The Official Journal of INTERNATIONAL JOURNAL OF WFOOT - World Federation of Oxygen-Ozone Therapy, FIO - Italian Federation of Ozone Therapy, OZONE THERAPY ACEOOT - Spanish Association of Ozone Therapy, formerly RIVISTA ITALIANA DI OSSIGENO-OZONOTERAPIA Hellenic, Indian, Slovach and Chinese National Societies

VOLUME 10 - No. 1 - April 2011 CENTAURO S.r.l., BOLOGNA

ISSN 1972-3539

INTERNATIONAL JOURNAL OF OZONE THERAPY formerly RIVISTA ITALIANA DI OSSIGENO-OZONOTERAPIA ThE OffICIAL JOURNAL Of WfOT - WORLD fEDERATION Of OxyGEN-OZONE ThERAPy, fIO - ITALIAN fEDERATION Of OZONE ThERAPy, ACEOOT - SPANISh ASSOCIATION Of OZONE ThERAPy, hELLENIC, INDIAN, SLOVACh AND ChINESE NATIONAL SOCIETIES

Index

edItorIal Part II - Oral Communications 37 Prof. M. Bonetti 5 session II - Randomized Clinical Studies 41 Prof. M. leonardi 7 session III - World Experiences 43

Saturday April 16th III World Congress of Oxygen-Ozone Therapy V° Congresso Nazionale F.I.O. session IV - Other Applications 45 From 14th To 16 th April 2011- Brescia Italy session IV - Oral Communications 51 session IV - Satellite Symposia 57 "Francesco rIccardo MontI" 8 Prize for research into oxygen-ozone therapy Parallel session - Veterinary Medicine 59

ProGraMMe 9 Posters session 63

Thursday April 14th authors Index 70 opening ceremony 21 Information & Congresses 22, 28, 36, 40, 44, 62 Friday April 15th WFOT Application Form 74 session I - Ozone Therapy in the 23 Muscolo-Skeletal Pathology Subscription Form 75 Part I - Spine FIO Application Form 76 Part I - Oral Communications 29 Part II - Articular 33 Instructions to Authors 78

Indexed in: EMBASE, Elsevier (http://www.scopus.com), Google Scholar (http://scholar.google.com) · Laserterapia · Tac · Correnti Analgesiche · Ecografie · Massoterapie · Ecodoppler · Rieducazione e Riabilitazione · Ozonoterapia · Tecar · Visite Specialistiche · Spine-Lab · Laserterapia · Tac · Correnti Analgesiche · Ecografie · Massoterapie · Ecodoppler · Rieducazione e Riabilitazione · Ozonoterapia · Tecar · Visite Specialistiche · Spine-Lab CALIBAN camiceria

www.giemmebrandscorporate.it www.centauro.it International Journal of Ozone Therapy 10: 5-6, 2011

Editorial dear Friends and colleagues, Cari Amici e Colleghi

It is a great honour to organize the WFoot’s è per me un grande onore organizzare questo III IIIrd World congress of oxygen-ozone therapy Congresso Mondiale di Ossigeno Ozono Terapia della coinciding with the V Italian congress of the W.F.O.O.T. che coincide con il V Congresso Italiano Federation of oxygen-ozone therapy. della Federazione di Ossigeno Ozono Terapia. after two years’ hard work the time has come Dopo due anni di duro lavoro finalmente è to spend three days completely devoted to oxygen- arrivato il momento di vivere insieme tre giornate ozone therapy. all the latest International devel- completamente dedicate all'ossigeno ozono terapia. opments in the field will be presented during the Durante il congresso verranno presentate tutte le congress. there will be a session led by a leading novità mondiali nella materia; vi sarà a tale prop- speaker form each continent from oceania to asia osito una sessione dedicata ad un relatore autorevole and the americas to then move on to an overview per ogni continente passando dall'Oceania all'Asia of the most important randomized studies pub- fino alle Americhe per poi passare ad esaminare tutti lished in the international literature. there will i più importanti studi randomizzati presentati in let- also be a session focused on oxygen-ozone applica- teratura internazionale. Vi sarà anche una sessione tions in veterinary medicine – a world first! interamente dedicata alle applicazioni in veterinaria the congress will be opened on thursday 14th novità assoluta a livello mondiale. april with a welcome address by the local author- Il congresso verrà aperto nella giornata di giovedì ity headed by Brescia’s Mayor adriano Paroli. 14 con il saluto delle Autorità locali a capo delle then work will start with a key note lecture by quali vi sarà il Sindaco di Brescia Dottor Adriano our President Vjiay Kumar. In fact the whole of Paroli successivamente inizieranno i lavori con thursday’s meeting will be devoted to key note la lettura magistrale del nostro Presidente Vjiay lectures with presentations by Professor Bocci on Kumar. La giornata di giovedì sarà infatti completa- the state-of-the-art of ozone therapy and Professor mente dedicata alle letture magistrali, con le pre- Fahmi on the main applications of ozone in mus- sentazioni del Professor Bocci sullo stato dell’arte culo-skeletal diseases. the “Francesco riccardo e del Professor Fahmi sulle principali applicazioni Monti” prize-giving ceremony has also been sched- dell'ozono nelle malattie muscolo-scheletriche, gio- uled for thursday with prizes being awarded vedì sarà anche il momento della consegna dei to Professor Marco leonardi, Professor Vjiay Premi “Francesco Riccardo Monti” che verranno Kumar, Professor Velio Bocci and Professor He assegnati al Professor Marco Leonardi, al Professor Xiaofeng. Vjiay Kumar, al Professor Velio Bocci e al Professor Friday’s meeting will be devoted to scientific He Xiaofeng. work, namely presentations on the spine and the La giornata di venerdì sarà interamente dedicata ai different applications of ozone therapy in mus- lavori scientifici ed in particolare alle comunicazio- culo-skeletal disease. saturday has an important ni sulla colonna vertebrale e sulle varie applicazioni session focused on other applications of oxygen- nella patologia muscolo-scheletrica, mentre la gior- ozone therapy from major auto-haemotransfusion nata di sabato avrà una ricca sessione dedicata alle to the topical use of ozone. altre applicazioni dell'ossigeno ozono passando Part of the meeting will also be devoted to an attraverso la grande auto emotrasfusione per arriva- entirely new topic, i.e. the assessment of recent re all’utilizzo dell’ozono a livello topico. anatomopathological studies on the treatment of Vi sarà anche una parte dedicata ad una novità the devastating infectious skin disease caused by assoluta come la valutazione dei recenti studi anato- Buruli ulcer in sub-saharan africa. mopatologici nel trattamento di una malattia così Before expressing my gratitude to all those who mutilante e devastante quale l'ulcera di Buruli carat- have helped me organize this important event, first teristica dell'Africa Subsahariana. and foremost I must thank my family and espe- Nel ringraziare tutti coloro che mi hanno aiutato cially my wife Graziella for their unstinting help nella realizzazione di questo importante evento scien- and support over the past two years. I would also tifico voglio, però, prima di tutto esprimere tutta like to thank the organizing committee who took la mia gratitudine e la mia riconoscenza alla mia on this commitment spending many entire eve- famiglia ed in particolare a mia moglie Graziella nings on the event. thanks too to the doctors who che mi sono sempre stati vicini in questi due anni have supported the scientific research, especially spronandomi sempre a fare il meglio.

5 Editorial

the members of the Italian Federation of oxygen- Ringrazio quindi tutto il Comitato Organizzatore ozone therapy. since the Federation was founded che ha accettato di condividere questo impegno in 2003 at the University of Florence, holding the dedicando serate intere all’evento. first FIo congress organized so successfully by Ringrazio anche tutti i medici che in questi anni Professor Gianni Pellicanò, its members are still hanno sostenuto con il loro impegno la ricer- with us eight years on and still committed to a ca scientifica, ed ovviamente un riconoscimento discipline so often hindered and denigrated by its importante ai medici della Federazione Italiana di many critics. Ossigeno Ozono Terapia che dalla sua nascita nel special thanks go to Marco leonardi and Mino 2003 presso l'Università di Firenze con il Primo andreula, my “fathers” both professionally and Congresso della F.I.O. magistralmente diretto dal personally, a credit to our discipline and guiding Professor Gianni Pellicanò sono ancora qui dopo figures for me and for ozone therapists all over otto anni ad impegnarsi per questa disciplina troppo Italy. spesso osteggiata e denigrata da tanti detrattori. thank you all. I look forward to seeing you Un ringraziamento particolare a Marco Leonardi soon for the IV WFoot World ozone therapy e Mino Andreula che considero i miei “padri” sia dal congress. punto di vista umano che professionale, una guida sicura per me e per tutta l’Ozono Terapia Italiana, che nobilitano la disciplina di cui ci occupiamo. Grazie a tutti, con l’augurio di ritrovarci presto per il IV Congresso Mondiale di Ozono Terapia della W.F.O.O.T.

Matteo Bonetti Matteo Bonetti

6 www.centauro.it International Journal of Ozone Therapy 10: 7, 2011

Editorial dear Friends, Cari Amici,

I am delighted to join dr Bonetti in welcoming sono molto felice di associarmi al Dr Bonetti nel you to Brescia for the World ozone congress. on darvi il benvenuto a Brescia per il Congresso this occasion I also have the pleasure of announc- Mondiale dedicato all’ozono. ing another important development of our offi- In questa occasione ho il piacere di annunciare cial journal, the International Journal of ozone una ulteriore importante evoluzione della nostra therapy. rivista, International Journal of Ozone Therapy, che From now on IJot will no longer be published abbandona la veste cartacea per internet. in hard copy format, but will be available for D’ora in poi IJOT sarà pubblicato sul web: http:// browsing online on the website: http://www.cen- www.centauro.it/, in versione sfogliabile, potremo tauro.it/. pubblicare gli articoli molto velocemente senza this new format will speed up publication of l’obbligo burocratico delle scadenze postali. articles and make them readily available to our Inoltre sarà molto più facile raggiungere i nostri readers all over the world without postal con- lettori in tutte le parti del mondo. straints. I will be presenting this new project Vi presenterò il progetto sia in sala che in un at the meeting both in the main auditorium apposito piccolo stand messoci a disposizione and at a small stand kindly made available by gentilmente dal Dr Bonetti, stand che vi invito a dr Bonetti. Please drop by to find out more. visitare. thank you Matteo for all your efforts in organizing Caro Matteo grazie per lo sforzo che hai fatto per this congress: the success of the meeting is yours l’organizzazione di questo convegno il cui successo alone! è totalmente merito tuo!

Marco Leonardi Marco leonardi

7 International Journal of Ozone Therapy 10: 8, 2011 www.centauro.it

“Francesco Riccardo Monti” Prize for Research into Oxygen-Ozone Therapy

during the World Federation’s third World congress of oxygen-ozone the “Francesco riccardo Monti” prizes will be awarded for research into oxygen-ozone therapy. thanks to the Foundation dedicated to artist Francesco riccardo Monti, these prizes represent a con- crete example of support and promotion for research into oxygen-ozone treatment at international level. the prize-giving must be seen as a scientific event drawing widescale attention to the work of leading researchers committed to ongoing daily research into oxygen-ozone therapy. It will serve as an occasion to promote the circulation of ideas, scientific discussion and yield more knowledge on this new treatment. the jury has decided to award this year’s “Francesco riccardo Monti” prizes to professors:

Vjiay Kumar Marco Leonardi He Xiaofung Velio Bocci

Professor Vjiay Kumar (India), a neurosurgeon and President of the World Federation of oxygen- ozone therapy has the important merit of having spread the practice of oxygen-ozone therapy with sci- entific rigour throughout asia starting from his native city new delhi. Vjiay Kumar is currently a world reference for the treatment of disc herniation. Professor Marco Leonardi (Italy) is full professor of neuroradiology at Bologna University, President of the Italian Federation of oxygen-ozone therapy and founder of the Italian Journal of oxygen-ozone therapy, currently the International Journal of ozone therapy, a journal indexed in elsevier’s embase database and internationally acknowledged as the only scientific journal devoted to ozone therapy. Professor He Xiaofung (china) is head of the Interventional radiology service at Guangzhou University and President of the chinese society of ozone therapy. His prize is awarded for his research activity, mainly on animals. lastly, Professor Velio Bocci (Italy) has been head of the Pharmacology Institute at siena University since 1971. He is the single person who has contributed most to international scientific research into oxy- gen-ozone therapy worldwide. His career has been crowned by more than five hundred articles published in the international literature. the prize-giving event is a major opportunity to debate the value of scientific research into ozone therapy all over the world. For this reason, the jury, chaired by Professor cosma andreula, would like to thank the Francesco riccardo Monti Foundation and invites all of you to the next World congress of the World Federation of oxygen-ozone therapy. chairman of the committee C. Andreula

8 www.centauro.it International Journal of Ozone Therapy 10: 9-20, 2011

9 Programme

Dear Colleagues, The Francesco Riccardo Monti prize for life time The 3rd World Congress of the Ozone achievements is a recognition for scientifi c work done Therapy Federation which follows to spread Oxygen-Ozone Therapy practice in Italy and those held in Beijing and Madrid around the world. wants to offer a further scientifi c value The great artist Francesco Riccardo Monti, who is now in a sector where approximation and represented by his heirs, was a sculptor and an architect vague knowledge lead - let me say - to from Cremona and he created many monumental works a mere justifi cation of a much easier of art. At the end of 1928 after winning a commission indifference. This is not acceptable and being prevented from completing it he had an and this congress is another important argument with a fascist party official and left Italy. meeting occasion to give validating He moved first to France and then to Manila in the certainties to physicians operating in Philippines where within a short time he became the this discipline. Recent clinical results of most important sculptor and architect in the country. national and international case history There he carried out great works of art merging the show a need for a bigger effort in the style of the European school with the local tradition. He research of rationality in the way this came back to Italy only for short periods between 1930 matter is dealt with. This 3rd World and 1932 to fi nish some uncompleted works. His style Congress then gives itself ambitious is full of poetic symbolism and leads to works of art targets. It wants to fi ght deception and rich in grace and imagination. His devotion is the same reestablish incontestable truth which is of those physicians who have always believed in the only possible with concrete knowledge. effectiveness of Oxygen-Ozone Therapy and have made It wants to give credit to all those possible for this around the world who have been very successful able to give certainty to this therapy. therapy to It wants to give the opportunity of a develop all over correct approach and give an occasion the world. of deep analysis.

For all this I feel honoured to organize the WFOOT 3rd World Congress of Ozone Therapy for the fi rst time in Italy. A big opportunity for all those who want to collaborate, compare, give the results of their own knowledge and experience, but above all for those who are humble enough to ask themselves “why?”

Thank you all

Matteo Bonetti

10 www.centauro.it International Journal of Ozone Therapy 10: 9-20, 2011

International Scientific Committee

Alvarado Ramiro - Bolivia Kumar Vijay Sheel - India Andreula Cosma - Italy Leonardi Marco - Italy Baeza Noci José - Spain Martin Florido Francisco J. - Spain Bas Murat - Turkey Martin Francisco Alfonsa - Spain Bergeron Yves - Canada Nabil Mawsouf Mohamed - Egypt Bocci Velio - Italy Pellicanò Giannantonio - Italy Catelani Cardoso Cláudia - Brazil Pepa Osvaldo Alberto - Argentina Clavo Bernardino - Spain Scarchilli Alberto - Italy De Monte Amato - Italy Schulz Siegfried - Germany Erario Angeles - Argentina Schwartz Tapia Adriana - Spain Fahmy Ziad - Germany Simko Marian - Switzerland Fawaz Asaad - Siria Stafa Altin - Albania Gallucci Massimo - Italy Tammam Youssef - Siria Galvan Francisco J. - Spain Ungureanu Florin Dan - Romania Gomez Manuel - Cuba Viebahn Renate - Germany He Xiaofeng - China Viti Paganelli Sergio - Venezuela Hernández Frank - Cuba Vyletelka Juray - Slovakia Konrad Heinz - Brazil Zambello Alessio - Italy Kos Wally - Australia

International Scientific Committee of Veterinary

Marco Ablondi - Italy Gaetano Penocchio - Italy Attilio Corradi - Italy Paolo Scrollavezza - Italy Corrado Dimauro - Italy Emilio Smadelli - Italy Helen Giuliano - Italy Alessandra Vigliani - Italy

Organizer Committee

Albertini Filippo - Italy Genovese Eugenio - Italy Alexandre Alberto - Italy Gjonovich Antonio - Italy Borrelli Emma - Italy Re Lamberto - Italy Cardelli Roberto - Italy Morosi Claudio - Italy IIID’Orta Giovanni WORLD - Italy Muto Mario - Italy CONGRESS Dall’Aglio Roberto - Italy Ottaviani Gian Maria - Italy De Santis Fabio - Italy Parodi Filippo - Italy Fabris Giuliano - Italy Sirito Mario - Italy OFFontana Alessandro Oxygen-Ozone - Italy Tabaracci Gabriele - Italy

11 Programme

Thursday April 14th Friday April 15th

15,00 Registration of participants Session I Opening Ceremony Ozone Therapy in the Musculo-Skeletal Pathology 15,30 Welcome of local Authorities PART I - Spine 16,00 V. S. Kumar - Ozone Therapy Today Moderators: C. Andreula, O. A. Pepa 16,20 V. Bocci - State of the Art: 8,30 M. Leonardi - State of the Art Has Ozonetherapy a Future in Medicine? 9,00 Y. Bergeron - Mini-Invasive 16,40 Z. Fahmy - The mean of ozone Treatments on the Spine therapy by musculoskeletal diseases 9,20 J. Baeza Noci - Ozone Therapy in 17,00-17,20 Coffee Break the Muscolo-Skeletal Pathology: Spine 17,20 Francesco Riccardo Monti 9,40 M. Gallucci - Other Ozone Awards Ceremony Therapeutical Approaches: 17,50 G. Pellicanò - History of Rock Facet Joints and Posterior Arch 18,35 Visit of “Mille Miglia” Museum 10,10 G. Pellicanò - Review of International Literature 10,30-10,50 Coffee Break

Oral Communications Moderators: M. Gallucci, A. Fawaz 10,50 J. Vyletelka - Internal Disc Disruption: Is it possible to treat with the Oxygen-Ozone Therapy? 10,57 A. Alexandre, L. Corò, A. M. Alexandre - Cerebrospinal fl uid nitric oxide metabolites are novel predictors of pain relief in degenerative lumbar diseases with spinal stenosis 11,04 A. Alexandre, L. Corò, A. M. Alexandre - Degenerative aspects on MRI follow-up of patients treated by ozone discolysis 11,11 F. de Santis, L. Cirillo, M. Dall’Olio, C. Princiotta, L. Simonetti, M. Leonardi - Lumbar Disk Hernias: Percutaneous Treatment with DiscoGel®in Patients who did not Respond to Oxygen-Ozone III WORLD CONGRESS Chemonucleolysis 11,18 A. Erario, A. Grangeat - Why Therapy oxygen ozone therapy is useful OF Oxygen-Ozone in degenerative disk pathology?

12 www.centauro.it International Journal of Ozone Therapy 10: 9-20, 2011

11,25 M. Simko - Our fi rst experiences Oral Communications (2009-2011) with combined lumbar Moderators: G. Pellicanò, M. Muto injection technique: ozone, steroids 14,40 M. Moretti - Effect of Treatment and long acting local anaesthetic with O2-O3 and Hyaluronic Acid in 11,32 A. Erario, A. M. Grangeat, Partial Tear of the Supraspinatus Tendon G. A. Moviglia, E. A. Croce, 14,47 R. Cardelli, E. Benedetti, E. Monti, N. Blasetti, M. L. Moviglia S. Montefi ori - Osteoarthritis of the Mesenchymal Stem Cells combined knee treated by intra-articular with Effector T Cells and low doses infi ltration of oxygen-ozone and of Ozone therapy produce regeneration hyaluronic acid of damaged inter vertebral disks in rats. 14,54 C. Morosi, U. Falzoni - Oxygen- 11,39 L. Brina, A. G. Popandopulo Ozone Therapy in Childhood. Personal Lumbar Vertebral disc pathology. Clinical Experience in Pediatric Surgery New frontieres: ozone+stem cells. 15,01 G. Tabaracci, V. Covi, 11,46 A. Alexandre, R. Paradiso, G. Arangio Febbo, M. T. Ghisellini A. M. Alexandre - Further studies Oxygen-Ozone Systemic Therapy and on patients affected by lumbar disc Local Drug-Resistant Severe hernia, and treated either by Rheumatoid Arthritis: A Case Report microdiscectomy or by in tradiscal 15,08 C. Catelani Cardoso, N. L. Pichara, oxigen-ozone injection. R. T. Bortolaz, M. A. Pereira, 11,53 R. Paradiso, A. Alexandre - Surgical S. B. Macedo, R. Dall’Aglio, treatment of disc herniation by J. M. Fiorini, J. E. Fiorini - Topic percutaneous laser disc decompression Ozone Therapy: Coadjuvant in the combined with intradiscal ozone treatment of exposed tibial fractures injection. 15,15 M. Moretti - Effectiveness of Infi ltration with O -O and Hyaluronic PART II - Articular 2 3 Acid in Overload Tendinopathy of the Moderators: M. Bas, H. Konrad Achilles Tendon in Athletes 12,00 X. He - Effi cacies of different treatment courses of ozone therapy Session II on lumbar disc herniation Randomized Clinical Studies 12,20 M. Muto - The Research: Moderators: F.D. Ungureanu, J. Vyletelka Modifi cations Induced by Ozone In 15,22 M. Gallucci - Ozone Versus Steroid in the Disk the Treatment of Lumbar Pain 12,40 E. Genovese - Mininvasives 15,42 A. Zambello - Epidural Steroid Treatments of Small and Big Injection vs Paravertebral O O Articulations Compared to Ozone 2 3 Infi ltration for Symptomatic Herniated 13,00 A. Scarchilli - The Experience in Disc Refractory to Conventional Shoulder and Knee Treatment Treatment - A prospective 13,20 J. Baeza Noci - Ozonetherapy in Randomized Study the adult hip pathology 16,02 F. J. Galvan - Prospective Clinical Study Comparing Ozone Therapy versus 13,40 -14,40 Lunch Open Surgery for the Treatment of Lumbar Herniation Disc. Preliminary Results

13 Programme

16,22 L. Re - A Randomized Clinical Study Saturday April 16th on Pain in Patients Treated with Ozone and NSAIDs V. Bocci - Ischemic stroke in n Castagneto Room patients to be treated with major ozonated autohemotherapy Session IV (MOAHT). Clinical trial in patients Other Applications with chronic heart failure (CHF) Moderators: F. Hernandez, L. Re treated with ozonetherapy. 8,30 S. Schulz - O2 / O3- Pneumoperitoneum 16,42 S. Mohga - Intra and Postoperative in Pre-Clinical Studies (e.g. cancer). Administration in Hepatobiliary Possible Mechanisms and its Outlook surgery (clinical study) in Human and Veterinary Medicine 17,02 -17,20 Coffee Break 8,45 B. Clavo - Ozone Therapy in Oncology 9,00 M. Nabil Mawsouf - Ozone Therapy Session III in Patients with Viral Hepatitis “C”. World Experiences Ten Years Experience Moderators: J. Baeza Noci, M. Simko 9,15 A. Schwartz Tapia - Ozone Theraphy 17,20 W. Kos - Oceania in Recurrent Vulvovaginal Candida Albicans Infections 17,40 V. S. Kumar - Asia 9,30 A. De Monte - Major Ozonated 18,00 C. Andreula - Europe Autohaemotherapy in the Treatment 18,20 R. Alvarado - America of Limb Ulcers not Responding to 18,40 M. Nabil Mawsouf - Africa Conventional Therapy 19,00 X. He - Decade review of ozone 9,45 M. L. Iabichella - Topical Ozonated therapy in China Autohemotherapy to treat Diabetic Ulcers of the Lower Limbs: Advantages and Limitations 10,00 C. Capuano - Oxygen Ozone Treatment for Lower Limb Peripheral Arterial Disease 10,15 A. Izzo, A. Bertolotti - The treatment of the buruli ulcer through the oxygen-ozone therapy: a pilot project in Zinviè, Benin 10,30 -11,00 Coffee Break 11,00 F. J. Martin Florido - Ozone Therapy in Odontology 11,15 R. Viebahn - Low-Dose Ozone Concept in Pain Syndrome: Pharmacology and Mechanism of Action 11,30 R. Viebahn - The Low-Dose Ozone Concept in Complementary Oncology

14 www.centauro.it International Journal of Ozone Therapy 10: 9-20, 2011

Oral Communications Satellite Symposia: Moderators: A. Martin Francisco, Y. Tammam *Ozone Therapy and Radiofrequency: 11,45 M. Sirito, L. Re, G. Martínez-Sánchez, 14,00 (A) F. Parodi - NovoX®’s G. Pérez-Davison - Role of ozone/ Presentation: Medical Ozonated Oil. oxygen in fi broblast growth factor Practical Application activation. Discovering the facts 14,30 (B) F. Parodi - Treatment of 11,52 G. Martínez-Sánchez, L. Re, neuropathic radicular discogenic pain A. Giuliani, G. Pérez-Davison with pulsed radiofrequency (PRF) on Clinical implications of ozone dorsal root ganglion (DRG) and U-Shaped dose responses intradiscal O2/O3 11,59 A. Erario, A. Grangeat *Ozonated Oil and Skin Ulcers: The amazing trip 15,00 (C) A. Paoli - The effects of sport 12,06 T. Barkhotkina - Ozonetherapy of massage with mineral oil, ozonated allergic rhinitis oil and passive recovery on performance and fatigue perception 12,13 C. Catelani Cardoso - Oxygen in competitive amateur cyclists Ozone Insufl ation of Maxillar Sinus: *Kinetic Column Test and Ozone therapy Safety, Effectiveness and Possible *Ion resonance and O3: Application in Three Different Clinical Situations 15,20 (D) F. Parodi - Kinetic Test for Centering Column and Cervical 12,20 F. Berni - The treatment with Rehabilitation Oxygen-Ozone Therapy by GEAT of patients affected by advanced senile 15,30 (E) G. Tabaracci, V. Covi dementia, assisted at their domicile Oxygen-Ozone Therapy and Ion and in pharmacological therapy with Cyclotron Resonance SEQEX antipsychotic psycholeptics, parasympathomimetics and melatonin 12,27 R. Quintero Marino - Ozone Therapy and Legislation 12,34 B. Clavo, N. Santana-Rodríguez, D. Fiuza, F. Robaina - Registration in Regulatory Medicines Agency. Why? Where? How to begin? 12,41 C. Catelani Cardoso, M. T. Ferreira, J. Meirelles, M. S. Lima, K. L. Rodrigues, L. R. Ferreira, R. Dall’Aglio - Study of Treatment with ozonized sunfl ower oil bioperoxoil on lesions induced in diabetic rats 12,48 F. Raggi, G. Vallesi - Intravenous laser blood irradiation in sports medicine 12,55 J. Baeza Noci - Zotero.org: The World Reference Database in Ozone therapy 13,02 - 14,00 Lunch

15 Programme

th 14,00 - 16,00 Tavola Rotonda F.I.O. Saturday April 16 Legal aspects of n San Paterio Room ozonotherapy in Italy and abroad. 8,30 Registration of participants Moderators: G. Barco, L. Re, M. Bonetti, M. Leonardi, A. Martin Francisco, Parallel Session - Veterinary Medicine J. Baeza Noci Moderators: G. Penocchio, A. Corradi A. Alexandre - Introduction 9,10 A. Vigliani - Practical Applications V. Bocci - Attempts of regulation of Oxygen-Ozone in equine orthopaedics through 30 years 9,40 H. Giuliano - Oxygen-Ozone Therapy L. Bellotti - The project of a new law in Neurological Patient G. Cesari, A. Alexandre 10,10 E. Smadelli - Infi ltrative Treatment The lawyer and the doctor with Oxygen-Ozone in Subjects with R. Dall’Aglio - Contraddictory Osteoarthritis applications of the rules 10,40 C. Dimauro - CT-Guided A. Schwartz - The situation in Spain Intraforaminal Oxygen-Ozone and Europe Treatment for Disc Herniation in the Dog M. Maggiorotti - Medicolegal aspects in ozonotherapy 10,10 - 11,30 Coffee Break 11,30 P. Scrollavezza - Ozone Treatment in Dairy Cow Mastitis 12,00 M. Ablondi - Effi cacy of an Ozonated-Oil Foam in the Treatment of Metritis and Endometritis in Dairy Cows. A Field Experience

12,30 - 14,00 Lunch

16 www.centauro.it International Journal of Ozone Therapy 10: 9-20, 2011

th 11. A. Gjonovich, G. Fiore - The Articular Pains to From Thursday 14 Algodystrophic Imprint:Treatment with to Saturday 16th Oxygen-Ozone 12. A. Gjonovich, G. Fiore - The Hyperalgic n Mazzotti Room Shoulder: clinical experience of Oxygen-Ozone Therapy Association with anesthetic suprasca- Posters session pular nerve block Moderator: A. Stafa 13. C. Catelani Cardoso, R. Dall’Aglio, 1. A. Fontana, M. Bonetti, G. D’Orta - Mono- F. Fraschini Not always the continuos infusion lateral Sciatalgia Associated with Contralateral of opioids is the best choice to treat chronic Gonalgia: Treatment with Oxygen-Ozone pain in the elderly people Therapy 14. C. de Michele - Chronic and Degenerative 2. M. Bonetti, M. Moretti, G. Guarino, Lumbago: from Ozonotherapy to Integrated G. Bragaglio Rhizoarthrosis: Our Experience Therapy with Oxygen-Ozone Treatment 15. M. Bonetti, M. Moretti, G. D’Orta, 3. A. Zambello, M. Bonetti, G. M. Ottaviani S. Giacomini, G. Bracchi Ozone and Oxygen-ozone Treatment of Fibromiangia Collagen Treatment for Articular Capsule Rupture of First Metatarso-Falangeal 4. C. Catelani Cardoso, R. Dall’Aglio, Articulation D. Rimonti, K. L. Rodrigues, L. R. Ferreira Ozonized Sunfl ower oil associated to lipoic acid in the prevention of muscle fatigue in fomula 1 race pilots 5. G. Tabaracci, V. Covi - Revision to 11 years in Case of a Herniated Disc Ejected at L4-L5, with Migrated Disc Fragment, and Herniated Disc Ejected at L5-S1 with Paraparesis and Cauda Syndrome, Treated with Paravertebral Infi ltra- tion Oxygen-Ozone 6. G. Tabaracci, C. Capuano, C. Capuano Biological Effects of Oxygen Ozone Therapy in Our Body 7. M. Bonetti, A. Fontana, G. M. Ottaviani Our Experience of Oxygen-Ozone Injection into the Interspinous Ligament 8. G. Ottaviani, M. Bonetti - MR Control after one month of a cervical herniated disc C5 C6 treat with ozone 9. G. Barco, C. Adamo - A Case of Pancreatic Cancer Treated with Temozolomide and Po- lytatomic Liquid Oxygen by Continuos Venous Infusion 10. A. Bariselli, M. Bonetti - Non-Invasive Ap- proaches to Back Pain in Patients with Somati- zation

17 Programme

HOW TO REACH THE MUSEUM LOCATION OF THE MUSEUM The Museum is situated inside the Monastery of Saint Eufemia, founded in 1008. Saint Eufemia is a district lying on the east side of Brescia, on the 45Bis “Gardesana Occidentale” Main Road: Viale della Rimembranza that is between Via Indipendenza and Via della Parrocchia.

