Combination therapy for onychomycosis using a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer

Onychomycosis remains difficult to cure by traditional methods. The aim of this study was to evaluate the efficacy of combination therapy with a fractional erbium yttrium aluminum garnet (Er:YAG) laser and 5 % amorolfine lacquer on onychomycosis. Nine patients with bilateral nails affected by distal and lateral subungual onychomycosis were included. The bilateral nails of each patient were divided into two groups. The 20 affected nails on one side of each patient as group 1 were treated with a fractional Er:YAG laser once a week and 5 % amorolfine lacquer twice weekly, while the 20 nails on the symmetrical side of each patient as group 2 were treated with amorolfine lacquer only. The laser treatment was conducted at weeks 1, 2, 3, 4, 8, and 12 in group 1. The clinical improvement, onychomycosis severity index (OSI), maximum linear clear nail growth (MLCNG), and mycological cure rate were evaluated. At week 24, 18 of 20 (90 %) nails in group 1 had achieved obvious clinical responses. The mean OSI score showed a significant decrease (5.24) and the average MLCNG was 3.1 mm in group 1. At week 24, 15 of 20 (75 %) nails achieved a negative mycological examination in group 1, compared with four of 20 (20 %) nails in group 2. The treatments were well-tolerated by most patients. This clinical study suggests that combination therapy of a fractional 2940-nm Er:YAG laser and 5 % amorolfine lacquer is an effective, safe, and convenient treatment method for onychomycosis.     

Pharmacokinetics of a Lidocaine Patch 5% in Dogs

Lidocaine is increasingly used in transdermal drug delivery systems for different pain conditions in human medicine whereby several pharmacokinetic studies have demonstrated minimal systemic absorption in men. In the present study, the pharmacokinetics of a lidocaine patch 5% was studied in six dogs. In the first experiment, one single lidocaine patch was applied for 12 h to the lateral side of the thorax after removing the hair either by clipping or by the application of a depilatory agent, according to a two‐way crossover design. No potential adverse effects induced by the patches were observed in either group. In dogs with clipped hair, a mean peak plasma lidocaine concentration of 62.94 ng/ml was obtained after 10.67 h. In the depilatory group, a mean peak plasma concentration of 103.55 ng/ml was reached after 9.27 h. Significant differences in the AUC_{0 → ∞}, C_max, k_a and T_1/2a were noticed between the two groups. No significant differences were found for the elimination parameters and for T_max. In the second experiment, the patches were applied for 60 h to the clipped skin in order to study the absorption kinetics after a prolonged application period. There, the mean peak lidocaine plasma concentration was 45.18 ng/ml achieved after 24 h and a final concentration of 29.37 ng/ml was obtained at 60 h. In conclusion, all dogs tolerated the transdermal lidocaine patch well. The results of this study suggest that there is an overall minimal absorption from the lidocaine patch. However, the application of a depilatory agent leads to a more rapid and increased absorption of lidocaine.     

Rapid inhalation induction in children: 8% sevoflurane compared with 5% halothane

Sevoflurane has a lower blood-gas solubility and a less pungent odour than halothane; this may allow more rapid induction of anaesthesia. In a randomized, blinded study, we compared the induction characteristics of maximum initial inspired concentration of 8% sevoflurane and 5% halothane using conventional vaporizers in children aged 3 months to 3 years. There was no statistically significant difference in induction times between the two groups: mean times to loss of consciousness were 1 min 12 s (SD 18 s, range 40 s-1 min 44 s) for sevoflurane and 1 min 16 s (SD 17 s, range 50 s-1 min 52 s) for halothane, although these times were shorter than in previous studies using a gradual increase in vapour concentration. A small number of complications were noted in both groups, although none interfered with induction of anaesthesia. Struggling scores were lower in the sevoflurane group than in the halothane group (chi-square for trends = 6.34, P < 0.02). A significant number (11 of 15) of parents of children in the sevoflurane group who had previous experience of halothane induction preferred sevoflurane (chi-square for trends = 4.03, P < 0.05). We conclude that with this technique, induction was rapid with both sevoflurane and halothane. Our assessment of patient struggling and parents' perceptions suggests that induction with sevoflurane was more pleasant than with halothane.      

