[Leish-l] Re : Re: inquiry

[Chang, Kwang-Poo]

I read your messsage with great interest.
 
KP

________________________________

From: buffet pierre [mailto:pierre.buffet at psl.aphp.fr]
Sent: Wed 6/15/2011 12:12 AM
To: Magill, Alan J COL MIL USA MEDCOM WRAIR
Cc: Chang, Kwang-Poo; John David; Satoskar, Abhay; vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
Subject: Re : Re: [Leish-l] inquiry



Alan and all,

I use topical lidocaine (EMLA or generics) as a routine for cryotherapy plus intralesional antimony which is now a reference ("WHO-recommended") local therapy, and - as shown in 4 clinical trials - works much better than each technique used alone. EMLA slightly reduces the pain linked to the introduction of the needle but does nothing on the pain linked to the injection of fluid in the lesion/dermis. I assume it would have only a very mild effect on the pain linked to dermal burning. I am afraid thermotherapy without injected lidocaine will be hardly sustainable. Therefore one has to integrate the constraints of injected anesthesia in the process of conventional thermotherapy.

My suggestion would be to test a low-tech "light" thermo as an enhancer of the efficacy intralesional antimony (just like the superficial painless cryo we use prior to intralesional of antimony). This does not remove the constraints of intralesional injections but would be based on available methods. Many patients with mutiple lesions require immediate intervention for only a few exposed lesions.

Pierre



Pierre Buffet MCU-PH
Service de Parasitologie Mycologie Pr. Mazier
Hôpital Pitié Salpêtrière
+ 33 (0)1 42 16 01 31     + 33 (0)6 23 21 43 00

Adresse postale Mailing address:
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----- Message d'origine -----
De: "Magill, Alan J COL MIL USA MEDCOM WRAIR" <ALAN.MAGILL at US.ARMY.MIL>
Date: Mercredi, Juin 15, 2011 4:58 am
Objet: Re: [Leish-l] inquiry
À: "Chang, Kwang-Poo" <KwangPoo.Chang at rosalindfranklin.edu>, John David <jdavid at hsph.harvard.edu>
Cc: "Satoskar, Abhay" <Abhay.Satoskar at osumc.edu>, "vishwamohan_katoch at yahoo.co.in" <vishwamohan_katoch at yahoo.co.in>, Raj <raj at cellabs.com.au>, "leish-l at lineu.icb.usp.br" <leish-l at lineu.icb.usp.br>


> John certainly knows well..
>
> 50C is not tolerable to human skin. All potential lesions to be
> treated need to be appropriately cleaned and anesthetized with
> intradermal and subQ injection of lidocaine. I have never tried the
> newer lidocaine creams such as EMLA, they might work as well. This can
> be somewhat rate limiting for multiple lesions as each lesion needs to
> be prepared, injected, and you need to wait about 10 plus minutes for
> the lidocaine to work.
>
> Trying the Thermomed device on normal skin (try on yourself) will show
> that most people can only get to about 43 or 44 C before quickly
> removing the device from their skin.
>
> Alan Magill
>
>
> ________________________________
> From: leish-l-bounces at lineu.icb.usp.br
> [leish-l-bounces at lineu.icb.usp.br] On Behalf Of Chang, Kwang-Poo [KwangPoo.Chang at rosalindfranklin.edu]
> Sent: Monday, June 06, 2011 12:02 PM
> To: John David
> Cc: Satoskar, Abhay; vishwamohan_katoch at yahoo.co.in; Raj; leish-l at lineu.icb.usp.br
> Subject: Re: [Leish-l] inquiry
>
> Any chance to make it available for additional trials elsewhere ?
>
> I recall your statement in our conversation about the advantage of
> this instrument over the heating lamp. That is to maintain the
> specific elevated temperature uniformly throughout the skin lesion for
> a sustained period. The 50 C must be the effective temperature that
> has been experimentally determined. It seems to be a tolerable
> temperature to human skin ?  Dr. Sharma may comment on this medically
> as a dermatologist ?
>
> KP
>
> ________________________________
> From: John David [mailto:jdavid at hsph.harvard.edu]
> Sent: Sunday, June 05, 2011 11:18 PM
> To: Chang, Kwang-Poo
> Cc: Sharmanl; Satoskar, Abhay; Raj; Petr Volf;
> leish-l at lineu.icb.usp.br; hgoto at usp.br; elfadil_abass at yahoo.com; vishwamohan_katoch at yahoo.co.in
> Subject: Re: [Leish-l] inquiry
>
> The Themomed instrument shown below can produce accurate 50 degrees C 
> plus or minus 0.2 degrees temperature by radio wave.
> from Themorsurgery Technologies. Picture below.
> Two papers of a trial in Brazil and one in Afghanistan on CL below.
> _______________________________________________
> Leish-l mailing list
> Leish-l at lineu.icb.usp.br
> http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l


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