小儿急性阑尾炎细菌移位及相关性的研究

目的 探讨小儿急性阑尾炎细菌移位的发生与阑尾组织一氧化氮合成酶(NOS)、血清一氧化氮(NO)的关系.方法 应用聚合酶链反应(PCR)定性检测全血细菌DNA(所有细菌共有的16SrRNA、大肠杆菌BG);腹腔液体及肠系膜淋巴结细菌培养;免疫组织化学方法定量检测阑尾组织NOS的表达;酶联免疫吸附试验(ELISA)定量检测不同时间血清中NO的变化.结果 对照组及单纯性阑尾炎组均未检出细菌DNA,化脓性阑尾炎组16SrRNA阳性率为70%,BG阳性率为60%,肠系膜淋巴结细菌培养阳性率(大肠杆菌)为50%,腹腔液体为40%.阑尾炎组NOS平均灰度值与对照组之间有明显差异(P<0.01).阑尾炎组术前NO浓度与术后组、对照组间均有差异(P<0.05).NOS平均灰度值与NO浓度呈相关性,二者与细菌移位的表达密切相关.结论 小儿急性阑尾炎发生细菌移位,而细菌移位可能与NOS、NO相关,及时检测血清细菌DNA和NO对小儿急性阑尾炎细菌移位的诊治有一定的临床价值.     

Diagnosing appendicitis in children with acute abdominal pain

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)     

小儿急性阑尾炎误诊原因分析

急性阑尾炎是小儿最常见的急腹症,以５一１２岁为多见。由于小儿生理、病理、解剖方面的特点,误诊率较成人为高,本报道我院儿科自１９８４年４月至２００１年１２月因误诊收住儿科后转外科手术确诊为急性阑尾炎的病例５０例。     

小儿急性阑尾炎的误诊分析

小儿急性阑尾炎是小儿外科常见急腹症之一,发病初期至儿内科就诊的占绝大多数,且由于其年龄、解剖生理特点等特殊性,误诊和出现并发症的几率较高,故对于儿科尤其是儿内科医师来说,只有做到早期诊断,才能不延误患儿的最佳治疗时机.现收集整理我科2007年1月至2008年6月经CT和B超等辅助检查,且有完整临床资料并得到我院外科手术、病理证实的急性阑尾炎患儿67例,并作一回顾性研究.     

Pattern of acute appendicitis in Nigerian children

A review of 47 cases of acute appendicitis in children seen at the Ife University Teaching Hospital over a 7-year period (1980-86) is presented. Over this period the disease was responsible for 0.43% of all paediatric admissions and 18% of all paediatric abdominal emergencies. The clinical features were similar to those in other populations, but in this series there was a tendency towards late presentation with complications which caused significant post-operative morbidity. However, there was only one death.     

Hydronephrosis secondary to acute appendicitis in children

Pediatric Radiology - Acute appendicitis in children remains at times a difficult clinical diagnosis since 20 to 30% of the patients present with atypical symptoms. Five patients with appendicitis...     

Ultrasound study of acute appendicitis in children with emphasis upon the diagnosis of retrocecal appendicitis

Acute appendicitis in children frequently presents equivocal clinical manifestations. Delay of the proper diagnosis and unnecessary laparotomies are common. Abdominal ultrasound has proved to be useful in the diagnosis of acute appendicitis in adults. We have performed a preoperative ultrasound study in 368 children with acute appendicitis. Among them, 92 had a retrocecal appendicitis. Ultrasound established the correct diagnosis in 92.6% of patients, and in 94.5% of those with a retrocecal appendicitis. At our institution an abdominal sonography is performed on any child with a doubtful clinical diagnosis of acute appendicitis, helping the surgeon to take the decision to perform a laparotomy.Presented at the ESPR meeting in Dubin 1989. Selected for publication by an International Group of the ESPR     

Perforated chronic duodenal ulcer in children with coexistence of acute appendicitis

Two cases of perforation of duodenal ulcer with coexistence of acute appendicitis are reported. Current concepts regarding this unusual complication of childhood duodenal ulcer are discussed.     

Perforated chronic duodenal ulcer in children with coexistence of acute appendicitis

Abstract Two cases of perforation of duodenal ulcer with coexistence of acute appendicitis are reported. Current concepts regarding this unusual complication of childhood duodenal ulcer are discussed.     

