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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
TARGETS THERAPEUTIC CLINICALCHARACTERISTICSINTRO SYSTEM
BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 2
LIGHT THERAPY USING POLARIZED, POLYCHROMATIC, LOW ENERGY LIGHT:
CLINICAL APPLICATIONS
TARGETS THERAPEUTIC CLINICALCHARACTERISTICSINTRO SYSTEM
BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 3
INTRODUCTION TO LIGHT THERAPY
CHARACTERISTICS OF EMITTED LIGHT
TARGET AREAS
THERAPEUTIC EFFECTS
CLINICAL APPLICATIONS
LIGHT THERAPY SYSTEM
CONTENTS
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BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 4
INTRODUCTION TO LIGHT THERAPY
TARGETS THERAPEUTIC CLINICALCHARACTERISTICSINTRO SYSTEM
BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 5
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
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BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 6
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
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BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 7
CHARACTERISTICS OF EMITED LIGHT
TARGETS THERAPEUTIC CLINICALCHARACTERISTICSINTRO SYSTEM
BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 8
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
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BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 9
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
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BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 10
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
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BIOPTRON MEDICAL PRESENTATION – FOR INTERNAL USE ONLY – © Copyright by BIOPTRON AG – Author: Dr. Sanja Vranic – Prepared on: 21.11.2007 11
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
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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
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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
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TARGET AREA
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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
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~~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]
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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
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POSSIBLE CELULAR TARGETS OF LIGHT THERAPY
Mitochondrion
Cell membrane
Human cell
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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
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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
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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
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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
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Click on box to launch animation
TARGET PROCESS
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THERAPEUTIC EFFECTS
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THERAPEUTIC EFFECTS
The main therapeutic effects of polarized light therapy are
Stimulation of tissue repair
Stimulation of body defense mechanisms
Reduction of pain sensation
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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
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STIMULATION OF TISSUE REPAIR WITH LIGHT THERAPY
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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
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STIMULATION OF NON-SPECIFIC IMMUNE REACTIONS WITH LIGHT THERAPY
Red blood cell
White blood cells
Neutrophil granulocyte
Natural killer cell
Monocyte / macrophage
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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
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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
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CLINICAL APPLICATIONS OF LIGHT THERAPY
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CLINICAL APPLICATIONS
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
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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
CLINICAL APPLICATIONS
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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
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PAIN MANAGEMENT: MUSCULOSKELETAL PAIN
Example: Lower back pain
Treatment with BIOPTRON 2
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PAIN MANAGEMENT: REHABILITATION
Light therapy can be applied to various parts of the body
BIOPTRON Pro 1 BIOPTRON Compact III BIOPTRON 2
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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
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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)
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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
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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
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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
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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
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BIOPTRON Light Therapy may help to reduce the symptoms of arthritis
PAIN THERAPY
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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)
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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
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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
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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
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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
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BIOPTRON Light Therapy may help to reduce the symptoms of sports injuries
PAIN THERAPY
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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
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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
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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
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BIOPTRON Light Therapy may help as a treatment in physiotherapy
PAIN THERAPY
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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
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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
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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
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WOUND HEALING: POST-OPERATIVE
Example: Cardiothoracic surgery
Source: First Surgical Hospital, University of Belgrade, Serbia & Montenegro
Immediately before treatment After 25 days of treatment
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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
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BASIC HISTOLOGY: NORMAL SKIN & UNDERLYING TISSUES
Epidermis
Dermis
Subcutaneous tissue
Cornified layer
Basal layer
Granular layer
Loose connective tissue, blood vessels & sensory cells
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TYPES OF BURN
Partial thickness - superficial
Full thickness Partial thickness - deep
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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
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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
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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
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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
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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.)
