Ice Bag Research Articles

Do We Successfully Achieve Therapeutic Hypothermia?

spontaneous circulation, but remain unconscious.[1] The recommendation for TH is largely based on the results of two randomized, prospective studies. One of these studies involved the use of a mattress to deliver cold air and ice packs to induce TH at 32-34℃ for 24 hours in five European countries. After TH, rewarming was performed slowly. Fifty-five percent of the hypothermia group demonstrated good neurological outcome, whereas only 39% of the control group exhibited good neurological outcome.[2] In another study conducted in Australia, ice packs were placed around the head and body of patients to induce TH at a targeted temperature of 33℃ for 12 hours, and active rewarming began at 18 hours. Induced TH resulted in improved neurological outcome in 49% of the hypothermia group, while the same outcome was seen in only 26% of the control group.[3] In these two studies, induced TH effectively improved neurological outcome in patients with ventricular fibrillation out-of-hospital cardiac arrest. However, it has not yet been established whether TH is an effective treatment strategy for CA patients presenting with nonshockable rhythm, such as pulseless electric activity and asystole.[4,5] In addition, researchers are divided in their opinions on various elements of TH, including appropriate target temperature, cooling methods and period, and rewarming speed, calling for further studies. When performing TH, we strive to take a simple and minimally invasive approach in order to cool the body quickly and easily. External cooling techniques such as cooling blankets and helmets or ice bags are typically used at the beginning of treatment. Endovascular cooling has also been used to provide faster cooling and a steady maintenance phase via a cooling catheter introduced into the central venous system and a water-circulating cooling device. Different cooling methods vary in times of initiation of cooling, achievement of the target temperature and maintenance of TH. However, neurological recovery and mortality rates do not appear to vary significantly based on the cooling method used.[6,7] Recently, amid increasing recognition of its fast cooling effect, a large-volume (30 mL/kg), ice-cold (4℃) intravenous fluid infusion is widely used in the early stage of TH along with other cooling methods.[8] Rates of cooling and rewarming are the most important factors to consider when performing

Is tap water safe for surgical hand washing?

The daily observation of surgical preoperative preparation prompted us to review and investigate the quality of water used during preoperative hand antisepsis. In this prospective study, the process of water sampling took place on two different days over a period of one week. The procedure required the collection of two samples of water from each of the three taps on the same day. The first sample was collected at 8am and the second at 3pm. In both cases, the water was collected either immediately after opening the tap (direct intake), or after using a torch to sterilize the tap and letting the water flow for five minutes (indirect intake). Thereafter, the taps’ filters and pipes were immersed into sodium hypochlorite solution 5% (solution 1:10) for thirty minutes and new samples were taken a week later. Bottles with 500ml capacity were used for the samples a nd were sealed immediately, avoiding any contact of the inner surface with the hands. Ten percent of the bottle remained empty for good mixing prior to analysis. To enable their transportation, the samples were immediately cooled with ice bags in special insulated boxes. The samples from indirect water intake remained in the refrigerator at 5o C and the transfer took place the next morning at 8am. Overall, 24 samples of water from three taps over two different days were included in the study. During direct intake from taps 1, 2 and 3, non-pathological levels of Pseudomonas Aeruginosa was detected (taps 1 and 2 >100 and tap 3 100 and tap 2 <10); again, this is a non-pathological result. In the new samples, the immersion of the taps’ filters and pipes only revealed the presence of Pseudomonas Aeruginosa (<4) in tap 1 during direct intake. From taps 2 and 3, no microorganism was detected. Similarly, no microorganism was observed from indirect intake. The use of tap water for surgical hand scrub is acceptable. However, regular maintenance of pipelines and the distribution network, the examination of the water, and disinfection of the taps is mandatory. Furthermore, the regular use of an alcohol-based hand antiseptic for a time period of 180 seconds following surgical hand scrub is an effective combination against possible pathogens present in tap water.

