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Mojtahedzadeh M, Najmeddin F, Pourheidar E, Najafi A, Bahman R, Yousefi-Mazhin E, Karballaei-Mirzahosseini H, Hassanpour R. Intragastric Botulinum Toxin Injection and Botulism: An Alarm for Clinicians. Case Rep Crit Care 2024; 2024:8183127. [PMID: 38716476 PMCID: PMC11074901 DOI: 10.1155/2024/8183127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/09/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Clostridium botulinum produces the most potent bacterial toxin, botulinum toxin A (BTXA), which has various therapeutic and cosmetic indications. Intragastric BTXA injection is a new obesity treatment method that was argued to be safe due to the inactivation of BTXA through the liver or metabolization within the gastric wall. However, a 36-year-old woman was admitted to the intensive care unit (ICU) due to developing botulism as a result of an intragastric injection of BTXA. The diplopia, headaches, ptosis, decreased muscle force, and respiratory distress two days after injection were her first chief complaints, and also, she experienced significant dysphagia, hoarse voice, thick tongue, constipation, hyposmia, and hypogeusia after two weeks. This case report highlights the necessity for physicians to have sufficient information about this method and consider possible life-threatening adverse effects including botulism.
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Affiliation(s)
- Mojtaba Mojtahedzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Najmeddin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Pourheidar
- Department of Intensive Care Unit, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Atabak Najafi
- Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Bahman
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Yousefi-Mazhin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rezvan Hassanpour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Brisinda G, Fico V, Tropeano G, Altieri G, Chiarello MM. Effectiveness and safety of botulinum toxin injection in the treatment of recurrent anal fissure following lateral internal sphincterotomy: cohort study. BJS Open 2024; 8:zrad156. [PMID: 38323879 PMCID: PMC10848301 DOI: 10.1093/bjsopen/zrad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/03/2023] [Accepted: 11/18/2023] [Indexed: 02/08/2024] Open
Affiliation(s)
- Giuseppe Brisinda
- University Department of Translational Medicine and Surgery, Catholic School of Medicine, Rome, Italy
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Valeria Fico
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Giuseppe Tropeano
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Gaia Altieri
- Emergency and Trauma Surgery Unit, Department of Abdominal and Endocrine Metabolic Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli, IRCS, Rome, Italy
| | - Maria Michela Chiarello
- General Surgery Operative Unit, Department of Surgery, Provincial Health Authority, Cosenza, Italy
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Wessels EM, Masclee GMC, Bredenoord AJ. An overview of the efficacy, safety, and predictors of achalasia treatments. Expert Rev Gastroenterol Hepatol 2023; 17:1241-1254. [PMID: 37978889 DOI: 10.1080/17474124.2023.2286279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/17/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION Achalasia is a rare esophageal motility disorder characterized by abnormal esophageal peristalsis and the inability of the lower esophageal sphincter to relax, resulting in poor esophageal emptying. This can be relieved by endoscopic and surgical treatments; each comes with certain advantages and disadvantages. AREAS COVERED This review aims to guide the clinician in clinical decision making on the different treatment options for achalasia regarding the efficacy, safety, and important predictors. EXPERT OPINION Botulinum toxin injection is only recommended for a selective group of achalasia patients because of the short term effect. Pneumatic dilation improves achalasia symptoms, but this effect diminishes over time and requiring repeated dilations to maintain clinical effect. Heller myotomy combined with fundoplication and peroral endoscopic myotomy are highly effective on the long term but are more invasive than dilations. Gastro-esophageal reflux complaints are more often encountered after peroral endoscopic myotomy. Patient factors such as age, comorbidities, and type of achalasia must be taken into account when choosing a treatment. The preference of the patient is also of great importance and therefore shared decision making has to play a fundamental role in deciding about treatment.
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Affiliation(s)
- Elise M Wessels
- Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Gwen M C Masclee
- Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, Netherlands
| | - Albert J Bredenoord
- Department of Gastroenterology & Hepatology, Amsterdam Gastroenterology and Metabolism, University Medical Centers Amsterdam, Amsterdam, Netherlands
- Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, Netherlands
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Chiarello MM, Fico V, Brisinda G. A commentary on "Comparison of doses and injection sites of botulinum toxin for chronic anal fissure: A systematic review and network meta-analysis of randomized controlled trials" [Int. J. Surg. 104 (2022) 106798]. Int J Surg 2022; 106:106880. [PMID: 36113840 DOI: 10.1016/j.ijsu.2022.106880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Maria Michela Chiarello
- Unità Operativa di Chirurgia Generale, Azienda Sanitaria Provinciale di Cosenza, Cosenza, Italy
| | - Valeria Fico
- Chirurgia d'Urgenza e del Trauma, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy
| | - Giuseppe Brisinda
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Roma, Italy.
