Multiple Intradermal Injections Research Articles

Causative agent for perioperative anaphylaxis in a child with autism successfully identified using the intradermal test under general anesthesia

BackgroundThe skin-prick and intradermal tests are the main diagnostic methods used to identify the causative agent in patients with suspected perioperative anaphylaxis. Although the intradermal test is more sensitive than the skin-prick test, multiple intradermal injections can be painful for children. Here, we present the case of a child with autism and suspected perioperative anaphylaxis. The causative agent was successfully identified using the intradermal test under general anesthesia.Case presentationAn 8-year-old boy with autism developed anaphylaxis during general anesthesia for the fourth cleft lip and palate surgery. An allergic workout was performed, but both the skin-prick and basophil activation tests for suspected causative agents yielded negative results. The patient was afraid of multiple injections, and an intradermal test was performed under general anesthesia by anesthesiologists and allergists. Piperacillin was confirmed as the causative agent, and subsequent surgery using the same anesthetic agents without piperacillin was uneventful.ConclusionsConcerted efforts should be made to identify the causative agent for diagnosing perioperative anaphylaxis.

Different Dilutions of Mesobotox in Facial Rejuvenation: Which is Better?

Microbotulinum toxin A treatment is a technique of delivering multiple intradermal injections of diluted botulinum toxin type A into the dermis or the interface between the dermis and the superficial layer of the facial muscles to preserve the facial mobility. The current study aimed to evaluate and compare the clinical effect of different dilutions of microbotulinum toxin A in periorbital and mid-facial rejuvenation. This randomized prospective interventional study included 30 female patients with different types of wrinkles in periorbital and/or mid-face. Patients were divided into three groups: group I (10 patients): 100U botulinum toxin in 5ml saline, group II (10 patients): 100U botulinum toxin in 7ml saline and group III (10 patients): 100U botulinum toxin in 10ml saline. A statistically significant better global esthetic improvement scale (GAIS) scores after 1 month were observed in group I compared to groups II and III. Also, after 6months better GAIS scores were observed in group I compared to group II and in group II compared to group III. Assessment of different esthetic parameters measured by the Antera 3D camera revealed a statistically significant improvement in all parameters (periorbital and mid-face) in group I and in most of parameters (periorbital and mid-face) in groups II and III with more evident improvement after 1 month compared to after 6months. Intradermal microbotulinum toxin A is a cost-effective method for improving periorbital and mid-face wrinkles with a better effect of 1:5 than 1:7 and 1:10 dilutions. Facial wrinkles possess a great burden on patients' psychological status, and the emergence of novel rejuvenation technique with minimal side effects is necessary. MicroBoNT-A usage in the literature was through variety of dilutions and concentrations. Therefore, a conclusive and comparative study was essential to compare the effect of different microBoNT-A dilutions. In this context, the current study aimed to evaluate and compare the clinical effect of different dilutions of microBoNT-A in periorbital and mid-facial rejuvenation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Lymphatic Mapping with Contrast-enhanced Ultrasound for Lymphaticovenous Anastomosis Surgery: How We Do It.

Lymphaticovenous anastomosis (LVA) surgery is an effective surgery for the treatment of lymphedema in the extremities. Indocyanine green lymphography is the reference standard for visualizing lymphatics for LVA surgery, but it has several limitations; most notably, superficial dermal congestion can mask deeper lymphatic vessels. To overcome the limitations, we add contrast-enhanced ultrasound (CEUS) lymphography. We have previously reported that CEUS lymphography can identify lymphatic vessels for LVA surgery that indocyanine green lymphography does not. Here, we describe how we perform CEUS lymphography, including workflow, technique, and documentation. Before informed consent, the patient must be screened for possible adverse reactions to microbubbles. The procedure involves multiple intradermal injections of the microbubble agent at various sites along the extremity. After each injection, imaging for microbubble uptake by lymphatic vessels is performed using an ultrasound scanner with contrast-specific software. We use sulfur hexafluoride lipid-type A microspheres (Lumason/SonoVue; Bracco Suisse SA), but we are investigating the performance of other Food & Drug Administration-approved microbubble agents for CEUS lymphography. Having a systematic approach to marking the skin can mitigate the hindrance of marking over ultrasound coupling gel. Another benefit of CEUS lymphography is the rapid identification of neighboring veins compatible in size and location for anastomosis. We hold regular scheduled multidisciplinary meetings for coordination of care, discussion of outcomes, quality assurance, and ongoing innovation.

