改良切口经胸微创封堵术治疗膜周室间隔缺损

目的 探讨改良切口经胸微创室间隔缺损封堵术的可行性和安全性.方法 2011年5月至2015年5月,289例单纯膜周室间隔缺损患儿在我中心接受改良切口经胸室间隔缺损封堵术.该操作采用长约1～2 cm的微创切口,无需损伤胸骨,完全食道超声引导下完成室间隔缺损封堵.术后1、3、6个月定期随访.结果 289例患儿中,277例(95.8％)成功完成微创封堵;12例封堵失败,改行常规外科修补术.277例患儿均经改良微创切口入路,切口长度1～2cm,平均(1.53±0.46)cm.均未损伤胸骨,亦未放置引流管.术后早期均未出现心包积液.膜周室缺直径平均(5.30±2.88)mm.封堵器大小4～12mm,平均(6.70±3.10)mm,包括对称封堵器191例,偏心封堵器86例.12例(4.3％)患儿术中存在少量残余分流.9例(3.2％)术后发生不完全性右束支传导阻滞;1例患儿于术后4d出现完全性房室传导阻滞,经激素治疗5d后好转.所有患儿平均住院时间(3.2±0.8)d,随访期间,没有主动脉瓣反流、恶性心律失常、封堵器脱落等严重并发症发生.至随访结束仍有4例(1.4％)存在少量残余分流.结论 改良切口经胸壁微创封堵术,不损伤胸骨,可以有效治疗膜周室间隔缺损.但其长期疗效尚需进一步随访研究.     

小腰大边封堵器介入治疗室间隔缺损伴膜部瘤形成的评价

目的评价应用新型国产小腰大边封堵器介入治疗室间隔缺损(VSD)伴膜部瘤形成的可行性、安全性和疗效,总结其技术难点与治疗策略。方法49例VSD伴膜部瘤形成患者,造影测量VSD左室面入口直径为8~22(13.8±4.9)mm,右室面均有2个或以上出口,最大出口直径为2~14(5.6±3.1)mm。根据膜部瘤大小、形态、位置及膜部瘤组织黏连牢固程度,植入不同类型和型号国产小腰大边封堵器,封堵器直径为4~16(6.8±2.6)mm。封堵后15min重复左心室造影和经胸心脏超声检查(TTE),观察封堵即刻效果。术后连续心电图(ECG)监护5d,定期行ECG、心脏超声检查(TTE)。结果49例术后15min左心室造影、TTE显示:45例完全封堵,4例术后造影示少量分流(<3mm),1个月后超声复查无残余分流。术中并左、右束支传导阻滞分别为3例和2例,均为一过性,1周内恢复。49例室间隔膜部瘤应用国产小腰大边封堵器封堵治疗均获成功。结论经导管采用国产小腰大边封堵器治疗VSD膜部瘤疗效可靠。技术关键是通过对膜部瘤大小、形态、位置及膜部瘤组织黏连牢固程度判断确定封堵部位及合适封堵器。     

室间隔缺损介入治疗中封堵器的选择

目的探讨介入治疗儿童室间隔缺损(VSD)时不同类型国产封堵器的选择方法及介入治疗VSD的可行性、安全性和疗效。方法介入治疗VSD患儿226例。年龄2~14岁(5.62岁);其中膜部VSD209例,嵴内型VSD14例,肌部VSD3例。封堵后再次行经胸超声心动图及左室造影,出院前及术后1、6和12个月复查心电图和超声心动图进行随访。结果211例患者封堵成功,技术成功率93.4%。其中7例应用小腰大边型VSD膜部封堵器,191例应用对称型VSD膜部封堵器,12例应用偏心型VSD膜部封堵器,另1例应用肌部VSD封堵器封堵成功。术中术后无严重并发症发生。结论应用不同类型国产封堵器介入治疗儿童VSD安全有效。根据VSD类型及形态特征合理选择不同类型封堵器十分关键,一般对称型封堵器适用于大多数VSD且易于放置到位,在某些情况下其他形态封堵器是必要的。     

