Bloodsuckers hit the medical comeback trail

Leeches worm their way back into doctors' affections

Leeches - the fleshy bloodsucking worms associated with the historic world of medicine - are making a comeback - even if the yuk factor means they often have to be hidden from public gaze.

A leech farm in Wales sells 15,000 leeches a year to the NHS, according to London medical student Robert Weinkove, who has written a history of the worm for the Student British Medical Journal.

Biopharm, a leech farm in Swansea, exports another 15,000 a year around the world.

Leeches were widely used up until this century for many medical conditions, including tonsillitis and piles.

"They went too far, overusing them and using them in the wrong way with little benefit, " said Mr Weinkove, a fifth-year medical student at the United Medical and Dental Schools of Guy's and St Thomas' Hospitals in London.

A few doctors were still using leeches in the 1930s and 40s, mainly on stroke patients, but their use died out until the 1960s when interest in the creature was reignited.

But it is only in the last 10 to 15 years that they have really caught on and their use has taken off in the last five years.

Image problem

Mr Weinkove believes it has taken so long for them to come back because they have an image problem.

People donate blood for medicinal purposes; leeches take it away...

"Doctors have been reluctant to use them because of their image, but now it has been proven that they can be useful in certain cases," he said.

Leeches are particularly useful in plastic surgery, such as breast reconstruction and where a part of the body has become severed and had to be sewn back on.

Sometimes, the patient's veins are too weak to take the blood away from the body part and the blood builds up, causing "venous congestion".

Attaching leeches to the body can draw the blood away gradually and painlessly since leech saliva contains an anaesthetic.

This allows the re-attached body part to survive until the veins are strong enough to work normally. One man who cut off his penis had to have leeches attached to drain the blood.

Swollen

The leeches suck the blood until they become totally engorged. They can take in up to 10 times their bodyweight in blood. When they are full they fall off and can be replaced with another leech.

A patient may need up to 30 leeches to drain blood away.

Mr Weinkove says most patients are willing to have leeches on their bodies if it is a choice between leeches, more operations or losing a part of the body.

He says children often give them names. But their family and friends are not so keen to see the creatures at work.

This has led some doctors to hide the leeches, using dressings. Another consideration is to ensure the leech feeds on the right part of the body.

'Dinner plate'

Doctors in Philidelphia have developed a plastic shield to hide the leech and keep it in place.

It involves a dinner plate-like object with a hole in it. This is used on severed fingers. The patient's arm is covered in plaster of paris to keep it raised in the air so the blood can be drained.

The dinner plate is put on top and the leech is attached and covered in fabric. One of the doctors involved is called Dr Callegari, conjuring up images of the famous German film.

Most hospitals in the UK which use leeches do not keep them on site when there is no specific need for them.

There are a handful of pharmacies up and down the country which have storage room for them. They can send leeches over to hospitals on request.

Leech saliva also has medicinal uses of its own. It prevents clotting and is being used in several new drugs, for example, to treat patients who have had a stroke, often due to blood clots in the brain.

A new one, hirudin, is being used in the US and may have less side effects than other anti-clotting drugs.

Leeches (Lintah) are probably the most misunderstood creatures in the world.

Classification & Relationships

Leeches are related to earthworms and lugworms (Oligochaetes), and bristle worms (Polychaetes). But unlike other worms they have a sucker at each end - one for feeding, the other for hanging on while they feed. They all belong to a group of legless invertebrates (animals without a skeleton) called Annelids - "anulus" is the Latin for "ring". This means that the body is divided into separate segments (which look like rings) connected by a continuous gut, a nerve and a blood vessel. They use external bristles (chaetae) to pull themselves along in a sort of concertina-like motion.

Not all worms are Annelids. Some belong to a group called Nematodes. Many nematodes are internal parasites, often living in the guts of mammals (including humans). Leeches are external parasites.

Habitat

European leeches live in fresh water and damp places. There are a few marine leeches living in the Atlantic Ocean which prey on fishes. They can also be commonly found in tropical rainforest such as the Amazon.

Movement

On the whole leeches do not have bristles, but their flattened body allows them to swim effectively in an undulating way. They lie in wait for a passing animal of the right kind and then home in on it. They can contract their bodies to become short and stubby, or extend them to become long and thin.

Feeding habits

Some leeches are blood-suckers, and attach themselves to the skin of animals at a place where blood vessels are near the surface.The mouth end has sharp jaws to cut through the skin of it host. They inject an anti-clotting substance to stop the blood coagulating (thickening) and feed until they are full. Then they drop off to digest their meal, but the puncture bleeds for a while afterwards.

