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The potentialities of microwave radiometry application have been considered as an adjuvant to invasive thermometry to control temperature during local MWF-hyperthermia. An increasing role of radiometric monitoring in intracavitary hyperthermia has been shown in experiments on heating rectal tumors. Technical aspects of radiometric temperature measurements combined with MWF-hyperthermia are discussed.
With the aim of testing the usefulness of static thermography for the diagnosis of the vibration syndrome with the AGA-680 Medical apparatus, 111 patients treated in the clinic for suspected vibration syndrome and 25 patients with the idiopathic Raynaud's syndrome have been examined. The vibration syndrome was found in 70 patients, basing on complex multispecialist examinations with no thermovisual evaluation. Ischaemic symptoms were found thermographically in 63 subjects (56%), the rates being the same for the vibration syndrome and non-diagnosed occupational disease groups. The highest sensitivity was that of the isotonic capillary test (100%) and pallesthesiometry (88.2%), whereas thermometry and capillaroscopy exhibited lower sensitivity (78.1% and 71.5%, respectively), the lowest sensitivities being those of static thermography (56%) and coolness test (31.8%). The highest correlation between the thermographic pathology and the results of the other tests was that relating to pallesthesiometry and isotopic capillary test. No temperature range characteristic for the vibration syndrome or parallelism of clinical and thermovisual evaluations has been found.
Clinical researches in hyperthermia have recently expanded rapidly with the increase in our knowledge of the biological effects of heat on experimental systems. This article provides background information on the biological rationale and current status of technologies concerning thermometry and heating equipment for the application of hyperthermia to human cancer treatment. Much data has been accumulated recently in hyperthermia treatment with and without radiation to superficial tumours which are refractory to conventional treatments. In this paper the treatment results published recently have been surveyed. The complete responses of tumours treated by heat alone are in the range of 15 per cent as opposed to approximately 60 per cent for the combination of heat plus radiation. Clinical results so far published have demonstrated that local control is consistently better in the lesions treated with radiation plus heat than with radiation alone. The morbidity related to heat therapy is within tolerable limits. Several articles on the clinical results of deep-seated tumours treated by hyperthermia are reviewed. Problems to be solved in the application of heat to cancer therapy are discussed.
Postoperative follow up examinations were conducted using vascular functional explorations (V.F.E.) including thermometry, Doppler, irrigraphy, digital plethysmography and tread mill. Immediate and long-term effects of lumbar sympathectomy have to be distinguished: the majority of hemodynamic variations noted are not due exclusively to lumbar sympathectomy, except for the iatrogenic development of vasomotor inertia (R.H.T. indifferent or negative) and perhaps values with time of the digital flow curve. Results of V.F.E. after lumbar sympathectomy are discussed in relation to three modalities and taking into account the efficacy and extent of the sympathetic chain resection. The question is raised as to the usefulness of lumbar sympathectomy when the pretreatment V.F.E. findings show hemodynamic elements of the type that would be expected after lumbar sympathectomy.
Detailed diagnostic evaluation of upper extremity vascular lesions is not possible with any single existing test or study. Arteriography and improved arteriographic techniques, including digital subtraction imaging, have increased dramatically the resolution of this procedure. Unfortunately, reactive vasospasm and limited run-off still preclude the provision of complete information about vascular anatomy. Surgical exploration, of course, provides direct access to arterial and venous structures in a limited area, but it has obvious limitations. Indirect information about the structural anatomy can be obtained by Doppler techniques, ultrasound scans, and radionuclide imaging. These techniques also provide limited information about changes in perfusion during stress. Plethysmography, thermography, thermometry, and measurements of segmental arterial pressure, when combined with stress testing, provide excellent indirect evidence of both static and dynamic states. A combination of pressure measurements and intraoperative ultrasound associated with direct surgical measurement will provide quantitative and qualitative analysis of antegrade and retrograde flow and allow the surgeon to look at the intima of vessels without surgically traumatizing the vessel wall. Within the next decade, real-time information with three-dimensional reconstruction of arterial and venous structures as well as quantitative analysis of segmental areas of blood flow will be provided by the use of combinations of these techniques or techniques that have not yet been reported.
In 17 patients at different time after transplantation of the allogenic kidney, artery stenosis of the transplant accompanied by gross hypertension and deterioration of renal function was registered. To diagnose the pathology isotope renography with I131 hippuran, rheography of the transplant, thermometry, thermography and selective angiography were used. Five patients were operated on. They successfully underwent different reconstructive procedures on the affected renal artery of the transplant. As a result arterial pressure returned to normal in all the patients and the transplant's function improved. Four patients underwent balloon dilatation of the stenosed renal artery. The effect was temporary.
Numerous techniques are in use in medicine for temperature determination either from thermal conduction phenomena, or from hot body radiations. These are essentially thermometry, radiometry and thermography. During attempts to treat cancer by hyperthermia, temperature knowledge, at the level of the target volume and the adjoining parts, is essential. These deep temperature measurements are yet a problem and certainly need new sensor technologies.