Podiatry care and amorolfine: An effective treatment of foot distal onychomycosis

BackgroundOnychomycosis constitute more than 40% of onychopathies in humans. Several suggestions have been published to standardize the treatment protocols.ObjectivesThe aim of this study was to evaluate the risk factors for onychomycosis as well as to compare laboratory and clinical data and to determine the effectiveness of amorolfine in the treatment.MethodSamples were obtained from 360 patients and processed in the laboratory. Treatment and improvement of lesions were followed up for 6 and 9 months in all cases.ResultsT. mentagrophytes and T. rubrum the most common dermatophytes whereas among non-dermatophytes the order of incidence was Scopularopsis brevicaulis, Acremonium roseum, Aspergillus spp., and Fusarium sp. Onychomycosis was successfully treated by amorolfine in 75.3% of cases.     

SPINAL ANAESTHESIA WITH 0.75% BUPIVACAINE AND 0.5% AMETHOCAINE IN 5% GLUCOSE

Three millititre of 0.75% plain bupivacaine and 0.5% amethocaine3 ml in 5% glucose were used for spinal anaesthesia and comparedin a double-blind study of 20 patients undergoing urologicalsurgery. The onset time to maximum cephalad spread of sensoryanalgesia was approximately 45 min for bupivacaine and approximately30 min in the amethocaine group (ns). The mean maximum spreadof sensory analgesia was similar for both agents: T6-7 180 minafter injection, although the cephalad spread of sensory analgesiawith bupivacaine persisted for longer at a significantly higherlevel than that of amethocaine. Duration of sensory analgesiawas significantly longer in the bupivacaine group from S3 toS5 and from T12 to L2 levels. Onset time to complete motor blockadeof the lower limbs was similar for both agents. Nine of 10 bupivacainepatients and seven of the 10 patients receiving amethocainehad complete motor blockade of the lower limbs. Duration ofmotor blockade was significantly longer for all degrees in thebupivacaine group.     

Spinal anaesthesia with articaine 5% vs bupivacaine 0.5% for day-case lower limb surgery: a double-blind randomized clinical trial

BACKGROUND: A local anaesthetic with fast onset and short reliable duration of anaesthesia may be preferable for out-patient lower limb surgery. Articaine is believed to act faster and to have a shorter duration of action than bupivacaine, but there are no conclusive data available. The purpose of this study was to compare articaine and bupivacaine for day-case lower limb surgery. METHODS: Eighty patients planned for day-case lower limb surgery enrolled in this study. Patients were randomized to receive hyperbaric articaine 80 mg or plain bupivacaine 15 mg intrathecally. Primary outcome variable was recovery time from motor block. Secondary outcomes were: onset of sensory and motor block, maximum spread of sensory block, time to micturition, discharge from the hospital, and complications. RESULTS: The groups were comparable for the medians and the range of the maximum blocks after 30 min. Median time to complete regression of motor block was 101 min (range 80-129) for articaine compared with 307 min (range 225-350) for bupivacaine (P<0.0005). First spontaneous micturition occurred after 257 min (210-293) in the articaine group and after 350 min (304-370) in the bupivacaine group (P<0.0005). In the articaine and bupivacaine groups, patients were discharged after 300 min (273-347) and 380 min (332-431), respectively (P<0.0005). There was no significant difference in the occurrence of complications between the groups. CONCLUSIONS: Spinal anaesthesia with 80 mg of hyperbaric articaine has a shorter duration than a spinal anaesthesia with 15 mg of plain bupivacaine in lower limb surgery of approximately 1 h duration.     

Incidence of Transient Neurologic Symptoms after Hyperbaric Subarachnoid Anesthesia with 5% Lidocaine and 5% Prilocaine

Background: Hyperbaric 5% lidocaine has been associated with transient neurologic symptoms (TNSs) after spinal anesthesia. A prospective, masked, randomized study was conducted to compare the incidence of TNSs after spinal anesthesia with hyperbaric 5% lidocaine or 5% prilocaine to assess the utility of prilocaine as an alternative to lidocaine in patients having short surgical procedures.

