Centro Medicina Cuantica

         Dr Andrei Rogozhin

El rayo laser selectivo de Photothermolysis aplicado al tejido fino vivo hace que diversos efectos en componentes del tejido fino dependan de espectros de absorción.  Los componentes principales de la piel que absorben la luz laser son agua, melanina y hemoglobina.  Se llaman los chromophoros de la piel y tienen diversos espectros de la absorción. 

  Cuadro 1.

    Espectros de absorción de chromophoros cutáneos:  (1) - hemoglobina;  (2) - oxyhemoglobina;  (3) - melanina.  El agua absorbe un poco en esta parte de espectros.  Ver los espectros de absorción ligera de los chromophores cutáneos.  La luz ultra violeta es absorbida fuertemente por el melanina y un poco absorbido por el agua.  Las luces amarillas y verdes son absorbidas notablemente por la melanina y un poco absorbido por el agua.  Algunas longitudes de onda en espectros verdes y amarillos son absorbidas fuertemente por la hemoglobina y la oxyhemoglobina y por consiguiente por los vasos sanguíneos.  La luz infrarroja es absorbida por el agua, no obstante la melanina y hemoglobina.  Eligiendo la longitud de onda derecha podemos afectar en los chromophoros del blanco de la piel.  Eligiendo la longitud de onda en espectros verde-amarillos cerca del máximo de la absorción de la hemoglobina y del oxyhemoglobina podemos quitar los recipientes cutáneos anormales (telangiactasias, manchas portuarias del vino) sin dañar del tejido fino circundante.  Este tratamiento se llama coagulación selectiva del laser basada en el principio del photothermolysis selectivo primero descubierto por R.R. Anderson y J.A. Parrish.  El laser que vuelve a allanar la piel,  el laser que elimina los tatuajes y  el laser que quita el pelo indeseado se basa en este concepto –  destrucción termal del  blanco sin dañar el tejido fino circundante.  La eficacia del tratamiento depende de los parámetros del laser tales como longitud de onda –  energía – del laser;  P, tamaño del punto de la luz laser:  diámetro cuadrado –  S, tiempo – de la exposición;  Т,  Fluence F = P*T/S.  Si los parámetros fueron elegidos apropiadamente,  los chromophoros fueron destruídos selectivamente dando en el blanco, sin dañar el tejido fino circundante.  Según el concepto del photothermolysis selectivo para quitar el vaso sanguíneo anormal es necesario resolver algunas demandas:  la longitud de onda del laser debe coincidir con la selección amarilla de la absorción de la hemoglobina y del oxyhemoglobina –  576 nm;  el punto de la luz laser se debe comparar con el diámetro de los recipientes anormales –  cerca de 0,5 milímetros;  la duración del pulso debe ser más pequeña que el tiempo termal de la relajación de recipientes;  la energía del laser no debe ser suficiente proporcionar el efecto del photothermolysis selectivo sino de no más de nota que las selecciones de la absorción de la hemoglobina y del oxyhemoglobin en los espectros azules se utilizan para la photothermolysis selectiva porque la profundidad de la penetración de la luz laser en el azul es extremadamente corta.  Las longitudes de onda infrarrojas también  se utilizan porque son absorbidas en pequeñas cantidades por la hemoglobina y la oxyhemoglobina.  El laser Yachroma-Med con sistema de vapor de  cobre, satisface todos los parámetros que exige.  Se ha tratado a millones de adultos y niños con eficacia con este laser.  Así se ha demostrado que el sistema de Yachroma-Med, es eficaz para el tratamiento en lesiones vasculares cutáneas.

Copper vapour laser treatment of cafe-au-lait macules

KUNACHAK SOMYOS, KULAPRADITHAROM BOONCHU, KUNACHAKR SOMSAK,* LEELAUDOMNITI PANADDA AND J.LEOPAIRUT

Department of Otolaryngology. Division of Laser Surgery. Ramathiliodi Hospital. Mahidol University School of Medicine. Bangkok, Thailand

* Division of Laser Surgery, Department of Cosmetic Surgery. Charoenkungpraclwrak Bangkok Metropolital Hospital Bangkok

Thailand

Department of Dermatology, Tliainakarin Hospital. Bangkok. Thailand

.Department of Pathology. Ramathihodi Hospital. Maludol University School of Medicine. Bangkok, Tlwiland

Accepted for publication 12 April 1996

Summary                    Cafe-au-lait macules are skin lesions known to resist all kinds of treatment. Green light at a wavelength of 511 nm from a copper vapour laser through a built-in computerized scanner (SCANALL) was employed to treat cafe-au-lait-macules in 16 patients. The laser was used in continuous mode with a mean energy density of 8-9 J/cm² (range 7-22 J/cm²). The mean number of treatment sessions was two. The response was good to excellent in 15 cases and poor in one. Transient hyperpigmentation at the periphery and temporary non-homogeneous hypopigmentation at the centre of the treated area was observed in some cases. These eventually returned to normal after a few months, without any textural change. Pre- and postoperative histological finding are also presented. There was no recurrence at a mean follow-up time of 22 months. Copper vapour laser is an effective modality for the treatment of cafe-au-lait macules

Cafe-au-lait spots or macules are light brown well-circumscribed flat lesions, present in 10-20'%) of the normal population.¹ There is no site of predilection. Lesions range in size from 1 to 20cm". They are found in 90-100% of patients with neurofibromatosis (von Recklinghausen's disease).³ However, to be significant as presumptive evidence of this disease in children over 5 years of age. the total number of spots should be six or more, each not less than 1-5 cm in diameter. In children under 5 years of age, five or more cafe-au-lait spots greater than 0-5 cm in diameter suggest a diag­nosis of neurofibromatosis. Owing to the locations of the lesions and their large size, they often pose a serious cosmetic problem. Treatment with hydroquinone or other bleaching agents is disappointing.³ Surgical exci­sion of cafe-au-lait macules, particularly large lesions, is impractical.

