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An injector gun of the type developed for vaccinations was used to perform intercostal nerve blocks. Analgesia was achieved in all patients to some degree, but the effectiveness of the technique was limited by the currently available local anaesthestics.
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Intralesional steroid therapy has a definite, if small, place in dermatology and triamcinolone acetonide is the preparation in most common use. Such therapy may be used, particularly in nail disorders, keloids and hypertrophic scars, cystic acne, and to speed regrowth of hair in localized alopecia areata. Other conditions in which it has a place include cutaneous lupus erythematosus and sarcoidosis. There are some conditions where use is occasionally indicated and yet others where further trial is merited.
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BACKGROUND: Hyperhidrosis (excessive, uncontrollable sweating) can be embarrassing and disabling, significantly impacting social and professional performance and quality of life. Treatments aim to reduce sweating, but few are effective, often carrying the risk of significant side-effects. The aims of this study were to evaluate the efficacy and safety of botulinum toxin type A (BTX-A) for plantar hyperhidrosis and to investigate the role of the Dermojet as a potential injection technique. METHODS: Ten adult patients (five men, five women), aged 19-51 years, with severe, previously unresponsive, plantar hyperhidrosis, were recruited to this single-center, open-label, noncomparative study. The hyperhidrotic area of each foot was injected over 15-20 sites without analgesia with 50 U BTX-A + 5 mL sterile saline using a Dermojet. Patients were followed up for 8 months with monthly sweat reduction assessments using Minor's iodine-starch test. Patients provided a treatment self-assessment after completion of follow-up. RESULTS: Within 7 days post-treatment, eight patients reported significantly decreased sweating, and seven patients were symptom free for up to 5 months. Patient self-assessment showed that seven of the 10 patients were satisfied with their treatment. One minor adverse event was reported comprising a temporary localized hematoma (one patient). CONCLUSIONS: Intracutaneous BTX-A injection using the Dermojet offers a simple, safe, and effective alternative for treatment of plantar hyperhidrosis.
OBJECTIVE: Botulinum toxin A (Botox) has been used as a local treatment for anal fissure since 1994. It effects a reversible chemical sphincterotomy without the need for patient compliance. This study examines the feasibility of injecting the treatment using a needle-less system. PATIENTS AND METHODS: The optimal angle for injection was determined in a preclinical study using fresh porcine specimens. Ten patients with chronic anal fissures were then injected with 20 units Botox at the site of the fissure. They underwent assessment with a visual analogue pain scale, incontinence score and anal manometry pre-injection, at 48 h postinjection and at six and 12 weeks postinjection. They were also examined at the initial and final visits. RESULTS: The optimal angle for injection was 60 degrees . All 10 patients (5 male; median age 40.5 years (range 26-68 years)) attended the 48 h follow up visit but only seven attended the six and 12 week visits. Six of seven patients healed their fissures. The remaining three were contacted by telephone at six months post injection and two of three remained asymptomatic without further treatment. In seven patients who underwent full follow up the median pain score pre-injection was 5.5 out of 10 (range 1-10) and this dropped to a median of 1 (range 0-6) at 12 weeks. The median drop in resting pressure was 47 cm H2O or 37% at six weeks. CONCLUSION: No needle injection of Botox is feasible with similar healing rates and reduction of resting pressure to conventional injection techniques.
Efficacy and acceptability of the Medi-Jector II, compared with conventional syringes, was evaluated in a cross-over study (two 4-week periods) in 14 adult insulin-dependent diabetic patients. In 6 out of these 14 patients the clinical diagnosis of needle phobia was confirmed by anxiety tests for trait (45.8 +/- 12.8 (SD) versus 34.0 +/- 6.2; p less than 0.05) and state (50.3 +/- 10.9 versus 28.9 +/- 5.2, p less than 0.05). Five patients (one needle-phobic) dropped out, all for Medi-Jector-related problems. No significant differences were found in body weight, insulin dosage, and number of hypoglycaemic reactions. HbA1 after the Medi-Jector period was significantly higher than after the conventional period (9.8 +/- 1.2 (SE) versus 9.1 +/- 1.1 (SE)%; p less than 0.05). The questionnaire, evaluating the Medi-Jector, revealed poor acceptance of the device (7/9 patients' general impression being moderate or bad). The use of the Medi-Jector in comparison with conventional injections caused the patients to complain about: more immediate pain (4/9 patients), delayed pain (often: 4/9, sometimes: 2/9), more insulin leakage (6/9), more bleeding (6/9), and more haematomas (5/9). Except for 'often occurring delayed pain' (4/5 needle-phobics versus 0/4 non-needle-phobics; p less than 0.05), needle-phobic patients scored the questionnaire similarly to the other patients. We conclude that the use of the Medi-Jector II did not cause a major short-term loss of metabolic control, but that the device was not well accepted by our patients, independent of the existence of needle phobia.
