The Medcross Group
		First World Congress of Magnetotherapy

This very detailed literature review is an extended version of a paper presented at The First World Congress of Magnetotherapy, London, 1996, organised by Coghill Research Laboratories. The full proceedings in hard copy are available from us.

Jiri Jerabek, M.D., Ph.D. Natl.Inst.Publ.Hlth. Šrobárova 48 100 42 Praha 10 Czech Republic Prague, 1994 Preface. In East Europe and former USSR magnetotherapy has become very popular physiatric method in treatment of many diseases. During my journeys in West Europe, Canada and the USA I found that there is a big gap in information between West and East world in this topics. The reason is clear, published works on magnetotherapy were written in local languages, i.e. Russian, Hungarian, Czech etc. that are rarely known in the West. Moreover, there have been troubles to obtain copies of Russian works. This book is intended to review these works and to share information on magnetotherapy with colleagues from the West. Except of clinical results many experimental works were performed in animals that never will be repeated because of their cruelty so no ethic commission will accept such an approach. However, regardless of non-ethic approach the results are essential for understanding of mechanism of action. That is why a section on experiments is rather extended. Someone can find that especially in works shortened in tables all the information are not entirely described. It is impossible to write a book with detailed description of all the conditions. If someone is interested in some particular work, he can try to find it according to the list of citations or contact the author of this book. This book is intended as the basic information about magnetotherapy in Middle and East Europe. It is hoped that this book will help to understand the problem and to convince unbelievers that magnetotherapy is not a quackery.

General considerations

Chapter 1. Magnetic field, its physical characteristics. In the space around moving electrical particles forces affecting other moving particles exist that are named magnetic. The source of this forces can be electrons in wires where the electric current flows, ions in electrolytic bath, electrons in cathodic tubes etc. Static magnetic field around permanent magnets is based on the same principle. In the permanent magnet motion of electrons (spin and orbital motion moment) is arranged so outside the magnet the forces are detectable. Magnetic fields are divided according to their distribution in the space and time. Regarding space distribution, magnetic fields can be uniform or non uniform. Uniform fields are those where in every point of the field the same value and direction is found. In non-uniform field this condition is not valid. In cases of magnetotherapy almost always non-uniform fields are used. The only exceptions are some experimental works. Regarding time distribution, static and time varying magnetic fields exist. Static magnetic field means, that no change of magnetic flux density or intensity can be found during considerably long time. In time varying magnetic fields magnetic flux density or intensity changes. Static magnetic fields are found around permanent magnets or electromagnets fed by DC, while time varying magnetic fields are present around electromagnets fed with e.g. alternating currents. Remember that time varying fields are found also around wires leading currents to any electrical appliance. Magnetic fields are characterised by intensity H and magnetic flux density B. Intensity of magnetic field is directly proportional to current flowing through the wire and indirectly proportional to the distance: H = I/2p r [1] where I = current intensity in amperes r = distance from the wire in meters The unit of H is ampere/meter (A/m) that is defined as the intensity of magnetic field in a distance r = 1/2p from the wire where the current 1 A is flowing. Older unit is 1 oersted (Oe). 1 Oe = 79.6 A/m Magnetic flux density unit is 1 T (Tesla). This unit is defined as follows: if a force acting on a wire 1 meter long where 1 A is flowing in a uniform magnetic field is 1 N (newton), this field has the magnetic flux density 1 T. Older, however sometimes used unit is 1 gauss (G). 1 G = 10-4 T, 1 T = 104 G. Relation between B and H is given by following equation: B = m . H [2] where m is the environment permeability. Relation m = m r . m 0 is valid, where m r is relative permeability and m 0 is permeability of vacuum. Chapter 2. Interaction mechanisms. There are three established physical mechanisms through which static and time-varying magnetic fields interact with living matter. 1) Magnetic induction - relevant to both static and time varying magnetic field and originates through the following interactions: a) Electrodynamic interactions with moving electrolytes are based on Lorentz forces on moving ionic charge carriers and thus electric fields and currents are induced. This type of interaction is the basis of magnetically induced blood flow potentials that have been studied with both static and time varying magnetic fields. b) Faraday currents - relevant to time varying magnetic fields only. Just this interaction is considered as the key mechanism of magnetotherapy. 2) Magnetomechanical effects - relevant mainly to the static magnetic fields. a) In the uniform magnetic field, both diamagnetic and paramagnetic molecules experience a torque, which tends to orientate them in a configuration that minimises their free energy within the field. As the fields used for magnetotherapy are relatively weak, this effect can not be considered as important for effects found. b) Magnetomechanic translation can be found in high gradient static magnetic fields that leads in cases of either paramagnetic or ferromagnetic particles to their motion. Here again, this effect is not important for magnetotherapy. 