This document discusses lasers and their medical applications. It begins with an introduction to lasers, including definitions of key terms like active medium and population inversion. It then describes different types of lasers like CO2, Nd:YAG, and excimer lasers, and their properties. The main body discusses various medical applications for different lasers, such as using CO2 lasers for skin resurfacing, excimer lasers for eye surgery, Nd:YAG lasers for treating liver tumors, and dye lasers for port wine stain removal. It concludes with advantages and disadvantages of medical laser use.
This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.
This topic has been introduced in the new edition of Bailey & Love - 26th. This topic covers the types, uses & special uses as well as complications of Diathermy.
HARMONIC SYNERGY® Blades use high-frequency mechanical vibration to simultaneously cut and coagulate at the same time, sealing vessels at lower temperatures than electrosurgery:
Precise: Minimal lateral thermal tissue damage for safer dissection near vital structures
Reliable: Seals and divides vessels <= 2mm, as well as lymphatics
Versatile: Cuts, coagulates and dissects, reducing instrument exchanges
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
PROCTOLOGY AND USE OF LASER SURGERY.
CLINICAL EXAMINATION
RELEVANCE OF PR AND PROCTOSCOPY
HAEMORRHOIDS
FISTULA ANO
PILONIDAL SINUS
FISSURE
ROLE OF LASER SURGERY
PER RECTAL EXAMINATION
PROCTOSCOPY
Different type of Energy Sources used in Surgery are described In this presentation...
like Radio frequency Electro-surgery
Ultrasound Energy
Laser
Argon beam Coagulation
energy devices are d most important part of an operation theator and surgery. in this presentation i have briefly described various energy devices used in general surgery and laparoscopy.
This presentation of introduction of laparoscopic surgery made by Dr. R.K. Mishra Director and chief surgeon World Laparoscopy Hospital. Dr. Mishra in this presentation has explained present pas and future of laparoscopic surgery. Laparoscopy is a surgical procedure which uses a special surgical instrument called a laparoscope to look inside the body, or to perform certain operations. World Laparoscopy Hospital is the center of excellence for laparoscopic and da vinci robotic surgery training and considered as one of the best institute in the world. For more detail about laparoscopic surgery please visit: http://www.laparoscopyhospital.com
Basics of laproscopic surgery..
by dr navdeep s kamboj presented at sgrdumsar amritsar.
topics covered--
1 basics of laparoscopy
2 lap cholecystectomy
3 lap appendixcectomy
pneumoperitonem
merits and demerits of laproscopy
ligasure
endoscopy,
laparoscopic instruments
Fistula is an abnormal condition in which there is a tunnel from the end of bowel movement to the skin around the anus. Healing Hands Clinic is a certified center of excellence for the treatment of fistula having centers at Pune, Chinchwad, Mumbai, Navi Mumbai, Chakan, Nashik, and Bengaluru. It deals with all type of anorectal disorders such as piles, fistula, constipation, fissure, hernia and others.
For more details visit: https://www.healinghandsclinic.co.in/fistula-treatment-centre/
HARMONIC SYNERGY® Blades use high-frequency mechanical vibration to simultaneously cut and coagulate at the same time, sealing vessels at lower temperatures than electrosurgery:
Precise: Minimal lateral thermal tissue damage for safer dissection near vital structures
Reliable: Seals and divides vessels <= 2mm, as well as lymphatics
Versatile: Cuts, coagulates and dissects, reducing instrument exchanges
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
PROCTOLOGY AND USE OF LASER SURGERY.
CLINICAL EXAMINATION
RELEVANCE OF PR AND PROCTOSCOPY
HAEMORRHOIDS
FISTULA ANO
PILONIDAL SINUS
FISSURE
ROLE OF LASER SURGERY
PER RECTAL EXAMINATION
PROCTOSCOPY
Different type of Energy Sources used in Surgery are described In this presentation...
like Radio frequency Electro-surgery
Ultrasound Energy
Laser
Argon beam Coagulation
energy devices are d most important part of an operation theator and surgery. in this presentation i have briefly described various energy devices used in general surgery and laparoscopy.
