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Anthony N Kalloo - One of the best experts on this subject based on the ideXlab platform.
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effects of Botulinum Toxin a on the sphincter of oddi an in vivo and in vitro study
Gut, 1998Co-Authors: J Sand, Anthony N Kalloo, I Nordback, P Arvola, I Porsti, Pankaj J. PasrichaAbstract:Background —Botulinum Toxin A is a potent inhibitor of the release of acetylcholine from nerve endings. Local injection of Botulinum Toxin has recently been suggested to be helpful in sphincter of Oddi dyskinesia by decreasing sphincter of Oddi pressure. Aims —To explore the mechanism of action of Botulinum Toxin A on sphincter of Oddi (SO) muscle. Methods —Four piglets underwent duodenoscopy and SO manometry was performed. After obtaining a baseline pressure, the SO was injected with normal saline and the experiment repeated after one week. The SO was then injected endoscopically with Botulinum Toxin (40 U) with follow up manometry one week later. The sphincter of Oddi was removed from 10 pigs, cut into three rings, and placed in an organ bath. The force of contraction was measured and registered on a polygraph. Rings were stimulated by 70 V (10 Hz, 0.5 ms) electrical field stimulation for 20 seconds, exogenous acetylcholine (100 μM), and KCl (125 mM). Botulinum Toxin (0.1 U/ml) or atropine (1 μM) was added to the incubation medium and the stimulation was repeated. Results —Mean basal SO pressure in the pigs remained unchanged after saline injection but decreased to about 50% of baseline value following Botulinum Toxin injection (p=0.04). The contractions induced by direct stimulation of SO smooth muscle with KCl were not significantly affected by either atropine or Botulinum Toxin. In all rings exogenous acetylcholine induced contractions, which were totally blocked by atropine, but not by Botulinum Toxin. Electrical field stimulation induced contractions that were inhibited by both atropine and Botulinum Toxin. Conclusion —Botulinum Toxin inhibits pig sphincter of Oddi smooth muscle contractions by a presynaptic cholinergic mechanism, similar to that described in skeletal muscle.
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intrasphincteric Botulinum Toxin for the treatment of achalasia
The New England Journal of Medicine, 1995Co-Authors: Pankaj J. Pasricha, William J Ravich, Thomas R Hendrix, Samuel Sostre, Bronwyn Jones, Anthony N KallooAbstract:Background Achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. We report the use of Botulinum Toxin, a paralytic agent, for the treatment of this condition. Methods In a double-blind trial, 21 patients with achalasia received either 80 units of Botulinum Toxin or placebo, injected endoscopically into the lower esophageal sphincter. One week later, the response to treatment was assessed on the basis of changes in the symptom scores (measured on a scale from 0 to 9), pharyngoesophagograms, and results of esophageal manometric and scintigraphic studies. Patients who received placebo initially were subsequently treated with Botulinum Toxin. After six months, esophageal scintigraphy was repeated. Results One week after treatment, the mean decrease in the symptom score was 5.4 points for the patients treated with Botulinum Toxin and 0.5 point for the placebo group (P = 0.001). The mean decrease in the pressure of the lower esophageal sphincter was 33 percent in the trea...
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intrasphincteric injection of Botulinum Toxin for suspected sphincter of oddi dysfunction
Gut, 1994Co-Authors: Pankaj J. Pasricha, E P Miskovsky, Anthony N KallooAbstract:Botulinum Toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected Botulinum Toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum Toxin was injected into the sphincter of Oddi, by a sclerotherapy needle passed through a duodenoscope. In the first patient, intrasphincteric injection of Botulinum Toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric Botulinum Toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically.
Pankaj J. Pasricha - One of the best experts on this subject based on the ideXlab platform.
