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Quantitative thermal sensory and pain threshold testing (QST) was performed in 29 adult healthy volunteers (mean age 24.2 +/- 2.7 years; range: 18-29 years; 20 females, 9 males) using the Thermal Sensory Analyser TSA-II (Medoc Advanced Medical Systems, Ramat Yishai, Israel, and Minneapolis, Minnesota, USA) before and after laser needle acupuncture and placebo stimulation, respectively. Significant (p < or = 0,001; t-test) gender-specific differences were seen on cold pain threshold analysis. No significant changes in parameters of thermal sensory and pain thresholds were found before and after laser needle or placebo stimulation at acupuncture points for acute pain. However, a trend towards change in the median value of cold pain sensation after laser needle stimulation (p = 0.479; paired t-test; n.s.) was seen within the group of healthy females. The influence of stimulation of acupuncture points for chronic pain on the various parameters needs to be clarified in future studies.

Not unlike thermoablation of liver metastases, thermoablation of metastases to the lungs is gaining clinical interest. Radiofrequency ablation and laser-induced interstitial thermotherapy are both used clinically. Initially it was suspected that percutaneous treatment of lung metastases would result in a rate of pneumothoraces and tissue reactions which would not be clinically acceptable. However, this did not prove true. Fear of pneumothoraces however did lead to the desire for an applicator with a maximally reduced diameter. While clinical results are not yet available, technical success rates of laser-induced interstitial thermotherapy of lung metastases are promising. The percentage of pneumothoraces does not differ significantly from that seen in diagnostic procedures. Large metastases may be treated by simultaneous use of multiple applicators or by repositioning of an applicator (pullback technique). Surgical experience is still guiding us in deciding which primaries' metastases may be successfully treated percutaneously. The literature indicates that lung metastases from colorectal primaries are especially suited. Radiotherapy is only an alternative method in cases of lung metastases if they cause symptoms (such as pain because of thorax infiltration or difficulty in breathing because of bronchial lesion). Due to the risk of radiation-induced pneumonia general radiotherapy is not to be recommended. The possibility of stereotactic ray treatment is being considered, but because breathing shifts the metastases it is not yet feasible. Therefore, percutaneous thermoablation could be used as a minimally invasive, rather riskless therapeutic option for a relatively high percentage of inoperable lung metastases.

Purpose: To demonstrate the potential of quantitative MRI-assisted thermometry for the treatment of tumor patients with regional hyperthermia (RHT) and interstitial laser thermotherapy (ILTT)., Methods: Two patients and seven tissue samples were investigated using the T1-relaxation time and the chemical shift of the proton resonance frequency (PRF) as temperature sensitive MRI-parameters at 0.2 and 1.5 T. Thermotherapy was applied using either a dedicated MRI-hyperthermia hybrid system or a temperature controlled laser with 830 nm., Results: Both patients were treated successfully showing clinical benefit. T1 and PRF are depending on the applied thermotherapy method and on the MR-system suitable for MRI-assisted thermometry. The clinical application based on phantom results is not necessarily adequate., Conclusion: Clinical application and phantom experiments of RHT and ILTT show the potential of MRI-assisted thermometry for further improvement of both minimal invasive thermotherapy methods. Further investigations concerning optimization of the MRI-techniques, the influence of perfusion or the determination of threshold values are necessary.

Purpose: To evaluate the effects of radiofrequency heated bipolar probes on the human arterial wall., Methods: Under standardised conditions, lesions were set on the inner layer of a piece of human cadaver arterial wall, using a radiofrequency-heated bipolar catheter. These lesions were measured and described both macroscopically and microscopically. Lesion size, applied energy levels and application conditions were correlated., Results: The size of a lesion depended significantly on the size of the catheter, angle and pressure of catheter application (p < 0.05) and length of impulse (p = 0.002). There was no influence from the energy level employed. It proved impossible to treat calcified plaques. The depth of a lesion depended on the angle of catheter application only. No perforations were seen., Conclusions: Radiofrequency-heated bipolar catheters ablate the tissue of the arterial wall. Increasing tissue resistance resulting from higher energy levels prevents perforation in the experimental set-up. Calcified plaques cannot be treated by this method.

Muscle spasm can be reduced by heat as well as by therapeutic cold. However, in upper motor neuron lesions, cold is more effective in reducing the spasticity. This effect lasts long enough to be of therapeutic value. Water immersion supports the reduction of muscle tone. Pain may be reduced by both thermal stimuli. The pain threshold seems to be elevated by the direct effect of both heat and cold on the free nerve endings and the pain-killing fibers. The tendency to bleed is increased with heat application and decreased with cold therapy. Edema resulting from trauma is increased with heat, and decreased in its development by cold application. Joint stiffness is decreased with heat application and increased with cold application. Water immersion removes weight from the joints and facilitates mobility.

