Low Level Laser Therapy [LLLT]:
A Bibliography of recent Papers
Phil AM Rogers MRCVS
Grange Research Centre, Teagasc, Dunsany, Co. Meath, Ireland
e-mail :
philrogers@tinet.ie
| Introduction
| Discussion | Summary | Abstracts |
Introduction
| Top
|
Medline
[http://www.ncbi.nlm.nih.gov/PubMed/medline.html]
and SPIE (International
Society for Optical Engineering) [http://www.spie.org/], [e-mail:
<spie@spie.org>] were
searched for recent abstracts on low level laser therapy (LLLT).
Medline was searched for papers published within the past 2 years.
Some older papers were taken from SPIE. Acupuncture
Progress [http://users.med.auth.gr/~karanik/english/acuprog.html]
contains additional abstracts but, due to time constraints, that
source was not searched.
This bibliography lists 51 abstracts on LLLT, 40 from Medline
and 11 from SPIE. For ease of use, the abstracts were shortened
and the terminology standardised. The bibliography follows an
earlier clinical paper "Clinical use of low level laser
therapy"
Abstract breakdown by year of publication was:
Year
|
99
|
98
|
97
|
96
|
95
|
94
|
93
|
92
|
91
|
Hits
|
11
|
16
|
14
|
6
|
1
|
-
|
1
|
1
|
1
|
The following table summarises the conditions or tissues
treated, and the outcome (no effect, general article with no
clear conclusion on outcome, or positive effect).
Condition / tissue treated
|
No
effect
|
General
article
|
Positive
effect
|
Cancer |
-
|
-
|
3, 22
|
Cardiovascular,
vascular, cardiac, lymph system |
-
|
-
|
11, 16, 17, 18, 27, 36, 46
|
Dental, oro-facial |
7
|
48, 49
|
6, 14, 20, 28, 29
|
General |
-
|
4, 24
|
41, 43
|
Kidney function |
-
|
-
|
19
|
Lung, pulmonary
function |
-
|
21
|
26, 30, 31, 32, 35, 42
|
Pain, rheumatology,
musculoskeletal, bone, joint, tendon, soft tissue |
8, 9, 13, 45
|
15, 23
|
1, 2, 5, 12, 37, 38, 39, 40
|
Reproduction,
endometrosis |
-
|
-
|
51
|
Skin, dermatology |
|
|
47
|
Vomiting |
|
|
34
|
Wounds, ulcers,
fibroblast activity |
10, 25
|
44
|
33, 50
|
Discussion
| Top
|
General effects of LLLT: Of 4 overviews
on LLLT, 2 were general reviews (4,
24,) and 2 indicated
positive effects (41, 43). Takac & Stojanovic claimed
the following general effects for LLLT:
- anti-inflammatory, analgesic and anti-edematous effect on
tissues;
- absolute increase in microcirculation, higher rates of
ATP, RNA and DNA synthesis, and thus better tissue
oxygenation and nutrition;
- increase in the absorption of interstitial fluid, better
tissue regeneration and stimulation of the analgesic
effect.
They concluded "The past three decades of laser
medicine and surgery have shown great progress and promise for
the future" (41).
Wounds: From the mid 1980's to the mid 1990's
many authors, especially those in clinical practice, hailed LLLT
as a valuable method in treating superficial lesions, such as
wounds, burns, granulomas. In contrast, of 5 recent studies, 2
indicated enhanced fibroblastic activity in vitro, and 2
failed to find evidence that laser per se helped wound healing in
vivo. However, one of those concluded that "a combination
of He-Ne laser and infrared light may promote the healing of
venous leg ulcers".
Cardiovascular, vascular, cardiac, lymph system: Of
7 articles, (11, 16, 17,
18, 27,
36, 46), all claimed positive
cardiovascular or circulatory effects.
Kidney function: Only one paper concluded:
"After LLLT renal blood microcirculation improved in 58% of
patients; secretion in 63.1%. Increased diuresis, improved
filtration and concentration functions of kidneys also were
marked" (19).
Lung, pulmonary function: Of 7 papers, 6
reported positive effects in bronchial and pulmonary diseases (26, 30,
31, 32, 35,
42) and one (21) inferred an immunomodulating
action of LLLT in bronchial asthma but details were not available.
Pain, rheumatology, musculoskeletal, bone, joint, tendon,
soft tissue, especially in dental and oro-facial applications: Of
14 papers on the use of LLLT in these conditions, 4 were negative,
2 uncommitted and 8 positive. LLLT had no significant
effect in delayed-onset muscle in people involved in weight-training
activity (8); in ankle sprain (9); on the hemosalivatory barrier in
patients with rheumatic diseases (13)
and it had no significant effect over that of whirlpool
treatment in minimizing the degree of experimental joint
contracture in rats (45). The
papers that had no detail in the abstracts were on
musculoskeletal pain (15) and
arthritis (23). The positive
papers were on experimental knee lesions in rats (1),
rheumatological pain associated with musculoskeletal conditions (2, 37,
38), carpal tunnel and
chronic pain syndromes (5, 39, 40)
and geriatric osteoarticular diseases (12).
Reproduction, endometrosis: One paper reported
good results of LLLT endometrosis with uterine varices in women.
Treatment was at LV03, CV06, SP08 for 5-10 min/point/d, for 7
sessions/course, for 1-2 courses (51).
Skin, dermatology: One paper reported that LLLT
helped in atopic dermatitis (47).
Vomiting: One paper reported that LLLT reduced
postoperative vomiting in children undergoing strabismus surgery.
Treatment was given at PC06 (34).
Cancer: Of 2 articles, both suggest that LLLT
can help in human cancer management - in radiation-induced
mucositis (3) and in controlling
postoperative complications and duration of lymphorrhoea in
breast cancer (22).
Summary
| Top
|
Tuner & Hode studied 1200 papers on LLLT and found 85
positive and 35 negative double-blind studies. The negative
studies were scrutinized carefully to pinpoint possible reasons
for the failures (43). As in
most areas of biology, there is evidence for and against the
efficacy of LLLT, but the balance seems to be positive. Further
research is needed on the uses and limitations of LLLT.
Abstracts
| Top
|
- Akai M, Usuba M, Maeshima T,
Shirasaki Y, Yasuoka S (1997) Laser's
effect on bone and cartilage change induced by joint
immobilization: an experiment with animal model.
Lasers Surg Med 21(5):480-4. akai-reh@h.u-tokyo.ac.jp
Dept of Physical Therapy, Tsukuba College of Technology,
Ibaraki, Japan. Influence of low-level (810 nm, Ga-Al-As
semiconductor) laser on bone and cartilage during joint
immobilization was examined with rats' knee model. The
hind limbs of 42 young Wistar rats were operated on in
order to immobilize the knee joint. They were assigned to
three groups 1 wk after operation; irradiance 3.9 W/cm2,
5.8 W/cm2, and sham treatment. After 6 times of treatment
for another 2 wk both hind legs were prepared for 1)
indentation of the articular surface of the knee (stiffness
and loss tangent), and for 2) dual energy X-ray
absorptiometry (bone mineral density) of the focused
regions. The indentation test revealed preservation of
articular cartilage stiffness with 3.9 and 5.8 W/cm2
therapy. Soft laser treatment may possibly prevent
biomechanical changes by immobilization. PMID:
9365959, UI: 98032663
- Basford JR, Sheffield CG,
Harmsen WS (1999) Laser
therapy: a randomized, controlled trial of the effects of
low-intensity Nd:YAG laser irradiation on musculoskeletal
back pain. Arch Phys Med Rehabil Jun;80(6):647-52.
Dept of Physical Medicine and Rehabilitation, Mayo Clinic
and Foundation, Rochester, MN 55902, USA. They assessed
the effectiveness of low-intensity laser therapy in the
treatment of musculoskeletal low back pain in a double-masked,
placebo-controlled, randomized clinical trial in a
physical medicine and rehabilitation clinic. 63
ambulatory men and women, 18-70 yr old, with symptomatic
nonradiating low back pain of >30 d duration and
normal neurologic examination results were block
randomized into two groups with a computer-generated
schedule. All underwent irradiation for 90 sec at eight
symmetric points along the lumbosacral spine 3 times/wk
for 4 wk by a masked therapist. The sole difference
between the groups was that the probes of a 1.06 um
neodymium:yttrium-aluminum-garnet laser emitted 542mW/cm2
for the treated subjects and were inactive for the
control subjects. Subject's perception of benefit, level
of function as assessed by the Oswestry Disability
Questionnaire, and lumbar mobility. The treated group had
a time-dependent improvement in 2/3 outcome measures:
perception of benefit and level of function. These
results were most marked at the midpoint evaluation (p<.005,
p<.01) and end of treatment (p<.017, p<.001) but
tended to lessen at the 1-mo follow-up (p<.10, p<.004).
