Lasers Med Sci 2002, 17:A1–A36 Ownership and Copyright Springer-Verlag London Limited 2002

1 PAST, PRESENT AND FUTURE OF LASER SURGERY & MEDICINE Kazuhiko Atsumi, MD, PhD, Prof. Emeritus; Tokyo University In 1966, the Ruby laser unit for medical use was constructed in Tokyo University and, in 1967, a skin cancer patient was treated with the unit. In 1968, the CO2 laser unit was constructed in Tokyo University and applied in clinical cases in Japan. Recently, many papers on laser surgery & medicine have been reported in the many scientific conferences in the World level. According to the analysis on the scientific papers recently reported in the major conferences on laser surgery and medicine in the World, the major topics of the research areas are classified into the several fields such as on plastic surgery / dermatology, PDT, low power laser applications, basic research, cardiovascular surgery, urology etc.. The many new lasers have been applied in the biomedical fields with the multiple wave length levels. As the infrared lasers such as holmium, thulium and erbium YAG lasers, as the visible lasers such as Cu, Hg, alexandrite, Ti:Sappire, semiconductors, as the ultraviolet lasers such as Xe Cl, ArF have been applied in the medical fields and FEL and X-ray have been investigated for the future biomedical applications. Before the 21st century, the many problems in the medical and health care fields have been confronting us in global level. These problems listed up as follows, should be solved by the application of lasers, 1) Diagnosis and therapy on intractable diseases. 2) Application for preventive medicine. 3) Contribution to health maintenance promotion. 4) Contribution to aging societies. 5) Saving of medical resources. 6) Enhancement of medical levels in the developing countries. 7) International contribution to the grobal emergent care and protection of accidents.

2 A NEED FOR NATIONAL POLICIES, REGULATION AND INSTITUTIONALIZATION IN HEALTH TECHNOLOGY ASSESSMENT IN EUROPE Isuf Kalo, M.D; Regional Adviser, Quality of Health Systems, WHO Regional Office for Europe, Copenhagen, Denmark To improve health system performance, a country should use its existing resources more efficiently to reduce waste and should encourage the most cost effective interventions within health technology assessment (HTA) and evidence-based medicine. The problems of health technology must be approached from a broad perspective which includes health technology at the level of individual health services (clinical technology and support technology) and health services technology at the community or public health level (technologies of protection, prevention and promotion). Initiatives to institutionalise health technology assessment, regulation and management remain very few and fragmentary, and are not part of any comprehensive vision and policy. The WHO Regional Office for Europe has encouraged the development of a HTA and its regulation which combines a top-down (institutionalisation) with a bottom-up (clinical benchmarking and feedback) approach. WHO Europe advocates the development of health technology assessment, management and regulation within the framework of a comprehensive and holistic national policy and institutionalisation of the necessary components and structures.

STATE-OF-THE-ART IN LASER DENTISTRY ABSTRACT NOT SUPPLIED

Laser application in surgery & medicine will be expected as the future medicine. 3 LASER PALLIATION OF THE HIV+ PATIENT Robert A. Convissar D.D.S; New York Hospital Medical Center HYSTORY AND FUTURE OF LASER PLASTIC SURGERY ABSTRACT NOT SUPPLIED

EC PROGRAMS ABSTRACT NOT SUPPLIED

Many oral manifestations of HIV infection can be used as markers for degree of immuno-supression. These manifestations may be treated with antibiotics, analgesics and antineoplastics. These drugs may interact and interfere with antiviral agents used to treat HIV infection, and possibly exarcebate it. This paper describes the use of lasers to palliate the painful symptoms of oral manifestations of HIV infection. This advantages and benefits to both patient and dentist will be discussed.

A2 4 EFFECTS OF PULSED Nd: YAG LASER ON MICROLEAKAGE OF COMPOSITE RESTORATIONS IN CI V CAVITIES A.Obeidi *, A. Ghasemi **, G. Ansari **, A. Azima; *Jahad Daneshgahi of Shahid Beheshti University of Medical Sciences, Tehran, IRAN. ** Dental School of Shahid Beheshti University of Medical Sciences, Tehran, IRAN BACKGROUND: Recurrent Caries have been proved as being one of the most usual complication following restoration and it has been identified that microleakage as the pri,mary cause of recurrent caries, pulpal inflammation and necrosis. PURPOSE: The purpose of this study was to evaluate the effects of pulsed Nd:YAG laser on creation of an impenetrable layer beneath the restoration by melting and recrystalization of dentin. MATERIAL AND METHODS: 32 sound extracted premolar teeth were subjected to two standardized, V shaped, class V cavity preparations n both surfaces of buccal & bilingual. Cavities were located at 1-2mm below the CEJ line. They were divided into two groups of experimental and control in a random manner. 20 and 15mJ pulse laser energies were tested. Etching, bonding and filling were performed using Tetric ceram composite materail. All samples were thermocysled for 1000 cycles followed by an immersing period of 1 week in 2% basic fuchsin solution. Specimens were then sliced longitudinally and evaluated under a digital scanner for the extent of dye penetration. RESULT: results indicated that the level of microleakage of laser treated cavities was significantly less than that of untrated cavities (P<0.05) for 20mJ/pulse laser energy. No significant decrease in microleakage level was observed for the 15mJPulse laser energy. DISCUSSION & CONCLUSION: The pulsed Nd: YAG laser with the energy of 20 mJ/Pulse and aforementioned features is appeared to be able to seal dentinal tubules and consequently reduces microleakage toward pulp.

5 X-RAY OPAQUE WAVEGUIDE FOR DENTISTRY T. DOSTÁLOVÁ Assoc. Prof., M.D., Ph.D.,1 H. JELÍNKOVÁ, Prof. Dr.Sci.,2 JAN ŠULC, M. Sc. 2 M. NÌMEC, M.Sc.,2 MITSUNOBU MIYAGI, Prof.,3; 1 Charles University, 1st Medical Faculty, Department of stomatology, GFH, Prague, 2 Czech Technical University, FNSPE, Prague, Czech Republic, 3 Tohoku University, Graduate School of Engineering Department of Electrical Communications, Sendai, Japan OBJECTIVE: The aim of study is to prepare a new x-ray contrast flexible waveguide, which will be suitable for x-ray systems in medicine namely dentistry, maxillofacial surgery or oncology. Summary background data: Recently, a process of miniaturization has occurred in the laser technology – for instance diode pumping lasers. A new method of laser transfer, i.e., the waveguide started to be used. MATERIAL AND METHODS: For the experiment, an Er:YAG laser system was used. The radiation was

Abstracts delivered to the investigated tissue by hollow glass waveguide. The inner diameter of the waveguide was 320 um, outer diameter is 630 um and the length is 100 mm. The root canal systems of 10 molars were treated endodontically. Digital x-ray images were taken with conventional files and with insertion of hollow glass waveguide. RESULTS: The position of metal instrument demonstrates the quality of opacity after conventional stepback technique. Waveguide is visible in left tooth canal. Bone density analysis shows no differences between left (waveguide) and right tooth canal. Conclusions: We confirmed that there are no x-ray opacity differences between metal instrument and waveguide. The digitalization of picture, 3-D image help to detect the precise position of waveguide in root canal.

LASER TREATMENT OF HARD AND SOFT TISSUE ABSTRACT NOT SUPPLIED

CLINICAL APPLICATION ABSTRACT NOT SUPPLIED

6 VITREO-RETINAL INTERFACE: DIAGNOSIS AND MEDICAL-SURGICAL TREATMENT P. Fortunato, C. De Libero, G. Virgili, S. Cappelli, F. Giansanti, P. Grasso Cannizzo, A. La Torre; Ophthalmology Institute – Florence University Despite insightful studies of various researchers, vitreous physiopathology is still only partially explored as a field of stufy for modern ophthalmology. There is much to be learned about the mechanisms that maintain the integrity of vitreo-retinal interface and, more deeply, about the biochemical relationship between retinal pigment epithelium and Bruch’s membrane; an imbalance between the physical and biological homeostasis at these levels may determine the onset of vitreoretinal interface disease. Despite the unclear relationship between internal limiting membrane (ILM) and hyaloid, and between pathogenesis and effect of vitreous detachment, surgical techniques are being developed that promise a resolution of most diseases associated with vitreous and retinal anomalies. Optical coherence tomography (OCT) is the main diagnostic technique supporting this advances. The authors, after briefly introducing vitreous physiology and pathology, will discuss the main indications to this type of surgery, which is guided by OCT. Diseases associated with vitreous traction will be described, focusing on surgical technique and results, such as macular hole, where tangential and centrifugal traction exists; retinal breaks, caused by anteroposterior traction; vitreomacular traction syndrome, due to antero-posterior traction to the macula; macular pucker, with foveal tangential and centripetal traction;

Abstracts tractional diabetic macular edema, which is the results of the multiple vitreous and retinal abnormalities associated with diabetes. Let’s examine our experience. We have treated 11 patients with full-thickness macular hole (stage IV Gass) and 11 patients with incomplete macular hole (stage III Gass) with pars plana vitrectomy, hyaloid peeling, ILM staining with ICG and its removal, completing the intervention with air-gas (perfluoropropane) tamponade; only in stage IV we have used adjuvants (autologous serum). The authors describe the incidence of retinal breaks in a sample of patients attending the emergency service, showing that only 4% of them will lead to retinal detachment. In 34 patients with epiretinal membrane, we have peeled the hyaloid, and in 37% of them the ILM as well. Criteria for offering surgery to patients were leakage from retinal vessels or severe metamorphopsias, that impaired patients’ quality of vision. Fifteen patients with macular pucker were treated with pars plana vitrectomy, hyaloid peeling and ILM peeling after ICG staining. Only recently 3 diabetic patients with tractional macular edema have undergone hyaloid and ILM peeling.

7 POSSIBLE APPLICATIONS OF MID-INFRARED SOLID STATE LASER IN OPHTHALMOLOGY V.K.Pustovalov, *B. Jean; Belarussian Institute of System Analysis, Minsk, Belarus. *University Eye Hospital, Tuebingen, Germany Recent development of infrared lasers ( Ho 2.1 µm, Er 2.94 µm, diode 0.81-1.9 µm) have led to an increasing interest for the use of infrared lasers in medicine. Some clinical experience with applications of infrared laser radiation for the treatment of different diseases in ophthalmology, for ablation, disruption and coagulation of ocular biotissues has disclosed marked advantages over applications of visible laser radiation. We offer to use in ophthalmology mid-infrared Cr:Zn-Se laser. Its unique parameters such as possibility to tune laser radiation wavelength in the range between 2.1 and 3.0 µm, to use one laser source with different regimes of irradiation (CW, quasi CW, Q–switched, nano- and picoseconds pulses), solidstate, portable, free combination of pulse length and energy has opened the door for applications in different fields of ophthalmology. Spectral interval 2.1-2.5 µm can be used for purposes of laser thermal keratoplasty ( LTK ) because -1) depth of radiation penetration is compared with variation of cornea thickness 2) monotonous increasing of the value of absorption coefficient in the interval 2.15 - 2.5 µm, 3) power of Cr:Zn-Se laser is enough for LTK treatment. From data for absorption coefficient of cornea ( water) we can see that the spectral interval 2.5 – 3.0 µm can be used for ablation of cornea. The advantages of Cr:Zn – Se laser for ablation purposes and possibility to substitute Er – Yag laser are next – 1) Cr: Zn – Se laser is a new laser source without visible limitations

A3 on energy, pulse duration, repetition frequency and so on. 2) possibility to tune the wavelength of laser radiation in the range 2.1 – 3.0 µm and as a sequence possibility to change the depth of laser penetration into different biotissues, the ablation thickness and rate for cornea and skin. 3) possibility to realize regimes of generation of laser nano- and picosecond pulses.

8 SOME CONSIDERATIONS FOR CHOOSING OF OPTIMUM WAVELENGTH APPROPRIATE FOR LASER TREATMENT OF INTRAOCULAR TUMORS V.K.Pustovalov, *B. Jean; Belarussian Institute of System Analysis, Minsk, Belarus. *University Eye Hospital, Tuebingen, Germany Investigation of laser treatment of pigmented and non pigmented intraocular chorio-retinal tumors is of great interest for laser applications in ophthalmology and oncology. At present argon (514 nm) and diode (810 nm) laser radiations are applied to perform coagulation of intraocular tumors. It is very important to predict the outcome of laser treatment of tumor and to eliminate after-operational complications, to provide a credible foundation and optimization of operational modes. The main problem of laser treatment of tumors is to achieve almost complete coagulation of tumor body ( volume) while the functioning of neighboring layers is preserved. If localized damage of intraocular tumor could be achieved then this could enable many more cases to be treated. There are three possibilities to deliver the laser energy to intraocular tumor: 1.Transpupillar irradiation, when radiation propagates through transparent ocular tissue (cornea, lens, vitreous, retina); 2.Transscleral irradiation, when radiation propagates through sclera; 3.Intraocular endoscopic delivery of radiation can be provided by fibre optic waveguide. The goals would be to use the most promising irradiation route (transpupillar, transscleral, or endoscopic direct contact) with best possible parameters of laser irradiation ( wavelength, pulse energy and duration, fluence, diameter of spot irradiation, etc) in each individual case. The investigation of most appropriate wavelength of laser radiation was made on the base of optical characteristics of pigmented and non pigmented tumor biotissues taking into account optical parameters of blood, water and others. It was established that radiation spectral interval between 1000 and 1300 nm ( Nd – Yag laser 1064 , 1320 nm and diode laser 1300 nm) is very appropriate for these goals. Laser coagulation of tumors can be used together with drug treatment and radiotherapy by ionizing radiation in order to achieve good results.

9 CYTOSTATIC MOLECULES MODIFICATIONS FOLLOWING THE IRRADIATION WITH OPTICAL BEAMS M.L. PascuA, B. CarstoceaB, S. TruicaA, A. StaicuA, L. VoicuA; AThe National Institut for Laser, Plasma and Radiation Physics, Laser Department, Bucharest, Romania. BCentral Military Hospital, Ophtalmology Clinic, Bucharest.

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BACKGROUND. Introduction of the photosensitivity properties of cytostatics drugs was made, considering already known indications; besides the biochemical action of the cytostatics, their effects could be enhanced by exposure to light at different doses.

11 CO2 LASER SURGERY IN SMALL ANIMAL PRACTICE

PURPOSE: The effects of coherent and noncoherent irradiation on spectroscopic characteristics of cytostatics were investigated. The irradiation was made using UV classic lamps ( Xe and Hg lamp) and a nitrogen pulsed laser.

BACKGROUND: Laser surgery is a technique widespread used in human surgery (e.g. endosurgery, ophtalmic, ENT and urologic surgery); now in veterinary surgery, too, laser is gaining popularity and is recognized as a better alternative for a wide variety of applications.

MATERIALS AND METHODS. The absorption, emission and excitation spectra were measured for methotrexate solutions in natural saline and sodium hydroxide at concentration between 10-5 -10-6M and pH 8.4 and for fluorouracil solutions in natural saline at concentration in the range 10-4 -10-5M. The solvent used for measuring the FTIR and Raman spectra was water and the concentrations in the range 10-4 -10-5M. RESULTS. There were measured absorption, fluorescence, FTIR and Raman spectra for the fluorouracil and methotrexate at different concentrations and in different solvents. For measuring the FTIR spectra we used a Nicolet Magna – IRTM 550 spectrometer and for Raman spectra, an Ocean Optics Raman System 2000. Major modifications of the absorption, fluorescence, FTIR and Raman spectra were observed. Discussion and conclusion: The spectroscopic modifications induced by coherent and noncoherent irradiation of cytostatic solutions used in cancer treatment were investigated. A comparison of the fluorouracil behaviour at irradiation with optical beams and the methotrexate evolution in the same condition is made. 10 SENSOR-CONTROLLED LASER PROCESSES FOR MEDICAL APPLICATIONS S. Roth, K. Tangermann; Bayerisches Laserzentrum (Bavarian Laser Center), Erlangen, Germany The connection of such key technologies as laser and sensor technology opens a broad field of applications especially in medicine. The development of sensorcontrolled medical laser systems represents a quantum leap in precision and safety in medical practice. This makes the treatment or surgery more gentle and safer for both physician and patient. This paper presents the possibilities and the potential of sensor-based laser procedures in medical practice. It deals with medical laser technology and sensor systems that are already used in medical diagnostics and therapy. A concrete example from laser surgery illustrates the advantages of laser ablation for an osteotomy of the mandible and a sensor and control concept for tissue-specific bone ablation. Thereby optical and acoustic process emissions are used for achieving switching-off criteria for the laser system before damaging the nerve. EQUINE LASER SURGERY ABSTRACT NOT SUPPLIED

Danilo Bellucci DVM; Studio Medico Veterinario – Milano ITALY

PURPOSE: Aim of this work is to evaluate applications of CO2 laser in small animal soft tissues surgery, highlining benefits and controindications, and to indicate proper regulations of the delivered beam according to selected surgical procedures. MATERIALS AND METHODS: Fifty animals (34 dogs and 16 cats) were evaluated for surgical problems and admitted for laser surgery; surgical procedures included oral surgery (tongue granulomas, oral granulomas, treatment of feline lymphocitic-plasmacytic stomatitis, staphylectomy, tonsillectomy, papyllomas), tumor surgery (squamous cell carcinomas, lipomas, mast cell tumours, sarcomas, anal gland neoplasms) and miscellaneous procedures (chronic abscesses, anal fistulae, ear canal ablation, lymph nodes biopsy, dog orchiectomy). RESULTS All the animals showed a pain free postoperative period, with no infections or other complications; intraoperative bleeding is easily controlled by defocusing the delivered beam, simply changing the distance between the laser tip and the tissue. DISCUSSION: The laser beam seals blood vessels, lymphatics and nerve endings, causing less postoperative swelling and pain; non contact delivery does not tear or bruise tissues, so postsurgical oedema is reduced and recovery time is shorter; the laser energy sterilizes tissues and prevents surgical sites infections offering superior precision and control for many soft tissues surgeries traditionally performed with a scalpel, cryosurgery or electrosurgical units. References Bartels K.E. Laser surgery. In: Bojrab MJ ed. Current Techniques in Small Animal Surgery. 4th Edition. Baltimore: William & Wilkins, 1998:45-52 Shelly B., Bartels E., and Clark D.: Use of an Nd:Yag Surgical Laser for Treatment of Squamous Cell Carcinoma in the Cat. J AmVet Med Assoc, 201(5):756-758, 1992 Payne JT. L’impiego chirurgico del laser e la terapia fotodinamica nella clinica dei piccoli animali. In: Waltham Focus Vol.6 N.4 1996: 19-23 Crowe DT.,Swalander D., Hittenmiller D., Newton J.: Clinical use of a 15 watt diode laser in small animal surgery: Results in 30 varied procedures. CeramOptec, Inc. Informational letter on the veterinary uses of the Ceralas D Fiber Diode Laser, East Longmeadow, Ma 1997. Hardie E.M., Stone E.A., Spaulding K.A., Cullen J.M.: Subtotal Canine Prostatectomy with the Neodymium: Yttrium-Aluminim_Garnet Laser. Vet Surg, 19,5348355, 1990

Abstracts Bartels KE: Lasers in Veterinary Medicine – A Review, Lasers in Surgery: Advanced Characterization, Therapeutics and System IV; Lasers in Vet.Med., Biomedical Optics, Vol. 2128F, No.81, 1994 Fry T.R., et al: Holmium:YAG Laser Discectomy in Chondrodystrophic Dogs, Lasers in Surgery: Advanced Characterization, Therapeutics and System IV; Lasers in Vet.Med., Biomedical Optics, Vol. 2128F, No.81, 1994 Feder B., Fry T., Kostolich M., Bartels KE.: Nd:YAG Laser Cytoreduction of an Invasive Intracranial Meningioma in a Dog; Progress in Vet Neuro, 4(1), 1993-3-9

12 PERIANAL FISTULAS IN DOGS: CO2 LASER SURGERY VERSUS CO2 LASER SURGERY ASSOCIATED WITH CYCLOSPORIN AND KETOCONAZOLE THERAPY C.Serra°, S.Pinna°, A. Venturini°, G. Rossi°°, D. Fortuna°°°; °Clinical Veterinary Department, University of Bologna. °°Department of Veterinary Science, University of Camerino. °°°Cardio-Thoracic Department, University of Pisa. Circumanal fistulas in dogs still represent an unresolved pathology in view of the high percentage of relapses that occur in subjects after traditional surgery. For this reason we retained it opportune to evaluate the possibility of an assisted laser surgery approach adjuvated by an appropriate therapeutic protocol. From a research population of 30 dogs with a histological diagnosis of circumanal fistulas, two homogeneous groups were identified: one group was treated with CO2 laser alone while the second group was treated with CO2 laser associated with cyclosporin and ketoconazole for 8 weeks. All the subjects received adequate antibiotic coverage and local medication daily. The assessment parameters used for verifying the success of the treatments were the following: histological analysis, healing time, relapses. The group treated with assisted laser surgery alone revealed complete remissione in 90% of the cases with a percentage of circumscribed and localised relapses equal to 10%. In the second group in which the basic therapy was associated with cyclosporin and ketoconazole there was a remission in 100% of the cases. The healing times were similar in the subjects who showed complete remission with no substantial differences between the group treated with laser only and the one treated subsequently with cyclosporin and ketoconazole. The results are in favour of assisted laser surgery due to the mini-invasiveness and conservation of the anatomical structures involved, and the association with cyclosporin and ketoconazole is extremely interesting in those cases in which the compromising of perianal tissues is such that it cannot guarantee complete laser assisted vaporisation of the inflamed tissues. Therefore the association of laser surgery and medical therapy is capable of guaranteeing complete recovery

A5 even in those cases in which the inflammatory process is extremely extensive and involves delicate and significant anatomical structures (anal sphincters), allowing for a mini-invasive and conservative approach without having to intervene via the use of invalidating surgical techniques.