In Physical Medicine and Rehabilitation structural and functional disorders in the genesis of back pain are of great importance. From an epidemiological point of view this has great consequences. Active and passive forms of physical therapy are available. Assuming that the intradiscal pressure has an influence on the origin of back pain, the aim of physiotherapy has to be that any movement of the vertebral column has to be controlled with a minimum of muscular contraction. Passive forms of physical therapy like heat and cold, electrotherapy or mechanotherapy have a reflective reaction beside a physical effect. Sometimes a combination of active and passive forms are of benefit. Every treatment concept has to pay regard to the actuality of pain, the load of every day life and the physical and social situation of the patient. Last but not least one has to learn to cope with the pain.

A randomized, open, controlled study was carried out in eight patients with spondylitis ankylosans, in a cross-over procedure including total body cryotherapy and whole spine paraffin mud packs. The effect of both therapies on clinical status and different laboratory data was investigated. No clinical changes were seen after either therapy; in contrast, in answering the spine function questionnaire patients reported an improvement after cryotherapy and a worsening after thermotherapy, but because of the small number of patients no positive conclusion was possible. The acute phase proteins (alpha-1-AGP, alpha-1-ACT, alpha-2-haptoglobin and alpha-2-coeruloplasmin) did not show any changes, only CRP increased after thermotherapy and declined after cryotherapy. Interesting changes were seen in the glycosylation profile of alpha-1-AGP: after thermotherapy an increase of bi-antennary oligosaccharides occurred, observed as appearance of a third peak in the affinity immunoelectrophoresis with con A and an increase of reactivity-coefficient of alpha-1 and glycoprotein which was also seen in the exacerbation of AS. This shows, that an activation of the inflammatory process may be possible by thermotherapy (perhaps because of an amplification of Il-6 production), but not by cryotherapy. Similar studies should be conducted in larger numbers of patients.

We describe a case of severe hypothermia in a 32-year-old patient who fell into a crevasse. Three hours later he was rescued and flown to a district hospital. On arrival he was apparently dead, with cadaveric skin, dilated and fixed pupils, pulseless and in respiratory arrest. His rectal temperature was 26 degrees C. On the ECG monitor there was first ventricular fibrillation, then, after several unsuccessful attempts at defibrillation, the heart became asystolic. Cardiopulmonary resuscitation was begun with orotracheal intubation and external cardiac compression, which eventually lasted 4 hours and continuously required a team of 6 persons. Only at a temperature of 32.5 degrees C could the patient be defibrillated with success. In the absence of extracorporeal circulation (ECC) the victim was rewarmed by warm-air breathing and by instillation of warm saline in peritoneum, stomach and bladder. In this way the rewarming velocity was 1.8 degrees C/hour. The postacute course was characterized by severe rhabdomyolysis (CK of 100,000 U/L) with non-oliguric renal failure, which necessitated several sessions of hemodialysis. Four months later the asymptomatic patient returned to work. Our case shows that a severely hypothermic patient can successfully be treated in a primary hospital not equipped with an ECC, provided that there is a sufficiently large team. Further, uninterrupted external cardiac compression guarantees efficient circulation even over several hours. Electric defibrillation in a hypothermic patient is ineffective unless normal body temperature has been reached. Lastly, every effort to continue resuscitation must be made in the still hypothermic patient whose absence of clinical response may obscure the real possibility of complete recovery.

In a cross-over study, the short-term efficacy of whole-body cold therapy and hot mud packs in patients with generalized tendomyopathy (fibromyalgia) was compared. As a pain assessment, visual analog scale and so-called pain score were measured; dolorimetry of the 24 tender points and eight control points was performed as well. Using these methods, we found that there is a significant improvement of all parameters examined during a 2-h period of measurements after cold application, and a marked improvement was also detectable 24 h after this therapy. In contrast, only pain score values showed a slight decrease immediately after hot mud-pack therapy, and no significant differences were found in visual analog scale and pressure tenderness as measured dolorimetrically. Central inhibition of nociceptors as a result of an activation of A-delta system as well as a blockade of gamma-motoneurons are discussed to be a mechanism of action of whole-body cold therapy, resulting in a decrease in muscle tonus. Long-term studies are needed to determine, if there is any enduring effect of whole-body cold therapy on pain in the patients with generalized tendomyopathy.

