Abstract:
A method of treating hemophiliac patients suffering injuries due to internal bleeding in the areas of muscles and joints, said bleeding resulting in hematoma or hemarthrosis with concomitant pain and swelling, by biostimulation of the affected area of said muscle and joint, with at least one beam of light with wavelength in the range of 500-1100 nanometers for at least three minutes with an intensity sufficient to reduce the said hematoma or hemarthrosis.

Description:
CROSS REFERENCE TO RELATED APPLICATION 
     The present application is a continuation-in-part of application Ser. No. 332,896 filed Apr. 4, 1989 now abandoned and the disclosure of which is incorporated herein in its entirety. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to a method for treatment of bleeding injuries in hemophiliac patients. 
     BACKGROUND OF THE INVENTION 
     Hemophilia is an inherited bleeding disorder caused by a missing clotting factor (Factor 8 in hemophilia A, and Factor 9 in hemophilia B). Hemophiliac patients suffer from bleeding mainly to the joints and muscles, which can be caused by even minor injuries. The bleeding, which can occur as often as two to three times per week, swells the affected area and causes enormous pain and limitation of joint movement and if not stopped can lead to death. Repeated bleeding attacks, if inadequately treated, gradually destroy the joints and can cause permanent handicaps. 
     The conventional treatment for injured hemophiliacs is the administration of infusions of the missing clotting factor. If there is no improvement within 12 hours of the first infusion, repeated infusions are given at 12 hour intervals until the joint recovers or the muscle hematoma subsides. 
     Infusions of clotting factors are very expensive. First of all these are administered in hospitals or special medical facilites and they run in the order of about up to $500 per infusion. About 10-15% of the patients develop antibodies against the clotting factor. Such patients require infusions of a special drug, which is even more expensive than the factor himself. For one such bleeding occurrence, an average patient requires a number of infusions, which can add up to a cost of about $5,000 or more. In addition, the infusions, which are manufactured from blood units, cause many complications ranging from transmission of viral diseases (hepatitis and even AIDS) to damage of the immune system. 
     Moreover, for the first several hours after infusion, the joint range of motion remains limited. Only after about 24 hours is the joint motion better than at the start of the bleeding, but it is still far from the baseline movement before the bleeding. Physical therapy, such as transcutaneous nerve electric stimulation, can enhance the recovery significantly. 
     The use of light in healing is not new. Even Hypocrates (460-370 B.C.) treated the ill on beds situated inside caves that had some light focused on them through openings in the ceilings. Hendride Mondeville (1120-1320 C.E.) in France used sunlight through red window coverings to treat scarring from smallpox with great success. In modern times, biostimulation with light waves has also become prominent, particularly the use of low-power (&#34;cold&#34; or &#34;soft&#34;) lasers, i.e. having energies below 100 milliwatts, have been recognised as a prominent mode of therapy for the treatment of pain, inflammatory conditions, neurogenic disorders and in healing wounds, burns, ulcers, tendons and bones. A review on this subject entitled &#34;Laser Biostimulation of Healing Wounds: Specific Effects and Mechanism of Action&#34; by Chukuka S. Enwemeka, was published in the Journal of Orthopaedic and Sports Physical Therapy--April 1988, pages 33-338.This technique of biostimulation with light energy, specifically low-power lasers, has been used so far exclusively for the treatment of normal people having the usual blood clotting factors and who were never in danger of profuse bleeding which can lead to death. 
     Lasers of higher energy were also used for surgical purposes and are known as surgical lasers in the medical field. Such lasers are used to cut, burn or fuse tissues, but not in a therapeutic manner. One such laser device is disclosed by L. Goldmann in U.S. Pat. No. 4,564,001, wherein the laser optic probe device is used by penetrating the skin and entering a blood vessel or the tissue immediately adjacent a damaged blood vessel for creating white scar tissue, causing the vessel to shrink in size and at least partially disappear from view. This method produces heat-induced blood clots at the point where the probe enters the vessel. The lasers used by Goldmann have an energy of 2 to 5 watts. Goldmann also discloses that this method could be used if required in emergency clotting of blood such as in the case of hemophilia. But, as stated above, this method requires penetrating the skin to enter the blood vessel and in effect fusing or scarring the vessel to block any flow of blood. This, of course, requires that each single point of damage is treated separately. 
     SUMMARY OF THE INVENTION 
     It is thus the object of the present invention to provide a rapid and effective method of enhancing the healing of joints and muscles of bleeding hemophiliacs in a non-invasive and less expensive manner than by conventional methods of treatment. 
     It is a further object of the present invention to provide a method for treatment of injuries in hemophiliacs which does not require expensive medical facilities, but can be administered by the patient himself at home. 
