Homemade Skin Care Recipes
Botulinum neurotoxins (BoNTs) are among the most poisonous substances existing in nature, the lethal dose for humans being estimated around 1 ng kg of body weight (131). Their high potency is due to the specific action on the neuroexocytosis process indeed, they block the neurotransmitter acetylcholine (Ach) release at the peripheral neuromuscular junctions, thus affecting a vital course for vertebrates (132). All seven serotypes (BoNT A-G) have common structures, which correlate FIGURE 3 Molecular mechanism of botulinum neurotoxins (BoNTs) (top panel) (1) toxin binding to specific receptors (R) on the presynaptic membrane (2) internalization of the toxin-receptor complex inside vesicles (3) reduction of the disulfide bond between the L and H chains, and translocation of the L chain into the cytosol (4) zinc-endopeptidase activity. Target proteins for the catalytic activity of the different BoNT types and their location are specified in the lower panel. SSV small synaptic vesicles...
Clostridial spores remain viable for long periods of time, even under conditions unfavorable to their growth. If safety cannot be guaranteed through intrinsic factors (pH, aw, Eh, microbial antagonism, preservatives) or extrinsic factors (T and shelf life), foods must undergo specific treatments in order to destroy contaminating spores. Sterilization by heat is the most common method used. In general, microbes are destroyed in an exponential fashion the initial number of a population exposed to heat diminishes at a constant rate per unit of time. Spore resistance to heat is conventionally designated as a D-value (decimal reduction time), i.e., the time necessary to kill 90 of the population at a specified temperature. D-values for C. botulinum show inter- and intratype variations. The spores of proteolytic strains types A and B show a greater resistance to heat (D112 C 1.23 min) than spores of nonproteolytic strains types B, E, and F (D80 C 0.6-1.25 min) (177). The International...
Fig. 7.3 a Patient before treatment to reshape the nose. b This patient submitted to nasal reshaping with fillers and botulinum toxin to block the depressor of the septum. There is a change in the smile line and elevation of the tip of the nose Fig. 7.3 a Patient before treatment to reshape the nose. b This patient submitted to nasal reshaping with fillers and botulinum toxin to block the depressor of the septum. There is a change in the smile line and elevation of the tip of the nose
The very strong botulinum neurotoxin is a heat-labile protein. Seven toxigenic types are differentiated, each of which produces an immunologi-cally distinct form of botulinum toxin. Types A, B, and E cause poisoning in humans. The toxin is a metalloprotease that catalyzes the proteolysis of components of the neuroexocytosis apparatus in the motor end plates, resulting in flaccid paralysis of the musculature. Pathogenesis and clinical picture. Classic botulism results from eating spoiled foods in which the toxin has been produced under anaerobic conditions by C. botulinum. The toxin is absorbed in the gastrointestinal tract, and then transported to the peripheral nervous system in the bloodstream. Within a matter of hours or days paralysis symptoms occur, especially in the nerves of the head. Frequent symptoms include seeing double, difficulty swallowing and speaking, constipation, and dry mucosa. Lethality rates range from 25-70 , depending on the amount of toxin ingested....
Dual-use examination room that can also be used for skin care. Elevation shows design of casework wall accommodating both usages. (Design Jain Malkin Inc.) a busy plastic surgery practice can generate many referrals with patients having a higher level of confidence about the efficacy of the procedures than they might have in a commercial setting not associated with a physician's office. The ambience of a spa or skin care salon is very important. Color, music, fragrance, burning candles, and an environment that appears clean and bright, with exquisite lighting that flatters skin tones and highlights products to be sold, optimize the experience for patrons and increase sales. Treatment rooms should have soft lighting and feel soothing. Figure 4-105 shows It should be noted that one can design a dual-use exam room that will also work for skin care services, optimizing use of the room even when the physician is out of the office. The room must be 10X12 feet, larger than the...
The confirmation of the clinical diagnosis of botulism is most effectively achieved by detection of the botulinum toxin in the clinical specimens from patients (61). Blood serum collected from patients before administration of the therapeutic polyvalent antiserum, and feces are routinely tested for botulinum toxin. Constipation from botulism can be an impediment to diagnosis an enema of sterile water may be required to obtain an adequate fecal sample. Other clinical samples that can be analyzed for botulinum neurotoxins are vomitus, gastric contents, or autopsy specimens submitted from fatal cases. The food source is also identified by demonstration of botulinum toxin. Failure in detecting preformed toxin in the foods consumed before illness might be presumptive of toxico-infectious botulism wound (101) or intestinal toxemia botulism (102) which, however, must be supported by additional epidemiological and laboratory findings. The persistence of botulinum toxin in the feces of both...
Botox is therefore an important resource for Botulinum toxin must be injected by an experienced doctor under sterile conditions in the clinic, with the treatment carried out as day-case surgery. Otherwise, significant complications may occur, including paralysis of the eyes. The preoperative marking of the injection sites is particularly important if adverse side effects are to be avoided. The patient should frown so that it is possible to see the area of maximum muscle activity. Particular care should be taken in the supraorbital region and lateral to the pupillary boundary (illustrations). No more than 1.5 ml botulinum toxin, corresponding to 60 U of Botox, should be injected per session. Treatment should be repeated after 4 months at the earliest. It is safe to give three injections per year. As the ampules supplied by the company contain 2.5 ml botulinum toxin, which is dissolved in non-preserved saline solution, it is advisable to inject 1.2 ml per...
