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Laser treatment of keloids: a clinical trial and an in vitro study with Nd:YAG laser.

Biochemical studies utilizing keloid fibroblast cultures revealed that Nd:YAG laser selectively suppressed collagen production by these cells. Based on these in vitro observations, eight patients with keloids were treated with Nd:YAG laser in a nondestructive manner. Results, with a 3-year follow-up, indicated flattening and softening of the lesions. Thus, the results suggest that Nd:YAG laser is an effective treatment modality for keloids, and its mechanism may involve bioinhibition of fibroblast functions.

Adult↗

Pulsed laser damage thresholds and laser treatment energy parameters, in vivo, of human aphakic intraocular membranes.

Energy and power density damage thresholds were determined for the perforation of human aphakic pupillary membranes and intraocular lens implants, in vivo, at the focal point of Neodymium-YAG ophthalmic laser systems, at 1,064 nm, which produced Q-switched nanosecond pulses (TEMoo, pulse duration; 20 ns) and mode-locked pulse trains (TEMoo, 9-11 pulses, pulse duration; 30 ps, entire pulse train delivered in 50-70 ns). Pulse energies bracketing the damage thresholds and focal diameter were tabulated. The energy density and power density thresholds for perforation of the pupillary membranes (hereafter referred to as perforation threshold) were slightly lower and power density damage thresholds higher for shorter duration pulses, eg--66 J/cm2 (2,200 GW/cm2) with the picosecond pulse trains vs 80 J/cm2 (2.7 GW/cm2) with the nanosecond pulses and were similar in pseudophakics and aphakics; 78 J/cm2 for pseudophakics vs 83 J/cm2 aphakics, both treated with single nanosecond Nd-YAG pulses, and 68 J/cm2 for pseudophakic vs 66 J/cm2 for aphakic patients treated with picosecond Nd-YAG laser pulse trains. The number of laser pulses and pulse energies required for successful discussion of the pupillary membranes depended not only on the pulse parameters but also on the characteristics of the membrane, such as thickness, nonuniformity, capsular haze, or capsular haze combined with fibrosis.

Aphakia, Postcataract↗

Role of primary photoacceptors in low-power laser effects: action of He-Ne laser radiation on bacteriophage T4-Escherichia coli interaction.

The effect of He-Ne laser radiation (lambda = 632.8 nm) on bacteriophage T4-Escherichia coli WP2 interactions was studied. Irradiation of bacteria having respiratory chain components as primary photoacceptors accelerated their division in a dose-dependent manner, but irradiation had no effect on the properties of the phage (measured as its ability to infect host cells). At the same time, exposure of bacteria to stimulating doses of He-Ne laser radiation (from 10(3) to 6 x 10(4) J/m2) increased their ability to promote the growth of unexposed phages. These results clearly indicate that low-power laser effects require primary photoacceptors (phage contains no chromophores for red light).

Escherichia coli↗

Potential use of holmium lasers for angioplasty: evaluation of a new solid-state laser for ablation of atherosclerotic plaque.

Tissue effects of the mid-IR Holmium laser (emitting at a wave-length of 2130 nm) were evaluated. This wavelength is attractive because it combines high water absorption and easy transmission through standard optical fibres. The laser was pulsed with pulse durations in the range of 100 microseconds and repetition rates between 2 and 6 Hertz. For all experiments a repetition rate of 2 Hertz was used. The laser beam was coupled into waterfree quartz fibers with core diameters of 200 and 800 microns with an efficiency of 70 and 80%, respectively. Ablation of atherosclerotic plaque has been performed at an ablation threshold of 10J/cm2 for the 800 microns and 40J/cm2 for the 200 microns fibre. Removal of calcified plaque was possible. Ablation efficiency increased in a non-linear fashion with increasing pulse energies. The ablation rate per pulse was approximately 2 mm at energy fluences of 1000J/cm2 for the 200 microns fibre and 1.25 mm at energy fluences of 70J/cm2 for the 800 microns fibre; a further increase in energy densities did not result in higher ablation rates. On macroscopic examination only very limited thermal injury was found in crater adjacent tissue structures. Crater edges were even and did not reveal signs of crater charring or debris in the crater lumen. However, the histologic specimens revealed zones of thermal damage extending 100 up to 1000 microns lateral into adjacent tissue. Thermal damage increased with increasing radiant exposures and depended on the medium used.

Angioplasty, Laser↗

Interstitial Nd:YAG laser ablation in normal rabbit liver: trial to maximize the size of laser-induced lesions.

