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Functionally, the lip serves to prevent food and drink from spilling out of the beginning of the gastrointestinal tract, and it is also used for vocalization. In addition, the lip has cosmetic importance as part of the face involved in making expressions, and in many cultures, it is considered to be sexually appealing. The results of lip reconstruction procedures must therefore be both functionally and cosmetically satisfactory. When the orbicularis oris muscle and oral mucosa are excised, functional reconstruction is prioritized. In contrast, if there are no functional problems, cosmetic reconstruction is the main focus. This case involved the reconstruction of a right upper lip defect caused by a dog bite. When the skin defect was covered with a local flap, the right angulus oris shifted medially, so we incorporated a YV flap at the right angulus oris to modify its position and allow for a cosmetically satisfactory result. We believe that this method can be used not only for cases in which asymmetry of the angulus oris is expected to occur at the time of lip reconstruction, but also for cases in which it has already occurred in the initial operation.

Background and aims Allergic rhinitis annually reach epidemic proportions in Japan. Approximately 30 to 40% of the population suffers from allergic rhinitis during the spring season. Symptoms comprise rhinorrhea, nasal congestion, and sneezing accompanied by irritation and itching of the eyes. The Ohshiro Clinic started using the conventional Nd:YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd:YAG laser. From 2010, we adopted a novel 810 nm diode laser, and the present retrospective study examined the efficacy rate of the treatment of allergic rhinitis in the 2018 season with this system, compared with a previous study in 2011. We aimed to confirm the degree of improvement for each symptom to evaluate effectiveness of the diode laser treatment. Subjects and methods Between January 8, 2018 and April 30, 2018, a large number of patients consulted our clinic with the major complaint of seasonal allergic rhinitis. They underwent a blood test, and the antigen-specific serum IgE antibody titers were measured for a definitive diagnosis of cedar pollinosis. A total of 211 target patients were treated during the trial period. The average age of the target group was 36.3 years, 134 males, and 77 females. The target patients were treated with lower nasal turbinate mucosal irradiation using a diode laser (ADL-20, Asuka Medical) delivering 810 nm at 7.5 W, with a total energy per treatment of 240 J/cm2. We adopted a five-step evaluation in accordance with the Japanese Guidelines for Allergic Rhinitis 2014 for the symptoms of rhinorrhea, sneezing and nasal obstruction. We assessed the degree of improvement in the severity of these symptoms following diode laser treatment from baseline to one month after treatment, in addition to assessing patient satisfaction with the degree of improvement in their quality of life (QOL). Results The 211 patients positive for cedar pollinosis by the antigen-specific serum IgE antibody tests were broken down by month by number and by improvement, no change or exacerbation as follows. January, 18 patients: 33.4%, 44.4% and 22.2%, respectively. February, 29: 10.4%, 44.4% and 22.2%, respectively. March, 146: 60.3%, 31.5% and 8.2%, respectively. April, 18: 77.8%, 16.7% and 5.5%, respectively. The monthly respective improvement, no change or worse patient QOL as percentages were as follows: January: 16.7%, 44.4% and 38.9%. February: 17.3%, 13.8% and 68.9%. March: 61.6%, 29.5% and 8.9%. April: 94.4%, 0.0% and 5.6%. The values for prevention of exacerbation versus exacerbation for each month were: January, 77.8% vs 22.2%; February, 41.4% vs 58.6%; March, 91.8% vs 8.2%; and April, 94.4% vs 5.6%. The mean efficacy rate for the trial period in the present study was therefore 52.6% which compared very favorably with the mean efficacy rate in the 2011 study of 53.4%. Conclusions The results showed that the 810 nm diode laser offered a safe and effective solution for the uncomfortable symptoms of allergic rhinitis and could be well applied during the season of Japanese cedar pollen dispersion. Furthermore, a tendency towards high efficacy was demonstrated for laser treatment in class 6 cedar pollinosis patients, based on the specific IgE antibody test.