3) Electronic interactions. Some chemical reactions are based on radical mechanism where static magnetic fields exhibit an effect on electronic spin states. It is possible that although the lifetime of those intermediates is short they can influence the biological matter via changed kinetics of chemical reactions. Nowadays mainly time varying magnetic fields are used for therapeutical purposes. As mentioned above, as the key mechanism of action induction of electrical currents are considered. In accordance with Faraday s law, magnetic fields that vary in time will induce potentials and circulating currents in biological systems, human body including. The current density can be estimated using following formula: J = E x s = p r2/2p r x dB/dt x s = s r/2 x dB/dt [3] for sinusoidal fields simplified equation is valid: J = p x r x f x s x B [4] where J = current density (A/m2) E = induced potentials (V/m) r = radius of the inductive loop (m) s = tissue conductivity (S/m) dB/dt = rate of change of magnetic flux density It was assessed that current density up to 100 mA/m2 is safe. From this viewpoint, to assure the maximum safety we recommend to take into account the highest conductivity of the tissue, i.e. 0.2 S/m. However, this calculation is an approach only as human body constitutes from many tissues with different conductivity values. This is also the reason why we cannot calculate exactly the induced currents. Chapter 3. Devices used. In former USSR since the seventies a device POLYUS 1 has been produced that has been widely used and majority of reviwed works used this device. It is a very simple apparatus that generates either sinusoidal field with f = 50Hz or interrupted sinusoidal field. A ratio on/off is about 1 : 1, the period is about 1 second. As applicators relatively flat electromagnets with core are used, the maximum B on the surface of an applicator is about 50mT. With regard to the size (diameter 200 mm, width 200 mm) and cylindrical shape of the applicator the field generated has relatively high gradient. Usually 2 applicators are connected to the device. Except of the POLYUS 1 a device ALIMP is produced generating pulsed magnetic field with halfsinusoidal shape (impulse width 10ms), Bmax on the surface of very flat applicators is up to 10mT, repeating frequency up to 100Hz. Regarding geometry very strong gradient around applicators was found. It is possible to attach up to 10 applicators to the device that are inserted in the textile cover to form a blanket. For home purposes devices EYa are produced, nothing more than an electromagnet inserted in a box fed directly from the net. Except of these devices other types are produced in small series, however, no detailed data are available. Other sources of magnetic fields are so called magnetophores. The magnetophore is a thin soft plastic material with ferromagnetic particles incorporated. This material is magnetised in order to have static magnets distributed as "chess board". Magnetic flux density on the surface is about 40 mT and as the material is about 3 mm thick, the gradient is enormous; in distance of 5 cm magnetic flux density is a small fragment of the surface B. In Hungary a device generating pulsed magnetic fields has been produced since 1982. Generally, two types of applicators are used; either a flat electromagnet with iron core or a solenoid. Magnetic flux density in the electromagnet is in the order of tens mT, in the solenoid up to 10mT. Repeating frequency 50, 25, 12.5, 6.25, 5 and 2 Hz. In Czech republic since 1970 static magnetic fields have been used, since 1978 pulsed magnetotherapy as well. Two conceptions exist in the pulsed magnetotherapy. The older one used as generator the net frequency that is divided and by this signal a power switch is driven that switches the current into electromagnets. Basically three types of applicators have been used. JLM-1 is an electromagnet with core, 300mm long, magnetic flux density on the front is 91mT, in the distance 10 cm about 5mT. JLM-2 is a flat solenoid with the inner diameter 220 mm; magnetic flux density inside is 25mT. JLM-3 is the biggest applicator used, a solenoid with the inner diameter 600 mm and 600 mm long. Magnetic flux density inside is about 10mT. Magnetic field generated has the repeating frequency 25, 16.6, 12.5, 10, 6.25, 5, 2 Hz. Almost all the works published in Czechoslovakia used this type of device. This device provided with 3 applicators is produced by Rukov Rumburk under the name MGTP-3. The most modern conception is represented by device UNIMAG, MEDIMAG and ULTIMAG produced by 2EL s.r.o., Hradec Kralove, Czech Republic. The device is driven by one-chip microcomputer that allows to generate various frequencies, modulations, shape of impulses, exposure duration etc. This device is very compact, small and handy. Simple models are designed for home purposes. 7 various applicators can be connected.

Internal diseases.

Chapter 4. Peripheral vascular diseases. Benda & Dipoldova (A1), Dipoldova & Benda (A5), and Dipoldova et al. (A4,A6) published works about efficacy of pulsed magnetic field [PMF] in ischaemic disorders of limbs [IDL] as a complication of diabetes mellitus [DM]. Therapy generally consisted of Hauffe-Schweringer baths [HB], CO2 baths [CO2B], special gymnastics [SG], and training in walking [TW]. As a special approach insufflation of spring gas to the region Th11-L1 [IG] or PMF with JLM-1, f=25 Hz, 20', 12-15 exposures of the same region [MF-1] or PMF with JLM-3, f=25 Hz, 20' of local exposures of the lower extremities, 12 times [MF2] were performed. Claudication distances, position tests according to Ratschow, tiptoeing tests and relative pulse volume [RPV] of calves were evaluated. For illustration the most important results from the first study are presented: Tab.1. Therapeutic procedures Therapy: N HB CO2B SG TW IG MF1 Group 1 38 + + + + - - Group 2 26 + + + + + - Group 3 35 + + + + - + Tab.2. Claudication distances in meters: Group 1 Group 2 Group 3 before after before after before after Mean 274.9 338.3 258.6 338.1 256.2 362.2 St.dev. 164.3 165.7 145.4 139.0 176.9 154.0 % of impr. 23.1 30.6 41.4 p 0.01 0.001 0.001 In the second mentioned study MF1 and MF2 were compared with regard to application of SG and TW. It was found that optimum was the combination of MF1 with SG. In the last study it was confirmed that even in cases of diabetic neuropathy PMF was highly effective; claudications and tiptoeing tests were markedly improved. It was interesting, that in those patients the best results were achieved with MF2. From all the mentioned studies it is obvious that PMF belongs to the complex balneological treatment of ischaemic disorders of the lower extremities. PMF is simple, well tolerated and cheap. Demecki & Kartashov (A2) used static magnetic field [ST] B=30mT and sinusoidal magnetic field [SIN] B=30mT, f=50Hz, [exposure time always 20', number of exposures 25] in atherosclerotic obliterations [AO] and endarteriitis obliterans [EO]. 