肉毒毒素在胃肠道疾病中的临床应用

肉毒毒素(BTX)是肉毒梭菌产生的一种细菌外毒素，以细菌外毒素和血凝素的复合体存在，作用于周围运动神经末梢神经肌肉接点，抑制突触前膜乙酰胆碱的释放，引起肌肉松弛性麻痹。1978年Scott等在志愿者身上用BTX治疗斜视，注射进的毒素可使活动过强的肌肉得以缓解。1993年Pasricha等研究证明LES内注射BTX可降低食管下括约肌压力(LESP)。BTX在消化道疾病中的临床应用开始受到高度重视。     

超声在聚丙烯酰胺水凝胶注射隆乳取出术中的引导价值

目的:探讨超声引导下取出聚丙烯酰胺水凝胶注射物后,乳房形态重塑效果。方法:超声引导下能精确地定位,明确聚丙烯酰胺水凝胶注射物在乳房分布层次及范围,彻底的取出注射物,取出后继发乳房畸形行假体再造术。结果:本组患者均在超声实时引导下,术中彻底取出注射物,即时假体植入,伤口均I期愈合,无感染及残留物。术后随访6~12个月,所有患者无包块及不对称,无包膜挛缩,外形良好。结论:超声引导下行注射物取出,即时乳房形态重塑,既能彻底取出注射物,又能改善乳房形态,效果满意。     

超声引导下亚甲蓝定位切除乳腺微小病灶

目的探讨超声引导下亚甲蓝注射对不可扪及的乳腺微小病灶定位活检的应用价值。方法在高频超声引导下,对153例、203枚乳腺微小病灶进行病灶表面亚甲蓝注射定位后进行手术切除活检。结果203枚病灶均获得精确切除,活检准确性100%,其中恶性肿瘤13例,占8.5%;重度不典型增生3例,占1.96%。其余病例均为良性病变。结论超声引导下亚甲蓝定位,可以有效提高体表不能扪及的乳腺微小病灶活检准确性,具有较高的应用价值。     

超声引导下泡沫硬化剂治疗下肢表浅静脉畸形25例疗效观察

目的 探讨超声引导下泡沫硬化剂对下肢表浅静脉畸形的治疗作用。方法 2009-2011年福建医科大学附属第一医院对25例下肢表浅静脉表浅畸形病人在超声引导下注射聚桂醇,观察注射后局部病灶内声像变化并随访观效。结果 25例病人中22例一次性硬化成功,未出现复发,3例病灶较大者经多次聚桂醇注射治疗后未出现再发。结论 泡沫硬化剂注射治疗下肢表浅静脉畸形效果满意,而超声能更精确地引导手术的进行。     

椎旁肌力量失衡与双足鼠脊柱侧凸模型的建立

目的使用A型肉毒毒素（botulinumtoxinA,BTX—A）注射造成双足鼠椎旁肌力量失衡,观察双足鼠出现脊柱侧凸的规律及追加注射BTX．A双足鼠侧凸的变化情况。方法将30只4周龄雌性SD大鼠随机分3组,每组10只。首先,所有大鼠截除双上肢建立双足鼠模型,术后即刻予高笼喂养。1周后,A组、B组大鼠椎旁肌右侧区域注射6．25U／100g剂量的BTX—A,C组为对照组,注射等量生理盐水。B组大鼠于首次注射6周后追加注射6．25U／100gBTX．A1次,A组、C组追加注射等量生理盐水1次。各组大鼠于首次注射后2周、4周、6周、8周、12周分别行X线检查。结果双足鼠模型全部建立成功．X线提示A、B组大鼠出现脊柱侧凸,且注射侧为凸侧。方差分析提示,BTX—A注射后2周侧凸角度最大,之后逐渐减小;追加注射BTX—A后,侧凸角度加大。结论双足鼠椎旁肌力量失衡可导致脊柱侧凸的发生,追加注射BTX—A可维持侧凸状态。     

肉毒素A在良性前列腺增生疾病中的应用与发展

肉毒素A（Botulinum Neurotoxin Type A;BTX—A）目前已广泛的应用于临床,它在神经源性逼尿肌过度活动、感觉性膀胱活动过度症等膀胱疾病方面的疗效得到共识。然而,少有BTX—A在治疗前列腺疾病方面的研究报道。本文探讨肉毒素A（BTX—A）在继发于良性前列腺增生的下尿路症状疾病中的应用及其进展。     

肉毒素 A 在良性前列腺增生疾病中的应用与发展

肉毒素A(Botulinum Neurotoxin Type A;BTX - A)目前已广泛的应用于临床,它在神经源性逼尿肌过度活动、感觉性膀胱活动过度症等膀胱疾病方面的疗效得到共识.然而,少有BTX - A在治疗前列腺疾病方面的研究报道.本文探讨肉毒素A(BTX - A)在继发于良性前列腺增生的下尿路症状疾病中的应用及其进展.     

