#46
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åñëè èñêàòü ïî çàïðîñó "radiotherapy heel spur", òî åñòü åùå èíôîðìàöèÿ....
íåìåöêèå èññëåäîâàòåëè íàøëè, ÷òî ðàäèîòåðàïèÿ ïðèíåñëà îáëåã÷åíèå 80% èç 117 èõ ïàöèåíòîâ íà äîñòàòî÷íûé ñðîê è ïëàíèðóþò ïðîäîëæàòü èñëåäîâàíèÿ ïî ïîäáîðó îïòèìàëüíî äîçû... Low-dose radiotherapy for painful heel spur. Retrospective study of 117 patients. Strahlenther Onkol. 2003 Department of Radiotherapy, Radiation Oncology and Nuclear Medicine, Weiden Hospital, Weiden, Germany. PURPOSE: Retrospective analysis of 117 patients treated between 1996 and 2000 with low-dose radiotherapy (RT) for painful heel spurs. PATIENTS AND METHODS: 71 women and 46 men were irradiated on 136 painful heel spurs in one (n = 104) or two radiation series (n = 13). The painful spurs were located either at the plantar (n = 94), dorsal (n = 5) or bilateral heel (n = 18). 82 patients had prior treatments, in 35 patients RT was the primary treatment. Low-dose RT was performed twice a week with one 6-MV photon field. Ten fractions of 0.5 Gy were applied to a total dose of 5 Gy. Evaluation was done on completion and during follow-up using the four-scale von Pannewitz score. RESULTS: On completion of RT, 27 patients were free of pain, 40 were much improved, 31 reported slight improvement, and 19 experienced no change. After a mean follow-up of 20 months, 75 out of 100 patients were free of pain, twelve had marked and three some improvement. Ten patients reported no change of symptoms. Mean duration of pain before RT was 6 months. RT applied < or = 6 months after the onset of clinical symptoms resulted in improvement in 94%. By contrast, an interval of > 6 months until the initiation of RT resulted in only 73% of patients with clinical improvement. CONCLUSION: Low-dose RT reveals a benefit in > 80% of the patients. RT should start during the first 6 months of symptoms. Prospective clinical studies with validated symptom scores should be conducted to assess optimal dose and fractionation scheme of RT. |
#47
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ïðè ýòîì çàïðîñå åñòü åùå ðàáîòû, íå ïîëó÷àåòñÿ âñå ñðàçó îñîçíàòü.
Èç òîã, ÷òî ïðî÷èòàë, íè÷åãî íå ïîçâîëÿåò îòâåðãóòü ìåòîä êàê íåýôôåêòèíûé è/èëè íåáåçîïàñíûé. ìîæåò èùó íå òî..? |
#48
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ïîïðîáîâàë äîèñêàòü.....
