[Encircling needling combined with physical factor therapy for severe pressure sore]

OBJECTIVE

To compare the clinical efficacy difference between encircling needling combined with physical factor therapy and simple physical factor therapy for severe pressure sore, and to explore the optimal method for severe pressure sores.

METHODS

Thirty-four patients with IV-grade pressure sore were randomly divided into an observation group and a control group, 17 cases in each one. Patients in the control group were treated with conventional nursing, ultrasonic wave and short-wave ultraviolet therapy; additionally, the encircling needling was applied in the observation group. All the treatment was given once a day, 5 times a week, and 4-week treatment constituted one session. Totally, two sessions of treatment were performed. Three indices, including the area of pressure sore, 24-h volume of exudates and wound-bed tissue type, were compared between the two groups before and after treatment; the clinical efficacy was evaluated in the two groups.

RESULTS

After treatment of one session and two sessions, the area of pressure sore, 24-h volume of exudates and wound-bed tissue type were significantly reduced in the two groups (P < 0.01, P < 0.05), which was more obvious in the observation group (all P < 0.05). The total effective rate in the observation group was 76.5% (13/17) after 1 session and 94.1% (16/17) after 2 sessions, which were superior to 35.3% (6/17) after 1 session and 64.7% (11/17) after 2 sessions in the control group (both P < 0.05).

CONCLUSION

Encircling needling combined with physical factor therapy can obviously reduce the pressure sore area and 24-h volume of exudates and improve wound-bed tissue type, which is superior to simple physical factor therapy.

[Complex treatment of oral mucosa cancer]

The analysis of the results of complex treatment of 58 patients with oral mucosa cancer was conducted. In the main group of 20 patients used a method developed by the authors comprehensive treatment, including chemoradiotherapy (CRT), cryodestruction (CD) of the tumor, followed by 24 hours of local microwave hyperthermia. In the control group of 38 patients with complex treatment consisted of a CRT and a CD of the tumor. Local recurrence rate of tumor growth in the first 12 months of observation in the main group patients was (7.7 +/- 5.96)%, in the control group--(31.6 +/- 7.54)%. The frequency of regional metastases for the entire observation period was (34.2 +/- 7.54)%--in the control group, in the main group were absent. The use of local microwave hyperthermia in a day after tumor CD allows to raise not only local, but also the overall anti-tumor effect of the CD and in general, comprehensive treatment.

[Experiment study on ultrashort wave for treating vascular crisis after rat tail replantation]

OBJECTIVE

To explore the effect and mechanism of ultrashort wave (USW) for prevention and treatment of vascular crisis after rat tail replantation.

METHODS

Eighty 3-month old female Sprague Dawley rats (weighing 232.8-289.6 g) were randomly divided into 5 groups. In each group, based on the caudal vein and the coccyx was retained, the tail was cut off. The tail artery was ligated in group A; the tail artery was anastomosed in groups B, C, D, and E to establish the tail replantation model. After surgery, the rats of group B were given normal management; the rats of group C were immediately given intraperitoneal injection (3.125 mL/kg) of diluted papaverine hydrochloride injection (1 mg/mL); the rats of groups D and E were immediately given the local USW treatment (once a day) at anastomotic site for 5 days at the dosage of 3 files and 50 mA for 20 minutes (group D) and 2 files and 28 mA for 20 minutes (group E). The survival rate of the rat tails was observed for 10 days after the tail replantation. The tail skin temperature difference between proximal and distal anastomosis was measured at pre- and post-operation; the change between postoperative and preoperative temperature difference was calculated. The blood plasma specimens were collected from the inner canthus before operation and from the tip of the tail at 8 hours after operation to measure the content of nitric oxide (NO).

RESULTS

The survival rates of the rat tails were 0 (0/14), 36.4% (8/22), 57.1% (8/14), 22.2% (4/18), and 75.0% (9/12) in groups A, B, C, D, and E, respectively, showing significant overall differences among 5 groups (chi2 = 19.935, P = 0.001); the survival rate of group E was significantly higher than that of group B at 7 days (P < 0.05), but no significant difference was found between the other groups by pairwise comparison (P > 0.05). At preoperation, there was no significant difference in tail skin temperature difference among 5 groups (P > 0.05); at 8 hours, 5 days, 6 days, and 7 days after operation, significant overall difference was found in the change of the skin temperature difference among groups (P < 0.05); pairwise comparison showed significant differences after operation (P < 0.05): group B > group D at 8 hours, group C > group D at 5 days, groups A, B, and C > group D at 6 days, groups B and C > groups A and E, and group B > group D at 7 days; but no significant difference was found between the other groups at the other time points (P > 0.05). Preoperative plasma NO content between each group had no significant difference (P > 0.05). The overall differences had significance in the NO content at postopoerative 8 hours and in the change of the NO content at pre- and post-operation among groups (P < 0.05). Significant differences were found by pairwise comparison (P < 0.05): group D > groups A, B, and C in the plasma NO content, group D > groups A and B in the change of the NO content at pre- and post-operation; but no significant difference was found between the other groups by pairwise comparison (P > 0.05).

CONCLUSION

Rat tail replantation model in this experiment is feasible. USW therapy can increase the survival rate of replanted rat tails, reduce skin temperature at 7 days, improve blood supply, increase the content of nitric oxide at the early period and prevent vascular crisis.

