Lasers in Spine Surgery: a Review
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Soft Tissue Laser Dentistry and Oral Surgery Peter Vitruk, Phd
Soft Tissue Laser Dentistry and Oral Surgery Peter Vitruk, PhD Introduction The “sound scientific basis and proven efficacy in order to ensure public safety” is one of the main eligibility requirements of the ADA CERP Recognition Standards and Procedures [1]. The outdated Laser Dentistry Curriculum Guidelines [2] from early 1990s is in need of an upgrade with respect to several important laser-tissue interaction concepts such as Absorption Spectra and Hot Glass Tip. This position statement of The American Board of Laser Surgery (ABLS) on soft tissue dentistry and oral surgery is written and approved by the ABLS’s Board of Directors. It focuses on soft tissue ablation and coagulation science as it relates to both (1) photo-thermal laser-tissue interaction, and (2) thermo-mechanical interaction of the hot glass tip with the tissue. Laser Wavelengths and Soft Tissue Chromophores Currently, the lasers that are practically available to clinical dentistry operate in three regions of the electromagnetic spectrum: near-infrared (near-IR) around 1,000 nm, i.e. diode lasers at 808, 810, 940, 970, 980, and 1,064 nm and Nd:YAG laser at 1,064 nm; mid-infrared (mid-IR) around 3,000 nm, i.e. erbium lasers at 2,780 nm and 2,940 nm; and infrared (IR) around 10,000 nm, i.e. CO2 lasers at 9,300 and 10,600 nm. The primary chromophores for ablation and coagulation of oral soft tissue are hemoglobin, oxyhemoglobin, melanin, and water [3]. These four chromophores are also distributed spatially within oral tissue. Water and melanin, for example, reside in the 100-300 µm-thick epithelium [4], while water, hemoglobin, and oxyhemoglobin reside in sub-epithelium (lamina propria and submucosa) [5], as illustrated in Figure 1. -
UNMH Orthopedic Surgery Clinical Privileges
UNMH Orthopedic Surgery Clinical Privileges Name: Effective Dates: To: o Initial privileges (initial appointment) o Renewal of privileges (reappointment) o Expansion of privileges (modification) All new applicants must meet the following requirements as approved by the UNMH Board of Trustees effective: 05/30/2014 INSTRUCTIONS Applicant: Check off the "Requested" box for each privilege requested. Applicants have the burden of producing information deemed adequate by the Hospital for a proper evaluation of current competence, current clinical activity, and other qualifications and for resolving any doubts related to qualifications for requested privileges. Department Chair: Check the appropriate box for recommendation on the last page of this form. If recommended with conditions or not recommended, provide condition or explanation on the last page of this form. OTHER REQUIREMENTS 1. Note that privileges granted may only be exercised at UNM Hospitals and clinics that have the appropriate equipment, license, beds, staff, and other support required to provide the services defined in this document. Site-specific services may be defined in hospital or department policy. 2. This document defines qualifications to exercise clinical privileges. The applicant must also adhere to any additional organizational, regulatory, or accreditation requirements that the organization is obligated to meet. Qualifications for Orthopedic Surgery Practice Area Code: 42 Version Code: 05-2014a Initial Applicant - To be eligible to apply for privileges in orthopedic -
06-1733 ) Issued: October 17, 2006 DEPARTMENT of the NAVY, MARINE ) CORPS, Camp Lejeune, NC, Employer ) ______)
United States Department of Labor Employees’ Compensation Appeals Board __________________________________________ ) L.S., Appellant ) ) and ) Docket No. 06-1733 ) Issued: October 17, 2006 DEPARTMENT OF THE NAVY, MARINE ) CORPS, Camp LeJeune, NC, Employer ) __________________________________________ ) Appearances: Case Submitted on the Record Appellant, pro se Office of Solicitor, for the Director DECISION AND ORDER Before: ALEC J. KOROMILAS, Chief Judge MICHAEL E. GROOM, Alternate Judge JAMES A. HAYNES, Alternate Judge JURISDICTION On July 24, 2006 appellant filed a timely appeal from the Office of Workers’ Compensation Programs’ June 9, 2006 merit decision terminating her compensation. Pursuant to 20 C.F.R. §§ 501.2(c) and 501.3(d)(2), the Board has jurisdiction over the merits of this case. ISSUE The issue is whether the