When performing procedures that employ lasers, eye protection must be adequate to prevent accident. Maintaining protective equipment can be particularly difficult for active pediatric patients. Adhesive eye shields (METRAS Eye Patch/METRAS Inc.) may be useful in this population as they offer more stability while adhering to the periorbital area. However, there have been no reports about their safety in pediatric patients. We conducted a written survey to 186 patients who received laser treatment, 168 of whom responded. Adhesive eye shields were used in 109 patients (intervention group), but not in the remaining 59 patients (control group). Four patients in the intervention group reported symptoms, such as redness and rash on the application site, which spontaneously resolved. The incidence of adverse effects was not significantly different between the two groups (p = 0.299, Fisher’s exact test). Therefore, adhesive eyes shields cause little skin irritation in pediatric patients.

The number of medical examinations for malignant tumors in the veterinary field is increasing year by year, and one in three dogs die from malignant tumors. Among malignant tumors in dogs, malignant melanoma that occurs in the oral cavity causes infiltration to the surrounding area and lung metastasis with high probability. In dogs, in cases where malignant melanoma with repeated local recurrence invades the difficult-to-resect site that presses the eyeball, treatment using local injection of indocyanine green and irradiation with a semiconductor laser was effective. Since a reaction that can be judged to be was observed, the case will be described.

1) Auditory system applies the transmission of sound waves and requires tools to measure these vibrations. Although not covered by health insurance, laser doppler can be used to measure vibrations to the middle and inner ear in real time, and is effective in developing surgical methods. There have been many reports of analysis overseas, mainly on the cadavars. 2) As a laser treatment, we can evaporate and cauterize the ossicles in middle ear surgeries such as tympanostomy and stapes surgery without causing vibration to the ossicles.

Allergic rhinitis has become a serious social problem in Japan, with a prevalence rate of close to 50%. The first choice of treatment is medication with anti-allergic drugs, but surgical treatment is also used for patients with poor response to medication. Vaporization of the inferior turbinate with CO₂ laser was a minimally invasive surgical treatment that was often selected because it was less invasive on the patient. In this report, we describe CO₂ laser vaporization of the inferior turbinate, and show a case report.

The number of patients with dysphagia is increasing with the aging of the global population. The most effective surgical treatment for upper esophageal sphincter (UES) dysfunction in dysphagia patients is cricopharyngeal myotomy. In recent years, endoscopic cricopharyngeal myotomy (ECPM) has become widespread as a less invasive approach than the conventional transcervical approach. ECPM using a CO₂ laser can transorally open the UES and improve passage of a bolus at the UES during swallowing. In this report, we describe features of the CO₂ laser used in ECPM and the surgical procedure using a micromanipulator.

Sensorineural hearing loss caused by a shock wave is the most critical etiology relating to blast-induced hearing loss. We have already established small animal models of blast-induced traumatic brain injury and lung injury that are induced by laser-induced shock-waves (LISWs). The use of LISWs has many advantages to mimic traumatic injuries for organs, e.g., highly controllable shock wave energy, site-selectivity and reproducibility. We, herein, present a novel hearing loss model based on LISWs to replicate a blast-induced hearing loss. Our results indicate that threshold elevation of the auditory brainstem response (ABR) after blast exposure was primarily caused by outer hair cell dysfunction induced by stereociliary bundle disruption. The bundle disruption pattern was unique; disturbed stereocilia were mostly observed in the outermost row, whereas those in the inner and middle rows stereocilia remained intact. In addition, The ABR examination showed a reduction in wave I amplitude without elevation of the threshold in the lower energy exposure group. This phenomenon was caused by loss of the synaptic ribbon. This type of hearing dysfunction has recently been described as hidden hearing loss caused by cochlear neuropathy, which is associated with tinnitus or hyperacusis.

