Predicting migraine responsiveness to botulinum toxin type A injections.

BACKGROUND: Botulinum toxin type A (BTX) is used prophylactically to reduce the frequency of migraine headaches, with inconsistent responses reported in the literature. The purpose of our study was to determine whether BTX injections at doses used for upper-face cosmetic purposes, which differ from doses typically used by headache specialists, could prevent imploding and ocular but not exploding migraines. OBSERVATIONS: Study participants were recruited among patients who had received or were planning to receive BTX injections for upper-face cosmetic purposes but also reported having migraines. Among the 18 patients who completed the study, most with imploding and ocular migraines experienced a significant reduction in their headache frequency, whereas those with exploding migraines generally did not. CONCLUSIONS: Our study supports the hypothesis that patients with imploding and ocular migraines are more responsive to BTX than those with exploding migraines. Injections of BTX at doses appropriate for cosmetic purposes may be sufficient to prevent migraine attacks.

Long-term efficacy of anchored barbed sutures in the face and neck.

BACKGROUND: The thread lift is a minimally invasive procedure that uses barbed sutures, inserted subcutaneously, to produce lifting of ptotic tissue of the face and neck. There are currently very limited data on longevity and patient satisfaction following barbed suture lifting procedures. OBJECTIVE: The purpose of this study was to assess long-term efficacy following the use of barbed sutures. MATERIALS AND METHODS: A satisfaction survey was mailed to 20 patients who were a minimum of 6 months (range, 6 to 16 months) postprocedure. Physician assessment of pre- and postprocedure photographs was also performed. RESULTS: At an average of 11.5 months postprocedure, patients felt that the barbed suture lift met their expectations, rating their satisfaction a 6.9 on a scale of 1 to 10. Independent physicians rated the overall improvement an average of 4.6 of 10. Higher scores were noted in Zone 1 (tear trough/malar fat pad and nasolabial folds) compared to Zone 2 (marionette lines, jowls, and jawline definition) and Zone 3 (platysmal bands and neck contour). CONCLUSION: The barbed suture lift procedure provides moderate long-term and sustained improvement for facial laxity, with most improvement seen in the tear trough/malar fat pads and nasolabial folds. In this study, clinical efficacy was seen up to 16 months postprocedure.

Pancreatic panniculitis associated with acinic cell adenocarcinoma: a case report and review of the literature.

Pancreatic panniculitis represents a rare skin manifestation of underlying pancreatic pathology. The clinical presentation of the condition is remarkably consistent and privy to several unique clinical and histopathologic findings. We report a case of a 50-year-old white woman with pancreatic panniculitis and newly diagnosed pancreatic acinic cell adenocarcinoma. The clinical and histopathologic features, underlying causes, and treatments are reviewed.

Blue nevi: a case report and review of the literature.

Blue nevi can present clinically as blue, gray, brown, or black solitary nodules or plaques on the skin. Histologically, they represent collections of melanocytes and melanophages in the dermis. We present a case of a cellular blue nevus in a 55-year-old white man that presented as an enlarging blue-gray nodule on the right dorsal foot. These cases can be challenging both clinically and histologically because malignant melanoma or malignant transformation of a blue nevus should be considered. We review the various types of blue nevi and the literature.

Prune-belly syndrome in two children and review of the literature.

Prune-belly syndrome is a congenital disorder characterized by abdominal wall musculature deficiency, urinary tract anomalies, and bilateral cryptorchidism. Because of the defect in the musculature, the abdominal skin has a peculiar wrinkled appearance. The syndrome is commonly associated with pulmonary, skeletal, cardiac, and gastrointestinal defects. Developmental delays and growth retardation have also been reported. The incidence of prune belly syndrome is approximately 1:40,000 live births. Over 95% of patients are men. Urinary tract disease is the major prognostic factor, with the complications of pulmonary hypoplasia and end stage renal disease resulting in a mortality rate of 60%. Treatment involves surgical correction of the abdominal wall defect and urinary tract abnormalities, early orchiopexy, and supportive management of associated defects.