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effects of Botulinum Toxin a on the sphincter of oddi an in vivo and in vitro study
Gut, 1998Co-Authors: J Sand, Anthony N Kalloo, I Nordback, P Arvola, I Porsti, Pankaj J. PasrichaAbstract:Background —Botulinum Toxin A is a potent inhibitor of the release of acetylcholine from nerve endings. Local injection of Botulinum Toxin has recently been suggested to be helpful in sphincter of Oddi dyskinesia by decreasing sphincter of Oddi pressure. Aims —To explore the mechanism of action of Botulinum Toxin A on sphincter of Oddi (SO) muscle. Methods —Four piglets underwent duodenoscopy and SO manometry was performed. After obtaining a baseline pressure, the SO was injected with normal saline and the experiment repeated after one week. The SO was then injected endoscopically with Botulinum Toxin (40 U) with follow up manometry one week later. The sphincter of Oddi was removed from 10 pigs, cut into three rings, and placed in an organ bath. The force of contraction was measured and registered on a polygraph. Rings were stimulated by 70 V (10 Hz, 0.5 ms) electrical field stimulation for 20 seconds, exogenous acetylcholine (100 μM), and KCl (125 mM). Botulinum Toxin (0.1 U/ml) or atropine (1 μM) was added to the incubation medium and the stimulation was repeated. Results —Mean basal SO pressure in the pigs remained unchanged after saline injection but decreased to about 50% of baseline value following Botulinum Toxin injection (p=0.04). The contractions induced by direct stimulation of SO smooth muscle with KCl were not significantly affected by either atropine or Botulinum Toxin. In all rings exogenous acetylcholine induced contractions, which were totally blocked by atropine, but not by Botulinum Toxin. Electrical field stimulation induced contractions that were inhibited by both atropine and Botulinum Toxin. Conclusion —Botulinum Toxin inhibits pig sphincter of Oddi smooth muscle contractions by a presynaptic cholinergic mechanism, similar to that described in skeletal muscle.
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intrasphincteric Botulinum Toxin for the treatment of achalasia
The New England Journal of Medicine, 1995Co-Authors: Pankaj J. Pasricha, William J Ravich, Thomas R Hendrix, Samuel Sostre, Bronwyn Jones, Anthony N KallooAbstract:Background Achalasia is a disorder of swallowing in which the lower esophageal sphincter fails to relax. We report the use of Botulinum Toxin, a paralytic agent, for the treatment of this condition. Methods In a double-blind trial, 21 patients with achalasia received either 80 units of Botulinum Toxin or placebo, injected endoscopically into the lower esophageal sphincter. One week later, the response to treatment was assessed on the basis of changes in the symptom scores (measured on a scale from 0 to 9), pharyngoesophagograms, and results of esophageal manometric and scintigraphic studies. Patients who received placebo initially were subsequently treated with Botulinum Toxin. After six months, esophageal scintigraphy was repeated. Results One week after treatment, the mean decrease in the symptom score was 5.4 points for the patients treated with Botulinum Toxin and 0.5 point for the placebo group (P = 0.001). The mean decrease in the pressure of the lower esophageal sphincter was 33 percent in the trea...
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intrasphincteric injection of Botulinum Toxin for suspected sphincter of oddi dysfunction
Gut, 1994Co-Authors: Pankaj J. Pasricha, E P Miskovsky, Anthony N KallooAbstract:Botulinum Toxin is a potent inhibitor of the release of acetylcholine from nerve endings. It has previously been shown that it can effectively reduce lower oesophageal sphincter pressures both in animals and humans with achalasia. This study examined the hypothesis that locally injected Botulinum Toxin could also reduce sphincter of Oddi pressure in patients with sphincter of Oddi dysfunction. Two patients with postcholecystectomy pain syndrome were diagnosed with sphincter of Oddi dysfunction (by biliary manometry in one patient and by hepatobiliary scanning criteria in the other). Botulinum Toxin was injected into the sphincter of Oddi, by a sclerotherapy needle passed through a duodenoscope. In the first patient, intrasphincteric injection of Botulinum Toxin reduced sphincter pressure by about 50%, an effect that was sustained for at least four months. In the second patient, intrasphincteric injection caused about a 50% improvement in bile flow, with normalisation of scintigraphy. Neither patient showed any sustained improvement in pain despite these objective findings. Both patients eventually had endoscopic sphincterotomy, which also did not result in symptomatic improvement in either patient. No side effects were seen. Intrasphincteric Botulinum Toxin is a simple and effective means of lowering sphincter of Oddi pressure. This technique has potential for being useful clinically.
