[Cryotherapy chambers and cold-water immersion : therapeutic use and risks]. / Chambres de cryothérapie et immersion en eau froide†: utilisation thérapeutique et risques.

Whole body cryotherapy is mainly performed either by immersion in cold water or in a cryotherapy chamber. Practiced since Antiquity and considered as a «â€…natural ¼ method, cryotherapy is attracting more and more followers. Beneficial health effects have been described in the literature. However, interpretation of its effects is difficult due to low quality of current studies. Cryotherapy could however be useful in addition to conventional therapies in various pathologies and situations, provided that the risks, contraindications and rules of good practice are known.

La cryothérapie du corps entier se pratique principalement soit par immersion en eau froide, soit en chambre de cryothérapie. Pratiquée depuis l'Antiquité et considérée comme une méthode «â€…naturelle ¼, la cryothérapie tend à attirer de plus en plus d'adeptes. Des effets bénéfiques pour la santé ont été décrits dans la littérature. Néanmoins, l'interprétation de ses effets est difficile en raison de la faible qualité des études actuelles. La cryothérapie pourrait toutefois être utile en complément des thérapies classiques dans diverses pathologies et situations, à condition de connaître les risques, les contre-indications et les règles de bonnes pratiques.

Função neuromuscular do bíceps braquial em contração isométrica após termoterapia / Neuromuscular function of braquial biceps in isometric contraction after termotherapy

A alteração na temperatura de um tecido pode promover efeitos fisiológicos que levam a alterações circulatórias e nervosas, tais como vasodilatação e aumento na flexibilidade. Objetivo: Avaliar, através de uma avaliação neuromuscular não invasiva, como a termoterapia influencia na força muscular e nos sinais mioelétricos do bíceps braquial em contração isométrica. Métodos: Dezessete voluntários foram orientados a fazer contração isométrica do músculo bíceps braquial concomitantemente com a eletromiografia de superfície. A avaliação eletromiográfica e de força foram realizadas antes e após a intervenção com recursos termoterapêuticos: gelo (15 minutos) e ultrassom continuo (1MHz, 0.8W/cm2, 7 minutos). Resultados: Mostraram que as mulheres possuem menos força e ativam menos unidades motoras. No entanto, a frequência de disparos elétricos nas vias efetoras é maior, o que indica maior propensão à fadiga. Após a aplicação do calor, não foram observadas diferenças na resposta neuromuscular do bíceps braquial em contração. Já a crioterapia, promoveu redução significativa na força e no número de unidades motoras ativadas durante a contração. O resfriamento do tecido muscular promove a diminuição da ação das fibras musculares, uma vez que há redução da velocidade da condução do impulso nervoso e do reflexo do arco miotático. Além disso, a crioterapia também diminui a sensibilidade dos órgãos tendinosos de Golgi, aumenta a viscosidade sanguínea, provoca a vasoconstrição. Todos estes fatores, somam-se para culminar na diminuição da ativação neuromuscular e, consequentemente, na redução da força do músculo

The change in temperature of a biological tissue can promote physiological effects that lead to circulatory and nerve changes, such as vasodilation and increased flexibility. Objective: The objective of this study was to evaluate, through a noninvasive neuromuscular assessment, how thermotherapy influences the muscular strength and the myoelectric signals of the biceps brachial in isometric contraction. Methods: Seventeen volunteers were instructed to perform isometric contraction of the brachial biceps muscle concomitantly with surface electromyography. Electromyographic and force evaluation were performed before and after the intervention with thermotherapeutic resources that consisted of ice therapy for 15 minutes and continuous ultrasound (1MHz, 0.8W/cm2) for 7 minutes. Results: Women have less strength and fewer motor units. However, the frequency of electric inputs of the effector pathways is higher, which indicates a greater propensity to fatigue. After the application of heat, no differences were observed in the neuromuscular response of the contracting brachial biceps. The cryotherapy, however, promoted a significant reduction in the strength and number of motor units activated during the contraction. Conclusion: The cooling of muscle tissue promotes a decrease of muscle fibers activities, since there is a reduction in the velocity of nerve impulse conduction and the reflex of the myotatic arch. In addition, cryotherapy also decreases the sensitivity of the Golgi tendon organs, increases blood viscosity, and causes vasoconstriction. All these factors are combined to culminate in the decrease of neuromuscular activation and, consequently, in the reduction of muscle strength

Small cryotherapy devices for the treatment of skin warts.

