Magazine w No.11 w www.inter-medic.net w www.podylas.com w
Laser and Light Solutions
Interview with Dr. Antonio Arroyo Coloproctology Unit of the Hospital of Elche
"I-PDT therapy is safe, secure and offers promising results in the healing of the fistulas�
I-PDT photodynamic laser therapy A solution for inflammatory diseases of the skin such as hidradenitis or basal cell carcinoma
SUMMARY
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Technical training for distributors of INTERmedic in Barcelona
I-PDT: hope in the treatment of fistulas, carcinomas and hidradenitis
Dr. Antonio Arroyo: "I-PDT therapy is safe, secure and offers promising results for anal fistulas"
Multidiode ™ 630 PDT: 630nm laser for precancerous and cancerous lesions of the skin
PUBLISHED BY INTERmedic Arfran SA Parque Tecnológico del Vallés Boters, 8-10 08290 Cerdanyola del Vallés Spain Tel: +34 902 25 45 45 marketing@inter-medic.net www.inter-medic.net www.podylas.com
LEGAL NOTICE
SCIENTIFIC COMITTEE
Dr. Mailin Franco Lissott Dr. Antonio J. Zalacain Vicuña Dr. Manuel Ángel Rodríguez Prieto Dr. Antonio Arroyo
PHOTOGRAPHS
INTERmedic archive Fotolia Dr. Manuel Ángel Rodríguez Prieto Dr. Antonio Arroyo
EDITORIAL INTERmedic
LAYOUT INTERmedic
INTERmedic is not responsible for opinions expressed or comments made by contributors or interviewees individually at any time and, under no circumstances, should they be considered to represent the opinion of the magazine. The opinion of the magazine is only reflected in the editorial section. The distribution or copying, by any means, of the contents of this publication is prohibited, unless expressly authorised by INTERmedic.
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NEWS
Technical Training to distributors, a key value in INTERmedic Provide support to the distributors in all areas. Following this premise, INTERmedic organized a week of technical training for distributors, in early June. The training was held in Barcelona with partners of INTERmedic from Canada, UK, Chile, Italy, Poland and Germany. The next technical training session for distributors will also be in Barcelona and is scheduled for November 2016.w
INTERmedic I-PDT in the XX National Meeting of the Spanish Association Coloproctology Photodynamic therapy I-PDT with INTERmedic using a 630nm PDT Multidiode™ 630 laser was one of the advanced technologies presented at the XX National Meeting of the Foundation of the Spanish Association of Coloproctology (RNAEC). The event, organized in late May in Elche by the General Hospital of the University of Alicante and the Hospital of Elche, brought together experts in gastroenterology and coloproctologic surgery in Spain. Dr. Antonio Arroyo, coordinator of the Coloproctology Department at Elche Hospital, gave a lecture on "photodynamic laser therapy with ALA in the treatment of complex fistulas" as part of the framework of the congress. In his presentation Dr. Arroyo showed for the first time the positive results recorded in patients treated with a single session of photodynamic laser therapy I-PDT, and announced the launch
of a multi-centre study in five hospitals, using this revolutionary technology for treating complex anal fistulas. w 3
PHOTODYNAMIC THERAPY WITH MULTIDIODE™ 630 PDT
I-PDT: a ray of hope for fistulas, hidradenitis and basal cell carcinomas The I-PDT photodynamic therapy with INTERmedic Multidiode™ 630 PDT laser offers a solution to people suffering from hidradenitis suppurativa and basal cell carcinoma, among other pathologies. The photodynamic laser therapy I-PDT is a minimally invasive laser solution that solves these pathologies in a few sessions, without surgery, without hospitalization and without sick leave. Effective, comfortable and with outstanding aesthetic results, this new treatment technique significantly improves the quality of life of patients and offers them hope for a cure, as evidenced by 4
INTERmedic Magazine
the excellent performance results seen so far in different clinical studies. In this article we look at what these three pathologies consist of, and what advantages treatment with I-PDT photodynamic laser therapy offers compared to the conventional approach with traditional treatment techniques, such as oral medication or surgery.