Gerd Plewig - One of the best experts on this subject based on the ideXlab platform.
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amelioration of body odor after intracutaneous axillary injection of Botulinum Toxin a
Archives of Dermatology, 2003Co-Authors: Marc Heckmann, Bianca Teichmann, Bettina M Pause, Gerd PlewigAbstract:Background Body odor is a ubiquitous phenomenon. It is commonly attributed to sweating and noted explicitly in the axillary area. Botulinum Toxin A has recently been shown to be effective for axillary hyperhidrosis. Its effect on axillary odor, however, is unknown. Observations Sixteen healthy volunteers were injected with Botulinum Toxin A (Dysport, 100 U dissolved in 0.9% sodium chloride solution) in one axilla and 0.9% sodium chloride solution in the other axilla in a randomized, double-blinded fashion. After 7 days, body odor was assessed by a T-shirt sniff test. A significant reduction of odor intensity was observed for the Botulinum Toxin A–treated side. The smell was also rated significantly less unpleasant. Conclusions These findings suggest that Botulinum Toxin A can ameliorate or even improve body odor. The underlying mechanisms may include interference with skin microbes and denervation of apoeccrine sweat glands, but this remains to be further investigated.
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Botulinum Toxin a for axillary hyperhidrosis excessive sweating
The New England Journal of Medicine, 2001Co-Authors: Marc Heckmann, Andres O Ceballosbaumann, Gerd PlewigAbstract:Background Treatment of primary focal hyperhidrosis is often unsatisfactory. Botulinum Toxin A can stop excessive sweating by blocking the release of acetylcholine, which mediates sympathetic neurotransmission in the sweat glands. Methods We conducted a multicenter trial of Botulinum Toxin A in 145 patients with axillary hyperhidrosis. The patients had rates of sweat production greater than 50 mg per minute and had had primary axillary hyperhidrosis that was unresponsive to topical therapy with aluminum chloride for more than one year. In each patient, Botulinum Toxin A (200 U) was injected into one axilla, and placebo was injected into the other in a randomized, double-blind manner. (The units of the Botulinum Toxin A preparation used in this study are not identical to those of other preparations.) Two weeks later, after the treatments were revealed, the axilla that had received placebo was injected with 100 U of Botulinum Toxin A. Changes in the rates of sweat production were measured by gravimetry. Res...
H Hamm - One of the best experts on this subject based on the ideXlab platform.
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the place of Botulinum Toxin type a in the treatment of focal hyperhidrosis
British Journal of Dermatology, 2004Co-Authors: Nicholas J Lowe, Anna Campanati, A Offidani, I Bodokh, S Cliff, P Jaen, O Kreyden, Markus Naumann, J Vadoud, H HammAbstract:Summary Background Hyperhidrosis (primary or secondary) is excessive sweating beyond that required toreturn body temperature to normal. It can be localized or generalized, commonly affecting theaxillae, palms, soles or face, and can have a substantial negative effect on a patient’s quality of life.Impact of disease Objective evaluation comprising quantitative assessment (gravimetric and Minor’siodine starch test) and subjective evaluation (Dermatology Quality of Life Index and HyperhidrosisImpact Questionnaire) allow accurate assessment of the impact of hyperhidrosis on patients.Botulinum Toxin type A Botulinum Toxin type A acts by inhibiting the release of acetylcholine at thepresynaptic membrane of cholinergic neurones. It has proved useful in treating a number of dis-eases relating to muscular dystonia and is now proving beneficial in treating hyperhidrosis. Clinicaltrials investigating Botulinum Toxin type A use in axillary and palmar hyperhidrosis show signi-ficant benefits with few side-effects reported, with a favourable impact also being seen on patientquality of life. Botulinum Toxin type A injections are generally well-tolerated with beneficial resultslasting from 4 to 16 months.Conclusions Botulinum Toxin type A injections are an effective and well-tolerated treatment forhyperhidrosis. This paper proposes a positioning of this treatment along with current establishedtreatments, and highlights the role of Botulinum Toxin type A as a valuable therapy for thetreatment of hyperhidrosis.Key words: axillary, Botulinum Toxin type A, hyperhidrosis, palmar, quality of life
