Coronary surgery: an update

In some hospitals all the coronary surgery that can be managed is confined to keeping up with emergencies and urgent cases. Increasingly surgical effort is extended to difficult cases for marginal benefit. Should the surgeon and cardiologist turn their backs on the seriously ill and treat more cost-effective cases?     

1起急性出血性结膜炎暴发疫情调查

[目的]掌握疫情有关情况,以便采取有效控制措施。[方法]2008年9月513,到榕江县古州镇发生急性出血性结膜炎暴发的现场进行调查。[结果32008年8月25日至9月27日,该镇合计发病773例,其中15所学校合计发病740例,学校罹患率为4．48％。773例病人,发病时间为8月25～31日的41例,9月1～5、6～10、11～15、16～20、21～25、26～27E1分别为151、201、159、167、47、7例;学生724例,占93．66％;发病10例以上的8所学校。病例对照研究结果,与病人共用毛巾、共用脸盆、照顾病人、有揉眼习惯是发病的危险因素,OR值分别为6．02、2．75、3．39、2．65。[结论]引起这起急性出血性结膜炎暴发的原因主要是疫情报告不及时,病人隔离措施未落实,学生的个人卫生习惯较差。     

Measles outbreak associated with an imported case in an infant--Alabama, 2002

Local transmission of measles is rare in the United States. Since 1997, the majority of measles outbreaks have been caused by imported cases. During October 19-November 15, 2002, an outbreak of 13 confirmed cases of measles occurred, with exposure in Alabama; 11 cases were among day care attendees who had not yet been vaccinated for measles. This was the largest outbreak of measles in the United States since 1999. In response to this outbreak, the Alabama Department of Public Health (ADPH) and CDC conducted an epidemiologic investigation that determined the outbreak was initiated by an imported case in an infant aged 9 months who had returned recently from the Philippines. Health-care providers should continue to include measles in differential diagnoses for febrile rash illnesses in infants, particularly those with recent travel to areas where measles is endemic.     

Commercial watercress as an emerging source of fascioliasis in Northern France in 2002: results from an outbreak investigation

In April 2002, five cases of fascioliasis were diagnosed in Tourcoing. A case-finding and a case-control study were carried out to identify the source of the outbreak and take appropriate control measures. Eighteen cases were identified through the medical laboratories carrying out serology for fascioliasis. Fourteen cases and 23 controls, identified by the physicians of the cases, were interviewed on symptoms of the disease and their consumption of uncooked plants. Cases were more likely than controls to have eaten commercialized raw watercress (OR 86.7, P < 0.001) and 13 (93%) of the cases reported its consumption. A single producer common to all cases was identified. The inspection of his watercress beds showed a lack of protection against Lymnaea truncatula. This outbreak of fascioliasis due to commercialized watercress indicates that actual sanitary regulations do not allow for the efficient prevention of infestation of watercress production in France.     

Foodborne botulism: an international outbreak

We report an outbreak of fishborne botulism caused by type E Clostridium botulinum. The eight cases, six in Israel and two in New York City, resulted from the consumption of ribbetz or kapchunka, a freshwater whitefish soaked in brine and air-dried, that was processed commercially in New York. Half the cases were males; the age range was 9 to 77 years. Five of the victims were hospitalized; the oldest died, and two others required ventilatory assistance. Laboratory confirmation of botulism was obtained in three cases. Prolonged lack of refrigeration during transatlantic flight and packaging contributing to an anaerobic environment were felt to be contributing environmental factors in the Israeli cases. Rapid communication and full cooperation between Israeli and US health authorities limited the extent of the outbreak. Despite adequate understanding of how foodborne botulism may be avoided, outbreaks still occur, particularly among people consuming certain high-risk or ethnic foods.     

The unilateral tubo-ovarian abscess with an IUD

2 cases of unilateral, tubo-ovarial abscesses are reported. One woman, 34 years old, had used a Dalkon shield for half a year, and the other, 40 years old, had used a copper-T device. Both abcesses were treated successfully. In the past 6 years, 7 of 10 cases of such abcesses were associated with IUD use, in 5 cases with the Dalkon shield.     