[Changes in the chromatin structure of lymphoid cells under the influence of low-intensity extremely high-frequency electromagnetic radiation against the background of inflammatory process]

Using the alkaline single cell gel electrophoresis technique (comet assay), changes in chromatin structure of peripheral blood leukocytes and peritoneal neutrophils have been studied in mice exposed to low-intensity extremely high-frequency electromagnetic radiation (42.2 GHz, 0.1 mW/cm2, 20 min at 1 h after induction of inflammation) against the background of the systemic inflammatory process. It was revealed that the exposure of mice with the developing inflammation leads to a pronounced decrease in the level of DNA damage to peripheral blood leukocytes and peritoneal neutrophils. It is supposed that the changes in the chromatin structure of lymphoid cells have a genoprotective character in the inflammatory process and can underlie the mechanisms of realization of antiinflammatory effects of the electromagnetic radiation.

[EHF-therapy in children the treatment with erosive and ulcerative lesions of the upper gastrointestinal tract]

The objective of the research is to show the efficacy of physiopuncture applied in patients with erosive ulcer damage of the upper gastro intestinal chambers.

MATERIALS AND METHODS

case and family histories of 198 patients at the age of 7-10 (15.6%) and 11-15 (78.9%) with chronic gastroduodenitis CEG (128) and ulcer UD (70) were studied. Ineffectiveness of previous medical therapy was established. Gastroduodenoscopy was conducted with the biopsy of antral stomach chamber mucosa coating. H. pylori was assessed using hystobacterioscopic Gimza method. Intraventricular pH measurements using REG, Gastroscan-24 and ultra sound were administered. The electrodermal resistance in the biologically active points (BAP) of meridians: stomach (e-36), pericardium (MC-6), triple (Tr-5), frontal medium (VS-12) was analyzed. The electrodermal resistance analysis in BAP showed the majority of BAP in patients with CEG and UD (98.4% and 100% respectively) was unprepared for the short wave frequency (SWF) therapy and required adjusting using SCANER. Eradicative triplex or quadric therapy based on intraatrium pH measurements and the following SWF therapy were administered to all patients. In 6-8 weeks all patients were discharged from the hospital with clinical endoscopic remission and normal pH ratio. The 1-1,5 year follow-up of 95 patients with CEG and 45 patients with UD showed clinical endoscopic remission, normal pH ration and H. pylori absence. The majority of BAP had normal electrodermal resistance indexes. SWF monotherapy was administered to children with morphological features of superficial gastritis. It is reasonable to administer SWF therapy during patients' rehabilitation to reduce drug load in long-term patients with CEG and UD.

Rehabilitation procedures in the management of spasticity

Spasticity is a major disabling symptom in many patients with spinal and/or cerebral lesions. During functional movements, spasticity manifests itself within the complex condition of the "spastic movement disorder". The pathophysiology of the spastic movement disorder relies on multiple factors including abnormal supraspinal drive, abnormal control of reflex activities, and changes in muscle mechanical properties. The most widely used procedures for management of spasticity are represented by pharmacological treatment aimed at inhibiting reflex hyperexcitability. In the last decades, several non pharmacological procedures for treating spasticity have been put forward, including muscle stretching, muscle reinforcement, physical agents and pain management. These procedures may have both neurophysiological and biomechanical effects on the spastic movement disorder. In the present paper, the literature concerning non-pharmacological procedures in the treatment of spasticity was reviewed and discussed, taking into account the multifaceted pathophysiology of the spastic movement disorder. Although further research in this field is recommended, existing evidence supports the potential role of rehabilitation interventions as a therapeutic tool, which could be integrated with traditional pharmacological procedures in the management of the spastic movement disorder.

Does short-wave diathermy increase the effectiveness of isokinetic exercise on pain, function, knee muscle strength, quality of life, and depression in the patients with knee osteoarthritis? A randomized controlled clinical study

BACKGROUND

Knee osteoarthritis (OA) is a painful condition causing disability and muscle weakness. Shortwave diathermy (SWD) is one of several physical therapy modalities and used predominantly as a pain reduction modality in the clinical practice. However, the efficacy of SWD in knee OA is still inconclusive.

AIM

The aim of this study was to determine if SWD increase the effectiveness of isokinetic exercise on pain, function, muscle strength, quality of life and depression in patients with OA.

DESIGN

This was a randomised, controlled clinical trial.

SETTING

Inpatient Physiotherapy Department.

POPULATION

Forty women aged between 42 and 74 years, with a diagnosis of bilateral primary knee OA.

METHODS

Patients were sequentially randomized into two groups. Group 1 (N.=20) received SWD and isokinetic muscular strengthening exercises. Group 2 (N.=20) served as control group and they received isokinetic exercises only. Both of the programs were performed three days a week, for a duration of four weeks, and a total of 12 sessions. Patients were assessed before treatment (BT), after treatment (AT), and at a three-month follow-up (F). Outcome measures included visual analogue scale, Western Ontario and McMaster University Osteoarthritis Index, six minute walking distance, isokinetic muscle testing, Short Form 36 and Beck depression index.

RESULTS

The patients with OA in each group had significant improvements in pain, disability, depression, walking distance, muscle strength, and quality of life AT and F when compared with their initial status (P<0.05). There was no statistically significant difference between the groups according to all the parameters regarding the change scores between AT-BT test and F-BT test (P>0.05) except some isokinetic peak torque measurements (F-BT scores of extension right 60°, 120° and flexion right 60°).

