先天性心脏病的镶嵌治疗进展

小儿介入治疗与心脏外科联合即"镶嵌治疗"改善了复杂先天性心脏病的治疗方法.在食道超声引导下,结合内、外科技术治疗复杂先天性心脏病,不仅避免了外科体外循环的不利影响,缩短了手术时间,而且弥补了小婴儿、低体质量儿等内科介入治疗的盲点.目前镶嵌治疗主要集中在房间隔缺损、多发性肌部室间隔缺损、肺动脉狭窄及术后残余分流和残余梗阻的介入治疗.     

复杂先天性心脏病的镶嵌治疗

近年随着小儿心导管技术的迅速发展,先天性心脏病已从以往的单纯手术治疗转变为手术和介入共同治疗.对于一些复杂的先天性心脏病,内科介入技术与外科手术相互结合的镶嵌治疗模式已经成为一个主要的发展方向,在围手术期应用介入技术支持外科手术可以达到更好的治疗效果.通过镶嵌治疗不仅可以提高治疗的效果,降低手术和介入治疗各自的风险,同时有利于手术方法的改良,也减轻了患者的痛苦和家庭的经济负担.     

先天性心脏病并肺动脉高压的诊治进展

肺动脉高压是先天性心脏病常见的并发症,如不及时诊断和治疗,会影响到先天性心脏病患儿的根治效果。通过先天性心脏病并肺动脉高压的基础和临床研究,对于及时终止肺动脉高压的进行性加剧,改善先天性心脏病患儿预后,具有重要意义。     

当今小儿先天性心脏病诊治的几个问题

当今先天性心脏病诊治的方向始终是预防、早期诊断和治疗.经过30多年的努力,我国手术治疗先天性心脏病的医疗单位已达500余个,年手术能力5～6万例.新生儿期和复杂心脏病已在多中心广泛开展.为加快我国先天性心脏病的诊治步伐,笔者提出几个问题与同道商讨.     

新生儿先天性心脏病的早期诊断及内科治疗

先天性心脏病(先心病)约占活产婴儿的7‰。新生儿先心病中复杂畸形较年长儿多见，临床表现不典型，病情发展迅速，大部分早期夭折，故需早期诊断及时治疗。本文分析我院65例新生儿先心病，就其早期诊断及内科治疗问题进行探讨。     

新生儿危重型先天性心脏病的术前处理体会

目的 总结新生儿危重型先天性心脏病的术前处理经验.方法 回顾性分析22例危重型先天性心脏病新生儿的术前处理方案.结果 该组病例从入院至明确诊断时间为(1.94±0.67) h,从明确诊断至进行手术时间为(9.36±0.85) h,经术前处理,患儿发绀和气促症状均有改善,至术前无一例死亡.结论 早期初步诊断,以最快的速度转运→明确诊断→适当的术前处理→及时手术治疗,消除不必要的时间拖延,这些措施可为手术治疗赢得时间,明显提高手术治疗效果.     

复杂先天性心脏病的标准化管理

复杂先天性心脏病的治疗一直是医院的一个难题,其高额花费和高病死率使其成为发展中国家的一个巨大的社会负担,因此建立必要的标准化流程,进行标准化管理,才有可能降低手术风险,减轻社会负担.现根据本院复杂先天性心脏病治疗中存在的问题,结合标准化管理中的要求,就复杂先天性心脏病诊断治疗的几个方面进行阐述,以期在未来进行更好的标准化管理.     

