Laser -- The Medicine of The Future

INTERSTITIAL PDT FOR PRIMARY AND METASTATIC TUMOUR

2008-10-05T19:09:00.004+07:00

Photo courtesy of House of Laser

PDT is one of the interesting modalities in cancer treatment.The availability of several photosensitizers and lasers are opening new pathways in photodynamic medicine, leading to a new era in the future of medicine.
(It should be mentioned that PDT will not be an umbrella only in oncology but will cover some areas including infectious and other degenerative processes or diseases as well.)
A technique of interstitial PDT has been offered in conjunction with other modalities in cancer treatment,as shown in this picture.
Selective cancer cells death by apoptosis and necrosis has been proposed to a formation of lysate following cytotoxic process of cancer cells.
Secondly vascular shutdown is another way to the killing of cancer cells.
Positive immune response is another way leading to improvement of patient condition.(see: Immunologic aspect of PDT/Laser therapy,a review by Santoso Cornain,MD,D.Sc, a link in this blog)

LIMFOMA MALIGNUM TONSIL

2008-07-02T15:25:00.004+07:00

Tonsil membesar satu sisi mungkin bukan pembesaran tonsil biasa akibat infeksi.Kemungkinan tumor harus difikirkan yaitu limfoma malignum yang melibatkan tonsil dan cincin Waldeyer.
Foto ini menunjukkan limfoma malignum pada tonsil palatina kanan.
Pada endoskopi ternyata dicurigai melibatkan jaringan limfoid nasofaring.
Gangguan menelan diatasi dengan pengangkatan tonsil yang mengandung tumor disusul dengan kemoterapi dan radiasi.

PDT:AFTER 4x24 HOURS

2008-06-18T22:06:00.004+07:00

This picture showed tumor condition 4 days after first illumination with laser.
The tumor was seen with prominent parts of necrotic (lower picture)and liquified mass(upper picture) area as result of PDT.
Please view pictures of previous posting.
Posting of PDT cases were also presented in Indonesian language in:
http://cahayamasadepan.blogspot.com

PDT: AFTER 2X24 HOURS

2008-06-16T15:17:00.004+07:00

Interstitial technique of PDT is used to debulk huge tumours.
The debulking process started hours after illumination by direct cytotoxic effect of PDT into tumour cells and by vascular shutdown
resulting in tumor apoptosis and necrosis.
In order to treat tumours thicker than 1 cm(limit of light penetration depth into the human tissue),the interstitial illumination technique was invented.
By this technique laser fibres with a light diffuser at the tip are implanted into the tumour tissue.
Laser fibres are feed-through needles,which can be placed under image guidance in the tumour(CT,MRI or US).
In large tumours,several fibres can be placed close to each other(12 cm apart) in order to illuminate the entire tumour volume.
Interstitial light delivery allows PDT to be used in the treatment of large,buried tumours and is particularly suitable for those whose surgery would involve extensive resection or for those who are unsuitable for surgery.
Due to the difficult and non precise light dosimetry in the tumout,interstitial PDT is mainly used with palliativeintention,as stated by Xu et al.
The pictures shown are PDT in large tumour of the neck,before (upper picture)and 2x24 hours (lower picture)after laser interstitial illumination.

PDT:A NOVELL APPROACH TO CANCER TREATMENT

2008-06-15T21:04:00.004+07:00

The content of this posting is derived from the review by Kecheng Xu,Guo Zhiqian,Lizhi Niu,from Fuda Cancer Hospital, Guangzhou.

PDT is a promising new approach for the treatment of cancer.

The principle of PDT is based on photochemical reaction,which is initiated by light activation of a photosensitizing drug causing tumour cell death.

Light is mainly applied by superficial illumination of the tumour and the surrounding tissue causing drug activation followed by tumour cell death.

The PDT is mostly used for superficial and endoluminal lesions like skin or bladder malignancies and also more frequently applied for the treatment of lung,esophageal,and head and neck cancer.

With the help of specially designed application systems,PDT is now becoming a practiceable option for solid lesions,including those in parenchymal organs such as the liver.

New techniques use glass fibres,which are stabbed into the tumour,leading the light directly into the tumour tissue.

The intra-operative application of PDT to treat and "mop-up" the tumour bed of any remaining tumour cells has been reported.

PDT damage heals mainly by regeneration rather than by scarring.
Due to the organ preserving principle of PDT,important structures are maintained with good functional and cosmetic outcome.

The principle of PDT and different indications for PDT were reviewed.

(Pictures show PDT procedure done in Gading Pluit Hospital,Jakarta,Indonesia. Photo courtesy of this blog author)

ACUPUNCTURE &HN CANCER

2008-06-13T04:39:00.004+07:00

ScienceDaily (Jun. 5, 2008) — New data from a randomized, controlled trial found that acupuncture provided significant reductions in pain, dysfunction, and dry mouth in head and neck cancer patients after neck dissection. The study was led by David Pfister, MD, Chief of the Head and Neck Medical Oncology Service, and Barrie Cassileth, PhD, Chief of the Integrative Medicine Service, at Memorial Slo an-Kettering Cancer Center (MSKCC). Dr. Pfister presented the findings May 30 at the annual meeting of the American Society for Clinical Oncology.(as reported by ScienceDaily to my desk)
My personal experience with surgery,radiotherapy,chemotherapy and PDT showed effectiveness of acupuncture (electro-acupuncture and laser-acupuncture) to control side effects and adverse events of cancer treatments.

PICTURE FROM BERLIN

2008-06-04T11:03:00.002+07:00

The picture showed author of this blog in front of the building where Max Planck lectured The Quantum Theory.
(Berlin,autumn,2006)

SURGERY FOR SNORING:TONSILLECTOMY AND UVULOPLASTY

2008-05-22T06:36:00.007+07:00

Snorer may have choices for surgical intervention.The type of surgery should be defined by an ENT Surgeon after clinical history and examination,including procedure name of sleep endoscopy.
This procedure of upper aerodigestive tract endoscopy examination while sleeping (through artificial sleep induced by medication)
The examination- using flexible endoscope(fiber endoscopy)- will look /locate the problem(s)(soft palate,uvula,tonsil,lateral pharyngeal wall,epiglottis etc).
The problem(s) of an individual case will be revealed and the surgery will be done based on these objective findings.

More than one finding or multi level obstruction maybe defined.
The picture of this posting show the patient following tonsillectomy and uvuloplasty,assisted by an Argon Beam Coagulator.(a medical device to coagulate/stop the bleeding during surgery).
This posting is only for public information.
You have to consult your doctor if you have problem of your health,including snoring.
One type of snoring is OSA(Obstructive Sleep Apnea), which is one of the major public health problem in the world.