Investigation of the diving reflex using an ice bag – Comparison of free breathing and no breathing

Bats are unique among extant flying animals, as they have compliant wings and an echolocation sensory system that distinguish them from birds and insects. Flying in the dark, guided by echolocation, has influenced the aerodynamics of bat flight perhaps more than previously realized and resulted in a characteristic flight that is now being revealed.

Cryotherapy Effects, Part 1: Comparison of Skin Temperatures and Patient-Reported Sensations for Different Modes of Administration

Context:Alterations in skin sensations may be responsible for pain reduction provided by cryotherapy, but the exact physiological mechanism is unknown.Objective:To investigate perceptions of skin sensations associated with different modes of cryotherapy administration and skin temperature at the point of perceived numbness.Design:Repeated measures.Participants:30 healthy subjects (12 Male, 18 Female, Age = 21.1±1.9 years).Interventions:Crushed ice bag, ice massage, and cold water immersion.Main Outcome Measures:Perceptions of sensations during each mode of cryotherapy administration were derived from a Modified McGill Pain Questionnaire. Skin temperature was recorded when numbness was reported for each treatment.Results:Participants experienced sensations that included cold, tight, tingling, stinging, and numb. Ice massage sensations transitioned rapidly from cold to numb, whereas cold water immersion and ice bag treatments produced altered sensations for longer duration. Ice massage decreased skin temperature significantly more than the other two modes of cryotherapy administration.Conclusions:Ice massage may be the best mode of cryotherapy administration for achievement of anaesthesia as rapidly as possible, whereas cold water immersion and ice bag application may be better for attainment of pain reduction associated with noxious stimulation of skin receptors.

Cryotherapy Effects, Part 2: Time to Numbness Onset and Numbness Duration

Context:Recommended treatment duration for cryotherapy varies, but the primary therapeutic benefit may be related to the amount of time required for changes in cutaneous sensation.Objective:To determine the amount of time required to induce numbness for three different modes of cryotherapy administration, and the amount of time that numbness persists after treatment.Design:Repeated measures.Participants:30 healthy adults (12 males, 18 females, age = 21.1 ± 1.9 years).Interventions:Crushed ice bag, ice massage, and cold water immersion.Main Outcome Measures:Time required to induce numbness and the amount of time numbness remained after removal of each mode of cryotherapy.Results:Ice massage and cold water immersion produced numbness significantly faster than the crushed ice. There were no significant differences in terms of numbness duration.Conclusions:Changes in cutaneous sensation can be achieved in a relatively short amount of time (6–12 minutes) with ice massage and cold water immersion. The duration of the treatment effect did not differ among the three modes of cryotherapy administration.

Smoking as a Confounding Factor on the Influence of Cold Therapy on the Vascular Endothelium Function of Young Men

[Purpose] This study was designed to determine whether smoking affects endothelium function after cold therapy in young men. [Subjects] The final cohort included 27 healthy men (age, 20–21 years). Because an impact on vascular endothelium function was anticipated to be caused by smoking, the study enrolled 14 participants in a smoking group and 13 in a non-smoking group. [Methods] Vascular endothelial function was assessed by determining the reactive hyperemia index (RHI), using finger-tonometry. RHI was measured twice, at rest (baseline) and after a cold stimulus. The forearm was cooled with an ice bag for 10 min as the cold stimulus. Comparisons between the RHI at baseline and after cold treatment, and between the smoking and non-smoking groups, were performed using the paired and unpaired t-tests, respectively. [Results] There was a significant difference in baseline RHI values between the smoking and non-smoking groups, but there was no significant difference between the baseline and post-treatment RHI values in either group. [Conclusion] These results suggest that cigarette smoking damages the endothelial cells in young men with a short history of smoking. However, cold therapy did not have a significant impact on the RHI in either group.

