阴沟肠杆菌致新生儿化脓性脑膜炎1例

<正>患儿,女,26d,因吐奶1d,反复右手、右足抽搐18h入院。患儿系G2P1,42+1周孕,自然分娩,产重3950g,单胎,无宫内窘迫,胎膜早破4h,羊水粪染III°,重量约500ml。入院前1d,患儿无明显诱因出现喷射性吐奶,约10ml～15ml。入院前18h,患儿出现反复尖叫,同时右手、右足、双眼眼睑抽动,每     

胎粪性腹膜炎误诊1例报告

患者．男．４２天．生后一周反复腹胀．加重２天入院。患儿出生后一周开始腹胀并逐渐加剧时伴呕吐,无热。在本市儿童医院住院称“肠胀气”经抗感染,胃肠减压处理好转出院。出院后数日。无任何诱因腹胀又出现并渐加重时有吐奶,于我院就诊收住院。患儿病后吃奶尚好,大便黄色糊状２～３次／日,尿正常、不发热。患儿系孕１产１,足月剖腹产,出生体重３０００ｇ,出生时无窒息缺氧,生后排过胎便,母乳喂养。家族史无特殊。体格检查;营养欠良．面色稍显苍白,前囟平坦、口唇干、咽不红、心率１２６次／分、心音有力、节律整齐、无杂音．双…     

新生儿硬肿症合并急性坏死性小肠结肠炎1例分析

1 临床资料 患儿,男,17天。2000年9月4日因“发热14天、腹胀、呕吐、大量血便二天”入院。患儿足月顺产,旧法接生,以未消毒剪刀断脐,产后青紫窒息五分钟。生后3天开始发热,腹泻、腹胀、大便呈现黄色水样便,带奶瓣。同时呕吐、拒奶、嗜睡,在本院门诊给予对症治疗后症状减轻,尚能进少量奶,吸吮有力,未引起家长重视。于入院前两天出现腹胀,呕吐加重,大量血便,即再     

10例先天性肠闭锁患儿术后肠内营养的应用

目的 研究先天性肠闭锁患儿术后营养状况的变化及干预措施.方法 对10例先天性肠闭锁行肠切除术后患儿的营养状况进行随访,当患儿出现呕吐、腹胀、腹泻等情况,估计存在经口摄入不足、肠吸收不良、腹泻病以及不能耐受分次喂养时给予24 h持续胃管喂养,对比观察肠内营养前后的体重变化并进行随访.结果 采用24 h持续胃管喂养的患儿呕吐、腹胀消失,90%患儿体重增加、10%体重不变,66.7%患儿腹泻治愈、33.3%好转,全部患儿能耐受分次喂养而出院.结论 持续胃管喂养用于先天性肠闭锁术后患儿,可以促进腹泻治愈,改善肠吸收不良状况及营养状况,是一种经济、有效的营养治疗方法.     

芬兰型先天性肾病综合征1例报道

男性患儿,出生5+ d,因“发现尿蛋白明显升高5+ d”入院。患儿系36+4周早产儿,产时伴羊水Ⅲ°胎粪污染、胎盘增大,生后即发现蛋白尿、低蛋白血症、进行性加重的水肿;全外显子基因检测提示患儿存在NPHS1的2个杂合突变位点,c.3325C>T（p.Arg1109*）和c.2479C>T（p.Arg827*）复杂杂合突变,诊断为芬兰型先天性肾病综合征（congenital nephrotic syndrome of the Finnish type, CNF）,其中c.2479C>T（p.Arg827*）基因突变位点国内未见报道。本次报道的c.2479C>T突变基因对国内CNF基因突变谱进行了扩充,原因不明的先天性肾病综合征（congenital nephrotic syndrome, CNS）建议早期行基因检测,CNS的早期诊断对预后评估、遗传咨询及临床管理具有重要意义。     

川崎病合并肠梗阻和脓毒症1例

1 病例资料 患儿,女, 1岁4个月,因"发热4 d,皮疹1 d"于2021年7月入广东省妇幼保健院儿科治疗.入院4d前出现反复中高热,偶有单声咳嗽、流清涕,无呕吐、腹泻、腹胀.先后予奥司他韦、头孢克洛及头孢克肟治疗,效果欠佳.入院体格检查:体温39.3℃,脉搏125次/min,呼吸频率35次/min,体重9.3 kg...     