In order to apply interstitial laser ablation to relatively small liver tumors in humans, it will be necessary to optimize the irradiation schedule. Nd:YAG laser was applied to normal rabbit liver in vivo at various power and energy outputs, including a protocol in which irradiation was repeated twice, with and without fiber tip advancement during the intermission. Ex vivo and in vivo tissue were also irradiated to determine the effect of perfusion on the lesion size. We obtained the same monotonic relationship between laser settings and lesion size in rabbit liver as we previously reported in rat liver. MR-guided fiber advancement between heating periods increased the transverse diameter of the lesion, and MR monitoring demonstrated this process. Our results suggest that repeated irradiation with brief intermissions, when combined with fiber advancement, may increase the lesion size.

Animals↗

Alteration of argon laser-induced scars by the pulsed dye laser.

Ten patients with portwine stains (PWS) with test sites previously exposed to an argon laser were evaluated and subsequently treated with five pulsed dye (585 nm) laser treatments over a 10 month period. Clinical assessments, skin surface texture analyses using optical profilometry, and light microscopic histological evaluations were performed prior to commencement and at the end of the study in all ten patients. A change in the skin texture with return of skin markings approximating those of normal skin measured by optical profilometry was observed in the argon treated PWS skin following pulsed dye laser treatments.

Adolescent↗

Increase of dermal blood volume fraction reduces the threshold for laser-induced purpura: implications for port wine stain laser treatment.

BACKGROUND AND OBJECTIVES: The average success rate in achieving total blanching of port wine stain (PWS) lesions treated with laser-induced selective photothermolysis is below 25%, even after multiple treatments. This is because smaller diameter (5-20 microm) PWS blood vessels are difficult to destroy with selective photothermolysis since the volumetric heat generated by absorption of laser light is insufficient to adequately heat the entire vessel wall. The aim of this study was to investigate a potential technique for more efficient photocoagulation of small diameter PWS blood vessels in PWS that respond poorly to selective photothermolysis. STUDY DESIGN/MATERIALS AND METHODS: The blood volume fraction (BVF) in the upper dermis of the forearm of human volunteers was increased by placing an inflated blood pressure cuff on the upper arm. Applied pressures were in the range of 80-100 mm Hg for up to 5 minutes. The increased BVF was determined by matching reflectance spectra measured with that computed using a diffusion model. The impact of increased BVF on purpura formation induced by a 0.45 milliseconds pulsed dye laser (PDL) at 585 nm wavelength was investigated in normal and in PWS skin. RESULTS: In the presence of a 100 mm Hg pressure cuff, the BVF, as determined from the diffusion model, increased by a factor of 3 in the forearm and by 6 in the hand. Increasing BVF by a factor of 3 corresponds to an increase in blood vessel diameters by a factor of radical 3 approximately 1.7. BVF increased at 1-3 minutes after application of the pressure cuff, remained constant at 3-5 minutes, and returned to baseline values at 3 minutes after removal of the pressure cuff. Approximately 40% less radiant exposure was needed to induce the same amount of purpura after PDL irradiation when the blood pressure cuff was used. Applying an 80 mm Hg pressure cuff reduced the required radiant exposure for purpura formation by 30%. Heating of blood vessels was calculated as a function of vessel diameter and of radiant exposure (at 585 nm and at 0.5 and 1.5 milliseconds pulse duration). CONCLUSIONS: Enlarging the vessel lumen, for example, by obstructing venous return, can significantly reduce the "small-vessel-limitation" in PDL treatment of PWS. Dilation of PWS blood vessels enables a more efficient destruction of smaller vessels without increasing the probability of epidermal damage.

Adult↗

Comparison of the effects of laser, ultrasound, and combined laser + ultrasound treatments in experimental tendon healing.

