Evaluation of provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal tonsillar infection in palmoplantar pustulosis.

J Dermatol Sci. 2003 Aug;32(2):105-13.

Evaluation of provocation test monitoring palmoplantar temperature with the use of thermography for diagnosis of focal tonsillar infection in palmoplantar pustulosis.

Asada H, Miyagawa S, Tamura M, Azukizawa H, Tanemura A, Yamaguchi Y, Sumikawa Y, Itami S, Kubo T,Yoshikawa K.

Source

Department of Dermatology, Nara Medical University, 840 Shijo-cho Kashihara, 634-8522, Nara, Japan. asadah@naramed-u.ac.jp

Abstract

BACKGROUND:

Since focal tonsillar infections are often associated with palmoplantar pustulosis (PPP), provocation tests have been performed for preoperative evaluation of tonsillectomy. However, these tests have not been fully established.

OBJECTIVES:

To introduce a more sensitive operative indication for tonsillectomy to the patients with PPP, we have monitored the temperature after provocation tests at palmoplantar sites, as measured by thermography, and we hypothesized that this methodology may lead to a more sensitive marker for tonsillectomy.

METHODS:

Twenty-two PPP patients with/without clinical tonsillitis were included in this study. After mechanical tonsillar massage, using infrared thermography, we have monitored the surface temperature at palmoplantar sites of 22 patients with PPP, five chronic tonsillitis patients without PPP, and four healthy controls, to compare the findings with the skin lesional outcome after tonsillectomy.

RESULTS:

There was a significant relationship between the effects of tonsillectomy and the results of provocation tests assessed by thermography. The sensitivity, specificity, and efficiency of the provocation tests with thermography of detecting a favorable outcome of tonsillectomy were 75.0, 83.3, and 77.3%, respectively, while those of the provocation tests as estimated with the conventional criteria were 37.5, 83.3, and 50.0%, respectively.

CONCLUSION:

Our results suggest that a new indicator using non-invasive thermography for the provocation tests is useful in predicting the effects of tonsillectomy for PPP.

Intracoronary thermography: does it help us in clinical decision making?

J Interv Cardiol. 2005 Dec;18(6):485-9.

Intracoronary thermography: does it help us in clinical decision making?

Toutouzas K, Drakopoulou M, Stefanadi E, Siasos G, Stefanadis C. Source 1st Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece. ktoutouz@otenet.gr

Abstract
The concept of the "vulnerable" plaque has recently emerged to explain how quiescent atherosclerotic lesions evolve to cause clinical events. The morphologic and immunologic determinants specific for the vulnerable plaque have been reported: a large lipid core (>or=40% plaque volume) composed of free cholesterol crystals, cholesterol esters, and oxidized lipids impregnated with tissue factor; a thin fibrous cap depleted of smooth muscle cells and collagen; an outward (positive) remodeling; inflammatory cell infiltration of fibrous cap and adventitia (mostly monocyte-macrophages, some activated T cells, and mast cells); and increased neovascularity. Despite the large amount of information regarding the morphological characteristics of remote lesions, we lack studies with functional assessment of non-culprit lesions. Coronary thermography is a technique for functional assessment of coronary atherosclerotic plaques. Several catheter designs have been proposed. There are catheters with thermistor(s) and wires with thermal sensors at the distal tip. All designs have several advantages and disadvantages. Despite the current limitations of coronary thermography, we gained important pathophysiological and clinical information regarding the vulnerability of atheromatic plaques. It has been documented both experimentally and clinically that increased heat generation is associated with increased macrophage concentration within the plaque. The correlation between local inflammatory involvement and local heat generation has also been observed with the peripheral inflammatory markers such as C-reactive protein. Whether systemic treatment, with agents such as statins or interventional techniques, such as drug-eluting stents, will have an impact on stabilizing vulnerable plaques need to be determined in future studies.

Conclusion
Although there are several techniques for evaluating morphologically atheromatic plaques, thermography is a promising method for the functional assessment of vulnerable plaque and has been introduced into clinical practice, with a good predictive value for clinical events in patients with increased temperature in the atherosclerotic plaque.

(J Interven Cardiol 2005;18:485-489).

PMID: 16336430 [PubMed - indexed for MEDLINE]

Contact-free infrared thermography for assessing effects during acupuncture: a randomized, single-blinded, placebo-controlled crossover clinical trial.

Acupuncture:

Anesthesiology. 2009 Sep;111(3):632-9.

Contact-free infrared thermography for assessing effects during acupuncture: a randomized, single-blinded, placebo-controlled crossover clinical trial.

Agarwal-Kozlowski K, Lange AC, Beck H. Center for Palliative Care and Pain Management, Doerenberg Medical Center, Bad Iburg, Germany.

BACKGROUND:
Although evidence of its effects is tentative, acupuncture has long been used in the treatment of
multiple maladies. So far, it has not been possible to discriminate the effects of the venue from
specific results of needling itself, thus physicians merely depend on patients' statements. The
authors investigated the efficacy of infrared thermography in distinguishing response to true
acupuncture as compared to nonacupoint cutaneous and muscular needling (sham or minimal
acupuncture), as well as without manipulation.

