ESWT History. ESWT treatment of mycardial Infarction during open heart surgery

Transcription

1 ESWT History Shockwaves were first identified during World War II. Submarine crews exposed to detonation of Hydrogen bombs incurred shockwave induced injury to lungs. On February 7 th 1980 the first successful, non-invasiv kidneystone treatment with shockwaves. Extracorporal Shockwave Therapy (Lithotripsy) becomes Urologists treatment of choice for Urolithiasis. To date > 30 Mio. lithotripsy procedures have been performed. Continued Application of ESWT in Orthopedics including frozen shoulder, tennis elbow, heel spur, bursitis, jumpers knee and achillodynia ESWT treatment of mycardial Infarction during open heart surgery December By accident, Dornier Systems develop the basic physical understanding for the interaction of shockwaves with tissue, materials. Observation of increased bone density following lithotripsy treatment leads to investigation of possible orthopedic applications the first treatments of non-healing fractures (pseudarthrosis). Application of ESWT in Dermatology including non-healing wounds, diabetic foot ulcers, decubital ulcers and burns.

2 ESWT Introduction Acoustic waves are pressure and density fluctuations and thus are also termed pressure waves ; Shockwaves are pressure waves with a specific and characteristic pressure profile : very short rise times (in the nanosecond range) high amplitudes ( up to 100 MPa ) short pulse duration ( < 1 microsecond ) Electrohydraulic shockwaves are generated by an electrical discharge in water. (other means of shockwave generation include piezoelectric and electromagnetic principles) The reflector geometry enables generation of either highly focused shock waves (Urolithiasis or Pseudarthrosis) or soft focused shock waves (for most soft tissue applications)

3 Biologic Effects of ESWT Change of cell membrane permeability Release of neurotransmitters Antibacterial effects Release of NO (nitrogen oxyde) Release of growth factors (VEGF, enos, BMP-2, PCNA) Induction of vessel growth Stem cell migration and differentiation Regeneration of vessels, skin, bone and nerve tissue. In addition to orthopedic applications since 1992, ESWT is nowadays used in Dermatology.

4 ESWT Clinical Results Female patient Age 94 Chronic skin lesion with staph. aureus infection Chronic leukemia Chronic obstructive pulmonary disease ( COPD ) Cortisone therapy Chronic Infectious Skin Ulcer Pre-treatment After 2 weeks 3 treatments with Soft Focus ESWT without anesthesia After 4 weeks After 7 weeks

5 ESWT Clinical Results Male patient Age 57 >1 year conservative unsuccessful treatment Chronic Ulcer Pre-treatment After 2 weeks 3 treatments with soft focus ESWT without anesthesia After 4 weeks After 6 weeks

6 ESWT Clinical Results Male patient Age 47 Trauma caused by boating accident Primary treatment with ESWT Chronic Ulcer Pre treatment After 2 weeks 3 treatments with soft focus ESWT without anesthesia After 5 weeks After 11 weeks

7 ESWT Clinical Results Male patient Age 20 Paraplegic due to bullet wound incurred 2 years earlier Decubital ulcer since 5 months Decubital Ulcer Pre treatment After 1 week 5 treatments with soft focus ESWT without anesthesia After 3 weeks After 5 weeks

8 ESWT Clinical Results Chronic infected ulcer After 6 weeks Pre treatment

9 Decubital ulcer After 6 months Pre-treatment

10 Burn wounds After 6 months Pre-treatment

11 Non-healing wound post fracture After 6 months Pre-treatment

12 Pseudarthrosis Male patient Age 59 Talus fracture Pre-treatment After 3 months After 5 months After 1 year

13 Pseudarthrosis Female Patient Age 36 Sub-total amputation Replantation K-Wire Spongio-plasty Plating Ext. Fixator After 4 years ESWT application Pre treatment After 3 months After 6 months

14 Pseudarthrosis After 6 months Pre treatment

15 Pseudarthrosis Female patient Age 59 Injury due to a fall Diabetic Pre treatment After 3 months After 6 months

16 Male Patient Age 46 Motorcycle accident Tibia fracture External fixator After 8 weeks removal of fixator and cast After 9 months ESWT application Pseudarthrosis After 2 months After 4 months

