Newsgroup: it.scienza.biologia
Titolo: Sanguisughe terapeutiche (was: Dermatologia: un collega cerca informazioni su terapia necrosi con larve)

 ma non mi hanno saputo spiegare perche'...
Mi scoccia vedere come un professionista di altissimo livello nel suo campo
come te, possa lasciarsi trascinare da un atteggiamento che oserei definire
"cicappino", fino al punto di criticare ogni cosa nuova o vecchia che non
sia di routine nell'attuale pratica medica ufficiale.  Perche` non recuperi
le fonti citate qui di seguito, in modo da integrare la tua preparazione
professionale con corrette cognizioni anche sulle sanguisughe in medicina?
Innanzitutto, perche` non si deve disprezzare l'irudoterapia?  (Attenzione a
non scrivere "iridoterapia", che la I e la U sono adiacenti sulla tastiera).
Bene, se non altro perche` essa ha incontestabili basi farmacologiche:
[----------------------------------------------------------------------------
*  Title: The role of the leech in medical therapeutics.
  Author: Eldor A; Orevi M; Rigbi M
 Address: Institute of Hematology, Tel-Aviv Sourasky Medical Center, Israel.
  Source: Blood Rev, 10(4):201-9 1996 Dec
          UI 97165155 ; ISSN 0268-960X
Abstract:
 Leeching is considered by many to be a discredited medical relic of the past.
 This view is not justified, since leeches still play an important part in
 modern medicine, as in microsurgery and in the treatment of patients with
 post-phlebitic syndrome. Hirudin, the potent thrombin inhibitor of leech
 saliva, has been cloned and is used in the treatment of cardiological and
 hematological disorders. In our search for other antihemostatic factors
 in Hirudo medicinalis saliva, we found inhibitors of platelet aggregation
 induced by thrombin, collagen, adenosine 5'-diphosphate, epinephrine,
 platelet-activating factor and arachidonic acid. We purified apyrase
 (adenosine 5'-triphosphate diphosphohydrolase), which is a non-specific
 inhibitor of platelet aggregation by virtue of its action on adenosine
 5'-diphosphate. We isolated and characterized the platelet-activating factor
 antagonist and also identified and recovered an inhibitor of coagulation
 factor Xa from leech saliva. This report summarizes our findings and those
 of other investigators, as well as the experience of one of us (A.E.)
 in leech therapy.
*  Title: Platelet aggregation and coagulation inhibitors in leech saliva
          and their roles in leech therapy.
  Author: Rigbi M; Orevi M; Eldor A
 Address: Department of Biological Chemistry, Hebrew University of Jerusalem,
          Israel.
  Source: Semin Thromb Hemost, 22(3):273-8 1996
          UI 96432985 ; ISSN 0094-6176
Abstract:
 Prolonged bleeding by the host after the leech ceases to feed and several
 reports that the use of leeches restores blood flow in the microcirculation
 after plastic surgery led us to search for inhibitors of platelet aggregation
 in Hirudo medicinalis saliva. Dilute leech saliva was collected by
 phagostimulating starved leeches with a solution of arginine in saline.
 The saliva is shown to inhibit human platelet aggregation induced by
 thrombin, collagen, adenosine diphosphate (ADP), epinephrine, platelet
 activating factor (1-O-alkyl-2-acetyl-sn-3-glycerophophoryl choline [PAF]),
 and arachidonic acid. We have isolated the PAF inhibitor and found it to be
 an amphipathic phosphoglyceride. We have also purified apyrase adenosine
 triphosphate ([ATP] diphosphohydrolase), which inhibits ADP-induced platelet
 aggregation, and have described collagenase. Besides well-known hirudin,
 Hirudo saliva contains a potent inhibitor of coagulation factor Xa.
 We also report antiaggregant and anticoagulant activities in the crop
 content of the closely related Nile leech, Limnatis nilotica. Anticoagulants
 of hematophagous species are surveyed. We have used medicinal leeches in
 plastic surgery for decompression of skin flaps and in patients with
 postphlebitic syndrome and peripheral arterial occlusions. Preliminary
 results indicate certain beneficial effects of leech therapy.
*  Title: Pharmacological properties of hirudin and its derivatives.
          Potential clinical advantages over heparin.
  Author: Monreal M; Costa J; Salva P
 Address: Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
  Source: Drugs Aging, 8(3):171-82 1996 Mar
          UI 96296973 ; ISSN 1170-229X
Abstract:
 Hirudin and its derivatives represent the first parenteral anticoagulants
 introduced since the discovery of heparin in the early 1900s. Hirudin,
 the naturally occurring anticoagulant of the leech, is a single peptide
 chain of 65 amino acids with a molecular weight of about 7000. Recombinant
 technology has developed methods to produce recombinant forms of hirudin
 (r-hirudin) in sufficient quantities for therapeutic use. Hirudin is a potent
 thrombin-specific inhibitor that forms equimolar complexes with thrombin.
