Blue Serpent Clock Egg

Blue Serpent Clock Egg
The Blue Serpent Clock Egg is a Tsar Imperial Fabergé egg , one of a series of ... The crafting of this imperial egg is credited to Mikhail ...

Quidco (section Egg Cash Back Store)
The Egg Cash Back Store was launched in June 2010 by Egg Banking and ... last Bachelor | first Lisa | title Egg's cashback credit card tempts ...

Rockestra Theme
of musicians dubbed "Rockestra", although the song is technically credited to Wings . recorded as part of Wings' 1979 album Back to the Egg . ...

Kelly Connell
Broadway debut in "The Butter And Egg Man" at Manhattan Punch Line Theatre. Other New York theatrical credits include productions at ...

Brett Swain (actor)
Swain's film credits include Mick Molloy's films Crackerjack (as the marijuana growing greenkeeper) and Bad Eggs (as Security Officer ...

Jack Gage (director)
His small-screen credits include an adaptation of Jane Eyre for Studio One , the comedy series The Egg and I , the drama series Foreign ...

Sam Menning
His television credits included Yes, Dear , In Case of Emergency and portrayed a homeless man called Pickled Egg Guy in My Name Is Earl ...

Born in the Basement
It was recorded at Egg Studios in Seattle with producer Conrad Uno ... The album's artwork is credited to The Poison Pen, with a band photo ...

Two-sided market
Example markets include credit cards, composed of cardholders and ... They are particularly useful for analyzing the chicken-and-egg problem ...
11 KB (1,558 words) - 22:01, 12 March 2011
The Link Alive (section Easter Eggs)
and some short clips, The DVD also contains some hidden 'Easter Eggs'. ... It features identical track listings and credits to the DVD. ...

Tim Skelly
that he would get a credit on the title screen for designing the game. names into their games as easter eggs , but Reactor was the first ..

Easter eggs in Microsoft products

Easter eggs in Microsoft products
Some of Microsoft 's early products included hidden Easter eggs . ... Windows: Windows 98 has a credits screen easter egg. The pipe screensaver in ...

Fred Culpitt
Culpitt is credited with inventing the Doll's House Illusion , the Costume Trunk Illusion and the Silk To Egg Trick , which continue to be ...

EPC
Egg Phosphocholine Export packing credit , credit available to the exporters, for financing purchase, processing, manufacturing or packing ...

Easter egg (media)
A virtual Easter egg is an intentional hidden message , in-joke or feature in a ... other stimuli intended as a joke or to display program credits. ...

Mr Egg
Matthew Egbert Wand, better known as Mr Egg (born 7 January 1959 in Inverness , Scotland ) is a musician credited as being one of the ...

Egg credit

Egg Banking
Egg Banking plc is a British internet bank owned by Citigroup , with headquarters ... Egg specialises in savings , credit card s and general ...

Carlton Hibbert
Credited as drummer on "Egg Shaped Fred" and "Take It Easy Chicken" Singles. Reputedly kicked out after he threw a pineapple at guitarist ...
993 B (144 words) - 22:01, 13 September 2010
Office of Fair Trading (section Credit card charges)
It said it would be prepared to investigate any charge over £12 £16 for Egg credit card accounts indicating that £12 would not be a "fair ...

Jolanda Egger
Occasionally she was credited as Yolanda Egger. Egger was the first ever Playmate of the Year of Swiss origin for the German edition of ...

law lemon

Lemon laws are American state laws that provide a remedy for purchasers of cars in order to compensate for cars that repeatedly fail to meet standards of quality and performance. These vehicles are called lemons. The federal lemon law (the Magnuson-Moss Warranty Act) protects citizens of all states. State lemon laws vary by state and may not necessarily cover used or leased cars. The rights afforded to consumers by lemon laws may exceed the warranties expressed in purchase contracts. Lemon law is the common nickname for these laws, but each state has different names for the laws and acts.

Federal lemon laws cover anything mechanical. The federal lemon law also provides that the warranter may be obligated to pay the prevailing party's attorney in a successful lemon law suit, as do most state lemon laws.
Contents


1 Basis
2 Canada                                                                                                       Basis

At the core of most lemon laws is the manufacturer's breach of warranty. A manufacturer's warranty is what makes the manufacturer legally responsible for repairs to the consumer's vehicle or good. It is a form of guarantee. An express warranty is typically a written warranty. An implied warranty unlike an express warranty, is not written. The law imposes these obligations on the manufacturer, the seller or both as a matter of public policy. These vary from state to state. [1]

Lemon laws may cover situations even when the vehicle is not under warranty, especially if the seller failed to disclose critical information such as previous damage to the buyer. Knowingly purchasing a car in "as is" condition does not void the buyer's rights under applicable lemon laws.[citation needed] Lemon laws are not limited to cars. There are RV, boat, motorcycle, and wheelchair lemon laws.
Canada

The Canadian Motor Vehicle Arbitration Plan Canada - Canadian Motor Vehicle Arbitration Plan is the dispute resolution program for consumers in Canada that have problems with the assembly of their vehicle or with how the manufacturer implements its new vehicle warranty. CAMVAP covers new or used owned or leased vehicles that are from the current model year and up to an additional four model years old.

CAMVAP is an arbitration program. It is free to consumers. Hearings are held in the consumer's home community. The process normally takes less than 70 days from start to finish. Most consumers are able to handle their own case without the assistance of lawyers. The manufacturers do not use lawyers. Their representatives usually are serving or retired district parts and services representatives. An inspection of the vehicle normally is part of an arbitration hearing and the arbitrator can order a technical inspection of the vehicle at the program's expense if doing so is required.

CAMVAP arbitrators can order the manufacturer to buyback the vehicle; repair it at the manufacturer's expense; pay for repairs already completed; pay out of pocket expenses for items such as towing, diagnostic testing, rental cars and accommodation related to the problem with the vehicle. The arbitrator can also order that the manufacturer has no liability.

CAMVAP is available in every Canadian Province and Territory.
[edit] See also

The Market for Lemons — why only bad cars are sold as used cars, and how bad products can crowd good products out of the market.

Fictitious domain name

A fictitious domain name is a domain name used in a work of fiction or popular culture to refer to a domain that does not actually exist, often with invalid or unofficial top-level domains, such as ".web".

Domain names used in works of fiction have often been registered in the DNS, either by their creators or by cybersquatters attempting to profit from it.[citation needed] This phenomenon prompted NBC to purchase the domain name Hornymanatee.com after talk-show host Conan O'Brien spoke the name while ad-libbing on his show. O'Brien subsequently created a website based on the concept and used it as a running gag on the show.

Truth in Domain Names Act

In the United States, the Truth in Domain Names Act of 2003, in combination with the PROTECT Act of 2003, forbids the use of a misleading domain name with the intention of attracting Internet users into visiting Internet pornography sites.

