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Ambivalence was particularly evident when some participants spoke about their feelings with regards to their relationship with their ill sisters. The group reaction to the mention of such confusion between sadness, care and frustration was one of consensus by means of non-verbal cues such as nodding and shared laughter. All participants spoke of other relationships in the family as having changed as a result of anorexia nervosa by either becoming closer in some cases, or more distant or difficult in others between different family members. No clear pattern of which dyads became closer or more distant was evident.
This study explored the experiences of brothers and sisters of adolescents with anorexia nervosa, with the aim of furthering understanding of their experiences, their understanding of the illness, and their experiences of service provision. The key findings from this study were that:
The syndrome of osteopetrosis associated with renal tubular acidosis and cerebral calcification, inherited as an autosomal recessive disorder, as seen in two sisters, is described. The primary defect in this rare syndrome is deficiency of carbonic anhydrase (CA) II. Significant reduction in blood levels of CA II were found in both parents and another sister, suggesting that these individuals are heterozygotic carriers.
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We presented 2 cases of PT of the breast involving in 2 sisters. On physical examination of the younger sister, a firm mass measuring approximately 3 cm in diameter was identified in upper inner quadrant of the right breast. Physical examination of the elder sister revealed a 3 cm lump in upper outer quadrant of the left breast.
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Star Swirl later arranges a royal summit at the finished castle with King Bullion and his daughter Princess Platinum of the Unicorn Kingdom. The respectful meeting is spoiled when Platinum begins insulting the sisters and calling them "blank flanks", proving herself to be resentful of their rule. Angered by her disrespect, Luna pulls a prank on Platinum with the help of Melvin, her Royal Canterlot Voice, and the castle's booby trapped throne, sending the unicorn princess flying outside. Luna quickly realizes she has gone too far and apologizes to Platinum, who also regrets her behavior, and the princesses agree to start over as friends. Platinum later helps design the castle tapestries and Equestrian flag, showing her acceptance of the sisters.
Later, the sisters spend time racing with Commander Hurricane in the sky when they are attacked by a griffon. Hurricane explains that the griffons once reached a truce with the Pegasi over airspace territory, which the griffons now believe has been violated by Equestria's formation. After Celestia fails to negotiate with the griffons' foul-tempered leader Gregor in an effort to avoid a fight, Luna is able to appease him with an offering of éclairs given in rhyme (inspired by the zebras) with her Royal Canterlot Voice, following advice from Melvin. Gregor explains that the departure of his last pastry chef had left him in a bad mood, and he agrees to sign a new treaty with Equestria.
Between these entries, Celestia and Luna write about their time spent with Star Swirl, who teaches Luna how to move stars when she becomes mesmerized by the night sky, particularly the moon. He also perfects his time travel spell and begins using it to travel to different points in Equestria's history. He is careful not to reveal anything about the future to the sisters, but Celestia is able to determine from his reactions that the sun, moon, and star markings on the Tree of Harmony are important.
Some time later, Celestia and Luna receive word that the Crystal Heart has been stolen from the Crystal Empire by a dragon, leaving the empire vulnerable. The sisters arrive at the empire to find the Crystal Ponies in a state of despair and their ruler, Princess Amore, depleted of her magic after trying to protect the empire with her own power. They learn that the dragon has taken the heart to his lair in the Crystalline Mountains where the heart was first found, considering everything from the mountain to be his hoard.
Accompanied by Melvin, Commander Hurricane's Pegasus army, and the griffons, the sisters travel to the dragon's lair to recover the heart. After their attempts to reason with the dragon fail, the dragon states that he actually thinks very little of the heart, but he still refuses to return it simply because it belongs to him, uncaring of the Crystal Ponies' plight. In a display of anger, Celestia bursts into flames and rebukes the dragon with her Royal Canterlot Voice. Terrified, the dragon drops the heart and flees back inside his cave. With the Crystal Heart restored, everyone celebrates in the empire's first Crystal Faire, confident the dragon will never menace the empire again.
When the sisters ask what they can do to help, Star Swirl tells them that, as Alicorns, they would not only be unharmed by raising and lowering the sun and moon, but their magic would also be rejuvenated. Acting on instinct, Luna successfully manages to lower the moon while Celestia raises the sun. Upon their completion, the sisters are overjoyed to discover they have earned their cutie marks, which Celestia notices are identical to the markings on the Tree of Harmony.
With their magic strengthened by the sun and moon, the sisters are able to restore Star Swirl and the other unicorns' magic. The sisters end their journal writing about their excitement for their upcoming adventures as princesses of Equestria.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
A 42-year-old female with no significant past medical history presented with worsening shortness of breath and chest pain. She has a significant family history of cardiac disease consisting of coronary artery disease (CAD) and valvular disease in her mother, CAD in her father, and two sisters both with congestive heart failure. She had been admitted 1 month prior for sharp, midsternal chest pain that radiated to the right arm, new onset dyspnea with minimal activity and ankle edema. At that time, a myocardial infarction had been ruled out as the electrocardiogram and troponin was normal three times. A Transthoracic echocardiogram (TTE) showed the aortic root to be 3.5 cm with a normal ejection fraction greater than 55%. A Computed tomography (CT) was performed which identified an aneurysmal dilatation of the mid ascending aorta measuring 5.1 cm with extensive calcifications seen along the LAD and right coronary artery concerning for extensive atherosclerosis. The follow-up visit 1 month later consisted of a TTE that identified a dilated aortic root at 4.1 cm and a CT Angiography that identified a 5.7 cm fusiform aneurysm of the ascending thoracic aorta with a suspected intramural hematoma (Fig. 1). Additionally, Left Heart Catherization identified the LAD to have a mid-saccular aneurysm which was immediately preceded by a severe 85% eccentric lesion and followed by a second 70% stenosis (Fig. 2). 2b1af7f3a8