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.     

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 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.     

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.     

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.     

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     

MANAGEMENT OF A PHAEOCHROMOCYTOMA IN A CHILD

The management of a case of phaeochromocytoma in a child usingalpha and beta receptor blocking drugs is described. This reportconfirms that estimations of plasma catecholamine concentrationsand direct measurement of arterial pressure are of considerablevalue. Methoxyflurane would appear to be a most suitable anaestheticfor patients with this condition.     

A modified knee disarticulation. A case report

A 36-year-old man with posttraumatic transarticular knee (TK) amputation illustrates the difficulties of prosthetic fitting. The excessively long and deformed stump was successfully overcome by an unusual surgical technique consisting of the shortening of the femoral bone by an osteotomy and plate fixation with preservation of the integrity of the condyles to correct the deformity. A short review of the literature concerning the advantages and limitations of TK amputations demonstrates some of the previously-reported surgical techniques.     

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.     

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.     

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 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 PAEDIATRIC VENTILATOR WITH A FLUIDIC CONTROL SYSTEM

A paediatric ventilator has been designed basically as a fluidic-logiccontrolled T-piece occluder. Inspiratory and expiratory time,inflation pressure limit, positive end-expiratory pressure (PEEP),continuous positive airway pressure (CPAP) and inspiratory flow-rateare controlled independently and intermittent mandatory ventilation(IMV) is available. Warning systems are provided for failureof the driving gas, low airway pressure and pressure inspiratorypressure limit. The breathing circuit is isolated from the controland warning systems for ease of sterilization.     

A CORRECTION

Mr. S. R. Wilson requests us to make the following correctionin his paper in the last number of the Journal, "Carbon Dioxidein Anæsthesia." On page 115, the percentage of CO was given as 6–8 percent., whereas it should be 4–6 per cent. In his article on Post-Anæsthetic Toxæmias (p. 130),he states that an adequate supply of ethylene is not obtainablein this country. He informs us that since writing the articleit has been supplied to him by the British Oxygen Co. (WembleyBranch), and he has found the same perfectly satisfactory.     

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 birthday

Conclusion The achievement over these ten years has been incredible and I wish to congratulate all those who have contributed to this success and, more particularly, all the Editorial Board. We can look at the future with confidence but our efforts must be sustained.In my opinion, the coat of arms of International Orthopaedics could well bear the motto: Pride and Optimism.

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Un anniversaireInternational Orthopaedics: Hier, Aujourd'hui et Demain

Conclusion Le chemin parcouru durant ces dix dernières années a été considérable et je tiens à féliciter tous ceux qui ont collaboré à cette réussite, en particulier tout l'Editorial Board. Nous pouvons regarder l'avenir avec confiance, mais les efforts consentis devront se maintenir.Pour moi, le blason de International Orthopaedics pourrait bien être: Fierté et Optimisme.