A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration.

INTRODUCTION: In physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period. MATERIAL AND METHODS: The patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion. RESULTS: At 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05). CONCLUSIONS: Focused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.

Ground reaction force analysis for assessing the efficacy of focused and radial shockwaves in the treatment of symptomatic plantar heel spur.

BACKGROUND: Extracorporeal shock wave therapy is among the conservative treatments for symptomatic heel spur. OBJECTIVE: The purpose of this trial is to evaluate and compare the therapeutic effects of radial shock wave (RSWT) and focused shock wave (FSWT) applied in the treatment of symptomatic heel spur. METHODS: Fifty-five participants were randomly divided into two comparative groups that were administered FSWT and RSWT, respectively. The severity of dysfunction (Foot Function Index, FFI), ground reaction forces (GRF) and walking temporal parameters were measured in all patients at baseline and at weeks 1, 3, 6, 12 and 24 after treatment. RESULTS: In both groups, a gradual decrease in the FFI values occurred after treatment. The percentage reduction in the FFI was comparable for both groups. Statistically significant changes were only noted between some measurements of GRF and walking temporal parameters. The percentage changes in the values of the force and temporal parameters were similar between the groups. CONCLUSIONS: Both FSWT and RSWT are efficacious in the treatment of symptomatic heel spur and their therapeutic effects are comparable. Objective data registered by force platforms during walking are not useful for tracing the progress of treatment applied to patients with symptomatic heel spur between consecutive procedures.

Comparison of ultrasound therapy and radial shock wave therapy in the treatment of venous leg ulcers - clinical, pilot study.

INTRODUCTION: Venous insufficiency and venous leg ulcers each year affect more and more people, especially in developed countries. The challenge of our time is to find an effective method of treating venous leg ulcers, which will further shorten treatment time and reduce the cost of treatment. AIM: To compare the effects of treating venous leg ulcers using ultrasound therapy, radial shock wave therapy and standard care. MATERIAL AND METHODS: Group A consisted of 17 patients. Patients were treated with ultrasound therapy US power density 0.5 W/cm2, pulsed wave with a duty cycle of 1/5, and 1 MHz frequency. Group B consisted of 17 patients. Patients were treated with the radial shock wave R-ESWT using surface energy density 0.17 mJ/mm2, 100 impulses/cm2, frequency of 5 Hz and a pressure of 0.2 MPa. Group C (control group) consisted of 17 patients. Patients in this group received standard care: gauze dressing saturated in 0.9% sodium chloride and elastic bandages changed daily for 4 weeks. RESULTS: Ultrasound therapy with 1 MHz and energy power density 0.5 W/cm2 for 4 weeks resulted in an average reduction of 68% of the area of ulceration. We used for venous leg ulcers 4-week treatment with radial shock wave therapy resulting in a 38% mean percentage reduction of the ulceration area. Standard care reduces the area of ulceration by only 16%. CONCLUSIONS: The use of ultrasound therapy for the treatment of venous leg ulcers is more effective than the use of radial shock wave therapy or standard care alone.

Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy.

Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy. Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment. Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC). Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05). Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.

Shockwave therapy in selected soft tissue diseases: a literature review.

OBJECTIVE: The aim of our study is to present the current state of knowledge on the use of shockwave therapy (SWT) in the treatment of soft tissue wounds, by reviewing the available literature. METHOD: Medical databases were searched for articles using the keywords: 'shockwave AND wound healing', 'shockwave AND ulcers', 'shockwave AND burns', 'shockwave AND bedsores', 'shockwave AND diabetic foot ulcer', 'ESWT AND wound healing', 'shock wave AND diabetic gangrene'. RESULTS: A total of 14 scientific articles were included in the study which described the methodology of treatments and list the type of generator, physical parameters used during the procedure, number of treatments and the type of treated wounds. From these articles, 191 soft tissue wounds were analysed. CONCLUSION: Evidence from the articles analysed in this study suggests a beneficial effect of SWT to treat diabetic foot ulcers, venous leg ulcers, pressure ulcers and burns. SWT can be used in combination with standard treatment in soft tissue wounds.

A Randomized, Controlled Clinical Study to Assess the Effect of Anodal and Cathodal Electrical Stimulation on Periwound Skin Blood Flow and Pressure Ulcer Size Reduction in Persons with Neurological Injuries.

