Lethal botox toxin in the hands of surgeons
2007/01/01 Galarraga Aiestaran, Ana - Elhuyar Zientzia Iturria: Elhuyar aldizkaria
This intoxication took place in 1820. In a village in southeast Germany, hundreds of people were intoxicated eating sausages. Years later, in Belgium, the researchers demonstrated the relationship between the neuromuscular paralysis of the intoxicated and the spores present in the ham they ate. The spores belonged to a bacterium, Clostridium botulinum.
Ubiquitous bacteria
Clostridium botulinum is a group of bacteria. Eight varieties are distinguished (A, B, C1, C2, D, E, F and G), all of them anaerobic, spherical and spore generators. They can be anywhere and are easily found on the surface of fruit and vegetables, in seafood, in the soil and in marine sediments.
The removal of spores is not easy, for example, they can last five hours at 100ºC and at 120ºC are enough five minutes to destroy them. When the conditions of the environment are adequate, spores grow alert and toxic bacteria. Among these conditions are the lack of oxygen and the lack of acidity of the medium. On the other hand, although the optimal temperature for the growth of the bacteria ranges between 25 and 37 °C, some types also grow up to 4 °C.
These conditions are common in some food preserves. If the preserves are well prepared, there is no risk, while if the conservation treatment has been incorrect Clostridium botulinum may increase. Varieties A and B produce enzymes that degrade food, so contaminated food has an unpleasant appearance and smell. However, the rest of varieties do not alter their appearance, smell or flavor, so the study of these characteristics does not allow to know if the food is contaminated.
Paralyzing toxin
Of the eight varieties, A, B, E (and in few cases F and G) are those that harm people. Specifically, its toxin is the cause of the disease. It highlights the strength of toxin, the most effective bacterial toxin and probably the strongest poison known to humans. The lethal dose to kill the laboratory mouse is 0.0003 micrograms/kilogram. The curve is 500. It is estimated that a gram of toxin, expanded in aerosols, has the capacity to kill 1.5 million people.
Toxin is a polypeptide without smell or flavor. Unlike the spore, it is easily denatured by heat (at 80ºC) and also in chlorinated water. It is able to withstand the acidity of the stomach and gastric enzymes.
The toxin can access the organism by various ways. One is based on contaminated food. There may also be infection of a wound and toxin in the wound itself. And although not usual, spores can penetrate the lungs by inhalation. Regardless of which pathway, the toxin enters blood circulation and reaches the confluence of nerve endings with the muscle. There it acts. Conclusion: paralysis.
Today it is rare to reach it. There are few intoxications, most of the cases occur in Georgia, Russia and the US, mainly from home-cooked meals and infected wounds. The last major intoxication occurred in March 2006, in Thailand: 163 people were intoxicated by homemade bamboo shoots. Fortunately, they were given adequate treatment and put on respiratory devices, which prevented death. In general, mortality from botulism has decreased considerably.
In addition to treating the disease, researchers have learned to use the toxin and now use it to paralyze the muscles they want. Botox is called the purified toxin of the Clostridum botulinum variety A used.
Available in cosmetic surgery
The button set was used in neurology about twenty years ago. It was used to treat spasms, avoiding disproportionate muscle contractions. Later they realized that the treatment also greatly improved the patient's face in some cases and it was thought that this could be interesting in aesthetic surgery.
They are frequent. For example, Propecia and Rogaine products are used against burusoil, but in reality, one was developed to treat benign prostate tumors and the other to control high blood pressure.
In the case of botox, it has been used in cosmetic surgery for 5-6 years as a complement to facial rejuvenation treatments. Pedro Cormenzana, specialist in Polyclinic Gipuzkoa, explains that in the treatments of facial rejuvenation, the aim is to improve the face, correcting on the one hand the sagging of the muscles and on the other eliminating the wrinkles.
Muscle flaccidity is corrected surgically, for example, with a lifting. To polish wrinkles can be filled and another option is to use the “chemical scalpel”, the button.
The bottle removes wrinkles, but it also does more: it affects the face. In fact, it relaxes the eye. This influence is evident in the vertical wrinkles between the eyebrows. Precisely because of the excessive contraction of the eyebrow muscles, deep wrinkles are created in some people who also have an irritating appearance. By loosening these muscles with the botox, the wrinkles disappear and the front is illuminated.
However, to achieve this effect, it is necessary to know well in which muscle the mouthpiece is injected. Otherwise, Cormenzana warns that undesirable effects such as the fall of a muscle can occur. To avoid this type of problems it is essential that the doctor who injects the button set knows the functional anatomy well.
The best results are obtained for the moment in the upper third of the face. Elsewhere there is a higher risk of producing an unwanted effect. However, it should be noted that the unwanted effects disappear over time. In fact, the effect of detection begins within four days of the mouthpiece injection and lasts between five and six months.
Vertical, horizontal and transversal
Finally, it is used to remove wrinkles from the edge of the eye. For this purpose, it is injected into the muscle surrounding the eye in about four points. Cormenzana determines that when choosing these points the age of the patient is very important: "In young people it can also be placed in the lower part of the eye, but it is not recommended in adults, but the lower eyelid is fallen."
As important as choosing points well is to use the appropriate dose and distribute it correctly. For these applications, the button set is sold under the name of Vistabel and the sale is controlled, as it is only available in hospital pharmacies.
The injected dose depends on sex and the target. Usually, higher doses are needed in men than in women. However, most of Cormenzana's patients are women, "despite the fact that in recent times more men are being encouraged, as in other aesthetic treatments." It seems that the use of botox will increase and 90% of the people who have tried it repeat it.
Currently, tests are being done in other places of the face, such as the nose. In the lower third of the face the results are not so easy to predict. However, it can be used to lift the edges of the lips, even on the neck, but in relatively young people.
You have to give much care in these places, it is very accurate. For example, in the barcode, that is, to polish wrinkles on the lips, very small doses should be used, divided into four or five points.
Beyond the aesthetics
However, surgeons should act more accurately in other cases, such as correcting asymmetries. In general, in applications beyond aesthetics, the corresponding treatment should be performed. It should not be forgotten that the button was used in neurology and is now also very useful to treat some alterations.
Mariano Sota, plastic surgeon at Donostia Hospital, says that researchers are discovering more and more applications. However, in the hospitals here the botulinum toxin is not widely used in practice; for example, Sota, although prepared for it, has never been given the administration of toxin in the Donostia Hospital. It must be taken into account that the treatment is not lasting, the effect only lasts a few months and then it must be applied again. Therefore, if there is another solution, it is used instead of botox.
However, sometimes botox can be the best solution, for example, to treat some alterations caused by involuntary movements of the muscles. The most common is torticolía, which affects the muscles on one side of the neck, with the head inclined from one side to the other. Then comes that of the eyelids: one of the eyelids closes involuntarily and can remain so always, even with the two eyes closed.
It also serves to correct strabismus, paralyze vibrations, relieve migraine caused by muscle tension, and avoid problems of extreme secretion of glands such as excessive saliva production or moderate sweating.
Lately it is being tested in many other cases: in ulcers to reduce reflux, to avoid scars when closing the wounds, in morbid obesity... In addition, the toxin of the Clostridium botulinum variety B is being used in various treatments. It is clear that the button set is more than a rough one.
