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Basic Basic TTherapeutic herapeutic MMethods in ethods in MMedicineedicine

Ján Jakuš

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Basic Basic TTherapeutic herapeutic MMethodsethods

CLASSIFICATIONCLASSIFICATION

NonNon-I-Invasivenvasive Methods Methods

•MechanicalMechanical•ElectrostimulationElectrostimulation•MagneticMagnetic•ThermThermalal•OpticOptic•Ionizing radiationIonizing radiation

InvasiveInvasive Methods Methods

•Mechanical Mechanical && CChemicalhemical•UltrasoundUltrasound•ElectricElectricalal•Methods of vital organ Methods of vital organ supportsupport

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-method of disintegration of cocnrements (in kidneys) by mechanical effect of numerous shock waves (50 – 4000) with frequency 1 – 10 Hz

Efficiency of this methode : 70 – 98%Risks: pain, bleeding

-based on photoacustic phenomenbased on photoacustic phenomenonon-shock waves are generated by short light impulses of He-Ne -shock waves are generated by short light impulses of He-Ne laser in duration of 1laser in duration of 1..5 – 3 ms and transmitted by optical 5 – 3 ms and transmitted by optical ffibers to the stoneibers to the stone

NON-INVASIVENON-INVASIVE1. Mechanical1. Mechanical Methods Methods

Extracorporal Shock – Wave Lithotripsy

Laser Lithotripsy

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-Waves Waves are are produced outside produced outside the patient´s body the patient´s body and and are foare fo--cused bycused by the water medium to the water medium to the stone (the stone (concrement)concrement) -- DDifference between ifference between acustic acustic impedanceimpedance of the of the cocnrement cocnrement and the surrounding tissueand the surrounding tissue- R- Rapid start of apid start of pressurepressure ((101088 PaPa) on the) on the border linesborder lines of stone - of stone - disintegration of the stonesdisintegration of the stones, , fragments arefragments are eliminated byeliminated by urinary systemurinary system

--

Extracorporal Shock – Wave Lithotripsy

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•Source of shock wavesSource of shock waves (electric, electromagnetic,(electric, electromagnetic, laser..., laser..., •The real source of shock The real source of shock waves is the waves is the condenser condenser (as a (as a source of voltage)source of voltage)•Scintilation pointScintilation point (located in (located in the primary focus of rotary the primary focus of rotary ellipsoid)ellipsoid)•Focusing deviceFocusing device (acustic len (acustic len--ses)ses)

Extracorporal Shock Extracorporal Shock - - Wave LithotripsyWave Lithotripsy

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2. 2. Methods of ElectrostimulationMethods of Electrostimulation

Electroconvulsion therapy- Electroshocks

Defibrilation

•used used in psychiatryin psychiatry – pacients with schizophrenia, – pacients with schizophrenia, oligophreniaoligophrenia and other mental diseases and other mental diseases •Condenser current 2-5 kV / 2-5 ms will Condenser current 2-5 kV / 2-5 ms will cause cause strong musstrong mus--cles conctractioncles conctraction, and „, and „offsetoffset“ of “ of an electric an electric brain brain activity. activity.

•live saving therapylive saving therapy•short electric discharge applied to short electric discharge applied to chestchest•condenser current with voltage condenser current with voltage 5 kV,5 kV, under a under a time 5 mstime 5 ms ,given ,givento the chest 3-timesto the chest 3-times

Avoid to ground pAvoid to ground patientatient !

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ChronaxChronaxiimetrymetry

Electrostimulation of peripheral nerves and muscles using DC current as a diagnostical test for determi-nation of chronaxy (i.e.the shortest time under which DC current with double intensity of Rheobase cau-ses AP. Rheobase is the lowest intensity of stimula-ting current (mA) that can cause AP

HOORWEG –WEISS´S CURVE (Strenght-duration curveHOORWEG –WEISS´S CURVE (Strenght-duration curve))

Used for proof of efficie-ncy of the neurosurgery treatment or in rehabili-tation

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Diadynamic currentsDiadynamic currents

RRectifiedectified AC AC currents or magnetic fields are used for stimulation of muscles and nerves as a therapy

Note: Note: High-frequency electric therapyHigh-frequency electric therapy by AC with by AC with ff >> 100 kHz, 100 kHz, have have heating heating effecteffect and are and are used used toto heat heat thethe tissues tissues:: look look Diathermy

EEffectsffects: stimulation of tissues, spasmo-lytic, analgetic, antioedematous, tonizing using in treatment and rehabilitation

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Electrolytic Electrolytic MethodsMethods

•treatment of skin – paralyzed muscles treatment of skin – paralyzed muscles •application of anodal DC results application of anodal DC results in in fall of pH under 7fall of pH under 7..36 36 and thand this is reducreduceses the pain feeling – strong analgetic effect the pain feeling – strong analgetic effect•application of cathode DC results application of cathode DC results in a in a riserise of of pH above 7 pH above 7..4 4 thus increasthus increasinging the pain feeling the pain feeling

2. Galvanism2. Galvanism

1. Iontophoresis

•method based on the fact that ions with the same charge are repelled •drugs are inserted into a body by an effect of DC (under time of 20 – 30 min)

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3. 3. MagneticMagnetic Methods Methods

• magnetotherapy as a therapeutic methode • in healthy subjects has no or minimal effects, curative effect can not be proved in all casses, problem with„dosis“• application of static magnets and electromagnets on the body surface during 10 – 45 min (5 – 80 mT)

