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2.
Medicine (Baltimore) ; 98(42): e17632, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626148

RESUMO

This study retrospectively analyzed the feasible effectiveness of ultrasound-guided acupotomy (USGAP) for the treatment of frozen shoulder (FS). A total of 36 patients with FS were analyzed in this retrospective study. All 36 patients received extracorporeal shock-wave therapy (ESWT). In addition, 18 of them also underwent USGAP intervention and were assigned to a treatment group, while the other 18 patients did not receive such intervention and were assigned to a control group. The primary efficacy endpoint was pain intensity, as measured by the Numeric Rating Scale (NRS). The secondary efficacy endpoint was assessed by the score of shoulder pain and disability index (SPADI). Furthermore, the adverse events were also documented during the treatment period. All efficacy endpoints were measured after the treatment. After treatment, patients who received USGAP exerted better efficacy endpoints in pain relief, as measured by NRS scale (P < .01), and shoulder disorders, as evaluated by SPADI (P < .01), than subjects who did not receive USGAP. Additionally, no adverse events occurred in either group. The results of this study indicated that USGAP may be used for the treatment of FS effectively. More studies are still needed to warrant the present results.


Assuntos
Terapia por Acupuntura/métodos , Bursite/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Terapia Assistida por Computador/métodos , Ultrassonografia/métodos , Bursite/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Retrospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(39): e17328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574868

RESUMO

INTRODUCTION: Gastric leiomyosarcoma (LMS) is a rare malignancy with minimal therapeutic options and has poor prognosis once metastasis develops. PATIENT CONCERNS: A case of gastric LMS with multiple metastases, pain, and progressive anemia 13 months after the initial diagnosis in a 43-year-old woman. DIAGNOSIS: Gastric LMS with liver metastases and multiple retroperitoneal lymphatic metastases. INTERVENTIONS: Minimally invasive therapies of repeated tetrahydropalmatine and oxaliplatin-based transarterial chemoembolization and high-intensity focused ultrasound treatment were performed. OUTCOMES: The treatments resulted in significant pain relief (numerical rating scale from 8-2 points) after the initial treatment, improvement in performance status and quality of life, and a progression-free survival of 4 months after treatment. CONCLUSION: This combined modality palliative treatment approach was well tolerated with noticeable pain relief.


Assuntos
Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Leiomiossarcoma/patologia , Manejo da Dor/métodos , Dor , Qualidade de Vida , Neoplasias Gástricas/patologia , Adulto , Terapia Combinada/métodos , Feminino , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/secundário , Imagem Multimodal/métodos , Estadiamento de Neoplasias , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor/métodos , Cuidados Paliativos/métodos , Intervalo Livre de Progressão , Resultado do Tratamento
4.
Oxid Med Cell Longev ; 2019: 5738368, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31485296

RESUMO

Diabetic foot ulcers (DFUs), the most serious complication of diabetes mellitus, can induce high morbidity, the need to amputate lower extremities, and even death. Although many adjunctive strategies have been applied for the treatment of DFUs, the low treatment efficiency, potential side effects, and high cost are still huge challenges. Recently, nanomaterial-based drug delivery systems (NDDSs) have achieved targeted drug delivery and controlled drug release, offering great promises in various therapeutics for diverse disorders. Additionally, the radial extracorporeal shock wave (rESW) has been shown to function as a robust trigger source for the NDDS to release its contents, as the rESW harbors a potent capability in generating pressure waves and in creating the cavitation effect. Here, we explored the performance of oxygen-loaded nanoperfluorocarbon (Nano-PFC) combined with the rESW as a treatment for DFUs. Prior to in vivo assessment, we first demonstrated the high oxygen affinity in vitro and great biocompatibility of Nano-PFC. Moreover, the rESW-responsive oxygen release behavior from oxygen-saturated Nano-PFC was also successfully verified in vitro and in vivo. Importantly, the wound healing of DFUs was significantly accelerated due to improved blood microcirculation, which was a result of rESW therapy (rESWT), and the targeted release of oxygen into the wound from oxygen-loaded Nano-PFC, which was triggered by the rESW. Collectively, the oxygen-saturated Nano-PFC and rESW provide a completely new approach to treat DFUs, and this study highlights the advantages of combining nanotechnology with rESW in therapeutics.


