球囊扩张术治疗儿童良性食管狭窄

１９９４年１月～１９９６年１２月，笔者应用球囊扩张术治疗儿童各类食管良性狭窄１５例。本文结合病例及治疗中的体会就球囊扩张术治疗儿童良性食管狭窄进行讨论。临床资料：１５例中，男１１例，女４例。年龄１７天～７岁，其中＜２岁９例。因先天性食管闭锁行食管吻合术后吻合口狭窄８例；食管化学烧灼伤致瘢痕狭窄５例，其中１例食管广泛狭窄，１例上、下段食管２处狭窄；胃管代食管术后胃管段狭窄１例；Ｎｉｓｓｅｎ术后食管下端狭窄１例。扩张时年龄最小的仅１７天（食道吻合术后１２天）。除食管闭锁术后狭窄的７例正常进食母乳外，…     

先天性食管旁疝20例报告

为了回顾和评价先天性食管旁疝各种术式的治疗效果，总结近十余年中经手术治疗的食管旁疝２例。患儿男１５例，女５例，年龄３天～６．５岁。本组半数误诊为肺脓肿或其他疾病。治疗结果：２例行Ｂｅｌｓｅｙ术，均复发；１５例行Ｎｉｓｓｅｎ术，术后１例折叠过紧，１例并发回肠套叠，３例食管下段轻度狭窄，余１１例随访２～１０年，２例有折叠部分疝出；Ｔｈａｌ手术２例，近期效果好。由于该病易发生胃扭转或嵌顿，确诊后应立即手术。应注意防治Ｎｉｓｓｅｎ手术后发生折叠过紧及滑脱等并发症，Ｔｈａｌ术的近期疗效好。     

小儿贲门痉挛的外科治疗

手术治疗小儿贲门痉挛１３例。年龄５个月～１４岁。贲门狭窄最短２ｃｍ，最长４ｃｍ。行Ｈｅｌｌｅｒ术，切开贲门肌层４～５ｃｍ，胃底浆肌层１．５～２．０ｃｍ，３例加胃底折叠术。１２例术后恢复顺利，１例并发食管胸膜瘘。均治愈。术后近期吞咽困难和呕吐消失。获随访１１例，随访时间６个月～８年，９例症状消失，无复发，２例症状改善，进生冷食物或进食快时仍有呕吐。食管吞钡Ｘ线检查９例，７例通过顺利，无返流，１例有返流，１例贲门口仍有狭窄。Ｈｅｌｌｅｒ术治疗小儿贲门痉挛有较好的效果。     

小儿食管良性狭窄的诊断与外科治疗

小儿食管良性狭窄２６例，经手术、病理证实属气管软骨迷入型１６例（６１．５％），胃粘膜异位型２例（７．７％），肌层增生肥厚型３例（１１．５％），Ａｌｌｉｓｏｎ－Ｊｏｈｎｓｔｏｎ狭窄合并食管裂孔疝及返流者４例（１５．４％），Ｓｃｈａｔｚｋｉ纤维环性狭窄１例（３．９％）。由于病因和狭窄程度不同，诊治方法各异。结合本组病例特点，就诊断与外科治疗问题进行讨论。     

小儿先天性短食管5例报告

小儿先天性短食管是一种较少见的疾病，我院从１９９１～１９９６年共收治５例，现报告如下。１临床资料一般资料：５例中男性４例，女性１例。年龄１～２岁。３例出生后即有呕吐，２例生后半年出现呕吐，均于进食后１０～３０分钟左右发生，吐物为食物。５例患儿发育及营...     

小儿食管化学烧伤性狭窄的外科处理

因误吞强碱、强酸等导致食管化学烧伤性狭窄患儿１８例。年龄１－８岁，病程平均５个月。累及食管上段者６例，中下段者１２例。全部患儿均施行胃造瘘术支持治疗，择期行食管扩张术１２例，各种术式修复６例。１８例中１０例获得随访。本组经验表明：伤后早期激素和抗生素治疗可防严重瘢痕狭窄的形成；年龄小、部位高、狭窄段短者尽早施行食管扩张有效；晚期有不开胸、顺蠕动、颈段食管与回肠腔径相近易于吻合无吻合口瘘之虑等优点，     

