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目的探讨螺旋CT虚拟内诊镜(CTVE)在小儿气管、支气管异物诊断上的应用价值。方法回顾性分析东南大学医学院附属徐州医院1998年1月至2004年12月收治的121例术前经CTVE诊断为气管支气管异物,并行支气管镜探查术患儿的诊疗情况,并分析CTVE诊断在临床应用上的意义及诊断的阳性符合率。结果121例经CTVE诊断并行支气管镜探查证实并取除异物者115例,诊断符合率95.04%。结论CTVE检查是目前无创非侵入性诊断小儿气管支气管异物的较理想方法。     

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??Brain development in preterm and little infants is immature. They are particularly vulnerable to various environmental stress factors??resulting in neurobehavioral abnormalities. However??due to the brain plasticity of preterm and little infants??early detection and intervention can reduce or eliminate neurobehavioral abnormalities. Neonatal behavior observation??NBO?? is an observation - intervention tool??which has a unique advantage in the early assessment and intervention of neurobehavioral abnormalities in preterm and little infants. NBO is cost-effective??practical??efficient??easily implemented??flexible and satisfactory. NBO has been widely used in many affiliated hospitals and preventive care organizations??and has achieved satisfactory results in clinical work.     

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??Neonatal behavioral neurological assessment??NBNA?? can early predict the neurodevelopmental outcome of all high-risk infants??including preterm infants with corrected gestational age??. At the same time??in the process of evaluation??NBNA stresses that the medical staff should share observation and interpretation of these behaviors with parents and give the necessary guidance??so that parents can understand their infant behavior and unique personality??this process is called neonatal behavioral neurological observation??NBNO??. NBNO can be used of early intervention for preterm infants and high-risk children from birth to 3 months.     

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??Pediatric professionals are facing two challenges when following up the preterm and young infants. One of the challenges is to identify those infants at high risk of neurodevelopmental disorders as early as possible and provide intervention for them. Another one is to identify the infants with normal developmental outcomes to avoid excessive diagnosis and intervention. In resent years??the general movements assessment has been widely used at home and abroad to predict the developmental outcomes of high risk infants with its high sensitivity and specificity??especially for cerebral palsy. It is suitable for application in the basic maternal and child health care institutions and the pediatric clinics at various levels in China. This paper describes the results of clinical studies of general movements assessment at home and abroad as well as its clinical experience in China.     

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??Necrotizing enterocolitis??NEC?? is considered to be the most common gastrointestinal emergency among neonates. Although the pathogenesis of NEC is incompletely understood??there are several established risk factors??including prematurity??altered intestinal blood flow/oxygen delivery??formula feeding and bacterial infection. Recently??a large number of studies showed that intestinal flora imbalance had been implicated as key risk factor in the pathogenesis of NEC. After birth??the neonatal gut must acquire a healthy complement of commensal bacteria??which leads to deficient or abnormal microbial colonization of the gut??may protect the immature gut from inflammation and injury. Providing a healthy complement of commensal bacteria can maintain the intestinal microflora balance??shift the balance of intestinal microbiota from a pathegenic to protective complement of bacteria??protect the gut from inflammation and subsequent injury??and prevent NEC. We review the relationship between intestinal microbiota and NEC in preterm infants??the mechanism of probiotics in preventing NEC??and the efficacy and safety of probiotics in preterm infants.     

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??Abstract?? Hematuria is one of the most common clinical symptoms of pediatric urinary system disease??the etiology is very complex.Imaging plays an important role in the diagnosis of hematuria.The ultrasound is the first imaging method??CT is more sensitive in the diagnosis of small occupying lesions??MRI has advantages of high resolution with no trauma??no contrast agent and no radiation. IVP can observe the urinary system diseases dynamically ??VCUG is good at diagnosing the lower urinary tract diseases and vesicoureteral reflux ??ECT is used for the evaluation of renal function.This paper will give a review of them.     

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1小儿急性喉炎概念及激素治疗1.1概念急性喉炎是指喉部黏膜弥漫性炎症,以声门下部为主。好发于婴幼儿。大多为上呼吸道感染的一部分,常由病毒感染引起,如副流感病毒、呼吸道合胞病毒、流感病毒、腺病毒等,易合并肺炎链球菌、金黄色葡萄球菌等细菌感染。部分患儿炎症同时累及气管、支气管,称之     

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??Enteroscopy has high diagnostic and therapeutic value in adult intestinal diseases and is a safe and effective method. However??enteroscopy is rarely used in children. Enteroscopy is used for the diagnosis and treatment of obscure gastrointestinal bleeding??intestinal polyps??Crohn’s disease??intestinal stenosis and biliary stricture in children. The paper summarizes the clinical application of enteroscopy in small bowel disorders in pediatric patients.     

