Homemade Skin Care Recipes

The Beauty of Food Turning Back The Clock

Passes down generation after generation, this book that you are about to get contains the secrets of the Persianprincesses that theyhave used to look the most beautiful. Hannan has attained this book after her mother who looked like she never ages, the book has tips and tricks that you can use in your kitchen right now to prevent wrinkles and get rid of them, look healthier and 5 years younger in a matter of few minutes, and empower your feminity within by being the most beautiful version of yourself. You can finally say goodbye to Botox treatments and needles, expensive shampoos and conditioners, and the skin care schemes that the smartest women are falling for. You can finally wave goodbye to wasting money and putting yourself at risk becausethese tips shared by Hannan and the Persian royalty have come up with are going to make your skin look years younger in a matter of few minutes, remove cellulite and gain a fresh look that defies science and the bashful words of your peers, you can finally be the most beautiful around. This electronic book is also very easily attained as you will be able to get it instantly after you make your purchase. More here...

The Beauty of Food Turning Back The Clock Summary


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I usually find books written on this category hard to understand and full of jargon. But the author was capable of presenting advanced techniques in an extremely easy to understand language.

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Therapeutic Uses Of Botulinum Toxin

However paradoxical it may seem, botulinum toxin has over the past decade risen to the status of 'wonder drug'.47,48 It is used to treat a variety of diseases characterized by spasm or overactivity of a particular muscle or group of muscles. In many of these illnesses the muscular hyperactivity is the primary disorder (e.g., cervical dystonia), while in others, it is secondary to another disease (e.g., rigidity and tremor in Parkinson's disease). In most of these conditions intramuscular injection of botulinum toxin has become the treatment of choice and has replaced previous and much less satisfactory surgical or pharmacological alternatives. Clinically effective paralysis with type A botulinum toxin typically lasts three or four months, but it can be longer.47,48 The widespread applicability of botulinum toxin's ability to relax tense muscles originates in the work of two investigators. Alan Scott was an ophthalmologist who pioneered preclinical evaluation of botulinum toxin in...

Clostridium Botulinum

Botulism is an intoxication which results in neuroparalysis, and can be caused by any of seven neurotoxins (Table 10.2).247 While heterogenous in some respects, these toxins share the ability to block acetylcholine release from cholinergic nerve endings.248 In the main, the toxins are serologically distinct.249'250 The paralytic action of botulinum toxin on skeletal muscle is well-known (see Chapters 17 and 18).251 Another toxin, designated C2, has no neurotoxicity, but is a binary toxin, consisting of an H chain which mediates binding to cell membranes252 and an L chain with ADP-ribosylating activity similar to i-toxins of C. perfringens and C. spiroforme.253 Clostridium botulinum types A and B are found in soils, while types C, D, E, and F are more common in wet environments.254 Germination of C. botulinum spores resident in the carcasses of dead animals or in rotting vegetation can yield sufficient toxin to cause outbreaks. Disease occurs mainly in ruminants, horses, mink, and...

The Organization Of The Botulinum Progenitor Toxin Genes

L and LL forms also contain NTNH, but in addition they incorporate an undefined number of smaller nontoxic proteins which possess haemagglutinating activity (HA). The nature of the progenitor toxin produced varies according to toxin type and host strain (Table 17.1). In type E and F strains, only type M progenitor toxin is produced. Type B, C and D BoNT is usually produced as either the M or L form, while BoNT G is composed exclusively of the L complex. All three forms are found in type A C. botulinum cultures.

Botulinum Toxin

The success of treating focal dystonias such as torticollis led to the use of botulinum toxin (BX) for focal symptoms and signs of spasticity. Botulinum toxin type A (Botox) and type B (MyoBloc) are among seven serotypes of the toxin. The agents have quickly become a new wrinkle in the fashion of managing the local effects of spasticity. sis.205 When the neurotransmitter fails to be released, the muscle fiber becomes paralyzed. The muscle becomes functionally denervated and atrophies, but axon terminals sprout to make new synaptic connections to neighboring muscle fibers and to repair paralyzed end plates by approximately 3 months after the injury.206 Retrograde transport probably puts some of the drug into spinal segments, where it can block recurrent inhibition mediated by Renshaw cells. The onset of the botulinum effect takes up to 72 hours. Side effects include weakening of the affected and, if diffusion occurs, of neighboring muscles, malaise, and local discomfort. Botulinum...

Skin Problems

Itching and Dry Skin With prolonged bed rest, weight-bearing surfaces such as the hips, tail-bone (sacrum and coccyx), ankles, and heels may develop pressure sores, also known as bedsores or decubitus ulcers. Factors that increase the risk of developing pressure sores include weight loss, poor nutrition, numbness and loss of sensation (feeling uncomfortable ordinarily prompts the patient to shift position), anemia, infection, paralysis, incontinence, spasticity, heart failure, poor circulation, friction, irritation, dry skin, excessive moisture, and wrinkled or unclean bedding or clothing.

Literature and Specialties

Tion works and individual monographs were devoted to such problems as children's diseases, the diseases of women, skin problems, eye complaints, and throat ailments. The following provide a few examples The earliest extant title concerned with the diseases of children is the Lu-hsin ching (Classic of the Fontanel), of unknown authorship and compiled around A.D. 907, which was presumably based on sources of the fourth century or even earlier. The oldest available text today on women's diseases and obstetrics is the Fu-jen liang fang (Good prescriptions for females) of 1237 by Ch'en Tzu-ming. A text, lost now, possibly dating back to T'ang times and indicating the Indian origins of Chinese ophthalmology, is the Lung-shu p'u-sa yen lun (Bodhisattva Nagaijuna's discourse on the eyes), and a first monograph on leprosy was published by Hsiieh Chi in 1529 under the title Li-yang chi-yao (Essentials of the li-lesions). On ailments affecting the throat, the oldest text extant is the Yen-hou...

Extrachromosomal Virulence Determinants in the Clostridia

The Clostridia produce more toxins than any other bacterial genus,2'3 and pathogenic Clostridia are usually identified on the basis of the characteristic toxins they produce. More than 20 toxins and other extracellular proteins contributing to virulence such as spreading factors and proteolytic enzymes have been identified in Clostridium spp4 Two of the toxins, botulinum and tetanus toxins, are the most powerful poisons known - lethal doses of botulinum and C botulinum types C. botulinum types C. botulinum type G C. botulinum types C. botulinum type G Abbreviations BoNT, botulinum neurotoxin CPE, C. perfringens enterotoxin HA, hemagglutinin NTNH, nontoxic nonhemagglutinin TeNT, tetanus neurotoxin see text for details. Genes encoding clostridial toxins that exist at least temporally on extrachromosomal virulence plasmids are those of C. botulinum type G, enterotoxigenic C. perfringens, and C. tetani. The genes for C. botulinum types C and D botulinum toxins are carried on...

Virulence Genes Located On Plasmids

One of the principal findings of genome mapping studies with strains belonging to different biotypes of C. perfringens was the frequent occurrence of extrachromosomal elements which carried the genes for toxins or other potential virulence factors. It has now been established that genes for three of the four typing determinants, the P-, e- and i-toxins are borne by plasmids, as are the genes for the X-toxin, a protease, enterotoxin and urease. Details are presented in Table 4.2. It is not clear if these are genuine plasmids in all cases or whether some of them may correspond to temperate phages that can exist as episomes. The association of toxin genes with extrachromosomal elements in some pathogenic Clostridia is well-known see Chapter 3.25 The genes for the botulinal neurotoxin are associated with phages in C. botulinum types C and D, and plasmids in type G strains. There is also strong evidence for the production of a-toxin in C. novyi resulting from lysogenization with phages25...

Physical Complications

As you lose more and more weight (especially if you reach that dangerous mark of 20 to 25 of your acceptable, normal weight) your body undergoes some dramatic physical changes. Your face and body take on an emaciated appearance. Your eyes may seerri vacant and hollow, your bones protrude, and your stomach and chest seem to cave in. Your hair falls out and you may develop fine, downy hair (lanugo) on other parts of your body. Your skin changes in color and texture it gets dry and rough, sometimes purplish or darker than normal. Sometimes your skin becomes yellow-tinged due to a condition called hypercarotenemia which is present in more than 80 of anorexics. The cause is not known and seems to be unique to the form of malnutrition that results from anorexia. Your fingernails take on a bluish tinge, which may extend to your wrist bones. It may also occur from your toes to above your kneecaps. Sometimes your fingernails develop ridges.

Crying Associated with Diaper Rash and Teething

Some babies with more sensitive skin will cry when they are wet, especially if they have a sore bottom or a rash. If you think that your baby's crying starts up when she is wet, the diaper may be changed as soon as the baby wets it. Even disposable diapers, although they are more absorbent than cloth diapers, should be changed to prevent skin irritation if you discover that your baby settles after a change.

