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| 2. |
- Bosdotter Enroth, Sofia, et al.
(författare)
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Bilateral forearm intravenous regional anesthesia with prilocaine for botulinum toxin treatment of palmar hyperhidrosis
- 2010
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Ingår i: The Journal of American Academy of Dermatology. - : Elsevier BV. - 0190-9622 .- 1097-6787. ; 63:3, s. 466-474
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Treatment of palmar hyperhidrosis with botulinum toxin (BTX) requires effective anesthesia, but previous methods have not provided enough pain relief or have resulted in a prolonged impaired hand function. OBJECTIVE: This is a study of bilateral forearm intravenous regional anesthesia using prilocaine for BTX treatment of palmar hyperhidrosis. METHODS: In all, 166 patients (100 female and 66 male) were treated bilaterally with intracutaneous BTX type A injections using intravenous regional anesthesia with prilocaine (5 mg/mL). In a subgroup of patients, forearm nerves were studied with neurophysiologic methods and blood concentrations of prilocaine were measured. Pain evaluation with a visual analog scale was accompanied with a questionnaire about the treatment. RESULTS: In all, 95% of the patients answering the questionnaire (response rate 89%) were satisfied with the anesthetic effect. No serious adverse events occurred. There was a fast recovery of motor function (in median 6 minutes) and sensory function (in median 20 minutes). No subclinical signs of sensory nerve damage were found. LIMITATIONS: Recall and reporting bias are potential sources of limitations in this study. CONCLUSION: Bilateral forearm intravenous regional anesthesia provides an effective and well-tolerated anesthesia during BTX treatment of palmar hyperhidrosis.
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| 4. |
- Gaines, Hans, et al.
(författare)
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Six-week follow-up after HIV-1 exposure: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy
- 2016
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 48:2, s. 93-98
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Forskningsöversikt (refereegranskat)abstract
- In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. A follow-up period of 12 weeks is recommended after a possible exposure for HIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.
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| 5. |
- Naver, Hans, et al.
(författare)
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Palmar and axillary hyperhidrosis treated with botulinum toxin : one-year clinical follow-up
- 2000
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 7:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- Focal hyperhidrosis is a common and sometimes handicapping condition for which the presently most effective treatment, sympathectomy, often leads to irreversible side-effects. We aimed to study effectiveness and tolerability of an alternative treatment with botulinum toxin injections over a period of one year for this condition. Twenty-eight patients with palmar (n = 19) and/or axillary (n = 13) hyperhidrosis were treated with intracutaneous injections of botulinum toxin (Botox(R)) 2 U/4 cm2. Sweat function was studied clinically and by objective measurements after treatment of one side. Treated and untreated sides, and pre- and post-treatment skin areas were compared. Subjective evaluation was performed after treatment of one side and 2-5 months after treatment of both sides. Duration of effect was controlled by a one-year follow-up. Sweating disappeared in eight out of 13 patients with axillary and in five out of 19 with palmar hyperhidrosis, and was reduced markedly in another five out of 13 and 10 out of 19 patients. Two-thirds of those treated for hand sweat noticed a slight and transient reduction of power of finger grip. No side-effects were noticed after treatment of axillary hyperhidrosis. We find intracutaneous injections of botulinum toxin with this technique safe and effective, and due to the relatively long duration of effect the treatment should be recommended before sympathectomy for focal hyperhidrosis.
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| 6. |
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| 7. |
- Naver, Hans, et al.
(författare)
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Treatment of focal hyperhidrosis with botulinum toxin type A : Brief overview of methodology and 2 years' experience
- 1999
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Ingår i: European Journal of Neurology. - : Wiley. - 1351-5101 .- 1468-1331. ; 6:Suppl 4, s. s117-s120
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Tidskriftsartikel (refereegranskat)abstract
- Focal hyperhidrosis is a relatively common condition in which patients experience excessive sweating, usually of the palms, axillae, face or feet. Until recently, the only effective treatment option for this chronic condition was surgery. We aimed to evaluate the efficacy and tolerability of botulinum toxin type A (BTX-A) in the treatment of patients with hyperhidrosis, establishing optimum dosages and methods of administration. One hundred and seventy patients with focal hyperhidrosis were referred for treatment, the majority with palmar and axillary hyperhidrosis. The iodine-starch test was used to locate and show the extent of the hyperhidrotic area. Using a template to mark the injection sites, 2 U doses of BTX-A were injected intradermally at regular intervals. Patients received either 0.5 or 0.8 U/cm2 with regional anaesthesia if required. The iodine starch test and measurements of evaporation were used to assess efficacy. The majority of patients reported a marked reduction in sweating, About one-third of the patients who received BTX-A 0.5 U/cm2 requested supplementary small injections into islands of skin where they experienced residual sweating. As a result, the standard dose was increased to BTX-A 0.8 U/cm2. The median duration of treatment effect was 10 months (range, 3 to >14 months). The effectiveness of BTX-A was not reduced by repeated use. BTX-A treatment was well tolerated by all patients. In conclusion, chemical sudomotor denervation with BTX-A should be recommended before surgical sympathectomy for the treatment of focal hyperhidrosis.
