肠气囊肿的诊断及治疗

肠气囊肿(pneumatosis cystoides intestinalis,PCI)是一种病因和发病机制尚有争议的极少见疾病.PCI的本质是出现于小肠和结肠黏膜下或浆膜下的气性囊肿,可累及从食管至直肠的全部或部分胃肠道,可导致腹胀、腹泻、腹痛及肠梗阻等症状.有关胃肠道壁内出现气性聚集的报道可以追溯到1730年.描述的名字有"pneumatosis intestinalis"、"gas cysts of the intestine'"和"pneumatosis cystoides intestinalis"等.在美国的医学文献中有关PCI的描述最早出现于1908年.     

Trichloroethylene concentration in the work environment in relation to the development of pneumatosis cystoides intestinalis

Four cases of primary pneumatosis cystoides intestinalis (PCI) were studied in relation to occupational trichloroethylene (TRI) exposure. Three of the patients were exposed to TRI in the process of washing or polishing of camera lenses. The maximum concentration of TRI in the work environment of two PCI patients often exceeded 50 ppm, though the geometric mean concentrations were below this value. Monitoring of TRI exposure by measuring urinary TRI metabolites suggested that the third patient had been working in the environment with an 8-h time weighted average TRI concentration exceeding 50 ppm. Scrutiny of 19 PCI cases thus far collected by us revealed that i) three groups of patients (7 in total) were working in the same factories, ii) most of the PCI patients were workers in small-scale factories having poor working conditions, and iii) occupational TRI exposure is probably responsible for the development of primary PCI.     

Vena portae obstruction as a cause of portal hypertension in a child with Turner syndrome

Cardiovascular and renal malformations are well-known in Turner syndrome. However, gastrointestinal bleeding is less frequent. The possible etiologies of gastrointestinal bleeding in Turner syndrome are intestinal teleangiectasia, inflammatory bowel disease and portal hypertension. The authors report a 3-year-old girl with Turner syndrome who presented with severe gastrointestinal bleeding requiring transfusion. The radiological examination indicated prehepatic portal hypertension as a reason for haematochezia. The liver biopsy demonstrated the anomaly of intrahepatic arteries and veins. In this report we describe a case of congenital portal vein obstruction and we reviewed liver abnormalities associated with Turner syndrome and causes of obstruction of vena portae in childhood.     

Cavernous hemangioma presenting as a right adnexal mass in a child

This is the case of an 11-year-old girl who presented with a right adnexal mass and vague abdominal symptoms since seven months prior to her hospital admission for surgery. CT-scan and sonographic images were those of a benign lesion, probably ovarian torsion or infarction. Serum tumoral markers were normal. A right salpingo-oophorectomy and appendectomy were performed. Pathology examination revealed a cavernous hemangioma of the ovary. The clinicopathologic presentation of this unusual benign ovarian tumor is discussed.     

Abdominal and flank pain as presenting symptoms of schwannoma

Spinal cord tumors have been reported to cause abdominal, flank, and back pain. This case report describes an extensive evaluation of an adolescent male presenting with flank, abdominal, and back pain leading to the diagnosis of a schwannoma. The case underscores the need to consider spinal cord tumors in the differential diagnosis of abdominal and/or flank pain.     

Abdominal actinomycosis presenting as a malignant tumor--report of a case and review of the literature

Actinomyces israelii is a normal inhabitant in the gastrointestinal tract of humans, it rarely causes disease. Abdominal involvement occurs in only 20 percent of all cases and can mimic malignant diseases, tuberculosis and inflammatory bowel disease. A case of a 36 years old female patient with abdominal actinomycosis and review of the literature is reported. Symptoms was presented as an acute abdomen associated with painful epigastric and left subcostal mass. The pathologic process infiltrated the retroperitoneal space simulated sarcoma or lymphoma. Diagnosis was established only at the second laparotomy, when histologic examination of the removed lymph node disclosed actinomycosis. The patient is completely free of symptoms 6 month after the second operation.     

Women's education, child welfare and child survival: a review of the evidence

This paper reviews recent evidence concerning the relative importance of women's education for child health, especially child survival in the Third World. Important regional patterns are uncovered, and particular attention is paid to discussion of the weaker associations observed in sub-Saharan Africa.     

A child presenting with fever and arthritis due to disseminated gonorrhoea

A 12-year-old boy with Down's syndrome presented with fever, arthritis and petechiae. Investigations revealed the presence of disseminated gonorrhoea. The patient made a good recovery after antibiotic therapy. A contact investigation was carried out, as well as talks with the family and school, and the case was reported to the Child Abuse Advice and Report Centre. The gonorrhoea was found to be caused by incest. Sexual abuse should be suspected in every child (certainly over the age of 1 year) with a sexually transmitted disease.     

An unusual combination of extrapulmonary manifestations of tuberculosis in a child

We report the case of a 10-year-old girl who presented to the emergency department with acute abdominal pain. She was diagnosed as having extrapulmonary tuberculosis (TB) with multifocal osteomyelitis of the spine and ribs, peritonitis and intestinal involvement. We describe the clinical presentation of this unusual constellation of the disease in the absence of pulmonary involvement in a child and discuss the diagnostic challenges and treatment of these rare forms of TB.