Reduction of pressure ulcer size with high-voltage pulsed current and high-frequency ultrasound: a randomised trial.

OBJECTIVE: International guidelines recommend the use of ultrasound (US) and electrical stimulation (ES) for treating chronic and recurrent pressure ulcers (PUs). The methodology of these procedures, however, still needs elaboration and confirmation by clinical studies. This parallel-group, randomised, single-blind, prospective, controlled clinical trial was conducted to determine whether by using high-frequency ultrasound (HFUS) and high-voltage monophasic pulsed current (HVMPC), the rate of change in the area of older patients' PUs can be accelerated. METHOD: Patients were randomly assigned to receive either: standard wound care (SWC) involving supportive care and topical treatments; SWC+US (1MHz; 0.5 W/cm2; 20%; 1-3 minutes/cm2); or SWC+ES (HVMPC, 154 µs, 100 pps, 100 V, 250 µC/sec, 50 minutes/day). US and ES were administered once a day, 5 days a week. The primary outcome was change in PU surface area measured against baseline after 6 weeks of treatment with SWC, SWC+US, and SWC+ES. RESULTS: We recruited 77 patients, aged 60-95 years (80% aged over 70 years of age), with 88 Category II, III and IV PUs were enrolled in the study. The percentage reduction in the surface area of PUs at the end of treatment was significantly greater in the SWC+US group (mean ± standard deviation, 77.48±11.59 %; p=0.024) and the SWC+ES group (76.19±32.83%; p=0.030) versus the control group (48.97±53.42%). The SWC+ES group also had a significantly greater proportion of PUs that decreased in area by at least 50% or closed than the control group (p=0.05 and 0.031, respectively). The SWC+US and SWC+ES groups were not statistically significant different regarding treatment results. Clinical side effects were not recorded. CONCLUSION: The results show that HFUS and HVMPC are comparable regarding their effectiveness in reducing the size of PUs in older people. DECLARATION OF INTEREST: The authors have nothing to disclose. All research activities were funded by the Academy of Physical Education, Katowice, Poland.

Early and long-term results of physical methods in the treatment of venous leg ulcers: randomized controlled trial.

OBJECTIVE: To estimate early and long-term results of physical methods in the treatment of venous leg ulcers. METHOD: In group A after surgical operation, 40 patients were treated with the high-voltage stimulation (HVS) (100 µs, 100 Hz, 100 V) and drug therapy. In group B after operation, 37 patients were treated with ultrasound (0.5 W/cm(2), 1 MHz) and drug therapy. In group C after operation, 33 patients were treated with low-level laser therapy (LLLT) (810 nm, 65 mW) and drug therapy. In group D after operation, 35 patients were treated with the compression stockings (25-31 mmHg) and drug therapy. In group E after operation, 37 patients were only treated with drug therapy. Group F consisted of 32 patients, conservatively treated with the HVS and drug therapy. Group G consisted of 20 patients, conservatively treated with ultrasound and drug therapy. Group H consisted of 21 patients, conservatively treated with LLLT and drug therapy. Group I consisted of 30 patients, conservatively treated with compression and drug therapy. Group J consisted of 27 patients only treated with drug therapy. RESULTS: Both short and long term parameters showed that compression therapy is the most efficient in ulcer healing. The electrical and ultrasound methods are less effective. The laser therapy ared useless. CONCLUSION: Superficial venous surgery in addition to compression therapy is the most efficient treatment of venous leg ulcers. The compression therapy should be continued both surgically and conservatively treated patients with healed ulcers. In special cases after superficial venous surgery (isolated superficial reflux) compression therapy could be applied only to the time of ulcer closure without continuing it longer. HVS and ultrasound therapy are useful methods in conservative treatment of venous leg ulcers. For surgically-treated patients these physical therapies are efficient only in superficial plus deep reflux cases. HVS and ultrasound can be alternative methods, but are less effective in recurrence risk. LLLT is not an efficient physical method in treatment of venous leg ulcers.

The use of therapeutic ultrasound in venous leg ulcers: a randomized, controlled clinical trial.