 It represents a new anticoagulant agent in a field in which heparin has been
 the only available drug for many years. In contrast to heparin, hirudin does
 not require antithrombin III as a cofactor, is not inactivated by antiheparin
 proteins, has no direct effects on platelets and may also inactivate thrombin
 bound to clot or the subendothelium. In humans, experience with r-hirudin in
 preventing or treating venous thromboembolism is very preliminary. However,
 r-hirudin achieved promising results in patients with unstable angina, or
 following coronary angioplasty. In patients with acute myocardial infarction,
 3 important clinical trials were stopped because of an excess of bleeding
 complications. At present, the discovery of a r-hirudin regimen that is more
 efficacious than heparin and at least as safe needs a reappraisal of the drug
 in further trials.
----------------------------------------------------------------------------]
By the way, non esistono soltanto le sanguisughe.  Anche gli anticoagulanti
prodotti da altri animali ematofagi - quando non addirittura essi stessi -
potrebbero trovare qualche impiego in medicina:
[----------------------------------------------------------------------------
*  Title: Thrombin inhibitors of bloodsucking animals.
  Author: Dodt J; Otte M; Strube KH; Friedrich T
 Address: Institut f¨ur Biochemie, Technischen Hochsch¨ule Darmstadt,
          BASF Aktiengesellschaft, Ludwigshafen, Germany.
  Source: Semin Thromb Hemost, 22(2):203-8 1996
          UI 96401342 ; ISSN 0094-6176
Abstract:
 Hematophagous animals have the unique ability to inhibit blood coagulation
 when sucking blood from a wound. This article concerns thrombin inhibitors
 from these animals, specifically the one from the insect Rhodnius prolixus.
 To date, the most-studied inhibitor from these animals is hirudin, which
 specifically neutralizes thrombin but no other clotting serine proteases.
 The biochemical properties of hirudin are described. Hirudinlike thrombin
 inhibitors from the Asian leech Hirudo manillensis, Haemadipsa sylvestris,
 and Haemadipsidae are also discussed. In addition, a thrombin inhibitor
 from the insect Rhodnius prolixus, Rhodniin, is extensively reviewed.
 There is considerable interest in these inhibitors because they may be found
 useful as treatment modalities for thromboembolic disorders. Hirudin is
 already extensively investigated, and some of the others may follow.
 Potentially these new inhibitors could be of greater clinical benefit than
 the presently used heparins.
----------------------------------------------------------------------------]
E ora vediamo le applicazioni cliniche in flebologia.  Da quanto esposto qui
di seguito dovresti trovare anche qualche risposta al tuo dubbio sull'impiego
delle sanguisughe nelle lesioni trofiche da sovraccarico venoso:
[----------------------------------------------------------------------------
*  Title: Leech therapy for complicated varicose veins.
  Author: Bapat RD; Acharya BS; Juvekar S; Dahanukar SA
 Address: Department of General Surgery, Therapeutics & Ayurveda Research
          Centre, Seth G.S. Medical College, Mumbai.
  Source: Indian J Med Res, 107():281-4 1998 Jun
          UI 98367219 ; ISSN 0971-5916
Abstract:
 Several methods of limb bandaging have been described to reduce the oedema
 and enhance ulcer healing in complicated varicose veins, with varying
 success rates. Leech therapy has never before been tried for the same.
 We evaluated the effectiveness of medicinal leech therapy in producing venous
 decongestion, reversal of oedema, hyperpigmentation and healing of varicose
 ulcer(s). Whether the leech selectively sucks venous blood was also
 investigated. Hirudo medicinalis (medicinal leech) was applied to the area
 surrounding the varicose ulcer(s) in 20 patients with varicose veins with
 complications and the patients monitored for ulcer healing, and decrease in
 hyperpigmentation, oedema and limb girth. The partial pressure of O2 (pO2)
 of 7 patients' arterial and venous blood was compared to that sucked by the
 leech. After leech therapy all the ulcers showed healing, while 95 per cent
 of patients showed a decrease in oedema and limb girth. Seventy five per cent
 patients demonstrated a decrease in hyperpigmentation. The mean pO2 of blood
 sucked by the leech was 40.05 +/- 7.24 mmHg, which was similar to the mean
 pO2 of the patients' venous blood (34.33 +/- 8.4 mmHg). Thus it appears
 from this study that the medicinal leech sucks venous blood and aids ulcer
 healing, and can probably therefore be used as an effective adjunct in the
 management of complicated varicose veins. This however requires further
 evaluation by controlled trials.
*  Title: Leech therapy in the management of acute venous congestion of an
          infant's lower limb.
  Author: Weinfeld AB; Kattash M; Grifka R; Friedman JD
