Medicine Essay, Research Paper
The Use of Leeches in Modern Therapeutic Medicine
The usage of bloodsuckers as a method of bloodletting reached a extremum during the eighteenth and early 19th centuries. At that clip, bloodsuckers were used by pharmacists and sawboness, in add-on to lancets, scarifiers and shed blooding cups, in an effort to reconstruct wellness by taking vitiated blood ( Eldor et al. 1996 ) . The first medical practician to utilize bloodsuckers for curative intents is presumed to be Nicander of Colophan and the usage of leeched was mentioned in ancient Chinese, Sanskrit, Persian and Arabic literature every bit good as in the Old Testament ( Eldor et al. 1996 ) . In the yesteryear, bloodsuckers were applied to congested or inflamed countries of the organic structure in conditions of congested haemorrhoids, conceited testiss, laryngitis, prolapsed rectum and inflamed vulva ( Eldor et al. 1996 ) . The death of leech therapy was a long delinquent victory of scientific discipline over superstitious notion. However, this pattern is doing a major rejoinder. Medicative bloodsuckers, Hirudinea medicinalis, are now used by fictile sawboness to take blood from postoperative occlusions in order to increase the success of tissue grafts, decrease mammoplasty, and the surgical reattachment of amputated appendages and figures by cut downing the frequence of mortification ( Lent 1990 ) . Leechs are besides used in the intervention of post-phlebetic syndrome, which is a complication that occurs as a consequence of venous valve devastation ( Eldor et al. 1996 ) . Therefore, bloodsuckers are good in get the better ofing many of the jobs normally associated with rehabilitative surgery and venous congestion.
The medicative bloodsucker, H. medicinalis, belongs to the group of Arhinchobdellida in the Class Hirudinea ( Huguet et al. 1999 ) . Leechs are segmented hermaphroditic, freshwater worms of the phylum Annelida and are equipped with two chumps used for cleaving and creeping ( Eldor et al. 1996 ) . The smaller, anterior chump houses the oral cavity which so leads to the buccal pit which contains three jaws each bearing a row of denticles. Rhythmic contractions of the jaw musculuss move the jaws back and Forth which consequences in the film editing of the host & # 8217 ; s tegument in a typical Mercedes Benz grade ( see Figure 1 ) . Saliva is secreted from canals which contains hirudin ( which acts as the rule decoagulant ) and inhibitors of thrombocyte collection ( See Tables 1 and 2 for a list of extra decoagulants and inhibitors ) .
As blood flows into the buccal pit, it is pumped into the harvest by rhythmic contractions of the throat ( see Figure 2 ) . Leeches ingest monolithic blood repasts of 900 % of their organic structure weight, and their repletion frequently lasts for a twelvemonth ( Lent 1988 ) ( see Figure 3 ) . The lowered sensitiveness to trouble from a bloodsucker bite has been related to two complementary activities of bloodsucker spit that cut down kinin-like activity in the host & # 8217 ; s blood. Initially, the plasma kallikrein is inhibited, which is determined by the suppression of kininogenase activity and secondly, the kininase activity is inhibited ( Eldor et al. 1996 ) .
After transfering or reattaching tissues, venous return sometimes fails which reduces the arterial supply of blood and finally consequences in tissue mortification. The leech removes extra blood from occluded tissues to forestall mortification, which provides the necessary clip for the capillaries to turn across the suturas ( Lent 1990 ) . The bloodsucker secretes the decoagulants into the lesion and aspirated blood in order to keep a uninterrupted flow of blood ( Eldor et al. 1996 ) . Once satiated, the leech beads off and the bite continues to shed blood for several hours after detaching. Once the leech beads from the bitten site, some minor itchiness and scarring of the bite lesion may happen. The bites are so cleaned with an antiseptic and covered with dry gauze and an elastic patch to avoid inordinate hemorrhage ( Eldor et al. 1996 ) . In nature, satiated leeched are much less active and tend to conceal for periods of 12 to eighteen months ( Eldor et al. 1996 ) . During this clip, they digest the blood with the aid of Aeromonas hydrophila, which is a symbiotic bacteria in the bowel of H. medicinalis ( Lent et al. 1988 ) .