BACKGROUND AND OBJECTIVE: Therapeutic ultrasound (US) and laser (L) treatments accelerate and facilitate wound healing, and also have beneficial effects on tendon healing. This randomized control study was designed to evaluate the effects of low-intensity US and low-level laser therapy (LLLT) on tendon healing in rats. STUDY DESIGN/MATERIALS AND METHODS: Eighty-four healthy male Swiss-Albino rats were divided into three groups consisting of 28 rats, the left Achilles tendons were used as treatment and the right Achilles tendons as controls. The right and left Achilles tendons of rats were traumatized longitudinally. The treatment was started on postinjury day one. We applied the treatment protocols including low-intensity US treatment in Group I (US Group), Sham US in Group II (SUS Group), LLLT in Group III (L Group), Sham L in Group IV (SL Group), US and LLLT in Group V (US + L Group), and Sham US and Sham L in Group VI (SUS + SL Group). The US treatment was applied with a power of 0.5 W/cm2, a frequency of 1 MHz, continuously, 5 minutes daily. A low-level Ga-As laser was applied with a 904 nm wavelength, 6 mW average power, 1 J/ cm2 dosage, 16 Hz frequency, for 1 minute duration, continuously. In the control groups, the similar procedures as in the corresponding treatment groups were applied with no current (Sham method). The treatment duration was planned for 9 days (sessions) in all groups, except the rats used for biochemical evaluation on the 4th day of treatment, which were treated for 4 days. We measured the levels of the tissue hydroxyproline for biochemical evaluation on the 4th, 10th, and 21st days following the beginning of treatment and the tendon breaking strength on the 21st day following the beginning of treatment for biomechanical evaluation. Seven rats in each group were killed on the 4th, 10th, and 21st days for biochemical evaluation and on the 21st day for biomechanical evaluation. RESULTS: The hydroxyproline levels were found to be significantly increased in the treatment groups on the 10th and 21st days compared to their control groups (P < 0.05). In comparison of the treatment groups on the 4th, 10th, and 21st days of the treatment, the levels of tissue hydroxyproline were found to be more increased in combined US+L Group compared with US Group and L Group, but the difference was not significant (P > 0.05). In comparison of the tendon breaking strengths, it was found as significantly increased in the treatment groups compared with their control groups (P < 0.05), although there was no significant difference between the treatment groups. CONCLUSIONS: Although US, L, and combined US + L treatments increased tendon healing biochemically and biomechanically more than the control groups, no statistically significant difference was found between them. Also we did not find significantly more cumulative positive effects of combined treatment. As a result, both of these physical modalities can be used successfully in the treatment of tendon healing.

Achilles Tendon↗

He-Ne laser effects on blood microcirculation during wound healing: a method of in vivo study through laser Doppler flowmetry.

BACKGROUND AND OBJECTIVES: Low-intensity laser therapy (LILT) is widely used for wound healing promotion and its mechanism of action may be due to an enhancement of blood supply. The aim of this study was to evaluate blood flow alterations in a wound healing model, using laser Doppler flowmetry (LDF) associated with a normalized perfusion parameter. STUDY DESIGN/MATERIALS AND METHODS: An injury was provoked in 15 rats and blood flow was measured periodically over a period of 21 days. Control groups were established to evaluate LDF and He-Ne laser effects on microcirculation. A 1 J/cm(2) dose was utilized, with 6 mW/cm(2) irradiance. RESULTS: The results demonstrated flow alterations provoked by lesion, and inflammatory response (P < 0.05). There were no statistical differences between groups. CONCLUSIONS: The results did not show a significant sustained effect on microcirculation with this He-Ne dose.

Animals↗

CO2 laser nerve welding: optimal laser parameters and the use of solders in vitro.

To improve the welding strength, an in vitro study was performed to investigate the bonding strength of CO2 laser nerve welding (LNW), with and without the use of human albumin solution, dried albumin solution, egg white, fibrinogen solution, fibrin glue, and red blood cells as a solder. Fifteen different combinations of laser power (50, 100, and 150 mW) and pulse duration (0.1 to 3 s) were used with a spot size of 320 microns. The results have been compared to suture, fibrin glue, and laser-assisted nerve repair (LANR). The strongest welds (associated with whitening and caramelization of tissue) were produced at 100 mW with pulses of 1.0 s and at 50 mW with pulses of 3 s. The use of a dried albumin solution as a solder at 100 mW with pulses of 1 s increased the bonding strength 9-fold as compared to LNW (bonding strength 21.0 +/- 8.6 g and 2.4 +/- 0.9 g, respectively). However, positioning the nerves between cottons soaked in saline for 20 minutes resulted in a decrease of the bonding strength (9.8 +/- 4.5 g). The use of a 20% albumin solution and egg white, both at 50 mW with pulses of 3 s, resulted in a bonding strength of, respectively, 5.7 +/- 2.1 g and 7.7 +/- 2.4 g. Other solders did not increase the bonding strength in comparison to LNW. The substantial increase in bonding strength for some solders suggests that it is worthwhile to investigate the dehiscence rate and nerve regeneration of solder enhanced LNW in an in vivo study.

Anastomosis, Surgical↗

Direct analysis of laser capture microdissected endometrial carcinoma and epithelium by matrix-assisted laser desorption/ionization mass spectrometry.