13 LOW LEVEL LASER THERAPY (LLLT): COMPARISON BETWEEN RANDOMIZED DOUBLE-BLIND CLINICAL TRIALS. D. Fortuna°, C. Paolini°°, L. Ronconi°°°; °°°Cardio-Thoracic Department, University of Pisa. °°DEKA MELA laser system - Calenzano (Florence). °°°El.En. Group laser system - Calenzano (Florence) There are numerous studies in literature regarding the clinical efficacy of Low Level Laser Therapy (LLLT), however the very few randomized, double blind clinical trials available present contrasting views. The purpose of this trial is that of understanding whether the efficacy of inefficacy of laser can be correlated to the type and management of the apparatus used. Our intention has not been that of evaluating the quality of the bibliographical studies and therefore we have not proceeded with methanalytical techniques. We have only selected randomized, double blind clinical trials in which diode lasers have been used. The data contained in the articles was recorded on an electronic sheet and then analyzed. In order to partially integrate the technical data referred by the authors, in some cases it was necessary to make direct contact with the authors and manufacturers themselves. Two groups were then identified: ’’Efficacious LLLT’’ and ’’Inefficacious LLLT’’, after which we compared the various parameters and processed the statistical analysis. The comparison between the two groups, ’’Efficacious LLLT’’ and ’’Inefficacious LLLT’’, revealed a highly significant difference (p>0,014) in relation to the Peak Power Density (W/cm2) and a significant difference with regard to the Fluence (J/cm2). In conclusion, this trial reveals that there is a greater therapeutic efficacy in the case of laser equipment operating with pulses rather than with continuous emission, and that the therapeutic effect is correlated to the exceeding of specific dosimetric thresholds that have been identified.

14 LASER SAFETY ASPECTS FOR MEDICAL APPLICATIONS Shimon Gabay, PhD; DGS Laser in Medicine Technologies, Beer-Sheva, ISRAEL Most applications of lasers in medicine are based on the producing of a controlled thermal damage into a preferably tissue location. Laser safety deals with non controlled damage (thermal or other) that could be randomely produced into a non preferable tissue locations. This kind of damage is not allowed and the laser

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safety material is designed to provide the user with a knowledge and with sufficient safety instructions and means to prevent such damage. Following the laser safety instructions is especially important for the medical applications because in these applications the laser beam is brough in a close proximity to the patient’s body and non-desired damage can be easially produced.

ment of the result as to allow that ’’common decision’’ to obtain the valid approval which casts a new light to the relations medic-patient that tend to be of poor quality nowadays.

Most medical lasers are classified as Class 4 laser products, the highest hazard class. Direct laser beam of class 4 is capable to produce skin burns and to ignite flamable materials, and even its scattered beam may produce severe eye damage. The paper presents the nature of the skin and eye damage for different spectral range, and the state of the art rules in preventing such damage. The safety means that should be implemented in, and around, the laser clinique and in the laser surgery room will also be highlighted.

The actual positionings, supported by the mass media and the communications systems, tend to amplify every smallest mistake by the medics and increase the rumors about the so called ’’bad practice’’ of the sanitary system. Thus creates a mere disappointment in the Medic, whose aims are the cure and the healing of the patient even in the aesthetic medicine.

PHYSICIAN RESPONSIBILITY IN LASER MEDICAL APPLICATION ABSTRACT NOT SUPPLIED

15 LASERTHERAPY IN AESTHETIC MEDICINE: THERAPY OR TREATMENT? P. Rocchi, MD; Bologna University There are some medical acts which always have as aim a better psycho-fisical health condition for the citizen. Nevertheless, these medical acts tend to have (it’s not just an idea of the Author of this abstract) deontological and medical dignity when they are prone to correct forensic and esthetic defects of negative reflexes on the psychological sphere of the patient, even with psycisomatic and behaviour’s implications with greatly limiting to a suitable healthy lifestyle. The physician which carries out a medical act with aesthetic aims is always acting on the basis of a professional services’ contract and, in comparison with other health operations, it acquires some specific and pecular characteristics, that should be evaluated for detecting the system of civil and penal responsability which can follow it. Even in the lasertherapy these etic-deontological and medical-forensic considerations could be applied if it is used for aesthetic aims. The medical-forensic aspect, in this case, has a great importance for the civil Responsability which springs out from the doctrinal dualism between the so-called ‘‘obligation of means’’ and ’’obligation of results’’. Thus, especially in the medical activities which are not directly healing, could constitute the the cause of the responsability even together with the missing of the aesthetic effects that have been wished for so long, if we don’t have the fundamental guarantee of the valid informing approval.In this case, we can find several legislative references, and every one enlights the important duty of the medic to give a wide and complete information about the sanitary system to be adopted including the possible risks.We should include even the reference to the potential achieve-

Besides, even the ’’citizen’’ using the sanitary services should have a correct and suitable attitude towards the Medic even if he lingers aesthetic aims.

16 DAY SURGERY REALITY IN ITALY L.Corbellini *, A. Bove, G. Bongarzoni; * President of S.I.C.A.D.S General Surgery , ’’G.D’Annunzio’’ Chieti University – Chieti – Italy Day Surgery had a great development in the last years in Italy . It allows at same time to obtain a good patient compliance, a more efficient use of acute in-patient beds thus reduce waiting lists (resource allocation or cut) Nevertheless there are many controversies about the use of an appropriate terminology, clinical and social reasons patient admission, (Surgical risk definitions and its stabilization), the comparison between transferring rate and his improvement as validation of the procedure (How many surgical procedures really carried out in Italy?), admission appropriateness and management, continuos audit of nursing, quality care improvement programmes using indicators of wellbeing patient. Quality control will make it possible to improve and reform the daily work at the unit. On these controversies S.I.C.A.D.S, Italian Society of Ambulatory and Day Surgery (I.A.A.S associated) have worked very hardly in the hope of an improvement of the number and the type of surgical procedures and the good acceptance by the patient. (‘‘customer care’’) In Italy surgical procedures in ambulatory or day surgery carried out are proposed by the Regional Health Services and examined by the specific Surgical Scientific Societies.

17 INTERSTITIAL PHOTODYNAMIC THERAPY FOR CANCERS OF SOLID ORGANS S.G. BOWN, MD; National Medical Laser Centre, UCL, London, UK OBJECTIVE: This paper describes the new techniques of interstitial PDT for image guided, percutaneous treatment of cancers of internal organs. METHODS: Laboratory experiments showed that PDT is well tolerated by the pancreas, prostate and surrounding normal organs. Under CT guidance, 16 patients with localized but inoperable cancers of the

Abstracts pancreas were sensitised with mTHPC and red light delivered percutaneously (laser fibres inserted through needles), 3 days later. 14 patients with localized recurrences of prostate cancer after radiotherapy were treated similarly. RESULTS: Pancreas: Post PDT scans showed substantial areas of tumour necrosis. 14 of 16 left hospital within 10 days. There was gastrointestinal bleeding in 2 and duodenal stenosis in 3, but no treatment related mortality. Median survival was 10 months from treatment. Prostate: Contrast enhanced CT/MR scans at 2 months showed substantial areas of necrosis in all. The PSA fell in 9 (to undetectable levels in 2). In 5, post PDT biopsies did not show cancer. 4 lost sexual potency and 4 experienced temporary incontinence. CONCLUSIONS: Interstitial PDT can produce substantial volumes of tumour necrosis in internal organs with acceptable levels of morbidity. The technique is worthy of further study.

18 ABLATION OF CUTANEOUS LESIONS USING AN ERBIUM:YAG LASER. Khalil A. Khatri, MD; Skin & Laser Surgery Center of New England, Cambridge, MA PURPOSE: To evaluate the use of Erbium:YAG laser to remove cutaneous lesions. METHODS: Seven female and ten male patients with skin types I to IV with various cutaneous lesions were treated with Erbium:YAG laser. An Er:YAG laser with a wavelength of 2.94µm was used with a fixed pulse width of 250µs. A fluence of 5 to 60 J/cm2, spot size 1.5, 3.0 and 5.0 mm, with repetition rate of 4 or 8 Hz was used to ablate benign, pre-malignant and superficial malignant skin lesions. The lesions were exposed to the laser until they were visibly removed. Photographs were taken before and after treatment at all follow up visits. The follow up visits ranged from few weeks after treatment to more than a year after initial treatment. A total of 227 facial lesions were treated. These lesions included Seborrheic Keratosis, Acrochordon, Verruca Vulgaris, Solar Lentigo, Benign Nevus, Sebaceous Hyperplasia, Xanthelasma, Milia, Actinic Keratosis and Squamous Cell Carcinoma in situ. A surgical excision was performed and microscopic evaluation was done after the ablation of SCC. RESULTS: All the lesions were removed successfully and there was no recurrence at time of the submission of this abstract. A microscopic evaluation confirmed the complete ablation of SCC in Situ. There was usual erythema, swelling and pinpoint bleeding associated with the use of Erbium:YAG laser. None of the patients had infections, scarring or permanent pigmentary alterations. CONCLUSION: Erbium:YAG laser is another effective and safe device that can be used to remove benign, pre-malignant and superficial malignant cutaneous lesions.

A7 19 EARLY TREATMENT OF CONGENITAL MELANOCYTIC NAEVI WITH THE CARBON DIOXIDE AND THE Nd_YAG LASERS Mrs R Dave, Mr P J Mahaffey; Bedford Laser Treatment Centre, Bedford Hospital, Bedford MK 429DJ. UK Congenital melanocytic naevi are a distinct entity as compared to the acquired naevi. Within these naevi the giant congenital melanocytic naevi (GCMN) attract special attention in terms of cosmesis as well as malignant change. We report our experience of treating 4 children with GCMN using carbon dioxide and Nd-YAG lasers. Two of the babies were treated within two weeks of birth, one baby at age 6, 9 and 15 months and one baby was treated at age 3 years. The naevi were situated on the head, neck and the trunk. The oldest child had received curettage as a neonate. At follow-up ranging from 6 months to 24 months we have noticed significant ablation of pigment and a pleasing aesthetic result. A decrease in the malignant potential of these naevi cannot be commented upon in this early phase. It is suggested in the literature that these naevi need to be treated ’early’ to achieve a good result. From our own experience we have found that treatment upto the age of 15 months gives pleasing results. We conclude that a combined modality using carbon dioxide and Nd-YAG lasers is a suitable alternative to treating GCMN.

20 ERBIUM:YAG LASER TREATMENT OF ACNE SCARS Khalil A. Khatri, MD; Skin & Laser Surgery Center of New England, Cambridge, MA PURPOSE: To evaluate the use of Erbium:YAG laser for treatment of Acne Scars. METHODS: Several female and male patients with skin types I to IV with Acne Scars were treated with Erbium:YAG laser. All patients received laser treatment and some patients underwent excision or punch elevation of deeper scars, followed by subcision prior to laser treatment. The standard techniques were used for excision and punch elevation. Subcision was performed by using an 18G, 1.5-inch needle intradermally to break the scar tissue. An Er:YAG laser with a wavelength of 2.94 µm was used with a fixed pulse width of 250 µs. A fluence of 10 J/cm2, spot size of 5.0 mm, with repetition rate of 4 or 8 Hz was used to resurface Acne Scars and the surrounding area. The area of treatment received minimum of 4 passes and the scars were treated with additional 2-4 passes. Post-operative care included keeping the area clean and moist. Sutures were removed in one week. Photographs were taken before and after treatment at all follow up visits. RESULTS: All treated Acne scars showed improvement at six-month follow-up. There was usual erythema, swelling and pinpoint bleeding associated with

A8 the use of Erbium:YAG laser. None of the patients had infections, scarring or permanent pigmentary alterations. CONCLUSION: Erbium:YAG laser is an effective and safe device for improving Acne Scars.

21 LASER REVISION OF SCARS : THE STATE OF THE ART George V. Oskarbski M.D; 1-Polish Society of Aesthetic Medicine 2-Hospital Medical School: Scuola Medica Ospedaliera Regione Lazio – Ospedale S. Eugenio - Rome BACKGROUND: Current laser technology offers a variety of treatments of types of scars and striae. A review of the scientific literature in this field offers considerations and protocol of laser therapy following clinical responses: scar type, laser used, number of treatments, preoperative, intraoperative, postoperative considerations. OBJECTIVE: To determine the effect of the experiences so in the literature as in the private management. METHODS: Reports of the studied authors and considerations from the private experience performed on personal record of cases . RESULTS: Global assessment scores and significant clinical improvement were significantly improved after laser treatment following the parameters suggested in literature CONCLUSION: The record cases is little but meanful according the suggestions of the scientific literature of the field.

22 EFFICACY of LOW POWER LASER GaAlAs (630 nm) in THE TREATMENT of VITILIGO PATIENTS Leila Ataie M.D., Gholamreza Esmaeeli Djavid; JAHAD Medical Laser Center, Iranian Academic Center for Education, Culture & Research (ACECR), Tehran University of Medical Sciences Branch, Tehran, Iran OBJECTIVE: Due to some documents concerning efficacy of low power laser therapy (LPLT) in melanogenesis and repigmentation of depigmented lesions of vitiligo patients, we decided to treat vitiligo patients with lesions resistant to conventional topical and systemic therapies, with low power lasers. METHODS: This is our experience and results with patients with progressive or static vitiligo including a before and after, open clinical study, between April 2001 and June 2002. Vitiligo patches were treated by using a 630-nm GaAlAs laser (20 mW & 1 j/cm2), 2 times a week for a maximum of 24 treatments. Patients were followed for 9 month and the effect of treatment was evaluated. RESULTS: Six patients were able to be evaluated for the purposes of this analysis. Their ages ranged from 11 to 46 years. Decreases in surface area of

Abstracts depigmented lesions were seen ranging between 25% and 75%. Pigmented stippling within depigmented lesions occurred in all patients. In two patients of repigmented of previously depigmented hair were seen. Only one patients experienced arrest of progression of disease after 24 sessions of treatment. CONCLUSION: LPLT is without side effects and probably effective in repigmentation of vitiligo but has minimal effect of progression of disease.

23 TATTOO REMOVAL George V. Oskarbski M.D; 1-Polish Society of Aesthetic Medicine 2-Hospital Medical School :Scuola Medica Ospedaliera Regione Lazio – Ospedale S. Eugenio - Rome BACKGROUND: An increasing percentage of the young population (in U.K. between 5 and 10%) have one or more either self-inflicted (amateur) or professional tattoos. The body considers pigment injected into the skin to be invasive , therefore responds by encapsulating the whole tattoo in a wall of collagen that traps it within the skin permanently.Often most people with tattoos later come to regret them. Tattoo removal with lasers is documented safe and effective and the method of choice for both doctors and patients. Based on the theory of photothermolysis, successful removal of a tattoo depends on the absorption of light by the particles of tattoo pigment in the skin.: the particles heat rapidly leading to an explosive fragmentation of the collagen capsule and the pigment itself , that can then be removed by the body’s own defence system. Different wavelengths of light target different coloured inks and in general, blue/black, red and green can all be removed with high degrees of success. Other colours may fade but are harder to remove with the same success. SETTING: Private practice. METHODS: Inflammation, erythema, blanching and occasional pin-point bleeding , pain,scars,shadow -effect are treatment end-points by IPL , NdYAG , diode . In order to allow the skin time to heal, treatments were studied by cooling, space in weeks and in the number of treatments required, valuing diffferences between professional and amatorial tattoos. RESULTS: Under valuation, at the moment not so satisfactory as literature suggests CONCLUSIONS: On my opinion, tattoo removal with lasers even if documented safe and effective has not achieved, at the moment, a golden standard.

24 LASER RESURFACING: EDULAT OINTMENT AS A NEW POST-TREATMENT WOUND DRESSING AFTER LASER RESURFACING E.M. van der Velden1,2, J.Defrancq3, M.F.Noorman van der Dussen3, N.Najmi3, O.E. IJsselmuiden1, A.M. Baruchin2; 1-Institute for Esthetic Medicine, Arnhem, The Netherlands. 2-The Barzilai Medical Centre, Ashkelon, and the Faculty of Health and Science, Ben Gurion University of the Negev, Beer-Sheba, Israel

Abstracts The approach to post-treatment wound dressing after laser resurfacing has seen a number of changes. Most of the treatment modalities nowadays consist of the application of an agent containing silversulfadiazine (Flammazine), sometimes combined with cerium(III) nitrate (Flammacerium). These substances are chosen for their antibacterial and eschar-inducing action. In our practice we have during the last five years seen a large number of patients showing adverse reactions to these substances. Our study indicates that the substances concerned may cause considerable discolorations of the skin. It is our opinion that the high silver content of flammazine-like agents causes these discolorations. Literature mentions several toxicological risks of nitrates and sulphur compounds as well. Patients complain of wound pain and itching.In addition, partial laser resurfacing - and consequently, partial application of flammazines – results in discolorations with sharp delineations, coinciding exactly with the edges of the treated skin surface. We have developed an alternative approach that is both more successful in that it does not cause any of these negative effects and gives no discomfort to the patient. The laser burn is treated with EdulaT ointment, containing 8% Calendula officinalis (Marigold) tincture in eucerinum petrolatum and vaselinum flavum. This is applied 3-5 times daily in a thick layer during the first week after laser treatment. In the following 6-8 weeks, a thin layer is applied twice daily. Wound healing is rapid and the cosmetic results are very positive. This is due to the mild action of the ointment’s ingredients, the effectiveness of which has been amply proved in other studies. Calendula tincture is known for its antibacterial and skin-healing properties.The sharp delineations of partially resurfaced skin are also removed when EdulaT ointment is used. The use of EdulaT ointment offers an alternative to wound treatment which is less costly, is more comfortable to the patient and has none of the side effects of the substances usually prescribed.

25 LASER EPILATION BY 810 WAVELENGTH ULTRALONG PULSE: 30 MONTHS OF EXPERIENCE N. PEPE, MD; Dottorando di Ricerca Universita` La Sapienza Roma BACKGROUND: Many wavelengths are used for laser epilation (694, 755, 810, 1064) with different results. We report a middle term experience. PURPOSE: The author show the effectiveness (related to the fluence) and the poor collateral effects (related to the ultralong pulse) MATERIALS & METHODS: The author experience is from December 1999 to june 2002. The laser used is diode 810 (diomed) with scanner. The patients treated are 430. The fluences applied in a first phase 20-30J in a second phase 40-50j with a pulsewidth 160-200ms. The session on average are 5 to 7. A 3-5% of patients abandon the treatment for the pain. RESULTS: The effectiveness is poor in the first phase (with low fluences), now with the higher fluences used

A9 and beam overlapping the personal satisfaction score is high (8-9 on a scale of 1 to 10) after 6 session. Collateral effects are essentially: blistering and subsequent transient hyperpigmentation. The results are permanent in the patients that we saw in the follow-up (10% approximately of the group treated). DISCUSSION & CONCLUSION: The 810 wavelength is effective for laser epilation at fluence of 40-50j in black (even fine hair) or in brown coarse hair. When we use the ultralong pulse the collateral effects are minimal. The permanence is on evaluation.

26 THE MAGIC OF LASER: AN EVALUATION OF 7 YEARS OF SIDE EFFECTS E.M. van der Velden1,2, R.J.van Suylen3, J.Defrancq4, O.E. IJsselmuiden1, O.Nahlieli2, D.Ben-Dor2, A.M. Baruchin2; 1: Institute for Esthetic Medicine, Arnhem, The Netherlands. 2: The Barzilai Medical Centre, Ashkelon, and the Faculty of Health and Science, Ben Gurion Univ. of the Negev, Beer-Sheba, Israel. 3: Academic Hospital Maastricht,The Netherlands. 4: De Eeuwfeestkliniek, Antwerpen, Belgium In this paper we present an overview of the complications of skin resurfacing with high energy, pulsed and scanned carbon dioxide (CO2) and erbium:yttriumaluminum-garnet (Er:YAG) lasers that we have seen in our practice over the last seven years. In our experience, little attention is paid to the potential adverse reactions to laser treatment. Important individual characteristics such as the Fitzpatrick skin phototype, the degree of exposure to ultraviolet light, pre-treatment and medical condition are too often neglected.By the medically trained as well as the lay patients, laser treatment is regarded as the panacea that may solve an unusually wide range of cosmetic and health problems. As a result, laser is often used for indications that warrant more effective, accepted treatment methods or where laser treatment is counter-indicated. Even for indications for which laser treatment would in principle be suitable, side-effects and complications are frequently observed. Among the severe complications we found are hyper-, hypo- and depigmentation, and hypertrophic scars. These complications may only start developing 3 months and sometimes as late as 1 year after treatment. Histology of hypo- and depigmented tissue indicates that depigmentation is triggered not so much by the heat-induced damage done to the melanocytes or the melanine as by its effect on tyrosinase production. The loss of tyrosinase seems to be irreversible, as a seven-year follow-up indicates.In this presentation we discuss how to avoid these - in most cases irreversible - side-effects by proposing preventive measures, such as the correct determination of the skin area to be treated, and adaptation of the laser treatment to the skin type. Finally, we present the hystologic evaluation of 3 cases that are representative for all 73 cases we have seen during a period of 7 years. The pathological examination of the skin will be discussed further.

A10 27 LASERLIPOSCULPTURE BY DIODE (810 NM) IN THE LOCALIZED FATTY DEPOSITS (LFD): 22 MONTHS OF EXPERIENCE. Pepe N.*, Cirillo P.F.**, Meloni V.***; *Dottorando di Ricerca UniversitÀ ’’La Sapienza’’ Roma, Italia. **Libero professionista Roma, Italia. ***Ricercatore UniversitÀ ’’La Sapienza’’ Roma, Italia

Abstracts Departamento de Epidemiologia Cali-Colombia SA. -Universidad Libre,Departamento de Histologia Cali-Colombia SA. 6-Universidad del Valle Dept. de Física y Optica cuantica, Cali-Colombia SA 5

PURPOSE: The authors tempt to achieve the same results by the thermal energy obtained by fiberoptic laser applied in contact modality in adipose tissue.

This study describes the scientific basis for a new lipoplasty technique based on the use of a low-level energy laser diode beam. A multidisciplinary team studied fat samples randomly taken from ten patients that underwent a liposculpture procedure. Transmission Electron Microscopy, Scanning Electron Microscopy, Magnetic Resonance Imaging, and HighResolution Harmonic Ultrasound studies were performed in order to clarify the laser effects on the adipose cells. Additionally, we performed Human Adipocyte Culture in order to verify in- vitro, the findings in the tests listed above.