The use of electrical stimulation (ES) should be considered for treating nonhealing pressure ulcers (PUs), but optimal ES wound treatment protocols have yet to be established. A randomized, controlled, double-blind clinical study was conducted to evaluate the effects of cathodal and anodal high-voltage monophasic pulsed current (HVMPC) on periwound skin blood flow (PSBF) and size reduction of Stage 2 to Stage 4 PUs of at least 4 weeks' duration. Persons >18 years of age, hospitalized with neurological injuries, at high risk for PU development (Norton scale <14 points; Waterlow scale >15 points), and with at least 1 Stage 2 to Stage 4 PU were eligible to participate in the study. Persons with necrotic wounds, osteomyelitis, electronic or metal implants in the PU area, PUs in need of surgical intervention, acute wound inflammation, diabetes (HBA1c >7%), diabetic neuropathy, cancer, and/or allergies to standard wound treatments were excluded. Patients were randomly assigned to 1 of 3 groups: anodal (AG), cathodal (CG), or placebo (PG) ES. All groups received individualized PU prevention and standard wound care. In the PG, sham ES was applied; the AG and CG were treated with anodal and cathodal HVMPC, respectively (154 µs 100 Hz; 360 µC/second; 1.08 C/day), 50 minutes per day, 5 days per week, for a maximum of 8 weeks. PSBF was measured using laser Doppler flowmetry at baseline, week 2, and week 4, and wound surface area measurements were obtained and analyzed using a digitizer connected to a personal computer. Data analysis utilized the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation. Nonlinear approximation based on exponential function was used to calculate treatment time needed to reduce the wound area by 50%. In all tests, the level of significance was set at P ≤.05. Of the 61 participating patients, 20 were in the AG (mean age 53.2 ± 13.82 years), 21 in the CG (mean age 55.67 ± 17.83 years), and 20 in the PG (mean age 52.5 ± 13.18 years). PUs (baseline size range 1.01 cm2 to 59.57 cm2; duration 4 to 48 weeks) were most frequently located in the sacral region (73.77%) and classified as Stage 3 (62.29%). PSBF at week 2 was significantly higher in the AG and CG than in the PG (P <.05). Week 4 differences were not statistically significant. Wound percentage area reduction calculated at week 8 for the AG (64.10% ± 29.22%) and CG (74.06% ± 23.23%) were significantly different from PG ulcers (41.42% ± 27.88%; P = .0391 and P = .0024, respectively). In both ES groups, PSBF at week 4 and percent wound surface area reductions between weeks 4 and 8 were positively correlated, but only the AG correlation was statistically significant (P = .049). In this study, both ES modalities improved blood flow and wound area reduction rate. Studies examining optimal ES treatment times for healing to occur, the effect of comorbidities and baseline wound variables on ES outcomes, and the nature of the relationship between blood flow and healing are necessary.

The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial.

BACKGROUND: Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available. OBJECTIVE: To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs). DESIGN: Prospective, randomized, controlled, clinical study. SETTING: Three nursing and care centers. PATIENTS: Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24). INTERVENTION: All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 µs; 100 pps; 0.25 A; 250 µC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU. MEASUREMENTS: Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6. RESULTS: Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results. LIMITATIONS: The time of treatment proved insufficient for PrUs to close. CONCLUSIONS: Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.

An attempt at objective and subjective evaluation of the therapeutic efficacy of focused and radial shockwave applied to symptomatic heel spur.

PURPOSE: The experiment was designed to evaluate and compare the efficacy of focused shockwave and radial shockwave in symptomatic heel spur treatment. Postural balance tests were used to ensure the objectivity of evaluations. METHODS: Forty three patients with symptomatic heel spur were divided into two comparative groups that received respectively focused shockwave therapy (the FSWT group; 2000 impulses, 4 Hz, 0.4 mJ/mm2) and radial shockwave therapy (the RSWT group; 2000 impulses, 8 Hz, 5 bars + 2000 impulses, 8 Hz, 2.5 bars). Each patient received 5 treatments at weekly intervals. Before therapy started and 1, 3, 6 and 12 weeks after it ended, the intensity of pain experienced by the patients was assessed and static balance tests were performed on a force platform. RESULTS: Successive measurements showed that the intensity of all kinds of pain under consideration was decreasing gradually and statistically significantly in both groups. The percentage reduction in pain intensity was similar between the groups. The standard deviation of the COP in the anterior-posterior and medial-lateral directions, 95% confidence ellipse area and COP velocity kept varying throughout the experiment, but in none of the groups changes were statistically significant. CONCLUSIONS: Focused shockwave therapy and radial shockwave therapy improve the well-being of patients with symptomatic heel spur significantly and comparably. Posturography cannot deliver unambiguous data for tracking changes that the two therapies induce in these patients.

Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial.

OBJECTIVE: To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs). DESIGN: Prospective, randomized, double-blind, controlled clinical study. SETTING: Two nursing and care centers. PATIENTS: Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm) or to the control group (24 patients; mean age of 76.33 ± 12.74 years; mean WSA of 9.71 ± 6.70 cm). INTERVENTIONS: Both the ES and control groups received standard wound care and respectively, cathodal HVMPC (154 microseconds; 100 pulses per second; 0.24 A; 250 µ/s) applied continuously for 50 minutes once a day, 5 times a week, or sham HVMPC. MAIN OUTCOME: Percentage area reduction over 6 weeks of intervention. MAIN RESULTS: In the ES group, there was a statistically significant decrease in WSA after 1 week of treatment (35% ± 30.5%) compared with 17.07% ± 34.13% in the control group (P = .032). After treatment, at week 6, percentage area reduction in the ES group was 80.31% ± 29.02% versus 54.65% ± 42.65% in the control group (P = .046). CONCLUSIONS: Cathodal HVMPC reduces the WSA of Stage II and III PrUs. The results are consistent with the results of other researchers who used HVMPC to treat PrUs.

Focused and Radial Shock Wave Therapy in the Treatment of Tennis Elbow: A Pilot Randomised Controlled Study.

The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm(2)) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.

A prospective, randomized, controlled, clinical study to evaluate the efficacy of high-frequency ultrasound in the treatment of Stage II and Stage III pressure ulcers in geriatric patients.

International guidelines recommend high-frequency ultrasound (HFUS; MHz) for treating infected pressure ulcers (PUs). A 2-year, prospective, randomized, controlled study was conducted to evaluate how HFUS affects PU healing among 42 geriatric patients treated in four nursing and care centers in Silesia, Poland. Participants (age range 71-95 years,) all with wounds that did not respond to previous treatment for at least 4 weeks, were randomly assigned to the treatment group (TG) (20 with 21 PUs, mean age 83.60 ± 5.04 years) or control group (CG) (22 with 23 PUs, mean age 82.59 ± 6.65 years). All patients received standard wound care (SWC); the TG additionally was provided HFUS (1 MHz, 0.5 W/ cm2, duty cycle of 20%, 1-3 minutes/cm2; one session per day, 5 days a week). Patients were monitored for 6 weeks or until wounds closed. Percent change in wound surface area (WSA), the Gilman's parameter, the weekly rate of change in WSA, and the percentage of PUs that improved (ie, decreased in size by at least 50% or closed) were used to compare differences. Data were analyzed using Fisher's exact test, the Wilcoxon matched pairs test, and the Mann-Whitney U test (P <0.05). Mean baseline WSA and the pretreatment duration of PUs were 15.38 ± 12.92 cm2 and 1.64 ± 0.73 months and 11.08 ± 7.52 cm2 and 2.26 ± 1.42 months in the TG and CG groups, respectively. After 6 weeks of treatment, the WSA of PUs decreased significantly in both groups (P = 0.000069 in the TG and P = 0.0062 in the CG) with significantly greater improvement in the TG (an average of 68.80% ± 37.23% compared with 37.24% ± 57.84%; P = 0.047). The value of the Gilman's parameter was greater in the TG than in the CG (0.88 ± 0.62 and 0.43 ± 0.50, respectively; P = 0.018). The mean weekly change of WSA was greater in the TG than in the CG but only for Stage II PUs (3.09 ± 2.93 cm2/week and 1.08 ± 1.43 cm2/week; P = 0.045). More Stage II PUs in the TG decreased by at least 50% (11 of 14 = 78.57%) than in the CG (seven of 18 = 38.89%) (P = 0.035). In the TG, seven of 14 (50%) Stage II PUs closed, four of seven (42.86%) Stage III PUs decreased by at least 50%, and one of seven (14.29%) Stage III PUs closed; respective values for the CG are three of 18 (16.67%), three of five (60%,) and zero of five (0%) (P = 0.062, P = 0.999, P = 0.999, respectively). The study showed HFUS therapy can reduce the WSA of PUs regardless of their shape, but further research is necessary, particularly to establish how ultrasound influences the healing of Stage III and Stage IV PUs.

