拉莫三嗪、德巴金和维生素B6联合治疗癫痫的临床观察

目的:了解拉莫三嗪(LTG)、丙戊酸钠(VPA)和维生素Be治疗儿童难治性癫痫的疗效。方法:收集儿童难治性癫痫32例,已在使用VPA且血药浓度在有效范围内(50～100ug/mL)者,即从0.15mg/(kg·d)、1次/天开始加LTG,第1个月每周增加LTG0.2mg/(kg·d),第2个月每周增加0.3mg/(kg·d),以后每周增加0.5～1mg/(kg·d),直至发作控制或剂量达10mg/kg·d)。未使用VPA者,从20mg/(kg·d)开始加VPA,并调整血药浓度至50～100ug/mL,再逐渐减停其它抗癫痫药物,加LTG,方法同上。所有患者口服维生素B630mg/天～60mg/天。结果:治疗12个月时17例(53.1%)完全控制,10例(31.25%)有效,5例(15.6%)无效,治疗后发作频率减少,差异有统计学意义(P<0.005),8例(25.0%)脑电图恢复正常,2例(6.25%)出现不良反应,所有患者均无明显血象及肝功改变。结论:LTG、VPA和维生素B,联用为1种有效、安全而且值得推广的治疗小儿难治性癫痫的方法。     

病毒唑与潘生丁治疗婴幼儿秋冬季腹泻病50例临床分析

目的:探讨病毒唑、潘生丁治疗秋冬季腹泻病的疗效.方法:病毒唑(10～15)mg/(kg·d)、1次/日,静注.潘生丁(3～5)mg/(kg·d)、3次/日,口服[1].结果:50例婴幼儿秋冬季腹泻经上述方法治疗后,47例治愈,2例好转,1例无效.结论:应用病毒唑与潘生丁联合治疗婴幼儿秋冬季腹泻经济、疗效好,值得基层医院推广应用.     

更昔洛韦配伍西咪替丁治疗婴幼儿轮状病毒性肠炎30例

目的探讨更昔洛韦配伍西咪替丁对婴幼儿轮状病毒性肠炎的治疗效果。方法将婴幼儿轮状病毒性肠炎86例随机分为3组,治疗组用更昔洛韦5mg/(kg·d)、西咪替丁10~15mg/(kg·d)静脉滴注,对照1组用西咪替丁10~15mg/(kg·d)静脉滴注,对照2组用更昔洛韦5mg/(kg·d)静脉滴注。3组均1次/d,3d为1疗程。结果治疗组、对照1组、对照2组总有效率分别为93.3%、75.0%、85.7%。治疗组与对照1组总有效率比较,有显著性差异(P<0.05);治疗组与对照2组总有效率比较无显著性差异(P>0.05);3组在用药后症状改善时间上有显著性差异(P<0.01)。结论更昔洛韦配伍西咪替丁治疗婴幼儿轮状病毒性腹泻疗效显著。     

盐酸溴己新佐治小儿支原体肺炎疗效观察

目的:观察盐酸溴己新佐治小儿支原体肺炎的疗效。方法:将95例患儿随机分为治疗组49例,对照组46例,治疗组常规应用大环内酯类药物阿奇霉素10mg/(kg·d)静脉滴注,或红霉素15～30mg/(kg·d),浓度为0.5～1mg/L,加入5%葡萄糖150～250ml中静脉滴注,同时应用盐酸溴己新,2～4mg,1次/d静脉滴注,对照组用阿奇霉素10mg/(kg·d)静脉滴注,或红霉素15～30mg/(kg·d),浓度为0.5～1mg/L,加入5%葡萄糖150～250ml中静脉滴注,两组均以7～14d为1个疗程。结果:治疗组总有效率为91.84%,对照组总有效率为73.91%,两组差异有统计学意义(P<0.05)。结论:盐酸溴己新佐治小儿支原体肺炎有较好的疗效,较单用阿奇霉素或红霉素疗效好,疗程短。     

