Features of pediatric head injury in Hong Kong

Head injury in children causes special concern in most communities. From 1989 to 1994, 2,785 children younger than 16 years old were admitted to our neurosurgical service because of head injury. Fall from a height was the major cause of head injury leading to admission in infants and children in preschool age groups, whereas traffic-related or bicycle-related accidents were more likely to be the cause of head injury for those aged 11–15 years. In all age groups there was a male preponderance. The overall mortality was 0.6%. Traffic-ralated accidents caused more severe injury and accounted for 67% of all fatalities. For patients under 6 years old, about 40% of head injuries occurred at home. Preventive measures for pediatric head injury in Hong Kong are suggested.     

Characteristics of children and their families at entry into foster care

This study provides an overview of children, their families, and their circumstances at the time that the child entered foster care in Israel. Data regarding a representative sample of 800 children were collected as part of the ongoing operation of a clinical information system set up for Israel's foster care service in 1988. Implications of our findings for interventions are discussed.     

8～12岁单纯性肥胖儿童心功能研究

利用多导生理仪，同步记录心电图、心音图、颈动脉搏动图和心阻抗微分图，测试８～１２岁肥胖儿童９４名，对照组儿童７６名，分析比较有关心功能数据。结果显示肥胖儿童收缩压、舒张压、平均动脉压、左室射血时间和心搏出量高于对照组儿童，心输出量与对照组比较差异无显著性，心功能指数低于对照组儿童。提示肥胖儿童由于回心血量增加，血压增高，而使心脏前、后负荷加重，心肌收缩力代偿性增强，单位体表面积心输出量下降，部分心功能指标已受到影响。     

Sterile surgical technique for shunt placement reduces the shunt infection rate in children: preliminary analysis of a prospective protocol in 115 consecutive procedures

Objective The objective of this study was to evaluate whether the rigid application of a sterile protocol for shunt placement was applicable on a routine basis and allowed the reduction of shunt infections (SI) in children. Materials and methods Since 2001, a rigid sterile protocol for shunt placement in children using neither antibiotic-impregnated catheters nor laminar airflow was prospectively applied at Erasme Hospital, Brussels, Belgium. For assessing the protocol efficacy before continuation, we preliminarily analyzed the results of the first 100 operated children (43 females, 57 males, 49 aged <12 months; 115 consecutive shunt placement/revision procedures). All procedures were performed by the same senior surgeon, one assistant, one circulating nurse, one anesthesiologist. The sterile protocol was rigidly imposed to these four staff members: uniformed surgical technique; limited implant and skin edge manipulation; minimized human circulation in the room; scheduling surgery as first morning operation; avoiding postoperative cerebrospinal fluid (CSF) leak; double gloving; procedures of less than 30-min duration; systemic antibiotics prophylaxis. We analyzed separately: (1) children carrying an increased risk of SI (n = 38) due to preoperative external ventricular drainage, CSF leak, meningitis, glucocorticoids, chemotherapy; (2) children aged <12 months; (3) procedures for shunt revision. Results Errors in protocol application were recorded in 71/115 procedures. They were mainly done by non-surgical staff, decreased with time and were medically justified in some young children. Surprisingly, no SI occurred (follow-up, 4 to 70 months). One child developed an appendicitis with peritonitis (Streptococcus faecalis) after 6 months. No SI was found. After peritonitis was cured, shunt reinsertion was uneventful. Conclusion These preliminary results suggest that a uniform and drastic sterile surgical technique for shunt placement: (1) can be rigidly applied on a routine basis; (2) can lower the early SI rate below 1%; (3) might have a stronger impact to reduce SI than using antibiotic-impregnated catheters and optimizing the operative environment such as using laminar airflow and reducing the non-surgical staff. This last issue will be evaluated further in the present ongoing protocol.     

小儿纵隔肠源性囊肿影像学表现及分析

目的 分析小儿纵隔肠源性囊肿及其并发症的影像学表现及诊断。资料与方法 回顾性分析经手术病理证实的8例小儿纵隔肠源性、神经肠源性囊肿及其并发畸形、感染及出血时的影像学表现。结果 小儿纵隔肠源性囊肿多位于中后纵隔，呈圆形或椭圆形，密度均匀，边缘清楚。较大时可占据一侧胸腔的大部分。并发感染时囊肿壁模糊，囊内密度增高；囊肿穿孔后可与支气管相通，引起吸入性肺炎及咯血。神经肠源性囊肿均存在脊椎畸形。25％病例同时存在腹部肠重复畸形。结论 小儿纵隔肠源性囊肿少见，除囊肿本身的特点以外，还须注意其他伴发征象，诊断应依靠临床和综合影像学分析。     

