The Therapeutic Value
of Pulsed
Electromagnetic Energy (Diapulse®)
In The Treatment of
The Post Partum Patient
A Pilot Study* |
John E. Fenn, M.D., F.R.C.S.
Dept. of Obstetrics & Gynecology
St. Michaels Hospital, Toronto, Canada |
The therapeutic value and the biological
effects of the irradiation of the electromagnetic spectrum have
been the subject of many studies since the turn of the century
when in 1895 Roentgen discovered X-Rays. Progress and knowledge
have been slow until the last decade when more information has
become available regarding the electro chemical intracellular
effects of electromagnetic energy below the level of 30 MHz:
that is its ability to deposit energy within the cell and alter
the intracellular electro chemical behavior. This being shown
by an acceleration of the processes of cellular repair to the
visible cellular changes representing physiological damage,
resultant cellular death and cellular repair.
The beneficial and adverse effects of irradiation of the different
levels of electromagnetic spectrum have been recognized and
accepted in general by the biophysical and bio-medical professions.
Until recently it was thought that the thermal factors involved
produced both the beneficial and adverse effects associated
with the irradiations of the electro-magnetic spectrum.
Although most of the work in the past has been concentrated
on the cellular effects of X radiation, that is, the indirectly
ionizing radiation, the importance of the directly ionizing
radiation is assuming its role of importance in the cellular
repair processes at the electrochemical and the bio-chemical
level. Dale and his co-workers using carboxy peptidase showed
that the reactions obtained, when the solutions were irradiated,
were limited by factors present within the solution. When one
considers the disassociation constant of water being subjected
to an intense field of electrons radiolysis — it is readily
seen the number of chemical changes possible that could take
place with resultant alteration of the PH; that is, an alteration
in the Redox System or hydrogen ion electron transfer process.
Many attempts have been made to eliminate the heat factor from
the use of electromagnetic energy. These attempts have utilized
various methods of micro energy and macro pulsations as well
as the use of hypothermia and hyperthermia
All of these methods have their limitations in that the thermal
factor is not completely eliminated; therefore prolonged exposure
will result in cellular death.
In 1933 Ginsberg postulated that by increasing the energy wave
packets and controlling the emission of these high energy quantums
the physiological response could be improved. The initial responses
were not as great as expected due to the equipment available
at that time. It was not sophisticated enough to generate the
wattage required nor was it able to produce a standard signal
or an invariable wave length.
In the late nineteen thirties Milinowski and Ginsberg developed
circuitry which could produce a standard signal capable of carrying
these high-energy quantums for a minute period of time. The
power produced was nine hundred and seventy-five watts for a
period of sixty-five microseconds. The amplitude of the pulse
together with the pulse width were constant, only the pulse
interval and energy involved could be varied in a standard manner
giving an average maximum power output of thirty-eight watts.
The wave-form itself was a flat topped wave oscilloscope as
compared to that of diathermy, which has a peak top wave. This
variance enabled different depths of penetration together with
different physiological effects such as vasodilatation and increased
smooth muscle activity and accelerated wound healing.
To date due to lack of sophisticated micro electro biophysical
and micro bio-chemical methods, most of these observations have
remained in the nebulous field of subjectivity and since they
have not been able to withstand objective scrutiny have been,
heretofore, labeled questionable.
It is only now that we are able to obtain information that is
objective in part. Until our laboratory methods at the intra-cellular
level become more refined and our technical assistance become
more specialized and more available, we as clinicians must,
as the saying goes, "fly by the seat of our pants":
i.e., be more tolerant to our research colleagues in offering
to them our whole hearted support, cooperation and encouragement,
we cannot afford to sit back and dogmatically state that because
we cannot understand certain mechanisms they are false.
The technicological aspects of modem medicine have advanced
so rapidly in the last two decades it is impossible for us who
are limited to the clinical confines of medicine to be current
in our research thinking — I am sure most of you have
undergone that embarrassing situation that develops when your
fourteen year old requests help in physics and mathematics or
even more horrifying is a question in biometrics. With the above
factors in mind I submit to you my experiences with the above-mentioned
modality in the treatment of the postnatal patient. |
| MATERIAL AND METHOD |
A pilot study was carried out on forty-seven
post-natal patients who were selected consecutively, no attention
being paid to age, parity, method of delivery, or obstetrician.
Initially, certain parameters of clinical evaluation were established.
The method of treatment was standard in that each patient would
receive the initial treatment as soon as feasible following
delivery, and it would consist of exposure of either the perineum,
if a vaginal delivery or the abdominal wound if a Caesarian
section. The settings used were a pulse frequency of six hundred
per second and peak power setting of six (975 watts of peak
power) for a period of ten minutes. The hepatic and the left
costovertebral regions were exposed for a period often minutes
each at a pulse frequency of four hundred per second and a peak
power of four (585 watts of peak power). The thirty minute treatment
was repeated twice daily for three days in vaginal deliveries
and five days in Caesarian sections. Clinical and laboratory
observations were recorded daily. These observations included
amount of medication. narcotics, barbiturates and analgesics.