膜周部室间隔缺损经导管封堵术后早期心律失常危险因素的探讨

目的心律失常是经导管封堵膜周部室间隔缺损术后的常见并发症,不仅影响术后心功能的恢复,而且直接关系到预后。分析18岁以内患者膜周部室间隔缺损经导管封堵术后早期心律失常及其危险因素,以期降低术后心律失常的发生率。方法2002年6月—2004年6月,89例膜周部室间隔缺损患者根据家长意愿接受了经导管应用Amplatzer装置及国产封堵器进行堵塞。80例应用AGA公司制造的Amlatzer膜周部室间隔缺损封堵器,9例应用国产封堵装置,术后定期行心脏超声及心电图检查。结果89例膜周部室间隔缺损封堵术均获成功。11例术后5d内发生了不同类型的传导阻滞,发生率为12%,分别为Ⅰ°房室传导阻滞1例,Ⅲ°房室传导阻滞1例,左前分支阻滞5例,不完全(部分)性右束支传导阻滞4例,完全性右束支传导阻滞3例,其中3例并发两种传导阻滞。分析本组心律失常的影响因素,发现:(1)室间隔缺损上缘距主动脉右冠瓣距离<3mm;(2)室间隔缺损直径≥8mm,封堵器直径≥10mm;(3)穿刺成功后动脉静脉(A-V)轨道建立时间≥60min及术中pH值<7·35与心律失常密切相关。结论心律失常是膜周部室间隔缺损封堵术后早期严重的并发症;严格选择手术适应证、缩短手术操作时间、防止酸中毒是降低膜周部室间隔缺损介入封堵术后心律失常发生率的有效措施。     

流入道型室间隔缺损介入治疗的适应证及并发症防治

目的 探讨流入道型室间隔缺损(IVSD)介入治疗适应证及并发症防治措施.方法 采用国产室间隔缺损(VSD)封堵器对46例IVSD患儿进行封堵治疗.经胸超声心动图(TTE)显示VSD直径(6.8±5.3) mm.所有患儿在透视及超声监测下通过建立股动静脉轨道,经右心系统释放封堵器,并分别于术后1、3、6、12、24个月通过TTE、心电图检查等方法,从患儿残余分流、瓣膜功能及心律方面进行随访评价.结果 封堵器置入成功40例,未成功6例,成功率82.6 %;4例封堵器释放后存在少量残余分流,术后1个月超声复查残余分流消失.随访中未发现新出现的三尖瓣返流病例;2例原为少量三尖瓣返流者,封堵术后出现中量返流;1例术前伴中度三尖瓣返流,术后出现了重度返流.4例于术后3～6 d出现Ⅲ度房室传导阻滞,常规应用激素等药物治疗,2例痊愈,2例置入临时起搏器8～10 d完全恢复;术后出现6例完全性左束支传导阻滞,5例完全性右束支传导阻滞,2例室性期前收缩,随访3个月均完全恢复.结论 部分IVSD可选择介入治疗,近中期效果良好.但应严格把握适应证,加强其并发症防治.     

室间隔缺损并主动脉瓣脱垂患儿的介入治疗及疗效评价

目的探讨室间隔缺损(VSD)并主动脉瓣脱垂(AVP)介入治疗的安全性和可行性。方法选择2007年5月-2009年4月在本院住院的VSD并轻度AVP患儿43例,均行经皮VSD堵闭术,经胸超声心动图显示VSD位置及内径,左心室造影均显示VSD并AVP,造影显示VSD大小为2.6～8.3 mm。其中19例为嵴内型(又称膜周流出道型),15例为隔瓣后型,9例为膜周部。右冠瓣脱垂27例,无冠瓣脱垂12例,右冠瓣并无冠瓣脱垂4例,并局限主动脉瓣返流8例。术后进行超声心动图、心电图的随访观察。结果36例成功封堵VSD,封堵成功率83.7%;7例试封堵后再次行左心室及主动脉造影,显示主动脉瓣下有明显切迹,瓣膜返流加重而放弃堵闭术,择期进行外科手术。采用偏心封堵器15例(5～12 mm),大边小腰封堵器(4～14 mm)16例,普通对称型封堵器(5～10 mm)5例。术后即刻造影有微量残余分流4例,原有的主动脉瓣返流无明显加重;随诊3～18个月,超声心动图示4例残余分流,分别在术后3～6个月消失,主动脉瓣局限返流无进一步增加,其中6例返流减少,未出现三尖瓣狭窄、主动脉瓣狭窄及主动脉瓣穿孔,心电图示无Ⅲ度房室传导阻滞等严重心律失...     

