Purpose: Photodynamic therapy (PDT) reportedly inhibits the development of intimal hyperplasia. In this study, we examined time-course arterial accumulation and distribution of a possible second generation photosensitizer mono-L-aspartyl chlorin e6 (NP e6) in rabbit arterial models.
Methods: The models included the balloon-injured (BI) model: rabbit vessels were injured by pulling a balloon catheter, and atherosclerotic (AS) model: rabbits were fed an atherogenic diet for 10 weeks after balloon injuries. All animals were photosensitized with 5mg/kg NP e6. Arterial NP e6 concentration was measured by high-performance liquid chromatography (HPLC) at 30 minutes, 1, 3 and 6 hours after NP e6 administration. Epifluorescence of NP e6 in the abdominal aorta was observed by our developed epifluorescence image analysis systems.
Results: The peak values of NP e6 concentration in BI and AS model (11.32, 10.77μg/g, respectively) were significantly high when compared with the control groups. In AS model, high concentration persisted over 6 hours after NP e6 administration (5.12μg/g) and the intensity of NP e6 fluorescence at 6 hours was observed higher than in the control arteries.
Balloon angioplasty was performed in the abdominal aorta of the AS model and injected with NP e6 at the time of balloon inflation. In this model, high fluorescence was observed not only in the intima but also in the treated media at 3 hours after NP e6 injection.
These results substantiates the efficacy of vascular PDT for destruction of smooth muscle cells in the treated media. This may offer a new approach to the inhibition of intimal hyperplasia after angioplasty.

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Photodynamic therapy (PDT) is a treatment for malignant tumors employing the interaction of a photosensitizer with laser light in the presence of molecular oxygen. Acontinuous wave laser, usually an argon laser-pumped dye laser, has normally been used as the excitation light source in PDT. Recently, some pulsed lasers have become available. The effectiveness of PDT using a pulsed laser varies greatly with the operating conditions, for instance, repetition rate, pulse width and pulse energy. This review describes mainly the cytotoxic efficacy when using a variety of pulsed lasers, and some factors that would contribute significantly to their therapeutic effects.

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The indications for treatment of uterine cervical disease by Nd-YAG laser conization in our department are as follows: the cases of women who earnestly desire a baby and have (1) microinvasive carcinoma without vascular space involvement, (2) carcinoma in situ (CIS), and (3) the cases suspected over CIS by cytology even if the diagnosis is severe dysplasia, as judged from colposcopical punch biopsy. The indications in pregnant women are as follows: cases including diagnostic conization with suspected microinvasion as judged from cytology even if the histological diagnosis is under CIS and microinvasion is demonstrated by punch biopsy. Cases having a wide focus and desire for complete therapy are also operated on even if the diagnosis is CIS. A cone height of at most 2cm is needed for prevention of cervical stenosis in non-pregnant women. In pregnant women, cervical cerclage is carried out in addition to therapeutic laser conization.

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We report 13 pregnant women with squamous intraepithelial lesions (SIL) of the uterine cervix who underwent LASER conizations. LASER conizations were performed during 4~5 months of gestation in 12 cases. Blood loss during the procedure in pregnant women (140.8±59.0ml, Mean±SE) was significantly (p<0.01) larger than that in non-pregnant women (43.7±7.8ml). However, no pregnant patient with SIL required blood transfusion. Stillbirth, which might be induced by chorioamnionitis, occurred in one patient at 23 weeks of gestation after the conization. Two patients were delivered of intact babies at 34 and 35 weeks of gestation, and the remaining patients were delivered of normal babies at term. No relapse of SIL was found except for one patient in whom re-conization had been done 6 years after the first conization. In conclusion, LASER conization might be a safe and useful procedure for women with SIL during pregnancy.

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This article describes one of the treatments, laser therapy, of condyloma acminaturn. We usually perform vaporization using carbon dioxide laser under regional anesthesia. Although laser therapy is easily performed in an outpatient clinic, the application shoud be limited after course observation or 5-fluorouracil cream is proved uneffective. Clinician should informed to the patients that this therapy is sometimes painful, result in scarring and recurrences.