Recently, a copper vapour laser with a built-in com­puterized graphic robotic scanner has become available. The penetration depth of the light from the copper vapour laser varies as the power changes. The max­imum depth for the yellow light is 0-5 mm for a 0'3 mm spot size at 5W laser power (N.Mehrtens, personal communication).

The histological change induced by. and the penetra­tion depth of green light, is not known. Green light, with

its characteristic quasicontinuous and a wavelength of 511 nm is well absorbed by melanin. The hypermela-nosis in a cafe-au-lait lesion is located superficially in the basal layer of epidermis. It should, therefore, be rational to use the copper vapour laser to treat cafe-au-lait macules.

This study was a clinical trial carried out to test the efficacy of copper vapour laser treatment of cafe-au-lait macules in Thai patients.

Patients and methods

The study was performed on 16 women aged 12-30 years with yellow to brown skin. Each patient presented with a solitary cafe-au-lait macule. There was no evidence of von Recklinghausen's disease in any of the patients.

The lesions were found on the leg in five, on the cheek in three, on the temple in two, and on the shoulder. forehead, chest, flank, wrist or back in the remaining six patients (one site each).

A copper vapour laser (VSM-10 from Visiray, Sydney. Australia) was used for treatment. This laser emits at two wavelengths, 578'2nm in the yellow and 510-6nm in the green region of the electromagnetic spectrum. At 400 ^m spot size, the maximum power to

Laser treatment of skin    pigmentations

 A new medical laser using copper bromide instead of the conventional copper vapour, has made significant improvements to   the treatment and removal of unsightly skin pigmentations such as

 birth marks and port wine stains.

Originally conceived at the Bulgarian Academy of Science in 1987,  the Copper Bromide Laser system was developed and  commercialised by Norseld Pty Ltd. Lighter and able to operate at

lower temperatures, the compact new laser provides outputs in two  colours, thus enabling multiple uses.

The yellow light is used for the treatment of port wine haemangiomas, facial capillary telangiectasia, spider angiomas and Campbell de Morgan spots. The yellow laser beam works by raising the temperature of the blood in the veins to 80C, causing them to block the blood flow and remove colouring under the skin.

The green light is used for the treatment of benign pigmented   lesions and combined green and yellow light for skin cancers,  tattoos and brown spots due to ageing. Sophisticated dose control  provides cost-effective and relatively painless treatment which can often be done without a local anaesthetic.

                Lasers for treating cancer by

                photodynamic thereapy

  Photodynamic therapy (PDT) is a method for treating cancers using   red light and the drug haematoporphyrina. After administration to   the patient, the drug is selectively retained by tumours, especially   those which grow on the surfaces of the body's hollow organs. The  drug, by itself, does nothing, but when a laser of the correct colour is  shone on the light-sensitive drug, it triggers a chemical reaction   which destroys the tumour. PDT was first used experimetally in  oncology in 1978 and has since benefited many thousands of   people worldwide.  A major recent world first in this method of treatment is the Gold  Vapour Laser invented in 1983 by Professor John Piper at the Macquarie University and developed and commercialised by Visiray Pty Limited in 1990. The new laser supersedes   argon-pumped dye lasers, and is the simplest and most direct  method of providing red light at the fixed wavelength.

  Gold Vapour Lasers are being used in medical research institutes   in the United Kingdom and Australia. In Hong Kong they are being    used to treat naso-pharangeal carcinoma, the second most   common type of cancer in South China with the highest incidence in  Hong Kong.  PDT is clearly one of the most important cancer therapies ever    developed and is giving new hope to millions of people all over the   world.

                Laser makes light weight of

                cosmetic surgery

 Blood vessels close to the surface of the skin can cause unsightly   red marks. Port wine stains are large red marks which deteriorate in   time to disfiguring swellings. There are surgical remedies to remove

these stains, but they are very expensive, often time consuming and  can be painful.

 In a major new development, a copper vapour laser has been  combined with a computerised high speed scanner that can reduce   the treatment time from many one-hour treatments spread over

 months, to just one 30 minute session. Invented by Phillip Butler and Peter Walker in 1986 and commercialised by Visiray Pty Limited in  1990, the Scanall Medical Laser System, can be used to remove

port wine stains as well as kidney spots, birth marks, spider veins in   legs and swollen veins resulting from excess drinking.   After sedation, the area of the skin to be treated is plotted by using   a computer and video display. The required exposure time is   selected and the laser light moves rapidly and evenly across the   lesion at the optimum speed, eliminating the inaccuracies of hand  held lasers. The system uses copper vapour for the laser instead of   the inert gas called argon because copper can provide enough

power at the theoretically ideal colour to give the best possible result. The innovation has introduced a new era of convenience and  precision for cosmetic surgery.

 Referensias en espanol

http://www.lapiel.com/portal/laserypiel/varices.htm

http://www.bli.uci.edu/clinic/tattoos.html

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