Post-traumatic symptoms in abused children

A variety of symptoms have been described as sequelae of physical and sexual abuse in childhood. This review suggests that some of these symptoms can be understood as developmentally mediated manifestations of post-traumatic disorders. Like traumatized combat or concentration camp survivors, severely abused children develop anxiety, compulsive repetitions, sleep disturbances and depression, ego constriction, and disturbed expressions of anger. The example of incest trauma illustrates how developmental transformations of childhood post-traumatic symptoms can produce the varying patterns of presenting psychopathology seen in adult survivors.     

Surgical treatment of bronchiectasis in children

Background purpose

Surgical treatment of childhood bronchiectasis has not been discussed extensively because of decline in prevalence and experience with this disease. It remains controversial as to which children would benefit from surgery and surgical points that may affect the outcome. Therefore, a retrospective series was prepared to evaluate the results of surgical treatment of bronchiectasis in children.

Methods

The records of 54 children who underwent surgery for bronchiectasis between 1991 and 2002 were analyzed retrospectively for age; sex; clinical features; radiologic examinations; details of surgery including type of resection, operative morbidity, and mortality; and outcome.

Results

Fifty-four patients underwent 58 pulmonary resections during the study period. The mean ages at diagnosis of bronchiectasis and at the time of surgery were 7.80 ± 3.70 years (range, 1 to 15 years) and 9.25 ± 3.92 years (range, 1.5 to 17 years), respectively, with a male to female ratio of 5:4. The causes of bronchiectasis were lung infection (n = 39), hereditary and inborn diseases (n = 14), and foreign body aspiration (n = 1). Chest X-rays, bronchography (n = 12) or chest computed tomography (n = 43), and ventilation-perfusion scintigraphy (n = 13) were used, and pulmonary function tests (n = 21) and bronchoscopy (n = 54) were performed. The types of resections were lobectomy (63%), pneumonectomy (18.5%), lobectomy with segmentectomy (11.1%), segmentectomy (3.7%), and bilobectomy (3.7%). Four patients required a second operation. Forty-one patients (76%) had complete resection, and 13 patients (24%) had incomplete resection. Intraoperative and postoperative complications were encountered in 4 (7.4%) and 4 patients (7.4%), respectively. The course after surgery was well in 23 (42.5%), improved in 23 (42.5%), and unchanged or worse in 5 patients (9.4%). The mortality rate was 5.6%.

Conclusions

The decision for bronchiectasis surgery should be made in cooperation with the chest diseases unit. Anatomic localization of the disease should be mapped clearly by radiologic and scintigraphic investigations. The morbidity and mortality rates of bronchiectasis surgery are within acceptable ranges. Most of the children benefit from surgery, especially when total excision is accomplished. Pneumonectomy is well tolerated in children without increase in morbidity and mortality. Therefore, pneumonectomy may be preferred instead of leaving residual disease when bronchiectasis is unilateral.     

臀肌挛缩症的手术治疗

臀肌挛缩症导致髋关节功能障碍,多见于儿童,其手术方法有多种。1982年6月~2002年11月,我院共收治31例,采用不同手术方法治疗,术后功能恢复较满意。1材料与方法1.1病例资料本组31例,男19例,女12例,年龄2~12岁。单侧5例,双侧26例。其中28例有多次臀肌注射史。患儿多因步态异常或双下肢不能下蹲,坐位时两下肢不能交叉而就诊。1.2临床表现患儿多呈外“八”字步态,快走不稳,呈跳跃式,髋关节活动有弹响或有下蹲障碍,坐位时双膝不能并拢,下蹲时双髋关节可呈现蛙腿征,臀部触及发现单侧或双侧臀肌萎缩及沿臀肌方向上条索状块。1.3治疗方法均采取手术…     

Do child sexual abuse experts hold pro-child beliefs?: A survey of the international society for traumatic stress studies

As psychologists become increasingly involved in child sexual abuse cases, professional concerns have been expressed about their partisan orientation as child advocates. A survey was administered to examine the beliefs about child sexual abuse and children's capabilities as witnesses held by a sample (N=340) from the International Society for Traumatic Stress Studies (ISTSS). Multivariate analyses of variance suggest that female ISTSS members generally have stronger beliefs in the credibility of child witnesses than male members. Additionally, ISTSS members who work with victims of sexual assault generally have stronger beliefs in the credibility of children than members who work with veterans or other sufferers of traumatic stress reactions. Moreover, ISTSS members from southern geographical regions are less likely than respondents from other regions to endorse items in a manner that has favorable implications for a child witness. Beliefs of ISTSS respondents do not differ as a function of their educational background. Implications for the role of child sexual abuse experts in the legal system are discussed.This article was accepted for publication under the Editorship of Charles R. Figley.     

