facial nerve and fallopian

Core Curriculum Syllabus: Facial Paralysis Core Curriculum Syllabus: Facial Paralysis Anatomy of the 7th Cranial Nerve Anatomy of the facial nerve and fallopian canal Intracranial nerve arises near pons and courses 12mm to porus acousticus. Meatal portion (10 mm) is anterior to the superior vestibular nerve and superior to the cochlear nerve. Intratemporal portion Labyrinthine segment (3-4 mm) passes through narrowest part of the fallopian canal. Common site of pathology: temporal bone fractures and Bell's palsy. Tympanic segment runs from geniculate ganglion to pyramidal turn (11 mm). Mastoid segment descends 13 mm to exit the stylomastoid foramen. Extracranial portion Nerve extends 15-20 mm from stylomastoid foramen to pes anserinus. Variable branching patterns. Clinical comment: The course of the facial nerve through the posterior fossa, temporal bone, and parotid gland renders this cranial nerve vulnerable to many neoplastic, traumatic, and infectious events. Disorders of the nerve provoke some interest in other medical specialties, but because of his background in head and neck anatomy and pathology and skill in temporal bone surgery, the otolaryngologist is most qualified to diagnose and manage paralysis of the facial nerve. Nevertheless, all clinicians should be able to recognize a peripheral paralysis and initiate proper evaluation. Anomalous Courses Most common anomaly: dehiscence of facial canal. Common sites: oval window and geniculate ganglion. Exposed nerve is more susceptible to injury during otologic surgery. Most course anomalies are within temporal bone: Prolapse of nerve against stapes Bifurcation around stapes Deviation across promontory Knuckle at the pyramidal (second) turn Duplication variants Anomalies are more common in malformations of the ear. II. Pathophysiology of the Facial Nerve Mixed Motor-Sensory Nerve Efferent fibers from the motor nucleus innervate muscles of facial expression, post-auricular, stylohyoid, posterior digastric, and stapedius muscles. Superior salivary nucleus projects efferent (parasympathetic preganglionic) fibers to sphenopalatine ganglion where postganglionic fibers then innervate lacrimal glands and mucinous glands of the nose. Another set of parasympathetic fibers synapse at the submandibular ganglion. Postganglionic fibers connect the submandibular and sublingual glands. Afferent fibers convey taste from anterior two-thirds of tongue to nucleus tractus solitarius via lingual nerve, chorda tympani, and nervus intermedius. Afferent fibers mediate sensation from posterior external auditory canal, concha, ear lobe, and deep parts of face. Projections unknown. Nerve Injury and Regeneration Sunderland classification of nerve injury: Neuropraxia: reversible conduction block (1° damage). Axonotmesis: loss of structural continuity of axon with intact endoneurial sheath (2° damage). Neurotmesis: 3°: loss of continuity of axons and endoneurial sheaths; 4°: loss of continuity of axons, sheaths, funiculus; 5°: complete loss of nerve continuity. Degeneration Interruption of the continuity of the axon separates the distal axon from its metabolic source, the neuron or cell body. Wallerian degeneration of the distal axon and myelin sheath begins within 24 hours. Macrophages phagocytose degraded myelin and axons. Regeneration Neuron metabolism leads to increases in mRNA, enzymes, and structural proteins. Axonal stumps swell with axoplasm and proliferation of neurofilaments. Conditions at the site of injury govern the fate and organization of the sprouts. Simple misdirection: the entry of one axon into a tubule destined for a muscle other than the one previously innervated. Clinical expression: synkinesis or associated movement . Complex misdirection: a single axon through branching innervates tubules to different muscles. Clinical expression: mass movement . Other sequelae of faulty regeneration: tics, spasms, contractures, weakness, and gustatory lacrimation. II. Differential Diagnosis of Peripheral Facial Paralysis Extracranial Traumatic Facial lacerations