The Journal of Japan Society for Laser Surgery and Medicine
Online ISSN : 1881-1639
Print ISSN : 0288-6200
ISSN-L : 0288-6200
Volume 29, Issue 2
Displaying 1-14 of 14 articles from this issue
ORIGINAL ARTICLE
  • Yoshiyuki Watanabe, Teruo Kouzu
    2008 Volume 29 Issue 2 Pages 95-100
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Though endoscopy has made a rapid progress in diagnoses in gastrointestinal (GI) diseases with the introduction of chromoscopy and magnifying endoscopy, a definite diagnosis should wait for a histopathology of the specimens biopsied during endoscopy. As a real time and less invasive method to obtain a definite diagnosis during GI endoscopy, optical biopsy using tissue spectroscopy technology has been under development. We made a feasibility study on how to establish endoscopic histopathology in combination with tissue spectroscopy. We used elastic scattering spectroscopy for taking spectra of tissues in the GI diseases and made analyses and comparisons of the spectra between normal and abnormal tissues. Patients underwent biopsies and optical biopsies during the same session of endoscopy. We compared the histopathological results with the spectra taken. The spectra taken in Barrett′s carcinoma, Barrett′s epithelium, and the normal gastric mucosa were peculiar to each. We expect that optical biopsy using elastic scattering spectroscopy will be a powerful tool for endoscopic histopathology when tissue scattering spectra data backed up by histopathology are accumulated and diagnostic software are established by the multiple endoscopic centers.
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AWARDED ARTICLE
  • Eiji Torikai, Yasunori Kageyama, Eiji Kohno, Toru Hirano, Akira Nagano
    2008 Volume 29 Issue 2 Pages 101-105
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    The first choice for treatment to osteoskeletal malignant tumor is mainly surgical resection. Thanks to taking these pre-operational chemotherapies, the survival rate has recently improved and excellent limb functions in patients have been restored. However some tumors do not respond to any current chemotherapy or radiotherapy. Therefore, a new treatment for osteoskeletal malignant tumor that can be performed under such conditions has been pursued. In the present study, we investigated the anti-tumor effect of PDT using talaporfin sodium (laserphyrin) on several osteoskeletal malignant tumors in in vitro and in vivo. In in vitro, we measured cell viability and demonstrated the cell death pattern, apoptosis or necrosis, after PDT. In in vivo, we measured the size of the tumor grafted SCID mice for 3 weeks after PDT and the PDT effect on the tumor cells was evaluated histologically. In addition, we detected the 1O2 production during the PDT. PDT was effective, both in in vitro and in vivo, for all cell lines in the study. In in vitro, the cell death patterns by PDT were mainly apoptosis on the condition of 50 % cell death and mainly necrosis on the condition of 90 % cell death. In in vivo, the local recurrence rates obviously were dependent on the dose of the drug and the amount of laser energy. Histological evaluation after PDT revealed a necrosis area and an apoptosis area on all tumors. The necrosis area was found near the incidence of the laser and the apoptosis area was found outside the necrosis area. The ratios of 1O2 production of tumors treated by irradiation with the photosensitizer to that of tumors treated by irradiation without the photosensitizer exhibited extremely high values about 20 - 60 times. PDT using talaporfin sodium was effective on osteoskeletal malignant tumor and might be innovative surgical modalities.
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  • Toshiro Sakae, Yukie Sato, Hiroyuki Okada, Hirotsugu Yamamoto, Yasuhir ...
    2008 Volume 29 Issue 2 Pages 106-111
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Wavelength tunable free electron laser, FEL, was applied to analyze efficacy and mechanism of laser ablation for dental hard tissues. Irradiation of LEBRA-FEL, Nihon University, on the tooth sections at the wavelength range from 2.0 to 6.0 μm, the wavelength-dependency and also tissue-specificity were clearly observed. Observation during the pit formation by the irradiation, it was suggested the ablation being a type of plasma ablation.
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ORIGINAL ARTICLE
  • Osamu Kasagawa, Masashi Marumo, Osamu Asako, Takeshi Marumo, Yuko Ito, ...
