婴幼儿动脉导管未闭的治疗经验

本文报告120例婴幼儿动脉导管未闭,107例诊断明确,施行动脉导管结扎术;9例室缺肺高压合并动脉导管未闭,先结扎动脉导管,3～6月再作室缺纠治术,另3例室缺肺高压和1例房缺合并动脉导管未闭,在心内直视术中处理好动脉导管,避免发生并发症。本组治疗经验是动脉导管未闭诊断确立后拟早期手术,如病情需要可急诊手术;室缺和房缺合并动脉导管未闭,可作一期纠治术,以减轻病儿二次手术的痛苦。     

消炎痛治疗足月新生儿动脉导管未闭疗效及安全性评价

目的 探讨口服消炎痛治疗足月新生儿动脉导管未闭(PDA)的疗效及安全性.方法 对经彩色多普勒超声心动图确诊的足月新生儿动脉导管未闭34例分为治疗组和对照组,治疗组23例给予服消炎痛治疗,每次0.2 mg/kg,鼻饲给药,每24小时1次,共用3次为一疗程,全部病例均仅用一疗程.未加用消炎痛治疗的11例作为对照组.比较两组动脉导管的关闭率;治疗组用药前后监测肾功能、血生化及血小板变化,观察记录尿量、胃肠道症状及出血情况等.结果 治疗组23例,动脉导管关闭17例,关闭率73.91%.对照组11例,关闭5例,关闭率45.45%,两组比较,治疗组PDA闭合率明显高于对照组,差异有显著性意义(P＜0.05).治疗组中除2例发生一过性少尿外,未发生其他不良反应.结论 消炎痛治疗足月新生儿PDA安全有效.     

低体重早产儿动脉导管未闭治疗进展

动脉导管未闭是一种新生儿常见疾病。在早产儿,尤其是低体重儿中其发病率更高。如未及时治疗,往往会导致新生儿颅内出血、呼吸窘迫综合征、慢性肺疾病等严重并发症。目前临床上有药物治疗、手术治疗、介入治疗及对症治疗,该文对低体重早产儿动脉导管未闭治疗的进展作一综述。     

残端样管状动脉导管未闭的介入治疗

目的探讨吸收性明胶海绵封堵残端样管状动脉导管未闭(PDA)即刻和早期疗效。方法选择残端样管状PDA,且其肺动脉侧破口直径<0.5 mm,分流少患儿2例。人为制造出一管状动脉导管盲端,在未闭动脉导管内释放压缩呈条状的吸收性明胶海绵。结果血栓形成达到封堵残端样管状未闭动脉导管的作用。结论吸收性明胶海绵治疗残端样管状PDA操作简单、疗效确切。     

导管法栓塞术治疗动脉导管未闭

非开胸关闭动脉导管技术,欧美自60年代已开展,1984年上海儿童医院报告4例.我科1988年采用股动脉穿刺,关闭动脉导管未闭(PDA)4例成功,总结如下.一、方法(一)确定未闭动脉导管的形态和直径:采用股动脉穿刺,将侧孔导管从股动脉送入,抵于未闭动脉导管动脉端上方1cm 处(相当于主动脉弓的远侧端)推     

小儿复杂动脉导管未闭的外科治疗

复杂动脉导管未闭是指合并其他先天性心脏、血管畸形的动脉导管未闭（PDA）,约占PDA总数的7%～12%。本院1995年5月至2007年10月共手术治疗复杂PDA患儿37例,包括非生命依赖型35例和生命依赖型2例,体外循环下一期封闭动脉导管并矫正并发的心血管畸形30例,分期治疗7例（先非体外循环下结扎动脉导管,1个月内体外循环下矫正心内畸形）,疗效满意。     

早产儿动脉导管未闭药物治疗前后肾动脉血流速度变化

运用多谱勒方法对5例早产儿动脉导管未闭患者在消炎痛治疗前后的肾动脉血流速度进行了动态观察。结果显示动脉导管未闭患者治疗前肾动脉平均血流速度显著低于治疗后24小时值（P＜0．05）；治疗前肾动脉血流在舒张末期呈“反向”。结果提示肾动脉血流速度检查有助于动脉导管患者消炎病治疗时的疗效观察。     

婴儿及新生儿动脉导管未闭急诊手术治疗26例分析

目的探讨婴儿期重症动脉导管未闭的急诊手术治疗经验。方法回顾性分析2007年9月至2012年8月我们收治的26例婴儿及新生儿动脉导管未闭患儿临床资料,其中新生儿12例,包括早产儿10例,足月新生儿2例,术前需呼吸机辅助通气者12例;婴儿14例,术前需呼吸机辅助通气6例。均行急诊动脉导管未闭手术治疗,15例经左腋下横切口,10例经左腋下直切口进行动脉导管结扎术。结果26例均顺利完成手术,1例术中出现动脉导管破裂,予直接缝合;术后复查无残余分流,无并发症。26例随访2～72个月,生长发育良好,心功能正常,无导管再通及假性动脉瘤形成。结论婴儿及新生儿粗大动脉导管未闭需及时手术治疗,以阻断异常分流,减少肺血,纠正心衰,及时关闭动脉导管,能有效缩短重症监护时间,降低死亡率。．     

早产儿动脉导管未闭发病率及消炎痛治疗10年总结

目的探讨早产儿动脉导管未闭的发病率及消炎痛的治疗效果。方法根据早产儿及患动脉导管未闭例数计算早产儿动脉导管未闭的发病率。观察早产儿动脉导管未闭发病率与早产儿体重及胎龄的关系，探讨消炎痛对早产儿动脉导管未闭患儿的治疗效果。结果早产儿动脉导管未闭的发病率为５．０６％（６０／１１８５），出生体重≤１５００克者，其发病率为６．５４％（１０／１５５），～２０００克者为５．２５％（２７／５１４），～２５００克者为４．８８％（１９／３８９），≥２５００克者为３．１５％（４／１２７），各组发病率有显著性差异（ｘ２＝６４．８５，Ｐ＜０．０１）。早产儿动脉导管未闻发病率与胎龄无关（ｘ２＝０．３４４，Ｐ＞０．０５）。消炎痛治疗４１例，痊愈３１例（７５．８１％）。≤１５００克、２０００克、２５００克及≥２５００克等组消炎病治愈率分别１００％、９０．９１％、５３．８４％和０（ｘ２＝１３．６２，Ｐ＜０．０５），治愈率与胎龄无关。结论早产儿动脉导管未闻的发病率及消炎痛对其治愈率随出生体重增加而降低，两者与胎龄无关。     

动脉导管未闭合并右位主动脉弓误治1例

动脉导管是胎儿时期肺动脉与主动脉间的正常血流通道, 为胚胎时期特殊循环方式所必需的血流通道, 如出生后动脉导管持续未闭即诊断为动脉导管未闭(patent ductus arteriosus, PDA), 发病率为10%～15%。右位主动脉弓是较常见的主动脉畸形, 但是动脉导管未闭合并右位主动脉弓相对罕见。随着影像学技术的发展, PDA的诊断并不困难, 但基层医院治疗经验不多, 依然面临挑战。上海交通大学医学院附属儿童医院收治1例被误治的动脉导管未闭合并右位主动脉弓患儿, 本文介绍其诊治经过, 以资借鉴。     

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.     

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   

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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.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

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.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.