CONCLUSION

Use of SWD in addition to isokinetic exercise program seems to have no further significant effect in terms of pain, disability, walking distance, muscle strength, quality of life and depression in patients with knee OA.

CLINICAL REHABILITATION IMPACT

Considering the time and cost of combination therapy is now, the isokinetic exercise program, as it is efficient, may be preferable for the treatment of knee OA, alone.

Therapeutic ultrasound for osteoarthritis of the knee or hip

BACKGROUND

Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Therapeutic ultrasound is one of several physical therapy modalities suggested for the management of pain and loss of function due to osteoarthritis (OA).

OBJECTIVES

To compare therapeutic ultrasound with sham or no specific intervention in terms of effects on pain and function safety outcomes in patients with knee or hip OA.

SEARCH STRATEGY

We updated the search in CENTRAL, CINAHL, EMBASE, MEDLINE and PEDro up to 23 July 2009, checked conference proceedings, reference lists, and contacted authors.

SELECTION CRITERIA

Studies were included if they were randomised or quasi-randomised controlled trials that compared therapeutic ultrasound with a sham intervention or no intervention in patients with osteoarthritis of the knee or hip.

DATA COLLECTION AND ANALYSIS

Two independent review authors extracted data using standardized forms. Investigators were contacted to obtain missing outcome information. Standardised mean differences (SMDs) were calculated for pain and function, relative risks for safety outcomes. Trials were combined using inverse-variance random-effects meta-analysis.

MAIN RESULTS

Compared to the previous version of the review, four additional trials were identified resulting in the inclusion of five small sized trials in a total of 341 patients with knee OA. No trial included patients with hip OA. Two evaluated pulsed ultrasound, two continuous and one evaluated both pulsed and continuous ultrasound as the active treatment. The methodological quality and the quality of reporting was poor and a high degree of heterogeneity among the trials was revealed for function (88%). For pain, there was an effect in favour of ultrasound therapy, which corresponded to a difference in pain scores between ultrasound and control of -1.2 cm on a 10-cm VAS (95% CI -1.9 to -0.6 cm). For function, we found a trend in favour of ultrasound, which corresponded to a difference in function scores of -1.3 units on a standardised WOMAC disability scale ranging from 0 to 10 (95% CI -3.0 to 0.3). Safety was evaluated in two trials including up to 136 patients; no adverse event, serious adverse event or withdrawals due to adverse events occurred in either trial.

AUTHORS' CONCLUSIONS

In contrast to the previous version of this review, our results suggest that therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee. Because of the low quality of the evidence, we are uncertain about the magnitude of the effects on pain relief and function, however. Therapeutic ultrasound is widely used for its potential benefits on both knee pain and function, which may be clinically relevant. Appropriately designed trials of adequate power are therefore warranted.

[The role of the short-wave therapy in rehabilitation of elderly patents with chronic obstructive pulmonary disease]

The positive clinical effects of using the short-wave therapy in rehabilitation of patients with chronic obstructive pulmonary disease are presented in this article. 49 patients were included in this investigation. The criteria of successful rehabilitation were more expressive in the cases when the short-wave therapy was included in rehabilitative program.

Effects of deep heat therapy on the patients with chronic low back pain

A randomized clinical trial was conducted in the Department of Physical Medicine & Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from 1st April 2006 to 31st March 2007. A total of 102 patients of Chronic LBP were included in the study. Out of them, 42 (41.2%) were male and 60 (58.8%) were female and male: female ratio was 1:1.43. The mean age of the patients was 42.22+/-8.07 years. They were divided randomly into two groups by the way of lottery for the clinical trial. Group A was treated with short wave diathermy (SWD) and non steroidal anti inflammatory drugs (NSAID) and Group B was treated with placebo SWD and NSAID. After treatment the result was compared and student's 't' test was done to see the level of significance. There was significant improvement after treatment in both the group (P=0). In comparison between two groups, it was found that there was no significant improvement in pre-treatment, after 1st week and after 2nd week. Improvement was found in Group A than Group B after 3rd week (P=0.05). And the improvement was gradually increased in Group A in comparison to Group B. Finally, it was found that there was significant improvement in Group A than Group B after 6th week (P=0). From the present study, it may be concluded that both the treatment (NSAID and SWD) is effective for the treatment of Chronic LBP. But the patient may be more benefited if SWD is used as an adjunct to NSAID.

Effect of transducer velocity on intramuscular temperature during a 1-MHz ultrasound treatment

STUDY DESIGN

A 3 x 2 repeated-measures design was used. The independent variables were transducer velocity (2-3 cm/s, 4-5 cm/s, and 7-8 cm/s) and time (pretreatment and posttreatment).

OBJECTIVE

To determine if transducer velocity of a 1-MHz ultrasound treatment affects intramuscular tissue temperature.

BACKGROUND

Most authors advocate ultrasound transducer velocities of 2 to 4 cm/s within an area of 2 to 3 times the effective radiating area or 2 times the size of the transducer head. However, a much faster rate of application (approximately 7-8 cm/s) is often observed in clinical settings.

