RUSSIAN HEALTH MINISTRY INSTITUTE
OF QUANTUM MEDICINE
JSC MILTA - HUMANITARIAN
INFORMATION TECHNOLOGY DESIGN AND RPODUCTION ENTERPRISE
USE OF LOW-ENERGY LASER RADIATION
IN CHILDREN WITH SELECTED SURGICAL DISEASES
Guidelines for Physicians
Logistics of the methodology...........................…………………………………..............6
Technology of using the
Treatment of patients with nonspecific cystitis...............................................…...........7
Treatment of children with enuresis using
Laser therapy of children with peritonitis...........................................................……..10
Use of low-energy lasers in treatment of
children with severe thermal injury........….12
Treatment of children with complicated acute
At the present time, there
is a pressing need for clinical adoption of new alternative
therapeutic methods in health care practice. Numerous reasons
for it include a steadily rising morbidity rate in Russia's
population of children because of increasingly greater impacts
of adverse endogenous and exogenous factors, a serious change
in resistance of children, insufficient efficacy of conventional
therapies and a high percentage of major disease entities
progressing to a chronic course. The most promising approach
today is reliance on new research-intensive treatment methods.
Experience with lasers in
different areas of medicine has shown their high efficacy
which is related to a broad range of beneficial effects
of laser light, but these methods have not found proper
use in pediatric practice, as interaction of photon energy
with biologic objects has not been adequately elucidated
and a scientifically validated approach to use of low-energy
lasers is lacking, even though their clinical effectiveness
is already apparent.
These guidelines are based
on extensive experience of use of low-energy laser therapy
and magnetic-laser therapy in large patient populations
with different surgical diseases. Various techniques of
it include treatment of reflexogenic zones, reference points,
blood, inflammatory sites, skin autografts, etc.
Therapy results have been
verified using instrumental, endoscopic, biochemical, cytologic,
electron microscopic and radiographic studies.
FORMULA OF THE METHODOLOGY
New methods have been designed
in pediatric surgical practice for treatment of children
with various urinary tract diseases accompanied by cystitis
and enuresis and patients with burns, peritonisits of appendiceal
origin and complicated acute pneumonia. These methods are
based on unique biologically active properties of low-intensive
laser light and magnetic-laser radiation which have biostimulating,
antioxidant, antiinflammatory, desersitizing, antiedematous,
analgesic and other effects. No counterpart therapeutic
methodologies are available thus far.
The addition of low-energy
laser and magnetic-laser therapy to surgical management
of children with the mentioned diseases has appreciably
improved therapy results for the first time in Russia's
pediatric surgical practice. Besides, these methodologies
are simple, safe for patients and the medical personnel;
they cause no complications and allow drug intake reduction.
LOGISTICS OF THE METHODOLOGY
Uzor-A-2K laser therapeutic
device, Voskhod factory, Kaluga; registration No. 94/271-122.
Multifunctional therapeutic arsenide-gallium device with
a semiconductor near infrared laser emitter with a 890 nm
wavelength. Average output power is regulated from 0 to
2 mW. The device has a pulsed operation mode with pulse
recurrence frequencies of 80, 150, 300, 600, 1,500 and 3,000
Hz. Automatically set laser radiation exposures are 4, 8,16,
32,128 and 256 seconds.
laser therapeutic device with an inbuilt radiation test,
MILTA-PKP GIT, Moscow, registration No. 93/199-92. It is
a semiconductor laser with a 890 nm wavelength and diode-emitted
light with wavelengths in the range of 890-950 nm. Controlled
power of diode-emitted pulsed infrared light is 0 to 130
mW. Average pulse power is 5 mW at 1,000 Hz frequency and
5 uWat 5 Hz frequency. Pulse recurrence rates of RIKTA-01
are 5,50 and 1,000 Hz. Static magnetic field induction in
the working plane of the emitter of the device's handpiece
is 40-60 mTI.
