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1.
Hemisplenectomy for giant splenic cysts in children 总被引:1,自引:0,他引:1
C. Kimber A. Pierro D. Drake E. Kiely L. Spitz 《Pediatric surgery international》1998,14(1-2):116-118
To analyse the clinical features and outcome following surgery of giant splenic cysts in␣children, all patients presenting
to a children's hospital over the years 1987–1996 were reviewed. Variables analysed included presenting symptoms, method of
diagnosis, operative procedure, and complications. Six patients (aged 8–16 years) presented with abdominal pain or a large
abdominal mass. Ultrasound examination demonstrated large (>5 cm) unilocular splenic cysts. Five of the six children underwent
hemisplenectomy without complication or blood transfusion. The remaining patient had an infected cyst, for which total splenectomy
was necessary because of major intraoperative haemorrhage. Hemisplenectomy is based on accurate dissection of the splenic
hilum with clear knowledge of the intracapsular vascular anatomy of the spleen. Preoperative vaccination is recommended in
the event that splenectomy is required. This retrospective review concludes that hemisplenectomy for splenic cysts is a safe
procedure in children.
Accepted: 3 November 1997 相似文献
2.
Meddah AT Leke L Romond MB Grenier E Cordonnier C Risbourg B Canarelli JP 《Pediatric surgery international》2001,17(7):515-520
The effects of mesenteric ischemia on ileal colonization, intestinal integrity, and bacterial translocation (BT) in newborn
piglets were investigated in 36-2-day-old Pietrain piglets. Group I, controls were not operated upon; group II underwent a
sham laparotomy; and group III underwent ligation of the mesenteric vessels in the distal ileum. After 3 days, the kidneys,
spleens, livers, and ileal segments were harvested for microbial and histologic analyses. Two piglets in the ischemic group
died; microscopic examination showed severe histologic lesions of the ischemic area. Escherichia coli counts were increased in the ischemic segment compared to the upper loop (P < 0.05). Ischemia favoured staphylococcal colonization, whereas in the sham group a drastic reduction of these organisms
was observed (P < 0.005). BT to the kidneys, spleen, and liver occurred normally in the control group. Ischemia significantly increased the
total microflora in the spleen and liver (P < 0.05) and furthered dissemination of Clostridium perfringens in the kidneys (P < 0.05); 50% of ischemic animals had proteolytic clostridia in this organ (P < 0.05). Moreover, the incidence of E. coli in the kidneys, spleen, and liver was significantly higher in the sham and ischemic groups than in the controls (P < 0.05). Ileal ischemia thus induced significant histologic lesions, and surgery rather than gut microflora controls translocation.
Accepted: 16 November 2000 相似文献
3.
E. Günel D. Fındık O. Çağlayan F. Çağlayan Z. Topgaç 《Pediatric surgery international》1998,14(1-2):40-42
Recurrent abdominal pain (RAP) is a significant problem in the pediatric population, and there has been much recent interest
in the role that Helicobacter pylori (Hp) might play in this disorder. In this case control study, the authors aimed to determine whether Hp is an agent responsible
for RAP, and to assess fasting gastrin concentrations in children with and without RAP in the Hp-positive and -negative groups.
The study was conducted in 42 patients with RAP and 50 healthy children attending routine day-case surgery as a control group,
aged 3 to 15 years, over a 12-month period. Of the 42 children with RAP, 30 were seropositive (71.4%) for Hp IgG, and of 50
children in the control group, 32 were seropositive (64%) for Hp IgG (P > 0.05). We found that Hp infection was as high in healthy children as in children with RAP. The mean fasting gastrin levels
in 62 Hp-seropositive children (60.4 ng/l) were not different from those in 30 Hp-seronegative children (57.3 ng/l) and those
in 42 children with RAP (58.2 ng/l) were also not significantly different from those in 50 healthy children (62.9 ng/l). Thus,
no association between childhood Hp infection, hypergastrinemia, and RAP was found in our Turkish population.
Accepted: 26 May 1998 相似文献
4.
One of the most severe complications of typhoid fever is perforation of the ileum (TPI); it is also a cause of high morbidity
and mortality in endemic areas. After surgery for TPI, other complications may set in postoperatively, compounding the problem.
