儿童腰背痛（Back Pain in Children）

儿童特别是少年（Ｐｒｅ－ａｄｏｌｅｓｃｅｎｔｓ）期腰背痛持续１～２周以上者,常是由于器质性（ｏｒｇａｎｉｃ）原因所引起,与成人多是机械性（ｍｅｃｈａｎｉｃａｌ）或精神因素（ｐｓｙｃｈｏｌｏｇｉｃａｌ）所致者不同。Ｈｅｎｓｉｎｇｅｒ研究了１００例骨骼...     

Blunt Traumatic Small Bowel Rupture: Are Children Different?

Background : In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children’s and an adults’ hospital was performed. Methods : Using the hospital patient database 17 children were identified with SBR over a 13.6‐year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7‐year period and clinical records were reviewed in all 16. Results : The population incidence was 0.48/100 000 per annum in children and 0.58/100 000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow‐up examination were documented in 54.6% of children and in 90.9% of adults in whom follow‐up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults. Conclusion : Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.     

The Measurement and Interpretation of Children’s Physical Activity

The accurate and reliable assessment of physical activity is necessary for any research study where physical activity is either an outcome measure or an intervention. The aim of this review is to examine the use of objective measurement techniques for the assessment and interpretation of children’s physical activity. Accurate measurement of children’s activity is challenging, as the activity is characteristically sporadic and intermittent, consisting of frequent, short bouts. Objective measures of physical activity include heart rate telemetry, pedometry and accelerometry, and each of these methods has strengths and limitations. Heart rate is suited to the measurement of sustained periods of moderate and vigorous activity, pedometry provides a valid measure of total activity, and accelerometry provides a valid measure of total activity as well as the pattern and intensity of activity. As the weaknesses of heart rate and accelerometry for the assessment of activity are not inter-correlated, a combination of the two methods may be more accurate than either method alone. Recent evidence suggests that the Actiheart, an integrated accelerometer and heart rate unit, provides a more accurate prediction of children’s energy expenditure than either heart rate or accelerometry alone. However, the cost of the Actiheart is prohibitive for large-scale studies. The pedometer is recommended when only the total amount of physical activity is of interest. When the intensity or the pattern of activity is of interest, accelerometry is the recommended measurement tool.

Key points

• The use of objective measures to assess physical activity in children is recommended.
• Pedometers provide an inexpensive objective measure of total activity that is highly correlated with more sophisticated techniques, e.g. accelerometry, and has been used to identify relationships between health and activity in children.
• Accelerometry allows examination of the temporal pattern and intensity of children’s activity, including sporadic physical activity and bouts of physical activity.

Key words: Activity pattern, heart rate, pedometry, accelerometry     

Juvenile Polyp in Thai Children—Clinical and Colonoscopic Presentation

Background The aim of this prospective study was to describe the clinical characteristics of colorectal polyp in Thai children. Methods From December 2002 to February 2005, children under 15 years of age presenting with rectal bleeding were prospectively enrolled. Demographic, clinical, and laboratory information was recorded. Location, number, characteristics, and histopathology of the polyps were noted. Results There were 32 patients with a mean age of 6.5 years. The most common presenting symptom was hematochezia, followed by prolapsing rectal mass and diarrhea. In 20 patients there was a single polyp, 6 had 2–4 polyps, and 6 were diagnosed with polyposis coli. Most of the polyps were located exclusively at the rectum and sigmoid colon. In only 7 cases were the polyps proximal to the rectosigmoid region. This included 6 patients who had polyps beyond the splenic flexure. All were juvenile polyps without evidence of adenomatous changes. Compared to those with isolated polyps, the patients with polyposis coli had a statistically significant incidence of right-sided polyps (P <0.001) and a history of prolapse of the rectal mass (P = 0.006). Conclusions Because of the high prevalence of right-sided polyps and the concern about malignant transformation, colonoscopy should be considered as the initial evaluation in children with rectal bleeding.     