Decreased innate immune response

Recently, we compared the expression of antimicrobial peptides in these two skin diseases to determine if the increased susceptibility to infection in AD is due to a deficiency in antimicrobial peptides.30 In this study, we compared the expression of HBD-2 and LL-37 in AD skin lesions to psoriatic lesions and normal skin using immunohistochemical staining, Western and immuno-dot blotting, and quantitative real-time reverse transcriptase-polymerase chain reaction (real-time RT-PCR). By immunohistochemistry and immuno-dot blot, we confirmed that there was abundant LL-37 and HBD-2 in the skin of all patients with psoriasis. Immunostaining of LL-37 and HBD-2, however, was significantly decreased in AD lesions. Real-time RT-PCR showed significantly lower expression of HBD-2 and LL-37 mRNA in AD lesions than in psoriasis lesions.

What It Can Do for You

Good for maintaining soft skin and to help heal sunburn and other minor surface burns, scrapes, and wounds. A small plant in a window of your home or office provides a fresh and ready supply cut open a thick leaf and squeeze the liquid right onto your skin. The gel from inside the leaf should not be confused with the bitter yellow juice from the rind of the leaves. In dried form, this juice is a potent laxative. (Note there is an illustration, but no title legend, for aloe vera.)

Antibioticsteroid combinations

Owing to the increased risk of bacterial resistance that may occur with frequent use of antibiotics, it is important to combine antimicrobial therapy with effective skin care since it is well established that the excoriated inflamed skin of AD predisposes to S. aureus colonization and infection. Use of antibiotic therapy must be carried out with good skin hydration to restore skin barrier function and effective anti-inflammatory therapy to reduce overall skin inflammation. Exacerbating

Clinical challenges

Complex regional pain syndrome (otherwise known as central pain syndrome, shoulder-hand syndrome, thalamic pain syndrome or Dejerine Roussy) following stroke appears as a painful, oedematose limb with altered heat and tactile sensations, dystrophic skin and is prone to non-use and psychological implications such as anxiety and depression (see Chapter 5). Onset following stroke may occur in the shoulder or hand (or both) in the first 5 months and one-third of these patients may resolve within 1 year (Pertoldi and di Benedetto, 2005). Onset seems to be related to aetiology of stroke (frequently involving the thalamus), severity, motor recovery, spasticity, sensory disorders and glenohumeral subluxation. Although the mechanisms are unclear, the hypersensitivity and interpretation of non-noxious stimuli to be noxious appears to arise from neurogenic inflammation leading to sensitisation of peripheral and central sensory neurones and variable involvement of the sympathetic nervous system....

Neck Back and Myofascial Pain

Recent randomized trials with good designs add to the potential armamentarium of interventions, although all of these results require confirmation by additional trials. For low back pain, osteopathic manual care and standard medical care produce equivalent results 140 bipolar magnets were no better than sham magnets 141 low energy laser treatment 3 times per week for 4 weeks is modestly better than sham treatment 142 40 units of botulinum toxin injected into 5 paralumbar sites is better than placebo for up to 8 weeks of less pain 143 neuromuscular electrical stimulation and TENS for 5 hours per day at 2-day intervals is better than placebo stimulation 144 percutaneous electrical nerve stimulation with acupuncturelike needles in the paraspinal muscles reduces the need for opioid analgesics more than sham treatment, TENS, or exercise 145 and facet injections with methylprednisolone are no better than placebo in patients who reported less pain after the facet was injected with local...

Topical Corticosteroids

The duration of therapy is usually the time required for resolution of symptoms or lesions. To avoid adverse effects, the highest-potency steroids should not be used for longer than 2 to 4 weeks continuously. However, these can be used intermittently for chronic conditions such as psoriasis in a pulse-therapy mode (e.g., apply every weekend, with steroid-sparing medication on weekdays). For conditions with dry skin, liberal use of emollients between steroid applications can minimize steroid exposure while maximizing the benefits of therapy.

The neurotoxin genes

Representative genes of all of the clostridial neurotoxins, from the various serotypes and physiological groups, have been isolated and sequenced (Table 17.2). The G+C ratio of these genes is characteristically low (ranging from 24.51 to 27.84 ). They therefore exhibit an extreme codon bias common to clostridial genes.31'32 After typical prokaryotic ribosome-binding sites, all of these genes utilize an AUG translational start codon and all terminate with an ochre (UAA) stop codon. The one exception is the BoNT F gene of C. barati ATCC 43756, which makes use of an amber (UGA) stop codon. For those genes that have been sequenced for a sufficient distance downstream of their stop codon (the BoNT A genes of C. botulinum strains NCTC 2916 and 62A the TeNT gene of C. tetani), sequence motifs typical of transcriptional termination signals are apparent. C. botulinum C. botulinum C. botulinum 0 'E-like' organisms refers to clostridial strains that share characteristics with C. botulinum group...

BDNAbased detection systems for neurotoxin genes

The DNA detection systems developed have been assessed in artificially contaminated foodstuffs or by using purified DNA. However, such systems have yet to be adopted as routine diagnostic tools for the typing detection of botulinum-producing clostridial strains. The laboratory investigation of suspected cases of botulism still, therefore, relies on immunological testing of samples for toxin, culture and selection of lipase positive bacteria, and testing of individual colonies for toxicity in the mouse bioassay.

Multiple toxin phenotypesgenotypes

Clostridial strains that express more than one toxin serotype are rare. The first published example was C. botulinum strain 84 isolated in Argentina,37 which was shown, using appropriate antitoxin sera, to express toxin with features common to both BoNT A and BoNT F. Similarly, strains have been isolated that express BoNT A and BoNT B,38,39 and BoNT B and BoNT F 40 Subsequent The development of primers for the specific detection of neurotoxin genes by PCR has facilitated a more thorough investigation of strains which produce more than one toxin. Thus, in a recent study, PCR screening indicated that out of the 79 C. botulinum type A strains, 49 also carried sequences specific to a BoNT B gene.35 Only one of these strains was found to produce BoNT B, although only at extremely low levels (25 mouse lethal doses, MLD) compared to BoNT A (500 000 MLD). A more recent study has also detected these unexpressed or 'silent' genes in type A C. botulinum strains.43 These particular strains were...

The role of bacteriophagemediated transfer of BoNT genes

Bacteriophages that infect clostridial strains expressing BoNT's were identified in the late 1960s and early 1970s.50-54 Those isolated from group I and II C. botulinum strains were shown to exist in a lysogenic state, with the bacteriophage DNA maintained as a chromosomally integrated prophage.55 As a result, bacteriophage-sensitive strains from these groups are difficult to isolate. For the few strains in which this has been possible, no change in toxigenicity was detected. Evidence for the participation of bacteriophages in the transfer of other BoNT genes is more tentative. Work in our laboratory with the group I C. botulinum strain NCTC 2916 has shown that approximately 1 kb downstream of the BoNT A gene is a gene, lycA, encoding a protein which has similarity to various types of lysozymes. Of particular significance is the homology with the lytic enzymes of the Lactobacillus bulgaricus bacteriophage (bMV-15X and the Streptococcus pneumoniae phage

Genetic basis of toxin production 279 C Do transposons have a role in the dissemination of BoNT genes

The observation that neurotoxin genes can have many different locations (chromosome, plasmid or bacteriophage) suggests that they themselves may be mobile through the agency of transposable genetic elements. Although there is no direct evidence for this supposition, a number of observations are worthy of note. It is, for instance, apparent in a number of cases, that nucleotide sequence conservation between toxin genes ends abruptly at defined points past their 3'-ends. This is most obvious between BoNT A genes of the type A C. botulinum strains NCTC 2916 and 62A, where any semblance of sequence homology ends at a point 100 bp downstream of their translational stop codons. The opposite is evident in comparison between strain NCTC 2916 and the type F C. botulinum strain Langeland. In this case, the neurotoxin structural genes, and the first 600 bp following their stop codons, share no significant homology, before becoming 96 identical, owing to the presence of highly conserved lyc...

Location of a genes encoding nontoxic components

From an early stage it was apparent that the genes coding for at least some of the non-toxic components of the toxin complex were in some way linked to the gene responsible for production of the neurotoxin. Thus, it was shown that atoxino-genic strains of C. botulinum which were reinfected with BoNT C encoding bacteriophage acquired the ability to produce haemagglutinating (HA) activity, in addition to the reacquisition of the ability to synthesize neurotoxin.78 This fact was exploited to clone a gene expressing HA activity by constructing a gene library of the bacteriophage C-st genome in E. coli, and screening it with anti-HA sera. Through nucleotide sequence analysis, the gene was subsequently shown to be on the opposite strand to, and 4.3 kb upstream of, the BoNT C 1 neurotoxin gene.79 The translated sequence specified a protein with a predicted molecular mass of 33 kDa. Its N-terminal sequence proved to be identical to a sequence derived experimentally from an equivalent sized...

