Book Reviews
Low Intensity Laser Therapy – The New Therapeutic Dimension
Fred Kahn
ISBN 978-0-9817701-1-6
Dr. Fred Kahn has been actively involved in laser therapy for many years and is the founder of Meditech International in Toronto, Canada. The company has, beside a production unit, also two well visited clinics in the city. The equipment has a computerized instruction/advisory system which is continuously updated as new experience and science is developing. Now, why is a book review starting with a company introduction? Well, it is because Dr. Kahn has written three books on laser therapy and they are all based upon the system of the author. This has to be underlined, because it limits the usefulness of the books for the general reader. For the owner of the particular equipment it could, on the other hand, be regarded as “the best company manual in the field”. WALT does not endorse any particular manufacturer but encourages experienced users to publish their knowledge.
Normally, a “company manual” would not be subjected to a review, but after the above “disclaimer”, the actual qualities of the books have to be underlined. Books 1 and 3 are not too useful for the average reader since a lot is centered on how to apply laser therapy using the Meditech equipment. Volume 2, however, is less centered on any particular equipment and has a very valuable and useful text on the subject of laser therapy. Various indications for laser therapy are presented with the medical background, followed by the therapeutic approach. A great asset of the book is the amount of impressing clinical photos. Apart from a large clinical chapter, Dr Kahn also shares his strong opinions about subject such as “The moral of our society and medicine” and “A dissection of advertising in the laser industry”.
Reading the book give my new insight into the fascinating field of laser therapy and also some happy grins. If you don’t mind paying for a book centered on a particular company and its philosophy, you will find this book interesting and also enjoyable. Low Intensity Laser Therapy
Jan Tunér DDS
The recently published texts by Dr. Fred Kahn provide a broad overview of Low Intensity Laser Therapy (LILT). These works are distinguished by Dr. Kahn’s extensive knowledge of Laser Therapy, his comprehensive definitions of disease entities and the vivid, full-color illustrations. Moreover, the texts provide a broad, up-to-date overview of clinical applications of LILT for many different medical conditions.
This important and insightful work is a major step forward in the study and utilization of laser technology and I strongly recommend it to all those engaged in the field, including specialists and students. “
Dr. Shimon Rochkind
http:/waltza.co.za/images/
Specialist in Neurosurgery & Microsurgery
Director, Division of Peripheral Nerve Reconstruction
Tel Aviv Sourasky Medical Center
Tel Aviv University, Israel
Member, Peripheral Nerve Committee, WFNS
Senior Editor, Photomedicine & Laser Surgery
Laser Therapy – Clinical Practice and Scientific Background
Tunér, J. and Hode, L., (2002), pp 570 with 1400 Refs.
Prima Books AB, Grängesberg, Sweden
www.prima-books.com
ISBN: 91-631-1344-9
Price: Euro 110
This book is sold out but is available as a paperback called
‘The Laser Therapy Handbook’
Price: Euro 35
Reviewed by: Raymond J. Lanzafame, MD, MBA, FACS
Clinical Journal of Laser Medicine & Surgery
The body of knowledge regarding the properties and uses of laser devices continues to expand and improve our understanding of the mechanisms involved. Several recent developments have expanded and intensified interest in furthering clinical applications in dentistry, dermatology, wound healing and other disciplines. The recent FDA approval of a few low power devices for LLLT is beginning to intensify interest in the United States. Work in these areas has been ongoing elsewhere in the world for more than 30 years.
Tunér and Hode have provided the reader with an excellent text which presents current information on a diverse array of laser related topics with a sound description of laser physics, light profiling and dosimetry. This second edition volume is a major advance over the predecessor, published in 1999. The current offering has been upgraded to a full colour publication. It is printed on high quality paper with crisp graphics and a tabbed reference section. Each chapter follows a logical progression and presents the relevant research for each topical area and displays this information in a different coloured font. This later feature makes it quite simple for the reader to understand the scientific bases for the following discussion and to retrieve the relevant reference in the bibliography. The bibliography consists of more than 1400 references. Each reference is numbered as it is cited in the text and a separate alphabetic listing is also provided.
Crisp graphics and easily read descriptions make this book easily understood by both the novice and the expert. It is clear that Tunér and Hode have produced a classic which should be a “must have” for the personal and institutional library.
Lasers in Medicine and Dentistry
Part One: Basic Science, and Up-to-date Clinical Application of Low Energy-Laser Laser Therapy LLLT
Zlatko Simunovic, M.D., Editor and Coordinating Author
ISBN 953-6059-30-4. Published in Year 2000.