Assuntos
Complicações do Diabetes/terapia , Pé Diabético/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Oxigenação Hiperbárica/métodos , Oxigênio/uso terapêutico , Cicatrização/fisiologia , Animais , Humanos , Oxigênio/administração & dosagem , Oxigênio/farmacologia , Ratos
5.
Rehabilitación (Madr., Ed. impr.) ; 53(3): 214-218, jul.-sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-185559

RESUMO

Las lesiones musculares son frecuentes en el ámbito laboral. Se producen por el mecanismo de traumatismos directos o indirectos bruscos, que ocasiona una rotura de sus fibras, provocando hematomas. Actualmente no existe un modelo único protocolizado de tratamiento. Presentamos el caso de un paciente diagnosticado de rotura muscular completa del delgado plantar por mecanismo traumático indirecto (elongación muscular brusca), con hematoma asociado de gran volumen. Se realizó estudio clínico mediante ecografía, resonancia magnética (RM), escala visual analógica (EVA) para valoración del dolor al inicio y al finalizar el tratamiento (3 semanas), así como la duración de su incapacidad laboral. Recibió terapia con ondas de choque electromagnéticas focales (OCEF) según protocolo. Al finalizar el tratamiento se objetivó una desaparición del hematoma y no hubo complicaciones. Las OCEF pudieran ser una alternativa terapéutica complementaria al tratamiento convencional en esta afección, no obstante, sería necesario proseguir la investigación incluyendo un mayor número de pacientes, y a través de estudios aleatorizados con grupo control


Muscle injuries are frequent in the workplace. They are produced by sudden direct or indirect trauma that involves a rupture of the fibres, causing bruising. Currently, there is no single protocol-based model of treatment. We present the case of a patient diagnosed with complete muscular rupture of the plantaris muscle by an indirect traumatic mechanism (abrupt muscular elongation), with an associated large-volume hematoma. Clinical study consisted of ultrasound, magnetic resonance (MR), pain assessment (VAS) at the beginning and at the end of the treatment (3 weeks), as well as duration of occupational disability. The patient underwent extracorporeal shockwave therapy (ESWT) according to the protocol. At the end of treatment, the hematoma was resolved and there were no complications. ESWT could be a complementary therapeutic alternative to conventional treatment in this entity. However, there is a need for further, randomised controlled studies including a larger number of patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Tratamento por Ondas de Choque Extracorpóreas/métodos , Músculo Esquelético/lesões , Hematoma/diagnóstico por imagem , Ruptura/terapia , Manejo da Dor/métodos , Traumatismos do Pé/terapia , Terapia por Exercício/métodos
6.
Medicine (Baltimore) ; 98(33): e16870, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415424

RESUMO

BACKGROUND: Although several trials have reported the use of extracorporeal shock wave therapy (ESWT) for mild to moderate carpal tunnel syndrome (CTS), little is known about the efficacy of ESWT. Thus, we performed a meta-analysis to evaluate whether ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in CTS. METHODS: Six randomized controlled trials investigating the effect of ESWT on CTS were retrieved from PubMed, Embase, and the Cochrane Library. We performed a pairwise meta-analysis using fixed- or random-effects models. RESULTS: ESWT showed significant overall effect size compared to the control (overall Hedge g pooled standardized mean difference (SMD) = 1.447; 95% confidence interval [CI], 0.439-2.456; P = .005). Symptoms, functional outcomes, and electrophysiologic parameters all improved with ESWT treatment. However, there was no obvious difference between the efficacy of ESWT and local corticosteroid injection (pooled SMD = 0.418; 95% CI, -0.131 to 0.968; P = .135). A publication bias was not evident in this study. CONCLUSION: Our meta-analysis revealed that ESWT can improve symptoms, functional outcomes, and electrophysiologic parameters in patients with CTS. Further research is needed to confirm the long-term effects and the optimal ESWT protocol for CTS.


Assuntos
Síndrome do Túnel Carpal/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
7.
Support Care Cancer ; 27(11): 4039-4041, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31446484

