Sarcoma (see CANCER) of bone, muscle or connective tissues in a limb is another reason for amputation.
The aim is to restore the patient to full mobility with a prosthetic (arti?cial) limb, which requires both a well-?tting PROSTHESIS and a well-healed surgical wound. If this is not possible, the aim is to leave the patient with a limb stump that is still useful for balancing, sitting and transferring. Common types of lower-limb amputation are shown in the illustration. The Symes amputation can be walked upon without requiring a prosthesis. The below-knee amputation preserves normal ?exion of the knee, and virtually normal walking can be achieved with a well-?tting arti?cial limb. Learning to walk is more di?cult following an above-knee amputation, but some highly motivated patients can manage well. After any amputation it is not unusual for the patient to experience the sensation that the limb is still present: this is called a ‘PHANTOM LIMB’ and the sensation may persist for a long time.... amputation
The condition is extremely rare, but used to occur as a side effect of women taking the drug thalidomide in early pregnancy.... phocomelia
Tinea capitis Usually seen in children in Britain and caused by microsporum species of human or animal (frequently a kitten) origin. Typically, patches of ALOPECIA are seen with broken-o? hair stumps which ?uoresce bright green under an ultraviolet (Wood’s) lamp. In Asia a chronic, scarring alopecia may be caused by a speci?c trichophyton (favus).
Tinea corporis is usually due to trichophyton species and forms ringed (hence ‘ringworm’) patches of redness and scaling on the trunk or limbs.
Tinea pedis (athlete’s foot) is caused by epidermophyton or trichophyton species. Its minor form manifests as itching, scaling or blistering in the lateral toe clefts. More severe forms can be extensive on the sole. Trichophyton rubrum can cause a chronic, dry, scaling in?ammation of the foot, eventually extending into the nails and on to the soles and top of the foot which may persist for years if untreated.
Tinea cruris typically causes a ‘butter?y’ rash on the upper inner thighs in young adult males. It is usually caused by spread from the feet.
Tinea unguium (onychomycosis) Affecting the nails, especially of the toes, T. rubrum is the usual cause and may persist for decades.
Tinea barbae This rash of the face and beard is rare. It may be very in?ammatory and is usually contracted from cattle by farm workers.
Treatment Tinea of the toe clefts and groin will usually respond to an antifungal cream containing terbina?ne or an azole. Tinea capitis, barbae, extensive tinea corporis and all nail infections require oral treatment with terbina?ne or itraconazole (a triazole antifungal agent taken orally and used for candidiasis of the mouth, throat and vulgovaginal area as well as for ringworm) which have largely superseded the earlier treatment with the antiobiotic griseofulvin. (See FUNGAL AND YEAST INFECTIONS.)... ringworm
Stockhard, Stockhard, Stokkard... stockard
Development of such mechanical and biomechanical devices points the way to a much wider use of e?ective prostheses, enabling people who would previously have died or been severely handicapped to lead normal or near normal lives. The technical hazards that have already been overcome provide a sound foundation for future successes. Progress so far in producing prostheses should also ensure that organ replacement is free from the serious ethical problems that surround the use of genetic manipulation to cure or prevent serious diseases (see ETHICS).
Limbs These are best made to meet the individual’s requirements but can be obtained ‘o? the shelf’. Arti?cial joints normally comprise complex mechanisms to stimulate ?exion and rotation movements. Leg prostheses are generally more useful than those for arms, because leg movements are easier to duplicate than those of the arm. Modern electronic circuitry that enables nerve impulses to be picked up and converted into appropriate movements is greatly improving the e?ectiveness of limb prostheses.
Eyes Arti?cial eyes are worn both for appearance and for psychological reasons. They are made of glass or plastic, and are thin shells of a boat-shape, representing the front half of the eye which has been removed. The stump which is left has still the eye-muscles in it, and so the arti?cial eye still has the power of moving with the other. A glass eye has to be replaced by a new one every year. Plastic eyes have the advantage of being more comfortable to wear, being more durable, and being unbreakable. Research is taking place aimed at creating a silicon chip that stimulates the visual cortex and thus helps to restore sight to the blind.
Dental prostheses is any arti?cial replacement of a tooth. There are three main types: a crown, a bridge and a denture. A crown is the replacement of the part of a tooth which sticks through the gum. It is ?xed to the remaining part of the tooth and may be made of metal, porcelain, plastic or a combination of these. A bridge is the replacement of two or three missing teeth and is usually ?xed in place. The replacement teeth are held in position by being joined to one or more crowns on the adjacent teeth. A denture is a removable prosthesis used to replace some or all the teeth. The teeth are made of plastic or porcelain and the base may be of plastic or metal. Removable teeth may be held more ?rmly by means of implants.
