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The Journal of Hand Surgery Jul 2020Venous congestion after digital replantation or revascularization threatens digit survival in the immediate postoperative period. External bloodletting, including leech... (Review)
Review
Venous congestion after digital replantation or revascularization threatens digit survival in the immediate postoperative period. External bloodletting, including leech therapy, provides a central role in salvage of the congested finger. Although there have been previous studies describing the initiation of leech therapy for digits experiencing venous insufficiency, few published articles and no consensus guidelines have discussed the weaning of leeches in the postoperative period. We review the current evidence behind leech therapy and offer a treatment algorithm based on available data and existing leech weaning protocols.
Topics: Amputation, Traumatic; Animals; Fingers; Humans; Leeches; Leeching; Replantation
PubMed: 32493632
DOI: 10.1016/j.jhsa.2020.03.026 -
Clinical and Experimental Allergy :... Jul 2017This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care...
This is an updated guideline for the diagnosis and management of allergic and non-allergic rhinitis, first published in 2007. It was produced by the Standards of Care Committee of the British Society of Allergy and Clinical Immunology, using accredited methods. Allergic rhinitis is common and affects 10-15% of children and 26% of adults in the UK, it affects quality of life, school and work attendance, and is a risk factor for development of asthma. Allergic rhinitis is diagnosed by history and examination, supported by specific allergy tests. Topical nasal corticosteroids are the treatment of choice for moderate to severe disease. Combination therapy with intranasal corticosteroid plus intranasal antihistamine is more effective than either alone and provides second line treatment for those with rhinitis poorly controlled on monotherapy. Immunotherapy is highly effective when the specific allergen is the responsible driver for the symptoms. Treatment of rhinitis is associated with benefits for asthma. Non-allergic rhinitis also is a risk factor for the development of asthma and may be eosinophilic and steroid-responsive or neurogenic and non- inflammatory. Non-allergic rhinitis may be a presenting complaint for systemic disorders such as granulomatous or eosinophilic polyangiitis, and sarcoidoisis. Infective rhinitis can be caused by viruses, and less commonly by bacteria, fungi and protozoa.
Topics: Disease Management; Humans; Rhinitis; Rhinitis, Allergic
PubMed: 30239057
DOI: 10.1111/cea.12953 -
Journal of Clinical and Diagnostic... Dec 2015The concept of Unani medicine is based on balancing body humours, the imbalance of which causes diseases. The application of leech therapy in medical and dental science... (Review)
Review
The concept of Unani medicine is based on balancing body humours, the imbalance of which causes diseases. The application of leech therapy in medical and dental science is well recognized. Although easy and non-invasive, complications also exist. The article aims to presents a brief review on the applications of leech therapy. The physiological effect, along with its therapeutic role in cancer, diabetes and dentistry have been underlined. Complications of leech therapy have also been dealt with.
PubMed: 26817000
DOI: 10.7860/JCDR/2015/16670.6918 -
Plastic and Reconstructive Surgery Jun 2022The use of medicinal leeches in modern reconstructive surgery is well-described. Leech therapy after rhinoplasty has not been previously well-characterized.
BACKGROUND
The use of medicinal leeches in modern reconstructive surgery is well-described. Leech therapy after rhinoplasty has not been previously well-characterized.
METHODS
The medical records of all patients who underwent open rhinoplasty by a single surgeon over a 4-year period were reviewed. Patient demographics, including age, sex, medical comorbidities, number of previous rhinoplasty surgeries, time to utilization of leech therapy, adjunct therapies used, resolution of skin changes, and smoking status, were recorded. Operative reports were reviewed for pertinent information, including number of tip grafts used, graft materials used, and placement of septal extension grafts or "unicorn" grafts.
RESULTS
Between April of 2016 and March of 2020, 545 patients underwent rhinoplasty performed by the senior author (P.S.N.). Of these patients, 39 (7.2 percent) underwent leech therapy postoperatively. The mean age of included patients was 47.4 years. Of the patients who required leech therapy, 34 (87.2 percent) had undergone revision rhinoplasty. The mean number of previous rhinoplasties was 3.4. The mean number of tip grafts used was 2.6. Thirty-three patients (84.6 percent) had either a traditional septal extension graft or unicorn graft placed. Nine patients (23.1 percent) were former smokers. Complete resolution of skin color changes was seen in 38 patients (97.4 percent). There were no major complications after leech therapy.
