单纯疱疹病毒性脑为临床诊断与治疗观察

为探讨单纯疱疹病毒性脑炎（ＨＳＶＥ）的诊断，应用间接ＥＬＩＳＡＳ法测定７０例病毒性脑炎患儿脑脊液的ＩｇＭ、ＩｇＧ，同时对１５例患儿的血清进行ＨＳＶ特异性ＩｇＧ的检测；采用ＥＬＩＳＡ双抗夹心法对７０例患儿的脑脊液同时检测ＨＳＶ抗原。结果：脑脊液ＨＳＶ抗原最阳性２０例，ＩｇＭ阳性７８例，ＩｇＧ血清／脑脊液比值〈２０为１２例。对ＨＳＶＥ患儿予以连续静脉滴注无环鸟苷７天，结果治愈，好转２０例（８０％）。提     

31例散发性脑炎的病原学诊断及临床分析

经酶联免疫吸附试验（ＥＬＩＳＡ）检测３１例散发性脑炎患儿血清和脑脊液（ＣＳＦ）中的单纯疱疹病毒Ⅰ、Ⅱ型（ＨＳＶ－Ｉ，ＨＳＶ－Ⅱ）ＩｇＭ、ＩｇＧ抗体；用聚合酶链反应（ＰＣＲ）检测ＣＳＦ中ＨＳＶ－ＤＮＡ。结果１５例确诊为单纯疤疹脑炎（ＨＳＥ），１６例为非单纯疱疹脑炎（ＮＨＳＳＥ）。在ＨＳＥ的临床表现中，意识障碍发生率显著高于ＮＨＳＳＥ；实验室脑脊液常规检测，ＨＳＥ多见红细胞；脑电图及ＣＴ检查额，颞部位有特征性改变。提示ＨＳＥ的病原学诊断对于早期诊断及指导临床治疗具有重要意义．     

单纯交疹病毒性脑炎诊断方法与治疗观察

目的 探讨单纯疱疹病毒性脑炎（ＨＳＶＥ）的诊断方法，了解对ＨＳＶＥ的治疗效果。方法应用聚合酶链反应（ＰＣＲ）的技术和酶联免疫吸附测定（ＥＬＩＳＡ）方法，对２７例病毒性脑炎患儿的脑脊液进行单纯疱疹病毒（ＨＳＶ）ＤＮＡ和特异性ＩｇＭ抗体检测。结果 ＨＳＶ－ＤＮＡ阳性１１例，ＨＳＶ－ＩｇＭ阳性４例，其中Ⅰ型３例，Ⅱ型１例；ＤＮＡ与ＩｇＭ同时阳性３例。将脑脊液检查ＨＳＶ－ＤＮＡ阳性或ＨＳＶ－Ｉdisplay stat     

抗心磷脂抗体、抗心肌线粒体抗体测定在扩张型心肌病的意义

目的 比较抗心磷脂抗体（ＡＣＡ）和抗心肌线粒体抗体（ＡＣＭＡ）对小儿扩张型心肌病（ＤＣＭ）诊断及病情了解的作用。方法 采用ＥＬＩＳＡ法测定ＤＣＭ３０例ＡＣＡ－ＩｇＧ和ＡＣＭＡ－ＩｇＧ,并与健康儿童对照,同时检测心肌酶、心电图和多普勒超声心动图。结果 ＤＣＭ患儿ＡＣＡ－ＩｇＧ和ＡＣＭＡ－ＩｇＧ阳性率分别为５３．３％和４０．０％,均显著高于健康儿（Ｐ均〈０．００１）。ＡＣＡ－ＩｇＧ阳性儿心肌酶ＣＫ－Ｍ     