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| 8. |
- Rystedt, Alma, et al.
(författare)
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Anhidrotic effect of intradermal injections of botulinum toxin : A comparison of different products and concentrations
- 2008
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Ingår i: Acta Dermato-Venereologica. - 0001-5555 .- 1651-2057. ; 88:3, s. 229-233
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Tidskriftsartikel (refereegranskat)abstract
- Botulinum toxin is used in various fields of medicine, including in the treatment of hyperhidrosis. Three products containing botulinum toxin are commercially available in Sweden; Botox, Dysport and Neurobloc. In the literature dose-response has varied with respect to these 3 products. We hypothesized that the dilution level of botulinum toxin is of importance for the effect and we therefore investigated anhidrosis after intradermal injections of each product in 3 different concentrations. Nine healthy subjects received 0.1 ml injections in the back. The anhidrotic areas were identified by an iodine-starch test after 3 weeks. When the 3 products were diluted to 100 U/ml level the achieved mean anhidrotic areas were approximately the same. This is in strong contrast with the large dose conversion factors suggested for intramuscular injections of the products. Furthermore, the lowest used concentrations for Botox(R) (25 U/ml) and Neurobloc (100 U/ml) led to the largest anhidrotic mean area per unit, respectively. The optimal concentration in this study was 25 U/ml for Botox, 100 U/ml for Dysport and 100 U/ml for Neurobloc, but for Botox and Neurobloc the optimal concentrations may be even lower.
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| 9. |
- Rystedt, Alma, et al.
(författare)
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Clinical Experience of Dose Conversion Ratios Between 2 Botulinum Toxin Products in the Treatment of Cervical Dystonia
- 2012
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Ingår i: Clinical neuropharmacology. - 0362-5664 .- 1537-162X. ; 35:6, s. 278-282
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:The units of different botulinum toxin products are not identical, and the dose equivalence has been debated for several years. In the year 2000, our clinic changed the recommended botulinum toxin product from Botox to Dysport for the treatment of cervical dystonia. Based on published reports, where dose conversion ratios from 1:1 to 1:6 (Botox:Dysport) had been used, and our own clinical experience, the dose conversion ratio was set to 1:2. The objective of this study was to retrospectively monitor the used doses of each product and the subsequent clinical effect.METHODS:A retrospective study, using casebook notes from 75 patients, was done to investigate treatment doses, subjective clinical effect, and the appearance of adverse events.RESULTS:The median dose conversion ratio that had been used at the product switch was 1:2.3 (Botox:Dysport). After clinical adjustment, the ratio was 1:2.1 at the next 3 treatments. There was a tendency for a more effective treatment and more adverse events after the product switch. A follow-up was performed 6.5 years later using casebook notes from 53 of the same patients. By this time, the doses had been reduced, and the median dose conversion ratio had decreased to 1:1.7 (Botox:Dysport). The adverse events reported at this point were fewer for the patients treated.CONCLUSIONS:In this study, the most appropriate dose conversion ratio to use when switching from Botox to Dysport was 1:1.7.
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| 10. |
- Rystedt, Alma, et al.
(författare)
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Effect of Botulinum Toxin Concentration on Reduction in Sweating : a randomized, double-blind study
- 2013
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Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 93:6, s. 674-678
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Tidskriftsartikel (refereegranskat)abstract
- Dose-response studies of botulinum toxin for reduction of sweating are sparse in the literature. The aim of this study was to determine the most appropriate concentrations of Botox (R), Dysport (R), Xeomin (R) and NeuroBloc (R), respectively, in order to achieve the greatest reduction in sweating, thus reducing the costs and increasing the safety of treatment. Four concentrations of each product were investigated. Intradermal injections of all products and concentrations were applied to the backs of 20 consenting subjects, in a randomized, double-blind manner. Areas of anhidrotic and hypohidrotic skin were measured with an iodine-starch test after 4, 8 and 12 weeks, respectively. Optimal concentrations were found to be 25 U/ml for Botox and Xeomin, approximately 100 U/ml for Dysport, and 50 U/ml for NeuroBloc. When comparing the mean anhidrotic area per unit for 100 U/ml of each product, the calculated dose conversion ratios were 1:1.6:1.2:1.3 (Botox:Dysport:Xeomin:NeuroBloc). If, instead, the optimal concentration for each product was compared, the dose conversion ratios were 1:4.8:1.3:2.2. Thus, it is crucial to consider botulinum toxin concentration in a treatment regimen.
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