The Truth in Domain Names Act follows the more general Anticybersquatting Consumer Protection Act passed in 1999 aimed at preventing typosquatting and deceptive use of names and trademarks in domain names

Abuse and regulation

Critics often claim abuse of administrative power over domain names. Particularly noteworthy was the VeriSign Site Finder system which redirected all unregistered .com and .net domains to a VeriSign webpage. For example, at a public meeting with VeriSign to air technical concerns about SiteFinder,[13] numerous people, active in the IETF and other technical bodies, explained how they were surprised by VeriSign's changing the fundamental behavior of a major component of Internet infrastructure, not having obtained the customary consensus. SiteFinder, at first, assumed every Internet query was for a website, and it monetized queries for incorrect domain names, taking the user to VeriSign's search site. Unfortunately, other applications, such as many implementations of email, treat a lack of response to a domain name query as an indication that the domain does not exist, and that the message can be treated as undeliverable. The original VeriSign implementation broke this assumption for mail, because it would always resolve an erroneous domain name to that of SiteFinder. While VeriSign later changed SiteFinder's behaviour with regard to email, there was still widespread protest about VeriSign's action being more in its financial interest than in the interest of the Internet infrastructure component for which VeriSign was the steward.

Despite widespread criticism, VeriSign only reluctantly removed it after the Internet Corporation for Assigned Names and Numbers (ICANN) threatened to revoke its contract to administer the root name servers. ICANN published the extensive set of letters exchanged, committee reports, and ICANN decisions.[14]

There is also significant disquiet regarding the United States' political influence over ICANN. This was a significant issue in the attempt to create a .xxx top-level domain and sparked greater interest in alternative DNS roots that would be beyond the control of any single country.[15]

Additionally, there are numerous accusations of domain name front running, whereby registrars, when given whois queries, automatically register the domain name for themselves. Network Solutions has been accused of this

Use in web site hosting

A domain name is a component of a Uniform Resource Locator (URL) used to access web sites, for example:

URL: http://www.example.net/index.html
Top-level domain name: .net
Second-level domain name: example.net
Host name: www.example.net

A domain name may point to multiple IP addresses to provide server redundancy for the services delivered. This is used for large, popular web sites. More commonly, however, one server at a given IP address may also host multiple web sites in different domains. Such address overloading enables virtual web hosting commonly used by large web hosting services to conserve IP address space. It is possible through a feature in the HTTP version 1.1 protocol, but not in HTTP 1.0, which requires that a request identifies the domain name being referenced

Domain name confusion

Intercapping is often used to emphasize the meaning of a domain name. However, DNS names are case-insensitive, and some names may be misinterpreted in certain uses of capitalization, creating slurls. For example: Who Represents, a database of artists and agents, chose whorepresents.com, which can be misread as whore presents. Similarly, a therapists' network is named therapistfinder.com. In such situations, the proper meaning may be clarified by use of hyphens in the domain name. For instance, Experts Exchange, a programmers' discussion site, for a long time used expertsexchange.com, but ultimately changed the name to experts-exchange.com.

Intellectual property entrepreneur Leo Stoller threatened to sue the owners of StealThisEmail.com on the basis that, when read as stealthisemail.com, it infringed on claimed (but invalid) trademark rights to the word "stealth".[12]

Resale of domain names

The business of resale of registered domain names is known as the domain aftermarket. Various factors influence the perceived value or market value of a domain name.

As of 2011, the most expensive domain name sales on record were:

Sex.com for $13 million in October 2010
FB.com for $8.5 million in November 2010
Business.com for $7.5 million in December 1999
AsSeenOnTv.com for $5.1 million in January 2000
Toys.com: Toys 'R' Us by auction for $5.1 million in 2009[11]
Altavista.com for $3.3 million in August 1998
Wine.com for $2.9 million in September 1999
CreditCards.com for $2.75 million in July 2004
Autos.com for $2.2 million in December 1999

Domain name registration

The right to use a domain name is delegated by domain name registrars which are accredited by the Internet Corporation for Assigned Names and Numbers (ICANN), the organization charged with overseeing the name and number systems of the Internet. In addition to ICANN, each top-level domain (TLD) is maintained and serviced technically by an administrative organization operating a registry. A registry is responsible for maintaining the database of names registered within the TLD it administers. The registry receives registration information from each domain name registrar authorized to assign names in the corresponding TLD and publishes the information using a special service, the whois protocol.

Registries and registrars usually charge an annual fee for the service of delegating a domain name to a user and providing a default set of name servers. Often this transaction is termed a sale or lease of the domain name, and the registrant may sometimes be called an "owner", but no such legal relationship is actually associated with the transaction, only the exclusive right to use the domain name. More correctly, authorized users are known as "registrants" or as "domain holders".

ICANN publishes the complete list of TLD registries and domain name registrars. Registrant information associated with domain names is maintained in an online database accessible with the WHOIS service. For most of the 250 country code top-level domains (ccTLDs), the domain registries maintain the WHOIS (Registrant, name servers, expiration dates, etc.) information.

Some domain name registries, often called network information centers (NIC), also function as registrars to end-users. The major generic top-level domain registries, such as for the COM, NET, ORG, INFO domains and others, use a registry-registrar model consisting of hundreds of domain name registrars (see lists at ICANN or VeriSign). In this method of management, the registry only manages the domain name database and the relationship with the registrars. The registrants (users of a domain name) are customers of the registrar, in some cases through additional layers of resellers.

In the process of registering a domain name and maintaining authority over the new name space created, registrars use several key pieces of information connected with a domain:

Administrative contact. A registrant usually designates an administrative contact to manage the domain name. The administrative contact usually has the highest level of control over a domain. Management functions delegated to the administrative contacts may include management of all business information, such as name of record, postal address, and contact information of the official registrant of the domain and the obligation to conform to the requirements of the domain registry in order to retain the right to use a domain name. Furthermore the administrative contact installs additional contact information for technical and billing functions.
Technical contact. The technical contact manages the name servers of a domain name. The functions of a technical contact include assuring conformance of the configurations of the domain name with the requirements of the domain registry, maintaining the domain zone records, and providing continuous functionality of the name servers (that leads to the accessibility of the domain name).
Billing contact. The party responsible for receiving billing invoices from the domain name registrar and paying applicable fees.
Name servers. Most registrars provide two or more name servers as part of the registration service. However, a registrant may specify its own authoritative name servers to host a domain's resource records. The registrar's policies govern the number of servers and the type of server information required. Some providers require a hostname and the corresponding IP address or just the hostname, which must be resolvable either in the new domain, or exist elsewhere. Based on traditional requirements (RFC 1034), typically a minimum of two servers is required.

Domain names are often seen in analogy to real estate in that (1) domain names are foundations on which a website (like a house or commercial building) can be built and (2) the highest "quality" domain names, like sought-after real estate, tend to carry significant value, usually due to their online brand-building potential, use in advertising, search engine optimization, and many other criteria.

A few companies have offered low-cost, below-cost or even cost-free domain registrations with a variety of models adopted to recoup the costs to the provider. These usually require that domains be hosted on their website within a framework or portal that includes advertising wrapped around the domain holder's content, revenue from which allows the provider to recoup the costs. Domain registrations were free of charge when the DNS was new. A domain holder can give away or sell infinite number of subdomains under their domain name. For example, the owner of example.org could provide subdomains such as foo.example.org and foo.bar.example.org to interested parties.

Because of the popularity of the Internet, many desirable domain names are already assigned and users must search for other acceptable names, using Web-based search features, or WHOIS and dig operating system tools. Many registrars have implemented Domain name suggestion tools which search domain name databases and suggest available alternative domain names related to keywords provided by the user.

