儿童再发性腹痛与肠系膜淋巴结肿大

本院在1997年1月至1998年12月,对48例再发性腹痛患儿进行高分辨力的腹部超声检查,其中男21例,女27例,年龄4岁至12岁;病程1个月至3年2个月,表现为反复脐周痛23例,上腹痛14例,无固定部位腹痛11例;脐周压痛17例,上腹压痛6例,无压痛22例。对照组35例,为无慢性腹痛史的健康儿童,其中男18例,女17例,年龄3岁6个月至12岁。超声仪器为泰索尼VMS和ALOKA-SSD650,探     

52例儿童外周淋巴结肿大的临床和病理分析

外周淋巴结肿大是儿科临床重要的体征之一,它可由淋巴结局部或全身性疾病所引起。病因多样,病变部位和伴随症状不一,临床诊断困难,常需结合病理形态学检查方能明确诊断。为了今后更好地对此类病人进行恰当的诊疗,现将我科10余年来资料较整的52例外周淋巴结肿大的临床和病理资料分析如下。     

综合医院发热伴颈部淋巴结肿大住院儿童临床特征变迁分析

目的:分析综合医院以发热伴颈部淋巴结肿大为主诉的住院患儿的病因及临床特征,为该类患儿的临床诊治提供思路。方法:回顾性分析北京大学第三医院儿科病房2016年1月1日至2020年12月31日以发热伴颈部淋巴结肿大为主诉收入院的56例患儿,根据年龄分为<6岁组(33例)及≥6岁组(23例),分析不同年龄组的病因构成差异;根据...     

33例儿童颈淋巴结肿大临床与病因分析

儿童颈淋巴结肿大病因很多,通过临床详细体格检查和实验室检查,绝大部分能够诊断,但仍有少数患儿诊断不明,需要做淋巴结活检明确诊断。现将我院2000至2005年儿童不明原因的颈淋巴结肿大,作淋巴结活检的33例患儿进行回顾性分析,报告如下。     

疑难病例分析--颈淋巴结肿大2年余伴间隙性发热

病史简介患儿 ,男性 ,５岁 ,来自江西省南昌市。因颈部淋巴结肿大２年就诊。患儿于１９９９年５月起发现颈部淋巴结肿大 ,当时不伴发热 ,亦无咳嗽、咯血、乏力、盗汗等症状。在当地医院就诊多次 ,曾行淋巴结穿刺术 ,病理诊断为“淋巴结结核” ,予抗结核治疗４０天 (具体用药情况不详 ) ,无效。于２０００年１０月出现发热 ,体温持续在３９℃ ,呈稽留热型 ,不伴寒战。在当地医院实验室检查 :Ｘ线胸片未见异常 ,骨髓形态学未见异常 ,ＥＳＲ(６０～３２)ｍｍ／ｈ ,血清抗支原体ＩｇＭ（ +） ,抗ＥＢＶ -ＩｇＭ（ +） ,ＡＫＰ正常 ,血培养 (-)。…     

肠套叠彩色超声诊断的临床意义

目的　探讨彩色超声 (彩超 )在肠套叠的诊断价值。方法　使用ToshiboPV6 0 0 0、Vivid7彩超仪 ,线阵变频探头频率 5～ 10MHz,全面扫查患儿腹部 ,重点探查病变部位形态体积及血液动力学改变 ,并引导盐水灌肠复位 2 6例。结果　根据体积部位诊断肠套叠 5 6例 ,发现有肠壁严重水肿 ,阻力指数明显增高 ,或无血流信号者 ,有明显肠梗阻、腹膜炎表现及继发性肠套叠等情况者提示临床不宜灌肠复位 ,本组超声引导下盐水及X线监视下空气灌肠复位成功 4 9例 (87.5 % ) ,7例行手术治疗 (12 .5 % )后复位成功。结论　彩超可诊断肠套叠 ,指导治疗方案。即可指导复位方式的选择 ,又可引导盐水灌肠复位     

儿童腹腔结核病30例诊断分析

目的 提高对儿童腹腔结核病的认识和诊断水平.方法 回顾性总结北京儿童医院住院治疗的30例腹腔结核病例的临床特点、诊断过程及预后资料,探讨各种诊断方法的临床意义.结果 20例患儿初诊为上呼吸道感染、胃肠炎、消化不良等疾病,另6例诊断为肺结核,初诊即诊断为腹腔结核者仅4例.30例中21例(70%)有腹痛、腹胀,腹泻或便秘等症状;均有腹部阳性体征(腹腔积液1O例次,腹部揉面感9例次,腹部压痛8例次,腹部包块4例次,肝脾肿大3例次).24例伴发腹腔外结核.PPD阳性28例(93%),腹部超声结果全部异常.剖腹探查3例,结肠镜活检2例,均获确诊;24例获临床诊断患儿经正规抗结核治疗效果明显.结论 儿童腹腔结核病初诊时容易被误诊,应引起重视;大多数患儿具有消化道症状和体征;腹腔外结核的存在是协助诊断的重要依据;PPD检查和腹部超声检查是诊断的重要依据;结肠镜和剖腹探查能够获得确切诊断证据.     

