Laparoscopic flip-flap technique versus conventional inguinal hernia repair in children.

BACKGROUND AND OBJECTIVES: Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Several pediatric laparoscopic inguinal hernia repair techniques have been introduced. But debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias. METHODS: A retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip-flap technique or conventional open repair. Patients were divided into 2 groups according to the type of surgery: Group A included those who underwent the new laparoscopic technique, and Group B included those who underwent conventional open repair. RESULTS: Group A comprised 15 patients (mean age, 39 months), and group B comprised 18 (mean age, 44 months). Mean operative time was 47.5 minutes for Group A versus 27.5 minutes for Group B. Intraoperative complications for Group A included 1 case (7%) of vas deferens injury, and 3 cases (20%) in which the flaps were torn during suturing. In Group B, no intraoperative complications were encountered. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up of 3 months revealed recurrence in 4 patients in Group A (27%), while there were no recurrences in Group B. CONCLUSION: Our preliminary experience shows unsatisfactory outcomes with laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard for children, in our experience. Future studies with more numbers and longterm follow-up should be conducted.     

人胎盘脂多糖辅助治疗支气管哮喘临床疗效观察

目的观察人胎盘脂多糖辅助治疗儿童支气管哮喘的临床疗效。方法将我院91例支气管哮喘患儿随机分成2组,治疗组46例,采用综合疗法,发作期应用沙丁胺醇、普米克令舒、氨茶碱治疗,缓解期肌内注射人胎盘脂多糖、气雾吸入倍氯米松;对照组45例,发作期用沙丁胺醇、普米克令舒、氨茶碱治疗,缓解期气雾吸入倍氯米松。结果治疗2周后治疗组、对照组对改善喘息、咳嗽症状比较,差异有显著性意义(P<0.05)。随访1年,治疗组复发率与对照组比较,差异有显著性意义(P<0.05)。结论人胎盘脂多糖辅助治疗支气管哮喘疗效确切,复发率低,值得临床推广应用。     

综合疗法治疗儿童单纯性肥胖症31例

目的探讨综合疗法治疗儿童肥胖症的疗效。方法对31例儿童肥胖症患者进行综合治疗，包括大黄膏身体各部位按摩，用内分泌治疗仪或用远红外线灯照射全身穴位，女患儿加用太空衣治疗，然后采用电脑减肥治疗仪在全身各部位进行治疗。同时制定饮食处方和运动处方并进行行为指导。结果治疗组体重减少5～10k，有效率93．5％；对照组体重减少2～4kg，有效率46．7％。同时腰围明显减小。结论综合疗法治疗儿童肥胖症是很有效的。且无任何不良反应。     

Integrated home monitoring predicts lead failure in a pacemaker dependent 4-year-old girl.

A 4-year-old girl with post-surgical complete atrioventricular block received an epicardial dual chamber pacemaker system. During further growth intermittent exit block occurred, first misinterpreted as neurological seizures. The epicardial lead was replaced using a transvenous approach, and a pacemaker with an integrated home monitoring facility was implanted. After her discharge, a rise in the pacing threshold automatically initiated an event message. On the basis of this information, the patient was called in and imminent dislodgement of the ventricular lead was diagnosed by x-ray. The lead was repositioned and was found stable over 1-year follow-up.     

儿童幽门螺杆菌感染的诊断和治疗

幽门螺杆菌（H．pylori）感染主要发生在儿童期，儿童期许多消化系统疾病，如慢性胃炎、消化性溃疡等与H．pylori感染密切相关，并可能与成年后胃癌的发生相关。H．pylori感染还可导致儿童缺铁性贫血。H．pylori感染主要经“口-口”或“粪-口”以及“胃-口”途径从人到人传播，社会经济因素对H．pylori感染的影响是主要的。胃镜活检胃黏膜细菌学检查是诊断H．pylori现症感染的“金标准”，粪抗原的测定和^13C-尿素呼气试验可用于诊断和评价疗效。质子泵抑制剂（PPI）加两种抗生素的三联疗法是目前最佳治疗方案，抗生素耐药的不断增加给治疗带来了困难．儿童H．pylori感染对大环内酯类药物的耐药高于成人。     

Living-Related Versus Deceased Donor Pediatric Liver Transplantation: A Multivariate Analysis of Technical and Immunological Complications in 235 Recipients

Timely access to a living donor (LD) reduced pretransplant mortality in pediatric liver transplantation (LT). We hypothesized that this strategy may provide better posttransplant outcome. Between July 1993 and April 2002, 235 children received a primary LT from a LD (n = 100) or a deceased donor (DD) (n = 135). Demographic, surgical and immunological variables were compared, and respective impact on posttransplant complications was studied using a multivariate analysis. Five-year patient survival rates were 92% and 85% for groups LD and DD, respectively (p = 0.181), the corresponding graft survival rates being 89% and 77% (p = 0.033). At multivariate analysis: (1) type of donor (DD) was correlated with higher rate of artery thrombosis (p < 0.012); (2) biliary complication rate at 5 years was 29% and 23% for groups LD and DD, respectively (p = 0.451); (3) lower acute rejection incidence could be correlated with type of donor (DD) (p = 0.001), and immunosuppressive therapy (tacrolimus) (p < 0.001). We conclude that (1) according to the multivariate analysis, LT with LD provided similar patient and graft outcome, when compared to DD; (2) a higher rate of artery thrombosis and a lower rate of rejection were observed in group DD; (3) this study confirms the efficacy of tacrolimus for immunoprophylaxis, whatever the type of organ donor is.     