Skin The Purpose of the Surface

Learn how your skin reflects your overall health Your skin is the largest organ you've got. It envelops your body in a waterproof protective covering that will take all kinds of abuse from birth through midlife crisis. Is there a price to pay You bet. According to traditional oriental theory, your skin reflects the inner workings of your body and spirit. Organs like the stomach, lungs, and bowels can greatly affect the texture, tone, and glow of your skin. Keep reading to learn some tips for stunning skin.

History of CB warfare and current threats

Used as an assassination weapon in London. In 1991, Iraq admitted its research, development, and BWA weapon productions of anthrax, botulinum toxin, Clostridium perfringens, aflatoxins, wheat cover smut, and ricin to the UN. In 1993, a Russian BW program manager, who had defected, revealed that Russia had a robust biological warfare program including active research into genetic engineering and binary biologicals. Table 20.1 provides a short summary of CWA users and the locations where they were used since WWI.

Oriental Medicine Makes the Connection

Today we benefit from the meticulous observations and connections made by Chinese doctors over 2,000 years ago. Eastern practitioners have already developed treatment strategies for the close relationship between the lungs and your skin that is born out in today's Western medical journals.

Genetic basis of toxin production 287 B Transcriptional analysis of neurotoxin gene loci

It is immediately apparent that the toxin complex genes of type C and type A C. botulinum strains are organized in two distinct, divergent units, namely, the NTNH-BoNT genes and a unit composed of the HA-encoding genes. The suspicion that these two units may form two distinct operons has been confirmed in two separate studies. In our own laboratory, Northern blots of RNA isolated from the type A strain NCTC 2916, and appropriate DNA probes, have indicated the presence of a single 3.2 kb transcript encompassing all three HA genes, a 7.5 kb transcript specific to the genes encoding NTNH A and BoNT A, and a 4.0 kb transcript specific to BoNT A alone.81 From this it would appear that the HA genes are translated from a single polycistronic message, whereas BoNT A is transcribed as either a monocistronic message or as a bicistronic transcript which also specifies the NTNH A gene (Figure 17.4). The existence of the last two transcripts was confirmed in primer extension studies, when it was...

The amygdala and emotional expression

A study on the amnesic patient H.M., whose surgical damage to the medial temporal lobe included removal of the amygdala bilaterally, provides confirmation of the blunting of affective responsiveness in humans with amygdala damage, and offers some further insights into the nature of this disorder. In the clinical setting, H.M. was known not to complain about normally painful conditions including hemorrhoids, and did not produce a normal skin-resistance change to electrical stimulation. He also was noted to rarely mention being hungry even when his meals were delayed, but he otherwise ate in a normal manner when given a meal. These observations were followed up in a systematic study of H.M.'s responsiveness to pain and hunger. In this study H.M's responses to thermal stimulation were compared to those of control subjects and amnesic patients without amygdala damage. H.M. showed a diminished ability to discriminate painful stimulation. Most prominent was his failure to identify any of...

Other clostridial binary toxins

Two families of clostridial binary toxins can be defined on the basis of the immunological relatedness, and functional complementation between the enzymatic and binding components. One family consists of t-toxin from C. perfringens type E, C. spiroforme (t) toxin, and the enzymatic components produced by certain defective strains of C. perfringens type E and C. difficile (t-like family), and the other family of C2 toxin of C. botulinum types C and D (C2 toxin family). Beyond their binary nature, the C2 toxins are unrelated to the t-toxins, either genetically or immunologically.

How do I use the penile prosthesis and how is it placed

To minimize the risk of infection, prior to the procedure your scrotal area is shaved, you are scrubbed with an antibacterial soap and you are given intravenous antibiotics to kill any residual bacteria that may be present on your skin. These intravenous antibiotics will be continued during your entire hospital stay, and you are discharged to home with a 10- to 14-day supply of oral antibiotics. good use of both hands. The reservoir in the three-piece unit is placed in the pelvis near the bladder. The tubing that connects the reservoir, pump, and cylinders runs deep under your skin so that it is not visible if you feel closely, you may be able to identify the tubing, but the goal is to have it be unnoticeable. Before the procedure is completed, your surgeon will test the prosthesis to ensure that all components are working well, that when inflated it gives you a fully rigid erection, and that the tips of the prosthesis are in a good position in the tip of your penis.

Purification And Characterization Of Toxins A And B A Toxin production

Numerous media have been used for the growth of C. difficile and production of the toxins. Taylor and Bartlett 27 purified toxin B from cultures grown anaero-bically in brain-heart infusion broth. Rolfe and Finegold28 reported that chopped meat-glucose broth, brain-heart infusion broth, and a basal synthetic medium supplemented with proteose peptone gave the highest yields of cytotoxic activity. Synthetic media have also been described for the production of the toxins, however, the density of growth achievable is considerably lower than that in rich media.29'30 The highest levels of toxin can be produced in dialysis sac cultures. The method was originally developed by Sterne and Wentzel for the production of botulinum toxin and works quite well for the production of toxins A and B.31 In this method the organisms are grown in a dialysis sac suspended in a rich media such as brain-heart infusion broth. The organisms grow slowly and to a very high density within the dialysis sac. The...

Biological properties

When administered systemically is unknown. In mice injected intraperitoneally there is some evidence of liver damage.56 Arnon et al.51 examined the effects of the toxins in rhesus monkeys and noted that the animals apparently died from cessation of breathing. Death is not accompanied by the floppy paralysis characteristic of the botulinum and tetanus neurotoxins.

Raynauds Phenomenon When the Cold Gets

Disorder of the small blood vessels that feed the skin. During an attack, arteries briefly contract, causing skin to turn white, then blue. Your skin turns red as arteries relax and let the blood and oxygen flow again. Hands and feet are the most common areas affected, but the nose and ears are also possible targets.

Sequence identity of toxins A and B

Putative promoters and transcriptional terminators of the toxin A and B genes have been proposed by Eichel-Streiber.71 The proposed promoters have unusual distances between the transcriptional start site and the ATG start codons, i.e. 169 nucleotides (nt) for toxin A and 239 nt for toxin B. Similar spacing is found in the promoter regions of tetanus and botulinum toxins. Whether these are the functional promoters of the toxin genes has not been determined. Stem loop structures beginning 69 nt downstream of the toxin A stop codon and 100 nt downstream of the toxin B stop codon were proposed as likely transcriptional terminators.

Mechanism Of Action

The Rho Rac family of low molecular weight GTP-binding proteins are therefore ideal candidates for modification by the toxins. This Ras-related family of proteins, which includes RhoA, RhoB, RhoC, Rac 1, Rac 2, and CDC42, has recently been implicated in the regulation of actin microfilament assembly (see Chapter 22).75 Additionally, C3 exoenzyme of C. botulinum and the newly discovered exoenzyme of C. limosum catalyze ADP-ribosylation of Rho and Rac proteins.76,77 Thus, a precedence exists for targeting of these proteins by clostridial enzymes.

Table 552 Neuroleptic Neurotoxicity

At present, prevention is the treatment of choice for TD. Therefore, neuroleptics should be used only when specifically needed and at the lowest possible doses. Once TD develops, the causative agent should be discontinued, if possible. Alternatively, the patient should be switched to an atypical neuroleptic like clozapine, which not only does not regularly cause TD but may even improve its symptoms.y If neurological impairment, disfigurement, or discomfort exists, treatment with the dopamine depleters reserpine or tetrabenazine should be considered. Noradrenergic antagonists (propranolol, clonidine), gamma-aminobutyric acid (GABA) agonists (clonazepam, diazepam, valproate, baclofen), botulinum toxin injections, and to a lesser degree, vitamin E, buspirone, and calcium channel blockers have been used with variable success.y , y

Clinicopathologic Correlations

Prevention of decubitus ulcers is extremely important in the care of bedridden or chair-bound patients. Repositioning or rotating the patient at least every 2 hours, minimizing moisture, practicing basic skin care, and improving the nutritional state are important. Skin should be cleansed at the time of soiling and at routine intervals. Care should be used to minimize the force and friction applied to the skin. Luggen AS Wrinkles and beyond skin problems in older adults. Adv Nurs Pract 11 55, 2003.