PHOTODYNAMIC THERAPY WITH MULTIDIODE™ 630 PDT
Basal cell carcinoma or basalioma What is it? It is a type of skin cancer most frequent among patients over the age of 50. It usually appears on the areas of the body most exposed to solar radiation (hands, face, neck and neckline). It can appear in the form of a nodule or ulcer, which can lead to bleeding. The diagnosis of basal cell carcinoma is confirmed by biopsy. Early detection and the slow growth of these types of tumours mean that in most cases they can be treated effectively. Who treats it? Dermatologist and plastic surgeon. BEFORE
Conventional approach. Depending on the size of the tumour and its location, its complete removal is performed by conventional surgery or Mohs surgery (removing the tumour layer by layer after verification). In small lesions, cryotherapy and topical immunomodulator drugs are used. I-PDT photodynamic laser therapy. Photodynamic therapy conveniently and effectively eliminates large, superficial and deep tumours, without resorting to surgery, leaving no scars. AFTER
Photos courtesy of Dr. Manuel Ángel Rodríguez Prieto. Dermatologist. Hospital of Leon (Leon, Spain) BEFORE
AFTER
Photos courtesy of Dr. Manuel Ángel Rodríguez Prieto. Dermatologist. Hospital of Leon (Leon, Spain) BEFORE
AFTER
Photos courtesy of Dr. Manuel Ángel Rodríguez Prieto. Dermatologist. Hospital of León (Leon, Spain) 5
PHOTODYNAMIC THERAPY WITH 630NM LASER
Hidradenitis suppurativa What is it? It is a chronic, inflammatory autoimmune disease characterized by the appearance of nodules, boils and fistulas in the apocrine glands in the armpits, groin, buttocks and genital area. It affects nearly half a million people in Spain, but most of the population does not know about. Hidradenitis suppurativa is difficult to diagnose, treat and, as of yet, there is no definitive solution. Who treats it? The dermatologist. Conventional approach. medication (retinoids, BEFORE
It includes antibiotics
oral and
immunosuppressants with unwanted side effects), corticosteroid injections and biological therapy, with slow and costly results. I-PDT photodynamic laser therapy. It is a minimally invasive therapy, which is fast, convenient and affordable for both doctor and patient. It involves injecting a photosensitizer in the area of the lesion and irradiating it with a 630nm laser from the inside. Studies performed in the Hospital of León find that there is a clear improvement in hidradenitis suppurativa in patients treated with a single session of I-PDT. AFTER
Photos courtesy of Dr. Manuel Ángel Rodríguez Prieto. Dermatologist. Hospital of Leon (Leon, Spain)
Anal/colorectal fistulas What is it? Anal or colorectal fistula is a channelshaped lesion in the anal area that contacts the skin, vagina or bladder. It is caused by injury, infection or inflammation, symptoms are severe pain, itching, burning, bleeding and discharge of stool. Sometimes an abscess can appear. Who treats it? The General Surgeon and the Proctologist. Conventional
The
approach.
BEFORE
traditional
treatment involves surgery, and the risks inherent to any surgical procedure (anaesthesia, infection), as well as the possibility of the occurrence of side effects such as stool incontinence. I-PDT photodynamic laser therapy. The purpose of photodynamic laser therapy for anal fistula is to encourage the healing process of that channel, removing the epithelial tissue and facilitating its closure. It induces selective necrosis without damaging adjacent tissues. AFTER
Photos courtesy of Dr. Manuel Ángel Rodríguez Prieto. Dermatologist. Hospital of Leon (Leon, Spain) 6
INTERmedic Magazine
INTERVIEW
Dr. Antonio Arroyo Sebastián Specialist in Surgery and Gastroenterology. (Elche, Spain)
"I-PDT therapy is safe, secure, reproducible and has encouraging results in the healing of the fistulas” Dr. Arroyo, an expert in the use of intralesional photodynamic therapy, I-PDT, in anal fistulas, explains his experience with this technique at the University Hospital of Elche (Spain). What is a complex fistula and where does the complexity lie in the treatment of this pathology? Anal fistula is a connection inside the anus with the outer skin. The aetiology of anal fistulas is not definitively clarified but it is assumed to occur as a result of an infection of the anal glands, due to its high prevalence. These formations are located in the anal canal at the level of the pectinate line. Its inner orifice is at the level of the crypts of Morgagni. According to this hypothesis, the infection of these glands by enteric bacteria results in the formation of an abscess that can spread through the different areas of the anal canal, appearing when they are drained or
DR ANTONIO ARROYO SEBASTIÁN Specialist in Surgery and Gastroenterology. General University Hospital of Elche (Spain)
Doctor of Medicine, Dr. Antonio Arroyo is responsible for the Coloproctology Unit at the General University Hospital of Elche. This unit, integrated into the service of Surgery and specializing in the treatment of diseases of the colon, rectum and anus, is an international benchmark in clinical practice and research. Currently, Dr. Arroyo is leading a multi-centre study on treatment of anal fistulas with photodynamic laser therapy I-PDT. 7
INTERVIEW
when opened spontaneously to the external orifice of fistulas. The problem is that these fistulas traverse the anal muscles that we use for fecal continence and any intervention thereon may be problematic. What impact is there on the population? The incidence rate of anal fistula is about 10/100,000. That is, it affects 10 out of every 100,000 people. What is life like for people with this disease? They have a very poor quality of life, with pus spots and faeces stains appearing daily on their underwear. What is the conventional treatment for fistulas? The classic surgical techniques - fistulectomy, with or without flaps, fistulectomy-sphincteroplasty and looping, employed as a means of drainage or cutting, "condemn" the patient to overall fecal incontinence rates of between 10% and 20%, with recurrence rates ranging from 20% to 40%. And what is photodynamic laser therapy? Photodynamic therapy (PT) is a therapeutic modality based on the photo-oxidation of biological materials induced by a photosensitizer, selectively localized in certain inflammatory cells or tumour tissues, so that when illuminated with a light of an appropriate wavelength of sufficient dose, such cells are destroyed. What benefits does photodynamic laser therapy I-PDT offer in the treatment of fistulas? This therapy produces a selective destruction of inflammatory fistulous tissue and causes a cure without damage to the surrounding tissues, thus