Heart The surgical replacement of stenosed or malfunctioning heart-valves with metal or plastic, human or pig valves has been routinely carried out for many years. So too has been the insertion into patients with abnormal heart rhythms of battery-driven arti?cial pacemakers (see CARDIAC PACEMAKER) to restore normal function. The replacement of a faulty heart with an arti?cial one is altogether more challenging. The ?rst working attempt to create an arti?cial heart took place in the early 1980s. Called the Jarvik-7, it had serious drawbacks: patients had to be permanently connected to apparatus the size of an anaesthetic trolley; and it caused deaths from infection and clotting of the blood. As a result, arti?cial hearts have been used primarily as bridging devices to keep patients alive until a suitable donor heart for transplantation can be found. Recent work in North America, however, is developing arti?cial hearts made of titanium and dacron. One type is planted into the chest cavity next to the patient’s own heart to assist it in its vital function of pumping blood around the body. Another replaces the heart completely. Eventually, it is probable that arti?cial hearts will replace heart transplants as the treatment of choice in patients with serious heart disorders.
Liver Arti?cial livers work in a similar way to kidney dialysis machines (see DIALYSIS). Blood is removed from the body and passed through a machine where it is cleaned and treated and then returned to the patient. The core of the device comprises several thousand ?exible membrane tubules on which live liver cells (from pigs or people) have been cultured. There is an exchange of biological molecules and water with the ‘circulating’ blood, and the membrane also screens the ‘foreign’ cells from the patient’s immune system, thus preventing any antagonistic immune reaction in the recipient.
Nose The making of a new nose is the oldest known operation in plastic surgery, Hindu records of such operations dating back to 1,000 BC. Loss of a nose may be due to eroding disease, war wounds, gun-shot wounds or dog bites. In essence the operation is the same as that practised a thousand years before Christ: namely the use of a skin graft, brought down from the forehead. Alternative sources of the skin graft today are skin from the arm, chest or abdomen. As a means of support, the new nose is built round a graft of bone or of cartilage from the ear.... prosthesis
Limb defects are rare and may be inherited or form part of a syndrome.
In a condition called phocomelia, hands, feet, or tiny finger- or toe-buds are attached to limb stumps or grow directly from the trunk.
The sedative drug thalidomide, when taken by pregnant women, is known to have caused phocomelia in fetuses.... limb defects
The extra digits may be fully formed or they may be fleshy stumps.
Polydactyly often runs in otherwise normal families; however, it may also occur as part of Laurence–Biedl–Moon syndrome or other congenital syndromes.... polydactyly
FAMILY: Lauraceae
SYNONYMS: Laurus camphora, true camphor, hon-sho, laurel camphor, gum camphor, Japanese camphor, Formosa camphor.
GENERAL DESCRIPTION: A tall, handsome, evergreen tree, up to 30 metres high, not unlike the linden. It has many branches bearing clusters of small white flowers followed by red berries. It produces a white crystalline substance, the crude camphor, from the wood of mature trees over fifty years old.
DISTRIBUTION: Native to Japan and Taiwan principally, also China; cultivated in India, Ceylon, Egypt, Madagascar, southern Europe and America.
OTHER SPECIES: There are many species of camphor: the ho-sho variety produces ho leaf and ho wood oil; the Chinese variety produces apopin oil; the Japan and Taiwan type, known as hon-sho or true camphor, produces two chemotypes: camphor-safrol (Japan) and camphor-linalol (Taiwan). All these are to be distinguished from the Borneo camphor or borneol which is of different botanical origin.
HERBAL/FOLK TRADITION: A long-standing traditional preventative of infectious disease; a lump of camphor would be worn around the neck as a protection. In addition it was used for nervous and respiratory diseases in general, and for heart failure! However, in its crude form it is very poisonous in large doses, and has been removed from the British Pharmacopoeia.
ACTIONS: Anti-inflammatory, antiseptic, antiviral, bactericidal, counter-irritant, diuretic, expectorant, stimulant, rubefacient, vermifuge.
EXTRACTION: Crude camphor is collected from the trees in crystalline form. The essential oil is produced by steam distillation from the wood, root stumps and branches and then rectified under vacuum and filter pressed to produce three fractions, known as white, brown and yellow camphor.