Real-time Navigation for Vascularized Lymph-node Transplantation Using Projection Mapping with Indocyanine Green Fluorescence.

The medical imaging projection system (MIPS) is a real-time surgical navigation device using indocyanine green (ICG) emission signals and active projection mapping. The difference between the object and the projected image is within 1 mm, and the time lag is within 0.1 seconds. We herein report the application of the MIPS to vascularized lymph-node transplantation (VLNT) surgery for lower extremity lymphedema to detect inguinal lymph nodes and perform color-coded navigation surgery for lymph-node resection. A left superficial inguinal lymph node was planned to be used as a donor for VLNT to the right lower leg in a 73-year-old woman with lower extremity lymphedema. Under general anesthesia, multiple intradermal injections of 0.1 ml of ICG were administered around the left inguinal donor site. The MIPS showed a clear linear projection image from a lateral injected point connecting to a lateral superficial inguinal lymph node. The left superficial circumflex iliac artery and vein were dissected for vascularized VLNT. Intraoperative real-time MIPS navigation continuously guided the transection plane colored by ICG fluorescence signals without shifting the visual focus from the surgical field. This is the first report of the intraoperative use of ICG projection mapping for VLNT donor-site surgery. The MIPS was able to visualize functional lymph nodes to facilitate minimally invasive donor-site surgery.

Frontal edema due to mesotherapy for androgenetic alopecia: A case series.

Androgenetic alopecia (AGA) is the most common form of non-cicatricial alopecia in both genders. Currently approved drugs for the treatment of AGA include topical minoxidil in women and topical minoxidil and oral finasteride in men. Other routes of administration of approved drugs have been proposed to enhance therapeutic results for AGA, including intradermal injections, known as mesotherapy. Mesotherapy-or intradermotherapy-is a non-surgical procedure, consisting of multiple intradermal injections of pharmacological substances diluted in small doses. Although minimally invasive, mesotherapy may be related to mild side effects like burning, erythema and headaches, as a few reports indicate. Among the most serious adverse events, subcutaneous necrosis, scalp abscesses, and angioedema have been described. This multicenter retrospective, descriptive study aims to report 14 cases of frontal edema resulting from mesotherapy for AGA treatment. In our patients, the edema mostly arose in the first two sessions and lasted between 1 and 4 days, with a favorable outcome after a local cold compress. In all our cases of edema, lidocaine was the anesthetic used. Minoxidil and dutasteride might also play a role as causative agents. To the best of our knowledge, this is the largest case series focused on frontal edema after mesotherapy for AGA and gives clinicians helpful information for when performing this technique. Dermatologists should already consider and be conscious of this possible mesotherapy side effect, as it can be remarkably disruptive to affected patients.

Intradermal immunotherapy with actinomycetales preparations as treatment for feline atopic syndrome: a randomized, placebo-controlled, double-blinded study.

Feline atopic syndrome (FAS) is a common disease. Single intradermal injections of heat-killed actinomycetales have shown beneficial effects in canine allergies. To evaluate the clinical effects of heat-killed actinomycetales [Gordonia bronchialis (GB) and Rodococcus coprophilus (RC)], alone or in combination, in FAS. Privately owned cats with a diagnosis of FAS were assigned randomly in three treatment groups (GB, RC and GB/RC combination) or placebo. Five intradermal injections were performed over a one year period. At each visit [Day (D)0, D20, D40, D60, D90, D180 and D365], clinical signs, global owner assessment score, use of rescue medications, clinical adverse effects, skin hydration and cutaneous pH were assessed. Seventeen cats were enrolled. When compared to the placebo group and improvement in treatment GB was sustained from D90. When compared with D0 significant improvement in the GB group was seen from D60. Over one year, a complete remission of the clinical signs was seen in 30-67% of cats in the treatment groups. A reduction in the pruritus score was seen for RC after 365 days of treatment (P = 0.04). Differences in the other variables were not seen. The use of multiple intradermal injections of heat-killed GB shows promise as effective and well-tolerated treatment for FAS. Because of the low cost and the lack of adverse effects, GB could be a beneficial treatment option for FAS. A larger study is needed to confirm these data and to evaluate the immunological changes occurring in the treated cats.