RESUMO

PURPOSE: Cancer patients sometimes show immobilizing musculoskeletal conditions which prohibit active exercise due to severe bodily pain. Therefore, before starting a rehabilitative exercise program, the pain has to be reduced to enable the patient to participate actively in the exercise program. Extracorporeal shock wave therapy (ESWT, the application of radial and/or focused shock waves with low or high energy) has been shown to be effective and efficient in the treatment of musculoskeletal disorders. However, one historical paradigm was the fact that, in the past, cancer was seen as a contraindication for the use of ESWT. METHODS: Clinical note to present indications, benefits, and contraindications of shock wave treatment in cancer patients. RESULTS: Malignant tumors in the treatment area have to be seen as a contraindication for the use of ESWT treatment. Cancer itself-in the form of the underlying disease-is not a contraindication for the treatment with radial and focused shock wave therapy with low or high energy. Plantar fasciitis and calcaneal spurs, calcified shoulder, tennis elbow or Achilles tendinopathy, and delayed healing and chronic wounds are typical approved standard indications for ESWT, and are allowed when the malignant tumor is not in the treatment area. There are also other musculoskeletal and non-musculoskeletal indications (e.g., myofascial syndrome, erectile dysfunction, polyneuropathy, and lymphedema) that are relevant for cancer survivors. These indications are recommended by the International Society for Medical Shockwave Treatment (ISMST) for "common empirically tested clinical use" and as exceptional indications/expert indications. CONCLUSION: ESWT is a safe and relevant modality for the supportive care and rehabilitation of cancer patients.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Neoplasias/reabilitação , Cuidados Paliativos/métodos , Sobreviventes de Câncer , Feminino , Humanos , Masculino , Neoplasias/mortalidade , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(31): e16660, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374039

RESUMO

INTRODUCTION: Primary hepatocellular carcinoma (HCC) is one of the most common malignancies, only 10% to 20% of HCC patients are surgically resectable as most of the patients are diagnosed at advanced stages at presentation. The efficiencies of transcatheter arterial chemoembolization (TACE), high-intensity focused ultrasound (HIFU), and three-dimensional conformal radiation therapy (3D-CRT) in patients with advanced HCC have been clinically confirmed. We here report a patient with HCC accompanied by venous tumor thrombus, who was treated with the combination of these 3 therapies. The patient survived for 16 months with good quality of life. PATIENT CONCERNS: The patient was a 72-year-old male with a primary multicentric HCC accompanied by tumor thrombus in the right hepatic vein. The patient had the symptoms of abdominal distention and liver pain. He refused sorafenib treatment because of personal reason. DIAGNOSIS: Primary multicentric HCC stage IIIB cT4N0M0, accompanied by tumor thrombus in the right hepatic vein; chronic viral hepatitis B; and hepatitis B virus-related decompensated liver cirrhosis. INTERVENTIONS: TACE + HIFU + 3D-CRT. OUTCOMES: The patient had an overall survival of 16 months with good quality of life. Compared with monotherapy, the combined therapy significantly prolonged patient survival time with improved clinical benefits. CONCLUSION: The combination of TACE, HIFU, and 3D-CRT is safe and effective in the treatment of advanced HCC, which provides a possible comprehensive treatment strategy for advanced HCC.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Neoplasias Hepáticas/terapia , Radioterapia Conformacional/métodos , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/patologia , Terapia Combinada , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/patologia , Masculino , Estadiamento de Neoplasias , Trombose Venosa/etiologia
9.
J Orthop Surg Res ; 14(1): 248, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387611

RESUMO

BACKGROUND: Tennis elbow or lateral epicondylitis is a common source of pain among craftsmen. Although it cannot be completely resolved, extracorporeal shock wave therapy (ESWT) and ultrasonics (US) have been found to be effective for tennis elbow as highlighted in previously published randomized controlled trials (RCTs) and reviews. However, the efficacy of these two therapies in treating tennis elbow is unknown. This meta-analysis compares the effectiveness of ESWT and US in relieving pain and restoring the functions of tennis elbow following tendinopathy. METHODS: RCTs published in the PubMed, Embase, Cochrane Library, and SpringerLink databases comparing ESWT and US in treating tennis elbow were identified by a software and manual search. The risk of bias and clinical relevance of the included studies were assessed. Publication bias was explored using funnel plot and statistical tests (Egger's test and Begg's test). The major outcomes of the studies were analyzed using the Review Manager 5.3. RESULTS: Five RCTs comprising five patients were included in the present meta-analysis. The results revealed a significantly lower VAS score of pain in the ESWT group (1 month: MD = 4.47, p = 0.0001; 3 months: MD = 20.32, p < 0.00001; and 6 months: MD = 4.32, p < 0.0001) compared to US. Besides, the grip strength was markedly higher 3 months after the intervention in ESWT (MD = 8.87, p < 0.00001) than in the US group. Although no significant difference was observed in the scores of the elbow function after 3 months of treatment (SMD = 1.51, p = 0.13), the subjective scores of elbow functions were found to be better in the ESWT group (SMD = 3.34; p = 0.0008) compared to the US group. CONCLUSIONS: Although there was no significant difference in the elbow function evaluation scores between ESWT and US, the superiority of the ESWT group in the VAS of pain (both at 1 month, 3 months, and 6 months follow-ups) raised grip strength in ESWT group and the scores for subjective evaluation of efficacy indicated that ESWT offers more effective therapy for lateral epicondylitis than US therapy.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Cotovelo de Tenista/terapia , Ondas Ultrassônicas , Tratamento por Ondas de Choque Extracorpóreas/normas , Seguimentos , Humanos , Manejo da Dor/métodos , Manejo da Dor/normas , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Cotovelo de Tenista/diagnóstico , Resultado do Tratamento , Terapia por Ultrassom/métodos , Terapia por Ultrassom/normas
10.
J Orthop Surg Res ; 14(1): 234, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337441

