幼年型卵巢粒层细胞瘤一例

患儿,女,8个月,因发现腹部包块6月余,伴发热7 d人院.患儿6个月前被其父母发现腹部有一包块, 约鸡蛋大小,质稍硬,边界不清,未行特殊治疗.近1周来包块生长迅速,伴有发热, 38℃左右,无腹泻,无咳嗽、咳痰,无黄疸,B超示:腹腔实性包块伴腹腔大量积液.于当地医院输液(具体治疗不详)后无明显改善,以腹腔包块待查急诊收入我院.     

小儿肝局灶性结节状增生一例

患儿:女,5岁.因发现腹部包块2周入院.2周前患儿无明显诱因突发腹痛,伴呕吐,呕吐物为胃内容物.未出现发热,腹胀等.家长发现其右上腹有一包块.到当地医院行腹部超声检查发现:右肝内低回声占位,考虑肝母细胞瘤,未治疗.     

高IgE综合征一例

患儿,男,12岁,以"腹部包块4个月"为主诉入我院小儿普通外科病房.患儿入院前6个月于其右侧腹股沟区发现鸡蛋大小包块,同时伴发热,体温波动于38～39℃之间,每日发热2～3次,包块触痛(+).于当地诊所行抗感染(头孢菌素类药物)治疗10 d,用药3 d后热退.经抽吸脓汁4次后,包块逐渐变小.同时在距原包块约10 cm右侧腹股沟区再次出现一约"拳头"大小的包块.10 d后患儿腹部触及包块,当地医院行彩色多普勒超声检查后考虑为"腹腔脓肿",遂入我院小儿外科住院行"腹腔囊肿根治术".术后约半个月复查彩色多普勒超声示腹腔内仍有囊肿,随诊中发现患儿腹部肿物逐渐增大,故再次入我院治疗.     

小儿急性甲状腺脓肿一例

患儿,男,1岁1个月,因"咳嗽1周、发热2d、颈部包块1d"入院.1周前患儿受凉后出现咳嗽,喉中有痰,2d前出现发热,最高达39.5℃,无畏寒、寒战.入院前1d家长发现其颈部有一包块,触之患儿哭吵明显.入院查体:T37.6℃,P 140次/min,R40次/min,发育正常,营养良好,神志清楚,精神欠佳.头颅、五官正常,颈旁可扪及2～3个肿大淋巴结,大者约1.0 cm×1.5 cm大小,质软.颈部活动受限,向左侧倾斜,颈前区中线偏左处可扪及约4.0 cm ×4.5 cm包块,突出皮肤,皮肤不红,皮温不高,质硬,边界清楚,触之患儿哭吵明显,可随吞咽上下移动.双肺呼吸音粗,无哕音,心脏、腹部、四肢、神经系统检查均正常.     

小儿空肠浆膜下血肿一例

患儿 男,7岁.因"腹痛1d伴呕吐数次"急诊入院,阵发性(上)腹部绞痛,疼痛无放散,非喷射样呕吐5～6次,约45 ml/次,为胃内容物,无发热、腹胀、腹泻,排少许正常便.体检:T 36.3℃,P 90次/min,R 25次/min,BP 96/51 mm-Hg;意识清,精神萎靡;皮肤略松弛,眼窝无明显凹陷;腹部未见胃肠型,无明显外伤外观,腹式呼吸存在,上腹部压痛阳性,无反跳痛及肌紧张,腹壁张力略高,无明显包块,移动性浊音阴性,上腹部鼓音区扩大;听诊肠鸣音6次/min,无亢进.     

高IgE综合征一例

患儿,男,12岁,以“腹部包块4个月”为主诉入我院小儿普通外科病房。患儿入院前6个月于其右侧腹股沟区发现鸡蛋大小包块,同时伴发热,体温波动于38～39℃之间,每日发热2～3次,包块触痛（＋）。于当地诊所行抗感染（头孢菌素类药物）治疗10d,用药3d后热退。经抽吸脓汁4次后,包块逐渐变小。同时在距原包块约10cm右侧腹股沟区再次出现一约“拳头”大小的包块。10d后患儿腹部触及包块,当地医院行彩色多普勒超声检查后考虑为“腹腔脓肿”,遂入我院小儿外科住院行“腹腔囊肿根治术”。     

儿童肠系膜巨大低分化肉瘤误诊为淋巴管瘤一例

患儿:男,5岁.因腹痛、发热2周,发现腹部肿物2 d入院.检查:T 37.5℃,全腹膨隆明显,腹部可扪及巨大包块,上至剑突下,下达盆腔,固定,压痛.血常规:WBC:14.8×109/L,Hb:123 g/L.CRP:109 mg/L.予抗炎治疗,腹痛好转,仍有发热,36.5℃～39℃之间.CT:腹部囊实性占位约196.9 mm×182.1 mm×127.4 mm,考虑淋巴管瘤合并出血.     

