儿童肺包虫病围手术期风险预防分析

目的分析小儿肺包虫围手术期（围术期）意外风险的预防方法。方法收集14岁以下有完整影像学数据,并经手术和病理学证实肺包虫病患儿31例,并对上述病例的手术方法及围术期并发症的处理归纳总结。结果31例均经手术治疗,其中1例双侧肺包虫分次分侧手术时均发生呼吸道包虫内囊壁碎片阻塞、心跳骤停,经抢救成活。3例手术后呼吸道阻塞窒息死亡。1例术中发生速发型过敏性休克死亡。结论儿童由于发育及解剖学特点其呼吸道狭窄,肺包虫围术期意外发生风险高。围术期及麻醉过程中应引起高度注意。     

Isolated hypoglossal paralysis

A 5 year old girl suffering from chronic tonsillitis and bilateral tympanic effusion developed atrophy of the right half of the tongue. With the exception of the twelfth cranial nerve (right) no neurological signs could be detected. We are reporting a case of an isolated hypoglossal nerve paralysis.     

Isolated tracheo-oesophageal fistula

Congenital isolated tracheo-oesophageal fistula is a rare malformation that presents with a characteristic triad of symptoms: choking and cyanosis on feeding, recurrent lower respiratory tract infection and abdominal distension. Children are invariably symptomatic from birth, although the symptoms may be intermittent and may vary in severity. A high index of suspicion is required because the symptoms are not specific. Establishing the diagnosis can be difficult and neither radiology nor bronchoscopy is infallible. Surgical division of the fistula is curative.     

Isolated Infundibuloarterial Inversion

Isolated infundibuloarterial inversion is a rare conotruncal cardiac anomaly characterized by a leftward and posterior aortic valve in the face of ventriculoarterial concordance. It has previously been described only in cases associated with severe additional defects of substantial hemodynamic significance. We present a case of isolated infundibuloarterial inversion with a small, hemodynamically insignificant ventricular septal defect. The nature of this lesion, diagnostic methods of imaging, and features aiding its discrimination from the more commonly recognized anatomically corrected malposition of the great arteries are discussed.     

Isolated asymptomatic proteinuria

Proteinuria is occasionally detected on "routine" examination (not done for a suspected renal or urinary tract problem) and often presents a diagnostic problem. Even mild proteinuria is abnormal and needs an explanation. Its degree and persistence should be ascertained and associated hematuria looked for. Nonpathological (including orthostatic) proteinuria and renal tubular disorders should be excluded. Persistent proteinuria is mostly due to a primary or secondary (eg hepatitis B) glomerular condition, which requires expert evaluation of renal biopsy. Aggressive therapy may be needed in some cases. The intensity of proteinuria can be decreased with ACE inhibitors. Long-term observation is essential.     

Isolated cerebral thrombo-embolism and Crohn disease

Arterial thrombo-embolism is an unusual complication in inflammatory bowel disease in adults and children. Cerebral arterial disease has been reported on only a few occasions. There are only two previous case reports of arterial disease occurring in a child with Crohn disease. However in both instances the arterial disease was part of a generalised Takayasu arteritis which resulted in multi-organ involvement. This report describes a 14-year-old boy who developed seizures before a histological diagnosis ofCrohn disease was made. These seizures were the result of a vascular lesion which was confined to the right middle cerebral artery.Conclusion Crohn disease as well as ulcerative colitis should be considered as a possible cause of cerebrovascular accidents in children     

Isolated Severe Bilateral Bronchomalacia

Airway malacia is uncommon condition having symptoms similar to common respiratory illnesses. Any child having persistent wheeze during infancy should be evaluated for airway malacia. The authors report a case of isolated severe bilateral bronchomalacia managed with tracheostomy and continuous positive pressure ventilation.     

Isolated pulmonary Goodpasture syndrome

The case of a 13-year-old girl with Goodpasture syndrome is reported. The presentation at this age with only pulmonary hemorrhage is unusual among Goodpasture syndrome patients. The case illustrates well the diagnostic difficulties in Goodpasture syndrome. The choices of treatment modalities available for this disease and the results and risks of such treatment options are reviewed. A discussion and classification of diffuse pulmonary hemorrhage is presented. The case emphasizes that Goodpasture syndrome should be considered in the differential diagnosis of diffuse pulmonary hemorrhage in spite of a lack of renal abnormalities and that serum anti-glomerular basement membrane antibody testing can be of great help in confirming the diagnosis.     

Isolated unilateral gaze palsy

A case of an isolated unilateral horizontal gaze paralysis is presented. The abnormality has remained static and in isolation for more than three years. A review of the benign causes of pontine gaze palsies is presented. The unique features of this case is the fact that the gaze paralysis is unilateral and unassociated with any other neurologic or systemic abnormality.