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颅内肿瘤是中枢神经系统常见病,包括所有来源于颅骨、脑膜、血管、垂体、颅神经、脑实质和残留的胚胎组织的肿瘤,还包括转移性肿瘤和淋巴瘤。临床上要求能确定肿瘤的位置、大小、范围、数目和性质。颅骨平片诊断价值有限,对少数伴钙化及出现颅骨改变的肿瘤能起到定位的作用。脑血管造影可作出定位诊断,有时对于血管丰富的肿瘤可作出定性诊断。CT和MRI对肿瘤的诊断优于传统的X线检查。CT定位与定量诊断可达98%,CT特征结合临床资料,定性诊断正确率可达60%以上。MRI对肿瘤定位及定性诊断更准确,但由于信号变化特征复杂,诊断准确性的提高…     

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组织细胞增生症为儿科少见病,其中幼年性黄色肉芽肿(juvenile xanthogranuloma,JXG)更为罕见,本院2002—2004年共收治5例,现分析其临床表现,病理特点及治疗。1病历资料我院从2002年到2004年收治5例病人(按入院时间简称例1~例5),其中男4人,女1人。发病年龄3个月到5岁,中位年龄10个月。5人全部有皮肤损害,表现为大小不等的淡黄色或红褐色丘疹。5例病人皮肤活检病理光镜下皆可见大量巨大组织细胞增生,胞核分叶。免疫组化:CD68(+),CD1a(-),S-100(-)。电镜:真皮可见大量组织细胞,细胞核多叶,均未见Birbeck颗粒(例3、例5未做电镜检查),明确JX…     

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1小儿骨关节创伤的定义及类型1.1骨折骨组织(包括骨皮质和骨小梁)的连续性中断,称为骨折。骨折断端可嵌插、分离或旋转,使受损部位躯干或肢体发生短缩、成角、弯曲畸形。骨骼的任何部位都可发生骨折,按病因分型,骨折可分为创伤性、疲劳性和病理性骨折。连续反复多次正常外力(如     

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骨软骨病,是以出现未成熟骨的二次骨化中心碎裂、塌陷、硬化和(或)轮廓异常等改变为影像学特征的一类疾病,多数以最初报告者的姓氏命名。儿童期发病,男孩多见。其中一些可以完全自愈;一些则会遗留受累骨永久畸形。早期多认为属于骨软骨的炎症性病变,故又将这类疾病称之为骨软骨炎。随着研究的深入,现已证实其中一部分的基本病理改变为原发或继发性骨坏死,如:股骨头骨骺缺血性坏死(Legg-Calve-Perthes病);一部分至今仍病因不明,如:胫骨内翻(Blount病)、少年性椎体骨软骨病(Scheuermann病)等;一部分甚至是骨骺发育的正常变异,如:所谓的“跟…     

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(上接本卷第4期第255页)10小儿脂肪肝脂肪在肝内蓄积超过肝重的5%或在组织学上50%的肝实质出现脂肪化时称为脂肪肝。小儿脂肪肝首先考虑营养性肝病,营养过剩和营养缺乏均可导致,如肥胖症、肝炎、糖尿病、高脂血症等引起者较多。CT平扫。肝脂肪浸润可分为局灶型与弥漫型两类。局灶型可累及肝的一段、一叶或两个以上的段或叶,也可呈单发或多发的小片(小灶)状分布。弥漫型累及整个肝脏,但每个叶或受累程度可以不一致。CT诊断脂肪肝的标准一般参照脾脏的CT值。正常人不同个体的肝CT值可有较大差异,但总是高于脾CT值,相差5～10Hu,如果肝脏的…     

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(上接本刊2006年第2期155页)5视隔发育不良此病于1956年由Demorsie首先命名,又称Demorsie综合征。包括视神经发育不良、透明隔发育不良或缺如。约有2/3同时伴有下丘脑、垂体无功能。据认为本病有2种亚型,一种为妊娠7周末至8周初,因缺血所引起的透明隔部分缺如、脑裂畸形及下丘脑无功能;另一种是一种轻型的有脑叶前脑无裂畸形,此型中透明隔完全缺如,但无脑裂畸形。5.1CT表现可见视神经萎缩,常为两侧视神经同时受累。还可见视神经骨管细小。第三脑室前隐窝球样扩大,为视交叉及下丘脑发育不良所致。由于透明隔缺如,侧脑室前角变方呈匣子状(图…     