排尿障碍,血尿,腹部肿块

<正> 病历摘要患儿,女,8天,住院号91750。因排尿困难8d,血尿2d 于1990年7月7日入西安市儿童医院。患儿2胎2产,孕41周顺产。生后Apgar 评分1min时10分,5min10分。生后12h 排胎便,未排尿。人工喂养,吸吮力强。生后第3d 仍未排尿,并出现喷射状呕吐,吐物为奶块及咖啡样液体,量多,经当地医院洗胃、止血处理后好转。入院前4d 仍未排尿,腹胀,压迫下腹部则有尿排出一,尿外观清亮,排尿后腹胀稍减。入院前2d 腹胀加重伴呕吐,呈喷射状,吐物为奶块,量多,同时伴腹泻,日4～6次,呈绿色或墨绿色稀便,量多,吃奶     

奶变态反应性腹泻可能作为轮状病毒感染的诱因一例报告

患儿、1980年1月17日剖腹产娩出,体重3,380g,人工喂养1周后出院。从出生后18日开始腹泻与呕吐,第3日腹泻黄色大便3～4次,呕吐2～3次,第5日腹泻8次,呕吐2～3次伴有发热,脱水,脸色不佳而入院。入院后次日腹泻增至15～20次,经输液后好转。生后18日开始腹泻持续至39日,经静脉营养补液和以豆浆代替奶治疗腹泻,病情稳定,但一旦试用奶喂养时又发生腹泻,反复3次,诊断为奶变态反应性腹泻,肠病理活检结果与奶变态反应性腹泻的病理改变相符。出生后第26、30、32、36、44日分别检查忠婴的粪便,用酶联抗体法(enzyme-linked immunozor bent assay)均检出轮状病毒抗原,考虑到新生儿的免疫功能尚未成熟,新生儿时期暴露轮状病毒的可能性大,奶变态反应性腹泻考虑可为轮状病毒感染的诱因。     

先天性小结肠症1例

患儿,女,2天,体重3kg ,足月顺产。生后4小时开始呕吐、腹胀,未排胎便。生后无窒息,母孕期无异常。查体:反应尚好,心肺(- ) ,腹胀明显,肝脾不大,肠鸣音1～2次 min ,神经系统无异常。灌肠后胎粪排出,可进奶。4小时后又开始呕吐,无自行排便。腹平片示:左腹及中下腹肠腔明显胀气扩张,有数个液平。钡剂灌肠示:乙状结肠至盲肠肠管普遍变细,呈蚯蚓状,宽约0 .7cm ,肠袋变浅,部分消失,蠕动消失,加压后仍不见肠管扩张,直肠正常。诊断:先天性小结肠症。给予静脉营养1周,渐改母乳喂养,用开塞露或灌肠刺激排便1～3次d。住院3周,患儿有时可自行排便,出院。…     

新生儿呕吐的观察及护理

呕吐是新生儿常见的临床症状之一,可由多种原因引起。2年来,经过新生儿62例呕吐的观察,得到一些经验和教训,现介绍如下。1临床常见的呕吐种类1.1呕吐羊水出生当天或次日呕吐,吐出物为泡沫状浅黄色或咖啡色液,吐净后可自行缓解。1.2溢奶喂食后侧卧口边溢出奶液,见于母乳量较充足的新生儿。1.3喂养不当水平式卧位喂奶,致大量空气吞入,牛奶太冷太热,奶咀孔太大奶流过急,吞咽过快等均可致喂奶后呕吐。1.4食道闭锁进食后即吐,吐奶液,口中常流出大量黏液,多发生青紫窒息。1.5幽门痉挛新生儿幽门功能暂时性失调,喂奶后短时间内即呕吐,吐物多为奶液。1.6巨结肠生后3d~4d出现呕吐,腹部膨隆,呕吐物中有胆汁和粪汁,无胎便或很少。1.7肛门闭锁生后无胎便,24h后出现呕吐、腹胀,呕吐频繁呈喷射状,呕吐物混有胆汁粪汁,腹胀严重不见缓解。1.8胎便性肠梗阻出生后呕吐、腹胀,先吐奶后吐胆汁,腹部肠型明显,胎便少。2对新生儿呕吐的观察2.1对呕吐时间及呕吐物性状特点的观察一般来说,生后3d~5d内出现呕吐,多为先天因素所致。其中羊水吸入、喂养不当、食道闭锁等疾患最早出现呕吐。生后5天以后出现呕吐,除了考虑先天因素外,还要考虑有感染的可能...     