High-Voltage Pulsed Current Electrical Stimulation in Wound Treatment.

Significance: A range of studies point to the efficacy of electrical stimulation (ES) in wound treatment, but the methodology of its application has not been determined to date. This article provides a critical review of the results of clinical trials published by researchers using high-voltage pulsed current (HVPC) to treat chronic wounds. In describing the methodology of the trials, the article gives special attention to electric stimulus parameters, the frequency of procedures and total treatment duration. Recent Advances: HVPC is a monophasic pulsed electric current that consists of double-peaked impulses (5-200 µs), at very high peak-current amplitude (2-2.5 A), and high voltage (up to 500 V), at a frequency of 1-125 pulses per second. HVPC can activate "skin battery" and cellular galvanotaxis, and improves blood flow and capillary density. Critical Issues: HVPC efficacy was evaluated in conservatively treated patients with diabetic foot, venous leg and pressure ulcers (PUs), and in some patients with surgically treated venous insufficiency. Future Directions: The efficacy of HVPC as one of several biophysical energies promoting venous leg ulcer (VLU) and PU healing has been confirmed. Additional studies are needed to investigate its effect on the healing of other types of soft tissue defects. Other areas that require more research include the identification of the therapeutic effect of HVPC on infected wounds, the determination of the efficacy of cathodal versus anodal stimulation, and the minimal daily/weekly duration of HVPC required to ensure optimal promotion of wound healing.

A comparative clinical study on five types of compression therapy in patients with venous leg ulcers.

The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective.

A randomized, controlled clinical pilot study comparing three types of compression therapy to treat venous leg ulcers in patients with superficial and/or segmental deep venous reflux .

Compression therapy--including inelastic, elastic, and intermittent pneumatic compression--is the standard of care for venous ulcers (VLUs) and chronic venous insufficiency, but there is no consensus in the literature regarding the most effective type of compression therapy. A prospective, randomized, clinical pilot study was conducted among 70 patients with unilateral VLUs treated in a hospital dermatology department in Poland to compare three types of compression therapy (intermittent pneumatic compression, stockings, and short-stretch bandages) in persons with superficial deep venous reflux alone or combined with the segmental variety. Study endpoints were change in ulcer dimensions and proportions healed. Patients with superficial or combined superficial and deep vein insufficiency were randomly allocated to receive one of the three therapies (one of each vein type for each treatment option, six groups total). All patients received saline-soaked gauze dressings along with micronized purified flavonoid fraction, diosmin, hesperidin, and Daflon 500 once daily. Compression treatments were changed or pneumatic compression provided daily for 15 days. Wound size reduction and percentage of wounds healed were significantly higher in groups receiving intermittent pneumatic compression or stockings than in groups using short-stretch bandages (for percentage change of ulcer surface area, P = 0.02; for healing rates P = 0.01). These results warrant additional randomized controlled clinical studies with a larger sample size and longer patient follow-up.

[Serum level of selected chemokines in systemic lupus erythematosus patients taking into consideration the peripheral blood leukocyte counts]. / Stezenie wybranych chemokin u chorych na toczen rumieniowaty ukladowy z uwzglednieniem liczby leukocytów we krwi obwodoweJ.

