Laser Treatment For Gynecology

Your recent Pap smear and biopsies have shown some abnormalities that will need treatment. The laser is an excellent tool for this treatment. The laser uses a powerful light to destroy abnormal tissues. Laser treatment has little effect on normal tissues and healing is fast. The treatment takes about fifteen minutes. 
Your laser treatment may be done in the outpatient clinic, the doctorís office or the operating room. Laser treatment also may be used to treat lesions of the vagina and vulva.


How is Laser Treatment done?
The doctor places a speculum in the vagina (like taking a Pap smear), so the cervix (mouth of the womb) can be seen. The laser beam is then turned on and the abnormal cells are slowly destroyed or vaporized. A local anesthetic may be used, however, most women have some mild cramping.


Important safety points should be noted:

• Protective safety glasses must always be worn to avoid accidental eye injuryn if the laser beam is misdirected.
• Occasionally, you may feel a hot sensation from the heat that builds up from the laser. Tell your doctor if you feel uncomfortable or need to move. The laser can be turned off temporarily. If you move suddenly, the laser beam could strike an area not being treated. This could cause pain or bleeding, so please tell the doctor if you have any discomfort.
• The treatment will produce a smoke-like vapor. This smoke will be removed with a suction-type machine that makes a sound like a vacuum cleaner.

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Comparison of Diode Lasers in soft- tissue surgery using cw- and superpulsed mode: an in vivo study

Purpose :
Dental soft tissue surgery by diode lasers in cw- mode often causes carbonization of the tissues with following necrosis and a delay of wound healing. In vitro studies have already shown, that superpulsed diode laser surgery has much less disadvantages for the tissues in histological approach. Purpose of this study is to investigate in vivo, if superpulsed mode of operation can realize an improvement for surgeon and patient in soft tissue surgery.

Materials and methods :
26 patients were treated by diode lasers in different modes of operation for soft tissue surgery. 12 patients were treated by superpulsed Elexxion Claros diode laser :
810nm; 10- 50 W peak ; 10- 20 μs pulse duration; 12000- 20.000 Hz; 400μm fiber and 14 patients were treated by Vision MDL-10 diode laser : 980nm; 2,5 W; cw- mode and also 400 μm fiber.
Clinical treatment was documented by photos and questionnaires for patients and surgeons. Questions concerned: carbonization, coagulation, cutting speed, pain, swelling, bleeding, need for drugs, functional reduction and fibrine layer on wounds- during treatment, directly after treatment, after 1 day, after 3 days and after 1 week.

Results
The clinical observations and the questionnaires showed in most cases significant differences between cw- mode and superpulsed diode laser treatment in surgery. There was less carbonization in the superpulsed group.
The cutting speed was higher and the cut itself more defined and deeper by using superpulsed mode.
Superpulsed laser treatment had a shorter healing time than cw- mode treatment; the fibrine layer was build faster and also the removal of it was faster.
There was often no swelling after superpulsed diode laser treatment; and if a
swelling occured it was smaller and quicker gone as in cw- mode treatment.
The duration of pain was shorter and the amount of pain smaller in the superpulsed group, therefore the patients in the superpulsed group needed less analgetic drugs.
There was less functional reduction in time and amount for the superpulsed group. Only coagulation ability was better in the cw- mode group.

Conclusion :
Clinical studies have shown that superpulsed diode laser surgery is superior to continuous wave done treatment. Carbonization and thermal damage of the tissues can be reduced to a minimum, therefore healing is faster as in cw- mode surgery. Generation of a soft tissue cut is faster and more precise. Patients have less pain; in amount and time period. The need of drugs is reduced. There are less functional restrictions and there is less swelling.
The advantages of superpulsed mode of operation for soft tissue diode laser surgery are evident. Continuous wave mode should no longer be implemented in diode laser surgery.
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Laser as good as surgery(EVLT) [AESTHETIC]

Laser as good as surgery
Mr. Michael Gough and Rosie Beale, Leeds General Infirmary, UK, have presented data comparing endovenous laser treatment (EVLT), a minimally invasive out-patient technique to the current standard of surgery for varicose veins in a randomized controlled trial in patients with saphenofemoral and long saphenous vein incompentence (<90% occlusion) Gough told Vascular News that the advantages of EVLT are that it avoids the need for general anaesthetic, leaves no scars, carries a lower risk of complications, has a faster recovery time and is potentially less expensive-both directly and indirectly. Assessment of patient suitability for EVLT requires ultrasound conformation of the sites of venous incompetence.


