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.     

Botulinum neurotoxin A: A review

Despite its ubiquity in cosmetic circles and broad general awareness, a literature search of botulinum neurotoxin in JPRAS and BJPS yielded a mere 4 articles germane to cosmesis. A pair each detailing its application in masseteric hypertrophy(1,2) and the use of cryoanalgesia.(3,4) Given that botulinum neurotoxin A is the most commonly used cosmetic treatment, with American figures being most accurate,(5) a review of the background, development and scientific evidence would be perhaps useful, if not overdue, as Plastic Surgeons increasingly incorporate non-surgical interventions into their practices as part of a comprehensive facial rejuvenation strategy.     

CALCULI IN A MECKEL'S DIVERTICULUM: A CASE REPORT AND A REVIEW

A case is reported of multiple calculi occurring in a Meckel's diverticulum which caused chronic abdominal pain in a 48-year-old man. The problem was diagnosed before operation by radiological studies. The features of this condition are well illustrated in this patient. The published literature is reviewed.     

VAGINAL DELIVERY IN A PATIENT WITH A PHAEOCHROMOCYTOMA: A case report

In pregnancy complicated by phaeochromocytoma, successful managementhas usually entailed elective Caesarean section followed byremoval of the tumour. We report a successful vaginal delivery,undertaken under extradural blockade, in a patient with provenphaeochromocytoma     

A Morgagni-Larrey hernia. A case report]

The paper reports a case of Morgagni-Larrey hernia observed by the authors. The etiopathogenesis is described and the importance of surgery is underlined even in asymptomatic cases in order to ensure a benign postoperative outcome.     

A choledochal diverticulum. A case report]

Due to the rarity of choledochal cystic dilatation, the authors report a clinical case of common bile duct diverticulum. This diverticulum was histologically composed of gastric ectopic mucosa (pyloric type) and it clinically caused chronic abdominal pain (in a young woman). The authors analyse the literature of the above pathology.     

A non-secreting bladder paraganglioma. A case report

The authors report the case of a 43 year old patient hospitalized for hematuria extending over eight years. Cystoscopy revealed an endovesical lesion which was resected and diagnosed as a non-secreting vesical paraganglioma. At operation, the cervical localization of the lesion was treated by total cystoprostatectomy. Starting out from this case report, the authors discuss the difficulties of diagnosing non-secreting vesical paragangliomas, the difficulties of assessing their malignancy and therefore the difficulties of treating them.     

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 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.     

Immunoglobulin A1 protease: A new therapeutic candidate for immunoglobulin A nephropathy

Immunoglobulin A nephropathy (IgAN), characterized by predominant or exclusive deposition of IgA1 in glomerular mesangium, is the most common primary glomerulonephritis worldwide. At present, the treatment is always limited due to the incomplete understanding of the pathogenesis of IgAN. Mesangial deposited IgA1 is the common final pathway leading to glomerulonephritis and renal injury. IgA1 protease, a proteolytic enzyme with strict substrate specificity for human IgA1, may be an effective therapeutic candidate for IgAN by removing the mesangial deposited IgA1.     

MIGRATION OF A URETERIC CALCULUS TO THE BLADDER VIA A URETEROCOLIC AND A VESICOCOLIC FISTULA

Following a difficult nephrectomy for pyonephrosis, two large calculi in the left pelvic ureter were not removed. The upper of these two calculi finally found its way into the bladder after ulcerating into the sigmoid colon and thence into the bladder. The calculi and the residual ureter were removed and the fistulæ closed, with a successful outcome.     

A new multiple sclerosis epidemic? A pilot survey

There may be an increasing incidence of multiple sclerosis in South Africa. All newly-diagnosed white Afrikaans-speaking patients from the Pretoria area were examined over a 12-month period and 5 new cases were diagnosed. This is a highly significant rise over the expected 0,2/100 000/year (P less than 0,001).     

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.     