STUDY PURPOSE: Effectiveness of cryotherapy on skin wart models. MATERIALS AND METHODS: Two small cryotherapy devices, Wartner and Wortie, were administered for 10″-60″ on tomatoes and potatoes used as skin wart models. Frozen surface and depth were evaluated by standardized photography and computer analysis. Tissue temperature at depths of 0.1-10 mm was assessed by an electronic thermometer during treatment. RESULTS: Cryotherapy induced a transient freezing of the tomato surface. The devices produced similar tomato tissue temperature reduction at all depths examined. At 5 mm, Wortie induced lower tissue temperatures than Wartner. Both devices induced potato tissue destruction to a depth of 0.5-1.2 mm at 40″ and 50″. Wartner induced a maximum destruction at 40″, Wortie led to a partially linear destruction depth with freezing time. The devices produced similar reduction of potato tissue temperature at all depths tested. Wartner induced more rapidly lower temperatures (1.5 mm, 10″, p = .001). Wortie induced lower tissue temperatures with time (0.1 mm, 50″, p = .025; 60″, p = .039; 5 mm, 60″, p = .05). None of the devices reached the lethal temperature of -22 °C. CONCLUSIONS: Both cryotherapy devices produced sufficient tissue damage, at least in the potatoes, to a depth of 0.5-1.2 mm when applied for 40″ (commercially proposed time).

Actualización sobre el tratamiento de las verrugas vulgares en los niños / Treatment of Warts in Children: An Update

Las verrugas víricas son una de las infecciones cutáneas más frecuentes en los niños. Aunque existen múltiples opciones de tratamiento, no hay ningún tratamiento que garantice una total eficacia con una única sesión terapéutica. En la edad pediátrica el tratamiento es particularmente complicado, no solo porque algunos métodos son mal tolerados, sino también porque a menudo las expectativas de los padres respecto a la eficacia del tratamiento son poco realistas. Este artículo proporciona una actualización sobre las diferentes terapias antiverrugas, particularmente enfocado a los pacientes pediátricos, excluyendo el tratamiento de las verrugas de la mucosa oral y anogenital

Warts are among the most common skin infections in children. Although numerous treatment options are available, none are completely effective in a single session. Treatment is particularly complicated in children, not only because certain treatments are poorly tolerated, but also because parents frequently have unrealistic expectations. In this article, we offer an update on the treatments available for warts, focusing specifically on pediatric patients. We do not discuss treatments for oral and anogenital warts

Tratamiento de verrugas víricas con sinecatequinas de té verde / Viral wart treatment with green tea sinecatechins

No disponible

The place of James Arnott (1797-1883) in the development of local anaesthesia in dentistry.

Dental disease in the form of caries and abscesses has been known since antiquity. Before the advent of anaesthesia, operations upon the mouth were painful. The introduction of general anaesthesia in the form of ether and chloroform seemed to provide a solution, but there was an unacceptable level of mortality. James Arnott introduced local anaesthesia by means of freezing with ice, which he considered safer. He waged a long campaign and his method received recognition and was used in France and the USA. His method stimulated the development of pharmacological anaesthesia.

Therapeutic devices for epilepsy.