PHOTODYNAMIC THERAPY IN NASOPHARYNX CANCER

2008-04-22T07:03:00.004+07:00

L.S.Handikin

ORL&HN Surgery

Photodynamic Therapy (PDT) is a (relatively) new modality in cancer therapy.

It is based on the selectivity of cancer cells to retain a number of photosensitizers (in comparison to normal cells).

Following activation of the drugs (photosensitizer) by a light of a specific wavelength delivered through fiber optic, a selective necrosis will take effect only on cancerous tissue.

The tumour is selectively destructed by fiber optic delivery of relatively low light energy.

There is interval time of the photosensitizer injected intravenously and light illumination due to the longer capacity of cancer cells to retain the drug.

The normal cells will escape the photochemical destruction of PDT.

The author will describe application of PDT in nasopharyngeal cancer which nowadays could be considered as an effective local treatment for recurrent or persistent nasopharyngeal carcinoma.

Keywords: photodynamic therapy,nasopharyngeal cancer,photosensitizer,light energy

Abstract of paper presented to Scientific Symposium of Recent Advances in Cancer Diagnosis&Therapy, multi-disciplinary aproach
in conjunction with the Grand Opening of Gading Cancer Center,March 14-16,2008,Gading Pluit Hospital,Jakarta,Indonesia

Slide:Post PDT endoscopy of nasopharynx cancer with necrosis

THE ROLE OF ACUPUNCTURE IN CANCER THERAPY

2008-03-28T00:06:00.008+07:00

The role of acupuncture in cancer therapy is evidenced.
It controls nausea,vomiting following chemotherapy and/or radiotherapy.
It alleviate cancer pain.
It should be integrated in cancer therapy : before,during and after any kind of treatment modality.
You may see smile on his/her face.

THE FATE OT FAT CELLS AFTER LASER LIPOLYSIS

2008-03-21T15:26:00.004+07:00

Laser can induce lipolysis using pulsed Nd:YAG laser.The laser has a 1064 nm wavelength and the fat cells will undergo cell wall destruction.You will get the end-product of an oily liquid in the target area where you can aspirate if you want.
The aesthetical aspect of the targeted part of the body in the laser lipolysis is to make the body in a balanced and a harmony condition.Healthy and beauty in a body will make you happy.
I hope that I can show you the end product of laser lipolysis in this blog.

THE FATE OF CANCER CELLS AFTER PDT

2008-03-21T10:06:00.004+07:00

Illumination of the cancer cells by laser light will selectively destroy these patological cells while normal cells will remain intact.The pictures show the illumination procedure and the end product(the liquid) with no more cancer cells(cytology show no cancer cells).

These pictures show you:
* the procedure of PDT and
* the end product of PDT in a syringe .
The aspirate shows no cancer cells by cytology examination.

A CEREMONY FOR GADING PLUIT CANCER CENTER

2008-03-13T05:27:00.004+07:00

Gading Pluit Cancer Center was officially opened(Wednesday,March 12,2008).A public education program on breast cancer,followed by a press conference to media representing the center activities.
A seminar named The Recent Advances in Cancer Diagnosis&Therapy, multidisiplinary approach were conducted on March 14-16,2008.

HPD-PDT SOME TECHNICAL CONSIDERATION

2008-03-11T04:51:00.006+07:00

HPD is abbreviation of Hematoporphyrin Derivative
It is a name of a photosensitizer,a chemical compound which will be sensitized and reacted to light.
The pathological cells which retain photosensitizer molecules will be dead due to direct cytotoxic process.
The bloodvessels nurturing the cancer will be shut down.
The necrotic cancer will stimulate the immunity of cancer patient.

The laser:

The machine generates the red visible laser light with a wavelength of 630 nm.The deviation of output wavelength is +/- 5 nm.
The output power of each way (of 3 ways) is from 100 mW to 1000 mw( 1 W),continuously adjustable.
The instability of output power is less or the same of +/- 10 %
The semiconductor laser beam,as the output power is less than 1 Watt,it may lead to three-degree burns on;ly in the situation of focusing or less than 10 mm distance to light extraction end
in using flat-head fiber.

Safety conduct

-Do not look directly at laser beam and its reflex.The visible red light is harmful to eyes.
-All field operator should wear protective glasses
-The protective glasses are specific in its optical density to the laser wavelength which provide enough protection to radiation of 630 nm laser beam
-Patient should wear protective glasses or putting mask on patient's face
-The exposed parts of patient's body should be covered with cloth cover
-Possible explosive matters should be forbidden (alcohol,gasoline,organic solvent.)
-Clothing,gauze and other flammable substances should be removed from the optical path
-A fire extingusher should be placed in the laser area
-Reliable grounding is very important to operation
-Warning labels should be placed to make personsaware of laser operation

LASER FOR POST-RADIATION DERMATITIS

2008-02-07T14:24:00.000+07:00

Laser may support healing process of post radiation dermatitis as you can see in the above pictures..

For nasopharyngeal cancer,the golden standard is radiation( eitther external radiation only or maybe combined with internal radiation(brachytherapy).

Most of the patients were diagnosed at the the late stage where a combination with chemotherapy were needed.

A new modality of treating nasopharyngeal cancer using laser and photosensitizer named Photodynamic Therapy is now going into popularity among cancer centers.A new generation of photosensitizer which is more potent is now available in the market.

LASER FOR DOUBLE CHIN

2008-01-29T22:01:00.000+07:00

Laser is offering treatment for double chin,a procedure as part of what is called laser lipolysis.Usually there is no suction procedure during or after lipolysis in this special area.

Tumescent anaesthesia is a special technique for this kind of minimal invasive procedure which is suitable to be done in the doctor office but should be done under strict aseptic and antiseptic control.

A small canulla for laser delivery to disrupt fat cell's wall will need small incission only.Therefore it does not necessary to do suctioning of the lysis product of the fat in this area and stitching of small incission.

TRANSNASAL LASER IRRADIATION

2008-01-29T18:30:00.000+07:00

If you sneeze after waking up in the morning you may have allergic rhinitis.You can go to a drugstore and take antihistamin (OTC,not under doctor prescription drugs) or you see your famili physician or your ENT doctor.They may prescribe another medication which should be under strict medical supervisison,for possible side effects like drowsiness or dry mouth.If the medicine does not help you ,the doctor will change the medication to nasal vasoconstrictor or steroid nasal spray.

The anti inflammatory of low power laser has been known very well among doctors and laymen.Laser will give you bonuses:biostimulation effect,local endorphin production to reduce pain,more ATP production antiseptic etc.