Total antioxidant capacity and oxidative stress after a 10-week dietary intervention program in obese children

Dietary and serum total antioxidant capacity (TAC) are considered appropriate tools for investigating the potential health effects of dietary antioxidants consumed in mixed diets. The aim was to analyze the impact of a dietary intervention on macronutrient intakes and to evaluate the improvement on oxidative status after weight loss (WL) by measuring dietary and serum TAC, and urinary F2-isoprostane levels as markers of oxidative stress. Forty-four overweight/obese children (mean age 11.5 years) were enrolled to undergo a 10-week WL program. They were dichotomized at the median of body mass index–standard deviation score (BMI-SDS) change, as high (HR) and low responders (LR) after intervention. Subjects were prescribed with a fixed full-day meal diet, calculated according to their basal metabolic rate and physical activity levels. A validated food-frequency questionnaire was used to retrospectively calculate TAC and daily nutrient intake. The HR subjects were able to reduce anthropometric indices and to improve lipid and glucose profile. They also significantly diminished fat intake (p?=?0.013). Moreover, baseline serum TAC values did significantly predict the reduction in urinary F2 isoprostane (B?=??0.236 (?0.393 to ?0.078); p?=?0.014) in the HR group after the WL program. Notably, changes in dietary TAC after the treatment were associated with a decrease in body weight after the 10-week intervention (B?=??2.815 (?5.313 to ?0.318), p?=?0.029) in the HR group. The -ΔSerumTAC/ΔDietaryTAC and the -ΔF2Isoprostane/ΔDietaryTAC ratios revealed that the relationships between oxidative markers and antioxidants dietary intake were more favorable in the HR than in the LR group. Conclusion: Our study showed that a 10-week WL program was able to reduce adiposity indices in obese children. Moreover, after the intervention changes in dietary TAC and WL were significantly associated. Our result suggests that specific food with a high TAC content (such as fruits, vegetables, and legumes) could be recommended to improve WL.     

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。     

Advancements in the diagnosis of acute appendicitis in children and adolescents.

The aim of our study was to further improve the preoperative diagnosis of acute appendicitis in children and adolescents. All diagnostic parameters from the patients' medical history (duration and quality of abdominal pain, stool behaviour), the laboratory (leukocytes, C-reactive protein), the clinic (defense, tenderness on percussion, nausea, vomiting, dry tongue) and repeated ultrasound investigations (visualisation of the appendix, indirect signs of an inflammatory process in the appendix region) were documented prospectively and were re-assessed with regard to their diagnostic value. As an additional parameter, procalcitonin was determined. 1156 patients (593 male/563 female) with a mean age of 9.51 years (+/- 1.2 yrs) (max. 15 yrs/min. 2.3 yrs), referred to the department with acute abdominal pain, were examined. 233 (141 male/92 female; 20.1 %) of these patients with a mean age of 10.47 years (+/- 1.1 yr) had appendicitis. Based on the patients' medical history, laboratory findings, the initial clinical investigation and the initial ultrasound investigation, 173 patients (74.3 % of the later operated 233 children with appendicitis) were diagnosed with certainty. The diagnosis of 60 patients (25.7 %) of this group remained uncertain. These patients received a saline enema (Clysmol, Pharmacia & Upjohn Company) and were subjected to a second clinical and sonographic investigation after approximately four hours of parenteral fluid substitution (Ringer's lactate, Mayrhofer Pharmazeutika Company, 4 ml/kg/h). The other 923 patients (79.83 %) were discharged and were followed up as outpatients in the following days. Based on this stepwise procedure, the percentage of correctly diagnosed appendicitis could be increased to 97.4 %. The measurement of procalcitonin proved to be of no value in the diagnosis of acute appendicitis. It may be concluded that in children with abdominal pain, high diagnostic accuracy can only be achieved by a carefully combined evaluation of all individual diagnostic parameters and repeated investigations.     