Office met its burden of proof to terminate appellant’s compensation effective June 10, 2006 on the grounds that she no longer had residuals of her employment injury after that date. FACTUAL HISTORY On May 5, 2000 appellant, then a 52-year-old registered dental hygienist, filed an occupational disease claim alleging that she sustained a ganglion cyst on the dorsum of her right wrist due to repeatedly grasping instruments at work. The Office accepted that appellant sustained a ganglion cyst of her right wrist. She stopped work on May 5, 2000 to undergo an excision of the mass of her ganglion cyst and repair of the extensor tendon of the right long finger. The surgery was performed by Dr. Richard S. Bahner, an attending Board-certified orthopedic surgeon, and was authorized by the Office. In July 2000, appellant returned to light-duty work on a full-time basis for the employing establishment. -
POST-OPERATIVE INSTRUCTIONS for HAND / UPPER EXTREMITY SURGERY Department of Orthopaedics ------After Your Surgery, Follow the Instructions As Checked Below
POST-OPERATIVE INSTRUCTIONS FOR HAND / UPPER EXTREMITY SURGERY Department of Orthopaedics --------------------------------------------------------------------------------------------------------------------------------------------------------------- After your surgery, follow the instructions as checked below. Instructions following anesthesia or sedation The medicines and/or anesthesia that you received today are strong and will affect your body for at least the next few hours. You may have trouble with coordination or thinking because of these medicines. For your safety, follow these instructions carefully for the next 24 hours: Do not drive at all. You must be taken home today by a responsible adult. Do not drink any alcoholic beverages You should rest today. Do not go to work. You should not do things that require you to think and act quickly. You should not do things that require careful work. For example, avoid cooking, sewing, and operating machinery or electrical appliances. You should not make important decisions or sign legal papers today. The medicines may make you feel drowsy or sick to your stomach. Or you may have a poor appetite. If these problems last longer than 24 hour or if they are severe, call your doctor. Medicines Refer to separate “Patient Medication List” Pain and Prescription Medicine You have been given a prescription for pain medicine. Take it as directed. Do not drive or drink alcohol while you are taking “narcotic” pain medicines. This includes medicine like: Percocet® (oxycodone hydrochloride; acetaminophen), Tylenol #3® (acetaminophen; codeine) and Vicodin® (hydrocodone bitartrate; acetaminophen). Nausea, dizziness and drowsiness are normal side effects of prescribed pain medicine. If you have these symptoms and can not tolerate them, stop taking the medicine. -
Cutaneous Laser Surgery
Cutaneous Laser Surgery Vineet Mishra, M.D. Director of Mohs Surgery & Procedural Dermatology Assistant Professor of Dermatology University of Texas Health Science Center – San Antonio Visible-Infrared Range What does it stand for? LASER 3 Components: – L Light – Pumping system – A Amplification . Energy source/power supply – S Stimulated – Lasing medium – E Emission – Optical cavity – R Radiation Lasing Medium Supplies electrons for the stimulated emission of radiation Determines wavelength of laser – Expressed in nm 3 Mediums: – Gaseous (CO2, argon, copper vapor) – Solid (diode, ruby, Neodymium:Yag) – Liquid (tunable dye, pulse dye) Laser vs. IPL LASER – coherent, monochromatic light IPL = intense pulsed light – non coherent light – 515‐1000nm Monochromatc Laser light is a single color – color = specific wavelength of each laser Wavelength Wavelength determines – Chromophore specificity . Chromophore = tissue target that absorbs a specific wavelength of light – Depth pulse travels Chromophore & Absorption Spectra Chromophore/Target Wavelength Abs. Spectra – Hemoglobin – Blue-green and yellow light – DNA, RNA, protein – UV light – Melanin – Ultraviolet > Visible >> near IR – Black ink tattoo – Visible and IR – Water – IR Absorption Curves Terms to Know Energy – Joules, the capacity to do work Power – Rate of energy delivery (Watts = J/sec) Fluence – Energy density (J/cm2) Thermal Relaxation Time (TRT) – time required for an object to lose 50% of its absorbed heat (cooling time) to surrounding tissues Thermal Relaxation Time Thermal Relaxation Time (TRT) – time required for an object to lose 50% of its absorbed heat (cooling time) to surrounding tissues – directly proportional to size of an object (proportional to square of its size) – smaller objects cool faster (shorter TRT) than larger ones (longer TRT) Selective Photothermolysis by Anderson and Parrish (Science, 1983) Selective Photothermolysis – Thermocoagulation of specific tissue target with minimum damage to surrounding tissue Requirements: – 1. -