Effect observation on 10% brine ice compress combined with hot water bubble for foot to temperature reduction in hand-foot-and-mouth disease among children

Objective To observe the effect of 10% brine ice compress combined with hot water bubble for foot to temperature reduction in hand-foot-and-mouth disease among children, to explore the most appropriate method for temperature reduction among the children with high fever. Methods 120 children cases of hand-foot-and-mouth disease with high fever in our hospital were randomly divided into two groups, the observation group with 60 cases used 10% brine ice compress combined with hot water bubble for foot to reduce temperature, the control group with 60 cases was given traditional rubber ice bag with hot water bubble for foot. We compared and observed the two groups by 30 rains, 60 mins, 90 mins of temperature reduction and the response of cold. Results 30 mins, 60 mins and 90 mins after ice compress, cooling effect of observation group were （0.91 ± 0.10）, （1.63 ±0.59）and （2.80 ± 0.47） respectively, significantly better than those of the control group, which were （0.59 ± 0.34）, （0.91 ± 0.15） and （1.69 ± 0.08） respectively, P 〈 0.05. Conclusion 10% brine ice compress combined with hot water bubble for foot to temperature reduction has good cooling effect, worthy for clinical promotion. Key words: Hand-foot-and-mouth disease ; 10% brine ice compress ; Hot water bubble forfoot; temperature reduction

Is the Deleterious Effect of Cryotherapy on Proprioception Mitigated by Exercise?

This study aimed to examine the acute effects of cryotherapy on knee position sense and to determine the time period necessary to normalize joint position sense when exercising after cryotherapy. 12 subjects visited the laboratory twice, once for cryotherapy followed by 30 min of exercise on a cycloergometer and once for cryotherapy followed by 30 min of rest. Sessions were randomly determined and separated by 48 h. Cryotherapy was applied in the form of ice bag, filled with 1 kg of crushed ice, for 20 min. Knee position sense was measured at baseline, after cryotherapy and every 5 min after cryotherapy removal until a total of 30 min. The main effect of cryotherapy was significant showing an increase in absolute (F7,154=43.76, p<0.001) and relative (F7,154=7.97, p<0.001) errors after cryotherapy. The intervention after cryotherapy (rest vs. exercise) revealed a significant main effect only for absolute error (F7,154=4.05, p<0.001), i.e., when subjects exercised after cryotherapy, the proprioceptive acuity reached the baseline values faster (10 min vs. 15 min). Our results indicated that the deleterious effect of cryotherapy on proprioception is mitigated by low intensity exercise, being the time necessary to normalize knee position sense reduced from 15 to 10 min.

Application of the self-made 10％ sodium chloride solution pad ice packs in early local soft tissue injury patients

Objective To explore the effect of self-made 10％ sodium chloride solution pad ice packs on the patients with local soft tissue injury in early time.Methods Totals of 62 cases with lower limb soft tissue injury were selected and randomly divided into experimental group ( n =32 ) that received the cold compress treatment by homemade 10％ sodium chloride solution pad ice packs,and control group( n =30) that received the cold compress treatment by water pad ice packs.Then,0,0.5,1.5,2 h later,the internal temperature,the temperature between the body surface and ice bag,hardness,the surface of contact surface size,and patients' satisfaction of two groups were observed.Results In the experimental group,the initial temperature of 10％sodium chloride solution pad ice packs was ( - 18.38 ±0.81 ) ℃,temperature between ice bag and body surface was 18℃ during cold compress,half an hour later,the temperature of inside ice bag was ( -9.73 ± 0.54)℃.After one hour in the room,the second cold compress,internal temperature was ( - 2.55 ± 1.66) ℃ and the temperature between ice bag and the surface was about 22 ℃,the end of ice internal temperature was (8.5 ±1.81 )℃.Hardness of first and secondary cold compress was small,the area size of skin contact with ice was about 72％.In the control goup,for the water cotton pad ice bags were so hardness that early thermometers were not inserted and temperature can not accurate measured.And the area of skin contact with ice was 29％.Significant differences were found in the contact area between two groups in different time (t =49.32,49.32,49.32,39.64,respectively; P ＜ 0.05 ).There was no significant difference in the pain degree of patients between two groups,while after 48 h cold compress,pain rating index and the swelling score of experimental group was significantly lower than that of control group(x2 =0.017,P ＜0.05).Patients' satisfaction of experimental group was significantly higher than that of control group ( x2 =4.4,P ＜ 0.05 ).Condusions Appling the selfmade 10％ sodium chloride solution pad ice packs,for the temperature between ice bag and the surface was higher than the skin freezing temperature( -5 ℃ ) and below the basal body temperature,which can reach the objective with no cause frostbite,it has large contact area,easy fixing and shaping,and good for patients with local soft tissue injury in early stage. Key words: Soft tissue injury; Cold compress; 10％ sodium chloride solution