The essential texts on biological implants (collagen), lipotransfer, botu-linum toxin, dermabrasion, ultrapulse CO2 laser, erbium-YAG laser, coblation, and chemical peeling can be found in Volume 1. As only ultrapulse CO2 laser treatment was shown in Volume 1, we have filmed short videos for Volume 2 on biological implants (collagen, hyaluronic acid), botulinum toxin, dermabrasion, erbium-YAG laser, and chemical peeling. For space reasons, these films have been kept very short and should show that adjuvant therapies should also be included in the repertoire of an experienced aesthetic surgeon.
Indwelling catheters should be removed as soon as clinically feasible. Elderly persons are more prone to aspiration pneumonia, which is the leading cause of death due to hospital-acquired infections. Selective decontamination of the digestive tract is not recommended by the Centers for Disease Control and Prevention (72). Simple procedures such as elevation of the head, using sucralfate, and early detection in at-risk patients (chronic lung disease, changing mental status, nasogastric tube, reintubation) are preferred. Old age probably does not increase the risk of intravenous catheter-associated infection, but these occur more frequently in the elderly due to the age-associated increased use of these devices. Appropriate skin care, e.g., using chlorhexidine antiseptic, and probable antibiotic-coated intravascular devices, may decrease the incidence. Hand washing after examining each patient is a simple preventive method that is commonly ignored.
In areas of normal skin, complete pigment loss, dotted centrally by perifollicular pigment resembling vitiligo, may develop. Direct immunofluorescent studies of clinically normal skin in patients with undifferentiated connective tissue syndrome reveal subepidermal immunoglobulin deposits in approximately one-third of cases.
The complex series of events making up neuromuscular transmission is subject to interference at several steps. Presynaptic blockade of the neuromuscular junction can occur if calcium does not enter the presynaptic terminal to participate in migration and emptying of the synaptic vesicles. The drug hemicholinium interferes with choline uptake by the presynaptic terminal and, thus, results in the depletion of ACh. Botulinum toxin interferes with ACh release. This bacterial toxin is used to treat focal dystonias (see Clinical Focus Box 9.1).
The genomes of C. botulinum strains contain a G + C ratio of 26-28 , which falls within the wider range (22-55 ) of the genus. Conventionally, the members of the species C. botulinum are distinguished from the other Clostridium spp. by their ability to synthesize powerful protein exotoxins (botulinum neurotoxins), responsible for the flaccid paralysis of botulism in humans and animals (16). Seven antigenic variants of the toxin have so far been identified and designated as types A to G in the chronological order of recognition (Table 1). They are similar in structure and pharmacological action (see Sec. VI) but differ from one another in their antigenicity, i.e., upon administration of the detoxified protein to humans or animals, immune response with production of antibodies against the native toxin occurs. The antisera specifically bind and neutralize the related toxins, with rare occurrences of cross-reactions, and are of important therapeutic and diagnostic value (17). Most strains...
The global epidemiology of foodborne botulism has been shaped by regional diet and soil ecology. Perhaps any food can cause botulism if it is contaminated with a neurotoxigenic clostridium, processed and stored under permissive conditions, and undercooked before consumption. Despite this potential, a majority of botulism is caused by a minority of foods (Table 3), reflecting in any region those culturally preferred foods in which botulinum neurotoxin is produced and persists. Similarly, a single neurotoxin type causes most foodborne botulism in a given region, usually the predominant type capable of causing human botulism found in that region's soil. Hauschild (8) and Dodds (62) have compiled comprehensive global reviews of the epidemiology of botulism and the soil microbiology of C. botulinum. From 1958 to 1989, a mean of 90 foodborne botulism cases was diagnosed each year in China (69). Fermented legumes, usually strong-smelling soybean curd (chou-doufu), caused over 60 of these...
Immunity to botulinum neurotoxin in the population appears to be very rare. A sample of human intravenous immune globulin, pooled from thousands of plasma donors, was unable to neutralize botulinum neurotoxins A and B at the level of 1 mouse LD50 (93). This absence of immunity probably reflects both the rarity of botulism and the extreme potency of the botulinum neurotoxins. If an analogy can be made with tetanospasmin, a closely related but slightly less potent clostridial neuro-toxin, a single lethal dose of botulinum neurotoxin may be smaller than an immunizing dose (94). This supposition may apply to foodborne botulism, which results from a limited ingestion of neuro-toxin. There are at least two unfortunate individuals who have had two episodes of foodborne botulism caused by the same neurotoxin, type B in Norway (94) and type E in Alaska (95). Neutralizing antibody was detected only in those survivors of type E foodborne botulism who had received equine antitoxin, and antibody...
Sequencing of the BoNT E and - F genes from neurotoxigenic C. butyricum and C. baratii has shown high relatedness with the corresponding BoNT genes from C. botulinum strains, respectively, of 97 and 70-74 (148,149). It is assumed that a lower degree of homology reflects an earlier transfer of the gene in the evolutionary scale (147). The possibility that BoNT genes are mobile and may have been transferred among progenitor strains through DNA vectors seems to be confirmed by other observations (a) phenotypically and genotypically similar Clostridia strains may or not carry BoNT genes (i.e., toxigenic versus nontoxi-genic strains of the same cultural groups see Sec. II) (b) strains of different cultural groups can produce the same BoNT type (e.g., BoNT B and - F are produced both by proteolytic and nonproteo-lytic strains of C. botulinum) (c) some strains of C. botulinum are able to form two BoNT types concomitantly (C. botulinum subtypes) (d) some strains of C. botulinum type A contain...