Blunt forces Penetrating wounds Mandible fractures Iatrogenic injuries Newborn paralysis Neoplastic Parotid tumors Tumors of the external canal and middle ear Facial nerve neurinomas Metastatic lesions Congenital absence of facial musculature Intratemporal Traumatic Fractures of petrous pyramid Penetrating injuries Iatrogenic injuries Neoplastic Glomus tumors Cholesteatoma Facial neurinomas Hemangiomas Meningiomas Acoustic neurinomas Squamous cell carcinomas Rhabdomyosarcoma Arachnoidal cysts Metastatic Infectious Herpes zoster oticus Acute otitis media Chronic otitis media Malignant otitis externa Idiopathic Bell's palsy Melkersson-Rosenthal syndrome Congenital: osteopetroses Intracranial Iatrogenic injury Neoplastic Congenital Mobius syndrome Absence of motor units IV. Evaluation of Facial Paralysis Examination The presence of a peripheral facial paralysis demands a complete head and neck examination with otoscopy and cranial nerve evaluation. Characteristics of a peripheral paralysis: At rest: less prominent wrinkles on forehead of affected side, eyebrow droop, flattened nasolabial fold, corner of mouth turned down. Unable to wrinkle forehead, raise eyebrow, wrinkle nasolabial fold, purse lips, show teeth, or completely close eye. Bell phenomenon: visible vertical rotation of globe on closing affected eye. Characteristics of a central facial paralysis: Because of uncrossed contributions from ipsilateral supranuclear areas, movements of the frontal and upper orbicularis oculi mm. tend to be spared. Facial movement may be present on affected side during emotional expression. Involvement of tongue. Presence of lacrimation and salivation. Electrodiagnostic Testing Expediency of management of acute paralysis may prevent conversion of minor injury into a more severe form with resulting sequelae. Nerve Excitability Test Technique: Using a stimulating electrode (square pulse of 0.3 msec duration) over the terminal ramifications of the facial nerve, one increases the current (milliamperes) until movement in the appropriate muscle group is just visible. Normal values (unaffected side of face) are compared to the side of paralysis. Interpretation: A difference of 3.5 mamp or more indicates an unfavorable prognosis. Electroneurography (Evoked Electromyography) Technique: Square wave impulses of 0.2 msec duration and 50-100 volt amplitude with a frequency of 1/sec are delivered with a bipolar electrode in front of the tragus while a second bipolar electrode captures the compound action potentials of underlying facial muscles in the nasolabial fold. Interpretation: The difference in amplitude of the potentials of the intact and involved side of the face correlate with the percentage of degenerated motor fibers (denervation). Advantage: Quantitative analysis of amount of degeneration. Disadvantage: Amplitudes are a 24-48 hour delayed representation of actual events occurring at site of lesion. Clinical applications: Facial nerves subjected to traumatic injuries of a magnitude requiring surgical repair undergo 90% degeneration within six days of injury. In cases of Bell's Palsy, a poor prognosis can be anticipated in patients reaching 95% or more degeneration within 14 days of onset of the palsy. Topographic Diagnosis - Topographic testing to determine the anatomical level of a peripheral lesion is possible because of the mixed function of the nerve and the branching pattern within the temporal bone. Larger, labelled illustration Tests of clinical value include: Petrosal nerve Schirmer test: quantitative evaluation of tear production Interpretation: When unilateral wetness is reduced by more than 30% of the total amount of both eyes after 5 minutes or when bilateral tearing is reduced to less than 25 mm after a 5-minute period, the Schirmer test is considered clinically significant and implies a lesion at or proximal to the geniculate ganglion. Stapedius nerve Impedance audiometry can record the presence or absence of stapedius muscle contraction to sound stimuli 70 to 100 dB above hearing threshold. Interpretation: Absence of the reflex