Raccomandazioni per l'uso della tecnica della

laser terapia biologica endovena a bassa

potenza nelle patologie cardiovascolari.
Gli autori

Riassunto
Introduzione
Percorsi diagnostici ottimali nella gestione degli scenari clinici pi frequenti nella pratica
Considerazioni conclusive
Appendice I: Effetti di alcuni trattamenti di frequente impiego, sui dati di funzionalit
tiroidea. Considerazioni pratiche
Appendice II: Tabella Riassuntiva delle principali interferenze farmacologiche segnalate
Bibliografia
Data di creazione: 08-11-12


Le nuove tecnologie applicate in ambito medico, consentono oggi risultati che fino a qualche anno
fa erano inimmaginabili, sia per risultati clinici che per sicurezza di impiego. La tecnologia, cosi
come la medicina, evolvono molto velocemente e ci rende necessario una formazione continua e
costante, cosi come lelaborazione di procedure diagnostiche e terapeutiche standardizzate che
riducano il rischio di decisioni errate e che evitino un ingente spreco di risorse




Introduzione
Blood irradiation therapy is a procedure in which the blood is exposed to a laser light for therapeutic
reasons
Blood irradiation therapy can be administered through a catheter in a vein.
The intravenous laser blood irradiation was accomplished for the first time approximately 25 years
ago in the former Soviet Union. Laserlight was brought directly into the flowing blood through a
one-way-catheter. By various in-vitro-tests before it could be verified that biological soft laser
irradiation of white blood cells caused various positive effects, in particular expression of
immunoglobulins, interferons and interleukins. After the introduction of the new method various
clinical studies were published, showing additional effects on various metabolic pathways.
The development and certification of a new intravenous laser blood irradiation device in 2005 in the
research support program Biophotonik II of the government of Niedersachsen opened for the first
time the possibility in Germany to check the new therapy in clinical studies. Nowadays this technic
is used all over the world. There are a lot of scientific articles published on Pubmed.


Originally this method was developed in Russia for the treatment of cardiovascular diseases.
Improvement of rheologic properties of the blood as well as improvement of microcirculation and
reduction of the area of infarction had been proved. Further reductions of dysrhythmia and sudden
cardiac death occurred.
So today it is used successfully for the treatment of coronary heart diseases, cardiomyopathies and
for avoiding of stent restenosis.
Light irradiation of the blood, a method also known as photochemotherapy, has a wide range of biomedical
effects which include immunomodulation, vasodilation, and antiarrhythmic [8] and antihypoxic effects [9].
There are many versions of this method depending on the physical parameters of the light used for the
irradiation (laser and nonlaser as well as light sources at different wavelengths) and by the way of
irradiation, that is, intravenous or transcutaneous irradiation [10]. Intravenous laser blood irradiation
(IVLBI) therapy was first introduced by Meshalkin in 1981 [11]. Originally, this method was developed for
the treatment of cardiovascular diseases. Since then, comprehensive research on IVLBI has been done,
revealing its effects on various systems including the hematologic and immunologic systems. In this regard,
IVLBI has been shown to have a positive influence on rheological properties of the blood; for example, it
leads to a decrease in blood viscosity [12], which is of great interest to surgery and cardiology. In addition,
helium-neon (He-Ne) laser irradiation induced an increase in phagocytic activity and structural modulation
of macrophages [13, 14] as well as proliferation of lymphocytes [15, 16].As previously mentioned,
irradiation of the blood is commonly administered either intravenously or through a transcutaneous
irradiation, while each method has its advantages as well as downsides. While transcutaneous irradiation
can be performed repetitively, is more patient friendly, and does not include penetration to the tissue, its
major disadvantages are that it includes irradiation of nearby tissue (skin, nerves, and mussels) and
requires a higher irradiation power (due to massive absorption). On the other hand, IVLBI includes insertion
of a small catheter to a vein, from which light would be administered. This kind of procedure requires a
much lower irradiation power; however, it involves inconveniency to the patient, higher risk for infections,
requires medical skills and overall canot be performed frequently. These limitations can be partially
overcome by inserting a self-powered irradiation devise inside a blood vessel. This way, blood would be
directly illuminated thus require low level of irradiation and since the device is self-powered, there would
be no need to go through repetitive procedures in order to replace the device or to perform a longer or
higher frequently therapy.As previously explained, blood irradiation therapy can be applied not only by
laser light but also with nonlaser light sources. In 1986, Karandashov and coworkers first applied blue light
for irradiation of the blood in patients with hypertension and angina pectoris [17]. Over the years,
numerous clinical studies were published in regard to the impact that blue light blood irradiation (BLBI) has
on blood lipid composition. It was shown that BLBI induces a significant decrease in the levels of total
cholesterol and low-density lipoproteins (LDL) and an increase in the content of high-density lipoproteins
(HDL) [18]. These findings are with no doubt of great significance to the treatment of coronary heart
disease and atherosclerosis.In general, a typical intravenous blood irradiation therapy includes light
administration to a vein via a catheter and irradiation of the blood with a relatively low-power light source
for half an hour or so. Such a procedure should be carried out once or twice a day during a period of several
days. An example commonly being used of such a therapy is blood irradiation with the He-Ne laser (632.8
nm) at a power of 13mW, for 2060 minutes once a day for up to ten days [19].
History
Intravenous laser blood irradiation was developed experimentally by the Russian researchers,
Meshalkin and Sergievskiy, and introduced into clinical practice in 1981. Originally the method
was applied in the treatment of cardiovascular abnormalities.
[1][2]

