Idiopathic neck and chest wall flushing could cause disabling effects on patients' quality of life. We aimed to evaluate the effectiveness of botulinum toxin-A (BTA) in the management of idiopathic neck and chest wall flushing. This was a pilot prospective clinical study of patients with severe idiopathic neck and anterior chest wall flushing. Two mouse units of BTA were injected intracutaneously with a maximum dose of 100 units per patient per session. The dermatology life quality index is used as the primary outcome measure. Twenty-two patients were included in the study (18 women, four men) with an average age of 26 years (range 18-48). Twenty patients (90.9%) had immediate improvement with almost complete resolution of their flushing. At four weeks follow-up, 18 of 22 patients were included in the final analysis, significant improvement in quality of life was achieved, and mean baseline dermatology life quality index score 7.78 (SD 3.25) improved significantly to 4.23 (SD 3.44) with a mean difference of 3.56 (SD 4.6; 95%, confidence interval 1.27, 5.84) with paired samples t-test 3.29 (d.f. 17) P < 0.004. BTA may provide an effective treatment in the management of idiopathic neck and chest wall flushing.

BACKGROUND:Patients with facial hyperhidrosis often experience occupational, social, and psychological problems. Botulinum toxin type A, which has been shown to be useful in the treatment of hyperhidrosis, can cause the paralysis of facial muscles if used in the skin overlying the facial muscles. It can, however, be used in the skin of the nose without significantly affecting the muscles of facial expression.METHODS:Two patients with severe nasal hyperhidrosis were treated with botulinum toxin.RESULTS:Two patients with severe nasal hyperhidrosis responded to a single session of treatment with intradermal injections of botulinum toxin.CONCLUSIONS:This treatment method for nasal hyperhidrosis is simple, well tolerated, and effective, and significantly improves the quality of life of the affected individuals.

BACKGROUND: Appendectomy is a commonly performed operation and it has been constantly refined and updated several times over the past century. The aim of this study was to explore the safety and efficacy of a new operative technique for open appendectomy. METHODS: This is a comparative study of 240 patients who underwent open appendectomy between July 1998 and July 2003 at Alburaihy Hospital, Taiz, Yemen. Hundred and twenty patients underwent appendectomy by the 'three none technique' and same number by classical method. Age, sex, incision, and degree of inflammation match were ensured. Differences in hospital stay, duration of operation, postoperative analgesia, morbidity and mortality were evaluated. RESULTS: In the 'three none' group there were 58 males (48.3%) and 62 females (51.7%) while there were 51 males (42.5%) and 69 females (57.5%) for the classical appendectomy group. The outcome measures are significantly better for 'three none' technique. CONCLUSIONS: The 'three none' is a safe, easy and cost-effective technique for open appendectomy.

The rarity and variable presentation of primary hyperparathyroidism can make its diagnosis a challenge – especially in the developing world where malnutrition may mask hypercalcaemia. Our case report is of a 25-year-old Yemeni woman who presented at AL Buraihi General Hospital with a pathological fracture of the right femur and a past history of multiple limb fractures. The diagnosis of primary hyperparathyroidism was suspected after full history and examination. It was then confirmed biochemically by raised PTH and serum calcium levels, and radiologically by ultrasonography of the patient's neck, which demonstrated a right inferior parathyroid adenoma. The patient underwent open reduction and internal fixation of her right femoral fracture but suffered a fracture of her left femur which was treated conservatively so as not to delay parathyroidectomy. Post-operatively, the patient suffered from transient hypocalcaemia, which was treated medically, and eventually went on to make a full recovery.