Methods: The number of patients to be enrolled (100 per group) was determined by power analysis (80%, P = 0.05) considering an incidence of TNSs after spinal anesthesia with lidocaine of at least 11% according to data reported in other studies. Two hundred patients scheduled for elective surgery expected to last < 60 min were allocated at random to receive spinal anesthesia with hyperbaric 5% lidocaine or hyperbaric 5% prilocaine. Three to 5 days after spinal anesthesia, all patients were interviewed by an anesthesiologist who was blinded to the group assignment and details of the anesthetic and surgical technique using a standardized symptom checklist. Patients with symptoms underwent neurologic examination.

Results: Both groups were comparable with regard to demographic data and details of the surgical and anesthetic procedures. The incidence of TNSs in both groups was low and differences were not found (4% in the lidocaine group and 1% in the prilocaine group). The mean age of patients with TNSs (58 yr) was higher than that of patients without TNSs (48 yr; P < 0.05). No relation with any of the other variables was found.     

Single-breath Vital Capacity Rapid Inhalation Induction in Children: 8% Sevoflurane versus 5% Halothane

Background: The authors compared the speed of induction of anesthesia with sevoflurane with and without nitrous oxide with the speed of halothane and nitrous oxide using a single-breath vital capacity induction.

Methods: With informed parental consent, 51 healthy unpremedicated children aged 5-12 yr were randomized to inhale a single breath of one of three gas mixtures: 8% sevoflurane in 66% nitrous oxide, 8% sevoflurane in oxygen, or 5% halothane in 66% nitrous oxide. A blinded observer recorded the times to loss of the eyelash reflex, return of conjugate gaze, the presence of airway reflex responses, involuntary movement, and hemodynamic responses.

Results: Forty-two children completed the study. The times (mean +/- SD) to loss of the eyelash reflex with sevoflurane/nitrous oxide, 38 +/- 8 s, and for sevoflurane-oxygen, 34 +/- 12 s, were less than that with halothane-nitrous oxide, 58 +/- 17 s (P < 0.01). Movement occurred less frequently during sevoflurane than during halothane anesthesia (P < 0.05). The times to return of conjugate gaze and the incidence of airway reflex responses were similar among the groups. The incidence of dysrhythmias in the sevoflurane groups was less than that in the halothane group (P < 0.01).     

Pharmacodynamics of subarachnoid hyperbaric 5% lignocaine

Twenty male patients (55 to 85 yr) undergoing cystoscopy received spinal anaesthesia with either 75 mg (n = 10) or 100 mg of hyperbaric lignocaine 5% under standardised conditions. Plantar flexion muscle power was recorded during onset and offset of anaesthesia using a load cell interfaced with a computer (PFPD) and these data were compared with intermittent clinical assessments of spinal anaesthesia. Onset of paralysis was rapid and complete with motor power declining exponentially to 5% of preoperative values by 5 minutes in all patients. Extent of block to cold and pinprick was similar in both dosage groups (median T₄), as was the rate of block onset. Block regression was complete by three hours in all patients and restitution of plantar flexion motor power was associated with normal thermosens-ibility at L₁ and recovery of the patient's ability to walk and micturate. Recovery of plantar flexion motor power occurred at 95.5±7.38 min in patients given 75 mg compared with 129±9.5 min in those given 100 mg lignocaine ( P <0.05). The time between onset and full motor recovery in the 75 mg group (7.2±1.2 min) was less than the 100 mg lignocaine group (29±5.1 min) ( P <0.001). The larger dose of lignocaine did not confer any clinical advantage in block onset or intensity and made the onset of recovery less predictable. The Bromage grading, while clinically appropriate during anaesthesia onset, does not provide data relating to the density of block and the PFPD was therefore useful for describing the anaesthesia recovery phase.     

Imiquimod 5% Cream for Keloid Management

BACKGROUND: Keloid treatment represents a therapeutic challenge. New adjuvant therapy is needed to reduce the high recurrence rate (50%) of excised keloids. OBJECTIVE: To describe the method for using imiquimod 5% cream in the prevention of keloid recurrence after surgery. METHODS: This is a review of the scientific rationale and clinical experience of using imiquimod 5% cream for keloid management. CONCLUSION: Topical application of imiquimod 5% cream after surgery reduces keloid recurrences.     