潮气呼吸法支气管舒张试验在5岁以下儿童哮喘诊断中的价值

目的 利用潮气呼吸法对小年龄哮喘患儿进行支气管舒张试验,探讨支气管舒张试验在5岁以下患儿哮喘诊断中的价值.方法 将2006年1月-2007年5月就诊的哮喘患儿246例,根据不同年龄段分为4组,Ⅰ组0～1岁,Ⅱ组～3岁,Ⅲ组～5岁,Ⅳ组～6岁.以0.5%沙丁胺醇作为支气管舒张约物,用潮气呼吸肺功能分析各组吸药前后肺功能指标变化.结果 Ⅰ、Ⅱ、Ⅲ组吸药前后达峰时间比(tPTEF/tE)、达峰容积比(VPEF/VE)差异均无统计学意义(t=0.065～0.179,P＞0.05);Ⅳ组吸药前后tPTEF/tE和VPEF/VE差异均有统计学意义(t=-4.295、5.029,P＜0.05).tPTEF/tE和VPEF/VE吸药前后差值与年龄呈正相关(P＜0.05).随年龄增大,差值逐渐增高.tPTEF/tE改善率和VPEF/VE改善率组问比较差异有统计学意义(P＜0.05).结论 潮气呼吸法支气管舒张试验在5岁以下哮喘患儿诊断中无明确临床价值,对于＞5岁哮喘患儿诊断与成人哮喘相同具有诊断意义.     

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??Objective??To study the clinical value of the test of tidal breathing lung function and exhaled nitric oxide in asthmatic children aged 2 to 5. Methods??216 children with asthma treated from January 2012 to June 2015 in the Pediatric Department of Xijing Hospital of Fourth Military Medical University were listed in asthma group??and 128 normal children in the same period were selected as control group. Tidal breathing lung function and exhaled nitric oxide at the acute and remission stages of asthma were tested respectively??and compared with control group. Tidal breathing lung function were compared before and after bronchial dilation test. Correlation between exhaled nitric oxide level and tidal breath lung function parameters was analyzed. Results??The ratio of time to peak tidal expiratory flow to total expiratory time??TPEF/TE?? and ratio of volume to peak expiratory flow to total expiratory volume??VPEF/VE?? in acute stage of asthma group were significantly lower than those of the asthma group in the remission stage and the control group??P??0.05??. TPEF/TE and VPEF/VE had significantly improved in asthma group in remission stage??but were still significantly lower than those of the control group??P??0.05??. TPEF/TE and VPEF/VE had significantly improved after bronchial dilation test in the acute stage of asthma group??P??0.05??. Taking an improvement rate of ≥15% either for TPEF/TE or for VPEF/VE as an indicator of positive bronchial dilation test??thus the positive rate was 69.90%. The levels of FeNO in acute and remission stages of asthma group???35.50±14.13??×10-9????28.16±5.52??×10-9?? were significantly higher than those of the control group???12.77±7.00??×10-9??P??0.05?????and the levels of FeNO in acute stage of asthma group were significantly higher than those of asthma group in remission stage??P??0.05??. FeNO levels were not correlated with TPTEF/TE and VPEF/VE in acute or in remission stages of asthma group. Conclusion??Tidal breathing lung function??exhaled nitric oxide test and bronchial dilation test are complementary??combined applications can effectively improve the diagnosis and treatment in early childhood asthma.     

Exhaled nitric oxide in healthy young children during tidal breathing through a facemask

The aim of this study was to establish reference values and to examine day-to-day and within-day variations of exhaled nitric oxide (eNO) during tidal breathing in healthy children using a newly described method. Exhaled NO was measured on-line and off-line during tidal breathing through a facemask. In a subgroup of children measurements were repeated during the course of a single day and on the same time on three consecutive days. A total of 133 healthy children were included in the study and measurements were obtained from 121 children aged 2-7 yr (61 boys and 60 girls). The geometric mean eNO concentration and 95% CI was 3.9 (3.5-4.2) parts per billion (p.p.b.) for on-line measurements and 3.0 (2.7-3.3) p.p.b. for off-line measurements. Exhaled NO was independent of gender, age, height and weight. The 95% reference intervals (RI) for on-line and off-line measurements were 1.2-8.2 and 1.3-7.1 p.p.b. respectively. Twenty-three children completed measurements of within-day and day-to-day variations, none of which showed significant variation. In conclusion, the established reference values and data on variability within and between days may facilitate the clinical application for measurement of eNO during tidal breathing in young children.     

Measurement of exhaled nitric oxide in young children during tidal breathing through a facemask

