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All,<br><br> I agree its worth trying anesthetic<br> cream instead of local anesthesia with lidocaine for heat therapy. This will simplify the TX and reduce cost. We have used EMLA in Tunisian children to clean and debri well the lesions before topical TX. Scraping and small biopsies can also be perform without pain. I have no experience with EMLA and RF therapy. <br> <br> <br> <br></font><br> <br>
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<b>From</b>: Richard Reithinger [mailto:rreithinger@yahoo.co.uk]
<br><b>Sent</b>: Wednesday, June 15, 2011 08:57 AM<br><b>To</b>: AbhaySatoskar <Abhay.Satoskar@osumc.edu>; John David <jdavid@hsph.harvard.edu>; Magill, Alan J COL MIL USA MEDCOM WRAIR; Kwang-PooChang <KwangPoo.Chang@rosalindfranklin.edu>
<br><b>Cc</b>: Raj <raj@cellabs.com.au>; vishwamohan_katoch@yahoo.co.in <vishwamohan_katoch@yahoo.co.in>; leish-l@lineu.icb.usp.br <leish-l@lineu.icb.usp.br>
<br><b>Subject</b>: Re: [Leish-l] Thermotherapy
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<DIV class=links>For one of the patients:</DIV>
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<P class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"><A title=Lancet. href="http://www.ncbi.nlm.nih.gov/pubmed/21315946"><SPAN style="COLOR: blue">Lancet.</SPAN></A> 2011 Feb 12;377(9765):610.<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" /><o:p></o:p></SPAN></DIV>
<P class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal; mso-outline-level: 1"><B><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'; mso-font-kerning: 18.0pt">Heat, Oriental sore, and HIV.<o:p></o:p></SPAN></B></DIV>
<P class=MsoNormal style="BACKGROUND: white; MARGIN: 0in 0in 0pt; LINE-HEIGHT: normal"><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'Arial','sans-serif'; mso-fareast-font-family: 'Times New Roman'"><A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Prasad%20N%22%5BAuthor%5D"><SPAN style="COLOR: blue">Prasad N</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ghiya%20BC%22%5BAuthor%5D"><SPAN style="COLOR: blue">Ghiya BC</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bumb%20RA%22%5BAuthor%5D"><SPAN style="COLOR: blue">Bumb RA</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Kaushal%20H%22%5BAuthor%5D"><SPAN style="COLOR: blue">Kaushal H</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Saboskar%20AA%22%5BAuthor%5D"><SPAN style="COLOR: blue">Saboskar AA</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lezama-Davila%20CM%22%5BAuthor%5D"><SPAN style="COLOR: blue">Lezama-Davila
CM</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Salotra%20P%22%5BAuthor%5D"><SPAN style="COLOR: blue">Salotra P</SPAN></A>, <A href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Satoskar%20AR%22%5BAuthor%5D"><SPAN style="COLOR: blue">Satoskar AR</SPAN></A>.<o:p></o:p></SPAN></DIV>
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<DIV class=cit><BR><BR>--- On <B>Wed, 15/6/11, Chang, Kwang-Poo <I><KwangPoo.Chang@rosalindfranklin.edu></I></B> wrote:<BR></DIV></DIV></DIV>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: rgb(16,16,255) 2px solid"><BR>From: Chang, Kwang-Poo <KwangPoo.Chang@rosalindfranklin.edu><BR>Subject: RE: Thermotherapy<BR>To: "Satoskar, Abhay" <Abhay.Satoskar@osumc.edu>, "Richard Reithinger" <rreithinger@yahoo.co.uk>, "John David" <jdavid@hsph.harvard.edu>, "Alan J COL MIL USA MEDCOM WRAIRMagill" <ALAN.MAGILL@US.ARMY.MIL><BR>Cc: vishwamohan_katoch@yahoo.co.in, "Raj" <raj@cellabs.com.au>, leish-l@lineu.icb.usp.br<BR>Date: Wednesday, 15 June, 2011, 13:41<BR><BR>
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<DIV dir=ltr><FONT face=Arial color=#000000 size=2>Dear Abhay,</FONT></DIV>
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<DIV dir=ltr><FONT face=Arial size=2>Where are your HIV-CL patients located in India ? Are these PKDL or CL caused by something else ?</FONT></DIV>
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<DIV dir=ltr><FONT face=Arial size=2>KP</FONT></DIV></DIV>
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<FONT face=Tahoma size=2><B>From:</B> Satoskar, Abhay [mailto:Abhay.Satoskar@osumc.edu]<BR><B>Sent:</B> Wed 6/15/2011 6:33 AM<BR><B>To:</B> Richard Reithinger; Chang, Kwang-Poo; John David; Alan J COL MIL USA MEDCOM WRAIRMagill<BR><B>Cc:</B> vishwamohan_katoch@yahoo.co.in; Raj; leish-l@lineu.icb.usp.br<BR><B>Subject:</B> RE: Thermotherapy<BR></FONT><BR></DIV>