Raw products are naturally contaminated with C. botulinum. Several studies have demonstrated that this organism is ubiquitous in soil. The factors determining type distribution are as yet unclear (62). Organic fertilizers of animal origin and sewage sediments contribute to soil contamination (154). It is therefore not surprising that foods of vegetable origin are contaminated with this microorganism. C. botulinum spores, generally types A and B, have been detected in red capsicum, apricots (155), carrots, onions (156), potatoes, parsley, spinach (157), garlic (158), cabbages (159), and cultivated mushrooms (160,161). Spore numbers in mushrooms range from
In his initial studies a century ago, van Ermengem demonstrated that the toxic substance responsible for foodborne botulism was heat sensitive (1). Botulinum toxins A, B, E, and F are inactivated by heating at 79 C for 20 minutes or 85 C for 5 minutes (186). Thermal inactivation of the toxin is not a linear function. Substances in food such as divalent cations and organic acid anions protect the toxin from heat. The toxin is stable at pH 5. Ionizing radiation at doses set for food preservation has no effect on their toxicity.
Chlorine and chlorine compounds are widely used by the food-processing industry because they are highly sporecidal in the absence of organic material. C. botulinum spore resistance to chlorine varies according to strain (178). In general, the most heat-resistant strains require longer exposure times. For the sanitation of machinery, solutions containing 100-200 ppm of hypochlorite are applied for at least 2 minutes. C. botulinum spores are inactivated by chlorine dioxide, ozone (187), and ethylene oxide (188), a cyclic ether that is a gas at room temperature and is usually used to sterilize dry food. Hydrogen peroxide, used for the aseptic packaging of foods such as milk and eggs, inactivates C. botulinum spores (189), but it is not the primary method to control C. botulinum.
The safety of certain foods is achieved by using one or more methods to inhibit the growth of C. botulinum and toxin production. This is the best solution for foods with a high humidity content that cannot be treated at temperatures high enough to kill C. botulinum spores without altering their organoleptic characteristics. As the lowest growth temperatures for proteolytic and nonproteolytic strains of C. botulinum are 10 C (190) and 3.3 C (191), respectively, refrigerated (4-8 C) storage cannot be the sole protection against botulism. In nonproteolytic strains, growth and toxin production in food may occur when the shelf life of the product is sufficiently long. Proteolytic strains grow in food when temperature abuse occurs during storage. Proteolytic strains have been shown to produce neurotoxin after one week at 15 C or after 2-3 days at 20 C (190). At the same storage temperature, the higher the number of bacteria inoculated, the earlier the production of the toxin (192,193)....
The emerging science of genomics must deal with two major quantitative realities. First, there are a large number of genes in eukaryotic genomes. Second, the pattern of gene expression in different tissues at different times is quite distinctive. For example, a skin cancer cell at its early stage may have a unique mRNA fingerprint that differs from that of both normal skin cells and the cells of a more advanced skin cancer.
Skin and soft-tissue infections are common problems in the elderly. In one study of nursing home residents, skin infections accounted for 35 of infections acquired in nursing homes in Maryland (1). The presence of a skin ulcer was the major risk factor for developing an infected ulcer or cellulitis. In addition to the normal changes of the aging skin such as decreased turgor, elasticity, and atrophy, elderly patients often have coexisting peripheral vascular disease or small-vessel disease of diabetes mellitus, which makes them increasingly vulnerable to skin and soft-tissue infections, and may result in delayed healing. The elderly are at risk for all the usual pathogens causing skin and soft-tissue infections but in addition, because of their impaired host defenses and frequent coexisting vascular disease and diabetes mellitus, the elderly are at greater risk of developing necrotizing soft-tissue infection, infected pressure ulcers, and diabetic foot infections (see also Chapter...
Immunosuppression of humans, either after receiving organ allografts or under conditions of an acquired immunodeficiency syndrome (AIDS), frequently results in extensive verrucosis (29). Recent observations demonstrate the presence of papillo-mavirus DNA of a broad spectrum of genotypes in biopsies from normal skin and follicles of plucked hair (30,31). This suggests that multiple infections with virus production are commonly taking place without any clinical symptoms. It is therefore highly likely that four modes of viral genome persistence exist (1) latent infections (possibly only with E1 gene expression), (2) inapparent infections (without clinical symptoms), (3) apparent infections (development of lesions), and (4) abortive infections (after integration of the viral genome into host cell DNA with the possible consequence of dysplasia and malignant progression).
Frequency of deaths in North America due to NSAIDrelated gastrointestinal effects versus deaths due to key diseases
This concept led to the development of a new class of drugs that specifically inhibit COX-2. Four drugs in this class have been licensed for RA rofecoxib, celecoxib, valdecoxib and etoricoxib. However, rofecoxib and valdecoxib have been subsequently withdrawn because concerns about cardiovascular toxicity in the former and skin problems (Stevens-Johnson syndrome) in the latter something of a shadow hangs over the whole group as a result.
