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Therapy of chronic wounds with water-filtered infrared-A (wIRA)
(2007)
- The central portion of chronic wounds is often hypoxic and relatively hypothermic, representing a deficient energy supply of the tissue, which impedes wound healing or even makes it impossible. Water-filtered infrared-A (wIRA) is a special form of heat radiation with a high tissue penetration and a low thermal load to the skin surface. wIRA produces a therapeutically usable field of heat and increases temperature, oxygen partial pressure and perfusion of the tissue. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing, especially in chronic wounds, and infection defense. wIRA acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA can advance wound healing or improve an impaired wound healing process and can especially enable wound healing in non-healing chronic wounds. wIRA can considerably alleviate the pain and diminish wound exudation and inflammation and can show positive immunomodulatory effects. In a prospective, randomized, controlled study of 40 patients with chronic venous stasis ulcers of the lower legs irradiation with wIRA and visible light (VIS) accelerated the wound healing process (on average 18 vs. 42 days until complete wound closure, residual ulcer area after 42 days 0.4 cm² vs. 2.8 cm²) and led to a reduction of the required dose of pain medication in comparison to the control group of patients treated with the same standard care (wound cleansing, wound dressing with antibacterial gauze, and compression garment therapy) without the concomitant irradiation. Another prospective study of 10 patients with non-healing chronic venous stasis ulcers of the lower legs included extensive thermographic investigation. Therapy with wIRA(+VIS) resulted in a complete or almost complete wound healing in 7 patients and a marked reduction of the ulcer size in another 2 of the 10 patients, a clear reduction of pain and required dose of pain medication, and a normalization of the thermographic image. In a current prospective, randomized, controlled, blinded study patients with non-healing chronic venous stasis ulcers of the lower legs are treated with compression garment therapy, wound cleansing, wound dressings and 30 minutes irradiation five times per week over 9 weeks. A preliminary analysis of the first 23 patients of this study has shown in the group with wIRA(+VIS) compared to a control group with VIS an advanced wound healing, an improved granulation and in the later phase of treatment a decrease of the bacterial burden. Some case reports have demonstrated that wIRA can also be used for mixed arterial-venous ulcers or arterial ulcers, if irradiation intensity is chosen appropriately low and if irradiation is monitored carefully. wIRA can be used concerning decubital ulcers both in a preventive and in a therapeutic indication. wIRA can improve the resorption of topically applied substances also on wounds. An irradiation with VIS and wIRA presumably acts with endogenous protoporphyrin IX (or protoporphyrin IX of bacteria) virtually similar as a mild photodynamic therapy (endogenous PDT-like effect). This could lead to improved cell regeneration and wound healing and to antibacterial effects. In conclusion, these results indicate that wIRA generally should be considered for the treatment of chronic wounds.
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Priorisierung in der Medizin – Diskussion einer Realität
(2012)
- Welche gesellschaftlichen Zwänge wirken auf die Medizin und ihre Anwender ein? Wie ist das Verhältnis von Ökonomie und medizinisch Gebotenem? Wie steht es mit der Finanzierung der nicht evidenzbasierten Behandlung? Stellen Rationierung und Rationalisierung die möglichen Prinzipien der Priorisierung dar? Führt die Priorisierung zur Qualitätsminderung oder gar Sorgfaltsverletzung? Diese Fragen behandelte der 4. Ärztetag am Dom in Frankfurt am Main. Feine Unterschiede – Über Vorliebe und Abneigung im ärztlichen Alltag (Prof. Dr. med. Ralph Bickeböller, niedergelassener Arzt, Frankfurt am Main) Die Ärzte gehen ihrem Handwerk im Zeichen der Regelleistungsvolumen, der diagnosebezogenen Entgeltpauschalen, der Leitlinien, der Evidence-based-medicine, der Regelung des Sozialgesetzbuches V, der Arznei- und Heilmittelrichtlinie und anderer vielfältiger Bestimmungen nach, so dass allein durch die Vielfalt