NEWSLETTER 5 (February 2002)
NEW LITERATURE IN BIOTHERAPY
Church, -JCT. Larval intervention in the chronic wound. EWMA Journal 2001; 1 (2): 14-17. The see the entire text, please click here as well as Figure 1 and Figure 2. (With the permission of the author and editor of the EWMA Journal).
Galeano,-M; Ioli,-V; Colonna,-M; Risitano,-G. Maggot therapy for treatment of osteomyelitis and deep wounds: an old remedy for an actual problem. Plast-Reconstr-Surg. 2001 Dec; 108(7): 2178-9.
Sherman,-R-A; Sherman,-J; Gilead,-L; Lipo,-M; Mumcuoglu,-K-Y. Maggot debridement therapy in outpatients. Arch-Phys-Med-Rehabil. 2001 Sep; 82(9): 1226-9
AB: OBJECTIVE: To identify the benefits, risks, and problems associated with outpatient maggot therapy. DESIGN: Descriptive case series, with survey. SETTING: Urban and rural clinics and homes. PARTICIPANTS: Seven caregivers with varying levels of formal health care training and 21 ambulatory patients (15 men, 6 women; average age, 63 yr) with nonhealing wounds. INTERVENTION: Maggot therapy. MAIN OUTCOME MEASURE: Therapists' opinions concerning clinical outcomes and the disadvantages of therapy. RESULTS: More than 95% of the therapists and 90% of their patients were satisfied with their outpatient maggot debridement therapy. Of the 8 patients who were advised to undergo amputation or major surgical debridement as an alternative to maggot debridement, only 3 required surgical resection (amputation) after maggot therapy. Maggot therapy completely or significantly debrided 18 (86%) of the wounds; 11 healed without any additional surgical procedures. There was anxiety about maggots escaping, but actual escapes were rare. Pain, reported by several patients, was controlled with oral analgesics. CONCLUSIONS: Outpatient maggot debridement is safe, effective, and acceptable to most patients, even when administered by nonphysicians. Maggot debridement is a valuable and rational treatment option for many ambulatory, home-bound, and extended care patients who have nonhealing wounds.
Grassberger,-M; Reiter,-C. Effect of temperature on Lucilia sericata (Diptera: Calliphoridae) development with special reference to the isomegalen- and isomorphen-diagram. Forensic-Sci-Int. 2001 Aug 15; 120(1-2): 32-6.
AB: Developmental behavior of eggs, larva and pupa of the blowfly species Lucilia sericata (Meigen) were studied under 10 different temperature regimes. Data from these studies were used to construct the isomegalen-diagram. In this diagram, time from hatching to peakfeeding is plotted against temperature, each line representing identical larval length at various temperatures. If the temperature is roughly constant, as is the case with corpses found indoors, the age of the maggot can be read off instantly from its length, provided that the maggot has not entered the migratory phase. Where temperature is variable, an age range can be estimated between the points where the measured larval length cuts the graph at the maximum and minimum temperatures recorded. Equally, the isomorphen-diagram representing all morphological stages from oviposition to eclosion should be used, if maggots in the migratory phase or pupae or puparia are recovered from the scene. The isomegalen- and the isomorphen-diagrams could facilitate a quick and more precise estimate of the postmortem interval even for the inexperienced investigator. In addition, our results vary from those of other investigators, suggesting a different thermal behavior of the holarctic blowfly L. sericata in various zoogeographic regions.
Wayman, -J., Nirojogi,-V, Walker,-A., Sowinski,-A., Walker,-MA. The cost effectiveness of larval therapy in venous ulcers. J. Tissue Viab. 10: 91-94.
AB. The treatment of necrotic ulcers involves considerable nursing time and expense. The current standard treatment involves repeated application of hydrogels. Larval debridement therapy (LDT) has been shown anecdotally to clear ulcers of necrotic slough but has never been compared directly with “modern” therapies. The aim of this study has been to compare LDT with hydrogel dressings in the treatment of necrotic venous ulcers. 12 patients with sloughy venous ulcers were randomized to receive either LDT or the control therapy –a hydrogel. Effective debridement occurred with a maximum of one larval application in 6/6 patients. 4/6 in the hydrogel group still required dressings at one month. The median cost of treatment of the larval group was £ 78.64 compared with £ 136.23 for the control treatment group (p<0.05). The study confirms both the clinical efficacy and cost effectiveness of larval therapy in the debridement of sloughy venous ulcers.
Bonn,-D. Maggot therapy: an alternative for wound infection. Lancet. 2000 Sep 30; 356(9236): 1174.
Cheng-Lai,-A. Cardiovascular drug highlight: hirudin. Heart-Dis. 1999 Mar-Apr; 1(1): 41-9.
