targetstherapeuticclinicalcharacteristicsintrosystem bioptron medical presentation – for internal...

TARGETS THERAPEUTIC CLINICALCHARACTERISTICSINTRO SYSTEM

BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 1



LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT:

CLINICAL APPLICATIONS



INTRODUCTION TO LIGHT THERAPY

CHARACTERISTICS OF EMITTED LIGHT

TARGET AREAS

THERAPEUTIC EFFECTS


LIGHT THERAPY SYSTEM

CONTENTS



INTRODUCTION TO LIGHT THERAPY



WHAT IS LIGHT?

Energy

Wavelength

Visible light

Ultraviolet radiation

Infra-red radiation

Microwaves X-rays Gamma-raysRadio waves

Electromagnetic spectrum

Light is a form of energy Light has wave-like properties Light is part of the electromagnetic spectrum

This is a range of types of radiation from low energy radio waves to high energy gamma rays



LIGHT THERAPY: HISTORY

Light has been used to treat various medical conditions since ancient times

Modern light therapy was pioneered by Niels Ryberg Finsen*, a Danish physician

Recent developments in light therapy have used low-power lasers & other sources of polarized

light

* Nobel Prize winner (Medicine) 1903



CHARACTERISTICS OF EMITED LIGHT



CHARACTERISTICS OF EMITTED LIGHT

The light emitted by this light therapy system has specific characteristics

Light emitted from visible & part of infra-red regions of the spectrum

Polarized

Polychromatic

Incoherent

Low energy

Light waves move in parallel

Light waves are ‘out-of-phase’

Optimal tissue penetration with minimal heat effects



Non-polarized light waves move (oscillate) in all directions (planes)

Polarized light waves are restricted to oscillate in parallel planes

Highly efficient polarization process used

(degree of polarization ~95%) Achieved using a system of

multi-layered mirrors

Non-polarized Polarized

POLARIZED LIGHT



POLYCHROMATIC LIGHT

Light emitted contains a range of wavelengths (480nm 3400nm)

This includes visible light & part of the infra-red region

No ultraviolet radiation is emitted safety

BIOPTRON light480nm 3400nm



INCOHERENT LIGHT

Light waves emitted by this system are not synchronized, i.e. theyare ‘out-of-phase’

Unlike laser light in which all the light waves are synchronized

BIOPTRON Light

Laser light



LOW ENERGY LIGHT

Light waves emitted have low energy density* This provides optimal tissue penetration with minimal

heating effect

*Energy density ~ 2.4 Joules/cm2 per minute

*Power density ~ 40 mW/cm2

High energy Low energyHEAT MINIMAL HEAT



LIGHT CHARACTERISTICS: BENEFITS

This combination of light characteristics confers several benefits;

Optimal tissue penetration

Minimal heating effects

No damage to the skin or underlying tissue

No known side effects



TARGET AREA



LIGHT PENETRATION INTO TISSUES

When the light therapy device is held over the skin, energy from emitted light penetrates the underlying tissues

This produces a biological response (called ‘photo-biostimulation’)

Different wavelengths of light can affect different tissues

Both visible light & infra-red radiation have been reported to stimulate changes at the cellular level



~~Subcutaneoustissue

Epidermis

Dermis

Cross-section of human skin & underlying tissues

0

Penetration depth mm (approx.)

650-1000

0.5

280-320320-400400-470470-550550-600600-650

>1350

UV

1.0

BIOPTRON Light

3.0

Visible Infra-red

LIGHT PENETRATION INTO TISSUESWavelength λ [nm]



POSSIBLE CELULAR TARGETS

The exact mechanism of action of photo-biostimulation is still under investigation

Proposed targets within the cell include Cell membrane

• Acting on polar heads of phospholipid bi-layer1

• Acting on calcium channels2

Mitochondria3

Changes to the local peripheral blood supply may also be involved4

1Karu T. Health Physics 1989; 56: 691-704 2Smith KC. Laser Therapy 1991; 3: 19-24 3Kertesz I. Optics & Laser Technology 1982; 16: 31-32 4Medenica L. J. Wound Care 2003;12: 37-40

Basic science 1



POSSIBLE CELULAR TARGETS OF LIGHT THERAPY

Mitochondrion

Cell membrane

Human cell



Light therapy may cause structural changes in the cell membrane & alter lipid-protein interactions1

This could reduce the activation energy required for certain enzymatic reactions1

Infra-red radiation has been shown to stimulate the cell membrane, probably via activation of Ca2+ channels2

Structural changes in cell membrane

Alteration in lipid-protein interactions

Decreased activation energy for enzyme reactions

1Kertesz I. Optics & Laser Technology 1982; 16: 31-32 2Smith KC. Laser Therapy 1991; 3: 19-24

Lipid bilayer;

Head

Tail

Membrane protein

Inside cell

Basic science 2EFFECTS ON CELL MEMBRANE



Absorption of visible light energy by the mitochondria is postulated to activate a chain of molecular events1

This results in an increase in available cell energy & the activation of nucleic acid synthesis (DNA & RNA)

This is essential for repairing tissue damage

Respiratory chain reactions

ADP ATP

ATP synthase

Nucleic acid synthesis, etc.1Karu T. Health Physics 1989; 56: 691-704

Cell energy

Outer membrane

Inner membrane

Basic scienceEFFECTS ON MITOCHONDRIA



OTHER TARGETS

Light therapy also causes dilatation of blood vessels in the area treated1

This has several beneficial effects;

1Lievens P. Laser 1988; 1: 6-12

Promotion of healing

Increased delivery of nutrients

Increased delivery of oxygen

Improved local blood flow



Light therapy may also improve the drainage of extra-cellular fluid into lymphatic vessels

This reduces edema (tissue swelling) Reduction of edema helps to decrease pain & improve

mobility of the affected area (e.g. a swollen joint)