Laser blood irradiation therapy was government-certified in Germany in 2005. In the following two
years, this method was established in more than 300 centers in Germany, Austria, Switzerland, Italy
and Australia.
[3]

Types
Intravenous
Intravenous or intravascular blood irradiation involves the in-vivo illumination of the blood by
feeding low level laser light generated by a 13 mW heliumneon laser at a wavelength of
632.8 nm into a vascular channel, usually a vein in the forearm, under the assumption that any
therapeutic effect will be circulated through the circulatory system.
[4]
The feasibility of
intravascular laser irradiation for therapy of cardiocirculatory diseases was first presented in the
American Heart Journal in 1982.
[5]
The technique was developed primarily in Asia (including
Russia) and is not extensively used in other parts of the world. It is claimed to improve blood flow
and its transport activities, but has not been subject to randomized controlled trials and is subject to
skepticism. While there have been some calls to increase research on this topic, others have called it
"useless".
[1]

Ultraviolet blood irradiation may also be applied, though it involves drawing blood out through a
vein and irradiating it outside of the body. Though promoted as a treatment for cancer, a 1952
review in the Journal of the American Medical Association
[6]
and another review by the American
Cancer Society in 1970 concluded the treatment was ineffective.
[7]
Stephen Barrett, writing for
Quackwatch, lists ultraviolet blood irradiation therapy as a questionable treatment.
[8]

Intranasal
Intranasal blood irradiation (also commonly known as "intranasal light therapy") involves the non-
invasive irradiation of the nasal cavity by inserting a small light diode (usually red color either of
low intensity laser or normal red light) to illuminate the nasal cavity walls. The microvascular blood
vessel network in the nasal cavity is receptive to external stimulation which is then circulated in the
body's circulatory system.
Transcutaneous
Transcutaneous therapy applies laser light on unbroken skin in areas with large numbers of blood
vessels (such as the forearm). Because of the skin acting as a barrier to the blood, the power of the
laser is often boosted to compensate.
[9]