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Miget G, Tan E, Pericolini M, Chesnel C, Haddad R, Turmel N, Amarenco G, Hentzen C. The Neurogenic Bowel Dysfunction score (NBD) is not suitable for patients with multiple sclerosis. Spinal Cord 2022; 60:1130-1135. [PMID: 35859189 DOI: 10.1038/s41393-022-00837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Bowel and anorectal dysfunctions are common in patients with multiple sclerosis (pwMS). The use of validated questionnaires is recommended in the initial assessment and patient's follow-up. The Neurogenic Bowel Dysfunction (NBD) score is the most used questionnaire but has been developed in spinal cord injured patients and has never been validated in other neurological diseases. We aimed to assess NBD's relevance in pwMS. SETTINGS Monocentric study in a tertiary neuro-urology department. METHODS A retrospective study in pwMS consulting for the first time in our department, that fulfilled the NBD questionnaire between 2010 and 2021 was performed. Qualitative and quantitative answers for each question were analyzed. Content validity and internal consistency were evaluated. RESULTS One hundred thirty-five pwMS (mean age 47.1, 58% of women) fulfilled the NBD questionnaire. Mean NBD score was 6.0 (SD 6.1) and 75% of patients had a score <9. Content validity analysis revealed 4 items not appropriate, 1 item with irrelevant calibration, and omission of some treatment widely used in pwMS. Internal consistency was appreciated with Cronbach's alpha = 0.48 IC 95% [0.31; 0.6]. CONCLUSION NBD questionnaire lacks content validity and presents a weak internal consistency in pwMS. A specific questionnaire is therefore required in pwMS to optimize bowel management and follow-up.
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Affiliation(s)
- Gabriel Miget
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France. .,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France.
| | - Eliane Tan
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Martina Pericolini
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France.,Urology Department, Policlinico Tor Vergata, Università Degli Studi di Roma "Tor Vergata", 00133, Rome, Italy
| | - Camille Chesnel
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Rebecca Haddad
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Nicolas Turmel
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Gérard Amarenco
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
| | - Claire Hentzen
- GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Sorbonne Université, 75020, Paris, France.,Department of Neuro-urology, Tenon Hospital, AP-HP, 4, Rue de la Chine, 75020, Paris, France
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Tustumi F. Evaluating the Non-conventional Achalasia Treatment Modalities. Front Med (Lausanne) 2022; 9:941464. [PMID: 35814742 PMCID: PMC9263126 DOI: 10.3389/fmed.2022.941464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionAchalasia is a primary esophageal dysmotility disorder. Despite the high volume of studies addressing the conventional treatments for achalasia, few are debated regarding the non-conventional treatments, such as cardiectomy, cardioplasty, endoluminal substances injection (ethanolamine oleate, polidocanol, botulinum toxin), stents, and certain drugs (beta-agonists, anticholinergic, nitrates, calcium channel blockers, and phosphodiesterase inhibitors).MethodsA critical review was performed.ResultsEndoscopic, surgical, and pharmacological treatments were included. A qualitative synthesis was presented.ConclusionNon-conventional therapeutic options for treating achalasia encompass medical, endoscopic, and surgical procedures. Clinicians and patients need to know all the tools for the management of achalasia. However, several currently available studies of non-conventional treatments lack high-quality evidence, and future randomized trials are still needed.
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Affiliation(s)
- Francisco Tustumi
- Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
- Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
- *Correspondence: Francisco Tustumi
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Brisinda G, Chiarello MM, Crocco A, Bentivoglio AR, Cariati M, Vanella S. Botulinum toxin injection for the treatment of chronic anal fissure: uni- and multivariate analysis of the factors that promote healing. Int J Colorectal Dis 2022; 37:693-700. [PMID: 35149889 PMCID: PMC8885481 DOI: 10.1007/s00384-022-04110-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE Anal fissure is caused by a pathological contraction of the internal anal sphincter. Lateral internal sphincterotomy remains the gold standard for the treatment of fissure. Botulinum toxin injections have been proposed to treat this condition without any risk of permanent injury of the internal sphincter. We investigate clinical and pathological variables and the effects of different dosage regimens of botulinum toxin to induce healing in patients with idiopathic anal fissure. METHODS This is a retrospective study at a single center. The patients underwent a pre-treatment evaluation that included clinical inspection of the fissure and anorectal manometry. We collected and analyzed demographic data, pathological variables, associated pathological conditions, and treatment variables. Success was defined as healing of the fissure, and improvement of symptoms was defined as asymptomatic persistent fissure. RESULTS The findings of 1003 patients treated with botulinum toxin injections were reported. At 2 months evaluation, complete healing was evident in 780 patients (77.7%). Resting anal tone (77.1 ± 18.9 mmHg) was significantly lower from baseline (P < 0.0001) and from 1-month value (P = 0.0008). Thirty-nine not healed patients underwent lateral internal sphincterotomy, and 184 were re-treated with 50 UI of botulinum toxin. In these patients, the healing rate was 93.9% (171 patients). Dose and injection site of toxin correlates with healing rate. There were no relapses during an average of about 71 months. CONCLUSION Our data show that injection of botulinum toxin into the internal anal sphincter is a safe and effective alternative to surgery in patients with chronic anal fissure.
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Affiliation(s)
- Giuseppe Brisinda
- Università Cattolica del Sacro Cuore, Roma, Italy.
- Dipartimento Di Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy.
| | | | - Anna Crocco
- Unità Operativa Di Chirurgia Oncologica Della Tiroide E Della Paratiroide, Istituto Nazionale Tumori, IRCCS Fondazione Pascale, Napoli, Italy
| | - Anna Rita Bentivoglio
- Università Cattolica del Sacro Cuore, Roma, Italy
- Unità Operativa Di Neurologia, Fondazione Policlinico Universitario A Gemelli, IRCCS, Roma, Italy
| | - Maria Cariati
- Unità Operativa Di Chirurgia Generale, Ospedale San Giovanni Di Dio, Crotone, Italy
| | - Serafino Vanella
- Unità Operativa Di Chirurgia Generale E Oncologica, Azienda Ospedaliera San Giuseppe Moscati, Avellino, Italy
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