OTHER TARGETS



Click on box to launch animation

TARGET PROCESS



THERAPEUTIC EFFECTS



THERAPEUTIC EFFECTS

The main therapeutic effects of polarized light therapy are

Stimulation of tissue repair

Stimulation of body defense mechanisms

Reduction of pain sensation



STIMULATION OF TISSUE REPAIR

Light therapy has a stimulatory effect on healing Stimulation of cell proliferation Enhanced collagen synthesis Release of growth factors Acceleration of wound closure Improved quality of scar tissue

Demonstrated by in vitro & in vivo data1-4 Findings confirmed by clinical studies5-8

1Mester E. Lasers Surg. Med. 1985; 5: 31-39 2Kertesz I. Optics & Laser Technology 1982; 16: 31-32 3Kubasova T. Photochem. Photobiol. 1988; 48: 505-509 4Bolton P. Laser Therapy 1992; 4: 33-37 5Depuyt K. Abstract 10th Annual EURAPS Meeting, 1999 6Medenica L. J. Wound Care 2003;12: 37-40 7Monstrey S. Br. J. Plastic Surg. 2002; 55: 420-426 8Iordanou P. Int. J. Nurs. Pract. 2002; 8: 49-55

Basic science 4

Clinical data



STIMULATION OF TISSUE REPAIR WITH LIGHT THERAPY



STIMULATION OF BODY DEFENSE MECHANISMS

Light therapy may promote non-specific cellular immune responses1 Activation of neutrophil granulocytes Activation of monocytes / macrophages Stimulation of natural killer cells

These activities have general bactericidal & anti-tumor effects

1Samoilova KA. Proc. Low-Power Light Biol. Syst. 1998; IV: 90-103

Basic science 5



STIMULATION OF NON-SPECIFIC IMMUNE REACTIONS WITH LIGHT THERAPY

Red blood cell

White blood cells

Neutrophil granulocyte

Natural killer cell

Monocyte / macrophage



REDUCTION OF PAIN SENSATION

Light therapy may influence pain sensation in several ways1-4

Improved local blood flow Reduction in muscle spasm Reduction of inflammation Induction of natural pain-killing chemicals Reduction of pain transmission by direct

action on peripheral nerves

1Konstantinovic L. Vojnosanit Pregl 1989; 46: 441-448 2Sakurai Y. Eur. J. Oral Science 2000; 108: 29-34 3Walker JB. Neurosci. Lett. 1983; 4: 297-303 4Tam G. J. Clin. Laser Med. Surg. 1999; 17: 29-33

Basic science 6

Clinical data



REDUCTION OF PAIN SENSATION WITH LIGHT THERAPY

Release of pain & inflammatory mediators

Stimulation of pain receptors & nerve pathways

Sensation of pain

Muscle spasm

Light therapy: potential effects

Cell damage Tissue ischemia



CLINICAL APPLICATIONS OF LIGHT THERAPY




WOUND HEALING Treatment of burns Treatment of skin ulcers (ulcus cruris, decubitus) Treatment of post-operative wounds Treatment of traumatic injuries

PAIN THERAPY Treatment of musculoskeletal pain in

rheumatology, physiotherapy and sports medicine



Light therapy can be used in many clinical fields

Surgery

Dermatology

Rheumatology

Sports medicine

Physical therapy

Care of the elderly

Occupational therapy

Pain management

Light therapy




in rheumatology: osteoarthritis, rheumatoid arthritis (chronic), arthroses

in physiotherapy: low back pain, shoulder and neck pain, carpal tunnel syndrome, scar tissue,musculoskeletal injuries

in sports medicine: soft tissue injuries of muscles, tendons & ligaments like muscle spasm, sprains, strains, tendonitis, ligament and muscle tears, dislocations, contusions, tennis elbow

PAIN THERAPY



PAIN MANAGEMENT: MUSCULOSKELETAL PAIN

Example: Lower back pain

Treatment with BIOPTRON 2



PAIN MANAGEMENT: REHABILITATION

Light therapy can be applied to various parts of the body

BIOPTRON Pro 1 BIOPTRON Compact III BIOPTRON 2



Rheumatology: Arthritis

– ‘Arthritis’ is the inflammation of a joint

– Main symptoms include – Pain, swelling, stiffness & loss of function in the affected joint(s)

– Huge costs to society – Major cause of disability & poor quality of life Treatment costs + loss of earnings

(time off work &/or unemployment; billions per year)

– There are many different types of arthritis, including – Osteoarthritis Rheumatoid arthritis

PAIN THERAPY



Basic anatomy #1: A joint

Ligament Bone

Articular cartilage Synovial membrane

Synovial fluid

Articular cartilage – acts as a shock absorber, protects bone

Synovial membrane – lines joint & secretes lubricant (synovial fluid)



Osteoarthritis Commonest joint disorder worldwide

Frequency increases with age

Present in most all people aged >60 years

Degenerative joint disease

Caused by wearing away of protective cartilage lining the joints

Risk factors: excess weight, injury to bone/joint, manual occupations, sports

Affects hip, knee, elbow, joints in hand/foot

PAIN THERAPY



Osteoarthritis Disease affecting synovial joints Characterised by loss of articular cartilage

with accompanying periarticular bone response

Diagnosis based upon symptoms + x-ray appearance + pathological joint changes

Main signs: microfractures, bone cysts, osteophyte formation & narrowing of joint space

Variable rate of disease progression; symptoms flare up & remit

PAIN THERAPY



Rheumatoid arthritis Occurs in 0.5-3% of population Usual age of onset 30-50 years old,

although can occur at any age Immune disorder affecting joints (& other

parts of the body) Caused by inflammation of the synovial

membrane lining the joints Risk factors: female gender, family

history, certain immunological/genetic characteristics

Affects small joints in hands/feet, knee, elbow, shoulder, neck

PAIN THERAPY



Rheumatoid arthritis Chronic, progressive, systemic

inflammatory disorder of unknown cause Characterised by inflammatory synovitis;

‘pannus’ blocks nutrient supply to underlying articular cartilage

Diagnosis based upon history + x-ray changes + blood tests

Rheumatoid factor present in ~70% cases; associated with greater disease severity

Non-articular disease affects lungs, blood vessels & heart, nerves, eyes, kidneys, etc.

