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Laser-induced thermal damage and corresponding histological artefacts interfere with accurate histological interpretation, thus hampering the judgment of given pathology and creating a dilemma about the effectiveness of lasers as a bioptic tool. The objective of the present study was to compare macroscopic and microscopic (morphometric, pathomorphological and histochemical) characteristics of biopsies procured by scalpel and two diode laser systems (808 nm and 980 nm) Study was conducted on 105 patients (81 male, 24 female; mean SD age 42 years) who were randomly divided into three groups (808 nm diode laser, 980 nm diode laser and scalpel) with 35 patients each. A total of 525 sections of 5 μm thickness were obtained from 105 formalin-fixed paraffin-embedded blocks. A total of 315 sections were stained using H&E for evaluation of morphometric (LTD) and pathomorphological changes (epithelial, connective tissue, vascular and cytological). PAS and Giemsa special stains were used for the evaluation of glycogen content and assessment of inflammation in 105 sections. The 808 nm DL at 2.5W continuous wave (cw) and 980 nm DL at 5W pulsed mode (pm) showed charring in 48% and 31% of samples respectively, while there was no charring in the scalpel group. Mean value of LTD in 808 nm DL group at cw was found to be five times higher than that produced in 980 nm DL group at pm. The 808 nm DL produced higher number of pathomorphological artefacts compared to the other two study groups (980 nm DL, scalpel group). On histochemical evaluation, majority of PAS stained sections showed uniform distribution in scalpel group, while 60% sections in 980 nm DL group and 54.2% sections in 808 nm DL showed patchy distribution.80% of Giemsa-stained sections revealed dense inflammation in scalpel group, 54.2% showed less dense in 808 nm DL group and inflammation was absent in 34.2% sections in 980 nm DL group. The 980 nm diode laser proved to be an effective and preferred bioptic tool over the 808 nm diode laser.

To summarize the current evidence and the reasons to go for thulium-based anatomical endoscopic enucleation of the prostate (AEEP). This review discusses the available literature on thulium-based AEEP. Thulium lasers operate at a wavelength between 1940 and 2013 nm. This wavelength, which has a low penetration depth in water, allows to perform smooth cuts in the prostatic tissue and allows urologists to perform various procedures: resection, vaporization, enucleation, or vapoenucleation of the prostate. Depending on the type of thulium laser, it can be used either in a continuous, or pulsed mode. In recent years, an increasing amount of evidence has described the thulium laser as a minimally invasive and size-independent treatment option for benign prostatic enlargement with excellent long-term results.

Introduction. Osteoarthritis of the knee is the most common presentation of osteoarthritis with prevalence between 12% and 35% of general population and is considered the leading cause of musculoskeletal disability in the elderly population worldwide. Aim. The study compared efficacy of kneading massage and pulsed ultrasound on pain, joint stiffness and difficulty in knee osteoarthritis (KOA). Material and methods. Fifty subjects with radiological evidence of KOA participated in the study. They were randomly allocated into kneading massage group (KMG) (25) and Ultrasound group (USG) (25). KMG received kneading massage for 7 minutes while USG received pulsed mode ultrasound for 15 minutes. Treatment was twice in a week for six weeks. Pain intensity (PI), joint stiffness and difficulty were assessed pre, 3rd and 6th weeks of treatment session with semantic differential scale and WOMAC. The data were analyzed using descriptive and inferential statistics, alpha level was set at 0.05 Results. There was a significant difference in present PI (F=11.45,P=0.001) and stiffness (F= 11.32, P=0.003) in USG. There was a significant reduction in PI (F=7.95, P=0.001) and joint stiffness (F=8.86, P=0.003) in KMG. At the 6th week, there was a significant differences in PI (t=12.23,P=0.000) and stiffness (t=8.08, P=0.000) when USG (3.00+0.4, vs 7.14+ 1.49) was compared with KMG (3.16+0.5 vs 7.50+1.5). Conclusion. Ultrasound (US) and kneading massage (KM) reduced PI and joint stiffness of KOA effectively; however US reduced PI than KM while KM reduces joint stiffness than US.

Background: The calcific tendinitis of the shoulder is a dysfunction conservatively treated by shock waves, iontophoresis, and phonophoresis, associated or not with the use of acetic acid. Objective: To check the effects of phonophoresis with acetic acid in the treatment of calcific tendinitis of the shoulder in resorption stage. Methods: Measurements of ROM, muscle strength and functionality of the shoulder (SPADI) were made pre and post-physiotherapeutic treatment. The treatment protocol consisted of 10 sessions of therapeutic ultrasound with acetic acid (frequency = 3 MHz; intensity = 1.4 W/cm2; pulsed mode of 1:4), for 10 minutes, 3 times a week. The data were analyzed using the SPSS software (20.0), through the Student’s t-test (paired) considering a significance level of 5%. Results: There was significant improvement regarding the ROM, muscle strength and functionality of the right shoulder (SPADI) comparing pre vs. post-treatment (P0.05), in the comparison between the shoulders (right X left) in the post-treatment. Conclusion: According to the results of this case study, the protocol used (10 sessions of therapeutic ultrasound + 5% acetic acid) was effective in the treatment of calcific tendinitis of shoulder, improving the ROM, muscle strength and functional capacity, in addition to eliminating the pain of the shoulder affected.

Objective To examine the effectiveness and safety of ultrasound-guided glossopharyngeal nerve block via the styloid process for primary glossopharyngeal neuralgia. Methods This retrospective study included all patients receiving glossopharyngeal nerve block via the styloid process under ultrasound guidance for primary glossopharyngeal neuralgia between January 2015 and May 2018 at our hospital. The primary outcome of the study was pain relief as assessed using the visual analog scale (VAS). Treatment was considered effective if the VAS score decreased by more than 2 points. Results Twelve patients were included in the analysis. The baseline VAS scores ranged from 5 to 9. All patients received previous pharmacotherapy. Other previous treatments included pulsed mode radiofrequency (n=4), microvascular decompression (n=2), and glossopharyngeal nerve block (not under ultrasound guidance; n=2). The patients completed a total of 48 injections for glossopharyngeal nerve block. At discharge from the hospital, and at 6, 12, and 18 months thereafter, 10/12, 10/12, 7/12, and 4/12 patients achieved pain relief and the effective rate was 83.3% at discharge, 83.3% at 6 months, 58.3% at 1 year, and 33.3% at 18 months, respectively. Conclusion Ultrasound-guided glossopharyngeal nerve block via the styloid process is a safe, radiation-free, repeatable, convenient, and effective treatment. It can provide a treatment option for patients with glossopharyngeal neuralgia.