References
1. ^
a

b

c
Moshkovska, T.; Mayberry, J. (2005). "It is time to test low level laser therapy in Great
Britain". Postgraduate Medical Journal 81 (957): 436441. doi:10.1136/pgmj.2004.027755.
PMC 1743298. PMID 15998818. edit
2. ^ Meshalkin E N, Sergievskii V S, Primenenie pryamogo lazernogo izlucheniya v eksperimental'noi i
klinicheskoi meditsine (Application of Direct Laser Radiation in Experimental and Clinical Medicine),
(Novosibirsk: Nauka), 1981
3. ^ Weber, M. F. M. (2007). "Intravenous laser blood irradiation: Introduction of a new therapy".
German Journal of Acupuncture and related Techniques 50 (3): 1223. doi:10.1078/0415-6412-
00282. Retrieved 14 Aug 2010. edit
4. ^ Weber, MH; Fussgnger-May TW (2007). "Intravenous laser blood irradiation". German Journal of
Acupuncture and related Techniques 50 (3): 1223. doi:10.1078/0415-6412-00282.
5. ^ Lee, G.; Ikeda, R. M.; Dwyer, R. M.; Hussein, H.; Dietrich, P.; Mason, D. T. (1982). "Feasibility of
intravascular laser irradiation for in vivo visualization and therapy of cardiocirculatory diseases".
American heart journal 103 (6): 10761077. doi:10.1016/0002-8703(82)90576-2.
PMID 7081024. edit
6. ^ Schwartz, SO; Kaplan SR; Stengle J; Stevenson FL (1952). "Ultraviolet Irradiation of Blood in Man".
JAMA 149 (13): 11803. doi:10.1001/jama.1952.02930300006002. PMID 14938136.
7. ^ "Ultraviolet Blood Irradiation Intravenous Treatment". CA: A Cancer Journal for Clinicians 20: 248.
1970. doi:10.3322/canjclin.20.4.248. edit
8. ^ Barrett, S (2010-06-23). "Index of Questionable Treatments". Quackwatch. Retrieved 2010-07-23.
9. ^ Harrington, James; Li, Junheng (1998). Biomedical optics and lasers: diagnostics and treatment:
1618 September 1998, Beijing, China. Bellingham, Washington: SPIE. ISBN 0-8194-3009-9.
Laser Blood Irradiation
Photohemotherapy (therapy method by light irradiation of blood) is a group of quite effective
methods of light therapy. It can be classified by physical parameters of light used for of
irradiation (red or infrared laser light, blue light, ultraviolet light), by the way of irradiation
(direct irradiation of blood inside of a vein intravenous, inside of artery intraarterial,
extracorporeal in plastic or quartz irradiation chamber as well as indirect transcutaneous
irradiation).
Intravenous Laser Blood Irradiation Therapy
Transcutaneous Laser Blood Irradiation Therapy
Blue Light Blood Irradiation Therapy
Intravenous Laser Blood Irradiation Therapy
There are several reports about positive outcomes of irradiation of blood with laser light for
the therapy of different pathologies. Red laser light is usually applied for blood irradiation.
Invasive and non-invasive methods of blood irradiation exist. Intravenous and extracorporeal
blood irradiation are examples of invasive blood irradiation, wile transcutaneous blood
irradiation is an example of non-invasive methods. Red LED light can also be used for blood
irradiation.
The method intravenous laser blood irradiation (LBI) with red helium-neon (HeNe) laser was
developed in experiment and introduced in clinic in 1981 by soviet scientists E.N. Meshalkin
and V.S. Sergievskiy. Originally the method was applied in the treatment of cardiovascular
pathologies. Some authors reported that the treatment possibilities of the method are very large
and include the improvement of rheological characteristics of the blood and microcirculation,
normalization of parameters of hormonal, immune, reproductive and many other systems.
HeNe laser (632.8 nm) or semiconductor laser diodes (633, 635 nm) are usually used to
perform the intravenous laser blood irradiation (IV LBI). The best therapy results of IV LBI
were obtained after using low power laser light with only 1-3 mW output power at the end of
the light-guide inside a vein and with exposure of 20 - 60 minutes. Some laser therapy
professionals recommend the use of 1 mW laser light for 20-30 min only. Procedures can be
performed on a daily base or every second day, from 3 up to 10 sessions on a course of
therapy.

