Online ISSN : 1884-7269
Print ISSN : 0898-5901
ISSN-L : 0898-5901
20 巻 , 3 号
Kaplan's Corner
Original Articles
  • MR Roh, BC Goo, JY Jung, HJ Chung, KY Chung
    2011 年 20 巻 3 号 p. 175-180
    発行日: 2011年
    公開日: 2011/09/22
    ジャーナル フリー
    Background and Aims: A variety of treatment modalities have been used to reduce the size of en-larged pores. The 1064 nm Nd:YAG laser, in addition to its role in removal of tattoos and age-related dyschromia, depilation and skin rejuvenation, may also play a role in reducing the size of enlarged pores. The present split-face controlled study assessed and compared the efficacy between the quasi long-pulsed (micropulsed) and the Q-switched modes of the Nd:YAG laser in the treatment of enlarged pores.
    Subjects and Methods: Twenty subjects with enlarged pores were recruited for the micropulsed vs Q-switched study, all treated with the same 1064 nm Nd:YAG laser system. Ten subjects were treated with the 300 μs micropulsed mode and the other ten subjects were treated with the 5 ns Qswitched mode. All subjects were treated on the right half of the face, the left half serving as an untreated control. Five laser sessions were performed. The pore sizes were measured using an image analysis program and the sebum level was measured with a Sebumeter® before and after the treatments.
    Results: The pore size and sebum level significantly decreased with treatment on the treated side (right cheek and right half of nose) in both the micropulsed and Q-switched modes compared to the control side (p<0.05), but without any statistically significant difference between the modes. Conclusions: The micropulsed and Q-switched Nd:YAG laser treatments reduced pore size and sebum levels with more or less equal efficacy and with no adverse side effects.
  • HJ Chung, BC Goo, HJ Lee, MR Roh, KY Chung
    2011 年 20 巻 3 号 p. 181-188
    発行日: 2011年
    公開日: 2011/09/22
    ジャーナル フリー
    Background and aims: Enlarged facial pores remain one of the major cosmetic concerns among Asian females. This study attempted to assess and compare the efficacy of a combination of the Qswitched and quasi long-pulsed (micropulsed) Nd:YAG laser to reduce the size of the enlarged pores with and without an exogenous photoenhancer.
    Methods: In twenty five female subjects mean age 34.04 yr and skin type II-IV, a carbon lotion as a photoenhancer was applied on one side of the face (Method 1) and the other side was used as the control (Method 2). The entire face was then treated with a single pass of the 1064 nm Nd:YAG laser in the micropulsed mode, pulse fluence and width of 2.3 J/cm2 and 300 μsec, respectively. Multiple passes were then delivered in the Q-switched mode (2.5 J/cm2 and 5 nsec).
    Results: Three weeks after the final treatment, 75% of the subjects showed improvement with method 1 whereas 67% showed improvement with method 2. No adverse side effects were reported with either method.
    Conclusions: Although histological confirmation was not performed, we were able to prove both subjectively and objectively that the use of the combination of the micropulsed and Q-switched modes of the Nd:YAG laser was useful in reducing pore size, and that the photoenhancer improved the efficacy.
  • HY Kang, JH Kim, BC Goo
    2011 年 20 巻 3 号 p. 189-194
    発行日: 2011年
    公開日: 2011/09/22
    ジャーナル フリー
    Background and Aims: Melasma is a treatment-resistant and acquired pigmentary facial skin condition of uncertain etiology particularly prevalent in the older Asian female. Traditional bleaching agents have offered some success. Intense pulsed light (IPL), fractionated nonablative and more recently ablative laser technology have also been used, but were associated with postoperative hyperpigmentation in the Asian skin. The present study examined the consecutive application of 2 modes of the 1064 nm Nd:YAG laser in the ‘dual toning’ process.
    Subjects and Methods: Thirty females, mean age 41.4 ± 11.96 yr, Fitzpatrick skin type IV, participated in the prospective uncontrolled study. All subjects were treated with the 1064 nm Nd:YAG laser, first with the 5 ns Q-switched mode, 1.2 J/cm2, 8 mm collimated handpiece with multiple passes and then immediately after with the micropulsed mode, 300 μs, 7.0 J/cm2, 5 mm handpiece, multiple passes. Mild and even erythema was the endpoint. Treatments were given every other week until maximum improvement was obtained. Improvement was rated at a final assessment 6 weeks after the final treatment on a 5 point scale where 1 was little or no improvement and 5 was maximum improvement.
    Results: At the final treatment session and at the 6-week assessment, 20 of the 30 patients (67%) saw a fair to excellent degree of improvement, 7 (23%) had visible improvement and little or no improvement was seen in 3 (10%) patients. There were no unexpected side effects in any patients.
    Conclusions: The dual toning technique using the 1064 nm Nd:YAG laser was safe and effective, and well-tolerated by all patents without anesthesia. Larger controlled studies are merited with more objective measurement techniques to confirm the results of this preliminary study.
Review Articles
  • Hyun Soo Lim
    2011 年 20 巻 3 号 p. 195-203
    発行日: 2011年
    公開日: 2011/09/22
    ジャーナル フリー
    Background and Aims: This study demonstrated the development of a laser system for cancer treatment with photodynamic therapy (PDT) based on a 635 nm laser diode. In order to optimize efficacy in PDT, the ideal laser system should deliver a homogeneous nondivergent light energy with a variable spot size and specific wavelength at a stable output power.