Internationalized domain names and History

The character set allowed in the Domain Name System initially prevented the representation of names and words of many languages in their native scripts or alphabets. ICANN approved the Punycode-based Internationalized domain name (IDNA) system, which maps Unicode strings into the valid DNS character set. For example, københavn.eu is mapped to xn--kbenhavn-54a.eu. Some registries have adopted IDNA.

History

On 15 March 1985, the first commercial Internet domain name (.com) was registered under the name Symbolics.com by Symbolics Inc., a computer systems firm in Cambridge, Massachusetts.

By 1992 fewer than 15,000 dot.com domains were registered.

In December 2009 there were 192 million domain names.[9] A big fraction of them are in the .com TLD, which as of March 15, 2010 had 84 million domain names, including 11.9 million online business and e-commerce sites, 4.3 million entertainment sites, 3.1 million finance related sites, and 1.8 million sports sites.[10]

Second-level and lower level domains

Below the top-level domains in the domain name hierarchy are the second-level domain (SLD) names. These are the names directly to the left of .com, .net, and the other top-level domains. As an example, in the domain en.wikipedia.org, wikipedia is the second-level domain.

Next are third-level domains, which are written immediately to the left of a second-level domain. There can be fourth- and fifth-level domains, and so on, with virtually no limitation. An example of an operational domain name with four levels of domain labels is www.sos.state.oh.us. The www preceding the domains is the host name of the World-Wide Web server. Each label is separated by a full stop (dot). 'sos' is said to be a sub-domain of 'state.oh.us', and 'state' a sub-domain of 'oh.us', etc. In general, subdomains are domains subordinate to their parent domain. An example of very deep levels of subdomain ordering are the IPv6 reverse resolution DNS zones, e.g., 1.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.0.ip6.arpa, which is the reverse DNS resolution domain name for the IP address of a loopback interface, or the localhost name.

Second-level (or lower-level, depending on the established parent hierarchy) domain names are often created based on the name of a company (e.g., bbc.co.uk), product or service (e.g., gmail.com). Below these levels, the next domain name component has been used to designate a particular host server. Therefore, ftp.wikipedia.org might be an FTP server, www.wikipedia.org would be a World Wide Web server, and mail.wikipedia.org could be an email server, each intended to perform only the implied function. Modern technology allows multiple physical servers with either different (cf. load balancing) or even identical addresses (cf. anycast) to serve a single hostname or domain name, or multiple domain names to be served by a single computer. The latter is very popular in Web hosting service centers, where service providers host the websites of many organizations on just a few servers.

The hierarchical DNS labels or components of domain names are separated in a fully qualified name by the full stop (dot, .).

Top-level domains

The top-level domains (TLDs) are the highest level of domain names of the Internet. They form the DNS root zone of the hierarchical Domain Name System. Every domain name ends in a top-level or first-level domain label.

When the Domain Name System was created in the 1980s, the domain name space was divided into two main groups of domains.[3] The country code top-level domains (ccTLD) were primarily based on the two-character territory codes of ISO-3166 country abbreviations. In addition, a group of seven generic top-level domains (gTLD) was implemented which represented a set of categories of names and multi-organizations.[4] These were the domains GOV, EDU, COM, MIL, ORG, NET, and INT.

During the growth of the Internet, it became desirable to create additional generic top-level domains. As of October 2009, there are 21 generic top-level domains and 250 two-letter country-code top-level domains.[5] In addition, the ARPA domain serves technical purposes in the infrastructure of the Domain Name System.

During the 32nd International Public ICANN Meeting in Paris in 2008,[6] ICANN started a new process of TLD naming policy to take a "significant step forward on the introduction of new generic top-level domains." This program envisions the availability of many new or already proposed domains, as well a new application and implementation process.[7] Observers believed that the new rules could result in hundreds of new top-level domains to be registered.[8]

An annotated list of top-level domains in the root zone database is published at the IANA website at http://www.iana.org/domains/root/db/ and a Wikipedia list exists.

Domain name space and syntax

The domain name space consists of a tree of domain names. Each node in the tree holds information associated with the domain name. The tree sub-divides into zones beginning at the root zone.
 Domain name syntax

A domain name consists of one or more parts, technically called labels, that are conventionally concatenated, and delimited by dots, such as example.com.

The right-most label conveys the top-level domain; for example, the domain name www.example.com belongs to the top-level domain com.
The hierarchy of domains descends from the right to the left label in the name; each label to the left specifies a subdivision, or subdomain of the domain to the right. For example: the label example specifies a node example.com as a subdomain of the com domain, and www is a label to create www.example.com, a subdomain of example.com. This tree of labels may consist of 127 levels. Each label may contain 1 up to and including 63 octets. The empty label is reserved for the root node. The full domain name may not exceed a total length of 253 characters.[2] In practice, some domain registries may have shorter limits.
A hostname is a domain name that has at least one associated IP address. For example, the domain names www.example.com and example.com are also hostnames, whereas the com domain is not. However, other top-level domains, particularly country code top-level domains, may indeed have an IP address, and if so, they are also hostnames.
Hostnames impose restrictions on which characters may be used in the domain name. A valid hostname is also a valid domain name, but a valid domain name is not necessarily valid as a hostname.

what is Domain

A domain name is an identification label that defines a realm of administrative autonomy, authority, or control in the Internet. Domain names are also hostnames that identify Internet Protocol (IP) resources such as web sites. Domain names are formed by the rules and procedures of the Domain Name System (DNS).

Domain names are used in various networking contexts and application-specific naming and addressing purposes. They are organized in subordinate levels (subdomains) of the DNS root domain, which is nameless. The first-level set of domain names are the top-level domains (TLDs), including the generic top-level domains (gTLDs), such as the prominent domains com, net and org, and the country code top-level domains (ccTLDs). Below these top-level domains in the DNS hierarchy are the second-level and third-level domain names that are typically open for reservation by end-users that wish to connect local area networks to the Internet, run web sites, or create other publicly accessible Internet resources. The registration of these domain names is usually administered by domain name registrars who sell their services to the public.

Individual Internet host computers use domain names as host identifiers, or hostnames. Hostnames are the leaf labels in the domain name system usually without further subordinate domain name space. Hostnames appear as a component in Uniform Resource Locators (URLs) for Internet resources such as web sites (e.g., en.wikipedia.org).

Domain names are also used as simple identification labels to indicate ownership or control of a resource. Such examples are the realm identifiers used in the Session Initiation Protocol (SIP), the DomainKeys used to verify DNS domains in e-mail systems, and in many other Uniform Resource Identifiers (URIs).

An important purpose of domain names is to provide easily recognizable and memorizable names to numerically addressed Internet resources. This abstraction allows any resource (e.g., website) to be moved to a different physical location in the address topology of the network, globally or locally in an intranet. Such a move usually requires changing the IP address of a resource and the corresponding translation of this IP address to and from its domain name.

Domain names are often referred to simply as domains and domain name registrants are frequently referred to as domain owners, although domain name registration with a registrar does not confer any legal ownership of the domain name, only an exclusive right of use.

