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Historical Article: Hirudo medicinalis: Ancient origins of, and trends in the use of medicinal leeches throughout history

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Blood letting and the therapeutic use of Hirudo medicinalis date back to ancient Egypt and the beginning of civilisation. Their popularity has varied over the years, reaching such a peak in Europe between 1825 and 1850 that supplies were exhausted. Towards the end of the century they fell out of favour and, during this period, the leech, once used by the physicians of emperors and influential academic surgeons, became associated with lay therapists and quackery. Leeches have enjoyed a renaissance in reconstructive microsurgery during the last 15 years, having been used by maxillofacial [Br. J. Oral Maxillofac. Surg 41 (2003) 44] and other reconstructive surgeons to aid salvage of compromised microvascular free tissue transfers [Laryngoscope 108 (1998) 1129; Br. J. Plast. Surg. 34 (1984) 358], replanted digits [Int. J. Microsurg. 3 (1981) 265], ears [Ann. Plast. Surg. 43 (1999) 427], lips [Plast. Reconstr. Surg. 102 (1998) 358; J. Reconstr. Microsurg. 9 (1993) 327] and nasal tips [Br. J. Oral Maxillofac. Surg. 36 (1998) 462]. Peer-reviewed evidence suggests that the survival of compromised, venous-congested tissues is improved by early application of a leech [J. Reconstr. Microsurg. 12 (1996) 165; Arch. Otolaryngol. Head Neck Surg. 114 (1988) 1395; Br. J. Plast. Surg. 45 (1992) 235]. Leeches have also recently been used to treat a wide range of conditions, including periorbital haematomas [Br. J. Ophthalmol. 75 (1991) 755], severe macroglossia [Otolaryngol. Head Neck Surg. 125 (2001) 649; J. Laryngol. Otol. 109 (1995) 442] and purpura fulminans [Ann. Plast. Surg. 35 (1995) 300]. The first medicinal leech farm, Biopharm, was set up in Swansea in 1981 by Dr Roy Sawyer, and now supplies leeches to hospitals all over the world. In this paper, we summarise the history of treatment with Hirudo medicinalis from its origin to the present day, and take a brief look at the possible future of the annelid.
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British Journal of Oral and Maxillofacial Surgery (2004) 42, 133—137
Historical Article: Hirudo medicinalis: ancient
origins of, and trends in the use of medicinal
leeches throughout history
I.S. Whitakera,*,J. Raob,D. Izadic,P.E. Butlerd
aDepartment of Anatomy, University of Cambridge, Cambridge, UK
bDepartment of Oral and Maxillofacial Surgery, South Manchester University Hospitals NHS Trust,
Manchester, UK
cAddenbrooke’s Hospital School of Clinical Medicine, University of Cambridge, Cambridge, UK
dRoyal Free Hospital, London, UK
Accepted 30 October 2003
KEYWORDS
Hirudo medicinalis;
Medicinal leech;
History
Summary Blood letting and the therapeutic use of Hirudo medicinalis date back to
ancient Egypt and the beginning of civilisation. Their popularity has varied over the
years, reaching such a peak in Europe between 1825 and 1850 that supplies were
exhausted. Towards the end of the century they fell out of favour and, during this
period, the leech, once used by the physicians of emperors and influential academic
surgeons, became associated with lay therapists and quackery. Leeches have enjoyed
a renaissance in reconstructive microsurgery during the last 15 years, having been
used by maxillofacial [Br. J. Oral Maxillofac. Surg. 41 (2003) 44] and other recon-
structive surgeons to aid salvage of compromised microvascular free tissue transfers
[Laryngoscope 108 (1998) 1129; Br. J. Plast. Surg. 34 (1984) 358], replanted digits
[Int. J. Microsurg. 3 (1981) 265], ears [Ann. Plast. Surg. 43 (1999) 427], lips [Plast.