OBJECTIVES To compare the efficacy of pulsed high-intensity focused ultrasound (PHIFU) versus continuous high-intensity focused ultrasound (CHIFU) ablation at identical doses. METHODS Continuous and pulsed HIFU (1200 J) at duty cycles (DCs) of 60% and 20% were examined for their capacity to ablate bovine liver tissue in vitro and rabbit liver tissue in vivo. After ablation, grayscale changes and pathologic characteristics were observed or measured, and the tissue necrosis volume, energy efficiency factor, and average grayscale density were calculated. RESULTS The pulsed mode generated greater liquefaction necrosis. An inconspicuous grayscale change was observed for PHIFU at a DC of 20% in some samples, which appeared as an elliptical cavity. The energy efficiency factor of PHIFU at a DC of 60% was significantly lower than that of CHIFU, as observed both in vitro and in vivo (P

To evaluate the feasibility of a 980-nm contact diode laser (CDL) as a method for creating a posterior laryngofissure in live pigs. Twenty-eight Landrace pigs (15–20 kg) were anesthetized, intubated, ventilated, and submitted to a cervical tracheostomy. An anterior and posterior midline longitudinal laryngofissure incision was created according to randomization—control (n = 4), posterior laryngofissure with a scalpel blade; electrocautery (n = 12), posterior laryngofissure by electrocautery (10, 15, 20, 25 W powers); CDL (n = 12), posterior laryngofissure by the CDL (10, 15, 20, 25 W peak powers in pulsed mode). Larynx and proximal trachea were excised, prepared for histopathology, and digital morphometric analysis. Measurements in and within each group were analyzed (Kruskal-Wallis and Dunn test) with a level of significance of p

Background This study prospectively compared intraoperative pain scores during percutaneous microwave ablation of the liver in patients randomized between continuous and pulsed energy delivery algorithms. Methods During a 12-month period, 20 patients who underwent microwave liver ablation were prospectively randomized between 2 different energy delivery modes: "continuous mode" (CM, n=10) and "pulsed mode" (PM, n=10). All ablation sessions were performed using the same microwave ablation platform under computed tomographic guidance and intravenous analgesia. Within 30 min post ablation, all patients completed a questionnaire assigning a numeric pain intensity score from 0 (no pain) to 10. Results Mean pain scores were 8.17±1.850 in the CM group and 4.50±1.567 in the PM group, with a statistically significant difference of 3.667±2.807 pain units (P=0.001). The mean procedure time was 53.5±20.90 min in the PM group vs. 58.5±17.44 min in the CM group (P=0.279). The mean size of the lesions was 2.81±0.95 cm in the PM group and 2.81±0.85 cm in the CM group (P=0.984). On a per-lesion basis, technical success was achieved in all evaluable tumors in both groups. No difference was noted in the local tumor control on the 6-month imaging evaluation. No complications were observed in the CM arm, while small perihepatic hemorrhagic fluid collections were reported in the PM group. Conclusions Both algorithms for microwave energy delivery have comparable treatment effects in terms of 6-month local tumor control for liver lesions

Aims: Radiofrequency-based electrophysical agents (EPAs) have been used in therapy practice over several decades (e.g. shortwave therapies). Currently, there is insufficient evidence supporting such EPAs operating below shortwave frequencies. This laboratory-based study investigated the deep physiological effects of 448 kHz capacitive resistive monopolar radiofrequency (CRMRF) and compared them to pulsed shortwave therapy (PSWT).Methods: In a randomized crossover study, 17 healthy volunteers initially received four treatment conditions: high, low and placebo dose conditions receiving 15-min CRMRF treatment and a control condition receiving no intervention. Fifteen participants additionally received high-dose PSWT as fifth condition, for comparison. Pre- and post-treatment measurements of deep blood flow and tissue extensibility were obtained using Doppler ultrasound and sonoelastography. Group data were compared using analysis of variance model. Statistical significance was set at p ≤ .05, 0.8 pow...

Bilateral vocal fold paralysis is a disabling condition that results in airway symptoms, dysphonia, and sometimes difficulty swallowing. Various types of glottal widening procedures have been described in the literature, all of which are performed in the operating room under general anesthesia. The aim is to report laser partial arytenoidectomy as an office-based treatment modality in a patient with bilateral vocal fold paralysis. Using Thulium laser fiber introduced through the working channel of fiberoptic nasopharyngoscope, a posterior cordectomy followed by resection of the vocal process of the right arytenoid was performed. The laser was used in a pulsed mode, power range 3.5 to 4.5 W, duration 70 to 300 milliseconds, repetition 2 to 4 Hz, and aiming beam 65%. The procedure was well tolerated and the patient was successfully decannulated 3 weeks later. Unsedated office-based laser arytenoidectomy might be considered a safe alternative to the commonly practiced glottal widening procedures in patients with a preexisting tracheotomy.

The article is devoted to a new method of treatment ofprimary axillary hyperhidrosis UHF technology. Anatomy, topography and function of the sweat glands, as well as the mechanism of action of ultrahigh-frequency therapy electromagnetic field frequency from 30 to 300 MHz (wavelength of 10 m to 1 m) in continuous or pulsed mode are described. The aim of the study was to investigate the efficacy and safety of UHF-therapy apparatus SweatX at axillary hyperhidrosis. Inclusion criteria was hyperhidrosis corresponding to the scale of gravity HDSS (Hyperhidrosis Disease Severity Scale) 3 rd and 4 th degree: before treatment in 8 patients HDSS level was equal to 4, in 12 patients - 3. Each patient received a series 4 treatments with an interval of 1 week. Underarm pictures with iodine-starch test subjects was performed at baseline and after 1, 3 and 6 months after the last treatment. Each procedure SweatX exposure consisted of two stages. The total processing time of each axilla was 8-10 minutes (about 20 minutes on both armpits). In the study, as well as between the procedures and follow-up visits were observed no undesirable side effects. After 6 months of follow up indicators HDSS sweating on a scale from 11 (55%) patients dropped to 2, and 9 (45%) patients -1. Thus, on the basis of SweatX use of UHF technology provides a safe, effective and lasting solution to the problems encountered in patients with primary hyperhidrosis underarm.

Non-invasive brain stimulation using focused ultrasound has largely been carried out in small animals. In the present study, we applied stimulatory focused ultrasound transcranially to the primary sensorimotor (SM1) and visual (V1) brain areas in sheep (Dorset, all female, n = 8), under the guidance of magnetic resonance imaging, and examined the electrophysiologic responses. By use of a 250-kHz focused ultrasound transducer, the area was sonicated in pulsed mode (tone-burst duration of 1 ms, duty cycle of 50%) for 300 ms. The acoustic intensity at the focal target was varied up to a spatial peak pulse-average intensity ( I sppa ) of 14.3 W/cm 2 . Sonication of SM1 elicited electromyographic responses from the contralateral hind leg, whereas stimulation of V1 generated electroencephalographic potentials. These responses were detected only above a certain acoustic intensity, and the threshold intensity, as well as the degree of responses, varied among sheep. Post-sonication animal behavior was normal, but minor microhemorrhages were observed from the V1 areas exposed to highly repetitive sonication (every second for ≥500 times for electroencephalographic measurements, I sppa = 6.6–10.5 W/cm 2 , mechanical index = 0.9–1.2). Our results suggest the potential translational utility of focused ultrasound as a new brain stimulation modality, yet also call for caution in the use of an excessive number of sonications.

The aim of the present work is to evaluate the effect of photodynamic therapy (PDT) by using argon laser with rose bengal (Herbs) as a photosensitizer when compared to the Avastin for treatment of corneal neovascularization (CNV) in rabbits. Thirty-Nine New Zealand male rabbits aged 2.5 months and weighing 2.5-3 kg are selected from the animal house of research institute of ophthalmology, Giza, Egypt. Three rabbits are used as control, and 36 rabbits are subjected to corneal neovascularization (CNV) induced by 3 silk sutures at mid-stromal depth approximately 1 mm from the limbus. After four days, sutures are removed and slit lamp examinations are performed to determine the area of CNV. Rabbits with CNV are divided into 3 groups: (1) The first group left without any treatment(n=12); (2) The second group (n=12 rabbits) were generally anesthetized and rose bengal(C20H4Cl4I4O5) with a dose of 50 mg/Kg was administered by slow intravenous injection in the marginal ear vein. After 15 minutes, rabbit’s eyes were exposed to argon laser(Quantel-Medical, Vitra, France) in a pulsed mode at 532 nm, spot size of 50 μm, pulse duration of 0.2 ms and a power of 150-200 mW/cm 2.; (3) The third group are treated with subconjunctival injection of 25 mg Avastin (n=12). The rabbits are followed up for 4 weeks and 3 rabbits are selected and sacrificed weekly from each group. The corneas are isolated for determination of protein content, SDS-poly acrylamide gel electrophoresis, total antioxidant capacity (TAC) and total oxidative capacity (TOC). Final results show that avastin is almost as effective as photodynamic therapy.