Multiple-deep-breath inhalation induction with 5% sevoflurane and 67% nitrous oxide: comparison with intravenous injection of propofol

Purpose. To evaluate the clinical characteristics of multiple-deep-breath inhalation induction with sevoflurane and nitrous oxide followed by the same inhalational anesthetics for maintenance, we compared the technique with intravenous propofol anesthesia. Methods. Forty patients scheduled for ophthalmic surgery under general anesthesia with a laryngeal mask airway (LMA) were assigned to two groups. Anesthesia was induced with multiple-deep-breath inhalation of 5% sevoflurane and 67% nitrous oxide in oxygen (group S: n = 20) or intravenous injection of 1% propofol at the rate of 1200 ml·h⁻¹ with spontaneous inhalation of 67% nitrous oxide in oxygen until the patient lost consciousness or received propofol up to 2 mg·kg⁻¹ (group P: n = 20). We attempted to insert an LMA when the patient's jaw relaxation was adequate. We compared induction times, recovery times, occurrence of adverse events, and patient satisfaction between the two groups. Results. The mean time to insertion of the LMA was significantly shorter in group P (209 ± 118 s) than in group S (302 ± 102 s; P < 0.05). The recovery times did not differ significantly between the groups. There were no serious side effects during the induction and recovery period in either group. Significantly more patients in group P than in group S wanted to have the same anesthetic method (90% vs 50%; P < 0.05). Conclusion. Multiple-deep-breath inhalation induction with 5% sevoflurane and 67% nitrous oxide followed by the same inhalational anesthetics for maintenance was safely performed without serious adverse events. However, the induction time was shorter and patient satisfaction was higher in propofol group than in the inhalational group. Received: April 11, 2001 / Accepted: November 6, 2001     

Acid-base changes caused by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution: a randomized prospective study

BACKGROUND: Preoperative acute normovolemic hemodilution (ANH) is an excellent model for evaluating the effects of different colloid solutions that are free of bicarbonate but have large chloride concentrations on acid-base equilibrium. METHODS: In 20 patients undergoing gynecologic surgery, ANH to a hematocrit of 22% was performed. Two groups of 10 patients each were randomly assigned to receive either 5% albumin or 6% hydroxyethyl starch solutions containing chloride concentrations of 150 and 154 mm, respectively, during ANH. Blood volume (double label measurement of plasma and red cell volumes), pH, Paco2, and serum concentrations of sodium, potassium, chloride, lactate, ionized calcium, phosphate, albumin, and total protein were measured before and 20 min after completion of ANH. Strong ion difference was calculated as serum sodium plus serum potassium minus serum chloride minus serum lactate. The amount of weak plasma acid was calculated using a computer program. RESULTS: After ANH, blood volume was well maintained in both groups. ANH caused slight metabolic acidosis with hyperchloremia and a concomitant decrease in strong ion difference. Plasma albumin concentration decreased after hemodilution with 6% hydroxyethyl starch solution and increased after hemodilution with 5% albumin solution. Despite a three-times larger decrease in strong ion difference after ANH with 6% hydroxyethyl starch solution, the decrease in pH was nearly the same in both groups. CONCLUSIONS: ANH with 5% albumin or 6% hydroxyethyl starch solutions led to metabolic acidosis. A dilution of extracellular bicarbonate or changes in strong ion difference and albumin concentration offer explanations for this type of acidosis.     

空气和高氧培养对大鼠甲状旁腺移植物存活期的影响及比较

以成年纯系雌性Ｗｉｓｔａｒ大鼠作供体，成年纯系雌性ＳＤ大鼠作受体，以子宫内膜下受区，在完全同等的实验条件下，将甲状旁腺分别在空气和高氧两种环境下进行培养，以观察不同培养条件对ＰＴＧ移植物存活期的影响，并就这两种培养效果及优缺点进行比较。     

Analgesic effects of a 5% lidocaine patch after cesarean section: A randomized placebo-controlled double-blind clinical trial