 Address: Division of Plastic Surgery, Baylor College of Medicine, Houston,
          Texas 77030, USA.
  Source: Plast Reconstr Surg, 102(5):1611-4 1998 Oct
          UI 98445002 ; ISSN 0032-1052
Abstract:
 We report the successful use of leech therapy in the postsurgical management
 of an infant with acute venous congestion of an entire lower limb. Two days
 of constant leech therapy, followed by 5 days of intermittent application,
 decongested the affected tissues. There were no complications related to the
 leech therapy, and mild cutaneous hyperpigmentation was the only long-term
 complication of the acute venous congestion. The volume of the affected
 tissue may limit the success of leech therapy in cases of acute venous
 congestion in the limbs of adults. Nevertheless, the use of leeches to
 manage acute venous congestion of large portions of infants' bodies should
 be considered when surgical therapies are not feasible.
----------------------------------------------------------------------------]
Inoltre da quest'ultimo studio vediamo che l'utilita` delle sanguisughe in
chirurgia plastica ricostruttiva non puo` piu` essere messa in dubbio:
[----------------------------------------------------------------------------
*  Title: The failing flap in facial plastic and reconstructive surgery:
          role of the medicinal leech.
  Author: Utley DS; Koch RJ; Goode RL
 Address: Division of Otolaryngology/Head and Neck Surgery, Facial Plastic
          and Reconstructive Surgery, Stanford University Medical Center,
          Palo Alto Veterans Administration Health Care System, California
          94305-5328, USA. 
utl...@leland.stanford.edu
  Source: Laryngoscope, 108(8 Pt 1):1129-35 1998 Aug
          UI 98370727 ; ISSN 0023-852X
Abstract:
 OBJECTIVE: To review the use of the medicinal leech, Hirudo medicinalis,
 in salvaging the failing, venous-congested flap. A protocol for the use of
 leeches is presented. Four illustrative cases of failing flaps (pectoralis
 major, midline forehead, and temporalis) are presented.
 STUDY DESIGN: Literature review comprised of MEDLINE search 1965 to present.
 Retrospective review of four cases involving the management of the failing,
 venous-congested flap.
 METHODS: A retrospective review of four cases of failing, venous-congested
 flaps was performed.
 RESULTS: The authors' experience, as well as the data from the reviewed
 medical literature, demonstrates the importance of early intervention in
 order to salvage the failing, venous-congested flap. Leeches are an immediate
 and efficacious treatment option.
 CONCLUSIONS: 1. Review of the literature indicates that the survival of the
 compromised, venous-congested flap is improved by early intervention with the
 medicinal leech. H medicinalis injects salivary components that inhibit both
 platelet aggregation and the coagulation cascade. The flap is decongested
 initially as the leech extracts blood and is further decongested as the bite
 wound oozes after the leech detaches. 2. When a flap begins to fail, salvage
 of that flap demands early recognition of reversible processes, such as
 venous congestion. The surgeon must be familiar with the use of leeches
 and should consider their use early, since flaps demonstrate significantly
 decreased survival after 3 hours if venous congestion is not relieved. In the
 four cases presented, a standardized protocol facilitated early leech use
 and provided for the psychological preparation of the patient, availability
 of leeches, and an antibiotic prophylaxis regimen. 3. The complications
 associated with leech use can be minimized with antibiotic therapy, wound
 care, and hematocrit monitoring. 4. The use of the medicinal leech for
 salvage of the venous-congested flap is a safe, efficacious, economical,
 and well-tolerated intervention.
----------------------------------------------------------------------------]
Infine, se un giorno ti capitera` di trovare Vanoli :-) ricoverato d'urgenza
nella tua divisione, la tua deontologia professionale richiede che tu sia
al corrente anche di questo caso clinico:
[----------------------------------------------------------------------------
*  Title: Penile replantation using the leech Hirudo medicinalis.
  Author: Pantuck AJ; Lobis MR; Ciocca R; Weiss RE
 Address: Division of Urologic, University of Medicine and Dentistry of
          New Jersey, Robert Wood Johnson Medical School, New Brunswick
          08903, USA.
  Source: Urology, 48(6):953-6 1996 Dec
          UI 97129148 ; ISSN 0090-4295
Abstract:
 A 37-year-old chronic schizophrenic man underwent penile replantation after
 complete autoamputation using a kitchen knife. We report the first case of
 using medicinal leeches to salvage a penile replant after the development
 of postoperative venous congestion.
----------------------------------------------------------------------------]
Saluti.
  -=| Ginzo |=-