Apartment, enjoying your state of independence. You may wish to experience yourself strolling in a department store, trying on new clothes. Find yourself sitting at the counter consulting a cosmetic sales representative regarding the special colours of lipstick and other make-up items that fit your skin tone and colour. As you try these on, you look in the mirror and you see with joy how much you like your face, and the rest of your body, and yourself, and your blooming femininity presenting the young woman in you. As this goes on, you may continue to experience yourself, on a date with a young man who truly communicates uncritical acceptance of you and loves you with respect and dignity, and, if you wish, you may experience the special joy of having a date and wondering about your natural and healthy attraction to the young man that you love too, wondering about the special compatibility and chemistry that exists between the two of you, trusting the centre core of your subconscious...
Skin color may be either normal (which is dominant) or albino (which is recessive and is characterized by a lack of pigmentation). The offspring will be albino only if both parents transmit that trait in the germ cells that form the zygote. It is possible that both parents could have normal skin coloring and still produce an albino child, as Fig. 4-1 shows. Although both parents show normal skin coloring, on average one of four conceptions could be albino (aa).
Dengis et al. (1998) looked at the results of pharmacological weakening of eye muscle, achieved by injecting microgram doses of botulinum toxin (botox), on changes in registered eye position. The botox procedure, developed by Scott (1980), corrects a strabismus by allowing the antagonist muscle to draw the stra-bismic eye into a straight (orthotropic) position by weakening the muscle that keeps the eye in the incorrect position. From animal studies, it was known that the botox injection has an immediate effect on afferent responses recorded from the trigeminal nerve (Manni et al., 1989). By measuring open loop pointing responses in patients, we found that the botox had no effect in the first hour following the injection. Over days and weeks, however, there were changes that could only have resulted from a proprioceptively derived signal about eye position. We interpeted these changes as resulting from the palisades, and not from the muscle spindles also found in human eye muscles and...
Metalloproteases, containing zinc as an essential metal ion for enzyme catalysis, are elaborated by many bacteria and are classified into 30 major families, which include the thermolysin-like, elastase-like, Serratia protease-like metalloproteases, and the neurotoxins of Clostridium tetani and Clostridium botulinum type B (211). V. vulnificus expresses a thermolysin-like metalloprotease (175,212214), which was originally described by Kreger and Lockwood (174). It was later isolated and characterized by Kothary and Kreger (214), who assigned it a molecular weight of 50.5 kDa and found that it had both caseinolytic and elastinolytic activity. Miyoshi et al. (213) also showed that the metalloprotease underwent autoproteolytic conversion to a 35 KDa active form, losing both a 186-amino-acid N-terminal propeptide and a 10 kDa C-terminal peptide in the process. Furthermore, it has been shown by a number of investigators that the metalloprotease possessed similar biological and immunological...
Clostridium botulinum produces an exotoxin that causes the deadly form of food poisoning called botulism. This is not an infectious disease, but a toxic disease. If the endospores of this soil organism survive in processed foods that have been canned or vacuum packed, they may multiply in the anaerobic conditions of the container, elaborating their potent exotoxin in the process of growth. If the food is eaten without further cooking (which would destroy the toxin), the toxin is absorbed and botulism results. The disease is difficult to diagnose bacteriologically, but the incriminated food or the patient's blood can be tested to demonstrate the toxin's effect in mice, which confirms the diagnosis.
For increasing growth (height) with the child's parents or guardians. If the drug is to be given at bedtime and not in the outpatient clinic, the nurse instructs the parents on the proper technique to administer the injections. The parents are encouraged to keep all clinic or office visits. The nurse explains that the child may experience sudden growth and increase in appetite. The nurse instructs the parents to report lack of growth, symptoms of diabetes (eg, increased hunger, increased thirst, or frequent voiding) or symptoms of hypothyroidism (eg, fatigue, dry skin, intolerance to cold).
When the patient has diabetes insipidus, the nurse measures the fluid intake and output accurately and observes the patient for signs of dehydration (dry mucous membranes, concentrated urine, poor skin turgor, flushed dry skin, confusion). This is especially important early in treatment and until such time as the optimum dosage is determined and symptoms have diminished. If the patient's output greatly exceeds intake, the nurse notifies the primary health care provider. In some instances, the primary health care provider may order specific gravity and volume measurements of each voiding or at hourly intervals. The nurse records these results in the chart to aid the primary health care provider in adjusting the dosage to the patient's needs.
The side effects to ultra-phototherapy B are, during treatment the psoriasis can sometimes get temporarily worse before getting better. The skin may itch and get red due to overexposure (sunburn). The long-term risk in developing skin cancer(s) from long-term exposure to UVB is unknown. Also, long-term exposure can cause freckling and loss of skin elasticity. During the course of therapy, your skin will be evaluated.
A plastic surgeon excised the lesion and was able to re-approximate the wound edges without a full-thickness skin graft. The pathology report identified the lesion as a basal cell carcinoma with clean margins of normal skin and subcutaneous tissue and stated that the entire lesion had been excised. K.B. was advised to wear SPF 30 sun protection on her face at all times and to avoid excessive sun exposure and tanning salons. The nurse provided L.N.'s daughter with instructions for proper skin care, incontinence management, enhanced nutrition, and frequent repositioning to prevent pressure ischemia to the prominent body areas. However, 6 months later L.N.'s pressure ulcer had deteriorated to a class III. She was hospitalized under the care of a plastic surgeon and wound-ostomy care nurse. Surgery was scheduled to d bride the sacral wound and close it with a full-thickness skin graft taken from her thigh. L.N. was
Depigmented macules appear on the skin and may merge into large areas that lack melanin. The brown pigment seen in the illustration is the person's normal skin color the pale areas are caused by vitiligo. (Reprinted with permission from Bickley LS. Bate's Guide to Physical Examination and History Taking. 8th Ed. Philadelphia Lippincott Williams & Wilkins, 2003.)
