纤维支气管镜在呼吸系统疾病诊治中的应用

目的提高纤维支气管镜(纤支镜)肘小儿呼吸系统疾病的诊断和治疗水平,拓宽纤支镜在儿科的应用范围。方法对110例患儿行纤支镜检查,应用“边麻边进”利多卡因气管内黏膜表面局部麻醉方法行镜下诊断和治疗。对110例患儿进行肺泡灌洗及病原学和细胞学检查。结果直视下发现异常73例,其中异物42例,内膜炎症24例,肿物3例,气管狭窄2例,气管软化、鼻后滴漏各1例。支气管肺泡灌洗(BAL)92例次,BAL液病原学培养30例次,其中阳性4例次,灌洗液肺炎支原体(MP)抗体检查IgM阳性3例,灌洗液细胞学检查发现大量含铁血黄素细胞1例。成功钳取异物11例,对于内膜感染通过纤支镜直接到达病变部位冲洗,清理脓苔及肉芽,清除梗阻,局部注药治疗,取得良好疗效。结论纤支镜术有助于提高呼吸系统疾病的诊断及治疗水平。     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

纤维支气管镜在PICU中的临床应用研究

目的 评估纤维支气管镜(纤支镜)检查及治疗在儿科重症监护中的应用价值.方法 回顾性总结我院PICU 2006年1月至2008年6月收治的97例患儿105例次纤支镜检查及治疗结果.结果 肺炎与肺不张主要原因有气道解剖结构异常、气道严重炎性病变、气管异物、炎性息肉、气管食管瘘;其中气道解剖结构异常最为常见,共45例(42.9%).先天性心脏病(先心病)患儿合并气道解剖结构异常40例(88.9%),明显多于非先心病患儿(P＜0.01);但非先心病患儿合并肺炎及气道严重炎性病变的发生率明显高于先心病患儿(P＜0.05).支气管肺泡灌洗液细菌培养阳性率27.8%,革兰阴性致病菌居多.纤支镜检查有助于气道内出血诊断和气道管理.纤支镜应用过程中,未见与纤支镜应用相关的死亡、大出血、气胸、心律失常等严重并发症的发生.结论 PICU开展纤支镜诊疗安全可靠,具有一定的临床应用价值.     

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.     

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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.     

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   

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.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

How well are we doing? – Metabolic control in patients with diabetes

OBJECTIVE: To compare the present level of metabolic control in children and adolescents with insulin-dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data. METHODOLOGY: Blood HbA1c concentrations, population characteristics, current treatment practices and short-term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children's Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998. RESULTS: Two hundred and sixty-eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11. 2 years); duration of IDDM was 0-16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (+/- SD) was 8.6 +/- 1.4% (range 5.2-14.0%), with 33% of children having a HbA1c concentration < 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 +/- 1.5%) than in those not in puberty (8.5 +/- 1.2%). CONCLUSION: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.