     In accordance with this invention there is thus provided a method of treating hemophiliac patients suffering injuries due to internal bleeding in the areas of muscles and joints, said bleeding resulting in hematoma or hemarthrosis with concomitant pain and swelling, by biostimulation of the affected area of said muscle and joint, with at least one beam of light with wavelength in the range of 500-1100 nanometers for at least three minutes with an intensity sufficient to reduce the said hematoma or hemarthrosis. 
     In a preferred method, the light beam is a low energy laser with a power of under 100 miliwatts and preferably between 1-7 milliwatts. 
     According to another preferred embodiment, the treatment area is irradiated by at least one traverse of the area by the light beam. Alternatively, the treatment may be by local irradiation in one spot. 
     Yet another preferred embodiment includes the irradiation with a plurality of light beams. 
     Irradiation may continue between three minutes and one half hour at a frequency from twice a day to every other day, depending on the type of injury, the type of light used and the reaction of the specific patient to the treatment. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     As stated earlier, a soft laser is a low energy laser with power below 100 milliwatts. Examples of such lasers are helium-neon lasers, infra-red lasers or a combination of infra-red and helium-neon lasers, to mention a few. The laser may operate either as an impulse or a continuous beam laser. Examples of suitable lasers for use in the method are those marketed by Medical Electronics GmbH, Germany, and Medec AG, Switzerland, for biostimulating devices. 
     In general the soft laser treatment of hemophiliacs is operative to accelerate healing of hematomas, hemarthrosis, crythema, synovitis, open wounds, inflammations, and similar problems, as well as reducing the concomitant pain. The laser treatment is generally given after one infusion of blood concentrate, which is supposed to stop the bleeding. The soft laser treatment then enhances the recovery of the joint or muscle. In some cases, laser treatment alone is effective. 
     Preliminary results indicate that the soft laser treatment can enhance recovery of joints and muscles even better, and in shorter time, than physical therapy. The treatment with the soft laser is without known complications, simple to use and can be used at home by the patient. 
     The intensity, duration and frequency of the irradiation treatment depend on a number of factors: the location of the injury, its size and depth, the amount of time which has elapsed between the occurrence of the injury and the treatment, and which laser is used and which mode of operation. 
     The treated area may be irradiated by local irradiation in one spot or by one or more traverses of the treated area by the laser beam. Any number of laser diodes may be employed, thus permitting simultaneous irradiation by a plurality of beams, particularly when a large area is to be treated. 
     Irradiation may continue between 3 minutes and one half hour, from twice a day to every other day, depending upon the type of laser and its mode of operation. For example irradiation with a helium-neon laser, used for more superficial wounds, is generally about three times as long as that with an infra-red laser, which is preferred for deeper wounds. 
     Test results of a pilot study conducted by a team at the Israel National Hemophilia Center at Tel-Hashomer Hospital are listed, by way of example only, in Table I. All treatments were carried out with an infra-red continuous laser, model LSI 2030, FLA09 of Medical Electronics GmbH. The study suggests enhanced absorption of the bleeding by the soft laser treatment, reduction of pain and, in many cases, reduction in the required number of infusions with their related complications and cost. 
     It is a particular feature of the present invention that the normal process of healing and absorption of blood is enhanced or accelerated. It is unclear whether the laser treatment stops the bleeding, but it provides a significant improvement in joint movement and reduction of pain. It serves to prevent further damage to the joint or muscle by accelerating the absorption of the blood therefrom. Thus, there appears to be less need for second or additional infusions, with attendant cost savings. 
     The scientific knowledge relevant to soft laser healing suggests that biostimulation with a soft laser (1) accelerates the inflammatory phase of wound healing by altering the levels of various prostaglandins, (2) increases APT synthesis by enhancing electron transfer in the inner membrane of mitochondria, (3) quickens protein (collagen) synthesis by quickening DNA and RNA synthesis, (4) augments fibroplasia by a mechanism that is still being explored, and (5) enhances the ability of immune cells to combat invading pathogens. 
     When using light sources other than lasers for biostimulation in treating hemophiliac bleeding in accordance with the invention, we have found the instruments of Medical Electronics GmbH to be quite satisfactory. These instruments have multiple light sources disposed in a manner to fit the anatomy of the body parts requiring treatment. For example, their Hyper-Photon 3D Photostimulation instrument comprises 128 high performance LEDs. 
     It will be appreciated by those skilled in the art that the invention is not limited to what has been shown and described hereinabove by way of example. Rather, the scope of the invention is limited solely by the claims which follow. 