酞咪呱啶酮联合促红细胞生成素治疗原发性骨髓纤维化疗效观察

目的:观察酞咪呱啶酮联合促红细胞生成素(EPO)治疗原发性骨髓纤维化(IMF)的疗效。方法:A组13例口服酞咪呱啶酮150~250mg/d,2~3次/d。EPO6000U/次皮下注射,3次/周,治疗3个月以上。B组16例采用甲基强的松龙20~30mg/(kg·d)×3d,l0~15mg/(kg·d)×3d,2mg/(kg·d)×7d,均为静脉滴注,以后改用口服强的松lmg/(kg·d)至1个月为1疗程。结果:A组Hb、PLT及WBC有效率分别为72.7%、50.0%及42.9%,同VEGF改善有显著差异。B组Hb、PLT及WBC有效率分别为64.3%、40.0%及22.2%,同VEGF有改善,但无显著差异。结论:酞咪呱啶酮与促红细胞生成素联用在治疗骨髓纤维化方面简单、安全、有效、廉价,在当前传统治疗方法疗效不理想的情况下,不失为一个较好的选择。     

更昔洛韦与炎琥宁治疗小儿疱疹性咽峡炎临床观察

目的:探讨更昔洛韦与炎琥宁治疗小儿疱疹性咽峡炎的疗效。方法:将53例患儿分为对照组和治疗组。对照组采用利巴韦林、炎琥宁,剂量均为10mg/(kg·次)～15mg/(kg·次)静脉点滴1次/d;治疗组采用更昔洛韦5mg/(kg·次)、炎琥宁10mg/(kg·次)～15 mg/(kg·次)静脉点滴,1次/d。结果:治疗组在退热及疱疹消失平均天数方面均优于对照组,有效率与对照组比较差异有显著性(P<0.01)。结论:更昔洛韦与炎琥宁治疗疱疹性咽峡炎疗效显著。     

吡喹酮及阿苯达唑单用或联用抗囊尾蚴效果观察

目的　为筛选吡喹酮及阿苯达唑两种药物治疗脑囊虫病的最佳方案。方法　 1)吡喹酮单剂 ,按 2 0mg/kg·d× 6d(每日每公斤体重 2 0mg ,分 3次服用 ,共服 6天 )或 10mg/kg·d× 12d给药 ,间隔 2～ 3个月后重复第一疗程。 2 )阿苯达唑单剂 ,按 15mg/kg·d× 15d给药 ,间隔 2～ 3个月后重复第一疗程。3)阿苯达唑与吡喹酮联合用药 ,第一疗程给予阿苯达唑 2 0mg/kg·d× 12d ,后续吡喹酮30mg/kg·d×12d ,间隔 2～ 3个月后重复第一疗程。 4)吡喹酮及阿苯达唑联合递增用药 ,第一疗程给予阿苯达唑2 0mg/kg·d×12d ,后续吡喹酮 30mg/kg·d× 12d ,间隔 2～ 3个月后 ,据第一疗程服药反应和囊尾蚴感染轻重给予吡喹酮 30mg/kg·d× 12d或 5 0mg/kg·d× 12d ,2～ 3个月后再给予吡喹酮 5 0mg/kg·d×12d。结果　 1～ 4种疗法的总有效率分别为 6 8.1% ,5 5 .0 % ,96 .1%和 98.1% ,按 χ2 检验 ,1、2种疗法的总有效率差异无显著性 (P >0 .0 5 ) ,3、4种疗法的总有效率差异也无显著性 (P >0 .0 5 ) ,但 4种疗法间的总有效率差异有非常显著性 (P <0 .0 1) ,其中 3、4种疗法的总有效率明显高于 1、2种 (P <0 .0 0 5 )。结论　 4种治疗方案均有抗囊尾蚴作用 ,但联合用药的总有效率明显优于单剂疗法     