Background and aim Minocycline therapy for acne vulgaris is associated with the occasional induction of various types of unsightly and often persistent hyperpigmentation, which is frequently resistant to hydroquinone treatment. Pigment-specific lasers have achieved some success with multiple treatment sessions. Recently, the picosecond domain 755 nm alexandrite laser (ps-Alex) has attracted attention in tattoo removal. The present study reports on the successful treatment, in a single ps-Alex session, of minocycline-associated pigmentation. Subject and method Subsequent to a course of minocycline, a 28-year-old Asian female developed persistent type 2 minocycline-related pigmentation on the bilateral lower extremities which was recalcitrant to hydroquinone treatment. The patient had a test treatment on a small area with a Q-switched ruby laser and the ps-Alex, following which the ps-Alex was selected for the actual treatment (spot size, 2 mm; fluence, 6.37 J/cm2; pulsewidth, 750 ps) on one leg first, followed later by the contralateral leg. Results Rapid clearance of the pigmentation was noted after a single ps-Alex session on both limbs without prolonged post-inflammatory hyperpigmentation (PIH). At one year post-treatment, clearance had been maintained. Conclusions Our results in this single case strongly suggest that the novel 755-nm ps-Alex laser is both safe and very effective for the treatment of type 2 minocycline-induced hyperpigmentation even in PIH-prone type IV Asian skin. Further trials with larger patient populations are warranted to confirm this optimistic result.

Background and aims Recently, novel picosecond pulse duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that ps-lasers could be an alternative treatment for dermal pigmented lesions. We performed a retrospective review to evaluate the efficacy and safety of the ps-laser for nevus of Ota. Subjects and methods A retrospective photographic review of 15 patients with nevus of Ota was performed (ages from 10 months to 65 yr). The patients were treated in the Ohshiro Clinic with a picosecond-domain 755 nm alexandrite laser (ps-Alex laser) from June 2015 to August 2017. Improvement was evaluated as the percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a four category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; and Excellent 75-100% improvement. Adverse events were also assessed. Results All patients obtained clinical improvement ranging from fair to excellent. All 5 patients whose primary treatment was the ps-Alex laser obtained excellent in 2-3 treatment sessions (average 2.5 sessions), and the average total treatment span was 10.0 months. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months of follow-up. Conclusions Our results suggest that 755 nm ps laser treatment is efficacious for the treatment of nevus of Ota with minimum adverse events.

Background and aims: Recently novel picosecond duration lasers (ps-lasers) have been developed for the treatment of multicolored and recalcitrant tattoos, and safety and efficacy have been reported. We therefore hypothesized that the ps-laser could be an alternative treatment for dermal pigmented lesions and performed a retrospective review to evaluate the efficacy and safety of the ps-laser. Subjects and methods: A retrospective photographic review of 10 patients with dermal pigmented lesions was performed (ages from 4 months to 52 yr), 6 nevus of Ota, 3 ectopic Mongolian spots and 1 Mongolian spots. The patients were treated in the Ohshiro Clinic with picosecond 755 nm alexandrite laser (ps-Alex laser) and picosecond 1064 nm Nd:YAG laser (ps-Nd:YAG laser) from April 2014 to December 2015 (ps-Alex laser, 7 patients; ps-Nd:YAG laser, 3 patients, 1 to 3 treatment sessions). Improvement was evaluated as percentage of pigmentation clearance comparing the baseline findings with those at 3 months after the final treatment using a five category grading scale: Poor, 0-24%; Fair, 25-49%; Good, 50-74%; Excellent, 75-94%; and Complete, 95-100% improvement. Adverse events were also assessed. Results: All ten patients obtained clinical improvement ranging from fair to excellent. Treatment with the ps-Alex laser caused transient hyperpigmentation followed by improvement to complete resolution at 3 months follow-up. The ps-Nd:YAG laser caused severe transient erythema and swelling but no post-inflammatory hyperpigmentation. Conclusions: Our results suggest that the 755 nm and 1064 nm ps-lasers are efficacious for the treatment of dermal pigment lesions, with minimum adverse events.