Study objectiveThis study aimed to evaluate the analgesic effects of a 5% lidocaine patch in acute postoperative pain after cesarean section.DesignThis is a prospective, randomized, double-blind study.SettingAfter surgery, active and placebo patches were applied in the operating room, and patients were evaluated during their stay at the postoperative recovery room and at the hospital ward.PatientsSeventy-two women (18 years of age or older and American Society of Anesthesiologists status II) scheduled for cesarean section under spinal anesthesia were enrolled in the study.InterventionsPatients were randomly assigned to an intervention or placebo group. According to the assigned group, a 5% lidocaine patch or a placebo patch was applied 1 cm above and below the Pfannenstiel incision after the surgery.MeasurementsThe primary outcome was the pain score, evaluated using an 11-point numerical verbal scale in the first 36 h postoperatively. Secondary outcomes were the quality of recovery 24 h after surgery, consumption of rescue opioids, and the presence of adverse effects.Main resultsSixty-five women completed the study. The pain score was lower in the lidocaine group at 6 h (lidocaine group: 2.16 ± 1.71, placebo group: 3.21 ± 2.25; p = 0.031), 12 h (lidocaine: 1.58 ± 0.81, placebo: 2.24 ± 0.74; p = 0.001), 24 h (lidocaine: 0.74 ± 0.89, placebo: 1.94 ± 1.39; p < 0.0001), and 36 h (lidocaine: 0.48 ± 1.03, placebo: 1.68 ± 0.94; p = 0.001) after surgery. There were no differences in secondary outcomes during the follow-up period.ConclusionThe lidocaine patch reduced pain scores compared to placebo in the first 36 h after the surgery, despite no influence over opioid consumption, quality of recovery, or incidence of side effects.     

Treatment of Bowen''s Disease with Topical 5% Imiquimod Cream: Retrospective Study

BACKGROUND: Topical 5% imiquimod cream is an FDA-approved treatment for superficial basal cell carcinomas. It has also been utilized in the treatment of Bowen's disease (squamous cell in situ). The current literature on this subject, however, is scant, and this treatment is only validated by case reports and two small open label studies. OBJECTIVE: The objective was to assess the efficacy of topical 5% imiquimod cream in the treatment of squamous cell in situ in a larger open-label case series. METHODS A retrospective study of 49 patients was performed. RESULTS: Forty-two of the 49 (86%) patients in the study had a complete response with topical imiquimod. The remaining 7 (14%) failed therapy and required additional treatments. The mean follow-up duration was 19 months, with a range of 1 to 44 months. CONCLUSION: Topical 5% imiquimod cream appears to be clinically beneficial in the treatment of Bowen's disease and should be considered as a treatment option.     

A comparison of glucose-free 2% lidocaine and hyperbaric 5% lidocaine for spinal anaesthesia

Fifty patients scheduled to undergo transurethral surgery of the bladder were allocated to receive spinal anaesthesia with either glucose-free 2% lidocaine (80 mg) or hyperbaric 5% lidocaine (80 mg). Onset time, cephalad spread of analgesia, duration of analgesia, duration and intensity of motor block, quality of analgesia, and the patients' ability to walk 5 m and to micturate postoperatively were assessed. Onset and spread of analgesia were fast and comparable in the two groups. At 60 min, the median segmental level of analgesia was T9 and T10 for the 2% and the 5% group, respectively, allowing transurethral surgery to be performed for at least 1 h. In the 2% group the motor block was more pronounced and longer lasting than in the 5% group. Two patients in the 5% group needed general anaesthesia because of pain. The time from injection of the spinal anaesthetic until the patients were able to walk 5 m and to micturate was equal in the two groups, and 89% of all the patients were able to walk and micturate within 4 h. It is concluded that spinal anaesthesia with 80 mg and 2% or 5% lidocaine provides analgesia for transurethral surgery and is characterized by fast recovery of motor and detrusor function.     

The effect of acetate Ringer dextrose (5%) and lactate Ringer dextrose (5%) in surgical patients

The clinical evaluation of acetate ringer dextrose (AR-D) for hemodynamic status, metabolism of glucose, electrolytes in serum and urine, liver and renal function and acid-base balance were performed in surgical patients compared with lactate ringer solution (LR-D). The 20 patients scheduled for gynecological operations were randomized into 2 groups. After the administration of AR-D or LR-D, we examined their clinical effects. The results suggest that there were no significant differences between AR-D group and LR-D group. We cannot confirm that AR-D is a better solution for surgical patients than LR-D regarding metabolism of lactate, pyruvate and glucose during operations.