Effects:• hyperaemia• spasmolytic• analgetic• antioedematous• antiinflammatory

Indications: diseases of joints, muscles, nerves

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4. 4. Thermic MethodsThermic Methods

• heat can be given to the body – positive thermotherapy , or can be taken away – negative thermotherapy• effects: hyperaemia, reflex vasodilatation, spasmolytic and analgetic effects, myorelaxation

Thermotherapeutical methods use: 1. conduction of heat

-packs, compresses (cold/warm, dry (45 -55°C)/moist, peloid, paraffin) 2. convection of heat1. Hydrotherapy

whole body bath:hypothermic (10 – 34 °C)izothermic (34 – 36 °C)hyperthermic (37 – 42°C)

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3. Whirling baths and underwater massage

2. Scottish torrents

4. Sauna

The method uses streams of cold and warm water- immunity rises up

hyperthermic with activation of skin receptors and hype- raemia of tissue

effect effect of hotof hot (80 – 100°C) and (80 – 100°C) and dry airdry air and a and a bath inbath in cold cold waterwater result result in in healing healing effecteffect

Methods which use: 3.3. IR radiationIR radiation

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Infrared lamp

Enables a local surface heating of the tissues, used in stomatology and dermatology

4. Methods which use the high frequency electric currents, elmg. fields, microwaves with thermal effect : DIATHERMY

5. Thermotherapeutic applications of ultrasound• diathermy and micromasage of the tissue, most of the heat is created on the border between fat and muscle tissue, and bet-ween skin and muscle• 1/3 of absorbed ultrasound is transformed to the heat

• short wave (27 MHz) resistive connection• ultra short wave (434 MHz) condenser connection• microwave (2400 MHz) inductive connection

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Ultrasound Ultrasound HHigh igh FFrequency requency MMassagassage - stimulation e - stimulation and and heating of the tissueheating of the tissuess

Frequency Frequency : 0: 0..8 – 1 MHz8 – 1 MHz

IntensityIntensity: 0: 0..2 – 02 – 0..3 W. cm-2 3 W. cm-2

The surface of treatmentThe surface of treatment: 1 – 10 cm2: 1 – 10 cm2

Effects:Effects: - - Spasmolytic effectSpasmolytic effect

AnalgeticAnalgetic – – removal of removal of painpain

BiostimulatBiostimulatoryory––healinghealing effecteffect

IndicationsIndications: chronic diseases of joints, muscles, nerves

ContraindicationContraindicationss: the-rapy of malignant tumors

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5. Light5. Light Methods Methods

1.Phototherapy

Heliotherapy – treatment by sun radiationTherapy with visible light – blue part of the spectrum – therapy of icterus (yellow coloured skin- in newborns)

2. Photodynamic Therapy

Photosensitive drug is given into the body and then activated by visible or laser lights while rea-cting with oxygen. It results in disorder of tumor metabolism, and in tumor is destroyed. It do-es not affect DNA.

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3. Ultraviolet light therapyUltraviolet light therapy

4. Laser radiation therapy

Types:UV-A (λ = 315 - 400nm), UV-B (280 -315nm),UV-C (100 - 280nm)•Source: Mercury lamp•Biological effects: Early erythema. Delayed pigmentation (within 48 – 72 hours). Production of vitamine D, Killing efect on bacteries, therefore it is used for disinfection of surgical and biopsy room at hospitals

•light amplification by stimulated emission of radiation•consists of 3 main parts: effective substance, excitation device, optic resonator•types: solid/liquid/gas/ semiconductor, continual/pulse, soft/hard

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Principle of laser: atom of a substance reaches an exci-tation due to a drift of electrones from basic to higher energetic levels. Laser radiation is produced by massive replacement of electrons back to their basic levels, under amplification by optic resonator

a/ a/ Low Low PPower ower LLasersasers• soft – lasers with a maximal power of 500 mW• Treatment effects: analgetic, anti- inflamatory, biostimulating• local application – skin, the lasers of a visible light spectrum are used• deep application – muscles, bones, the lasers with longer wavelengths in IR spectrum are used,as well.

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bb/ / High High PPower ower LLasersasers

Solid YAG laser- used for photocoagulation ofretinal ablation – (emits radiation in green part of light spectrum, power supply up to 1,5 W)Excimer laser – for therapy of myopy and astig-matism.This laser emits UV radiation causing pho-tochemical reaction when connecting with eye and thus takes off the corneal tissue (1 impulse remo-ves about 0.25 mm of cornea)-works as a „contac-tless“ scalpel

YAG laser

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6. 6. Methods of Methods of Ionizing Ionizing RRadiationadiation

• Therapy by nuclear (α, β, γ, neutrons) and non-nuclear (X- ray) radiations• Principle of effect: direct effect -production of instabile electric charged particles (cations, anions) in cells or non-direct effect - creation of reactive radicals because water radiolysis

Comparison of stochastic (non

depending on dosis) and deterministic

(depending on dosis) effects of

ionizing radiation

Radiation geometry: intensity of radiation decreases with square of the length

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TherapyTherapy with low energy with low energy of radiationof radiation (biggest dosis remains on surface and close under the surface of the body)• conventional X-ray radiation (electr- ons with10 MeV)• gama radiation from radioactive sour-ce 60CO (radioisotop of cobalt)• streams of neutrons (deuterons with 50MeV)

Therapy with Therapy with high high energy of radienergy of radia- a- tiontion (dosis grows with the depth)- reaching the tumor precisely-stream of protons (140 MeV)- stream of П-mesons 953 MeV)- O2 ions (3,6 GeV)