儿童急性阑尾炎手术后粘连性肠梗阻的相关因素分析

目的探讨儿童急性阑尾炎(acute appendicitis,AA)术后发生粘连性肠梗阻(adhesive ileus,AI)的影响因素及相关预防措施。方法收集天津市儿童医院2014年1月至2017年6月行阑尾切除术(acute appendicitis resection,AAR)的168例AA患者为研究对象,按照术后是否发生AI分为梗阻组(n=42)和未梗阻组(n=126),以性别、年龄、病程、阑尾炎类型、是否穿孔、手术方式、手术操作时间、是否留置引流管、术前相关炎症指标(PCT、CRP、白细胞及中性粒细胞)为自变量进行回归分析。结果42例AAR后发生AI的时间与年龄存在相关性(r=0.535,P<0.05),Logistic分析结果显示:病程长(OR=1.071,95%CI:1.040~1.104)、PCT水平升高(OR=1.735,95%CI:1.178~2.555)为AI的危险因素;而年龄较大(OR=0.966,95%CI:0.945~0.987)、男性(OR=0.199,95%CI:0.049~0.802)及采用腹腔镜手术(OR=0.092,95%CI:0.015~0.543)为AI的保护因素。结论AA病程、PCT、年龄、性别及手术方式是AAR后发生粘连性肠梗阻的影响因素,当儿童AA满足手术适应证时,应及早行腹腔镜阑尾切除术;对于年龄较小及术前PCT水平较高的患者,术后应警惕AI发生的可能。     

Leukocyte and neutrophil counts in healthy Puerto Rican children and children with acute appendicitis

Blood counts were performed on 107 healthy Puerto Rican children aged 1 to 5 years to establish normal ranges of leukocyte and neutrophil counts and were compared with preoperative counts in 30 Puerto Rican children with acute appendicitis and also with values published in healthy black and white children of the same age. In healthy Puerto Rican patients and in patients with acute appendicitis, the mean leukocyte and neutrophil counts were significantly higher than in blacks.     

Decrease in the antioxidant capacity of red blood cells in children with celiac disease.

The erythrocyte glutathione metabolism of 11 children with acute celiac disease (CD), 11 children under gluten free diet with CD and 5 children with cow's milk allergy was compared to that of 11 children with nutritive iron deficiency and to 22 healthy children as controls. Erythrocyte glutathione (GSH) content of celiac children was elevated and the glutathione disulfide (GSSG) level was significantly decreased as compared to normal controls. Erythrocyte GSSG/GSH ratio in acute CD differed also from the one in iron deficiency. In vitro oxidative load of acetylphenylhydrazine proved the impaired glutathione stability of the erythrocytes in acute CD and cow's milk allergy. A parallel rise of methemoglobin and hemichrome level of blood cells was seen. Further on, the selenium content of the red blood cells of CD patients decreased. All alterations of the erythrocyte tended to normalize during the dietetic period. These data suggest a reduced protective capacity of erythrocytes in CD and in cow's milk allergy in childhood against oxidizing stresses.     

白细胞介素6及其基因启动子多态性在儿童急性阑尾炎中的表现

目的①研究血清、腹腔渗液中自细胞介素6（interleukin-6，IL-6）的水平在小儿急性阑尾炎诊断及严重程度分型中的价值；②探讨IL-6基因启动子-174G／C、-572G／C位点的多态性与小儿急性阑尾炎严重程度的关系。方法选取101例急性阑尾炎患儿，依据病理诊断分为普通组（单纯／化脓）、重症组（坏疽／穿孔）两组，以健康儿童为对照，ELISA法检测血清及腹腔渗液中IL-6浓度，用PCR-RFLP并测序法确定IL-6基因启动子的基因型。应用SPSS10．0统计软件对原始数据进行统计学处理。结果①普通组及重症组血IL-6浓度均明显高于对照组，P〈0．01；重症组血IL-6浓度明显高于普通组P〈0．01；重症组腹腔渗液IL-6、血C反应蛋白的浓度明显高于普通组，发病时间明显长于普通组，P〈0．01。②重症组-572CC型频率明显高于普通组，P=0．011；三组间-174位点基因型频率的差异无显著性意义。③重症组及对照组-572CC型患儿血清IL-6表达水平明显高于-572G携带型，P〈0．05；普通组-572CC型血清IL-6的表达水平高于-572G携带者，P=0．056。④logistic regression多因素分析结果表明-572位点的基因型、发病时间（症状出现至手术）与重症阑尾炎的发生有关。结论①IL-6有助于小儿急性阑尾炎的诊断及严重程度分型。但非急性阑尾炎或急性重症阑尾炎的特异性检测指标；②IL-6基因启动子-572位点CC型与小儿重症阑尾炎发生有关，IL-6基因-572C等位基因调控转录及表达的具体机制尚需进一步研究。