Comparison of Two Anticoagulants for Pain Associated with Platelet-Rich Plasma Injections.

Platelet-rich plasma (PRP) has long been used in skin rejuvenation and hair loss treatment. Some patients require multiple intradermal injections into the face and scalp, and the way in which these patients process and experience pain differs, depending on the patient. Minimizing pain and discomfort during nonsurgical procedures is essential for patient satisfaction. In our experience, the use of acid citrate dextrose-A (ACD-A) as an anticoagulant caused more patient discomfort than did sodium citrate (Na-citrate) among patients who underwent facial rejuvenation with PRP. The aim of the present study was to evaluate patient-related discomfort in PRP sessions using two different anticoagulants. This clinical trial included 10 patients who received facial PRP injections for facial rejuvenation and 10 patients who received PRP injections in their scalps for hair loss. On the application area, half the surface was treated with Na-citrate PRP injections, and the other half was treated with the same amount of ACD-A PRP injections. Neither the doctors who applied the treatment nor the patients were given information about which anticoagulant was used in each area. Immediately after the procedure, the patients were asked to score their pain on each side of the application area on a scale of 1-10 using a visual analog scale (VAS). PRP injections using Na-citrate as an anticoagulant caused less discomfort on both the face and scalp as compared with that of ACD-A. The outcome was statistically significant. Anticoagulants used in PRP preparation affected patients' pain perceptions during the injections. The sensation of pain with PRP prepared with Na-citrate as an anticoagulant was lower than that of PRP prepared with ACD-A. Further studies are required to evaluate the correlation between anticoagulants used for PRP preparation and pain feelings during injections. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Development of Botulinum Toxin A-Coated Microneedles for Treating Palmar Hyperhidrosis

Hyperhidrosis is a disorder that is characterized by the production of excess amounts of sweat. The botulinum neurotoxin A (BoNT/A) has been used to treat hyperhidrosis through multiple intradermal injections at the site of the condition. However, because of BoNT/A toxicity, it is important to precisely deliver the proper dose of the toxin to the target site. In addition, the use of a conventional hypodermic needle for multiple injections in the palm makes the approach undesirable and painful. Here, we designed a BoNT/A-coated microneedle (BoNT-MN) array and tested its efficacy as a substitute pain-free method to treat hyperhidrosis. BoNT-MNs were prepared by coating polylactic acid microneedles with a BoNT/A formulation and were found to successfully penetrate into a thick skin in vitro. The coating formulations were then tested for their stability at 4, 25, and 37 °C for 24 h. BoNT-MNs were found to be much more stable than BoNT/A in a liquid state. Additionally, we carried out in vivo experiments by treating the right paws of mice with BoNT-MNs and found that the treatment induced a significant reduction in the sweating response in the mouse foot pad. Thus, BoNT/A treatment using microneedles is beneficial and may be used as a more efficient and less painful approach to treat hyperhidrosis.

Evaluating Vascular Hyperpermeability-inducing Agents in the Skin with the Miles Assay.

The primary function of the vascular endothelium in vertebrate organisms is to serve as a barrier between the blood and each tissue of the body, whereby the permeability of the endothelium to blood cells, plasma macromolecules, and water can be adapted according to the physiological need. In certain diseases, cytokines and growth factors are released that target the endothelial barrier to transiently increase vascular permeability; however, their prolonged presence may cause chronic vascular hyperpermeability and thereby tissue-damaging edema. The Miles assay is an in vivo technique that allows researchers to study vascular hyperpermeability through the proxy measurement of vascular leakage. Here, we provide a detailed protocol on how to perform this procedure in the mouse, which is the most widely used model organism to study mammalian physiology and pathology. The procedure involves the intravenous injection of Evans blue dye to label the circulating albumin followed by multiple intradermal injections of permeability-inducing agents and vehicle control solutions into opposing flanks of the mouse. Consequently, Evans blue dye gradually leaks into the dermis, where it accumulates and can be extracted for quantification as leakage induced by the permeability-inducing agent relative to the vehicle. The Miles assay can be performed in wild type or genetically modified mouse models and may be combined with drug administration to study molecular mechanisms that regulate vascular permeability and identify agents/targets capable of inducing or blocking hyperpermeability.