A prospective study of 121 children who were operated upon for TPI to identify the postoperative complications showed that
the most common was wound infection. The most serious were: mechanical intestinal obstruction, abdominal dehiscence, and enterocutaneous
fistulae. Physicians caring for such children should be aware of these complications and their mode of presentation so as
to quickly and decisively manage them to prevent more deaths.
Accepted: 8 April 1998 相似文献
5.
The role of magnetic resonance imaging in the preoperative assessment of anorectal anomalies 总被引:1,自引:0,他引:1
The role of magnetic resonance imaging (MRI) compared to other investigations in providing information relevant to and affecting
surgical management in patients with anorectal anomalies (ARA) was studied in two groups of patients. In group 1 a pilot study
was done in 9 patients with colostomy for high ARA awaiting posterior sagittal anorectoplasty. These patients had MRI, plain
radiographs, a distal loopogram through the mucous fistula, ultrasound scans of the spinal cord and urinary tract, and a micturating
cystourethrogram. The level of bowel and spinal-cord termination was correctly determined in all patients by MRI and conventional
investigations. The presence or absence of a fistula, urological abnormalities, and bony abnormalities of the pelvis and spine
were better visualized by conventional investigations than with MRI. The striated-muscle complex (SMC) was well-visualized
by MRI, the thickness accurately graded, and the findings confirmed at operation. The information on muscle thickness and
the presence or absence of a fistula was interesting, but played no part in decisions made about surgical management, and
the operative technique was not altered. In group 2 the patients were much older and had MRI for persistent problems, mainly
soiling; 6 had low lesions and 6 had high lesions. Three patients with low lesions were found to have intraspinal abnormalities
on MRI; 4 were found to have malpositioned bowel in the SMC, which was again accurately visualized and graded. Therefore,
in 7/12 patients of this group a surgically correctable abnormality was found. We conclude that MRI has no role as a primary
investigation in patients with high ARA, but it is useful if there are suspected spinal-cord problems or persistent problems
after definitive surgery.
Accepted: 6 May 1998 相似文献
6.
B. H. P. Nagel M. Palmbach D. Petersen M. B. Ranke 《European journal of pediatrics》1997,156(10):758-763
In order to validate an association between pituitary size and severity of growth hormone deficiency (GHD) we evaluated the
magnetic resonance images (MRI) of 107 children with different causes of short stature. Ninety-one MRIs were evaluable (64
male, 27 female; age: 9.1 ± 3.9 years). The levels of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor
binding protein-3 (IGFBP-3), and tests of GH stimulation and spontaneous secretion, led to the following sub-groups: severe
isolated GHD (SIGHD) (GH < 7 ng/ml) (n = 21); partial, isolated GHD (GH 7–10 ng/ml) (n = 22); multiple pituitary hormone deficiency (MPHD) (n = 13); neurosecretory dysfunction (n = 10); non-classifiable diagnosis (NC) (n = 13); idiopathic short stature (n = 9); and intra-uterine growth retardation (n = 3). Pituitary height (PHT) was measured and hypoplasia was assumed when PHT was <−2 SDS. An ectopic posterior pituitary
with missing stalk and a hypoplastic anterior pituitary was present in 12 (57%) SIGHD cases, 12 (92%) MPHD cases and 1 patient
from the NC group. An isolated hypoplastic anterior pituitary was observed in 15%−33% of the other groups. PHT (mm; mean,
SD) in MPHD (1.7 ± 0.5) was lower than in SIGHD (2.7 ± 1.0, P < 0.05), with PHT of both groups being lower than in all the other groups (3.8 ± 0.9, P < 0.0001). PHT SDS correlates with IGF-I SDS (r = 0.48, P < 0.0001), IGFBP-3 SDS (r = 0.46, P < 0.0001) and the highest peaks in tests of GH stimulation and GH spontaneous secretion (r = 0.36, P < 0.0001). In contrast to all the other groups, no correlation with age was observed in MPHD and SIGHD. Breech delivery was
recorded in up to 26% of patients in all seven groups. Surprisingly, only 1 out of 23 patients with an ectopic posterior pituitary
was born by breech delivery, suggesting that ectopia of the posterior lobe is not necessarily related to breech delivery.