CHARACTERISTICS: White camphor is the lightest (lowest boiling) fraction, a colourless to pale yellow liquid with a sharp, pungent camphoraceous odour. Brown camphor is the middle fraction. Yellow camphor, a blue-green or yellowish liquid, is the heaviest.
PRINCIPAL CONSTITUENTS: 1 White camphor contains mainly cineol, with pinene, terpineol, menthol, thymol and no safrol. 2. Brown camphor contains up to 80 per cent safrol and some terpineol. 3. Yellow camphor contains mainly safrol, sesquiterpenes and sesquiterpene alcohols.
SAFETY DATA: Brown and yellow camphor (containing safrol) are toxic and carcinogenic and ‘should not be used in therapy, either internally or externally.’. White camphor does not contain safrol and is relatively non-toxic, non-sensitizing and non-irritant. It is, however, an enviromental hazard or marine pollutant.
AROMATHERAPY/HOME: USE White camphor may be used with care for:
Skin care: Acne, inflammation, oily conditions, spots; also for insect prevention (flies, moths, etc).
Circulation Muscles And Joints: Arthritis, muscular aches and pains, rheumatism, sprains, etc.
Respiratory System: Bronchitis, chills, coughs.
Immune System: Colds, fever, ’flu, infectious disease.
OTHER USES: White and brown camphor are used as the starting material for the isolation of many perfumery chemicals, for example safrol and cineol. White camphor is used as a solvent in the paint and lacquer industry, and for the production of celluloid. Fractions of white oil are used as fragrance and masking agents in detergents, soaps, disinfectants and household products.... camphor
FAMILY: Pinaceae
SYNONYMS: Atlantic cedar, Atlas cedar, African cedar, Moroccan cedarwood (oil), libanol (oil).
GENERAL DESCRIPTION: Pyramid-shaped evergreen tree with a majestic stature, up to 40 metres high. The wood itself is hard and strongly aromatic, due to the high percentage of essential oil which it contains.
DISTRIBUTION: Native to the Atlas mountains of Algeria; the oil is mainly produced in Morocco.
OTHER SPECIES: Believed to have originated from the famous Lebanon cedars (C. libani), which grow wild in Lebanon and on the island of Cyprus. It is also a close botanical relation to the Himalayan deodar cedarwood (C. deodora), which produces a very similar essential oil. (NB the oil is quite different from the Texas or Virginia cedarwood.)
HERBAL/FOLK TRADITION: The oil from the Lebanon cedar was possibly the first to be extracted, it was used by the ancient Egyptians for embalming purposes, cosmetics and perfumery. The oil was one of the ingredients of ‘mithridat’, a renowned poison antidote that was used for centuries. The Lebanon cedar was prized as a building wood; its odour repelled ants, moths and other harmful insects, as does the oil from the Atlas cedar.
Traditionally, the oil was used in the East for bronchial and urinary tract infections, as a preservative and as an incense. It is still used as a temple incense by the Tibetans, and is employed in their traditional medicine.
ACTIONS: Antiseptic, antiputrescent, antiseborrheic, aphrodisiac, astringent, diuretic, expectorant, fungicidal, mucolytic, sedative (nervous), stimulant (circulatory), tonic.
EXTRACTION: Essential oil by steam distillation from the wood, stumps and sawdust. A resinoid and absolute are also produced in small quantities.
CHARACTERISTICS: A yellow, orange or deep amber viscous oil with a warm, camphoraceous top note and sweet tenacious, woody-balsamic undertone. It blends well with rosewood, bergamot, boronia, cypress, calamus, cassie, costus, jasmine, juniper, neroli, mimosa, labdanum, olibanum, clary sage, vetiver, rosemary, ylang ylang, oriental and floral bases.
PRINCIPAL CONSTITUENTS: Atlantone, caryophyllene, cedrol, cadinene, among others.
SAFETY DATA: Non-toxic, non-irritant, non-sensitizing. Best avoided during pregnancy.
AROMATHERAPY/HOME: USE
Skin Care: Acne, dandruff, dermatitis, eczema, fungal infections, greasy skin, hair loss, skin eruptions, ulcers.
Circulation Muscles And Joints: Arthritis, rheumatism.
Respiratory System: Bronchitis, catarrh, congestion, coughs.
Genito-Urinary System: Cystitis, leucorrhoea, pruritis.
Nervous System: Nervous tension and stress-related conditions.
OTHER USES: Fragrance component and fixative in cosmetics and household products, soaps, detergents, etc, as well as in perfumes, especially men’s fragrances.... cedarwood, atlas