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The result of laser treatment for intraepithelial neoplasia and microinvasive carcinoma of the cervix was reported and the detailed technical know-how was presented in this paper. CO₂, YAG, and KTP/YAG laser sauces were selected for either of vaporization or conization. The primary cure rates of 43 patients with mild dysplasia, 132 with moderate dysplasia, 136 with severe dysplasia and 109 with carcinoma in situ (CIS) in the method of vaporization were 93%, 92%, 94% and 91% respectively. While those of 26 with mild dysplasia, 73 with moderate dysplaisa, 112 with severe dysplasia, 174 with carcinoma in situ (CIS) and 87 with microinvasive carcinoma in the method of conization were 92%, 99%, 97%, 94% and 95% respectively. After the laser treatment, 26 pregnancies have experienced in those of vaporization and 23 pregnancies have also achieved in the cases of conization for CIS and microinvasive carcinoma. We appreciate the procedure suitable for the conservative management of early cervical meoplasia.

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CO₂ lasers and Nd: YAG lasers are widely employed by obstetrics and gynecologists for the treatment of early-stage cancer in the uterine cervix because these lasers allow the favorable transpiration of soft tissue by arresting bleeding. In recent years, the proportion of early-stage cervical cancers has been increasing. Since the average age of child bearing is also increasing, ellorts are being cade to preserve the uterus for future fecundation. Since 1989, we have been using laser therapy to treat early cancerous foci in the uterine cervix. In principle, CO₂ laser transpiration is used for moderate to severe dysplasia, and Nd: YAG laser conization is used for carcinomas in situ and microinvasive, I a 1 stage cancers. In this paper, we describe the technical points of our laser therapy protocol as well as the results of laser therapy treatments for cervical cancer complicated by pregnancy.

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Cervical conization is widely used for diagnostic and therapeutic purposes in the management of cervical intraepithelial neoplasia (CIN) or early invasive carcinoma. Recently, according as patients of childbearing age or pregnant women with these tumors are increased in number, this conservative surgery is often chosen for maintaining their fertility and pregnancy. Conization has a simple operative procedure, but it may be complicated by hemorrhage or stenosis, furthermore in case of the therapeutic purpose, complete excision should be kept in mind. The laser technique, which has begun to be applied in our department since 1990, is seems advantageous for conization. In this study, our methods and archivements of laser conization were described.

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Among the laser surgeries directed at the treatment for intraepithelial neoplasm of the cervix (CIN) are vaporization conization and excisional conization, which, as common practices, have been gaining ground in the last decade. This is in part because more accurate techniques of laser irradiation and detailed knowledge of CIN, such as its relation to HPV infection, have been dramatically obtained. On the other hand, much need for preserving the uterus, which comes from an increase in delayed marriage and younger women afflicted with CIN, is now forcing us to get used to performing the laser surgery. In addition, most of us, if not all, don't question the usefulness of the laser surgery for CIN associated with pregnancy, subsequently seeing her give birth hopefully to her healthy baby. We hereto present our own practice in treating patients, including pregnant women, with CIN with the laser surgery. In particular, we focus upon the indication, applied techniques, protocol of follow-up, and several tricks of laser surgery in our institution. Thus far, more than three hundred patients with CIN have been treated with CO₂, laser vaporization or conization, though by the initial treatment of laser surgery about 90% complete remission was attained. As for a relapse, except for those who had a total abdominal hysterectomy applied to, the second laser surgery accomplished complete remission, clearly suggesting that, in fact, laser surgery offers us a reliable and safe way to apply to the patients with CIN. We also address laser surgery applied to cervical adenocarcinoma in situ associated with pregnancy in relation to our own case.

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1Three hundred and fifty nine women with dysplasia, carcinoma in situ (CIS) and microinvasive carcinoma (MIC) were treated by CO, laser excision conization. Two hundred and thirty two patients (64.6%) were performed laser conization in the outpatient unit. Two hundred and forty two patients (67.4%) after conization were followed up by cytology, colposcopy and histology. The recurrence rate afterr 1 year was 3.8%. Postoperative bleeding rate was 1.7% in the inpatient laser conization group, while 11.6% in the outpatient group because of the lack of bed rest at home. Bed rest at home for a few days after conization must be insisted on in the outpatient group. Twenty four women after conization had given birth. Six of these cases (25%) were delivered preterm and 4 patients had preterm ruptured membranes (PROM). Laser conization seemed to increase the risk of preterm delivery and PROM in subsequent pregnancies. Pregnant women with prior conization need careful antenatal care. These results suggested that CO₂, laser conization was a highly effective method treating early cervical neoplasia, although we have to consider some complications.

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[in Japanese]

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