Dean Payne and Petra Oyston

E-Toxin is the most potent clostridial toxin after botulinum and tetanus neurotoxins. The toxin is produced by Clostridium perfringens types B and D but not by types A, C or E.1 Clostridium perfringens types B and D have a limited host range, being mainly isolated from sheep and lambs, only occasionally from goats and cattle, and rarely from man.2 They are responsible for producing severe and rapidly fatal enterotoxaemia C. perfringens type B enterotoxaemia infection of lambs causes lamb dysentery while type D enterotoxaemia causes pulpy kidney disease in sheep and lambs (see Chapter 10). Mortality rates in both diseases can be as high as 100 and their outbreak is of great economic importance wherever animals are raised intensively.3 Neither diesease is transmissible, but sporadic outbreaks occur when the microbial balance of the gut is disrupted, for example after antibiotic treatment or by changes in diet. Pulpy kidney disease is often associated with a change from a poor to a rich...

Adjuvant Pharmacotherapy

Local injections of botulinum toxin lessens the resistance to passive movement on the Ash-worth Scale and the flexor posture of the fingers and wrist,305,306 as well as inversion plantar flexion of the ankle or toe extension and claw-ing307,308 in the hemiparetic limbs. Both Botox (up to 300 units) and Dysport (up to 1000 units) preparations of botulinum toxin A have improved hand opening for hygiene, posture, and pain control.306 Botox injections of up to 300 units into the ankle and toe flexors and extensors was equivalent in efficacy to the injection of 100 units into the tibialis posterior followed by continuous stretch of the calf muscles.309 The effects of injections are ap

Drug Therapy of Chronic Migraine CM

The classes of medications used for CM are, for the most part, medications shared with the fields of neurology and psychiatry, and all the medications target the central nervous system. Included are the anti-epileptics, botulinum neurotoxins, and antidepressants. In addition some supplements and vitamins can be utilized as adjuvants. As noted, only onabotulinumtoxinA is FDA-approved for CM the rest are off label and mostly untested clinically. (Botulinum toxin A, BOTOX)

Mecanism Of Centripetal Lipid Accumulation Supraclavicular Fat And Face

Hypothyroidism is considered primary when increased TSH levels accompany low T3 and T4 levels, suggesting thyroid pathology. In secondary or central hypothyroidism, low T3 and T4 are associated with low TSH and suggest pituitary insufficiency. Thyroid hormone deficiency causes mental retardation in infants, growth delay in children, and myxedema in adults. Symptoms of thyroid hormone insufficiency include cold intolerance, weight gain, memory loss, dry skin, hair loss, brittle nails, constipation, increased sleep demand, and fatigue. Severe, untreated hypothyroidism can lead to coma and even death. Hypothyroidism from TSH or TRH deficiency can result from hypothalamic or pituitary destruction (neoplastic, inflammatory, granulomatous, vascular, traumatic, autoimmune, or from radiation necrosis). In the presence of an expanding pituitary mass (i.e., pituitary adenoma), loss of TSH secretion is typically associated with other hormonal abnormalities because there is a step-wise loss of...

Parakeratosis pustulosa Hjorth Sabouraud syndrome

Parakeratosis Pustulosa

These usually disappear before the patient presents to the doctor. Confluent eczematoid changes cover the skin immediately adjacent to the distal edge of the nail. The affected area is pink or of normal skin colour and densely studded with fine scales there is a clear margin between the normal and affected areas. The skin changes may extend to the dorsal aspect of the finger or toe, but usually only the finger tip is affected. The most striking and characteristic change is the hyperkeratosis beneath the nail tip. The nail plate is lifted up, deformed and often thickened. Commonly the deformity produced is asymmetrical and limited to one corner of the distal edge, or at least more pronounced at the corners of the nail. Pitting occurs in some cases rarely, transverse ridging of the nail plate is present. In most cases the condition resolves within a few months, but in some cases it may persist for many years, even into adult life.

General Considerations

The most important function of the skin is to protect the body from the environment. The skin has evolved in humans to be a relatively impermeable surface layer that prevents the loss of water, protects against external hazards, and insulates against thermal changes. It is also actively involved in the production of vitamin D. The skin appears to have the lowest water permeability of any naturally produced membrane. Its barrier to invasion retards potentially noxious agents from entering the body and causing internal damage. This barrier protects against many physical stresses and prohibits the invasion of microorganisms. By observing patients with extensive skin problems, such as burns, clinicians can appreciate the importance of this organ.

Evaluation Guidelines Table163

Not usually useful except EMG is often used to guide botulinum toxin injections for theraphy Electrophysiology. Electroencephalography (EEG) is useful in studying any intermittent movement disorder, but the recording obtained must include episodes of the patient's movements in order to determine if there is a cortical event that occurs simultaneously. Cases of paroxysmal dyskinesias can sometimes be associated with epileptiform discharges in the contralateral frontal cortical region, and although they may not be detected in a standard EEG, double-density electrodes may provide the phase-reversal indicative of a seizure. In myoclonic disorders, EEG testing is important for documentation of a possible associated cortical event at the time of the myoclonic jerk detected by electromyography (EMG). Sensory evoked potentials and specialized computerized back-averaging techniques can be used with simultaneous EMG to clarify the brain stem or cortical origins. Tremors can be characterized...

Diarrhea Squirts for the Squirts

In Oriental Medicine, the characteristics of the diarrhea and your child's health determine diagnosis and treatment. Dehydration is a concern with the loss of fluids. This results in oriental medicine as a deficient yin condition. You'll notice that your child has a dry mouth, dry skin, and red lips and tongue. The diarrhea will be yellowish, and the amount of urination will be less than you would expect.

Endocrine And Metabolic Diseases

Acute Acromegaly

Peri-orbital puffiness, brittle hair, dry skin, slowing of cerebration, low husky voice, macroglossia, and delayed relaxation of heel reflexes are the main clinical features of myxedema (Fig. 10) Thyroid-replacement therapy may lead to a striking improvement of the facies. Myxedema is associated with pericardial effusion, which rarely leads to cardiac tamponade (91). Fig. 10. Myxedema 80-yr-old female admitted in heart failure. She had stopped taking her thyroid medicine a year before. She has a pasty face, some periorbital puffiness, dry skin, and coarse hair. Thyroid-stimulating hormone level was 100 pU mL. Fig. 10. Myxedema 80-yr-old female admitted in heart failure. She had stopped taking her thyroid medicine a year before. She has a pasty face, some periorbital puffiness, dry skin, and coarse hair. Thyroid-stimulating hormone level was 100 pU mL.

Geneenvironment Interactions Topical Corticosteroids

The positive anti-inflammatory effects of topical corti-costeroids have to be balanced with their potential to induce cutaneous atrophy as a result of the inhibition of the synthesis of collagen and glycosaminoglycans,180-182 and also against their effects on the integrity of the epidermal barrier.183-185 A significant increase in TEWL has been observed in patients following the long-term application of topical corticosteroids.186,187 Short-term application of topical corticosteroids (3 weeks) has also been associated with a significant increase in TEWL from normal skin.184 It appears, therefore, that within 3 weeks, topical corticosteroids can cause significant disruption of the epidermal barrier. These findings should not surprise, considering that even a single supra-physiological dose of endogenous glucocorticoids induced by stress has been shown to impair epidermal Rebound flare after the discontinuation of topical corticosteroids is not uncommon. It occurs both in the context of...

Splinting the Pediatric Patient

Splint Wearing Schedule Form

The overall goal of splinting in the pediatric population is to maximize hand function. This can be achieved through splint use with the following goals (1) provide protection and support to weak muscles and joints, (2) provide proximal support and stability for improved distal function, (3) normalize muscle tone, (4) provide positioning of a joint, which then allows overall limb use and improved body movement and function, (5) compensate for muscle imbalance, (6) substitute for muscles that are not functional, (7) increase joint range of motion, (8) improve joint alignment, (9) decrease edema, (10) prevent or correct deformities, (11) make skin care and hygiene tasks easier, and (12) assist in task performance.

General management of patients with atopic dermatitis

Wet Wrap Therapy For Atopic Dermatitis

Education of patients and their caregivers is a crucial component in caring for patients with atopic dermatitis AD. Learning about the chronic or relapsing nature of AD, exacerbating factors, and therapeutic options is important for both patients and caregivers. Just as asthma action plans are integral to the management of asthmatic patients, so too, clinicians treating patients with AD need to provide both verbal and written information that includes general disease information along with detailed skin care recommendations (Figure 13.1). Patients or caregivers may forget or confuse skin care recommendations given them without a written step-care plan. This should be reviewed and modified at follow-up visits. There are many ways to customize care plans so that they meet the individual patient and family needs. Factors including severity of disease, age, patient history, and current environment all need to be considered. Development of a skin care programme that is agreed upon by the...