A number of specialized clinical allergy tools have also been developed. One example is the allergen avoidance database tool which, when queried, produces an extensive list of skin care products that do not contain known allergens specific for a given patient (Yiannias & el-Azhary 2000). Another program predicts sensitization to flour allergens in bakers using a stepwise logic regression method (Popp et al 1994). We anticipate that more sophisticated bioinformatics tools will appear in the future to support research, clinical practice and the screening of novel synthetic or genetically manipulated (GM) foods and products. Novel GM foods, nutraceuticals, cosmetics and other products need to be carefully assessed for allergenic safety before they reach consumers. Immunoinformatics currently provides the only cost-effective and efficient means of performing such safety screening, hence its importance to the future of market acceptance of GM products.
Diseases can also affect synaptic mechanisms. For example, the toxin produced by the bacillus Clostridium tetani (tetanus toxin) is a protease that destroys certain proteins in the synaptic-vesicle docking mechanism of neurons that provide inhibitory synaptic input to the neurons supplying skeletal muscles. The toxin of the Clostridium botulinum bacilli and the venom of the black widow spider also affect neurotransmitter
Reptiles occupy habitats ranging from aquatic to extremely hot and dry. Three major adaptations have freed the reptiles from maintaining the close association with water that is necessary for most amphibians. First, reptiles do not need fresh water to reproduce, because they employ internal fertilization and lay eggs with shells that retard evaporative water loss. Second, they have scaly, dry skin that retards evaporative water loss. Third, they excrete nitrogenous wastes as uric acid solids, losing little water in the process.
The overall prevention of infective endocarditis still depends not only on prophylactic antibiotics or other measures but on care to avoid unnecessary bacteremia in the elderly. Bacteremia from dental procedures and oral diseases can ultimately be prevented only by good dental and oral care, usually initiated by the patients themselves. Good dental care and self-care are probably associated with a lower risk of bacteremia due to dental sources (22). In addition, ignored skin problems are a frequent source of bacteremia in the elderly, which can only be avoided by the person's own careful care of their skin and attention to periodic skin infections such as boils, which will arise throughout the person's life. In a recent review, Kjerulf and colleagues have pointed out the need not only for earlier detection of infective endocarditis and earlier antibiotic therapy, but the need for educating patients who already have cardiac disease or cardiac valve prostheses (23). The patient's own...
No-Craving Script You're at the beach lying on a blanket. The warm sun penetrates your skin and relaxes you thoroughly. A fresh breeze blows over your body as you run your hands through the clean white sand and let the grains fall through your fingers. You're feeling refreshed and at ease, and pleasant thoughts run through your mind. You can hear the sounds of waves splashing rhythmically against the shore. Nearby some children are playing a game. A bright red beach ball lands near your blanket. You look up and see two of the children running toward you to get their ball. You stand up, pick up the ball and toss it to them. They laugh and giggle and run back to their game. You go to the blanket and lie down. You're enjoying this day completely.
The patient was provided with a clam-shell anteroposterior thumb-spica splint that was custom fabricated by an occupational hand therapist. For the interval between the office evaluation and surgery, the patient was instructed to wear the splint at all times except to shower. Unlike a cast, a removable splint is less likely to cause skin problems prior to surgery, and the splint can be reused during the postoperative course.
Baumann L (2002) Cosmetic dermatology principles and practice. McGraw-Hill, New York Carruthers J, Carruthers A (2003) Aesthetic botulinum A toxin in the mid and lower face and neck. Dermatol Surg 29(5 468-476 Connor MS et al. (2003) Management of the aging forehead a review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 95(6 642-648 de Maio M (2003) Challenges in the mid and the lower face. J Cosmet Laser Ther 5(3-4 213-215 de Maio M (2003) Botulinum toxin in association with other rejuvenation methods. J Cosmet Laser Ther 5(3-4) 2i0-2i2 9. Rzany B (2003) Bericht zum 1. Expertentreffen zur Anwendung von Botulinumtoxin A in der sthetischen Dermatologie. Kosmetische Medizin 24 2-8 10. Wieder JM, Moy RL (1998) Understanding botulinum toxin. Surgical anatomy of the frown, forehead, and periocular region. Dermatol Surg 24(11 1172-1174
Oxygen, CO2 and N2 are most often used in MAP controlled atmosphere storage. Normally, the concentration of O2 in a pack is kept very low (1-5 ) to reduce the respiration rate of fruit (Lee et al, 1995), thus prolonging the shelf-life by delaying the oxidative breakdown of the complex substrates that make up the product. Also, O2 concentrations below 8 reduce the production of ethylene, a key component of the ripening and maturation process. However, at O2
The role of HPV in the development of skin cancer is still not clear. The viral epidemiology suggests that there is a large reservoir of latent HPV infection in the normal skin of the general population and in immunocompromised individuals. Preliminary evidence suggests that increased exposure, as in the transplant population, is associated with an increased risk of skin cancer but this needs to be confirmed in prospective studies. Malignant skin lesions in both immunocompetent and immunosuppressed patients frequently contain HPV DNA, and it is tempting to ascribe them a functional role. However, no particular HPV type predominates and it remains a possibility that HPV is merely a passenger, present but not active in the development of skin cancer. The technology is now in place to address this, to determine the molecular epidemiology of HPV infection in keratinizing epithelia and to examine its role in skin carcinogenesis.
