There is a very close relationship between what goes on in the mind and the state of the skin. There are a number of possible reasons for this, the first being the fact that in the embryo stage, the skin is formed from the same substance as the brain—the ectoderm. The skin and the brain are probably the most fascinating and complicated organs of the body. Like the brain, the skin is still to be fully explored and understood.

Secondly, the bond between the skin and the mind may well be related to the fact that there are more nerve pathways leading to the brain from the skin than from any other organ. These can relay messages to and from the brain faster than the speed of light, instantly recording pleasure, pain, touch, temperature or irritation. It is estimated that in just one square centimetre of skin you will find approximately 100 sweat glands, 10 hairs, one metre of blood vessels, four metres of nerve fibres, hundreds of nerve endings programmed to record pain, 25 pressure receptors sensitive to tactile stimuli, two sensory receptors to record cold, 12 sensory receptors to record heat, countless lymph vessels, and 15 sebaceous glands.

The skin also acts as an important erogenous zone. It is apparent how important in infants the effect of stroking, and caressing, is for satisfactory emotional development. Similarly, the skin has important sexual connotations, as well as being of great psychological importance to us with respect to our external appearance.

There is nothing at all that happens in our minds that does not affect our bodies, and the reverse is also true. The skin is paramount among all the body organs as an instrument of expression. Everyone knows that blushing signifies embarrassment, that anger provokes flushing, that fear is expressed in blanching, that sweating is a response to excessive emotional excitement. Presumably such reactions were, in ancient times, appropriate to some emergency, preparing our ancestors for some form of useful defence. In modem society these reactions have lost their functional aspect because of social disapproval of the expression of primitive instinctual drives; for us blushing, pallor and sweating are cutaneous signs by which the inhibited instincts are betrayed. The manifestation of emotions in the skin are brought about chiefly by neural discharges within the autonomic nervous system and changes in hormones from the endocrine system. There is a very dose association between both these systems and the skin.

Obviously, then, the mind will most definitely influence the type and timing of various skin disorders, and conversely, these disorders will affect the mind. Some doctors will deny that the psyche has any other than a superficial relationship to skin disorders, insisting upon organic causes in every case. Others may see the psyche lurking behind every pimple. It is a clinical fact that patients often react more strongly emotionally to skin diseases which are freely visible than to far more serious internal, and consequently hidden, disorders. The skin occupies a special place in the human psyche, being a kind of outermost representative of the ego. The slightest blemish may call forth deep hidden fears. A small patch of alopecia (hair loss) is not in itself a very serious symptom, but if the patient privately believes that it signifies loss of virility, his or her anxiety over the symptom may not seem so disproportionate. This then poses a special problem for the person making diagnoses. It is often quite difficult to know whether anxiety is causative or reactive, that is, whether the emotional distress caused the akin disease or the skin disease caused the anxiety. Often, of course, both factors are present in a viscious cycle. It may be true that skin diseases are not, on the whole, fatal, but it is also true that many of these disorders ruin life emotionally, even though they spare it physically.

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It is important to eat a high carbohydrate and low-fat diet The following practical tips which we have set out in an easy A to Z format will help you reduce the fat content of some of your favourite recipes at the same time as you are lowering their G.I. factor.

Alcohol. Although excessive alcohol consumption can be fattening, as an ingredient in a recipe, alcohol itself won’t create a high kilojoule dish. Alcohol evaporates during cooking, so you lose the kilojoules and are left with the flavour. A little wine in a sauce can give a delicious flavour, and sherry in an Asian style marinade is essential.

Bacon. Bacon is a valuable ingredient in many dishes because of the flavour it offers. You can make a little bacon go a long way by trimming off all fat and chopping it finely. Lean ham is often a more economical and leaner way to go. In casseroles and soups, a ham or bacon bone imparts a fine flavour without much fat.

