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PubMed2003

Emerging therapeutic applications of botulinum toxin.

Botulinum toxin, the most potent known biological neurotoxin, holds great promise in the therapy of many diseases. It has been used effectively to treat strabismus, dystonias and other movement disorders, and spasticity. However, a number of potential new therapeutic indications have emerged and attracted a considerable amount of interest from the scientific community. These emerging indications included treatment for conditions associated with pain (e.g. headaches, myofascial pain, chronic low back pain), hypersecretion of glands (e.g. hyperhidrosis, sialorrhea, intrinsic rhinitis), and excessive or dyssynergic muscle contraction, and for cosmesis (e.g. myokymia, bruxism, anal fissure). There is a need for more controlled clinical trials, dose-ranging studies to determine optimal treatment, validated clinical scales and studies developed to assess the value of electromyographic guidance and skill of investigators on the outcome of treatment for some of these diseases. The long-term cost effectiveness of treatment and immunoresistance from repeated injections are also important clinical issues to address.

Botulinum Toxins↗

PubMedDate not supplied

47 patients in 14 families with the rare genodermatosis keratosis punctata palmoplantaris Buschke-Fischer-Brauer.

We summarize the clinical data of 47 patients with the rare genodermatosis keratosis punctata palmoplantaris Buschke-Fischer-Brauer. The pedigrees of 14 German families were studied. In three families there was only one member affected, two or more affected members were found in the other families. These family pedigrees were consistent with autosomal dominant inheritance. Variable expression of the disease was noted in members within one family. Over pressure points punctate keratoses coalesced into hyperkeratotic plaques. There was palmoplantar hyperhidrosis in 3 families associated with keratosis. Continuous systemic retinoid treatment can clear symptoms. Future genetic classification on a molecular basis may reveal the existence of more than one entity of this clinically heterogeneous genodermatosis.

Adolescent↗

PubMed1976

Apocrine gland organic hamartoma (apocrine nevus).

A patient had two fleshy, nontender masses, each partially filling an axillary vault. These tumors arose at puberty in normal-appearing axillae. The masses were accompanied by localized hyperhidrosis. Histopathological examination of the lesions showed that the reticular layer of the dermis had been replaced solely by lobular masses of unencapsulated, mature apocrine elements. These very rare tumors are best classified as apocrine gland organic hamartomas, or apocrine nevi. To our knowledge, such a case has never been reported or photographed.

Adult↗

PubMed2002

[Serotonin syndrome caused by tandospirone citrate alone].

We describe a case of serotonin syndrome provoked by tandospirone citrate alone, a serotonergic antianxiety agent. A 42-year-old alcoholic woman started to take tandospirone (30 mg/day in 3 divided doses) because of psychosomatic complaints. One month later, dellirium, marked rigidity and myoclonus in the neck and extremities, fever, hyperhidrosis and diarrhoea developed in succession. Tandospirone was discontinued, and all symptoms disappeared within the following 6 days. We diagnosed her condition as serotonin syndrome, although alcoholic withdrawal syndrome might have superimposed. Serotonin syndrome caused by tandospirone alone has not been reported, although it is widely used in Japan.

Adult↗

PubMed2003

[Experiences with endoscopic thoracic sympathectomy].

PATIENTS AND METHOD: Thoracic sympathectomy using thoracoscopy was performed in 38 cases on 35 patients from January 01. 1996, till December 31. 2000. In 3 cases bilateral sympathectomy was carried out. The youngest patient was 18, the oldest was 76 years old, the average age was 42 years. The indications for surgery were Raynaud syndrome, causalgia, post-traumatic sympathetic dystrophy, thoracic outlet syndrome combined with vasospastic syndrome, Buerger syndrome, obliteration of digital arteries, embolism and hyperhidrosis. This method was chosen if conservative therapy was unsuccessful. Laparoscopic instruments are particularly suitable for minimal invasive interventions. RESULTS: Authors describe their operative technique whereby the postoperative pain and also the duration of hospitalisation can be reduced, and the cosmetic result can be improved. In two cases conversion was the only choice due to pleural adhesions. Pneumothorax occurred in two cases, haemothorax in one case and transient intercostal neuralgy was seen in 3 cases. In four cases sympathetic activity returned during the follow up. Ceasing the sympathetic innervation dilates the arterioles of the skin, and the temperature of the skin increases. During follow-up the complaints of the patients improved significantly, the progression became slower and clear improvement was found with instrumental investigations. CONCLUSION: This method can be recommended to every institute where the conditions for traditional laparoscopic surgery are given and staff is experienced in thoracotomy.

Adult↗

PubMed1976

[The articular capsule in idiopathic hypertrophic osteoarthropathy (author's transl)].