BACKGROUND AND AIMS: Allergic rhinitis annually reach epidemic proportions in Japan. Approximately 30 to 40% of the population suffers from allergic rhinitis during the spring season. Symptoms comprise rhinorrhea, nasal congestion, and sneezing accompanied by irritation and itching of the eyes. The Ohshiro Clinic started using the conventional Nd:YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd:YAG laser. From 2010, we adopted a novel 810 nm diode laser, and the present retrospective study examined the efficacy rate of the treatment of allergic rhinitis in the 2018 season with this system, compared with a previous study in 2011. We aimed to confirm the degree of improvement for each symptom to evaluate effectiveness of the diode laser treatment. SUBJECTS AND METHODS: Between January 8, 2018 and April 30, 2018, a large number of patients consulted our clinic with the major complaint of seasonal allergic rhinitis. They underwent a blood test, and the antigen-specific serum IgE antibody titers were measured for a definitive diagnosis of cedar pollinosis. A total of 211 target patients were treated during the trial period. The average age of the target group was 36.3 years, 134 males, and 77 females. The target patients were treated with lower nasal turbinate mucosal irradiation using a diode laser (ADL-20, Asuka Medical) delivering 810 nm at 7.5 W, with a total energy per treatment of 240 J/cm(2). We adopted a five-step evaluation in accordance with the Japanese Guidelines for Allergic Rhinitis 2014 for the symptoms of rhinorrhea, sneezing and nasal obstruction. We assessed the degree of improvement in the severity of these symptoms following diode laser treatment from baseline to one month after treatment, in addition to assessing patient satisfaction with the degree of improvement in their quality of life (QOL). RESULTS: The 211 patients positive for cedar pollinosis by the antigen-specific serum IgE antibody tests were broken down by month by number and by improvement, no change or exacerbation as follows. January, 18 patients: 33.4%, 44.4% and 22.2%, respectively. February, 29: 10.4%, 44.4% and 22.2%, respectively. March, 146: 60.3%, 31.5% and 8.2%, respectively. April, 18: 77.8%, 16.7% and 5.5%, respectively. The monthly respective improvement, no change or worse patient QOL as percentages were as follows: January: 16.7%, 44.4% and 38.9%. February: 17.3%, 13.8% and 68.9%. March: 61.6%, 29.5% and 8.9%. April: 94.4%, 0.0% and 5.6%. The values for prevention of exacerbation versus exacerbation for each month were: January, 77.8% vs 22.2%; February, 41.4% vs 58.6%; March, 91.8% vs 8.2%; and April, 94.4% vs 5.6%. The mean efficacy rate for the trial period in the present study was therefore 52.6% which compared very favorably with the mean efficacy rate in the 2011 study of 53.4%. CONCLUSIONS: The results showed that the 810 nm diode laser offered a safe and effective solution for the uncomfortable symptoms of allergic rhinitis and could be well applied during the season of Japanese cedar pollen dispersion. Furthermore, a tendency towards high efficacy was demonstrated for laser treatment in class 6 cedar pollinosis patients, based on the specific IgE antibody test.

This study aimed to retrospectively evaluate the efficacy and safety of laser treatment of oral vascular lesions using the multiple spot irradiation technique with a single-pulsed wave.In laser therapy for vascular lesions, heat accumulation induced by excessive irradiation can cause adverse events postoperatively, including ulcer formation, resultant scarring, and severe pain. To prevent heat accumulation and side effects, we have applied a multiple pulsed spot irradiation technique, the so-called "leopard technique" (LT) to oral vascular lesions. This approach was originally proposed for laser treatment of nevi. It can avoid thermal concentration at the same spot and spare the epithelium, which promotes smooth healing. The goal of the study was to evaluate this procedure and treatment outcomes.The subjects were 46 patients with 47 oral vascular lesions treated with the LT using a Nd:YAG laser (1064 nm), including 24 thick lesions treated using a combination of the LT and intralesional photocoagulation.All treatment outcomes were satisfactory without serious complications such as deep ulcer formation, scarring, bleeding, or severe swelling.Laser therapy with the LT is a promising less-invasive treatment for oral vascular lesions.

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.

We report two treatment strategies using intralesional laser photocoagulation (ILP) for large venous malformations (VMs) in the oral cavity. ILP is considered to be an effective technique for massive vascular lesion. The satisfactory results could have been obtained, since we started ILP for the treatment of large VMs. Recently, to improve the safety, reliability, and effectiveness of the treatment, we developed modifications of ILP that include a combination of ILP and transmucosal irradiation; and compartmentalization and serial step irradiation. In the former, ILP is performed for a deep layer lesion and transmucosal irradiation with multiple spots fashioned using a single pulse is added for the superficial layer in the same session, to increase the efficacy of regression. In the latter, the lesion is divided by virtual compartment and each area will be sequentially treated by ILP. The irradiated area and total energy in a session should be limited to avoid severe reactions and excessive thermal destruction of surrounding tissue. All treatment outcomes by each technique were satisfactory without serious complications, such as deep ulcer formation, bleeding, or severe swelling developing obstruction. Both treatment strategies improve the safety, reliability, and effectiveness of ILP and make the method less traumatic for patients.