Effects of Cold Modality Application With Static and Intermittent Pneumatic Compression on Tissue Temperature and Systemic Cardiovascular Responses

Background:In the therapeutic setting, cryotherapy with varying levels of intermittent cyclical compression often replaces an ice bag and elastic wrap. However, little is known about the cardiovascular strain and tissue temperature decreases associated with cooling and intermittent compression.Hypothesis:The authors hypothesized that higher levels of intermittent compression will result in greater reductions of tissue temperature and that all cold modalities will cause acute increases in cardiovascular strain.Design:Experimental crossover repeated measure design.Methods:Ten healthy subjects (23 ± 3 years) volunteered for 4 cryotherapy sessions (30-minute treatments with 30-minute passive recovery). Treatments included ice with elastic wrap and Game Ready (GR) with no, medium (5-50 mmHg), and high compression (5-75 mmHg). Throughout the experiment, oral, skin surface, and intramuscular quadriceps temperatures were measured along with mean arterial pressure, heart rate, rate pressure product, forearm blood flow, and forearm vascular conductance.Results:Mean arterial pressure increased up to 5 minutes (P < 0.05). Forearm blood flow and forearm vascular conductance decreased after baseline (P < 0.05), but there were no differences between treatments. Peak intramuscular changes from baseline were −14 ± 2°C (ice), −11 ± 6°C (GRHIGH), −10 ± 5°C (GRMED), and −7 ± 3°C (GRNO). Ice cooled the muscle the most, while GR with medium and high compression cooled more than GR without compression (P < 0.05).Conclusions:The application of cold and intermittent pneumatic compression using GR did not produce acute cardiovascular strain that exceeded the strain produced by standard ice bags/elastic wrap treatment. Greater temperature decreases are achieved with medium- and high-pressure settings when using the GR system.Clinical Relevance:Type of cold and amount of compression affect tissue cooling in healthy lean subjects. All tested cold modalities caused acute increases in cardiovascular strain; however, these increases are no more than what healthy subjects experience with the onset of exercise.

In-hospital hypothermia

Mild therapeutic hypothermia after cardiac arrest has become standard in post-resuscitation care in many hospitals as it is recommended by current guidelines. The last update of guidelines by the European Resuscitation Council on post-cardiac arrest treatment in 2010 recommends hypothermia for every patient after cardiac arrest who remains unconscious after cardiac arrest [1]. In addition to milestone trials [2-4], current published retrospective data from the large Finnish registry showed in a large group of patients a significant reduction of hospital mortality of survivors of out-of-hospital cardiac arrest after implementation of hypothermia [5]. The mild therapeutic hypothermia procedure after cardiac arrest can be divided into three phases: introduction, maintenance and rewarming. The cooling techniques and devices to induce cooling of the cardiac arrest survivor can be separated into three main groups: conventional cooling (no device), non-invasive (surface) systems, and invasive (intravascular) systems (Table ​(Table11). Table 1 Cooling techniques Conventional cooling methods The easiest way to induce hypothermia after cardiac arrest is by using cold saline (for example, 0.9% NaCl solution), crushed ice or ice bags. Kim and colleagues reported the safety and efficacy of the administration of up to 2 litres of 4°C cold saline to the patient after hospital admission [6]. Others published data using 30 ml/kg body weight of saline 0.9% NaCl or Ringer's lactate combined sometimes with ice bags, which led to an acceptable reduction of the temperature [7-10]. Furthermore cold saline as well as other methods like cooling caps and helmets have been evaluated for induction mainly in the preclinical setting [4,11,12]. Kliegel and colleagues pointed out that cold infusion alone is effective for induction but not for tight maintenance of the target temperature [13]. However, in at least one trial the combination of cold saline and ice packs was proven to be effective even to maintain temperature [7]. Focusing on the induction in the in-hospital setting, most authors rank cold saline and crushed ice more as effective adjuvant methods to be combined with a computer-controlled cooling device [10]. The big advantage of cold saline is its availability at almost every place in the hospital if provided and the low costs. Following the data available concerning different amounts of saline administered to the patient, a median amount of 1 to 2 litres of saline seems safe after cardiac arrest. To maintain target temperature with cold saline and ice bags seems to require a high binding of personnel method without a very precise influence on the central body temperature.

