Pulsed High Frequency
(Diapulse)
and Routine Hospital Antibiotic Therapy in the
Management of Pelvic Inflammatory
Disease: A Preliminary Report |
MARSHALL JAY LOBELL, M.D., New York, New
York
This study was conducted under the direction of M. Leo Bohrow,
M.D..
Harlem Hospital, New York, New York.
Department of Gynecology, Harlem Hospital Center. |
Pelvic inflammatory disease in 45 patients
was treated with pulsed high frequency energy (Diapulse) in
addition to routine hospital therapy of antibiotics, sedatives,
and bed rest. These patients recovered more quickly (7.4 days
in hospital) then those receiving only the routine treatment
(13.5 days in hospital)
Data concerning the incidence, symptoms, diagnosis, and pathogenesis
of the group of pathologic conditions known as pelvic inflammatory
disease are well known. In spite of the discovery of antibiotics,
the treatment of this disease still leaves much to be desired.
Hypersensitivity of the patient, untoward reactions, and lack
of antibacterial action of the antibiotic used against the specific
causative organisms are but a few reasons for therapeutic failure
even when infection plays an important etiologic role.
The purpose of this investigation was to study the therapeutic
value of pulsed high-frequency (PHF) energy in the treatment
of pelvic inflammatory disease in hospitalized patients. Pulsed
high frequency currents are a development of a coordinated group
of physicists and electronic engineers at a number of universities.’
Before the development of PHF many clinicians had used constant
high frequency currents for therapeutic purposes, primarily
for heating of diseased tissues. Since the constant high frequency
current produces heat locally and hyperpyrexia systemically,
it was used successfully for some conditions but was contraindicated
in many others, especially when infection was present. In contrast,
the PHF current produces high intensity, high-frequency electric
energy without hyperpyrexia.
Clinical investigations have demonstrated the safety and efficacy
of a specially developed PHF generator.* Each pulse of energy,
even at maximum setting, has a duration of 65 microseconds and
the interval between pulses is 1600 microseconds. This allows
ample time for heat dissipation between pulses. When used over
the affected area , over the left adrenal, and over the liver,
it not only hastens local recovery but also increases general
body resistance in arthritis,2’3 bursitis,4 peripheral
vascular insufficiency,5 hypertension,8 sinusitis and allied
conditions,7 and wound healing.8
It has been shown that body defense mechanisms are stimulated
when the liver and adrenals are treated with PHF energy. This
is manifested by an increased response of the reticuloendothelial
system and an in-crease in the gamma globulin fraction of the
blood.9"0 |
| Material and Methods |
This is a preliminary report describing the
results obtained in 100 unselected hospitalized patients with
pelvic inflammatory disease, who were divided into three groups:
Group I, comprising 45 patients, received PHF energy in addition
to routine therapy. Group II was composed of 45 patients who
received only the routine therapy - antibiotics, sedatives,
and bed rest. Group III consisted of 10 patients who were placed
under the PHF generator but not actually treated, with the purpose
of ascertaining the possible psychogenic effects of such a treatment.
These patients also received routine therapy. The authors and
the nurse administering treatments knew which patients were
receiving PHF. The physicians in charge of the patients were
unaware of this fact.
The study extended over a period of four months, from September
through December, 1961. The average number of treatments that
a patient received was seven, the range being from two to eleven.
The duration of each treatment was 30 minutes, the suprapubic,
liver, and left adrenal areas receiving 10 minutes respectively.
The suprapubic area received a dosage of 600-pulses/ minute
at a penetration of 6. The liver and left adrenal received a
dosage of 400 pulses/minute at a penetration of 4.
Before any patient was included in the study, careful examination
was done to rule out the presence of malignant disease or other
conditions, which required immediate surgery.
In the management of patients with pelvic inflammatory disease,
laboratory findings are not dependable criteria for determining
the progress of the disease. Some patients with large, tender,
bilateral adnexal masses and abdominal and pelvic pain were
afebrile and had normal white counts. In others with less obvious
involvement, fever and leucocytosis were high. The progress
of the disease and response to therapy are best determined by
studying the subjective and objective clinical findings.
For these reasons the therapeutic response of each patient was
determined as follows:
1. Subjective signs and symptoms as related by the patients,
especially pain, discomfort, or other symptoms, which had brought
the patient to the hospital.
2. Physical examination, especially such diagnostic procedures
as x-ray, recto-vaginal examination, inspection of the cervix,
study of vaginal discharges including menstrual bleeding, and
palpation to determine local tenderness and presence and size
of masses.
