婴幼儿血管瘤的阶段性治疗

目的 探讨糖皮质激素及手术治疗对婴幼儿血管瘤的效果。方法 2003年7月～2006年7月对本院收治1～3个月婴儿草莓状血管瘤26例予盐酸曲安奈德注射液瘤体内注射（1mg／12cm^2，总量不超过2mg／kg），2～3周1次，共3～5次；3个月以上婴儿草莓状及海绵状血管瘤50例予手术切除，缺损较大者以皮片移植或局部皮瓣转移修复。其中创口直接缝合38例，植皮3例，以局部皮瓣转移修复9例。结果 草莓状血管瘤26例经激素注射1、2次充血减轻，4、5次瘤体均变平，边缘萎缩。手术50例，术后皮片皮瓣均成活，形态良好。结论 激素注射是控制小龄婴儿血管瘤安全、可靠、简便方法，对大龄患儿可耐受手术及麻醉则以手术切除效果为佳。     

儿童创伤肉芽创面中厚植皮术

目的：采用中厚植皮术治疗创伤肉芽创面，评价其可行性。方法：１２例儿童创伤肉芽创旅行大张开洞中厚植皮移植术，结果：１２例皮片完全存活。随诊皮片柔软耐磨、无瘢痕增生挛缩，除外１例在睑及下唇轻度外翻畸形，其余１１例无功能障碍，该订式能有效避免刃厚邮票植皮术后的局部瘢痕增生、挛缩畸形而影响外观、主生长发育，常需Ⅱ期多次整形的缺点。结论笔者建议对于儿童创伤肉芽创面，尤其对于功能部位，环形创面部位及面、会阴等     

糖皮质激素瘤内注射治疗婴儿血管瘤对免疫功能影响的研究

目的研究局部注射糖皮质激素治疗婴儿血管瘤对患儿免疫功能的影响。方法选择1岁以内血管瘤患儿30例,采用曲安奈德40mg／次及倍他米松磷酸钠5mg／次瘤内注射进行治疗。分别于治疗前及治疗后2周、4周、6周、8周、3个月、6个月测定血清IgA、IgG、IgM及C3含量。治疗前后2～4周测定淋巴细胞转化率。结果治疗后血清免疫球蛋白及补体C3含量无明显减少,治疗后血清IgA、IgG、IgM及C3平均值低于治疗前,经配对t检验,差异无统计学意义（P〉0．05）;治疗前后淋巴细胞转化率无明显变化,差异无统计学意义（P〉0．05）。结论按本研究所用剂量瘤内注射糖皮质激素治疗婴儿血管瘤,患儿血清免疫球蛋白、补体C3及淋巴细胞转化率无明显变化,说明对患儿体液免疫及细胞免疫功能无明显影响。     

儿童食管瘢痕性狭窄的外科治疗

目的 探讨儿童食管瘢痕性狭窄的外科治疗方法、效果及并发症的预防。方法 分析1991年10月—2001年10月间手术治疗的食管瘢痕性狭窄病人15例，行胃代食管术8例，狭窄段切除、食管端端吻合术1例，结肠代食管术6例。结果 15例均治愈。随访发现结肠代食管者生活质量最好，旷置食管未发生积液性囊肿。胃代食管者术后3例发生重度胃食管反流。结论 经胸骨后结肠代食管术是治疗本病的较好术式，尤其适用于长段狭窄和高位狭窄。胃代食管手术较为简单，但术后可能发生严重胃食管反流。     

结核病

0377皮上划痕法初种卡介苗发生峨痕疙瘩111例及其防洽玉林地区防疫站等广西医学(5):24,1981 本文介绍1977年7月对北流县15岁以下儿童接种卡介苗235,637人除陵城镇对3,212名先做结核菌素试验,阴性反应者接种外,其余均直接接种。方法是皮上划“井字形痕。一年后在井字瘢痕处形成瘢痕疙瘩111例。在调在的3,242名接种儿童中发生瘢痕疙瘩者111例占3.4％其中男童1,650名中有45人女童1,592人中有66人女高于男,发生年令为8—17岁。     

气道消融术在现代儿科介入呼吸病学的应用

儿童气道消融术主要包括热消融术和冷冻治疗术，其中热消融术包括激光、高频电凝切、氩等离子体凝固等。气道消融术主要应用于气道阻塞性疾病，如肉芽组织增生、瘢痕增生及肿瘤等。热消融术及冻切术可快速畅通气道，用于严重气道阻塞的治疗；冻融术可破坏局部组织及血供，可有效抑制肉芽组织及瘢痕再生。适时、规范地综合应用气道消融术是安全有效治疗的关键。     

