Abstracts Laser Tokyo 2009
ABSTRACTS LASER TOKYO 2009
Special Lectures
L-1 Tutorial Lecture 1 THE PRESENT STATUS OF LASER SAFETY D Sliney
L-2 Special Lecture 1 HISTORY OF LASER SURGERY I Kaplan Tel Aviv University, Israel
Since laser surgery is almost confined to the CO2 laser, the paper will deal with its use as a surgical instrument, highlighting its advantages and the history of its introduction into surgery.
PROF. ISAAC KAPLAN Professor Isaac Kaplan was born in South Africa in 1919. He served in the British Army in North Africa during World War II. In 1950 he qualified in Medicine at the University of the Witwatesrand (Johannesburg. South Africa). In 1952 he emigrated to Israel. In 1954 he completed specialist training in General Surgery at the Hadassah University Hospital, Jerusalem. In 1955 he trained in Plastic Surgery with Sir Harold Gillies in England. In 1958 he established and headed the Dept. of Plastic and Reconstructive and Maxillofacial Surgery, at the Beilinson Hospital Israel. In 1967 he established the first Burns Unit in Israel. In 1968-1969 he headed an international team under the auspices of the “Children’s Medical Relief International”, and established hospital for Plastic and Maxillofacial Surgery for children, in Saigon, during the Vietnam War. He was appointed Professor of Surgery and Incumbent of the chair of Plastic Surgery, Tel Aviv University, Medical School. In 1972 he co-developed the Sharplan Laser (Sharon and Kaplan), and embarked on CO2 Laser Surgery. Since then engaged in medical laser research and development of Medical laser instruments and accessories. In 1975 he founded the International Society for Laser Surgery and Medicine, and served as President until 1979. He founded the Israel Society of laser Surgery and Medicine and served as President until 1995. In 1975 he received the Christian Johann Berger Award, Denmark. In 1979 he was nominated Honorary Life President of the International Society for Laser Surgery and Medicine. In 1986 he received the Rothschild Prize for Innovation, Israel. In 1989 he was made visiting Professor, of the National University of Cordova (Argentine). In 1991 he received the Diffenbach Award for Plastic Surgery. In 1993 he became visiting Professor of the University of Ascunsion, Paraguay. In 1994 he became honorary Professor of the Post Graduate Medical School, Beijing, China. In 1995 he became Honorary Professor of the National University of Cordova (Argentine). In 1999 he was nominated “Investigator Collaborator” of the Ministry of Science and Technology of Cuba. In 1999 he received the William B. Mark Memorial award (USA). In 2000 he received the Academic Award of Excellence (S.A.Zionist Federation), Israel. In 2001 he became Honorary Professor of the SriRamchandra Medical College (India). In 2001 he became Honorary President of the World Federation of Societies for Laser Medicine and Surgery. He published over 200 professional articles; two books on Plastic Surgery, four books on Laser Surgery and several chapters in other books on Lasers in Medicine and Surgery.
PROF. ISAAC KAPLAN Profile Emeritus. Prof of Surgery, and past incumbent of the Chair of Plastic surgery, Tel Aviv University. 1919 -Born and educated in South Africa.Served British Army in North Africa during World War II 1950 -Qualified in Medicine at the University of Witwatersrand Johannesburg. South Africa). 1952 -Emigrated to Israel. 1954 Completed Specialist training in General Surgery at the Hadassah University Hospital, Jerusalem. 1955 -Trained in Plastic Surgery with Sir Harold Giillies in England. 1958 -Established and headed the Dept. of Plastic and reconstructive and Maxillofacial Surgery, Beilinson Hospital. Israel. (Tel Aviv University). 1967 -Established the first Burns Unit in Israel. 1968-69 -Headed International Team under the auspices of the "Children’s Medical Relief International”, and established a hospital for Plastic and Maxillofacial Surgery for children, Saigon, during the Vietnam War. Appointed Professor of Surgery and Incumbent of the Chair of Plastic Surgery,
244 Laser Tokyo 2009 PROGRAM & ABSTRACTS
Tel-Aviv University, Medical School. 1972 -Co-developed the Sharplan Laser (Sharon and Kaplan), and embarked on C02 Laser Surgery. Since then engaged in medical laser research and development of medical lasers instruments, and acces- sories. 1975 -Founded the International Society for Laser Surgery and Medicine, and served as President until 1979.Founded the Israeli Society of laser Surgery and Medicine and served as President until 1995. 1975 -Received the Christian Johann Berger Award, Denmark. 1979 -Honorary Life President of the International Society for Laser Surgery and Medicine. 1986 -Received Rothschild Prize for Innovation, Israel. 1989 -Visiting Professor, of the National University of Cordova (Argentine). 1991 -Received the Diffenbach Award for Plastic Surgery. 1993 -Visiting Professor of the University of Ascuncion., Paraguay. 1994 -Honorary Professor of the Post Graduate Medical School, Beijing, China. 1995 -Honorary Professor of the National University of Cordova (Argentine). 1999 -“Investigator, Collaborator” of the Ministry of Science and technology of Cuba. 1999 -William B. Mark memorial award (USA) 2000 -Academic Award of Excellence (S. A. Zionist Federation), Israel. 2001 -Honorary Professor of the Sri Ramachandra medical college (India). 2001 -Honorary President of the world Federation of Societies for Laser Medicine and Surgery. 2006 -Honorary President of the International Society of Phototherapy. Published over 200 Professional Articles; 2 Books on Plastic Surgery; 4 Books on Laser Surgery and several chapters in other books on Lasers in Medicine and Surgery. Honorary Member of the following societies 1. Spanish Society of Plastic & Reconstructive Surgery. 2. International Society for Maxillofacial Surgery. 3. International Society for Plastic Surgery. 4. International Society for Laser Surgery and Medicine (Founder and Hon. President). 5. Israel Society for Lasers in Dentistry (Hon.President). 6. The American Society for Laser in Medicine and Surgery. 7. The Taiwan Society for Laser in Medicine and Surgery. 8. The Latin America Society for Laser in Medicine and Surgery (Hon. President). 9. The Argentinean Society for Laser in Medicine and surgery. 10. The Argentinean Society for Plastic Surgery. 11. National Laser Society of Cuba. 12. Italian Society of Laser Surgery. 13. Paraguayan Society for Laser Surgery. 14. Italian Society of colon proctology. 15. American Society of Plastic & Reconstruction Surgery. 16. The Lund Laser Club. 17. The European Laser Association. 18. The National Surgical Society of Cuba. 19.The German Society of Laser Surgery and Medicine. 20. The Laser Society of Mar-Del -Plata. 21. The Greek Laser society 22. The Indian Association of Laser Surgery & Medicine. 23. The World Association of Laser Therapy (Hon.President). 24. The World Federation of Laser Medical Societies (Hon. President). 25. The International Phototherapy Association (Hon. President).
L-3 Presidential Lecture OHSHIRO’S NEW CLASSIFICATION OF LASER TREATMENT T Ohshiro
L-4 Tutorial Lecture 2 CELLULAR BASICS OF LASER AND NONLASER PHOTOBIOLOGY IN LIVING CELLS T Karu
ABSTRACTS 245 LASER TOKYO 2009
L-5 Tutorial Lecture 3 PHOTOTHERAPY IN PERIPHERAL NERVE REGENERATION S Rochkind
L-6 Tutorial Lecture 4 THE ESSENTIALS OF WOUND HEALING, AND THE ROLE OF PHO- TOTHERAPY IN ITS ACCELERATION WHEN DELAYED M Dyson
L-7 Tutorial Lecture 5 LASER AND LED PHOTOBIOLOGY KC Smith Professor Emeritus, Stanford University School of Medicine, Founder and First President, American Society for Photobiology, USA
Low Level Light Therapy (LLLT) is a very important, and relatively new area of Photomedicine. However, it has not been widely accepted into the main stream of science and medicine. This is because so many research papers and books have been published on LLLT that are full of errors and falsehoods. The two main reasons for bad papers on LLLT are the lack of proper scientific training by the authors, and their lack of knowledge of photobiology. This is also true for the reviewers and editors of journals on LLLT. I will discuss how to over- come these problems. I will also discuss the basics of Photobiology, e.g., The First Law of Photochemistry, etc., and how to perform quality research on LLLT, and how to write quality papers.
L-8 Special Lecture 2 WORLD HISTORY AND FUTURE ON LASER SURGERY AND MEDICINE K Atsumi
246 Laser Tokyo 2009 PROGRAM & ABSTRACTS
L-9 Special Invited Lecture 309 DAYS IN OUTER SPACE: MY PERSONAL EXPERIENCES - THE PRESENTATION OF MODERN SITUATION IN THE FIELD OF HUMAN SPACEFLIGHTS IN RUSSIA A Alexandrov Russia
The space and Earth exploration projects conducted on board of manned spacecrafts include both fundamental and applied research and experiments. The experience of human spaceflights on such spacecrafts as Salyut, Mir, International Space Station (ISS) enables us to plan long-term spaceflights, more than one year and a half long. The experience of space research carried out (the results of biological, medical, biotechnological, technical experiments) enables us to make plans of exploration Solar System planets by manned spacecrafts. The problem of crew psychological comfort in terms of long-term space flight is extremely important. Long- term flights on orbital stations have made it possible to control this problem during carrying out space pro- grams today. The future prospects for cosmonautics include the invention of new and effective vehicles flying to the ISS and the invention of spacecrafts for flights beyond the Earth orbit. The results of robotic space probes are still unexcelled, but the human brain is the most effective instrument of
Alexander Alexandrov
Alexander Alexandrov is a Soviet cosmonaut, twice named Hero of the Soviet Union, an active member of the International Informatization Academy. He was born in Moscow, 1943. In 1969 finished his studies of automatic flight vehicle control systems in Bauman Moscow Higher Technical School. Since 1964 he is in RKK Energia, where he took part in control systems development and testing for the Voskhod 2, Soyuz-T manned space vehicles and Salyut and Mir space stations. He was involved in Appollo-Soyuz project, training of cosmonauts’ crew and personnel for the control centers in Moscow and Houston; took part in work of Moscow Flight Control Center. From 1976 to 1980 Alexandrov, being shift flight director of the Moscow Flight Control Center, managed missions of Saylut 4, Saylut 6 space stations and Soyuz and Progress spacecraft. In 1978 joined the Energia cosmonaut corps. Completed aerobatic light-motored airplane flight training , para- chule training. He took part in two space flights: first as on board engineer of Soyuz T-9 craft and Saylut 7 – Cosmo 1443 orbit station, then, from Juli 22 to December 29, 1987, on Mir station and Soyuz TM-3 ship missions. He walked free space twice. Alexandrov is Candidate of Engineering of Science (1988). At present he is President Adviser of RSCENenzgia. Medals and Awards: two Hero of the Soviet Union Gold Stars (1983, 1987), two Orders of Lenin (1983, 1987), Laureate of State Prize of Ukraine (1983), Hero of Syrian Arab Republic (1987), Companion of the Friendship and Collaboration Order (Syria, 1987), Laureate of State Prize of Russia (2003), Honorary citizen of: Antracit, Djezkazgan, Arkalyk, Kaluga, Leninsk, Leninabad (Turkmenia), Fontone (France) cities and towns.
revealing unknown in the space exploration.
ABSTRACTS 247 LASER TOKYO 2009
World Federation of Societies for Laser Medicine and Surgery
WO-1 OPENING DECLARATION OF WORLD FEDERATION OF SOCIETIES FOR LASER MEDICINE AND SURGERY K Rau
WO-2 CERTIFICATION OF INTERNATIONAL MEDICAL LASER SPECIALIST T Ohshiro
WO-3 HISTORY OF ISLSM I Kaplan Tel Aviv University, Israel
The ISLSM was founded in 1975 in Tel Aviv. Meetings were held subsequently every two years in different parts of the world. The paper will deal with these meetings.
WO-4 HISTORY OF WORLD FEDERATION OF SOCIETIES FOR LASER MEDICINE AND SURGERY (WFSLMS) K Atsumi
W-1 HISTORY OF AMERICAN SOCIETY FOR LASER MEDICINE & SURGERY (ASLMS) G Glantz
W-2 HISTORY OF APALMS N Nimsakul Institute of Modem Medicine, Bangkok, Thailand
After Prof. Kazuhiko Atsumi hosted the 4th ISLSM Congress in Tokyo in 1981, the interest in, and research and development of, Laser applications in both the medical and surgical fields expanded and grew rapidly among Asian countries, such as Japan, china and South East Asia. After long discussions, leaders in the laser field in this large region agreed to form a separate Society in this region, and the Asian-Pacific Association for Laser Medicine and Surgery (APALMS) was officially founded in Tokyo in 1985, and the first scientific meeting was held in Tokyo that year. Since 1985, the APALMS has been organizing scientific meetings of every two year (biannual), and the follow- ing are the APALS meetingd with the presidents during 1985 to 2008.
248 Laser Tokyo 2009 PROGRAM & ABSTRACTS
Meeting/YearLocation President Meeting/Year Location President
1st 1985 Tokyo, Japan Prof. K azuhiko Atsumi 7th 1998 HCMC, Vietnam Dr. Tran Cong Duyet 2nd 1987 Shanghai, China Prof. Jia-Nan Qin 8th 2000 Singapore Prof. Goh Chee lank 3rd 1990 Bali, Indonesia Prof. Darwan M. Purda 9th 2002 Pattaya, Thailand Prof. Narong Nimsakul 4th 1992 Singapore Prof. Fong Poh Him 10th 2004 Shanghai, China Prof. Jing Zhu 5th 1994 Jerusalem, Israel Prof. Isaac Kaplan 11th 2006 GOA, India Prof, Krishna Rau 6th 1996 Seoul, Korea Prof. Tai-Kwun Lee 12th 2008 Seoul, Korea Prof, Jin-Wang Kim There are traditional ways of practicing medicine this region, such as acupuncture. Therapeutic massage and vibrational medicine, etc., which are much more holistic approaches With the introduction of hi-technological techniques and tools such as the Laser systems, which were then integrated or combined with existing tradi- tional Oriental medicine, many new and advanced therapeutic methods have been explored and established.
W-3 HISTORY OF IPA T Okunaka International University of Health and Welfare, Tokyo, Japan
The International photodynamic association (IPA) was founded in 1986 by Dr. Yoshihiro Hayata, professor of Tokyo Medical University in 1985, and first meeting was held in Tokyo. The IPA is an academic society whose membership consists of the most prominent international clinicians and scientists involved in performing and researching PDT and PDD. IPA has 700 active members with 30 board members. The purpose of the IPA is promote the study of diagnosis and treatment using light and photosensitisers, to disseminate such information to the members of the IPA, the medical community and to the general public. The IPA organises an International Congress every two years which is a unique opportunity to sum up research activities in the clini- cal and basic research aspects of PDT. 11th World congress of the IPA was held in Shanghai in 2007, and the latest world congress, 12th IPA meeting took place on June 2009 in Seattle by Prof. David Kessel. We will hold a 13th meeting in Innsbruck, Austria on May 2011, and 14th meeting in Seoul in 2013.
W-4 HISTORY OF WORLD ASSOCIATION OF LASER THERAPY S Rochkind Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel
The World Association for Laser Therapy (WALT) was formed in 1994 in Barcelona, Spain at the joint Congress of the International Laser Therapy Association (ILTA) and the International Society for Laser Application in Medicine (ISLAM) when these two international groups merged and WALT became a body for promoting research, education and clinical applications in the field of photo-therapy with lasers and other light sources. The multi-national membership includes the world's leading experts in all forms of treatment mediated by the photo-bio-modulating effects of light occurring without thermal effects on irradiated tissue. WALT hosts its World Congress every two years with venues spread worldwide. Jerusalem, Israel (1996), Kansas City, USA (1998), Athens, Greece (2000), Tsukuba, Japan (2002), Guaruja, Brazil (2004), Lemesos, Cyprus (2006) and Sun City, South Africa (2008) have all welcomed WALT. The 2010 Congress will be held in Bergen, Norway under the Chairmanship of Professor Jan Bjordal, University of Bergen. The official journal of WALT is Photomedicine and Laser Surgery, published 6 times a year. The aims of the Association are: 1. To promote the evidence-based clinical application of laser therapy in the fields of medical practice, dentistry, veterinary medicine and allied health professions. 2. To encourage research into the clinical application of photo-therapy in accordance with internationally accepted standards of best practice. 3. To encourage laboratory-based research into mechanisms of photo-bio-modulation. 4. To promote education, encourage international co-operation and provide a forum for information exchange.
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W-5 HISTORY OF JaLTA C Shiroto Shiroto Clinic, Goshogawara, Aomori, Japan
Since Maiman from U.S.A. performed the first successful ruby laser oscillation in 1960, the application of it to medical science has started next year. Japan has started to apply it to medical science since 1965. It was the beginning of LLLT that Prof. Mester from Hungary made use of LLLT for refractory cutaneous ulcer in 1968. Japan started to release the report of LLLT, and the number of reports has been increasing over the years. In 1989, The Japan Laser Therpy Association based on LLLT was established and had the first meeting where Prof. Motegi served in the president of it. Next year, in 1990, the second meeting was held in Okinawa, Japan, and The First Meeting of the International Laser Therapy Association was held at the same time that Prof.. Ohshiro was the president of it. The Japan Laser Therapy Association has been raised to society status since 3rd meeting in 1991, and it has continued on this day. The twenty-first meeting had been just held this summer. The fourteenth meeting and WALT 2002 World Association for Laser Therapy Forth World Congress were held together. Prof. Hanaoka served in the president of them. In 2006, under the president of Prof. Asagai, the eighteenth meeting and the First Meeting of the International Phototherapy Association were held at the same time.
W-6 HISTORY OF THE INTERNATIONAL ASSOCIATION FOR LASER AND SPORTS MEDICINE (IALSM) J Kubota Kubota Junichiro Clinic, Ikebukuro, Toshimaku, Tokyo, Japan
The International Association for Laser and Spots Medicine (IALSM) and the Japan Association for Laser and Sports Medicine (JALSM) were born in 1997. They were preceded by the First Japan and Hellenic Symposium for Laser and Sports Medicine in Athens, Greece in May of 1995. The meeting concluded with the strong idea that it should be possible to provide a great deal of help and support to injured sportsmen and women who are trying to get back to their normal regimen of training and competition by the synergistic combination of conventional therapeutic modalities with laser surgery and medicine, in particular the integration of low reac- tive level Laser therapy (LLLT) as phototherapy applications. The first Congress of IALSM in conjunction with the first Congress of JALSM was held in Tokyo, Japan during December 1st through the 3rd, 1997. Congress president was Associate Professor Junichiro Kubota. Honorary congress president was Professor Kazuhiko Atsumi. Vice president is Professor Kazuo Sugawara. The second Congress of the IALSM was held by Professor Fernando Soriano in Rosario, Argentina, on March 10-12, 2000. The third Congress of the IALSM as a Sports Medicine Symposia in the 14th World Congress of the International Society for Laser Surgery and Medicine was held by Professor Toshio Ohshiro in Chennai, India, on August 27-30, 2001. The forth Congress of the IALSM as two symposiums in the Joint International Laser Conference was held by Professor David Baxter in Edinburgh, Scotland, on September 21-23, 2003. The fifth Congress of the IALSM was held by Dr. Junichiro Kubota in conjunction with the newly named the Japan Association for Laser Medicine and Sports Science on November 29th, 2008 in Tokyo, Japan. The meet- ing was held in a symposium format.
W-7 HISTORY OF INTERNATIONAL LASER NURSING PJ Smalley Technology Concepts Internationa, Illinois, USA
Nursing professionals have participated in international laser societies and conferences since 1983. Though not always included in annual programs, the nursing community has been diligently working towards raising the level of education and training available, as well as contributing to the development and implementation of international safety standards for practice. Staff safety is the first priority in ensuring safe patient care, and ensuring capable and responsible assistance in providing laser surgical and medical interventions. Nurses and physicians must work as a team, and it is essen- tial that laser education has a strong foundation of science, in order to properly and effectively assess risk, pro- vide appropriate control measures, and maintain excellence through quality assurance programs. International nursing activities over the past 25 years, have included: conference presentations, teaching in practical workshops, instructing in core curriculum courses for both doctors and nurses, committee member- ship in a variety of organizations, stamdards development, publications, clinical research, facility consultations,
250 Laser Tokyo 2009 PROGRAM & ABSTRACTS
work with government regulatory agencies and health ministries, and assisting in surgical procedures during teaching sessions. As we are challenged with more and more laser technology, we are also learning about an increasing number of safety risks. We must all work towards greater partnerships and collaborations, in education, clinical prac- tice, and in product safety in the industry. We look forward to the next 25 years of participation in the interna- tional community of laser professionals.
W-8 LASER ACADEMY – FACTS AND WORDS FOR AN UNIVERSAL SPECIALIZATION L Longo Associate Professor Laser Surgery and Medicine, Specialization School in General Surgery – Siena University, Institute Laser Medicine, Firenze, Italy
Since 1960 Laser medical technology done the usual way of the new discovers: at first totally refused by medi- cine world, then acclaimed, then criticated and now seriously investigated. Goal of our lecture is to systemize the role of lasers for non surgical treatments. Materials and method: An International Academy for Laser medicine and Surgery was founded in Florence (www.ialms.com). She could be the link between different groups of researchers public and private, Institutions, Societies, Associations. The Academy is a service non political and open for all the world. Only qualities requested for the admission are open intelligence, coherence, loyalty. The Academy would like to avoid the fragmentation of the knowledge and to select it. The scientific data published in literature are filtered following the Helsinki Convention rules. The conclusions are reported in an annual conference titled Laser Florence – A window on the laser medicine world (www.laserflorence.org). The new data are published in the Proceedings and shown in specific Courses. The selection of the data is based on the W. H. O. guidelines which says that “each substance, energy, tool which modifies a physiological process of the human body must be studied .and verified”. Common protocols of research and clinical treatment could be proposed with special regard for non surgical laser effects on biological tissues: effect on wound healing, inflammation, pain, metabolic diseases, immunity. Results and discussion: first result obtained is the union of scientists of all the world with first multicountries studies also in double blind and without political and industrial influences. In details data are obtained for wound healing, antinflammatory effects on fibromyositic rheumatisms included S. of Dupuytren, La Peyronie, inhibitory effects on keloids and hypertrophyc scars, rejuvenation effects on skin distrophic, stem cells, brain and spinal cord injuries. Second results obtained was to know new laser applications as evidence based medicine. In particular Russian and Asian Authors shown incredible effects of laser beams: hypoglicemic effect on diabetes insuline depen- dant, increasing of lymphocytes activities on the blood, variation of all the blnsert the abstract text, (see note 6 on page 1). You should prepare your abstract in a word-processing program, such as Microsoft Word®, where you can check it for for length, spelling, and so on, then copy it or cut and paste it here.
WA-1 KAPLAN’S ROMANCE WITH CO2 LASER AM Baruchin The Barzilai Medical Centre & the Faculty of Health Sciences, Israel; and Ben Gurion University of the Negev, Beer-Sheva, Israel
W-9 HISTORY OF JAPAN SOCIETY FOR LASER SURGERY AND MEDICINE (JSLSM) H Kato Niiza-Shiki Central General Hospital, Saitama, Japan and International University of Health and Welfare, and Tokyo Medical University
Japan Society for Laser Surgery and Medicine (JSLSM) was as a Research Meeting for Laser Surgery and Medicine by Professor Kazuhiko Atsumi in 1977. The present organization as JSLSM started since 1980. The annual meeting, this year, is the thirty anniversary, however actually meetings count 33 times. In these annual meetings more than 4,000 papers including basic laser researches and clinical studies were presented so far. This society consists of a permanent honorary chairman, and a chairman of board directors, two vice chairmen, a president and vice president of annual congress, four advisory board members, 36 board directors, 46 honor- able members, 17 special members, 97 councilors, 1263 members, 47 student members and 9 industrial mem-
ABSTRACTS 251 LASER TOKYO 2009
bers. This society has twelve committees and holds an annual congress every year, three board director meetings a year and convocation and general assembly are held svery year. For the laser specialty, seminars and accredit examinations are performed one or two times a year. This society has approved ---laser specialist and--- laser engineers so far. JSLSM publishes the Journal of JSLSM four times a year. This society shows its own clinical guidelines for laser treatment in order to offer safe, high quality and less invasive treatment for the patients.
W-10 HISTORY OF JAPANESE SOCIETY FOR LASER REPRODUCTION (JaSLaR) A Fukuda IVF Osaka Clinic, Osaka, Japan
Infertility treatment has been developing in this half century especially after the invention of in vitro fertiliza- tion and embryo transfer (IVF-ET) in 1978 and intracytoplasmic sperm injection (ICSI). Assisted hatching using acidified solution was first applied to treat the impairment of the hatcing process following in vitro fertilization in the human in 1990. Laser hatching was replaced acidified solution method soon after in 1992 to avoid adverse effect of acid on embryos. This is the first event that laser got involved in the treatment of infertility. Although infertility treatment progressed rapidly, infertility specialists are still struggling to treat difficult cases and age related declined fertility problems. Dr. Toshio Ohshiro, a plastic surgeon, happened to find the effect of low reactive laser therapy (LLLT) on female reproductive function in 1987. While he was treating lumbago of the postmenopausal female patient, her menstruations resumed. This case motivated him to investigate if LLLT improved the female reproductive functions. Dr. Ohshiro and his long time friend professo Masato Inoue, a well known infertility specialist, collaborated to study the effect of LLLT on 74 difficult infertility patients from 1996 through 2000. Their study showed that 16 casses (22%) of 74 treated patients succeeded in achieving pregnancy and 11 couples (15%) delivered 13 healthy babies. They have demonstrated the beneficial effect of LLLT on infertility treatment. Dr. Ohshiro founded Japanese Society for Laser Reproduction (JaSLaR) aiming not only further investigation of beneficial effect of laser in the field of reproduction, but also establishing the sci- entific basis of laser on reproductive functions. The subject of research areas covers laser application on assist- ed reproductive technologies, laser surgery related to reproduction and LLLT on reproductive functions. 1st Annual Conference of JaSLaR 2006 (President: Dr. Toshio Ohshiro) in Tokyo; 8 topics were presented. 2nd Annual Conference 2007 (President: Dr. T. Ohshiro) in Tokyo; 6 topics and 2 symposia. 3rdAnnual Conference 2008 (President: Professor Bunpei Ishizuka) in Tokyo; 6 topics, 1 symposia and 2 work- shops. 4th Annual Conference 2009 (President: Professor Toshimichi Ishikawa) in Tokyo; 6 topics and 2 symposia. 5th Annual Conference 2010 (President Dr. Aisaku Fukuda) will be held in Osaka, first out of Tokyo. Recently, JaSLaR has been recognized as important resources among fertility specialists.
W-11 THE ESTM HISTORY AND EXPERIENCE U Rossi President, ESTM, Italy
Aims and Background: The European School of Transfusion Medicine (ESTM) stemmed out of documents by Council of Europe (1963, 1985), International Society of Blood Transfusion (ISBT) European Congresses (1991, 1993), and the Italian Transfusion Medicine Society (SIMTI) through its “Symposia for European Cooperation” (1990-1994). Perspectives of the new European political situation were discussed in 1991 by the SIMTI Board. One felt time had come to help Colleagues facing new problems. In 1992, ESTM was founded in Milano, as a non-profit Association aiming at harmonising Transfusion Medicine within a “wider” Europe. Subjects and Methods: 80 courses have been organised in 31 countries, within and outside Europe. 118 coordi- nators and 595 teachers (from 32 European countries, and some from outside Europe), and more than 3.000 participants (from 41 European and 19 non-European countries) have been involved. Results: Increasing request for joint ESTM activities is shown by many national, European and international Organisations caring about transfusion. ESTM received in 2002 the ISBT Award. ESTM courses are accredited by the Royal College of Pathologists (London) since 1995, and by the European Committee for Accreditation in Haematology since 2003. Collaboration since 2004 with the Arabic Transfusion Medicine Courses (ATMC). A Latin-American ESTM-like initiative is currently being discussed. Agreement was reached on basic requirements for transfusion safety. Appreciation was gained of the contribution of clinical medicine to blood safety. It has been fully realised that “Transfusing medical science into medical practice” is the present essential challenge all over Europe. Conclusions: A growing interest and affection is being perceived by all participants to ESTM activities, wishing ESTM's goals could better be reached by ensuring continuity, financial support (free of any commercial inter- est), and long-term commitment. Continuity may as well be assured through collaboration with Institutions active in Transfusion Medicine education, such as WHO, European Union, Council of Europe, EBA, ISBT,
252 Laser Tokyo 2009 PROGRAM & ABSTRACTS
NATA, IPFA, NESA, TIF, and national or international Cooperation programmes. It is indeed the ESTM experi- ence that sharing professional activities with Colleagues of different countries, and helping them with a “twin- ning” attitude, is the key to real progress of Transfusion Medicine in Europe, and in neighbouring countries.
W-12 HISTORY OF THE AMERICAN SOCIETY FOR PHOTOBIOLOGY KC Smith Professor Emeritus, Stanford University School of Medicine, Founder and First President, American Society for Photobiology, USA
“Photobiology is broadly defined to include all biological phenomena involving non-ionizing radiation. It is recognized that photobiological responses are the result of chemical and/or physical changes induced in bio- logical systems by non-ionizing radiation.” (Constitution of the American Society for Photobiology) The science of photobiology is roughly divided into 12 different specialty areas. Photophysics, Photochemistry, Photosensitization, UV Radiation Effects on Molecules and Cells, Environmental Photobiology, Photomedicine, Non-Visual Photoreception, Vision, Photomorphogenesis, Photomovement, Photosynthesis, Bioluminescence. In the United States, prior to the formation of the American Society for Photobiology (ASP) in 1972, the science in each of these 12 areas was usually a subsection of a major scientific society. For example, UV radiation pho- tobiology was a minor section in the Biophysical Society. Now that photobiology is under one roof, people can communicate with each other at the meetings, and bene- fit from cross-discipline interaction. The different areas of photobiology will be defined, and the steps that led up to the founding of the American Society for Photobiology will be discussed.
W-13 HISTORY OF LASER MEDICINE AND SURGERY IN ARMENIA HS Arakelyan, AS Safaryan, and NL Gzraryan Panarmenian Association of Laser Therapy and Integrative Medicine, Yerevan, Armenia
Armenia is one of the first Republic of former Soviet Union where during the laser appearance began to study the influence of laser irradiation on human organism, and use laser as for treating the most problematic dis- eases. In Armenia beginning from 1968 year was organized Scientific Practical Department of Laser Biomedicine and Laser Cosmetology at the Institute of Medical Radiology of National Academy of Sciences of Republic of Armenia. After that many hospitals, Low Level Laser’s Departments have been opened in Yerevan. Since 1995 fundamental researches have began in Medical Center “Magnolia”, Medical Center “Ignatcia” later on the Pan Armenian Association of Laser Therapy and Integrative Medicine, at present carry out works in the field of Low Power Laser Therapy, Photo-Dynamic Therapy and Integrative Laser Therapy. Particularly has been studied the effects of laser influence, various magnetic fields, light–color therapy combined with various medicinal plants which contain photo sensitizers and ferromagnetic. There was also development of new meth- ods for treating incurable diseases (Vitiligo, Psoriasis, Alzheimer Diseases, Ishemic Heart Diseases etc.). Special Laser Photolysis Method which has been developed by us is used for synthesis of biologically active drugs, some of which have bactericidal, anti-inflammatory and other properties. The basis of these bioactive drugs are noble and other metals (Au, Ag, Zn, Cu, etc.), which have beneficial effects on thermal burns, Alopecia, Vitiligo and other problematic diseases and in nearly future the usage of these bioactive unique drugs can greatly increase treatment efficiency in oncology and other problematic fields in medicine. Integrative Laser Therapy is one of the most rapid developing branches in medicine. The main object is making a synthesis Laser and Integrative medicine and all various branches of up-to-date medicine. Integrative Medicine is the field of health care that focuses on how biochemical individuality, metabolic balance, ecological context, genet- ic predisposition, lifestyle patterns, and other factors have the potential to strongly influence human physiology and the push-pull dynamics of health and disease.
W-14 HISTORY OF THE INTERNATIONAL PHOTOTHERAPY ASSOCIATION (IPTA) Y Asagai Shinano Handicapped Children's Hospital, Shinano, Japan
In the last 3 decades, the use of laser therapy, also known as low reactive level laser therapy (LLLT), has become much more accepted due to both advances in the accrual of evidence-based scientific basics and also increased clinical applications, with the result that laser therapy systems have received some approvals under
ABSTRACTS 253 LASER TOKYO 2009
510k submissions from the US Food and Drug Administration (FDA). However, in the past decade since the development of the so-called ‘NASA LED’ in 1998, light-emitting diode arrays have attracted a great deal of pan-speciality attention in a number of fields, especially in the treatment of active acne vulgaris, skin rejuvena- tion, antiageing, wound healing and pain attenuation. LED-based systems have also shown excellent efficacy in photodynamic therapy (PDT) for non-melanoma skin cancers, acne and even skin rejuvenation with aminolae- vulinic acid (5-ALA) in particular as the photosensitizer of choice. The World Association for Laser Therapy (WALT) has provided an excellent forum for laser therapy practice and research, but a gap was left into which other forms of light therapy had fallen so it was felt that there was no focal point for this group of clinicians and researchers. Accordingly in 2006 a new society was formed, the International Phototherapy Association (IPTA), and the inaugural international congress was successfully held in July 2006, In Nagano Prefecture, Japan, under the presidency of the author. The journal Laser Therapy was proposed and accepted as the offi- cial IPTA organ at the 2006 IPTA AGM. The 2nd congress was hosted by Professor David Baxter in Queenstown, New Zealand in April 2008, and the 3rd congress will be held in Florence, Italy in November 2009 under the presidency of Professor Leonardo Longo. This brings the IPTA into its proposed calendar of holding meetings in odd years so as not to conflict with the WALT congress, held in even years. The 2011 meeting is planned for Egypt with Dr Sherif Awad as President, so the IPTA is certainly living up to its interna- tional aspect. We fully expect the Association to grow in strength, and invite interested medical and paramed- ical professionals and researchers to join its growing ranks.
W-15 WORLD FEDERATION FOR LASER DENTISTRY HS Loh Faculty of Dentistry, National University Health System, Kent Ridge, Singapore
The World Federation for Laser Dentistry(WFLD) was formed in 1988 as the Society for Lasers in Dentistry, with an international executive committee to manage its activities and congress which is held once 2-yearly. It has more than 50 country members, and the Federation has 5 Divisions: 1.Asian Pacific 2.European 3.Middle East and Africa 4.North America and Canada 5.South and Central Americas The objective and purpose of the Federation shall be to serve as a non-profit medium for exchange, advance- ment and dissemination of scientific knowledge related to the use of lasers for application and research in the oral and dental environment, including the prevention of dental diseases. The Federation had conducted laser certification courses and workshops, instituted a Master degree program, and provided speakers and experts for international fora and conferences.
