribution of the laser-induced lesions on treatment outcome. METHODS: This was a prospective, double-blind, randomized study that included 29 patients with BPH (both the patients and the study physician assistant in charge of the follow-up evaluation were blinded to the treatment rendered). The patients were randomized to receive either a 15 W for 180 s (15 patients) or 50 W for 60 s (14 patients) laser regimen (powers measured at the fiber tip). There were two study phases for each treatment group: the irradiated sites were not overlapping during the first phase (lesions 1.5 cm apart), and were overlapping during the second phase (lesion less than 1.0 cm apart). RESULTS: Morbidity was minimal in both groups. At 1 year of follow-up, there was significant improvement of the American Urological Association-7 symptom score, the peak urinary flow rate, and the postvoid residual in both treatment groups. These improvements were not statistically significantly different regardless of time or the phase of the study for the two treatment groups. There were 3 treatment failures, 2 of whom were later successfully re-treated with larger amounts of laser energy. Furthermore, the peak flows in the second phase of the study were statistically significantly higher than those in the first phase of the study, regardless of the treatment group. CONCLUSIONS: Our results suggest that both the 15 W for 180 s and the 50 W for 60 s are equally safe and effective treatments for BPH. Perhaps more importantly, they also suggest that the spatial distribution of lesions and overlapping of treated (irradiated) sites has significant impact on treatment outcome.

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PubMed1995

Thermocoagulation effect of diode laser radiation in the human prostate: acute and chronic study.

OBJECTIVES: To evaluate the safety and efficacy of low-power slow-heating diode laser-induced photocoagulation of prostatic tissue for treatment of benign prostatic hyperplasia, we conducted a series of acute and chronic studies using a diode laser (810 nm) to irradiate human prostate. METHODS: The study included 6 patients undergoing radical prostatectomy because of malignancy. Laser radiation to the prostate was given transurethrally, in a noncontact mode, at the time of the procedure in 2 patients (acute group): 10 W for 300 seconds on the right side of the prostate and 15 W for 180 seconds on the left. In the remaining 4 patients (chronic group), laser radiation was given at 1, 7, 10, and 12 weeks prior to the prostatectomy. RESULTS: In the acute group the average depth of coagulation was 8.5 and 9.0 mm for the laser regimens of 15 W for 180 seconds and the 10 W for 300 seconds, respectively. In the chronic group, the average depth of coagulation was 8.9 mm for both laser regimens studied. In the acute group, there was an ill-defined hemorrhagic ring at the periphery of the lesion. At 1 week, an intact necrotic coagulum was present. At 7 weeks, some of the coagulated tissue had already sloughed off. Longer follow-up at 10 and 12 weeks demonstrated formation of a well-defined cavity with mostly re-epithelialized surface. CONCLUSIONS: Our findings suggest that noncontact diode laser (810 nm) irradiation can induce in the human prostate significant coagulation necrosis followed by sloughing of tissue and cavitation of the prostatic urethra.

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PubMed1995

Effect of temperature and flow rate of irrigant on coagulation necrosis in canine prostate treated with neodymium:YAG laser.

We studied the effect of the irrigant temperature (5 degrees-38 degrees C) and flow rate (100-500 mL/min) on the extent of coagulation necrosis induced during Nd:YAG laser irradiation in the canine prostate model. The tissue response was quantified based on histopathologic evaluation of the lesions. Changing the irrigant temperature or the flow rate within the ranges studied did not significantly affect the size of the thermal lesions. The intraprostatic temperature distribution during laser irradiation is mainly governed by blood perfusion rather than by irrigant variables.

Animals↗
PubMed1995

Comparison of thermocoagulation effects of low power, slow heating versus high power, rapid heating Nd: YAG laser regimens in a canine prostate model.

We compared the thermocoagulation effects of low power, slow heating (15 W x 180 seconds) versus high power, rapid heating (50 W x 60 seconds) laser regimens in the canine prostate. The study was performed in 20 mongrel canines. On each prostate, the low power regimen was delivered at the 2 and 4 o'clock positions, and the high power at the 8 and 10 o'clock positions. The laser power was measured at the fiber tip. Seven dogs (acute group) were sacrificed 1 hour after the procedure. The other 13 dogs (chronic group) were sacrificed at different time intervals from 3 days to 9 weeks after the procedure. The average depth of coagulation was significantly greater in lesions treated at low power (acute: 10.7 mm., chronic: 13.3 mm.) than in those treated at high power (acute: 8.5 mm., chronic: 11.6 mm.). Another potential benefit of the low power regimen observed in the study was preservation of the integrity and efficiency of the laser probe.