Tuberculosis in an indigenous young white south Wales population

Concerns about tuberculosis in young people in two linked deprived non-metropolitan communities triggered an investigation into local disease incidence and control measures. A pragmatic case-finding exercise, epidemiological enquiry and DNA genotyping were carried out to establish incidence and connections between cases over a five-year period. Of the 91 cases identified, 88 were from the white indigenous population. Approximately one third of cases were aged under thirty. Eight disease clusters were identified. Epidemiological investigation found spurious links between these, and DNA genotyping was necessary to clarify links. Seven cases and several contacts had been in prisons throughout the United Kingdom. Index cases under thirty generated more contacts, more contacts needing prophylaxis and more secondary cases than older patients. The workload resulting from tuberculosis control in younger cases was considerable. Tuberculosis remains an important problem in this population.     

某部队结核病聚集流行的现场调查与控制研究

目的探讨部队某部新兵连一起结核病聚集的流行因素,控制结核的进一步蔓延。方法对该部所有新兵及密切接触者进行流行病学调查、X线检查、结核菌素试验、X线检查异常者进行痰结核菌检查,查找结核菌,确诊结核病人,追踪传染源。结果 2008年2月-2009年2月1年内,640名新兵中共确诊活动性结核34例,罹患率5.31%。时间分布呈现两个小高峰,在春秋季。PPD检测人数扩大到新兵密切接触者,共833例,阳性共598例,结核感染率71.79%;强阳性48例,强阳性率5.76%。大大高于对照的未发病部队(P<0.01)。结论首发病例的误诊和未隔离是本次暴发的源头。应加强上下级卫生防疫部门的沟通,采取综合性的结核病防治措施,预防结核病的聚集流行。     

Meningococcal disease--probable transmission during an international flight

Two cases of meningococcal disease were identified in passengers who travelled on the same international flight. Both cases were serogroup B with the same allelic profile. The public health action involved chemoprophylaxis for persons seated adjacent to, and in the rows in front and behind, each case. The most likely scenario is that transmission of N. meningitidis occurred on board a long distance flight, either from one case to the other or from an asymptomatic carrier to both cases. This scenario and the absence of reports of similar cases in the literature, indicate the risk to other passengers in this setting is low. This investigation reinforces the need for, and the distribution of, good national and international surveillance information to better inform public health decision making.     

一起阑尾炎暴发的流行病学调查

采用病例对照设计比较患者和对照的既往病史和暴露史，以探讨一起阑尾炎暴发的原因。１９９７ 年４ 月１１ 日至１０月１ 日，武汉市某中学出现１３ 例阑尾炎患者，９ 例发生于５ 月１２ 日至６ 月１３ 日之间。学生罹患率为４１ ％ （１２／２９０） ，９ 个班中５ 个班有学生发病，分别为１ 、２ 、２ 、３ 、４ 例，呈聚集趋势。患者中学习紧张和吃冷饮 的比例多于对照，病检显示病毒性阑尾炎特征。综上，本次暴发似由传染因子所致，学习紧张和吃冷饮似为辅助因素。     

Nosocomial pneumococcal infection: an outbreak

When an outbreak of pneumococcal disease occurs an institution--be it a hospital, nursing home, day care center, or other facility--management includes treatment of affected cases and prevention of new cases. Patients and staff should be tested for nasopharyngeal carriage and their vaccination status ascertained. Antibiotic use should be reviewed, especially if the causative strain is resistant.     

Investigation and management of loss of efficacy of an antiepileptic medication using carbamazepine as an example.

Cases reported as loss of efficacy (secondary failure) of carbamazepine (CBZ) for epilepsy were analysed to determine the cause. In these cases, seizures previously controlled with CBZ, recurred or increased in frequency. The following causes were identified in 131 cases where adequate information was available: use for types of epilepsy where this drug is not recommended, lowering of the blood levels of the drug on switching over from branded to a generic CBZ, change in the galenic form, drug interactions, progression of the underlying brain pathology such as a brain tumor, and unexplained increase in the blood levels of the drug. In cases where the increase in seizures was transient no special measures or changes in therapy were required. Unexplained failure occurred only in seven cases (5.3%). Based on this information, a flow chart was designed to evaluate such a problem step by step and to take appropriate measures. Only when true therapeutic failure is identified, should another antiepileptic drug be substituted for CBZ. Similar approach can be used for other antiepileptic drugs.     