益宫颗粒促进子宫复旧及泌乳的临床分析

目的探讨益宫颗粒促进产后子宫复旧的临床疗效和安全性。方法将2011年10月～2012年6月在北京市回民医院以剖宫产分娩的初产妇116例随机分为观察组和对照组,每组58例,术后两组均常规给予补液抗炎、缩宫剂等治疗,观察组产妇于产后第1天开始服用益宫颗粒,7 d为1个疗程。比较两组产妇平均恶露量、恶露干净天数、子宫底下降高度、B超子宫大小、乳汁分泌量及新生儿呕吐、新生儿皮疹、新生儿黄疸、新生儿腹胀腹泻等情况。结果在平均恶露量、恶露干净天数、子宫底下降高度、B超子宫大小、乳汁分泌量等方面,观察组与对照组比较差异有统计学意义（P〈0.05）;新生儿在哺乳期间恶心呕吐、皮疹、腹胀腹泻、黄疸指数升高方面,两组比较差异无统计学意义（P〉0.05）。结论益宫颗粒能明显促进剖宫产术后子宫复旧及产后泌乳,对新生儿无不良影响,具有服用简便、安全性高等特点,值得临床推广应用。     

1例来自孟加拉国的青蒿素耐药恶性疟病例分析

收集并分析了联合国驻刚果(金)稳定特派团中国二级医院于2021年2月20日收治的1例来自孟加拉国的青蒿素耐药恶性疟病例的临床资料和实验室检查,讨论了青蒿素耐药目前的现状及相关治疗,为救治青蒿素耐药恶性疟提供思路.该患者主因"高热伴腹痛,呕吐3d"入院.自诉曾3次得过"疟疾"并痊愈.入院前曾在乌维拉一级医院接受过蒿甲醚治...     

Norovirus gastroenteritis accompanied by ischemic colitis: a case report

A 57-year-old woman was admitted to our hospital because of frequent bloody diarrhea, vomiting, and abdominal cramps. While the patient was diagnosed with norovirus gastroenteritis based on the presence by chance of positive norovirus antigen in the stool samples, endoscopic as well as pathological examinations demonstrated left-sided ischemic colitis. The patient soon recovered solely by supportive treatment. Although it is believed that patients with viral gastroenteritis do not develop bloody diarrhea, the present case suggested that conditions of viral gastroenteritis, such as intensified peristalsis, elevation of the intraluminal gut pressure, hypovolemia, and hemoconcentration might trigger ischemic colitis resulting in bloody diarrhea. Physicians should not exclude the diagnosis of viral gastroenteritis simply by depending on the presence of bloody diarrhea. Further studies to clarify the incidence of ischemic colitis in patients with viral gastroenteritis are indispensable.     