Posttraumatic Movement Disorders

Post-traumatic parkinsonism may respond to dopaminergic and cholinergic medications. Post-traumatic action tremors only occasionally respond to standard medical treatment. Selected cases may benefit from botulinum toxin injections into involved muscles and ventrolateral thalamotomy. Medications are usually not helpful for dystonia associated with central and peripheral trauma, although botulinum toxin injections can produce temporary relief. y Post-traumatic chorea and choreoathetosis may respond to valproic acid and haloperidol, whereas trauma-induced cortical myoclonus can be treated with clonazepam.

The clinical manifestations of atopic dermatitis

Atopic Dermatitis Hands

The term atopic dermatitis was introduced by Wise and Sulzberger in 1933 as a skin disease characterized by dry skin, pruritus, and chronic relapsing erythematous lesions.1 The name 'atopy' comes from the Greek meaning 'wrongly placed'. Coca et al had introduced the term atopy to describe a hereditary disorder different from anaphylaxis which was clinically characterized by hay fever and bronchial asthma. The disorder was further characterised by a tendency different from normal subjects, i.e. to become sensitized to environmental factors.2 In 1967 Ishizaka et al3 and Johansson4 showed that IgE antibodies were characteristic of the atopic condition. Dry skin during the last year Firooz et al11 studied the frequency of the main criteria (Table 1.3). The most common symptoms were itch, which was seen in 70 , and history of dry skin in 40 of patients. dry skin In infancy AD can be mixed with seborrhoeic dermatitis, which also can occur on the face and scalp. These infants often suffer...

Psychosomatic aspects of atopic dermatitis

Significance Neurosecratory

Embryologically, skin and the central nervous system (CNS) have the same origin in the ectoderm and are functionally closely related. One speaks of the skin as 'reflecting the soul'. Skin is a communication organ and plays an important role in the development and socialization over a whole life span. Skin is sensitive to tactile stimuli and responds to emotional stimuli. Skin diseases have a direct influence on communication, physical experience, as well as sexuality. Since skin is subject to one's own perception as well as those of others, skin diseases provoke reactions from the social environment and have an influence on self-confidence as well as relationships to other people culminating in either real or alleged stigmatization. Because of the immediate availability of their skin manifestation, patients have access to their lesions at all times, so that behavioural aspects (such as scratching, touching, exaggeration or neglect of the required skin care) may lead to new lesions and...

Press Acu Points to Pause Your Menopause

Acupoints For Menopuase

The natural process of menopause has been getting comforting help from Oriental Medicine for centuries. As you've already read, diet, exercise, and a healthy outlook are key components of any comprehensive treatment plan. Hot flashes, dry skin, vaginal dryness, increased thirst, insomnia, forgetfulness, and anxiety are part of the deficient heart yin pattern in Oriental Medicine. The term deficient yin in this case often refers to the reduction in estrogen. The term heart addresses not only the organ itself, but the accompanying forgetfulness, insomnia, palpitations, and mood changes.

Familial Amyloid Polyneuropathy

Clinical Features and Associated Disorders FAP Type 1 (Portuguese). This TTR-derived FAP was originally described in Portugal but has now been found in a wide variety of locations including Scandinavia and Mediterranean countries as well as North and South America and Japan. The age of onset varies with ethnic origin. The Portuguese develop symptoms in their twenties or thirties, whereas the Swedes and the French become symptomatic in their late fifties. The initial symptom is painful dysesthesia with attacks of stabbing pain in the lower limbs. With initial small fiber involvement, loss of pain and temperature sensation is reported. Patients are prone to foot ulcers, osteomyelitis, Charcot joints, and trophic skin changes. The neuropathy slowly progresses and eventually involves all nerve fiber types and all sensory modalities. Subsequent motor involvement results in muscle wasting and weakness with loss of reflexes. Months or years after the onset of disease in the lower limb, the...

Drug transport from an emulsion to the skin

The release of a drug from a formulation depends on its thermodynamic activity in the vehicle (Higuchi, 1960). Thermodynamic activity is a function of the drug concentration, drug solubility, percentage of drug saturation in the vehicle, and both drug-drug and drug-excipient interactions. Under certain conditions, drugs with the same level of saturation or fractional solubility in different vehicles have similar thermodynamic activity. Assuming that drug-skin and vehicle-skin interactions do not substantially alter normal skin transport, the drug-saturated formulations possess the highest thermodynamic activity, resulting in maximal drug release and skin delivery potential. The strength of a drug in a formulation does not always directly correlate to the potential of drug release from that formulation to the skin. That is, a higher strength of the drug does not necessarily mean that more medicine is delivered. Given the same strength of a drug, on the other hand, the release potential...

Skin Disorders And Clinical Trial Methods Adapting Study Design To Setting And Disease

Independently of the 'active' intervention administered, accessory non-pharmacological treatment and skin care seem to play a significant role in the outcome of most skin disorders. It is common sense that emollients may improve dry skin and wet soaks may help to dry exudat-ing lesions. As a consequence, accessory care requires careful standardisation. However, while it is relatively easy to ensure that the pharmacological treatment is conducted in an appropriate way (particularly timing and administration route), non-pharmacological accessory care is prone to a larger variability that is affected by social and cultural factors among others. To a greater extent, variability may affect topical treatment as compared with systemic treatment. Topical treatment is usually more cumbersome in comparison with systemic treatment and may well depend on the physician's and patient's consistency. As documented in randomised clinical trials of the retinoid derivative tazarotene in psoriasis, the...

BRM other agents Can also consider BRM earlier even as first line bul costly

Topical agents may be incorporated into various vehicles including ointments, creams, gels, lotions, foams, pastes, and shampoos. Ointments provide occlusion, which may increase drug penetration and enhance efficacy. Creams and lotions are easier to spread, especially in hairy areas. Gels may have drying and cooling effects in addition to easy spreadability. Foams may have enhanced delivery and or efficacy in comparison to lotions or creams and become a cosmetically elegant liquid upon skin contact, with good patient acceptance.16 Shampoos incorporating tar distillates or salicylic acid are useful for scalp psoriasis. Pastes such as Lasar's paste have an inherent stiffness, which minimizes the spread of medication and are useful for incorporating drugs, such as anthralin. Anthralin, especially in higher concentrations used in short-contact methods, may cause skin irritation and burning if in contact with normal skin. The selection of an appropriate vehicle is often an important...

Healing Hands Acupressure and Reflexology

Bodywork, which can be loosely defined as any kind of therapy that touches your skin, is being used throughout North America in private clinics, hospitals, and medical centers as part of a comprehensive treatment plan for cancer patients. Stanford University Hospital has been offering it since 1993. Shadyside Hospital Center for Complementary Medicine in Pittsburgh, Pennsylvania, offers shiatsu as well as

Megavitamin and orthomolecular therapy

Megavitamin therapists treat patients who have cancer, as well as those suffering from diabetes, schizophrenia, AIDS, pneumonia, flu, learning disabilities, depression, aging, autism, skin problems, hyperactivity, mental retardation, arthritis, and other diseases. The American Psychiatric Association and the NIH issued statements about megavitamin or orthomolecular therapies for psychiatric diseases, calling them and their unsubstantiated promotion ineffective, harmful, and deplorable.

Corticobasal Ganglionic Degeneration

Pharmacotherapy generally provides minimal if any improvement in most symptoms, but an empirical trial of levodopa is nonetheless reasonable and will occasionally result in modest symptomatic amelioration of rigidity. Clonazepam may yield modest improvement in myoclonus, but it may cause sedation with worsening of balance and cognitive function. Botulinum toxin injection can permit a clenched dystonic hand to be opened for hygiene maintenance. Pharmacotherapy should be supplemented

Causes And Outcomes Of Sexual Harassment

Sexual harassment harms those targeted,29,30 and this harm may persist for years after the harassment has ended.5 Many studies have documented the extensive physical and emotional costs for those who have been harassed. It is believed that costs to emotional well-being are directly related to harassment, whereas the physical health consequences are by-products of the increased psychological distress associated with sexual harassment.20 More specifically, sexual harassment has been linked to gastrointestinal (heartburn, diarrhea, stomach pains), musculoskeletal (headaches pain in joints, muscles, back, and neck), and cardiovascular symptoms (chest pain, tachycardia), headache, eyestrain, skin problems,24,31 and chronic diseases, such as hypertension, neurological disorders, diabetes, cardiovascular diseases, and so on.32

Extremity Spasticity1

Purposes of splints used in the management of upper extremity spasticity include prevention or correction of contractures, facilitation of normal movement, enhancement of function, inhibition of spasticity, and diminution of pain.1,48 With advances in tone modifying chemical agents such as the administration of botulinum toxin, joint spasticity may be

Acupuncture Tools of the Trade

Electromagnetic acupuncture is a non-needle technique, using magnets that have a mild electrical current that passes through the magnet and stimulates the acu-points and channels. You may feel a light tapping or a little buzzy sensation on your skin. I use this technique frequently for joint pain and injuries or where the area may be too sensitive to the patient for needle acupuncture. Your acu-pro can use moxibustion in two ways. He or she can place it directly on your skin, either by itself or with a paste made from ginger, garlic, salt, or pepper. The other method is more indirect The acu-pro lights a stick of moxa and holds it over the acu-point the heat is meant to affect. The heat from the burning plant warms the channels and increases circulation of Qi, especially if your condition is worse from cold. Your practitioner's style and training will probably determine whether he or she decides to use direct or indirect moxibustion. Despite how it sounds, it's very weird and...