198 patients were treated. Effect depended on the stage of diseases. If sinusoidal field was used in the Io. and the IIo. very good effect was reached in 66%, good effect in 21%, no effect in 13% of the treated patients. If static field was used, very good effect was observed in 60%, good effect in 21%, no effect in 17% and impairment in 2% of the patients. In patients with the IIIo of both the diseases neither objective nor subjective improvement was found. Duration of relief was reported from 8 to 10 months. Authors concluded that application of the sinusoidal magnetic field is more suitable than the use of static field. Zhukov et al. (A25) used static magnetic field, B=10mT, exposure duration [not more than 30'] and number of exposures [not more than 20] according to clinical conditions. The 1st group [54 patients, age 18-66 years, duration of disease 3-13 years] suffered from venous varices of calves, compensated as well as decompensated, the 2nd group [67 patients, age 24-68 years, disease duration 2-40 years] with postphlebitic syndromes. In the first group pO2 of venous blood was observed together with tissue pO2 reduction - that informed about open arteriovenous anastomoses. Moreover, increased amount of capillary filtrate was found. It is obvious that magnetotherapy here is not suitable. In the second group no signs of clinical or laboratory improvements were found. However, if oedema was the leading symptom [regardless of the group], marked reduction of capillary filtration was observed, diminished extravasal protein loss and normalised colloid-osmotic ratio that resulted into reduced oedemas. This was accompanied by elevated tissue pO2. The authors recommend magnetotherapy in cases of venous insufficiencies with oedemas only. Table 3. Arterial diseases Diagnosis Field Exposure Results Ref. B(mT) Type Other Duration Number IDL in DM, AO 12.5 st --- 20' 10 2 impaired, 6 no effect, 119 improved, claudication distances ñ . Long lasting improvement after 3 series during 3 months. A11 AO 30 st --- 20' 20 Analgesia, claudication distances ñ , rheological improvement. A12 AO, EO 10-30 st --- 30' 30 Analgesia, skin temperature ñ , inflammatory signs in EO ò . Effective in 80%. A14 AO, pelvis arteriae obliterat 50 st --- 20' 20 No effect in 89 from 3021, in comparison with other physiatric procedures, the best spasmolytic action, anticoagulation, tissue regeneration activated. Antiinflammatory activity, analgesia. A20 AO 30 st --- various regimens tissue pO2 ñ compared with controls A23 AO 50 st --- various regimens In 80% positive effect, analgesia, spasmolytic action on vessels, bacteriostatic effect, acceleration of skin defects healing. A18 AO 40 st magf. 30' 15 Frontal surface of thigh exposed. 157 patients. In 103 (65.5%) functional normalisation of circulation; in 41 no effect; in 13 vertigo, blood pressure ò ò ò , tachycardia. After interruption normalisation. In positive cases analgesia, blood pressure ò , rheograms improved, coagulationò A24 AO, EO 2.5 puls; 100Hz half sinus 20' 15 15 EO, 27 AO with trophic ulcers. In 10 complete, in 22 marked analgesia. 8 no effect. In 9 persons with ulcers live granulations. A10 DM with AO 50 st --- 20' up to 50 More than 1700 patients. In 7.5% unpleasant reactions connected with blood pressure depression. Marked diuresis, muscle and joints pains. These troubles ceased after the 4.-5. exposure. In 62.5% immediate improvement, in 24.7% with some delay, no effect in 9.8%. Improvement duration 1-10 years. A8 AO 50 st --- 15' 20 Rheograms improved, skin temperature ñ , heart beat rate ò . A 9 VWF 25 sinus 50 Hz 10' 10 Native plethysmograms normalized in controls in 6 from 17 records, in the exposed in 17 from 25. No changes after the cold provocation test. A13 Table 4. Venous diseases Diagnosis Field Exposure Results Ref. B(mT) Type Other Duration Number Insuf.acuta v.axill. et subclaviae 50 sinus 50 Hz 20' 30 42 patients, clinical improvement in all of them, improvement duration 1 - 8 years. A22 Chron.ven. insufficency 10 st --- 30' 10 Oedemas ò , arterial blood pO2 ñ , venous blood pO2 ò , lung circulation probably improved as well. A26 Thrombo-phlebitis ac. 20-40 st --- 30' 25-30 54 patients [49 males, 5 females], age 30-60 years. In all of them after the 4th-5th exposure complete analgesia, general improvement, ceasing of thrombi, oedemasò , collaterals opened, capillaroscopic picture improved, leucocytes + thrombocytes number ò , FW ò , coagulation ò . A17 Thrombo-phlebitis ac. 20-40 st --- 30' 25-30 45 patients [39 females, 6 males], age 30-60 years. Inflammation signs ò , plasmatic concentration of Fe3+ ò , Cu2+ ñ against controls; Cu/Fe ratio ñ . In deep thrombophlebitis more expressed. A 7 Venous crural ulcers No details described Clinical improvement, discussion on improved microcirculation. A21 Venous crural ulcers No details described, static field Before the therapy PMNLs, lymphocytes and extracel. microorganisms in the defect, little fibroblasts and macrophages. After the treatment a lot of macrophages, histiocytes, fibroblasts. PMNLs reduced. Complete healing in 53 from 61 patients. A19 In the next chapters microcirculation improvement will be considered as the basic mechanism of action. Litvin et al. (A16) observed in oedemas in various pathological conditions improvement of rheovascular index by 5.25% and decrease of distal index by 15% as reflection of vascular tonus improvement. Detlavs et al. (A3) described a large study in more than 3000 persons suffering from various locomotor apparatus diseases. They used either ST [B = 10, 20, 30mT] or pulsed MF [ALPHA-PULSAR device B=0.3-1.5mT, f=80Hz, quasi rectangular pulse duration 0.5 ms]; exposure duration in tens of minutes, number of exposures up to 30. Usually cervical part of spine was exposed because of cervical osteochondritis. Even after the only one exposure increased number of open capillaries in the nail bed was observed and their elongation. Hypocoagulation was observed as well due mainly to suppression of thrombocytes' functions. With increased number of exposures the changes were more expressed. Only one work on lymphatic vessels was found. Krylov et al. (A15) gave evidence on good efficacy of pulsed magnetic field with rectangular shape, B=20mT, exposure duration 20', number of exposures 15 in primary lymphoedemas. Not only clinical improvements were reported but also elastometry, plethysmography, lymphoscitigraphy and percutaneous pO2 showed improvement. By volume measurement of affected extremity reduction of oedema by 20-50% was found. Effect was noted in 41 from 43 patients . Chapter 5. Heart diseases and hypertension. Kirichenko (K7) studied influence of static magnetic field [B=15 or 25mT, exposure duration 20', number of exposures 10] on haemostasis in patients with ischaemic heart disease [IHD] and hypertension. Praecordium and Th3 - Th7 region were exposed. A group hypertension IIo consisted of 53 males