Risk Factors for a First Febrile Seizure: A Matched Case-Control Study

Summary We conducted a matched casecontrol study to identify risk factors for first febrile seizures, with special emphasis on characteristics of the acute illness episode. Cases were identified through hospital emergency departments; controls were identified through outpatient clinics and emergency departments. Sixtynine children with first febrile seizures and no history of previous unprovoked seizures were matched for age (±6 months), site of routine pediatric care, and date of visit (±weeks) with 1 or 2 febrile controls who had no history of previous febrile or unprovoked seizures. Medical records for the index visit were reviewed, and parents were interviewed by telephone. Illness characteristics examined included height of temperature, type of underlying illness, contact with a physician during the illness but before the index visit, and use of acetaminophen or decongestants. Family history of febrile and of unprovoked seizures, sociodemographic characteristics, daycare use, and selected preand perinatal variables were also studied. On multivariable analysis, significant independent risk factors were height of temperature, history of febrile seizures in a firstor in a higher degree relative. Gastroenteritis as the underlying illness had a significant inverse (i.e., protective) association with febrile seizures. Maternal smoking during pregnancy was a marginally significant predictor of febrile seizures.     

某区医院发热伴呼吸道症状病人临床分析

目的：探讨常见呼吸道发热疾病的临床特点及与传染性非典型肺炎(严重急性呼吸综合症，SAGS)的鉴别。方法：发热门诊诊治的以发热体温高于38℃伴呼吸道症状患者702例，对病因、临床表现、实验室检查、胸部X线、治疗及转归进行比较。结果：常见呼吸道发热患者中，急性上呼吸道感染596例占总数的85％，577病例白细胞计数不高占82％，淋巴细胞计数不降低，X线检查正常或仅有支气管炎表现。有基础肺部或全身疾病患者，虽然有发热，但往往以肺部或全身原发疾病相应症状为重要或首发表现，可有气急，体温以中度发热为主，78％病例有白细胞计数及中性比例升高。胸片除肺炎改变外，多有肺部基础疾病的表现，抗生素治疗有效；而单纯性肺炎胸部X线多表现为节段性或局灶性肺炎。这部分病例也以发热为主要或首发症状，一般表现为咳嗽、咳痰，气急少见，易与SARS混淆。结论：临床呼吸道发热疾病以急性上呼吸道感染最多见，容易忽略，要注意筛查。单纯性肺炎与SARS的鉴别，应结合流行病史、治疗反应及实验室检查结果进行。     

Clinical influence of vagotomy on postoperative acute phase response

BACKGROUND: Although there is increasing evidence suggesting that the vagus nerve functions as a connector between the nervous and immune systems in animals, little is known about the role of the vagus nerve in postoperative acute phase response in humans. MATERIALS AND METHODS: The extent of fever and acute phase protein response and the production of inflammatory cytokine during the early postoperative period were compared among the patients who had undergone total gastrectomy including truncal vagotomy (n = 13), those having distal gastrectomy with division of vagal branches (n = 14), and the patients with vagal nerve preserving gastrectomy (n = 12). RESULTS: There was no significant difference in serum levels of C-reactive protein, alpha-1-antirypsin, and interleukin-6 among the three groups. Also, postoperative maximum body temperature was similar. CONCLUSIONS: Vagotomy did not influence acute phase response after gastric cancer surgery. A multipathway mechanism for acute phase response including the induction of fever is suggested.     

呼和浩特市农区首次发现流行性出血热报告

呼和浩特市历史上未曾发现流行性出血热自然疫源地，也未见到流行性出血热疫情报告。1995年3月，本市中文齐镇发生1例临床表现典型并经血清学证实的流行性出血热病例。病家及其周围居民区家鼠密度为3.61％，以褐家鼠为优势种。送检捕获鼠鼠肺51份，阳性率21.57％。病家周围健康人群流行性出血热隐性感染调查，阳性率2.71％（1/37）。流行病学调查表明，病人病前1周－2个月内无外出史，故病人系本地感染。动物流行病学调查证实，呼和浩特农区存在流行性出血热自然疫源地。     

The effects of ambient and hypothalamic temperatures on the hyperthermic responses to prostaglandins E1 and E2