A miniature electron spin resonance (ESR) probehead that includes a static field source and a microwave resonator for in vivo measurement of paramagnetic defects in tooth enamel was developed. These defects are known to be a good marker for quantifying the ionizing radiation dose absorbed in teeth. The probehead has a typical length of just 30 mm and total weight of 220 g. The patient "bites" into the probehead while the measurement procedure is being carried out. The probehead operates in pulsed mode at a frequency of ∼ 11.2 GHz and supplies a static magnetic field of ∼ 400 mT. A detailed design of the probehead is provided together with its specifications in terms of measurement volume and signal-to-noise ratio for a typical sample. A specially developed simulation program was used to predict the spatial distribution of the acquired signal under conditions of grossly inhomogeneous static and RF fields. Experimental results with irradiated incisor teeth validated the probehead's sensitivity, being able to detect signals in tooth irradiated by only 2 Gy. Subject to additional improvements and tests, this type of probehead can potentially have significant clinical applications ranging from mass triage following major nuclear events to routine occupational evaluation of ionizing radiation absorbed over long periods of time.

One of the numerous sub-areas of interventional radiology is the use of X-rays in gastroenterology. X-ray fluoroscopy is applied in therapeutic procedures, including endoscopic retrograde cholangiopancreatography (ERCP) that is frequently performed. The ERCP procedure is aimed at imaging the pancreatic duct and biliary tracts.In this paper radiation risk to the gastrenterologist performing ERCP procedures was investigated. The procedures were performed by a single gastroenterologist in the ERCP Laboratory, University Clinical Hospital Military Memorial Medical Academy - Central Veterans' Hospital in Łódź, Poland. The study comprised 2 series of measurements, one taken during the procedures with continuous fluoroscopy mode, the other during procedures with fluoroscopy in pulsed mode at a frequency of 3 pulses/s. Exposure parameters, anatomical data of patient and dose equivalents for the eyes, skin of the hand and the effective dose for whole body of the gastroenterologist were recorded during each procedure.The collected data cover 70 ERCP procedures - 40 procedures were controlled by continuous fluoroscopy and 30 by pulsed fluoroscopy. The results reveal that pulsed fluoroscopy makes it possible to reduce doses received by the gastroeneterologist from 45% to 60% compared to continuous fluoroscopy.Endoscopic retrograde cholangiopancreatography procedures can cause radiation risk to the gastroenterologist performing them. The use of continuous fluoroscopy can result in achieving an equivalent dose to eye lens nearly 20 mSv per year, i.e., the decreased annual limit recommended by the International Commission on Radiological Protection (ICRP). Med Pr 2017;68(6):735-741.Wykorzystanie promieniowania rentgenowskiego (rtg.) w gastroenterologii stanowi jeden z licznych podobszarów radiologii interwencyjnej. W gastroenterologii fluoroskopia rtg. jest używana w procedurach terapeutycznych, z których częsta jest endoskopowa cholangiopankreatografia wsteczna (ECPW). Procedura ECPW pokazuje radiologiczny obraz dróg żółciowych i przewodu trzustkowego.W ramach niniejszej pracy przeprowadzono ocenę narażenia na promieniowanie rtg. gastroenterologa wykonującego zabiegi ECPW pod kontrolą fluoroskopii. Badania przeprowadzono w Pracowni ECPW Uniwersyteckiego Szpitala Klinicznego im. Wojskowej Akademii Medycznej – Centralnego Szpitala Weteranów w Łodzi, gdzie gastroenterolog wykonuje je samodzielnie. Realizując cel pracy, wykonano 2 serie pomiarów – pierwsza składała się z zabiegów wykonanych w trybie fluoroskopii ciągłej, druga – z zabiegów, które wykonano w trybie fluoroskopii impulsowej (o częstotliwości 3 pulsy/s). Podczas każdej procedury rejestrowano parametry ekspozycji, dane anatomiczne pacjenta, a także otrzymywane przez gastroenterologa równoważniki dawek dla soczewek oczu i skóry dłoni oraz dawkę efektywną dla całego ciała.Zebrano dane dotyczące ogółem 70 zabiegów ECPW, w tym 40 zabiegów wykonanych w trybie fluoroskopii ciągłej i 30 – w trybie fluoroskopii impulsowej. Na podstawie uzyskanych wyników stwierdzono, że gastroenterolog wykonujący procedury ECPW w trybie fluoroskopii impulsowej otrzymuje dawki promieniowania niższe o 45–60% niż podczas pracy w trybie fluoroskopii ciągłej.Procedury ECPW mogą być źródłem narażenia na promieniowanie rtg. dla wykonującego je gastroenterologa. Używanie trybu fluoroskopii ciągłej może pozwolić na osiągnięcie obniżonej wartości rocznego limitu dawki równoważnej dla soczewek oczu (tj. 20 mSv), rekomendowanej przez Międzynarodową Komisję Ochrony Radiologicznej (International Commission on Radiological Protection – ICRP). Med. Pr. 2017;68(6):735–741.

Burn is defined as a traumatic injury of thermal origin, which affects the organic tissue. Low-level laser therapy (LLLT) has gained great prominence as a treatment in this type of injury; however, the application parameters are still controversial in the literature. The aims of this study were to review the literature studies that use LLLT as a treatment in burns conducted in an experimental model, discuss the main parameters used, and highlight the benefits found in order to choose an appropriate therapeutic window to be applied in this type of injury. The selection of the studies related to the theme was carried out in the main databases (PubMed, Cochrane Library, LILACS, Web of Science, and Scopus in the period from 2001 to 2017). Subsequently, the articles were then chosen that fell within the inclusion criteria previously established. In the end, 22 were evaluated, and the main parameters were presented. The analyzed studies presented both LLLT use in continuous and pulsed mode. Differences between the parameters used (power, fluence, and total energy) were observed. In addition, the protocols are distinct as to the type of injury and the number of treatment sessions. Among the results obtained by the authors are the improvements in the local microcirculation and cellular proliferation; however, a study reported no effects with LLLT as a treatment. LLLT is effective in accelerating the healing process. However, there is immense difficulty in establishing the most adequate protocol, due to the great discrepancy found in the applied dosimetry values.