 > carne, queste si dedichino alla rimozione dei tessuti necrotici?
Ho sentito dire anchio che le sanguisughe hanno grosse proprietą
antistaminiche...
Non le larve, le sanguisughe proprio...
orsa


Per quanto ne so io non hanno proprieta' antiistaminiche tutt'altro..nella
loro saliva e' contenuto un mix di sostanze vasodilatatrici e anticoagulanti
che alla bestia servono per mangiare e che il medico sfrutta per il
mantenere la circolazione (vasodilatando anche i piccoli vasi ) e mantenedo
il sangue piu' fluido (impedendo la coagulazione)  di ferite molto
delicate.evitando cosi' l'ischemia e la conseguente 
necrosi.ad
 esempio la
ricostruzione di un dito amputato dove qualunque altra tecnica sarebbe  di
difficile applicazione per la dificolta di raggiungere efficacemente il
microcircolo.
Se avessreo effetto antiistaminico avrebbero l'effetto opposto e cioe'
inibire l'istamina sostanza mastocitaria che ha effetti vasodilatatori
causando cosi' una vasocostrizione che francamente non credo che interessi
ne all'animale ne al dito "ricucito" ;-)
Ciao
P.S Ginzo cosa hai contro gli iscritti al CICAP ;-))
*********************************************************************
                                    Claustro
 