and 24 females, age 37 -64 years. A group IHD II and III was composed of 43 males and 17 females, age 37 - 64 years. Except of these groups 30 healthy persons were included. The whole patients' group was divided into three subgroups. To the 1st subgroup [30 hypertonics and 25 persons with IHD] remedies were administered and in addition the patients were exposed to the field with B=25mT. The 2nd subgroup [24 hypertonics and 21 patients with IHD] was treated with drugs and was exposed to the field with B=15mT. The 3rd group [23 hypertonics and 14 with IHD] was treated with drugs only. At the beginning in all the patients tendency to hypercoagulation, increased thrombocytes' functions and antiheparin activity were found as well as elevated fibrinogen and fibrinogen B plasmatic concentrations. On the other hand fibrinolytic activity was depressed. After the treatment, except of subjective and clinical improvement expressed mainly in the group 2 (blood pressure depressed, pulse frequency slowed down, ECG curve improved, higher left ventricle output, better X-ray picture of heart and lungs), reduction of thrombocytes' functions were observed in hypertonics by 7.9%, in IHD by 19.1%. Aggregation was not significantly changed, however, PF-3 secretion was decreased in hypertonics by 10.6%, in IHD patients by 8.5%. PF-4 secretion by 2.2% and by 9.7%. In the 2nd group elevation of free heparin concentration was found in hypertonics by 37%, in IHD patients by 85.7% and depression of fibrinogen concentration by 12.5 and 19.1%. Moreover, activation of non-enzymatic fibrinolysis by activation of heparin-plasmin and heparin-plasminogen was observed. Number of basophilic leukocytes increased by 74.3 and 300%, respectively, and the cells had more granules. Magnetotherapy was used [B=20mT, f=50Hz, exposure time 15', number of exposures 12, every other day] in the complex rehabilitation care in patients after myocardial infarction (K3). Region C4 - Th2 was exposed. 50 patients were exposed, 50 patients served as a placebo group, treated by non-energised device. At the beginning the submaximum load in this group was 89.0+3.14 W, in the exposed group 90.0+3.14 W. After the end of the therapy the submaximum load was in the control group 109.5+4.52 W, in the exposed group 133.0+4.14 W. Frequency of angina pectoris episodes was reduced in controls by 36.6%, in the exposed patients by 57.4%. Nitroglycerine administration was completely eliminated in 13 controls and in 27 exposed. Degen (K2) described increased diuresis in cardiac patients treated with magnetic fields (see also chapter Animal experiments) that led to reduction of the amount of circulating blood and thus to the liver size reduction and blood pressure reduction in patients suffering from hypertension. In the hand and arm vasodilatation of small and middle arteries was observed and acceleration of blood perfusion. In cardiac patients no adverse effect has ever been found. However, Klemenov (K9) described tachycardia onset in one patient after exposure of praecordium to magnetic field [B=35mT, f=50Hz] . Although this case was the only one, he recommended Bmax=10mT and the longest exposure time 5 - 7 minutes. Muravev et al. (K12) observed sporadic palpitations and stenocardiae in older persons treated for IHD. This was accompanied by impairment of ECG curves. It was recommended to use magnetic fields here carefully with individual approach. Table 5. Diagnosis Field Exposure Results Ref. B(mT) Type Other Duration Number IHD 20 st --- 15' various Both left and right ventricle systolic volumes ñ , isometric phase of contraction ò , diastole ñ , pulse wave on a.brachialis elevated. K 4 IHD 25 st --- 20' 15 Coagulation ò , heparin metabolism ñ , plasmatic antiheparin activity ò , basophilic leukocytes number ñ , non-enzymatic fibrinolysis ñ . K 8 IHD 30 st; sinus ---; 50 Hz 20';20' 20 Patients after myocardial infarction, 100 exposed, 26 controls. Static field not effective. In sin. field functional and subjective improvement [LDH and AST incl.] in 66% against controls. K 1 IHD A review Parasympathetic division activated, aldosterone concentration ò after paravert.ganglia exposures. If sinus caroticus exposed, brain arterial tonus ò . Direct exposure of vessels caused their dilatation and development of collaterals. Sinusoidal field more active than static. 50mT was a ceiling value, stronger field can cause lipid metabolism activation ð atherosclerotic changes development! K16 IHD 20 sinus 50 Hz 15' 15 Praecordium or Th2-Th4 area exposed. No effect if praecordium exposed. If Th area exposed, aldosterone concentration ò , cortisol ñ . Better clin. results, less stenocardiae, higher physical load possible. K14 IHD, hypertension 30 st --- 20' 20 Systolic and minute volume ñ , perif.resistance ò ò , blood pressure ò , arterial blood velocity ñ . K 6 IHD, hypertension 1.5 puls 10 Hz half-sinus 20' 10 In hypertension head, in IHD both the head and thorax exposed. 80 persons with hypertension (BP 200-230/100-140) resistant to drugs. BP ò by 15-19%, sleep improved, headaches and ste-nocardiae ò . Central haemodynamics improved. In IHD stenocardias ò , ECG improved in 70%, mainly T-wave and ST segment, QRS shortening. Effect duration 3-6 month, doses of remedies ò . K10 IHD, hypertension 1.5 puls 10 Hz half-sinus 20' 10 In hypertension BP ò , headachesò , less frequent, sensitivity to weather ò . Sleep improved. In IHD tolerance to load ñ , ECG improvement. K11 IHD, hypertension 35; 16 sinus; sinus 50 Hz; 50 Hz 20'; 20' 18; 18 51 persons with IHD, 56 with hypertension. Th2-Th4 exposed. In 92% improvement. Sympat.tonus ò , remedies ò , load tolerance ñ , plasm.aldosterone ò , urine epinephrine excretion ò . 16 mT ineffective. K15 Hypertension 16 st --- 45' 10 Hypertension II, chest and neck exposed. BP syst. and diast. ò . In hyperkinetic form syst. and minute volumes ò , in hypokinetic form opposite effect. Doses of remedies ò . K 5 Hypertension 10 puls 10 Hz half-sinus 20' 20 Totally 50 patients with hypertension I and IIA; 108 with IIB, 9 renal hypertension. Chest and Th2 - Th4 exposed. 30 of them as placebo group. In hyperkinetic form pulse frequency ò , perif.resistance ñ if it was primarily low. In the hypokinetic form perif.resistance ò , pulse frequency ñ , syst.vol. ñ . Eukinetic form-perif.resistance ò . Renin, aldosterone and cAMP concentration ò . PGb, PGf2a concentration ñ . M-receptors activated, response of beta-adrenoreceptors ò , alpha-adrenoreceptors response ñ . K13 Chapter 6. Lung diseases. Tab. 6. Diagnosis Field Exposure Results Ref. B(mT) Type Other Duration Number Asthma bronchiale 15-35 st --- 25' 10-15 22 patients, 14 improved, 7 no effect, 1 impaired. Doses of steroids ò . L 5 Asthma bronchiale 25-30 sinus 50 Hz 20' 15-20 Chest from back and sides exposed. Vital capacity ñ by 330+106 ml, minute volume by 0.4-24 l, mean 8.4+2.25. Forced exspirium ñ by 7.3+2.28%. In two cases asthmatic episode interrupted. L 6 Chronic bronchitis 30 st magf 40' 10 Head zones exposed. 