Celiac Disease—Musculoskeletal Manifestations and Mechanisms in Children to Adults

Purpose of Review

We aim to review the current literature on the association of musculoskeletal disorders and celiac disease that is a common disorder, affecting about 1% of the population. Extra-intestinal symptoms and presentations predominate.

Recent Findings

While the literature supports an association with reduced bone mineral density and increased fracture risk and celiac disease, there is little evidence supporting associations with other rheumatological conditions. Patients frequently report musculoskeletal symptoms; however, studies of specific disease entities suffer from a lack of standardization of testing for celiac disease and a lack of control groups.

Summary

Well-controlled, preferably population-based studies are required to further explore a relationship between celiac disease and musculoskeletal disorders.

     

Interviewing Children About Trauma: Problems with “Specific” Questions

A methodological ambiguity is described that may well adversely affect the quality of information provided by young child witnesses. Because the information children provide during interviews is sometimes the only evidence in forensic situations, its quality is a serious concern. Specific questions are often necessary to elicit enough information, but we describe a confusion between wh- questions (which request particular information) and yes/no questions (which merely require confirmation or disconfirmation). Research in which children are systematically interviewed about stressful medical experiences is reviewed, and we present results of a pilot investigation in which 2- to 13-year-old children were interviewed about traumatic injuries necessitating hospital treatment. Yes/no questions were problematic for preschoolers. Implications for testimony are discussed.     

The Surgical Treatment of Graves�� Disease in Children and Adolescents

Background  

Surgery as definitive treatment of pediatric Graves’ disease is recommended for children and adolescents experiencing adverse effects of thionamides or disease relapse after at least 2 years of medical treatment. In addition, it is indicated in patients with a large goiter or with suspicious nodules. Total or near-total thyroidectomy should be performed, since subtotal thyroidectomy is associated with a high risk of relapse in this group. Patients should be referred to surgeons experienced in thyroid surgery because studies show that children and adolescents have a higher complication rate than adults.     

Aortopexy in Infants and Children—Long-term Follow-up in Twenty Patients

Background Aortopexy has become an established surgical procedure for the treatment of tracheomalacia (TM) in infants and children. The aim of the present study was to evaluate the clinical outcome and respiratory function after aortopexy in the long term. Methods Between 1992 and 2006, 20 patients (6 female, 14 male) with TM were treated by bronchoscopically monitored pexis of the aorta via a right anterior thoracotomy. Patient age ranged from 4 months to 11 years (mean: 29 months). Five infants had previous surgery of esophageal atresia or tracheo-esophageal fistulae, and five other patients were operated on for gastroesophageal reflux. Postoperative tidal expiratory flow (TEF25%) was compared to age-related values. Results Mean follow-up was 7.8 years (range: 13 months to 10.7 years). There was no early or late mortality. Most patients (n = 16) showed immediate and permanent relief of symptoms. Compared to corresponding age groups, median TEF25% was slightly but not significantly decreased after aortopexy (p = 0.15). In one patient a re-aortopexy was necessary. Another patient experienced recurrent tracheo-esophageal fistula 3 years after aortopexy. Conclusions The bronchoscopically guided aortopexy is an efficient and simple method in the surgical treatment of TM in infants and children. The follow-up data in this series of 20 patients showed improvement of respiratory function and permanent relief of symptoms in the long term.     

Is There Still a Need for Living-related Liver Transplantation in Children?

