一例社交焦虑认知行为咨询的案例概念化

目的:应用Boschen等所提出的模型制订一例社交焦虑认知行为咨询的案例概念化咨询方案。方法:首先按照案例概念化的流程和要求将个案的内容以模式图的形式呈现给来访者,然后根据每一部分的具体问题按照相对应的咨询方法进行干预。结果:综合评价结果显示,来访者的社交焦虑症状减轻,社交回避程度下降。结论:社交焦虑认知行为咨询的案例概念化有助于有社交焦虑问题的来访者对自身问题的理解,在心理咨询中具有实际应用价值。     

Castleman's disease of the retroperitoneum--a case report

A rare case of Castleman's disease of retroperitoneum is reported. The patient was an operated case of serous papillary carcinoma ovary. She was found to have an abdominal mass during follow-up. The mass was considered to be metastatic in origin and was resected. Histologically, it was diagnosed as a case of Castleman's disease.     

电视腹腔镜病历报告打印系统

电视腹腔镜病历打印系统能够提高医师的工作效率.本文中电视腹腔镜病历打印系统的设计过程包括病历报告的智能创建、预览以及打印功能.在Windows XP平台上,采用ACCESS数据库管理系统,利用Visual C ＋＋ 6.0基于MFC进行程序开发.结果显示出本文中设计的电视腹腔镜病历打印系统提供了丰富规范的典型病历打印界面,因为不需要医生直接输入文字进行病情描述,因此便于医生快捷编辑病历并生成报告,此病历打印系统还具有图文并茂的打印功能.     

Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.     

Gender acts as a context for interpreting diagnostic criteria

This study used a unique methodology to determine the aspects of case vignettes that elicited an effect of case gender on diagnosis. A total of 99 psychiatrists and psychologists were shown cases representing a man or a woman that contained varying numbers of histrionic and antisocial criteria. The cases were presented by computer a few sentences at a time. Clinicians were asked to offer a diagnosis for the case after each group of sentences was presented. Results indicated that case gender tended to affect clinicians' diagnostic decisions when criteria related to that diagnosis were shown, suggesting that case gender was acting as a context in which diagnostic criteria were interpreted.     

Restriction endonuclease digestion analysis of DNA from viruses isolated from different sites of two fatal cases of herpes simplex virus type-1 infection

Herpes simplex virus (HSV) type-1 was isolated from a fatal case of herpes simplex encephalitis (case 1) and from a fatal case of disseminated herpes simplex (case 2). The virus was isolated from the lip lesion, the frontal lobe and the temporal lobe of the brain in case 1 and from a mesenteric node, myocardium and salivary gland in case 2. Restriction endonuclease digestion analysis showed that each case was infected with different substrains of HSV. The changes in band pattern in isolates from case 1 occurred in the "variable" region of the genome, showing that viruses with such variations can be isolated simultaneously from different tissues. The changes in band patterns in isolates from case 2 indicated the presence of two virus substrains, one in the mesenteric node and salivary gland and a second in the myocardium.     

The patient perspective,experience and satisfaction of day case unicompartmental knee arthroplasty: A short-term mixed-methods study

BackgroundDay case unicompartmental knee arthroplasty (UKA) is increasingly being performed worldwide. When performed in the appropriate patient, day case UKA has been demonstrated to be safe, cost effective and improve resource allocation. Limited evidence highlights increased patient satisfaction of day case UKA when compared with inpatient UKA. A detailed study of the patient perspective, experience and satisfaction following day case UKA has not been described before.MethodsA retrospective case series review of 21 consecutive patients (19 unilateral, 2 bilateral) undergoing day case UKA in an elective orthopaedic centre was undertaken. A qualitative and quantitative patient assessment of the day case UKA experience was administered. A five-point Likert scale satisfaction questionnaire, Oxford Knee Score (OKS) and open-ended interview was undertaken. The qualitative responses underwent thematic analysis.ResultsOne hundred percent of patients expressed satisfaction (76.2% completely satisfied, 33.8% moderately satisfied) with day case UKA. The majority of patients (90.5%) reported that if they had to undergo UKA again they would prefer a day case over an inpatient procedure. Patients consider surgical outcome, physiotherapy provision, discharge planning, postoperative medications and follow up as key aspects of day case UKA care. One patient was re-admitted following discharge.ConclusionsThe present study demonstrates a high level of patient satisfaction with day case UKA. The results reported herein are subject to the study limitations of sample size, recall bias and inclusion criteria. We recommend that the themes identified by patients are addressed through a multidisciplinary approach with well-defined clinical pathways for a high-quality patient-centred experience.     

