26607302 DITI in Medicine Praatje for Fisio Nederland
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Transcript of 26607302 DITI in Medicine Praatje for Fisio Nederland
The sympathetic control of skin
blood-flow.
Sensory (afferent) signals that driveautonomic activity may originatefrom (A) the viscera (visceral sensory);(B) the surface of the body(somatic sensory); and the externalenvironment (special sensory).
Sympathetic preganglionicneurons are located in the lateralhorn (intermediolateral cellcolumn) of the spinal cord (A).
Sympathetic postganglionicneurons are located in theparavertebral ganglia (B) and inthe preaortic ganglia.
The adrenal medulla is a specializedsympathetic ganglion (D).
Thermography:
It has been shown that the surface temperature of the human body is symmetrical.
It is a reflection of blood flow in the dermal microcirculation, and the control of this microcirculation is autonomic and specifically, sympathetic.
The major basis of clinical thermography is the correlation of temperature recordings with various conditions from disease and injury as it relates to autonomic function.
Early Thermography
• 400 BC – Hippocrates took the first thermograms using wet mud over the body.
(He is said to have stated “should one part of
the body be colder or hotter than the other corresponding part, disease is present in that part”)
• ADD CLIP ART – MARY
• MUD BATH ?
• ANIMAL?
That man’s a little nutsy
Sir William Herschel.
Who discovered infrared radiation 1800.
One of Herschel’s experiments to detect heat in the spectrum.
Sir John Herschel.
who made the first thermogram 1840.
The very first thermal image in 1948 took 40 minutes to to scan
Contact thermography
Henk van der Veen, Dutch general practitioner , pioneer in the use of videothermography as diagnostic in painful diseases sitting in front of a large videothermograph developed by Philips biomedical systems in the early 80th.
2004
20092009
Videothermography was used to measure skin temperature, and activity was recorded with the Upper Limb Activity Monitor. Both methods have recently been validated for use in patients with CRPS.
0
50
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1963 1967 1971 1975 1979 1983 1987 1991 1995 1999 2003
Fig. 1. Number of articles listed in medline from 1963 to 2003(*expected).
Fig. 5. Number of published articles categorized according to the organ system. (n=2993)
33.6%
19.4%19.4%
11.9%
5.3%2.9% 2.7% 2.1% 1.4%0.4% 0.1%0.1% 0.1%
0
200
400
600
800
1000
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Breast Vascular Endocrine Gynecolocic
BreastNervous systemExtremityVascularFaceDentalEndocrineSpineCardiacGynecolocicUrologicMusculoskeletal
97.9%
3.6%
Diagnostic aid
Monitoring for therapeuticeffect & disease progression
Fig.4. Usage of infrared thermography : diagnostic aid vs.monitoring for therapeutic effect and disease progression.
0
100
200
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Cancer Peripheral n. Diabetes Headache Radiculopathy Hyperhidrosis
동부
Fig. 6. Number of published articles categorized according to the clinical settings. (n=2113)
27.5%
10.6%7.0%
3.5%
3.0%2.4%2.2%1.5%2.4% 1.4% 1.5%1.8% 1.1% 0.7%0.4%
28.2%
November 2008
Thermal Modeling of Snake Infrared Reception: Evidence for Limited Detection Range B. S. JONESa, W. F. LYNNb and M. O. STONEc, 1
a Department of Biomedical Engineering, Wright State University, Dayton, OH, 45435, U.S.A.b Veridian Engineering, 5200 Springfield Pike, Suite 200, Dayton, OH, 45431, U.S.A.c Air Force Research Laboratory, Materials and Manufacturing Directorate, Wright-Patterson Air Force Base, OH, 45433-7702, U.S.A.
Received 28 October 2000; accepted 21 December 2000. ; Available online 28 February 2002.
AbstractFor more than 40 years, information has circulated with regard to the sensitivity of infrared pit organs in both boid and crotaline snakes (pythons and pit vipers, respectively). The most often quoted sensitivity is 0.003°C
Factors that influence the reliability of thermographic measurement in patients and controls can be divided into:
Equipment-related
Subject-related and
Surrounding-related factors.
ThermographyThe stethoscope of pain medicine
Thalamus
Cervical Disc Herniationat C4/5
Multiple sclerosis
PoliomielitisRight Leg
Conclusion Published: 23 Jan 2008In the present study, we have established the ability of 3D and thermal surface imaging to produce reliable, quantifiable measures of joint volume, shape, and temperature to aid in the assessment of disease activity in arthritis.