Leech therapy is used in a assortment of instances to alleviate venous congestion. Leechs are said to hold the ability to restore venous escape, keeping alimentary capillary perfusion of the compromised tissue until neovascularity is established ( Pantuck et al, 1996 ) . A instance study done on the direction of ague venous congestion on an baby & # 8217 ; s lower limb describes the effectivity of leech therapy. The baby & # 8217 ; s venous congestion was due to the ligation of the right common vena, and although options to bleed therapy are available after close scrutiny and careful considerations of the patient & # 8217 ; s status the usage of bloodsuckers instead than a surgical operation was decided upon ( Weinfeld et al 1998 ) . To get down the process two bloodsuckers were applied, one the anterior tibial part and the other to the plantar surface of the pes. As the bloodsucker therapy proceeded two bloodsuckers were used at the same time at clip intervals of 60 to 120 proceedingss ( Weinfeld et al. 1998 ) . Following the withdrawal of a bloodsucker, unfertile heparin-soaked gauze spongers were applied to the hemorrhage puncture sites to advance continued drainage. The leech therapy in this instance proved to be successful and at a one twelvemonth follow-up the kid had normal motor and centripetal map in the right lower limb ( Weinfeld et al. 1998 ) ( see Figure 4 ) . Another illustration of the usage of bloodsuckers in venous congestion is shown in a instance study on a adult male diagnosed with a little interhemispheric subdural haematoma. The patient & # 8217 ; s oropharynx was observed to be filled with the lingua bring forthing an acute air passage exigency ( Grossman et al. 1998 ) . The determination to undergo leech therapy in this instance was made after merely eight hours, and in the induction of the therapy one or two bloodsuckers were applied to the ventral surface of the bellied lingua ( Grossman et al. 1998 ) . The bloodsuckers remained in the place until satiated at which clip they were replaced. A sum of 16 bloodsuckers were used with two six-hour clip frames ( Grossman et al. 1998 ) . Within 20 hours of the therapeutical process there was a dramatic betterment in the linguistic puffiness ( Grossman et al. 1998 ) . The patient was able to travel his lingua and the lingua could be reduced manually within the unwritten pit ( see Figure 5 ) . The patients nasotracheal cannulation ( tubing which allows for continued air flow to the patient ) , was removed 30 hours after admittance and 48 hours after that, the patient was discharged ( Grossman et al. 1998 ) .
Leech therapy has besides been used to salve a venous congested penial replantation. The undermentioned instance study was done on a schizophrenic adult male who amputated the distal tierce of his phallus with a kitchen knife. Two yearss following surgery the patient began to demo marks of venous congestion and consent was granted to undergo leech therapy. One to two bloodsuckers were applied daily to the distal phallus for clip periods runing from 20 to 45 proceedingss ( Pantuck et al. 1996 ) . At the terminal of five yearss marks of venous congestion were no longer evident and leech therapy was discontinued ( Pantuck et al. 1996 ) . In a follow-up done after three months, the bloodsucker therapy was observed to be successful, demoing a well-h
ealed functional Phallus ( Pantuck et al. 1996 ) ( see Figure 6 ) .
Overall, the aim of leech therapy is to bring forth equal venous escape from the tissue by seting the figure and frequence of the application of the bloodsuckers to outdo suit the clinical state of affairs. The application of bloodsuckers is initiated by marks of venous inadequacy or congestion and is terminated when these marks no longer be. Medicinal bloodsucker therapy has besides resurged in plastic surgery where it is chiefly reserved for instances in which surgical rectification is non possible, or for the impermanent relief of venous congestion while the patient awaits a proper surgical intercession ( Varghese et al.1996 ) . Medicative bloodsuckers may besides be used successfully in decongesting blood flow in replanted parts including ears and figures, every bit good as sections of the lip, phallus, nose and scalp ( Daane et al. 1997 ) . Leechs have besides been used in chest decrease processs ( Daane et al. 1997 ) .
Unfortunately, there are some complications that can originate from utilizing bloodsuckers in curative medical specialty. The first and foremost of these possible complications is wound infection ( Varghese et Al. 1996 ) . The most common infection is due to the bacteria, A. hydrophila, which is a portion of the normal gut vegetation of bloodsuckers ( Varghese et al.1996 ) . A. hydrophila plays an of import function in the ability of the bloodsuckers to digest blood, by providing proteolytic enzymes to the bloodsucker ( Daane et al. 1997 ) . This bacteria, a gm negative rod, can do infection in patients at ratios changing from 0 % to 20 % within 24 hours to ten yearss after bloodsucker usage, ensuing in complications from child would infection to the possibility of extended tissue loss or harm ( Daane et al. 1997 ) . Antibiotics effectual in contending lesion infection are penicillans, Mefoxins, Achromycins and aminoglycosides ( Haycox et al.1995 ) .
Although bloodsuckers are non natural virus bearers, they can convey viruses, such as hepatitis B, to worlds if infected ( Daane et al. 1997 ) . In order to extinguish the hazard of the transmittal of these viruses, bloodsuckers are merely reused if a method of filleting is applied to run out the ingested blood for exigency reuse. In most state of affairss, the bloodsuckers are disposed of by puting them in a container of intoxicant and so flinging with infective waste ( Daane et al. 1997 ) . Other complications that can originate due to medicative bloodsucker therapy is the possibility of extended blood loss, where blood transfusions may be necessary ( Daane et al. 1997 ) . Transfusions are frequently required because of anticoagulation and the uninterrupted flow of blood from the bloodsuckers feeding site ( Daane et al. 1997 ) . Besides, allergic reactions to bloodsuckers have been reported ( from the chemical components in the leech spit ) , but allergic reactions to the common medicative bloodsucker, H. medicinalis, is highly rare ( Daane et al. 1997 ) .