Animals↗
PubMed1995

In vivo autofluorescence of an unpigmented melanoma in mice. Correlation of spectroscopic properties to microscopic structure.

Recently, fluorescence spectroscopy and imaging have been under investigation for in vivo diagnosis of several types of superficial cancer, including primary melanomas of the skin. Here we report on a detailed investigation of the autofluorescence properties of a K1735P melanoma implanted intradermally in the ears of syngeneic C3H/HeN mice. Although this tumour can produce melanin in some cases, it appeared as an unpigmented lesion in our experiments. Excitation-emission maps in the wavelength range of 360-700 nm were recorded from tumours and normal ears. The control ears and the tumour-bearing ears showed fluorescence in a broad range of excitation and emission wavelengths. Valleys of decreased fluorescence were observed in the 385-425 nm range and could be related to absorption of the excitation light by haemoglobin, oxyhaemoglobin and a third unknown absorber. The spectroscopic differences between the malignant melanoma and the control skin could be related to either differences in blood oxygenation or the tissue dimensions. However, no spectroscopic features were detected reflecting intrinsic differences between the melanoma and normal tissue.

Animals↗
PubMed1995

Application of a multivariate technique to Raman spectra for quantification of body chemicals.

Raman spectroscopy is a highly specific technique for the identification of molecules by way of the associated characteristic spectra. The aim of this feasibility study is to assess the combination of the multivariate calibration technique of Partial Least-Squares with Raman spectroscopy for the estimation of glucose, lactic acid, and urea concentrations in the presence of each other in a water substrate. The instrument is a CCD-based Raman spectrometer utilizing the 514.5 nm argon laser line. The estimates for the analyte concentrations yielded a standard deviation of concentration residuals of 20.71 mg/dL for glucose, 12.92 mg/dL for lactic acid, and 19.07 mg/dL for urea.

Calibration↗
PubMed1995

The Q-switched Alexandrite laser's effects on tattoos in guinea pigs and harvested human skin.

BACKGROUND: Developmental work in tattoo removal is currently carried out in animal models whose skin has different optical and mechanical properties from human skin. OBJECTIVE: To observe laser effects on tattoos in a new human skin model and that of in vivo guinea pig skin. METHODS: A comparison of the efficacy of the Q-switched Alexandrite laser (750 nm, 100-120 nanoseconds) in tattooed harvested human skin and guinea pig skin was performed. Visual assessments as well as histologic and electron microscopy evaluation before and after treatment are reported. RESULTS: Mild to moderate clearing of black tattoo pigment, as judged by visual assessment, was found after one laser treatment in both the in vitro human skin model and guinea pig skin. Blue and green ink showed similar results to black ink in human skin whereas red and yellow ink did not respond in our model. CONCLUSION: Possible mechanisms of tattoo lightening and the usefulness of the in vitro human skin model are discussed.

Animals↗
PubMed1995

Histopathological evaluation of laser thermocoagulation in the human prostate: optimization of laser irradiation for benign prostatic hyperplasia.

We have previously shown in a canine prostate model that a noncontact low power neodymium:YAG laser regimen of 15 watts for 180 seconds yields a larger volume of coagulation necrosis than the currently recommended high power regimen of 50 watts for 60 seconds. These 2 regimens have not yet been compared in humans. The objective of this study was to evaluate histopathologically the thermocoagulation effect of these 2 laser regimens in the human prostate and the effect of the spatial distribution of the laser lesions on the extent of coagulation necrosis. The study was conducted in 10 patients undergoing radical prostatectomy or cystoprostatectomy. The laser treatment was given transurethrally 1 hour before removal of the specimen. There were no fractures of the prostate. The coagulation necrosis did not reach the peripheral zone and it was minimal in areas rich in fibromuscular tissue, such as the bladder neck. At times, nodular benign prostatic hyperplasia was unaffected. A 4-quadrant treatment in the same plane often yielded small nonconfluent lesions. Confluent lesions in the same plane yielded approximately 30% greater depth of coagulation necrosis, which was achieved when 3 or 4 lesions were created on each side of the prostate (per single transverse plane). Likewise, coagulation necrosis observed with 15 watts for 180 seconds was approximately 40% greater than that noted with the 50 watts for 60 seconds regimen. Our findings suggest that noncontact laser prostatectomy is a safe procedure that can be improved by modifying the laser regimen and the spatial distribution of lesions.