    2008 Volume 29 Issue 2 Pages 112-118
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Hemorrhoidectomy based on the Milligan-Morgan technique, which has been conventionally used, is currently adopted as a standard radical procedure for internal hemorrhoids by Japanese clinical surgeons. However, problems related to the control of perioperative bleeding and the remission of postoperative complaints for a local site still remain. When a Nd-YAG laser contact probe is used instead of a scalpel or electrocautery, which are conventionally used in this operation method, hemorrhoids can easily be removed from the base layer with minimum invasion and without bleeding. The operation becomes easy using the Nd-YAG laser contact probe. Furthermore, the desired clinical outcomes, such as mild local algia and enlargement, rapid postoperative healing of operation sites, and shortening of hospitalization duration, can be achieved. To determine the effectiveness of the Nd-YAG laser contact probe, the outcomes of operation using this probe were compared with those using a scalpel or electrocautery through an animal experiment. At the site of laser probe surgery, the proliferation of keratinocytes was enhanced. Moreover, the expression levels of inducible nitric oxide synthase (iNOS), keratinocyte growth factor (KGF), and KGF receptor (KGFR) were higher with the use of the laser probe than with the use of a scalpel or electrocautery. On the basis of these findings, we concluded that reepithelization occurs at a relatively early stage after operation when using the laser probe. The Nd-YAG laser contact probe facilitates easy and bloodless operation, and rapid healing of the operation site; it is clinically effective for minimally invasive surgery.
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  • Yuichi Shinoda
    2008 Volume 29 Issue 2 Pages 119-121
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    We assessed the effectiveness of following low level laser therapy (LLLT) in the treatment of cervical pain with spondylosis and herniation. The patient is 62 years old female with cervical pain. Cervical MRI showed spondylosis and herniation. After 1 month treatment of low laser level irradiation on ganglion stellatum, LLLT reduced pain. LLLT should be considered for the relief of cervical pain, particularly since it has few side effects. The results are conflicting in different studies and may depend on the method of application and other features of the LLLT. Clinicians and researchers consistently should investigate the characteristics of the LLLT device and the application techniques.
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  • Yuki Taniguchi, Toshio Ohshiro, Takafumi Ohshiro, Shunji Fujii, Kastum ...
    2008 Volume 29 Issue 2 Pages 122-126
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    The characteristics of laser hardware influence the treatment progress, plan and efficacy. It is important that clinicians understand the specifics of laser characteristics. However most clinician do not consider the characteristics of laser when they are treating a patient. The integral parts which affect the quality of laser light are the oscillator, the lens which focuses and arranges laser light, and the homogenizer which allows uniform distribution of light intensity. The quality and performance of these parts influence clinical results. Using a new model Q switched ruby laser as an example and from the treatment results there of, we demonstrate and suggest the importance of understanding optic properties of the laser hardware.
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  • Mitsuaki Komatsu, Yoshio Ishii, Kazuhiro Watanabe, Shinichi Kogure
    2008 Volume 29 Issue 2 Pages 127-133
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    It has been reported that low-power laser irradiation (LLI) can block the conduction of nerve impulses and improve recovery from nerve injuries. Since the underlying mechanism remains unclear, we examined thermographic analysis on the effect of LLI on compound action potentials (CAPs) using the law of polar excitation in frog sciatic nerve. Eighteen frogs (Xenopus laevis) were used and their bilateral sciatic nerves were prepared. Amplitudes of cathode-make-exciation (CE) and anode-break-excitation (AE) induced by a supramaximal stimulus with 10 ms pulse duration, and temperature on the nerve surface were simultaneously recorded during LLI (Ar+ laser; 488 nm or 514 nm; 50 mW; 30 min). In the case of 514 nm LLI, standardized CE and AE amplitudes gradually attenuated to 81±5% and 74±7% at 30 min after the onset of LLI, while temperature increased to 38.9±2.4 °C. In the case of 488 nm LLI, CE and AE amplitude attenuated to 74±10% and 42±14% (p<0.01) at 30 min after, while temperature increased to 40.9±2.5°C. Negative correlations between each type of CAP amplitude and temperature deviation were obtained, resulting in good fitting curves of a quadratic function. We conclude that the suppressive effects of LLI on the polar excitations are mainly based on the thermal influence.
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Topical papers: Photodynamic Detection (PDD) and the Therapy (PDT) using 5-aminolevulinic Acid (5-ALA)
REVIEW ARTICLE
  • Norio Miyoshi
    2008 Volume 29 Issue 2 Pages 134
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
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  • Sadao Kaneko
    2008 Volume 29 Issue 2 Pages 135-146
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    The treatment results for malignant brain tumors are not encouraging, and the postoperative survival time in patients with glioblastoma is only 1.5 year on an average. Although multidisciplinary treatment is conducted for malignant brain tumors similar to that for cancers in other organ, it has become apparent from recent developments in surgical methods that if a brain tumor could be completely removed macroscopically, postoperative survival time would also be significantly improved. Nonetheless, it is extremely difficult to differentiate a malignant brain tumor from normal brain tissues by naked eye or under surgical microscope. In particular, when a malignant brain tumor infiltrates into the normal brain tissues or is present near the eloquent brain area, serious complications may occur after extensive surgical removal.