This presentation of introduction of laparoscopic surgery made by Dr. R.K. Mishra Director and chief surgeon World Laparoscopy Hospital. Dr. Mishra in this presentation has explained present pas and future of laparoscopic surgery. Laparoscopy is a surgical procedure which uses a special surgical instrument called a laparoscope to look inside the body, or to perform certain operations. World Laparoscopy Hospital is the center of excellence for laparoscopic and da vinci robotic surgery training and considered as one of the best institute in the world. For more detail about laparoscopic surgery please visit: http://www.laparoscopyhospital.com
Basics of laproscopic surgery..
by dr navdeep s kamboj presented at sgrdumsar amritsar.
topics covered--
1 basics of laparoscopy
2 lap cholecystectomy
3 lap appendixcectomy
pneumoperitonem
merits and demerits of laproscopy
ligasure
endoscopy,
laparoscopic instruments
Fistula is an abnormal condition in which there is a tunnel from the end of bowel movement to the skin around the anus. Healing Hands Clinic is a certified center of excellence for the treatment of fistula having centers at Pune, Chinchwad, Mumbai, Navi Mumbai, Chakan, Nashik, and Bengaluru. It deals with all type of anorectal disorders such as piles, fistula, constipation, fissure, hernia and others.
For more details visit: https://www.healinghandsclinic.co.in/fistula-treatment-centre/
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. Introduction
Components
Principle of LASER and effects in tissue
Some medical laser and its properties
General applications
Advantages/disadvantages
4. LASER beam invented by MAIMAN in 1960
1962, Leon Goldman
Dr. Goldman’s experiment was the first use of lasers in the medical
history
One of the most influential technological achievements
5. device that transforms light of various frequency into a chromatic
radiation in visible, infrared and ultraviolet regions with all the waves in
the phase capable of mobilizing immense heat and power when
focused at close range
7. • Light emitted from
LASER is of one
wavelength
• In contrast, ordinary
white light- combination
of many colors or
wavelength
8. LASER light is emitted in narrow beam in a specific direction
9. Wavelengths form LASER are in a phase in space and time
Ordinary light can be mixture of many wavelength
10. ACTIVE MEDIUM:
An optical cavity at the center of the laser device
Core is composed of chemical elements, molecules or compounds
LASER are generically named for the material of the active medium
May be gas, crystals, semiconductors
Gas-CO2, Argon , HE
Solid state semiconductors: chromium, yttrium, scandium
11. EXCITATION MECHANISM:
Pump energy into active medium by one of the three basic methods:
optical, electrical or chemical
OPTICAL RESONATOR:
HR mirror(high reflectance): reflects 100% of laser light
Partially transmissive mirror: reflects less than 100% light and transmits
remainder
12.
13. Energy applied to active medium raising
electrons to unstable energy level
Atoms spontaneously decay to relatively
long lived, lower energy, metastable stage.
Population inversion achieved in metastable
stage
Lasing action occurs when electron
spontaneously returns to the ground state
and produces a photon
If energy is of precise wavelength, it will
stimulate production of another photon of
same wavelength
14. HR mirror and partially reflective mirror directs the photon back in the
medium along the long axis of the laser
Partially reflective mirror allows transmission of small amount of
coherent radiation
15.
16. Biological effects laser light is due to absorption phenomenon by
chromophores.
CHROMOPHORES- light absorbing substances in tissue(water, Hb,
Melanin)
Absorption – function of wavelength and chromophores
If absorption is greater penetration is less and vice versa
19. • Conversion of laser light to heat
• Tissue reflectivity is important in
determining what proportion of beam will
effectively penetrate the tissue.
• Wavelength if longer, reflectivity
considerably lower, absorption is less,
penetrance is higher
• Conversion of absorbed light to heat
produces “Primary heat”
• Transfer of heat in tissue via Conduction
of heat results in increase volume
“Secondary heat”
• Secondary heat denaturation of tissue
20. Hyperthermia:
moderate rise in temperature 41º to 44º
resulting in cell death due to changes in enzymatic processes
Coagulation:
irreversible necrosis without immediate tissue destruction
temperature reaches from 50º to 100º C for around a second
produces desiccation, blanching, and a shrinking of the tissues by
denaturation of proteins and collagen
21. Volatilization:
means a loss of material.
various constituents of tissue disappear in smoke at above 100º C in
a relatively short time of around one tenth of a second.
At the edges of the volatilization zone region of coagulation
necrosis
there is a gradual transition between the volatilization and healthy
zones.
hemostatic effect is due to this region of coagulation necrosis.
If the volatilized zone has a large area in diameter, it is possible to
destroy tumours bigger than those treated by a simple coagulation.
If the volatilized region is narrow a cutting effect obtained.
22. Port-wine stains presence from birth of abnormal blood vessels in the
upper part of the dermis reddish color in skin
When a wavelength is used which is absorbed more by hemoglobin than
by the epidermis or the non-blood components of the dermis selectively
heats the red corpuscles present in the abnormal vessels
The heat will then be diffused from the corpuscles to the walls of the
vessel necrosed and permanently closed
Important to select the exposure time so that the heating will not go
beyond the vessel
If exposure time prolonged scarring effect due to involvement of
epidermis and dermis
23. Tumors of trachea causing obstruction Nd:Yag Laser at 1065nm
coagulation of the mass of tumor volatilization of the coagulated
zone to remove the obstruction
For a cancer, the volatilization effect of the laser temporary, but will
allow the establishment of a slower, more long-term treatment such as
radiotherapy
24. creation of a plasma
an explosive vaporization
the phenomenon of cavitation
Each of which is associated with the production of a shock wave.
