The article summarizes 25-year experience of photodynamic therapy (PDT) application for the treatment of skin cancer at “uncomfortable” critical locations. Ways for optimizing PDT physical and chemical parameters are presented as well. The authors assess PDT effectiveness for treating primary and recurrent skin cancer depending on the process location. The obtained results are characterized by two parameters: clinical outcome and cosmetic results.

Objective. To assess the effectiveness of intravenous laser blood irradiation (ILBI) with wavelength 405 nm in the complex postoperative treatment of patients with peritonitis. Materials and methods. 130 patients who were taken into the trial had peritonitis with endotoxemia of various degrees. Laser device «Matrix VLOK» with laser tips «KL-VL0K-405» was used. Results. When ILBI sessions with 405 nm laser light were added to the medicamentous therapy of patients with peritonitis and a syndrome of endogenous intoxication, the syndrome was eradicated thus, reducing the number of complications, mortality rate and terms of hospitalization. The obtained results have shown that the traditional medicamentous therapy added with ILBI is effective and reasonable in all clinical forms of purulent peritonitis accompanied by a syndrome of endogenous intoxication.

Objective. To investigate the effect of intravenous laser blood irradiation (ILBI) on platelet aggregation and blood microcirculation in patients with IHD. Materials and methods. 115 patients with stable angina were divided into two groups - control (32 patients), and studied (83 patients). Patients from the control group received only drug therapy, and the therapy of patients in the studied group was added with ILBI sessions. Platelet aggregation analyzer AP 2110 (Solar, Belarus) and laser analyzer of blood microcirculation LAKK-02 (LAZMA, Russia) were used for measurements. Functional tests were made: occlusive and ionophoretic (with acetylcholine). Calculations of the following parameters were made too: mean microcirculatory flow index (M), maximum microcirculatory flow index as a response to acetylcholine ionophoresis (Mmax), maximum amplitude of endothelial oscillations (Amax), maximum frequency of endothelial oscillations (Fmax), and microcirculatory efficiency index (MEI). Results and discussion. Out trial has shown that patients with the ischemic heart disease have low, normal, and high platelet aggregation rates. After the treatment patients from the studied group with low and high platelet aggregation showed the normalized platelet aggregation activity. The studied group also demonstrated a proven elevation of both: the initially low mean microcirculatory flow index (M) and maximum microcirculatory flow index (Mmax) as a response to acetylcholine ionophoresis). Patients from the control group had no any proven changes in the evaluated parameters. Conclusion. When used in the complex treatment of patients with IHD, intravenous laser blood irradiation (ILBI) improves positive outcomes by normalizing platelet aggregation rate, blood microcirculation and functional activity of endothelium.

Objective. To study cardiodynamic changes in patients with IHD under laser irradiation (LI) as compared to highly effective neurohormonal modulator Carvedilol, a beta-blocker. Material and methods. 115 men (males) under 60 years with IHD and tension angina pectoris of the functional class II-III were taken into the trial. All patients were divided into two groups. In Carvedilol group ( 65 patients) 53 patients received 50 mg of Carvedilol for 7 days and 12 patients received Carvedilol placebo. In the laser therapy group ( 50 patients) 39 were treated with infrared LI therapy for 10 days and 11 patients had sham LI. The bicycle ergometer test and ultrasound heart examination were performed in all patients receiving Carvedilol and LI at the beginning of treatment and after it. Results. A 10-day course of laser therapy increased the tolerance to physical loading comparable to Carvedilol therapy (+35.0% and +34.1%). Besides, a statistically important improvement of cardiodynamics was noticed too. It was characterized with the decrease of peripheral vessel resistance by 19%, with the increase of left ventricular ejection fraction by 9.1% as well as by the improvement of cardiac diastolic function (increase of early transmitral blood flow ratio to the late transmitral blood flow ratio - E/A by 21.8%). Similar results were seen in patients treated with Carvedilol (-9.2%, +11.4%, +20.4%). Conclusion. A revealed similarity in positive cardiodynamic changes with similar improvement of functional class in patients with IHD under laser therapy and under beta blockers (Carvedilol) motivates the authors to recommend LI therapy in the complex treatment of heart failure at early stages.