GPS NAVIGATOR: TomTom Navigator and similar: Lat= 45.52411 N - Lon= 10.26783 E - Garmin, e Trex e simili: Lat= 45° 31’.446 N - Lon= 10° 16’.0698 E How to reach us: By car: A4 and A21 Highway “Brescia Centro” exit Follow direction to S. Eufemia, Proceed along Via Maggia, Via Mensi, Via Fiorentini, Via Gatti, Via Zammarchi, Viale S. Eufemia. A4 Highway: “Brescia Est” exit Follow direction to Brescia along the South ring road S. Eufemia exit. Follow direction to S.Eufemia. Proceed along Via Serenissima, Viale Sant’Eufemia. From the city centre of Brescia: Piazzale Arnaldo, Viale Venezia della Mille Miglia, Viale della Bornata, S. Eufemia. By bus: From the city: n. 3 Urban line (Rezzato direction) and n. 11 from Garda Lake bus stop “Eufemia” Others extra urban lines: station bus stop of Brescia and then urban lines. By train: Brescia Station, Bus line n. 3 (Rezzato direction) and n. 11, Taxi. By plane: Valerio Catullo Verona Airport, Shuttle bus from/to Verona Porta Nuova station, Train from/to Brescia station. Orio al Serio International Airport, Shuttle bus from/to Brescia bus station. Milano Malpensa Airport, Shuttle bus from/to Milano Centrale station,III Train from/to Brescia or WORLDShuttle bus from/to Brescia bus CONGRESS station. Milano Linate Airport, Shuttle bus from/to Milano Centrale station, Train from/to Brescia or Shuttle bus from/to Brescia bus station. GENERAL INFORMATION CONFERENCE DATE AND LOCATION The conference will take place in S. Eufemia (BS) at the Mille Miglia Museum Viale della Rimembranza, 3 on April 14th, 15th and 16th 2011. ABSTRACTS OF Oxygen-Ozone Submitted abstracts related to the topics of the conference will be selected for presentation as posters or oral communications. Abstracts will be published on the International Journal Of Ozone Therapy. All abstracts must be in English and must mention authors and their affi liations. They must contain title, goals, materials and me- thods, results and conclusions. Maximum length allowed for each abstract is 3000 characters including spaces. Please send your abstracts to [email protected] POSTERS All posters presentations have been given a number. The number corresponding to each poster is indicated on page n. 8 of this programm. Posters must be hung on panels with the corresponding number in Mazzotti Room. A hostess will assist you. Poster must be mounted on Thursday 14th in the afternoon and removed on Saturday 16th after the end of works.

18 www.centauro.it International Journal of Ozone Therapy 10: 9-20, 2011

CME ACCREDITATION SYSTEM (ONLY FOR ITALIAN PARTICIPANTS) We are very glad to inform you that the Congress has been granted CME credits by Italian Minister of Health. Doctors will collect 14 points per attending full Congress. Veterinary surgeons will collect 3 points per attending the Veterinary Session. We will give you all the necessary forms at the registration.

REGISTRATION FEE (VAT INCLUDED) Before February 1st After March 1st Regular fee: ❏ 250 ❏ 350 F.I.O. & W.F.O.O.T Members: ❏ 100 ❏ 200 Veterinarians - whole congress: ❏ 250 ❏ 350 Veterinarians - Saturday session: ❏ 80 ❏ 100

Registration fee includes: congress kit coffee break lunch

SATELLITE SYMPOSIA: Participation is free but registration is required. Please mark the Symposia you are interested in on the regi- stration form and return it to [email protected] within March 31st

SOCIAL EVENT FOR ACCOMPANYING PERSONS ON APRIL 15th 1st Option: Trip to Venice with a guide, all day 100,00. 2nd Option: Visit at the city of Brescia and exhibition of Matisse at the Museum of Santa Giulia 60,00

PRE-REGISTRATION: You are kindly requested to mark the excursion you are interested in by email to [email protected] within March 18th. You will pay the fee on site. N.b. : In case the excursions you have chosen haven’t reached the minimum number of participants (15) the III WORLDOrganizing Secretariat CONGRESS will inform you about the possible variation of plan. SOCIAL EVENT ON APRIL 16th The President, prof. Bonetti, is pleased to invite all the registered participants and their accompanying people to the basketball game to be held Sunday April 17 at 18.00 at Pala San Filippo, Via Bazoli, Therapy2 Brescia. People wishing to watch the game must present the badge of the congress.

HOW TO PAY FOR REGISTRATIONS It is possible to pay by cheque or bank transfer in favour of Koinè eventi (see attached registration form). Koinè eventi will send the invoice to the participant or to the paying company/institution. OF Oxygen-OzoneNote: in case of reservation paid by public or private institution you are kindly requested to provide us with an authorization written on the institution letterhead with all invoicing details (name, address, VAT No.). Please send the authorization along with the reservation form.

HOTEL RESERVATIONS (Prices are available in the reservation form). Koinè eventi has reserved a certain number of rooms at the Villa Fenaroli Palace Hotel especially for the con- ference. To make a reservation please fi ll in the attached form and send it to Koinè eventi to allow them to reserve the room/rooms depending on availability and according to your request. After the reservation has been successfully made Koinè will send you a voucher with the full address of the hotel. English will be the offi cial language of the conference.

19 Programme

Many thanks to our Sponsor:

20 www.centauro.it International Journal of Ozone Therapy 10: 21, 2011

Opening Ceremony

thursday, april 14th, 2011 • "Mille Miglia" Museum • 15,30-18,35

State of Art: Has Ozonetherapy a Future in gate not only the biological aspect, but especially the Medicine? clinical results, which so far are meagre, because only multicenter, randomized clinical trials will be able to V. Bocci convince everyone of the validity of ozonetherapy. Department of Physiology, University of Siena, 53100, Italy

that an oxidant can act either as a useful physiologi- The Mean of Ozone Therapy by cal messenger or a death signal is well clarified by ex- amining the behaviour of blood treated with different Musculoskeletal Diseases ozone doses. Blood is an ideal tissue because is com- Z. Fahmy posed of plasma and cells able to cooperate for tam- ing the oxidant properties of ozone. the plasma has a the major pain in rheumatic arthritis is musculoskele- wealth of reductants, which can be easily measured be- tal pain. Because of inflammation with its associated pro- fore and after ozonation. Blood cells contain not only ducts of alogenetic substances plays dominant role in pain GsH and thioredoxin but enzymes able to promptly production in many of these conditions, treatment with reduce oxidized compounds, thus restoring the initial ozone is the backbone of many therapeutic regiments. antioxidant status. the work performed during the last Musculoskeletal conditions without an associated in- sixteen years has clarified the most important com- flammatory component or obvious pathologic changes pounds generated ex vivo during the initial reaction of "such as fibrositis and the myofascial pain syndrome" ozone with some plasma components and how these still prove frustratingly difficult to treat. compounds activate some biochemical pathways in cells these entities are characterized by diffuse or locali- revealed by therapeutic effects after the transfusion of zed musculoskeletal pain and stiffness. the ozonated blood in the donor. We have shown that local injections therapy with ozone is an essential appropriate ozone doses are not toxic and we can ap- part of the therapeutic repertoire in rheumatic diseases. preciate the relevance of the subtle interaction between In some soft tissue lesions it can be curative ans it is the generated compounds and the antioxidant defences. an important adjunct to other treatment in the overall In spite of the present evidence, it is regretful that management of rheumatoid arthritis. orthodox medicine, on the basis of prejudice and lack In my lecture i will demonstrate to you the applica- of knowledge, does not want to acknowledge the value tion procedure and local injection therapy in the diffe- of ozonetherapy. thus we must to continue to investi- rent joints.

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Session I Ozone Therapy in the Musculo-Skeketal Pathology

Part I - Spine

Moderators: c. andreula, o.a. Pepa

Friday, april 15th, 2011 • "Mille Miglia" Museum • 8,30-10,30

1 8,30-9,00 39% (29 to 49%): Internal disc disruption; 15% (15 to 20%): Z-joint (or facet joint); State of the Art 15% (7 to 23%): sacroiliac joint. M. leonardi Internal Disc Disruption (IDD) Neuroscience Department, Neuroradiology O.U., In 1970, Henry crock introduced the term “Internal University of Bologna, Bellaria Hospital; Bologna, Italy disc disruption” and suggested the following defini- tion: “changes in the internal structure of a disc and ozone is an unstable allotropic form of oxygen, it has its metabolic functions.” the internal disc disruption’s the chemical symbol o3 and a molecular weight of 48. physiopathological process starts with a compression, Its biological effects include enhanced glycolysis, effects leading to a microfracture of the vertebral endplate. on red blood cells and rheology, bactericidal, fungicidal a disc provocation procedure followed by disco- and virustatic action, immunomodulating, analgesic and graphy with computed tomography is the only test al- anti-inflammatory effects. lowing to confirm a diagnosis of symptomatic internal this broad spectrum of action explains the wide disc disruption. range of indications for ozone appplication in medicine Minimally invasive treatment for Idd presently con- to treat infections, autoimmune disease, ischaemia, der- sists in “intradiscal electrothermal annuloplasty”. In the matological, neurodegenerative, neoplastic and ortho- last few years, we have been using cooled bipolar radio- paedic disease. frequency technology which consists in creating a wider the main fields of ozone application in neuroradio- lesion along the whole height of the posterior annulus logy are in disk disease, low back and sciatic nerve pain; with 2 cooled bipolar electrodes in order to avoid a too more recent applications are the treatment of cervical high temperature near the tip of the catheter. disk disease and cervical spinal pain. the many anatomical components responsible for Z-Joint (or facet joint) spinal pain include the paravertebral muscles, bony ver- schwarzer and al. have demonstrated that articular tebral structures, ligaments, joint capsules, nerve roots facet was responsible for chronic low back pain in a per- and intervertebral disks. centage raging from 15% among young patients to 40% Backache is therefore multifactorial in origin and the among older patients. the only way to diagnose a facet many pathogenetic mechanisms underlying back pain syndrome is to perform diagnostic blocks. When proven have led to the development of the techniques currently indicated, neurotomy of the medial branch by thermo- adopted in the administration of ozone therapy: intradi- lesion gives the best clinical results. thermolesion is scal, intraforaminal, paravertebral intramuscular injec- performed after sensitive and motor stimulation with a tion, performed separately or in combination. radiofrequency electrode heated to 80oc for 90 seconds. the autor presents his experience in these fields. Sacroiliac Joint sacroiliac joint is innervated by the posterior rami 2 9,00-9,20 of s1 to s4 with significant anatomic variability. Fluo- roscopic injection remains the only technique allowing Mini-Invasive Treatments of the Spine to differentiate between a symptomatic from a non- Y. Bergeron symptomatic sacroiliac joint. a new radiofrequency thermolesion treatment In the last few years, some major breakthroughs known as sInergytM is now available. With this techni- made it possible to identify the source of most com- que, a wider neurotomy is possible, allowing to make up mon vertebral low back pain. the source of pain (not for the anatomic variability of the posterior branches its cause) can be identified in nearly 80% of cases, and in their lateral divisions which innervate the sacroiliac can be divided into 3 categories: joint.

23 Friday April 15th, 2011 - Session I - Part I - "Spine"

Conclusion pain. Facet joints are responsible of a well defined syn- In the last few years, the source of chronic low back drome that can be diagnosed by detailed history and pain has been identified thanks to major scientific bre- physical examination. However, establishing a diagnosis akthroughs. a precise diagnosis must be confirmed be- of facet syndrome is difficult because findings are non- fore using the many therapeutic approaches now avai- specific, moreover the assessment of the role of facet lable in the minimally invasive medical treatment of joints in low back pain is difficult because usually pain common vertebral disorders. depends on more concomitant factors. lumbosacral facet syndrome is characterized by low back pain that may radiate to the buttock and posterior thigh, without 3 9,20-9,40 a precise dermatomeric distribution. Pain typically does not radiate below the knee. the pain is usually worst Ozone Therapy in the Musculo-Skeletal in the morning and it is exacerbated by rest, hyperex- Pathology: Spine tension and torsion movements. Imaging can show fa- J. Baeza-noci cet joint osteoarthritis and sings of instability, however a mismatch between clinical and imaging findings is Percuntaeus Treatment Unit for Spinal Diseases. Hospital Virgen del Consuelo; Valencia-Spain - [email protected] frequent. several interventional procedures have been developed for the management of facet syndrome; they Key words: ozonetherapy, guideline, ozone injection, spine can be divided in joint injections and medial branch of the dorsal ramus nerve block procedures. Fellows reading papers about ozone injections for Intra-articular facet joint injections have a diagnostic treating spinal disorders, usually get messed up by dif- and therapeutic role. diagnostic injection of local anae- ferent approaches. this paper aim is offer both rookies sthetic is performed to confirm the clinical diagnosis of and skilled doctors a guideline based in publications facet syndrome. If the joints are the source of pain, the available whether indexed or not. patient experiences rapid pain relief after the injection. degenerative spine compiles failure of three struc- For therapeutic injection a long acting steroid is added tures, disc and facet joints. Young patients usually start to the anaesthetic to produce more durable pain relief. with disc herniation; facet joints failure come along Injection of oxigen-ozone can be usefully associated or years after. Middle age patients usually start with disc used as alternative to steroid administration, in case of herniation over a degeneration of the ‘three-joint-com- contraindication to steroid therapy. plex’. some times, radicular pain is due to lateral steno- sis or facet joint diseases, like articular cysts. spine pain 5 10,10-10,30 may arise from disc, facets or both. this complex approach to spine degeneration ren- ders a complex strategy for the treatment. the use of Review of International Literature ozone as a therapeutic agent in spine pathology should G. Pellicanò be tailored to the patient, based in some scientific pro- Radiodiagnostic and Interventional Unit 2, Careggi University ved points: intradiscal ozone produces disc dehydration Hospital; Florence, Italy and reduces intradiscal inflammation and degeneration process; epidural and periradicular ozone produces re- In the last few years many papers appeared into the duction of nerve root and ganglia inflammation and International literature about oxygen-ozone theraphy improves nerval microcirculation locally; deep para- for the herniated disc, reporting very high rate of suc- vertebral ozone injection, over facet joints, produces cess of this treatment. In particular we can found papers reduction of local inflammatory process and classical about comparison among different way of treatment paravertebral ozone injection produces local relaxing with ozone combinated with other drugs. In 2003 an- and antalgic effect and may produce systemic effect, as dreula and coworkers published one of the most impor- a small autohemotherapy. tant “milestone” papers on aJnr: Minimally Invasive We can then build up a decision tree to fit the best tre- oxygen-ozone therapy for lumbar disk Herniation. atment for each patient, based upon clinical symptoms they assessed the therapeutic outcome of oxygen- and complementary tests. ozone therapy and compared the outcome of admini- stering medical ozone alone with the outcome of medi- cal ozone followed by injection of a corticosteroid and an anesthetic at the same session. six hundred patients 4 9,40-10,10 were treated with a single session of oxygen-ozone the- rapy. all presented with clinical signs of lumbar disk Other Ozone Therapeutical Approaches: nerve root compression, with ct and/or Mr evidence Facet Joints and Posterior Arch of contained disk herniation. three hundred patients M. Gallucci (group a) received an intradiscal (4 ml) and perigan- Department of Neuroradiology, University of L’Aquila, Italy glionic (8 ml) injection of an oxygen-ozone mixture at an ozone concentration of 27 µg/ml. the other 300 pa- Facet joints are a very common but underestimated tients (group B) received, in addition, a periganglionic source of pain. a recent study showed that facet joints injection of corticosteroid and anesthetic. therapeutic are responsible of at least 31% of cases of low back outcome was assessed 6 months after treatment by using

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a modified Macnab method. results were evaluated by a) underwent intradiscal and intraforaminal injections two observers blinded to patient distribution within the of a steroid and an anesthetic, and 82 patients (group B) two groups. a satisfactory therapeutic outcome was ob- underwent the same treatment with the addition of an tained in both groups. In group a, treatment was a suc- o2-o3 mixture. Procedures were performed with com- cess (excellent or good outcome) in 70.3% and deemed puted tomographic guidance. an oswestry low Back a failure (poor outcome or recourse to surgery) in the Pain disability Questionnaire was administered before remaining 29.7%. In group B, treatment was a success treatment and at intervals, the last at 6-month follow- in 78.3% and deemed a failure in the remaining 21.7%. up. Patients and clinicians were blinded as to which tre- the difference in outcome between the two groups was atment was performed. results were compared with the statistically significant (P < .05).they can conclude that chi2 test. 6 months, treatment was successful in 36 (47%) combined intradiscal and periganglionic injection of patients in group a and in 61 (74%) patients in group B. medical ozone and periganglionic injection of steroids the difference was significant (P < .01). Intraforaminal has a cumulative effect that enhances the overall out- and intradiscal injections of a steroid, an anesthetic, and come of treatment for pain caused by disk herniation. o2-o3 are more effective at 6 months than injections of oxygen-ozone therapy is a useful treatment for lumbar only a steroid and an anesthetic in the same sites. disk herniation that has failed to respond to conser- on the contrary very fiew papers are present to re- vative management. Many others groups published in port advers effects of this therapy: we analyze the most the following years many others papers reporting their recent papers, but there is a common comment that must experiences with the same results. a Metaanalysis of be underline: in all this cases there is no evidence of the the effectiveness and safety of ozone treatments for direct consequence of the oxygen-ozone therapy with Herniated lumbar discs was publish on J Vasc Interv the adverse effect or with the death of the patient. It is radiol by Jim steppan, thomas Meaders, Mario Muto, really surprising the this papers were accepted for pu- and Kieran J. Murphy, in 2010. random-effects meta- blication on important scientific international journals. analyses were used to estimate outcomes for oxygen/ Case 1 (20): a 45-year-old woman was referred to the ozone treatment of herniated discs. a literature search orthopedics department for an intradiscal (10-ml) and provided relevant studies that were weighted by a study periganglionic (20-ml) injection of o2-o3 mixture at an quality score. separate metaanalyses were performed ozone concentration of 27 µg/ml for the treatment of for visual analog scale (Vas), oswestry disability In- lumbar disk hernition. the injections were administered dex (odI), and modified Macnab outcome scales, as by an extraspinal lateral approach at the l1-l2 level well as for complication rate. Institutional review board using a 22-gauge 17.78-cm spinal needle. time for each approval was not required for this retrospective analysis. injection was globally 15 seconds. no premedication or Metaanalyses were performed on the oxygen/ozone tre- anesthesia was given, and the procedure was performed atment results for almost 8,000 patients from multiple at an outpatient facility. Immediately after the procedure centers. the mean improvement was 3.9 for Vas and she noticed “patches” obscuring her vision in both eyes. 25.7 for odI. the likelihood of showing improvement an ophthalmic examination 7 days after infiltration di- on the modified Macnab scale was 79.7%. the means sclosed a visual acuity of 20/320 os and 20/40 od with for the Vas and odI outcomes are well above the a massive premacular hemorrhage involving the left minimum clinically important difference and the mini- macula. drainage of premacular hemorrhage into the mum (significant) detectable change. the likelihood of vitreal cavity by neodymium: yttrium-aluminum-garnet complications was 0.064%. In their conclusions oxygen/ (nd:YaG) laser was obtained 3 weeks later in the left ozone treatment of herniated discs is an effective and eye. We consider more likely that an abrupt, transient extremely safe procedure. the estimated improvement spike in cerebrospinal fluid pressure after disk infil- tra- in pain and function is impressive in view of the broad tion was responsible for the retinal hemorrhages. We also inclusion criteria, which included patients ranging in suggest that an increased intradiscal pressure with an age from 13 to 94 years with all types of disc hernia- overload and microrupture of the disk after the injection tions. Pain and function outcomes are similar to the out- could have caused a quick spread of the mixture into epi- comes for lumbar discs treated with surgical discectomy, dural space proportional to the speed and volume of the but the complication rate is much lower (<0.1%) and infiltration. an increase in cerebrospinal fluid pressure the recovery time is significantly shorter. after the injection was thus transmitted directly through In 2007 Gallucci and coworkers published on ra- the optic nerve sheaths to the retinal venous circulation, diology a paper entitled: treatment with intradiscal and thus causing distension and rupture of peripapillary and intraforaminal injections of steroid and oxygen-ozone retinal capillaries. But they wrtite, “In our case, the real versus steroid only. their purpose was to prospectively mechanism of action producing intraocular hemorrhages compare the clinical effectiveness of intraforaminal and after intradiscal infiltration of o2-o3 is unclear. intradiscal injections of a mixture of a steroid, a local our considerations: anesthetic, and oxygen-ozone (o2-o3) (chemodiscoly- – too much quantity (10 cc intradiscal and 20 cc peri- sis) versus intraforaminal and intradiscal injections of ganglionar); a steroid and an anesthetic in the management of ra- – We too experimented the ozone presence in the epi- dicular pain related to acute lumbar disk herniation. dural spaces even if only very few cc; hundred fifty-nine patients (86 men, 73 women; age – the action mechanism can be accepted but not using range, 18-71 years) were included and were randomly our mixture quantity; assigned to two groups. seventy-seven patients (group – no informations regarding the procedure guidance;

25 Friday April 15th, 2011 - Session I - Part I - "Spine"

– no correlation between causes and effects. our considerations: Case 2 (21): the patient was admitted from a local – the concentration (10 µg/ml) is low but what about pain clinic and developed, during a lumbar (l5-s1) the quantity and injection pressure? intradiscal ozone injection for sciatica, a tension-type – Is it correct to treat patient with a bulging without frontal headache without nausea and vomiting and radiculopathy? then, almost suddenly, bilateral blindness. at entrance, – Which procedure was performed? Which guidance type? the oculistic evaluation was negative; the neurologic Case 4 (11): a 57-year-old man previously treated examination showed right inferior facial nerve palsy, with oxygen-ozone therapy presented low back and bi- global amnesia, spatial and temporal agitated disorien- lateral pain. the lumbar computed tomography revea- tation, delirium, and bilateral cortical blindness, with led the presence of l4 –l5 and l5–s1 herniated discs. sparing of the fotomotor reflex. Magnetic resonance three days after admission in the hospital, the patient images showed hyperintensities in the occipital cortex, developed a fulminant septicemia. an abdominal-pelvic and frontal white matter bilaterally and in the left tha- and chest computed tomography and blood culture led lamus in the t2-weighted sequences Visual disturbances to the diagnosis of pyogenic lumbar muscle involve- gradually recovered by the fourth day, making possible ment, accompanied with septic pulmonary embolism a discharge in 10 days. secondary to escherichia coli infection. this case report Intense painful stimulus during the procedure, which identifies a rare and fatal complication of oxygen-ozone was not image guided, could have provoked paroxy- therapy in the treatment of a herniated lumbar disc. stic cardiac arrhythmias leading to embolic migration acute fatal septicemia should be considered among the of thrombotic debris from cardiac chambers. Patients, major complications of the oxygen-ozone therapy in the according to available protocols, receive an intradiscal treatment of a herniated lumbar disc. the most likely 4-ml and periganglionic 8-ml injection of an oxygen- pathophysiological mechanism in our case was direct ozone mixture at an ozone concentration of 27 µg/ml inoculation of the bacteria during the procedure. our considerations: In our opinion, prophylactic antibiotic therapy should – no radiological guidance; always be given to the patient. – We can assume that intense pain can provoke arith- our considerations: mia, but, if our procedure is correct, a so intense pain – Paravertebral treatment for sciatalgia? isn’t present; – Which technique? concentration Quantity? – We don’t undestand if this pain theory is an ipothesis – Was antibacteric filter used? or the patient really suffered for this pain? – asepsis? – ct guidance!!! – Is antibiotic prophilaxys really needed? Case 3 (17): the patient was a 59-year-old female Case 5 (7): a pyogenic discitis at c3-c4 with associa- who had no history of any major disease. she had a typi- ted ventral epidural abscess involvingc1-c4 after intra- cal low back pain nuclear magnetic resonance (nMr) discal oxygen-ozone chemonucleolysis: a case report. of the lumbosacral spinal cord (!!!) showed a posterior a 57-year-old female patient with nuchal stiffness was protrusion of the l4 - l5 disk that contacted the pro- previously treated with ozone therapy at the discs of ximal portion of the l5 radicular pouch and a median c3-c4, c4-c5, and c6-c7. Five days later, she presen- posterior protrusion of the l5 -s1 disk with moderate ted with an attack of neck pain and fever followed by bilateral foraminal stenosis.1 month later, she received progressive quadriplegia with sudden onset of dyspnea a percutaneal intra-discal (l5) injection of an o2o3 mi- and was referred to our hospital. on admission, physi- xture with an ozone concentration of 10 µg/ml. the cal examination revealed a temperature of 38.8 degrees patient did not complain of any sensation immediately c, evident neck tenderness, marked global weakness after introduction of needle and drug, but a few minutes (grade 1-2/5 Mrc) in bilateral upper-limb, and a mo- after the procedure, she experienced paresthesia along dest global weakness in bilateral lower-limb (grade 4/5 the anterolateral compartment of the left leg and hype- Mrc). laboratory findings showed a significantly ele- sthesia over the dorsum of the left foot; the day after, vated Wcc, esr, and crP. Blood culture was nega- lombosciatalgia occurred in left limb. tive. enhanced-Mr imaging demonstrated a purulent according to clinical, physical, and electrophysiologic discitis at c3-c4 and a ventral c1-c4 epidural abscess findings, ventral and dorsal root injury was diagnosed. with homogenous enhancement indicative of a solid authors considerations: phlegmonous granulation tissue. surgeons formulated – the real mechanism underlining this double injury is a 3-stage treatment involving c1-c4 multilevel decom- not clear. pressive laminectomies, subtotal unilateral c3-c4 face- – the hypothesis of a direct toxic effect of ozone is un- tectomies, and tissue sampling for culture with applica- remarkable. tion of a corset after surgery, followed by a delayed se- – assuming the presence of microfractures of the annu- condary posterior thorough drainage of epidural liquid lus fibrosus, one possibility is that an abrupt, transient pus using a suction-irrigation drainage, after the abscess spike in cFP after disk infiltration was responsible for had turned to a necrotic liquid abscess, on the basis of the lesions. findings of enhanced-Mr imaging, by 10-day duration – the possibility of direct damage by needle introduc- of intravenously antibiotic therapy tailored to strep- tion may be clinically excluded because the subject did tococcus bovis isolated from infected tissue. over the not complain of electric shock sensation after needle next few weeks, the patient made an excellent neurolo- introduction. gic recovery. However, she did not consent to undergo

26 www.centauro.it International Journal of Ozone Therapy 10: 23-27, 2011

further occipitocervical fusion until the follow-up Mr 8 Wu Z, Wei lX, li J, et al. Percutaneous treatment of non- imaging at 8 months demonstrated postlaminectomy contained lumbar disc herniation by injection of oxygen- ozone combined with collagenase. eur J radiol. 2009 kyphosis. after surgery, the patient remained clinically dec; 72 (3): 499-504. epub 2008 sep 7. PubMed PMId: satisfactory in neurology without evidence of a recur- 18778905. rence of spinal infection. a slight improvement in the 9 Muto M, ambrosanio G, Guarnieri G, et al. low back cervical spine curve was demonstrated in the follow-up pain and sciatica: treatment with intradiscal-intraforami- radiograph at nearly 4-month postoccipitocervical fu- nal o2-o3 injection. our experience. radiol Med. 2008 aug; 113 (5): 695-706. epub 2008 Jul 1. english, Italian. sion. Infection is a common risk for any invasive spinal PubMed PMId: 18594765. techniques involving puncture, so attention should be 1 0 H a n HJ, Kim JY, Jang HY, et al. Fluoroscopic-guided in- paid to the sterility during the procedures. a high index tradiscal oxygen-ozone injection therapy for thoracolum- of suspicion along with reliance on enhanced-MrI is bar intervertebral disc herniations in dogs. In Vivo. 2007 essential to diagnose the condition and institute appro- Jul-aug; 21 (4): 609-13. PubMed PMId: 17708354. 1 1 clavo B, robaina F, Kovacs F, et al. Fulminating septice- priate treatment on an individual basis. mia secondary to oxygen-ozone therapy for lumbar disc our considerations: herniation: case report. spine 2007; 32: e121-3. spine – once more the accurate analisys of this case allow us (Phila Pa 1976). 2007 aug 15; 32 (18): 2036; author reply to conclude to pay attention to asepsis and sterility as is 2037. PubMed PMId: 17700457. usual in all, and not ozone only, percutaneous neurora- 1 2 leonardi M. re: Gazzeri r, Galarza M, neroni M, et al. Fulminating septicemia secondary to oxygen-ozone the- diological procedures. rapy for lumbar disc herniation: case report. spine 2007; In conclusion, in all these papers the complications 32: e121-3. spine (Phila Pa 1976). 2007 aug 15; 32 (18): must be related to the operators rather than the proce- 2036-7; author reply 2037. PubMed PMId: 17700456. dure. and finally we must remember the International 13 Wei cJ, li YH, chen Y, et al. [Percutaneous intradiscal oxygen-ozone injection for lumbar disc herniation: no Journal of ozone therapy founded in 2002 by Matteo need of perioperative antibiotic prophylaxis]. nan Fang Bonetti and Marco leonardi a really International fo- Yi Ke da Xue Xue Bao. 2007 Mar; 27 (3): 384-6. chi- rum for all ozone operators. nese. PubMed PMId: 17426000. 1 4 devetag chalaupka F, caneve G, Mauri M, et al. thun- References derclap headache caused by minimally invasive medical 1 alexandre a, corò l, Paradiso r, et al. treatment of procedures: description of 2 cases. Headache. 2007 Feb; symptomatic lumbar spinal degenerative pathologies by 47 (2): 293-5. PubMed PMId: 17300374. means of combined conservative biochemical treatments. 1 5 G a z z e r i r, Galarza M, neroni M, et al. Fulminating sep- acta neurochir suppl. 2011; 108: 127-35. PubMed PMId: ticemia secondary to oxygen-ozone therapy for lumbar 21107949. disc herniation: case report. spine (Phila Pa 1976). 2007 2 Borrelli e. Mechanism of action of oxygen ozone therapy Feb 1; 32 (3): e121-3. PubMed PMId: 17268255. in the treatment of disc herniation and low back pain. 16 Gallucci M, limbucci n, Zugaro l, et al. treatment acta neurochir suppl. 2011; 108: 123-5. PubMed PMId: with intradiscal and intraforaminal injections of steroid 21107948. and oxygen-ozone versus steroid only. radiology. 2007 3 Postacchini F, Postacchini r. operative management Mar; 242 (3): 907-13. epub 2007 Jan 5. PubMed PMId: of lumbar disc herniation: the evolution of knowledge 17209164. and surgical techniques in the last century. acta neu- 17 Ginanneschi F, cervelli c, Milani P, et al. Ventral and rochir suppl. 2011; 108: 17-21. review. PubMed PMId: dorsal root injury after oxygen-ozone therapy for lumbar 21107933. disk herniation. surg neurol. 2006 dec; 66 6): 619-20; di- 4 steppan J, Meaders t, Muto M, et al. a metaanalysis of scussion 620-1. PubMed PMId: 17145327. the effectiveness and safety of ozone treatments for her- 1 8 alexandre a, corò l, azuelos a, et al. Intradiscal in- niated lumbar discs. J Vasc Interv radiol. 2010 apr; 21 jection of oxygen-ozone gas mixture for the treatment of (4): 534-48. epub 2010 Feb 25. review. PubMed PMId: cervical disc herniations. acta neurochir suppl. 2005; 92: 20188591. 79-82. PubMed PMId: 15830973. 5 Felder-Puig r, Gyimesi M, Mittermayr t, et al. [chemo- 19 Muto M, andreula c, leonardi M. treatment of hernia- nucleolysis and intradiscal electrothermal therapy: what is ted lumbar disc by intradiscal and intraforaminal oxygen- ozone o-o injection. J neuroradiol. 2004 Jun; 31 (3): the current evidence?]. rofo. 2009 oct; 181 (10): 936-44. 2 3 epub 2009 sep 24. German. PubMed PMId: 19780005. 183-9. PubMed PMId: 15356443. 6 Paoloni M, di sante l, cacchio a, et al. Intramuscular 2 0 lo Giudice G, Valdi F, Gismondi M, et al. acute bilateral oxygen-ozone therapy in the treatment of acute back pain vitreo-retinal hemorrhages following oxygen-ozone the- with lumbar disc herniation: a multicenter, randomized, rapy for lumbar disk herniation. am J ophthalmol. 2004 double-blind, clinical trial of active and simulated lumbar Jul; 138 (1): 175-7. PubMed PMId: 15234314. paravertebral injection. spine (Phila Pa 1976). 2009 Jun 1; 2 1 corea F, amici s, Murgia n, et al. a case of Vertebrobasilar 34 (13): 1337-44. PubMed PMId: 19478653. stroke during oxygen-ozone therapy Journal of stroke 7 Bo W, longyi c, Jian t, et al. a pyogenic discitis at c3-c4 and cerebrovascular disease, Vol. 13, n.6 nov-dec 2004. with associated ventral epidural abscess involving c1-c4 after intradiscal oxygen-ozone chemonucleolysis: a case All the articles published on International Journal Of report. spine (Phila Pa 1976). 2009 apr 15; 34 (8): e298- Ozone therapy can be found at website: www.webfio.it/ 304. PubMed PMId: 19365239. rivista.htm.