Background and aims: There are many Q-switched lasers. The Q-switched ruby laser is the one most popularly used in dermatology, aesthetic surgery and plastic surgery, to remove pigmented lesions or tattoos. Correct and regular calibration of such a system is essential. However, some clinics fail to perform this with the excuse of having no measuring instrument (MI) in their offices or treatment rooms in some of their hospitals or clinics, or even the case of well-known medical universities in Japan. The present article explains the precise calibration procedure and beam pattern checking for the Q-switched ruby systems in the first author's clinic. Rationale: In the case of treatment with a medical laser, the calibration and the irradiated pattern (IP) check of the laser being used for treatment are the most important factors for treatment efficacy and safety. If these factors change, the treatment result could be different from that expected. Such kind of data are not acceptable as scientific information for a presentation or published paper. With such unreliable results and incorrect beam pattern, replicating such a study would be impossible Regular calibration check: In our clinic, we have 2 Q-switched ruby laser systems. On a daily basis, the beam patterns, both the optical axis of the beam and its treatment footprint, are checked on dedicated printed sheets and footprint paper, respectively, at the beginning of the day and after the last procedure. Every two weeks we calibrate our systems in-house using a precise MI. Every six months we calibrate the systems in-house with the MI, and then we send the systems back to the manufacturers for calibration. Once every year, we have our MI calibrated by an accredited facility in Japan. In this way, we are not only ensuring accurate and safe treatment for our patients, but we are also producing accurate system and treatment data which can be replicated by others, the basis of evidence-based medicine.

In recent years, through the availability of examination by bone metabolism markers, diagnosis and treatment for osteoporosis in elderly people has been greatly advanced. However, bone metabolism in cases of cerebral palsy has not been fully examined. Though children with cerebral palsy tend to be susceptible to insufficiency fractures, a method of treatment for insufficiency fractures has not been established. In the longitudinal progress of bone metabolism, although there was a difference depending on the severity, reduced bone resorption tended to be mild but osteo-genesis tended to decrease in the severe cases. Osteogenesis and bone resorption markers decreased at around ages 8 and 15. The bone resorption marker maintained mild advancement after age 15. With LED irradiation, all of IGF-1, ucOC, osteogenic marker; BAP, and urinary bone resorption marker; NTx/Cr showed a tendency to normalize. In particular, IGF-1, BAP, and NTx/Cr increased significantly one month after irradiation, compared to the non-irradiation group. Bone density assessed by the DIP method showed no apparent change in the short term either. Irradiation by a commercial LED light bulb indicated a possible positive effect on bone metabolism for children with severe cerebral palsy.

Background and Aims: Allergic rhinitis annually reaches epidemic proportions in Japan, and represents a major problem. The application of the CO2 laser in the treatment of allergic rhinitis was first successfully reported in 1982, but CO2 laser ablation is associated with side effects. The Ohshiro Clinic started using the conventional Nd: YAG laser for the treatment of allergic rhinitis in 1993, and from 2005 we started using a diode laser-pumped Nd: YAG laser with efficacy and safety at least equal to the others. Even more recently, we have adopted a novel 808 nm diode laser, and the present retrospective study examined the difference in of the efficacy rate between the pre-seasonal and intra-seasonal treatment of allergic rhinitis with this system. Subjects and methods: One thousand, two hundred and ten patients primarily presented to the Ohshiro Clinic with allergic rhinitis during the period from December 2010 to April 2011, of whom 531 were selected for blood tests to identify 13 kinds of Japanese allergens including cedar pollen. In the 2010-2011 season, huge clouds of cedar pollen appeared from February 26th. The subjects were therefore divided into two groups depending on the treatment period, namely the pre-seasonal and intra-seasonal groups, December 1st, 2010 to February 25th, 2011 and February 26th to April 6th 2011, respectively. All patients were treated with the new 808 nm diode laser system. Results: A high success rate was achieved in both groups, with no significant difference seen regarding the symptoms of rhinorrhea, obstruction, sneezing, quality of life (QOL) or severity. Conclusions: The 808 nm diode laser offers an excellent solution for the uncomfortable symptoms of allergic rhinitis, and could be equally well applied before or during the Japanese cedar pollen dispersed season.