Proper safeguards and attention should be used in managing bloodsuckers to cut down the hazards of infection in patients ( See Table 3 ) . The hazard of infection may be decreased by first dunking the bloodsuckers in 0.02 % chlorhexidine hydrochloride solution for 10 to fifteen seconds before using the bloodsucker to the lesion ( Haycox et al.1995 ) . Besides, the disposal of antibiotics to the patient before leech application has been proven to cut down the hazards of infection ( Haycox et al. 1995 ) .
Leechs are besides the beginning of the most powerful decoagulant found in nature, hirudin, the cistron for which has now been cloned, and leech spit may stamp down the spread of tumours ( Lent et al. 1988 ) . Another chemical found in leech spit is calin, which prevents thrombocytes from attaching to collagen and organizing stoppers ( Godfrey 1997 ) . A new development from the Southern Illinois University is the & # 8220 ; mechanical bloodsucker & # 8221 ; . This leech consists of a suction chamber with uninterrupted Lipo-Hepin extracts, attached at a full-thickness clout biopsy site ( Daane et al. 1997 ) . The new & # 8220 ; mechanical bloodsucker & # 8221 ; has proved to be superior to the medicative bloodsucker in reconstructing blood flow in engorged replanted tissue in rats. Possibly the & # 8220 ; mechanical bloodsucker & # 8221 ; will take over the 3500 twelvemonth old function of the medicative bloodsucker in rehabilitative surgery, opening new doors in the field of medical engineering and render the ancient medicative pattern of utilizing existent bloodsuckers obsolete.
Despite the hazard of wound infection and complications that can originate from medicative bloodsucker therapy, most patients accept the usage of bloodsuckers when presented with a clear account of the benefits ( Daane et al. 1997 ) . The survival rate for major replanted parts or revascularizations utilizing bloodsuckers is about 85 % , and the success rate for tissue transportations is about 95 % ( Varghese et Al. 1996 ) . Leeches increase the success of these operations by taking extra blood, which prevents the tissues from deceasing while the capillaries regrow ( Lent 1990 ) . Therefore, the ancient pattern of leech therapy is still considered to be a well-accepted medical technique used in replantation and rehabilitative processs.
Table 1: Anticoagulants and related inhibitors from bloodsuckers ( Eldor et al. 1996 ) .
Table 2: Inhibitors of thrombocyte collection from bloodsuckers ( Eldor et al. 1996 ) .
Table 3: Guidelines for the disposal of bloodsuckers ( Daane et al. 1997 ) .
Figure 1: A individual bloodsucker bite, dwelling of a set of three scratchs, one from each jaw ( about 1mm ) . This bite was made in parafilm on a 37|C surface, a method for measuring leech hungriness. However, bloodsuckers make similar lesions in the tegument of their quarry, and both sorts of bites resemble the Mercedes-Benz logo ( Lent 1990 ) .
Figure 2: Ventral position of a cleft bloodsucker caput shows the animate being & # 8217 ; s nervous system and eating variety meats ( Lent et al.1988 ) .
Figure 3: Feeding rhythm of the medicative bloodsucker alternated between hungriness and repletion. The hungriness stage consists of two subphases, appetency and consumption. During the appetitive stage the bloodsucker swims toward moving ridge beginnings. Once it finds a warm blooded host, it will feed for half an hr, devouring up to nine times its weight in blood. Satiate bloodsuckers do non seize with teeth ; they avoid warm surfaces and conceal under stones or in crannies ( Lent et al. 1988 )
Figure 4: Before: Lower appendages of a 2-day -old babe miss with terrible venous congestion 3 hours after ligation of the right common iliac vena for an unrepairable avulsion hurt that occurred during cardiac catheterisation. The thigh, leg, and pes are dark purple and dropsical.
After: Lower appendages 1 twelvemonth after leech therapy. Mild coeval hyperpigmentation is present in some parts ; otherwise, the limb is clinically normal.
( Weinfeld et al. 1997 )
Before After
Figure 5: Before: Appearance of lingua instantly after admittance to the intensive attention unit.
After: Appearance of lingua 30 hours after induction of leech therapy.
( Grossman et al.1998 )
Before After
Figure 6: Before: A individual bloodsucker attached at the coronal junction. The phallus, draped to forestall leech migration, appears twilight, tense, and dropsical.
After: A three-month followup reveals a well-healed Phallus.
( Pantuck et al. 1996 )
Before After
36a