LASER FOR STROKE

2008-01-29T17:20:00.000+07:00

Laser has a role in the prevention,treatment and stroke rehabilitation.

You can see your blood condition under the microscope.

If you look your red blood cells clustering each other or making a "military parade", it means that your blood is not efficient bringing oxygen to your tissue or organ.

You should be aware of this condition ,because you might have a problem with your blood circulation.

If you are brought into laser irradiation under your doctor recommendation and supervision ,your organ will have more oxygen and they will work more efficiently.

GLOBAL WARMING IS GLOBAL WARNING FOR DISEASES

2007-11-02T08:22:00.000+07:00

I just viewed a wake up call CD: An inconvenient truth, a presentation by former US Vice President Al Gore.
My son who have just entered a medical school told me that it was late for his father to be aware of the issue when he had learned the problems while he was still in the elementary school.
I said it is better late than never.
But maybe I was one among the majority people in the world who do not have any opportunity or time to think gobally or understand the global problems.We faced so many local problems here.
We just think about how to get enough money to buy bread (or rice in our contex ) for tomorrow and enough money to send our children to school.
One of the most interesting problem of global warming is its influence on health and diseases in general,not only of human species only.
I remember a meeting in Tokyo two years ago(2005):laser(energy medicine) should be an umbrella to many physical,mental,socio-economical problems of the world.
We need a political goodwill and change of our mindset now.

LASER FOR VIRAL ENCEPHALITIS

2007-10-25T22:54:00.000+07:00

We had a very recent dreadful experience when a colleague doctor was suffering from an encephalitis as a complication of a very contagious varicella.
He contracted the same disease along with his children ,making him delired,febrile and convulsed and fell into an unconscious state.
He was sent to ICU to go under strict control of our intensivist.
He was given acyclovir as a principal anti- viral therapy.
However,we gave him a supportive therapy by a photonic energy infusion ,and it is our believe that this supportive therapy has resulted in a very soon and fast recovery,without any sequelae of the brain insult.Brother,we thank God for your recovery!

WORKSHOP ON LASER LIPOLYSIS

2007-07-29T17:22:00.000+07:00

It's great to experience a workshop on laser lipolysis!
The event was conducted on Saturday and Monday,July 21 and 22,2007.
Place:Pelni Hospital,an old hospital who had rejuvenated its face with a six level building with its top level facilities for an updated conferences/meetings. Internet and multimedia equipment will facilitate your meeting or confefrences.
The schedule of laserlipolysis workshop consisted of introduction,background of laserlipolysis,comparison with the existing traditional techniques,the history of development of laserlipolysis,technical information,the interaction of the laser beam and the fat,tools and indication,sequence of the procedures,how to treat the different areas and energy used,after care following the procedures,live demo of 6(six) patients,3 without aspiration and 3 with aspiration techniques.
I was invited to be moderator for this interesting workshop with speakers :Prof.Dr.Nichola Zerbinati (dermatovenereologist )and Mr.Dario Di Fiore,Area Manager Deka Company.

Laser -- The Medicine of The Future: LASER FOR DIABETES MELLITUS AND SHOULDER HAND SYNDROME

2007-07-03T21:10:00.000+07:00

Laser -- The Medicine of The Future: LASER FOR DIABETES MELLITUS AND SHOULDER HAND SYNDROME

LASER FOR DIABETES MELLITUS AND SHOULDER HAND SYNDROME

2007-07-03T20:44:00.000+07:00

I have just finished my laser therapy for my latest patient with and diabetes mellitus,neuropathy ,shoulder hand syndrome.
She was a lady of 68 years of age with a long lasting diabetes mellitus and paraesthesia of both of her feet and hands.
I give her a laser therapy on the left shoulder point detected by electrodetector and directly she could raise her hand without pain.
I could see tears dropped off on both of her eyes.
She told me that she consumed food supplement for years and was happy of her condition.
Posted by :lshandik@gmail.com

FACIAL PARESIS POST MASTOIDECTOMY

2007-06-24T21:11:00.000+07:00

Facial paresis or paralysis were complication which might be unpredictable following mastoid surgery.
Even if you are operated by an experienced surgeon,the unwanted complication might be happened.
I want to tell you of an interesting case of my own ,who was a nurse in my hospital.
The paresis was almost complete a day following the surgery for a left mastoiditis.
I give her low power laser therapy and the result was a complete recovery.
Another recovery was found in a patient with otalgia and vertigo due to right mastoiditis with choleasteatoma ,who underwent mastoidectomy.
Again,low power laser is not as low as one may think of it!

Posted by L.S.Handikin,MD
Jakarta,Indonesia
lshandik@gmail.com

A REPORT MORE THAN 25 YEARS AGO

2007-06-24T19:31:00.000+07:00

More than 25 years ago,my work with Kurniawan(now professor of anatomic pathology) was publish in the official publication of The International Society for Preventive Oncology: CancerDetection and Prevention,volume 4 numbers 1-4,1981.
Our work was on the usage of an acidic metachromatic dye named toluidine blue for study of the in vivo technique for laryngeal lesions .
Our experience suggest that in vivo staining may be a useful method for early detection of laryngeal cancer used as an adjunct to microlaryngoscopy.
Now it progress to a technique of using toluidine blue as a photosensitizer in photodynamic therapy used in cancer therapy.

Posted by: L.S.Handikin,MD.,Otorhinolaryngologist
President,TheIndonesian Sociey for Laser Medicine
lshandik@gmail.com

LASER SOFTENED KELOID

2007-06-21T17:59:00.000+07:00

Low power laser softened the keloid scar.
It is a new fact I just find in my patient.
This should be is a good news I want to tell you ,readers of this blog.
Of course I want to meet more patients and more experiences.
Scarring is something to avoid in post operative cases,but it should be considered before any surgery.
If you have tendency of keloid, do not forget to tell your surgeon before the operation commence.

Posted by L.S.Handikin,MD
Otorhinolaryngologist,Head and Neck Surgeon
Jakarta,Indonesia

NAMES OF LIGHT WARRIORS

2007-06-19T21:54:00.000+07:00

I have several names to mention as persons who may represent light warriors.
One of them is Freddy Kuhuwael,a medical doctor who devotes laser as a scalpel.If you know him,you should have visited Makassar one or several times .
Let me mention a lady doctor specializing in otorhinolaryngolgy,Dr.Sari.She dedicated laser as a tool in photodynamic therapy , a new important armamentarium in medicine you should know.
Interest,knowledge,dedication and last but not least:imagination are important values in laser surgery and medicine.

