[Publishers’ note: In this final issue of Volume 9, it gives the Publishers great pleasure and honour to welcome Dr Semion Rochkind, the current WALT President, and his colleagues with their very important and exciting Guest Editorial on the use of laser therapy to enhance the effects of composite allogenic implants on the repair and regeneration of totally transected spinal cords in the rat model.
Spinal injuries are increasing, particularly in the field of sports medicine, where the increased participation in fast contact sports such as American football and rugby football naturally leads to a rise in the number of injuries. Both of these sports involve fairly aggressive tackling of fast-moving players, causing extremely rapid deceleration resulting in severe torsion or other stresses to the spinal column of the tackled player. This can very easily lead to spinal injury, particularly in the cervical and lumbar spine. Other fields where spinal avulsion or crush injuries are happening more often include horse riding and racing, and motor sports. Traffic accidents account for yet another patient population, and given the steady increase in the number of cars on the roads of all industrialized and developing nations, a concomitant rise in spinal injuries is to be expected. Conventional treatment for these severe and in many cases totally incapacitating injuries usually concentrate on immobilization, accompanied by physical therapy for the affected limbs and body areas to try and prevent total atrophy. The results are not exceptional.
Dr Rochkind, a neurosurgeon, has been an active proponent of low incident levels of laser energy in the repair of damaged neuronal tissues for more than ten years, and his results have conclusively shown that laser therapy assists in the repair of damaged nerve cells in both the peripheral and more recently the central nervous systems. This Editorial must surely provide some real hope for both victims of spinal accidents, and their physicians. Despite its clearly argued conclusion, this Editorial is probably going to add to the controversy which surrounds laser therapy and photobioactivation, but controversy is a vehicle for advancement, always provided the antagonists and sceptics are prepared to accept such studies as Dr Rochkind's earlier works and the present Editorial. Some will continue to ignore them or dismiss them without even trying to read and understand. We hope these so-called ‘dispassionate critics’ will very quickly drag their heads up from the sand, and finally become aware that laser therapy offers tremendous hope for many classes of patient, including those suffering from severely incapacitating spinal injuries.]

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The purpose of this study was to investigate the effects of low level laser therapy (LLLT: GaAlAs diode laser: 830 nm) on serum opsonic activity, which was assessed by neutrophil-associated chemiluminescence (CL) responses to zymosan opsonized with sera irradiated in vitro with various doses of LLL. We used both lucigenin-dependent CL (LgCL) for superoxide (O₂^-) detection and luminol-dependent CL (LmCL) which detects myeloperoxidase (MPO)-dependent formation of hypochlorous acid in combination with an MPO inhibitor, sodium azide (NaN₃). When serum opsonic activity was assessed by LgLC, NaN₃ markedly enhanced the responses, suggesting that O₂^- accumulates due to the MPO blockade, leading to the excitation of LgCL. However, LLL-irradiation had no effects on serum opsonic activity. On the other hand, when serum opsonic activity was assessed by LmCL, NaN₃ strongly inhibited the response. The effects of LLLT at different output powers were characterized by similar values, but significantly higher values were observed at the highest dose tested (60 mW for 1 min) in the absence of NaN₃. Since this enhancement effect disappeared in the presence of NaN₃, it was suggested that high dose LLL-irradiation probably activates opsonic activity by facilitating the degranulation of MPO from neutrophils. However, lower doses similar to those used for therapeutic purposes had no effects at any output powers tested.

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The potential therapeutic effect of 780 nm low power diode laser irradiation (LPDLI) was evaluated in vivo on wound healing, and in vitro on proliferation of cultured normal human fibroblasts (NHF) and keratinocytes (NHK). In five patients suffering from cutaneous fissures (F patients) one fissure in each patient was irradiated along the length of the fissure every 2 or 3 days, using 780 nm LPDLI, 30 mW, 30 sec per point. Fissures located on the opposite side of the body served as controls. In vitro, NHF and NHK were irradiated with this diode laser, via a fibreoptic light guide (25 mW) for 0-20 sec. Complete closure occurred in 80% of irradiated fissures, and in 60% of controls. Initial healing (25% closure) occurred earlier, at 2.2±1.1 days in irradiated fissures vs. 3.5±0.9 days (p < 0.06) in the nonirradiated fissures, but the timing of complete healing did not differ significantly between the two groups. In vitro, a single laser exposure to NHK (2-7 sec) and NHF (9-10 sec) increased proliferation parameters compared with sham-irradiated controls: ³H-Thymidine incorporation at 6-24 hours by 2.29±0.31 (p.001); the percentage of dividing cells at 24 hours by 1.55±0.11 (p < 0.05); and cell numbers at 48 hrs by 1.45±0.07 (p < 0.01). These results suggest that 780 nm LPDLI irradiation promotes wound healing, presumably by enhancing proliferation of fibroblasts and keratinocytes.

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Studies on low intensity 904 nm laser therapy in the treatment of musculoskeletal disorders show conflicting results. Yet, on the basis of a systematic review we concluded that 904 nm laser therapy for musculoskeletal disorders seems to be promising, when compared to placebo laser therapy. Quick pain relief and fast functional recovery are reported to be the most prominent claims of laser therapy. This paper presents a rationale of choices regarding the patients and type of treatment when designing a randomized, double blind, clinical trial on 904 nm laser therapy, as well as safeguards concerning optimum dose, constancy of dose and double blinding the actual laser therapy.

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The present study reports on 25 patients with multiple drug resistant chronic pulmonary tuberculosis (MDR-PTB), comprising of 13 males and 12 females. Intravenous (IV) helium neon (HeNe) and/or nitrogen (N₂) laser therapy was administered together with intracavitary (IC) N₂ laser therapy. Ten sittings of IV laser therapy were given on alternate days or weekly according to the protocol and N₂ laser IC irradiation was administered weekly for a period of 3 months, and monthly thereafter for another three months. Patients were followed up for 3 to 6 months post-therapy. All the patients included in the study were hospitalized during the therapy and continued to receive chemotherapy concomitantly with the LLLT. Of the 25 patients included in this study, five were lost to follow up. Clinical and bacteriological improvement was seen in 14 (70%) and 15 (75%) of the patients, respectively, while haematological and radiological improvement was observed in 14 (70%) and 17 (85%) of the patients, respectively. No major side effects were noted. Two patients developed pneumothorax and three had haemoptysis after the procedure, which did not pose a problem. There was no mortality. It can therefore be concluded from this preliminary clinical trial that intravenous and intracavitary laser therapy acts as a useful adjuvant to chemotherapy in the treatment of MDR-PTB, and that there is a strong possibility that LLLT on its own may well be very usefu1 in the therapy of new, untreated cases of PTB.

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