METHODS:
Thermographic imaging was performed in 50 healthy volunteers randomly assigned to four
groups: Acupuncture of Hegu (LI 4), needling of a cutaneous and a muscular point where no
acupuncture point has been described yet, and without manipulation. In a crossover protocol,
each proband completed all four arms of the protocol in a random order. Infrared thermograms
were gathered at defined points in each group.

RESULTS:
A significant increase in surface temperature occurred within 2 min after needling the
acupuncture point Hegu (from 30.1 +/- 2.7 degrees C [SD] to 31.2 +/- 3.0 degrees C and to 31.9
+/- 2.5 degrees C after 10 min, P < 0.001), whereas needling of the cutaneous and muscular
point, as well as without any manipulation resulted in a decrease of temperature in the monitored
area.

CONCLUSION:
Contact-free infrared thermographic imaging is a reliable and easy-to-handle tool to
distinguish between needling at Hegu and needling of a nonacupoint ("sham"
acupuncture).

Thermography and Return to Play Decisions
Dr. William A. Sands

Inflammation is a consistent indicator of injury and ongoing healing. Thermal imaging is
used for the characterization of inflammation. Thermal imaging can be used to monitor
the location, status, and progress of an injury by comparisons of the size of the injured
area and its temperature.

• Injuries foster a number of decisions that suffer from uncertainty, yet may require firm commitment, vigilance, and follow-through to resolve the injury. Uncertainty arises from variations in diagnoses, healing capacities, pain tolerance, effectiveness of healing modalities and medications, and
psychological support (1,3,6,8,9). Those who treat athletic injuries, coaches, athletes, and parents are often faced with return to play decisions that are wrought with pitfalls due to the lack of pertinent information regarding the athlete’s current injury state, his/her current performance status, and the risks and benefits of returning to activity. However, thermography technology may reduce the uncertainty.

Thermography involves the use of a special camera that can detect a portion of the
electromagnetic spectrum that lies just below the region of visible light–infrared light. Infrared light is the product of heat; all objects show heat, unless the object is at the temperature of absolute zero.

People are terrific heat sources. The heat that people produce is variable depending on the region of the body, metabolism, and other factors. One of the greatest sources of heat is that due to inflammation. Inflammation is derived from the same word as “flame” and accompanies all types of pain and injury. Inflammation is detectable as a heat source in the injured athlete, particularly when the temperature of the inflamed area is higher than that of the surrounding skin.

One of the interesting properties of inflammation and the detection of the heat produced by inflamed tissues is that even deep tissues often show a “signature” of heat in the overlying skin. In athletic injury, inflammation is usually reasonably close to the skin surface and easily detectable by thermal imaging equipment (2,4,5,10,11,12).

Thermal imaging has been used for injury and disease detection, malingering, and other
characteristics (2,4,5,7,10,11). Recent experience has shown that thermal imaging can be
used to assess the status and change of active inflammation that can reduce the
uncertainty regarding return to play decisions. Pain and inflammation have always been
coincident; thermal imaging can assess the presence of inflammation and thus provide
information about the progress of injury healing.

Monitoring the healing and recovery from injury with thermal imaging can help determine
whether an athlete’s injury has ceased the active inflammation period. Clearly, if
inflammation is still present, return to play should be postponed, further medical
consultation is needed, and increased vigilance and caution are merited. Injuries that have
become mostly or completely pain-free have been monitored with thermal imaging and the
injuries have shown a return of inflammation after premature return to play.

In conclusion, thermal imaging can provide a window into the world of injury recovery and
reduce the uncertainty involved in return to play decisions. Thermal imaging equipment
has been dropping in price for years and is available in a variety of camera-types and
configurations. Those concerned with return to play decisions are encouraged to consider
thermal imaging.

Viscero-cutaneous reflexes in relation to abdominal and pelvic pain. A study from 1982 with females with IUD insertions

• 
  

Phe van der Veen

Thermology International 08/2013; 23(3):87-92.

ABSTRACT OBJECTIVES: The aim of this study was to establish whether there is a relationship between a specific area of the abdominal wall and the uterus as the accompanying organ. The null hypothesis in this study was: the uterus has no specific area of skin which relates to viscero- cutaneous reactivity. The study had to able to take place in a G.P.'s practice, and had to comply with strict medical ethics requirements (a medical ethics review board did not exist at that time), particularly the study must not constitute any risk or cause any discomfort to the participants.

STUDY DESIGN: The target group consisted of 31 healthy women between 20 and 45 years of age who wanted an IUD inserted or replaced. The study took place in a G.P.'s practice where IUDs had already been inserted over a period of many years.

INTERVENTION: The IUD-insertion procedure was not changed during the study. After oral consent had been obtained from the patient, infrared thermographic images were recorded of the the abdominal wall immediately before and after IUD insertion.

STATISTICS: The average temperatures of four areas were measured and analysed in 1982 and 2012 with the Wilcoxon Signed Rank test.

RESULTS: There is one specific area where the skin temperature changes significantly more than elsewhere (p<0.001). This area is the same area as the one in which temperature changes have been measured in a study with pregnant women.

CONCLUSIONS: The null hypothesis must be rejected. This study shows the potential of mapping 'referred zones' with infrared thermography. The findings also question abdominal wall pain as an independent disease entity. Changes of inner organs should be considered as cause of abdominal wall pain.