MAIN EFFECTS OF LASER CICATRIZERS 808 nm.

LLLT = Low Level Laser Theraphy

Increases the production of nitric oxide in endothelial cells of blood vessels, leading to active vasodilation.
Increases the VEGF (vascular endothelian growth factor), ie the vessel growth factor
Increases angiogenesis and the formation of new blood vessels
Increases L-Arginine which is the precursor of NO (Nitric Oxide)
Increases the synthesis of intra-tissue collagen
Increases Macroblasts and Microblasts by accelerating the wound repair process.
Increases the keratinocytes of the dermis.
Increases the mitochondria ADP by improving the oxygen supply
Increases ROS (Reactive Oxigene Species), decreasing the oxidative stress of inflamed tissue.
Increases Macrophages and Lymphocytes with greater inactivation of the gold staphylococcus mostly attributed to the ulcer.
Activating the immune system, stimulating T Helper Cells (CD4) decreases T suppressor cells (CD8).
It inhibits the plasminogen activator and increases blood vessel production
Laser therapy is painless

Ulcera Venosa

Female patient, suffering from a venous ulcer in her left leg, had been subjected to the usual specialist medical treatments, without benefiting from it. After 9 Laser applications a clear reduction of the extension and depth of the ulcer was obtained and at the 15th session its complete healing.

Ulcera Diabetica

Female patient suffering from diabetic ulcer on the left heel had undergone multiple specialized vascular surgeon treatments with no results. After 8 Laser applications we notice a reduction in diameter of the lesion, at the 15th session we appreciate a reduction in the depth of the ulcer, at the 22nd session we highlight a strong healing and a complete healing at the 30th application

Ulcera Venosa - Arto Inferiore

Female patient suffering from severe chronic venous insufficiency with large varicose veins and numerous small ulcerations of the skin at the ankle. After numerous protracted surgical and vascular treatments for 3 years, no improvement was achieved. After a cycle of Laser photodynamic therapy from the sixth to the twelfth session, there is a progressive reduction of ulcerative cracks, an increase in the new scar granulation tissue. From the twelfth to the twentieth application, the progressive improvement in the repair of ulcers and a sharp decrease in swelling and ankle edema made the subject of the lesions are evident. At the twenty-fifth session, the ankle returned completely normal in the color of the same skin.

EFFECTS OF THE LASER 808 nm. ON THE PAIN THERAPY

LLLT = Low Level Laser Theraphy

Decreases Interleukin -1ß, IL-6, IL-10 and TNF-α, resulting in an anti-inflammatory action.

Decreases the production of Cox-2 (cyclooxygenase) with antiedema and analgesic effect

It decreases prostaglandin with an inflammatory action E2 (PGE2) and increases the prostaglandins with an anti-inflammatory action PGF2 -PGI2 (Prostacyclin).

It increases the excretion of corticosteroids in the urine as evidence of the action of the laser on the hypothalamus-hypophysis axis, which mediates to the reaction of pain-induced stress, releasing Cortisol, Vasopressin.

It increases the synthesis of endorphins from the center to the periphery at the level of the gelatinous substance of Rolando and at the level of the posterior horns of the spinal cord. The laser blocks the production of Substance P which is responsible for algogenic substances such as Bradichinin and Serotonin through the "gate control system" theory of Melzac, Wall and Casey.

Phlogosis indexes such as VES, PCR, CPK decrease.

Causes a movement of the intracellular calcium in the sarcoplasmic reticulum and the relaxation of the smooth musculature and a muscle relaxant action on the skeletal one.

Therapy is painless. Illustrative n.1

Illustrative slide 31/12/2018

The slide shows the results of the most frequent pathologies, acute and chronic, treated with the Laser: Arthrosis of the shoulder, hip, spine-lumbar spine, cervical spine, fingers of the hands and foot, knee pathologies, meniscopathy, ligament injury, epicondylitis, epitrocleitis, bursitis (tennis elbow). Tendinitis, pubalgia, neuritis, neuralgia, sprains. Venous and diabetic ulcers, phlebitis. In the evaluation of the results we have used the Reumatology Scale, of V.A.S. Scale, of the Oswestry Disability Scale, of the M.C. Gill pain questionnaires, of the Status index and of the Dynamometer. The results were classified into four types: Excellent, Good, Modest, Not evaluable.

Tavola n.2 Controls

The controls were performed after 5 applications, at the end of the treatment and after 2/6 months from the completed treatment. The average of the applications was 12 sessions per session.

Tavola n.3 Classification of results

Very Good: The total disappearance of symptoms and complete restoration of normal function. Good: The disappearance of 60% of the symptoms and a substantial improvement in the quality of life. Poor: The disappearance of 20% of pain symptoms with minimal improvement in joint function.AnyValue: no change compared to the pre-treatment phase.

Presentation table

Effects of energy-based laser density in scapular humeral periarthritis compared to treatment with corticosteroid and oral Fans infiltrations (non-steroidal anti-inflammatory drugs) following the "wait and see" policy. Therefore the main purpose of the study was to compare the effectiveness of three types of treatment over a long period of time. Up to now, work on laser efficacy has been presented no later than 6 months after treatment. The work was published in the Lasers text in Medicine Science and Praxis (Trilogy Upsates).