is due to a lesion proximal to stapedius nerve (vertical segment of facial nerve). (Caution: The Schirmer's test can give false negative results.) Diagnostic Studies Audiometry Pure tone audiometry records cochlear nerve function. Stapedial reflex is part of topographic testing. Speech discrimination, tone decay, auditory evoked potentials are used to screen for retrocochlear lesions, e.g., tumors of the cerebellopontine angle. X-ray Computed tomography with and without contrast (radiopaque and air) is preferred for lesions of IAC, posterior fossa, and brain stem. High resolution scans needed for base of skull lesions. MRI is best for soft tissue assessment and tumors of the facial nerve. V. Management of Facial Paralysis Extracranial Etiologies Traumatic injuries: lacerations, gunshot wounds, iatrogenic. Most important areas to repair: main trunk, temporofacial and cervicofacial divisions. When immediate repair in contaminated or extensive wounds is not feasible, proximal and distal stumps should be tagged. The transected ends lose response to electrical stimulation within 72 hours. If not properly identified, these endings may become involved in scar tissue. Anastomosis or grafting in such cases may be impossible. Methods of repair: direct end-to-end anastomosis and interpositional grafting. Do not approximate ends under tension! Iatrogenic injury Complication of parotid surgery. Tumors are best managed by the experienced otolaryngologist-head and neck surgeon. Integrity of nerve should be ascertained prior to closure. Immediate repair indicated. Neoplasia A mass in the parotid associated with facial paralysis is a sign of malignancy. Two most common cell types: adenoid cystic and undifferentiated. Sacrifice of involved nerve and nerve adjacent to tumor indicated in high-grade malignancies: adenoid cystic, high-grade mucoepidermoid carcinoma, ex-pleomorphic adenoma, etc. Reconstruction: interpositional grafting and 7-12 cranial nerve crossover. Intratemporal Etiologies Temporal bone fractures Signs: bleeding from the external canal, hemotympanum, step-deformity of the osseous canal, conductive hearing loss (longitudinal fracture), sensorineural hearing loss (transverse fracture), CSF otorrhea, and facial nerve involvement (20% of longitudinal fractures and 50% of transverse fractures). In general, paralysis of immediate onset carries a poor prognosis and paralysis of delayed onset has a more favorable recovery. All paralysis should be followed with electrical testing, as exceptions to the maxim exist. Timely exploration and repair ensure better quality of return of function. Types of pathology: intraneural hematoma, impingement of bone and transection of nerve. Most common site of injury: adjacent to geniculate ganglion. Surgical approaches: Longitudinal fractures are explored through the middle fossa, and mastoid, if necessary. Facial nerve is examined via transmastoid, translabyrinthine approach in transverse fractures. Iatrogenic injury Incidence 0.6-3.7% Most common areas: pyramidal turn and the tympanic segment over the oval window. Neoplasia The primary tumor of the facial nerve per se is the facial neurinoma. Weakness of the face is the most common symptom. Treatment is surgical removal with grafting of the involved segment of nerve. Many benign and malignant masses may involve the facial nerve in its course through the temporal bone: glomus tumors, meningiomas, cholesteatomas, squamous cell carcinoma, rhabdomyosarcoma, etc. Surgical removal is necessary in most cases. Radiation therapy may be palliative depending on cell type, size, and location. If the nerve cannot be spared at the time of resection, interpositional grafting is warranted. Idiopathic facial palsy (Bell's Palsy) Bell's Palsy is the most common cause of facial paralysis (greater than 50% of cases of acute palsy). Unfortunately, this leads to over-diagnosis of the condition and a false sense of security. Every patient with a facial paralysis needs a complete evaluation. When the diagnosis of Bell's palsy is made (by exclusion), the patient must be