Therapeutic devices provide new options for treating drug-resistant epilepsy. These devices act by a variety of mechanisms to modulate neuronal activity. Only vagus nerve stimulation (VNS), which continues to develop new technology, is approved for use in the United States. Deep brain stimulation of anterior thalamus for partial epilepsy recently was approved in Europe and several other countries. Responsive neurostimulation, which delivers stimuli to 1 or 2 seizure foci in response to a detected seizure, recently completed a successful multicenter trial. Several other trials of brain stimulation are in planning or underway. Transcutaneous magnetic stimulation (TMS) may provide a noninvasive method to stimulate cortex. Controlled studies of TMS are split on efficacy, which may depend on whether a seizure focus is near a possible region for stimulation. Seizure detection devices in the form of shake detectors via portable accelerometers can provide notification of an ongoing tonic-clonic seizure, or peace of mind in the absence of notification. Prediction of seizures from various aspects of electroencephalography (EEG) is in early stages. Prediction appears to be possible in a subpopulation of people with refractory seizures, and a clinical trial of an implantable prediction device is underway. Cooling of neocortex or hippocampus reversibly can attenuate epileptiform EEG activity and seizures, but engineering problems remain in its implementation. Optogenetics is a new technique that can control excitability of specific populations of neurons with light. Inhibition of epileptiform activity has been demonstrated in hippocampal slices, but use in humans will require more work. In general, devices provide useful palliation for otherwise uncontrollable seizures, but with a different risk profile than with most drugs. Optimizing the place of devices in therapy for epilepsy will require further development and clinical experience.

Design of microprobe for accurate thermal treatment of tumor.

Thermal treatment has become an alternative modality for cancer treatment. Low temperature freezing and high temperature heating kill tumor cells effectively through direct and indirect injuries by biochemical and physical stresses. Hyperthermia at a mildly elevated temperature has also been reported to induce biochemical alternations to kill tumor cells and to stimulate immunological response to prevent metastasis. The comprehensive multi-scale biological responses to different thermal history experienced demand an accurate temperature control of the thermal system used for such a treatment. A thermal system was built in our lab utilizing RF heating and liquid nitrogen cooling through a needle probe. In practice, difficulties involved in temperature measurement for in vivo monitoring and control of thermal input through two-phase LN2 flow inside the probe compromise the treatment outcome. To ensure an accurate temperature control, a new model was developed to study the dynamic freezing capacity of the cryo-probe by accounting for the probe shape and dimensions. The model was validated by experiments and used to predict the freezing processes under different conditions. Numerical simulation results showed that combined with RF heating, the system could be used to perform different treatment protocols with an accurate temperature control.

Cold therapy for the management of pain associated with deep breathing and coughing post-cardiac surgery.

BACKGROUND: Coughing has been identified as the most painful experience post cardiac surgery. METHODS: Participants (n = 32), in a randomized crossover trial, applied a frozen gel pack to their sternal incision dressing before performing deep breathing and coughing (DB & C) exercises. Pain scores from 0 to 10 at rest were compared with pain scores post DB & C with and without the gel pack. Participants were also asked to describe their sensations with the frozen gel pack, as well as their preferences for gel pack application. RESULTS: The repeated measures analysis of variance revealed a significant reduction in pain scores between pre- and post-application of the gel pack (F = 28.69, p < .001). There were 22 (69%) participants who preferred the application of the gel pack compared with no gel pack. All 32 (100%) participants would reapply the gel pack in the future. CONCLUSION: This study demonstrates that cold therapy can be used to manage sternal incisional pain when DB & C.

Agentes físicos superficiales y dolor. Análisis de su eficacia a la luz de la evidencia científica / Superficial physical modalities and pain. Analysis of their efficacy in light of the scientific evidence