由KLHL3新基因突变所致假性醛固酮减少症Ⅱ型1例报告

患者，女，41岁，因“发现血钾升高18 d”入院。入院前18 d患者在外院住院期间查见血钾升高，予以对症处理，血钾正常后出院，因出院后反复血钾升高来我院就诊。患者有“急性肾炎”及“妊娠高血压”病史；入院半年前发现血压轻度升高未予干预。其父亲有“高血压、糖尿病”病史。入院后实验室检查发现患者具有高钾血症、高氯血症、代谢性酸中毒、血浆肾素水平低下但醛固酮水平正常等特点，基因检测发现KLHL3（Kelch like family member 3）基因出现一个c.1115delG新突变，从而确诊为假性醛固酮减少症Ⅱ型。给予间断性规律盐酸氢氯噻嗪口服治疗，患者血清电解质水平、血pH及BE、BEB恢复正常范围，随访12个月，患者无不适。     

TORSION OF AN OVARIAN CYST COMPLICATING PRFGNAN CY A CASE REPORT

A female patient, aged 24, Hospital number 108916, was admitted to the St. Eliza_ beth''s Hospital on November 24, 1943, with the complaint of intermittent attacks of dull aching pain over the left iliac region for 3 days, and amenorrhoea for 5 months. Star- ting at 3 a. m. on November 21, the patient was awakened by a sudden pain in the left iliac region accoppanied by a sense of severe abdominal distensiom This pain lasted for about seven hours, disappeared and returned for another few hours. Patient had about six such attacks on the first day, each lasting for a few hours. There was no fever, no nausea and no vomiting. On the second day the pain became more severe and con- tinuous. Late in the evening, a doctor was called in and the patient received an injec- tion which she believed to be morphine. This relieved her only for a few hours. On the third day, the pain became unbearable; she began to have nausea and vomiting. She then came to this hospital. On the day of admission she had three attacks of vomiting. There was no vaginal bleeding tbroughout. Patient was constipated for four days.     

妊娠合并嗜铬细胞瘤1例

患者,女性,27岁,平素月经规律,末次月经2014年1月6日,预产期2014年10月13日。停经8周出现恶心、呕吐等早孕反应,较剧烈,持续至孕4个月,于当地医院查尿酮体间断阳性,予补液等治疗后好转。停经25周查空腹血糖5.57 mmol/L,诊断为妊娠期糖尿病,经运动、饮食控制后血糖基本达标。1个月前无明显诱因自觉胸闷,出现间断发热、出汗,伴恶心、呕吐、心悸、头晕,每日发作约10余次,渐频繁,就诊外院查血压145/100 mmHg（1 mmHg=0.133 kPa）, 后复查血压正常。2周前因起身时晕厥就诊外院,予补液治疗,1 d前无明显诱因出现胸闷、喘憋,平卧时加重,血压175/100 mmHg,尿蛋白（+++）,考虑重度子痫前期,给予解痉、降压、补液治疗。腹部超声提示腹腔占位,性质待查,以“重度子痫前期,腹部包块性质待查”转诊入北京大学人民医院。     

肾移植术后双侧乳头状肾癌1例

With the continuous development of kidney transplantation technique, the survival time after kidney transplantation is gradually prolonged. Thus, the malignant tumor has been the important influencing factor on the long-term survival for kidney transplantation patients. Renal cell carcinoma is a relatively common tumor after kidney transplantation. Besides, clear cell renal cell carcinoma and papillary renal cell carcinoma are the relatively common pathological types for renal cell carcinoma following kidney transplantation. However, bilateral renal cell carcinoma following kidney transplantation is comparatively rare. In this article, we presented a case of bilateral papillary renal cell carcinoma, which occurred after kidney transplantation. And the diagnosis and treatment were introduced in detail. The patient was 37 years old, and he underwent kidney transplantation 13 years ago in our hospital, because of kidney failure. After kidney transplantation, he had regular medical check-up every year. In this year, his urological ultrasound results indicated bilateral renal tumors. And then, he received abdominal and pelvic computed tomography, and the result also showed bilateral renal tumors, which were likely to be malignant tumors. After adequate consultation, the patient chose surgical treatment. The patient received long-term immunosuppressive therapy, because of kidney transplantation. Considering this, the surgeon decided to choose a staging surgical treatment, in order to reduce the bad influence of one-stage surgery. Then, the patient first underwent retroperitoneal laparoscopic radical nephrectomy for right renal tumor in our hospital, and he had no complications after operation. The pathological results showed papillary renal cell carcinoma. He was discharged successfully. He underwent retroperitoneal laparoscopic radical nephrectomy for left renal tumor in our hospital one month later, and he had no complications after operation. The pathological results also showed papillary renal cell carcinoma. He was discharged successfully two days after surgery. In the 3-month follow-up, the patient was recovering well. To sum up, the incidence of bilateral renal cell carcinoma following kidney transplantation is relatively rare, and bilateral radical nephrectomy is effective and safe treatment. Above all, it is the patient''s condition that determines the choice of staging surgery or simultaneous surgery.     

