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Medical Care



Primary Palmar Hyperhidrosis Topical antiperspirant therapy Iontophoresis using tap water (aluminium and zirconium salts) Pay special attention to Educate re-application time/technique correct techique, device, to maximise efficacy and water mineral content, minimise side effects.
and patient education/training.
response & able to Specialist management for hyperhidrosis Westside Dermatology in conjunction with Queensland Vascular Group Onabotulinumtoxin A injections Adjust technique, frequency, duration water mineral content. Consider adding anticholinergics to water.
Repeat P.R.N.
response & able to Make adjustments to technique, dose and/or area covered.
Consider systemic medications: 1. Anticholinergics Repeat P.R.N.
(eg. glycopyrrolate, oxybutynin, propantheline) No response and in carefully cases are idiopathic, however the selected and educated patients condition maybe secondary to who fully understand the risks and complications of ETS drugs, neurological disorders or including, but not limited to, To maximise efficacy and systemic diseases. minimize side effects, consider combination therapy Endoscopic thoracic sympathectomy adjusted to patient needs and The Sweat Free Clinic is WHAT INVESTIGATIONS ARE NEEDED FOR PALMAR Australia's first multidisciplinary specialist clinic In most patients this condition is primary and idiopathic, and no investigations are needed. Primary Sweat Free Clinic is comprised of issue discusses the management hyperhidrosis typically has an dermatologists, vascular surgeons options for sweaty palms, or palmar onset before puberty, is bilateral and specialist nurse practitioners and symmetrical, and does not who manage all aspects of occur during sleep. It is often focal, excessive sweating.
and involves areas such as the BOTOX Treatment is now available under Sweat Free Clinic Hyperhidrosis is a common condition hands, feet, underarms or face. Specialist PBS listing for the management Westside Dermatology Over the next 6 months we will that afflicts 3% of the population. Secondary hyperhidrosis is usually of severe underarm sweating.
185 Moggill Road, Taringa. 4068 cover management options for The most commonly involved areas asymmetrical, of late onset, and • Patients entitled to 3 treatments per annum plantar, axillary, generalized, include the hands, feet, axillae, and often generalized.
• Botox lasts on average 6.1 months• Costing to patients equivalent to $2 per day and facial hyperhidrosis. This first face. The majority of hyperhidrosis Non-surgical options for the Endoscopic Thoracic Sympathectomy Management of Palmar Hyperhidrosis for Palmar Hyperdidrosis Dr Andrew Cartmill MBBS, FACD Consultant Laser Dermatologist B.Sc., M.B.B.S. (Hons), F.R.A.C.S. (Vasc) Vascular and Endovascular Surgeon applied on a nightly basis and can be ionized. Sweat production washed off in the morning. The is reduced via dysfunction of the In many cases, symptoms of palmar compensatory hyperhidrosis in other find it much less debilitating than rate-limiting factor is skin irritation. eccrine gland. Iontophoresis is hyperhidrosis are relatively mild and regions of the body, which is a risk the palmar symptoms prior to This over the counter topical should considered to be third line therapy are well controlled without the need particularly with higher T2 ganglion treatment. Provided patients are well always be applied to dry skin. Ask failing topical and oral medications. for surgery. In more severe cases transection. The lung is reinflated informed through a comprehensive patients to use a hairdryer on ‘cool' It can be effective in up to 70% of or after failure of medical therapy, over a drain tube, which is removed pre-operative discussion about settings to evaporate sweat prior to palmar-plantar hyperhidrosis. patients are often considered for on the first post-operative morning expectations, this risk is not a minimally-invasive endoscopic prior to discharge home.
major concern. Other risks include thoracic sympathectomy (ETS). The small pneumothoraces which Failing iontophoresis I usually ETS is a very well-tolerated aim is to reduce the sympathetic spontaneously resolve, bleeding, Primary palmar hyperhidrosis usually Anticholinergics such as compound creams or wipes procedure which carries a success outflow the palms whilst preserving infection and Horner's syndrome. presents in late childhood and is Propanthelene Bromide can reduce containing Glycopyrrolate. Once rate for eliminating palmar other sympathetic nerve functions.