The possibility to use a laser for multiple surgical function is interesting from an aconomical point of view: the 810 wavelength is used for volumetric reduction of turbinates, EVLT, mucosal resection, epilation

Finally optical transmittance studies were realized to establish a physical correlation between in vitro irradiated adipose cells and laser irradiation time. Fat samples were processed as follows:

MATERIALS & METHODS: A first phase was a preclinic study on human tissue on a table to verify the correct dose. In a second phase, from august 2000 to april 2001, are treated 14 patients with exclusive laserlipolysis technique. From april 2001 to june 2002 are treated 34 patients modifying the doses and introducing an aspirative time

Application of tumescent technique and exposure to laser beam for 4 minutes. Partial disruption of the adipose cell was observed; several cells without disruption of the cellular membrane were preserved. The adipose cells lost their round shape, and fat spread into the intercellular space.Application of tumescent technique and exposure to laser beam for 6 minutes. Transitory pores were observed in the cell membrane. There was found microscopic evidence that fat was outside the adipose cells, and remained in the interstitial space. Structures such as the capillaries and the remaining interstitial space, were however preserved. Without the use of tumescent solution, in vitro exposure of adipose tissue to laser beam for 4, and 6 minutes was performed and compared with samples without laser exposure (Zero minutes). Laser penetration through adipose tissue decreased when the tumescent solution was not utilized. The Scanning and Transmission Electron Microscopic findings after six minutes laser exposure without the use of tumescent solution correspond to those observed at 4 min. laser exposure by equal intensity (10 mW) combined with the use of a tumescent solution, suggesting that the application of the tumescent solution is a important enhancement factor.The effect of this new technique can be summarized as follows:

BACKGROUND: The association of ultrasonic energy (interstitially or trancutaneously) to the fat aspiration results advantageous for adipolysis and for production of scar tissue e subsequent retraction of overlying flap in the aspirated area.

RESULTS: In the second phase (introducing an aspirative time) we obtain a volumetriv reduction without skin irregularities. We ecographically evaluate the subcutaneous tissues in patients with only liposuction and with laser assistance. The authors are istologically studying the effects on cutaneous and subcutaneous tissues. DISCUSSION & CONCLUSIONS: A good record of cases and a long followup, without complications, confirm the laser application on LFD. THE laser assistance shows advantages: reduction of local anesthesia injected, reduction of ecchimosis, less difficult tunnelisation of scar areas, more skin retraction. The disadvantages are: elongation of surgical time, laser cost. The limit respect the UAL (ultrasonic assisted liposuction) is the lesse lipolytic effect, but the advantage is the possibility to perform a superficial tunnelisation thanks to the reduct dimension of the fiberoptic. The future should be the application of laser in other procedures: cervical or limb lifting.

28 LOW LEVEL LASER ASSISTED LIPOPLASTY, L.A.L. A NEW TECHNIQUE. NEIRA 4L TECHNIQUE Rodrigo Neira1 MD, C.Ortiz1 MD, J.Arroyabe3BSc,Msc, H Ramírez5MD, MI Gutierrez4MD, C Isaza2MD, O Gutierrez2MD,PhD, Wcriollo2BSc, MA Reyes6, AF Robledo6, JA Montoya6 Fis, Y Banguero6 Fis,F Sequeda6 PhD, Esolarte6 Dr rernat6; 1-Centro Medico Imbanaco-Cali-Colombia SA. 2-Universidad del Valle-Departamento Ceulas in Vitro,Cali-Colombia SA. 3-Centro Internacional de Agricultura Tropical Cali-Colombia SA. 4-Universidad del Valle

Facilitates fat extraction since the fat comes out liquefied. Reduces surgical trauma. Reduces post-surgical echimoses formation since it reduces surgical trauma. Less post surgical edema is seen. Patients present just minimum post-surgical pain Patients return to normal activities at 72 hours, Satisfactory silhouette contour can be acquired. Skin retraction is seen over time and follow up. Aesthetic results in the 700 patients that have been follow-up to now were particularly satisfactory; skin retraction, silhouette contour were also satisfactory besides smoother skin surface can be obtained. The laser technique (L.A.L technique) could considered an efficient tool during liposuction procedures and this might be a new focus in the plastic surgery field.

Abstracts 29 DEVELOPMENTS IN THE VIDEOMICROSCOPIC ASSESSMENT OF CAPILLARY VASCULAR MALFORMATIONS V. Sivarajan, IR Mackay; Canniesburn Plastic Surgery Unit, Glasgow, Scotland BACKGROUND: Videomicroscopy can be used to visualise the ectatic dermal capillaries found within Capillary Vascular Malformations (CVM’s). PURPOSE: A drawback to the use of the videomicroscope is the amount of reflection seen from the skin surface, which obscures the dermal capillaries. In an effort to reduce this reflection we used a green filtered light with the videomicroscope (wavelength 530 nm). MATERIALS & METHODS: Twenty-four sites on eighteen patients with a CVM were examined using both normal white light and green filter Videomicroscopy. Twelve women and six men with a mean age of 33 years (range 9-50) were examined: These patients had had between 0 and 28 treatments (mean 12, S.D. 9.7): Width measurements for both the deep dermal and superficial dermal capillaries were recorded for each modality. RESULTS: There was no statistically significant difference found for the deep dermal vessels. However, for the superficial dermal capillaries a statistically significant (p<0.01) increase in the measurements taken with the green filtered lens was found. CONCLUSIONS: We attribute this to the reduction in reflection seen with the green filter. Another development we demonstrate is the use of a depth measuring contact lens, which reduces reflection and allows depths of capillaries within the dermis to be measured.

30 LASER TREATMENT OF HEMANGIOMAS AND VASCULAR MALFORMATIONS – 15 YEARS OF CLINICAL EXPERIENCE H.-P. Berlien, Margitta Poetke, C. Philipp; Klinik für Lasermedizin, Klinikum Neukölln Lasers have been used in the treatment of hemangiomas since the early 1980s. Several study groups have reported good results, others have been less enthusiastic and emphasized other treatments like cryosurgery. We reviewed our experience with the use of laser therapy in treating complicated hemangiomas of infants. During a 15-year period, 1332 infants with hemangiomas were treated with flashlamp-pumped pulsed dye laser, argon laser or Nd:YAG laser. The lesions reported were particular troublesome because of significant cosmetic disfigurement, maceration or ulceration, bleeding, and of potential functional impairment. We performed 392 treatments with the flashlamppumped pulsed dye laser laser in 215 patients with 275 cutaneous hemangiomas, 1117 children with 2231 mixed cutaneous or subcutaneous hemangiomas were treated in 4262 sessions with the Nd:YAG laser. This was a transcutaneous application with local ice cube cooling to protect the overlying skin. All deep-

A11 seated lesions were treated with interstitial laser irradiation. Regression of these lesions was seen in 89% of cases 4-6 weeks after the first treatment. Overall, excellent results were achieved in 41% of infants and good results occured in 51%. Improvement with flattening of the lesion, less swelling, and improvement in the vascular red or bluish hue was visible after laser treatment. In 8% treatment was deemed to have failed because of further growth of the hemangioma. Complications associated with laser treatment, such as postoperative bleeding and infection were not seen. We treated 859 patients with vascular malformations during the same period. The patients were divided into three groups: 489 patients with capillary malformations (port-wine stains), 56 patients with lymphatic, and 314 patients with venous malformations. We managed to achieve a clear symptomatic improvement in all cases. On the basis of our results we conclude that laser therapy may successfully prevent enlargement and promote involution of hemangiomas with minimal adverse effects. Therapy should be initiated as early as possible, when lesions are relatively flat, for optimal results. Furthermore, vascular malformations should be treated in time in order to minimize secondary symptoms. For port-wine stains the flashlamp-pumped pulsed dye laser is very effective and may be the treatment of choice.

31 EVLT ENDOVENOUS LASER TREATMENT OF THE GREATER AND SHORT SAPHENOUS VEINS BY DIODE 810 WAVELENGTH: EXPERIENCE ON 55 CASES IN 15 MONTHS V. MELONI N.PEPE L GIOFFRE’; IV Clinica Chirurgica UniversitÀ La Sapienza Roma BACKGROUND: As in arterious pathology, where the endovascular treatment has the same indications of surgical therapy, in the venous too the endovascular approach is an alternative solution. The obliteration of disfunctioning veins is possible giving different physical energy (Radiofrequency, laser). The endovasal treatment of saphenous varices by 810 diode laser is probably the most important progress in the last 10 years in this pathology. Actually in the world are performed some thousand of cases in 3-4 years. Min codified the method the materials and the dose to obtain the FDA and CE certifications. PURPOSE: The authors show our experience and our approach to the venous pathology by EVLT. MATERIALS & METHODS: The experience of our group is based on 55 veins (50 GSV; 5 SSV) treated for primitive venous insufficiency for an amount of 45 patients from april 2001 to june 2002. In the first cases the anesthesia was general but now is routinely local (klein solution modified). The doses are from 12 w to 18 w for 0,2 mm to 0,5 mm for 1 second. RESULTS: The postsurgical results with a 15 month follow-up are 100% asymptomatic patient, 1 case of pervious (2 mm) and refluent greater saphenous vein, 1 case of pervious not refluent (restore?) greater saphenous vein the others are completely closed.

A12 The only collateral effect is transient paresthesia of the internal saphenous nerve in 2 cases when we performed ’’long’’ EVLT DISCUSSION & CONCLUSIONS: The EVLT, for the moment, is effective as the surgical procedure without the long convalescence of the last. We don’t know how will happen in the future but the basis are promising.

32 ENDOLUMINAL PHOTOTHERMOSCLEROSIS LASER 808 nm FOR THE TREATMENT OF THE SAPHENOUS AND COLLATERAL VARICAE OF THE PELVIC LIMBS. INDICATIONS AND LIMITS (THEORETIC – EXPERIMENTAL) O. Marangoni, M.D., M. Melato M.D. *, L. Longo M.D. °; G. Bassi Foundation – Trieste, Italy * Trieste University, Italy ° General Surgery Institute and Phlebology Center, Siena University, Italy The high incidence of recidivists (50% at the age of 15 years) after surgical treatment of the variceal disease (poliform, multifactorial, evolutive), encouraged us to search mini-invasive treatments, which are efficacious and with immediate recuperation. In 1987 the first saphenous endovarical laser at 1064 nm, showed that photosclerosis was far less stable. Over the last five years, the diode 808nm seems to obtain interesting results. The introduction of the fiber in the anterior saphena of the knee with fix fluences, although offering good results in short time, does not convince us on the length of the fibrosis, with the exception of old patients, depending on the individual and evolutive diversity, on the thickness and on the varical parietal structures. In young patients the fibro-muscolar hypertrophy of the intimy-media, makes to surmise high percentages of recanalization. Analysing the theoretic parameters of the thermic endoluminal behaviour applied on different saphenous thicknesses, we wanted to try a fiber (1000ìm) connected to a laser 808 nm laser (Eufoton Trieste, Italy) and we analysed, histologically, the damage. The 808 nm radiation has a fairly scarce selectivity on the hemoglobins, while the peak incandescience determines the thermodynamic ,conductor, and photothermic effects.These effects raise the endovasal temperature through blood vaporization, so they coagulate the longitudinal segmentum (3 mm) of the venous wall at direct contact with the fiber (1-2 sec) in vasa with the diameter till 10 mm and with a parietal thickness of 1.0 – 1.2mm. The effect is far less efficacious on bigger thickness of 1.5mm, (young age of the varico) and at the same condition of thermic penetration. Viceversa, on velamentous walls of 0.5mm (old) it is easy to show the perforation, caused by the damage, beyond the vasal wrapping.In vasa with diameters bigger than 12mm, the heat can not spread all over the internal parietal circumference, hence, the endosclerosis could result to be incomplete. Besides, the venous wall is scarce of chromophores, so it is partially transparent at 808nm. As a consequence we have experimented on segmenta of stripping saphenae, dying with exogen chromophores (Blue Metilene, Green Indocianin). This experiment, speeding and uniting the thermic intraparietal distribution, has limited the thermia inside the medium, with a little extravasal propagation, so it

Abstracts would safeguard the nervous perivenous structures.The reflection on these data induces us to estimate the endo photosclerosis on the anterior saphenae after the crossectomy, on the reticular and collateral varicos. The methodology, after the crossectomy, has the advantage of letting only the inguinal lesion without bleeding, haematoma and lymphatic damage. The reticular varicos find indication in the cases which are resistant to the sclerotherapy or when in this therapy there remains pigments, matting, allergies. The study has been ongoing for 10 months (Fluences 10-12W cw, 3-5mm/sec) on a small omogeneous casistic: (elderly people, slim, not under homonal therapy) and this analysis is showing good results with neither complications nor recidivists.

33 TRANSILLUMINATION AND LASER-ASSISTED APPROPRIATE SAPHENOUS SURGERY L. Corcos°, D. De Anna°°, L. Longo°°°; University of San Marino/Ferrara°, Udine°° and Siena°°°. Italy OBJECTIVE. To underline that flush ligationinterruption is the essential condition for the appropriate surgical treatment of the incompetent long saphenous veins (LSV). To describe the appropriate use of transillumination combined with endovascular laser treatment (EVL) of the incompetent LSV. MATERIALS AND METHODS. 20 patients (24 limbs) selected by noninvasive examinations underwent the following procedure: preoperative mapping, local (13 limbs) and spinal (11 limbs) anestesia, cannulation of the LSV below the knee by a fiber-optic probe n. 18 G., LSV flush ligation-interruption by a short inguinal incision guided by transillumination, pulsed laser emission every 2 cm. with 10-16 W. while retracting the probe. An 810 nm. Diode Laser was used. In 16/24 limbs micro-phlebectomies were performed. RESULTS. Percutaneous approach below the knee: 18/24. Length of the inguinal incision: mean 10,2 mm. LSV operating time: mean 18,4 m’. Hospitalization; mean 8,4 hours. Healing time: mean 3 days. Haematomas 0. Ecchimosis 3/24. Moderate pain: 4/24. Cosmetic results 24. In 3/24 limbs short LSV segments were not completely occluded. No residual reflux was detected in all the limbs (2-5 months follow-up). CONCLUSIONS. Transillumination leads to a minimal inguinal approach to the LSV junction, makes possible a proper flush ligation and shortens the operating time. The 810 nm. Diode Laser leads to an adequate vein wall fibrosis. The method seems to be less traumatic than traditional stripping and more radical than EVL alone.

34 TREATMENT OF ANGIOMAS AND TELANGIECTASIAS J. Kubota, MD; Director, Japan Photo Therapy Laboratories and Total Beauty Clinic, Tokyo, Japan BACKGROUND: Vascular lesions still present a major problem, and the search for a good treatment continues. The use of inappropriate treatment methods, can occasionally cause unwanted side effects. Even when

Abstracts

A13

the method used is appropriate, the result can be disappointing. It is important to choose an appropriate laser, and where laser treatment is not effective, we must select the most appropriate conventional treatment or combination of treatments.

tissue could be extracted from fluorescence spectra of tissue with the aid of fluorescence and relevant multivariate techniques. Furthermore the relative contribution and corresponding spectra of fluorophores could be determined.

MATERIALS & METHODS: My treatment programme is as follows; a 532 nm diode laser is the first choice for telangiectasias; the flashlamp-pumped dye laser for port wine stains and strawberry marks; and the Nd:YAG laser with a cooling device for 1∼3 mm leg veins of the reticular and web type. For leg veins over 3 mm, surgery is required.

DISCUSSION & CONCLUSION. Fluorescence might provide insight into the spectral features that are responsible for absence or presence of disease in tissue. Fluorescence excitation-emission matrices provides more information for tissue optical characterization.

RESULTS: The diode pumped 532 nm laser is excellent for superficial telangiectasias. Good effects with the pulsed dye laser are limited to vessels in the upper layers of the dermis, thus the penetration depth of the laser must thus be optimised combined with epidermal cooling. DISCUSSION & CONCLUSION: We must always avoid side effects in laser treatment of vascular lesions. Development of new wavelengths and adaptation of existing wavelengths are currently being investigated, in combination with a mandatory efficient epidermal cooling device. Further improvements in both equipment and techniques are expected to give even better results.

ROLE OF IPL AND LASER IN THE TREATMENT OF THE TELANGIECTASES

References 1. I.Georgakoudi, B.C.Jacobson et al. Cancer Research, 62, 682-687, 2002. 2. A.Vaitkuviene, E.Auksorius, V.Gavriushin, J.Vaitkus, ’’Chemometrical analysis of endometrial tissue fluorescence spectra,’’ Proc. SPIE (in print).

36 LIF CHEMOMETRIAL ANALYSIS OF MUCOUS FOR CERVICAL MATURATION MONITORING IN PREGNANCY A. Vaitkuviene, D.Ramasauskaite, A.Smilgeviciute, O.Tamasauskas, R.Vanceviciute, D.Veleckas; Institute of Materials Science and Applied Research, Vilnius University; * Vilnius City Clinical Hospital, Vilnius, Lithuania

ABSTRACT NOT SUPPLIED

BACKGROUND: Cervical maturation conventionally is evaluated by manual examination (Bishop score) and sonography. Chemometrical analysis of cervical mucous has potention to become next objective method of cervical maturation monitoring.

35 MULTIVARIATE ANALYSIS OF FLUORESCENCE EXCITATION EMISSION MATRICES OF ENDOMETRIAL TISSUE

PURPOSE. It is proposed to evaluate the changes in cervical mucous at 28 – 30 weeks of pregnancy and delivery by method sensitive to molecular structure of mucous.

A.Vaitkuviene 1, E. Auksorius 1, 2, S. Juodkazis 1, 3, H.Misawa 3, J. Vaitkus 1, 2; 1 Institute of Materials Science and Applied Research, 2 Faculty of Physics, Vilnius University, Vilnius, Lithuania; 3 Dept. Ecosystem Engineering, University of Tokushima, Tokushima, Japan BACKGROUND: Fluorescence of human tissue and exogenous dyes injected into body has been widely used for diagnosing and treating disease. It is important to determine biochemicals giving rise to overall tissue fluorescence and get information about the tissue . Purpose. The tissue fluorescence was quantitatively analysed to understand the relative contribution of fluorophores. MATERIALS & METHODS. Fluorescence excitationemission matrices from 200 to 500 nm and 200 to 800 nm were measured, respectively, in addition to our previous measurements to characterize biochemicals quantitatively in endometrial tissue . Multivariate curve resolution algorithm was used to resolve spectra of biochemicals and to determine their relative contribution. RESULTS. It was shown the spectra underlying features, such as the number of fluorophores presented in

Material and methods: Transvaginal sonographic assessment of cervical lenght and light induced fluorescence spectra chemometrical analysis were performed in pregnancy and delivery. LED 375 nm and hydrogenium lamp 312 nm exitation induced fluorescence chemometrical analysis of cervical mucus were used. RESULTS: Pure collagen fluorescence peak shift and amplitude change were observed during maturation of the cervix. The additional components of fluorescence spectrum were found. DISCUSSION & CONCLUSIONS: Chemometrical markers of cervical maturation are in concordance with conventional methods. LIF monitoring of the cervix in pregnancy would be offered as next quantitative method for on site investigation.

37 AMNIOTIC FLUID LIF SPECTROPHOTOMETRIC ANALYSIS AND LAMELLAR BODY COUNT FOR PREDICTION OF FETAL LUNG MATURITY Ramasauskaite D., Vaitkuviene A; Vilnius University Hospital, Vilnius – Lithuania

A14 BACKGROUND: Measuring optical absorbance of amniotic fluid at a wave length of 650 nm is conventional test for fetal lung maturity.Lamellar body count is the screening method for this purpose.These methods can′t be used when amniotic fluid specimens are collected by vaginal pool method and are contaminated with gross blood,meconium or mucous.In these cases light induced fluorescence (LIF) spectrophotometricy could be used. PURPOSE: To compare lamellar body counts (LBC) with amniotic fluid spectrophotometric analysis of assessment of risk of respiratory distress syndrome(RDS). MATERIALS & METHODS: :Amniotic fluid specimens were analyzed for maturity using two tests: LBC (Sysmex K- 1000) and LIF spectrophotometricy.Amniotic fluid specimens were evaluated by exitation of hydrogenium lamp at 360 nm and LED at 375 and 350 nm. RESULTS: By exitation of 375 nm no fluorescence was measured.360 nm exitation revealed fluorescence in diapasone of 350 – 600 nm with significant diference in spectral shape and amplitude of mature and not mature amniotic fluid. Maturity is suggested by acount of LBC more than 50000/µl. Discussion & conclusion: LED (ex.350nm) is an acceptable method to fetal lung maturity evaluation together with LBC .LIF has potential to be useful for on site investigation in perinatology. 38 LASER TREATMENT IN DAY SURGERY N.F. Mortellaro *, M. Veroux *, P.F. Veroux *, N . Mortellaro **; *Dept. Of Surgical Sciences, Catania University; ** Service of Laser –Day Surgery, Ascoli-Tomaselli Hospital, Catania Since the 60s there appeared the first hospital structures which began to offer surgical services in Day Surgery, in which the patients were recovered, they underwent to surgical operations and were discharged in one day time. The aims were the reduction of the patients’ discomforts, of the waiting list and of the costs. The use of laser instrumentation in surgery in D.S., in 20 years of our experience, confirms the fact that many pathologies can be treated by laser, with undoubted advantages both for the surgeon and for the patient. Instead of the classic bistoury, the surgeon could use a light band that, thanks to its properties,could accelerate and sometimes simplify the surgical operation to be carried out. The main property of the surgical laser is to concentrate a great energy density which can make removals, destructions, photocoagulations and cuttings of the biological tissues. Our surgical casistics include the use of CO2 laser, Nd-YAG and Argon. METHODS: The main points of lasersurgery in D.S. are: Detection of the pathology to be treated. Accurate selection of the patients. Carrying out of routine’s analysis.

Abstracts Local and block anesthesia. Antibiotic prophylaxis. RESULTS: The operative simplicity, the reduction of surgical times, a more rapid healing of the surgical wounds, the poor edema and the scant post-surgical pain allow us to confirm that the surgical lasers should deserve an important role in surgery room.

39 DEVELOPMENT OF A PHOTODINAMIC THERAPY (PDT) LAMP SOURCE FOR TREATMENT OF ANAL INTRAEPITHELIAL NEOPLASIA J.Makaryeva, M.Padgett*; Vilnius University, * Glasgow University, UK Photodynamic therapy (PDT) is a method of cancer treatment involving application of a drug which causes cancerous and pre-cancerous tissue to become sensitive to light, followed by illumination of the area with a suitable light source, causing destruction of the cancer. In this work we developed a photodynamic therapy (PDT) light source for a treatment of anal intraepithelial neoplasia (AIN). Filtered light source emission spectrum is well matched to the strongest absorption peak of the Protoporphyrin IX (at 405 nm). Light from the light source is coupled into a well designed in size and shape light delivery insert for AIN treatment. Further analysis of a light delivery insert provided treatment area and intensity suitable for PDT of AIN in a clinical environment. With the mirror placed at an angle of about 50 degrees we have a treatment area of 2 cm in a diameter and the power of 7 mW/cm2. Rotation of the light delivery insert allows to choose a direct treatment area and by pushing it in and out we have also had a depth control. The next step of the research is in vivo experiments in a hospital.