Measurement of digital laminar and venous temperatures as a means of comparing three methods of topically applied cold treatment for digits of horses

To compare effects of 3 methods of topically applied cold treatment (cryotherapy) on digital laminar and venous temperatures in horses. 9 healthy adult Thoroughbreds. Thermocouples were placed in palmar digital veins and digital laminae of both forelimbs of horses. Three methods of cryotherapy were applied to the distal aspects of the limbs: wader boot (63-cm-tall vinyl boot filled with ice and water [ice slurry]), ice bag (5-L fluid bag filled with ice slurry), and a gel pack boot (boot containing frozen gel packs). Gel packs and ice slurries were replenished every hour during cryotherapy. The forelimb that received the first treatment was randomly assigned; thereafter, control and treated forelimbs were alternated for each treatment. For each treatment, temperatures were recorded every minute during 15-minute pretreatment, 2-hour treatment, and ≥ 30 minute rewarming periods. Once temperatures had returned to within 3°C below pretreatment values, the experiment was repeated in a similar manner for other cryotherapy methods. Digital venous temperatures were similar to laminar temperatures during each treatment. Ice bag and wader boot treatments caused similar cooling of digits. Gel boot treatment did not cause substantial cooling of digits. Ice bag treatment caused laminar and digital venous cooling equivalent to that of wader boot treatment. Cryotherapy by use of 5-L fluid bags with an ice slurry may be a readily available, practical, and efficient method for prevention of laminitis in horses. Digital laminar and venous temperatures were similar in forelimbs of horses before and during cryotherapy.

Effect of Two Recovery Methods on Repeated Closed-Handed and Open-Handed Weight-Assisted Pull-Ups

The purpose of this study was to examine 2 recovery modalities (with and without an ice bag treatment) on closed-handed and open-handed weight-assisted pull-ups in recreationally-trained rock climbers. Healthy and recreationally active volunteers (n = 9) completed 4 counterbalanced trials separated by 72 hours. Trials included 3 sets of closed-handed and open-handed weight-assisted pull-ups supported by 50% of body weight, until failure. Between each set, participants sat quietly in a chair and engaged in approximately 20 minutes of either passive or ice bag treatment. Ice bags were placed on the participants' arms and shoulders. Heart rate (HR), ratings of perceived exertion (RPE), session-RPE (S-RPE), and perceived recovery were also assessed. Hand-grip strength pretrial and posttrial was not different between ice bag conditions. Also, there were no differences between treatments for HR, RPE, perceived recovery, S-RPE, or comfort ratings. The overall number of open-handed pull-ups (mean ± SD = 19 ± 5) was lower than closed-handed pull-ups (34 ± 14; p < 0.001). Ice bag recovery attenuated the decrease in open-handed pull-up performance for sets 2 (22 ± 5; p = 0.004) and 3 (22 ± 5; p = 0.003) relative to set 3 using passive recovery only (i.e., no ice bag; 17 ± 6). There were no differences (p = 0.31) between treatments for closed-handed pull-ups. The findings support the recommendations to use ice bags for recovery between bouts of rock climbing that involve a predominantly open-handed grip to maintain performance.