Although microdialysis measurements suggest that extracellular dopamine concentrations in the rat striatum are in the low nanomolar range, some recent voltammetry studies suggest that the concentration may be considerably higher, perhaps in the micromolar range. The presence of such high dopamine levels in the extracellular space has to be rationalized with the rapid, linear clearance of extracellular dopamine observed after electrical stimulation of the medial forebrain bundle. Kinetic analysis of dopamine clearance after evoked release suggests that the basal extracellular dopamine concentration is below the K(M) of dopamine uptake, which is near 0.2 microm. However, dopamine clearance after pressure ejection of dopamine into the rat striatum is slow and non-linear, which may alternatively be a sign that basal dopamine release is only slightly slower than the maximal velocity of dopamine uptake, Vmax. A high basal extracellular dopamine concentration would exist if basal dopamine release were only slightly slower than the Vmax of uptake. This report introduces a new kinetic analysis of dopamine uptake that sheds light on the possible source of the different clearance rates observed following evoked dopamine release and dopamine pressure ejection. Furthermore, the analysis rationalizes the rapid dopamine clearance after evoked release with the possibility that basal extracellular dopamine levels are above the K(M) of the transporter.
BACKGROUND: The treatment of palmar and plantar warts is difficult and often frustrating. The need for multiple destructive treatments and recurrences after apparent cure are common. OBJECTIVE: The purpose of this study was to determine if intralesional natural alpha interferon might offer an effective alternative therapy for common plantar and palmar warts. METHODS: A series of 22 private office patients with palmar and plantar warts were treated with intralesional natural alpha interferon using a needless injector. We treated twice weekly for a minimum of 8 weeks or until clear. RESULTS: Sixteen patients (73%) showed complete clearing of their warts in a mean of 11 weeks of twice weekly treatment. Upon follow-up, which averaged 9.5 months, 17 of 21 patients (81%) remained clear of their warts. CONCLUSION: Natural alpha interferon by needless injector appears to represent an effective alternative treatment for palmar and plantar human papillomavirus lesions. Further study of this modality is indicated.
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The Ebola virus (EBOV) envelope glycoprotein (GP) is the primary target of protective immunity. Mature GP consists of two disulfide-linked subunits, GP1 and membrane-bound GP2. GP is highly glycosylated with both N- and O-linked carbohydrates. We measured the influences of GP glycosylation on antigenicity, immunogenicity, and protection by testing DNA vaccines comprised of GP genes with deleted N-linked glycosylation sites or with deletions in the central hypervariable mucin region. We showed that mutation of one of the two N-linked GP2 glycosylation sites was highly detrimental to the antigenicity and immunogenicity of GP. Our data indicate that this is likely due to the inability of GP2 and GP1 to dimerize at the cell surface and suggest that glycosylation at this site is required for achieving the conformational integrity of GP2 and GP1. In contrast, mutation of two N-linked sites on GP1, which flank previously defined protective antibody epitopes on GP, may enhance immunogenicity, possibly by unmasking epitopes. We further showed that although deleting the mucin region apparently had no effect on antigenicity in vitro, it negatively impacted the elicitation of protective immunity in mice. In addition, we confirmed the presence of previously identified B-cell and T-cell epitopes in GP but show that when analyzed individually none of them were neither absolutely required nor sufficient for protective immunity to EBOV. Finally, we identified other potential regions of GP that may contain relevant antibody or T-cell epitopes.
Heaf testing was carried out on 98 preschool Asian children who had received a BCG vaccination. A strongly positive Heaf reaction (grade 3) occurred in only two children. Heaf testing can still be used in tuberculosis screening after neonatal BCG.
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Placement of IV catheters is a painful and stressful procedure for children. J-Tip is a needle-less Food and Drug Administration approved injection system that can be used for delivery of local anesthetic before IV cannulation. In this study, we compared the effectiveness of J-Tip versus eutectic mixture of local anesthetics (EMLA) to facilitate IV cannulation and provide adequate analgesia before IV placement. Children 7-19 years of age (n = 116) were randomized to receive 0.25 mL of 1% buffered lidocaine with J-Tip (n = 57) or 2.5 g of EMLA (n = 59) before IV cannulation. Measurements of success of cannulation (number of attempts for IV placement) and pain (0-10 visual analog scale) at application of local anesthetic and at cannulation were performed. There was a significant (P = 0.0001) difference in pain ratings during IV cannulation between EMLA (median = 3) and the J-Tip (median = 0). Eighty-four percent of patients reported no pain at the time of J-Tip lidocaine application compared to 61% in the EMLA group at the time of dressing removal (P = 0.004). We did not find differences in the number of attempts for IV cannulation. J-Tip application of 1% buffered lidocaine before IV cannulation is not painful and has better anesthetic effectiveness compared with EMLA.