CONCLUSIONS
Leech therapy is a useful tool for the rhinoplasty surgeon, particularly in the setting of complex revision rhinoplasty, in patients who have undergone multiple previous nasal surgical procedures, or in patients who require significant cartilage grafting to reconstruct the nasal tip or lengthen the nose.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Cartilage; Humans; Leeching; Middle Aged; Nasal Septum; Nose; Retrospective Studies; Rhinoplasty; Treatment Outcome
PubMed: 35383721
DOI: 10.1097/PRS.0000000000009096 -
European Heart Journal Mar 2021Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk...
Cardiovascular health after menopause transition, pregnancy disorders, and other gynaecologic conditions: a consensus document from European cardiologists, gynaecologists, and endocrinologists.
Women undergo important changes in sex hormones throughout their lifetime that can impact cardiovascular disease risk. Whereas the traditional cardiovascular risk factors dominate in older age, there are several female-specific risk factors and inflammatory risk variables that influence a woman's risk at younger and middle age. Hypertensive pregnancy disorders and gestational diabetes are associated with a higher risk in younger women. Menopause transition has an additional adverse effect to ageing that may demand specific attention to ensure optimal cardiovascular risk profile and quality of life. In this position paper, we provide an update of gynaecological and obstetric conditions that interact with cardiovascular risk in women. Practice points for clinical use are given according to the latest standards from various related disciplines (Figure 1).
Topics: Aged; Cardiologists; Cardiovascular Diseases; Consensus; Endocrinologists; Female; Humans; Menopause; Middle Aged; Pregnancy; Quality of Life; Risk Factors
PubMed: 33495787
DOI: 10.1093/eurheartj/ehaa1044 -
Integrative Medicine Research Dec 2017Complementary medicine methods have a long history, but modern medicine has just recently focused on their possible modes of action. Medicinal leech therapy (MLT) or... (Review)
Review
Complementary medicine methods have a long history, but modern medicine has just recently focused on their possible modes of action. Medicinal leech therapy (MLT) or hirudotherapy, an old technique, has been studied by many researchers for possible effects on various diseases such as inflammatory diseases, osteoarthritis, and after different surgeries. has widest therapeutic usage among the leeches, but worldwide, many different species were tested and studied. Leeches secrete more than 20 identified bioactive substances such as antistasin, eglins, guamerin, hirudin, saratin, bdellins, complement, and carboxypeptidase inhibitors. They have analgesic, anti-inflammatory, platelet inhibitory, anticoagulant, and thrombin regulatory functions, as well as extracellular matrix degradative and antimicrobial effects, but with further studies, the spectrum of effects may widen. The technique is cheap, effective, easy to apply, and its modes of action have been elucidated for certain diseases. In conclusion, for treatment of some diseases, MLT is not an alternative, but is a complementary and/or integrative choice. MLT is a part of multidisciplinary treatments, and secretes various bioactive substances. These substances vary among species and different species should be evaluated for both treatment capability and their particular secreted molecules. There is huge potential for novel substances and these could be future therapeutics.
PubMed: 29296560
DOI: 10.1016/j.imr.2017.08.001 -
Journal of Ayurveda and Integrative... 2020Medicinal leech therapy or Hirudino therapy have roots back in ancient civilization. It was a prevalent form of therapy in various ailments. The novel Ayurveda text... (Review)
Review
Medicinal leech therapy or Hirudino therapy have roots back in ancient civilization. It was a prevalent form of therapy in various ailments. The novel Ayurveda text Sushruta Samhita devoted a complete chapter on hirudino therapy. In the early 20th century this therapy had a major setback due to origin and evolution of antibiotics. There was a discontinuity in the flow of knowledge about this therapy. Then, resumed and revived after few recent decades, due to its contribution in reconstructive surgeries. During this period, the research work on various aspects have been conducted. The present paper summarizes the various aspects of medicinal leech therapy both from Ayurveda text and the present knowledge and to enable the fraternity to use the both source for benefits of humankind.