17 Male Patient Age 46 Motorcycle accident Tibia fracture External fixator After 8 weeks removal and cast After 9 months ESWT application Pseudarthrosis CT pre treatment CT 4 months post ESWT

18 Study Results Orthopedics Achilles tendon Bursitis Fasciitis plantaris Tendinosis calcarea Non-union (Pseudarthroses) PPS (Patella tip syndrom) Epicondylopathia humeri radialis Epicondylopathia humeri ulnaris Over a period of 2 years, 409 patients were treated for a variety of sports related injuries at the sports medicine clinic in Hellersen. 74% patients reported positive to very positive therapeutic results

19 Study Results Dermatology Clinical studies conducted by Dr. Wolfgang Schaden, Vienna and Dr. Richard Thiele, Berlin Total 200 patients 74,5% of the wounds healed completely within 2-12 weeks.

20 ESWT Indications Orthopedics Achilles tendon Bursitis Fasciitis Plantaris Tendinosis calcarea Pseudarthrosis PPS Epicondylopathia humeri radialis Epicondylopathia humeri ulnaris Dermatology Non-healing wounds Post-traumatic lesions Ulcers Decubitus Burns

21 ESWT forecast Da Vinci projects Dermatology Orthopedics Odontology Neurology Cardiology

22 ESWT forecast Dermatology Combat Wound Initiative 2007 Dermatology Orthopedics Odontology Neurology Cardiology Walter Reed Army Medical Center Extensive survey on ESWT 3-years study with wounded soldiers from Afghanistan and Iraque Cooperation with the Army Research Center Aim : Improve wound healing quality Comparison Standard of Care vs. Standard of Care + ESWT Budget: 10 Mio. USD Data: data elements per patient

23 ESWT forecast Dermatology Cellulite Dermatology Currently numerous studies running regarding the effectivness of the ESWT in cellulite care Orthopedics Odontology Neurology Cardiology Adipocellular / Lipolysis First, very positive results out of running studies in Korea and Italy Burns First, very positive results out of a running study at the Verbrennungszentrum in Berlin

24 ESWT forecast Orthopedics Dermatology Orthopedics Odontology Neurology Cardiology Arthrosis In a study in Berlin a patient s knee was treated with ESWT The knee was re-arthroscoped after 1 year. The cartilage was almost totally recovered.

25 ESWT forecast Dentistry Dermatology Orthopedics Odontology Neurology Cardiology Bacterial Parodontitis At the University of Kentucky rats were infected during 12 weeks with the bacteria Porphyromonas gingivalis. After 12 weeks the animals were sacrificed, skeletonized, measured on bone reduction and compared with the control group. The bones of the ESWT-treated animals were almost totally reproduced.

26 ESWT forecast Neurology Dermatology Orthopedics Odontology Neurology Nerve transplantation At the Ludwig-Boltzmann-Institut in Vienna rats were treated. The sciata nerve was cut, turned by 180 and reimplanted. After ESWT clear advantages of the treated animals in comparison with the control group were measured (Step-test, Catwalk, Plain-test). Cardiology Peripheral nerve system Spinal cord Brain ESWT Work in Progress

27 ESWT forecast Cardiology Heart surgery Dermatology Orthopedics Odontology Neurology Cardiology At the Allgemeinen Krankenhaus Vienna an artificial infarction of the heart was induced with rats and pigs by blocking the coronary vessel. All ESWT treated animals showed significant growth of new blood vessels in the infarct area. The remarkable results were shown officially at the ISMST-Congres in Toronto June First human treatment (open heart surgery) in December 2007.

28 ESWT forecast furthermore Dermatology Orthopedics Dentistry Neurology Cardiology furthermore Plants Soja bean sprouts were treated with ESWT. A clearly faster growth of the treated plants was registered in comparison to the control group. In Kärnten currently wounds on trees are treated with ESWT, results in late summer 2007