The Internet Corporation for Assigned Names and Numbers (ICANN) manages the top-level development and architecture of the Internet domain name space. It authorizes domain name registrars, through which domain names may be registered and reassigned. The use of domain names in commerce may subject strings in them to trademark law. In 2010, the number of active domains reached 196 million.[1]Contents
[hide]

1 Domain name space
1.1 Domain name syntax
1.2 Top-level domains
1.3 Second-level and lower level domains
1.4 Internationalized domain names
2 History
3 Domain name registration
4 Resale of domain names
5 Domain name confusion
6 Use in web site hosting
7 Abuse and regulation
7.1 Truth in Domain Names Act
8 Fictitious domain name
9 See also

laser treatments Side effects and risks

Some normal side effects may occur after laser hair removal treatments, including itching, redness, and swelling around the treatment area. These side effects should not last more than three days. Some level of pain should also be expected during treatments. Numbing creams are available at most clinics, usually for an additional cost. Icing the area after the treatment helps relieve the side effects faster

Unwanted side effects such as hypo- or hyper-pigmentation or, in extreme cases, burning of the skin call for an adjustment in laser settings. Risks include the chance of burning the skin or discoloration of the skin, hypopigmentation (white spots), flare of acne, swelling around the follicle, scab forming, purpura, and infection. These risks can be avoided when being treated with an appropriate laser type and at appropriate settings for the individual's skin type.

Some patients may show side effects from an allergy to either the hair removal gel used with certain laser types or to a numbing cream. A physician should be consulted if an allergic reaction presents itself after the treatment.

Number of sessions and Intervals between sessions

Number of sessions

Multiple treatments depending on the type of hair and skin color have been shown to provide long-term reduction of hair. Most patients need a minimum of seven treatments. Current parameters differ from device to device but most clinicians recommend waiting from three (or four) to eight weeks depending on the area being treated.

The number of sessions depends on various parameters, including the area of the body treated, skin color, coarseness of hair, reason for hirsutism, and sex. Coarse dark hair on light skin is easiest to treat. Hair on darker skin is harder to treat. Certain areas (notably men's faces) may require considerably more treatments to achieve desired results. In addition, since hair grows in several phases (anagen, telogen, catagen) and laser can only affect the currently active growing follicles (anagen), several sessions are needed to kill hair in all phases of growth.

Laser does not work well on light-colored, red hair, grey hair, white hair and fine and vellus hair ("peachfuzz") of any color.
Intervals between sessions

Usually treatments are spaced three (or four) to eight weeks apart depending on the body area and the hair cycle length for that area. For example, faces usually require more frequent treatments three to four weeks apart, whereas legs require less frequent treatments and patients should be advised to wait six or more weeks..

Typically the shedding of the treated hairs takes about two to three weeks. These hairs should be allowed to fall out on their own and should not be manipulated by the patient.

Other uses

Hair removal lasers are effective treatment for pseudofolliculitis barbae (commonly called ingrown hairs or "shaving bumps"). For darker skin patients with black hair, the long-pulsed Nd:YAG laser with a cooling tip can be safe and effective when used by an experienced practitioner.

They have recently been reported as helpful treatment for pilonidal cysts, since they eliminate the ingrown hairs that produce the troublesome foreign body reactions in this congenital malady.

Laser parameters that affect results

Several wavelengths of laser energy have been used for hair removal, from visible light to near-infrared radiation. These lasers are usually defined by the lasing medium used to create the wavelength (measured in nanometers (nm)):
Argon: 488 nm (DeepSkyBlue) or 514.5 nm (Cyan) (no longer used for hair removal)
Ruby laser: 694.3 nm (OrangeRed) (no longer used for hair removal; only safe for patients with very pale skin) [9]
Alexandrite: 755 nm (Red) (most effective on pale skin and not safe on darker skin at effective settings)
Pulsed diode array: 810 nm (Near-Infrared) (for pale to medium type skin)
Nd:YAG laser: 1064 nm (Near-Infrared) (made for treating darker skin types, though effective on all skin types)

Pulse width is an important consideration. Longer pulse widths may be safer for darker skin, but shorter pulse widths are more effective in disabling hair follicles.[citation needed] Repetition rate is believed to have a cumulative effect, based on the concept of thermal relaxation time.[citation needed] Shooting two or three pulses at the same target with a specific delay between pulses can cause a slight improvement in the heating of an area. This may increase the "kill rate" for each treatment.

Spot size, or the width of the laser beam, affects treatment. Theoretically, the width of the ideal beam is about four times as wide as the target is deep. Hair removal lasers have a spot size about the size of a fingertip (8-18mm). Larger spot sizes help laser light penetrate deeper and make treatments faster and more effective.

Fluence or energy level is another important consideration. Fluence is measured in joules per square centimeter (J/cm²). It's important to get treated at high enough settings to heat up the follicles enough to disable them from producing hair.

Epidermal cooling has been determined to allow higher fluences and reduce pain and side effects, especially in darker skin. Three types of cooling have been developed:

Contact cooling: through a window cooled by circulating water or other internal coolant
Cryogen spray: Sprayed directly onto the skin immediately before and/or after the laser pulse
Air cooling: forced cold air at -34 degrees C (Zimmer Cryo 5 unit

Photothermal effect

It is sometimes used during treatment of blood vessel lesion s, laser resurfacing , laser hair removal and laser surgery . External links ...

Hair care

Hair care is an overall term for parts of hygiene and cosmetology involving the ... Laser hair removal and electrolysis are also available ...

Laser medicine

Laser medicine is the use of various types of laser s in medical diagnosis , ... cosmetic applications such as laser hair removal and tattoo ...

Intense pulsed light

Cheaper and faster than laser hair removal , the IPL removal procedure has become very popular. of IPL compared to laser epilation is ...

Electrology

Electrology is the practice of electrical epilation to permanently remove human hair . ... in the 1990s after laser hair removal was developed ...

laser hair removal Mechanism of action

The primary principle behind laser hair removal is selective photothermolysis (SPTL).[4] Lasers can cause localized damage by selectively heating dark target matter, (melanin), in the area that causes hair growth, (the follicle), while not heating the rest of the skin. Light is absorbed by dark objects, so laser energy can be absorbed by dark material in the skin (but with much more speed and intensity). This dark target matter, or chromophore, can be naturally-occurring or artificially introduced.

Hair removal lasers selectively target melanin:

Melanin is considered the primary chromophore for all hair removal lasers currently on the market. Melanin occurs naturally in the skin (it gives skin and hair its color). There are two types of melanin in hair: eumelanin (which gives hair brown or black color) and pheomelanin (which gives hair blonde or red color). Because of the selective absorption of photons of laser light, only black or brown hair can be removed.
Laser works best with dark coarse hair. Light skin and dark hair are an ideal combination, but new lasers are now able to target dark black hair even in patients with dark skin.[5]

Hair removal lasers have been in use since 1997 and has been approved for "permanent hair reduction" in the United States by the Food and Drug Administration (FDA).[6] "Permanent" hair reduction is defined as the long-term, stable reduction in the number of hairs re-growing after a treatment regime. Indeed, many patients experience complete regrowth of hair on their treated areas in the years following their last treatment.