三种不同类型抗心磷脂抗体在小儿病毒性心肌炎中的价值

采用酶联免疫吸附试验（ＥＬＩＳＡ）法测定６２例ＣｏｘＢ组病毒引起的病毒性心肌炎（ＶＭ）患儿和４０名健康儿童的血清抗心磷脂抗体（ＡＣＡ）。结果：ＶＭ组ＡＣＡ－ＩｇＧ、ＡＣＡ－ＩｇＡ、ＡＣＡ－ＩｇＭ阳性率（分别为４５．２％、３０．６％、３３．９％）均显著高于正常对照组（分别为２．５％、０、０）;ＶＭ发病早期ＡＣＡ－ｉｇＡ、ＡＣＡ－ＩｇＭ阳性显著多于ＡＣＡ－ｉｇＧ阳性恩赐 ＡＣＡ－ＩｇＧ阳性者的ＣＫ－Ｍ     

60例人类微小病毒B19感染患儿的病原血清学检测及特征

目的了解人类微小病毒Ｂ１９（ｈｕｍａｎｐａｒｖｏｖｉｒｕｓ，Ｂ１９）在儿童中的感染情况。方法采用聚合酶链反应（ＰＣＲ）和酶联免疫吸附（ＥＬＩＳＡ）方法，对１９４例住院治疗（大部分来自血液病房）患儿和１００例健康查体儿童的血清标本进行了检测。抗原为作者采用基因工程方法制备的重组Ｂ１９病毒外壳蛋白ＶＰ１和ＶＰ２。结果在１９４份患儿血清标本中，５５份检测出Ｂ１９病毒ＤＮＡ，３０份Ｂ１９病毒特异性ＩｇＭ抗体检测为阳性，３７份Ｂ１９病毒特异性ＩｇＧ抗体检测结果为阳性，阳性率分别为２８．４％，１５．５％和１９．１％，共有６０例患儿存在Ｂ１９病毒的近期感染。在１００份健康查体儿童血清标本中，３份检出Ｂ１９病毒ＤＮＡ，２份Ｂ１９特异性ＩｇＭ抗体检测结果为阳性，１２份Ｂ１９特异性ＩｇＧ抗体检测结果为阳性，阳性率分别为３０％，２０％和１２０％。结论人类微小病毒Ｂ１９在我国儿童中有较高的感染率，能够导致人类多种疾病，应该引起足够的重视     

肠道病毒特异性抗体和RNA检测对心肌炎的诊断价值

用间接酶联免疫吸附试验（ＥＬＩＳＡ）和抗体捕捉ＥＬＩＳＡ（ＭａｃＥＬＩＳＡ）分别检测６４例急性心肌炎、２０例疑似心肌炎、２０例非心肌炎和５２例正常儿血柯萨奇病毒Ｂ（ＣＶＢ）特异ＩｇＧ和ＩｇＭ。其中４９例心肌炎及２３例先天性心脏病同时用聚合酶链反应（ＰＣＲ）检测其血清中肠道病毒ＲＮＡ。结果：心肌炎组ＩｇＧ阳性３８例（５９．４％），ＩｓＭ阳性３３例（５１．６％），ＰＣＲ检测阳性２６例（５３．１％），均明显高于非心肌炎组及正常小儿组。病程早期（２周内）ＰＣＲ检测ＩｇＭ阳性率较高，二者下降较快，约６周后降至接近正常水平；ＩｇＧ则出现较晚，约２～６周达高峰，持续１０～２２周后降至接近正常水平。本研究表明：ＣＶＢ是引起心肌炎的主要病原；三种方法检测均敏感、特异；ＭａｃＥＬＩＳＡ检测特异ＩｇＭ比间接ＥＬＩＳＡ检测ＩｇＧ更有早期诊断价值。     

快速诊断单纯疱疹病毒脑炎

目的探讨快速诊断单纯疱疹病毒脑炎（ＨＳＥ），比较不同病毒学试验的诊断价值。方法用聚合酶链反应技术检测１７７例急性脑炎患儿的脑脊液（ＣＳＦ）标本中单纯疱疹病毒（ＨＳＶ）特异性ＤＮＡ；用酶联免疫吸附方法检测ＣＳＦ和血清标本中ＨＳＶ特异性ＩｇＭ和ＩｇＧ抗体。结果ＣＳＦ中ＨＳＶ特异性ＤＮＡ、ＩｇＭ和ＩｇＧ抗体阳性率分别为１．７％（３／１７７）、１０％（１／１００）和４７０％（４７／１００），血清ＨＳＶＩｇＭ、ＩｇＧ抗体阳性率分别为１２．５％（６／４８）、７２．９％（５１／７０）（因为标本量不足或缺如，未能对全部病例进行抗体检测）；３例患儿确诊为ＨＳＥ。结论用套式ＰＣＲ检测ＣＳＦ诊断ＨＳＥ较敏感、特异。     