îïÿòü æå ...íåìåöêèå èññëåäîâàòåëè âûÿñíÿëè ôàêòîðû ïðåäðàñïîëàãàþùèå ê 1)âîçìîæíîé íåýôôåêòèâíîñòè ðàäèîòåðàïèè è ê 2)âîçâðàùåíèþ áîëåé â ïÿòî÷íîé îáëàñòè. â äëèòåëüíîì èññëåäîâàíèè âûÿñíèëè, ÷òî âåðîÿòíîñòü æèòü áåç áîëè ïîñëå ðàäèîòåðàïèè âûøå ó: -ïàöèåíòîâ ïîñëå îäíîé ñåðèè ëå÷åíèÿ -ó ïàöèåíòîâ â âîçðàñòå áîëüøå 58 ëåò -ïîñëå ïðèìåíåíèÿ ìåòîäèêè high voltage -ñ "áîëåâûì" àíàìíåçîì ìåíüøå èëè ðàâíûì 6 ìåñ. -ëå÷åíûõ ñ ïðèìåíåíèåì ðàçîâîé äîçû 0.5 Ãð -áåç ïðåäøåñòâóþùåãî ëå÷åíèÿ -ó ìóæ÷èí (çäåñü p=0.059, åñëè ð-ïîêàçàòåëü ñòàòèñòè÷åñêîé çíà÷èìîñòè îòëè÷èé ñðåäíåãî â ñðàâíèâàåìûõ ãðóïïàõ, òî ðàçëè÷èå ìåæäó ìóæ÷èíàìè è æåíùèíàìè ñòàòèñòè÷åñêè íåäîñòîâåðíî.... îïÿòü æå äëÿ òåõ, êòî îáû÷íî áåðåò ð ìåíüøå 0.05).  îðèãèíàëå àáñòðàêòà òàê: Demographic, clinical and treatment related predictors for event-free probability following low-dose radiotherapy for painful heel spurs - a retrospective multicenter study of 502 patients. Acta Oncol. 2007 Department of Radiotherapy, St. Josefs-Hospital, Wiesbaden, Germany. A total of 502 patients treated between 1990 and 2002 with low-dose radiotherapy (RT) for painful heel spurs were analysed for prognostic factors for long-term treatment success. The median follow-up was 26 months, ranging from 1 to 103 months. Events were defined as (1) slightly improved or unchanged pain after therapy, or (2) recurrent pain sensations during the follow-up period. Overall 8-year event-free probability was 60.9%. Event-free probabilities of patients with one/two series (414/88) were 69.7%/32.2% (p<0.001); >58/ < or = 58 years (236/266), 81.3%/47.9% (p=0.001); high voltage/orthovoltage (341/161), 67.9%/60.6% (p=0.019); pain anamnesis < or = 6 months/ >6 months (308/194), 76.3%/43.9% (p=0.001); single dose 0.5/1.0 Gy (100/401), 86.2%/55.1% (p=0.009); without/with prior treatment (121/381), 83.1%/54.9% (p=0.023); men/women (165/337), 61.2%/61.5% (p=0.059). The multivariate Cox regression analysis with inclusion of the number of treatment series, age, photon energy, pain history, single-dose and prior treatments revealed patients with only one treatment series (p<0.001), an age >58 years (p=0.011) and therapy with high voltage photons (p=0.050) to be significant prognostic factors for pain relief. Overall low-dose RT is a very effective treatment in painful heel spurs. È îíè æå ïðèçíàëè íèçêîäîçîâóþ ðàäèîòåðàïèþ ýôôåêòèâíîé â ëå÷åíèè "ïÿòî÷íîé øïîðû". |
#49
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âîò åùå èññëåäîâàíèå èç ãåðìàíèè...
ïðîñëåæåíà ñóäüáà 73 íåïóòåâûõ ïÿòî÷åê (áîëÿùèõ) îò 62 ïàöèåíòîâ â ïðîöåññå è ïîñëå (â ñðåäíåì ïîë-ãîäà) êóðñà ðàäèîòåðàïèè.... ãðàæäàíå íå îòìå÷àëè óëó÷øåíèÿ ñïóñòÿ 6 íåäåëü ïîñëå êóðñà â 17.8% ïÿòîê, â 8.6% ïÿòîê - ñïóñòÿ 28 ìåñÿöåâ, â 10.3% ïÿòîê ñïóñòÿ 40 ìåñÿöåâ. ó îñòàëüíûõ ýôôåêò òîé èëè èíîé ñòåïåíè âûðàæåííîñòè äîñòèãíóò â ïðîöåññå ëå÷åíèÿ è äîñòàòî÷íî äëèòåëüíî ïîñëå åãî. îòìå÷åíî ïîâûøåíèå ýôôåêòèâíîñòè ðàäèîòåðàïèè ó ïîæèëûõ ïàöèåíòîâ (èì âîîáùå ìîæåò áûòü ðåêîìåíäîâàíî êàê ïåðâè÷íîå ëå÷åíèå) è ó òåõ, êòî áåðåã ñâîþ ïÿòî÷êó îò ìåõàíè÷åñêîé òðàâìàòèçàöèèâ ïåðèîä ðàäèîòåðàïèè (íå âûÿñíèë ÷òî ýòî - "èçáåãàòü òðàâìàòèçàöèè".... íå õîäèòü ñîâñåì....???? ïîëüçîâàòüñÿ ïîäïÿòî÷íèêàìè...???? íå áèòü ïÿòêîé î çåìëþ...????) Effectiveness and prognostic factors of radiotherapy for painful plantar heel spurs. Strahlenther Onkol. 