W-16 PRESENT STATUS OF LASER MEDICINE AND SURGERY (LMS) IN CHINA G Ying
W-17 LASER HISTORY IN DERMATOLOGY IN EGYPT SS Awad, T Abel-Raheem, and MH El-Tonsy Minia University, Dermatology Department, Egypt
In the old ages, the ancient Egyptians were pioneers in introducing light as a therapeutic tool in managing many health problems. In the new Era again an Egyptian, Professor El-Mofty, was a pioneer in introducing Psoralens in conjunction with UV light to treat skin diseases. In the Laser Era, Professor El-Tonsy introduced the new therapeutic technology to Egypt. The first Laser unit was installed in Dermatology Department at Minia University in 1990 and was a Nd:YAG long pulsed laser. This laser was chosen after a scientific research of the available lasers at that time, the needs and applications required by the population. The Nd:YAG laser from Karl Zeis, Germany, was installed mainly with the purpose of treating vascular congenital anomalies which included hemangiomas, and lymphangiomas. Many research works were conducted in collaboration with other local and international laboratories and many publications were issued. Nowadays, many devices are available in Minia including CO2, Erbium YAG, IPL, Tunable Lasers and many research works are published every year on different skin problems. Laser centres are now available in different provinces of Egypt and Lasers became main tool in the armamen- tarium of Dermatologists, required to manage many skin conditions.
254 Laser Tokyo 2009 PROGRAM & ABSTRACTS
W-18 HISTORY OF LASERS IN ENGLAND VH Oswal James Cook University Hosptial, Middlesbrough, Cleveland, UK
In a structured social medical system such as the National Health Service (NHS) in the United Kingdom (UK), the funds are meagre, demands from doctors are high and expectations from patients match the advances in medicine. Raising money by public appeal was an alternative. I followed this route. The appeal was launched in 1982. It was most successful and within six months, exceeded the target by 75%. We thus acquired Coherent CO2 laser in 1982, one of the very first if not The First laser in the country. There was of course no knowledge of its clin- ical application, safety and so on. I undertook many bench experiments on animal tissue, video-recorded the results, and studied them frame by frame. Various parameters were studied and correlation to power and exposure setting and the tissue effects were established for various tissue types. An important issue of airway fire was addressed, and a fire proof endotra- cheal tube, < Oswal-Hunton flexo-metallic endotracheal anaesthetic tube > was designed. Several laryngeal procedures were successfully undertaken. Remarkable lack of oedema was the most striking feature in the laryngeal surgery. Laser was successfully used in paediatric respiratory papillomatosis, and various vocal cord pathology including malignancy. A number of bronchoscopies were performed for improving the obstructed airway due to bronchial malignancy. Cancer and benign pathology of oral cavity was also tackled, with remark- able results. Transoral total glossectomy was carried out in one partient. The first British Conference in CO2 laser in ENT was held in 1983 with international gathering in Middlesbrough, UK. First laser course was also held, with hands-on training for four surgeons. First book on CO2 Laser in Otolaryngology was authored and published in 1988. Refinements in surgery continued with better understanding of the technology and also technical improvement with additions such as AcuSpot, AcuBlade and now Acupulse. Other wavelength such as KTP and Ho:Yag lasers were added and the range of surgery was extended to nasal and ear pathology. Second and a substantive book ‘Principles and Practice of Lasers in Otolaryngology and H & N surgery was authored and published in 2002, the volume also has a CD demonstrating some forty procedures. The course continues till date, 26th course was just held in the first week of October 2009. Nationally, British Medical Laser Association was established in 1983. It continues to thrive to date.
W-19 HISTORY OF LASER MEDICINE AND SURGERY IN ARGENTINA FA Soriano, M Soriano, and V Campana IAMEL (Instituto Argentino de Medicina Laser), Rosario, Argentina; and Catedra de Biologia Universidad Nacional de Cordoba, Cordoba, Argentina
Laser therapy was introduced in Argentina in ’80 decade. In the beginning, magic effects were assured by doc- tors who advertised their treatments not only for pain relief but also for depression, smoke addiction and lost of weight. No scientific works supported these kinds of medical applications and the lack of results predis- posed the scientific medical associations to refuse LLLT as an acceptable method of treatment. Prof. Hugo Juri and his team from the University of Cordoba, Argentina, demonstrated in animals important effects on the chemical mediators of the inflammatory process after the irradiation with HeNe laser. Supported by these find- ings, we begun to work with LLLT patients with osteoarticular pain and venous leg ulcer, and we demonstrated that there are several benefits in clinical effects. Thanks to this works LLLT was introduced in the programmes of the medical scientific association courses and also in postgraduate courses of the University of Rosario. Laser Surgery was introduced by Prof Horacio Poteca (University of La Plata) with the use of CO2 laser in dermato- logic and general surgery also in 80’ decade. In 1991 Prof Soriano begun in Rosario CO2 dermatologic surg- eries and in 1994 the first laser resurfacing with CO2 Silk Touch scanner was preformed in IAMEL. From 1999 with the introduction of the first laser epilation devices up to date the use of lasers by dermatologic and plastic surgerons increased dramatically. The first meeting in Rosario took place in 1991 and only eighteen doctors attended this course. One year later we organised the First Interuniversity and International Symposium of Laser in Medicine and Surgery, with over a hundred colleagues attending this meeting. In 1995 it was held in Buenos Aires the 10th Congress of ISLSM, receiving more than 180 foreign participants and 105 participants from Argentina. The II Congress of International Association for Laser and Sports Medicine took place in Rosario city and it was a successful meeting with over 600 attendants from our country. There is a growing interest in using medical and surgery lasers in Argentina.
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W-20 HISTORY OF LASER MEDICINE AND SURGERY (LMS) IN INDIA S Krishna
W-21 HISTORY OF LASER IN MEDICINE AND SURGERY IN INDONESIA P Hasan Dept of Surgery, Pluit Hospital, Jakarta, Indonesia
he first Symposium on Laser in Medicine and Surgery was co-host by Medical Faculty, Christian University Krida Wacana (Ukrida) and APALMS, held at Horizon Hotel, Jakarta. At this meeting the formation of the Indonesian Society for Laser Medicine (IKLASI) on May 10, 1986 which was supported by The Minister of Health, Republic of Indonesia and the APALMS was announced and declared and 5 Doctors pioneering in laser applications in medicine was established as the founder of this Laser Society, On November 1988 the Society was formally accepted by The Indonesian Medical Association as one of its Chapter. As one of the Asian Pacific Countries, Indonesia are active in participating International laser meetings, and laser applications promotion activities as well as laser teaching and laser training in various event locally and abroad. In March 1990 we had hosted the 3rd APALMS Congress in conjunction with the 1st National Congress of the Indonesian Society for Laser Medicine, held at Pertamina Cottages, Bali. We are expecting to have our 6th National Congress in 2007 but it is still not come to reality until this moment due to our internal situation which is not so favorable. Development of Laser medicine in Indonesia are over all slow, this may cause by high investment in laser equipment and fast development and frequent changes in laser technology, resulting laser equipment installed became quickly out of date and under-utilised.
W-22 ISRAEL SOCIETY FOR LASER IN MEDICAL SCIENCES (A.K.A ISRAEL SOCIETY FOR LASER SURGERY & MEDICINE) AM Baruchin The Barzilai Medical Centre & the Faculty of Health Sciences, Israel; and Ben Gurion University of the Negev, Beer-Sheva, Israel
The Isreal Society for laser surgery & Medicine ,was founded in Tel-Aviv, in 5th November 1975, at the same time that the International Society for laser Surgery and Medicine (ISLSM) was founded.Thus, the Israeli society was the first national society, to be form .Its membership was opened to MD’S,DMD’S,PhD’S while associate membership was available to nurses engineers and others.Apart from regular meetings of the society it also hosted the congress of ISLSM in 1985 and that of the Asian Pacific Society for lasers in Dentistry. Prof Isaac Kaplan,Co-developer of the SHARPLAN Laser (Sharon and Kaplan-1972),was the founder and the first president of the Society, he served as President until 1995,followed by Prof. Badri Azaz and Prof Yoseph Elidan.The name of the society was eventually changed to: Israel Society for Laser In Medical Sciences. We meet every 6 months. 120 members ca. Few months ago ,following Prof Elidan’s unexpected and untimely resignation for personal motives, the cur- rent Board allowed the organization to go dormant until a new Board is elected by an active membership.
W-23 THE HISTORY OF LASER SURGERY & MEDICINE AND PHOTOTHERAPY IN KOREA JW Kim, and JO Lee Best Well Institiue, Korean Medical Laser & Phototherapy laboratory & Department of Plastic Surgery, Korea
Korea has a solid history of surgery and phototherapy spanning more than a century, but not a great deal of knowledge regarding medical advances in Korea is known, particularly from the aspect of lasersurgery and phototherapy. The first westernized hospital in korteajejoongwon , established in the 1880’s through the inci- dental successful treatment of Korean Royal Family relative by US missionary doctor. Jejungwon in turn devel- oped into the Severance Hospital Medical School at the turn of the 20th Century. Throughout the somewhat dark years of the Japanese occupation, not much advanced field for Korean doctors, and most had to graduate overseas. However , things changed at the end of the war, and 1955 the first use of phototherapy in korea
256 Laser Tokyo 2009 PROGRAM & ABSTRACTS
using an infrared lamp was recored in skin graft healing, and other applications with different light source was seen in ophthalmology and otorhinolaryngology. Plastic surgery then recognized as a medical speciality in its own right. With the aid of ISLMS, APALMS, ILTA ,principal author Jin Wang Kim and their colleagues attend the congress and this led to him and others to concentrate their efforts to bring all aspects of laser surgery , laser therapy and phototherapy into korea, in combination with laser surgery and conventional approaches also. This has born fruit in New Millenium , and now a very large variety of medical specialities use laser surgery and phototherapy in everyday clinical practice, with more indications being added as our experience grows, photherapy is surely the Medicine of the New Milennium in Korea.
W-24 HISTORY OF LASER MEDICINE AND SURGERY IN NEW ZEALAND GD Baxter, and S Tumilty Centre for Physiotherapy Research, University of Otago, New Zealand
Aims: To provide an overview of the historical background and context to the contemporary medical and sur- gical use of laser technologies in New Zealand. Background: Aotearoa/New Zealand is a developed country of just over 4 million inhabitants, which ranks well in international comparisons on a variety of social, economic and health indices. It has a well developed healthcare system based upon universal coverage, and ‘no fault’ insurance cover for injuries. There is currently not widespread use of laser medicine and surgery within the country, but there has been rapid development in use over the last two decades. Materials and Methods: Systematic reviews of the literature (1966-date), online searches using relevant key words, and personal contact with key figures within the field. Results: In New Zealand, lasers currently find a range of medical applications in rehabilitation (including phys- iotherapy), dermatology (e.g. treatment of port wine stains, pyogenic granuloma) and aesthetic medicine, urol- ogy (treatment of prostate), and dentistry (including treatment of dental caries); there is also a developing research interest in laser-tissue interactions, including laser-mediated effects upon experimental models of dia- betic wound healing. A variety of University-based research teams have contributed to the development of such applications, including teams at the Universities of Otago and Canterbury. The earliest reports of applica- tion of lasers in medicine or surgery date from the late 1980s, and were initially based upon the applications of high power laser systems in dentistry. Such dental research applications continue to the current day, based in part upon the work of researchers and clinicians at the Faculty of Dentistry at Otago University. The University’s School of Physiotherapy has also developed a research profile in laser treatment of tendinopathy and is currently contributing to an international network of laser research. Most recently, the School along with the International Phototherapy Association hosted the first dedicated laser conference (NZLaser08) at Queenstown in the South Island. Conclusions: Despite limited use of laser technologies in medicine and surgery in comparison to other devel- oped countries, such applications are rapidly developing in New Zealand, supported by an expanding research base.
W-25 HISTORY OF LASER MEDICINE AND SURGERY IN RUSSIA VA Mikhailov Multiprofile Clinic “Curare-medicine”, Moscow, Russia
IIn to 1964 scientists N.G.Basov and A.M.Prohorov (Russia) and Charles H.Townes (USA) were awarded the Nobel Prize for their works on creation of the molecular generator. HISTORY OF LASER SURGERY DEVELOP- MENT:A.A.Vishnevsky and A.G.Golovnja (1973) performed the first surgical operation on biliary tracts with using of CO2 laser. A.A.Vishnevsky (1973) was the first to perform a skin grafting operation with CO2 laser. O.K. Skobelkin (1975) performed the first surgical operation on gastro-intestinal system. Bredikis J.J. (1984) performed the first laser beating-heart myocardial revascularization of myocardium.In 1986 the Institute of Laser Medicine was organized under the guidance of O.K.Skobelkin. Scientific grout, headed by O.K.Skobelkin was the first in application of laser scalpel in surgical operations and have designed and developed a variety of devices for their use in medicine. DEVELOPMENT OF LOW LEVEL LASER THERAPY:Fundamental researches reported by Subkova S.M (1978), karu T.I. (1982, 1989), indicate that the initial link of the laser biostimulation is the absorption of light by a cell-like photoreceptor molecule. Bajnozarova E.D.’s experimental researches (1977) showed that LLLT effects are raised by activity of the major enzymes. Moroz A.M. (1980) - red light increases blood concentration of glucose. Chesnokova N.P. (1983): infra-red radiation stimulates wound regen- eration. He-Ne laser activates processes in skin cells (Ratzbaum I.M.1981), mitochondrium of neurocytes (Adzhimolaev T.A. 1976), regeneration of a bone tissue (Bogdanovich U.J. 1978). Application in practical medi- cine: endocrinology (Koshelev V. I. 1976), gynecology (Davidov S.N. (1979), cardiology (Borisov A.V. 1978), dermatology (Rakcheev A.P.1971), gastroenterology (Baibekov I.M.1981), angiology (Tchukov B.N. 1982), oncology (Mikhailov V. A. 1989, Gamaleya N.F.1989). DEVELOPMENT OF INTRAVENOUS LASER BLOOD IRRADIATION (ILBI):Meshalkin E.N., Sergievsky V.S.(1978)- ILBI was applied in some experiments on animals.
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Clinical Use of ILBI: Meshalkin E.N 1981 and Kipshidze I.N.1986) - for treatment of ischemic disease. Karaskov A.M. (1986) - for the treatment of septic endocarditis. Semskov V.S. et al (1984) ) - for treatment of pancreatitis. Voronina V.A. (1985) - in a treatment of peritonitis. Sytchev P.S. (1986) used ILBI as a preventive measure of purulent - septic complications . Mokeev A.F. (1986)- in the complex treatment of hepatic icterus. Mikhailov V.A. (1989)- in oncology.
W-26 GERMAN ASSOCIATION OF LASER MEDICINE A Hofstetter Life Center, Hospital Grosshadern, University of Munich, Munich, Germany
The German Laser Association (DGLM) has several roots, but the central root has been the Urology with its endoscopical experience. So Dr. Müßiggang and myself founded a laser research team at the University ofMunich, Dept. of Urology at the beginning of the 1970s. 1973 Prof. Waidelich arranged the first Intern. Congr. of Laser Medicine at Munich and gave so essential impulses for laser research. 1976 I unified several working groups of other medical disciplines and clinical application centres to a study group. From this arised on 27th of June 1981 the German Association of Laser Medicine ( DGLM ).The aim of the foundation of DGLM has been to provide research and development activities in German institutions ( state,university and industry ) concerned with the application of lasers in medicine.The presidents of the association, the annual meetings and the development of our laser journal from 1981 - 2006 You can find on table 1 - 3. The future development of medicine will be determined by the demands for conservative as well as cost saving diagnostic and therpeutical methods. I believe laser technology is one of the keys to reach this aim.
W-27 HISTORY OF LASER MEDICINE AND SURGERY IN TAIWAN MC Kao Emeritus Professor, Neurosurgery, National Taiwan University, President, Laser Medicine Foundation, R.O.C., Founder President of Laser Medicine Society, R.O.C.
1. The Laser Medicine Society of Taiwan was established at Dec. 1984. 2. The CO2 Surgical laser was first introduced at 1975 by Dr. Kaplan. 3. The Argon laser was introduced at 1977 for ophthalmology application. 4. The Bulletin of the Society established since 1985. 5. The Laser Medicine Research Center was established in 1987 at National Taiwan University. 6. The laser medicine curricula started from 1987 at the College of Medicine, National Taiwan University. Basic laser medicine for junior class. Clinical laser medicine for senior class. 7. The Asian Pacific Laser Medicine Society (July, 1985, Tokyo) 8. The 6th Congress of ISLSM (Oct. 1985, Jerusalem) 9. The 7th Congress of ISLSM (June, 1987, Munich) 10. The 8th Congress of ISLSM (Nov. 1989, Taipei) 11. The 4th Congress of European Laser Association (July, 1988, London) 12. Clinical application of low power lasers (Aug. 1988, Tokyo) 13. Contact Nd-YAG laser (Jan. 1989, Taipei) 14. Proceedings of the 8th Congress of ISLSM (Nov. 1989, Taipei) 15. The 2nd World Congress of low power laser application in medicine (Sept. 1989, Tokyo) 16. Laser Laparoscopic Cholecystectomy (Training box for endoscopic surgery) 17. International Congress of Photodynamic Therapy and Laser Medicine Society (Oct. 1991, Peking) 18. Excimer laser angioplasty. 19. Confocal laser scanning microscope (Jan. 1991, Taipei) 20. Cell Scan System (Feb. 1993, National Taiwan University) 21. Excellent Paper Awards (Feb, 1993) 22. Excimer laser for refractory surgery (1994) 23. Laser application in dentistry (1995) 24. Laser assisted uvla palatoplasty (1995) 25. Ultrapulse CO2 laser for skin rejuvenation (1996) 26. Laser hair transplantation (1996) 27. Q-switched ruby laser for Ota nevus (1997) 28. The 6th Congress of Asian Pacific Society of Laser Medicine and Surgery (1996, Seoul) 29. The 9th Congress of International YAG Laser Symposium (1997, Taipei) 30. Percutaneous laser disc decompression (1997) 31. Interstial photodynamic therapy for prostate hypertrophy 32. International Symposium on Optoelectronic Biotechnology and Laser Medicine (April, 1999, Taipei) 33. Intralase + Wavefront + LASIK (2005) 34. Dermatology excimer laser 35. Anti-Aging Symposium (2005, Taipei)
258 Laser Tokyo 2009 PROGRAM & ABSTRACTS
36. Q-switched YAG laser for tattoos (2005, Taipei) 37. First Congress of World Federation of Societies for Laser Medicine and Surgery (Sept. 2005, Tokyo)
W-28 HISTORY OF LASER MEDICINE IN VIETNAM KH Khang 1, TC Duyet 2 1: Director of National Institute of Dermatology Venereology (NIDV), Vietnam ; and 2: President of Ho Chi Minh Association of LASER medicine and surgery
The first LASER was invented in 1960, relatively recently in terms of Scientific and medical history but in the decades since its first successful test. The laser has become a highly sophisticated tool that has revolutionized the medical field in variety of ways. Here is just history of laser medicine in Vietnam. - 1985: First úse òf low power He-Ne in treatment of skin diseases. - 1992: use of CO2 LASER in treatment of hemorrhoid and skin diseases - 1995: Center of LASER technology was established in Hanoi. - 1995: Association of LASER medicine and Surgery in Ho Chi Minh City. - 1998: International conference on LASER medicine and Surgery in Ho Chi Minh city (Asia and Pacific Region) - 1999: Japanese expert developed the technique of treatment of lumbar hernia. - 2000 up to now: He-Ne LASER, CO2 LASER, diode LASER, YAG-KTP LASER, pulsed dye LASER, copper vapor LASER, excimer LASER…, have been using in dermatology, surgery, dentistry, ophthalmology in the whole country. In dermatology, the CO2 LASER and He-Ne LASER are available in skin disease units at provincial level. They are used to treat mainly skin conditions such as warts, acne, keratosis, condyloma accuminata. At the national level, NIDV is equipped with the most advanced laser technology including carbon dioxide laser, the YAG-KTP LASER, copper vapor LASER... for removal of birthmarks, facial scar removal, resurfacing, and skin peeling... (1) Director of National Institute of Dermatology Venereology (NIDV). (2) President of Ho Chi Minh Association of LASER medicine and surgery.
W-29 HISTORY OF LASER MEDICINE AND SURGERY (LMS) IN FRANCE J Abitbol
W-30 HISTORY OF LASER MEDICINE AND SURGERY (LMS) IN HUNGARY A Mester
W-31 HISTORY OF LASER MEDICINE AND SURGERY (LMS) IN SWEDEN J Tunér
W-32 HISTORY OF LASER MEDICINE AND SURGERY (LMS) IN AUSTRALIA R Chow
W-33 HISTORY OF EUROPEAN LASER ASSOCIATION VH Oswal James Cook University Hospital, Middlesbrough, UK
Introduction of Lasers in Clinical practice truly represented a modern multi-disciplinary tool involving a variety of skilled health care workers. In consideration of this, many national organisations were established for exchange and promotion of knowledge.
ABSTRACTS 259 LASER TOKYO 2009
Political and economic union of some European countries identified Europe as a regional power. Number of European member states steadily expanded. With such heightened regional activity, a concept of Europe-wide laser organisation was conceived and a formal European Laser Association (ELA) to represent a unified ‘European’ organ was born and christened (registered) in October 1991. ELA organised as well as sponsored a number of conferences. However, as the knowledge base widened, insti- tutions established their own in-house training programmes. The role of ELA to provide a forum for exchange of knowledge base was beginning to wear off. At the turn of the century, ELA went in to hibernation and remained a notional but defunct organisation. Advances in laser technology extended to aesthetics and skin rejuvenation with exponential growth. Due to relatively low powers used for this type of work, non-medical establishments such as beauty salons could also use this newer technology. Following demise of the USSR in 1989, the EU expansion took in a number of member states from the Eastern block countries. Many of these did not have an organised base for laser technology. The Executive Council of the ELA felt that there could be a need for resurrecting the original purpose of promoting the knowledge base to this ‘new look Europe’. The task of revitalisation is now complete, and the first Joint Conference is being held in 6-8 May 2010, at a Mediterranean resort town of Tarragona, Spain with participation of some six organi- sations from various European countries. Please log on to Laser Europe 2010 and come and join us for this momentous occasion.
260 Laser Tokyo 2009 PROGRAM & ABSTRACTS
Symposia
S-1-1 PHOTOTHERAPY FOR ATOPIC DERMATITIS M Ichihashi Doshisha University, Kyoto Japan; Morinomiya Medical College, Osaka, Japan; and Sun Care Institute, Osaka, Japan
Aims and Backgrounds: Atopic dermatitis (AD) is a common pruritic inflammatory skin disease with a relaps- ing-remmiting course. The etiology and pathogenesis of AD have not been fully elucidated. The importance of Th-2 cells occurs mainly in the acute phace, and that of Th-1 occurs in the chronic stage of AD. In this sympo- sium, we will try to evaluate the efficacy and safety of phototherapy for AD through survey of literatures and presentations of papers based on speakers clinical experiences. AD is commonly treated with topical use of corticosteroids and calcineurin inhibitors, but in cases resistant to conventional treatments, phototherapy is often chosen for the control of the disease. Results & Discussion: Around 30 years ago, PUVA (psoralen + UVA) was introduced to be an effective pho- totherapy for AD, based on the clinical observation of sunlight, although there are concerns regarding its long- term safety. Since then, many papers were reported showing clinical efficacy of various phototherapies for AD, but relatively few analytical and statistical studies were undertaken. Small amount of UVB irradiation induces antimicrobial peptides (AMPs) expression in normal human keratinocytes, longer UVB induces antigen-specific tolerance, whereas shorter UVB induces innate immunity, possibly to defend against pathogens without antigen specificity. Narrowband UVB can be used for chronic AD and UVA1 phototherapy may be useful for acute AD. For localized AD lesions, pulse-dye laser (595nm) was reported to be effective to reduce the severity of the dis- ease. LLLT has been used for AD and reported to be effective in some cases. More analytical studies are required for better use of LLLT for AD. Phototherapy is one of the promising treatments for AD, particulary for cases resistant to conventional treatments.
S-1-2 LOW REACTIVE LEVEL LASER THERAPY ( LLLT) IN PATIENTS WITH ATOPIC DERMATITIS (ADULT TYPE)-ORAL STEROIDS THERAPY AND TENDERNESS AT TENDER POINT SITES- A Shoji Department of Dermatology, Ikeda Kaisei Hospital, Osaka, Japan
Aims and background: We reported that the proportion of the effect was remarkably different between male and female. Upon this finding, we investigated what hinders the effect of SGL treatment for AD and the rela- tionship between skin symptoms (SS) and the tenderness at the tender point sites (TS) as well as between oral steroid therapy and SS and/or TS. Material and method: Patients with serious and moderate AD treated with or without oral steroid: Male 164 (range 12-74, average 24.2), female 194 (range 12-63, average 25.8), total 537 (range 12-74, average 25.2). Method All patients were treated with topical steroid and/or moisturinzing and antihistamines together with a treatment by using SGL (treatment of the patients with LUKETRON
ABSTRACTS 261 LASER TOKYO 2009
S-1-3 TREATMENT OF ATOPIC DERMATITIS WITH LOW REACTIVE LEVEL LASER THERAPY ON THE NECK IN THE REGION OF THE STELLATE GANGLION - CLINICAL APPLICATION S Fujisawa Fujisawa Dermatology Clinic, Tokyo, Japan
Aims and Background: Atopic dermatitis (AD) is improved and autonomic nervous system hypertonus is stabi- lized by applying low reactive level laser therapy to the neck in the region of the stellate ganglion (SG-LLLT). The treatment outcomes are similar to stellate ganglion block (SGB). We tested the effectiveness of SG-LLLT treatment of sympathetic nervous system instability and severe AD. Materials and Methods: 138 AD patients (64 males, 74 females) aged from seven to 74 years were chosen as study subjects. In addition to SG-LLLT, the patients were treated appropriately with improvements in lifestyle, pharmacotherapy, and narrow-band Ultraviolet B light treatment. The study subjects were not treated with cor- ticosteroids or tacrolimus. Results: Sympathetic nervous system hypertonus was reduced by SG-LLLT, and AD symptoms also improved. Conclusions: SG-LLLT is currently only an auxiliary therapy, but it stabilizes turgescent autonomic nerves in severe AD. Further development of SG-LLLT as physiotherapy for AD is expected in the future.
S-1-4 UV THERAPY IN ATOPIC DERMATITIS A Fukunaga, and C Nishigori Division of Dermatology, Department of Internal related, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
Aims and Background: It has been reported that UV therapy such as PUVA, narrow-band UVB and UVA1 ther- apy is effective for treatment of atopic dermatitis. According to 2009 guidelines for management of atopic der- matitis of Japanese Dermatological Association, UV therapy is available for steroid-resistant patients and patients who arose side effects following usual therapy. But the action mechanism of UV therapy is unclear and standardization of UV therapy for atopic dermatitis has not yet been established. Materials and Methods: To grasp the present situation how UV therapy is applied for atopic dermatitis, a ques- tionnaire survey about atopic dermatitis and UV therapy has performed in large-scale hospitals and private practices. The action mechanism of UV therapy has been examined with the fundamental experiments about skin dendritic cells. Results: Forty percent of dermatologists who replied the questionnaire applied UV therapy to the management of atopic dermatitis. Dermatologists from clinical experiences of thirty years up had a tendency not to use UV therapy for atopic dermatitis. Dermatologists who work in large facilities and examine many patients with atopic dermatitis usually have used UV therapy for atopic dermatitis. Narrow-band UVB therapy was the most common for outpatients. UV therapy was mainly applied for moderate or severe patients. The frequency of UV therapy was less than once a week in almost all dermatologists. The majority (approximate 70%) did not check MPD (minimal phototoxic dose) and MED (minimal erythema dose) before UV therapy. The reasons that UV therapy is inapplicable included the ineffectiveness of UV therapy, the precaution of photocarcinogenesis and the sufficiency with other usual therapies. Low dose of broad-band UVB radiation induced migration of Langerhans cells (LC) from the epidermis to draining lymph nodes, peaked 7days after the radiation. Low dose of broad-band UVB radiation also could suppress contact hypersensitivity, peaked 7 days after the radiation. The injection of LCs which migatated into draining lymph nodes 7days after UVB radiation could tranfer the immunosuppressive effect into naïve recipient mice. Conclusions: The standardization of UV therapy and the evaluation of safety of UV therapy for atopic dermatitis will be required to develop UV therapy. LCs after UVB radiation seem to act as immunnoregulatory cells and and the role of LCs may be involved in the effectiveness of UV therapy.
S-2-1 CLINICAL AND EXPERIMENTAL TRIALS TO PROMOTE WOUND HEALING AND SKIN FLAP SURVIVAL T Nakajima, and K Kishi Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
Scarless wound healing and augment skin flap survival are great concern in plastic surgeon as well as general clinician. We can achieve several animal experiments and draw useful results clinically. 1. Scarless wound healing. Ordinary cutaneous wounds leave scar formation. However cutaneous wounds made at a proper developmen-
262 Laser Tokyo 2009 PROGRAM & ABSTRACTS
tal stages regenerate completely without any alteration in the epidermal texture, provided that the wounds are made in utero prior to embryonic day (E) 13 in mice. In contrast, wounds created after E14 disrupt epidermal patterning and leave a flattened, glossy, visible mark. We found that mesenchymal stem cells and skin derived precursors have the potential to regenerate skin. These cells will be in clinical use to reduce scar in the near future. 2. Effect of low power laser on skin ulcer and skin flap survival. We irradiate diode laser and He-Ne Laser on dorsal surface of rat skin and rabbit ear. From our experiments, rapid epithelization was found on skin defect and survival area of skin flap is significant increased. 3. PGE1 and FGF We have applied prostaglandin E1 (PGE1) and basic fibroblastic growth factor (bFGF) onto the back of the rat skin flap. Both medicines cause an excellent increase in skin flap survival. These results were also confirmed clinically. These cause were regarded as direct action on improving microcirculation within the skin.
S-2-2 HOW THE EFFECTS OF LOW LEVEL LASER THERAPY ON THE NEUROENDOCRINE IMMUNE SYSTEM AFFECT WOUND HEALING: A REVIEW M Dyson Emeritus Reader in Tissue Repair Biology, Kings College London (KCL), Hertfordshire, London, University of London
Wound healing is controlled by the nerves, endocrine secretions and immune cells of the neuroendocrine immune system (NEIS). Shortly after injury cutaneous neural c-fibre activity and soluble protein mediators (SPMs), including cytokines secreted by cells of the immune system, initiate acute inflammation, an essential part of the wound healing process. Many SPMs are produced by cells of the skin-associated lymphoid tissue (SALT) and by blood-borne immune cells that originate in the bone marrow and enter the injured skin via its vasculature. These cells and the cutaneous c-fibres are readily accessible to photons and can be affected by them and therefore by low level laser therapy (LLLT). The components of the NEIS are linked by nerves and vessels, many of which are located in the skin and in the granulation tissue that develops in it during dermal repair. Photons have ready access to immune cells in transit through the cutaneous vasculature, where they can be absorbed by and modify the activity of some of these cells directly. For example, the release of SPMs can be stimulated. These SPMs and other hormones can be transported to and affect distant cells that have not been exposed to photons during LLLT. Both local (direct) and distant (indirect) changes can therefore be produced when intact and/or injured skin are exposed to LLLT. Investigations into the direct and indirect effects of LLLT on the SALT and other components of the NEIS will be reviewed. Some of the SPMs their cells secrete activate specific cell types while others attract to the injured skin defensive immune cells and stem cells that can differentiate into fibroblasts and other reparative cells. Published evidence supports the hypothesis that LLLT can affect both neural activity and the synthesis and release of SPMs, affecting wound healing. Different SPMs are required at different stages of healing; it is sug- gested that the appropriate selection of treatment parameters may affect their synthesis selectively.
S-2-3 THE PHOTOTHERAPY FOR WOUND HEALINIG AND SKIN REJUVENATION J Kubota Kubota Junichiro Clinic, Ikebukuro, Toshimaku, Tokyo, Japan
Aims and Background: Failing skin flaps still present plastic surgeons with major problems. My main studies have been into the effect of low energy diode laser on skin flap survival in the rat model. Low incident levels of near infrared diode laser energy at 830 nm have been shown an enhanced blood supply on the skin flap. Torpid skin ulcers are still a major concern for clinicians, and even when they are seriously affected patients still prefer to attend on an outpatient basis. Research has shown that a 1000 mW defocused 830 nm diode laser energy accelerate wound healing. All the ulcers healed rapidly and well with defocused laser therapy. Skin ulcers showed no tendency towards recurrence in long-term follow up. By the way, Nonablative skin rejuvenation has become a patient driven application in the aesthetic surgical field, and variety of approaches using various light sources has produced varying results, but in general patient’s satisfaction with the results, particularly with wrinkle reduction and skin condition. A new approach was recently evolved using a combination of bipolar radiofrequency (RF) energy with a near infrared light. It was hypothesized that this approach, combined with LED therapy, might produce better and more consistent results. Materials and Methods: The systems used were a combined IR/RF device and an LED system with 830 nm and 633 nm heads. Patients underwent once treatment with IR/RF: 90-100J X 7 times irradiations on the full face in
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one session per one month and LED. Subjective and objective assessments were made at baseline (pre-treat- ment) and at photography and patient’s assessment after the final treatment. Objective blinded and indepen- dent clinician assessment of the clinical photography scored the same. Results: Patient satisfaction index (excellent plus very good) was 75%, and overall efficacy (clinician excellent plus very good) was 80%. There were no adverse side effects reported by any patient, and all were pain-free during and after treatment. Conclusions: The combination of the RF/IR light system and LED phototherapy gave very good results with a robust follow-up over 8 weeks after the final treatment, and appears to be a safe, effective, pain-free and very well tolerated approach in non-ablative skin rejuvenation.
S-2-4 LLLT AND PHOTOTHERAPY ASSISTED HYDROGEL DRESSING IN WOUND HEALING JW Kim 1, and JO Lee 2 1: Best Well Institiue, Korean Medical Laser & Phototherapy laboratory & Department of Plastic Surgery, Seoul, Korea; and 2:Best Well Institiue, Department of Dermatology
Aims and Background: The aim of this article is to determine the benefit of light source to wound healing . As a result of the influence of fetal wound healing, recent trends in wound dressing have been Focus on wet con- dition. The other current focus on the wet condition .There are several research and clinical application of laser and light source in wound healing .And many light source applied for wound healing and disease. And the laser and light dosimetry by using autoflorescence NADH , Elastin, Collagen, Flavin and Hematophopirin For optic diagnosisof evaluation & color analysis ,OTC was useful compared to SEM, Biopsy Such as non photo- sensitizer PDT and light application technology such as avoid perfocused model of moto carlo simulation. Material and Method : We followed 100 patients who were treated with hydorgel and light therapy and whose wound surface area was less than 15% . 300 patients has deep second and 50 had third degree burn and other wounds. Fifty patient were admitted while the others received out patient treatment.About the patients between 2003 and May 2009, we treated 500 burn and trauma patients with hydrogel and new light source.Results: Seventy-four cancer lesions ≤ 1.0 cm in diameter and 21 lesions > 1.0 cm in diameter were identified. The CR rates were 94.0% and 90.4% (19/21), respectively. For large tumors or deeply invasive tumors such as nodular-type lesions, NPe6-PDT was capable of destroying the residual cancer lesions after mass reduction using electrocautery. Results: The mean healing period for deep second degree burn was 10 days and third degree burn was 17 days. So the hospitalization required for these patients was reduced. The wound dressing method was very simple and used light source for 10 min. Compared gel dressing only this combined dressing produced more natural and healthy tissue withot psoriasis and dyschromia. Conclusions: The combination dressing described seem to have many advantages for Asian Patients, who are more apt to have complications such as scarring hyperpigmentation and hypopigmentation compared to west- ern patients. A combination of various kinds of laser or light sources and a wet hydrogel dressing in children and unmarried young women to reduce the donor site morbidity and operation risk. And in skin graft patients they provide a more natural skin ccolor appearance as well as hair function and skin tonicity.