Legal interventions for child victims

Many commentators have expressed concern over the plight of children in the nation's court system, fearing that child victim/witnesses might suffer significant trauma. In efforts to alleviate this presumed trauma, new laws were passed and traditional procedures were modified. This paper synthesizes available research addressing 2 questions pertaining to the mental health needs of child victims: (1) To what extent are children traumatized by their involvement in the justice system, and (2) What interventions are effective in reducing children's trauma? The review concludes that most children can testify without suffering long‐term adverse effects. It also identifies elements of the justice system that appear to heighten stress for children. Finally, it suggests several strategies that might be effective in alleviating that stress.     

Trauma of the larynx and craniofacial structures: airway implications

Laryngeal trauma in children is potentially life-threatening. An organized approach by all who care for these children in an emergency situation is essential. Prompt recognition and treatment of such injuries will minimize the risk of long-term complications that would require multiple operative procedures and prolonged rehabilitation.     

儿童颅脑损伤的临床特点及手术策略（附257例分析）

目的分析总结儿童颅脑损伤的临床特点及手术方法。方法回顾性分析我院2003年1月～2010年12月收治的257例颅脑损伤患儿的临床资料,平均年龄6.3（1～14）岁,其中小于3岁者52例,3～6岁者98例,7～14岁者107例;闭合性颅脑损伤217例,开放性颅脑损伤40例。按GCS评分：13～15分92例,9～12分62例,6～8分87例,3～5分16例。其中,轻型颅脑损伤90例,中型颅脑损伤57例,重型颅脑损伤89例,特重型颅脑损伤21例。手术治疗97例,包括颅内血肿清除＋保留颅骨62例（其中环钻开颅14例）、颅内血肿清除＋去骨瓣减压术11例、颅内血肿清除＋凹陷骨折复位术18例、开放性颅脑损伤清创术或颅内异物摘除术等6例。21例患儿施行气管切开术。非手术治疗160例。结果术后按照GOS评估预后：恢复良好212例（82.5%）;中残18例（7.0%）;重残8例（3.1%）;植物生存2例（0.8%）,死亡17例（6.6%）。本组住院时间平均29（11～195）d。95例患儿获随访,随访时间6个月～2年。出现癫痫症状26例,硬膜下积液20例,交通性脑积水11例。结论儿童因解剖、生理、病理生理等与成人有所不同,容易导致颅脑损伤后原发损伤重、临床症状重、病情变化快;强调对每个患儿行个体及规范化治疗,积极预防术后并发症及癫痫的发生,及时、恰当的综合治疗,可降低病死率及致残率,且小儿神经系统修复能力强,与成人相比多预后良好。     

Treating psychic trauma in children: A preliminary discussion

Treatment techniques for psychic trauma in children are as yet at a very preliminary stage. No generally accepted research study has established one certain technique as standard. Possibilities for treatment of childhood post-traumatic stress disorders cluster into family, group, and individual treatments. Among the individual treatment modalities available, play therapy, psychodynamic psychotherapy, cognitive and behavioral therapies, and medication hold the most promise. A combination of several of these treatments would, in most cases, be the best program available today.This paper was delivered at the National Institute of Mental Health Symposium on Traumatized Children, April 1986, Rockville, Maryland. It was revised in June 1988 for publication in this journal.     