LASER IN NECK SCAR FOLLOWING TRACHEOSTOMY

2007-06-17T03:53:00.000+07:00

I have an interesting case of a neck scar following tracheostomy.He had an inspiratory stridor during examination.
The past history tells a cardiac surgery,following which a respiratory distress had complicated post operatively.
The main problem is a keloid formation tendency.He has a keloid scars on the deltoid region following a smallpox vaccination,xiphoid region following incission for heart surgery.
CT scann of the neck and thorax showed a retrosternal abberant of thyroid gland.
My thorax surgeon told this patient should undergo a tracheal resection and end to end anastomosis.However the underlying problem of scar formation following surgery is a real threat for surgery.
I decided to give him a low power laser therapy following which a real thing happened : less stridorous sound and less dyspneuic sensation.Thank God The Almighty.

LASER AND TORCHS INFECTIONS

2007-06-13T21:24:00.000+07:00

Recently I was attracted by patients with interesting infections.As an otolaryngologist I always check my patient neck forsigns and symptoms of TORCHS enlargement of lymph glands.This is maybe a late signs of nasopharyngeal carcinoma metastasis to neck glands.
My experiences teached me of non specific neck gland enlargements of banal infections or specific infection process of tuberculous origin.
I have read some experiences of how low power laser therapy can do and solve for this interesting problems.
But let me write a short notes on these cases:
1.A woman with a general inflammation and pain due to the toxoplasma,rubella,citomegalovirus and herpes simplex infections.
2.A young female with otalgia(ear pain),headache,referred to me for suspected cholesteatoma of right mastoid cavity.There is no reason to do the mastoid surgery because this patient was a case of TORCHS infections.
3.A boy with autism with mother suffering from TORCHS.
4.An adult male with headache,tinnitus,hearing loss suffered from TORCHS infections
and some other cases I think will make a long list of TORCHS infected persons.
I believe that laser therapy has a place to help these patients.If you know them,will you send them to the hands of doctors who understand laser as a medicine?

LASER AND HEALTH INSURANCE

2007-06-06T05:43:00.000+07:00

There is still a problem for my patients dealing with reimbursement for laser services.It is true that usually you will not be reimbursed for aesthetic laser services.
As a clinician I would say that laser has some evidence based datas of better or best outcomes only if it is in the hand of competent medical personnels.Examples of the cases are laser therapy for congenital hemangioma which is a real medical problems and not merely an aesthetic problems or laser therapy for chronic pain.
In this case I would write a letter of confirmation that laser therapy is a needed procedure to make solution for the problem.
Please check your insurance company before your laser treatment by your doctor for confirmation of reimbursement!

LASER FOR SINUSITIS

2007-05-27T19:23:00.000+07:00

These X ray pictures (Water's position)show sinus condition before(upper) and after laser therapy(lower).

They tell the story of low power laser therapy for sinusitis.

This is one among my case studies in my private clinic.

www.cahayamasadepan.blogspot.com

I have some interesting experiences in treating sinusitis with low power laser.

1.Simptoms and signs are variables,but always dealing with ear nose and throat problems.
2.Diagnosis of sinusitis is difficult without X- ray,esp.Waters position.
3.CT scan is a necessity and adjunctive esp.if you need a surgical approach.
4.Functional Endoscopic Surgery is done for minimal invasive treatment.
5.Surgical laser to correct anatomical problems and functional endoscopic surgery is appropriate if it is needed to do surgery and biomodulation effects as a bonus.
6.Low power laser is not low if you know the apropriate dosage for the patients.

This is my personal experiences and opinion only.You can contact me at lshandik@gmail.com,if you need my personal second opinion.

NEW GENERATION OF LIGHT WARRIORS

2007-05-21T01:46:00.000+07:00

More than 30 medical doctors from Jakarta and surroundings,Surabaya and surroundings,Bali,Lombok,Makassar,Palembang,Jambi and others got a gathering in Pelni Hospital, an old hospital situated in western part of Jakarta,the capital city of Indonesia.
Most of them are lady doctors who have a dream to get competency in aesthetic practices or attenuating pain of their patients.
Basics of laser medicine were lectured by Abraham Arimuko,a specialist doctor in skin and venereal disease,Handikin specialist in otorhinolaryngology,Santoso Cornain,a professor in immunology,Peter Hasan,medical doctor,founder of Iklasi.
The theme for live demo of laser in superficial skin lesions were coloured by a vivid demo of peripherasl blood analysis following laser therapy.
The lasers demonstrated were carbondioxide laser,Q- switch Nd:YAG,Erbrium Glass laser,Diode laser.Patient models were of verruca,naevi pigmentosus,skin tags ,tattoo.
A new generation of laser practitioners were born,however they should proceed to preceptorship programs developed by IKLASI.

LASER ACCUPUNCTURE IN TORTICOLLIS

2007-05-13T08:21:00.000+07:00

Torticollis (inability to perform lateral, dorso or anteroflexion of the neck) is an interesting clinical sign. Patients will look for a helpful doctor to take care. I will tell you a story about an anxious lady with a very painful neck. She was brought to our clinic on a wheelchair. Both of her hands were touching her neck at all times.

I had to put her flat on the bed in order to detect the points and start injecting the laser light. Then, the painful neck was starting to fade away, her condition was gradually improved. She could flex her neck laterally to the right and left side without any meaningful pain sensation. Thanks to this lady, I learned even more lessons of this bright red light called laser.

LIST OF PATIENTS BEING TREATED WITH LASER

2007-05-11T06:39:00.000+07:00

There are cases of interest being treated with laser.
One of the case is a woman with aphonia following typhoid fever.Laryngeal endoscopy is not remarkable.
It is an amazing event when we can hear the sound uttered just following laser irradiation,guided by a detector to find points in the neck.
Another cases being treated and/or under list:allergic rhinitis with sinusitis,anosmia and tinnitus,a child with hearing loss following head trauma etc.
May I quote Toshio Ohshiro MD DMedSci:

Pure light is the medicine of life

L.S.Handikin,MD
Jakarta,Indonesia

LASER THERAPY FOR PSORIASIS,VITILIGO ETC

2007-05-02T06:28:00.000+07:00

I was invited by Bing Wibisono,MD,Director of Laser Skin Center,Gading Pluit Hospital,Jakarta to deliver speech on the Seminar on Phototherapy in Skin Diseases last Saturday,April 28,2007.This is a new era for laser therapy in the field of Dermatology,where doctors may find some difficult to treat lesions and diseases.
A friend of mine named Benny Wiryadi MD,PhD an expert in psoriasis talked about the story behind this autoimmun process of the disease.It is along way and of a long list of treatments of psoriasis :creams,ointments,lotions,shampoos etc.(topical) and oral psoralen,injections(systemic),phototherapies(ultraviolet).
Patients come and go to consult the doctor with a hope to have a longer remission.
A monochromatic excimer light with its 308 nm wavelength will give a rapid and effective treatment in resistance psoriasis.
Another indications for MEL@308 nm are:vitiligo,alopecia areata,atopic dermatitis.
I will tell you about this interesting excimer technology in the next posts.Keep eye on this blog.

