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 I - SUMMARY :

- Created in 1952, Mesotherapy is a mode of treatment, but not a new medicine.

- It uses intradermal or local subcutaneous injection of small quantities of drugs, most of them allopathical.

- It is a bridge between allopathic, and alternative or complementary medicine


- The local administration of minimal doses makes a less iatrogenic therapeutic for a more effective action.

- This mode of treatment, done after an accurate diagnosis, is reserved only for physicians and requires special training.

 

II - DEFINITION :

             Mesotherapy is a mode of treatment in which intradermal or superficial subcutaneous injections are used to let penetration of small quantities of drugs in the body. It uses essentially injectable allopathic drugs, mineral salts, vitamins, and occasionally homeopathic drugs.

            All these medecines are diluted and administrated in small quantities to a specific area, or to special points, selected in accordance with the pathology in need of treatment. The local persistence of the injected drugs allow low frequency in the treatment.
 
”little, seldom, in the right place”(Michel Pistor)

  

III - CHRONOLOGY:

             The basic idea of Mesotherapy came to an open-minded country family physician, Dr. Michel Pistor, in 1952, following a clinical observation. It consisted of drawing the medication to the area of a lesion using intradermal injections. But the idea allready existed. For example, some local injections of drugs were used for the treatment of osteoarthritic pains. And the history of Mesotherapy goes back to Hippocrate (400 years B.C.) who stated that he treated a patient by applying a prickly pear (our Sabra).

            But, Doctor Michel Pistor was the first pratician to study and systematize this method for multiple diseases. He improved and distributed his technology, educated many students, and created the French Society of Mesotherapy with more than 1500 members (for more than 5000 fully-formed physicians), and then the International Society of Mesotherapy which included 20 nations: Belgium, Brazil, France, Israel, Italy, …

            The 8th International Congress of Mesotherrapy took place in 1998 in Sao Paulo (Brazil) and assembled more than 500 practitionners (about forty were from Europe).

            In the last couple of years, an Academic Diploma of Mesotherapy exists in Marseille and Bordeaux. Since 2002, an Inter-University Diploma of Mesotherapy exists in Paris, Marseille, Bordeaux, Clermond Ferrand and Dijon.

In 2003, Mesotherapy was introduced officiely in the French « Sal Habriuth ».
 

            Mesotherapy is in application in some  public hospitals or in health-care centers.


            Some prominent dates:

- in 1976, Dr Andre Dalloz-Bourguignon opened the first
hospital consultation in Hopital Necker, Paris.

- in 1982, Dr Daniel Corbel (Tours) and then Doctor Andre Kaplan (Paris) first tested the radioactive isotopes.

- This work gave Mesotherapy recognition of the French Medical Academy in 1987: the Mesotherapy is proclaimed ”integral part of the Medecine”.

 

IV - SCIENTIFIC  BASIS OF MESOTHERAPY:

 For many years, Mesotherapy was practiced based on clinical observations. It took a long time for Mesotherapy to become a scientific technique, based on scientific work.

                  A number of clinical studies were done, particularly in the French Society of Mesotherapy, and the results were published in its' bulletin (n° 123 in juillet 2005) or in the end-of-term reports of the International Congress of Mesotherapy. Some of these clinical studies were done with randomization in double blind, and a lot of interesting experiments were used since 1982. Starting 1983, radio active isotopes were used to revolutionizes all the conceptions for the way of action of Mesotherapy.

- André Dalloz-Bourguignon (Paris, France - 1982) studied the diffusion of drugs in the subcutaneous tissues in the human body by xerography.

-  Pitzurra (Pérouse, Italy – 1983) experiments on Guinea pigs, testing the diffusion of drugs injected in the articulation of the knee by intradermal or intramuscular ways.

-  Questel et Le Coz (Paris, France – 1983) carried out synovia biopsies during arthroscopies of the knee, with pharmacological dosages injected with intradermal pathway of
          - methylene blue
          - non-steroidal anti-inflammatory agent


-  Gutelman et Gerard (Brussels, Belgium – 1992) authenticated with chromatographically and spectrographically analyses the mixtures used for Mesotherapy.