TECHNOLOGY OF USING THE METHODOLOGY
TREATMENT OF PATIENTS WITH NONSPECIFIC CYSTITIS
A semiconductor laser therapeutic device with pulsed mode
operation in the infrared wavelength range.
No special preparation is required for laser tr3atment of
patients with cystitis. Girls should come to the treatment
session with a filled urinary bladder so that it displaces
the uterus backward; otherwise the fundus overlying the
empty bladder will be irradiated.
TECHNIQUE. The procedure
of transcutaneous laser light therapy of any clinical form
of cystitis at its any phase is standard. The supine patients
keeps the feet on the coach and the knees slightly apart
(the abdomional wall is relaxed). The emitter with a mirror
mount is snuggly pressed into the upper pubic area of the
anterior abdominal wall. Without relieving the pressure,
the emitting part of the laser is directed toward the small
pelvic cavity by making the angle between the emitter and
the abdominal surface sharp.
The bladder is irradiated
by 50-150 Hz pulses. Exposure durations vary from 60 to
120 seconds depending on the anterior abdominal wall thickness.
Treatment sessions are held daily or at a one-day interval.
A course of laser therapy is 2-4 sessions for acute and
4-10 sessions for chronic cystitis.
The first procedure usually
relieves or reverses pain,decreases the micturition frequency
and increases bladder effective capacity. Cystitis symptoms
subside with more treatments. The final procedure is given
in the absence of clinical symptoms.
Laser therapy can be added
to the management of chronic cystitis associated with a
primary disease or be used alone in the presence of acute
nonspecific primary cystitis. The choice depends on the
extent and morphologic presentations: local catarrhal or
ulcerous cystitis may be treated without drugs.
Treatment of hemorrhagic
and radiation cystitis does not differ from that of other
forms. Complete reversal of cystitis is seen after three
to five treatment sessions and confirmed by cystoscopic
and biochemical studies.
laser therapy of cystitis is an effective intervention for
patients with urinary tract diseases. When urinary tract
malformations are treated surgically, this method of bladder
treatment is useful in preoperative preparation as a deterrent
of severe postoperative complications.
Nonspecific cystitis of various origins.
Patients with malignant tumors are not eligible for laser
treatment, as biostimulation can promote tumor growth and
EFFICACY OF THE METHODOLOGY
Experience with low-energy
laser therapy in more than 200 children in urology and nephrology
clinics has shown its high effectiveness in reversal of
inflammation and in patient preparation for surgery.
After a course of therapy,
cystoscopy usually shows a clean, pink urinary bladder mucosa
without hyperemia, edema, fibrinous deposits, lesions or
vascular injections. Bullae resolve in most cases.
This methodology alone can
be used to treat primary cystitis. Its use allows tapering
the drug dosage. Low-energy laser therapy can be successfully
used as a single intervention in patients with allergy.
Therapeutic effects are mediated by immunostimulation in
The methodology is safe
and simple. All of these advantages make it recommendable
for use by urologists of pediatric centers, as it is well
tolerated by children and causes no negative response.
No complications of low-intensive
laser therapy have been seen.
TREATMENT OF CHILDREN WITH
ENURESIS USING LOW-ENERGY LASERS
laser devices with a 890 wavelength are used.
TECHNIQUE. If cystic
mucosal inflammation is present and is a cause of hyperreflexia,
infrared light is applied to the bladder as described above
during four-five treatment sessions.
The reflex therapy is continued
without intervals by application of light guide of the semiconductor
laser to reference points. Exposure of one point is ten
seconds and the pulse frequency 1,000 Hz. Light flow power
of this treatment is 2-5 mW.
Points are selected on two
1. Paravertebrally at the
level of the 2nd-4th sacral vertebral foramina.
2. One-two centimeters anteriorly
on the external-lateral surface of the foot and the same
distance beneath the anterior external ankle.
3. One cm above the upper
margin of the external ankle.
4. Depression between the
shin bone and the upper calf bone.
5. Anal sphincter; exposure
is 60 seconds, treatment is delivered without contact from
a 5 cm distance.