METHODS AND MEASURES

Eleven healthy screened volunteers (9 males, 2 females; mean +/- SD age, 22.6 +/- 1.7 years; mean +/- SD height, 175.7 +/- 13.7 cm; mean +/- SD body mass, 82.5 +/- 19.5 kg) were randomly assigned to a treatment order with all conditions administered during a single testing session. Each transducer velocity condition was administered for 10 minutes, using 1-MHz ultrasound with a 100% continuous duty cycle at an intensity of 1.5 W/cm2 over an area twice the size of the transducer head. After the first treatment, the 2 remaining subsequent velocity conditions were administered after the intramuscular temperature returned to within +/- 0.3 degrees C of the initial pretreatment temperature for 5 minutes. The dependent variable was left triceps surae muscle temperature measured at 3 cm below one half the measured skinfold thickness.

RESULTS

Temperature increase across the 3 velocities was within 0.4 degrees C (F2.20 = 0.07, P = .93). Posttreatment values (mean +/- SD) ranged from 42.7 degrees C +/- 2.3 degrees C for the slowest velocity to 43.1 degrees C +/- 1.4 degrees C for the fastest velocity. Temperature increase was significant for time (F1.01 = 155.68, P<.00001), increasing from 37.8 degrees C +/- 0.8 degrees C pretreatment to 42.9 degrees C +/- 1.9 degrees C after treatment.

CONCLUSION

Very similar intramuscular temperature increases can be observed among ultrasound treatments (10-minute duration, 1-MHz frequency, 100% continuous duty cycle, 1.5 W/cm2 intensity, within an area twice the size of the transducer head), with transducer velocities of 2 to 3, 4 to 5, and 7 to 8 cm/s.

An evaluation of pulsed shortwave on knee osteoarthritis using radioleucoscintigraphy: a randomised, double blind, controlled trial

OBJECTIVE

To evaluate the effects of pulsed shortwave on osteoarthritis of the knee.

METHODS

A double blinded, randomised, controlled trial. Thirteen female and 14 male patients with radiographic evidence of knee osteoarthritis were randomly allocated to either low dose (10 W), or high dose (20 W) or placebo high frequency pulsed shortwave. Knee radioleucoscintigraphy was performed pre and post treatment as well as objective functional and subjective evaluations.

RESULTS

There were no significant differences between the groups in the pre and post treatment percentage change for radioleucoscintigraphy (P > 0.05). Functional and subjective measures also revealed no pre and post treatment differences between the groups (P > 0.05), except for improved knee range of motion in the placebo group (P < 0.05).

CONCLUSION

Joint inflammation in knee osteoarthritis, measured using radioleucoscintigraphy, was not altered significantly by pulsed shortwave, therefore this therapeutic modality has little or no anti-inflammatory effect on conditions such as osteoarthritis of the knee.

The effect of heat on tissue extensibility: A comparison of deep and superficial heating

OBJECTIVE

To compare the effects of deep heating (shortwave diathermy [SWD]) and superficial heating (hydrocollator packs) on tissue extensibility.

DESIGN

A double-blind, repeated-measures study. Possible effects of sex and intervention order were controlled.

SETTING

A clinical laboratory.

PARTICIPANTS

Twenty-four subjects with no neurologic or musculoskeletal pathologies affecting their lower limbs.

INTERVENTIONS

Three intervention conditions: deep heating (SWD), superficial heating (hot packs), and no heating were applied in preallocated order to each subject at least 36 hours apart.

MAIN OUTCOME MEASURES

Ankle dorsiflexion in weight bearing was measured by using an inclinometer to ascertain changes in the extensibility of the calf muscles and associated soft tissues.

RESULTS

Deep heating increased the range of ankle dorsiflexion by 1.8 degrees +/-1.9 degrees . The change in ankle dorsiflexion after superficial and no heating was 0.7 degrees +/-1.5 degrees and -0.1 degrees +/-1.0 degrees , respectively.

CONCLUSIONS

Deep heating, in the absence of stretching, increases tissue extensibility more than superficial heating or no heating. Superficial heating is more effective than no heating, but the difference was not statistically significant.

Effectiveness of manual therapy or pulsed shortwave diathermy in addition to advice and exercise for neck disorders: A pragmatic randomized controlled trial in physical therapy clinics

OBJECTIVE

To determine whether manual therapy or pulsed shortwave diathermy, in addition to advice and exercise, provide better clinical outcome at 6 months than advice and exercise alone in primary care patients with nonspecific neck disorders.

METHODS

This was a multicenter, 3-arm randomized controlled trial in 15 physical therapy departments. Of the 735 screened patients, 350 were recruited to the study (mean age 51 years) from July 2000 to June 2002. Participants were randomized to advice and exercise plus manual therapy, advice and exercise plus pulsed shortwave, or advice and exercise alone. Assessments were undertaken at baseline, 6 weeks, and 6 months. The primary outcome was the Northwick Park Neck Pain Questionnaire. Analysis was by intention to treat.

RESULTS

Of the participants, 115 were allocated to advice and exercise, 114 to advice and exercise plus manual therapy, and 121 to advice and exercise plus pulsed shortwave; 98% received the allocated treatment. There was 93% followup at 6 months. The mean +/- SD fall in Northwick Park score at 6 months was 11.5 +/- 15.7 for advice and exercise alone, 10.2 +/- 14.1 for advice and exercise plus manual therapy, and 10.3 +/- 15.0 for advice and exercise plus pulsed shortwave. There were no statistically significant differences in mean changes between groups.