Post herpetic neuralgia (PHN) can be an extremely painful condition which in many cases proves resistant to all the accepted forms of treatment. It is frequently most severe in the elderly and may persist for years with no predictable course. Since 1980, we have been applying low reactive level laser therapy (LLLT) for patients with PHN. We report herein on the results of a retrospective study concerning those patients in whom LLLT has been applied for pain attenuation of PHN. One hundred and twenty-three patients (73 male, 50 female, mean age: 66.11yr) have received LLLT for various entities of PHN over the past 29 years. In these cases the affected tissue area(s) was as follows: thorax and back (48 cases); head and neck (41 cases); abdomen and lumbar (17 cases); upper limb (9 cases); and lower limb (8 cases). The overall total improvement rate was 60.16%. Patient whose treatment was given within six month of onset obtained the highest improvement rate (mean, 76.34%). LLLT was effective for PHN in the acute and chronic phase, but LLLT was particularly effective for the acute phase patients whose onset before treatment was 6 months or less. The results demonstrate a significant reduction in PHN pain intensity, hypersensitivity and other complaints

Low reactive-level laser therapy (LLLT) has been reported to reduce chronic and acute pain. Recently, some studies have shown that LLLT may also delay skeletal muscle fatigue during high-intensity exercise. We have hypothesized that laser irradiation may also attenuate muscle fatigue or pain experienced after sports or exercise. However, only a few reports have described the use of lasers in sports medicine. This study was conducted to determine the effectiveness of LLLT in aiding the recovery from exercise-induced skeletal muscle fatigue. Subjects and Methods: Isometric plantar flexion was repeatedly performed on 9 students until the force output declined to 50% maximal voluntary contraction (MVC). Subjects were assigned to perform 3 experiments under different LLLT conditions: laser irradiation to the neck (NKL), to the muscle (MSL), and no laser irradiation (CON). MVC and muscle hardness, girth, blood oxygen saturation, and heart rate were measured during the pre-exercise, post-exercise, and recovery phases. The neck and muscle were irradiated for 15 s using the Oh-Lase HT 2001 semi-conductor laser (830 nm; 60 mW, continuous wave), immediately after MVC measurement during the post-exercise phase.Results: The total exercise time and mean output forces were analyzed using repeated-measures and one-factor ANOVA with post-hoc tests; no significant differences were observed among the 3 conditions for the pre and post-exercise MVC levels before irradiation (NKL, 68.1% MVC; MSL, 66.4% MVC; CON, 66.1% MVC). However, the MVC at 5 and 10 min after exercise was significantly greater in the NKL and MSL groups than in the CON group (MVC after 5 min: 80.4%, 76.9%, and 69.7% for the NKL, MSL, and CON groups, respectively; MVC after 10 min: 81.8%, 81.2%, and 74.4%). Further, no significant differences were observed in the MVC recorded at 15 and 30 min. Therefore, compared to the CON group, the NKL and MSL groups exhibited early muscle-strength recovery from fatigue caused by repeated contractions.Conclusion: We concluded that LLLT at the parameters used in the present study effectively promoted the recovery of the isometric force output after muscle fatigue induced by repeated contractions, especially in the acute-exhaustion phase.

単純性血管腫は毛細血管性血管奇形であり，真皮内に異常拡張した様々な径の毛細血管が存在する病態である．単純性血管腫に対する治療としては，拡張した異常血管を選択的に破壊する目的で1980年代にフラッシュランプ励起パルス色素レーザーが開発され，1999年には冷却装置を搭載した可変式長パルス幅フラッシュランプ励起パルス色素レーザーが登場し，治療効果は著しく向上した．しかしながら完全な消褪効果を得ることは困難であり，治療抵抗性の病変に対して，より長波長のパルスレーザーを使用したり，各種の照射方法の工夫がなされてきている．本稿では，レーザー治療の歴史的変遷から単純性血管腫に対するレーザー治療の概略を解説する．

Background: Mono-L-aspartyl chlorin e6 (Talaporfin sodium) is a novel photosensitizer, and is currently being used in photodynamic therapy for various malignant tumors in combination with irradiation with a 664 nm laser. An interesting characteristic of Talaporfin sodium is that the skin photosensitivity after injection of this agent disappears faster than any other existing photosensitizers. This study examined the vascular events that occurred postirradiation in the chicken comb as a capillary malformation model after photosensitization with Talaporfin sodium.Materials and Methods: A single intravenous bolus injections of Talaporfin sodium was administered to the chickens, and a 1 cm diameter area of the comb of each animal was irradiated with a 664 nm visible red laser. The gross changes in the chicken combs were recorded for 7-14 days after photodynamic therapy. For the histological examination, HE, PTAH and Azan stained sections were analyzed.Results: All treated chicken combs had blanched after photodynamic therapy. Microscopy demonstrated an absence of erythrocytes and the vessel lumina were obliterated, leaving the normal overlying epidermis completely intact. Concomitantly with selective destruction of the capillaries in the target area, moderate invasion of inflammatory cells and a slight increase in the stroma were observed.Conclusions: In the chicken comb model, photodynamic therapy with Talaporfin sodium effectively achieved selective destruction of the microvasculature while leaving the epidermis intact. Our results strongly suggest that photodynamic therapy with Talaporfin sodium could be a feasible method to treat dermal hypervascular lesions.