Clinical effect of the self-made hypothermic blanket on temperature lowering for children with high fever after cardiac surgery

Objective To observe the clinical effect of self-made hypothermic blanket on children with high fever after cardiac surgery.Methods Eighty children with high fever after cardiac surgery (anus temperature ≥39.5 ℃ ) were randomly divided into experiment group and control group.The experiment group used self-made hypothermic blanket to cool and the control group used the traditional ice bag on the head,armpits and other parts to cool.To monitor children's body temperature and heart rate after 1 hour,4 hours and 8 hours.Results The temperature at 1 hour,4 hours and 8 hours were (39.03 ±0.34),(38.50 ±0.39) and (37.99 ±0.45)℃ in the experiment group and (39.50±0.37),(39.13 ±0.80),(38.87 ±0.75)℃ in the control group,respectively; and the differences were statistically significant ( t =5.75,4.42,6.33 ;P ＜ 0.05 ).Heart rate reduced at 1 hour,4 hours and 8 hours,but compared with that in the control group,the difference was statistically significant at 4 hours and 8 hours ( t =2.58,3.69 ; P ＜ 0.05 ).The cooling amplitude of the experiment group at 8 hours was obviously higher than that at 1 hour and 4 hours and that in the control group.Conclusions The cooling effect of self-made hypothermic blanket is better than the traditional cooling with ice bag,especially long-term cooling effect and it is cconductive to the rehabilitation of children after cardiac surgery. Key words: High fever; Cardiac surgery; Children; Physical cooling

The Elimination of Warm Ischemic Time in Kidney Transplantation Using the Ice Bag Technique: A Feasibility Study

Warm ischemic time is an established risk factor for delayed graft function (DGF) after kidney transplantation. DGF is a negative prognostic indicator for long-term allograft survival. We propose a technique that eliminates warm ischemic time during the arterial and venous anastomoses. This is a retrospective review of the first 20 cases performed between January and May 2010 at Albert Einstein Medical Center, Philadelphia, Pennsylvania, a nonuniversity tertiary care center. Approximately one-half of the patients who underwent kidney transplantation were selected for this method of implantation while the feasibility of this technique was evaluated. Fifteen patients were male. DGF was seen in 6 of 20 patients (30%). There were no graft losses. Operative time was not lengthened. There were no complications related to the use of this technique. Renal parenchyma frostbite was never encountered. We propose a technique that eliminates warm ischemic time. This may lead to less DGF. In the case of a difficult anastomosis or if an anastomosis needs to be performed again, damage to the kidney is minimized. Right and left donor kidneys and kidneys with multiple vessels can safely be transplanted with this technique. It also allows for improved resident and fellow teaching.

Gout Deserves Tender Treatment in Elderly

Gout Deserves Tender Treatment in Elderly

Cooling Times of the Gastrocnemius Vary Based on Adipose Tissue Thickness

It has been reported there is a direct relationship between adipose tissue thickness and skeletal muscle cooling time. Therefore, a standard ice application of 20-25min may be suitable to cool the injured muscle of lean athletes, but not effective for larger athletes. Previous research has suggested different cooling times for various skinfold thicknesses of the thigh, however, this has not been assessed in the gastrocnemius. PURPOSE: To compare skeletal muscle temperature change after 25min of ice application. METHODS: Fourteen healthy adults (2 males, 12 females; 22.8±2.8 years; 165.9±12.0cm; 65.9±15.5kg) participated. Participants were placed prone. The thickest part of the dominant lower leg was identified with circumference measurements. The medial portion of the gastronemius was pinched 3 times with a skinfold caliper. An average was determined and was divided by two. 10 millimeters was added to this number and an intramuscular thermocouple was inserted to that depth. The thermocouple was marked with a permanent marker to ensure proper depth was achieved. Participants were randomized into either an ice group (750g bag of crushed ice) or sham group (750g bag of candy corn). This was a crossover design, so the participants received the opposite treatment 1 week later. Temperature was recorded every second. Participants were analyzed in 3 groups based on skinfold thickness; 11-20mm, 21-30mm, and 31-40mm. RESULTS: A one-way ANOVA was run to analyze change in temperature from baseline at 25min for all groups. There was a significant difference in intramuscular temperature change between groups (p=.048). Baseline temperature was 36.95±1.47°C (11-20mm), 35.83±1.77°C (21-30mm) and 36.08±3.44°C (31-40mm). Post hoc tests revealed that the 31-40mm group had significantly less temperature change (-4.03±.11°C) than the 11-20mm (-7.34±2.14°C) (p=.043) and 21-30mm (-7.97±1.57°C) (p=.016) groups. CONCLUSIONS: Adipose tissue thickness did affect intramuscular temperature change at 25min, with larger skinfold thicknesses resulting in less change. It is important for clinicians to realize that if intramuscular cooling is the goal of the cryotherapy session, than larger amounts of adipose tissue over the muscle will result in a decreased rate of cooling and more time may be needed than the standard application time.

