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Literatur über Blutegel

(chronologisch geordnet, vor allem ältere Werke sind vergriffen)

 

Kähler Schweizer, Dominique (Dr. med.):
La thérapie par les sangsues

Secrets et bienfaits de l'hirudothérapie
2008, Editions Jouvence
Cet ouvrage est un livre pragmatique contenant de nombreuses informations utiles, puisées dans la pratique quotidienne de l'auteur, à la fois experte en hirudothérapie et en culture de sangsues à usage thérapeutique. Il sera utile au patient en quête de nouveaux traitements efficaces et sans effets secondaires nuisibles, comme au thérapeute ou au médecin soucieux d'élargir leur moyen d'action. - C'est le seul livre écrit en français sur ce thème depuis 150 ans: il comble ainsi un vide littéraire, mais aussi et surtout permet de redécouvrir une thérapie qui a fait ses preuves et dont les nouvelles applications sont incessantes.
 


Michalsen, Andreas / Manfred Roth (Hrsg.):
Blutegeltherapie

Stuttgart 2006, Haug Verlag
 

Moser, Claudia / Karla Moser:
So hilft Ihnen die Blutegel-Therapie

Heidelberg 2002, Haug Verlag

 

Müller, Ingo Wilhelm:
Handbuch der Blutegeltherapie

Heidelberg 2000, Haug

 

Pukownik, Peter:
Blutegel-Therapie, den Körper entgiften

München 1995, Südwest

Abele, Johann:
Propädeutik der Humoraltherapie

Heidelberg 1992, Haug Verlag

 

Abele, Ulrich / Stiefvater, Erich:
Aschner-Fibel

Ulm 1964, Haug Verlag

Kuppe,Karl-Otto:
Der Blutegel in der ärztlichen Praxis

Stuttgart, 1955, Hippokrates, neue Auflage 1971, 1976, 1977

Chambron, Prosper (Dr. pharm.):
La sangsue médicinale

1938 (Lyon, thèse)
C'est un des livres les plus récents en français.
Thèse de pharmacie bien faite. De très bons conseils
pour la conservation des sangsues en officine.


Aschner,Bernhard:
Technik der Konstitutionstherapie

Wien 1936, neu bearbeitet von Ingo Müller Heidelberg,Haug 1995, 7.Auflage

Bottenberg,Heinz:
Biologische Therapie des praktischen Arzt

München 1936

Bottenberg, Heinz:
Die Blutegelbehandlung

Stuttgart-Leipzig 1935, neu bearbeitet 1948,3. Auflage 1983

Anglas, J. (Dr. ès-sciences):
La sangsue

1916 (Paris, Vigot frères)
Petite brochure sur l'anatomie de la sangsue avec une
très jolie planche colorée et superposée.


Ebrard, E. (Dr. med.):
Nouvelle monographie des sangsues médicinales

1857 (Paris, J.B. Baillière et fils)
Très complet et beaucoup d'expériences personelles.

Fermond, M.Ch. (Pharmacien en chef de
l'hôpital de la Salpétrière à Paris):
Monographie des sangsues médicinales

1854 (Paris, Germer Baillière)
Monographie très complète. Plutôt théorique.

Moquin-Tandon, Alfred (Dr. ès-sciences et Dr. med.):
Monographie de la Familles des hirudinées

1827 (Paris, J.B. Baillière)
1846 (Paris, J.B. Baillière), 2ème édition largement augmentée
Grand livre de référence.
C'est le premier auteur à avoir tenté une classification des sangsues.
La première édition est encore très rudimentaire. L'édition de
1846 sert de référence jusqu'à nos jours.


Martin, Joseph (Négociant en sangsues à Paris):
Histoire pratique des sangsues
1845 (Paris, Imprimerie Panckouche)
Petite brochure intéressante sur le commerce des sangsues et
ses aléatoires.

Hufeland,Christoph Wilhelm:
Lehrbuch der allgemeinen Heilkunde

Jena 1818,bearbeitet von Ingo Müller,Heidelberg:Haug 1993

Vitet, Louis (Prof. Dr. med.):
Traité de la sangsue médicinale

1809 (Paris, H. Nicolle)
Jusqu'à Louis Vitet on a encore pensé que les sangsues étaient des larves d'insectes.
C'est le manuel le plus complet d'application médicale de la sangsue au
début du 19ème siècle.