Laser hair removal has become extremely popular because of its speed and efficacy, although some of the efficacy is dependent upon the skill and experience of the laser operator, and the choice and availability of different laser technology at the clinic which is performing the procedure. Some will need touch-up treatments, especially on large areas, after the initial set of 3-8 treatments. It has also been noted that some people are "non-responders" –this occurs when the the incorrect device is being used, the device parameters are too low or the patient is simply not a good candidate for treatment.

Laser hair removal

Epilation by laser was performed experimentally for about 20 years before it became commercially available in the mid 1990s. Intense Pulsed Light (IPL) epilators, though technically not a laser, use xenon flash lamps that emit full spectrum light. Laser and light-based methods, sometimes called phototricholysis or photoepilation, are now most commonly referred to collectively as "laser hair removal". One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998.

The efficacy of laser hair removal is now generally accepted in the dermatology community, and laser hair removal is widely practiced. Many reviews of laser hair removal methods, safety, and efficacy have been published in the dermatology literature

lawyer Criticism

The aggressive representation of injured parties by personal injury lawyers has spawned movements to establish tort reform in the United States in recent years. Tort reform proponents argue that such reforms are necessary because personal injury litigation has led to a substantial increase in health care costs; they further claim that many doctors have had to leave practice or relocate because of cost-prohibitive medical malpractice insurance rates. A recent publication by the Harvard School of Public Health found that in only 60% of medical malpractice litigation cases was there evidence of medical error. [1]

Injury lawyer Professional regulations and associations

Personal injury lawyers are regulated by codes of conduct established by state bar associations, which have the power to take disciplinary action against lawyers who violate professional or ethical regulations. The American Bar Association (ABA) Joint Committee on Lawyer Regulation offers assistance to state bars, helping them to draft, implement, and/or promote regulatory policies regarding personal injury lawyers.

Personal injury lawyers may belong to any number of professional associations, some of which are mandatory and others voluntary. For instance, personal injury lawyers are licensed by their state bar associations, of which they must be members. Among the more common professional associations that personal injury lawyers may voluntarily join are the following:

American Bar Association – a professional association dedicated to improving the legal system and providing accreditation for law schools and continuing legal education programs (

Association of Personal Injury Lawyers – an association founded in 1990 by personal injury lawyers on behalf of accident victims

Association of Trial Lawyers of America – also known as ATLA, an association of trial lawyers that was founded in 1946 by a group of plaintiff’s attorneys committed to safeguarding victims’ rights. In 2007, ATLA changed its name to the American Association for Justice, also known as the AAJ.[3]

The Mission of the American Association for Justice is to promote a fair and effective justice system—and to support the work of attorneys in their efforts to ensure that any person who is injured by the misconduct or negligence of others can obtain justice in America's courtrooms, even when taking on the most powerful interests.

lawyer Compensation

Typically lawyers’ fees are based on a number of factors, which may include the time and energy spent on a case, the outcome of a case, the difficulty of a claim, the experience and prominence of the lawyer, and the costs associated with the case. There are several standard payment options a personal injury lawyer may offer his/her clients. These options include contingency fees, hourly rates, flat fees, and retainers.

A contingency fee is a prior arrangement between lawyer and client in which the lawyer receives a set percentage of the amount of recovery awarded to the plaintiff in a case. In most cases, monetary recovery is obtained through settlement, mediation, arbitration or trial. Generally, when a lawyer takes a case on a contingency fee, a client has no obligation to pay his/her lawyer a fee unless the case is successfully resolved. Most personal injury lawyers work on a contingency fee basis. An hourly rate is also a common payment option that involves an agreed amount of compensation for each hour the lawyer spends on the case until its resolution. In some cases, personal injury lawyers charge a flat fee, which is a set amount, or a retainer, which is an arrangement where a certain amount of money is paid before legal representation begins. These fee arrangements may also be combined.

lawyer Doing business

As with other types of lawyers, personal injury lawyers may choose to start a solo practice or join a small, mid-size, or large law film as an associate. Personal injury lawyers may also be partners (owners) of a law firm or strive to be a partner.
Sole practitioners of personal injury law offer a number of benefits to potential clients, which include more personal attention and a one-on-one working relationship between the lawyer and the client. Sole practitioners are also more willing to take on smaller cases and often have lower fees and costs.
A small law firm generally consists of two to ten lawyers who can provide more expertise in a given area of personal injury law and can handle a wider range of legal issues. Mid-size law firms with ten to 50 lawyers offer legal representation in almost every major area of litigation and may house several highly experienced and knowledgeable personal injury lawyers. Large law firms with more than 50 lawyers are often the most reputable, having built up the firm for a number of years and consisting of lawyers with high levels of expertise.

injury lawyer Career structure

The career structure of most lawyers varies widely. Once licensed, a lawyer may take on any kind of case whether or not they have much experience in it. However, legal ethics require an inexperienced lawyer to enlist appropriate help or take the time to learn the issues to competently represent the client. Most lawyers prefer to stick to one area of the law to gain the knowledge and experience necessary to provide the highest quality legal representation to their clients.

Personal injury lawyers choose to delve into a more specialized area involving only personal injury litigation. Personal injury litigation involves a large number of claims including accidents, medical malpractice, product liability, workplace injury, wrongful death, and more. Some personal injury lawyers choose to devote the majority of their time and energy to one area of litigation within personal injury law, thus becoming more experienced at handling very specific types of cases (e.g. medical mistakes, aviation accidents, work accidents).

personal injury lawyer Certification and education

In order to practice law in the United States, a personal injury lawyer must pass a written bar examination and, in some cases, a written ethics examination. Bar examinations vary on a state-to-state basis. However, most states require applicants to have completed a four-year college degree and a law degree from an accredited law school (California is one notable exception, but the non-accredited law school must meet certain requirements.)[1]

In most states, a personal injury lawyer is required to take the Multistate Bar Examination (MBE)[2], the Multistate Essay Examination (MEE), and the Multistate Professional Responsibility Examination (MPRE) and a state bar exam. Some states require another exam, the Multistate Performance Test (MPT), as well.

Once admitted to the state bar, personal injury lawyers must remain up-to-date on the latest legal and non-legal developments in their field of practice by completing a required number of continuing legal education (CLE) courses designed to help personal injury lawyers stay abreast of developments in their field. The number of CLE hours required varies by state.

Lawyers can concentrate their practices to certain areas of law, which is typically true of personal injury lawyers. By limiting the range of cases they handle, personal injury lawyers are able to acquire specialized knowledge and experience. However, to be certified as a specialist in personal injury, a lawyer must complete a specialty certification program accredited by the American Bar Association (ABA).

Certification programs have set standards of competence, knowledge and experience that lawyers must meet in order to be recognized in their area of practice as a specialist. Lawyers who have completed a specialty certification program in personal injury law at an accredited certifying organization are recognized as personal injury specialists. Some states, such as New Jersey, offer a certification as a "Certified Trial Attorney", which can be for both plaintiff and defense attorneys.

personal injury lawyer Responsibilities

A personal injury lawyer has numerous responsibilities in serving his or her clients. These responsibilities encompass both professional and ethical rules and codes of conduct set forth by state bar associations where the lawyers are licensed. Once licensed to practice law by their state bar association, lawyers are legally permitted to file legal complaints, argue cases in state court, draft legal documents, and offer legal advice to victims of personal injury.