Effect Of Ice Bag Recovery On Closed- And Open-Handed Weight-Assisted Pull-Ups

Effect Of Ice Bag Recovery On Closed- And Open-Handed Weight-Assisted Pull-Ups

Analgesic effectiveness of the association of transcutaneous electrical nerve stimulation and cryotherapy for chronic low back pain

BACKGROUND AND OBJECTIVES: Transcutaneous electrical nerve stimulation (TENS) and cryotherapy are physical therapy resources individually used, since there is the possibility of interaction between TENS and cryotherapy if they are associated. This study aimed at evaluating the analgesic effectiveness of the association or not of TENS and cryotherapy to relieve chronic low back pain. METHOD: Clinical trial involving six chronic low back pain patients distributed in three groups: cryotherapy, TENS, and the association of both techniques. Analgesia was induced for 20 minutes during 5 days, with one session per day. All patients were submitted to conventional kinesiotherapy with ischiotibial, lumbar square and iliopsoas elongation, aiming at increasing adherence to treatment. Cryotherapy was applied with crushed ice bag and TENS was in burst with Physiotonus TENS/FES 3050 equipment of the BIOSET brand, with pulse trains of 2 Hz, individual pulse frequencies of 100 Hz and pulse duration of 150 µs. Pain intensity was evaluated by the visual analog scale before and after each session. RESULTS: With regard to pain intensity in the cryotherapy group, initial and final medians were 5.5 and 4, respectively. For the TENS and TENS associated to cryotherapy groups they were 5 and 3, respectively. With regard to pain relief, 100% have referred good relief in the TENS group; in cryotherapy and TENS associated to cryotherapy groups 50% have referred good relief and 50% very good relief. CONCLUSION: Although the combined therapy has caused no significant improvement as compared to isolated therapies the three analgesic modalities used in this study were effective to relieve chronic low back pain. Satisfaction was higher in the cryotherapy group as compared to the TENS group.

Comparing Kidney Perfusion Using Noncontrast Arterial Spin Labeling MRI and Microsphere Methods in an Interventional Swine Model

The purpose of this study was to assess the ability of a flow-sensitive alternating inversion recovery-arterial spin labeling (FAIR-ASL) technique to track renal perfusion changes during pharmacologic and physiologic alterations in renal blood flow using microspheres as a gold standard. Fluorescent microsphere and FAIR-ASL perfusion were compared in the cortex of the kidney for 11 swine across 4 interventional time points: (1) under baseline conditions, (2) during an acetylcholine and fluid bolus challenge to increase perfusion, (3) initially after switching to isoflurane anesthesia, and (4) after 2 hours of isoflurane anesthesia. In 10 of the 11 swine, a bag of ice was placed on the hilum of 1 kidney at the beginning of isoflurane administration to further reduce perfusion in 1 kidney. Both ASL and microspheres tracked the expected cortical perfusion changes (P < 0.02) across the interventions, including an increase in perfusion during the acetylcholine challenge and decrease during the administration of isoflurane. Both techniques also measured lower cortical perfusion in the iced compared with the non-iced kidneys (P ≤ 0.01). The ASL values were systematically lower compared with microsphere perfusion. Very good correlation (r = 0.81, P < 0.0001) was observed between the techniques, and the relationship appeared linear for perfusion values in the expected physiologic range (microsphere perfusion <550 mL/min/100 g) although ASL values saturated for perfusion >550 mL/min/100 g. Cortical perfusion measured with ASL correlated with microspheres and reliably detected changes in renal perfusion in response to physiologic challenge.