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Lasers in Medical Sciences - Volume:2 Issue: 1, Winter 2011

Journal of Lasers in Medical Sciences
Volume:2 Issue: 1, Winter 2011

  • تاریخ انتشار: 1390/03/30
  • تعداد عناوین: 9
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  • Nikolai Tsankov, Simin Meymandi, Ivan Grozdev, Hamidreza Shafiei Page 1
    Introduction
    Palmoplantar psoriasis could hardly be differentiated from chronictylotic eczema both clinically and histologically. The most commonly used therapeuticoptions for palmoplantar psoriasis are long-term therapy with topical corticosteroidsand local PUVA. Frequently, it is a recalcitrant disease. We investigated the efficacyand tolerability of the combination of topical calcipotriol with local UVA radiationin comparison with local PUVA therapy.
    Methods
    In a total of 43 patients with palmoplantar psoriasis, 33 were given 15sessions of local UVA radiation and topical calcipotriol and the remainder received15 sessions of local PUVA (psoralen + UVA radiation).
    Results
    The statistical analyses of the results showed that the effect and tolerability of both therapeutic modalities are comparable.
    Conclusion
    Combination of topical calcipotriol and local UVA radiation is anoptional corticosteroid-free therapeutic modality for palmoplantar psoriasis. It hasa comparable effectiveness and tolerability with local PUVA.
  • Ali Mostafaie, Alireza Mahboub Ahari, Fatemeh Sadeghi Ghyassi, Sakineh Hajebrahimi, Mahmoud Yousefi Page 6
    Introduction
    To compare the efficacy and cost-effectiveness of Femtosecond laser versus mechanical Microkeratome corneal flap creation in correction of refractive errors.
    Methods
    In this review, a comprehensive search of Medline, SCOPUS, Cochrane,TRIP database, supplemented by HTA and economic databases was performed. Wesearched for randomized controlled trials (RCTs) of Femtosecond laser which includedmechanical Microkeratome in other arm. The quality of the retrieved studies wasappraised by two independent reviewers and appropriate articles were finalized.
    Result
    A total of 1142 articles were identified, of which, 1059 were excluded after review of the titles and abstracts and 83 articles remained. Systematic reviews andRCTs were evaluated through CASP international worksheet. Eventually, 61 titleswere excluded, leaving 22 articles to be reviewed.Safety: There was no individual evidence to cover all safety components aboutFemtosecond laser, but in summary, this modality seems a safe method for cornealflap creation.Effectiveness: No statistically significant difference was shown in visual acuityand refractive errors. The important secondary end point of this review was diffuseLamellar keratitis in 17% of the Femtosecond group versus 5% in mechanicalMicrokeratome. Inflammation was low-grade and improved during the first 3 monthsof follow-up period with a low dose medication without corneal scarring. The twogroups was comparable in all clinical outcomes including Unorrected Visual Acuity(UCVA), Best Special Corrected Visual Acuity (BSCVA), manifest refraction, wavefront aberrometry, Schirmer test, and Tear Break up time (TBUT).Cost Analysis: Results showed that marginal cost incurred due to Femtosecondtechnology adoption may vary from 27 to 117 € (resulted from sensitivity analysis). Itis clear that additional cost may be a small proportion of LASIK procedure total cost.
    Conclusion
    Although Femtosecond flap creation is a modern method with a good quality of corneal flap, but, there is no high-quality evidence to show superiorityof Femtosecond laser in clinical outcomes. Although the efficacy and cost of thesystems is almost equal, traditional method still remains as the standard approach.
  • Gholamreza Esmaeeli Djavid, Amirhossein Emami, Leila Ataie-Fashtami, Seyed Reza Safaeinodehi, Farzad Merikh-Baiat, Mohsen Fateh, Nasrin Zand Page 12
    Introduction
    Chemotherapy-induced oral mucositis (COM) is a common, debilitating complication of cancer therapy. The aims of this study were to evaluate the effect of low level laser therapy (LLLT) on prevention of COM in patients with hematologicmalignancies.
    Methods
    Fifty-five patients hospitalized to undergo chemotherapy in Imam Hospital were included into the study. These patients were divided into two groups. The oral cavity of the patients were illuminated by continues laser beam using a GaAlAslaser device with wavelength of 630 nm, power output 30 mW, and dose of 5 J/cm2for six days (LLLT group). The patients in the second group underwent placeboirradiation (power output equal to zero) with the similar protocol. The severity ofthe COM was clinically evaluated based on WHO grading scale. The patientys’quality of life was assessed before and after the intervention according to EORTCQLQ-C30 questionnaire.