集束干预护理在危重患者肠内营养的临床应用

目的:通过对危重患者胃肠内营养进行集束干预管理(Bundle of Care),降低肠内营养(enteral nutrition,EN)并发症,提高危重患者EN的耐受性。方法:选取2011年1月～2011年6月,我院ICU进行EN治疗的112例危重患者(APACHEⅡ评分≥15分)作为研究组,同时选择2009年入住我院ICU行EN治疗的危重患者128例作为常规护理对照组,进行集束化护理的临床病例研究。集束干预护理包括:接受EN患者均给予半卧位,床头抬高30～45度;定时回抽胃内容物,测定胃残液量;防止误吸,预防堵管,预防腹泻措施等综合护理干预措施,分别统计两组腹泻、腹痛、腹胀、恶心、呕吐、误吸等并发症的发生率。结果:危重患者EN并发症对照组为14.06%,研究组为3.57%。差异有统计学意义(P<0.05)。结论:实施集束干预管理对提高危重患者EN耐受性,降低并发症有促进作用。     

Post-Gastrectomy Problems in Patients with Personality Defects: The “Albatross” Syndrome

Of a series of 130 patients undergoing operation for peptic ulcer disease at the Vancouver General Hospital, seven patients with personality defects had a disastrous outcome after operation.

The main features of this postgastrectomy syndrome were remarkably similar: persistent abdominal pain without demonstrable cause, intermittent and inexplicable nausea and vomiting, continued analgesic drug dependence and marked nutritional deficiencies. The high incidence was surprising and was not confined to any particular socioeconomic group. Such patients fall into three groups: those with true ulcer disease, those with salicylate addiction, and those without positive signs of ulcer but with chronic complaints. A history of a personality defect should warn the surgeon, and operation should be performed only for the complications of true ulcer disease. Though operation may cure the ulcer, the patient is worse off because the resulting physiologic derangements cannot be accepted or handled by him. These patients continue to haunt the surgeon, and the syndrome has been named the “albatross” syndrome.

     

自身免疫性淋巴细胞增生综合征1例并文献复习

报道2013年10月北京大学第一医院诊治的1例自身免疫性淋巴细胞增生综合征（autoimmune lymphoproliferative syndrome,ALPS）的临床诊疗过程,并复习国内外最新文献。该男性患儿就诊时为11个月,生后早期起病,病程中主要表现为淋巴结、肝脾肿大,伴溶血性贫血、慢性感染（巨细胞病毒、细小病毒B19感染以及慢性腹泻）,外周血双阴性T细胞（double negative T cells,DNTs）明显升高（占淋巴细胞的27.18%,CD3+T淋巴细胞的35.16%）,多种自身抗体阳性（包括抗核抗体、双链DNA、类风湿因子）以及高丙种球蛋白血症。父母双方均体健,否认自身免疫性疾病病史。经基因诊断提示存在FAS基因c.309A＞C杂合突变,位于FAS基因3号外显子,导致FAS蛋白第103位氨基酸由精氨酸（R）突变为丝氨酸（S）。但基因结果仍需进一步验证父母双方基因及正常对照,明确是否为致病基因。该患儿临床经过糖皮质激素治疗,并在外院接受霉酚酸酯治疗,贫血改善,仍有反复感染,肝脾回缩但未至正常。ALPS的特征是编码细胞Fas/FasL凋亡途径的基因发生突变引起的一组临床症候群,特点突出,早期容易误诊为其他疾病,需对外周血淋巴细胞进行分析,治疗手段主要依赖于免疫抑制剂治疗。