前炎症细胞因子及IgG亚类在支气管哮喘发病中的作用

目的：探讨前炎症细胞因子（ＰＩＣ）及ＩｇＧ亚类在儿童支气管哮喘发病中的作用。方法：采用ＥＬＩＳＡ方法检测哮喘不同病期（发作期３５例,稳定期１８例）和２８例正常对照组血清及外周血单个核细胞（ＰＢＭＣ）诱生ＩＬ－６、ＩＬ－８、ＴＮＦ－α水平和血清ＩｇＧ亚类浓度。结果：哮喘发作期血清ＩＬ－６、ＩＬ－８、ＴＮＦ－α显著升高,随病情缓解渐降低。发作期哮喘ＩｇＧ亚类缺陷检出率为２８．５７％（１０／３５）,以Ｉ     

单纯疱疹病毒性脑炎诊断方法与治疗观察

目的探讨单纯疱疹病毒性脑炎（ＨＳＶＥ）的诊断方法，了解对ＨＳＶＥ的治疗效果。方法应用聚合酶链反应（ＰＣＲ）技术和酶联免疫吸附测定（ＥＬＩＳＡ）方法，对２７例病毒性脑炎患儿的脑脊液进行单纯疱疹病毒（ＨＳＶ）ＤＮＡ和特异性ＩｇＭ抗体检测。结果ＨＳＶＤＮＡ阳性１１例；ＨＳＶＩｇＭ阳性４例，其中Ⅰ型３例，Ⅱ型１例；ＤＮＡ与ＩｇＭ同时阳性３例。将脑脊液检查ＨＳＶＤＮＡ阳性或ＨＳＶＩｇＭ抗体阳性者１２例诊断为ＨＳＶＥ，占４４％。对ＨＳＶＥ患儿予以静脉滴注无环鸟苷，连续用药一周，结果治愈８例，好转２例，自动出院及死亡各１例。结论ＰＣＲ与ＩｇＭ抗体检测两种方法相结合有助于ＨＳＶＥ病原学早期诊断，并指导ＨＳＶＥ的临床治疗     

Effects of dietary zinc deficiency on hepatic ornithine carbamoyltransferase and alcohol dehydrogenase activities in rats

Hepatic ornithine carbamoyltransferase (OCT) and alcohol dehydrogenase (ADH) activities were measured in six groups of rats: (A) fed a severe zinc-(Zn-) deficient diet (1.98 ppm) for 5 weeks; (B) pair-fed control for group (A); (C) fed a less severe Zn-deficient diet (6.10 ppm) for 5 weeks; (D) pair-fed control for group (C); (E) fed a Zn-supplemented control diet (90.4 ppm) for 5 weeks; and (F) first fed the severe Zn-deficient diet for 5 weeks and then replaced on the Zn-supplemented control diet until a body weight corresponding to the final weight of group (E) was obtained. Hepatic OCT was similar in all these six groups. On the contrary, hepatic ADH was significantly reduced in groups (A) and (C) and in each of the corresponding pair-fed groups, (B) and (D). No differences were found between groups (A) and (B) or between groups (C) and (D). In group (F), ADH activity improved to a level equivalent to that in group (E). The changes in ADH activities were accompanied by changes in the hepatic Zn content. Thus, it is clear that: (1) the hepatic Zn content may not be affected by the amount of Zn intake alone, but by the combination of Zn and food intake; and (2) ADH, and not OCT, reflected the hepatic Zn content.     