followed 6 - 9 months or until recovery of facial movement. Failure of any return of function implies an etiology other than Bell's palsy. Re-evaluation is mandatory in such cases, as the most commonly overlooked diagnosis is one of neoplasia. Etiology is still unknown. Entrapment theory: an inflammatory response leads to compression and ischemia of the nerve in the narrowest part of the fallopian canal, the meatal foramen and labyrinthine segment. Electrical testing follows the degeneration of the motor fibers. Decompression of the nerve is indicated when 90-94% degeneration occurs within 2 weeks of onset. Steroids are indicated early in the course of the disease. The use of acyclovir is under investigation. Surgical decompression is accomplished via the middle fossa by an otologist-neurotologist. Transmastoid decompression is no more efficacious than steroid therapy. Infection Acute suppurative otitis media is caused by gram-positive cocci and Hemophilus influenza. Invasion into the facial canal through a dehiscence may evoke an inflammatory response with edema, compression, and ischemia resulting in facial weakness. Treatment includes myringotomy, appropriate antibiotics, and transmastoid decompression if degeneration progresses. Facial paralysis due to chronic otitis media requires tympanomastoidectomy for eradication of infection or cholesteatoma. Otalgia, facial weakness and a vesicular eruption on the concha or external canal (sensory distribution of 7th cranial nerve) characterize herpes zoster oticus (Ramsay-Hunt Syndrome). Site of pathology: labyrinthine segment of nerve. Acyclovir is treatment of choice. Malignant otitis externa is due to Pseudomonas invasion of soft tissue, cartilage, and bone. Treatment includes debridement of infected tissue, decompression of facial nerve when involved, and six weeks of semi-synthetic penicillin in combination with an aminoglycoside. Cipro may have a role in long-term therapy. Other Etiologies Congenital Mobius syndrome: hypoplasia of 6th and 7th cranial nerve nuclei. Birth trauma: due to forceps compression or compression of side of face against sacrum during labor. Osteopetroses: hereditary bone diseases. May result in bony obliteration of foramina with compression of cranial nerves. Decompression is indicated on rare occasion. Intracranial: Most common causes are neoplastic and iatrogenic . References Coker NJ and Fisch U: Disorders of the Facial Nerve. Otolaryngology , English GM (ed)Harper and Row, Hagarstown, 1984. Miehlke A: Surgery of the Facial Nerve , W.B. Saunders, Philadelphia, l973. Fisch U: Facial Nerve Surgery , Aesculapius, Birmingham, l977. Coker NJ: Facial Reanimation. Operative Challenges in Otolaryngology - Head and Neck Surgery , Pillsbury HC and Goldsmith MM (eds), pp. 688-694. Year Book Medical Publishers, Chicago, 1990. Coker NJ: Management of Traumatic Injuries to the Facial Nerve. Otolaryngol Clinics North Am , Weisman RA and Stanley Jr. RB (eds), 24:215-227. W.B. Saunders Co., Philadelphia, 1991. Coker NJ: Acute Facial Paralysis. Head and Neck Surgery - Otolaryngology , Bailey BJ (ed), 1992. Next | Core Curriculum Table of Contents | Department Home page BCM Public | BCM Intranet | Privacy Notices | Contact BCM | BCM Site Map | ©2001-2006 Baylor College of Medicine Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery Mail: One Baylor Plaza, NA102, Houston, TX 77030 Phone : 713-798-5906 E-mail: oto@bcm.edu Last modified: Jan. 23, 2006

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Bath & Spa products at MSN Shopping MSN Home My MSN Hotmail Shopping Money People & Chat Sign In Web search: Shopping Save this page Feedback Site map Help Home | Beauty | Books | Clothing | Computers | Deals | Electronics | Flowers | Home & Garden | Jewelry | Movies | Music | More ... Search Shopping Home > Beauty & Fragrance > Bath & Spa > $60 - $80 Bath & Spa Advertisement Featured Stores See all stores 323 items found Narrow your selection: Category Aromatherapy Shower Gels Bath Powders Bath & Spa Sets Bath & Body Oil Bath Soaks Spa Appliances Body Wash More... Brand