Evaluating Vascular Hyperpermeability-inducing Agents in the Skin with the Miles Assay

The primary function of the vascular endothelium in vertebrate organisms is to serve as a barrier between the blood and each tissue of the body, whereby the permeability of the endothelium to blood cells, plasma macromolecules, and water can be adapted according to the physiological need. In certain diseases, cytokines and growth factors are released that target the endothelial barrier to transiently increase vascular permeability; however, their prolonged presence may cause chronic vascular hyperpermeability and thereby tissue-damaging edema. The Miles assay is an in vivo technique that allows researchers to study vascular hyperpermeability through the proxy measurement of vascular leakage. Here, we provide a detailed protocol on how to perform this procedure in the mouse, which is the most widely used model organism to study mammalian physiology and pathology. The procedure involves the intravenous injection of Evans blue dye to label the circulating albumin followed by multiple intradermal injections of permeability-inducing agents and vehicle control solutions into opposing flanks of the mouse. Consequently, Evans blue dye gradually leaks into the dermis, where it accumulates and can be extracted for quantification as leakage induced by the permeability-inducing agent relative to the vehicle. The Miles assay can be performed in wild type or genetically modified mouse models and may be combined with drug administration to study molecular mechanisms that regulate vascular permeability and identify agents/targets capable of inducing or blocking hyperpermeability.

Personalized vaccine for advanced HCC.

TPS527 Background: The chronic inflammation and viral infection associated with HCC combined with liver tolerogenic mechanisms creates a profoundly immunosuppressive microenvironment. Modulating the microenvironment with checkpoint blockade benefits ~20% of patients. The non-responders and those with poor liver function are an unmet need. Checkpoint blockade requires effector cells to be resident within tumors. However, the majority of HCC lesions lack effector cells. Therefore, a strategy for amplifying the tumor-specific immune response, while counteracting the immunosuppressive mechanisms may provide an improved immunotherapy. Endogenous heat shock proteins (HSP) chaperone tumor neoantigens. A concentrated composition of calreticulin, hsp70, hsp90 and gr94/gp96 (CRCL) is purified from biopsy samples. In addition, a bioengineered allograft (BAG) derived from healthy blood donors with a Th1 memory phenotype, CD3/CD28-coated microbeads and high expression of CD40L has potent immunomodulatory and counter-regulatory properties. The combination of CRCL with BAG is being evaluated as a strategy to amplify tumor-specific immunity and counter-regulate the immunosuppressive microenvironment. Methods: An open-label Phase II clinical trial evaluating the safety and efficacy of CRCL+BAG vaccine in Child-Pugh A/B advanced/metastatic HCC w/o Sorafenib. Approximately 6-10 cores of tumor are collected at baseline. The tumor is lysed and CRCL purified using an isoelectric focusing technique. Subjects are primed with multiple intradermal injections of BAG cells alone to increase the titer of allo-specific Th1/Tc1 cells. Next, multiple intradermal injections of BAG+CRCL are administered to elicit increased titers of tumor-specific Th1/Tc1 cells. Subsequent intravenous infusions of BAG cells activate allo- and tumor-specific memory cells, enabling their infiltration into tumor lesions. The BAG allo-rejection response creates a type I cytokine storm which serves to down-regulate suppressor circuits. Response is evaluated by mRECIST and experimental biomarkers. Longitudinal CT scans with concurrent biopsies as well as multiple collections of PBMC and plasma permits immunomonitoring of these immune mechanisms. Clinical trial information: NCT02409524.

Frontal Edema Due to Topical Application of %5 Minoxidil Solution Following Mesotherapy Injections.

