Toshio Ohshiro

Effects of low-power diode lasers on flap survival

We investigated the effect of low-power laser irradiation on the survival of experimental skin flaps in rats. A gallium-aluminum-arsenide diode laser that was developed by the Japan Medical Laser Laboratory was used. The laser power was 15 mW and the wavelength 830 nm. Irradiation was carried out, either before or after flap elevation, in two groups of 20 Wistar strain rats. A third group of 20 rats served as controls. A caudally based skin flap, 3 × 9 cm, was designed on the back of each rat. Laser irradiation therapy was performed for 5 consecutive days for 6 minutes per flap per day, preoperatively in one group and postoperatively in the other. Seven days postoperatively, the survival areas of the flaps were measured and compared. The survival area was increased significantly in both groups receiving laser therapy, probably due to the observed proliferation of blood vessels around the irradiated points and an increase in blood flow.

Treatment of pigmentation of the lips and oral mucosa in Peutz-Jeghers' syndrome using ruby and argon lasers

Three patients with punctate pigmented spots on the lips and oral mucosa, accompanying the P-J Syndrome, were successfully treated with ruby and argon lasers. The basic principles of laser treatment, the characteristics of the different laser systems and the skin reaction to ruby and argon lasers are discussed.

Detection of small vessels for microsurgery by a Doppler flowmeter.

The Doppler flowmeter saved time and helped us to quickly find the exact position of the donor and the recipient vessels in the microvascular transfer of a free deltopectoral flap to the face.

Surgical treatment of malunited fracture of zygoma with diplopia and with comments on blow-out fracture

Summary Blow-out fracture is discussed and its classification is described, based on the factors producing the restriction of extra-ocular muscle (EOM) movement. Zygomatic fracture is complicated by EOM restriction and diplopia is present in 15% of recent and 56% of late fractures respectively. The mechanism of EOM restriction in malunited fracture of the zygoma if postulated and the rational surgical treatment is described in detail, together with the favourable results. Surgical intervention is aimed at the creation of a normal bony orbit and thus the establishment of conditions under which the EOM are minimally affected by tethering by intra-orbital scars. Orbital and antral approaches to the orbital contents are available via a single incision and an en bloc resection of a segment of the orbital rim, anterior part of orbital floor and anterior wall of antrum. Partial ostectomy along the proposed line of section is sometimes useful for easy reduction of a malunited fracture of the zygoma. For reconstruction of an extensive bony defect of the orbital floor, or for the fixation of a bone graft or for the creation of the base on which the bone graft is to be placed, the insertion of a short Kirschner wire (K-wire) is useful.

Adjunctive 830 nm light-emitting diode therapy can improve the results following aesthetic procedures

BACKGROUND Aggressive, or even minimally aggressive, aesthetic interventions are almost inevitably followed by such events as discomfort, erythema, edema and hematoma formation which could lengthen patient downtime and represent a major problem to the surgeon. Recently, low level light therapy with light-emitting diodes (LED-LLLT) at 830 nm has attracted attention in wound healing indications for its anti-inflammatory effects and control of erythema, edema and bruising. RATIONALE The wavelength of 830 nm offers deep penetration into living biological tissue, including bone. A new-generation of 830 nm LEDs, based on those developed in the NASA Space Medicine Laboratory, has enabled the construction of planar array-based LED-LLLT systems with clinically useful irradiances. Irradiation with 830 nm energy has been shown in vitro and in vivo to increase the action potential of epidermal and dermal cells significantly. The response of the inflammatory stage cells is enhanced both in terms of function and trophic factor release, and fibroblasts demonstrate superior collagenesis and elastinogenesis. CONCLUSIONS A growing body of clinical evidence is showing that applying 830 nm LED-LLLT as soon as possible post-procedure, both invasive and noninvasive, successfully hastens the resolution of sequelae associated with patient downtime in addition to significantly speeding up frank wound healing. This article reviews that evidence, and attempts to show that 830 nm LED-LLLT delivers swift resolution of postoperative sequelae, minimizes downtime and enhances patient satisfaction.

Low Level Laser Therapy for chronic knee joint pain patients

BACKGROUND AND AIMS Chronic knee joint pain is one of the most frequent complaints which is seen in the outpatient clinic in our medical institute. In previous studies we have reported the benefits of low level laser therapy (LLLT) for chronic pain in the shoulder joints, elbow, hand, finger and the lower back. The present study is a report on the effects of LLLT for chronic knee joint pain. MATERIALS AND METHODS Over the past 5 years, 35 subjects visited the outpatient clinic with complaints of chronic knee joint pain caused by the knee osteoarthritis-induced degenerative meniscal tear. They received low level laser therapy. A 1000 mW semi-conductor laser device was used to deliver 20.1 J/cm(2) per point in continuous wave at 830nm, and four points were irradiated per session (1 treatment) twice a week for 4 weeks. RESULTS A visual analogue scale (VAS) was used to determine the effects of LLLT for the chronic pain and after the end of the treatment regimen a significant improvement was observed (p<0.001). After treatment, no significant differences were observed in the knee joint range of motion. Discussions with the patients revealed that it was important for them to learn how to avoid postures that would cause them knee pain in everyday life in order to have continuous benefits from the treatment. CONCLUSION The present study demonstrated that 830 nm LLLT was an effective form of treatment for chronic knee pain caused by knee osteoarthritis. Patients were advised to undertake training involving gentle flexion and extension of the knee.

The production of VEGF involving MAP kinase activation by low level laser therapy in human granulosa cells.

OBJECTIVE The function of granulosa cells is regulated by various hormones and growth factors. Our aim is to clarify the regulation of vascular endothelial growth factor (VEGF) production via mitogen-activated protein kinase (MAPK) induced by low level laser therapy (LLLT) in human granulosa cells. METHODS A human granulosa cell line, KGN cells, were cultured and incubated after LLLT (60mW, GaAlAs 830nm). The levels of VEGF in the culture media were determined by an enzyme-linked immunosorbent assay. The activation of MAP kinase in KGN cells was detected by western blot analysis. RESULTS VEGF production was significantly increased by LLLT in a time-dependent manner. MAP kinase activity was increased by LLLT. In addition it was enhanced by LLLT and follicle-stimulating hormone (FSH) stimulation. CONCLUSIONS The results suggested that VEGF is induced by LLLT through mechanisms involving MAPK. The increase in VEGF may contribute to neovascularization, which in turn would promote various ovulation phenomena as well as follicular growth.

Guest Editorial: Light and Life: A Personal Overview of Development in the Fields of Photosurgery and Phototherapy

1 FIRST OF ALL may I sincerely thank Dr Raymond Lanzafame, Editor-in-Chief, of Photomedicine and Laser Surgery (PMLS), for the opportunity to address the journal readers through the medium of this Guest Editorial. It is a real honor and pleasure for me, and I was delighted to humbly accept the offer. For those readers who do not know me, I was the Founding Editor-in-Chief of the journal Laser Therapy, started by John Wiley and Sons of Chichester, UK, back in 1988.1 In the same year, I was named President-Elect of a new society dedicated to laser therapy and photobioactivation, the International Laser Therapy Association (ILTA), at a gathering of leaders in the field held during a major international laser congress in the London Hilton Hotel. I successfully held the first ILTA congress in Okinawa, Japan, in 1990 under the sub-banner of “Light and Life,” and that was the start of the present-day focus on low reactive level laser therapy, or LLLT. Of course, the roots go back, much further back, and there is evidence that the physicians of the Ancient Egyptians 4,000 years ago were harnessing the curative power of sunlight through phytochemical photosensitization in what the Ancient Greeks later termed “heliotherapy.”2 Photosensitization of tissue to specific wavelengths is at the core of present-day photodynamic therapy (PDT), but the Ancients were using PDT 4000 years ago. Hippocrates, the “father of medicine,” prescribed sunlight for melancholia, and believed the Greeks were a much happier nation than their northern neighbors because they had so much sunlight. In more modern times, in the 18th and 19th centuries, heliotherapy was used to treat depression and the eruptive stages of rubella and rubeola by putting the patient in a room with red-tinted windows. One of the more famous patients in recorded history was “Mad” King George III (1760 to 1801) of Great Britain and Northern Ireland who underwent red light heliotherapy. As we now know, his “madness” was actually one of the clinical symptoms of porphyria; it is quite possible that the heliotherapy drove him even more “madness.” In the late 19th century, Fubini and his colleagues3 in Italy showed that visible red light, provided via lenses and filters from sunlight selectively activated the respiratory component of cellular mitochondria. There is nothing new under the sun. The pre-eminent Russian photobiologist Professor Tiina Karu has consistently shown that one of the main, if not the main, target for visible red light, is the Cu2 component of cytochrome C oxidase in the respiratory chain of mitochondria.4 Modern phototherapy, however, owes its inception to the Danish physician and scientist, Nils Finsen, who developed the first artificial light source for phototherapy,5 receiving the Nobel Prize for medicine with the use of his invention to treat lupus erythematosus in 1903. When this knowledge was combined with the photon or “quantum”-based precepts of light postulated by the Scottish scientist John Clerk Maxwell (1831–1879), followed almost half a century later by Albert Einstein’s and then Max Plank’s better-known quantum theory, the first “optical maser,” the laser, was finally developed by Maiman in 1960, not even half a century ago. We had a new light source to play with in photomedicine and photosurgery! The pioneering work of the late EndrÇ Mester in the late 1960s and early 1970s represented the first real steps toward the use of low incident levels of laser energy in medicine,6 earning him the soubriquet of the “Father of Phototherapy.” He was in turn inspired by the findings of early adopters of the carbon dioxide (CO2) laser showing that patients had less postoperative pain and less inflammation when operated on with the so-called “light knife” that those who had undergone surgery with the conventional surgical scalpel. Other forms of thermally-based surgery, such as electrosurgery with the Bovie knife, did not demonstrate these interesting and useful side effects, so it was surmised that it was the ‘L’ in the acronym “laser” (i.e., “light”) that was responsible for the beneficial effects associated with CO2 laser surgery. My own experience of this soon manifested itself in my treatment of different types of cutaneous nevi with laser in the late 1970s. I was successfully treating hemangioma simplex or port wine stain (PWS) with a combination of the pulsed ruby and argon lasers, and I would sometimes see a patient treated elsewhere unsuccessfully with another approach. One particular patient presented with a large PWS which had been partially treated with needle electrocautery.

Low Level Laser Therapy (Lllt) for Chronic Joint Pain of the Elbow, Wrist and Fingers

BACKGROUND AND AIMS In previous studies, we successfully applied Low Level Laser Therapy (LLLT) in patients with non-specific chronic pain of the shoulder joint and lower back. The purpose of the present study was to assess the effectiveness of LLLT for chronic joint pain of the elbow, wrist, and fingers. SUBJECTS AND METHODS Nine male and 15 female patients with chronic joint pain of the elbow, wrist, or fingers, who were treated at the rehabilitation outpatient clinic at our hospital from April, 2007 to March, 2009 were enrolled in the study. We used a 1000 mW semiconductor laser device. Each tender point and three points around it were irradiated with laser energy. Each point was irradiated twice for 20 s per treatment, giving a total of three minutes for all 4 points. Patients visited the clinic twice a week, and were evaluated after four weeks of treatment. Pain was evaluated with a Visual Analogue Scale (VAS). Statistical analysis of the VAS scores after laser irradiation was performed with Wilcoxons signed rank sum test, using SPSS Ver.17. RESULTS All VAS scores were totaled and statistically analyzed. The average VAS score before irradiation was 59.2±12.9, and 33.1±12.2 after the irradiation, showing a significant improvement in VAS score (p<0.001) after treatment. The treatment effect lasted for about one and a half days in the case of wrist pain, epicondylitis lateralis (tennis elbow), and carpal tunnel syndrome. In other pain entities, it lasted for about three to fifteen hours. No change in the range of motion (ROM) was seen in any of the 24 subjects. CONCLUSION We concluded that LLLT at the wavelength and parameters used in the present study was effective for chronic pain of the elbow, wrist, and fingers.

Investigation regarding prevention of insufficiency fractures in children with severe cerebral palsy by Light-Emitting Diode (LED) irradiation

Bone metabolism in children with severe fractures was examined, risk factors for fractures were characterized, and effects of LED (light-emitting diode) irradiation on the risk factors for fractures were investigated. Since insufficiency fracture in children with severe cerebral palsy can be caused without obvious external force in daily care, it is sometimes handled as a medical accident and can lead to a lawsuit. It is very important to explain the possibility of an insufficiency fracture to guardians before a fracture is caused. However, risk factors for fractures in bone metabolism has not been well investigated and preventive treatment of fractures have also not been established. Risk factors in bone metabolism were investigated in 14 cases of insufficiency fracture in children with severe cerebral palsy accompanied by akathisia in this study. Fractures were likely caused around 8 years old when children grew rapidly, and either IGF-1 or BAP showed low values in all cases. A group with LED irradiation consisting of 25 cases indicated a normal value of IGF-1 related to bone growth, BAP related to bone density and NTX/Cr. A case irradiated to LED for more than one month clearly showed normal bone metabolism compared with the change within a non irradiated group after one year. LED irradiation increased bone density and femur cortical bone thickness, and improved bone age. Adequate effects were not seen in two children at 14 years of age. The commercially available LED light bulbs that we used have a peak at 446-477 nm in the blue wave length, but also have second peaks at 574 nm in green, at 590 nm in yellow, and even 612 nm in orange and 660 nm in red are included. Although it is thought that such a variety of wave lengths might have a good influence on bone metabolism; exposure time and distance, number of regions, and time period irradiated to LED are important factors, since the LED power density is low (0.9 mW/m(2) with a 30 cm distance). Our results suggest that LED irradiation can be a phototherapy to activate human homeostasis.