Basic Standards for Fellowship Training in Orthopedic Hand Surgery BOT 7/2011, Effective 7/2012 Page 2
Basic Standards for Fellowship Training in Orthopedic Hand Surgery American Osteopathic Association and American Osteopathic Academy of Orthopedics TABLE OF CONTENTS Article I: Introduction .................................................................................................. 3 Article II: Mission ........................................................................................................... 3 Article III Educational Program Goals/Core Competencies .................................... 3 Article IV: Institutional Requirements .......................................................................... 3 Article V: Program Requirements and Content .......................................................... 4 Article VI: Program Director / Faculty Qualifications ............................................... 5 Article VII: Fellow Requirements ..................................................................................... 5 Article VIII: Evaluation ....................................................................................................... 5 Basic Standards for Fellowship Training in Orthopedic Hand Surgery BOT 7/2011, Effective 7/2012 Page 2 Basic Standards for Fellowship Training in Orthopedic Hand Surgery This is an amendment to the Basic Standards for Residency Training in Orthopedic Surgery which governs and defines orthopedic surgical training. The Basic Standards are, therefore, incorporated into this document. SECTION I - INTRODUCTION These are the Basic Standards for Fellowship Training in Orthopedic -
Experts Describe the Gold Standard in Medical
Christopher Zachary, MBBS, FRCP Experts describe the gold standard in Professor and Chair Department of Dermatology medical and aesthetic laser therapy, University of California-Irvine sharing their experiences using clinically- effective, time-proven technologies. asers have without question revolutionized the practice Expanding the Level of Service and ® of dermatology, permitting clinicians to treat conditions Patient Satisfaction with Gemini for which no medical therapies exist or offering results Efficient Management of Rosacea and Photodamage that exceed those of conventional therapeutics. From with the Gemini Laser medical conditions like acne and rosacea to cosmetic Lrejuvenation, laser systems can address a variety of the most Photorejuvenation in Asian Skin Tones: common presentations that bring patients to the dermatolo- Role of the Gemini Laser gist’s office. Gemini for Photorejuvenation: Given their remarkable utility, well-designed and manufac- A Cornerstone of the Cosmetic Practice tured lasers can be a tremendous asset to dermatologists. Yet, often physicians are overwhelmed by the prospect of incorpo- Targeting Patients’ Aesthetic Goals with the VariLite™ rating laser procedures into practice. Technology is costly, and there may be a tremendous sense of pressure to attract The VariLite for Fundamental Cosmetic Applications patients and, as important, provide treatment that meets their VariLite: A Reliable, Predictable Tool for Vascular and goals. There may also be a learning curve, as residency pro- Pigmented Lesions grams currently offer little training in aesthetic dermatology, Continued on page 3 Expert Contributors William Baugh, MD C. William Hanke, MD, MPH Assistant Clinical Professor, Visiting Professor of Dermatology, Western School of Medicine University of Iowa, Carver College of Medicine Medical Director Clinical Professor of Otolaryngology Head and Full Spectrum Dermatology, Neck Surgery, Fullerton, CA Indiana University School of Medicine Carmel, IN Henry H. -
A Practical Comparison of Ipls and the Copper Bromide Laser for Photorejuvenation, Acne and the Treatment of Vascular & Pigmented Lesions