CONCLUSION

The addition of pulsed shortwave or manual therapy to advice and exercise did not provide any additional benefits in the physical therapy treatment of neck disorders.

[Thromboresistance of vascular wall endothelium in patients with chronic generalized periodontitis and its changes during combined short wave therapy]

Thromboresistance of endothelial vessels is decreased in patients with chronic generalized periodontitis (CGP). The severity and type of thromboresistance suppression in the vascular wall depend on the severity of CGP. Combined short wave therapy completely or partially (depending on the disease severity) restored thromboresistance of endothelial vessels.

Therapeutic ultrasound for osteoarthritis of the knee

BACKGROUND

Therapeutic ultrasound is one of several physical therapy modalities suggested for the management of pain and loss of function due to OA.

OBJECTIVES

To assess the effectiveness of therapeutic ultrasound therapy for treating OA.

SEARCH STRATEGY

We searched the Cochrane Musculoskeletal Group trials register, and MEDLINE, up to the end of December 2000, using the sensitive search strategy developed by the Cochrane Collaboration. The search was complemented with bibliography searching of the reference list of the trials retrieved from the electronic search. Key experts in the area were contacted for further published and unpublished articles.

SELECTION CRITERIA

All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing therapeutic ultrasound against placebo or another active intervention in patients with OA were selected.

DATA COLLECTION AND ANALYSIS

Two reviewers determined the studies to be included based on inclusion and exclusion criteria (LB, VW). Data were independently abstracted by two reviewers (VW, LB), and checked by a third reviewer (BS) using a pre-developed adapted form for the OA sub-group of the Cochrane Musculoskeletal Group. The same two reviewers, using a validated scale, assessed the methodological quality of the RCTs and CCTs independently. OA outcome measures were extracted from the publications. The pooled analysis was performed using weighted mean differences (WMDs) for joint counts, pain, global and functional assessments. A chi-square test was used to assess heterogeneity among trials. Fixed effects models were used throughout and random effects for outcomes showing heterogeneity.

MAIN RESULTS

Three trials, including 294 patients with knee OA were included. Only one trial (n=74) compared therapeutic ultrasound to placebo. This trial showed no difference in range of motion, pain or gait velocity after 4 weeks of therapeutic ultrasound. Two trials compared therapeutic ultrasound to an active therapy (n=220). These trials showed no statistical difference between galvanic current or short wave diathermy for the outcomes of pain and patient-assessed improvement.

REVIEWER'S CONCLUSIONS

Ultrasound therapy appears to have no benefit over placebo or short wave diathermy for patients with knee OA. These conclusions are limited by the poor reporting of the characteristics of the device, of the population, of the OA,and therapeutic application of the ultrasound and low methodological quality of the trials included. No conclusions can be drawn about the use of ultrasound in smaller joints such as the wrists or hands.

Temperature change in human muscle during and after pulsed short-wave diathermy

STUDY DESIGN

A time series design was used, with the dependent variable being gastrocnemius muscle temperature at a depth of 3 cm.

OBJECTIVES

To determine the rate of temperature rise and the rate of post-treatment temperature decline in skeletal muscle following the application of pulsed short-wave diathermy (PSWD).

BACKGROUND

Data on PSWD rate and longevity of heating are 20 years old and outdated. With the recent introduction of advanced diathermy equipment, results of our study would provide clinicians with much needed information regarding treatment duration.

METHODS AND MEASURES

A 23-gauge thermistor was inserted into the center of the medial head of the anesthetized gastrocnemius muscle, 3 cm below the skin's surface of 20 subjects. The PSWD (27.12 MHz frequency) was applied using the following parameters: 800 bursts per second; 400 microseconds burst duration; 850 microseconds interburst interval; with a peak root mean square (RMS) amplitude of 150 W per burst and an average RMS output of 48 W. Temperature changes were documented every 5 minutes during the treatment and additionally at 5 and 10 minutes following treatment.

RESULTS

The average baseline and peak temperatures were 35.84 +/- 0.93 degrees C and 39.80 +/- 0.83 degrees C, respectively. Mean temperature increases were: 1.36 +/- 0.90 degrees C (5 min); 2.87 +/- 1.44 degrees C (10 min); 3.78 +/- 1.19 degrees C (15 min); 3.49 +/- 1.13 degrees C (20 min). After the treatment terminated, intramuscular temperature dropped 0.97 +/- 0.68 degree C in 5 minutes and 1.78 +/- 0.69 degrees C in 10 minutes.

CONCLUSIONS

PSWD is an effective modality if temperature elevation of deep tissue over a large area is the clinical objective.

Short wave diathermy for small spontaneous pneumothorax

BACKGROUND

The treatment of small spontaneous pneumothorax can involve observation, tube thoracostomy, and surgery. This study evaluated the use of short wave diathermy as a method of accelerating the resolution of small pneumothoraces.

METHODS

Twenty two patients with pneumothoraces of less than 30% by volume were randomly allocated to receive short wave diathermy for 25 minutes each day (n = 11) or observation with bed rest (n = 11). Chest radiographs were taken until the pneumothoraces resolved.