Objective. To study the effectiveness of laser therapy in treating patients with subacute thyroiditis de Quervain, and to compare the obtained results with the results after traditional therapy with glucocorticoids. Results. The authors compared results of traditional treatment of 49 patients with subacute thyroiditis with glucocorticoids and the results of treatment of 122 patients with the same pathology who were treated with a combined technique having a basic curative factor - infrared spectrum of laser light. All patients were treated in the endocrinological therapeutic department for the same period of time (2002-2006). Laser therapy included infrared laser light with wavelength 0.89 mkm, defocused beam with power 3.5 Wt, pulse frequency 3,000 Hz, irradiated surface of 1 cm², absorbed dose 2.5-3 J. The irradiation was done in the contact-mirror technique in the projection of the thyroid gland, exposure time 3-5 min. per each lobe. The course of treatment consisted of 10 sessions. In case of mild subacute thyroiditis, laser therapy was used as a monotherapy. In moderate subacute thyroiditis laser therapy was combined with non-steroid anti-inflammatory drugs (Ortophenum, Nimesulide). Patients with a severe form who had no desired effect were injected 20 mg of Kenalog into the diseased lobe at the end of treatment. Average terms of hospitalization of patients receiving glucocorticoid therapy were 22 days, of patients receiving laser therapy - only 12 days. Of 49 patients having glucocorticoid therapy, 6 patients (12.2%) were hospitalized again with the disease recurrence. Of 122 patients having laser therapy the disease recurrence was seen in 5 patients (4.1%). All of them had a repeated course of treatment which included laser therapy and one or two Kenalog injections; no «re-recurrences» were registered. These data were obtained in 2004. The authors have a patent of the Russian Federation ( No 2345804) for their technique which was registered on February 10, 2009.

Objective. To increase the effectiveness of treatment in patients with the chronic obstructive pulmonary disease (COPD) by combining laser and ultrasound therapy so as to improve the sputum discharge. Materials and Methods. The study included 54 patients with COPD. The article describes the dynamics of basic clinical and laboratory parameters and parameters of external respiratory function under low-intensity laser irradiation and ultrasound exposure in the proposed curative regimen. Results. Clinical effectiveness of the complex laser-ultrasound therapy has been proven by a statistically important positive dynamics of clinical and laboratory parameters as compared to the traditional medicine therapy. The effectiveness of laser-ultrasound therapy was also confirmed by the improvement of the respiratory function.

Objective. To improve results of endoscopic treatment of patients with gastric polyps using modern laser technologies. Materials and Methods. 217 patients with gastric polyps were treated endoscopically; 348 polyps were removed. All patients were divided into three groups depending on a polypectomy technique: electrosurgical, laser photocoagulation and combined. Results. 217 patients with 348 polypoid neoplasms of the gastric mucosa had gastroduodenoscopy. Polyps were removed in 121 patient in Group I; in 82 patients in Group II; in 14 patients in Group III. After the endoscopic polypectomy postoperative bleedings were seen in 13 (6%) patients: 10 (8.3%) patients from Group I; 2 (2.4%) patients from Group II; 1 (7.1%) patient from Group III. Bleedings developed on 1-3 days after the surgery. In all cases, bleedings were arrested endoscopically. Patients of the laser group stayed in the hospital after the surgical procedure less number of days as compared to the patients from the electrosurgical group and the group with combined approach. More polyp recurrences were seen in patients from Group I (n-13); 1 patient in Group II and 1 patient in Group III. Laser photodestruction of gastric polyps is more reasonable in patients with recurrent polyps, with hyperplastic polyps when electrosurgical polypectomy is associated with a high risk of recurrences. Conclusion. Laser photodestruction is an effective treatment modality for patients with gastric polyps. The discussed techniques reduces the incidence of early postoperative complications , reduces terms of hospitalization as well as reduces the number of recurrent cases.

The aim of this study is to analyze immediate and long-term results of surgical interventions added with laser beam in patients with kidney cancer, stage I (n = 231). Patients were operated in the oncourological department in the Oncologic Center subordinate to the JSC “Russian Railways”. Kidney resection using laser beam with wavelength 970 nm was done in 48 (20.8%) patients; traditional partial nephrectomy with intraorganic blood arrest - in 55 (23.8%) patients, nephrectomy - in 128 (55.4%) patients. The follow-up median was 70 months. 3-year survival among the patients after “laser kidney resection” was 100%; more so, the disease-free survival rate in them was 97.9 ± 2.1%. Among patients who had conventional kidney resection, 3-year survival was seen in 98.2 ± 1.8%, and the recurrence-free survival - in 96.3 ± 2.6%. In the group of patients who had nephrectomy, these figures were 98.4 ± 1.1% and 97.6 ± 1.4%, respectively. Differences in parameters of 3-year survival and disease-free survival in patients from these groups were not statistically important because the survival median was not reached in any of the groups. However, laser beam applied in partial nephrectomy positively modifies the postoperative period in both : terms and quality of the restored kidney function and rehabilitation of patients in general.

Purpose. To conduct a comparative study of two techniques protecting patients from the surgical aggression: multimodal combined anesthesia with transcutaneous laser blood irradiation (TLBI) and total intravenous anesthesia. Materials and Methods. 58 patients (43 women and 15 men), aged 23-79 who underwent laparoscopic cholecystectomy (n - 45) and phlebectomy (n - 13) had anaesthesiologic support during their surgeries. Patients were divided into two groups (control and studied). In the studied group (32 patients) the anesthesia was multimodal and combined added with TLBI ; in the control group (26 patients) the anesthesia was general, total, intravenous. Conclusion. A comparative analysis of the obtained data on the monitoring of peripheral and central hemodynamics and bispectral index has shown that the combined application of non-narcotic analgetics (Acupan, Paracetamol, Ketorol) and TLBI can replace narcotic analgetics in the modern multimodal anaesthesia so as to protect the human organism of surgical aggression.

