The simple, inexpensive and effective multiparametric physical method for diagnosing oncological diseases based on Rayleigh light scattering is proposed. Dynamic and static parameters of plasma blood proteins in dilute water solutions with different pH and ionic strength were studied simultaneously for the first time.

The accumulation of administrated fluorescein in some breast diseases was investigated. The fluorescein concentration in about 200 macropreparations of resected mammas was measured with ratio fluorometer. The accumulation of dye in breast cancers is significantly different from that in benign diseases when determined in more than 10 hours after the dye administration. The critical value 1.75 of fluorescein accumulation factor sets the false positive error as well as false negative error to be equal to 6.6% for the fluorescent method of diagnostics. These data may be used both in express intra-surgical fluorescent diagnostics and in NMR imaging with chemically modified fluorescein.

The complex for tumor diagnostics and therapy on the basis of spatial-temporary light modulators (STLM) conjugated with laser, gastroscopy, videocamera on the base of CCD- matrix and computer is assembled. The choice of modulator operating mode permits us to achieve many effects, in particular, to make a contour radiating area, to provide a more intensive effect on the border of the center of pathology and to redistribute the emission intensity on the surface of pathologic tissue. The work of STLM and dependencies its characteristics from different parameters in full is described.

The laser fluorescent methods are very promising for photosensitizer distribution control in diagnostics and photodynamic therapy of tumors in intracavital organs. We have developed the laser fluorescent imaging system employing high sensitive CCD-camera. The system is adjusted to the standard endoscope (Olympus), cystoscope and can be also used for surface tumor observations. The high sensitivity of the system makes it possible to evaluate the photosensitizer distribution, its dynamic during PDT treatment and control the irradiation process observing tissues in fluorescent light during endoscopic investigations of stomach and lungs. The ways of improving of fluorescent imaging systems are discussed including the choosing of suitable laser source for fluorescent excitation and special filters for enhancing fluorescent contrast.

In this paper the results of fluorescence diagnostics and photodynamic therapy of early stage malignancies of lung (17 patients) and esophagus (8 patients) are presented. 13 patients had multiple primary tumors. As photosensitizers the new drugs Photoheme and Photosense were used. Complete remission was obtained in 92%. The patients are followed up without relapses to 2,5 years.

The investigations carried out in our group on biological systems of various organization level (enzyme molecules in solution, human and animal cell cultures), allowed us to conclude, that the light-induced changes of spatial structure of cells components form the basis of biological activity (and as a consequence therapeutic effect) of various wavelength low-intensity laser emission. Photophysical mechanism of these changes lies in the reorientation of highregulated anisotropic parts (domains) with the liquid-crystalline type of ordering of the cell components due to the interaction between the electric field and the light induced integral electric dipole of the domain. The mechanism of such reorientation is well established in physics of liquid crystals of nematic type and is known as light induced analogue of Frederix's effect. The following results enable us to draw the conclusion about the determining role of the orientations effects on the biological activity mechanism of low-intensity laser radiation: (1) the possibility of reversible modification of spatial structure and enzyme molecules functional activity under the influence of laser radiation outside the band of their own or admixture absorption; (2) the dependence of biological effect of laser radiation on the functional activity of cells vs. polarization degree of the light with the maximum photobiological effects observed for linear-polarized radiation; (3) the equivalence of a static magnetic field and low-intensity laser radiation in action on functional activity of the cells and the lowering of the laser field intensity for the achieving the definite changes of the cell functional activity in the presence of static magnetic field.

The mechanism of treatment effect of low-energy He-Ne laser irradiation in patients with precancerous changes of gastric mucosa has been studied. There has been found that the treatment effect of low-energy laser irradiation depends on the initial level as well as on the change in the levels of hormonal, immune systems, processes of peroxide oxidation of lipoids and antioxidant activity. The positive clinico-morphological effect in 65.1% of patients with precancerous changes of gastric mucosa associates with the influence of intravascular laser irradiation on the nonspecific mechanisms of adaptation and the factors of immunologic defence.

Laser therapy methods are used in clinics throughout the world. It is shown that flash-lamp pumped dye lasers are effective when treating for a number of diseases including combined tumor therapy. On the other hand, light sources were used in medicine too, and there are yet no conclusive results as to the beneficial effects of these methods. We have shown that one can treat by applying the sources on the bases of either a dye laser or a powerful pulse lamp.

The results of laser therapy present in 374 patients with erosive-ulcerous and inflammatory damages of respiratory organs and of gastro-intestinal tract after oncological operations. Two types of laser namely endoscopic laser on the basis of He-Ne and Cu laser were used as sources of radiation. It was shown high therapeutic effectiveness of laser therapy. This method may be recommended for the above-mentioned category of the patients.

