Page kidney after botulinum toxin injection during chiropractic care / 영남의대학술지

Page kidney refers to the phenomenon of hypertension secondary to long-standing compression of renal parenchyma caused by renal subcapsular collection. The most common cause of renal subcapsular collection is a hematoma which usually occurs after a history of blunt trauma. A 42-year-old female patient who received botulinum toxin injection in her back during chiropractic care was admitted to the emergency room with sudden bilateral flank pain and hypertension. The computed tomography (CT) images demonstrated the presence of bilateral subcapsular renal hematoma. The patient was treated conservatively and recovered well. The follow up CT images showed markedly resolved bilateral hematoma.

Long-term outcome of botulinum toxin injection for the treatment of chronic anal fissure: a randomized controlled trial.

Background: Lateral internal sphincterotomy has been accepted as the gold standard for chronic anal fissure. Despite the effectiveness, it carries a risk of fecal incontinence. Non-operative management of chronic anal fissure has been used as alternative treatment. Objectives: Evaluate the efficacy and long-term outcomes of botulinum toxin injection for the treatment of chronic anal fissure. Material and method: A prospective randomized controlled trial was conducted on 40 patients diagnosed with chronic anal fissure who were assigned to undergo either botulinum toxin injection or lateral internal sphincterotomy. Results: The wound-healing rate at 12 weeks and the reduction of post-treatment-resting pressure was significantly better in the sphincterotomy group. Complications and the continence status were not different between the two treatment groups. None of the patients in the sphincterotomy group required additional treatment, while seven patients in the botulinum toxin injection group underwent subsequent sphincterotomy within three years. Conclusion: The long-term result of botulinum toxin injection for chronic anal fissure was inferior to lateral internal sphincterotomy.

Multilevel botulinum toxin type a as a treatment for spasticity in children with cerebral palsy: a retrospective study

INTRODUCTION: Cerebral palsy is the most common cause of physical disability in children. Spasticity is a disabling clinical symptom that is prevalent among patients suffering from cerebral palsy. The treatment of spasticity with botulinum toxin type A (BTX-A) is a well-established option in the interdisciplinary management of spasticity, providing focal reductions in muscle tone in cerebral palsy patients. OBJECTIVE: The aim of this retrospective study was to describe the effect of multilevel BTX-A injections in the lower extremities, focusing mainly on gross motor function and functional status in cerebral palsy patients. METHODS: Data from 71 cerebral palsy patients (64 percent male, 36 percent female, mean age 6.7 ±3.2 years) were analyzed retrospectively. We used the Ashworth and Tardieu scales to evaluate the degree of spasticity. Motor function was measured by the Gross Motor Function Measure (GMFM-88), and functional status was classified by the Gross Motor Function Classification System (GMFCS I-V). Multilevel BTX-A injections were applied after sedation and with electrostimulation guidance. The evaluations were repeated every three months, and the patients were followed for six months. RESULTS: We found that the Ashworth and Tardieu scores decreased significantly at the three-month evaluation (p<0.05) but not at the six-month evaluation (p>0.05). Although the improvement in spasticity was not maintained at the six-month evaluation, GMFM-88 scores increased significantly at the three- and six-month assessments. GMFSC levels showed no change in the three- and six-month assessments. CONCLUSION: We believe that a single multilevel BTX-A injection reduces spasticity and improves motor function in children with cerebral palsy.

The Complications Developed after Repeated Botulinum Toxin Injection

PURPOSE: To investigate the incidence of complication associated with repeated botulinum toxin chemodenervation in extraocular muscle. METHODS: 47 patients who had taken botulinum toxin chemodenervation from 1996 to November 2001 were reviewed retrospectively. 10 patients had taken repeated injection. Saline diluted botulinum toxin was directly injected into the extraocular muscle through the Teflon coated needle. RESULTS: In 10 patients, 5 patients had complications which were 2 cases of hypertropia, 2 cases of ptosis and 1 case of retrobulbar hemorrhage who was 44 year old woman taken 5 times of botulinum toxin injection. She was successfully treated with lateral canthotomy and cantholysis. CONCLUSIONS: Rate of complication in repeated botulinum toxin chemodenervation was not different from that of single procedure. We experienced one case of retrobulbar hemorrhage in 10 patients with repeated botulinum injection.