Cold injury is an objective danger in mountain climbing as well as in many outdoor and recreational sports such as skiing, fishing, etc. Symptoms are easily recognizable by the experienced, and prevention is mostly possible. Cold injury should be divided by pathological means in general hypothermia and local frostbite injuries. Life-threatening deep hypothermia with coma and insufficient circulation or cardiac arrest is reversible under the condition of sufficient core rewarming, for instance by CEC. Because of the big tolerance of hypothermic patients to hypoxia, clinical death is not like biological death and therefore reversible. Local frostbite is not life-threatening, but has often deleterious effects. Rapid rewarming in warm water of 37 to 42 degrees C is mandatory. After rewarming, the difference between superficial and deep frostbite can be established. Scintigraphy seems to be of great help in setting early prognosis. Daily sterile treatment of the injury, whirlpool bath and prevention of infections belong to standard treatment. There are little objective informations about the role of vasodilators, anticoagulants, antibiotics, sympathectomy and others. Early experience with Prostavasine seems to bee encouraging.

This retrospective study comprises 234 cases of accidental hypothermia (core temperature less than 35 degrees C) hospitalized in 95 Swiss clinics between 1980 and 1987. The most frequent accidents were alpine (n = 78) in origin, followed by cold exposure after injuries (n = 63) and suicide attempts (n = 43). Hypothermia was induced by cold air in 129 cases and by water in 47 cases. Patients were divided evenly between the degree of hypothermia: 75 mild (32-35 degrees C), 79 moderate (28-32 degrees C) and 66 severe (less than 28 degrees C). Among the survivors the coldest patient had a core temperature of 17.5 degrees C and the longest cardiac arrest with a favourable outcome lasted 4.75 hours. Out of the 234 patients 68 died (29%). We assessed all variables relative to outcome, in particular the mechanism of the accident, the mode of cooling, temperature, circulation, age and sex, underlying diseases, rewarming methods, medication and complications during the hospital course. All variables were tested in two multiple regression analysis models (retrospective model n = 181: prospective model n = 128) with regard to significance (p less than 0.05) and survival. Results are expressed with ODD's ratios (OR). The negative survival factors are asphyxia (OR 30), invasive rewarming methods (OR 20), slow rate of cooling (OR 10), asystole on arrival (OR 9), pulmonary edema or ARDS during hospitalization (OR 8), elevated serum potassium (OR 2/mmol/l) and age (OR 1.03/year). The positive survival factors are rapid cooling rate (OR 10), presence of ventricular fibrillation in cardiac arrest patients (OR 9) and presence of narcotics and/or alcohol during hypothermia (OR 5).(ABSTRACT TRUNCATED AT 250 WORDS)

In a 29-year-old polytraumatised motorbike driver, massive blood transfusion led to a decrease of the body temperature to 28.1 degrees C rectal on the second day after admission. We could rewarm the patient using only a Clinitron bed, although he had persisting blood loss due to an intravasal coagulopathy. This method has proven to be noninvasive, effective and without any side effects.

The aims of physical therapy in the treatment of osteoporosis are lying in inhibition of progression of the degenerative process and combat of the symptoms. There is no chance of being cured of manifest osteoporosis but we can try to keep a "status presens" for giving the patient a possibility of an adequate quality of life. The used methods are mechanotherapy, electrotherapy and thermotherapy. Cryotherapy as an assisting method and therapeutic exercises especially act as a preventive measure against decreased function of locomotor system. All the other kinds of therapy try to reduce the principle symptom as pain and to produce an improvement of the general condition of the trophic situation.

102 patients with prospectively radioresistant malignant tumours of the head and neck area were treated by a combination of hyperthermia and radiotherapy. 92 patients who received a sufficient dose were analysed. 71 of them (77%) developed an improvement of the disease, in 54 cases (59%) a complete remission was achieved. Local recurrences occurred in only 13 cases (24%) within an average of 11 months from the end of treatment. Distant metastases did not exceed usual frequency, and apparently there was no hyperthermia-dependent provocation. Advantages of this combined therapy are better regression of large hyp- and anoxic tumours and good tolerance. Its influence on survival-time, however, seems doubtful.

Hyperthermic perfusion was used in 15 adult patients with soft tissue sarcoma of the limbs. Only patients were selected with prognostically unfavorable or recurrent tumors, which were excised with a limited safety margin. Three patients died from pulmonary metastases 16, 24 and 34 months after perfusion. In 2 patients a local recurrence developed. Ten patients are alive and free of recurrence. The follow-up period ranges from 7 - 47 months with a median of 30 months. These results encourage the further use of hyperthermic perfusion.