 

 

Fachartikel über Blutegel

 

Malassis Sylvain:
Les Sangsues
2005, Ordre national des pharmaciens français
(télécharger le texte)

 

 

Medizinische Indikationen

 

Blutegel und Arthrosen

 

Andereya S, Stanzel S, Maus U, Mueller-Rath R, Mumme T, Siebert CH, Stock F, Schneider U.:
Assessment of leech therapy for knee osteoarthritis: a randomized study

Acta Orthop., 2008 Apr;79(2):235-43

 

Pilcher H.:
Medicinal leeches: stuck on you.

Nature. 2004 Nov 4;432(7013):10-1
 

[No authors listed],
Summaries for patients. Leeches to treat knee osteoarthritis.

Ann Intern Med. 2003 Nov 4;139(9):I22. (Full text free)


Hochberg MC.:
Multidisciplinary integrative approach to treating knee pain in patients with osteoarthritis.

Ann Intern Med. 2003 Nov 4;139(9):781-3.

Michalsen A, Klotz S, Lüdtke R, Moebus S, Spahn G, Dobos GJ.:
Effectiveness of leech therapy in osteoarthritis of the knee: a randomized, controlled trial.

Ann Intern Med. 2003 Nov 4;139(9):724-30. (Full text free)


Michalsen A, Moebus S, Spahn G, Esch T, Langhorst J, Dobos GJ.:
Leech therapy for symptomatic treatment of knee osteoarthritis: results and implications of a pilot study.

Altern Ther Health Med. 2002 Sep-Oct;8(5):84-8.

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.

 

Michalsen A, Lüdtke R, Cesur O, Afra D, Musial F, Baecker M, Fink M, Dobos GJ:
Effectiveness of leech therapy in women with symptomatic arthrosis of the first carpometacarpal joint: A randomized controlled trial

Pain 2008 Jul 15;137(2):452-9. Epub 2008 Apr 14

 


 

 

Blutegel - Bakteriologie

 

Aydin A, Nazik H, Kuvat SV, Gurler N, Ongen B, Tuncer S, Hocaoglu E, Kesim SN:

External decontamination of wild leeches with hypochloric acid

(BMC Infect Dis., 2004, Aug 25;4:28)
BACKGROUND: Medicinal leech, Hirudo medicinalis, has been used in plastic and reconstructive surgery, to relieve venous congestion and to improve the microrevascularization of flaps. In many countries, wild leeches are still provided from local markets and utilised with antibiotic prophylaxies. In this research, results of identification of bacteria in the transport fluid is reported, oral and intestinal floras and the antibiograms of the identified microorganisms are investigated. Also, to avoid possible infections, the ability of hypochloric acid, a disinfectant, to suppress the relevant microorganisms without changing the life style and behavior of leeches in terms of sucking function, is investigated. METHODS: Bacterial identifications and antibiograms of oral and intestinal flora and transport medium were performed for 10 leeches. The optimum concentration of hypochloric acid which eliminated microorganisms without affecting the viability and sucking function of the leeches were determined by dilution of hypochloric acid to 100, 50, 25, 12.5, 6.25 ppm concentrations in different groups of 25 leeches. Finally, 20 leeches were applied atraumatically to the bleeding areas of rats, the duration of suction was determined and compared statistically between the leeches treated and not treated with hypochloric acid solution. RESULTS: Aeromonas hydrophilia was the most commonly identified microorganism and found to be resistant to first generation cephalosporins, frequently used in prophylaxis at surgical wards. In the next stages of the study, the leeches were subjected to a series of diluted hypochloric acid solutions. Although disinfection of the transport material and suppression of the oral flora of hirudo medicinalis were successful in 100, 50, 25, 12.5, 6.25 ppm concentrations; 12.5 ppm solution was the greatest concentration in which hirudo medicinalis could survive and sucking function was not affected significantly. CONCLUSIONS: External decontamination of wild leeches with 12.5 ppm hypochloric acid enables bacterial suppression without causing negative effects on leech sucking function and life.


Bauters TG, Buyle FM, Verschraegen G, Vermis K, Vogelaers D, Claeys G, Robays H:
Infection risk related to the use of medicinal leeches.
(Department of Pharmacy, University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium)
OBJECTIVE: To assess the incidence of postoperative wound infections related to treatment with medicinal leeches at Ghent University Hospital. METHOD: A 2-year retrospective analysis of bacteriologic culture results of soft tissue infections in patients treated with medicinal leeches. RESULTS: Cultures of suspected wound infections were taken and susceptibility testing of isolates was performed on 17 of 47 patients (36.2%). Aeromonas was frequently isolated (18.5%). CONCLUSIONS: A high incidence of infection during and after application of medicinal leeches, despite their external decontamination, necessitates an antibiotic prophylaxis. In particular Aeromonas must be covered, as soft tissue infections with these bacteria can give serious complications. The prophylactic antibiotic should cover the most frequent isolated species taking into account the importance of Aeromonas and the susceptibility pattern. Based on the results, fluoroquinolones seem to be a good choice. The authors believe that practical recommendations to hospital pharmacists on prophylaxis during Hirudo medicinalis treatment, might enhance the safety of it's use by reducing the number of infections.

