A Double-Blind, Placebo-Controlled Study of Appropriate Site of Botulinum Toxin Therapy in Hemifacial Spasm.

INTRODUCTION: Hemifacial spasm (HFS) is a condition causing poor quality of life. Treatment with botulinum toxin A (BTX) injection is effective. Only one randomized controlled trial with a single-blind fashion has evaluated if oral injection is needed in HFS. The present study aimed to evaluate the necessity of oral BTX injection in HFS by a randomized, double-blind, placebo-controlled method. METHODS: We conducted a double-blind, placebo-controlled trial in patients with HFS who never received BTX treatment. Eligible patients randomly received either 15 units of BTX around the eye and normal saline around the mouth (group A) or 15 units of BTX around both the eye and the mouth (group B). The primary outcomes were self-reported symptoms and observed frequency of spasms, while the secondary outcome was the duration of improvement or the time between the injection and the recurrence of symptoms to the same condition as before treatment. Student t test and survival analyses were used to compare the duration of symptoms between both groups. The mean changes were compared to secondary outcomes between the two groups. RESULTS: There were 60 patients enrolled, half in each group. Baseline characteristics between both groups were similar. The mean (SD) of the duration of improvement in group A and B was 22.97 (18.85) and 17.53 (14.90) weeks, respectively (p = 0.220). There was no difference between both groups by survival analysis. Group B had a higher percentage of mouth improvement but there was no difference in the percentage of eye improvement, visual analog scale of eye and mouth spasm, or frequency of eye and mouth spasm. Group B had a higher incidence of side effects particularly mouth drooping (30% vs 10%) than group A (p = 0.053). CONCLUSION: The mouth injection of BTX may not be necessary for HFS. It may be beneficial to reduce mouth symptoms with a higher rate of mouth drooping.

Anterior skin numbness after total knee arthroplasty: A prospective comparison study between diabetic and non-diabetic patients.

BACKGROUND: Anterior skin numbness from injury of the infrapatellar branch of saphenous nerve (IPBSN) and/or the anterior-inferior branch of the femoral cutaneous nerve (AIBFN) has been reported after TKA. A recent study has demonstrated no difference in skin numbness between minimally invasive and standard approach TKA. The purpose of our study was to compare the area of skin numbness following TKA in the diabetic and non-diabetic patient. MATERIAL AND METHODS: 120 patients (41 type II diabetic and 74 non-diabetic) undergoing TKA were evaluated. Five diabetic patients with preoperative skin numbness were excluded. Area of anterior skin numbness was periodically evaluated with a minimum 2-year follow-up (FU). RESULTS: Clinically, there was no difference in prevalence of skin numbness (73.2% vs 68.9%, p = 0.36) and warmness (97.6% vs 97.3%, p = 1.00) between diabetics and non-diabetics. Average area of numbness was comparable. However, duration of numbness recovery was significantly longer in diabetics (8.6 vs 5.3 months, p = 0.001). Diabetics had a higher rate of global anterior numbness (48.3% vs 22.9%, p = 0.045). Prevalence of supero-lateral skin numbness (2.6%, n = 3) correlated with the skin incision extended proximally above upper pole of patella at least 4.0 cm. CONCLUSION: The duration of numbness recovery following TKA was significantly longer in diabetic patients.

The Socioeconomic Burden of Cholangiocarcinoma Associated With Opisthorchis viverrini Sensu Lato Infection in Northeast Thailand: A Preliminary Analysis.

The northeast of Thailand, which is the poorest region of the country, has the highest incidence of cholangiocarcinoma (CCA) worldwide. This is associated with infection with the liver fluke Opisthorchis viverrini. Although an estimated 20,000 people die every year of this disease, the socioeconomic impact of this mortality on the victims' family and the community in which he or she lived remains unknown. Here, we provide background information on the socioeconomic groups most effected by CCA and provide a qualitative estimate of the likely financial burden on the family and community. Most victims of CCA are small-scale farmers. Mortality occurs most commonly in males between the ages of 40 and 65, having either children or grandchildren to support. Costs can be divided between premortality with the family paying for transport and accommodation to the hospital, as well as costs not covered by the Thai Universal Health Coverage scheme. The main costs, however, are likely to be postmortem with loss of income and potentially the loss of a major contributor to farm work. What is urgently required is a quantitative estimate of the costs of CCA and long-term studies of the families and communities affected to determine where and how the burden of CCA falls.

Fatal peripheral T-cell lymphoma following intramuscular tuberculosis of the forearm.

Intramuscular tuberculosis (TB) is a rare disease, and lymphoma may occur following a bout of TB. We report on an unusual presentation of peripheral T-cell lymphoma that occurred after an infiltrative lesion of intramuscular TB of the forearm in an immunocompetent host. To our knowledge, this is the first case where TB of a muscle presenting as an infiltrative lesion instead of an abscess developed into peripheral T-cell lymphoma.

Geometry of the clavicle and reliability of measurement using PACS.

PURPOSE: To investigate the geometry of the clavicle and to assess the reliability of Picture Archiving Communication System (PACS) for its measurement. METHODS: One hundred pairs of dry clavicles from 78 males and 22 females were measured on radiographs using PACS. Measurements included all of the following parameters: length, width, medial and lateral angulation. The intraclass correlation coefficient (ICC) for the inter-observer and intra-observer reliability was calculated. RESULTS: The mean left clavicle length among males and females was 149.25 ± 9.64 and 133.30 ± 8.32 mm, respectively. The respective mean right clavicle length among the males and females was 147.77 ± 9.99 and 132.08 ± 6.92 mm. The clavicles from male cadavers were significantly longer, wider and thicker than those from females, on both the left and right (P < 0.05). Among both the male and female clavicles, the left side was significantly longer than the right (P < 0.05). There was good to excellent intra-observer reliability (ICC > 0.70) for all parameters. Inter-observer reliability was also found good to excellent for all parameters except for medial clavicular angulation; for which there was fair reliability (ICC = 0.697). CONCLUSION: The geometry of the clavicle is influenced by sex and side. Use of PACS as a measurement tool is reliable. Data from this study will be useful for pre-contouring plate or improving future designs of the anatomical plate of the clavicle.