Reviewed by: Chukuka S. Enwemeka, Ph.D., FACSM
“Lasers in Medicine and Dentistry” is a gargantuan attempt to cover, in a single publication, the use of low energy lasers in medicine and dentistry. Even with more than forty authors contributing to this book, it remains an ambitious effort to encapsulate the field in one volume. The book features leading figures-researchers, clinicians, and educators-that have contributed immensely to the advancement of the field, warranting praises for the editor and coordinating author for successfully bringing together such eminent contributors. The thirty-seven chapters of the book cover a wide range of topics, history, biophysics, mechanisms of light tissue interactions, cellular and subcellular effects of lasers, and the effects of lasers in various clinical situations including, wound healing, pain, neurological conditions, sports injuries, etc., and the use of lasers in such disciplines as dermatology, rheumatology, pediatrics, geriatrics, dentistry, and obstetrics and gynecology to mention a few. The book contains several well-written chapters. The chapters on “Laser Physics” and “Biophysical Aspects of Low Level Laser Therapy” by Professors Mihail Pascu and Herbert Klima respectively, provide a valuable background that permits a better understanding of the nature of light, including the technological innovations required to produce various lasers, the characteristics of various lasers, laser dose determination, beam penetration and absorption in biological tissues, technological requirements for beam quality, the effects of light and electromagnetism on living things, and the influence of light on the dynamics of the NADH-oxidation subsystem.
These two chapters are nicely followed by those of Drs. Tiina Karu and Gerard Danhof, which cover many of the biological effects of lasers. Both authors detail the mechanism by which the photobiological effects ascribed to laser therapy are produced, including light absorption, mammalian photoacceptor chromophores, primary and secondary mechanisms of laser photobiology, bioenergetics of laser tissue interaction, and mechanisms involved in wound healing, laser analgesia, and laser enhanced haemodynamics. Further coverage of laser photobiology is presented in chapters seven and eight, contributed by Drs. Mario Trelles, Josefa Rigau and Mariano Velez and Drs. Philip van der Veen and Pierre Lievens respectively. They offer specific information on the effects of laser therapy on mast cells and the biological effects of lasers on lymphatic, muscular, and cartilaginous tissues. The long list of references at the end of chapter four should be of great value to readers and researchers seeking additional information on these topics. Furthermore, persons interested in the use of lasers for microdissection will find the chapter by Professor Karl Otto Greulich and Dr. Shamci Monajembashi of Germany quite valuable.
These chapters are followed by others that cover specific clinical conditions. Chapters 10 to 12 deal with wound healing, ulcers, and bedsores, while chapter 13 covers the effects of low energy lasers in preventing radiation-induced mucositis. Chapters 14 to 16 deal with pain, neurological diseases, and nerve injuries. Readers will find Chapter 16 of great benefit as it captures the emerging cuttingedge works on the effects of lasers on nerve regeneration. Other chapters cover the clinical specialties of sports medicine, rheumatology, dermatology, aesthetics, ENT, oral maxilofacial surgery, gynecology, and gastroenterology, as well as dentistry and acupuncture.
The sharp dichotomy in the lengths of the chapters-some long and detailed, and others extremely short and scant-could reflect the obvious differences in the levels of development of laser therapy in the fields that the book has attempted to cover. The diverse levels of writing, tone, presentation and grammar raise a concern that warrants the attention of the editor in a future edition of the book. The inclusion of the biographical sketches and photos of each author at the end of each chapter may be construed to be an unnecessary commercial ploy, as do the “Introductory Remarks” offered by several eminent personalities in the field. Similarly, putting the national flags of certain nations and the name, “European Medical Laser Association” (EMLA), on the front cover of the book leave a political tinge that raises questions concerning the role of EMLA in preparing and marketing the book. The name of the publisher is not easy to discern as the copyright is held by the coordinating author. Nonetheless, this book is a good first effort to cover a broad range of topics, which hitherto are scattered here and there in a wide range of books and journals. It is gratifying to learn that efforts are currently on-going to produce a new edition. Hopefully, it will be a great improvement over the present one.
Ten Lectures on Basic Science of Laser Phototherapy
Author: Tiina Karu
Laboratory of Laser Biology and Medicine, Institute on Laser and Informatic Technologies of Russian Acad. Sci.,
Troitsk, 142190 Moscow Region, Russian Federation
Published by Prima Books AB, Grangesberg, Sweden, 2007
In 1967, Dr. Endre´ Mester (Hungary) wondered if the new ruby lasers (red light at 694 nm) would cause cancer. He shaved off the hair of mice, and irradiated one group, and not the other. The irrradiated mice did not get cancer, but their hair grew back more quickly than did the hair of the unirradiated mice. He is credited with discovering laser biostimulation.
I met Dr. Mester at a laser conference in Florence, Italy, in 1979. He presented striking evidence of the healing of leg ulcers with low-intensity red laser light. There were no controls, but these patients had failed to respond to traditional medicine, and were cured with the Low Level Light Therapy. It was a striking example of the photostimulation of wound healing.