Tendinosynovitis right hand
Thermograms of a patient subjected to restorative surgery,
ligamentoplastia of the cruciate ligament
Thermogramof the right leg of a
patient with medial tibial stress syndrome.
Thermogram of an athlete with Grade I ankle sprain
Varicocele
Case report• HISTORY AND SUBJECTIVE COMPLAINTS:
• Patient 49, has a lot of radiating pain starting from his right hip across the lower abdomen into the testicles. Pain is constant and started 2 years ago after he had surgery of an inguinal hernia at his right groin. He got several treatment without any result, pain is still there. He takes painkillers but they don’t help.
• History: has a L3 and L4 disc compression, 2 inguinal hernia (right and left). Is not a smoker, has no high blood pressure and is not a diabetic.
Inguinal Area: There is hyperthermia with hot spots in the inguinal area wich seems more or less symmetrical and due to body habitus. Scrotus seems thermographically normal, no signs of varicocele.
Case report continuedThere is hypertermia with hot spots in the lower back which might correlate withDiscopathy and a radicular syndrome which is in the L1 to L3 Dermatome. This might be the causeFor his symptoms
Positive VAS Deference
Treatment and Diagnosis aids
• Full spine radiographs– Film exposed to x rays or gamma rays
• Motion X Rays• Surface EMG• Digital thermography
Plantar Fasiitis
PLANTAR INFRARED THERMOGRAPHY MEASUREMENTSAND LOW BACK PAIN INTENSITY
Nina Zaproudina, MD,a Zhiyong Ming, MD,b and Osmo O.P. Ha¨nninen, DMSc, PhDc; Finland
Myofascial Trigger Point
Trigger point inupper part of left
Rhomboid
Trigger points
Paracervical botox injections
To summarize, this means that if a patient has a thermal asymmetry with a temperature difference greater than _+ 0.62 ~ C, then an abnormality is presumed to exist.
Clinical Case
Circulatory loss in injured fingers
Herpes Zoster
Focal hypothermia relating to a malignant cyst
Small metastatic tumors indicated by focal areas of hypothermia over the lumbar spine
Image several weeks earlier
Image 2 weeks prior to image above
Chorioamnionitis
Biomed Instrum Technol. 1996 Nov-Dec;30(6):526-30. Application of telethermography in the evaluation of preterm premature rupture of the fetal membranes.Sheinberg M, Hayashi R, Bromley J, Dormer L.
MVA, Steering wheel impacted the low chest, subsequent x-ray as a result of thermal findings showed fractures in the low sternum and left last rib.
Periodontal Disease & Other Oral Pathologies
There is mounting evidence that oral pathology is also a major source of breast cancer. Independent studies done over the past 10 years have produced evidence that oral pathology always exists on the same side
of the body where the breast cancer appears.
Thermography after a root canal treatment
Hypothermic asymmetry over the left lower chest has a history
of CAD
J Vasc Br 2003;2(2):151-60
Thermal coronary angiography showing perfusion of the anterior descending coronary artery and
heart muscle
Search TRAM flap at youtube.com
60 % occlusion of the right carotid artery
Isotherm 16 color Medical scale
Carotid Artery occlusion (Right side)
Inflammation over the right kidney
Focal hypothermia over T1 / T2
Thalamus
Patients with diagnosed Chronic Fatigue Syndrome and Fibromyalgia
Hyperthermia over both lobes of the thyroid
Indicating thyroid ‘dysfunction’
Visualizing sweat glands(macro lens imaging)
A focal area of inflammation that guided a sonographer to a deep abscess
TMJ
Facial paralysis (bells palsy)
Occlusion of the left internal carotid artery
Infarction of the left hemisphere
Total right side hemiparesis
Infrared Thermography in the Diagnosis and Management of Sports Injuries
valuable diagnostic tool in sports medicine and musculoskeletal disorders.
Thermography not only helps confirm a diagnosis, but can be used as a gauge to clinically assess progress and treatment response, as well as a prognostic indicator.
Thermography is noninvasive, risk-free, and relatively portable, it is a practical cost effective tool in the clinical setting.
Epicondylitis, patellofemoral syndromes, ankle injures, shin splints, stress fractures, myofascial pain syndromes, spinal pain syndromes, shoulder injures, and foot pain syndromes, sympathetic maintained pain, and reflex sympathetic dysfunction.