In the use of hyperthermia treatment, it is apparent from the work of other investigators that only a proportion of large clinical neoplastic tumors of substantial size and deep location can be heated to adequate temperatures (over 42 degrees c). It is therefore of major significance that we have tested the concept that OK-432 can be used as an immunoheat potentiator. A ThermaTech 2000 was used as the radio-frequency generator at 13.56 MHz, including an ancillary computer in the thermometry unit. Minor response in advanced and metastatic tumors was observed in 3 of 3 evaluable patients using OK-432. With other anticancer drugs, no change was observed in 11 of 16 patients, and progressive disease in 5 of 16. However, OK-432 has severe side effects including chills & fever, therefore improved immunoheat potentiators are desirable.
Thermography results of 126 patients were analysed for the diagnosis of recurrences of rectal cancer. Sixteen patients were examined after radical operations for rectal cancer without signs of recurrence to study the features of a thermal regimen in this area. The examination included thermoscopy, thermography and distant thermometry. The presence of the zone of hyperthermia in the perineum with the involvement of the sacral region and the coccygeal bone after extirpation of the rectum was shown to indicate cancer recurrence. The coincidence of thermography findings with those of computerized and ultrasound tomography was observed in 81.7% of the cases. As a result of a perineal fistula, chronic prostatitis, etc., false positive results of thermography were marked in 17 (18.3%) patients. False negative results were not observed. A rise of local temperature from +0.5 to 1 degrees C was considered suspicious of cancer recurrence. These patients were actively followed up and it allowed one to confirm cancer recurrence in them after 3-6 mos. The use of thermography as a screening test made it possible to detect cancer recurrence and to define a high risk group in need of an active follow up and more thorough clinical examination.
Numerous methods for the exploration of the microangiopathy of collagen disease exist, but their perspective differs as a function of their use to assist early diagnosis, to establish a prognosis, to provide follow-up data or to attempt better understanding of the mechanism of these affections. Progressive systemic sclerosis is a very suitable collagen disease with which to illustrate these methods, since in this affection the microangiopathy is frequent, diffuse, of early onset and also formally implicated in the pathogenic rank. Biopsy specimens provide details of morphologic anomalies of the microcirculation. Capillary changes have been demonstrated in muscle and the choroid but in clinical practice histology samples involve mainly the digital pulp, subungual fold and accessory salivary glands. Isotopic and fluorescent angiography are, on the contrary, in vivo methods for dynamic exploration of skin microcirculation, but the invasive nature of these methods is an obstacle to their repetition in a same patient and to follow-up of the microangiopathy. Non-invasive vascular explorations avoid this pitfall. Thermometry, thermography, digital plethysmography under hot and cold conditions, videomicroscopy of the nailbed, percutaneous PO2 and laser-doppler tests measure functional parameters, the hemodynamic significance of which require discussion. Capillaroscopy, mainly oriented towards the study of capillary morphologic changes, also allows, together with plethysmography, measurement of digital systolic pressure. Exploration of the microangiopathy of collagen disease requires a judicious combination of currently available morphologic and functional techniques which, far from being superimposable are on the contrary complementary.
A group of patients with athero-arteriosclerotic vascular disease (coronary heart disease and atherosclerosis of the extremities) have been subjected to platelet antiaggregating-antidyslipidaemic treatment with a chlofibrate-dipyridamol association; a control series was treated with chlofibrate alone. Frequency of angina pectoris, pain intensity and trinitrine consumption ware evaluated in patients with coronary heart disease, claudicometry, oscillometry and thermometry in patients with atherosclerosis of the extremities. The following laboratory parameters were also analysed: cholesterolaemia, triglyceridaemia, prothrombin activity, fibrinogenaemia, uricaemia and tolerance of oral glucose loading. Analysis of the results has shown that the association improved the parameters considered in statistically significant fashion; chlofibrate alone led to significant modifications of coronaropathic group parameters (with the exception of pain intensity) whereas it did not lead to significant changes in parameters evaluated for atherosclerosis of the extremities. All laboratory parameters were modified favourably by the association to a statistically greater extent than by chlofibrate alone. Both the association and chlofibrate were well tolerated.
Since 1969 Serbia has been conducting the programme of eradication louse-borne typhus. To this effect of Law on the eradication of communicable diseases has been passed. In addition to Republic Commission, as well as 6 regional commissions, and 18 communal commissions in whose territory the disease is being eradicated, have been formed. The operations consist of four phases: preparatory attack, consolidation and final phase. The methods and measures applied under the programme include the measures concerned with the control of vectors, i.e. lousiness, measures to detect the source of infection, respectively patients with louse-borne typhus and Brill-Zinsser disease. The control of louseiness effected through the impregnation of underwears and bed linens by means of syntheic insecticides (DDT, Maltox), as well as through health education activities, has yielded good results, so that the highest rate of lousiness: 9.08% (Sjenica, Tutin 4.37%), was reduced to less than 1% in 1972. To detect the source of infection, both active and pasiive investigation has been carried out. Active investigation included regular control of the health state through thermometry applied to registered households with lice. Passive investigation is carried out trough out -patient units and residential services which take care of all febrile patients coming from endemic areas. The results obtained from the three-year operations indicate that the percentage of dected patients with Brill-Zinsser amounts to 0--4--3.9%, as well as that it is still lagging behind with respect to the immunity acquired through previous affections in the endemic areas. The distribution of detected patients with Brill-Zinsser especially indicates that a small number of patients from endemic ares has been detected. The paper presents the criteria for the evaluation of results, making a proposal that a professional body should be formed at the federal level to coordinate the methods and programmes of operations. In addition that body's task would be to expand the operations to all endemic areas in the country.