It was shown, that IV HeNe LBI stimulates the immune response of the organism, activates
erythrogenesis and improves deformability of erythrocyte membranes, has anti-hypoxic
activity on tissues and general antitoxic influence on the organism at different pathological
processes. IV LBI is used for its biostimulative, analgetic, antiallergic, immunocorrective,
antitoxic, vasodilative, antiarrhythmic, antibacterial, antihypoxic, spasmolytic, anti-
inflammatory and some other properties.
IV LBI activates nonspecific mechanisms of anti-infectious immunity. Intensifying of
bactericidal activity of serum of the blood and system of the complement, reduction of the
degree of C - reactive protein, level of middle molecules and toxicity of plasma, increasing the
content of IgA, IgM and IgG in the serum of the blood, as well as decreasing of the level of
circulating immune complexes are proved. There are studies on boosting effect of IV LBI on
the cellular immunity (N. F. Gamaleya et al., 1991). Under influence of IV LBI the phagocytic
activity of macrophages increases, concentration of microbes in exudate in the abdominal
cavity of patients with peritonitis decreases, reduction of inflammatory exhibiting of disease,
activation of microcirculation are detected.
The immunological effect of IV LBI can be explained by normalization of intercellular
relationships within the subpopulation of T-lymphocytes and increasing the amount of immune
cells in a blood. It increases the function activity of B-lymphocytes, strengthens the immune
response, reduces the degree of intoxication and as a result improves the general condition of
patients (V. S. Sergievskiy at al., 1991).
IV LBI promotes improving the rheological properties of blood, rising fluidity and activating
transport functions. That is accompanied by increasing the oxygen level, as well as decreasing
the carbon dioxide partial pressure. The arterio-venous difference by oxygen is enlarged, that
testifies the liquidation of a tissue hypoxia and enrichment the oxygenation. It is a sign of
normalization of tissue metabolism. Probably, the basis of activation of oxygen transport
function of IV LBI is the influence on hemoglobin with transforming it in more favorable
conformation state. The augmentation of oxygen level improves metabolism of the organism
tissues. In addition, the laser irradiation activates the ATP synthesis and energy formation in
cells (A. S. Krjuk et al., 1986). Application of IV LBI in a cardiology has shown that
procedures have analgetic effect, show reliable rising tolerance of patients towards physical
tolerance test, elongation of the period of remission.
It was proved that IV LBI reduces aggregation ability of thrombocytes, activates fibrinolysis,
which results in peripheral blood flow velocity increasing and tissues oxygenation enriching.
The improvement of microcirculation and utilization of oxygen in tissues as a result of IV LBI
is intimately linked with positive influence on metabolism: higher level of oxidation of energy-
carrying molecules of glucose, pyruvate, and other substances.
After IV LBI vasodilation and change in rheological properties of blood are revealed. IV LBI
can also unblock the capillaries and collaterals, which then can improve supply of nutrients to
tissue and improve the nerve cells function (N. N. Kapshidze et al., 1993).
IV LBI can increase the concentration of antibiotics and some other medications in the pocus
of inflammation. It is known, that due to local edema blood circulation can be seriously
disrupted in the areas of inflammation; for example, in kidneys. It was shown, that the
concentration of antibiotics in healthy kidney is about 10 times higher, than in the inflamed
kidney. Laser irradiation helps to increase concentration of the antibiotics in target areas.
Similar studies showing favorable effect of blood irradiation for increasing concentration of
administered antibiotics in inflamed prostate gland
Activation of microcirculation is one of the most pronounced effects of IV LBI. The
improvement of microcirculation after IV LBI was detected in all structures of the central
nervous system. This effect was the strongest in the highly developed vascular system
hypothalamus. The capillaries of the hypothalamus are remarkable for high permeability for
macro-molecular proteins. That can further amplify influence of the irradiated blood to
subthalamic nuclei. It is assumed, that IV LBI can increase the functional activity of
hypothalamus and all limbic system, which then can cause the activation of energetic,
metabolism, immune and vegetative responses, mobilization of adaptive reserves of the
organism. Top

