深圳市6～12岁正常儿童超声骨密度测定及分析

目的　了解深圳地区儿童超声骨密度状况 ,建立深圳市儿童超声骨密度正常参考值。方法　选择 6～ 12岁深圳居住的正常儿童 6 97例为检测对象 ,用定量超声骨密度仪测定受检者足跟部骨密度 (BMD)值 ,同时测量受检者体重、身高。结果　 6～ 12岁儿童BMD正常参考值 (g/cm2 )分别为 6岁 :0 4 4 5± 0 16 6、7岁 :0 5 0 9±0 15 1、8岁 :0 5 10± 0 133、9岁 :0 5 19± 0 132、10岁 :0 5 2 0± 0 15 3、11岁 :0 5 30± 0 175、12岁 :0 5 4 5± 0 2 0 6。男童与女童之间BMD存在差别但经体重较正后无显著性差别 (P >0 0 5 )。男童与女童BMD随年龄增加呈线性增长 (男 r=0 72 2 ,P <0 0 0 1;女 r=0 785 ,P <0 0 0 1) ,并与体重显著相关 (r=0 984 ,P <0 0 0 1)。结论　 6～ 12岁儿童足跟部BMD与性别无关 ,而与年龄增加呈线性增长 ,这种增长与体重显著相关。     

彩色多普勒评价小儿重症肺炎肾血流动力学变化及其临床意义

目的探讨小儿重症肺炎肾血流动力学变化的临床意义.方法应用彩色多普勒测定38例小儿重症肺炎急性期和恢复期及24例正常对照组肾血流动力学变化.结果小儿重症肺炎急性期肾主动脉及各分支收缩期峰值血流速度(Vmax)、舒张末期血流速度(Vmin)均显著下降(P＜0.01),阻力指数(RI)、搏动指数(PI)明显升高(P＜0.01),恢复期与对照组各项测定值比较无显著差异.结论肾脏血流动力学的病理变化是小儿重症肺炎肾脏损害和功能障碍的重要原因,给予临床干预可恢复正常.彩色多普勒测定肾血流变化可用于重症肺炎患儿肾脏损害的早期诊断及指导治疗.     

蓝巩膜在缺铁性贫血诊断中的价值和意义

为了探讨蓝巩膜与缺铁性贫血 ( 1DA)的关系 ,我们对 15 0例蓝巩膜患儿进行了检测和对比 ,发现蓝巩膜在IDA体征中意义较大。而且为IDA早期诊断 (ID)提供了较为可靠的线索。临床资料一、对象 :蓝巩膜患儿 15 0例 ,男 80例 ,女 70例。年龄 6个月～ 6岁 ,平均 4.3± 1.5岁。体重 5～ 2 2 .4千克 ,平均 11.5± 2 .3千克。对照组为无蓝巩膜正常查体儿。男 3 9例 ,女 3 6例。年龄 8个月～ 6岁 ,平均 4.5±1.7岁。体重 6.5～ 2 5千克 ,平均 12 .1± 1.9千克。两组资料在男女性别、年龄及体重方面无差异 (P >0 .0 5 )。二、方法 :蓝巩膜评定固定…     

儿童先天性心脏病围术期血制品用量分析

当前 ,先天性心脏病手术年龄不断提前 ,手术中用血量大。针对这一状况 ,我们对儿童先心病围术期血制品用量进行分析 ,探讨节约用血的方法。资料与方法一、一般资料　本组资料收集 1999年 5～ 7月 ,我院在体外循环下行先天性心脏病纠治的手术病例 14 9例。将其分为 3组 ,第一组 :1岁以下 2 8例 ,平均年龄 ( 0 .74± 0 .2 4 )岁 ,体重 ( 6.86± 1.73 )ｋｇ ;第二组 :1～ 5岁 79例 ,平均年龄( 2 .77± 1.2 9)岁 ,体重 ( 12 .94± 5 .3 9)ｋｇ ;第三组 :5～ 13岁 4 2例 ,平均年龄 ( 7.97± 2 .2 4 )岁 ,体重 ( 2 1.98± 10 .4 2 )ｋｇ。二、体外…     

39324名0～12岁小儿身高体重指数分析

本文统计了39324名0～12岁小儿体格发育资料,对小儿身高体重指数进行再分析.结果提示:身高体重指数(Quitelet index,QI)和体块指数(Body Mass index,BMI)均能较好克服判断肥胖时身高对体重指标的影响,用于实际工作,较按性别、年龄、身高分组的体重标准简单,应用指数标化法,可便于资料对比.文中附0～12岁小儿主要身高体重指数参考值。     

健康儿童脑血流速度及脉动指数的意义

目的探讨健康儿童脑血流动力学变化。方法应用经颅多普勒检测120名健康儿童脑底动脉的血流速度及脉动指数。结果婴儿期血流速度最低，以后血流速度随年龄增长渐增快，约6岁左右达最高值，随后血流速度逐渐减低。脉动指数在婴儿期最高，以后渐减低。除10～14岁组外各动脉血流速度两性别之间无明显差异。结论采用经颅多普勒检测可了解儿童脑血流动力学变化，为诊断小儿脑血管疾病提供可靠、定量依据．     

