High-voltage therapy of prostate cancer–High-voltage therapy is becoming increasingly important as a form of individual differential therapy of carcinoma of the prostate. Around 40% of all patients with a diagnosis of carcinoma of the prostate can be treated with high-voltage therapy. The precondition is the absence of bone and soft-tissue metastases and of juxtaregional lymph-node metastases. Individual carcinoma therapy is based on pre-therapeutic tumor classification according to the TNM system. The 5-year survival rates are presented from a retrospective study carried out using primary radiation monotherapy and a combined hormone and radiation therapy; these figures were calculated by the life-table method. The study revealed no significant differences between the two forms of therapy as regards 5-year survival rates. The 5-year survival rates of all patients of the classifications T0-T3Nx-N2M0 irradiated (n: 198) (72% +/- 11% for hormone plus radiation therapy and 74% +/- 11% for radiation monotherapy) did not differ greatly from those of a normal male population of the same age (77%). High-voltage therapy of carcinoma of the prostate can thus be classified as a curative method of treatment.
high voltage therapy Significance: A range of studies point to the efficacy of electrical stimulation (ES) in wound treatment, but the methodology of its application has not been determined to date. This article provides a critical review of the results of clinical trials published by researchers using high-voltage pulsed current (HVPC) to treat chronic wounds. In describing the methodology of the trials, the article gives special attention to electric stimulus parameters, the frequency of procedures and total treatment duration. Recent Advances: HVPC is a monophasic pulsed electric current that consists of double-peaked impulses (5-200 μs), at very high peak-current amplitude (2-2.5 A), and high voltage (up to 500 V), at a frequency of 1-125 pulses per second. HVPC can activate “skin battery” and cellular galvanotaxis, and improves blood flow and capillary density. Critical Issues: HVPC efficacy was evaluated in conservatively treated patients with diabetic foot, venous leg and pressure ulcers (PUs), and in some patients with surgically treated venous insufficiency. Future Directions: The efficacy of HVPC as one of several biophysical energies promoting venous leg ulcer (VLU) and PU healing has been confirmed. Additional studies are needed to investigate its effect on the healing of other types of soft tissue defects. Other areas that require more research include the identification of the therapeutic effect of HVPC on infected wounds, the determination of the efficacy of cathodal versus anodal stimulation, and the minimal daily/weekly duration of HVPC required to ensure optimal promotion of wound healing.
high voltage therapy Effects and Clinical uses-Examples of multimodal and dedicated machines that deliver high voltage therapy stimulation
high voltage therapy Effects and Clinical uses-There are several key areas in which high voltage therapy is employed clinically. The main two of these are for Wound Healing and Pain Management. Additionally there are applications which have been advocated (and researched to a limited extent) for Oedema Management and Muscle Strengthening. Each is briefly summarised below with links to essential research and references.
high voltage therapy for Wound Healing,This topic has been reasonably well researched (along with many other electrical stimulation options) and has been reviewed in Watson (2008) and Kloth (2005) to name but 2 papers.A trial concerning the effects of high voltage therapy was reported by Kloth and Feedar (1988). A group of 16 patients with stage IV decubitus ulcers were recruited for the trial and all had lesions that had been unresponsive to previous treatment. Patients were allocated randomly to a treatment group (n=59) or sham treatment)group (n=57). The ES consisted of monophasic twin-pulse stimulation at 105 pps. delivered at a voltage just below that required to achieve visible muscle contraction (typically 100–175V). These stimulation parameters are reported as being arbitrarily set. ES was given for one 45 minute session a day for 5 days a week. Sham group patients had electrodes placed in the same way, but the machine output was set to zero. Electrode polarity was set initially for the wound electrode to be positive, with the negative electrode placed on the skin surface proximally.
If a healing plateau was reached during the trial, the wound electrode was made negative and the treatment continued. If a second plateau was reached, the electrode polarity was reversed daily thereafter. Whichever electrode was placed at the wound site, the relative arrangement was maintained in that the positive electrode was always placed cephalad in relation to the negative electrode.All patients in the treatment group achieved complete healing of their ulcers (on average over 7.3 weeks at a mean healing rate of 44.8% per week). The control group patients did less well, with an increase in mean wound size of almost 29% between the first and last treatments. A subgroup of patients who were in the control group went on to complete a course of ES following the main trial; the three patients achieved full healing of their ulcers over 8.3 weeks with an average healing rate of 38% per week.Griffin et al. (1991) assessed the effects of high voltage therapy on pressure ulcer healing in a group of patients with spinal cord injury. Seventeen patients were assigned randomly to either a treatment or a control (sham treatment) group. ES treatments were carried out for 1 hour a day for 20 consecutive days with repeated wound assessments during this period. high voltage therapy was delivered by means of a negative wound electrode with the stimulator delivering 100pps. at an intensity of 200 volts using similar twin pulses to the previous study. The percentage change (decrease) in ulcer size for the treatment group was significantly greater at days 5, 15 and 20 and the average change for all ulcers in the treatment group was an 80% size reduction compared with a 52% decrease for the control group.A more recent study by Houghton et al (2003) involved 27 patients with a total of 42 chronic leg ulcers of varying aetiology (diabetic, arterial, venous) and employed a placebo controlled RCT design. Following initial assessment, there was a stable (baseline) period during which only ‘conventional’ therapy was employed, followed by a 4 week treatment phase with the patients divided into treatment or sham groups.
The high voltage pulses were delivered at 150V, 100pps and 100μsec duration, using 45 minute treatment periods, 3 times a week for the 4 weeks. The wound electrode was made negative throughout the treatment period i.e. no polarity reversal. Assessment included a one month follow up period. The treatment group wounds significantly reduced in size (mean 44% of original) compared with the sham group (mean 16%). The significant differences were not maintained at the 1 month follow up assessment, though there was a clear trend seen in the results.Goldman et al (2002) aimed to evaluate the ability of high voltage pulsed current (high voltage therapy) to increase microcirculation in critically ischemic wounds and, as a result, to improve wound healing. The diabetic patients presented with maleolar ischaemic lesions and serial measures were made of wound parameters, including oxygen tension. The results indicated that the use of electrical stimulation with these patient objectively improved tissue oxygenation and improved the anticipated wound healing profile.In addition to the wound healing / wound closure studies, high voltage therapy has been shown (with other stimulation modalities) to have both a germicidal and antibacterial effect. Papers include Kincaid et al, 1989; Weiss et al, 1989; Guffey et al, 1989.There are many trial like those reported above. There is little doubt that high voltage therapy has the capacity to influence wound healing in the clinical environment. There are several other forms of electrical stimulation which have also been demonstrated to have such an effect, and whilst they are ‘supportable’ from the published evidence, what is lacking is the critical comparative trial which directly compares different forms of stimulation with a common research method in order to establish whether a particular modality is superior to the others, or indeed, whether they are all as effective as each other.
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