The horse leech (Haemopis sanguisuga), which can be 30 cm long when extended, does not suck horses' blood, but feeds on earthworms, and decaying flesh.

Medical uses

The medicinal leech was used in medieval times in Europe for certain illnesses because doctors believed that sucking out some of their patient's blood helped them to recover. To do this they would apply a leech or two and let them feed. Surprisingly, leeches have come back into fashion for medical use. The anti-coagulant they secrete into a wound helps to stop a scab forming, preventing the skin from sealing over too quickly. This promotes healing from the inside outwards. This is especially important where very delicate repairs have been made to torn tissue.

Fancy having two or three leeches hidden under your bandages! In films about tropical rainforest adventures the tough guys are always removing leeches from their legs.

Additional reading:

An extract from “A Sanguine Attachment 2000 Years of Leeches in Medicine “ by Roy T Sawyer Managing Director, Biopharm. Encyclopedia Britannica INC.

The leech was indispensable in 19th Century medicine for bloodletting, a practice believed to be a cure for anything from headaches to gout. Leeching was largely abandoned as medical science advanced, only occasionally being called upon to treat bruising and black eyes. However, the medicinal leech is making a comeback in modern medicine thanks in part to the work of Dr. Roy Sawyer, an American scientist who established the world's first leech farm. Based at Hendy near Swansea, South Wales, Biopharm is home to over 50,000 leeches which are supplied to hospitals and research laboratories around the world.

Thousands of patients owe the successful reattachment of body parts to miraculous technological advances in plastic and reconstructive surgery; at least some of these operations might have failed if leeches had not been reintroduced into the operating room. The appendages reattached include fingers, hands, toes, legs, ears, noses and scalps.

The pioneering use of leeches in modern plastic and reconstructive surgery can be attributed to two Slovenian surgeons, M. Derganc and F. Zdravic from Ljubljana who published a paper in the British Journal of Plastic Surgery in 1960 describing leech-assisted tissue flap surgery (in which a flap of skin is freed or rotated from an adjacent body area to cover a defect or injury). These surgeons credit their own use of leeches to a Parisian surgeon, one Philippe-Frédéric, who reported in 1836 that he had used leeches to restore circulation following reconstruction of a nose.

The rationale behind the use of leeches in surgical procedures is fairly straightforward; nonetheless, it is subject to misunderstanding, even by clinicians. The key to success is the exploitation of a unique property of the leech bite, namely, the creation of a puncture wound that bleeds literally for hours. The leech's saliva contains substances that anaesthetise the wound area, dilate the blood vessels to increase blood flow, and prevent the blood from clotting.

Microsurgeons today are adept at reattaching severed body parts, such as fingers. They usually have little trouble attaching the two ends of the arteries, because arteries are thick-walled and relatively easy to suture. The veins, however, are thin-walled and especially difficult to suture, particularly if the tissue is badly damaged. All too often the surgeon can get blood to flow in the reattached arteries but not veins. With the venous circulation severely compromised, the blood going to the reattached finger becomes congested, or stagnant; the reattached portion turns blue and lifeless and is at serious risk of being lost. It is precisely in such cases that leeches are summoned.

Links

• Worm world: Larry Leech - very delightful site for children & adults
• BBC News: Bloodsuckers hit the medical comeback trail
• BBC News: Leeches offer vein hope
• Biopharm Leeches Online Website - Suppliers of Medicinal Leeches since 1812
• Jiskha Homework Help - Science: Biology: Leeches - barebone info without the frills
• Armeniaweek: Treatment that Sucks: Leeches practice medicine at Yerevan center
• Medicinal Uses of Leeches from the Amazon and elsewhere: An Interview with Roy T. Sawyer
• Norman Miller: Science/Health/Medical: Use of leeches...

Kuasa Tuhan

Kita hanya mampu merancang, tuhan yang menentukan. Keadaan cuaca tidak menyebelahi aku sehari dua ini. Hujan yang turun diwaktu petang menyukarkan kerja menyiapkan kolam. Keadaan dinding dan lantai kolam yang basah tidak memungkinkan kerja 'plaster' dijalankan.

Aku cuma sempat menjalankan kerja disebahagian dinding sebelah dalam sahaja. Harap-harap besok cuaca akan kembali ceria dan kerja dapat disambung kembali. Aku berharap kerja ini dapat disiapkan pada 7hb Feb dan selepas itu kerja menaikkan pagar pula boleh dimulakan.