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目的探讨经胸超声心动图(TTE)及实时三维超声心动图在房间隔缺损(ASD)、室间隔缺损(VSD)封堵术中的临床应用价值。方法应用二维及三维超声心动图对2004-10—2005-10在天津市儿童医院就诊的24例继发孔ASD,10例VSD进行术前检查筛选,术中超声引导及术后随访检查。结果24例ASD患儿术前经TTE检测ASD直径(15·6±7·9)mm(5~26mm),所选Mmplatzer封堵器直径为(19·1±5·1)mm(5~32mm),23例封堵成功。室间隔膜部缺损直径:左室面缺损为5~9mm,右室侧口的直径为2·4~6·0mm,术中选择Amplatzer封堵器型号为4~6mm,10例VSD无残余分流。结论二维及三维TTE联合应用于ASD、VSD介入治疗具有很好的应用价值。     

国产器材封堵儿童室间隔缺损682例并发症分析

目的 探讨应用国产器材封堵儿童VSD并发症的发生率、发生原因及防治措施.方法 将2004年3月至2012年6月在河北医科大学第一医院行介入治疗的VSD患儿682例纳入本研究.其中男307例,女375例;年龄2～13岁[(6.01±3.65)岁];体质量10.1 ～54.6 kg[(14.5 ±6.7) kg].患儿均应用国产封堵器进行介入治疗,对其术中、术后并发症发生情况进行观察和随访,并对临床资料进行回顾性分析.结果 术前经胸超声心动图检测VSD大小为1.9 ～11.2 mm[(5.5±2.4) mm];术中左心室造影测量VSD大小为1.9～12.1 mm[(6.1±2.3) mm];所选封堵器为4.0～14.0mm[(8.2±3.7) mm].应用国产封堵器介入治疗儿童VSD的总成功率为96.77％(660/682例),总并发症发生率为14.37％(98/682例),其中心脏并发症87例,血管并发症9例,其他并发症2例.严重并发症发生率为1.32％(9/682例),其中Ⅲ度房室传导阻滞4例,重度三尖瓣关闭不全2例,股动脉血栓2例,封堵器脱落1例,经相应治疗后无一例死亡.随访时间3～57个月[(29.1±26.7)个月].结论 国产器材封堵儿童VSD安全、有效,并发症发生率低.术前正确判断、术中准确操作和术后严格随访是减少并发症发生的有效措施.     

室间隔缺损介入治疗后超迟发性房室传导阻滞一例

患儿女,8岁,因"阵发性头晕20余天,咳嗽10余天,晕倒4次"为主诉,于2007年9月入院.患儿曾于2003年10月在我院行膜部室间隔缺损封堵术,术前室间隔缺损大小为8.3 mm,应用10 mm Amplatzer膜部室间隔缺损封堵器,术后左窒造影示封堵完全,无残余分流,术后第2天心脏超声示封堵器位置和形态良好,心电图示不完全右束支传导阻滞,术后第4天出院.出院后未同院复查,直至20多大前无明显诱因出现阵发性头晕,并晕倒4次,近10余天出现咳嗽而来我院就诊.     