RESULTS

There were no significant differences in the clinical characteristics between the two groups of patients. However, the mean (SD) rate of absorption was significantly higher with short wave diathermy than with observation (3.44 (0.94)% versus 1.57 (0.53)%, difference = 1.87, 95% confidence interval (CI) 1.19 to 2.55, p < 0.001). The time to complete reexpansion was shorter with short wave diathermy than with observation (6.86 (3.51) days versus 11.64 (3.61) days, difference = -4.78 days, 95% CI -7.95 to -1.61, p < 0.005). No evidence of damage resulting from short wave diathermy was found.

CONCLUSIONS

Although further study is necessary, these results indicate that short wave diathermy may be an alternative treatment for patients with small spontaneous pneumothoraces.

Physiotherapy in the treatment of temporomandibular joint disorders: a comparative study of four treatment methods

Temporomandibular joint pain dysfunction syndrome (TMJPDS) comprises of a constellation of signs and symptoms including joint tenderness and pain on function, restricted jaw movement, clicking, jaw locking and tenderness in the muscles of mastication. Headache may also be a feature. Physiotherapy is commonly employed in the treatment of this condition but there is little published material reporting the relative efficacy of the different types of treatment currently available. Further, no attempt seems to have been made to compare the costs of physiotherapy with other forms of treatment of this disorder such as occlusal splint therapy. This paper reports a comparative evaluation of four different physiotherapy treatments and placebo in the management of TMJPDS and comments on their cost benefit aspects compared with that of splint therapy. The four methods of physiotherapy tested were short-wave diathermy, megapulse, ultrasound and soft laser. There was no statistically significant difference in success rate between any of the four tested (range 70.4-77.7%) although each individually was significantly better than placebo treatment. The time of improvement appeared to vary between the four methods.

Surgical management of refractory craniomandibular pain using radiofrequency thermolysis: a report of thirty patients

Radiofrequency thermolysis has traditionally been used to treat pain disorders of differing etiologies primarily in the low back and cervical areas. This paper describes the use and results of a different and simplified approach to surgical management of extracapsular disorders, namely, temporal tendinitis, Ernest Syndrome, and occipital myalgia-neuralgia where conservative attempts have failed. A brief discussion of the pain disorders are addressed along with the methods of differential diagnosis, conservative therapy, and traditional surgical treatment. Finally, surgical management using radiofrequency thermolysis is described with results of treatment in 30 patients showing a 96% success rate.

The effects of physiotherapy on osteoarthritic knees of females

The purpose of this study was to investigate the effect of ultrasound and shortwave diathermy, with and without therapeutic exercise on osteoarthritic (OA) knees. From February 1987 to January 1989, we collected 94 OA knees from 61 female patients and divided them into 4 groups. Group 1 received ultrasound therapy, group 2 had shortwave diathermy, group 3 received ultrasound and an exercise program, and group 4 received shortwave diathermy and exercise therapy. All 61 patients (94 knees) were assessed by functional incapacity scoring and isokinetic testing before and after treatment. At the termination of treatment, all patients had significant improvement in both functional capacity and peak torque. This study failed to prove any significant difference in treatment effect between ultrasound and shortwave diathermy for chronic OA knees. However, the exercise program in addition to the diathermy did promote the treatment effect in both function and muscle torque.

Effects of ultrasound, shortwaves, and physical exertion on pregnancy outcome in physiotherapists

STUDY OBJECTIVE

The aim of the study was to investigate whether occupational exposure among physiotherapists is associated with spontaneous abortion or congenital malformation in the offspring.

DESIGN

The study was a retrospective nested case-control study, where the pregnancy outcome data were based on the medical registers.

SETTING

All registered physiotherapists in Finland who had become pregnant during the study period were included in the study.

SUBJECTS

Cases were defined as women who had been treated for spontaneous abortion during 1973-1983 or had delivered a malformed child during 1973-1982. One pregnancy per woman was randomly selected for the study. Three age matched (+/- 18 months) controls were selected for each abortion case and five for each malformation case. The final study population was 204 cases and 483 controls in the spontaneous abortion study, and 46 cases and 187 controls in the congenital malformation study.

MEASUREMENTS AND MAIN RESULTS

Exposure information was collected by mailed questionnaires from 1329 women. The response rate was 92% in the spontaneous abortion study, and 89% in the congenital malformation study. Heavy lifting (including patient transfers) was associated significantly with spontaneous abortion. Exposure to ultrasound and shortwaves showed about threefold odds ratios for spontaneous abortions occurring after the 10th week of gestation but in analysis where potential confounding variables were controlled, neither reached statistical significance. Deep heat therapies together, and shortwaves alone, were associated significantly with congenital malformations, but the increase was found in the lower exposure category only. From the potential confounding variables, previous abortion (spontaneous or induced) was associated significantly with spontaneous abortion, and febrile disease in early pregnancy was associated with congenital malformation.

CONCLUSION

Physical exertion during early pregnancy seems to be a risk factor for spontaneous abortion. The findings raise suspicion of the potential harmful effect of shortwaves and ultrasound on the pregnancy, but no firm conclusion can be drawn on the bases of these results alone.