Some aspects of the effect of hyperthermia on mammalian cells are presented. Hyperthermia is an efficient means to kill cells or to reinforce the action of radiation. These effects depend on temperature. Between both effects exists a steep temperature gradient, making necessary an exact measurement of temperature. The cytotoxic effect prefers radioresistant cells such as hypoxic cells or cells in the late DNA synthesis phase. A combination will be favorable because both therapy methods supplement each other, but produce no interaction. If one wishes to take advantage of the radiosensitizing effect, hyperthermia intervenes in the processes of recovery after the radiation insult. It is therefore indicated especially in case of tumors presenting a great capacity of cells recovery. Here, a real interaction between hyperthermia and radiotherapy takes place at the same target. Cellular death after hyperthermia and radiotherapy is caused by different mechanisms. All these data suggest the following recommendations for clinical practice: The temperature should be chosen higher or lower than 42 degrees C depending on the desired effect (cytotoxic or radiosensitizing effect). Under the point of view of recovery, radiotherapy should be followed by hyperthermia. In order to avoid an induction of resistance against hyperthermal treatment, hyperthermia should be combined as often as possible with radiotherapy.

Two patients with sporotrichosis, one of the cutaneous-lymphatic type, the other of the fixed cutaneous type, were treated with local heat therapy. The "pocket warmer" used for this purpose has the advantage of being able to maintain a constant temperature of 44 degrees-45 degrees C on the skin surface for several hours, while permitting unrestricted freedom of movement. There are no side effects. The duration of treatment depends on the type of lesion, location, depth, and size. Generally, local application for 1-2 h per day for 5-6 weeks seems to be sufficient.

From December 1978 to February 1981 91 regional hyperthermic perfusions with melphalan (1.0 or 1.5 mg/kg body weight) were performed in 87 patients with malignant melanoma of the extremities. During a one-hour perfusion with whole blood at an intramuscular temperature of 42 degrees C the flow rate was 264 +/- 62 ml/min in the upper and 495 +/- 42 ml/min in the lower limb. Apart from one intima dissection there were no serious intraoperative complications. Postoperatively one female patient died on the 19th day from acute right heart failure with severe bone marrow suppression. In six patients intransigent metastases appeared after an average of six months. One patient developed lung metastases 7 months postoperatively from which he died. Seventy-nine patients remained free of tumour during the observation period.

The craniocervical syndrome is an entity whose symptoms: vertigo, cephalea, tinnitus, facial pain, otalgia, dysphagia, pain of the carotid artery are thought to be caused by cervical factors. In the majority of cases the cranio-cervical syndrome is caused by a spondylarthrogenic segmental dysfunction whose pathophysiology is explained. In the pathogenesis lesions of the joints of the skull which may be responsible for pain and dysfunction in the segmental areas are of great importance. The neurology of the joints of the skull, as well as the pathological mechanisms of spondylarthrogenic disturbances, responsible for the different kinds of dysfunction of the equilibrium and for cephalea are discussed. The pathophysiological basis of manual diagnosis is explained; also the radiological findings of the upper cervical vertebral column are principally discussed. A short review of therapeutic recommendations is given.

Local tumor hyperthermia (42--43 degrees C) during moderate whole body hyperthermia (40 degrees C) and hyperglycemia (5 . 10(-3) g ml-1) led to an amplification of tumor hyperacidification of deltapH = 0,47 +/- 0,19 In 12 from 20 animals. As cause of this phenomenon the stimulation of glycolysis by temperature increase (van't Hoff's law) and the stop of microcirculation by hyperthermia plus decrease of erythrocyte flexibility was discussed 5 tumors regressed totally.

Twenty-six patients who had tumors known to be refractory to conventional treatment modalities were treated with 2450 MHz microwave hyperthermia in combination with radiation. Twenty-two out of the 26 patients were treated with external hyperthermia. Twelve out of the 22 patients (54.5%) experienced complete regression and 6 patients (27.3%) partial regression. Four patients who had tumors in the oral cavity and vagina were treated with internal coaxial applicators especially developed for intracavitary hyperthermia. One patient experienced complete regression and 3 patients partial regression.

Inflammatory diseases in childhood are quite different from those occurring in adults. The reasons are the special physiological, anatomical and immunological factors at the different stages of development. The different diagnostic possibilities (nasal swabs for virological and bacteriological examinations, X-ray, sonography, CT, endoscopy of the nose and paranasal sinuses) are discussed and the principles of the conservative and surgical therapy were demonstrated.