The results of clinical roentgenological, cytological examinations as well as the histological examination of biopsy material with electron microscopy are reported for two cases of primary idiopathic hypertrophic osteoarthropathy. In both cases, a watchglass nail was present in the hands and feet; clubbed, distended knee, ankle and wrist joints; appositional enlargement of the shaft of the long bones; the hands and the phalanges of the foot as well as arthralgia and an hyperhidrosis. The morphological examination of biopsy material confirmed the already established increased periosteal bone enlargement. In addition, a fibrosis of the synovial membrane with thickening of the fibrous tissue matrix and increased vascularization of the synovial membrane could be established. Inflammatory processes could be excluded. The reported findings could be attributed to a generalized defect in hormonal or enzymatic regulation of the mesenchym. The vascularization can be explained as a reaction to the lengthening of the transit route between vessels and joint lumen. The thickening of the connective tissue together with the lengthening of the transit route is considered to be an essential causal factor in the arthralgic complaints of strain in hypertrophic osteoarthropathy.

Adult↗

PubMed2003

[Eccrine angiomatous hamartoma: an atypical case].

BACKGROUND: We report a case of eccrine angiomatous hamartoma. This rare and benign skin disease is histologically characterized by the proliferation of both eccrine glands and vascular structures. CASE REPORT: A 65 year-old man had developed during the previous 8 years post-traumatic, angiomatous, extensive and plurifocal lesions of the left lower limb. There was neither pain or local hyperhidrosis. The diagnosis of eccrine angiomatous hamartoma was made on histological evidence. DISCUSSION: This observation is original because of the onset of the disease after 50 years of age, its widespread and plurifocal character and probable triggering-off by minor local trauma. The classical surgical treatment of eccrine angiomatous hamartoma was not suitable and a laser-CO2 therapy was undertaken instead. The results were very discreet.

Aged↗

PubMedDate not supplied

Effect of stress and other psychological factors on the pathophysiology and treatment of dermatoses.

Psychological factors precipitate or increase the morbidity of many dermatoses. There is increasing evidence that stress influences disease processes and contributes to the inflammation through vasoactive neuropeptides, lymphokines or other chemical mediators. Experimental results indicate that the endocrine, nervous and immune systems can no longer be considered autonomous, but involve complex bidirectional interactions between them. Dermatology holds a distinct position in psychosomatic medicine because it deals with an organ that can be readily seen and touched. The psychological states of anxiety, fear, shame, pleasure, and sexual excitation are visibly indicated by blushing, hair-rising, growing pale, itching or hyperhidrosis. The skin, therefore, clearly responds to many psychologic and stressful stimuli. As the skin is exposed to view, dermatoses elicit reactions from the patients' environment and the easy accessibility of the skin allows patients to interact directly with their lesions. In addition to the classic stress response involving increased levels of neuroendocrine hormones and autonomic neurotransmitters, stress also affects the immune system. Stress has been reported to cause decreased natural killer cell cytotoxicity, depressed mitogenic responses in lymphocytes, increased IgA levels, enhanced neutrophil phagocytosis and activation of interferon synthesis in lymphocytes. Psychodermatological syndromes can be classified according to the type and degree of causal relationship between the psychological etiology and the dermatoses. There is some overlap between the groups, but there is a satisfactory classification under three major headings that suggests an approach to treatment.

Journal Article↗

PubMed1954

Anogenital moniliasis.

Thirty cases of anogenital moniliasis were studied. Only five followed oral use of broad spectrum antibiotics. Although anogenital pruritus commonly follows the use of such drugs, it is rarely proved to be moniliasis, which is clinically diagnosed by symptoms of intertriginous denudation with satellite vesicopustules or the presence of cheesy, grossly detachable plaques. The diagnosis may be confirmed by microscopic observation of delicate hyphae and clusters of spores, or of chlamydospores on corn meal agar. One per cent aqueous gentian violet, 0.1 per cent gentian violet jel, or locally applied mercurials are the most effective forms of treatment, but effort must also be directed against predisposing factors (obesity, hyperhidrosis, oral or local use of broad spectrum antibiotics, diabetes and pregnancy).

Anal Canal↗

PubMed1992

[Pheochromocytoma: a motley tumor].

Four patients admitted to our hospital with different symptomatology are studied: a 9-years-old boy with hyperhidrosis; a 47-years-old woman with arterial hypertension and two young males, 25 and 36-years-old, respectively, with thoracic pain. In all cases, the presence of pheochromocytoma was suspected. One of them died due to left ventricular failure with acute lung edema. The other three patients were diagnosed by hormonal determinations, detecting a supra-renal body with abdominal echography and computerized axial tomography and undergoing surgery. Currently, they are asymptomatic.

Adrenal Gland Neoplasms↗

PubMed1992

Papillon-Lefèvre syndrome.

