Treatment of axillary osmidrosis: a comparison between subcutaneous laser and superficial liposuction curettage.

BACKGROUND: Axillary osmidrosis can lead to personal and social problems, particularly in Asian culture. Superficial liposuction with curettage and subcutaneous laser are surgical intervention commonly used for osmidrosis. OBJECTIVE: Retrospectively, we compared the effectiveness and complications between superficial liposuction with curettage and subcutaneous laser in an Asian population. METHODS: Totally, 66 and 19 patients receiving subcutaneous laser and superficial liposuction with curettage (LC) were recruited. The effectiveness of treatment was assessed by patients subjectively. Recurrence rate of osmidrosis and complications were also evaluated. RESULTS: 95% of patients showed good-to-excellent improvement in LC group and only 30% of patients showing good-to-excellent results in laser group (P < 0.01). Binary logistic regression revealed that the odds ratio of LC was 53.288 (P = 0.006) for >50% improvement in osmidrosis. The recurrence rate was not significantly different (P = 0.139), however, the duration to recurrence of osmidrosis was significantly longer in LC group (P < 0.01). The complication rate was 31% in LC group and 6% in laser group (P < 0.01). CONCLUSION: Superficial liposuction with curettage provides more effective treatment with higher complication rates and is possibly suitable for severe patients. For mild-to-moderate osmidrosis, or preferring a better cosmetic result or short recovery, subcutaneous laser could be applied.

Streptococcus agalactiae infective endocarditis with large vegetation in a patient with underlying protein S deficiency.

We present a case of a patient with underlying protein S deficiency who suffered from infective endocarditis with a large anterior mitral leaflet (AML) mass of approximately 4.5 cm in length. Intraoperative transesophageal echocardiography (TEE) revealed the mass at the AML base and a rupture of the posterior mitral leaflet chordae tendinae. The vegetation's large size may have been caused by one or more of three factors: location, underlying disease, and the microorganism causing infection. Patients with protein S deficiency are prone to thromboembolic events during cardiac surgery. Infective endocarditis caused by Streptococcus agalactiae usually has a poor prognosis, and, thus, early surgery is recommended.

Roles of A-type potassium currents in tuning spike frequency and integrating synaptic transmission in noradrenergic neurons of the A7 catecholamine cell group in rats.

We investigated voltage-dependent K(+) currents (I(K)) in noradrenergic (NAergic) A7 neurons. The I(K) evoked consisted of A-type I(K) (I(A)), which had the characteristics of a low threshold for activation (approximately -50 mV), fast activation/inactivation, and rapid recovery from inactivation. Since the I(A) were blocked by heteropodatoxin-2 (Hptx-2), a specific Kv4 channel blocker, and the NAergic A7 neurons were shown to be reactive with antibodies against Kv4.1/Kv4.3 channel proteins, we conclude that the I(A) evoked in NAergic neurons are mediated by Kv4.1/Kv4.3 channels. I(A) were also evoked using voltage commands of a single action potential (AP), a subthreshold voltage change between two consecutive APs, or excitatory postsynaptic potential (EPSP) activity recorded in current-clamp mode (CCM). Blockade of the I(A) by 4-AP, a broad spectrum I(A) blocker, or by Hptx-2 increased the half-width and spontaneous firing of APs and reduced the amount of synaptic drive needed to elicit APs in CCM, showing that the I(A) play important roles in regulating the shape and firing frequency of APs and in synaptic integration in NAergic A7 neurons. Since these neurons are the principal projection neurons to the dorsal horn of the spinal cord, these results also suggest roles for Kv4.1/4.3 channels in descending NAergic pain regulation.

Physiological and morphological properties of, and effect of substance P on, neurons in the A7 catecholamine cell group in rats.

The A7 catecholamine cell group consists of noradrenergic (NAergic) neurons that project to the dorsal horn of the spinal cord. Here, we characterized their morphology and physiology properties and tested the effect of substance P (Sub-P) on them, since the results of many morphological studies suggest that A7 neurons are densely innervated by Sub-P-releasing terminals from nuclei involved in the descending inhibitory system, such as the lateral hypothalamus and periaqueductal gray area. Whole cell recordings were made from neurons located approximately 200 microm rostral to the trigeminal motor nucleus (the presumed A7 area) in sagittal brainstem slices from rats aged 7-10 days. After recording, the neurons were injected with biocytin and immunostained with antibody against dopamine-beta-hydroxylase (DBH). DBH-immunoreactive (ir) cells were presumed to be NAergic neurons. They had a large somata diameter ( approximately 20 microm) and relatively simple dendritic branching patterns. They fired action potentials (AP) spontaneously with or without blockade of synaptic inputs, and had similar properties to those of NAergic neurons in other areas, including the existence of calcium channel-mediated APs and a voltage-dependent delay in initiation of the AP (an indicator of the existence of A-type potassium currents) and an ability to be hyperpolarized by norepinephrine. Furthermore, in all DBH-ir neurons tested, Sub-P caused depolarization of the membrane potential and an increase in neuronal firing rate by acting on neurokinin-1 receptors. Non-DBH-ir neurons with a smaller somata size were also found in the A7 area. These showed great diversity in firing patterns and about half were depolarized by Sub-P. Morphological examination suggested that the non-DBH-ir neurons form contacts with DBH-ir neurons. These results provide the first description of the intrinsic regulation of membrane properties of, and the excitatory effect of Sub-P on, A7 area neurons, which play an important role in pain regulation.