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PubMed1995

Histopathologic effects of laser radiation on the human prostate.

High levels of applied laser irradiation to the prostate will carbonize or vaporize tissue, and may cause explosive expansion of superheated tissue water. Lower levels, used most often to relieve obstruction caused by benign prostatic hypertrophy, will cause coagulation necrosis. This effect is apparent within 1 h of application. In contrast to the canine, in which laser-coagulated prostate sloughs in 2 to 3 weeks leaving a smooth cavity, in the human necrotic tissue is sloughed irregularly over a period ranging up to 12 weeks. This difference is attributed to the dominantly glandular nature of the canine prostate, and the dense fibromuscular composition of the human prostate stroma. Sloughing is accomplished by surface liquefaction, cavitation of the necrotic coagulum, and to a lesser degree, formation of granulation tissue at the margins. As often occurs at the margin of spontaneous infarcts in the prostate, squamous metaplasia may be prominent at the margins of laser-induced coagulation necrosis.

Humans↗
PubMed1994

Tissue optical property measurements: overestimation of absorption coefficient with spectrophotometric techniques.

This study examines the validity of optical property measurements by comparing surface temperatures rises predicted by a well-tested mathematical model with temperatures measured experimentally during laser irradiation. Analysis is based on the early temperature response that is proportional to the absorption coefficient. The results of the investigation suggest that values for tissue absorption coefficient can be greatly overestimated when current spectrophotometric techniques are used. This seems especially true when a broad light beam and a low port-to-beam-size ratio are used for transmission and reflection measurements with an integrating sphere.

Absorption↗
PubMed1994

Temperature dependence of the absorption coefficient of water for midinfrared laser radiation.

The dynamics of the water absorption peak around 1.94 microns was examined. This peak is important for the absorption of holmium and thulium laser radiation. To examine the effect of temperature on the absorption coefficient, the transmission of pulsed Ho:YAG, Ho:YAG, Ho:YSGG, and Tm:YAG laser radiation through water of 22 degrees C, 49 degrees C, and 70 degrees C was measured as a function of the thickness of the water layer. From these data the absorption coefficients were determined at the three wavelengths. We found that at all three wavelengths, the absorption coefficients decreased when increasing the temperature. Second, the absorption spectrum of water was measured from 1,850-2,150 nm with a spectrophotometer. It was found that the absorption peak at 1.94 microns (at 22 degrees C) shifts to shorter wavelengths with increasing temperatures, to 1.92 microns at 70 degrees C. A model was developed to predict the temperature distribution incorporating the dynamic change in absorption coefficient. The temperature distributions are compared to the predictions of a model assuming constant optical properties. It is shown in this study that the dynamics of the absorption coefficient has a significant influence on the expected zone of damage and ablation parameters in the 2-microns wavelength range.

Absorption↗
PubMed1994

Effects of surface irrigation on the thermal response of tissue during laser irradiation.

Effects of surface irrigation on the thermal response of tissue during laser irradiation are investigated. In particular, influence of temperature and flow rate of the irrigation fluid on the resulting temperature distributions and coagulation depths are studied. Intraluminal Nd:YAG laser irradiation of bovine muscle is performed in vitro for a fixed value of the irrigation flow rate while the irrigation temperature is varied, and for a fixed irrigation temperature while the irrigation flow rate is kept constant. Thermocouples are used to measure the temperatures within the tissue for various irradiation and irrigation conditions. Higher temperatures and deeper coagulation depths are achieved as the temperature of the irrigation fluid is increased. For sufficiently low values of irradiance and exposure time, the use of cold irrigation is shown to prevent or delay tissue carbonization. Beyond a critical irradiance and an exposure time, use of cold irrigation does not prevent tissue carbonization. Coagulation depths and temperature distributions are not affected by a change in the flow rate of laminar irrigation. Application of stagnant irrigation, however, results in an increase in coagulation depth. Results of this study suggest that the dominating mechanism of heat transfer during application of laminar irrigation is thermal diffusion as compared to the bulk motion of the fluid.