肉毒素 A 在良性前列腺增生疾病中的应用与发展

肉毒素A(Botulinum Neurotoxin Type A;BTX - A)目前已广泛的应用于临床,它在神经源性逼尿肌过度活动、感觉性膀胱活动过度症等膀胱疾病方面的疗效得到共识.然而,少有BTX - A在治疗前列腺疾病方面的研究报道.本文探讨肉毒素A(BTX - A)在继发于良性前列腺增生的下尿路症状疾病中的应用及其进展.     

肉毒素 A 在良性前列腺增生疾病中的应用与发展

肉毒素A(Botulinum Neurotoxin Type A;BTX - A)目前已广泛的应用于临床,它在神经源性逼尿肌过度活动、感觉性膀胱活动过度症等膀胱疾病方面的疗效得到共识.然而,少有BTX - A在治疗前列腺疾病方面的研究报道.本文探讨肉毒素A(BTX - A)在继发于良性前列腺增生的下尿路症状疾病中的应用及其进展.     

肉毒素 A 在良性前列腺增生疾病中的应用与发展

肉毒素A(Botulinum Neurotoxin Type A;BTX - A)目前已广泛的应用于临床,它在神经源性逼尿肌过度活动、感觉性膀胱活动过度症等膀胱疾病方面的疗效得到共识.然而,少有BTX - A在治疗前列腺疾病方面的研究报道.本文探讨肉毒素A(BTX - A)在继发于良性前列腺增生的下尿路症状疾病中的应用及其进展.     

Botulinum toxin therapy for neurogenic detrusor overactivity

Detrusor injection of botulinum toxin (BTX) has shown great promise in the treatment of neurogenic detrusor overactivity (NDO) refractory to conservative therapy. Despite a paucity of prospective evidence, there exists a growing consensus that BTX injection therapy is a well-tolerated, low-risk therapy. Injections result in substantial subjective improvement in continence and quality of life. Moreover, assessment of urodynamic parameters demonstrates objective changes: (1) an increase in maximum cystometric capacity; (2) when applicable, a reduction in maximal detrusor voiding pressures; and (3) an increase in bladder compliance in cases where baseline bladder compliance measures were abnormal. While BTX bladder injection offers both objective and subjective measures of incontinence control, treatment duration is limited by the gradual reinnervation of injected tissue over an approximately 6- to 9-month interval. However, repeat injection cycles do appear to achieve similar levels of efficacy. The objective of this review is to provide a focused summary of the current body of literature, investigating the safety and efficacy of bladder BTX injection in patients with NDO.     

Botulinum toxin injection: a review of injection principles and protocols

Despite the favorable outcomes seen using botulinum toxin (BTX) for voiding dysfunction using BTX, a standardized technique and protocol for toxin injection is not defined. We reviewed the current literature on intravesical BTX injection for DO (detrusor overactivity). Specific attention was placed on defining optimal injection protocol, including dose, volume, and injection sites. In addition, we sought to describe a standard technique to BTX injection.     

Longitudinal examination of health outcomes associated with botulinum toxin use in children with cerebral palsy

A prospective cohort study with annual follow-up was conducted on 172 children with spastic type cerebral palsy receiving botulinum toxin type A (BTX) injections for spasticity management. A mixed modeling procedure was used to identify changes in both physical functioning outcomes for the child (using the WeeFIM measure) as well as quality of life of the parent caregiver (using the Stein and Reissman Impact on the Family Scale) with increasing utilization of BTX injections. The study found that each additional BTX injection administration was associated with a 2.3% improvement in the WeeFIM compared to the average baseline score (p < .01). Similarly, the study found an improvement of 2.5% compared to baseline in the parent's overall perception of the severity of the child's condition with each additional BTX injection administration (p < .001). These findings suggest that BTX injections may be associated with beneficial outcomes in childhood spasticity.     

