Correspondence to:This is the first reported case of isolated Madu Onwudike FRCSEd,

Botulinum toxin Type A is an effective and well-tolerated treatment for axillary hyperhidrosis. Timing of repeat injections as determined subjectively by patients is comparable to studies using colorimetric and gravimetric techniques to quantify the severity of sweating prior to the administration of repeat injections. The authors have indicated no significant interest with commercial supporters.

A 75-year-old man who had an emergency laparotomy for small bowel obstruction was found at operation to have multiple mid-ileal strictures. Histology of the resected specimen confirmed diaphragm disease of the bowel. The pathogenesis of this disease remains unclear but it is associated with long-term use of NSAID. Diagnosis is often difficult as many clinicians are unaware of this condition. The relevant literature has been reviewed.

This study examined the effect of post-procedure leg compression in a full range of patients with superficial truncal incompetence treated exclusively with radiofrequency ablation (RFA). There was no significant difference in the target vein occlusion rate, quality of life, venous clinical severity score, patient satisfaction, and pain score with or without compression. This study provides further evidence that varicose vein patients undergoing RFA may not require post-procedure compression. Objective: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). Methods: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. Results: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2eC6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n ¼ 47) and 98% (n ¼ 45), respectively (p ¼ 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference À1, 95% CI À2 e 3, p ¼ .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI À1 e 2, p ¼ .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p ¼ .72) and pain score 2.0 vs. 2.0 (p ¼ .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p ¼ 1.0 for above the knee and p ¼ 1.0 for below the knee). Conclusion: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.

No abstract