General condition of the patient T.P.R. height of fundus and
number of perineal napkins required per day, and the condition
and odour of the lochia. The incision, whether it be perineal
or abdominal was observed for heat. swelling. redness and induration.
Laboratory investigation consisted of an initial and final Hb
and smear with a daily white count routine. daily urinalysis:
this was recorded on the standard information form.
Using the above parameters a trial double blind study was carried
out on six patients. One standard Diapulse unit was devitalized
by removing one two-ampere fuse in the output portion of the
circuitry. This prevents the power from reaching the treatment
head but does not interfere in any way with the operation of
the machine: that is, both the indicating lights and the wattage
meter register, the cooling fan operates. In other words the
units outwardly behave the same. The neon tuning lights were
covered with adhesive tape and the tuning knobs of both machines
were taped in a fixed position. The viable unit was tuned by
me every morning so that the operator did not know which machine
was viable: they were marked A and B machines.
Within twenty-four hours it became obvious to the operator and
the nursing supervisor which machine was viable. This pointed
up future difficulties when further studies of a double blind
nature are commenced.
The hospital and clinical records of one hundred and fifty-three
of my own private patients of the previous year, involving three
hospitals, were reviewed. The pertinent clinical and laboratory
findings were recorded. The absence of chronic cervicitis was
assumed to be those cases, which did not require cauterization
or the administration of a triple sulfa vaginal cream at the
time of the six week post delivery visit
I regret that this observation is done in hindsight however
I hasten to add that had it not been for the critical observance
of one of my colleagues, observing the absence of chronic cervicitis
in those patients who were his responsibility and concern, we
would have never realized the most important objective finding
of this study. |
| SUMMARY |
Our comparable results are recorded
in the following table:
| |
Control |
Treated |
| Number of Cases |
153 |
47 |
| Ave (Average) |
24 (16 –to- 17 years old) |
25 (14 –to- 43 years old) |
| Vaginal Deliveries |
144 |
47 |
| 1. Spontaneous |
70 |
23 |
| 2. Low forceps |
68 |
18 |
| 3. Mid forceps |
4 |
6 |
| 4. Breech (assisted) |
2 |
0 |
| Episiotomies |
Control |
Treated |
| 1. Mid line |
82 |
22 |
| 2. L.M.L.Z. |
1 |
0 |
| 3. R.M.L. |
4 |
10 |
| 4. Lateral |
0 |
0 |
| Vaginal Tears & Extensions |
5 |
8 |
| Caesarian Section |
10 |
6 |
| Morbidity |
12 |
3 |
| 1. Endometritis |
10 |
2 |
| 2. Abcess |
2 |
1 |
| 3. Chronic Cervicitis |
128 (84%) |
4 (9%) |
| Medication |
Control |
Treated |
| 1. Morphine grs. 1⁄4 |
3 |
1 |
| 2. Demerol 100 mgms. |
21 |
2 |
| 3. A.P.C. & C grs. 1⁄2 |
85 |
20 |
| 4. Numbutal grs. 1 1⁄2 |
130 |
45 |
| 5. Seconal grs. 1 1/2 |
43 |
6 |
A review of the nurses’ clinical notes in the control
group were valueless because of the tremendous variation in
the terminology used.
In the treated group the observations were made by one supervisor
having fifteen years experience in obstetrical nursing and her
observations suggested a marked improvement in the condition
of the perineum and abdominal wound with respect to edema and
redness induration. |
| DISCUSSION |
We realized we required more objective methods
for evaluation. Using the CU5 Polaroid camera together with
a Bakelite Fergusson vaginal speculum, we developed a standard
photographic technique, which could be used by an inexperienced
photographer.
At six weeks from the time of delivery, the patient would be
examined and the cervix photographed so that at the completion
of the study the photographs would be assessed by an impartial
panel of gynecologists as to whether or not chronic cervicitis
is present The panel would be blind in that they would not know
which photographs were those of the untreated or those of the
treated Prior to the assessment they would be provided with
a standard cervical photograph.
Since this study was presented we have carried out small animal
studies on rabbits and pigs using artificially induced hematomas
and wounds. These studies have been comparative in nature, using
all forms of electromagnetic energy other than the X-ray irradiations
and have shown that pulsed electromagnetic energy of sufficiently
high peak power does accelerate the wound healing processes
by as much as forty-seven per-cent for the hematomas and thirty
per-cent increase in the tensile strength of wounds over a certain
period of time. These studies will be published in the near
future.
The purpose in presenting this paper to this meeting was the
hope that interest in other centres be stimulated so that our
studies may be repeated and the results confirmed |
|