25. With nano or pico second pulsed Nd:YaG laser a very high intensity
of luminous flux over a small area ionizes atom creates a plasma
At the boundary of ionized region high pressure gradient
propagation of shockwave expansion of the shock wave causes
destructive effect
Principally used in ophthalmology to break the membranes developing
after implanting artificial lens
26. When exposure time of laser is lower than characteristic time for
thermal diffusion produces a thermal containment accumulation of
heat without diffusion explosive vaporization of the target
Mechanism involved in selective photothermolysis
Treatment of cutaneous angiomas.
Capillaries of angiomas are not coagulated but explode resulting in
purpura(briefly) reabsorbed through the skin
27. If mechanical containment added to thermal containment gas bubble
created which will implode when the laser beam is interrupted
creating a phenomenon of cavitation
Mechanism used for fragmentation of urinary calculi.
28. Pure ablation of material without thermal lesions at the margins, such as
one would get with a scalpel
occurs because of the Principle of dissociation
With very short wavelengths (190 to 300 nm), the electric field associated
with the light is higher than binding energy between molecules
Molecular bonds broken the tissue components vaporized without
generation of any heat at the edges
Effect obtained with lasers of very energetic wavelengths such as those
emitting in the ultra-violet (excimer lasers emit at 193 nm (ArF), 248 nm
(KrF) or 308 nm (XeCl)).
Action is very superficial, only over several microns, because light at
these wavelengths is very strongly absorbed by tissue.
29. No practical advantage for making incisions or for ablating vascular
tissues because they will bleed in the same way as with a scalpel
Can only be used on tissues which will not bleed
Lasers are suitable for this application because of the reproducibility of
their effects which can be modelled, and because of the absence of
mechanical contact with the tissue
Excimer lasers have found an application in ophthalmology for
photorefractive keratoplasty.
Laser used is an argon-fluoride excimer laser laser beam at 193 nm,
immediately stopped by the superficial layers of the cornea
resulting in a photoablation of the surface.
30. Involves the relatively selective uptake of a photosensitizing drug and
subsequent irradiation with light of a suitable wavelength
In the presence of oxygen, singlet oxygen is produced with the
induction of a cytotoxic action
Illumination is required at a wavelength corresponding to the peak
absorption of the drug
31. The illumination delivered at several hours to several days after the
administration of the photosensitizer
A wavelength is used which is absorbed well by the drug and which
suits the depth of the desired effect in tissue
Light in the green region of the spectrum is used for superficial effects
and in the red for deeper effects
A laser is used as the source of light because it is necessary to use a
fiber optic for endoscopic treatments
34. “Excited dimer”
Form of ultraviolet laser
Are of Nobel gas halide types
Photo ablative effect
Wavelength depends on the molecules used
35. APPLICATIONS :
The ultraviolet light from an excimer laser is well absorbed
by biological matter and organic compounds.
Excimer lasers have the useful property remove exceptionally fine
layers of surface material with almost no heating or change to the
remainder of the material which is left intact.
Well suited to precision delicate surgeries such as eye
surgery LASIK.
36. Use of nobel gas argon as the active medium
Tissue depth penetration of 1mm-superficial coagulation
Precise cutting with minimal damage to surrounding tissue
Applications:
Retinal photocoagulation
Arterial recanalization
37. Uses organic dye as a lasing medium
Usually liquid solution(rhodamine, kitone red)
Dye can be used for much wider range of wavelength
Wide bandwidth makes it suitable for tunable laser or pulsed laser
38. Applications:
Dermatology- to make skin tone even
Wide range of wavelengths allows very close matching to the
absorption lines of certain tissues, such as melanin or hemoglobin,
while reducing the possibility of damage to the surrounding tissue.
