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Basic Therapeutic Methods in Medicine

Ján Jaku




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Basic Therapeutic Methods CLASSIFICATION

• Non-Invasive Methods
• Mechanical
• Electrostimulation
• Magnetic
• Thermal
• Optic
• Ionizing radiation

• Invasive Methods
• Mechanical Chemical
• Ultrasound
• Electrical
• Methods of vital organ
• support

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NON-INVASIVE1. Mechanical Methods
Extracorporal Shock Wave Lithotripsy

• 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
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Extracorporal Shock Wave Lithotripsy

• -Waves are produced outside the patients body
  and are fo-cused by the water medium to the stone
  (concrement)
• - Difference between acustic impedance of the
  cocnrement and the surrounding tissue
• - Rapid start of pressure (108 Pa) on the border
  lines of stone - disintegration of the stones,
  fragments are eliminated by urinary system
• -

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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)

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2. Methods of Electrostimulation
Electroconvulsion therapy- Electroshocks

• used in psychiatry pacients with schizophrenia,
  oligophrenia and 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 !
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Chronaximetry
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 WEISSS CURVE
(Strenght-duration curve)
Used for proof of efficie-ncy of the neurosurgery
treatment or in rehabili-tation
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Diadynamic currents
Rectified AC 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 gt 100 kHz, have heating effect and are used
to heat the tissues look Diathermy
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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

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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
  withdosis
• 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. Thermic 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
-55C)/moist, peloid, paraffin)
2. convection of heat

• Hydrotherapy

whole body bath hypothermic (10 34
C) izothermic (34 36 C) hyperthermic (37
42C)
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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 100C) and dry air and
a bath in cold water result in healing
effect

Methods which use
3. IR 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

• 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 skin and muscle
• 1/3 of absorbed ultrasound is transformed to the
  heat

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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
• Biostimulatoryhealing effect

Indications chronic diseases of joints,
muscles, nerves Contraindications the-rapy of
malignant tumors
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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 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 therapy

• TypesUV-A (? 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

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

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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/ 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.

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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
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6. Methods of Ionizing Radiation

• Therapy by nuclear (a, ß, ?, 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

Radiation geometry intensity of radiation
decreases with
square of the length
Comparison of stochastic (non depending on dosis)
and deterministic (depending on dosis) effects of
ionizing radiation
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• 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 ?-mesons 953 MeV) - O2 ions (3,6 GeV)