Application of ozone in medicine: general ideas

Ozone (О₃) is gas with a strong specific odour; it is allotropic form of oxygen. Ozone is much more strong oxidant than oxygen. That is why ozone oxidizes many substances which are inert to oxygen under normal conditions. Characteristic products of a majority of ozone chemical changes are ozonides, which are formed during the ozone reaction with the С=С bonds. In natural surroundings the reaction of ozone with the olefinic bonds of fatty acids (mainly with triglycerides) is dominant.

Ozone as an antiseptic agent was firstly applied by H.Wolff in 1915 during the World War I. Later the information about the successful application of ozone in treatment of various diseases has being gradually collected. However, for a long time were used mainly those methods of ozone therapy, which implied direct contacts of the gas with skin surface and various cavities.. The ozone-oxygen gaseous mixture with high ozone concentrations (40 - 80 mkg/ml) proved to be effective in treating infected, badly healing wounds, decubituses, gangrene, combustions, skin mycosis, etc., and also as a haemostatic agent. The low concentrations of ozone promote a cuticularization and adhesion.

At treatment of colitis, proctitis, fistulas and many other diseases of an intestine the rectal insufflation of the ozone-oxygen gaseous mixture is used. The ozone dissolved in the distilled water, was successfully applied to a sanitation of various cavities of human body. Nowadays parenteral (intravenous, intramuscular, intraarticular, hypodermic) injectons of therapeutic doses of ozone are mainly applied. For the intravenous injections ozone dissolved in a saline or in a blood of the patient is used. In parenteral injection of ozone triggering or activization of the cascade of biochemical processes takes place. It is manifested in the activization of the system of the antioxidant protection, which is damaged under different pathologic conditions. Therapeutic doses of ozone injected parenterally, essentially enhance microcirculation and improve trophic processes in organs and tissues, influence on rheological functions of the blood, expresses imunomodulating effect, promote sharp activization of the detoxication protective system of an organism.

The variety of mechanisms of medical effects of ozone has determined the breadth of its medical application.

Methods of the ozone therapy:

The major autohemotherapy (MAH) with ozone. 50-150 ml of a venous blood are taken into a special container with anticoagulants, then an ozone-oxygen gaseous mixture (50 - 300 ml), with ozone concentration 5 - 30 mkg/ml) is added. Contents of the container should be mixed carefully, then the blood, enriched with ozone-oxygen mixture, is injected back to the patient's vein. The quantity of the ozone, dissolved in blood, is calculated as a multiplication of the volume of the gas applied on the concentration of ozone in it.

Intravenous injection of an ozonized saline (OS). Saline (200 - 400 ml) is previously ozonized by ozone-oxygen mixture, passing through it until the concentration of ozone in liquid achieves - 2-6 mkg/ml; then it is administered intravenously to the patient.

Rectal insufflation of an gaseous ozone-oxygen mixture in amount of 50 - 500 ml with concentration of ozone - 5-60 mkg/ml.

Minor autohemotherapy with ozone. 5-15 ml of venous blood is taken in syringe, then it is mixed with an ozone-oxygen gaseous mixture with the subsequent intramuscular injection of it.

Hypodermic, intramuscular, periarticular and intra-articular injection of an ozone-oxygen gaseous mixture.

Intraarterial or intravenous injection of an ozone-oxygen gaseous mixture. This method is the least wide-spread, it has the concrete indications and demands the certain skills and care in usage.

Ozone-acupuncture. Injection into special acupuncture points of ozone-oxygen gaseous mixture (0,2-1 ml) with concentration of ozone 5-15 mkg/ml.

Drinking, gargling or irrigation by ozonized saline or ozonised distilled water.

External application of the gaseous ozone-oxygen mixture. Use of special cells with normal or low pressure of gas (for example, " ozone boots " application).

Application of ozonised oils, containing ozonides.

Ozone therapy in surgery

1. Peritonitis.
2. Sepsis.
3. Treatment and prevention of purulent postoperative complications.
4. Oncologic diseases, including treatment during the postoperative term.
5. Acute pancreatitis.
6. Cardiosurgical interventions
7. Osteomyelitis.
8. Combustions.
9. Trophic ulcers, decubituses.
10. Pre-surgical preparation and postoperative aftertreatment of the patients who had various surgical interventions.