S-3-1 CANCER DIAGNOSIS OBSERVING AUTOFLUORESCENCE FROM CANCER LESION Y Ohsaki, K Shibukawa, T Sasaki, S Okumura, and M Kitada Respiratory Center, Asahikawa Medical College, Hokkaido, Japan
Improvement of detection rate of central type early lung cancer by using an autofluorescence bronchoscopy (AFB) has been reported. AFI (Olympus), SAFE-3000 (Pentax) are available in Japan. However, AFB systems require skill to make accurate diagnosis of the bronchial wall because those systems use a black and white CCD. We developed a new fluorescence endoscopic system, PDS-2000 (Hamamatsu Photonics) with a sensitive color ICCD which enables real-time color fluorescence observation of the bronchus. The difference among those systems will be discussed. To determine whether autofluorescence observation using PDS-2000 improve the accuracy in central type lung cancer diagnosis comparing to the conventional white-light bronchoscopy (WLB), we performed a clinical trial. WLB followed by AFB using PDS-2000 was performed in 72 subjects with bronchial cancer or those with high risk for bronchial cancer. Biopsy specimens were taken from all sites which were considered to be abnormal by WLB as well as by the PDS-2000 observation. Findings of bronchial wall by WLB as well as by PDS-2000 were classified into four classes, normal, suspect of abnormal, abnormal and artifact. The Pathological findings were evaluated by the pathologists and classified into nine classes, normal, inflammation, metaplasia, mild dys- plasia, moderate dysplasia, severe dysplasia, carcinoma in situ, carcinoma and unclassified. The sensitivity was compared between WLB and PDS-2000. The pathological diagnosis of 246 biopsy specimens were carcinoma
264 Laser Tokyo 2009 PROGRAM & ABSTRACTS
in 22, severe dysplasia in 12, moderate and mild dysplasia in 4, metaplasia in 51 and normal or nonspecific findings in 157. The sensitivity of WLB and AFB with PDS-2000 in the detection of severe dysplasia or cancer was 58.8% and 82.4%. The difference was statistically significant. These results of our trial will be discuused. Our AFB system, PDS-2000, enables color observation of autofluorescence from human body including normal bronchail wall and bronchial cancer. We noticed that cancer lesion in the bronchus was found as region with red autofluorescence against green autofluorescence back-ground from normal bronchail wall. Therefore, we mesured the wavelength of the autoflurescence using a fluorospectrometer through the biopsy channel of the endoscope. The results of this study will be disscussed.
S-3-2 OUTCOME OF PHOTODYNAMIC THERAPY USING NPE6 FOR CENTRALLY LOCATED LUNG CANCER GREATER THAN 1.0cm IN DIAMETER J Usuda, S Ichinose, T Ishizumi, H Hayashi, K Ohtani, S Maehara, K Furukawa, T Okunaka, H Kato, and N Ikeda Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan
Aims and Background: Most centrally located early lung cancers (CLELC) less than ≤ 1.0 cm in diameter do not invade beyond the bronchial cartilage, and photodynamic therapy (PDT) is recommended as a treatment option for such lesions. NPe6, a second-generation photosensitizer, has a longer absorption band (664 nm) than Photofrin (630 nm); therefore, we hypothesized that NPe6-PDT might exert a strong anti-tumor effect for cancer lesions greater than > 1.0 cm in diameter, which are regarded as extracartilaginous invasions and are not considered suitable for treatment with Photofrin-PDT. Materials and Methods: Between June 2004 and December 2008, 75 patients (91 lesions) with CLELC under- went NPe6-PDT after the extent of their tumors had been assessed using fluorescence bronchoscopy for photo- dynamic diagnosis (PDD) and the depth of their tumors had been assessed using optical coherence tomogra- phy (OCT). Results: Seventy-four cancer lesions ≤ 1.0 cm in diameter and 21 lesions > 1.0 cm in diameter were identified. The CR rates were 94.0% and 90.4% (19/21), respectively. For large tumors or deeply invasive tumors such as nodular-type lesions, NPe6-PDT was capable of destroying the residual cancer lesions after mass reduction using electrocautery. Conclusions: NPe6-PDT has a strong anti-tumor effect against CLELC > 1.0 cm in diameter that have invaded beyond the bronchial cartilage, enabling residual cancer lesions of large nodular or polypoid type-lung cancer that persist after mass reduction using electrocautery to be destroyed. Therefore, the PDT guidelines for lung cancers should be revised, and NPe6-PDT might enable an expansion of the clinical indications.
S-3-3 EARLY DETECTION OF BRONCHIAL LESIONS USING AUTOFLUORESCENCE BRONCHOSCOPY AND OPTICAL COHERENCE TOMOGRAPHY H Honda Department of Thoracic Surgery Tokyo Medical University, Tokyo, Japan
S-3-4 MANAGEMENT OF MULTIPLE PRIMARY LUNG CANCER PATIENTS WITH CENTRALLY LOCATED EARLY CANCER LESIONS K Ohtani 1, J Usuda 1, S Ichinose 1, T Inoue 1, S Maehara 1, M Yamada 1, S Ono 1, H Tsutsui 1, K Furukawa 2, T Okunaka 3, H Kato 1, and N Ikeda 1 1:Department of Thoracic Surgery, Tokyo Medical University, Tokyo, Japan; 2:Department of Thoracic Surgery, Tokyo Medical University Ibaraki medical center; and 3:International University of Health and Welfare, Sannou Hospital respiratory center
Background: Patients with centrally located early lung cancer (CLELC) are often heavy smokers with a consid- erably high risk of multiple lung cancer lesions (MPLC); treatment strategies for such patients must preserve the cardiopulmonary function. Methods: Between June 2004 and June 2008, patients with CLELC underwent PDT using NPe6, second-genera-
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tion photosensitizer at Tokyo Medical University Hospital. Among these patients, we retrospectively analyzed MPLC which were treated by surgery plus PDT or PDT alone, and examined the effectiveness of PDT and we propose a treatment strategy for patients with MPLC. Results: A total of 64 patients with CLELC received NPe6-PDT, and MPLCs were observed in 22 patients (34.4%). Among the patients with MPLC, 10 patients underwent surgery (9 lobectomies and 1 pneumonectomy) for primary lung cancer and then underwent NPe6-PDT for the treatment of secondary primary CLELC. In 8 of these 10 patients, CLELC was found as metachronous lesions using sputum cytology and a bronchoscopical examination using autofluorescence bronchoscopy. In 11 of the 22 patients, all 28 lesions were CLELC and identified by autofluorescence bronchoscopy and were performed PDT alone. Among the 22 patients with MPLC including peripheral type lung cancres which were resected by surgery, all 39 CLELC lesions exhibited a complete response after PDT, and all patients were alive. Conclusions: For lung cancer patients with a long-term history of smoking, careful follow-up examinations after surgical resection are needed considering the incidence of metachronous primary lung cancers. PDT can play an important role for the treatment strategy for MPLC.
S-4-1 COMBINATION THERAPY OF PDT WITH PROTON IRRADIATION N Miyoshi 1, Y Fukunaga 1, K Kume 2, and E Minehara 2 1: University of Fukui, Fukui, Japan; and 2:Wakasa-wan Energy Research Center
It is very important to cure the tumor patients to recover completely the tumor. It is useful method for it to combine the other therapies, for example, the laser irradiation with proton beam, which is a new combination therapy for the prostate cancer. We prepared the prostate cancer animal model (PC-3/BALB-c-nu/nu) and irradiated the model changing the sequence of laser and proto beam. The therapeutic effect was good results when the laser irradiated after the proton beam to decrease completely and no recurred of tumor.
S-4-2 NEW TRENDS FOR THE APPLICATION OF LASER LIGHT IN MEDICINE: EXPERIMENTAL CONFIGURATIONS FOR MULTIPHOTON LIFD AND PDT G Graschew, TA Roelofs, S Rakowsky, and PM Schlag Surgical Research Unit OP 2000, Experimental and Clinical Research Center, Max-Delbrueck-Center for Molecular Medicine, and Charité - University Medicine Berlin, Campus Berlin-Buch, Berlin, Germany
Aims and Background: Multiphoton excitation of photosensitizers (PS) for laser-induced fluorescence diagnosis (LIFD) and photodynamic therapy (PDT) of tumours is principally realised by the application of short (fs) laser pulses with sufficient high photon density of approximately twice the wavelength of the single-photon absorp- tion of the PS. Multiphoton excitation of the PS exhibits various advantages over single-photon excitation, such as a higher penetration depth of the laser light into the tissue, less photobleaching of the PS and reduced non- specific tissue damage. Various modular configurations have been designed, developed and implemented that solve the experimental bottle-necks for the applications of multiphoton LIFD and PDT. This also includes an evaluation of the applicability of photonic crystal fibres for beam delivery of fs pulsed laser light. Materials and Methods: Multiphoton excitation is done with a fs Ti:Sa laser (Spectra Physics Tsunami; pulse duration 100-200 fs FWHM, repetition rate 82 MHz, average power 0,5-0,75 W, wavelength range 780-820 nm). Two-photon photodynamic activity of mTHPC-CMPEG4 upon excitation with 150 fs pulses at 780 nm wave- length served as a test for the functionalities and the optimisation of the various configurations. Results: The optical core of the various configurations consists of either an inverted microscope (Zeiss Axiovert 100) for cellular samples or a surgical microscope (Leica Wild M680) for tissue samples. A special unit scans the focussed laser beam over the sample to allow for homogeneous irradiation of sufficient photon density. A single photon camera with image intensifier (Hamamatsu C2400) allows for detection and imaging of the very low fluorescence levels. The Spectral Cube System (Applied Spectral Imaging) enables wavelength-resolved imaging (spectral range 400-1000 nm, resolution 6 nm). The modular character of the various configurations allows for multiple functionalities and the simultaneous acquisition of intensity- and wavelength-resolved images. Conclusions: The realised experimental configurations allow for further investigation of the various photophysi- cal, photochemical and cellular aspects to characterize and optimise multiphoton LIFD and PDT. Future devel- opments include the application of multiphoton excitation regimes for nanoparticles as well as the advance- ment of multimodal imaging strategies.
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S-4-3 ONE OF THE POSSIBLE MECHANISMS OF DECELERATION OF TUMOR GROWTH IN ONCOLOGICAL PATIENTS BY LOW POWER VISIBLE AND NEAR IR LIGHT AA Zimin, NA Zhevago, and KA Samoilova Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia
Aims and Background: To study the growth promoting (GP) activity of blood serum in breast cancer (BC) patients after a course of phototherapy with polychromatic VIS + nIR light as to human tumor and normal cells as targets. Materials and Methods: 19 patients with BC of I-II stages before and after mastectomy were randomly divided into 2 groups. The 1st (control) group (n=8) was given the conventional postoperative wound cure. The 2nd group (n=11) additionally obtained daily irradiations of lumbosacral region with polychromatic light (Swiss phototherapeutic device Bioptron-2, 480–3400 nm, 40 mW/cm2, 12 J/cm2). As target cells were used: strains of the human BC cells (Hs578T, BT474, HBL-100) and the human epidermoid carcinoma cells (A431) as well as 2 strains of human fibroblasts (FB) and keratinocytes (KC). Cells were cultured in 96-well clusters at 37ºC, 5% CO2 and 95% humidity in standard nutrient medium with the addition of 10% fetal calf (FC) serum. After 2 to 3 days of cultivation the medium was replaced with fresh medium containing serum of BC patients (2.5%) taken in three consecutive terms: one day before and one day after mastectomy, and 7 days after postoperational phototherapeutic course. On the 3rd or 4th day of growth cells were counted using a colorimetric method (Kueng and Mosman, 1989). Optical density of the dye absorbed by cells reflected the cell number and was used as an indicator, on one hand, of the cells proliferative activity, and, on the other hand, of the GP potential of the blood serum added to the medium. Results: Phototherapeutic course enhances GP activity of the BC patient's serum as to FB and KC by 11% and 15% respectively, however, statistically significantly downregulates this activity as to BC cells and A431 cells on average by 14% and 6%, respectively. If the former may explain the light-induced wound healing acceleration, the letter may represents one of the possible mechanisms by which polychromatic VIS + nIR light can inhibit tumor progression and metastasis dissemination. Conclusion: These data bring an important evidence for oncological safety of polychromatic VIS + nIR light and may contribute to broader application of this radiation in clinical medicine including oncology.
S-4-4 NOVEL NON-THERMAL ELECTRICAL BLOCKADE BY PHOTOSENSITIZATION REACTION: APPLICATION OF PHOTODYNAMIC THERAPY FOR ARRHYTHMIA THERAPY T Arai 1, A Ito 1, S Miyoshi 2, and S Takatsuki 2 1: Department of Applied Physics, Faculty of Science and Technology, Keio Univ., Yokohama, Japan; and 2: Division of Cardiology, School of Medicine, Keio Univ.
Aims: To develop non-thermal myocardial electrical blockade to suppress severe complications in RF ablation, we aimed to apply photosensitization reaction based therapy, i.e., photodaynamic therapy, to treat arrhythmia. Background: Photodynamic therapy (PDT) is well-known selective cancer therapy modality. In the other hand, basic research on tumor microcirculation reveals an essential problem in this therapy because of vascular shu— off during PDT. Our idea is to select normal blood circulation tissue (i.e., myocardial tissue) instead of tumor tissue as a target of PDT. Meanwhile, electrical blockade of myocardial tissue by Radio-freqency current, RF abalation, has been used as an arrhythmia therapy. Thermal severe complications such as cardial tamponade, pulmonary vein stenosis, and esophageal fistula occur 3% of RF ablation treated atrial fibrillation patients. Non- or less thermal modality for electrical blockade of myocardial tissue should be developed. Our idea was to use PDT to myocardial tissue for electrical blockade modality. Non-thermal characteristics of photosensitization reaction gives excellent benefit on myocardial electrical blockade procedure. Moreover, myocardial blood circulation may make stable/homogeneous PDT effect. In our method, the photosensitizer selective accumulation is not available, so that, we used short interval of typically 30min after the injection. PS dose may be reduced in the case of this short interval PDT procedure. Materials and Methods: We used talaporfin sodium (Meiji-seika kaisha, Tokyo) as a PS. This PS may be the best for this application because of efficient singlet oxygen generation and fast excretion time. 1) We investigated mechanism of electri- cal blockade using PDT, in vitro, ex vivo. A laser scanning confocal microscope was used. 2) We demonstrated myocardial electrical blockade on; a) rat heart, b) pig heart, from surgical approach of laser delivery. 3) We demonstrated interventional electrical blockade using a pig tricuspid valve (TV) model. In this interventional approach, we used newly developed steerable thin laser ablation catheter with a X-ray fluroscopic equipment under electrophysiological measurement by means of a Halo-catheter and a multi-channel electrophysiological measurement system. Results: We revealed immediate electrical blockade by ion channel injury, then cell membrane was damaged.
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Myocardial cells became to complete necrosis. In rat and pig in vivo chronic model, we obtained permanent electrical blockade. In acute animal model in vivo, ex vivo, we demonstrated immediate electrical blockage within 10-20s. These performance reveals applicability of this PDT treatment for AF therapy. Conclusion: We think our non-thermal PDT myocardial electrical blockade might become 2nd generation AF treatment system.
S-5-1 MECHANISM OF INACTIVATION OF NEURAL ACTIVITY IN LLLT Y Kataoka Riken Center for Molecular Imaging Science, Kobe, Hyogo, Japan
Aims and background: Low-reactive level laser therapy (LLLT) has been used for pain relief. Some basic researches indicated that such a photo-dynamic effect is brought about by suppression of neural activity, although the precise mechanism has remained unknown. We studied cellular mechanism of inactivation of neural activity in LLLT with a near-infrared diode laser (continuous wave; wavelength, 830 nm), by applying electrophysiological and biochemical techniques to rodent experimental models. Materials and Methods: In order to study the effect of laser irradiation on neural activity including neuronal membrane functions and synaptic transmission, we performed patch clamp study in cultured rat hippocampal neurons and extracellular recording of field excitatory postsynaptic potential in rat hippocampal slices. Single unit recording in the auditory cortex in vivo was also performed in gerbils. Content of adenosine triphosphate (ATP) in the parietal cortex of rat brain was assayed by the luciferase-luciferin method. In these studies, the nervous tissues or neurons were irradiated with the near-infrared diode laser (diameter of irradiated spot, 2-3 mm; power density, 1-5 W/cm2) for 10-15 min. Results: We observed that the near-infrared laser irradiation reversibly inactivated synaptic transmission in the central nervous system of rodents. In the study with patch clamp technique, the laser irradiation induced hyperpolarization of the membrane potential and reduction of input membrane resistance in cultured neurons. Biochemical analysis of the content of ATP revealed that the laser irradiation increased ATP in the neural tis- sue. Furthermore, laser irradiation failed to suppress synaptic transmission under application of a chemical agent opening ATP-sensitive potassium channels. Conclusions: Our electrophysiological and biochemical studies suggested that activation of ATP-sensitive potas- sium channels in neurons is involved in the cellular mechanism of LLLT using the near-infrared diode laser. LLLT is expected to be applied to the treatment for neurological disorders in the central nervous system, besides that in the peripheral tissues.
S-5-2 PHOTOTHERAPY IN PERIPHERAL NERVE INJURY FOR MUSCLE PRESERVATION AND NERVE REGENERATION S Rochkind Division of Peripheral Nerve Reconstruction, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Israel
Background: Posttraumatic nerve repair and prevention of muscle atrophy represent a major challenge of restorative medicine. Considerable interest exists in the potential therapeutic value of laser phototherapy for restoring or temporary preventing denervated muscle atrophy as well as enhancing regeneration of severely injured peripheral nerve. Methods: Low power laser irradiation (laser phototherapy) was applied for treatment of rat denervated muscle in order to estimate biochemical transformation on cellular and tissue levels, as well as on rat sciatic nerve model after crush injury, direct or side-to-end anastomosis and neurotube reconstruction. Nerve cells’ growth and axonal sprouting were investigated on embryonic rat brain cultures. The animal outcome allowed clinical double-blind, placebo-controlled randomized study which measured the effectiveness of 780-nm laser pho- totherapy on patients suffering from incomplete peripheral nerve injuries for 6 months up to several years. Results: In denervated muscle, animal study suggests that function of denervated muscles can be partially pre- served by temporary prevention of denervation–induced biochemical changes. The function of denervated muscles can be restored, not completely but to a very substantial degree, by laser treatment, initiated at the earliest possible stage post-injury. In peripheral nerve injury, laser phototherapy has a protective and immediate effect, it maintains functional activity of the injured nerve, decreases scar tissue formation at the injury site, decreases degeneration in corre- sponding motor neurons of the spinal cord and significantly increases axonal growth and myelinization.In cell cultures, laser irradiation accelerates migration, nerve cell growth and fiber sprouting. In a pilot, clinical, double-blind, placebo-controlled randomized study in patients with incomplete long-term peripheral nerve injury, 780-nm laser irradiation can progressively improve peripheral nerve function, which leads to significant functional recovery. Conclusions: Laser phototherapy temporarily preserves the function of a denervated muscle, accelerates and enhances axonal growth and regeneration after peripheral nerve injury or reconstructive procedure. Laser acti-
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vation of nerve cells, their growth and axonal sprouting can be considered as potential treatment of neuronal injury. Animal and clinical studies show the promoting action of phototherapy on peripheral nerve regenera- tion, which makes it possible to conclude that the time for broader clinical trials has come.
S-5-3 PHOTODYNAMIC MEDICINE IN NEUROSURGERY S Kaneko Kashiwabara Neurosurgical Hospital, Hokkaido, Japan
Photodynamic medicine such as photodynamic diagnosis ( PDD) , fluorescence guided tumor resection ( FGR) and photodynamic therapy (PDT) using low level laser and photosensitizer are currently undergoing intensive clinical investigations as adjunctive treatment for malignant brain tumors. Photodynamic medicine is very promising for the treatment of malignant brain tumors. We have applied to 295 brain tumor patients for photodynamic diagnosis and 63 malignant brain tumor patients for photodynamic ther- apy. Especially, We have applied photodynamic therapy following fluorescence guided tumor resection for 11 patients with malignant glioma at or near the eloquent brain areas and spinal cord malignant glioma We have gotten a good prognosis and are able to minimize the neurological deficit of these patients by this method. I would like to talk on clinical results of this study and the current overview of photodynamic medicine in neu- rosurgery.
S-5-4 EFFECTS OF LOW-POWER LASER IRRADIATION ON THE PAROXYSMAL DISCHARGE THRESHOLD IN THE RABBIT HIPPOCAMPUS S Kogure, K Kozuka, and M Kakuno Department of Bioengineering, Graduate School of Engineering, Soka University, Tokyo, Japan
Aims and Background: In frog sciatic nerves, Ar+ low-power laser irradiation (LLI) selectively blocked the gen- eration of anode break excitation. Since anode break excitation is associated with membrane hyperpolarization, we tested an h current (Ih) blocker, ZD7288, instead of laser irradiation and obtained almost the same results (Y. Matsuda et al. LSM, 2006). We have demonstrated that Ih blockers (CsCl and ZD7288) increase the paroxys- mal discharge threshold (PADT) in the rabbit hippocampus CA1 (M. Kitayama et al. Epilepsia, 2003). Taking the similarity of effects between Ih blockers and LLI into consideration, the present study examined the effects of LLI on PADT in rabbit hippocampus CA1 to clarify the possibility of using LLI to develop a novel treatment of epileptic disorders. Materials and Methods: Forty-two adult male rabbits were used. The animals were anesthetized with intra- venous pentobarbital sodium, immobilized with intravenous and intramuscular D-tubocurarine, and placed in a stereotaxic apparatus on artificial respiration. A pair of concentric electrodes was implanted into the CA1 region: the right anterior electrode was used for stimulating and LLI. The stimulus train for inducing the parox- ysmal discharge was 1-ms pulses of 50 Hz for 1 s. The diode laser (532 or 808 nm; 50-100 mW) was introduced into the CA1 apical dendritic layer with an optical fiber (125 Ȑm), where Ih channels occur in higher density than the soma. We measured PADT before and after LLI. Results: The average PADT was 185±10 ȐA (mean±SE; n=24) before LLI. After 10 min LLI (532 nm) of 50, 75 and 100 mW, PADT magnitudes increased to 111±14 (n=8), 138±19 (n=9; p<0.05) and 195±24 % (n=11; p<0.01), respectively. The PADT increment was maintained at least for 16.3 hrs. After 10 min LLI (808 nm) of 50 and 100 mW, PADT showed almost no changes such as 110±21 (n=3) and 102±5 (n=3), respectively. In both LLI applications, the temperature near the right anterior electrode increased 1.0-2.6 ˚C, whereas the histological damage was microscopically confirmed to be nothing. Conclusions: We conclude that LLI with 532 nm and 75-100 mW has a potential to suppress the generation of paroxysmal discharge in the rabbit hippocampus CA1.
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S-6-1 MODIFIED PHOTODYNAMIC THERAPY (PDT) USING PHOTOFRIN WITH EXCIMER-DYE LASER FOR EARLY GASTRIC CANCER IN ELDERLY PATIENTS T Nakamura 1, T Oinuma 2, H Yamagishi 2, H Hiraishi 2, H Masuyama 3, and A Terano 4 1: Department of Medical Informatics, Dokkyo Medical University School of Medicine, Tochigi, Japan; 2: Department of Gastroenterology, Dokkyo Medical University School of Medicine; 3: Masuyama Gastrointestinal Clinic; and 4: The President, Dokkyo Medical University
Aims and Background: Photodynamic therapy (PDT) is based on the theoretical principle: the specific low level laser light irradiation activates a photosensitizer which is selectively concentrated in rapidly proliferating tissues including malignant tumor cells, resulting in selective necrosis by the intracellular singlet oxygen from photo- chemical reaction. PDT using porfimer sodium (Photofrin) with excimer-dye laser (EDL) is approved in Japan. These indications for gastrointestinal (GI) cancers are limited to superficial esophageal and early gastric cancer not indicated for other curative treatments. Meanwhile, endoscopic mucosal resection (EMR) is considered the first choice of treatment for intra-mucosal GI cancers especially for young patients. Thus PDT has been consid- ered as an alternative treatments for GI cancers in elderly patients such as recurrent cancer after other treat- ments; however, its efficacy was relatively limited. Therefore, we have designed a new therapy called Modified PDT. The major points of Modified PDT are as follows. 1. Irradiation of EDL is applied to the lesion not only 48 but also 72 hours after Photofrin injection. 2. When the cancer is polypoid type, partial resection of the can- cer is performed before irradiation. 3. Before the second irradiation, necrotic tissue covering the surface of the lesion is removed. In this study, we describe the efficacy of Modified PDT using Photofrin with EDL for early gastric cancers in elderly patients which are not suited for EMR or surgery. Materials and Methods: Irradiation of EDL (60 to 80 Hz, output 4 mJ) was applied not only 48 but also 72 hours after Photofrin (2 mg/kg) injection. Before the second irradiation, necrotic tissue covering the surface of the tumor was removed. The procedure of Modified PDT was carried out on 17 patients (mean age 74.3 years) with 28 cancerous lesions (including 2 esophageal squamous cell carcinomas). Written informed consent was obtained from all patients and their families. Complete response (CR) was defined as: there was no evidence of residual and/or recurrent cancer cells by endoscopic observation and biopsy over 24 months after PDT. Results: CR was achieved in 24 of 26 (92.3%) lesion of gastric cancers and 2 of 2 lesions of esophageal cancers. In total, CR was achieved in 15 of 17 (88.2%) patients. Serious complication was not occurred. Conclusions: Modified PDT is remarkably effective in the treatment for early gastric cancer in elderly patients.
S-6-2 LASER IN COLOPROCTOLOGY BK Rau, and S Krishna Dept. of Gastroenterology, Billroth Hospital R A Puram, Chennai, India
Laser energy has been used in colo proctology through the colonoscope and in open surgery of peri anal lesions. The video colonoscope can be passed up to the ileo caecal junction and into the terminal ileum for about 20cms routinely. Hence laser energy can be delivered to mucosal lesions of entire colon and terminal ileum. The lesions amenable are bleeders and tumors. The common causes of colonic bleedings are tumors (benign/ malignant) diverticular disease, ulceration (tubercle, amoebic, solitary rectal ulcer) haemorrhoids, fis- sure in ano, AV malformation, angiodysplasia and post radiation procto colitis. Malignant tumor bleed is con- trolled by surface photo coagulation using non contact mode delivery of laser energy to the ulcerated bleeding area. Benign tumors are ablated at one sitting (e.g. Polyps, villous adenoma, suture line grannulomas and recurrence of cancer). The AV malformations cause intermittent colonic bleed. Colonoscopy can localise the lesion by the color change. Selective angiogram, DSA delineates the extent of lesion and presence of other AV malformation. In advanced cancer of colon causing intestinal obstruction laser can burr a hole through the tumor tissue and relieve large bowel obstruction. This avoids emergency colostomy. Patient can be evaluated for definitive surgery. If the lesion is resectable, one stage surgical resection procedure can be carried out. If the disease has spread, the luminisation of colon obviates colostomy. The patency of lumen is maintained by a self expanding metal prosthesis across the tumor tissue. The syndrome of benign solitary rectal ulcer is some- thing of an enigma. The accepted patho physiology is that of a perineal descent syndrome associated with abnormal sphincter tone leading to ulceration as a result of the passage of hard feces, Since solitary rectal ulceration is limited to the mucosal and sub mucosal layers it was felt that laser excision / photocoagulation of the ulcerated area removes the fibrotic layer in the floor of the ulcer. The raw surface is covered by new mucosa, with relief of the symptoms. This procedure does not entail any surgical correction or anal dilatation. Open Surgery: In peri anal lesions, laser surgery has great advantage in that blood loss is minimal and post operative pain is insignificant. In peri anal surgery, hemorrhoids ,fistulae and fissures, the procedures are done as an out patient procedure under local anesthesia. The post operative pain is significantly reduced. In compli- cated fistulae laser surgery provides bloodless field to dissect the branching tracts of fistulae. A novel method of introducing the laser fiber into the fistulous tract and ablating the epithelium of tract without excision of the tract is reported with good results. Another important step in peri anal fistula management is the ablation of the
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pathological anal gland with laser energy without excision of track in low level fistulae, making this procedure a minimally invasive one.
S-6-3 PHOTODYNAMIC THERAPY FOR ESOPHAGEAL, GASTRIC AND DUODENAL CANCERS Y Nishiwaki, Y Ikematsu, T Kanai, K Hirayama, H Tamura, and T Hayashi Dept. of Surgery, Hamamatsu Medical Center, Shizuoka, Japan
Aims and Background: Although operative techniques and perioperative patient care have been greatly devel- oped, there are still some patients who are inappropriate for surgical therapy. On the other hand, very early- staged cancers are being detected due to advancement of diagnostic techniques and surveillance system. This time we evaluated the value of photodynamic therapy (PDT) for upper gastrointestinal cancers in our depart- ment during the recent 13 years. Subjects & Methods: We applied PDT to 4 esophageal cancers, 37 gastric cancers and one duodenal cancer, who had been excluded from endoscopic resection and/or were poor-risk for surgical resection. Four gastric patients who had not been cured by endoscopic resection were included. Endoscopic resection was suitable for small, mucosal and well-differentiated adenocarcinoma without ulceration. PDT consisted of polyhemato- porphyrin ether/ester administration (Photofrin, 2 mg/Kg) and pulsed excimer-dye laser irradiation at 630 nm 48 hours (and 96 hours) after sensitization. Results: Our definition of complete response (CR) was endoscopically and pathologically cancer-free at three months after the therapy. Two out of three early esophageal cancers and one early duodenal cancer obtained CR. The CR rates of early gastric cancer were 85% (22/26) in mucosal cancer and 50% (4/8) in submucosal can- cer. Six out of 8 gastric patients who did not obtain CR underwent surgical resection. Argon plasma coagulator was used in one patient with heart-failure because of her refusal of the second PDT. Photofrin-PDT was repeat- ed 6 times in one patient due to his poor respiratory and renal function. One esophageal patient and all three gastric patients with an advanced cancer obtained PR. There were no serious side effects except skin photosen- sitivity. Conclusions: Photofrin-PDT was a very effective modality for upper GI cancers, because we obtained the high CR rate despite applying PDT to those who were excluded from endoscopic resection, or had not been cured by radiation therapy or endoscopic treatment. Although it is difficult to gain CR in advanced cancers, it is pos- sible to improve quality of the patients' life by controlling local lesions using PDT. In order to improve the CR rate of PDT, we emphasize the importance of diagnosing lesions accurately and irradiating laser to them suffi- ciently.
S-6-4 GASTRIC CANCER SPECIFIC PORPHYRIN ACCUMULATION H Matsui Graduate School for Comprehensive Human Sciences, University of Tukuba, Ibaraki, Japan
[Introduction] Policard reported the tumor specific porphyrin accumulation in 1924. Utilizing this phenomenon, Dougherty proposed a photodynamic therapy (PDT) with hematoporphyrin (HP) in 1979. Moreover, Kennedy proposed a new PDT method with aminolevulinic acid (ALA), a precursor of heme biosynthesis. However, mechanisms of these cancer specific porphyrin accumulations still remain unknown. We have been continu- ously investigating these mechanisms in vitro system with a rat gastric epithelial cell, RGM1 and its tumorigenic mutant RGK-1. Recently, we have gotten several evidences to prove Nitric Oxide (NO) induced these phenom- ena. I would like to propose a possible mechanism of cancer specific porphyrin accumulation after both the ALA and the HP treatment in this lecture. [Study 1: porphyrin accumulation after the ALA] Gastric cancer cells emitted porohyrin specific fluorescence 3hours after 1 mM ALA treatment. HPLC analysis revealed this fluorescence was indicative of protoporphyrin, the last precursor in heme biosynthesis. We investigated to find that a ferrocheletase activity particularly decreased in cancer cells. Since the active-site of the enzyme, an iron-sulfur-cluster (ISC), should irreversibly react with NO to be inactivated it, we hypothesized that cancer specific high concentration of NO plays an important role to induce this phenomenon. To elucidate this hypothesis, we examined intracellular NO concen- trations in each cell, treated cells with a chemical NO donor, and inserted NOS2 (iNOS) cDNA in a normal cell to induce high NO conditions. In cancer cells, the NO concentration was higher than that of the normal cell. The NO donor treatment induced a cancer cell specific increase of fluorescence. The NOS2 DNA insert resulted that the cell emitted porphyry fluorescence. Moreover, we investigated whether dinitrosyl dithiolate iron com- plex (DNIC), a molecules induced by the reaction between NO and ISC, was formed in each cells or not, and found that it particularly formed in cancer cells. We thus concluded that NO induced cancer specific fluores- cence. [Study 2: porphyrin accumulation after the HP] As described above, cancer specific porphyrin accumulation was well known since 1924, the mechanisms of this phenomenon still remain unknown; on the contrary, the cellular mechanisms of heme/ porphyrin transport are not revealed. In 2005, a new heme transporter, Heme-
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Carrier-Protein-1 (HCP-1) was reported. This protein is located in intestinal epithelial
S-7-1 MITOCHONDRIAL SIGNALING IN MAMMALIAN CELLS ACTIVATED BY RED AND NEAR IR RADIATION T Karu Institute of Laser and Information Technologies of Russian Acad. Sci,Troitsk, Moscow Region, Russian Federation
Mitochondrial signaling is an information channel between mitochondrial respiratory chain and the nucleus for the transduction signals regarding the functional state of the mitochondria. The present contribution examines the question whether radiation of visible and near IR (IR-A) radiation can activate this retrograde-type cellular signaling pathway. Experimental data about modulation of elements of mitochondrial retrograde signaling by the irradiation (mitochondrial membrane potential delta psi, reactive oxygen species, calcium ions, nitric oxide, fission-fusion homeostasis of mitochondria) are reviewed. The terminal enzyme of the mitochondrial respirato- ry chain cytochrome c oxidase is considered as the photoacceptor. Functions of cytochrome c oxidase as a sig- nal generator as well as a signal transducer in irradiated cells are outlined.
