Dermatological image search engines on the Internet: do they work?

BACKGROUND: Atlases on CD-ROM first substituted the use of paediatric dermatology atlases printed on paper. This permitted a faster search and a practical comparison of differential diagnoses. The third step in the evolution of clinical atlases was the onset of the online atlas. Many doctors now use the Internet image search engines to obtain clinical images directly. OBJECTIVES: The aim of this study was to test the reliability of the image search engines compared to the online atlases. METHODS: We tested seven Internet image search engines with three paediatric dermatology diseases. RESULTS: In general, the service offered by the search engines is good, and continues to be free of charge. The coincidence between what we searched for and what we found was generally excellent, and contained no advertisements. Most Internet search engines provided similar results but some were more user friendly than others. It is not necessary to repeat the same research with Picsearch, Lycos and MSN, as the response would be the same; there is a possibility that they might share software. CONCLUSIONS: Image search engines are a useful, free and precise method to obtain paediatric dermatology images for teaching purposes. There is still the matter of copyright to be resolved. What are the legal uses of these 'free' images? How do we define 'teaching purposes'? New watermark methods and encrypted electronic signatures might solve these problems and answer these questions.

The true and the false: pixel-byte syndrome.

The possible use of retouched images for fraudulent purposes in scientific articles, posters, and conferences is not a future but a present possibility (probably already used) that poses serious questions as to the need for additional control mechanisms other than scientific peer quality review in evaluating and accepting articles. We propose the term "pixel-byte syndrome" to illustrate how easy it might be to electronically create a new syndrome for fraudulent purposes. The aim of this article is to stimulate discussion among professionals, add some examples of easy-to-realize frauds and sow the seeds of doubt in the minds of some of the referees of journal articles and the scientific secretariat of congresses in reviewing digitally retouched images.

[Neonatal buprenorphine withdrawal syndrome, what is the right therapy?]. / Sindrome di astinenza da buprenorfina in neonato, quale terapia?

Buprenorphine is a new substance now widely used in detoxification of heroin addicts. In this report we describe the case of a newborn baby who suffered from a neonatal withdrawal syndrome characterized by a severe and prolonged course. This syndrome was followed by marked symptoms of impaired neurological development and by epilepsy. The ineffectiveness of methadone in relieving withdrawal symptoms from buprenorphine and its potential dangerous effects in this case are also outlined, whereas the efficacy of therapy with phenobarbytal is stressed. We think that this case is noteworthy, since the widespread use of buprenorphine among drug addicts will probably provoke an increase in the number of cases of buprenorphine withdrawal syndrome in the next years.

Transesophageal echocardiography as an important tool in the diagnosis of postinfarction papillary muscle rupture.

Papillary muscle complicating acute myocardial infarction is an uncommon but potentially catastrophic event. We present 3 such cases to illustrate the difficulties in early identification of rupture. In each case, transesophageal echocardiography was employed providing rapid and unequivocal identification of the disorder. Prompt surgical intervention led to survival in 2 patients.