Measurement of exhaled nitric oxide (eNO) offers a non-invasive means for assessment of airway inflammation. The currently available methods are difficult to apply in preschool children. We evaluated four methods potentially applicable for eNO measurement during tidal breathing in young children. eNO was assessed during tidal breathing in 24 children, 2-7 yr old, using a facemask which separated nasal and oral airflow. Facemasks with and without a one-way valve allowing exhalation through the nose were used. Expiratory flow control was not attempted. Measurements of eNO were performed both on-line and off-line. In 11 children, 8-12 yr old, measurements were compared with the standard single breath on-line method. eNO was significantly lower applying the one-way valve in on-line and off-line measurements in comparison with measurements without the valve [4.6 and 3.9 parts per billion (ppb) vs. 6.9 ppb and 6.5 ppb]. The mean within subject coefficient of variation (CV) was significantly lower in on-line measurements with the one-way valve (9.6%) compared with the other three methods (18.8, 27.7 and 29.3% respectively). Measurements with a facemask fitted with a one-way valve yielded similar eNO levels as the standard single breath method (7.0 ppb vs. 6.9 ppb) and reproducibility (9.8% vs. 7.1%). In conclusion, reproducible measurements of eNO can be obtained without control of expiration flow using a facemask fitted with a one-way valve on the nasal compartment. The likely explanation to this is that the one-way valve reduces the admixture of nasal NO, thereby improving the reliability of eNO measurements.     

1002例4岁以下小儿潮气呼吸流速-容量环正常值的研究

目的测定健康小儿潮气呼吸肺功能正常值。方法用潮气呼吸方法测定1002例1~47个月小儿流速-容量曲线并计算其衍生参数。结果流速-容量环在健康婴幼儿呈不典型椭圆型,随年龄增长渐趋光滑。4岁以下小儿各项肺功能测定值主要与身高、体重、月龄相关,以前两者尤其是身高关系更为明显。有关参数显示小儿肺容量的增加大于流速的增长,小气道的发育快于大气道,代谢率随着年龄的增长而降低,达峰时间比(TPTEF/TE),达峰容积比(VPEF/VE)在各年龄组间差异存在,其数值的变化可反映小气道的阻塞情况。结论小儿肺功能与身高、体重、月龄相关,尤与身高相关更为显著;潮气呼吸肺功能测定简便、准确、重复性好,可作为4岁以下小儿检测肺功能的首选。     

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??Objective??To explore the correlation between FeNO levels and airway reversibility and its clinical significance in assessment of children with asthma. Methods??A total of 161 children at 5 to14 years old with asthma admitted to pediatric respiratory outpatient of Shengjing Hospital Affiliated to China Medical University from November 2014 to November 2015 were divided into allergic group and non-allergic group according to the allergic condition. FeNO and bronchial dilatation tests were made in the two groups. The correlation between FeNO levels and improvement rate after bronchodilator in two groups was analyzed. Results????1??FeNO level in allergy group was obviously higher than that in non-allergic group??P??0.002??. ??2?? FeNO level of children in allergic group was positively correlated with improvent of bronchial improvement??P??0.05????and negatively correlated with FEV1%?? FEV1/FVC%?? FEF50%?? FEF25% and FEF75/25% of basic lung function??P??0.05????but was irrelevant to FVC%?? PEF% and FEF75% of basic lung function??P??0.05??.??3??FeNO level of children in non-allergic group was irrelevant to improvement rates of bronchial dilation and basic lung function??P??0.05??. Conclusion??For asthmatic children with allergic constitution??FeNO level is positively correlated with airway reversibility. It may be a good noninvasive predictor for evaluating asthma and airway reversibility in children with asthma. While for children without allergic constitution??FeNO level cannot indicate the airway reversibility effectively.     

潮气呼吸肺功能检测在1~4岁儿童喘息性疾病中的临床应用

目的 探讨潮气呼吸肺功能检测在1~4 岁儿童喘息性疾病中的临床意义。方法 选择1~4 岁喘息患儿141 例（哮喘41 例、喘息性支气管炎54 例、支气管肺炎46 例）作为观察组,另选取非呼吸道疾病患儿30 例作为对照组,进行潮气呼吸肺功能检测,并观察喘息患儿支气管舒张试验前后肺功能的变化。结果 观察组患儿TBFV 环形态以阻塞性改变为主（65%）,达峰时间比（TPTEF/TE）、达峰容积比（VPEF/VE）亦明显低于对照组（P<0.05）。哮喘组支气管舒张试验后TPTEF/TE、VPEF/VE 较试验前明显改善（P<0.05）。以TPTEF/TE、VPEF/VE 任意一个改善率≥ 15% 作为支气管舒张试验的阳性标准,潮气呼吸支气管舒张试验诊断哮喘的灵敏度为47%,特异度为84%。哮喘组患儿舒张试验前TPTEF/TE ≥ 23% 者的阳性率28%,TPTEF/TE<23% 者的阳性率为65%（P<0.05）。结论 1~4 岁喘息患儿肺功能损害以阻塞性通气障碍为主;潮气呼吸支气管舒张试验可在一定程度上反映哮喘气道可逆性特征;在1~4 岁儿童中以潮气呼吸支气管舒张试验诊断哮喘的敏感性不高,但在阻塞程度重的患儿中诊断意义相对较大。     