S-7-2 BIOLOGICAL EFFECTS OF PHOTOMECHANICAL WAVES: FROM BIOSTIMULATION TO GENE TRANSFECTION S Sato 1, Y Satoh 1, D Saitoh 1, T Ando 2, M Terakawa 2, and M Obara 2 1: National Defense Medical College, Saitama, Japan; and 2: Keio University
It has been known for many years that a pressure wave or shock wave is induced by irradiation of solid mater- ial or tissue with a high-power laser pulse; the pressure wave is called photomechanical wave or laser-induced stress wave (LISW). Photomechanical wave (hereafter abbreviated as PMW) is often undesirable since it causes collateral tissue damage during laser surgery, while PMWs can increase the permeability of not only biological membrane, such as plasma membrane and nuclear envelope, but also stratum corneum, the primary barrier of skin. Doukas et al. have been applying these effects to delivery of drug molecules to cells in vitro and tissue in vivo. We have extended this technique to deliver macromolecules such as genes to various tissues in vivo; effi- cient, targeted gene delivery to skin, brain, muscle and spinal cord has been so far demonstrated in animal studies. Although the detailed mechanism of transfection by PMWs has not been revealed yet, the results of the recent experiments suggest that PMWs accelerate cell proliferation in tissue, enabling efficient transfer of exogenous genes to cells and then to their nuclei. We have also found that angeiogenesis can be accelerated by the application of PMWs alone. We assessed angionenesis in the grafted skin tissue in rats under the various conditions. When skin grafts were pretreated with PMWs ex vivo, angiogenesis after transplantation was enhanced significantly, compared with that of normal grafting. This is probably based on the same mechanism of shock wave therapy. Recently, shock wave, which is generated by a lithotripter, has been revealed to upregulate vascular endothelial growth factor (VEGF) in ischemic tissue, and as a result, neovascularization can be accelerated, suggesting the possible modi- fication of tissue at a molecular level. Shock waves have also been shown to have the effects of bone forma- tion and pain relief. It is interesting to note that there are many similarlities between biological effects caused by low-level laser light and those by shock waves. However, the obvious advantage in the use of shock waves or PMWs is their much larger penetration depth in tissue, enabling deep tissue treatment. Furthermore, there are many advantages in the use of PMWs compared to shock waves generated by conventional methods: high controllability of energy, easy handing and possible fiber-based endoscopic application, opening up a new regime of laser and photonic therapy.
S-7-3 PHOTOCHEMICAL TISSUE BONDING (PTB) FOR WOUND REPAIRS M Yao, S Tsao, Y Wang, RW Redmond, and IE Kochevar Wellman center for photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114 USA; Institution of Traumatic Medicine, Department of Burns and Plastic Surgery, No. 3 People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (MY, YW)
We have developed a novel technology for bonding tissue surfaces together. This technology is based on a light-activated chemical process that produces molecular bridges between tissue surfaces. An immediate water- tight seal is formed without damage to adjacent tissue. PTB relies on formation of covalent crosslinks between protein molecules on the surfaces rather than the heat-driven processes that underlie laser welding, an older light-activated process. In laser welding heat denatures tissue proteins and causes thermal damage to adjacent
272 Laser Tokyo 2009 PROGRAM & ABSTRACTS
tissue. As the tissue cools, the protein molecules intertwine to weld the tissues together. In PTB, an FDA- approved dye (Rose Bengal) is applied to the surfaces of the tissues to be bonded. No additional materials, such as glues or proteins, are needed. After removing excess dye, the tissues surfaces are placed in contact and treated with low power green laser light for a short period, generally 0.5-4 min, to activate the dye and initiate the bonding chemistry. The bonding is complete when the light is turned off and requires no further “curing” time. Our studies in multiple tissue types indicate that the wound heals normally after PTB treatment. We have demonstrated that PTB reliably reattaches peripheral nerves in rat and rabbit models with improved outcomes, can seal corneal incisions and corneal grafting, can be used for anastomosis of blood vessels and bonding tendons in rat models, can replace superficial sutures for closing skin incisions and excisions in a porcine model and seals incisions in hard-to-suture canine vocal fold. We are currently completing follow-ups on a pilot clinical study (31 patients) using PTB to close skin wounds after excision of basal cell carcinomas and atypical nevi. The initial results suggest that superficial closure of these surgical wounds with PTB results in less scarring than using interrupted sutures. The PTB technology has been patented by the Massachusetts General Hospital.
S-7-4 TARGETED GENE TRANSFER INTO RAT SPINAL CORD BY LASER-INDUCED STRESS WAVES T Ando 1, S Sato 2, T Toyooka 3, Y Uozumi 3, H Nawashiro 3, H Ashida 2, and M Obara 1 1: Department of Electronics and Electrical Engineering, Keio University, Yokohama, Japan; 2: Division of Biomedical Information Science, National Defense Medical College Research Institute, Japan; and 3: Department of Neurosurgery, National Defense Medical College, Japan
Aims and Background: Laser-mediated gene transfection is attractive as a nonviral method for targeted gene therapy because of its high spatial controllability of laser energy. We have been investigating gene transfer by the use of laser-induced stress waves (LISWs) or photomechanical waves (PWs).The aim of this study is to demonstrate efficient targeted gene delivery into rat spinal cord by nanosecond pulsed laser-induced stress waves. Materials and Methods: Female Sprague-Dawley rats were used in this study. The spinal cord was exposed by removing the tenth thoracic vertebra. The solution of plasmid DNA coding for enhanced green fluorescent pro- tein (EGFP) or luciferase was intraparenchymally injected into the spinal cord, on which a 0.5 mm thick black natural rubber disk was placed as a laser target. A 1.0 mm thick transparent polyethylene terephthalate sheet was bonded on the top of the rubber to confine the laser-induced plasma for increasing peak pressure of an LISW. The target was irradiated with a 532-nm nanosecond laser pulse of a Q-switched Nd:YAG laser. Expression of EGFP was examined with a fluorescent microscope. Luciferase activity was measured with a luminometer and a standard luciferase assay kit. To evaluate the safety of LISW-mediated gene transfer, the hind limb movements at 24 h after operation were observed in an open field and assessed on the basis of the locomotor BBB (Basso-Beattie-Bresnahan) scores. Results: Efficient EGFP expression was observed in the white matter, as well as in the gray matter of the spinal cord that had been irradiated with 10 pulses of LISWs generated at a laser fluence of 0.3 J/cm2. Levels of luciferase activities for the spinal cord segment exposed to the LISWs after plasmid DNA injection were signifi- cantly higher than those for the spinal cord only injected with plasmid DNA. There was no significant differ- ence in BBB scores between the plasmid DNA injection alone group and the plasmid DNA injection plus LISWs application group, demonstrating that LISWs caused no functional damage. Conclusions: We have demonstrated that exogenous genes can be efficiently delivered into rat spinal cords by applying nanosecond pulse laser-induced stress waves without remarkable functional damage. These results will open up the capability of safe gene therapy for spinal cord neurodegenerative diseases and injuries.
S-8-1 COMBINED LASER TREATMENT FOR PORT WINE STAINS T Ohshiro 1, T Ohshiro 2, K Sasaki 1, Y Taniguchi 1, and T Nakajima 3 1: Ohshiro Clinic, Tokyo, Japan; 2: Japan Medical Laser Laboratory, Tokyo, Japan; and 3: Department of Plastic and Reconstructive Surgery, School of Medicine, Keio University, Tokyo, Japan
Capillary malformations (PWS) consist of various diameter microvessels in upper dermis and morphological appearances vary not only among individuals but according to self-conditions. Since 1980s, pulsed dye laser (PDL) has been a golden standard method for PWS. PDL emitted 585/595 nm wavelength laser light and pulse duration was fixed on 0.45/0.5ms. Because of this specification of conventional PDL, clinically good results were limited in the cases of superficially situated lesions, and lager/smaller diameter microvessels and deeply situated vessels in dermis were difficult to treat. Since late 1990s the specifications of PDL have been improved and skin cooling devices have been developed to avoid the skin injuries. As a result, operators have been able to select the parameters such as light dosage, pulse duration (0.45-40ms), spot sizes under their own considera- tions, and the therapeutic outcome was remarkably improved. However the complete removal of PWS has
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been challenging. Currently, for the treatment of refractory PWS, the various wavelength laser machines such as long-pulsed PDL (LPPDL) and long pulsed Nd:YAG laser (LPYAG) have been applied, and new irradiation techniques have been tried. In our clinic, for the treatment of PWS, conventional PDL, LPPDL, LPYAG and Argon laser have been used. It is difficult to obtain the completely clearance of PWS only by single laser treatment, so we have applied the com- bined laser treatments and have developed the new additional technique depending on the types of PWS. In my presentation our therapeutic strategy of PWS and the new coming modality based on our preclinical research will be reported.
S-8-2 THE CO2 LASER IN THE TREATMENT OF VASCULAR LESIONS I Kaplan Tel Aviv University, Israel
This topic was chosen because it enables one to highlight the advantages of the CO2 laser as a surgical modali- ty. Cases in the neonate, children, adults and the aged will be presented.
S-8-3 IMPROVEMENT OF PDL TREATMENT FOR CAPILLARY MALFORMATIONS AND HEMANGIOMAS K Kasai, Y Yamamura, and N Kondo Kasai Clinic for Plastic Surgery, Osaka, Japan
Aims and Background: Since pulsed dye laser (PDL) had been developed, PDL had been the golden standard for treating cutaneous vascular lesions. However, it does not mean every lesion can be cleared by this treat- ment. In order to improve clinical results, investigators and manufacturers are seeking to renovate PDL machines. In addition, clinicians are trying to establish better treatment protocol. As a result, clinical efficacy of PDL treatment has greatly improved in these days. The aim of this short presentation is to show what was important to improve the result of PDL treatment for this 20 years period. Materials and Methods: History of development in PDL treatment was investigated in the point of equipment, technology and treatment protocol. Results: High energy, large spot size exposure enabled deep penetration. Skin surface cooling lessened the risk of burn in high fluence exposure. Elongated pulse duration lessened postoperative purpura, but not so much improved final result. Detailed tuning of wavelength had small meaning for clinical result. Conclusions: Variable pulsed PDL with Contact cooling device is considered to be the best way for treating capillary malformations and hemangiomas.
S-8-4 LONG PULSED LASER TREATMENT OF RESISTANT PORT WINE STAINS T Kono, and H Sakurai Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
Laser treatment of vascular lesions was first developed in 1960s and the risks of scarring and texture changes were very common in early days. In 1983, the concept of selective photothermolysis revolutionized laser treat- ment of vascular lesions. According to the principle of selective photothermolysis, the pulse duration of laser light should be equal to or less than the thermal relaxation time of target vessel in order to maximize laser energy deposition within the vessel and to confine thermal damage to the treated vessel. Since then, the pulsed dye laser (PDL) has become the gold standard in the treatment of Port-wine stains (PWS). However, for techni- cal reasons in the past, no PDL had possibly been developed with a pulse duration longer than 1ms until late 1990s. PDL treatment produces reasonably good results in a limited population of PWS patients due to PDL’s ability to destroy selective dermal blood vessels. Presently, most patients are treated using similar laser parame- ters, with selection based on the clinical judgment of the physician. Often, these decisions are made without taking into consideration individual variations in PWS geometry or optical properties of human skin. PWS ves- sel diameter and depth distribution vary on an individual patient basis, and even between different areas on the same patient. Finding an appropriate PWS treatment protocol has become more complicated recently sec- ondary to laser manufacturers introducing devices that allow the operator to vary several treatment parameters such as wavelength, pulse duration, light dosage, and skin cooling.
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S-8-5 MANAGEMENT WITH LASER PHOTOCOAGULATION AND SCLEROTHERAPY FOR PEDIATRIC PATIENTS WITH COMBINED VASCULAR MALFORMATION S Watanabe 1, K Koroyasu 2, and S Takagi 3 1: Saitama Children's Medical Center, Saitama, Japan; 2: Tokyo Rosai Hospital; and 3: Imakiire General Hospital
Aims and Background: Management for combined vascular malformations is always challenging, based on an evident fact of critical level by only one treatment option, either LASER photocoagulation or sclerotherapy. The aim of this study is to demonstrate the benefit and effectiveness of combination management LASER and scle- rotherapy for combined vascular malformation. Materials and Methods: 15 pediatric patients (age 0-15, mean 8.8y) were treated for combined vascular malfor- mations (5 Arterio Venous Malformation, 6 Capillary Venous Malformation, 4 Klippel Trenaunay Syndrome) with ethanol sclerotherapy in 1-3 sessions following Pulsed Dye and/or Nd: YAG in 1-5 sessions. Follow-up period ranged 1-7 years. Results: Marked shrinkage of mass in 11 patients, good response of overlying skin lesion in 10, without major complication but minor permanent scarring in 1 by LASER and 1 by sclerotherapy. Conclusions: The combination therapy of LASER and sclerotherapy is effective and relatively safe for the treat- ment of combined vascular malformations. Skin scarring is minor but esthetically serious complication, the rate is usually high after only sclerotherapy for combined vascular malformation. Combination management can reduce the complication rate of skin scarring, LASER photocoagulation plays a major role in management of this difficult disease.
S-9-1 THE CONDITION KNOWN AS “ DARK RINGS UNDER THE EYES” IS A KIND OF DERMAL MELANOCYTOSIS WHICH CAN BE SUCCESSFULLY TREATED BY Q-SWITCHED RUBY LASER S Watanabe Department of Dermatology, Teikyo University School of Medicine, Tokyo, Japan
Background: In general, dark rings under the eyes are believed to be a phenomenon caused mainly by physio- logical change because of their daily fluctuation. Medically speaking, the precise cause or pathogenesis of dark rings is unknown, and this condition has not been clearly defined. In our experience, the dark rings associated with conventional nevus of Ota can be successfully treated with Q-switched ruby laser (QSRL). Objective: This study was conducted to clarify the nature of dark rings under the eyes and to determine the efficacy of QSRL. Patients and Methods: Fifty-four patients who received a biopsy for pigment macules of the face were retrieved, and of that number 12 patients with bilateral homogeneous pigment macule on suborbital regions were selected for study of the dark rings. Of those patients, the histology and the efficacy of QSRL were evalu- ated retrospectively. Results: Histologically, all 12 patients indicated dermal melanocytosis which was confirmed by the Masson- Fontana silver stain and staining against S100. In five patients who received QSRL therapy two times or more, the clinical improvement of two patients were scored as good (40–69%), and two other patients as excellent (>70% clearance). Conclusions: We speculate that so-called dark rings under the eyes in the Japanese population is a kind of der- mal melanocytosis which can be successfully treated by QSRL.
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S-9-2 Abraham Baruchin
S-9-3 LOW-LEVEL LASER-TONING FOR TREATMENT OF JAPANESE FEMALE MELASMA PATIENTS WITH 1.5 JOULE 5nsec 1064nm Q-SWITCHED Nd:YAG LASER K Ichikawa Department of Plastic Surgery, Tokai University School of Medicine, Kanagawa, Japan
Aims and Background: Recently efficacies of low-level laser-toning for melasma were reported in U.S and Korea. We evaluated its effectiveness in Japanese population. Sixteen Japanese female patients (27 – 43 y/o, mean 35.5) were observed under treatment of cheek melasma using laser-toning. Materials and Methods: We used 5 nsec 1064 nm Q-switched Nd: YAG laser (Spectra VRM III, Lutronic Inc.). 1.5 Joule Collimate beam was irradiated with three passes with standard facial session. Session was repeated at least six times with interval of one week. No ointment was used. Effectiveness was evaluated in five grades (excellent, good, fair, no change, worsen). Results: Effectiveness of the therapy was observed in twelve (75 percent) of patients, i.e., more than fair. Four patients remarked no apparent change and they were dermal melasma. No patients worsened the symptom. One patient claimed moderate pain during the first session, but no other adverse reaction was seen during the observation period. Conclusions: Very short pulse duration, less than 10 nsec, is necessary for laser toning. Collimated and top-flat shape of beam prevents focal inflammation and ensures its effectiveness. The author thinks that low-level laser- toning for Japanese patients are effective for improvement of epidermal melasma and useful for control of der- mal melasma.
S-9-4 LONG-PULSED ALEXANDRITE LASER (GENTLELASE) TREATMENT ON SO CALLED NEVUS SPILUS I Ono Department of Dermatology, Sapporo Medical University School of Medicine, Hokkaido, Japan
Nevus Spilus is a cutaneous pigmentoses lesion having brown spots present at birth or appearing at adoles- cence and if it exits on face or other exposing body surface, it may cause a problem in physical appearance which will not be eliminated spontaneously. Histopathologically, it is thought that causation is increase in amount of melanin pigments in epidermal basal layer. Before the laser therapy introduced, dry-ice therapy or dermablation were performed and showed some improvement only temporally and recurrence rate was high. Especially for men, hypertrichosis exists more frequently in lesion, supposing some relationships to hair folli- cles. While the laser treatment efficacy on Nevus spilus is relatively good in delayed-type Nevus spilus, so- called Becker’s nevus, it has also been a problem that there is a tendency to be observed poor results on near- ly oval shape or dotted pigmentation of Nevus spilus. This time, we treated these patients with a long-pulsed alexandrite laser (GentleLASETM), and the GentleLASE treatment has confirmed the same or better results than conventional laser treatments using Q-switched ones. As the GentleLASE has large spot size and short pulse width, from the point of view of the treatment efficiency, it is expected to be a highly effective device. We treated Nevus Spilus with the long-pulsed alexandrite laser under the hypothesis that melanocyte stem cells in the bulge area of hair follicles might cause hyperpigmentation in the Nevus spilus. After the first treatment to have epidermal peeling, many patients experienced that hyperpigmentation was gradually cleared with several treatments with dynamic cooling devece DCD. Melanocyte stem cells in the bulge area of hair follicles may cause hyperpigmentation in the epidermis and the melanosyte stem cells are destroyed by heat transferred from hair shafts. We perform the 1st treatment with no DCD to peel the epidermis, and the subsequent treat- ments to destroy melanocyte stem cells again by the heat transferred from the hair shafts, with DCD, protecting the epidermis but destroying hair follicles. In the Nevus Spilus treatment, we performed multiple treatments to destroy the cells which cause hyperpigmentation considering the hair cycle, and it was noted that the color of lesions was gradually cleared. Using this laser device, approximately 70% improvement was observed at the lesion area with multiple treatments (usually 5-10 times), so that I have presented the practical treatment method and clinical course of Nevus spilus.
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S-10-1 KELOID, HYPERTROPHIC SCARS AND INFLAMMATION K Kishi, N Hattori, Y Sakamoto, R Shimizu, K Okabe, and T Nakajima Department of Plastic and Reconstructive Surgery, Keio University, Tokyo, Japan
Aims and Background: Keloid and hypertrophic scar has been thought to be a clonic inflammation of the skin. The detailed study of the character of inflammatory cells have never been performed yet. In the present report, we show the profiles of the topical inflammatory cells, especially T cells of keloid and hypertrophic scars. Materials and Methods: Tissue samples were taken from the patients who were undergone resection of keloid and hypertrophic scars. Samples were fixed with 4% paraformaldehyde, and sliced into 7micro-m frozen sec- tion or paraffin section. In order to observe the profiles of inflammatory cells including CD3, CD4, CD8, immunohistochemical staining was performed. Then the CD4 positive cells were further categorized immuno- histochemically into Th1 and Th2 cells populations by double staining CD4 cells with either Il-4 or IFN-gamma. Results: In the peripheral area of both of keloid and hypertrophic scar, CD4 positive cells are much abundant than CD8 positive cells. Among CD4 positive cells, Il-4 positive Th1 cells are rich in the peripheral active area. On the contrary, IFN-gamma positive Th2 cells were rich in the central area where the redness become reduced and flattened. Conclusions: From these observations, it is assumed that CD4/CD8, and Th1/Th2 ratios are related to the growth and regression of the keloid and hypertrophic scars. These phenomena may be useful in treating keloid and hypertrophic scar in the future.
S-10-2 IPL TREATMENT EXPERIENCE IN EGYPTIANS SS Awad, WH Abdel-Razek, and M El-Khayat Minia University, Dermatology Department, Egypt
Background: Nowadays sources of light are widely used in therapy. They have been adapted to many medical procedures ranging from surgery, oncology, physiotherapy, dentistry, dermatology and bio-stimulation. Intensive Pulsed Light or IPL is an emerging light therapy technique in removing excessive hairs and can be used in many other skin conditions. Aim of Work: this study evaluates efficiency of IPL application on Egyptian patients with darker skin types. Patients & Methods: five hundred Egyptian patients complaining of hirsutism or hypertrichosis were included in the study. The age of patients ranged from 8 to 65 years old, and females constituted 90% of the cases while males 10%. Skin types ranged from 3 to 5 and face lesions were treated in 90% of cases while neck, chest, axil- la and limbs were the target in 10% of the treated cases. Fifteen joules were the initial dose delivered through IPL filter of 575nm or 610nm with incremental increase on subsequent sessions when needed. Three sessions with 3 weeks interval was the planned scheme for patients. Results: The improvement after 1st session ranged from 20-60%, after 2nd session from 30-80% and after the third session reached up to 95% improvement. Double pulse with 30ms duration and 30ms interval proved to provide the optimum improvement. Satisfactory results were maintained for a period ranging from 6 months to 3 years after which repeating the procedure maybe required. The main side effects reported during the study included mild to moderate pain while the application of the therapy, mild erythema just after sessions, hyperpigmentation at site of probe application, increase growth of fluffy non pigmented hair and persistence of non pigmented or grey hairs. In conclusion, IPL therapy proved itself in managing hirsutism problems in Egyptians and all side effects were temporary sequels. All patients were satisfied by the results yet repeating procedure maybe required after pos- sible recurrence of disfiguring hair growth.
S-10-3 A PROSPECTIVE STUDY OF THE INFLUENCE THAT TOPICAL STEROID EXERTS IN LOW REACTIVE LEVEL LASER THERAPY (LLLT) FOR THE TREATMENT OF HYPERTROPHIC SCARS AND KELOIDS K Sasaki 1, T Ohshiro 2, T Ohshiro 1, and Y Taniguchi 1 1: Keikoukai Ohshiro Clinic, Tokyo, Japan; and 2: Japan Medical Laser Laboratory, Tokyo, Japan
Aims and Background: The application of Low reactive Level Laser Therapy (LLLT) for the treatment of hyper- trophic scars and keloids has been already reported and investigated. According to these reports, LLLT for hypertrophic scars and keloids was accepted very quickly into routine practice. In this prospective study, we assessed LLLT for the treatment of hypertrophic scars and keloids and examined the influence of a topical
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steroid. Material and Methods: Subjects comprised 20 patients who were treated for hypertrophic scars and keloids, 9 patients treated with LLLT but no topical steroid and 11 patients treated with LLLT plus a topical steroid. Clinical photography of the lesions was performed, and 5 items were assessed for each lesion, namely Itching, Pain, Erythema, Hardness and Pliability on an 11-point scale for each value. The actual measurement values in mm and cm2 of 2 items (Thickness and size) were used. Each treatment session consisted of direct local appli- cation of an 830nm, 60mW, continuous wave, GaAlAs diode laser (Oh-lase 3D1, JMLL Tokyo Japan) to the tar- get area for 30 seconds to 2 minutes per lesion depending on the size and number of lesions existing on each patient. The attending clinician firmly pinched the lesion between fingers and thumb during laser therapy. Results: In both groups, a significant difference (p<0.01) between pretreatment and the 5th or 10th treatment session was recognized in the Erythema, Hardness and Pliability items. In the Itching and Thickness items, a significant difference (p<0.05) between pretreatment and the 5th or 10th treatment session was also recognized. There were no statistically significant differences between the group with no topical steroid and the group with topical steroid in most of the items, but the topical steroid group achieved better improvement in the Erythema and Hardness items after 10th treatment session, compared to the group with no topical steroid. Conclusions: LLLT for the treatment of hypertrophic scars and keloids is a safe and effective method even for lesions resistant to conventional treatments with topical steroids and mechanical compression and LLLT without a topical steroid has also been shown in the present study to be a safe and effective method.
S-10-4 1064nm Nd:YAG LASER TREATMENT FOR KELOIDS AND HYPERTROPHIC SCARS S Akaishi, R Ogawa, S Koike, and H Hyakusoku Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan
Aims and Background: Many investigators have employed this technique and the 585-nm Pulsed Dye Laser (PDL) is presently the mainstay treatment of keloids and hypertrophic scars. However, the efficacy of this method is surrounded by considerable controversy. The purpose of this study is to investigate the effect of 1064nm Nd:YAG laser on hypertrophic scars and keloids. Materials and Methods: 16 keloids and 6 hypertrophic scars of 22 patients were treated with a 1064nm Nd:YAG laser with a 5 mm spot size, fluences of 14 J/cm2 and pulse widths of 0.3 msec, every 3 to 4 weeks. The biop- sies of treated and untreated region were examined and assessed histologically and microscopically. Results: After 14.05 treatment sessions on the average, clinical assessments of the scars were improved. Clinical assessment (scar volume, erythema, hardness, itch and pain) were classified from 0 points to 3 points. It had decreased from 9.86 to 6.34 points after laser treatment. Histological and microscopical examination revealed the collagen fibers where laser was applied were disrupted after irradiation. Conclusions: During laser treatments, a decrease in clinical assessment was reported. Histological and micro- scopical findings will support the effectiveness of Nd:YAG laser. The optimal laser is currently 585 nm PDL, although the recent results of 1064nm Nd:YAG laser are promising.
S-11-1 LASER SKIN REJUVENAITON IN ASIAN JW Kim, and JO Lee Best Well Institute, Department of Plastic Surgery, Seoul, Korea
Introduction: This talk will heightlight several non-invasive & invasive treatments including light & laser skin rejuvenation and how they can be used in combination to give synergistic effet for the patient. Purpose: All of the face and body skin rejuvenation with laser or quasilaser noncoherent light sourve closely related with proper stimulation wound healing and enhanced circulation for bllod suuply in skin rejuvenation . Recent trend of laser and light therapy is target cell stimulation with RF for synergistic effect. Material and Method: We followed 300 patients who were treated with photoaging, evaluation of skin quality and skin elastitity and color match after finished laser and light skin rejuvenation,NSLSR(Non surgical LaserLight Skin Rejuvenation) Patients: Between 2003 and May 2009 we treated 300 patients and result as below.l Results : 1.Skin color tone unification and oxygen supply to the skin increased. 2. Collagen production and skin tightness is increased. 3. Stimulating preexisted fibroblast in photoaging in 633nm is effective. 4.Pain was decreased during the treatment of 830nm LED application. Conclusion: Treatment of 300 patients shows that the satisfaction rate is very high in patient especially in Asian. Like ablating lasers, nonablatihg laser and quasilaser light source therapy system is one of recent trend of facial skin rejuvenation. Recently developed this innovative technology also enables hybrid aesthetic and reconstruc- tive surgery and cosmetic surgery. Simultaneously using with minimal invasive and less invasive procedure and NSLSR is promising.
278 Laser Tokyo 2009 PROGRAM & ABSTRACTS
S-11-2 REJUVENATION WITH LASERS AND LIGHTS FOR ORIENTALS S Wakamatsu, and K Negishi Aoyama Institute of Womens Medicine, Tokyo Womens Medical University, Tokyo, Japan
We have engaged in the treatment of facial rejuvenation with lasers, lights and varieties of recent modalities for more than thirty years in the extension of aesthetic plastic surgery. Purpose: Conventional face-lift operation does not improve the skin texture, pigmentation or clearness of the skin. Laser has long been used for removal of solar lentigens and mole removals. Initial stage of laser applica- tion with CO2 or Q-switched Ruby laser has been notorious with the post inflammatory pigmetation lasting for more than four months to even half a year which is characteristic to the orientals. Fifteen years history of invention and new application of Intensive Pulsed Light for generalized improvement of the skin has opened a new era of aesthetic and anti-aging treatments. Moderate light energy irradiation of skin seems to accelarate the metabolism and remodelling of various levels of tissue resulting in so called rejuvenation. In addition, increased knowledges and engagement from the medical feelds for prevention and treatment of pigmentation and texture of the skin which has long been considered to belong to non medical personnals has tremendously improved the result of treatments. The inclusion of moderate amount of pigmentation in the oriental dermis is best fit among races to this type of treatment because the target organ is melanin which converts the lights to heat. We restrict the presentation to the fundamental knowleges and results of skin responce to the various light ori- gins not involving the recent modified technologies such as fraxels.
S-11-3 PHOTOTHERAPY AS ADJUNCTIVE TREATMENT IN AESTHETIC SURGERY TO PREVENT SCARRING MA Trelles Instituto Médico Vilafortuny / FUNDACIÓN ANTONI DE GIMBERNAT, Cambrils, Tarragona, Spain
LED therapy has been reported as a treatment for revitalizing the skin. This photo treatment is a non-invasive, office based procedure, following the principles of tissue biostimulation. Effects are achieved through increase in mediators related to cell metabolism activation to enhance and to stimulate collagen formation. The use of LEDs of 633 and 830 3 nm quasi monochromatic light of high intensity is a safe and effective treatment modali- ty for dermatologic procedures, including scar revision. Its action include modulation of wound healing which is a vital stage at the post-op period of removal of fibrotic tissue. The CO2 laser permits removal of scar tissue involving the epidermis and dermis condition. Improvement obtained with the use of this laser is enhanced with sessions of LED therapy . Scars vary in depth, width and color. The pulsed CO2 laser eliminates fibrotic tissue with well controlled deposit of thermal damage in the dermis. After treatment, sessions of LED therapy positively remodels collagen, significantly avoiding fibrotic scar tissue regrowth. The regenerated skin obtains improved characteristics once reepithelization is obtained appearing quite similar to that of normal skin. LED therapy speeds up and modulates the healing of the treated area and, in addition, enhances cosmetic characteristics. Scar revision is carried out with the Ultrapulse CO2 laser (Lumenis, Yokneam, Israel) with a 1 mm spot size, 7 W power and pulses of 350 µs. Delay time between pulses is set at 200 ms to avoid thermal accumulation in adjacent tissue. Treatment starts by vaporization of the elevated portions of the scar, from the center to the periphery. Once the process of smoothing the scar to the level of the surrounding healthy skin is accom- plished, the remaining debris following laser treatment are left in place and a fine layer of ointment, to help epithelization, is applied several times a day until the scabs fall off. Usually, two or three sessions of ablative pulsed CO2 laser are required to obtain an improvement. To comple- ment, LED therapy not only is used during the time tissue undergoes the process of reepithelization, but also in between sessions of ablative laser treatment if they are necessary. The first session of LED therapy is immediately after CO2 laser surgery followed by a total of six sessions, two per week, combining 633 and 830 nm alternatively, directly on the treated scar. Combination of treatments accelerates wound healing and can drastically reduces post-op surgical symptoms, significantly improving tissue healing, quality of results and help sustain the achieved effects. The area where scar tissue has been removed once it is reepithelized, the use of preso-therapy with silicon patches is recommend, for a period of three months (at least), 24 hours a day. The use of silicon patches for preso-therapy efficaciously complements the scar treatment programme obtaining excellent results.
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S-11-4 A MULTIPLE DEVICE APPROACH TO NONABLATIVE, TOTAL SKIN PHOTO-REJUVENATION M Enokibori Mizuki Clinic, Laser Surgery & Aesthetic Dermatology, Otsu, Japan
Aims and Background: Photodamaged skin manifests vascular and pigmentary alterations, rhytides, enlarged pores, and sagging. Darker skin types and differences in healing response of the Asian skin type, when com- pared to that of the European skin, complicate treatment and require separate evaluation. We investigated and found advantages of our combination protocol using multiple devices for treating the signs of photodamaged skins in Asian population. Material and Methods: Over 5000 subjects (skin types II to V) with photodamaged skin were treated over the last 8 years. At each treatment session, subjects received the following treatments at four to six week intervals: The entire face of each subject was initially treated by a combination of optical and conducted radiofrequency energy , and long-pulsed 1064nm Nd:YAG laser (LPNYAG) for epilation, improvement of pore size and reduc- tion of fine wrinkles. Next, the Intense Pulse Light, long-pulse duration pulsed-dye laser combined with LPNYAG, and Q-switched Nd:YAG laser were used for removing of vascular and pigmentary lesions and toning the skin. Q-switched Alexandrite laser, Q-switched Ruby laser and carbon dioxide CO2 laser were used for local lesions. Optional treatment with two kind of non-ablative fractional resurfacing laser were used for skin tightening and acne scars. Digital photographs were taken before the initial treatment and prior to each subse- quent treatment and histologies were taken of three patients to investigate the effects of non-ablative fractional resurfacing. Results: Treatments resulted in improvements to photodamaged skin with minimal discomfort and side effects, and patient satisfaction was high. Histologies taken one month after the 7th treatment of non-ablative fractional resurfacing showed an increase of fine elastic fibers in the papillary and reticular dermis as well as collagen fibroneogenesis. Conclusions: Our protocol, which uses the combination of various laser techniques and devices, has achieved total skin photo-rejuvenation and demonstrated advantages of the respective laser treatment and also their combined effects resulting in improved clinical outcome with significantly less recovery time and adverse effects.
S-11-5 SKIN REJUVENATION USING A FRACTIONAL ULTRAPULSE CO2 LASER K Iwaki Iwaki Clinic, Kyoto, Japan
Aims and Background: Ablative fractional resurfacing using CO2 laser is intended to provide deep fine skin ablation with small spot size while leaving the peripheral healthy tissue in a net-like pattern thus providing a high safety level and a fast wound healing effect. This study was conducted to evaluate the effectiveness, heal- ing process and long-term follow of this procedure. Materials and Method: The system used was the UltraPulse Encore CO2 Laser (Lumenis Ltd.), with two types of hand-pieces: DeepFX hand-piece, which provides deep ablation with a 0.12mm-spot, and CPG hand-piece, which provides shallow ablation with 1.3mm-spot. The objective is wrinkle in lower lid, pore, skin-texture, acne scar, reddish face and others. Three different radiation techniques are used depending on the symptom of each case. The treatment is provided one or two times at intervals of three to five months, followed by the long-term observation over a period up to one year. Results: One or two treatment cycles resulted in a satisfactory skin rejuvenation effect. Some transient mild-to- moderate pigmentation has been observed, which has improved in all cases within one to four months. No other side-effect was recognized. It should be realized that it takes as long as four to five months to show dis- appearance of pigmentation and adequate effect, given the process of wound healing through new collagen formation. Conclusion: One or two treatment cycles by ablative fractional resurfacing results in a highly satisfactory effect while it has a longer downtime (approximately five days) and a larger tendency of pigmentation after treat- ment. On the contrary, the non-ablative treatment needs multiple treatments (five to ten cycles) to obtain the equal level of effect as the former treatment, while it is less-invasive and associated with a shorter downtime. It is recommended that the selection of treatment be individualized according to patient’s expectation, lifestyle and personality.
