Focal Hyperhidrosis of the Anal Fold: Successful Treatment with Botulinum Toxin A

BACKGROUND: Treatment of focal hyperhidrosis with botulinum toxin A (BTX-A) is known to be effective in the axillary, palmar, and plantar region. No studies evaluating the treatment of hyperhidrosis in the anal fold with BTX-A are available, however. OBJECTIVE: The objective was to evaluate whether or not injections with BTX-A are an effective therapy option for the treatment of focal hyperhidrosis of the anal fold. MATERIAL AND METHODS: Eleven male patients (median age, 28.3 years) with focal hyperhidrosis of the anal fold as assessed by modified iodine-starch test were enrolled. Each patient received intradermal injections with 38 U on average (30-54 U) of BTX-A (BOTOX, Allergan Inc.). Changes in sweat rates were documented by comparing the size of hyperhidrotic area in square centimeters before and 4 weeks after injection. RESULTS: The mean reduction of hyperhidrotic area was 29.9 cm(2) (range, 27-43 cm(2)), corresponding to a reduction of 78.5%. Apart from painful injections, no side effects were observed. CONCLUSION: BTX-A is an effective therapy for patients with focal hyperhidrosis of the anal fold.     

Effect of Subcutaneous Infiltration Anesthesia on Pain in Photodynamic Therapy: A Controlled Open Pilot Trial

BACKGROUND: Photodynamic therapy (PDT) has been established as a treatment option for nonmelanoma skin cancer, such as superficial basal cell carcinoma, actinic keratoses, or Bowen's disease. OBJECTIVE: A major drawback of PDT is pain during treatment that can cause extreme distress for some patients. METHODS: This study was a controlled, open trial comparing PDT in 16 patients on one side of the face with orally administered analgesics and PDT on the contralateral side of the face with subcutaneous infiltration anesthesia (SIA). The 5-aminolevulinic acid gel was applied 5 hours before treatment. Pain was assessed by the patient using a visual analog scale directly after treatment. RESULTS: Fifteen of 16 (94%) patients reported less pain during PDT after SIA compared to oral analgesics only. This effect was significant (Wilcoxon test for matched pairs, p= .001). No side effects due to SIA were observed. CONCLUSION: SIA is an effective and rather safe method for the control of PDT-associated pain.     

Complement (C3) levels and the effect of C3 depletion in infections of Trypanosoma brucei in mice

Summary Circulating C3 levels and parasitaemias have been measured in four groups of mice chronically infected with Trypanosoma brucei : group A (normal); group B (irradiated, reconstituted); Group C (T cell-deprived); and group D (T cell-deprived, C3-depleted by treatment with cobra venom factor). In groups A-C, C3 levels first rose two to three times normal, C3 thus behaving as an acute phase reactant. Three weeks after infection C3 returned to normal levels for the remainder of the infection. It is thus unlikely that the severe generalized immunodepression seen in mice infected with this trypanosome, is in any way dependent upon a reduction of circulating C3. The curves of parasitaemia in all four groups of mice were essentially similar, even though in group D mice, C3 levels were reduced to about 10% of normal for the first 3 weeks of infection. From this finding, it is argued that complement has no essential role in the mechanisms whereby mice control successive variant populations of T. brucei in the blood. Variant-specific IgM antibodies, acting as trypagglutinins, are probably all that are required to control blood stream infections.     

Need for Fast Pathway Ablation in Typical Irregular AV Nodal Reentrant Tachycardia in a Patient with Multiple AV Nodal Pathways

A case of a 60-year-old male with irregular AV nodal reentrant tachycardia of the common type is reported. Electrophysiological study revealed multiple antegrade slowly conducting AV nodal pathways and one exclusively retrogradely conducting fast AV nodal pathway. Despite the recommendation for slow pathway ablation as the treatment of choice in patients with AVNRT, first pathway ablation was successfully performed in this case due to the risk of total A V block of ablating the slow pathways. The present report shows that there is the rare patient in whom fast pathway ablation is required for curative treatment of AV nodal reentrant tachycardia.     

Peer teaching pilot programme for caries prevention in underprivileged and migrant populations

Background.  Focused caries prevention programmes for migrant children often fail because there is an important barrier of linguistic and cultural diversity.
Aim.  The aim of this study was to evaluate whether a tailored peer teaching approach can improve oral health behaviours of underprivileged and/or multinational migrant first graders.
Design.  Two fourth grade classes (30 children, mean age 9.6) and two first grade classes (38 children, mean age 6.6) with high migrant background participated. The fourth graders took part in a preparatory course of oral health and developed a concept for tutoring first graders in oral health concepts as well as the Fones toothbrushing method. Later then, the fourth graders instructed the first graders during two lessons. Toothbrushing of each first grader was filmed before and 7 days after instruction. Toothbrushing time, method, and systematic were evaluated.
Results.  After instruction, circular toothbrushing movements and systematic toothbrushing were observed significantly more often ( P  = 0.0001); toothbrushing time did not change.
Conclusions.  This pilot study shows that tutoring by older peers of similar origin resulted in significant changes towards better oral health in underprivileged and/or multinational migrant first graders. Authentic role models could be provided, and communication and cultural barriers circumvented.     

Hemodynamic effects of dobutamine and dopexamine after cardiopulmonary bypass in pediatric cardiac surgery*

Background: After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery. Methods: The study was performed in a prospective, randomized, and double‐blinded cross‐over design. The investigation included 11 children for elective, noncomplex congenital heart surgery. After weaning from cardiopulmonary bypass and a 20‐min period of steady state, children received either 2.5 μg·kg^?1·min^?1 dobutamine or 1 μg·kg^?1·min^?1 dopexamine for 20 min. Cardiac index (transpulmonary thermodilution), mean arterial pressure, central venous pressure, stroke volume, systemic vascular resistance, and central venous oxygen saturation were determined. The primary outcome variable was cardiac index. Results: No difference in cardiac index was observed between the two groups (P = 0.594). Both drugs increased cardiac index, dopexamine from 3.9 ± 0.6 to 4.7 ± 0.8 l·min^?1·m^?2 (P = 0.003) and dobutamine from 4.1 ± 0.7 to 4.8 ± 0.7 l·min^?1·m^?2 (P = 0.004). During treatment with dobutamine, children presented with significantly higher mean arterial pressure (P = 0.003) and systemic vascular resistance index (P = 0.026). Conclusions: This trial demonstrates that low‐dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects.     

ASSESSMENT OF SMALL HEALTH RISKS BASED ON EXACT SAMPLE SIZES

Exact sample sizes and critical numbers of cases for the rejection of a known event probability (10^-2 to 10^-6) in favour of an increased probability (1⋅5- to 50-fold) at levels {α; β} = {0⋅05; 0⋅10} and {α; β} = {0⋅10; 0⋅05} are presented. The numbers are thoroughly validated using the characteristics of the confidence interval for the unknown true event probability. Equivalence is shown to be obtainable for the tolerated maximal value of the relative risk and the upper limit of the confidence interval for the true event probability. Also demonstrated is the use of the tables for planned actions to reduce given empirical risks. In addition, use of the tables is shown for judging results from given data sets.