27 www.centauro.it International Journal of Ozone Therapy 10: 29-32, 2011

Session I Ozone Therapy in the Musculo-Skeketal Pathology

Part I - Oral Communications

Moderators: M. Gallucci, a. Fawaz

Friday, april 15th, 2011 • "Mille Miglia" Museum • 10,50-12,00

1 10,50-10,57 2 10,57-11,04

Internal Disc Disruptionì: Is it Possible to Cerebrospinal Fluid Nitric Oxide Treat with the Oxygen – Ozone Therapy? Metabolites are Novel Predictors of Pain J. Vyletelka Relief in Degenerative Lumbar Diseases Department of Neurology, Faculty Hospital, Žilina, Slovakia with Spinal Stenosis a. alexandre, l. corò, a.M. alexandre* Introduction and objective: Internal disc disruption European Neurosurgical Institute (EU.N.I.); Treviso, Italy or discogenic pain syndrome is very specific problem of * Dipartimento di Bio-immagini e Scienze Radiologiche - the spine. this entity is result of a structurally damaged Istituto di Radiologia. Università Cattolica del Sacro Cuore. and internaly painful intervertebral disc. Patients with Policlinico A. Gemelli; Roma, Italy internal disc disruption classically complain of axial type of pain, either low back pain or neck pain. Goals: the lumbar spinal stenosis (lss) is defined as the symptoms of this disorder although predominan- a narrowing of the spinal canal together with neuronal tly axial in nature, may also have a radiating component and vascular structures via circumjacent bone and soft with radicular or nerve root type pain. tissue. In patients aged over 65 years, the lss is among Unlike disc herniation however, this pain is not the the most frequent causes of lumbago, either with or wi- result of discal compression upon nerve root. Internal thout sciatica. the leading symptom is neurogenic clau- disc disruption / Idd / occurs when the annulsus of the dicatio with lumbogluteal or sciatic pain, which occurs disc develops a rip or tear or is disrupted, which creates while walking and leads to a limitation of the walking pathways for the degenerated nucleus material to leak distance. Its typical constellation of symptoms including onto nerve fibers located in the outer edges of annulus. subjective leg weakness is leading to the tentative dia- the nucleus material contains high levels of inflam- gnosis. nowadays, the imaging technique of choice for matory substances which causes pain when it comes in the diagnosis is magnetic resonance imaging. a conser- contact with the nerves. vative treatment is initially sufficient in most cases. the the objective of this work is to evaluate a therapeu- indication for surgery is given, if the pain and limitation tic effect of the oxygen-ozone mixture in patients with of walking distance are not tolerable any more. additio- Idd in the lumbar region. nal fusion should be taken into account, when degenera- Methods: 10 patients with clinical signs and symptoms tive spondylolisthesis or other pathomorphological alte- of Idd, confirmed with ct guided discography and/or rations result in an instability. conservative and surgical MrI were treated by the intradiscal application of oxy- therapeutic goals imply pain relief, amelioration of the gen – ozone mixture under ct control. physical functionality, mobility and general quality of life. all of them were given oxygen-ozone mixture at Materials and Methods: a large number of patients, ozone concentration of 27 mg/ml in volume 4-5 ml. the among which 70 with lumbar canal stenosis (lcs), and therapeutic effect was evaluated after 6 months with 77 with lumbar disc herniation (ldH), were examined the modified Mcnab method. and treated. the csF [nox] was measured using the Results: 7 patients had exellent or good results, and 3 Griess method. (the Griess test is a chemical analysis patients with the poor results decided to continue with test which detects the presence of organic nitrite com- conservative treatment. pounds). Conclusion: Percutaneous intradiscal medical ozone We have studied the variations of [nox] in the csF, injection is an effective und safe method for treating and correlated with the severity of neurologic impai- Idd, but the evaluation for real effects requires an in- rment and clinical recovery, assessed using the Japa- vestigation with more patients. nese orthopedic association score and Hirabayashi’s

29 Friday April 15th, 2011 - Session I - Part I - "Oral Communications"

method. Measurement were performed before and 15 pedicles; in this case too, changes are probably a reflec- days after the treatment of such patients by oxygen- tion of abnormal stresses, by loading or motion. ozone discolysis combined with a series of paraverte- Furthermore the fact that a degenerative disc can be bral oxygen-ozone injections. identified without concomitant vertebral body marrow Results: [nox] was significantly higher than that in changes indicates that they do not represent an invaria- controls, and correlated with postoperative recovery ble outcome, but, part of a spectrum of the same disease. rates, but not with preoperative neurologic severity. With these considerations we made an analytical eva- [nox] significantly correlated with neurologic recovery luation of neuroimaging controls of our series of patient following surgery for lcs. who underwent discolysis. the influence of antioxidant substances and of ozone, Result: the analytical evaluation of neuroimaging injected in the epidural space, favouring the clinical im- control in our series demonstrates that discolysis boosts provement are evaluated and appear to be highly po- the natural evolution of disc pathology, in particular it sitive. determinates dehydration of the disc and a stabiliza- Conclusion: the variations of [nox] in the csF we tion of vertebral endplates signal changes from type 1 measured, correlated with the severity of neurologic (typically representing oedema and inflammation of the impairment and clinical recovery, demonstrate that ce- bone marrow) to type 2, type 3 in which the bone mar- rebrospinal fluid nitric oxide metabolites are novel pre- row is respectively substituted by fat or bone sclerosis, dictors of pain relief in degenerative lumbar diseases or even to normal. with spinal stenosis. We agree that a brief oxidative stress caused by ozone Furthermore the influence of antioxidant substances administration with discolysis may correct a persistent and of ozone, injected in the epidural space, favouring imbalance due to excessive chronic oxidative injury. the clinical improvement appear to be highly positive. Conclusion: as vertebral endplates changes are part of the process of discovertebral complex degeneration we wonder if there is any modification in Modic chan- 3 11,04-11,11 ges during ozone treatment, aboveall after discolysis. the analytical evaluation of neuroimaging control in Degenerative Aspects on MRI Follow-up of our series demonstrates that discolysis boosts the na- Patients Treated by Ozone Discolysis tural evolution of disc pathology, in particular it deter- minates dehydration of the disc and a stabilization of a. alexandre, l. corò, a.M. alexandre*. vertebral endplates signal changes. European Neurosurgical Institute (EUNI); Treviso, Italy * Dipartimento di Bio-immagini e Scienze Radiologiche - Istituto di Radiologia. Università Cattolica del Sacro Cuore. Policlinico A. Gemelli; Roma, Italy 4 11,11-11,18 Goals : the disc is avascular, and disc cells depend Lumbar Disk Hernias: Percutaneous on diffusion from blood vessels at the disc’s margins to ® supply the nutrients essential for cellular activity and Treatment with Discogel in Patients to remove metabolic wastes. this is key concept since Who Did Not Respond to Oxygen-Ozone it as has been proved that a fall in nutrient supply can Chemonucleolysis reduce the number of viable cells in the disc, leading to F. de santis, l. cirillo, M. dall’olio, c. Princiotta, degeneration. l. simonetti, M. leonardi as vertebral endplates changes are part of the pro- Neuroscience Department, Neuroradiology O.U., cess of discovertebral complex degeneration we won- University of Bologna, Bellaria Hospital; Bologna, Italy der if there is any modification in Modic changes during ozone treatment, aboveall after discolysis. Purpose

Materials and Methods: Histopathological correlation o2-o3 chemonucleolysis is one of the mini-invasive of Modic changes shows in type I changes disruption treatments for disc herniation. With this treatment, from and fissuring of the endplate and vascularized fibrous 2003 since now, we obtained good results in 70-75% of tissues within the adjacent marrow. enhancement of patients treated for lumbar discal herniation. type I vertebral body marrow changes is seen with ad- the aim of this study is to assess the therapeutic out- ministration of contrast material that at times extends come of intradiscal injection of discoGel® (radiopaque to involve the disc itself and is presumably related to gelified ethanol) in patients who did not respond to the the vascularized fibrous tissue within the adjacent mar- previous oxygen-ozone treatment. row. type II changes show evidence of endplate disrup- Material and Methods tion too, with lipid marrow replacement in the adjacent From december 2008 to january 2010, we treated 32 vertebral body. patients, chosen from those who did not respond to the

type III changes correlate with extensive bony scle- previous o2-o3 chemonucleolysis, by intradiscal injec- rosis on plain radiographs. the lack of signal in the type tion of discoGel®. III change reflects the relative absence of marrow in lumbar discal puncture was performed by extraspi- areas of advanced sclerosis. nal lateral approach using a 22G × 15 cm Bd spinal ne- similar marrow changes have also been noted in the edle, under fluoroscopic guidance.

30 www.centauro.it International Journal of Ozone Therapy 10: 29-32, 2011

therapeutic outcome was assessed six months after matory modulating action of ozone therapy what allows treatment using a questionnaire and direct patients in- to reduce these interleukins and therefore its usefulness terview. in these diseases.

Results treatment was a success (back pain relief) in 24 out 6 11,25-11,32 of 32 patients (75%) whereas it was deemed a failure (poor outcome - recourse to surgery) in the remaining Our First Experiences (2009-2011) with 8 patients. no complications occurred in our patients. Combined Lumbar Injection Technique: Ozone, Steroids and Long Acting Local Conclusion Anaesthetic our experience of intradiscal discoGel® injection has been safe and effective. M. simko In our opinion, discoGel® intradiscal injection, be- CIMED; Fribourg, Switzerland; E-mail: [email protected] cause of its higher cost, is a useful treatment option to be since June 2009 to March 2011 we performed 681 considered when the o2-o3 chemionucleolisis fails, be- fore recourse to surgery, or when surgery is not possible. combined lumbar infiltrations (peridural, periradicular, facet joints, intradiscal), 20 infiltrations of the sacroiliac joints and 9 sacrococcygeal infiltrations. all the infil- trations were performed under ct guidance and after 5 11,18-11,25 information to the patients. Prior to therapeutic injec- tion, we always injected iopamidol (Iopamiro®). For the Why Oxygen Ozone Therapy is Useful in infiltration, we injected long acting local anaesthetic, Degenerative Disk Pathology? either ropivacaine (naropin®) or levobupivacaine (chi- ® Á. erario, a. Grangeat rocaine ), between 2-8 cc ozone and triamcinolone (Ke- ® Instituto Argentino de Ozonoterapia. Buenos Aires, Argentina nacort ), between 40 (for diabetic patients) and 120 mg (for repeated or bilateral joint infiltrations). control ct Back pain is the most frequent chronic pain in people was obtained at the end of each infiltration. all patients and has personal, social and economic impact. the most were under observation 20-30 minutes after infiltration. notable cause is the degeneration of the intervertebral only in 2 cases, we observed adverse reaction pos- disk. degeneration of the intervertebral disk is a mul- sibly related to ozone (vagal reaction), without conse- tifactorial process which includes mechanical, genetic quence for the patients. no other ozone-related adverse and biological factors. events were observed. the normal disk includes a gelatinous pulpous nu- the long term effects of ozone + cortisone compared cleus surrounded by a structure called fibrous ring. to cortisone only infiltrations are under evaluation. Biomechanical properties and biological interactions between these two structures allow the disk to per- form different functions and the normal performing of 7 11,32-11,39 these functions depends on the molecular integrity of the disk. the normal disk has the ability to gather and Mesenchymal Stem Cells Combined release water. as the water content decreases, abnorma- with Effector T Cells and Low Doses of lities in the functions increase. Ozone Therapy Produce Regeneration of the hydration of the disk is maintained by extracellu- Damaged Inter Vertebral Disks in Rats lar matrix produced by the nucleus pulposus condrocites. these cells produce and maintain a constant array of col- Á. erario, a.M. Grangeat*,**, G.a. Moviglia**, e.a. croce*, lagen, supported by a network of proteoglycans with ne- n. Blasetti**, M.l. Moviglia** gative charge that attract and retain water within the disk. * Instituto Argentino de Ozonoterapia; Buenos Aires, Argentina In the degenerate disk there is a net loss of proteo- ** Centro de Investigaciones en Ingeniería de Tejido y Terapia glycans and core water. this reduction in proteoglycans Celular, Maimonides University; Buenos Aires, Argentina and water content leads to degeneration. the precise molecular mechanisms that lead to the Introduction: the intradiscal injection of the ozone degeneration of the intervertebral disk are still under oxygen mix is very well known as a minimally invasive discussion, but one of the most important causes is the treatment that solves the injury caused by the herniated mechanical stress that triggers a degenerative cascade intervertebral disk. Its action mechanism consists in sti- of chemical mediators of inflammation, such as nitric mulating the immune system to reabsorb the herniated oxide (no), Metalloproteinases (MMPs), tumoral ne- nucleus pulposus portion, to reduce the inflammation of crosis Factor alpha (tnF alpha), and a series of Inter- the disk and the nerve root, and to aid the restitution of leukins chemical mediators. during the last few years, the torn fibrous annulet. it has been discovered the implication of Il-17 in dege- Objective: We have developed a regenerative treat- nerative disk disease, herniated disk, and other chronic ment that combines ozone oxygen and stem cells on an inflammatory diseases such as rheumatoid arthritis and experimental model of rats that produces the regenera- crohn’s disease. there is no doubt that it is the inflam- tion of the intervertebral disk.

31 Friday April 15th, 2011 - Session I - Part I - "Oral Communications"

Materials and Methods: thirty (200g) female Fisher Goals: lumbar disc herniation provoquing radiculo- rats were divided into five groups. the first group was pathy and acute or chronic pain, have been the object kept without any treatment, as a normal control. ani- of innumerable studies and publications, with the aim of mals from group 2 to 5 received an Intra intervertebral pinpoint the physiopathology, and suggesting the most disk Injection of High concentrated ozone to promote appropriate treatment. We want to compare the results the reabsorption of the disk. a month later, animals of microdiscectomy versus intradiscal oxygen-ozone in- from group 3, 4 and 5, were treated with an intra disk jection in patients affected by lumbar disc herniation. injection of a mix of male effector t cells (etc) and Matherials and Methods: these are the results of 5 Mesenchymal stem cells (Msc). Fifteen days before years follow-up of 300 patients treated by microdiscec- this cell implant, group 4 was treated with 6 subcuta- tomy, as compared with 300 patients treated by intradi- neous injections of oxygen at low concentrations and scal oxigen-ozone injection. group five with ozone instead of oxygen and the same Results: In these series results are in favour of discoly- regimen. sis in cases of contained herniations and also in cases of three animals of each group were euthanatized 15 either sublegamentous or extraligamentous herniations. days after and three 30 days after the cell implant. results are in favour of microdiscectomy in case of animals from Group 2 had a dramatic decrease in big, estruded and migrated herniations, combined with the size of the disk. animals from Group 3 and 4 had severe clinical impairment. Progressively, through the partial recovery of the disk size but poor or null syn- time, results obtained in the two series are equivalent, thesis of intercellular matrix. Group 5 had high con- both for the control of pain, and for the management of centration of inflammatory cells and condroblasts with neurological deficits. fibrous cartilage differentiation at day fifteenth. at day Conclusion: retrospective analysis of the results of thirtieth the rats had better differentiation of the disk microdiscectomy has underlined the relevant difference which was almost of normal size. between short and long term outcomes, and has engen- Results: the three agents, ozone therapy + etc mi- dered in neurosurgeons a more careful attitude, with xed and Msc, could produce a recovery of inter verte- diminution of indications, and increase of conservative bral disks. this effect seems to be mediated through the treatments. Msc differentiation induced by etc and modulated by the low doses of ozone therapy. 10 11,53-12,00

8 11,39-11,46 Surgical Treatment of Disc Herniation by Lum bar Vertebral Disc Pathology. Percutaneous Laser Disc Decompression New Frontieres: Ozone+Stem Cells Combined with Intradiscal Ozone Injection r. Paradiso, a. alexandre l. Brina, a.G. Popandopulo

authors describe 30 patients with lumbar disc desease We present a series of patients treated by the combi- and radicular simptoms treated with paravertebral inie- nation of these two techniques: percutaneous laser disc ctio oxige-ozone mixture and autologs and then stem cells decompression and intradiscal ozone injection. in paravertebral muscle iniection. stem cells was preleve- We have taken in consideration a large series of pa- ted from iliac crest patiets. all patients performed lumbar tients, going to treat different type of morphology and spine rMn before treatment. rMn lumbar spine after lesion of the discs. treatment showed totaly absnce of disc prolapse and fon- thereby we have treated contained, subligamentous damentely completly grow hight and trophism of disc. but also extraligamentous and extruded herniations. In all the cases ozone was first injected in order to obtain discographic demonstration of intradiscal matrix situation, and in order to obtain the manual direct sen- 9 11,46-11,53 sation of consistency of the disc, and of relative instabi- lity of the segment. Further Studies on Patients Affected by after this percutaneous laser disc decompression was Lumbar Disc Hernia, and Treated Either by performed by 980 nm diod, by 360 micron fiberoptic. Microdiscectomy, or by Intradiscal the treatment is performed under local anesthesia, Oxigen-Ozone Injection and the treatment is episodically interrupted if the pa- a. alexandre, r. Paradiso, a.M. alexandre* tient complains for warm, burning sensation, or pain ei- ther local or radiating to the limb. EU N.I. European Neurosurgical Institute; Treviso, Italy * Department of Bio-imaging and Radiological Sciences – the evaluation of the results, which is positive in Institute of Radiology. Catholic University of Sacred Heart, about 80%-85% of cases, will be presented in detail de- Policlinico A. Gemelli; Rome, Italy pending on the type of hernia.

32 www.centauro.it International Journal of Ozone Therapy 10: 33-35, 2011

Session I Ozone Therapy in the Musculo-Skeketal Pathology

Part II - Articular

Moderators: M. Bas, H. Konrad

Friday, april 15th, 2011 • "Mille Miglia" Museum • 12,00-13,40

1 12,00-12,20 choice should be one week treatment course and 30d follow-up after ozone therapy, and then the second tre- Efficacies of Different Treatment Courses of atment is taken whether or not according to the impro- Ozone Therapy on Lumbar Disc Herniation vement of clinical symptoms. X. He Department of Interventional Therapy, Nanfang Hospital, 12,2012,40 Southern Medical University; Guangzhou, China 2

Key words: lumbar disc herniation, ozone efficacy eva- The Research: Modifications Induced by luation Ozone In the Disk M. Muto Objective to compare the clinical effective rates of different treatment courses of ozone therapy so as to oxygen-ozone administration is a recently developed provide references for clinical treatment. percutaneous treatment for herniated discs which now Methods five hundred and sixteen patients who were has consolidated clinical results in a large number of admitted in our hospital from July 2007 to June 2010 patients treated to date. It is an instable gas,colourless were involved in the study. the three treatment courses ,irritating with a thorny smell, oxidative and antiseptic, of one week, two weeks and four weeks were compared disinfectant and antiviral. It’s prepared and used in real in the aspect of clinical effective rates. all patients were time transforming a small percentage of o2 to o3 by divided into three groups having the three treatment special generators. courses respectively and were performed the intradiscal We preliminary studied the impact on swine interver- therapy and periradicular therapy with the mixture of tebral discs of intradiscal, intraforaminal, cutaneous and o2-o3 combined with nerve root block. the 336 patients intramuscular injection of an oxygen-ozone mixture. in Group 1 received the ozone therapy only once, and the pigs were sedated and five needles were positioned then were dripped conventionally with dehydrants for 3d. within discs d11 to l5 followed by cutaneous and in- the 132 patients in Group 2 were performed ozone tramuscular injection. the swine were killed 48 h after therapy in the same way again 7d later after the first injection of the o2-o3 mixture and the discs from d10 treatment, and then had the conventional drip with to s1 were fixed in 10% buffered formalin. the ana- dehydrants for 1d; the 48 patients in Group 3 took the tomical specimen was cut with an electric saw and the four weeks treatment course, which means after the specimens were stained with hematoxylin-eosin. the first or second ozone therapy, the patients were treated sections revealed micro and macrovacuolar degenera- secondly or thirdly in the same way 30d later, and then tion with small halos of necrosis and oedema. Muscle they took the postoperative conventional drip with de- sections showed halos of rhabdomyolysis also with sub- hydrants for 3d. the dehydrants included 250 ml 20% cutaneous oedema. Mannitol, 5mg dexamethasone and some neurotrophic the micro and macrovacuolar degeneration may ac- drugs (Vitamin B1, B6 and neurotropin). count for the reduce disc volume with decreased in- Results the effective rates of the three groups were tradiscal pressure and impairment of nerve structures. 82.44% (277/336), 86.36% (114/132) and 95.83% (46/48), Further studies on pigs killed 28 days after treatment respectively. the statistical analysis shows no significant will confirm the persistence of micro and macrovacuo- difference among the three groups. lar degeneration as the first factor accounting for a re- Conclusion the treatment courses of one week, 2 we- duction in disc volume and intradiscal pressure hence eks and four weeks all could reach effective results. ta- being one of the reasons for the success of intradiscal king the cost-effectiveness into consideration, the best oxygen-ozone administration.

33 Friday April 15th, 2011 - Session I - Part II - "Articular"

References (joint disease and less or more developed muscolar tro- 1 Muto M. alterazioni indotte da infiltrazioni intradiscali e phism of the patient) and could be ask ozone blistering intramuscolari di ossigeno-ozono: studio anatomo-pato- or joint injection ever with a low doses and low concen- logico. risultati preliminari. rivista Italiana di ossigeno- tration of ozone. ozonoterapia. 2004; 3: 7-13 2 tian Jl, et al. changes of csF and spinal path-morpho- one of major advantage is that o2-o3 is in the lo- logy after hight concentration ozone injection into the cal application for small doses not considered doping, subarachnoid space: an experimental study in pigs. am J and several of the disease before speaking are tipical neuroradiol. 2007; 28: 1051-54. in sportsman. the success of this treatment is not con- 3 andreula c, Muto M, leonardi M. Interventional spinal fined to resolving only pain like common physiotherapy procedures eur J radiol. 2004; 50: 112-9. 4 Guarnieri G, Vassallo P, Muto M, et al. a comparison equipement but to aid the repaires processis provided of Minimally Invasive techniques in Percutaneous treat- considered and treated while the trigger cause the ment of lumbar Herniated discs. a review the neuro- inflammatory process. radiology Journal. 2009; 22: 108-121.

5 13,20-13,40 4 13,00-13,20 Ozonetherapy in the Adult Hip Pathology The Experience in Shoulder and Knee J. Baeza-noci Treatment Orthopedic Surgeon Hospital Virgen del Consuelo; Valencia, a. scarchilli Spain

Interesting developments have occurred in the treat- Introduction ment of shoulder and knee pathologies; thanks to major Anatomy: the hip region is located lateral to the glu- advances in the basic science, diagnostic imaging tech- teal region (i.e. the buttock), inferior to the iliac crest, and niques, actually we are able to recognize diseases and overlying the greater trochanter of the femur, or “thigh mechanism anatomic-pathogenic not well known until bone”. In adults, three of the bones of the pelvis have fu- few years ago. sed into the hip bone which forms part of the hip region. ozone injection could be utilized in a several cases the hip joint, scientifically referred to as the aceta- of disorder that required conservative management. bulofemoral joint, is the joint between the femur and essentials are following careful diagnostic evaluations acetabulum of the pelvis and its primary function is to and classifications. support the weight of the body in both static (e.g. stan- In the shoulder are common disorders affecting the ding) and dynamic (e.g. walking or running) postures. rotators cuff tendons that in the first stage (inflamma- anamnesis and examination Pain is quite helpful in tory) could to benefit by ozone thanks to effects eutro- order to reach a proper diagnosis. We have to inquire phying and antinflammatory. I perform the treatment in about pain beginning, lasting and evolution in time and the shoulder with a 20 G needle and a volume of 5-10 during one day. Physical limitations is another impor- ml of o2-o3 at a concentration of 10 µg/ml, without ima- tant point to evaluate. Kind of limbing, points of pain, ging – guided and with different approach it depends on range of motion and pain during the examination are the necessity, but this procedure not guided is advisa- the rest of factors to take into account. at this point we ble only by experts in the shoulder joint. the treatment should have one or few possible diagnosis. schedule includes five injections a weekly intervals complementary examination the main tool to con- accompanied by a passive rehabilitation programme firm the clinical diagnosis is usually standard X-ray. so- with a physiotherapist to facilitate joint recovery and nography is partially useful in case of bursitis. MrI and maintenance of the outcome achieved, this programme bone-scintigraphy are useful in early stages of avascular generally lasts two three months. necrosis of the hip (aVnH). In the knee in my opinion, the ozone-therapy has got benefit in a reduced number of cases, en fact in this joint Goals the disease are or traumatic lesions where the surgery the target of the present study is to evaluate possible restoration is natural solution or, to the root of the pro- target diseases for ozonetherapy (ot) based on physio- blem, there is a chondral disease aggravated by daily pathological congruency and clinical results. weight-bearing and gravitational stress where ozone the- Indications for ot: trochanteric bursitis serveral bru- rapy not been shown in the clinicals studies to be if not sae protect some hip elements against overuse. all can in association of viscosupplementation effective. be susceptible of inflammation, but the most frequent therefore mains indications for ozone therapy in the one with difference in the trochanteric bursae. knee are as well for this joint those that are determinated detailed anamnesis and examination should make to do ability antinflammatories ed eutrophying in case of: us suspect of it; x-ray examination should help as to di- – enthesitis – tendinitis: jumping’s Knee and insertion of smiss other diagnosis. Unfortunately, sonography and the quadriceps tendon; MrI only confirm about 60% of the cases. – bursitis; standard treatment includes nsaId, physiotherapy, – rheumatic sinovitis; local injections and surgery; local injections can be done – bendeletta ileo-tibial diseas. with steroids or with ozone. the technique will be different as appropriates cases Hip osteoarthritis (Hoa) degeneration of the hip

34 www.centauro.it International Journal of Ozone Therapy 10: 33-35, 2011

joint implies a physiopathological mechanism of chro- data collected where: nic inflammation in which ozone has demonstrated to – Patient number. play an important role. – age and gender. clinical history and X-ray examination gives the dia- side. gnosis in most of the cases. It is useful to use an scale to Kellgren degree. measure joint degeneration; personally I use Kellgren – Vas pain pre and post treatment. classification in 4 degrees from I to IV. – number of sessions / dose per session. the treatment should include elimination of worse- – relapse and time free of symptoms before relapse. ning factors like obesity and lack of exercise. Physio- only patients with a follow up longer than 1 year therapy, analgesics and nsaId are useful to alleviate where included in this paper. the symptoms. local intraticular injections of steroids Ot Technique: ozone as been administered through and/or hyaluronic acid have found to be useful depen- local injections, inside the bursae in case of bursitis and ding on the degree of joint degeneration. severe joint inside the joint in case of Hoa. For bursae injection, nee- destruction can only be solved with hip replacement. dles used vary from 27G × 40 mm in case of thin patients AVNH: this is a disease where there is cellular death to 25G × 76 mm (spinal) in fat patients. For joint injec- (necrosis) of bone components due to interruption of tions, needles used vary from 21G × 76 mm in thin pa- the blood supply in the femoral head. tients to 22G × 150 mm in fat patients. needles in Hoa symptoms are similar to Hoa, but appear usually at were thicker because it was easier to target properly. 20 younger patients. cc three-bodies siliconed syringe was used in all patients. X-ray examination is absolutely different from Hoa, approach was usually lateral, with the patient in la- showing the classical findings describes by Ficat in his teral decubitus. there is no need to use guidance for classification (grades 0 to IV). bursae injection. However, in fat patients and in case of treatment depends on the degree of the disease. doubts or clinical failure, sonography or fluoroscopy are Grades 0 and I can be treated with rest and analgesics, mandatory to get a 100% accuracy. nsaIds, hyperbaric chamber or free vascular fibular graft. Grades III and IV should be treated as Hoa with Results severe degeneration (Kellgren III or IV). treatment is trochanteric bursitis: grade II is still very controversial. – number of cases: 56. as we know from dr. Velio Bocci, great autohemo- – age: mean: 56 years; range 43 to 75. therapy (GaHt) as shown to be superior than hyper- – Gender: 51 women; 5 men. baric chamber to increase ppo 2 in quantity and time. I – side: 28 right; 28 left. have no experience to treat this disease with GaHt, as – Kellgren: 0: 53; I:3 all my patients with aVnH always arrive at my office Vas Pain: Pre-treatment: 7,14; post-treatment: 2,6. with grades II or superior. Vas Pain improvement: >2: 46 (82%); >3: 42 (75%) . number of sessions: mean: 4; range: 1 to 8. Methods dose per session: mean: 270 µgr; range: 100 to 400 (10 the present study is an open prospective study with cc @ 10 µgr/ml to 20 cc @ 20 µgr/ml). the following inclusion criteria: relapse: 15 (24%). For Bursitis: – time free of symptoms: 31 months. – clinical diagnosis (with or without imaging). – Hoa. – Kellgren 0-I. – number of cases: 133. – no previous surgery. – age: mean: 65 years; range 49 to 83. – Failure of conservative treatment: at least 30 days with – Gender: 67 women; 66 men. nsaIds and at least 10 sessions of physiotherapy For – side: 88 right; 45 left. Hoa: – Kellgren: mean: 2,7; I:9: II: 51; III: 39; IV: 34 – clinical and radiological diagnosis (Kellgren I or Vas Pain: Pre-treatment: 7,33; post-treatment: 3,3. greater). Vas Pain improvement: >2: 106 (8%); >3: 97 (73%). – Primary oa. number of sessions: mean: 5; range: 3 to 10. – no previous surgery. dose per session: mean: 260 µgr; range: 100 to 400 Failure of conservative treatment: at least 30 days (10 cc @ 10 µgr/ml to 20 cc @ 20 µgr/ml). with nsaIds and at least 10 sessions of physiotherapy relapse: 33 (25%)

35 Dear colleagues,

With great emotion we wish to inform you that spanish association of Medical Professionals in ozone therapy (aeProMo), has recently obtained the regularisation of the ozone therapy in the spanish autonomous community (state) of catalonia.

so this community becomes the seventh out of 17 where ozone therapy is practiced according to writ- ten regulations issued by the Health authorities in favour of the ozone therapy, thanks to aeProMo?s efforts. the seven autonomous communities (states) are: Baleares Islands, canary Islands, castilla-la Mancha, castilla león, catatonia, Galicia, and Madrid.