Not all patients with varicose veins caused by saphenofemoral/saphenopopliteal incompetence are suitable for EVLT. Although uncommon, a very tortuous greater or super saphenous vein may be a relative contra-indication owing to difficulties in advancing the guide-wire. Nevertheless, around 71% of patients with primary varicose veins are suitable for EVLT.

Beale presented results of the study so far, covering 96 limbs in 81 patients: 41 female, 40 male, with a median age of 49 years. All subjects had similar classifications of disease and maximum long saphenous vein diameters. Patients received one of EVLT-1 (810nm diode laser, 12 watts pulsed laser), EVLT-2 (14 watts continuous laser) or surgery to treat their varicose veins. Prior to treatment their veins were assessed using the Aberdeen Varicose Vein Score-AVVS and duplex ultrasound. Subjects kept an analgesic diary for one week following treatment and also recorded analogue pain scores. Six weeks post treatment they received sclerotherapy, followed by another AVVS and duplex ultrasound session at three months. The principal outcome measures were abolition of saphenofemoral/long saphenous vein incompetence (as measured by the AVVS).

Ultrasound findings for the saphenofemoral junctions at three months showed that all 21 limbs that underwent EVLT-2 had competent veins, said Beale. This compared to around 98% of the 26 that received surgery and 81% of the 34 that had EVLT-2. In the long saphenous vein the findings were more alike, with both laser treatments succeeding in more than 90% of limbs, while surgery"s success rate was around 88%. All groups experienced a significant improvement in AVVS: EVLT-1 went from 13.17 pre-treatment down to 5.61 post-treatment; EVLT-2 went from 11.55 to 3.94; and surgery, from 14.31 to 5.80, but there were no inter-group differences, Beale added.

While analgesia use and pain scores were similar across the three groups, there was one area where both types of laser treatment scored highly: return to normal activity and work. Patients, on average, went back to work a mere four days after receiving laser treatment, while patients recovering from surgery took an average of 14 days to return to normal activity and a total of 17 days to return to work.

However, in a third of cases, laser treatment is not enough on its own.
Thirty-seven percent of cases required delayed sclerotherapy (1-2 treatments) to achieve satisfactory cosmesis.
"Scelotherapy has to be built into treatment for EVLT," Beale commented. In terms of complications, eight (12%) of the subjects who received EVLT developed phlebitis, while two (3.8%) had nerve injury. In surgery, two (6.7%) subjects had wound problems while four (15%) developed nerve injury and one developed acute respiratory distress.

"In summary," said Beale, "EVLT shows a comparable abolition of long saphenous vein reflux and symptom control in all groups. There is a shorter recovery time following EVLT." Gough added, "EVLT-1 and -2 had similar results and so either can be used. We have opted for EVLT-1 as it is easier and more accurate to administer the correct laser dose Longer terms follow-up is obviously needed to prove conclusively that EVLT is as good (it will probably be better) as surgery."
He concluded: "The randomized trial is still ongoing although it is unlikely that many more patients will be recruited-most patients prefer EVLT to surgery and are thus not very willing to be randomized. We will stop at 120 patients, which we have already reached but some are still awaiting their follow-up." 

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Clinical Application of Percutaneous Laser Disk Decompression

Key words:

Diskectomy, percutaneous; Laser surgery; Radiology, interventional

In recent years, the author of semi-conductor laser therapeutic apparatus using percutaneous laser disc decompression (percutaneous laser disk decompression, PLDD) treatment of lumbar disc herniation, has achieved some results. Automatic aspiration of the technology and compared to excision, a simple, safe, injury, etc., are presented below.

Materials and Methods

1. Clinical data:

100 cases collected by the hospital to be diagnosed as clinical lumbar disc herniation by CT or MRI in patients with a clear diagnosis for PLDD treatment, follow-up of 6 to 18 months. 100 cases of patients, male 56 cases, 44 cases of women aged 17 ~ 72 years old, the average age of 48.5 years old.

Course of disease and clinical performance: the initial incidence of 2 months to 20 years, clinical low back pain with radiation leg pain, inability to walk, limp, the affected muscle atrophy, limb cold.

Physical examination: unilateral or bilateral limb elevation test positive, the level of the corresponding disc next to the spinous process tenderness. After pre-treatment CT or MRI examination. L4 ~ 5 of them were 65 cases of disc herniation, L5 ~ S1 disc herniation, 35 cases have been more than six weeks of conservative treatment is invalid or the result is not significant.

Semiconductor Laser Therapeutic Apparatus used: wavelength 980 nm, the end of the maximum output power 15 W. Optical fibers: 400 nm; 18G needle 2, a long 15 cm; Y-type switch 1.

Selected for the following conditions have PLDD indications:

(1) clinically diagnosed as lumbar disc herniation, with recent (within 3 months) CT or MR for the diagnosis of lumbar disc herniation were clear;

(2) 6 weeks of conservative treatment fails;

(3) the extent of leg pain than back pain;

(4) positive straight leg raising test;

(5) of sensory, motor response, tendon reflexes were diminished.

And for the following contraindications:

(1) there is a serious clinical bleeding tendency and who can not be corrected;

(2) spondylolisthesis;

(3) disc was broken from the Free State;

(4) spinal stenosis (bony, ligament thickening, calcification).

(5) Marking the level of the history of trauma or surgery has been the history of lumbar intervertebral disc or Chemonucleolysis history;

(6) significant stenosis in the vertebral space;

(7) clear mental disorder;

(8) pregnant women.

2. Operation Methods: Patients from lateral position (side up) in the DSA machine tools, positioning under fluoroscopy puncture, topical 2% lidocaine anesthesia 5 ml (from the skin to the superficial muscle layer), with 18G, length 15 cm of the needle away from the open side of vertebral spinous process centerline 8 ~ 14 cm Department (L4 ~ 5 to 8 ~ 12 cm, L5 ~ S1 for 10 ~ 14 cm), under the supervision of the perspective from the rear side into the needle, needle sagittal direction of the trunk surface and 45 ° ~ 60 ° angle. Needle is located in the best position of the corresponding intervertebral space after the 1 / 3 the level of the Agency (Figure 1), after the success of lateral puncture, rotating C-arm, is situated to the perspective, the spinous process at the level of the needle puncture nucleus, the L5 ~ S1 disc iliac wing due to stop before the needle into the needle bent into approximately 160 ° around (Figure 2), after the correct position, pull out the needle puncture needle core, will be 0.4 mm thick needle through the fiber-optic delivery into, and beyond the top needle 0.5 cm, the use of Y-shaped lock switch and then to the end of the output power 15 W, pulse time of 1 s, interval time of 5 s on the nucleus points to 1 point or more laser decompression. Operation, when patients have a bulging waist flu, with space needle by Y-switch liposuction, each disc to the energy by about 1 200 ~ 1 300 J (L3 ~ 4, L5 ~ S1), 1 300 ~ 1 500 J (L4 ~ 5), the whole process about 20 ~ 30 min.

Results

100 cases of 100 patients with intervertebral disc, the success rate of puncture was 100%, follow-up period was 6 to 18 months. Reference MacNab [1] to evaluate the standard cure, 72% efficient. Of which 22 patients were cured and 50 cases of effective, 28 cases were followed up for 6 months without improvement in symptoms was considered null and void, without any complication. According to the affordability of different patients, respectively after 3,6 months or 1,3,6,12-month CT or MRI follow-up visit, some cases (24/100) 1 month for only the performance of the Department of nucleus density circular lower three months after the performance of some patients to varying degrees for the disc back to Steiner (49/100), part of cases (23/100) had no significant disc back satisfied, but to improve symptoms in varying degrees.

Discussion

Principle PLDD through laser vaporization of the nucleus pulposus for cutting, as well as the solidification of the part of disc nucleus pulposus to reduce intradiscal pressure and volume, so as to achieve the purpose of treatment of lumbar disc herniation. In recent years the use of laser disc decompression has been in clinical and medical skills to gradually extend the awareness of staff and patient acceptance, more in line with the interventional radiology Development trends and operation of micro-trauma of the requirements, should be promoted as a new method for the treatment of disc herniation.

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Long - term Effect of Transscleral Diode Laser Cyclophotocoagulation in Treatment of Refractory Glaucoma

AIM: 
To evaluate the long-term efficiency of diode laser transscleral cyclophotocoagulation (DL Tscpc) for refractory glaucoma.


METHODS: 
Retrospective analysis was made in 431 eyes with refractory glaucoma treated by DL Tscpc
with lower energy power (1.5-2.5W) and more laser spots (26-34). Intraocular pressure (IOP), visualacuity, ocular symptoms and complications were observed after DLTscpc. Patients were followed up over 36 months.


RESULTS: 
Mean pre-operative IOP was (56.2±12.7)mmHg which was significantly different from the final follow-up mean IOP (17.3±8.8)mmHg. (P < 0.05). The success rate was 94.4% (68/72). Postoperative visual acuity kept no change in 399 eyes; elevated in 30 eyes and decreased in two eyes. The pain sense disappeared or remarkably relieved. The main complications included mild uveitis and hyphemae. Atrophy of eyeball occurred in two eyes.

CONCLUSION: 
It is concluded that DL TScpc is a simple, safe and effective therapy for eyes with refractory glaucoma through long-term observation.

KEYWORDS: 
Diode laser; cyclophotocoagulation; refractory glaucoma


Introduction
Refractory glaucoma refers to the application of drugs and surgery are difficult to control glaucoma. Used to the conventional type of glaucoma filtration surgery, or ciliary body destructive procedures, such as frozen or ciliary body ciliary body electric coagulation. However, the clinical effect of Poor, and more complications. Our diode laser transscleral cyclophotocoagulation (diode laser transclero-cyclophotocoagulation, DL Tscpc) treatment of refractory glaucoma 690 cases of 697, of which 430 cases of 431 that we tracked 3a above, results were satisfactory. Are reported below.


1 Subjects and Methods
1.1 Object
430 cases of 431, male 255, female 176, aged 16 to 89 (mean 52) years old. These include neovascular glaucoma, 213 (49.4%), complex ocular trauma secondary glaucoma 17 (3.9%), high intraocular pressure after silicone oil injection for 8 (1.9%), primary angle-closure glaucoma absolute phase 187 (43.4%), primary open-angle glaucoma, 4 (0.9%), congenital glaucoma in 2 eyes (0.5%). Are pre-treatment application of multi-drug combination therapy intraocular pressure is still ≥ 40mmHg (1mmHg = 0.33kpa). Pre-treatment visual acuity light perception to 0.25. Instruments is the semiconductor lasers, wavelength 810nm, power 100 ~ 2 500mW, time of 10 ~ 5 000ms. Cpc probe of its front-end for a round cap with a contact probe, the diameter of 3mm, the laser beam can be precisely focused on the location of the sclera after 1.5mm.


1.2 Methods: 
The preoperative intraocular pressure lowering drugs was added, where appropriate, will
be reduced to the lowest possible level of intraocular pressure. Patient was supine, with 20g / L lidocaine 2.5mL and 7.5g / L bupivacaine 1.5mL mixed Across retrobulbar anesthesia, the laser fiber placed in contact with the first central government after the corneoscleral margin of 1.5 ~ 2mm Department, probe directed towards the ciliary body crown, hit radio range of Cape scleral edge of the week, in addition to internal and external rectus two time zones, the uniform distribution of 26 ~ 34 hit radio spots, each spot between the interval 1.5 ~ 2.0mm, laser energy use 1.5 ~ 2.5W, time 1.0 ~ 2.0s, starting from the 1.5W, hit fire and did not hear the explosion that increased 0.1W, if the continuous treatment of 3:00 have pops and a decrease 0.1W. After partial adrenal cortex hormones and antibiotics given to drug points, eyes, and symptomatic use IOP lowering drugs, oral pain medications when necessary. If the postoperative intraocular pressure control is not satisfactory, 1mo after re-DLTscpc, methods and the same as the initial
treatment. The patient's visual acuity, intraocular pressure, as well as the conjunctiva, cornea, anterior chamber, iris, lens and other organizations, the situation changes and conduct follow-up observation of medication, follow-up period were less than 3a.


2 Result
2.1 Efficacy criterion: cure: After treatment, IOP ≤ 21mmHg; markedly: more than 3 antihypertensive drugs with IOP ≤ 21mmHg, and decreased by 20% compared with before surgery. Invalid: intraocular pressure decreased less than 20%.