PAIN THERAPY



BIOPTRON Light Therapy may help to reduce the symptoms of arthritis

PAIN THERAPY



Basic anatomy: Soft tissues

Tendon – connects a muscle to a bone

Ligament – connects a bone to another bone

muscle

ligaments

tendons

(bone*)

subcutaneous tissue

skin

(*not a soft tissue)



Sports medicine: Sprains & strains

Strain: injury to a muscle or tendon Sprain: injury to a ligament

Both are caused by overstretching or tearing Symptoms: pain, swelling, loss of movement,

bruising Sprains commonly involve ankle, knee & wrist Strains commonly affect upper arm, elbow,

thigh, ankle, groin & abdomen Risk factors: playing sports, gardening, lifting

heavy objects, etc

PAIN THERAPY



Sports medicine: Dislocations

Dislocation: Displacement of bones at a joint Caused by forces pulling a bone into an

abnormal position, or by violent muscle contractions

Symptoms: pain, swelling, loss of movement, fracture, joint damage

Commonly affects shoulder, thumb/finger, jaw

Risk factors: any violent collision (car crash, falling, contact sport), electrocution

PAIN THERAPY



Sports medicine: Contusions

Contusion: Bleeding into the tissue beneath the skin surface (bruise) Caused by blunt trauma to the body Pressure of impact ruptures small

blood vessels, causing blood to pool around the injured area

Symptoms: swelling, pain Risk factors: playing contact sports

(martial arts, football, boxing, etc.)

PAIN THERAPY



Sports medicine: Tendinitis & tenosynovitis

Tendinitis: Inflammation around a tendon Tenosynovitis: Inflammation around a

tendon sheath Caused by overuse or overloading of

the tendon (e.g. tennis elbow) Symptoms: pain, stiffness, weakness,

loss of movement Risk factors: playing sports (patellar

tendon, Achilles tendon), repetitive hand movements - typing, packing, sewing (tendons in wrist/hand)

PAIN THERAPY



BIOPTRON Light Therapy may help to reduce the symptoms of sports injuries

PAIN THERAPY



Physiotherapy: Lower back pain– Occurs in >75% of people at some point in their lives– Recurrent or persistent lower back pain is a major

cause of disability– 90% of low back pain is caused by injury to tissues in

the back and spine– Other (less common) causes include spinal

infection/inflammation, bone disease and tumours– Symptoms: pain, stiffness, difficulty walking/bending,

scoliosis– Risk factors: lifting, bad posture, obesity, pregnancy,

old age, etc

PAIN THERAPY



Physiotherapy: Carpal tunnel syndrome

– Swelling of tissues in the carpal tunnel causes compression of the median nerve loss of sensation & loss of movement in the hand

– Occurs in 1-3% of the population, more common in women than men (smaller carpal tunnels)

– Symptoms: numbness or aching in the hand (often worse at night) weakness/muscle wasting in the thumb

– Risk factors: prolonged use of hands (typing, sewing, etc), injury or infection in wrist/hand; also seen in pregnancy, diabetes, obesity, arthritis & hypothyroidism

Carpal tunnel is a narrow anatomical passage in the wrist

Median nerve passes through it to supply part of the palm, thumb & certain fingers

PAIN THERAPY



Physiotherapy: Neck & shoulder pain– Common problem for many people– Often due to minor injury, poor sleep position or

prolonged work over a computer keyboard– Injury to the soft tissues in the shoulder/neck

include muscle strain/tear, tendonitis, and whiplash injury

– Neck/shoulder pain may also occur with arthritis, bone disease (ankylosing spondylitis), disc prolapse and tumours

– Symptoms: pain, stiffness, difficulty moving head or upper arm, headache

PAIN THERAPY



BIOPTRON Light Therapy may help as a treatment in physiotherapy

PAIN THERAPY



WOUND HEALING

Burns therapy: partial thickness burns – superficial & deep

Skin ulcers: venous leg ulcersdiabetic foot ulcerspressure sores

Traumatic wounds: surgical wounds – incisionsnon-surgical injuries –minor cuts & bruises



Source: Dept. Plastic Surgery, University Hospital Ghent, Belgium

Example: Burns to face & neck

WOUND HEALING: BURNS

Immediately before treatment

After 12 days of treatment

After 9 months of treatment



Source: Dept. Plastic Surgery, University Hospital Ghent, Belgium

Example: Pressure sore to sacrum

WOUND HEALING: PRESSURE SORES

Immediately before treatment

After 18 days of treatment

After 4 weeks of treatment



WOUND HEALING: POST-OPERATIVE

Example: Cardiothoracic surgery

Source: First Surgical Hospital, University of Belgrade, Serbia & Montenegro

Immediately before treatment After 25 days of treatment



Burns

Burns are common injuries Young children & elderly people are particularly vulnerable

Burns often occur in the home Examples: spilling hot coffee, steam from cooking,

flames/hot coals from a fire, excessively hot bath water, etc.

Severity of a burn is classified by the depth of injury Partial thickness burn; superficial or deep Full thickness burn



BASIC HISTOLOGY: NORMAL SKIN & UNDERLYING TISSUES

Epidermis

Dermis

Subcutaneous tissue

Cornified layer

Basal layer

Granular layer

Loose connective tissue, blood vessels & sensory cells



TYPES OF BURN

Partial thickness - superficial

Full thickness Partial thickness - deep



Tissues affected Outer skin layer (epidermis) only

Common causes Sunburn (mild)

Any sudden & brief burst of heat

Signs & symptoms Burn is red & painful – no blisters

Medical treatment Basic first aid – cold compress pain relief; dressing not required

Complications None

Burn usually heals within a few days

PARTIAL THICKNESS BURNS: SUPERFICIAL



PARTIAL THICKNESS BURNS: DEEP

Tissues affected Outer skin layer (epidermis) + part of

underlying layer (dermis)