2004 Department of Radiotherapy and Radiooncology, University Hospital, Marienhospital Herne, Ruhr University of Bochum, Germany BACKGROUND AND PURPOSE: The efficacy of radiation treatment (RT) for plantar heel pain has been reported repeatedly. Yet, the results referring to the pain relief rate, to long-term effects and prognostic factors are not consistent. In this paper, the effectiveness (pain relief rate and long-term results) and prognostic factors of RT for plantar heel pain have been investigated. PATIENTS AND METHODS: From January 2000 to October 2000, 62 patients (73 heels) with painful plantar heel spurs and a minimum pain history of 3 months were treated and evaluated in a prospective study. Mean age was 54 years (range 28-84 years). All patients were treated with a total dose of 5 Gy in seven fractions (= one series), given twice a week at a single-dose sequence of 0.25-0.25-0.5-1.0-1.0-1.0-1.0 Gy (10-MV photons, source-skin distance [SSD] 100 cm, direct portal, field size 12 x 17 cm). The mean duration of heel pain before RT was 26 weeks (= 6.5 months; range 3-120 months). By means of a visual analog scale (VAS) the patients had to self-assess the quantity of their heel pain once before, three times during and four times after RT at a longterm median follow-up of 28 and 40 months. Additionally, the patients had to assess their mechanical heel stress extent during RT. Effectiveness was estimated according to the patients' judgment of pain reduction. RESULTS: A significant reduction of heel pain extent measured by VAS has been observed already during the RT series (before RT: 6.3 +/- 1.5 vs. 3.8 +/- 2.1 at the end of RT; p < 0.001). 6 weeks after RT (FU 1) pain reduction (> 20%) was achieved in 60 heels (82.3%; n = 73), in 64 heels (91.4%; n = 70) after a mean follow-up of 28 months (FU 2), and in 61 heels (89.7%; n = 68) after a mean follow-up of 40 months (FU 3), respectively. Sufficient pain relief (> 80% compared to initial extent) was observed in 18/73 heels (24.6%) at FU 1 (FU 2: 42/70; 60.0%; FU 3: 37/68; 54.4%), including 13/73 heels (17.8%) with complete pain relief (FU 2: 39/70; 55.7%; FU 3: 36/68; 52.9%). Partial improvement (50-80% pain reduction) was observed in 27/73 heels (37.0%) at FU 1 (FU 2: 14/70; 20.0%; FU 3: 15/68; 22.1%), and minor partial improvement (20-50% pain reduction) in 15/73 heels (20.5%) at FU 1 (FU 2: 8/70; 11.4%; FU 3: 9/68; 13.2%), respectively. No change was seen in 13/73 heels (17.8%) at FU 1 (FU 2: 6/70; 8.6%; FU 3: 7/68; 10.3%). Older patients (p = 0.04) and patients who avoided heel stress during the period of RT (p < 0.01) demonstrated a better short-term response (FU 1); both effects were lost 28 and 40 months after RT. Moreover, significant differences in the extent of heel pain reduction by RT were observed in dependence on previous pain duration (at FU 2-3). CONCLUSION: The results confirm the high efficacy of RT in painful plantar spur and add new aspects to formerly published data concerning the time course of changes in heel pain reduction. Pain relief can be expected during and shortly after RT. In addition, the initial success can be transformed into effective long-term results > 2 years after RT; however, further improvement is not to be expected. As a new prognostic factor, the reduction of mechanical heel stress during RT may ameliorate the short-term results, whereas short heel pain history improves the long-term results. Especially for older patients, RT should be taken into consideration as primary treatment. |
#50
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 íàøåì ðåãèîíå ÐÒ ïëàíòàðíûõ ôàñöèèòîâ äîâîëüíî ðàñïðîñòðàíåíà.