河南省一起恙虫病暴发疫情调查分析

目的 对2015年河南省发生的一起恙虫病暴发疫情进行调查分析,了解其发病特点及流行特征,分析恙虫病感染的影响因素,为制定针对性预防控制措施提供依据。方法 采用现场流行病学调查的方法,搜索病例,填写《恙虫病个案调查表》,对病例进行血清学、免疫学以及分子生物学实验。采用病例对照研究的方法,以搜索到的临床诊断病例和确诊病例作为病例组,按1∶2匹配的方式,随机选择与病例所在的同村、年龄相差5岁以内的同性别且无临床症状的村民为对照,收集可疑危险因素。结果 本次疫情10月16日至11月20日,共发现病例48例,其中发热≥38.5℃的病例超过83.3%,发现特异性焦痂或溃疡的病例68.7%,有皮疹的病例60.4%,其他临床症状还包括头痛、浅表淋巴结肿大、寒战等。对采集的16份病人标本进行检测,其中血清抗体IgM阳性15份。外斐氏反应检测OXk血清抗体,抗体滴度>1∶160的13份,最高抗体滴度>1∶640,第二次采集病人恢复期血清有7份抗体呈4倍增高。恙虫病PCR核酸检测,阳性4份。结论 本次疫情为一起恙虫病暴发疫情,临床症状上主要表现为发热、特异性焦痂或溃疡、皮疹、头疼等;外斐氏试验可以作为重要诊断依据,PCR核酸检测方法,作为确诊依据之一,具有重要的意义;去参加田间劳动、在屋内堆放柴草或农作物、在家中饲养家禽及在家中饲养宠物为发病的独立影响因素。     

Cholera in Bahrain: epidemiological characteristics of an outbreak

In the period 10 August 1978-23 January 1979, 913 culture-confirmed cases of cholera caused by Vibrio cholerae, biotype El Tor, serotype Ogawa, occurred in Bahrain. After discovery of the initial cases, others occurred sporadically, and the incidence reached a peak of 25-35 cases per day during the seventh week of the outbreak (16-22 September). The overall attack rate (27 per 10 000) was low and the outbreak subsided without mass immunization campaigns or rigorous border control of persons and imports. Investigation of 746 culture-confirmed cases that occurred in the period 10 August—13 October 1978, showed that cases occurred throughout most areas of the country and mainly affected infants, young children, and adult working-age males. Symptoms were very mild; fewer than 20% of patients required specific rehydration therapy. The highest attack rate (84 per 10 000) occurred in infants less than 1 year of age. No common vehicle or mode of transmission was identified. A matched-pair study of 35 cases and controls showed that adult cases were more likely than controls to have consumed food or beverage outside of the home before becoming ill. V. cholerae was isolated from stored drinking water in the houses of 8 cases but not from numerous samples of food and tap-water. It was presumed that cholera transmission occurred through a complex interaction of mild and asymptomatically infected persons with food, water, and the environment.     

老年癫痫65例临床分析

目的探讨老年癫痫的临床特点、病因、治疗及预后。方法回顾性分析解放军总医院癫痫门诊收治的65例老年癫痫患者的临床资料。结果65例老年癫痫患者占所有就诊癫痫患者的2．8％。70．8％为部分性发作,24．6％为全身强直阵挛发作．4．6％以癫痫持续状态起病。发病原因：40．0％为脑血管病,其余主要为脑外伤、脑肿瘤、睡眠呼吸暂停综合征、缺氧性脑病、阿尔茨海默病、低血糖等,20．0％原因不明。常规脑电图异常率44_4％,动态脑电图异常率84．2％。80．0％患者药物治疗,抗癫痫药物主要为卡马西平、丙戊酸钠、苯妥英钠及托吡酯,73．1％为单药治疗,治疗后88．5％发作减少,9．6％未再出现发作,1．9％发作加重。结论老年癫痫绝大多数为继发性癫痫,有明确的病因,部分性发作比例高。抗癫痫药物治疗效果较好。因老年患者基础疾病多且病情复杂,抗癫痫药应从小剂量开始,逐渐加量,以小剂量长期治疗。     

Malignant tumors associated with thyroid cancer in an autopsy material

In the Department of Pathology of Albert Szent-Gy?rgyi Medical University at Szeged in Hungary 37,504 autopsies were performed in the last 30 years and double multiple primary malignant tumours were found in 385 cases (4.2%). In thyroid cancer cases the tumours of other organs were more frequent (22.7%), and these tumour-associations were observed mainly simultaneously, there were no important sex differences. In the most of cases the thyroid cancer was only a side diagnosis beside other malignancies, in the more rare metachronous cases the thyroid cancer was secondary following postoperative irradiation of the first tumour (4 cases of 5). We have seen thyroid cancers most frequently together with lung, breast and digestive system tumours.     