6. The lower external point
of the ear antihelix.
7. Angle between the first
and second wrist bones.
Ten treatment sessions make
a course of therapy which is repeated two-three times a
year at an interval of four-six months.
INDICATIONS. Enuresis, micturition
CONTRAINDICATIONS. The only contraindication
for low-energy laser therapy in these patients is the presence
of a tumor.
EFFICACY OF THE METHODOLOGY
Laser treatment stops enuresis
or makes its episods less frequent. The bladder volume increases
20-25 percent in almost all cases.
Our experience of laser
therapy of 286 children has shown that drug withdrawal was
affordable in 30 percent of the group. Microcirculation
and tissue blood flow were evaluated by biomicroscopy with
photography of conjuctival small vessels. Pretreatment microcirculation
disorders in this population were of grades 11-111. Eight-ten
laser treatments improved microcirculation to grades 0-1.
There were no complications of therapy.
The treatment methodology
is simple and physiologic. It allows a significant decrease
in the drug intake, an especially important benefit for
children with enuresis and proneness to allergy. The high
clinical efficacy of low-energy laser therapy is determined
by improvement of urinary tract tissue nutrition and neurotransmission,
reversal of bladder mucosal inflammation and general stimulating
effects on the organism.
LASER THERAPY OF CHILDREN
Two major pathogenetically
relevant actions of photon energy in patients with peritonitis
are stimulation of gastrointestinal tract motility and improvement
of peritoneal regeneration processes.
EQUIPMENT. The Russian-made
infrared laser devices Uzor and RIKTAwith a 890 nm wavelength,
pulse frequencies of 50 and 150 Hz and average power of
5 and 3 W respectively are used in clinical practice.
The first and second postoperative
days are the best time for laser treatment. Exposure of
each treated area is 1 minute. Four fields are irradiated:
the right iliac, right mesogastric, epigastric and left
mesogastric areas.Two-three daily sessions of laser therapy
usually prove sufficient.
ileus in the presence of appendiceal peritonitis.
Contraindications for laser therapy in children with peritonitis
1) inadequate abdominal
pus elimination and drainage during the operation;
2) intraabdominal abscesses
and residual pustules,
3) focal secondary omentitis,
4) doubt about complete
elimination of preoperative adhesion ileus.
EFFICACY OF THE METHODOLOGY
Low-energy laser therapy
produces no subjective sensations of patients. Its effects
on intestinal motility are evaluated clinically and radiographically.
The effectiveness of treatment was confirmed in some of
our patients by direct small intestinal electromyography.
Pretreatment electromyograms recorded by an implanted electrode
showed low-altitude waves in the presence of intestinal
aperistalsis. The electromyograms showed high-amplitude
waves with an adequate rapid component and spike potential
as early as after the first treatment session. Intestinal
motility registration at 30 minutes, one hour and three
hours following the treatment indicated stable and prolonged
stimulation of peristalsis in the presence of peritonitis.
An explanation for the positive
effect is the additive action of local and general biologic
effects of infrared laser light on the body. Local effects
occur as activation of energy production in cells of the
gastrointestinal neural apparatus which are sites of action
of neurohumoral factors, while the generalized biologic
effect indirectly stimulates higher vegetative regulation
centers of the adrenosympathetic system.
Use of laser therapy in
the management of 27 children with appendicitis-related
peritonitis (on rigorous indications) was found to stimulate
intestinal motility. This made postoperative progress smoother
and averted many complications.
USE OF LOW-ENERGY LASERS
IN TREATMENT OF CHILDREN WITH SEVERE THERMAL INJURY
Energy of laser light is
used in pediatric cotnbustiology for closure of burn surfaces
using autodermoplasty, preparation of sluggishly granulating
wounds for autodermoplasy and promotion of skin autograft
assimilation in the postoperative period.
laser devices RIKTA and Uzor with a 890 nm wavelength in
combination with magnetic treatment.