腮腺炎并胰腺炎及感音性耳聋1例

患儿 ,男 ,5岁 ,因乏力、呕吐 3d入院。患儿 3d前出现乏力 ,精神不振 ,呕吐 2～ 3次 /d ,伴腹痛 ,无头痛、发热。给予青霉素和利巴韦林治疗 3d ,上述症状未见缓解。 8d前有发热和双侧腮腺肿痛 ,5d前发热及腮腺肿痛消失。查体 :体温 3 8.4℃ ,呼吸 3 0次 /min ,脉搏 96次 /min ,     

新生儿期美克尔憩室穿孔误诊为腹壁脓肿一例

患儿:男,15个月.生后25 d发现右下腹包块伴发热2 d.门诊诊断右下腹包块待查收住院.吃奶好,无呕吐,大小便正常,无腹痛.     

小儿大网膜炎性肌纤维母细胞瘤一例

患儿 :女 ,12岁。发热 3d伴腹部疼痛 ,抽搐 1次。以病毒感染收住儿科。查体发现腹部有一包块转入外科。家属述近 2 0d来体重减轻约 5kg。查体 :T38～ 39℃、P 88～ 112次 /min、R 2 5次 /min ,BP 12 0 /80mmHg。头颈心肺正常。下腹部隆起 ,可触及一包块 ,约 15 .0cm× 12 .0cm× 10 .0cm大小 ,边界清 ,稍有活动 ,表面光滑 ,质地硬 ,形态不规则 ,肿块上界达脐上约 4 .0cm ,下界入盆腔。血常规 :Hgb 92 g/L、Rbc3.6 0× 10 12 /L、Wbc 15 .3× 10 9/L、N 0 .89、M 0 .0 4、L0 .0 7、PLT 931× 10 /L。ESR 130mm/h。凝血酶原时间 ,凝…     

新生儿咳嗽5天，发热3天

1病历摘要患儿,男,江西郊区(县)人,出生25d。患儿因“咳嗽5d,发热3d,加重半天”为主诉入本院。患儿于入院前5d出现咳嗽,为阵发性单声咳,痰少;3d前开始发热,T38℃左右,外院予“头孢拉定、退热剂”等治疗,疗效不显著;入院当日晨起咳嗽加剧,为连声咳,伴面色发绀、呼吸急促。起病以来,患儿精神较差,纳减,大、小便正常,无呕吐、腹泻、抽搐、皮疹。出生史:G2P2,孕38周,出生体重3000g,在浙江某一镇医院自然分娩,Apgar评分不详,否认窒息抢救史,无胎膜早破,羊水清,胎盘、脐带不详。生后6h开奶,混合喂养,奶量不详。父母自述体健,母自述孕期无异常;姐…     

Seven days vs. 10 days ceftriaxone therapy in bacterial meningitis

Ceftriaxone is recommended in children with acute bacterial meningitis (ABM) for 10 days. However, the drug is expensive, and shorter duration of therapy, if equally effective, would cut costs of therapy and hospitalization. The aim of this study was to compare the outcome of 7 days vs. 10 days' ceftriaxone therapy in children with ABM. Seventy-three children aged 3 months to 12 years with ABM, consecutively admitted to hospital were enrolled. Ceftriaxone was given for 7 days to all. Randomization to group I (7 days) and group II (10 days) therapy was done on the seventh day. At the end of 7 days' therapy in group I and 10 days in group II, children were evaluated using a clinical scoring system. Children with a score of more than 10 were labelled as 'treatment failures' and were continued on ceftriaxone. If a score was less than 10, the antibiotic was stopped. Complications were appropriately evaluated and managed. All children were followed-up 1 month after discharge: neurodevelopmental assessment, Denver Development Screening Tests, IQ and hearing assessment were done. After excluding four patients, there were 35 children in group I and 34 in group II. The two groups were comparable with respect to age, sex, nutritional status, presenting clinical features, and CSF parameters. Organism identification was possible in 38 per cent of children: (Streptococcus pneumoniae, 21 per cent; Haemophilus influenzae, 13 per cent; meningococcus, 4 per cent). Treatment failure rate was comparable in both groups (9 in group I and 8 in group II) as was the sequelae at discharge and at 1 month (9 in group I, 15 in group II,p > 0.1). Status epilepticus and focal deficits at presentation were significantly associated with treatment failures and sequelae in both the groups (p < 0.05). Length of hospital stay was shorter in group I (10.8 +/- 6.0 days) as compared with group II (14.4 +/- 7.2 days,p < 0.05) and frequency of nosocomial infection was significantly more in group II (p < 0.05). It was concluded that clinical outcome of patients treated with 7 days' ceftriaxone therapy is similar to that of 10 days' therapy, and is associated with lesser nosocomial infection and earlier hospital discharge. Seven days ceftriaxone therapy may be recommended for uncomplicated ABM in children in developing countries.     