Reconstr. Surg. 102 (1998) 358; J. Reconstr. Microsurg. 9 (1993) 327] and nasal tips
[Br. J. Oral Maxillofac. Surg. 36 (1998) 462]. Peer-reviewed evidence suggests that
the survival of compromised, venous-congested tissues is improved by early applica-
tion of a leech [J. Reconstr. Microsurg. 12 (1996) 165; Arch. Otolaryngol. Head Neck
Surg. 114 (1988) 1395; Br. J. Plast. Surg. 45 (1992) 235]. Leeches have also recently
been used to treat a wide range of conditions, including periorbital haematomas [Br.
J. Ophthalmol. 75 (1991) 755], severe macroglossia [Otolaryngol. Head Neck Surg.
125 (2001) 649; J. Laryngol. Otol. 109 (1995) 442] and purpura fulminans [Ann. Plast.
Surg. 35 (1995) 300]. The first medicinal leech farm, Biopharm, was set up in Swansea
in 1981 by Dr Roy Sawyer, and now supplies leeches to hospitals all over the world. In
this paper, we summarise the history of treatment with Hirudo medicinalis from its
origin to the present day, and take a brief look at the possible future of the annelid.
© 2003 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier
Ltd. All rights reserved.
*Corresponding author. Present address: 8 Avonlea Road, Sale, Cheshire M33 4HZ, UK. Tel.: +44-161-962-7563.
E-mail address: iain whitaker@yahoo.com (I.S. Whitaker).
0266-4356/$ — see front matter © 2003 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/S0266-4356(03)00242-0
134 I.S. Whitaker et al.
History of leech therapy
Hirudo medicinalis has stimulated human imag-
ination for centuries. Its intimate contact with
humans have provoked a somewhat symbiotic
relationship in which the leech feeds off humans
and humans use the leech for medicine, stories
and imagery in popular culture12,13 (Fig. 1).
It is impossible to note accurately the time when
man learned of the existence of leeches. How-
ever, we do know that both the annelid and the
doctor have been closely linked since the dark
ages. ‘Leech’ is derived from the Anglo-Saxon
word ‘laece’ which, when literally translated,
means physician. It is also important to note that
‘leech’ is etymologically distinct from the Latin
word ‘Hirudo’. The name Hirudo medicinalis was
assigned by Linnaeus in 1758.14 Linnaeus (also Carl
von Linné, 1707—1778) was a Swedish botanist,
physician and zoologist whose work laid the founda-
tions of modern biological systematics and nomen-
clature.
The first recorded use of medicinal leeches
dates back to ancient Egypt and the beginning of
civilisation. Leeches can be seen in wall paintings
found in sepulchre of the 18th dynasty pharaohs
(1567—1308 b.c.). The first written record of their
medicinal use has been attributed to Nicader of
Colophain (200—130 b.c.) in his medical poem
Alexipharmaca.15 In the 1st century a.d. there was
more extensive written reference to their usage.
About this time, Chinese writings described medic-
inal leeching, as did references in Sanskrit, Persian
Figure 1 Johnson, James Rawlins. ‘A treatise on the
medicinal leech’ (London, 1816) (History & Special Col-
lections UCLA Louise M. Darling Biomedical Library).
and Arabic literature. The Romans were also famil-
iar with leeches during this period, and it was they
who named them ‘Hirudo’.
Plinius, described and noted that leeches sucked
blood, and documented their useful effects when
treating ‘rheumatic pains, gout or fevers of any
kind’. He compared them with sanguisuga–—from
sanguis (blood) and sugo (I suck).
The Syrian, Themisson of Laodicae, a pupil of
Asclepiades16 advanced the use of leeches for blood
letting at the beginning of the Christian era. He pos-
tulated that evil spirits caused illness and removal
of these evil spirits required withdrawal of blood.
Galen (130—201 a.d.), physician to Marcus Aure-
lius, further advanced the practice of blood letting
through the development of his humoral concept
of disease. This concept built on one first outlined
by Hippocrates (460—370 b.c.), who believed in the
rule of harmony and the theory that all body sys-
tems were in balance and that disease resulted from
imbalance.