国产与进口头孢他啶治疗小儿细菌性下呼吸道感染的成本-效果分析

目的对国产与进口头孢他啶治疗小儿细菌性下呼吸道感染进行成本—效果分析。方法对我院2008年10月-2009年10月间患小儿细菌性下呼吸道感染且单用头孢他啶治疗的住院患者136例进行回顾性分析,根据药品不同产地将其分为A、B两组,A组给与头孢他啶（国产）60mg/（kg·d）,分2次静脉滴注;B组给与头孢他啶（进口）60mg/（kg·d）,分2次静脉滴注,两组疗程均为7d,分别计算两组病人治疗后的细菌清除率、不良反应发生率,两组的治疗有效率和总成本,计算成本-效果比。结果疗程结束后A、B两组的药物治疗成本分别为：A组236.4元、B组982.5元,组间比较存在显著性差异（P〈0.05）;治疗有效率分别为：91.30%、94.03%;A、B两组的细菌清除率分别为：86.36%、90.70%;两组不良反应发生率分别为：5.80%、2.99%,组间比较差异均无显著性（P〈0.05）;两组成本-效果比分别为：2.59、10.45。结论国产头孢他啶的成本-效果比优于进口头孢他啶,为较佳的治疗方案。     

Pyridinium crosslinks of collagen as a marker of bone resorption rates in children and adolescents: Normal values and clinical application

The aim of our study was to establish normal values of urinary pyridinoline (Pyr) and deoxypyridinoline (DPyr) excretion for children aged 3–18 years, examine the biological variability of the marker, and assess its clinical value for pediatric patients with growth hormone deficiency. Pyr and DPyr was measured in first void urine samples from 692 healthy subjects (340 boys, 352 girls) by high-performance liquid chromatography. At sampling, age, body height, and weight was recorded for all individuals. Short-term variability in crosslinks excretion was examined in four healthy children. The clinical value of the marker was studied in seven patients with growth hormone (GH) deficiency. In childhood, crosslinks excretion exceeded normal adult values by about fivefold and declined during puberty. In the age range of 13–18 years, gender-related differences in Pyr and DPyr levels were observed, presumably resulting from the earlier onset of puberty in girls. Urinary levels of Pyr and DPyr were highly correlated both in males and females. Pyr/DPyr ratio was significantly higher in adolescents than children, suggesting enhanced release of Pyr from extraosseous sources. In both genders, neither age nor anthropometric variables showed a linear effect on crosslinks excretion. The range of within-subject, short-term variability in urinary Pyr and DPyr was relatively high (CV: 6%–21%), indicating that single measurements of crosslinks excretion may not adequately reflect bone resorption rates in children. Pyr and DPyr levels were significantly lower in GH-deficient patients and normalized during human growth hormone (hGH) therapy. Significant correlations between growth velocity (GV) and crosslinks levels were found, but individual prediction of GV increment during hGH treatment may be inaccurate. Pyr/DPyr ratio was not related to GV. It is concluded that measurement of urinary Pyr and DPyr excretion in children may be a valuable tool to assess bone resorption rates in population-based studies. In individual patients, however, only qualitative evaluation of disease severity and response to treatment seems justified.     

综合治疗儿童单纯肥胖症

以新医学模式对35例儿童单纯肥胖症采用以家庭为基础的饮食调整,运动疗法和行为指导综合治疗。并设单纯饮食治疗组和对照组。对体重、皮脂厚度和身高进行观测,疗程3个月。结果显示:综合治疗组明显优于单纯饮食治疗组,更优于对照组。并讨论了综合治疗的可行性和治疗效果的可靠性,以及新医学模式在肥胖症治疗中的重要作用。     

Promoting inter-agency collaborátion in child services

Summary Effective collaboration between agencies is often difficult to achieve. Children and their families/carers, who have complex therapeutic needs, present particular difficulties in that agencies need to work together, if they are to produce a co-ordinated and integrated package of care. A Multi-Agency-Consultation-Team (MACT) was set up in an attempt to overcome some of these problems of interagency co-operation. This paper describes the protocol, types of children referred and the recommendations made by the team. Follow-up of these children at 4 months suggests that a MACT does have a role to play in developing high quality services.