40 BIOCOMPATIBLE METALLIC STENT FOR MEDICAL THERAPY Y. P. Kathuria; Faculty of Science and Engineering, Ritsumeikan University, Kusatsu-shi Japan In medicine, coronary artery obstruction is a major problem, which leads to complicate problems of hammorage eventually leading to bypass surgery. In order to treat this coronary artery obstruction, usually a standard angioplasty technique is applied. But its clinical efficacy is limited by acute vessel occlusion and restenosis problems in the first six months. To reduce these deficiencies a new clinical therapy has been introduced with the implantation of metallic cardiovascular stent with adequate radio opacity. Metallic stent is typically a hollow cylindrical tube with a patterned slit structure in two or three segments. It controls the flow of blood in the damaged vessel, thus avoiding it from being ruptured. The study shows that stent geometry i.e. diameter and mesh density produced with different porosities, defined as a percentage of metal free unit area per total unit area of the stent are most important for long term successful results. Typically the porosity varies between 76 % to 85% values and actually offers regulatory resistance to the blood flow in the vessel. These mesh / fine slit structures can easily be created

Abstracts with the application of laser technology. Various biomaterials such as stainless steel, titanium and tantalum alloys have been used for such applications. Fig.1 shows the block diagram and the actual section of a laser generated metallic stent using pulsed Nd-YAG laser. It consists of three / four segmented parts, connected via bridges with a total length of about 20mm. By dividing the stent into three / four segments, it provides high flexibility. The metallic body of the stent show a good x-rays visibility of the device under the angioplastic control. As processed sample is not free from dross, spatter and corrosion etc. It is therefore essential to make the product completely free from dross with improved properties against the wear and corrosion before its actual implantation in the body. To overcome the dross / spatter problem we find that during the post processing, the soft etching method shall yields the most effective results. In this method all the hydrogen containing etching products i.e. HCL, H2SO4 and HNO3 must be avoided, because of hydrogen brittleness with the test materials. Therefore the best results are obtained for electrochemical etching with a weak acid that does not contain hydrogen (FeCl3). As such the metallic stent (SUS316L) has good mechanical properties but possess the lowest corrosion resistance. The in vitro corrosion of the stainless steel in the physiological solution show the presence of toxic ions such as Cr, Ni and Mo etc with the toxicity in the following order Cr6+ > Mo6+ = Fe3+ > Co2+ > Ni2+. Whereas the wear of the stainless steel is responsible for the accumulation of the debris around the implant. It is therefore essential to improve the stent against the wear and corrosion properties, which is usually done by the ion implantation technique. This produces the microstructural defects and become responsible for improved wear and corrosion resistance. Recently nuclear irradiation and fluorinated polymer coating as post processing techniques has been found much beneficial for the increased life and the biocompatibility of the invitro stent.

41 A LASER-SCANNING ENDOSCOPE BASED ON POLYSILICON MICROMACHINED MIRRORS N.G. Theofanous1, M. George4, P.G. Papageorgas 1, H. Álbrecht2, U. Hofmann3, D. Maroulis1, M. Schurr4, A. Menciassi5, C. Depeursinge6; 1. University of Athens, Dep. of Informatics and Telecommunications, Panepistimiopolis,Athens, Greece ; 2. Laser- and Medical-Technology GmbH (LMTB), Berlin, Germany; 3 . Fraunhofer Institute of Silicon Technology (ISIT), Itzehoe, Germany; 4. Eberhard-Karls-University of Tuebingen, Sec. for Minimal Invasive Surgery, Tuebingen, Germany; 5. Scuola Superiore Sant’Anna, ARTS & MiTech Lab. Pisa Italy; 6. Swiss Federal Institute of Technology (EPFL), Institute of Applied Optics, CH-Ecublens, Lausanne, Switzerland Usual endoscopic systems provide a continuous vision and a direct optical monitoring of otherwise inaccessible regions during medical operations or diagnosis procedures. This straightforward vision is valuable for having direct information on the state of the targeted tissue. For this reason, a large amount of experimental/technical and clinical work has been already carried out in the construction and improve-

A15 ment of such endoscopic systems. Purely optical methods are suited to visualize with these endoscopes different tissue states and often make use of laser illumination to produce diagnostic fluorescence in deep-seated tumors. A laser-scanning endoscope device of this type has been developed aiming to provide superior resolution and chromatic representation in comparison with the above endoscopes. The scanning operation of the laser beams used in this endoscope device relies on tinny microelectromechanical (MEMS) silicon mirrors. One major advantage of the microscanning endoscope system proved to be the high resolution achieved, that is in the order of 50 êm combined with robustness and simplicity in the design of the endoscope head. A second advantage comes from the scanning technique that uses laser sources for illumination with optical powers being order of magnitudes smaller than the ones used in the ordinary endoscopes thus reducing substantially the system cost.

42 HAEMORROIDECTOMY IN DAY-SURGERY N.F Mortellaro.*, M Veroux.*, P. F Veroux.*, P Cardillo.*, N Mortellaro.**, E.G. Pennisi **; *Department of Surgery Sciences, Transplant and Advanced Technologies, Az. Polyclinic University of Catania. ** Service Laser-Surgery – Day Surgery, Az. Hosp. Garibaldi P.O. Ascoli Catania Since the 60s there appeared the first hospital structures which began to offer surgical services in Day Surgery, in which the patients were recovered, they underwent to surgical operations and were discharged in one day time . The aims were the reduction of the patients’ discomforts, of the waiting list and of the costs. The use of laser instrumentation in surgery in D.S., in 20 years of our experience, confirms the fact that many pathologies can be treated by laser, with undoubted advantages both for the surgeon and for the patient. Instead of the classic bistoury, the surgeon could use a light band that, thanks to its properties,could accelerate and sometimes simplify the surgical operation to be carried out. The main property of the surgical laser is to concentrate a great energy density which can make removals, destructions, photocoagulations and cuttings of the biological tissues. Our surgical casistics include the use of CO2 laser, Nd-YAG and Argon. METHODS: The main points of lasersurgery in D.S. are: Detection of the pathology to be treated, Accurate selection of the patients, Carrying out of routine’s analysis, Local and block anesthesia, Antibiotic prophylaxis. RESULTS: The operative simplicity, the reduction of surgical times, a more rapid healing of the surgical wounds, the poor edema and the scant post-surgical pain allow us to confirm that the surgical lasers should deserve an important role in surgery room.

A16 We have different surgical techniques employed for haemorroid treatment. The therapeutic aim is the ablation of the pathogenic tissue (internal or external emorroid with possible mucosal prolapse) without provoking sphinteric alterations. With Day Surgery, the haemorroidectomia’s operation has been included in those operations carried out in the so-called daily surgery and so the patients, after a short time recovery, have been discharged from the hospital. Nevertheless, the surgical problem of emorroidectomia in D.S. depends mainly on four factors: Type of anesthesia; Length of the surgical operation; Accurate hemostasis; Post-surgical pain. The use of laser instrumentation has remarkably modified the surgical and post-surgical iter in the treatment of the emorroid pathology. Hence, the operative characterstics of the surgical lasers allow and assure: Reduction of surgical times Perfect hemostasis, Very scant or absent post-surgical edema Poorest post-surgical pain. Most rapid healing without cicatrial retraction Prompt resuming of the working activity

43 PERCUTANEOUS LASER DISC DECOMPRESSION (PLDD) DSJ Choy, MD; Columbus University, New York One of the early applications of laser to medical/ surgical problems was by Ascher and Choy in 1986 when the first percutaneous laser disc decompression (PLDD) was performed at the University of Graz with success. The preliminary laboratory and basic science work was performed at the St. Luke’s Hospital, Columbia University, from 1984 to 1986. PLDD is based on the noncompressibility of water. Water is the major component of the intervertebral disc nucleus. In herniated disc disease (HNP), the disc protrusion presses against the nerve root, causing pain. A Nd:YAG laser (the optimal laser for PLDD) introduced via a needle inserted into the disc under X-ray guidance and with local anesthesia, is able to vaporize a small volume of the nucleus pulposus, resulting in an immediate disc shrinkage, with relief of pressure on the nerve root. Most patients get off the table pain free. Over 35,000 cases have been done worldwide, with a success rate of 85-90% and a complication rate of 1%. The recurrence rate has been 5%. Compared to traditional open surgery, which is 68 years old, PLDD is simple, requires no general anesthesia, no hospitalization, is more effective, has a lower complication rate, and has a short recovery time. Most patients are back at work in 4 to 5 days.

44 - 45 VIBRATIONAL ANALYSIS OF TENDONS MECHANICAL PROPRIETIES G.M. Revel 1, A. Scalise 2, L. Scalise 1, E.P. Tomasini 1; 1 Dipartimento Di Meccanica - Universita` Degli Studi Di Ancona, Ancona, Italy; 2 Clinica Di Chirurgia Plastica E Ricostruttiva – Universita` Degli Studi Di Ancona, Ancona, Italy

Abstracts BACKGROUND: The in-vitro measurement of mechanical properties of tendons has been from several years object of many studies reported in literature. In fact, the possibility of experimentally determining these properties can be of great help to improve understanding on the in-vivo behavior of these particular structures and, as a consequence, to increase the efficiency in the clinical treatment of tendon pathologies, as traumas, inflammation or metabolic problems (diabetes or arthritis). Vibrational characteristics of tendons can be investigated together with the traditional mechanical parameters such as load and deformation and the results can be usefully correlated. In literature some investigations have been performed in order to study how the Achilles tendon vibrations influence the response of the muscle propioception and human posture. PURPOSE. In the present work the experimental procedure has been further updated with a measurement technique for the non-invasive determination of tendon cross-sectional area during tensile vibration tests at different load levels. The measurement techniques is based on a triangulation sensors moved around the tendon in such a way as to determine its perimeter. From the perimeter, the area can be easily extracted by integration. At each load level, resonance frequency, damping, area and tensile force are measured, allowing thus a complete mechanical characterization of the tendon. MATERIALS & METHODS. Structural properties (load, deformation) are recorded in order to have the possibility to calculate mechanical properties (stress, strain, Young’s modulus), independent from specimen size or shape. Our test bench has been designed with the aim to measure the following data: Load applied to the specimen. Specimen elongation. Specimen transversal area. Specimen vibrational behavior. Specimen initial dimension. Four tendon calcaneus communis from two young rabbits (15 and 16 weeks; 2.85 – 2.95 Kg) have been used in this study. Samples are dissected from the hindlimbs cleaning all extraneous soft and hard tissue. The tendon testing machine (TTM) – see figure 1 - consists of a device to apply known stress and strain to the tendon under controlled conditions. The main body of the machine is composed of a rigid and heavy structure, where the clamps and the driven displacement screw are fixed . The lower clamp is fixed on the machine base and inserted into a cuvette, with an hole in the bottom, containing physiologic solution. The upper clamp is connected to the force transducer (Working range: 0 –200 kg; Sensitivity: 2mV/kg; Accuracy: 0.1% at 200 kg) with preamplifier incorporated for optimal signal conditioning. The load cell is connected to the driven displacement screw. Two precision levels (1 cm/turn and 1mm/turn) can be manually controlled. Driven screw displacement is measured continuously by a laser triangulation displacement transducer (range ±8mm, resolution 0.5 êm). Loaded and unloaded cross-sectional areas in the middle region of the sample are determined in the measurement set up by a non-contact optical gauge. Tendon vibration analysis has been carried out exciting the specimen by the use of a small hammer. This kind of excitation device is chosen because it could be also suitable for in-vivo tests. A single point laser Doppler

Abstracts vibrometer (measurement range: 1-100 mms-1), set perpendicular to the specimen, measures the vibrational velocity on the tendon RESULTS: The vibration amplitudes may be different for the different tests, as no control was given on the applied impulse. The only utilised requirement was to have at least 2-3 vibration cycles, in such a way as to not prevent the possibility of measuring the resonance frequency. However, it should be considered that this might introduce uncertainty in the resonance frequency measurement. In fact, since the tendons have strongly non-linear behaviour, their resonance frequencies change with the excitation force amplitude and, in addition, may change slightly also during the single measured transient vibration. This problem is more relevant while measuring the resonance frequencies in the low range of applied loads, as the vibration is strongly dumped and thus the determination of the frequency peak more difficult, as the peak is significantly wider. The influence of that was taken into account by estimating the standard variation of the first natural frequencies in the 15 tests performed at each stress level. This value gives an estimate of the measurement repeatability and will be reported in the frequency diagrams as error bars around the mean values, computed averaging on 15 consecutive measurements. These tests are in agreement also with the results previously found by authors in , where the feasibility of an approach based on load-frequency curves was demonstrated, with the final aim of exporting the procedure for in-vivo experiments. However, in this present work an important new step is introduced, which is the possibility of measuring at each load level the cross-sectional area, thus allowing the computation of the actual stress in the tendon. DISCUSSION & CONCLUSION: The possibility to realise a measurement test machine for the determination of mechanical proprieties of tendons is demonstrated in the present work. A completely non-contact methodology has been designed and applied allowing high repeatability and precision. Particular attention has been dedicated in the definition of such crosssection area measurement. Moreover authors demonstrate as first resonance frequency as well as damping values are function of stress level. In particular first resonance appears to be a valid parameter for the in-vivo measurement of some physiological characteristics of tendons.

46 SCIENTIFIC BASIS OF PHOTODYNAMIC THERAPY Harry Moseley; The Photobiology Unit, University of Dundee, Ninewells Hospital & Medical School, Dundee DD1 9SY, United Kingdom Photodynamic therapy (PDT) involves the use of a photoactive drug (photosensitiser) and light. Upon absorption of light, the photosensitiser initiates oxygen-mediated chemical reactions that lead to the direct or indirect production of species such as singlet oxygen that cause cell death. The reaction of the cytotoxic species with subcellular organelles and molecules such as proteins and DNA lead to apoptosis or necrosis of the cells hosting the photosenstiser. Pref-

A17 erential accumulation of photosensitiser in cancer cells means that, as an anti-cancer treatment, this has the potential to kill selectively the tumour cells while leaving healthy cells undamaged. Photodynamic mechanisms proceed from the first excited singlet state (S1) via either Type I or Type II mechanism. A Type I reaction involves the photosensitiser losing an electron to form a radical cation, typically reacting with oxygen to form superoxide and hydroxyl radicals. In a Type II reaction, the sensitiser relaxes into the first excited triplet state (T1) which interacts with oxygen to form singlet oxygen. The species produced are very reactive and can cause cell death by either apoptosis or necrosis. Cells membranes are a primary site of action. Functional impairment of mitchondria is also observed. Moreover, PDT can result in damage to DNA. Choice of light source depends on the photosensitiser and site of lesion. The common photosensitisers are di-haematoporphyrin esters and ethers (Photofrin), meta-taetrahydroxyphenylchlorin (m-THPC, Foscan), benzoporphyrin derivative (Visudyne) and 5-aminolaevulinic acid (ALA, Levulan) which converts into protoporphyrin IX (PPIX). Historically, lasers have been used, in particular dye lasers. These tend to be unreliable, requiring considerable technical support. Diode lasers are now available. These are compact, high output and reliable, and are ideally suited to PDT treatment of systemic cancer. For superifical skin and oral cavity cancer, non-laser sources may be used. These include tungsten filament quartz halogen lamps, xenon arc lamps, metal halide lamps, fluorescent lamps and light emitting diodes (LEDs). There has been renewed interest in clinical applications of PDT. This has led to the establishment of new centres such as the Scottish Photo Dynamic Centre, as well as other more established centres. These are strategically important for the development of the technique, since they combine medical and scientific interests to meet the challenges of providing high quality patient care based on sound scientific principles.

47 QUALITY EVALUATION OF LASER MEDICAL APPLICATIONS M. Dal Maso, MD; Florence University Laser surgery is a standard operating procedure for many specialists in cardiology, dermatology, gynecology, neurosurgery, ophthalmology, orthopedics and many others. Innovative technologies have dramatically reduced the risk/benefit ratios of health care. These reductions have led to marked growths in health care utilization resulting in the spiraling increases in health care costs. With innovative technologies, the question regarding health care delivery has changed from ’’can it be done?’’ to ’’should it be done?’’ Physicians do not currently have enaugh the information necessary to answer this question. Quality of care issues must replace risk/benefit ratios as the new paradigm for a physician’s ordering of health care delivery. Quality of care issues include: medical indication, minimizing risks, cost efficiency and patient

A18 satisfaction. Much of health care delivered today lacks the warrantedness and efficacy components of medical indication making it unnecessary. New and, as yet, undeveloped information systems must provide information on all quality of care issues to physicians so appropriate decisions regarding health care delivery can be made. With this information, quality of care will improve and large portions of current health care delivery will be found unnecessary or nonessential. Consequently, information systems can serve to control health care costs and to improve quality of health care. The role of technology in the cost of health care is a primary issue in current debates concerning national health care reform. The broad scope of studies for understanding technological impacts in health is known as health care technology assessment. HCTA is the systematic evaluation of the properties, impacts, and other attributes of health care technologies, including: technical performance, clinical safety and efficacy/effectiveness, cost-effectiveness and other economic attributes, appropriate circumstances/indications for use, and social, legal, ethical, and political impacts. The main purpose of HCTA is to inform technology-related policy making in health care. Making the best use of new and old technology requires better-informed health care decisions, which can help to counter the market imperfections. Costeffectiveness analysis is presented as one way to assist decisions that must consider the effect of limited resources. Another approach – medical effectiveness derives from the lack of knowledge about the impact on patient outcomes of many treatments delivered for specific conditions under the average conditions of care in the community. The evaluation of new and old technologies – including all the information and communication technology systems (ICT) - is required to improve the patient outcomes and productivity in every the sanitary system.

48 PHOTOSELECTIVE VAPORIZATION OF THE PROSTATE: LONG-TERM EXPERIENCE WITH HIGH POWER KTP LASER Reza S. Malek; Mayo Clinic, Rochester, MN BACKGROUND: Photoselective Vaporization of the prostate (PVP) utilizes potassium titanyl phosphate (KTP) laser energy whose photons at 532 nm wavelength are selectively absorbed by hemoglobin with shallow penetration of only 800 êm. Because of these properties, thermal energy is confined in a small volume of superficial tissue which is rapidly removed by vaporization of cellular water leaving only 1-2 mm rim of coagulation. PURPOSE: A video demonstration of the scientific background, technique of prostatic resection, and immediate postoperative outcome with high power KTP laser PVP is presented. Long-term outcome is discussed. MATERIAL & METHODS: Transurethral noncontact PVP was performed under general anesthesia with high power (60 to 80 W) KTP laser in 71 men with obstructive benign prostatic hyperplasia (BPH). Mean prostatic volume was 43 ml. Mean lasing time was 46

Abstracts min. during which a TURP-like cavity was created easily, with minimal or no blood loss and no fluid absorption. All 71 men were outpatients and became catheter-free in less than 24 hours. None required bladder irrigation, blood transfusion, or recatheterization. RESULTS: Preoperative mean AUA symptom score was 22. Postoperatively, at 3, 6, 12, 24, and 36 months respectively, it improved significantly* to 5.3, 4.2, 3.9, 3.6, and 3.6. Similarly, preoperative mean Qmax of 7.8 ml/s improved significantly* to 27.7, 26.9, 27.3, 26.2, and 23.3 respectively, at same postoperative intervals. Approximate sustained improvements in mean AUA symptom score and mean Qmax were 80% and 200%, respectively. Four patients (6%) had mild dysuria for 2 weeks requiring no treatment, two (3%) had delayed hematuria, and one (2%) had a bladder neck stenosis dilated but none had incontinence, newly developed impotence, or required reoperation. Throughout the follow-up, 90% of the patients remain very satisfied and 10% are satisfied with their outcome with a mean quality of life score of 0.29 at 3 years; up to 27% have experienced retrograde ejaculation. (*P<0.001) DISCUSSION & CONCLUSION: Technically, PVP is easy to perform. It produces rapid, safe, and effective relief from obstructive BPH with minimal morbidity. Thus far, significant improvements have been achieved and sustained without deterioration over several years of observation. PVP compares favorably with standard TURP.

49 PDT OF PROSTATE CANCER BY MEANS OF 5-ALA-INDUCED PPIX-IN-VIVO EXPERIMENTS ON THE DUNNING RAT TUMOR MODEL HofstetterT A., SrokaT R., StockerT S., Knüchel_ R., ZaakT D; T Department of Urology and Laser-Research-Laboratory, Ludwig_Maximilians-University, Munich, Germany; _ Institute of Pathology, University of Regensburg, Germany PURPOSE: In order to expand the use of photodynamic therapy (PDT) in the treatment of prostate carcinoma (PCA), the aim of this study was to evaluate PDT by means of 5-aminolevulinic acid (5-ALA)induced protoporphyrin IX (PPIX) in an in-vivo tumor model. MATERIALS & METHODS: The model used was the Dunning R3327 tumor. First of all, the pharmacokinetics and the localization of PPIX were obtained using fluorescence measurement techniques. Thereafter, PDT using 150mg 5-ALA/kg b.w. i.v. was performed by homogenous irradiation of the photosensitized tunor (diode laser λ=633nm). The tumors were resected 2 days post PDT and the extent of the necrosis was determined histopathologically. RESULTS: The kinetics of PPIX fluorescence revealed a maximum intensity in the tumor tissue within 3h and 4.5h post application of 5-ALA. At this time specific PPIX-fluorescence could be localized selectively in the tumor cells. The PDT induced necrosis (n=18) was determined to be 94% +- 12% (range: 60-100%) while the necrosis of the controls (n=12) differs significantly (p<0.01), being less than 10%.

Abstracts CONCLUSIONS: These first in-vivo results demonstrate the effective potential of 5-ALA-mediated PDT on prostate carcinoma in an animal model.