Galen taught the importance of maintaining bal-
ance between the four bodily fluids, or humours:
blood, phlegm, yellow bile and black bile. Each fluid
was associated with a specific personality charac-
teristic. The belief was that removal of the patients
blood would correct the humoral imbalance and re-
store good health. Alexander de Tralles (525—605
a.d.) even treated hearing loss with leeches, in ad-
dition to more novel treatments, such as the juices
of roaches. Avicenna (980—1037 a.d.), believed that
leeches drew blood from deeper sources than wet
cupping. His ‘Canon of Medicine’ included several
pages of instruction about leeches.17
In the Middle Ages, barber surgeons, armed with a
staff for the patient to grasp (so the veins on the arm
would stand out sharply), a basin to hold leeches
and catch blood, and a copious supply of linen ban-
dages, continued the practice of blood letting.
The blood stained linen bandages wrapped
around the barber’s pole in the wind was respon-
sible for the modern day red and white striped
pole outside some hairdressers salons. The earliest
barber’s poles were surmounted by a leech basin,
which in time has transformed into a ball on top of
the poles.
Leeches were kept in special vessels that were
filled with water and had perforated tops to let
them breathe. Early leech jars were glass (Fig. 2),
and later ceramic, and were often beautifully dec-
orated and highly prized collectors’ items. For
house calls, physicians would often carry small
glass or pewter containers containing a dozen or
so leeches.18 Leeches were better tolerated than
other methods of blood letting (e.g. the fleam and
the scarifier19)(Fig. 3) as the pain of the bite was
Hirudo medicinalis: ancient origins of, and trends in the use of medicinal leeches 135
Figure 2 Bossche, Willem van den. Historia Medica
(Bruxellae, 1639).
far less painful than the wound inflicted by the
other two methods. The fleam consisted of a blade
cocked by a spring mechanism, and was also known
as a spring lancet. The scarifier was used to make
several cuts in the skin at one time, and a bleed-
ing cup was placed over the abrasions. In general,
leeches were considered to be of greater benefit
when blood had to be removed from a part of the
body where a lancet or cup could not be used,
such as ‘haemorrhoidal tumours, prolapsed rec-
tum and inflamed vulva ... watching that they did
not creep out of reach within any of the internal
cavities, as serious results might ensue’.27
In France, under the influence of Broussais
(1772—1832), head doctor of the Val de Grˆ
ace Hos-
pital in Paris and surgeon in Napoleon’s Grande
Armée, the use of leeches spread rapidly.
Figure 3 Bloodletting man’. The Calendar of Re-
giomontanus (1475).
Figure 4 François-Joseph-Victor Broussais (1772—
1838).
Broussais has been referred to as ‘the most san-
guinary physician in history’20 (Fig. 4). He proposed
that all diseases resulted from an excess build up
of blood and alleviation of this condition required
heavy leeching and starvation. French physicians
would commonly prescribe leeches to be applied
to newly hospitalised patients even before seeing
them.21 Leeches became the therapeutic agent
par excellence, and even inspired fashion. Fe-
males wore imitation leech decorations; ‘fastidious
ladies ... used to deck their dresses with embroi-
dered leeches22 and their cosmetic uses included
enhancement of their pale complexions.
During this period in Russia, Mudrov and Di-
adkovsky were equally enthusiastic about using
leeches. They reported that phlebotomy with
leeches achieved excellent results in various con-
ditions, including inflammation of the cerebrum,
liver and kidney disease, rheumatism, tubercu-
losis, epilepsy, hysterics and sexually transmit-
ted diseases. Contraindications to the treatment
were not mentioned, and it seemed that they
treated patients irrespective of age and state of
health.
The use of leeches became so popular during this
period that the species became endangered in Eu-
rope. Patients were prescribed up to 80 leeches a
session. Russia consumed about 30 million leeches
annually. In 1833 alone, French doctors imported
almost 42 million leeches, and the annual consump-
tion approached 100 million. The ever increasing
demand made prices soar, and the French govern-
ment granted awards to companies who could im-
prove production by developing new stocks from
marshes, streams and ponds. Leech harvesting be-
came a popular way of earning money, and people
136 I.S. Whitaker et al.
waded into ponds and then removed and sold the
leeches that had become attached to their feet and
legs.