Neuroparacoccidioidomycosis: analysis of 13 cases observed in an endemic area in Brazil

The epidemiological, clinical and laboratory features of 13 cases of neuroparacoccidioidomycosis (NPCM) were analysed. All patients were men, with a mean age of 41.6 years. The lungs were involved in 11 cases (84.6%) and only two cases had mycosis limited to the central nervous system. Co-morbidity was observed in four patients (malignant neoplasm in three and diabetes mellitus in one). The most frequent neurological manifestations were paresis (eight cases), headache (five cases) and gait disturbance (four cases). Neuroimaging diagnosis showed a predominance of multiple round lesions with ring enhancement following contrast medium injection. Lesions were seen in the brain hemispheres (nine cases), thalamus (nine cases), cerebellum (four cases), brainstem (four cases) and spinal cord (four cases). Most cases responded well to therapy. Lesions with enhancement following contrast medium injection persisted in four patients for a period of 6 months to 8 years. These findings emphasize the importance of considering NPCM in the differential diagnosis of brain and spinal cord lesions in endemic areas of paracoccidioidomycosis.     

MRI of an intrathoracic malignant tumor invading the chest wall

22 patients with intrathoracic malignant tumors suspected of invading the chest wall were examined with CT and MRI. Chest wall invasion was operatively confirmed in 19 cases and excluded in the other 3 cases. CT showed tumor infiltration of the chest wall in 14/19 cases, no morphological changes in 5/19 cases. Thoracic wall invasion was demonstrated by MR in all 19 cases. Typical MR finding of malignant invasion was local lesion within the chest wall showing high signal intensity in post-Gd T1-weighted images and in T2-weighted images. Reactive inflammatory changes as well as malignant infiltration of the pleura showed high signal intensity on enhanced T1-weighted images and on T2-weighted images.     

Malaria control in an Amazon municipality

This study aimed to evaluate the organization of malaria control actions in the Indigenous population of the municipality of S?o Gabriel da Cachoeira, Amazonas, AM, Brazil, from 2003 to 2007. This is an ecological study to evaluate the impact of control measures. Statistical analysis of the indicators revealed that the number of cases showed an increasing trend, with the highest numbers occurring in the rural areas. The same trend was observed for the Annual Parasite Index (API), however the highest APIs were found in the urban areas. The proportion of cases caused by Plasmodium falciparum showed a reduction. Hospitalization and mortality rates presented fluctuations and the fatality rate decreased. The findings indicate that control actions have proved partially effective and that they have provided a broader capacity to detect cases and to provide immediate treatment. Although the municipality still presents a high risk for transmission, the Pluriannual Plan in progress seems to have a good prognosis for the control of the disease, if maintained in a sustainable and permanent way.     

Multi-resistant Acinetobacter baumannii: description of an Outbreak centred on an intensive care unit in an Australian hospital

Multi-resistant Acinetobacter baumannii (MRAB) is an increasingly important cause of nosocomial outbreaks, particularly in intensive care units (ICUs). Over a 4-year period, more than 130 patients colonised or infected with MRAB were identified at our institution, with 90 per cent of cases from the adult ICU or neighbouring high-dependency wards. Most isolates were from wound or respiratory sites but 14.5 per cent came from sterile sites. Typing of isolates by pulsed-field gel electrophoresis (PFGE) showed that six distinct pulsotypes circulated during this period, including two strains that exhibited high-level carbapenem resistance. PFGE typing also helped direct infection control efforts, which included isolation/cohorting of cases, emphasis on handwashing and use of barrier precautions by staff, plus improved cleaning of the environment. Inappropriate prescribing of antibiotics, particularly third-generation cephalosporins and carbapenems, was reduced. Despite these measures, control of the outbreak was difficult. MRAB may become endemic in institutions, despite the use of recommended infection control measures. [AIC Aust Infect Control 1999; 4(2):12-15]