Sir, A 37‑year‑old woman referred to our clinic complaining of hair loss. On dermatological examination, thinning of the hair on vertex was noticed. Laboratory findings were in normal limits. She was diagnosed as female androgenetic alopecia and decided to perform scalp mesotherapy. Three sessions of multiple intradermal biotin injections were performed by point by point mesotherapy injection technique [1] at 15 days intervals. There were not detected any complications after these biotin mesotherapy sessions. Fourth biotin mesotherapy treatment was performed similar to previous sessions, additionally, immediately after mesotherapy injections, approximately in 10 min, topical %5 minoxidil solution was topically applied with gentle massage. 16 h after the fourth session a firm frontal edema was developed, erythema and pain were not associated to edema [Figure 1]. Frontal edema resolved gradually in 2 days. After 2 weeks, the fifth biotin mesotherapy treatment was performed again without topical application of minoxidil and no complication was detected after the fifth session. Minoxidil solution can be used in the treatment of alopecia by topical application or by mesotherapy injection. It is shown that minoxidil enhances hair growth by prolonging the anagen phase and induces new hair growth. [2] It is instructed not to use minoxidil over than 1–2 cc within mesotherapy cocktail because the hypotension can be seen due to excess vasodilatation. [2,3] The vasodilator effect of minoxidil is well‑known, and vasodilatory edema is a well‑known side effect of vasodilators. [4] With respect of these knowledges, we comment the reason of frontal edema in this patient is due to the excessive absorption of topical applicated %5 minoxidil after hundreds of mesotherapy injections. Though minoxidil was applicated topically, it was absorpted too much by the pores of injected sites and effected as a locally vasodilator and caused the frontal edema. The previous mesotherapy sessions and the last mesotherapy sessions were not complicated, so we suggest the biotin mesotherapy injection does not have a role in this side effect. In the medical literature, we could not found a reported case describing facial edema due to minoxidil application neither by topically nor by mesotherapy injection. However, in patient forum sites we detected that patients noticed “puffy face” due to topical application of minoxidil solution. We present this case to remind the locally edematous effect of minoxidil solution.

Beneficial effects of activated macrophages on sulfur mustard-induced cutaneous burns, an in vivo experience

Objective: Macrophages are known to have key functions in almost every stage of wound healing and there is evidence for their beneficial effects in treating decubital ulcers and deep sternal wound infections in human. This study aimed to investigate the efficacy of a treatment with activated macrophages on ameliorating acute and long-term sulfur mustard (SM) induced skin injuries in the hairless guinea pig (HGP) model. Methods: HGP were exposed to SM vapor and treated with either a single or multiple intra-dermal injections of human activated macrophages in suspension (hAMS) into the wound bed. Clinical and histological evaluations were conducted up to 4 weeks post-exposure. Results: A single treatment with hAMS early after exposure (15 min and 6 h) resulted in a reduction in the number of damaged cells and vesications in the epidermis at 24 h. A substantial increase in cellular infiltration, mostly polymorphonuclears, was taking place in the hAMS-treated animals starting as early as 1 h after exposure. This flow of inflammatory cells continued, in the treated group, for at least 4 weeks, long after the injected macrophages were not detected. Repeated injections of hAMS (15 min, 48 h and 7 d post-exposure) decreased significantly the area of the wounds and improved the integrity of the barrier function as expressed by measuring trans-epidermal water loss up to 10 d. Conclusions: Our results indicate that the role of macrophages in wound healing is complex; their efficacy may depend on the timing of administration. Further investigation is required to determine whether they are required during the early phase of wound development and/or during the late phase of scar formation and remodeling.

Skin rejuvenation using mesotherapy: indications, techniques and ingredients

Mesotherapy is a skin rejuvenation procedure that has gained popularity in recent years. The products that are used for mesotherapy can be administered using multiple intradermal injections, either individually or through use of a dermal roller, which penetrates usually 192 needles at the same time, and also through topical creams. In this article, the author, who has gained experience in using this procedure over the past 10 years, provides information on the background to mesotherapy's development, the contents of the products used, techniques of administration, and her personal experiences with clients. A random sample from of 100 clients who received mesotherapy via individual injections was selected and descriptive data on their age, gender, ethnicity, and frequency of treatments are presented in this article. Use of the dermal roller technique is also presented, with similar data on the client group who had received this treatment at the same clinic. The data can be interpreted as inferring that the procedure of individual injections is particularly well tolerated by clients. However, further evidence is needed on client outcomes and satisfaction with this treatment, and its use in conjunction with procedures such as botulinum toxin and dermal fillers.