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focal hyperhidrosis effective treatment with intracutaneous Botulinum Toxin
Archives of Dermatology, 1998Co-Authors: Markus Naumann, H Hamm, Uta B Hofmann, Ilka Bergmann, Klaus V Toyka, Karlheinz ReinersAbstract:Objective: To evaluate the effect of intracutaneous injections of Botulinum Toxin type A on excessive focal hyperhidrosis. Design: Therapeutic before-and-after trial over 4 months. Setting: Neurological and dermatological university departments. Patients: Eleven patients with excessive axillary, palmar, or plantar hyperhidrosis fulfilling the following criteria : (1) local and systemic drug therapy had failed to improve their symptoms; (2) the patients were severely disabled with respect to their occupation and social activities ; and (3) a successful treatment by Botulinum Toxin would obviate the need for destructive surgical procedures. Interventions: Three mouse units of Botulinum Toxin (Botox) per 4-cm 2 skin area was injected intracutaneously in 16 axillae, 8 palms, and 2 soles. Main Outcome Measures: Reduction of hyperhidrosis as documented by the Minor iodine-starch test and gravimetrical assessment of local spontaneous sweat production measured over 1 minute. Results: In all patients, Botulinum Toxin completely abolished sweating in the injected areas (P<.001) within 3 to 7 days. No relevant adverse effects occurred and no clinical recurrence of hyperhidrosis was observed within the follow-up period of up to 5 months. Occasionally, subclinical reactivation of sweat gland function was observed 4 months after treatment. Conclusions: Intracutaneous Botulinum Toxin seems preferable to any hitherto used conservative or surgical procedures and may become the therapy of choice in pathological focal hyperhidrosis.
Rajesh Dikshit - One of the best experts on this subject based on the ideXlab platform.
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facial rejuvenation after intradermal Botulinum Toxin is it really the Botulinum Toxin or is it the pricks
Dermatologic Surgery, 2010Co-Authors: Rinky Kapoor, Debraj Shome, Vandana Jain, Rajesh DikshitAbstract:BACKGROUND The use of intradermal Botulinum Toxin A (onaBotulinumToxinA) remains a relatively new technique and is an off-label cosmetic application for facial skin rejuvenation. There is little documented clinical evidence of the objective benefits of this therapy. PURPOSE To determine whether intradermal facial onaBotulinumToxinA injection has any benefits. STUDY DESIGN Interventional, comparative, split face clinical trial. METHODS Informed consent was obtained from 10 physicians. One half of the physician's faces were randomly injected with onaBotulinumToxinA (2 U/0.1 mL; 30 facial injections on half of the face, each 0.1 mL) intradermally and the other half of the face with normal saline (30 facial injections on half of the face, each 0.1 mL). The injecting clinician and the subjects were blinded to the contents of the syringes. One and 4 weeks later, two neutral, blinded observers assessed the subjects in person. The patients were also photographed in ambient light surroundings and the same observers compared the halves of their faces in photographs and rated them on a scale of −4 to +4. RESULTS Global improvement in skin texture and tightness was noted in the post-treatment photographs (the skin appeared to be tenser and smoother), although there was no difference between the two groups and, hence, the changes could not be clinically ascribed to the intradermal Botulinum Toxin injections. No other meaningful clinical difference could be demonstrated between the two sides of the face, in any of the 10 subjects, in person or in photographs. The small study sample precluded formal statistical analysis. CONCLUSION Intradermal Botulinum Toxin A injection does not appear to have any benefit in facial rejuvenation. The authors have indicated no significant interest with commercial supporters.