Botulinum A toxin for glabellar wrinkles. Dose and response.

BACKGROUND: Botulinum A exotoxin injection is a well-established method for treatment of glabellar frown lines, crow's feet, and horizontal furrows of the forehead. However, there is no consensus as to the optimal dosage per injection site or the concentration of injectate to be used. OBJECTIVE: The purpose of this study was to determine the minimal effective dose per injection site to be used as well as the effect of concentration in response to treatment. RESULTS: A total of 46 subjects were divided into ten groups and injected with escalating doses and concentrations of botulinum toxin. The response and longevity of treatment were then followed on a monthly basis. A dose between 2.5-4 U per injection site (12.5-20 U total) was determined to be an effective starting dose, with a duration of 2-5 months (median 14 weeks). CONCLUSIONS: There was no statistically significant difference in safety or efficacy for concentrations ranging from 50 to 200 U/ml of botulinum toxin.

An analysis of resuscitative requirements of petrol (gasoline) burns.

A retrospective study was carried out to confirm the clinical impression that petrol (gasoline) burns had a greater resuscitation requirement than other types of thermal injury. A total of 450 admissions to the St Andrews Hospital Regional Burn Unit from 1982 to 1988 were reviewed. Patients with pre-existing cardiovascular disease, respiratory disease, inhalation injury and fatalities occurring within the first 72 h of admission were excluded from the study. Forty-four patients met all requirements for inclusion within the study. These 44 patients consisted of 15 with petrol burns and 29 with non-petrol burns, all of whom were resuscitated using the modified Muir and Barclay formula, with adjustments made on the basis of clinical and laboratory monitoring. Comparison of resuscitation requirements of the two groups by the Wilcoxon Rank Sum Test showed that the petrol burns group had a significantly greater fluid resuscitation requirement (P less than 0.01).

Damage to tissue defenses by EMLA cream.

EMLA is a new topical agent that safely anesthetizes intact skin. The purpose of this study was to determine if this cream could be safely used for anesthetizing wounds. This investigation evaluated the potential toxicity of EMLA cream in wounds by measuring its effect on host defenses and on the biology of wound repair. In contaminated wounds, EMLA cream elicited an exaggerated inflammatory response that damaged host defenses, inviting the development of infection. As a result of these investigations, we do not recommend the use of EMLA cream in wounds.