必奇冲剂与地塞米松治疗婴幼儿腹泻的疗效观察

20 0 1年 1～ 12月 ,我们选用必奇冲剂加用地塞米松针保留灌肠治疗婴幼儿腹泻 80例 ,效果满意 ,报告如下。1　资料与方法1.1　一般资料　全部为门诊腹泻患儿 ,男 4 2例 ,女 38例 ,年龄 6个月～ 3岁。均为急性腹泻 ,病程为 5 d以内。发热 36例 ,体温在 38～ 4 0℃波动 ,大便性状以稀水样便或蛋花样便为主 ,大便次数为 10～ 2 0 / d,伴有轻度或中度脱水。1.2　治疗方法　全部病例均静脉输液 ,选用头胞噻肟针10 0 mg/ (kg· d) ,丁胺卡那霉素 15 mg/ (kg· d) ,病毒唑 15 mg/(kg·d) ,同时补充液体 ,纠正水电解质平衡。观察组在以上常规治疗基…     

丹参联和甲氰咪胍佐治儿童过敏性紫癜36例疗效观察

目的:评价丹参联合甲氰咪胍对过敏性紫癜患儿的治疗效果。方法:全部病例均给予扑尔敏、维生素C治疗,伴有感染者加用敏感抗生素。腹痛明显、呕血、便血或关节肿痛者加用地塞米松静脉点滴或强的松口服,疗程1周～4周减量停用。观察组加用丹参0.5 mL/(kg·d)～1 mL/(kg·d)加入5%葡萄糖中静脉点滴,甲氰咪胍10 mg/ (kg·d)～15 mg/(kg·d)加入5%葡萄糖中静脉点滴,两药均为1次/d,使用时间均为7 d～10 d。结果:观察组优于对照组。结论:丹参联和甲氰咪胍佐治儿童过敏性紫癜取得满意疗效,值得临床推广应用。     

联合用药治疗小儿非溃疡性消化不良

目的　探讨一种治疗小儿非溃疡性消化不良 (NUD)的新方法。方法　治疗组 60例用阿莫西林、丽珠得乐、西米替丁 (甲氰咪胍 )及多潘立酮 (吗丁啉 )四联治疗 ,1个月为一疗程 (其中阿莫西林只连用 2周 )。应用剂量 :阿莫西林5 0～ 10 0mg/ (kg·d)分 3次口服 ;丽珠得乐 5～ 8mg/ (kg·d)分 3次口服 ;西米替丁 5～ 10mg/ (kg·d)晚上顿服或分早晚 2次口服 ;多潘立酮 0 3mg/ (kg·d)分 3次口服。对照组 15例 ,单用多潘立酮 1个月 ,剂量同前。结果　治疗组 1个疗程后全部患儿 ( 10 0 % )症状消失 ;对照组 1个疗程后 10例 ( 67% )症状消失 ,( χ2 =2 1 4,P <0 0 1)。结论　应用阿莫西林、丽珠得乐、西米替丁、多潘立酮四种药物联合治疗小儿NUD比单用多潘立酮疗效好。     

Bacillus Calmette-Guerins vaccination at birth causing tuberculous granulomatous lymphadenitis

A rare but severe complication of Bacillus Calmette-Guerin (BCG) vaccination is the development of BCG disease, which can result in necrotizing granulomatous lymphadenitis. Symptoms can present as late as several months following the BCG vaccination. The key finding in BCG disease is the formation of caseating granulomas in draining lymph nodes; detection of BCG organisms from tissue samples are evident.     

HTLV-I infection in selected populations in Australia and the western Pacific region.