Common causes Scalds from hot liquids

Flames from fire

Contact with hot objects

Signs & symptoms Burn is deeply red*, painful, swollen + blistered [*may also appear white or ‘wet’]

Medical treatment Hospital treatment – if area affected >10-15% total skin area; burns to face/hands/feet/genital area

Outpatient treatment for smaller burns – wound is cleaned & protected with a dressing; pain relief

Complications Infection of wound; scarring

Burn usually heals within 3-4 weeks



FULL THICKNESS BURNS

Tissues affected Outer skin layer (epidermis) + all of

underlying layer (dermis) muscle bone

Common causes Severe scalds from hot liquids

Prolonged contact with flames or hot objects

Electrical or chemical sources

Signs & symptoms Wound is white, dry & swollen; skin may be blackened; wound is painless (nerve endings destroyed)

Medical treatment Hospital treatment (burns unit) – cleaning of wound (surgery); skin graft may be needed

Complications Infection; scarring; loss of function

Burn may take many weeks to heal completely



BIOPTRON Light Therapy may help to stimulate wound healing following a burn injury (& may also help to reduce pain from the wound)

WOUND HEALING: BURNS



SKIN ULCERS A skin ulcer is an erosion in the surface layer of skin

(epidermis) that exposes the underlying tissue (dermis, subdermal tissue)

Skin ulcers are often difficult to treat & may take many months to heal

Common types of skin ulcer include; Venous ulcer (lower leg) Diabetic ulcer (foot) Pressure sore (lower spine, pelvis, back of head, etc.)



VENOUS LEG ULCERS

1 person in 50 will develop a venous leg ulcer during their life Commonly occur in elderly people More common in women than men

Caused by ‘pooling’ of blood in the veins in the lower leg

Treatment includes Regular wound dressing to keep wound clean Compression bandages Elevation of leg when at rest Regular exercise

To reduce pooling of blood



Valves in veins become damaged allows blood to flow ‘downhill’ towards the feet (due to gravity)

Increased pressure from the blood causes fluid to build up in the tissues around the lower leg/ankle

Prevents normal flow of oxygen & nutrients to the tissues begin to die

‘Venous’ ulcer forms

VENOUS LEG ULCERS: DEVELOPMENT

Venous blood flow: normal

Venous blood flow: abnormal

x

normal valve: closes when leg muscles contract, preventing backflow of blood

damaged valve: opens when leg muscles contract, allowing backflow of blood



VENOUS LEG ULCERS: DEVELOPMENT The precise mechanism for the pathogenesis of venous ulcer

formation remains unclear: various theories have been reported

Venous stasis and tissue hypoxia were cited as the main etiological factors

Later studies recorded elevated oxygen levels in venous blood samples from patients with chronic venous insufficiency and ulcerations, which led to the development of the theory of tissue hypoxia associated with arteriovenous fistulas

More recent publications have included reports of the blockade of capillary exchange of gases/nutrients by pre-capillary accumulation of fibrin (subsequently leading to cell death and formation of venous ulceration), and the role of leucocytes in venous ulcer pathogenesis

Detail slide



Venous pooling prevents nutrients/oxygen reaching epidermis & the epidermal cells start to die, areas of dead tissue fall off & expose the dermal tissue underneath [zone A]: this is an ulcer

Tissue around the ulcer becomes discoloured & eczematous (i.e. itching, flaking skin) [zone B]: it is very vulnerable to injury

VENOUS LEG ULCER: PATHOLOGY

A

B



WOUND HEALING: VENOUS LEG ULCERS

BIOPTRON Light Therapy may help to stimulate wound healing in a venous leg ulcer



DIABETIC FOOT ULCERS Diabetes is becoming more common in many populations People with long-term diabetes often develop foot injuries

caused by ulceration Lifetime risk of diabetic foot ulcer is 1 in 10 (10%)

Diabetic foot ulcers can become so severe that amputation of the lower leg is required Risk of amputation x15-46 higher for a diabetic

Diabetic foot ulcers account for ~25% of all hospital admissions for diabetes (USA & UK)

Treatment options; Prevention via patient education, good foot hygiene, etc. Wound care, infection control, surgery

Information from : Armstrong DG & Lavery LA. Am Fam Physician (online) 1998; 57(6)



DIABETIC FOOT ULCERS: DEVELOPMENTThere are several reasons why diabetic people develop foot ulcers –

Diabetes damages nerves supplying sensory information to the legs & feet Diabetic person may not notice when he/she injures his/her foot (e.g.

cuts, blisters, etc.); consequently, an injury may worsen before it is detected

Diabetes damages blood vessels (arteries) supplying the legs & feet Cells may be damaged by not receiving sufficient nutrients & oxygen; if

this is prolonged & severe, the cells will die

Diabetes causes other changes that may contribute to foot ulceration Decreased sweating resulting in dry, broken skin Impaired wound healing Foot joint deformity causing areas of increased pressure



DIABETIC FOOT ULCERS: DEVELOPMENT

Factors contributing to diabetic foot ulcer formation –

Detail slide

Peripheral neuropathy (loss of protective sensation)

Peripheral arterial occlusive disease

Autonomic neuropathy (decreased sweating & dry skin)

Structural foot deformity (increased focal pressure & movement limitation)

Impaired wound healing (poor glucose control)



DIABETIC FOOT ULCERS: LOCATION

Diabetic ulcers commonly develop in the weight-bearing areas on the sole of the foot

Diabetic ulcers also develop at other pressure points, such as on the toes (which are often deformed in diabetes due to joint damage)



WOUND HEALING: DIABETIC FOOT ULCERS

BIOPTRON Light Therapy may help to stimulate wound healing in a diabetic foot ulcer



PRESSURE SORES

Pressure sores can occur in anyone who is unable to move part of their body Sedation (general anesthetic), severe illness (coma, stroke),

splinting (broken limb), severe pain, etc.