儿童膜周部室间隔缺损介入治疗的临床评价

目的　评价经导管室间隔缺损封堵术介入治疗膜周部室间隔缺损 (VSD)的安全性及临床疗效。方法　 2 0 0 2年 11月～ 2 0 0 4年 7月 ,共 5 0例膜周部室间隔缺损的患儿接受了Amplatzer偏心状封堵器经导管介入治疗。男 2 6例 ,女 2 4例 ;平均年龄 (9 1± 4 8)岁 (2～ 17岁 )。其中 1例合并主动脉窦窦瘤 ,2例为外科修补术后残余漏 ,1例合并镜面右位心。经胸超声心动图 (transthoracicechocardiography ,TTE)提示 ,VSD的平均直径 (4 8± 0 9)mm (3～ 7mm )。封堵前右心导管提示 ,肺循环血流量 /体循环血流量 (Qp/Qs)比值平均为 1 32 (1 1～ 2 0 )。 4例中等量左向右分流 ,其余均为少量左向右分流。所有患儿在X线透视及超声监测下通过建立股动静脉轨道 ,经右心系统释放封堵器。并分别于术后 1、3、6、12个月进行超声心动图、心电图、X线胸片随访评价。结果　 4 7例患儿封堵器置入成功 ,技术成功率为 94 % ,无死亡病例。术后出现少量残余分流 2例 (<3mm) ,完全性左束支传导阻滞 1例 ,无其他严重并发症发生。所有患儿接受了平均 7个月的随访 (1～ 18个月 ) ,随访中无封堵器移位、脱落以及瓣膜损伤等并发症发生 ,1例残余分流于 6个月随访时消失。超声测量的左室舒张末径 (leftventricleend diastolicdimension     

生物标记物粪便胆汁酸的测定在过敏性紫癜患儿诊治中的意义

目的 探讨生物标记物粪便胆汁酸浓度在过敏性紫癜(HSP)患者中的变化及其在诊治中的临床意义。方法 选取2014~2016年确诊为HSP的19例患儿为HSP组,另选取27例健康儿童为健康对照组。采集HSP组患儿急性期、恢复期及健康对照组儿童粪便标本,应用液相质谱技术检测各组儿童粪便胆汁酸水平。结果 HSP组患儿恢复期胆酸水平均高于健康对照组和HSP组急性期 (P < 0.016)。HSP组患儿恢复期鹅脱氧胆酸水平高于健康对照组 (P < 0.016)。HSP组患儿急性期和恢复期脱氧胆酸、石胆酸水平均低于健康对照组 (分别P < 0.05、P < 0.016)。各组间熊去氧胆酸水平比较差异均无统计学意义 (P > 0.05)。结论 HSP患儿急性期粪便次级胆汁酸脱氧胆酸和石胆酸低于健康对照组,这可能与HSP的发病或转归有关。     

霉酚酸酯和环磷酰胺治疗儿童大量蛋白尿型过敏性紫癜性肾炎的前瞻性随机对照研究

目的 探讨霉酚酸酯(MMF)和环磷酰胺(CTX)分别治疗具有大量蛋白尿[24?h尿蛋白定量≥50?mg/kg或晨尿蛋白/肌酐(mg/mg)≥2.0]的过敏性紫癜性肾炎(HSPN)患儿的疗效和安全性.方法 前瞻性纳入2016年8月至2019年11月在首都儿科研究所附属儿童医院肾脏内科住院并诊断为有大量蛋白尿的HSPN患儿...     

