肉毒毒素A在前列腺疾病中的应用及其进展

本文在介绍肉毒毒素A的结构、功能的基础上,对目前其在泌尿外科特别是在前列腺疾病中的应用给予总结,并指出今后研究的重点及可能存在的问题。     

A型肉毒毒素注射治疗难治性前列腺增生症病例的临床研究

目的：通过对经尿道镜于尿道外括约肌和前列腺内注射A型肉毒毒素（BTX—A）治疗难治性BPH病例的临床疗效的观察,寻求此类病例的最佳治疗方法。方法：具有手术指征但存在手术禁忌证且药物治疗无效的BPH病例35例,经尿道镜于尿道外括约肌、前列腺多点注射BTX—A进行治疗。对治疗前后患者症状及各项尿动力参数变化进行观察比较。结果：35例患者经尿道前列腺及尿道外括约肌注射A型肉毒毒素后5～l3d治疗效果开始显现,平均7．2d。术后随访3～8个月,随访期未发生毒副作用。4例患者治疗后效果减退,准备行第2次注射。结论：BTX—A经尿道镜注射于前列腺治疗具有手术指征但存在手术禁忌证且药物治疗无效的BPH病例。操作简单,治疗效果确切,无毒副作用。     

A型肉毒杆菌毒素治疗膀胱过度活动症研究进展

就A型肉毒杆菌毒素(BTX-A)的生物学特性及其在膀胱过度活动症(OAB)中的治疗进展作一综述,认为BTX是厌氧梭状芽孢杆菌产生的一种神经毒素,由神经毒素和非神经毒素的血凝素成份组成;采用BTX-A治疗OAB取得满意疗效,但也出现了一些并发症和副作用,还需要经大规模、多中心、对照及双盲实验加以证实。     

A型肉毒毒素治疗面部肌肉痉挛

目的:通过面部局部注射A型肉毒毒素(botulinumtoxinA,BTXA),探讨治疗面部肌肉痉挛的安全、简单而有效的方法。方法:对82例面部痉挛的患者,根据面部痉挛的部位,确定BTXA的注射点及注射剂量,并可根据产生的作用而行重复注射。结果:注射24h,症状开始改善,2～7天痉挛迅速缓解,所治疗的82例患者症状全部获得了缓解。结论:BTXA已作为一种药物,用于治疗面部的肌肉张力异常和面部神经肌肉兴奋性过高等症。治疗无痛苦、操作简单、恢复快,是治疗面部肌肉痉挛的比较安全有效的技术。     

A型肉毒毒素治疗化脓性汗腺炎的研究进展

化脓性汗腺炎是一种病变首发于毛囊的慢性化脓性炎症,以反复发作的痛性结节、脓肿、窦道、瘢痕形成为主要特点.其发病机制与遗传、免疫、感染、内分泌、吸烟、肥胖等多种因素有关.以往,化脓性汗腺炎的治疗包括抗生素治疗、手术治疗、放射治疗、激光治疗等,但效果都不尽理想.近年来,相关报道显示A型肉毒毒素注射治疗化脓性汗腺炎具有较好的...     

A型肉毒毒素产品差异研究进展

A型肉毒毒素（botulinum toxin type A,BTX-A）注射已经作为临床治疗及美容领域的一线治疗手段,可以有效且安全地改善肌肉组织的兴奋性,提升患者生活质量。随着适应证拓展,不同种类BTX-A相继问世,其间的差异化也愈发受到重视。深入了解不同BTX-A间的差异对于临床药物转化、规范化治疗及降低医疗成本有重要意义。现对不同BTX-A间的差异化分别从分子结构、生产过程、产品特征、效力、临床剂量转换、毒素弥散及免疫原性等方面的研究进展作一综述。     

