血液灌流抢救毒鼠强中毒的疗效

目的 观察血液灌流(HP)在抢救毒鼠强中毒的疗效方法应用HP加常规方法治疗9例毒鼠强中毒患儿(HP组),与单纯常规方法治疗的5例毒鼠强中毒患儿(NHP组)疗效进行比较。结果 治疗后HP组血中毒鼠强浓度显著降低(P<0.01)、血清酶明显降低(P<0.05);同期两组比较,HP组血清酶水平较低、血清酶恢复正常时间及抽搐时间明显缩短(P<0.05) 结论 HP治疗毒鼠强中毒效果明显     

小儿急性毒鼠强中毒的血液灌流治疗

目的　 探讨子母活性炭血液灌流对毒鼠强中毒的治疗价值。 方法 　采用BP 2 1血液灌流装置对 14例毒鼠强中毒患儿进行床边血液灌流治疗 ,测定患儿灌流前血、尿液、灌流后即刻及 2 4h血、72h的血、尿毒鼠强浓度 ;并与既往常规治疗的 11例患儿疗效进行比较。 结果 　血液灌流后毒鼠强浓度明显下降 (P <0 0 1) ;血液灌流组与常规非血液灌流组比较 ,相同时期内血液、尿液毒鼠强浓度有明显下降 ,血浓度下降值分别为 ( 74 9± 2 1 8) μg/ml和 ( 11 5± 5 9) μg/ml,尿毒鼠强浓度下降值分别为( 79 4± 14 9) μg/ml和 ( 16 4 ± 7 8) μg/ml,两者均有显著差异P <0 0 1。 结论 　炭肾血液灌流对毒鼠强有很好的吸附作用 ,吸附前后的血药浓度明显降低 ,炭肾血液灌流治疗毒鼠强中毒比常规治疗更有效。     

血液灌流治疗儿童急性毒鼠强中毒的疗效观察

目的 分析总结血液灌流治疗急性毒鼠强中毒的经验和价值.方法 根据患儿法定监护人的选择,将67例误服毒鼠强的患儿分为血液灌流组(灌流组)和常规治疗组(对照组),灌流组48例,在常规治疗的基础上进行血液灌流治疗,对照组19例,只接受常规治疗,比较不同血清毒鼠强浓度范围时患儿的治疗效果.结果 血清毒鼠强浓度＞0.5 mg/dl时,灌流组和对照组患儿均很快死亡;血清毒鼠强浓度为0.20～0.49 mg/dl时,灌流组患儿血清毒鼠强浓度下降值明显大于对照组[(0.28±0.02) mg/dl vs (0.13±0.03)mg/dl] (P＜0.05);血清毒鼠强浓度＜0.2 mg/dl时,两组浓度下降值差异无统计学意义[(0.12±0.02) mg/dl vs (0.11±0.03) mg/dl](P＞0.05).结论 应根据患儿血清毒鼠强浓度决定治疗方案,选择最为经济实用的治疗方法.     

血液灌流对毒鼠强中毒患儿心肝肾的保护作用

目的探讨血液灌流(HP)对毒鼠强中毒患儿心肝肾功能的影响。方法毒鼠强中毒患儿45例按不同治疗方式分为HP组(26例)和非HP组(19例),HP组用HP装置,进行床边治疗,非HP组进行对症处理。测血清酶,比较治疗前后心肝肾功能。结果治疗前两组均有不同程度的心肝肾功能损害,两组无显著差异(P>0.05)。治疗后HP组心肝肾功能较非HP组患儿恢复好,两组有显著性差异(P<0.01)。结论早期HP对毒鼠强中毒患儿心肝肾功能具有保护作用。     

血液灌流治疗毒鼠强中毒疗效观察

目的探讨血液灌流（HP）对儿童毒鼠强中毒的疗效。方法根据临床表现，将63例毒鼠强中毒患儿分为轻、中、重3级，均予常规治疗。对32例有严重惊厥的中、重度患儿进行HP治疗。结果行HP治疗的重症患儿（HP组）22例中，13例治愈，4例死亡，3例留有严重后遗症；出现与治疗相关的并发症脑疝4例，DIC2例。未行HP治疗的重症患儿（非HP组）7例中，5例死亡，2例留有严重后遗症。HP组疗效明显优于非肝组（P〈0.05）。结论HP治疗毒鼠强中毒患儿疗效良好。     

血液灌流治疗重度毒鼠强中毒24例

目的　探讨血液灌流 (HP)治疗重度毒鼠强中毒的疗效。方法　将 1999年 1月～ 2 0 0 2年 12月重度毒鼠强中毒 4 8例患儿分HP组和常规组。常规组采用洗胃、导泻、止痉、降颅内压、二巯基丙磺酸钠综合治疗 ;HP组在综合治疗基础上加用HP治疗。结果　HP组抢救成功例数高于常规组 (χ2 =8.17　P <0 .0 1)。HP组较常规组更能明显缩短患儿抽搐时间 (t =11.0 0　P <0 .0 1)、昏迷时间 (t =9.32　P <0 .0 1)、住院时间 (t =3.6 7　P <0 .0 1) ,且在中毒 6h内行HP治疗者 ,存活率明显增加。结论　HP是抢救重度毒鼠强中毒的有效方法     

