小儿创伤性膈肌破裂诊治分析(附13例报告)

目的探讨小儿创伤性膈肌破裂的诊治体会。方法回顾性分析我院2000年7月～2006年12月收治的13例膈肌破裂的诊治经过,以实例分析的方法,总结膈疝的特点及误诊原因,手术方法采用剖腹术9例,剖胸术2例,胸腹联合切口1例,剖腹术后剖胸术1例。结果本组治愈11例,死亡2例,死亡率13.7%。结论对于利器伤所致的膈肌破裂应警惕膈肌多处裂伤的可能:而钝性伤所致的膈肌破裂多伴有合并伤,早期诊断、及时手术是提高治愈率,降低病死率的关键;绝大多数膈肌破裂可经腹手术而治愈     

婴幼儿先天性膈疝的诊治分析

目的通过回顾性分析26例先天性膈疝患儿病例资料,总结婴幼儿先天性膈疝的诊治经验。方法26例均行胸腹部平片,10例行上消化道造影检查明确诊断。均行疝内容物复位横膈修补术。其中24例选择经腹腔左上腹横切口,2例右侧膈疝采取经胸腔入路。结果23例治愈,3例死于呼吸衰竭。存活23例中,15例获随访,随访时间3个月～4年,其中14例生长发育正常,1例复发,经再次手术治愈。8例失访。结论婴幼儿先天性膈疝易与许多胸肺疾病混淆,X平片是诊断膈疝的首选方法,该病一旦诊断明确,宜尽早行膈疝修补术。     

先天性膈疝的临床特点及外科治疗经验

为提高新生儿先天性膈疝（CDH）的早期诊断、治疗及预后水平，对28例先天性膈疝病例进行临床特征、手术过程回顾性分析。全部进行正位及胸部X-线检查，5例做上消化道造影，13例做血气分析。X-线证实胸腔内有含水的肠管，腹析显示部分婴儿严重的缺氧、呼吸性酸中毒；消化道造影显示结肠或小肠在胸腔内。结果：2例新生儿放弃治疗，26例患儿手术治疗，3例死亡，23例病人恢复良好。结果：对患有先天性膈疝的新生儿必须早期诊断和手术治疗。     

小儿延迟性脾破裂的诊断与治疗

目的 探讨小儿延迟性脾破裂的发生机理、诊断与治疗。方法 总结１６年来治的６例小儿延迟性脾破裂的临床资料,６例均为腹部闭合性损伤,伤后出现脾破裂症状的时间均在４８小时以上,经腹穿、ＣＴ或了超确诊,手术证实。结果 ６例中５例行脾切除术,１例行脾修补术,术后未发生暴发性感染,均痊愈。结论 小儿延迟性脾破裂容易误诊,应掌握其发生机理,提高对本病的认识和警惕性。有价值的影像学检查是提高诊断率、降低病死率的关     

先天性膈疝和食道裂孔疝与小儿贫血

小儿贫血的原因多种,但血液系统外的疾病常被忽视或误诊。总结我院5年来因贫血就诊,而最后经手术确诊为先天性膈疝、食道裂孔疝的患儿15例,报道如下。资料与方法我院住院患儿经外科手术确诊,男8例,女7例,年龄3个月～2岁。膈疝6例,均伴有中重度贫血,食道裂孔疝9例,贫血为轻、中度。病史特点:1例膈疝患儿有急性呕血、便血史,1例食道裂孔疝患儿有急性呕吐咖啡渣样物,5例食道裂孔疝患儿有反复呕吐史。全部病例中有5例患儿有轻—重度营养不良。其余的病例除贫血外,无典型的消化道症状。去除病因后,血红蛋白逐渐恢复正常。结果6例膈疝患儿发生呕吐…     

