Editorial: by the sweat of thy brow.
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In a prospective study, we have examined the efficacy of intracutaneous injections of botulinum toxin in Frey's syndrome. In a controlled study, the long term results after surgical treatment for parotid tumors were investigated in 98 consecutive patients. Patients, who reacted positive by Minor's iodine-starch test, and who had subjective complaints too, were offered treatment. A total of four patients entered the study. The affected area was visualised by Minor's iodine-starch test. The coloured areas were injected with botulinum toxin (Botox) 2.5 U/0.1 ml. We injected 0.5 U/cm2. The distance between each injections points was 1 cm. All patients became free of symptoms. The injections were given with little discomfort to the patients and no side effects. At the control one year after the injections three patients had minor recurrent complaints, which were treated successfully by reinjections. Botulinum toxin injections are thus safe and effective in the treatment of FS.
Two cases of anomalous nervous regeneration seen lastly in our Department suggest us this brief reconsideration specially on the physiopathology of these group of malaties triggered during the development of salivary reflex.
In order to overcome the short comings of a total parotidectomy in reference to appearance and the possible Frey syndrom, the author proposes the free dermis fat transplant directly after the extirpation of the gland. This diminishes the formation of serous fluid in the operated area. Long term observations showed no signs of the Frey syndrome. Further experimental research and clinincal observations will determine if the free fat transplantation is a workable method to prevent the Frey syndrom.
The pediatrician is faced with evaluating a panoply of skin rashes, a subset of which may be induced by food allergy. Acute urticaria is a common manifestation of an allergic skin response to food, but food is rarely a cause of chronic urticaria. Approximately one third of infants/children with moderate to severe atopic dermatitis have food allergy. Although diagnosis of acute urticaria provoked by a food may be evident from a straightforward history and confirmed by diagnostic tests to detect food-specific IgE antibody, determination of the role of food allergy in patients with atopic dermatitis is more difficult and may require additional diagnostic maneuvers, including elimination diets and oral food challenges. The immunopathologic basis of food-allergic disorders that affect the skin and a rational approach to diagnosis and treatment are discussed. Additional disorders that are caused by or mimic ones caused by food allergy are reviewed.
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