儿童原发性淋巴结性隐球菌病二例

隐球菌病是由新型隐球菌所引起的亚急性和慢性深部真菌病,主要侵犯中枢神经系统和肺脏,亦可侵犯骨髓、皮肤、黏膜和其他脏器。常发生于细胞免疫功能缺陷的人群,如获得性免疫缺陷综合征、应用类固醇、环孢霉素A等免疫抑制剂或器官移植后、白血病或淋巴瘤的患者,但是也有少数的患者可无任何基础疾病。单纯以发热、腹痛、腹腔淋巴结肿大为突出表现的原发性淋巴结性隐球菌病临床少见,     

腹泻患儿头皮静脉压的测定及其临床意义

由于小儿营养状况的改善 ,传统的评价腹泻小儿脱水程度的部分指标如皮肤弹性等因受主观因素影响 ,对脱水程度的估计不准确。本文设计一种通过测头皮静脉压（ＳＶＰ）客观判断脱水程度的方法 ,取得了理想的效果。资料和方法一、病例选择选择１９９８年１月～１９９９年１月入院的腹泻患儿５８例 ,随机分为２组 ,传统组３０例 ,按传统方法评价脱水程度 ,轻度１０例 ,中度１３例 ,重度７例 ;观察组２８例 ,按入院时ＳＶＰ值判断脱水程度 ,轻度５例 ,中度１５例 ,重度８例。两组均无心血管、呼吸及中枢神经系统疾病 ,年龄、性别、病情无统计学差…     

Evaluation of peripheral lymphadenopathy in children

The aim of this study was to evaluate children with lymphadenopathy and clinical approach to the suspicion of malignancy. The authors evaluated 457 patients with peripheral lymphadenopathy, less than 19 years of age, and referred to the Pediatric Oncology Department of Gazi University Medical School during the periods March 1996-April 2004. A total of 346 patients had benign disorders and 111 had malignant pathologies. Excisional biopsies were performed to 134 patients. A specific etiology could be found 39% in the benign group. Of the 457 patients, 218 were presented as acute, the rest as chronic lymphadenopathy. In the acute lymphadenopathy group, 98.2% of the patients had benign etiologies. The malignant disorders were mostly represented as chronic lymphadenopathy. Concerning the extension, 193 patients had localized lymphadenopathy and 264 had generalized lymphadenopaties. Cervical region was the most frequent site in both localized and generalized lymphadenopathy groups. Malignancies occurred as generalized lymphadenopathy. Supraclavicular area were involved only in the malignant group. Axillary involvement was predominant in BCG vaccine associated lymphadenitis and mycobacterium tuberculosis. All the lymph nodes less than 1 cm were due to benign causes. The malignant lesions were usually more than 3 cm in diameters. The following findings should alert the pediatrician for the probability of a malignant disorder: lymphadenopathy of more than 3 cm in size, of more than 4 weeks in duration, with supraclavicular involvement, and with abnormal laboratory and radiological findings.     

Lipid profile in children with acute viral hepatitis A

BACKGROUND: Most of the knowledge about lipid parameters in acute hepatitis is originated from adult studies. In this study, the authors investigated lipid profile of children with acute hepatitis A (AVH) at diagnosis and recovery in order to observe the behavior of lipid parameters in such children. METHODS: A total of 28 children (mean age, 8.2 +/- 2.7 years) with AVH and 20 gender and age-matched healthy children were included. In addition to the routine tests, triglyceride, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), plasma apo A-I and apo B were studied at diagnosis and recovery. RESULTS: Serum triglyceride and apo B level was higher, and apo A-I level was lower in patients compared to healthy children (P < 0.01, <0.05 and <0.01, respectively). On admission, three children had fulminant hepatic failure (FHF). Serum lipid parameters were evaluated in respect with the presence of icterus and FHF, and found that apo A-I level was lower in icteric children and LDL and apo A-I were lower in FHF compared to others (P < 0.05, P < 0.01 and P < 0.05, respectively). At recovery, while triglyceride, cholesterol, LDL, and apo B decreased (P < 0.01), HDL and apo A-I increased (P < 0.01). Serum apo A-I level was inversely correlated with serum ammonia level but was positively correlated with serum albumin (P < 0.05). CONCLUSIONS: It was shown that serum triglyceride and apo B level increased, but apo A-I level decreased in patients with AVH. While cholestasis lowers apo A-I level, severe hepatic damage lowers both apo A-I and LDL. These parameters return to normal levels within 30 days. An interesting relationship between ammonia and apo A-I deserves further investigations, speculatively focused on hepatocyte nuclear factor 4 alpha.     