Tavola n.1

Scapulo-humeral periarthritis is a pathology increasingly present in general outpatient medicine. Pain and functional impotence are the main characteristics. The incidence is estimated between 6-8 per 1000 patients per year in the population; it is estimated that 18% -21% of people over 65 are affected by this condition.

Tavola n.2

In the slide you can see the RX in front-back and lateral-lateral projection, a left shoulder periatritis in a 55-year-old woman. In fact, there is a calcification in the free part of the trochitis, not far from the tuberculum magum, which causes inflammation and pain in the scapulohumeral joint.

Tavola n.3

Between January 2006 and February 2007, ninety-eight (98) patients were recruited and sent by family doctors, physiotherapists and orthopedic specialists. Sixty patients with a mean age of 42 years, were subjected to selection criteria and assigned to the randomized study. Despite the randomization there were some differences between the intervention group compared to concomitant neck disorders, previous episodes of shoulder periarthritis, shoulder pain. The differences in these variable prognoses had a small effect on the analysis of the results.

Tavola n.4

In selecting the patients admitted to the study, we applied inclusion criteria and exclusion criteria. Among the included we have selected both male and female patients between the ages of 30 and 70 years. The American college of rheumatology was taken into consideration; the shoulder pain had to increase with pressure and resistance to movement. The diagnosis of periarthritis had to be done by RX or Tac of the shoulder. Instead we excluded patients who had bilateral disorders behind their backs; if the pain was dated for less than 6 weeks; also excluded patients with cervical radiculopathy, those with shoulder surgery, rupture or ligament injury (rotator cuff, supra and infraspeptatus with subacromial conflict); disorders lasting less than 6 weeks and musculoskeletal disorders

Tavola n.5

We used a computerized randomization that compiled and cataloged the prospectus for each patient. The randomized study block was made after the pre-stratification of painful behaviors that lasted less than or equal to 12 weeks or more than 12 weeks. The assignment of patients to treatment with cortisteroid infiltrations, patients with LLLT, or non-steroidal anti-inflammatory drugs, was made after final selection by physiotherapists and on the basic evaluation.

Tavola n.6

Among the candidates eligible for 6 weeks of treatment, nineteen (19) 32% patients were assigned to the non-steroidal anti-inflammatory group and, if necessary, treated with Celecoxib 200 mg per day. Twenty-three percent patients were assigned to infiltration therapy on site with 1ml of triamcinolone acetonide (40 mg and 1 ml lidocaine 2% hydrochloride) for up to 3 injections during the observation period. Twenty-one 35% patients were treated with the Laser Diode 904 nm. pulsed action, with a maximum power of 60 mw of power.

Tavola n.7

Irradiation parameters: The average power was 27 mw, maximum pulsation of 200ns (nanoseconds); frequency of 1280 Hz; 4 / J of energy dose for Trigger point; average points treated from 2 to 8; 3-4 Joules per square centimeter as an energy dose per single point; total fluency of 32J / square centimeter. Number of applications equal to 12. One application per day for 5 consecutive days followed by two days of interval.

Tavola n.8

During the follow-up, in the group treated with non-steroidal anti-inflammatories, 2 patients took paracetamol, 4 took an anti-inflammatory during the first year (31%). In the treated group with corticosteroid infiltration, 5 received 2 injections, 3 received 3 injections (0.9 ml-1.5 ml) equal to 35%. In the laser therapy group, 2 patients were subjected to 10 sessions, each of them (9%).

Tavola n.9

Signals were calculated by subtracting the results from the follow-up baseline; we estimated the differences (95 confidence interval) in an improvement between the groups. The main analysis was made on the intention to basic treatment; Manova was used for repeating data to prevent multiple checks; a p less than 0.05 was judged as significant

Tavola n.10

The evaluation of the results was done once during the intervention, three weeks after the rondamization and at 6,12,26,52 weeks. We used the Likert scale compared to the baseline, the anatomical and functional state of the scapulo-humeral joint, with the severity of the main symptoms (Vas scale) and the improvement of quality of life.

Tavola n.11

In this slide you can see, as in the first and second tests, there is a noticeable difference in favor of infiltration with corticosteroids. On the other hand, at 26 and 52 weeks, we noticed statistically significant differences for the nearest verification points in favor of the laser therapy which showed better results compared even with the "wait and see" policy with non-steroidal anti-inflammatory drugs. But the difference between these last two options was small between (5% and 10%) and not relevant. The long-term results of the anti-inflammatory Celecoxib were also better than infiltration with triamcinolone acetonide but the long-term differences were modest. The course of pain severity, shoulder disability, pressure pain, competed with the data reported for the results evaluation indexes

Tavola n.12

In conclusion, our results show that corticosteroids are the best choice in the short term, for patients with shoulder periarthritis. In the long term, our work shows that low energy density Laser Therapy becomes the best solution, followed by Fans (non-steroidal anti-inflammatory drugs). The association of corticosteroid infiltration alternating with the Laser therapy cycle should represent the best and most complete therapeutic approach. For those who could not access the injection therapy with cortisone, or the common anti-inflammatories for other related diseases, laser therapy remains a non-invasive method, easy to apply, free of side effects and of absolute therapeutic efficacy.