In Germany, they shipped an estimated 30 million
leeches annually to the United States, and German
authorities too became concerned about the ability
of the country to meet domestic needs. European
leeches were preferred to their American counter-
part, Hirudo decora, as the American leech did not
make as deep or as large an incision and drew less
blood. Americans were having difficulty in obtain-
ing European medicinal leeches, and in 1835, a $500
award was offered to anyone who could breed Eu-
ropean leeches in the United States.23
By the end of the 19th century, the leech had lost
its popularity. This is well illustrated by the records
of a certain English hospital, which stated that in
1832 almost 100,000 leeches were used, whereas
50 years later the number had fallen to less than
2000 leeches.24 Their therapeutic use did not fit
into the emerging modern concepts of medicine.
There was now an increased emphasis on exper-
imental methods and stringent restraints on em-
pirical methods. With the development of modern
physiology, pathology and microbiology, leeches fell
out of favour, not only with physicians, but also
with patients. During this period only occasional
references can be found with regard to removal of
blood.
Haycraft25 brought leeches back into mainstream
thinking with his discovery in 1884 that a pure anti-
coagulating preparation was contained in the saliva
of leeches which he named ‘Hirudine’ from the
Latin ‘Hirudo’. In hindsight it seems that Haycraft
simply confirmed an earlier observation made by a
Russian, Professor Diakonov. In his article Changes
of human blood in the leech in 1809, he wrote
that ‘lack of blood coagulation and dissolution of
red blood corpuscles in the leech’s intestinal duct
testifies that some dissolving agent exists there’.
In 1955, Markwardt26 isolated and accurately char-
acterised Hirudin from leeches’ pharyngeal glands.
It was not until 1986 that this potent anticoag-
ulant was first produced in quantity by genetic
engineering.27
Medicinal leeches have recently been re-
discovered and are used by maxillofacial and
other microsurgeons to aid salvage of compro-
mised venous engorged tissue, including free
and pedicled flaps, and amputated digits, ears
and nasal tips.2—8 Peer-reviewed evidence has
suggested that the survival of a compromised,
venous-congested flap is improved by early appli-
cation of a leech.9—11
In 1981, an American biologist, Roy Sawyer, aban-
doned his academic career to found Biopharm Ltd,
a company in Swansea, Wales, devoted to breed-
ing and farming leeches and developing new drugs
for clinical use. Biopharm estimates that it sup-
plies about 25,000 leeches to the United Kingdom
and Ireland each year and 60,000 to the United
States.
Researchers led by head and neck surgeon Gre-
gory Hartig at the University of Wisconsin at Madison
in the United States, are developing a mechanical
leech,28 which they think has distinct advantages
over its flesh-and-blood counterpart.
They postulate that the device can deliver and
disperse the anticoagulant heparin better to com-
promised tissue, and the device’s porous tip, im-
planted just beneath the skin, rotates to inhibit co-
agulation further. The development team think that
the biggest advantage of the mechanical leech is a
psychological one, as patients seem to prefer being
attached to a machine than a live creature.
The ancient art of applying leeches still has a role
to play in contemporary reconstructive surgery, but
will the mechanical leech force its living counter-
part into retirement? Only time will tell.
References
1. Rao J, Whitaker IS. Use of Hirudo medicinalis by maxillo-
facial surgery units in the UK: current views and practice.
Br J Oral Maxillofac Surg 2003;41:44—5.
2. Utley DS, Koch RJ, Goode RL. The failing flap in facial
plastic and reconstructive surgery: role of the medicinal
leech. Laryngoscope 1998;108:1129—35.
3. Batchelor AGG, Davison P, Sully L. The salvage of congested
skin flaps by the application of leeches. Br J Plast Surg
1984;34:358—60.