der Regelungen und durch die Vielzahl der Kontroll- und Regressmechanismen ein System etabliert ist, das einen mehr oder weniger starken Druck auf die Ärzte entfaltet, das Notwendige, Zweckmäßige und Wirtschaftliche am Patienten durchzuführen. Wie steht es mit dem Symbolwert von operativen Eingriffen, wenn man als Operateur für eine Inkontinenzoperation, die vielleicht eine halbe Stunde dauert und zwei postoperative Visiten benötigt, deutlich mehr erlösen kann als für eine organerhaltende Nierentumorresektion von drei Stunden mit sieben postoperativen Visiten? Nicht nur Ärzte haben ihre Prioritäten, u. a. tritt der Patient als Kunde auf, der durch seine Entscheidung für eine Dienstleistung ein Entgelt für den Dienstleistenden generiert. Warum bedürfen wir überhaupt einer Priorisierung in der Medizin? Weil die gesundheitlichen Bedürfnisse der Bürger unbegrenzt sind, weil es den medizinischen Fortschritt gibt und weil die Ressourcen begrenzt sind. Es geht unter anderem deshalb um die Frage, ob es für das Gesamtsystem Medizin gelingen kann, Präferenzen mit einer der festgelegten Rangordnung folgenden Ressourcenverteilung zu entwickeln, die nachvollziehbar, transparent, demokratisch und so weit wie möglich gerecht ist. Aufgrund der notwendigen Rationierung innerhalb des Gesundheitswesens ist deshalb für eine offene Priorisierung das Wort zu reden, die unterschiedliche Präferenzen, unterschiedliche Partizipationsmöglichkeiten, vor allem konkrete Ungerechtigkeiten für ein Leben in Wohlergehen für uns alle wahrnehmen und demokratisch diskutierten lässt. Die Allokation der stets zu knappen Ressourcen im Gesundheitswesen aus volkswirtschaftlicher Sicht (Prof. Dr. Klaus-Dirk Henke, Fachgebiet Finanzwissenschaft und Gesundheitsökonomie, Technische Universität Berlin) Die Allokation der stets zu knappen Ressourcen wird anhand einer Fünf-Ebenen-Betrachtung erläutert. Beim top-down und beim bottom-up Ansatz wird deutlich, dass und in welcher Form die unterschiedlichen Verwendungszwecke miteinander konkurrieren. Zu einer wünschenswerten Allokation der Ressourcen gibt es Hinweise aus der Wohlfahrtstheorie, aber keine empirische Basis für eine optimale Zuordnung der knappen Mittel. Anreizkompatible Finanzierungs- und Vergütungssysteme sowie die Ergebnisse der Krankheitskostenrechnungen helfen bei der Verwirklichung einer besseren Allokation. Von zentraler Bedeutung sind jedoch die vier ausgewählten Wettbewerbsfelder im Gesundheitswesen. Außerdem wird für die zukünftige Entwicklung die wachsende Bedeutung des Humankapitals für Wachstum und Produktivität in den Vordergrund gestellt und das Gesundheitswesen innerhalb der vielen Wirtschaftszweige angesichts der Wirtschafts- und Finanzkrise in 2008/2009 als besonders stabil eingeschätzt. Priorisierung und die deutsche Vergangenheit – Warum die Priorisierungsdebatte so heikel ist (Prof. Dr. Weyma Lübbe, Lehrstuhl für Praktische Philosophie, Universität Regensburg) Die Debatte über eine Priorisierung medizinischer Maßnahmen ist in Deutschland nach wie vor überwiegend eine akademische Debatte. Von politischer Seite wird das Thema als „unethisch“ bezeichnet und die Diskussion wird durch Negierung der Knappheit vermieden. Diese im internationalen Vergleich auffällige Zurückhaltung der Politik ist auch durch die Angst bedingt, offizielle Stellen könnten durch eine solche Debatte gezwungen werden, vergleichende Urteile über den „Wert“ des (Über-)Lebens verschiedener Patienten oder Patientengruppen zu fällen. Lebenswerturteile von staatlicher Seite waren wesentlicher Bestandteil der Kampagnen, mit denen im Nationalsozialismus das Euthanasie-Programm vorbereitet wurde. Damit möchte niemand auch nur entfernt in Verbindung gebracht werden. Der vorliegende Beitrag argumentiert, dass interpersonell vergleichende Lebenswerturteile kein unvermeidbarer Bestandteil einer Priorisierungsdebatte sind und dass sie in der Tat vermieden werden sollten. Im Rahmen politiknaher Fachkontroversen, namentlich in der Kontroverse zwischen deutschen Gesundheitsökonomen und dem Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) über die Methoden der Kosten-Nutzen-Bewertung für Arzneimittel nach § 35 b SGB V, werden sie freilich nicht konsequent vermieden. Eine kontinuierliche kritische Beobachtung und Beurteilung der Implementation ökonomischer Evaluationsmethoden im Blick auf rechtliche und ethische Maßstäbe ist daher unbedingt zu empfehlen.
