Orientador: Luiz Antonio Corrêa / Resumo: Nos últimos anos, foram desenvolvidas diversas modalidades alternativas para o tratamento da HPB. Entre elas, incluem-se terapêuticas medicamentosas e aquelas que se convencionou denominar de "minimamente invasivas". Estas últimas fundamentam-se na aplicação de calor (hipertermia e termoterapia), de laser, de radiofreqüência, de ultrasom, na dilatação uretral com balões, na colocação de endopróteses uretrais e na incisão transuretral da próstata. Entre os métodos que utilizam o calor para tratamento da HPB, encontra-se a termoterapia induzida pela água ou WIT (water induced thermotherapy). Com o objetivo de se estudar os efeitos do calor sobre a próstata, foi realizado este trabalho experimental, que utilizou o equipamento ThermoflexTM (Argomed Ltda.), o qual, de modo controlado, produz aquecimento da água que circula de um reservatório até a extremidade de uma sonda tipo Foley, onde existe um balão insuflável termotransmissor, que deve ser posicionado na uretra prostática. Utilizou-se, no experimento, 27 cães, sem raça definida, com peso variando de 11,5 a 32,0kg, distribuídos em três subgrupos controles (n=9) e três experimentais (n=18). Os animais foram sacrificados 12, 72 horas e duas semanas (momentos M1, M2 e M3) após o procedimento. Nessa ocasião, as próstatas foram removidas e seus volumes foram aferidos por gravimetria, volume de água deslocado em bureta, peso do volume de água deslocado e, indiretamente, pelas medidas dos eixos cranio-caudal, dorsoventral e latero-lateral, com um paquímetro. Durante todo o período de experimentação, foram realizados exames ultra-sonográficos... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Over the past years, several alternative treatments for Benign Prostate Hyperplasia (BPH) have been developed including drug therapies and the so called "minimally invasive" therapies. These latter are based on the application of heat (hyperthermia and thermotherapy), laser, radiofrequency, ultrasound; balloon urethral dilation; placement of urethral endoprotheses and transurethral incision of the prostate. One of the methods that use heat to treat BPH is water-induced thermotherapy (WIT). The present experimental work was undertaken with the purpose of studying the effects of heat on the prostate using ThermoflexTM (Argomed Ltda.), a device that heats the water that circulates from a reservoir to the tip of a Foley-like catheter, which has an inflatable thermotransmitting balloon that is placed in the prostatic urethra. Twenty-seven mongrel dogs, weighing 11.5-32.0 kg, were divided into three control (N=9) and three experimental (N=18) subgroups. The animals were sacrificed 12 hrs., 72 hrs. and two weeks (moments M1, M2 and M3, respectively) after heat application. Their prostates were removed and prostatic volume was estimated by gravimetry, the amount of water displaced from a burette, weight of the displaced water volume and, indirectly, by measuring the cranio-caudal, dorso-ventral and latero-lateral axes with a pachymeter. Throughout the experiment, transabdominal ultrasonographic examinations were performed to determine prostatic volume, considering prostatic shape... (Complete abstract click electronic address below) / Doutor

Hyperthermia based cancer treatments delivered under various modalities have the potential to become an effective option to eradicate the disease, maintain functionality of infected organs, and minimize complications and relapse. Moreover, hyperthermia therapies are a form of minimally invasive cancer treatment which are key to improving the quality of life post-treatment. Many modalities are available for delivering the heat source. However, the ability to control the energy deposition to prevent damage to adjacent healthy tissue is a limiting factor in all forms of thermal therapies, including cryotherapy, microwave, radio-frequency, ultrasound, and laser. The application of a laser heat source under the guidance of real-time treatment data has the potential to provide unprecedented control over the temperature field induced within the biological domain. The computational infrastructure developed in this work combines a computational model of bioheat transfer based on a nonlinear version of the Pennes equation for heterogeneous media with the precise timing and orchestration of the real-time solutions to the problems of calibration, optimal control, data transfer, registration, finite element mesh refinement, cellular damage prediction, and laser control; it is an example of Dynamic-Data-Driven Applications System (DDDAS) in which simulation models interact with measurement devices and assimilates data over a computational grid for the purpose of producing high-fidelity predictions of physical events. The tool controls the thermal source, provides a prediction of the entire outcome of the treatment and, using intra-operative data, updates itself to increase the accuracy of the prediction. A precise mathematical framework for the real-time finite element solution of the problems of calibration, optimal heat source control, and goal-oriented error estimation applied to the equations of bioheat transfer is presented. It is demonstrated that current finite element technology, parallel computer architecture, data transfer infrastructure, and thermal imaging modalities are capable of inducing a precise computer controlled temperature field within a biological domain. The project thus addresses a set of problems falling in the intersection of applied mathematics, imaging physics, computational science, computer science and visualizations, biomedical engineering, and medical science. The work involves contributions in the three component areas of the CAM program; A, Applicable Mathematics; B, Numerical Analysis and Scientific Computing; and C, Mathematical modeling and Applications. The ultimate goal of this research is to provide the medical community a minimally invasive clinical tool that uses predictive computational techniques to provide the optimal hyperthermia laser treatment procedure given real-time, patient specific data. / text