50 HOLMIUM LASER ENDOURETHRECTOMY FOR TREATMENT OF URETHRAL STRICTURES G.B. Muraro M.D., Grifoni R. M.D; Italian National Research Center of Ageing (INRCA), Department of Urology INTRODUCTION: Treating urethral strictures is one of the oldest problems in urologic patients. Endoscopy might be proposed reasonably for cases of multiple recurrences or for long, extensive stenoses. Yet, the recurrence rate is unaccettable. Presumably for the presence of residual scar tissue not fully removed. The Holaser in a relatively new multi purpose medical laser that has been recently used in many types of urological procedures. In this study we report its application in the treatment of urethral stricture disease. MATERIALS & METHODS: From January 2000 to December 2001 54 male patients age-ranged between 48 and 81, were enrolled according on the basis of retrograde and micturating uretrocystogram, uretroscopy and uroflowmetry. Patiens underwent uretrotomy using Ho laser fiber of 550ê at 1.2-1,8 Jaule of energy with a power of 10-30 Hz. 20 strictures were of the anterior uretra (16 bulbar and 4 penile) and 34 of the posterior uretra, the lenght of the stenotic tract was between 0,4 and 2,5 cm. The bare-end firing laser fiber was placed in direct contact with the tissue and a full-thickness linear incision was made through the tissue within a normal timeframe at either end. After the procedure was performed and indwelling Foley catheter was placed for 24 hrs. The mean duration of hospital staying was 24 hrs. All patients fully recovered, without showing any obstructive symptoms urinatying. At 12-24 months follow-up additional procedures were required only in 10 patients (26.3%). CONCLUSION: There is no consensus on the most appriopate treatment of recurrence strictures. Laser incision and vaporization of scarred tissue is reported to avoid this sequelae. Our study shows that Ho laser urethrotomy is a feasible safe and effective option for patients of obliterative urethral strictures. The shorter hospital staying, less discomfort, minimal mobility, early return to work and the absence of blood transfusion are obvious advantages.

51 LASER TREATMENT OF BPH R. Waidelich1, R. Muschter2, A. Hofstetter1; Department of Urology, University of Munich1 and Diakoniekkrankenhaus Rotenburg2, Germany The term ’’laser treatment of BPH’’ summarizes a variety of techniques using different laser wavelengths, application systems and surgical techniques to achieve contrasting tissue effects such as incision, resection, vaporization, or coagulation.

A19 Laser procedures being relevant in clinical use are: transurethral laser coagulation, interstitial laser coagulation, transurethral laser vaporization, and transurethral laser resection or enucleation. We discuss principles of laser physics relevant for these procedures and present results of clinical studies performed in our institutions as well as a metaanalysis of the literature. 52 MONOCHROMATIC LIGHT - A NEW, NON INVASIVE TREATMENT FOR ERECTILE DYSFUNCTION: A PLACEBO-CONTROLLED, SINGLE BLINDED PILOT STUDY Y. Yacobi M.D., A. Sidi M.D; Department of Urologic Surgery, The Wolfson Medical Center, Holon, Israel BACKGROUND: In vitro and animal studies have shown that the application of monochromatic light may induce vasorelaxation, which is the event to produce penile erection. The hypothesis was that application of monochromatic light (ML) to the vascular bed of the penis might restore erectile function. Purpose: To prove this hypothesis, a specifically designed device, emitting monochromatic light, was externally applied to the penis of patients with ED. This study has been conducted to prove the efficacy and safety of ML for the treatment of ED. MATERIALS & METHODS: 44 volunteers were randomly assigned to treatment with placebo or monochromatic light. 39 patients completed all treatments and follow up visit: 18 patients in the treatment group (A) and 21 in the placebo group (B). The treatments were delivered for 19 minutes, twice a week, total of 6 treatment sessions. The treatment parameters were: ML – 808nm, power – 150 mW. Questions 3 and 4, as well as the Erectile Function Domain from the International Index of Erectile Function (IIEF) assessed the improvement in ED. RESULTS: The baseline median values for questions 3 and 4 were identical in both groups - 2.0. In group B the median remained 2.0 after the treatment for question 3 and 4 while in group A it increased by 1.5 to 3.5 (for question 3 - p=0.0536; for question 4 - p=0.03). Median Erectile Function domain score (question 1-5 and 15) was 14 in group B and decreased to 12. In group A baseline score was 13 and it increased to 20.5 after treatment (p=0.02). Many patients in the treatment group reported occurrence of morning erections. Improvements were usually reported after the 4th or 5th treatment sessions. There were no adverse effects as a result of the treatment. DISCUSSION & TREATMENT: The treatment performed by low power laser parameters used in this study had showed improvement in ED. The improvement duration in avarage was of 6 month. Further studies are needed for optimiziation of treating parameters: wavelength and power. 53 LOW TEMPERATURE SOLDER FOR LASER TISSUE WELDING A.Lauto, * LJR Foster, L Poole-Warren; The University of New South Wales, Department of Biochemical Engineering *Department of Biotechnology, Sydney, Australia.

A20 This study investigated the minimum temperature for tissue welding of solid albumin solders. Solder strips comprising two layers (65% albumin, 35% water) were welted onto rectagular sections of dog small intestine by a diode laser (λ= 808 nm). The laser delivered a power of 170 +- 10 mW through an optical fiber (spot size ∼ 1mm) for 100 seconds. A solder layer incorporated also a dye (carbon black, 0.25%) to absorb the laser radiation. A thermocouple recorded the solder temperature at the tissue interface during welding. The repaired tissue was tested for tensile strentgh by a calibrated tensiometer. Solder strips were also immersed in a thermal bath at 55 and 60° C for 100 seconds and solubilized in saline solution to study their solubility. The strips fused on tissue at 55 ≤ T ≤ 62 °C had higher tensile strength than the strips soldered at 51 ≤ T<55 ° C (19.1 +- 6.6 versus 13.1+- 6.4 gmf). The strips were almost insoluble when heated at 60 °C while they solubilized significantly if heated at 55 °C. The solid solder could efficiently weld at 60 °C as it became insoluble and formed stable bonds with tissue. Fluid albumin solders, by contrast, requires temperatures ≥ 70 °C for tissue repair, which cause more irreversible thermal damage. 54 LASER TREATMENT OF BLADDER CARCINOMA WITH THE AID OF FLUORESCENCE ENDOSCOPY Edwin Hungerhuber1, Dirk Zaak1, Ruth Knüchel2, Alfons Hofstetter1; 1Department of Urology, Klinikum GroΒhadern, Ludwig-Maximilians-University of Munich, Germany; 2Institute of Pathology, University of Regensburg, Germany BACKGROUND: The initial encouraging results using 5-aminolevulinic acid (5-ALA) induced fluorescence endoscopy (AFE) have promised a procedure with an outstanding sensitivity for the detection of early stage bladder cancer. PURPOSE: We summarise our clinical experience using this additional detection device together with Nd:YAG laser coagulation in patients with bladder carcinoma. MATERIALS & METHODS: 2-3 h prior to endoscopy, 1.5 g 5-ALA dissolved in 50 ml 5.7% sodium monohydrogenphosphate was instilled intravesically. Prior to AFE, all patients underwent white light endoscopy. A special light source (D-Light; K. Storz GmbH, Tuttlingen, Germany) provided blue light (375-440 nm) for fluorescence excitation. Suspicious sites were identified by their red fluorescence contrasting against backscattered blue light when observed through the long pass filter (445 nm) integrated in the telescope eyepiece. Nd:YAG laser treatment was carried out using 20-40 W.

Abstracts clinically feasible procedure with an outstanding detection rate for flat urothelial high risk lesions. It enables a precise localisation of neoplastic tissue for Nd:YAG laser treatment of bladder carcinoma.

55 PHOTOMODULATION OF CELLULAR AND SUBCELLULAR ACTIVITIES BY HE-NE LASER L. Moro, M. Greco, E. Marra, S. Passarella*; Centro di Studio sui Mitocondri e Metabolismo Energetico, CNR, Bari, Italy *Dipartimento di Scienze Animali, Vegetali e dell’Ambiente, UniversitÀ del Molise, Campobasso, Italy BACKGROUND. In hepatocytes, proliferation of tetraploid and binuclear cells and an increase in cytosolic and mitochondrial protein synthesis are caused by He-Ne laser irradiation. PURPOSE. To gain some insight into the mechanism of photomodulation of cellular and subcellular activities in isolated hepatocytes, intracellular mediators of cell photostimulation were investigated in intact cells and isolated mitochondria. MATERIALS & METHODS: Irradiation of isolated hepatocytes and isolated rat liver mitochondria was carried out with He-Ne laser (wavelength: 632.8 nm; fluence: 0.24 J cm-2; fluence rate: 12 mW cm-2). Changes in cytosolic (c) and mitochondrial (m) calcium concentration, and in mitochondrial ([ [ m) and plasma ([ [ c) membrane potential were monitored using either colorimetric or fluorescent probes. C-fos expression was studied by Northern and immunoblotting analysis. RESULTS: As a result of irradiation, an increase in c and a calcium-dependent increase in [ [ c were found. The increase in c, in turn, caused an increase in c-fos expression. Finally, an increase in m, probably owing to the increase in [ [ m, was found. DISCUSSION & CONCLUSION: Increase in c, leading to activation of gene expression, and a general activation of mitochondrial metabolism, could play a major role in the mechanism of photostimulation of cellular activities by He-Ne laser.

56 PROLIFERATION OF CHICKEN FIBROBLASTS INDUCED BY LIGHT EMITTING DIODES: A COMPARATIVE TRIAL FOR DIFFERENT WAVELENGTHS E. Vinck, B. Cagnie, D. Cambier, H. Declercq, and R. Cornelissen; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium The effectiveness and applicability of a variety of light sources, in the treatment of wounds has thoroughly been investigated, in vitro as well as in vivo.

RESULTS: 120 AFE were carried out in 108 patients. In 101 neoplastic urothelial lesions had been detected, in 19.8% only due to their positive fluorescence. No side effects had been observed due to the laser therapy.

The current commercial availability of Light Emitting Diode (LED) sources therefore also invites research to explore the effect of low power infrared, red and green light on wound healing, e.g. by means of fibroblast proliferation.

DISCUSSION & CONCLUSION: 5-aminolevulinic acid induced fluorescence endoscopy has proven to be a

Therefore a controlled and randomised study on cultured embryonic chicken fibroblasts was conducted.

Abstracts The fibroblasts were irradiated during three consecutive days, at several wavelengths (950 nm, 660 nm and 570 nm) and a respective power output of 160 mW, 80 mW or 10 mW. Treatment duration varied from 1 minute to 3 minutes to obtain a surface energy density of 0.9 J/cm2 (infrared and red light) or 0.2 J/cm2 (green light). Statistical analysis revealed that LED irradiation for all three wavelengths induced a higher rate of proliferation in comparison of the control group. This difference was statistically significant (p<.001). With regard to the amount of proliferation the green probe yielded a significantly higher number of cells, than the red (p<.001) an the infrared probe (p<.001). Furthermore, the red probe provided a higher increase (p<.001) than the IR probe. LED irradiation results in an increased fibroblast proliferation in vitro. This outcome postulates beneficial stimulatory effects of LED at the applied wavelength, energy density and power output on wound healing in vivo. Further investigation is necessary to examine this hypothesis.

57 INFLUENCES OF COPPER VAPOR LASER ON GLYCOSPHINGOLIPID (GSL) PROFILE OF MICE SKIN Nunes, S1, Moreno, ED3, Barcellos Oliveira, H3, Salvador, GS1, Straus, AH2, Takahashi, HK2, Tolosa, EMC1; 1 Faculdade de Medicina da Universidade de São Paulo; 2Universidade Federal de São Paulo Escola Paulista de Medicina; 3 Marinha do Brasil. OBJECTIVE: To evaluate the effects of CVL with low energy and short pulse widths on GSL profile of mice skin. METHODS: 20 female mice, C57BL/6(9-11 weeks old) were distributed into four groups. All animals had hair plugged on their backs 24hs before proceedings. The control group CG was’t exposed to laser beam. Group L1 had 3 exposures (0,5w and 0,25w/20ms). Group L2 had 4 exposures (0,25w/20ms) and Group L3 had 6 exposures (0,25w/20ms). Before laser exposure, each mouse was anesthetized with eter and covered with a piece of black cloth that had aluminum foil inside and a central hole of 2cm diameter that determine exposed area. It was used a CVL prototype (510nm,13khz, pulse width of 20ms and spot size of 0,8cm). Histological evaluation (HE) and GSL extraction and analisis (HPTLC) were performed. RESULTS: 7 days after last laser pulse euthanasia was performed. CG presented natural skin color while L1,L2 and L3 showed a dark gray color on exposed areas. Histological evaluation showed decreased number of hair follicles in L1, L2 and L3 compared to CG.GSL profile of CG presented H1 band. L1 showed new band above H1. L2 and L3 exhibited increased in general GSL quantity. L2 and L3 also presented a new GSL band bellow H1. DISCUSSION: Laser radiation modifies the composition of cell membrane. This can contribute to alter cell function or behavior.

A21 CONCLUSION: CVL changed GSL profile of mice skin, these compounds and their possible actions are currently under study.

58 THE INFLUENCE OF LOW LEVEL INFRA RED LASERTHERAPY ON THE REGENERATION OF CARTILAGE TISSUE P.Lievens , Ph.van der Veen; Department of Rehabilitation Research, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium This study concerns the influence of Laser treatment on the regeneration process of cartilage tissue. There is no need saying that the regeneration of cartilage tissue is a very big problem in rheumatic diseases for example. The lack of blood supply is one of the most important factors involved. Lots of previous publications give us prove of the regeneration capacities of Lasertherapy (in woundhealing, bone repaire etc.) In this study we have choosen to experiment on cartilage tissue of the ear of mice. We are aware of the fact that the elastic cartilage tissue of the ear is not totally comparable with the hyaline cartilage of articulations. For technical reasons however and because of the fact that the chondrocytes are comparable, we decided to use mice ears in our experiment. A 0,4 mm hole was drilled in both ears on 30 mice. The right ears remain untreated, while the left ears were treated daily with IR-Laser (904 nm) for 3 minutes. Macroscopical as well as histological evaluations were performed on the cartilage regeneration of both ears. Our results show that after one day postsurgery no differences were found between the irradiated and the non irradiated group. After the second day, only in the irradiated group there is a clear activation of the perichondrium. After four days, there is a significant ingrow of the perichondrium into the drill hole in the experimental group and there is only an active perichondrium zone in our control group. Our conclusion is that IR-Laser has an influence on cartilage regeneration

59 THE INFLUENCE OF IR-LASER ON THE PROLIFERATION OF FIBROBLASTS: AN IN-VITRO STUDY Ph.van der Veen, Y de Rop, P. Lievens; Department of Rehabilitation Research - Vrije Universiteit Brussel PURPOSE: In contribution on the effects of the positive influence of LLLT on the mechanism of wound healing, we investigaded whether IR-Laser (GaAs, 904 nm) has an influence on the proliferation of fibroblasts, wich are responsable for the necessary wound healing. METHODS: To control the reproductability, the interand intra reliability, we cultivated cells coming from the abdomen of two different (NMRI) mice and we divided 4 groups per mouse. Two were irradiated, two were not. Then we did a BrdU-labeling with 4 flasks (2 were irradiated, 2 were controlled). Differences between the

A22 experimental and control groups were examined by means of a t-test and a non parametric Mann-Whitney test. RESULTS: Our results show a significant (p<0,05) increase of fibroblasts proliferation after IR-irradiation. The BrdU-labeling showed an increased DNA activity. There is also a perfect match between the increased number of fibroblasts and the DNA activity. CONCLUSION: IR-low level laser therapy has a positive influence on fibroblast proliferation and will enhance the wound healing process

60 CYTOPROLIFERATIVE ACTIVITY OF THE HILT: IN VITRO SURVEY C. Tarantino°, G. Rossi°°, G. Flamini°°°, D. Fortuna°°°°; °Dept of Animal Pathology, University of Pisa:.°°Dept of Veterinary Science, University of Camerino.;°°° Dept Bio-organic and Bio-Pharmacy, University of Pisa;°°°°Cardio-Thoracic Department, University of Pisa. Nowadays Nd:YAG is used efficaciously in antiinflammatory and pain therapies. The aim of this study is mainly to assess the possibility of its use also in reparative therapy, and for this reason we have assayed the cytoproliferative effect. Only one study6 exists in the bibliography that demonstrates the capacity of Nd:YAG laser to increase the mytocic index. The majority of the works only indicate for this laser the parameters inhibiting cellular profileration. The objective of this study is that of determining the parameters of a pulsed Nd:YAG laser (PW: pulsed wave) capable of inducing the increase in the mitotic index on two cellular lines: the continuous line of ’’VERO’’ kidney and the human HCT-8 ileocecal adenocarcinoma.Following we carried out cytometabolic assessments.For this purpose cellular cultures of HCT-8 cells were exposed to single 7.69 J/cm2 (12 sec) doses of irradiation. The assessment of the cellular proliferation was carried out by means of spectrophotometry, immunohistochemical tests (IHC) and direct counts. The values that resulted in increasing the cellular proliferation of the HCT-8 line were then applied to the VERO line in order to verify its efficacy.The average values, obtained from the 450 nm spectrophotometric readings of the wells treated with doses of 2.7 Watt and 15 Hz for 12’’, indicated an increase in the optical density equal to 0.0075 O.D. in the treated cells compared to the controls (greater cell density and thickness of the monostratum). This proliferative increase was also observed immunohistochemically as a mean increase for the microscopic field (400X) of nuclei expressing the antigens Ki67 and PCNA in the treated cells compared to the controls, together with a greater expression of Insulin Like Growth Factor 1 (ILGF-1) and Cyclin D1. The variation in these parameters did not provide any significant increases. The application of these parameters to the VERO cells did not induce constant values in relation to the proliferative response. Lastly, by treating the monostrata with 50µl dose of 400 µMol solution of the isoflavone, genisteine, which resulted in having an oncosuppression effect on several neoplastic cellular lines, blocking the tyrosinkinasic metabolic path, there was an arrest in the cellular cycle of the HCT8 cells, by-passable via an

Abstracts additional exposition of the monostratum to irradiation with Nd:YAG PW.The results indicate that irradiation with Nd:YAG 1064 nm PW induces the proliferation of HCT-8 cells in vitro with specific parameters, and there is a direct specificity between the dosimeter and the cellular line; in fact the same parameters that stimulate the HCT-8 line are not as effective in favouring the multiplication of the VERO line. 61 PHOTOBIOMODULATION OF HUMAN T-LYMPHOCYTE PROLIFERATION IN VITRO M Dyson*, A Agaiby** and L Ghali**; *Department of Physical Therapy and Rehabilitation Sciences, The University of Kansas Medical Center, Kansas City, Kansas, USA. **GKT Medical and Dental School, KCL, Guy’s Hospital, London, UK. The biomodulatory action of low level laser therapy (LLLT) on human T-lymphocyte proliferation was investigated in vitro at energy densities ranging from 1.2 to 13.2 J/cm2 . The wavelength, pulsing frequency and power output were maintained constant at 820 nm, 5000Hz and 50 mW respectively. The T-lymphocytes used in these experiments were separated from human peripheral blood; monocytes obtained from the same blood samples were added to suspensions of the T-lymphocytes to induce proliferation. Cell suspensions of 106 cells/ml were divided into 2 aliquots, one of which was treated with the mitogen phytohaemagglutin (PHA). The mitogen treated and non-mitogen treated cells were either exposed to coherent infrared radiation or were shamirradiated. The cells were then cultured for 3 days after which their ability to incorporate 3H-thymidine was used as a measure of proliferation. Exposure of non-mitogen treated T-lymphocytes to energy densities of either 1.2 or 3.6 J/cm2 stimulated their proliferation, whereas energy densities of 10.8 and 13.2 J/cm2 were inhibitory. In contrast, the proliferation of the mitogen treated T-lymphocytes was inhibited by all the energy densities tested in the 1.2 to 13.2 J/cm2 range. The results indicate that the sensitivity of these cells to LLLT varies according to their proliferative level, only non-mitogen treated cells being capable of increased proliferation. Although cell proliferation can be increased in non-mitogen treated (i.e. resting) T-lymphocytes by exposure to low energy densities, there appears to be an energy density limit above which inhibition of cell proliferation occurs. Cells whose mitotic activity had been stimulated by PHA had their proliferation inhibited by energy densities which stimulated proliferation in resting cells. If the photobiomodulation of T-lymphocyte proliferation observed in vitro also occurs in vivo, then LLLT could be of clinical value in the treatment of various lymphoproliferative disorders.

62 STANDARD GROWTH CURVE WHICH WAS INTEGRATED TO OBTAIN A MATHEMATICAL REPRESENTATION FOR CALCULATING SHIELDING REQUIREMENTS IN DIAGNOSTICS X-RAY DEPARTMENTS BY COMPUTER Ali Rahimi (MSc); Mazandaran University of Medical Sciences - Faculty of Health Sari - Iran

Abstracts Specifically, these methods reassess shielding calculations in X-ray areas with respect to the methodology of the calculation of the barrier thickness and the number of sources consider in the area. Thus, they generate an overall solution for the cases met at the medical radiation structural design. This report provides an extension of an existing method for the calculation of the barrier thickness required to reduce the three types of radiation exposure emitted from the source, the primary, secondary and leakage radiation, to a specified weekly design limit (MPD). Because each of these three types of radiation are of different beam quality, having different shielding requirements, NCRP 49 has provided means to calculate the necessary protective barrier thickness for each type of radiation individually. However, this report (NCRP 49) provides little guidance for the contribution of each of the three types of radiation to the barrier thickness requirement. The medical physicist have to estimate which components of the field are most important to be shielded and how they are to combine, if more than one component is significant to generate a single shielding requirement. In questionable situations, multiple half-value layers (HVLs) of material recommended to be added; by the general ’’add one half value layer (HVL)’’ approximation of NCRP 49. Since the specified half value layers are those measured at high attenuation, the resultant barrier may be unnecessarily thick. Additionally, barrier requirements specified using the techniques stated at NCRP 49, show enormous variations among users. Part of the variations is due to different assumptions made regarding the use of the examined room and the characteristics of adjoining space. Many of the differences result from the difficulty of accurately relating information from the calculations to graphs and tables involved in the calculation process specified by this report. Moreover, the latest technological developments such as mammography are not addressed and attenuation data for three-phase generators, that are most widely used today, is not provided. The design and shielding barriers in diagnostic X-ray departments generally follows the ALARA principle. That means that, in practice, the exposure levels are kept ’’as low as reasonably achievable’’, taking into account consideration economical and technical factors. Additionally, the calculation of barrier requirements includes many uncertainties (e.g. the workload, the actual kVp used etc.).

63 THE TWO TYPES OF STETHOSCOPE SYSTEMS FOR RESPIRATION SYSTEM DIAGNOSTIC OF HUMAN BODY Abashkin Vladimir, Akimova Elena; Centre of Optoelectronics, Institute of Applied Physics Academy of Sciences of Moldova Diagnostics by stethoscope the lung diseases demands high experience from the doctor and gives qualitative information only. One sound channel information cannot be recorded for the next analysis, monitoring and statistics. We propose two sets of four channel stethoscope for resolving these problems. The first set is based on fibre optic sensors of sound pressure. Skin contact membrance in the bell transmits vibra-

A23 tions by the air pressure to other membrance coupled with an optical shutter. Modulated optical signal corresponds to vibrations of the chest. One fibre delivers light into the bell. Other fibre delivers modulated by shutter optical signal back to photo diode (PD). Both laser diode and 4 PD’s are situated in module of stethoscope. It collects simultaneously 4 sound signals at a time. The second set from 4 bells is electrical stethoscope. It is based on optical principle of primary sensitvity with the two membranes and shutter. But the source of light, PD and signal preamplifier of PD current are situated into the bell. Sensors are connected with module by electrical cable. Proposed diagnostic method is based on the intensities of respiratory noise and vocal sound comparisons for diseases diagnostics. Analyses produces on te base transformation of time domain sound signals into frequency domain. The data from both sets can be recorded, processed and used in diagnostics by using PC.