Braga A, Lineaweaver WC, Whitney TM, Follansbee S, Buncke HJ:
Sensitivities of Aeromonas hydrophila cultured from medicinal leeches to oral antibiotics

(Microsurgical Replantation Transplantation Department, Davies Medical Center, San Francisco, CA 94118)
Infections associated with medicinal leech application are caused by Aeromonas hydrophila, an organism that resides in the leech gut. We cultured the intestinal tracts of 25 leeches and evaluated the efficacy of oral antibiotics against Aeromonas hydrophila. Cultures of this organism showed no sensitivity to ampicillin and inconsistent sensitivity to cephalothin (equivalent to cephalexin). The Aeromonas hydrophila cultures did show consistent sensitivity to ciprofloxacin, tetracycline, and trimethoprim-sulfamethoxasole. These three antibiotics should be considered if oral antibiotic coverage is used in association with leech application.

Eroglu C, Hokelek M, Guneren E, Esen S, Pekbay A, Uysal OA:
Bacterial flora of Hirudo medicinalis and their antibiotic sensitivities in the Middle Black Sea Region, Turkey.
(Division of Clinical Microbiology and Infectious Disease, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey)
The rate of infectious complications of leech therapy is almost 20% because Hirudo medicinalis has endosymbiotic bacteria. The aim of this study was to determine the bacterial flora of H. medicinalis and their antibiotic sensitivities in a region in Turkey. Sixteen adult leeches were collected in Middle Black Sea region, Turkey. They were rubbed onto blood agar plates directly under ether anesthesia to obtain surface cultures. They were then killed to obtain mouth and gut cultures. Culture swabs were applied to blood agar, eosin methylene blue agar, and ampicillin blood agar plates. Gut contents were applied to blood culture medium as well. Bacteria were isolated in 15 of 16 leech surfaces, in 7 of 16 mouths, and in 15 of 16 guts. Isolated bacteria were identified with Analytical Profile Index 32 E and Analytical Profile Index 20 NE (fermentative and nonfermentative respectively). Most common types of cultured bacteria were Aeromonas hydrophila (N = 25), Ochrobacter anthropi (N = 23), nonfermenting Gram-negative rods (N = 12), Acinetobacter lwoffi (N = 3), and A. sobria (N = 2) in 73 isolates. A standard disk diffusion test was performed on isolated bacteria. All isolates were 100% susceptible to ciprofloxacin, cefotaxime, ceftazidime, gentamicin, and trimethoprim/sulfamethoxazole. Because leeches are carriers of Aeromonas and other bacteria, appropriate antibiotic prophylaxis should be administrated to the patient who needs leech therapy. Antibacterial agents can be determined by the resistance pattern of the bacterial flora of regional H. medicinalis.

Nehili M, Ilk C, Mehlhorn H, Ruhnau K, Dick W, Njayou M:
Experiments on the possible role of leeches as vectors of animal and human pathogens: a light and electron microscopy study.
(Department of Zoology and Parasitology, Ruhr-University Bochum, Germany)
The presence and survival of pathogens inside the gut of leeches were studied by means of light and electron microscopy. In African leeches from Cameroon, blood was serologically positive for human immunodeficiency virus (HIV) and hepatitis B; blood of Hirudo medicinalis bought in German pharmacies contained up to 11 different species of bacteria. In experiments done at low (3 degrees C) and high (22 degrees, 32 degrees C) temperatures, it was shown that ingested red and white blood cells survive for long periods. The time was prolonged to at least 6 months in cases in which the leeches were stored at 3 degrees C. The same effect occurred with pathogens. Bacteriophages (viruses of bacteria) and bacteria persisted in large numbers for at least 6 months in the gut of experimentally infected leeches. Protozoan parasites such as Toxoplasma gondii, Trypanosoma brucei brucei, or Plasmodium berghei were even capable of reproducing inside the gut of the leech. In the case of Plasmodium parasites, this proceeded at low (3 degrees C) and high (22 degrees C) temperatures until all erythrocytes were used up. These parasites survived as long as the erythrocytes and lymphocytes were of good shape, i.e., around 5-6 weeks p.i. Single stages survived longer, especially at low temperatures. However, electron microscopy studies gave no hint of penetration of such pathogens into the unicellular salivary glands, which would initiate a direct transmission. Such transmission, however, is possible--many fish leeches directly transmit several blood parasites--when the leeches are squeezed during skin attachment or when they are manipulated by dropping salt solution on their backs while they are sucking. Consequently, the leech is a potential vector of many pathogens, especially in regions with an endemic spread of human and/or animal pathogens.