4. Foucher G, Henderson HR, Maneau M, Merie M, Braun FM.
Distal digital replantation: one of the best indicators for
microsurgery. Int J Microsurg 1981;3:265—70.
5. Cho BH, Ahn HB. Microsurgical replantation of a partial ear,
with leech therapy. Ann Plast Surg 1999;43:427—9.
6. Walton RL, Beahm EK, Brown RE, Upton J, Reinke
K, Fudem G, et al. Microsurgical replantation of the
lip: a multi-institutional experience. Plast Reconstr Surg
1998;102:358—68.
7. Hirase Y, Kojima T, Hayashi J, Nakano M. Successful upper
labial replantation after 17 hours of ischemia: case report.
J Reconstr Microsurg 1993;9:327—9.
8. Mortenson BW, Dawson KH, Murakami C. Medicinal leeches
used to salvage a traumatic nasal flap. Br J Oral Maxillofac
Surg 1998;36:462—4.
9. De Chalain TM. Exploring the use of the medicinal
leech: a clinical risk-benefit analysis. J Reconstr Microsurg
1996;12:165—72.
10. Hayden RE, Phillips JG, McLear PW, Leeches. Objective
monitoring of altered perfusion in congested flaps . Arch
Otolaryngol Head Neck Surg 1988;114:1395—9.
11. Lee C, Mehran RJ, Lessard ML, Kerrigan CL. Leeches: con-
trolled trial in venous compromised rat epigastric flaps. Br
J Plast Surg 1992;45:235—8.
Hirudo medicinalis: ancient origins of, and trends in the use of medicinal leeches 137
12. Grzimek HCB. Grzinek’s animal life encyclopaedia, vol. 1.
New York: Van Nostrand Reinhold; 1974.
13. Sawyer RT. Leech biology and behaviour, vols. 1—2. Oxford:
Clarendon Press; 1986.
14. Mory RN, Mindell D, Bloom DA. The leech and the physician:
biology, etymology, and medical practice with Hirudinea
medicinalis.World J Surg 2000;24:878—83.
15. Wells MD, Manktelow RT, Boyd JB, Bowen V. The med-
ical leech: an old treatment revisited. Microsurgery
1993;14:183—6.
16. Price RA. Treatise on the utility of sangui-suction or leech
bleeding. London: Simpkin and Marshall; 1822. p. 3—4.
17. Grunner OCA. Treatise on the Canon of Medicine of Avicenna
incorporating a translation of the first book. London: Luzac
and Co; 1930. p. 513—4.
18. Kravetz RE. Leech jar. Am J Gastroenterol 2001;96:894.
19. Adams SL. The medicinal leech: historical perspectives.
Semin Thromb Hemost 1989;15:261—4.
20. Rolleston JD. François-Joseph-Victor Broussais 1772 to 1832:
his life and doctrines. Proc R Soc Med 1959;22:405.
21. Upshaw J, O’Leary JP. The medicinal leech: past and
present. Am Surg 2000;66:313—4.
22. Thearle MJ. Leeches in medicine. Aust NZ J Surg
1998;68:292—5.
23. Shurtleff B, Channing W, Walker W. Premium for breeding
leeches. Boston Med Surg 1835;12:322.
24. Hare CJ. Good remedies–—out of fashion. London: Churchill;
1883. p. 30—47.
25. Haycraft JB. On the action of secretion obtained from the
medicinal leech on coagulation of the blood. Proc R Soc
Lond 1884;36:478.
26. Markwardt F. Untersuchungen über Hirudin. Naturwis-
senschaften 1955;52:537.
27. Fields WS. The history of leeching and hirudin. Haemostasis
1991;21(Suppl 1):3—10.
28. Conforti ML, Connor NP, Heisey DM, Vanderby R, Kunz D,
Hartig GK. Development of a mechanical device to replace
medicinal leech (Hirudo medicinalis) for treatment of ve-
nous congestion. Rehabil Res Dev 2002;39:497—504.