Basically the general methods of the ozone therapy are applied: the lamjor autohemotherapy or intravenous injection of 200-400 ml OS with ozone concentration 3-6 mkg/ml, 2 -5 procedures during a treatment. Usually general treatment is combined with the local application of ozone. For example, the combination of the ozone therapy with a sanitation of abdominal cavity by plenty of OS is expedient in case of peritonitis. In case of lesion of the inferior limbs procedures of the general ozone therapy are combined with the external application of gaseous ozone-oxygen mixture ("ozone boots ") or use of oils, containing ozonides.

The basic mechanisms of medical action of ozone concerning the patients suffering surgical pathologies: microbicidal and bacteriostatic effect, intensifying of the microcirculation processes , purification of wounds and cuticularization acceleration, intensifying of various stages of immune defence, detoxication, stimulation of regenerative processes, anesthetizing and antistress effect.

Ozone therapy in a neurology

1. Ischemic insult.
2. Discirculatory encephalopathy.
3. Neuro-circulatory dystonia.
4. Diseases of peripheric nervous system.

In treatment of ischemic lesions of vascular origin usually the procedures of the general ozone therapy are used with low or average concentration of ozone (200-400 ml of saline with ozone concentration 2-5 mkg/ml or rectal insufflation of 100-150 ml of a gaseous mixture with ozone concentration 15-25 mkg/ml). The durationh of treatment lasts from 2-3 to 6-8 procedures, as a rule, 1-2- 3 times per week.

In case of a hemorrhagic insult use of ozone in the acute period is not recommended , because the improvement of microcirculatory processes by changing the rheological properties of blood can stimulate the development of the pathological process.

In case of diseases of peripheric nervous system, including neuro-circulatory and neurodystrophical, the application of hypodermic injections of small quantities of ozone is recommended: (0,5-5 ml with ozone concentration in cmixture 5-15 mkg/ml).

Ozone therapy in gastroenterology

1. Peptic ulcer of stomach and duodenum.
2. Chronic gastritis and gastroduodenitis.
3. Acute and chronic hepatitis of various genesis, including viral.
4. Chronic proctitis, proctosigmoiditis.
5. Non-specific ulcerous colitis.
6. Chronic anal fissures.

The methods of general ozone therapy are effective in these cases. Alongside with expressed inflammatory effect, ozone strengthens trophic processes in a mucosa of a stomach and duodenum, and also renders microcidal effect to Helicobacter pylory (in combination with medicines, containing bismuth). Concentration of ozone in liquid in intravenous injection of the OS - 3-5 mkg/ml, duration of treatment - from 4 to 10 procedures 1-2 times per one week. In rectal insufflation concentration of ozone should be from 10 to 30 mkg/ml, total amount: 50 - 200 ml, duration of treatment - 4-7 procedures. Additionally to drinking of 100-150 ml of the ozonized distilled water, with concentration of ozone 4-7 mkg/ml in it is recommended. In treatment of acute and chronic viral hepatitis the combination of ozone with the medicines, containing interferon is recommended. The durationof treatment is from 6 to 12 procedures of general ozone therapy, with an opportunity of further repetition.

In treatment of inflammatory diseases of an intestines the rectal insufflations of 50 - 300 ml of ozone-oxygen mixture with concentration of ozone from 10 up to 40 mkg/ml are used. In case of intestine lower concentrations of ozone are recommended, at spastic states - more high. In case of non-specific ulcerous colitis to obtaint haemostatic effect the use of ozone-oxygen mixture with high concentration of ozone - 60 -80 mkg/ml is recommended. The quantity of injected gas depends on an acceptability ofthe patient and at the first stage of treatment can be less than 40 - 60 ml. In case of presence of chronic anal fissures alongside with rectal insufflations of ozone with low concentrations usage of ozonized oil is recommended.

Ozone in treatment of diabetes and its complications

Ozone is used in treatment of the patients suffering by diabetes of the 1 or 2 type. The positive effect is frequently observed after the first procedures. In this method the improvement of a general status of the patients is observed, the level of a glucose in blood is reduced, and also positive dynamics in peripheric microangiopathy and polyneuropathy is observed. Usually methods of general ozone therapy are used, and in cases of trophic problems they are recommended to use in combination with local applications such as " ozone boots ", hypodermic or intramuscular injection ofozone-oxygen mixture. The concentration of gas in boot of ozone is 15-40 mkg/ml, duration of the procedure is from 10-15 of minutes, duration of treatment - 3-8 procedures.

It is necessary to note, that ozone therapy for the patients with diabetes should be carried out under the constant control of glucosea level in blood and, as a rule, be accompanied with the reduction of the amount of the injected insulin or others hypoglycohaemic medicines.