Also referred to as a plaintiff lawyer, a personal injury lawyer is responsible for interviewing prospective clients and evaluating their cases to determine the legal matter, identify the distinct issues rooted within the plaintiff’s larger problem, and extensively research every issue to build a strong case. The ultimate professional responsibility of a personal injury lawyer is to help plaintiffs obtain the justice and compensation they deserve for their losses and suffering through advocacy, oral arguments, client counseling, and legal advice.

Personal injury lawyers must also adhere to strict standards of legal ethics when dealing with clients. While the guidelines vary according to state, the basic codes of conduct state that a lawyer must knowledgeably evaluate legal matters and exercise competence in any legal matter undertaken. Moreover, personal injury lawyers owe their clients a duty of loyalty and confidentiality and must work to protect their clients’ best interests.

Personal injury lawyer

A personal injury lawyer is a lawyer who provides legal representation to those who claim to have been injured, physically or psychologically, as a result of the negligence or wrongdoing of another person, company, government agency, or other entity. Thus, personal injury lawyers tend to be especially knowledgeable and have more experience with regard to the area of law known as tort law, which includes civil wrongs and economic or non-economic damages to a person’s property, reputation, or rights.

Even though personal injury lawyers are trained and licensed to practice virtually any field of law, they generally only handle cases that fall under tort law including, but not limited to: work injuries, automobile and other accidents, defective products, medical mistakes, slip and fall accidents, and more.

The expression "trial lawyers" can refer to personal injury lawyers,[citation needed] even though most cases handled by personal injury lawyers settle rather than going to trial and other types of lawyers, such as defendants' lawyers and criminal prosecutors, also appear in trials.

mesothelioma Multimodality Therapy

All of the standard approaches to treating solid tumors—radiation, chemotherapy, and surgery—have been investigated in patients with malignant pleural mesothelioma. Although surgery, by itself, is not very effective, surgery combined with adjuvant chemotherapy and radiation (trimodality therapy) has produced significant survival extension (3–14 years) among patients with favorable prognostic factors.[29] However, other large series of examining multimodality treatment have only demonstrated modest improvement in survival (median survival 14.5 months and only 29.6% surviving 2 years).[28] Reducing the bulk of the tumor with cytoreductive surgery is key to extending survival. Two surgeries have been developed: extrapleural pneumonectomy and pleurectomy/decortication. The indications for performing these operations are unique. The choice of operation depends on the size of the patient's tumor. This is an important consideration because tumor volume has been identified as a prognostic factor in mesothelioma.[34] Pleurectomy/decortication spares the underlying lung and is performed in patients with early stage disease when the intention is to remove all gross visible tumor (macroscopic complete resection), not simply palliation.[35] Extrapleural pneumonectomy is a more extensive operation that involves resection of the parietal and visceral pleurae, underlying lung, ipsilateral diaphragm, and ipsilateral pericardium. This operation is indicated for a subset of patients with more advanced tumors, who can tolerate a pneumonectomy

mesothelioma Heated Intraoperative Intraperitoneal Chemotherapy

A procedure known as heated intraoperative intraperitoneal chemotherapy was developed by Paul Sugarbaker at the Washington Cancer Institute.[32] The surgeon removes as much of the tumor as possible followed by the direct administration of a chemotherapy agent, heated to between 40 and 48°C, in the abdomen. The fluid is perfused for 60 to 120 minutes and then drained.

This technique permits the administration of high concentrations of selected drugs into the abdominal and pelvic surfaces. Heating the chemotherapy treatment increases the penetration of the drugs into tissues. Also, heating itself damages the malignant cells more than the normal cells.

This technique is also used in patients with malignant pleural mesothelioma

Mesothelioma Immunotherapy

Treatment regimens involving immunotherapy have yielded variable results. For example, intrapleural inoculation of Bacillus Calmette-Guérin (BCG) in an attempt to boost the immune response, was found to be of no benefit to the patient (while it may benefit patients with bladder cancer). Mesothelioma cells proved susceptible to in vitro lysis by LAK cells following activation by interleukin-2 (IL-2), but patients undergoing this particular therapy experienced major side effects. Indeed, this trial was suspended in view of the unacceptably high levels of IL-2 toxicity and the severity of side effects such as fever and cachexia. Nonetheless, other trials involving interferon alpha have proved more encouraging with 20% of patients experiencing a greater than 50% reduction in tumor mass combined with minimal side effects.
 Heated

mesothelioma Chemotherapy

Chemotherapy is the only treatment for mesothelioma that has been proven to improve survival in randomised and controlled trials. The landmark study published in 2003 by Vogelzang and colleagues compared cisplatin chemotherapy alone with a combination of cisplatin and pemetrexed (brand name Alimta) chemotherapy in patients who had not received chemotherapy for malignant pleural mesothelioma previously and were not candidates for more aggressive "curative" surgery.[30] This trial was the first to report a survival advantage from chemotherapy in malignant pleural mesothelioma, showing a statistically significant improvement in median survival from 10 months in the patients treated with cisplatin alone to 13.3 months in the group of patients treated with cisplatin in the combination with pemetrexed and who also received supplementation with folate and vitamin B12. Vitamin supplementation was given to most patients in the trial and pemetrexed related side effects were significantly less in patients receiving pemetrexed when they also received daily oral folate 500mcg and intramuscular vitamin B12 1000mcg every 9 weeks compared with patients receiving pemetrexed without vitamin supplementation. The objective response rate increased from 20% in the cisplatin group to 46% in the combination pemetrexed group. Some side effects such as nausea and vomiting, stomatitis, and diarrhoea were more common in the combination pemetrexed group but only affected a minority of patients and overall the combination of pemetrexed and cisplatin was well tolerated when patients received vitamin supplementation; both quality of life and lung function tests improved in the combination pemetrexed group. In February 2004, the United States Food and Drug Administration approved pemetrexed for treatment of malignant pleural mesothelioma. However, there are still unanswered questions about the optimal use of chemotherapy, including when to start treatment, and the optimal number of cycles to give.

Cisplatin in combination with raltitrexed has shown an improvement in survival similar to that reported for pemetrexed in combination with cisplatin, but raltitrexed is no longer commercially available for this indication. For patients unable to tolerate pemetrexed, cisplatin in combination with gemcitabine or vinorelbine is an alternative, or vinorelbine on its own, although a survival benefit has not been shown for these drugs. For patients in whom cisplatin cannot be used, carboplatin can be substituted but non-randomised data have shown lower response rates and high rates of haematological toxicity for carboplatin-based combinations, albeit with similar survival figures to patients receiving cisplatin.[31]

In January 2009, the United States FDA approved using conventional therapies such as surgery in combination with radiation and or chemotherapy on stage I or II Mesothelioma after research conducted by a nationwide study by Duke University concluded an almost 50 point increase in remission rates.