The inactivation of Escherichia coli under selected treatments using high hydrostatic pressure (HHP), pulsed electric fields (PEF), and ultrasound (US) was studied in apple juice. HHP was carried out from 300 to 600 MPa (0.5–7 min, 21 °C), PEF was applied from 23.07 to 30.76 kV/cm (20–40 °C) using up to 21 pulses, and US was performed in continuous and pulsed mode at 120 μm and temperature from 50 to 60 °C (0–30 min). The best treatment was HHP that inactivated 7 log of bacterial cells in less than 1 min. US also showed positive results (>6 log reduction) after 5 min when temperature was kept at 60 °C regardless of the operation mode. Inactivation with PEF showed about 5 log reduction using the highest electric field strength. The color of the juice showed some changes after processing; the L* value parameter was significantly different (p

BACKGROUND C-arm fluoroscopy equipment is important for interventional pain management and can cause radiation injury to physicians and patients. We compared radiation safety education and efforts to reduce the radiation exposure of pain specialists. METHODS A survey of 49 pain specialists was conducted anonymously in 2016. The questionnaire had 16 questions. That questionnaire was about radiation safety knowledge and efforts to reduce exposure. We investigated the correlation between radiation safety education and efforts of radiation protection. We compared the results from 2016 and a published survey from 2011. RESULTS According to the 2016 survey, all respondents used C-arm fluoroscopy in pain interventions. Nineteen respondents (39%) had received radiation safety education. Physicians had insufficient knowledge about radiation safety. When the radiation safety education group and the non-education group are compared, there was no significant difference in efforts to reduce radiation exposure and radiation safety knowledge. When the 2011 and 2016 surveys were compared, the use of low dose mode (P = 0.000) and pulsed mode had increased significantly (P = 0.001). The number checking for damage to radiation protective garments (P = 0.000) and use of the dosimeter had also increased significantly (P = 0.009). But there was no significant difference in other efforts to reduce radiation exposure. CONCLUSIONS Pain physicians seem to lack knowledge of radiation safety and the number of physicians receiving radiation safety education is low. According to this study, education does not lead to practice. Therefore, pain physicians should receive regular radiation safety education and the education should be mandatory.

Thermal effect of dual wavelength (980 and 1064 nm) laser application in skin incision closure was assessed on 18 male and female Wister rats. 1-cm-long incisions were made on the shaved dorsal region of 220-250 g animals. The incisions were closed by laser irradiation at 1 W and exposure time, 5 seconds in continuous-wave mode (CW) and 1 W and exposure time, 10 seconds in pulsed mode to deliver total energies of 5 J and 10 J per spot onto the incisions, respectively. Animals from each group were sacrificed at 0th, 4th, and 7th days and the skin samples of the weld area were excised for histological analysis using Hematoxylin and Eosin (HE) stain. Mean thermally altered area (TAA) of CW-mode laser-treated groups was found to increase significantly (p0.05) compared with pulsed mode laser treated group at 0th and 4th days post-irradiation while no significant difference (p0.05) was statistically found at 7th day post-irradiation. Moreover, tighter closure was observed with CW group at 7th day post-irradiation. We thus conclude that 1 W, 5 J for 5 seconds CW mode laser application of 980 and 1064 nm combined beam form in skin incision closure was found to have absolute wound healing capability with minimal thermal alteration.

Percutaneous denervation procedures offer pain relief by denervation of the nerves that innervate painful joints. The denervation may be performed by radiofrequency thermoneurolysis using a thermal or a pulsed mode, cryoneurolysis, or laser denervation. Significant publications only exist for radiof

Objective To evaluate the efficacy and safety of thulium-YAG laser in sialendoscopic fragmentation of salivary lithiasis. Design Retrospective, interventional case series. Material Sixty-three patients treated by interventional sialendoscopy with thulium-Yag laser fragmentation between 2003 and 2010 at Edouard Herriot Hospital were included in the study. The laser was used for non-floating or large lithiasis (>4 mm). Methods The sialendoscopic thulium fiber laser was used in a pulsed mode with an average power output of 2–8 W to fragment and facilitate extraction of salivary stones. Several variables were studied: success rate, total number of procedures, total energy per procedure, size and number of salivary stones removed, and complications. Results Our series of 63 cases includes 40 cases of parotid lithiasis and 23 cases of submandibular lithiasis. In nine cases, two sessions of laser were performed. Stone size was evaluated pre-operatively by ultrasound and varied between 2 and 18 mm. Laser fragmentation was possible in every case. Complete extraction of the lithiasis was possible in 51 cases (73.9%) and partial extraction in eight cases (12.6%). Extraction failed in four cases (6.3%). Mean stone size was 5.4 mm (5.7 mm for parotid glands and 5.0 mm for sub-mandibular glands) and mean energy per procedure was 1,450 J (range: 1,400–1,800 J). Ductal perforations were observed in 12.7% of the cases. 65.1% of patients were free of symptoms with a mean follow-up of 18 months. Conclusion Thulium-YAG laser appears to be an effective and safe technique in the treatment of salivary lithiasis. Lasers Surg. Med. 44: 783–786, 2012. © 2012 Wiley Periodicals, Inc.

Background: Lasers have become standard tools for the surgical treatment of oral lesions. The purpose of this study is to determine the surgical margins and histologically evaluate the tissue thermal effects induced by different types of surgical instruments. Material and Methods: Cuts were made in pork tonguesâ mucosa with different lasers (Er:YAG at 2W with and without air / water spray and at 4W with and without air / water spray; CO2 at 3.5W and 7W in pulsed mode and at 7W in continuous mode; the diode laser at 3.5W and boost 3.5W in pulsed mode; Nd:YAG at 6W, 40Hz and electroscalpel at 5W and conventional scalpel as control. Macroscopic and microscopic morphological changes were evaluated. Results: The results of this study showed that the surgical instruments that caused greater tissue damage extension were: the Nd:YAG laser (670.68μm), the diode 3.5W and boost PW (626.82μm), the CO2 7W CW (571.18μm), the CO2 at 7W PW (485.45μm), the diode 3.5W PW (456.15μm), the electroscalpel (409.57μm) and lastly the CO2 laser 3.5W PW (306.19μm) and Er:YAG (74.66μm) laser, regardless of power, mode or air / water spray used. An association between the Tissue Damage Extension and the Degree of Carbonization (r = 0.789; P = 0.01), and an association between the Tissue Damage Extension and Regularity of the Incision were found (r = -, 299; P = 0.01). Conclusions: The results of this study suggest that lasers can be used in soft tissues biopsies of the oral cavity, enabling a correct histopathological analysis, as long as the biological effects of each laser type are considered. The Er:YAG laser revealed its potential for biopsies of the oral mucosa ensuring a successful histological evaluation and the CO2 laser at 3,5W in pulsed mode presented itself as the best choice for surgeries with hemostasis.

The aim of this in vitro study was to investigate the antibacterial effect of the dual wavelength (2780 nm Er,Cr:YSGG and 940 nm diode) laser in elimination of Enterococcus faecalis in comparison with a 2780 nm Er,Cr:YSGG laser alone.Various laser wavelengths have been introduced as an adjunct in root canal treatment because of laser's bactericidal effect.Seventy- five slices of dentin with thicknesses of 300, 500, and 1000 μm (n = 25 each) obtained from caries-free bovine teeth were inoculated with 1 μL of E. faecalis suspension [1.67 × 10(7) colony-forming units (CFU)] and divided randomly into three groups: (A) samples indirectly irradiated with power settings of 1.06 W, 50 Hz, and 50 μs for Er,Cr:YSGG laser; (B) samples indirectly irradiated with Er,Cr:YSGG laser with the same power settings as group A and simultaneously with a 940 nm diode laser of 0.51 W in pulsed mode; and five samples from each thickness that were chosen as an unirradiated control group (Co). After irradiation, the CFU of E. faecalis were counted and the bacterial reduction was analyzed using Kruskal-Wallis nonparametric and post-hoc Dunnett tests.There were statistical differences between groups A and B compared with the control group over all the three dentin slice thicknesses (p 0.001). However, there was no statistical difference between groups A and B in killing of E. faecalis on 500 μm dentin slices. There were significantly more viable bacteria in group A than in group B in 300 and 1000 μm dentin slices (p 0.01).The results of this in vitro study showed that the dual wavelength laser system obtained a significantly higher bactericidal effect on E. faecalis than Er,Cr:YSGG laser, reaching a depth of 1000 μm of dentin.

