LASER CIRCUMCISION

Laser has its role in circumcision. If you look for a tool to make a bloodless incision in doing circumcision, laser is the choice!

Carbon dioxide (C0₂) laser is the favorite because it cuts and coagulates almost at the same time. Water is the chromophore or absorbing component of the tissue when you replace the scalpel with laser. However, you lose your tactile sensation while using it because you cannot transmit the laser with a fiber. You can use it with fiber but you have to pay for the technology

You can design appropriate delivery system as needed like putting a prism in the hand piece for lateral or side firing.

If you like, you may use Nd:YAG laser where you deliver it with your intact tactile sensation. Increased quality of treatment including less pain is due to less edema post-operatively and increased level of local endorphins production following laser surgery.

If you need more information, you may contact The Indonesian Society for Laser Medicine via e-mail at iklasi_pusat @yahoo.com

LASER FOR VASCULAR LESIONS

Laser has beneficial effects for vascular lesions. In these congenital or acquired lesions, I use what is called as color-specific laser. In these particular lesions, hemoglobin is the targeted chromophore. Photons (= energy units of laser) will be much absorbed by hemoglobin. Surgeons will not use knife, they will have difficulties to control bleedings when they use it. So, laser is the only answer.


Some patients have been referred to me by my colleagues (thank you to my dear friends!):

• a 2-month-old baby with recurrent epistaxis due to nasal hemangioma, result: complete cure after laser surgery
• a lady doctor with facial telangiectasia, result: complete cure after laser surgery
• a 48-year-old male case with nasopharyngeal hemangioma with oropharyngeal extension and tongue hemangioma, result: residual lesions which needed a second treatment
• a 16-year-old male with tongue hemangioma, result: controlled after laser surgery (picture shown above)
  
• other cases with superficial varices of the facial and or legs
  

In my humble opinion, laser has an important role to make solution of these cases. However, most of the cases are within aesthetic indication, therefore you have to pay from your own pocket.

LASER ACUPUNCTURE IN DYSPHAGIA

In this article, I present to you an interesting case of dysphagia (=difficulty to swallow) in a male patient. He was found to have a solid tumor in the hypopharynx which I operated twice. When I controlled the lesion by endoscopy, it had gone and I found everything normal except for paralysis of pharyngeal arch. I dilated the esophagus with a bougie with no result. Recently, I did acupuncture with laser (not by needle) and he restored swallowing after one time treatment only!

LASER IN POST-RADIATION DERMATITIS

Radio therapy is one modality treatment given to a patient with head and neck cancer.However, due to the complicated anatomical structures of the head and neck, you may find side effects of this particular treatment. Hyperpigmentation and dryness of the skin is frequently seen with redness ulceration and inflammatory reactions.

Low power laser will sooth and the healing of these lesions is quick with regeneration of the skin lesions.Please find picture of my patient with neck dermatitis following radiotherapy for metastasis of nasopharyngeal cancer.

My experiences showed that low power laser have beneficial effects to post-radiation dermatitis. Biostimulation of these skin lesions improves the skin's condition very fast, shortly after laser illumination. Delivery technique using scanner will distribute laser energy evenly on the lesion.

SEQUENTIAL FOLLOW UP IN TREATING RECURRENT NASOPHARYNGEAL CARCINOMA WITH PHOTODYNAMIC THERAPY: Could patient acquire the advantages?*

Marlinda Adham¹, Fikry Hamdan¹, Heike Nyst², H.J.C.M. Sterenborg³, Robert van Veen³, Averdi Roezin¹,L.S.Handikin⁴, I.Bing Tan⁵

¹ENT Department, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, ²Amsterdam Medisch Centrum, ³Erasmus Medisch Centrum, ⁴PELNI Hospital, Jakarta,Indonesia, ⁵Netherland Kanker Institute Antonie van Leeuwenhoek, Amsterdam

OBJECTIVES

• Nasopharyngeal carcinoma (NPC) is endemic in certain parts of Asia, such as Southern China, but occurs sporadically in the Western world

• At Dr. Cipto Mangunkusumo Hospital, Jakarta, there are 90-120 new cases each year

• NPC is sensitive to both radiotherapy and chemotherapy (the first line treatment for NPC is irradiation)

• Several therapeutic modalities have been used in recurrent NPC including external irradiation, brachytherapy, chemotherapy, neck dissection, and combinations of those treatment. Serious side effects are seen following re-irradiation

METHODS

• Foscan (mTHPC, meta-tetrahydroxyphenilchlorin, temoporfin) is a second-generation photosensitizer which is activated by red light (652nm).

• It is a purified synthetic compound with a photophysical efficiency that allows short treatment times (typically 100 to 300 seconds), using small drug dosages

• The period of skin photosensitivity is approximately 2 weeks following injection of Foscan

Light delivery is achieved by using a linear diffuser inserted in a dedicated applicator for controlled light delivery
1 : cylindrical diffuser in shielding tube
2: target area
3: soft palate is shielded
4: variable diffuser length

7 days before PDT
mass on the right side of nasopharynx

20 weeks after PDT
No more necrotic area --> smooth mucosal surface

CT scan before PDT

CT Scan after PDT

BACKGROUND

• Photodynamic therapy is a therapeutic concept based on the ability of a number of photo-sensitizers to concentrate in tumour’s tissue

• Light of a specific wave length illuminating the sensitized cells can then be used to cause selective necrosis of the tumour

• The tumour is readily illuminated by fibreoptic delivery of light energy thus facilitating selective tumour destruction while sparing surrounding tissue

• Squamous cell carcinomas of the head and neck have been shown to respond favorably to PDT

• An induced period of generalized photosensitivity remains a side effect of Photodynamic therapy

CASE REPORT

• We reported a 59-year-old man with recurrent of stage II NPC post-external radiation 50 Gy locoregional, 2 Gy/day, 5 day/week, with booster 20 Gy into tumour bed seven months earlier

• Foscan was injected with dosage 0,1 mg/kgBW, 48 hours before illumination with PDT

CONCLUSION

• Photodynamic therapy could be an effective local treatment modality for recurrent or persistent nasopharyngeal carcinoma

• PDT treatment of recurrent/ persistent NPC has become feasible using a novel nasopharyngeal applicator

• Sequential follow up is necessary and useful for the patient to proof mucosal changes after illumination of photodynamic therapy

* Poster, presented at:
The 16th World Congress of the International Society for Laser Surgery and Medicine
The 1st Congress of the World Federation of Societies for Laser Medicine and Surgery
The 16th Congress of International YAG Laser Society
The 26th Annual Meeting of Japan Society for Laser Surgery and Medicine
Tokyo, Japan, September 7-10, 2005