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小肠是消化道中最长的一段,分十二指肠、空肠和回肠三部分。成人小肠全长5～7m,占消化道全长的75%。由于小肠处于消化道的中段,而且具有管腔长、走行迂回弯转、游离度大的特点,所以小肠疾病的早期诊断非常困难。小肠镜的研制和临床应用为小肠疾病的诊断提供了较好的方法。应用小肠镜不仅可以直接观察黏膜状态,发现病灶,还可以取活检组织进行病理学检查,进一步明确诊断。近年来,随着小肠镜应用范围的逐渐扩大,临床对小肠疾病的认识也逐步提高,尤其是小肠黏膜活检的开展,提示了许多小肠黏膜微观病理学改变对小肠疾病发病机制的研究提供了许多…     

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先天性心脏病(简称先心病)常有多种畸形并存,手术治疗前应做出准确的诊断,特别是病理解剖诊断。心导管检查在目前而言仍是先心病诊断的金标准,但同时它是一项有创性检查,操作复杂,技术、设备要求高,费用较昂贵,不适于作为常规随访手段,并且受到体位限制,可能造成位置重叠而未必能很好地显示心脏与大血管的解剖关系。近几年,随着多层螺旋CT(MSCT)在临床应用的逐步开展,在提高扫描速度、改善图像质量、减少运动伪影和开发新功能等方面取得了长足的进步,但有关MSCT在先心病诊断中应用的报道文献不多。本文旨在探讨MSCT对小儿先心病诊断中…     

Transient renovascular hypertension in childhood

Two children aged 18 and 30 months presented with severe renovascular hypertensio. Initially, surgical intervention was postponed because of the patients' young age. Adequate control of the hypertension and reversal of its sequelae were achieved with aggressive medical management. At present, both patients, aged 9 and 12 years respectively, have discontinued all medication, have achieved normal growth, are normotensive and have normal renal function.     

Percutaneous treatment of renovascular hypertension

Percutaneous transluminal dilatation of a right sided fibrous renal artery stenosis was performed in a 5-year-old boy with severe hypertension. Biochemical and hemodynamic activity of the renal artery stenosis was demonstrated by measurement of renal venous renin concentration and of pre- and poststenotic blood pressure. Hypertension disappeared within 3 weeks and the renin values became normal. The method is less traumatic than operative revascularization and may be an alternative procedure to vascular surgery in the treatment of renovascular hypertension in childhood.     

Percutaneous transluminal angioplasty for renovascular hypertension in a neonate

AIM: To report on the first case of successful percutaneous transluminal renal artery angioplasty in a neonate. METHODS: Case report: a 5-d-old neonate was admitted with cardiorespiratory failure. Monitoring of blood pressure revealed severe arterial hypertension. Doppler sonography detected stenotic flow in the right renal artery. A (99m)Tc-MAG3 scan revealed highly diminished elimination by the right kidney. Selective renin levels were 23,968 ng/l in the right and 3770 ng/l in the left renal vein and the aorta. Percutaneous transluminal angioplasty using a 2 x 10 mm balloon catheter was performed on the 8th day of life. RESULTS: The patient was discharged from hospital normotensive without anti-hypertensive medication. During 8 mo follow-up the blood pressure remained normal, Doppler sonography revealed no recurrent artery stenosis, and renal function improved. CONCLUSION: Neonatal percutaneous transluminal angioplasty for renal artery stenosis may be feasible in selected patients.     

Two cases of hyponatremic-hypertensive syndrome in childhood with renovascular hypertension

We report two children with renovascular hypertension and fibromuscular dysplasia. They initially presented with severe hyponatremia, hypokalemia, polyuria, and transient proteinuria. This combination of symptoms is known to occur in patients with renovascular and malignant hypertension, and is known as hyponatremic-hypertensive syndrome (HHS), although it is considered rare in children. Since in both of our patients, the renal arterial stenosis was very severely or almost totally occlusive, we could not perform percutaneous transluminal renal artery angioplasty, and therefore nephrectomy was the only option. A histological study showed partial or complete occlusion with intimal hyperplasia and medial fibroplasia of intrarenal arteries such as the interlobular arteries. Conclusion: Both patients showed rapidly progressive renovascular hypertension and loss of function of the affected kidney. In order to preserve renal function in such cases, early invasive intervention appears to be necessary.     

The role of CT angiography in the evaluation of pediatric renovascular hypertension

Historically, the evaluation of renovascular hypertension has been accomplished by US, renal scintigraphy and digital subtraction angiography. Based on its high accuracy reported in adults renal CT angiography (CTA) with pediatric-appropriate low radiation dose techniques has become an important tool in the workup of renovascular hypertension in children. Renal CTA has several advantages over more conventional imaging modalities, including rapid and non-invasive acquisition, high resolution and easy reproducibility. Additionally, in our experience high-quality renal CTA can be performed using low-dose radiation exposures and can be acquired without sedation in most instances. This article illustrates by examples the usefulness of renal CTA for diagnosis of childhood renovascular hypertension and provides an overview of renal CTA findings in the most common childhood renovascular diseases.     