Direct analysis of laser capture microdissected malignant and normal endometrial epithelium using matrix-assisted laser desorption/ionization (MALDI) time-of-flight mass spectrometry (MS) was able to detect a number of proteins that are overexpressed in malignant epithelial cells. A total of 16 physiologic and malignant endometrial samples were laser capture microdissected, including four proliferative and four secretory endometria, and eight endometrioid adenocarcinomas. Two of these proteins, at 10,834 and 10,843 Da, likely correspond to calgranulin A and chaperonin 10, two proteins that had previously been identified in endometrioid adenocarcinoma in whole tissue homogenate by MS analysis. Direct analysis by MALDI-MS not only confirms that these proteins are overexpressed in endometrial carcinoma, but also localizes them to the epithelial cells, the expected cancer site.

Biomarkers, Tumor↗

Analysis of cyclic and acyclic analogs of retinol, retinoic acid, and retinal by laser desorption ionization-, matrix-assisted laser desorption ionization-mass spectrometry, and UV/Vis spectroscopy.

Laser desorption ionization (LDI)- and matrix-assisted laser desorption ionization (MALDI)-mass spectrometry (LDI-MS, MALDI-MS) at 337-nm laser wavelength were used to analyze retinol (vitamin A), retinoic acid, and retinal and their analogs 3-hydroxyretinol, 3-hydroxyretinoic acid, 3-hydroxyretinal, 4-oxoretinol, 4-oxoretinoic acid, 4-oxoretinal, 3,4-didehydroretinol (vitamin A(2)), 3,4-didehydroretinoic acid, 3,4-didehydroretinal, acycloretinol, acycloretinoic acid, and acycloretinal. The compounds exhibit sufficient ionizability which allows to obtain mass spectra by LDI which are similar in quality to those obtained by MALDI. Mass spectra were recorded with a linear time-of-flight (TOF) instrument or a reflectron-type (RETOF) instrument in positive-ion mode. Under the conditions of LDI-MS the compounds form abundant radical molecular ions (M+*), whereas in the MALDI mass spectra abundant protonated molecular ions ([M + H]+) are observed. Characteristic fragment ions provide additional structural information. High-performance liquid chromatography (HPLC) coupled with UV/Vis photodiode detection was used to assist in retinoid characterization. Synthesis of 3-hydroxyretinal, 4-oxoretinal, and acycloretinal was performed by oxidative cleavage of the all-trans-carotenoids of zeaxanthin, canthaxanthin, and lycopene.

Molecular Structure↗

Micromanipulation of chromosomes in PTK2 cells using laser microsurgery (optical scalpel) in combination with laser-induced optical force (optical tweezers).

An optical scalpel and optical tweezer have been combined to perform intracellular microsurgery and micromanipulation in vivo. When only laser microsurgery was performed on metaphase chromosomes, the dissected sister chromatid fragments drifted off to either the side of the spindle or completely off the spindle. At anaphase the fragments separated and the two arms generally moved to their respective daughter cells. When the chromosome arm was cut during anaphase A and B, the distal chromosome fragment separated from the rest of the chromosome and moved toward the pole, following the proximal chromosome fragment. Distal chromosome fragments laser-dissected during metaphase were held together throughout anaphase using the optical trap. Optical trapping of dissected chromosome fragments during anaphase A and B inhibited movement of the chromosome fragment to its pole. As a result, the trapped chromosome fragments were (1) incorporated into the opposite daughter cell, (2) lost in the cleavage furrow during cytokinesis, or (3) eventually incorporated into the correct daughter cell. These results indicate that optical traps are effective in holding laser-dissected chromosome fragments throughout mitosis. This new tool should be useful for studies on chromosome movement and cell genetics.

Animals↗

Nd:YAG laser irradiation to intraluminal mass lesions of the superior vena cava under laser balloon angioscopy in an experimental canine model.

A laser balloon angioscopic procedure was developed in a canine model for intraluminal mass lesions in the superior vena cava, using an endoscope bearing a very thin balloon through which Nd:YAG laser could penetrate. The balloon was made from artificially modified natural latex rubber and well expanded with saline infused through a biopsy channel. The endoscopic image of the object obtained through direct contact of the balloon expanded with saline was clear enough to observe the internal surface or branches in not only normal, but also pathological conditions of the canine SVC. The Nd:YAG laser was able to be successfully irradiated through the balloon using this procedure which, although still in its preliminary stage, may be a useful clinical, diagnostic and therapeutic tool of the future.

Angioplasty, Balloon↗

[Optoacoustic tissue alterations for optimizing laser cyclophotocoagulation. Transscleral detection of laser-induced optoacoustic pressure transients].