A floating knee treated conservatively: A case report

Ipsilateral fractures of the femur and tibia are usually considered a primary indication for internal fixation. A case of severely comminuted, open fracture of the distal femur and proximal tibia involving the knee which was managed conservatively is described here. This case is reported to make a plea for the trial of conservative management before opting for primary internal fixation of such complicated fractures. The conservative approach is strongly advocated when the essential requirements for internal fixation cannot be rigidly met.     

A METHOD OF CONTROLLED VENTILATION WITH A CIRCLE-ABSORBER BREATHING SYSTEM

A simple method of adapting a pressure-cycled ventilator ofthe flow generator type to ventilate patients on a circle-absorberanaesthetic system is described. Standard lengths of corrugatedblack rubber tubing are placed between the ventilator and thecircle-absorber as deadspace, replacing the reservoir bag. Theperformance of this modification was investigated and a functionalvolume for the tubing calculated. There was a simple relationshipbetween the tidal volume, the length of tubing and the freshgas flow required to avoid dilution of the anaesthetic gasesby the driving gases.     

A LONG CONTINENT ILEOVESICOSTOMY USING A SINGLE PIECE OF BOWEL

PURPOSE: In 1981 Mitrofanoff presented a procedure to create a continent urinary stoma for intermittent catheterization. Since then, several other methods have been introduced, including the Yang-Monti ileovesicostomy. The length of these ileovesicostomies is limited by the circumference of the bowel segment used, which is inadequate in some cases. We developed a procedure to double the length of the Yang-Monti ileovesicostomy using a single section of bowel. MATERIALS AND METHODS: A 3.5 cm. section of ileum is isolated on its mesentery. The bowel is divided into 2 segments for 80% of its circumference, leaving the bowel intact over the mesentery. Each ring of bowel is then divided adjacent to the mesentery but on opposite sides, allowing the bowel to be unfolded and reconfigured in a single long strip that may then be tubularized. The blood supply to the tube is excellent and it is in the center of the reconfigured ileum. The ends may be trimmed or widely spatulated as necessary. RESULTS: We have performed this procedure in 8 patients. The resulting ileovesicostomy created from a 3.5 cm. section ofileum is 10 to 14 cm. long and accepts a 12F catheter. A larger tube may be created from a longer piece of ileum. All patients are dry and they perform catheterization easily. CONCLUSIONS: This form of ileovesicostomy allows the creation of a long bowel tube that is easily catheterized. The longer length of the tube increases application of the continent stoma principle to more patients and enables reconstruction to be performed with optimal placement and without tension.     

A COMPUTER-CONTROLLED SYRINGE DRIVER FOR USE DURING ANAESTHESIA: A Modification of the Graseby MS16A

The requirements of a drug infusion device for use in theatreare discussed. A modification of the Graseby MS16A syringe pumpand an interface circuit permitting its remote control by micro-computerare described. The pump is controlled via a standard computerinterface (RS232) which makes it a unique and powerful researchtool. Aspects of safety are considered.     

A MODIFICATION OF DISSECTION TECHNIQUE FOR A SAFER LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has been associated with a rise in the rate of bile duct injury. A simple modification of a dissection technique that enables safer laparoscopic cholecystectomy is presented. This modification has resulted in a decreased risk of injury to the bile ducts and associated vasculature.     

A neodymium-YAG endolaser

We used a CW-YAG endolaser to photocoagulate the fundus of the rabbit and monkey. We varied the power settings, exposure durations, and probe-retina distances to establish the parameters for threshold and bursting (choroidal hemorrhage) lesions. We found that the amount of energy needed to create a retinal lesion increased proportionally with the distance between the probe and the retina. To produce a choroidal hemorrhage at a given distance required at least four times the power required for a threshold coagulative lesion at the same distance. We also found that we could achieve a strong choroidal reaction without hemorrhage by using the coagulative threshold parameters of power and distance with an increased exposure time. Photocoagulation of the retina using the CW-YAG depended on the presence of melanin.