Munchausen syndrome by proxy--a cause of preterm delivery.

OBJECTIVE: To present the first case of Munchausen syndrome by proxy involving self-induced preterm delivery. CLINICAL FEATURES: A 27-year-old Caucasian woman induced antepartum haemorrhage and rupture of membranes with a knitting needle at 26 weeks' gestation, leading to delivery of the infant. This "prenatal child abuse" led to a prolonged intensive care stay, extensive treatment and subsequent bronchopulmonary dysplasia. As the child recovered from the effects of extreme prematurity, he became a victim of fabricated illness and recurrent smothering episodes. INTERVENTION AND OUTCOME: After the diagnosis of Munchausen syndrome by proxy was made, the child was removed from the mother and he has since enjoyed good health. CONCLUSION: Self-induction of antepartum haemorrhage can lead to preterm delivery and may be recognisable by certain clinical parameters. The victim of self-induced preterm delivery, if survival ensues, may be subject to further abuse.     

Successful reversal of sleep apnoea syndrome following treatment for acromegaly, confirmed by polygraphic studies

A patient with acromegaly was shown to have obstructive sleep apnoea by polygraphic recordings. Following successful hypophysectomy, further recordings demonstrated resolution of obstructive sleep apnoea.     

Road traffic accidents in patients with obstructive sleep apnoea

Three patients involved in road traffic accidents were suspected to have obstructive sleep apnoea (OSA). Two of them fell asleep while riding motorcycles and one patient fell asleep behind the wheel of a truck causing it to overturn. The diagnosis of OSA in each case was suspected based on a history of loud snoring, restless sleep, and excessive daytime somnolence and was confirmed by sleep studies.     

The relationship of arrhythmias to walking activity during mobilization after myocardial infarction

The extent to which everyday walking activity is responsible for ventricular arrhythmias in the first 6 weeks after suspected myocardial infarction has been studied by simultaneous 24-hour recordings of electrocardiogram and walking activity. Forty-eight recordings from 46 patients were identified which contained couplets, ventricular tachycardia or R-on-T extrasystoles. In 24 recordings (50%) all the arrhythmias occurred whilst the patient was at rest and in a further four recordings there were fewer arrhythmias during activity than would have been expected by chance. Nineteen recordings (40%) contained arrhythmias which may have been induced by activity but in only three of these was the relationship definite. Clear evidence of arrhythmias precipitated by walking was found in only a minority of patients mobilizing after suspected myocardial infarction.     

Covert video surveillance and the principle of double effect: a response to criticism.

In some young children brought by their parents for diagnosis of acute life-threatening events investigations suggested imposed apnoea as the cause rather than spontaneous occurrence. Covert video surveillance of the cot in which the baby was monitored allowed confirmation or rebuttal of this diagnosis. That parents were not informed of the video recording was essential for diagnosis and we assert ethically justifiable as the child was the patient to whom a predominant duty of care was owed. The procedure also avoids the risk of separation of child from parent on inadequate information.     

彩色多普勒超声心动图评价新生儿青紫

目的：用彩色多普勒超声心动图对新生儿青紫原因进行分析评价。方法：对107例青紫新生儿应用彩色多普勒超声心动图进行检查，并经手术病理及心血管造影、心导管和CT、胸片等对照。结果：生理性青紫15例，占14．02％；病理性青紫92例，占85．98％。病理性青紫中，中央性青紫85例，其中心源性青紫21例，由各种复合心脏畸形所致；肺源性青紫64例，主要由肺部疾患及新生儿窒息引起。周围性青紫6列，主要由心力衰竭、硬肿症和寒冷所致。其他原因青紫1例，为低血糖症引起的呼吸暂停所致。结论：彩色多普勒超声心动图可作为新生儿青紫原因分析的常规检查手段。     

新生儿先天性心脏病的彩色多普勒超声诊断及分析

目的：研究新生儿先天性心脏病的类型及临床特点。方法：对1995－2001年61例新生儿先天性心脏病的彩色多普勒超声波特点进行分析，并随访4例紫绀型先心病，12例非青紫型先心病患儿3个月至7年。结果：非青紫型先心病40例（65．6％）最常见类型为室间隔缺损（31．1％），动脉导管未闭（18．0％），房间隔缺损（6．6％），肺动脉瓣狭窄（1．6％）；青紫型21例（34．4％）中大动脉转位位居第一（11．5％），第二位为法乐氏四联征（8．2％），单心室（6．6％），居第三位。经胎儿超声心动图产前诊断先心病2例，1例为室间隔缺损，1例为单心室，新生儿先心病的临床表现主要为心脏杂音（82．0％），气促（62．3％）,持续性青紫（34．4％）。随访紫绀型先心4例，均手术治疗，2例术后死亡；非青紫型患儿12例，自愈7例，3例手术矫正，2例未愈无并发症。结论：为控制先心病胎儿的出生，降低婴幼儿的死亡率，应重视先心病的产前诊断并对重症患者终止妊娠，先后宜尽早行彩色多普勒超声检查以确诊。     

How do we know who has had deep vein thrombosis?