70 exposed, 70 controls. Spirometric parameters ñ ñ ñ , FW ò , expectoration improved, frequency of asthmatic episodes ò . L 3 Chronic bronchitis in children 10-30 st magf 3 hours 30 24 exposed, age 5-6; 16 controls. Pneumotachographic parameters ñ in exposed, mainly exspirium. Cough and dyspnoe ò , general improvement. L 8 Chronic bronchitis 9; 35 sinus; sinus 50Hz; 50Hz 1 hour; 20' 20 In rats optimum 35mT. Inflammatory signs ò ò ò , desensibilisation, synergism with ATB. The same in humans bronchiectasiae. PMNLs infiltration ò , in a long lasting follow up prevention of fibrous lung degeneration. L 2 Chronic lung inflammat. processes 35; 35; 35 sinus; puls; inter. 50Hz; 50Hz; 50 Hz 10'; 10'; 10' 20; 20; 20 93 chron.pneumonia, 122 chron.bronchitis, bronchiectasiae incl. Back and lateral sides of chest exposed the same results in all the regimens, i.e. general clin.improvement, ventilation parameters ñ , infl. signs ò , normalisation of immunological parameters, lung haemodynamics ñ ñ . L 4 Lung tuberculosis No details described Stat.mag.fields in the order of 10mT could be useful take a care in simultaneous purulent processes. L 9 Lung tuberculosis 21 st --- 20' 30 Faster healing of tuberculous cavities. L10 Lung tuberculosis 40 sinus 50 Hz 20 100 + 42 exposed, 26 controls, complex therapy in both the groups. Cough seizures in exposed ò within 2 weeks, in controls within 3-4 weeks. Koch bacillus production ò in exposed within 1 month, in controls not at all. Cavities healed in 14 exposed within 1.5 month, in controls in 4 patients only. L 7 Lung cancers 20-25 st --- 3-5' 30 45 patients treated with cyclophosphamide+metothrexate+actinotherapy. In 20 cases mag.field added. In the exposed group suprarenal gland function suppression less pronounced. L 1 Chapter 7. Gastrointestinal diseases. Gokhar-Kharmadyan and Salivarova (G2) described efficiency of magnetotherapy in gastric and duodenal ulcers. They used either static magnetic field [B=20mT] or sinusoidal field [B=7.5 or 19mT, 50Hz], exposure time always 12', number of exposure 10, epigastrium exposed. 151 patients were treated, age 30-50 years, disease duration up to 10 years. No effect was found if static magnetic field was used, while in cases of sinusoidal magnetotherapy with B=7.5mT the effect was prompt. Not only subjective and clinical improvements were reported but also depression of stomach acidity was found, complete healing was noted in 71 persons, in 38 marked reduction of ulcer size was found. By measurement of gastric and duodenal muscles potentials normalisation was found in majority of the tested persons, mainly in muscle rhytmicity. In hyperkinetic curves a voltage decrease, in hypokinetic curves an increase was found. Improved microcirculation was observed in the exposed area and even improved hepatic perfusion was noted. In laboratory tests lower levels of gamma-globulins, histamin and serotonin, higher levels of alpha-1 and alpha-2 globulins. Higher norepinephrine excretion in urine. Tab.7. Diagnosis Field Exposure Results Ref. B(mT) Type Other Duration Number Gastric and duodenal ulcers 26 sinus 50 Hz 20' 20 60 patients, in all of them troubles ò ò on the 6th-8th day. No effect on gastric acidity, healing not substantially affected compared with controls. G 3 Gastric and duodenal ulcers 35 sinus 50 Hz 12' 20 92 males, 45 females, age 17-60 years. 48 of them remedies only, 89 remedies + mag.field. In combination faster troubles reduction, faster healing. Electrogastrograms normalisation in the controls 5/21, in the exposed 16/27. No side effects, no effect on gastric chemism. G 4 Gastric and duodenal ulcers,chro-nic gastritis 20-35 sinus 50 Hz 20' 20 Epigastrium exposed. Marked improvement after the 6th-10th exposure, after the 15th exposure palpation pains ceased. X-ray picture normalized in 21/25. No gastric chemism changes, normalisation of gastric motility. No effect in chronic gastritis. G 9 Gastric and duodenal ulcers 40 sinus 50 Hz 10' 15 70 exposed, 70 controls. Subj.improvement in 22 exposed versus 12 controls, no effect in 3 exp./10 contr., full healing in 22 exp./12 contr., improvement duration 1-5 years 44 exp./24 contr. G10 Duodenal ulcers 35 st --- 15' 20 Simultaneously with hyperbaric oxygenation. Tissue oxygenation ñ , microcirculation ñ , healing ñ . G 5 Acute pancreatitis 36 st magf. 24 hours 25 d. Experiments in dogs first. 80 patients with ac.pancreatitis, 29 with cholecystopancreatitis; 22 males, 87 females. In 104 conservative treatment, in 5 surgery. Magnetophores localised on epigastrium and L1-L2 region. Clinical improvement within 5 days in 14, within 10 days in 17, within 15 days in 41, with in 20 days in 35, 21+ in 2. Not only clin. but laboratory improvement as well. Amplification of remedies activity. G11 Chronic pancreatitis 17.5; 24; 35 sinus; inter.; puls 50Hz; 5 Hz; 50Hz 20'; 20'; 20' 15; 15; 15 4 groups-sinusoidal, sinus.interrupted, pulsed, pulsed interrupted. In all the cases impairment after magnetotherapy with B=35mT. 17.5 and 24mT sinusoidal exhibited good effects not only clinically but laboratory signs [trypsin activity ò , tryps.inhibitors ñ callicrein ò ] improved as well. Optimum - 17.5 mT. G 1 Inflammatory diseases of dist.part of colon and rectum 40 st --- 20' 15-20 Various inflammations. Special applicators. Subj. improvements, coprograms and histological normalisation, stool pH alkalic. These results in 80% of treated, while in controls in 30% only. In 3 exposed - haemorrhages, v.s. mechanical irritation. G 6 Postradiation rectitides, cystitides 40 st --- 30' 10 After the radiotherapy of gynaecological tumours. 