Laser therapy with semiconductor laser (wavelength 890 nm) was performed in 41 patients with II^a - III^ast. breast cancer. LLLT was used before surgery and in postoperative period during 2 years. LLLT decreased postoperative complications by 15.3% and decreased duration of lymphorrhea. 5 years survival in patients with II^ast. breast cancer treated by LLLT was 100%, in control group--85.71%. In patients with III^ast. breast cancer treated by LLLT survival was 94.44%, in control group--78.94%. 91.3% of patients with II^ast. treated by LLLT had not recurrences in 5 year period, in the controls they were in about 77.7%. 82.35% of patients with III^ast. treated by laser therapy had no recurrences in 5 year period, in control group--60%.

The clinical materials of observation of 1574 women are presented. High diagnostic accuracy of cytolitic screening in diagnostics of pathologic state uterine cervix caused by virus infection. High efficiency of treatment of the patients with cervix intraepithalial neoplasia and flat condylomas cervix by methods by cryo- and laser treatment is shown.

The application of the laser therapy and phototherapy with utilization of High Intensive Impulse Laser Therapeutic Unit and High Intensive Impulse Light Therapeutic Unit has created new side prospects in treatment of side-effects and complications when treating oncological diseases and a great number of non-tumoral diseases of adults as well as children. The application of the laser therapy and phototherapy in complex treatment of children's oncological diseases has shown that this method has a significant antiinflammatory and anaesthetic effect as well as powerful regenerative influence on tissues. Its application decreases considerably the duration of treatment of complications when treating children's malignant tumors and enables to keep to scheduled terms of complex treatment.

The copper-vapor laser radiation simulates the regeneration processes in the wound and inhibits the tumor growth and metastatic spreading. It gives us the basis to application this laser in oncological practice. The result of the experiments have shown that laser radiation with different wavelength is considered to be a highly active factor producing a significant effect on the antitumoral resistance of the organism. The character of this action, its sign and grade depend on the specific radiator textures as well as upon the effect place to the organism of the tumor carrier and the state of the organism.

The purpose of this review is the brief description of the laser surgical systems market in Russia and their characteristics.

Powerful infra-red laser radiation may induce necrosis of a malignant tumor located in a human bone without destructing skin cover. A superficial irradiation of the osteogenic sarcoma with an Nd-YAG laser (pulse power no less than 10 MW, average power 100 - 300 mW, time of exposure 10 - 90 min) has resulted in a severe damage of the tumor (more than 90% of the tumor mass) in 57% of cases. A combined laser/gamma irradiation showed a severe damage in 83% of cases. The results obtained suggest that laser radiation with the above parameters combined with gamma radiation may be used in treatment of osteogenic sarcoma.

The result of treatment of 566 patients with precancerous diseases, cancer and benign tumors of respiratory and gastro-intestinal tract are presented. The `Raduga-1' as a source of laser radiation has been used. The wavelength of radiation 1060 nm. The maximum of basic radiation at the end of lightguide is 50 W. It is shown that the method of endoscopic laser destruction is a highly effective one and may be recommended for radical treatment.

The existing methods of laser destruction of biotissues, widely spread in surgery and coagulation action, are based on local heat emission in the tissues after light absorption. Here we present the results of the simulation of tissues heat destruction, taking into account the influence of blood and lymph circulation on the processes of heat transfer. The problem is adapted to the case of liver tissue with tumor. A liver is considered as a capillary-porous body with internal blood circulation. Heatconductivity and tissue-blood heat transfer are considered. Heat action is assumed to be implemented with contact laser scalpel. The mathematical model consists of two inhomogeneous nonlinear equations of heatconductivity with spherical symmetry. Nonstationary temperature fields of tissue and blood are determined and the main parameters are: (1) coefficients of heatconductivity and capacitance of blood and tissue, (2) blood and tissue density, (3) total metabolic energy, (4) volume coefficient accounting for heat-exchange between tissue and blood, and (5) blood circulation velocity. The power of laser radiation was taken into account in boundary conditions set for the center of coagulated tissue volume. We also took into account the process connected with changing of substance phase (vaporization). The original computer programs allow one to solve the problem varying in a wide range of the main parameters. Reasonable agreement was found between the calculation results and the experimental data for operations on microsamples and on test animals. It was demonstrated, in particular, that liver tissue coagulation regime is achieved at 10 W laser power during 25 s. The coagulation radius of 0.7 cm with the given tumor radius of 0.5 cm corresponds to the real clinical situation in case of metastasis liver affection.