Introducción: Los agentes físicos son todos los elementos físicos con que cuenta el fisioterapeuta que se emplean para intervenir en el cuerpo con fines curativos; sin embargo, el aumento de las publicaciones científicas ha llevado a un incremento en el conocimiento de la efectividad de ciertos agentes fisioterapéuticos en relación con el dolor. Materiales y métodos: Se realizó una búsqueda amplia en las bases de datos Pubmed (Medline), Physiotherapy Evidence Database (PEDro) y Centre for Reviews and Dissemination (DARE), donde la búsqueda se realizó entre el 1 de agosto y el 1 de noviembre del año 2008, con los siguientes límites: estudios publicados desde el año 2003 en adelante, escritos en idioma inglés y español, hechos en humanos; se aceptaron sólo estudios metaanálisis, revisiones sistemáticas, estudios controlados y aleatorios y guías de práctica clínica. Resultados: De los 2.477 estudios que potencialmente podrían entrar a este trabajo, al pasar por los criterios de inclusión y exclusión sólo se incluyeron para su análisis 30investigaciones.Conclusiones: Falta investigación en el estudio de los agentes físicos superficiales para el tratamiento del dolor y que son tan utilizadas actualmente; pese a esto se dispone de evidencia de buen nivel que sustenta la aplicación de ciertos agentes fisioterapéuticos en ciertas enfermedades dolorosas (AU)

Introduction: Physical agents are all of the physical elements that physiotherapists use to intervene in the body with curative intent. However, the increase in scientific publications has allowed greater knowledge to be gained on the effectiveness of certain therapeutic agents in relation to pain. Material and methods: We performed a broad, systematic search of Pubmed (Medline),the Physiotherapy Evidence Database (PEDro) and the Centre for Reviews and Dissemination(D.A.R.E) between August 1 and November 1, 2008 with the following criteria: studies published since 2003, written in English or Spanish, and performed in humans. Only metaanalyses, systematic reviews, randomized controlled trials and clinical practice guidelines were accepted. Results: Of the 2477 studies that could potentially have been included, only 30 met the inclusion and exclusion criteria. Conclusions: Further investigation is needed into commonly used physical agents. Nevertheless, there is a good level of evidence to support the use of certain therapeutic agents in some painful conditions (AU)

Early recovery of pulmonary vein conduction after cryoballoon ablation for paroxysmal atrial fibrillation: a prospective study.

AIMS: To assess the incidence of early pulmonary vein (PV) reconnection, characterize the anatomic features of the reconducting veins, and analyse the time course of their recovery in a series of consecutive patients with paroxysmal atrial fibrillation (AF) undergoing ablation with the Arctic Front Cryoballoon. METHODS AND RESULTS: We prospectively enrolled 26 patients (20 males; age 55.4 +/- 4.1) for circumferential PV cryoballoon isolation for highly symptomatic paroxysmal AF. Following isolation of all veins, we analysed PV potentials in each vein after 30 and 60 min with a circular mapping catheter. After successful electrical isolation of all 104 PV's, recurrence was observed only in three veins (2.8%) after 30 min. Two further cryoballoon applications in each of these veins lead to their isolation. These veins were still electrically disconnected at 60 min. No PV reconnection was observed in any of the other 101 veins (97.1%) at 30 and 60 min. CONCLUSION: Cryoballoon ablation of the PV's ostia is a very effective technique to achieve electrical isolation, with a very low rate of early reconnection.

Effect of topical aerosol skin refrigerant (spray and stretch technique) on passive and active stretching.

OBJECTIVES: The purpose of this study was to examine the effects of the use of a vapocoolant blend of pentafluoropropane and tetrafluoroethane (Gebauer's Spray and Stretch) on hip flexion stretching. METHODS: Thirty volunteers were randomly assigned to spray and stretch treatment and stretch only control groups. Each group was assessed pre- and posttest on passive and active hip flexion range of motion (ROM). RESULTS: Findings indicated greater posttest hip flexion gains for the spray and stretch group over the stretch only group for both active and passive ROM. Additionally, females achieved greater pre- and posttest differences on active ROM compared to males. CONCLUSIONS: Study findings suggest that spray and stretch techniques can be an effective treatment in increasing hip flexion ROM.

Are room temperature and thermal neutral synonymous terms? An investigation of common therapeutic modality control variables.