Mesothelioma radiation

For patients with localized disease, and who can tolerate a radical surgery, radiation is often given post-operatively as a consolidative treatment. The entire hemi-thorax is treated with radiation therapy, often given simultaneously with chemotherapy. This approach of using surgery followed by radiation with chemotherapy has been pioneered by the thoracic oncology team at Brigham & Women's Hospital in Boston.[29] Delivering radiation and chemotherapy after a radical surgery has led to extended life expectancy in selected patient populations with some patients surviving more than 5 years. As part of a curative approach to mesothelioma, radiotherapy is also commonly applied to the sites of chest drain insertion, in order to prevent growth of the tumor along the track in the chest wall.

Although mesothelioma is generally resistant to curative treatment with radiotherapy alone, palliative treatment regimens are sometimes used to relieve symptoms arising from tumor growth, such as obstruction of a major blood vessel. Radiation therapy when given alone with curative intent has never been shown to improve survival from mesothelioma. The necessary radiation dose to treat mesothelioma that has not been surgically removed would be very toxic.

Mesothelioma Surgery

Surgery, by itself, has proved disappointing. In one large series, the median survival with surgery (including extrapleural pneumonectomy) was only 11.7 months. However, research indicates varied success when used in combination with radiation and chemotherapy (Duke, 2008). (For more information on multimodality therapy with surgery, see below). A pleurectomy/decortication is the most common surgery, in which the lining of the chest is removed. Less common is an extrapleural pneumonectomy (EPP), in which the lung, lining of the inside of the chest, the hemi-diaphragm and the pericardium are removed.

mesothelioma Treatment

The prognosis for malignant mesothelioma remains disappointing, although there have been some modest improvements in prognosis from newer chemotherapies and multimodality treatments. Treatment of malignant mesothelioma at earlier stages has a better prognosis, but cures are exceedingly rare. Clinical behavior of the malignancy is affected by several factors including the continuous mesothelial surface of the pleural cavity which favors local metastasis via exfoliated cells, invasion to underlying tissue and other organs within the pleural cavity, and the extremely long latency period between asbestos exposure and development of the disease. The histological subtype and the patient's age and health status also help predict prognosis.

Mesothelioma Pathophysiology

The mesothelium consists of a single layer of flattened to cuboidal cells forming the epithelial lining of the serous cavities of the body including the peritoneal, pericardial and pleural cavities. Deposition of asbestos fibers in the parenchyma of the lung may result in the penetration of the visceral pleura from where the fiber can then be carried to the pleural surface, thus leading to the development of malignant mesothelial plaques. The processes leading to the development of peritoneal mesothelioma remain unresolved, although it has been proposed that asbestos fibers from the lung are transported to the abdomen and associated organs via the lymphatic system. Additionally, asbestos fibers may be deposited in the gut after ingestion of sputum contaminated with asbestos fibers.

Pleural contamination with asbestos or other mineral fibers has been shown to cause cancer. Long thin asbestos fibers (blue asbestos, amphibole fibers) are more potent carcinogens than "feathery fibers" (chrysotile or white asbestos fibers).[6] However, there is now evidence that smaller particles may be more dangerous than the larger fibers. They remain suspended in the air where they can be inhaled, and may penetrate more easily and deeper into the lungs. "We probably will find out a lot more about the health aspects of asbestos from [the World Trade Center attack], unfortunately," said Dr. Alan Fein, chief of pulmonary and critical-care medicine at North Shore-Long Island Jewish Health System. Dr. Fein has treated several patients for "World Trade Center syndrome" or respiratory ailments from brief exposures of only a day or two near the collapsed buildings.[27]

Mesothelioma development in rats has been demonstrated following intra-pleural inoculation of phosphorylated chrysotile fibers. It has been suggested that in humans, transport of fibers to the pleura is critical to the pathogenesis of mesothelioma. This is supported by the observed recruitment of significant numbers of macrophages and other cells of the immune system to localized lesions of accumulated asbestos fibers in the pleural and peritoneal cavities of rats. These lesions continued to attract and accumulate macrophages as the disease progressed, and cellular changes within the lesion culminated in a morphologically malignant tumor.

Experimental evidence suggests that asbestos acts as a complete carcinogen with the development of mesothelioma occurring in sequential stages of initiation and promotion. The molecular mechanisms underlying the malignant transformation of normal mesothelial cells by asbestos fibers remain unclear despite the demonstration of its oncogenic capabilities (see next-but-one paragraph). However, complete in vitro transformation of normal human mesothelial cells to malignant phenotype following exposure to asbestos fibers has not yet been achieved. In general, asbestos fibers are thought to act through direct physical interactions with the cells of the mesothelium in conjunction with indirect effects following interaction with inflammatory cells such as macrophages.

Analysis of the interactions between asbestos fibers and DNA has shown that phagocytosed fibers are able to make contact with chromosomes, often adhering to the chromatin fibers or becoming entangled within the chromosome. This contact between the asbestos fiber and the chromosomes or structural proteins of the spindle apparatus can induce complex abnormalities. The most common abnormality is monosomy of chromosome 22. Other frequent abnormalities include structural rearrangement of 1p, 3p, 9p and 6q chromosome arms.

Common gene abnormalities in mesothelioma cell lines include deletion of the tumor suppressor genes:

    * Neurofibromatosis type 2 at 22q12
    * P16INK4A
    * P14ARF

Asbestos has also been shown to mediate the entry of foreign DNA into target cells. Incorporation of this foreign DNA may lead to mutations and oncogenesis by several possible mechanisms:

    * Inactivation of tumor suppressor genes
    * Activation of oncogenes
    * Activation of proto-oncogenes due to incorporation of foreign DNA containing a promoter region
    * Activation of DNA repair enzymes, which may be prone to error
    * Activation of telomerase
    * Prevention of apoptosis

Asbestos fibers have been shown to alter the function and secretory properties of macrophages, ultimately creating conditions which favour the development of mesothelioma. Following asbestos phagocytosis, macrophages generate increased amounts of hydroxyl radicals, which are normal by-products of cellular anaerobic metabolism. However, these free radicals are also known clastogenic and membrane-active agents thought to promote asbestos carcinogenicity. These oxidants can participate in the oncogenic process by directly and indirectly interacting with DNA, modifying membrane-associated cellular events, including oncogene activation and perturbation of cellular antioxidant defences.

Asbestos also may possess immunosuppressive properties. For example, chrysotile fibres have been shown to depress the in vitro proliferation of phytohemagglutinin-stimulated peripheral blood lymphocytes, suppress natural killer cell lysis and significantly reduce lymphokine-activated killer cell viability and recovery. Furthermore, genetic alterations in asbestos-activated macrophages may result in the release of potent mesothelial cell mitogens such as platelet-derived growth factor (PDGF) and transforming growth factor-β (TGF-β) which in turn, may induce the chronic stimulation and proliferation of mesothelial cells after injury by asbestos fibres.

mesothelioma Screening

There is no universally agreed protocol for screening people who have been exposed to asbestos. Screening tests might diagnose mesothelioma earlier than conventional methods thus improving the survival prospects for patients. The serum osteopontin level might be useful in screening asbestos-exposed people for mesothelioma. The level of soluble mesothelin-related protein is elevated in the serum of about 75% of patients at diagnosis and it has been suggested that it may be useful for screening.[25] Doctors have begun testing the Mesomark assay which measures levels of soluble mesothelin-related proteins (SMRPs) released by diseased mesothelioma cells.[26]

