小儿肺吸虫性心包炎的外科治疗

目的 总结小儿肺吸虫性心包炎的外科治疗经验.方法 对我院2000年1月至2009年6月间行外科治疗的54例小儿肺吸虫性心包炎进行回顾性研究,对其临床表现、诊断方法、治疗方法及疗效进行总结.结果 诊断急性心包炎45例,行心前区心包大部切除并心包引流术,诊断缩窄性心包炎9例,行心包剥脱术.其中1例急性心包炎行心包部分切除术后心包再缩窄,再次行心包剥脱术,所有病例治愈出院,远期疗效良好.结论 小儿肺吸虫性心包炎中等量以上积液,尽早行心包部分切除能缩短病程,避免缩窄性心包炎的发生.     

缩窄性心包炎15例临床病理分析北大核心CSCD

目的探讨小儿缩窄性心包炎的临床及病理学特征。方法对广州医科大学附属广州市妇女儿童医疗中心2003年1月至2015年12月诊断为缩窄性心包炎患儿的临床资料及病理学检查结果进行回顾性分析。结果缩窄性心包炎患儿共15例,年龄1岁4个月～14岁,平均6岁。病程2周～36个月。临床表现主要有腹胀（11例）、水肿（9例）、气促（7例）、腹痛（7例）、乏力（5例）、咳嗽（3例）、尿少（1例）等。心脏彩超检查提示双心房扩大7例,三尖瓣反流6例,二尖瓣反流5例,心包膜增厚4例,下腔静脉增宽3例,右心房内实质性占位性病变1例;心脏CT发现心包增厚10例,心包钙化4例。经外科手术治疗10例,手术方式为心包剥脱术,1例曾因疑诊＂缩窄性心包炎＂行心包开窗术。10例手术患儿总住院时间11～57 d,平均29 d;术后重症监护病房住院时间3～10 d,平均5.5 d;术后恢复顺利,无死亡病例。术后心包病理学检查结果均为非特异性炎症,表现为纤维结缔组织增生、玻璃样变、小血管增生、淤血及出血、纤维素渗出或沉积、淋巴细胞或中性粒细胞浸润及钙化灶。随访1～2年,除1例因复发再次手术,其余患儿心功能均改善,临床症状消失,生长发育恢复正常。结论小儿缩窄性心包炎临床症状不典型,超声心动图检查阳性率低,心脏CT诊断符合率高,病理学多为非特异性炎症,心包剥脱术是主要治疗手段,对于疑诊病例,心包开窗术不失为一种可取的过渡性治疗。     

小儿肺吸虫性心包炎的外科治疗

目的 总结小儿肺吸虫性心包炎的外科治疗经验.方法 对我院2000年1月至2009年6月间行外科治疗的54例小儿肺吸虫性心包炎进行回顾性研究,对其临床表现、诊断方法、治疗方法及疗效进行总结.结果 诊断急性心包炎45例,行心前区心包大部切除并心包引流术,诊断缩窄性心包炎9例,行心包剥脱术.其中1例急性心包炎行心包部分切除术后心包再缩窄,再次行心包剥脱术,所有病例治愈出院,远期疗效良好.结论 小儿肺吸虫性心包炎中等量以上积液,尽早行心包部分切除能缩短病程,避免缩窄性心包炎的发生.

Abstract：

Objective To summarize our experience of surgical treatment of paragonimus pericarditis in children. Methods Between January 2000 and June 2009,54 children with paragonimus pericarditis in our hospital were treated surgically. The clinical manifestations, diagnosis, treatment and effects were reviewed. Results Forty-five children were diagnosed as acute pericarditis and underwent pericardial resection (Most of the precordial pericardium) and pericardial drainage. Nine patients were diagnsed as constrictive pericarditis and underwent pericardial stripping. Of them, one patient with acute pericarditis developed re-constriction after pericardial resection and underwent repeated pericardial stripping. All 54 children were cured. The result of long term follow-up was satisfactory. Conclusions Patients with paragonimus pericarditis with moderate or severe pericardial effusion require early pericardial resection. This could shorten the course and avoided occurrence of constrictive pericarditis.     

儿童缩窄性心包炎48例的外科治疗

目的：探讨儿童缩窄性心包炎的临床特点及治疗方法。方法：对儿童缩窄心包炎４８例的临床资料进行分析。结果：４８例均经手术证实，占同期缩窄性心包炎手术的１５．１％（４８／３１９）。术后死亡２例，余治愈或好转出院。病理检查证实结核病变者１７例（３５．４％），余为非特异性改变。３９例术后随访６个月￣２５ａ，治愈３２例，明显改善４例，３例出院时症状明显改善，术后６ａ、７ａ及１２ａ因再次复发二次行心包切除术。结     

小儿心包炎166例临床分析

目的 通过大样本病例分析，阐述小儿心包炎的临床特点。方法 对我院1987年2月-2002年10月收治的166例小儿心包炎病因、临床表现、实验室和影像学检查以及转归等进行分析与总结。结果 小儿心包炎的病因以化脓性感染居首位(34．9％)，其次为非持异性(27．1％)、风湿性(13．9％)、肿瘤性(10．2％)、结核性(6％)、病毒性(4．3％)及尿毒症(3．6％)。化脓性心包炎病原菌以金黄色葡萄球菌为主。临床表现包括：发热(43％)；心悸、心前区痛及不适(23％)；肝大(81％)；颈静脉怒张(37％)；双下肢浮肿(21％)；本组病例仅17％病程中可闻及心包摩擦音。93．4％患儿有心电图改变．急性期表现为窦性心动过速，ST段抬高，病程2周以上则以T波低平或倒置及低电压为常见。二维超声心动图对心包炎有确诊价值，能判断心包积液部位和程度以及用于引导和监测心包穿刺，并观察疗效。化脓性心包炎经积极抗生素及手术治疗治愈率达70．7％．发展为缩窄性心包炎者占24％。10例结核性心包炎中3例发展为缩窄性心包炎。全部23例缩窄性心包炎19例行手术治疗，其中16例痊愈，3例死亡；余4例未手术自动出院。结论 小儿心包炎预后与早期诊断、有效治疗、病程进展快慢及病因有密切关系。由于联合应用有效抗菌素和心包切开引流，心包炎疗效及预后有了很大改观。     