Cancer can develop into a recurrent metastatic disease with latency periods of years to decades. Dormant cancer cells, which represent a major cause of recurrent cancer, are relatively insensitive to most chemotherapeutic drugs and radiation. We previously demonstrated that cancer cells exhibited dormancy in a cell density-dependent manner. Dormant cancer cells exhibited increased porphyrin metabolism and sensitivity to 5-aminolevulinic acid-based photodynamic therapy (ALA-PDT). However, the metabolic changes in dormant cancer cells or the factors that enhance porphyrin metabolism have not been fully clarified. In this study, we revealed that lipid metabolism was increased in dormant cancer cells, leading to ALA-PDT sensitivity. We performed microarray analysis in non-dormant and dormant cancer cells and revealed that lipid metabolism was remarkably enhanced in dormant cancer cells. In addition, triacsin-C, a potent inhibitor of acyl-CoA synthetases (ACSs), reduced protoporphyrin IX (PpIX) accumulation and decreased ALA-PDT sensitivity. We demonstrated that lipid metabolism including ACS expression was positively associated with PpIX accumulation. This research suggested that the enhancement of lipid metabolism in cancer cells induces PpIX accumulation and ALA-PDT sensitivity.

Photodynamic diagnosis (PDD), where the metabolites of orally given 5-aminolevulinic acid (5-ALA) accumulate in the tumor cells, is simple, enables intraoperative real-time detection of the tumor tissue, and thus is valid in malignant brain tumor surgery. On the other hand, photodynamic therapy (PDT), where talaporfin sodium in combination with a semiconductor laser selectively kills tumor cells in the defined brain area, is considered promising as less invasive therapy to treat unresectable brain tumors invading eloquent brain regions. In this article, we summarize biological effect, clinical application, and future perspectives of PDD and PDT.

Photomedicine for skin diseases includes PUVA therapy, narrow band UVB therapy, excimer light, and excimer laser, which are the main topical treatments for leukoderma, psoriasis, sarcoidosis, and cutaneous lymphoma. Furthermore, the alexandrite laser for pigmented lesions and the dye laser for vascular lesions have a large psychological therapeutic effect as well as improved appearance and contribute to the improvement of QOL of patients.

Photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA) can visually clarify the accurate location of tumors. Near-infrared imaging using indocyanine green (ICG) fluorescence can provide minimally invasive imaging of vessels and lymphatic ducts deep inside organs that cannot be seen with the naked eye. Recent advances in fluorescence techniques using 5-ALA-PDD and ICG imaging improve visualization and detection of various cancers and can confirm blood and lymphatic circulation in gastrointestinal surgeries, including thoraco-laparoscopic surgery. It can also increase the safety of minimally invasive surgery and improve diagnostic accuracy and treatment results. Further application of these techniques is expected in various medical fields.

Of 207 cases of infantile hemangioma (IH) collected at Tokyo Women’s Medical University Yachiyo Medical Center and Saitama Red Cross Hospital, 79 IH cases of head and face were treated. Vbeam II^®, 595 nm-long pulsed dye laser with adjustable pulse duration (LPDL), or oral propranolol as drug therapy, and combined therapy, were used to treat high-risk infants with life-threatening or functionally disabling lesions. A statistical comparison was performed between IH treated groups and followed up groups, using 5-item rating scale for improvement at 12 and 24 weeks. A significant difference in treated IH groups were observed at 24 weeks compared with the follow-up groups. Therefore, we believe that LPDL and oral propranolol therapy should be strongly applied to IH on head and face to prevent serious sequelae.

With the availability of propranolol for infantile hemangioma in Japan, treatment options have been expanded for intractable cases including life- and function-threatening lesions, multiple and widespread lesions, rapidly growing lesions, subcutaneous lesions, and ulcerated lesions. On the other hand, the timing of propranolol intervention for this tumor, which grows most rapidly between 5.5 and 7.5 weeks of age and reaches 80% of its peak size by 5 months of age, is still controversial in clinical practice.

In this article, I would like to introduce the current debate on the concept and timing of propranolol therapy for infantile hemangioma.

Sequelae after infantile hemangioma involution on the body surface includes telangiectasia, residual fibrous adipose tissue, skin atrophy and excess skin, and scarring, which occur at a relatively high rate. A pulsed dye laser is effective for telangiectasia. Surgical treatment is required for residual fibrofatty tissue, skin atrophy, excess skin and scars. Further research is needed on the issue of how to avoid sequelae in order to reduce the burden on patients.

Although infantile hemangioma regresses spontaneously, disappearance is incomplete, and there are many complications and sequelae during the course of the disease. Since the efficacy of propranolol treatment was reported in 2008, oral propranolol treatment has become the first choice for infantile hemangioma. On the other hand, dye laser treatment has little effect on early shrinkage of the tumor, but it destroys the blood vessels on the skin surface and produces a discoloration effect. In addition, oral propranolol and laser therapy are also used in combination at many facilities, and are used together with the expectation of a synergistic effect, especially in large, severe cases, or in cases of exposed areas that pose major cosmetic problems. We look back on the history of infantile hemangioma treatment while viewing the treatment experience at our department, and consider the indications and significance of propranolol and laser combination therapy, as well as future issues.

Intraoperative real-time navigation using indocyanine green (ICG) fluorescence imaging is becoming increasingly popular in the field of hepato-biliary-pancreatic surgery, which requires an understanding of complex anatomical structures. This paper outlines the current status and prospects of ICG fluorescence imaging, focusing on its fundamentals and applications in surgery.

As radiological imaging has progressed, smaller nodules are more frequently detected. The trend of minimal invasiveness in thoracic surgery has paved the way for video-assisted thoracic surgery. In localization for small nodules and segmentectomy for such nodules, fluorescent dyes, such as indocyanine green (ICG) have been used more often. Therefore, we herein describe the utility of fluorescent imaging in the treatment of lung cancer, which is currently the mainstream of thoracic surgery, focusing on the clinical application of ICG.

Sentinel lymph node (SLN) biopsy is now the standard of care for patients with clinically node-negative breast cancer and completion of axillary lymph node dissection can be spared in patients who had negative-SLNs. Accurate and safe assessment of axillary lymph node status is required because lymph node involvement is accepted as the most powerful prognostic indicator The combined method using blue dye and radioisotope (RI) have been used worldwide. The RI method yield the high detection rate but has some drawbacks including radiation exposure and requirement of RI facilities and nuclear medicine. The indocyanine green (ICG) fluorescence method which was developed is accepted as an alternative SLN mapping to the RI method. Here we report the current status and perspectives on this image guided SLN biopsy using ICG.

New diagnostic techniques, such as near-infrared fluorescence using indocyanine green (ICG) dye and photodynamic diagnosis (PDD) using 5-aminolevulinic acid (5-ALA), are useful in various clinical fields for visualizing biological information that cannot be detected by the naked eye. Fluorescence-guided surgery combined with ICG fluorescence and 5-ALA-PDD improves surgical safety and treatment results. The evolution of irradiation equipment along with future drug exploitation is expected to lead to accurate diagnosis with minimally invasive methods and development of a high-quality image system.

We developed a new color charge-coupled device camera system for intraoperative indocyanine green fluorescence-guided surgery. The device consists of a combination of custom-made optical filters and a high-sensitive image sensor with non-Bayer color filter array, i.e., HyperEye technology, which can detect simultaneously color and near-infrared images. After practical research, this device resulted in a medical imaging system, HyperEye Medical System.

The blood flow assessment and Sentinel node (SN) detection using indocyanine green fluorescence, near-infrared fluorescent clip and fluorescent tumor labeling has been involved in the intraoperative fluorescence imaging. Along with the reports accumulation, the blood flow assessment of the colo-rectum has been regarded as important. Feasibility of the SN detection is advancing slowly but quite promising. Introduction of the devices including clip using near-infrared fluorescent resin has been started, and the novel tumor labeling probes is now developing steadily.