Bagaimanapun jika kerja 'plaster' tak dapat dilaksanakan, aku akan teruskan dengan kerja menaikkan pagar. Aku terpaksa memagar kawasan projek ternakan lintah ini kerana ianya terletak di kampung dan berhampiran kawasan sawah padi. Aku bimbang ada haiwan yang bakal memasuki kawasan ternakan. Tujuan pagar dibuat juga demi memastikan keselamatan lintah ternakan kami terjamin. Jangan korang tak tahu, dah banyak berlaku kecurian di kolam ternakan lintah.

Permintaan untuk mendapatkan induk dan benih lintah begitu banyak sekali. Setakat hari ini stok yang ada pada aku hampir kehabisan. Cuma tinggal 400 ekor sahaja lagi, itupun dah ditempah. En. Zahir tak dapat datang hari ini atas sebab yang tak dapat dielakkan. Untuk pengetahuan pengunjung blog Warisan AR, kami memberikan kursus percuma (site consultation) kepada bakal penternak yang membeli induk dari kami.

Bakal penternak akan didedahkan dengan segala hal berkenaan ternakan lintah secara praktikal. Bakal penternak juga diajar bagaimana menguruskan ternakan lintah secara lebih sistematik dan berkesan. Tiada fakta dan data yang disembunyikan. Segalanya didedahkan merangkumi dari aspek penyediaan tapak sehinggalah kepada teknik pembiakan yang paling berkesan.

Rasanya setakat ini dahulu lapuran untuk hari ini. Matapun dah mengantuk amat. Aku akan cuba sambung semula lapuran perkembangan pembinaan kolam pada besok hari. Insayaallah kita bertemu kembali.

ps: gambar-gambar sebahagian dari hasil kerja yang dapat dibereskan pada hari ini. Wassalam.

Kita Perlu Belajar

Hari ini aku tak dapat menunaikan janji aku untuk mengemaskini perkembangan pembinaan kolam ternakan lintah. Waktu yang terlalu padat tidak membenarkan aku untuk melihat perkembangan kerja pembinaan kolam. Aku berada di Hotel Seri Malaysia di Alor Setar bagi mengikuti SeminarPembangunan Usahawan Bumiputera ICT & E-Dagang Negeri Kedah.

Seminar sehari ini dianjurkan oleh Unit Pembangunan Usahawan dari Perbadanan Kemajuan Negeri Kedah (PKNK) dengan kerjasama Multimedia Super Corridor (MSC).



Insyaallah aku akan lapurkan perkembangan terkini status pembinaan kolam pada esok hari. Baiklah untuk tidak menghampakan para pengunjung aku ingin berkongsi sedikit maklumat berkenaan lintah dan penggunaannya. Semoga ianya dapat memberikan gambaran yang lebih luas kepada para pengunjung blog saya.

Lemak Lintah or Leech Fats contains enzymes of Hirudo Medicinalis (Medicinal leeches). Modern medicine uses Hirudo Medicinalis (Medicinal leeches) to treat blood clotting for skin grafts. Another lesser known of the leech is the strengthening and enlargement of the male organ. The original formula was developed by the Javanese community.

For hundred of years the native man of Malaya/Java - the elite and adepts who usually keep 4 wives - have been using a special ointment to care for their penis and maintain its virility.

This traditional method and remedy have a striking similarity with the practice of desert Arab men known for their sexual prowess as explained in Sir R F Burton's translation of Sheikh Umar el-Nefzawi book entitled "Rawd at-Tirr" or in English, The Perfumed Garden. In chapter 17 of this classical Tunisian-Arab sex-journal of the 16th century, it expounded on how the penis can be made bigger and stronger with this massage oil:

[ What is Hirudin? ]

Hirudin is a enzyme derived from the medicinal leech Hirudo Medicinalis, once used by doctors for bloodletting. Hirudin is often used following microsurgery (e.g. the replacement of a severed finger) to restore blocked or collapsed blood vessels and encourage the growth of new capillaries. The anticoagulants in the saliva of this and other species are now being investigated for the treatment and prevention of thrombosis.