Clau...@freemail.it
                                 icq 12443395
                              La mia lista di Mp3
 
http://members.it.tripod.de/listamp3/index.html
**********************************************************************

 P.S Ginzo cosa hai contro gli iscritti al CICAP ;-))
Vedi, i medici del Settecento curavano le ulcere vascolari con dei salassi
effettuati applicando sanguisughe.  La loro spiegazione (trombonesca) era
che i salassi curavano quasi tutte le malattie.  Siccome questa spiegazione
e` oggi scientificamente inaccettabile, il CICAP ne deduce che le sanguisughe
non servono a niente e che i resoconti di guarigioni di ulcere vascolari
avvenute con l'effettuazione di salassi erano solo inganni e autoinganni.
Dove sta l'errore di questo modo di ragionare?  Semplice: non tiene conto
che la validita` delle terapie mediche non si basa sulle spiegazioni teoriche
che ne vengono date, le quali possono benissimo essere delle castronerie, ma
soltanto sulla loro provata efficacia: se una terapia funziona ed e` sicura,
quella terapia va impiegata e basta.  Le spiegazioni scientifiche adeguate
verranno semmai trovate in futuro.  Sarebbe criminale mettere fuori legge
(come vorrebbero quelli del CICAP) terapie funzionanti come l'agopuntura,
l'irudo- e la larvoterapia, solo perche` non si capisce bene come funzionino.
L'atteggiamento di quelli del CICAP e` di uno scetticismo portato a tali
estremi che finisce per trasformarsi in una chiusura totale verso il nuovo.
Cosi` si spiega come mai anche medici di elevatissimo livello scientifico
e culturale possano lasciarsi andare a manifestazioni di ortodossa arroganza
schernendo terapie del passato come quelle a base di larve e sanguisughe,
senza sospettare che la biochirurgia (chirurgia con strumenti viventi) puo`
rappresentare un avanzamento anziche` un arretramento della medicina.
Saluti.
  -=| Ginzo |=-

 parlare dell'antistaSina.  Chi vuole, puo` leggersi queste tre referenze:
veramente interessanti...
orsa

senza sospettare che la biochirurgia
Infatti ..colui a cui ti riferisci non credo sia iscritto al CICAP ;-))
CMQ se ti interessa sapere la voce ufficiale puoi sempre fare un salto qui
http://www.cicap.org
Ciauzz
Andrea Giannozzi


   New Jersey, Robert Wood Johnson Medical School, New Brunswick
Paradossalmente quest'articolo che hai postato con intenti anche scherzosi
e' l'unica cosa seria degli abstract che mi hai inviato. Comunque per Vanoli
ho un altro programma.... :-)))
D> "Come va l'impianto sperimentale di proboscide d'elefante
D> che abbiamo fatto?"
V> "Bene, dottore, benissimo, ho un grande successo con le
V> donne... pero'..."
D> "Pero' cosa?"
V> "Tutte le volte che sono vicino ad una banana la proboscide
V> esce, l'afferra e me la schiaffa nel c..lo!"
Yours sincerely
        ___
 /\/\/\/ _/
/     / /_      -Doctor Diabolicus-
\/\/\/\__/
E-mail:   
d...@mclink.it
URL   :   
http://web.tiscalinet.it/ScienzaEmedicina
Fido  :   2:335/392.101

 V> esce, l'afferra e me la schiaffa nel c..lo!"
ragazzi, non si puň seguire un NG cosě... si muore dal ridere .)))))
orsa




gentili  da spiegarmi  cosa  e'  precisamente  il  CICAP?
In estrema sintesi, un comitato di scettici: di persone, cioe', che prima di
credere a supposti "fatti" del mondo reale, pretendono di essere convinti da
prove concrete.
La cosa migliore e' che tu ti faccia da sola una idea andando a visitare il
sito indicato in un'altro messaggio, 
http://www.cicap.org


...