Effect of blood transfusions on oxidative stress in preterm infants

OBJECTIVE: To confirm the increase in non-transferrin bound iron (NTBI) after packed red cell (PRC) transfusion and to evaluate the association with increased oxidative stress in preterm infants. METHOD: Twenty healthy preterm infants (gestational age 28.2 (2.2) weeks; birth weight 1047 (230) g), who required blood transfusion for anaemia of prematurity were prospectively studied. Serum concentrations of NTBI, total hydroperoxides (TH), and protein SH groups, and plasma total radical trapping antioxidant capability (TAC) were measured within three hours before and after PRC transfusion. The infants were transfused with 38.6 (23) ml PRCs over 5.8 (1.0) hours, at a mean age of 43.3 (25.1) days. RESULTS: After PRC transfusion, haemoglobin concentration increased from 9.2 (1.1) to 14.6 (1.5) g/l. Mean plasma NTBI concentration after transfusion was significantly higher (0.43 (0.45) v 2.03 (1.31) micromol/l; p = 0.001), while plasma concentrations of TH (212.3 (42.2) v 214.7 (66.3) Carr units/l) and protein SH groups (317.5 (38.8) v 353.8 (57.4) micromol/), and TAC (256.3 (36.1) v 267.1 (42.4) micromol HClO/ml) remained unchanged. CONCLUSION: For three hours after PRC transfusion, plasma NTBI is significantly increased in preterm infants, but this is not associated with significant changes in oxidative stress.     

发育期大鼠高热惊厥后γ氨基丁酸B受体亚基表达及结合改变的远期观察

目的 探讨高热惊厥（febrile seizures,FS）对发育期大鼠脑内γ氨基丁酸B受体（γ-aminobutyric acid B receptor,GABABR）亚基GABABR1与GABABR2表达及结合改变的远期影响。方法 采用热水浴诱导大鼠反复惊厥。隔日诱导惊厥1次,共诱导10次。发育期大鼠随机分为正常对照组（n=64）和高热处理组（n=268）。正常对照组大鼠置于37℃水中,高热处理组大鼠置于44．8℃热水中。高热处理组大鼠按其是否出现惊厥又分为高热对照组（H,n=64）和高热惊厥组。隔日诱导惊厥1次,共10次。惊厥组大鼠取惊厥1次（FS1,n=64）和10次（FS10,n=64）者作为实验对象。采用免疫双标记检测GABABR1与GABABR2共位点表达的改变;采用竞争RT-PCR检测GABABR1与GABABR2定量表达的改变;采用免疫共沉/／Westem Blot检测GABABR1与GABAB R2结合的改变。结果 （1）10次高热处理后,大鼠海马GABABR1和GABABR2的表达明显降低。（2）H组和FS1组大鼠GABABR1和GABABR2表达量及二者结合量在末次处理后7～15d恢复正常,而FS10组未恢复正常。（3）FS10组在末次处理后30dGABABR1表达恢复正常,而GABABR2及二者结合量未恢复正常。结论 发育期大鼠反复高热惊厥可导致GABABR亚单位GABABR1与GABABR2表达及二者结合量的远期改变。     

Final height and body disproportion in thalassaemic boys and girls with spontaneous or induced puberty

