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Basic T herapeutic M ethods in M edicine

Basic T herapeutic M ethods in M edicine. Ján Jakuš. Basic T herapeutic M ethods CLASSIFICATION. Non -I nvasive Methods ( NO SURGERY) Mechanical Electrostimulation Magnetic Therm al Ultrasound Optic Ionizing radiation. Invasive Methods (SURGERY IS NEEDED) Mechanical & C hemical

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Basic T herapeutic M ethods in M edicine

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  1. Basic Therapeutic Methods in Medicine Ján Jakuš

  2. Basic Therapeutic MethodsCLASSIFICATION Non-InvasiveMethods ( NO SURGERY) • Mechanical • Electrostimulation • Magnetic • Thermal • Ultrasound • Optic • Ionizing radiation InvasiveMethods (SURGERY IS NEEDED) • Mechanical &Chemical • Ultrasound • Electrical • Methods of vital organ support

  3. NON-INVASIVE1. Mechanical Methods Extracorporal Shock waveLithotripsy-affects a body surface • method of disintegration of cocnrements (in kidneys) by mechanical effect of numerous shock waves (50 –4000) with frequency 1 – 10 Hz based on pressure,ultrasound or laser energies ( Fig.1) Efficiency of this methode : 70 – 98% Risks:pain, bleeding Laser Lithotripsy-is introduced into an organ - Is based on the photoacustic phenomenon.Shock waves are generated by short light impulses of He-Ne laser under a duration of 1.5 – 3 ms and the impulses are transmitted by optical fibers to the stone directly.

  4. Extracorporal Shockwave Lithotripsy -Pressurewavesare produced by device outside the patient´s body and are focused throughthe water medium to the stone(concrement) -Difference between anresistanceof theconcrement and the surrounding tissueresistanceenablesthe stone destruction - Rapid start of destruction by pressure(108 Pa) results in a smashof the stone, hencethefragments and sandareelimina-ted byurine • -

  5. Extracorporal Shock wave Lithotripsy • Source of shock wavesare: (electric, electromagnetic,ultrasound or optic -laser) • The real source of shock waves is the condenser (as a source of voltage forcreationofwaves) • Litotripteris a device forlithotripsy • Focusing device (acusticlen-ses)

  6. 2. Noninvasive Methods of Electrostimulation Electroconvulsion therapy- Electroshocks • used in psychiatry – pacients with schizophrenia, oligophreniaand other mental diseases • Condenser current under voltage 2-5 kV / 2-5 ms will cause strong muscles conctraction, and „offset“ of an electric brain activity. Defibrilation • live saving therapy • short electric discharge is 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) is valid for artificial electricstimulation Used for proof of efficie-ncy of the neurosurgery treatment or in rehabili-tation

  8. Diadynamic currents AC currentsofdifferentshapes or magnetic fields are usedforstimulationof muscles and nervesas a therapy Effects: stimulation of tissues, spasmo- lytic, analgetic, antioedematous, tonizing using in treatment and rehabilitation Note: High-frequencyelectrictherapy by AC currentswith f> 100 kHz, has heatingeffect and are used to heat the tissues: look a Diathermy (Nave and Navebook)

  9. Electrolytic Methods 1. Ionophoresis • method based on the fact that ions with the same charge as the electrode are repelled e.g + +, or – drugs are inserted into a body by an effect of DC electric current (under time of 20 – 30 min) 2. Galvanism • treatment of skin and paralyzed muscles • application of anodal +DC results in fall of pH under 7.36 (Acidosis) and thisreduces the pain feeling (strong analgesia) • application of cathodal- DC results in a riseof pH above 7.4 (Alkalosis) thus increasing the pain feeling –stimulatoryeffect

  10. 3. Magnetic Noninvasive 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 , with intensity 5 – 80 mT. Effects of magnetic fields: • hyperaemia (tisues are oversupplied) • spasmolytic ( muscle relaxation • analgetic ( against pain) • antioedematous ( against swelling) • antiinflammatory(against inflamat) Indications:diseases of joints, muscles, nerves

