Postmenopausal craniofacial hyperhidrosis treated with botulinum toxin type B

Hyperhidrosis can seriously impair patients’ quality of life. Medical history, including heredity and hyperhidrosis during youth, as well as current age and time elapsed since menopause, is important to consider when distinguishing between postmenopausal hyperhidrosis and vasomotor symptoms to enable adequate treatment. This report concerns a subgroup of eight postmenopausal patients participating in a randomized controlled trial regarding botulinum toxin (Btx) type B treatment in craniofacial hyperhidrosis. Even though the sample size is small and the enrolment is not yet completed, the promising data collected hitherto are interesting to present in advance because this subtype of craniofacial hyperhidrosis is often underrecognized and challenging to treat. Patients were randomized to receive Btx type B or placebo. Measurements were performed before treatment and 3 ± 1 weeks after. The Dermatology Life Quality Index (DLQI) score was improved for all patients after Btx type B treatment (n = 3) with a median decrease of 9 points (90% median improvement). The placebo group (n = 5) had a median increase of 2 points (–18% median decline). When the same group (n = 5) received Btx type B (open) the DLQI score decreased with a median of 7 points compared with baseline (91% median improvement). Treatment‐related adverse events were temporary and did not prevent improvement of life quality. Furthermore, background data evaluation uncovered interesting findings regarding vasomotor symptoms in relation to postmenopausal hyperhidrosis. In conclusion, the results indicated that Btx type B seems to be a safe and effective treatment in postmenopausal craniofacial hyperhidrosis. Further research is encouraged.     

The outcome of ganglion clipping in hyperhidrosis and blushing

A total of 114 patients with various sympathetic disorders underwent endoscopic sympathetic block over different thoracic ganglions by the clipping method. The advantages of this method include the recognition of the clipped level, changeability, and reversibility. However, 4.4% of patients were unilaterally clipped at the wrong level.     

Evaluation of plantar hyperhidrosis in patients undergoing video-assisted thoracoscopic sympathectomy

Background Sympathectomy is the treatment of choice for primary hyperhidrosis. One curious occurrence that is difficult to explain from an anatomophysiological point of view in cases of video-assisted thoracoscopic sympathectomy (VATS) for the treatment of palmar hyperhidrosis (PH) is the observed improvement in plantar hyperhidrosis (PLH). Nevertheless, current reports on VATS rarely describe the effect on PLH or just give superficial data. The aim of this study was to prospectively investigate, how surgery affects PLH in patients with PH and PLH over one-year period. Methods From May 2003 to January 2004, 70 consecutive patients with combined PH and PLH underwent VATS at the T2, T3, or T4 ganglion level (47 women and 23 men, with mean age of 23 years). Results Immediately after the operation, all the patients said they were free from PH episodes, except for two patients (2.8%) who suffered from continued PH. Compensatory hyperhidrosis (CH) of various degrees was observed in 58 (90.6%) patients after one year. Only 13 (20.3%) suffered from severe CH. There was a great initial improvement in PLH in 50% of the cases, followed by progressive regression, such that only 23.4% still presented that improvement after one year. The number of cases without overall improvement increased progressively (from 17.1% to 37.5%) and the numbers with slight improvement remained stable (32.9–39.1%). Of the 24 patients with no improvement after one year, 6 patients graded plantar sweating worse. Conclusion Patients with PH and PLH who undergo VATS to treat their PH present a good initial improvement in PLH that reduces to a lower level of improvement after the one-year period.     

Compensatory motor function of the somatosensory cortex for dysfunction of the motor cortex following cerebellar hemispherectomy in the monkey

Summary Electrical activities of the motor and somatosensory cortices preceding visually-initiated hand movements were recorded with electrodes chronically implanted on the surface and at 2.5–3.0 mm depth in the cortex of monkeys, and changes in field potentials in these cortices after cerebellar hemispherectomy were observed for many weeks. As previously reported, a unilateral cerebellar hemispherectomy including the lateral and interpositus nuclei eliminates the cerebellar-mediated superficial thalamo-cortical (T-C) responses recorded in the forelimb motor cortex contralateral to the hemispherectomy. These T-C responses normally precede the hand movement, and the operation results in the delay of movement initiation. The electrodes in the forelimb area of the contralateral primary somatosensory cortex showed an enhancement of superficial T-C responses of the somatosensory cortex for 30–40 days after the operation. The enhanced potentials preceded the delayed movement as do the cerebellar-mediated superficial T-C responses of the motor cortex in normal situations. Local cooling of the somatosensory cortex following the cerebellar hemispherectomy disturbed the reaction time movement for a few weeks after the operation. This effect was rarely encountered in normal monkeys. The present study suggests the compensatory motor function of the somatosensory cortex for the dysfunction of the motor cortex in early weeks after cerebellar hemispherectomy.Supported by a Grant-in-Aid for Scientific Research from the Ministry of Education, Science and Culture of Japan     