    Photodynamic medicine includes the use of photodynamic diagnosis (PDD) and photodynamic therapy (PDT). PDD is a diagnostic method for differentiating tumor tissues from normal tissues by detection of fluorescence in malignant brain tumor tissues during tumor removal. 5-Aminolevulinic acid (ALA) is used as a photosensitizer for PDD. PDT is a local therapeutic method for malignant brain tumors using a photosensitizer and light. Hematoporphyrin derivative (HpD) is used as a photosensitizer for PDT. In the present study, 250 brain tumor patients were treated using PDD and 63 patients underwent PDT. Based on our clinical experience, the advantages and disadvantages of PDD and PDT can be summarized as follows. Advantages: (1) PDD enabled to differentiate malignant brain tumor tissues from normal brain tissues by naked eye before tumor removal during surgery. (2) Macroscopic total removal of the malignant brain tumor was possible by using PDD, and PDD might contribute to prolong patient survival. (3) PDT might be effective for treating malignant brain tumor that has invaded the eloquent brain area and small deep-seated tumor in the brain. (4) Photodynamic medicine (PDT and PDT) has fewer side effects and offers a good quality of life. Disadvantages: (1) In PDD, it is very difficult to differentiate infiltrative tumor tissues or guerilla cells from normal tissues. Additionally, false-negative and false-positive findings are obtained, especially in brain edema tissues or recurrent tumor tissues. (2) In PDT, the depth of light penetration into the tumor tissue is limited. (3) The concentration of the photosensitizer and the oxygen in malignant brain tumor tissues is heterogeneous.
    Conclusion: Photodynamic medicine involving PDD and PDT is very effective for the treatment of malignant brain tumors.
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  • Keiji Inoue, Taro Syuin
    2008 Volume 29 Issue 2 Pages 147-152
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Photodynamic diagnosis (PDD) is clinically-recognized as an effective procedure of detection for various cancers. In the urological field the fluorescence in bladder tumors was first studied under ultraviolet light following the oral administration of tetracycline in the early 1960s. Present system of PDD with intravesical instillations of 5-aminolevulinic acid (ALA) as a photosensitizer for superficial bladder cancer was clinically reported in the early 1990s, and then drew keen attention.
    Recently, it has proved PDD using ALA to be a procedure with an outstanding sensitivity for detection of superficial bladder cancer, in particular in the detection of flat lesions such as dysplasia and carcinoma in situ without additional complication. Furthermore, it was suggested that transurethral resection of bladder tumor (TURBT) guided PDD as an application of PDD reduced the risk of residual tumor and subsequent intravesical recurrence compared to conventional TUR-Bt in the patients with superficial bladder cancer. However, there are many problems concerning accuracy of diagnosis that remains to be solved such as false-positive findings and photobleaching phenomenon.
    PDD using ALA is officially approved diagnostic procedure for superficial bladder cancer in Europe, and is also recommended by the degree of Grade B in the guideline of European Association of Urology (EAU), whereas in Japan, PDD was administered on a clinical trial basis under doctor's initiative. In this article, we review the present state of PDD using ALA for superficial bladder cancer.
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  • Hirofumi Matsui, Jumpei Udo, Tsuyoshi Kaneko, Osamu Shimokawa, Ichinos ...
    2008 Volume 29 Issue 2 Pages 153-159
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Application of δ-aminolevulinic acid (ALA) results in the endogenous accumulation of protoporphyrin IX and is a useful approach in the photodynamic therapy (PDT) for cancers. We have a hypothesis that when clarifying mechanisms "Why does ALA cause cancer specific fluorescence?", the most suitable patient selection becomes possible to treat by PDT, and we have advanced the examination up to date in order to investigate the role of nitric oxide (NO) in the specific accumulation of protoporphyrin and ALA-induced PDT of cancerous cells. When the NOS2-expressing cells were treated with ALA and then exposed to visible light, they became more sensitive to the light with accumulating porphyrins, as compared with the ALA-treated control cells. An increase in the generation of NO in transfected cells led to the accumulation of protoporphyrin with a concomitant decrease of ferrochelatase, the final step enzyme of heme biosynthesis. The treatment of cells with an NOS inhibitor, NG-monomethyl-L-arginine acetate, resulted in the inhibition of protoporphyrin accumulation and cell death.