TECHNIQUE. Skin flaps
from donor surfaces are perforated 1:2 or 1:4 and irradiated
during autodermoplasty with an arsenide-gallium laser with
890 nm wavelength, 10 mW power and 1,000 Hz pulse frequency
for 60 seconds.
two treatments using the same regimen (see above), torpidly
granulating wounds debride of purulent detritus, get a bright
color and show prominent marginal epithelialization.
Such wounds heal faster
because of a higher phagocyte activity and an increase in
numbers of orthogonal capillaries.
Bood photomodification is
used during preparation of patients with extensive burns
for autodermoplastic surgery and in treatment of children
with slowly granulating wounds. This method significantly
improves the patient's condition and wound healing.
blood photomodification uses a laser light guide which is
not inserted intravenously but is fixed to the skin above
any ofsuperifical vein. Light beam power is 5-10 W; exposure
varies from 15 to 30 minutes depending on the patients's
age, clinical condition, the surface area and quality of
thermal injury. The exposure duration is 10 minutes for
children under five years, 15 minutes for children younger
than 10 and 20 minutes at ages under 15.
This treatment inode is
convenient in that it requires no special antiseptic treatment
of the light guide (rubbing it with 70-96 percent alcohol
is enough), is noninvasive and easily tolerated by patients
who do not feel the procedure.
The procedure is carried
out with the patient supine in order to avoid orthostatic
collapse due to blood redistribution. Laser irradiation
improves organic and tissue blood flow, which is observable
rheographycally as change in vessel blood filling.
Semiconductor pulsed lasers
are used in transcutanebus blood photomodification. Pulse
frequency is 1,000 Hz. Three to ten sessions make a treatment
course. We saw no complications of the blood photomodification
In the postoperative period,
the bum surface is irradiated with 890 nm arsenide-gallium
lasers of different modifications (RIKTA or Uzor) which
combine infrared light and the magnetic field.
of laser irradiation in our patient population varied from
60 to 300 seconds, depending on the burn surface area. The
pulse frequency was 1,000 Hz. Laser treatment was given
at a one-day interval during wound redressing.
burns with different surface
areas and depths.
Chemical skin burns. Laser treatment of extensive poorly
granulating wounds for repair stimulation has the role of
an adjunct procedure during the preparation for autodermoplasty.
EFFICACY OF THE METHODOLOGY
Laser irradiation of the
skin autograft during the operation induced complete assimilation
of it in most of patients. Use of laser light during initial
autograft lysis stopped this process and facilitated assimilation
with activation of granulation and subsequent epithelialization
without rough scarring, i.e. the tissue became organ-specific.
Cytologic evaluation of
burn wound repair has shown
that regular laser treatment
(with wound redressing at a one-day interval) returned the
cell pattern in the wound area to normal and hastened repair,
with change of its phases once within three-four days.
Electron microscopy of fluid
samples from wounds revealed fibroblasts, activated phagocytes
(macrophages) with prominent pseudopodia and abundant phagosomes
(intense cell vacuolation) with inclusions of detritus fragmens
and digested microorganisms.
Use of low-energy lasers
in more than 300 patients with bums for blood photomodification
and biostimulation of isolated donor skin grafts during
autodermoplasty and of graft sites in the postoperative
period appreciably improved therapy results and shorted
the hospital stay of children by a mean seven days.
TREATMENT OF CHILDREN WITH
COMPLICATED ACUTE PNEUMONIA
lasers with sources of the static magnetic fild are used
in treatment of patients with complicated forms of acute
pneumonia, such as lobitis and pleuropneumonia. The combination
of three physical factors - low-energy infrared laser light,
low-energy diode-emitted incoherent red light and a weak
static magnetic field (40-60 mTL) - yields prominent therapeutic
effects by improving the blood flow and reversing inflammation.
treatment using RIKTA and Uzor devices is conducted at three
chest projections of the inflammatory site at 4 mW and 50
to 1,000 Hz during 5-6 minutes. Apart from the effects of
the above mentioned physical factors, this treatment duration
is consistent with the ultradian chronobiologic rhythm,
which is five minutes, and with biorhythms of the integral
intracellular circuitry and blood redistribution.