IKLASI AWARDS 2007

2007-05-02T05:45:00.000+07:00

THE INDONESIAN SOCIETY FOR LASER MEDICINE has awarded trophy to Tiur Farida MD,specialist in Physical Medicine and Rehabilitation for research on the laser therapy on hand rheumatoid arthritis.This is the 3rd trophy given by IKLASI(The short of Ikatan Kedokteran Lasert Indonesia=The Indonesian Society for Laser Medicine) to research in clinical application of laser.The ceremony was held in Santika Hotel,Jakarta last Saturday,April 28,2007 and the award was handed over by Mulyono Soedirman,MD,chairman of Continuing Professional Development Comission of The Indonesian Medical Association.
I posted this news to this blog with a hope that its will inspire young doctors and researchers to joint research programs in laser medicine.
You may contact me :L.S.Handikin,MD,President The Indonesian Society for Laser Medicine by email: lshandik@gmail.com
P.S.Welcome to Basic Course on Laser Medicine and Surgery will be held in Pelni Hospital,Jakarta next Sunday,May,20,2007,contact Riza by phone 62-21-5306793 office hour to check available seat!

IN HOUSE TRAINING FOR DIODE 980 nm LASER

2007-05-01T19:50:00.000+07:00

I want to tell you about a surgical laser of 980 nm in wavelength.If you need a laser to do minimal invasive surgery with less bleeding and more convenient in a user friendly atmosphere,you can choose it.I was delighted to bring doctors at The Department of Otolaryngology,Head and Neck Surgery,Faculty of Medicine,University of Andalas/Dr.M.Djamil Hospital,Padang,West Sumatra to join in a house training for laser surgery in ENT Head and Neck last August,2006.Congratulation to you all and have a great experiences in

laser surgery!

LASER FOR DIABETIC ULCERS

2007-04-30T01:11:00.000+07:00

Last November we supported an Asia Pacific Congress on Diabetic Ulcer Problems.Experts talked about diabetic foot problems and how to take care of this difficult to treat complication of diabetes meliitus.There were interesting topics of treatments incl.antibiotics,anti-inflammatory agents,physical therapy incl.ozone therapy,low power laser therapy,stemcells to surgical treatment.
Laser treatment will be discussed in the next publication of this interesting topic incl.pictures of the lesions,before and after treatment.

PHOTOTHERAPY WITH RED AND BLUE LIGHT IN ACNE VULGARIS

2007-04-30T00:22:00.000+07:00

If you have one of the commonest skin conditions to affect humans named acne vulgaris,you may interested in this article.
Researchers from the Unit of Dermatology,Imperial College of Science,Technology andMedicine,Hammersmith Hospital,.London,Papageorgiou,Kasambas and A.Chu had done study on phototherapy with blue(415 nm) and red(660 nm) light in the treatment of acne vulgaris.
They have evaluated the use of blue light and mixed blue and red light inj the treatment of acne vulgaris.
The combined blue-red light phototherapy was significantly superior to that achieved by blue light(at weeks 4 and 8 but not week 12),benzoyl peroxide(at weeks 8 and 12) or white light(at each assessment).
The results achieved probably by combining the antibacterial and anti-inflammatory action and is effective of treating acne vulgaris of mild to moderate severity,with no significant short-term adverse effect.Consult your doctor for further clarification.
(Source:British Journal of Dermatology 2000;142:973-978)

IN HOUSE TRAINING FOR LASER SURGERY

2007-04-30T00:19:00.000+07:00

Date:August 2006
Place:Dr.M.Djamil.Padang,West Sunatra
Laser:Diode 980 nm,ex Biolitec,Germany

To Meet Summit: Outstanding Master Blogging

2007-04-25T08:12:00.000+07:00

To Meet Summit: Outstanding Master Blogging
Thank you for outstanding works
Liek Sari Handikin
lshandik@gmail.com.

LASER IN A RARE CASE OF NASOPHARYNGEAL NEUROFIBROMA

2007-04-22T09:40:00.000+07:00

I want to describe an interesting case of nasopharyngeal neurofibroma sent to me (at last). This is a very rare benign tumor of the nasopharynx which I operated last week only. She is a young female aged 23 years complaining right nasal obstruction. Biopsy showed a benign tumor named neurofibroma.

I decided to resect the tumor by lateral rhinotomy approach, assisted by carbondioxide laser. A carbodioxide laser tell us: what you get is what you see,I decide to use it. Please enjoy how the case teach us in these pictures.

INSTRUMENTS FOR LASER ACUPUNCTURE

2007-04-21T22:23:00.000+07:00

There are some instruments to use for laser acupuncture.First the laser itself:two main types of laser are:Helium Neon (gas)and the solid state diode laser .
The penetration of these two lasers are different , depends on the wavelength.The longer the wavelength, the deeper is its penetration.
Why we use laser,are there advantages of lasers over needles?
First we can say that laser acupuncture is painless and no sensation of numbness in the side of patients.People sometime afraid of needles, especially children.
Secondly it is harmless and does not cause tissue damage.
Thirdly it is completely sterile
The last one it is simple to operate.
I myself prefer to use instrument for laser acupuncture equipped with point detector.
IT'S GREAT TO TREAT AND CURE WITH LASER ACUPUNCTURE!

LASER ACUPUNCTURE AND PRAYERS

2007-04-21T20:53:00.000+07:00

Two days ago I have a patient :a Mr.H who suffered from low back pain.
I remember he had been hospitalised for more than 4 weeks,lying on his back like a baby and every time went to toilet on a wheel-chair.
Now he visited my clinic ,walked like a giant without any feeling of pain .He looked very happy with a smile around his face,very nice gentleman with his long grey hair.
He told me that his big boss had called him by telephone to learn his health condition,(he is an engineer by profession in an airline company),of course this is why he looked so happy. Laser had given us more experiences to learn.
Now I'd like to send a good news.If you believe laser will give positive effect for your health then consult your medical doctor,because it should be given by an experienced and competent hand.
I read a report in my red journal:relief of chronic low back pain immediately after one session of low level laser acupuncture therapy.Significant improvement in functional and symptomatic outcomes were revealed.With silent prayers it gives more! Thank you Dr.Dhiya!