Dissertation submitted in partial compliance with the requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2008. / Dry needling is the most effective way of treating Myofascial Pain Syndrome and appears to be as effective as an injection of an anaesthetic into myofascial trigger points. However the side effect common to both dry needling and the injection of an anaesthetic, is the development of post-needling soreness. Post-needling soreness results from bleeding at the area of needle insertion. The immediate application of cold to a needled area may decrease the severity of the cellular damage by restricting local bleeding. Cryotherapy can also decrease both nerve excitability and histamine release, which may result in decreased pain experienced by patients. The purpose of this study was to determine the effectiveness of cryotherapy on post dry needling soreness. Therefore a randomised, 2 group parallel controlled clinical trial was proposed to test this hypothesis. Sixty asymptomatic volunteer participants between 18 and 50 were randomly divided into two equal groups - group A (combination group) received dry needling in conjunction with a cold gel pack, and group B received dry needling only. Algometer readings, a Numerical Pain Rating Scale (NRS 101) and a 24 Hour Pain Diary were used as assessment tools. SPSS version 15 was used for data analysis (SPSS Inc. Chicago, Ill, USA). Baseline demographics and outcome measurements (NRS 101, Algometer readings and 24 Hour Pain Diaries) were compared between the two groups using Pearson’s chi square tests or Independent Samples t-tests as appropriate For the evaluation of the treatment effect for the NRS 101 and Algometer outcomes, repeated measures ANOVA procedure was used. Twenty four hour Pain Diaries by group interactions were reported for comparison of the treatment effect in the two treatment groups. The number of participants reporting pain at various time points post treatment were compared cross-sectionally by group with Pearson’s chi square tests. A Mann-Whitney U test was used to compare time points post treatment at which the worst pain was experienced between groups. The change in the presence of pain over time was recorded as either no change, an increase (from no pain to pain) or a decrease (from pain to no pain). This wascompared between treatment groups using the Pearson’s chi square test. Intragroup correlations between changes in outcome variables were achieved with Pearson’s correlation. P values of <0.05 were considered as statistically significant. The results of the study showed no evidence of a beneficial effect of cryotherapy on objective or subjective findings. Thus it can be concluded that cryotherapy as used in this study had no significant effect on reducing post dry needling soreness.

We present Bessel function and Gaussian beam models for a study of microwave power deposition in bounded and inhomogeneous lossy media. The aim is to develop methods that can accurately simulate practical results commonly found in electromagnetic hyperthermic treatment, which is a noninvasive method. The Bessel function method has a closed form solution and can be used to compute accurate results of electromagnetic fields emanating from applicators with cosinusoidal aperture fields. On the other hand, the Gaussian beam method is approximate but has the capability to simplify boundary value problems and to compute fields in three-dimensions with extremely low CPU time (less than 30 sec). Although the Gaussian beam method is derived from geometrical optics theory, it performs very well in domains outside the realm of geometrical optics which stipulates that aperture dimension/λ ≥ 5 in the design of microwave systems. This condition has no relevance to the Gaussian beam method since the method shows that a limit of aperture dimension/ λ ≥ 0.9 is possible, which is a very important achievement in the design and application of microwave systems. Experimental verifications of the two theoretical models are integral parts of the presentation and show the viability of the methods.

