We describe our experience and the problems we encountered organizing an autonomous surgical unit in which the equipment and organization enable three lasers to be used in may different applications in medicine and surgery. The three lasers--CO2, Nd:YAG, and argon--may now be used by all the departments concerned within our teaching hospital. As our unit goes into operation, we have determined that we must now begin an evaluation 1) To assess the clinical value of laser usage via the careful selection of cases for laser treatment, the storage of data for future reference on card and computer records, and the assessment of the vital role of the laser within a range of modern therapeutic aids; 2) to achieve technical improvements, by the optimum use of laser sources and related optical equipment; and 3) to assess the economics of the unit, the profitability of bringing together the three types of laser, and the total cost involved.
The technique of argon laser treatment of port wine hemangiomas has been greatly improved since first used in the medical field. Complications may however occur and the authors report in this paper their experience and special studies performed on hyperpigmentation. This complication is due to an increase in melanic normal production as it has been proved by optical and electron microscope studies on pigmented skin biopsies.
Using carbon dioxide laser, the authors proved the existence of a new type of wart, localized under the heel. Its considerable extension between the dermis and epidermis, far from the visible excrescence, may explain the absence of positive response to classical treatment in some cases.
In order to set up a disinfection protocol, the tip of the optical fibre of an Nd-YAP laser, λ=1.34 μm, was contaminated in vitro with: Mycobacterium smegmatis (CIP 7326), Candida albicans (ATCC 2091), Bacillus stearothermophilus (ATCC 7953) or Streptococcus sanguis (ATCC 10556). It was then treated with various biocidal solutions, Septinol(®) V, glutaraldehyde 2%, ethanol 95° and NaOCl 6%, using one of two protocols: 10 s of contact, or 5 s of contact followed by 5 s of wiping. The latter technique proved to be the most effective. Whatever the biocidal solution used, all the bacteria adhering to the fibre were eliminated. The protocol was checked in vivo in the canals of 10 teeth presenting root canal infections. No bacteria withstood the treatment with Septinol(®) V. This treatment does not alter the qualities and performance of the fibre as far as light transmission is concerned.
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