This way was offered to a single 28-year-old patient by a specialist. She wanted to eliminate the dark circles under her eyes. She said she looked like after making a night of it, even she has slept long enough. “And if I don´t sleep long enough, in the morning are my lids are swollen and I look like Derrick.“

She thought i tis enough to cut a little bit the lower eyelash, then to cut away a little bit of skin and then to saw it again. But it wasn´t so easy. She doesn´t have any wrinkles and it means she doesn´t have any abundant skin that could be cut away.

Her surgeon has prepared another way how to solve this problem:

Her skin is connected to a bone under the eyes by a bine. The bines may be smooth, but also strong and they fix skin to the bone. On the dividing line of the contour of bone and the hole after the eye a cut will be created. The cut creates the circles. To make these both surfaces equal it is enough to use a collagen or fat. But there is a risk, too. Skin is too thin in this place. If the fat is used – the biological material which may be changed by the time – there is a risk that an unequal relief may be created. The collagen and other materials are too expensive although the operation is short. The advantage of it is that, that you can inject some amount of collagen and if the patient is still not satisfied the process may be repeated. So i tis the operation without a scalpel.

A “sac“ under the eye may be created also by accumulated fat and a released muscle. The muscle is getting weaker year by year and the sacs are more marked. They make an impression as the hole was making bigger. It is an ilusion.

If there are wrinkles, too, it is necessary to make an combined operation. To shorten skin and to take out the fat. The cut is lead two millimetres under eyelash. By this cut you can make the way to the fat free and so it can be taken out. But this method is not used every time.

Before the operation it is necessary to estimate the given state individually. Has the patient many wrinkles? How weak is skin? Is there too much of skin?

In the case that skin is strong enough and “only“ full of wrinkles, there is another method: to use the laser, which makes skin smooth and make the collagen fibres stronger.

When the upper lid is slack, it creates the sad appearance of face and a human looks tired. Then skin, muscle and fat are taken out – in different combination and according to necessary extant.

It is provided by the local anaesthesia. The cuts are lead on the upper lids in a natural line. On the lower lid several milimetres under its border. The both ends several millimetres beyond the outer canthus. The abundant skin, muscle and fat are taken out according to necessary extant.

Stitches are removed on the fifth or sixth day after the operation.

A skin strap of a needed width is cut off closely above the red, the red is extended up on the place where the skin strap was cut off. Although the smoothest injection and stitches are used, the patient has to hope the scars will be invisible, or only less visible.

The marks of the intervention stay everytime, depends on individuality. Everyone has a visible white line etween the red and the lip which make the contrast. And after the intervention the contrast isn´t so visible anymore and a patient should know it.

A permanent make-up – the tattooed contour of lips by pigmented color – save the situation. It will last 3 – 5 years, according to the quality of skin. This is provided in tattoo saloons or in bigger comestic saloons. The price is 2 – 3 tousends crowns.

● itching

● dry skin

● warm

● woollen, nylon and acryl fibres

● viral infections

● staphylococcus skin infections ( Staphylococcus aureaus bacteria infection)

● food non-toleration

● food irritants (spice, spicy vegetable, tomatoes, citrus fruits)

● rash/urticaria

● weather and climate changes

● contact with original or further allergens (mites, pets)

● other irritating matters (soup, chlorine water in the pool)

● it can be worsen by the stress, although eczema does not belong to the psychogenic diseases

Special regime is necessary in case of infants and children. Nursing mother should exclude all irritating food components – eggs, milk, dairy products, and nuts. Unless the clinical state of the child is not improved within a month, the former eating habits can be returned. It is necessary to nurse the child as long as possible, at least for six months.

While starting with the artificial food the food ingredients should be added gradually one by one! The allergy causing food (chapter on the allergens) is added to the food as late as possible. If the child reacts to new food ingredient by clinical state worsening, its elimination is needed at once.

The child’s skin is creamed regularly – the appropriate unguent is recommended by your physician.

The child should have the nails cut due to the limitations of the skin damages caused by itching. As for the sleeping suit the soft long sleeved cotton pyjamas with trousers are recommended since they protect the patients from irritating and itching.

The child should have made the surroundings harmonic and peaceful without any stress factors. The good, profound sleep should be supported.

● the incidence and bites are common due to their spread extent considering the honey production and the plants fertilisation

● lives in bee hives, nests and tree hollows

● is generally not aggressive; it does not sting if it is not provoked

● always looses its sting

● appears more often at the beginning of the summer

African bee – cross breaded

● came to Brazil in 1956 for the sake of breeding improvements, but it gained aggressive features; it gradually spreads through the whole continent northwards

● is dangerous due to its extreme aggression, it attacks in hundreds

Bumblebee (Bombus terrestris)

● robust hairy insect with distinctive colours

● nests in the ground made out of wax and collected fibrous material

● nests look like grapes

● is usually not aggressive, it does not sing until being provoked

Wasp (Vespula vulgaris)

● almost without hairs with typical black and yellow stripes on the abdomen

● nests on the ground, or under wood

● makes the nests from chewed wood with more small holes layers situated one under another

● is attracted to food and sweet beverages – often flies around in garden restaurants and when people eat outside

● is very aggressive and attacks even without being provoked

● loose the sting only seldom

● usually appear in the late summer and autumn (vintage time)

The allergy reaction initiator determination is important for the therapy, but also for the prevention and avoidance of further episodes.