儿童头面部血管瘤的治疗选择

目的总结儿童头面部血管瘤的治疗选择及疗效，探索使容貌受损减少，而疗效最佳的头面部血管瘤治疗方案。方法2001～2007年本院收治192例头面部血管瘤患儿，根据瘤体大小、类型和侵犯部位的不同，采用完全切除瘤体、切除大部分瘤体加残余瘤体注射硬化剂、密集缝扎瘤体加局部注射硬化剂等治疗方法。结果192均治愈，其中一期手术治愈142例，术后继续注射硬化剂治愈42例，术后复发再次治疗8例。无一例遗留明显术后畸形。结论儿童头面部血管瘤易侵犯五官，影响容貌，宜尽寸治疗。手术治疗以不影响容貌为原则，可根据瘤体大小、部位、类型等设计切口，选择分次治疗，而不强求一次于术治疗。手术后可采用局部注射硬化剂或激光治疗残余瘤体。     

注射百白破疫苗205例的临床体会

目的做好儿童预防免疫工作，保证儿童健康。方法对月龄满3、4、5、18个月的205例需要接种百白破疫苗的儿童，取吸附百白破疫苗0．5ml，部位取小儿臀部外上1／4处深部肌肉注射。结果2003～2004年本组接种百白破的205例儿童，成功率100％；注射部位无感染、无无菌性化脓等并发症，接种后副反应小，达到了接种的预期目的。结论有效地接种百白破疫苗，才能有效地预防百日咳、白喉、破伤风3种传染病。     

曲安奈德、尿激酶、脂肪乳剂联合应用于肠粘连预防的动物试验研究

目的探讨曲安奈德、尿激酶、脂肪乳剂联合应用于预防动物肠粘连。方法将家兔腹部造成五种不同的损伤,在不同的时期,观察用药组与非用药组的表现及病理变化。结果曲安奈德、尿激酶、脂肪乳联合应用组与非用药组相比能显著减少炎症反应和渗出,能有效降低腹膜粘连和肠粘连的发生。结论曲安奈德、尿激酶、脂肪乳联合应用预防动物肠粘连是有效的。     

小儿体表海绵状血管瘤的诊断及局部注射治疗

目的 总结彩色多普勒B型超声、增强CT及三维立体重建影像检查对血管瘤诊断的意义,比较地塞米松、平阳霉素瘤内注射治疗小儿浅表海绵状血管瘤的疗效.方法 选取1995年～1999年浅表海绵状血管瘤80例为A组,瘤内注射地塞米松;2000年～2005年80例为B组,瘤内注射平阳霉素.两组均每1～2周注射1次,共注射2～6次不等,直至肿物不再缩小.两组患儿年龄2个月～10岁,男∶女≈1∶3.全部病例均通过病史、体格检查及彩色多普勒B超确诊.部分行增强CT及三维立体重建影像检查进一步明确血管瘤的大小、形态、位置、血流及与周围血管的关系.结果 A、B两组治愈率分别为75%、92.5%,好转率为25%、7.5%,总有效率均为100%.平阳霉素组治愈率明显高于地塞米松组.全部病例无明显瘢痕形成.A组78%出现肥胖、多毛等,停药后恢复正常;B组注射后发热、腹泻、皮疹的发生率分别为47.5%、22.5%、7.5%,经对症处理后恢复正常,无肺炎样症状、肺纤维化及过敏发生.结论 平阳霉素瘤内注射治疗小儿浅表海绵状血管瘤疗效满意,是治疗小儿浅表海绵状血管瘤的首选方法.     

Prolonged childhood Cushing's syndrome secondary to intralesional triamcinolone acetonide

Intralesional corticosteroids have been used in the treatment of hypertrophic keloid scars for over 40 years. The few complications documented have mostly been local skin changes, viz depigmentation and cutaneous atrophy. Cushing's syndrome following intralesional injection is rare and usually self-limiting following cessation of therapy. This report describes a 9-year-old girl who developed Cushing's syndrome 2-3 weeks after a single treatment with 40 mg triamcinolone acetonide injected into keloids. Features of Cushing's syndrome and a suppressed hypothalamic-pituitary axis were present up to 9 months later. Three years after glucocorticoid injections, features of Cushing's syndrome had largely disappeared. Dosages of intralesional steroids normally recommended for adults are inappropriate for children.     

皮肤扩张术修复儿童头面颈部创面和瘢痕

目的 探寻儿童头面颈部创面和瘢痕的简便、易行、疗效优于传统植皮和皮瓣转移的治疗方法。方法 回顾性分析、比较一次性快速扩张、单个扩张器常规扩张修复术及多个扩张器修复术治疗的使用及其效果。结果 27例儿童病例全部取得了满意的效果、恢复良好容貌。经随访2—6年，外观、色泽和功能满意。结论 ①皮肤软组织扩张术是儿童头面颈部大面积创面和瘢痕最好的治疗方式。②根据头面颈部创面和瘢痕的大小，分别选择一次性快速扩张、单个扩张器及多个扩张器两期修复术。     

Adherence to isoniazid preventive chemotherapy: a prospective community based study.