RESUMO

BACKGROUND: Acute injuries of the hamstring muscle complex (HMC) type 3b (interfascicle/bundle-tear) are frequently observed in various sports disciplines both in elite and recreational sport. The treatment of choice of acute HMC injuries type 3b is a progressive physiotherapeutic exercise programme. Besides this, there is currently only insufficient scientific evidence to support other treatment methods, including local infiltrations and injections of platelet-rich-plasma. Very recently, it was demonstrated that extracorporeal shock wave therapy (ESWT) may accelerate regeneration after acute skeletal muscle injury. The aim of the present study is to test the hypothesis that the combination of radial ESWT (rESWT) and a specific rehabilitation program (RP) is effective and safe in treatment of acute HMC injury type 3b in athletes, and is statistically significantly more effective than the combination of sham-rESWT and RP. METHODS: We will perform a double blind, randomized, sham-controlled clinical trial at the clinic KinEf Kinesiología Deportiva, Ciudad Autónoma de Buenos Aires, Argentina. Forty patients with acute HMC injury type 3b will be randomly allocated to receive either rESWT (nine rESWT sessions; three sessions per week; 2500 radial extracorporeal shock waves (rESWs) per session; energy density depending on what the patient tolerates) or sham-rESWT. In addition, all patients will receive a specific rehabilitation program that will last for 8 weeks. The primary outcome measure will be the individual time (days) necessary to return to play. Secondary outcomes will include the presence or absence of reinjury during a time period of 6 months after inclusion into the study. DISCUSSION: Because of the lack of adequate treatment options for acute HMC injury type 3b in athletes and particularly the high reinjury rate, we hypothesize that the results of this trial will be of importance and have impact on clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov ID NCT03473899 . Registered March 22, 2018.


Assuntos
Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/reabilitação , Tratamento por Ondas de Choque Extracorpóreas/métodos , Músculos Isquiotibiais/lesões , Adolescente , Adulto , Traumatismos em Atletas/terapia , Terapia Combinada/métodos , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Placebos , Estudos Prospectivos , Lesões dos Tecidos Moles/reabilitação , Lesões dos Tecidos Moles/terapia , Resultado do Tratamento , Adulto Jovem
11.
Br J Radiol ; 92(1099): 20190073, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31166700

RESUMO

OBJECTIVES: To evaluate the value of preoperative MRI features and laboratory indicators in predicting the early response of hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization (TACE) combined with high-intensity focused ultrasound (HIFU) treatment and to establish a preoperative prediction model. METHODS: A total of 188 patients with 223 tumors who underwent TACE/HIFU treatment from January 2011 to June 2017 were included. Tumors were divided into three groups (< 2 cm, 2 - 5 cm,> 5 cm) and classified as non-complete response (NCR) and complete response (CR) cohorts according to the Response Evaluation Criteria in Cancer of the Liver (RECICL) 2015 revised version. Univariate analysis and multivariate logistic regression analysis were used to determine independent predictors, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic power of each predictor. The prediction model was derived on the ß coefficient of the multivariate regression analysis of the predictors. RESULTS: Irregular margins in the 2 - 5 cm group were closely related to early NCR. Irregular margins, arterial peritumoral enhancement and abnormal alpha-fetoprotein (AFP) were independent predictors of early NCR in the > 5 cm group. The prediction model of this group suggests that irregular margins combined with arterial peritumoral enhancement and abnormal AFP combined with irregular margins and arterial peritumoral enhancement predict an increased risk of early NCR. CONCLUSION: Irregular margins of 2 - 5 cm tumors and irregular margins, arterial peritumoral enhancement, and abnormal AFP of tumors > 5 cm can be applied to predict the early response of HCC to TACE/HIFU treatment. ADVANCES IN KNOWLEDGE: TACE combined with HIFU treatment may be able to significantly improve survival in patients with advanced HCC. Conventional MRI features and laboratory indicators are readily available without complex post-processing. It is feasible to predict the response of HCC after TACE/HIFU treatment based on preoperative conventional MRI features and laboratory indicators, the combination of multiple features predicts high-risk of non-complete response.


