추적

차이

문서의 선택한 두 판 사이의 차이를 보여줍니다.

차이 보기로 링크

다음 판		이전 판
med:obs_botulinum_toxin [2012/06/07 09:58] – 새로 만듦 V_Lmed:obs_botulinum_toxin [2025/06/02 00:47] (현재) – V_L
줄 1: 줄 1:
 +{{tag>의학 obs_botulinum_toxin}}
 +======Botulinum Toxin======
 +
 +Botulinum neurotoxins
 +
 +Botulinum neurotoxin A (BoNT-A) is derived from the Gram-negative anaerobic bacterium Clostridium botulinum (Brubaker et al. 2008). The end-organ effects of BoNTs are mediated at the parasympathetic presynaptic nerve terminal. Efferents affect much of the clinical efficacy of BoNT mediated by direct inhibition of acetylcholine and adenosine-5-triphosphate release from presynaptic cholinergic nerve terminals, resulting in reversible chemodenervation and flaccid muscle paralysis (Anger et al. 2010). The onset of action typically occurs within 48–72 h and can last between 6 and 9 months. This reversibility of clinical response is secondary to axonal regeneration and nerve sprouting, which leads to attenuation of clinical effect and the need for repeated injections (Simpson 2004).
 +
 +Most studies have injected BoNT directly into the detrusor muscle (Sahai et al. 2009; Brubaker et al. 2008). Adverse effects of BoNT-A include gross haematuria, injection site pain, urinary tract infection and post-void reflux and urinary retention (Simpson 2004). Thus, the ability and the willingness to perform clean intermittent catheterisation (CISC) following BoNT-A injections should be mandatory (Sahai et al. 2009).
 +
 +Brubaker et al. (2008) reported on a population of women with refractory idiopathic UUI randomised to BoNT-A vs placebo. Patient Global Impression of Improvement scores at 2 months were significantly better in the treatment group (p = 0.003) and 60% of the women achieved a clinical response (p = 0.0001). There was a highly significant reduction in daily incontinence episodes in the BoNT-A group (p = 0.0001). Furthermore, perception of bladder control was greater in the BoNT-A cohort (p = 0.0001). However, reported adverse effects included urinary tract infections and increased post-void residual urine in the BoNT-A arm (Brubaker et al. 2008). Sahai and colleagues (2009) randomised 16 patients to 200 U of BoNT-A and 18 patients to placebo and noted a significant improvement in the primary outcome measure of maximum cystometric capacity at 4 weeks and 12 weeks. There were also significant improvements in frequency, urgency and UUI episodes and QoL scores. These effects were maintained at 24 weeks follow-up.
 +
 +
 + 
 +
 +
 +
 +
 +
 +
 +  * 출처: [[http://informahealthcare.com/doi/abs/10.3109/01443615.2011.649317|]]
 +