An attempt was made to identify all patients diagnosed as having deep vein thrombosis (DVT) in a large teaching hospital during one year. A review of the radiology records showed that 124 (81%) of the 154 venograms performed were for suspected DVT, and that the diagnosis was confirmed in 57 (46%). During the same period, the Hospital Activity Analysis (HAA) records revealed 174 episodes classified as 'phlebitis or thrombophlebitis' in 162 patients. Only 37 of these episodes (21%) had been confirmed by X-ray venography and at least 29 patients were incorrectly classified by HAA. 'Medical' patients accounted for 54% of the episodes of DVT, yet in only 25% of these was the diagnosis confirmed by venography, while 'surgical' DVTs were less frequent but were more often confirmed by venography.     

海南省2007-2008年麻疹监测病例流行病学特征分析

目的分析海南省2007～2008年麻疹监测病例流行病学特征,为制定消除麻疹策略提供科学依据。方法采用描述流行病学方法分析2007-2008年麻疹监测系统报告数据。结果2007～2008年全省监测报告“发热出疹”麻疹疑似病例1240例,报告发病率2007年为2．52／10万,2008年为12．21／10万,监测病例报告2007年有14个市县,占77．78％,2008年有17个市县报告,占94．44％;监测病例中确诊为麻疹病例78例,实验室确诊52例,占66．67％,临床诊断26例,占33．33％,麻疹年发病率分别为0．32／10万、0．59／10万,无死亡病例;确诊病例中2007年本地常住人17占74．07％,流动人17占25．93％,2008年常住人12占50．98％,流动人口占49．02％。排除病例中风疹病例两年均在35％v;t上。发病呈高度散发,仍以冬春季为主,最小年龄为7月龄,最大为35岁,15岁以下儿童占病例总数的60．26％,无免疫史和免疫史不详者占87．23％。结论海南省开展麻疹症状监测以来,监测系统是敏感的,2007-2008年麻疹发病率已降到历史最低水平。     

Lung microRNA profile in chronic cyanotic piglets with decreased pulmonary blood flow

Background Cyanotic congenital heart defects with decreased pulmonary blood flow due to lung ischemia,hypoxia,and others lead to infant morbidity and mortality more than acyanotic heart disease does.Despite the great effort of medical research,their genetic link and underlying microRNAs molecular mechanisms remain obscure.In this study,we aimed to investigate microRNAs regulation during cyanotic defects in lung of immature piglets.Methods Cyanotic piglet model was induced by main pulmonary artery-left atrium shunt with distal pulmonary artery banding.Four weeks later,hemodynamic parameters confirmed the development of cyanotic defects and pulmonary lobe RNA was extracted from all animals.We studied the repertoire of porcine lung microRNAs by Solexa deep sequencing technology and quantified highly expressed microRNAs by microarray hybridization.Furthermore,we quantitated selected microRNAs from cyanotic and control piglets by quantitative RT-PCR.Results After surgical procedure 4 weeks later,the cyanotic model produced lower arterial oxygen tension,arterial oxygen saturation,and higher arterial carbon dioxide tension,hematocrit and hemoglobin concentration than controls (all P ＜0.05).In 1273 miRNAs expressed in the immature piglets lungs,2 most abundant microRNAs (miR-370 and miR-320) demonstrated significant difference between cyanotic and control group (all P ＜0.05).Conclusion Our results extended lung microRNA profile in immature piglets and suggested that miR-370 and miR-320 are significantly up-regulated in cyanotic lung tissues.     

Hyperkalaemic periodic paralysis: a rare presentation of Addison's disease

A 44 year old man with longstanding diabetes mellitus gave a 6-month history of periodic attacks of flaccid quadriplegia. Following one of these episodes he was admitted for assessment. In view of persistent hyperkalaemia, hypoadrenalism was suspected and Addison's disease was confirmed biochemically. Adrenal replacement therapy restored the potassium levels to normal and resulted in no further attacks of paralysis.     

南宁市疑似脑膜炎患儿抗生素使用情况调查分析

目的：了解南宁地区疑似脑膜炎患儿抗生素的使用情况，以求规范、合理使用抗生素。方法：使用统一的调查表格收集符合筛选标准的疑似脑膜炎患儿的相关资料，并进行流行病学统计、分析。结果：共评估了1272例脑膜炎疑似患儿。使用的抗生素以青霉素类(75．00％)和头孢菌素类(64．23％)为主；排前五位的是：青霉素(39．15％)、头孢噻肟(36．16％)、氨苄西林(10．38％)、头孢拉定(7．70％)和头孢唑啉(7．23％)。50％以上的病例在就诊期间使用了2种或2种以上的抗生素，34．98％的病人在就诊前已使用了抗生素，注射途径给药的抗生素占71．18％；就诊期间注射给药的抗生素占98．27％。年长儿青霉素使用率(44．88％)较年龄较小的婴幼儿(36．95％)高，而新生儿较1个月以上的幼儿的头孢塞肟、氨苄西林、阿莫西林-舒巴坦和头孢曲松的使用率高。脑脊液生化、常规异常和／或血白细胞升高组抗生素使用率(92．525)较正常组(83．165)高。结论本调查中疑似脑膜炎患儿的抗生素治疗往往以引起该病的主要病原菌为依据，以经验用药为主，建议对类似病人应尽可能做病原学检查以指导治疗；抗生素的使用应进一步规范化。     

The investigation of life-threatening child abuse and Munchausen syndrome by proxy.

