不同病原肺炎的严重状态

肺炎是儿科最常见的疾病之一 ,病情严重度不一。虽然新的抗生素不断涌现 ,治疗理论和治疗技术不断进步 ,肺炎依然是儿童死亡的首位原因。所以 ,认识肺炎的严重状态对临床医生仍具有十分现实的意义。本文所述之严重状态包括原发感染所导致的全身严重状态 ,肺部病变广泛程度或累及胸腔、纵隔以及肺脏与其他脏器功能不全或衰竭。导致肺部感染的各种病原微生物及今年在我国爆发的新型冠状病毒感染等 ,均可引起小儿肺炎的严重状态。重者可伴有败血症、休克、呼吸衰竭甚至MODS等。另外 ,部分院内感染所致的肺炎也常常重笃 ,病死率高。本文讨论常…     

Portosystemic shunt as a bridge to liver transplantation in infants: A comparison of two techniques

Portosystemic shunts can serve as a bridge to liver transplantation in patients with end‐stage liver disease by providing portal decompression to treat life‐threatening variceal bleeding and prevent recurrent episodes until an organ becomes available. The conventional TIPS procedure, however, is technically challenging to perform in infants due to the small size of their intrahepatic vasculature. We report two cases of emergent creation of portosystemic shunts as a bridge to liver transplantation in infants with life‐threatening variceal bleeding using a conventional TIPS technique in the first case and a percutaneous DIPS technique in the other. Both procedures were successful at reducing the portosystemic pressure gradient and preventing further variceal bleeds until a liver transplant could be performed. The novel percutaneous DIPS procedure is a valuable alternative to the conventional TIPS in infants, as it is better suited for small or challenging intrahepatic vascular anatomy.     

Dependency level of babies on the neonatal unit: a comparison of two different classification systems

BACKGROUND—Monitoring activity on the neonatal unit is important for planning service provision and as part of monitoring quality of care. The dependency level of the patients cared for must be taken into account as well as the number of patients. Two different systems for determining dependency level are in common use.AIM—To develop a system that would allow the accurate determination of dependency level for babies in our care using both the British Association for Perinatal Medicine and Neonatal Nurses Association definitions and the Northern Neonatal Network definitions and to perform a comparison between these two systems.METHOD—Forty details relating to current clinical status and treatment being given were recorded daily for every patient on two neonatal units over a 17 month period. These details were recorded in a computer database, and dependency levels were calculated for each patient day using both systems.RESULTS—A total of 21 905 patient days were recorded for 1555 patients. There was good agreement between the two systems on what constituted the highest level of dependency, but overall comparability was poor, with the two systems assigning comparable dependency levels to only 76% of patient days.CONCLUSIONS—There is limited comparability in dependency levels between these two widely used systems. There is a need for a standardisation of definitions to allow meaningful comparisons to be made between units.     

Hydrothorax: transdiaphragmatic migration of a ventriculoperitoneal shunt catheter

Symptomatic hydrothorax following ventriculoperitoneal shunt insertion is a very rare complication. The patient was a 5-month-old child known to have had shunted congenital hydrocephalus two months before. He presented to the emergency room in respiratory distress. Chest X-ray and computerized tomography images confirmed left hydrothorax and showed transdiaphragmatic migration of the tip of the peritoneal catheter to the thoracic cavity. After the catheter had been shortened and replaced to the peritoneal cavity, the patient's symptoms abated.     

Periorbital cellulitis: A comparison of different treatment regimens

Periorbital cellulitis was retrospectively investigated in a cohort of 69 children, 1.5–16 years of age, who were admitted to Hacettepe University Children's Hospital. The aim of the study was to define the most important cause of the disease and to choose the most appropriate antimicrobial regimen. Sinusitis (43%) was found to be the most frequent disease associated with periorbital cellulitis. Trauma (25%) and odontogenic infections (6%) were the next most common predisposing causes. Staphylococcus aureus was isolated from 14 (74%) of 19 cultures. Two antibiotic combinations, penicillin plus chloramphenicol and sulbactam-ampicillin (SAM) with or without ornidazole was used in 30 (43%) and 39 (57%) of 69 cases, respectively. The duration of treatment with these two antibiotic combinations was generally between 7 and 10 days. No statistical difference was found between the two antibiotic combinations in the cure and recurrence rates but five (17%) of the 30 cases using penicillin plus chloramphenicol, and one (3%) of the 39 cases using SAM with or without ornidazole had recurrent periorbital cellulitis. It was concluded that SAM can be the first line of drug treatment for periorbital cellulitis as it is easily used in every age group and etiology (trauma, sinusitis, etc.). It provides total recovery and has less side effects and risk of recurrence. It also has a broad antimicrobial spectrum.     

Whole-body protein parameters in premature infants: a comparison of different 15N tracer substances and different methods.

[15N]glycine, [15N]leucine, and [15N]yeast protein thermitase hydrolysate (YPTH) as tracers for investigating the protein turnover rates in premature infants were studied in nine human milk-fed neonates (born after 32 to 34 wk of gestation) by paired comparison of the tracers. The 15N enrichment of total urinary nitrogen and ammonia after administration of a single oral dose of 15N was measured by emission spectrometry. Flux rates were calculated using a three-compartment model and the ammonia end product method. The mean whole-body protein synthesis rates, as determined by the three-compartment model derived from the three 15N tracers, differed significantly (p less than 0.01) among [15N]glycine (15.9 g/kg/d), [15N] leucine (9.1 g/kg/d), and 15N-YPTH (5.9 g/kg/d). When the corresponding rates were determined from the excretion of label in ammonia, the results showed the opposite tendency; the lowest apparent synthesis rates were found after [15N]glycine (7.5 g/kg/d), followed by [15N]leucine (14.4 g/kg/d), and the highest figure resulted after [15N] YPTH (16.7 g/kg/d). The results of this comparison substantiate the assumption that there are methodologic errors in connection with the use of different tracers and models for the calculation of whole-body protein parameters in preterm infants, with respect to the main requirement for tracer kinetic studies; the tracer nitrogen must be representative of total amino acid nitrogen. Seen in this light, mixtures of completely labeled amino acids such as YPTH may represent the most reliable tracer substance.(ABSTRACT TRUNCATED AT 250 WORDS)     