EFFECT OF CYPROTERONE ACETATE (CA) ON GROWTH AND ENDOCRINE FUNCTION IN PRECOCIOUS PUBERTY

Abstract. Stahnke, N., Ilicki, A. and Willig, R. P. (Department of Paediatrics, University Hospital, Hamburg, West Germany). Effect of cyproterone acetate (CA) on growth and endocrine function in precocious puberty. Acta Paediatr Scand, Suppl. 277: 32, 1979.–16 girls with precocious puberty have been studied. Following low dosage cyproterone acetate (CA) therapy (mean daily dosage 65 mg/m² BSA) a beneficial effect on growth and skeletal maturation was observed. During high dosage therapy (150 mg/m² per day) endocrinological studies were performed in 10 of these patients. There was no significant difference in HGH levels (insulin-and arginine-test), T₃ and TSH values (TRH-test) between patients and controls, T₄ concentration was significantly increased. Basal prolactin levels and prolactin response to TRH was definitely elevated. Oral glucose load and arginine infusion resulted in a significantly enhanced insulin release. There was a significant reduction in basal LH levels and an increase in FSH response to LH-RH. Basal and diurnal plasma cortisol values were markedly reduced and the cortisol release due to corticotrophin injection, (lsinevasopressin (LVP) injection and insulin-hypoglycemia as well. A definite increase in basal ACTH levels was observed, during LVP-and insulin-hypoglycemia test ACTH concentrations were within or significantly above normal range. In our patients a primary adrenocortical insufficiency due to CA treatment was evident.     

Obesogenic home food availability,diet, and BMI in Pakistani and White toddlers

Individuals of South Asian ethnicity have an increased risk for obesity and related diseases. Foods available in the home during the first 1000 days (conception to 24 months old) are an important determinant of diet, yet no study has examined the association of early‐life home food availability (HFA) with later diet and obesity risk in South Asian households. We examined whether obesogenic HFA at 18 months of age is associated with dietary intake and body mass index (BMI) at 36 months of age in low‐income Pakistani and White households in the United Kingdom. In this prospective birth cohort study (Born in Bradford 1000), follow‐up assessments occurred at 18 (n = 1032) and 36 (n = 986) months of age. Variety and quantity of snack foods and sugar‐sweetened beverages (SSBs) in the home and consumed were measured using the HFA Inventory Checklist and food frequency questionnaires, respectively. BMI was calculated using measured length/height and weight. Multinomial logistic regression models examined associations between HFA and tertiles of dietary intake, and multivariable linear regression models assessed associations between HFA and BMI. Pakistani households had a greater variety and quantity of snack foods and SSBs available compared with White households. Variety and quantity of snack foods and SSBs in the home at 18 months were positively associated with children''s intake of these items at 36 months, but associations between HFA and BMI were null. Reducing obesogenic HFA during the first 1000 days may promote the development of more healthful diets, though this may not be associated with lower obesity risk during toddlerhood.     

Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances.

OBJECTIVES: To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition. METHODS: The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18-64 years). RESULTS: Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related. CONCLUSIONS: Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs.     

Prenatal dietary diversity may influence underweight in infants in a Ugandan birth‐cohort

Growth faltering in early childhood is prevalent in many low resource countries. Poor maternal dietary diversity during pregnancy has been linked with increased risk of fetal growth failure and adverse birth outcomes but may also influence subsequent infant growth. Our aim is to assess the role of prenatal maternal dietary diversity in infant growth in rural Uganda. Data from 3291 women and infant pairs enrolled in a birth cohort from 2014 to 2016 were analysed ({"type":"clinical-trial","attrs":{"text":"NCT04233944","term_id":"NCT04233944"}}NCT04233944). Maternal diets were assessed using dietary recall in the second or third trimesters of pregnancy. Maternal dietary diversity scores (DDS) were calculated using the FAO Minimum Dietary Diversity for Women (MDD‐W). Cox regression models were used to evaluate associations of the DDS with the incidence of underweight, stunting and wasting in infants from 3 to 12 months, adjusting for confounding factors. The median DDS for women was low, at 3.0 (interquartile range 3.0–4.0), relative to the threshold of consuming five or more food groups daily. Infants of women in highest quartile of DDS (diverse diets) were less likely to be underweight (adjusted hazard ratio: 0.70, 95% confidence interval: 0.61, 0.80) compared with infants of women in Quartile 1 (p for trend <0.001) in models controlling for maternal factors. There was no significant association between DDS and stunting or wasting. Our findings suggest a relationship between higher maternal dietary diversity and lower risk of underweight in infancy. These findings suggest that programmes to improve infant growth could additionally consider strengthening prenatal dietary diversity to improve child outcomes globally.