In the rest of communities the therapy is tolerated by the health authorities. It is worth remembering that in Madrid the therapy had been prohibited for several years. one of our main objectives is that one day, rather soon than later, the whole country regularizes this medical therapy and we are working very hard to get it.

We take this opportunity to encourage our colleagues to take the necessary legal steps to obtain the regularization of the ozone therapy in your own countries. By experience we know that is a difficult task and a time consuming exercise, but worth to go ahead. Item five of the “Madrid declaration on ozone therapy? (annex, General Basis for treatment, p. 14 and following) details the requirements suggested to the health authorities to take into account for the regularization. the declaration can be consulted both in english and spanish in aeProMo's website: www.aepromo.org.

the Madrid declaration on ozone therapy (17 pages), has been signed by all the speakers of the "International Meeting of schools of ozone therapy" that took place at the royal national academy of Medicine (June 3-4, 2010) in Madrid. thirteen national and international ozone therapy associations from the continents of asia, america and europe have also signed it so far.

the International scientific committee of ozonoterapia (Isco3) will take as a base document for its work the "Madrid declaration" to improve it in accordance with the scientific advances of the ozone therapy.

the Working Group in charge of putting into mottion the Isco3 has as its President the emeritus Professor of Physiology at the University of siena.dr Velio Bocci.

the Isco3 will be officially inaugurated this october 8 in Vienna. Up to fifteen members will be selected on the basis of applications sent by professionals from all over the world. If you want to present your application to the Isco3 or receive more information, we invite you to send a e-mail to: internation- [email protected]

Kind regards Dr Adriana Schwartz aeProMo’s President tel. (+ 34) 669685429; (+ 34) 913515175 Fax (+34) 913515175 www.centauro.it International Journal of Ozone Therapy 10: 37-39, 2011

Session I Ozone Therapy in the Musculo-Skeketal Pathology

Part II - Oral Communications

Moderators: G. Pellicanò, M. Muto

Friday, april 15th, 2011 • "Mille Miglia" Museum • 14,40-15,22

1 14,40-14,47 0.6. the pain after two weeks of treatment was 2.8 with sd of 1.2. Conclusions: treatment with Ultrasound-guided infil- Effect of Treatment with O2-O3 and Hyaluronic Acid in Partial Tear of tration of o2-o3 in this preliminary study is an effective treatment method in partial tears of the supraspinatus the Supraspinatus Tendon tendon but it is necessary to continue the study on a M. Moretti larger sample size used to propose a on a large scale. the partial tear of the supraspinatus tendon is a com- mon cause of shoulder pain. Many methods have been 2 14,47-14,54 proposed that can avoid surgery that often do not re- liefe the symptoms of the patient in a satisfactory man- Osteoarthritis of the Knee Treated by ner. Infiltration with o2-o3 are an effective remedy for Intra-Articular Infiltration of Oxygen-Ozone joint pain caused by shoulder impingement of the su- and Hyaluronic Acid praspinatus tendon without tear. although hyaluronic r. cardelli, e. Benedetti, e. Monti, s. Montefiori acid has been shown to be an effective remedy in partial Physiokinenis and Physical Therapy Clinic “Arcobaleno”; tears of the supraspinatus both for its anti-inflammatory Imola (Bologna); Italy effect and for the repair effect. It is necessary however to use ultrasound guidance osteoarthritis of the knee is a chronic invalidating beacuse the blind infiltration is carried out to high per- degenerative disease with high social and healthcare centage of cases where you can not get properly in the costs. our study aimed to assess the therapeutic efficacy shoulder joint. of intra-articular injection of a combination of oxygen- Materials and Methods: 40 patients were selected (26 ozone and hyaluronic acid to treat osteoarthritis of the males and 14 females) with shoulder pain for at least knee joint. six months without benefit and subjected to infiltration Between January 2007 and January 2010, 100 (one with cortisone and physical therapy that is in our view hundred) patients with clinical and radiological evi- not effective (ultrasound and laser theraphy). Patients dence of osteoarthritis of the knee were treated by 5 were underwent to ultrasound musculoskeletal (eMs) (five) intra-articular injections of a combination of oxy- to confirm the presence of a partial tear of the supra- gen ozone gas mixture and hyaluronic acid (5 cc. of o2- spinatus tendon. o3 at 16 µg microgr. and 2 ml hyaluronic acid ), once a the size of the tear of the supraspinatus had to be week one time in a year. less than 1.5 cm to include the patient in the study. the one month after the end of treatment all patients had patient was then subjected to magnetic resonance ima- a 30% recovery of function in the knee joint treated. ging (MrI) for further confirmation of the size of the all patients referred major pain relief reaching al- lesion. most zero on the Vas scale, previous Vas 8±2 after the patient was then subjected to Us-guided infiltra- intra-articulation injections of oxygen-ozone and hya- tion of o2-o3 hyaluronic acid and low molecular weight luronic acid. (MW). We used JoInteX 16 mg. Were inoculated 5 although our series is small, the preliminary findings ml of o2-o3, and then 2 ml of hyaluronic acid (16 mg). are encouraging. Pain was assessed with Vas before treatment and after Intra-articular injections of a combination of oxygen- two weeks. ozone and hyaluronic acid solution yielded prompt re- Results: the mean age of patients in the sample lief of pain and clinical symptoms in the patients tre- analyzed was found to be 57.8 years with standard de- ated, thereby delaying or avoiding recourse to knee viation (sd) of 13.4. the initial pain was 8.2 with sd of replacement surgery.

37 Friday April 15th, 2011 - Session I - Part II - "Oral Communications"

3 14,54-15,01 is also gradually reduced the use of nsaIds, previou- sly required daily, until the current situation of sporadic Oxygen-Ozone Therapy In Childhood. use, bound only to painful crises, which are reduced in Personal Clinical Experience In Pediatric frequency and severity, often resolved with the rest. Surgery c. Morosi**, P. U. Falzoni* 5 15,08-15,15 * Specialist in General Surgery and Pediatric Surgery, Medical Director at “Azienda Ospedaliera Maggiore della Carità di Novara” Pediatric Surgery Division; Novara, Italy Topic Ozone Therapy: Coadjuvant in the ** Specialist in Preventive Medicine for Workers and Applied Treatment of Exposed Tibial Fractures. Psychology; MMG Sesto Calende; Varese, Italy A Case Report the authors demonstrate the possible applications of c. catelani-cardoso3, n.l. Pichara1, r.t. Bortolaz1, 2 4 5 6 oxygen-ozone therapy in treating infective pathologies M.a. Pereira , s.B. Macedo , r. d’aglio , J.M. Fiorini , J.e. Fiorini7 related to pediatric surgery. 1 Medic; 2 Pharmaceutic; 3 Doctor in Chemotherapy, Università they considered outpatients between 6 months and degli Studi di Milano; Milano, Italy 16 years of age suffering from asexual pathologies (sub- 4 Professor Doctor of the University of Brasília cutaneous-mucous perianal abscesses, fistulas and com- 5 Professor / Researcher - UNIMI plicated pilonidal cysts, suppurated epidermoid cysts, 6 Researcher / Specialist in Periodontia subcutaneous suppurated phlogosis). 7 Professor / Researcher Doctor in Microbiology – UNIFENAS, Ozone Research Center; Lab. Biology and Physiology of outpatient treatments were carried out with an Microorganisms - UNIFENAS; Alfenas, MG; Hospital ozone generator, capable of producing a variable mix Universitário Alzira Velano (HUAV); Alfenas, MG, Brasil from 2 to 80 micrograms per liter, with the consent of patients’ legal guardians. Key-words: ozone therapy, osteomyelitis, exposed tibial In every clinical case, neither sedatives nor anesthesia fracture. were used and the procedures were positively tolerated without any particular measure following the operations. Abstract: traumas that cause lesions with bone expo- there were no signs of relapses in post treatment as- sure can lead to osteomyelitis, an infection of the bone sessments of patients, underlying the treatment success. and bone marrow difficult-to-treat, which may result in despite the small number of treated cases, considering progressive inflammatory destruction of the bone and the cure’s minimal invasiveness, high tolerance, fast re- bone necrosis. significant recovery is slowly using con- solution, low risk of complications, and low social costs, ventional treatment. therefore, alternative oxidants the- this method can be considered a valid alternative to tra- rapies can resolve the problem faster and thus reducing ditional pediatric surgeries of abscessed pathologies. medical costs. the present paper reports the case of a patient with exposed tibial fractures, who was initially treated, without success, with broad-spectrum antibio- 4 15,01-15,08 tics. the topic application of ozonized saline solution, the ozonized oil (Bioperoxoil®) and creams of its dilu- Oxygen-Ozone Systemic Therapy and tions, besides the use of a gaseous mixture of oxygen and ozone, led to the complete recovery of the patient after Local Drug-Resistant Severe Rheumatoid twenty-six days of hospitalization. the topical ozone the- Arthritis. A Case Report rapy helped stopping the infection, causing a soft chemi- G. tabaracci, V. covi, G. arangio Febbo, M.t. Ghisellini cal debridment, preparing the tissue to receive dermal grafts and to favoring the attachment of then. the authors describe the case of a patient of 50 ye- ars, suffering from severe rheumatoid arthritis onset in adolescence, treated over the years with all the conven- 6 15,15-15,22 tional therapies, with the exception of biological drugs, without achieving significant clinical improvement. since 2008, the patient is treated with oxygen-ozone Effectiveness of Infiltration with O2-O3 and therapy, both in general (Gaet), and local (peri and Hyaluronic Acid in Overload Tendinopathy intra-articular infiltration), in combination with con- of the Achilles Tendon in Athletes ventional therapy. It has been observed since the first M. Moretti sessions, a significant improvement in joint pain relief, range of motion and muscle strength, followed by a gra- achilles tendinopathy is a common cause of heel dual stabilization of the overall clinical picture, without pain in athletes who practice sports which need to run. exacerbation of the disease. simultaneously, the patient the causes can be the flat or cable feet, the use of ina- has decreased both the number and dosage of drugs dequate footwear but also the simple overload training. in use, particularly cortisone, reduced from 8 mg to 4 For many years the infiltration with cortisone have mg daily over 4 months, and in the next 18 months to been used but have not demonstrated effectiveness and 2 mg / day, and methotrexate, from 10 mg taken once a are also often associated with complications such as week, to 7.5 mg every 2 weeks. at 4 months of therapy, tendinosis and tendon rupture. also in the professional

38 www.centauro.it International Journal of Ozone Therapy 10: 37-39, 2011

athlete can not be used because they are considered a rapy without success. the rest should not have given doping practice and therefore it is necessary to require benefit to the athletes. athletes should not use soft or- permission for their use to the anti-doping commission. thotics during the treatment period but had to observe

Aim of the study: In view of the fact that the o2-o3 is complete rest. the therapy was to inject 5 ml of o2-o3 a practice proven effective in other tendon as epicon- in peritendinous way and 2 ml of low molecular weight dylitis, medial epicondylitis and impingement syndrome hyaluronic acid (16 mg JoInteX). Were conducted th- of the rotator cuff and that hyaluronic acid is an effec- ree sessions spaced three days apart. Pain was assessed tive therapy not only against chondropathies but also with Vas before treatment and two weeks after the end tendinopathy we want to determine if these treatments of therapy. the athletes were obviously undergone ul- in combination can be a good remedy for this problem trasound examination before starting therapy. of frequently entity. Results: the sample presented a mean age of 41.2 ye- Materials and Methods: the study included 34 athle- ars with standard deviation (sd) of 3.2. the pain before tes (29 males and 6 females) who presented achilles treatment had a value of 8.2 with sd of 0.8. the pain two tendinopathy overload during physical activity. the weeks after the end of therapy was 2.1 with sd of 0.5. pain must have been present for at least three months Conclusions: the infiltration with o2-o3 and low mole- and the patient must have already been subjected to cular weight hyaluronic acid appear to be an effective re- physical therapy in our view unnecessary (laser, ultra- medy to the overload tendinopathy but we need a study sound and iontophoresis) and anti-inflammatory the- on a larger sample size to offer this therapy to a wider use.

39 www.centauro.it International Journal of Ozone Therapy 10: 41-42, 2011

Session II Randomized Clinical Studies

Moderators: F.d. Ungureanu, J. Vyletelka

Friday, april 15th, 2011 • "Mille Miglia" Museum • 15,22-17,02

1 15,22-15,42 2 15,42-16,02

Ozone Versus Steroid in the Treatment of Epidural Steroid Injection vs Paravertebral

Lumbar Pain O2O3 Infiltration for Symptomatic Herniated M. Gallucci Disc Refractory to Conventional Treatment. Department of Neuroradiology, University of L’Aquila, Italy A Prospective Randomized Study a. Zambello*, B. Fara**, G. tabaracci***, M. Bianchi**** low back pain and sciatica are said to affect most of * Circolo Fondazione Macchi Hospital; Cittiglio the population at least once during a lifetime.neverthe- ** San Bartolomeo Hospita; Sarzana less, the natural history of lumbar disk herniation is favo- *** San Rocco Orthopaedic Medical Centre; Montichiari rable: Improvement of symptoms is the norm,and most **** Sant'Antonio Abate Hospital; Gallarate episodes resolve spontaneously or after conservative Key words: peridural, low back pain, sciatica, ozone the- therapy. the natural history of lumbar disk herniation rapy, cruralgia, corticosteroids, herniated disc has been elucidated by means of serial imaging studies, Summary which showed spontaneous clinical and anatomic reso- : the medical management of patients with lution in 67%-76% of patients after 1 year. therefore, symptomatic herniated disc of the lumbar spine to treat an invasive approach is reserved for patients failing to low back pain, sciatica and cruralgia includes epidural respond to conservative treatment. surgery is less inva- injection of steroids and intramus cular paravertebral infiltration of an o o mixture. our study compared the sive than it was in the past because of new microsurgi- 2 3 cal techniques. However, its success rate is not optimal: short (three weeks) and long-term (six months) efficacy Pain resolution is present in no more than 80%–85% of of the two treatments after failure to response to con- patients, and a failed back surgery syndrome develops ventional medical management (steroids and muscle in 10%-40% of patients. to prospectively compare the relaxants). 351 patients were enrolled: 171 (Group a) clinical effectiveness of intraforaminal and intradiscal were treated by epidural steroid injection, while 180 injections of a mixture of a steroid, a local anesthetic, (Group B) underwent paravertebral administration of an o2o3 mixture. In the short-term 59% of patients and oxygen-ozone (o2-o3) (chemodiscolysis) versus in- traforaminal and intradiscal injections of a steroid and treated by epidural injection and 88.2% (p<0.05) of pa- tients treated with o o had a total or near total remis- an anesthetic in the management of radicular pain re- 2 3 lated to acute lumbar disk herniation, we studied 159 sion of pain. long-term outcome remained excellent or Pts. seventy-seven patients (group a) underwent in- good in 47.3% of patients treated by epidural injection and 77.1% (p<0.05) of patients treated with oo . Gi- tradiscal and intraforaminal injections of a steroid and 2 3 an anesthetic, and 82 patients (group B) underwent the ven the relative simplicity of treatment administration, limited contraindications and the lack of side-effects, same treatment with the addition of an o2-o3 mixture. Procedures were performed with computed tomogra- ozone therapy is the first choice treatment in patients phic guidance. an oswestry low Back Pain disability refractory to conventional medical management. Questionnaire was administered before treatment and at intervals, the last at 6-month follow-up. Patients and 3 16,02-16,22 clinicians were blinded as to which treatment was per- formed. results were compared with the t2 test. Prospective Clinical Study Comparing Results: after 6 months, treatment was successful in 36 (47%) patients in group a and in 61 (74%) patients Ozone Therapy Versus Open Surgery for in group B. the difference was significant (P <.01). the Treatment of Lumbar Herniation Disc. Conclusion: Intraforaminal and intradiscal injections Preliminary Results of a steroid, an anesthetic, and o2-o3 are more effective F. Galván arnaldes, r. rodríguez de oya, J. García lópez at 6 months than injections of only a steroid and an ane- Hospital Monográfico de Traumatología, Cirugía Ortopédica y sthetic in the same sites. Rehabilitación ASEPEYO; Madrid. Spain

41 Friday April 15th, 2011 - Session II - "Randomized Clinical Studies"

Key words: ozone therapy, lumbar herniation disc, ozo- Materials and Methods: 978 patients suffering from notest, microdisectomy. pain or sport traumatism were enrolled. 326 patients were randomized to nsaIds, 327 were assigned to the ozonotest is the first randomized parallel prospec- nsaIds plus o therapy and 325 patients to o therapy. tive clinical study. the aim of this study is to compare the 3 3 there was no placebo group. severity of pain was asses- results between lumbar discolisis treated with ozone the- sed by using 10 cm visual analogue scale (Vas), once rapy and lumbar microdisectomy by means of ozonotest before treatment and one time a week for eight weeks study. the inclusion criteria were: age between 20 and after. local injections of low ozone concentrations (5-12 65 years old; lumbar herniated disc confirmed by MrI; µg/ml) were applied locally with 27/25 G needles. lower limb pain at the same level of diagnosed MrI her- Results: the age range of the patients was 35 to 86 niation, together with at least one clinical signs of radi- years (mean: 43.2 years). Mean +/– sd pretreatment cular stretching; no clinical symptoms or signs of medical pain scores for all-treated groups were 7.935 +/– 2.142 disease (high temperature, loss of weight); patient must without significant difference among groups. at the end be working and failed conservative treatment: reduction of week 8, mean +/– sd of pain score was 4.425 +/– of daily activities, medical and rehabilitation treatment 2.382, 3.171 +/– 2.371 and 2.406 +/– 2.483for nsaIds, for at least two months or hospital admission for bed rest nsaIds + o or o-treated groups respectively. alls and treatment with opioids. the treatments were: intradi- 3 3 treatments significantly reduced postoperative pain and scal ozone therapy discolisis under local anaesthetics and there were no statistically significant difference groups. xray control and one paravertebral ozone infiltration at adverse effect was not observed in group treated with the oPd every week for three weeks or lumbar micro- only o . typical nsaIds adverse reaction was observed disectomy. the study included 51 patients, from which 34 3 in 10 % of the patients submitted to this intervention. patients were treated with ozone therapy and 17 patients Conclusions: since all treatment showed almost were treated with microdisectomy. the preliminary re- equal analgesic effect, considering its safety profile sults indicate that 9 patients need to be treated with ozone therapy, seems to be the preferred choice to al- surgery after ozone therapy treatment (26.1%). 3 out of leviate back pain or sport traumatisms. no side effects those 17 patients who underwent microdisectomy had were recorded during ozone therapy at short and long- unsatisfactory result (17.6%). 25 patients out of 34 trea- term follow-up. In our experience, o-o treatment of ted with ozone therapy were able to work, without pro- 2 3 pain and inflammatory diseases has revolutionized the blems (74.9%). those patients needed 12.1 weeks of re- approach to pains management. covery period before working. complications after ozone therapy where: 1 patient who had a transient retrograde eyaculation and after microdisectomy 1 patient had espondilodiscytis. taking into account the cost, lumbar 6 16,42-17,02 discolisis treated with ozone therapy had a price of 199 € per patient and microdisectomy, 1.120 € per patient. Intra and Postoperative Ozone Administration in Hepatobiliary Surgery 4 16,22-16,42 (Clinical Study) s. Mohga A Randomized Clinical Study on Pain in University of Cairo; Cairo, Egypt Patients Treated with Ozone and NSAIDs Hepatic resection is the main line of treatment for he- l. re1-2, G. Malcangi2, G. P. davison2, a. Mercanti2, patic cancer, liver affection by hepatic surgery especially l. di serafino2, V. Barbera2, a. re2, G.M. sanchez2 on top of cancer is sometimes very deleterious. there is 1 Pharmacology, D.I.S.M.A.R., University of Ancona, Italy; E-mail: [email protected] a lot of problems that could happen during and after sur- 2 Medinat s.r.l. Clinic; Camerano, Italy; E-mail: medinat.camer- gery, the main intraoperative problem that could be met [email protected] is the clamping ischemia during surgery and elevation of liver enzymes after surgery especially in day one, two Key words: ozone, ozone therapy, pain, inflammatory di- and three postoperative. sorders, back pain. our work were done on 30 patients undergoing Background: Pain management is an important com- hepatic resection they were randomly divided into 2 ponent in patients suffering for disorders related to groups: Group 1 received intra and postoperative ozone lumbal pain or sport traumatism. the modulation of by major autohemotherapy and Group 2 received the interleukins productions and of some biochemical pa- conventional intraoperative IV liver support drugs. thways present in inflammation and pain, indicate the Conclusion: Group 1 the ozone group shows statisti- rationale of the use of ozone. cally significant prolongation of ischemia time and there Aims: We hypothesized that ozone therapy its better is marked difference between the level of enzyme eleva- safety profile, is likely to be a better choice, if it would tion between the 2 groups. so we could conclude that the be as effective as non steroidal antinflammatory drugs usage of ozone during hepatic surgery may help much to (nsaIds) in controlling pain. minimize the complications of anthesia and surgery on Settings and Design: a randomized controlled trial hepatic cells. was performed on patients who underwent back pain I think it is a good work and we have got good results (either cervical or lumbar) and sport traumatism. with new indications for ozone usage.

42 www.centauro.it International Journal of Ozone Therapy 10: 43, 2011

Session III World Experiences

Moderators: J. Baeza-noci, M. simko

Friday, april 15th, 2011 • "Mille Miglia" Museum • 17,20-19,20

6 18,40-18,0 two years. ozone therapy for tumor still in its infancy, but it has been seen some good signs. In september Decade Review of Ozone Therapy in China 2008, with the strong support of the President of china X. He chapter of the World Medical association Pain, Prof. Department of Interventional Therapy, Nanfang Hospital, ni JiaXiang, the china Federation of ozone therapy Southern Medical University; Guangzhou, China (cFot) was established, with Prof. He Xiaofeng as director, liver specialist Prof. Guo Yabing, orthopaedic It has been ten years since ozone therapy was per- specialist Prof. Yu Bin, neurological expert Peng Kairun formed in 2000 in china. In the paste decade, ozone as core strength of the federation. In February 2009, the therapy got great achievement. It was only used for book called “the clinical application of ozone therapy” lumbar disc herniation initially, but now it could be edited by the He Xiaofeng was officially published. It used to treat various pains, osteoarthritis, gynaecologi- is the first professional book about ozone therapy in cal inflammation, ulcers, viral hepatitis, cerebral infarc- china, collecting the latest researches in various fields. tion and so on. currently, hundreds of hospitals have the first and second annual conferences have been already undertaken the program of the ozone therapy, successfully held since the establishment of Federation, and according to incomplete statistics, hundreds of with more than 300 participants at each session and 288 thousands of patient received this therapy each year. memberships. and about 30 hospital or medical units Patients with cervical and lumbar disc herniation re- have been granted “demonstration Unit ozone the- ached over 50,000 patients each year, with more than rapy” or “standardized Unit of ozone therapy”. 80% excellent rate. In china, HBV prevalence in the Meanwhile, with the financial support of Germany population is very high, and the efficacy of ozone au- HUMares company, a “nanFanG HosPItal- tohemotherapy equivalents to that of oral antiviral HUMares clinical training center of ozone therapy” drugs, thus for patients with drug resistance, ozone au- was established, which specialized in systematic training tohemotherapy is the best choice. currently, many ho- the physician who are fresh on ozone therapy. training spitals in the domestic use ozone therapy for cerebral contents include ozone therapy for the disc herniation, infarction in clinical research, and had rapid develop- liver disease, cerebrovascular disease, osteoarthritis, as ment. the preliminary study outcomes show that ozone well as animal experiment practice. We believe that in therapy can reduce cerebral edema and promote brain the near future, ozone therapy can benefit more pa- tissue repair, which has been the new topic in the last tients like other treatments.

43 News

February 9, 2011.

ISCO3 President Emeritus Professor Velio Bocci has launched a research project looking for ozonethera- pists who may be interested in participating.

Professor Bocci says that "after two decades of work in ozonetherapy, in spite of the fact that the basic mechanisms of action of ozone in biological fluids have been clarified, orthodox medicine remains scepti- cal about its medical value.

"He adds that"only objective clinical results obtained after performing randomized and well control- led clinical trials, published in valid peer-reviewed medical journals, can modify this negative behaviour." He mentions that "although we know the versatility of ozone, ozonetherapy is not a panacea and indeed we must carefully select the most suitable diseases where ozonetherapy procure better results than the ordinary medication".

Professor Bocci is proposing a research and has written two protocols: one regards the "stroke" and the second the "cHF".

according to Professor Bocci "the basic concept is to have two arms: one is the control patients, who are treated with the optimized orthodox therapy (although not necessarily yielding good results), while the other arm (including comparable patients) treated with the same supporting therapy PlUs oZonated MaJor aHt, should markedly improve the outcome.

on the basis of preliminary data a minimal number of 30 + 30 patients should be enough to yield a sta- tistically significant result. as everybody knows, clinical trials are terribly expensive and we have no funds or support from pharmaceuticals or others."

researcH

Ischemic stroke treated with major ozonated autohemotherapy (MoaHt). clinical trial with chronic heart failure (cHF) treated with ozonetherapy

* ProPosals For researcH by Professor Velio Bocci, Isco3 President.

* a protocol for the ischemic stroke in patients to be treated with major ozonated autohemotherapy (MoaHt).

* Protocol for performing a clinical trial in patients with chronic heart failure (cHF) treated with ozone- therapy.

Visit: http://www.isco3.org/research.html www.centauro.it International Journal of Ozone Therapy 10: 45-50, 2011

Session IV Other Applications

Moderators: F. Hernandez, l. re saturday, april 16th, 2011 • "Mille Miglia" Museum • castagneto room • 8,30-11,45

2 8,45-9,00 – delayed healing after radiotherapy. – delayed healing after chemotherapy extravasation Ozone therapy in Oncology – radiation-induced hematuria. B. clavo1,2,3,a,b,*, n. santana-rodríguez3,4, e. oliva5, – radiation-induced proctitis. c. Méndez3, J.l. Matin-Barrasa3, I.J. Jorge2, d. Gutiérrez1, – radiation-induced brain injury. dolores Fiuza3,4, Francisco robaina2 ● to prevent toxicity from radio-chemotherapy. Here, 1 Depatment Radiation Oncology, 2 Chronic Pain Unit; 3 Research ozone should to be administered before/during radio- Unit, 4 Experimental Surgery Unit, 5 Nefrology, Dr Negrin Uni- chemotherapy (“ozone preconditioning”). the main versity Hospital; Las Palmas, Canary Islands, Spain action’s mechanisms of ozone are immunemodulation a ICIC, Canary Islands Institute for Cancer Research; and the enhancement of antioxidant system. We will Las Palmas, Spain b GICOR; Spanish Group for Clinical Investigation in Radiation present: Oncology; Madrid, Spain – theoretical background and preclinical and clinical data from studies in cuba our studies have been supported from Grants: FUncIs PI – our related research is progress. 98/31 and FUncIs PI 05/02 (from the Health and research Results/Conclusion: ozone therapy as adjuvant in Foundation of the autonomous Government of the canary oncology could improve results of radiotherapy and Islands, spain) and FIs Int 07/030, FIs Int 07/172 and FIs chemotherapy. additionally, ozone therapy can be use- 10/1485 (from the Instituto de salud carlos III -spanish Health ful to prevent or to treat side effects of those treatments. system- Madrid, spain). - e- mail: [email protected] several reports support these sentences, although the final demonstration will depend of well addressed cli- Goals: to show the potential usefulnes of ozone the- nical trials. rapy in cancer patients: theoretical background and our related studies and clinical experiences. Materials and Methods: We will present the role of ozone in 4 different topics: 3 9,00-9,15 ● to enhance effect of radio-chemotherapy. It will be presented: Ozone Therapy In Patients with Viral – preclinical works about the direct and indirect ef- Hepatitis “C” Ten Years Experience fect of ozone in tumor cells. M.n. Mawsouf *, t.t. tanbouli ** – a short review of the relevance of tumor hypoxia * Cancer Institute, Cairo University; Cairo, Egypt and their modification. ** Cairo Medical Clinics; Cairo, Egypt – our clinical reports about modification of tumor hypoxia/ischemia in patients and our experience with Hepatitis “c” is a medical problem in egypt. the ozone therapy during radio-chemotherapy in the tre- usual line of treatment is very expensive with major atment of: head and neck cancer and brain tumours. side effects and low efficacy especially in genotype 4, ● to avoid a delayed commencement of radio-chemo- which is common in egypt. In the past ten years several therapy in patients with delayed wound-healing after studies were done to evaluate the role of ozone therapy cancer surgery. the main action’s mechanisms of ozone in HcV. the first study included 60 genotype 4 hepatitis could be a local-improvement of tissue blood flow, oxy- “c” patients who received combined ozone treatment genation and metabolism. of Major autoHaemotherapy in a dose range from 4 mg ● to treat toxicity by radiotherapy and chemotherapy. to 9 mg and rectal insufflation in a dose range from 6 the main action’s mechanisms of ozone are immune- mg to 14 mg per visit. the numbers of visits were th- modulation, the enhancement of antioxidant system ree times per week for eight weeks followed by twice and local-improvement of tissue blood flow, oxygena- per week for sixteen weeks. It was found that following tion and metabolism. It will be shown our experience eight weeks of ozone therapy, the viral load decreased with ozone therapy in the treatment of: in 91.67% of cases that reached –ve Pcr in 20 % of