Parkinsonism Plus Syndromes

With PSP, responds to botulinum toxin injection, and dry eyes may be treated with topical lubricants. Although physical, occupational, and speech therapy are of limited potential, these options may be beneficial in some patients and their families. Electroconvulsive therapy, adrenal implantation, and pallidotomy have been of no benefit. Corticobasal Ganglionic Degeneration. Corticobasal ganglionic degeneration (CBGD) is a distinctive parkinsonism-plus syndrome because specific cortical signs are associated with it and it has a particular pathological picture. Autopsy in patients with CBGD reveals asymmetrical, focal frontoparietal atrophy, ballooned and enlarged cells in the cortex, depigmentation of the substantia nigra without Lewy bodies, and diffuse neuronal loss. y There is no familial predisposition, and no environmental factors increase the risk of disease. Clinically, patients usually develop symptoms after age 60, and neurological signs of CBGD include focal or asymmetrical...

Facelifts An Uplifting Experience

Acu-points circulate much-needed blood and vital Qi throughout our bodies, including the face. Just as the rest of your skin can improve with Oriental Medicine, so can your looks. While these procedures are not performed as much as those designed to treat, say, backaches or asthma, I've had some success with them and want to share them with you as an option for your skin care. Oriental Medicine can clean your skin of itchy lesions and improve your overall health.

Affective Reactions to Stigmatized Individuals

Many types of stigmas have the capacity to evoke strong negative affective responses in observers (Bodenhausen, 1993 Hosoda, Stone-Romero, & Stone, 2003 Stone et al., 1992 Stone & Colella, 1996). This is especially true for marks that (a) are considered to be disruptive (e.g., person is considered to be emotionally unstable), (b) have to do with aesthetic factors (e.g., gross physical deformities, severe skin problems), or (c) pose a threat to the well-being of others (e.g., leprosy, psychopathy, AIDS). Especially important here are personality-based stigmas. Individuals with such stigmas may be viewed as having the potential to be disruptive (e.g., to have low levels of sociability) and to threaten the welfare of others (e.g., to have low levels of emotional stability). As a result, they may be the targets of both access and treatment discrimination in work organizations.

Anorexia Nervosa The Relentless Pursuit of Thinness

Anorexia nervosa is a complex psychological disorder that literally involves self-starvation. People who suffer from this illness eat next to nothing, refuse to maintain a healthy body weight for their corresponding height, and frequently claim to feel fat even though they are obviously emaciated. Because anorexics are severely malnourished, they often experience symptoms of starvation brittle nails and hair dry skin extreme sensitivity to the cold anemia (low iron) lanugo (fine hair growth on body surface) loss of bone swollen joints and dangerously low blood pressure, heart rates, and potassium levels. If not caught and treated in time, victims of anorexia nervosa can literally diet themselves to death.

Commonest Allergenic Essential Oils and Components

Photosensitivity and phototoxicity occurs with some allergens such as musk ambrette and 6-methyl coumarin that are now removed from skin care products. Children were often found to be sensitive to Peru balsam, probably due to the use of baby-care products containing this (e.g., talcum powder used on nappy rash).

Candida Infection In Atopic Dermatitis

More than 50 different Candida species have been characterized and many of these species can be isolated from human sources but only a few are dominant. Candida can be isolated from normal skin but is more frequently present in the gastrointestinal tract and on mucous membranes. Candida colonisation does not imply illness Candida is present in up to 65 of asymptomatic individuals.35 Skin diseases like immune deficiency, diabetes mellitus, hormonal dysfunction, and the use of drugs like oral antibiotics and cortico-steroids predispose to infections with Candida yeasts.

Clinical manifestations

Because botulinum toxin is hematogenously distributed and because relative blood flow and density of innervation are greatest in the bulbar musculature, all three forms of botulism manifest clinically as a symmetrical flaccid paralysis that first affects and descends from the muscles of the head, face, mouth and Foodborne botulism begins with gastrointestinal symptoms of nausea, vomiting and diarrhea in about one-third of cases. These symptoms are thought to result from metabolic byproducts of growth of C. botulinum or from the presence of other toxic contaminants in the food, as gastrointestinal distress is not seen in wound botulism. However, constipation is common in foodborne botulism once flaccid paralysis become evident. Illness usually begins 18-36 h after ingestion of the contaminated food, but can range from as little as 2 h to as long as 8 days. The incubation period in wound botulism is 4-14 days. Fever may be present in wound botulism but is absent in foodborne botulism...

Sensorimotor Impairment Scales

Terrater reliability and reproducibility if done under the same conditions, such as similar positioning of the patient. No universal technique is employed, despite its frequent use in clinical trials. The scale attempts to quantify the resistance to passive range of motion across a single joint. The Ashworth has been a primary outcome measure for clinical trials of drug interventions with injections of botulinum toxin, oral tizanidine, and intrathecal baclofen, as well as for surgical interventions such as dorsal rhi-zotomy. No direct relationship, however, exists between changes in the Ashworth score and improvements or declines in functional activities. The Tone Assessment Scale is one of many attempts to improve upon the information gained by the Ashworth Scale by asessing tone in different postures, but adds little information and no greater interrater reliability compared to the Ashworth.39

Large Number Of Different Skin Diseases

Typically, this condition is characterised by itching, dry skin and inflammatory lesions especially involving skin creases. Patients suffering from atopic dermatitis may also develop IgE-mediated allergic diseases such as bronchial asthma or allergic rhinitis. An overall cumulative prevalence of between 5 and 20 has been suggested by the age of 11. Around 60-70 of children are clear of significant disease by their mid-teens. Even if genetic factors seem to play a major role, environmental factors such as allergens and irritants are important and there is reasonable evidence to suggest that the prevalence has increased

Steroids or Corticosteroids

There are two general types of steroids. The anabolic steroids are abused by some professional athletes they have little medical use, especially in cancer patients. The glucocorticoids or corticosteroids, however, are used for many medical conditions, including problems related to breathing, arthritis, pain, and infection. Administered over a period of years, they often cause a multitude of side effects, some of which are serious, such as weight gain, diabetes, skin problems, osteoporosis, and fractures. Used for short periods of time, their benefits may strongly outweigh their risks. They are commonly used in patients with cancer, both as a part of chemotherapy and to control symptoms, especially with brain tumors and advancing disease.

Signs and Symptoms of Hypothyroidism

Hypothyroidism can affect virtually any tissue or organ in the body. The most common symptoms, such as fatigue, lethargy, sleepiness, cold intolerance, and dry skin, are nonspecific and can be seen with many other disorders. The classic overt signs, such as myxedema and delayed deep tendon reflexes, are seen uncommonly now because more patients are screened or seek medical attention earlier. Patients with mild hypothyroidism may have subtle symptoms that progress so slowly that they are not noticed easily by the patient or family. The lack of overt or specific signs and symptoms emphasizes the importance of using the serum TSH level to identify patients with hypothyroidism.

Stimulate Axonal Regeneration

Potential inhibitors of the axon growth cone in adults, based on their inhibitory function during CNS development, include members of the netrin, ephrin, semaphorin, and slit families of axon guidance proteins. Specific proteases cleave molecules such as the sema-phorins. Another approach to the injury site would alter the gene expression for a sema-phorin or its receptor by introducing antisense constructs into scar-associated cells or neu-rons.49 These oligonucleotides, which then block protein synthesis of the inhibitory substance or of its receptor, can be delivered by viral vectors. Another approach is to block the intracellular messenger that inhibits, for example, the formation of structural proteins such as actin and microtubles. The C-3 toxin from Clostridia botulinum is an antagonist to Rho, which is one such inhibitor. The drug inactivated Rho, promoted axonal growth, and had

Results And Future Work

The reconstructions produced during this project were fairly impressive however, there is still work that needs to be done to make the process simpler and more automated and the final images more lifelike. The reconstructed visages look computer-generated and are often evocative of video-game characters, but this can be rectified over time with the use of better skin textures and increased model complexity (an increased number of polygons). Also, the gradual increase in automation will allow the artist to produce models to a much higher level of detail than currently possible in a reasonable timeframe, which will only improve the realism of the reconstructed faces. Additionally, we hope to incorporate ongoing work in fields such as realistic hair modeling to improve the appearance of the heads, as well as the appearance of complicated skin features like the fine tissues around the eyes.