CONTEXT: Therapeutic modality control variables are thought to be thermal neutral, a term sometimes used interchangeably with room temperature. We question this common assumption. OBJECTIVE: To determine thermal neutrality of common therapeutic modality control variables. DESIGN: We performed 5 laboratory experiments, including (1) water temperature over 3 weeks in 3 different containers (glass, plastic, and polystyrene); (2) water temperature and volume of 4 beakers (2 insulated, 2 uninsulated) over 4 weeks, with 1 beaker of each type covered by polyethylene; and skin interface temperature of (3) a dry, nonheated hydrocollator pack held against the chest, (4) kitty litter applied to the knee, and (5) room-temperature ultrasound gel to the forearm. SETTING: Therapeutic modalities laboratory. PATIENTS OR OTHER PARTICIPANTS: College student volunteers were subjects in experiments 3, 4, and 5. MAIN OUTCOME MEASURE(S): We measured temperature and volume change. Data were evaluated using descriptive and interferential statistics. RESULTS: Water temperature plateaued significantly below room temperature. Temperatures significantly increased in all but the open, insulated container. Open containers plateaued at approximately 2 degrees C below room temperature and lost significant amounts of water; closed containers plateaued at room temperature with negligible water loss. In experiments 3 through 5, skin temperatures rose significantly during hydrocollator pack, kitty litter, and ultrasound gel application. CONCLUSIONS: Room-temperature water baths, dry hydrocollator packs, kitty litter, and ultrasound gel were not thermally neutral. Room temperature should not be used synonymously with thermal neutral. Care must be taken to ensure that control variables truly are controlled.

Cryoultrasound therapy and tendonitis in athletes: a comparative evaluation versus laser CO2 and t.e.ca.r. therapy.

Aim of this study is to compare the different kinds of tendonitis in athletes using cryoultrasound therapy, lasertherapy CO2 and t.e.ca.r. therapy (transfert energetic capacitive and resistive). Forty five athletes were selected; they were all affected by severe insertional tendonitis of the Achilles tendon (15 of them), of the patellar tendon (15 of them) and of the epicondylar region (15 of them) during the last two months. They were divided into three groups. The first group underwent a treatment of 12 lasertherapy CO2 sessions, the second group 12 cryoultrasound therapy sessions and the last group 12 t.e.ca.r. therapy sessions. Each patient was registered by an independent observer according to the pain before (initial V.A.S.) and after treatment (final V.A.S.) using the analogic visual range from 0 (lack of pain) to 10 (unbearable pain) and the indicator of efficacy (difference between initial V.A.S. and final V.A.S./initial V.A.S.x 100). The obtained results were expressed as a difference between the two V.A.S. values and as a parameter of effectiveness (value ranging from 0 to 100) in order to correlate the initial condition of the patients with the performed physiotherapic treatment. The obtained V.A.S. score was submitted to statistic evaluation by analysis of variance through repeated measures, taking into consideration a value of p<0.05. Possible differences among the group of patients were shown by analysis of variance through one single way by comparison among groups. Every patient benefited from the treatment. Analyzing the initial and final V.A.S. values in the three groups, statistically significant variations emerged (p<0.05). A meaningful difference resulted among the different kinds of treatment; a marked difference was noticed between laser CO2 and cryoultrasound therapy (p<0.01). No statistically significant differences were observed between t.e.ca.r. and laser CO2 therapy or between t.e.ca.r. and cryoultrasound therapy. It must be admitted that the mean difference between initial and final V.A.S. is higher in the Cryoultrasound group (7.40), than in the Laser group (6.33) compared to t.e.ca.r. group (6.74). This result would explain a higher range of effectiveness in the Cryoultrasound group (85) compared to the laser CO2 (71.9 ) and t.e.ca.r. group (77.3). It can be asserted that cryoultrasound is a useful instrument for the physician working in the sports field. It offers advantages in comparison with laser CO2. It does not show significant differences with t.e.ca.r. therapy, although it shows a better mean range of effectiveness.