    The levels of mitochondrial ferrochelatase in the NOS2-induced cells decreased. These results indicate that the generation of NO augments the ALA-induced accumulation of protoporphyrin IX and subsequent photo-damage in cancerous cells by decreasing the levels of mitochondrial iron-containing enzymes. Based on the fact that the production of NO in cancerous cells is elevated, NO in the cells is responsible for susceptibility with ALA-induced PDT.
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  • Yoshinari Matsumoto, Yoichi Akita, Tiharu Kawamura, Hirono Nakaseko, D ...
    2008 Volume 29 Issue 2 Pages 160-163
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Photodynamic therapy (PDT) is a novel noninvasive cancer therapy. PDT with topical 5-aminolevulinic acid (ALA) has been used to treat skin tumors in dermatology. Topically applied ALA converted to photosensitizing protoporphyrin IX endogenously in tumor tissues. PDT is a well-establised treatment modality which has mainly shown to be effective for actinic keratoses, Bowen′s diseases (squamous cell carcinoma in situ) and superficial basal cell carcinomas. We observed a complete response after one or two sessions of PDT for 82 of 98 actinic keratoses, 20 of 35 Bowen′s diseases, and 3 of 4 superficial basal cell carcinomas.PDT has been used for the treatment of extramammary Paget′s diseases and mycosis fungoides. Photodynamic diagnosis allows the delineation of clinically ill-defined tumors and the detection of tumor relapse or new tumors which were not clinically detectable. PDT in dermatology is a convenient, non-invasive treatment with excellent cosmetic outcomes without surgical scars. More research is required to determine the exact parameters optimal for the treatment of each tumors.
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  • Norio Miyoshi, Yukihiro Fukunaga, Sadao Kaneko, Haruo Hisazumi
    2008 Volume 29 Issue 2 Pages 164-168
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Japanese association of 5-aminolevulinic acid (5-ALA: porphyrin precussors) was started at 2001 in Okazaki first meeting. The third meeting was combined with the 9th world congress of the international photodynamic association (9th IPA) as the satellite small first international symposium of the 5-ALA at 2003 in Fukuoka, Japan.
    The studies of photodetection (PD) and photodynamic therapy (PDT) of clinical cancer in Japan were mainly doing of PD for glioblastoma (GBM) as the fluorescent guide of the cancer tissue during the operation in neurosurgery and studies of PDT for skin cancers and acne in dermatology areas also has being done using the 5-ALA. Recently, the PD of bladder cancer and stomach cancer are applied during the operation using the endoscopes in Japan.
    In basic research using a cultivated cancer cell line and the transplanted tumor model, we applied the many kinds of the 5 ester derivatives (high purity-99.99% produces from a Japanese company) of the 5-ALA for a cultivated human leukemia cell line (HL-60) to find the protoporphyrin-IX (Pp-IX) uptake in the cell and to find the photodynamic cell damages. Our Japanese group developed the fluorescent analyzer system using a blue-laser (405nm) for the clinical and animal study. Furthermore, it was also developed for the new laser of 2 wavelengths 635 (for Pp-IX) and 670 nm which is targeting of the photoproduct of protoporphyrin-IX (Pp-IX). It was reviewed the photoproduct effect as a new photosensitizer in human leukemia cells using the laser..
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  • Toru Hirano, Eiji Kohno, Wu Ying Ying, Junkoh Yamamoto
    2008 Volume 29 Issue 2 Pages 169-176
    Published: July 15, 2008
    Released on J-STAGE: September 25, 2009
    JOURNAL FREE ACCESS
    Administered 5-aminolevulinic acid (5-ALA) turns into protoporphyrin IX(Pp-IX) in cells, and the irradiation causes Pp-IX-mediated singlet oxygen generation. It damages surrounding cells and tissue, and, at the same time, Pp-IX itself. When Pp-IX is irradiated at 635 nm, new absorption of photoproducts appears at 670 nm. To increase the effect of 5-ALA-mediated PDT with additional irradiation at 670 nm, we studied its effectiveness using Pp-IX solutions, 5-ALA-administered tumor cells (9L, HeLa), and HeLa tumor-bearing mice.
    When a Pp-IX solution was irradiated at 635 nm, singlet oxygen was generated by excitation with nearly 670 nm, indicating the production of photoproducts. Photoproduct-mediated singlet oxygen generation was higher in 9L cells than HeLa cells and photoproducts did not produce an additional PDT effect in HeLa tumors. The cause was suggested as the low uptake of 5-ALA in HeLa cells. Further study is necessary to obtain the irradiation method for the efficient application of 5-ALA-mediated PDT.
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