OBJECTIVE: To report a case of progressive disease caused by Mycobacterium bovis after BCG vaccination in a patient asymptomatically infected with the human immunodeficiency virus (HIV). CLINICAL FEATURES: A 34-year-old white man about to commence employment as a developmental care worker had a BCG vaccination. Five months later, he had a positive result to a serological test for HIV antibody. Nine months after BCG vaccination, he presented with fever (38.7 degrees C), a large left axillary lymph node and a small left pleural effusion. The lymph node was biopsied and acid-fast bacilli observed in Ziehl-Neelsen stained smears. Culture grew Mycobacterium bovis (BCG). TREATMENT AND OUTCOME: He was successfully treated with isoniazid, rifampicin and ethambutol for a period of nine months. CONCLUSION: BCG vaccination of asymptomatic HIV-positive patients is not recommended. The detection of those at risk for HIV infection before vaccination administration is essential. Self-exclusion based on information supplied to all potential recipients is likely to be the most effective method.     

澳门卡介苗接种并发淋巴腺炎的病例分析

目的:本调查研究旨在通过描述卡介苗接种后并发的淋巴腺炎的婴儿临床特点和转归,探讨有关治疗方案。方法:选取接诊的25例卡介苗接种后并发的淋巴腺炎的婴儿个案,从病历中调查有关患儿的临床特点、治疗经过和转归。结果:对过去7年在澳门仁伯爵综合医院接受治疗的25名卡介苗接种后并发的淋巴腺炎的婴儿进行调查,发现84%儿童在接种后6个月内发生淋巴腺炎,16%儿童接种后7至9个月内发生淋巴腺炎,接种后平均4.4个月内发生淋巴腺炎。有36%患儿经治疗后淋巴结肿大消失,32%经观察后肿大淋巴结直径变小,有16%患儿单纯观察数月后肿大的淋巴结消失。全部病例均不需接受抗结核病药物治疗。68%病例胸部X光平片检查正常,其中8例未进行胸部X光平片检查。结论:建议治疗非化脓性卡介苗所并发的淋巴腺炎首选观察,若肿大的淋巴结脓性变,采用单纯抗生素治疗或合并切开排脓。     

Clinical characteristics and needle aspiration management of Bacillus Calmette-Guérin lymphadenitis in children

Objectives:

To describe characteristics of children developing Bacillus Calmette-Guérin (BCG) lymphadenitis, and to evaluate needle aspiration treatment.

Methods:

Children developing BCG lymphadenitis following BCG vaccination in Al-Rass General Hospital, Al-Rass, Saudi Arabia were prospectively studied from October 2008 to September 2013. Non-suppurative BCG lymphadenitis was conservatively managed, while suppurative lymphadenitis was treated by needle aspiration.

Results:

The mean (SD) age of children (n=23) was 4.1 (1.4) months, and symptoms duration was 2.08 (1.38) months. Fifteen (65.2%) children had suppurative, whereas 8 (34.8%) had non-suppurative lymphadenitis. Age, gender, birth weight, and duration of symptoms were not significantly different between children with suppurative and non-suppurative lymphadenitis (p>0.05). Children with suppurative adenitis had higher weight, and larger size of the involved lymph nodes compared with those with non-suppurative nodes (p=0.001). Most (91.3%) had axillary lesions; with a mean lymph node size of 3.2 cm. Abscesses were detected by ultrasound in 8 (80%). Non-suppurative lymphadenitis was conservatively managed, while suppurative was aspirated. The mean duration for resolution was 3.25 months. Lymph nodes aspirate were positive for acid and alcohol fast bacilli in 10 patients (66.6%), and 3 of them grew Staphylococcus aureus.