The aim of the study was to evaluate whether sex hormone replacement therapy adversely affected final height and body disproportion in thalassaemic boys and girls. Thirty-six patients with spontaneous (SP) or induced puberty (IP) were studied in order to define the pattern of height growth through three observations: the first (A) at the age of 7-9; the second (B) at onset of spontaneous or induced puberty; and the third (C) when final height was reached. We examined 14 females with SP (f-SP) and 8 with IP (f-IP); 7 males with SP (m-SP) and 7 with IP (m-IP). Girls with IP reached the same final height of girls with SP (f-IP 153.8 (4.3) versus f-SP 154.4 (5.5) cm); p > 0.05) close to target height (f-IP 155.9 (5.2) cm versus f-SP 155.5 (3.6) cm). Girls with IP reached the final height at older chronological age (CA) (17.0 (0.6) y) than girls with SP (CA of 15.3 (0.7) y), but at the same bone age (BA) (f-IP 15.1 (0.9) y versus f-SP 14.8 (0.6) y). There was no difference between the two groups for pubertal growth (f-SP 16.2 (7.7) cm versus f-IP 12.2 (7.4) cm (p > 0.05)) that was negatively correlated with both prepubertal growth and BA at onset of puberty in both groups. Values of sitting height (sds) with respect to BA (SHsdsBA) were not significantly different between the two groups, and showed a worsening from the first observation to final height, reaching values around -2 SD, in both groups. Values of subischial leg length (sds) with respect to BA (SLLsdsBA) were in the normal range at both observations in all girls. High serum ferritin levels were observed in both groups (f-SP 3189 (2296) ng/ml and f-IP 3998 (2545) ng/ml; p > 0.05). Also boys with induced puberty reached the same final height of those with spontaneous one (m-IP 160.9 (5.5) cm versus m-SP 161.8 (2.4) cm; p > 0.05), but it was lower than target height in both groups (m-IP 168.1 (4.1) cm versus m-SP 169.6 (3.2) cm). Boys with IP reached final height at CA of 18.6 (1.1) y slightly older than boys with SP (CA 17.2 (0.9) y), but at the same BA (m-IP 15.9 (1.5) y versus m-SP 16.3 (0.8) y). Pubertal growth values were significantly different between boys with SP 18.9 (5.3) cm and those with IP 13.8 (4.9) cm (p < 0.05), but they were negatively correlated with prepubertal growth values in both groups (m-SP r = -0.91; p < 0.002 and m-IP r = -0.51; p < 0.05). SHsdsBA showed a worsening from the first observation to final height, reaching values around -3 SD in both groups, while SLLsdsBA were always in the normal range in all patients. Serum ferritin levels were higher in boys with IP (3400 (1179) ng/ml) than in those with SP (2020 (496) ng/ml). Conclusions: Our data showed that: (a) patients of both sexes with induced puberty reached the same final height of patients with spontaneous puberty; (b) all patients showed a body disproportion with truncal shortening and normal leg length that was more severe in boys of both groups at final height; (c) body disproportion was independent of pubertal or prepubertal period of greater height gain, suggesting that sexual steroids replacement therapy did not adversely affect either final height or body disproportion. Further studies, focused on the pathogenesis of the truncal shortening, are necessary in order to acquire more insight into the causes of this impairment.     

Bronchodilation in infants with malacia or recurrent wheeze.

BACKGROUND: Controversy remains regarding the effectiveness of bronchodilators in wheezy infants. AIMS: To assess the effect of inhaled beta(2) agonists on lung function in infants with malacia or recurrent wheeze, and to determine whether a negative effect of beta(2) agonists on forced expiratory flow (V'(maxFRC)) is more pronounced in infants with airway malacia, compared to infants with wheeze. METHODS: We retrospectively analysed lung function data of 27 infants: eight with malacia, 19 with recurrent wheeze. Mean (SD) age was 51 (18) weeks. Mean V'(maxFRC) (in Z score) was assessed before and after inhalation of beta(2) agonists. RESULTS: Baseline V'(maxFRC) was below reference values for both groups. Following inhalation of beta(2) agonists the mean (95% CI) change in mean V'(maxFRC) in Z scores was -0.10 (-0.26 to 0.05) and -0.33 (-0.55 to -0.11) for the malacia and wheeze group, respectively. CONCLUSIONS: In infants with wheeze, inhaled beta(2) agonists caused a significant reduction in mean V'(maxFRC). Infants with malacia were not more likely to worsen after beta(2) agonists than were infants with recurrent wheeze.     

18F-fluorodeoxyglucose uptake of bone and soft tissue sarcomas in pediatric patients