PHOTOMEDICINE AND LASER SURGERY

2007-04-18T07:16:00.000+07:00

This is a name for a scientific journal dealing with photomedicine and laser surgery.Recently the journal includes more photomedicine and LLLT( shortage for Low Level Laser Therapy).The latest research,technologies, and therapeutic applications of laser medicine and photobiology.
This journal is the Official Journal of World Association for Laser Therapy(WALT),North American Association for Laser Therapy(NAALT),International Society for Laser Surgery and Medicine,International Musculoskeletal Laser Society.
Photomedicine and Laser Surgery is the central forum in the growing fields of phototherapy,low-level laser therapy,photobiology,and biophotonics and the application of these techniques and technologies in medicine.
It covers the latest developments in the areas of photobiomodulation relative to improved understanding of the mechanisms of biostimulation and bioinhibition;and explores the concepts of low-level laser therapies as a means of increasing collagen synthesis,reversing photoaging,and stimulating wound healing.
The journal provides the newest procedures and developments in laser surgery and related biotechnology including:
*Basic and clinical research
*Expanded application
*Prodedures in medicine,surgery,dentistry,and safety
*New instrumentation
*Optical diagnostics
*A broad range of activities related to the understanding and apllications of biostimulation
Please visit www.liebertpub.com/pho to subscribe.

Posted by :Liek Sari Handikin,MD.,President,The Indonesian Society for Laser Medicine

THE LEGEND OF THE LIGHT-BEARERS

2007-04-14T23:39:00.000+07:00

I am fortunate enough to have an opportunity to read The Legend of the Light-Bearers,a fable authored by Dr.Joe Rubino.
He is a known motivator and co-founder of The Center for Personal Reinvention, an organization for training and development of leadership and productivity and CEO of Visionary International Partnership.
To know and learn more about this person with the background as a dentist you can surf Google search engine and put his name as a keyword,but I think you may have known him as an icon for personal development program in North America.
One of his books is The Magic Lantern:A Fable About Leadership Personal.
I myself is interested in light especially of laser with its photon as unit of energy.
You can applylaser for several kind of diseases ,you can understand it if you have changed your mindset,so you will have another opportunity to relief human misery.

CHANGE YOUR MINDSET,CHANGE YOUR LIFE

2007-04-10T17:07:00.000+07:00

Everything is changing ,your mind, your body and your soul.
You should change your mindset first and then you will be able to run on your own life -track.
You are leader of yourself.
Do not follow anybody who run on the wrong track,you are you.
Focus on what you want to be.
I learn that laser go direct to hit the target.
Its color depends on its wavelength and it is always a single color.
If you have your own "color",you go direct to where you want to go or what you want to be. As shown here in my picture, it is KTP532 laser in the color of green used for cutting laryngeal cancer.

LASER AND THE MYSTERY OF HEARING LOSS

2007-04-09T23:39:00.000+07:00

Imagine if you suddenly could not hear when someone calls you. You suffer from sudden hearing loss. I have several studies on my own patients with difficulties in hearing. It seems likely that they want to tell their feelings with their eyes hoping a miracles to come.
I always tell my young friends to send immediately to the emergency room if this is a case with sudden hearing loss.
Sudden hearing loss is a mini-stroke ,so refer the patient immediately!
What can laser do with these cases?You can even try to prevent these cases!

Some cases of sudden hearing loss which were treated with lasers are reported at http://rehab-med.blogspot.com

Further inquiries, kindly send an e-mail to me: lshandik@gmail.com

THE SECRET OF HEALING LIGHT

2007-04-09T22:24:00.000+07:00

I think you still remember my recent writings of Warrior of the Light.
Now I introduce you to another interesting book named The Secret Life of Water.The author of the book is a wellknown name: Dr.Masaru Emoto. This book has many illustration of pictures of water crystals..He made it using a high speed photograpgy,and we can see beautiful views of water crystals. You talked nicely to the water and you will have beautiful crystal as reward.
He wrote other books:The Hidden Messages in Water and The True Power of Water.These books are best sellers,according to New York Times.
Now I can tell you that water is well understood as a chromophore that absorp light.I have a carbon dioxide laser in my office to cut,ablate ,excise,coagulate or evaporate the undesired tissues from the body of my patients.The works is done by this wonderful molecules named water.Water and light make a beautiful interaction, a dance of miracles we can imagine!
You may ask an expert to heal your chronic pain using light!

TECHNIQUE OF TUMOR DEBULKING IN THE HEAD &NECK USING Nd:YAG LASER

2007-04-08T22:52:00.000+07:00

L.S.Handikin,P.Hasan,Pelni &Husada Hospital,Jakarta-Indonesia

Abstract

The goal of tumor treatment is eradiaction of the disease while maintaining the patient"s quality of life.In saome cases with head and neck tumor we have used Nd:YAG laser for tumor debulking.
Tumor was diagnosed clinically and its pathology was verified through biopsy.Squamous cell carcinoma underwent in vivo staining technique to observe dysplasia,ca in situ,pre invasive carcinoma or second focus of malignancy.
Tumor delineation was done with imaging system(contrast CT scanning,MRI).Whenever possible debulking procedures were done endoscopically,to minimize surgical trauma.Imaging control was done to observe the result.We used knife for skin incission only.Nd:YAG laser was used for cutting,coagulating and evaporating purposes.
For illustration,cases of nasal,paranasal,tonsillar,laryngeal and nasopharyngeal tumors treated with Nd:YAG laser were presented.

Keywords:Nd:YAG laser;Head and Neck Tumor;Tumor debulking

WARRIOR OF THE LIGHT

2007-04-08T05:21:00.000+07:00

Warrior of the Light is a short notes on accepting failure,embracing life,and rising to your destiny.I just recently find this book handed to me by my daughter,who endorsed it to me hoping me read the book it,and it was what I have done.
May I quote some words of this interesting book:
What is a Warrior of the Light?....".He is someone capable of understanding the miracle of life,of fighting to the last for something he believes in-and of hearing the bells that the waves set ringing on the seabed."...."He had never thought of himself as a Warrior of the Light.....Everyone is capable of these things.And,though no one thinks of himself as a Warrior of the Light,we all are......(prologue)"He realizes that he is acting as a channel for some higher wisdom"(page 13).......-the Universe is going to help Warriors of the Light and hinder the prejudiced.The Earth's energy needs to be renewed.New ideas need space.Body and soul need new challenges.The future has become the present,and every dream-except those dream that involve preconceived ideas-will have a chance to be heard....(page 17)
PAULO COELHO(the author of this book) has inspired millions worldwide,including me,and maybe you too.