A simulation program to study the three dimensional temperature distributions produced by hyperthermia in anatomically realistic inhomogeneous tissue models has been developed. The anatomical data for the inhomogeneous tissues of the human body are entered on a digitizing tablet from serial CT scans. The program not only predicts temperature distributions in regions dominated by blood perfusion (with large number of small capillaries), but it can also predict the temperatures inside of and at the vicinity of large blood vessels. The program can be used for different power deposition patterns from various heating modalities, but they must be calculated independently. In this study, the author's attention has been focused on ferromagnetic implants. The program has been used to comparatively evaluate two and three dimensional simulations in a series of parametric calculations based on simple tissue models for both uniform power deposition and ferromagnetic implants. The conclusions drawn from these studies are that two dimensional simulations can lead to significant errors in many situations, and therefore three dimensional simulations will be necessary for accurate patient treatment planning. The conclusion from the geometrically simple model is substantiated by the results obtained using the full 3D model for actual patient anatomical simulations. The program has also been used for several parametric studies. The effect of the thermal conductivity used in the models on the temperature field has been studied, and the results show that its value in the range of 0.4 to 0.6 W/m/°C (valid for most soft tissues) has only a slight effect on the resultant temperature fields. The heating ability of the ferromagnetic implants has also been investigated for different blood perfusions. The effects of the Curie point of the ferromagnetic seeds, and seed spacing are also studied. Finally, the impact of large blood vessels on the resultant temperatures are studied, and the results show that the effect is dramatic and therefore it must be included in the simulations in order to predict accurate temperature fields. Finally, the program has been used to analyze a previously performed dog experiment, and a previously performed clinical treatment. A comparison between the predicted temperatures and the measured ones show that good agreement has been achieved for the clinical treatment, but not for the dog experiment. These results are studied in detail, and the conditions under which this program can be used as a hyperthermia patient treatment planning tool is discussed.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal. / Myofasciitis IS a very common yet misunderstood problem. There are many treatments available yet there is no research to substantiate which of the many treatments available is the most effective (Travell and Simons 1983:6). The purpose of this study was to investigate the relative effectiveness of Cryotherapy versus moist heat in the treatment of myofasciitis of the shoulder girdle muscles. Patients for this comparative, randomized clinical trial were obtained by consecutive sampling. Any patient between eighteen and fifty-five presenting to the Chiropractic Clinic at Technikon Natal with neck pain, upper back pain or shoulder paIn was considered a potential candidate. Thirty patients underwent a screening process to assess their viability for the study. This screening procedure consisted of questions regarding the pattern of pain referral and of palpation of the relevant zones for muscle spasm, twitch responses, patient jump sign and/or referred palll. The thirty patients were randomly divided into two groups of fifteen. One group received cold and passive stretching and the other group received moist heat and passive stretching. Each patient was treated five times within a three week period. Thereafter a follow-up appointment was scheduled one month after the final treatment to assess the long term effects of the treatments . The subjective information was questionnaires: (1) the CMCC Neck Numerical Pain Rating Scale-l0l assessed us Ing three Disability Index, (2) the and (3) the Short Form McGill Pain Questionnaire. These three forms were used to subjectively assess vanaus aspects of the patient's pain. Patients were required to fill these forms out at the first and final appointment. / M

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic in the Faculty of Health at Technikon Natal / Myofasciitis IS a very common yet misunderstood problem. There are many treatments available yet there is no research to substantiate which of the many treatments available is the most effective (Travell and Simons 1983:6). The purpose of this study was to investigate the relative effectiveness of Cryotherapy versus moist heat in the treatment of myofasciitis of the shoulder girdle muscles. Patients for this comparative, randomized clinical trial were obtained by consecutive sampling. Any patient between eighteen and fifty-five presenting to the Chiropractic Clinic at Technikon Natal with neck pain, upper back pain or shoulder paIn was considered a potential candidate. Thirty patients underwent a screening process to assess their viability for the study. This screening procedure consisted of questions regarding the pattern of pain referral and of palpation of the relevant zones for muscle spasm, twitch responses, patient jump sign and/or referred palll. The thirty patients were randomly divided into two groups of fifteen. One group received cold and passive stretching and the other group received moist heat and passive stretching. Each patient was treated five times within a three week period. Thereafter a follow-up appointment was scheduled one month after the final treatment to assess the long term effects of the treatments . The subjective information was questionnaires: (1) the CMCC Neck Numerical Pain Rating Scale-l0l assessed us Ing three Disability Index, (2) the and (3) the Short Form McGill Pain Questionnaire. These three forms were used to subjectively assess vanaus aspects of the patient's pain. Patients were required to fill these forms out at the first and / M