UNLABELLED: Chemokines promote leukocyte traffic into the site of inflammation. It depends on the repertoire of chemokines synthesized locally, and the temporal expression of chemokine receptors on leukocytes among them lymphocytes B and T which play crucial role in the pathogenesis of autoimmune diseases for example in systemic lupus erythematosus (SLE). RANTES (regulated upon activation in normal T cells expressed and secreted) is chemokine influencing T cells and BLC 1 (B-lymphocyte chemoattractant 1) is chemokine which affects B cells. The aim of the study was to evaluate serum concentration of the above mentioned chemokines in treated SLE patients and to analyze the relationships between their concentration in patients group and the control one. Another aim of our study was to assess the relationships between serum levels of these chemokines and the total peripheral blood leukocyte count and between serum levels of these chemokines and absolute peripheral blood counts of the individual forms of these cells in SLE patients. MATERIAL AND METHODS: Serum levels of RANTES and BLC 1 were determined in 48 treated women with SLE and mild-to-moderate disease severity. The results were compared between the total SLE group and the control (29 healthy women). The correlation between chemokines and between their levels and peripheral blood leukocyte count were evaluated. The relationships between the analyzed chemokines were also determined in the control group. RESULTS: Lower level of RANTES in serum was revealed in patients with SLE compared to the control and the tendency to higher concentration of BLC 1 in serum was observed. No relationships were observed between the levels of these chemokines both in the SLE patients and in the control group. Whereas the negative correlations between BLC 1 and total leukocyte count and BLC 1 and absolute number of neutrophils were found without such correlation between BLC 1 the subgroup of patients with concomitant neutropenia. CONCLUSION: We suggest that in treated patients with SLE lowered level of RANTES and tendency to higher level of BLC 1 is observed which have not any connections with the peripheral blood leukocyte counts and individual forms of these cells counts.

Serum levels of selected chemokines in systemic lupus erythematosus patients.

Chemokines promote leukocyte traffic into the site of inflammation. Serum levels of monocyte chemotactic protein 1 (MCP-1), stromal cell-derived factor-1 (SDF-1), interferon-gamma-inducible protein 10 (IP-10), and interleukin-8 (IL-8) were evaluated in 48 treated women with systemic lupus erythematosus (SLE) and mild-to-moderate disease severity. The results were compared between the whole SLE group and the control (29 women). The relationships between chemokines, their concentrations, and peripheral blood leukocyte count and between the chemokines and individual leukocyte populations (polymorphonuclear leukocytes-PMNs, lymphocytes-Ls, monocytes-Ms, eosinophils) counts were determined. The relationships between the analyzed chemokines were also determined in the control. SLE subjects had significantly higher MCP-1, SDF-1, IP-10, and lower IL-8 concentrations compared to the control. Moderate, positive correlations between MCP-1/SDF-1, SDF-1/IP-10 and a negative correlation between MCP-1/IL8 were observed in the patient group. Moderate, negative correlations were found between SDF-1/total leukocyte count, SDF-1/absolute number of PMNs as well as between IP-10/total leukocyte count, IP-10/absolute PMNs, Ls, and Ms counts in peripheral blood of SLE group. We suggest that the obtained results and correlations observed between the examined parameters might be used to monitor SLE course and progression. However, further randomized clinical studies should be carried out on in untreated and treated patients with SLE.

The effects of treatment the avascular necrosis of the femoral head with extracorporeal focused shockwave therapy.

Background.Avascular necrosis of the femoral head continues to represent a major challenge for the orthopaedist and trauma surgeon. A fully effective method of treatment is yet to be introduced. After femoral head collapse, only total hip replacement can help the patient. Our study aims to assess the effects of treatment of avascular necrosis of the femoral head with extra corporeal focused shockwave therapy.Material and methods. A prospective study was carried out in patients with avascular necrosis of the femoral head, ARCO stage I-III, diagnosed by MRI imaging. Shock waves are applied under x-ray guidance. Four points are marked on the skin above the lesion. Each spot receives a dose of 1500 pulses at an energy flux density of 0.4 mJ/mm2 and a frequency of 4 Hz. Each patient undergoes 5 therapy sessions. A posturometric and stabilometric assessment is carried out before and after the therapy. Other examinations include a tensometric evaluation of the strength of the treated limb, and an assessment of pain intensity (VAS scale)and hip function (Harris hip score). Follow-up visits are scheduled at 6 weeks and 3, 6 and 12 months post-treatment.Results. Nine patients were treated with shockwave therapy at the Department of Orthopaedics and Musculoskeletal Traumatology, Medical Faculty, Medical University of Silesia, between 5 May 2011 and 1 June 2012. The patients demonstrated pain reduction and improved mobility of the treated joint (VAS score decreasing from 6.75 +/- 0.71 to 2.5 +/- 1.7; Harris hip score increasing from 55.21 +/- 15.45 to 89.21 +/- 8.26). Tensometric platform testing carried out after the treatment revealed a statistically significant difference between mean velocity of the centre of pressure (CoP) movement when walking with eyes open and closed (p<0.05) and mean CoP movement along the x (walking with eyes closed) and y (free standing with eyes closed) axes.Conclusions. 1. Extracorporeal focused shockwave therapy resulted in considerable improvement in the patients' quality of life at 6 weeks' follow-up. 2. At 6 months some patients reported intensified pain and worse hip function.