Following Catastrophic Epilepsy Patients from Childhood to Adulthood

Summary:  As patients with catastrophic epilepsies move from childhood to adulthood, evolving and innovative therapeutic regimens are often required. However, the goal of providing the best quality of life while minimizing both seizures and side effects remains the same. Clinicians can develop appropriate care plans by being aware of patients' changing needs. Clinical symptoms of the catastrophic epilepsies may change over time; by understanding the natural history of a patient's condition, clinicians can help ease the transition from childhood to adulthood. Additionally, as children with catastrophic epilepsies become adults, medical issues (e.g., medication side effects, tolerance, and dependence) and nonmedical issues (e.g., guardian/caretaker issue, group home applications, and respite care options) must be considered when developing strategies for patient care. Regular assessment of patients, the development of emergency plans, and maintenance of consistency in the delivery of care are also important issues to consider. Finally, a multidisciplinary care plan that incorporates resources from health-care practitioners, social service professionals, and community agencies can be valuable in optimizing treatment for patients with catastrophic epilepsies.     

深圳南山0～2岁儿童营养状况及其影响因素的调查研究

目的 了解深圳南山0～2岁儿童营养状况及影响因素。方法 Z评分法、NCHS标准评价儿童营养,检测血红蛋白和血Cu、Fe、Zn、Ca、Mg、P,问卷调查有关社会环境因素。结果 深圳南山0～2岁儿童营养不良率为8.08％。常住儿童与暂住儿童营养不良率间差别有显著性意义(P<0.01)。营养不良的影响因素:儿童户籍是否常、暂住,膳食结构中谷类食物量,婴儿期是否母乳喂养。儿童年龄与贫血患病率间存在一定线性依从关系(P<0.01),暂住与常住儿童贫血患病率间差别有显著性意义(尸<0.05)。235名儿童的血Cu、Mg值均正常,而儿童缺Ca、Zn、P、Fe的发生率分别为71.06％、54.89％、22.12％和6.8％。结论 我区0～2岁儿童营养状况不容乐观,尤其暂住儿童更是高危人群。我们在重点营养干预同时,要注意改善整体儿童营养状况。     

Obesity of Czech children and adolescents: relation to parental obesity and socioeconomic factors

The purpose of this study was to estimate the change in overweight and obesity prevalence and the influence of socioeconomic status and parental obesity on overweight and obesity of children and adolescents in the Czech Republic. The roles of family history of obesity, dietary factors and physical activity were evaluated. The quota sample of 1,417 children and adolescents aged 6.00–17.99 years was examined in November 2005 as a part of the survey Lifestyle and Obesity. The quota sample was nationally representative, and subjects were selected according to the gender, age, region, size of residential location and education of parents. In the subjects weight, height and waist circumferences were measured and BMI was calculated. Food intake and physical activity were estimated by food frequency and physical activity questionnaires. The results were compared with the data from the 6th National Anthropological Survey of Children and Adolescents 2001, the Czech Republic. The data was evaluated by Pearson’s chi-square test and by linear regression analysis with backward factor reduction. Enhancing prevalence of obesity was found in younger age categories in comparison with the year 2001. Parental overweight and obesity significantly increased the risk of overweight and obesity. BMI in children (6–12.99 years) was associated with the intake of sweetened carbonated drinks and potatoes including fried ones (positive association) and low-sugar carbonated drinks and physical activity (negative association). In adolescents (13–17.99 years) BMI was associated with parental obesity, fat meat intake, time spent on the computer (positive association) and fish intake and physical activity (negative association). The results show an increase in obesity prevalence in younger children in the Czech Republic. Parental obesity significantly enhanced the risk ratio of obesity predominantly in adolescents.     

东莞市正常儿童头发中微量元素含量参考值的研究

目的探讨东莞市区幼儿园3～7岁学龄前正常儿童头发中微量元素含量均值,以此作为东莞市区儿童头发中微量元素正常参考值.方法采取在群体自愿参加者中,选出经体检无重要脏器病变,营养一般,身高、体重在均值以上(称正常儿童).在枕后贴发根部剪0.5g头发检测其锌、铁、钙、铜、锰、铅元素含量.结果在1125例受检儿童中(称普查儿,占适龄儿95%).筛选出621例儿童,占总受检儿童的55.2%.这621例正常儿中,他们头发中锌、铁、钙、铜、锰、铅元素的含量分别为:93.473μg/g、29.710μg/g、779.50μg/g、9.773μg/g、3.222μg/g、9.251μg/g.结论检测的结果显示,2003年东莞市区正常儿童与2003年普查儿童相比,正常儿童发中微量元素含量明显升高,但差异无统计学意义.2003年东莞市正常儿童发中微量元素均值与广州市正常儿童相比,显著低于广州市正常儿童.由此可见,正常儿童发中微量元素含量均值受地域影响而有较大差异.东莞市区儿童发中微量元素含量应参照东莞市正常儿童发中微量元素含量均值较为合理.