Este trabalho tem o objetivo de desenvolver, caracterizar e avaliar, do ponto de vista dos voluntários, uma Placa Polimérica Derivada de Óleo de Mamona (PPDOM) para utilização com fins termoterápicos. A PPDOM tem utilidade similar às bolsas de gel ou de água quente, disponíveis comercialmente, apresentando bom acoplamento e moldando-se ao corpo sem variações na espessura, possibilitando uma troca de temperatura mais uniforme na área de aplicação. Os requisitos da PPDOM foram determinados por análise de referências científicas, através de trabalhos indicando os índices de desempenho necessários na termoterapia, e seu desenvolvimento foi iterativo, sendo a formulação do polímero derivado de óleo de mamona modificada de acordo com as características obtidas no protótipo anterior, até produzir placas capazes de atender aos requisitos propostos. Foram confeccionadas três placas (5, 10 e 15 mm) e realizados os testes de retenção de calor, troca de calor, termogravimetria e calorimetria exploratória diferencial. Foi selecionado um material de revestimento para as PPDOMs capaz de suportar a temperatura de trabalho, atóxico, asséptico, não alergênico e flexível, e fabricado um envoltório de tecido 100% algodão, para facilitar sua aplicação, eliminando a necessidade de utilização de toalhas. Para avaliar a aplicabilidade clínica da PPDOM, 30 voluntários se submeteram a sua aplicação durante 20 minutos e responderam a um questionário, através da escala de Likert, sobre parâmetros subjetivos como conforto, sensação térmica, toque superficial, aparência, além de expressarem a opinião a respeito do material desenvolvido. Os resultados demonstraram que a placa desenvolvida atinge temperatura máxima de 80,1 ± 0,8 graus Celsius após 15,0 min de aquecimento em água inicialmente à temperatura de ebulição e, se aplicada nestas condições, eleva a temperatura da pele acima dos 40 graus Celsius, que é a temperatura clínica, em 3,0 min, mantendo-a acima deste valor até 32,5 min após o contato com a pele. As respostas dos voluntários indicaram aceitação, sendo este um produto viável para aplicação clínica. / The objective of this work is to develop, characterize and evaluate, from the viewpoint of volunteers, a Polymeric Plate Derived from Castor Oil (PPDCO) for thermotherapeutic application. The PPDCO has utility similar to the gel or hot water bags, which are commercially available, attaching well to the patient\'s body and molding to it without variation in thickness, allowing more uniform temperature exchange in the application region. The requirements of the PPDCO were determined by analysis of scientific references that indicated the performance factors required in thermotherapy, and the development was iterative, being the formulation of the polymer derived from castor oil modified according to the characteristics obtained in the previous manufactured prototype, until producing plates that completely fulfill the proposed requirements. Three plates were prepared (5, 10 and 15 mm) and tested for heat retention, heat exchange, thermogravimetry and differential scanning calorimetry. It was selected a coating material for the PPDCOs capable of withstanding the operating temperature, non-toxic, aseptic, non-allergenic and flexible, and it was also made a 100% cotton wrap, to facilitate the PPDCO application, eliminating the use of towels. To evaluate the clinical applicability of PPDCOs, 30 volunteers underwent its application for 20 minutes and answered a questionnaire using the Likert scale about subjective parameters such as comfort, thermal sensation, light touch, appearance, and express their opinion about the developed material. The results showed that the developed plate reaches a maximum temperature of 80.1 \'+ OU -\' 0.8 Celsius degrees after 15.0 min of heating in water initially at boiling temperature and, if applied in these conditions, increases skin temperature above 40 Celsius degrees, which is the clinic temperature, in 3.0 min, keeping it above this value up to 32.5 min after contact with the skin. The responses of the volunteers indicated their acceptance, being the PPDCO a viable product for clinical application.

published_or_final_version / abstract / toc / Surgery / Doctoral / Doctor of Philosophy

Thesis (M.A.)--University of North Carolina at Chapel Hill, 2002. / Includes bibliographical references (leaves 57-59).