Transcript Snímka 1

Basic Therapeutic Methods in
Medicine
Ján Jakuš
1
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
2
NON-INVASIVE
1. 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
3
Extracorporal Shock – Wave Lithotripsy
-Waves are produced outside
the patient´s body and are focused 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
4
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 lenses)
5
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 muscles 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 !
6
Chronaximetry
Electrostimulation of peripheral nerves and muscles
using DC current as a diagnostical test for determination of chronaxy (i.e.the shortest time under which
DC current with double intensity of Rheobase causes AP. Rheobase is the lowest intensity of stimulating current (mA) that can cause AP
HOORWEG –WEISS´S CURVE (Strenght-duration curve)
Used for proof of efficiency of the neurosurgery
treatment or in rehabilitation
7
Diadynamic currents
Rectified AC currents or magnetic
fields are used for stimulation of
muscles and nerves as a therapy
Effects: stimulation of tissues, spasmolytic, 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
8
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
9
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
10
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 -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)
11
2. Scottish torrents
The method uses streams of cold and warm waterimmunity rises up
3. Whirling baths and underwater massage
hyperthermic with activation of skin receptors and hyperaemia of tissue
4. Sauna
effect of hot (80 – 100°C) and dry air and a bath in cold
water result in healing effect
Methods which use: 3. IR radiation
12
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)
• ultra short wave (434 MHz)
• microwave (2400 MHz)
resistive connection
condenser connection
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 between skin and muscle
• 1/3 of absorbed ultrasound is transformed to the heat
13
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–healing effect
Indications: chronic
diseases of joints, muscles,
nerves
Contraindications: therapy of malignant tumors
14
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 reacting with oxygen. It results in
disorder of tumor metabolism,
and in tumor is destroyed. It does not affect DNA.
15
3. Ultraviolet light 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
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
16
Principle of laser: atom of a substance reaches an excitation 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, antiinflamatory, 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.
17
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 astigmatism.This laser emits UV radiation causing photochemical reaction when connecting with eye and
thus takes off the corneal tissue (1 impulse removes about 0.25 mm of cornea)-works as a „contacYAG laser
tless“ scalpel
18
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
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
19
Therapy with low energy of radiation
(biggest dosis remains on surface and
close under the surface of the body)
• conventional X-ray radiation (electrons with10 MeV)
• gama radiation from radioactive sour-c
60CO (radioisotop of cobalt)
• streams of neutrons (deuterons with
50MeV)
Therapy with high energy of radiation (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)
20