疑似先天性心脏病新生儿的紧急处置

严重先天性心脏病的早期诊断及准确及时的处理对提高治疗效果,降低其病死率至关重要。现结合国外临床指南,对疑似严重先天性心脏病新生儿的诊治进行阐释。     

先天性心脏病术后心律失常诊治经验

目的探讨先天性心脏病术后心律失常的诊断与治疗。方法对137例先天性心脏病术后心律失常的发生率、发病因素、治疗与转归进行总结分析。结果137例先天性心脏病患儿均经体外循环下直视心脏手术，手术后有56例发生89例次心律失常，发生率40．9％，其中激动起源异常31例次，以室上性心律失常多见，各型传导阻滞58例次，以完全性右束支传导阻滞最多。结论病因除手术因素外，以心功能不全、洋地黄中毒和电解质紊乱为主。除室内传导阻滞随访后未见恢复外，其他病例通过病因或抗心律失常治疗多数痊愈，有效率分别为91．7％和83．3％。     

先天性心脏病的无创伤性诊断

先天性心脏病的无创伤性诊断陈树宝自本世纪２０年代开始应用心导管检查，４０年代开展选择性心血管造影技术后，先天性心脏病（简称先心病）的诊断水平发生了很大的飞跃，也促进了外科治疗水平的提高。长期以来，心导管造影检查是先心病手术前确诊的唯一方法。６０～７０...     

Play therapy in children with autism: Its role,implications, and limitations

Play is a pleasurable physical or mental activity that enhances the child’s skills involving negotiation abilities,problem-solving,manual dexterity,sharing,decision-making,and working in a group.Play affects all the brain’s areas,structures,and functions.Children with autism have adaptive behavior,adaptive response,and social interaction limitations.This review explores the different applications of play therapy in helping children with autism disorder.Play is usually significantly impaired in c...     

The Effect of Conductive Education,Intensive Therapy,and Special Education Services on Motor Skills in Children with Cerebral Palsy

Purpose: The purpose of this study was to compare the effects of intensive therapy, conductive education, and special education on function in 19 children with cerebral palsy.

Methods: Subjects participated in a five-week program of conductive education, intensive therapy, or special education. Professionals, blinded to group assignment, administered the Pediatric Evaluation of Disability Inventory (PEDI), the Gross Motor Function Measure (GMFM), and the Fine Motor Scale of the Peabody Developmental Motor Scales before and after intervention. Professionals providing treatment and parents completed a survey about their perceptions of change in the children.

Results: ANOVA showed no statistically significant differences between groups before or after treatment. Using t-tests, statistically significant within group changes were found only for the intensive therapy group on the PEDI Self-care and Social Function scales and the Crawling and Kneeling scale of the GMFM. Individual changes from preto post-test were also examined and are discussed. Surveys revealed that both parents and professionals perceived improvement in all children.

Conclusions: Greatest improvements were noted in the group receiving intensive therapy, with children in all groups showing some improvement in function.     

Comparison of different therapy approaches in children with Down syndrome

BACKGROUND: Children with Down syndrome have sensory integrative dysfunction as a result of limited sensory experience from lack of normal motor control. The aim of the present study was to compare the effects of sensory integrative therapy alone, vestibular stimulation in addition to sensory integrative therapy and neurodevelopmental therapy, on children with Down syndrome. METHODS: The present study was carried out at the Occupational Therapy Unit, School of Physical Therapy and Rehabilitation of Hacettepe University. Forty-five children who were diagnosed as having Down syndrome by the Departments of Paediatric Neurology and Medical Genetics at Hacettepe University were assessed and randomly divided into three groups. Sensory integrative therapy was given to the first group (n=15), vestibular stimulation in addition sensory integrative therapy was given to the second group (n=15) and neurodevelopmental therapy was given to the third group (n=15). All children were evaluated with Ayres Southern California Sensory Integration Test, Pivot Prone Test, Gravitational Insecurity Test and Pegboard Test. The hypotonicity of extensor muscles, joint stability, automatic movement reactions and locomotor skills were tested. Treatment programs were 1.5 h per session, 3 days per week for 3 months. RESULTS: When these groups were compared, statistically significant differences were found in subjects' performance of balance on right foot-eyes open, pivot prone position-quality score and locomotor skills-front tests (P<0.05). There were no significant differences in the other tests (P>0.05). CONCLUSIONS: The results of the present study showed that sensory integration, vestibular stimulation and neurodevelopmental therapy were effective in children with Down syndrome. It was concluded that when designing rehabilitation programs for children with Down syndrome, all treatment methods should be applied in combination, and should support each other according to the individual needs of the child.     