Active personal dosemeters (APD) have been found to be very efficient tools to reduce occupational doses in many applications of ionizing radiation. In order to be used in interventional radiology and cardiology (IR/IC), APDs should be able to measure low energy photons and pulsed radiation with relatively high instantaneous personal dose equivalent rates. A study concerning the optimization of the use of APDs in IR/IC was performed in the framework of the ORAMED project, a Collaborative Project (2008–2011) supported by the European Commission within its 7th Framework Program. In particular, eight commercial APDs were tested in continuous and pulsed X-ray fields delivered by calibration laboratories in order to evaluate their performances. Most of APDs provide a response in pulsed mode more or less affected by the personal dose equivalent rate, which means they could be used in routine monitoring provided that correction factors are introduced. These results emphasize the importance of adding tests in pulsed mode in type-test procedures for APDs. Some general recommendations are proposed in the end of this paper for the selection and use of APDs at IR/IC workplaces.

Atualmente, a drenagem linfática manual (DLM) é um dos recursos de grande destaque no tratamento de edemas, linfedemas e condições inestéticas, porém, na prática clínica têm-se observado sua aplicação de forma iatrogênica. Os objetivos deste relato de caso foram apontar as sequelas da aplicação iatrogênica da DLM, em uma jovem caucasiana, e verificar os efeitos da intervenção fisioterapêutica no tratamento dessas. Voluntária de 27 anos, apresentava-se com uma equimose importante na região lateral da coxa esquerda (28 x 9,5 cm), telangiectasias, microvaricosidades e petéquias em ambas as coxas e pernas, dor de forte intensidade e edema, após ter se submetido a um procedimento manual iatrogênico com finalidade estética há dois dias. As condutas fisioterapêuticas adotadas foram: Ultrassom 3 MHz, pulsado (2 ms on, 8 ms off), 0,4 W/cm² SATP na região da equimose e DLM (Método Leduc) durante 20 minutos, na coxa esquerda. Foram realizadas nove sessões até a alta no 16º dia pós-lesão, observando-se apenas a redução gradativa da dor e da equimose. Verificou-se a efetividade da intervenção fisioterapêutica em apenas algumas das sequelas provocadas pela iatrogenia, sem desconsiderar que a remissão espontânea dos sinais e sintomas também pode ter contribuído para tal. Destaca-se a importância de conscientizar os fisioterapeutas que atuam com este procedimento para que o aplique de forma adequada, evitando tais iatrogenias. Recently, the manual lymphatic drainage (MLD) is an important resource in the treatment of edemas, lymphedemas, and other unaesthetic conditions. However, problems caused by the incorrect application of this therapy have been observed in the clinical practice. The aims of this case report were to describe sequelae resulting from the negligent application of MLD on a young patient, and to determine the effects of physical therapy on the treatment of sequelae. A 27-year-old Caucasian woman presented with a large ecchymosis (28 x 9.5 cm) on the outer side of the left thigh, telangiectasias, micro varicose veins, and petechiae on the legs and thighs, intense pain, and edema, after undergoing an incorrect manual procedure for aesthetic purposes two days earlier. Physical therapy consisted of ultrasound application (3 MHz, pulsed mode, 20% duty cycle, SATP intensity of 0.4 W/cm²) to the ecchymosis site and MLD (Leduc method) for 20 minutes on the left thigh. The patient underwent nine physical therapy sessions until discharge from the hospital 16 days after injury. The effectiveness of physiotherapy intervention was verified in only some of the consequences caused by iatrogenic, without disregarding that the spontaneous remission of signs symptoms can have contributed to such fact. The study emphasizes the importance of awareness among physical therapists who work with this procedure to apply it appropriately in order to avoid such conditions.

Since 1960, when Maiman built the first laser equipment, this technology has gone through a continuous development and an increasing utilization in several fields. Nowadays many pathologies find a less traumatic solution in laser technology. Laser can be either used to treat lesions with a high bleeding risk such as hemangioma and lymphangioma or in patients with coagulation diseases or hypertension, taking advantage of its capability to coagulate. Moreover healing and scarring are improved by the laser's effect of biostimulation and inhibition of bacterial growth, this leading to a greater comfort for the patient. The tissue vaporization and the dimension of the damaged area depend on several factors, those related to the laser used, such as wavelength, power, emission mode (continued or pulsed mode) and the power density, and those concerning to the treated tissue, like color and consistency. In this Study, we used an Lithium Borate, (LBO), laser, instead of scalpel for earlobe reduction in a 35-year-old male patient with pending lobule. LBO laser works through a solid active medium emitting a visible green light. A diode laser, with a wavelength of 810 nm, stimulates a crystal of Nd:YAG, which has a wavelength of 1064 nm. Then a crystal of LBO doubles the vibration frequency of the photons, leading to a final wavelength of 532 nm.

Amalgam tattoos are common, asymptomatic, pigmented oral lesions that clinically exist as isolated, blue, gray, or black macules on the gingival, buccal, and alveolar mucosae, the palate, and/or the tongue. In this case report, the successful use of an erbium, chromium-doped:yttrium, scandium, gallium, and garnet laser for the removal of an amalgam tattoo is explained. A 46-year-old man is presented with a half decade history of an amalgam tattoo on his left maxillary premolar–molar gingiva. Depigmentation procedure was performed under topical anesthesia with the use of an erbium, chromium-doped:yttrium, scandium, gallium, and garnet laser at 2 W in the soft tissue pulsed mode for 10 min. The pigmented tissue was completely removed. The de-epithelialization area healed completely on the 10th day after treatment. The period of healing was uneventful. The amalgam tattoo was completely removed with erbium, chromium-doped:yttrium, scandium, gallium, and garnet laser, and the treated area healed without any adverse effect.

Objective. Premature complexes (PCs) in the electrocardiogram (ECG) signal have been reported for myocardial contrast echocardiography and also for burst mode (physical therapy) ultrasound with gas body contrast agents at lower peak rarefactional pressure amplitudes (PRPAs). For contrast echocardiography, irreversibly injured cardiomyocytes have been associated with the arrhythmia. The objective was to determine whether cardiomyocyte injury is associated with the PCs induced by the burst mode at lower PRPAs. Methods. Anesthetized rats were exposed to focused 1.5-MHz ultrasound in a water bath. Evans blue dye was injected intraperitoneally to stain injured cardiomyocytes, and a perflutren lipid microsphere ultrasound contrast agent was infused intravenously. The continuous burst mode simulated physical therapy ultrasound. Intermittent 2-millisecond bursts, or envelopes of pulses simulating diagnostic ultrasound, were triggered 1:4 at end systole. Premature complexes were observed on ECG recordings, and stained cardiomyocytes were counted in frozen sections. Results. The continuous burst mode produced variable PCs and stained cells above a 0.3-MPa PRPA. The triggered bursts above 0.3 MPa and pulse envelopes above 1.2 MPa produced statistically significant (P < .01) PCs and stained cardiomyocytes. Conclusions. Irreversible cardiomyocyte injury was associated with the development of PCs for the burst mode and occurred at substantially lower PRPAs than for pulsed ultrasound. Key words: arrhythmia; contrast agent adverse effects; gas body activation; myocardial contrast echocardiography; ultrasonic cavitation biology.