45 Saturday April 16th, 2011 - Session IV - "Other Applications" Castagneto Room

cases. Following 24 weeks of ozone therapy, there was the most common gynaecological disease found in the further decrease of the viral load that reached 95 % of primary health care and makes a health issue of great cases with a –ve Pcr level in 36.67 % of cases. after importance because of its high frequency. eight weeks of ozone therapy, the abnormal enzyme le- Method used: 150 patients were selected with ages vels were back to normal in 20 % of cases for the sGPt ranging from 30 to 50 years, with vulvo-vaginitis for at enzyme, and were back to normal in 23.33 % of cases least 6 months of evolution, refractory to usual drug tre- for the sGot enzyme. atment and positive cultures for candidiasis. a second study included 50 genotype 4 hepatitis Material used: Hydrocolontherapy machine. Bozon “c” patients who received ozone therapy for 24 weeks. n ozone generator. disposable vaginal insufflator VIn- Patients received combined treatment of Major auto- 100. set for vaginal injection pure ozonides Bozon- Haemotherapy in a dose range from 2.8 mg to 8.4 mg rVPo 6. and rectal insufflation in a dose range from 6 mg to 12 Procedure: It was performed one hydrocolontherapy mg per visit. the number of visits were three times per with ozonized water. It was given: diet low in carbo- week for 12 weeks followed by twice per week for 12 hydrates of high glucemic index, homeopathic proto- weeks. the general condition in 94 % of cases impro- col, daily intravaginal showers with ozonized water ved. there was a decrease in the quantitative P. c.r. in (10 sessions), daily intravaginal ozone insufflations at 71.8 % of cases that reached –ve P. c.r. in 24 % of cases concentration of 20 micrograms / ml at speed of 0.1 lt/ after 8 weeks treatment. the number of -ve P. c.r. cases mn. during 10 mn. (10 sessions), application of ozonized for HcV virus increased to reach 36 % of cases after 24 oil with peroxide number of 800, during 10 days, 4 au- weeks treatment. there was a statistically significant im- tohemotherapy at 20 mcg/ml once a week. at the end provement as regards the parameters of sGot, sGPt, of treatment were repopulated the vaginal flora with albumin, bilirubin and prothrombin after 8 weeks from lactobacillus vaginal tablets for 7 days and repopulated the start of the study. a third study was carried on 30 the intestinal flora with lactobacillus using oral route, HcV patients gave similar results to the previous two. during 1 month. ozone therapy was found to be effective even in cases Results: 85% of patients favourably responded to of liver cirrhosis and impending liver cell failure where treatment, 10% remained asymptomatic for a period of there is no place for drug therapy. less than one year and 5% of patients did not respond several researches are going on and from the prelimi- to treatment. nary data of those we noticed that the use of combined Conclusions: Intravaginal ozone therapy offers a sy- ozone and interferon therapy gave better results than nergistic action to drug treatment, homeopathic, diet either of them. ozone enhanced the effect of interfe- and / or an effective alternative to conventional treat- ron and decreased its side effects. one year follow-up ment with usual fungicides, not only achieving a remis- of HcV cases treated with ozone therapy had a 40% re- sion of symptoms and negative cultures of vaginal exu- lapse. However the liver function tests were not affected dates in patients with vulvovaginitis, but also an incre- denoting that the virus had little effect on the liver. a hi- ase of Ig a and lactobacillus in the vaginal epithelium. sto-pathological study on 98 HcV patients denoted that ozone has an anti-inflammatory and anti-fibrotic effect. ozone therapy was found to be an effective, safe and less expensive method in Hepatitis “c” patients wea- 5 9,30-9,45 ther used alone or in combination with drug therapy and weather the condition is early or late. Major Ozonated Autohaemotherapy in the Treatment of Limb Ulcers not Responding to Conventional Theraphy 4 9,15-9,30 a. de Monte1, c. Gori2 1 Director of Anaesthesia and ICU Department, Azienda Ozone Therapy in Recurrent Vulvovaginal Ospedaliero-Universitaria; Udine, Italy 2 Nurse, Poliambulatorio PASS; Udine, Italy Candida Albicans Infections a. schwartz tapia chronic leg ulceration is a common pathology with a Gynecologist, President of the Spanish Association of Medical Pro- large impact on individual health condition and on pu- fessionals in Ozone Therapy (AEPROMO) - www.aepromo.org; blic national health system finances. It is expected that President of the International Medical Ozone Federation (IMEOF); Secretary of the International Scientific Committee of Ozone- approximately 1% of the population is affected by this therapy (ISCO3) www.isco3.org; Director, Fiorela Clinic, Madrid disturbance, and the percentage rises up to 3% or more - www.clinicafiorela.com - E-mail: [email protected]; Spain when considering people aged over sixty five. Health financial reports estimates hat 1% of annual Key Words: vaginitis, vulvo-vaginitis, candida albicans, healthcare budget in european countries is absorbed by hydrocolontherapy, diet therapy, homeopathy leg ulcer treatment. In Usa patients, the population suf- fering leg ulcerations counts more than 6 millions of pe- Objective of research: assess the effectiveness of the ople and the financial impact approaches 2 billions of €. ozone and diet therapy treatment of recurrent vulvo va- Whatever the initial pathogenetic event causing the ginal by candida albicans infections. ulceration, the lesion maintenance follows the impai- Introduction: vaginitis caused by candida albicans is rment of blood flow and the inadequate oxygen deli-

46 www.centauro.it International Journal of Ozone Therapy 10: 45-50, 2011

very to the damaged area. the ischemic environment did not change the ongoing previous therapy and that produced by hypoperfusion gives rise to an increased the only implemented treatment was o3-aHt. production of reactive oxygen substances (ros) that We conclude considering that it is at least surprising hinder the physiologic healing process and perpetuates the strong opposition to the medical application of ozo- the chronic state of the ulcer. the chronic inflamma- nated autohaemotherapy, in spite of the tremendous tion is responsible of persisting platelets and coagula- epidemiological data concerning chronic ulceration. tion cascade activation, vascular permeability, edema ozonated autohemotherapy still remains a treatment and capillary compression that ends to an impairment that has been successfully applied for decades to treat of microcirculation. local ischemia phenomenon will chronic vascular disease, it is simply to carry out and it produce hypoxia, low pH, high lactic acid concentra- is cost contained. tion, lipo-peroxidation, and the intermittent ischemia that frequently occurs is a further cause of tissue injury. the benefit of ozone autohemotherapy has been 6 9,45-10,00 successfully demonstrated in the treatment of chronic ischemic ulcers. the beneficial effect is represented by Topical Ozonated Autohoemotherapy to vasodilatation mediated by the increased generation of nitric oxide and carbon monoxide. also the increased treat Diabetic Ulcers of the Lower Limbs: concentration of 2,3-diphosphoglycerate in erythrocytes Advantages and Limitations has a positive effect in oxygen delivery to the tissue by M.l. Iabichella shifting to the right the oxygenated hemoglobin disso- S.O. Angiologia Clinica Barbantini; Lucca, Italy ciation curve. Furthermore, blood exposition to ozone causes an upregulation of endogenous antioxidant sy- Backgroung: Il debridment gioca un ruolo fondamen- stem that increases the efficacy of ros scavenging. the tale nella “wound-bed preparation” poiché condiziona final effect on chronic ulcer is the resuming of physiolo- il processo di guarigione dell’ulcera. Infatti, il trapianto gical healing process. di cute omologa e/o autologa se eseguito in ulcere ben In this presentation we report a series of patients suf- preparate, favorisce la guarigione dell’ulcera vascolare fering chronic ulcerations not responding to conventio- cutanea in un’alta percentuale dei pazienti trattati. to- nal medical and surgical therapy, that was successfully pical ozonated autohoemotherapy, nella nostra pratica treated with ozonated autohemotherapy (o3-aHt). clinica, è efficace nella preparazione del letto dell’ul- Method: twenty one ambulant patients suffering cera in casi resistenti a precedenti trattamenti. tuttavia, from chronic ulcerations (15 M, 6 F), mean age 65 yrs com’è noto, la microangiopatia diabetica limita il pro- (range 33-80 yrs) , after signing the informed consent cesso di riparazione tissutale e spesso impedisce la gua- underwent weekly or twice weekly o3-aHt. the o3- rigione nelle lesioni trofiche vascolari. aHt included 225 ml collection of blood into a 500 ml Scopo: Individuare vantaggi e limiti della toa in ozone-resistant vacuum bottle (B-Braun) containing lesioni trofiche degli arti inferiori di pazienti diabetici 20 ml of sodiun citrate 3,8% as described by Bocci. con Paod (Peripheral arterial occlusive disease) con the blood was mixed with 225 ml of a o2-o3 gas mi- scarsa responsività ai classici trattamenti di debridement. xture containing o2 (96%) and o3 (4%) produced by Casistica: dei 20 pazienti (12 Uomini e 8 donne; an ozone generator (Haensler ozonosan Photonic, If- età media: 70+11 anni) tutti diabetici (14 Id e 6 nId) fezheim, Germany). after 10 minutes of gentle mixing, con lesioni croniche cutanee che non rispondevano alle the blood was re-infused within 25 minutes. at first pa- usuali tecniche di detersione, 17 presentavano Paod tient examination, a picture of the lesion was taken and allo stadio II B (1 dei quali era in trattamento dialitico its area was estimated by drawing the perimeter of the e già amputato all’arto controlaterale) e 3 allo stadio I. ulcer on a transparent graph paper. serial ulcer photo- I pazienti erano esaurientemente informati dell’uso graphs were taken at intervals of 3-4 weeks until the compassionevole del trattamento proposto ed accettato end of treatment. Patient’s daily therapy and topic dres- di esservi sottoposti. sing were maintained as usual. Metodo: abbiamo applicato sul letto dell’ulcera una Results: three patients were on insulin treatment, in miscela di sangue autologo-ozono, Mos preparata con six patient amputation was considered mainly because uno strumento (ozonline Model e-80, Medica Bologna, the pain was extremely problematic to be controlled. the Italy) che permette di controllare in tempo reale, me- majority of ulcers had a multifactorial origin. deep ul- diante un fotometro, la concentazione di o3 generata cers involving the muscles were observed in 9 cases. the dall’o2, e fornisce una stima affidabile delle concentra- average ulcer area was ranging from 1 to 150 cm2 (mean zioni di ozono somministrate, ripetibile nelle diverse 30 cm2). Ulcers were reported to have been opened from applicazioni effettuate. la Mos è preparata con due 3 to 60 months (median 10). a successful complete he- siringhe sterili connesse da un dispositivo a tre vie in aling was obtained in 19 patients; the two remaining polipropilene ozono-resistente. Il sangue è prelevato reached a healing of 90 % of ulcer surface and under- da una via venosa del paziente mediante vacutainer, went plastic surgery to complete the recovery. the mean prima raccolto in una provetta da emocromo da 4 cc number of o3-aHt required was 26 (range 10-120). (contenente anticoagulante) e poi introdotto in una si- Conclusion: our experience confirms the result ob- ringa con ago pre-eparinato. la siringa con sangue ve- tained by others authors in the treatment of ischemic noso poi è collegata mediante un dispositivo a tre vie, a lesions. It is worthy to point out that our study protocol una seconda siringa contenente una prestabilita quan-

47 Saturday April 16th, 2011 - Session IV - "Other Applications" Castagneto Room

tità di ozono da somministrare (secondo un rapporto e la suscettibilità alle infezioni nelle ulcere trattate con – di 1cc sangue / 3cc di o3 a 60 + cg/ml). Questo sistema toa. I dati da noi ottenuti incoraggiano l’impiego della assicura una precisa e ripetibile concentrazione di som- toa nei presidi ambulatoriali e territoriali per la scarsa ministrazione del gas (ozono) nel volume di sangue incidenza di effetti collaterali o eventi avversi. Inoltre, venoso (autologo). la miscela sangue-ozono (Mos) è il basso costo del metodo e la sua efficacia potrebbero ottenuta attraverso la chiusura del rubinetto a tre vie incidere positivamente nel management vulnologico ri- permettendo dolcemente il passaggio dell’ozono verso ducendo la necessità di ricoveri o cure più costose di la siringa contenente il sangue e agitando la miscela per debridement, con un notevole risparmio della spesa sa- 2 minuti. successivamente, la parte gassosa residua è nitaria in questa patologia cronica. eliminata dalla Mos, la quale è pronta per la sommini- strazione nell’ulcera. Per permettere il contatto Mos- letto dell’ulcera e assicurarne la persistenza nel tempo 7 10,00-10,15 l’ulcera, dopo essere stata detersa con acqua ozonizzata o salina, è coperta con una membrana semipermeabile Oxygen Ozone Treatment for Lower Limb (film) che garantisce un ambiente chiuso. l’aria pre- Peripheral Arterial Disease sente tra film e fondo dell’ulcera è aspirata nella siringa vuota del sistema a tre vie prima di somministrare la c. capuano, c. capuano, G. tabaracci Mos. Il foro sul film prodotto dall’ago è sigillato con lower limb peripheral arterial disease (Pad) is a un secondo film. Il contatto tra la Mos e il tessuto cu- common complication of diabetes mellitus. as compa- taneo ulcerato realizza una nuova via di somministra- red to normal subjects, Pad prevalence is significantly zione dell’ozono che noi abbiamo denominiamo topical higher in diabetic patients and is associated with more ozonated autohemotherapy (toa). severe clinical manifestations and a higher risk of criti- Risultati: Il dolore riferito inizialmente dai pazienti si cal limb ischemia (clI) and limb loss. the majority of è ridotto significativamente fin dalla prima applicazione non-traumatic major amputations are performed in dia- della tao. betic subjects. diabetes mellitus is characterized by me- tutte le ulcere trattate con tao hanno mostrato tabolic abnormalities. It is a disorder of carbohydrate una significativa riduzione e/o scomparsa della fibrina metabolism resulting in hyperglycemia and glycosuria, e presenza di tessuto di granulazione già dopo la terza due to an inadequate production or utilization of in- applicazione, con riduzione della loro profondità ed sulin. long-term complications causing morbidity and estensione. premature mortality are characterized by microvascular la detersione completa dell’ulcera è avvenuta dopo disease with capillary basement membrane thickening, 3-5 tao. la carica batterica si è negativizzata nel 72% macrovascular disease with accelerated arterial sclerosis, dei casi già dopo la seconda applicazione. neuropathy involving both the somatic and autonomic Il debridement è effettuato stato senza cruentare i nervous systems, neuromuscular dysfunction with mu- tessuti limitrofi sani (con risparmio dell’utilizzo della scle wasting, embryopathy, and decreased resistance to sala operatoria in molti casi). infections. such chronic complications involve the eyes, la toa ha favorito il processo di granulazione ne- kidneys, heart, nerves, and blood vessels. these chan- cessario in preparazione al trapianto cutaneo, stimo- ges combined with the pre-existing microvascular and lando il miglioramento e/o la precoce guarigione delle macrovascular circulatory impairments characterize the lesioni trapiantate e, pertanto, una riduzione della fre- mechanisms that may lead to gangrene after foot injury. quenza a ricorrere a un nuovo trapianto cutaneo. ozone treatment is capable of stabilizing oxygen me- nessun trapianto cutaneo effettuato dopo toa ha tabolism and modulating oxidative stress, accompanied mostrato segni precoci o tardivi d’infezione. nessuna by germicidal actions, can improve the quality of life of reazione avversa è stata segnalata durante la sommini- these patients. the ozone treatment improves glycemic strazione di toa. control and preventes oxidative stress and it could be a Limiti: necessità del prelievo venoso ogni 48-72 ore future alternative in the therapy (without side effects!) per effettuare la toa e l’indaginosità della sua applica- of diabetes and its complications. zione (possibile fuoriuscita di sangue per scarsa tenuta del film) limita l’impiego routinario di questo metodo. Inoltre, per l’impiego clinico sarebbero necessari un’ap- 8 10,15-10,30 parecchiatura ed un Kit monouso dedicato alla toa. Il personale infermieristico, inoltre, dovrebbe essere for- The Treatment of the Buruli Ulcer Through mato e addestrato per effettuare la toa ambulatorial- mente e nei presidii territoriali. the Oxygen-Ozone Therapy: a Pilot Project Conclusioni: Il dato per noi sorprendente nell’im- In Zinvié, Benin piego di toa è stato la rapida rimozione della fibrina a. Izzo, a. Bertolotti con comparsa di tessuto di granulazione nel letto dell’ulcera e la riduzione del dolore già dopo la sua Intermed onlus is an humanitarian organisation, spe- prima applicazione associato alla minore necessità di cialized in health interventions in subsahara africa. the effettuare toilette chirurgica e utilizzo, in alcuni casi main goal of the organization is to support the primary della sala operatoria. la presenza di microangiopatia healt care related activities including psychiatric care diabetica sembra influenzare scarsamente la detersione end support and neglected tropical diseases.

48 www.centauro.it International Journal of Ozone Therapy 10: 45-50, 2011

Introduction: For the past two years InterMed on- plement a pilot project for the treatment of the ulcer lus has been tackling a severe disease caused by Mycobac- though the use of the oxigen-ozone therapy. terium Ulcerans. Known as Buruli ulcer, this disease ta- Specific objectives - they are as follows: kes its name from a region in Uganda where an outbreak strengthen the capacity of the reference laboratory occurred in 1958. the germ responsible for the disease of Zinvié in collaboration with the anatomy/Pathology was isolated by Maccalliun et al. in australia in 1948. reference laboratory of ospedale civile of Brescia during a primary health care project implemented (University of Brescia). at the Zinvié dispensary in Benin, InterMed onlus support implementation and monitoring of the tre- noted numerous cases of Buruli ulcer especially among atment of Buruli Ulcer in collaboration with the ana- children. due to frequent bathing in Benin’s many ri- tomy/Pathology reference laboratory of ospedale ci- vers or lagoons, the children were bitten by an aquatic vile of Brescia (University of Brescia). insect responsible for inoculation of the mycobacterium estabilish a specific methodology and practices for causing the disease. treatment of the Buruli Ulcer for the laboratory of Initially a nodular formation appears on the skin ul- Zinvié in collaboration with the University of Brescia. cerating after about a week to give rise to lesions which strengthen the capacity of the laboratory of the la- may be extensive. boratory of Zinvié by providing equipments and drugs current treatment is surgery which is seldom confi- supply and other materials. ned to excision of the nodule because patients present develop and produce training and advocacy tools. when thev already have huge ulcers making resection Methodology: the pilot project aims to treat the Bu- highly invasive with large excisions requiring skin grafts. ruli Ulcer at the Health centre of Zinvié and to carry When possible patients are also given medical treatment out diagnostic investigations at the centre where there with rifampicin and streptomycin. InterMed onlus is the laboratory. works in cooperation with the treatment centre for Bu- the methodology is based on a clised collaboration ruli ulcer at the "la croix" Hospital run by monks. In between InterMed and the o spedale c ivile of Brescia. Benin and in agreement with the Hospital management In order to treat patients the following exams be un- it has installed an oxygen and ozone device to treat pa- dertaken respectively at the lab in Zinvié and at the tients with the disease. after staff were trained by In- lab of anatomy/Patology of ospedale civile of Brescia: terMed to administer ozone therapy, a draft treat- a - laboratory of Zinvié: ment protocol was established which includes: 1 Zieehel nielsen. – prepare the ozonized water at a concentration of 30 y/ml; B - laboratory of the ospedale civile of Brescia (ana- – wash the lesions; tomy/Pathology): – position the bag with insufflation of the mixture at 1 cultere exam concentration of 25-30 y/ml, close the bag with an ela- 2 Hystologic exam stic band, treatment time 20 mint; 3 Pcr – medicate whit gauze. Results: We observed absence of Micobacterium Ul- Following this protocol, InterMed carried out two cerans in our sample after ozone therapy. to three weekly treatment session obtaining excellent ozone therapy can support other treatments, but it results. can’t substitute them. ozone therapy improves the con- taken in consideration these results reached through dition of the wound, favouring healing and killing myco- the oxigen-ozone therapy, InterMed is aiming to bacterium ulcerans. We have treated our patients, accor- expand the intervention by reinforcing and strengthe- ding to oMs guide lines, with rifampicine and streptomi- ning Health centre in Zinvié cine and, contemporary with the antibiotic therapy, we Background: after training the nuns responsible of have used ozone therapy. the anatomy Patological Isti- the centre on the oxigen-ozone theraphy, some pa- tute of civile in Brescia, Italy, has observed through hi- tients were selected, both from the dispensary of Zin- stological examination, that there is not presence of Mi- vié and from the three dispensaries located in the bush. cobacterium Ulcerans in the samples treated with ozone. normally there are about 50 people a day who visit these centres, the majority of whom are children. the therapy has been used both in the form of a gas and of ozone wa- 9 11,00-11,15 ter to treat oral infections, skin mycosis, intestinal disbio- sis, skin ulcers and fistulas. among these diseases also Ozone Therapy in Odontology many cases of Buruli Ulcer have been treated. In the F.M. Florido first stage of the Buruli Ulcer the InterMed staff has noticed that a nodule on the skin became soon an ulcer From the time of swiss dentist e.a. Fisch up to the affecting also the under skintissue causing serious fun- modern era ozone has been used in numerous dental ctional damage. In these patients the o2-o3 therapy was diseases. In the last decade the application of ozone applied locally in form of a gas using bags sealed with in the field of dentistry has had an even larger impact bandage and kept on, after insufflation of the mixture as witnessed by the high number of published studies for about 20 minutes at a concentration of 25-30 y/ml. which endorse this technique. In medicine as well as Project Proposal - The proposal: the general objec- dentistry, the current trend is to use minimally invasive tive is to strengthen the capacity of the Zinvié centre techniques and this criterion has worked in favour of for screening and treatment of Buruli ulcer and to im- the growth of ozone therapy among dentists.

49 Saturday April 16th, 2011 - Session IV - "Other Applications" Castagneto Room

ozone is an important gas given that it possesses nu- ment in treatment of pain and secondary prevention as merous qualities like its power to act as a disinfectant, shown by different clinical results in triggerpoints, dia- deodorant, bactericide, astringent, cicatrizant, oxygena- betic foot, rheumatoide arthritis. tor, and as an oxidizing gas in teeth whitening treatments. In dentistry, ozone can be applied in the form of ionized water and oil, the direct application of gas, gum infiltra- 11 11,30-11,45 tions, etc. recently ozone has taken a new path in dentistry being used in aesthetic dentistry such as teeth whitening. The Low-Dose Ozone Concept in We will describe the scientific studies which demon- strate the effectiveness of ozone therapy in tooth decay, Complementary Oncology Rationale, periodontal disease, oral mucosa, implants, root canals Guidelines and Treatment Strategies and oral surgery in general. r. Viebahn-Haensler, Nordring 8, 76473 Iffezheim; Baden-Baden, Germany

10 11,15-11,30 Introduction: For decades now, both internistic and general practices have been using medical ozone as an additive and supportive method with classical oncolo- Low-Dose Ozone Concept in Pain gical therapy; the results have been an increased tole- Syndrome: Pharmacology and rance to chemotherapy and radiation, and an improved Mechanism of Action. ability to regenerate after surgical intervention with an r. Viebahn-Haensler, improvement of the patient’s general condition as an Nordring 8, 76473 Iffezheim; Baden-Baden, Germany accompanying factor. Rationale: recent investigations have provided re- Introduction: In chronic inflammatory processes such sults in biological models on angiogenesis based on an a as chronic polyarthritis, inflammatory conditions of the regulation of hypoxemic tissue by an improved oxygen joints, myofascial triggerpoints or fibromyalgia as well availability and an increase of the antioxidant capacity as acute stages of herniated lumbar discs, the low-dose of the biological system as well as a general immuno- ozone concept has proven it's high effectivity as trea- modulation. this three main mechanisms of systemi- ting module in a complementary therapeutical strategy. cally administered ozone are discussed in the context of subcutanuous, intramuscular, intraarticular and intra- 1. Hypoxic environment discal injections are the topical methods of choice, and 2. Immunodeficiency Major auto-Haemotherapy as well as rectal insufflation 3. chronic oxidative stress in carcinoma petients and the systemic ones. 4. Protection of healthy organs from side effects of che- Mechanism of Action and Clinical Results: like the motherapy and radiotherapy as the basis of a comple- classical indication, the vascular inflammatory disease, mentary ozone concept in oncology. the diabetic angiopathia in particular, chronic pain syn- Results and Conclusion: treatment strategies concei- drome profits from the regulation of hypoxia, an incre- ved as a low-dose ozone concept for secondary preven- ase of cellular antioxidative capacity, and no regula- tion: particularly applied prior to starting and during tion. thus ozone or better “ozone-peroxides” interferes chemotherapy, as well as before and after radiation, but in the inflammation cycle and might be able to interrupt also prior to a surgical intervention, in the form of Ma- the inflammatory amplification by scavenging an excess jor-ozone- autohemotherapy and/or rectal insufflation. of superoxide radicals, reducing oH radicals with their the patients should profit from the conventional on- degenerative consequences. If used properly in the con- cological therapies, in the same way as from a correctly cerned forms of application and accurately in dosages applied complementary concept and hence profit from and concentrations, Medical ozone is an important ele- a reduction of adverse effects.

50 www.centauro.it International Journal of Ozone Therapy 10: 51-56, 2011

Session IV Other Applications Oral Communications

Moderators: a. Martin Francisco, Y. tammam saturday, april 16th, 2011 • "Mille Miglia" Museum • castagneto room • 11,45-13,00

1 11,45-11,52 1 Medinat srl Clinic; Camerano, Italy 2 Pharmacology, D.I.S.M.A.R., University of Ancona, Italy 3 Department of Chemistry and Medical Biochemistry, Univ. of Role of Ozone/Oxygen in Fibroblast Milan; Milan, Italy Growth Factor Activation. Discovering the Facts. Key words: ozone, hormesis, adaptive responses, age, M. sirito3*, l. re1,2, G. Martínez-sánchez2, G. Perez-davison2 oxidative stress, skin 1 Pharmacology, D.I.S.M.A.R., University of Ancona, Italy 2 Medinat srl Clinic; Camerano, Italy redox environment involves a broad network of 3* Anti Aging Center, Thermal Institute of Angolo Terme, Italy pro-oxidant and antioxidant components. Health be- nefit or damage can be induced as consequence of an Key words: ozone; fibroblast growth factor; platelet rich adaptive cellular stress response. a consequence of hor- plasma. metic amplification is an increase in the homeodynamic space of a living system in terms of an increased defense Background: Basic fibroblast growth factor (bFGF) capacity and a reduced load of damaged macromole- is a pleiotropic mitogen which plays an important role cules. ozone, when used at appropriate doses, promo- in cell growth, differentiation, migration, and survival in tes the formation of reactive oxygen species and lipid different cells and organ systems. application of bFGF peroxides allows them to become late and long-lasting has been shown to promote cellular proliferation and messengers. Healthy aging may be achieved by horme- collagen synthesis in vivo. FGF is markedly up-regula- sis through mild and periodic, but not severe or chronic, ted following bone or tendon injury and are active at physical and mental challenges, and by the use of nutri- multiple stages of the healing process stimulation, of lo- tional hormesis incorporating mild stress-inducing mo- cal blood circulation, lipolisis and smooth muscle. lecules called hormetins. the paradoxical concept that Method: looking at physic and chemical properties ozone eventually induces an antioxidant response capa- of the ozone molecule, the present work deals the pos- ble of reversing a chronic oxidative stress is common in sible therapeutic action as FGF activator. the animal and vegetal kingdom; it is already supported Results: Incubation (2 h) of platelet rich plasma with by findings of an increased level of antioxidant enzymes – o2-o3 80 + g/ml increases in approximately 600 % the during ozone therapy. those facts can include ozone as basal concentration of FGF. a hormetin. the established scientific foundations of Conclusion: this fact in combination with previous hormesis are ready to pave the way for new and effec- demonstration of the stimulating action of o3, releasing tive approaches in redox-related disease research and other platelet factors make potentially possible the au- intervention; ozone therapy can be a good candidate. tologous treatment in aesthetic and clinical tissues con- ditions in which FGF has a protagonist role. the ver- satility and amplitude of beneficial effect of ozone has 3 11,59-12,06 become evident in orthopedics, cutaneous and mucosal infections as well as in dentistry, the induction of FGF The Amazing trip (Review) and other growth factors by ozone can support and po- Á. erario, a. Grangeat tentiate those applications. Instituto Argentino de Ozonoterapia (IAOT); Buenos Aires, Argentina

2 11,52-11,59 If we were able to transform us into the size of an atom, maybe it would be easier to explain the bioche- Clinical Implications of Ozone U-Shaped mical effects of ozone in the organism. When ozone is Dose Responses placed in contact with blood, ozonolisis occurs. the G. Martínez- sánchez1, l. re1,2, a. Giuliani3, G. Pérez-davison1 products of its reaction are responsible for many effects

51 Saturday April 16th, 2011 - Session IV - "Oral Comunications" Castagneto Room

of ozone therapy. every product has its own duty but tion, function of a mucociliary (Mc) transport, allergy everything happens simultaneously. testing of the patients before and after the treatment.

