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<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Dear Tony,<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Thank you so much for letting us know your
invaluable experience with detailed information on treating CL lesions by
physical means. This is certainly a much needed ‘education’ for me.
I am not qualified to comment on what you said, but wish to provide the
following information:<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<ol style='margin-top:0in' start=1 type=1>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>The
device, ThermoSurgery instrument, delivers radiowave to generate heat at
50 C (pretty precisely) for 30 seconds under anesthesia with 2% lidocaine
(John David’s article TSRSTMH 100, 642. 2006). No re-emergence of
lesion after 1.5 years according to Abhay’s e-mail message.<o:p></o:p></span></font></li>
</ol>
<p class=MsoNormal style='margin-left:.25in'><font size=2 color=navy
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<ol style='margin-top:0in' start=2 type=1>
<li class=MsoNormal style='color:navy;mso-list:l0 level1 lfo1'><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial'>I
was told that the Tropical Medicine Center of Cukurova University, <st1:City
w:st="on"><st1:place w:st="on">Adana</st1:place></st1:City> discontinued
cryotherapy for treating CL because lesions re-merged. Intra-lesion antimony
injection is currently in practice.<o:p></o:p></span></font></li>
</ol>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Anthony Bryceson
[mailto:a.bryceson@doctors.org.uk] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Wednesday, June 08, 2011
6:30 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Chang, Kwang-Poo<br>
<b><span style='font-weight:bold'>Cc:</span></b> John David; Satoskar, Abhay;
vishwamohan_katoch@yahoo.co.in; Raj; leish-l@lineu.icb.usp.br<br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [Leish-l] inquiry</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>I have been following the correspondence on heat therapy with interest,
having explored it myself in the past.<o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>There are two forms of heat therapy. The first uses heat
physiologically to promote natural healing, while the second uses heat as form
of cautery to burn out the lesion.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>To promote natural healing, heat is applied to the skin at temperatures
in the range 37-40oC. Many species of cutaneous Leishmania do not survive at
37oC and lymphocytes act most efficiently at 40oC. This form of therapy
disadvantages the parasite and advantages the host. Temperatures must be
accurately applied because the skin burns at 42-45oC, depending on the method
and duration of application. The difficulty of this approach is how to achieve
accurate delivery and maintain the temperature for many hours per day over many
days. Infra-red treatment, as introduced by George Rahim in <st1:City w:st="on"><st1:place
w:st="on">Baghdad</st1:place></st1:City>, probably comes into this
category; heat from a lamp was applied through a cone, but temperature control
was difficult and it was not easy to prevent burns. At the Hospital for
Tropical Diseases, <st1:City w:st="on"><st1:place w:st="on">London</st1:place></st1:City>,
we developed a method whereby a fine coiled wire was imbedded in a
flexible pad made from the stuff that dentists use for making plates. Pads
could be custom made, for example to fit the pinna of an ear. A thermistor was
incorporated alongside the heating wire in the pad with feedback to the power
box so as to maintain an accurate-ish temperature. Nevertheless it was
difficult absolutely to prevent burns and patients were effectively tied to the
machine for long periods of time. The method worked reasonably well, but we
abandoned it as impractical. Eduardo Missoni wrote up some case histories; but
we never published anything formally. <o:p></o:p></span></font></p>
</div>
<div>
<p style='mso-margin-top-alt:0in;margin-right:0in;margin-bottom:2.0pt;
margin-left:0in'><span class=apple-style-span><i><font size=1
face="Trebuchet MS"><span style='font-size:8.0pt;font-family:"Trebuchet MS";
font-style:italic'> Missoni E. Heat treatment of cutaneous leishmaniasis.
Trop Doct. 1984;14:46</span></font></i></span><font size=1 face="Trebuchet MS"><span
style='font-size:6.0pt;font-family:"Trebuchet MS"'>.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>WRAIR developed a method whereby water from a water-bath was pumped
through an intravenous fluid bag that was applied over the lesion. But I
understand that the system did not seem practiacble and was not taken
forward. <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Heat cautery burns out the lesions, and the Thermomed instrument that
delivers a temperature of 50oC between two electrodes implanted into the lesion
comes into this category. It must of course be used with local anaesthetic. I
have never used it; but its advantage seems to be that it is painless, and
effective, often at a single setting if the lesions is small. John David speaks
very highly of it. It is not suitable for all lesions and there can be
complications. see <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><a
href="http://www.crd.york.ac.uk/CMS2Web/ShowRecord.asp?LinkFrom=OAI&ID=32010001498">http://www.crd.york.ac.uk/CMS2Web/ShowRecord.asp?LinkFrom=OAI&ID=32010001498</a> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>for example: "Post treatment wound care is essential, as
blistering and secondary infection are the most common adverse effects."