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Photodynamic therapy (PDT) and waterfiltered infrared A (wIRA) in patients with recalcitrant common hand and foot warts
(2004)
- Background: Common warts (verrucae vulgares) are human papilloma virus (HPV) infections with a high incidence and prevalence, most often affecting hands and feet, being able to impair quality of life. About 30 different therapeutic regimens described in literature reveal a lack of a single striking strategy. Recent publications showed positive results of photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) in the treatment of HPV-induced skin diseases, especially warts, using visible light (VIS) to stimulate an absorption band of endogenously formed protoporphyrin IX. Additional experiences adding waterfiltered infrared A (wIRA) during 5-ALA-PDT revealed positive effects. Aim of the study: First prospective randomised controlled blind study including PDT and wIRA in the treatment of recalcitrant common hand and foot warts. Comparison of "5-ALA cream (ALA) vs. placebo cream (PLC)" and "irradiation with visible light and wIRA (VIS+wIRA) vs. irradiation with visible light alone (VIS)". Methods: Pre-treatment with keratolysis (salicylic acid) and curettage. PDT treatment: topical application of 5-ALA (Medac) in "unguentum emulsificans aquosum" vs. placebo; irradiation: combination of VIS and a large amount of wIRA (Hydrosun® radiator type 501, 4 mm water cuvette, waterfiltered spectrum 590-1400 nm, contact-free, typically painless) vs. VIS alone. Post-treatment with retinoic acid ointment. One to three therapy cycles every 3 weeks. Main variable of interest: "Percent change of total wart area of each patient over the time" (18 weeks). Global judgement by patient and by physician and subjective rating of feeling/pain (visual analogue scales). 80 patients with therapy-resistant common hand and foot warts were assigned randomly into one of the four therapy groups with comparable numbers of warts at comparable sites in all groups. Results: The individual total wart area decreased during 18 weeks in group 1 (ALA+VIS+wIRA) and in group 2 (PLC+VIS+wIRA) significantly more than in both groups without wIRA (group 3 (ALA+VIS) and 4 (PLC+VIS)): medians and interquartile ranges: -94% (-100%/-84%) vs. -99% (-100%/-71%) vs. -47% (-75%/0%) vs. -73% (-92%/-27%). After 18 weeks the two groups with wIRA differed remarkably from the two groups without wIRA: 42% vs. 7% completely cured patients; 72% vs. 34% vanished warts. Global judgement by patient and by physician and subjective rating of feeling was much better in the two groups with wIRA than in the two groups without wIRA. Conclusions: The above described complete treatment scheme of hand and foot warts (keratolysis, curettage, PDT treatment, irradiation with VIS+wIRA, retinoic acid ointment; three therapy cycles every 3 weeks) proved to be effective. Within this treatment scheme wIRA as non-invasive and painless treatment modality revealed to be an important, effective factor, while photodynamic therapy with 5-ALA in the described form did not contribute recognisably - neither alone (without wIRA) nor in combination with wIRA - to a clinical improvement. For future treatment of warts an even improved scheme is proposed: one treatment cycle (keratolysis, curettage, wIRA, without PDT) once a week for six to nine weeks. © 2004 Fuchs et al; licensee German Medical Science. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL : http://www.egms.de/en/gms/volume2.shtml
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Water-filtered infrared-A radiation (wIRA) is not implicated in cellular degeneration of human skin
(2007)
- Background: Excessive exposure to solar ultraviolet radiation is involved in the complex biologic process of cutaneous aging. Wavelengths in the ultraviolet-A and -B range (UV-A and UV-B) have been shown to be responsible for the induction of proteases, e. g. the collagenase matrix metalloproteinase 1 (MMP-1), which are related to cell aging. As devices emitting longer wavelengths are widely used in therapeutic and cosmetic interventions and as the induction of MMP-1 by water-filtered infrared-A (wIRA) had been discussed, it was of interest to assess effects of wIRA on the cellular and molecular level known to be possibly involved in cutaneous degeneration. Objectives: Investigation of the biological implications of widely used water-filtered infrared-A (wIRA) radiators for clinical use on human skin fibroblasts assessed by MMP-1 gene expression (MMP-1 messenger ribonucleic acid (mRNA) expression). Methods: Human skin fibroblasts were irradiated with approximately 88% wIRA (780-1400 nm) and 12% red light (RL, 665-780 nm) with 380 mW/cm² wIRA(+RL) (333 mW/cm² wIRA) on the one hand and for comparison with UV-A (330-400 nm, mainly UV-A1) and a small amount of blue light (BL, 400-450 nm) with 28 mW/cm² UV-A(+BL) on the other hand. Survival curves were established by colony forming ability after single exposures between 15 minutes and 8 hours to wIRA(+RL) (340-10880 J/cm² wIRA(+RL), 300-9600 J/cm² wIRA) or 15-45 minutes to UV-A(+BL) (25-75 J/cm² UV-A(+BL)). Both conventional Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) and quantitative real-time RT-PCR techniques were used to determine the induction of MMP-1 mRNA at two physiologic temperatures for skin fibroblasts (30°C and 37°C) in single exposure regimens (15-60 minutes wIRA(+RL), 340-1360 J/cm² wIRA(+RL), 300-1200 J/cm² wIRA; 30 minutes UV-A(+BL), 50 J/cm² UV-A(+BL)) and in addition at 30°C in a repeated exposure protocol (up to 10 times 15 minutes wIRA(+RL) with 340 J/cm² wIRA(+RL), 300 J/cm² wIRA at each time). Results: Single exposure of cultured human