Port-wine stains and other blood vessel disorders
scars and kidney stones
Tattoo removal
39. Most effective laser scalpel
The CO2 laser produces a beam of infrared light
Cutting and vaporization instrument
Seals lymphatics as it cuts through, thus decreasing spread of malignant
cells
Loss of tissue through evaporization
40. Application :
Carbon dioxide lasers have become useful in surgical procedures because
water (which makes up most biological tissue) absorbs this frequency of
light very well
best suited for soft tissue procedures
Advantages: less bleeding, shorter surgery time, less risk of infection, and
less post-op swelling
gynecological, dentistry, oral and maxillofacial surgery, Skin resurfacing
41. Most widely used in medical field
High penetration capacity of >5mm
Mechanism: Photocoagulation
Endoscopic LASER
Application:
To arrest bleeding GI varices
Debulking GI and pulmonary tumors
Coagulates bladder tumor
used to remove skin cancer
used for laser prostate surgery
42. solid state laser, where YAG (Yttrium Aluminum Garnet) crystals are
doped with rare-earth holmium ions
Treats tissue in liquid filled environment( blood, saline)
Endoscopic laser
Application:
Ablation of tissues, urology, prostatic surgery
Orthopaedic laser used in arthroscopy
43. Shallow penetration
the output of an Er:YAG laser is strongly absorbed by water
Extreme surgical precision
Application:
laser resurfacing of human skin; acne scarring, melasma
the output of Er:YAG lasers also absorbed by hydroxyapatite
makes it a good laser for cutting bone as well as soft tissue
44. Semiconductor device that emits LASER light as electric current passes
through them
Tunable laser
Fiberoptic delivery system
Mechanism: photocoagulation
Application:
Hair removal
45. solid-state laser that uses a potassium titanyl phosphate (KTP) crystal
as its frequencing doubling device
Fiberoptic delivery system
Application:
Cholecystectomy
48. UPPER GI CARCINOMA
Early Gastric cancer
Endoscopic laser therapy (Nd: YAG) can eliminate cancers completely
3 Requirements: Lesion <4cm with no lymph node metastasis, Follow-
up, operator
Advanced carcinoma : palliative procedure to relieve obstruction,
dysphagia or bleeding
Destroy neoplastic tissues & recanalise lumen
Relief of dysphagia 92%,perforation 10%
Outpatient basis
49. LIVER
Fibrotic Liver Resection
Controlled resection of liver without bloodloss possible
Nd:YAG Laser with tissue contact tip
Insitu ablation of Intrahepatic malignancies (metastases)
Palliation in HCC
50. BILE DUCT STONES
Laser Lithotripsy
Coumarin pulsed dye laser
For Bileduct stones that can’t be extracted easily
Break stones into small fragments which pass spontaneously
Light energy to Acoustic energy
51. VASCULAR APPLICATIONS
Laser Endarterectomy – Argon laser
Combination of Helium laser for fluorescence excitation & Holmium
laser for plaque ablation are tried
Laser Angioplasty – Co2,Argon,Nd:YAG
52. UROLOGY
Renal stones - Laser lithotripsy
Coumarin-based pulsed dye laser
Light energy is delivered through Flexible quartz fibers, directed
Endoscopically onto a calculus
Mechanism of action occurs via plasma formation between the fiber tip
and the calculus, which develops an acoustic shockwave that disrupts
the stone along fracture lines
Endoscopic extraction
53. BPH
Photovaporisation - Tissue water is vaporized resulting in an
instantaneous Debulking of prostatic tissue.
KTP or Greenlight is commonly used for its vaporization effects on
prostate tissue.
Less bleeding and fluid absorption than standard TURP
Demerit: Lack of tissue obtained for postoperative pathological
analysis
54. Urothelial stricture Disease
Nd:YAG, KTP, and Ho:YAG lasers used
vaporize fibrous strictures
Urothelial malignancies
Transitional cell carcinoma of bladder, ureter, and renal pelvis
55. SKIN LESIONS
CO2 Lasers - Condyloma acuminata, Haemangioma of external
genetalia,early penile carcinoma.
58. Misdirection of laser energy
perforation of viscous or large blood vessels
Eye damage
Skin damage
Fire and explosion
Gas embolism:
laparoscopic or Hysteroscopic laser surgery
Population inversion:population inversion is when more atoms are in upper state than lower so that emission of photons dominate over the absorption
Higher state must be metastable-a stage in which electrons stay for longer time so that transition to lower state occurs by stimulated emission rather than spontaneous
Energy applied to active medium raising electrons to unstable energy level
Atoms spontaneously decay to relatively long lived, lower energy, metastable stage.
Population inversion achieved in metastable stage
Lasing action occurs when electron spontaneously returns to the ground state and produces a photon
If energy is of precise wavelength, it will stimulate production of another photon of same wavelength
UV light has high absorption less penetration, infrared has less absorption , more penetration
Water has highest absorption, light acts superficially
Long wavelength: infrared and red
Mechanical effects results from:
neodymium-doped yttrium aluminium garnet
emit light with a wavelength of 1064 nm, in the infrared
erbium-doped yttrium aluminium garnet (Er:Y3Al5O12)
wavelength of 2940 nm, which is infrared light
Laser plume: vapours , smoke, particulate debris produced during the surgical procedure