64 LASER ENT TODAY: STATE OF THE ART V. Oswal, MB, MS, FRCS, DLO. DORL; Honorary Otolaryngologist North Riding Infirmary, James Cook University Hospital Middlesbrough, Cleveland, England INTRODUCTION: The CO2 laser has been in routine use as a workhorse laser in otolaryngology all over the world since the eighties. Recent innovations such as various electromagnetic production modes; beamguiding software; and refined optical instruments transmitting the beam from laser arm to target have extended its use to ear and nose. The Flashscanner: This miniature optomechanical system is compatible with CO2 laser of any make. Newer generation flashscanner is operated by software integrated in the laser device. The software has various commercial names: ’’Surgitouch’’ in ENT and ’’Silktouch’’ in cosmetology. The rotatory mode of the flashscanner makes the CO2 laser an ideal tool for all indications requiring surface vaporisation or abrasion, over a given surface. Each surface sweep of the beam vaporises a layer of tissue from 0.15mm, to as thin as 50µm: this produces a genuine ’’shaving’’ effect. Flashscanner is used in a number of applications, namely, tonsil ablation, surgery for snoring, tumour debulking etc. Acublade: In addition to rotatory mode, the beam can also travel along a linear or a curved line of a given length. This software application, named AcubladeT, is a flashscanner, adapted for CO2 laser-assisted microincision and microdissection. The coagulation depth, less than 50µm, does not invalidate meaningful histological examination. The Acuspot Micropoint Micromanipulator: The micropoint micromanipulator concentrates the delivered energy on a smaller surface, thus achieving the same effect, but with less pulsed power. This results in reduced thermal conduction around the target, improved macroscopic incision and consistent microscopic cellular vaporisation. Via a set of mirrors, the micropoint micromanipulator provides a 250-µm diameter beam for a working distance of 350mm. The combined improvement provided by the micropoint

A24 micromanipulator and the SuperpulseT electromagnetic wave facilitate the incision and dissection of the vocal fold epithelium with greater precision and shallow thermal damage. The Otolam: The Otolam is a specially adapted handpiece for CO2 laser-assisted tympanic membrane fenestration. The Otolam can be safely used in infants and adults under local anaesthesia. A second laser with a different wavelength is a useful addition to the CO2 wavelength for ENT surgery and several competitors have made in-roads in the recent years. The Ho: YAG, the KTP, and the Diode are the major contenders for the second place. Reference: Oswal V et al, Eds, (2002). Principle and Practice of Lasers in Otolaryngology and Head and Neck Surgery. Kugler, The Hague, Netherlands MY EXPERIENCE WITH LASERS IN ENT ABSTRACT NOT SUPPLIED 65 DEPENDENCE OF LASER THERAPY EFFICACY ON THE TYPE OF VEGETATIVE REACTIVITY OF THE NERVOUS SYSTEM L.Kukui*, V.Issakov, P.Zarishnyuk; *Department of Acute Infarction, Pokrov City Hospital, Research Institute of Pulmonology, Pavlov State Medical University, St. Petersburg, Russia Different efficiency of laser therapy in various patients has been well known. We have established a close correlation of results of laser treatment with the type of the nervous system vegetative reactivity (VR). Its determination was performed prior to treatment by means of the cold test or calculation of κerdo index. Examined were 150 patients with influenza and acute respiratory disease complicated with pneumonia submitted to standard treatment. Among them, 70 individuals received additionally 5-7 sessions of percutaneous irradiation with infrared (IR) light of a semiconductor laser (the type <>, 890 nm, impulse power 80-125 W, the mean power 28.8-45 mW, time of irradiation 4 min). Other 40 patients were submitted to extracorporal irradiation of 140 ml of blood with red light of He-Ne laser followed by blood retransfusion (3 times each other day). The rest of 40 patients composed group of control of the basis therapy. It has been found that in patients with normal and sympathetic VR there was a complete resorption of infiltrate in 72-100% of cases, whereas in people with parasympathetic VR and in the control group, only in 35% and 37% of cases, respectively. Laser therapy of these patients led to a faster disappearance of fever and cough, development of positive changes in the content of CD3+, CD4+ T-lymphocytes and leukocytes, as well as normalization of erythrocyte sedimentation rate. Thus, there has been established a high efficiency of the combined laser and standard therapy in patients with normal and sympathetic types of VR, whereas results of the complex treatment of patients with the parasympathetic type of VR turned out even worse than in the people of the control group submitted to the standard therapy.

Abstracts 66 THINKING OF DIODE LASER AGAIN: A PLURIVALENT DEVICE George V. Oskarbski M.D; 1-Polish Society of Aesthetic Medicine 2-Hospital Medical School: Scuola Medica Ospedaliera Regione Lazio –Ospedale S. Eugenio - Rome BACKGROUND: Even if diode was defined the most efficient laser (R. Rox Anderson, M.D. Harvard Medical School March, 1998), the evaluation of clinical checks has produced controversial opinion and perplexity on the effectiveness as for hair removal as for vascular lesions and pigmented lesions. No aesthetic laser is absolutely reliable for results, indeed. The good expectations in recent years had a result on the technology of diode laser and we can find good devices for price/benefits report and performance. A three years long experience ripens judgement on applications and methods. SETTING: Private practice. METHODS: Evidence based treatments for aesthetic pathologies by a 30 watt diode laser with changeable lens, as compared with other lasers. RESULTS: The percentage of satisfied patients is strictly related to the power and flexibility of the device, as well as the experience of the operator. CONCLUSIONS: The late instruments represent a valuable standard for price/benefits report suggesting a new approach in the near future.

67 THE SCIENTIFIC BASIS AND CLINICAL SUPPORT OF LASER AND LIGHT BIOMODULATION J. R. Basford1, J. J. Anders2, G.D. Baxter3; 1 Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota USA; 2Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 3School of Rehabilitation Sciences, University of Ulster, Northern Ireland BACKGROUND: The therapeutic benefits of laser and monochromatic light were first reported in the late 1960s. Although interest has grown with time, the scientific basis of this therapy has lagged therapeutic use. PURPOSE: This session will review and assess the laboratory and clinical research underlying laser and light therapy. MATERIALS & METHODS: Systematic literature review; interviews with world leaders in laser and light therapy. RESULTS: Laboratory research reveals a plethora of laser/light therapy effects. Cell culture studies show findings that range from frequency dependent action spectra to alterations in ATP production, enzyme and protein synthesis, and response to the environment. The key to light based therapy appears to lie in the respiratory chain although evidence of membraneassociated effects is also common. Clinical research provides a less concrete level of knowledge. Scattered findings of clinical benefits are reported in a variety of musculoskeletal, painful, neurological and

Abstracts immune-based diseases. Although outliers abound, a consensus of sorts has developed that (1) a dose of 1-4 J/cm2 at the location of the treated tissue is optimal, (2) IR wavelengths are more effective for deeper tissue treatments, (3) visible red light may be better suited for superficial wound treatment, and (4) coherency may not be important. A similar agreement on the necessity/ideal frequency of pulsed therapies does not exist. DISCUSSION & CONCLUSION: Our understanding of the scientific and clinical bases of laser/light therapy has improved significantly over the last few decades. The certainty and magnitude of effects, as well as the optimal treatment parameters, are well established in the laboratory. Clinical benefits are more tenuous, but with the growing consensus on treatment approaches, areas of strongest benefits should become clear. Clinical trials to determine optimal irradiation parameters and to compare light therapy with alternative treatments are essential. 68 PHYSICAL GROUNDS FOR BIOLOGICAL ACTIVITY OF LASER RADIATION A.N. Rubinov; Stepanov Institute of Physics National Academy of Sciences of Belarus New approach to understanding biological activity of low intensity laser radiation, in which coherence is a factor of major importance, is developed. It is based on the dipole interaction of gradient laser fields with cells, organelles, membranes etc. The gradients of laser intensity in the object originate due to the interference of the light, scattered in the tissue, with the incident light beam (speckles formation). Apart of the speckles different types of the light spatial modulation can be created purposely using different schemes of beams interference. It is shown that gradient laser fields may cause the spatial modulation of particles concentration and the raise of their ’’partial temperature’’. Experimental observation of trapping of different types of particles, including human lymphocytes, in the interference fields of He-Ne and Ar lasers is presented. Sweep-net effect on particles of different size at moving the laser field is demonstrated and crystal-like self-organization of particles in the laser gradient field is observed. The influence of gradient laser fields on erythrocyte columns, apoptosis of human lymphocytes as well as on their chromosomal aberrations is demonstrated. It may be concluded from the experimental studies that the influence of interference laser field with rightly chosen period can stimulate reparation system of a cell increasing its viability. 69 PREPARATION OF A SCIENTIFIC PAPER ON CLINICAL LASER RESEARCH OR APPLICATIONS: PITFALLS AND HOW TO AVOID THEM R Glen Calderhead; SG Biomedical, Tochigi and JM Planning; Shinjuku, Tokyo, Japan It is said that clinicians today learn less and less about more and more until they end up knowing nothing about everything, whereas researchers learn more and

A25 more about less and less until they end up knowing everything about nothing. This is a phenomenon which is slowly creeping into the field of clinical applications and basic research in laser surgery and laser therapy. This trend is definitely to be discouraged, as it will effectively narrow the scope of both clinicians and researchers at a time when the scope needs to be expanded just as appropriate applications in laser surgery, and bona fide applications for laser therapy are also expanding. ’’Publish, or be damned’’ is a wellknown dictum in the heady halls of academe. Unfortunately, for many of the papers which are submitted on laser applications but which do not reach the pages of the target journal, and indeed for some papers which are published elsewhere by journals which should know a little better, or should at least have done their homework, the saying should perhaps be amended to; ’’Publish and be damned,’’ meaning that the papers actually do more harm than good to the cause of lasers in medical science. It is the author’s firm belief that any report, whether so-called ‘anecdotal’ or on a basic research or clinical study project, deserves to be published if the project is valid, and the data are thorough, comprehensive, well-collected and scientifically analyzed to provide a firm base for the conclusion. It is however very important in such studies to compare apples with apples, and not apples with oranges even though they are all fruit. It is also extremely important to report accurately the parameters of the laser used in the study to enable repeatability. It is a sad fact that too many journals are starting to lean towards the ‘science’ of a study at the expense of the ‘practice’, even though it is the actual clinical practice which drives advances in medical and surgical applications of the laser. The ‘skeletons’ of an ‘ideal’ research and clinical paper will be presented, and then the methods of adding the correct amount of appropriate ‘soft tissue’ will be examined, so as to arrive at a well-toned and balanced whole, which will hopefully lead to the acceptance of the paper. In the event of a paper’s being returned for some degree of revision and resubmission, strategies will be presented to enable the authors to use the comments of the reviewers and journal editor to ensure that the resubmitted paper will be accepted. It is hoped that, following the steps set out in this presentation, the ‘publish or be damned’ aphorism will morph into ‘publish and be praised’.

70 THE ORAL MEDICOSCIENTIFIC PRESENTATION: ART, ENTERTAINMENT OR SCIENCE – ALL, SOME OR NONE? A Brief Guide for Presenters and Moderators R Glen Calderhead; SG Biomedical, Tochigi and JM Planning; Shinjuku, Tokyo, Japan The summons from a medical congress or symposium chairman, chairwoman or president to be a session moderator or to deliver an invited lecture, or the offer to participate in a free paper session are events which can turn the most seasoned clinician and researcher into something which lies on the bed of the ocean and shivers, namely, a nervous wreck. However, proper planning and the following of a few simple rules can eliminate the mental trauma for the presenter often wrongly associated with having to give an oral presentation, and indeed obviate the sometimes much more

A26 serious trauma inflicted upon the hapless audience by an ill-prepared presentation and a hapless presenter, not to mention a mutinous moderator. The first point is that an oral presentation is not a scientific paper, and therefore while it may follow in general the usual divisions of a written article, it should not be a pictorial representation of a piece of rigid scientific writing. Secondly, presenters are almost always given a time limit for their presentation. It is the height of bad manners and total ignorance to exceed this time limit, as the presenter is often one of a series. Whereas the presenter’s information may be (to them) the most important revelation since the evolution of the laser or man’s discovery of fire, exceeding the time limit is at the very least robbing other presenters of their equal chance, and at the very worst stealing time from the all important coffee breaks, lunch break, or evening’s entertainment. This is also, however, very often the fault of the moderator, so a few pointers will be given to moderating a session: ‘Everything in moderation, especially moderating’. Thirdly, organization of general content to fit in the allotted time is an obviously important point, but one which sometimes gets lost in the euphoria of being invited to give a presentation. Cramming 30 slides into a ten-minute presentation is one of the more common and unforgivable pitfalls seen under this category. Fourthly, ‘know thy stuff’ is a pivotal admonition for the oral presenter: an oral presentation should not just be a reading from what is obviously material cribbed directly from a retrospective or prospective paper. Fifthly, ‘What we see is what you are’ should be the maxim for presenters, and this refers to three main factors: the quality and design of slides or other audiovisual (AV) techniques; the appropriate nature of the AV materials; and the appearance and delivery of the presentation. Sixthly, and finally, as TS Elliot said in the prologue to one of his poems, ‘I gotta use words when I talk to ya’. The presenter must remember above all that we, the audience, need to hear these words, even if they are echoed on the screen (which they all definitely should not be, going back to point five). In the ideal presentation, this sextet of admonitions has no strict boundaries between each, and all points are interdependent and interactive. Each will be examined in its own right. In particular, specific guidelines will be presented on the appropriate design and content of slides, either as good old-fashioned ‘steam’ slides or in a MicrosoftT PowerPointY presentation, and other AV techniques will be explored, good or bad (especially overhead projection !!!!). Finally, the importance of the moderator to the overall success of their session will be examined and pitfalls will be discussed. PDD AND PDT: STATE OF THE ART ABSTRACT NOT SUPPLIED 71 IS PHOTODYNAMIC THERAPY AN APPROPRIATE TREATMENT OF FELINE SUPERFICIAL SQUAMOUS CELL CARCINOMAS? TWO CASE STUDIES IN SMALL ANIMAL PRACTICE E. Vinck, B. Cagnie, H. Vinck, and D. Cambier; Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Belgium

Abstracts Oncologic research and cancer treatment is more common in human medicine than in veterinary medicine. Nevertheless the latest decennium chemotherapy, radiotherapy and surgery also figure largely in the cancer treatment of pets. For this matter, the present study tried to explore the feasibility of Photodynamic Therapy (PDT) as a proper and advantageous alternative for those treatments. PDT using topical 5-aminolaevulinic acid (5-ALA) cream was applied on superficial squamous cell carcinomas at the nasal planum of two cats. Five hours after the cream was applied, the photosensitising agent was removed and irradiation was accomplished with a red Light Emitting Diode (LED) contrivance with a wavelength of 660 nm. LED irradiation was administrated during 20 minutes, at a power output of 80 mW, with an energy density outcome of 38 J/cm2. The day following irradiation, the tumour area became erythematous and somewhat oedematous. After two days a scab occurred. Long–term post treatment observation showed complete removal of the malign cells related with regain of normal skin structure after three weeks. Follow-up period of one year for the first case and of two months for the second case revealed no recurrence. These promising results demonstrate that PDT is an alternative method to treat superficial skin tumours. Especially when taking into account that chemotherapy and radiotherapy are time-consuming treatments and that surgery (complete removal of the nasal planum) is not an esthetical solution.

72 PHOTODYNAMIC THERAPY (PDT) FOR TREATMENT OF FACIAL SQUAMOUS CELL CARCINOMA (SCC) IN CATS USING VERTEPORFIN (VISUDYNET): A PILOT STUDY G. Rossi°, A. Spaterna°, O. Zeira°, S. Mari°, S. Patroncini°°, C.Serra°°°, D. Fortuna°°°°; °Department of Veterinary Science, University of Camerino; °°Practitioner.°°°Clinical Veterinary Department, University of Bologna; °°°°Cardio-Thoracic Department, University of Pisa In human PDT have shown good results in the curative treatment of squamous cell carcinoma (SCC), a neoplasm frequently observed also in cats. Different molecules are employed as sensitizer for the PDT; in this preliminary study, three cats with naturally occurring facial SCC were treated with Verteporfin (Visudyne), a novel sensitizer for PDT, to determine safety and efficacy of this molecule. Each cats, presenting with a different tumor localization (pinnae of the ear, nose, lips and palpebral skin) and different histological grade of the tumor, was given an intravenous injection of 6 mgr/m2 of Visudyne per 15’ prior to irradiation with 385 J/cm2 . In one case, a large tumor of the nose (greater than 2 cm deep) was debulked by a CO2-laser vaporisation prior to PDT. In two cats, systemic reactions, included nausea associated with mild to moderate dispnoea (probably related to the facial and nasal oedema) 2 days after PDT treatment were observed. Variation in body temperature, hematological, and

Abstracts biochemical evidence of toxicity was not seen in any cat following drug administration. Local reaction (necrosis and loss of affected tissues) was well tolerated and all animals were exposed to normal daylight after less than 2 days (mean, 1.5 days) without residual photosensitization. The tumors were evaluated for complete response rates and local control durations by (two) byoptic samples taken 45 days and 120 days following treatment. The neoplastic lesions were histologically diagnosed and graded at time 0 and, succesively, in the follow-up. In all histological samples, different parameters scored by immunohistochemestry were rapresented by citockeratin, Ki67 and p27 antigens. p27 protein is one of the cdk inhibitors which regulates the progression from G1 to S phase of the cell cycle. Reduced expression of p27 protein has been reported to be correlated with poor clinical outcome in human patients with SCC. In our cases the mean p27 labeling index was increased significantly in samples taken 45 days after PDT; conversely, we observed a drop of the mean Ki67 (a nuclear marker of cell proliferation) labeling index at the same time point. A high p27 labeling index before PDT was associated significantly with good disease free. Finally, in any control sample, cytokeratins expressions was observed restricted to the epidermal layer only. Until now, of the three feline facial SCCs treated, we are observed a long-term clinical and histological complete responses (CR). PDT with the photosensitizer Visudine was safe and effective in treating SCCs of the feline skin, because no significant systemic toxicity or skin photosensitization was observed in any animal. Nevertheless, further studies with long-term follow-up are necessary to optimize the use of Visudine-PDT in veterinary and human medicine.

73 RADIOSENSITIZED TREATMENT OF MALIGNANT BRAIN TUMOURS Bloznelyte´ – Ple˙šniene´ L.; Lithuanian Oncology Center, Vilnius, LITHUANIA Around 12 000 deaths from glioblastoma occurs within the European Community annually. At present, the best available treatment for malignant brain tumours results in a median survival of patients of 15 months despite surgery, radiotherapy, and chemotherapy. The purpose of this paper is to review our results of radiosensitized treatment of malignant brain tumours MATERIALS & METHODS: Since 1985 the large experimental work was provided by us including 1042 mice and rats with 12 different types of inoculated tumours and including 20 dogs and cats with spontaneous tumors. Our experimental work was devoted to new methods of PDT, especially to gammadynamic (radiosensitized) tumours treatment. Since 2000-01 the total of 16 patients with advanced primary or metastatical brain tumours (18) underwent gammadynamic (radiosensitized) tumours treatment. There were 10 patients with primary malignant brain tumours and 6 patients with metastatical disease among them. The age of the patients varied from 9 to 65 years. Hematoporphyrin derivative (HpD) was injected i/v with a dose of 5 mg/kg body weight. 24, 48 and 72h.

A27 after injection, tumours were irradiated with gamma rays 2 Gy at a time (the full dose of a course was 6 Gy). The duration of such treatment was only 3 days. RESULTS: As the immediate result of the radiosensitized treatment of malignant brain tumours 4 malignancies fully disappeared after the first course of treatment. Significant response was established in 5 malignant brain tumours, partial response was noticed in 7 tumours. For the rest effectiveness of ammadynamic (radiosensitized) tumours treatment GDT was slight. At present 14 of these patients which underwent GDT are alive. 2 of them are without brain tumours. CONCLUSIONS: GDT is new and effective method of treatment in malignant brain tumours.

74 TREATMENT OF WALKER ASCITES TUMOR CELLS BY COMBINATION OF PHOTODYNAMIC THERAPY WITH CYCLOPHOSPHAMIDE AND INTERLEUKIN-2 ENTRAPPED IN LIPOSOMES V.F. Dima, M.D. Ionescu, Carmen Balotescu, St. V. Dima+; Cantacuzino Institute, Bucharest, ROMANIA; *Centro Medico-Chirurgico I.S.I. Hahnemann+, Rome, ITALY BACKGROUND: In this study, we demonstrated that photodynamic therapy (PDT) combined with chemoimmunotherapy stimulated antitumor activity, increased survival rates and reduced invasive capacity of ascites tumor cells. PURPOSE. The aim of this study was to investigate the beneficial and adverse local effects of PDT combined with chemoimmunotherapy on rats bearing Walker ascites tumor cells. MATERIALS & METHODS: Experiments were performed on five batches of Wistar inbred rats with Walker-256 ascites tumor cells receiving i.p. PDT (Photofrin II/PII/10 mg/kg and 18 hrs later HeNe laser irradiation /632.8 nm; 10 mW) or Cyclophosphamide (CY/15mg/kg) or interleukin-2 (25,000 U/dose) or associated therapy (PDT + IL-2 + CY). The control batch consisted of untreated rats (W256/HBSS). P II, IL-2 or CY were entrapped in liposomes (prepared from a mixture of phosphatydil-choline / cholesterol at a molar ratio 70uM/30 uM). MAIN RESULTS: The following results were noticed: (a) sole administration of PDT, IL-2 or CY reduced tumor growth, gave survival rates between 21.5 and 45.3% and cure rates ranging from 16.3 to 31.7%; (b) combined therapy (PDT+IL-2+CY) decreased tumor growth, increased survival rates (88.4%) and cure rates were 69.2% forty-two days post-transplantation. The above results were confirmed by immunological tests and electron microscopy observations. DISCUSSION: Our results regarding survival and cure rates are in contradiction with higher rates reported by Tochner et al., 1986, but are in full agreement with other studies (Evrard et al., 1993, Freedman et al., 1994) in patients with peritoneal malignancies. In conclusion, in this study we noticed that PDT combined with chemoimmunotherapy reduced mortality as well as tumor volumes and increased cure

A28

Abstracts

rates in rats with ascites tumor cells. This approach points to the need for further evaluation in patients with peritoneal malignancies.

