On Friday, July 2, 2004 at 1:10:55 PM UTC-6, doe wrote:
> >Subject: Selective bloodletting for severe ulcerative colitis
> >From: ironj...@aol.comdoe (doe)
> >Date: 6/30/2004 7:43 PM Mountain Daylight Time
> >Message-id: <20040630214303...@mb-m12.aol.com>
> >
> >I wonder what the results .. here .. are .. ?
> >And I wonder how you .. become .. one of the .. selected ..
> >
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> >
> >Scand J Gastroenterol. 2004 May;39(5):416-7. Related Articles, Links
> >
> >
> >Selective bloodletting for severe ulcerative colitis.
> >
> >Premehand P, Takeuchi K, Bjarnason I.
> >
> >Dept. of Gastroenterology, King's College Hospital, London, UK.
> >ppremc...@yahoo.com
> >
> >PMID: 15180176 [PubMed - in process]
> >
> >--------------------------------------------------------------------------
> >------
> >
> Went to the University Library and pulled the article ..
> This is a snip ..
> Seems to compare .. apheresis TO .. bloodletting ..
> Same result .. different methods and expense ..
> <<snip>>
> With current insight into the pathogenesis of various 'inflammatory' diseases ,
> and the involvement of circulating cells, cytokines and other cell-cell
> signalling molecules, a possible rationale for bloodletting emerges, i.e.
> removal of pro-inflammatory cells or substances thereby interrupting a viscous
> cycle whereby effector molecules perpetuate inflammation.
> The Japanese experience in ulcerative colitiis , if confirmed in controlled
> trials , has the potential to alter our approach to the treatment of severe
> exacerbation of ulcerative colitis, thus obviating the need for surgery, which
> is associated with significant morbidity.
> While the precise mechansim of benefit of this treatmemt is not fully
> understood , the apheresis systems are also showing promise in Crohn disease .
> We suggest that this may herald a new therapeutic approach whereby speciific
> constituents of blood are removed rather than neurtralized with antibodies ,
> which are unavoidably associated with tolerance and side effects.
> <<snip>>
> Who loves ya.
> Tom
> Jesus Was A Vegetarian! http://jesuswasavegetarian.7h.com
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Selective bloodletting for severe ulcerative colitis.
Purushothaman Premchand1, Ken Takeuchi, Ingvar Bjarnason2•Institutions (2)
30 Apr 2004-Scandinavian Journal of Gastroenterology (Taylor & Francis)-Vol.. 39, Iss: 5, pp 416-417
TL;DR: This is the first long-term follow-up study of patients with ulcerative colitis treated in this manner and expands on previous studies in this disease using the same devices.

Abstract: Both of the classic chronic intestinal inflammatory bowel diseases ulcerative colitis and Crohn disease are characterized by periods of well-being interrupted by episodes of increased clinical disease activity or relapse of disease. The mainstay of medical treatment for severe flare-ups initially involves hospitalization, nutritional support, high doses of intravenous corticosteroids and sometimes antimicrobial treatment (1). Up to now, failure of conventional medication has often been followed by surgery. However, for Crohn disease, there is the additional option of treatment with elemental diets and, more recently, tumour necrosis factor antibodies, with other biological agents that may avert surgery awaiting outcome trials (2). These strategies have not, however, been successful in patients with severe ulcerative colitis (defined as patients with bloody diarrhoea in excess of 4 times a day and systemic disturbances such as fever, tachycardia, anaemia, etc.) that have not responded to high i.v. doses of prednisolone over 7–10 days (persistent frequent bowel movements ( 9), rapid pulse ( 100/min), high temperature ( 38°C) and low serum albumen ( 30 g/L) being poor prognostic indicators and predictive of surgery). Current practice recommends that these patients undergo colectomy (with various reconstructive continence pouch operations being available) or a trial of intravenous cyclosporine, although this is of unproven efficacy and the patients remain at extreme risk for a colectomy over the subsequent few months (3). A recently published study from Japan (4), supported by a number of abstracts at the Digestive Disease Week in Orlando, USA, in May 2003, suggests that a new form of treatment for steroid-resistant patients with severe ulcerative colitis which involves granulocyte, monocyte and macrophage apheresis may induce sustained clinical remission of the disease and reduce the need for colectomy. This is the first long-term follow-up study of patients with ulcerative colitis treated in this manner and expands on previous studies in this disease using the same (5, 6) or similar devices (7–9). Based on the evidence that neutrophils appear to be the main effector cells in the relapse of ulcerative colitis, relating quantitatively to clinical and laboratory disease activity indices (10), Japan Immunoresearch Laboratories in Japan designed a new medical device for selectively removing circulating granulocytes, monocytes and macrophage from the circulation by passing blood through a column packed with specifically designed cellulose acetate beads (carriers) which adsorb Fc and complement receptor-bearing leucocytes (4). This device, named the Adacolumn, removes up to 65% of the circulating granulocytes, monocytes and macrophages, together with a small fraction of lymphocytes (11). Hanai et al. assessed the efficacy of this treatment and treated 146 consecutive patients with severe exacerbation of ulcerative colitis (defined as 3 or more of the criteria of Truelove & Witts (12), namely stool frequency 6/day, bloody stools, body temperature 37°C, tachycardia 90 beats/min, haemoglobin 75% of normal values and an erythrocyte sedimentation rate of 30/h) as inpatients. Ninety-two of the patients did not respond to first-line treatment with mesalazine preparations. These patients underwent treatment with oral ( n = 51) or intravenous ( n = 41) prednisolone (40–80 mg day 1) for 7–18 days. Thirty-one patients did not respond to this treatment and these underwent s lective white cell removal by Adacolumn, one or two sessions/week for a total of 10 sessions. Twenty-five achieved full clinical remission (with reduced doses and often cessation of corticosteroids), the condition of 2 patients improved and 4 patients had a colectomy (one had a toxic megacolon and another, a perforation before this treatment). Those in clinical remission continued with their mesalazine, 20 were put on 6mercaptopurine (30–50 mg day 1) and 7 received treatments with intermittent Adacolumn. Remarkably, in this group of patients at extreme risk of relapse of disease and colectomy, 80% remained in clinical remission over the next 12 months and only one had to undergo colectomy. This treatment is all the more impressive in that it comes with no significant side effects. Selective removal of constituents of circulating blood is r miniscent of the rather cruder technique of bloodletting. Bloodletting and its therapeutic usage dates back to 400 BC, the time of Hippocrates, in ancient Greece. It was subsequently popularized by the Greek physician Claudius Galen (AD 129–203) while working in Rome, and who became the unassailable authority on medicine for over 1500 years. Bloodletting was routinely and extensively performed in m dieval times to harmonize the four humours—blood, phlegm, yellow bile and black bile. It may just be the folly of the past, but it is difficult to imagine that this procedure would have been so widely practised for such a long time if it had not had some degree of efficacy. With current insight into the pathogenesis of various ‘inflammatory’ diseases, and the involvement of circulating cells, cytokines and other cell–cell signalling molecules, a possible rationale for bloodletting emerges, i.e. removal of CURRENT OPINION

https://typeset.io/papers/selective-bloodletting-for-severe-ulcerative-colitis-4nwnazhb5g

Who loves ya.
Tom

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