Histomorphochemical effects of shortwave diathermy on healing of experimental muscular injury in dogs

The biceps femoris muscle was surgically incised and sutured in 10 clinically healthy mongrel dogs, aged 1-2 yr and weighing 10-15 kg. The surgical wounds of 5 dogs were exposed to shortwave diathermy for 5 min daily for 7 days, starting a day after the creation of trauma. The remaining 5 dogs served as control. After 15 days of healing, the tissues from biceps femoris muscle were collected and subjected to histomorphological and histochemical examination. Mature collagen bundles were seen at healing site in diathermy treated animals while there were immature collagen fibres and more number of fibroblasts in control animals. Normal muscle fibres could be seen on either side of the healing tissue in treated animals whereas in control animals, atrophied and necrosed muscle fibres were encountered. The neutral and acid mucopolysaccharides, lipid droplets in the intermyofibrillar area and the activity of alkaline phosphatase, adenosine triphosphatase and lactate dehydrogenase at the healing site was better in treated as compared to controls.

[Personal experiences in the conservative therapy of patellar chondropathy]

150 knees were re-examined and rated with a modified Bentley-score to estimate the results of the conservative treatment of chondromalacia patellae. 25 several methods in 74 various combinations were used in the treatment. Only injections of Arteparon, short waves and iontophoresis with histamine were applied as single treatment in some knees. None of these methods, applied as single or in combination with other ones, gave results, which were statistically significant better than those of the other ones. In the conservative treatment of chondromalacia patellae the polypragmasy should be stopped and arthro-muscular rehabilitation should be regarded as the principle task.

[Clinical results of hyperthermia alone in the treatment of refractory human tumors]

Retrospective analysis of patients with refractory tumors which were treated with hyperthermia alone in five institutions was performed. Hyperthermia was applied to 30 refractory tumors including 19 deep-seated tumors for a total of 427 sessions by 8 MHz or 13.56 MHz radiofrequency capacitive heating devices. Of the 30 tumors treated, 3 (10%) showed complete regression and 2 (7%) more than 50% regression. Although tumor regression was observed in small tumors, large deep-seated tumors did not respond to heat alone. Thus, response rate of hyperthermia alone was lower than expected, although subjective improvement by hyperthermia was noted in 53% patients. We consider that hyperthermia should be combined with radiation or chemotherapy whenever possible.

Interstitial thermoradiotherapy

The more recent engineering and clinical aspects of interstitial hyperthermia are reviewed. The advantages and difficulties of microwave, radiofrequency, and ferromagnetic seeds are evaluated and some future directions for improvements are outlined.

[Hyperthermia in malignant tumors of the extremities--experimental heating by a radiofrequency applicator and its clinical significance]

We studied hyperthermia for malignant tumors of the extremities, and obtained the following findings. In osteosarcoma cultured cells from OST (Human) and Dunn (Mouse), proliferation was clearly inhibited on being heated to 42 approximately 43 degrees C. On heat-treating the femurs of pigs, a rise in temperature to 42.5 degrees C or above was observed so that an antitumor effect could be anticipated. Moreover, no abnormal rise in temperature in the tissues surrounding the bone and light microscopy revealed no particular abnormalities. Clinically, a rise in temperature above 42.5 degrees C was observed in the majority of the malignant bone tumors (4 cases of osteosarcoma and 1 case of chordoma) and soft tissue tumors (1 case of epithelioid sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, malignant melanoma and osteosarcoma) of which 2 cases were metastatic tumors. Before administration, 7 patients complained of pain, 4 of whom (57%) experienced an alleviation following treatment. Also in 5 (50%) out of 10 cases a shrinking of the tumor was observed and especially, in the case of soft tissue tumors a tendency towards a softening of tumor texture was seen.

Management of chronic pelvic inflammatory disease with shortwave diathermy. A case report

Patients with pelvic inflammatory disease (PID) are not routinely referred for physical therapy until the condition is found to be resistant to antibiotic therapy. A 39-year-old black woman with an eight-year history of PID was treated with shortwave diathermy (SWD) using a modified "cross-fire" technique. A thermal dosage treatment lasting between 20 and 30 minutes (for each half of the cross-fire technique treatment) was administered. At the beginning of every treatment session, the patient rated her pain perception on a 10-point ratio scale. The patient received a total of nine treatments, after which she was completely pain free. The results of this case study suggest that SWD may be effective in the management of pelvic infections that are unresponsive to chemotherapy. Further studies using larger sample sizes and a control group, however, are needed before conclusive statements can be made on the relative efficacy of SWD in the management of chronic PID.

[Hyperthermia in combined radiotherapy of cancer of the mouth mucosa]

Combined treatment of patients with cancer of the oral mucosa using a dynamic course of irradiation in combination with local hyperthermia was proposed. Altogether 55 patients were treated, of them in 51 (92.7%) complete tumor regression was achieved. The short-term results were indicative of the efficacy of the above method.

[Preoperative 2-stage UHF-hyperthermia in combination with single-stage irradiation in breast cancer]

The authors described a method of two-stage UHF-hyperthermia combined with single irradiation of the breast prior to operation. At the 1st stage the temperature was 39 degrees C, duration of exposure 30 min directly before irradiation, irradiation at a dose of 13 Gy. The 2nd stage followed 2 h after irradiation, the temperature was 42 degrees C, duration 90 min. The above therapy did not deteriorate the conditions of surgical intervention, nor did it complicate a postoperative course. Local and general reactions were of transient nature. No recurrences were noted after 1 year of follow-up. A study of tumor pathomorphosis showed injuries of I degree in 30.8%, II degree in 46.2%, III degree in 5.6%, in single irradiation in 18, 8.4 and 2.8%, respectively.

