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The synthetic long or short is a risk reversal, but, technically speaking, an actual synthetic position is a risk reversal made up of the atthe-money options. Using the Exxon example one more time, if we were to sell the October 70 put for the price listed at 7.61 and buy the October 70 call option for 7.48 as shown in Figure 6.16, we would actually come out with a very slight credit of .13. Synthetics placed for a credit are not terribly common, but it does happen when the volatility is in ated on one side over the other. The purchased call option has a long delta of 57.5 percent, and the short put option has a long delta of 42.5 percent, giving us a combined delta of 1.00 equivalent to the underlying 100 shares of stock. The synthetic will trade the same as the underlying, so why pay two commissions The simple answer is leverage. The margin on the option position is typically 20 percent of the value of the underlying shares, while the underlying itself has a typical cash requirement of 100 percent or a margin of at least 50 percent. So in the case of the Exxon shares represented, 100 shares would have a cash requirement of $7,044 or a $3,522 margin. The synthetic long would have margin of $1,408 minus the small credit of $13 plus the costs of trading. All of that looks very attractive and in theory works exactly as does the underlying. The risk to the synthetic is that you have two

and neck to anchor skin in a more vertical position had a limited period of popularity Early results were promising,63 but enthusiasm has waned as the results have not been as predictable or as lasting as desired Barbed polypropylene suture threads marketed as Contour Threads received FDA approval for lifting ptotic skin of the face and neck Although not currently available, these were highly anticipated as new, novel method for performing an in of ce quick 20 to 30 minutes lifting procedure that required local anesthetic only Step-by-step technique The thread is introduced proximally in the lateral neck and anchored to the thick con uence of fascia and muscle bers of the sternocleidomastoid muscle The long needle is then weaved thorough dermal and subdermal skin exiting just proximal to the platsymal midline.

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This obscure and oddly named disease is included in this chapter because an abnormality of voltage-gated potassium channels has been discovered in some patients. It is characterized by continuous muscle ber activity referred to as neuromyotonia, hyperhydrosis, severe weight loss, insomnia, and hallucinations. Most cases so far described have ended fatally in a matter of months, but plasma exchange has reversed the syndrome in the case described by Ligouri and colleagues. Some cases have an associated thymoma. The condition is also included in the discussion of the other forms of continuous muscle ber activity in the following chapter. In addition to the various seizure disorders that are attributable to disorders of ion channels, also mentioned here for completeness are the Lambert-Eaton myasthenic syndrome that results from an autoimmune attack in calcium channels (it is discussed in the previous chapter), a rare paraneoplastic encephalitis that has been attributed to antibodies against potassium channels (Thieben et al), and spinocerebellar ataxia type 6, which is due to an inherited abnormality of the -1A voltage-dependent calcium channel (see Chap. 5).

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The skin is then massaged back over the thread engaging the barbs as the counter pressure is held on the distal end of suture The skin is xated in a vertically and laterally elevated position Topical antibiotic ointment is applied to the exit and entry ports, and the patient is discharged soon after with little to no downtime A mild bunching of the redundant skin can be noted on the lateral neck but usually attened out over the next few days If it does not completely resolve, the barbs can be released or disengaged from the skin by massaging the skin in the opposite direction to the barbs However, if too many of the barbs are disengaged, the neck skin would immediately drop back into the native position Complications to avoid Complications most commonly include infection and extrusion (Figure 616).

Physical Therapy and Rehabilitation In all but the most seriously ill patients, beginning within a few days of the stroke, the paralyzed limbs should ideally be carried through a full range of passive movement several times a day The purpose is to avoid contracture (and periarthritis), especially at the shoulder, elbow, hip, and ankle Soreness and aching in the paralyzed limbs should not be allowed to interfere with exercises Patients should be moved from bed to chair as soon as the stroke is completed and blood pressure is stable Prophylaxis for deep venous thrombosis is appropriate if the patient cannot be mobilized An assessment for swallowing dif culty should be made early during recovery and dietary adjustments made if there is a risk of aspiration.

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