OBJECTIVES: To estimate the usefulness of therapeutic ultrasound for healing of venous leg ulcers. METHODS: Eighty-one patients were included in this study. Patients in groups 1 and 2 were treated surgically. Patients in groups 3 and 4 were treated conservatively. Patients in groups 1 and 3 were additionally treated with the ultrasound (1 MHz, 0.5 W/cm(2)) once daily, six times a week for seven weeks. RESULTS: Comparison of the number of complete healed wounds indicated statistically significant differences between groups 1 and 4 (P = 0.03), 2 and 4 (P = 0.03), 3 and 4 (P = 0.03) in favour of groups 1, 2 and 3. Comparison of the other parameters also demonstrated more efficient therapy effects in groups 1, 2 and 3 than in group 4. There were no statistical differences in all examined parameters between groups 1, 2 and 3 (P > 0.05). CONCLUSIONS: The ultrasound is an efficient and useful method only in conservatively treated venous leg ulcers. There are no special reasons for application of the ultrasound in surgically treated patients. A well-conducted surgical operation is much more effective for a healing process than conservative pharmacological procedures.

Application of various power densities of ultrasound in the treatment of leg ulcers.

AIM: The objective of our study was to determine which ultrasound power density (0.5 W/cm(2) or 1 W/cm(2)) is more effective at reducing the area and volume of leg ulceration. METHODS: A total of 65 patients with venous ulcers were randomly divided into three groups: A, B and C. In group A, 22 patients were treated with ultrasound rated at 1 W/cm(2) and with compressive therapy. In group B, 21 patients were treated with ultrasound rated at 0.5 W/cm(2) and with compressive therapy. In both groups the patients were treated with a pulsed wave of a duty cycle of 1/5 (impulse time=2 ms, pause time=8 ms) and frequency of 1 MHz. The 22 patients in group C (control group) were subjected to topical pharmacological treatment. RESULTS: We found a statistically significant reduction of the ulcer area, volume and linear dimensions in all three groups of patients. The ulcer area reduction rate was highest in group B. The volume reduction rate in group B was higher than in group A only. The rate of reduction of suppurate area was highest in group B. CONCLUSION: We have demonstrated that ultrasound rated at 0.5 W/cm(2) causes greater and faster changes in the healing process than ultrasound rated at 1 W/cm(2).

[Laser's biostimulation in healing or crural ulcerations]. / Biostymulacja laserowa w leczeniu owrzodzen zylnych goleni.

The objective of this paper was to evaluate effect of laser's biostimulation on the process of healing of crural ulcerations. Three comparative groups of patients, A, B and C, were made at random from the patients with venous crural ulcerations. The group A consisted of 17, the group B 15, the group C 17 patients. The patients in all comparative groups were treated pharmacologically and got compress therapy. Ulcerations at patients in group A were additionally irradiated by light of biostimulation's laser (810 nm) in this way that every time ulcerations got dose of energy 4 J/cm2. The patient's in-group B additionally got blind trial (with placebo in the form of quasi-laserotherapy). The evaluated factors were to estimate how laser's biostimulation causes any changes of the size of the ulcers and of the volume of tissue defect. The speed of changes of size and volume of tissue defect per week was calculated. After the treatment there was statistically significant decrease of size of ulcers in all comparative groups while there was no statistically significant difference between the groups observed. After the treatment there was statistically significant decrease of volume of ulcers only in groups A and C but there was no statistically significant difference between the groups observed.

[High voltage electrical stimulation in leg ulcer's treatment]. / Elektrostymulacja wysokonapieciowa w leczeniu owrzodzen zylnych podudzi.

The results of leg ulcers treatment in two comparative groups, A and B, are presented in the article. In the group A 22 patients with leg ulcers were treated with the use of high voltage electrical stimulation. In the group B 20 patients with leg ulcers were treated actively with the use of traditional methods. The average time of treating patients subjected to electrical stimulation was 7 weeks and in the control group the average time of treatment was 6 weeks. The healing progress was estimated on the basis of rate of wounds surfaces and volumes changes per week and their proportional changes. In the group A the average rate of ulcer surface decreasing was 1.4 cm2 per week and the average volume diminishing in this group was 1.0 cm2 per week. These indicators in the group B were respectively 1.0 cm2 and 0.6 cm3. In the group A wound surface decreased by 73.4% during the treatment and wound volume by 91.3%. In the group B these indicators were respectively 46.9% and 67.6%. After the treatment all indicators estimating the progress of wound healing in the groups A and B proved the statistically significant increases. The proportional indicators of wounds surfaces and volumes were significantly higher in the group A than in the group B.