西宁地区儿童创伤性急性肺损伤41例

目的总结西宁地区儿童创伤性急性肺损伤（ALI）的早期诊断、影像学检查与治疗经验。方法创伤性AU患儿41例，致伤原因包括车祸挤压伤19例，坠落伤11例，砸伤6例，撞击伤3例，爆震伤2例。41例均有合并伤，并血气胸24例，创伤性休克19例，急性呼吸窘迫综合征（ARDS）8例。受伤1～5h，均行胸部X线检查，其中20例胸部X线检查未见异常而由CT确诊。采用单纯胸带固定加药物保守治疗20例，行胸腔闭式引流术18例，手术开胸止血、肺修补、膈肌修补、肝脾修补或脾切除术8例，机械通气辅助呼吸8例。结果胸部X线检查阳性率为51．2％；CT检查阳性率为100％。治愈37例；病死4例，其中3例死于ARDS，1例死于脑外伤。41例中发生低血容量性休克19例，肾功能衰竭11例，ARDS8例。结论西宁地区创伤性AU受多重因素影响，起病急、发展快，更易发生ARDS，及早作出诊断和治疗，是救治小儿ALI的关键。     

胸腔镜补片修补小儿先天性后外侧膈疝

目的探讨胸腔镜下用补片修补小儿后外侧膈疝的方法及临床效果。方法收集2016年3月至2021年5月广州市妇女儿童医疗中心胸外科后外侧膈疝行胸腔镜补片修补手术的16例患儿的临床资料, 其中男9例, 女7例;平均年龄为22(1～132)个月。补片修补膈疝手术操作时, 先借助于疝针将补片缝合固定于胸壁, 再将补片另外的边缘与相应的膈肌缺损缘进行连续缝合, 完全关闭膈肌缺损。总结病例的临床特点、手术时间、出血量、胸腔引流管留置时间、ICU住院时间以及临床效果。结果 5例为右后外侧膈疝, 11例为左后外侧膈疝;术中见12例有疝囊, 4例无疝囊;根据CDHSG分型, B型13例, C型3例。所有病例均在胸腔镜下完成手术, 无中转开胸。手术时间最快者110 min, 最慢者255 min, 术中几乎没有出血。术后胸腔引流管放置0～10 d, ICU住院时间0～11 d。所有患儿都顺利出院, 随访时间7～69个月, 1例术后2年复发。所有病例无胸壁畸形, 生长发育正常。结论胸腔镜补片修补膈疝效果良好, 借助于疝针可以简化手术操作, 连续缝合可以缩短手术时间。     

小儿脑瘤误诊原因分析

本文对30例小儿脑瘤误诊的原因进行了分析,并列举了典型病例。指出小儿脑瘤具有隐晦性,多样性,代偿性等临床特点而易造成误诊。并且提出了小儿脑瘤早期诊断的要点。     

小儿阑尾炎误诊分析

目的 分析小儿阑尾炎的误诊原因，降低小儿阑尾炎的误诊率，减少术后并发症的发生。方法 回顾我院外科1997～2002年误诊的225例急性阑尾炎的临床资料，通过对其病史、手术所见，实验室及辅助检查结果进行回顾性研究，分析误诊原因。结果术前诊断为其他疾病，手术确诊为阑尾炎的163例；术前诊断为阑尾炎，手术证实为其他疾病的62例。全部病例均经手术治疗，术后痊愈出院，并发症的发生率为16.44％。结论 对小儿急性阑尾炎的临床症状特点缺乏足够的认识，腹部体征的掌握不准确及过多的依赖辅助检查是误诊的主要原因。对酷似阑尾炎的病例，应当允许阑尾误切的存在，但应注意诊断和鉴别诊断，尽量减少误切。     

23例先天性膈疝临床分析

本文报道1973～1986年收集23例小儿先天性膈疝。年龄最小16天,最大8岁。胸腹裂孔疝20例;胸骨后疝2例;食道裂孔疝1例。临床症状取决于疝入胸腔内腹腔脏器多少。临床多表现呼吸困难、紫绀、呕吐、心音移位、胸腔闻及肠鸣音。临床出现呼吸困难、紫绀、呕吐、心音移位应怀疑本病,需进行胸腹X线摄片证实。并对先天性膈疝的临床表现、诊断和鉴别诊断、误诊原因进行讨论。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.