Pressure sores can develop in a matter of hours Pressure sores are ulcers caused by downward

pressure of the body’s weight + friction forces Pressure sores can take many weeks to heal &

can become infected



Pressure sores: development

Downward force of the body’s weight ‘squashes’ the underlying tissue & prevents normal blood flow

Tissues are starved of nutrients & oxygen, cells being to die & an ulcer (or ‘sore’) begins to form

Severe sores can extend down into muscle, bone & even joints

Bony parts of body are more vulnerable to development of pressure sores

Wet skin is more susceptible to damage (e.g. incontinence)

Early stage –skin intact

Sore (ulcer) formation

Deep sore – into muscle/bone

e

d

s

bm



Pressure sores: locationPressure sores develop in bony, weight-bearing parts of the body

Pressure sores: location



WOUND HEALING: PRESSURE SORES

BIOPTRON Light Therapy may help to stimulate wound healing in a pressure sore



TRAUMATIC WOUNDS: SURGICAL INCISIONS

A surgical incision is a wound made during surgery by a cutting instrument, such as a scalpel

There are many different types of surgical incision Chosen by the surgeon depending

on the procedure being carried out

Example: Abdominal surgical incisions

5 Pararectus6 Low transverse abdominal7 Pfannenstiel

12

3

45

6

7

11 Midline2 Paramedian3 Subcostal4 McBurney



SURGICAL INCISIONS

Incision

Incision with sutures

epidermis

dermis

blood vessel (cut)

The edges of a surgical incision are sewn or stapled together to close the wound & promote healing

Complications include wound infection, delayed healing, & scarring



TRAUMATIC WOUNDS: NON-SURGICAL INJURIES Non-surgical traumatic injuries include incisions + lacerations &

contusions Incisions

Clean cut from a sharp object (e.g. knife or broken glass) Wound edges are straight May bleed profusely as blood vessels cut

Lacerations Rough tear caused by crushing or ripping forces Tissue damage & increased risk of infection Less bleeding

Contusions Rupturing of blood vessels beneath skin (bruising) caused by blunt

force or punch Fracture to bone or other internal injury may be present



Incision:Clean edges

Profuse bleeding

Contusion:Bleeding from small blood

vessels under the skin

Laceration:Rough tear

Tissue damage

NON-SURGICAL INJURIES



WOUND HEALING: TRAUMATIC WOUNDS

BIOPTRON Light Therapy may help to stimulate wound healing following a traumatic wound



NEW INDICATIONS FOR THE USE OF BIOPTRON LIGHT THERAPY

In addition to the existing clinical applications of BIOPTRON Light Therapy, four new sets of indications have been added -

Dermatological conditions

Paediatric indications

Indications in the newborn baby

Seasonal affective disorder



DERMATOLOGICAL CONDITIONS

Acne Atopic dermatitis Psoriasis Herpes infections Superficial bacterial infections Oral mucosal lesions



NORMAL SKIN STRUCTURE

Cornified layer

Basal layer

Granular layer Epidermis

Dermis

Subcutaneous fat

Hair follicle

Sebaceous gland

Sweat gland

Blood vessels



DERMATOLOGY: ACNE Acne vulgaris

Common rash occurring on the face, back & chest• Mainly affects teenagers & young adults• More common in males (testosterone dependent)

Caused by blockage & inflammation of the sebaceous glands

• ‘Blackheads’ & inflammatory pustules• Often heals with scarring

Can cause adverse psychosocial effects• Poor self-image, low self-confidence, depression

Treatment • Topical then systemic - antibiotics, retinoids



ACNE: COMEDONE LESIONS

Blackhead (open comedone)

Whitehead (closed comedone)

Hair follicle

Sebaceous gland duct blocked by ‘plug’

Sebum oxidized & darkened

Bacteria



BIOPTRON LIGHT THERAPY & ACNE

BIOPTRON Light Therapy may help to treat acne by reducing skin inflammation & promoting healing



Patient details 60 juvenile patients with acne & other skin disorders (atopic dermatitis, herpes simplex, boils)

BLT regimen Duration: 2-4 minutes per treatment area

Frequency: 3 to 12 exposures in total per day (depending upon number of treatment areas)

Results • Good therapeutic response observed in 91% patients

• Reduced skin healing time

• No damage to skin following treatment

Conclusions Clinical observations confirm marked benefits & healing effects of BLT

Patient tolerance was good

Device was easy to use

BLT STUDY DATA: ACNE

MA Khan, Russian Scientific Center of Reconstructive Medicine & Balneotherapy, Moscow,2001



BIOPTRON LIGHT THERAPY & ACNE




DERMATOLOGY: ATOPIC DERMATITIS Atopic dermatitis (‘eczema’)

Common condition• Occurs in >5% population• More common in children (up to 15%)

Also called ‘endogenous’ eczema • Occurs in people with allergies (hay fever, asthma)• Exacerbating factors = detergents, animal fur, some foods,

(house dust mites??)Main clinical features

• Skin reddens & tiny vesicles may form itching• Surface thickens & cracks bleeding painful• Secondary infection may occur



ATOPIC DERMATITIS (CONTINUED) Quality of life issues with atopic dermatitis

Constant itching/soreness, loss of sleep (child & parents) Embarrassment at skin lesions

Treatment of atopic dermatitis General treatment

• Avoid known irritants Topical therapy

• Topical steroid cream + barrier cream + bath soap substitute

2nd line agents (severe disease)• UV therapy, oral steroids, immunosuppressants

Prognosis Children commonly ‘grow out’ of the condition Older children & adults often have chronic disease



ATOPIC DERMATITIS: PATHOLOGY

Normal skin Fully developed atopic dermatitis lesion

Spongiosis (vesicles)

Hyperkeratosis & parakeratosis

(skin scales)



ATOPIC DERMATITIS: COMMON AREAS AFFECTED

adult



BIOPTRON LIGHT THERAPY & ATOPIC DERMATITIS

BIOPTRON Light Therapy may help to treat atopic dermatitis by reducing skin inflammation & promoting healing



BLT STUDY DATA: ATOPIC DERMATITIS

Patient details 36 patients with atopic dermatitis;