Further reading
29. Menage MJ, Wright G. Use of leeches in a case of severe
periorbital haematoma. Br J Ophthalmol 1991;75:755—6.
30. Byrne PJ, Bernstein PE. The use of medicinal leeches to
treat macroglossia secondary to blunt trauma. Otolaryngol
Head Neck Surg 2001;125:649—50.
31. Smeets IM, Engelberts I. The use of leeches in a case
of post-operative life-threatening macroglossia. J Laryngol
Otol 1995;109:442—4.
32. de Chalain T, Cohen SR, Burstein FD. Successful use of
leeches in the treatment of purpura fulminans. Ann Plast
Surg 1995;35:300—6.
... Leeches are one of the oldest medical treatments of mankind. Their ability to suck blood from the patient painlessly yet effectively made their use more popular than mechanical methods of bloodletting, such as the fleam and scarifier, even in the days of Galen's humoral pathology [1]. Shortly after the discovery of blood circulation [2], many diseases nonetheless continued to be attributed to an excess of blood in the body [1], and the consumption of leeches continuously increased and peaked in the 19th century, with an annual consumption of 100 million [3]. ...
... Their ability to suck blood from the patient painlessly yet effectively made their use more popular than mechanical methods of bloodletting, such as the fleam and scarifier, even in the days of Galen's humoral pathology [1]. Shortly after the discovery of blood circulation [2], many diseases nonetheless continued to be attributed to an excess of blood in the body [1], and the consumption of leeches continuously increased and peaked in the 19th century, with an annual consumption of 100 million [3]. The advancement of scientific medicine, especially its subfields of physiology and pathology, eventually led to the decline of this centuries-old application [4]. ...
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The treatment of disease conditions with the application of medicinal leeches is termed as Leech Therapy . It has been termed as Jaloukavacharana in ancient Ayurvedic texts. Acharya Sushruta, the father of Surgery has stated the uses of leeches in Anushastras, which means the instruments or tools which can be used as Para surgical tools Jaloukavacharana has been an established therapy of Raktamokshana by Anushastras. Leech therapy (Hirudotherapy) is one of the oldest practices in medicine; it is known from the time of extreme antiquity and is still alive . Leeches were used for treatment in Egypt as early as 1500 BC.Salivary glands of a medical leech contain more than 100 bioactive substances and the salivary gland secretion has anti-edematous, bacteriostatic, and analgesic effects; it possesses resolving activity, eliminates microcirculation disorders, restores the damaged vascular permeability of tissues and organs, eliminates hypoxia (oxygen starvation), reduces blood pressure, increases immune system activity, detoxifies the organism by antioxidant pathways, relieves it from the threatening complications, such as infarct and strokes, and improves the bioenergetic status of the organism. By the virtue of salivary gland secretions which are proteinatious enzymes, it acts on various diseases like Arthritis, Chronic non healing wound, Venous diseases, Reconstruction surgeries, and many more.