Conclusion:

Bacillus Calmette-Guérin adenitis occurs in young children, mainly as unilocular suppurative left axillary group with a mean size of 3.2 cm. Needle aspiration is safe in treatment of suppurative lymphadenitis. Mycobacteria stained positive in most of the suppurative lesions. Excision is not needed.The Bacillus Calmette-Guérin (BCG) vaccine was derived by in vitro attenuation of Mycobacterium bovis strains in 1906, and the World Health Organization (WHO) incorporated the vaccine in the Expanded Program of Immunization (EPI) in 1974.1 It is estimated that 89% of the targeted children received BCG vaccination in the year 2012.2 The efficacy of the BCG vaccine for tuberculosis protection is controversial; however, it is known to be effective against disseminated tuberculosis (TB) and tuberculous meningitis.3 The most common complication of BCG vaccination is regional lymphadenitis. In Saudi children, the incidence was reported as 1.96 per 1000.4,5 Different methods of management are recommended; however, their beneficial effects remain controversial.6 Non-suppurated lymphadenitis resolves without treatment in 4-6 months.7 In a Saudi setting, the mean age of developing BCG-related complications in lymph nodes was 4.8 months. Suppurative adenitis was treated with total excision or incision and drainage.8 Needle aspiration is infrequently studied as a mode of treatment of suppurative BCG lymphadenitis. This study aimed to describe the clinical characteristics of children developing BCG lymphadenitis and to evaluate the value of needle aspiration in treatment of the suppurative type.     

成人卡介苗（BCG）接种的临床反应性研究

目的探讨成人接种BCG的可行性及反应情况。方法对随机抽取两个乡镇中的20～55岁的健康村民进行PPD皮试，给分在研究组的接种BCG，每6个月一次，共3次。结果接种BCG的12415人中，对PPD反应阴性的3203人接种BCG后是一个正常的接种免疫反应过程，整个过程时间约2个月；对PPD反应阴性或强阳性的9212人接种BCG后24h内就有3579人发生红肿硬结，72h内又有2963人发生红肿硬结，整个过程时间约1个月；随着BCG接种次数的增多，反应强度有所降低，整个反应过程的时间有所缩短；下一次的接种有助于上一次接种创面的愈合。结论健康成人接种BCG是可行的；BCG接种对结核病有一定的治疗作用。     

淋巴结状态对食管癌术后生存的影响分析

目的 探讨食管癌根治术后淋巴结状态对预后的影响.方法 回顾性分析2004年1月～2008年3月在该院经胸行食管癌根治术,并且有随访资料的1 006例患者,分析术后淋巴结状态,应用SPSS软件,采用Kaplan-Meier方法进行生存分析,评估淋巴结状态与生存期的关系.结果 全组共检出淋巴结9 794个,转移淋巴结1 283个,总体转移度0.13;1 006例患者总体淋巴结转移率为44.4％,平均每例检出淋巴结数目为10.2个.全组术后1、3、5年生存率分别为93.9％、74.5％和55.9％.中位生存时间为82.0个月(95％ CI 51.5～112.5).影响预后的淋巴结状态为淋巴结清扫数目(负相关P =0.03),淋巴结转移数目(P=0.00),转移淋巴结区数(p=0.00),和淋巴结转移度无明显相关(P =0.33).结论 影响经胸食管癌切除术后预后的主要因素之一是淋巴结转移,淋巴结转移数目明显影响食管癌的预后,2009年第7版的AJCC分期中基于淋巴结转移数目的新法N分期标准能更好地反映食管癌切除术后患者预后的变化;过度的淋巴结清扫无助于改善预后.     

OT强阳性新兵血清抗38KDa抗体检测的意义

目的:调查新兵亚临床结核感染与OT试验强阳性的相关性,探讨军队结核病预防新措施。方法:采用ELISA和免疫层析法分别检测了10399名新兵中OT强阳性者血清抗38KDa抗体和抗LAM(脂阿拉伯甘露聚糖)抗体;对抗体阳性者作为期3个月随访和1年信访。结果:OT强阳性新兵血清抗LAM抗体均为阴性;无卡痕和有卡痕OT强阳性组血清抗38KDa抗体阳性分别有5例和1例,阳性比率分别为3.96%和0.56%,差异显著(P<0.05)。抗体阳性者3个月随访发现:无卡痕OT强阳性组有3例新兵出现结核体质特征或症状,其中2例1年内诊断为胸膜炎结核,1例因身体不适调离原工作岗位。结论:血清抗38KDa抗体水平与新兵结核菌亚临床感染有关。OT强阳性且38KDa抗体阳性新兵,应给于3个月预防性抗痨治疗。     

