发热伴出疹症候群监测预警研究进展

目的 对发热伴出疹症候群（RFS）监测预警研究进行系统综述,为我国RFS监测与防控提供参考。方法 以“发热”“出疹”“监测”以及“fever” “rash” “surveillance”为中英文检索词并补充其自由词,系统检索中国知网、万方数据知识服务平台、PubMed、Web of Science数据库,语种限定为中文及英文,对纳入文献信息进行摘录整理及汇总描述。结果 共纳入36篇文献,中英文分别为21篇和15篇。RFS病原学监测共19篇,病原体主要包括麻疹病毒、水痘-带状疱疹病毒、风疹病毒、肠道病毒、人类B19病毒、登革病毒、A组链球菌、伤寒/副伤寒沙门菌、人疱疹病毒、腮腺炎病毒和腺病毒;重大活动/突发自然灾害监测8篇,监测时段集中在2010-2015年,包括运动会、世界博览会、地震、热带风暴和宗教集会等;异常病例/聚集性疫情监测预警8篇,以国外研究为主,监测症候群范围广,监测场所为医疗机构,主要依靠《国际疾病分类》第九版（ICD-9）编码或患者主诉中诊断及症状进行自动判别预警;仅1篇针对预测研究,为蒙古国开展的基于传染病监测数据预测研究。36篇文献的分析方法包括描述性分析法、基于时间的预警模型（如回归分析法、固定阈值法、休哈特控制图法及累积和控制图法）和时间序列分析方法。结论 未来RFS监测体系方向应聚焦已知病原和可能的未知病原监测预警相结合的模式,可进一步完善预警系统设计,实现无感化病例监测与早期预警,应用当下的信息抓取技术和智能建模方法,提高RFS监测预警的敏感度和特异性。     

When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum

Purpose

Increasing use of implantable bars for minimally invasive pectus excavatum repair has introduced metal allergy (nickel and chromium) to pediatric surgeons. Metal allergy is a well-recognized entity in neurologic, orthopedic, and craniofacial surgery. This study was performed to evaluate metal allergy and its effects on treatment with the Nuss procedure in 862 patients.

Methods

After institutional review board approval, we undertook a retrospective review of a prospectively gathered database of patients undergoing the Nuss procedure. Metal allergy was diagnosed either with the use of dermal patch or clinically, based on rash, fever, elevated erythrocyte sedimentation rate, cultures, and pathology specimens. Data collection included demographics, an allergy to jewelry, and history of atopy. Clinical outcomes including need for reoperation, removal of stainless steel bar, and replacement with titanium bar were evaluated.

Results

Over an 18-year period (1987-2005), 862 patients underwent the Nuss procedure. Nineteen (2.2%) were diagnosed with metal allergy, with an average age of 14.7 years (9-23 years). Eighteen (95%) were males. A history of atopy was present in 9 (56%) patients. Ten (63%) patients presented with rash and erythema, 1 (6%) with granuloma, 5 (32%) with pleural effusion, and 3 (15%) were diagnosed on preoperative screening. Stainless steel bars were removed because of allergic skin breakdown in 3 patients, with 2 patients requiring replacement titanium bars. In all 3 of these patients, symptoms resolved after removal of stainless steel bars. Titanium bars were placed in the 3 patients who were diagnosed preoperatively with metal allergy, without event.

Conclusions

Allergy symptoms often are misdiagnosed as infection, but require different treatment. If a history of metal allergy or atopy is suggested preoperatively, the patient should be tested for metal allergy, and if positive, a titanium bar used. Because the consequences of metal allergy may include the need to replace the bar, pediatric surgeons should be aware of this occurrence.     

正清风痛宁致药疹32例临床分析及预防策略

正清风痛宁是治疗风湿及类风湿性关节炎的主要药物。随着使用范围的扩大,逐渐成为治疗风湿病的一线药物。由于使用广泛,此药的不良反应也不断地被发现。临床常有引起过敏和发生药物性皮炎的报道[1],我院自1990至2005年期间,收治了32例正清风痛宁引起的药疹,现总结报告如下。1病     

Fever of unknown origin: a review of 20 patients with Adult-onset Still's disease

