逐步加压超声诊断小儿急性阑尾炎的价值

目的 评价逐步加压超声诊断小儿急性阑尾炎的价值及影响因素.方法 对拟急性阑尾炎行剖腹手术,且术前72 h经同一医师超声检查的104患儿进行超声声像与手术病理结果 对比.结果 逐步加压超声对小儿急性阑尾炎的检出率为91.26%,1～4岁、～9岁、～15岁患儿的检出率分别为100.00%、92.16%和87.50%.结论 逐步加压超声可有效地解决小儿特别是幼儿急性阑尾炎临床诊断的困难.     

彩色多普勒超声诊断小儿急性阑尾炎的临床应用研究

目的探讨彩色多普勒超声诊断小儿急性阑尾炎的临床应用。方法对临床拟诊的78例急性阑尾炎的患儿全部行彩色多普勒超声检查以明确诊断及鉴别诊断。结果78例临床拟诊的急性阑尾炎病人，经彩色多普勒超声检查诊断为急性阑尾炎的51例，全部行手术治疗，经手术及术后病理检查50例证实为急性阑尾炎。本组出现假阳性1例，假阴性1例，准确率为97．7％。结论采用无创伤性、简单安全的彩色多普勒超声诊断小儿急性阑尾炎可靠、准确，值得推广应用。     

右足跟试验对小儿急性阑尾炎诊断价值的探讨

<正> 右足跟试验是在临床实践中发现的一种鉴别急性阑尾炎的辅助检查方法。1985年5月至2001年6月,我们将其用于425例急性腹痛的患儿,现将临床资料进行总结,以探讨其在小儿急性阑尾炎中的诊断价值。     

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。     

腹内压测定诊断小儿急性阑尾炎的意义

急性阑尾炎是小儿最常见的急腹症 ,因小儿病史不确切 ,检查不合作 ,明确诊断有一定困难 ,为避免不必要的手术及延误手术致并发症发生 ,提高诊断正确率 ,笔者采用了经直肠间接测腹内压 (intraabdominalpressure,IAP)作为小儿急性阑尾炎的辅助诊断方法 ,现就其临床意义作一探讨。资料和方法一、临床资料2 0 0 1年 6月～ 2 0 0 2年 5月我院经手术和病理检查确诊为阑尾炎的 4 0例患儿 ,术前及术后 1d测IAP。根据手术结果分二组 :急性阑尾炎未穿孔组 ,男10例 ,女 9例 ,3～ 14岁 ,平均年龄 (8.4 2± 3.34)岁 ;急性阑尾炎穿孔组 ,男 12例 ,女 9…     

腹部超声诊断在小儿急性阑尾炎的作用

目的 了解腹部B超在小儿急性阑尾炎诊断中的作用。方法 回顾了我院1999～2003年409例小儿急性阑尾炎住院的诊治经过。结果 409例患儿中225例患儿术前未行腹部B超检查，17例误诊，其中15例手术探查未发现明显病因。184例(44．99％)行术前腹部B超检查，其中27例入院诊断为腹部其他疾病，经腹部B超检查确诊为急性阑尾炎，184例B超检查病例中3例误诊，20例漏诊，漏诊患儿中单纯性阑尾炎11例，化脓性阑尾炎7例。结论 B超检查能减少小儿急性阑尾炎误诊率，有助于阑尾炎的确诊。     

小儿急性阑尾炎的临床及诊治进展

急性阑尾炎是小儿腹部外科常见疾病,传统影像学检查对小儿急性阑尾炎的诊断较困难,同时大多数儿童典型症状出现的时间较晚,导致明确诊断的时间延长,往往容易导致各种并发症,包括阑尾穿孔、脓肿形成、腹膜炎和败血症等,使其病死率大大增加。因此,本文旨在回顾小儿急性阑尾炎的临床诊治进展,以期更好地指导临床医生对小儿急性阑尾炎的诊疗工作。     

小儿急性阑尾炎循证的计算机辅助诊断

目的　根据循证医学原理 ,采用计算机辅助的小儿阑尾炎评分系统对小儿阑尾炎病例进行分析 ,寻找增加诊断准确率的新方法。方法　检索文献 ,收集小儿急性阑尾炎的诊断证据 ,得出经评估在诊断中具有显著意义的征候 ,以Bayes条件概率数学模型 ,QBASIC语言编制计算机程序。采用该程序对 1999年 1月～ 2 0 0 3年 6月总计 2 37例入院诊断为急性阑尾炎小儿病例进行分析。结果　未手术组 83例 ,诊断概率均值为 0 .10 2 1± 0 .2 5 ;手术治疗组 15 4例 ,其中临床误诊组 8例 ,平均诊断概率为 0 .15 2 5± 0 .2 5 4 ;病理诊断为阑尾炎 14 6例 ,诊断概率 0 .8712± 0 .2 7,符合率 95 .89%。阑尾炎组诊断概率与误诊组或手术组相比P <0 .0 1。结论　本程序对小儿阑尾炎具有较高的诊断准确性 ,是一种简便、快捷和相对精确的辅助诊断工具 ,也适用于小儿阑尾炎治疗方法的选择。     

原发性小肠淋巴瘤的外科诊断与处理

目的 探讨小肠淋巴瘤与外科急腹症之间的鉴别诊断,以便采取正确的处理方法及早诊断和治疗.方法 对我院2000-2011年外科收治的10例小肠淋巴瘤患儿进行回顾性分析.结果 10例患儿中8例入院时诊断为阑尾炎或阑尾脓肿,2例诊断为急性肠套叠,经过反复分析病史,结合影像学所见,实行开腹探查.术中快速冰冻病理检查,确诊为小肠淋...     

