Counterparalysis for treatment of paralytic scoliosis with botulinum toxin type A.

In this study, botulinum toxin was used to treat paralytic scoliosis. Twelve children with paralytic scoliosis and severe, complicating additional diseases required surgical delay. Although this use of botulinum toxin is experimental, alternative treatments posed greater risks. An institutional review board protocol for nonestablished dosage and indication for treatment was initiated to monitor safety and effect. Treatment was intended to supplement, not replace, other desirable treatment modalities. The effect was to be measured by the return of efficacy of conservative treatment in halting curve progression. Short-term results show that none of the children had worsened scoliosis; all had some reduction in curve measurement (up to >50 degrees).

Treatment of metabolic alkalosis with intravenous infusion of concentrated hydrochloric acid.

A concentrated hydrochloric acid (1 N) infusion was utilized for treatment on 35 occasions of metabolic alkalosis in 24 patients. The amount of hydrochloric acid to be infused was calculated from total base excess. To avoid over-correction, two thirds of the calculated dosage of hydrochloric acid only was infused. 1 N hydrochloric acid solution was infused at a speed of 1 mEq/min through a roentgenographically confirmed central venous line. Metabolic alkalosis was successfully treated in all instances without any complication. However, increased respiratory stimulation was not demonstrated in these observations. Concentrated hydrochloric acid infusion is a safe, reliable, and effective method of rapid correction of metabolic alkalosis. Because only small volumes are needed, this method is especially useful when fluid intake must be restricted.