280 Laser Tokyo 2009 PROGRAM & ABSTRACTS
S-12-1 PAIN ATTENUATION WITH LOW LEVEL LASER THERAPY ON PERIARTHRITIS SCAPULOHUMERALIS K Mizutani, and Y Musha The Department of Second Orthopedic Surgery, Toho University, Tokyo, Japan
Purpose and Background: To determine the clinical effect of low level laser therapy (LLLT) on serum prostaglandin (PG) E2 levels. Subjects and Methods: 76 women, with a mean age of 61.4 years, with periarthritis scapulohumeralis were investigated. The following items were evaluated: 1) efficacy of LLLT assessed by patient’s satisfaction or dissat- isfaction, 2) pain-scoring with visual analog scale (VAS), 3) serum PGE2 levels. Serum PGE2 levels were deter- mined by the RIA-PEG method, and 4.4 pg/mL or more was considered abnormal. Using a diode semiconductor laser unit with a power of 1 W and wavelength of 830 nm, irradiation was administered focusing on the trigger point for 3 min. daily or on alternate days a total of 10 times. No physical nor analgesic requirement were available. Results: The therapy was considered effective in 64 cases (84.2 %). There are no significant difference between the age and morbid period by satisfied or dissatisfied group. The VAS, 3.0 ± 1.6 after irradiation in the satisfied were significantly lower than 8.0 ± 2.0 before irradiation in the same patients, and than 6.4 ± 2.2 after irradia- tion in the dissatisfied (P<0.001). There was a significant difference in % change in VAS by each group (P<0.001). Serum PGE2 levels in the satisfied were 5.4 ± 0.3 after irradiation, which were significantly lower than 7.2 ± 0.5 before irradiation (P<0.001). But in dissatisfied, there was no significant difference between serum PGE2 levels before and after irradiation. % change in serum PGE2 levels showed a significant difference between the groups (P<0.05). The rate of the satisfied with abnormal PGE2 levels was 73.4% (47 cases) before irradiation, which declined to 65.6 % (42 cases) after irradiation. However, PGE2 levels remained abnormal even after irradiation in 22 (34.4 %) of satisfied group. Statistical analysis of forty consecutive casas with high PGE2 level was made. The outcome revealed significant decline before and after laser irradiation particularly in satisfied group, but does not in the dissatisfied. Conclusion: LLLT may be valid for alleviating nociceptive pain associated with serum PGE2 levels.
S-12-2 THE ESTABLISHMENT OF PHOTODYNAMIC THERAPY FOR SEPTIC ARTHRITIS T Iriuchishima Bone and Joint Surgery, Nihon University, Tokyo, Japan; University of Pittsburgh Medical Center
Background: We have reported the methicillin resistant staphylococcus aureus (MRSA) inactivation by photody- namic therapy (PDT) using photosensitizer Na-Pheophorbide a (Na-Phde a) in vitro and in vivo. For the clinical application of PDT using Na-Phde a, the influence of PDT to normal joint tissue has to been cleared. Methods: Study 1; Cultured synovial cells obtained from normal, or rheumatoid arthritis (RA) and Chondrocytes from normal or osteoarthritis patients were incubated with 34 É mol/l of Na-Phde a for 30 minutes and up take of Na-Phde a was assayed by fluorescence microscopy (400 nm). Study 2; Five hundred sixty and 280 É mol/l of Na-Phde a were injected into knee joint of mice. Thirty minutes after injection, percutaneous laser irradiation was performed for 5 minutes at a laser power 125 mW using semiconductor laser device. Results: Na-Phde a uptake was observed only in synovial cells. The intensity of Na-Phde a was stronger in RA synovial cells. No uptake was observed in any chondrocyte. Joint swelling was observed at every time point within 3 weeks after PDT (P<0.05). Histological examination of the treated knees demonstrated inflammatory changes with synovial proliferation and infiltration of neutrophils at 1 week after PDT. In joints of 8 weeks after PDT, the synovitis was recovered. No significant effect was observed on cartilage, bone marrow and menisci. Conclusion: PDT using Na-Phde a has a potential to be a useful and safety remedy for the treatment of MRSA septic arthritis. Some more results of our on going studies will be included.
S-12-3 EXTENDED EXPERIENCE IN DIODE LASER THERAPY (LLLT) FOR PAIN ATTENUATION C Shiroto 1, S Nakaji 2, and T Umeda 2 1: Shiroto Clinic, Goshogawara, Aomori, Japan; and 2: Department of Social Medicine, Hirosaki Univercity, Aomori, Japan
We have been studying the efficacy of low level laser therapy (LLLT) in pain attenuation using the diode laser since 1984 and we have presented updates in many journals and various national and international confer-
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ences. The Leuktron Laser (The GaAlAs diode system), which delivers 60 mW in continuous wave at a wavelength of 830 nm was jointly developed by the Japan Medical Laser Laboratory lead by Prof. Ohshiro and Matsushita Electric Company, and marketed by Mochida Pharmaceutical company in Sep. 1988. The pain treatment using this Leuktron has received very good results. In 1994, new model was also developed. It was the 150 mW version. In 1989, neare-infrared phototherapy system called Super Laser was also developed by the other company. We have used these 3 models for pain attenuation and compared the results and found out that there were no sig- nificant differences among them. Therefore, we have decided to mainly use the 60 mW type laser. In 1998, a defocused 1000mW diode laser which is aimed not only at pain treatment, but also for skin ulcers, infertility, and other non-pain entities, was released. Even though we already compared the results before, we wanted to make sure that we were using the best system for our patients. Therefore we tested and compared the 60 mW and the 1000mW and found out the 60 mW was better for pain attenuation. In Nov. 2006, the Puls laser 10W was released. We compared this Puls Laser and 60mW laser and discovered that pain treatment using 10W to be a lot more effective than the conventional 60 mW. The LLLT we have used for passed 26 years for pain attenuation faced the new change due to the release of Puls 10W. The current study covers the period from April 1984 to February 2008 (24 years) with the details of 62,631 cases.
S-12-4 LLLT FOR CHILDREN WITH CONGENITAL DISLOCATION OF THE HIP AND PERTHES DISEASE Y Asagai 1, and T Ohshiro 2 1: Shinano Handicapped Children's Hospital, Nagano, Japan; and 2: Japan Medical Laser Laboratory, Tokyo, Japan
Since the introduction of LLLT in 1993, reduction of the congenital dislocation of the hip has been successfully achieved in all the 113 patients (under 6 months of age) treated conservatively. Reduction of the tension of the soft tissues around the hip joint by LLLT may have contributed to the moderate reduction force during the use of a Pavlik harness and during traction, and the prevention of avascular necrosis of the femoral head. LLLT favorably affected the formation of the hip acetabulum and growth of the femoral head. This is probably because the good centripetalism combined with the direct bioactivative effect on bone cells associated with laser therapy facilitated acetabular repair, leading to the prevention of coxa magna. We have used near infrared irradiation therapy(NIIT) in conjunction with brace treatment for 28 patients(mean age:6 years) affected by Perthes disease. To improve limited range of motion and subluxsation of the hip by using both NIIT and traction at the early stage. NIIT and brace treatment prevented vicious circle consisting of delayed healing of necrosis due to head collapse and exacerbation of head deformity, with a result that the lat- eral portion of epiphyseal nucleus was rapidly reconstituted. There is no established means of treating Perthes disease. Our approach (the combination of brace and NIIT) was shown in the present study to potentially alle- viate femoral head necrosis in children with Perthes disease. This therapy is a promising approach to realizing the long-standing dreams (prevention of femoral head deformation without surgical treatment and shortening of the treatment period) of those managing children with Perthes disease.
S-13-1 ADVANCED LASER TECHNOLOGY VH Oswal James Cook University Hospital, Middlesbrough, Cleveland, UK
Over the past three decades, laser light has been used as intense heat source to cause instant tissue destruction by vaporisation. The tissue temperature rises at the point of impact. At 100 degree C, intra and extra cellular water boils, resulting in micro explosion and death of the cellular structure. However, unlike cold steel instruments, heat from the laser beam is also dissipated within the tissue. the tissue immediately deep and adjacent to the vaporised layer consists of necrotic layer composed of charred tissue, coagulum and hyperthermic tissue. This unwanted effect is known as ‘collateral’ tissue damage, the extent of which is governed by such factors as power setting, exposure time, type of laser used and so on. The necrotic layer is eventually removed by the inflammatory process, leading to healing with fibrous tissue and scar forma- tion. Scarring of the vocal fold is obviously a totally unwanted ‘collateral’ effect of the laser surgery on the vocal fold. Advances in laser technology aim at minimising the collateral damage. In Superpulse and Ultrapulse mode, the pulsing of energy at a repetition rate of say 400 Hz results in 400 on and 400 off duty cycles. Each pulse deliv- ers high peak energy during the ‘on’ phase of the duty cycle, when instant vaporisation takes place. The ensu- ing ‘off’ phase allows cooling of tissue, thus limiting collateral damage. The average heating over a period of exposure time is thus much reduced. Limiting the thermal penetration this way results in much less necrosis of the tissue, leading to minimum scar formation.
282 Laser Tokyo 2009 PROGRAM & ABSTRACTS
Recently a completely novel approach has been advocated to minimise collateral damage caused by conven- tional CO2 laser. Pulse dye laser (PDL), emitting at 585 nm has been used to treat Juvenile onset recurrent res- piratory papillomatosis (JORRP). The light at this wavelength is selectively absorbed by blood haemoglobin in the microvasculature of the lesion, resulting in ischaemia and cell death. At a low energy level of 2 joules per pulse, there is selective ischaemic destruction of the target tissue, and at the same time, sparing of the superfi- cial layer. A number of reports indicate minimum scarring of the vocal fold following excision of JORRP. Lack of damage of the superficial layer of the anterior commissure is thought to have an added advantage by avoid- ing potential web formation. Further extension of the use of PDL in phonosurgery is possible.
S-13-2 LASERS IN UROLOGY A Hofstetter Life Center, Hospital Grosshadern, University of Munich, Munich, German
After 30 years of research and clinical application this paper should give a survey of the possibilities to use lasers in Urology, beginning with the low power effects via hypothermy till to laser induced shockwave lithotripsy. For summing up it is to say, that the use of lasers in urology has led to novel procedures in tumour diagnosis and therapy and in stone destruction, so that the laser nowadays in certain indications in Urology is not only an alternative but also the way of choice. New ways in treatment of bladder and prostate cancer are the photodynamic procedures. The value of athermic, pulsed microbeam N-lasers on in vitro fertilisation or in gentechniques is under test.
S-13-3 AN AVAILABILITY OF LASER APPLICATION FOR PERIPHERAL ARTERIAL DISEASE M Okada 1, M Yoshida 2, and Y Tsuji 3 1: Osaka Saiseikai Nakatsu Hospital, Osaka, Japan: 2: Himeji Cardiovascular Center, and 3: Shinsuma Hospital
Purpose: In recent years the number of the patients with peripheral arterial disease is increasing in Japan. For those patients there are many kinds of treatment such as endoarterectomy, bypass methods with saphenous vein and artificial vascular grafts and also balloonangioplasty ,laser method, stent-therapy. We have performed all of these procedures . Among them we have applied laser method. And we have confirmed that laser method was available for the patients with intermittent claudication. Material and methods: We have performed initially experimental study and then we have taken a excellent results of the expeirments. Threafter, we have clinically done 115 patients(male:98, female:17, mean age: 67) with intemittent claudication using Argon -Laser. Optimal laser applications were 200c temperature at the metal tip probe and 5 sec in irradiation time for each shot. On the other hands, optimal laser interventions were 6 w at the metal tip probe in output and 3sec in irradiation time. Results: We have had a excellent results by application of laser for the patients with intermittent claudication. We have also taken a good results in the follow-up study of long-term periods . That is, initial successful rates were 93% in the stenotic lesions and 74% in the occulsive lesions. We have performed several kinds of treat- ment for the patients with hypertension, hyperlipidemia and diabetes mellitus. Finally, we have received satis- factory results in the long-term periods in 120 months after laser application. Successful rates were 85% in the stenotic lesions and 75% in occlusive lesions during 120 months. Conclusion: Laser application was much easer procedure and effective for the patients with intermittent claudi- cation in additional to drug treatment and another methods. However, it is very important to select the patients with intermittent claudication and to choose the procedures.Further, follow-up study is necessary.
S-13-4 DEVELOPMENT OF THE LASER PERCUSSION Y Hashishin, S Sano, and T Nakayama Kinki University, Osaka, Japan
Background: A doctor dose not know the laser excision depth during the laser treatment. A doctor can not control the laser irradiation parameter in accordance with the condition of the affected part. So, we should identify the affected part and should detect that condition in real time, by non contact and by non invasion while the laser treatment. We use the laser induced-sound when laser attack a biological tissue. The laser induced-sound wave form change depending on the target sample type and condition. Therefore, the laser induced-sound has many information of laser irradiation sample. In this research, the irradiation laser was used CW-CO2 laser, and the laser induced-sound charasteristic generated from the biological tissue was examined. Materials and Methods: The irradiation laser was used CW-CO2 laser. The irradiation sample was 10 wt%
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gelatin that dissolved in purified water was used as the biological sample. Also, some bone and fat etc. of pig were used. The laser induced-sound was measured using the ultrasonic sound pressure meter (20 Hz-70 kHz). In this case, condenser type, non-directional microphones were used. All measurements were made in air. Results and discussion: We investigated the characteristics of sounds produced by the incision of soft and hard biological tissue. The sound occurred intermittently. The laser exposure conditions are CW-10W power, 80 ms time and 1 mm beam diameter. As for the sound wave form, we discovered that it was different to the result by the biological tissue. So, the control of the laser conditions based on sound pressure information will allow the cutting parameters to be improved and regulated. Conclusion: It found that the wave form of the laser-induced sound was different by the difference in the bio- logical tissue. It was suggested that the identity of the affected part and that condition could be detected in real time by the analysis of the laser induced-sound. The conditions of irradiation are controlled from the laser induced - sound and it becomes possible that the incision volume is adjusted in real time. If this laser percus- sion is realized in practice, it can be expected that even a relatively inexperienced doctor will be able to per- form laser treatment safely and reliably.
S-14-1 DIAGNOSTIC VALUE OF NARROW BAND IMAGING FOR EARLY HEAD AND NECK CANCERS A Watanabe, M Taniguchi, and H Tsujie Department of Otolaryngology, Head and Neck Surgery, Keiyukai Sapporo Hospital, Hokkaido, Japan
Objectives: Evaluate the diagnostic value of rhinolaryngoscopy using narrow band imaging (NBI) system, a novel optical technique that enhances endoscopic diagnostic capability, in detecting squamous cell carcinoma of the head and neck (SCCHN) in patients with esophageal cancer (EC), who are at a high risk for developing SCCHNs. Methods: Between January 2006 and December 2006, consecutive 667 EC patients prospectively underwent rhi- nolaryngoscopy screening by using both conventional white light and NBI system. The Lugol staining and his- tological examinations were performed on superficial demarcated brownish lesions detected by NBI system and demarcated red lesions, elevated lesions, or depressive lesions detected by white light. Sensitivity, speci- ficity, accuracy, and positive/negative predictive value for detecting SCCHNs by each method were calculated by the histological results and compared with chi-square test. Difference was considered significant at p<0.05. Results: Forty-five (6.7%) of 667 patients had SCCHNs, including those at the oral cavity (n=1), larynx (n=1), oropharynx (n=7), and hypopharynx (n=36). Sensitivity, specificity, accuracy, positive predict value, and nega- tive predictive value for detecting SCCHNs by white light system were 51.1%, 99.7, 96.4%, 92%, 96.6%. In con- trast, those by NBI system were 97.7%**, 98.9%, 98.8%*, 86.3%, 99.8%** (*p<0.01, **p<0.001 vs white light). Especially, sensitivity for detecting small lesions of 10mm or less in diameter was 100 % for NBI whereas 18 % for white light system (p<0.001). Conclusion: NBI endoscope significantly improves diagnostic accuracy, sensitivity, and negative predict value in detecting SCCHN in EC patients. NBI endoscope would be highly beneficial in detecting superficial SCCHNs in high-risk patients.
S-14-2 OPTHALMOLOGIC APPLICATIONS OF LINEARLY POLARIZED NEAR-INFRARED RADIATION THERAPY APPLIED TO THE STELLATE GANGLION S Mori Mori Ophthalmic Hospital, Nagasaki, Japan
A stellate ganglion block (SGB) via local anesthetic is generally expected to increase ocular blood flow and is clinically applied to treat retinal artery/vein obstruction, retinitis pigmentosa, and optic neuritis. However, the procedure is not widely used as an ophthalmological treatment because it requires skill and imposes significant stress on the patient due to needle pain, the invasive nature of the procedure, and the potential for complica- tions. In contrast, stellate ganglion light near-infrared radiation therapy(SGL)non-invasively provides the same ocular blood flow increasing effects as SGB and appears likely to gain wide acceptance and use in the treatment of ocular disease. As the first ophthalmologist to apply SGL in the field of ophthalmology, the author of this paper herein presents new findings based on clinical use of SGL to treat ocular diseases.
284 Laser Tokyo 2009 PROGRAM & ABSTRACTS
S-14-3 THE EFFICACY OF A 308-nm MONOCHROMATIC EXCIMER LAMP TARGETED UVB PHOTOTHERAPY FOR VARIOUS SKIN DISEASES M Yokogawa, T Takata, Y Nagano, M Ikeda, and S Sano Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
Aims and background: The xenon chloride excimer lamp emits 308-nm monochromatic UV with higher energy than conventional narrow-band UVB, offering a novel targeted phototherapy. The aim of this study was to evaluate its therapeutic efficacy in various skin diseases. Materials and methods: This study was done at our clinic from September 2007. The various skin diseases, including psoriatic erythemas, nail psoriasis, vitiligo, scleroderma, and other problems were treated with 308- nm monochromatic excimer lamp. Results: Most of psoriatic erythemas and vitiliginous lesions rapidly improved following irradiation, despite that some of them had been resistant to narrow-band UVB irradiation, suggesting a therapeutic predominance of the excimer lamps. However, severe lesions and nail involvement in patients with psoriasis were necessary the pretreatments to demonstrate favorable responses. Interestingly, a few patients with scleroderma showed remarkable improvement with reduction of skin stiffness. And another two patients with cutaneous mucinosis demonstrated significant improvement of erythematous plaques associated with reduction of mucin deposition in the dermis. The most common side-effects were erythema and hyperpigmentation. Others included intense erythema and, more rarely, blisters were seen in few patients. Conclusions: We conclude that treatment with 308-nm monochromatic excimer lamp represents an alternative UV therapy not only for psoriasis and vitiligo but also for lesions in the dermis.
S-14-4 LOW POWER LASER IRRADIATION FOR PAINLESS OHTHODONTICS MY Chen May You Orthodontic Offices, Osaka, Japan
Aims and Background: Teeth movement in orthodontic treatment accompanies with temporary pain, which bothers patients. The patients can take NSAID, but the anodyne could inhibit the tooth movement due to supression of prostaglandin synthesis. I here introduce our attempt to employ low power laser irradiation for the pain relief in orthodontic treatment. Materials and Methods:The gallium aluminium arsenic diode laser at the wave length of 830nm and 20mW was irradiated for 2 minutes to the buccal gingiva of 1st molar on one side after inserting elastic separators. The other side was treated as a sham irradiation control by double blind tests. Effects of He-Ne laser and Cold laser were also investigated. The pain was evaluated by the visual analog scale (VAS). Results: The average VAS value of the diode laser-irradiated sides was significantly smaller than that of non- irradiated sides.The irradiation of He-Ne laser and the short dulation of high intensity diode laser (Lumix2) also caused a significant pain attenulation effect in the average VAS values. Conclusions: We can use low powered laser to reduce the pain during orthodontic treatment.
S-15-1 LASER TREATMENT OF MUSCULOSKELETAL PAIN AND DYSFUNCTION: CURRENT EVIDENCE D Baxter, and S Tumilty Centre for Physiotherapy Research, University of Otago, New Zealand
Aims: To assess current evidence for clinical effectiveness of laser therapy and laser acupuncture in the man- agement of musculoskeletal pain and dysfunction. Background: Low level laser therapy and laser acupuncture are popular treatment choices for the non-pharma- cological management of musculoskeletal pain in physical medicine and rehabilitation; however such applica- tions have been contentious, in part due to confusion about the underlying mechanisms of action and early reviews which found conflicting evidence of effectiveness. Materials and Methods: For this study, we undertook online searches for systematic reviews of the literature since 2000 using relevant key words. Results: Systematic reviews in this area have found Conflicting or No Evidence of clinical effectiveness for low level laser therapy for the management of osteoarthritis; ‘shoulder conditions’; and low back pain. In contrast there was Limited to Strong Evidence of clinical effectiveness reported for rheumatoid arthritis; chronic joint disorders; chronic neck pain; knee pain; and tendinopathies. For laser acupuncture, there is moderate evidence of its clinical effectiveness in the management of myofacial pain, and limited evidence of effectiveness in the treatment of chronic tension headache. Conclusions: There is limited to moderate evidence to support the use of laser technologies in the management
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of musculoskeletal pain and dysfunction; however recent systematic reviews highlight the importance of the use of appropriate parameters.
S-15-2 HOW WOULD THE REACTIVITY FOR LOW POWER LASER BEAMS BE ACQUIRED AFTER ANTI-TNF TREATMENT ON RA PATIENTS? J Obata Japan Rheumatism and Laser Laboratory, Kanagawa, Japan
Aims and Background: Rheumatoid arthritis (RA) is a progressive systemic chronic disease mostly in bones and joints which repeats remissions and relapses constantly. Since auto-immune mechanisms and cytokine net- works play a significant role in the onset and course of RA symptoms, immuno-therapies and anti-cytokine treatments are mainly used to treat it at present. Among them anti-cytokine treatments for tumor necrosis factor α (TNF α) and Interleukin 6 are especially effective. Some newest reports showed that Anti-TNF treatment could get the clinical remission containing pain reliving effect and the imaging remission that destruction of joints was suppressed. But LLLT could get only the clinical remission with pain relieving. Many reports showed that the pain relieving effective ratio of Low reactive Level Laser Treatment (LLLT) on RA was about 70%. However, why is the LLLT ineffective for about 30% cases of RA? Materials: The quality of laser instruments used in this study was Ga-Al-As diode laser with 830nm wave length, a 60mW continuous wave of energy output and a power density of 7.64W/cm2. About 4 or 8 points on only one painful joint were irradiated for 5 minutes. A recombinant human TNF receptor-Fc fusion protein (Etanercept) for Anti-TNF therapy was injected 2 times a week into 12 patients with RA who didn’t take an immediate pain reliving effect by LLLT. Results: Etanercept was effective for about 90% of RA patients by using EULAR Disease Activity Score (DAS28). But, all cases had at least one paSinful joint after the injections of Etanercept for 8~48 weeks. The painful joints of 12 cases were tried to treatment by LLLT again after the Etanercept injections. The result was that LLLL was effective for 50% of them. Conclusions: It was speculated that threshold of pain after Etanercept treatment with decreasing production of Prostaglandin E2 would change to higher level than that of the first trial of LLLT before Etanercept treatment. As a result, the reactivity for Laser beams would be acquired by decreasing the concentration of Bradykinin in synovial tissue by anti-TNF treatment.
S-15-3 THE USE OF LOW LEVEL LASER THERAPY IN MUSCULOSKELETAL PHYSIOTHERAPY IN NEW ZEALAND S Tumilty Centre for Physiotherapy Research, Otago University, New Zealand
Aims and Background: Low Level Laser Therapy (LLLT), a relatively new option for New Zealand physiothera- pists, is mostly used as an adjunct therapy and seldom used as a stand-alone treatment in New Zealand. The aim of this presentation is to describe a series of research projects that have taken place to assess the effective- ness of LLLT for the treatment of tendinopathy. Materials and Methods: A systematic review with meta-analysis was carried out on published randomised con- trolled trials of LLLT to treat tendinopathy. The results of this review provided an effective dosage window from 12 positive studies showing benefit in the treatment of tendinopathy. The dose recommended for Achilles tendinopathy was then used in a pilot study and a subsequent adequately powered randomised controlled trial to assess the clinical effectiveness of this modality. Patients were randomised into an active laser or placebo group (20 for the pilot study and 40 for the main RCT); all patients, therapists and investigator were blinded to allocation. All patients were given an eccentric exercise program and irradiated 3 times per week for 4 weeks with either an active or placebo laser at 6 standardized points over the affected tendons. Irradiation parame- ters in the active laser group were: 810nm, 100mW, applied to 6 points on the tendon for 30 seconds giving a dose of 3J per point and 18J per session. In the main RCT the power density of the probe was adjusted to 100mW/cm2 to satisfy critique of the parameters used in the pilot study. Outcome measures were the VISA-A questionnaire and a visual analogue scale of pain. Patients were measured before treatment, at 4 and 12 weeks. ANCOVA was used to analyze data, using the effects of baseline measurements as a covariate. Data from the pilot study was used for power calculations for the main RCT. Results: Both studies showed within groups, there were significant improvements (p < 0.05) at 4 and 12 weeks for all outcome measures. However, there was no difference between groups at 4 and 12 weeks (p>0.05). Conclusion: This use of the above parameters demonstrated no added benefit of LLLT over that of eccentric exercise in the treatment of Achilles Tendinopathy.
286 Laser Tokyo 2009 PROGRAM & ABSTRACTS
S-15-4 LLLT FOR CHILDREN WITH SPASTIC CEREBRAL PALSY Y Asagai 1, and T Ohshiro 2 1: Shinano Handicapped Children's Hospital, Nagano, Japan; and 2: Japan Medical Laser Laboratory, Tokyo, Japan
In 1991, we introduced low level laser therapy (LLLT) as a new therapeutic method for suppressing myotonia in cerebral palsy. GaAlAs diode laser was used( wave length at 810 nm, output 100 mW, irradiation time 1 minute per target site with continuous wave for 15 minutes in total per day). The target sites were the acupuncture and the nerve block points, and the muscles where the myotonia was observed. The myotonic suppression of any sites on the body is possible. The laser irradiation is not effective for regions where irre- versible joint contracture occurs. The laser irradiation before the slow stretching training is useful because the pain associated with the stretching is suppressed. The irradiation is completely free from pain or serious adverse reaction. The laser irradiation might act as a trigger for improving the imbalance of the antagonistic muscles, thus LLLT can be positioned as supplementary treatment for enhancing the effect of functional train- ing.
S-16-1 LIGHT INTERACTION WITH THE INJURED AND DISEASED CENTRAL NERVOUS SYSTEM JJ Anders Uniformed Services University of the Health Science, Maryland, USA
Light therapy (LT) effects on CNS altered by spinal cord injury (SCI) or amyotrophic lateral sclerosis (ALS) were examined. SCI Background: SCI is a severe CNS trauma with no restorative therapies. Materials and Methods: Two SCI rat models were used: contusion and dorsal hemisection. 810nm light was applied transcutaneously at the lesion site after injury and daily for 14 consecutive days. The daily dosage was 1589 J/cm2, 0.3cm2 spot area, 2997 seconds with 150mW output power. Axons were labeled with mini-ruby and counted and measured from the lesion site distally. Functional recovery was assessed by footprint analysis and BBB test. Results: The average distance of axonal regrowth of the LT groups in the hemisection (6.89±0.96 mm) and contusion (7.04±0.76 mm) models was significantly longer than the untreated control groups (3.66±0.26 mm, hemisection; 2.89±0.84 mm, contusion). LT groups had a statistically significant higher total axon number compared to untreated groups in both models. Statistically significant functional recovery was found in the LT groups com- pared to the controls for both models. Conclusions: LT applied non-invasively promotes axonal regeneration and functional recovery in acute SCI caused by different types of trauma suggesting that light is a promising therapy for SCI. ALS Background: ALS is a progressive, fatal, neurodegenerative disease characterized by grad- ual loss of motor neurons. Impaired mitochondrial energy metabolism may be involved. LT has biostimulatory effects on mitochondria and may increase survival of motor neurons in ALS. Materials and Methods: A mouse model of ALS (SOD-1 G93A transgenic) was used. The experimental group were treated with light (810 nm diode laser, 1.2 J/cm2, three times a week, at three sites: motor cortex and cervical and lumbar enlargements). Mice were treated from 50 days of age until death. Behavioral tests and weight monitoring were done once a week. Survival data was collected. Results: The light treated group had a significant improvement in rotarod performance at 130 days of age. These mice showed a rapid decline in motor function starting at 150 days of age. There was no significant difference in survival between control and treatment groups. Conclusion: Since the genetic defect in the SOD-1 transgenic mice causes a progressive degeneration of the mitochondria, light may have a positive effect only on the early stages of the disease. when the electron transport chain is still intact.
S-16-2 BENEFICIAL AND ADVERSE EFFECTS OF PHOTOTHERAPY M Ichihashi Doshisha University, Kyoto, Japan; Morinomiya Medical College, Osaka Japan; and Sun Care Institute, Osaka, Japan
Aims and Background: Therapeutic effect of sunlight was already recognized even a century ago by better clin- ical management of psoriasis patients with heliotherapy and a carbon arc lamp. In 1970s, PUVA (psoralen + UVA) phototherapy was introduced to treat psoriasis patients and evaluated to be a new effective modality to control psoriasis lesions resistant to conventional treatments, and accepted worldwide, resulting in confirmed increase of non-melanoma skin cancer of PUVA-treated patients compared with non-treated population, after more than 10 years clinical experiences. In 1980s, narrowband UV phototherapy (NBUVB) was introduced to treat psoriasis and other skin diseases by the development of light source emitting a limited ranged light, and theoretical less side effects, particularly for skin malignancies, although we have no convincing statistical data
ABSTRACTS 287 LASER TOKYO 2009
showing a safety of NBUVB compared to other modalities using light source. Results & Discussion: IPL is popular to rejuvenate photo-aged skin, and LED is getting a position as an effective phototherapy for acne treatment. NBUVB and other UV-phototherapy are now understood to influence the pathologic immune response in psoriasis and other skin diseases, by altering the deviated antigen presentation, effecting cytokine expression pattern and decreasing the number of macrophages by apoptosis and inducing immunosuppression. Further, UV radiation induces growth arrest and apoptosis by lipid peroxidation, DNA damage, transcription factor activation through ROS. These molecular and cellular alterations, together with clinical efficacy, make phototherapy to be a first-line therapy for intractable skin diseases, although guidelines in the patient management and safety of each phototherapy remain to be established.
S-16-3 LESS-INVASIVE MID-INFRARED LASER TREATMENT TECHNIQUES BASED ON THE OPTICAL PROPERTIES OF BIOLOGICAL TISSUES K Ishii, H Tsukimoto, S Watanabe, H Hazama, and K Awazu Graduate School of Engineering, Osaka University, Osaka, Japan
In the last decade, many infrared (IR) lasers with several specific wavelengths were developed. These corre- spond to Nd:YAG laser (1.064Ȑm), Ho:YAG laser (2.1Ȑm), Er:Cr:YSGG laser (2.79Ȑm), Er:YAG laser (2.94Ȑm) and CO2 laser (10.6Ȑm etc.) and so on. These lasers can mainly induce chemical, thermal or mechanical effects like an ablation of hard and soft tissues. Examples of medical uses are general surgery, dermatology, dentistry, angiostomy, otolaryngology, gastroenterology and urology and so on as a laser surgical knife. In several years, some mid-infrared (MIR) tunable light sources have appeared. A free electron laser (FEL) is famous for the spe- cial laser system with wide range wavelength tenability and high-power laser pulses. However, the researches using FEL have been limited to seed researches because it requires a controlled area for radiation and a huge facility. Recently, developments of table-top light sources with wavelength tunability have made progress and optical parametric oscillation, difference-frequency generation (DFG) and quantum cascade laser etc. have started to become widely used at a laboratory level. Consequently, application studies in a MIR region have gained recognitions. MIR wavelengths correspond to the molecular stretching and vending vibrations. Thus MIR tunability means to be able to provide MIR photon energies with a specific target, molecular bonds and functional groups, by the irradiation with a wavelength corresponding to a molecular vibration. MIR laser irra- diation can realize a limitation of therapeutic effects and an inhibition of side effects and leads to less-invasive treatments in a tissue level. In order to get the less-invasive treatment effects, it is essential to determine the MIR optical property (i.e. MIR absorption coefficient) of a target tissue and use the optimal wavelength for real- izing a less-invasive interaction to a normal tissue. Recently, many medical applications using new MIR wave- lengths, for example, angioplasty for cardiovascular surgery and neurosurgery, preventive dentistry, ophthal- mology, orthopedic surgery, have been proposed. In this presentation, we will give some novel therapeutic applications using MIR lasers. Specifically, (1) less-invasive laser angioplasty with a wavelength of 5.75Ȑm and (2) selective mucosal ablation by the combination of CO2 laser and submucosal injection solution for the devel- opment of novel endoscopic submucosal dissection technique will be presented.
S-16-4 A NOVEL TYPE OF PACEMAKER?: EFFECTS OF LOW-POWER LASER IRRADIATION ON FROG CARDIAC AUTOMATISM S Kogure, and K Tsuchiya Department of Bioengineering, Graduate School of Engineering, Soka University, Tokyo, Japan
Aims and Background: In frog sciatic nerves, Ar+ low-power laser irradiation (LLI) selectively blocked the gen- eration of anode break excitation. Since anode break excitation is associated with membrane hyperpolarization, we tested an h current (Ih) blocker, ZD7288, instead of laser irradiation and obtained almost the same results (Y. Matsuda et al. LSM, 2006). The Ih was first identified in cardiac sinoatrial node cells of the rabbit as a pace- maker current (D. DiFrancesco et al. JP, 1986). Taking the similarity of effects between Ih blockers and LLI into consideration, the present study examined the effects of LLI on frog cardiac automatism to clarify the possibility of using LLI to develop a novel type of pacemaker. Materials and Methods: Twenty-three frogs (Xenopus laevis) were used. After the spinal amputation, the ventral skin and muscle over the heart was cut, and the heart was set in sight. Electrocardiogram (ECG) from a bipolar ball electrode of which tips were put on each side of the ventricle was recorded on magnetic tape via a bio- physical amplifier with a low-pass filter of 1.5-300 Hz. The experimental group received continuous LLI (532 or 808 nm; 30 mW; 12.6 mm2) to the venous sinus near the right atrium. Heart rate was calculated every 10 min and ECG waveform was analyzed. To compare the LLI effect with those of neurotransmitters of autonomic ner- vous system, 0.2 ml of 60 ȐM noradrenalin or 6 ȐM acetylchorine was applied to the venous sinus every 1 hr. Results: The control group showed an average heart rate of 45.0±3.5/min (mean±SE; n=6) at first. The rate gradually decreased and reached to 0 level at 12.6±1.5 hrs after the starting point. From approximately 10 hrs to the last point, a burst pattern of ECG was often observed. 532 nm LLI induced a transient tachycardia at first, kept relatively higher rate during the early period, and stopped the automatism at 15.3±2.0 hrs (n=5). In con-
288 Laser Tokyo 2009 PROGRAM & ABSTRACTS
trast, 808 nm LLI induced a steep slope of bradycardia during the early period and stopped the automatism at 8.4±1.5 hrs (n=5). The reciprocal effects of both LLIs were similar to those of sympathetic (noradrenalin) and parasympathetic neurotransmitter application (acetylchorine). Conclusions: We conclude that 532 nm LLI has a potential to induce a transient tachycardia and to prolong the automatism, whereas 808 nm LLI induces a bradycardia and shortens the automatism of frog heart.