Jo Malone Thierry Mugler Decleor HoMedics Yves Saint Laurent Fresh GiftBaskets.com Giorgio More... Seller eBay.com Strawberrynet PerfumeDistributor.com Sephora.com NORDSTROM.com Perfume Bay Neiman Marcus Saltworks More... Price range $60 - $65 $65 - $70 $70 - $75 $75 - $80 $ to $ See all options Show sale items only Show free shipping only Calculated in 0.078 seconds Previous Page 1 2 3 4 5 6 7 8 9 10 of 22 Next View: List Grid Text checked items Sort by Most popular Highest user rating Lowest price Highest price Name A-Z Name Z-A 250-ml Nutmeg Ginger Bath Oil by Jo Malone $60.00 Fragrance, to me, is a moment in time captured in a bottle.--Jo Malone.Jo Malone's fascination with fragrance started ... More early. As a child, she filled bottles with fragrance rose petals to create scents of her own. The Jo Malone phenomenon began years later, with just a few bottles of Nutmeg and Ginger Bath Oil made by hand and given as thank you presents to a handful of devoted skin care clients. Word spread wildly.The softly foaming Bath Oil is a luxurious way to fragrance and moisturise the skin--it's pure relaxation. The 250ml (8.5 ounce) Bath Oil comes in an easily portable plastic bottle. The 200ml (6.7 ounce) Deluxe Bath Oil comes in a stunning glass decanter. Both are presented in an elegant gift box and tied with Jo's signature black ribbon--perfect gifts for any occasion.Choose from the below fragrances, based on clean, natural ingredients--always with a twist of the unexpected. Learn more about Jo Malone fragrances. At Neiman Marcus | Details Rate it Bali Reef - Bath Salt - 40 lb. Bag (coarse) $71.60 Bali Reef Bath Salt - Traditional Bali sea salts are famous for the ancient methods used to produce the crystals. First ... More of all, the production is only possible during the dry months, as the warmth of the sun is the initial and final drying process. The sea water is placed in canal systems made of tree trunks for evaporation, which takes approximately one week. Then the solid salt crystals are hand carried to a drying platform, housed in a grass hut, fuelled by coconut husk fire. The sea salt crystals are then sun-dried again, and the final product is displayed on the beach for sale. For the people of Bali, the Sea is considered revered and sacred water. It is very significant to Balinese ceremonies and purification rituals. Many believe that the ocean water, under the full moon, is the most powerfully charged water. The sacred sea is believed to have the power to both purify and sanctify. Due to this traditional process, the texture of the salts will vary. The Bali salt crystals are a porous and light weight crystal making them ideal for absorbing essential oils. They dissolve quickly in water and have a pretty light grey color. The unique geometric shape of the crystals and the natural grey color make this a great salt to combine with dried herbs. No colorants are necessary to make a beautiful finished product. At 1 store | Details Rate it Ceara Atlantic Sea Salt - 55lb. Bag (extra large) $63.25 CEARA - Bath Salt Crystals are pure natural sea salt for making Bath Salt, Salt Scrubs, Aromatherapy Treatments, ... More Potpourri, Soap. This high mineral bath salt will increase the quality of any bath salt or spa recipe. CEARA Bath Salt Crystals are produced through the natural evaporation of sea water. Salt water is captured in shallow ponds and allowed to evaporate by means of the sun and wind. During the process, a salt bed forms on the bottom of the pond. The salt is harvested, washed, screened and packaged. The typical salt crystal crop takes from one to five years to produce. In high mineral salt production, the environmental conditions directly influence the salt quality through the quality of its main raw material - sea water. The sea water used to make CEARA Bath Salt Crystals is especially clean as it is collected from a mangrove area, an ecosystem that removes undesired elements from the water. This removal is accomplished through a filtration process carried by indigenous plants and shellfish. Characteristics: Natural White, Perfect for Scenting and Coloring, High Mineral Content, Dry, Uniform Crystal Size. Uses: Bath Salts, Salt Scrubs, Aromatherapy, Potpourri, Soap, Spas. Grades Available: Extra Small 0-1mm, Small 1-2mm, Medium 3-4mm, Large 4mm, Extra Large 8mm Packaging Available: 5lb, 25lb & 55lb. bags. At 1 store | Details Rate it ANGEL INNOCENT Perfume by Thierry Mugler 2.7oz GLITTERING BODY POWDER for Women by Thierry Mugler $61.99 YEAR INTRODUCED - 1998 In the spirit of his first fragrance Angel, Thierry Mugler created this enchanting, exciting ... More scent. This time, to keep that sweet, soft feeling that made Angel so popular, Praline was used as base note. A magical fragrance. FRAGRANCE NOTES - Bergamot, Tangerine, Red berries, Black current, White musks, Praline. At 1 store | Details Rate it Versus Perfume for Women by Gianni Versace Set(Eau De Toilette Spray 1.7 Oz+Body Lotion 1.0 Oz+Shower Gel 1.0 Oz) by Versace $74.99 Gianni Versace introduced Versus in 1991; its a sharp, oriental fragrance possessing feminine notes of rose, cedar ... More wood, amber, musk and plum. Its best for casual wear. At 1 store | Details Rate it BVLGARI Perfume by Bvlgari PERFUMED DUSTING POWDER 3.4 oz - Womens Perfume by Bvlgari $79.99 BVLGARI Perfume comes in PERFUMED DUSTING POWDER 3.4 oz. EXTRA 10% Off with coupon code: PG10. Launched by the design ... More house of Bvlgari in 1994, BVLGARI PERFUME is classified as a refined, flowery fragrance. This feminine scent possesses a blend of violet, orange blossom, and jasmine. It is recommended for evening wear. At 1 store | Details Rate it 250-ml French Lime Blossom Bath by Jo Malone $60.00 Fragrance, to me, is a moment in time captured in a bottle.--Jo Malone.Jo Malone's fascination with fragrance started ... More early. As a child, she filled bottles with fragrance rose petals to create scents of her own. The Jo Malone phenomenon began years later, with just a few bottles of Nutmeg and Ginger Bath Oil made by hand and given as thank you presents to a handful of devoted skin care clients. Word spread wildly.The softly foaming Bath Oil is a luxurious way to fragrance and moisturise the skin--it's pure relaxation. The 250ml (8.5 ounce) Bath Oil comes in an easily portable plastic bottle. The 200ml (6.7 ounce) Deluxe Bath Oil comes in a stunning glass decanter. Both are presented in an elegant gift box and tied with Jo's signature black ribbon--perfect gifts for any occasion.Choose from the below fragrances, based on clean, natural ingredients--always with a twist of the unexpected. Learn more about Jo Malone fragrances. 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This basket will include a body scrub, soothing ... More eye mask, body butter, mud mask, Hawaiian bath crystals, bath pillow, colorful sponge and a scented candle. $74.99 as shown. At Giftbaskets.com | Details Rate it checked items Sort by Most popular Highest user rating Lowest price Highest price Name A-Z Name Z-A Previous Page 1 2 3 4 5 6 7 8 9 10 of 22 Next View: List Grid Text What's this? Search Shopping Shopping help About this site FAQ Newsletter sign-up Trends & deals Home Baby Beauty Books Car & Garage Clothing Computer Deals Electronics Flowers Furnishings Garden Gifts Health Jewelry Kitchen Movies Music Office Pets Shoes Sports Toys Video Games ©2006 Microsoft Legal MSN Privacy Advertise Images credit: Getty Images Feedback

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BBC News | AFRICA | Senegal doctors demand skin cream ban low graphics version | feedback | help You are in: World: Africa Front Page World Africa Americas Asia-Pacific Europe Middle East South Asia ------------- From Our Own Correspondent ------------- Letter From America UK UK Politics Business Sci/Tech Health Education Entertainment Talking Point In Depth AudioVideo Sunday, 3 September, 2000, 14:49 GMT 15:49 UK Senegal doctors demand skin cream ban Most African women do not try to lighten their skin tone Skin specialists in Senegal have called for a ban on imports of skin-lightening creams because of health risks. Doctors say women are