PubMed: 30709686
DOI: 10.1016/j.jaim.2018.09.003 -
The Journal of Craniofacial Surgery Jun 2021Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to...
Facial trauma can pose challenging reconstructive obstacles in both maintaining tissue viability and restoring aesthetic appearance. Medicinal leech therapy can help to promote vascular decompression in the setting of venous congestion. A retrospective chart review was conducted to identify patients who underwent medicinal leech therapy following venous stasis secondary to repair of a complex facial laceration. Three patients were identified; 2 suffered auricular avulsion, while 1 suffered a lip avulsion. All patients suffered from venous congestion and underwent medicinal leech therapy for 48 to 72 hours with reduction of edema and stasis. Decompression was successfully achieved with no further sequelae on last follow-up. Medicinal leech therapy is an adequate treatment for venous congestion following traumatic soft-tissue repair of the face. The authors advocate for the utilization of medicinal leeches to combat venous congestion after repair, particularly when arterial inflow remains intact.
Topics: Animals; Humans; Lacerations; Leeches; Leeching; Retrospective Studies; Soft Tissue Injuries
PubMed: 33170826
DOI: 10.1097/SCS.0000000000007111 -
Best Practice & Research. Clinical... Nov 2014Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during... (Review)
Review
Transplantation affords recipients the potential for a full life and, for some, parenthood. Female transplant recipients must continue to take immunosuppression during pregnancy and breast-feeding. This article reviews case and series reports regarding breast-feeding in those taking transplant medications. Avoidance of breast-feeding has been the customary advice because of the potential adverse effects of immunosuppressive exposure on the infant. Subsequent studies have demonstrated that not all medication exposure translates to risk for the infant, that the exposure in utero is greater than via breast milk and that no lingering effects due to breast-feeding have been found to date in infants who were breast-fed while their mothers were taking prednisone, azathioprine, cyclosporine, and/or tacrolimus. Thus, except for those medications where clinical information is inadequate (mycophenolic acid products, sirolimus, everolimus, and belatacept), the recommendation for transplant recipients regarding breast-feeding has evolved into one that is cautiously optimistic.
Topics: Breast Feeding; Evidence-Based Medicine; Female; Guidelines as Topic; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Infant; Infant, Newborn; Milk, Human; Organ Transplantation; Pregnancy; Risk Factors
PubMed: 25271063
DOI: 10.1016/j.bpobgyn.2014.09.001 -
Technical Innovations & Patient Support... Dec 2022Radiation therapy has become increasingly complex over time and is rapidly evolving. Radiation therapists play a key role within the interdisciplinary team and their...
Radiation therapy has become increasingly complex over time and is rapidly evolving. Radiation therapists play a key role within the interdisciplinary team and their education must prepare them to function effectively in the future in order to ensure a safe, high quality radiation therapy service. The aim of this research was to evaluate the current status of radiation therapist education to establish the duration of education programs, the percentage of radiation therapy-specific content and the professional title on graduation. A survey was developed, based on the questionnaire used for the ESTRO 3rd Revision of the Core Curriculum for Radiation Therapists. This was piloted by colleagues to verify the validity of the survey and also its use outside of the European context. The final survey was distributed purposively through Survey Monkey via a local gatekeeper to key radiation therapy personnel covering all of Europe and Australia, New Zealand, USA and South Korea in January 2021 who distributed it to educational institutes and clinical departments in their respective countries. 101 responses were received of which 58 were fully complete and available for analysis representing 30 countries, 26 European and 4 beyond Europe. The duration and radiation therapy-specific content of education programs varied considerably with dedicated radiation therapy programs from the respondents offered only in Ireland, Australia, New Zealand, and the U.S.A. 17 countries in the survey offer 'combined' programs with the majority dedicating less than 20% of their content to radiation therapy. Of note is that several respondents were unable to state the percentage of content related to radiation therapy and there was a variation in content and duration of programs, even within a single country. This survey has demonstrated that there remains a significant deficit in the educational programs of radiation therapists in many regions.
PubMed: 36238200
DOI: 10.1016/j.tipsro.2022.09.006