Using high-voltage electrical stimulation in the treatment of recalcitrant pressure ulcers: results of a randomized, controlled clinical study .

 The use of electrical stimulation has been studied in a variety of wounds emphasizing different variables with regard to provision of therapy. The purpose of this prospective, randomized, controlled clinical study was to evaluate the effect of high-voltage electrical stimulation (HVES) on nonhealing, lower-extremity, Stage II and Stage III pressure ulcers. Patients admitted for care and eligible to participate in the study received standard supportive care and topical treatments covered with wet-to-moist dressings. Patients assigned to the treatment arm of the study also received HVES (100 V; 100 µs; 100 Hz) continuously for 50 minutes once daily, five times per week. Patients were followed until healing for a maximum of 6 weeks. Wound tracings and measurements were obtained weekly. Over a 4-year period, 26 patients were enrolled in the treatment and 24 in the control group. Ulcers had existed for an average of 3.17 and 2.83 months in the treatment and control groups, respectively. Most were classified as Stage II (17 in the treatment and 16 in the control group) with an average baseline size of 4.54 cm2 and 3.97 cm2, respectively. Wound areas and linear measurements decreased significantly in both groups (P <0.05), but increases in granulation tissue were significant in the treatment group only (P = 0.006). Wound area, linear measurement, wound volume, and granulation tissue changes were statistically significantly greater in the treatment than in the control group starting in the second week of treatment. Week 6 surface area change was 88.9% (SD 14) in the treatment and 44.4% (SD 63.1) in the control group (P = 0.00003). Correlation coefficients between changes in wound surface area, longest length, and longest width were R = 0.96 and R = 0.98 in the treatment and R = 0.94 and R = 0.89 in the control group. HVES improved the healing rate of recalcitrant Stage II and Stage III pressure ulcers. Research to compare the effectiveness of using cathodic and anodal stimulation combined or alone and to determine the optimal duration of these two types of electrical stimulation is warranted.

Physical therapy in the treatment of venous leg ulcers: biophysical mechanisms.

UNLABELLED:  The present study sought to estimate the hemodynamic effects inside wounds after applying infrared thermography. Clinical results were analyzed to evaluate any correspondence with hemodynamic events occurring inside the wounds. METHODS: Group 1 consisted of 20 patients with venous leg ulcers (12 women, 8 men). Patients from group 1 received 1 high-voltage stimulation (HVS) procedure. Group 2 consisted of 23 patients (16 women, 7 men). Patients from group 2 received 1 ultrasound (US) procedure. Group 3 consisted of 21 patients (13 women, 8 men). Patients from group 3 received 1 low-level laser therapy (LLLT) procedure. Group 4 consisted of 23 patients (15 women, 8 men). Patients from group 4 received 1 compression therapy (CT) procedure. Group 5 consisted of 19 patients (11 women, 8 men). Patients from group 5 received 1 quasi-CT procedure. Infrared thermography was used to monitor arterial hemodynamic effects for each ulcer. Infrared thermography, based on analysis of wound surface temperatures, was used to reflect normal or abnormal arterial circulation in capillaries. The average and maximal temperatures before and after each physical procedure were measured 5, 10, 15, and 30 minutes afterward. RESULTS: The application of HVS and LLLT did not change the temperature inside the wounds. A significant temperature increase was noted after application of US and CT. The quasi-CT induced a thermal effect (only for a few minutes), but was not as intense as the effect of the compression stockings. The measurements showed a prolonged and steady thermal effect. CONCLUSION: The hemodynamic effect (improvement of arterial microcirculation inside the venous leg ulcer) is one of the most significant biophysical mechanisms of healing after clinically efficient compression therapy. Hemodynamic reactions are not basic mechanisms of high voltage stimulation and ultrasound therapy during the healing of venous leg ulcers. Computed thermography is a simple and useful tool to measure hemodynamic effects in wound healing. .