Papillon-Lefèvre syndrome, also known as hyperkeratosis palmaris et plantaris or hyperkeratosis palmoplantaris, is a devastating dermatological disease characterized by a thickening of the stratum corneum of the skin on the palms of the hands and soles of the feet. In addition, some patients manifest excessive sweating (hyperhidrosis), the growth of fine body hair and the development of dirty-colored skin on the affected parts. Calcification of the falx cerebri of the dura mater, as well as other areas of the brain, have been reported. From a dental standpoint, young patients with Papillon-Lefèvre syndrome have juvenile or precocious periodontosis, with severe destruction of the alveolar bone in both deciduous and permanent dentitions. Bone loss has been observed as early as two years of age, with premature exfoliation of the teeth. There is usually gingival enlargement, gingival ulceration and the formation of deep periodontal pockets; but in some cases, there is no inflammatory reaction and only the periodontium of the secondary teeth is affected. This disease eludes all known forms of therapy and results in edentulousness after only a few years.

Aggressive Periodontitis↗

PubMed1992

[Autonomic nervous system disorders in 230 cases of basilar impression and Arnold-Chiari deformity].

Within the period of 1971 to 1989 we operated on 230 cases of craniocervical malformations characterised by 189 cases of basilar impression associated with Arnold-chiari malformation, 28 cases of isolated basilar impression and 13 cases of Arnold-Chiari malformation. Autonomic disturbance was observed in 136 (59.1%) cases: sexual disorders like reduced potency and impotency were observed in 86 (60.9%) out of 141 male patients, urinary symptoms in 39 (17%) patients; and other autonomic features like dyspnea, anhidrosis, hyperhidrosis, Claude Bernard-Horner syndrome and constipation in 41 (17.8%) patients.

Adolescent↗

PubMed2004

[From Morvan's disease to potassium channelopathies].

The term Morvan's disease, first coined in 1890, is still in use, although the generic term neuromyotonia--which is not exempt from criticism--has largely superseded it. Symptoms and signs are variable, ranging from benign painful fasciculations, pseudomyotonic cases, rigid forms, cases in which central nervous system features are also present (with, in addition to nerve hyperexcitability, agitation, confusion, delirium, insomnia, hyperhidrosis and tachycardia). A distal peripheral motor nerve is the origin of nerve hyperexcitability. There is growing evidence that autoimmunity is involved in the pathogenesis of many cases. Antibodies to voltage-gated potassium channels are detected in the serum of many patients with peripheral nerve hyperexcitability. Other cases are probably genetic. Inherited disorders are related to episodic dominant ataxia type 1, with the same mutation of a gene coding for potassium channel subunit Kv 1-1. Many inappropriate or non specific names are used to refer to peripheral nerve hyperexcitability. Isaacs syndrome, voltage-gated potassium channelopathy, or Morvan's syndrome are suggested.

Humans↗

PubMed2004

Vibration anesthesia: a noninvasive method of reducing discomfort prior to dermatologic procedures.

In some dermatologic and cosmetic procedures, local anesthesia is not sufficient for relieving pain; often patients are averse to injections. We propose vibration anesthesia, the use of vibration delivered with commercially available inexpensive massagers to reduce discomfort. We find the analgesic effect of vibration helpful in minimizing pain in patients undergoing injections of botulinum toxin type A treatment for hyperhidrosis, injection of filler substances such as Restylane and Juvederm, laser therapy for leg veins, nail-fold injections, Q-switched laser treatment of tattoos, incision and drainage of abscesses, and cautery of facial warts, as well as facilitating anesthetic injections for needle-phobic patients. We expect that additional uses will be found as experience with this modality grows. Although the use of vibration anesthesia generally does not eliminate pain completely, it can serve to make the injection or procedure much more tolerable.

Anesthesia↗

PubMed2005

Evaluation and prevention of diabetic neuropathy.

Diabetic neuropathy is a debilitating disorder that occurs in nearly 50 percent of patients with diabetes. It is a late finding in type 1 diabetes but can be an early finding in type 2 diabetes. The primary types of diabetic neuropathy are sensorimotor and autonomic. Patients may present with only one type of diabetic neuropathy or may develop combinations of neuropathies (e.g., distal symmetric polyneuropathy and autonomic neuropathy). Distal symmetric polyneuropathy is the most common form of diabetic neuropathy. Diabetic neuropathy also can cause motor deficits, silent cardiac ischemia, orthostatic hypotension, vasomotor instability, hyperhidrosis, gastroparesis, bladder dysfunction, and sexual dysfunction. Strict glycemic control and good daily foot care are key to preventing complications of diabetic neuropathy.

Diabetic Neuropathies↗

PubMed2005

Inter- and intra-individual variability in transdermal fentanyl absorption in cancer pain patients.