Treatment of shigellosis with cefixime: two days vs. five days

BACKGROUND: Although the recommended standard course of therapy for shigellosis is 5 days of oral ampicillin or trimethoprim-sulfamethoxazole therapy, successful outcome has been reported in adults treated with abbreviated courses of antibiotics. The purpose of this study was to compare short course (2-day) vs. 5-day therapy with cefixime for treatment of diarrheal disease caused by Shigella sonnei in children. METHODS: This was a prospective, randomized, double blind, placebo-controlled study. Patients were eligible if they were at least 6 months of age and presented to the Children's Hospital of Pittsburgh during an outbreak of diarrhea caused by S. sonnei, with (1) a history of fever and diarrhea (at least three loose or watery stools per day), (2) bloody diarrhea or (3) diarrhea and known exposure to an individual with documented shigellosis. Patients were randomized to receive either 2 days of cefixime (8 mg/kg(day) given once daily followed by 3 days of placebo or 5 days of cefixime. Telephone follow-up was performed on Days 3, 7 and 14 after enrollment. Follow-up stool cultures were obtained on Day 7 to assess bacteriologic cure. There were standardized definitions for cure, improvement, failure and relapse. RESULTS: Forty-seven patients were enrolled. Eleven were eliminated from analysis because their stool cultures were not positive for S. sonnei. There were 36 evaluable patients, 21 in the 2-day group and 15 in the 5-day group. Patients ranged in age from 6 months to 17 years. Forty-four percent of the subjects were male. Symptoms were improved or had resolved by Day 3 of therapy in all patients. There were 8 patients who experienced a clinical relapse: 5 of 21 (24%) patients in the 2-day treatment group and 3 of 15 (20%) in the 5-day group. There were 13 patients who experienced a bacteriologic failure (defined as the occurrence of a positive culture at the Day 7 follow-up visit), 11 of 20 (55%) in the 2-day group and 2 of 14 (14%) in the 5-day group (P < 0.02). CONCLUSION: Two- and 5-day treatment courses with cefixime for treatment of diarrheal disease caused by S. sonnei result in similar rates of clinical cure and clinical relapses; however, there was a higher rate of bacteriologic failure with shorter course therapy.     

66日龄婴儿发现多发皮下结节1月余

患儿,男,66?d,因发现皮下结节46?d,腹胀10?d入院。患儿主要临床表现为全身脂肪组织减少,皮下结节,胰岛素抵抗型糖尿病,高三酰甘油血症,肝脂肪变性,最终确诊为先天性全身性脂肪代谢障碍1型。经改用含中链脂肪酸比例高的配方奶及先后予胰岛素注射、二甲双胍口服后病情好转。基因检测显示AGPAT2基因存在c.646A > T纯合突变,其父母均为该突变的携带者。该病例为国内报道的起病年龄最小、且以多发皮下结节为首发症状的先天性全身性脂肪代谢障碍1型患儿。     

Two dosages of clarithromycin for five days, amoxicillin/clavulanate for five days or penicillin V for ten days in acute group A streptococcal tonsillopharyngitis

BACKGROUND: Short course antimicrobial therapy is suggested for group A streptococcal tonsillopharyngitis. METHODS: The bacteriologic and clinical efficacies of clarithromycin [30 or 15 mg/kg/day twice daily (b.i.d.)] or amoxicillin/clavulanate (43.8/6.2 mg/kg/day b.i.d.) for 5 days or penicillin V (30 mg/kg/day 3 times a day) for 10 days were compared. In a randomized, open label, parallel group, multicenter study, 626 children (2-16 years old) with tonsillopharyngitis were enrolled; 537 were evaluable for efficacy. Follow-up evaluations were performed at 4-8 and 21-28 days after therapy. RESULTS: At enrollment, 26% of the Streptococcus pyogenes isolates were clarithromycin-nonsusceptible. All regimens had an apparently similar clinical efficacy. The long term S. pyogenes eradication rates were 102 of 123 (83%) with amoxicillin/clavulanate and 88 of 114 (77%) with penicillin V. In the 30- and 15-mg/kg/day clarithromycin groups, eradication occurred in 71 of 86 (83%) and 59 of 80 (74%) of the clarithromycin-susceptible isolates (P = 0.33), and in 4 of 28 (14%) and 5 of 26 (19%) of the clarithromycin-resistant isolates, respectively (clarithromycin-susceptible versus -resistant, P < 0.0001). Both clarithromycin dosages were well-tolerated. CONCLUSIONS: In group A streptococcal tonsillopharyngitis, 5 days of clarithromycin or amoxicillin/clavulanate treatment had clinical efficacy comparable with that of 10 days of penicillin V treatment; however, amoxicillin/clavulanate and penicillin V were bacteriologically more effective than clarithromycin because of its failure to eradicate the clarithromycin-resistant S. pyogenes isolates. The 5-day clarithromycin regimens are not recommended for treatment of streptococcal tonsillopharyngitis in areas where in vitro resistance of group A streptococci to clarithromycin is common.