Transcutaneous Laser Blood Irradiation Therapy
In addition to the invasive method of intravenous laser blood irradiation (IV LBI) non-invasive
transcutaneous laser blood irradiation (TLBI) is also available.
This non-invasive and relatively simple method of blood irradiation has been taken into use
only after development of bright enough red and infrared lasers. It was shown that infrared
radiation can go deep enough to reach vessels and irradiate blood. In addition, red laser light
can also influence blood in superficial veins. Currently semiconductor laser diodes with red
(630-670 nm) or near infrared (800-1300 nm) light emission are used to perform TLBI
therapy.
Recent studies suggested that the medical effects of HeNe laser TLBI are similar or very close
to the effects of HeNe laser IV LBI. It is believed, that the treatment results of 20 mW HeNe
laser transcutaneous blood irradiation are similar to 1 mW HeNe laser intravenous blood
irradiation. Laser light is delivered to the skin in the area of a large vein or artery through a
special light-guide. Contact of the light-guide with the skin with some pressure can increase
penetration of the light.
The biggest advantage of TLBI is that this method of blood irradiation is painless. Another
important issue is that the need for intravenous injection is completely eliminated. This is why
TLBI has the greatest advantage for the treatment of children. It can be also applied for the
treatment of patients with small or difficult to find deep veins.
Unfortunately, not enough research exists to date directly comparing medical and biological
effects of IV and transcutaneous LBI with each other. G. Brill (1994) suggested that the effects
of the laser therapy depend on the method of irradiation. He considered, that the term
transcutaneous laser blood irradiation is not quite correct, because it mentions only
irradiation of blood and hides the irradiation of other nearby tissues, including all layers of
skin, possibly acupuncture points, nerves, lymphatic glands and vessel, and even muscle and
bone tissues. In case of IV LBI the main portion of the laser light is absorbed by blood, while
in case of TLBI only minor part can reach blood. So, it is better not only to mention TLBI, but
also to specify the exact area of irradiation. Top
Blue Light Blood Irradiation Therapy
Methods of laser and non-laser (incoherent, monochromic, narrow-band or broadband) light
blood irradiation therapy are widely applied in the treatment of different pathologies.
Ultraviolet light was the first light, successfully used for blood irradiation therapy. In the
second half of the XX century laser blood irradiation was introduced. Recently it was shown
that blue light irradiation of blood can also be successfully used in the therapy of different
conditions.
It was discovered that several molecules in the blood have absorption spectra in blue region. It
was proposed, that blue light can have positive effects in the therapy of different conditions.
H. Kost et al. (1986) offered to irradiate blood with incoherent narrow-band blue light for the
treatment of patients with ischemic heart disease and hypertensive disease. The decrease of
low-density lipoproteins and cholesterol amount in the blood serum was detected. Further
studies showed that blue light blood irradiation has wide therapeutic activities.
V.I. Karandashov et al. (1996, 2000) studied the medical and biological actions of
extracorporeal blue light irradiation in animal experiments and clinical trials. It was reported
that viscosity of blood decreased immediately after the reinfusion of the blue light irradiated
blood. It is important to mention, that the viscosity of the blood plasma also reduced, but to
smaller degree than the viscosity of blood. It can improve the blood microcirculation, increase
nutrients and oxygen supply to different tissues. It can also help in delivery of medication to
the target tissues.
After blood irradiation the decrease of concentration of cholesterol, triglycerides, lipoproteins
and glucose was also detected in patients with originally increased values. No signs for blood
cell damage was obtained. The blue light blood irradiation therapy helped to keep the level of
atherogenic lipids in the blood of patients with atherosclerosis relatively low for several
months.
Blue blood irradiation had favorable results for patients with bronchial asthma. Patients
reported improvement in heavy breathing. In addition to that positive influence of the activity
of immune system was found. All the above mentioned results was detected after a single
procedure of blood irradiation, and repeating treatments made results of therapy stronger.
L.V. Gasparyan (2000) reported about the experience of applying intravenous blue light blood
irradiation for the therapy of different conditions, including hearing loss, atherosclerosis, and
chronic inflammations of prostate gland. The results of the therapy are very encouraging. Blue
light blood irradiation in general vas a better therapy tool then red laser intravenous blood
irradiation in the given dosage and protocol.
As continuation of studies of effects of blue LED light irradiation effects on blood L.V.
Gasparyan et al. (2003) examined effects of LED light irradiation of different wavelengths on
blood platelets in vitro in animal experiments. It was reported, that blue and red light can
significantly decrease aggregation activity of blood platelets. It was proposed, that increasing
levels of NO can be results of light irradiation of blue and red band.
A.Makela (2004) discussed the biochemical background of positive influence of blue light in
case of diabetes mellitus and some other conditions. She examined several molecules which
can act as primary photoacceptors for blue light and some other molecules which can
participate in blue light action.
Blue light blood irradiation therapy shows promising results in the treatment of different
pathologies. In the near future the blue light blood irradiation will be used wider, than today,
because equipment for non-invasive transcutaneous blue light blood irradiation is now
available.