If you do not know the name of the insect, the identification can be helped by following facts:

● how did it look like? the colour, pattern

● where was it found? (trees, grass, ground)

● how did it behave? (was it provoked into biting; was it aggressive)

● did it leave the sting in the affected spot?

The professional diagnosis is made with the help of the skin tests with the toxin of the particular suspicious insect (commercially prepared). According to the severe reactions danger many various concentrations are gradually used.

If the skin tests are not persuasive, the laboratory examination, where all IgE type antibodies against the insect species toxins (as far as we are concerned it goes for bees and wasps) are determined, will be made.

● olfactory

● respiratory

The main respiratory (breathing) function of the nose and the nasal cavity is to provide the transport of the air to the lungs. In addition to that, other important functions include:

● processes of the inhaled air (warming-cooling, humectation)

● enables the resistance against the strong air

● filters the inhaled air

● provides the immunology barrier

In order to provide these “services” the nasal cavity is fit out with the complex structure. The nasal mucosa is able to make itself thinner and rougher hence it has an important influence on the air rate of flow resistance. The nasal resistance can alter from the slight to complex obstruction. The changes of the nasal mucosa thickness are influenced by the vascular system, too. The nasal mucosa contains a large amount of the mucous glands, which humidify the inhaled air. The nose noticeably prevents the lungs from the flow of the inhaled parts. It is able to remove the pollen grains of 15-30μm almost complex and enables the reduction the mites allergens of approximately 5μm up to 50%. The soluble chemicals can be removed from the inhaled air by being dissolved in the mucous.

The nose plays its role in the defensive line of the immune mechanisms, as well. By the collecting and the phagocytic process it liquidates a part of the microorganisms. The mucosa consists of lyzozymes; there is also immunoglobulin, especially the phlegmy IgA together with the phagocytes, there. On the other hand it is full of mastocytes, which play a negative role in allergic people lives.

What is a common cold (runny nose)?

The common cold (rhinitis) is defined as the nasal mucosa inflammation, which is characterised by one or more symptoms:

● nasal obstruction

● secretion

● sneezing

● nasal itch

While taking the symptoms into consideration, it can be difficult to distinguish the infectious cold from the allergic one. No diagnosis can be usually made only from the clinical count without anamnestic data and a special allergist examination. Similar problems can be brought about by polyps, anatomic mechanic factors, swellings and tumours and in the case of small children by foreign bodies (beans, bullets, peas).

The nasal cavities, which enable the air circulation, relate anatomically to the nose. When somebody suffers an allergy, they are usually affected by the allergic inflammation, as well. Sinusitis itself, as this disease is called, is usually a symptom of an allergy.

The typical symptoms, i.e. the itchy papules appear fast. They develop themselves even after several hours since the allergy reaction start (after allergen food consummation, after insect sting, medication administration, etc.). They can persist on the same place for hours, disappear later on, but usually, reappear elsewhere.

If the state of health lasts for a long time, the symptoms might not be caused by the IgE antibody mediated allergy. We should take into account even the immunocomplex reaction (III.type) or other diseases, as well.

The urticaria can reappear after a shorter or longer period of time. It can be also the episode, from which the patients do not have to suffer for years.

The acute urticaria lasts several hours; hence the total time of the particular episodes should not overrun 6 weeks.

The chronic urticaria takes more than 6 weeks. It can last for months or years. In this case, the atopic process should be excluded.

What causes the urticaria?

The most frequent allergy reaction causes, which lead to the urticaria, include:

● medications: usually antibiotics, although the reaction can occur after any medication

● food: including small amounts of chocolate, fish, nuts, eggs, etc.

● bee or wasp sticks

The significant part of the urticaria symptoms do not belong to the allergic reaction. The mediators – the one, who are released during the allergic reaction, can be released even in other ways (we talk about the pseudo-allergic reaction). The urticaria can appear even after the first contact with the person having the irritating factors.

The correction of nose is in the plastic surgery considered as the most technical method, because nose is a threedimensional organ in the middle of face. By the intervention it is necessary to “play“ with small bones and gristles, what is too difficult and hard work. The millimetres play an important role. Some phases of the intervention are provided by assessment, intuitive and following the experiences.

The correction of nose belongs among the most frequent operations made on men, too.

The dicreasing of nose is the intervention that is provided by the local or whole anaesthesia.