中国首例输入性裂谷热病例的流行病学调查

目的 描述中国首例输入性裂谷热病例的发病就诊过程、流行病学特征和疫情处理过程,以期对输入性裂谷热病例的管理有所启示.方法 对该患者开展现场流行病学调查.采集患者的血液和唾液标本,应用实时荧光PCR方法对患者标本开展黄热病和裂谷热病毒核酸检测.结果 患者男,45岁,2016年7月14日晚在安哥拉出现发热、头痛等症状,症状持续加重.7月21日22:30患者抵京.抵京后,患者到北京市一传染病专科医院住院治疗,当日经北京市疾病预防控制中心检测患者为裂谷热病毒核酸阳性.经治疗,患者病情好转.9月6日患者治愈出院.结论 该患者为我国首例输入性裂谷热病例.病例在安哥拉工作期间被蚊虫叮咬感染裂谷热.我国与疫情发生国存在持续的人员往来,应加强入境病例排查,做到病例早发现、早隔离,降低出现续发病例的可能性.     

Sclerosing stromal tumour of the ovary--a clinicopathologic spectrum

Majority of the Sclerosing stromal tumours of the ovary documented in the literature are single case reports. We report a series of 4 cases. Among the 4 cases encountered the mean age at presentation was 22.2 years. The clinical presentation varied from asymptomatic mass per abdomen (2 cases), menorrhagia (1 case) and amenorrhoea (1 case). The tumour was unilateral in all the cases with an average size of 10 cms. Grossly the appearances varied from a solid, partly cystic, edematous tumour (2 cases) to solid,firm tumour with yellow flecks (1 case) to unilocular cystic tumour (1 case). Microscopically, the tumour was characterized by cellular pseudolobules composed of a disorderly admixture of collagen-producing fibroblasts and lipid rich lutein cells with shrunken nuclei. In one case the lutein cells had a robust appearance with abundant cytoplasm and vesicular nuclei. The pseudolobules were very vascular and separated by hypocellular dense to oedematous fibrous tissue. Frozen section demonstrated fat in luteinized cells in 3 cases.     

Trichophyton violaceum infection occurring in a nursing home]

Six cases of Trichophyton (T.) violaceum infection seen in a nursing home are reported. A 66-year-old female (case 1) was found with tinea corporis on her face, chest and shoulder, associated with black dot ringworm. A KOH examination of hair showed endothrix parasitism. Reddish purple colonies were isolated from the patient on Sabouraud's dextrose agar, and intercalary and terminal chlamydospores were observed on slide culture. PCR-RFLP analysis of the microorganism showed a pattern of T. violaceum type. Therefore, the isolated fungus was identified as T. violaceum, a typical anthropophilic dermatophyte which had spread among residents and staffs easily. Using a mycological method, we examined 59 persons (21 residents and 38 staff members) who had had contact with case 1. The results were as follows. An 85-year-old female (case 2) and an 83-year-old female (case 3) were carriers of T. violaceum. A 23-year-old male (case 4) had tinea corporis on his right forearm due to T. violaceum. A 24-year-old male (case 5) probably had tinea corporis on his right forearm due to T. violaceum. One year after case 1's first visit to our clinic, we observed an 88-year-old female (case 6) of tinea capitis by T. violaceum. It seems that the organism was preserved in surroundings and members of the nursing home. The contagion in our cases could either have been caused by directly touching the person or by sharing their comb. PCR-RFLP analysis was performed within a short time, so that we managed effectively to select a way of treatment and to prevent the infection from spreading.     

Analysis of referral behaviour: responses to simulated case histories may not reflect real clinical behaviour.

In an attempt to develop a measure of the referral behaviour of general practitioners, 21 simulated case histories were constructed which presented between three and six stages at which a decision was required whether or not refer a 'patient' to hospital. Twenty general practitioners completed the case histories and their responses were compared with their referral rates to outpatient departments. No significant correlations were found between the doctors' responses to the vignettes and their actual referral rates, and the repeatability of the vignettes was disappointing. The fact that the case histories appeared realistic to the doctors who completed them was not reflected in objective measures of their validity. Simulated case histories should not be used as a method of measuring doctors' behaviour without establishing their validity and reliability.     

广东从化市首起甲型H1N1流感疫情的调查

目的探讨从化市首例甲型H1N1流感病例的发生过程,为制订防控措施提供依据。方法按照2009年卫生部《甲型H1N1流感流行病学调查和暴发疫情处理技术指南（试行）》的要求进行现场流行病学调查。结果病例潜伏期74h,体温37.5℃,无明显呼吸道症状;临床症状较轻;咽拭子样本检测,甲型H1N1流感病毒核酸阳性,确诊为甲型H1N1流感病例;未见续发二代病例。结论本事件为输入性二代病例引发本地感染甲型H1N1流感疫情,感染者在无防护的环境下,接触保留带有甲型H1N1流感病毒的被褥或尘埃后导致感染。     

Two examples of strains in the therapeutic alliance in an integrative cognitive therapy

Two case examples are presented to illustrate methods of recognizing and working with strains in the therapeutic alliance in an integrative cognitive therapy. I argue that developmental, personality, and therapy-readiness constructs are useful in understanding strains in the alliance and whether to confront such strains directly. Attachment theory was relevant to understanding the therapeutic alliance in the first case, when the client reacted to the possibility of termination in an insecure manner. Direct discussion of the alliance strain was useful in this case. The client in the second case was resistant to interpersonal influence. I did not address strains directly because the client would probably not have seen this work as relevant to his goals. In this case, a focus on strains could have weakened our alliance rather than strengthened it.     

