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1. part,

  1. 1. 11 BasicBasic TTherapeuticherapeutic MMethods inethods in MMedicineedicine Ján Jakuš
  2. 2. 2 BasicBasic TTherapeuticherapeutic MMethodsethods CLASSIFICATIONCLASSIFICATION NonNon-I-Invasivenvasive MethodsMethods •MechanicalMechanical •ElectrostimulationElectrostimulation •MagneticMagnetic •ThermThermalal •OpticOptic •Ionizing radiationIonizing radiation InvasiveInvasive MethodsMethods •MechanicalMechanical && CChemicalhemical •UltrasoundUltrasound •ElectricElectricalal •Methods of vital organMethods of vital organ supportsupport
  3. 3. 3 -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 optical5 – 3 ms and transmitted by optical ffibers to the stoneibers to the stone NON-INVASIVENON-INVASIVE 1. Mechanical1. Mechanical MethodsMethods Extracorporal Shock – Wave Lithotripsy Laser Lithotripsy
  4. 4. 4 -WavesWaves areare produced outsideproduced outside the patient´s bodythe patient´s body andand are foare fo-- cused bycused by the water medium tothe water medium to the stone (the stone (concrement)concrement) -- DDifference betweenifference between acusticacustic impedanceimpedance of theof the cocnrementcocnrement and the surrounding tissueand the surrounding tissue - R- Rapid start ofapid 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
  5. 5. 5 •Source of shock wavesSource of shock waves (electric, electromagnetic,(electric, electromagnetic, laser...,laser..., •The real source of shockThe real source of shock waves is thewaves is the condensercondenser (as a(as a source of voltage)source of voltage) •Scintilation pointScintilation point (located in(located in the primary focus of rotarythe primary focus of rotary ellipsoid)ellipsoid) •Focusing deviceFocusing device (acustic len(acustic len-- ses)ses) Extracorporal ShockExtracorporal Shock -- Wave LithotripsyWave Lithotripsy
  6. 6. 6 2.2. Methods of ElectrostimulationMethods of Electrostimulation Electroconvulsion therapy- Electroshocks Defibrilation •usedused in psychiatryin psychiatry – pacients with schizophrenia,– pacients with schizophrenia, oligophreniaoligophrenia and other mental diseasesand other mental diseases •Condenser current 2-5 kV / 2-5 ms willCondenser current 2-5 kV / 2-5 ms will causecause strong musstrong mus-- cles conctractioncles conctraction, and „, and „offsetoffset“ of“ of an electrican electric brainbrain activity.activity. •live saving therapylive saving therapy •short electric discharge applied toshort electric discharge applied to chestchest •condenser current with voltagecondenser current with voltage 5 kV,5 kV, under aunder a time 5 mstime 5 ms ,given,given to the chest 3-timesto the chest 3-times Avoid to ground pAvoid to ground patientatient !
  7. 7. 7 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
  8. 8. 8 Diadynamic currentsDiadynamic currents RRectifiedectified ACAC 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 withby AC with ff >> 100 kHz,100 kHz, havehave heatingheating effecteffect and areand are usedused toto heatheat thethe tissuestissues:: looklook Diathermy EEffectsffects: stimulation of tissues, spasmo- lytic, analgetic, antioedematous, tonizing using in treatment and rehabilitation
  9. 9. 9 ElectrolyticElectrolytic MethodsMethods •treatment of skin – paralyzed musclestreatment of skin – paralyzed muscles •application of anodal DC resultsapplication of anodal DC results inin fall of pH under 7fall of pH under 7..3636 and thand thisis reducreduceses the pain feeling – strong analgetic effectthe pain feeling – strong analgetic effect •application of cathode DC resultsapplication of cathode DC results in ain a riserise ofof pH above 7pH above 7..44 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)
  10. 10. 10 3.3. MagneticMagnetic MethodsMethods • 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
  11. 11. 11 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 heat 1. Hydrotherapy whole body bath: hypothermic (10 – 34 °C) izothermic (34 – 36 °C) hyperthermic (37 – 42°C)
  12. 12. 12 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 effecteffect of hotof hot (80 – 100°C) and(80 – 100°C) and dry airdry air and aand a bath inbath in coldcold waterwater resultresult inin healinghealing effecteffect Methods which use: 3.3. IR radiationIR radiation
  13. 13. 13 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
  14. 14. 14 UltrasoundUltrasound HHighigh FFrequencyrequency MMassagassage - stimulatione - stimulation andand heating of the tissueheating of the tissuess FrequencyFrequency : 0: 0..8 – 1 MHz8 – 1 MHz IntensityIntensity: 0: 0..2 – 02 – 0..3 W. cm-23 W. cm-2 The surface of treatmentThe surface of treatment: 1 – 10 cm2: 1 – 10 cm2 Effects:Effects: -- Spasmolytic effectSpasmolytic effect AnalgeticAnalgetic –– removal ofremoval of painpain BiostimulatBiostimulatoryory––healinghealing effecteffect IndicationsIndications: chronic diseases of joints, muscles, nerves ContraindicationContraindicationss: the- rapy of malignant tumors
  15. 15. 15 5. Light5. Light MethodsMethods 1.Phototherapy Heliotherapy – treatment by sun radiation Therapy 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.
  16. 16. 16 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
  17. 17. 17 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/ LowLow PPowerower 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.
  18. 18. 18 bb// HighHigh PPowerower LLasersasers Solid YAG laser- used for photocoagulation of retinal 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
  19. 19. 19 6.6. Methods ofMethods of IonizingIonizing 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
  20. 20. 20 TherapyTherapy with low energywith 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 60 CO (radioisotop of cobalt) • streams of neutrons (deuterons with 50MeV) Therapy withTherapy with highhigh 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)

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