Repeated botulinum-A toxin injections in the treatment of myelodysplastic children and patients with spinal cord injuries with neurogenic bladder dysfunction

OBJECTIVES: To examine the effects of repeated detrusor injections of botulinum-A toxin (BTX) for possible changes in bladder function, muscular structure of the detrusor, increase in BTX tolerance (tachyphylaxis) and side-effects, as BTX is a new treatment alternative for patients with a neurogenic bladder condition that is difficult to treat and refractory to anticholinergic medication. PATIENTS AND METHODS: Between 2000 and 2005, 19 patients with myelodysplasia (MDP) and 25 spinal cord-injured (SCI) patients were treated with repeated suburothelial BTX injections (Dysport, Ipsen-Pharma, Ettlingen, Germany) or injections into the intramural detrusor. The follow-up was > or = 3 years (range 3-5, median 4.5). RESULTS: Detrusor compliance, bladder capacity, and detrusor pressure at maximum filling improved significantly (P < 0.001) compared to baseline after each BTX injection. There was prolonged efficacy of each BTX administration and all repeated injections in the paediatric and adult patients with neurogenic bladder dysfunction over a median follow-up of 4.5 years. There was no evidence for drug tolerance or changes in the morphological appearance of the bladder. Safety was good: no complications were associated with the injection procedure itself. Early in the treatment programme, three patients who received a dose of 1000 units Dysport showed systemic side-effects and generalized muscle weakness. These resolved without intervention and did not recur after reducing the adult dose to 750 units (paediatric dose 20 units/kg, not >400 units), which seems to be the optimum for good efficacy with an adequate safety margin. CONCLUSION: BTX injection is a safe and effective treatment for neurogenic detrusor hyperreflexia. Repeat treatments are as effective as the first: there was no indication of a lack of efficacy due to tachyphylaxis, antibody formation, or fibrosis of the detrusor muscle in this sample.     

Patients’ perspective of botulinum toxin‐A as a long‐term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury

OBJECTIVE

To evaluate patients’ perspective on whether they would consider botulinum toxin‐A (BTX‐A) injections as a long‐term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI).

PATIENTS AND METHODS

In all, 72 patients with SCI and urodynamically confirmed NDO refractory to anticholinergics, who have had at least one or more injections with BTX‐A were invited to participate in a 5‐min telephone questionnaire covering various aspects of their treatment. Questions about patient satisfaction were rated on a scale from 1 to 10 (1, not satisfied; to 10, very satisfied).

RESULTS

Of the 72 patients surveyed, 48 (67%) were still actively undergoing repeat BTX‐A injections. The mean patient satisfaction score was 6.2. Of the 48 patients, 43 (90%) replied that they would consider continuing with BTX‐A injections as a long‐term treatment option. Only seven (15%) of patients still having BTX‐A injections would consider an alternative permanent surgical option in the next 5 years. Of those patients considering a one‐off permanent surgical solution, younger patients were likely to consider this at a later interval than those in an older group (Spearman’s correlation coefficient, ?0.52, 95% confidence interval ?0.78 to ?0.10, P = 0.02). The annual new patient recruitment rate was high (mean 14.4) and the annual withdrawal rate was low (mean 4.8).

CONCLUSION

With high satisfaction and low annual withdrawal rates, there are increasingly many patients on BTX‐A. Most consider continuing BTX‐A injections in the long term, increasing the future demand for this service. There is an urgent need for further research into optimizing the current delivery of an intradetrusor BTX‐A injection service for patients with NDO.     

A Review of Botulinum Toxcin Use for Chronic Pelvic Pain Syndrome

The inability of urologists to consistently and effectively treat men with chronic pelvic pain syndrome (CPPS), also known as chronic abacterial prostatitis, is a source of great frustration. Botulinum toxin (BTX), a potent neurotoxin, can act on most of the peripheral nerves of the pelvis through a variety of mechanisms. BTX injection therapy for CPPS treatment has shown modest improvements. BTX is ideal for integration into a multimodal treatment plan, which may help achieve pain relief in men with chronic pelvic pain.     

Concomitant repeated intravesical injections of botulinum toxin‐type A and laparoscopic antegrade continence enema; a new solution for an old problem

OBJECTIVE

To report our experience of treating bladder and bowel dysfunction in children with myelomeningocele, with simultaneous laparoscopic antegrade continence enema (LACE) and repeated intravesical injection of botulinum toxin‐type A (BTX‐A).