[Early results of patient rehabilitation after anterior cruciate ligament reconstruction]. / Wczesne wyniki usprawniania leczniczego chorych po rekonstrukcji wiezadla krzyzowego przedniego.

In the Orthopedic Department of the Upper-Silesian Rehabilitation Center "Repty" in Ustron 54 patients have been rehabilitated after a plasty of the anterior cruciate ligament and transplantation of 1/3 middle part of the patellar ligament with two osseous blocks at each end. The rehabilitation was conducted according to the scheme worked out in our department. The results of the rehabilitation were assessed by the objective and subjective methods (for example the goniometric pendulum test, the modified Lysholm's scale, the WAS questionnaire). The patients had been divided randomly into two comparative study groups that were subject to exactly the same rehabilitation scheme, but one of the group was additionally provided with the impulsive magnetic field therapy. A satisfactory improvement was observed in both groups of patients. There was no significant advantage of additional treatment with the impulsive magnetic field.

Modern application of high voltage stimulation for enhanced healing of venous crural ulceration.

The objective of this paper was to evaluate the effect of high voltage stimulation (HVS) on the process of healing of crural ulceration. Three comparative groups of patients, A, B and C, were drawn at random from patients with venous crural ulceration. Thirty-three patients in group A were subjected to treatment with HVS. In the course of treatment, doubled-peak monophasic impulses of a total duration of 0.1 ms and frequency of 100 Hz were applied. The voltage was 100 V. Group B, made up of 32 patients treated with topically applied medicine, and group C, made up of 14 patients treated with Unna's boot were used as control. In all patients in all groups (A, B and C) a significant reduction in wound size in relation to baseline was found. The rate of wound area change was highest in group A. The rate of pus cleansing was significantly highest in group A. The degree of granulation after 2 weeks was significantly greater in group A than in the other groups (P<0.003). High voltage stimulation was an efficient method of enhancement of the healing of crural ulceration.

[Electrically enhanced damaged tissues healing. Part I: direct current in bone healing]. / Elektryczne wspomaganie gojenia uszkodzonych tkanek. Czesc I: Prad staly i pulsujacy w leczeniu kosci.

The reasons of investigators' interest of damaged tissues healing with electrical current in concise form are represented by the authors. The nonunions and pseudarthroses healing with direct current through negative polarized electrode is described in this article. Hypothetic biological healing mechanisms (as piezoelectric activity, streaming potentials, electric properties of glycosaminoglycan etc.) are discussed. Technical data of currents and their antibacterial properties are described.

[Electrically enhanced damaged tissues healing. Part II: direct and pulse current in soft tissue healing]. / Elektryczne wspomaganie gojenia uszkodzonych tkanek. Czesc II. Prad staly i pulsujacy w leczeniu tkanek miekkich. Leczenie tkanek pradem zmiennym.

Methodology of soft tissues wounds, ulcers and pressure sores healing with direct current is described by the authors. Results of clinical trials and animal experiments are represented, as well as technical and using data. Electrical properties of damaged tissues (e. i. skin battery, vascular-interstitial closed circuits etc.) and probable electrical healing mechanisms are discussed. Effects of electrical current on batteries are described. Inductive and capacitive coupling of electric and magnetic fields, and high voltage electrostimulation for enhance tissue healing are also described in the article.

Marmoset monkey trophoblastic tissue growth and matrix metalloproteinase secretion in culture.

Marmoset monkey blastocysts maintained in culture produced trophoblastic vesicles up to 4 mm in diameter that were subdivided into fragments and subcultured to produce new vesicles. These tissues are composed of an outer layer of trophoblast-like cells and an inner layer of endoderm-like cells, and resemble a blastocyst wall. When such vesicles were cultured in serum-free medium for 14 days, they increased in size but there was no significant difference in their protein content at the end of culture. The proliferation index, measured by BrdU incorporation, varied considerably within and between vesicles. The purpose of this investigation was to determine which matrix metalloproteinases are secreted by marmoset monkey trophoblastic tissue in vitro, and the effect of extracellular laminin on this secretion. It was determined by zymography that the vesicles secreted matrix metalloproteinase 2, but not matrix metalloproteinase 9, and that matrix metalloproteinase 2 was secreted as the proenzyme (72 kDa). Matrix metalloproteinases 1, 3 and 7 were not detectable in the culture medium. The addition of laminin (5-20 micrograms ml-1), either as a substrate or in solution in the medium, did not have a consistent effect on matrix metalloproteinase 2 secretion during the culture period. The vesicles were found to express both matrix metalloproteinases 2 and 9 in both types of cell when examined by immunohistochemistry. The expression of matrix metalloproteinase 9 in the vesicles, but the absence of its secretion, indicates that specific factors, possibly of endometrial origin, may be required for inducing secretion.