横结肠代食管在食管瘢痕狭窄患儿中的应用

目的探讨小儿食管化学烧伤瘢痕狭窄36例外科治疗的疗效。方法采用结肠左动脉升支供血，横结肠代食管结肠颈部吻合或结肠咽吻合。结果颈部吻合口瘘、吻合口狭窄各3例。术后气管切开2例，经治疗后顺利进食，无手术死亡。结论对食管瘢痕狭窄小儿应积极采取食管重建术。食管替代物以横结肠为最佳。     

正常小儿近端食管功能的测压研究

目的：探讨正常小儿近端食管测压的特点，方法：应用计算机消化道测压系统，对６０例正常小儿进行了食管测压，年龄３～１２岁。结果；咽部静息压为０．６７±０．１９ｋＰａ。吞咽收缩压力为１．９９±０．５７ｋＰａ，收缩时间０．５秒，近端食管括约肌（ＵＥＳ）压力随小儿状态不同有很大差异，ＵＥＳ静息压为２．６６～１０．６４ｋＰａ，ＵＥＳ收缩压为７．９８～１５．９６ｋＰａ，近端食管括约肌长度（ＵＥＳＬ）为１．５０±     

译文摘要

译文摘要儿童结肠血管发育异常作者报道１９７０～１９９３年９例结肠血管发育异常的患儿，发病年龄为１～１ｌ岁（平均２．３岁），其中０例症状出现于１岁前。诊断年龄为１岁５个月～１３岁（平均５．３岁），平均延误诊断２．９年。９例患儿都有便血，其中３例黑便，血...     

婴幼儿食管瘢痕狭窄的外科治疗

目的：回顾性分析婴幼儿食管良性狭窄30例外科治疗结果。探讨外科治疗各种方法的优劣。方法：30例中男20例，女10例。年龄1岁5个月-5岁，平均29个月。体重5-20kg。除1例为农药烧伤外，余均为误服强酸、碱烧伤。颈段食管完全闭塞3例，基本闭塞5例，余食管造影均见钡剂在食管全长呈不规则线样通过、其中5例伤后曾有时间不等声嘶及吸气性呼吸困难，6例在外院行胃造瘘，全部病例采用保留结肠左动脉升支供血，经胸骨后径路顺蠕动吻合横结肠代食管结肠颈部吻合或结肠咽吻合。结果：手术后颈部吻合口瘘1例，吻合口狭窄1例。术后气管切开1例，经治疗后顺利进食，无手术死亡。经4-20余年随访，患儿发育正常。结论：主张对的食管瘢痕狭窄应积极采取食管重建术。食管替代物中以横结肠为最佳。同期食管瘢痕切除食管的危险性大，手术应以食管旷置为佳。重建平面需在颈部或咽部，不主张任何形式的胸内吻合。     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

氨磷汀在儿童肿瘤化疗中的应用

目的研究氨磷汀在儿童肿瘤化疗中的作用及不良反应。方法随机选择肿瘤32例患儿,采用自身对照,观察患儿在同一化疗方案中使用氨磷汀辅助治疗后黏膜损伤、骨髓抑制时间、发热持续时间、抗生素及刺激因子应用时间及氨磷汀的不良反应。结果氨磷汀辅助治疗组发生黏膜溃疡4例,明显低于对照组9例;中性粒细胞<0.5×109/L持续时间缩短,血小板<5×109/L持续时间缩短;发热持续时间、抗生素和刺激因子应用时间缩短。两组化疗过程中均未出现低体温、皮疹、低血压等情况,化疗后肾功能、心电图均正常;对肝功能影响程度相似;氨磷汀组低钙血症尤其是低钙性抽搐发生率高。结论氨磷汀能够有效保护正常组织细胞,不良反应较低,可在儿童肿瘤患者化疗中应用。     

Determinants of pregnancy in adolescents in Nepal

Objective : Social factors and prevalent norms in the community determine the proportion of teenage pregnancy in the community. In the light of high risk associated with teenage pregnancy, the socio-cultural determinants, which influence the conception among teenagers in Nepal, need to be understood. These determinants may be modified by suitable interventions to reduce teenage pregnancy. Aim of this study was to examine the socio-cultural determinants of teenage pregnancy in eastern Nepal.Methods : A case-control study design was selected for comparing the education, economic status, family support and freedom towards conception among teenagers as compared to higher age group women.Result : Seventy adolescent pregnant women were compared with seventy primigravida women in the 20 to 29 years age group. The teenage pregnant women were less educated, had poor economic background, more likely to have accidental pregnancies as compared to the other group and more likely to have love marriages. Husbands were more likely to decide about continuation of pregnancy. They had less psychological and social support from the family.Conclusion : Marriage at young age and pregnancy during teens are associated with less social acceptance and poor support in the family.     