A high (18)F-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) imaging in sarcomas of adults has been reported. The current study aimed at defining the degree of (18)F-FDG uptake of pediatric sarcomas. This retrospective study included 29 patients (23 males, 6 females; mean age 14 ± 5 years) with soft tissue (n = 9) or bone (n = 20) sarcomas. Twenty-two patients (76%) underwent (18)F-FDG PET/CT and 7 (24%) had dedicated (18)F-FDG PET studies. Tumor (18)F-FDG uptake was quantified by standard uptake value (SUV)(max) and tumor-to-liver ratios (SUV ratios; tumor SUV(max)/liver SUV(mean)). Tumor SUV(max) and SUV ratios were correlated with tumor Ki-67 expression. SUV(max) ranged from 1.4 to 24 g/mL (median 2.5 g/mL) in soft tissue sarcomas and 1.6 to 20.4 g/mL (median 6.9 g/mL) in bone sarcomas (P = .03), and from 1.6 to 9.2 g/mL (median 3.9 g/mL) and 3.5 to 20.4 g/mL (median 12 g/mL) in Ewing sarcoma and osteosarcoma, respectively (P = .009). Tumor SUV ratios ranged from 0.8 to 8.7 (median 1.9) in soft tissue sarcomas and 1.4 to 8.9 (median 3.8) in bone sarcomas (P = .08). Ewing sarcoma had a significantly lower tumor SUV ratio than osteosarcoma (P = .01). Ki-67 expression correlated significantly with the (18)F-FDG uptake in bone but not in soft tissue sarcomas. All sarcomas were visualized by (18)F-FDG PET/CT imaging. A higher (18)F-FDG uptake was observed in osteosarcoma than in Ewing and soft tissue sarcomas. The results of this study suggest that the degree of tumor (18)F-FDG uptake is sufficient to allow for monitoring of therapeutic responses in pediatric sarcomas.     

A randomized, masked study of triiodothyronine plus thyroxine administration in preterm infants less than 28 weeks of gestational age: hormonal and clinical effects

A randomized, placebo-controlled, masked study was conducted of the responses of thyroid parameters, cortisol, and the cardiovascular system to a single dose of triiodothyronine (T(3)) 24 h after birth, followed by a daily dose of thyroxine (T(4)) during 6 wk to infants <28 wk gestational age. Thirty-one infants were assigned to three groups: 1) group A: T(3) 24 h after birth plus daily T(4) during 6 wk; 2) group B: placebo T(3) and T(4) during 6 wk; and 3) group C: placebo T(3) and placebo T(4). T(4), free T(4), T(3), free T(3), reverse T(3), thyroid-stimulating hormone, and cortisol were measured in cord blood and on days 1, 3, 7, 14, 21, 42, and 56. Data on pulse rate, blood pressure, and cumulative dose of inotropic agents were collected. T(3) (0.5 microg/kg) resulted in a plasma increase until day 3. Thereafter, plasma T(3) levels were comparable between the groups. T(4), free T(4), and reverse T(3) were increased in groups A and B during the period of T(4) administration. Thyroid-stimulating hormone suppression was of shorter duration in group A. T(3) and T(4) administration did not have any effect on cortisol levels. We did not find any effects of T(3) or of T(4) administration on the cardiovascular system. A single injection of T(3) (0.5 microg/kg) given 22-26 h after birth only leads to a 2-d increase of T(3) levels and does not have effects on the cardiovascular system. This study does not support the use of T(3) according to our regimen in preterm infants.     

Lipoxin A4受体样蛋白基因转染增强Lipoxin A4拮抗结缔组织生长因子诱导的人肺成纤维细胞增殖

目的克隆Lipoxin A4受体样蛋白(LRLP)基因,并转染人肺成纤维细胞(HLF).观察其增强Lipoxin A4拮抗结缔组织生长因子(CTGF)诱导的细胞增殖作用.方法构建LRLP与绿色荧光蛋白(GFP)融合基因的真核表达载体pEGFP/LRLP,并转染HLF,用G418筛选稳定表达融合基因的细胞克隆株HLF/LRLP.用10 nmol/L Lipoxin A4预处理HLF和HLF/LRLP细胞30 min后,加入1 μg/mlCTGF诱导细胞增殖.MTT法检测细胞增殖抑制率.流式细胞术检测细胞周期.Western blot检测细胞周期蛋白D1的蛋白表达量.凝胶迁移率改变试验检测信号转导子和转录激活子3(STAT3)的DNA结合力.结果 (1)成功建立稳定表达LRLP和GFP融合基因的HLF/LRLP细胞株.(2) 1 μg/ml CTGF刺激24 h,可显著诱导HLF增殖.Lipoxin A4预处理对其有抑制作用,10 nmol/L Lipoxin A4对HLF/LRLP的细胞增殖抑制率显著高于对HLF细胞的增殖抑制率(P<0.05).(3)与未转染和空载体转染的HLF相比,10 nmol/L Lipoxin A4诱导更多的HLF/LRLP细胞生长停滞在G0/G1期(P<0.05).(4) 10 nmol/L Lipoxin A4拮抗CTGF诱导的细胞周期蛋白D1表达上调,并且对HLF/LRLP细胞的拮抗作用强于对HLF细胞(P<0.05).(5) 10 nmol/L Lipoxin A4拮抗CTGF诱导的STAT3 DNA结合力上调,并且对HLF/LRLP细胞的拮抗作用强于对HLF细胞(P<0.05).结论 LRLP基因转染,增强Lipoxin A4 拮抗CTGF诱导的人肺成纤维细胞增殖.     