-  Daniel Corbel (Pr Itti ‘s department, Tours, France – 1983) worked on radio actives isotopes, and specially :

          - the local pharmacokinetic, regional and « full body », of different isotopes injected by intradermal pathway

           - the diffusion of different molecules to their « target organs ».

 

- Andre Kaplan (Pr Milhaud ‘s department, Paris, France – 1983 to 1994) worked on radio actives isotopes and specially :

      - the different depth injection (marked calcitonine, Dr Didier Rincourt ‘s doctorate thesis) 

      - with Dr Gerard Coutris :

           . intradermal pharmacokinetics of small and big molecules (colloids)

              . intradermal scintigraphy, or mesoscintigraphy, (lymphatic glands or  ducts, osseous lesions, etc…)


            All these works leaded to a smattering of intradermal pharmacokinetics, that we can sum up :

            - the superficial derma forms a cutaneous reservoir for injected molecules which persistence is inversely proportional to the depth of the injection

            - the low density molecules diffuse by the capillary bed to the systemic circulation

            - the high density molecules diffuse by the lymphatic vessels

            - all those products are going up and are concentrated in their target organs and tissues according to their own affinity, shunting the hepatic first
passage.

 

            Let notice that the transdermic pathway to administer molecules is closed to the « patch » way, and to the ointments with systemic penetration. But, all these galenic forms can only introduce a restricted number of low density molecules, because of the difficulty to clear the epidermal barrier. This obstacle is also resolved by our technique.

  

V - PROCEDURE :


            During his duty, the mésotherapeute physician stays in an universal and hospitable logic that his teachers learned him, but is also open-mind and interested to the others ways to treat patients.

            At a first time, he will establish a diagnosis as accurate as possible, practicing clinical and further examinations.

            That is only when he did the diagnosis that he will decide the best treatment for the patient, privileging Mesotherapy for its low iatrogenicity and its effectiveness in some diseased states.

            In the same way, anamnesis, medicinal contra-indications, allergies are taking account for the patient safety.

            The equipment is simple : « hand, syringe, needle ». Electrical, mechanic, pneumatic or others apparatus could impress the public and will not add anything to a good training ; painless injections without any traumatism for the patient.

            The use of one-purpose materials, and a good asepsis of the integument are completely obvious.

 

            The injection depth (from 0.2 mm to a few mm), and the injection in such and such  points or areas are examined in accordance with the pathology and the actual Mesotherapy differents leanings. But this is not our purpose in this article.

 

            On the other hand, it seems an evidence  for every one that two factors occur during the Mesotherapy act ;

            - accumulation of some quantity of pharmacological active drugs up to superficial derma, particularly elaborate by Andre Dalloz-Bourguignon (the three units theory)

            - injection action, the punctum, concerning the nociceptive structures of the derma. The M.P.S., or Systematize Punctual Mesotherapy, privileges this approach. (Didier Mrejen)

 

VI - CHEMICALS :

            The drugs use in France do not always find their correspondents in Israel. So, it was necessary to adjust available medications to the different treatments.

  Among the numerous therapeutic classification, we are going to use ;

- essentially allopathic drugs which pharmacology is codified

- mineral salts

- trace elements

- sometime, homeopathic injectables

 
Some conditions have to be fulfilled for use in intradermal or subcutaneous :

- aqueous and non oily solute

- pH 7, isotonic to the tissues, or lightly lower

- dilution, usually in 1/10th, of the active principles in a neutral excipient

-  use of small amount : 1 to 2 ml, rarely more

-  mixtures of very few and compatible active principles (works of the Belgian school)

Some example of drugs :

- local anesthetics

- non-steroidal anti-inflammatory agent

- beta-blockers

- vasodilatators

- calcitonine


- anti-free radicals

- mineral salts

- vaccines

never corticoids , inducing subcutaneous sclerosis with superficial injection

 

VII - CRITERION OF  THE  UTILISATION FOR THE MESOTHERAPY :

            We shall use preferably the Mesotherapy :

1°) when it is effective and less iatrogenic, for example : tendinitis

2°) when the mesotherapy is more effective, for example :

algoneurodystrophy or Regional Complex Syndrome.