BACKGROUND: Considerable problems occur in transscleral laser cyclophotocoagulation concerning energy dosage. We investigated the feasibility of localizing the ciliary body by the detection of thermoelastic pressure transients and of supervising on-line the degree of tissue damage during treatment. METHOD: We used a specially designed handpiece to apply short pulsed laser radiation with low energy levels to enucleated bulbs of rabbits. With an adjusted pressure transducer we examined acoustical transients generated in the area of absorption of the ciliary muscle or the pigmented epithelial layer and measured axial resolution of the method at various distances to the corneoscleral limbus. RESULTS: We detected acoustic transients that allowed rough localization of the target area. A marked change in signal was recorded with increasing level of ciliary destruction. CONCLUSION: This procedure can serve as an essential tool in the on-line supervision of the coagulation process. The laser parameters can thus be adjusted optimally to the progress of the treatment.

Acoustics↗

Bilirubin calculi crushing by laser irradiation at a molecular oscillating region wavelength based on infrared absorption spectrum analysis using a free-electron laser: an experimental study.

We investigated a new laser technique of crushing bilirubin calculi, our aim being to crush calculi in isolation using a minimally invasive procedure. Infrared absorption spectrum analysis of the bilirubin calculi was conducted, revealing maximum absorption spectrum at a wavelength of the C=O stretching vibration of ester binding that exists within the molecular structure of bilirubin calcium. As an experiment to crush calculi using the free-electron laser, we set the laser at the effective irradiation wavelength of ester binding, and conducted noncontact irradiation of the bilirubin calculi. The calculi began to slowly ablate until the irradiated site had been completely obliterated after 20s of irradiation. Moreover, absorption spectrum analysis of the irradiated site, from a comparison of absorption peak ratios, revealed that absorption peak intensities decreased over time at the absorption wavelength of ester binding. These findings suggest that irradiation of molecular oscillating region wavelengths peculiar to calculi based on infrared absorption spectrum analysis results in the gradual crushing of calculi in isolation by breaking down their molecular structure.

Bilirubin↗

Clinical success, complications and restenosis rates with excimer laser coronary angioplasty. The Percutaneous Excimer Laser Coronary Angioplasty Registry.

The role of excimer laser angioplasty in treating complex coronary artery disease remains uncertain. A randomized trial comparing this new technology with balloon angioplasty cannot be designed until systematic analysis identifies the lesion types that are likely to benefit from treatment with excimer laser angioplasty. In a cohort of 764 patients who had 858 coronary stenoses treated with excimer laser-facilitated angioplasty, relative risk analysis was used to examine acute success, complications and restenosis rates, and the results were compared with those of balloon angioplasty to identify the lesion types that show the greatest benefit with the new treatment. Clinical success was achieved in 657 patients (86%), as indicated by < or = 50% residual stenosis and no in-hospital complication. A major in-hospital complication (death, bypass surgery, or Q-wave or non-Q-wave myocardial infarction) occurred in 58 patients (7.6%). Follow-up angiography was obtained in 70% of eligible patients. Combining angiographic and noninvasive restenosis rates yielded an overall restenosis rate of 46%. Relative risk analysis showed that major complications occurred frequently in lesions at an arterial bifurcation (odds ratio [OR] 5.96 [2.76, 12.6]; p = 0.001). However, certain complex lesions that are difficult to treat with balloon angioplasty (saphenous vein graft lesions, lesions > 10 mm, ostial lesions, calcified stenoses, total occlusions and unsuccessful balloon dilatations), analyzed together as a group, had lower complication rates by univariate (OR 0.59 [0.35, 1.00]; p = 0.051) and multivariate logistic regression (p = 0.006) analyses.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

Effectiveness of holmium laser-assisted coronary angioplasty. The Holmium Laser Coronary Registry.

The efficacy of holmium laser-assisted angioplasty was studied in 365 narrowings in 331 consecutive patients with coronary artery disease. Clinical indications for study were unstable angina pectoris in 140 patients (42%), stable angina in 136 patients (41%), postmyocardial infarction angina in 35 patients (10.5%), silent myocardial ischemia in 11 patients (3%), acute myocardial infarction in 1 patient (0.3%) and undefined in 8 patients (2%). Coronary morphology characteristics by Multivessel Angioplasty Prognosis Study group criteria were type A in 12.6%, type B1 in 34.2%, type B2 in 27.4% and type C in 25.4%. The laser successfully crossed the total length of the narrowing in 85.2%. Procedural success was 94.2%. Laser alone reduced mean percent luminal narrowing from 88 +/- 11% to 57 +/- 22%. Subsequent balloon angioplasty further reduced the mean luminal narrowing to 23 +/- 18%. Major complication rate was 2.7% (death 0.3%, Q-wave myocardial infarction 0.5%, and emergent bypass surgery 2.7%). Six-month angiographic restenosis (> 50% stenosis) rate was 44%.

Angioplasty, Balloon, Coronary↗