Lumbar mobility did not differ between the groups at any
time. All tests were two-sample t tests with unequal
variances. Treatment with low-intensity 1.06 um laser
irradiation gave a moderate reduction in pain and
improvement in function in patients with musculoskeletal
low back pain. Benefits, however, were limited and
decreased with time. Further research is warranted. Publication
Types: Clinical trial Randomized controlled trial PMID:
10378490, UI: 99304835
- Bensadoun RJ, Franquin JC,
Ciais G, Darcourt V, Schubert MM, Viot M, Dejou J,
Tardieu C, Benezery K, Nguyen TD, Laudoyer Y, Dassonville
O, Poissonnet G, Vallicioni J, Thyss A, Hamdi M, Chauvel
P, Demard F (1999) Low-energy
He/Ne laser in the prevention of radiation-induced
mucositis: A multicenter phase III randomized study in
patients with head and neck cancer. Support Care
Cancer Jul;7(4):244-52. External Radiotherapy Unit,
Centre Antoine-Lacassagne, Nice, France. rene-jean.bensadoun@cal.nice.fnclcc.fr
Use of low-energy He-Ne laser (LEL) appears to be a
simple atraumatic technique for the prevention and
treatment of mucositis of various origins. Preliminary
findings, and significant results obtained for
chemotherapy-induced mucositis in a previous phase III
study, prompted a randomized multicenter double-blind
trial to evaluate LEL in the prevention of acute
radiation-induced stomatitis. Irradiation by LEL
corresponds to local application of a high-photon-density
monochromatic light source. Activation of epithelial
healing for LEL-treated surfaces, the most commonly
recognized effect, has been confirmed by numerous in
vitro studies. The mechanism of action at a molecular and
enzymatic level is presently being studied. From
September 1994 to March 1998, 30 patients were randomized.
Technical specification: 60 mW (25 mW at Reims, 1 patient),
He-Ne, wavelength 632.8 nm. The trial was open to
patients with carcinoma of the oropharynx, hypopharynx
and oral cavity, treated by radiotherapy alone (65 Gy at
a rate of 2 Gy/fraction, 5 fractions/wk) without prior
surgery or concomitant chemotherapy. The malignant tumor
had to be located outside the tested laser application
areas (9 points): posterior third of the internal
surfaces of the cheeks, soft palate and anterior
tonsillar pillars. Patients were randomized to LEL or
placebo light treatment, starting on the first day of
radiotherapy and before each session. The treatment time
(t) for each application point was given by the equation
: t(s)= energy (J/cm2) x surface (cm2)/Power (W).
Objective assessment of the degree of mucositis was
recorded weekly by a physician blinded to the type of
treatment, using the WHO scale for grading of mucositis
and a segmented visual analogue scale for pain evaluation.
Protocol feasibility and compliance were excellent. Grade
3 mucositis occured with a frequency of 35.2% without LEL
and of 7.6% with LEL (p<.01). The frequency of "severe
pain" (grade 3) was 23.8% without LEL, falling to 1.9%
with LEL (p<.05). Pain relief was significantly
reduced throughout the treatment period (wk 2-7). LEL
therapy can reduce the severity and duration of oral
mucositis associated with radiation therapy. Also, there
is great potential for use of LEL in combined treatment
protocols with concomitant chemotherapy and radiotherapy.
PMID: 10423050, UI: 99349913
- Bissell JH (1999) Therapeutic modalities in hand surgery. J
Hand Surg [Am] May;24(3):435-48. Dept of Physical
Medicine and Rehabilitation, Centura Rehabilitation, St
Mary Corwin Medical Center, Pueblo, CO 81004, USA.
Therapeutic modalities are useful adjuncts in the
rehabilitation of many patients commonly seen by hand
surgeons. Therapeutic heat, cold, ES- and laser- and
magnetic field- treatments are evaluated for their
respective mechanisms of action, indications,
contraindications, and clinical results. The most
therapeutic modalities have been extensively investigated
and relevant basic science and randomized well-controlled
clinical studies addressing the efficacy of therapeutic
modalities are emphasized. Publication Types: Review
Review, academic PMID: 10357520, UI: 99284412
- Branco K, Naeser MA (1999) Carpal tunnel syndrome: clinical outcome
after LLLT-acupuncture, microamps TENS, and other
alternative therapies: an open protocol study. J
Altern Complement Med Feb;5(1):5-26. Acupuncture
Healthcare Services, Westport, Massachusetts, USA. They
measured outcome for carpal tunnel syndrome (CTS)
patients (who previously failed standard medical/surgical
treatments) treated primarily with a red-beam, LLLT-AP
and microamps TENS on the affected hand; secondarily,
with other alternative therapies. DESIGN: Open treatment
protocol, patients diagnosed with CTS by their physicians.
Treatment was given by licensed acupuncturist in a
private practice office. 36 hands were treated (from 22
women, 9 men), ages 24-84 yr, median pain duration, 24 mo.
14 hands had failed 1-2 surgical release procedures.
Primary treatment: red-beam, 670 nm, continuous wave, 5
mW, diode LLLT pointer (1-7 J per point), and microamps
TENS (<900 uA) on affected hands. Secondary treatment:
infrared LLLT (904 nm, pulsed, 10 W) and/or needle AP on
deeper acupoints; Chinese herbal medicine and supplements,
on a case-by-case basis (3 treatments/wk for 4-5 wk). Pre-
and posttreatment Melzack pain scores and profession and
employment status were recorded. Posttreatment, pain
significantly reduced (p<.0001), and 33/36 hands (91.6%)
no pain, or pain reduced by >50%. 14 hands that failed
surgical release were successfully treated. Patients
remained employed, if not retired. Follow-up after 1-2 yr
with cases aged <60, only 2/23 hands (8.3%) had return
of pain, but were successfully re-treated within a few
weeks. Possible mechanisms for effectiveness include
increased adenosine triphosphate (ATP) on cellular level,
decreased inflammation, temporary increase in serotonin. Combined
treatment with LLLT-AP + microamp TENS + Chinese herbs
has potential cost-savings (current estimated cost per
case, $12,000; this treatment, $1,000). It is safe when
applied by licensed acupuncturist trained in laser-AP;
supplemental home treatments may be performed by patient
under supervision of acupuncturist. Publication Types:
Clinical trial PMID: 10100028, UI: 99199801
- Brugnera A, Cruz FM, Zanin FA
& Pecora JD (1999) Clinical
results evaluation of dentinary hypersensitivity patients
treated with laser therapy. Proc. SPIE Vol. 3593, p.
66-68, Lasers in Dentistry V, John D. Featherstone; Peter
Rechmann; Daniel Fried; Eds. Camilo Castelo Branco Univ.;Univ.
of Sao Paulo School of Dentistry. The aim was to show the
% of cured patients treated with LLLT clinically
diagnosed dentinary hypersensitivity. They report on >300
human teeth treated at the Laser Center of Camilo Castelo
Branco Univ during 1995-1997. Pulpal vitality was
verified using thermal tests, and only reversible process
was treated. The teeth were dried with cotton pellets and
laser beam was applied, using He-Ne laser, and ArGaAl
Lasers. All teeth received 4 joules/session, up to 5
sessions. 79% of patients were treated in 3 sessions with
success; 8.6% were cured in 4 sessions; and 4.3% were
successfully treated in 5 sessions, obtaining 92% success.
LLLT is an effective and useful treatment to dentinary
hypersensibility. (c)1999 SPIE
- Conti PC (1997) LLLT in the treatment of temporomandibular
disorders (TMD): a double-blind pilot study. Cranio
Apr;15(2):144-9. Bauru School of Dentistry, Univ of Sao
Paulo, Brazil. The aim was to evaluate the efficacy of
LLLT in patients with Temporomandibular Disorders (TMD)
in a double-blind design. 20 patients with a chief
complaint of pain were divided into myogenous and
arthrogenous groups. They were also divided on the basis
of the treatment rendered: real versus placebo treatment.
An 830 nm Ga-Al-As Laser device with a energy power of 4
joules was used (OMNILASE, LASERDYNE PTY LTD) in three
treatment sessions. To evaluate the effect of laser
treatment, a Visual Analogue Scale (VAS) was used for
pain and active range of motion (AROM) was used to
measure changes in mandibular function. After real LLLT,
there was a reported improvement in pain only for the
myogenous pain patients (p</=.02). For arthrogenous
pain patients, real LLLT gave an improvement in Total
Vertical Opening (TVO) (p<.05), Protrusive excursion (PROT)
(p<.02) and Left lateral excursion (LATLEF) (p<.02).
The placebo control group showed improvement in TVO and
PROT for those patients with myogenous pain and LATLEF
for those patients with arthrogenous pain. A repeated
measurement one-way ANOVA showed no significant
differences between real and placebo groups. Considering
the non-invasive and harmless characteristics of this
modality, more research is recommended, using higher
power and increased frequency of laser applications. Publication
Types: Clinical trial Randomized controlled trial PMID:
9586517, UI: 98247664
- Craig JA, Barlas P, Baxter GD,
Walsh DM, Allen JM (1996) Delayed-onset
muscle soreness: lack of effect of combined phototherapy/LLLT
at low pulse repetition rates. J Clin Laser Med Surg
Dec;14(6):375-80. Rehabilitation Sciences Research Group,
School of Health Sciences, Univ of Ulster, Jordanstown, N.
Ireland. A double-blind, placebo-controlled study using
male subjects (n=60), was conducted to investigate the
efficacy of three different frequencies of combined
phototherapy/low-intensity laser therapy (CLILT) in
alleviating the signs and symptoms of delayed-onset
muscle soreness (DOMS). The study was approved by the
Univ's ethical committee. After screening for relevant
pathologies, recent analgesic or steroid drug usage,
current pain, diabetes, or current involvement in regular
weight-training activities, subjects were randomly
allocated to one of five experimental groups: Control,
Placebo, or 2.5-Hz, 5-Hz, or 20-Hz CLILT groups (660-950
nm; 31.7 J/cm2; pulsed at the given frequencies for a
duration of 12 min; n=12 all groups). Once baseline
measurements were obtained, DOMS was induced in the
nondominant arm, which was exercised in a standardized
fashion until exhaustion, using repeated eccentric
contractions of the elbow flexors. The procedure was
repeated twice more to ensure exhaustion was achieved,
after which subjects were treated according to group
allocation. In the CLILT/placebo groups, the treatment
head was applied directly to the affected arm at the
level of the musculotendinous junction. Subjects returned
on 2 consecutive days for further treatment and
assessment. The range of variables used to assess DOMS
included range of movement (universal goniometer),
mechanical pain threshold/tenderness (algometer) and pain
(visual analogue scale and McGill Pain Questionnaire).