Compensation for distal impairments of grasping in adults with hemiparesis

Previous studies have shown that patients with arm and hand paresis following stroke recruit an additional degree of freedom (the trunk) to transport the hand during reaching and use alternative strategies for grasping. The few studies of grasping parameters of the impaired hand have been case studies mainly focusing on describing grasping in the presence of particular impairments such as hemi-neglect or optic ataxia and have not focussed on the role of the trunk in prehension. We hypothesized that the trunk movement not only ensures the transport of the hand to the object, but it also assists in orienting the hand for grasping when distal deficits are present. Nineteen patients with chronic hemiparesis and seven healthy subjects participated in the study. Patients had sustained a stroke of non-traumatic origin 6–82 months previously (31±22 months) and had mild or moderate to severe arm paresis. Using a whole hand grasp, subjects reached and grasped a cylinder (35 mm) that was placed sagittally (T1) or at a 45° angle to the sagittal midline in the ipsilateral workspace (T2), both at about 90% arms length (10 trials per target). Eight infrared emitting diodes were placed on bony landmarks of the hand, arm and trunk and kinematic data were recorded by an optical motion analysis system (Optotrak) for 2–5 s at 120 Hz. Hand position and orientation were recorded by a Fastrack Polhemus system. Our results show that during goal-directed prehension tasks, individuals with hemiparesis oriented the hand more frontally for grasping and used more trunk anterior displacement or rotation to transport the hand to the target compared to healthy subjects. Despite these changes, the major characteristics of reaching and grasping such as grip aperture size, temporal coordination between hand transport and aperture formation and the relative timing of grip aperture were largely preserved. For patients with more severe distal impairments, the amount of trunk displacement was also correlated with a more frontal hand orientation for grasping. Furthermore, in healthy subjects and patients without distal impairments, the trunk movement was mostly related to proximal arm movements while in those with distal impairments, trunk movement was related to both proximal and distal arm movements. Data support the hypothesis that the trunk movement is used to assist both arm transport and hand orientation for grasping when distal deficits are present.     

Early biochemical and morphological changes of the rat adrenal medulla induced by xylitol

Long-term administration of high doses of xylitol and other polyols in rats has been associated with an increase in adrenal medullary hyperplasia and neoplasia. In order to exclude age-related factors and to differentiate between unspecific stress reactions and direct effects of the compound administered, a model was developed for quantifying early adrenomedullary responses. Male SD rats were fed xylitol (10% or 20% in the diet) for 2 and 8 weeks, and early biochemical changes were correlated with a stereological analysis of the adrenal medulla. At first, the in vivo rate of catecholamine (CA) biosynthesis was slightly decreased (at 2 weeks). This was followed by an increase in dopamine--hydroxylase (DBH) activity (at 8 weeks). By that time, the total chromaffin cell volume had increased and the number of chromaffin cells per reference volume had decreased in a dose-dependent way. The total number of chromaffin cells per adrenal gland showed a distinct tendency towards an increase. Adrenal epinephrine and norepinephrine contents were not altered, and both tyrosine hydroxylase and phenylethanolamine-N-methyltransferase activities remained unchanged. These data suggest that continued xylitol administration evoked an inhibitory effect on CA synthesis that, together with stimulation of the adrenal medulla brought about by the compound, resulted in compensatory medullary hypertrophy and hyperplasia.     

Body weight set point studies in weanling rats with dorsomedial hypothalamic lesions (DMNL rats)