START BASICS JUMP TO BIG OPPORTUNITY IN LASER MEDICINE

2007-04-05T23:25:00.000+07:00

Dear colleguae,
There is an exclusive world of medical practice:Laser Medicine.
As President of The Indonesian Society for Laser Medicine,(IKLASI)may I invite you to joint our Basic Training Program in Laser Medicine and Surgery.The training will be dated on Sunday,May 20, 2007 Venue:Auditorium Pelni Hospital,AIP II KS Tubun 92-94,Jakarta Barat 11410.Trainers will be scientist- medical doctors-laser expert-experienced laser clinicians.Topics laser basics:introduction to laser medicine,laser physics,laser tissue interaction,laser safety,how to operate laser,laser application in various medical specialties etc.Live demo will also be demonstrated esp.for skin lesions.We welcome you whether you are a general practitioner or specialist physician.Please contact Riza by phone 62-21-5306793 ,HP/SMS :0817-0136600 or fax:62-21-5306907 e-mail:iklasi_pusat@yahoo.com
Regards
IKLASI(Ikatan Kedokteran Laser Inddonesia)
L.S.Handikin MD (President)

New Generation Lasers & Leading Edge Treatments With CANDELA Technology

2007-04-04T22:50:00.000+07:00

A laser workshop was taken place in Gerbera Room, Mulia Hotel, Jakarta, Indonesia on February 28, 2007. There were 2 speakers: Taro Kondo, MD (Tokyo Women Medical University) and Aryani Sudharmono, MD (Division of Aesthetic Dermatology, Dept. of Dermatology and Venereal Diseases, Faculty of Medicine, University of Indonesia).

Taro Kondo talked about “Gentle YAG Treatment in Hair Removal ,Vascular Lesions and Skin Rejuvenation” while Aryani Sudharmono presented “V Beam Experiences in Indonesia”. As an addition to the speakers’ presentations, a live demo was presented by Taro Kondo for Gentle YAG and V Beam Perfecta.

Overall, this meeting was a great opportunity both for doctors and investors. The market is growing even greater and faster with the raising demand and better understanding of individual health as well as the interest to beauty and wellness.

Many doctors are interested in Laser Medicine and Surgery. Recent data shows that more than 400 doctors are now registered as members of The Indonesian Society for Laser Medicine. Training and education are most important and highly critical in the competency development programs in laser medicine.

Let me quote some basic principles on the selective photothermolysis as written by Yacov Domankevitz, a senior scientist at Candela Corporation:

Laser treatment of vascular lesions is based on the principle of selective photothermolysis (Parrish and Anderson). By proper selection of laser system parameters, selective heating of vessels within the skin is possible while producing only minimal damage to the overlying epidermis and adjacent dermis.

The basic elements of selective photothermolysis for the treatment of vascular anomalies are:

1. Selective Absorption -- Laser energy should be preferentially absorbed by blood vessels and not by the overlying epidermis and adjacent dermis.

2. Optical Penetration Depth (OPD) -- Laser energy should penetrate sufficiently deep to reach the larger and deeper situated vessels.

3. Energy Deposition -- Laser energy at the vessel site should be sufficient to heat the vessels to the damaging temperature.

4. Damage Confinement -- The exposure time of the laser energy should be less or equal to the thermal relaxation time of the vessels

5. Epidermal Cooling -- Although this is not a basic element of selective

photothermolysis it is an essential element in many laser therapies.

The Role of Laser in Otorhinolaryngology, Head, and Neck Surgery

2007-04-01T22:05:00.000+07:00

A visit to HNO –Praxis Dr.med.F.-P.August, ambulante Operationen.Laserchirurgie

This is a report on my trip to Germany last November 2006. I was delighted to visit a country where actually I should be trained in Stuttgart several years ago. Two younger doctors accompanied me, dr. Bestari and dr. Muh.Abdu from Padang (School of Medicine,University of Andalas).

Before our departure, we have finished the in-house training for them in dr.M.Djamil Hospital (please see our pictures at http://www.flickr.com/handikin). We concentrated on the application techniques of diode laser (980 nm in wavelength) in surgical daily practice. So, we were happy to meet Dr.August, a young doctor who is very keen and a skilled master in laser surgery.

We went to Kleinmachnow, a small area outside Postdam, a well-known city not so far from Berlin, attending small group seminars, discussions, sharing experiences and practical observation in the clinic and hospital. The weather was around 5 degree Celsius so we had to put jackets and ”kopiah” around the clock.

Laser technology was so close even for the rural area like this. We hope that Indonesia, which is an archipelago, will be able to conduct this kind of services.

Laser medicine changes medical services into a practical, very easy to do minimal invasive surgery in one day setting. At last, it should be economical for the patients’ pocket and insurance company as well.

Please find our pictures here, they will tell you many things by themselves! If you wish to have further personal contact with me, you can write an e-mail to lshandik@gmail.com

LASER CIRCUMCISION

2007-03-31T12:26:00.000+07:00

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

2007-03-26T08:12:00.000+07:00

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

2007-03-25T23:50:00.000+07:00

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

2007-03-25T23:07:00.000+07:00

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?*

2007-03-04T09:11:00.000+07:00

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

The Basics of Laser (4)

2007-02-22T23:54:00.000+07:00

What is photochemical effect of laser?

The main concept of photochemistry concerns a certain molecule which functions as a photosensitizer. With the existence of photosensitizer in a particular cell (e.g. cancer cell), the cell becomes sensitive to the damage caused by the photon absorption from a certain wavelength. The effect is selective and does not damage normal cells.

What is selective photothermolysis effect?

It is the thermal lytic effect resulted by light pulse which is selectively absorbed by pigmented target such as melanin and hemoglobin. Recent research showed that this effect enables cancer therapy with combination of selective nanophotothermolysis using primary and secondary antibodies, and gold nanoparticles. Laser radiation will form bubbles on the cancer cells’ wall and cause selective damage to the cancer cells.

What are the safety issues to be concerned in the use of laser?

A laser surgeon has medical, legal, and ethical responsibilities. He/she has to acquire information regarding basic laser knowledge, how to operate laser equipments, the indications, and contraindication of laser (“If you don’t need a laser,don’t use one but if you need it use it properly”). It is important to follow instructions from the manufacturers and laser safety officer at laser-applied institutions. Always use goggles (laser safety eyewear), smoke evacuator, warning sign on operating room entries, and laser safety doorlock.

How should laser be properly used?