Human immunodeficiency virus infection in children hospitalised with tuberculosis

The impact of HIV infection on clinical presentation and outcome of tuberculosis (TB) was studied in children hospitalised at the Brooklyn Hospital for Chest Diseases (BCH), Cape Town over the 2-year period January 1998 to December 1999. Clinical data were extracted from a prospectively compiled patient register. Of 261 children with TB, 114 (median age 24 mths) were not HIV-infected and 36 (median age 23 mths) were HIV-infected. The HIV status of 111 children (median age 37 mths) was not determined. Pulmonary TB with or without extrapulmonary TB occurred in 97 (85%) children who were not HIV-infected, 35 (97%) HIV-infected children and 87 (78%) of those not tested (p = 0.025). A tuberculin reaction > or = 15 mm was elicited in ten (31%) of 32 HIV-infected children, 76 (72%) of 106 non-HIV-infected and 62 (71%) of those not tested (p < 0.001). Mycobacterium tuberculosis was cultured from 116 (49%) of 238 children and drug sensitivity was evaluated in 79. Nine isolates (11%) were resistant to isoniazid (INH) and 11 (14%) to INH and rifampicin (RMP). Two HIV-infected children treated previously in BCH for drug-sensitive TB were re-admitted with INH and RMP resistance. Two (2%) non-HIV-infected children, six (17%) HIV-infected children and one (1%) child with undetermined HIV status died (p < 0.001).     

Prevalence,treatment, and outcome of heart disease in live-born children: A prospective analysis of 91,823 live-born children

Summary All 91,823 children born in 1980 in Bohemia (population 6.314 million; area 52,478 square kilometers) were examined at least four times during infancy and at the age of three and four years. All children who died were autopsied and those with heart disease were selected. A total of 779 children (8.223/1000 live births) were suspected by provincial pediatric cardiologists of having a heart disease. All of these were examined at the age of four years at our Center of Pediatric Cardiology. At this age heart disease was proved in 613 alive or decreased children (6.676/1000 live births), congenital cardiac malformations in 589 (6.415/1000 live births), and cardiomyopathies in 24. The most frequent congenital heart defects (CHD) were ventricular septal defect (VSD) (31.41%), atrial septal defect (ASD) (11.37%), aortic stenosis (AS) (7.64%), pulmonary stenosis (PS) (7.13%), coarctation of the aorta (CoA) (5.77%), and transposition of the great arteries (TGA) (5.43%), followed by persistent ductus arteriosus (PDA) (4.75%), atrioventricular septal defect (AVSD) and hypoplastic left heart syndrome (HLHS) (4.07% each), tetralogy of Fallot (TF) (3.56%), and pulmonary atresia (PA) (2.38%). A prevalence of less than 0.1/1000 live births was found for the remaining cardiovascular defects.One hundred fifty-nine (25.9%) patients were admitted to our highly specialized center, 116 (19.7%) catheterized and 85 (13.9%) treated surgically, during the first four years of life. A total of 440 (71.8%) patients survived the fourth year of life. The percentage of deaths was 25.6% among those with congenital heart diseases and 71% with cardiomyopathies. The overall mortality rate was 27% in surgically and 26% in medically treated patients.