dermal fibroblasts to UV-A(+BL) radiation yielded a very high increase in MMP-1 mRNA expression (11 ±1 fold expression for RT-PCR and 76 ±2 fold expression for real-time RT-PCR both at 30°C, 75 ±1 fold expression for real-time RT-PCR at 37°C) and a dose-dependent decrease in cell survival. In contrast, wIRA(+RL) did not produce cell death and did not induce a systematic increase in MMP-1 mRNA expression (less than twofold expression, within the laboratory range of fluctuation) detectable with the sensitive methods applied. Additionally, repeated exposure of human skin fibroblasts to wIRA(+RL) did not induce MMP-1 mRNA expression systematically (less than twofold expression by up to 10 consecutive wIRA(+RL) exposures and analysis with real-time RT-PCR). Conclusions: wIRA(+RL) even at the investigated disproportionally high irradiances does not induce cell death or a systematic increase of MMP-1 mRNA expression, both of which can be easily induced by UV-A radiation. Furthermore, these results support previous findings of in vivo investigations on collagenase induction by UV-A but not wIRA and show that infrared-A with appropriate irradiances does not seem to be involved in MMP-1 mediated photoaging of the skin. As suggested by previously published studies wIRA could even be implicated in a protective manner. Used abbreviations: BL: blue light; IR-A: infrared-A; MMP-1: matrix metalloproteinase 1; mRNA: messenger ribonucleic acid; PBS: phosphate buffered saline; RL: red light; UV-A, UV-A1, UV-B: ultraviolet-A (315-400 nm), -A1 (340-400 nm), -B (280-315 nm); wIRA: water-filtered infrared-A (780-1400 nm) Keywords: Matrix metalloproteinase 1 (MMP-1), photoaging, ultraviolet-A (UV-A), ultraviolet-A1 (UV-A1), UV-A radiation, infrared-A radiation (IR-A), water-filtered infrared-A (wIRA
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Therapy of acute wounds with water-filtered infrared-A (wIRA)
(2007)
- Water-filtered infrared-A (wIRA) as a special form of heat radiation with a high tissue penetration and with a low thermal load to the skin surface acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA produces a therapeutically usable field of heat in the tissue and increases tissue temperature, tissue oxygen partial pressure, and tissue perfusion. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing and infection defense. wIRA can considerably alleviate the pain (with remarkably less need for analgesics) and diminish an elevated wound exudation and inflammation and can show positive immunomodulatory effects. wIRA can advance wound healing or improve an impaired wound healing both in acute and in chronic wounds including infected wounds. Even the normal wound healing process can be improved. A prospective, randomized, controlled, double-blind study with 111 patients after major abdominal surgery at the University Hospital Heidelberg, Germany, showed with 20 minutes irradiation twice a day (starting on the second postoperative day) in the group with wIRA and visible light VIS (wIRA(+VIS), approximately 75% wIRA, 25% VIS) compared to a control group with only VIS a significant and relevant pain reduction combined with a markedly decreased required dose of analgesics: during 230 single irradiations with wIRA(+VIS) the pain decreased without any exception (median of decrease of pain on postoperative days 2-6 was 13.4 on a 100 mm visual analog scale VAS 0-100), while pain remained unchanged in the control group (p<0.001). The required dose of analgesics was 57-70% lower in the subgroups with wIRA(+VIS) compared to the control subgroups with only VIS (median 598 versus 1398 ml ropivacaine, p<0.001, for peridural catheter analgesia; 31 versus 102 mg piritramide, p=0.001, for patient-controlled analgesia; 3.4 versus 10.2 g metamizole, p=0.005, for intravenous and oral analgesia). During irradiation with wIRA(+VIS) the subcutaneous oxygen partial pressure rose markedly by approximately 30% and the subcutaneous temperature by approximately 2.7°C (both in a tissue depth of 2 cm), whereas both remained unchanged in the control group: after irradiation the median of the subcutaneous oxygen partial pressure was 41.6 (with wIRA) versus 30.2 mm Hg in the control group (p<0.001), the median of the subcutaneous temperature was 38.9 versus 36.4°C (p<0.001). The overall evaluation of the effect of irradiation, including wound healing, pain and cosmesis, assessed on a VAS (0-100 with 50 as indifferent point of no effect) by the surgeon (median 79.0 versus 46.8, p<0.001) or the patient (79.0 versus 50.2, p<0.001) was markedly better in the group with wIRA compared to the control group. This was also true for single aspects: Wound healing assessed on a VAS by the surgeon (median 88.6 versus 78.5, p<0.001) or the patient (median 85.8 versus 81.0, p=0.040, trend) and cosmetic result assessed on a VAS by the surgeon (median 84.5 versus 76.5, p<0.001) or the patient (median 86.7 versus 73.6, p=0.001). In addition there was a trend in favor of the wIRA group to a lower rate of total wound infections (3 of 46, approximately 7%, versus 7 of 48, approximately 15%, p=0.208) including late infections after discharge, caused by the different rate of late infections after discharge: 0 of 46 in the wIRA group and 4 of 48 in the control group. And there was a trend towards a shorter postoperative hospital stay: 9 days in the wIRA group versus 11 days in the control group (p=0.037). The principal finding of this study was that postoperative irradiation with wIRA can improve even a normal wound healing process. A prospective, randomized, controlled, double-blind study with 45 severely burned children at the Children’s Hospital Park Schönfeld, Kassel, Germany, showed with 30 minutes