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目的利用潮气呼吸法进行小年龄儿童的支气管舒张试验,以确立适合0~6岁儿童支气管舒张试验的评定标准。方法2003-06—2004-03就诊于复旦大学附属儿科医院门诊及病房≤6岁的喘息性支气管炎患儿36例,以同期收治的支气管炎患儿25例作为急性支气管炎组,沙丁胺醇和异丙托溴铵两药联合应用作为支气管舒张药物。用潮气呼吸法分析评价支气管炎患儿与喘息性支气管炎患儿吸入两药前后肺功能的变化,以确立小年龄儿童气道高反应性疾病支气管舒张试验的评定标准。结果适合小年龄喘息性支气管炎患儿的支气管舒张试验的评定标准:(1)吸入支气管舒张剂前后,急性支气管炎组呼吸频率(RR)略有改善,喘息性支气管炎组达峰时间比(tPTEF/tE)、达峰容积比(VPEF/VE)明显改善。(2)两组比较达峰时间比(tPTEF/tE)改善率、达峰容积比(VPEF/VE)改善率差异有统计学意义。(3)以达峰时间比(tPTEF/tE)和达峰容积比(VPEF/VE)任意一个改善率≥15%为阳性标准,灵敏度为72·2%,特异度为80·0%。喘息性支气管炎组支气管舒张试验阳性率为72·2%。结论达峰时间比(tPTEF/tE)改善率或达峰容积比(VPEF/VE)改善率≥15%可以作为小年龄儿童支气管舒张试验的评定标准。     

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??Abstract: Objective To learn the level of exhaled nitric oxide??ENO?? in Jinan schoolchildren??setting up normal reference value range and analyzing associate influencing factors. Method A total of 473 school children in Jinan aged 7 to 13 years were included in this study. By means of filling out the questionnaire and site examination??we selected eligible children and then measured the exhaled nitric oxide and Peak Expiratory Flow ??PEF??. Result The 473 cases of healthy schoolchildren were selected??male 257??female 216??in this study and we concluded the geometric mean and the 95% CI was 7.780??4.656??13.002??× 109 mol/L. We found that ENO’s level of 10??13-years-old children significantly higher than 7??9 year-old children??P??0.05??. The geometric mean and the 95% CI were 8.680??5.936??12.692??× 109 mol/L and 6.710??3.588??12.546??× 109 mol/L.In our study we found that age had positive relation with ENO ??P??0.05??while gender??height??weight ??PEFR and passive smoking had no significant correlation with ENO??P??0.05??. Conclusion The geometric mean and the 95% CI of ENO in children aged 7??13 years in Jinan is 7.780??4.656??13.002??× 109 mol/L?? in which 10??13-year- old children was significantly higher than 7??9-years old children ??P??0.05?? and the geometric mean and the 95% CI are 8.680??5.936??12.692??× 109 mol/L and 6.710??3.588??12.546??× 109 mol/L. Gender is an independent influencing factor of ENO level.     

三种骨龄评价方法在3～17岁儿童临床应用中的一致性比较研究

目的评价Greulich-Pyle图谱法(GP)、中国人手腕骨发育标准-CHN法(CHN)和中国人手腕标准-中华05法(TW3-C RUS)测得的骨龄是否会影响临床医生对儿童骨成熟水平的判断。方法纳入因身材矮小或提前发育或怀疑生长发育问题有必要行X线片评估的3~17岁儿童左手正位X线骨龄片。排除患遗传代谢性、骨软骨发育障碍性疾病的儿童,排除接受过生长激素等治疗的儿童。1名经过骨龄片评估培训的研究生依序对每张X线骨龄片用上述3种方法分别评价,采用Bland-Altman法构建一致性限。结果 567例左手正位X线片进入分析,男童269例,女童298例,男、女童各分3~4、~6、~8、~10、~12、~14和~17年龄组,每组17~78例。男103例和女142例达到青春期发育标准。男、女童所有年龄组测得的骨龄CHN法GP法和TW3-C RUS法;男、女童中除3个年龄组外,余11个年龄组测得骨龄TW3-C RUS法均GP法。男、女童的所有年龄组3种方法评价的最大骨龄与最小骨龄的差值随年龄增加而增大。鉴于TW3-C RUS评价男童最大骨龄为16岁,女童最大骨龄为15岁,去除TW3-C RUS法男童≥16岁(18例)和女童≥15岁(34例)的骨龄片,515例左手正位的X线片(男251例,女264例)进入3种方法一致性限分析。男童3~4岁骨龄和~6岁骨龄TW3-C RUS法与GP法一致性良好,女童3~4岁骨龄CHN法与TW3-C RUS法、~8岁骨龄TW3-C RUS法与GP法一致性良好,女童未发育组TW3-C RUS法与GP法一致性良好,余男、女童不同骨龄和发育情况3种骨龄测量法一致性差。结论 3种骨龄测量方法得出的骨龄结果不能相互替代,临床应用时应明确骨龄测评的方法。