Changes in seroprevalence of hepatitis A in children and adolescents in Manisa, Turkey

BACKGROUND: Hepatitis A virus (HAV), being an enteric transmitting virus wide world, occurs mostly in children of developing countries. However, the virus has recently been seen in adolescents and young adults worldwide. The aim of the present study was to evaluate the seroprevalence of the HAV infection in children and adolescents in Manisa, Turkey, and to verify whether the increased incidence of HAV infection in other parts of the world and Turkey generally is also true for the area of Manisa. METHODS: The authors studied blood samples of 1395 adolescents and children aged between 6 months and 17 years from the Manisa area in order to evaluate the existence of anti-HAV antibodies using micro-ELISA test. RESULTS: Total seropositivity was 44.6% while age related values were as followed: 6-23 months, 47.8%; 2-6 years, 23.7%; 7-10 years, 43.4%; 11-14 years, 52.4%; and 15-17 years, 76.6%. These results suggest that the seropositivity increases significantly among children at school age and also increases parallel to age. CONCLUSIONS: According to these results, the authors concluded that there has been a shift of seropositivity from children to adolescents especially in families with an average or high socio-economical level.     

Clinical significance of TT virus infection in children with chronic hepatitis B

BACKGROUND: The pathogenic role of TT virus (TTV) is not clear in patients with chronic hepatitis B. The aims of the present study were to determine the frequency of TTV positivity in serum and saliva samples and the possible role of TTV in children with chronic hepatitis B. METHODS: Sera and saliva from 29 healthy children and 25 children with chronic hepatitis B were tested for TTV-DNA by means of real-time polymerase chain reaction (PCR). RESULTS: Fifty-two percent (13/25) of the serum samples and 32% (8/25) of the saliva samples were positive for TTV-DNA in children with chronic hepatitis B. In healthy non-transfused children, TTV-DNA was detected in 58% (17/29) of the serum samples and 41% (12/29) of the saliva samples. Six (46%) of 13 children with chronic hepatitis and 10 (59%) of 17 healthy children had TTV-DNA positivity both in serum and saliva samples. Two serum samples were negative for TTV-DNA while the saliva samples were positive for TTV-DNA in chronic hepatitis B and control groups. Mean age, sex, serum alanine aminotransferase levels, hepatitis B virus (HBV)-DNA values were similar in TTV-positive and -negative children with chronic hepatitis B. However, total histologic activity index (HAI), periportal necrosis and portal inflammation scores were significantly higher in children with HBV-DNA and TTV-DNA viremia (P = 0.013, P = 0.008, P = 0.015, respectively). CONCLUSIONS: Because total HAI, periportal necrosis and portal inflammation scores were higher in children with TTV coinfection, TTV infection may contribute to the progression of liver damage in children with chronic hepatitis B.     

Immunogenicity of hepatitis a vaccine in children with cancer

This study evaluated the immuned response of the hepatitis A vaccine in children with cancer who were receiving chemotherapy. Twenty-eight patients with lymphomas or solid tumors and who had negative serology for hepatitis A were enrolled. The median age was 4.7 years (range 2-16). The patients received 1440 IU hepatitis A vaccine at 0 and 6 months. Seroconversion rates at the first and seventh months were 60% (n = 17/28 patients) and 89% (n = 24/27 patients). No adverse effects were observed. The hepatitis A vaccine was found to be effective and safe in children with cancer.     

要重视儿童慢性病毒性肝炎的诊断和治疗

<正>多种病毒感染均可引起肝脏炎症,然而一般所称病毒性肝炎常仅指由嗜肝病毒感染引起者。迄今为止,有明确临床意义的嗜肝病毒包括甲型肝炎病毒(HAV)、乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、丁型肝炎病毒(HDV)     

Changing patterns of hepatitis A and E sero-prevalences in children after the 1999 earthquakes in Duzce, Turkey