A practical comparison of IPLs and the Copper Bromide Laser for photorejuvenation, acne and the treatment of vascular & pigmented lesions. Authors: Peter Davis, Adelaide, Australia, Godfrey Town, Laser Protection Adviser, Haywards Heath, United Kingdom Abstract: The recent rapid growth in demand for non-invasive light-based cosmetic treatments such as removal of unwanted facial and body hair, skin rejuvenation, removal of age-related and sun induced blemishes including pigment and vascular lesions as well as lines and wrinkles has led to a boom in the sale of medical devices that claim to treat these conditions. The often onerous safety regulations governing the sale and use of Class 4 lasers has contributed disproportionately to the popularity of similarly powerful non-laser Intense Pulse Light sources (“IPL”), particularly in the salon and spa sector. The practical science-based comparisons made in this review and the well- documented case studies in peer reviewed literature show that single treatment success in eradicating vascular and pigmented lesions may only be achieved by high fluence, wavelength-specific laser treatment and without the need for skin cooling. Introduction: hair removal with IPL The recent success of IPL in delaying hair re-growth (“hair management”) and permanent hair reduction (“photo-waxing”) is dependant upon using high energy settings for the former and is thought to work primarily because melanin absorbs energy across a wide spectrum of wavelengths. Cumulatively enough energy is absorbed to damage the hair follicle. It is also suggested that the longer wavelengths absorbed by blood and tissue water may also collectively damage hair follicle support structures such as the blood supply to the hair bulb aided by the overall temperature rise in the adjacent tissue. -
Hand Surgery: a Guide for Medical Students
Hand Surgery: A Guide for Medical Students Trevor Carroll and Margaret Jain MD Table of Contents Trigger Finger 3 Carpal Tunnel Syndrome 13 Basal Joint Arthritis 23 Ganglion Cyst 36 Scaphoid Fracture 43 Cubital Tunnel Syndrome 54 Low Ulnar Nerve Injury 64 Trigger Finger (stenosing tenosynovitis) • Anatomy and Mechanism of Injury • Risk Factors • Symptoms • Physical Exam • Classification • Treatments Trigger Finger: Anatomy and MOI (Thompson and Netter, p191) • The flexor tendons run within the synovial tendinous sheath in the finger • During flexion, the tendons contract, running underneath the pulley system • Overtime, the flexor tendons and/or the A1 pulley can get inflamed during finger flexion. • Occassionally, the flexor tendons and/or the A1 pulley abnormally thicken. This decreases the normal space between these structures necessary for the tendon to smoothly glide • In more severe cases, patients can have their fingers momentarily or permanently locked in flexion usually at the PIP joint (Trigger Finger‐OrthoInfo ) Trigger Finger: Risk Factors • Age: 40‐60 • Female > Male • Repetitive tasks may be related – Computers, machinery • Gout • Rheumatoid arthritis • Diabetes (poor prognostic sign) • Carpal tunnel syndrome (often concurrently) Trigger Finger: Subjective • C/O focal distal palm pain • Pain can radiate proximally in the palm and distally in finger • C/O finger locking, clicking, sticking—often worse during sleep or in the early morning • Sometimes “snapping” during flexion • Can improve throughout the day Trigger Finger: -
Second Harmonic Generation Microscopy: a Tool for Quantitative Analysis of Tissues
Chapter 5 Second Harmonic Generation Microscopy: A Tool for Quantitative Analysis of Tissues Juan M. Bueno, Francisco J. Ávila, and Pablo Artal Additional information is available at the end of the chapter http://dx.doi.org/10.5772/63493 Abstract Second harmonic generation (SHG) is a second‐order non‐linear optical process produced in birefringent crystals or in biological tissues with non‐centrosymmetric structure such as collagen or microtubules structures. SHG signal originates from two excitation photons which interact with the material and are “reconverted” to form a new emitted photon with half of wavelength. Although theoretically predicted by Maria Göpert‐Mayer in 1930s, the experimental SHG demonstration arrived with the invention of the laser in the 1960s. SHG was first obtained in ruby by using a high excitation oscillator. After that starting point, the harmonic generation reached an increasing interest and importance, based on its