Males & females aged 12-51 years

IgE levels 262 - 2345 IU/mL

BLT regimen Duration: 10 minutes per session

Frequency: 1 session per day

Course: ≥10 sessions

Results & conclusions

• 21/36 (58%) patients showed immediate improvement,

• 6/36 (17%) patients improved with co-application of skin ointment

• Complete remission observed in several patients

• Erythema & skin fissuring decreased

• Itching & excoriation eliminated

BLT shows good therapeutic effects in this disease



DERMATOLOGY: PSORIASIS Psoriasis is an incurable, chronic skin disorder

Affects up to 3% of the population• Men & women affected equally• 25% patients have clinically severe disease• 10-15% patients also have destructive arthropathy

Aetiology not fully understood• Genetic component + environmental factors• T-cell disorder

Clinical features• Well defined, red, scaly patches• Commonly on extensor surfaces (knees, elbows)

Associated with reduced quality of life issues• Low self-confidence/ self-esteem, employment, etc.



PSORIASIS Treatment of psoriasis

Concerned with control of disease not cure Topical therapies (mild/moderate disease)

• Emollients, steroids, retinoid, coal tar extracts Phototherapy

• Psoralen UV-A, UV-B Systemic therapies (severe/resistant disease)

• Methotrexate, ciclosporin, acitretin• Careful monitoring for toxic side effects

Prognosis Relapsing-remitting pattern is common Many patients have the disease for life Disease severity cannot be predicted



PSORIASIS: PATHOLOGY

Normal skin Fully developed psoriatic lesion

Hyperkeratosis & parakeratosis

(skin scales)

Sterile pustule

Dilated blood vessels

Inflammatory cells

Rete ridges accentuated



BIOPTRON LIGHT THERAPY & PSORIASIS

BIOPTRON Light Therapy may help to treat psoriasis by reducing skin inflammation & promoting healing



DERMATOLOGY: HERPES SKIN INFECTIONS Herpes viruses

Cause a wide range of human disease Characterized by their ability to become latent (silent) &

persist within an individual for life

Two main types of herpes virus considered here;Herpes simplex virus

• HSV type 1 – cold sores• (HSV type 2 – genital herpes)

Varicella zoster virus • Chickenpox – children• Shingles – older adults



HERPES SKIN INFECTIONS

Treatment

Complications

Symptoms

Entry into body

Chickenpox: Aciclovir (adults)

Shingles: Aciclovir, valaciclovir, faciclovir

Prophylaxis – Zoster immunoglobulin

Chickenpox: Pneumonia, CNS involvement (rare)

Shingles: Eye complications, persistent pain

Chickenpox: 14-21 days after initial exposure → malaise, fever & rapid development of vesicles

Shingles: Reactivation of latent VZV from spinal/cranial nerve → severe dermatomal pain & skin lesions

Via upper respiratory tract mucosa

Aciclovir – oral, cream

Corneal ulceration, acute encephalitis, erythema multiforme (all rare)

Primary infection is usually subclinical. Viral reactivation causes ‘cold sore’ around mouth/lips. Recurrence occurs in ~1/3

rd of people.

Via the mouth (or skin)

Herpes simplex 1 Varicella zoster



BIOPTRON LIGHT THERAPY & HERPES SKIN INFECTIONS

BIOPTRON Light Therapy may help to treat herpes skin infections by reducing skin inflammation, stimulating the immune system & promoting healing



Patient details 20 patients with Herpes simplex (HS) lesions

12 patients with Herpes zoster (HZ) lesions

(Male & female, aged 15 – 60 years)

BLT regimen Duration: 3-4 minutes per session

Frequency: 2 sessions per day

Results • Good therapeutic response observed in 85% patients

• Pain & itching disappeared after 1-2 days HS group

& after 1-3 days HZ group

• No permanent skin changes after treatment

• Neurological pain reduced by 50% in HZ patients

Conclusions Clinical observations confirm analgesic, anti-inflammatory & healing effects of BLT

Device was easy for patients to use at home

BLT STUDY DATA: HERPES SKIN INFECTIONS



DERMATOLOGY: SUPERFICIAL BACTERIAL INFECTIONS

Infection usually prevented by skin’s normal ‘friendly’ bacterial floraDamage to epidermis can allow penetration by

pathogens & subsequent skin infectionCommon pathogens include staphylococcus &

streptococcus

Bacterial skin infections considered here; ImpetigoBoilsErysipelas



SUPERFICIAL BACTERIAL INFECTIONS: IMPERTIGO

Impetigo Staphylococcal skin infection (90% cases)

• Bacteria penetrate the outer layers of epidermis• Pus collects beneath cornified layer

Commonly seen in younger children• Spread by direct contact → highly infectious!

Clinical features• Yellow-orange pustules + crusting• Pustules rupture easily

Treatment• Topical antibiotic cream• Add oral antibiotics if severe



SUPERFICIAL BACTERIAL INFECTIONS: BOILS Boils (furuncles)

Caused by staphylococcus infection• Entry via hair follicle

Commonly seen in young adults• Associated with local trauma, illness, poor nutrition

Clinical features• Painful, red swellings with central ‘core’• Often recurrent• Large boils = caruncle

Treatment• Oral antibiotics incision & drainage



SUPERFICIAL BACTERIAL INFECTIONS: ERYSIPELAS

Erysipelas Superficial infection of dermis

• Usually caused by streptococcus• Entry via trauma site or leg ulcer• Commonly affects lower leg or face

Clinical features• Hot, red area on the skin • Well-demarcated edges• Overlaps clinically with cellulitis

Treatment • Antibiotics – oral; iv (severe disease)



BIOPTRON LIGHT THERAPY & SUPERFICIAL BACTERIAL INFECTIONS

BIOPTRON Light Therapy may help to treat superficial bacterial skin infections by reducing skin inflammation, stimulating the immune system & promoting healing



DERMATOLOGY: ORAL MUCOSAL LESIONS The oral mucosa is affected by various conditions;