新生儿持续肺动脉高压的诊断与鉴别诊断

新生儿持续肺动脉高压是新生儿期的危重症,正确的诊断和鉴别诊断对临床合理处理有重要意义.本文对新生儿持续肺动脉高压的临床表现与诊断的关系、相关的临床诊断程序、辅助检查方法及常见需要鉴别的疾病等进行介绍,重点对肺动脉高压的超声诊断方法进行了评价.     

Abdominal lymphangioma in childhood

The symptoms of abdominal lymphangioma are unspecific and depend on site and size of the tumor. The most frequent symptoms consist of pain up to the clinical picture of a pseudo-appendicitis, digestive problems, palpable or even exterior visible tumors such as the pseudo-ascites. Often the diagnosis cannot be found by clinical examination or further investigation. As a differential diagnosis all mesenterial cysts as well as other cystic tumors which originate in an abdominal organ must be taken in account. In most cases possible complications make surgical intervention necessary through which an exact diagnosis of the actually asymptomatic tumor can be found. Lymphangioma can lead to obstruction of the intestine, the ureter or the bile-duct. Inflammations of the cyst wall, bleeding into the cyst, torsion of the cyst pedicle and rupture of the cyst occur. The only curative therapy is the total surgical removal. Prognosis is good and relapse seldom occurs. We report on a 4.5-year-old boy with a cystic lymphangioma of the mesosigma. In addition, we discuss cases from the literature of the past 15 years.     

Laryngeal cancer in children: case report

Squamous cell carcinoma of the larynx is very rare in children and adolescents. It is usually diagnosed at late stages because early symptoms are often attributed to the maturation process or other common laryngeal pediatric diseases. Early visualization of vocal cords with fexible laryngoscopy is important in children presenting suggestive symptoms of laryngeal pathology. Defnitive diagnosis of carcinoma is made by biopsy, and juvenile laryngeal papillomatosis the most important differential diagnosis. Treatment constitutes a clinical challenge. There are no established protocols, and clinicians should make a special effort to preserve the functions of the larynx, and avoid long term complications. We present a 12-years-old child with invasive laryngeal carcinoma, without prior history of juvenile papillomatosis or radiotherapy, which responded favorably to chemotherapy and radiotherapy.     

The newborn with cardiological problems. The dilemma between malformative and non-malformative pathology

Cardiovascular impairment is frequent during the neonatal period and can be expression of malformative or not-malformative pathology. In both conditions the clinical presentation is often dramatic with cyanosis and/or heart failure. The neonatologist has to make differential diagnosis as soon as possible, because cardiac malformations in the neonatal period are usually ductus arteriosus-dependent and can worsen suddenly after its closure. Since colour Doppler-echocardiography is not available in all the neonatal units in order to be helped in the diagnosis, it is very important that neonatologists learn to use the indications obtained with a careful physical examination and with some simple instrumental tests, as chest X-ray, electrocardiogram and blood gas analysis. In this article a review is made of the most frequent heart malformations associated with cyanosis and/or heart failure during the neonatal period (complete transposition of the great arteries, Fallot's tetralogy, tricuspid and pulmonary atresia, aortic coarctation, interventricular septal defect, persistence of ductus arteriosus) and the most common neonatal pathologic conditions simulating congenital heart diseases (persistence of fetal circulation, neonatal transitory myocardial ischemia, hypervolemia, hypoglycemia, hypocalcemia). Some clinical, instrumental and laboratory findings that could be useful for the diagnosis in absence of echocardiography are also reported.     

Abusive Head Trauma: A Review of Current Knowledge

Abusive head trauma is a specific type of child maltreatment associated with high morbidity and mortality rates that can be challenging to diagnose as there is often no history or a fabricated one. Including the diagnosis in a differential requires a high level of suspicion from frontline providers especially when the clinical presentation is subtle as signs and symptoms can mimic other common conditions in pediatrics. This may result in a delayed or missed diagnosis. A thorough and comprehensive history and physical exam and complete documentation are essential for timely diagnosis. Consultation with a child abuse pediatrician is recommended if available. This article reviews current knowledge of the epidemiology, presenting signs and symptoms, clinical findings, and differential diagnosis of abusive head trauma with a focus on relevant information for the emergency department care provider.     