 In this study we aimed to investigate the findings in patients with adult-onset Still's disease (AOSD) admitted with fever of unknown origin (FUO) during the last 18 years in our unit, in order to discover the ratio of such patients to all patients with FUO during the same period, and to determine the clinical features of AOSD in FUO. The number and the aetiologies of the patients with FUO diagnosed between 1984 and 2001, and the clinical features of those with AOSD, were taken from the patient files. The diagnosis of AOSD was reanalysed according to the diagnostic criteria of Cush et al. [11]. The presumed diagnoses before a diagnosis of AOSD was established were also noted. The χ² and Fisher's exact tests were used for statistical analysis. We studied 130 patients with a diagnosis of FUO, 36 (28%) of whom had collagen vascular diseases. Of these 36 patients, 20 (56%, 12 female, 8 male, mean age 34 years, range 16–65) had AOSD. Clinical and laboratory findings were as follows: fever (100%), arthralgia (90%), rash (85%), sore throat (75%), arthritis (65%), myalgia (60%), splenomegaly (40%), hepatomegaly (25%), lymphadenopathy (15%), anaemia (65%), neutrophilic leukocytosis (90%), increased erythrocyte sedimentation rate (100%), elevated transaminase levels (65%), a negative RF (100%), and a negative FANA (80%). Antibiotics had been prescribed in 18 (90%) of cases. The presumed infectious diagnoses were streptococcal tonsillitis/pharyngitis (50%), infective endocarditis (four patients), sepsis (two patients) and acute bacterial meningitis (two patients). The presumed non-infectious diagnoses were acute rheumatic fever (three patients), seronegative rheumatoid arthritis (two patients) and polymyositis (two patients). Sixteen patients were followed for a mean duration of 30 months (range 2–59). A remission was obtained with indomethacin in three cases (19%), and with prednisolone in the remainder. Relapse was detected in three cases (19%). AOSD is one of the most frequent aetiologies of FUO. During the diagnostic course of a patient with FUO, a maculopapular rash and/or arthralgia and/or sore throat should raise the suspicion of AOSD. Because the disease has heterogeneous clinical findings, certain bacterial infections (e.g. streptococcal pharyngitis and sepsis) are generally considered and the prescribing of antibiotics is common. Received: 3 May 2002 / Accepted: 2 October 2002     

手足口病525例发病情况及临床分析

目的了解手足口病的发病情况及临床特征,提高对本病的认识,防止爆发流行。方法采用回顾性方法对2008年1月至2008年10月平谷区医院就诊的525例手足口病患者进行分析。结果5～7月份为该病的高发季节,发病人群主要为1～5岁的散居儿童和幼托儿童,特别是1～3岁儿童。临床表现主要为发热和皮疹,皮疹部位以手、足、口、臀、膝等为主。结论除对患儿进行积极的隔离治疗和疫点处理外,有效的健康教育对该病的预防能起到事半功倍的效果。     

第25例:临床表现发热、皮疹、胸痛

<正>患者男性,39岁,因"发热、皮疹4 d,胸痛3 h"于2007年9月25日入院。患者入院前4 d连续工作劳累后突发高热,体温在39～40℃,同时出现上下肢紫红色斑、丘疹,次日出现针尖大小血疱,伴明显疼痛,皮肤科以"带状疱疹,血栓性脉管炎"收住院。3 h后突发胸前区闷痛,伴憋气、出汗,胸痛持续不缓解,急查心电图示Ⅰ、aVL、V2～V6导联抬高0.1～0.5 mV,     

一例带有出疹发热的焦虑症的诊断与治疗

概述:一住院患者症状为每日不定时出疹,自觉发热、乏力,夜间盗汗、失眠,通过运用常规的检测和治疗方法,患者症状基本没有改善.本文通过介绍一种成功治疗案例,以供大家今后针对该类病患的治疗参考.     

儿童皮肤科护士皮疹分诊识别状况调查

目的总结儿童皮疹的分诊识别经验,探讨提高皮疹分诊识别率的方法。方法收集本院皮肤科门诊419例以皮疹就诊的患儿门诊资料,对其皮疹的特点、伴随症状、医生诊断以及分诊识别状况进行分析。结果419例中,分诊判断与医生诊断符合319例,分诊识别率为76．13％。其中确诊为变态反应性皮肤病识别率为82．4％,确诊为病毒和细菌感染性疾病识别率为66．3％。分诊识别率排前5位的疾病依次为：湿疹,急性荨麻疹,药物疹,水痘,手足口病。结论儿童皮疹可见于多种疾病,分诊护士应仔细观察皮疹的表现与特点,了解伴随症状,防止错误分诊。