With a power box to carry around and electrodes to sterilise, i don't know how
useful it may be under field conditions.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Cryotherapy and simple curettage are other techniques that have been
used successfully to destroy leishmanial sores.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Curettage requires local anaesthetic, but is simple to perform.
The curette can be cleaned and safely sterilised by flaming in small
steel dish with a few ml of methylated spirit (wait a moment before
picking up the curette). Currie published a small study, and was pleased
with the results.<o:p></o:p></span></font></p>
</div>
<div>
<p style='mso-margin-top-alt:0in;margin-right:0in;margin-bottom:2.0pt;
margin-left:0in'><span class=apple-style-span><i><font size=1
face="Trebuchet MS"><span style='font-size:8.0pt;font-family:"Trebuchet MS";
font-style:italic'> Currie MA. Treatment of cutaneous leishmaniasis by
curettage. Br Med J (Clin Res Ed). 1983;287:1105-1106.</span></font></i></span><font
size=1 face="Trebuchet MS"><span style='font-size:6.0pt;font-family:"Trebuchet MS"'><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>If I were looking for a simple portable method of treatment in the
field I would seriously consider curettage under local anaesthetic. Perhaps
there is a dermato-leishmaniac out there who would like to compare
curettage with intralesional SSG? But please plan the study carefully - the
literature on treatment of CL is littered with uninterpretable publications.
It's time we got our act together.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Anthony Bryceson<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>On 6 Jun 2011, at 17:02, Chang, Kwang-Poo wrote:<o:p></o:p></span></font></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><br>
<br>
<o:p></o:p></span></font></p>
<u1:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="country-region"><u1:smarttagtype namespaceuri="urn:schemas-microsoft-com:office:smarttags" name="place">
<div link=blue vlink=purple style='word-wrap: break-word;-webkit-nbsp-mode: space;
-webkit-line-break: after-white-space'>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Any chance to make it available for
additional trials elsewhere ?<u1:p></u1:p></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><u1:p> </u1:p></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>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 ?<u1:p></u1:p></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><u1:p> </u1:p></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>KP<u1:p></u1:p></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><u1:p> </u1:p></span></font><o:p></o:p></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> John David
[mailto:jdavid@hsph.harvard.edu] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Sunday, June 05, 2011 11:18
PM<br>
<b><span style='font-weight:bold'>To:</span></b> Chang, Kwang-Poo<br>
<b><span style='font-weight:bold'>Cc:</span></b> Sharmanl; Satoskar, Abhay;
Raj; Petr Volf; <a href="mailto:leish-l@lineu.icb.usp.br">leish-l@lineu.icb.usp.br</a>;
<a href="mailto:hgoto@usp.br">hgoto@usp.br</a>; <a
href="mailto:elfadil_abass@yahoo.com">elfadil_abass@yahoo.com</a>; <a
href="mailto:vishwamohan_katoch@yahoo.co.in">vishwamohan_katoch@yahoo.co.in</a><br>
<b><span style='font-weight:bold'>Subject:</span></b> Re: [Leish-l] inquiry</span></font><u1:p></u1:p><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><u1:p> </u1:p><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The Themomed instrument shown below can produce accurate 50 degrees C
plus or minus 0.2 degrees temperature by radio wave.<u1:p></u1:p><o:p></o:p></span></font></p>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>from Themorsurgery Technologies. Picture below.<u1:p></u1:p><o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Two papers of a trial in <st1:country-region u2:st="on"><st1:country-region
w:st="on">Brazil</st1:country-region></st1:country-region> and one in <st1:country-region u2:st="on"><st1:place u2:st="on"><st1:country-region
w:st="on"><st1:place w:st="on">Afghanistan</st1:place></st1:country-region></st1:place></st1:country-region>
on CL below.<u1:p></u1:p><o:p></o:p></span></font></p>
</div>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>_______________________________________________<br>
Leish-l mailing list<br>
<a href="mailto:Leish-l@lineu.icb.usp.br">Leish-l@lineu.icb.usp.br</a><br>
http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l<br>
<br>
<o:p></o:p></span></font></p>
</div>
</u1:smarttagtype></u1:smarttagtype>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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