Assuntos
Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Neoplasias Hepáticas/terapia , Imagem por Ressonância Magnética/métodos , Cuidados Pré-Operatórios/métodos , Adulto , Carcinoma Hepatocelular/diagnóstico por imagem , Feminino , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
J Wound Care ; 28(6): 383-395, 2019 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-31166864

RESUMO

OBJECTIVE: The objective of this paper is to present the secondary safety and efficacy outcomes from two studies of focused extracorporeal shockwave therapy (ESWT) used adjunctively with standard care in the treatment of neuropathic diabetic foot ulcers (DFU) (1A or 2A on the University of Texas grading scheme), compared with sham treatment and standard care. METHOD: We carried out two multicentre, multinational, randomised, sham-controlled, double-blinded, phase III clinical studies using standard care with adjunctive focused ESWT compared with sham treatment and standard care in patients with a DFU. DFUs that did not reduce in volume by at least 50% over two weeks' standard treatment were included. DFUs were randomised and managed with standard care and focused ESWT (pulsed acoustic cellular expression; dermaPACE System, SANUWAVE Health, Inc.) active therapy, or with standard care and sham treatment, four times over a two-week treatment phase in study 1 and up to eight times over 12 weeks in study 2. Standard care continued in both studies throughout the 12-week treatment phase. Secondary outcomes were indicators of wound closure and progression, pain, infection, amputation and recurrence, and device reliability. Efficacy-related secondary endpoints were measured at 12, 20 and 24 weeks. The studies were analysed separately and following statistical comparison to justify the method, as a pooled data set. RESULTS: Wound area reduction (48.6% versus 10.7%, p=0.015, intention to treat (ITT) population with last observation carried forward (LOCF)) and perimeter reduction (46.4% versus 25.0%, p=0.022, ITT population with LOCF) were significantly greater in the active therapy group compared with the sham-treated group, respectively. The difference in time to wound closure in the pooled ITT population was significantly in favour of the active therapy group (84 days versus 112 days for 25% of subjects to reach wound closure in the active and sham-treated groups, respectively; p=0.0346). The proportion of subjects who achieved wound area reduction (WAR) from baseline at week 12 of ≥90% was significantly higher in the active therapy group. The incidence and nature of infection were consistent with previously published studies, and pain was not increased in the active therapy group. Amputation was insignificantly higher in the sham-treated group and recurrence did not differ. The ESWT device was found to be reliable. CONCLUSION: The outcomes for the primary and secondary endpoints from these studies show that ESWT administered adjunctively with standard care is an effective advanced therapy for neuropathic DFUs (grade 1A and 2A) that do not respond to two weeks' standard care alone by reducing wound volume by at least 50%.


Assuntos
Pé Diabético/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Cicatrização , Idoso , Amputação/estatística & dados numéricos , Pé Diabético/complicações , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Recidiva , Resultado do Tratamento , Infecção dos Ferimentos/epidemiologia
13.
Oncology ; 97(1): 44-48, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31071712

RESUMO

Prostate cancer (PrC) is one of the most common tumors diagnosed in men. The detection rate of localized PrC has been dramatically enhanced by screening and the development of visualization methods. There are currently several techniques for focal treatment available, among which the most interesting in our opinion is high-intensity focused ultrasound (HIFU). Currently, HIFU hemiablation of PrC is not an established treatment, although evidence of its effectiveness and safety is growing. We have been performing HIFU hemiablation since 2013 and here report our results to add to the evidence on the effectiveness of the technique. Between October 2013 and December 2016, we performed HIFU hemiablation of the prostate for a total of 35 patients with confirmed PrC stage

Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Recidiva Local de Neoplasia/radioterapia , Neoplasias da Próstata/radioterapia , Terapia de Salvação , Idoso , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Próstata/patologia , Próstata/efeitos da radiação , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia
14.
Medicine (Baltimore) ; 98(20): e15523, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096453