Stomatitis• Inflammation of the lining of the mouth• Multiple causes (infection, allergy, illness)

Chelitis• Fissuring of the corners of the mouth• Caused by dentures, infection, deficiency states

Aphthous ulcers• Small, painful ulcers on tongue or cheeks • Occur in ~20% population• Normally heal without scarring



BIOPTRON LIGHT THERAPY & ORAL MUCOSAL LESIONS

BIOPTRON Light Therapy may help to treat oral mucosal lesions by reducing inflammation, stimulating the immune system & promoting healing



BLT STUDY DATA: ORAL MUCOSAL LESIONS

Patient details Patients with various types of oral mucosal disease were divided into 2 groups;

• Test group = conventional medical treatment + BLT

• Control group = conventional therapy only

BLT regimen Details not available


Test group results:

• Re-epithelialization of the lesions x1.6 faster

• Superior condition of the mouth & teeth

• Good improvement in patients with sialosis / gingivitis

BLT provides an effective therapy in oral diseases



PAEDIATRIC INDICATIONS BIOPTRON Light Therapy can be used to treat the

following types of condition in children;

Paediatric dermatological conditions• Allergic eczema, skin infections

Paediatric respiratory conditions• Upper respiratory tract infections

Paediatric musculoskeletal conditions• Arthritis, congenital conditions, bone fractures,

etc.Paediatric neurological disorders

• Polio, degenerative conditions, etc.



PAEDIATRIC INDICATIONS: DERMATOLOGY Allergic eczema

Background• Affects >15% of children; onset between 2-18 months• Often a family history of allergy• ~70% cases resolve by age 11 years

Clinical features• Inflamed, red skin patches weeping• Itching, scratching, loss of sleep • Secondary infection common

Treatment• Topical steroid cream + barrier cream + bath soap substitute• Prevent of scratching, cotton underclothes Mild night sedation Antibiotics for secondary infection



PAEDIATRIC ALLERGIC ECZEMA: COMMON AREAS AFFECTED



PAEDIATRIC INDICATIONS: DERMATOLOGY

ErysipelasStreptococcal infection of dermis, commonly affects leg or face; affected skin area is hot, red & swollen

Varicella zosterCauses chickenpox – malaise, fever & vesicular rash on trunk/head; lesions resolve spontaneously, usually with complete healing

ImpetigoContagious staphlococcal skin infection; small pustules with honey-coloured crusts; topical antibiotic cream

Herpes simplexEruption of painful blisters around the mouth & nose; oral aciclovir for severe infections only

Bacterial infectionsViral infections

Paediatric skin infections

Molluscum contagiosumCaused by a pox virus; multiple small lesions at any site on body, spread by direct contact, ‘crops’ may continue for 6-12 months; resolves spontaneously



PAEDIATRIC INDICATIONS: RESPIRATORY Upper respiratory tract infections in children

treated with BIOPTRON Light Therapy Commonly caused by viral infections

• Children <5 years have up to 8 episodes per year Coryza (common cold)

• Rhinovirus (multiple strains)• Nasal discharge, blockage, sneezing, malaise• Symptomatic treatment

Sinusitis• Infection (bacterial) of paranasal sinuses• Headache, facial pain, nasal discharge• Antibiotic therapy

Tonsillitis• Adenovirus (50% cases)• Sore throat, malaise• Symptomatic treatment



BLT STUDY CASE: RESPIRATORY DISEASES (CHILDREN)

Patient details 331 children with various respiratory diseases;

Susceptible to frequent illnesses 148

Bronchial asthma 46

Sinusitis 52

Acute respiratory viral infection 85

BLT regimen Duration: 4-6 minutes per treatment area [+ conventional treatment]

(Face, submandibular & cervical lymph nodes, pharynx, immune organs & reflexogenous zones)


Course: 10-12 sessions (bronchial asthma 2-3 courses per year)


• Pharynx pain disappeared by Day 2

• Reduction of tissue swelling & restored nasal breathing by Day 3

• Complete clinical recovery around Day 4

• Asthma remission after 2nd treatment course in 58% children

Clinical observations support use of BLT in children



BLT STUDY DATA: EFFECTS OF RADIATION

Patient details Children & adolescents exposed to acute & chronic radiation from the Chernobyl catastrophe

BLT regimen Treatment applied to sacrum & sternum;

• BLT-1 device x6 areas irradiated (30 min exposure)

• BLT-2 device x2 areas irradiated (20 min exposure)

Results Respiratory system;

• Increased permeability of small/medium bronchi

• Recovery of bronchial epithelial function

Hematology;

• Increased number of leukocytes, T- & B-lymphocytes

Conclusions Both types of BLT devices provided similar efficacy



PAEDIATRIC INDICATIONS: MUSCULOSKELETAL Musculoskeletal conditions in children treated with

BIOPTRON Light Therapy Juvenile chronic arthritis

• Still’s disease, ankylosing spondilitis, rheumatoid arthritis, etc.

• Chronic pain & swelling of the joints systemic symptoms

Congenital orthopaedic conditions• Deformity of spine, leg/foot

Traumatic conditions• Bone fractures, post-surgical wounds, injury



BLT STUDY DATA: CHRONIC MUSCULOSKELETAL DISORDERS

Patient details 98 children (<1 year to 18 years old)

Various musculoskeletal disorders; juvenile rheumatoid arthritis, flaccid paralysis, torticolis, muscular contractures & scoliosis

BLT regimen Details not provided

Results BLT was effective in;

• Alleviation of pain

• Healing of wounds (caused by immobility)

• Decrease of muscle hypertonia

Conclusions BLT was a useful in the treatment & rehabilitation of children with these types of medical problems



BLT STUDY DATA: MUSCULOSKELETAL INJURIES (CHILDREN)

Patient details 78 children with musculoskeletal injuries;