2.2 IOP: The mean preoperative intraocular pressure (56.2 ± 12.7) mmHg, mean IOP of last follow-up (17.3 ± 8.80) mmHg. After a sub-DL Tscpc IOP 356 eyes of 431 patients were lower than 21mmHg, surgery rate was 82.6%. 69 Line 2 DL Tscpc surgery, of which 57 IOP ≤ 21mmHg, 3 Yan IOP decreased by 20% compared with preoperative patients without eye pain discomfort. Operation invalid 9 eyes, 2 for complex ocular trauma secondary glaucoma, four for neovascular glaucoma, one for primary angle-closure glaucoma absolute period, two for the high intraocular pressure after silicone oil injection; invalid After statistical analysis, operation efficiency with age, gender, disease duration, IOP was no significant correlation (P> 0.05). In this group of 431 post-operative 1wk; 1, 3, 6, 12, 24, 36,48, 60mo intraocular pressure were observed in different periods of analysis, were lower than preoperative IOP, differences were statistically significant 


2.3 Vision: 431 eyes of 399 no change in visual acuity. 30 visual acuity was improved, including 11 from the pre-treatment visual acuity after treatment index / 30cm up to 0.04 ~ 0.05, between 8 after treatment visual acuity from 0.02 to 0.06 between pre-treatment increased to 0.1 ~ 0.25, 10 from the light-sensing to improve to the index / 30cm ~ 0.02. 2 from light perception visual acuity dropped to light perception.

2.4 Subjective symptoms: After treatment, 431 were eye pain disappeared or eased.

2.5 Complications: postoperative hyphema 7, anterior chamber exudation 13, symptomatic hemorrhage after treatment 1mo absorption, inflammation disappeared. 2 eyeball atrophy, a row before surgery Time cyclocryotherapy, a line three times in patients with transscleral cyclophotocoagulation. 

2.6 Treatment of the relationship between the number and efficacy of 431 eyes of 356 (82.6%) treatment 1 Successful, 57 (13.2%) treatment of two successful, 7 eyes (1.6%) treatment three times successfully, the cumulative success rate (97.4%).

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Endovenous laser ablation of varicose veins with the 1470-nm diode laser

Background

Endovenous laser ablation (EVLA) is one of the most accepted treatment options for varicose veins. In previous studies conducted with a laser at 810 to 1320 nm, paresthesia, pain, and ecchymosis were common adverse effects. We hypothesized that a lower linear endovenous energy density (LEED), as used with 1470-nm diode laser fibers, would lead to a reduction in adverse events.

Methods

We conducted a prospective, nonrandomized observational cohort study of 312 consecutively treated lower limbs legs in 286 patients. Of these, a bare laser fiber (ELVeS-plus kit) was used to treat 168 legs in 150 patients (group 1), and a radial fiber (ELVeS-radial kit) was used in 144 legs in 136 patients (group 2). Laser treatment was performed in the great saphenous vein. Follow-up for all patients was 3 months. The primary end point was the occurrence of ecchymosis and bruising. This was correlated to the reduced LEED needed with the 1470-nm diode laser.

Results

Laser fiber (odds ratio [OR], 22.3; 95% confidence interval [CI], 20.2-24.5) and body mass index (OR, 0.35; 95% CI, 0.15-0.55) were identified as independent parameters for LEED. In group 2 compared with group 1, LEED in the great saphenous vein could be reduced from 79.4 ± 9.1 to 57.4 ± 10 J/cm (P < .0001). LEED was an independent parameter for skin bleeding (OR, 1.04; 95% CI, 1.017-1.058). Ecchymosis and bruising were significantly less frequent in group 2 than in group 1 (P < .0001). The need for analgesia was low, with 103.08 ± 15.34 mg diclofenac-sodium in group 1 vs 82.08 ± 18.86 mg in group 2 (P < .04). Occlusion with elimination of reflux was achieved in 100% of group 1 and group 2 (P < 1). No recanalization occurred at follow-up.

Conclusion

Endovenous laser treatment of varicose veins in the great saphenous vein with the 1470-nm diode laser is safe and highly effective. The lower energy level needed using the radial laser fiber significantly minimized adverse effects compared with the bare laser fiber.

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Diode Laser as A Therapeutic Tool

Lasers have been used safely as a therapeutic tool for over 30 years. Instead of ablating tissue, LT stimulates cellular activity that improves the speed and quality of healing. In over 1,800 publications worldwide, LT has demonstrated its non-invasive, non-toxic quality, and its ability to augment and in some cases, replace, pharmaceuticals and surgical intervention. LT is most often used as a primary medical treatment, but is also effective as a complement to other modalities, such as needle acupuncture and chiropractic adjustment. Acupuncturists, Chiropractors, Physical Therapists, Dentists, Osteopaths and M.D.'s currently use LT for a variety of problems; including the treatment of acute pain and chronic degenerative conditions, improving the speed and quality of wound healing, and for muscle, tendon and ligament injuries.

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