Physical therapy in the management of myofacial pain dysfunction syndrome

A study of the effectiveness of physical therapy for patients with myofacial pain dysfunction syndrome was performed. Clinical evaluation of 120 patients revealed marked male preponderance, distribution according to age showed a great prevalence of the third decade, and most common chief complaints were pain and muscle tenderness. Patients were classified randomly into three equal groups treated by muscle relaxant drugs, shortwave diathermy, and ultrasonic therapy, respectively. Regular follow-up was carried out for 6 to 12 months to assess patients' responses to different forms of treatment. Evaluation revealed marked relief of symptoms by the use of physical therapy, and the best results were obtained by the use of ultrasonic therapy.

Measurement of stiffness in the metacarpophalangeal joint: the effects of physiotherapy

Five common modes of physiotherapy were applied to a group of normal subjects and to a group of patients with rheumatoid arthritis. The metacarpophalangeal joint stiffness was measured before therapy and immediately afterwards and the results compared. The only statistically significant result was that short-wave diathermy and ultrasound both reduced the amount of energy dissipated in the joints of the patients. No significant changes occurred in the normal group.

[Gonarthrosis: physiokinesitherapy treatment]

After a description of the main features of gonarthrosis, the physiokinesitherapy techniques employed in the treatment of this joint condition are presented. This is followed by remarks on hospital cases encountered.

[Application of radiofrequency hyperthermia for treating advanced urinary bladder cancer--a case report]

A patient with advanced urinary bladder cancer treated with a combination of radiation and hyperthermia, using short-wave radiofrequency (RF) and intravesical irrigation with warm water is reported. The tumor temperature was successfully maintained at 43 degrees to 44.6 degrees by external application of 13.56 MHZ RF when the bladder was irrigated with heated saline (intravesical temperature: 43 degrees) Hyperthermia was performed for 30 min immediately after each course of external bladder irradiation (Linac: 400 rad, twice a week; total 5 weeks exposure of 4000 rad). The tumor disappeared completely (CR) after the completion of the combination therapy.

The role of physical agents in the treatment of spine pain

Transcutaneous electrical nerve stimulation (TENS) and electroacupuncture are effective agents in the management of spine pain. Ultrasound and shortwave therapy are often used, but the demonstrated effectiveness of these physical agents in the treatment of spine pain is questionable. Pain relief is the major reason for the use of physical agents. As the pain is controlled, the patient is better able to carry out a home program, tolerate traction, or relax sufficiently to allow mobilization of the spine. Physical agents alone have no long-range value.

Effect of short-wave diathermy on mobility and radiological stage of the knee in the development of experimental osteoarthritis

The objective of the study was to determine the effect of short-wave diathermy on joint mobility and radiographic changes during the development of osteoarthritis. An experimental model for osteoarthritis was developed by periodic immobilization of rabbit knees. Nine rabbits was given short wave diathermy in the same knee 55 times for 5 minutes with a power of 50 W for 11 weeks. An identically immobilized group of 17 rabbits was used as control. The most significant effect on the mobility of the treated knee was the development of extension deficiency. This limitation developed within a week and was permanent. A smaller effect was found on flexion mobility. Flexion deficiency decreased at the end of the immobilization period and increased during remobilization, though at the end of the experiment there were no differences compared with the control. Radiographic changes were similar during the development of osteoarthritis in treated and non-treated groups.

Shortwave diathermy effects on 35S-sulfate uptake and glycosaminoglycan concentration in rabbit knee tissue

The effect of shortwave diathermy on glycosaminoglycan metabolism in different connective tissues of rabbit knee was studied by both autoradiography and radioactivity measurements and quantification of the separated glycosaminoglycans. Of 30 rabbits used, 12 received 100W shortwave diathermy to the right knee 10 minutes a day for 5 days. Autoradiography clearly showed a higher uptake of 35S-sulfate by the capsular tissues of the knee treated with shortwave diathermy than in the contralateral knee. The most prominent feature of the biochemical analysis was the increase in the galactosamine (43%) and glucosamine (26%) concentrations of the collateral ligament glycosaminoglycans of the treated knee.

Physical principles of local heat therapy for cancer

Local hyperthermia therapy for cancer can produce selective heating of solid tumors on the basis of known physical laws. If energy is deposited in the general region of the tumor, temperature tends to develop in the tumor higher than that in surrounding normal tissues. The goal of therapy is to achieve cytotoxic temperature elevations in the tumor for an adequate period of time, without damaging nearby normal tissues. Several modalities exist for local heat treatment, of which radiofrequency and ultrasound offer the most promise for controlled, localized heating at depth. A paucity of blood flow in the tumor compared to that in adjacent normal tissues can enhance selective tumor heating considerably. The tumor types that have reduced flow in their central regions are especially vulnerable to heat therapy, both because they can be heated more efficiently and because hypoxic and acidotic tumor tissues are more susceptible to damage by heat. This effect is more pronounced in larger tumors, which have smaller surface-to-volume ratios and so lose heat less rapidly by thermal diffusion. Selective heat treatment of larger tumor masses with low blood perfusion, therefore, is physically practical and rational therapy. Vigorous research efforts are now underway at many centers to optimize this approach.