Indigenous leishmaniasis in Taiwan: report of a case.

Taiwan is not considered an endemic area of leishmaniasis. Imported cases are encountered infrequently, and only two cases of indigenous cutaneous leishmaniasis have been reported.(1) We found one new case in the past 20 years. The patient presented with erythematous plaques on the nasal bridge and right thumb. Skin biopsy specimens from both sites revealed numerous Leishman-Donovan bodies in macrophages. There was no history of travel outside the country, and the diagnosis of indigenous cutaneous leishmaniasis was made. Polymerase chain reactions (PCR) identified the species as Leishmania tropica. The route of infection in this patient is unclear. Because pentavalent antimony, the drug of choice for leishmaniasis, is not available in Taiwan, the patient was treated with levamisole and potassium iodide, with an excellent response.

Warm and neutral tumescent anesthetic solutions are essential factors for a less painful injection.

BACKGROUND: Tumescent local anesthesia is widely used in dermatologic surgery. Minimizing pain associated with injections is crucial to successful surgical procedures. OBJECTIVE: This study investigates the pain associated with warm and room temperatures in neutralized or nonneutralized tumescent anesthetic solutions injection. METHODS: Thirty-six patients with axilla osmidrosis who underwent local anesthesia for surgery were randomly assigned to three groups. Group A received warm neutral (40 degrees C) and room-temperature neutral (22 degrees C) tumescent injections to each axillary region. Group B received warm neutral (pH 7.35) and warm nonneutral (pH 4.78) tumescent injections on each side of axilla. Group C received warm nonneutral and room-temperature nonneutral tumescent injections on each side of axilla. Pain associated with infiltration of anesthesia was rated on a visual analog scale (VAS). RESULTS: A statistically significant decrease (p < .001) in pain sensation was reported on the warm, neutral injection side (mean rating, 32.7 mm) compared with the room-temperature, neutral injection side (mean rating, 53.3 mm). Patient-reported pain intensity was significantly lower on the side that received warm, neutral tumescent anesthesia (mean rating, 26.8 mm) than on the side receiving warm, nonneutral tumescent anesthesia (mean rating, 44.9 mm; p < .001). The difference in VAS scores between warm neutral (mean rating, 23.9 mm) and room-temperature nonneutral (mean rating, 61.2 mm) was statistically significant (p < .001). CONCLUSION: The warm, neutral tumescent anesthetic preparation effectively suppressed patient pain during dermatologic surgical procedures.

Treatment for axillary osmidrosis with suction-assisted cartilage shaver.

Axillary osmidrosis is a common and distressing social problem for many. Topical astringents are temporary and inadequate. Permanent solutions often involve invasive surgical treatment. This study is to evaluate the effectiveness and advantages of treating axillary osmidrosis with suction-assisted cartilage shaver. Eighty-nine patients with osmidrosis were treated with suction-assisted cartilage shaver under local anesthesia on an outpatient basis. Patients were followed-up and surveyed for satisfaction with surgery by completing a questionnaire. Of the 89 patients, 82 patients (92.1%) expressed positive satisfaction with the procedure. In the elimination of odour, a total of 81 patients (91.0%) ranked good to excellent, and seven patients (7.9%) expressed fair results. All of the 89 patients (100%) detected the clearing of wound induration within 3 months. Eighty patients (89.9%) felt their arms were back in full range of movement within 1 month, and all had such hindrance resolved within 2 months. Thus, the procedure proved itself a promising treatment for the removal of sweat glands with advantages of a short operation time, inconspicuous scar, and a rapid recovery for returning to daily activities.