16 patients. At the beginning pains, blood and mucus in the stool, haematuria. Rectoscopically inflammatory signs, mucosa desquamation, rhagadae, ulcerations. After 3-4 applications analgesia, blood and mucus ò in the stool, FW ò , inflammatory signs ò according to rectoscopy. Mucus production, oedema, mucosa hyperaemiaò G 7; G 8 Chapter 8. Neurological diseases Valentova (N25,N27) used PMT (JLM-3, f=25 Hz, 20', 10-12 exposures) in complex spa therapy in spastic patients and patients with Parkinsonism. For evaluation the author used simple tests for general locomotion and rising mechanisms. At the end of treatment the motoric tests improved significantly for walking (p<0.001) and for change of position (p<0.01). The subjective tension in muscles of lower extremities was reduced in 84.6%, vertebral complaints in 84.6% , general improvement was reported in 96% of the patients. No changes in reflexes of lower extremities were found. No intolerance with other types of procedures was noted. Valentova & Dipoldova (N28) reported about efficacy of a single exposure to PMF (JLM-3, f=12.5 and 25 Hz, location Th and LS area and lower extremities, 10' exposure for each area) in 35 patients suffering from multiple sclerosis (MS). 3 parameters were evaluated: 1) time of walking for 10 meters, 2) time of walking upstairs (1 floor), 3) time of walking downstairs (1 floor). Tab. 8. Before After PMT Mean in sec. Mean in sec. p 12.5 Hz +/- SD +/- SD Walking 10 m 12.47 +/- 9.96 10.44 +/- 7.75 0.001 Upstairs 19.54 +/-13.45 16.80 +/-12.72 0.001 Downstairs 19.75 +/-12.60 16.80 +/-10.50 0.01 : Before After PMT Mean in sec. Mean in sec. p 12.5 Hz +/- SD +/- SD Walking 10 m 10.76 +/- 6.05 9.66 +/- 5.03 0.05 Upstairs 17.33 +/-11.87 15.88 +/-10.67 0.05 Downstairs 18.33 +/-12.50 16.92 +/-10.20 0.01 Valentova (N26) described a group of 71 patients treated for MS. Therapy included water procedures (CO2 baths + whirling baths of extremities) - WP, reflex massages - M, kinesitherapy - K, and PMT (JLM-3, 12.5 Hz, exposures - see below). The group was divided into 3 subgroups with regard to the type of therapy. Tab.9. 1st half of treatment 2nd half of treatment WP K M PMT WP K M PMT Group 1 (N=20) - + - +1) + + + +1) Group 2 (N=15) + + + (p) + + + +1) Group 3 (N=36) + + + +2) + + + +2) (p) = placebo exposure; 1) = Th-L region & lower extremities exposed 10'; 2) = exposures from shoulders to legs, in 3 regions, 10' each. Evaluation: locomotor tests and subjective changes were evaluated. After the first half of treatment placebo effect was checked between groups 1 and 2. Tab.10. - 0 +1 +2 +3 Group 1 1 4 6 8 1 Group 2 1 3 2 8 1 - = impairment; 0 = no effect; +1 = partial improvement; +2 = = improved; +3 = markedly improved X2 for trend = 8.333; p = 0.080 At the end objective evaluation did not exhibit statistically significant improvements. But subjective improvement reported by the patients was the best in the group 3. Tab.11. - 0 + Group 1 1 8 11 Group 2 0 5 10 Group 3 0 6 30 X2group 1 * group 2 = 3.330; p = 0.069 X2group 1 * group 3 = 15.233; p = 9.501 x 10-5 X2group 2 * group 3 = 13.333; p = 2.607 x 10-4 The author concluded that magnetotherapy was always well tolerated and because this method is simple, it is possible to use it in the out-patient rehabilitation care in MS patients. Dudyreva (N5) studied brain perfusion under influence of static magnetic field [B=30-40mT, exposure duration 20', number of exposures 10-15]. Magnetotherapy was used in 13 persons suffering from atherosclerosis cerebri, in 62 patients with cervical osteochondritis and in 47 patients with combination of both the diseases. In 106 of them stenosis of vertebral arteries was found with perfusion asymmetry and venostasis in vertebrobasilar region. Collateral development was found in temporal artery region. A/ After the exposure of sinus caroticus: Tab. 12. Vertebrobasilar region. Beginning After the 1st exp. End of treatment Rheogr.index (mohm) 51.0+/-6.6 90.0+/-8.6 100.0+/-14.1 Vascular tonus (%) 28.0+/-0.7 26.6+/-0.1 25.2+/-1.2 Tab.13. A.temporalis interna Beginning After the 1st exp. End of treatment Vascular tonus (%) 28.2+/-0.7 25.8+/-1.3 22.5+/-1.4 Rheographic index unchanged. B/ After exposure of suboccipital region. Tab. 14. Vertebrobasilar region. Beginning After the 1st exp. End of treatment Rheogr.index (mohm) 51.0+/-3.5 80.0+/-10.1 80.0+/-9.7 Vascular tonus (%) 27.2+/-0.8 25.1+/-1.3 23.1+/-1.3 Tab. 15. A.temporalis interna Beginning After the 1st exp. End of treatment Vascular tonus (%) 27.5+/-0.8 25.1+/-1.3 23.1+/-1.3 Rheographic index unchanged. Gabrielyan et al. (N6) performed sinusoidal magnetotherapy with B=25mT, f=50Hz in patients with atherosclerotic encephalopathy. The first two exposures lasted 10', the next ones 15', total number of exposures 10-15. Applicators were localised bitemporarilly. Totally 120 patients were treated [79 males, 41 females], age 40-60. The 1st group [62 patients] suffered from the initial stage of the disease, the 2nd group [31 persons] had the II. and III. stage, the 3rd group (placebo) was composed of 14 patients in the initial stage, from the II. and III. stage suffered 13 persons. In the 1st group marked subjective improvement and improvement in psychic functions was noted in 13 persons, improvement in 40, no effect in 4, impairment in 3 and 5 patients did not finish therapy for intolerance. In the 2nd group subjective improvement was found in 21, no effect in 8, impairment in 2 patients. Minimum improvement was found in the 3rd group. Rheoencephalograms showed reduction of arterial tonus and improved circulation mainly in the occipital region. On EEG records in the 1st group normalisation of basal curves was found, marked reduction of beta/activities and symetrisation of curves from both hemispheres, higher response to light stimulation. Similar, however less pronounced changes were found in the 2nd group. No EEG response in the 3rd (placebo) group. In some patients from the 2nd group improvement of vestibular functions was observed. Neretin et al. (N17,N18) used magnetotherapy in patients suffering from syringomyelia (60 persons) and posttraumatic cystic myelopathy (11 persons). Magnetic filed used - B=10-30mT, basic f=50Hz, interrupted regimen, impulse:pause ratio 2:10, repeated frequency 1 sec. 20 persons served as the control group. Except of magnetotherapy or blind exposure all the patients were treated by massages, vitamins and electrostimulation with a device STIMUL 1 was performed. In syringomyelia in 51 cases pains were reduced as well as paresthesiae, hyperhydrosis and cyanosis. Hand temperature increased by 2+0.28oC, muscular strength increased by 6.0+2.04 kg. On EMG at the beginning polyphasic potentials were present in 13% of cases, after the treatment in 32%. By means of luminescent capillaroscopy reduced perifocal oedema was found and increased number of opened capillaries in nail bed. IR radiation of the skin was amplified. The effect lasted 0.5-1 year. In the control group changes far less pronounced. No effect in cystic myelopathy. No adverse side effects found, it is recommended to apply magnetotherapy in the period 1-2 months. Tab. 16. Diagnosis Field Exposure Results Ref. B(mT) Type Other Duration Number Vasomotoric dystoniae, brain art. spasms, stp. neuroinfect. 