成人卡介苗接种后反应性分析

目的 探讨成人接种卡介苗（BeG）的可行性及反应情况。方法对随机抽取两个乡镇中的20-55岁的健康村民进行PPD皮试。根据PPD皮试反应情况分为PPD皮试反应阴性组和阳性或强阳性组，每个观察对象均接种BCG，每6个月1次，共接种3次，观察BCG接种后反应情况。结果在接种BCG的11008人中，对PPD反应阴性的2793人接种BCG后均表现为正常的接种免疫反应过程，整个过程时间约2个月；对PPD反应阳性或强阳性的8215人接种BCG后24h内有2932人发生红肿硬结。72h内有2763人发生红肿硬结，整个过程时间约1个月，随着BCG接种次数的增多。反应强度有所降低，整个反应过程的时间有所缩短，下一次的接种有助于上一次接种创面的愈合。结论健康成人接种BCG是可行的，BCG接种对结核病有一定的治疗作用。     

153例儿童结核菌素试验结果分析

目的:了解辖区儿童接种卡介苗(BCG)的效果及是否接种过BCG。方法:选择辖区内153例资料完整的入幼儿园和入学前的3岁~7岁儿童进行结核菌素(PPD)试验。采用一次性1ml无菌注射器取0.1ml即5IUPPD作左前臂内侧中下1/3交界处皮内注射,使其局部形成皮丘,48h~72h后观察硬结直径。结果:试验者中有BCG接种史139例,阳性率为85.6%;无BCG接种史的14例,阳性率为28.6%。强阳性4例,年龄分布在4岁~5岁年龄段。其中3例无BCG接种史及2例有结核病家庭史和接触史。结论:对入幼儿园和入学前儿童进行PPD试验,不仅是评价BCG接种效果的一种最直接的方法,也是发现结核病感染者的一种有效的方法。     

Assessing the risk of tuberculosis infection among healthcare workers: the Melbourne Mantoux Study. Melbourne Mantoux Study Group.

OBJECTIVE: To determine the potential prevalence of nosocomial infection with Mycobacterium tuberculosis among hospital employees in teaching hospitals in Melbourne. DESIGN: Cross-sectional survey of positive tuberculin skin test (Mantoux) responses among employees in 14 public hospitals in Melbourne, January 1996 to April 1999. PARTICIPANTS: All consenting employees in participating hospitals (4,070 healthcare and 4,298 non-healthcare workers; participation rates, 13%-66%). OUTCOME MEASURES: Prevalence of positive responses to tuberculin skin tests among healthcare and non-healthcare workers and association with employee and hospital characteristics. RESULTS: Healthcare workers were significantly more likely to have a positive tuberculin response than non-healthcare workers (19.3% versus 13.7%; odds ratio, 1.5; 95% CI, 1.3-1.7; P<0.001). Multivariable analysis revealed that age, country of birth (high versus low tuberculosis [TB] prevalence), history of BCG (bacille Calmette-Guérin) vaccination, years since last BCG, occupation (healthcare versus non-healthcare worker) and years of hospital employment were all significantly associated with a positive response. Rates of positive responses among employees varied greatly between hospitals (6%-35%). These differences were not explained by employee characteristics, hospital TB patient load (number of admissions or bed-days) or percentage of hospital patients from countries with high TB prevalence. The hospital with the highest rate of positive responses was notable for its lack of negative-pressure isolation rooms for TB patients. CONCLUSIONS: Positive tuberculin responses are relatively common among hospital employees in Melbourne, with rates varying between hospitals and being higher among healthcare than non-healthcare workers. Employee characteristics, such as age, country of birth and past BCG status, explain little of this variation. More emphasis on TB infection control measures and regular staff screening may be needed.