Immunohistochemical investigations suggested a low cutaneous IL-10 protein expression.3 Similar results were found by quantification of IL-10 protein in blister fluids.4 We found that the cutaneous IL-10 mRNA expression in psoriasis was significantly lower than in atopic dermatitis or cutaneous T-cell lymphoma. The level of IL-10 mRNA expression did not differ from healthy skin, even though numerous pro-inflammatory cytokines are overexpressed. These results are in particular remarkable since TNF, a major inducer of IL-10 was highly expressed. All in all this indicates a relative IL-10 deficiency in psoriasis5 which might have a genetic background.
Many studies comparing functional results of FAP patients with IPAA with patients with IRA point out that results for patients with IPAA were poorer regarding the number of bowel movements per day, leakage, pad usage, perianal skin problems, food avoidance and inability to distinguish gas. Results of the HRQL surveys, however, demonstrate no difference between the IPAA and IRA groups. The Physical and Mental Summary Scales for IPAA and IRA groups are not significantly different, and none of the eight dimensions of the SF-36 Health Survey demonstrated statistical differences between IPAA and IRA groups. Therefore, better functional results are not equated with better HRQL.
Although botulism is increasingly rare in developed countries, the food industry remains deeply concerned about the threat to public health from food contamination with C. botulinum. Botulism may result when a food (a) contains spores that survive processing or that contaminate after processing (b) by composition or storage favors outgrowth and toxin production by C. botulinum (c) is eaten without sufficient cooking to inactivate preformed neurotoxin. The primary objective of the food-processing industry is to achieve the widest possible margin of safety against outgrowth and toxin production by C. botulinum. Safety margins are estimated on the basis of the rate of occurrence of C. botulinum spores in the foods and the capacity of the processing and storage system to destroy or inhibit the organism. At present, food processors are dealing with this situation by developing hazard analysis systems for critical control points (HACCP) in their food-production plants.
The use of specific hyperimmune globulins in the treatment of diseases associated with toxins produced by corynebacteria and clostridia is now well established (13-15). Diphtheria antitoxin, when administered early in the disease, appears to prevent a number of complications associated with diphtheria (13). Similarly, the use of tetanus and botulinum antitoxins is critical to the recovery of patients with tetanus and botulism (14,15). One anecdotal study suggested that the use of IVIG facilitated the resolution of Clostridium difficile enterocolitis (16).
Mous cell carcinomas in immunosuppressed as well as in immunocompetent individuals containing in part novel HPV sequences (53-57). At present more than 80 of these tumors are HPV positive. A recent report describes a higher prevalence of some types in these lesions with HPVs 20, 23, 38 and two putative novel types accounting for 73 of the virus-positive biopsies (58). The significance of these findings is difficult to assess. Problems arise from the high rate of HPV prevalence in plucked hair follicles and in biopsies from normal skin (30,31), where up to 50 of the analyzed materials were found to be HPV-positive. In these materials a broad spectrum of different HPV genotypes has been detected, leading in addition to the identification of several putative novel genotypes.
Some C. botulinum C and D strains produce nonbotulinum enzymatic toxins, C2 and C3 toxins, along with type C and D neurotoxins (138). C2 toxin is composed of two subunits a binding component recognizing specific receptors on a variety of eukaryotic cells, and an enzyme component that ADP-ribosylates intracellular non-muscular G actin. This protein normally forms the microfilaments of the cytoskeleton its ADP-ribosylation causes loss of the cell shape, an increase in vascular permeability, and enterotoxic and cytotoxic effects. C2 toxin may help the diffusion of the botulinum neurotoxin in the body by increasing vascular permeability, but it does not produce the symptoms of botulism. Although it is lethal in mice, its clinical significance for humans is unclear (139).
Lelic constitution) or by phenotype (observable characteristics of appearance or physiology). Both genotypes and phenotypes show variation within a population. Variation is of two types discontinuous, showing two or more distinct phenotypes, and continuous, showing phenotypes with a wide range of quantitative values. Discontinuous variants are often determined by alleles of one gene. For example, people with normal skin pigmentation have the functional allele coding for the enzyme tyrosinase, which converts tyrosine into the dark pigment melanin, whereas albinos have a mutated form of the gene that codes for a protein that can no longer make the conversion.
The nurse inspects the skin every 4 hours for redness, rash, or lesions that appear as red wheals or blisters. When a skin rash or irritation is present, the nurse administers frequent skin care. Emollients, antipyretic creams, or a topical corticosteroid may be prescribed. An antihistamine may be prescribed. Harsh soaps and perfumed lotions are avoided. The nurse instructs the patient to avoid rubbing the area and not to wear rough or irritating clothing.
C. botulinum are rod-shaped cells (2-22 im long and 0.5-2 im wide), motile by perithricous flagella and capable of forming subterminal endospores, which confer on the rods the peculiar shape of a closter Greek for spindle (Fig. 1). The location of spores within the cell and the level of spore production vary by strain. Spores, the most resistant bacterial forms existing in nature, allow the survival of the microorganism under restrictive environmental conditions, such as chemical-physical shocks and or decreased availability of nutrients. Gram stain results are positive due to the thickness of the cell wall, mainly constituted by peptidoglycan of the meso-diaminopimelic acid direct-linked type, and to the lack of the outer envelope proper of gram-negative microorganisms.
Although a minority of infant botulism cases are caused by eating honey containing spores of C. botulinum (53), this discussion is focused on foodborne botulism, which is caused by the direct consumption of botulinum neurotoxin in contaminated food. Because all forms of botulism are due to the systemic distribution of botulinum neurotoxin, much of this discussion also pertains to infant botulism and wound botulism. Almost all botulism in humans is due to neurotoxin type A, B, or E. Over half of foodborne botulism patients suffer from prodromal nausea or vomiting (54), which do not occur in infant or wound botulism. This gastrointestinal distress may be due to metabolites from C. botulinum or co-contaminants in the tainted food. Progressive cranial nerve palsies, a sine qua non of botulism, are among the first symptoms and signs to appear and the last to recede. These include double vision, drooping eyelids, slurred and muted speech, an inability to swallow food and saliva, gaze...
Infant botulism results from intestinal colonization with a Clostridium-producing botulinum neuro-toxin. The precise source of clostridia causing infant botulism is usually not known. C. botulinum producing the same type of neurotoxin has been isolated both from affected infants and from soil and dust samples within their homes (53). Testing of food has been unable to identify a dietary vehicle for infant botulism with the prominent exception of honey, fed to a minority of infant botulism cases. Indigenous honey has been linked by epidemiology and microbiology to type A infant botulism in Japan (82) and Argentina (83), type B in Italy (84), and types A and B in the United States (53). These toxin types match the prevailing types causing foodborne botulism in these nations with the exception of Japan, where botulism is primarily caused by aquatic, not terrestrial food. Regional variations may become increasingly less relevant, as honey purchased in today's market is often a blend of...
It is important that windows start at 42 inches off the floor so that cabinets can be put under them, and patient privacy in an exam room is not violated. Even in a waiting room or lobby, windows should not start at the floor because it limits the area of seating. The glazing color should be gray, not bronze, because the latter tends to make skin look jaundiced.
Drug names are derived in a variety of ways. Some are named for their origin. Adrenaline, for example, is named for its source, the adrenal gland. Even its generic name, epinephrine, informs us that it comes from the gland that is above the kidney. Pitocin, a drug used to induce labor, is named for its source, the pituitary gland, combined with the chemical name of the hormone, oxytocin. Botox, currently injected into the skin for cosmetic removal of wrinkles, is the toxin from the organism that causes botulism, a type of food poisoning. Aspirin (an anti-inflammatory agent), Taxol (an antitumor agent), digitalis (used to treat heart failure), and atropine (a smooth muscle relaxant) are all named for the
Immediate attention is essential if an ulcerated area does form. No pressure should be applied to the area. The good skin around the affected area must be preserved and toughened. Special skinlike bandages may be applied. Cleaning the area (debridement) may be necessary and should be performed by someone who is trained in this technique. removed, the bony edge removed, and the wound covered with healthy skin.
Clinically normal skin of patients with DLE demonstrates a negative LBT. The LBT in clinically normal skin of patients with SLE varies with sun exposure. Approximately 50 of patients with SLE have a positive LBT in clinically normal, sun-protected skin, whereas 80 have a positive LBT in clinically normal, sun-exposed areas.
It is clearly a breach of the standard of care for physicians or their assistants to perform procedures for which they are not adequately trained. Melanomas have been incompletely excised by unskilled physicians. In one case, a woman's face was badly scarred by a physician who was trained in the use of a laser by a salesperson. The physician's prior experience involved an orange. Botox injections have caused
Plastic surgery suites vary considerably, depending on the focus of the practice (cosmetic or reconstructive) and whether there is an intention to provide skin care or spa services (a recent trend). Skin care spa services may include microdermabrasion skin resurfacing, chemical peels, permanent hair removal by a diode laser, facials, body and cellulite treatments, as well as makeup tattooing of eyeliner or brows. These procedures are explained in greater detail, and room requirements discussed, in the Dermatology section of this chapter and at the end of this section.
A dermatologist treats diseases of the skin. It is not uncommon to find a one-physician practice. Since dermatologists rarely make hospital rounds or emergency house calls, their appointment schedule is strictly adhered to without the sort of interruption that plagues many other physicians. A one-physician suite would be composed of three examination or treatment rooms, a waiting room to accommodate eight to ten persons, a small lab, a toilet room, a business office, a consultation room, a minor surgery, and a large storage closet for drug samples (Figure 4-107). Larger practices may include a surgery facility, as well as offer ancillary services such as laser hair removal, chemical peels, facials, Botox (botu-linum toxin) injections, sclerotherapy, Endermologie , and massage. The reader is referred to Chapter 6 for a decentralized plan of a group-practice dermatology suite and to Figure 4-108 for a centralized plan. Figure 4-109 shows the relationship of rooms.
Erythema1, skin cancer, and accelerated skin aging are possible in the 230nm to 380 nm wavelength range (actinic ultraviolet). The most severe effects occur in the UV-B (280-315nm). Increased pigmentation can result following chronic exposures in the 280 nm to 480 nm wavelength range. At high irradiances, these wavelengths also produce long-wave erythema of the skin. In addition, photosensitive reactions are possible in the 310 nm to 400 nm (near ultraviolet) and 400 nm to 600 nm (visible) wavelength regions. The most significant effects in the 700 nm to 1000 nm range (infrared) will be skin burns and excessive dry skin.
Botulism is caused by a protein toxin released by several strains of bacteria of the genus Clostridium, including the eponymous Clostridium botulinum. This toxin is the most lethal biological poison known 100,000 times more poisonous than sarin gas. One gram (about 1 28 of an ounce) in aerosol form could theoretically kill 1 million people. Unlike other A-list bacterial agents, such as anthrax, plague, and tularemia, where the agent is the bacterium itself, in the case of C. botulinum, we cut right to the chase the isolated, purified toxin produced by the bacterium, which is entirely responsible for the disease caused by this bacterium, is the agent. Like B. anthracis, C. botulinum is a spore-forming bacterium, and could readily be aerosolized as such. But since the object of delivering the bacterium is to deliver its toxin, it is more efficient to simply aerosolize the toxin itself, which is relatively easy to collect and concentrate. The toxin produced by C. botulinum and related...
The acetylcholine (ACh) released by the axon terminals diffuses across the synaptic cleft and binds to ACh receptors in the plasma membrane of the end plate, thereby stimulating the muscle fiber. Prior to its release, the ACh is contained in synaptic vesicles that dock and fuse with the plasma membrane of the axon terminal and undergo exo-cytosis (see chapter 7, fig. 7.21). The potentially deadly botulinum toxin, produced by the bacteria Clostridium botulinum, is selectively taken into cholinergic nerve endings and cleaves the proteins needed for the exocytosis of the synaptic vesicles. This blocks nerve stimulation of the muscles, producing a flaccid paralysis. Interestingly, botulinum toxin is now used medically in certain cases to relieve muscle spasms due to excessive nerve stimulation. For example, it is injected into an affected extraocular muscle in order to help correct strabismus (deviation of the eye). Intramuscular injections of Botox (a brand name for botulinum toxin) are...
Impetigo is a skin infection commonly found in children of preschool age, but may also occur in adults. Impetigo accounts for about 10 of all pediatric skin problems (4). It typically spreads from one part of the body to another through scratching and is a highly communicable disease.
Some organisms are confined to totally anaerobic environments and use only fermentation. Usually, there are two metabolic reasons for this. First, these organisms lack the molecular machinery for oxidative phosphorylation, and second, they lack enzymes to detoxify the toxic by-products of O2, such as hydrogen peroxide (H2O2). An example of such an obligate anaerobe is Clostridium botulinum, the bacterium that thrives in sealed containers of foods and releases the potentially deadly botulinum toxin. Other bacteria, such as My-cobacterium tuberculosis, which causes tuberculosis, cannot carry out fermentation and must grow in aerobic environments. Still others, such as Escherichia coli, which grows in the human large intestine, can perform either respiration or fermentation, but prefer the former in an aerobic environment. And several bacteria carry on cellular respiration not fer-mentation without using oxygen gas as an electron acceptor. Instead, to oxidize their cytochromes, these...
Doctor Well, you know that nothing The patient needs something he per-has happened except a thought, an ceives as useful to occupy his mind. The idea, and all of the little blood vessels laughing place may be the beach, televi-in the face have opened up and turned sion, fishing, golfing, needlepoint, playred, or clamped down and blanched. ing dolls, anything. It becomes the key What you think is going to affect the word for subsequent rapid induction for blood supply to your skin, and that dressing changes, and so on to simply affects healing, and you can start right 'go to your laughing place.' now. You need to have happy, relaxing, enjoyable thoughts to free up all of your healing energy. Brer Rabbit said 'everybody's got a laughing place,' and when I tell you to go to your laughing place, I mean for you to imagine that you are in a safe, peaceful place, enjoying yourself, totally free of responsibility, just goofing off. What would you choose for a laughing place
Because thyroid hormone affects the growth and function of many tissues, a deficiency of this hormone in infancy causes physical and mental retardation as well as other symptoms that together constitute congenital hypothyroidism, formerly called cretinism. In the adult, thyroid deficiency causes myxedema, in which there is weight gain, lethargy, rough, dry skin, and facial swelling. Both of these conditions are easily treated with thyroid hormone. Most U.S. states now require testing of newborns for hypothyroidism. If not diagnosed at birth, hypothyroidism will lead to mental retardation within 6 months.
Successful diabetes management depends on strict patient adherence to the regimen of blood glucose monitoring, medication use, skin care, diet and exercise. Attempts to apply telemedicine for diabetic care were begun in the early 1990s. The solutions used in the early phase were based on communication through a standard telephony network. The first experience from the application of telemonitoring systems in patients with diabetes showed that they can be helpful in reduction of the incidence and severity of complications of type 1 diabetes and probably also in patients with type 2 diabetes 51 57 67 .
Mild botulism deriving from exposure to low levels of botulinum toxin may lead to failure in detecting the toxin in clinical samples. A negative result for toxin in these specimens, however, is not sufficient for excluding the diagnosis of botulism if it is not supported by the research of spores. Detection of the neurotoxigenic organisms from the biological samples is even more conclusive in investigations of botulism other than foodborne. The repeated recovery of neurotoxigenic organisms from the feces of patients over extended periods of time supports the hypothesis of intestinal colonization, while isolation from an injured tissue implies wound infection. Serum is not cultured because botulism patients are presumed to not have bacteremia, an assumption that has not been adequately tested in wound botulism. Recovery of the toxigenic organisms, but not the toxin, from foods is inconclusive. However, according to the HACCP (hazard analysis and critical control points) system, raw...
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