Fetal therapy

The advances in fetal therapy including endoscopic approaches and the advent of safer anesthetic techniques has led to the intrauterine management of potentially lethal diseases or diseases associated with high morbidity. This review will elicit certain newer techniques for fetal therapy including their application and complications.     

Une approche complémentaire dans le trouble de stress post-traumatique chez l’enfant : la médiation équine thérapeutique

BackgroundEquine-Assisted Therapy is a new approach for post-traumatic stress disorder in children, which comes in complementarity with usual therapies and is based on recent scientific studies. Horses and poneys participate more and more often in therapies for people in mental or physical difficulties. The aim is to introduce a horse as an intermediary which intervenes as a mediator for therapy. This care assisted by a horse must be included into the child's global therapeutic program. The horse facilitates development of therapeutic alliance and therapy with the triad child-therapist-horse improves interpersonal adaptation skills, positive attachment and resilience. Some recent studies have shown the interest and benefits for children with post-traumatic stress disorder.AimsA case pilot study is analyzed, starting from an experiment of equine assisted therapy for children with post-traumatic stress disorder symptoms following different psychotraumas (terrorist attack, mistreatment, injury, aggression).MethodTen equine-assisted therapy group sessions have been proposed to three children, aged from 6 to 11 years, addressed by Nice Pediatric Evaluation Psychotraumatism Center, which realizes the follow-up and other therapies. Equine assisted sessions have been carried out by the equine therapist, in presence of the psychomotor therapist, while the psychologist met with the parents. A CPTS-RI questionnaire (index of psychotraumatic stress reaction) was submitted by the psychomotor therapist to each of the three children before the first session of equine assisted therapy and after ten sessions.ResultsAccording to symptoms observed, therapeutic goals, means used and modalities are defined and described. Global results show good joining and participation, and positive evolution. For the three children, equine-assisted therapy has been facilitating for adherence to care, it improved socio-emotional and cognitive functioning, helped regulation in behaviour and emotions, restored confidence and self-esteem, provided wellness.PerspectivesTo understand action of equine assisted therapy for children with posttraumatic stress disorder so as to be able to explain benefits and effectiveness of this complementary therapy. Factors involved are analyzed depending on several approaches: psycho-affective, cognitive, social, neurobiological and therapeutic. This preliminary study must be continued with a larger sample so as to obtain data for evidence based practice and validate equine assisted therapy results in child post-traumatic stress disorder.     

Acute infectious diarrhoea in children: new insights in antisecretory treatment with racecadotril

In developing countries acute infectious diarrhoea remains one of the leading causes of death among young children, especially those under 1 year of age. In contrast, in industrialized nations the death rate is very low, although the disease is an important cause of morbidity and consumes substantial healthcare costs. A variety of viral, bacterial and parasitic organisms have been implicated in the pathogenesis of acute diarrhoea. The primary objectives of treatment of acute infectious diarrhoea are correction of dehydration with oral replacement therapy (ORT) and maintenance of good nutritional status via food intake. With regards drug therapy antimicrobial agents are not usually recommended since the disease is generally self-limiting. Racecadotril is powerful and selective enkephalinase inhibitor and has emerged as a promising drug in the antisecretory therapy of acute infectious diarrhoea in children. CONCLUSION: There is encouraging evidence that treatment with racecadotril can provide clinically relevant symptomatic relief by reducing the severity and duration of diarrhoeal episodes. The drug is well tolerated and has a favourable safety profile. However, further comparative studies and cost-effectiveness analyses are needed to define the position of the drug in the management of diarrhoeal illness in children.