AB: Hirudin is a polypeptide of 65 to 66 amino acids derived from the saliva of the medicinal leech Hirudo medicinalis. It is the most potent naturally occurring specific inhibitor of thrombin. Through genetic engineering, recombinant forms of hirudin (r-hirudin) have been made available in sufficient quantities for therapeutic use. Because hirudin is capable of inhibiting clot-bound thrombin and fluid-phase thrombin, it has great potential for management of patients with various types of thromboembolic complications. Clinical trials with hirudin have been conducted in patients with coronary artery disease, heparin-induced thrombocytopenia, and in patients undergoing orthopedic surgery. The results of selected clinical trials in each of these areas are reviewed here. At present, most clinical benefits of r-hirudin have been demonstrated in the management of patients with heparin-induced thrombocytopenia. For this reason, lepirudin (a form of r-hirudin) has recently been approved by the United States Food and Drug Administration (FDA) for anticoagulation in patients with heparin-induced thrombocytopenia and associated thromboembolic disease.
Michalsen,-A; Deuse,-U; Esch,-T; Dobos,-G; Moebus,-S. Effect of leeches therapy (Hirudo medicinalis) in painful osteoarthritis of the knee: a pilot study. Ann-Rheum-Dis. 2001 Oct; 60(10): 986.
Weinfeld,-A-B; Yuksel,-E; Boutros,-S; Gura,-D-H; Akyurek,-M; Friedman,-J-D. Clinical and scientific considerations in leech therapy for the management of acute venous congestion: an updated review. Ann-Plast-Surg. 2000 Aug; 45(2): 207-12.
AB: Any surgical intervention that involves the manipulation of veins, large or small, carries the risk of acute venous congestion. Venous congestion is the product of an imbalance between arterial inflow and venous outflow, and results in the stasis of blood in the tissues that are normally drained by the affected veins. The resultant lack of tissue perfusion causes hypoxia, acidosis, and arterial thrombi formation, which can potentially progress to tissue necrosis and wet gangrene. In the past several decades, the use of leeches (Hirudo medicinalis) has been rediscovered as an effective method of relieving acute venous congestion. This updated review of leech therapy focuses on the use of medicinal leeches in a variety of clinical conditions characterized by acute venous congestion, and points out the experimental use of leeches in other pathological entities. A discussion of the recent scientific findings that explain the possible mechanisms of action of leech therapy is also provided.
Smolle,-J; Cerroni,-L; Kerl,-H. Multiple pseudolymphomas caused by Hirudo medicinalis therapy. J-Am-Acad-Dermatol. 2000 Nov; 43(5 Pt 1): 867-9.
Guneren,-E; Erolu,-L; Akba,-H; Uysal,-O-A; Hokelek,-M; Erolu,-C. The use of Hirudo medicinalis in nipple-areolar congestion. Ann-Plast-Surg. 2000 Dec; 45(6): 679-81.
Ceyhan,-N; Ugur,-A. Investigation of in vitro antimicrobial activity of honey. Riv-Biol. 2001 May-Aug; 94(2): 363-71.
AB: Apitherapy or therapy with bee products as honey is an old tradition. In this study, the antimicrobial activity of 84 honey samples were investigated against 8 bacteria potential pathogens and 2 fungi. Honey samples were obtained from 10 different floral sources. The findings indicate that honey samples with thyme, thyme + acorn, pine + carob, pine + carob + anis and pine + chestnut are more effective than the other honey of floral sources. The results of the survey show that most of honey samples at 50% (w/v) can completely inhibit the growth of all of the tested bacteria. The fungi were less sensitive than the bacteria to the antimicrobial activity of honey. The sensitivity of microorganisms to sugar solutions with similar sugar contents as some honey samples which have high antimicrobial activity were also assayed. This sugar solutions inhibited a narrow range of bacteria and did not inhibit any of the fungi tested. In conclusion, these results encourage further studies to investigate possible benefits of the use of honey among therapies in the treatment of bacterial infections.
Branas,-P; Jordan,-R; Fry-Smith,-A; Burls,-A; Hyde,-C. Treatments for fatigue in multiple sclerosis: a rapid and systematic review. Health-Technol-Assess. 2000; 4(27): 1-61.