This last risk can be caused by most often bilateral and symmetrical. palmar, plantar and axillary again, as per anticholinerics, hyperhidrosis of over 90%. The interruption of the T1 (Stellate) Sweat production ranges from mild sweating. Start patients on 15mg systemic side-effects limits the use. This is achieved through 2 small main risk to be considered is gangion and is therefore a very rare to very severe. Palmar hyperhidrosis nocte, increase as tolerated to intercostal incisions beneath the the chance of ‘compensatory can affect schooling, and work, ❘❘ Botox injections a maximum of 45 mg per day. armpit for endoscopic access to hyperhidrosis' which may occur in and has a significant impact on The use of Botulinumtoxin A has Anticholinergic side effects such the chest cavity. Unilateral lung 25-50% of cases. As expected, There is usually minimal pain aside relationships and self-confidence. been approved by the PBS for the as sedation can be seen in up to deflation is performed under general not all sympathetic outflow can from some transient generalised management of severe axillary anaesthesia, to facilitate exposure of be eliminated, and compensatory chest discomfort and surgical site Treatment options 80% of cases, however if tolerated, hyperhidrosis not responding to oral medication can be considered the sympathetic chain on each side. sweating particularly in the chest pain. These both rapidly subside. ❘❘ Avoidance of triggers Driclor, however BOTOX can For palmar hyperhidrosis, the aim is and abdomen can occur. Usually Patients can expect to be in hospital Decreasing trigger factors for as second line management. be used off label for palmar the interruption of the T3 ganglion this is mild, well-tolerated, and for 1 night after the procedure, sweating, including caffeine and A combination of Driclor and hyperhidrosis. In this setting I use only by direct division of the chain. much less severe than the palmar and usually return to work duties, energy drinks can improve mild anticholinergics can reduce this treatment as the last resort prior This will prevent sympathetic signals sweating the procedure was schooling and regular activities palmar hyperhidrosis, however has sweating to an acceptable level in to the consideration of surgery. to the hands to reduce sweating, originally performed for. Indeed within a few days.
little impact on severe cases. one third of palmar hyperhidrosis Unlike it's use in the axillary vault, whilst minimising the likelihood of most patients who develop this side effects such as transient muscle ❘❘ AntiperspirantsDriclor or Aluminium Chloride ❘❘ Iontophoresis weakness can be seen, additionally Hexahydrate 20% is first line This procedure is conducted in clinic efficacy is limited to 3-4 months in Referrals to: management and can be and involves passing of an ionized this area, compared to 6-7 months Sweat Free Clinic successful in mild cases of palmar substance through intact skin. The for axillary sweating. Non-PBS listing Westside Dermatology hyperhidrosis. This should be most common medium is tap water, also adds costs to the patient. 185 Moggill Road, Taringa. 4068 however compounded solutions P 3871 34 37F 38711570


Early days in drug discovery by crystallography - personal recollections

Acta Crystallographica Section A Early days in drug discovery by crystallography – personal recollections Received 10 December 2012 Accepted 11 December 2012 The Walter and Eliza Hall Institute of Medical Research, 1G Royal Parade, Parkville, Victoria, Australia. Correspondence e-mail: The influences of Lawrence Bragg and Max Perutz are evident in thecontemporary emphasis on ‘structural enablement' in drug discovery. Onthis occasion of the centenary of Bragg's equation, his role in supporting theearliest structural studies of biological materials at the Cavendish Laboratory isremembered. The 1962 Nobel Prizes for the structures of DNA and proteinsmarked the golden anniversary of the von Laue and Bragg discoveries.

Brain Images, Babies, and Bathwater: Critiquing Critiques of Functional Neuroimaging BY MARTHA J. FARAH Since the mid-1980s, psychologists and neurosci- of imaging's limitations without "throwing the baby out entists have used brain imaging to test hypotheses with the bathwater." about human thought processes and their neural The criticisms I review here can be grouped into four