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<DIV>All,</DIV>
<DIV><FONT face=tahoma>I think there some interesting<A rel=nofollow></A> discussions here. I think its worth trying anesthetic<A rel=nofollow></A> cream for heat therapy. We will do that. As Richard indicated that the greatest advantage of RF<A rel=nofollow></A><A rel=nofollow></A> therapy ( even if it need local anesthesia with lidocaine<A rel=nofollow></A><A rel=nofollow></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 rel=nofollow></A><A rel=nofollow></A> SSG<A rel=nofollow></A><A rel=nofollow></A> even after their CD4<A rel=nofollow></A><A rel=nofollow></A>+ T cell counts increasing to > 200 after starting HAART<A rel=nofollow></A><A rel=nofollow></A>. These patients were treated<A rel=nofollow></A> with RF<A
rel=nofollow></A><A rel=nofollow></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>
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<DIV><FONT face=tahoma><FONT face=tahoma><FONT face=tahoma><A rel=nofollow><FONT face=tahoma>Abhay</FONT></A></FONT></FONT></FONT></DIV>
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<DIV><FONT face=Tahoma size=2><A rel=nofollow></A><FONT face=Tahoma size=2><A rel=nofollow></A></FONT><FONT face=Tahoma size=2><FONT face=Tahoma size=2>Abhay</FONT></FONT> R Satoskar<A rel=nofollow></A><A rel=nofollow></A> MD, PhD</FONT></DIV>
<DIV><FONT face=tahoma size=2>Professor</FONT></DIV>
<DIV><FONT face=tahoma size=2>Departments of Pathology and Microbiology</FONT></DIV>
<DIV><FONT face=tahoma size=2>129 Hamilton Hall</FONT></DIV>
<DIV><FONT face=tahoma size=2>1645 Neil Avenue</FONT></DIV>
<DIV><FONT face=tahoma size=2>The Ohio State University</FONT></DIV>
<DIV><FONT face=tahoma size=2>Columbus, Ohio</FONT></DIV>
<DIV><FONT face=tahoma size=2>Tel: 614-366-3417</FONT></DIV></DIV>
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<FONT face=Tahoma color=#000000 size=2><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></FONT><BR></DIV>
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<DIV><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'sans-serif'">All, </SPAN></DIV>
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<DIV><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'sans-serif'">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>
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<DIV><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'sans-serif'">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>
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<DIV><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'sans-serif'">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>
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<DIV><SPAN style="FONT-SIZE: 10pt; FONT-FAMILY: 'sans-serif'">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></DIV>
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: rgb(16,16,255) 2px solid"><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=yiv766059484plainMail>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 rel=nofollow>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 rel=nofollow>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 rel=nofollow>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 rel=nofollow>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 rel=nofollow>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 rel=nofollow>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 rel=nofollow>leish-l@lineu.icb.usp.br</A>; <A href="http://uk.mc256.mail.yahoo.com/mc/compose?to=hgoto@usp.br" target=_blank rel=nofollow>hgoto@usp.br</A>; <A href="http://uk.mc256.mail.yahoo.com/mc/compose?to=elfadil_abass@yahoo.com" target=_blank
rel=nofollow>elfadil_abass@yahoo.com</A>; <A href="http://uk.mc256.mail.yahoo.com/mc/compose?to=vishwamohan_katoch@yahoo.co.in" target=_blank rel=nofollow>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>Leish-l mailing list<BR><A href="http://uk.mc256.mail.yahoo.com/mc/compose?to=Leish-l@lineu.icb.usp.br" target=_blank rel=nofollow>Leish-l@lineu.icb.usp.br</A><BR><A href="http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l" target=_blank rel=nofollow>http://lineu.icb.usp.br/cgi-bin/mailman/listinfo/leish-l</A><BR></DIV></BLOCKQUOTE></TD></TR></TBODY></TABLE></DIV></DIV></DIV></DIV></BLOCKQUOTE></td></tr></table>