    Results
    The incidence of COM in LLLT group (31%) was less than the placebogroup (41%). Mean duration of COM healing was 4.8 and 12 days in LLLT andplacebo groups, respectively (p=0.03). Xereostomia was significantly less severe inLLLT group in comparison with the placebo group (p=0.007).
    Conclusion
    Our findings showed that LLLT significantly reduced the incidence oforal mucositis of WHO grade 3 and 4 as the most debilitating form of oral mucositis,in which oral alimentation is impossible. Also, LLLT could reduce duration of oralmucositis, decreased the risk of secondary infection, and accelerated return to normalnutrition.
  • Soheila Mokmeli, Zahra Ayatollahzadeh Shirazi, Mahrokh Daemi, Fatemah Ayatollahzadehshirazi, Alireza Soosanabadi, Mitra Hajizadeh Page 18
    Introuduction: Low-level laser therapy (LLLT) is shown effective in healing diabetic foot ulcer when combined with conventional therapy. Since; Diabetes mellitus is a leading cause of impaired wound healing. The aim of this study is to determine the effect of different diabetic control’s methods on the healing response of diabetic foot ulcer in those patients treated with Low level laser therapy (LLLT), added to conventional therapy.
    Methods
    This study contains 74 diabetic foot-ulcers which most of them prone to resistance to conventional therapy. Different stages of diabetic foot ulcers and ways ofcontrolling blood glucose level are included in this study. There were 3 response groups;Group 1-Insulin receiving patients, most of them had a very tight blood glyceamic levelprofile controlling. Group 2- Non-insulin receiving or drug dependent patients, had aperiodical blood glyceamic level profile with flatuance. Group 3- Mixed methods. Mostof the patients in this group had tight blood glyceamic level profile controlling. Theway to control blood glucose level should be according to the internist`s consult. Thewounds irradiation are performed by the combination of infra-red and red, (860 nm and650 nm) laser, with the total energy density of 3.6 J/cm² in addition of intravenous lasertherapy (IVL) with 2.5 MW, 650 nm (red) laser used for 30 minutes. All wounds havebeen photographed from equal distance, before and after treatments, and all the woundswere staged by a surgeon who was neutral about the effects of the laser therapy. Thesurgeon’s judgment was established only by the visual assessments of the wounds. Allthe mathematical and statistical analysis is based on the descriptive statistics using thesoftware package SPSS16.
    Conclusion
    LLLT promote the tissue repair process of diabetic foot ulcer. Healing response of the patients was not dependent on methods of controlling blood glucose level. Previously it was reported that tight control of diabetes containing continuous subcutaneous insulin infusion and others on split mixed doses promotes healing of diabetic foot lesions. In this study; we found interruption of LLLT in the treatment of diabetic wound; can give a very acceptable result even in the absence of tight controlling of glucose level. When the quantity presentations value of the mean blood glucose level distribution was on the range of 144- 275 mg/dl. In this multi-disciplinary method we achieved a remarkably shorter mean healing time of two months, compared with other reported studies with healing time of three to six months.
  • Behrooz Barikbin, Golsan Kardan, Maryam Yousefi, Hamideh Moravvej Page 26
    Introduction
    Vitiligo is a cutaneous disorder of pigmentation, for which, there are some proven modalities of treatment. In this study, we evaluated the efficacy ofthe addition of topical pimecrolimus to 308nm Excimer laser in reducing treatmentduration and improving the response rate of eyelid vitiligo, compared with 308nmExcimer laser monotherapy.
    Methods
    Fifty two symmetrically localized lesions of eyelid vitiligo in 26 patientswere observed. Each of vitiliginous patches was treated with 308nm Excimer lasertwice a week for a total of 30 sessions. Topical pimecrolimus 1% cream was appliedto the patches of right eyelid(group A lesions) and eucerine cream as a placebo tothe left side patches(group B lesions)twice daily, throughout the study. Photographswere taken at baseline, 6 and 15 weeks after starting the treatment.
    Results
    Twenty two patients (44 lesions) completed the study. Repigmentation wasappeared in all (100%) of groups A and B lesions. A 75% or more repigmentationwas achieved in 17(78%) of group A versus 14 (64%) of group B lesions. Theaverage number of sessions needed for the appearance of repigmentation was 8 forgroup A lesions and 12 for group. The repigmentaion of 50% or more in patientswith disease duration of 2 years or less and those with more than 2 years durationere 100% and 59.2%, respectively.