RESUMO

BACKGROUND: Knee osteoarthritis (KOA) is a major cause leading to chronic bone and muscle pain. Extracorporeal shock wave therapy (ESWT) has been applied in treating KOA in recent years. METHODS: From April 2016 to April 2017, 82 patients were diagnosed with KOA that received ESWT were selected as the ESWT group. The treatment parameters were as follows, 2.0 bar, 0.25 mJ/mm, and 8 Hz/s for twice a week for 4 weeks continuously. In addition, 104 patients receiving oral administration of nonsteroidal anti-inflammatory drugs (NSAIDs) from April 2015 to April 2016 were also selected as the NSAIDs group. At 4, 8, 12, and 16 weeks upon the completion of treatment, the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were adopted to evaluate the changes in pain and function of patients in both groups. For the ESWT group, the 50-m quick walk time and gait analysis were applied to observe the functional recovery at 4, 8, 12, and 16 weeks upon the completion of treatment; meanwhile, patients were followed up by magnetic resonance imaging (MRI) at 24 weeks upon the completion of treatment, so as to observe the cartilage changes. RESULTS: Differences in VAS, 4, 8, and 12 weeks after treatment were statistically significant compared with that before treatment (4.59 ±â€Š0.5, P < .05; 2.55 ±â€Š0.5, P < .05; 4.39 ±â€Š0.49, P < .05). Differences in 4, 8, and 12 weeks after treatment were statistically significant compared with that before treatment (90.41 ±â€Š6.64, P < .05; 59.94 ±â€Š3.19, P < .05; 90.49 ±â€Š6.87, P < .05). Gait analysis suggested differences in 50 m walk time, walking speed, swing phase, and stance phase 8 weeks after treatment were statistically significant compared with that before treatment (36.23 ±â€Š4.08, P < .05; 1.25 ±â€Š0.09, P < .05; 58.56 ±â€Š0.87, P < .05; 41.44 ±â€Š0.87, P < .05). Differences in the VAS and WOMAC at 4 and 8 weeks after treatment between ESWT group and NASIDs group were not statistically significant. CONCLUSIONS: The ESWT has potential in reducing pain and improving knee function, and the therapeutic effects may peak at 8 weeks after the completion of treatment. Further research is needed to arrive at a definitive conclusion.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Osteoartrite do Joelho/terapia , Idoso , Anti-Inflamatórios não Esteroides/uso terapêutico , Feminino , Marcha , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor , Escala Visual Analógica , Teste de Caminhada
15.
Georgian Med News ; (287): 35-39, 2019 Feb.
Artigo em Russo | MEDLINE | ID: mdl-30958285

RESUMO

The aim of the research was to study the effectiveness of combined prophylaxis of pathological postoperative face skin scars according to the Vancouver scale. The research involved 29 patients, aging 16-48 years old, who underwent maxillofacial surgery by extraoral accesses with wound primary intention healing. The patients were divided into three groups: the control group, which involved the patients, who after the surgery did not undergo any preventive measures to avoid pathological skin scars development, and two study groups. The patients of the first study group underwent the monotherapy comprising three sessions of extracorporeal shock wave therapy once every 4-5 days. The patients of the second study group underwent three sessions of extracorporeal shock wave therapy once every 4-5 days and local use of silicone gel Strataderm. The Vancouver scale was used to evaluate clinically the effectiveness of the suggested methods of pathological scars development prevention. It involved evaluation (in points) of their consistency, pigmentation, and vascularization. The scars were assessed on the 7th, 30th day after the surgery and in 6 months. Positive results were attained in the patients of both study groups; they were manifested by increased elasticity and compliance of scars, pigmentation becoming of just about surrounding skin natural color, normalization of blood supply to scars, and more rapid disappearance of suture marks. However, these positive signs were more significant in the patients of the second study group that allowed us concluding that combined use of extracorporeal shock wave therapy and local applying of silicone gel Strataderm was advisable.