Conclusion PHT is significantly correlated with GH secretion in several types of short stature. Patients with␣ectopic posterior pituitary,
missing stalk and hypoplastic␣anterior pituitary either suffer from SIGHD or MPHD, and this anatomical defect is not necessarily
related to breech delivery.
Received: 1 December 1996 and in revised form: 8 February 1997 / Accepted: 18 February 1997 相似文献
7.
Z. Q. Wang T. Todani Y. Watanabe A. Toki K. Ogura O. Miyamoto T. Toyoshima T. Itano 《Pediatric surgery international》1998,14(1-2):9-13
We investigated the possible involvement of apoptosis in the increased germ-cell degeneration in undescended testes (UDT).
Experimental unilateral cryptorchidism was induced in 21-day-old rats, and both testes were removed for in-situ TUNEL staining
of apoptotic cells at 1, 3, 7, 10, and 14 days postoperation. A gradual increase in the incidence of apoptosis was seen at
21–28 days of age in the control testes, followed by a decrease thereafter. After 10 days postoperation, the weight of the
UDT was significantly lower than that of the contralateral descended testis (CDT) and the controls. However, the weight of
scrotal testes in each group was similar. UDTs demonstrated a markedly increased incidence of apoptosis. By 7 days postoperation,
the percentage of seminiferous tubules containing apoptotic germ cells significantly increased in UDTs compared with that
in CDTs and controls (P < 0.001). Moreover, there was a significant difference in the percentage of seminiferous tubules containing apoptotic germ
cells between CDTs and controls (P < 0.01). In addition, an increased incidence of seminiferous tubules containing 8–10 and >10 apoptotic germ cells from 7,
10, and 14 days postoperation in UDTs was detected. In-situ TUNEL analysis demonstrated spermatocytes to be the main type
of germ cells affected in all groups. These findings suggest that spermatogenesis decreases not only in the␣UDT, but also
in the CDT, and that the germ-cell degeneration in cryptorchidism took the form of apoptosis. 相似文献
8.
The impact of surfactant replacement therapy on cerebral and systemic circulation and lung function 总被引:2,自引:0,他引:2
J. A. Schipper G. I. Mohammad H. L. M. van Straaten J. G. Koppe 《European journal of pediatrics》1997,156(3):224-227
The influence of surfactant administration on cerebral and systemic circulation and on lung function was evaluated in 12
premature mechanically ventilated infants (mean birth weight 1560 ± 770 g, mean gestational age 30.0 ± 3.2 weeks) with respiratory
distress syndrome (RDS) receiving surfactant replacement therapy. We measured mean cerebral blood flow velocity (MCBFV), heart
rate (HR), mean arterial pressure (MAP), static compliance (Crs), resistance of respiratory system (Rrs), functional residual
capacity (FRC) and fraction of inspired oxygen (FiO2). In addition to a very low compliance and a moderately elevated resistance of the respiratory system a significant drop
in MAP, HR, MCBFV and FiO2 was noticed after surfactant administration. After 30 min HR, MAP and MCBFV values returned to baseline levels. We postulate
that the drop in MCBFV, MAP, HR and FiO2 with a minor, though not significant, improvement of the FRC can most likely be explained by a “relative” hypovolaemia in
other organs and parts of the body due to expansion of the lung vascular bed. Compensation for the redistribution of circulatory
volume occurred within several minutes. Blood pressure control and treatment of hypovolaemia is mandatory before surfactant
is administered.
Conclusion In RDS patients there is a significant drop of MAP, HR, MCBFV and FiO2 after bolus surfactant administration.
Received: 30 August 1995 and in revised form: 30 April 1996 / Accepted 23 July 1996 相似文献
9.
High frequency of beta-catenin mutations in hepatoblastoma 总被引:1,自引:0,他引:1
10.
A wandering spleen and splenic cysts are uncommon conditions in children. A combination of both entities has only rarely
been reported in the literature. Another case of this complex pathology in 12-year-old girl is presented. She was initially
referred for evaluation of a large abdominal mass. Diagnostic studies raised the suspicion of a hematoma in an abnormally
located spleen, but the definitive diagnosis was established at laparotomy. Successful surgical management consisted of total
cystectomy and splenopexy.