Low reactive level laser therapy (LLLT) involving low incident levels of laser light, is known for its normalizing effect on abnormalities of living bodies. A joint study by Keio University Institute of Physical Education Japan Medical Laser Laboratory and the Ohshiro Clinic was conducted to investigate the application of the GaAlAs diode laser in the field of sports medicine during pre-training or pre-competition warm up and post-training cooling down. The ‘Sit and Reach’ test, blood oxygenation and pulse rates were measured in 17 athletes, 15 males and 2 females, before laser irradiation (A), after the first laser irradiation (B), after physical exertion (C) and after a second laser irradiation (D). The Oh-Lase HT 2001 semi-conductor laser was applied to the neck while the subject adopted a sitting position on the floor with the legs stretched forward. The subjects were requested to stretch (toe-touch) as far as possible followed by another 8 seconds of laser irradiation while the subjects were stretched and were measured for maximum stretching distance. The procedure was repeated. When statistical significance was evaluated there were significant changes between A and B, A and C, A and D, B and D, and C and D in the performance of the Sit and Reach Test, whereas significant differences in heart rate were seen between A and C, B and C, B and D, and C and D, and significant differences between A and B, A and D, B and C, and C and D in the blood oxygen saturation level. The results where significant differences between A and B, and C and D imply that the use of the GaAlAs laser during warm up and cool down is beneficial.

Allergic rhinitis is a condition which shows a high prevalence throughout the world. Once a person is sensitized to a specific allergen, spontaneous resolution of the allergy occurs only very rarely and this results in a steady accumulation of patient population. Worldwide attention to this affliction is being paid from both the medical and the economic perspectives. In Japan, the most typical seasonal allergic rhinitis is caused by cedar pollen during the spring months of late February to early May. Rough estimates of a 15 to 20% prevalence rate have been reported and hence Japanese cedar pollinosis is deemed as a national disease. The efficacy and cost-effectiveness of the treatment are of great concern to the social medical system of Japan. Previously there have been several reports regarding the cost-effectiveness of new medications and desensitization immunotherapy. The authors have previously reported their experience of treating allergic rhinitis with the Nd:YAG laser and its efficacy. However there are no reports, as of yet, on the cost-effectiveness of this procedure. The authors compared the costs of three typical treatment protocols for cedar pollenosis: Nd:YAG laser treatment, anti-histamine prescription and desensitization immunotherapy. The results revealed that the direct costs associated with the Nd:YAG laser treatment were less compared to the two other treatment protocols. The authors also believe that the indirect economical losses associated with allergic rhinitis such as loss of work force for hospital visits was also lessened with the Nd:YAG laser treatment.

Facial nerve palsy is one of the most common diseases in head and neck lesions, and affected patients suffer from facial disfigurement and dysfunction. Since 1980, we have been applying low reactive level laser therapy (LLLT) for patients with facial paralysis. We report herein on the results of a retrospective study concerning those patients in whom LLLT has been applied for peripheral facial paralysis. Seventy-four patients (42 male and 32 female) received LLLT for various entities of facial paralysis over the past 28 years, and included 50 cases with idiopathic facial paralysis, 9 cases with Ramsay-Hunt syndrome, 8 cases of facial and neck tumor, and 7 cases of facial trauma.The overall total improvement rate was 71.4%. No adverse effects were reported in the patients received LLLT for facial paralysis. Among the 4 diagnostic groups, there was no difference in the mean improvement rate. In all patients whose treatment was given within one month of onset was obtained a complete recovery within 4 months. The longer was the period between onset to starting the treatment, the longer was the required therapeutic period. LLLT was effective for facial paralysis in both the acute and chronic phase. LLLT was particularly effective for the acute phase patients whose onset before treatment was 1 month or less. During the period of between 2 months and 6 months from onset, when the injured nerve had the possibility of recovery, LLLT should be performed. In the chronic phase, during the period of over 6 months from onset, LLLT can improve the synkinesis and contracture of the facial muscle. This study is the first report about LLLT for a wide variety of facial paresis. It is not a randomized control study, however, and further study is warranted in order to assess both the efficacy and possible LLLT mechanisms in detail.