Granulomatous variant of chronic pigmented purpuric dermatoses: report of four new cases and an association with hyperlipidaemia.

Four patients presenting with chronic pigmented purpuric dermatosis (CPPD) on the limbs were found to have granulomatous inflammation superimposed on the pathological changes of CPPD. Three of the four patients had hyperlipidaemia. Therefore, the granulomatous reaction observed could be associated with hyperlipidaemia. Whether it occurs only in Asian people or not needs further observation.

An unusual concomitant tremor and myoclonus after a contralateral infarct at thalamus and subthalamic nucleus.

A 72-year-old woman experienced a sudden onset of spontaneous tremor and myoclonus of right extremities that completely subsided 24 hours after onset. Neuroimaging study revealed an infarct at the left ventral portion of thalamus and subthalamic nucleus. Concomitant dyskinetic movement disorders after stroke are extremely rare and the mechanism is herein discussed.

Intractable hiccup caused by medulla oblongata lesions.

Intractable hiccup is a rare manifestation of a brainstem lesion. We present five cases of intractable hiccups associated with medulla oblongata lesions: three of these had brainstem infarction compatible with Wallenberg's lateral medullary syndrome; one, clinically probable multiple sclerosis with a medullary lesion; and one, choroid plexus papilloma of the fourth ventricle with medullary compression. Using magnetic resonance imaging, it was demonstrated that the lesions affecting the dorsal and/or lateral medulla oblongata were responsible for the intractable hiccups.

Unilateral symptomatic palatal myoclonus: MRI evidence of contralateral inferior olivary lesion.

Symptomatic palatal myoclonus is a rare syndrome of segmental myoclonus which is thought to occur after damage to certain brainstem or cerebellar structures. We report two patients with unilateral PM, who showed hypertrophy of the inferior olivary nucleus on magnetic resonance imaging. In the first patient this was due to a left pontine tegmental hemorrhage, and a right-sided oculo-palato-facial myoclonus developed one month after the episode. The second one had a basilar artery occlusion with ischemic infarcts at the basis pontis, dorso-lateral aspects of the left pons, and left cerebellar dentate nucleus, as well as the occipital lobe. A delayed left oculopalatal myoclonus was recognized 3 months later. Interruption of the "dentato-rubro-olivary pathway" by the lesion with ensuing neuronal loss, cytoplasmic vacuolation, and astrocytic proliferation in the inferior olive, together with an increase of water content as mobile proton may cause the MR signal abnormalities in patients with unilateral symptomatic palatal myoclonus.

The serum ferrokinetics in Parkinson's disease.

Ferrous ion is an essential cofactor in dopamine synthesis and its decrease may reduce the dopamine production in the nigrostriatal system, the basis of pathogenetic mechanism in Parkinson's disease (PD). Therefore, parkinsonians may have an abnormal systemic ferrokinetics. The serum iron, ferritin, total-iron-binding-capacity (TIBC) levels and transferrin saturation were analysed in 15 patients with Parkinson's disease and 30 controls. The serum iron was lower in PD (95.53 +/- 33.5 micrograms/dl) than in controls (102.5 +/- 32.5 micrograms/dl), but the difference was statistically nonsignificant. The ferritin, TIBC and transferrin saturation were also similar in both groups. The systemic ferrokinetics in our PD was normal, but the ferrokinetics between the central and systemic compartments was different in PD. Therefore, reduction of central dopamine in PD is unlikely due to hypoferruginemia.

Evidence that the long-latency stretch responses of the human wrist extensor muscle involve a transcerebral pathway.

Ballistic wrist extensor movements were interrupted by a sudden perturbing force in two conditions, and subjects were asked either to compensate for ('oppose') the perturbation or to cease the extensor movement ('let-go') when the interruption occurred. In the first condition, the interruption occurred unexpectedly in some of the trials, whereas in the second it occurred on every trial. Responses were recorded from the flexor and extensor carpi radialis muscles, and from the scalp and cervical spine. Unexpected perturbing forces were associated with an early extensor EMG response (M1) and longer latency EMG responses in both flexor and extensor muscles. When the interruptions occurred in every trial, both the late EMG activity and the cerebral responses were markedly attenuated. The relation between expectation of perturbation and the occurrence or size of the late EMG activity indicates that this response is under supraspinal control. The potentials recorded over the cervical spine and scalp were, like the late EMG activity, influenced by the expectancy of interruption. These potentials persisted even when the potentials related to the mechanically elicited SEP were removed by subtraction of responses to anticipated interruptions from those to unanticipated interruptions. The earliest of these potentials preceded the late EMG activity by 30-50 ms. They were present when the late responses were present, absent when the late responses were absent, and became progressively smaller when the late responses became smaller, suggesting a tight coupling between these events and the late EMG events. These results indicate that cerebral activity, unrelated merely to mechanical stimulation, consistently precedes the late EMG activity, and thereby directly suggests that the long-latency response has a cerebral (possible cortical) pathway.

Effect of reference point on visual evoked potentials: clinical relevance.

For clinical purposes the VEP is generally recorded from the mid-occipital region referenced to the vertex or mid-frontal region. This may lead to interpretive errors that can be avoided if a relatively inactive reference point, such as linked mastoids, is used simultaneously. The additional recording derivation may also be helpful in clarifying aberrant or ambiguous wave forms. The diagnostic yield from the two montages is similar, although the linked-mastoid reference provides a greater number of technically inadequate recordings due to smaller size of P100 and increased contamination by muscle artifact.