Measurements were taken before and after treatment on
each day, except for the McGill Pain questionnaire, which
was completed at the end of the study. Analysis of
results using repeated measures and one-factor analysis
of variance with relevant post hoc tests showed
significant changes in ranges of movement accompanied by
increases in subjective pain and tenderness for all
groups over time (p=0.0001); however, such analysis
failed to show any significant differences between groups
on any of the days. The data give no convincing
evidence for any putative hypoalgesic effect of CLILT
upon DOMS at the parameters used here. Publication
Types: Clinical trial Randomized controlled trial PMID:
9467328, UI: 98128434
- de Bie RA, de Vet HC, Lenssen
TF, van den Wildenberg FA, Kootstra G, Knipschild PG (1998)
LLLT in ankle sprains: a
randomized clinical trial. Arch Phys Med Rehabil Nov;79(11):1415-20.
Dept of Epidemiology, Maastricht Univ, The Netherlands.
To test the efficacy of LLLT on lateral ankle sprains as
an addition to a standardized treatment regimen, a trial
was conducted in an ambulatory care setting in which high-dose
laser (5J/cm2), low-dose laser (0.5J/cm2), and placebo
laser therapy (0J/cm2) at skin level were compared in a
randomized, double-blind, controlled clinical trial with
a follow-up of 1 yr. Patients, therapists, assessors, and
analysts were blinded to the assigned treatment. After
informed consent and verification of exclusion criteria,
217 patients with acute lateral ankle sprains were
randomized to three groups. 12 treatments of 904nm laser
therapy in 4 wk were used with a standardized treatment
regimen of 4 wk of brace therapy combined with
standardized home exercises and advice. The laser therapy
device used was a 904nm Ga-As laser, with 25-W peak power
and 5,000 or 500Hz frequency, a pulse duration of 200nsec,
and an irradiated area of 1cm2. Pain and function were
reported by the patient. Intention-to-treat analysis of
the short-term results showed no statistically
significant difference on the primary outcome measure,
pain (p=.41), although the placebo group showed slightly
less pain. Function was significantly better in the
placebo group at 10 d (p=.01) and 14 d (p=.03) after
randomization. The placebo group also performed
significantly better on days of sick leave (p=.02) and at
some points for hindrance in activities in daily life and
pressure pain, as well as subjective recovery (p=.05).
Intention-to-treat analysis showed that total days of
absenteeism from work and sports were remarkably lower in
the placebo group than in the laser groups, ranging from
3.7-5.3 and 6-8 d, respectively. The total number of
relapses at 1 yr in the LLLT group (n=22) was
significantly higher (p=.04) than in the other two groups
(HLLT, n=13; placebo, n=13). Subgroup analysis to correct
for possible confounders did not alter these findings. Neither
high- nor low-dose laser therapy was effective in the
treatment of lateral ankle sprains. Publication Types:
Clinical trial Randomized controlled trial PMID: 9821903,
UI: 99037665
- Flemming KA, Cullum NA,
Nelson EA (1999) A
systematic review of laser therapy for venous leg ulcers.
J Wound Care Mar;8(3):111-4. Centre for Evidence Based
Nursing, Univ of York, UK. A systematic review of
randomised controlled trials (RCTs) was conducted to
establish the effectiveness of LLLT as a treatment for
venous leg ulcers. Wound-care journals, conference
proceedings and electronic databases (including Medline
and Cinahl) were searched up to October 1997 for RCTs
comparing LLLT with sham laser, no laser, or non-coherent
light of other wavelengths. In addition, companies who
manufacture or distribute therapeutic lasers were
contacted for any unpublished or ongoing studies. Results
from searches were scrutinised by one reviewer to
identify possible RCTs and full reports of these were
obtained. Details of eligible studies were extracted and
summarised using a data extraction sheet. A second
reviewer checked the data extraction. Meta-analysis was
used to combine the results of trials where the
interventions and outcome measures were sufficiently
similar. A total of 4 eligible RCTs were identified. Two
compared treatment with laser therapy to sham or placebo
laser treatment. One study compared laser therapy with
ultraviolet therapy. The fourth was a three-armed study
which compared the effects of laser therapy alone, laser
therapy plus infrared light, and non-coherent unpolarised
red light. The comparisons of laser therapy with placebo,
and laser therapy with ultraviolet therapy, showed no
significant difference between treatments with regard to
ulcer healing rates. The comparison of laser with red
light showed a significant increase in complete healing
at 9 mo for the combination of laser and infrared light
compared to non-coherent unpolarised red light. There
was no evidence that LLLT per se helped to heal
venous leg ulcers but a combination
of He-Ne laser and infrared light may promote their
healing. However, more research is needed.
PMID: 10362987, UI: 99291166
- Gao YQ, Liu TC & Tang XJ
(1998) Intravascular low-intensity
He-Ne laser irradiation therapy on idiopathic edema.
Proc. SPIE Vol. 3344, p. 167-170, 1997 Shanghai
International Conference on Laser Medicine and Surgery,
Jing Zhu; Ed. Huanan Normal Univ.; Post of Five Hospital.
194 patients with psoriasis were treated by i/v LLLT
combined with i/v Vit C 2.0g and inhaled oxygen, 1 hour,
once/d, for 5-40 times, and 13 times in average, 10 times
with 4-7 d intervals. 23 cases were cured, 61 had good
effect, 110 cases improved and 10 relapsed. Curative
effect was related to treatment times - cured and good
effect: 5 times 12.5%; 10 times 31%; 15 times 94%. A
matched control group in 17 patients was treated by drug;
1 had good effect, 13 improved and 3 had no effect. (c)1999
SPIE
- Giavelli S, Fava G,
Castronuovo G, Spinoglio L, Galanti A (1998) [LLLT in osteoarticular diseases in geriatric
patients - Article in Italian]. Radiol Med (Torino)
Apr;95(4):303-9. Dipartimento di Radiologia e
Laserterapia, Istituto Gerontologico Pio Albergo
Trivulzio, Milano. Laser light absorption through the
skin causes tissue changes, targeting the nervous, the
lymphatic, the circulatory and the immune systems with an
antalgic, anti-inflammatory, anti-edemic effect and
stimulating tissue repair. Therefore LLLT is now commonly
used in many rehabilitation centers, including the "Istituto
Gerontologico Pio Albergo Trivulzio", Milan, Italy.
However, to activate the treatment program, the basic
medical research results must always be considered to
choose the best optical wavelength spectrum, technique
and dose, for rehabilitative laser therapy. We analyzed
the therapeutic effects of different wavelengths and
powers in various treatment schedules. In particular, a
protocol was designed to test such physical parameters as
laser type, doses and individual schedule in different
pathologic conditions. We report the results obtained
with LLLT in the rehabilitation of geriatric patients,
considering the various physical and technical parameters
used in our protocol. We used the following laser
equipment: an He-Ne laser with 632.8 nm wavelength (Mectronic),
a GaAs Laser with 904 nm wavelength (Mectronic) and a CO2
Laser with 10,600 nm wavelength (Etoile). To evaluate the
patient clinical status, we use a different form for each
involved joint; the laser beam is targeted on the region
of interest and irradiation is carried out with the
sweeping method or the points technique. Irradiation
technique, doses and physical parameters (laser type,
wavelength, session dose and number) are indicated on the
form. The complete treatment cycle was 5 sessions/wk for
20 sessions in all. At the end of the treatment cycle,
the results were scored on a 5-grade semiquantitative
scale--excellent, good, fair, poor and no results. We
examined 3 groups of patients affected with gonarthrosis
(149 patients), lumbar arthrosis (117 patients), and
algodystrophy (140 patients) respectively. In
gonarthrosis patients, the statistical analysis of the
results showed no significant differences between CO2
laser and GaAs laser treatments (p=.975), but significant
differences between CO2 laser and He-Ne laser treatments
(p=.02) and between GaAs laser and He-Ne laser treatments
(p=.003). In lumbar arthrosis patients treated with GaAs
or He-Ne laser, significant differences were found
between the two laser treatments and the combined
sweeping-points techniques appeared to have a positive
trend relative to the sweeping method alone, especially
in sciatic suffering. In the algodystrophy syndrome, in
hemiplegic patients, significant differences were found
between CO2 and He-Ne laser treatments (p=.026), between
high and low CO2 laser doses (p=.024), and between low CO2
laser dose and high He-Ne laser dose (p=.006). LLLT
can be used to treat osteoarticular pain in geriatric
patients. For best results, the diagnostic picture must
be correct and a treatment program defining the physical
parameters used (wavelength, dose and irradiation
technique) must also be designed. PMID: 9676207, UI:
98340896
- Gladkova ND, Karachistov AB,
Komarova LG, Alekseeva OP & Grunina EA (1996) Clinical effectiveness of low-power laser
radiation and functioning of hemosalivatory barrier in
patients with rheumatic diseases. Proc. SPIE Vol.
2929, p. 124-131, Effects of Low-Power Light on
Biological Systems II, Giulio Jori; Tina I. Karu; Eds.