According to the necessity the chondral or bone part of nose are operated.

The cuts are lead inside of nose, rarely outside on skin. In that case is their size minimal and placed on the less visible place.

After the intervention tampons are placed inside of nose for two days. From the outside it is fixed by a strap and a splint for 1 – 2 weeks.

Edema and bruise disappear within the next 10 days. The less sensitivity of nose, the fixation of skin, tangible small roughness and other showings are normal changes in the time after the operation and they disappear continuosly.

The final result will be visible mostly 4 – 6 months later, sometimes much later.

The size and form of nose should not be evaluate isolated, but complexy in comparison to whole face. The goal of the operation should be the achievement of balance between the length of nose, forehead and chin by the side-view. The difference between the width of back and tip of nose should not be big. There are many of such small details on nose.

The operation of nose is provided by the local anaesthesia. At first a pill for relaxation is given to the patient, then wadding tampons are put inside his or her nose. The tampons are sodden in special solution, which make mucous numb and then the nose will be made numb by injections. The already mentioned “special solution“ is 10 % cocaine.

Even if the nose is numb, a patient may feel touching, pressure or pull, but he or she shoud not feel the sharp pain.

The most of doctors say it is better to provide this operation only under the local anaesthesia. Because if there is a whole anaesthesia, as a patient wake up, he or she wants to breath through nose. There are tampons in nose and suddenly they can´t breath. It is a shock and within the first several seconds a patient doesn´t know or doesn´t realise it is enough only to open mouth. And to avoid this unpleasant shock it is better to use the local anaesthesia.

But some surgeons say the second way is better.

Three days later the dripping wet ends and the only sign that there was an operation is the light red color in face of different intesity – it depends on the type of skin, how big place have been operated and how deep was the ray.

There comes the critical period of time. If the red color doesn´t disappear, face can´t be exposed to the day light – neither if it is cloudy. Solarium is strictly forbidden. There is a tendency among people to go out after the operation. But the UV rays are still dangerous, although the sun isn´t shining. Each patient has to use a sun bathing lotion with an UV filter with the factor 20 or more all day long. It isn´t necessary inside of a flat or a house.

The color of face is fading until it disappears completely so the difference between the parts that were operated and the rest of face is invisible. It may takes weeks or months. Individualy it may takes four to six months. Then is the patient already out of dangerous and the sun light rays aren´t so dangerous anymore. The sun light rays may cause the different chromatosis and the creation of color stains.

If the patient follows the instructions there won´t stay any signs on skin. If it takes too long time, it can become boring. The patient may forget some rules or he doesn´t want to do it. He will go out, although the sun isn´t shining in the evening, but the sun light rays may still be there and they can cause many problems.

The most effectiv and the most modern is the laser method. The operated place is healing as the burn on skin – by small edema, dripping wet, sometimes small scars – lasting several days while the vaseline is beeing used. Then there is the red color in face tha may lead several weeks or several months.

By using one type of the laser only some types of „mistakes of beauty“ may be improved. If the patient want some hair on body beeing elliminated, it is necessary to use another type of laser. The laser isn´t a substitution of a classic facelift. The both methods may be used simultaneously, but it can be substituted. By using laser, not only wrinkles can be smoothed, but also the scars after acne. The instructions of a doctor must be fullfiled exactly.

A young passionate girl who likes going skiing had scars on her face caused by acne since she was a teenager. In November she was operated and in March she had to come on control. As she came she had unequal stains. She put a lotion on her face because a doctor told it to her. And she didn´t take part in any exotic holiday. She went „only“ skiing. But she protected her face by shawl…but the sun rays went through the shawl also wenn the sun wasn´t shining.

Several minutes of exposition of UV rays is enough, and not staying the whole days on an uphill. It wasn´t so bad for her but it was necessary to have next time for recovery. The stains may disappear spontaneously. If not, face may be operated by laser one more time, but the result isn´t sure.

are used with the bacterial infections. These preparations are aimed at ceasing of the bacteria growth or their killing. Since there are so many types of the micro-organisms and their changing sensibility to the antibiotic treatment, new antibiotics are produced every year.

Nowadays there is a whole range of various antibiotics types, which vary from each other in their chemical structure. Some belong to the related groups, others are different. Within the related groups the cross-reactions often appear i.e. the patient replies to all antibiotics of a particular group with the allergy.

Since the antibiotic treatment is considered an often impact, the allergic patients have their drug allergens marked in their health documentation. In spite of that we should be aware of the particular allergy starting allergen and should inform about it our doctor every time we visit him.

It is possible that the doctor, who is standing in for our doctor, does not have our health documentation at his/her disposal or that we will fall ill during our vacation or business trip. One particular antibiotic can be named differently, which commonly happens especially while travelling abroad. Moreover the medication, which was prescribed recently and which name you do not know, can belong to the derived group of antibiotics with the cross reaction.