Several methods, ultrasound and laser, are used to tissue repair and healing processes. The objective was to compare the effect of laser (LLLT) and ultrasound (LIPUS) on fibroblast cell culture. Cultures irradiated with laser energy were divided into three groups: I- control; II- 6 J/cm2; and group III: 50 mJ/cm2. Cultures irradiated with ultrasound were divided into five groups: 1- control; 2- 0.2 W/cm2 in pulsed mode at 10% (1:9 duty cycle); 3- 0.6 W/cm2 in pulsed mode at 10% (1:9 duty cycle); 4- 0.2 W/cm2 in pulsed mode at 20% (2:8 duty cycle); and 5- 0.6 W/ cm2 in pulsed mode at 20% (2:8 duty cycle). Each group was irradiated at 24 h intervals, with the following post-irradiation incubation periods: 24, 48, and 72 h; after each irradiation cycle the cultures were analyzed using MTT cytotoxicity test. Analysis of results demonstrated that the effect of laser therapy on fibroblast cell culture was greater than that of LIPUS (p < 0.05). Results showed that LLLT significantly increased fibroblastic activity more than LIPUS. Therefore, in the first and second phases of tissue repair, laser treatment may be more effective than ultrasound.

Objective. Chronic shoulder pain is difficult to treat, and the efficacy of most interventions is limited. This study was conducted to evaluate pulsed mode radiofrequency (PRF) lesioning of the suprascapular nerve for treating chronic shoulder pain. Interventions. Thirteen procedures using PRF lesioning of suprascapular nerve were performed under fluoroscopic guide in 11 patients (13 shoulder joints) with chronic shoulder pain for at least 3 months. Outcome Measures. The patients were evaluated for pain, shoulder disability function, and medication requirements prior to and after treatment. Results. At 1-month follow-up assessment, 10 (76.9%) shoulder joints had significant pain relief (visual analog scale ≥ 50% reduction), and at 6-month follow-up assessment, nine (69.2%) still had significant pain relief. The mean VAS score of 11 patients before PRF was 7.5 ± 1.0, and the scores at 1-month and 6-month follow-up were 2.8 ± 2.6 and 2.5 ± 2.8, respectively. A significant pain reduction (P < 0.001) was observed. The mean Shoulder Pain and Disability Index scores at 6-month follow-up also showed a significant decrease compared with pre-PRF (P < 0.001). Medication requirements were evaluated 1 month and 6 months after the PRF. Nine (81.8%) patients had their medication requirement decreased. Conclusions. Pulsed mode radiofrequency lesioning to suprascapular nerve is a potential treatment option for patients suffering chronic shoulder pain. It provides long-lasting pain relief and decreases pain medication requirements.

Many techniques of thermotherapy have emerged over the last several years in the field of oncology using different types of physical agents, including ultrasound. Only ultrasound can target deep seated lesions non-invasively without need for percutaneous probe insertion. Depending on their utilization, it is possible to select either thermal effects, in a continuous mode, at low temperature (allowing thermo-induced biological effects) or at high temperature (allowing thermoablation), or mechanical effects, in a pulsed mode, at low energy level (allowing biological effects) or at high energy levels (histotripsy). Thermoablation by focused ultrasound is now developing fast for applications in many organs. It gained a well defined role for the treatment of prostatic cancer and uterine leiomyoma but needs to be better evaluated in other organs such as the breast. Treatment of abdominal tumors must still be considered as experimental as long as problems related to acoustic interfaces (produced by ribs and gas) and movement correction are not resolved. Biological applications of focused ultrasound are currently being explored and have a great long term potential.

The purpose of the present study was to compare the healing process of rabbit's skin after the ablation of continuous wave CO(2) laser and pulsed CO(2) laser at low irradiances.Because of its advantages, the CO(2) laser has been viewed as an alternative to the traditional scalpel. Simple thermal models suggest that suitably short pulses of laser irradiation can leave a smaller thermal damaged zone to ablated tissue, which may lead to faster healing.One continuous-wave (cw, 2 watt) and two pulsed CO(2) lasers (sp(1), 100 Hz, 2 watt; and sp(2), 25 Hz, 2 watt) were used to ablate twelve rabbits' ear skin for 2 min, respectively. After sacrifice at 0, 3, 7, 14, 28, and 56 days postsurgery, gross observation and histological examination were performed.sp(1) and sp(2) resulted in similar ablation rates to cw laser. At 3, 7, 14, and 28 days postsurgery, the scores of the group cw were significantly lower than both the sp(1) and sp(2) scores (p0.01). From 7 to 28 days, wounds of sp1 showed the best histological outcomes.At a relatively low irradiance, pulsed CO(2) laser is capable of bloodless skin ablation with improved wound healing. Increasing repetition rate of the CO(2) laser may help to achieve a better surgical outcome. Pulsed CO(2) laser may be a valuable instrument for ablation skin and skin lesions.

Purpose of review Tissue Doppler imaging (TDI) is a diagnostic method that provides quantitative data about myocardial function. The present review discusses the most recent developments in the application of TDI in coronary artery disease. Recent findings The most widely used TDI modality is velocity imaging, and systolic function is measured as peak velocity during LV ejection. Several recent studies show that TDI measurements during the LV isovolumic phases provide unique information regarding myocardial dysfunction. Since velocity imaging is confounded by influence from velocities in other segments, the TDI-based modalities strain- and strain rate imaging (SRI) have been introduced to measure regional shortening fraction and shortening rate, respectively.Velocity imaging during stress echocardiography has been validated clinically and appears equivalent, but not superior to conventional visual assessment of grey scale images. Potentially, more comprehensive evaluation that includes the use of SRI may improve the diagnostic power of TDI further. Preliminary reports suggest that TDI may have an important role in the assessment of viability in acute coronary occlusion, but this needs to be demonstrated in appropriately designed clinical trials. Summary At the present time tissue Doppler velocity imaging can be recommended for clinical use, especially the pulsed mode. Strain rate imaging may be useful as additional imaging, but needs further refinement before it is ready for routine clinical use.

Suprascapular nerve blockade improves pain, range of motion, and disability in acute and chronic shoulder pain. Pain relief usually lasts several hours with local anesthetic. If steroids are added, the relief lasts several weeks. Since repetitive steroid exposure is associated with several hazards, alternative long-term therapies would be desirable. Pulsed mode radiofrequency is a non-destructive, safe, and repeatable long-term pain control therapy. We report a case, wherein a series of fluoroscopically guided, suprascapular nerve pulsed mode RF treatments were performed. Each provided 4-5 months of pain relief and improvement in shoulder function, without deterioration in muscle strength.

Background and Aims: Lichen pilaris is a very common disease typically seen among young adults on their upper arms as a manifestation of hyperkeratotic lesions occurring in the pores. Only a few treatments have been reported as significantly effective, so often natural resolution over time is the only option. The present study examined the use of a 1064 nm Q-switched Nd:YAG laser (QSNY) in quasi long-pulsed mode, in an attempt to treat a case of lichen pilaris. Subject and Methods: A 33-year-old male presented with light-brown aggregated papules observed on both sides of the upper arms. The affected areas were treated every other week (QSNY, pulse width 300 µs, pulse energy 3.0 J/cm2, spot size 6 mm and repetition rate 10 Hz). Clinical photography was taken of the lesions at baseline and three months after the final treatment in addition to macrophotography and 3-D photography, biopsies being taken at both time points for histological comparison. Results: The clinical photography and objective image evaluation demonstrated shrinkage of pores and improvement of the unevenness of the skin. Histological examination suggested that the effect of the micropulsed QSNY on the horny layer, epidermal keratinocytes and dermal collagen resulted in a peeling effect and increased dermal collagen density, which eventually led to the shrinkage of the pores and improvement of the skin condition. Conclusions: The results of this single patient case report suggest that the micropulsed QSNY could be an effective treatment option for lichen pilaris, improvement of which is often difficult. Further studies with an appropriately-sized population are merited to confirm these preliminary results.