L'elevata frequenza delle tireopatie fa s che anche il Medico non specialista si trovi
quotidianamente a dovere affrontare problemi diagnostici tiroidei ex-novo oppure ad intervenire su
pazienti affetti da patologie tiroidee gi accertate. La consultazione dell' endocrinologo avviene
solitamente dopo un primo approccio diagnostico, eseguito in ambito non specialistico.
Il solo fatto che la l-tiroxina fosse nel 2001 all'11 posto nell'elenco dei principi attivi
maggiormente prescritti in Italia, fa s che la gestione dei pazienti tireopatici non possa essere
ritenuta di esclusiva pertinenza specialistica.
La scarsa sensibilit dell'esame clinico nella maggior parte delle disfunzioni tiroidee di gravit
lieve-moderata e l'efficacia delle misure terapeutiche nell'impedirne sequele cliniche rilevanti, ha
condotto alla formulazione di proposte di screening per le tireopatie, da applicare a sottogruppi
selezionati di individui o alla popolazione generale.
L'analisi dei dati di prescrizione in diverse realt territoriali ed ospedaliere, pongono le richieste di
esami tiroidei ai primi posti tra le indagini diagnostiche e mostrano un frequente ricorso a
metodiche inappropriate.
Anomalie prescrittive di frequente riscontro, quali richieste di parametri non indispensabili per la
soluzione di specifici quesiti clinici (es. dosaggio sistematico di ormoni tiroidei e TSH o ripetuto di
anticorpi antitiroidei) comportano una importante dispersione di risorse.
La revisione delle Linee Guida pi recenti sull'argomento,

pur se elaborate da autorevoli Societ
Scientifiche e contenenti indicazioni rilevanti, ha messo in evidenza documenti redatti per un
utilizzo prevalentemente specialistico, con limiti metodologici non trascurabili. Alle stesse
conclusioni sono giunti altri esperti metodologi nell'applicare i criteri di valutazione alle Linee
Guida esistenti in ambito tiroidologico. La valutazione comparata delle linee guida disponibili
accessibile nella Banca Dati di Linee Guida del Programma Nazionale Linee Guida.
Da quanto esposto, emerge la necessit di un documento diretto a tutti i medici in generale.
Le carenze metodologiche delle Linee Guida esaminate e la scarsa disponibilit a tutt'oggi di studi
adeguati a supporto di un buon grading di evidenza, si traducono inevitabilmente in una serie di
raccomandazioni la cui forza conseguentemente limitata.
Le raccomandazioni di questo documento di sintesi derivano, oltre che dalle Linee Guida
revisionate, anche da una attenta analisi della loro praticabilit in diverse situazioni cliniche e delle
loro implicazioni in termini di rapporto costo\beneficio.


Le raccomandazioni nell'adozione di procedure diagnostiche ottimali in area clinica deve prevedere
approcci diversi basati sulle situazioni cliniche reali piuttosto che sulle singole patologie.
L'importanza di strategie di indagine specifiche per differenti obiettivi diagnostici deriva dalla ovvia
constatazione che metodiche utilissime per rispondere a un quesito specifico possono essere
assolutamente inutili per soddisfare altre esigenze diagnostiche; per esempio: il reperto di un TSH
normale solitamente garanzia di eutiroidismo, ma questo non esaurisce la diagnostica di base nella
patologia iperplastica perch non fornisce le informazioni indispensabili riguardo la situazione
morfo- volumetrica ed il rischio neoplastico del gozzo.

Deve essere evidenziato inoltre che, nelle fasi diagnostiche di inquadramento si possono rendere
necessari accertamenti pi estesi o diversi rispetto a quelli da utilizzare nel monitoraggio successivo
delle differenti patologie gi riconosciute. Queste diversit tra prima diagnosi e follow-up devono
essere tenute ben presenti nella impostazione dell'approccio alle varie situazioni cliniche.
L'accertamento della funzione tiroidea nell'individuo asintomatico