Mesothelioma Diagnosis

Diagnosing mesothelioma is often difficult, because the symptoms are similar to those of a number of other conditions. Diagnosis begins with a review of the patient's medical history. A history of exposure to asbestos may increase clinical suspicion for mesothelioma. A physical examination is performed, followed by chest X-ray and often lung function tests. The X-ray may reveal pleural thickening commonly seen after asbestos exposure and increases suspicion of mesothelioma. A CT (or CAT) scan or an MRI is usually performed. If a large amount of fluid is present, abnormal cells may be detected by cytopathology if this fluid is aspirated with a syringe. For pleural fluid, this is done by thoracentesis or tube thoracostomy (chest tube); for ascites, with paracentesis or ascitic drain; and for pericardial[disambiguation needed] effusion with pericardiocentesis. While absence of malignant cells on cytology does not completely exclude mesothelioma, it makes it much more unlikely, especially if an alternative diagnosis can be made (e.g. tuberculosis, heart failure). Unfortunately, the diagnosis of malignant mesothelioma by cytology alone is difficult, even with expert pathologists.

Generally, a biopsy is needed to confirm a diagnosis of malignant mesothelioma. A doctor removes a sample of tissue for examination under a microscope by a pathologist. A biopsy may be done in different ways, depending on where the abnormal area is located. If the cancer is in the chest, the doctor may perform a thoracoscopy. In this procedure, the doctor makes a small cut through the chest wall and puts a thin, lighted tube called a thoracoscope into the chest between two ribs. Thoracoscopy allows the doctor to look inside the chest and obtain tissue samples. Alternatively, the chest surgeon might directly open the chest (thoracotomy). If the cancer is in the abdomen, the doctor may perform a laparoscopy. To obtain tissue for examination, the doctor makes a small incision in the abdomen and inserts a special instrument into the abdominal cavity. If these procedures do not yield enough tissue, more extensive diagnostic surgery may be necessary.

Immunohistochemical studies play an important role for the pathologist in differentiating malignant mesothelioma from neoplastic mimics. There are numerous tests and panels available. No single test is perfect for distinguishing mesothelioma from carcinoma or even benign versus malignant.
Typical immunohistochemistry results Positive Negative

positive

EMA (epithelial membrane antigen) in a membranous distribution

WT1 (Wilms' tumour 1)

Calretinin

Mesothelin-1

.
Cytokeratin 5/6.


HBME-1 (human mesothelial cell 1)

NEGATIVE

CEA (carcinoembryonic antigen)

B72.3

MOC-3 1

CD15

Ber-EP4

TTF-1 (thyroid transcription factor-1)

There are three histological types of malignant mesothelioma: (1) Epithelioid; (2) Sarcomatoid; and (3) Biphasic (Mixed). Epithelioid comprises about 50-60% of malignant mesothelioma cases and generally holds a better prognosis than the Sarcomatoid or Biphasic subtypes.[22]

Occupational of mesothelioma

Exposure to asbestos fibers has been recognized as an occupational health hazard since the early 20th century. Numerous epidemiological studies have associated occupational exposure to asbestos with the development of pleural plaques, diffuse pleural thickening, asbestosis, carcinoma of the lung and larynx, gastrointestinal tumors, and diffuse malignant mesothelioma of the pleura and peritoneum. Asbestos has been widely used in many industrial products, including cement, brake linings, gaskets, roof shingles, flooring products, textiles, and insulation.

Commercial asbestos mining at Wittenoom, Western Australia, occurred between 1945 and 1966. A cohort study of miners employed at the mine reported that while no deaths occurred within the first 10 years after crocidolite exposure, 85 deaths attributable to mesothelioma had occurred by 1985. By 1994, 539 reported deaths due to mesothelioma had been reported in Western Australia.

mesothelioma Environmental exposures

Incidence of mesothelioma had been found to be higher in populations living near naturally occurring asbestos. For example, in central Cappadocia, Turkey, mesothelioma was causing 50% of all deaths in three small villages — Tuzköy, Karain and Sarıhıdır. Initially, this was attributed to erionite, a zeolite mineral with similar properties to asbestos, however, recently, detailed epidemiological investigation showed that erionite causes mesothelioma mostly in families with a genetic predisposition.[18][19] The documented presence of asbestos fibers in water supplies and food products has fostered concerns about the possible impact of long-term and, as yet, unknown exposure of the general population to these fibers.

Cause of mesothelioma





Working with asbestos is the major risk factor for mesothelioma.[5] In the United States, asbestos is the major cause of malignant mesothelioma and has been considered "indisputably"[6] associated with the development of mesothelioma. Indeed, the relationship between asbestos and mesothelioma is so strong that many consider mesothelioma a “signal” or “sentinel” tumor.[7][8][9][10] A history of asbestos exposure exists in most cases. However, mesothelioma has been reported in some individuals without any known exposure to asbestos. In rare cases, mesothelioma has also been associated with irradiation, intrapleural thorium dioxide (Thorotrast), and inhalation of other fibrous silicates, such as erionite. Some studies suggest that simian virus 40 (SV40) may act as a cofactor in the development of mesothelioma.[11]

Asbestos was known in antiquity, but it was not mined and widely used commercially until the late 19th century. Its use greatly increased during World War II. Since the early 1940s, millions of American workers have been exposed to asbestos dust. Initially, the risks associated with asbestos exposure were not publicly known. However, an increased risk of developing mesothelioma was later found among shipyard workers, people who work in asbestos mines and mills, producers of asbestos products, workers in the heating and construction industries, and other tradespeople. Today, the official position of the U.S. Occupational Safety and Health Administration (OSHA) and the U.S. EPA is that protections and "permissible exposure limits" required by U.S. regulations, while adequate to prevent most asbestos-related non-malignant disease, they are not adequate to prevent or protect against asbestos-related cancers such as mesothelioma.[12] Likewise, the British Government's Health and Safety Executive (HSE) states formally that any threshold for mesothelioma must be at a very low level and it is widely agreed that if any such threshold does exist at all, then it cannot currently be quantified. For practical purposes, therefore, HSE assumes that no such "safe" threshold exists. Others have noted as well that there is no evidence of a threshold level below which there is no risk of mesothelioma.[13] There appears to be a linear, dose-response relationship, with increasing dose producing increasing disease.[14] Nevertheless, mesothelioma may be related to brief, low level or indirect exposures to asbestos.[6] The dose necessary for effect appears to be lower for asbestos-induced mesothelioma than for pulmonary asbestosis or lung cancer.[6] Again, there is no known safe level of exposure to asbestos as it relates to increased risk of mesothelioma.

The duration of exposure to asbestos causing mesothelioma can be short. For example, cases of mesothelioma have been documented with only 1–3 months of exposure.[15][16] People who work with asbestos wear personal protective equipment to lower their risk of exposure.

Latency, the time from first exposure to manifestation of disease, is prolonged in the case of mesothelioma. It is virtually never less than fifteen years and peaks at 30–40 years.[6] In a review of occupationally related mesothelioma cases, the median latency was 32 years.[17] Based upon the data from Peto et al, the risk of mesothelioma appears to increase to the third or fourth power from first exposure.[14]