Accepted: 6 November 1997 相似文献
11.
The purpose of this study was to compare structural changes in the pulmonary vasculature in newborns with congenital diaphragmatic
hernia (CDH) complicated by persistent pulmonary hypertension (PPH) and stillborns with CDH. Victorian blue van Gieson (VVG)
staining and immunostaining with anti-alpha smooth-muscle actin (ASMA) was performed on lung tissue obtained at autopsy from
23 newborns with CDH complicated by PPH, 7 stillborns with CDH, and 11 age-matched controls with sudden infant death syndrome
(SIDS). The degrees of adventitial and medial thickness and area were measured in pulmonary arteries with an external diameter
(ED) of <75 μm, 75–100 μm, 100–150 μm, 150–250 μm, 250–500 μm, and >500 μm by image analyzer and compared statistically. The
degrees of adventitial and medial thickness and area were measured in pulmonary veins with an ED of <100 μm, 100–200 μm, and
>200 μm by image analyzer and compared statistically. In order to determine whether the characteristic structural changes
were size-related, each was related to ED. There was a significant increase in adventitial thickness and area in arteries
of all sizes in both newborns and stillborns with CDH compared to SIDS patients (P < 0.05). The degree of medial thickness in newborns and stillborns with CDH was significantly increased compared to SIDS
patients (P < 0.01). The degree of medial area was significantly increased for arteries with ED less than 100 μm (P < 0.05) in newborns and stillborns with CDH compared with SIDS patients. There was a significant increase in adventitial
thickness and area in veins of all sizes in newborns with CDH compared to stillborns with CDH and SIDS (P < 0.05). The degree of adventitial thickness and area of pulmonary veins were similar in stillborns with CDH and SIDS. There
were no significant differences in medial thickness of veins between the three groups. The presence of abnormally thick-walled
pulmonary arteries in stillborns with CDH suggests that the intrapulmonary arteries in CDH may become excessively muscularized
during fetal life, becoming unable to adapt normally at birth. The absence of structural changes in pulmonary veins in stillborns
with CDH suggests that the pulmonary venous changes observed in newborns with CDH complicated by PPH occur after birth as
a result of increases in transvascular pressure or a response to release of peptide growth factors.
Accepted: 10 March 1998 相似文献
12.
We evaluated whether deletions of the DAZ (deleted in azoospermia) gene, abnormal karyotypes or hypogonadotropic hypogonadism
(HH) were demonstrable in infertile men who had undergone surgery in childhood for cryptorchidism with a simultaneous testicular
biopsy that demonstrated no or almost no germ cells. In six men with infertility after surgery for cryptorchidism, the adult
karyotype and analyses for the DAZ gene, serum follicle-stimulating hormone, luteinizing hormone, and testosterone were performed
from a peripheral blood sample. Testicular volume was also measured. All patients exhibited a 46,XY karyotype. There were
no deletions of the DAZ-gene, no HH and no testicular atrophy. The infertility was thus not proved to be congenital, and consequently,
surgical treatment is indicated before the germ cells disappear from undescended testes. This appears to be before 15 months
of age. 相似文献
13.
Use of albumin in neonatal resuscitation 总被引:3,自引:0,他引:3
N. R. C. Roberton 《European journal of pediatrics》1997,156(6):428-431
The use of albumin plasma has become popular during resuscitation of the term baby with very low Apgar scores (≤ 2 at 1 min).
There is no evidence of benefit from this practice which may actually be damaging to babies with severe asphyxia causing myocardial
damage.
Received: 4 May 1996 and in revised form: 7 October 1996 / Accepted: 16 October 1996 相似文献
14.
