Analysis of queries sent to PubMed at the point of care: Observation of search behaviour in a medical teaching hospital

Background

A dengue fever outbreak occured in French Guiana in 2006. The objectives were to study the value of a syndromic surveillance system set up within the armed forces, compared to the traditional clinical surveillance system during this outbreak, to highlight issues involved in comparing military and civilian surveillance systems and to discuss the interest of syndromic surveillance for public health response.

Methods

Military syndromic surveillance allows the surveillance of suspected dengue fever cases among the 3,000 armed forces personnel. Within the same population, clinical surveillance uses several definition criteria for dengue fever cases, depending on the epidemiological situation. Civilian laboratory surveillance allows the surveillance of biologically confirmed cases, within the 200,000 inhabitants.

Results

It was shown that syndromic surveillance detected the dengue fever outbreak several weeks before clinical surveillance, allowing quick and effective enhancement of vector control within the armed forces. Syndromic surveillance was also found to have detected the outbreak before civilian laboratory surveillance.

Conclusion

Military syndromic surveillance allowed an early warning for this outbreak to be issued, enabling a quicker public health response by the armed forces. Civilian surveillance system has since introduced syndromic surveillance as part of its surveillance strategy. This should enable quicker public health responses in the future.     

股内侧肌穿支皮瓣的解剖学基础与膝周创伤修复

目的:探讨股内侧肌穿支皮瓣的解剖学特征,为临床膝周软组织缺损的修复提供一种新的术式。方法:实验于2005-01/10在解放军南京军区福州总医院军区临床解剖学研究中心实验室完成。30侧动脉内灌注红色乳胶的成人下肢标本由南京军区福州总医院军区临床解剖学研究中心提供。30侧成人下肢标本,以收肌结节、髌骨中点、腹股沟韧带中点为观测标志,重点解剖观测股内侧肌肌支的起源、走行、分支、分布及其远端吻合情况。一侧新鲜标本上,摹拟术式设计。结果:在股三角尖部自股动脉恒定发出的股内侧肌支,入肌门后在肌内沿肌束行向外下方,直至髌旁并与髌周动脉环相吻合。沿途除发出肌支营养股内侧肌外,还发出1～3支(77%为1支)、外径0.5～0.9mm肌皮穿支垂直穿过股内侧肌达深筋膜,并浅出至股内侧肌表面皮肤。皮瓣切取面积可达8.5cm×15.0cm。结论:可形成的以股内侧肌肌支-穿支逆行皮瓣转位可修复膝部软组织缺损。     

黑色素性室管膜瘤1例

黑色素性室管膜瘤(Melanotic ependymoma)属室管膜瘤的一种．临床十分罕见，我科发现1例，现报道如下。     

Spinal cord central echo complex: histoanatomic correlation

Real-time sonography consistently demonstrates an echo complex centrally located in the spinal cord. This echogenic focus is currently attributed to the central canal. The authors sought the source of this central echo with ultrasound (US) and histoanatomic study of both fresh and fixed cadaver spinal cords. Correlative transverse sections of the spinal cord were stained with hematoxylin-eosin and Luxol fast blue for cells and myelin and with Holzer stain for glial fibrils. The central echo complex is produced by the interface between the myelinated ventral white commissure and the central end of the anterior median fissure. Variations in the shape of the central complex seem to reflect varying degrees of flaring of the central end of the anterior median fissure. The inconstant residual central canal and islands of residual ependymal cells are clearly not the source of the central echo complex.     

Temporal lobe necrosis in nasopharyngeal carcinoma: Pictorial essay

Nasopharyngeal carcinoma (NPC) shows a high frequency of skull base erosion and intracranial spread. This tumour is usually treated with radiation therapy. The medial and inferior portions of both temporal lobes are included within the radiation portals. These areas are therefore potential sites of radiation-induced necrosis. It is important to recognize this complication and separate it from intracranial tumour recurrence because the treatments of these entities are different.     

Consistency of microvascular and autonomic abnormalities in diabetes

The progression of early measures of microvascular disease and autonomic neuropathy were studied in a group of 81 children with insulin dependent diabetes mellitus over a mean interval of 4.2 years. Repeated measurements were made of blood pressure, albumin excretion, joint mobility, and pupillary dilatation in darkness. Over the years between the first and the second study, systolic and diastolic blood pressure showed positive tracking correlations (r = 0.38 and r = 0.32) with a small but significant deviation from normality; albumin/creatinine ratio was significantly increased (0.79 v 0.55); a greater number of children were identified in the second study as having limitation of mobility of the fifth metacarpophalangeal joint; and pupillary dilatation in darkness significantly decreased (61.5% v 62.9%); 62% of the children with one or more abnormal measurements in the first study were found to have measurements outside the normal ranges in the second study, indicating a consistency in observations over time. It remains to be seen with what accuracy these measurements predict adult onset clinical disease.     

The influence of thin-section tomography on the treatment of cervical spine injuries

A study was performed to determine the influence of routine thin-section tomography on subsequent treatment of the patient with acute trauma to the cervical spine. Of 79 such patients who underwent tomography over a 14-month period, 55 had suspicious indirect findings on the radiograph and 25% of these were shown to have fractures, while 67% of the patients without radiographic abnormalities who presented with a neurological deficit also demonstrated fractures on tomography. Of the patients who were shown to have fractures prior to tomography, 54% had more extensive injury than originally suspected. In nearly 18% of patients, the mode of therapy was changed significantly after tomographic evaluation. Indications for tomography are discussed and specific recommendations for systematic radiographic evaluation of cervical spine injuries are presented.