单阻断方法测定135例婴幼儿肺炎患儿呼吸道阻力和顺应性的变化

为观察2岁以下婴幼儿肺炎的呼吸道阻力与顺应性的变化,将肺炎组135名,对照组77名儿童,按月龄分为5组(1m～3m、4m～6m、7m～12m、13m～18m、19m～24m),用单阻断法直接测定呼吸道阻力(Rrs,Rrs/kg)和顺应性(Crs,Crs/kg)。结果显示,肺炎组在各月龄中,呼吸道阻力高于对照组,但顺应性小于对照组,差异有统计学意义(P均<0.05),尤其是经过体重校正的Rrs/kg和Crs/kg。如:1m～3m组,正常小儿气道阻力和顺应性分别为:0.90±0.55(kPa×s/l)/kg和13.17±4.41(ml/kPa)/kg,而肺炎组分别为:2.135±2.54(kPa×s/l)/kg和9.27±3.82(ml/kPa)/kg。提示婴幼儿肺炎时呼吸道阻力增高,顺应性下降。     

新生儿窒息肺动脉压力变化的无创性动态监测

目的　研究新生儿窒息后肺动脉压力的变化特点及临床意义 ,提供简便无创的检测方法。方法　应用彩色脉冲多谱勒超声于生后 2 4h内、3、7及 12～ 14d分别检测了 30例窒息新生儿及 2 5例正常新生儿左 /右心室射血前期、左 /右心室射血时间及其比值的变化 ,并依此推算肺动脉压力。结果　窒息与正常新生儿肺动脉压力在 2 4h内分别为肺动脉舒张压 (5 5 1± 17 3)mmHg对 (15 0± 3 0 )mmHg ,肺动脉阻力 (14 2± 3 9)mmHg/(L·min·m2 )对 (5 3± 1 3)mmHg/(L·min·m2 ) ,肺循环阻力 /体循环阻力比值 (0 84± 0 4 7)对 (0 2 7± 0 2 0 ) ,差异极显著 ,P <0 0 1。至生后 1周末 ,两组婴儿上述各指标间均无明显差异。结论　肺动脉高压是新生儿窒息的重要病理生理变化 ,在生后 1周内应重视对窒息新生儿肺动脉压力的检测。多谱勒超声心动图简便、无创 ,适于观察新生儿肺动脉压力的变化     

应用Amplatzer堵闭器封堵0～1岁婴儿动脉导管未闭临床分析

目的　探讨应用AmplatzerDuctOccluder(ADO)封堵 0～ 1岁婴儿动脉导管未闭 (PDA)的可行性 ,并对其疗效及相关技术进行评价。方法　 30例PDA患儿 ,平均年龄 (7 4± 3 6 )个月 ,平均体重 (6 1± 2 7)kg ,15例合并肺动脉高压。所有患儿均应用ADO进行堵闭。结果　PDA最窄处直径平均 (4 8± 2 4 )mm (2 1～7 2mm) ,其中 2 0例 (6 6 7% )为大型PDA(>4 0mm)。 4例操作过程中输送鞘出现了扭曲弯折 (13 3% ) ,后换用Cook长鞘顺利完成堵闭 ,致使手术时间过长 (超过 12 0min)。 30例平均手术时间 (76 9± 30 1)min (4 5～15 0min) ,平均X线透视时间 (7 4± 5 2 )min(4～ 2 5min)。 30例平均随访 1 5年 ,仅 1例存在残余分流 ,完全闭合率达 96 7%。 2例出现降主动脉血流速度增快 (>2 0m/s) ,其余病例均未见溶血、堵闭器脱落、左右肺动脉及降主动脉狭窄。结论　应用ADO关闭 0～ 1岁婴儿PDA是安全、可行、有效的治疗方法 ,但对于体重 5 0kg的婴儿 ,装置及其输送系统尚需进一步改进。     

小儿先天性心脏病重度肺高压手术后远期疗效

目的　评估小儿先天性心脏病 (先心病 )重度肺高压手术治疗的远期疗效 ,分析影响其远期疗效的因素。方法　系统观察 1 981～ 2 0 0 1年 ,1 1 2例 (其中男 68例 ,女 44例 ,年龄 2个月～ 1 6岁 )左向右分流先心病伴重度肺高压手术治疗后的转归。病种包括房间隔缺损 (ASD) 3例 ,室间隔缺损 (VSD) 81例 ,室间隔缺损伴动脉导管未闭 (PDA) 1 2例 ,室间隔缺损伴房间隔缺损 1例 ,室间隔缺损伴房间隔缺损伴动脉导管未闭 1例 ,动脉导管未闭 1 3例 ,主肺动脉隔缺损 1例。肺动脉收缩压与体动脉收缩压之比 (Pp/Ps)≥0 .75者列为观察对象。年龄 2个月～ 1 6岁。结果　住院死亡 3例 ,术后半年、2年、3年各死亡 1例 ,手术生存率 97.32 % ,1年生存率 96 .43 % ,5年生存率 94.64 %。生存者纽约心脏病学会 (NYHA)心功能分级 :Ⅰ、Ⅱ级 (优良组 ) 99例 (93 .4 % ) ,Ⅲ级 (差组 ) 7例 (6 .60 % )。死亡病例均为术后持续肺高压。生存病例 ,优良组与差组术时年龄比较 ,(3 .39± 2 .94)岁对 (6 .57±3 .51 )岁 (P <0 .0 5)。肺血管阻力比较 ,(6 .78± 4 .0 4 )U/M2 对 (1 2 .2 6± 4 .1 7)U/M2 (P <0 .0 1 )。结论　小儿左向右分流先心病伴重度肺高压术后远期疗效与术时年龄 ,肺血管阻力有关 ,婴幼儿期手术预后较理想。     

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.