Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one...Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry(HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type Ⅱ achalasia are better after treatment compared to younger patients, males and type Ⅲ achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.展开更多
Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the eff...Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the efficacy of facial nerve blockade in combination with a single administration of different low BTX. Methods: Forty patients with CM submitted to unilateral facial nerve blockade (supraorbital, supratrochlear and auriculotemporal) were divided into 4 randomized groups in a double-blind manner in order to receiveim, after 7 days: 25 IU Botox®(Botox group), 25 IU Prosigne®(25-Pro group), 33.3 IU Prosigne®(33-Pro group) or saline (control group), with the dose divided for application to 10 sites in the frontal and bilateral temporal regions. Analgesia and adverse effects were evaluated: 1) before blockade of the facial nerves and 2) 4 weeks, 3) 8 weeks and 4) 12 weeks after BTX-A or saline application (HC clinical trial no. 12465). Results: Botox®(25 IU) or Prosigne®(33.3 IU) resulted in at least seven-day intervals between headache attacks associated with 70% reduction in frequency and intensity of crises over 12 weeks (P ®resulted in 8 weeks of analgesia. The conversion factor between Botox®and Prosigne®was 1:1.3. Conclusions: Im application of Botox®(25 IU) or Prosigne®(33.3 IU) one week after nerve blockade on the painful side was equally effective for 12 weeks in patients with chronic daily headache, with the conversion factor between Botox®and Prosigne®being 1:1.3.展开更多
文摘Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry(HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometric type by HRM are also predictors of responsiveness to treatment. Older patients, females and type Ⅱ achalasia are better after treatment compared to younger patients, males and type Ⅲ achalasia. Self-expandable metallic stents are an alternative in patients non responding to conventional therapies.
文摘Background: The treatments suggested for chronic migraine (CM) include: 1) intramuscular (im) botulinum toxin (BTX) every 12 weeks, and 2) blockade of peripheral nerves of the head. The present study evaluated the efficacy of facial nerve blockade in combination with a single administration of different low BTX. Methods: Forty patients with CM submitted to unilateral facial nerve blockade (supraorbital, supratrochlear and auriculotemporal) were divided into 4 randomized groups in a double-blind manner in order to receiveim, after 7 days: 25 IU Botox®(Botox group), 25 IU Prosigne®(25-Pro group), 33.3 IU Prosigne®(33-Pro group) or saline (control group), with the dose divided for application to 10 sites in the frontal and bilateral temporal regions. Analgesia and adverse effects were evaluated: 1) before blockade of the facial nerves and 2) 4 weeks, 3) 8 weeks and 4) 12 weeks after BTX-A or saline application (HC clinical trial no. 12465). Results: Botox®(25 IU) or Prosigne®(33.3 IU) resulted in at least seven-day intervals between headache attacks associated with 70% reduction in frequency and intensity of crises over 12 weeks (P ®resulted in 8 weeks of analgesia. The conversion factor between Botox®and Prosigne®was 1:1.3. Conclusions: Im application of Botox®(25 IU) or Prosigne®(33.3 IU) one week after nerve blockade on the painful side was equally effective for 12 weeks in patients with chronic daily headache, with the conversion factor between Botox®and Prosigne®being 1:1.3.