PATIENTS AND METHODS

Six girls and 14 boys (mean age, 8.7 years) with myelomeningocele were included in this study. All patients had received one or two intravesical injection(s) of BTX‐A, but had persistent fecal incontinence or constipation despite improved urinary symptoms. We performed a two‐port laparoscopic appendicostomy, immediately after repeated intravesical injection of BTX‐A, through a V‐shaped skin flap at McBurney’s point. The stoma was finally covered by a quadrilateral skin flap, using the ‘VQ’ technique. The degree of urinary incontinence and bowel dysfunction were determined in each patient, and conventional urodynamic studies were performed 4 months after each injection.

RESULTS

All patients were followed‐up for a mean (range) of 19.1 (14–33) months. Urinary continence improved significantly after the first injection, and remained constant after repeat injections. The maximum detrusor pressure, bladder compliance and capacity improved significantly (P < 0.001) compared with baseline. Interestingly, the simultaneous intravesical BTX‐A injection/LACE procedure significantly improved all urodynamic variables compared with the values obtained after the last BTX‐A injection alone. The laparoscopic procedure was well tolerated, and 19 (95%) children were nappy‐free at the final follow‐up. Only two patients had stoma stenosis, and one patient had minor stoma leakage.

CONCLUSION

Concomitant repeat intravesical injection of BTX‐A and LACE can effectively manage bladder and bowel dysfunction in children with myelomeningocele. The procedure may further contribute to improve bladder urodynamic function, as effective evacuation of the bowel provides more room for bladder distension.     

Management of Frey's syndrome and hypersialorrhea with botulinum toxin

Botulinum toxin (BTX) is a safe and reliable drug for the treatment of Frey's syndrome and hypersialorrhea. Currently, the intradermal injection of BTX is the standard treatment of Frey's syndrome. A disappearance of Frey's syndrome for 1 to 1.5 year could almost be promised. Recently, BTX was introduced for the treatment of hypersialorrhea. Although some questions exist about the optimal dosage and the type of major salivary glands that should be treated, hypersialorrhea was reduced in almost all affected children and adults for up to 6 months by using ultrasound-guided intraglandular BTX injections.     

A Randomized, Evaluator-Blinded, Two-Center Study of the Safety and Effect of Volume on the Diffusion and Efficacy of Botulinum Toxin Type A in the Treatment of Lateral Orbital Rhytides

BACKGROUND: There has been considerable discussion about the effect of the degree of dilution of botulinum toxin (BTX) but very few scientific studies. OBJECTIVE: The objective was to observe as to whether a fivefold difference in concentration of BTX solution would produce a difference in clinical effect or duration of effect. METHODS AND MATERIALS: Twenty individuals were enrolled at two sites and a within-subject paired-comparison study was performed on the lateral orbital area with a single injection of 5 U of BTX (BOTOX Cosmetic, Allergan Inc., Irvine, CA). The results were assessed both clinically and using a computer-assisted estimation of the degree of wrinkling. RESULTS: No statistically significant differences were observed between the two sides. CONCLUSIONS: This is a small study and it may be that dilution does affect BTX result. We were, however, unable to detect any difference in this study, which suggests that the degree of dilution, at least within a fivefold margin, has only a small effect on the results of BTX injection in the lateral orbital area.     

Muscle Changes Can Account for Bone Loss After Botulinum Toxin Injection

Studies to date have assumed that botulinum toxin type A (BTX) affects bone indirectly, through its action on muscle. We hypothesized that BTX has no discernable effect on bone morphometry, independent of its effect on muscle. Therefore, we investigated whether BTX had an additional effect on bone when combined with tenotomy compared to tenotomy in isolation. Female BALB/c mice (n = 73) underwent one of the following procedures in the left leg: BTX injection and Achilles tenotomy (BTX-TEN), BTX injection and sham surgery (BTX-sham), Achilles tenotomy (TEN), or sham surgery (sham). BTX groups were injected with 20 μL of BTX (1 U/100 g) in the posterior lower hindlimb. At 4 weeks, muscle cross-sectional area (MCSA) and tibial bone morphometry were assessed using micro-CT. Each treatment, other than sham, resulted in significant muscle and bone loss (P < 0.05). BTX-TEN experienced the greatest muscle loss (23–45% lower than other groups) and bone loss (20–30% lower bone volume fraction than other groups). BTX-sham had significantly lower MCSA and bone volume fraction than TEN and sham. After adjusting for differences in MCSA, there were no significant between-group differences in bone properties. We found that BTX injection resulted in more adverse muscle and bone effects than tenotomy and that effects were amplified when the procedures were combined. However, between-group differences in bone could be accounted for by MCSA. We conclude that any independent effect of BTX on bone morphometry is likely small or negligible compared with the effect on muscle.