Since then, Low Level Light Therapy, whether using lasers or light emitting diode devices, has had a checkered history. Many people untrained in photobiology, or even science in general, started using lasers to treat everything, and claimed ”miracles” that were unsupported by the facts. This has had a bad effect on the field of Low Level Light Therapy, such that it has been largely ignored by the main stream of science and medicine (particularly in the United States), to the detriment of the welfare of patients who could benefit from this treatment, when performed appropriately.
Fortunately, a few highly qualified scientists have worked in this field to determine how Low Level Light Therapy works at the cellular and biochemical levels. The leading scientist in this area is Dr. Tiina Karu, and the author of this book.
In this book, Dr. Karu not only reviews her own wealth of research, but she also provides an extensive review of the literature on Low Level Light Therapy. Due to the lack of space, I cannot give credit for each result that I report, but they are in the book.
The book is divided into 10 lectures (titles abbreviated here):
- Introduction
- Brief History. Effect of Coherence and Pulsing. Is a Laser Necessary?
- Dependence of Biological Response on Radiation Dose, Intensity and Polarization
- Dependence of Biological Response on Wavelength and Monochromaticity
- Identification of the Photoreceptors
- Cellular Signaling Pathways
- How Does Cellular Signaling Work?
- Irradiation Effects are Detectable in the Cells of Subsequent Generations
- Other Examples of Cellular Activation via The Mitochondria
- Activation of Other Redox Chains, and CW (continuous wave) vs Pulsed Light
There is also a concluding section with remarks and pictures of Dr. Karu’s 25 years in the field of laser phototherapy.
In classical photobiology, the photoreceptors for such things as photosynthesis, phototropism, photomovement, photoperiodism and vision have been studied for many decades. However, little attention has been given to the study of the photoreceptor(s) for Low Level Light Therapy. However, Dr. Karu has identified cytochrome c oxidase in mitochondria as the receptor, and has performed numerous studies on this enzyme that catalyzes the final step in the mitochondrial respiratory chain (the transfer of electrons from cytochrome c to molecular oxygen), and the cascade of molecular events that follow the absorption of light, which lead to the observed biological effect.
Low Level Light Therapy has been found, e.g. to reverse the detrimental effects of certain toxic chemicals in the eye, stimulate the recovery of damaged peripheral nerves and spinal cord, stimulate the healing of oral mucositis that results from anticancer therapy, the healing of chronic ulcers in the legs of diabetic patients and the treatment of pain.
A number of phototherapy studies have also been performed at the cellular level, e.g. the stimulation by light of the adhesion of mammalian cells to glass (laboratory test system), improving the fertility of sperm, stimulating the proliferation of satellite (stem) cells, and stimulating DNA and RNA synthesis.
Using the cDNA microarray technique, when human fibroblasts were irradiated at 628 nm, 111 genes were up-regulated. Most of these genes were those that directly or indirectly play roles in the enhancement of cell proliferation, and the suppression of apoptosis.
The magnitude of the Low Level Light Therapy effect is dependent upon the initial redox status of the cells. The response is stronger when the redox potential of the target cells is in a more reduced state. The response to light is weak or absent when the overall redox potential of a cell is optimal or near-optimal for the particular growth conditions. These facts help explain why the results for Low Level Light Therapy may differ from experiment to experiment, and investigator to investigator, and why sometimes the results are negative (cells were in an optimal state).
Of course, there are other reasons for false-negative experiments, e.g. wrong wavelength, wrong dose, poor experimental design, etc.
Much of the book is devoted to experiments to determine the optimum use of light, e.g. pulsed vs continuous wave light, coherent vs noncoherent light, polarized vs nonpolarized light, monochromatic vs dichromatic light, single vs consecutive irradiation, dose and intensity effects, optimum techniques for irradiating cells, lasers vs conventional light sources, and of course, the effect of wavelength, by determining action spectra (the relative effectiveness of wavelengths between 600 and 850 nm).
Another large section of the book is devoted to identifying the photoreceptor(s) for Low Level Light Therapy, and studying the molecular basis for their action, determining the multiple functions of mitochondria (where cytochrome c oxidase resides), explaining cellular signaling pathways, and studying cell proliferation.
Some may find this book difficult to read, as some sections are written more like a scientific paper than a general lecture. Although the experts will appreciate all the formulas, the nonexperts will appreciate the summaries at the end of each chapter, which give the ”take home lesson.”
This reviewer hopes that this book will stimulate further scientific studies on Low Level Light Therapy, so that this therapy will be more widely accepted, and be used in a responsible manner.
Kendric C. Smith
Radiation Oncology (Radiation Biology)
Stanford University School of Medicine
Founding President, American Society for Photobiology
kendric∂stanford.edu
http://www.stanford.edu/~kendric/
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