Animals↗
PubMed1994

Rate process model for arterial tissue thermal damage: implications on vessel photocoagulation.

A numerical model for thermal damage to human arterial tissue is presented, based on protein denaturation kinetics. The model involves determination of coefficients of rate processes A & delta E, which are tissue type-dependent (arterial tissue in this study), and definition of threshold damage. A feedback-controlled constant surface temperature device was used to induce 80 coagulative lesions of arterial human tissue ranging in temperature from 66 degrees C to 76 degrees C and in duration from 15 to 1,500 seconds. The measured coefficients were determined to be A = 5.6 x 10(63) s-1 and delta E = 430 KJ mole-1. These numerical values closely approximate the coefficients of the rate process for denaturation of collagen molecules. These and other histological observations strongly suggest collagen to be the primary coagulating component of arterial tissue at the onset of thermal coagulative damage. The ability of this model to predict onset of tissue coagulation during laser coagulation was studied using 10 postmortem human arterial samples exposed to argon laser irradiation.

Algorithms↗
PubMed1994

Ultrasonic Doppler detection of laser-tissue interaction.

Laser therapy for the safe and effective coagulation and ablation of tissues requires precise control of the amount of energy delivered to and absorbed by the volume of tissue of interest. We propose that an ultrasonic transducer pointing in the same direction as the laser fiber could be used to monitor the changes in ultrasonic properties caused by the absorption of light by the tissue. A modified 20 MHz pulsed Doppler was used to evaluate the ultrasonic effects of 35 exposures of beef liver and muscle to a high power diode laser in vitro in real time. We found two distinct levels of acoustic activity in the tissue. Type 1 activity consisted of slow variations in the phase and small changes in the amplitude of the echoes, while type 2 activity consisted of large and rapid fluctuations in amplitude and phase. We found that the residual increase in echogenicity of the tissue and the delay to the onset of type 2 activity were functions of laser power and tissue type and were correlated to lesion severity. We hypothesize that type 1 activity corresponds to motion (thermal expansion and contraction) of the tissue, and that type 2 activity corresponds to the creation of gas bubbles (vaporization) in the tissue. We conclude that the absorption of energy changes the acoustic properties of tissue during and after exposure and that Doppler signal processing can be used to differentiate various levels of laser-tissue interaction in real time.

Animals↗
PubMed1994

Jet-assisted laser tools for tooth preparation.

Previous oral calcified-tissue laser ablations have yielded inadequate results because of the difficulty in producing a desired effect on a surface without concomitant pulp or osseous damage. The purpose of this study was to characterize a new modality of ablating teeth using argon and diode lasers (488.5 nm, 805 nm) in combination with the repetitive placement of specific photoabsorptive dyes. In this design, energy from laser light, that would otherwise be reflected, is coupled to the tooth-dye interface. Thirty-two specimens of recently extracted human enamel were sectioned and prepared into 3 x 2 x 2 rectangular blocks and smoothed with a polishing point. Two-microliter droplets of dye were placed on the external enamel surface and subsequently air-dried. Specimens were then ablated with the laser-dye combinations, producing craters approximately 100-200 mum in depth and devoid of visual carbonization. Similar irradiations were performed on enamel specimens without dye application, and displayed no cavitation or surface carbonization. SEM studies showed evidence of crater formation within the enamel surface. Optimization of laser parameters integrated with specific dispensing of dye is necessary before this technique can be studied further.

Coloring Agents↗
PubMed1994

Low-power laser radiation for the treatment of benign prostatic hyperplasia: initial clinical experience.

Fifteen patients with significant bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH) were entered in a Phase II open pilot study designed to evaluate the effectiveness of a low-power-slow-heating (15 W x 180 seconds) laser regimen. Laser prostatectomies were performed with a right-angle firing neodymium:YAG laser fiber. Perioperative morbidity was minimal. Nine patients (60%) were able to void on their own within 72 hours after the procedure. The mean postoperative need for catheter drainage was 3.8 days (range 1 to 12). With a mean follow-up of 5 months (range 3-15 months), the improvement of the mean peak urinary flow rate was from 12.8 to 29 mL/sec, the mean postvoiding residual volume was reduced from 100 to 35 mL, and the AUA Symptom Score improved from 28.5 to 6. None of the patients required retreatment, and all the patients were pleased with the outcome. These results suggest that the laser regimen used in our study is safe and effective for the treatment of BPH.

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