Effect of diagnosis of “smoker's lung”

Abstract

Vol 349 • January 25, 1997 253 contracted; electromyography (EMG) revealed a marked increase in interference pattern. With use of EMG, and after obtaining informed consent, we injected 10 units of botulinum toxin (BOTOX, Allergan) into two sites of the anterior vaginal wall muscles. Spasms improved within 24 h, and resolved within 60 h; the benefit persisted for 5 weeks. 7 weeks after her initial injection, 40 units of botulinum toxin were injected under EMG guidance. By 8 days, bladder, urethral, and vaginal symptoms resolved. 2 weeks later, she had intercourse for the first time in 8 years. The benefit has persisted for over 24 months; she is now engaged to be married. Botulinum toxin blocks release of acetylcholine, preventing neuromuscular transmission and leading to muscle weakness. Local botulinum toxin injections have been shown to be safe and effective in relieving the muscle spasms associated with dystonia, spasticity and other sphincters including the larynx, urinary sphincter, cricopharyngeal muscle, oesophageal sphincters in achalasia, rectal sphincters associated with intractable constipation, and anal fissures. Unlike dystonia, most patients with vaginismus are effectively treated with behavioural therapy or progressive dilator therapy. Other similar urological conditions include interstitial cystitis, and urethral syndrome, voiding dysfunction, and pelvic pain, often presenting with urgency, frequent urination, and pain associated with inappropriate contraction of the pelvic floor musculature and/or urethral sphincter. Botulinum toxin therapy acutely relieved the inappropriate spasms, allowing resumption of intercourse.