Holoprosencephaly and trisomy 21 in a child born to a nondiabetic mother

This is the second reported case of a child with holoprosencephaly and trisomy 21. The first case was born to a diabetic woman; in our case, there was no evidence of diabetes in the mother. Most of the distinctive facial features of Down syndrome were obscured by the presence of cyclopia and a supraorbital proboscis in this infant. The relevance of chromosome analysis in cases with holoprosencephaly is discussed.     

Disseminated petriellidiosis (allescheriasis) in a patient with refractory acute lymphoblastic leukaemia

A case of disseminated petriellidiosis is presented. This complication occurred in a patient with refractory acute lymphoblastic leukaemia, who was receiving repeated courses of cytotoxic drugs, antibiotics and prolonged corticosteroid therapy. The diagnosis of infection by Petriellidium boydii was established by pathological and microbiological studies of a specimen obtained at open lung biopsy. The portal of entry was probably through the lung spreading later via the blood stream to the brain, thyroid and kidneys. The present case once again emphasises the importance of specific microbiological identification in definitive diagnosis. To our knowledge, only three cases of disseminated petriellidiosis have been reported and this case appears to be the first case with renal involvement.     

The expressed emotion of case managers of the seriously mentally ill: the influence of expressed emotion on clinical outcomes

BACKGROUND: Expressed emotion (EE) measured from relatives and informal carers has been consistently demonstrated to be associated with clinical outcome in schizophrenic patients. There have also been published studies that have investigated EE in professional carers that have suggested that the quality of the relationship between staff and patient may also be associated with patient outcomes. A large controlled trial of the effectiveness of different intensities of case management provided the opportunity to assess the association between the EE of case managers, including the quality of the relationship they had with patients under their care, and later clinical outcomes. METHOD: This was a prospective naturalistic study of EE present in a case manager patient dyad and subsequent patient outcomes. EE was assessed from the Five Minute Speech Sample (FMSS) at least 3 months after the case manager became responsible for the patient's care and a range of clinical outcomes were assessed 6 to 9 months later. Assessment of clinical outcomes was made independent and blind of the EE ratings. RESULTS: High EE ratings were significantly associated with individual case managers and not to symptom or illness factors. High EE was not associated with later clinical outcome, however, the positive relationship between case manager and patient was. The absence of a positive relationship was significantly associated with poorer outcomes. CONCLUSIONS: In spite of very low face-to-face contact between case managers and patients, compared with the amount of contact patients have with their informal carers and family, aspects of staff attitudes and behaviour did influence clinical outcome. There are potential implications of these results for staff training and clinical practice.     

Thematic Mapping Maps Much Territory But Needs Stronger Evidence‐based Coordinates: A Commentary

Thematic mapping (TM) is a transtheoretical, transdiagnostic, pattern‐focused method of case formulation. It involves systematically gathering a broad range relevant client information, collecting representative behavioral episodes, using inductive and deductive reasoning to identify themes and subthemes that characterize a client's dysfunctional patterns, and then developing a treatment plan to address them. The TM method includes debiasing steps to minimize clinician judgment errors and addresses a client's cultural context. TM was developed in response to several "case misconceptualizations" that the authors contend have created a crisis in the field of case conceptualization. This commentary critiques the case misconceptualizations and the TM method is evaluated. Acknowledging multiple innovations of TM, the commentary recommends a stronger evidence‐based focus, and discusses the benefits of theory‐guided case formulation, reasons to consider diagnosis in case formulation, and research as a means to resolve case misconceptualizations.     

Infiltrated cutaneous leishmaniasis and sporotrichosis caused by Leishmania major. First Senegalese case

We report in Senegal a case of infiltrated cutaneous leishmaniasis and sporothricoid due to Leishmania major MON-74. The diagnosis of our case was based on the cytologic, histologic and immunoparasitological examination. The patient was completely cured by 3 courses of 15 days of glucan-time. Our case completes the spectrum of the clinical presentation of tegumentary leishmaniasis.     

Clear cell odontogenic carcinoma of the maxilla

Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor associated with aggressive clinical behavior, metastasis and low survival. We report a case of CCOC affecting the maxilla of 62 year-old woman. It was first described as a clinicopathological entity in 1985 and to date only 67 cases were described in the English literature. We are understanding of the behavior of this carcinomas was depend on limited case reports. For these reason we found important to report this case of CCOC in the maxilla.