Won Oak Kim

Hyperhidrosis is most often characterized by excessive sweating of the axillae, palms, soles, and craniofacial area. BTX-A injections for the treatment of hyperhidrosis have shown good results in the afflicted areas. However, few studies have reported on the effects of the use of BTX-A injections using vapocoolant spray combined vibration techniques in the facial area, perianal and groin area, or scrotum. BTX-A 0.8 units/0.1 mL and 2 units/0.1 mL were injected in these region, respectively, using a 33G needle. As a result, sweating was significantly reduced in all patients. Side effects observed with this treatment modality consisted of local bleeding and tolerable to mild pain during injection.

This study addresses the treatment of palmar hyperhidrosis, which has been difficult to manage. A new treatment has been developed using radiofrequency microneedling to reduce sweating non‐surgically by ablating sweat glands. Based on ultrasound measurements of the dermis and precise microneedling damage, effective energy was applied to locate the sweat glands and disabled their function. Radiofrequency microneedling with ultrasound can safely and effectively treat hyperhidrosis in a minimally invasive way.

Dexmedetomidine (DMT), a highly selective α2-adrenoceptor agonist, has been used safely as a sedative in patients under regional anesthesia. The purpose of this study was to determine the 50% effective dose (ED50) of single-dose DMT to induce adequate light sedation in elderly patients in comparison with younger patients undergoing transurethral resection of the prostate (TURP) with spinal anesthesia.

To justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo. Ten RCTs (574 patients) were included in this systemic review. Relevant studies were identified through searches of MEDLINE, SCOPUS and the Cochrane database library. The outcome was the adequacy of cutaneous anesthesia reflected in the patient's assessment of pain intensity during minor dermatologic procedures and adverse effects after application of the lidocaine/tetracaine medicated patch or peel versus placebo. The efficacy of the lidocaine/tetracaine patch or peel was consistently very significantly beneficial 30 or 60 minutes after the application compared to placebo (Relative risk, RR: 2.5; Number needed to treat, NNT: 2.2). We did not identify any difference in the effectiveness of adequate analgesia between the lidocaine/tetracaine patch and peel (the number needed to treat or to harm, NNT 2.4 vs. 2.0). No serious side effects or adverse events were observed with the lidocaine/tetracaine medicated patch or peel and placebo. Minor skin reactions were transient and resolved without treatment (Odd ratio, OR: 1.4 and 95% confidence interval, CI: 0.9-2.1; NNT: 14.9). The lidocaine/tetracaine medicated patch or peel is a well accepted, effective and safe method for minor dermatologic procedures based on pooled data of trials in terms of adequacy of cutaneous anesthesia and adverse effects.

Clinical research has expanded tremendously in the past few decades and consequently there has been growing interest in the ethical guidelines that are being followed for the protection of human subjects. This review summarizes historical scandals and social responses chronologically from World War II to the Death of Ellen Roche (2001) to emphasize the lessons we must learn from history. International ethical guidelines for studies with human subjects are also briefly described in order to understand the circumstances of clinical research. The tasks and responsibilities of the institutions and investigators in human subject research to preserve the safety and welfare of research subjects are summarized. Next, several debated ethical issues and insights are arranged as controversial topics. This brief review and summary seeks to highlight important arguments and make suggestions to institutional review boards (IRBs) to contribute to the future evolution of ethics in clinical research as we advance forward.

Kim WO, et al. Korean J Anesthesiol. 2011 Nov;61(5):405-412. http://dx.doi.org/10.4097/kjae.2011.61.5.405

Plantar hyperhidrosis is a distressing problem that can affect a patient's quality of life. Although various conservative modalities have been suggested, severe plantar hyperhidrosis is often not sufficiently treated. The aim of this study was to evaluate the safety and the effectiveness of a chemical lumbar sympathetic block (CLSB) with alcohol in patients with severe plantar hyperhidrosis. Sixty-nine patients were treated by a neurolytic lumbar block. A single-needle or two-needle technique was used with patients in the prone position. Of 138 procedures, the number of successful blocks was 68 (49.3%) for L3 to L4 and 28 (20.3%) for L4 to L5. The degree of anhydrosis was excellent in 6 patients (8.7%), good in 32 patients (46.4%), fair in 32 patients (34.8%), and poor in 7 patients (10.1%). Of 69 patients, 56 (81.1%) were partially or fully satisfied. Noted complications included temporary sexual dysfunction in 1 patient, compensatory hyperhidrosis in 1 patient, and transient genitofemoral neuritis in 3 patients. Although 62 patients (89.9%) recurred at 6 to 18 months, 3 patients (4.3%) remained stable until 18 to 24 months. The careful use of CLSB on an outpatient basis can be a safe, minimally invasive, and effective treatment for severe plantar hyperhidrosis.