皮质激素在癫痫治疗中的应用

皮质激素在癫痫中的应用已有近50a的历史，现已证明其对某些癫痫综合征如婴儿痉挛症、Landau—Kleffner综合征、Rassmussen综合征、具有睡眠中癫痫性电持续状态的癫痫综合征等具有肯定的治疗作用，其确切的作用机制尚不清楚。在皮质激素应用过程中应注意其不良反应。     

Role of nutrients in the regulation of in vivo protein metabolism in humans

Nutrients regulate protein metabolism both in an acute fashion and on a long-term basis. The ingestion of meals is associated with a dramatic switch from an overall catabolic state to a state of net protein anabolism. The acute response of protein metabolism to meal ingestion is mediated, in part, by an increase in insulin secretion, itself a consequence of glucose absorption. Whereas insulin may primarily suppress rates of proteolysis, amino acids are responsible for the stimulation of protein synthesis that follows food intake. In the long run, the effects of nutrition on protein metabolism depend on the energy supply, the source of the energy (carbohydrate versus fat) and dietary protein intake. Finally, specific amino acids, such as glutamine, may play an additional role as protein anabolic agents.     

他汀类药物在儿童家族性高胆固醇血症治疗中的研究进展

家族性高胆固醇血症(FH)是一种常染色体显性遗传的脂质代谢障碍疾病,由于FH早期就可引起动脉粥样硬化病变,增加患者严重心血管疾病的患病风险和死亡风险,因此目前越来越强调患者自儿童期就使用他汀类药物进行治疗,以改善远期预后。文章综述他汀类药物治疗儿童FH的必要性、有效性和安全性,同时也提出目前存在的一些问题和思考。     

Diagnosis of Chlamydia pneumoniae in community-acquired pneumonia in children in Chile

The incidence of Chlamydia pneumoniae in community-acquired pneumonia in children was studied prospectively in 112 children aged 1 mo to 14 y. Diagnosis of C. pneumoniae was performed by polymerase chain reaction (PCR) on nasopharyngeal aspirates and serology by the microimmunofluorescence test on a single serum specimen. Three (2.7%) cases of pneumonia due to this agent were diagnosed by both PCR and serology. C. pneumoniae was not found in any of 62 children below 5 y of age. In the age group 5-8 y, only 1/30 (3%) was found positive, and in the age group 9-14 y, C. pneumoniae was diagnosed in 2/20 (10%) children. Conclusion: Although the number of enrolled patients is small, and the diagnostic techniques used may have some limitations, the results of this study suggest that C. pneumoniae plays a minor role in the aetiology of pneumonia in children less than 9 y of age in our country. However, it should be considered as a potential agent in pneumonia in older children.     

Efficacy of amphotericin B in multi-drug resistant kala-azar in children in first decade of life

Fifty children in the first decade of life, and suffering from multiple drug resistant kala-azar, confirmed by demonstration of amastigotes in aspirates of bone marrow or spleen were treated with amphotericin B in gradually increasing dosage to a total dose of 20 mg/kg. All patients had classical features of severe kala-azar, and had taken more than one course of antimony and pentamidine, and three patients had taken one additional course of ketoconazole besides many courses of antimony and pentamidine. The clinical response started just after first infusion in 8 patients, and the patients became afebrile. By 5th infusion, all looked better and 18 patients became afebrile. By 15th infusion all patients were afebrile and cheerful. Their spleens became smaller and body weights and total white cell counts increased. Forty eight patients had parasitological cure at the end of treatment, and only 2 patients required an additional 5 infusions for parasitological cure. All patients were ultimately cured. No one relapsed within six months of follow up. All patients had shivering, rigor and rise of temperature on the day of infusion, which could be minimized with prior administration of low dose of hydrocortisone, but could not be eliminated. Eighteen patients had loose motions during treatment, while 14 patients had decrease in appetite which improved quickly when the treatment was over. Fourteen patients had transient rise of blood urea, in six patients serum creatinine also increased and 16 patients had a minor fall in serum potassium. It is concluded that amphotericin B is a very effective drug for multidrug resistant kala-azar in children, and should be used without hesitation in all such cases in children, but under close medical supervision.