Cheese. At around 30 per cent fat (23 per cent of this being saturated)) cheese can contribute quite a lot of fat to a recipe. Although there are a number of fat-reduced cheeses available, many of these lose a lot ricotta from a deli—you may rind the texture and flavour more acceptable than that of the ricotta available in tuba in the supermarket, flavoured cottage cheeses are ideal low-fat toppings for crackers. Try ricotta in lasagne instead of a creamy white sauce.

Cream and sour cream. Keep to very small amounts as these are high In saturated fat. A 300 ml container of cream can be poured into icecube trays and frozen providing small serves of cream easily when you need it Adding one ice-cube block (about 20 ml) of cream to 9 dish, adds only 7 grams of fat.

Dried beans, peas and lentils. These are all low in fat and very nutritious. Incorporating them in a recipe, perhaps as partial substitution of meat, will lower the fat content of the finished product Canned beans, chick peas and lentils are now widely available. They are very convenient to use and a great time saver. They are comparable in food value to the dried ones that you soak and cook yourself.

Eggs. Be conscious of eggs in a recipe as they can add fat. Sometimes just the beaten egg white can be substituted for the whole egg.

Filo pastry. Unlike most other pastry, filo is low in fat. To keep it that way brush between the sheets with skim milk instead of melted butter when you prepare it. Look for it in the freezer section of the supermarket with other prepared pastry and use it as a pie topping or a strudel map.

Grilling. Grill tender cuts of meat, chicken and fish rather than fry. Marinating first will add flavour, moisture and tenderness.

Health food shops. Health food shops can be traps for the unwary. Check out the high fat ingredients, such as hydrogenated vegetable oil, nuts, coconut and palm kernel oil in the products such as muesli bars, nut bars, health cakes and pies (even if made with wholemeal flour) that they stock on their shelves.

Ice cream. A source of carbohydrate, calcium, riboflavin, retinol and protein and low-fat varieties have the lower G.I. factor—definitely a nutritious and icy treat.

Jam. A dollop of jam on toast contains far fewer kilojoules than a smear of butter or margarine on toast. So, enjoy your jam and give fat the flick!

Keep jars of minced garlic, chilli or gingerin the refrigerator to spice up your cooking in an instant.

Lemon juice. Try a fresh squeeze with ground black pepper on vegetables rather than a dob of butter. Lemon Juice provides acidity that slows gastric emptying and lowers the G.I.

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Summary of main points.

• The treatment of obesity has had only limited success and attempts at prevention have been a total failure.

• The traditional models for understanding obesity using simple energy balance may be partially responsible for these poor success rates.

• Scientific thinking in this area has evolved from simple physics, to biological and physiological ways of explaining the obesity.

• A new Ideological paradigm is needed to incorporate the influences of biology, the environment and individual behaviour.

• The inclusion of physiological adjustment to changing energy stores in the model is also a key factor in understanding the dynamics of changing body fatness.

• The mediators through which the influences and moderators work are fat intake and fat utilisation in the body.

In spite of the huge personal expenditure on weight control, the burgeoning weight control industry, and the vast media attention given to the problem, it is obvious that all countries in the western world are losing the battle of the bulge. One possible reason for this is that the issue may have been inadequately conceptualized in scientific terms. The failure to even stabilise the growth rate of obesity at the population level has led some health experts to suggest a paradigm shift in thinking about weight control. It has been claimed that all science progresses through ‘paradigm shifts’ in thinking where a paradigm is defined as ‘. . . the collective set of attitudes, values, procedures, techniques etc., that form the generally accepted perspective of a particular discipline at a particular time’. In light of this, it is interesting to consider the evolution of thinking that has occurred in this area and to come up with a possible alternative, more all-encompassing approach on which better program planning—both prevention and treatment—can be based.

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Laser laparoscopy for endometriosis is surgery which attempts to remove and destroy endometrial implants, cysts and adhesions using a laser beam.

Lasers are fine, highly concentrated beams of light that can be precisely aimed and controlled. They have been used in some branches of medicine for many years. Opthamologists use lasers to treat a variety of eye diseases and dermatologists use them to remove skin cancers and other skin growths.