Objective. To estimate the diagnostic value of colonoscopy using modern imaging techniques such as NBI, ZOOM and confocal laser endomicroscopy, to detect tumors in the colon mucosa and to make their differentiation. Materials and methods: 102 patients (74 men and 28 women), mean age 62.0 ± 8.3, had colonoscopy added with NBI, ZOOM and confocal laser endomicroscopy. Bioptats were also taken. Then the researchers compared findings obtained during endoscopic examination with findings of histological examination. They analyzed the macroscopic picture of neoplasms and morphological findings as well as patients’ age peculiarities and neoplasm location. To perform CLEM, the Cellvizio system developed by «Mauna Kea Technologies» (French) was used. The approaches discussed above allowed to verify 259 focal lesions in the colon mucosa. Results. The performed trial has proven the diagnostic value of complex endoscopic examination potentiated with NBI, ZOOM and CLEM. For hyperplastic polyps diagnostic sensitivity, specificity, and accuracy were 100%, 98.8% and 97.9%, respectively. In case of adenomas, diagnostic sensitivity, specificity, and accuracy were 100%, 91.7% and 96.5%, respectively. It has been found out that 81.5% of tumors are localized in left parts of the colon. Conclusion. Colonoscopy with NBI, ZOOM and CLEM significantly improves diagnostic efficiency of detecting focal lesions in the colon mucous and allows to define the histological structure in vivo. Neoplasm location, neoplasm size and patient’s age are important prognostic factors in the diagnostics of tumors in the colon mucous.

Purpose. To assess the diagnostic value of esophagogastroduodenoscopy (EGDS) added with modern visualization techniques NBI, ZOOM and confocal laser endomicroscopy so as to reveal focal neoplasms in the stomach mucous. Place: Moscow, state budget - funded organizations “United Hospital and Out-Patient Unit” and “Central State Medical Academy” subordinate to the Affair Management Department of the President of Russian Federation. Materials and methods: 150 patients aged 29-96 were examined. EGDS was added with NBI, ZOOM and confocal laser endomicroscopy with the target biopsy. Macroscopic and endomicroscopic pictures of various neoplasms ( metaplasia, hyperplasia, adenoma, dysplasia, cancer) were compared with findings of histological examination. CLEM testing was made using Cellvizio system developed by the French firm «Mauna Kea Technologies». The techniques discussed above verified 176 focal neoplasms in the stomach mucous. Results. A diagnostic value of complex endoscopic examination including NBI, ZOOM and CLEM has been assessed. For the intestinal metaplasia the diagnostic sensitivity, specificity, and accuracy were 94.2%, 84.7% and 90.3%, respectively. In dysplasia/cancer cases the diagnostic sensitivity, specificity and accuracy were 93.7%, 87.8% and 89.8%, respectively. Conclusion. EDGS added with NBI, ZOOM and CLEM considerably increases the diagnostic effectiveness in revealing focal lesions in the stomach mucous and allows to define the histological structure of neoplasms in vivo.

Purpose. To evaluate microcirculation in the prostate gland of patients suffering of chronic nonbacterial prostatitis (CNP) with laser Doppler flowmetry (LDF) before and after the course of combined treatment which includes permanent magnetic field therapy (PMFT), low-level laser light therapy (LLLT) and red light selective chromotherapy (RLSC). Materials and methods. This trial was performed in the department of medical rehabilitology of the Altai State Medical University. 70 patients with CNP at the stage of latent inflammation were taken into the study. 35 patients were in the studied group and received combined treatment which included PMFT, LLLT , RLSC as well as medication therapy, prostate massage, dietotherapy and exercise therapy every day for 10 days. 35 patients in the control group received only the basic treatment. Prostate microcirculation was evaluated by laser Doppler flowmetry (LDF). Results. The results obtained in the studied group after the course of the combined therapy have shown the activation of microcirculatory control mechanisms, activation of capillary perfusion, increase in microcirculatory blood pressure, improvement in the venous outflow and less stagnations in the venular chain of the microcirculatory flow. The performed trial demonstrated that all patients had the stagnation form of their microcirculatory disorders. The discussed combined therapy which includes PMFT, LLLT and RLSC added to the basic therapy of patients with chronic non bacterial prostatitis significantly improves therapeutic efficacy if to compare with the controls who received only the basic therapy. The proposed combined technique significantly improves the prostate gland microcirculation as well.