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Tıbbi sülükler Annelida şubesinin Hirudinea alt-sınıfında yer alan halkalı yapıda, hermafrodit, amfibik yaşam süren ektoparazit canlılardır. Ektoparazit olan tıbbi sülükler konağın kanıyla beslenmektedir. Tıbbi sülüklerin kan emerken salgıladıkları biyo-aktif maddelerin etkisi dolayısı ile yüzyıllardır tedavi amaçlı kullanılmaktadır ve buna bağlı olarak ticareti yapılmaktadır. Sülüklerin salgılarında bulunan en bilinir madde hirudin’dir (Rigbi ve ark., 1996). Tıbbi sülük tedavisi ile ilgili en eski kayıtlar M.Ö. 1567–1308 arasında eski Mısır’a kadar ulaşır (Whitaker ve ark., 2004). Hirudoterapi (Sülük tedavisi) Rusya ve eski Sovyetler Birliği ülkelerinde ayrıca ABD, Kanada, Fransa, Almanya ve Hollanda gibi birçok ülkede klinik uygulamada aktif olarak kullanılmaktadır (Baskova ve ark., 2008). Türkiye’de ise 27.10.2014 tarihinde Sağlık Bakanlığı tarafından yayınlanan “Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği” ile tıbbi sülüklerin tedavide kullanılmasının önü açılmıştır. En popüler ve en bilinen Tıbbi sülük türü Hirudo medicinalis Linnaeus, 1758 olmasına rağmen, aynı amaç ile kullanılan ve çoğu zaman aynı isimle adlandırılan birçok türü bulunmaktadır. H. medicinalis “Avrupa tıbbi sülüğü” İngiltere, orta ve batı Avrupa, Litvanya ve Ukrayna’da, Hirudo verbana “Güney tıbbi sülüğü” doğu Akdeniz, Balkanlar, Moldova, Ukrayna, Rusya, Türkiye ve Ermenistan’da (Elliott ve Kutschera, 2011), Hirudo orientalis “İran tıbbi sülüğü” Trans Kafkasya, İran ve orta Asya’da (Trontelj ve Utevsky, 2005; Utevsky ve ark., 2010), Hirudo troctina “Ejder sülüğü” kuzeybatı Afrika ve İspanya’da (Hechtel ve Sawyer, 2002), Hirudo nipponia Japonya’da ve yeni kayıt olan Hirudo sulukii ise Türkiye’nin güneydoğusunda (Sağlam ve ark., 2016) dağılım göstermektedir. Hirudo cinsi dışında Hirudinaria manillensis (Asya tıbbi sülüğü) ve Macrobdella decora (Kuzey Amerikan tıbbi sülüğü) türleri tıbbi amaçlı kullanılmaktadır (Gödekmerdan ve ark., 2011). Tıbbi sülükler çoğunlukla göl, gölet ve bataklıkların durgun sularında yaşarlar fakat akarsularda da nadiren görülebilmektedirler. Sülük ticaretinin uluslararası boyuta gelmesi ile karlı bir işe dönüşmesi tıbbi sülük popülasyonunu aşırı avcılık baskısı altına almış, bunun yanı sıra küresel ısınma ya da bataklık kurutma eylemleri kaynaklı sulak alanların azalmasıyla H. medicinalis ve H. verbana türlerinin nesli tükenme tehlikesi altına girmiştir (Uğural, 2017). Bu nedenle H. medicinalis ve H. Verbana türleri Nesli Tehlikede Olan Yabani Hayvan ve Bitki Türlerinin Uluslararası Ticaretine İlişkin Sözleşme (Convention on International Trade in Endangered Species of Wild Fauna and Flora: CITES) ile koruma altına alınmıştır.
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Background: Several leech species of the genera Hirudo, Hirudinaria and Whitmania are widely used in Traditional Chinese Medicine for the oral treatment of disorders associated with blood stasis. Among them, the non-hematophagous leech Whitmania pigra expresses a variety of components that have the potential to act on the vertebrate blood coagulation system. Objective: Whether or not the thrombin inhibitor hirudin, probably the most prominent leech-derived anticoagulant, is actually present in Whitmania pigra, is still a matter of debate. To answer that open question was the ultimate aim of the study. Methods: We identified several putative hirudin-encoding sequences in transcriptome data of Whitmania pigra. Upon gene synthesis and molecular cloning the respective recombinant proteins were expressed in Escherichia coli, purified, processed and eventually functionally characterized for thrombin-inhibitory potencies in coagulation assays. Results: We were successful in the identification and functional characterization of several putative hirudins in Whitmania pigra. Some, but not all of these factors are indeed thrombin inhibitors. Whitmania pigra hence expresses both hirudins (factors that inhibit thrombin) and hirudin-like factors (that do not or only very weakly inhibit thrombin). Furthermore we revealed the exon/intron-structures of the corresponding genes. Coding sequences of some putative hirudins of Whitmania pigra were present also in transcriptome datasets of Hirudo nipponia, a hematophagous leech that is likewise used in TCM. Conclusions: Based on both structural and functional data we provide very strong evidence for the expression of hirudins in Whitmania pigra. This is the first description of hirudins in a non-hematophagous leech.