Laser equipment may inflict serious losses to human health if safety norms established by relevant standards and other documentation are not properly observed. It is explained by physical properties of laser emission (LE) which differs from general light sources by quantitative behavior of such parameters as the degrees of coherence, monochromaticity, brightness, polarization. Thus, biological effects due to laser emission, as a rule, are more expressed comparing with other types of emission from other spontaneous light sources. LE effects biological tissues through the density of energy flow and impulse duration. It is common knowledge nowadays that LE biological action is assessed by two criteria: physical parameters and absorptive properties of tissues exposed to rays. LE causes the greatest danger to the eyes due to their specific structure. The next target organ vulnerable to LE is skin. Pathological changes of skin depend on the LE power, time of exposure, wave length, and the extent of skin pigmentation. Along with different kinds of damage directly in the tissues exposed to rays, LE may cause changes in organs and body systems subject to indirect exposure. It is important that these changes may develop due to low intensity levels of LE that do not cause local damage. National and international standards on LE safety are based on maximum allowable levels (MAL) of exposure. It has been generally accepted that the main MAL criterion is LE threshold minimal exposure which causes damage to retina, eyes, and skin. As distinct from foreign safety standards, hygienic norms and regulations are in force in the Russian Federation where additional co-efficients along with standard generally accepted MAL values have been introduced for the persons who are subject to occupational regular exposure to lasers. This approach has been chosen after the results of follow-up and health studies of these occupational contingents have been analyzed, and experiments on laboratory animals assessed.

New sensitizers for photodynamic therapy were synthesized on the base of biologically generated chlorins and bacteriochlorins. Derivatives of chlorophyll a and bacteriochlorophyll were prepared from the biomass of blue-green algae Spirulina Platensis and purple bacteria Rhodobacter Capsulatus, generated using specially designed photobioreactor. The strategy for chemical transformation of natural chlorophylls and bacteriochlorophyll has been discussed. Purpurin 18 and its dihydroanalogue bacteriopurpurin were chosen as the key intermediates. Modifications of peripheral substituents, such as introducing the new functional groups, hydrogenation of the B-pyrrolic ring, and insertion of amino acid residues gave the series of novel sensitizers, including water soluble chlorin p₆ analogues, and derivatives with graded amphiphility for the studies of tumor accumulation in the malignant tissues.

The photodynamic therapy is highly promising for its dual specificity, namely, for the site of accumulation of the phototoxic substance and for the site of action of laser. A drawback of the PDT technique is a low selectivity of the photosensitizers accumulation in tumor tissue. Therapeutic doses of photosensitizers are fairly high, that leads to unfavorable effects (toxicoses, lesions of normal skin, prolonged rehabilitation). This drawback can be overcome is photoimmunotoxins are used, i.e. conjugates of photosensitizers with antibodies to specific tumor markers. We tried to introduce a simple model for estimation of singlet oxygen effect on cells for the case of free photosensitizers, presented in outside solution, and in case of conjugated dye, bound by cell surface receptors. To achieve the same effect the required concentration of conjugated photosensitizer can be significantly decreased (50 to 100 fold) as compared with free dye. Methods for porphyrins and different phthalocyanines and naphthalocyanines conjugation with protein were developed. The use of bacteriophage T4 as a model for studying the action of photoimmunotoxines on virus, unambiguously demonstrated the applicability of this approach for targeted destruction of viral particles.

The kinetics of photosensitizer distribution and elimination have been studied using fluorescent methods in organs and tumors of A/Snell mice with embriocarcinoma inoculated into their thigh muscles for the porphyrin compound 2,4-di((alpha) -methoxyethyl)deuteroporphyrin-- IX (DMH, `Dimehin') and its complex with polysaccharide chitosan. DMH fluorescence differs in samples of liver and faeces which follows from the spectra comparison. DMH is metabolizable upon passing through liver into a form eliminated by the gastrointestinal tract as our pharmacokinetic data have shown. DMH has been found to be a short-term highly photodynamically efficient photosensitizer judging by combined analysis of our toxicological, pharmacokinetic and photodynamic research data. DMH-chitosan uptake and distribution studies have shown the complex's long-term persistence in blood circulation, high level accumulation in spleen and lungs, whereas there was no complex registered in tumors and other tissues following i.v. administration.

The analysis of the results of photodynamic therapy (PDT) for treating malignant neoplasms of the skin, mammary glands, tongue, oral mucous, lower lip, larynx, lungs, urinary bladder rectum and other locations has been made. During 1992 - 1995 478 tumoral foci in 125 patients have been treated with PDT. All patients were previously treated with conventional techniques without effect or they were not treated due to contraindications either because of severe accompanying diseases or because of old age. A part of the patients had PDT because of recurrences or intradermal metastases in 1 - 2 years after surgical, radial or combined treatment. Two home-made preparations were used as photosensitizers: Photohem (hematoporphyrine derivative) and Photosense (aluminum sulfonated phthalocyanine). Light sources were: the argon pumped dye laser (`Innova-200', `Coherent') and home-made laser devices: copper-vapor laser-pumped dye laser (`Yakhroma-2', Frjazino), gas-discharge unit `Ksenon' (wavelength 630 nm), gold-vapor laser (wavelength 627.8 nm) for Photohem; while for Photosense sessions we used solid-state laser on ittrium aluminate `Poljus-1' (wavelength 670 nm). Up to now we have follow-up control data within 2 months and 3 years. Positive effect of PDT was seen in 92% of patients including complete regression of tumors in 66.4% and partial in 25.6%. Currently, this new perspective technique of treating malignant neoplasms is successfully being used in Russia; new photosensitizers and light sources for PDT and fluorescent tumor diagnostics are being developed as well.