This preparation is suitable for those who:

1. have problems in maintain and prolonging an erection.
2. want to increase/enhance their manhood.
3. want to avoid early release
4. want to strengthen the walls and the chambers weak urinary tract
5. develop and correct misplaced veins and poor blood flow

This oil is formulated using botanicals, herbs and oils that are well known for their special properties. The oil is further enhanced with Hirudo Medicinalis. The anticoagulant effect of Hirudin, along with the natural herbs and oils, encourages the natural process of regeneration of blood vessels along the length of the penis. If there are any obstructions in the blood vessels, the natural effect of the oil will clear them.

In cross section, the penis is divided into 3 compartments. Most of the penis is filled by 2 identical zones that are the ramrod- like corpora carvernosa (CC) that become erect when blood is trapped in thousands of sponge like spaces. The long thin compartment that runs along the underside of the penis in the middle is the corpus spongiosum (CS) that is the nerve center. When you start to get an erection, blood flows into these compartments causing the penis to enlarge. This happens because of physical or psychological stimulation. As blood enters these compartments, there is a temporary reduction in the rate and volume of blood leaving the penis.

This special oil is applied along the entire length of the penis. The massaging of the oil will improve blood flow into the corpora carvernosa (CC) resulting in more blood being trapped in its sponge like spaces. Male vigor and stamina is returned to the user as the natural process of regeneration of blood vessels allows for a better blood flow into these compartments, hence an enhanced erection. Most importantly, this oil is also used for esoteric massage to delay aging and to enhance mental faculty. Herein lies the key to an extraordinary control of ejaculation. When the veins are engorged with blood and energy, the physical exercises (included) trains the control of all major muscles along the penis. With regular use of the oil and the accompanying exercises, the user can learn to control these muscles to ejaculate at will. Thus, the can control if he wants an ejaculation, thus wasting precious energy, or to withhold the ejaculation and prolong the sexual encounter. The man with supreme control of these penile muscles can also experience multiple orgasm by with-holding ejaculation at the precise moment just before ejaculation. Through such controls, which becomes at will with practice, a man can have multiple orgasms as well as satisfy his female counterpart.

Episod Ke 5

Sudah 2 hari aku tak update. Banyak kerja yang aku perlu selesaikan. Balik rumah dah malam. Badan letih amat, tak sedar dah tertidur sambil baca s/khabar. Kerja pembinaan kolam simen berjalan agak perlahan tapi lancar tanpa sebarang gangguan. Cuaca juga banyak memberi ruang kepada aku. Syukur Alhamdulillah. Hari ini hujan turun sebaik saja aku dan Pak Long Harun selesai bertugas.

Nampaknya perancangan asal aku untuk menyiapkan kolam sebelum Tahun Baru Cina nampak tipis harapannya. Maklumlah tukangnya pun dah veteran manakala pembantunya pulak still amatur lagi (aku la tu). Bagaimanapun kami berjaya juga menjalankan misi walaupun agak tergelincir sikit dari plan asal perjalanan projek.

Hari ini dan semalam aku menerima kunjungan tetamu dari Pulau Pinang (bakal penternak) yang begitu berminat untuk mengusahakan penternakan lintah. Walaupun aku memaklumkan tapak projek kolam ternakan lintah aku belum lagi siap lagi, mereka tetap ingin berkunjung. Semalam Saudari Zainisah dan saudara dari Air Melintas, Tasek Gelugor telah mengunjungi untuk mengetahui dengan lebih jelas lagi tentang penternakan lintah. Banyak juga soalan yang dilontarkan untuk aku jawab.

Hari ini pula aku menerima kunjungan Saudara Izam dan rakan-rakan dari Bayan Baru, Pulau Pinang. Minat sungguh depa untuk mengusahakan ternakan lintah ini. Berbagai soalan keluar dari mulut masing-masing. Lepas seorang-seorang bersoal-jawab dengan aku. Jenuh jugak aku nak beri penjelasan supaya mereka betul-betul faham. Izam dan rakan-rakan pulang bersama 30 ekor induk dan makanan lintah sebagai percubaan katanya. Dia bercadang untuk masukkan dalam akuarium dulu sebagai percubaan. Aku juga memberikan serba-sedikit panduan bagaimana nak 'setup' suasana dalam akuarium supaya lintah selesa mendiaminya.

Rasanya setakat ini dahulu untuk kali ini. Insyaallah aku sambung besok jika sempat. Aku akan berada di Hotel Malaysia, Alor Setar pada besok hari untuk menghadiri Seminar IT yg dianjurkan oleh PKNK. Sebelum berpisah saksikan persembahan slide aktiviti hari ini.



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