Institute of Applied Physics; Nizhny Novgorod Medical
Academy. We estimated the clinical effectiveness of
several regimes and ways of LLLT on the basis of a double-blind,
placebo-controlling randomizing comparative test in 454
patients with rheumatic diseases (RD). LLLT for RD has a
well-expressed placebo effect. The level of clinical
effect of LLLT for RD was not so high. We could achieve
no "considerable improvement" in any case and
only 18% showed "an improvement". Only in 15%
of patients with RD, a sufficient functioning of hemo-salivary
barrier was observed, the latter providing a reserve for
adaption mechanism, which leads under the influence of
stressor agents of medium strength not only to anesthetic,
but also to moderately expressed anti- inflammatory
effect. LLLT should be viewed as a symptomatic means,
with a primary anesthetic and feeble anti-inflammatory
effect, which can not influence the course of the
rheumatoid process. (c)1999 SPIE
- Harazaki M, Isshiki Y (1997)
Soft laser irradiation
effects on pain reduction in orthodontic treatment.
Bull Tokyo Dent Coll Nov;38(4):291-5. Dept of
Orthodontics, Tokyo Dental College, Chiba, Japan. The
effects of LLLT on reduction of pain while undergoing
orthodontic treatment was examined in this study. These
patients were randomly separated into 3 groups: non-treated
control group (CG), blind irradiation group (BG), and
laser irradiated group (LG). The effect of laser
irradiation on reduction in pain was analyzed by a
questionnaire given to patients who had been wired with
an edgewise appliance of a multi-bracket system for
orthodontic therapy. Just after application of the
initial wire, LG patients were irradiated with the soft
laser from the labial and lingual sites for a total of
one minute. Reduction in pain was found in some
patients who had been irradiated. In particular, delay in
the pain appearance was noted as compared to the other
two control groups. Publication Types: Clinical trial
Randomized controlled trial PMID: 9566142, UI: 98227264
- Jacobsen FM, Couppe C,
Hilden J (1997) Comments on
the use of LLLT in painful musculo-skeletal disorders.
Pain Oct;73(1):110-1. Publication Types: Comment Letter
Comments: Comment on: Pain 1993 Jan;52(1):63-6 PMID:
9414066, UI: 98074877
- Khotiaintsev KS, Doger-Guerrero
E, Glebova L, Svirid V & Sirenko Y (1996) Laser blood irradiation effect on
electrophysiological characteristics of acute coronary
syndrome patients. Proc. SPIE Vol. 2929, p. 132-137,
Effects of Low-Power Light on Biological Systems II,
Giulio Jori; Tina I. Karu; Eds. Instituto de Fisiologia/Univ.
Autonoma de Puebla; Kiev Mohlya Academy Univ.; Univ.
Nacional Autonoma de Mexico; Institute of Cardiology.
This paper treats electro-physiological effects of the
low-level laser irradiation of blood (LBI). The data
presented here are based on the observation of almost 200
patients suffering from the acute disruption of coronary
blood circulation, unstable angina pectoris and
myocardial infarction. Statistically significant changes
of the electro-physiological characteristics were
observed in the group of 65 patients, treated by the LBI.
In particular, the significant 6% extension of the
effective refractory period was observed. The electrical
situation threshold has increased by 20.6%. The
significant changes of some other important electro-physiological
characteristics were within the range of 5-15%. In this
paper, the data obtained on the LBI effectiveness are
compared also with the results obtained on 94 patients
who in addition to the standard anti-angina therapy were
treated by the autohaemo- transfusion performed
simultaneously with the UV-light irradiation of the
transfused blood. There was a significant positive effect
of the low energy LBI. Electrophysiological data gave
good correlation with observed anti-arrhythmic effect of
the LBI. This is proved by the data obtained on the
electrophysiological characteristics of the
cardiovascular system and by other clinical data on the
experimental and control group of patients. The research
established the exact effect of the low level LBI. LBI
gave marked positive changes in electro-physiological
characteristics of the cardiovascular system of the
patients, it also led to the pronounced anti-arrhythmic
effect. (c)1999 SPIE
- Kipshidze N, Sahota H,
Komorowski R, Nikolaychik V, Keelan MH Jr (1998) Photoremodeling of arterial wall reduces
restenosis after balloon angioplasty in an
atherosclerotic rabbit model. J Am Coll Cardiol Apr;31(5):1152-7.
Medical College of Wisconsin, Milwaukee 53226, USA.
Kipshidz@post.its.mew.edu OBJECTIVES: This study
evaluated the long-term impact of endoluminal low power
red laser light (LPRLL) on restenosis in an
atherosclerotic rabbit model. BACKGROUND: Despite
widespread application of balloon angioplasty for
treatment of coronary artery disease, restenosis limits
its clinical benefits. Restenosis is a complex process
and may be partly attributed to the inability of the
vascular endothelium to regenerate and cover the denuded
area at the site of arterial injury. We found earlier
that LPRLL stimulates endothelial cell proliferation in
vitro and contributes to rapid endothelial regeneration
after balloon injury in nonatherosclerotic rabbits.
METHODS: Rabbit abdominal aortas (n=12) were treated in
separate zones with balloon dilation and balloon dilation
plus laser illumination. Endoluminal laser therapy was
performed using a laser-balloon catheter delivering a
single dose of 10 mW for 3 min from a He-Ne laser (632 nm).
Angiography was performed before and after treatment and
was repeated 8 wk before harvesting the aortas.
Quantitative angiographic analysis showed no differences
in the minimal lumen diameter (MLD) between the two zones
before treatment; an increase in the MLD in both zones
after balloon angioplasty and a significant versus slight
reduction of the MLD in the balloon treatment versus
balloon plus laser zones at 8 wk. Histologic examination
showed a very high level of myointimal hyperplasia in the
balloon treatment zones but a minimal level in the LPRLL-treated
zones. Morphometric analysis revealed a statistically
significant difference in the lumen area, intimal area
and intima/media ratio between the balloon versus balloon
plus laser treatment sites. Endoluminal irradiation
with LPRLL prevents restenosis after balloon angioplasty
in an atherosclerotic rabbit model. PMID: 9562022, UI:
98220489
- Kniazeva TA, Nosova AV,
Zubkova SM (1997) [The
development of systems for the early rehabilitation of
patients with ischemic heart disease following
aortocoronary bypass - Article in Russian]. Vopr
Kurortol Fizioter Lech Fiz Kult Jul-Aug;(4):7-10. Two
rehabilitation complexes are described for CHD patients
early after aortocoronary shunting. The first complex
includes "dry" effervescent baths, magnetolaser
therapy applied to the heart area, cryomassage of the
abdomen. The second complex consisted of the above
modalities plus dry air baths. Indications and
contraindications to these complexes are specified.
Publication Types: Clinical trial Randomized controlled
trial PMID: 9424839, UI: 97451924
- Koultcavenia, EV (1998) Influence of LLLT on kidney functions.
Proc. SPIE Vol. 3569, p. 70-74, Effects of Low-Power
Light on Biological Systems IV, Giovanni F. Bottiroli;
Tiina I. Karu; Rachel Lubart; Eds. Novosibirsk Research
Institute of Tuberculosis. Most renal diseases are
accompanied by lowering of kidney functions. That makes
the quality of the treatment worse. On an example 69
patients receiving LLLT, the influence of the laser
radiation on a contracting system of blood, on current of
an active and inactive tubercular inflammation and on
partial functions of kidneys were investigated. LLLT did
not influence the contracting system; it promoted
stopping of unspecific and moderate peaking of specific
inflammation of kidneys. After LLLT blood
microcirculation in kidney improved in 58% of patients;
secretion in 63.1%; stimulation of urodynamic stable in
79%. Increased diuresis, improved filtration and
concentration functions of kidneys also were marked.
(c)1999 SPIE
- Lizarelli RF, Ciconelli KP,
Braga CA & Berro RJ (1999) Low-powered
laser therapy associated with oral implantology. Proc.
SPIE Vol. 3593, p. 69-73, Lasers in Dentistry V, John D.
Featherstone; Peter Rechmann; Daniel Fried; Eds. Univ. of
Sao Paulo; Odontology Association of Ribeirao Preto. The
objective of this present work to evaluate in the level
of pain and tumor the effect of the low-power density
laser irradiation of GaAlAs 790 nm in implanted patients
during the postoperative period. Forty five clinic
situations were selected and divided in three different
groups: Group I, control, without laser application, but
with analgesic and anti-inflammatory medication; Group II,
patients were irradiated on the day of the surgery, after
surgery, and on the two subsequent days; and Group III,
patients were irradiated on the day of the surgery, on
the day of the surgery, before and after the end of the
same, and in the two subsequent days after. All the
applications were accomplished using the same energy
parameters and by the same operator. The measures, with
relationship to the pain and the tumor, they were
accomplished in the immediate postoperative, in the
postoperative always by the same examiner. The
statistical analysis sustained the clinic observations. The
low power density laser of GaAlAs 790 nm suggested the
same clinical results when pain and tumor formation were
controlled by analgesic and anti- inflammatory medication.
(c)1999 SPIE
- Mikhailov VA, Aleksandrova
OIu, Gol'dina EM (1998) [The
immunomodulating action of low-energy laser radiation in
the treatment of bronchial asthma - Article in Russian].
Vopr Kurortol Fizioter Lech Fiz Kult Jul-Aug;(4):23-5.