  11. 4. Thermic Noninvasive 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,, paraffin)2.convectionof heat 2a . Hydrotherapy whole body bath: hypothermic (10 – 34 °C) izothermic (34 – 36 °C) hyperthermic (37 – 42°C)

  12. 2b. Scottish torrents The method uses streams of cold and warm water- immunity rises up 2c Whirling baths and underwater massage hyperthermic baths with activation of skin receptors and hyperaemia of tissue 2.D Sauna effect of hot (80 – 100°C) and dry air and a final bath in cold 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, microwaves(allwith the thermal effect: DIATHERMY) • short wave (27 MHz) resistive connection • ultra short wave (434 MHz) condenser connection • microwave (2400 MHz) inductive connection 5. Noninvasive Ultrasound Methods • 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,tendons and nerves Contraindications: the-rapy of malignant tumors

  15. 5. Light Noninvasive 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 is activated by visible or laser lightswhile reacting with tissue oxygen. This activation results in disorder of tumor metabolism, and a tumor is destroyed. It does 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 autopsy rooms at hospitals 4. Laser radiation therapy • Point is : light amplification by stimulated emission of fotons. • Laserconsists 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 (Fotons amplification) a/ Low PowerLasers • soft – lasers with a maximal power of 500 mW • Treatment effects:analgetic, anti- inflamatory, biostimulating • local application – skin (the lasers of a visiblelight spectrum are used) • deep application – muscles, bones, (the lasers with longer wavelengths in IR spectrum are used,aswell)

  18. b/ High Power Lasers Solid YAG laser-used for photocoagulation of Lens-cataract (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 non-stable 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 with energy of 10 MeV) • gama radiation from radioactive source 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)

  21. INVASIVE METHODS 1. Mechanical and chemical 1. Rotary and elevator instruments Are widely used in surgery and stomatology (scalpels, tweezers, peans) 2. Water scalpel • cuts tissues by narrow water torrent (isotonic solution of NaCl) • device consists of: pressure pump, high pressure hose and water engine • skin cuts are smooth and thin Instruments

  22. 3. Cryocauthery instruments Are used for deep freezing of tissues (from 25°C to -190°C) – liquid N2 is used.The cooling must be fast. If the cooling is slow , than water molecules change into the ice crystals and these may damage the cells during rewarming. Advantage: anaesthetic effect of cold, small destructionof the tissue,no bleeding Using: ophthalmology, gyneacology, urology, oncology

  23. 2. Ultrasound Invasive Methods • ultrasound (US) with high intensity (50 – 1000 W/cm2) • selective destruction of tissues High frequency focusing US (1 – 3 MHz) Low frequency US (20 – 50 kHz) Ultrasound is produced bypiezo- electric crystal and conducted by special wave- conducting system, that amlifies the amplitude by 10 times. US scalpel oscilates in re-sonance with transformer´s fre-quency. It is widely used in oto-laryngology and neurosurgery.

  24. Phacoemulsificator This device is utilised for extrac-tionof cloudy lense (cataract). Method is based on low frequency ultrasound application, which destructs the cloudy lense.Lense is then coagulated and sucked off. extraction of cloudy lense 3.ElectricalInvasive M. Electrotomy and electrocoagulation • use effect of HF electric currents> 100 KHz • production of heat by contact ofdifferent electrode with tissue –result: water is evaporated and cells are destructed. This enables a tissue coagulation andclos- ngthevessels– i.ethe skin cuts do not bleed

  25. 4. Noninvasive methods of vital organ support 1. Breathing support – artificial respiration • is used when no spontaneous respi- ration is present apnoe, or by pulmo- nary insufficiency- partial presure of oxygen in arterial blood is < 5kPa, pH<7.25VENTILATORS • pressure controled ventilators-switch inspirationto expiration by setting of pressure of inhaled air • volume controled ventilators-can set inspiratory volume of breathing and its frequency - optimal value of pulmo- nary ventilation

  26. Parameters which can by set up on the ventilator: (normal values) • respiratory exchange ratio (TI:TE=1:1.5 or 1:2) • respiratory frequency (8 – 24 /min) • inspiratory oxygen concentration (20 – 100%) • inspiratory pressure (maximal value is 7 kPa) • postinspiration time (between end of inspiration and the start of expiration)control of PaO2 (by oxymetry) and PaCO2(by capnogram) Special type: CPAP (continuous positive airway pressure)