A novel application of dorsal window chambers: Repetitive imaging of tumor-associated lymphatics

The purpose of this study was to establish a lymphangiography assay allowing repetitive imaging of tumor-associated lymphatics, and to investigate potential associations between tumor-induced changes in pre-existing lymphatics and tumor angiogenesis. A-07-GFP human melanoma xenografts grown in dorsal window chambers were used as preclinical tumor model. Lymphatics were visualized after multiple intradermal injections of 155kDa tetramethylrhodamine isothiocyanate dextran outside the window chambers, and tumor vasculature was assessed from high-resolution transillumination images. Lymphangiography was performed thrice in window chambers with or without A-07-GFP tumors, with 3–4days between repetitions. The lymphangiography assay was highly reproducible. A-07-GFP tumors induced dilation of pre-existing lymphatics after the onset of tumor angiogenesis, and the dilation was correlated with tumor size.

Anti-arthritic effect of GN1, a novel synthetic analog of glucosamine, in the collagen-induced arthritis model in rats

Glucosamine is a naturally occurring amino monosaccharide that maintains the elasticity and strength of the cartilage tissues. It has been used to treat osteoarthritis in humans; however, in severe conditions of inflammation and pain, glucosamine alone is not enough, and it is important to improve its biological activity. Our research group has recently taken an interest in the synthetic manipulation of amino sugars to develop some efficient pharmacophores, e.g., β-D-glucosamine, to combat rheumatoid arthritis, and tested its anti-arthritic effects in the collagen-induced arthritis (CIA) model in rats. Arthritis was induced in female Sprague-Dawley rats by multiple intradermal injections of bovine type II collagen and challenged again with the same antigen preparation 7 days later. Arthritis was evaluated by arthritic score, body weight loss, paw volume measurement, and histological changes. The animals in the arthritic control group showed a gradual decrease in their body weight and concurrent increase in the paw volumes compared to the normal control group. In contrast, increased hind paw swelling was significantly suppressed with no further noticeable reduction in body weight in the glucosamine (p < 0.05) and GN1-treated (p < 0.02) arthritic animals. Histopathological evaluation of isolated knee joints by grading system and classification of the stages in arthritic lesion development revealed suppression of the inflammatory changes in the GN1-treated animals. Moreover, both the pro-inflammatory markers C-reactive protein (CRP) and low-density lipoprotein (LDL) levels were found to be significantly decreased in animals treated with GN1 (p < 0.03 for CRP and p < 0.05 for LDL) compared to the arthritic control group. These results suggest that GN1 has both anti-arthritic and anti-inflammatory properties. Its effects in the CIA model suggest that it could be useful in the treatment of rheumatoid arthritis.

Mesoterapia como opción terapéutica en patología dolorosa del aparato locomotor

Introduction Mesotherapy is a technique that consists in the application of multiple intradermal injections (deep dermis) with different drugs according to the conditions to be treated. It is used in different medical specialties, its use being especially interesting in pain, a prevalent symptom in our specialty. This work has aimed to assess the effectiveness and safety of this treatment in patients with chronic painful condition of the locomotor apparatus. Material and methods We conducted a prospective study of the results obtained with the application of this technique in 59 patients, referred from the Rehabilitation Service, suffering from different conditions. The medications used for pain treatment were a combination of Piroxicam, Lidocaine 1% and Pentoxifylline. The Visual Analogue Scale (VAS), the Health Questionnaire EuroQol-5D (EQ-5D Index score) and the measurement of the painful zone diameter were used to evaluate the results. The statistical analysis was conducted with the SPSS V15.0 computer program and the method consisted in a comparison of means, using the Student's T test for matched data of each of the 3 measurement instruments used. Results and conclusions None of the patients dropped out of the treatment. Their mean age was 46 years old and 74.5% of the patients were women. Neck pain was the most frequently treated condition. We have demonstrated a statistically significant improvement (p<0.001) of the painful condition of the locomotor apparatus after mesotherapy treatment, with mean decreases of 52.28 mm (95% CI: 44.78–59.79) in the VAS, 45.86 cm (95% CI: 30.97–60.75) in the lesion diameter and average increase in the EQ-5D Index score of 0.3550 (95% CI: 0.2924–0.4177). As side effects, 26% of the patients had hematomas in the application zone that resolved spontaneously. Mesotherapy is a safe and effective method for the treatment of chronic painful condition of the locomotor apparatus.