A型肉毒毒素注射治疗头痛的临床观察

目的观察A型肉毒毒素注射治疗头痛的效果。方法头痛病人20例,随机分为三组注射A型肉毒毒素。Ⅰ组,双侧皱眉肌每点注射25U;Ⅱ组,双侧皱眉肌和双额肌每点注射10U;Ⅲ组,除了双侧皱眉肌和额肌外,在降眉肌、颞肌、枕肌、头顶帽状腱膜或颈椎旁的明显压痛点注射5～10U,总量不超过100U。3个月后疼痛复发者可重复注射。结果治疗后第7天,三组的头痛视觉模拟评分(VAS)由治疗前7.2、7.1和7.3分降至2.8、2.3和2.5分,头痛程度比治疗前分别降低了67.5%、68.1%和68.8%,组间差异无显著意义。头痛发作次数由治疗前平均每周12.7、13.1和11.9次减少至5.0、4.9和4.7次,分别降低了60.6%、62.2%和60.5%;服用原镇痛药片由治疗前每周平均14.2、13.8和13.6片,分别减少至5.6、5.7和4.9片,比治疗前降低了60.5%、58.1%和63.9%;疗效维持是3.8、3.6和4.0个月;病人满意度分别为2.2、2.1和2.0分。Ⅲ组有1例感觉抬头乏力,2周后渐恢复。结论A型肉毒毒素注射可有效减轻头痛,但不同注射点和剂量对临床效果无明显影响。     

A型肉毒毒素治疗面部皱纹300例

目的：观察A型肉毒毒素治疗面部皱纹的运用效果。方法：对以面部美容为目的的300例患者应用A型肉毒毒素定点、定量注射治疗,注射点均匀、对称分布于面部肌肉层。其中包括额部皱纹、鱼尾纹、眉间皱纹、下睑纹、鼻唇沟纹。结果：300例患者行A型肉毒毒素治疗后显效者234例（占78％）,有效者66例（占22％）,无效者为0例。结论：A型肉毒毒素在治疗面部皱纹确切有效,操作简便、易行,无痛苦,不影响工作,易于推广。     

Anatomic considerations for treatment with botulinum toxin

Botulinum toxin A treatment continues to increase in popularity and number. Many more patients are undergoing cosmetic Botox procedures and many, diverse practitioners are providing them. The best results are obtained from a careful history and physical examination of the patient combined with a detailed understanding of facial and neck anatomy. Understanding the dynamic anatomic relationships, such as agonist-antagonist muscles and contraction force vectors, is key to providing the patient with an excellent outcome.     

Injection of botulinum toxin for the treatment of post-laryngectomy pharyngoesophageal spasm-related disorders

Introduction

Pharyngoesophageal spasm (PES) can cause dysphagia, central valve leak (CVL), and dypshonia in post-laryngectomy patients. Botulinum toxin has been used effectively for the treatment of PES, but data regarding patient-reported outcomes and efficacy for CVL are limited. We evaluated the results of botox injection for PES spasm using subjective and objective measures.

Methods

Data were collected prospectively (February 2010 to August 2013) on 13 patients undergoing botox injection for PES as identified by video fluoroscopy. We collected digital voice recordings, air-pressure measurements (APMs) for speech, and quality of life (QoL) data before and after the procedure: University of Washington QoL questionnaire (UW-QoL), MD Anderson Swallowing Inventory (MDADI) and the Voice Handicap Index (VHI-30).

Results

APMs for a sustained vowel decreased by 18% after botox injection, whereas maximum phonatory times increased by 63% (mean increase, 8 to 13 seconds). Sustained vowel amplitude decreased (mean, 87db to 83db) with an associated reduction in sustained vowel frequency (117Hz to 77Hz). MDADI scores improved by 10.2% overall, and UW-QoL scores showed an improvement in score of 7.6%. Mean scores for VHI-30 deteriorated by 2% overall but, when considering only those patients experiencing dysphonia, an improvement of 9.4% was seen. There was an overall net reduction for the CVL cohort of 12 speech valves in the year after injection.

Conclusions

Our series confirm the safety and objective efficacy of botox injection for PES. QoL measurements were less convincing, and this disparity between subjective and objective measurements must be considered when treating such patients.     