Hip arthroplasty is one of the most common surgical procedures for pain relief due to coxarthrosis. However, the operation is contraindicated for some elderly patients because of multiple co-morbidities. On the other hand, conventional drugs either have too many side effects or are ineffective. Major symptoms of patients with hip pain include groin, thigh and trochanteric pain. In recent years, pulsed mode radiofrequency has been used to manage a wide spectrum of chronic pain modalities, and in clinical models in treatment such as myofascial trigger points, phantom limb pain, occipital neuralgia, meralgia paraesthetica and premature ejaculation (1–5). Pulsed mode radiofrequency produces fewer histopathological changes than conventional radiofrequency and takes advantage of a significant reduction in complications or side effects (6).

Background There are various methods advocated for the treatment of verruca plantaris. However, many verrucas do not respond to simple treatment. Objective This study presents our results using Nd: YAG laser ablation therapy for such recalcitrant cases. Methods We performed a retrospective audit by sending a questionnaire to all patients with recalcitrant verrucas who had been treated with Nd:YAG laser ablation over the previous 12 months. The questionnaire asked whether treatment had been successful, successful but new lesions had emerged, partially successful with improvement or unsuccessful. A Fontana Nd:YAG laser was used at the following specifications; long pulsed mode with pulse width 25 ms, frequency 1.0 Hz; fluence 240 J/cm2 and spot size 2 mm. Some patients requested local anaesthesia and had direct infiltration with 0.5% plain lidocaine. Results Fifty-three of the original 87 patients responded (60.9% response rate) with a male to female ratio of 24:29, mean age of 47 years and an age range between 22–72. Thirty-seven patients reported complete success post treatment (69.8%) and a further five reported improvement. The remaining 11 felt their treatment was unsuccessful. The cure rate was 81.8% in unilateral single cases, 68.1% in unilateral multiple cases and 65% in bilateral cases. Ten patients requested sublesional lidocaine injections of which 4 had skin breakdown after Nd: YAG ablation. Conclusion Nd:YAG laser ablation is effective in the treatment of recalcitrant verruca plantaris. However, we caution against the use of direct local anaesthesia infiltration before laser treatment.

Lymphatic Malformation (LM) according to ISSVA Classification, is a rare benign disorder with unknown aetiology. LM may grow slowly over years or develop rapidly over the course of days becoming a bulky lump, infected or bleeding. We propose our three steps Diode Laser protocol for LM management, based on its persistent vascular blood component. 1. Histological and cytological examination, to evaluate the vascular blood component (10-40%), shows mature lymphocytes with red blood cells and endothelial cells. 2. Diode Laser Photocoagulation (DLP) in pulsed mode (on 100ms / off 400ms) at 10W and 800nm with a 300μm fibre kept 2-3mm from the tissues, to reduce the lesion. 3. Diode Laser surgical excision in pulsed mode (on 50ms / off 200ms) at 8W and 800nm with a 300 μm fibre in close contact with tissues, and histological intraoperative margins control on frozen sections. Even if it has inconstant results (lesions decreasing rate is 10% to 40% proportionally to vascular blood component), DLP simplifies the last and the most important step. Use of Diode Laser also in surgical excision reduces intra and postoperatory complications.

Hereditary Haemorrhagic Telangiectasia (HHT) is a muco-cutaneous inherited disease. Symptoms are epistaxis, visceral arterio-venous malformations, multiple muco-cutaneous telangiectasia with the risk of number increasing enlargement, bleeding, and super-infection. The aim of this work is to show the dual Diode Laser efficacy in preventive treatment of Early Lesions (EL < 2mm) and therapeutic treatment of Advanced Lesions (AL < 2mm). 21 patients affected by HHT with 822 muco-cutaneous telangiectatic nodules have been treated in several sessions with local anaesthesia and cooling of treated sites. EL preventive treatment consists of single Laser impulse (fibre 320) in ultrapulsed mode (2 mm single point spot). AL therapeutic treatment consists of repeated Laser impulses in pulsed mode (on 200ms / off 400ms). According to the results, Diode Laser used in pulsed and ultra-pulsed mode is very effective as noninvasive treatment both in early and advanced oral and perioral telangiectasia.

Background. Nonablative remodeling has been recently proposed as an alternative to CO2 and Er:YAG resurfacing. Objective. To evaluate the efficacy and safety of a 1540 nm Er:glass laser with contact cooling in nonablative skin remodeling, focused on perioral and periorbital rhytides. Methods. Sixty patients (mean age 47 years), Fitzpatrick skin types I–IV were treated four times over 6-week intervals. Patients were evaluated using digital photographs, histology, ultrasound imaging, and profilometry with silicone imprints in order to quantitate the degree of clinical improvement. Results. All subjects reported subjective improvement in the quality and visual aspect of their skin. This was confirmed by a 40.2% reduction of anisotropy (P < .001) 6 weeks after the fourth treatment. Ultrasound imaging demonstrated a 17% increase of dermis thickness (P < .005). Biopsy specimens showed evidence of new collagen formation. Conclusion. This study has clearly demonstrated that irradiation with 1540 nm Er:glass laser can lead to new collagen formation, dermis thickening, reduction of anisotropy of the skin, and clinical improvements. The lack of adverse effects confirmed that this 1540 nm laser emitting in a pulsed mode coupled with an efficient cooling system is safe.

This paper reviews the clinical trials investigating the efficacy of short-wave diathermy (SWD) in the management of various conditions. SWD is a form of electromagnetic radiation used therapeutically in either a continuous or pulsed mode. Research has found that, although the popularity of this equipment has declined recently, it is still widely available. The efficacy of this modality is questionable. Few clinical trials have been conducted in the past 10–15 years. The quality of other available studies is varied, with many lacking objective outcome measures and appropriate design structure. A critical appraisal of the literature available on the use of SWD in the treatment of pain, soft-tissue injuries, rheumatology conditions, wound healing and a selection of other conditions is provided. It is concluded that SWD appears to be effective in the treatment of some conditions, but further controlled trials are necessary to provide confirmation.

Ten volunteers (19-23 years old) performed 9 sets of 12 bilateral knee-extension exercises at 60% 1RM. Following exercise, 4 ultrasound treatments (5-cm transducer head, 1.0-MHz frequency, pulsed mode at 1.0 W/cm2) were applied for 8 min daily to the quadriceps muscle of a randomly selected treatment leg. The placebo leg received similar treatment with the ultrasound apparatus turned off. Knee-extension peak torque values and delayed onset muscle soreness (DOMS) were assessed on each leg prior to exercise and at 20 min and 24, 48, 72, and 96 hr postexercise. Postexercise peak torques declined to 60-70% of preexercise values and returned to normal by 96 hr. DOMS sensation peaked 24 hr postexercise and diminished thereafter. No significant differences in peak torque or DOMS were noted between ultrasound- or placebo-treated legs at any time postexercise. Hence ultrasound, as applied in this study, does not appear to be effective in enhancing postexercise muscle strength recovery or in diminishing DOMS.

