Basic T herapeutic M ethods in M edicine

1. Basic Therapeutic Methods in Medicine Ján Jakuš

2. Basic Therapeutic MethodsCLASSIFICATION • Non-Invasive Methods • Mechanical • Electrostimulation • Magnetic • Thermal • Optic • Ionizing radiation • Invasive Methods • Mechanical &Chemical • Ultrasound • Electrical • Methods of vital organ • support

3. NON-INVASIVE1. Mechanical Methods Extracorporal Shock – WaveLithotripsy • 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 Laser Lithotripsy -based on photoacustic phenomenon -shock waves are generated by short light impulses of He-Ne laser in duration of 1.5 – 3 ms and transmitted by optical fibers to the stone

4. Extracorporal Shock – Wave Lithotripsy -Waves are produced outside the patient´s body and are fo-cused bythe water medium to the stone (concrement) • -Difference between acustic impedance of thecocnrement and the surrounding tissue • - Rapid start of pressure(108 Pa) on theborder lines of stone - disintegration of the stones, fragments areeliminated byurinary system • -

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

6. 2. Methods of Electrostimulation Electroconvulsion therapy- Electroshocks • used in psychiatry – pacients with schizophrenia, oligophreniaand other mental diseases • Condenser current 2-5 kV / 2-5 ms will cause strong mus-cles conctraction, and „offset“ of an electric brain activity. Defibrilation • live saving therapy • short electric discharge applied to • chest • condenser current with voltage • 5 kV, under a time 5 ms ,given • to the chest 3-times Avoid to ground patient!

7. Chronaximetry Electrostimulation of peripheral nerves and muscles usingDC current as a diagnostical test for determi-nation of chronaxy(i.e.the shortest timeunder which DC current with doubleintensity 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 curve) Used for proof of efficie-ncy of the neurosurgery treatment or in rehabili-tation

8. Diadynamic currents RectifiedAC currents or magnetic fields are used for stimulation of muscles and nerves as a therapy Effects: stimulation of tissues, spasmo- lytic, analgetic, antioedematous, tonizing using in treatment and rehabilitation Note: High-frequency electric therapy by AC with f> 100 kHz, have heating effect and are used to heat the tissues: look Diathermy

9. Electrolytic Methods 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) 2. Galvanism • treatment of skin – paralyzed muscles • application of anodal DC results in fall of pH under 7.36 and this reduces the pain feeling – strong analgetic effect • application of cathode DC results in a rise of pH above 7.4 • thus increasing the pain feeling

10. 3. Magnetic 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

11. 4. Thermic Methods • heat can be given to the body – positive thermotherapy, • or can be taken away – negative thermotherapy • effects:hyperaemia, reflexvasodilatation,spasmolytic and analgetic effects, myorelaxation Thermotherapeutical methods use:1. conduction of heat-packs, compresses (cold/warm, dry (45 -55°C)/moist, peloid, paraffin)2.convectionof heat Hydrotherapy whole body bath: hypothermic (10 – 34 °C) izothermic (34 – 36 °C) hyperthermic (37 – 42°C)

12. 2. Scottish torrents The method uses streams of cold and warm water- immunity rises up 3. Whirling baths and underwater massage hyperthermic with activation of skin receptors and hype- raemia of tissue 4. Sauna effect of hot (80 – 100°C) and dry air and a bath incold water result inhealing effect Methods which use:3.IR radiation

13. Infrared lamp Enables a local surface heating of the tissues, used in stomatology and dermatology 4.Methodswhichuse thehigh frequency electric currents, elmg. fields, microwaveswith thermal effect: DIATHERMY • short wave (27 MHz) resistive connection • ultra short wave (434 MHz) condenser connection • microwave (2400 MHz) inductive connection 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 skinand muscle • 1/3 of absorbed ultrasound is transformed to the heat

14. Ultrasound High Frequency Massage - stimulation and heating of the tissues • Frequency : 0.8 – 1 MHz • Intensity: 0.2 – 0.3 W. cm-2 • The surface of treatment: 1 – 10 cm2 Effects: - Spasmolytic effect Analgetic – removal of pain Biostimulatory–healingeffect Indications: chronic diseases of joints, muscles, nerves Contraindications: the-rapy of malignant tumors

15. 5. Light Methods 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 lightswhile rea-cting with oxygen. It results in disorder of tumor metabolism, and in tumor is destroyed. It do-es not affect DNA.

16. 3. Ultraviolet light therapy • Types:UV-A(λ = 315 -400nm), UV-B(280 -315nm),UV-C(100 - 280nm) • Source: Mercurylamp • Biological effects: Early erythema.Delayed pigmentation (within 48 – 72 hours).Production of vitamine D, Killing efect on bacteries, therefore it is used for disinfectionof surgical and biopsy room at hospitals 4. Laser radiation therapy • 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. 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/ Low Power Lasers • 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. b/ High Power Lasers 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. 6. Methods of Ionizing Radiation • Therapy by nuclear (α, β, γ, neutrons) and non-nuclear (X- • ray) radiations • Principle of effect: direct effect -production of instabile • electriccharged particles (cations, anions) in cells or • non-direct effect - creation of reactive • radicalsbecause water radiolysis Radiation geometry: intensity of radiation decreases with square of the length Comparison ofstochastic(nondepending ondosis) anddeterministic(depending on dosis) effects ofionizing radiation

20. Therapy with low energy of 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 high energy of radia- tion (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)