Contactant thermometry of fingers' skin in thermal functional test is a routine examination common now in vascular changes diagnosis. The sensitivity of this test is increased by the use of a linear thermograph, averaging the temperature of the skin area being examined. In order to ensure correct measurement results, conditions and principles of the test performance must be observed carefully, as indicated by the authors. Evaluation of time thermograms of fingers' skin should involve three types of thermoregulating reaction: homoiothermic, poikilothermic and amphithermic. The first type may be numbered among absolute, whereas the other two among relative physiological standards. Evaluation should include: fingers' skin temperature before cooling, the rate of temperature rise between the 1st and the 5th minute after cooling and the temperature taken at the 15th minute after cooling. Repeated measurements allow to differentiate changes in fingers' skin temperature, resulting from a damage to vessels due to vibration, as well as a relative physiological standard.
Following preliminary experimental animal studies showing Doppler ultrasound to be reliable in predicting intestinal viability and to correlate well with subserosal thermistor thermometry measurements, the Doppler technique has been used clinically for intraoperative intestinal viability assessment in colon-esophageal bypasses and colonic resections. Our clinical experience has shown Doppler ultrasound to be far superior to traditional predictive criteria. The presence of good Doppler sounds confirms adequate collateral pulsatile blood flow ensuring viability of the intestinal segment, whereas the absence of Doppler sounds indicates the need for appropriate revascularization. Based on the reliability of Doppler ultrasound, its simple technique and its relative inexpensiveness, we recommend the routine use of Doppler ultrasound for the evaluation of the quality and adequacy of intestinal blood flow in predicting the viability of a segment of the intestine.
The biological rationale for hyperthermia and radiation is strong, initial results in superficial tumor sites have established efficacy in human cancer, and deep tumor sites are beginning to yield to our efforts at deep regional heating. Major thrusts of new clinical research should go toward improved equipment and defining techniques with existing devices, which can lead us into definitive Phase III trials to assess the role of regional hyperthermia in primary multimodality management of cancer. Detailed thermometry is an absolute requirement for all future clinical studies. Invasive techniques to achieve deep hyperthermia are under investigation and may prove to be useful. Whole-body hyperthermia with radiation and/or chemotherapy has been less well studied in the laboratory than has local hyperthermia, and studies to show clinical efficacy in humans are lacking.
To determine vascular competency in the upper extremity, one must completely evaluate both structural anatomy and the functional performance capabilities of the vascular system. Unfortunately, no single noninvasive test currently available is capable of providing all that information (Table 4-1). Definitive structural anatomy can only be ascertained by surgery or arteriography, although gross anatomic detail can be provided by Doppler techniques and radionuclide scans. Radionuclide scans give good dynamic and static perfusion data and can be coupled with stress testing, but their repeatability is limited by radiation. Isotope clearance techniques are difficult to combine with stress testing, but they do provide excellent information on vascular perfusion. Measurement of segmental arterial pressures, plethysmography, thermography, thermometry, and Allen testing all provide excellent perfusion data and can all be combined with stress testing. The future is bright. Current advances in high-resolution ultrasound real-time imaging combined with quantitative flow by Doppler assessment will provide noninvasive information about structural anatomy and blood-flow characteristics.
The ultimate goal of quality assessment and quality assurance in clinical hyperthermia must be the delivery of satisfactorily similar thermotherapy to all patients entered into a given treatment protocol. Therefore, in addition to dealing with performance evaluation and calibration of equipment for heating and thermometry, hyperthermia quality assurance must also address specification, planning, administration, documentation, evaluation, and reconstruction of the clinical treatments themselves.
The state of hyperthermia physics is reviewed. Major changes affecting the field are: (a) it is becoming far more sophisticated than just a few years ago, now that experts from many engineering and physical specialties are involved; (b) the ubiquitous computer is central to developments in data acquisition and analysis, treatment control, device comparison, treatment planning, and thermal dosimetry; and (c) entrepreneurial firms are arising to produce clinically engineered equipment. University and other research centers can concentrate their efforts on investigating new technologies up to the development of physical prototypes; they need no longer spend time on constructing complete clinical systems. At present, regional heating systems are unable to reliably induce therapeutic temperatures throughout the entire tumor volume. Interstitial techniques are able to accomplish this and so may make the greatest clinical impact in the near future. Invasive thermometry coupled with computerized data acquisition systems and numerical models appears to be a very promising approach to detailed thermal dosimetry. The tools for performing good clinical trials of hyperthermia are gradually becoming available.