[Digital goniometry "Spasmometr GC-2"]. / Goniometr cyfrowy "Spasmometr GC-2".

The review of modern application of goniometric assessment in rehabilitation of patients with movement organs system disorders is done by the authors. The construction and principle of operation of digital goniometer, applied to pendulum testing of lower extremities with pathologic changed muscle tone, are described. An electro-optical transducer transmits the digitized time-dependent function of an angle between the thigh and leg axes of subject via an interface to the special computer programme. The function is registered, some coefficients describing extremity motion in joint are determined and the patient is assigned to the proper rehabilitation group by the composed programme. Normal values of the pendulum test coefficients in the asymptomatic subjects are performed.

[The QT syndrome. A family study of 4 generations]. / Das QT-Syndrom. Eine Familienstudie über vier Generationen.

Starting from two related children diagnosed with a syndrome of QT prolongation (Romano-Ward) a nearly complete family history was revealed in that 8 further patients with a QT-time over 115% of normal were found. Four additional family members had died of a sudden syncope at a young age, 2 of them in early childhood. No less than 6 sudden infant or early childhood deaths without clear cause were found in one generation of 12 members. This demonstrates the urgent necessity to examine the whole family with this syndrome in as much detail as possible. Quite often these syncopes are wrongly diagnosed as epileptic seizure. The treatment with beta-blocking medication very much improves the bad prognosis. This treatment should also include family members with QT-prolongation sofar without any symptoms.

Treatment of spinal spasticity by electrical stimulation.

We present the results and the methodology of trials using transcutaneous electrical stimulation. The aim of our work was to decrease spasticity in 44 patients with traumatic damage to the spinal cord; 35 non-electrically stimulated spastics were used as controls. Both groups were randomly selected from inpatients in the Paraplegic Department at the Hospital Rehabilitation Centre. This electrical stimulation procedure leads to a long-lasting reduction in spasticity, an increased range of passive and active movements, the facilitation of lost functions, an improvement in breathing, an increase in pulmonary capacity, the reappearance of some neurological reflexes, and a diminution of supersensitivity to skin irritation. Blood pressure and neurogenic bladder functions were restored to normal. In addition to clinical observations, we investigated muscle force and the electromyogram; other measurements used in the trials involved the use of a specially adapted neurological hammer, a pendulum test, spirometry, cystometry, sphincterometry and biochemical estimations.

[Piperacillin dosage and elimination in premature infants]. / Dosierung und Elimination von Piperacillin bei Frühgeborenen.

In 19 premature newborns (mean birth weight 1600 g, range 800-2430 g), receiving a daily dose of 100-150 mg piperacillin/kg body weight in four divided doses, serum concentration of the drug at the end of its interval of administration was a mean of 32.6 +/- 25.0 mg/l. In six mature newborns it was lower at 12.5 +/- 9.0 mg/l. The mean serum drug level on days 1, 5 and 10 in ten premature newborns at the end of the respective interval of administration was reduced to about 69% of the initial level. Elimination of piperacillin (half-life and clearance) was determined in the middle of their first week of treatment in 11 prematures. Compared with values in adults, mean half-life was increased fourfold. In individual cases it was increased tenfold. Compared with a control group of mature newborns, clearance was markedly reduced. Because of the danger of underdosage as a result of increasing maturation of elimination during the period of treatment, piperacillin should be given in slightly higher doses, 200-300 mg/kg in premature and mature newborns. However, the clearly prolonged half-life makes it possible to divide daily dosage into two doses.

[A familial brain malformation syndrome with symptomatic hypernatremia]. / Ein familiäres Hirnmissbildungssyndrom mit symptomatischer Hypernatriämie.

A familial cerebral malformation combined with chronic hypernatremia is reported. We found three children of a Moroccan family with microcephaly and hypoplasia of the frontal brain. The frontal parts of the lateral ventricles were absent. Two of the children had a defect of the midline structures with fusion of the lateral ventricles similar to holoprosencephaly. Further clinical symptoms were generalized spasticity, delay of mental development and hypodipsia.