10-20 sinus 50 Hz 10'-20' 15-20 Good effects in vasomotor.dystonias, in hypertension I. and II., in hypertension III. rather impairment. In atherosclerosis sleep improved, cephalea ò . In some patients with vegetative lability tendency to hypotension, swoon, puls frequency ò . N 7 Conditions after brain strokes 9;25 sinus 50 Hz 6'-15' 10-15 Highly effective even after 1 year after the stroke. Arterial tonus on ipsilateral side ò , on the contralateral side ñ . N24 Conditions after brain strokes, healthy persons 5 puls; rect. 50 Hz 30' 1 No significant changes in microcirculation parameters, however tendency to arterial tonus decrease was clear. After the head exposure higher IR radiation of extremities-distal effect. No sig. changes in EEG; in patients after the brain stroke tendency to improvement in delta and impairment in theta activities. Significant ò thrombocytes aggregation induced by collagen or ADP. Erythrocyte deformability ñ blood viscosity ò . Trend to hypocoagulation. N 2 Neuroinfec-tions 10-20 sin 50 Hz 5-10' 12 In 12 with acute neuroinfection PMNLs ò , lymphocytes ñ , in 4 no laboratory effect. In all of them clinical improvement. In 3 persons in subacute stadium the same, less expressed, in 7 no lab.effect, clinically +, in 4 no effect. In chronic neuroinfections both lab. and clin. improvement in 22, in 29 lab. improvement but clinically +. N12 Migraine, MS ? puls 10 Hz 15' 20 Immediate effect in MS in 30%, in migraines in 60%. Episodes frequency and intensity ò for 3-4 months. After a single exposure PMNLs activity ñ , after the whole treatment ò . N16 Various diseases, MS including Not described exactly In MS good effect, mainly in the spastic form and in micturition disturbances. N14 MS 5 puls 2.5Hz; halfs 20' 20 Thermographically confirmed skin vessels dilatation. N 8 MS 5; 70-80 puls; puls 12Hz; 15Hz 15'; 20' 1.-3.; 4.-15 Neither clinical nor laboratory changes. N 4 Migraine 3-4 puls 2Hz; halfs 10'-15' 15 Placebo exposure in 6, exposed 12. In 9 exposed improvement, in controls in 2. N13 Spinal deg.diseases, ASC, stp. cardiosurg., posttraum. conditions of spinal cord 25 puls 50Hz; halfs 25'-30' 10-15 Magnetotherapy in complex spa treatment. Various reasons of spinal cord affections, various localisations, various clinical, reflexological and EMG pictures. Mag. fields caused spasms reduction in spastic conditions. In floppy conditions muscle tonisation and fasciculation potentials ò . In floppy pareses ò , in spastics ñ threshold for muscle response. Dysuric disturbances and movability of patients improved. N17 Spinal cord injuries - various origin 40-70 st --- 60' 1-3 x daily; months In rats experiments positive results in clinical and electrophysiological tests. Then 104 patients 2-4 up to 1 month after the injury with various localisation. Marked functional improvement; bed-ridden controls 83.5%, exposed 60%, in chair in controls 4%, exposed 22%, selfmovability without tools in controls 12.5%, in exposed 18%. Not only clinical improvement, but EMG as well. N25 Tab.16 - cont. Object Field Exposure Results Ref. Observed B(mT) Type Other Duration Number Polyradiculoneuritides in children 2.8 st --- 10'-15' 10 11 children with typical symptomatology, cause unknown. After the initial exposures some impairment, after the 4th exposure improvement in all of them. In 7 children complete healing. No negative effects observed. N 3 Polyradiculoneuritides 35+-5 st ferr. 10'-20' 10 The 1st exposure 10', the following ones 20', paravertebral localisation. 39 remedies only, 39 remedies+mag.fields. Skin hyperaemia, analgesia, reflexology improvement. In the same time interval in the controls improved 22, exposed 36. In hypertonic patients blood pressure ò by 10-20 mmHg. N23 N.inguinalis injuries 2.8 - 5.6 sinus 50Hz 10'-15' 12-15 Mainly traumas, however peroperation injuries too. Pains, dysuria, motoric disturbances at the beginning. After the 5th-6th exposure improvement. Totally from 30 persons 10 without problems, marked improvement in 12, no effect in 6, interrupted for impairment in 2. Explanation - oedema reduction, microcirculation ñ . N30 Peripheral nerve affections - various origin 23; 23 sinus; puls 50Hz; 50Hz halfs 15'-30' 15-30' 10-12 10-12 130 patients, application along the nerve and paravertebral application. Positive results mainly in ischaemiae and inflammatory diseases - in 73%. Care was recommended in patients with hypotonia and in cases of diencephalic disturbances. N21 Peripheral nerves pareses Detailed information not described Immediately after the exposure muscular irritability ñ in both healthy and affected muscles. 50Hz more effective than 2Hz. N15 Sclerodermia complica-tions 35 sinus 50 Hz 10 15-20 C4-Th7 and Th10-L2 areas exposed. At the beginning Raynaud syndrome, palms' hyperhydrosis, sensitivity to cold, reflexes decreased, velocity n.ulnarisñ , oedemas. From 20 treated 19 improved in all the parameters described; velocity n.ulnaris ñ by 5-7m/s. N 9 Meniere syndrome 10 sinus 50 Hz 15'; twice daily 10 days 5 males, 20 females, 22-55 years. In 4 audiometry ñ , in 5 tinnitus ceased, in 7 patients ò . In all of them episodes of swoon ò . Impr. 1-2 years in 21. N20 Various diseases A review, B up to 70mT, static and sinusoidal fields, exposure duration 15'-20', number of exposures 15 - 20 From animal experiments it is clear that static magnetic fields ò reticular formation activity if it is stimulated, if not, magnetic fields activated reticular formation. Static magnetic suppresses sympathetic part > relative parasympathetic activation. Sinusoidal magnetic field activated sympathetic part From clinical practice it is obvious that good effects can be expected in neuralgiae, neuritides, polyradiculoneuritides. In optochiasmatic leptomeningitides optimum sinusoidal field, B=10mT, 10-15', 10-20 times. In circulatory brain disturbances opt. pulsed mag.field B<=25mT, f=30-50Hz. N22 Gliomas IIIo and IVo 25-250 st --- 30' 10 12 patients; magnetotherapy started at the 12th day after the surgery together with chemotherapy. After 3-4 months repeated. Follow up 30 months. Reoperation in 2. Cytostatics' transport improved, effect potentiation, postsurgery oedema reduced. N 1 Various diseases A review, various fields, various regimens In N pole ñ , in the S pole ò coagulation. Used in brain aneurysms for their obliteration. Sinusoidal 50Hz field, B=10-40mT, 2'-15', 12-15 exposures good results in optochiasmatic leptomeningitis. In 16/18 patients visual functions ñ and liquor normalisation better results if disease lasted <3 months. In 43 