F. Zepp H.-J. Schmitt A. Kaufhold A. Schuind M. Knuf P. Habermehl C. Meyer H. Bogaerts M. Slaoui R. Clemens 《European journal of pediatrics》1996,156(1):18-24
The lack of an adequate immune response to the major polysaccharide of the Haemophilus influenzae type b (Hib) capsule (polyribosyl ribitol phosphate) (PRP) in very young infants (< 18 months) can be overcome by conjugating
PRP to a T-cell dependent carrier protein. We studied whether administration of a tetanus-PRP conjugate vaccine reconstituted
with a diphtheria-tetanus-acellular pertussis-hepatitis B (DTPa-HBV) vaccine as a three dose primary course at 3, 4 and 5
months of age induced PRP-specific immunological memory, by examining the anti-PRP response to a dose of unconjugated PRP
given with the DTPa-HBV booster approximately 1 year later. The unconjugated PRP elicited protective anti-PRP antibody levels
(≥ 0.15 μg/ml) in all but 3 of the 369 vaccinees, including 13 infants who failed to demonstrate a measurable immune response
after the primary course. In a sub-cohort of 54 subjects all had anti-PRP levels ≥ 0.5 μg/ml within 7–14 days of the booster
showing a rapid anamnestic type response. Both primary and booster responses were predominantly IgG1 indicating a T-cell dependent
response. The DTPa-HBV components elicited protective anti-diphtheria, anti-tetanus and anti-HBs antibody levels in ≥ 98.5%
of vaccinees, and immune responses to each of the acellular pertussis vaccine components in 92.3%–97.3% of subjects.
Conclusion The tetanus-PRP conjugate vaccine not only elicited a good primary humoral response, but also induced immunological memory
so that the infants were able to mount a large and rapid immune response to subsequent exposure to plain PRP, indicating that
protection against circulating wild-type Hib had been generated. Successful induction of immunological memory occurred even
when there was no measurable humoral anti-PRP response to the primary course. Tetanus-PRP conjugate vaccine can be used in
combination with DTPa-HBV vaccine, when administered separately or as a single injection in the same syringe, in primary immunisation
schedules at 3, 4 and 5 months of age.
Received: 7 August 1996 / Accepted: 4 September 1996 相似文献
15.
R. Almaas T. Rootwelt S. Øyasæter O. D. Saugstad 《European journal of pediatrics》1997,156(6):488-492
Infant cereals and formulas are usually fortified with iron to prevent iron deficiency. To enhance iron bioavailability,
supplemental ascorbic acid is recommended. Ascorbic acid is considered to be an antioxidant in vivo, but has pro-oxidant effects
when exposed to non-protein-bound iron. We measured formation of free radicals in cereals and infant formulas after addition
of ascorbic acid. The production of hydroxyl radicals was assessed by hydroxylation of salicylic acid to 2,5-dihydroxybenzoic
acid (2,5-DHBA). Production of 2,5-DHBA increased with increasing ascorbic acid doses added. Addition of 0.8 mM ascorbic acid
to breast milk produced less radicals (0.03 ± 0.05 μM) than addition of ascorbic acid to low-iron formula (0.13 ± 0.08 μM,
P = 0.019), medium-iron formula (0.34 ± 0.12 μM, P < 0.0001) or high-iron formula (0.44 ± 0.08 μM, P < 0.0001). Even when iron content in breast milk was adjusted to a level comparable with that of formulas, production of 2,5-DHBA
was lower. Breast milk seems to contain substances that reduce hydroxyl radical formation.
Conclusion Supplemental ascorbic acid causes hydro-xyl radical formation in iron-fortified infant nutrients in vitro.
Received: 30 March 1996 / Accepted in revised form: 10 December 1996 相似文献
16.
M. H. Cnossen F. J. Smit A. de Goede-Bolder P. G. Frets H. J. Duivenvoorden M. F. Niermeijer 《European journal of pediatrics》1997,156(6):482-487
Since 1985 a multidisciplinary team in the Sophia Children's University Hospital in Rotterdam provides diagnostic follow
up and genetic counselling services for neurofibromatosis type 1 (NF1) patients and their families. Parents of 68 affected
children as well as 24 affected parents were interviewed. Of the affected children, 50% and 33% of the affected adults were
treated for symptoms related to NF1 before a specific diagnosis was made. Although the disease is fully penetrant by the age
of 5 years, 35% of the affected children had not been diagnosed by this age. Parents stated a preference for early diagnosis
of NF1. Diagnosis of NF1 did not seem to be a reason to refrain from having children. The general attitude towards prenatal
diagnosis was positive; however few parents would actually terminate an affected pregnancy.
Conclusion Overall delay in diagnosis of NF1 is significant. Knowledge of symptoms should make an early diagnosis possible with beneficial
effects for the patient and family members.