     
                       TABLE I______________________________________                RESULTS OF  RESULTS OFPATIENT DESCRIPTION  FIRST       2NDNUMBER  OF INJURY    TREATMENT   TREATMENT______________________________________1       Bleeding in  1/2 hour laser                            No second   shin. Hematoma                treatment.  treatment   and swelling Reduction of                            needed.   26.5 × 27.5 cm                swelling and   Great pain.  hematoma to                26 × 27 cm.                No infusion                required. Pain                ceased.2       Bleeding in the                1/4 hour laser                            No second   muscles of the                treatment. No                            treatment   left knee.   change in size                            needed. No   Difficulty in                (still 30 ×                            infusion   movement.    31.5) but   needed   Swelling and improvement in   hematoma 30 ×                movement. No   31.5 cm. Medium                pain.   to strong pain.3       Hematoma in the                15 minutes  Repeat laser   right elbow of                laser treatment                            treatment one   20 cm.       Reduction to                            hour later                29.4 cm.    lasting 15                            minutes.                            Hematoma                            reduced to 19                            cm. No infusion                            needed.4       Bleeding in the                3 minutes laser                            5 minutes laser   right elbow. treatment. 5°                            treatment   Straightening                improvement in                            immediately   elbow limited                bending and after the first   to 50°, bending                straightening                            treatment.   limited to 80°.                elbow.      Improvement of                            another 5° in                            bending and                            straightening                            the elbow.5       Bleeding in  3 minutes laser                            3 minutes laser   right knee.  treatment.  treatment one   Hematoma with                Reduction of                            hour after   swelling 31.5 ×                swelling and                            first treatment   31.9 cm. Great                hematoma to Hematoma   pain.        31.3 × 31.2.                            reduced to                Medium pain.                            31 × 31.2. Pain                Difficulty in                            disappeared. No                straightening                            infusion                the knee.   needed.                            Substantial                            improvement in                            straightening.6       Bleeding in  3 minutes laser                            8 minutes laser   left shin.   treatment. No                            treatment   Hematoma and difference. after first   swelling 1.6             treatment.   cm.                      Reduction of                            hematoma and                            swelling of                            8 mm.   Bleeding in  8 minutes laser                            8 minutes laser   right shoulder.                treatment. No                            treatment after   Great pain.  difference. first   Hematoma of              treatment. Pain   about 30 cm.             ceased and                            hematoma                            shrank by 2                            mm.8       Bleeding in  3 minutes laser                            3 minutes laser   left ankle.  treatment.  treatment one   Hematoma of  Hematoma    hour after   10 × 27 cm                shrank to   first   without pain.                26.5 × 10.                            treatment.                            Reduction of                            swelling to                            26.0 × 10 cm.9       Bleeding in  3 minutes laser   left shoulder                treatment.   with         Bleeding and   sharp pain.  pain ceased.10      Bleeding in  3 minutes laser                            Received no   left sole.   treatment.  infusion or   Hard, swollen                Hematoma did                            second   hematoma of  not shrink but                            treatment.   31.4 cm of dark                the color   After two days,   color.       became much the hematoma                lighter and the                            disappeared.                hematoma be-                came softer.11      Hemarthrosis in                15 minutes  4 minutes laser   the right knee                laser treatment                            treatment.   27.6 cm.     Hemarthrosis                            Hemarthrosis in   Hemarthrosis in                reduced in  right knee   the left knee                right knee to                            reduced to 25   24.2 cm.     26 cm and in                            cm. and in left                left knee to 23                            knee to 20 cm.                cm.         Received no                            infusion at all12      Large, hard  30 minutes  No second   hematoma around                laser       treatment   the ankle    treatment. The                            needed.   hematoma     hematoma   preventing   disappeared.   movement.    Complete                freedom of                movement.13      Hematoma in  10 minutes  No second   sciatic nerve                laser treatment                            treatment   Very great   Clear clinical                            needed.   pain.        improvement                immediately                after                irradiation.14      Huge hematoma                5 minutes laser                            5 minutes laser   in right thigh,                treatment.  treatment one   to the extent                Circumference                            hour after   of 3.5 cm.   of hematoma first treatment   Difficulty in                shrank to 2.55                            Hematome   bending causing                cm. Easing of                            shrank an   a limp.      movement.   additional 1 cm.                Received no Free movement                infusion.   permitting                            riding a                            bicycle the                            following day.15      Hematoma in  15 minutes  No second   left thigh of                laser treatment                            treatment.   26.7 cm.     hematoma    Received no                reduced to 26                            infusion.                cm.16      Hematoma in  3 minutes laser                            Received no   right elbow of                treatment.  second   27.6 cm.     Hematoma    infusion.                shrank to 27                cm. Received                only one in-                fusion.17      Hemarthrosis in                15 minutes  No second   right knee of                laser       infusion   27 cm.       treatment. Size                            required. No                reduced to 24.7                            additional                cm. Received                            treatment                one infusion.                            required.18      Hematoma in the                30 minutes  No second   chest of 7 ×                laser treatmemt                            infusion or   4.5 cm.      Reduction of                            treatment                hematoma to required.                3.5 × 6.______________________________________