Ozone therapy in dermatology & cosmetology

1. Neurodermitis, psoriasis, eczema, pyoderma.
2. Onychomycosis, epidermophytosis, candidiasis.
3. Herpetic lesions of skin and mucous, acuminate condylomas.
4. Complex treatment of venereal diseases.
5. Acne, furunculosis, telangiectasia.
6. Lipodystrophy (cellulitis), striae, cicatrixes.
7. Alopecia.

In this group of diseases the basic methods of ozone therapy are the local ones; they can be combined with the methods of general ozone therapy. The intramuscular injection of an ozone-oxygen mixture, minor autohemotherapy, application of ozonized oil, the external application of gaseous ozone-oxygen mixture ("inside the cell ") are recommended. In case of viral lesions of skin and mucosa the combination of the general methods and local ozone therapy is the most effective.

It is necessary to note that approximately in 0,2-0,5 % of cases an allergic dermatitis can be a reaction to the application of ozonized oil, which demands increasing of the time periods between procedures or the cancellation of this method of treatment.

Duration of treatment, quantity and frequency of the medical manipulations can vary within a wide range. In some cases several courses of treatment are possible and recommended.

Ozone therapy in obstetrics

1. Anemia of the pregnant women.
2. Small-for-date fetus.
3. Gestational toxicosis.

The application of ozone promotes enriching of oxygenation inblood, intensifying of blood supply of the placenta and fetus. Normalization of hormone producing function of a fetoplacental complex, regulation of humoral immunal defence takes place.

The basic procedure is the intravenous injection of 200 ml of OS with concentration of ozone 1-3 mkg/ml.

Diseases of cardiovascular system

1. Ischemia of heart muscle, atherosclerotic lesions of blood vessels.
2. Idiopathic hypertensia.
3. Infringement of cardial rhythm.
4. Obliterating endarteritis.
5. Infectious endo- and myocarditis.

The application of ozone promotes improvement of microcirculation as a result of normalization of rheological functions of blood, and also ascending of fibrinolytic activity, decreasing of a level of fibrinogen and aggregation of plateletes. Normalization of peroxidation processes and activation of antioxidant system occurs. The deficiency of blood supplies caused by arteriosclerosis, with the following hypoxia, are the main point for ozone-oxygen therapy. Oxygenation of tissues essentially strengthens, normalization of various metabolic distresses takes place.

The basic medical methods: intravenous injection of OS, rectal insufflations of ozone, minor autohemotherapy, " ozone boots " to the extremities.

As a rule, low or average doses of injected ozone (200-400 ml of OS with concentration of ozone 2-5 mkg/ml or 100-200 ml of gas with concentration 15 - 30 mkg/ml in case of rectal insufflation) are used. The duration of treatment is of from 3-4 to 8-10 procedures administered 1-2 times per week. The efficacy of treatment depends on the severity of the disease, age of the patient and other factors. Several courses of ozone therapy with an interval of 4 -12 months are reecommended.

Ozone therapy in gynaecology and urology

1. Acute and chronic inflammatory diseases of female genitalia (metroendometritis, colpitis, bartholinitis, pelvioperitonitis, salpingo-oophoritis, etc.), sexually transmitted infections.
2. Septic states.
3. Genital herpes.
4. Prophylaxis of various postoperative complications and aftertreatment of the patients in the postoperative period.
5. Condylomatosis.
6. Candidiasis of genitalia.
7. Chronic urethritis and prostatitis.

The basic methods are: general ozone therapy (may be in combination with intravaginal insufflations of an ozone-oxygen mixture, intrametrial or intravaginal irrigations of ozonized saline or distilled water, application of ozonized oil.

In treatment of chronic endometriosis ozonized saline is used with ozone concentration 3-5 mkg/ml, and if infection is detected (bacterial, viral, chlamidya, etc.) - additional intravenous injection of OS (up to 2-2.5 mkg of ozone for a procedure) is recommended - 5 - 6 procedures.

The treatment of chronic colpitis both of a various bacterial or viral etiology includes intravaginal irrigations of OS in volume up to 1 l with ozone concentration in the solution up to 6-10 mkg/ml. The duration of treatment consists of 8 - 10 procedures. In treatment of chronic atrophic (senile) colpitis concentration of ozone in OS is up to 5 mkg/ml, duration of treatment - 12-15 procedures. The combination with application of the ozonized oil (1-2 times per day) is recommended.

