Tomasz Biniszkiewicz

Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuropathy

AIM The aim of this randomized, placebo-controlled, double-blind study was to assess whether a low frequency magnetic field can influence pain intensity, quality of life and sleep, and glycaemic control in patients with painful diabetic polyneuropathy. METHODS Sixty-one patients were randomized into two groups: the study group comprised 32 patients exposed to a low frequency magnetic field, average pain duration 23 months; the control group included 29 patients who received sham exposure, average pain duration 28 months. Patients were exposed for three weeks, 20 min a day, five days a week. The magnetic field generator was a Viofor JPS device (Med & Life, Komorow, Poland). All subjects filled out the following questionnaires five times (at the beginning and after one, two, three and five weeks): SFMPQ-VAS (pain evaluation), EuroQol EQ-5D and MOS Sleep Scale. HbA(1c) was evaluated at baseline and after five weeks. RESULTS Significant reductions in pain intensity were seen in both the study group (visual analogue scale [VAS] value of 73 mm at baseline versus 33 mm after three weeks) and controls (VAS 69 mm at baseline versus 41 mm after three weeks). The extent of pain reduction did not differ significantly between the groups at any time. Also, both groups had similar improvements in EuroQol, MOS and HbA(1c) values. CONCLUSION Genuine magnetic field exposure has no advantage over sham exposure in reducing pain intensity, improving quality of life, and decreasing sleep disturbances and HbA(1c).

Therapeutic effects of 5-ALA-induced photodynamic therapy in vulvar lichen sclerosus

BACKGROUND Lichen sclerosus (LS) is a rarely diagnosed, chronic inflammatory skin and mucosal condition. Its therapy is difficult and frequently not satisfactory. The data on photodynamic therapy (PDT) of vulva are promising but scanty. The aim of our study was to evaluate the therapeutic efficacy of photodynamic therapy in genital LS in women. METHODS Twenty-four patients with clinical and histopathological diagnosis of lichen sclerosus accompanied with chronic vulvar itching, lasting between 3 months and 11 years, with human papillomavirus (HPV), bacterial and mycotic infections excluded, received three to six PDT cycles (180J, 700mW/cm(2)) in 14 days long intervals. Simultaneously they received no topical corticosteroids. Photodynamic diagnosis (PDD) was conducted prior to therapy and 4 weeks after its completion. RESULTS In 17 patients, the itching ceased completely, in 6 women it decreased, in 1 patient the itching continued, none of the patients presented exacerbation of itching. PDD after completion of therapy revealed in 10 patients normal, green fluorescence of vulva and in 14 women pathological, red fluorescence, usually fainter than before PDT. CONCLUSION PDT is an effective therapeutic modality for chronic itching in lichen sclerosus.

Analgesic effect of low-power infrared laser radiation in rats

The aim of the study was to confirm the analgesic effect of low-power laser radiation with a tail-immersion test and check if nitric oxide is involved in laser radiation-induced analgesia in rats. The experiment was performed on male Wistar rats. On the day of experiment the scull of rats was exposed to IR laser radiation for 10 min and antinociceptive effect was determined by means of tail immersion test. The experiments were also performed on 1-NAME and methylene blue pretreated rates, in which both chemicals were administered into right lateral brain ventricle. The results were compared to the ones obtained in the control group in which sham irradiation was made. It was observed that 10 min. exposure to low-power IR laser radiation induced only transient distinct antinociceptive effect in rats. This effect was prevented by ICV. injection of 1-NAME, an inhibitor of nitric oxide synthase and methylene blue, an inhibitor of soluble guanylate cyclase. It seems that nitric oxide is involved in mechanism of low-power laser radiation- induced analgesia.

Fluorescent diagnosis of urinary bladder cancer-—a comparison of two diagnostic modalities

UNLABELLED White light cystoscopy (WLC) is considered to be a standard examination for localisation and surveillance of transitional cell cancer of urinary bladder. However, in patients who have undergone transurethral resection of bladder tumour (TUR-BT) sensitivity of this method is too low for early detection of cancer recurrence. In order to improve this unsatisfactory situation new diagnostic procedures are still under investigation. Fluorescent diagnosis is a modern diagnostic option based on the detection of distinctive fluorescence of normal and pathological tissue. Currently two techniques are in clinical use: autofluorescent diagnosis, also termed laser-induced fluorescence (LIF) and photodynamic diagnosis (PDD). In this study we have analysed sensitivity and specificity of the fluorescent diagnosis to validate the best mode of bladder cancer diagnosis. A total of 281 patients, after electroresection of bladder tumour due to transitional cell carcinoma, without any signs of tumour recurrence in white-light cystoscopy, were divided in two groups: 52 patients underwent PDD and in 229 patients autofluorescent diagnosis was performed. Bladder washings and excisions from suspicious red fluorescent spots were taken for histopathological and cytological analyses. Sensitivity and specificity of PDD equalled to 90.91 and 66.60%, respectively. In case of autofluorescence diagnosis these values amounted to: 97.83 and 70.07%, respectively. The overall sensitivity and specificity of fluorescent examination equalled to 96.49 and 69.46%, respectively. CONCLUSION Autofluorescence diagnosis (LIF) of pathological lesions within urinary bladder has been proven to be more sensitive than PDD as evaluated by a non-parametrical test for structure indicators comparison (LIF versus PDD, P=0.0056).