3. Laboratory procedures such as blood studies, including leucocytosis
and differential white cell count, urinalysis and changes in
body temperature - these used merely for corroboration in conjunction
with the clinical findings. |
| Results |
The patients in each group were divided into
three categories: those with acute pelvic inflammatory disease,
those with chronic pelvic inflammatory disease, and those with
chronic pelvic inflammatory disease complicated by adnexal masses.
Since the natural course and the prognosis of the three forms
of pelvic inflammatory disease are quite different, it was thought
best to compare them separately.
For the purpose of this study, patients were termed acute if
they showed all signs and symptoms of pelvic inflammatory disease
without any previous history of the disease. Those patients
whose disease manifested itself by repeated reinfections or
exacerbations were termed chronic.
Table 1
| |
Acute PID |
Chronic PID |
Chronic PID w/ Masses |
Total |
| Group 1* |
| Days in Hosp (range) |
2-7 |
3-13 |
5-22 |
2-22 |
| Days in Hosp (average) |
4.3 |
7.2 |
10.0 |
7.4 |
| # Of Patients |
11 |
22 |
12 |
45 |
| Group 2† |
| Days in Hosp (range) |
4-13 |
5-17 |
6-54 |
4-54 |
| Days in Hosp (average) |
7.2 |
10.3 |
21.0135 |
7.4 |
| # Of Patients |
10 |
20 |
15 |
45 |
| Group 3‡ |
| Days in Hosp (range) |
4 |
4-17 |
0 |
4-17 |
| Days in Hosp (average) |
4 |
11.1 |
0 |
10.4 |
| # Of Patients |
1 |
9 |
0 |
10 |
* = Patients who received PHF.
† = Patients who did
not receive PHF.
‡ = Placebo group-machine left on standby but not running.
Only the authors and the nurse running the machine knew this.
The average hospital stay for patients with acute pelvic inflammatory
disease who were treated with PHF was 4.3 days. For those who
were treated with antibiotics, sedatives, and bed rest but who
did not receive PHF the average hospital stay was 7.2 days (Table
1).
The average hospital stay for patients with chronic pelvic inflammatory
disease was 7.2 days for patients treated with PHF, 10.3 days
for those who did not receive PHF (Table 1).
The most striking differences occurred in the patients who had
chronic pelvic inflammatory disease complicated by adnexal masses.
The average hospital stay for the PHF-treated group was 10.0
days, for the group not having PHF but receiving routine hospital
therapy 21.0 days (Table1).
Two patients in each of the latter groups required surgery because
of persistence of masses and lack of response of the disease.
Of the two PHF-treated patients who required surgery, the required
total hospitalizations were 22 days each; in the two who did
not receive PHF these stays were 52 and 54 days, respectively.
Concrete conclusions cannot be drawn from only four patients,
but the results are highly suggestive.
Nine of the 10 patients in Group III suffered from chronic pelvic
inflammatory disease. The average hospital stay of these nine
patients was 111 days. The similarity between this group and
the patients in Group II with chronic pelvic inflammatory disease
should be noted (Table 1). There were no untoward effects from
PHF treatment. |
| Discussion |
Since all patients received antibiotics,
sedatives, and bed rest, at least some of the benefit might
be attributed to these measures. Alleviation of symptoms occurred
in most patients with routine therapy alone. In Group I when
PHF was used in conjunction with the routine hospital therapy,
the response to therapy was much more rapid and complete. Total
subsidence of symptoms, improved general well-being, return
of temperature to normal, alleviation of abdominal and pelvic
pain and tenderness, and disappearance of adnexal masses occurred
in most PHF treated patients after three or four treatments.
Not all patients received PHF treatments every day, some only
two or three times a week. Only one nurse was trained in the
use of the machine so that several patients did not receive
their first PHF treatment until they had been in hospital for
two or three days. Earlier and more frequent PHF treatments
might have produced even more rapid response and shortened the
hospital stay. |
| Summary |
In this preliminary study various types of
pelvic inflammatory disease were treated in 100 hospitalized
patients, who were divided into three groups. The 45 patients
in Group I received PHF energy in addition to the routine hospital
therapy of antibiotics, sedatives, and bed rest. The 45 in Group
II received only antibiotics, sedatives, and bed rest. The 10
in Group III were placed under the PHF machine but received
no PHF treatment. They did receive antibiotics, bed rest, and
sedation. The patients in Group I responded much more rapidly
and more completely than those in Groups II or III. The average
hospital stay for the PHF-treated patients was 7.4 days, for
the controls 13.5 days.
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Page 117. |
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