ignoring medical warnings of side effects, which include severe acne or patchy colouring. The creams, which contain corticoids and hydroquinone, for its antiseptic properties, are available in many African countries despite the known health risks. We have tried all sorts of ways of informing people Dr Mame Thierno Dieng Many women have permanent dark marks on their faces, the result of using creams from India and Pakistan which practically make the skin peel off in strips. Dr Souleymane Chehadi, a dermatologist in Dakar, says whitening creams are like using bleach - a high price to pay to try to look like "those top fair-skinned models" in women's magazines. But he says men must share some of the responsibility "because they prefer fair-skinned women." Dr Chehadi says nearly half his patients have problems linked to skin-whiteners. Women defiant Several women selected to play in the national basketball team in this month's Olympic Games in Sydney have been told to stop using the creams immediately because of other less visible effects. Corticoids are banned by the sporting authorities. "We have tried all sorts of ways of informing people, but we don't feel the authorities really appreciate the seriousness of the problem," says Dr Mame Thierno Dieng, from Dakar's Dantec Hospital. "Imports of skin-whitening products must be banned." He says the ban of imports in the neighbouring country of Gambia has "obtained results." Banned in South Africa But doctors in Banjul say the creams are still used in Gambia as they are popular with the wives of some political leaders. Skin-whitening creams were banned in South Africa in 1992 because of the health concerns, but they are still easily available. Most of the creams on sale in Johannesburg come from the UK, France and the United States. And in central Kinshasa in the Democratic Republic of Congo (DRC) shops stock a range of skin-lightening soaps, creams and lotions with names like ClearSkin, Venus and Cleartone. In Dakar, one tube of cream costs between about five cents and three dollars. Women who use the creams go through one to two tubes a day. Cheaper version of the cream are even more dangerous, say doctors. Called "xeesal" in Senegal, the creams come mainly from Nigeria, South Africa and Europe. Search BBC News Online Advanced search options BBC RADIO NEWS BBC ONE TV NEWS WORLD NEWS SUMMARY BBC NEWS 24 BULLETIN PROGRAMMES GUIDE See also: 18 Apr 00 | Africa The heavy cost of light skin Internet links: Africa News Online - Senegal Senegal Online The BBC is not responsible for the content of external internet sites Top Africa stories now: Huge challenge for African Union Kenya hit by malaria epidemic New hope for Aids vaccine Winnie Mandela faces fraud trial Ratsiraka moots Madagascar return Nigerian woman fights stoning Opposition attacks Ivory Coast poll African Union replaces dictators' club Links to more Africa stories are at the foot of the page. E-mail this story to a friend Links to more Africa stories In This Section Huge challenge for African Union Kenya hit by malaria epidemic New hope for Aids vaccine Winnie Mandela faces fraud trial Ratsiraka moots Madagascar return Nigerian woman fights stoning Opposition attacks Ivory Coast poll African Union replaces dictators' club Winnie: From 'mother' to 'mugger' Sierra Leone TRC to begin work Carlos Alberto new Zamalek coach Geremi apologises to Cameroon Selection change welcomed CAR accelerates anti-corruption drive Zambia pleads for more donations Workers redundant at Jensen plant Rebels face life without a cause CAR leader praises crash pilot Bombs shatter Algerian celebrations Oromo rebels deny Ethiopian 'victory' Madagascar's chance for change ^^ Back to top News Front Page | World | UK | UK Politics | Business | Sci/Tech | Health | Education | Entertainment | Talking Point | In Depth | AudioVideo ---------------------------------------------------------------------------------- To BBC Sport>> | To BBC Weather>> ---------------------------------------------------------------------------------- © MMIII | News Sources | Privacy