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oxidized vitamin E regenerating this essential lipophilic antioxidant Free radicals in the skin are generated by factors such as sunlight, smoking, and pollution When light in the UVB spectrum (290 320 nm) is absorbed by DNA, it generates cyclopyrimidine and thymine dimers30 If these errors are not corrected by nucleotide excision repair, there can be resultant C to T and CC to TT mutations, characteristic of actinic damage The peak spectrum for this is 300 nm In addition, UV light can be absorbed by trans-urocanic acid to produce singlet oxygen31 The peak spectrum for this is 345 nm As most dermatologists know, the damaging effects of sun exposure include wrinkling, dryness, telangiectasias, and pigmentation There can also be upregulation of matrix metalloproteinases 1, 2, 3, and 9, which may breakdown existing collagen.

32 Vitamin C has a number of uses in dermatology, primarily because of its antioxidant action and the skin bene ts that would result Its photoprotective abilities were demonstrated in porcine skin, as a function of reduced erythema and a reduction in the number of sunburn cells33 Vitamin C can help decrease in ammation by suppressing activation of the transcription factor, nuclear factor kappa beta34 By inhibiting elastin formation, it may also help in photoaged skin where elastin synthesis is increased35 In addition, Alster and West have reported a reduction in post-laser resurfacing erythema36 Topical formulations have shown promise for delivering antioxidant bene ts directly to the skin The reasoning for this is that most damage occurs as a result of exogenous radiation or other injury.

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Research on the percutaneous absorption of L-ascorbic acid demonstrated that it must be formulated at an acidic pH, less than or equal to 35, in order to enter the skin37 This way it does not carry a charge and can permeate the lipid membranes of the stratum corneum In one study, maximum concentration for optimal absorption was found to be 15% to 20% and levels above that resulted in lower levels of absorption In the same study, tissue saturation was achieved after three daily applications and bore a half-life of approximately 4 days Several double-blinded trials have proven the bene ts of topically applied L-ascorbic acid.

In one trial, a comparative study of 19 patients comparing 10% ascorbic acid versus vehicle on one half of the face for 3 months optical pro lometry image analysis showed a signi cant improvement in average roughness and mean roughness or depth on the side treated with ascorbic acid34 Clinical assessments also showed greater improvement in ne wrinkling,.

patient will experience repeated recurrences Previously, the only treatment option for these patients with varicose veins from saphenous insuf ciency was surgical ligation and stripping of the vessels under general anesthesia This procedure resulted in signi cant postoperative downtime with surgical scars, swelling, bruising, and pain The expense of a hospital stay and missed work, along with an unacceptable rate of recurrence has decreased the popularity of this procedure While RF-mediated elimination started the noninvasive varicose vein trend, endovenous obliteration with lasers has revolutionized varicose vein treatment Radiofrequency This method involves the placement of a catheter within the varicose vein through a small puncture or incision The catheter is threaded up to the saphenofemoral junction typically under duplex ultrasound guidance.

centers, but Sakakibara and colleagues have reported that half of their patients with brainstem strokes had urinary symptoms, for which lesions in the pons were most often responsible; the precision of anatomic localization of the strokes was limited and the symptoms varied Therapy of Disordered Micturition Several drugs are useful in the management of accid and spastic disturbances of bladder function In the case of a accid paralysis, bethanechol (Urecholine) produces contraction of the detrusor by direct stimulation of its muscarinic cholinergic receptors In spastic paralysis, the detrusor can be relaxed by propantheline (Pro-Banthine, 15 to 30 mg three times daily), which acts as a muscarinic antagonist, and by oxybutynin (Ditropan, 5 mg two to three times daily), which acts directly on the smooth muscle and also has a muscarinic antagonist action Atropine, which is mainly a muscarinic antagonist, only partially inhibits detrusor contraction.

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