Ñ ó÷åòîì ïðèâåäåíûõ êîëëåãîé èññëåäîâàíèé, ëè÷íîãî îïûòà, ìîæíî ãîâîðèòü î çíà÷èìîé ýôôåêòèâíîñòè ìåòîäà. Íî êîñòüþ â ãîðëå ñòîèò âîïðîñ î áåçîïàñíîñòè. À åñëè ïàöèåíòó íðàâèòñÿ, è äâà, òðè, áîëåå êóðñîâ îí ïîëó÷èë? Íåîáõîäèìû äëèòåëüíûå ïðîñïåêòèâíûå èññëåäîâàíèÿ èëè ðåòðîñïåêòèâíûå çà çíà÷èòåëüíûé ïåðèîä, íàâåðíîå. Ñïàñèáî óâàæàåìûì Àíäðåÿì çà èíòåðåñíóþ èíôîðìàöèþ. |
#51
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âîò è ÿ ïðèìåðíî î òîì æå....
äóìàþ, ÷òî äàëüíåéøèé õîä ìîèõ ïîèñêîâ ïî óêàçàííûì âûøå çàïðîñàì ïîäðîáíî ïðåäñòàâëÿòü íå ñòîèò. îáùèé ñìûñë âûâîäîâ èññëåäîâàòåëåé óæå áûë ïðîãîâîðåí, òàê èëè èíà÷å....÷òî ëå÷åíèå äîñòàòî÷íî ýôôåêòèâíî óæå ïðè ïðîâåäåíèè è â îòäàëåííîì ïåðèîäå.... ÷òî ðåêîìåíäóåòñÿ íàçíà÷àòü åãî ðàíüøå, íå îòäàâàÿ ýòîìó ìåòîäó ðîëü ïðîöåäóðû îò÷àÿíüÿ.....×åòêèõ ñðàâíèòåëüíûõ èññëåäîâàíèé ñ äðóãèìè ìåòîäàìè íåò, íî ïðè ñîïîñòàâëåíèè öèôð ýôôåêòèâíîñòè ÌÍÎÉ, ðàäèîòåðàïèÿ íå óñòóïàåò äðóãèì ìåòîäàì.)) Âñå äàííûå â îñíîâíîì èç Ãåðìàíèè. Ñàìè íåìöû ñîçíàþòñÿ, ÷òî äîñòàòî÷íî øèðîêî ïðèìåíÿþò ðàäèîòåðàïèþ ïðè ìíîãèõ äîáðîêà÷åñòâåííûõ çàáîëåâàíèÿõ (íå òîëüêî ïðè ïëàíòàðíûõ ôàñöèèòàõ), îñîçíàâàÿ, ÷òî íóæíû äàëüíåéøèå ìîùíûå èññëåäîâàíèÿ ïî âûðàáîòêå íàèáîëåå ýôôåêòèâíîé ìåòîäèêè, ïî áåçîïàñíîñòè è ò.ä. Ñîãëàñåí, ÷òî âîïðîñ áåçîïàñíîñòè - î÷åíü âàæåí, ïåðâîñòåïåíåí, ìîæåò áûòü.  ×åëÿáèíñêå - ïðîöåäóðà èñïîëüçóåòñÿ àêòèâíî, íðàâèòñÿ è ïàöèåíòàì è âðà÷àì, èìååòñÿ î÷åðåäü íà ïðîâåäåíèå ïðîöåäóðû (ïðèìåðíî íà ìåñÿö âïåðåä âñå ðàñïèñàíî). ß ïîíÿë, ÷òî ó íåêîòîðûõ êîëëåã åñòü âåñîìûå àðãóìåíòû íå òîëüêî ïðîòèâ êîêàèíîòåðàïèè, ñóïðîòèâ ðàäèîëå÷åíèÿ èì òîæå åñòü ÷òî äîáàâèòü. Î÷åíü ïðîøó, åñëè ñî÷òåòå âîçìîæíûì - âûñêàæèòåñü!!! (à òî âåäü ïðîäîëæàþ ëþäåé íàïðàâëÿòü....îíè è ñàìè òðåáóþò ïîä÷àñ....) |
#52
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Öèòàòà:
Öèòàòà:
