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Initially introduced as Botox , this product was first used for cosmetic purposes in 1981 Botox Cosmetic, still usually referred to as Botox, was approved by the FDA in 2002 for treatment of (glabellar) frown lines Botox is formed from fermented cultures of C botulinum The cultures are subjected to autolysis, releasing a 900 kD toxic complex Prior to placement in storage vials, the compound is diluted with human serum albumin The manufacturers then freeze dry and seal the toxin One vial of Botox contains 100 U of BTX-A DILUTION AND STORAGE Physicians do not agree on the optimal dilution ratio for the toxin or on how long the toxin retains its potency after dilution However, Klein published a survey of expert Botox users and found that most of them use a dilution of 25 cc per 100U vial11 This dilution was used in the Allergan FDA trials as well Reports in the literature support the use of 1 cc to 10 cc dilutions11 See Table 22-2 for dilution guidelines The 100-U bottle of Botox is diluted with 09% saline Preservative-free saline was recommended initially until studies showed that pain perception was decreased when preservativecontaining saline was used12 When diluting the bottle, care must be taken to gently inject the saline into the bottle to prevent foaming and bubbles, which may denature the toxin and decrease its potency Many physicians remove the TABLE 22-2 The Amount of Saline Used to Dilute Botox Determines the Number of Units in Each 01 cc DILUTION TABLE FOR BOTOX VOLUME OF DILUENT ADDED (CC) 10 20 25 30 NUMBER OF UNITS PER 01 CC 10 5 4 33

FIGURE 3-14

Who else can get away with it, looking stonefaced and with just the slightest twinkle in his eyes, if you look really carefully Since then Lex, as always, hasn t looked back but has worked nonstop as instructor all over Europe and the Middle East, and as writer The book in front of you is, in fact, an update of a book he wrote many moons ago, and which has served as a textbook in various Dutch schools The upgrade (and translation into English) has been done in an incredibly short time, and as the first one ever, he has kept his deadlines with editor Tony Davis from Apress Of course Nothing less should be expected from Lex.

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Lex is one of the original members of the OakTable Network, and the man behind the idea of Mini Oak Tables (MOTs), which he produces in his loft, where he has a fair selection of tools to handle most things you d ever want to do to wood Lately, he has also produced a bathroom table for me with the universal dimensions 42 4 42 centimeters After all, 42 is the answer according to the Hitchhiker s Guide to the Galaxy And he has started producing bottle openers in oak They work Before writing this, I had the pleasure of reading the comments made by Cary Millsap and Joakim Treugut (both Oakies as well) on the contents of this book, and they must be the most consistently positive remarks I ve seen from those two for a very, very long time I think Lex has done it again.

rubber stopper before adding the saline, which prevents the rapid addition of saline to the bottle because of the vacuum of the bottle and helps avoid leaving a few expensive drops of BTX-A in the vial Novice practitioners should be advised to never insert the needle of the syringe that is to be used for injection into the rubber stopper This would make it dull and increase the pain on injection In addition, it is important not to shake the bottle or flick the syringe to eliminate air bubbles as agitation of the toxin may lead to loss of potency Once the BTX-A has been diluted with saline, it begins to lose potency, but the point at which the potency losses become clinically significant is unknown Many authors suggest that BTX-A should be used within 48 hours; however, a few authors state that Botox may remain in the refrigerator up to 4 weeks13 If one plans to keep Botox for an extended period of time, preservative-containing saline should be used and the reconstituted Botox should be kept in a refrigerator In the primary author s experience, the best Botox is fresh Botox and should be used within 24 hours of dilution Botox should not be refrozen once prepared as this also causes a definite loss of potency, due to the formation of ice crystals

5 After you assign tags and privileges, click Upload While your video uploads, you can probably make yourself a cup of tea, shine your shoes, or dust around the house, depending on how large the file is (the maximum size is 100MB) Figure 3-14 shows a typical progress bar during upload Once the video is processed, it appears on your MySpace page under Videos You can send the link to friends and colleagues, via e-mail or via the MySpace network You will find that most networking sites like MySpace use pretty much the same step-bystep method of uploading and categorizing Once you are familiar with one, you should be able to drop into any of the others and not have any trouble adjusting

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