窒息新生儿选择头部亚低温治疗前后血清神经元特异性烯醇化酶的变化

目的 探讨窒息脑损伤新生儿选择头部亚低温治疗前后血清神经元特异性烯醇化酶(NSE)的变化及早期亚低温治疗效果.方法 窒息新生儿82例.其中轻度窒息39例,重度窒息43例.无窒息足月新生儿29例作为健康对照组.重度窒息新生儿随机分成亚低温治疗组和常规治疗组,亚低温治疗组采用选择性头部亚低温治疗方法 ,维持鼻咽温度(34.0±0.5)℃,持续72 h;常规治疗组仅采用常规对症治疗.分别于治疗前、治疗72 h采集各组新生儿静脉血2 mL,采用放射免疫分析方法 检测血清NSE.采用SPSS 12.0软件进行统计学分析.结果 轻度窒息组血清NSE水平[(34.83±6.17)μg/L]及重度窒息组[(59.58±8.87)μg/L]均明显高于健康对照组[(30.57±4.88)μg/L](t=3.07 P<0.01;t=16.02 P<0.001);且重度窒息组明显高于轻度窒息组(t=14.52 P<0.001).亚低温治疗组和常规治疗组患儿治疗前血清NSE水平分别为(60.65±8.85)μg/L、(58.46±8.98)μg/L,二组比较无显著差异(t=0.81 P>0.05);治疗72 h亚低温治疗组[(40.97±6.55)μg/L]明显低于常规治疗组[(48.15±5.57)μg/L](t=3.86 P<0.001).结论 NSE可作为新生儿窒息脑损伤的早期监测指标之一,早期亚低温治疗重度窒息新生儿有脑神经保护作用.     

血液灌流在儿童急性毒鼠强中毒救治中的应用

目的：观察血液灌流(HP)治疗儿童急性毒鼠强(TET)中毒的疗效。方法：32例急性TET中毒儿童，年龄1~8岁，平均年龄4.6±2.4岁，均予以HP治疗。HP前、HP治疗1 h、2 h及HP后12 h、24 h测血清TET浓度，观察HP治疗开始到意识恢复时间、抽搐停止时间。结果：17例行HP治疗1次，12例2次，2例4次，1例 3次。27例(84%)治愈，2例(7%)好转，3例(9%)死亡。HP治疗1 h、2 h的TET浓度逐渐降低，且明显低于治疗前(P<0.01)。HP后12 h、24 h的TET浓度仍显著低于治疗前(P<0.01)。意识恢复时间为5.4±4.2 h、抽搐停止时间为10.1±7.3 h。结论：儿童急性TET中毒行HP治疗是有效的。［中国当代儿科杂志，2010，12（7）：536-538］     

心力衰竭患儿血浆血管活性肠肽和胰高血糖素的变化

目的 探讨心力衰竭(CHF)患儿血浆血管活性肠肽(VIP)及胰高血糖素(Glu)变化及其临床意义。方法 CHF患儿40例,男23例,女17例;年龄0.5~7.8岁。其中心功能Ⅰ级15例,心功能Ⅱ~Ⅳ级25例。应用放射免疫法测定患儿血浆VIP和Glu水平,以年龄性别相匹配且无CHF健康体检者23例为正常对照。结果 CHF患儿血浆VIP明显高于正常组[(43.22±5.48)ng／L vs(32.24±4.46)ng／L P<0.05];CHF患儿血浆Glu亦明显高于正常组[(298.23±123.43)ng／L vs(224.67±89.44)ng／L P<0.05]。应用洋地黄治疗,心功能控制后血浆VIP水平较治疗前明显下降[(34.78±5.43)ng／L vs(43.22±5.48)ng／L P<0.05],Glu水平亦较治疗前明显下降[(236.22±98.57)ng／L vs(298.23±123.43)ng／L P<0.05]。结论 CHF患儿血浆VIP、Glu水平明显升高,VIP、Glu参与CHF的病理生理过程。     

血液灌流对毒鼠强中毒预后的影响

毒鼠强是国家禁止生产销售的灭鼠剂 ,毒性强、降解慢 ,可引起二次中毒 ,急性中毒患者病死率高 ,对神经系统创伤大。我们对 2 0 0 1年 1月～ 10月收治的 17例误服毒鼠强患儿采用血液灌流 (HP)方法治疗 ,并进行为期 1年的随访观察 ,现将结果报告如下。资料和方法1 一般资料 :观察期间我院共收治 2 3例毒鼠强中毒患儿 ,其中 2例在HP前即死亡 ,未计入本组。随访资料完整者 17例 ,男 10例 ,女 7例 ,平均年龄 (6 1± 4 9)岁。 17例患儿被分为HP组 11例 ,非HP组 6例。两组年龄、性别、中毒时间、惊厥、心率及呼吸频率差异无显著意义 (P均 >0 …     

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.