小儿心包炎92例临床分析

本文报告小儿心包炎92例,其中有42例由肺吸虫感染引起,对诊断和治疗进行讨讨。强调二维超声心动图诊断的可靠性,肺吸虫性心包炎应早期手术解除心脏压迫,才能减少心包粘连缩窄和提高治愈率。     

实验性心包炎心钠素与内皮素变化及其临床意义

目的　研究实验性心包炎心钠素 (ANP)与内皮素 (ET)的变化 ,为临床诊治小儿心包炎提供实验依据。方法　家兔 2 4只 ,随机分为实验组 1 3只 ,在心包腔内注入 30 %尿素 (2ml/kg) ;对照组 1 1只 ,在心包腔内注入生理盐水 (2ml/kg)作为对照。注射前与注射后 1、4、7、1 0、1 5与 2 1d分别测定血浆ANP与ET。注射后2 1d测定心肌中ANP与ET ,同时切取心脏作病理与电镜检查。结果　注射后 1～ 1 0d血浆ANP和ET较注射前与对照组明显增高 (P <0 .0 5) ,注射后 1 5dANP下降 ,注射后 2 1d血浆与心肌中的ANP均较注射前与对照组明显下降 (P <0 .0 1 ) ,注射后 2 1d血浆与心肌ET则显著增高 (P <0 .0 1 )。届时心包病理与电镜检查示心包增厚 ,心肌萎缩与损害。结论　心包炎早期血浆ANP与ET均升高 ,说明心功能不全处于代偿期 ,应早期切开引流 ,心包炎后期血浆ANP下降而ET持续升高表示心包已增厚 ,心肌发生萎缩与损害 ,心功能处于失偿期 ,应及时行心包大部剥脱手术 ,解除心肌束缚 ,有望心功能得到恢复     

小儿肺吸虫性心包炎

１９７７～１９８７年共收治肺吸虫性心包炎１０８例，年龄２～１３岁，大多来自农村，均有生食石蟹及饮不洁生水史。潜伏期１０天～６年。常有心慌、气促、咳喘、浮肿、乏力及食欲不振等症状，并发感染者伴发热。皮下游走性包块６例（５．６％），血中嗜酸粒细胞计数为（１～２０）×１０９／Ｌ，Ｘ线或Ｂ超检查发现心包腔内大量积液，其中慢性心包缩窄２２例，并发肺炎６例。过去单纯靠药物治疗或附加心包腔穿刺抽液，部分病例病程迁延，引起心包压塞和慢性缩窄。在药物治疗的同时及早施行心包切开引流及部分心包切除术能解除心包压塞。防止向慢性缩窄迁延。     

小儿心包炎166例临床分析

目的　通过大样本病例分析 ,阐述小儿心包炎的临床特点。方法　对我院 1987年 2月— 2 0 0 2年 10月收治的 16 6例小儿心包炎病因、临床表现、实验室和影像学检查以及转归等进行分析与总结。结果　小儿心包炎的病因以化脓性感染居首位 (34 9% ) ,其次为非特异性 (2 7 1% )、风湿性 (13 9% )、肿瘤性 (10 2 % )、结核性 (6 % )、病毒性 (4 3% )及尿毒症 (3 6 % )。化脓性心包炎病原菌以金黄色葡萄球菌为主。临床表现包括 :发热 (4 3% ) ;心悸、心前区痛及不适(2 3% ) ;肝大 (81% ) ;颈静脉怒张 (37% ) ;双下肢浮肿 (2 1% ) ;本组病例仅 17%病程中可闻及心包摩擦音。 93 4 %患儿有心电图改变 ,急性期表现为窦性心动过速 ,ST段抬高 ,病程 2周以上则以T波低平或倒置及低电压为常见。二维超声心动图对心包炎有确诊价值 ,能判断心包积液部位和程度以及用于引导和监测心包穿刺 ,并观察疗效。化脓性心包炎经积极抗生素及手术治疗治愈率达 70 7% ,发展为缩窄性心包炎者占 2 4 %。 10例结核性心包炎中 3例发展为缩窄性心包炎。全部2 3例缩窄性心包炎 19例行手术治疗 ,其中 16例痊愈 ,3例死亡 ;余 4例未手术自动出院。结论　小儿心包炎预后与早期诊断、有效治疗、病程进展快慢及病因有密切关系。由于联合应用有     

以腹痛为主要表现的小儿急性心包炎（附八例报告）

目的：探讨以腹痛为主要表现的小儿急性心包炎的临床特征，以进一步提高诊断水平。方法：回顾性总结我院1984-1998年间收治的8例以腹痛为主要表现的小儿急性心包炎。结果：8例主诉均有腹痛，其中以腹痛为首发表现的4例。伴气急7例，明显心包填塞征象5例。全部表现有EKG异常，胸片7例心影增大，2DE均发现心包积液。治愈6例，好转2例。结论：急性心包炎，特别是病毒性心包炎可以腹痛为主要表现。细致的体检，及时的辅助检查有助早期鉴别。     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.