Treatment ofspasticity

The treatment of spasticity requires mainly physiotherapy, nursing care, occupational therapy and in many cases orthotic management. Whereas spasticity as a consequence of a stroke might in many cases also have a certain beneficial compensatory aspect, it can also lead to increased disability, loss of function, pain, and hindered care, and also carries the risk of secondary complications. If physical treatment reaches a limit, in generalized symptoms of spasticity one might want to consider the option of oral agents and intrathecal baclofen, but orally given medication such as baclofen in cortical or subcortical stroke has a disappointing effect vs. side-effect ratio in most cases. In focal or sometimes multifocal spasticity, botulinum toxin as a part of a longer-term strategy is an often successful treatment option in many cases, requiring patient assessment and definition of the goals of treatment 107 . Botulinum toxin (which exists in seven different serotypes, proteins A-G) acts...

Painful Arachnoiditis

Regional anesthetic techniques have been wrongly perceived as dangerous for children. Moreover, there are few data about the outcomes of such treatment. Children inherently differ from adults in outcome measures that require assessment. It is also difficult to subject soft but vital results such as quality of life and parental satisfaction to classical outcomes analysis. As a result, physicians initially resorted to interventional techniques only in the most desperate cases involving children with intractable cancer pain who had nothing left to lose. Quality of life improved so much that we have started to use these techniques for patients whose disease courses are also fatal but less predictable. Interventional techniques are still underused for children with diseases such as HIV and CF. Palliative care is just beginning to embrace children whose quality of life is poor, but whose lifespans are indefinite. Interventional techniques may also be appropriate for these children. In all...

Routes of Administration and Drug Formulations

Ding, chocolate syrup, or applesauce immediately before administration of individual doses. Honey, although capable of masking unpleasant taste of medication, may contain spores of Clostridium botulinum and should not be given to infants less than 1 year of age due to increased risk for developing illness. Most hospitals caring for pe-diatric patients compound formulations in their inpatient pharmacy. Limited accessibility to compounded oral liquids in community pharmacies poses a greater challenge. A list of community pharmacies with compounding capabilities should be maintained and provided to the parents and caregivers before discharge from the hospital.

Patient Care and Monitoring

Monitor normalization of organ function to baseline state including mental status, urine output to greater than 0.5 mL kg h (1 mL kg h in pediatric patients), normal skin color and temperature, and normalization of base deficit and or lactate. Begin supportive care measures including stress ulcer prophylaxis and antithrombotic therapy if there is no evidence of ongoing bleeding.

Cetuximab and Panitumumab

Both agents are well tolerated with infusion-related reactions being cetuximab's dose-limiting toxicity and rash most commonly seen with panitumumab. Patients receiving cetuximab require premedication with acetaminophen and diphenhydramine and may require modifications to their adminstration schedule or permanent discontinuation if they develop severe allergic toxicity. A skin rash and diarrhea are also commonly seen with both agents, and health care practitioners should provide counseling to patients about these adverse effects. Treatment options include common medications used to treat acne (doxycycline), topical and systemic steroids, and general skin care. Development of rash may be a surrogate marker of response and clinicians should attempt to minimize the complications of the rash prior to discontinuing therapy.41 Other toxicities common to both agents include low magnesium, calcium, and potassium levels that require checking levels and replacement therapy as clinically...

Etiology and Pathology

When medical examiners in the 1940s and 1950s tested the blood of infants who had died suddenly and inexplicably, they often found fulminant infections that could easily have caused death. For the next several years, bacterial and viral infections were considered a major cause of sudden infant deaths. But when those deaths from infection were weeded out, there still remained a large number for which pathologists could find no infectious agents. Researchers then found other possible causes of death, including the following powerful allergic reactions to cow's milk, to house dust mites, or to some unidentified allergen botulism, beginning in 1976 when a number of infants infected with Clostridium botulinum were discovered in California a severe, undetected respiratory viral infection a response to vaccination against childhood diseases overheating hypothermia high sodium in the blood deficiency of a trace element like magnesium, zinc, copper, calcium, selenium, or manganese a vitamin...

Clinical Manifestation and Pathology

The onset of disease usually occurs within 12 to 36 hours of ingestion of food contaminated with botulinum toxin. Botulism typically presents with an array of distressing signs of motor nerve dysfunction, including double or blurred vision and difficulty with speech and swallowing. The unabated disease progresses to generalized paralysis and death from respiratory muscle involvement. Diagnosis is confirmed by detecting botulinum toxin in the blood, feces, or wound site of the patient. Depending on the dose of toxin, untreated botulism carries a high fatality rate. Early treatment with antitoxin accompanied by respiratory assistance and other supportive intensive care may be life-saving. Infant botulism, a condition confined to babies between 2 weeks and 9 months of age, typically presents with listlessness and generalized weakness ( floppy baby ) and has been shown to cause some cases of sudden infant death syndrome (SIDS). It has been associated with ingestion of various processed...

Description of Lesions

Esquema Paisatge Les Coves

If a skin lesion is found, it should be classified as a primary or secondary lesion, and its shape and distribution should be described. Primary lesions arise from normal skin. They result from anatomic changes in the epidermis, dermis, or subcutaneous tissue. The primary lesion is the most characteristic lesion of the skin disorder. Secondary lesions result from changes in the primary lesion. They develop during the course of the cutaneous disease.

Elastic Wound Closure Strips

Normal skin on either side of the wound and used as an anchor point for the strip. The edges of strip will curl up over time and can be trimmed by the patient as needed. Closure strips usually fall off completely in 2 to 3 weeks. Wound closure strips are not recommended in children as they have a tendency to remove them prematurely. Wound closure strips can also be used after suture removal to give the wound more time to gain tensile strength. Figure 18.30.

In vivo tendon and ligament force measurements in humans

In order to overcome some of the disadvantages of the buckle transducer technique, an alternative method has recently been developed. As was the case for the buckle method this new optic fiber technique was first applied to animal tendons 9 . However, it had already been successfully used as a pressure transducer in sensitive skin application 10 and for measurement of foot pressure in different phases of cross-country skiing 11 . The measurement is based on light intensity modulation by mechanical modification of the geometric properties of the plastic fiber. The structure of optical fibers used in animal and human experiments 9,12-14 consists of two-layered cylinders of polymers with small diameters. When the fiber is bent or compressed the light can be reduced linearly with pressure, and the sensitivity depends on fiber index, fiber stiffness and or bending radius characteristics. Figure 1.5.5 demonstrates the principle of the light modulation in the two-layer (cladding and core)...

What is the role of therapeutic injections

Local trigger point injections can be done with local anesthetic, with or without steroid, NSAIDs, botulinum toxin, or 5-HT3 receptor antagonists. The analgesic action is explained by inhibition of dorsal horn efferents by nociceptive counter irritant based on gate control theory. Botulinum toxin can be used to decrease painful muscle spasm by blocking acetylcholine release in trigger points (used for treatment of cervical dystonia and piriformis syndrome). Dry needling technique can be used as well to mechanically break the taut muscle fibers in the trigger points.

Side Effects of Antidepressants

Antimuscarinic cholinergic properties cause dry mouth, dental caries (due to dry mouth), blurred vision, constipation, sinus tachycardia, urinary retention, and memory loss and confusion. The most serious of these effects is the possibility of an anticholin-ergic delirium (atropine psychosis). This is usually associated with elevated plasma levels of TCA drugs but can be seen at therapeutic blood levels. Typical symptoms include impaired short-term memory, confusion, and peripheral signs of anticholiner-gic activity such as dry mouth, enlarged pupils, and dry skin. Older patients seem to

Autonomic and Other Problems

Drooling may be accompanied by speech problems and dysphagia. Anticholinergics, botulinum toxin injections, and sublingual atropine can decrease drooling. Speech therapists perform swallowing studies to assess the risk of aspiration, and nutritionists optimize diet. Patients at high risk of aspiration or poor nutrition may require placement of a percutaneous endoscopic gastrostomy tube. Nausea improves if patients take their PD medications with meals or pharmacologic therapy (domperidone in Canada or trimethobenzamide). Sexual dysfunction or urinary problems may require a urolo-gic evaluation. Adjustment of PD therapy to increase on time, removal of drugs that decrease sexual response, and pharmacologic therapy (sildenafil or yohimbine) may help treat sexual dysfunction. Patients with urinary frequency may find a bedside urinal along with a decrease in evening fluids helpful. Improvement in PD symptom control can improve urinary frequency, but worsening symptoms may require...