BACKGROUND: Current international guidelines recommend 6-9 months of isoniazid (INH) preventive chemotherapy to prevent the development of active tuberculosis in children exposed to a susceptible strain of M tuberculosis. However, this is dependent on good adherence and retrospective studies have indicated that adherence to unsupervised INH preventive chemotherapy is poor. AIM: To prospectively document adherence to six months of unsupervised INH monotherapy and outcome in children with household exposure to an adult pulmonary tuberculosis index case. METHODS: From February 2003 to January 2005 in two suburbs of Cape Town, South Africa, all children <5 years old in household contact with an adult pulmonary tuberculosis index case were screened for tuberculosis and given unsupervised INH preventive chemotherapy once active tuberculosis was excluded. Adherence and outcome were monitored. RESULTS: In total, 217 index cases from 185 households were identified; 274 children <5 years old experienced household exposure, of whom 229 (84%) were fully evaluated. Thirty eight children were treated for tuberculosis and 180 received preventive chemotherapy. Of the children who received preventive chemotherapy, 36/180 (20%) completed > or =5 months of unsupervised INH monotherapy. During the subsequent surveillance period six children developed tuberculosis: two received no preventive chemotherapy, and four had very poor adherence. CONCLUSION: Adherence to six months of unsupervised INH preventive chemotherapy was poor. Strategies to improve adherence, such as using shorter duration multidrug regimens and/or supervision of preventive treatment require further evaluation, particularly in children who are at high risk to progress to disease following exposure.     

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??Abstract??Objective??To observe the efficacy and safety of Rituximab ??Roche Pharmaceuticals RTX?? trade name?? rituximab?? treatment for children with systemic lupus erythematosus??and try to find a useful alternative therapeutic approach to those with bad response to traditional therapies. Methods??Produced by Roche Pharmaceuticals??CD20 monoclonal antibody rituximab was used by intravenous injection. Initial dose was 188 mg/m2?? 2 weeks later the second injection was given at 375 mg/m2. Thirty minutes before each injection 5mg Dexamethasone and 10mg Promethazine were given to prevent drug allergy. Results??Twelve cases of SLE in children were performed flow cytometry detection of CD20+ 4 weeks after administration??10 cases were 0??85.71%?? in B cell depletion?? and gradually rose after 6??8 months. IgG?? IgM and IgA plasma had no significant difference from the baseline. Clinical manifestations and clinical signs in 12 cases of children were evaluated??and the average score dropped from 16.0±2.95 to 8.67±1.83. ANA?? Anti-ds-DNA?? C3 and C4 had different degrees of improvement. In 6 cases of lupus nephritis children with urinary protein was significantly improved after 6 months of Rituximab treatment??4 cases of elevated serum creatinine and blood urea nitrogen was also returned to normal after 6 months of treatment. One case had severe pulmonary infection. Conclusion??Significant effects of CD20+ monoclonal antibody ??rituximab?? treatment are shown for children with SLE and lupus nephritis?? especially in severe children. This provides a new alternative treatment for those with poor tolerance to traditional Prednisone and cyclophosphamide treatment and with poor clinical effect. However?? infection problem can not be ignored. The Rituximab replacement treatment for children with SLE still need further study.     

A better incision for pectus excavatum repair: avoiding the keloid triangle

The most common approach to the pepair of pectus excavatum and pectus carinatum deformities is via a central transverse submammary incision. The subsequent suprasternal scar is conspicuous and prone to hypertrophic and keloid scarring. To avoid the keloid triangle and to produce a less noticeable scar, we have utilized bilateral inframammary incisions for repairs of five female and two male patients with pectus defects. This approach provides excellent access for cartilage resection, sternotomy, and sternal tupport without increasing opearative time or compromising operative exposure. On follow-up for up to 25 months, all patients have had excellent cosmetic and functional results. Chest wall configuration and stability, wound healing, and scar formation have all been without complication. No keloid or hypertrophic scars have developed. To date, there has been no recurrence of pectus defects. We believe bilateral inframammary incisions are a superior approach for pectus repairs by enchancing cosmesis with less noticeable scars and fewer hypertropic and keloid scars, all without compromising operative exposure or increasing operative time.     

Adherence to isoniazid preventive chemotherapy: a prospective community based study

Background

Current international guidelines recommend 6–9 months of isoniazid (INH) preventive chemotherapy to prevent the development of active tuberculosis in children exposed to a susceptible strain of M tuberculosis. However, this is dependent on good adherence and retrospective studies have indicated that adherence to unsupervised INH preventive chemotherapy is poor.