irradiation once a day (starting on the first day, day of burn as day 1) in the group with wIRA and visible light VIS (wIRA(+VIS), approximately 75% wIRA, 25% VIS) compared to a control group with only VIS a markedly faster reduction of wound size. On the fifth day (after 4 days with irradiation) decision was taken, whether surgical debridement of necrotic tissue was necessary because of deeper (second degree, type b) burns (11 of 21 in the group with wIRA, 14 of 24 in the control group) or non-surgical treatment was possible (second degree, type a, burns). The patients treated conservatively were kept within the study and irradiated till complete reepithelialization. The patients in the group with wIRA showed a markedly faster reduction of wound area: a median reduction of wound size of 50% was reached already after 7 days compared to 9 days in the control group, a median reduction of wound size of 90% was already achieved after 9 days compared to 13 days in the control group. In addition the group with wIRA showed superior results till 3 months after the burn in terms of the overall surgical assessment of the wound, cosmesis, and assessment of effects of irradiation compared to the control group. In a prospective, randomized, controlled study with 12 volunteers at the University Medical Center Charité, Berlin, Germany, within each volunteer 4 experimental superficial wounds (5 mm diameter) as an acute wound model were generated by suction cup technique, removing the roof of the blister with a scalpel and a sterile forceps (day 1). 4 different treatments were used and investigated during 10 days: no therapy, only wIRA(+VIS) (approximately 75% wIRA, 25% VIS; 30 minutes irradiation once a day), only dexpanthenol (= D-panthenol) cream once a day, wIRA(+VIS) and dexpanthenol cream once a day. Healing of the small experimental wounds was from a clinical point of view excellent with all 4 treatments. Therefore there were only small differences between the treatments with slight advantages of the combination wIRA(+VIS) and dexpanthenol cream and of dexpanthenol cream alone concerning relative change of wound size and assessment of feeling of the wound area. However laser scanning microscopy with a scoring system revealed differences between the 4 treatments concerning the formation of the stratum corneum (from first layer of corneocytes to full formation) especially on the days 5-7: fastest formation of the stratum corneum was seen in wounds treated with wIRA(+VIS) and dexpanthenol cream, second was wIRA(+VIS) alone, third dexpanthenol cream alone and last were untreated wounds. Bacterial counts of the wounds (taken every 2 days) showed, that wIRA(+VIS) and the combination of wIRA(+VIS) with dexpanthenol cream were able to inhibit the colonisation with physiological skin flora up to day 5 when compared with the two other groups (untreated group and group with dexpanthenol cream alone). At any investigated time, the amount of colonisation under therapy with wIRA(+VIS) alone was lower (interpreted as more suppressed) compared with the group with wIRA(+VIS) and dexpanthenol cream. During rehabilitation after hip and knee endoprosthetic operations the resorption of wound seromas and wound hematomas was both clinically and sonographically faster and pain was reduced by irradiation with wIRA(+VIS). wIRA can be used successfully for persistent postoperative pain e.g. after thoracotomy. As perspectives for wIRA it seems clinically prudent to use wIRA both pre- and postoperatively, e.g. in abdominal and thoracic operations. wIRA can be used preoperatively (e.g. during 1-2 weeks) to precondition donor and recipient sites of skin flaps, transplants or partial-thickness skin grafts, and postoperatively to improve wound healing and to decrease pain, inflammation and infections at all mentioned sites. wIRA can be used to support routine pre- or intraoperative antibiotic administration or it might even be discussed to replace this under certain conditions by wIRA.
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Therapy of acute wounds with water-filtered infrared-A (wIRA)
(2007)
- Water-filtered infrared-A (wIRA) as a special form of heat radiation with a high tissue penetration and with a low thermal load to the skin surface acts both by thermal and thermic as well as by non-thermal and non-thermic effects. wIRA produces a therapeutically usable field of heat in the tissue and increases tissue temperature, tissue oxygen partial pressure, and tissue perfusion. These three factors are decisive for a sufficient tissue supply with energy and oxygen and consequently as well for wound healing and infection defense. wIRA can considerably alleviate the pain (with remarkably less need for analgesics) and diminish an elevated wound exudation and inflammation and can show positive immunomodulatory effects. wIRA can advance wound healing or improve an impaired wound healing both in acute and in chronic wounds including infected wounds. Even the normal wound healing process can be improved. A prospective, randomized, controlled, double-blind study with 111 patients after major abdominal surgery at the University Hospital Heidelberg, Germany, showed with 20 minutes irradiation twice a day (starting on the second postoperative day) in the group with wIRA and visible light VIS (wIRA(+VIS), approximately 75% wIRA, 25% VIS) compared to a control group with only VIS a significant and relevant pain reduction combined with a markedly decreased required dose of analgesics: during 230 single irradiations with wIRA(+VIS) the pain decreased without any exception (median of decrease of pain on postoperative days 2-6 was 13.4 on a 100 mm visual analog scale VAS 0-100), while pain remained