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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
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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
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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
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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
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WOUND HEALING: VENOUS LEG ULCERS
BIOPTRON Light Therapy may help to stimulate wound healing in a venous leg ulcer
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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)
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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
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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)
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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)
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WOUND HEALING: DIABETIC FOOT ULCERS
BIOPTRON Light Therapy may help to stimulate wound healing in a diabetic foot ulcer
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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
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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
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d
s
bm
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Pressure sores: locationPressure sores develop in bony, weight-bearing parts of the body
Pressure sores: location
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WOUND HEALING: PRESSURE SORES
BIOPTRON Light Therapy may help to stimulate wound healing in a pressure sore
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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
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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
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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
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Incision:Clean edges
Profuse bleeding
Contusion:Bleeding from small blood
vessels under the skin
Laceration:Rough tear
Tissue damage
NON-SURGICAL INJURIES
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WOUND HEALING: TRAUMATIC WOUNDS
BIOPTRON Light Therapy may help to stimulate wound healing following a traumatic wound
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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
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DERMATOLOGICAL CONDITIONS
Acne Atopic dermatitis Psoriasis Herpes infections Superficial bacterial infections Oral mucosal lesions
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NORMAL SKIN STRUCTURE
Cornified layer
Basal layer
Granular layer Epidermis
Dermis
Subcutaneous fat
Hair follicle
Sebaceous gland
Sweat gland
Blood vessels
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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
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ACNE: COMEDONE LESIONS
Blackhead (open comedone)
Whitehead (closed comedone)
Hair follicle
Sebaceous gland duct blocked by ‘plug’
Sebum oxidized & darkened
Bacteria
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BIOPTRON LIGHT THERAPY & ACNE
BIOPTRON Light Therapy may help to treat acne by reducing skin inflammation & promoting healing
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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
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BIOPTRON LIGHT THERAPY & ACNE
Click on box to launch animation
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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
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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
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ATOPIC DERMATITIS: PATHOLOGY
Normal skin Fully developed atopic dermatitis lesion
Spongiosis (vesicles)
Hyperkeratosis & parakeratosis
(skin scales)
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ATOPIC DERMATITIS: COMMON AREAS AFFECTED
adult
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BIOPTRON LIGHT THERAPY & ATOPIC DERMATITIS
BIOPTRON Light Therapy may help to treat atopic dermatitis by reducing skin inflammation & promoting healing
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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
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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.
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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
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PSORIASIS: PATHOLOGY
Normal skin Fully developed psoriatic lesion
Hyperkeratosis & parakeratosis
(skin scales)
Sterile pustule
Dilated blood vessels
Inflammatory cells
Rete ridges accentuated
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BIOPTRON LIGHT THERAPY & PSORIASIS
BIOPTRON Light Therapy may help to treat psoriasis by reducing skin inflammation & promoting healing
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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
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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
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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
Results & conclusions
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
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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.
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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
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PAEDIATRIC ALLERGIC ECZEMA: COMMON AREAS AFFECTED
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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
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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
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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)
Frequency: 2 sessions per day
Course: 10-12 sessions (bronchial asthma 2-3 courses per year)
Results & conclusions
• 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
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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
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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
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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
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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
Frequency: 2 sessions per day
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
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PAEDIATRIC INDICATIONS: NEUROLOGY
Neurological conditions in children treated with BIOPTRON Light TherapyPoliomyelitisPeripheral nerve palsiesTraumatic injuries to nerves Inflammatory neurological disordersDegenerative neurological disordersNeuromuscular disorders
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Patient details 315 patients with various neurological diseases (affecting PN, CNS, spinal cord, brain)
BLT regimen Duration: 10 minutes per session
Frequency: 3-4 sessions per day
Results & conclusions
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
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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
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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
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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
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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
BLT regimen Duration: 10 minutes per session
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
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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
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BIOPTRON LIGHT THERAPY & SEASONAL AFFECTIVE DISORDER
BIOPTRON Light Therapy may help to treat seasonal affective disorder by providing a source of bright light therapy
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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
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BIOPTRON Compact III BIOPTRON Pro 1 BIOPTRON 2
LIGHT THERAPY SYSTEM
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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
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QUALITY ASSURANCE CERTIFICATION
ISO 9001
93/42/EEC with annex
ISO 13485
Declaration of Conformity
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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
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The convenient solution for clinical useThe convenient solution for medical useMEDICAL DEVICES: BIOPTRON 2
Domestic Stand Professional Stand
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• 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
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MEDICAL DEVICES: BIOPTRON Pro 1
Click on box to launch animation
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Storage and transport case
The versatile, ergonomic and elegant solution for professional and home use
MEDICAL DEVICES: BIOPTRON Compact III
Optional available stand
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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
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CONVINCING MEDICAL RESULTS … … THE INNOVATIVE SOLUTION FOR YOUR PATIENTS
BIOPTRON Compact III BIOPTRON Pro 1 BIOPTRON 2
ONE TECHNOLOGY
THREE MODELS
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