Compact sealed-off gold vapor laser (GVL) with 2 W average power and 628 nm wavelength was used for endoscopic photodynamic therapy in 20 patients with different tumors in respiratory system and upper gastrointestinal tract. Russian-made hematoporphyrin derivative (Hpd) `Photohem' was used as a photosensitizer. It was given intravenously at a dose of 2 - 2.5 mg/kg body weight 48 hours prior to tumor illumination with 628 nm light from GVL. Intermittent irradiation with GVL was done through flexible endoscope always under local anaesthesia at a power of 200 - 400 mW/sm² and a dose of 150 - 400 J/sm². 80% patients showed complete or partial response depending on stage of tumor. In cases of early gastric cancer all patients had complete remission with repeated negative biopsies. No major complication occurred.

Photodynamic therapy (PDT) using quantoscope (scanning electron-beam pumped semiconductor laser, (lambda) equals 670 +/- 2 nm, P equals 10 W) and Phthalocyanine Al as photosensitizer (PS) have been provided in nine patients (27 tumor sites) with spread skin malignancies (basal cell, squamous cell cancer, melanoma, metastases of breast cancer) and cancer of lip T1 - T2 N0 M0. During PDT power density has been from 200 to 450 mW/cm², light doses ranging from 150 to 700 J/cm². We have fulfilled diagnostic of tumor after injection of PS and have controlled treatment using Spectral-Fluorescent Video Complex. In five patients (23 sites) we had complete clinical response and in four patients (4 sites) partial response after PDT. Results of our study show that using of scanning electron- beam pumped semiconductor laser is perspective in treating of spread skin malignancies.

Vascular effect of PDT has been studied in patients with corneal vascularized leucomas (10 patients) and in patients with corneal neovascularized transplant (3 patients). For vascularized leucomas the method of photodynamic therapy consisted of the local injection of dimegin (deiteroporphyrin derivative) into the space of the newly-formed vessels under operating microscope (opton) with the microneedle (diameter 200 microns) and corneal irradiation by the operating microscope light. For corneal neovascularized transplant the injection of photogem (hematoporphyrin derivative) intravenously were made with subsequent irradiation by light of dye laser (5 hours after the injection) with light density of 150 mW/cm² for 15 minutes. In all the cases at the time of irradiation the aggregated blood flow was appeared, followed by blood flow stasis. In postoperative period the vessels disintegrated into separate fragments which disappeared completely after 10 - 15 days. Taking into account the data of light microscopy, the disappearance of the vessels took place as a result of the vascular endothelium lisis along the vascular walls. Neovascularized cornea and newly-formed vessels in tumor stroms have much in common. The vessel alterations study presented in this paper, may serve to specify the mechanism of photodynamic destruction of neovascularized stroma of tumor.

Some results of the copper and gold vapor lasers and of helium-cadmium lasers used in medical practice are presented. The most in medical use copper vapor laser is commonly applied for low-intensity laser therapy and endoscopic surgery. A universal capability of dye lasers oscillating in 600 - 670 red region for excitation of the preparates used in photodynamic therapy is demonstrated. The copper vapor lasers are shown also to effectively coagulate pre- tumor neoplasms. A new method of laser beams shaping fitted to tumor configuration basing on quantum optical systems including image brightness amplifiers is described. Variability of the irradiating beam contrast is displayed, including the contrast inversion. Possibilities of the copper vapor lasers use for tumors drugless phototherapy and the two-step and two-stage methods of the photodynamic therapy are discussed. Some Russian medical systems based on the copper vapor lasers and dye lasers pumped by them are specified in parameters.

In this work we present the experimental results indicating that under photodynamic therapy the primary stage of the photodestruction of malignant cells is based on the irreversible photodestruction of glycolysis enzymes located, first of all, in mitochondria playing a key role in the energy supply for the tumor cells. It was shown that the formation of complexes between glycolysis enzymes and a sensitizer promotes an effective destruction of the formers. The formation of strong complexes was demonstrated for a number of glycolysis enzymes (glyceraldehyde-2-phosphate dehydrogenase, pyruvate kinase, lactate dehydrogenase) with the use of water-soluble pigments chlorin e₆ and tetra(carboxyphenyl)porphyrin (T(CP)P) as sensitizers. The direct correlation was shown between the effectiveness of the photodestruction of enzyme molecules and the enzyme-sensitizer binding constant.