75 THE EFFECTS OF LINEARLY POLARIZED 0.6-1.6 µM IRRADIATION ON STELLATE GANGLION FUNCTION IN NORMAL SUBJECTS AND PEOPLE WITH COMPLEX REGIONAL PAIN SYNDROME 1 (CRPS 1) J. R. Basford1, P. Low2, P. Sandroni2; 1-Department of Physical Medicine and Rehabilitation, 2 -Department of Neurology, Mayo Clinic, Rochester, Minnesota USA 55905 BACKGROUND: Stellate ganglion blocks are performed to treat upper extremity pain, but involve the risk of morbidity. Linearly polarized red light is promoted as a safe alternative to this procedure, but its effects are poorly established. PURPOSE: To assess the effect of linearly polarized radiation on stellate ganglion function. Material and Methods: This study involved two phases. In the Calibration Phase, six adults (ages 18–60) with normal neurological examinations underwent transcutaneous irradiation of the right stellate ganglion with a linearly polarized Iodide lamp (480 seconds; probe diameter 0.7 cm; 0.6-1.6 µm bandpass filter; duty cycle: on-1 sec, off-4 sec.; ’’on’’ beam intensity 3.90W/ cm2). The Treatment Phase involved twelve subjects (ages 18–60). Six with CRPS 1 of an upper extremity and six controls with normal neurological examinations and histories. At their first session, subjects and their controls were randomized to receive either active (as described above) or placebo irradiation. Assignments were reversed a week later. Upper and lower extremity temperature, sudomotor, and vasomotor function was assessed before treatment and for 30-minutes following irradiation. Results: Calibration Phase: Subjects could not detect the beam. There were no adverse consequences. Treatment Phase: Data collection is complete for five of six CRPS 1 patients. Analysis has not begun, but one subject reported ’’90%’’ improvement. Discussion and Conclusion: To be presented.

76 GENOMIC ANALYSIS OF SPINAL CORD FOLLOWING INJURY AND PHOTO-BIOMODULATION 1

3

3

K.R. Byrnes , R.W. Waynant , I.K. Ilev , B. Johnson2, Pollard H. 2, Srivastava M. 2, Eidelman O. 2, Huang, W. 2, J.J. Anders2; 1. Neuroscience Program, Uniformed Services University, Bethesda, MD, USA 2. Department of Anatomy, Physiology and Genetics, Uniformed Services University; 3. Center for Devices and Radiological Health, Food and Drug Administration, Rockville, MD, USA Following spinal cord injury, damaged axons fail to regrow, leading to a permanent loss of function. Recent research in our laboratory has demonstrated that treatment of injured spinal cord with a specific wavelength of light (photo-biomodulation) increases

axonal regrowth and suppresses the inflammatory cell invasion that follows the lesion. We hypothesize that cells responding to the injury may exhibit characteristic changes in global gene expression and that alteration of this expression by photo-biomodulation, leading to the observed increases in axonal regrowth and inflammatory cell suppression, may be followed objectively by genomic analysis. To test this hypothesis, the injured spinal cord from rat was exposed to laser light (810nm, 150mW, 2,997 seconds, 0.3cm2 spot area, 1589J/cm2) and spinal cord samples, including the injury site, were harvested at 6 and 48 hours postinjury. Total RNA was prepared from the spinal cord and cDNA copies were labeled with for microarray analysis. Each microarray blot was analyzed using GRASP, a statistically weighted graphical inspection algorithm. A subset of genes was noted to change significantly following injury. Among these were genes historically associated with injury in the nervous system whose expression was altered by photobiomodulation. These included cytoskeletal protein genes, cellular proliferation and cytokine secretion genes, leukocyte adhesion protein genes, genes for receptors for growth factors such as BDNF and NT3, and genes involved in neurotransmitter release and monocyte differentiation. Although the precise role these genes play in axonal regeneration after spinal cord injury is currently unclear, these data provide unambiguous, objective, functional evidence for the fact that photo-biomodulation exerts specific molecular and ameliorative effects on the injured spinal cord.

77 LOW-LEVEL-LASER THERAPY IN MILD AND MODERATE CTS – A DOUBLE BLIND, RANDOMISED STUDY Th. Rappl, Ch. Laback, St Quasthoff, M. Auer-Grumbach, R. Gumpert, E. Scharnagl; Division of Plastic and Reconstructive Surgery, Department of Neurology, Department of Trauma – Surgery, University Hospital of Graz, Austria Background: Compression of a peripheral nerve can induce a variety of cellular and biochemical changes including local hypoxämia. According to several studies LLLT is supposed to have a benefit on these proceedings. Purpose: The aim was to evaluate the LLLT in CTS (ENG: < 6,9 ms) monitored by EMG and VAS (Visual Analogous Scale) recordings. Materials and Methods: 72 hands with CTS treated by LLLT (15 sessions/30 min, over a period of 5 weeks) were evaluated by a double blind – randomised study. ENG and VAS (visual analogous scale) were performed pror to and after LLLT. LLLT (wavelength 830 nm, 400 mW) with an energy of 3J per point focused on the Carpal – tunnel, on trigger and acupuncture – points was performed in 38 cases, in 38 cases (control – group) we used a red light pen. Follow-up ranged from 8 to 12 months. Results: ENG and VAS improved in 66%, didn’t change in 8% and got worse in 26% in the LLLT group after a 12 month period. No improvement was recorded in the control group.

Abstracts Conclusions: The results suggest that LLLT can be recommended in mild or average CTS (ENG < 4,9 ms) especially if a conservative treatment is required. 78 THE EFFECT OF LOW POWER LASER THERAPY ON OSTEOARTHRITIS OF THE KNEE Basirnia A., Sadeghipoor G., Esmaeeli Djavid G., Jamili P., Sheikhbahaee N., Mortazavi S.M.J M.D.*; 1) JAHAD Medical Laser Center, Iranian Academic Center for Education, Culture & Research (ACECR),Tehran University of Medical Sciences Branch .Tehran, Iran. 2) Laser in Medicine Research Group, Tehran University of Medical Sciences. * Assistant Professor of Orthopedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, Tehran, Iran. Objective: Knee osteoarthritis affects a large proportion of the population. Low power laser therapy (LPLT) has been found effective in the management of pain related to osteoarthritis. The aim of this study was to assess the efficacy of low power laser therapy on knee osteoarthritis. Material and methods: Treatment was performed on 20 patients, aging from 42 to 60 years. All patients had received conservative treatment with poor results. Laser device used for this treatment was pulsed IR diode laser; 810 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The total number of applications was 12 sessions. Irradiation was performed on 5 periarticular tender points, each for 2 min. The treatment outcome (pain relief and functional ability) was observed and measured according to the following methods: 1) Numerical rating scales (NRS), 2) Self assessment by the patient, 3) Index of severity for osteoarthritis of the knee (ISK), 4) Analgesic requirements. Results: We achieved significant improvement in pain relief and quality of life in 70% of patients, comparing to their previous status (p<0.05). There was no significant change in range of motion of the Knee. Conclusion: This study has demonstrated that low power laser therapy can reduce the symptoms as well as improve the quality of life of patients with knee osteoarthritis. 79 LOW LEVEL LASER THERAPY (830NM) IN LATERAL EPICONDYLITIS : A CASE REPORT Sadeghipour Roodsari.G, Basirnia.A, Sheikhbahaee.N, Jamili.P, Mortazavi M.MD; JAHAD medical laser center, Tehran university of medicine, Tehran , Iran. Objective and Background: Among the other treatment modalities of lateral epicondylitis , low power laser therapy (LPLT) has been promoted as highly successful method. The aim of this study is to evaluate the efficacy of LPLT on lateral epicondylitis using described method. Case description: The patient was a 46-year-old man who had lateral epicondylitis for 3 years. He had performed all the current treatments with no satisfactory results. Low power laser therapy consisted of 12 treatments, 5 per week. Patient was irradiated on

A29 tender points on the lateral epicondyle and on the forearm extensors. The laser instrument was infrared diode laser , GaAlAs 830nm, 10 w peak power and 150 Hz frequency. The evaluation of patient s pain and functional ability was measured before the beginning of laser irradiation, after 6 treatment at the end of the therapy according to following: 1) Visual analouge scale (VAS) 2) Hand dynamometer 3) Subjective assessment and 4) Physical examination Results: In the end of the treatment the visual analouge scale reduced from 5 to 2, the hand dynamometer markedly increased from 10 mmhg to 150 mmhg, subjective assessment show exelent result and physical examination in all aspects. Conclusion: This case demonstrated the potential use of low power laser therapy as a treatment for lateral epicondylitis if carried out as described in this article. Further double blind studies are needed to confirm our findings in compare with placebo. 80 THE USE OF LOW LEVEL LASER THERAPY (LLLT) IN THE TREATMENT OF TRIGGER POINTS THAT ARE ASSOCIATED WITH ROTATOR CUFF TENDONITIS Al-Shenqiti, J Oldham; Centre For Rehabilitation Science, University Of Manchester, England. Background and objective: LLLT is effective in treating soft tissue disorders and painful conditions including trigger points (TrPs). Purpose: To investigate the efficacy of LLLT in the treatment of TrPs associated with rotator cuff tendonitis. Materials and Methods: 60 patients were randomly allocated to either sham or laser therapy. The active laser (Excel, Omega Universal Technologies Ltd, UK) parameters included a wavelength 820 nm, power output 100 mW, frequency 5000 Hz (modulated) and energy density 32 J/cm2. 12 treatments were given over four weeks. The blinded outcome measures were pain, range of motion (ROM), functional activities and pressure pain threshold (PPT). Outcome measures were carried out pre and post treatment, then 3 months later. Results: Considerable improvement in pain (p < 0.001) was seen for the laser compared to sham group post treatment, and at follow-up (6 points on a 10 VAS compared to 2 points respectively). Similarly, significant differences in favour of laser were seen for ROM (p < 0.01), functional activities (p ≤ 0.001) and PPT (p ≤ 0.05). Discussion and Conclusion: LLLT is effective in treating patients with TrPs associated with rotator cuff tendonitis. Mechanisms of action are not yet clear, and will require further investigation. 81 THE HYPOGLYCEMIC EFFECT OF BIOMODULATED LASER THERAPY IN THE MANAGEMENT OF DIABETES MELLITUS: CONCEPT, METHODOLOGY, RESULTS AND PERSPECTIVES. P. Ramdawon, MD, Ph.D., D.Sc.; Centre of Energy Laser Medicine, International Academy of Light Medicine, Mauritius

A30 INTRODUCTION: Diabetes Mellitus (DM) is an extremely devastating disease with life-threatening complications. Therefore, a method is sought to act on the human organism so that blood sugar level returns normal and diabetic complications disappear. AIM: A highly effective treatment method for Types I and II Dm is elaborated with the application of bioresonance information quantum laser therapy (BIQLT). REVIEW AND THEORY: The ‘‘resonance absorption phenomenon’’ being developed as a conceptual approach for direct influence on the organism at the atomic and molecular levels, LLLT is performed as BIQLT. PROCEDURES: DM was successfully treated with BIQLT in 60 clinical cases. The average age of patients was 45.5 years. The average number of treatment sessions was 36. RESULTS: All patients could stop their anti-diabetic medications by the 6th week of treatment. The various complications due to DM disappeared fully. FOLLOW-UP & CONCLUSIONS: Follow-up for 7 years. Even in advanced cases, the pancreatic β-cells retain the ability to restore their functions. Laser energy can stimulate and cause the regeneration of β-cells. BIQLT is effective in treating DM at all stages. BIQLT excludes any harmful side effects, is noninvasive and highly effective. BIQLT represents a major ‘‘breakthrough’’ in diabetology.

BIOMODULATED LASER THERAPY FOR CORONARY ARTERY DISEASE: THE REPLACEMENT THERAPY FOR CORONARY ARTERY BYPASS GRAFTING ABSTRACT NOT SUPPLIED

LASER THERAPY OF ARTERIAL HYPERTENSION: A RANDOMISED DOUBLE-BLIND STUDY ABSTRACT NOT SUPPLIED

82 TRANSCUTANEOUS PHOTOMODIFICATION OF BLOOD IN SKIN MICROVESSELS AS A TRIGGER MECHANISM OF THE SYSTEMIC EFFECTS OF VISIBLE AND INFRARED LIGHT K.A.Samoilova; Institute of Cytology, Russian Academy of Sciences, St.Petersburg, Russia Background: Up to now the mechanisms of systemic effects of laser light has been poorly studied. Taking into consideration a sufficiently deep penetration of visible and infrared (IR) light into the human skin, high density of superficial vascular network and relatively low speed of blood flow in thin capillaries, we assume, that the systemic consequences of the blood photomodification in cutaneous microvessels may be of high significance. Purpose of our studies was to elucidate the mechanisms by which exposure to light of a small area of the patient body (and correspondingly photomodification of a small volume of blood) results in a great variety of functional and therapeutic effects.

Abstracts Materials and methods: Three variants of parallel experiments have been carried out. 1. The volunteers back (15 cm2) was irradiated with visible+IR polarized (VIP) light of a Swiss phototherapeutic device Bioptron (400-3000 nm, 95% of polarization, power density 40 mW/cm2, dose 12 J/cm2). 2. The blood samples of the same volunteers were VIP-irradiated in vitro. 3. The irradiated and non-irradiated autologous blood samples were mixed at a volume ratio 1:10, to model events in vivo, when a small amount of transcutaneously photomodified blood was mixed in a vascular bed with its main circulating volume. More then 25 parameters of blood were examined: erythrocyte rheologic and transport properties, functional activity of leukocytes, level of cytokines and growth factors, the capacity of plasma to stimulate cell proliferation in vitro, etc. Results: Exposure of small area of volunteers’ body leads to an immediate changes of cells and plasma of the circulating blood. The similar changes are also observed after irradiation of blood in vitro and after mixing irradiated and non-irradiated autologous blood samples. Thus, after light treatment the human blood acquires properties of a biologically active preparation with wide spectrum of activity, able to ‘‘translate’’ light-induced changes to much higher volume of autologous blood. One of the mechanisms of the ‘‘translation’’ and fast changes of blood could be lightinitiated, blood cell-mediated cascade of the reactive oxygen species, whose formation after treatment of various types of cells with visible and IR light has been documented in literature.

83 COMPARISON OF EFFECTS OF POLARIZED AND NON-POLARIZED LIGHT ON HUMAN BLOOD IN VIVO AND IN VITRO: I. PHAGOCYTOSIS OF MONOCYTES AND GRANULOCYTES K.D.Obolenskaya, K.A.Samoilova; Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia So far it remains unclear as to which peculiarity of the laser light is responsible for development of its biological and therapeutic effects. Whereas monochromacity is not considered anymore by most experts as the necessary condition for efficiency of the laser light, some authors even report additivity of effects produced by a combination of visible and infrared laser radiations, the significance of coherency and polarization remains to be a subjects of discussions and investigations. The goal of this study was to compare the changes of monocyte and granulocyte phagocytosis after irradiation of volunteers’ blood in vivo (transcutaneously) and in vitro with polychromatic visible+infrared polarized (VIP) and non-polarized (VInP) light. One group of volunteers was exposed to VIP light of a Swiss Bioptron-2 phototherapeutic device (400-3000 nm, 95% of polarization, power density - 40 mW/cm2, the dose - 12 J/cm2). Another group was irradiated with VInP light of the same device without polarizing mirrors (400-3000 nm, power density 38 mW/cm2, the dose 11,2 J/cm2). In both cases the sacral zone of

Abstracts volunteers back (15 cm2) was irradiated. Blood samples were irradiated in Petri dishes, using the doses 2,4 and 2,24 J/cm2, respectively. Both types of radiation induced an immediate increase of phagocytic activity of both monocytes and granulocytes in the entire volume of circulating blood. Effect of polarized light developed somewhat faster to reach maximum values in 0.5 h, rather than in 24h, as in the case of the non-polarized light. At initially similar phagocytosis parameters, the value of effects of these radiation types turns out to be similar both in vivo and in vitro. The blood irradiated with polarized and nonpolarized light acquires ability to ’’translate’’ the lightinduced changes of phagocytic activity to leukocytes of the 10-fold greater volume of non-irradiated autologous blood, which can provide mechanism of fast changes of the functional state of leukocytes of the entire circulating blood after exposure of volunteers to these radiations.

84 COMPARISON OF EFFECTS OF POLARIZED AND NON-POLARIZED LIGHT ON HUMAN BLOOD IN VIVO AND IN VITRO: II. LIPID PEROXIDE CONTENT IN ERYTHROCYTE MEMBRANES AND PLASMA A.V.Vologdina, K.A.Samoilova; Institute of Cytology, Russian Academy of Sciences, St.Petersburg, Russia The problem of role of the laser light polarization it has not been finally solved up to now. The goal of this study was to compare the effects of visible+infrared polarized and non-polarized (VIP and VInP) light on the structural state of human erythrocyte membrane (content of lipid peroxides – LPO) and level of LPO in plasma after irradiation of blood in vivo (transcutaneously) and in vitro. Small area of volunteers’ back (15cm2) was exposed either to VIP or VInP light of a similar power density and dose. The light sources were a Swiss phototherapeutic device Bioptron-2 for irradiation of the 1st group of volunteers (400-3000 nm, 95% polarization, power density 40 mW/cm2, the dose 12 J/cm2), and the same apparatus without polarizing mirrors (400-3000 nm, 38 mW/cm2, 11,2 J/cm2) for exposure of the 2nd group. Blood samples of the same volunteers were irradiated in Petri dishes with a 5-fold lower doses (2,4 and 2,24 J/cm2). To model events in vivo, when a small amount of transcutaneously photomodified blood is mixed in the vascular bed with much higher volume of circulating blood the irradiated and non- unirradiated autologous blood samples were mixed at a volume ratio 1:10. Both radiations produce in vivo and in vitro similar regulatory effects on the parameters studied, promoting reduction of the initially increased parameters and a rise of initially decreased ones. The blood irradiated both with polarized and non-polarized light is able to ‘‘translate’’ the light-induced changes of erythrocytes and plasma to a much higher volume of the non-irradiated autologous blood, which may explain a development of rapid changes of its entire circulating volume. Changes induced by non-polarized light develop somewhat slower; in its action on erythrocytes, upregulatory effect predominates, whereas polarized light has predominantly downregulatory

A31 effect. Since many pathological states are accompanied by an increase of the LPO level, more favorable might be use of the polarized, rather than non-polarized light, with its fast downregulatory effect on the LPO content in red blood cell membranes and regulatory effect on this parameters of plasma.

85 AN IN VITRO STUDY OF THE EFFECTS OF LOW-LEVEL LASER RADIATION ON HUMAN BLOOD Dan G. Siposan, MD; Technical Military Academy, Bucharest, Romania Background: In the last time the study of the effects of Low-Level Laser Radiation (LLLR) on the blood is considered to be a subject of great importance in elucidating the mechanisms of action between LLLR and biologic tissues. Different methods of blood phototherapy have been developed and used in clinical purposes with benefic effects. Purpose: This study investigates some in Vitro effects of LLLR on some selected rheologic indices of human blood. After establishing whether or not damaging effects could appear due to laser irradiation of the blood, we tried to find a new method for rejuvenating the blood preserved in Haemonetics-type bags. Material and Methods: Blood samples were obtained from adult regular donors (volunteers). HeNe laser and laser diodes were used as radiation source, in a wide range of wavelengths, power densities, doses and other parameters of irradiation protocol. Results: In the first series of experiments we established that LLLR does not alter the fresh blood from healthy donors, for doses between 0 and 10 J/cm3 and power densities between 30 and 180 mW/cm3. In the second series of experiments we established that LLLR does have, in some specific conditions, a revitalizing effect on the erythrocytes in preserved blood. Discussion and Conclusions: We concluded that laser irradiation of the preserved blood, following a selected protocol of irradiation, could be used as a new method to improve the performances of preservation: prolonging the period of storage and blood rejuvenation before transfusion.

86 LOW LEVEL LASER THERAPY (LLLT); AS A BETTER TREATMENT OPTION FOR CORONARY ARTERY DISEASE (CAD) P.B. Katariya, MD1, S. S. Ghumare, MD2; 1Laser Cure Clinic, Apte Road, Pune-India. 2Indian Institute of Laser Medicine, Ashwini society, Pune. Introduction: LLLT (monotherapy) is being tried on 65 patients who were advised early CABG surgery. The researchers were concerned with gross limitations and problems of CABG; in the long-term management of CAD. The researchers wanted to invent much better, safer and non-surgical option for CABG; because CAD has been the most important killer in many countries of the world including India. This research, with careful observational studies, has been conducted since 1998, without any financial support; from any source.

A32

Abstracts

Experiment: Low Level Laser Therapy (LLLT) has been used on 65 patients advised CABG, for their severe angina on efforts. Many of them have associated diseases like diabetes, myocardial infarction, hypertension etc. Few patients joined the research being not relieved by CABG. The efficacy of LLLT has been evaluated by different clinical and laboratory parameters like frequency and intensity of angina attacks, exercise tolerance, and need for anti angina medicines, and stress thallium myocardial perfusion studies; before and after the LLLT. Instruments: Specially designed and indigenously manufactured, programmable special laser equipment was used for this experiment. Infra red laser of 905 nm 800mw(18 probes) was used for transcutaneous external laser therapy. A Red laser of 630 nm of 5 mw was used for intravenous and supravenous laser application. Observations: After completion of total 60 plus OPD visits; in span of few months (according to the severity of angina and associated disease) the researchers observed, the effects of LLLT, as follows: 1. 94 % patients required less or no, anti angina medicine after few weeks of LLLT. 2. LLLT remarkably reduces the frequency and intensity of angina. 3. 94% patients showed much better exercise tolerance even with less or no anti angina medicines. LLLT improves myocardial perfusion on thallium scan studies 4. If compared with CABG, the LLLT was found to be more effective, safe, least invasive, while being cost effective.

signals. The infrared thermography appears to be a promising research tool for an objective monitoring of an inflammatory reaction. AIM: Assess the efficacy of the low level laser on inflammation reaction associated with extraction of impacted lower third molars in double blind placebo controled in 20 patients. SUBJECTS: Twenty patients with impacted lowed molar classified according to the Pell- Gregory classification. METHODS: Patients were randomly devided into two groups according to the treatment. Patients of the group A were treated with semi-conductive GaAlAs laser emitting radiation of 685 nm, with maximal output of 30 mW and received 3 x 10 J during one week postoperatively. The laser gives a spot size of approximately 0,2 cm2 and power density of 150 mW/cm2. The extraction area was irradiated along with the lingual and buccal bony wall immediatelly after extraction, 1 and 3 day after extraction. Patients in the group B were treated with inactive placebo probe in the same exposure schedule. Patients evaluated post-extraction symptoms in a standartized protocol and the level of pain on visual analog scale. Thermographic measurement of local inflammatory was performed by ThermaCAM SC 2000 before extraction, 30 mins after extraction and 1, 3, 5, 7 day after extraction always before lasertherapy. This study has been carried out thanks to a granted project GAUK 1/2001 and the research project of the Ministry of education, youth and sports of the Czech Republic, no. FJ MSM 111100005.