Procedures are carried out
daily or at a one-day interval. The course is 6-10 treatments.
In the presence of refractory
postpneumonia bronchial obstruction, energy of infrared
laser light is symmetrically applied to Head zones: 1)-forearm;
2) median axillary lines
at the level of fourth intercostal spaces; 3) scapular 'ines
of the 6th intercostal spaces.
The treatment uses the RIKTA
quantum therapeutic device. The pulse frequency is 1,000
Hz. A zone is treated from a five centimeter distance (if
the divergence angle of the laser beam is 45-60 degrees).
Static magnetic field induction is 40-60 mTI. A total of
ten treatments are given.
Reference points are treated
by applying the cross section of the light guide to each
point for 30 seconds. The 1,000 Hz pulse frequency and 2-5
mW power of the semiconductor infrared laser are used in
The points are selected
1 - paravertebrally at the
level of the 5th-10th vertebral processes;
2 - nostril grooves;
3 - nasal mucosa (near the nostril opening,
4 - each tonsil through the mouth (30-second
treatment without contact);
5 - uppermost point of the external ear
6 - uppermost part of the sternal jugular
fossa, one point (children under 5);
7 - center of the sternum, one point (children
older than 5);
8 - angle between the 1 st and 2nd hand
bones. INDICATIONS. Indications for magnetic-laser
therapy are acute segmental, polysegmental and lobar pneumonia,
pleuropneumonia and persistent bronchial obstruction. CONTRAINDICATIONS.
Purulent destructive complications.
EFFICACY OF THE METHODOLOGY.
Mass spectrometric and gas
analytic evaluation of external respiration and gas exchange
in 60 patients showed that these functions significantly
improved after six-eight procedures. Lung diffucion capacity,
the ventilation equivalent, oxygen uptake rate and blood
gas delivery improved twofold as compared to these findings
in control groups. Apart from clinical and radiographic
improvement, this indicates a fuller recovery of respiratory
membrane function after magnetic-laser therapy.
in these patients suggested that the combination of magnetic
and laser radiation restores a normal inflow-outflow ratio
in capillaries by improving their tone on the one hand and
the blood rheology on the other, a change which is not invariably
obtainable by infusion of rheologically active substances.
This in turn facilitates a more rapid inflammation reversal.
Laser therapy produced no
complications.This methodology proved effective in 80 percent
of children with persistent obstruction and allergy. In
addition, it allowed a significant tapering of the drug
Printed by decision of the
Scientific Council of the Institute of
(Rector: A.Y.Grabovshchiner, Academician
of the Academy of Problems of Quality)
The guidelines have been
written by associates of the Moscow Institute of Pediatrics
and Pediatric Surgery (Director: A.D.Tsaregorodtsev, Prof.,
Y.L.Vishnevsky, Prod., M.D.,S.I.Vozdvizhensky,
prof., M.DJ.V.Kazanskaya, M.D.,Y.Y.Gatkin, Cand.Med.Sc.,
V.V.Biryukov, Prof., M.D., V.M.Bannikov, Cand.Med.Sc., N.A.Stepanova,
M.D., A.K.Konovalov, M.D., A.B.Bogdanov, research assistant
USE OF LOW-ENERGY LASER
RADIATION IN CHILDREN WITH SELECTED SURGICAL DISEASES
Guidelines for Physicians
Moscow, JSC MILTA-PKP GIT,
These guidelines present
pathogenetically relevant methodologies of low-energy laser
therapy of children with urinary tract diseases, appendiceal
peritonitis, burns and complicated acute pneumonia. Indications
and contraindications for low-energy laser therapy and its
optimum dosage have been defined for surgical management
of these patinent groups. The guidelines are oriented toward
surgeons of regional hospitals, medical educational centers
and research institutes.
© 2001 JSC MILTA-PKP GIT, authors.