[Leish-l] Local therapy

[buffet pierre]

John

In my personal experience intralesional antimony is not more painful than injected anesthesia. Injected antimony is not painful by itself upon injection. What is indeed painful in tissue distension linked to the injection of fluid - this is why injected anesthesia is useless when performing IL injections of antimony. Epicutaneous anesthesia with lidocaine cream, superficial short cryotherapy just before injection (that also increases efficacy as mentioned in a previous message), small needles and slow injections reduce the negative reactions of patients of all ages. There is no residual pain after injection. In L. major CL we rarely need to repeat the procedure more than 3 times (when cryo is used along). Yet I agree that this is more than the single session of thermo.

Each local method has therefore its strengths and weaknesses and none of the methods creating pain and requiring specific material or devices are optimal in the fields, which emphasizes the need for effective and widely  available ointments or oral agents. I completely agree that this is particularly true for children.

Pierre


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----- Message d'origine -----
De: John David <jdavid at hsph.harvard.edu>
Date: Samedi, Juin 18, 2011 10:47 pm
Objet: Re: [Leish-l] inquiry
À: "Magill, Alan J COL MIL USA MEDCOM WRAIR" <ALAN.MAGILL at US.ARMY.MIL>
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>


> Local anesthesia must be given when using heat therapy. I should  
>  mention that some have advocated local lesion injection of 
> pentavalent  
>  antimony. This, usually given without anesthesia, is very painful. I  
> 
>  have seen it given in a clinic where adults winced terribly and it 
> was  
>  complete bedlam with the loud piercing screams of  children.
>  And they had to return weekly for at least five times. I can't  
>  recommend that.
>  John David
>  
>  
>  
>  On Jun 8, 2011, at 3:45 PM, Magill, Alan J COL MIL USA MEDCOM WRAIR  
> 
>  wrote:
>  
>  > 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.
>  
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