Low reactive Level Therapy ( LLLT ) is now well into its 30th decade, and its beneficial effects such as pain attenuation, accelerated or enhanced wound healing have been very well reported and investigated. For clinics such as ours which utilizes LLLT for medical treatments, LLLT for hypertrophic scars and keloids very quickly became, and remains, routine. We believed that many facilities and institutions have also been using LLLT for the treatment of hypertrophic scars and keloids, but to our surprise there were very few medical facilities using LLLT and practically none for the treatment of scars. Recently, starting in the 1990‘s, there have been several reports where High reactive Laser Treatment (HLLT ) has been used in an attempt to treat hypertrophic scars and keloids. However no literature concerning LLLT for these lesions appears in MedLine, even though the treatment is safe and effective with no side effects and complications when compared to HLLT. The authors herein re-introduce the technique and protocol of LLLT which they have used for the past twenty years for the treatment of hypertrophic scars and keloids. We present a series of representative cases and discuss the most efficient treatment modality in combination with conventional treatment methods.

Photomodulation is an athermal process that manipulates or regulates cell activity using light energy. Previous studies of a specific sequence or coded pulsed 590 nm LED photomodulation have shown the improvement of wrinkle, roughness, pigmentation, and erythema. The purpose of this study was to investigate the antiageing effects of continuous 630 nm red light LED for Japanese subjects, in their 20’s to 50’s. Pre- and post-treatment clinical photographs were taken using the Canfield imaging systems (VISIA II™), which simultaneously counted the characteristic numbers of wrinkles, roughness, hair follicles and pigmentation. The erythema level was also assessed before and after treatment using the Mexameter® (MX18, CK corp.). Two independent observers assessed the photographs and the data. Results showed the improvement of signs of sun-induced aging or environmental damaged skin. No side effects were noted. LED photomodulation is a safe and effective, pain-free and non-ablative modality for improvement of sun-induced aging or environmentally damaged skin in Asians.

In Japan, nearly 15 to 20 % of the population suffers from allergic rhinitis during the spring season. Conventional treatment with oral anti-histamines has side-effects such as drowsiness and dryness of the throat and is not acceptable for some patients.Laser treatment usually uses the carbon dioxide (CO2) laser to charr the mucosal lining of the inferior turbinate in order to prevent onset of symptoms. This treatment has a downtime of roughly one month. Complications such as pain and hemorrhage sometimes require hospital admission. We have been using a flashlamp pumped Nd:YAG laser since 1993 with more favorable results both in efficacy and efficiency of treatment with less patient discomfort. A single treatment session takes around 2 to 3 minutes for both sides compared to 20 to 40 minutes with the CO2 laser and the downtime, which consists of rhinorhea, is much shorter lasting only 2,3 days to up to one week. Treatment using the flashlamp pumped Nd:YAG laser is very reliable but improvement may be achieved using a diode laser pumped Nd:YAG laser where theoretically the homogeneity of the incident laser beam will increase. We report our experience using the hardware developed by Fibertech Co. on 40 patients as a preliminary report with further reports with larger series of patients ensuing. We also compare this new laser system with the conventional YAG laser and describe the advantage of the diode laser pumped Nd:YAG laser in the treatment of allergic rhinitis, especially in an office practice setting of ENT doctors.

Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder wall, characterized by pelvic pain, urinary urgency, and frequency. Its etiology is unknown. IC remains a diagnosis of exclusion. Although there are no uniformly effective therapies, many treatment options are currently available. We present an IC patient who successfully underwent LLLT using an 830 nm GaAlAs diode laser. After 40 LLLT treatment sessions, the interstitial symptom index total score which was previously 19 decreased to 8 and the interstitial problem index total score which was previous 15 decreased to 6. Symptoms of severe bladder irritation and pelvic pain, urinary urgency and frequency improved almost completely for an extended period.

Acne vulgaris is the most common skin disorder in adolescence. Various treatment methods, such as topical/oral antibiotics, topical retinoids, chemical peels and phototherapy, have been reported with various success rates. Recently the resistance to antibiotics necessitates the physician to seek novel treatment modalities. Since 2005, we have applied a 630 nm light emitting diode (LED)-based device for acne in addition to conventional treatments. The conventional treatments, consisting of CO2 laser irradiation, dye laser irradiation, topical retinoids and topical/oral antibiotics, were performed for infectious lesions, and LED therapy was concomitantly performed once a week. Within 3 months, severe symptoms were improved and well controlled in all cases. The 630 nm LED irradiation seems to be an optional treatment in controlling the various grades of acne vulgaris.