S-16-5 EXPOSURE TO VISIBLE AND NEAR IR LIGHT OF TUMOR CELLS IN VITRO ENHANCES THEIR SENSITIVITY TO CYTOLITIC ACTIVITY OF NATURAL KILLERS NA Filatova, NA Knyazev, and KA Samoilova Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia
Aims and Background: The aim of this study is to investigate the effect of polychromatic VIS + nIR (480 – 3400 nm) light and full spectral range of VIS radiation (385-750 nm) on sensitivity of tumor cells to cytolytic activity of natural killers (NK). Materials and Methods: Murine hepatoma cells (MH-22a) and human erythromyeloleukimia cells (K-562) were exposed to light under conditions in vitro at doses either stimulating cell proliferation or not affecting it: Swiss phototherapeutic devices “Bioptron 2”(VIS + nIR) or “Q-light” (VIS), 40 mW/cm2, 4.8 J/cm2, 9.6 J/cm2, 38.4 J/cm2). Sensitivity of tumor cells to NK cells was evaluated in 3H-uridine test. After labeling by 3H-uridine the cells were added to murine splenocytes with ratio of tumor cells and splenocytes from 1:5 to 1:50. The percent- age of disintegrated tumor cells was estimated from intensity of label in surrounding medium. Structural changes of the tumor cell surface we studied by spectrophotomethrical method of vital quantitative estimation of the supra-membraneous components by their staining with 0.01% Alcian blue (AB). Results: Death of non-irradiated hepatoma cells after cocultivation with allogenic splenocytes in the ratio of 1:5, 1:10, 1:20, and 1:50 amounted to 14.7%, 15.3%, 21.2%, and 30.2% respectively. After irradiation with VIS + IR light (4 J/cm2) the number of disintegrated tumor cells was much higher: 31%, 35.2%, 40.1%, and 40.9%, which 1.8 times higher than in the case of non-irradiated cells (p<0,01). Effect of polychromatic VIS radiation was maximal at the higher dose – 9.6 J/cm2. Death of tumor cells at various ratios with effector cells reached 15.8%, 32.9%, 48.3%, and 58.5%. A similar regularity was also revealed after irradiation of κ-562 cells, although they were 1.44 times more sensitive than MH-22a cells to VIS+nIR light (9.6 J/cm2) and 2.3 times more sensitive to VIS irradiation (38.4 J/cm2). Staining with AC of tumor cells has shown that, first, the hepatoma cells absorb AC 5.5 times stronger as compared with the κ-562 cells and, second, the amount of AC-positive molecules can decrease by 7% in MH-22a cells after exposure to VIS+nIR light 4.8 J/cm2, and increase by 7% in K-562 cells. Conclusion: Exposure to polychromatic VIS + nIR light at doses not inhibiting tumor cells proliferation enhances their sensitivity to NK cells due to changes in the supra-membraneous glycoproteins expression.
S-17-1 CO2 LASER APPLICATIONS IN ORAL SURGERY HS Loh Faculty of Dentistry, National University Health System, Kent Ridge, Singapore
There is a growing acceptance of laser applications for their effectiveness in the management of dental condi- tions, with predictable and reproducible results. The experience to use lasers to cut, vaporize and coagulate with favorable biological responses is consistent from established energy parameters and techniques. Wound healing is within normal expectations, with reduced scarring and contractures. Also, there is no evidence of the risk of malignant transformation of treated tissues. Dysfunction is minimal as a result of reduced tissue manipu- lation and instrumentation. Laser therapy is suited for intra-oral mucosa lesions, including leukoplakia. Pre- prosthodontic laser surgery provides better outcomes in broad-based mucosa lesions. Perio-endodontic appli- cations are enhanced with histochemical and immunological changes. Immuno-modulation is promising for oral lichen planus. Overall cure rate for pre-malignant conditions is good and laser ablation for difficult oral cancers provide better functional and aesthetic results. Photo-coagulation and photo-thermolysis by selective laser absorption benefit vascular and pigmented conditions. Minimally invasive facial procedures are on the rise with laser cosmetic therapy. Molecular and cellular changes with the current understanding of laser stimu- lation help improve the management of facial pain eg. trigeminal neuralgia, TMJ disorders and post-operative pain. There is a growing confidence in its scientific and evidence basis with higher energy levels used for pain relief and cure. The future is bright with new and combination systems, improved instrumentation and low- ered costs.
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S-17-2 RD Vieru
S-17-3 THE USE OF LASERS IN ORAL SURGERY K Nakajima Oarai-Nakajima Dental Office, Ibaraki, Japan
The development of laser use in surgical dentistry has expanded to include all oral tissues, with accepted pro- tocols for selected wavelengths being adopted. 10 is exceeded also by the kind according to wavelength. From such laser, 410nm, 910nm, 940nm, 1064nm, 2940nm, and 10600nm which I am using, explained this time. When using one laser according to the wavelength trait, or when using some kinds of laser to the same case, it is introduced with a case how it uses. LASERS VELscope-LED Dental Inc, LUMIX2-USA laser Biotech Inc, Ezlase-Biolase Inc, Neocure 7400- SYOFU Inc, Opusduo Aqalite EC-LUMINES Inc, Bellaser-TAKARA BELMONT Inc. Diode laser 410nm- Application to the cnacer medical checkup which uses VELscope. 910nm- The case of Stomatitis in which the LLLT effect which uses LUMIX2 was expected 940nm- Frenectomy and hemostasia. Nd:YAG laser (1064nm) The application to removal of gingival melanin pigmentation is compared with CO2 laser and Er:YAG laser. Er:YAG laser (2940nm) Application to apicotomy CO2 laser (10600nm) Application to a fibromectomy The case which uses two or more laser Application to Implant and Peri-implantitis. The operation and inspection performed by one laser were used for the case which suited the wavelength trait. It was based on the trait of each wavelength when two or more laser was used. Naturally, Er:YAG laser is indispensable in the case of the application to the hard tissue. When other laser was pigment absorbency, it was used for formation of hemostasia or a blood clot. The good result in which any case employed the trait of laser efficiently was obtained. The patient is happy with the results.
S-17-4 THE APPLICATION OF “ER,CR;YSGG LASER” FOR ORAL SURGERY AND IMPLANTS T Tsuda Medical Corporation Kouyoukai, Chief Director / Dentist
Dental implant is getting popular and acquires citizenship in recent years. Many clinicians are performing root form implants, Sinus Elevation and distraction osteogenesis. Authors continue to maintain an awareness of the feature which Waterlase has such as pain relief, anti-inflammatory property and sterilization effect. Especially, it’s encourage healing effect is the remarkable. Those properties can be applicable to following Implant procedure. Exposing the Implant site. The gum tissue opened to expose the area of bone where the implant will be placed by Waterlase(Er,Cr; YSGG laser). Preparation of Implant Site. Waterlase is used to prepare the bone to receive the implant. The laser drilling is remarkable application for Waterlase. The alleviation of post-surgery pains and reduction of inflammation also expected by using Waterlase. And it’s a secondary operation. The distraction osteogenesis and sinus elevation are one of remarkable application of Waterlase. The implant procedures done by Waterlase are explained in this presentation. The damage When it is going to apply laser to an in plant, it is the influence in the irradiation that it must think first. An in plant exists near the part to irradiate. The irradiation The surface of an in plant main part. The danger that change, heat influence, etc. of quality will start should be considered. Moreover, irradiation conditions. I if risk control can be carried out, it will be necessary to investigate the level.
290 Laser Tokyo 2009 PROGRAM & ABSTRACTS
I want to speak about basic research first, to display bone reclamation especially a Sinus Elevation, distraction osteogenesis, the case in which expected bone extraction and its recovery effect further, and laser irradiation was performed, etc., and to describe the irradiation level and its reaction in various kinds of application, this time.
S-18-1 THE LASER CAN BE THE “ IT ” THING TO HAVE FOR GPS 940nm, 980nm, 2780nm LASER IN ENDODONTICS AND PERIODONTICS FOR CLINICAL DENTISTS
K Nakashima Nakashima Dental Office, Tokyo, Japan
The Application of 980nm and 2780nm laser in Endodontics and Periodontcs at clinical levels found to be very much useful in my office. The main purpose of usage of laser is better bactericidal effect and irrigation effect and cutting effect at the site. What we must know is that how to deal with root canal problems and gum prob- lems before we choose laser as a tool. Once you know the treatment procedure with conventional method for endo and perio problems then it is very much useful to use laser. The laser is a tool to help us treat patients under comfortable condition. The laser minimizes our time and yield more business. Again, you must know the conventional treatment method very well before you use laser. I am not going show any procedural photos of any treatments because you must be able to picture the final stage of healing of any disease before you apply laser. I am going to talk about what we can do with laser as a tool to treat root canal problems and gum problems on the fundamentals of laser treatments. I am not doing anything special. What I am doing with laser is very fundamental treatment for root canal and gum problems with basic knowledge as much as you know. Let us use the laser for better results by using laser.
S-18-2 TISSUE REGENERATION EFFECT OF HIGH INTENSITY DIODE COLD LASERS AND THE CLINICAL APPLICATIONS IN PERIODONTAL THERAPY N Marquina 1, and R Gougaloff 2 1: USA Laser Biotech Inc., Virginia, USA; and 2: Redondo Beach Dental Group
Aims and Background: Aims of the study investigated the expected effects of high intensity super-pulsed diode cold lasers on periodontal tissue regeneration and measure the clinical effectiveness as an adjunct procedure in patients undergoing conventional scaling and root planning (SRP) periodontal therapy. Materials and Methods: Theoretical photon-tissue interaction models were constructed based on current bio- physical and physiological research. Biophysical models describing the expected behavior of gingival tissues exposed to different types of laser energy densities and wavelengths have been developed. The models are compared against clinical results obtained from subjects undergoing periodontal therapy using a specific high intensity laser treatment device (Lumix 2 Dental, wavelength 910 nm, pulse width 200 ns, peak power 45W, maximum adjustable average power 250 mW, maximum adjustable repetition rate 80 KHz, aperture diameter 8 mm, power density 0.5W/cm2; USA Laser Biotech Inc., Richmond, Virginia, USA). Each subject in the study has at least two periodontally compromised sites on different teeth on each side of the same jaw. Laser treatment is rendered on one randomly chosen side only in a single blind fashion. Both sides receive SRPs. Clinical Attachment Level (CAL), Bleeding on Probing (BOP), Plaque Index (PI) and Radiographic Bone Levels (RBL) are used to compare the treatment and control groups. Systemic effects of the laser treatments are measured by comparing the results from the control sites against subjects undergoing periodontal therapy and that are not enrolled in the study. Results: The theoretical models suggest that gingival tissues respond well to laser energy delivered in short bursts (low duty cycles) of high intensity pulses and repetition rates of 30,000 pulses per second. Conclusions: Applications of high intensity super-pulsed diode cold lasers procedures are effective as adjunct to conventional periodontal therapies.
ABSTRACTS 291 LASER TOKYO 2009
S-18-3 APPLICATION OF LOW LEVEL LASER AND USEFUL OF WATERLASE FOR DENTAL AND ORAL DISEASE S Asanami Dept of Oral Surgery International University of Health and Welfare Mita Hospital, Tokyo, Japan
It is well known that using low-output laser has a positive effect on the following two main areas of treatment of dentistry, just like be seen in other clinical fields, one is pain control and the other is acceleration of wound healing. However, its usage has not been limited to only these two areas. The low-output laser has recently come to be applied a lot, especially in dental implant treatment and tooth bleaching. We conducted a basic experiment using rabbit to investigate the effect of the low-output laser on osseointegra- tion of implants. The result also shows that is usage has decreased the degree of peripheral inflammation. Then, we now have started its clinical application. At the last, we also introduce a new laser instrument called “waterlase”, which has a very strong cutting power and is an ideal tool for caries treatment and cavity preparation.
S-18-4 WATERLASE TURBO DENTISTRY S Sato Sato Dental Clinic, Tokyo, Japan
Waterlase dentistry is occuring in dentistry with a technolgy breakthrough that gives dentists the capability to perform a wide range of hard and soft tissue procedures with less trauma, reduced post-op complications. It is a Erbium:Chromium,Yttrium Scandium Gadolinium Garnet (Er,Cr:YSGG) laser which the wavelength is 2780nm. It is near to the wavelength of Erbium Yttrium Alminium Garnet (Er:YAG) laser 2960nm. Both wave- lengths coincides nicely with the peak of water absoption. But the most biggest difference between Er:YAG laser is that the Er,Cr:YSGG laser has a shorter and sharp steep high intensive impulse which makes a power- ful impact. It delivers a gentle spray of water from the tip of the handpiece and helps the “hydrophotonic process” which is based on absorption in water of microsecond pulses of 2780 nm YSGG laser energy. It is precise, safe, effective and now more efficient than ever at removing hard tissue during tooth cavity prepara- tion procedures. It removes tissue through gentle forces created by water-vapor micro-expansion, instead of the grinding forces of the high-speed drill. When used for cutting soft tissue, the unique YSGG laser wave- length incises and ablates with minimal to no bleeding by rapidly coagulating blood vessels. Thus, without mechanical contact from the laser tip, without the uncomfortable heat and vibration of the dental drill. What actually for other treatments, we could cut and drill bone tissues in surgery. And another advantage is there are no high speed drilling howling sounds to fear the patients. And the new Waterlase turbo system is indicated for various hard and soft tissue procedures that absolutely do not require tissue contact or access through tis- sue to reach the site, such as Class I – V cavity preparations, carries removal, enameloplasty and excavation of pits and fissures for placement of sealants. So, in contrast to the high-speed drill, the Waterlase turbo is a non- contact cutting device that uses a beam of laser energy instead of a bur to excavate tissue. The beam of energy works like a bur, cutting through tissue approximately 2-3 mm from the end of the tip. The laser energy con- tinues to cut effectively in depth and to the sides as long as the beam is in focus, 2-3 mm from the targeted tis- sue and the tip is in constant motion from side to side. With many procedures, it’s possible to use less anes- thetic, and often no anesthetic at all.
S-19-1 EFFECTS OF LASER ON PATIENTS WITH DIABETES TYPE I AND II L Longo Institute Laser Medicine, Siena University, Firenze, Italy
Introduction: Diabetes mellitus (DM) is a wide-spread disease, a serious public health problem and a risk factor for many fatal issues. Non Surgical Laser Therapy (NSLT) has been found to regulate the function of several cellular and biological mechanisms and to have a beneficial effect on glucose uptake and glycaemia. The objective of this study is to test a NSLT treatment protocol and its effect on glycaemia in a sample of DM type I and type II patients. Patients and Method: A total of 74 DM patients where enrolled, 27 type I and 47 type II. 10 patients per group were given placebo treatment. NSLT applications with a specific treatment protocol were carried out during the period June 2004 and August 2009. Results: Between before and after treatment DM type I patients showed a 20% mean fall in glycaemia and DM type II a 22% mean fall. HbA1c from baseline value after 3 months fell by 20% in type 1 and 25% in type 2, after 6 months by 24% in type 1 and 32% in type 2, after 9 months by 31% in type 1 and 37% in type 2 and after 12 months by 39% in type 1 and 41% in type 2.
292 Laser Tokyo 2009 PROGRAM & ABSTRACTS
Conclusions: LASER as an adjunct to the pre-existing treatment with other anti-diabetic drugs produced a fur- ther significant glycaemic improvement. LASER may become a valuable addition to the therapies available to patients with DM type I and II.
S-19-2 LOW-LEVEL LASER IRRADIATION ATTENUATES PRODUCTION OF REACTIVE OXYGEN SPECIES BY HUMAN NEUTROPHILS S Nakaji, M Matsuzaka, I Takahashi, K Danjo, K Iwane, R Tsuya, K Yamai, T Iwasaki, T Hasebe, R Inoue, and T Umeda Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
Aims and Background: In recent years, the role of low-level laser therapy (LLLT) has been gaining great atten- tion in relieving various clinical situations including chronic inflammatory conditions. Reactive oxygen species (ROS) can impair protein, nucleic acids, and a wide range of molecular species; additionally, excess ROS pro- duction has been recognized to play a role in many inflammatory conditions. The aim of this study was to examine the effects of LLLT on ROS production by human neutrophils. Subjects and Methods: The blood samples were obtained from 20 healthy male volunteers (mean age, of 30.7 years; range, 25-35 years, and neutrophils were isolated and determined using the infrared diode laser (GaAIAs) of 830-nm continuous wave (150 mW/cm2). After irradiation, ROS produced by neutrophils were measured using luminol-dependent chemiluminescence (LmCL), and expressions of CD11b and CD16 on neu- trophil surface were measured by flow cytometry. Results: The LmCL response of neutrophils was reduced by 60 minutes of laser irradiation prior to the stimula- tion with opsonized zymosan and calcium ionophore. The attenuation effect of LLLT was greater in neutrophils of smokers than non-smokers. Expressions of CD11b and CD16 on surface of neutrophils were not affected by LLLT. Conclusions: Attenuation of ROS production by neutrophils may play a role in the effects of LLLT in the treat- ment of inflammatory tissues. Thus, there is a potential usage of LLLT to improve wound healing in smokers.
S-19-3 ADENOSINE TRIPHOSPHATE (ATP) IN MECHANISM OF LLLT Y Kataoka Riken Center for Molecular Imaging Science, Hyogo, Japan
Aims and background: Low-reactive level laser therapy (LLLT) is known to relieve pain and hasten the tissue healing. One possible mechanism of such photo-dynamic effects is suppression of excessive neural activity. We proposed a hypothesis that activation of ATP-sensitive potassium channels by the increase in adenosine triphosphate (ATP) in neurons is involved in the relief of excessive neural activity by LLLT with a near-infrared laser (continuous wave; wavelength, 830 nm). We studied the effect of near-infrared laser irradiation on ATP synthesis in the central nervous system. Furthermore, the relationship between tissue ATP level and the sup- pressive effect of laser on neural activity was evaluated. Materials and Methods: In order to study the effect of laser irradiation on synaptic transmission, we performed extracellular recording of field excitatory postsynaptic potential in rat hippocampal slices. Content of ATP in the slice tissue was assayed by the luciferase-luciferin method. In these studies, the hippocampal slices were irradiated with the near-infrared diode laser (power density, 1-5 W/cm2) for 10-15 min. Results and Conclusions: We observed that the near-infrared laser irradiation reversibly inactivated synaptic transmission in the rat hippocampal slices. The laser irradiation increased ATP content in the hippocampal slices. The suppressive effect of laser irradiation on synaptic transmission was more potent in older slices con- taining ATP at the lower concentrations than fresh slices. This may contribute to the clinical phenomenon that more potent effects of low-reactive level laser irradiation are often seen in the tissue under pathological states than physiological states.
S-19-4 R Chow
ABSTRACTS 293 LASER TOKYO 2009
S-20-1 COMMON OVERUSE UPPER-EXTREMITY INJURIES IN RECREATIONAL EXERCISE LASERTHERAPY IS INCLUDED IN THE TREATMENT PROTOCOLS FA Soriano, R Soriano, and V Campana IAMEL (Instituto Argentino de Medicina Laser), Rosario, Argentina; and Catedra de Biologia Universidad Nacional de Cordoba, Cordoba, Argentina.
Approximately 50% of all sports injuries are secondary to overuse and result from repetitive microtrauma that causes local tissue damage Treatment in most cases involves rest with splinting, icing, and NSAIDs in acute cases, although surgical decompression is indicated in chronic or recurrent cases. The majority of patients with sport injuries that consulted to our Services are adults that practise sports in a reg- ular or sporadic way. Epicondylitis, patellofemoral syndrome, Achilles tendinitis, plantar fascitis, and stress frac- ture emerge as the most common overuse injuries that athletes encounter Treatment protocols are based on the stage of the inflammatory process that is active at the time of diagnosis. Control of the inflammatory response is the treatment objective during the inflammatory stage. In this presentation we will discuss the place that Lasertherapy occupies in our daily clinical practice alone or in general combined with other therapeutic modal- ities, in the treatment of overuse injuries related with sports activities.
S-20-2 DIODE LASER THERAPY FOR SPORTS-RELATED INJURY J Kubota Kubota Junichiro Clinic, Ikebukuro, Toshimaku, Tokyo, Japan
S-20-3 ASSESSMENTS OF PHYSIOLOGICAL AND PSYCHOLOGICAL STRESSES IN RUGBY PLAYERS, MARATHON RUNNERS AND JUDOISTS AND THE APPLICATION POTENTIALITY OF PHOTOTEHRAPY TO REDUCE THOSE STRESSES T Umeda, I Takahashi, M Matsuzaka, K Danjo, K Iwane, R Tsuya, K Yamai, T Iwasaki, T Hasebe, R Inoue, and S Nakaji Department of Social Medicine, Hirosaki University Graduate School of Medicine, Aomori, Japan
Aims and Background: The participation in physical activities and/or during sports practice have been recog- nized to cause various physical/psychological stresses and even certain physical damages in some cases. The present 4-part study was designed to elicit stress and to examine how the low level laser therapy (LLLT) could counteract stress formation. Subjects and Methods: In Part one of the study, physical and psychological stresses of 59 top athletes, including rugby players, judoists and marathon runners, before and immediately after a match or run were examined in terms of the changes in blood biochemistry and neutrophil reactive oxygen species production, as well as the Profile of Moods State (POMS) scores. In Part 2 of the study, the efficacy of GaAlAs diode laser LLLT in chronic pain treatment was assessed in 1087 patients in a 4-yr period with a questionnaire. In Part 3 of the study, the effect of LLLT on the ROS production capacity of fMLP-stimulated pooled human neutrophils was examined under in vitro condition. In Part 4 of the study, the efficacy of LLLT in the treatment of knee and ankle pain in 10 sumo wrestlers was assessed by the laser speckle flowmetry analysis of superficial blood flow before and after the application of LLLT. Results: In part 1, detrimental changes in the blood biochemistry parameters associated with muscle damage were seen in all groups, concomitantly with a significant increase in ROS production with the exception in rugby players. An increase was seen in the POMS total mood disturbance (TMD) score. All athletes therefore had both post-activity physiological and psychological stress. In part 2, LLLT achieved an average of 75% improvement in pain attenuation, however, it also showed some improvements in psychosomatic elements. In part 3, significant retardation of human neutrophil ROS activity was seen with specific LLLT parameters in vitro. In part 4, the blood flow showed an increase even after 60 min of LLLT in all subjects. It was also increased concomitantly with pain attenuation in all subjects. Conclusions: LLLT plays an important role in sports medicine in terms its potential to reduce both physiological and psychological stresses, including muscle damage, oxidative stress and pain.
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S-20-4 EFFECT OF IRRADIATION WITH A GaAlAs DIODE LASER ON RECOVERY FROM EXERCISE-INDUCED SKELETAL MUSCLE FATIGUE IN HUMANS M Murayama 1, Y Ishide 1, T Ohshiro 2, F Ueda, T Ohshiro 3, S Fujii 3 K Takenouchi 2, and M Kohzuma 2 1: Institute of Physical Education, Keio University, Yokohama, Japan; 2: Japan Medical Laser Laboratory, Tokyo, Japan; and 3: Ohshiro Clinic, Tokyo, Japan
Aim and Background: Low reactive-level laser therapy (LLLT) is being evaluated for the treatment of chronic and acute pain. Recently, some studies have shown that LLLT may delay the development of skeletal muscle fatigue during high-intensity exercise. Accordingly, it may be hypothesized that laser irradiation also attenuates muscle fatigue or pain experienced after sports or exercise. However, only a few reports have described the use of lasers in sports medicine for non-treatment purposes. This study was conducted to determine the effec- tiveness of low reactive-level laser irradiation (LLLI) in aiding the recovery from exercise-induced skeletal mus- cle fatigue. Subjects and Methods: Isometric plantar flexion was repeatedly performed on 9 students until the force output declined to 50% maximal voluntary contraction (MVC). All subjects were randomly assigned to perform 1 of 3 experiments under different LLLI conditions: laser irradiation to the neck (NKL), laser irradiation to the muscle (MSL), and no laser irradiation (CON). MVC and the indicators of recovery from fatigue (muscle hardness, girth, blood oxygen saturation, and heart rate) were measured during the pre-exercise, post-exercise (0 min), and recov- ery phases (after 5, 10, 15, and 30 min). The neck and muscle were irradiated for 15 s using the Oh-Lase HT 2001 semi-conductor laser (830 nm; 60 mW), immediately after MVC measurement during the post-exercise phase. Results: The total exercise time and mean output forces were analyzed using repeated-measures and one-factor ANOVA with post-hoc tests; no significant differences were observed among the 3 conditions (NKL, MSL, and CON). Then, no significant difference was observed in the post-exercise MVC levels before irradiation (NKL, 68.1% MVC; MSL, 66.4% MVC; CON, 66.1% MVC). However, the MVC at 5 and 10 min after exercise was signifi- cantly greater in the NKL and MSL groups than in the CON group (MVC after 5 min: 80.4%, 76.9%, and 69.7% for the NKL, MSL, and CON groups, respectively; MVC after 10 min: 81.8%, 81.2%, and 74.4%). Further, no sig- nificant differences were observed in the MVC recorded at 15 and 30 min. Therefore, compared to the CON group, the NKL and MSL groups exhibited early muscle-strength recovery from fatigue caused by repeated con- tractions. Conclusion: We concluded that LLLI effectively promotes the recovery of the isometric force output after mus- cle fatigue induced by repeated contractions, especially in the acute-exhaustion phase.
S-21-1 IS LASER ASSISTED HATCHING BENEFICIAL TO ART TREATMENT? A Fukuda 1, A Ohtani 1, S Mizuno 1, A Haruki 1, and Y Morimoto 2 1: IVF Osaka Clinic, Osaka, Japan; and 2: IVF Namba Clinic, Osaka, Japan
In vivo hatching of blastocyst is critical component of the physiologic events culminating in implantation. It has been speculated that the failure of the embryo to hatch following in vitro fertilization and subsequent embryo transfer (IVF-ET) may be one of the reasons for low efficiency of the treatment of assisted reproductive tech- nology (ART). It has been postulated that failure of implantation in a substantial number of transferred embryos may be because of their inability to escape from their zona pellucida (ZP) after reaching the blastocyst stage. Failure of ZP rupture and subsequent impaired hatching have been proposed to account for the relative decrease in implantation rates after IVF-ET in patients with advanced age, thick ZP, and high FSH levels. The clinical application of assisted hatching (AH) has been proposed as one approach toward the enhancement of implantation and pregnancy rates following IVF-ET. It has been suggested that AH of embryos enhances implantation by mechanically facilitating the hatching process, thus allowing earlier embryo-endometrium con- tact and communication. Three methods of AH are currently available to create a gap or thinner area in the ZP, those are, mechanical partial zona dissection or zona drilling, chemical zona drilling by acidified Tyrode’s solu- tion, and the laser technique have been reported to have a beneficial effect on implantation and pregnancy rates. In the present study, the effect of zona drilling using laser technique and acidified Tyrode’s solution was examined not only on the clinical outcome but also practical aspect of laboratory procedures. Moreover, appli- cation of laser AH on embryo biopsy and intracytoplasmic sperm injection was investigated. The present study revealed that no differences were noted in the effect of AH on both laboratory and clinical outcome between laser and Tyrode’s method. However, laboratory procedures of laser AH was more reproducible, and less intertechnician variation compared to Tyrode’s method. On the other hand, acidified Tyrode’s method was less expensive and can be done any where on the micromanipulator without expensive instrument. Pretreatment of ZP by laser AH was beneficial on the ICSI procedure of fragile oocytes and embryo biopsy for preimplantation genetic diagnosis. In conclusions, laser AH is beneficial to the ART treatment for the sake of not only patients, but also laboratory personnels.
ABSTRACTS 295 LASER TOKYO 2009
S-21-2 EXPERIENCE OF LASER ASSISTED HATCHING, 11,626 CASES IN KATO LADIES CLINIC Y Takehara Kato Ladies Clinic, Tokyo, Japan
Aims and Background: Recent IVF focuses on single embryo transfer to avoid multiple pregnancies, and this requires the selection of best quality embryo, sometimes result in blastcyst transfer. Even though the selected best blastcyst is transferred, there are many cases that do not become pregnancies, probably based on zona thickness and/or zona hardening because of freezing procedure. Assisted Hatching (AH) is supposed to improve implantation rate. There are two types of AH, namely chemical AH using acid tyrode and mechanical AH such as laser. We ini- tially started AH by acid tyrode and we removed all zona pelucida so that any part of the embryo could implant on endometrium. We performed 4121 cycles of AH to the patients whose average age was 36.7 years old. We had good pregnancy results (39.4%), but this technique is quite difficult and extremely skillful, then we changed our AH method to Laser assisted hatching (LAH). There were 20,000 IVF cases in our clinic last year and we have experienced many LAH until now. We disclose our huge data about LAH to show its safety and good results. Subjects and Methods: Patients in Kato Ladies Clinic from March 1, 2004 to July 31, 2009 were classified into day 2 single embryo transfer (ET) group and single blastcyst transfer (BT) group depend on their tube patency or their past clinical histories. Those BT group was further divided in two groups such as AH positive group (11626 cycles, 37.7 years old) and AH negative group (10964 cycles, 38.1 years old). Ovulation inductions were done by minimal stimulation or without any stimulation. Blastcysts were cryopreserved by vitrification and thawed at 5 days after ovulation, or hormone replacement cycles in case patients could not ovulate sponta- neously. In AH positive group, thawed blastcysts zona pelucida were punctured by laser and embryos were denuded by aspirating using glass pipette with informed consents. Embryo transfers were done with transvagi- nal echo probe showing whole ET procedures to the patients. Pregnancies were diagnosed 7 days after blast- cyst transfer by blood beta-hCG level, miscarriage rate, twin rate were calculated. Results: Pregnancies, abortions, ectopic pregnancies of LAH positive group, and negative group were 5166 (44.4%) vs.5366 (48.8%). 1735 (33.6%) vs. 1620 (30.3%). 27 (0.5%) vs. 15 (0.3%), respectively. Conclusions: LAH is proven to be safe method for cryo-thawed blastcysts, and its effectiveness will be depicted by slides in the conference.
S21-3 LASER SAFETY FOR HEALTHCARE PROFESSIONALS PJ Smalley Technology Concepts International, Chicago, Illinois, USA
LASER, OH&S, OD, MPE, AEL, NOHA, LSO, LSC, LSS, LPA, HCLS, LGAC, LEV, VLT, NOHD, IEC, ISO, SHOULDS AND SHALLS...... A universe of laser standards, terminology, regulations, guidelines, professional recommended practices, poli- cies, and procedures, governs the use of Class 3b and Class 4 medical lasers, in many countries around the world. Though healthcare professionals always strive to provide excellence in patient care, and a safe working environment for ourselves and our colleagues, we often feel inadequately prepared to read, interpret, and implement those rules that define our clinical practices, as we incorporate more and more laser technology into daily use, in a wide variety of practice settings. Safety concerns including: management of surgical plume, ocular hazards and protective eyewear, controlled access to the laser room, electrical hazards, and fire hazards will be discussed. This presentation will also explore laser safety regulations and standards, and will define those agencies and procedures that govern safe laser practice, from a clinical and risk management perspective. The standards of reference are the IEC 60825 (International Electrotechnical Commission), and recommended professional nurs- ing standards.
S-21-4 LASER ASSISTED HATCHING FOR CRYOPRESERVED CLEAVED EMBRYOS K Hiraoka Kinutani Women’s Clinic, Hiroshima, Japan
Aims and Background: Assisted reproductive technology generally produces surplus embryos that can be cry- opreserved for later use. The success of a cryopreservation programme will undoubtedly increase the cumula- tive pregnancy rates. Success associated with the transfer of cryopreserved embryos has been generally lower
296 Laser Tokyo 2009 PROGRAM & ABSTRACTS
than that obtained with fresh embryo transfer. One explanation may be due to zona pellucida (ZP) hardening during the cryopreservation process. Therefore, an artificial thinning or opening in the ZP, i.e. assisted hatching (AH), may be useful for cryopreserved embryo transfer. Recently, AH by 1.48 _m diode laser has been intro- duced and has enabled to reliably produce equally sized ZP thinning or opening. However, studies evaluating the effect of the size of ZP thinning or opening for cryopreserved embryos by laser AH are lacking. The aim of this study was to evaluate the results of two different sizes (quarter or half of ZP) of ZP thinning by laser AH for cryopreserved cleaved embryos (Experiment 1) and two different sizes (one eighth or half of ZP) of ZP opening by laser AH for cryopreserved cleaved embryos that were cultured to blastocyst (Experiment 2). Materials and Methods: Experiment 1: A total of 120 cryopreserved cleaved embryo transfers were assigned to either quarter or half of ZP thinning group. Laser AH was conducted at the cleavage-stage. Experiment 2: A total of 71 cryopreserved cleaved embryo transfers were assigned to either one eighth or half of ZP opening group. The cryopreserved cleaved embryos were cultured to blastocyst and laser AH was con- ducted at the blastocyst-stage. Results: Experiment 1: The rates of clinical pregnancy (46.7 versus 25.0%) and implantation (32.0 versus 16.2%) were significantly greater in the half thinning group than in the quarter thinning group (P = 0.0218 and P = 0.0090, respectively). Experiment 2: The rates of clinical pregnancy (74.2 versus 42.5%) and implantation (51.9 versus 27.4%) were significantly greater in the half opening group than in the one eighth opening group (P = 0.0090 and P = 0.0117, respectively). Conclusions: Our results suggest that the area of ZP thinning or opening can affect the outcome of cryopre- served embryo transfer and that higher pregnancy and implantation rates can be attained as the area of ZP thinning or opening increases up to half. The laser seems to be beneficial, allowing for quick, easy-to-perform in a clinical situation where half of ZP needs to be thinned or opened.
S-22-1 LASER TREATMENT FOR EARLY STAGE ADENOCARCINOMA OF THE UTERINE CERVIX K Kubushiro, Y Yamamoto, N Sakurai, H Taoka, Y Asakawa, and M Fukuda Department of Obstetrics and Gynecology, Toho University School of Medicine, Ohashi Medical Center, Tokyo, Japan
It is well known that squamous cell carcinoma (SCC) is the most common histological form of cervical cancer. The proportion of adenocarcinoma (AC) cases is increasing in Japan. A standard treatment protocol for squa- mous intraepithelial cervical lesions has been established: both LASER vaporization for a dysplastic lesion and cervical conization for SCC of CIN3 and FIGO stage Ia1 are acceptable therapeutic options that help preserve the patient’s fertility. By using conization for SCC of stage Ia1 in cases with no positive surgical margin or inva- sion of the lymph-vascular space, hysterectomy can be avoided. However, with regard to AC, we need to be extra cautious while planning and executing treatment, even in the case of early stage disease, i.e., adenocarcinoma in situ (AIS) or FIGO stage Ia1. This is because unlike squa- mous lesions, early stage AC is difficult to diagnose on the basis of colposcopy findings. Therefore, adequate pathological evaluation, as performed in cases of stromal invasion of cancer tissue, is occasionally not carried out. Microinvasive AC is frequently diagnosed by examining a conization specimen. As per the “Guidelines for the treatment of cervical cancer,” issued by the Japan Society of Gynecologic Oncology in 2007, hysterectomy is recommended as the treatment of AIS (stage 0) even in cases where a negative surgical margin is found in the conization specimen. The rationale for this recommendation is that a glandular epithelial lesion gives rise to skip lesions at distant locations, and approximately 20% cases where the conization specimen shows a negative surgical margin may have a remnant lesion in the residual uterus. In the case of microinvasive AC (stage Ia), treatment should be customized for individual patients by considering the depth of stromal invasion. Modified radical hysterectomy or radical hysterectomy including pelvic lymphadenectomy is the preferred treatment for patients with deep stromal invasion, whereas total hysterectomy without lymphadenectomy is preferred for those with superficial invasion. Cervical conization should be considered when fertility preservation is strongly desired. In this lecture, we will discuss LASER treatment for early stage adenocarcinoma of the uterine cervix by pre- senting our studies and their findings. Concurrently, we will discuss fertility-preserving treatment measures for the cervical cancer.