CT of the chest in the evaluation of idiopathic pulmonary arterial hypertension in children

Background Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease in children. By definition it is a diagnosis of exclusion, and CT of the chest is primarily performed to exclude other causes. Previous studies have defined CT features suggestive of the diagnosis of IPAH, but these have all been limited to the adult population. Objective Contrast-enhanced chest CT and high-resolution CT findings in IPAH were evaluated in an attempt to define features consistently seen in children with this condition. Materials and methods The chest CT scans performed at initial presentation were reviewed in 17 children with echocardiographic or angiographic evidence of IPAH. Result There were nine boys and eight girls, ranging in age from 1 month to 17 years. The extrapulmonary findings included cardiomegaly with right-sided cardiac enlargement, which was seen in 13 children. The central pulmonary arteries were enlarged in 15 children, with peripheral enlargement in two. In six children this resulted in bronchial compression. In addition, mediastinal and hilar lymphadenopathy was noted in three children. Prominent intrapulmonary features included a peripheral vasculopathy, with enlarged tortuous vessels, seen in eight children. Ill-defined ground-glass centrilobular opacities were also noted in eight children, representing the most common parenchymal abnormality. Other findings included septal lines in five, diffuse ground-glass opacification in four and focal hyperlucent zones in three. Mosaic attenuation was seen in one child. Conclusion A variety of imaging findings are identified in IPAH. Features particularly consistent with the diagnosis include peripheral vasculopathy and centrilobular opacities in the setting of cardiomegaly and central pulmonary arterial enlargement.     

Successful percutaneous transluminal angioplasty for treatment of renovascular hypertension in a 15-month-old child

In young children with renal artery stenosis the applicability of percutaneous transluminal angioplasty is limited by the small vessel size. We report our experience in a 15-month-old girl with severe hypertension, who underwent successful balloon dilatation of a tight renal artery stenosis caused by fibromuscular dysplasia. The procedure was performed using the guided co-axial balloon catheter technique with a 6 F right coronary Judkins catheter, a 0.014′′ guidewire and a 2 mm coronary artery balloon dilatation catheter. Antihypertensive medication was discontinued 6 weeks after the procedure. During a follow up period of 11 months, Doppler sonography revealed no evidence of recurrent renal artery stenosis. Conclusion Percutaneous transluminal angioplasty of renal artery stenosis can be performed safely in young children using equipment originally designed for treatment of coronary artery stenosis in adults. Received: 4 July 1997 / Accepted in revised form: 3 November 1997     

MR angiography in the evaluation of a renovascular cause of neonatal hypertension

Neonatal hypertension occurs in 2% of all infants and it is caused by renovascular abnormalities in 70% of these infants. The gold standard for diagnosing renovascular disease is conventional renal angiography. However, in neonates the procedure is not commonly used because of its invasive and technically challenging nature. MRI and MR angiography (MRA) are less invasive yet reliable means of detecting renovascular disease in adults. There is minimal literature on the use of MRI/MRA in neonatal hypertension. We report a neonate with hypertension secondary to a renovascular abnormality in which MRI/MRA was helpful in uncovering segmental renal artery stenosis. The infant underwent partial nephrectomy with subsequent resolution of his hypertension. Further studies are needed to validate the use of MRI/MRA in the evaluation of neonatal hypertension.     

The captopril test in children with renovascular and renal hypertension

We used the captopril test (CT) in 32 children, 8 with renovascular hypertension (RVH), 17 with renal hypertension (RH) and 7 with normal blood pressure, in order to study the renin-angiotensin system activation (RASA). All children affected by RVH presented a positive CT: a post-captopril plasma renin activity (PRA) of 12 ng ml^-1 h ^-1 or more, an absolute PRA increase of 10 ng ml ^-1 h ^-1 or more and a 150% increase or more, or 400% or more if the baseline PRA was less than 3 ng ml^-1 h^-1. The CT may be useful for demonstrating the RASA in RVH.     

Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis

Background: The diagnosis of squalene aspiration pneumonia in children is often difficult because of minimal non-specific symptoms. Objective: To investigate the radiological findings of squalene aspiration pneumonia in children. Materials and methods: We reviewed the chest radiographs (n = 8) and CT scans (n = 7), including high-resolution CT (n = 3), of eight patients (four boys, four girls; age 3 months to 6 years) with squalene aspiration pneumonia. All patients presented minimal symptoms. Results: Chest radiographs showed right-sided predominantly parahilar infiltrations. The extent and the opacity of the lesions decreased slowly during the follow-up period (mean 5.4 months) after halting the exposure. On CT, affected areas appeared as dense consolidations surrounded by ground-glass opacities showing a crazy-paving pattern in a geographic lobular distribution in all patients. The lesions were predominantly in the right lung and dependent areas in all patients and extensively involved all pulmonary lobes in five patients. Conclusions: These radiological findings, although non-specific, can lead to an appropriate diagnosis, particularly when patients present few symptoms.