Assuntos
Cicatriz/prevenção & controle , Tratamento por Ondas de Choque Extracorpóreas/métodos , Géis de Silicone/uso terapêutico , Pele , Adolescente , Adulto , Cicatriz/patologia , Face/patologia , Face/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Géis de Silicone/administração & dosagem , Pele/lesões , Cirurgia Bucal , Resultado do Tratamento , Adulto Jovem
16.
Int J Hyperthermia ; 36(1): 486-492, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994010

RESUMO

OBJECTIVE: To evaluate the combined efficacy of high-intensity focused ultrasound (HIFU), gonadotropin-releasing hormone agonist (GnRH-a) and the levonorgestrel-releasing intrauterine system (LNG-IUS) for the treatment of severe adenomyosis. METHOD: Four hundred and sixty-six patients with adenomyosis admitted to the Department of Gynecology of Shanghai First Maternity and Infant Hospital underwent HIFU treatment, and then were consecutively administered with GnRH-a 1 d, 1 month and 3 months after HIFU treatment. The uterine size was then measured with ultrasound or MRI 2-4 weeks after three cycles of GnRH-a injection. The LNG-IUS was then inserted when the uterine length less than 9 cm. The visual analog scale (VAS), verbal rating scale (VRS), menstrual volume score, uterus volume, MRI, serum levels of hemoglobin and CA125 were measured at pre and 3-, 6-, 12-month post-HIFU. RESULTS: Dysmenorrhea and menorrhagia significantly relieved after combined treatment with HIFU, GnRH-a and the LNS-IUS. The uterine volume shrank and returned to its normal size. The serum CA-125 level was reduced to the normal level after the combined treatment. CONCLUSIONS: The combined therapeutic regimen of HIFU, GnRH-a and LNS-IUS is safe, effective and efficient for curing severe adenomyosis.


Assuntos
Adenomiose , Tratamento por Ondas de Choque Extracorpóreas/métodos , Hormônio Liberador de Gonadotropina/uso terapêutico , Levanogestrel/uso terapêutico , Adenomiose/diagnóstico por imagem , Adenomiose/tratamento farmacológico , Adenomiose/patologia , Adenomiose/terapia , Feminino , Hormônio Liberador de Gonadotropina/farmacologia , Humanos , Levanogestrel/farmacologia
17.
Wounds ; 31(5): 132-136, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30990778

RESUMO

INTRODUCTION: It is hypothesized that cumulative extended application of extracorporeal shockwave therapy (ESWT) can be beneficial to sustain the effect of ESWT and improve the long-term outcome in chronic diabetic foot ulcers (DFUs). OBJECTIVE: The purpose of this study is to investigate the effectiveness of multiple extended booster ESWT to maintain the effects of ESWT on the outcomes of chronic DFUs. MATERIALS AND METHODS: Four patients with a DFU were treated with ESWT, including 1 patient with 12 treatments and 3 patients with 6 treatments. Evaluations included clinical assessment, blood flow perfusion, and biopsy of the ulcers. RESULTS: At 48 weeks, the results showed completely healed ulcers in 2 patients and improved ulcers in the other 2 patients. In the DFU Scale Short-Form, the score decreased in 1 patient and remained unchanged in 3 at 48 weeks. Blood perfusion increased in 1 patient but remained unchanged in 3. In immunohistochemical analysis, the angiogenic, anti-inflammatory, proliferative, and tissue repair biomarkers were elevated in 1 patient and decreased in 3. CONCLUSIONS: The effects of ESWT appear to maintain certain levels for an extended period of time at 1 year but start to show deterioration on tissue viability. Therefore, it is speculated that intermittent booster ESWT may maintain the effects of ESWT and sustain the tissue viability and repairing. The use of ESWT appeared to be effective for DFU treatment, and extended ESWT showed a tendency of sustaining ESWT effects when multiple booster treatments are utilized in patients with a DFU.


Assuntos
Pé Diabético/terapia , Tratamento por Ondas de Choque Extracorpóreas/métodos , Biomarcadores/metabolismo , Velocidade do Fluxo Sanguíneo/fisiologia , Doença Crônica , Pé Diabético/fisiopatologia , Humanos , Neovascularização Fisiológica/fisiologia , Resultado do Tratamento , Cicatrização/fisiologia
18.
Medicine (Baltimore) ; 98(8): e14589, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813181