AB: BACKGROUND: Multiple sclerosis (MS) is an important problem both for people with the disease and for society. There is no cure, and alleviation of symptoms forms the cornerstone of care. Excessive fatigue that severely limits activity is experienced by at least two-thirds of the estimated 60,000 people with MS in the UK. OBJECTIVES: (1) To identify current treatments for fatigue in MS and their evidence-base. (2) To systematically review the evidence for those treatments that have been investigated in more than one rigorous study, in order to determine their effectiveness and cost-effectiveness. METHODS: The review was carried out in two stages: a formal scoping review (to assess the range of interventions used by people with MS), and a systematic review for treatments that had been identified as promising and that had been investigated in clinical trials (as identified in the scoping review). A systematic review of research on costs and cost-effectiveness of those interventions identified as promising was also performed. Electronic databases, including MEDLINE and EMBASE, were searched for the period 1991-June 1999 (scoping review) and 1966-December 1999 (systematic review). Reference lists from publications were also searched, and experts were contacted for any additional information not already identified. RESULTS: Interventions identified for the treatment of fatigue in MS (1) Behavioural advice. This is the main element of initial clinical management and no rigorous research of its effectiveness was identified. (2) Drugs (amantadine, pemoline, potassium-channel blockers and antidepressants). (3) Training, rehabilitation and devices (cooling vests and electromagnetic fields). (4) Alternative therapies (bee venom, cannabis, acupuncture/acupressure and yoga). Only two drugs, amantadine and pemoline, met the criteria for full systematic review. RESULTS - EFFECTIVENESS OF AMANTADINE: One parallel and three crossover trials were found, involving a total of 236 people with MS. All studies were open to bias. All studies showed a pattern in favour of amantadine compared with placebo, but there is considerable uncertainty about the validity and clinical significance of this finding. This pattern of benefit was considerably undermined when different assumptions were used in the sensitivity analysis. RESULTS - EFFECTIVENESS OF PEMOLINE: One parallel and one crossover trial were found involving a total of 126 people with MS. Both studies were open to bias. There was no overall tendency in favour of pemoline over placebo and an excess of reports of adverse effects with pemoline. RESULTS - HEALTH ECONOMIC ANALYSIS: The drug costs of amantadine and pemoline are modest (pound 200 and pound 80 per annum, respectively). No economic evaluations were identified in the systematic review, and available data were insufficient to allow modelling of cost-effectiveness in this rapid review. CONCLUSIONS: There is insufficient evidence to allow people with MS, clinicians or policy makers to make informed decisions on the appropriate use of the many treatments on offer. Only amantadine appears to have some proven ability to alleviate the fatigue in MS, though only a proportion of users will obtain benefit and then only some of these patients will benefit sufficiently to take the drug in the long term. CONCLUSIONS - RECOMMENDATIONS FOR RESEARCH: The frequency, severity and impact of fatigue, the poverty of available research, and the absence of any ongoing research, suggest that new research is an urgent priority. People with MS, clinicians and policy makers should work together to ensure that the evidence required is collected as quickly as possible by encouraging involvement in rigorous research. Research should not be restricted to the two drugs reviewed in depth in this report. All interventions identified in the scoping review (see above) should be considered, as should basic scientific research into the underlying mechanism of fatigue in MS.
Lee,-J-H; Kwon,-Y-B; Han,-H-J; Mar,-W-C; Lee,-H-J; Yang,-I-S; Beitz,-A-J; Kang,-S-K. Bee venom pretreatment has both an antinociceptive and anti-inflammatory effect on carrageenan-induced inflammation. J-Vet-Med-Sci. 2001 Mar; 63(3): 251-9.
AB: Although the injection of bee venom (BV) has been reported to evoke tonic pain and hyperalgesia, there is conflicting evidence in the literature indicating that BV can also exert an anti-inflammatory and antinociceptive effects on inflammation. In this regard, BV has been traditionally used in Oriental medicine to relieve pain and to treat chronic inflammatory diseases such as rheumatoid arthritis. The present study was designed to test the hypothesis that BV induces acute nociception under normal conditions, but that it can serve as a potent anti-inflammatory and antinociceptive agent in a localized inflammatory state. The experiments were designed to evaluate the effect of BV pretreatment on carrageenan (CR)-induced acute paw edema and thermal hyperalgesia. In addition, spinal cord Fos expression induced by peripheral inflammation was quantitatively analyzed. In normal animals subcutaneous BV injection into the hindlimb was found to slightly increase Fos expression in the spinal cord without producing detectable nociceptive behaviors or hyperalgesia. In contrast pretreatment with BV (0.8 mg/kg) 30 min prior to CR injection suppressed both the paw edema and thermal hyperalgesia evoked by CR. In addition, there was a positive correlation between the percent change in paw volume and the expression of Fos positive neurons in the spinal cord. These results indicate that BV pretreatment has both antinociceptive and anti-inflammatory effects in CR-induced inflammatory pain. These data also suggest that BV administration may be useful in the treatment of the pain and edema associated with chronic inflammatory diseases.
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