H2o2 is one of these products, and a very important Results and Discussion: as a result of treatment, we molecule. It is one reactive oxidative species (ros), noticed expressed clinical effect in the form of nasal non radical, and it can diffuse through plasmatic mem- breathing normalization, disappearance or reduction of brane. once inside the cell, it triggers a lot of chemical secretions, and normalization of endoscopic and X-ray reactions, which reflect the therapeutic effects of ozone pattern. study of structure and function of a Mc appara- therapy. It improves oxygen delivery, immune activation tus is the most objective criterion for the valuation of ef- and stress oxidative modulation. ficacy of drugs, used in the treatment of rhinitis patients. one of the greatest effects is the activation of heme therefore, and on the assumption of possible negative oxygenase 1(Ho-1). affect of ozone for ciliated epithelium, we gave special the oxidative precondition with ozone induces the priority to the determination of Mc apparatus state. activity of Ho-1. In this way, it increases the co pro- ozone therapy results in the optimization of mean duction. the co is an important vascular regulator, Mc transient time from 28,1±0,9 to 19,2±0,5 min. anti-apoptotic and anti-inflammatory molecule. It de- eosinophil content in an impression smear of nasal creases proinflammatory molecules like Il-6, Il-1β and mucosa is normalized from 17% to 2%. tnF α. While conducting allergy diagnostics through inhibi- In the last few years a lot of interleuquines were tion reaction of leukocyte locomotion, results of which discovered that could be modulated by the action of reflect level of body sensitization to the fullest, we noti- ozone therapy, one of this is Il-17. It has an important ced that 94% of patients overwhelmingly react to mul- role on disk herniation and other chronic diseases. tiple allergens. ozonetherapy may reduce number of In conclusion, the chemical messengers produced by allergens by 80% on the average. the interaction between ozone and cellular and plasma- contents of eosinophils, IgE, and lymphocytotoxic tic structures diffuse in organs and trigger hundreds of antibodies and helper/suppressor index is in the peri- responses according the target cells. pheral blood is normalized. Conclusions: the conducted research permits to con- firm that ozonetherapy in various combinations helps to 4 12,06-12,13 considerably improve treatment of ar without side ef- fects, intrinsic to the traditional drug therapy of this disease. Ozonetherapy of Allergic Rhinitis t. Barkhotkina Medical Center “Politekhnik”, Kharkov National Technical 5 12,13-12,20 University; Ukraine, Kharkov Oxygen Ozone Insufflation of Maxillar Key words: ar, endonasal corticosteroids, ozone therapy Sinus: Safety, Effectiveness and Possible allergic disease incidence makes up 30% of the Application in Three Different Clinical whole population. allergic rhinitis (ar) is the most Situations common, being very dangerous because of its complica- c. catelani-cardoso1, r. dall’aglio1, P. Gerace2 tions and thus significantly lowering quality of life. Università degli Studi di Milano; Milan, Italy according to criteria of eaacI, approved by the european rhinologic society, nowadays treatment of Key words: cluster headache, oxygen ozone therapy, si- ar is based on three postulates: nusitis 1. control over patient’s surroundings; 2. Immunotherapy; Introduction: cluster headache, also known as hista- 3. Pharmacotherapy. nowadays, ecs are considered to mine headache, is a form of neurovascular cephalgia. at- be first-line drugs for the treatment of ar in all age tacks usually are severe and unilateral and typically are groups. However, it has been proved that ecs have located at the temple and periorbital region. It’s an ex- side effects for the hypothalamo-pituitary-adrenal axis, cruciatingly painful. the pain is associated with ipsilate- growth of children, bone tissue, and eyesight. they can ral lacrimation, nasal congestion, conjunctival injection, lead to the impairment of homeostatic mechanisms, miosis, ptosis, and lid edema. treatment with high-dose which regulate electrolyte imbalance, as well as to steri- oxygen inhalation has been used in acute cluster heada- lization effect in women. che attacks 1,2. therefore, nowadays there are no working and yet chronic inflamation of maxillary sinus has been lin- safe method of the treatment of ar. and search for ked with focused infections and cluster headche. such method is an actual problem. the elevation of mucous secretion is one of the hi- Materials and Methods: We use ozonetherapy as in- stamine-mediators syntoms and posterior rhinorree 3 is travenous infusions of the ozonized saline, inhalation of associated with chronic flogosis of respiratory tract. ozonide hydrosol, and injections of gaseous ozone di- the polimerization of mucous4 happens due to dou- rectly into the polypus tissue. to valuate effectiveness ble bond formation and this is the result of a reducent of ozonetherapy, we conducted standard clinical, endo- reaction. the application of an oxidant agent like ozone scopic, cytological, immunological and X-ray examina- can rupt this ligation and cause the mucous fluidification

52 www.centauro.it International Journal of Ozone Therapy 10: 51-56, 2011

and excretion, like happens with the inhalation sulphur analysed persons were confined to their bed protected solutions and the a aerosolterapie and n-acetylcysteine by bars and they were afflicted by psychomotor disor- 5. Patients with chronic purulent frontal sinusitis treated ders, neurovegetative disorders, emotional problems with irrigation of the paranasal sinuses with ozone-oxy- and cognitive disorders. the syntomatology was made gen mixture recovered faster than the controls 6,7. up by hippocratic facies, amimia, bustle, constant voca- Objective: to ascertain the safety, and the effective- lisation, sleep disorders, indifference, collecting, short ness of the oxygen-ozone mixture insufflations of sinus term memory disorders, special-temporal disorientation in the acute treatment of cluster headache. and apraxia. the patients were also depressed and they Methodology: Using a long blunt needle, the oxygen frequently thought about death and suicide. all 12 pa- ozone gas misture (5 ml at 12 mcg of ozone /ml, once a tients were subjected to pharmacological therapy with week, during 6 weeks) were introduced in the entrance colina alfoscerato, clotiapina and melatonina; five of of maxillary sinus. While the gas was introduced, patient them also with Quetiapina. Finally three of them were was orienteted to brief only through the mounth. also assisted by a physiotherapist. From september 2010 Results: over thirty treated patients, 28 presented to the end of december 2010 the patients were treated completely resolution of the headche in the following with a cycle of 8 Gaet using an appropriate and ap- 24 hours. the pauses between episodes became more proved machine. once a week a 150 mg blood sample longer too. correlate pathologies like asmatic bronchi- was withdrawn from each patient, it was enriched with tis, polialgie, asthenia and persistent cough had attenua- 180 ml of ozone (3 syringes of 60 ml) using a mixture of tion. one patient presented inflammation of tear duct o2-o3 with a concentration of 30 mg and then the blood and the other had another cephalgic acute episode. already enriched with ozone was transfused into the pa- Conclusion: the insufflation of the mixture of oxygen tient’s blood. at the end of the oxygen-ozone therapy ozone presented incouraging results on the remission of with Gaet, 10 of the 12 patients started walking assi- cluster headache. the praticity and the low cost of the sted by a person or using a special support, they recove- procedure can favor the spread of this application too. red part of their clear-headedness and orientation and 90% improved their sleeping disorders. two patients References recovered part of their cognitive functions, but not 1 Bennett nH, et al. normobaric and hyperbaric oxygen completely their motorial functions; they needed con- therapy for migraine and cluster headache. cochrane da- tinuous support. looking at the results of this study we tabase of systematic reviews. 2008; Issue 3. art. no. 2 cohen as, et al. High-Flow oxygen for treatment of can finally say that the treatment with o2-o3 therapy is cluster Headache a randomized trial. JaMa. 2009, efficient for patients with mental, chronic and degene- december 9; 302 (22): 2451-2457. rative diseases and cerebrovascular diseases. the treat- 3 Maintz l, novak, n. Histamine and histamine intole- ment with o2-o3 therapy together with the medications rance. am J clin nutr. 2007; 85: 1185-96. quoted in this document didn’t produce any undesired 4 Holmen JM, et al. Mucins and their o-Glycans from human bronchial epithelial cell cultures. aJP-lung cell effects and unfavourable reactions. on the other hand Mol Physiol. 2004; V287: l824–l834. we noticed that with these treatments the quality of life 5 Baran eMa, et al. dose-finding and 24-h monitoring for of the patients improved very much. efficacy and safety of aerosolized nacystelyn in cystic fi- brosis. eur respir J. 2002; 19: 294-302. 6 Muminov aI, Khushvakova nZh. ozone therapy in pa- tients with chronic purulent frontal sinusitis. Vestn otori- 7 12,27-12,34 nolaringol. 2002; 6: 46. 7 Petrov GM, Kudriavtsev BP, akulich II. the efficacy of Ozone Therapy and Legislation using ozone preparations in the combined treatment of pa- ranasal sinusitis. Voen Med Zh. 1996 dec; 317 (12): 26-8, 80. r. Quintero Mariño Spanish Association of Medical Professionals in Ozone Therapy (AEPROMO); International Medical Ozone Federation (IMEOF); International Scientific Committee of Ozone Therapy 6 12,20-12,27 (ISCO3)

The Treatment with Oxygen-Ozone the presentation is based on the on going rese- Therapy by Geat of Patients Affected by arch conducted by adriana schwartz (physician) Advanced Senile Dementia, Assisted at aeProMo and IMeoF’s President, and roberto Quintero Mariño (lawyer) aeProMo, IMeoF and Their Domicile and in Pharmacological Isco3’s legal advisor. Therapy with Antipsychotic Psycholeptics, despite the time elapsed since the discovery of the Parasympathomimetics and Melatonin ozone for medical purposes, it can not find a positive F. Berni presence in the laws or regulations of the states. our Surgery Martini; Volterra, Pisa; Surgery FisioK; Carpi, Modena research aims to place the reality of the ozone therapy within the legal structure of the countries where is wi- the study was based on 12 patients, 8 males and 4 fe- dely applied. It is the first time that this kind of research males, after receiving the authorisation of their doctors has been conducted. in charge. the patients were between 78 and 86 years In 2009 an Italian sport newspaper with a daily circu- old, affected by senile dementia and with limited mo- lation of 400.000 copies and with three millions readers bility. the patients were all assisted at their home. the has affirmed in various stories that the ozone therapy

53 Saturday April 16th, 2011 - Session IV - "Oral Comunications" Castagneto Room

is a doping, that its practice is forbidden in Italian pri- 8 12,34-12,41 vate clinics and that the equipment used has not legal authorization. Information such as the kind printed in Italy, indi- Registration in Regulatory Medicines cate once again the real importance of knowing where Agency. Why? Where? How to begin? is placed the ozone therapy in the laws the countries; B. clavo1,2,3.a,b, n. santana-rodrìguez3,4, d. Fiuza3,4, F. robaina2 and the urgent need to put as main objective of the me- 1 Department Radiation Oncology; 2 Chronic Pain Unit; dical ozone associations’ agendas, the regularization of 3 Research Unit; 4 Experimental Surgery Unit; Dr Negrin the ozone therapy, following the examples undertaking University Hospital;. Las Palmas, Canary Islands, Spain a ICIC; Institute for Cancer Research, Las Palmas, so far for a very few number of countries. Canary Islands, Spain the following eleven countries have been assessed: b GICOR, Spanish Group for Clinical Investigation in Radiation australia, Brazil, colombia, cuba, egypt, Germany, Oncology; Madrid, Spain Greece, Italy, russia, spain, and the United states, the Our clinical trials have been supported by Grants from: Instituto research examined in each country, whenever it was de Salud Carlos III- research program from the Spanish Health possible, the legislation, the administrative decisions System-Madrid, Spain: FIS INT 07/030, FIS INT 07/172, FIS 06/1413, and FIS EC 07/90024 Spanish Society of Neumology and the rulings of the judiciary on ozone therapy or in and Thoracic Surgery: Grant’2010 other subjects of health in which the ozone therapy may be included. subjects such as regulations on ozone the- Goals: since more than one century, many reports rapy included those which have forbidden it; the agree- and some studies have documented the high potential ments reached between the administration and the me- usefulness of ozone therapy in many different disea- dical sector; who can practice it; the requirements that a ses. However, to date, most doctors from the orthodox medical centre should have; the written statements that medicine show skepticism and prejudice against ozone the patient must sign before starting the ozone therapy’s therapy. In 2009 Bocci1 wrote: “while it is important to treatment; and the right of the patients are assessed. continue specific biologic studies, it is imperative to a comparative legal review provides a panoramic perform controlled and extensive clinical trials to prove view of the legal status that the ozone therapy has in beyond any doubt the value of ozone therapy…Unless each of the countries analyzed. this is done, there is no future for ozone therapy wi- the main conclusion of the research is that the ozone thin official medicine”. Following our experience with therapy enjoys a very limited acceptance on the regu- 3 “non-commercial” clinical trials, one of them about lations and rulings of the countries assessed. as the ozone therapy, the aim of our presentation is to show research is the first on this kind, it is still an on going the most relevant steps and web-windows in the regi- one because the subject is too vast, the legal informa- stration procedure in the regulatory medicines agency tion needed is not easily obtained and in some cases the Materials and Methods: Why register a trial? knowledge that the associations and physicians have on Where can we register a trial? How much does legal matters are wrong. it cost? Where can we find support? national rese- Based on the findings the authors make the following arch programs. european programs (for collaborative proposals: to adopt a strategy towards the legal recogni- works). research alliances from ozone societies? and/ tion of the ozone therapy; to approach the legal matters or ozone companies? to the ozone therapy with the contribution of legal ex- Points to keep in mind: Write a good protocol with perts on health, administrative matters and international necessary collaborations. law; to adopt legal standings that should be adopted by Costs: Insurance (around 6,000 , high variability), ta- the associations on various subjects related to the ozone xes for the national Medicines agency (around 6,000€, vis-à-vis the legislation and the administration; to adopt +/- constant), +/- taxes for the ethic committee (600€). the requirements that must have the medical centers to to obtain the eudract number. How to begin? In the be authorized to function; to deal with the shortcomings eudract main page: https://eudract.emea.europa.eu/ and challenges of the research in a more efficient way, eudract/index.do. Go to “eudract number step 1”, including the active participation of the physicians them- click. apply for security code. …introduce your name selves; to organize trainings for the physicians within a and email and they send it to you a password for fur- more systematic environment; to deep the knowledge ther access. Go to “eudract number step 2”, click. of the laws, regulations and rulings of the judiciary that apply for eudract number. now, you have an official might have relation with the ozone therapy and how reference number for the trial! Go to “create new cli- them are implemented in the physicians’ daily life; to nical trial application”….and follow all the steps… know the international law that may have relation with Results/Conclusion: the final approval for a treat- the juridical status of the ozone in the countries, in par- ment in a clinical indication depends from the regula- ticular the legislation of the european Union; to make tory Medicines agency, and it is obtained in basis to cli- sure that the legal research has influence in the sugge- nical trials, better if randomized clinical trials. We have stions that the associations present to the authorities to walk together by this difficult but necessary journey. through drafts laws and/or regulations; to establish in which way the public and private health insurances and References the insurance companies are covering the ozone therapy; 1 Bocci et al. the ozone paradox: ozone is a strong oxidant to advise the associations to prevent them from provi- as well as a medical drug. Med res rev. 2009 Jul; 29 (4): ding legal information that is wrong. 646-82. review.

54 www.centauro.it International Journal of Ozone Therapy 10: 51-56, 2011

9 12,41-12,48 – Endurance tests: 1. nr. of swimming lanes. 2. cord jumping. Study of Treatment with Ozonized Measurements: all athletes were evaluated in 8 dif- Sunflower Oil Bioperoxoil on Lesions ferent times of the period of study: 1. before the treat- ment, 2. after the treatment, 3. every 4 weeks after the Induced in Diabetic Rats end of the treatment. M.t. Ferreira1, J. Meirelles1, M.s. lima2, K.l. rodrigues3, c. catelani-cardoso4, l.r. Ferreira5, r. dall’aglio4 Results 1 Graduating student of PUC-MG; Poços de Caldas, MG, Brazil In all the athletes involved in the study, the musco- 2 Post graduating student of Unifal; Alfenas, MG, Brazil 3 Department of Pharmacology, University of Milan, Italy lar enpowerment was increased immediately after the 4 Teacher at PhD of Pathology PUC-MG; Poços de Caldas, MG, Brazil treatment and this effect seemed to last for 16 weeks; 5 Post graduating student in laboratory animal science, USP; São afterwords, it seemed to disappear and previous condi- Paulo; SP Brazil. tion was restored. Very similar results were obtained in Key words: ozonized oil, cicatrizing activity, nosocomial all the other tests that were performed infection Discussion an ozonized sunflower oil, Bioperoxoil® was tested In our study, intravenous laser treatment seemed to for its healing properties on lesions in rats with induced be effective in sports medicine, even though we have to diabetic. the experimental diabetes was induced with 6 highlight that the number of cases was very small. In mg/kg IP of streptozotocina. Healing experiments were order to verify the plausibility of our findings, a deep carried out on Wistar rats with topical application of review of the medical literature on low lever laser 3.5 mg/ml of the ozonized oil during seven days after therapy (lllt) was performed and hypotheses were induced skin lesions. Bioperoxoil® formulation demon- made to better understand our results. strated protective effects on skin connective tissue and to enhance wound healing during the seven days of tre- References atment as compared to placebo and negative control. 1 F. raggi, G. Vallesi. Intravenous laser Blood Irradiation the overall results indicated an antimicrobial activity, in sports Medicine. schmerz & akupunktur 3/2008; 34: antiinflammatory and wound healing properties for the 126-129. ozonized oil Bioperoxoil®, as demonstrated by histolo- gical results. the ozonized oil results were always supe- rior but were statistically significant only regarding the stimulation of fibroblast number. 11 12,55-13,02 Zotero.org: the World Reference Database 10 12,48-12,55 in Ozonetherapy J. Baeza-noci Intravenous Laser Blood Irradiation in Orthopedic Surgeon Hospital Virgen del Consuelo; Valencia, Spain Sports Medicine F. raggi, G. Vallesi Terni, Italy Introduction during many years the lack of publications about Introduction: Many scientific papers have been writ- ozonetherapy (ot) and the great dispersion of them ten so far, showing biological actions and therapeutic have made very difficult the development of ot in the properties of intravenous laser blood irradiation; this scientific community using modern scientific criteria. new medical technology is currently used for the treat- this fact has been a personal concern during many ye- ment of different pathologies like rheumatic, cardiova- ars. this lead the author to create a personal database scular, pulmonary and neurological diseases. But, to our and, later, create the Zotero ot group. knowledge, no scientific works have been performed, so far, about laser blood irradiation in sports medicine. so, Goals we decided to perform a short study, in order to confirm create a reference database for ot publications the effects that had been observed in our patient. world wide that allow authors to upload the references of their publications and the researchers to find easily Materials and Methods the information for their work, so ot investigation can Study population: 4 male body building athletes were grow quicker. enrolled in the study. Mean age was 23,2. Treatment protocol: all athletes underwent 10 ses- Materials & Methods sions of intravenous laser blood irradiation. all athletes during the development of the first personal data- were invited to avoid any drugs or vitamins during the base, the author found another databased maintained period of study. by a Finnish chemistry doctor (Miika sallinen) in his Outcomes: the following outcomes were measured: personal web about ot. Unfortunately, this database – Maximum strength tests: 1. Pectoral muscle maximum was compiled using a word processor, so it was quite lifting power. 2. Weight lifting from the floor. 3. squat. useless for data mining.

55 Saturday April 16th, 2011 - Session IV - "Oral Comunications" Castagneto Room

some time later, the author found Zotero.org, an ferences or just propose one person of their team to open free database for references devoted to scientific upload them. anyone can use the database without re- research. after contacting with his Finnish fellow, both striction in reading mode. decided to use this free tool to unify both databases and Results create Zotero ot group. Zotero.org is a production of the center for History Presently, Zotero ot group has compiled more than and new Media at George Mason University. It is gene- one thousand references about ot, and growing. rously funded by the United states Institute of Museum We are waiting applications from all over the world and library services, the andrew W. Mellon Founda- to increase the number of references and help to upload tion, and the alfred P. sloan Foundation. Zotero.org is and maintain the database, specially from countries that designed not only to compile references and make ea- usually do not publish in journals indexed by popular sier researching but also include this references in the indexers like Pubmed or embase. scientific papers by using add-ins in the most popular Discussion and Conclusion word processors. authors can apply the ot group to upload their re- What are you waiting for apply?

56 www.centauro.it International Journal of Ozone Therapy 10: 57-58, 2011

Session IV Other Applications Satellite Symposia: * Ozone Therapy and Radiofrequency saturday, april 16th, 2011 • "Mille Miglia" Museum • castagneto room • 14,00-16,00

2 14,30-15,00 3 15-00-15,20

Treatment of Neuropathic Radicular The Effects of Sport Massage with Mineral Discogenic Pain with Pulsed Radiofrquency Oil, Ozonated Oil and Passive Recovery (PRF) on Dorsal Root Ganglion (DRG) and on Performace and Fatigue Perception in

Intradiscal O2/O3 Competitive Amateur Cyclists F. Parodi, G. Frigerio, c. reverberi a. Paoli

Key Words: radicular pain, herniated disc, PrF treat- Key words: massage, lactate, cyclism, ozone, heart rate ment, Intradiscal o2-o3 treatment Context: although few papers investigated the effects Introduction: the radicular chronic pain is present on of massage on recovery variables, there is a lack of data 9.9% of word population and is the mostly kind of neu- about the effects of massage with different kinds of oil. ropathic pain. Objective: to verify the effects of passive rest (Pr), the cause is often discogenic, from herniated disc or sports massage with commercial massage oil (cMo) bulging compression. or with ozonated oil - Bioperoxoil (oZo) on some phy- this review would to compare three groups of pa- siological and perceptive variables in cyclists. tients, with radicular discogenic pain treated with PrF Design: We used a model with 3 independent varia- on the dorsal root Ganglion (drG) and intradiscal bles: cMo, oZo, Pr and 4 dependent variables: blood o2-o3 for discolysis. lactate (Bl), feelings of fatigue measured with visual Method: three groups of 20 patients with chronic ra- analog scale (Vas), heart rate (Hr) and power output dicular disogenic pain had been considered and evalua- (P). subjects performed in laboratory three protocols in ted with a control group. three days. during each session subjects executed three the first one had been treated with PrF on drG bouts of all-out Wingate test followed by a recovery (l4-l5 and l5-s1) at 2 Hz, 10 ms, 45 volt, 250 ohm for period in one of the three different experimental con-

5 min. at every level, the second one with intradiscal o2- ditions. after recovery, a maximal ramp test was per- o3 at 27 mg/ml, volume 4 ml, plus intraforaminal o2-o3 formed. at 12 mg/ml, volume 4 ml and the third one with PrF Setting: department of Human anatomy and Physio- on drG plus intradiscal o2-o3 at the same conditions. logy, University of Padua the data was collect with somministration of the li- Participants: 15 competitive amateur cyclists kert scale at 7 point questionnaire before and at 3 and data collection and analysis: one-way anoVa and 6 months from the treatment. a repeated measures analysis of variance were used the statistical analysis had been done with the chi when appropriate. square test. Results: oZo results in a significant (p<0.002) de- Results: compared with the control group, we had crease in blood lactate concentration at minute 10 and observed a significative (p<0,005) reduction at 3 and 15 compared both to Pr and cMo, whilst no signifi- 6 months of the likert scale scorein all the patients of cant differences were detected between the latter. In group 1 and 2, without difference between them. the oZo session athletes reached a higher Pmax and In the third group, we observed a more strong reported a significant lower Vas compared to Pr and (p<0,001) reduction of likert score at 3 and 6 months, cMo (p<0.033). to compare with the control and 1 and 2 groups too. Conclusions: our data confirms previous findings Conclusions: the association PrF on drG with in- about the inefficiency of massage “per se” on the im- tradiscal o2-o3 seems to be a more efficacy treatment provement of performance and blood lactate removal in radicular neuropathic pain due at the herniated or and its slightly positive effect on the decrease of the fe- bulging disc compression. elings of fatigue. on the other hand, the use of ozonated

57 Saturday April 16th, 2011 - Session IV - "Satellite Symposia" Castagneto Room

oil during massage increased the blood lactate removal, these features show that it is possible to use both improving performances and reduced the feeling of fa- treatments in combination, in different fields, such as tigue during subsequent ramp test. orthopedics, internal medicine, gynecology, rheumato- logy, vascular, geriatric, and many others. oxygen - ozone therapy is done through the admi- 5 15,20-15,30 nistration of a mixture of two gases, at different levels and through different routes, mainly by injection, and Oxygen-Ozone Therapy and Ion Cyclotron generally, as well as other possible special uses (insuf- Resonance SEQEX flation, bagging, water and oil), while Ion cyclotron re- G. tabaracci, V. covi sonance seQeX is a technique in which therapy is best determined by the body itself: it applies to the patient the authors believe that the assessment of a patient by lying on a mat, which delivers electromagnetic waves should take place in the totality of the person, not just of different shape, intensity and frequency, by detecting for the reason of the submission to examination. and displaying the response of ‘body in order to select In general, in fact, the specific disease are associated frequencies that have produced an optimal effect for with other systemic diseases and secondary, which may the restoration of proper cellular homeostasis, then sto- be contributory cause and aggravation of the condition red in a card that will be used later to provide therapy. currently highlighted. during the course of therapy, further tests will be In addition, the patient often comes to observation performed to re-evaluate the Patient based on indivi- after undergoing numerous treatments, pharmacologi- dual response. the use of systemic therapy and without cal or otherwise, without having taken from them spe- side effects such as seQeX is therefore important to cial benefits, and therefore will be refractory to the use globally and deeply change the reactivity of the sick. of more conventional therapies. the criteria for selection of treatment to be applied to the possibility of using therapies without side effects, a given disease are based on the type of disease on clini- and action both targeted and systemic, it is therefore cal and instrumental evaluation, taking into account po- the most desirable, and this is done through the use of tential contraindications to either therapy, such as into- oxygen - ozone therapy and Ion cyclotron resonance lerance invasiveness, as regards the oxygen - ozone, the seQeX. presence of peace - maker of serious heart disease or in Both therapies have anti-inflammatory, analgesic and the case of seQeX, and gestational status in both cases. anti-edema, are able to modulate the immune system seQeX therapy is also recommended as a first step in and reactivate the microcirculation. prediction of treatment with oxygen - ozone, or in con- In addition, the oxygen - ozone therapy acts as an junction with it. antiviral, antibacterial and antifungal, is drying on the Given the synergy and the respective power between intervertebral nucleus pulposus, has revitalizing action the two treatments is preferable to involve them in all on tissues and direct neurotrophic, while Ion risonance cases where it is possible, as in patients with specific di- stimulates tissue repair and metabolism. seases associated with multidistrict diseases.

58 www.centauro.it International Journal of Ozone Therapy 10: 59-61, 2011

Parallel Session Veterinary Medicine

Moderators: G. Penocchio, a. corradi saturday, april 16th, 2011 • "Mille Miglia" Museum • san Paterio room • 14,00-16,00

1 9,10-9,40 thritis can be: primary (idiopathic) or secondary (in dy- splasia, trauma, functional overuse, arthritis, congenital Practical Applications of Oxygen-Ozone diseases, etc.). the etiology is probably multifactorial. Therapy in Equine Orthopaedics to be considered are predisposing risk factors such as: age, heredity, mechanical factors (articular malposition a. Vigliani or deformities, joint instability from ligament hyper la- xity, occupational and sports injuries), sex, obesity, and the author considers the more important orthopae- inflammation. the excessive workload, which would be dic pathologies in equine medicine, in which oxygen- subject to the joint, the predisposition, the release of ozonetherapy is used. In particular he studies the treat- inflammatory cytokines by the synovia (which is often ment of ‘backache’. dense), a synovial liquid lubricant synovial fluid poor of hyaluronic acid, would bring the chondrocyte, suffering, unable to replace the damaged extracellular matrix. In 2 9,40-10,10 addition, the synovial fluid produced would be of an altered composition because of the material resulting Oxygen-Ozone therapy in from cartilage degeneration. Neurological Patient as a macroscopic result we have: loss of evenness, the H. Giuliano appearance of fissures and ulcers with the surrounding cartilage yellowish, frayed and velvet like and cartilagi- this relation aim to explain how ozone can be es- nous neoproduction in areas not subject to load (with sential in the healing of a neurological lesion and in the subsequent formation of osteophytes and ossification rehabilitation of a neurological patient. enchondral). the subchondral bone alterations invol- due to his anti-radical propierties, his metabolic sti- ved include: sclerosis in areas under load to increase the mulation and immunostimolation effect, ozone is an thickness of the trabeculae, eburnation or thickening of important Factor in the healing process. the bone that serves as the articular surface when the the oxygenation effect on the muscle is very impor- cartilage has disappeared and formation of osteophytes tant in physiotherapy. in areas not subject to load. combination of traditional therapies with oxygen- the capsule undergoes thickening and fibrosis re- ozone therapy can reduce the time of recovery and can sulting in functional limitation and impedes the venous avoid complication of immobility typical in neurological and lymphatic drainage. the principal symptom is the patient. pain caused by movement. objective articular indica- this relation presents clinical cases in which oxygen- tions: hard tumefaction for osteophytes and soft when ozone therapy has been used during the rehabilitation. deposits are present, skin rarely hot and flushed, loca- lized tenderness. distinct irregularities of crepitation when palpating, in movement and in the articulation. deformation in the late phase. 3 10,10-10,40 radiological examination showed a reduction in joint space narrowing, subchondral sclerosis, osteo- Infiltrative Treatment with Oxygen-Ozone phytes, and less frequent erosions. the general therapies in Subjects with Osteoarthritis are rest associated with pharmacotherapy, rehabilitative e. smadelli therapy and surgery. Pharmacotherapy: osteoarthritis (oa) is a chronic joint disease marked 1. Fast-acting symptomatic drugs (nsaIds, analgesics). by degeneration of the cartilage and bone of the joints 2. slow-acting antiarthritic symptomatic drugs (galacto- characterized by lesions in joint cartilage and changes saminoglucuronglycan sulphate, chondroitin sulphate, in the bone underlying the articular margins. osteoar- glucosamine sulphate, hyaluronic acid.

59 Saturday April 16th, 2011 - Parallel Session - "Veterinary Medicine" San Paterio Room

3. chondroprotection drugs. Intervertebral disc herniation is common in dogs. 4. surgical remedies are corrective (for deformations two differing pathophysiologic mechanism are descri- and misalignments) and substitutive (prostheses for hip bed. In Hansen type I intervertebral disc herniation, and knee and elbow). the nucleus polpousus undergoes chondroid degenera- Inspired by the data emerging from the literature on tion and subsequent mineralization. therapeutic effectiveness of intra-articular and para-ar- the annulus fibrosus weakens, and disk material can ticular infiltration of o2-o3 in humans, we actualized in extrude into the vertebral canal causing an acute neu- the period January 2005 to december 2010 a study con- rophaty. chondrodistrophic breeds are most commonly sisting of 32 patients suffering from degenerative joint affected. In Hansen type II intervertebral disc hernia- disease and inflammation an intra-articular infiltration tion, the annulus fibrosus undergoes progressive thicke- of an oxygen-ozone gas mixture. We have treated 30 ning due to fibroid degeneration. this lead in a progres- dogs and two cats suffering from severe arthritic disease sive protrusion of the affected disk into the vertebral with oxygen-ozone, using 40 mm 22g needles, injecting canal with subsequent spinal cord compression. 5-10 cc. gas mixture at 25 µg/ml, after sedation. It was taking inspiration from the human literature on the thought to use ozone oxygen therapy for several rea- effectiveness intraforaminal injection ozone therapy, 78 sons: subjects unresponsive to medical therapy, subjects dogs suffering from herniated discs were treated in the who could not be subjected to any kind of surgery whe- period January 2003 - december 2010 (16 cervical and ther for anesthetic risks or for economic reasons, or for 62 lumbar), with infiltration intraerniaria and / or intra- almost certain absence of surgical results. foraminal gaseous mixture of oxygen-ozone ct-guided. the dogs treated were subjects with differences of after general anesthesia dogs with disc herniation were race and age and diversity of localization. as a result of treated with oxygen-ozone 22G needle under ct gui- our case histories, it was possible to ascertain that the dance with 9 cm. o2-o3 therapy reported a significant improvement in Were injected 10 cc. gas mixture at 25 µg/ml. the de- symptoms with the disappearance of the main symptom scent of the needle was monitored with ct, which were of lameness following an administration in 6 subjects then repeated ct scans to monitor the precise distri- (20%) after about 36-48 hours, 15 (50 %) subjects af- bution of the gas mixture. In our series, we found that ter two administrations of o2-o3 and 6 subjects (20%) treatment with o2-o3 has favored a quick resolution in the third administration of o2-o3. In 3 (9%) subjects of pain and rapid recovery of neurological objectivity the injection of o2-o3 had no obvious effects, except a negative in 54 patients (69%), which allowed discharge reduction of pain. patients within 48h. In the remaining 24 cases in 6 regarding the two cats undergoing ozone therapy, (7.5%) was successfully repeated the treatment, while we had a very noticeable improvement within 48-72 in 18 (23%), has resorted to surgery because the ozone hours and an almost total absence of symptoms in both had no symptomatic benefit. cases after about seven days. In light of the results obtained in most cases it was With arthritis the ozone treatment produces fairly necessary to confine the patient, but only to reduce his good analgesic and anti-inflammatory effects. clearly physical activity with consequent benefits for the dog to it is not a pathology that cures the problem for which the pet owner, as no doubt save money. the cycle of ozone therapy is applied. Moreover it does We believe that this therapy is a good alternative to not preclude other therapies including pharmacological, traditional surgery. and should be repeated during the acute phases where it helps significantly to attenuate the pathological pro- cess and the pain. It is injected intra-articular and peri- articular. 5 11,30-12,00 In light of the results obtained we can take into con- Ozone Treatment in Dairy Cow Mastitis sideration the utilization of the o2-o3 therapy in situa- tions where conventional therapies, such as medicinal P. scrollavezza or surgical cannot be utilized for various problems. Department of Clinical Science, Study University of Camerino; Camerino, Italy

considered germicidal, metabolic and immunomodu- 4 10,40-11,10 lant properties of ozone and the standardization of the methodical therapeutics in human medicine, we wanted CT-Guided Intraforaminal Oxigen-Ozone to study the effects of ozone on common bovine patho- Treatment for Disc Herniation in the Dog logies, particularly mastitis. c. dimauro since 1993, we have been treating streptococcal, stha- Clinica veterinaria S.Antonio; Salò, Brescia, Italy phylococcal, coliform, pseudomonas, corynebacterium pyogenes and mycotic mastitis with local ozone insuf- the author evaluated the results of the therapeutic flation associated or not with ozonized autoemotherapy. efficacy of computed tomography (ct) guided intra- the ozone treatment can cure all kinds of mastitis and foraminal oxygen-ozone therapy in the treatment of sterilize the milk that can be shortly after used in the disc herniation in dogs, as an alternative to conventional derivates processing, butter and cheese. Furthermore, methods commonly used in veterinary medicine. we observed a decrease in the number of the milk leu-

60 www.centauro.it International Journal of Ozone Therapy 10: 59-61, 2011

kocytes cells and an increase of milk production in cows group: Group a contains cows treated with ozonated oil treated with ozonized autoemotherapy from 5 to 30%. foam at day 1 and at day 5; Group B or control group author also reports the results of ozone treatment was treated with oxytetraciclines at the same days. and the administration route in different situations. In the same way other 50 cows affected by endome- tritis were enrolled and divided in two groups: Group c contains cows treated one shot with ozonated oil foam; 6 12,00-12,30 Group d or control group was treated with oxytetraci- clines at the same days. Efficacy of an Ozonated-Oil Foam in the all the cows were sampled before every treatment Treatment of Metritis and Endometritis in to understand what kind of bacteria were involved in the pathologies; all the cows showed the presence of Dairy Cows. A Field Experience streptococcus spp; staphylococcus spp and for some ca- M. ablondi, B. Pogliacomi ses of metritis corynebacterium Pyogenes. Studio Veterinario “Pogliacomi-Ablondi” all the cows of the fourth group recovery after the treatments without any significant differences between Metritis and endometritis are worldwide one of the the two treatement protocols. most expensive voice for dairy Farmers. Genetic Fac- these results shows as ozone therapy with ozona- tors; environment and management are the main causes ted oil applied on cows with Metritis and endometritis inducing these pathologies. might be effective, harmless and can be administrated the authors would like to verify the efficacy of a treat- without the risk of antibiotic resistance or hypersensi- ment based on the intrauterine infusion of an ozonated-oil tivity in animals. foam (riger spray©) for the treatement of these diseases’. also in the perspective of animal Welfare and food In a large farm (1000 milking cows) in the northern safety ozone therapy guarantees a sufficient level of of Italy 50 cows affected by Metritis were divided in two safety for animal and for consumers.