In order to further characterize a previously postulated "organismic" set point, weanling DMNL and control (CON) rats were maintained on lab chow ad lib (AL) for 55 post-operative days. Subsequently, some DMNL and CON rats were food-restricted (REST) to 80% of the food intake of their AL-fed counterparts for 24 days. At this point, representative rats from each group were killed by decapitation and the remaining animals were re-fed AL and killed 7 and 22 days thereafter. At the end of REST, both DMNL and CON showed significant weight loss, which was greater in CON than in DMNL rats. After 7 days of refeeding, DMNL rats normalized their body weights but re-fed CON still weighed less than AL-fed CON 22 days after refeeding. Food intake in formerly REST groups overshot on refeeding for 7 days, but this was significant only in DMNL rats. Notably, during this time formerly REST-DMNL ate as much as AL-fed CON. Efficiency of food utilization was normal in DMNL during AL feeding and became reduced on REST as it did in REST-CON. Notably, on refeeding formerly REST-DMNL rats overshot that of AL-fed DMNL rats by the same magnitude as previously REST-CON overshot the values of AL-fed CON. After 22 days of refeeding, this overshoot was still evident in DMNL but not in CON. At the end of the REST period, plasma insulin and glucose were similar in AL-fed DMNL and AL-fed CON. They were significantly and comparably reduced in both REST-DMNL and REST-CON compared to the AL-fed DMNL and AL-fed CON. On refeeding these changes normalized within seven days. At the end of REST, plasma free fatty acid concentrations were higher in REST-DMNL and REST-CON than in AL-fed DMNL and AL-fed CON. After seven days of refeeding they normalized only in formerly REST-CON. Plasma glycerol and total protein were normal throughout all groups, as was carcass protein. Carcass fat was equivalently reduced in both DMNL and CON at the end of REST and normalized 7 days after refeeding. AL-DMNL had the same carcass fat as AL-CON and REST-DMNL had the same carcass fat as REST-CON. In conjunction with previously reported normal anabolic hormone levels the data suggest that DMNL rats are not growth-retarded but are merely scaled down in size without compromise of their homeostatic competence. We take this as strong evidence for the existence of an "organismic" set point.     

The long-term results of upper dorsal sympathetic ganglionectomy and endoscopic thoracic sympathectomy for palmar hyperhidrosis

To assess and compare the long-term results of upper dorsal sympathetic ganglionectomy (UDS) and endoscopic thoracic sympathectomy (ETS), we examined 84 patients who underwent UDS and 71 patients who underwent ETS for the treatment of palmar hyperhidrosis. The period of follow-up ranged from 37 to 228 months. The immediate success rate was 100% in the UDS group and 98.6% in the ETS group. Troublesome compensatory hyperhidrosis occurred in 67.8% of the UDS patients and 84.8% of the ETS patients; however, 55% of the UDS patients and 63% of the ETS patients felt satisfied with their operation. The main reasons for dissatisfaction were recurrence and compensatory hyperhidrosis. Interestingly, simultaneous cure of plantar hyperhidrosis occurred in 28 (40%) of the UDS patients and 28 (44%) of the ETS patients with concomitant plantar hyperhidrosis. ETS required both a shorter operation time and hospital stay than UDS. Thus, we now perform ETS as the treatment of choice because of its excellent illumination and adequate magnification via a minimally invasive approach. The use of ETS as the first choice of treatment for palmar hyperhidrosis is supported not only by the immediate results, complications, and cure of plantar hyperhidrosis, but also by the long-term results. Nevertheless, compensatory hyperhidrosis was also a major complication after ETS.     

The compensatory ‘rebound’ of reactive astrogliosis: glial fibrillary acidic protein immunohistochemical analysis of reactive astrogliosis after a puncture wound to the brain of rats with portocaval anastomosis

Summary This study was designed to compare the degree of reactive astrogliosis occurring around a puncture wound in the brain of normal rats and at different intervals after a similar puncture wound in rats with a portocaval anastomosis. The gliosis was evaluated by the number of astrocytes, the thickness of their processes and the intensity of the glial fibrillary acidic protein immunoreactivity. After the puncture wound in the brain of rats with a portocaval anastomosis, the gliosis varied at different intervals being: (1) decreased at 10 days, (2) markedly increased at 5 weeks and (3) significantly decreased at 8, 12, and 16 weeks. These findings suggest that 5 weeks after portocaval anastomosis, an active proliferation of the metabolically altered astrocytes occurs with heightened synthesis of glial fibrillary acidic protein in the period of adaptive compensation, the so-called compensatory rebound. At 8 weeks or more after portocaval anastomosis, these altered astrocytes were considered to be in the phase of decompensation and incapable of maintaining the reactive response which occurred in normal rats. The compensatory rebound and decompensatory decline illustrate the dynamic plasticity of the reactive astrogliosis.Supported by grant from the National Foundation of Natural Sciences No. 386-0956. This paper was read at the XIth International Congress of Neuropathology, September 7, 1990 in Kyoto, Japan     

云南省龙陵县新型农村合作医疗制度补偿方案研究

目的探讨龙陵县新型农村合作医疗制度补偿方案,以资在云南省范围内全面实施新农合制度时参考.方法采用流行病学现场研究方法进行研究.结果龙陵县新农合制度补偿方案是“家庭账户 住院费用分段补偿”模式.2004年度,在家庭账户方案保持不变的基础上对住院补偿办法做了调整.参合农民与医务人员对新农合制度补偿方案满意度评价分布的差异有统计学意义(P<0.001).结论龙陵县现行新农合制度补偿方案基本可行,社会满意度较高,值得借鉴和推广,建议该县调整家庭账户方案,提高起付线,试行住院费用按比例补偿的办法.