unchanged in the control group (p<0.001). The required dose of analgesics was 57-70% lower in the subgroups with wIRA(+VIS) compared to the control subgroups with only VIS (median 598 versus 1398 ml ropivacaine, p<0.001, for peridural catheter analgesia; 31 versus 102 mg piritramide, p=0.001, for patient-controlled analgesia; 3.4 versus 10.2 g metamizole, p=0.005, for intravenous and oral analgesia). During irradiation with wIRA(+VIS) the subcutaneous oxygen partial pressure rose markedly by approximately 30% and the subcutaneous temperature by approximately 2.7°C (both in a tissue depth of 2 cm), whereas both remained unchanged in the control group: after irradiation the median of the subcutaneous oxygen partial pressure was 41.6 (with wIRA) versus 30.2 mm Hg in the control group (p<0.001), the median of the subcutaneous temperature was 38.9 versus 36.4°C (p<0.001). The overall evaluation of the effect of irradiation, including wound healing, pain and cosmesis, assessed on a VAS (0-100 with 50 as indifferent point of no effect) by the surgeon (median 79.0 versus 46.8, p<0.001) or the patient (79.0 versus 50.2, p<0.001) was markedly better in the group with wIRA compared to the control group. This was also true for single aspects: Wound healing assessed on a VAS by the surgeon (median 88.6 versus 78.5, p<0.001) or the patient (median 85.8 versus 81.0, p=0.040, trend) and cosmetic result assessed on a VAS by the surgeon (median 84.5 versus 76.5, p<0.001) or the patient (median 86.7 versus 73.6, p=0.001). In addition there was a trend in favor of the wIRA group to a lower rate of total wound infections (3 of 46, approximately 7%, versus 7 of 48, approximately 15%, p=0.208) including late infections after discharge, caused by the different rate of late infections after discharge: 0 of 46 in the wIRA group and 4 of 48 in the control group. And there was a trend towards a shorter postoperative hospital stay: 9 days in the wIRA group versus 11 days in the control group (p=0.037). The principal finding of this study was that postoperative irradiation with wIRA can improve even a normal wound healing process. A prospective, randomized, controlled, double-blind study with 45 severely burned children at the Children’s Hospital Park Schönfeld, Kassel, Germany, showed with 30 minutes irradiation once a day (starting on the first day, day of burn as day 1) in the group with wIRA and visible light VIS (wIRA(+VIS), approximately 75% wIRA, 25% VIS) compared to a control group with only VIS a markedly faster reduction of wound size. On the fifth day (after 4 days with irradiation) decision was taken, whether surgical debridement of necrotic tissue was necessary because of deeper (second degree, type b) burns (11 of 21 in the group with wIRA, 14 of 24 in the control group) or non-surgical treatment was possible (second degree, type a, burns). The patients treated conservatively were kept within the study and irradiated till complete reepithelialization. The patients in the group with wIRA showed a markedly faster reduction of wound area: a median reduction of wound size of 50% was reached already after 7 days compared to 9 days in the control group, a median reduction of wound size of 90% was already achieved after 9 days compared to 13 days in the control group. In addition the group with wIRA showed superior results till 3 months after the burn in terms of the overall surgical assessment of the wound, cosmesis, and assessment of effects of irradiation compared to the control group. In a prospective, randomized, controlled study with 12 volunteers at the University Medical Center Charité, Berlin, Germany, within each volunteer 4 experimental superficial wounds (5 mm diameter) as an acute wound model were generated by suction cup technique, removing the roof of the blister with a scalpel and a sterile forceps (day 1). 4 different treatments were used and investigated during 10 days: no therapy, only wIRA(+VIS) (approximately 75% wIRA, 25% VIS; 30 minutes irradiation once a day), only dexpanthenol (= D-panthenol) cream once a day, wIRA(+VIS) and dexpanthenol cream once a day. Healing of the small experimental wounds was from a clinical point of view excellent with all 4 treatments. Therefore there were only small differences between the treatments with slight advantages of the combination wIRA(+VIS) and dexpanthenol cream and of dexpanthenol cream alone concerning relative change of wound size and assessment of feeling of the wound area. However laser scanning microscopy with a scoring system revealed differences between the 4 treatments concerning the formation of the stratum corneum (from first layer of corneocytes to full formation) especially on the days 5-7: fastest formation of the stratum corneum was seen in wounds treated with wIRA(+VIS) and dexpanthenol cream, second was wIRA(+VIS) alone, third dexpanthenol cream alone and last were untreated wounds. Bacterial counts of the wounds (taken every 2 days) showed, that wIRA(+VIS) and the combination of wIRA(+VIS) with dexpanthenol cream were able to inhibit the colonisation with physiological skin flora up to day 5 when compared with the two other groups (untreated group and group with dexpanthenol cream alone). At any investigated time, the amount of colonisation under therapy with wIRA(+VIS) alone was lower (interpreted as more suppressed) compared with the group with wIRA(+VIS) and dexpanthenol cream. During rehabilitation after hip and knee endoprosthetic operations the resorption of wound seromas and wound hematomas was both clinically and sonographically faster and pain was reduced by irradiation with wIRA(+VIS). wIRA can be used successfully for persistent postoperative pain e.g. after thoracotomy. As perspectives