61 www.centauro.it International Journal of Ozone Therapy 10: 63-69, 2011

Posters Session

Moderators: a. stafa

From thursday 14th to saturday, april 16th, 2011 • "Mille Miglia" Museum • Mazzotti room

1 when performing daily tasks such as turning a key, ope- ning a car door, picking up a book or threading a nee- Monolateral Sciatalgia Associated with dle. sufferers tend to drop objects and perceive a loss of Contralateral Gonalgia: Treatment with strength between thumb and index finger. rhizoarthoro- sis commonly affects one side. Oxygen-Ozone Therapy the joint deformity is very painful and may even pre- a. Fontana, M. Bonetti, G. d’orta vent sleep. It is invalidating as normal thumb function, Neuroradiology Service, Brescia City Hospital such as gripping and fine joint movements like drawing and embroidery, are impaired with a major impact on the onset of monolateral sciatalgia secondary to patients’ quality of life. disk protrusion or herniation giving rise to nerve root conservative management includes administration compression in the lumbar plexus often leads to antal- of anti-inflammatory drugs, splints to temporarily im- gic scoliosis. the posture is automatically adopted by mobilize the joint, or intra-articular cortisone injections. the patient to avoid weight-loading on the painful or a specific palmar splint may be of therapeutic use to hyposthenic limb caused by the mechanical compres- block the joint, at least at night. analgesics like parace- sion of the herniated disk. this posture overloads the tamol and non-steroidal anti-inflammatory drugs may controlateral leg frequently resulting in gonalgia due to also be useful in the most painful stages. local treat- excessive weight on the joint. ment with hyaluronic acid injections has also proved this study describes the treatment of patients with effective. When conservative management fails surgery gonalgia following epidoes of monolateral sciatalgia by is indicated, the procedure of choice being biological peri-articular injection of an oxygen-ozone gas. twenty- arthroplasty. six patients were treated for unilateral lumboscialtalgia We describe our experience treating rhizoarthrosis by administration of ten oxygen-ozone injections twice with oxygen-ozone administration. We treated 68 pa- weekly. When pain resolved in the limb affected by tients between March 2008 and december 2010. We the discal pathology, the patients reported the onset of used 25 G 5/8 orange colour code terumo needles in- knee pain in the healthy limb. Having ruled out meni- jecting an oxygen-ozone mixture at a concentration of scal or ligamentous injury by Mr scan, patients were XX/25 µg/ml?) (inserire dettagli dosaggio o2-o3) di- offered oxygen-ozone injections to treat knee pain. rectly into the trapeziometacarpal joint. the first treat- Patients received six subcutaneous peri-patellar trigger ment was always performed under ct guidance to en- point injections twice weekly with an oxygen-ozone sure perfect joint access and control the distribution of gas mixture at a concentration of 25 µg/ml using 27 G the gas mixture. Mesorelle® needles. at one month follow-up after tre- once the correct entry point had been identified it atment all patients reported a clear-cut improvement of was marked on the skin with a dermographic pencil and pain with recovery of a correct posture. this point remained constant for subsequent treatments. the natural anti-inflammatory effect of oxygen- on average six to ten oxygen-ozone injections were ozone make it an effective therapeutic option in the tre- made twice weekly depending on severity: 24 patients atment of patients with gonalgia secondary to antalgic had six treatment sessions, 33 had eight and the remai- scoliosis, thereby avoiding drug management. ning 11 had ten injections. as the area to treat is highly sensitive, local anaesthesia was administered by ethyl chloride spray. 2 Injections were well-tolerated by all patients. all pa- tients underwent clinical follow-up one month after the Rhizoarthrosis: Our Experience with end of treatment. among the 68 patients treated, clini- Oxygen-Ozone Treatment cal outcome was excellent in 46 (68%) and satisfactory M. Bonetti, M. Moretti, G. Guarino, G. Bragaglio in 14 (20%) whereas no clinical benefit was obtained in Oberdan Specialist Centre; Brescia, Italy the remaining eight patients (12%). although ours is a small cohort, oxygen-ozone tre- rhizoarthorosis consists of degenerative arthritis of atment of trapeziometacarpal rhizoarthrosis appears to the base of the thumb. the condition mainly affects wo- be a valid alternative to nsaIds and/or steroids espe- men over the age of forty with pain at the thumb base cially in the early stage of illness.

63 From Thursday 14th to Saturday April 16th, 2011 - Posters Session Mazzotti Room

3 25 G needles injecting 2 cc of an oxygen-ozone gas mi-

xture (XX/25 µg/ml?) (inserire dettagli dosaggio o2-o3) Oxygen-Ozone Treatment of Fibromyalgia into each point in the paravertebral cervical spine. the a. Zambello, M. Bonetti, G.M. ottaviani clinical outcome was satisfactory in ten out of 16 patients Oberdan Specialist Centre; Brescia, Italy treated, relieving the problem of fatigue and tiredness accompanied by headache. a clinically excellent out- Fibromyalgia (FM) is a little-known painful and inva- come was achieved in the remaining six patients: bilateral lidating syndrome. diagnosis may be arduous or conver- cervicobrachial pain and chronic fatigue disappeared in sely too easy. the condition has been studied for years one 56-year-old woman who had no signs of anxiety or and many associations are battling to find a definitive depression. the remaining five patients had no clinical cure. current medical management affords only tempo- improvement. although our cohort is too smalll to be si- rary or partial relief of symptoms. FM is classified among gnificant, we believe oxygen-ozone therapy administered the functional extra-articular rheumatisms. the condition by aHt and associated with local ozone treatment when is characterized by chronic diffuse musculoskeletal pain indicated is a highly valid treatment for FM patients as and tender points. FM is confined to a small percentage it lacks side-effects and contraindications and does not of patients, whereas the majority have one or more so- interact with concomitant medications matoform disorders not readily distinguished from FM proper. FM patients are in constant pain, unaware of the causes of their condition and convinced of some specific 4 impairment that can be cured by drug treatment. Un- less the problem is tackled by doctor and patient alike, Ozonized Sunflower Oil Associated to the truth is unlikely to be accepted by either party. at Lipoic Acid in the Prevention of Muscle onset FM symptoms do not give rise to depression, but Fatigue in Fomula 1 Race Pilots a behaviour and conviction (reinforced over time) that 1 1 2 make sufferers feel chronically deluded and the victims c. catela-cardoso , r. dall’aglio , d. rimonti , K.l. rod- rigues3, l.r. Ferreira4 of other people’s unfairness. their stories often refer lack 1 of affection in their families, abandonment and a lack Department of Pharmacology, University of Milan, Italy 2 Graduate Student in Science of Nutrition; 3 Laboratory of of undertsanding at work and in their personal lives. as Biochemistry and Physiology, Unifal; Alfenas, MG, Brazil; Msc. pain symptoms worsen, patients start to search for causes Student in Physiologic Science; 4 Associate Professor, PUC- visting one doctor after another and becoming depres- Minas University; Poços de Caldas, MG, Brazil sed and cyclothymic with short periods of well-being in- Key words: ozonized oil, muscle, fatigue. terspersed with periods of acute pain. this is why anti- depressants have always been given to FM patients the Formula 1 pilots are exposed to extreme conditions world over. However, old and new antidepressants only and must support up to two hours of muscle endurance affect mood offering patients poor pain control, and the and resistance facing an approximately weight force symptoms accompanying pain strengthen the conviction of about 4 gauges. Pilots were evaluated in this study that FM sufferers have a systemic condition. Yet no FM regarding cardiac frequency and lactic acid levels, be- patients have a systemic illness and blood tests and in- fore and after the race. two groups of three pilots were strumental diagnostic investigations are normal. their studied. one received an inert cream (placebo) and the pain and mental distress, however, are real and compro- other received a cream with ozonized sunflower oil plus mise patients’ social lives. the cause of FM is currently lipoic acid (Bioperoxoil®) as active component. Both unknown and no biochemical markers are available. the groups received 4 g of cream, distributed in the region condition comprises a set of symptoms shared by other of the arms and forearms. the average elevation of lac- diseases. the most striking features of FM are pain ac- tic acid level in the control group (108%) was higher companied by cognitive dysfunction with deficits in short than the treated group (15,42%), compared to their but not long-term memory, impaired concentration, sud- basal levels. no pilots, in the treated group, overcome den changes in mood varying with the weather, etc. FM their aerobic limit, whereas, in the control group, two almost always affects women (M/F = 1/9) namely the 20- pilots overcome their aerobic limit. cardiac frequency 55 year-old age group. there is no known cure or uni- presented no significant changes between the two stu- versally accepted treatment for FM and many alternative died groups. those findings suggest the potential of the and complementary therapies have proved successful Bioperoxoil® in prevention of muscle fatigue. including massophysiotherapy, acupuncture, chiropractic therapy, osteopathy, tens etc. In the last three years we have observed 16 patients classified as FM. aware of the 5 clinical difficulty in managing such patients, we devised a treatment protocol administering oxygen-ozone therapy Revision to 11 Years in Case of a Herniated by auto-haemotransfusion (aHt). the idea stemmed Disc Ejected at L4-L5, with Migrated Disc from the excellent results of aHt on pain and mood and in the treatment of chronic fatigue reported in the lite- Fragment, and Herniated Disc Ejected rature. We administered a cycle of ten weekly treatment at L5-S1 with Paraparesis and Cauda sessions. twelve patients also received targeted ozone Syndrome, Treated with Paravertebral injections into the tender points. In particular we used Infiltration of Oxygen-Ozone

64 www.centauro.it International Journal of Ozone Therapy 10: 63-69, 2011

G. tabaracci, V. covi adjunct is well established and is being vigorously pur- sued by many scientists and clinicians. as technology We report the clinical and instrumental history of a advances, undoubtedly new techniques will enlarge in patient who presented to our observation in 2000 for the scope of the effective use of this versatile modality. a herniated disc ejected at l4-l5, with migrated disc fragment, and a second herniated disc ejected at l5-s1, associated with cauda equina syndrome. 7 a few hours after the first session of oxygen-ozone therapy, the Patient showed a marked improvement in Our Experience of Oxygen-Ozone Injection low back pain relief, increased strength of the extensors Into the Interspinous Ligament of the feet and the disappearance of the cauda equina M. Bonetti, a Fontana, G.M. ottaviani syndrome. after two more sessions, after 10 days of tre- Neuroradiology Service, City of Brescia Clinical Institute; atment course, the subjective and motor symptoms and Brescia, Italy appeared completely regressed. Further assessment at the end of the cycle, the patient showed recovery from a recent advances in neuroimaging, namely spine ima- clinical point of view and a gradual return to normality ging with Fat-sat sequences after gadolinium admi- of the picture observed in MrI. nistration, have shown that inflammation of the inter- the controls at 6 months, 18 months 7 and 11 years, spinous ligament may be responsible for low back pain. show the long-lasting condition obtained, as highlighted Baastrup syndrome, a condition described by the da- in the MrI performed more recently, where you can ap- nish radiologist christian Baastrup in 1933, also known preciate the stabilization of the situation at the level of as “kissing spines” is characterized by arthrosis of the l4-l5 discs and l5-s1. Is also noted that the l3-l4 disc adjacent facet joints of the spine leading to the forma- has not been over the years undergone changes, com- tion of false joints. chronic inflammation of the inter- pared to the situation of initial presentation. oxygen- spinous ligament in Baastrup syndrome is responsible ozone therapy may therefore be a valuable therapeutic for pain refractory to the usual treatment with anti-in- option in the presence of herniated discs and accom- flammatory drugs and analgesics. panying symptoms causing paresis, thanks to the posi- this paper describes the diagnostic and therapeutic tive results obtained and maintained over time. work-up leading patients with a diagnosis of interspi- nous ligament to undergo oxygen-ozone treatment with targeted injection of the gas mixture directly into the 6 interspinous ligaments and paravertebral musculature. all treated patients (24) presented pain in the medio- Biological Effects of Oxigen Ozone Therapy inferior dorsal and lumbosacral spine with pronounced arthrosis associated with antalgic contracture of the in Our Body paravertebral musculature. diagnosis had been establi- G. tabaracci, c. capuano, c. capuano, G. tabaracci shed by Mr scan of the lumbosacral spine with Fat- sat sequences after gadolinium administration. treat- How ozone acts and exerts therapeutic effects? ment comprised 5cc injections of an oxygen-ozone gas Has ozonetherapy a future in medicine? mixture at a concentration of 25 µg/ml into the inflamed ozonetherapy can be considered as a complemen- interspinous ligaments using 23 G needles. When mar- tary medical approach, today? ked facet joint encraochment was present bilateral pa- Has ozone biological effects? raspinous injections were made. What are? treatment benefit was almost immediate and persi- these and other questions we ask many ourself many sted at two-month outpatient follow-up. oxygen-ozone times because the biochemical relationship among therapy proved an effective treatment option for in- ozone and body fluids is very complex and it’s no easy flammation in the interspinous ligaments, relieving pain to understand biological effects step by step. often we and reducing the antalgic contracture of the paraverte- know many clinical improvements of our patients but bral musculature. we need to demostrate the mechanism of the action of ozone on blood cells. the therapeutic use of ozone has an excellent safety 8 record and there have been no toxic effects observed from proper clinical use. endovenous ozone therapy Resolution of C5-C6 Herniated Disc decreases blood cholesterol levels and stimulates antio- xidative respons in patients affected by heart disease. Following CT-Guided Oxygen-Ozone extracorporeal blood oxygenation and ozonation is Injection. MR Follow-up at One Month much more effective than prostacyclin for treating skin G.M. ottaviani, M. Bonetti lesions in peripheral artery disease. ozonized autohe- Centro Polispecialistico Oberdan; Brescia, Italy motransfusion may be useful to improve both the poor rheological properties of the blood and the oxygen de- We describe a male patient with c5-c6 herniated livery to tissues in patients suffering from peripheral disc with deficits in the left c6 distribution territory. occlusive arterial disease. the use of ozone as a healing symptoms included motor deficit in the deltoid and

65 From Thursday 14th to Saturday April 16th, 2011 - Posters Session Mazzotti Room

brachial biceps muscles and sensory deficit on the radial 9 side of the hand (1st and 2nd digits) associated with loss of the biceps reflex. the deficits resolved completely A Case of Pancreatic Cancer Treated with following oxygen-ozone injection using the “ct-guided Temozolomide and Polyatomic Liquid intraforminal technique” with Mr follow-up after one Oxygen by Continuous Venous Infusion month. 1 2 a 44-year-old man came to our observation on 27th G. Barco , c. adamo July 2010 presenting left cervicobrachial pain charac- 1 Chairman Eumedica Ozono; 2 Chairman SIMPe terized by loss of strength and paraesthesias in his left arm. clinically the deficit was assessed in the distribu- the pazient F.V. a man of 78 years, was diagnosed tion of the left c6 with motor deficit of the deltoid and with a nodule at the head of the pancreas (35×23 mm brachial biceps muscles and sensory deficit on the ra- by ultrasuond on 21/08/2007 and by contrast ct scan on dial side of the hand (1st and 2nd digits) associated with 28/08/2007 54×38×34 mm) with involvement of mesen- disappearance of the biceps reflex. an Mr scan done teric artery and vein. elsewhere on 14th april 2010 disclosed a large c5-c6 left Given his age, and the high anestetic risk, and the lo- paramedian disc herniation. cal extend of the disease, which necessitated a long in- Given the severity of the patient’s symptoms, the cli- tervention, a surgical operation was non recommended. nical examination and Mr evidence, a neurosurgeon the patient was proposed treatment with temozolo- had advised the patient to undergo surgery without mide 150 mg/day on an empty stomach between meals delay. the patient, however, declined and came to our with simultaneous continuous central venous infusion observation requesting oxygen-ozone therapy. after si- of polyatomic liquid oxigen (oPl®) with 25mg hours of gning his informed consent the patient underwent ct- superoxide ion (2.5 ml/h). guided intraforaminal injection of oxygen-ozone at a the pazient accepted the treatment, a Porter type concentration of 20 mg/ml administering 2 cc of the gas chatheter was positioned to allow central venous con- mixture through a 22G needle. tinuous infusion of the oPl® and treatment began on the patient was examined clinically two hours la- 3/10/2007. ter and reported a marked improvement in pain with after 3 cycles of therapy, a check was made that sho- a clear-cut increase in strength. clinical follow-up after wed a reduction in the nodule size (45×40 mm ct on ten days showed a complete resolution of pain and pa- 19/12/2007, 30×24 mm ultrasound on 11/1/2008). raesthesias and a full recovery of his motor deficit. the Five further cicles of therapy were given and the patient is not taking any pain-killers or anti-inflamma- size of the nodule was reevaluated (tac on 29/05/2008 tory drugs. Mr follow-up scan on 10th september 2010 43×39 mm, ultrasound scan on 25/08/2008 25×22 mm, documented a complete disappearance of the c5-c6 Pet on 24/9/08 of the nodule at the head of the pan- disc herniation. clinically the patient currently has no creas with sUV max 3). complaint. the Patient continued the therapy and the case sta- our patient presented severe clinical and neurosurgical bilized with the dimension of the nodule uncharged symptoms for which the only therapeutic option to date after follow up checks (01/09/2010 ultrasuond, rMn has been surgery. 12/09/2009). Having seen the patient’s clinical records, we doubted In January 2010 the patient had high temperature so whether oxygen-ozone injection would have helped alle- that it was necessary to remove the venous catheter and so- viate the patient’s symptoms. It was only at the patient’s spend the continuous infusion of oPl® and the treatment. insistence that oxygen-ozone therapy was attempted. Ultrasound scan, tac and Pet checks did not de- Following treatment, the patient rapidly improved sur- tect changes in the case so that it was decided, with the prising both our team and the neurosurgeon, thereby pazient agreement, to discontinue the therapy and mo- ruling out surgery. His clinical improvement was in line nitor the situation whith the intention of resuming the with Mr evidence of a complete disappearance of the therapy in case if recurrence. treated disc herniation at one month follow-up. subsequent checks performed up to october 2010 We emphasize the safety of oxygen-ozone therapy as have non shown changes in the case. opposed to herniectomy too readily suggested by the neurosurgeon. this is a common occurrence in daily cli- 10 nical practice where all the risks of surgical intervention are seldom entertained. these include anaesthesia risks, the possibility of hernia recurrence, perimedullary and Non-Invasive Approaches to Back Pain periradicular adherences and, last but not least, hospital in Patients with Somatization admission and a varying period of convalescence and ab- a. Bariselli, M. Bonetti sence from work. Oberdan Surgery; Brescia, Italy We suggest oxygen-ozone treatment should always be considered a first therapeutic approach to these patients somatization implies a tendency to experience and as it has been shown to alleviate cervical pain compli- communicate psychological distress in the form of so- cated or not by brachial pain and to impact on the her- matic symptoms and to seek medical help for them. so niated disc itself as widely documented in the literature defined, it is neither a disorder nor a diagnostic category (19-23). but a generic term for a set of experimental, cognitive,

66 www.centauro.it International Journal of Ozone Therapy 10: 63-69, 2011

and behavioral characteristics of patients who complain treatment cycle consisted of 12-15 sessions divided into of physical symptoms in the absence of relevant medical three a week for two weeks then twice weekly. the low findings. In our work at the oberdan surgery we have initial ozone concentration was due to the constant pre- noted that patients trated for back disorders, namely sence of hyperalgaesia or allodynia. the needles used low back pain, presents diseases that often cannot be were 25-30 gauge 0.5×16 mm and access points varied fully explained by a general medical condition or dia- from three to five depending on diffusion of the gas mix- gnostic tests even though they have painful symptoms ture. the average duration of therapy was six weeks. the resistant to treatment. the most common concurrence treatment was well-tolerated except for mild discomfort of somatization is with affective and anxiety disorders, in the first sessions; no patient dropped out of the study. and, to a lesser degree, the somatoform disorders. it is during the study we monitored the nrs trend for assumed that a certain percentage of these patients may pain and changes in hyperalgaesia/allodynia on a se- present strong somatoform disorders associated with mantic scale from 0 to 5. at the end of the treatment anxiety. cycle an nrs 0-2 and a value between 0 and 1 on the the hypotesis is linked to the fact that chronic disor- dyaesthesia scale were deemed positive. eighty percent ders are often correlated to somatization and hypochon- of patients had a positive response to treatment: ave- dria. this study set out to demonstrate that the use of rage initial nrs 8, after two weeks 4.3, final 2; dyae- non-invasive techniques like intensive short-term dina- sthesia scale initial average value 4.1, after two weeks mic psychotherapy (IstdP) and relaxation techniques 2.6, final 1.6 (values relative to all ten patients). at two- can yield satisfactory outcomes in terms of quality of life month follow-up these outcomes were maintained with linked to the underlying disorder and general state of complete functional recovery and a normalization of health. Persistent somatization poses a serious clinical, skin sensitivity. social, and economic problem and hence early identifi- although ours is a small well-selected cohort, the cation of potential chronic somatizers should be attem- results of oxygen-ozone therapy were positive. In ad- pted to avoid its development. etiology of somatization dition to pain control, the treatment normalized local is multifactorial and so should be its management. autonomic system activity and resolved the neuropathic component. opiate and antidepressant administration also proved a valid treatment adjunct. as oxygen-ozone is a safe well-tolerated treatment 11 method it is indicated in similar cases of sympathetic hyperactivity as an alternative to more aggressive tre- Oxygen-Ozone Therapy Treatment of atments such as anaesthetic block of the autonomic Algodystrophic Joint Pain nervous system or anaesthesia with guanetidine, a drug a. Gjonovich*, G. Fiore** currently unavailable in Italy. * Specialista Anestesia Rianimazione, Terapia del dolore; Padova, Italy ** UOS Terapia Antalgica; Monselice Usl 17,Padova, Italy 12 We assessed the efficacy of oxygen-ozone injections for post-traumatic algodystrophic joint pain resistant to Hyperalgic Shoulder: Clinical Experience treatment. Combining Oxygen-Ozone Therapy ten patients were enrolled in the study. all patients had suffered a traumatic injury involving contusion and with Anaesthetic Block of the distorsion at least six months earlier without injury to Suprascapular Nerve either bones or ligaments. trauma affected the ankles a. Gjonovich*, G. Fiore** in seven patients and the knees in three. all patients * Specialista Anestesia Rianimazione, Terapia del dolore; Padova, Italy had Mr evidence of algodystrophy and all had severe ** UOS Terapia Antalgica; Monselice Usl 17,Padova, Italy pain (nrs > 7) associated with severely impaired joint function. locally the lesion site showed subcutaneous oxygen-ozone injections have long been usd to treat swelling and oedema often associated with acrocyanosis painful shoulder resistant to treatment, yielding excel- and/or pallor: all patients had sensory impairment (se- lent outcomes in terms of pain control and functional ven hyperalgaesia; three allodynia). symptoms indica- joint recovery with success rates of between 65 and 70%. ted both sympathetic hyperactivity and a neuropathic our study investigated how oxygen-ozone injections component. all patients were treated with a combina- combined with anaesthetic lock of the suprascapular tion of morphine (oxycodone sr 10-20 mg/die) and an nerve impacts on pain resolution. antidepressant (agomelatin 25 mg/die) throughout the We enrolled 40 patients with painful shoulder lasting treatment cycle (agomelatin was continued for 30 days at least three months with severe pain (nrs > 7), at le- after the end of the oxygen-ozone injections). all pa- ast 50% loss of joint function and (partial) lesional dege- tients had undergone the usual drug and rehabilitation nerative disease involving at least the supraspinatus mu- protocols without success. scle. all patients had already undergone a physiotherapy oxygen-ozone therapy was administered by periarti- protocol and the usual infiltrative techniques. the 40 cular injection at an initial concentration of 3y/ml rising patients were divided into two groups treated as follows: to 10y/ml, while the amount administered varied from a) oxygen-ozone injection alone; 30 to 60 ml depending on the joint to be treated. the B) oxygen-ozone injection and suprascapular nerve block.

67 From Thursday 14th to Saturday April 16th, 2011 - Posters Session Mazzotti Room

the periarticular infiltration technique was used with the ozone is an useful treatment for the management anterior, lateral and posterior access injecting 5-10 ml of lumbar disk herniation. o2-o3 seems to play a role of the gas mixture into each site at a concentration of in pain relief too. It also stimulates the immune system 10 y/ml. suprascapular nerve block was done according with concomitant anti-inflammatory and neoangiogene- to the Moore technique administering 5-10 ml 0.5% bu- tic effects and can directly affect substance P and no pivacaine. Patients were treated twice weekly up to a and stimulate IGF1. In situations of high circulating maximum of ten treatment sessions. peroxides levels as in diabetes, senescence, and rheu- Pain was monitored by periodically noting the nrs matic diseases with discal entrapment, only repeated and assessing the percentage recovery of joint function. local applications of ozone associated to simultaneous at the end of the study the success rate was virtually systemic administration by rectal insufflations or major identical in the two groups: group a 75%, 70% group B. autohaemotransfusions will fully develop its metabo- the interesting finding was that pain relief in the group lic effects such as: the production of key enzymes (like treated with anaesthetic block occurred sooner and was GPX, or 2,3-dPG, releasing oxygen from erythrocytes), reduced by 40% at the third treatment session. By the cytochines like cytochine gamma interferon (gIFn) and eighth session outcomes were identical. In terms of fun- Il8, the induction of lipoic acid (ala) synthesis (con- ctional joint recovery, group B had 80% joint function at tributing to reduce lactic acid) 5. case report: a 83-year- the sixth treatment session against 60% in group a. By old woman with an untreatable lumbosacral pain and the tenth session outcomes in both groups were identical. multiple radiculitis looked for ozone therapy assistance. all patients completed the study and no major side- Her radiculitis were caused by lesions that comprise l1 effects or adverse events were recorded. the treatment until the s1 vertebrae. she also had osteoporosis. she was well-tolerated by both groups. Group B patients had serious physical limitations (paraplegia). several had an earlier nrs reduction and faster recovery of pharmacologic agents and minimally invasive treat- joint function. ments (comprising ganglionary block) had been propo- our experience confirms the efficacy of oxygen- sed before and failed. to reverse bone resorption, she ozone infiltration exploiting the gas’s various mechani- was receiving biphosphonates. sms of action (effect on prostaglandins, neoangiogenesis Objective: to demonstrate the effectiveness of the and enhanced local oxygenation, stimulation and opti- association of oxygen-ozone therapy (local, and syste- mization of tissue repair processes, improved function mic)in the treatment of pain of damaged muscle fibres and reduced attrition). com- Methodology: at the beginning of the ozone’s treat- bining oxygen-ozone therapy with suprascapular nerve ment, she was receiving spinal opioids throw an spinal block is indicated for hyperalgic shoulder resistant to continuous infusion. the five first’s session of treatment treatment to speed up pain relief and functional joint consisted of gas infiltrations of the mixture of ozone recovery. as oxygen-zone administration is straightfor- oxygen at the concentration of 12 mcg/ml, in the re- ward and well-tolerated with a high success rate, it may gions paravertebral and sacroiliac (20 ml+20 ml re- be indicated in the early treatment of this condition. spectively). rectal insufflations with 100 ml the gas mi- xture of ozone oxygen at the concentration of 50 mcg/ ml, had been done too. the pain receded of a visual 13 analogue pain scale (Vas) 6 to 3. the suspension of infusion with opioid had been requested. thus, Major Not Always the Continuous Infusion of auto Hemo therapy with ozone oxygen(MaHto) Opioids Is the Best Choice to Treat Chronic have started. In the tree first’s weeks, the total doses Pain in the Elderly People were 4500 mcg, augmenting slowly in the next ones until c. catelan-cardoso, r. dall’aglio, F. Fraschini the maximal doses of 7500 mcg Results: since the third MaHto the patient receives Università degli Studi di Milano, Milan, Italy no analgesic medication anymore. In the last 8 months, Key words: lumbosacral pain, oxygen ozone therapy, pa- the patient presents no pain (Vas=0). she can walk raplegia alone. nowadays she recieve a support therapy with Fluimucil, 400 mg, VIt c, 1 gr, VIt B12 1000 mcgr, Fo- Introduction: disorders of the lumbar spine continue lic acid, 50 mcgr, acetil carnitin, 1 gr, VIt B 12.6 gr, 1 to present some of the most common and clinically im- ampoule of fosforilasi associated with a a maintenance portant problems of the population 1. the spine-related MaHt every 45 days. expenditures have increased substantially in the last ye- Conclusion: only the association of ozone oxygen ars 2. spinal cord Injury (scI) affects 28.5-40 subjects therapy, systemic and local, caused the completely re- per 1 million people in first-world countries. the neu- mission of pain in this case report of untreatable lum- rological level of scI determines the extent but not the bosacral pain. degree of bone loss with greater bone loss being ob- served in tetraplegia and complete spinal cord lesions. References Pharmacological interventions hitherto have focused on 1 Keith H, Bridwell Pa, anderson sd, et al. What's new in reversing bone resorption 3 as well analgesic ones to im- spine surgeryJ Bone Joint surg am. 2008; 90: 1609-1619. 2 Brook I, Martin ra; deyo sK, et al. expenditures and prove the quality of life. a proposed treatment for lum- Health status among adults With Back and neck Pro- bar disk herniation is chemodiscolysis by means of per- blems. JaMa. Feb 2008; 299: 656-664. 4 cutaneous intradiscal oxygen-ozone (o2-o3) injection . 3 Gilchrist nl, Frampton cM, acland rH, et al. alendro-

68 www.centauro.it International Journal of Ozone Therapy 10: 63-69, 2011

nate Prevents Bone loss in Patients with acute spinal physiological and a-traumatic vertebral movements. cord Injury: a randomized, double-Blind, Placebo- at the end of the cycle of o therapy is necessary to controlled study. the Journal of clinical endocrinology 3 & Metabolism. 92 (4): 1385–1390. conduct a postural examination to determine the type 4 Gallucci M, limbucci n, et al. sciatica: treatment with of rehabilitation required. Intradiscal and Intraforaminal Injections of steroid and this therapy is often associated with rehabilitation of oxygen-ozone versus steroid only. radiology. Mar masticatory function, a frequent cause of disorders of 2007; 242: 907-913. the patient, because the mouth is a preferred gateway 5 dall’aglio r, cardoso cc, Gomez M, et al. Biochemical and Pharmaceutical aspects of entrapment: the Possible in the postural system. role of Free radicals and ozone in nerve root com- at last people need to maintain good efficiency of pression. rivista Italiana di ossigeno-ozonoterapia. the voluntary muscular system and try to correct impro- 2004; 3: 105-111. per habits of life.