RESUMO

This retrospective study investigated the efficacy and safety of extracorporeal shock wave (EPSW) combined with hyaluronic acid (HA) for patients with knee osteoarthritis (KOA).This retrospective study included 70 patients with KOA. Of those subjects, 35 of them received EPSW combined HA, and were allocated to a treatment group, while the other 35 participants received HA alone and were allocated to a control group. Patients in both groups were treated for a total of 8 weeks. The primary outcome was measured by visual analog scale (VAS). The secondary outcomes were measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and knee injury and osteoarthritis outcome score (KOOS). In addition, adverse events (AEs) were also evaluated. All outcomes were measured before and after the treatment.After the treatment, patients in the treatment group exhibited better efficacy in VAS (P < .01), WOMAC scale (pain, P < .01; function, P < .01; and stiffness, P < .01), and KOOS scores (pain, P < .01; function in daily living, P < .01; symptoms, P < .01; sport and recreation, P < .01; and quality of life, P < .01), than patients in the control group. In addition, no significant differences regarding the AEs were found between 2 groups.The findings of this study demonstrated that the efficacy of EPSW combined with HA is superior to the HA alone for patients with KOA.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Ácido Hialurônico/administração & dosagem , Osteoartrite do Joelho/terapia , Viscossuplementos/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Feminino , Humanos , Ácido Hialurônico/efeitos adversos , Injeções Intra-Articulares , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Viscossuplementos/efeitos adversos
19.
Int Urol Nephrol ; 51(5): 773-781, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30903393

RESUMO

PURPOSE: To look at the evidence base for LISWT as a treatment modality for vasculogenic erectile dysfunction, focusing on the long-term outcomes at over 6 months following treatment. METHODS: A systematic literature search was conducted utilising MEDLINE and Scopus databases from 2010 to September 2018 by two independent reviewers. Outcome measures extracted for long-term efficacy included International Index of Erectile Function scores and Erection Hardness Scores. Subgroup analysis for LISWT effectiveness included age, PDE5i responsiveness, presence of vascular co-morbidities and smoking status. RESULTS: The search identified eleven studies, representing a total of 799 patients. Nine studies found a significant improvement in erectile function after LISWT at 6-month follow-up (median IIEF-EF improvement in 5.3 at 6 months). However, of five studies assessing erectile function at 12 months; two identified a plateauing of results, with three a deterioration (IIEF-EF score changes of - 2 to 0.1 from 6 months). Erectile function did, however, remain above baseline results in all of these studies. Subgroup analysis revealed increasing age to reduce the response to LISWT treatment. Whilst ED severity, PDE5i responsiveness and co-morbidities potentially influence effectiveness, results are still inconsistent. CONCLUSIONS: LISWT may be a safe and acceptable potential ED treatment with demonstrated benefits at 6 months. There is some question regarding efficacy deterioration beyond this, but there is still a demonstrated benefit seen even at 12 months post treatment. However, quality of evidence remains low with larger multiinstitutional studies required, standardising confounders such as shockwave administration and oral medication use.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/métodos , Impotência Vasculogênica/terapia , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento
20.
Ultrasound Med Biol ; 45(5): 1316-1323, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30739723

RESUMO

Extracorporeal shock wave therapy (ESWT) has been found to have a positive effect in the treatment of pain in Achilles tendinopathy, although the exact mechanism is not yet completely understood. Among the mechanisms suggested to underlie ESWT effects are direct stimulation of healing, neovascularization and direct suppressive effects on nociceptors and hyperstimulation, which would block the gate-control system. The neovascularization observed in flogistic tissue is associated with stimulated nerve fibers around tendons and induces a painful condition. The objectives of the present study were to evaluate the effect of ESWT on pain and function in patients with non-insertional Achilles tendinopathy (NIAT) and to assess the neovascularization phenomenon using power Doppler ultrasound (PDU). Twelve patients with NIAT underwent five sessions of focused ESWT over 5 wk. Outcome measures were the visual analogue scale, the Victorian Institute of Sport Assessment-Achilles questionnaire and active dorsiflexion and plantar flexion ankle articular range of motion. Moreover, the patients' clinical impressions of treatment results after ESWT were investigated using the Roles and Maudsley score. Patients were assessed at baseline and 1 and 3 mo after treatment. They had a significant reduction in pain with improvement of arthrokinematic motion and functionality and a positive clinical impression of treatment outcome (50% of patients considered their clinical picture as good/excellent after 3 mo). However, the pulse Doppler ultrasound exam did not reveal neovascularization in 91.7% of the patients 1 and 2 mo after focused ESWT, and in some patients there was a reduction in blood vessels related to flogistic processes. The present observational study confirmed the efficacy of ESWT in pain reduction in NIAT, with a higher degree of patient satisfaction, although doubt persists over the neovascularization effect on the Achilles tendons treated.


Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Tratamento por Ondas de Choque Extracorpóreas/métodos , Neovascularização Patológica/complicações , Dor/etiologia , Tendinopatia/complicações , Tendinopatia/terapia , Ultrassonografia Doppler/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/terapia , Manejo da Dor/métodos , Projetos Piloto , Tendinopatia/diagnóstico por imagem
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