1/4. BOTOX delivery by iontophoresis.We report two patients with severe palmar hyperhidrosis who responded to BOTOX delivered not by injection, the usual method of delivery, but by iontophoresis. The Botulinum molecule has been considered too large for delivery into the skin this way. However, other large peptides, both non-ionic and cationic, have been delivered successfully by this method, so we suspected that BOTOX could in fact be iontophoresed. Our saline-controlled treatment of these two patients with a small iontophoresis unit (Iomed Phoresor II) allowed small volumes of standard BOTOX dilutions to be used, and demonstrates that iontophoresis can indeed deliver BOTOX successfully. This has important therapeutic potential for the large number of patients with focal hyperhidrosis. They may be spared painful injections, and in more severe cases, invasive surgery.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
2/4. Management of reflex sweating in spinal cord injured patients.reflex sweating can be a problem for cervical spinal cord injured patients. Patient comfort and skin breakdown have been the major concerns. Five patients were studied prospectively, using a patch containing 1.5mg of scopolamine. Patches were changed every third day. Each patient was carefully monitored before and after application of the patch for signs and symptoms of anticholinergic side effects such as dizziness, blurred vision and dry mouth. patients were also monitored for changes in patch signs before and after use, including residual urine volumes, blood pressure, heart rate, and mental status. Our study indicates that topical scopolamine successfully controlled reflex sweating in 5 patients without anticholinergic side effects.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |
3/4. edema due to altered sweating function.We report a case with idiopathic edema accompanied with excessive sweating on bathing. The subject is a 26 year-old male. He was admitted to our hospital because of pretibial edema. He complained of excessive sweating only after daily bathing. sweating on daily bathing reduced pretibial edema after long-term standing. Daily urine volume decreased by about 200 to 500 mL/day on bathing everyday. Plasma renin, aldosterone and bradykinin levels increased. Subcutaneous injection of pilocarpine increased sweating around the injection site. The cessation of daily bathing restored plasma renin, aldosterone and bradykinin levels; urine volumes increased. However, pretibial edema appeared and body weight increased by 8.5 Kg. serum triiodothyronine (T3), thyroxine (T4) levels and basal metabolic rate (BMR) decreased. Circulating plasma volume increased with the cessation of bathing. Alterations in the autonomic nervous system may be involved in the appearance of general edema through increased plasma volume due to altered sweating function.- - - - - - - - - - ranking = 4keywords = volume (Clic here for more details about this article) |
4/4. Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter.PURPOSE: Negative pressure pulmonary oedema (NPPE) is a well-recognized but rare complication secondary to upper airway obstruction such as laryngeal spasm during emergence from general anaesthesia. Cauterization of the second and third thoracic sympathetic ganglia is a treatment for hyperhidrosis of the hands. We report a case of NPPE induced by direct suctioning of the endotracheal tube adapter during thoracic sympathetic ganglionectomy without recognized upper airway obstruction. CLINICAL FEATURES: A 19-yr-old otherwise healthy, non-smoking man was scheduled for elective bilateral chest endoscopic ablation of the second and third thoracic sympathetic ganglion for hyperhidrosis of the hands under general anaesthesia. To view and cauterize the ganglion with the endoscope, the surgeon requested cessation of positive pressure ventilation. As the surgeon could not satisfactorily visualize the target ganglia, he requested brief application of wall suction via the ETT tube adapter. A pressure of -100 mmHg was generated which lasted for three to four seconds. The goal was to reduce further the lung volume by increasing the pneumothorax produced by the endoscope. The patient developed negative pressure pulmonary oedema without upper airway obstruction. CONCLUSION: This case demonstrated that intrathoracic negative pressure generated by direct ETT adapter suctioning may produce pulmonary oedema similar to that induced by laryngeal spasm during the emergence of general anaesthesia.- - - - - - - - - - ranking = 1keywords = volume (Clic here for more details about this article) |