• Test group (n=48) = conventional medical treatment + BLT

• Control group (n=30) = conventional therapy only

BLT regimen Duration: 4-6 minutes


Results Children receiving BLT (test group) demonstrated -

• Faster reduction in pain levels

• Faster recovery time

Conclusions Good therapeutic effect with BLT & no side effects observed

Children had no negative emotions regarding BLT



PAEDIATRIC INDICATIONS: NEUROLOGY

Neurological conditions in children treated with BIOPTRON Light TherapyPoliomyelitisPeripheral nerve palsiesTraumatic injuries to nerves Inflammatory neurological disordersDegenerative neurological disordersNeuromuscular disorders



Patient details 315 patients with various neurological diseases (affecting PN, CNS, spinal cord, brain)


Frequency: 3-4 sessions per day


BLT provided good therapeutic effect

BLT had several advantages over other types of treatment;

• BLT reduced pain levels effectively

• BLT allowed faster recovery time in some patients

• BLT could easily be combined with other treatments

• BLT was simple to use, clean, painless & inexpensive

• BLT was easy to use in patients who had limited mobility

BLT STUDY DATA: NEUROLOGICAL DISORDERS



BIOPTRON LIGHT THERAPY & PAEDIATRIC INDICATIONS

BIOPTRON Light Therapy may help to treat various conditions in children by reducing pain & inflammation, stimulating the immune system & promoting healing



INDICATIONS IN THE NEW BORN BABY

BIOPTRON Light Therapy can be used to treat the following types of condition in newborn babies Traumatic injuries

• Lacerations, abrasions, bruises, etc.Nappy / diaper / napkin rash (intertrigo)

• Caused by Candida infectionPhlebitis

• Caused by intravenous lines/injections Pressure sores

• In babies that are unable to move normally



BIOPTRON LIGHT THERAPY & INDICATIONS IN THE NEW BORN BABY

BIOPTRON Light Therapy may help to treat various conditions in newborn babies by reducing pain/inflammation, stimulating the immune system & promoting healing



BLT STUDY DATA: CONDITIONS IN NEWBORN INFANTS

Patient details Newborn babies (requiring Life Support & ICU therapy)

Various illnesses; phlebitis, skin necrosis, pressure sores & skin infections, etc


Frequency: 3-4 sessions per day

Results • Babies all responded well

• Best results obtained for treatment of phlebitis

• Pain reduced within 24 hours

• Skin problems improved within 2-3 days

Conclusions BLT was an effective treatment in newborn babies

Parents were very happy with BLT

BLT also suitable for low birth weight infants



SEASONAL AFFECTIVE DISORDER (SAD) SAD & bright light therapy

BIOPTRON Pro 110,000 to 20,000 lux

BIOPTRON Compact III10,000 to 22,000 lux

BIOPTRON 213,000 to 14,000 lux

Indoor light <500 lux

Outdoor (cloudy) <5000 lux

Midday summer sun >50,000 lux



BIOPTRON LIGHT THERAPY & SEASONAL AFFECTIVE DISORDER

BIOPTRON Light Therapy may help to treat seasonal affective disorder by providing a source of bright light therapy



BLT STUDY DATA: LIGHT THERAPY & SAD

>60 studies carried out worldwide Response rates 60% - 90% Light therapy = 1st line treatment for SAD

Mild side effects reported after light therapy Eye strain/visual disturbance 19-27% Headache 13-21% Agitation 6-13% No damage to eye or retina

Finland study (Lönnqvist) Office workers received light therapy November - February Improvement in mood, energy levels, alertness & productivity Positive effects occurred in people without SAD



BIOPTRON Compact III BIOPTRON Pro 1 BIOPTRON 2

LIGHT THERAPY SYSTEM



BIOPTRON AG: THE COMPANY BIOPTRON AG

Swiss manufacturing company Founded in 1988 Holder of patents for the

BIOPTRON Light Therapy System Integrated into Zepter International

in 1996

Distribution Using synergies enables us today to

distribute the products to more than 50 countries worldwide

More than 2,000,000 satisfied users



QUALITY ASSURANCE CERTIFICATION

ISO 9001

93/42/EEC with annex

ISO 13485

Declaration of Conformity



MEDICAL DEVICES: TYPE COMPARISON

Identical: Technical characteristics Polarization up to 95% Polychromacy 480-3400 nm Low energy density ~2.4 J/cm2 Incoherency

Different: Treatment areas Approximate filter diameters

4 cm BIOPTRON Compact III

11 cm BIOPTRON Pro 1

15 cm BIOPTRON 2

BC

BPro

B2Proportional representation of the filter diameters



The convenient solution for clinical useThe convenient solution for medical useMEDICAL DEVICES: BIOPTRON 2

Domestic Stand Professional Stand



• free adjustable head inclination

• 360° rotation of the head

• adjustable stand hight

• 10 cm distance holderTable Stand

Floor Stand

The versatile, ergonomic and elegant solution for professional and home use

MEDICAL DEVICES: BIOPTRON Pro 1

Available with ergonomic table stand or floor stand



MEDICAL DEVICES: BIOPTRON Pro 1




Storage and transport case

The versatile, ergonomic and elegant solution for professional and home use

MEDICAL DEVICES: BIOPTRON Compact III

Optional available stand



BIOPTRON Light Therapy is safe & effective

Swiss quality Developed & manufactured by BIOPTRON AG, Switzerland

Conclusive therapeutic results Clinically proven efficacy & visible results, that encourage patient compliance

Versatile Units are mobile, easy to use & maintenance-free

Multifunctional Therapy can be applied in medical practice & in the patients home

Cost-effective Potential shortening of hospitalization

No side effects any negative side effects are not known

Wide application area from traumatology to surgery, from rheumatology to sports medicine, from geriatrics to home care and more.

LIGHT THERAPY SYSTEM – SOME ADVANTAGES AT A GLANCE



CONVINCING MEDICAL RESULTS … … THE INNOVATIVE SOLUTION FOR YOUR PATIENTS

BIOPTRON Compact III BIOPTRON Pro 1 BIOPTRON 2

ONE TECHNOLOGY

THREE MODELS

targetstherapeuticclinicalcharacteristicsintrosystem bioptron medical presentation – for internal...

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