The use of covert video surveillance in the investigation of suspected life-threatening child abuse and Munchausen syndrome by proxy raises important ethical questions. That the recently reported provision of this facility in North Staffordshire was not presented to a Local Research Ethics Committee (LREC) for approval as a research exercise raises important questions about the ethical review of research and practice. The case made for avoiding such review is first set out and then examined. The three main premisses which form the basis of the view that LREC approval is not required are identified and tested in turn. The conclusion is that there is an undeniable element of research involved in the procedure and that the welfare of all those subjected to the surveillance would be best protected by the submission of the protocol to an independent committee for ethical assessment.     

深圳市1例发热伴血小板减少综合征病例调查与应急处置

目的 综合分析1例发热伴血小板减少综合征(SFTS)病例的流行病学特征和应急处置情况,为制定该病的应急处置措施和防控策略提供依据.方法 对病例、密切接触者和共同暴露者开展流行病学调查和实验室检测.在病例居住和工作场所及可疑暴露地开展寄生蜱和游离蜱等媒介密度监测,并对采集到的蜱虫开展布尼亚病毒(SFTSV)核酸检测.对病...     

Covert video surveillance--an assessment of the Staffordshire protocol.

An assessment of a protocol devised to guide practitioners thinking of using covert video surveillance. Such surveillance is particularly used to help identify cases of Munchausen's syndrome by proxy. The protocol in question has been written by staff at the Academic Department of Paediatrics, North Staffordshire Hospital, Stoke-on-Trent in association with their local Area Child Protection Committee and has been commended by the Department of Health to others wishing to implement covert video surveillance.     

Pierre Robin Syndrome: case report

A case of a female neonate with Pierre Robin Syndrome with frequent cyanotic episodes and feeding difficulties which could not be adequately managed by positioning and oral airway placement is presented. Tongue-anterior mandible fusion procedure was performed with satisfactory results.     

洛阳市涧西区2005-2006年麻疹监测与控制分析

目的解洛阳市涧西区麻疹流行病学特征和麻疹监测系统运转状况。方法对2005-2006年麻疹监测和预防接种资料进行分析、评价。结果涧西区2005-2006年共报告疑似麻疹病例247例,较法定传染病报告系统(218例)多13·30%,其中诊断麻疹152例。麻疹发病有明显春未夏初季节高峰。疑似麻疹病例的及时报告、及时调查、合格血清标本采集率分别为69·44%、78·29%。2005-2006年麻疹减毒活疫苗(MV)常规免疫,强化免疫的报告接种均(90%。结论接种MV是控制麻疹的基础,适时开展MV强化免疫,消除免疫空白,提高麻疹监测质量是加速控制麻疹的关键。     

不同剂量的异丙酚在无痛人工流产时对呼吸功能的影响

目的：观察不同剂量的异丙酚在无痛人工流产时对呼吸功能的影响。方法：随机选择行无痛人工流产的患者60例,年龄20～44岁,ASAⅠ～Ⅱ级,静脉推注异丙酚镇痛。按异丙酚剂量分为两组,Ⅰ组用量1.5mg/kg（30例）;Ⅱ组用量2.0mg/kg（30例）。观察用药后呼吸暂停时间和恢复时间,测定给药1～10min呼吸的变化并记录。结果：大剂量的异丙酚可致呼吸暂停,且呼吸恢复时间明显减慢。结论：异丙酚对呼吸影响较大,有抑制呼吸作用,并可致呼吸暂停,应由专业医师使用。     

MEG和EEG在癫痫治疗中的作用

脑电图(EEG)只能选择性地探测切线位的电源,而脑磁图(MEG)可以同时测量切线和径向的电活动,两者均可独立提供其他神经影像学方法所无法提供的神经生理学数据。当执行多导联的任务时,MEG检查时间远少于EEG所需,且精确性更佳,而EEG的优势在于长程视频监测。因此,MEG和EEG在癫痫检查中可互为补充,两者分析结果与侵入性电极获得的结果相比无明显差异。头皮EEG可提供丰富的信息,但考虑外形非规则和内容物导电率的不均一性,构建EEG头颅模型变得十分困难。因此在同样使用标准半球模型情况下,MEG信号偶极子定位方法要比EEG偶极子定位方法优越。然而,如果使用拟和度好的头颅模型并加强EEG信号的分析,EEG定位的精确性和MEG相比较并无明显区别。目前,研究的重点是联合使用全脑MEG和多导联EEG,并发展更佳的源模型技术。