“Clearly thermography will be a powerful medical tool and its contribution to health care Is at its infancy stage of utilization”
Mathew H. M. Lee MD
Epicondylitis
isotopic bone scan
Thermograph of the feet of a diabetic patient
Diabetes Technol Ther. 2009 Oct;11(10):663-7.
Feasibility of a thermographic method for early detection of foot disorders in diabetes.
Roback K, Johansson M, Starkhammar A.Center for Medical Technology Assessment, Department of Medical and Health Sciences,
Linköping University, Linköping, Sweden. [email protected]
CONCLUSIONS: The foot indicator detected a relatively high share of the different types of complications but not all. It can be used as a complement to current practices for foot examination. The instrument provides rapid imaging of the foot temperature, and the study indicates that it yields valuable diagnostic information in early stages of foot disease.
Thermography in the clinical settings
Assessment of microcirculatory involvement and determination of amputation level through
skin thermometry.
J Vasc Br 2003;2(2):151-60
In the acute settingTrauma in the ICU
Left Leg Right Leg
In the surgery ward
Brachial plexus entrapment
• Right side brachial plexus entrapment
• Lower right arm sympathetic reaction
Myofascial Trigger Point - in semispinalis cervicus
Stress Fracture Football player
with stress fracture, confirmed with scintigraphy
Sympathetic Pain
Sympathetic irritation in the heel of the left foot
Fracture to left ankle
Sympathetic shutdown in affected limb
Three stress fractures of the transverse processes of the lumbar spine.
Sinus Headaches
All of these patients suffer with headaches. We can see by the patterns in the forehead and sinuses that they are caused by sinus and/or allergies
Sinusitis and middle ear infection
Frey’s Syndrome – 50 year old male
Minor’s starch iodine test (current method foridentifying affected skin area)
Post fracture
Poor healing response left ankle after cast removal
Right ankle fracture
• 6 weeks post fracture right ankle
• Weight transfer to left shin
T 4 Syndrome
Post surgery
• Right knee 3 weeks post arthroscopy
Sympathetic Regional Blocks
Am J Chin Med. 2007;35(6):967-75.
A method of selecting acupoints for acupuncture treatment of peripheral facial paralysis by thermography.Zhang D.Department of Biomedical Engineering, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing 100700, China. [email protected]
Monitoring the effects of Acupuncture
Baseline before needle placement
Stabilized result after needle Removal
Sequential recording at 5 minute intervals with needles in place
• Posterior cruciate strain left knee
• Vascular damage below knee
Posterior cruciate
Right Lung Cancer
Fibromyalgia(an autoimmune disease)
Lung cancer is an organ disease and in the later stages can be seen as a malfunctioning lung as evidenced by the relatively colder pattern.
Fibromyalgia is an immune deficiency, evidenced by the hypothermia at T-2 and the trigger points which are more inflammatory.
This patient was diagnosed with IBC. After only three weeks of continued treatment with herceptin and a naturopathic protocol suggested by her
doctor she was rescanned to see if there was any regression in her symptoms. As you can see, the improvement was remarkable.
The Ability to Monitor a Patients Progress During Treatment
October 19, 2006 November 9, 2006
Mother Breastfeeding only with the right breast
Perforated Breast Implant
Abces right breast
Patient known with asthma
Left knee medial ligament strain
Medial ligament
Complex Regional Pain Syndrome
• RSD left toes
RSD of the right foot
Neuropathy in the fingers of the right hand
Early stage bilateral carpal tunnel syndrome
Chronic right carpal tunnel syndrome
RSD (CRPS) of the left hand.
Glove-like hypothermia.
The return of normal sympathetic function after treatment was short term.
“Hunting phenomenon”
Subclavian artery steal syndrome
Carpal tunnelPre- surgery
Post-surgery
Bulging Disc, L5/S1 Nerve Root Irritation: Before and After Treatment
Scorpion bite right thumb
Disadvantages related to thermographicmeasurements.
• The lack of standardization in the manner in• which thermographic measurements are performed• The sparse analyzing methods available• to analyse thermographic data, • The lack of knowledge regarding the underlying
mechanisms that result in temperature differences• The need for a dynamic measurement.
BREATHING
Thank you for listening
The human mind is like a parachute
It is of no use unless it is open