“Photodynamic laser
therapy is harmless, safe, reproducible and offers encouraging results in the healing of the fistulas.“
preventing fecal incontinence which occurs with surgery. What are the benefits to the patient from laser photodynamic therapy? This therapy is harmless, safe, reproducible and offers encouraging results in the treatment of this pathology. How is treatment with I-PDT performed? Under spinal anesthesia, the fistulous tract is located and injected with the 5-ALA photosensitizer. Subsequently a 630 nm red laser light will be applied through a 1mm thick optical fibre (with an Multidiode™ 630 PDT, by INTERmedic Spain). What effect does the laser have on the tissue? The laser induces the destruction of the fistulous tissue, while preserving the healthy tissue. The Elche Hospital is one of the first in which this technology is being used for fistulas, in a clinical trial. What results have been obtained so far? The preliminary experience of a pilot project conducted in the Coloproctology Unit at the General University Hospital of Elche using this technique in 20 consecutive patients with complex anal fistula showed a cure rate of 80%, with a rate of incontinence of 0%. How many sessions of I-PDT treatment are necessary to solve this condition? So far there is only evidence of one single treatment session. Are we talking about improvement or healing? We're talking about healing.
The photodynamic laser therapy with INTERmedic using a Multidiode™ 630 PDT laser allows anal and colorectal fistulas to be treated simply and effectively, by the using a special optical fibre that delivers energy to the interior of the lesion 8
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And in terms of cost, is this an affordable therapy, both for doctors and for patients? A safe, secure therapy that cures 80% of fistulas without the complications of traditional surgery, I-PDT therapy is priceless.w
Multidiode™ 630 PDT: the intralesional laser revolution for photodynamic INTERmedic offers a minimally invasive solution to treat hidradenitis suppurativa and basal cell carcinomas through global innovation
The new concept of intralesional photodynamic therapy I-PDT for the treatment of skin lesions is a world first developed thanks to the research of INTERmedic in the field of laser technology and in different multi-centre studies.
630nm laser and photosensitizer In its commitment to constant innovation in health technologies, INTERmedic has developed the new Multidiode™ 630 PDT system for photodynamic therapy. This 630 nm laser is indicated in the minimally invasive treatment of pathologies such as basal cell carcinoma or hidradenitis suppurativa, until now very difficult or impossible to cure.
Effective in precancerous and cancerous skin lesions Basal cell carcinoma Hidradenitis suppurativa Fistulas Basaliomas Actinic keratosis Bowen's disease Paget’s disease Leukoplakia Viral warts 9
Photodynamic therapy with Multidiode™ 630 PDT is a comfortable procedure for both doctor and patient, working through the combined application of a photosensitive drug and a laser light source that activates this substance in the exact location of the lesion. The objective of the treatment is to selectively destroy the diseased cells without damaging the rest of the tissue. This innovative laser therapy has shown good results in the treatment of pre-cancerous and cancerous benign skin lesions, such as the basal cell carcinoma. In addition, it can be applied in other medical specialties for small cell carcinoma, lung cancer and as a palliative in Barrett's esophagus.
Non-invasive therapy with plenty of advantages This treatment method offers multiple benefits to both the doctor and the patient because
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the procedures are minimally invasive, and are made easy and do not require hospitalization. As this is an outpatient procedure, treatment costs are reduced dramatically. Multidiode™ 630 PDT, in combination with the photosensitizer, selectively destroys diseased cells without altering the adjacent tissues. The therapy is safe, effective and fast, with no side effects and allows the patient to immediately continue with their daily activities without going through a period of incapacitation.
For percutaneous and intralesional use Photodynamic therapy I-PDT is indicated both for its percutaneous application - through a head of topical treatment and for its intralesional use. The equipment uses different types of optical fibres that allow the laser to be administered with precision. The result is precise control in the administration of the energy, with maximum
effectiveness and light penetration into the tissue to ensure optimal treatment.
Good results and new applications The results obtained with this technique by Dr. Rodriguez Prieto, a dermatologist at the Hospital of León, are very satisfactory and promising in the treatment of conditions such as basal cell carcinoma, 70 patients treated with a high rate of healing, and hidradenitis suppurativa, of which 40 patients were successfully treated. Intralesional photodynamic laser therapy with Multidiode™ 630 PDT has demonstrated a high rate of effectiveness in both small and superficial skin tumours, as well as with thicker lesions located deeper in the tissue. In addition to the excellent results with basal cell carcinoma, I-PDT therapy is also demonstrating its effectiveness in the treatment of hidradenitis suppurativa, keloids and fistulas.w
Patient with a keloid on the left ear, during a session of photodynamic Multidiode™ PDT 630 laser therapy
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