眼震电图检查儿童先天性眼震的意义

目的：探讨眼震电图对先天性眼震患者手术效果的评定及其临床意义。方法：对42例儿童先天性眼震患者行手术前后眼震电图检测,中间位检查方法为令患者头正位注视正前方50cm处与双眼平行的目标光点;代偿位检查时令患者放松以平时视物最佳位为准,在此位患者眼震最小。观察中间位和代偿位眼震的速度、幅度和频率。眼震幅度、频率和速度计算均取最大眼震反应期10s时期内的平均值。结果：眼震电图可以记录到跳动型和钟摆型两种不同的眼震波,跳动型呈锯齿波,钟摆型呈正弦波。手术后中心位和代偿位的眼震与术前相比有明显降低。42例患者的眼震速度在中心位和代偿位有不同程度的下降或消失,占88.09%,42例患者中眼震幅度下降者35例,占83.3%（P〈0.01）。术后眼震频率在中心位和代偿位也均有下降,但以中心位明显,其中16例患者代偿位眼震的频率、幅度和速度降为零。结论：眼震电图检查可以作为儿童先天性眼震的量化标准来指导手术,评价手术治疗效果。     

小儿巨大胆总管囊肿11例手术体会

目的总结小儿先天性巨大胆总管囊肿的外科手术治疗经验。方法对11例先天性巨大胆总管囊肿患儿施行胆囊切除、胆总管囊肿切除术、肝管夺肠Roux—en—Y型吻合术。结果术后均痊愈出院,10例获随访3～12个月,未见胆道感染、黄疸、营养不良等并发症出现。结论常规术中胆道造影,完全地切除囊肿,合理地处理囊肿远近端胆管异常是巨大胆总管囊肿手术成功的关键。     

Eosinophilic cystitis causing spontaneous rupture of the urinary bladder in a child

We report a unique case of eosinophilic cystitis causing intraperitoneal bladder perforation in a child diagnosed by chance with no signs or history of trauma. To our knowledge, this is the first case of eosinophilic cystitis complicated by bladder rupture in children. The patient was successfully treated with primary repair. For children with non-traumatic bladder perforation, eosinophilic cystitis must be considered in the differential diagnosis.     

小儿电视胸腔镜肺切除术

目的：探讨应用电视胸腔镜施行小儿肺切除的可行性与手术方法。方法：本组11例，男7例，女4例，平均年龄8．9岁，其中先天性肺囊肿并发气胸5例，肺大疱合并气胸5例，左上肺隔离症1例，采用单腔插管全身麻醉，施行电视胸腔镜肺切除术，结果：肺楔形切除或部分切除6例，肺叶切除5例，手术时间平均100min，术后留置胸管和住院时间分别为2d和9．2d，术后平均随访8．4个月，无复发。结论：小儿电视胸腔镜肺切除术安全可行，具有良好应用前景。     

儿童与成人脊髓纵裂的对比分析

目的比较儿童与成人脊髓纵裂的临床特征、治疗和预后的异同。方法对110例儿童和29例成人脊髓纵裂患者的临床表现、影像学和手术疗效进行回顾分析。结果相对成人而言,儿童脊髓纵裂下肢运动障碍,脊柱侧弯、腰背部皮肤特征性的改变等症状、体征较多见;外科治疗对于下肢无力、步态异常、疼痛和感觉障碍效果较好,对于大小便功能障碍效果不理想。而成人以疼痛、下肢无力等症状较多见,外科治疗对于疼痛、下肢无力疗效明显,对大小便功能障碍效果较儿童更差。结论儿童和成人脊髓纵裂在临床特征、预后等方面均有差别,在确定治疗方案时应有所区别。     

Laparoscopic Nephrectomy in Children: Two Case Reports

We successfully performed a laparoscopic nephrectomy on 2 young girls in March 1994 and August 1994. The first patient was a 9-year-old girl with a hypoplastic kidney associated with an ectopic ureterocele, and the other was a 3-year-old girl with a nonfunctioning hydronephrotic kidney caused by stricture of the pyeloureteral junction. The operating times were 153 and 183 minutes, respectively. No complications occurred intraoperatively or postoperatively in either patient. The 9-year-old girl resumed normal daily activities by postoperative day 2, and the 3-year-old girl by postoperative day 3. Both girls were discharged on day 4.     

腹腔镜小儿阑尾切除术31例临床分析

目的总结腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗小儿阑尾炎的疗效。方法采用LA治疗小儿急性阑尾炎31例。结果均顺利完成LA,无腹腔内出血,无肠管、输尿管等副损伤,无中转开腹,术后无粘连性肠梗阻、腹盆腔脓肿及手术切口感染等并发症发生。结论 LA治疗小儿急性阑尾炎具有安全、微创、并发症少及恢复快的优点,值得推广。