Silver AC, Rabinowitz NM, Küffer S, Graf J:
Identification of Aeromonas veronii genes required for colonization of the medical leech, Hirudo verbana

(
Department of Molecular and Cell Biology, University of Connecticut, 91 N. Eagleville Rd., Unit-3125, Storrs, CT 06269, USA.)
Most digestive tracts contain a complex consortium of beneficial microorganisms, making it challenging to tease apart the molecular interactions between symbiont and host. The digestive tract of Hirudo verbana, the medicinal leech, is an ideal model system because it harbors a simple microbial community in the crop, comprising the genetically amenable Aeromonas veronii and a Rikenella-like bacterium. Signature-tagged mutagenesis (STM) was used to identify genes required for digestive tract colonization. Of 3,850 transposon (Tn) mutants screened, 46 were identified as colonization mutants. Previously we determined that the complement system of the ingested blood remained active inside the crop and prevented serum-sensitive mutants from colonizing. The identification of 26 serum-sensitive mutants indicated a successful screen. The remaining 20 serum-resistant mutants are described in this study and revealed new insights into symbiont-host interactions. An in vivo competition assay compared the colonization levels of the mutants to that of a wild-type competitor. Attenuated colonization mutants were grouped into five classes: surface modification, regulatory, nutritional, host interaction, and unknown function. One STM mutant, JG736, with a Tn insertion in lpp, encoding Braun's lipoprotein, was characterized in detail. This mutant had a >25,000-fold colonization defect relative to colonization by the wild-type strain at 72 h and, in vitro, an increased sensitivity to sodium dodecyl sulfate, suggesting the presence of an additional antimicrobial property in the crop. The classes of genes identified in this study are consistent with findings from previous STM studies involving pathogenic bacteria, suggesting parallel molecular requirements for beneficial and pathogenic host colonization.

Worthen PL, Gode CJ, Graf J:
Culture-independent characterization of the digestive-tract microbiota of the medicinal leech reveals a tripartite symbiosis.
(Department of Molecular and Cell Biology, University of Connecticut, 91 N. Eagleville Rd., Unit 3125, Storrs, CT 06269-3125, USA)
Culture-based studies of the microbial community within the gut of the medicinal leech have typically been focused on various Aeromonas species, which were believed to be the sole symbiont of the leech digestive tract. In this study, analysis of 16S rRNA gene clone libraries confirmed the presence of Aeromonas veronii and revealed a second symbiont, clone PW3, a novel member of the Rikenellaceae, within the crop, a large compartment where ingested blood is stored prior to digestion. The diversity of the bacterial community in the leech intestinum was determined, and additional symbionts were detected, including members of the alpha-, gamma-, and delta-Proteobacteria, Fusobacteria, Firmicutes, and Bacteroidetes. The relative abundances of the clones suggested that A. veronii and the novel clone, PW3, also dominate the intestinum community, while other clones, representing transient organisms, were typically present in low numbers. The identities of these transients varied greatly between individual leeches. Neither time after feeding nor feeding on defibrinated blood caused a change in identity of the dominant members of the microbial communities. Terminal restriction fragment length polymorphism analysis was used to verify that the results from the clone libraries were representative of a larger data set. The presence of a two-member bacterial community in the crop provides a unique opportunity to investigate both symbiont-symbiont and symbiont-host interactions in a natural model of digestive-tract associations.

 

Blutegel und Chirurgie

 

Knobloch K, Gohritz A, Busch K, Spies M, Vogt PM:

Plastische Hand- und Wiederherstellungschirurgie
Handchir Mikrochir Plast Chir. 2007 Apr; 39(2): 103-7
Medical leech therapy has enjoyed a renaissance in the world of reconstructive microsurgery during recent years. Especially venous congestion is decreased using hirudo medicinalis application such as following replantation of amputated fingers or congested flaps. They provide a temporary relief to venous engorgement whilst venous drainage is re-established. Living in symbiosis with Aeromonas hydrophila, who can digest the sixfold blood meal related to their body weight, and a broad number of anticoagulant agents such as the thrombin inhibitor hirudin, apyrase as well as collagenase, hyaluronidase, Factor Xa inhibitor and fibrinase I and II, leeches decrease venous congestion. Laser Doppler flowmetry could demonstrate a significant increase in superficial skin perfusion following leech application 16 mm around the biting zone. Following the initial blood meal accounting for about 2.5 ml, the anticoagulant effect of the various leeches enzymes follows within the next 5-6 hours, which both account for the beneficial effects. Infection associated with leech therapy is a documented complication of leech application, with reported incidences ranging from 2.4 to 20 % and a chinolone antibiotic is currently recommended to face the potential Aeromonas hydrophila infection. Anemia is a second adverse effect during medicinal leech application which has to be taken account with repetitive blood samples. Besides the successful applications of leeches in various applications in plastic and reconstructive microsurgery, randomized-controlled trials are pending to elucidate the value of hirudo medicinalis according to evidence-based criteria above from case series and case studies.