[Nonoperative ablation for liver metastases. Possibilities and limitations as a curative treatment]. / Nichtoperative Ablation. Möglichkeiten und Grenzen der Ablationsverfahren zur Behandlung von Lebermetastasen unter kurativer Intention.

Under the term "nonoperative ablation" are grouped a number of heterogeneous approaches for the treatment of liver metastases, including laser-induced thermotherapy (LITT), radio-frequency therapy (RF), and cryotherapy. In general these procedures had been intended only for palliative purposes. The establishment of clinically relevant lesion size and a lack of long-term survival data were regarded as main limitations to using them with curative intention. During the last years however, new application systems have demonstrated remarkable results in RF and LITT, and some clinical studies have shown long-term survival in selected patients comparable to that for hepatic resection. We review possibilities and limitations of nonoperative ablation procedures with curative intent, highlighting the histopathological bases of thermal ablation techniques and clinical aspects such as R0 ablation and long-term survival.

Heat stroke : a review of cooling methods.

The prognosis of heat stroke in patients is directly related to the degree of hyperthermia and its duration. Therefore, the most important feature in the treatment of heat stroke is rapid cooling. Several cooling methods have been presented in the literature including immersion in water at different temperatures, evaporative cooling, ice pack application, pharmacological treatment and invasive techniques. This article describes the various cooling techniques in terms of efficacy, availability, adverse effects and mortality rate. Data suggest that cooling should be initiated immediately at time of collapse and should be based on feasible field measures including ice or tepid water (1-16 degrees C), which are readily available. In the emergency department, management should be matched to the patient's age and medical background and include immersion in ice water (1-5 degrees C) or evaporative cooling.

Cooling efficiency of cryogen spray during laser therapy of skin.

BACKGROUND AND OBJECTIVES: Cryogen spray cooling (CSC) is used extensively for epidermal protection during laser-induced photothermolysis of port wine stains and other vascular skin lesions. The efficacy of CSC depends critically on the heat transfer coefficient (H) at the skin surface for which, however, no reliable values exist. Reported values for H, based on tissue phantoms, vary from 1,600 to 60,000 W/m(2) K. STUDY DESIGN/MATERIALS AND METHODS: A simple experimental model was designed and constructed, consisting of a pure silver-measuring disk (diameter 10 mm, thickness approximately 1 mm), embedded in a thermal insulator. The disk was covered with a 10 microm thick stratum corneum layer, detached from in vivo human skin. The heat transfer coefficient of the stratum corneum/cryogen interface was measured during CSC with short spurts of atomized tetrafluoroethane. RESULTS: H was found to be dependent on the specific design of the cryogen valve and nozzle. With nozzles used in typical clinical settings, H was 11,500 W/m(2) K, when averaged over a 100 ms spurt, and 8,000 W/m(2) K when averaged over a 200 ms spurt. CONCLUSIONS: The presented model enables accurate prediction of H and thus improve control over temperature depth profile and cooling efficiency during laser therapy. Thereby, it may contribute to improvement of therapeutic outcome.

[The comparative efficacy of methods for the cryo-electropulse therapy of osteoarthrosis patients]. / Sravnitel'naia éffektivnost' metodov krioélektroimpul'snoi terapii bol'nykh osteoartrozom.

Comparative trials of two methods of cryoelectroimpulse therapy in combination with kinesitherapy and massage performed in 132 patients with osteoarthritis (OA) demonstrated that both methods relieve pain syndrome, improve peripheral circulation, condition of the neuromuscular system. Overall course effectiveness of parallel use of cryotherapy and transcutaneous electroneurostimulation (cryo-TCENS) combined with exercise and massage was found less than that of cryotherapy and sinusoidal modulated currents (cryoamplipulsetherapy). However, the effect of a single cryo-TCENS procedure was rather high. This may be explained by a labile technique which allows impact on the most painful (trigger) zones in OA patients. Thus, cryo-TCENS should be applied in short courses (maximum 6 procedures) or in single impacts in severe OA pain while cryoamplipulstherapy is more effective in courses consisting of 10-12 procedures.