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<div>All,</div>
<div><font face="tahoma">I think there some interesting<a></a> discussions here. I think its worth trying anesthetic<a></a> cream for heat therapy. We will do that. As Richard indicated that the greatest advantage of RF<a></a><a></a> therapy ( even if it need
local anesthesia with lidocaine<a></a><a></a>) is that in most patient just one treatment for 1 min is enough to induce complete clinical cure. More importantly, in India we had three HIV patients with CL who failed to respond to intralesional<a></a><a></a> SSG<a></a><a></a>
even after their CD4<a></a><a></a>+ T cell counts increasing to > 200 after starting HAART<a></a><a></a>. These patients were treated<a></a> with RF<a></a><a></a> therapy which resulted in complete lesion healing in 5-6 weeks. The patients have remained
disease free after 1.5 years. As we know treating CL in HIV patients can be difficult so I think we have an effective alternative.</font></div>
<div><font face="tahoma"></font> </div>
<div><font face="tahoma"><font face="tahoma"><font face="tahoma"><a><font face="tahoma">Abhay</font></a></font></font></font></div>
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<div><font size="2" face="Tahoma"><a></a><font size="2" face="Tahoma"><a></a></font><font size="2" face="Tahoma"><font size="2" face="Tahoma">Abhay</font></font> R Satoskar<a></a><a></a> MD, PhD</font></div>
<div><font size="2" face="tahoma">Professor</font></div>
<div><font size="2" face="tahoma">Departments of Pathology and Microbiology</font></div>
<div><font size="2" face="tahoma">129 Hamilton Hall</font></div>
<div><font size="2" face="tahoma">1645 Neil Avenue</font></div>
<div><font size="2" face="tahoma">The Ohio State University</font></div>
<div><font size="2" face="tahoma">Columbus, Ohio</font></div>
<div><font size="2" face="tahoma">Tel: 614-366-3417</font></div>
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<font color="#000000" size="2" face="Tahoma"><b>From:</b> Richard Reithinger [rreithinger@yahoo.co.uk]<br>
<b>Sent:</b> Wednesday, June 15, 2011 4:02 AM<br>
<b>To:</b> Kwang-PooChang; John David; Alan J COL MIL USA MEDCOM WRAIRMagill<br>
<b>Cc:</b> Satoskar, Abhay; vishwamohan_katoch@yahoo.co.in; Raj; leish-l@lineu.icb.usp.br<br>
<b>Subject:</b> Thermotherapy<br>
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<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt">All, </span>
</div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt"></span> </div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt">Agree with Alan: patients need at least intradermal anesthesia prior application of radiofrequency waves using the ThermoMed device; 50C is way to high for someone to endure for 5 min or
so. </span></div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt"></span> </div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt">The reason the device appears to work better than other similar approaches is that the radiofrequencies yield a relatively homogenous/stable field where skin particles get excited, and in
turn generate the heat; the heat (temperature) is then controlled by a thermistor embedded in the device. Following application of radiofrequency-generated heat, application of a topical antibiotic is recommended to avoid post-treatment secondary infections.
From an operational point of view we also know that the ThermoMed device is more useful in situations where (i) you have lots of patients (i.e. economies of scale); (ii) patients with smaller lesions; and (iii) patient with lesions that are not located on
joint or body areas that are difficult to access. Whilst a clear disadvantage of the device has been cost, the advantages have been that many patients only require one application session of radiofrequency-generated heat (i.e. patient lost to follow-up are
not an issue) and that the device is portable (e.g. can be used in mobile-type of treatment service provision).</span></div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt"></span> </div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt">Having said, I second Tony Bryceson's comment, that there is scope for additional well-designed and carried out clinical trials looking at this approach, comparing it to IM/IV or IL SbV or
other treatment modalities.</span></div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt"></span> </div>
<div><span style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt">Richard Reithinger</span></div>
<div><br>
--- On <b>Wed, 8/6/11, Magill, Alan J COL MIL USA MEDCOM WRAIR <i><ALAN.MAGILL@US.ARMY.MIL></i></b> wrote:<br>
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<blockquote style="BORDER-LEFT: rgb(16,16,255) 2px solid; PADDING-LEFT: 5px; MARGIN-LEFT: 5px">
<br>
From: Magill, Alan J COL MIL USA MEDCOM WRAIR <ALAN.MAGILL@US.ARMY.MIL><br>
Subject: Re: [Leish-l] inquiry<br>
To: "Chang, Kwang-Poo" <KwangPoo.Chang@rosalindfranklin.edu>, "John David" <jdavid@hsph.harvard.edu><br>
Cc: "Satoskar, Abhay" <Abhay.Satoskar@osumc.edu>, "vishwamohan_katoch@yahoo.co.in" <vishwamohan_katoch@yahoo.co.in>, "Raj" <raj@cellabs.com.au>, "leish-l@lineu.icb.usp.br" <leish-l@lineu.icb.usp.br><br>
Date: Wednesday, 8 June, 2011, 20:45<br>
<br>
<div class="plainMail">John certainly knows well..<br>
<br>
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.<br>
<br>
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.<br>
<br>
Alan Magill<br>
<br>
<br>
________________________________<br>
From: <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l-bounces@lineu.icb.usp.br" target="_blank">
leish-l-bounces@lineu.icb.usp.br</a> [<a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l-bounces@lineu.icb.usp.br" target="_blank">leish-l-bounces@lineu.icb.usp.br</a>] On Behalf Of Chang, Kwang-Poo [<a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=KwangPoo.Chang@rosalindfranklin.edu" target="_blank">KwangPoo.Chang@rosalindfranklin.edu</a>]<br>
Sent: Monday, June 06, 2011 12:02 PM<br>
To: John David<br>
Cc: Satoskar, Abhay; <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=vishwamohan_katoch@yahoo.co.in" target="_blank">
vishwamohan_katoch@yahoo.co.in</a>; Raj; <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l@lineu.icb.usp.br" target="_blank">
leish-l@lineu.icb.usp.br</a><br>
Subject: Re: [Leish-l] inquiry<br>
<br>
Any chance to make it available for additional trials elsewhere ?<br>
<br>
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 ?<br>
<br>
KP<br>
<br>
________________________________<br>
From: John David [mailto:<a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=jdavid@hsph.harvard.edu" target="_blank">jdavid@hsph.harvard.edu</a>]<br>
Sent: Sunday, June 05, 2011 11:18 PM<br>
To: Chang, Kwang-Poo<br>
Cc: Sharmanl; Satoskar, Abhay; Raj; Petr Volf; <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=leish-l@lineu.icb.usp.br" target="_blank">
leish-l@lineu.icb.usp.br</a>; <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=hgoto@usp.br" target="_blank">
hgoto@usp.br</a>; <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=elfadil_abass@yahoo.com" target="_blank">
elfadil_abass@yahoo.com</a>; <a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=vishwamohan_katoch@yahoo.co.in" target="_blank">
vishwamohan_katoch@yahoo.co.in</a><br>
Subject: Re: [Leish-l] inquiry<br>
<br>
The Themomed instrument shown below can produce accurate 50 degrees C plus or minus 0.2 degrees temperature by radio wave.<br>
from Themorsurgery Technologies. Picture below.<br>
Two papers of a trial in Brazil and one in Afghanistan on CL below.<br>
_______________________________________________<br>
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<a href="http://uk.mc256.mail.yahoo.com/mc/compose?to=Leish-l@lineu.icb.usp.br" target="_blank">Leish-l@lineu.icb.usp.br</a><br>
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