 

 

Blutegel und Hämatome (Blutergüsse)

 

Nielsen A. :
Ask the experts. A resurgence of the medical uses of leeches.

Explore (NY). 2006 Jan;2(1):88

Grossman MD, Karlovitz A.:
Lingual trauma: the use of medicinal leeches in the treatment of massive lingual hematoma.

J Trauma. 1998 Jun;44(6):1083-5

Pantuck AJ.: Re:
Leech therapy for massive scrotal hematoma following percutaneous transluminal angioplasty.

J Urol. 1998 May;159(5):1647-8

Goessl C, Steffen-Wilke K, Miller K.:
Leech therapy for massive scrotal hematoma following percutaneous transluminal angioplasty.

J Urol. 1997 Aug;158(2):545

Lee NJ, Peckitt NS.:
Treatment of a sublingual hematoma with medicinal leeches: report of case.

J Oral Maxillofac Surg. 1996 Jan;54(1):101-3

Menage MJ, Wright G.:
Use of leeches in a case of severe periorbital haematoma.

Br J Ophthalmol. 1991 Dec;75(12):755-6.

Isgar B, Turner AG.:
Large scrotal haematoma treated with medicinal leeches.

Br J Urol. 1989 Nov;64(5):549-50

Bunker TD.:
The contemporary use of the medicinal leech.

Injury. 1981 Mar;12(5):430-2.

 

Andere Indikationen

 

Dippenaar R, Smith J, Goussard P, Walters E.:
Meningococcal purpura fulminans treated with medicinal leeches

Pediatr Crit Care Med. 2006 Sep; 7(5): 476-8.

Schwickert M, Saha J:
Recurrent herpes zoster with neuralgia [Article in German]

Forsch Komplement Med (2006), 2006 Jun;13(3):184-6. Epub 2006 Jun 26

Seleznev KG, Shchetinina EA, Trophimenko NP, Nikonov GI, Baskova IP:
Use of the medicinal leech in the treatment of ear diseases

ORL J. Otorhinolaryngol Relat Spec, 1992;54(1):1-4.

Mironov P, Despotov B:
Treatment of myocardial infarct by leeches [Article in French]

Folia Med (Plovdiv), 1966;8(5):273-7.

 

Nebenwirkungen

 

Beer AM, Fey S, Kuhnen C, Mentzel T.:
Kutane Arthropodenreaktion nach Blutegeltherapie

Akt. Dermatol 2001; 27: 42-46
Bei einer 69-jährigen Patientin wurden während eines stationären Aufenthaltes Blutegel im Bereich der unteren Lendenwirbelsäule bei Polyarthralgie angesetzt. Monate später führten ambulant durchgeführte Massagen unter Zuhilfenahme von ätherischen Oelsalben zu starkem Pruritus im Bereich der Bissstellen. Ein Jahr später kam die Patientin erneut zur stationären Aufnahme wegen progredienter Arthralgien. Im Bereich der Blutegelbisse fanden sich 9 gut kirschkerngrosse, livid-rote juckende Papeln mit zentraler Hypopigmentierung. Zunächst bestand der Verdacht auf hypertrophe Narben. Zum Ausschluss einer Sarkoidose wurde die übliche Diagnostik mit Probeexzision durchgeführt. Histologisch fand sich eine pseudolymphomatoide entzündliche Gewebsreaktion mit follikulärer Hyperplasie und Gewebseosinophilie, das Gesamtbild passend zu einer Arthropodenreaktion. Eine Arthropodenreaktion ist eine sehr seltene Komplikation nach Blutegeltherapie. Es ist davon auszugehen, dass die Anwendugn der ätherischen Oelsalbe eine Aktivierung der Arthropodenreaktion verursachte.


 

   
     
    Copyright © Hirumed GmbH, letzte Aktualisierung vom 8.12.2008, verantwortlich für den Inhalt: Dr. Dominique Kähler