A case of type A botulism

The neurotoxin produced by Clostridium botulinum, is responsible for botulism. The clinical signs are digestive disorders, pupillar alterations, and peripheral muscular weakness. The failure of thoracic muscles is responsible for the severity of botulism. We describe a case of a 74 year old woman who presented a severe form of botulism, requiring a prolonged intensive care unit stay.     

Identifying A psychological profile of Type A behaviour pattern

A conceptual model of Type A behaviour pattern (TABP) is presented which frames the pattern in terms of current cognitive-behavioural psychology and in the wider context of the psychosocial risk factors of CHD. Type A behaviours are considered as stemming from Type A appraisals, elicited in specific situations in individuals with enhanced emotional reactivity who hold a system of beliefs identifiable as Type A. A study was performed in order to assess the possible associations of personality dimensions such as extraversion and neuroticism to TABP and identify specific dysfunctional beliefs associated with TABP. The Bortner Rating Scale (BRS) was administered as a measure of TABP, together with the Maudsley Personality Inventory (MPI) for measuring extraversion and neuroticism and a shortened version of the Dysfunctional Attitude Scale (DAS), in a random subsample of a male white-collar population screened in the worksite for cardiovascular risk factors (N = 200). BRS scores showed a high direct correlation with DAS total scores (r = 0.64), a significant one with neuroticism (r = 0.29) and a weaker one with extraversion (r = 0.15). DAS was factor analysed and a solution found identifying eight factors. Two of them were correlated with TABP, namely ‘support-reliance’, directly correlated, and ‘self-confidence’, inversely. At a robust stepwise multiple regression analysis, using the above psychometric measures as independent variables and BRS scores as dependent variable, a model was found accounting for 35 per cent of variance of TABP distribution. The findings give partial support to the model proposed. The identified dysfunctional beliefs involved a higher sense of dependency of Type A individuals. A prospective study is under way to assess the possible predictive power of these cognitive factors. If confirmed, the model could partially account for inconsistencies of empirical findings in TABP studies.     

A case of acquired hemophilia A with massive hemothorax

Acquired hemophilia A (AHA) is an uncommon but potentially life-threatening hemorrhagic disorder caused by the development of an inhibitor against coagulation factor VIII (FVIII). AHA is very rare, affecting approximately 1 in 1 million individuals. However, the incidence may actually be higher, because diagnosis is difficult and the disease can be overlooked. We report a case of an 80-year-old man who presented with sudden onset of severe hemothorax. The patient was diagnosed with presumed AHA based on acute onset of bleeding symptoms and unexplained isolated prolonged activated partial thromboplastin time. Diagnosis was definitely established by demonstrating a decrease in FVIII activity, presence of FVIII inhibitor activity, and normal von Willebrand factor. The patient was successfully treated with recombinant activated coagulation factor VII and transcatheter artery embolization of the intercostal arteries.     

A surgical case of subdural hematoma with hemophilia A

A 54-year-old man presented with unconsciousness. Computed tomography revealed acute subdural hematoma. Emergency evacuation of hematoma was performed showing any excessive tendency to bleed or difficulty to stop bleeding during the operation. However transfusion of fresh frozen plasma was needed to stop continuous bleeding from the surgical wound after the operation. The patient underwent craniotomy again 18 days after the operation because he suffered hemorrhagic infarction and recurrence of acute subdural hematoma. After the second operation, a coagulability examination revealed that his activated partial thromboplastin test was prolonged (74.5 seconds) and his plasma factor VIII level was 20% of normal, so he was diagnosed as having mild hemophilia A. Cranioplasty was accomplished with replacement therapy, and he was discharged with mild recent memory disturbance and homonymous hemianopsia.     

A variant of mirror hand. A case report

We describe a rare variant of mirror hand in a 20-year-old man who presented with multiple fingers. Radiographs revealed two ulnae (one vestigial) and a radius. There was duplication of the humeral head. The unique features of this case are the age of patient before the start of treatment and extension of the duplication proximal to the elbow.     

A window,A Mirror

这是一个最好的时代,这是一个最坏的时代。在这个变幻莫测的时代,新鲜事物总是能够在瞬间爆发出让人意想不到的威力。任何事物都将面对新旧的对抗,面对艰难的选择。而媒体的变革、企业的营销环境无疑也将面     

A case of type A dissection involving right aortic arch

Aortic dissection involving right aortic arch (RAA) is quite rare. A patient with RAA and aberrant left subclavian artery (type 3 RAA) developed type A dissection, but successfully underwent ascending and hemiarch replacement under hypothermic circulatory arrest with continuous retrograde cerebral perfusion. We approached the lesion through a midline sternotomy and could reconstruct the first two arch vessels involved by the dissection. We would have added bilateral thoracotomy, if the distal arch vessels had required reconstruction. To our knowledge, this is the first report of successful surgical repair for type A dissection involving RAA.     

A Complete Dislocation of the Calcaneus: A Case Report

Isolated dislocation of calcaneus from cuboid and talus is extremely rare. This is a report of a 40-year-old man who sustained an open dislocation of calcaneus from cuboid and talus with subluxation of the talonavicular joint. Immediate reduction and stabilization with Kirschner wires and an external fixator was performed. At 2-year follow-up, there was no evidence of infection or avascular necrosis of tarsal bones. However, osteoarthrosis of the calcaneocuboid joint was evident. The functional result after 2 years was satisfactory. This case illustrates that the diagnosis of concomitant injuries in the adjacent column of the foot and compliance with principles of management of multiple injuries in the midfoot are paramount in reducing morbidity, which is common in such injuries.     

A Rare Manifestation of Herpes Zoster: A Case Report

Herpes zoster has an incidence of 350,000 cases per year in the United States. The involvement of the foot and ankle is rare. Most surgeons are not aware of this disease as a cause of extremity pain, its manifestation, and the treatment options. Post-herpetic neuralgia is a common sequela of herpes zoster and can be prevented with prompt treatment. In this article, we present a case of a 53-year-old female with right heel pain secondary to herpes zoster.     

去甲基酶JHDM2 A的功能研究概况

JHDM2A是一种组蛋白赖氨酸去甲基酶,可特异性催化甲基化H3K9脱甲基,发挥表观遗传学效应,在雄性生殖细胞和于细胞的分化方面有重要功能.