Conclusion: LLLT is a better, safer and cost effective option; if compared to CABG, for CAD.

88 CHANGES OF SKIN IMPEDANCE IN HEALTHY VOLUNTEERS AFTER LASER APPLICATION

1.LLLT could be the optimal viable option if CABG heart surgery is unsuitable or contra indicated due to reasons like high operative risks or patient’s unwillingness.

Erosova, Z.1., Pilecka, N.1,2, Navratil, L. 1,2, Skopek, J. 1,2, Dylevsky, I.2,3, Kuna, P.2; 1 Charles University Prague, 1st Fac. of Med., Institute of Biophysics, Dept. of Clinical Radiobiology, Czech Rep.; 2 University of South Bohemia, eskι Budejovice, Faculty of Social and Health Studies, Dept. of Radiology, Czech Rep.; 3 Charles University Prague, 2nd Fac. of Med., Institute of Biophysics, Dept. of Anatomy, Czech Rep.

87 EFFECT OF LOW LEVEL LASER ON POSTSURGICAL INFLAMMATORY REACTION EVALUATED BY INFRARED THERMOGRAPHY 1,2

2

3

Fikackova, H. , Ramba, J. , Navratilova, B. , Jirman, R.4, Navratil, L.1,5, Pilecka, N.1,5, Erosova, Z1; 1Charles University Prague, 1st Fac. of Med., Institute of Biophysics, Dept. of Clinical Radiobiology, Czech Rep.; 2 Private stomatosurgery practice, Prague, Czech Rep.; 3 Stomatosurgery ambulance, Prague, Czech Rep.; 4 Charles University Prague, 1st Fac. Med., Dept. Stomatology, Czech Rep.; 5 University of South Bohemia, eskι Budejovice, Faculty of Social and Health Studies, Dept. of Radiology, Czech Rep. Low level laser therapy has been reported as an effective tool for treatment postsurgical conditions due to its analgesic, anti-inflammatory and stimulating effects. The infrared thermography is a diagnostic method based on its ability to record infrared radiation emitted by the skin and convers it into electronic video

BACKGROUND: Physiological and pathophysiological events in biological tissue are characterized by a shift of the electrical impedance spectra of the tissue under study. PURPOSE: To evaluate an influence of non-invazive therapeutical laser on human skin. MATERIAL AND METHODS: Measurements of impedance (resistance of ac current) were carried out in healthy voluteers on forearm and abdomen skin before and during laser irradiation. Low-level lasers with green, red and infra red light were used. RESULTS: Different changes of skin impedance were obtained in case of green laser on one hand and red and infra red laser on the other hand. CONCLUSION: This non-invasive method can be used as an objective tool to measure skin characteristic.

Abstracts This study has been carried out thanks to the research project of the Ministry of education, youth and sports of the Czech Republic, no. FJ MSM 111100005 and a granted project GAUK 12/2000.

89 EFFECT OF LOW LEVEL LASERTHERAPY ON TINNITUS ASSOCIATED WITH TEMPOROMANDIBULAR JOINT DISORDERS (PILOT STUDY) Fikackova, H1,2, Jirman, R.4, Pilecka, N.1,3, Navratil, L.2,3, Erosova, Z1., Kymplova, J.2,3; 1 Charles University Prague, 1st Fac. of Med., Institute of Biophysics, Dept. of Clinical Radiobiology,Czech Rep.; 2 University of South Bohemia, eskι Budejovice, Faculty of Social and Health Studies, Dept. of Radiology, Czech Rep.; 3 Laser centrum THERAP-TILIA, Prague, Czech Rep.; 4 Charles University Prague, 1st Fac. of Med., Dept. of Stomatology, Czech Rep. Tinnitus can be defined as the conscious experience of a sound that originates in the head of its owner.The patients with tinnitus suffer from a constant ringing, hissing, or buzzing sound. Although tinnitus can be a symptom of some ear disease such as otitis externa, otosclerosis, Meniere’s disease or an acoustic, the review of literature has shown tinnitus is also highly significantly associated with temporomandidular joint disorders (TMD).There is a presumption that treatment of TMD can improve the symptoms of tinnitus. AIM: Assess the effect of low level laser on duration, loudness and annoyance of tinnitus using a blind controled study. MATERIAL: 1O patients with tinnitus associated with temporomandibular joint disorders. METHODS: Patients were randomly divided into two groups on the basis of the treatment. Patients of the group A were treated with semi-conductive GaAlAs laser emitting radiation of 685 nm, with maximal output of 30 mW . The laser gives a spot size of approximately 0,2 cm2 by handheld delivery probe kept in light contact with the area to be treated. The patients received 2 x 8 J at each of the 9 treatment episodes during three weeks. The two treatment points were as follows : intraorally in the region where muscle lateralis pterygoideus is palpated and extraorally through the meatus acusticus externus. For the control group B, the laser device was adjusted in the same schedule, but without power. Patients evaluated duration, loudness and annoyance of tinnitus each day, before and after laserotherapy and at one month follow-up. This study has been carried out thanks to the research project of the Ministry of education, youth and sports of the Czech Republic, no. FJ MSM 111100005 and a granted project GAUK 1/2001 and 11I2000.

A33 Fac. of Med., Institute of Biophysics, Dept. of Clinical Radiobiology, Czech Rep;.2 University of South Bohemia, eskι Budejovice, Faculty of Social and Health Studies, Dept. of Radiology, Czech Rep; 3 Laser centrum THERAP-TILIA, Prague, Czech Rep. The way how laser radiation interacts with tissue as well as the depth of laser light penetration is mainly determined by its wavelength. The infrared thermography was used for evaluation of the influence of low level green laser on temperature changes of human skin. Infrared thermography allows to image and measure the amount of heat given by blood flowing within and beneath the skin and muscles. Thermography is completely non – invasive diagnostic method unique in its capability to show physiological change. Aim: To confirm the hypothesis that the mechanism of the low power laser emitting radiation of 532 nm wavelength is determined by an athermical, photochemical reaction of absorbed photons with tissue and therefore is not connected with temperature changes resulted from the increase of microcirculation. Methods: The study group were consisted of 15 healthy volunteers. Irradiation parameters: Scanning stand of therapeutic laser MED 2000 (LASOTRONIC) with harmonic resonator Nd:YAG, average power output: 10 mW, wavelength: 532 nm, energy density: 4 J/cm2, irradiation time for the area of spot size: 1 cm2 was 7 min. Thermography was performed by the infrared camera ThermaCAM SC 2000 with thermal sensitivity 0,08 0C. Skin temperature was recorded concomitantly 3 minutes before irradiation, throughout the irradiation and 3 minutes after irradiation at 5 seconds intervals. The temperature changes during thermographic measurement were evaluated by computer software and statisticaly analysed. Conclusion: Statistic analysis of null hypothesis confirmed the presumption that low power green laser does not influence temperature of healthy human skin. This study has been carried out thanks to the research project of the Ministry of education, youth and sports of the Czech Republic, no. FJ MSM 111100005 and a granted project GAUK 1/2001. EFFECT OF LOW LEVEL LASER ON POSTSURGICAL INFLAMMATORY REACTION EVALUATED BY INFRARED THERMOGRAPHY ABSTRACT NOT SUPPLIED 91 OUR EXPERIECE WITH SKIN LESION VAPORIZATION USING CO2 LASER

90 LOW LEVEL GREEN LASER DOES NOT CHANGE TEMPERATURE OF HUMAN SKIN

Kymplova, J.1,2, Pilecka, N.1,3, Navratil, L.1,3; 1 Charles University Prague, 1st. Fac. of Med, Institute of Biophysics, Czech Rep. 2 Centrum of laser aesthetics, Prague, Czech Rep. 3 University of South Bohemia, Ceske´ Budejovice, Fac. of Social and Health Studies, Czech Rep.

Fikackova H1., Pilecka, N1,2, Navratil, L.2,3, Ziskovα, R.2, Erosova, Z1; 1Charles University Prague, 1st

A microDERM analysis has been used for skin lesion examination in last two years. Based on this analysis

A34 and fidings of dermatologist, an optimal way of lesion elimination has been chozen. A histological examination has been done, if neccessary. Naevus naevocellularis, naevus intradermalis, naevus compound, fibroma molle, verruca vulgaris and verruca seborrhoica were the most frequent cases, carcinoma basocellulare, neurofibrom a angiokeratom were the rare ones. Verrucae vulgares were with multiple planar eruption, usually on a cicatricial skin (after repeated application of liquid nitrogen or surgical excise). Verrucae were extracted using CO2 laser without any local anaesthesia, 3-5times with one week pauses. A keratolytic substance of verruca was vaporized to a base. No less than 112 patients were successfully treated in this way. The angiokeratom hallucis circumscriptum was a very interesting finding. Its formation started 18 years ago but no changes were find in last 10 years. After vaporization a very guick heeling was observed. A high power laser therapy has been completed with a low power laser therapy (energy density 2J/cm2, daily, 10 applications). A cheloid occurrence was minimal. This study has been carried out thanks to granted project FJ MSM 111100005 and GAUK 12/00 92 HEALING PROCESS IN THE SKIN OF WISTAR RATS TREATED WITH MAYTENUS ILICIFOLIA EXTRACT AND LASER RADIATION R. MATIAS, D.M. Dourado, M. M. da Silva, P. T. C. Carvalho, K. Oliskovicz; UNIDERP, Campo Grande, MS, Brasil. This study has had as a goal to test histologically the healing effectiveness of Maytenus ilicifolia extract and laser He-Ne radiation on injuries experimentally inflicted in Winstar rats. Three experimental groups were used and an injury in the ventral dorsum was made in each subject. Group G1 was treated with the ointment without M. ilicifolia. Group G2 was treated with ointment made of the vegetal drug (25%). Group G3 was ointment laser radiation. The treatment in all the groups took place right after the injury infliction and the immolation time was 24 hours, 3, 7 and 18 days. In G1, after 18 days, epithelium healing was displayed below the scab and the fibrosis process was less intense than in G2 and G3. In G2, after 18 days, the ulcer was much smaller, displaying retraction in its ends with newly formed vessels and fibrosis could be seen. In G3, after 18 days, there was more fibrosis in the granulation tissue and the healing process was more patent. We have assumed that subjects treated with laser have displayed more patent healing and a slightly higher granulation tissue laying at histological level compared to the subjects treated with M. ilicifolia and the control group. FMB, UNIDERP 93 EFFECT OF LOW POWER Ga-Al-As LASER RADIATION ON (650 nm) ON THE CARRAGEENAN INDUCED RAT PAW EDEMA Albertini, R.1, Aimbire, F S.C.1, Correa, F.I.1, Ribeiro, W. 1, Cogo, J.C1., Antunes, E.2, Teixeira, S.A.2, De

Abstracts Nucci, G.2, Castro- Faria-Neto, H.C3., Zβngaro, R.A., Pacheco, M.T.T., Lopes-Martins, R.A.B.1*; 1Dept. of Pharmacology, IP&D UNIVAP R, Shishima Hifumi, Sa˜o Jose´ dos Campos-SP-Brazil 2Dept. of Pharmacology, Faculty of Medical Sciences, UNICAMP;, Campinas-SP- Brazil Inflammation consists of local and systemic reactions of the organism against an aggression. The purpose of the present study was to investigate the effect of therapy with a Ga-Al-As laser, using the rat paw edema model. The paw edema was induced by subplantar injection of carrageenan. The paw volume was measured before, and 1, 2, 3 and 4 hours after the injection using a hydroplethysmometer (Ugo Basile). To investigate the mechanism action of the Ga-Al-As laser on inflammatory edema, parallel studies were performed using adrenallectomized rats or rats treated with sodium diclofenac. The rats were irradiated with the Ga-Al-As laser during 80 s each hour. The energy densities that produced an anti-inflammatory effect were 1 J/cm2 and 2.5 J/cm2, reducing the edema by 27 % and 45.4 % respectively. The best energy density to achieve an anti-inflammatory effect was 2.5 J/cm2 given at 1, 2 or 3 hours after induction of edema. The energy density of 2.5 J/cm2 produced antiinflammatory effects similarly to cyclooxygenase inhibitor, sodium diclofenac at a dose of 1 mg/kg.. In adrenallectomized animals, the laser irradiation failed to inhibit the edema. Our results suggest that Ga-Al-As laser radiation exerts its anti-inflammatory effects by stimulating the release of adrenal corticosteroid hormones. Financial Support: FAPESP 01/03027-0

94 THE EFFECT OF TWO LOW POWER LASERS RADIATIONS – GA-AS AND HE-NE – ON THE TOPIC DERMATITIS INDUCED BY CROTON OIL IN MICE EAR. Santos, M.S.A., Aimbire F.S.C., Cogo, J.C., Ribeiro, W., Lopes-Martins, R.A.B; * Laboratory of Pharmacology – Institute of Research and Development - IP&D – UNIVAP. Av. Shishima Hifumi, 2911 – Sa˜o Jose´ dos Campos-SP – Brazil. Contact dermatitis is a common inflammatory reaction frequently induced by chemical agents found in different products. In this present work we used the inflammatory model of topic dermatitis induced by chemical agent (croton oil) in mice ears and it was investigated the effect of laser therapy He-Ne (632,8 nm) and Ga-As (904 nm), in the acute inflammatory process. For this purpose were employed the energy densities of 1.0; 2.0; and 5.0 J/cm2, at different times after stimulus (0, 30, 60, 90 and 120 min.). The mouse ear edema was quantified through samples taken with a punch of 8 mm diameter and weighed in analytical scales. Our results demonstrate that He-Ne laser was effective to inhibit the croton oil-induced edema. We also demonstrate that the best energy densities were respectively 2.0, 5.0 and 1.0 J/cm2 at 30 and 60 minutes. It can be concluded that the He-Ne Laser was effective in reducing the edema resulting from the application of croton oil in mouse ears, while the Laser Ga-As did not show any anti-inflammatory effect in this

Abstracts model. It was observed an important tendency to worsening the dermatitis state after the Ga-As laser application. Financial Support: UNIVAP

95 LLLT ON DAMAGED MUSCLE CAUSED BY Bothrops moojeni SNAKE VENOM D.M. Dourado1,2, M.A. Cruz-Ho˝fling1; 1I.B. UNICAMP, Campinas, SP, 2UNIDERP, Campo Grande, MS, Brasil. The benefits of the He-Ne laser irradiation of the gastrocnemius of Swiss mice injected (i.m.) with Bothrops moojeni snake venom mimicking a snakebite were evaluated. Bothropic venoms are a mixture of toxins including myotoxins, hemorrhagins, anticoagulant factors and other factors responsible for the severity of the systemic and local effects. Sorotherapy has shown to be ineffective for neutralizing the local effects, resulting sometimes in permanent disability. Low-level laser therapy (LLLT) could be a new noninvasive therapeutic approach capable of accelerating revascularization and regeneration of muscle tissue. Three groups were tested: A (saline control), B (venom), C (venom+laser). Macroscopical. histopatological and a semi-quantitative evaluation was done after 24 h, 3 d and 7 d after the envenomation. Two, five and 8 sections of LLLT (4 J/cm2 during 1 m 32 s, each) were administered to rats of the group C sacrificed at 24 h, 3 d and 7 d, respectively. The analyses performed showed that in unirradiated (B group) venom-induced myonecrosis progressed with inflamatory infiltrate and extensive area of degenerated fibers. By 3 days an incipient number of regenerating fibers appear. Motor nerves presented injured axons. LLLT accelerate phagocytosis of fibers remnants and recovery of the tissue, decreasing the edema and increasing regeneration.

A35 channel recorder Gemini (Ugo Basile). Contraction amplitude, intensity, resistance to the muscular fatigue, creatine kinase release and area under the contraction curve were analyzed. Our results clearly demonstrate that laser radiation was able to induce an increase in time to achieve muscle fatigue at 1.0 J/cm2 . According to literature we may suggest that laser therapy may be acting raising the GMPc causing vasodilation and promoting and increase in blood supply to the skeletal muscle, this way reducing muscular fatigue. Financial Support: UNIVAP

97 MATHEMATICAL METHODS OF AUTOFLUORESCENCE SPECTRA IMAGING J.Makaryceva, M.Tamosiunas, J. Didziapetriene*, R.Rotomskis; Laser research centre, Vilnius University, *Lithuanian oncology centre, Vilnius, Lithuania Autofluorescence diagnostic is based on the detection of fluorescence arising from natural compounds within tissue. Diagnostic techniques based on optical spectroscopy have the potential to link the biochemical and morphological properties of tissues. These tissue features can be interpreted to shed light on a variety of clinical problems, such as precancerous and cancerous growth. Fluorescence spectroscopy can be developed and employed to differentiate diseased from nondiseased tissues in vivo. The altered biochemical and morphological state that occurs as tissues progresses from a nondiseased to a diseased state is reflected in the spectral characteristics of the measured fluorescence. Mathematical algorithms then can be developed and optimised to classify tissues into their respective histological category based on their spectral features.

Labat, R.M., Aimbire, F S.C., Prianti Jr., A., Ribeiro, W., Cogo, J.C., Zaˆngaro, R.A., Pacheco, M.T.T., Souza, F.B., Lima, M.O, Lopes-Martins, R.A.B.*; 1 Laboratoty. of Pharmacology, IP&D UNIVAP R, Shishima Hifumi, Sa˜o Jose´ dos Campos-SP-Brazil

We used 8 C57Bl/CBA mice, from which 4 was control ones, without tumour, and 4 diseased mice with hepatoma A22 on their right back leg. Autofluorescence spectra of normal and cancerous tissues have been measured from several parts (left and right legs, back, stomach, paw and tale) of mice in vivo. After that we compared spectra from different sites of control mice with the according sites of diseased mice. This was done in order to find out if the tumour had influenced whole organism in which case this would be reflected in spectral changes in all organs of organism that had tumour. This would let to detect tumour by measuring autofluorescence spectra from random places of the body.

Fatigue is a common symptom in neurological diseases. It is also physiologically defined as a failure to sustain force output or work rate during exercise. Skeletal muscle fatigue may lead to lesions and inflammatory reactions of the skeletal muscle. In this context, there are several experiences developed with lowlevel laser therapy as an alternative to antiinflammatory treatment. In this study we reported the As-Ga-Al (630-680nm) effects at the muscular fatigue model induced by tetanic contraction using the rat tibial muscle electrically stimulated. It was employed 4 distinct groups, 1 by control and other 3 by irradiation with 0,5J/cm2; 1,0J/cm2 and 2,5J/cm2 respectively. Skeletal muscle contractions were registered using a two

As a first step, two methods of pre-processing were applied to the spectral data. The preprocessed spectra are then dimentionally reduced to an informative set of principal components that describe most of the variance of the original spectral data set using PCA. A multivariate statistical algorithm was used to extract useful information from tissue autofluorescence spectra acquired in vivo. Principal component analysis was used to dimensionally reduce the pre-processed spectral data matrix to an informative set of principal components that describe most of the variance of the original spectral data. An unpaired, one-sided t-test was employed to determine the diagnostic content of each principal component. Discriminant analysis was

96 EFFECT OF LOW POWER Ga-Al-As LASER RADIATION ON (650 nm) ON THE SKELETAL MUSCLE FATIGUE INDUCED BY ELECTRICAL STIMULATION IN RATS

A36 used to develop a classification scheme for the discrimination of these useful spectral parameters into relevant histological/histopathological categories. The best discrimination was observed between stomachs; left and right back legs tissues of control and ill mice (with tumour on the right leg). The best sensitivity and specificity achieved by this algorithm for particular sites accordingly are 70,6% and 46% (stomach), 100% and 83,3% (left leg), 66,1% ir 83,3% (right leg). This reflects the high classification accuracy of fluorescence spectroscopy for the detection of cancer in vivo.

MULTIVARIATE ANALYSIS OF FLUORESCENCE EXCITATION EMISSION MATRICES OF ENDOMETRIAL TISSUE A. Vaitkuviene, E. Auksorius, S. Juodkazis, J. Vaitkus

DEVELOPMENT OF A PHOTODINAMIC THERAPY (PDT) LAMP SOURCE FOR TREATMENT OF AN ALL INTRA EPITHELIA NEOPLASIA J. Makaryeva, M. Padgett

98 SEM AND AFM STUDIES OF RAT INJURED TIBIAE AFTER HeNe RADIATION. M.A. Cruz-Ho˝fling1, I. Garavello-Freitas2, Z. Jingguo2, V. Baranauskas2 ; 1I.B., 2 FEEC UNICAMP, Campinas, SP, Brasil. Atomic force microscopy (AFM) and scanning electron microscopy (SEM) have been used to quantify bone morphology during post-injury ossification in rat tibiae and characterize the differences induced by laser photostimulation compared with the naturallyoccurring regenerative process. A hole (1.5 mm diameter) was done surgically in the tibia and two different doses of laser radiation were applied during 7 or 14 consecutive days starting 24 h after lesion. The collagen fiber lamellar organization, in the matrix, typical of mature bone, was promoted by HeNe laser radiation doses of either 31.5 J cm-2 or 94.5 J cm-2. Newlyformed collagen fibrils at the injury site of the irradiated animals improved lamellar organization and diameter of d = 613 - 650 nm (after 7 daily laser doses), which are close to the spatial organization and average diameter (d = 710 nm), typically found in the cortical surface of intact non-irradiated tibiae (controls), although smaller diameters fibrils (d = 360 nm) have also been observed in the regenerated tibiae of animals that received larger laser doses (14 daily doses of 94.5 Jcm-2). SEM and AFM images of the cortical bone at the recovery stages of 8 and 15 days after the injury are discussed.

Abstracts