S-22-2 PHOTODYNAMIC THERAPY FOR CERVICAL INTRAEPITHERIAL NEOPLASIA S Yamaguchi, H Kuroda, M Muraji, S Wakahashi, S Kanayama, Y Miyahara, T Yamada, Y Hashiguchi, T Sudo, and R Nishimura Department of Gynecologic Oncology, Hyogo Cancer Center, Akashi, Hyogo, Japan
Aims and Background:Since PDT is minimally invasive with no surgical excision, it should be a cervix-sparing
ABSTRACTS 297 LASER TOKYO 2009
treatment, which may be particularly attractive to women desiring to preserve fertility. We report the effective- ness of PDT in cases of CIN. Material and Methods:Between 1996 and 2006, 165 women with a histological diagnosis of CIN (CIN1: 14; CIN2: 13; CIN3:severe dysplasia79 CIS:54; MIC:5) were hoped to retain their fertility and chose PDT for its potential as a cervix-preserving therapy. All patients received intravenous PHE, 2mg/kg to photosensitize the lesions (Photofrin, Japan Wyeth Lederly Co., Ltd. Japan). Phototherapy was performed using a YAG-OPO Laser (Ishikawajima-Harima, Heavy Industry Co., Ltd. Japan) with an irradiation dose of 100 J/cm2 using a 630 nm wavelength. After treatment, all patients were hospitalized in a dark room with protection from light for 3 weeks. The patients were examined every 3 months after PDT treatment. The clinical effect was judged using cytology and directed biopsy. DNA samples were analyzed by L1 consensus primers for amplification and detection of HPV-DNA. Results:Toxicity was predominantly mild cutaneous photosensitivity (grade 1-2 in 95 patients, and grade 3 in 1 patient). Grade 1 and 2 cutaneous photosensitivity were cured within 2 weeks with or without topical treat- ment of steroid. Cervical stenosis occurred in some patients. PDT was performed safely for all patients. 134 patients(81%) had no abnormal cytologic findings at 3 months following treatment after PDT, remaining 31 patients(19%) still had abnormal cytology. Finally 21 patients with CIN1-2 of cervical biopsy were followed by no treatment, however 10 patients with CIN3 had conization treatment. HPV typing was performed before and after PDT therapy for 69 patients. Before treatment, HPV was detected in 64 of 69 patients (93%), including 30 patients with high-risk HPV (16 +18). Three months after PDT, HPV-DNA could not be detected in 47 out of 64 patients (74%) who showed HPV-DNA positive cervical smears before treatment. Of all 165 patients, 22 patients have become pregnant following PDT including 14 women who have delivered term babies without complica- tions. Conclusions: PDT is an effective and minimally invasive treatment for CIN, which also appears to eradicate HPV infection.
S-22-3 PHOTODYNAMIC THERAPY FOR UTERINE CERVICAL CANCER AND FERTILITY PRESERVATION M Sakamoto 1,2, S Okamoto 1,2, K Miyake 1, Y Koyamatsu 1,3, T Akiya1, M Nakano 1,2, T Muroya 3, Y Tenjin 1, K Ochiai 2, and T Tanaka 2. 1: Dept. of Gynecology, Sasaki Foundation Kyoundo Hospital, Tokyo, Japan; 2: Dept. of OB/GY, Jikei University School of Medicine; and 3: Dept. of Gynecology, Kokoro to Karada no Genki Plaza
The number of the patient with dysplasia and CIS of the uterine cervix has been increasing recently, especially in the younger ages who need fertility preservation. Although cervical conization is standard therapy for dys- plasia and CIS, the significant increase in the obstetrical risks such as premature delivery after conization has been reported. On the other hand, PDT is an excellent procedure to treat dysplasia and CIS by photochemical reaction generated by laser irradiation to the lesion after injection of tumor-specific photosensitizer. We have developed protocol and applied PDT to dysplasia and CIS for 20 years. PDT was performed for 520 cases (146 dysplasia, 342 CIS, 4 AIS, 24 MIC, 1 MIAC, 2 invasive SCC, and 1 invasive adenoca.) 97% (503/520) of PDT cases were CR by the first PDT. 8 out of 16 PR cases turned out to be CR by the second PDT. CR rates for dys- plasia, CIS, MIC were 99%, 97%, and 92%, respectively.Two kinds of uterine preservation therapy (PDT and conization) for dysplasia and CIS were compared with respect to cure rate and fertility after therapy. Although cure rate by PDT is nearly equal to that by conization, pregnancy rate and delivery rate after PDT were signifi- cantly higher, and premature delivery rate after PDT was lower than those after conization. These data suggest- ed that PDT for uterine cervical cancer might be superior therapy for fertility preservation as compared to conization.
S-22-4 FREQUENCY AND EXPRESSION OF RADIATION DAMAGES IN PATIENTS WITH PROSTATIC CANCER AFTER DISTANT RADIATION THERAPY AND THE LOW-INTENSITY PHOTOTHERAPY WITH NEAR IR DIODE LIGHT GM Zarinov 1, AA Zimin 2, KA Samoilova 2, NY Neklasova 1, and LA Volodina 1 1: Russian Research Centre of Radiology and Surgical Technologies of Rosmedtechnologies, St. Petersburg, Russia; and 2: Institute of Cytology, of the Russian Academy of Sciences, St Petersburg, Russia
Aims and Background: The low-intensity radiation of visible and near IR (nIR) range has already been used in oncology for many years for treatment of complications appearing after radiotherapy and surgical treatment of tumors of various localizations, however, data on effect of such accompanying therapy on frequency ofradia-
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tion lesions in deeply located organs (urinary bladder, rectum) in patients with prostate cancer (PC) are absent. Materials and methods: 820 patients with PC of I-IV stages were submitted to distant radiation therapy (DRT) and hormonal therapy from January 2000 to June 2009. Patients were divided into the control (n = 455) and the main (n = 365) group. In control group, prevention of radiation damages was realized by the commonly accepted scheme. Patients of the main group were additionally given the 12-day course of phototherapy with the matrix photodiode apparatus “Lasernoe Solnyshko” (NIIEFA, St. Petersburg, λ = 890 nm, 45 mW, 10.8 J, pulsed-periodic mode, duration of pulses from 120 to 150 ns, frequency of pulses from 80 to 3000 Hz). Action of light was performed onto the skin areas submitted to DLT beginning with its 12th session. To evaluate statis- tical significance of differences in frequency of radiation complications, the χ2 criterion was used. Results: In the control group, frequency of radiation reactions from urinary bladder amounted to 2.6%, whereas in patients of the main group – to 0.27% (p < 0.05). Frequency of radiation reactions from rectum in control group was 3.73%, while in the main group – 1.4% (p < 0.05). Differences were also recorded in the degree of expression of complications produced by radiation therapy. In the control group, complications from urinary bladder of I, II, and IV degrees were noticed in patients with localized, locally-spread, and generalized PC forms, whereas in patients obtaining phototherapy, complications of II degree were recorded only in patients with the generalized PC form. In control group, radiation damages of rectum of I, II, and III degrees were pre- sent in patients of all PC forms, while in the main group, complications of I-III degrees were revealed only in patients with localized and generalized PC forms. Conclusion: In patients with PC after course of phototherapy with the low-intensity nIR radiation of photodi- odes, frequency of radiation lesions of urinary bladder and rectum decreased (10 and 2.7 times, respectively); also decreased was expression of the degree of these lesions.
S-23-1 NEW INDICATION OF PDT FOR LUNG CANCER- FOR THE OPTIMAL SELECTION OF PATIENTS H Kato 1,2,3, K Miyajima 1,3, H Inada 1,3, T Kono 1, J Usuda 3, and N Ikeda 3 1: Niizashiki Central General Hospital, Saitama, Japan; 2: International University of Health and Welfare, Tokyo, Japan; and 3: Tokyo Medical University for PDT, Tokyo, Japan
Early detection and the precise diagnosis of lung cancer are important for the achievement of curative PDT. Lung cancer is the leading cause of death from cancer throughout the world, due to the high prevalence of tobacco smoking, the environmental pollution, the aging society and detection of lung cancer at the late stage. And also the treatments are difficult in patients with impaired lung function such as chronic obstructive pul- monary disease (COPD) caused by tobacco smoking. In addition, recently patients with multiple primary lung cancer are increasing. At present, there is a high demand for non-invasive, safe and accurate therapies. Therefore the non-invasive treatment such as PDT is recently making attention. In order to anticipate these desires of people, early detec- tion is important firstly. The screenings by chest CT and sputum cytology as methodologies of early detection of lung cancer have been pointed out. Sputum cytology-detected squamous cell carcinoma is sometimes difficult to localize by bronchoscopy. Because early-stage central-type lung cancer, including carcinoma in situ, is often invisible endoscopically. This led to the development of the new technologies of bronchoscopic photodynamic diagnosis (PDD) and autofluorescence bronchoscopy for localizing invisible early lesions, and the SAFE 3000 (HOYA Pentax, Japan) is presented. On the other hand, clarification of the depth of invasion of the bronchial wall is also an important issue. The new technology of optical coherence tomography with the HOYA Pentax company is now in the process of developing. The mucosal structure can be seen much more clearly by this new technology than by ultrasonography. The PDT result is well corespondant with precise diagnosis of early stage lung cancer.
S-23-2 CLINICAL RESPONSES OF TOPICAL PHOTODYNAMIC THERAPY IN DERMATOLOGY Y Matsumoto, Y Akita, H Nakaseko, D Watanabe, and Y Tamada Department of Dermatology, Aichi Medical University, School of Medicine, Aichi, Japan
Introduction; Photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) has been used to treat skin diseases in dermatology. The efficient photosensitizer protoporphyrin IX is formed endogenously after applica- tion of the hydrophilic porphyrin precursor ALA in tumor tissues. PDT involves the activation of a photosensi- tizer by visible light to create cytotoxic oxygen species and free radicals, which selectively destroy rapidly pro- liferating cells. Purpose and Materials; We evaluated the treatment of actinic keratoses, Bowen’s diseases (squamous cell carci- noma in situ) and superficial basal cell carcinomas, extramammary Paget’s disease, mycosis fungoides, acne vulgaris, sarcoidosis, recalcitrant hand and foot warts and toenail onychomycosis.
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Methods; The skin surface was treated with a 20% ALA ointment, occlusively dressed with a cling film and cov- ered with alminum foil for light protection. About 4-6 hours after application of ALA, light irradiation of 50- 100J/cm2 was given to the lesion using an excimer dye laser (PDT EDL-1, Hamamatsu Photonics) emitting 630 nm laser light or Thera Beam VR 630 (USHIO). Results; After three sessions of PDT performed a week apart, the complete response rate was about 82% for lesions with actinic keratoses, 75% for lesions with Bowen’s diseases. A therapeutical benefit of PDT is also evi- dent for inflammatory dermatoses such as acne vulgaris, sarcoidosis, recalcitrant hand and foot warts and toe- nail onychomycosis. Discussion; Topical ALA-based PDT in dermatology is a convenient, non-invasive treatment with excellent cos- metic outcomes without surgical scars for treating skin cancers and non-neoplastic cutaneous lesions.
S-23-3 THE ROLE OF PDT ON AGE-RELATED MACULAR DEGENERATION IN THE ERA OF ANTI-VEGF THERAPY A Obana 1,2, and Y Gohto 1 1: Department of Ophthalmology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan; and 2: Photochemical Medicine Department, Photon Medical Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
Aims and Background: Choroidal neovascularization (CNV) of age-related macular degeneration (AMD) is gen- erally classified into three types, predominantly classic CNV, minimally classic CNV and occult with no classic CNV, based on fluorescein angiographical findings. TAP study clearly showed that PDT using verteporphin induced better visual prognosis in predominantly classic and occult with no classic CNV. Thus, PDT can pre- serve visual acuity, however no improvement of visual acuity was achieved. The clinical use of anti-vascular endothelial growth factor (anti-VEGF) agents to AMD began in 2005. Since intravitreous injection of anti-VEGF can achieve improvement of visual acuity, such therapy has recently become the most popular therapy for AMD, and the number of patients received PDT monotherapy decreased all over the world, although the effec- tiveness of the combined therapy of PDT and anti-VEGF is still investigating. Therefore, the following questions occurs; PDT monotherapy has become a past therapy? We don’t need PDT any more? In the present study, we investigated the PDT effects on CNV classified with the basis of pathological point of view, and consider the role of PDT on the AMD treatment. Patients and Methods: Pre-treatment CNV was classified into two types; type 1 was CNV existed below the reti- nal pigment epithelium (RPE) and type 1+2 was CNV extended into subretinal space. The eyes with no exuda- tive changes after successful PDT were divided into two types; sub-pigment epithelial dry type and sub-sensory retinal dry type. In the former, the lesion remained below the RPE and in the latter, fibrous scar persisted in the subretinal space. The morphological changes were investigated in one hundred and five eyes of 104 patients. Results: 77% of type 1 and 89% of type 1+2 became dry lesions in a mean follow-up time of 23.9 ± 8.4 months with a mean treatment times of 2.0 and 2.2, respectively. Type 1 favourably ended into sub-pigment epithelial dry type, while type 1+2 sub-sensory retinal dry type (p=1.06×10-10, chi-square test). Visual acuity of the former was better than the latter. Conclusions: The damaged RPE was repaired during the temporary closure of CNV by PDT, and exudation resolved with CNV remaining beneath the RPE in type 1. This is an important merit of PDT that had not been obtained by previous laser photocoagulation, and we consider that PDT still has a certain possibility in the treatment of AMD in the era of anti-VEGF therapy.
S-23-4 PHOTODYNAMIC THERAPY FOR RECURRENT OR RESIDUAL UTERINE CERVICAL CANCER AFTER CONIZATION M Sakamoto 1, 2, S Okamoto 1, 2, K Miyake 1, Y Koyamatsu1, 3, T Akiya 1, M Nakano 1, 2, T Muroya 3, Y Tenjin 1, K Ochiai 2, and T Tanaka 2. 1: Dept. of Gynecology, Sasaki Foundation Kyoundo Hospital, Tokyo, Japan; 2: Dept. of OB/GY, Jikei University School of Medicine; and 3: Dept. of Gynecology, Kokoro to Karada no Genki Plaza
Cervical conization has been widely used as the uterine preservation treatment over the cervical cancer in the early stage up to stage Ia. In the case of recurrent cervical cancer after conization or in the case of residual can- cer with positive surgical margin of the cone, either simple total hysterectomy or the 2nd cervical conization is usually performed. However, if the 2nd conization is performed when aiming at fertility preservation, the possi- bilities of premature delivery are thought to become high because of shortened cervical length. Therefore, we performed PDT for the case of recurrent or residual cervical cancer after conization to evaluate its response rate and clinical outcome. PDT was performed with informed consent to 18 cases of recurrent or residual cervi- cal cancer after cervical conization under the diagnosis of severe dysplasia (2 cases), CIS (7 cases), AIS (one
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case) and stage Ia (8 cases) of cervical cancer. The excimer-dye laser irradiation was performed using col- poscopy and endocervical probe at 100J/cm2 48 hours after intra-venous administration of Photofrin at 2mg/kg. 17 out of 18 cases of recurrent and residual cervical cancer who underwent cervical conization showed CR after PDT (CR rate: 94%). No case of re-recurrence after CR has been observed so far. Observation period ranges from 2 years 9 months through 13 years 7 months after PDT. Furthermore, five among 18 cases who underwent PDT resulted in pregnancy and delivered healthy babies. Although the further accumulation of cases is required, PDT is considered to be a very useful uterine preservation therapy even for postoperative recurrence and residual cancer after cervical conization.
S-24-1 POSTHERPETIC NEURALGIA - CLINICAL PRACTICE FOR POSTHERPETIC NEURALGIA Y Ide Toho University Sakura Medical Center, Chiba, Japan
Aims and Background: Postherpetic neuralgia(PHN) is a one of majar causes of chronic pain. In Japan, pain clinician takes care of the patients suffered from chronic pain by the procedures of neural block or low lebel light therapy(LLLT) and medication. I will show the treatment for PHN and clinical practice for PHN in my office. Material and Methods: 1.Procedure for PHN Neural Block: Epidural, intercostal, Stellate Ganglion block etc. LLLT: Irradiation for painful area or sympathetic ganglion 2.Medication for PHN tricyclic antidepressant: Imipramine, Amitriptyline, Nortriptyline, etc. serotonin-noradrenaline reuptake inhibitor: Milnacipran anticonvalsants: Carbamazepine, Phenytoin, valproate, diazepam, etc. antiarrthymic drugs: Lidocaine, Mexiletine NMDA antagonists: Ketamine, Dextromethorphan nonsteroidal anti-inflammatory drugs(NSAIDs) 3.Infusion for PHN lidocaine The patients with PHN are treated by 1,2 and/ or 3 in my office. Results: 14 new patients were came to my office from April/2008 to March/2009. Now, 3 patients were need procedure for PHN. Others were free from pain or satisfied by only medication. The percentage of satisfied patients was about 80%. Conclusions: Some patients with PHN were difficult to cure, but 80% of the patients with PHN could be satis- fied by these treatments.
S-24-2 COMPARATIVE STUDY OF 10 W PULSE LOW REACTIVE LEVEL LASER THERAPY (LLLT) AND UNDER 1 W NON-PULSE LLLT IN THE TREAT- MENT OF HERPETIC NEURALGIA AND POSTHERPETIC NEURALGIA H Yamada Department of Dermatology International Goodwill Hospital, Yokohama, Japan
Aims and Backgrounds: To evaluate the efficacy of 10 W pulse low reactive laser therapy (LLLT) in the treat- ment of herptic neuralgia and postherpetic neuralgia (PHN). Materials and Methods: Seventeen patients of herptic neuralgia and PHN were treated with 10 W pulse LLLT, using a Ga-Al-As diod laser at 830 nm (Medilase soft pulse 10 MLD-1006) (Mochida Siemens Medical System Co.,Ltd.) during 2008-2009. The efficacy of 10 W pulse LLLT was compared with the efficacy of under 1W non- pulse LLLT in which twenty patients of herpetic nueralgia and PHN had already been treated during 1993-2000. Results: The results of seventeen patients were excellent in 3 patients, good in 10 patients, fair in 4 patients and poor in 0 patient. The rate of improvement was 76.5 % and the mean pain release score (PRS) was 3.2. No clin- ical significant adverse effect resulting from 10 W pulse LLLT was noted. When the twenty patients back- grounds treated with under 1 W non-pulse LLLT were compared to the patients backgrounds treated with 10 W pulse LLLT, there was no statistic significant differences between the age, duration of neuralgia prior to LLLT, frequency of LLLT and duration of LLLT. When the results in the treatment of the two regimens mentioned above, there were no statistic significant differences in the rate of improvement and the PRS. Conclusion: Our results suggested that 10 W pulse LLLT was useful for the treatment of herpetic neuralgia and PHN patients. Although there was no statistic significant differences in the efficacy between 10 W pulse LLLT and under 1 W non-pulse LLLT, the former showed a superior tendency in the rate of improvement and the evaluation of PRS.
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S-24-3 LOW REACTIVE LEVEL LASER THERAPY IN THE TREATMENT OF POST HERPETIC NEURALGIA K Sasaki 1, T Ohshiro 2, T Ohshiro 1, and Y Taniguchi 1 1: Ohshiro Clinic, Tokyo, Japan; and 2: Japan Medical Laser Laboratory, Tokyo, Japan
Aims and Background: Post herpetic neuralgia (PHN) can be an extremely painful condition which in many cases proves resistant to all the accepted forms of treatment. It’s frequently most severe in the elderly and many persist for years with no predictable course. Since 1980, we have been applying low reactive level laser therapy (LLLT) for patients with post herpetic neuralgia (PHN). Material and Methods: We report herein on the results of a retrospective study concerning those patients in whom LLLT has been applied for pain attenuation of PHN. 123patients (73 male, 50 female, mean age: 67.11yrs.) received LLLT for various entities of PHN over the past 29 years. All cases were affected thorax and back (48cases), head and neck (41cases), abdomen and back (17 cases), upper limb (9 cases), and lower limb (8 cases). An 830 nm GaAlAs diode laser system, the Ohlase3D1 (Japan Medical Lase Laboratory, Tokyo, Japan), was used for the laser therapy. This device gives an incident output power in continuous wave of 60mW with an incident power density of 3W/cm2. Results: The over total improvement rate was 60.16%. Patient whose treatment was given within six month of onset obtained high improved rate (76.47%). No significant difference of the improvement rate between each age group was seen. Conclusions: LLLT was effective for PHN in the acute and chronic phase, but LLLT was particularly effective for the acute phase patients whose onset before treatment was 6 months or less. The results demonstrate a signifi- cant reduction in PHN pain intensity and other complaints.
S-24-4 NON SURGICAL LASER IN THE TREATMENT OF CENTRAL NERVOUS SYSTEM INJURIES L Longo Institute Laser Medicine, Siena University, Firenze, Italy
Background and Objective: Since many years the effects of non surgical laser and light on biological tissue have been demonstrated, in vitro and in vivo. Aim of our study is to verify the anti-inflammatory and regenerative effects of non surgical laser and light thera- py on patients with, chronic lesions not good treatable with traditional therapies. Materials and Methods: We enrolled patients both sex and age 14-55 y.o, with traumatic spinal cord and trau- matic brain injuries, occurred since one year minimum before laser treatment. Standardization of these patients is difficult because each patient is totally different in term of lesion, loss of sensibility, degree of inflamma- tion/degeneration. Since the trauma all patients treated with CNS injuries had total-subtotal sensory and motor paralysis under lesion level. EEG, NMR, neurophysiologic tests and electromyograms documented spinal cord and brain lesions. We used a diode laser 808 nm, with fluence 4-12 Joule/scm in average, with a first cycle of 15 sessions, three for day. We repeated in average half cycle for month, until today. We don’t know how many cycles do these patients need and what is the end point of their improvement. In addition, we associated olistic massage with laser treatment. Results: On Central Nervous System injuries, after first cycle all the patients had different degree of improve- ment sensory, motor and voluntary command and important improvement of the EEG, RMN and EMG features. Further improvement added after each cycle. Conclusion: Non surgical laser therapy was very useful in these patients with CNS chronic injuries. Number of sessions and time of improvement are variable for each patient and years of treatment could be required.
S-25-1 LLLT IN INFERTILITY S Suzuki Ginza women's clinic, Tokyo, Japan
At present, infertility in the most important problem in Japan. Causes of infertility have not yet completely resolved, but we know that number of infertile woman have been increasing recently, specially aged infertile woman. For aged infertile woman, blood supply to their reproductive organs is very important. Especially, blood supply to the ovarian tissue is definitely important for oocyte quality. It has been known that mitochondria in oocyte cytoplasm are quite important to determine the oocyte quality. Laser treatment for aged infertile woman have been known to increase blood supply to reproductive organs and many successful pregnancy have been reported at many clinics in our country.
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At this symposium I would like to report the present status of infertility treatments in our country and also add the efficacy of laser for aged infertile woman in Japan.
S-25-2 LLLT IN MALE INFERTILITY P Hasan Dept of Surgery, Pluit Hospital, Jakarta, Indonesia
Background and Objectives: Successful modality to overcome male infertility are rarely seen in the medical publications. Various attempts had been advocated to increase ability of infertile male to obtain the yearning baby, but none are fruitful. Base on the fact that LLLT can biostimulate physiological processes including cell replication and wound repair/ regeneration, a study was designed to investigate the posibility to improve infer- tile male. Material and methods: Forty infertile male, age ranging 25-47, all subjects entering this study are unable to make their partner become pregnant after 5 or more years effort with other treatment but had patent deferent ducts and normal hormonal levels as well as normal liver function. They comprised 6 azoospermic subjects, 15 severe oligospermic(sperm count less than 10.000.000/cc) and 19 moderate oligospermic(10.000.000- 30.000.000/cc). Every subject underwent a series of 10 twice weekly 10 minutes 30 mwatts HeNe Laser irradia- tion each at both testicles using difusing lens without pharmaceutical medications. Sperm count was examined pre and 10-14 days post laser irradiation. Results: The azoospermic subjects showed no response at all but in both severe and moderate oligospermic subjects, a 2- to 4- fold increase in the post irradiation sperm count was noted. Average were 3.1 fold in the severely oligospermic cases and 2.6 fold in the moderate oligospermic cases. Some improvement in sperm quality ie. better mobility and less abnormal spermatozoa. Conclusion: LLLT could possibly offer a safe non invasive therapeutic modality to treat the moderate oligosper- mic subfertile male.
S-25-3 THE USEFULNESS OF LLLT IN THE TREATMENT OF INFERTILITY H Tamura Tamura Ladies Clinic, Kyoto, Japan
Aims and Background: Even though the usefulness of LLLT in a realm of infertility treatment has been recog- nized, it hasn’t been accepted as common knowledge yet. With experiences since LLLT was introduced to our clinic in ’06, we’ve reviewed its availability. Materials and Methods: Among cases supposed to be intractable, i.e. those cases with more than 2 years of infertility treatment history in our clinic as well as corresponding to any of those, endometrial thickness ≤7mm, number of growing follicle ≤2, serum FSH value ≥10mIU/ml or ratio of good cleaved embryos ≤50%, we’ve picked up those with LLLT questionnaire score ≥15 (a value that state of tension of sympathetic nerve system is scored) as the targets of the study. The frequency and duration of LLLT to be performed were set to be 2-4 times/w for the first month and subsequently 1-3 times/w for more than 6 weeks. Technique procedure of LLLT was carried out based on central preference as follows: irradiation was performed 1)in the vicinity of both stellate ganglia, while exerting cervical part to perform stretching motion in the supine position; 2)both on the central umbilical hypochondrium and central part between umbilicus and pubis, for 1 to 3 minutes each. For cases of Assisted Reproductive Thechnology(ART), irradiation has been performed 1 hour before and 30 min- utes after ET as well as 3-4 days and 7-10 days after that respectively, also on brachial region and both legs in addition to the parts mentioned above. Results: Of 412 patients for whom LLLT had been performed from ’06 to ’08, 131 patients got pregnant. The breakdown was; 78 of 219 ART cases(35.6%), 38 of 122 Controled Ovarian Stimulation(COS) cases(31.1%) and 15 of other 71 cases(21.1%). The age-specific pregnancy was 10 out of 17 patients(58.8%), 78 out of 215 patients(36.3%) and 43 out of 180 patients(23.9%) in their 20’s, 30’s and 40’s respectively. Comparing changes before and after treatment in each parameter which was decisive to pick up subjects for LLLT, improvements have been recognized in all parameters. In particular, significant difference has been found in improvement in endometrial thickness. Conclusions: It has been assumed that LLLT based on central preference is effective for intractable cases with ART and that bloodstream-improving effect and tension-relaxing action for sympathetic nerve system as well may be associated with th effectiveness. We believe LLLT should be added as a method to promote infertility treatment.
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S-25-4 PROXIMAL PRIORITY TREATMENT USING THE NECK IRRADIATOR FOR ADJUNCTIVE TREATMENT OF FEMALE INFERTILITY Y Taniguchi 1, T Ohshiro 2, T Ohshiro 1, and K Sasaki 1 1: Ohshiro Clinic, Tokyo, Japan; and 2: Japan Medical Laser Laboratory, Shinanomachi, Shinjyuku, Tokyo, Japan
Aims and Background: In the past 50 years, the tendency to postpone childbearing spread throughout the developed world. In Japan, the trend towards females marrying later in life than before has increased the aver- age age of woman bearing children for the first time. The functions of organs decrease as the age increase. The fecundity of women also decreases due to mainly the decreasing quality of oocytes. The number of children being born in Japan has steadily decreased for 28th straight year and become a grave socio-economical con- cern for the future. Artificial reproductive technology (ART) has shown advances in the past two decades, how- ever there has been no new solutions to the problem of poor responders and the old problem of age. We have previously reported the efficacy of low reactive level laser therapy (LLLT) for the adjunctive treatment of refrac- tory female infertility. We introduce the new treatment result, using a new therapeutic device Material and Methods: Infertile patients presenting to Ohshiro clinic during the period of April 1, 2006 to August 31, 2009 were treated using a new therapeutic device, the Neck Irradiator. Each treatment session is consisted of 10 minutes of the proximal priority treatment and another 10 minutes of local (abdominal-lumbar area) treatment. Patients received treatment once every one to two weeks, depending on the patients’ sched- ule. Results: The average of the patients was 41.4 years. The average period of infertility was 3.6 years. An average number of 12.17 LLLT sessions per patient was performed. The pregnancy rate was 8.9%. Conclusions: LLLT is effective as adjunctive treatment of refractory female infertility. Using the Neck Irradiator, treatment has become more concise and patient can relax.
S-26-1 KEY WORDS ON LASER VOICE SURGERY J Abitbol, and P Abitbol Jean Abitol, Paris, France
The authors will present the keywords on Laser Voice Surgery after a 30 years of experience and more than 16000 cases. CO2 Laser 1° Think of every patient as a performer and evaluate the ratio : benefits and risks 2° There are “ lips on the vocal cords : Superior, intern, inferior ; Respect if possible one of the 3 lips of the vocal folds 3° Respect the surgical line : microscope, laryngoscope on the same line 4° Benign lesions are always on the epithelium of the vocal folds : We do a mucosectomy with the CO2 Laser; so we respect the vocal ligament Phonosurgical classification is: 1. Protrude lesions: polyp, granuloma, nodules, cyst; Reinke’s edema 2. Flat lesions: edema, laryngitis, Leucoplakia, carcinoma in situ, Papilloma 3. Recessed lesions: Sulcus vocalis, notch, atrophy of the cord 4. Excessive structures: arytenoidectomy, stenosis, web 5° CO2 Phonosurgical procedure for vocal folds Protection af the airway palpation of the lesion and the opposite side Laser impact on the vessels Laser with a fast hand speed Icy Cotonoïde Pulse Dye Laser on vocal cords Wave Length: 585 nm : Pulse in Microseconds : 100 – 4500 Power in Joules : 1Joule Photochemical Decomposition: Binding Molecular Rupture It is an office Phonosurgery for Vascular Lesions Varices & Striking Zone (Hematoma) Papilloma ; Leucoplasia ; Polypoid cord ; Edema post- radiotherapy; Scar CONCLUSION What to avoid To do a thermal effect: it creates a web between the vocal ligament and the epithelium: the voice is a disaster; there is no more vibrations What to do To aim the beam with the border of the beam To avoid thermal effect To protect the trachea
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What we see is not always what we have to remove Phonosurgery: It is not a Cosmetic Surgery; It is a Functional surgery If we know how we do operate! We do not and we cannot know how the patient heals
S-26-2 MOTION OF TYMPANIC OSSICLES IN MICE MEASURED BY A LASER DOPPLER VIBROMETER S Kanzaki 1, K Ogawa 1, and K Matsuo 2 1: Department of Otolaryngology Head and Neck surgery, School of Medicine, Keio University, Tokyo, Japan; and 2: Center for Integrated Medical Research, School of Medicine, Keio University, Tokyo, Japan
Aims and Background: The three auditory ossicles transmit vibrations from the tympanic membrane to the inner ear. In most of middle ear diseases such as chronic otitis media and otosclrelosis, ossicles can not effi- ciently transmit sound vibration. However, methods to monitor vibration of each ossicle are still under devel- opment. In this study, we applied a laser Doppler vibrometer for monitoring mobility of the tympanic mem- brane and ossicles in mice. Materials and Methods: We used the NLV-2500-5 laser vibrometer controller (Polytec Japan,Yokohama) which incorporates a velocity demodulator with 8 ranges for velocities up to 10 m/s and frequencies upto 2.5 MHz, and an internal CCD video camera to visualize the malleal handle behind tympanic membrane. We measured mobility of the malleal handle through the tympanic membrane of mice exposed to pure tone intermittent sound at 4,12, and 20 kHz. Results: Based on Fast Fourier transform (FFT) analysis, typmanic membranes of wild-type mice responded to pure tone sounds at the 12 and 20 kHz but not at 4 kHz, suggesting that the mouse tympanic membrane is more sensitive to sounds of the higher frequenciesis unlike in humans. The observed tympanic membrane shift was only 0.8 nm at 12 kHz, and 1.5 nm at 20 kHz of pure tone intermittent sound. Neither injury nor perfora- tion of tympanic membranes was observed after testing. Conclusions: Measurements on the tympanic membrane can be used to diagnose pathologies of the middle ear, such as luxations of the ossicles, otosclerosis or dysfunctions of middle ear. We are currently testing mouse models of middle ear diseases using this device. This is a non-invasive method employing the highly sensitive single-point vibrometer to monitor vibration of the tympanic membrane, and is applicable for human middel ear diseases or conductive hearing loss.
S-26-3 EFFECTS OF LOW LEVEL LASER THERAPY (LLLT) ON GENTAMICIN VESTIBULOTOXICITY IN RAT UTRICLE CK Rhee, JC Ahn, and MW Suh Department of Otolaryngology-Head & Neck Surgery and Medical Laser Research Center, Dankook university College of Medicine, Cheonan, Korea
Purpose: To investigate the effects of low level laser therapy (LLLT) for prevention and treatment of aminogly- coside-induced vestibular ototoxicity. Materials and Methods: An organotypic culture of explanted utricular maculae hair cells from 2 to 4 days old rat was performed. The cultured utricular hair cells were divided into 6 groups. Group C: the hair cells were cul- tured for 14 days. Group G: cultured hair cells were treated with 1 mM gentamicin (GM) for 48 hours and cul- tured continuously for 12 days. Group L: LLLT with 670 nm diode laser 10.8 J/cm2/day (3 mW/cm2 for 60 min) was irradiated to the cultured hair cells for 14 days. Group LG: LLLT 10.8 J/ cm2/day was given for 2 days fol- lowed by GM insult and cultured for 12 days. Group GL: insulted with GM followed by LLLT 10.8 J/ cm2/day continuously for 12 days. LGL group: LLLT 10.8 J/ cm2/day for 2 days, then GM insulted, and followed by the LLLT 10.8 J/ cm2/day for 12 days. The hair cells in each group were counted by confocal laser scanning micro- scope after FM1-43 staining and examined by scanning electron microscope (SEM). Results: The vestibular hair cells of group G was severely damaged and the number of hair cells was signifi- cantly less than those in group C. The hair cells of group L showed no difference compared to group C. Significantly higher number of cells was seen in group LG and GL comparing to group G. The cells were more in group LG than in group GL. Group LGL showed the most vestibular hair cells compared to the groups G, LG, and GL. SEM showed severely damaged hair cells in group G while they were relatively well preserved in groups C, L, LG, GL, and LGL. Conclusion: LLLT before and after GM insult on utricular hair cells were effective to prevent and treat GM oto- toxicity. Clinical implication: This study indicates that LLLT may be effective to treat various inner ear diseases and ototoxicity.