Received: 25 July 1996 / Accepted: 21 October 1996 相似文献
17.
Neuroblastoma is, at the same time, the most common and the most puzzling extracranial solid tumour in childhood, being able
to regress spontaneously despite widespread dissemination, showing a striking high incidence of the in situ form, and, finally,
being resistant even to aggressive chemotherapy. The reasons of this bizarre behaviour are still largely unknown due to our
little knowledge of neuroblastoma pathophysiology. There is increasing body of evidence that the insulin-like growth factor
system plays a crucial role in the proliferation and differentiation of neuroblastoma cells and it is conceivable that a better
knowledge of this role might potentially lead to new and more effective therapeutic strategies. Here we review the most recent
insights into the biology of neuroblastoma, focusing on the close links with the insulin-like growth factor system and the
potential clinical perspectives.
Received: 13 May 1996 and in revised form: 15 July 1996 / Accepted: 15 July 1996 相似文献
18.
G. Kusenbach A. Rübben E. M. Schneider M. Barker A. Büssing L. Lassay H. Skopnik G. Heiman 《European journal of pediatrics》1997,156(6):440-443
A 3-year-old boy of German descent suffered from two episodes of Streptococcus pneumoniae meningitis within 2 months. One month previously, the first skin lesion of Kaposi sarcoma (KS) had been observed behind his
right ear. During the following 2 years KS disseminated not only mucocutaneously but also to visceral organs. Immunological
evaluation revealed severe lymphocytopenia with reduced helper/suppressor T-cell ratio and impaired humoral immune response
to pneumococci. Extensive laboratory tests gave no evidence for known immunocompromising infections. However, recently described
DNA sequences from a Kaposi sarcoma-associated herpesvirus (KSHV) could be identified within skin tissue. As chemotherapy
failed to stop tumour progression the patient was referred for bone marrow transplantation. Eighteen months later the KS is
in remission and the patient in a good general condition.
Conclusion The case supports the hypothesis that KSHV is involved in the aetiology of KS. Bone marrow transplantation is possibly a therapeutic
option for KS in patients with immunodeficiency not related to human immunodeficiency virus infection.
Received: 1 August 1996 / Accepted: 15 December 1996 相似文献
19.
Messineo A Codrich D Monai M Martellossi S Ventura A 《Pediatric surgery international》2001,17(7):521-523
Internal anal sphincter (IAS) achalasia is a disorder of defecation in which the IAS fails to relax. Botulinum toxin (BT),
which has been successfully used to relax the anal and lower esophageal sphincters, was injected twice into the IAS of one
adolescent and three infants with manometric, radiologic, and in 2 cases histochemical diagnosis of anal achalasia; in the
adolescent a third injection was necessary. Spontaneous defecation was achieved in all patients following the second injection.
In one case a diagnosis of short-segment Hirschsprung's disease was obtained after the second injection. Local infiltration
of BT into the IAS proved effective in the treatment of IAS achalasia. Double-blind studies and longer follow-up periods are
needed to better evaluate these preliminary results and define the limits of this promising therapy.
Accepted: 16 November 2000 相似文献
20.
Clara cell 10 kDa protein (CC10) has been thought to be fairly specific to Clara cells and a major secretory protein that
is both synthesized and released from Clara cells. In the present study, morphometric analyses of the immunohistochemical
expression of CC10 were carried out on the bronchioles of human neonates with congenital diaphragmatic hernia (CDH) and then
compared with morphometric analyses from a gestationally and postnatally age-matched control group in order to clarify the
immaturity of Clara cells in CDH lungs. No difference was found in CC10 expression between the affected side and the unaffected
side of the lungs in the CDH group. However, compared with the lungs of the control group, the CDH group showed a significant
decrease in CC10 expression, namely, the ratio of CC10-positive cells per bronchiole, per unit perimeter of bronchiole, and
per unit bronchiolar surface area. These results suggest that in the lungs of CDH cases, a possible delay in either functional
maturation or the development of CC10 synthesis by the bronchioles may exist, and this retardation of functional maturation
of the airway is also considered to play a role in the postnatal respiratory insufficiency observed in CDH patients.
Accepted: 25 February 1998 相似文献