Insomnio en niños y adolescentes. Documento de consenso

Insomnia is very common during childhood (30% of children under 5), and causes a serious cognitive and emotional consequence in learning, as well as significant medical comorbidity. It also affects the quality of life, not only of the child, but also of the whole family. Paediatrician training in its diagnosis and treatment is usually poor. For this reason a consensus document is presented on the management of insomnia in children and adolescents. This has been developed by members of the Spanish Paediatrics Association, the Spanish Sleep Society, the Spanish Society of Paediatric Outpatient and Primary Care, the Spanish Adolescent Medicine Society, the Spanish Child and Adolescent Society, and the Spanish Paediatric Neurology Society. The group suggests that diagnosis must be clinical and complementary tests will only be required in doubtful cases or when a differential diagnosis is needed. Likewise, treatment should be mainly based on cognitive-behavioural therapy and the modification of sleeping habits. Using medicines and other substances to make the sleep easier is currently quite common, even although there are no clinical guidelines to support this.     

Severe Hypertension in a 4-Year-Old Child

The diagnosis and management of acute pediatric hypertension in the ED aim to minimize end-organ dysfunction. Severe hypertension is often due to a secondary cause for which a systems-based approach can guide the development of a pertinent differential diagnosis. Traditionally, history, physical examination, and laboratory data guide the initial narrowing of the differential. When a vascular cause is suspected, echocardiography and/or CT imaging will often lead to a diagnosis. This case demonstrates that ED ultrasound is both effective and rapid in facilitating the ability to make this diagnosis. It may also assist in quickly ruling out other diagnoses before any other imaging studies are performed or laboratory values seen. The learning curve for emergency ultrasound is relatively low, and its use can lead to improved outcomes with relatively little risk to the patient. Finally, for treatment of a hypertensive emergency or urgency, a handful of medications that decrease peripheral vascular resistance can provide immediate blood pressure control. However, some agents may be more effective for certain causes, furthering the need to establish a timely diagnosis.     

亚急性坏死性淋巴结炎33例

目的 探讨儿童亚急性坏死性淋巴结炎(SNL)的病因及，临床特征，提高对儿童SNL的认识，减少误诊。方法 结合文献资料对SNL患儿33例临床及实验室相关检查进行回顾分析。结果 本组33例患儿淋巴结活检确诊SNL；发病以学龄儿为主，2／3患儿冬春季节发病，男女之比3.7：1；均有淋巴结大，发热32例，白细胞总数减少21例；其中1例发展为系统性红斑狼疮，1例复发。结论 对不明原因发热伴淋巴结大者，除做相关化验检查外，应早期行淋巴结活检以明确诊断。SNL是自限性疾病，预后多良好，但也有复发。少数发展为系统性红斑狼疮，应长期随访。     

儿童抗N-甲基-D-天门冬氨酸受体脑炎的诊断与鉴别诊断

自身免疫性脑炎相对少见,且临床表现多种多样,很难在疾病早期给予确诊。因此,儿科临床医生应该熟悉自身免疫性脑炎的临床症状、体征、辅助检查特点、影像学改变、免疫学特征以及鉴别诊断要点。为正确诊断抗N-甲基-D-天门冬氨酸受体（NMDAR）脑炎,患儿应该进行包括寡克隆带检测的脑脊液检查、头颅磁共振扫描以及普通脑电图和/ 或24 h 视频脑电图检查。对于早期出现精神症状和癫癎发作的患儿尤其注意进行血液和脑脊液中抗NMDAR 抗体测定。脑电图出现“δ 刷”时对该病临床诊断有帮助。脑脊液NMDAR 抗体阳性是诊断该病的金标准。抗NMDAR 脑炎的鉴别诊断非常宽泛,儿童患者应该主要与单纯疱疹病毒性脑炎、其他自身免疫性脑炎及精神病相鉴别。     

Alcoholic ketoacidosis in an 11-year-old boy

A history of ethanol consumption combined with vomiting, anion gap metabolic acidosis, and altered mental status is consistent with a broad differential diagnosis, which requires a systematic approach. Alcoholic ketoacidosis is rare after binge drinking in the na?ve individual and typically occurs in patients with heavy, chronic use. We present the case of an 11-year-old boy with acute ethanol intoxication and a clinical course that is most consistent with alcoholic ketoacidosis. Alcoholic ketoacidosis should be considered in the differential diagnosis of children with unexplained ketoacidosis when there is history or evidence of ethanol consumption combined with the appropriate clinical presentation.     

儿童发作性头痛的诊断探讨

目的：探讨儿童发作性头痛的诊断和鉴别诊断。方法：分析122例发作性头痛患儿的临床过程、脑电图(EEG)或视频脑电图(V-EEG)、经颅超声多普勒(TCD)描记资料,并予以诊断、治疗和临床随访。结果：122例患者中,85例为偏头痛,35例为神经性头痛,1例头痛性癫痫,1例为颅内肿瘤。EEG和V-EEG结果显示大部分在正常范围,部分异常EEG中以弥散性慢波增多为主,仅有1例EEG显示有癫痫波;而TCD结果表明74例患儿脑动脉血流速度有不同程度增快。结论：儿童发作性头痛以偏头痛、神经性头痛多见;头痛的诊断必须依靠临床表现、EEG和TCD等检查结果综合判断。头痛性癫痫临床少见,以头痛为主诉的儿童不应轻易诊断为癫痫。