applications to characterize biological tissues using multiphoton microscopes. In particular, collagen has been one of the most often analyzed structures since it provides an efficient SHG signal. In late 1970s, it was discovered that SHG signal took place in three‐dimensional optical interaction at the focal point of a microscope objective with high numerical aperture. This finding allowed researchers to develop microscopes with 3D submicron resolution and an in depth analysis of biological specimens. Since SHG is a polarization‐sensitive non‐linear optical process, the implementation of polarization into multiphoton microscopes has allowed the study of both molecular architecture and fibrilar distribution of type‐I collagen fibers. The analysis of collagen‐based structures is particularly interesting since they represent 80% of the connective tissue of the human body. -
Low-Level Laser Therapy in Acute Pain: a Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo-Controlled Trials
14258c08.PGS 6/8/06 2:20 PM Page 158 Photomedicine and Laser Surgery Volume 24, Number 2, 2006 © Mary Ann Liebert, Inc. Pp. 158–168 Low-Level Laser Therapy in Acute Pain: A Systematic Review of Possible Mechanisms of Action and Clinical Effects in Randomized Placebo-Controlled Trials JAN MAGNUS BJORDAL, P.T., Ph.D.,1 MARK I. JOHNSON, Ph.D.,2 VEGARD IVERSEN, Ph.D.3 FLAVIO AIMBIRE, M.SC.,4 and RODRIGO ALVARO BRANDAO LOPES-MARTINS, M.Pharmacol., Ph.D.5 ABSTRACT Objective: The aim of this study was to review the biological and clinical short-term effects of low-level laser ther- apy (LLLT) in acute pain from soft-tissue injury. Background Data: It is unclear if and how LLLT can reduce acute pain. Methods: Literature search of (i) controlled laboratory trials investigating potential biological mecha- nisms for pain relief and (ii) randomized placebo-controlled clinical trials which measure outcomes within the first 7 days after acute soft-tissue injury. Results: There is strong evidence from 19 out of 22 controlled laboratory studies that LLLT can modulate inflammatory pain by reducing levels of biochemical markers (PGE2, mRNA Cox 2, IL-1, TNF␣), neutrophil cell influx, oxidative stress, and formation of edema and hemorrhage in a dose- dependent manner (median dose 7.5 J/cm2, range 0.3–19 J/cm2). Four comparisons with non-steroidal anti-in- flammatory drugs (NSAIDs) in animal studies found optimal doses of LLLT and NSAIDs to be equally effective. Seven randomized placebo-controlled trials found no significant results after irradiating only a single point on the skin overlying the site of injury, or after using a total energy dose below 5 Joules. -
D'évaluation Des Technologies De La Santé Du Québec
(CETS 2000-2 RE) Report – June 2000 A STATE-OF-KNOWLEDGE UPDATE THE EXCIMER LASER IN OPHTHALMOLOGY: Conseil d’Évaluation des Technologies de la Santé du Québec Report submitted to the Minister of Research, Science And Technology of Québec Conseil d’évaluation des technologies de la santé du Québec Information concerning this report or any other report published by the Conseil d'évaluation des tech- nologies de la santé can be obtained by contacting AÉTMIS. On June 28, 2000 was created the Agence d’évaluation des technologies et des modes d’intervention en santé (AÉTMIS) which took over from the Conseil d’évaluation des technologies de la santé. Agence d’évaluation des technologies et des modes d’intervention en santé 2021, avenue Union, Bureau 1040 Montréal (Québec) H3A 2S9 Telephone: (514) 873-2563 Fax: (514) 873-1369 E-mail: [email protected] Web site address: http://www.aetmis.gouv.qc.ca Legal deposit - Bibliothèque nationale du Québec, 2001 - National Library of Canada ISBN 2-550-37028-7 How to cite this report : Conseil d’évaluation des technologies de la santé du Québec. The excimer laser in ophtalmology: A state- of-knowledge update (CÉTS 2000-2 RE). Montréal: CÉTS, 2000, xi- 103 p Conseil d’évaluation des technologies de la santé du Québec THE EXCIMER LASER IN OPHTHALMOLOGY: A MANDATE STATE-OF-KNOWLEDGE UPDATE To promote and support health technology assessment, In May 1997, the Conseil d’évaluation des technologies de disseminate the results of the assessments and la santé du Québec (CETS) published a report dealing spe- encourage their use in decision making by all cifically with excimer laser photorefractive keratectomy stakeholders involved in the diffusion of these (PRK).