OBJECTIVE: To assess and compare the value of split-liver transplantation (SLT) and living-related liver transplantation (LRT). SUMMARY BACKGROUND DATA: The concept of SLT results from the development of reduced-size transplantation. A further development of SLT, the in situ split technique, is derived from LRT, which itself marks the optimized outcome in terms of postoperative graft function and survival. The combination of SLT and LRT has abolished deaths on the waiting list, thus raising the question whether living donor liver transplantation is still necessary. METHODS: Outcomes and postoperative liver function of 43 primary LRT patients were compared with those of 49 primary SLT patients (14 ex situ, 35 in situ) with known graft weight performed between April 1996 and December 2000. Survival rates were analyzed using the Kaplan-Meier method. RESULTS: After a median follow-up of 35 months, actual patient survival rates were 82% in the SLT group and 88% in the LRT group. Actual graft survival rates were 76% and 81%, respectively. The incidence of primary nonfunction was 12% in the SLT group and 2.3% in the LRT group. Liver function parameters (prothrombin time, factor V, bilirubin clearance) and surgical complication rates did not differ significantly. In the SLT group, mean cold ischemic time was longer than in the LRT group. Serum values of alanine aminotransferase during the first postoperative week were significantly higher in the SLT group. In the LRT group, there were more grafts with signs of fatty degeneration than in the SLT group. CONCLUSIONS: The short- and long-term outcomes after LRT and SLT did not differ significantly. To avoid the risk for the donor in LRT, SLT represents the first-line therapy in pediatric liver transplantation in countries where cadaveric organs are available. LRT provides a solution for urgent cases in which a cadaveric graft cannot be found in time or if the choice of the optimal time point for transplantation is vital.     

加拿大儿童心连心(Children’s Heartlink)再次走进华西医院

<正>加拿大儿童心连心(Children’s Heartlink)为帮助我国西南地区提高先天性心脏病的治疗水平,从2006年至今,持续与华西医院保持密切合作,先后6次资助来自加拿大多伦多儿童医院Sickkids的国际顶尖医疗团队来华西医院开展技术指导和学术交流。2012年1月15日,加拿大儿童心连心(Children’s Heartlink)负责人Estelle和Andreas再次莅临华西医院,与小儿心脏外科医生、     

Intensified Daily Dialysis: The Best Chronic Dialysis Option for Children?

Children receiving chronic hemodialysis (HD) three times a week have many obstacles to overcome. Not only do they have to endure dietary restrictions, but they also need to take various medications on a daily basis, which contribute to anorexia. Children on such conventional dialysis programs often have poorly controlled blood pressure (which can lead to left ventricular hypertrophy and/or left ventricular dysfunction) and impaired statural growth. Therefore, the need for more frequent and/or intensive dialysis is recognized. Nevertheless despite limited center experience, daily dialysis is currently most often limited as a rescue treatment. When performed, daily intensified HD provides a modality for preserving cardiovascular health and promoting normal growth in children. Therefore, the time spent on chronic dialysis preserves their chances of the best possible outcome.     

Anti-HLA Antibodies Posttransplantation in Children: Do We Know What It Means?

Objective

Anti-HLA antibodies posttransplantation are associated with the appearance of acute and chronic rejection. The goal of this study was to determine the association between the presence of anti-HLA antibodies posttransplantation in children and the clinical outcome.

Patients and Methods

We studied the presence and the level of class I and II anti-HLA antibodies by microbead technology (Luminex) in 32 children after kidney transplantation; 87% underwent a first transplantation. Their mean age was 13.9 ± 2.52 years. When anti-HLA was positive, 60% of children showed an increase in creatinine within the previous 3 months. The statistical analysis was performed with the SPSS 9.0 program.

Results

Only 4/32 children displayed class I anti-HLA antibodies at low levels (5-7.2) and 43% class II anti-HLA antibodies (level: 5-308). We did not observe an association between the presence of antibodies and age, sex, type of donor, immunosuppression, hypertension, proteinuria, time from transplantation, or reason to evaluate antibodies; 37.5% showed good graft function. The presence of anti-HLA antibodies posttransplantation was associated with retransplantations and with the percentage of antibodies by panel-reactive antibodies. There was trend towards an association with a previous acute rejection episode (P = .072); 62.5% of children with C4d-positive biopsies displayed anti-HLA antibodies vs 20% of those who were C4d-negative (P = .088). Graft survival was 100%.

Conclusions

The presence of anti-HLA antibodies posttransplantation was influenced by pretransplantation factors—previous level of anti-HLA antibodies, retransplantation, DR matching— and also by posttransplantation factors, such as the occurrence of an acute rejection episode.