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S-26-4 LASER TREATMENT FOR LARYNGEAL CANCER K Araki, M Tomifuji, and A Shiotani National Defense Medical College, Department of Otolaryngology-Head and Neck Surgery, Saitama, Japan
Aims and Background: The organ preservation treatment for laryngeal cancer is increasingly recognised it’s importance. The outcome in patient’s quality of life may vary widely from the treatment options. Especially, the treatment for early glottic cancer offers variety of options because external radiation treatment gives good results. Laser cordectomy is one of the other prevalent options for early glottic cancer. The outcome of this treatment is considered almost same as radiation treatment. In our institution, the procedure of laser cordecto- my is classified by the classification proposed by European Laryngological Society. We will demonstrate the representative procedure of our operation and present our outcome of this treatment. Subjects: We analyzed patients who were operated laser cordectomy in our institution from July 2006 to September 2009. Results: The outcome of this procedure was almost same as that of radiation therapy. And patient’s voice after type I or II laser cordectomy also demonstrated good outcome. Conclusions: Laser cordectomy is one of the potent options for treatment of early glottic cancer.
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Poster
P-1 LOW POWER AND NEAR IR LIGHT IN ONCOLOGY: REVIEW OF PRECLINICAL AND CLINICAL DATA AA Zimin, NA Zhevago, and KA Samoilova Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia
Aims and Background: Attitude to the phototherapeutic methods using low power visible (VIS) and near IR (nIR) light of lasers, light emitting diodes (LEDs) and other sources often turns out to be reserved due to appre- hension of their stimulatory effect on tumor growth, which is based mainly on data of a possibility of an increase of proliferative activity of tumor cells after their exposure to light in vitro. Much less is known that these kinds of phototherapy have been successfully used for many years for prevention and therapy of compli- cations developed in oncological patients after surgery, chemo- and radiotherapy. It is also not widely-known about a large and positive experience of application of these photoradiations in experimental oncology, first of all in laboratory animals with transplanted tumors. The aim of this paper is to review the literature data on application of the low power VIS and nIR light for the last 25 years in patients with oncological diseases and in laboratory animals with transplanted tumors. Materials and Methods: This review includes information from databases Medline, Index Medicus, and Russian libraries for the last 25 years. The search string used for clinical and experimental trials was as follows: low level laser therapy OR low power laser OR low energy laser OR low intensity light therapy AND cancer. Results: We have found that VIS and nIR radiations used for treatment of complications developed in oncologi- cal patients after surgery, chemo- and radiotherapy (mucosites, skin radiation reactions, local radiation thera- py-induced complications in the wound, postoperational complications in patients with cancer of gastrointesti- nal tract, lung and urogenital tract, postmastectomy syndrome, preoperational laser therapy of patients with cancer of oncological patients and palliative treatment. Unfortunately, there are very few works concerning fol- low-up results after treatment with VIS and nIR radiations; however, the experimental data indicate decrease of mortality and downregulation of tumor growth and metastasis dissemination in animals with transplanted tumors after exposure to light. Conclusion: Further studies with an emphasis on follow-up results should be carried out for creating clinical protocols.
P-2 IMMUNOREHABILITATION OF BREAST CANCER PATIENTS WITH LOW POWER POLYCHROMATIC (VISIBLE + IR) RADIATION AFTER MASTECTOMY AA Zimin, NA Zhevago, and KA Samoilova Institute of Cytology, Russian Academy of Sciences, St. Petersburg, Russia
Aims and Background: Rehabilitation of patients with oncological diseases after surgery, chemo- and radiother- apy remains an actual problem of current medicine. We aimed in this work to analyze the changes of cellular and humoral immunity in patients with breast cancer (BC) after mastectomy and subsequent course of pho- totherapy with polychromatic visible and IR light. Materials and Methods: nineteen patients with BC of I-II stages were randomly divided into 2 groups. The 1st (control) group (n=8) without light treatment (L-) was given the conventional postoperative wound cure . The 2nd group, (L+, n=11) additionally received daily irradiations with polychromatic light (Swiss phototherapeutic device Bioptron-2, 480–3400 nm, 40 mW/cm2, 12 J/cm2). Current immunologic methods were used: flow cytometry of mononuclears (Mnc), DNA–cytometry of the Mnc suspension in combination with human cancer cells K-562, immunoturbodimetric assay of IgG, IgA, and IgM levels, ELISA of the serum content of cytokines. Results: Testing of the initial immunologic parameters (prevalues) of patients' peripheral blood revealed a num- ber of deviations from the norm: an increase of CD+3 T–lymphocytes (Lym), CD4+ T–helpers, and activated CD3+/HLA DR+T–Lym, a decrease of CD 19+ B–Lym and HLA DR+ cells, a decreased cytotoxic activity of CD 16+ cells (natural killers - NK), decreased phagocytic activity of neutrophilic granulocytes (GC). Mastectomy promoted disturbance of the immune status, which was recorded both 1 and 7 days after surgery: fast changes involved sharp rise of the absolute amount of leukocytes (neutrophilic GC). Decrease of monocyte and Lym amount (predominantly CD3+T – Lym and CD4+T-helpers), downregulation of NK and GC activity. Phototherapy corrected the surgery consequences: the increase of total amount of leukocytes in the L+ individ- uals decreased more markedly than in the non-irradiated (L-) ones. The postoperationally reduced amount of Lym and monocytes as well as NK-activity, GC phagocytic activity and level of IgM was restored more inten- sively in light-exposed patients. Phototherapeutic course prevented the surgery-produced decrease of the amount of CD4+ T–helpers, CD19+ B–Lym, HLA DR+ cells, and CD 16+/NK cells, and promoted after 7 days
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the rise of the amount of activated CD3+ T–Lym, whereas it falls in the absence of phototherapy. Conclusion: The course of phototherapy promotes in patients with BC correction of many parameters of immu- nity changed due to mastectomy.
P-3 APPLICATION OF LOW LEVEL LASER THERAPY FOR BRAEST CANCER TREATMENT INDUCED SYMPTOMS K Yamada, H Kaise, A Ogata, S Komatsu, M Oda, F Kimura, M Kawarazaki, A Ushio, Y Nakayama, and N Kohno Tokyo Medical University Hospital, Tokyo, Japan
Backgrounds: The progresses of multidisciplinary therapy have led to the improvement of prognosis for cancer patients. Many kinds of systemic chemotherapies and endocrine therapies are performed for breast cancer patients. However it is a fact that these cancer treatments induce peripheral neuropathy, hot flash and joint pain in many patients. We generally try to control these symptoms, peripheral neuropathy, due to Taxans (especially Paclitaxel®), and hot flash due to LH-RH, and joint pain, especially due to aromatase inhibitors by medication. However many patients are still anxious about these symptoms. We investigated the efficacy and safety of diode laser therapy for breast cancer women who have intractable peripheral neuropathy, joint pain and hot flash induced by drug therapy. Materials and Methods: After approval of the ethics committee of Tokyo Medical University Hospital, 34 women, median age 50 years, were treated for peripheral neuropathy, joint pain and hot flash by an 830 nm GaAlAs Diode laser therapy system from November 2007. The effect of this treatment was evaluated using the 10-point scale Brief Pain Index (BPI) questionnaire before and after irradiation. Results: After laser irradiation, the BPI score decreased an average of 4 points in half of the patients suffering from peripheral neuropathy, and reached 2 points or less in all joint pain patients. No cases had increases in BPI or adverse events after laser therapy. Conclusions: The results of this study suggest that low-energy laser therapy (LLLT) for peripheral neuropathy, hot flash and joint pain is effective and safe. The mechanism, however, is still unknown. In this article we introduce the applications LLLT for breast cancer treatment-induced symptoms.
P-4 ISCHEMIC HEART DISEASES TREATMENT BY MEANS OF INTRAVENOUS HeNe LASER BLOOD IRRIDATION COMBINED WITH PHOTOTHERAPY HS Arakelyan 1,2, and SB Palmer 1 1:University of Quantum Dynamics, South Pasadena, California, USA; and 2:Pan-Armenian Association of Laser Therapy and Integrative Medicine, Yerevan , Armenia
Aims and Background: Ischemic Heart Disease (IHD), like oncological diseases, is a great problem worldwide and there is a pressing need for more effective therapy. Intensive growth of morbidity by Ischemic Heart Disease forces scientists to search for new opportunities to its treatment. The purpose of the work is the devel- opment and application of a new efficient method of prophylactics and treatment of IHD and to compare ther- apeutic efficiency of Combined Intravenous HeNe Laser Blood Irradiation (IV HeNe LBI) and Phytotherapy (PhT) with separate IV HeNe LBI and PhT for the treatment of the patients with IHD. Materials and Methods: For this purpose, 39 man patients have been studied with diagnosis of stabile, 3rd func- tional class angina pectoris established by Tred-mill Electreocardiography. They have been divided into the fol- lowing 3 groups:1. 13 patients have been treated with combination of IV HeNe LBI and PhT – Hawthorn and Peppermint ( Group 1).2. 13 patients have been treated with IV HeNe LBI (Group 2).3. 13 patients have been treated with PhT – Hawthorn and Peppermint (Group 3). IV HeNe (630 nm) LBI has been done outputing power at the end of light-guide inserted into a vein from 1 up to 3mW, exposition beginning from 20 reaching till 60 minutes. Procedures were conducted on a daily base, 10 sessions on a course of therapy (3 courses in general). For PhT has been used Hawthorn (Crataegus Oxycanthus) and Peppermint (Mentha piperita). Results and Conclusions: After treatment course BP, biochemical blood parameters - LDL, HDL, coagulographic parameters and functional class of angina pectoris (by Tred-mill Electrocardiography) have been restudied and the highest improvement of the mentioned parameters has been noticed in Group 1 then Group 2, and Group 3. LT gives an opportunity at the same time to decrease the treatment time and the number of pharmacological drugs and their doses during pharmacotherapy. The primary acceptors (triggers) of LT should be able to accept the certain frequency laser wave. For instance, the acceptor for helium-neon laser is catalase enzyme that con- tains porphirine. Maximum of light absorbtion of the enzyme is 628 nm (antioxidant effect). The same is true regarding enzyme superoxiddismutase and the result is antioxidant effect as well and at the same time lipid peroxidative oxidation decreasing takes place. Thus, IV LLLT and PhT may be reasonable options of IHD thera- py and their combined use considerably increases treatment effectiveness.
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P-5 THE TREATMENT OF IMPOTENCE RELATED WITH PROSTATE INFLAMMATIONS BY MEANS OF INTRAVENOUS AND LOCAL NON INVASIVE LASER THERAPY HS Arakelyan 1,2, and SB Palmer 1 1:University of Quantum Dynamics, South Pasadena, California , USA; and 2:Pan-Armenian Association of Laser Therapy and Integrative Medicine, Yerevan , Armenia
Aims and Background: Nonspecific prostatitis is one of the most prevalent genital disorders among men of reproductive age. Impotence, or erectile dysfunction, is the inability to achieve or maintain an erection more than 20 percent of the time. Erectile dysfunction affects millions of men. It is estimated that nearly 5 percent of men become impotent by the age of 40, and 15 to 25 percent by the age of 65. Accurate risk factor identifica- tion and characterization are essential for prevention or treatment of erectile dysfunction. The purpose of the work is the development and application of a new efficient method of prophylactics and treatment of impotence and to compare therapeutic efficiency of various forms of Laser Therapy – Intravenous, Local Non Invasive and their combination during impotence related with prostate inflammations. Methods 26 man patients with the diagnosis of impotence related with prostate inflammations have been classi- fied into the following 3 groups: 1. 9 patients have been treated with combination of IV HeNe LBI and Local Non Invasive Laser Therapy (Group 1); 2. 8 patients have been treated with IV HeNe LBI (Group 2) 3. 9 patients have been treated with Local Non Invasive Laser Therapy on Prostate projection zone (Group 3). The patients’ mean ages are 17-31. IV HeNe (630 nm) LBI has been done outputing power at the end of the light- guide inserted into a vein from 1 up to 3mW, exposition from 10 – 15 minutes. Procedures were conducted on a daily base, 10 sessions on a course periodically – 20-25 days intervals; 3 courses in general. Local Non Invasive Laser Therapy has been given utilizing HeNe Laser on Prostate projection zone at intervals 5-8 min- utes; on a course of 10-12 procedures, 3 courses in general. Results and Conclusions After treatment course the highest efficiency is noticed during combined laser therapy (Group 1) – in the patients of this group has been noticed as the improvement of potency as well as symptoms associated with prostate inflammations. In the second and third groups is noticed the improvement of the men- tioned symptoms as well but the efficiency of these two groups is almost equal. Thus, IV LLLT and local non invasive laser therapy may be reasonable options of impotence related with prostate inflammations therapy. Their combined use considerably increases treatment effectiveness without increasing side effects' risk. Combined use of these therapeutic options is effective, safe, not expensive, conve- nient option of erectile dysfunction treatment.
P-6 A RISK FACTOR ANALYSIS FOR VERTEBRAL BONE INJURY AFTER PERCUTANEOUS LASER DISC DECOMPRESSION R Kosaka 1, T Yonezawa 2, T Onomura 3, and M Kinoshita 2 1: Hirakata City Hospital, Hirakata, Osaka, Japan; 2: Osaka Medical College, Takatsuki; and 3: Nishinomiya Kyoritsu Rehabilitation Hospital, Nishinomiya, Japan
Aims and Background: Percutaneous Laser Disc Decompression; PLDD is one of minimum invasive alternatives to open surgery for contained-type disc herniation. Laser energy is introduced through a thin catheter to vapor- ize the center of the herniated disc, thus reducing intradical pressure and nerve root inflammation. Reported success rate is favorable, 70-75% Bone necrosis adjacent to the disc after PLDD has been recently reported as one of complications, however, most of them are illustrated as a case report and the true incidence of bone necrosis is unknown. The aims of this study are to clarify the incidence of bone necrosis after PLDD in a same institute, and to identify ’disc at the risk' for postoperative bone marrow lesions. Subjects and Methods: Consecutive 72 patients receiving PLDD in our institute for a symptomatic heniation of the lumbar or cervical disc were examined. Pre and post MRI scans were conducted for all 72 patients under the same imaging sequence. Changes of signal intensity in the vertebral marrow adjacent to the disc on both T1 and T2 weighted mid- and para-saggital images were recorded and compared pre- and postoperatively. Subsequent MRIs were scanned for patients demonstrating postoperative marrow lesions. Results: On postoperative MRI, 6 patients presented signal changes in the marrow adjacent to the treated disc. During the serial follow-up of these patients, spontaneous normalization of signal intensity was observed in 4, and the true incidence of bone necrosis was only 2.8%. Those marrow lesions were not associated both with postoperative deterioration of symptom and the final outcome. Possible risk factors for postoperative bone lesions were analyzed in 58 lumbar discs with a multivariate logistic model. Several clinical parameters related to patients’ population, symptom, imaging and treatment were included. Age, preoperative JOA score, preoper- ative disc height and preceding Modic’s change on MRI were chosen as independent variables for final logistic model, and preceding Modic’s change, which might indicate preceding degeneration of the end plate, was determined as a significant predictor for postoperative marrow lesions. Conclusions: Preoperative presence of Modic’s change on MRI was identified as a predictor for postoperative
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marrow damage. For avoiding bone damage, it is crucial to exclude patients with preceding signal changes close to the end plate on MRI from the candidates of PLDD.
P-7 MANAGEMENT OF FOREIGN-BODY INJECTED PENILE SHAFT BY CO2 LASER B Titapiwatanakun, and N Nimsakul Institute of Modem Medicine, Bangkok, Thailand
The practice of injection of foreign-bodies into the penile shaft still being seen in Thailand. The injected materials are wax. greese. vegetable oils (olive, palm oil), industrial silicone. silicone with additive, etc. Complications after injection are infection, hard lump, and deformities in various degree. During 1980 to 2009, 68 cases of deformities from FB-injection have been corrected by using CO2 laser, with satisfactory results. The goals of surgical intervention are 1. Minimizing blood loss with CO2 laser 2. Removal of foreign-body as much as possible. 3. Correction of deformity. 4. Preservation of function. Surgical method and post-operative care arc clearly demonstrated.
P-8 LLLT COMBINED WITH NANO SPRAY AND IONTOPHORESIS FOR FACIAL SKIN CARE AND SCALP CARE. THAILAND EXPERIENCE. V Bunmas 1, P Tongsan 2, B Titapiwatanakun 2, and N Nimsakul 2 1 Dept. of Plastic Surgery, Burapha University, Thailand; and 2: Institute of Modem Medicine, Bangkok, Thailand
The novel combination use of LLLT (diode, 660nm), Nano Spray and Iontophoresis developed by Spotech company in Korea-NTS 2000, has been clinically used for Facial rejuvenation, and many Skin problem, includ- ing Scalp care and treatment for Alopeccia. The Unit is equipped with 660 nm. Diode Laser of 30 m Watt output; Nano Spray gun delivers Spray pressure at 35 cmHg, with the pore of less than I micron. Total effect of the combination use of LLLT is aiming at non-invasive effect of: (1). Improving of blood circulation (2). Cleaning of the treated Skin and scalp. (3). Sterilization (4). Deep penetration of desiring solution. Clinical applications have been done at 4 centers in Thailand during May to November, 2009. More clinical applications will be explored and long-term results will be monitored, but at this preliminary report, the results are very promising for: (1). Rejuvenation or facial Skin. (2). Treatment of active acne. (3). Reduction of hyper-pigmentation of facial Skin (4). Alopecia. (5). Bum and wound healing.
P-9 INTRAVENOUS LASER BLOOD IRRADIATION (ILBI) VA Mikhailov Multiprofile Clinic “Curare-medicine”, Moscow, Russia
Key words: ILBI, disease of cardiovascular, pulmonary, dermatological, endocrine, musculoskeletal system, frequency modulation.
Extracorporeal irradiation of blood using ultraviolet(UV) light has been well-documented particularly in the Russian literature, but the technique required a high level of technical skill and was relatively invasive. The extracorporeal approach was necessary due to the poor penetration of UV light into living tissue. The develop- ment over the past 3 decades of efficient and comparatively inexpensive laser devices delivering low levels of laser energy in the visible red and near infrared wavebands offered deep penetration of light into living tissue and allowed the application of the transcutaneous approach for irradiating blood in vivo. This approach,
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although noninvasive, could not deliver laser energy efficiently and precisely to the main target, i.e., the blood, so the next stage was the minimally invasive delivery of laser energy concentrated directly into the blood itself using the intravenous approach, and ILBI successfully developed. Apparatus: 1. HeNe laser (632.8 nm, output at fibre tip of 1-2 mW). 2. Semiconductor diode laser ( 640 nm – 670 nm, 1-2 mW) 3. Frequency-modulated diode laser (640 nm – 670 nm, 1-2 mW Contraindications.Absolute:Cardiogenic shock, Expressed arterial hypotension,Stagnant cardiopathy,Circulatory inefficiency, stages II b and III, Anemia (Hb less than 60 g/l),Sick sinus syndrome,Existence of blood coagu- lopathies. Relative:Oncological diseases,Acute forms of specific infectious diseases, Dysmenorrhea,The first half term of pregnancy where there is the potential for an abortion,Acute zymosis, either viral. CONCLUSIONS :1.The application of ILBI in the treatment of various diseases improved rheological properties of blood, stimulated blood cells, and enhanced the metabolic processes in tissues including the improvement of cellular and humoral immunity. 2. The overall efficacy of ILBI was very high, resulting in a reduced period of treatment as well as an increase in the duration of remission. 3. The use of ILBI in combination with other methods of treatment increased the efficiency of the applicable therapy and improved the treatment results. 4. Most recently, it has been seen that application of ILBI method with a frequency modulated beam has increased the efficacy of the treatment compared to continuous wave irradiation. and it has also increased the number of diseases for which
P-10 APPLICATION OF COPPER-SILVER-POTASSIUM CITRATE LASER-PHORESIS IN REGENERATIVE MEDICINE SB Palmer 1, WJ Martin 1, and HS Arakelyan 1,2 1: University of Quantum Dynamics, South Pasadena, California, USA; and 2: Pan-Armenian Association of Laser Therapy and Integrative Medicine Yerevan, Armenia
Aims and Background: The regeneration of damaged tissue is a big problem for both medicine and basic bio- medical research. The body’s own tissue repair is a highly coordinated succession of cell movements that resembles processes during embryonic development. In both, the embryo and the adult organism these events are stimulated by so-called bone morphogenetic proteins (BMPs). BMPs are growth factors that trigger specific signaling cascades through binding to receptors on their target cells .Embryonic or adult stem cells – eventually modulating the functions of appropriate cells. The entire wound healing process is a complex series of events that begins at the moment of injury and can continue for months to years. Once the protective barrier is bro- ken, the normal (physiologic) process of wound healing is immediately set in motion. The classic model of wound healing is divided into three or four sequential, yet overlapping, phases: homeostasis, inflammatory, proliferative and remodeling. The purpose of the work: Is the development and application of a new efficient method of treatment of wounds. Methods: 36 patients with the various forms of wounds have been classified into the following groups: 1. 11 patients have been treated with Local Non Invasive Laser Therapy on wound projection zone. (Group 1). 2. 13 patients have been treated with local application of solution electrolytically processed Copper-Silver- Potassium Citrate. (Group 2). 3. 12 patients have been treated with combination of Local Non Invasive Laser Therapy and Copper-Silver- Potassium Citrate. (Group 3). HeNe (630 nm, 1 up to 3mW) has been used on wound projection zone. A solution electrolytically processed Copper-Silver-Potassium Citrate, made by using non-ionized pure water at 25-45 degrees Celsius and dissolving a 50% solution of Citric Acid, Potassium Carbonate added to adjust pH to 5.5 then placing Silver in the vessel and as the Anode until 0.22 grams per liter is dissolved into the solution using 12VDC at 200 Ampere hours or about 120 minutes, then Copper as Anode until 2 grams per liter is dissolved into solution at the same voltage and amperage for another 120 minutes, the other 50% Citric Acid is added to bring the pH under 4.0; solution is then vacuum filtered and bottled. Results and Conclusions: After treatment course the highest efficiency is noticed in #2 and #3 groups. In the patients of these groups has been noticed as the improvement of wound healing process as well as symptoms associated with inflammation.
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P-11 COMPARISON BETWEEN Nd-YAG LASER AND DIODE LASER IN PERCUTANEOUS LASER DISC DECOMPRESSION BY USING INVERSE ADDING DOUBLING METHOD N Ito 1, K Ishii 2, and K Awazu 2 1: Ito Clinic, Osaka, Japan; and 2: Diivision of Susainable Energy Environmental Engineering, Graduate School of Engineering, Osaka University, Osaka, Japan
Aims and Background: In percutaneous laser disc decompression, the accurate knowledge about the optical properties of target tissue is important for the understanding prediction of propagation and distribution of light in tissues. Light propagations, absorption and scattering, changes by the kinetic changes of optical properties in laser irradiations. This problem is clinically very important for the realization of safe laser treatments because the understandings of optical properties by several laser parameters can realize the pre-estimated treatment effects. The objective of this study is determination of the optical properties of the optical properties of treat- ment tissues for the safe laser treatments. Materials and Methods: In this paper, we examined to determine the determine the optical properties changes of a coagulated tissue after the Nd-YAG and diode laser irradiations by using double integrating sphere system and inverse adding-doubling method in the wavelength of 405, 980, and 1064 nm. Results: After laser irradiations with a variety of irradiation parameters, the absorption coefficient of treated tis- sue re-increased and the reduced scattering of a treated tissue re-decrease. Conclusions: The changes of optical properties should be accounted for while planning the therapeutic proce- dure for the realization of safe PLDD treatements.
P-12 COMPARISON OF THE EFFICACY OF PUVA VERSUS BBUVB FOR PSORIASIS VULGARIS TH Khang, and LH Doanh National Institute of Dermatology - Venereology, Hanoi, Vietnam
Aims and Background: Psoriasis is the T cell mediated chronic inflammatory disease. The Psoriasis vulgaris is estimated about 65% of all types of psoriasis who come to Vietnam National Institute of Dermatology and Venereology. Our institute have started treating Psoriasis by PUVA and BBUVB since 2005. The research has aims with assessing the efficacy of PUVA for Psoriasis vulgaris, and comparison PUVA with BBUVB. Materials and Methods: The study was conducted on 24 patients with various degrees of psoriasis vulgaris. The patients were randomly divided into two groups: group 1 (included 15 patients who received PUVA) and group 2 (included 9 patients who received BBUVB). The PUVA carried out 3 times per week and BBUVB took 5 times per week. The dose of UV was based on the skin type. PASI score was measured at beginning, and after every 2 weeks in both of group. When PASI reduced by 75%, we switched patients to remaining protocol. The patients were assessed on the times to reach PASI 75%, side effects. Results: The PASI score's means were 10.67 +/- 3.4 and 8.74 +/- 1.9 in PUVA and BBUVB groups, respectively. The times to reach PASI 75% was 17.53 +/- 7.34 (estimated in 6 weeks) in PUVA group and that was 22.00 +/- 5.57 (estimated in 4 and a half of weeks. When we calculated the cumulative UV dose at PASI 75%, the PUVA group was 187.87 +/- 127.13 J and BBUVB group was 2,641.11 +/- 1,239.78 mJ. In BBUVB vs PUVA, we recog- nized side effects of erythema (9/9 vs 14/15), burning (2/9 vs 0/15), moderated hyperpigmented (2/9 vs 7/15), seborrheic reaction (0/9 vs 2/15), nausea and vomiting (0/9 vs 2/15), mild and moderate itching (9/9 vs 13/15), drowsy and headache (0/9 vs 2/15), eye vision effect (0/9 vs 1/15), biliburin increase (0/9 vs 1/15) Conclusion: Although, the times of BBUVB group to reach PASI 75% was less than PUVA group, with 5 times per week, BBUVB could help the psoriasis vulgaris lesions to be healed shortly. The side effects were more severe in BBUVB than PUVA group.
P-13 ANTINOCICEPTIVE EFFECTS OF LOW LEVEL LASER THERAPY IN HYPERALGESIA AG Braz 1, A Constantini 1, CCS Martignago 1, II Kerppers 1, RM Magnani 1, and E Munin 2 1: Universidade Estadual do Centro Oeste - UNICENTRO, Brazil; and 2: Universidade Camilo Castelo Branco - UNICASTELO, Brazil
Aims and Background: The aim of this article was to evaluate the effects of Low Level Laser Therapy (LLLT), λ=904 nm, in acute and subacute hyperalgesia caused at rodents with electrolytic lesion of dorsolateral ventro- lateral periaqueductal gray.
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Materials and Methods: It was used 20 rats wistar, weighting 220-250g, maintaining accord to the rules of Animal Ethics Committee of CESCAGE (Ponta Grossa – PR – Brazil). The latency tests were performed at rat’s tails, with tail-flick test, to obtain the baseline of each rat between 2.5 at 3.5 seconds, with the median of three tests before the electrolytic lesion. One day after tail flick tests, the specimens were anesthetized and their heads were keep stable with a Stereotaxic device, for surgical procedure and implant of electrode at coordi- nates -5,04mm AP, 0,5mm ML and 5,4mm DV, using the bregma as reference. The electrodes where fixed at skull with acrylic resin. Five days after the post operatory, the animals were anesthetized and was performed the electrolytic lesions with electric charge (60Hz and 2mA) for 15 seconds, and 5 animals were used for sham group (GS). Five days after electrolytic lesions, tail-flick test where performed again, then were injected intra- dermic capsaicina (2%) at ventral middle of the tail, then animals were irradiated by a infrared laser beam (λ=904 nm, P=45mW) with different doses in each group: G4=4 J/cm2, G10=10 J/cm2 and G20=20 J/cm2, and tail-flick were performed at each 5 minutes during 50 minutes. Results: The analgesic effect of the laser was found in the groups being studied for the apical one-way ANOVA, p = 0.02, F test = 3.95, and post Tukey test for significant group of 10 J/cm2. Conclusions: It could be observed that infrared laser (λ=904 nm) improves analgesia in acute and subacute hyperalgesia in the proposed doses (4 J/cm2, 10 J/cm2 and 20 J/cm2) and G10 group showed the best antinoci- ceptive effects. These results emphasize previous data showing the non-opioid nature of this analgesia.
P-14 EFFECTS OF LED AT MUSCLES AFTER MAXIMUM VOLUNTARY CONTRACTION IN THE EMG SIGNAL AG Braz1, MM Andrade 1, RM Magnani 1, LF Monteiro Neto 2, and LAL Conrado 3 1: Universidade Estadual do Centro Oeste - UNICENTRO; 2: Faculdade de Medicina de São Jose do Rio Preto, Brazil; and 3: Universidade Camilo Castelo Branco, Brazil
Aims and Background: The aim of this study was to compare the effects of LED (light-emitting diode), λ=630 nm±15 nm, in masseter and temporalis muscles EMG activity, after a sustained maximum voluntary contraction. Materials and Methods: This study was performed at Human Moviment Analysis Laboratory of UNICENTRO (Guarapuava – PR – Brazil). It is a vertical study, with 10 young women (18-25 years), without any temporo- madibular pain or disorders, and respecting all terms of Research and Ethics Committee of the UNICENTRO. The electrodes were placed at subjects with orthostatic position over the masseter and temporalis muscles (both sides) according to SENIAM, following the Noraxon Chart after the skin was cleaned with alcohol (70%). It was used a biofeedback system, which could be observed by the subjects in a monitor PC. They were instructed to bite a little synthetic soft slice with maximum voluntary contraction (MVC). After the maximum voluntary bite, they were instructed to bite again maintaining this MVC at the same level for one minute (MVC1). As soon after MVC1 the electrodes of left masseter was took off and were irradiated on 2 points by LED (λ=630 nm±15 nm; P=400mW; S=1cm2) for 15 seconds each point (DE=6J/cm2). Three minutes after the MVC1 the volunteers were instructed to proceed like MVC1 that is considered as MVC2. All data were com- pared between MVC1 and MVC2 pre and post LED. Results: The measures for the study were normalized EMG activity to the masseter and temporalis muscles. A repeated measure analysis of variance (ANOVA) was used to determine if significant differences exist in the measures across the two symmetric muscles at two moments before and after LED irradiation (p=0,02310). The significant ratios (p < 0,05) were further explored using Tukey’s Honestly Significant differences post hoc test for the masseter and temporalis muscles pre and post LED irradiation. Significant differences were found between the two bilateral muscles when compared the same muscle pre and post LED. Conclusions: It was evidenced that LED could improve masseter EMG signal and this evidence could be observed at the both sides. The EMG signal of temporalis increased at the side irradiated, but decreased at the opposite side, showing that LED could have a systemic range.
P-15 PIXEL RADIOFREQUENCY AND INTENSIVE PULSE LIGHT TREAT- MENT FOR ACNE SCARS I Petrovska Sesova, I Gjosevska, and A Petrusevska Dermatology and Aesthetic Clinic Dr. Ancevski, Skopje, Macedonia
Aims and Background: The study presents new protocol treatment Pixel radiofrequency and Intensive Pulse Light (IPL) on Acne scars on facial region. So far we had a success to treat a number of acne scars but this was for the first time in our practise to use combination of Pixel radiofrequency and IPL. Advantages from both methods were used and good results in relatively short period of time have been achieved. Materials and Methods: According to detailed dermatology diagnostic the following program defined a: first Pixel radiofrequency temperature=40-420C; total energy=18-20 kJ; power 70W) treatment was applied three times, with ten days between each treatment and after that IPL treatment was applied three times with three
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weeks between each treatment (with fluency range of 35 to 40 (J/cm2), filter 560 - 590 (nm), double and triple pulses). Results: Improvement of treated region was observed and this was good sign to continue with the same pro- gram. At the end of the treatment, acne scars were almost invisible and what is very important no side effects were observed. Conclusions: This combination of Pixel radiofrequency and Intensive Pulse Light (IPL) treatment on Acne scars at facial region resulted with high level of patient satisfaction, clearly visible improvement of the treated region. This gave us a lot of confidence to use and upgrade similar program on acne scars problems.
P-16 EXPERIMENTAL EFFECTS OF LLLT ON MYOPHATY INDUCED BY CARRAGEENAN IN SYSTEM AND TISSUE LEVEL S Dávila, F Soriano, R Soriano, and V Campana IAMEL (Instituto Argentino de Medicina Laser), Rosario, Argentina; and Cátedra de Física Biomédica – Facultad de Ciencias Médicas – Universidad Nacional de Córdoba, Córdoba, Argentina
In this work we studied the antiinflammatory effect of gallium arseniure laser (As.Ga) in myopathy induced in rats through the determination of nitric oxide (NO) in plasma and in skeletal muscle histomorphometric evalua- tion. Wistar female rats were used: (A) Control, (B) Laser, (C) Injuries and sacrificed at 24 hours, (D) Injuries and sacrificed at 10 days and (E) Injuries + laser. The myopathy was induced by intramuscular injection of 50 Ȑl 1% of carrageenan λ (Tipo IV) in the left hind limb only once. Were applied with 9.5 J/cm2 laser day/rat for 10 days. The NO was determined by spectrophotometry and for statistical analysis ANOVA was used. Histologic examination was performed under a light microscope after staining with hematoxylin-eosin, ana- lyzed with the AxioVision 4.8 and statistically with Chi Square (Pearson test) whereas significant differences when p <0.05 for all cases. Groups C (14.36 ± 3.9) and D (21.62 ± 3.8) showed a significant increase in NO compared with group A (7.39 ± 2.4), B (9.94 ± 2.1) and E (11.11 ± 1.8) (p <0.001). Also, significant differences were found between groups C and D (p <0.001). Regarding the inflammatory infiltrate, significant differences between groups C (37.80%) and D (63.40%) (p <0.001) and between them and the groups A (0%), B (0%) and E (3.40%) (p <0.001). From these results we conclude that the injection of carrageenan achieved satisfactorily reproduce an acute inflammatory process during the first 24 hours, and then evolves into the chronic phase. The As.Ga laser thera- py has anti-inflammatory effect in acute experimental myopathy, evidenced by the decrease of NO and the favorable histology.
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APPRECIATION
The organizing committee of congress would like to acknowledge and express their appreciation to all the companies who have supported the congress by taking booth space and by advertising in the program. The levels of sponsorship have enabled us to host the congress with a higher level of hospitality than otherwise possible.
Accordingly we record our sincere thanks to:
CONTRIBUTOR The Federation of Pharmaceutical Manufacturers' Associations of Japan Ophir Japan Ltd.
CONGRESS EXHIBIORS Candela Corporation Cynosure K.K. DANILSMC Co., Ltd./ CREATIO-CORPORATION Integral Corporation JMEC Co., Ltd. Lumenis Co., Ltd. M & M Co., Ltd. Meilleur Co., Ltd. Minato Medical Science Co., Ltd. Mochida Siemens Medical Systems Co., Ltd. Niic Co., Ltd. Ophir Japan Ltd. Wavelengths Company Co., Ltd.
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