Mind the buttons and facilities provided in the laser machine (main switch, safety keyswitch, standby/ready switch, emergency off switch, power regulator, mode regulator, frequency/pulse regulator, time regulator, fluence calculator). Turn on the main switch, then the safety keyswitch. Set the necessary parameter, use adequate protections, change standby to ready, direct the handpiece to the target, step on the footswitch after the direction is set correctly. Keep laser in vertical position against tissue surface and keep the movement so that the speed is constant. Release the step on footswitch after it is done. Repeat necessary procedures. Afterwards, turn off all switches in reverse sequence.

The Basics of Laser (3)

2007-02-22T06:33:00.000+07:00

What are the types of laser pulse?

Continues wave: continuous power output while the shutter is being opened (pedal) Pulsed wave: interrupted light output (msec)

Superpulsed wave: very short light outswitched put (msec)

Ultrapulsed: very short light output (nsec)

Q-laser: very short exposure time with extremely high energy

How can the laser interact with the tissues?

Absorption of photon by the tissues is basically the main effect resulted by laser. Reflection, refraction, and transmission will have no effect in the absence of photon absorption.

What are the biological effects on the tissues?

Cells’ growth stimulation, increased cell regeneration, increased tissues’ activities, anti-inflammatory effect, reduced swelling/edema, increased microcirculation, less fibrosis, stimulation of nerves’ function, pain attenuation due to increased production of local endorphins, and increased ATP production in mitochondria

What does photothermal effect of laser mean?

Photothermal effect of laser is thermal effect resulted by the photon which directly related to kinetic molecule excitation produced by total movement, rotation, and molecular action of the tissues. Photothermal effect may cause an increase in temperature, coagulation, protein denaturation, hemostasis, carbonization, and tissue evaporation.

The Basics of Laser (2)

2007-02-20T21:39:00.000+07:00

What are the characteristics of laser?

Monochromatic: has single wavelength depends on the media

Collimated: the light travels with a synchronized direction with very minimum degree of deviation

Coherent: electromagnetic wave has the same form and phase

Brightness: laser seems bright due to the high energy emission in the optic cavity

What is the difference between conventional light source and laser?

Conventional light source has diffuse distribution and is originally white because it consists of many color spectra (multiple wavelengths). Meanwhile, laser has single direction and single color or monochromatic (single wavelength)

What is the benefit of monochromatic characteristic?

Laser energy will be absorbed by specific chromophor of the target organ

What are the basic radiometry terms that you must understand?

Power output = radiant power = W(Watts)= J(Joule)/second

Power density = irradiance = intensity =W/cm²

Light energy = Joules =J

Fluence = energy density = J/cm²

The Basics of Laser (1)

2007-02-17T22:05:00.000+07:00

What is laser?

Laser is a light as the result of a technology called Light Amplification by Stimulated Emmission of Radiation. The acronym of this technology became what we acknowledge as laser.

What is the basic theory of laser?

The basic concept of laser was first established by Albert Einstein in The Quantum Theory of Radiation (1917). In a “ground state” condition, atomic energy or molecules are surrounded by electrons. If there is sufficient amount of energy absorbed by the atoms or molecules, then the electron will be positioned in a higher orbit. The electron will be back to the previous orbit while emitting a light spontaneously (spontaneous emission). The unit of this light energy is called photon. In 1960, Maiman successfully invented laser light from ruby crystal.

How can a laser be produced?

Laser is produced by placing atoms in a cavity which then given an electrical energy. The atoms will convert in an excited state called population inversion. Photon emission is parallel with the same speed, direction, and frequency. On one side of the cavity there is a mirror with total reflection ability, while on the other side there is a partial mirror from which the laser comes out.

What are the active media to produce laser?

Active material (or active media) to produce laser can be in the form of gas (Helium-Neon, carbon dioxide, Argon), liquid (dye in organic solution), solid (alexandrite, neodymium, erbium, chromium), or semi-conductor (gallium arsenide, diode).

Technique of Debulking of Nasal, Paranasal, Oral and Nasopharyngeal Tumours With Nd:YAG/KTP 532 Lasers*

2007-02-06T21:32:00.000+07:00

ABSTRACT

Nd:YAG/KTP 532 lasers were aplied in surgical resection of upper aerodigestive tract tumours i.e. intra oral, oropharyngeal, intranasal, paranasal, nasopharyngeal tumours. The lasers were used to assist in primary tumours resection with coagulation of tumour bed, ablation, and evaporation of tumour lesions. The lasers were delivered through direct or open surgery and/or by endoscopy. Controls were done through telescopic or microscopic monitor. The tumours were intranasal polyps, intranasal myxoma, intranasal, and paranasal fibromyxoma, olfactory neuroblastoma, nasopharyngeal carcinoma, palatal adenoid cystic carcinoma, and squamous cell carcinoma, tonsillar malignant lymphoma, nasopharyngeal angiofibroma, and rhabdomyosarcoma.

Video recording of laser ablation in a persistent nasopharyngeal carcinoma will be presented. In our opinion, Nd:YAG/KTP 532 lasers were useful adjunct in the control of primary tumours and for palliative debulking of tumours to maintain patient's quality of life.

Keywords: Nd:YAG/KTP 532 laser, upper aerodigestive tract tumours

* Paper presented at The Shanghai International Conference in Laser Medicine and Surgery, November 4-6, 1997, Shanghai, China

Copyright to L.S. Handikin, M.D., FASLMS, FIPA
(any kind of reproduction on this paper should strictly be done under the permission of the author)

A Brief Introduction to Laser

2007-02-06T21:11:00.000+07:00

The word laser is an acronym for Light Amplification by Stimulated Emission of Radiation.

Laser is an absolutely outstanding inventions of the last century. It has become a valuable tool in various fields, including medicine. Laser is a light source, but different from the traditional light source, it is not used for illumination purposes.

Laser light is the result of a process called stimulated emission. Stimulated emission occurs when an incoming photon stimulates an excited atom so that it emits a photon identical to the incoming photon. The incoming photon has to have a wavelength (i.e. energy) which is identical to the energy which the atom will release when it falls from the excited level to a more stable one.

The use of laser in medicine is clearly evident. I have used laser for the purpose of surgical and non-surgical procedures, mostly in otorhinolaryngology head & neck surgeries. The results were significant, i.e. minimal bleeding in minimal invasive surgery.

From what I have experienced, I concluded that laser is the therapeutic modality which is beneficial in numerous medical conditions. Surely, it promotes better quality of life and affect humankind, especially through biostimulation and anti-inflammatory effects of low power laser.

To know more about lasers in medicine, keep yourself posted to this blog!