Mesotherapy - The french connection

Mesotherapy involves the use of multiple intradermal or subcutaneous injections of a mixture of compounds in minute doses, by means of very fine needles, directly over/near the affected sites. Originally invented in France to manage painful medical conditions, it is presently the buzz word in the field of cosmetic dermatology, chiefly to get rid of disfiguring fat. Depending upon the condition treated, the drugs injected, the techniques followed and the number of sessions involved vary. The wider reception of mesotherapy by its stakeholders are probably due to factors like inexpensive equipments, relatively minimal training for providers, much reduced dosage need of the drugs with resultant minimal untoward effects, quicker realization of benefits, minimal invasiveness/pain involved and not the least it is an outpatient procedure. Despite so many plus points, it has to be noted that currently there is a dearth of rigorous scientific studies to prove its efficacy and safety. Further, the average cost per session alone ranges from 200 USD to 600 USD.

Abstract 5238: Near-infrared fluorescence imaging of human lymphatics in healthy subjects and in cancer survivors

Abstract Near-infrared (NIR) fluorescence imaging was used to non-invasively image the (dys)function of the lymphatics in healthy control subjects and in subjects clinically diagnosed with unilateral lymphedema, a little understood disease characterized by chronic swelling and commonly observed in cancer survivors following therapeutic, complete nodal dissection. As part of an FDA approved feasibility trial and after informed consent, 24 control and 20 lymphedema (both hereditary and acquired) subjects received multiple intradermal injections of 25 µg of indocyanine green (total dose ≤ 400 µg) in bilateral arms or legs. The limbs were illuminated with NIR excitation light and the resulting fluorescent signal was imaged using custom, intensified CCD cameras. Lymphatic architecture and propulsive lymphatic flow from the injection sites to the nodal basin was observed. The apparent lymph velocities and propulsion periods were determined for the control subjects arms and legs as well as for the asymptomatic and symptomatic limbs of the lymphedema subjects. While the lymphatics of the control subjects consisted of well-defined vessels which propelled fluid from the injection sites to the regional nodal basin, diseased lymphatics exhibited distinct architectural malformations, such as (i) extravascular fluorescence in which the ICG diffused away from the injection site or leaked out of the lymphatic vessels, (ii) dense networks of lymphatic capillaries, (iii) tortuous lymphatic vessels, and (iv) lymphatic backflow and/or reflux. Statistical analyses of control subjects found subtle but significant differences in the left and right velocities in both arms (0.84 cm/s and 0.76 cm/s, p=8.1e-5) and legs (0.99 cm/s and 0.87 cm/s, p=0.032) but not in the periods of contralateral limbs. The difference in velocity in control arms (0.79 cm/s) and legs (0.94 cm/s) is small but significant (p=1.22e-7) while the difference in period is not. Significant differences in period exist between control (arms: 48.2 s; legs: 52.2 s) and both asymptomatic (arms: 39.6 s, p=2.68e-6; legs: 65.3 s, p=0.0022) and symptomatic (arms: 33.2 s, p=4.14e-5; legs: 72.1 s, p=0.00014) limbs. Significant differences were also found between the velocities in the control (0.94 cm/s) and both asymptomatic (0.83 cm/s, p=0.0084) and symptomatic (0.78 cm/s, p=0.0036) legs but not in the arms of control and lymphedema subjects. Results demonstrate that non-invasive NIR fluorescence imaging of microgram amounts of fluorophore can detect architectural and functional lymphatic abnormalities. The lack of significant differences between the velocities and periods of the asymptomatic and symptomatic limbs suggests that lymphedema may be a systemic disease regardless of onset etiology. Supported in parts by the American Cancer Society and the Longaberger Foundation (RSG-06-213-01-LR) and the National Institutes of Health (R01 HL092923 and U54 CA136404). Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 5238.

Facilitated Multiple Intradermal Injections Using the Double-Syringe Technique

Facilitated Multiple Intradermal Injections Using the Double-Syringe Technique