for wIRA it seems clinically prudent to use wIRA both pre- and postoperatively, e.g. in abdominal and thoracic operations. wIRA can be used preoperatively (e.g. during 1-2 weeks) to precondition donor and recipient sites of skin flaps, transplants or partial-thickness skin grafts, and postoperatively to improve wound healing and to decrease pain, inflammation and infections at all mentioned sites. wIRA can be used to support routine pre- or intraoperative antibiotic administration or it might even be discussed to replace this under certain conditions by wIRA. Keywords: water-filtered infrared-A (wIRA), wound healing, acute wounds, prospective, randomized, controlled, double-blind studies, reduction of pain, problem wounds, wound infections, infection defense, wound exudation, inflammation, thermal and non-thermal effects, thermic and non-thermic effects, energy supply, oxygen supply, tissue oxygen partial pressure, tissue temperature, tissue blood flow, visual analog scales (VAS), quality of life
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Klinische Anwendungen von wassergefiltertem Infrarot A (wIRA)
(2008)
- Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hohem Eindringvermögen in das Gewebe bei geringer thermischer Oberflächenbelastung. wIRA wirkt sowohl über thermische und temperaturabhängige als auch über nicht-thermische und temperaturunabhängige Effekte. wIRA erzeugt ein therapeutisch nutzbares Wärmefeld im Gewebe und steigert Temperatur und Sauerstoffpartialdruck im Gewebe sowie die Gewebedurchblutung. Diese drei Faktoren sind entscheidend für eine ausreichende Versorgung des Gewebes mit Energie und Sauerstoff und deshalb auch für alle Prozesse der Regeneration und Heilung, wie Wundheilung und Infektionsabwehr. wIRA vermag Schmerzen deutlich zu mindern (mit bemerkenswert niedrigerem Analgetikabedarf) und eine erhöhte Sekretion (bei Wunden oder z.B. tracheal/bronchial) und Entzündung herabzusetzen sowie positive immunmodulierende Effekte zu zeigen. wIRA kann sowohl bei akuten als auch bei chronischen Wunden einschließlich infizierter Wunden die Wundheilung beschleunigen oder bei stagnierender Wundheilung verbessern. Selbst der normale Wundheilungsprozess kann verbessert werden. wIRA kann zur Therapie von hartnäckigen vulgären Hand- und Fußwarzen (ein Therapiezyklus mit kontinuierlicher Keratolyse mit Salizylsäurepflaster, unblutiger Kürettage, einer wIRA-Bestrahlung von 30 Minuten pro Woche für 6-9 Wochen), bei Herpes labialis, Herpes zoster, Condylomata acuminata, Sklerodermie, Morphea und Akne papulopustulosa eingesetzt werden. wIRA kann zur Resorptionsverbesserung topischer Dermatika und Substanzen (wie Cortison oder lokaler Anästhetika) als Alternative zu einem Okklusivverband verwendet werden. wIRA kann im Rahmen einer photodynamischen Therapie zusammen mit einer oder mehreren Wirkbanden im sichtbaren Bereich und einem topisch aufgetragenen Photosensibilisator bei aktinischen Keratosen eingesetzt werden. Im Rahmen von Physiotherapie, Sportmedizin und Orthopädie kann die klinische Anwendung von wIRA präventiv, therapeutisch, regenerativ oder rehabilitativ erfolgen. wIRA kann eingesetzt werden bei muskulären Verspannungen, Myogelosen, Lumbago, Erkrankungen des rheumatischen Formenkreises, M. Bechterew, Arthrosen, Arthritiden, Kontusionen, Fibromyalgie (vorzugsweise wIRA in Kombination mit Bewegung, d.h. wIRA mit leichter Ergometerarbeit), zur Regeneration nach Sport (wIRA allein oder wIRA in Kombination mit Bewegung), zur postoperativen Rehabilitation und zur Förderung der Lipolyse (wIRA in Kombination mit Bewegung). In der Neonatologie kann wIRA zur Aufrechterhaltung oder Erhöhung der Körpertemperatur und zum Erzeugen eines "Wärmedepots" vor einem erforderlichen Transport des Neugeborenen verwendet werden. In der Onkologie kann wIRA für eine (lokale oder systemische) Hyperthermie in Kombination mit Strahlentherapie oder Chemotherapie eingesetzt werden.
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Wassergefiltertes Infrarot A (wIRA) zur Verbesserung der Wundheilung bei akuten und chronischen Wunden
(2008)
- Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung. wIRA entspricht dem Großteil der in gemäßigten Klimazonen die Erdoberfläche wasserdampfgefiltert erreichenden Sonnenwärmestrahlung. wIRA vermag sowohl bei akuten Wunden als auch bei chronischen Wunden einschließlich infizierter Wunden Schmerzen deutlich zu mindern und eine erhöhte Wundsekretion und Entzündung herabzusetzen sowie positive immunmodulierende Effekte zu zeigen. wIRA kann die Wundheilung beschleunigen oder bei stagnierender Wundheilung verbessern oder sogar ermöglichen. Temperatur, Sauerstoffpartialdruck und Durchblutung im Gewebe als drei energetisch für Wundheilung wichtige Faktoren steigen. Selbst der normale Wundheilungsprozess kann durch wIRA verbessert werden. Die genannten Wirkungen sind durch sechs prospektive Studien belegt. Drei Studien wurden bei akuten Wunden durchgeführt: randomisierte, kontrollierte, doppeltblinde Studien der chirurgischen Universitätsklinik Heidelberg bei frischen abdominalen Operationswunden mit 111 Patienten und der Kinderchirurgie Kassel bei 45 schwerbrandverletzten Kindern sowie der Dermatologie der Charité Berlin bei 12 Probanden mit experimentellen Wunden. Drei Studien betreffen chronische venöse Unterschenkel-Ulzera: randomisierte, kontrollierte Studie in Basel mit 40 Patienten sowie prospektive Studie der Universität Tromsø/Norwegen und des Krankenhauses in Hillerød/Dänemark mit 10 Patienten mit u.a. aufwändiger Verlaufskontrolle mit Thermographie und derzeit durchgeführte randomisierte, kontrollierte, verblindete Studie der Universitätshautklinik Freiburg mit einem geplanten Umfang von ca. 50 Patienten.