Summary The effects of ambient and hypothalamic temperatures were studied on the hyperthermic responses to prostaglandins E₁ and E₂ (PGE₁ and PGE₂) injected intraventricularly in the unanesthetized rabbit. Hyperthermic responses to PGE₁ observed at different thermal environments were approximately equal in magnitude and time course. However, the prevailing ambient temperature influenced the thermoregulatory mechanisms by which the hyperthermia was achieved. In a hot environment, PGE₁-hyperthermia was brought about by suppression of heat loss mechanism with little change in heat production. During cold exposure body temperature was raised mainly by an increase in heat production without a significant change in heat loss. PGEs-hyperthermias were attenuated by warming and enhanced by cooling the anterior hypothalamus. These changes in the hyperthermic responses to PGE₁ and PGE₂ are in contrast to those obtained with intraventricular injection of noradrenaline at different ambient temperatures and during hypothalamic heating and cooling. It is therefore unlikely that noradrenaline is involved in the hyperthermic responses to PGEs. On the other hand, the results support the view that prostaglandins may be mediators of pyrogen-induced fever.     

Large left atrial myxoma presented as fever of unknown origin: a challenging diagnosis and a review of the literature

Myxoma is the most common type of primary tumors of the heart in adults. The majority of patients with myxomas may experience symptoms due to central or peripheral embolism or intracardiac obstruction, while in some cases, they may be completely asymptomatic. Rarely, patients develop unusual symptoms that complicate the diagnostic evaluation. Herein, we describe the case of a 70-year-old patient with a long-lasting low-grade fever due to a large left atrial myxoma revealed during a transthoracic echocardiography.     

Response of body temperature and serum iron concentration to repeated pyrogen injection in rabbits

We measured body temperature and serum iron concentration after five daily consecutive injections of febrile doses of Salmonella typhosa lipopolysaccharide (0.1 g/kg) and two doses of Staphylococcus aureus cell walls (1×10⁷ and 5×10⁷ cells) in rabbits. Tolerance to endotoxin injection, as manifest by a significant attenuation in the body temperature elevation, developed after the first injection of endotoxin. The endotoxin-induced fall in serum iron concentration was attenuated significantly by the 5th day of endotoxin injection. In contrast, no tolerance developed in either the body temperature or serum iron response following repeated daily injections of S. aureus. Rabbits rendered tolerant to endotoxin showed normal febrile and serum iron responses to subsequent S. aureus injection. Rabbits given serial injections of S. aureus, although not tolerant to S. aureus itself, exhibited attenuated body temperature responses but not serum iron responses to endotoxin injection. We suggest that repeated injection of endotoxin diminishes the ability of endotoxin to stimulate endogenous pyrogen (EP) synthesis and/or release, a property not shared by the gram-positive pyrogen S. aureus. However, repeated injection of S. aureus weakens the central endotoxin-EP pathway.     

低温保存内生致热原对其致热活性的影响

本实验用家兔全血加精制大肠杆菌内毒素，体外培养提取粗制家兔内生致热原。给大鼠静脉注射复制发热模型，观察了不同温度保存和不同时间保存的ＥＰ对其致热活性的影响。结果表明：４℃保存３天，－４０℃保存３天，７天，３０天和１８０天的ＥＰ与４℃保存１天的ＥＰ比较，其发热第一时相发热峰值和１小时体温反应指数均无显著性差异（Ｐ＜０．０５）。发热第二时相△Ｔ和第二时相１小时ＴＲＩ，在４℃保存３天和－４０℃保存３天，     

精氨酸加压素对家兔血细胞生成内生致热原的影响

本文观察了精氨酸加压素对体外培育的兔全血细胞产生内生致热原的影响。结果表明，ＡＶＲ对内毒素诱生ＥＰ过程有明显抑制作用；而ＡＶＰ单独与血细胞培养无降温物质产生；同时，所用剂量的ＡＶＰ对ＥＰ性发热无直接抑制作用。因此作者认为，ＡＶＰ１能够抑制ＥＴ诱生家兔血细胞生成ＥＰ，这可能是其降低或阻断ＥＴ性发热的主要机制之一。