    Conclusions
    Repigmentation rate obtained by the combination therapy of eyelidvitiligo with 308nm Excimer laser and topical Pimecrolimus 1%cream is significantlyhigher, and obtained in fewer sessions in comparison with 308nm Excimer laser andplacebo combination therapy.
  • Hamideh Moravvej, Behrooz Barikbin, Seyed Alireza Ghavam, Soheil Karimi Page 30
    The desire to achieve cosmetic rejuvenation and reduce effects of aging andphotodamage urged scientists to develop effectual techniques which have minimalside effects and impressive long-term efficacy. Traditional ablative resurfacing lasertherapy has been used for several years;however, it has harmful side effects on thepatient’s skin such as dyspigmentation, persistent erythema, infections, acneiformeruptions and scarring. It also prolongs downtime, so it puts a significant burdenon society. Nonablative resurfacing laser therapy declines side effects of traditionaltherapies, although it has lower effectiveness in comparison with ablative one.Nonablative fractional resurfacing laser therapy commenced a modern technique whichdiminished side effects, while maintains the efficacy of traditional methods. The aimof of this current review is to sum up nonablative fractional laser therapies used forskin photorejuvenation at the past and present time and to evaluate the indications,advantages and classification of it and non-fractional resurfacing laser therapy.
  • Sakineh Hajebrahimi, Alireza Mahboub Ahari, Fatemeh Sadeghi Ghyassi, Ali Mostafaie, Mahmoud Yousefi Page 36
    Introduction
    Our aim was to compare the cost effectiveness of holmium laserprostate enucleation (HOLEP) versus trans-urethral resection of prostate.
    Materials And Methods
    We searched all available databases for any controlled trialscomparing HOLEP and TURP from January 2000 to February 2009. Two independentreviewers studied and appraised the selected evidences. Then, effectiveness and costeffectiveness of HOLEP was evaluated.
    Results
    We identified four randomized controlled trials and one systematic review according to the inclusion criteria. Most of the studies had moderate quality ofevidence with limited sample sizes. Overall success rate of HOLEP was comparablewith TURP; but, some secondary outcomes such as pick flow rate twelve monthsafter the surgery was better in HOLEP. A comparison between the original costsand those obtained from sensitivity analysis showed that the cost parameters weresensitive to the number of the patients treated. Increasing the number of the patientsfrom 200 to 300 changed the study’s results in favor of the new techniques.
    Conclusion
    Since the holmium and thulium laser sets are sensitive to the number of the patients and multipurpose, they potentially can be applied for stone fragmentation.Thus, utilization of these equipments will divide the costs between two groups ofthe services. In economic terms, these properties lower overhead costs and justifythe purchasing of these equipments.
  • Massoud Seifi, Elahe Vahid-Dastjerdi Page 43
    Introduction
    To determine efficacy of low level laser therapy for clicking temporomandibular joint (TMJ) with a diode laser following orthodontic treatment.
    Methods
    Performance of LLLT with a diode laser for temporomandibular clicking and postoperative findings were evaluated in a case of an orthodontic patient followingthe termination of treatment. Patient had a history of severe clicking before initiationof treatment protocol. Low level diode laser (wave length 808 nm, power 0.7 watt,Time 60 seconds), applied for the purpose of relieving the signs.
    Results
    During the process of intervention and establishing the proper dental occlusion sign of temporomandibular joint dysfunction i.e. clicking reduced significantly(p<0.05) but remained at the lowest level from the perspective of frequency andseverity index. Patient had no sign and symptom at the end of treatment. Clicking wasreemerged in the retention period, i.e. after six months. Clinical signs disappearedimmediately after the application of laser once (p<0.05) with no recurrence afterfour months follow up.
    Conclusion
    Low level laser therapy serves as an adjuvant to orthodontic treatment while establishing the proper occlusion of stomatognathic system has pivotal rolein function and stability of outcome.
  • Mohammad Reza Razzaghi, Abdolah Razi, Hooman Mokhtarpour, Mohammad Mohsen Mazloomfard, Behzad Lotfi Page 46
    Endourologic pyeloplasty is being a substitute of open pyeloplasty in management ofureteropelvic junction obstruction. This procedure can be done in different mannerslike balloon dilation, cold knife and electrosurgical endoureterotomy, accucise andlasers.A 47 year old woman referred with history of previous open pyeloplasty.Hydronephrosis of right kidney with unremarkable T ½ was found in DTPA scan.A full-thickness lateral incision was done with holmium:YAG laser just below theright UPJ and carried through the stenotic segment until the renal pelvis was reached.Half-time of radioisotope excretion was 13 min for the right kidney in diureticrenogram 3 months following operation.