A transdermal therapeutic system (TTS) is recommended for use in chronic cancer pain, particularly in the advanced stages. The aim of this trial was to study intra- and interindividual variabilities in fentanyl transdermal absorption and investigate physiological and clinical parameters that can influence the absorption in patients treated using a TTS for moderate to severe cancer pain. The study group consisted of 108 patients (71 men and 37 women; mean age, 61.3 years) with chronic cancer pain. A total of 507 patches were analysed. The TTSs used to administer fentanyl were removed after a 72-h period. The amount of fentanyl remaining in the patches was determined using a high-performance liquid chromatography method with ultraviolet detection. Depending on the analgesic requirements of the patient, the dose of fentanyl administered by TTS ranged from 25 to 500 microg/h. The study period was 6 months. Large interindividual variability in the amount of remaining fentanyl in the patches occurred. For 58.1% of patches, absorption was 60 to 84%; for 33.2% of them, it was lower; and for 8.8%, it was higher than this range. The intra-individual variability ranged from 2.8 to 75.1%. The bioavailability of fentanyl was statistically different according to patient age. Patients >75 years of age absorbed 50% of the fentanyl during the selected 72-h period, whereas patients <65 years absorbed 66%. Moreover, there is a significant difference in the percentage of absorbed fentanyl according to the type of cancer. The absorption was higher in patients with breast or digestive cancer than in those with lung cancer. Hyperhidrosis, hypertrichosis and the localization of patches on the skin did not influence bioavailability. For the entire group, transdermal fentanyl treatment provided good to excellent pain relief in the majority of patients.

Administration, Cutaneous↗

PubMed1992

[Autonomic dysfunction of central nervous system disorders].

Central nervous system disorders, such as cerebrovascular or spinal cord lesions often cause dysfunctions of the autonomic nervous system. In most cases of acute cerebrovascular accidents, blood pressure is transiently elevated. Some patients, especially with pontine or thalamic hemorrhage, suffer from extremely high fever. In patients with large lesions in the cerebral hemisphere or lesions in the brainstem, cardiopulmonary state may be affected. In spite of absence of acute myocardial infarction, electrocardiogram may show ST-T changes resembling acute myocardial infarction. Cheyne-Stokes respiration or sleep apnea can occur. Lesions in the medulla oblongata cause dysfunctions of automatic respiration. Patients with large cerebrovascular lesions in the unilateral hemisphere often show transient hyperhidrosis on the contralateral side. Prognosis of patients with these autonomic failures is poor. In patients with spinal shock, blood pressure and heart rate are reduced. In chronic stage, autonomic hyperreflexia, such as attacks of episodic hypertension can occur. Lesions in the high cervical cord often bring nonsymptomatic perforating gastric ulcer.

Autonomic Nervous System Diseases↗

PubMed2005

Shoulder-hand syndrome after stroke. A complex regional pain syndrome.

Complex regional pain syndrome (CRPS) types I and II are neuropathic pain disorders that develop as an exaggerated response to a traumatic lesion or nerve damage, that generally affects the extremities, or as the consequence of a distant process such as a stroke, spinal lesion or myocardial infarction. It rarely appears without an apparent cause. CRPS of upper limbs after stroke is frequently today called shoulder-hand syndrome (SHS). The onset and severity of SHS appears to be related with the aetiology of the stroke, the severity and recovery of motor deficit, spasticity and sensory disturbances. Another important aetiological factor is glenohumeral subluxation. The physiopathology of the disease is still not known. In CRPS, there is an exaggerated inflammatory response and some chemical mediators have been identified and are present in the inflammatory soup around the primary afferent fibres that, through different processes, can induce hyper-excitability of the afferent fibres (peripheral sensitization). It is hypothesized that a localized neurogenic inflammation is at the basis of oedema, vasodilation and hyperhidrosis that are present in the initial phases of CRPS. The repeated discharge of the C fibres causes an increased medullary excitability (central sensitization). Another important factor is the reorganisation of the central nervous system, and in particular this appears to affect the primary somatosensory cortex. The central role of the sympathetic nerve is presently in doubt. However, it is thought that a sub-group of CRPS patients exists in whom a predominant factor is the hyper-activity of the sympathetic nervous system, and that it responds positively to sympathetic block. Diagnosis is clinical and there are no specific tests, nor pathognomic symptoms to identify this disease with certainty. Diagnosis of CRPS after stroke appears more complex than in other pathological situations: the paretic upper arm frequently appears painful, oedematose, with altered heat and tactile sensations and slightly dystrophic skin within a non-use syndrome. Some investigations can aid differential diagnosis with other diseases. Treatment may be non-pharmacological, pharmacological, with psychotherapy, regional anaesthesia, neuromodulation and sympathectomy. In any case there is little evidence that supports the efficacy of the interventions normally used to treat or prevent CRPS-SHS. The key to effective treatment undoubtedly lies in a an expert multidisciplinary team that is co-ordinated and motivated and that treats the disorder with individualised therapy.

Algorithms↗