Impact of low-frequency pulsed magnetic fields on defensin and CRP concentrations in patients with painful diabetic polyneuropathy and in healthy subjects.

Aim. The aim was to assess whether magnetic field influences defensin and CRP concentrations in patients with diabetic polyneuropathy and in healthy subjects. Methods. 61 diabetic patients were randomly divided into 2 groups: study group—32 patients exposed to low-frequency magnetic field; and control group—29 patients with sham exposure. Additionally, 20 healthy subjects exposed to low-frequency magnetic field. Exposures were performed during 3 weeks, 5 days in a week. Defensin and CRP concentrations were measured at baseline, after 3 weeks and at the end of the study. Results. There were no significant changes in defensin concentration in patients with diabetes in both the real and sham exposure group. We observed increased concentration of defensin in healthy subjects in week 5 vs. baseline value (P<0.02). Conclusions. Magnetic field has no impact on defensin concentration in diabetic patients but has positive influence on this parameter in healthy subjects.

Efficiency of autofluorescence diagnosis and photodynamic therapy (PDT) of bladder tumors: our own experience

The efficiency of autofluorescence diagnosis within urinary bladder was analyzed in the study. We examined two groups of patients: the first one consisting of 22 patients suspected to have bladder cancer and the second one consisting of 45 patients who have undergone transurethral electro resection due to urinary bladder neoplasms. Our goal was to detect cancerous tissue invisible in white-light examination. In the first group sensitivity was 100 percent and specificity was 69.23 percent. In the second group sensitivity was 96 percent and specificity was 80 percent. We also report in the study treatment efficiency of PDT in 12 patients with superficial bladder cancer. In our procedure two hours after the instillation of bladder with ALA solution, the lesion was irradiated by laser light. In 9 out of 12 treated patients regression of bladder tumor was obtained, while in 3 cases a progression of neoplasmatic process was observed.

Reactivity to thermal pain stimulus in rats exposed to low-energy laser radiation

The influence on pain perception of acute and chronic exposure to infrared laser radiation applied to the skulls of rats is examined. The experiment was carried out on 60 Wistar white male rats. A semiconductive infrared laser (wavelength -- 904 nm, frequency -- 100 Hz, pulse duration -- 10 ns, mean power 10 mW, energy density 1.5 J/cm2) was used. A skull fornix of rats was irradiated with use of a multidiode probe 10 minutes daily for 14 consecutive days. The pain perception was determined by the latency of foot-licking or jumping from the surface of a 56 degree(s)C hot plate. The measurements were made immediately before irradiation, at 1, 5, 10, 15, 20, 25 and 30 minutes after irradiation, and then every 15 minutes until 120 minutes after irradiation. The pain perception is estimated immediately after irradiation, 24 hours after exposure at the 7th and 14th day of irradiation as well as at the 7th and 14th day after the last irradiation. A pretreatment with Naloxone (1 ml/kg of body weight i.p.) was made in a part of the animals in order to evaluate the involvement of the opioid system in the observed effect. Obtained data show that low-energy laser irradiation affects the pain reactivity of rats. The inhibition of the analgesic effect of laser irradiation by the antagonist of opioids -- Naloxone -- and also the prolonged character of this action as a result of direct irradiation of the skull indicate the involvement of the opioid system in the occurrence of laser-induced analgesia.

Photodynamic diagnostics and therapy of premalignant lesions and cancer: a three-year clinical experience

The results of application of photodynamic diagnostics (PDD) and photodynamic therapy (PDT) for diagnosis and treatment of premalignant lesions and malignant tumours of different tissues were presented. In the period 1998-2000 a total of 314 patients were diagnosed with use of different methods of PDD and a total of 78 patients were treated with use of PDD. On the basis of obtained result we consider PDD and PDT to be sensitive, efficient and non-invasive methods of diagnostics and therapy of malignant lesions.

Laser-induced fluorescent endoscopy (LIFE) in detection of malignant lesions of the colon

110 patients were subjected to colonscopy under white light and autofluorescence. An adapted Xillix LIFE system and xenon light source with interference filter were used in the autofluorescence diagnostics. Both techniques revealed 67 small lesions, including 45 neoplastic ones and 22 others in the examined patients. The autofluorescence examination revealed 43 neoplastic changes, while conventional white-light colonscopy allowed for localization of 39 neoplastic lesions. Autofluorescent imaging of large intestine mucosa is more sensitive in the detection of small neoplastic changes than traditional colonscopy.