Treatment of genital herpes: in case of herpetic infection ( detected in blood, urethra, vagina or cervix the combination of intravenous injection of OS (7 - 12 procedures) and intravaginal insufflations is recommended.

In treatment of a chronic urethritis or prostatitis administration of ozonized oil in combination with general ozone theraphy is possible. It is necessary to note, that at presence of acute inflammatory lesions the ozonized oil is necessary to dilute by a medical liquid paraffin (in relations - 1:1 - 1:3).

Ozone therapy in an stomatology

1. Stomatitis, gingivitis.
2. Paradontosis.
3. Phlegmon and abscesses of jaw-facial area.

In treatment of dental diseases the leading role have the methods of the local ozone therapy, first of all treatment of mucous with ozonized water or OS, application of ozonide oil. Application of ozone results in considerable reduction of number of bacteria, the microcirculation in mucosa is improved; it influences positively on the disease.

In case of a surgical intervention the treatment of sinuses after liquidation of a suppurative focus is rather effective. To stimulate protective forces and accelerate the processes of healing, the combination with the procedures of parenteral ozone therapy is possible.

Ozone therapy in otorhinolaryngology

1. Inflammatory diseases of a nasopharynx and of sinuses.
2. Post-operative status, including after removal of tumor.
3. Acute and chronic diseases of an ear.

Methods of the local ozone therapy are used: treatment with ozonized water or OS, application of the ozonide oil. The combination with the procedures of the general ozone therapy is possible. Number of local procedures - 4-12, general - 3-8.

Ozone therapy of locomotor disorders

1. Arthrosis and arthritis.
2. Treatment of fractures.

Analgetic effect of the ozone therapy, stimulation of reparative processes, normalization of processes of microcirculation is observed.

Methods of the general and local ozone therapy are applied. Most frequently para-articular and intraarticular injection of gaseous ozone-oxygen mixture is used, less often - OS. The application of " ozone boot " with concentration of ozone 15-50 mkg/ml is possible.

Depending on the etiological factors of the arthritis the quantity of ozone applied during the procedure of general ozone therapy could be increased ( to obtain immunosuppressive effect in case of autoimmune lesions), or reduced (immunostimulating effect).

Ozone therapy in treatment of the respiratory diseases

1. Bronchitis and pneumonia, especially in case of lingering course.
2. Bronchial asthma.
3. Pulmonary tuberculosis.

Methods of general ozone therapy are used. Usually microbicidal, inflammatory, immunostimulative effects of ozone are used. In treatment of tuberculosis ozone, on the one hand, renders the expressed medical action even when the practically complete stability of microorganisms to traditional medicines is discovered. On the other hand, when ozone is included in complex treatment the efficacy of other medicines strengthens. It is necessary to remind, that inhalation of ozone now practically is not applied, as the ozone even in low (close to therapeutic) concentrations can render damaging effect to the epithelium of therespiratory organs.

Contraindications to the ozone therapy

1. Acute myocardial infarction.
2. Early period after various, including internal bleedings.
3. Hyperthyroidism.
4. Tendency to cramps.
5. Acute alcohol intoxication.
6. Thrombocytopenia.
7. Allergic reaction on ozone odour.

Apparatus for ozone therapy

Medical ozonising device should include an ozon-producing part with of air cooling; metrological system capable to measure concentration of ozone in ozone-oxygen gaseous mixture and in solutions; the block capable to open and regulate intensity of gas flow; a destructor of the unused ozone.

The ozon-producing part should provide a wide range of ozone concentrations in gaseous mixture (from the minimum values 1-2 mkg/ml to maximum - not less than 70-80 mkg/ml). And the concentration of ozone should be regulated smoothly within this range.

Metrology should be supplied only with methods of direct detecting of ozone concentration . The concentrations of ozone estimated by any indirect methods (by force of a current in a main circuit of the ozonising device's electrical supply, voltage, by calculations etc.) can differ remarkably from thetrue values.

The destructor of the unused ozone should provide work site concentration (WSC) of ozone not more than 0,1 мг/м³ under the conditions of continuous multihour operation of the device.

The demands listed above are necessary for modern ozoning installations for medical application. Some other demands can be added, namely: the control(management) of installation should be simplified as much as possible, that can be achieved by integration of control(management) of installation on the basis of modern microprocessors. Besides, the presence of the built - in timer in the installation is desirable to simplify series of technological operations. And, certainly, the basic complete set of medical ozonising device should include series of adaptations ensuring realization of different existing methods of ozone therapy.