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The following is an offshoot from a more extended investigation upon the coagulation of the blood not yet ready for publication. The blood flowing from a leech-bite is not readily stopped, often flowing for upwards of an hour after the animal has been removed. The blood with in the body of the creature remains fluid for an indefinite time; and when ejected it is found to have lost its coagulability. These are facts known to every surgeon, but they have received no explanation.
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To review the use of the medicinal leech, Hirudo medicinalis, in salvaging the failing, venous-congested flap. A protocol for the use of leeches is presented. Four illustrative cases of failing flaps (pectoralis major, midline forehead, and temporalis) are presented. Literature review comprised of MEDLINE search 1965 to present. Retrospective review of four cases involving the management of the failing, venous-congested flap. A retrospective review of four cases of failing, venous-congested flaps was performed. The authors' experience, as well as the data from the reviewed medical literature, demonstrates the importance of early intervention in order to salvage the failing, venous-congested flap. Leeches are an immediate and efficacious treatment option. 1. Review of the literature indicates that the survival of the compromised, venous-congested flap is improved by early intervention with the medicinal leech. H medicinalis injects salivary components that inhibit both platelet aggregation and the coagulation cascade. The flap is decongested initially as the leech extracts blood and is further decongested as the bite wound oozes after the leech detaches. 2. When a flap begins to fail, salvage of that flap demands early recognition of reversible processes, such as venous congestion. The surgeon must be familiar with the use of leeches and should consider their use early, since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. In the four cases presented, a standardized protocol facilitated early leech use and provided for the psychological preparation of the patient, availability of leeches, and an antibiotic prophylaxis regimen. 3. The complications associated with leech use can be minimized with antibiotic therapy, wound care, and hematocrit monitoring. 4. The use of the medicinal leech for salvage of the venous-congested flap is a safe, efficacious, economical, and well-tolerated intervention.
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Leeches have been used in medicine for blood-letting since ancient times. Leeching has varied in popularity over the years. It reached its zenith during the early decades of the 19th century with a gradual decline by the end of the century. Since the 1980s leeches have been introduced to remove blood where its accumulation may interfere with healing, particularly after plastic tissue-flap surgery. The history and current use of medicinal leeches in Australia is examined.
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Leeches were studied for their efficacy to improve survival of venous compromised rat skin flaps. In 22 rats, bilateral epigastric island flaps were created and subjected to 6 h of venous occlusion. One flap in each animal was randomised to leech treatment, while the contralateral flap served as its own control. Flap survival, leech feeding time, weight gained by the leech and bleeding time from leech bites were measured. The area of flap survival was significantly increased in leech treated flaps compared to contralateral controls (n = 22 pairs, p = 0.03; Wilcoxon signed rank test). Weight gained in the feeding leech averaged 1.3 +/- 0.2 g (n = 18). Leech feeding time was 107 +/- 13 min (n = 18). Bleeding time from each leech bite averaged 79 +/- 12 min (n = 18). Hence, the extent of flap necrosis resulting from venous impairment can be partly diminished by leech treatment until definitive surgical venous revascularisation.
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A case of severe penetrating eye injury and resulting periorbital haematoma is described. Leeches applied to the eyelids enabled examination of the globe to be carried out and improved the surgical approach. Leeches provide a speedy and efficient means of reducing a periorbital haematoma.
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Leeching is an art dating back at least to ancient Egypt. It reached its zenith in the late 18th and early 19th centuries. The antithrombotic quality of leech saliva was first noted by Haycraft in 1884 and the active anticoagulant ingredient isolated in 1904 by Jacoby. He gave this agent the name 'hirudin'. Hirudin was isolated in pure crystalline form by Markwardt in 1957 and first produced in quantity by genetic engineering in 1986. The salivary glands of several species of leech also contain other biologically active substances which are currently undergoing investigation.