Pulsed mode carbon dioxide laser allows precise ablation of fine facial tissue while minimizing thermal damage to the skin. Changes in the structure of dermal collagen may account for the overall tightening effect observed. Preoperative preparation of the skin is important to prevent postoperative pigment changes. Prophylactic antivirals are used to reduce the risk of Herpes infection. The carbon dioxide laser produces pain when applied to the skin and various anesthetic techniques may be used. After lasing, the face can be dressed with occlusive dressings or left open. Sunscreens are required after reepithelization.

This study examined the effects of therapeutic pulsed ultrasound (US) on the development of disuse muscle atrophy in rat gastrocnemius muscle. Male Wistar rats were randomly distributed into control, immobilization (Im), sham US, and US groups. In the Im, sham US and US groups, the bilateral ankle joints of each rat were immobilized in full plantar flexion with a plaster cast for a 4-wk period. The pulsed US (frequency, 1 MHz; intensity, 1.0 W/cm2; pulsed mode 1:4; 15 min) was irradiated to the gastrocnemius muscle in the US group over a 4-wk immobilization period. The pulsed US irradiation delivered only non-thermal effects to the muscle. In conjunction with US irradiation, 5-bromo-2'-deoxyuridine (BrdU) was injected subcutaneously to label the nuclei of proliferating satellite cells 1 h before each pulsed US irradiation. Immobilization resulted in significant decreases in the mean diameters of type I, IIA and IIB muscle fibers of the gastrocnemius muscle in the Im, sham US and US groups compared with the control group. However, the degrees of muscle fiber atrophy for all types were significantly lower in the US group compared with the Im and sham US groups. Although the number of capillaries and the concentrations of insulin-like growth factor and basic fibroblast growth factor did not change in the muscle, the number of BrdU-positive nuclei in the muscle was significantly increased by pulsed US irradiation in the US group. The results of this study suggest that pulsed US irradiation inhibits the development of disuse muscle atrophy partly via activation of satellite cells., Ultrasound in Medicine & Biology, 40(7), pp.1578-1586; 2014

During simulated manipulation of children's forearm fractures, levels of scattered radiation from both plain radiographs and an image intensifier in different modes were measured at various sites on the surgeon, anaesthetist, radiographer, and patient both with and without recommended shielding. By using fluoroscopy in the pulsed screening mode but allowing only single pulses to occur, radiation levels could be substantially reduced to the eye, thyroid, and gonads of all those exposed. The radiographer and the anaesthetist were so far from the source and guarded by various pieces of equipment that levels were almost unrecordable. Effective dose equivalent for the surgeon using pulsed mode, based on circa six pulses per manipulation, during 100 manipulations per year, would equate to 1 microSv even in the unshielded state (< 0.1 microSv shielded), which is approximately 1/1,000 of background radiation at sea level. Because the current dose limit is 50 mSv (50,000 microSv) per year for employees, we are many orders of magnitude in the safety zone.

Experimental studies of photostimulation of the visual analyzer by combinations of red, green, blue, and yellow colors in a pulsed mode were carried out. Significant improvement of a visual acuity is shown after photostimulation course in patients with macular degeneration and degenerative changes of the optic nerve.

Laboratory investigations have been conducted to assess the viability of Adipose Derived stem and Regenerative Cells (ADRCs) and adipocytes harvested using a third generation (VASER®) Ultrasound Assisted Liposuction system. Methods: Lipoaspirate samples were collected from consented patients undergoing elective liposuction procedures. The VASER system was set at 60–70% amplitude in the pulsed mode; the aspiration system was set for a vacuum level of 15 inHg or less. Laboratory analysis included measurement of free lipid volume; lipolysis assay to determine the health (quality) of the aspirated adipose tissue; analysis of ADRCs released from adipose tissue for number and viability; CFU-F assay to evaluate adherent cell population of ADRCs; and flow cytometery and cytological analysis, including cell surface protein examination and HE ADRC viability was 87.4±4.5%. Further evaluation demonstrated that ADRCs were composed of different stromal vascular and hematopoietic subpopulations proportionate to cells obtained from syringe acquired tissue. Conclusions: Collectively these data indicate that adipose tissue acquired using VASER methodology is viable at harvest and suitable as a source of Adipose Derived stem and Regenerative Cells (ADRCs) and fat grafting material.

Background: Although many clinicians know about the reducing effects of the pulsed and low-dose modes for fluoroscopic radiation when performing interventional procedures, few studies have quantified the reduction of radiation-absorbed doses (RADs). The aim of this study is to compare how much the RADs from a fluoroscopy are reduced according to the C-arm fluoroscopic modes used. Methods: We measured the RADs in the C-arm fluoroscopic modes including ‘conventional mode’, ‘pulsed mode’, ‘low-dose mode’, and ‘pulsed ＋ low-dose mode’. Clinical imaging conditions were simulated using a lead apron instead of a patient. According to each mode, one experimenter radiographed the lead apron, which was on the table, consecutively 5 times on the AP views. We regarded this as one set and a total of 10 sets were done according to each mode. Cumulative exposure time, RADs, peak X-ray energy, and current, which were viewed on the monitor, were recorded. Results: Pulsed, low-dose, and pulsed ＋ low-dose modes showed significantly decreased RADs by 32%, 57%, and 83% compared to the conventional mode. The mean cumulative exposure time was significantly lower in the pulsed and pulsed ＋ low-dose modes than in the conventional mode. All modes had pretty much the same peak X-ray energy. The mean current was significantly lower in the low-dose and pulsed ＋ low-dose modes than in the conventional mode. Conclusions: The use of the pulsed and low-dose modes together significantly reduced the RADs compared to the conventional mode. Therefore, the proper use of the fluoroscopy and its C-arm modes will reduce the radiation exposure of patients and clinicians. (Korean J Pain 2011; 24: 199-204)

Purpose Animal studies of excisional biopsies have shown less thermal damage when a carbon dioxide (CO 2 ) laser (10.6 μm) is used in a char-free (CF) mode than in a continuous-wave (CW) mode. The authors' aim was to evaluate and compare clinical and histopathologic findings of excisional biopsies performed with CW and CF CO 2 laser (10.6 μm) modes. Materials and Methods This prospective randomized controlled clinical trial included 60 patients with similar fibrous hyperplasias of the buccal plane willing to undergo excisional CO 2 laser biopsy. Patients were randomly allocated to the CW (5 W) or CF (140 Hz, 400 μs, 33 mJ) group. Duration of surgery, intra- and postoperative complications, and the width (micrometers) of the histopathologic collateral thermal damage zone were registered as primary outcome variables. Secondary outcome variables were pain (patients filled in a visual analog scale [VAS]) and analgesic intake (recorded by patients). Results The study group consisted of 36 women and 24 men with a median age of 50.5 years. Median durations of surgery were 74.5 seconds in the CW group and 83.5 seconds in the CF group. Intraoperative venous bleeding occurred in 16.7% of patients in the CW group and in 13.3% of patients in the CF group. Median areas of histopathologic collateral damage zones were similar in the CW group (166.5 μm) and the CF group (162.5 μm). There was no statistically significant difference between the VAS values of the 2 groups. Analgesic intake was recorded by 16.7% of patients in the CW group and by 6.7% of patients in the CF group ( P = .23, not significant). No statistically significant correlation was found between areas of thermal damage zones and postoperative VAS scores. Conclusions In contrast to previous animal studies, no significant difference was found in the widths of thermal damage zones between the CW and CF groups. The VAS values and analgesic intake were low in the 2 groups. The 2 CO 2 laser modes are appropriate for the excision of intraoral mucosal lesions. A safety border of at least 1 mm is recommended regardless of the laser mode used.