Disconnection as a cause of ventriculoperitoneal shunt malfunction in multicomponent shunt systems

The cause of malfunction in 275 consecutive ventriculoperitoneal (VP) shunt revisions over an 8-year period were retrospectively analyzed. In all cases the shunt revised was a multicomponent (Holter) VP shunt. Disconnections in the system accounted for 41 (15%) of the malfunctions. The more distal the connection was from the ventricle, the higher the likelihood of disconnection. Furthermore, occipitally placed shunts had a significantly higher tendency to dislocate than frontally placed shunts.     

Laparoscopic management of impalpable testes: comparison of different techniques

Purpose  

Laparoscopy is an important modality for management of impalpable testes. We present long-term outcomes of intra-abdominal testes managed by either single stage orchidopexy or two-stage Fowler Stephen’s orchidopexy (FSO) over 12 years.     

胎儿部分脐-体静脉分流病例1例

孕妇,34岁,G2P1,2016年足月剖宫产1女婴,现体健.本次自然受孕,孕13+周行胎儿颈项透明层(nuchal translucency, NT)超声检查提示:NT增厚(4.6 mm),静脉导管a波倒置.于孕16+周行羊膜腔穿刺,羊水染色体核型及染色体微阵列未见异常.孕24+周行三维超声检查提示:胎儿心胸比例增大(...     

Treatment of cerebrospinal fluid shunt infections: a decision analysis

BACKGROUND: Cerebrospinal fluid shunts transfer cerebrospinal fluid (CSF) from the lateral ventricles in the brain to the peritoneum (ventriculoperitoneal shunt) or the right atrium (ventriculoatrial shunt) via subcutaneous Silastic tubing. As with any implanted foreign body, infection is a serious complication. Although there are several therapeutic modalities currently used for the treatment of shunt infections, controversy remains as to which is best given that there has been only one randomized trial comparing their effectiveness. OBJECTIVE: To determine which treatment modality is most effective by using decision analysis to compare three approaches with regard to cure rate, morbidity and mortality. METHODS: We constructed a decision tree to map out the different treatment modalities and assigned probability values obtained from previously published studies. A utility value was assigned to each treatment outcome, ranging from 0 to 1.0, with a higher score indicating a more favorable outcome. Calculations were performed using Decision Analysis TreeAge computer software. RESULTS: The removal of an infected shunt with establishment of external ventricular drainage or ventricular taps and administration of antibiotics leads to the highest expected value, 0.86. Removal of an infected shunt followed by immediate replacement and administration of antibiotics is less effective, with an expected value of 0.76. The use of antibiotics alone results in the lowest expected value, 0.61. Sensitivity analysis showed the above findings to be robust with respect to clinically relevant changes for the baseline probabilities and utility values. CONCLUSION: A protocol of shunt removal, external ventricular drainage placement or ventricular taps and antibiotics, followed by creation of a new shunt when CSF sterility is achieved, is the most effective method of treatment for CSF shunt infection.     

Protrusion of a peritoneal catheter through the umblicus: an unusual complication of a ventriculoperitoneal shunt

 Protrusion of a ventriculoperitoneal (VP) shunt through the umblicus is one of the rarecomplications of shunt insertion reported in the medical literature. One such case is presented here in a child in whom a VP shunt had been placed for congenital hydrocephalus. Accepted: 23 October 2000     

Transoral protrusion of a peritoneal catheter: a rare complication of ventriculoperitoneal shunt

Ventriculoperitoneal (VP) shunt surgery is the most used technique for the treatment of hydrocephalus. This procedure is associated with a large amount of complications. Bowel perforation caused by a peritoneal shunt catheter is one of these complications, sometimes fatal, and is usually difficult to recognize, except when protrusion of the peritoneal catheter through a natural orifice occurs. This report presents the case of a 2-year-old boy who had undergone a VP shunt and later presented with protrusion of the peritoneal catheter through his mouth. The shunt device was removed and an external shunt procedure was achieved, using the original ventricular catheter kept in place. The diagnosis of bacterial meningitis was retained and an antibiotic therapy was started. The evolution was fatal in 15 days secondary to a bacterial ventriculitis. Through the reported cases of bowel perforation, many risk factors were individualized, such as age, congenital etiology of the hydrocephalus, silicon allergy or the length of the peritoneal catheter. Bowel perforation is a serious complication of VP shunt surgery, leading sometimes to a fatal outcome.     

A rare case of shunt malfunction attributable to a broken Codman-Hakim programmable shunt valve after a blow to the head

We report a rare case of shunt malfunction resulting from breakage of the Codman-Hakim programmable shunt valve system following a blow to the head. Originally, the patient had suffered intraventricular hemorrhage a month after birth; ventriculoperitoneal shunt was performed at 7 months. After that, the shunt valve functioned well for 7 years. The patient presented with headaches after receiving a blow behind the right ear. The headache became exacerbated with activity and improved with rest. Damage to the shunt valve was identified during surgery, with a crack at the top of the valve housing. Symptoms resolved following a change of the complete shunt system. The possibility of damage to the shunt valve following a blow should be considered in shunt patients presenting with headaches.