肌注肉毒毒素A和糖皮质激素治疗咬肌肥大

目的:探讨良性咬肌肥大的非手术治疗方法。方法:每侧咬肌内注射肉毒毒素A约50U和曲安奈德约20mg,注射时使药物均匀分布于咬肌内,避免将曲安奈德注射到皮下组织内以免引起皮下脂肪萎缩凹陷。结果:应用本方法治疗11例,其中单纯咬肌肥大者6例,辅助下颌骨截骨手术治疗咬肌肥大5例,注射治疗后2周即可见咬肌区明显萎缩,8～12周效果稳定,经3～8个月随访未见复发,咬合功能正常,无并发症发生。结论:联合应用肉毒毒素A和曲安奈德肌内注射治疗咬肌肥大,起效快,疗效显著,是非手术治疗咬肌肥大的良好选择。     

Frey syndrome treatment with botulinum toxin

The goal of this work is to present our results of the intradermic infiltration with botulinum toxin in patients with Frey syndrome. Sixteen hemifaces in 15 patients were studied. Gustatory stimulation was evoked by sucking on a slice of lemon while measurements were done on both hemifaces, with the normal side being used as a control. Skin temperature and color (erythema) were measured with a digital surface thermometer and a skin chromameter, respectively. Sweat quantity and surface were measured by using the previously described blotting paper and iodine-sublimated paper histogram methods, respectively. Testing was repeated 2 weeks after skin infiltration with botulinum toxin (dilution of 50 U/mL). The interinjection distances were 1 cm, and 0.1 mL (5 U) was infiltrated at each injection site. Frey syndrome complaints disappeared in all patients. Small residual amounts of sweat were measurable. The difference in sweat quantity before and after botulinum toxin infiltration was significant in every patient (P < 0.001). Skin temperature and color measurement gave inconclusive results. In conclusion, Frey syndrome treatment with botulinum toxin is an efficient and well-tolerated technique. Further work should address the optimal injection parameters.     

Adverse events after botulinum A toxin injection for neurogenic voiding disorders

OBJECTIVES: To review the side effects of local injections of botulinum A toxin (BTX-A). METHODS: A medline search for publications about adverse events after injection of BTX-A for lower urinary tract dysfunctions. RESULTS: We found four publications that report generalised side effects after BTX-A injection for detrusor overactivity (two) and detrusor-sphincter dyssynergia (two). The causes of generalised adverse events are not clear, but spread outside the target organ and into the systemic circulation may contribute. The dose used, the injection volume and the injection technique can all play a role. CONCLUSION: Generalised side effects after BTX-A injection for voiding disorders are rare but they can be very disabling for spinal cord-injured patients. Although no long-term side effects are reported so far, urologists should be aware that these effects of BTX-A injections are unknown.     

Evaluation of botulinum toxin A in treatment of tinnitus

OBJECTIVES: The purpose of this study was to evaluate the potential benefit of botulinum toxin A in treatment of tinnitus with a prospective, double-blinded study design. STUDY DESIGN: Double-blinded, prospective clinical study. METHODS: Thirty patients with tinnitus were randomly placed into 1 of 2 treatment arms. Patients either received botulinum toxin A (20 to 50 units) or saline injection at the first treatment, and the opposite treatment 4 months later. Prospective data including tinnitus matching test, tinnitus handicap inventory (THI), tinnitus rating scale (TRS), and patient questionnaires were obtained over a 4-month period after each injection. RESULTS: Twenty-six patients completed both injections and follow-up and were included in data analysis. After botulinum toxin A, subjective tinnitus changes included 7 patients improved, 3 worsened, and 16 unchanged. Following placebo, 2 patients were improved, 7 worsened, and 17 unchanged. Comparison of the treatment and placebo groups was statistically significant (P < 0.005) when including better, worse, and same effects. A significant decrease in THI scores between pretreatment and 4 month postbotulinum toxin A injection (P = 0.0422) was recorded. None of the other comparisons of pretreatment to 1 month, or pretreatment to 4 months were significantly different. CONCLUSIONS: This small study found improvement in THI scores and patient subjective results after botulinum toxin A injection compared with placebo, suggesting a possible benefit of botulinum toxin A in tinnitus management. Larger studies need to be completed to further evaluate potential benefits of botulinum toxin A in treatment of this difficult problem.