  27. 2. Substitution of Heart function –Extracorporal Circulation Supporting Device Blood pump – elastic tube and rotor with 2 valves – they rotate, compress the tube and drive the blood forward. Amount and pressure of blood is regulated by turning the pump rotation Oxygenator– substitutes the lung function, blood is eliminated from CO2 and is saturated by O2 Warmer device – modifies the temperature of oxygenated blood which returnes to the body to 37.5 °C

  28. 2. Extracorporeal Circulation - scheme

  29. 2.Heart substitutions • transplatantion of human´s heart, problems with donors • implantation of artificial heart dri- ving of pump is provided by pressure ofcompressed air, suitable non-iritable material is used (imunology) • surgery substitution of coronary ar- teries (bypass) and heart valves (be- cause of stenosis or insufficiency) PACEMAKING – uses DC current to treat the „sick sinussyndrom“ therapy artificial heart pacemaker

  30. 3. Artificial kidney - hemodialysis Enables to treat the intoxications or disordersaffecting the function of kidney– it is based upon filtration, resorbtion Basic parts of this device: • Extracorporeal blood circulation- see the previous chapter • Dialysing circulation – circle which provides flow and preparationof dialysing solution – by mixing water and NaHCO3,pH is changed to 7.36 and osmolarity to 5300 mOsm/l (as in bloodplasma). Integrity of dialysing membrane is controled by detection of hemoglobine amount. Temperature of dialysing solution is kept on the same value.

  31. Dialyser – is divided into 2 parts (blood part and dialy-sing part) bydialysing membrane. Blood flows by laminary streaming (200 – 300 ml/min) on the one side of the membrane and passes the dialysing membrane. Dialysing solutionflows in an opposit direction by turbulent streaming (500ml/min) on the other side of the membrane. It results in increasing of concentration gradient, which leads to rapid diffusionof low weight molecules-toxic substances (urea, aceton) fromblood to dialysing solution. Velocity of ultrafiltration and amount of water can be regulated by transmembrane pressure .

  32. 3. Artificial kidney-scheme of hemodialysis and peritoneal dialysis Peritoneal dialysis– peritoneum works as a filter for hemo-perfusion, hemofiltration ( intoxication treatment and liver failure disorders) Hemodialysis Peritoneal dialysis

  33. 4. Artificial lenses are implanted because of eye injuries or the cataract Composition of lens: • optic part – increases refractive power of the eye • haptic part – for mechanical fixation in the eye ball Types: • solid and hard (polyme- tacrylate) • soft ( hydrogels,jelly matters)

  34. 5. Cochlear electrode implants for deaf patients whose conduction of APsthrough the acoustic nerve retained intact Multiple electrode stimulating sys- tem consists of 2 parts: External part • sound processor • sensitive microphoneamplifier • transmitter Internal part • receiver implanted under the skin • electrode system-is inserted into Scala media of theCochlea near to basilar membrane in the vicini-ty of the acustic nerve

  35. 6. Prothesis of limbs • Mechanical prothesis – of knee and ankle, enable walking with assistance • Bioprothesis – biosignals conducted from device by needle electrodes into preserved muscles. There is a lack of feedback between afferent and efferent signals. Mechanism of unit can be electric and hydraulic. • Biomanipulator – bioprothesis of new generation – more complicated functions with feedback from sensors • Endoprothesis– artificial joints being made from special steel (knee, hip joint)

  36. 7. Injection pumps • enable to assure an exact timetable for drug´s application into the blood circulation • to speed a dose, quantify of injcted solution, a time of application, all functions can be seen on display • operation of the pump is controlled by PC microprocessor, with ability to choose the mode Trombolytic pumps Druge.g.heparine(which dissolve the clots or prevents its formation) is applied into the blood by a pulse of compressed air Insulin pumps Automatic programmable insu-lin applicator device with auto-matic control of sugar level in blood

  37. Thanks For Your Attention!

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