Aim:   Hepatitis A and E are enteric viral diseases that are characteristically found in developing countries. Sero-epidemiological data about both infections showed higher prevalence rates soon after the 1999 earthquakes in Duzce, Turkey. The aim of the present study was to evaluate the data 4 years after the earthquakes.
Methods:   The study group included 589 children (72.3% boys) who were between the ages of 6 months and 17 years (mean age 11.5 years). The children were separated into three groups: Group 1 (ages 6 months to 5.9 years), Group 2 (ages 6.0–12.9 years) and Group 3 (ages 13.0–17.0 years). Serum anti-hepatitis A virus IgG and anti-hepatitis E virus IgG were determined using commercial enzyme-linked immunosorbent assay kits. The data were tested for statistical significance with the χ²-test.
Results:   The sero-prevalence rates of hepatitis A and E were 63.8% and 0.3%, respectively. The sero-prevalence rates of both hepatitis A and E increased with age, and there was no significant difference between the genders. Hepatitis A infection was associated with socio-economic condition, crowded living environment, and education level of the family ( P  < 0.01).
Conclusions:   Hepatitis A infection is still common, whereas hepatitis E infection appears to be relatively rare in paediatric age groups in Duzce, Turkey.     

School-aged children with Kawasaki disease: high incidence of cervical lymphadenopathy and coronary artery involvement

OBJECTIVE: We describe 10 school-aged children with Kawasaki disease (KD) with a high incidence of cervical lymphadenopathy and coronary abnormality. METHODS: Based on a database of 1002 children with KD in Chang Gung Children's Hospital from January 1983 to March 2001, 10 (1%) school-aged patients (five boys, five girls) who met the diagnostic criteria of KD were included for analysis. RESULTS: Cervical lymphadenopathy was noted in all (100%) of these patients. Unilateral neck mass mimicking acute suppurative infections not responding to antibiotic therapy was the initial presentation in nine (90%) of the 10 patients. The mean interval between disease onset and diagnosis was 9.9 +/- 3.3 days (range, 6-15 days). Seven (70%) of these patients responded to one course of high-dose intravenous immunoglobulin (IVIG) therapy (2 g/kg) and oral aspirin (80-100 mg/kg per day), two (20%) required a second course of IVIG, and one (10%) responded to high-dose aspirin treatment only. Coronary artery abnormality (dilatation or aneurysm) was documented by echocardiography in seven (70%) patients (four boys, three girls). In six patients, the coronary artery abnormalities resolved in 1 year, while one patient had persistent right coronary artery aneurysm, which necessitated continued anticoagulant and low-dose aspirin therapy. CONCLUSION: The incidence of school-aged children among patients with KD is about 1% in our hospital. These patients are notable for the high incidence of initial manifestations of unilateral neck mass and coronary artery involvement. This disease should be listed as the differential diagnosis in school-aged children presenting with fever and neck mass that do not respond to antibiotic therapy.     

Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy

Background: Among typical patients with Kawasaki disease (KD), a few KD patients present with only fever and cervical lymphadenopathy at admission (KDL). These patients have a significant risk for misdiagnosis, delay in treatment for KD, and development of coronary artery abnormalities. Therefore, the development of an easy tool for early diagnosis in these patients is desirable. Methods and Results: Patients who presented with only fever and cervical lymphadenopathy at admission were studied. Of these, 14 patients were eventually diagnosed with KD (KDL) and 24 patients were successfully treated using antibiotics (control). KDL patients were significantly older than control patients (P > 0.022). Among the laboratory findings, neutrophil counts (P > 0.003), C‐reactive protein (CRP; P < 0.001), and aspartate aminotransferase (AST; P > 0.018) were significantly different between the groups. To discriminate KDL patients from controls, cut‐off points of the aforementioned parameters (KDL indices) were determined using the receiver operating characteristic curves in order to maximize sensitivity and accuracy (age, 5.0 years; neutrophil counts, 10 000/μL; CRP, 7.0 mg/dL; AST, 30 IU/L). One point was assigned if a subject exceeded the cut‐off point in a KDL index. If a patient with three or four KDL indices was considered to have KD, the sensitivity was 78% and the specificity 100%. None of the patients with one or zero KDL index developed KD. Conclusions: KDL indices may be helpful in discriminating KDL from lymphadenitis at admission. It is important to monitor the symptoms of KD in a patient with three or four KDL indices at admission.     

儿童自身免疫性肝炎诊断及治疗

自身免疫性肝炎((autoimmune hepatitis,AIH)是一种呈进行性进展、以汇管区周围炎症为主的自身免疫性肝脏疾病.AIH发病率低,尤其对于儿童患者,缺乏特异的症状和体征,在临床上容易误诊或漏诊.目前用于诊断AIH的评分系统主要有国际自身免疫性肝炎小组的IAIHG评分系统,简化评分系统亦可用于诊断儿童AIH.目前AIH在治疗上也取得一定的进展,但主要是对成年人AIH的治疗.糖皮质激素及多种免疫抑制剂可用于治疗儿童AIH,但仍需根据AIH患儿病情选择合适的治疗方案.