    Materials and Methods: We developed a digital laser beam controller using the constant current method to protect the laser diode resonator from the current spikes and other fluctuations, and electrical faults. To improve the PDT effects, the laser system should deliver stable laser energy in continuous wave (CW), burst mode and super burst mode, with variable irradiation times depending on the tumor type and condition.
    Results and Comments: The experimental results showed the diode laser system described herein was eminently suitable for PDT. The laser beam was homogeneous without diverging and the output power increased stably and in a linear manner from 10 mW to 1500 mW according to the increasing input current. Variation between the set and delivered output was less than 7%.
    Conclusions: The diode laser system developed by the author for use in PDT was compact, user-friendly, and delivered a stable and easily adjustable output power at a specific wavelength and user-set emission modes.
  • Won-Serk Kim, R Glen Calderhead
    2011 年 20 巻 3 号 p. 205-215
    発行日: 2011年
    公開日: 2011/09/22
    ジャーナル フリー
    Background: Low level light therapy (LLLT) has attracted attention in many clinical fields with a new generation of light-emitting diodes (LEDs) which can irradiate large targets. To pain control, the first main application of LLLT, have been added LED-LLLT in the accelerated healing of wounds, both traumatic and iatrogenic, inflammatory acne and the patient-driven application of skin rejuvenation.
    Rationale and Applications: The rationale behind LED-LLLT is underpinned by the reported efficacy of LED-LLLT at a cellular and subcellular level, particularly for the 633 nm and 830 nm wavelengths, and evidence for this is presented. Improved blood flow and neovascularization are associated with 830 nm. A large variety of cytokines, chemokines and macromolecules can be induced by LED phototherapy. Among the clinical applications, non-healing wounds can be healed through restoring the collagenesis/collagenase imbalance in such examples, and ‘normal’ wounds heal faster and better. Pain, including postoperative pain, postoperative edema and many types of inflammation can be significantly reduced.
    Experimental and clinical evidence: Some personal examples of evidence are offered by the first author, including controlled animal models demonstrating the systemic effect of 830 nm LED-LLLT on wound healing and on induced inflammation. Human patients are presented to illustrate the efficacy of LED phototherapy on treatment-resistant inflammatory disorders.
    Conclusions: Provided an LED phototherapy system has the correct wavelength for the target cells, delivers an appropriate power density and an adequate energy density, then it will be at least partly, if not significantly, effective. The use of LED-LLLT as an adjunct to conventional surgical or nonsurgical indications is an even more exciting prospect. LED-LLLT is here to stay.
  • Masayoshi Okada, Masato Yoshida, Yoshihiko Tsuji, Hiroyuki Horii
    2011 年 20 巻 3 号 p. 217-232
    発行日: 2011年
    公開日: 2011/09/22
    ジャーナル フリー
    Background: Recently, several kinds of lasers have been widely employed in the field of medicine and surgery. However, laser applications are very rare in the field of cardiovascular surgery throughout the world. So, we have experimentally tried to use lasers in the field of cardiovascular surgery. There were three categories: 1) Transmyocardial laser revascularization (TMLR), 2) Laser vascular anastomosis, and 3) Laser angioplasty in the peripheral arterial diseases.
    By the way, surgery for ischemic heart disease has been widely performed in Japan. Especially coronary artery bypass grafting (CABG) for these patients has been done as a popular surgical method. Among these patients there are a few cases for whom CABG and percutaneous coronary intervention (PCI) could not be carried out, because of diffuse stenosis and small caliber of coronary arteries.
    Materials and methods of TMLR: A new method of tranasmyocardial revascularization by CO2 laser (output 100 W, irradiation time 0.2 sec) was experimentally performed to save severely ill patients. In this study, a feasibility of transmyocardial laser revascularization from left ventricular cavity through artificially created channels by laser was precisely evaluated. Results: In trials on dogs laser holes 0.2mm in diameter have been shown microscopically to be patent even 3 years after their creation, thus this procedure could be used as a new method of transmyocardial laser revascularization.
    Clinical application of TMLR: Subsequently, transmyocardial laser revascularization was employed in a 55-year-old male patient with severe angina pectoris who had undergone pericardiectomy 7 years before. He was completely recovered from severe chest pain.
    Conclusions of TMLR: This patient was the first successful case in the world with TMLR alone. This method might be done for the patients who percutaneous coronary intervention and coronary artery bypass grafting could be carried out.
    Laser vascular anastomosis: At present time, in vascular surgery there are some problems to keep long-term patency after anastomosis of the conventional suture method, especially for smallcaliber vessels.
    Materials and methods of Laser vascular anastomosis: From these standpoints, a low energy CO2 laser was employed experimentally in vascular anastomosis for small-caliber vessels.
    Resullts of Laser vascular anastomosis: From preliminary experiments it could be concluded that the optimal laser output was 20-40 mW and irradiation time was 6-12 sec/mm for vascular anastomosis of small-caliber vessels in the extremities. And then, histologic findings and intensity of the laser anastomotic sites were investigated thereafter. Subseqently, good enough intensity and good healing of laser anastomotic sites as well as the conventional suture method could be observed. There were no statistic differences between laser and suture methods. A feasibility of laser anastomosis could be considered and clinical application could be recognized.
    Clinical applications of Laser vascular anastomosis: On February 21, 1985, arterio-venous laser anastomosis for the patient with renal failure was smoothly done and she could accept hemodialysis.
    Conclusions of Laser vascular anastomosis: This patient was the first clinical successful case in the world. Thereafter, Laser vascular anastomosis were in 111 patients with intermittent claudication, refractory crural ulcer, and coronary disorders. Thereafter, they are going well.
    (View PDF for the rest of the abstract.)
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