patients with malignant gliomas mag.field used in combination with chemotherapy, other 28 patients chemotherapy only. In the exposed group necessity of transfusion administration ò 5 times, better psychic conditions. Lifetime in the exposed group 22.4 months, in the controls 9 months. In some cases tumour growth stopped (CT examination), even reduction of its size. N10 See N10 A review; malignant gliomas Except of information as above, in vitro experiments showed that magnetic field enhanced activity of metothrexate, ftorafure, and sarkolysine against gliomas cells in tissue culture. Recommended: surgery > chemotherapy > magnetic fields. N11 Chapter 9. Rheumatic diseases. Since 1980 pulsed magnetotherapy (PMT) has been used mainly in these branches because of increasing number of locomotor apparatus diseases. Jerabek (R8) published the first results with PMT in arthritides, spondylitides, "frozen shoulders", "tennis elbows" and ankylosing spondylitis. for mixed diagnoses only subjective improvements were evaluated without any statistics. Analgesic action of PMT was approved in 80% of the treated patients. Thurzova et al. (R19) reported about 34 patients treated (JLM-1, 12.5 Hz, 20', 15 times) for vertebral algic syndromes of C and L spine. Significant reduction of pains, improvement of spinal functions, reduction of paravertebral spasms were proved. All the cases of L-spine were successful, while in CB and CC syndromes very good effects were in 6, good effects in 10 and no effects in 3 patients. Valentova et al. (R21) confirmed those results in 90 patients in spa treated except of common procedures also by PMT. 30 of them were treated with a combination of PMT and balneoprocedures, 30 patients served as a placebo group (PMT was applied with non-energised device), 30 patients were treated with classical spa therapy. It was shown that PMT did not exhibit any placebo effect and PMT was always well tolerated. Vaclavik (R20) applied PMT in patients with vert.alg.syndromes, gonarthritides and epicondylitides. He compared efficacy of PMT with other types of electrotherapy. He did not find statistically significant differences among various therapies immediately after the cure. But duration of pain relief was markedly longer if PMT was applied. It is interesting, that if "trigger points" in vert.alg.syndromes were exposed, immediate effects were reached. Kocian et al. (R11,R12) proved efficacy of PMT with JLM-1 in coxarthritides, mainly subjective improvement and Jezek (1990) reported good efficacy of JLM-2 in gonarthritides. Kovarovicova (R13) used JLM-3 in vert.syndromes comparing PMT to peloid packs. She found significantly improved Lasagne manoeuvre and Thomayer distance. Subjective evaluation by patients favoured PMT. Optimal combination - peloid packs and PMT. Gavlas et al. (R5) performed a large study in patients treated in spa Frantiskovy Lazne for arthritides of load-bearing joints. The patients were divided into 2 groups; one treated by current balneotherapy + pulsed magnetic field (PMF) (JLM-1, f=3.125 or 6.25 Hz, exposure 20' daily, number of exposures 12-19), and a control group that had the same balneological therapy, but PMT was performed with the device switched off. The group balneo: 36 females (born 1900-1952; 15 hip and 22 knee joints); 20 males (born 1910-1949; 8 hip and 12 knee joints). Overweight: 31 females and 19 males. The bal + PMF group: 92 females (born 1909-1953, 52 hip and 44 knee joints); 46 males (born 1911-1951, 22 hip and 25 knee joints). Overweight: 78 females and 43 males. Evaluation: consumption of analgesic drugs (yes/no), subjective improvement, walking time at distance 2 x 30 m with 3 stairs 15 cm high (patients had to perform it twice), duration of pain relief was recorded by mail response - that's the reason why not all the patients were evaluated. Results were processed by commonly used statistical methods. Tab. 17a. Consumption of analgesic drugs - males Balneo BAL + PMT Yes No Yes No Before 16 4 < X2=0.50; p=0.469 > 40 6 After 9 11 < X2=8.14; p=0.004 > 6 40 Tab. 17b. Consumption of analgesic drugs - females Balneo BAL + PMT Yes No Yes No Before 32 4 < X2=0.15; p=0.823 > 83 9 After 11 25 < X2=8.11; p=0.004 > 9 83 Tab. 18. Improvement of walking time after the therapy Balneo (performed in 8 males and 19 females) 0 - +4'' +5 - +9'' 10''+ Males 4 3 1 Females 8 2 9 Bal + PMT (performed in 28 males and 64 females) 0- +4'' +5 - +9'' 10''+ Males 10 6 12 Females 20 25 19 X2 for trend between the groups - males=1.609, N.S. - females=3.037, p=0.081 Tab. 19. Subjective improvement after the therapy Balneo Bal + PMT Score 0 +1 +2 +3 0 +1 +2 +3 Males 1 8 9 2 1 11 25 9 Females 2 24 10 0 2 19 52 19 X2 for trend between the groups - males=2.479, p=0.115 - females=25.312, p=0.000 Tab. 20. Pain relief duration in months: Males Females x +/- SD N x +/- SD N Balneo 8.13 +/- 2.26 8 7.11 +/- 2.71 27 BAL + PMT 16.33 +/- 3.82 18 16.48 +/- 3.49 27 tcalc 10.77; p < 0.01 10.81; p < 0.01 Jerabek & Zidekova (R9) treated 16 females (age 19-48) and 71 males (age 22-64) with ankylosing spondylitis (AS) in various stage of the disease. In addition to this basic diagnosis DM in 8, hypertension in 9, IHD in 11, anaemia in 5, hepatic lesion in 21, renal colic (in patient's history) in 6 and blindness caused by pharmacotherapy in 2 patients were present. Therapy: all the patients were bed-ridden, received NSAIDs, analgesic and other drugs recommended by their GPs, PMT (JLM-1, local application, 10-15' daily, 10 exposures), no other rehabilitation procedures were performed. Evaluation: spinal movability tests (measurements of Stibor, Schober, Thomayer and chin-sternum distance, lateroflexion of the body, rotation of the head and Forestiere-Fleche) were performed before and after the whole cure , urine and blood samples were taken for biochemical and haematological tests. In 48 patients analgesic effect was tested by means of pain scale. General examinations were performed daily. The control group - 14 patients treated with non-energised device (10 exposures) served as control. Because no significant spine movability changes were found and only in 2 males and 2 females certain subjective improvement was reported, conditions before-after the therapy were compared and the result were processed statistically by means of non-parametrical tests. Results: in all the mentioned movability tests high statistically significant differences were found (p<0.01). Particular data not shown here. As successful therapy improvement in 5 or more out of the 9 spinal movability parameters tested was considered. Tab. 20. Results in control group: