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Cosmetic upper-facial rejuvenation with botulinum.

OBJECTIVE: This study was conducted to evaluate the cosmetic use of botulinum toxin type A (Botox), which blocks the release of acetylcholine at the presynaptic neuromuscular junction leading to an irreversible, but temporary chemical denervation muscular paralysis and weakness. This produces a significant cosmetic improvement of wrinkling in the upper face due to hyperfunctional animation. METHOD: A prospective clinical study representing our experience with this new technique is presented. Patient selection and evaluation, classification of animation lines, techniques, results and complications are discussed. In a 15-month period, 23 patients with seven anatomic sites were injected. Twenty-three patients had the lateral aspect and the inferior aspect of their squint lines injected, and 26 patients had their glabellar frownlines injected. RESULTS: Significant improvement occurred to the average depth and length of the glabellar frownlines. The subjective improvement by the patients was also significant. Regarding the crow's feet, the lateral canthal lines showed more improvement than the inferior lateral canthal lines because the latter has a greater component of zygomaticus major and minor muscle, which contributes to the inferior lateral squint line. CONCLUSION: Botox is a safe, easy-to-use, effective modality for the temporary elimination of hyperfunctioning upper-facial muscles.

Botulinum Toxins, Type A↗

One is too many.

Two Toronto street nurses have turned into political activists in their struggle to stop the homeless from dying in the streets. Alicia Odette and Cathy Crowe helped initiate and publicize the June 24 to July 30 coroner's inquest into the freezing death of three homeless men last winter. Now they are busy ensuring the inquest's recommendations are implemented.

Cause of Death↗

MR-imaging of the TMJ: artefacts caused by dental alloys.

The aim of the study was to investigate the influence of dental alloys and their components on magnetic resonance imaging of the temporomandibular joint. A plaster and a water- filled acrylic resin phantom - representing the disc and the condyle of the TMJ - were used. Cylindrical crow-type samples of 13 alloys and 14 pure substances were investigated. All alloys were examined with regard to their magnetic susceptibility, using a vibrating sample magnetometer. Metallic artefacts appeared on spin-echo technique as distortions, and on gradient-echo technique signal loss could be observed. Precious alloys were shown to be diamagnetic. The non precious alloys we investigated were paramagnetic. Paramagnetic alloys with a magnetic molar-susceptibility Cmol > 2000 x10(-6) cm3/mol can produce clinically relevant artefacts.

Artifacts↗

[Osterosclerotic myeloma and polyneuropathy].

INTRODUCTION: The peripheral neuropathy is a common complication in patients with osteosclerotic myeloma. The association with hepatosplenomegaly, lymphadenopathy and variable endocrine disturbances and skin changes constitute the POEMS syndrome. The pathogenesis of this syndrome is unclear, but the presence of M protein and elevated levels of interleukin-6 in the serum of patients, suggests an immunologic mechanism. CASE: A 68 year old woman presented with a 2 year history of progressive weakness and paresthesias in both legs. Neurological examination revealed a sensorimotor polyneuropathy, involving predominantly the lower extremities. In addition to neurological findings, the patient had lymphadenopathy and skin hyperpigmentation. Serum protein immunoelectrophoresis revealed a peak of monoclonal IgA lambda paraprotein. Radiographic examination disclosed multiple osteosclerotic lesions. Electrophysiological evaluation showed a severe axonal and demyelinating sensorimotor polyneuropathy. Biopsy of sural nerve revealed demyelination and axonal degeneration. Axillary lymph node biopsy were consistent with giant lymph node hyperplasia. Interleukin-6 serum levels were normal. CONCLUSIONS: The POEMS syndrome or Crow-Fusake syndrome is a rare multisystem disorder often associated with osteosclerotic myeloma. A severe demyelinating sensorimotor polyneuropathy frequently constitutes the chief complaint. These patients have a polyneu-ropathy which resembles idiopathic chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and the electrophysi-ological studies are essential in the diagnosis. The pathogenesis has not been explained. Presumably, the plasma cells secrete an immunoglobulin or another substance that is toxic to peripheral nerves. Interleukin-6 is implicated in the pathogenesis of this disease.

Aged↗

Inbreeding in Escazú, Costa Rica (1800-1840, 1850-1899): isonymy and ecclesiastical dispensations.

We investigate the inbreeding levels in Escazú, Costa Rica, during 1800-1840 and 1850-1899. Inbreeding was researched through analysis of ecclesiastical dispensations and by two isonymy methods (Crow and Mange 1965; Pinto-Cisternas et al. 1985). As expected, the dispensation inbreeding coefficients were lower than those obtained through isonymy. However, the three methods indicate that consanguinity increased in the community during the second part of the nineteenth century.

Anthropology↗

Gait analysis of adult patients with complete congenital dislocation of the hip.

Comprehensive gait analysis is valuable in understanding the performance of patients with lower limb disorders. The gait pattern of adult patients with untreated congenital dislocation of the hip (CDH) has not yet been reported. We studied the gait pattern in nine women (mean age 31.4 years) with Crows group IV CDH. Six had unilateral and three had bilateral involvement. They were not treated during childhood and had no pain at the time of study. A control group comprised 15 normal female subjects of the same age group. Gait was studied using a motion-analysis system, force plateforms, and computer calculation during level walking. Common abnormal gait patterns seen in patients with both unilateral and bilateral CDH were slower walking velocity, which was due to a shorter stride length, less forward tilting of the pelvis, insufficient flexion, and excessive internal rotation of the hips. The patients with unilateral CDH had a shorter step length, lower pelvis, a lateral shift of the ground reaction force, decreased maximum adduction moments of the hip and knee on the diseased side, and increased maximum adduction moments of the hip and knee on the unaffected side. This asymmetry may have been due to leg length inequality. Thus, correlation of the leg length discrepancy may be important for unilateral CDH patients in improving their gait.

Adult↗

Laparoscopic Hill's vagotomy by the abdominal wall lifting method.

We performed laparoscopic Hill's vagotomy by the abdominal wall lifting method in nine patients with intractable duodenal ulcer. Our original I-type lifting bar is a curved stainless-steel rod 5 mm in diameter. One I-type lifting bar is inserted intraperitoneally into each of the right and left hypochondrial regions. An incision is made in the lesser omentum near the gastroesophageal junction, and the right esophageal wall and right crus of the diaphragm are dissected and exposed. The posterior trunk of the vagus nerve is identified and divided. Then the neurovascular bundle is dissected and divided repeatedly along the lesser curvature of the stomach from the first branch of the crow's foot to the gastroesophageal junction. The mean operating time was 163 min, with little blood loss. The reduction rate of basal acid output and maximal acid output was, respectively, 73.7 +/- 0.1 and 63.7 +/- 0.1%. Four weeks after surgery, gastroduodenoscopy revealed ulcer healing to a scar.

Adult↗

[Selection intensity in the population of Kurst district].

Total selection indices and their components in the Kursk Oblast, calculated from Crow's equations, are: Itot = = 0.403, I(f) = 0.345, Im = 0.043. The selection intensity was higher in rural than in urban populations. The levels of total selection and differential fertility in rural populations depended on the genetic and demographic structure of these populations. An increase of homozygosity in the rural populations (decreases in the mean square distance between spouses' birthplaces and in the frequency of long-range migrations, increase in ethnic assortativeness, etc.) increased the selection intensity.

Adolescent↗

[Fatalities caused by exposure to heat].

Between 1978 and 1987 52 cases of death by burning or in connection with fire (13 females and 39 males) were examined at the Institute of Legal Medicine of the Medical School of Hannover. The causes were fires in flats (25), cars (15) and buildings(4), clothes set on fire (3) and explosions (3). In two cases death was caused by scalding. These cases could be divided into accidents (30), over 1/3 caused by smoking (11)), suicides (9) and homicides (6). The other seven cases could not be clarified definitively. Evidence of CO-elevation (38), soot inhalation (33), petechiae (11) and "crow's feet" (6) were noted. However, isolated findings cannot lead to a satisfactory assessment after death by burning. The reconstruction of events requires a comprehensive evaluation of the case history, the scene of death and the autopsy as well as complementary analyses. Therefore intensive cooperation between criminal investigators and forensic physicians is absolutely necessary.

Accidents↗

[A genetic-demographic study of the South Altaian population of the Mendur-Sokkon village (Altai Republic)].

The main demographic parameters of the population of South Altaians from the Mendur-Sokkon village, Ust'-Kanskii raion, Altai Republic, were studied. This population was classified as a growing one because the population's reproductive size was large (37%), the prereproductive part constituted the majority of the population (52%), and the average number of surviving children per spouse was 2.6. The population studied began to mix with other ethnic groups (mostly Russians and Kazakhs) only recently; therefore, the proportion of interethnic hybrids was only 5%. The tribal structure of the Mendur-Sokkon population was typical of all South Altaians and characterized by stringent observance of exogamous regulations. An ethnically pure core was preserved in the population. The degree of endogamy was 0.36; however, the population mostly exchanged marriage migrants within the Ust'-Kanskii raion. A study of postreproductive females revealed that the average number of surviving children and pregnancies per female was 4.9 and 5.3, respectively; these values were lower than those in indigenous northern Siberian populations studied earlier. The high value of the Crow's index of total selection (Itot = 0.63) was mainly accounted for by the differential fecundity component, I(f) = 0.40, whereas the prereproductive mortality component (Im = 0.16) was considerably lower than in northern Siberian populations (Nganasans, Forest and Tundra Nentsi, Evens, Asian Eskimos, etc.) and closer to the values characteristic of urban human populations.

Adolescent↗

The incidence of systemic lupus erythematosus in North American Indians.

The annual incidence (AI) of systemic lupus erythematosus (SLE) was determined in 75 highly inbred North American Indian tribes, a total of approximately 800,000 people, during the fiscal years 1971-1975. Seventy-two of the Indian tribes had an AI of SLE which was of similar magnitude to previously published studies from Sweden, Rochester (Minn.), Alabama, New York City, and San Francisco. However, Three tribes, the Crow, Arapahoe, and Sioux Indians, had a markedly elevated AI of SLE. These three tribes share common historical, geographic, and cultural characteristics. Further, they all reside in the northern half of the United States, in states that do not receive intense sun exposure, thereby eliminating photosensitivity as a major determinant of this increased prevalence. Finally, the AI of SLE in the Sioux Indians was highest for "full-blooded" members and lowest for genetic admixtures.

Humans↗

Laser blepharoplasty and laser resurfacing of the periorbital area.

Although blepharoplasty has long been the traditional method of improving the aesthetic appearance of the eyelid area, it yields little improvement in several of the major signs of periorbital aging including (1) wrinkling of the infrabrow and lower lid skin, (2) crow's foot wrinkles, (3) malar bags and wrinkles, (4) crepey changes in the periorbital skin texture, (5) pigment spots and other actinic damage, (6) elongation of the apparent vertical height of the lower lid, and (7) loss of the gentle, indistinct transition between the lower lid and cheek skin. All of these indications can be improved by the combination of laser blepharoplasty and laser resurfacing of the periorbital region. In addition to resurfacing, the author prefers to use the laser for the incisional aspects of the blepharoplasty, as it is quick, causes less sensory nerve stimulation, is less likely to damage the inferior oblique muscle, and has essentially no bleeding--and therefore, less ecchymosis--postoperatively. This technique is described and illustrated photographically. Its outcomes include a high-quality result that maintains itself well over time, improvement in the signs of periorbital aging not treated by traditional blepharoplasty, a low rate of complication, and high patient satisfaction.

Blepharoplasty↗

Demographic implications of socioeconomic transition among the tribal populations of Manipur, India.

The demographic implications of socioeconomic transition are studied among the three subsistence categories of the Gangte, a little known tribe from northeast India. Reproductive histories of 444 ever-married women and other data on the 343 households from which these women were drawn were collected from 11 villages representing the 3 transitional groups. A trend of increasing household income and literacy of couples was observed from shifting cultivators to settled agriculturists to the town-dwelling Gangte. The effect of socioeconomic transition is also seen in the constriction at the base of the age-sex pyramid of the town dwellers compared with the other subsistence categories, suggesting a relatively lower proportion of children in the 0-5-year-old age group. Although exogamy is practiced among all the subsistence categories, a considerably higher percentage of admixture with non-Gangte is observed among the town dwellers compared with the others. Overall infant and child mortality among the Gangte is low. However, variation exists among the three subsistence groups in the sense that a considerable reduction is seen from the traditional shifting cultivators to the urbanized town dwellers, reflecting better socioeconomic conditions and greater awareness and accessibility of the town dwellers to public health amenities. No consistent or perceptible trend is evident in mean number of live births. The genetic implications of this demographic transition are reflected in Crow's indexes of selection.

Adolescent↗

Mutation-selection balance with multiple alleles.

Human genetic disorders provide an extraordinary richness of data on the diversity of defective alleles. Well over 100 defective alleles for each of several human genetic disorders have been identified, including breast cancer (BRCA1), cystic fibrosis (CFTR), muscular dystrophy (DZM), and phenylketonuria (PAH). These observations raise the classical question of balance between the action of mutation generating new defective alleles and selection removing those alleles from the population. The problem of multiple-allele, mutation-selection balance was considered by Crow and Kimura, who obtained some approximate results showing that the level of dominance and degrees of interallelic complementation are important in determining the equilibrium allele frequencies. Here those deterministic results are reviewed and extended, showing that there are conditions yielding surprisingly high equilibrium frequencies of defective alleles. Just as the equilibrium mutation load is independent of the level of dominance, it is also independent of the number of defective alleles.

Alleles↗

Prevalence of Toxoplasma gondii antibodies in wild and domestic animals in northern California.

Wild and domestic animals from 3 geographic-climatologic areas in northern California were tested for antibodies against Toxoplasma gondii. A total of 2,796 serum samples representing 37 species of wild mammals, 35 species of wild birds, and 5 species of domestic animals were tested by the indirect hemagglutination test. Of 1,174 wild mammal serums tested, 10.8% were positive, which compared with 14.7% of the 1,221 domestic mammal serums. Of 229 wild carnivores tested, 45% were seropositive, including 69% of 86 bobcats, 28% of 58 coyotes, 48% of 25 raccoons, 27% of 26 gray foxes, 22% of 32 striped skunks, a civet cat, and a mink. Serologic evidence of infection was found in 38% of 47 rural domestic cats, but none of the 7 dogs tested was seropositive. Of 160 murid rodents (rats and house mice) in rural habitats, 4% were seropositive, which compared with 2% of 399 cricetine rodents (mostly deer mice) collected from wilderness habitats. Seven percent of 56 wild Artiodactyla (deer and feral pigs) were seropositive, which compared with 15% of 1,048 domestic sheep tested. Of 401 birds tested, 3.5% had antibodies against T gondii. The highest prevalence of antibodies among birds was in crows (14%). Toxoplasma was isolated from 1 raven, by mouse inoculation. In general, the highest prevalence of seropositive carnivores, rodents, and sheep was in the coastal region below 100 ft elevation, where the weather is cool and damp for much of the year. In the central valley the highest prevalence among sheep was in areas under irrigation. The prevalence of antibodies was lowest in the mountain areas, where climatologic extremes prevail at various seasons of the year.

Animals↗

Morphometric study of the muscles spindles of the eye muscle in human fetuses between 24-29 weeks.

The studies were carried out on human fetuses with the crow-rump length between 230 to 270 mm (24-29 weeks). The length of recti muscles varies from 12-15 mm in 24th week to 25-28 mm in 29th week. Number of muscle spindles varies from 29-36 in 24th week to 54-59 in 29th week. The length of the muscle spindles is from 30-300 microns in 24th week to 40-450 microns in 29th week. The diameter of the muscle spindles varies from 11-36 microns in 24th week to 15-70 microns in 29th week.

Embryonic and Fetal Development↗

Changes over 100 years in degree of isolation of 21 parishes of the Lima Valley, Italy, assessed by surname isonymy.

Changes over 100 years (1887-1986) in degree of isolation of 21 parishes of the Lima valley, Italy, were assessed using surname analysis. Crow and Mange's inbreeding coefficients and Lasker and Kaplan's repeated pair values were calculated using 8026 marriage records; temporal changes were assessed by dividing birth cohorts into 4 time periods of 25 years each: 1887-1911, 1912-1936, 1937-1961, and 1962-1986. Analysis was carried out at 2 hierarchical levels: the population of the valley as a whole and the valley's subdivision into 21 parishes. The relationship between population size and level of isonymy during the breakdown of isolates was investigated. The results show that there is a small difference in inbreeding coefficients between the first 2 periods at either hierarchical level of analysis and a substantial decrease in marital isonymy during the study period is mostly due to the change in male random isonymy. Furthermore, the Fn value at the higher hierarchical level almost coincides with the mean F value at the lower hierarchical level, indicating that over time the parish remained the fundamental reproductive unit. Regression analysis showed that geographic isolation became increasingly important in differentiation among the parishes in population size and in levels of inbreeding. The marked deviation from equilibrium between drift and migration that characterizes the breakdown of isolates of almost all the rural populations is an important disturbing factor in assessing the relationship between level of inbreeding and population size. Comparison over time allows us to better describe the evolutionary forces at the basis of the changes in genetic structure of a population.

Cohort Studies↗

Membrane phase transition of intact human platelets: correlation with cold-induced activation.

Using Fourier transform infrared spectroscopy (FTIR), we have determined the phase transition temperature (Tm) of lipids in intact human platelets and have shown that it occurs between 15 and 18 degrees C, the temperature at which cold activation of platelets has previously been reported (Zucker and Borrelli, 1954, Blood, 28:602-608; White and Krivit, 1967, Blood, 30:625-635). The temperature at which the platelets pass through Tm is highly correlated with initial platelet shape change. However, shape change continues after the cells have passed through the phase transition. Cold-induced activation has previously prevented long-term storage of platelets at 4 degrees C. Antifreeze glycoproteins (AFGPs) isolated from polar fishes previously have been used to prevent ice crystal growth during freezing of tissues as well as leakage of solutes from liposomes as they were chilled through their Tm. We sought to determine if these AFGPs were able to stabilize platelets for long-term storage at 4 degrees C. Incubating platelets with antifreeze glycoproteins during long-term storage and rapid rewarming to 37 degrees C abrogated granule secretion associated with cold activation in a dose-dependent manner. This work suggests that AFGPs may be a possible solute for use in long-term low temperature storage of platelets.

Antifreeze Proteins↗