 öåëîì âñå-òàêè ñòîèò ïðèçíàòü, ÷òî ïðîñïåêòèâíîãî èññëåäîâàíèÿ ðåíòãåíîòåðàïèè íå áûëî. Îæèäàåì ðåçóëüòàòîâ àíîíñèðîâàííîãî ìóëüòèöåíòðîâîãî ÐÊÈ. Åùå,êñòàòè, ïî ÍÏÂÑ íàøëîñü The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. CONCLUSIONS: These results provide some evidence that the use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen. Äà è ïî ÝÊÓÂÒ ÐÊÈ óæå íå ìàëî – àïäåéò íàçðåë. ß æ è ïðåäóïðåäèë, ÷òî îáçîð íåñâåæèé. Íî àïäåéòîì ñåðüåçíûì çàíèìàòüñÿ äîëæíû òå, êîìó ïîëîæåíî. Êîêðåéí ðóëèò. |
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#53
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ïóñòü ðóëèò, æäåì!!))
à òî 20 ïàöèåíòîâ - ýòî äåéñòâèòåëüíî ñëàáåíüêî. |
#54
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×òî êîíñåíñóñ?
ß ïðàâèëüíî ïîíÿë, ÷òî ïî áåçîïàñíîñòè ëó÷åâîé òåðàïèè èíôîðìàöèè ïðîñòî íåò? À ïðèìåíÿåòñÿ îíà íå òîëüêî ó íàñ?
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#55
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ëè÷íî ÿ ïðèìåðíî òàê è ïîíÿë: ïðèìåíÿåòñÿ íå òîëüêî â ÐÔ, è äîêàçàòåëüñòâ áåçîïàñíîñòè/íåáåçîïàñíîñòè ïðèìåíåíèÿ ðåíòãåíîòåðàïèè ïðè äàííîì çàáîëåâàíèè - íåò (ìíîé ïîêà íå íàéäåíû). åñëè êòî òî çíàåò ïðî ýòî ïîäðîáíåå - îí ïîêà íå âûñêàçàëñÿ.
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#56
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#57
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È íå íàäî âñÿêèì ãëóïîñòÿì âåðèòü.
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#58
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Öèòàòà:
Öèòàòà:
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#59
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ýíäîñêîïè÷åñêàÿ ïëàíòàðíàÿ ðàäèî÷àñòîòíàÿ ìèêðîôàñöèîòîìèÿ
Çäðàâñòâóéòå.
Î÷åíü õî÷åòñÿ ÷òî-íèáóäü ïðî÷èòàòü î äîêàçàòåëüíîñòè ìåòîäà "ýíäîñêîïè÷åñêàÿ ïëàíòàðíàÿ ðàäèî÷àñòîòíàÿ ìèêðîôàñöèîòîìèÿ" äëÿ ëå÷åíèÿ ïëàíòàðíîãî ôàñöèèòà [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#60
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ].  ñàìîì íèçó ýòîé ñòðàíèöû, ñïðàâà àíàëîãè÷íàÿ ññûëêà.
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