3°) when any effective treatment is available, for example :

   La Peyronie disease (induration of the corpus cavernosum)

 

 

VIII – CONTRA-INDICATIONS :

injection phobia is the most important one

- allergia to one of the active principle

- psoriasis : possibility of reactivation at the injection points

- risk of cheloids for the African’s skin

- all the « non-indications » : example: severe gonarthrosis, consequently     only surgical.


 
IX -SIDE - EFFECTS :


Mild :

     - scratches

     - hematoma at the injection point

     - vagal malaise

 

Serious :
            Abscess with Mycobacterium

 

Rare, they side-effects are noted essentially :

1) Omission of precautions

              - deficiency in the asepsis

              - absence of anamnesis

              - lack of taking in account allergies or side-effects

  2) Technical fault

               - using injectors without any needles

                - non adequate materials

                 - bad depth of injection

                 - « wild » mesotherapy with a non professional mesotherapeutist

 
Any anaphylactic shock was found in the writing
 

X - INDICATIONS :

Two notes :

- Mesotherapy was rapidly used by the Aesthetic Medicine, especially in the course of treatment for cellulitis. That is why during a long time, public and number of practitioners thought it was the only indication.

- Veterinarian also used this mode of treatment, making out of date any psychological or placebo imputation

 

- osteoarthropathy :

   - arthrosis and arthrosical pains

   - non chirurgical articular disorders

   - lumbago and sciatica

   - osteoporosis

   - Carpal Tunnel Syndrome

 

sporting pathologies :

   - sprain

   - tendonitis

   - tenosynovitis, as Trigger Finger

   - sequels of sprain , fracture, orthopedic or surgery endoscopic

  
- muscular contracture

   
painful and neurology pathologies:

   - cephalea and migraine

   - Regional Complex Syndrome

   - nevralgia

   - stress and anxiety

 

prophylaxis of chronic infections :

   - repeating ORL infections

   - repeating bronchial infections

   - some repeating urinary infections

 

- allergy and immunity :

   - respiratory allergies

   - non organic asthenia and psychoasthenia

   - immunity fall (AISD is a non-indication
)

 

aesthetic medecine :

   - local adiposis or hydrolipodystriphy : cellulilitis

   - skin aging

   - hair loss (for women)


- stomatology

   - gingivitis and parodontitis

 

            The indications for which the drugs cannot be found in Israel are not quoted.

  

- XI - AVANTAGES OF THE MESOTHERAPY :

  The preferential, but not exclusive, use of this technology give some advantages :

- use of conventional drugs with well known pharmacology

- small  amounts

- local injections

        = very low iatrogenicity (shunting the hepatic first passage)

- active drugs a long time in situ

-  reduction of the course of treatment frequency
 

            = economical advantage

- any oral dose 

           = certainty of observance

- possibility to treat fragile patients

     - digestive pathology (colitis-ulcer)

     - expectant mothers

     - old people with polymedicaments

 


CONCLUSION

            Medicine is now at the time where the patient does not admit sickness and pain, and on the other hand rises up against all the side-effects of these more and more strong drugs. This explain why all the alternative medicines are so successful.

            Between the conventional, and complementary, medicine, we find the Mesotherapy : « the softest of the hard medicines, and the hardest of the soft medicines » (Pistor)

            Its apprenticeship is not opposed to every hospitalo-universitary teaching of the classical medicine.

            A such medicine is worth of the therapeutic arsenal for every general practitioner and for some specialists too.

 

Andre KAPLAN M.D.

     Former physician attached at Saint-Antoine Hospital (Paris-France)

     Former training course teacher of the French Society of Mesotherapy

     Doctor at Hadassah Hospital  Jerusalem-Israel



Israel Society of Mesotherapy

      President Dr Kaplan  

      75 / 16 Dereh Hevron 93546 Jerusalem

      Tel-Fax 02-6711246   
mesotherapisrael@hotmail.com

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