Aim

To prospectively document adherence to six months of unsupervised INH monotherapy and outcome in children with household exposure to an adult pulmonary tuberculosis index case.

Methods

From February 2003 to January 2005 in two suburbs of Cape Town, South Africa, all children <5 years old in household contact with an adult pulmonary tuberculosis index case were screened for tuberculosis and given unsupervised INH preventive chemotherapy once active tuberculosis was excluded. Adherence and outcome were monitored.

Results

In total, 217 index cases from 185 households were identified; 274 children <5 years old experienced household exposure, of whom 229 (84%) were fully evaluated. Thirty eight children were treated for tuberculosis and 180 received preventive chemotherapy. Of the children who received preventive chemotherapy, 36/180 (20%) completed ⩾5 months of unsupervised INH monotherapy. During the subsequent surveillance period six children developed tuberculosis: two received no preventive chemotherapy, and four had very poor adherence.

Conclusion

Adherence to six months of unsupervised INH preventive chemotherapy was poor. Strategies to improve adherence, such as using shorter duration multidrug regimens and/or supervision of preventive treatment require further evaluation, particularly in children who are at high risk to progress to disease following exposure.     

先天性腹裂分期修复术14例诊治分析

目的 探讨先天性腹裂的治疗方法。方法 对14例先天性腹裂的诊疗情况进行回顾性研究分析，结果 14例先天性腹裂手术患儿中，10例存活，4例死亡。10例存活患儿8例获3月。5年随访，发育基本正常。结论 先天性腹裂是一种严重的先天性畸形，合理的手术方式、呼吸系统支持、全胃肠道外营养、预防及正确处理并发症是治疗成功的关键。     

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??Abstract??Objective The time-effect relationship in treating postural orthostatic tachycardia syndrome ??POTS?? of children with alpha receptor agonist midodrine hydrochloride was analyzed to explore the optimum course of treatment for POTS children. Methods A total of 104 cases of the POTS children were studied from 2005 to 2011 in Peking University First Hospital. A chi-square test was used to evaluate the relationship between effect and time of medication?? and the time-effect curve was constructed. Results According to the 104 cases?? the time accumulative total efficacy for 1 month?? 2 months?? 3 months?? 4 months?? 5 months and 6 months were 19.23%?? 48.08%?? 69.23%?? 73.08%?? 74.04% and 75.96%?? respectively. The time accumulative total efficacy for 3 months was higher than that for 1 month or 2 months ??P??0.05???? but there was no difference in the efficacy among 4 months?? 5 months and 6 months treatment and with 3 months treatment. Conclusion It has the best treatment efficacy when the course of treatment for POTS children with midodrine hydrochloride is 3 months?? and prolonging the duration of treatment does not significantly improve the therapeutic effect.     

44例小儿重复肾的诊治分析

目的探讨小儿重复肾的诊断方法和手术技巧,以提高其诊治水平。方法回顾性分析2006年9月至2011年10月经作者手术治疗的44例重复。肾患儿临床资料,其中男性10例,女性34例,年龄1个月至13岁,平均年龄2．2岁。均采用B超、MRU、IVU等相结合的方法进行诊断。均行重复肾及所属输尿管切除术。结果44例患儿术中诊断与术前相符,均经手术治疗痊愈出院。42例获随访,随访时间7个月至5年,3例出现输尿管残端综合征,经手术切除输尿管残端后治愈。1例术后出现残肾断面漏尿,经肾周引流管流出,术后6d漏尿停止,B超检查无肾周积液,拔除引流管后康复出院。其余患儿恢复良好。结论B超、IVU、MRU等相结合是诊断小儿重复肾畸形的主要方法,可确诊重复肾;CTU、VCU对诊断有补充作用。手术切除重复肾是治疗重度积水、扩张重复。肾的主要方法,尽量低位切除重复输尿管、完全切除重复肾、保护残留。肾肾盏及所属正常输尿管是手术成功的关键。     

Antithrombin III concentrates for treatment of disseminated intravascular coagulation in children

Six children (1 month to 5 years old) with DIC were treated with bolus injection of AT-III concentrates and/or continuous heparin infusion. In one case, when AT-III concentrates were administered without heparin, the platelet count was normalized in accordance with a rise in the plasma AT-III level. In the other children, who were treated with both AT-III concentrates and heparin, most of the abnormalities in coagulation studies were normalized within 5 days in four of five cases. These findings suggest that the administration of AT-III concentrates may significantly enhance the therapeutic efficacy of heparin, and that the use of AT-III concentrates with heparin is a safe and effective regimen for the treatment of childhood DIC.