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Leistungssteigerung im Sport - Ursachen, Methoden, Bewertungen, Lösungen : [Tagungsbericht über die Veranstaltung des Arbeitskreises Sportmedizin der Akademie für ärztliche Fortbildung und Weiterbildung der Landesärztekammer Hessen und des Hessischen Ärzteblattes in Zusammenarbeit mit der Sektion Breiten- Freizeit- und Alterssport der Deutschen Gesellschaft für Sportmedizin und Prävention (DGSP), der Verbände mit besonderer Aufgabenstellung, Verbände für Wissenschaft und Bildung und Förderverbände (VmbAWBF) im Deutschen Sportbund (DSB) und dem FIFA Medical Assessment and Research Center (F-MARC), Bad Nauheim, 09. - 10.05.2003]
(2003)
- Einleitung Welche Methoden der Leistungssteigerung gibt es eigentlich im Sport? Von körperlicher Aktivität und Training (mit einer Fülle positiver Wirkungen) über Ernährung und Nahrungsergänzungsmittel bis zu unerlaubten Mitteln. Welche Methoden wirken? Was ist sinnvoll? Was ist erlaubt? Was ist überflüssig? Wo kann der einzelne mit seinen eigenen Erwartungshaltungen dazu beitragen, zum Beispiel unrealistischen Leistungsdruck gegenüber Sporttreibenden und damit eine potentielle Dopingproblematik im Ursprung zu vermeiden? Diese Fragen wollte die Veranstaltung „Leistungssteigerung im Sport - Ursachen, Methoden, Bewertungen, Lösungen“ des Arbeitskreises Sportmedizin der Akademie für ärztliche Fortbildung und Weiterbildung der Landesärztekammer Hessen (Prof. Dr. med. Gerd Hoffmann, Prof. Dr. med. Ingeborg Siegfried) und des Hessischen Ärzteblattes (Prof. Dr. med. Toni Graf-Baumann) in Zusammenarbeit mit der Sektion Breiten-, Freizeit- und Alterssport der Deutschen Gesellschaft für Sportmedizin und Prävention (DGSP), der Verbände mit besonderer Aufgabenstellung, Verbände für Wissenschaft und Bildung und Förderverbände (VmbAWBF) im Deutschen Sportbund (DSB) und dem FIFA Medical Assessment and Research Center (F-MARC) in einer bevölkerungsoffenen Informationsveranstaltung am 09.05.2003 und einer Fort- und Weiterbildungsveranstaltung am 10.05.2003 beantworten. Bericht über die Beiträge - Eröffnung - Ursachen für Leistungssteigerung im Sport und Lösungsansätze (Dr. med. Udo Schreiber) - Training, Übertraining, Regeneration, Rehabilitation - Grundsätzliche Überlegungen unter spezieller Berücksichtigung des Bewegungssystems (Dr. med. Udo Schreiber) - Training, Übertraining, Regeneration, Rehabilitation - sportmedizinisch-internistische Aspekte: Wirkung körperlicher Aktivität auf verschiedene Organsysteme (Prof. Dr. med. Gerd Hoffmann) - Muskulatur und Muskelphysiologie (Dr. med. Udo Schreiber) - Auswirkungen körperlicher Aktivität auf das Immunsystem (Prof. Dr. med. Reinhard Bretzel) - Sport trotz Medikamenten und Medikamente wegen Sport (Prof. Dr. med. Bernd Waldecker) - Ernährung und Sport einschließlich sportartspezifischer und trainingsphasenspezifischer Aspekte (Prof. Dr. med. Gerd Hoffmann) - Flüssigkeitssubstitution im Sport (Diplom-Oecotrophologin Dr. Annette Hauenschild) - Nahrungsergänzungsmittel zur Leistungssteigerung im Sport (Dr. med. Kurt-Reiner Geiß) - Leistungssteigernde Mittel und Methoden im Sport; Grenzen zur verbotenen Leistungssteigerung im Sport - Doping im Sport (Prof. Dr. med. Eide-Dittmar Lübs) - Ethische und rechtliche Aspekte verbotener Leistungssteigerung (Prof. Dr. med. Toni Graf-Baumann) - Brauchen wir leistungssteigernde Verfahren? Lösungsansätze (Dr. med. Dierk Heimann)
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Wassergefiltertes Infrarot A (wIRA) für die Wundheilung
(2010)
- Wassergefiltertes Infrarot A (wIRA) ist eine spezielle Form der Wärmestrahlung mit hohem Penetrationsvermögen ins Gewebe bei geringer thermischer Oberflächenbelastung. wIRA entspricht dem Großteil der Sonnenwärmestrahlung, die in gemäßigten Klimazonen die Erdoberfläche wasserdampfgefiltert erreicht. wIRA steigert die drei energetisch für die Wundheilung wichtigen Faktoren Temperatur, Sauerstoffpartialdruck und Durchblutung im Gewebe. wIRA mindert Schmerzen, Entzündung und Wundsekretion. Entsprechend kann wIRA sehr gut zur Verbesserung der Wundheilung bei akuten und chronischen Wunden eingesetzt werden.
