Med Pregl. 2004 Jan-Feb;57(1-2):13-7.

The role of physical rehabilitation in the treatment of exudative pleurisy.

[Article in Serbian]

Milojevi? M, Kuruc V.

INTRODUCTION: Exudates are due to a variety of diseases, the major and most common ones being tuberculosis, nonspecific inflammation and malignancy. They are usually treated conservatively, sometimes combined with surgery and physical treatment. Physical therapy includes positional exercises, breathing exercises and biostimulation.

AIM OF THE STUDY: The study was aimed to find out the following: 1) Is lung function improved by physical therapy; 2) Can adhesions be diminished and mobility of the affected hemidiaphragm improved by physical treatment; 3) Is there a direct positive correlation between physical treatment and obtained improvement, or the same can be achieved in patients receiving medicamentous treatment only; 4) What are the effects of some factors we cannot influence (sex, age, effusion level, position of adhesions) on lung function and diaphragm mobility improvement, that is on the efficiency of physical treatment; 5) How do the factors we can influence (the time interval before initiating the treatment and its duration) affect improvement of the same lung function parameters, that is treatment efficacy?

MATERIAL AND METHODS: Physical treatment of patients with exudative pleurisy was accomplished at the Department of Rehabilitation in our Institute and it consisted of directed breathing exercises and laser biostimulation. Its effects were examined in a group of 175 patients, who received both conservative and physical treatment, and results were compared with the control group patients, treated only conservatively (with antibiotics, antituberculotics, corticosteroids).

RESULTS: Comparative analysis confirmed a significant improvement of lung function parameters (VC, FEV1, PEF) as well as of hemidiaphragm mobility on the affected side of the thorax in favour of the examined group. The severity of the lung function and diaphragm mobility impairments have been found to be in correlation with the localization of adhesions, whereas the degree of improvement correlated with the time interval before the treatment initiation, as well as with its duration.

DISCUSSION AND CONCLUSION: The applied physical therapy resulted in: 1) significant improvement of all examined lung function parameters in the examined group, which was not registered in the control group; 2) significant improvement of the diaphragm mobility in general; 3) factors such as sex, age and effusion level have no effects on the physical treatment results; 4) treatment results are affected by the time interval passed before the treatment initiation and its duration, as well as the localization of adhesions; anterior adhesions affected lung function and diaphragm mobility least, posterior ones more, while the influence of lateral adhesions was most significant. It is finally concluded that physical treatment should necessarily be included in the treatment of exudative pleurisy.

Med Pregl. 2003 Nov-Dec;56(11-12):516-20.

Laser biostimulation in the treatment of pleurisy.

[Article in Serbian]

Milojevi? M, Kuruc V.

Institut za plu?ne bolesti, Sremska Kamenica, Medicinski fakultet, Novi Sad.

INTRODUCTION: Low-intensity lasers have been utilized in medicine in two ways: for local stimulation and for stimulation of acupuncture points. Literature data reveal that this method has been indiscriminately applied in psychiatry, rheumatology, gynecology, dermatology, otorhinolaryngology, in diverse acute and chronic pains, inflammations, vascular disorders, angina pectoris, bronchial asthma. Most commonly reported clinical effects are analgesia, spasmolytic and anti-inflammatory effects, as well as faster wound and bone healing.

MATERIAL AND METHODS: This prospective study analyses effects of laser biostimulation on patients with pleurisy. The analysis included 25 patients treated at the Institute of Lung Diseases in Sremska Kamenica during 2000, 2001 and 2002. Apart from conservative treatment, these patients were treated with laser biostimulation of acupuncture points and local region for ten days. During treatment, changes of present clinical signs, general symptoms, radiological findings, as well as changes of some relevant biochemical parameters were recorded.

RESULTS: Results were compared with the control group which included the same number of patients, who differed from the examined group only by not being exposed to laser biostimulation. The examined group of patients with pleuritis presented with quicker resorption of pleural effusion, less pleural adhesions, more significant decrease of clinical symptoms, especially pain, as well as more significant increase of cortisol and immunoglobulin A and decrease of circulating immune complexes (CIC), leukocytes and sedimentation rate than the control group.

DISCUSSION: Mechanisms of laser biostimulation in treatment of pleurisy were described in detail and the obtained results were correlated to those reported by other authors.

CONCLUSION: 1. Patients with pleurisy undergoing laser stimulation presented with faster resorption of effusion and remission of the subjective symptoms, as well as significant decrease of biochemical acute inflammation parameters in the peripheral blood and therefore with faster recovery. 2. In patients with pleurisy laser treatment increases regenerative mechanisms of the pleural surface, thus decreasing the quantity of formed adhesions and resulting in better mobility of the diaphragm.