PMID: 9855770, UI: 99073001
- Mikhailov VA, Skobelkin OK,
Denisov IN, Frank GA & Voltchenko NN (1996) Results of treatment in patients with IIa -
IIIast. breast cancer treated by combination of LLLT and
surgery (5-year experience). Proc. SPIE Vol. 2728, p.
83-91, CIS Selected Papers: Laser Use in Oncology, Andrey
V. Ivanov; Mishik A. Kazaryan; Eds. Ctr. of Laser
Medicine, M.I. Setchenov Moscow Medical Academy, P.A.
Hertzen Moscow Research Oncology Institute. Laser therapy
with semiconductor laser (wavelength 890 nm) was
performed in 41 patients with stage IIa-IIIa breast
cancer. LLLT was used before surgery and postoperative
period for 2 yr. LLLT decreased postoperative
complications by 15.3% and decreased duration of
lymphorrhea. In LLLT- and control- patients with stage
IIa breast cancer, respectively, 5 yr survival was 100
and 86%, and 5 yr non-recurrence was 91.3 and 77.7%. In
stage IIIa patients, survival was 94 and 79%, and non-recurrence
was 82 and 60%. (c)1999 SPIE
- Minor MA, Sanford MK (1998) The role of physical therapy and physical
modalities in pain management. Rheum Dis Clin North
Am Feb;25(1):233-48, viii. Dept of Physical Therapy,
School of Health Related Professions, Univ of Missouri
School of Medicine, Columbia, USA. This article provides
an overview to arthritis care of the common physical
modalities (heat, cold, TENS, LLLT, topical applications,
and external devices). The rationale for use and
effectiveness of the various physical modalities are
discussed. Exercise is presented in terms of mode and
effect of range of motion, muscle conditioning, and
aerobic exercise. Publication Types: Review Review,
tutorial PMID: 10083966, UI: 99183712
- Ohshiro T, Calderhead RG (1991)
Development of low reactive-level
laser therapy and its present status. J Clin Laser
Med Surg Aug;9(4):267-75. Japan Medical Laser Laboratory,
Tokyo. A new subspecialty in the medical application of
the laser has developed, especially over the last decade,
depending on the therapeutic rather than the surgical
applications of the laser. LLLT is now being recognized
as a valid medical tool. Two types of LLLT are presented,
simultaneous and pure. In surgical laser applications,
ranges of heat are generated in the target tissue,
destroying or altering its architecture. This is referred
to as high reactive-level laser treatment, or HLLT. In
addition, nonphotothermally destructive reactions may
also occur, such as photo-osmosis. These are also part of
HLLT. Simultaneously, nondestructive thermal and
nonthermal bioactivation occur at the periphery of the
target tissue: this is "simultaneous LLLT" and
occurs along with HLLT, explaining some of the advantages
of laser surgery. Laser systems have been developed which
deliver power and energy densities below the destructive
level, only to activate the irradiated tissue. This is
"pure LLLT." The history and background of LLLT
are presented, the terminology discussed, and practical
applications of LLLT are presented. Publication Types:
Historical article Review Review, tutorial PMID: 10149466,
UI: 92900937
- Petersen SL, Botes C,
Olivier A, Guthrie AJ (1999) The
effect of LLLT on wound healing in horses. Equine Vet
J May;31(3):228-31. Equine Research Centre, Faculty of
Veterinary Science, Univ of Pretoria, Onderstepoort,
Republic of South Africa. Laser therapy is used in many
countries, including South Africa, for the treatment of
skin wounds. Low level GaAlAs laser was administered to
full thickness skin wounds (3 x 3 cm) induced surgically
on the dorsal aspect of the metacarpophalangeal joints of
6 crossbred horses in a randomised, blind, controlled
study. Treated wounds that received a daily laser dosage
of 2 J/cm2 were compared with nontreated control wounds
on the opposite leg. There were no wound complications.
Both groups of wounds were cleaned daily using tap water.
Wound contraction and epithelialisation were evaluated
using photoplanimetry. There were no significant
differences in wound contraction or epithelialisation
between the laser treated and the control wounds. LLLT
had no clinically significant effect
on second intention wound healing. PMID: 10402136, UI:
99328586
- Pidaev AV (1997) [A mathematical assessment of the efficacy
of the methods for treating patients with chronic
nonspecific lung diseases at a health resort - Article in
Russian]. Lik Sprava Nov-Dec;(6):168-72. A total of
866 patients with chronic unspecific lung diseases were
examined. Medical data collection, storage and
acquisition involved making use of the operational system
UNIX as well as data base control systems UBASE and
INFORMIX. Usage of bronchodilators, antibacterial drugs
and corticosteroids were related to the results of
treatment. Patients with chronic nonspecific lung
diseases can also derive benefit from such
nonpharmacologic modes of treatment as apparatus-aided
training of breathing, hypoxia and hypercapnia training,
AP-laser therapy treatments, herbal aromatic substances. PMID:
9589970, UI: 98251881
- Piller NB, Thelander A (1998)
Treatment of chronic
postmastectomy lymphedema with LLLT: a 2.5 year follow-up.
Lymphology Jun;31(2):74-86. Dept of Public Health, School
of Medicine, Flinders Medical Centre, Bedford Park, South
Australia. binbp@flinders.edu.au Ten women with
unilateral arm lymphedema after axillary clearance (radical
mastectomy) and radiotherapy for breast cancer received
16 treatment sessions with LLLT over 10 wk and seven
patients were followed for 36 mo. The effect of LLLT was
monitored by arm circumference, plethysmography,
tonometry, bioimpedance and a questionnaire dealing with
subjective symptoms. After treatment, edema volume (both
extracellular and intracellular) was decreased, the
tissue (except for the upper arm) progressively softened
or approached a normal texture, and the patients reported
improvement in aches/pains, tightness, heaviness, cramps,
pins/needles, and mobility of the arm. Skin integrity was
also improved and the index for risk of infection
decreased. Follow-up assessment at 1, 3, 6, and 30-36 mo
showed varying trends although at 30-36 mo most
subjective parameters and bioimpedance derived data on
ECF and ICF tended to return toward pre-treatment levels.
Arm circumference continued to show overall improvement,
however, with a volume reduction of the affected arm
reaching 29%. Tonometry also showed maintenance of near
normal values for the involved forearm and anterior and
posterior chest; however, the upper arm showed
progressive induration. LLLT, at least initially,
improved most objective and subjective parameters of post-mastectomy
arm lymphedema. PMID: 9664272, UI: 98328974
- Pinheiro AL, Cavalcanti ET,
Pinheiro TI, Alves MJ, Manzi CT (1997) LLLT in the management of disorders of the
maxillofacial region. J Clin Laser Med Surg 15(4):181-3.
School of Dentistry, Universidade Federal de Pernambuco,
Recife, Brazil. They analysed the effects of LLLT on the
treatment of maxillofacial disorders. Pioneer work
published by Mester et al. opened a new frontier in the
clinical treatment of many disorders with the use of LLLT.
Although LLLT is not well accepted in many places, its
use is growing steadily in others, including Europe and
more recently in Brazil. 141 female and 24 male patients,
between 7 and 81 yr olde (mean=39.2 yr old), suffering
from disorders of the maxillofacial region were treated
with 632.8-nm, 670-nm, and 830-nm diode lasers at the
Laser Center of the Universidade Federal de Pernambuco.
The disorders included temperomandibular joint pain,
trigeminal neuralgia, muscular pain, aphatae,
inflammation, and tooth hypersensitivity both
postoperatively and in small hemangiomas. Most treatment
consisted of a series of 12 applications (twice/wk), and
in eight cases a second series was applied. Patients were
treated with an average dose of 2.5 J/cm2. 120/165
patients were asymptomatic at the end of the treatment,
25 improved considerably, and 20 were symptomatic. LLLT
had many benefits in treating many disorders of the
maxillofacial region. PMID: 9612167, UI: 98275114
- Pinheiro AL, Cavalcanti ET,
Pinheiro TI, Alves MJ, Miranda ER, De Quevedo AS, Manzi
CT, Vieira AL, Rolim AB (1998) LLLT
is an important tool to treat disorders of the
maxillofacial region. J Clin Laser Med Surg Aug;16(4):223-6.
Laser Center, School of Dentistry, Universidade Federal
de Pernambuco, Brazil. They report on the effects of LLLT
in the treatment of maxillofacial disorders. Further to
our previous work, this paper reports the results of the
use of LLLT on the treatment of several disorders of the
oral and maxillofacial region. This paper presents LLLT
as an effective method of treating such disorders. 205
female and 36 male patients ages between 7 and 81 yr old
(mean 38.9 yr old), suffering from disorders of the
maxillofacial region, were treated with 632.8, 670, and
830 nm diode lasers at the Laser Center of the
Universidade Federal de Pernambuco, Recife, Brazil (UFPE).
The disorders included temporomandibular joint (TMJ) pain,
trigeminal neuralgia, muscular pain, aphatae,
inflammation, and tooth hypersensitivity postoperatively
and in small hemangiomas. Most treatment consisted of a
series of 12 applications (twice/wk) and in 15 cases a
second series was applied. Patients were treated with an
average dose of 1.8 J/cm2. RESULTS: One hundred fifty
four out of 241 patients were asymptomatic at the end of
the treatment, 50 improved considerably, and 37 were
symptomatic. LLLT was effective and beneficial in
treating many disorders of the maxillofacial region.
PMID: 9796491, UI: 99012583
- Polosukhin VV (1997) Dynamics of the ultrastructural changes in
blood and lymphatic capillaries of bronchi in
inflammation and following endobronchial laser therapy.
Virchows Arch Oct;431(4):283-90. Laboratory of Laser
Researches of Lymphatic System, Siberian Branch, Russian
Academy of Medical Sciences, Novosibirsk, Russia. An
ultrastructural and autoradiographic analysis of changes
in 188 biopsy specimens of bronchial mucosa of the large
bronchi from 76 patients with chronic inflammatory lung
diseases was carried out. Fibrosis results in an apparent
reduction of metabolic activity in endothelial cells,
affecting the proliferation of basal cells with changes
in cell differentiation. Endobronchial laser therapy
with an He-Ne laser induced proliferative and metabolic
processes in the lamina propria of the bronchial mucosa
with hyperaemia, intensive diapedesis of leucocytes and
formation of leucocytic infiltrations and granulation
tissue. The proliferative and metabolic activity of
endothelial and stromal cells increased, and delicate
fibrous connective tissue was formed. PMID: 9368666,
UI: 98035071
- Prozorova GG, Sil'vestrov VP,
Simvolokov SI, Nikitin AV (1997) [The efficacy of membrane-stabilizing therapy
in patients with chronic obstructive bronchitis - Article
in Russian]. Ter Arkh 69(10):34-6. A membrane
stabilizing effect of endobronchial laser therapy and
antioxidative drugs piracetam and solcoseril was studied
in 83 patients with chronic bronchitis. Malonic
dialdehyde was measured to evaluate effects of this
treatment on cellular and humoral immunity, blood
coagulation and lipid peroxidation. Addition of
membrane stabilizers to standard therapy of chronic
bronchitis lowered malonic dialdehyde concentrations
while the addition of the stabilizers and endobronchial
laser therapy relieved clinical symptoms earlier,
improved parameters of immunity, hemostasis and lipid
peroxidation. PMID: 9471786, UI: 98083659
- Rakitina DR, Urias'ev OM,
Garmash VIa, Ivanova MV, Krasnovid NI, Lebedev AV (1997) [Effects of laser therapy on lipids and
antioxidants in blood of patients with bronchial asthma -
Article in Russian]. Ter Arkh 69(12):49-50. Laser
therapy was assessed for effects on lipoperoxides and
free radical catchers in blood lipids of patients with
bronchial asthma (BA). When a group of 52 BA patients was
compared to healthy donors by dienic conjugates, vitamin
E and overall lipid-soluble antioxidants levels in the
whole blood and plasma, were higher in asthmatics.
Combination of laser therapy with conventional treatment
returned these parameters close to normal. PMID:
9503535, UI: 98164276
- Rigau J, Sun CH, Trelles MA
& Berns MW (1996) Effects
of the 633-nm laser on the behavior and morphology of
primary fibroblast culture. Proc. SPIE Vol. 2630, p.
38-42, Effects of Low-Power Light on Biological Systems,
Tiina I. Karu; Anthony R. Young; Eds. Instituto Medico
Vilafortuny, Beckman Laser Institute and Medical Clinic,
Instituto Medico Vilafortuny, Beckman Laser Institute and
Medical Clinic. We previously described the influence of
LLLT on the primary fibroblast ATCC CRL1471 CCD-19SK
passage 7 in culture, metabolic changes and statistical
significance absorption of (superscript 3)[H]Hydroxyproline
after 2 irradiations (12 hour intervals) with Ar:DYE
Laser, 633 nm wavelength, output power 38 mw, spot size 3.5
cm, power density 4 mw/cm(superscript 2), energy density
plus or minus 2 J/cm(superscript 2). The aim of this work
was to investigate, by using the same procedure, the
behavior of the confluence monolayer fibroblasts culture
when a central scratch of 0.4-1 mm and 2 irradiations
were performed. Colony formation, haptotaxis (direction)
and chemotaxis- chemokinesis (movement) appeared sooner
in the LLLT cultures than in non-treated cultures. LLLT
induced fibroblast biological effects. (c)1999 SPIE
- Schlager A, Offer T,
Baldissera I (1998) Laser
stimulation of acupoint PC06 reduces postoperative
vomiting in children undergoing strabismus surgery.
Br J Anaesth Oct;81(4):529-32. Dept of Anaesthesia and
Intensive Care Medicine, Leopold Franzens Univ of
Innsbruck, Austria. We conducted a double-blind,
randomized, placebo-controlled study to investigate the
effectiveness of AP at PC06 on postoperative vomiting in
children undergoing strabismus surgery. LLLT-AP was
performed at PC06 15 min before induction of anaesthesia
and 15 min after arriving in the recovery room. In the
laser-AP group, the incidence of vomiting was
significantly lower (25%) than that in the placebo group
(85%). Publication Types: Clinical trial Randomized
controlled trial PMID: 9924226, UI: 99123301
- Sergeeva LV, Dobkin VG,
Baenskii AV, Kulikovskaia NV, Litvinov VI (1997) [Use of immunochemical studies to predict the
course of fibrous cavernous tuberculosis of lung and
postoperative complications in patients on chemo and
laser therapy - Article in Russian]. Probl Tuberk (4):23-6.
Central NII of Tuberculosis RAMN, Moscow. 103 patients
with fibrocavernous tuberculosis of the lung were
examined. All had chemotherapy, including 3-4
antituberculous agents. Laser therapy was performed with
a UZOR-2K low-energy semiconductor laser. The course of
the disease was poor in patients with profound changes in
the serum level of protein, with high antigenemia and
antibody production; X-ray positive changes were achieved
to a lesser extent, bacterial expellation stopped less
frequently and more slowly. The decreases in the serum
content of the proteins tested, in the level of
antigenemia and antibody production that occur with drug
and laser therapies are also an important factor in
preoperative preparation, which is highly effective in
preventing postoperative complications. PMID: 9333810,
UI: 97444869
- Shuvalova IN, Klimenko IT,
Zhukova LP, Oborin IuI (1998) [The
effect of low-intensity laser radiation in the infrared
and red ranges on arterial pressure regulation in
patients with borderline hypertension - Article in
Russian]. Lik Sprava Oct-Nov;(7):141-3. Effectiveness
was studied of LLLT on regulation of arterial blood
pressure (BP) in 185 patients (51 men, 134 women). The
above patients were prescribed four therapeutic complexes:
group I was exposed to infra-red irradiation by zones;
group II--to scanning He-Ne laser across the portal zone
and paravertebrally CIII-Th5; group III--to He-Ne laser
in the area of right sinocarotid zone; group IV underwent
hydrolaser shower (in red and intra-red range).
Complaints were studied as were data from lab
investigations, the condition of different bodily systems,
BP level, the functional state of the cardiovascular
system as per ECG and rheography findings. A positive
clinical effect was achieved in all the groups studied. In
the rehabilitation of patients with borderline
hypertension during the sanatorium stage, LLLT markedly
enhanced the efficiency of the therapy administered. LLLT
can be prescribed to patients irrespective of their
hemodynamic types. Irradiation of the right sinocarotid
zone and hydrolaser therapy are indicated to patients
presenting with hypo- and eukinetic types of hemodynamics
and baseline sympatheticotonia. PMID: 10050485, UI:
99159392
- Simunovic Z (1996) LLLT with trigger points technique: a
clinical study on 243 patients. J Clin Laser Med Surg
Aug;14(4):163-7. Laser Center, Locarno, Switzerland.
Among the various methods of application techniques in
LLLT (He-Ne 632.8 nm visible red or infrared 820-830 nm
continuous wave and 904 nm pulsed emission) there are
very promising "trigger points" (TPs), i.e.,
myofascial zones of particular sensibility and of highest
projection of focal pain points, due to ischemic
conditions. The effect of LLLT and the results obtained
after clinical treatment of >200 patients (headaches
and facial pain, skeletomuscular ailments, myogenic neck
pain, shoulder and arm pain, epicondylitis humery,
tenosynovitis, low back and radicular pain, Achilles
tendinitis) to whom the "trigger points" were
applied were better than we had ever expected. According
to clinical parameters, it has been observed that the
rigidity decreases, the mobility is restored (functional
recovery), and the spontaneous or induced pain decreases
or even disappears, by movement, too. LLLT improves local
microcirculation and it can also improve oxygen supply to
hypoxic cells in the TP areas and at the same time it can
remove the collected waste products. The normalization of
the microcirculation, obtained due to laser applications,
interrupts the "circulus vitiosus" of the
origin of the pain and its development (Melzak: muscular
tension > pain > increased tension > increased
pain, etc.). Results measured according to VAS/VRS/PTM:
in acute pain, diminished >70%; in chronic pain >60%.
Clinical effectiveness (success or failure) depends on
the correctly applied energy dose; over/underdosage
produces opposite, negative effects on cellular
metabolism. We noted no negative effects and the use
of analgesic drugs could be reduced or completely
excluded. LLLT can be used as monotherapy or as a
supplementary treatment to other therapeutic procedures
for pain treatment. Publication Types: Clinical trial
Controlled clinical trial PMID: 9456632, UI: 98117748
- Simunovic Z, Trobonjaca T,
Trobonjaca Z (1998) Treatment
of medial and lateral epicondylitis - tennis and golfer's
elbow - with LLLT: a multicenter double blind, placebo-controlled
clinical study on 324 patients. J Clin Laser Med Surg
Jun;16(3):145-51. Laser Center, Locarno, Switzerland.
tzlatko@mamed.medri.hr Among the other treatment
modalities of medial and lateral epicondylitis, LLLT has
been promoted as a highly successful method. The aim of
this clinical study was to assess the efficacy of LLLT
using trigger points (TPs) and scanner application
techniques under placebo-controlled conditions. The
current clinical study was completed at two Laser Centers
(Locarno, Switzerland and Opatija, Croatia) as a double-blind,
placebo controlled, crossover clinical study. The patient
population (n=324), with either medial epicondylitis (Golfer's
elbow; n=50) or lateral epicondylitis (Tennis elbow; n=274),
was recruited. Unilateral cases of either type of
epicondylitis (n=283) were randomly allocated to one of
three treatment groups according to the LLLT technique
applied: (1) Trigger points; (2) Scanner; (3) Combination
Treatment (i.e., TPs and scanner technique). Bilateral
cases of either type of epicondylitis (n=41) were subject
to crossover, placebo-controlled conditions. Laser
devices used to perform these treatments were infrared (IR)
diode laser (GaAlAs) 830 nm continuous wave for treatment
of TPs and He-Ne 632.8 nm combined with IR diode laser
904 nm, pulsed wave for scanner technique. Energy doses
were equally controlled and measured in Joules/cm2 either
during TPs or scanner technique sessions in all groups of
patients. The treatment outcome (pain relief and
functional ability) was observed and measured according
to the following methods: (1) short form of McGill's Pain
Questionnaire (SF-MPQ); (2) visual analogue scales (VAS);
(3) verbal rating scales (VRS); (4) patient's pain diary;
and (5) hand dynamometer. Total relief of the pain with
consequently improved functional ability was achieved in
82% of acute and 66% of chronic cases, all of which were
treated by combination of TPs and scanner technique. The
best results were obtained using combination treatment (i.e.,
TPs and scanner technique). Good results are obtained
from adequate treatment technique correctly applied,
individual energy doses, adequate medical education,
clinical experience, and correct approach of laser
therapists. Under- and overirradiation dosage can result
in the absence of positive therapy effects or even
opposite, negative (e.g., inhibitory) effects. The
data gave further evidence of the efficacy of LLLT in the
management of lateral and medial epicondylitis.
Publication Types: Clinical trial Multicenter study
Randomized controlled trial PMID: 9743652, UI: 98416293
- Smith CF & Vangsness CT
(1992) Future of laser
biostimulation in America today: microlight 830. Proc.
SPIE Vol. 1643, p. 275-276, Laser Surgery: Advanced
Characterization, Therapeutics, and Systems III, R. Rox
Anderson; Ed. Univ. of Southern California School of
Medicine. For the last 2 yr we have been investigating
the use of a 830 nm laser for LLLT in chronic pain
syndromes. The laser output does not exceed 100 mW. This
wave length has been carefully selected to be in the 'window'
of wavelengths between 650 and 900 nm. At this level, the
laser energy will penetrate the epidermis, the dermis and
the subcutaneous layers to the deep tissue. The tissue
effect of this laser energy is not thermal but rather a
stimulation of micro-circulation with a secondary effect
of blocking pain enzymes and activation of the synthesis
of endorphin enzymes. We have experience with
approximately 75 patients who have been treated with LLLT.
We used a double-blind study at several General Motors
facilities in Michigan to determine the effectiveness of
LLLT in inflammatory conditions. Repetitive injuries in
the work place have moved from 18% of industrial
accidents in 1981 to 52% in 1989. Carpal Tunnel Syndrome
is the number one economic problem in occupational
medicine; 15% of employees of American automotive plants
have Carpal Tunnel Syndrome. This large number of
patients have been treated in the past by standard
physiotherapy treatment modalities and ultimately by
surgery for failure of conservative therapy. Incidence of
'return to work activities' has been low. LLLT affords
a positive solution to this problem not only
therapeutically but prophylactically. Indications for
treatment are Chronic Pain Syndrome and Carpal Tunnel
Syndrome of mild to moderate degree. (c)1999 SPIE.
- Smith CF, Vangsness CT,
Anderson T & Good W (1995) Treatment
of repetitive use carpal tunnel syndrome. Proc. SPIE
Vol. 2395, p. 658-661, Lasers in Surgery: Advanced
Characterization, Therapeutics, and Systems V, R. Rox
Anderson; Ed. Univ. of Southern California School of
Medicine) AC(General Motors). In 1990, a randomized,
double-blind study was initiated to evaluate the use of
an eight-point conservative treatment program in carpal
tunnel syndrome. A total of 160 patients were delineated
with symptoms of carpal tunnel syndrome. These patients
were then divided into two groups. Both groups were
subjected to an ergonomically correct eight-point work
modification program. A counterfeit LLLT unit was used in
Group A, while an actual LLLT unit was used in Group B. Groups
A and B were statistically significantly different in
terms of return to work, conduction study improvement,
and certain range of motion and strength studies. (c)1999
SPIE
- Takac S, Stojanovic S (1998)
[Diagnostic and
biostimulating lasers - Article in Serbo-Croatian (Roman)].
Med Pregl May-Jun;51(5-6):245-9. Zavod za sudsku medicinu,
Medicinski fakultet, Novi Sad. They present data on the
application of diagnostic and biostimulating laser
instruments in medicine. For diagnostic purposes there
are several types of laser instruments and procedures
available: Laser Microscopic Masonic Analyzer (LAMMA),
Flow cytometry. Doppler effects of laser rays (Laser
Doppler velocytometry, Laser Doppler spermokhinezymetry,
Laser Doppler spectrometry), Laser fluorescent microscopy,
Laser nephelometry, Transilumination by lasers (diaphanography),
Laser spectroscopy, Laser holography, Laser rethinoscopy,
Microirradiation by lasers. Literary data concerning
favorable effects of low power laser radiation on series
of diseases covering different medical specialties are
cited, pointing to possibility of significant enrichment
of already available arsenal of physical methods, thera-pies
and rehabilitation procedures. Mechanisms of
biostimulation of human tissues and organs under low
power laser radiation are also presented. All these
stimulatory and regulatory mechanisms of the cell
metabolism are involved in the wound epitelization,
reduction of edema and inflammation and reestablishement
of arterial, venous and lymph microcirculation and
consequently inducing better tissue nutrition. The use of
laser spectroscopy for quantitative analysis of cations
from a single drop of dried blood on a piece of filter
paper was not realized, although individual analyses of
frozen skin biopsies for calcium, arsenic and gold were
accomplished. In Europe, this technique has also found
its application in forensic medicine. Furthermore, laser-based
methods have been used to study air pollution with
carcinogens in occupational exposures and also for the
detection of narcotic drugs. Laser cytofluorometry
utilizes the argon laser for scanning of single stained
cells and has achieved utilization in mass examination
programs for Pap-smear determinations. The same technique
is used in cell sorting system that is now important in
monoclonal antibody determination in hybridoma technology.
Other possible diagnostic applications include laser
particle size measurement techniques, and laser
nephelometry for determination of immunoglobulins classes
and autoantibodies such as rheumatoid factors. Laser
Doppler velocimetry is used to measure blood flow by
means of a simple probe that rests on the lip.
Biostumulating laser instruments. World famous scientist
Endre Mester, from Budapest, is one of the pioneers with
great experimental and clinical experience in the use of
biostimulating effects of lasers. His former student, O.
Ribari first used biostimulating effects of He-Na laser (390
mJ power) for the epitelization of perforated tympanic
membrane and treatment of postoperative fistulas of the
neck and of the mastoid. Generally speaking,
biostimulating effect of LLLT is in its anti-inflammatory,
analgesic and anti-edematous effect on tissues. There is
absolute increase in microcirculation, higher rates of
ATP, RNA and DNA synthesis, and thus better tissue
oxygenation and nutrition. There is also increase in the
absorption of interstitial fluid, better tissue
regeneration and stimulation of the analgesic effect. The
past three decades of laser medicine and surgery have
shown great progress and promise for the future. PMID:
9720352, UI: 98386821
- Tkachishin VS (1999) [Effectiveness of nondrug treatment of
chronic bronchitis in persons exposed to radiation due to
Chernobyl AES accident - Article in Russian]. Ter
Arkh 71(3):24-8. AIM: Assessment of efficacy of combined
treatment of chronic bronchitis (CB) in subjects exposed
to radiation after the Chernobyl accident including
nonpharmacological (NP) modalities vs conventional
chemotherapy (CT). 149 patients with different forms of
CB in exacerbation were divided into 2 groups. The study
group of 62 patients received NP + CT. Control group of
87 patients received CT alone. The response was judged by
achievement of partial or complete remission, general
condition score, external respiration function. The
combined treatment significantly more frequently (p<.05)
led to CB remission and more marked improvement of the
patient's condition. External respiration improved
insignificantly. Combined treatment by
nonpharmacological methods improved the treatment results
in exacerbation of chronic bronchitis. PMID: 10234759,
UI: 99251067
- Tuner J, Hode L (1998) It's all in the parameters: a critical
analysis of some well-known negative studies on LLLT.
J Clin Laser Med Surg Oct;16(5):245-8. Swedish Laser
Medical Society, Stockholm, Sweden. Scientific studies
include references to historical studies on LLLT in
general and to old studies on the specific subject in
particular. Some studies are quoted often. It is fair to
take a second look at these, since few people seem to
have read them carefully, and others have read them only
in the abstract form. This paper critically reviews the
parameter pitfalls found in many of the classic "negative"
studies. A study of 1,200 papers on LLLT has resulted
in 85 positive and 35 negative double-blind studies. The
negative studies have been scrutinized carefully in an
effort to pinpoint possible reasons for the failures. In
the following, most are double-blind studies, but some
non-blinded and animal studies have been included to give
typical examples of pitfalls. Publication Types:
Review Review, tutorial Comments: Comment in: J Clin
Laser Med Surg 1998 Oct;16(5):243 PMID: 9893504, UI:
99109382
- Urioste SS, Arndt KA, Dover
JS (1999) Keloids and
hypertrophic scars: review and treatment strategies.
Semin Cutan Med Surg Jun;18(2):159-71. Beth Israel
Deaconess Medical Center, Chestnut Hill, MA 02467, USA.
Keloids and hypertrophic scars represent exuberant forms
of scar formation that frequently are pruritic, painful,
and occasionally form strictures. As well, they may
result in significant cosmetic disfigurement. Recent
years have seen an increased understanding in the
molecular and biological mechanisms of keloidal scar
formation, allowing for the development of more specific
therapeutic options for these lesions. Despite these
developments, keloids and hypertrophic scars remain
difficult to manage. Clinical, histopathological, and
biochemical features of keloids and hypertrophic scars,
as well as treatment guidelines, are discussed.
Publication Types: Review Review, tutorial PMID: 10385284,
UI: 99312010
- Usuba M, Akai M, Shirasaki Y
(1998) Effect of LLLT on
viscoelasticity of the contracted knee joint: comparison
with whirlpool treatment in rats. Lasers Surg Med 22(2):81-5.
Dept of Physical Therapy, Tsukuba College of Technology,
Ibaraki, Japan. usuba@k.tsukubatech.ac.jp The purpose of
this study was to compare the effect of LLLT with sham
and whirlpool treatment on the contracted knee joint in
rat. 48 Wistar rats were operated on to immobilize knee
joint, and 1 wk after operation they were randomly
assigned to 4 treatment groups: laser 40 mW (3.9 W/cm2),
laser 60 mW (5.8 W/cm2), whirlpool (42 degrees C), and
sham laser. Tunable Ga-Al-As semiconductor (810 nm) laser
was used for another 2 wk of treatment. Removing and
preparing bilateral hind legs, degree of knee contracture
was assessed by measuring the knee flexion angle, weight
of the gastrocnemius muscle, and periarticular connective
tissue viscoelasticity measuring phase-lag and stiffness.
LLLT had no significant effect except the phase-lag of
laser 60 mW. It did not provide a significant effect for
minimizing the degree of experimental joint contracture
over whirlpool treatment. PMID: 9484700, UI: 98145732
- Vasil'ev AP, Strel'tsova NN,
Kiianiuk NS (1997) [The
stress-limiting action of low-intensity laser radiation
in patients with ischemic heart disease - Article in
Russian]. Vopr Kurortol Fizioter Lech Fiz Kult Nov-Dec;(6):3-5.
In 20 patients with exercise-induced angina, the cold
test brought about activated lipid peroxidation, modified
the lipid phase of a red cell membrane, which correlated
with systolic changes. After LLLT for 1 mo, the cold test
caused no activation of lipid peroxidative processes, no
significant changes in the organization of a cell
membrane lipid bilayer, or any profound cardiac
performance abnormalities. LLLT has membrane-stabilizing
and antistress effects. LLLT should be used in
coronary heart disease patients having a functional
component of coronary insufficiency. PMID: 9484017,
UI: 98145011
- von Kobyletzki G, Freitag M,
Herde M, Hoxtermann S, Stucker M, Hoffmann K, Altmeyer P (1999) [Phototherapy in severe atopic
dermatitis: Comparison between current UVA1 therapy, UVA1
cold light and combined UVA-UVB therapy - Article in
German]. Hautarzt Jan;50(1):27-33. Dermatologische
Klinik, Ruhr-Universitat Bochum. Severe atopic dermatitis,
especially when involving the face, does not respond well
to conventional therapy. In the present prospective
randomized trial, we compared therapeutic efficiency of
medium-dose UVA1, medium-dose cold light UVA1 (15
treatment courses with 50 J/cm2 each) and combined UVA-UVB
phototherapy. Four (13.3%) of 30 UVA1 treated patients,
one (3.4%) of 30 UVA1 cold light treated patients and
three (30%) of 10 patients treated with combined UVA-UVB
discontinued therapy course before finishing treatment
protocol because skin status did not improve or even
deteriorated. In the other patients treated over a period
of 3 wk, skin status improved significantly or even
cleared completely in 80.8% of UVA1 treated and in 89.7%
of UVA1 cold light treated patients resulting in a
significant decrease of the SCORAD-Score (UVA1 group from
68.6+10.9 SD to 29.8+7.1 SD and UVA1 cold
light group from 72.5+13.4 SD to 23.8+11.6
SD; p<.05 each). In the UVA-UVB treated group, the
SCORAD-Score also decreased (from 71.0+9.4 SD to
41.6+10.5 SD), but significantly less than in both
UVA1 treated groups (p<.05 each). 4 wk after
completing therapy UVA1 treated patients showed a
prolonged therapy benefit as compared to UVA-UVB treated
patients. Plasma levels of eosinophil cationic protein
and soluble interleukin-2 receptor significantly
decreased under UVA1 phototherapy but not under UVA-UVB
therapy. Compared to conventional UVA1 phototherapy,
UVA1 cold light phototherapy showed advantages due to the
absence of potentially proinflammatory effects based on
temperature-induced increase of skin blood flow (quantified
by Laser doppler scanning) and increased sweat production
(determined by the patient using a visual analog scale).
Publication Types: Clinical trial Randomized controlled
trial PMID: 10068928, UI: 99168053
- Walsh LJ (1997) The current status of LLLT in dentistry. Part
1: Soft tissue applications. Aust Dent J Aug;42(4):247-54.
Dept of Dentistry, Univ of Queensland. Despite >30 yr
experience with LLLT or 'biostimulation' in dentistry,
concerns remain as to its effectiveness as a treatment
modality. Controlled clinical studies have shown that
while LLLT is effective for some specific applications,
it is not a panacea. This paper provides an outline of
the biological basis of LLLT and summarizes the findings
of controlled clinical studies of the use of LLLT for
specific soft tissue applications in dentistry. Areas of
controversy where there is a pressing need for further
research are identified. Publication Types: Review Review,
tutorial Comments: Comment in: Aust Dent J 1997 Dec;42(6):414
PMID: 9316312, UI: 97462037
- Walsh LJ (1997) The current status of LLLT in dentistry. Part
2: Hard tissue applications. Aust Dent J Oct;42(5):302-6.
Dept of Dentistry, Univ of Queensland. While most
applications of LLLT in dentistry are directed toward
soft tissues, in recent years there has been increasing
interest in tooth-related or hard tissue applications of
LLLT. He reviews the applications of LLLT in the
treatment of dentine hypersensitivity and pain arising
from the periodontal ligament, and describes the
phenomenon of lethal laser photosensitization and its
applications in the treatment of dental caries. Technical
aspects of LLLT equipment and safety concerns are also
discussed. Publication Types: Review Review, tutorial
PMID: 9409045, UI: 98073439
- Webb C, Dyson M, Lewis WH (1998)
Stimulatory effect of 660 nm
low level laser energy on hypertrophic scar-derived
fibroblasts: possible mechanisms for increase in cell
counts. Lasers Surg Med 22(5):294-301. Dept of
Rehabilitation Sciences, The Hong Kong Polytechnic Univ,
Hong Kong. Varying effects of red light wavelengths on in
vitro cells have been reported. LLLT is used to assist
wound healing especially for indolent ulcers. On healing,
burn wounds may become hypertrophic, resulting in
excessive wound contraction, poor cosmesis, and
functional impairment. This study enquired whether 660 nm
LLLT affected hypertrophic scar-derived fibroblasts. The
experiments investigated the effect of a 660 nm, 17 mW
laser diode at dosages of 2.4 J/cm2 and 4 J/cm2 on cell
counts of two human fibroblast cell lines, derived from
hypertrophic scar tissue (HSF) and normal dermal (NDF)
tissue explants, respectively. The protocol avoided
transfer of postirradiated cells. Estimation of
fibroblasts utilized the methylene blue bioassay. Post-660
nm-irradiated HSFs had very significantly higher cell
counts than controls p<.01 on d1-4 (Mann-Whitney U-test),
and p<.01 on d1-3 for similarly irradiated NDFs. PMID:
9671996, UI: 98335717
- Ye HZ (1993) Views on treatment of endometriosis by using
laser acupuncture and moxibustion. Proc. SPIE Vol.
1616, p. 497-500, International Conference on
Photodynamic Therapy and Laser Medicine, Jun-Heng Li; Ed.
Hospital of Yangzi Petrochemical Corp. This article
emphasizes the treatment of endometriosis by using laser-AP
and moxibustion which belongs to Shi Zhen. The major
pathophysiology is that the circulation of the Qi and
blood is obstructed. The obstruction of Qi leads to a
block of blood and poor circulation that causes pain. The
treatment should be introduced mainly by adjusting Qi and
blood. We used an He-Ne LLLT unit. Its output was >/=
20 mw, wavelength 632.8 nm with a single-red light. Using
a double tube fiber bundle it was applied at LV03, CV06,
SP08 for 5-10 min/point/d, for 7 sessions/course. LLLT
results in cleaning the liver, adjusting the oxygen, and
disencumbering the varices and the pain. When it makes
the circulation of Qi free, the blood is normally
transported and the pain disappears. After 1-2 courses of
therapy, clinical re-examination indicated the
disappearance of scleromata in the uterus. 5 patients
treated and continually re-checked recovered. Finally,
their menses turned normal and clinical symptoms vanished
within 6 mo. (c)1999 SPIE