There are several different types of lasers used in laser laparoscopy and each one has its own particular characteristics and uses. The three types of lasers that are most commonly used in the treatment of endometriosis are the carbon dioxide laser, the argon laser and the Nd:YAG laser. The type of laser used by your gynaecologist will usually depend on which type is available.

Who is suitable for laser laparoscopy

Laser laparoscopy is most suitable for women with minimal to moderate endometriosis. It is not usually suitable for women with severe endometriosis.

Things to discuss before laser laparoscopy

At some stage before the operation you and your gynaecologist should discuss what procedures are proposed and what should be done if a laparotomy is needed.

What happens with laser laparoscopy

A laser laparoscopy involves the same basic routine as that which is used for a diagnostic laparoscopy except that a laser instrument is inserted through a channel in the laparoscope. The laser beam then travels through special fibres known as fibre-optics before being directed onto the relevant tissue in the pelvic cavity.

The laser beam can be used to remove or destroy superficial endometrial implants and endometriomas, and to remove adhesions. The implants, endometriomas and adhesions are removed or destroyed by directing and focussing the laser on to them and using the intense energy of the laser beam to ‘vaporise’ or break up their cells.

Effectiveness of laser laparoscopy

Laser laparoscopy has several advantages over other surgery. It involves less risk of accidentally damaging underlying organs because the gynaecologist is able to precisely control the depth and amount of tissue being destroyed. Similarly, because the laser destroys only the target tissue and leaves the surrounding tissue undamaged, there is likely to be less pain and discomfort and faster healing of the affected area. It is thought that the main advantage of laser laparoscopy is that it may produce less scarring and fewer adhesions than other types of surgery. In addition, because laser surgery usually involves a laparoscopy it has all the advantages associated with having laparoscopic surgery rather than a laparotomy.

The main disadvantage of laser laparoscopy as opposed to conventional laparoscopic surgery is that some women have taken significantly longer to recover from the operation because they were under the general anaesthetic for a greater period of time as laser laparoscopy takes longer to perform.

So far, there are few statistics on the effectiveness of laser laparoscopy. At present there is no evidence to suggest that laser laparoscopy is any more effective than other surgeries in terms of eradicating the disease or relieving the symptoms. Rather, in the hands of an experienced operator, the results of laser laparoscopy appear to be similar to those of other surgical treatments.

Risks and complications of laser laparoscopy

The risks and complications of laser laparoscopy are the same as those associated with a diagnostic laparoscopy.

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The menstrual cycle involves a series of hormonal events which occur at fairly regular intervals. The average menstrual cycle is approximately 28 days, although this may vary considerably between women. The menstrual cycle involves four distinct phases:

Day 1-5: menstruation (the menstrual period);

Day 3-13: the proliferative or follicular phase;

Day 14: ovulation;

Day 15-28: the luteal or secretory phase.

Although the first day of menstruation is usually referred to as the start of the menstrual cycle, the menstrual period (days 1-5) is actually the culmination of the hormonal changes which make up the menstrual cycle. Therefore, in our explanation of the menstrual cycle we will start by looking at the proliferative phase (days 3-13) and we will use a 28-day cycle to explain the process.

Proliferative or follicular phase-The proliferative phase extends from the time of menstruation to ovulation. It is known as the proliferative phase because it is the phase during which the endometrium begins to thicken or proliferate in readiness for implantation of the fertilised ovum. It is sometimes also known as the follicular phase.

During the proliferative phase the pituitary gland releases the follicle stimulating hormone (FSH) which stimulates the growth and development of several ovarian follicles in the ovary. These follicles enlarge and move towards die surface of the ovary. However, usually only one follicle continues to grow and undergo the full cycle of growth and development.

During the proliferative phase the oestrogen levels in the bloodstream rise progressively until just prior to ovulation. The rising oestrogen levels stimulate the endometrium to proliferate so that it is ready to nourish a fertilised ovum.

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