Patient Encounter Part 2

MS patients usually have upper motor neuron spasticity this type of spasticity cannot be treated with muscle relaxants (i.e., carisoprodol). MS patients must be treated with agents specific for upper motor neuron spasticity (Table 29-8).10 MS spasticity is classified as focal or generalized. If the spasticity involves on1l0y one muscle group, it is focal and may benefit from botulinum toxin administration.1 Systemic medications are used for generalized spasticity. No clear conclusion can be reached regarding the superiority in efficacy of one agent medication selection is usually based on adverse effects (see Table 29-8).10

Outcome and Quality of Life

Facial nerve function is regarded as the most important outcome criterion by all patients. Some patients who show good recovery will nonetheless suffer from side effects such as synkinesia and aberrant innervation of tear secretion. Synk-inesia can be treated successfully with specialized physiotherapy or with muscular injection of botulinum toxin at 4-month intervals.

Treatment of Spasticity

A number of options are now available for the treatment of spasticity that interferes with gait or produces uncomfortable spasms such as the flexor spasms typical of spinal cord lesions. It must be emphasized, however, that spasticity may be helpful in compensating for weakness, especially in gait. Overzealous treatment of spasticity may in fact cause a decrement in function, particularly gait, especially when drugs with systemic effects are used. The development of botulinum toxin injections now offers the option of targeting muscles to avoid the deleterious effects of drugs on helpful spasticity. Injections of botulinum toxin into spastic leg adductors can facilitate nursing care y injections into the arm muscles can relieve painful spasms. y Injections of botulinum toxin into specific muscles also can be used in ambulatory patients to facilitate normal gait patterns while preserving spasticity in muscles that are necessary for walking. Injections into the gastrocnemius-soleus...

Associated Neurological Findings see IabJe155

The parasympathetic pupillomotor fibers from the Edinger-Westphal nucleus in the third nerve nuclear complex of the midbrain is impaired with lesions of the third nerve nucleus or nerve, which result in a paralysis of the pupillary sphincter, producing pupillary dilatation. Attention to autonomic function, especially sweating, can be helpful in defining the level of acute transverse spinal cord lesions. A loss of sweating occurs below the level of the lesion. Sometimes this can be appreciated by lightly rubbing the dorsal surface of the forefinger along the skin, starting below the expected level of the lesion and stroking upward the finger slides easily over the smooth dry skin below the lesion but sticks momentarily as it meets the normal moist skin at the upper border of the lesion.

Associated Medical Findings

Skeletal abnormalities like kyphoscoliosis and pes cavus, as well as diabetes and cardiac symptoms, are associated with Friedreich's ataxia. Cold intolerance, dry skin, and hair loss indicate hypothyroidism. Pulmonary and gynecological examination might show signs of bronchial or ovarian carcinoma, respectively. Cervical adenopathy might reveal Hodgkin's disease. Subacute, reversible ataxia associated with pyrexia suggests viral cerebellitis. Repeated bronchopulmonary infections suggest ataxia-telangiectasia. Examination of the cardiovascular system might disclose a structural cardiac lesion or rhythm disturbances, which indicate a possible

Additional Neurological Findings

The general physical examination may reveal reversible memory disturbances, the most common causes of which are intracranial masses, normal pressure hydrocephalus, thyroid dysfunction, and vitamin B12 deficiency. Examination of the patient's general appearance, vital signs, skin and mucous membranes, head, neck, chest, and abdomen should reveal clinical signs that will aid in the differential diagnoses of dementia and amnesic syndromes. Fever, tachycardia, hypertension or hypotension, sweating, hypothermia, and impaired level of consciousness should suggest a systemic disease, anticholinergic intoxication, or withdrawal from ethanol or sedative drugs rather than an isolated memory disorder. Jaundice suggests hepatic disease glossitis, intestinal problems, and yellowish skin suggest a vitamin B12 deficiency hot, dry skin is often characteristic of anticholinergic drug intoxication. Hypothermia, hypotension, bradycardia, coarse dry skin, brittle hair, and subcutaneous edema are...

Yin and Yangthe Great Balancing

Blood has an additional meaning in Oriental Medicine than what most of us grew up with. Blood is seen as a form of Qi that flows through our veins and carries the energy of Qi within to nourish and moisten your body. A common strategy in Oriental Medicine for dry skin is to eat foods and herbs that strengthen the blood aspect in your body. A relative deficiency in blood can also lead to mental restlessness, forget-fulness, or insomnia. These correspondences have been observed, treated, and explained by the concept of the energy that your blood possesses. pale complexion, dry skin, loss of hair, pale lips and tongue, and a thin pulse. Stuck blood. If your blood is stuck, you'll probably feel a localized, fixed, stabbing pain.

Organophosphate Insecticides

At the time of ingestion, vomiting should be induced. The primary treatment for mild to moderate organophosphate poisoning is the administration of atropine sulfate (1 mg intravenously or intramuscularly) and pralidoxime (Protopam, 2-PAM, 1 g intravenously). However, potential complications of atropine toxicity include flushed, hot, and dry skin, fever, and delirium. Also, 2-PAM may cause dangerous increases in blood pressure. y In patients with very severe organophosphate poisoning, intravenous administration of pralidoxime will restore consciousness within 40 minutes.

Wound Care Complications Clinical Summary

All wounds are subject to two main complications infection and dehiscence. All wounds evaluated in the emergency department are assumed to be contaminated. Contamination of a wound occurs either at the time of the injury or through direct migration of normal skin flora. A key factor in determining bacterial concentration in the wound is time elapsed until presentation. Wounds should therefore be thoroughly cleaned and irrigated in a timely manner following presentation. Wound infection is suggested by pain, warmth, erythema, edema, and purulent drainage.

Other Clostridia

Other toxigenic Clostridia include the species Clostridium difficile, Clostridium sordellii, Clostridium novyi, Clostridium haemolyticum, Clostridium chauvoei, Clostridium septicum, Clostridium histolyticum, Clostridium spiroforme, and Clostridium colinum.4'62 Except for C. difficile, where toxin genes are chromo-somally located, and C. novyi which is closely related to C. botulinum types C and D, detailed investigations of the genetic locations of virulence factors have not been carried out. It can be expected that future investigations will reveal an association of many virulence factors in these species with episomal or mobile genetic elements.


Sugiyama H. (1980) Clostridium botulinum neurotoxin. Microbiol Rev 44 419-448. 7. Sakaguchi G. (1983) Clostridium botulinum toxins. Pharmacol Ther 19 165-194. 8. Oguma K., Fujinaga Y. and Inoue E. (1995) Structure and function of Clostridium botulinum toxins. Microbiol Immunol 39 161-168. 9. Franciosa G., Feirreira J.L. and Hatheway C.L. (1994) Detection of type A, B, and E botulism neurotoxin genes in Clostridium botulinum and other Clostridium species by PCR evidence of unexpressed type B toxin genes in type A toxigenic organisms. J Clin Microbiol 32 1911-1917. 10. Hutson R.A., Zhou Y Collins M.D., Johnson E.A., Hatheway C.L. and Sugiyama H. (1996) Genetic characterization of Clostridium botulinum type A containing silent type B neurotoxin gene sequences. J Biol Chem 271 10786-10792. 12. Fujinaga Y., Inoue K., Shimazaki S., Tomochika K., Tsuzuki K., Fujii N., Watanabe T., Ohyama T., Takeshi K., Inoue K. and Oguma K. (1994) Molecular construction of Clostridium botulinum type C...


Sodium and chloride are the major electrolytes in the body water. They are needed for acid-base balance and for the regulation of the concentration of the body fluids. Chloride is a component of bile and hydrochloric acid. Fish, eggs, whey and poultry meal are rich in both sodium and chloride. A deficiency of these minerals can arise from excessive fluid loss, such as occurs in vomiting and diarrhoea. Signs include exhaustion, inability to control water balance, dry skin and hair loss. An excess will cause a greater than normal fluid intake and may predispose animals to hypertension and therefore heart and kidney problems. Zinc is required by all animals for maintaining a healthy skin and coat. Very high calcium diets can increase the animal's need for zinc. Zinc is relatively non-toxic and signs of dietary excess are rarely encountered in animals consuming normal commercial pet food but have been reported as a result of pica, following the consumption of large numbers of pennies....

Beauty for Newbies

Beauty for Newbies

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