14 15 Chronic Low Back Pain: From the Ozone Therapy to the Integrated Therapy Ozone and Collagen Treatment for Rupture c. de Michele of the First Metatarsophalangeal Joint Studio Sintesis, Centro di Medicina della Complessità e del Capsule Movimento; Roma, Italy M. Bonetti, M. Moretti, G. d’orta. s. Giacomini, G. Bracchi Centro Polispecialistico Oberdan; Brescia, Italy the frequency of relapses every three years has led the author, (who practice o3 therapy since 1985) to We describe the successful combined ozone and col- deepen the problem by ensuring that upstream of the lagen treatment of a basketball player with rupture of onset of pain, there is a Postural deficit syndrome. the first metatarsophalengeal joint capsule. In agreement with the studies of H. Mathias publi- While playing, a 33-year-old basketball player suf- shed in “spine”, we claim that the lesions of the disc fered a contusive injury with rupture of the left first at the base of the low back pain due to slipped disc metatarsophalengeal joint capsule. the injury was im- begin to emerge in late childhood and adolescence, de- mediately investigated by Mr scan of the forefoot. velop during the second and third decade of life and the patient was clinically assessed by two orthopaedic come to their clinical expression in the third quarter. specialists and both judged the lesion curable in two the tonic postural system matures after 12 years, under months with appropriate physiotherapy. together with the influence of psycho-socio-cultural, environmental, the patient we inserted a combined ozone and collagen motor, genetic and pathological factors. treatment into the physiotherapy schedule devised by the quality of the adult posture is related to the the orthopaedic specialists consisting in tecar, laser and type of development of both maxillary, mandibular and magnetic therapy. the patient underwent six treatment dental structures and variables which intervene during sessions in the first week with periarticular injection of growth. If the forces that interfere with these processes 2-3 cc of a 25 µg/ml oxygen-ozone gas mixture on the do not carry along with lines of force which are consi- first day and one vial of Md-Matrix (extracellular col- stent with the physiological relationship with the force lagen matrix) on the following day for a total of three of gravity, postural alterations may occur. the Fran- ozone injections and three collagen injections. a clinical coforte’s plane together with the bipupillare plan, the benefit was already apparent on the second day of tre- plan of the vestibular apparatus and the axial structures atment and the patient was able to stand on the sole of of the skull (vertical sheet that separates the cerebral his foot. We believe this highly significant outcome was hemyspheres and medians bones) are the anatomical due to the well-known pharmacological effects of injec- elements with respect to which the spatial reference of tion of an oxygen-ozone gas mixture supported by the verticality is developed. If the body axis deviates from use of collagen matrix. collagen serves to strengthen the physical perpendicularity, the joint loads on the mo- tissues, create a defence against free radicals, improve ving structures become asymmetric and, hence, trauma- joint mobility and favour muscle distension thereby tic factors. this triggers a phenomenon of reactive trau- alleviating pain. the following week the patient under- matic inflammation with general interest on the neuro- went four more treatments following the same schedule, immune level. When the body is less able to compensate i.e. injections of ozone followed by collagen. His clinical for a stressor occasional factor, organ symptoms occur. response was deemed excellent and an Mr scan de-

the o3 therapy is an important approach that attacks monstrated complete healing of the lesion. the patient the local inflammation on several fronts, i.e. biochemi- is now able to resume competitive basketball. cal, immunological and neurological systems, allowing In conclusion, we emphasize that ozone combined the restoration of the management of posture through with collagen is a highly effective well-tolerated natural postural reflexes and the action of involuntary muscles. treatment lacking any allergic reactions. the treatment It is necessary to correct any problems, dysmetabolic is straightforward to administer and can be deemed an disorders and overweight, and after, as soon as possi- innovative therapy able to shorten injury recovery ti- ble, introduce breathing exercises, by taking particu- mes by more then 50% compared with traditional phy- lar care to abdominal breathing in order to introduce siotherapy protocols.

69 Authors Index

Authors Index

A D ablondi M. 11, 16, 61 d’orta G. 11, 17, 69 adamo c. 17, 66 dall’aglio r. 11, 13, 15, 16, 17, albertini F. 11 52, 55, 64, 68 alexandre a. 11, 12, 13, 16, 27, dall’olio M. 12, 30 29, 30, 32 de Michele c. 17, 69 alexandre a.M. 12, 13, 29, 30, 32 de Monte a. 11, 14, 46 alvarado r. 11, 14 de santis F. 11, 12, 30 andreula c. 4, 8, 11, 12, 14, 23 dimauro c. 11, 16, 60 arangio Febbo G. 13, 38

B E erario a. 11, 12, 13, 15, 31, 51 Baeza noci J. 11, 12, 13, 14, 15, 16, 24, 34, 43, 55 Barco G. 16, 17, 66 Bariselli a. 17, 66 Bas M. 11, 13, 33 F Bellotti l. 16 Fabris G. 11 Benedetti e. 13, 37 Bergeron Y. 11, 12, 13 Fahmy Z. 11, 12, 21 Berni F. 15, 53 Falzoni U. 13, 38 Bertolotti a. 14, 48 Fawaz a. 11, 12, 29 Blasetti n. 13, 31 Ferreira l.r. 15, 17, 55, 64 Bocci V. 8, 11, 12, 14, 16, 21 Ferreira M.t. 15, 55 Bonetti M. 1, 6, 9, 10, 16, 17, 19, Fiore G. 17, 67 63, 64, 65, 66, 69 Fiorini J.e. 13, 38 Borrelli e. 11 Fiorini J.M. 13, 38 Bortolaz r.t. 13, 38 Fiuza d. 15, 45, 54 Bracchi G. 17, 69 Fontana a. 11, 17, 63, 65 Bragaglio G. 17, 63 Fraschini F. 17, 68 Brina l. 13, 32

C G capuano c. 14, 17, 48, 65 Gallucci M. 11, 12, 13, 24, 29, 41 capuano c. 17, 48, 65 Galvan F.J. 11, 13, 41 cardelli r. 11, 13, 37 Genovese e. 11, 13 catelani cardoso c. 11, 13, 15, 17, Ghisellini M.t. 13, 38 38, 52, 55 Giacomini s. 17, 69 cesari G. 16 Giuliani a. 15, 51 cirillo l. 12, 30 Giuliano H. 11, 16, 59 clavo B. 11, 14, 15, 45, 54 Gjonovich a. 11, 17, 67 corò l. 12, 29, 30 Gomez M. 11 corradi a. 11, 16, 59 Grangeat a. 12, 15, 31, 51 covi V. 13, 15, 17, 38, 58, 65 Grangeat a.M. 13, 31, croce e.a. 13, 31 Guarino G. 17, 63

70 www.centauro.it International Journal of Ozone Therapy 10: 70-72, 2011

H P

He X. 8, 11, 43 Paoli a. 15, 57 Hernández F. 11, 14, 45 Paradiso r. 13, 32 Parodi F. 11, 15, 57 Pellicanò G. 11, 12, 13, 24, 37 Penocchio G. 11, 16, 59 I Pepa o.a. 11, 12, 23 Pereira M.a. 13, 38 Iabichella M.l. 14, 47 Pérez-davison G 15, 51 Izzo a. 14, 48 Pichara n.l. 13, 38 Popandopulo a.G. 13, 32 Princiotta c. 12, 30 K

Konrad H. 11, 13, 33 Kos W. 11, 14 Q Kumar V.s 8, 11, 12, 14 Quintero Marino r. 15, 53

L R leonardi M. 7, 8, 11, 12, 16, 23, 30 lima M.s. 15, 55 raggi F. 15, 55 ramiro a. 11 re a. 42 re l. 11, 42 M rimonti d. 17, 64 robaina F. 15, 45, 54 Macedo s.B. 13, 38 rodrigues K.l. 15, 17, 55, 64 Maggiorotti M. 16 Martin Florido F.J. 11, 14, Martin Francisco a. 15, 16, 51 Martínez-sánchez G. 15, 51 S Meirelles J. 15, 55 Mohga s 14, 42 santana-rodríguez n. 15, 45, 54 Montefiori s. 37 scarchilli a. 11, 13, 34 Monti e. 13, 37 schulz s. 11, 14 Moretti M. 13, 17, 37, 38, 63, 69 schwartz a. 16 Morosi c. 11, 13, 38 schwartz t.a. 11, 14, 46, Moviglia G.a. 13, 31 scrollavezza P. 11, 16, 60 Moviglia M.l. 13, 31 simko M. 11, 13, 14, 31, 43 Muto M. 11, 13, 33, 37 simonetti l. 12, 30 sirito M. 11, 15, 51 smadelli e. 11, 16, 59 N stafa a. 11, 17, 63 nabil Mawsouf M. 11, 14 T O tabaracci G. 11, 13, 15, 17, 38, ottaviani G. 17 41, 48, 58, 65 ottaviani G.M. 11, 17, 64, 65 tammam Y. 11, 15, 51

71 Authors Index

U Vigliani a. 11, 16, 59 Viti Paganelli s. 11 Ungureanu F.d. 11, 13, 41 Vyletelka J. 11, 12, 13, 29, 41

V Z Vallesi G. 15, 55 Viebahn r. 11, 14, 50 Zambello a. 11, 13, 17, 41, 64

72 World Federation of Oxygen - Ozone Therapy

PRESIDENT Dr. Vijam Sheel Kumar Kumar Pain Management & Speciality Centre D.1/28 Vasant Vihar 110057 New Delhi Tel.: 91 11 26142282 - 26154106 mail: [email protected]

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Mi impegno al versamento della quota sociale annua di 125,00 €. Di cui 85,00 € come iscrizione alla FIO e 40,00 € come abbonamento alla Rivista “International Journal of Ozone Therapy”, organo ufficiale della FIO, Banca Carige agenzia 2 di Brescia, IBAN: IT 35K0617511202000000624780, oppure inviare con bollettino postale C/C nr. 43650316, intestato a F.I.O. (Federazione Italiana di Ossigeno-Ozonoterapia).

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Presso: x-Ray Service Srl Sede amministrativa: Via Leonardo da Vinci, 20 - 25122 Brescia

Sede operativa: Via Oberdan, 140 - 25128 Brescia

Tel.: 030.3701312/030.3387729 - Fax: 030.3387728 e-mail: [email protected]

Comunicazione all’Abbonato - In relazione a quanto disposto dall’art. 10 della L. n. 675/1996, Le assicuriamo che i Suoi dati (nome, cognome, titolo di studio, attività svolta e indirizzo), presenti nel nostro archivio informatico, verranno utilizzati esclusivamente per l’invio di lettere commerciali e avvisi promozionali inerenti al rapporto editore-abbonato. Ai sensi dell’art. 13 della L. n. 675/1996, Lei potrà opporsi all’utilizzo dei dati in nostro possesso se trattati in maniera difforme a quanto disposto dalla legge

Via Oberdan, 140 - 25128 Brescia • C.F.: 98109470173 • Tel. 030 3701312 • Fax 030 3387728 FEDERAZIONE ITALIANA DI OSSIGENO-OZONOTERAPIA

date……. re: association membership fee dear colleague, this is a reminder that the association membership fee for 2010 is € 125,00, inclusive of a subscription to the International Journal of ozone therapy, payment by bank draft to Banca Carige - agenzia 2 - Brescia, Italia IBan: It 35 K 06175 11202 000000624780 sWIFt code: crGeItGG542, or by credit card thank you in advance for your payment. Yours sincerely, dr Matteo Bonetti FIo secretary

objeto: cuota de asociación estimado colega, quería recordarte que la cuota de asociación por el año 2010 es de € 125,00, la que incluye la subscripción a International Journal of ozone therapy, con un pago en la Banca Carige - agencia 2 - Brescia, Italia IBan: It 35 K 06175 11202 000000624780 codigo sWIFt: crGeItGG542, o con la tarjeta de crédito. te agradezco desde ahora por el pago de la cuota. cordialmente dr Matteo Bonetti segreteria FIo

oggetto: quota associativa caro collega, desidero ricordarti che la quota sociale della FIo è per il 2010 di € 125,00, comprensiva dell’abbonamento alla rivista International Journal of ozone therapy, con un bonifico alla Banca Carige - agenzia 2 - Brescia, Italia IBan: It 35 K 06175 11202 000000624780 o con carta di credito. oppure inviare con bollettino postale: c/c nr. 43650316, intestato a F.I.o. (Federazione Italiana di ossigeno-ozonoterapia) ti ringrazio fin da ora per il pagamento. cordialmente dr Matteo Bonetti segreteria FIo WFOOT WORLD FEDERATION OXYGEN-OZONE THERAPY

V.J. Kumar President

Cosma f. Andreula, Vice-President Advisors: E. Iliakis, J. Baeza Noci, Byung Chan Jeon, Matteo Bonetti, Secretary General x. he, O. Pepa, x.f. Vilasuso, G. Barco, Alessandro fontana, Treasurer J.C. De Lucas-García, M. Leonardi, J. Vilitelka

INSTRUCTIONS FOR AUTHORS INTERNATIONAL JOURNAL First formulated in 2002 - revised in Febraury, 2011 OF OZONE THERAPY The International Journal of Ozone Therapy (IJOT) is a clinical practice journal documenting the current state of ozone therapy practice worldwide. The Official Journal of the WfOOT - World federation IJOT publishes original clinical observations, descriptions of new techniques of Oxygen-Ozone Therapy, fIO - Italian federation of or procedures, case reports, and articles on the ethical and social aspects of related health care. submissions suitable for the Journal include observa- Ozone Therapy, ACEOOT - Spanish Association of Ozone tional studies, clinical trials, epidemiological work, reports on health services Therapy, hellenic, Indian, Slovach and Chinese and outcomes, and advances in applied (translational) and/or basic research. National Societies the instructions for submission of articles to IJOT follow the Uniform Requirements for Manuscripts Submitted to Biomedical INTERNATIONAL REVIEWERS Journals of the International Committee of Medical Journal edi- tors (IcMJe, http://www.icmje.org), if not otherwise indicated below. Ramiro Alvarado (Bolivia), G. Barco (President Eumedica), Research and Publication Ethics Velio Bocci (Italy), Marco Brayda-Bruno (Italy), For the policies on research and publication ethics not stated in J.C. De Lucas-García (Spain), Eugenio Genovese (Italy), these instructions, the Guidelines on Good Publication Practice is- Stergios Ikonomidis (Greece), Emmanuel Iliakis (Greece), sued by the committee on Publication ethics should be applied. Byung Chan Jeon (South Korea), Vjiay Sheel Kumar (India), 1. Author responsibility for originality: each author acknowledges responsi- Mario Muto (Italy), Josè Baeza Noci (Spain), bility for the integrity of the manuscript, assures the originality of the paper, and guarantees that submitted manuscripts do not contain previously pub- Gianni Pellicanò (Italy), Osvaldo Pepa (Argentina), lished material and are not under consideration for publication elsewhere. If Vassilio Politis (Greece), Rafik Raslan (Dubai), the submitted manuscript builds on or includes parts of previously published Hector Salgado (Spain), X.F. Vilasuso (U.S.A.), articles, authors are encouraged to enclose copies of the articles with the Sergio Viti Paganelli (Venezuela), new submission. the editor reserves the right to request the original data Wally Kos (Australia), Juray Vilitelka (Slovakia), obtained in the investigation. 2. Registration of clinical trial research: any research that includes clinical He Xlaofeng (China) trials should be registered with the primary national clinical trial registra- tion authority accredited by WHo (http://www.who.int/ictrp/network/pri- mary/en/index.html) or IcMJe. SCIENTIFIC EDITOR 3. Disclosure statement: this is not intended to prevent authors with po- Matteo Bonetti tential conflicts of interest from contributing to IJOT. rather, the Journal will place on record any relationship that may exist with disclosed, or Servizio di Neuroradiologia - Istituto Clinico Città di Brescia competing, products or firms. disclosed information will be held in confi- via Gualla, 15 - 25100 Brescia dence during the review process and the editors will examine any printed Tel. ..39/030/3710311 - Fax ..39/030/3710370 disclosure accompanying a published article. authors are responsible for e-mail: [email protected] notifying the Journal of financial arrangements including, but not limited to, agreements for research support including provision of equipment or materials, membership of speaker bureaus, consulting fees, or ownership interests. It is important that disclosure statements be updated promptly PUBLISHING STAFF to reflect any new relationships that arise after initial submission of the manuscript. If the study is supported by a commercial sponsor, the authors PUBLISHER must document the input of the sponsoring agency in study design, data collection, analysis of results, interpretation of data, and report writing. NICOLA LEONARDI It is important to specify whether the sponsors could have suppressed or Direttore responsabile influenced publication if the results were negative or detrimental to the Centauro srl product they produce. authors should also state if the company was in- volved in the original study design, the collection and monitoring of data, Via del Pratello, 8 analysis and/or interpretation, and/or the writing and approval of the report. I-40139 Bologna, Italy 4. Statement of human and animal rights: Manuscripts involving examina- Tel: ..39/051/227634 tion of volunteers and patients must include a statement that the study Fax: ..39/051/220099 protocol has been approved by an institutional review board (IrB) and that the subjects gave informed consent, thus meeting the stand- ards of the declaration of Helsinki (revised version) developed by the World Medical association as a statement of ethical principles for medi- LANGUAGE EDITOR cal research involving human subjects, including research on identifi- Anne Collins able human material and data (http://www.wma.net). With animal sub- e-mail: [email protected] jects, research should be performed based on a national or Institutional Guide for the care and Use of laboratory animals, and ethical treat- MANAGING EDITOR Elisabetta Madrigali For information: e-mail: [email protected] Centauro s.r.l. Via del Pratello, 8 - I-40122 Bologna Tel: ..39/051/227634 - Fax: ..39/051/220099 ADVERTISING e-mail: [email protected] Serena Preti www.centauro.it e-mail: [email protected] SINGLE ISSUE (only digital version): Euro 30,00 Reg. Trib. di Bologna n. 7159 del 20-09-2001 ment of all experimental animals is expected throughout all experiments. the reader’s interest. – to be informative enough to prepare readers to 5. Duplicate/Redundant publication: IJOT only accepts manuscripts de- understand your paper. – Content and Organization: 1. common ground scribing original research. the editorial office of the IJOT does not accept ➜ context ➜ relevant background ➜ orients the reader. 2. disruption duplicate submission or redundant publication. redundant (or duplicate) ➜ Problem ➜ Gap in Knowledge, Question ➜ Motivates the reader. 3. publication is publication of a paper that overlaps substantially with a paper resolution ➜ response ➜ Promise of an answer ➜ Makes a contract with already published in print or electronic media as defined by the updated the reader. 1. Common Ground: states the consensus, shared understanding, IcMJe guidelines that cover allegations of scientific misconduct. When sub- common ground in the field, what’s know and not known. Gives the reader mitting a paper, authors should make a full statement to the editor on all context and provides relevant background information, not a literature re- submissions and previous reports that might be regarded as redundant pub- view. 2. Disruption: states the problem/the question that the paper addresses. lication of the same or similar work. If authors believe that their manuscript conveys the significance, i.e. the cost of leaving problem unsolved, or the may be considered redundant, they should address this issue in a letter to benefit of solving it. 3. Resolution: Implicitly promises that you will present the editor accompanying the submission. the authors should also explain your answer in the results and discussion. try not to state the answer; that in the letter how their report overlaps already published material, or how has the effect of closing off the paper rather than leading into it. When draft- it differs. copies of such published material should be included with the ing: although the Introduction unfolds in the above order, 1-2-3, when you’re submitted paper to help the editor examine the possibility of redundant drafting, write it in a 3-2-1 order. By writing the Introduction in this order, publication. If redundant publication is attempted without such notification, you are sure to work through and clearly set up your main point, the ques- authors should expect editorial action to be taken. at the very least, rejec- tion that it answers, and to include only relevant background information. tion of the manuscript may be expected. When revising: “the key is to think like a reader -- readers expect and need 6. Authorship: the editor considers authorship to belong to those persons a sense of structure. since readers read each sentence in light of how they who accept intellectual and public responsibility for the statements made see it contributing to the whole, when you revise it makes sense to diagnose and results reported. By submitting a manuscript for publication, each au- first the largest elements of the paper, then focus on the coherence of your thor acknowledges having made a substantial contribution to the concept paragraphs, the clarity of your sentences, and only last on matters of spelling and design of the study, the analysis and interpretation of the results, and and punctuation. of course, in reality, no one revises so neatly; all of us revise the writing of the paper, in addition to having approved the final submitted as we go. But, it is useful to keep in mind that when you revise from the top version. authorship should not be attributed to departmental chairs not down, from global structure to sections to paragraphs to sentences to words, directly involved in the study, to physicians or technicians who provided you are more likely to discover useful revisions than if you start at the bottom routine services, or to technical advisors. a group study should carry the with words and sentences and work up”. Booth Wc, colomb GG, Williams group name and reference contributing authors in the acknowledgments. JM, et al. the craft of research. chicago: University of chicago Press; 2008. Peer Review Process original research should be organized in the customary format, as described Papers are accepted on the understanding that they are subject to peer below. the text of the manuscript should be submitted as a single document review, editorial revision, and, in some cases, comment by the editor. with the following sections (in order): Manuscripts are examined by independent peer reviewers. articles and 1. Author Information Page (First page) - Full title of the article, authors’ other material published in the Journal represent the opinions of the au- names, highest academic degree earned by each author, authors’ affiliations, thors and should not be construed to reflect the opinions of the publisher. name and complete address for correspondence, address for reprints if dif- Language ferent from address for correspondence, fax number, telephone number, and the official language of IJOT is english. Most papers in IJOT have been e-mail address. written by non-native english speakers, and they will also be read by many 2. Acknowledgments and Funding Page (second page) - the non-native speakers. For the purposes of clarity, it is strongly recommended acknowledgments section lists all funding sources for the research of the that authors not fluent in english have their manuscript professionally ed- study, and details substantive contributions of individuals. the authors must ited for english usage prior to submission. a professional editor will im- reveal all possible conflicts of Interest/disclosures. prove the english to ensure that author meaning is clear and to identify 3. Title Page (third page) - the full title, itemized list of the number of ta- problems that require author review. authors are invited to contact the bles, the number and types (color or black-and-white) of figures, and three- IJOT language editor anne collins ([email protected]) for referral to profes- to-five key words for use as indexing terms should be included. appropriate sional english language editing services. authors should make contact key words should be selected from the Medical subject Heading. the word with and arrange payment to their chosen editing service directly. Please count of the text should be specified. note that the use of such a service is at the author’s own expense and risk 4. Summary - a summary of up to 250 words should summarize the prob- and does not guarantee that the article will be accepted for publication. lems presented and describe the studies undertaken, results and conclusions. centauro Publishers does not receive any commission or other benefit from since the abstract must be explicative, the abbreviations must be reduced to editing services. accordingly, centauro Publishers neither endorses nor ac- a minimum and explained. references should not be cited in the abstract. cepts any responsibility or liability for such editing services. 5. Text - typical main headings include Introduction, Materials and Methods, results, discussion, and conclusions. abbreviations must be defined at first Copyright and Purchase of Offprints mention in the text, tables and figures. the complete names and short ad- all articles published in IJOT are protected by copyright, which embraces dresses of manufacturers of any equipment used in Materials and Methods the exclusive right to reproduce and distribute the article (e.g., as offprints), must be supplied. If animals are used in experiments, state the species, the as well as all translation rights. no material published in the Journal may be strain, the number of animals used, and any other pertinent descriptive char- reproduced without written permission from the publisher. IJOT offers au- acteristics. If human subjects or patients are employed, provide a table with thors a complimentary hard copy and .pdf file of the issue in which their article relevant characteristics. When describing surgical or neurointerventional pro- is published, for personal use. to purchase offprints of articles published by cedures on animals, identify the pre-anesthetic and anesthetic agents used, IJOT please contact centauro srl for a quotation at [email protected]. and state the amount or concentration and the route and frequency of admin- Publication Types istration of each agent. Generic names of drugs must be given. Manuscripts Original Research Articles are full-length research papers, which are favored that describe studies on humans must indicate that the study was approved by IJOT. articles cover topics relevant to clinical studies, and may include by an Institutional review committee and that all subjects gave informed both basic and experimental work. consent. reports of studies on both animals and humans must indicate that Review Articles are comprehensive, state-of-the-art papers focusing on im- all procedures followed were in accordance with institutional guidelines. portant clinical problems and should address a specific topic in a scholarly 6. References - citations should be listed in order of appearance in the text, manner. such articles may be invited by the editor or may be unsolicited and between square brackets [ ]. references must be listed at the end of the reviews. text in the order of citation. Journal titles should be abbreviated according to Case Reports/Technical Notes should be unusually educational and medi- Index Medicus. For citation rules not specified here, authors should refer to cally important. although IJOT preferentially encourages submission of the NLM Style Guide for Authors, Editors, and Publishers (http://www.nlm. full-length original research articles, the Journal will consider publication nih.gov/citingmedicine). all references must be checked by the author(s). of a limited number of concise case reports and technical notes. Journal article: laredo Jd, Bard M. thoracic spine: percutaneous trephine Editorials are usually invited by the editor. biopsy. radiology. 1986; 160: 485-489. Editorial Comments are specific comments on the articles published in Journal article if the number of authors is more than six: list the first three IJOT and are usually invited by the editor. authors followed by et al. Letters to the Editor contain constructive comments or criticism of a specific Geibprasert s, Krings t, Pereira V, et al. clinical characteristics of dural ar- paper published by IJOT. letters dealing with subjects of general interest teriovenous shunts in 446 patients of three different ethnicities. Intervent within the field of IJOT, or personal opinions on a specific subject within neuroradiol. 2009; 15: 395-400. the ambit of IJOT, may also be accepted. Entire book: Valavanis a. Medical radiology: interventional neuroradiology. All papers should be sent to the Scientific Editor dr. Matteo Bonetti: mat- Heidelberg: springer Verlag; 1993. [email protected] Part of book if number of authors is more than two: Manuscript Preparation Bonneville JF, clarisse J, et al. radiologie interventionnelle. In: Manelfe c ed. Imagerie du rachis et de la moelle. Paris: Vigot editeur; 1989. p. 761-776. Introductions that Satisfy Reader Expectations 7. Tables - each table must be typed on a separate sheet and double-spaced, – Overview: once you have a revised draft, you need to ensure that your if possible. tables should be numbered using the arabic system, followed by Introduction frames it, so that your readers will understand where you are a brief informative title. Use type of the same font and size as employed in taking them. the Introduction should orient readers and motivate them the text. Include footnotes at the bottom of each table. tables must be num- to read the rest of the paper. the Introduction must also make a contract bered in the order cited in the text. tables should not duplicate data given with the reader that a question will be answered. – Functions: – to awaken in the text or figures. 8. Figure Legends - Provide figure legends on a separate sheet. legends must Illustrations may be compressed using the stuffIt, aladdin, or Zip programs. be double-spaced, and figures must be numbered in the order cited in the text. do not label an image with arrows, numbers, or letters, but rather indicate 9. Figures - Figures should preferably be submitted online in .tiff format on a duplicate copy or a sketch where such indications are desired. to: [email protected]. the time required to send files will vary depend- authors are advised to refer to the Journal guidelines when formatting their ing on the number of figures, but image resolution must not be reduced to work. otherwise the editorial office may return a submission to the authors decrease transmission time. When labeling the figures, please ensure that for improvement before any editor is assigned. the label corresponds to the figure number. If it is not possible to send figures via the Internet, images may be sent by Digital images (originals or images acquired by a scanner) must meet the express courier in one of the following formats: following criteria: original x-ray films, slides, or glossy or opaque prints. clearly indicate on the Black-and-white figures: Images must be acquired using the grey scale with back of the image the first author’s name and the number corresponding to a minimum resolution of 300 pixels per inch or 150 pixels per cm. Images the figure caption and citation in the text. must have a base of at least 8.1 cm for one item or a minimum base of 16.9 Figures may be submitted on a cd-roM or dVd, copied in Iso9006 cm for several items. format legible on both Pc and Mac. Floppy disks are not recommended. 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INTERNATIONAL JOURNAL OF OZONE THERAPY Conflicts of Interest/Disclosures, Copyright Transfer Agreement, Financial Support, Exclusive Publication Statement, and Author Contribution Form

Manuscript no.: ______date: ______

With respect to the article entitled: ______the authors certify that: (Conflicts of Interest/Disclosures) the corresponding author must disclose all relevant financial, personal, and/or profes- sional relationships with other people or organizations related to the subject of this article. Is there any actual or potential conflict of interest in the subject of this article? no (___). If yes, please give details in the space below.

______(Copyright Transfer Agreement) all rights, title, and interest in the manuscript, including copyright ownership, are trans- ferred to centauro srl Publisher, Bologna. authors reserve all proprietary rights (such as patent rights) other than copyright and the right to use parts of this article in their own subsequent work as soon as the article is accepted for publication. the article may not be published elsewhere without permission from the publisher. (Financial Support) If the authors or their institution(s) is/are affiliated with any organization having a financial interest (including the provision of financial support) in the subject of this article, the authors should indicate (a) the name of the industry/institution providing support for the study, (b) the type of affiliation of the organization (stockholder, consultant, donor of honorarium, granting body, source of other financial or material support, provider of equipment, or other support category), and (c) that the authors had complete control of the data and information submitted for publication. any other non-financial conflict of interest should also be disclosed to the editor, with the understanding that the information may be published if deemed appropriate by the editor. no, I (We) do not have any conflict of interest related to this article (___).

If yes, (a) (______) (b) (______) (c) (______). (Exclusive Publication Statement) none of the material in this manuscript has been published previously or submitted for publication elsewhere prior to appearance in nrJ. (Author Contribution Form) the corresponding author must certify that all authors participated in and contributed suf- ficiently to the conception and design of the work, and analysis of the data, as well as the writing of the manuscript, and assume public responsibility for the content of the paper. the corresponding author also certifies that all authors have reviewed the final version of the manuscript and approved it for publication. name (print) signature date this signed statement must be received before the manuscript can be processed for publication.

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