The authors have over 30 years experience of treatment with lasers, more than 25 of which have been with low reactive-level laser therapy. (LLLT) Based on our experience, we have continuously attempted to develop new treatments and broaden the clinical application of lasers. Many patients receiving LLLT for an entity other than sight problems have spontaneously described a sense of increased visual acuity following their treatment, and the present study was designed to see if there was in fact, any effect of LLLT on vision. Six healthy adult subjects aged 56∼68 years old, were treated with LLLT according to the proximal priority theory (PPT). The subjects’ close range, far range visual acuity and astigmatism were examined prior to, one hour after and 24 hours after LLLT. The laser hardware used in this experiment was the OhLase HT2001 (Japan Medical Laser Laboratory, Tokyo, Japan) and the Screenoscope (Topcon, Tokyo, Japan). A high rate of improvement was seen for both close range and far range visual acuity but a particularly noteworthy improvement rate of 91.7% was seen at examination for far sightedness immediately after LLLT. LLLT in the field of ophthalmology is promising and further controlled studies carried out by ophthalmologic specialists in larger patient groups may yield new indications for LLLT in this field.

Various biological effects including anti-inflammatory response following low reactive level laser therapy (LLLT) have been described in different studies. The purpose of this study was to evaluate the anti-inflammatory effect of LLLT using 60 mW GaAlAs (830 nm) laser on damaged tissue induced by high reactive level laser treatment (HLLT). Two acquired pigmented nevi of a single person’s face were treated with high reactive level lasers (Ultra Pulse CO2 laser and Q-switched Alexandrite laser). After high reactive level lasers irradiation, one acquired pigmented nevus was exposed to 60 mW GaAlAs laser irradiation, whereas the other nevus was not irradiated and served as control. Both nevi were evaluated with digital photographs, thermography and a questionnaire survey. Compared to the nonirradiated control nevus, LLLT decreased the rubor and calor of the acute inflammation caused by HLLT. LLLT immediately after HLLT (Xenogeneous combined laser treatment) seems to be useful to control acute inflammation caused by HLLT.

Recently in Japan, the trend towards females marrying later in life than before has increased the average age of women bearing children for the first time. The number of children being born in Japan has steadily decreased for the 26th straight year and has become a grave socio-economical concern for the future. Artificial reproductive technology (ART) has shown advances in the past two decades, however there are no new solutions to the old problem of age. The authors have previously reported the efficacy of low reactive level laser therapy (LLLT) for the adjunctive treatment of refractory female infertility and will report a new method of LLLT, incorporating the Proximal Priority Treatment (PPT) with the use of novel device named the Neck Irradiator. A retrospective survey of patients receiving PPT with the Neck Irradiator showed that approximately 10% of the patients became pregnant with this treatment. The authors compare and contrast this new treatment with previous treatment modalities and will discuss LLLT for the treatment of female infertility.

Without using the lower eyelid, functional reconstruction of the tarsoconjunctival layer is challenging for subtotal full-thickness defects of the upper eyelid. In 2 cases of ocular sebaceous carcinoma, the levator function and conjunctiva were reconstructed using the inferiorly based orbital septal flap and conchal cartilage graft. The raw surface of the orbital septal flap was epithelialized within 14 days postoperatively. The new upper eyelid with a stable lid margin could open and close properly. Our surgical procedures may be available in the case that the lower eyelid is not usable.

It is well accepted that with lasers, there are two modalities of treatment. One is the use of the photobiodestructive effect, as for example, in laser surgery where high reactive level laser therapy (HLLT) is used as a scalpel, and the other is the use of the photobioactivating effect, otherwise known as low reactive level laser treatment or laser therapy (LLLT)(1-8). Since October 1996, we have performed laser therapy as an adjunctive treatment to 73 female patients being treated for infertility either by artificial insemination or by other assisted reproduction treatments (ART). The average age of the patients was 39.3 years, the average period of treatment prior to this study was 8.98 years. The average number of ART was 15 times. Two types of lasers; the 632.8nm, helium-neon laser and the 830nm diode laser were used in this study. An average of 21 laser treatment sessions was performed on the patients resulting in 14 confirmed pregnancies and 11 live births.

Background and Aims: Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. Methods: Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. Results and Conclusions: Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual.