托特罗定和奥昔布宁治疗原发性儿童膀胱过度活动症的疗效和安全性比较

目的：比较托特罗定和奥昔布宁在小儿原发性膀胱过度活动症（OAB）的疗效和安全性。方法：共204例确诊为OAB的患儿随机分为安慰剂组68例、托特罗定组68例和奥昔布宁组68例,疗程2周后评估疗效及安全性。结果：安慰剂组总有效率为25%,托特罗定组总有效率达89%,奥昔布宁组有效率达92%,托特罗定组和奥昔布宁组疗效明显高于安慰剂组（P<0.05）,托特罗定组和奥昔布宁组疗效相似。托特罗定组不良反应发生率为28%,而奥昔布宁组不良反应发生率为57%,托特罗定组不良反应发生率明显低于奥昔布宁组（P<0.05）。结论：在小儿OAB的药物治疗中,托特罗定和奥昔布宁疗效相似,但托特罗定具有更好的安全性。     

儿童特异性日间尿频的诊疗进展

儿童特异性日间尿频(extraordinary daytime only urinary frequency, EDOUF)又称精神性尿频、假性尿路感染或日间尿频综合征, 是一种常见的儿童下尿路功能障碍性疾病, 是指受过如厕训练的儿童仅在日间出现尿频, 每小时至少排尿1次, 平均每次排尿量少于预期膀胱容量的50%(常为10%～15%), 入睡后症状消失, 不伴尿急和遗尿。目前EDOUF的病因及发病机制尚不明确, 通常与焦虑或压力事件有关, 也可能与饮食习惯、自身体质有关。其治疗目前国内外相关报道较少, 临床上以认知行为疗法、泌尿疗法及药物治疗为主, 近年来骶旁神经电刺激疗法也被逐步应用。本文对儿童EDOUF的诊疗进展进行综述。     

尿动力学检测在儿童尿频症中的应用

目的 探讨儿童白天尿频症的尿流动力学病理改变和治疗方法.方法 随机选择40例白天尿频症患儿,进行尿动力学检测,观察尿流曲线、功能性膀胱容量(FBC)、逼尿肌稳定性及不稳定性指数、膀胱顺应性(BC)、最大膀胱测量容量(CBCmax)及CBCmax百分数、逼尿肌与尿道外括约肌协同性.在充盈性膀胱内压测定过程中当膀胱容量达正常CBCmax之前出现逼尿肌不稳定性收缩(DI)时嘱患儿收紧盆底肌、延长储尿时间,进行膀胱储尿功能训练,其中20例合并有DI的患儿在相同条件下间隔30 min再行充盈性膀胱内压测定,比较两次测定的CBCmax百分数和不稳定指数.同期选15名排尿正常儿童做对照研究.结果 膀胱充盈期出现DI 17例,DI合并低顺应性膀胱15例,单纯低顺应性膀胱4例,充盈性膀胱内压测定正常4例.3例排尿期盆底肌电活动间断增强.CBCmax下降28例.第1次CBCmax与FBC比较有明显增加(P＜0.05).20例进行2次充盈性膀胱内压测定,第2次逼尿肌不稳定指数明显下降(P＜0.05)、CBCmax百分数明显增加(P＜0.05).而正常对照组2次CBCmax无明显差异.结论 儿童白天尿频症的主要尿动力学病理变化是DI,低顺应性膀胱和CBCmax降低是DI引起逼尿肌收缩的继发改变,均为功能性紊乱,而非膀胱壁组织结构器质性病变.行为疗法是治疗儿童尿频症的有效方法,其中以排尿训练为主,抗胆碱能药可辅助治疗儿童尿频症.     

学龄前儿童尿频症

作者自1981.5～1987.5,对3～8岁单纯在白天尿频患儿共503人,经各项检查均无明显阳性发现。暂定名“学龄前儿童尿频症”,特报告诊治体会。一、本病特点:(1)尿频:均表现为日间尿次数明显增多,多伴尿急,无尿痛,无遗尿。仅10%(48人)夜间排尿1～2次。病前均无泌尿系外伤史及尿     

托特罗定叠加槐杞黄颗粒和心理行为干预治疗晨尿渗透浓度正常的原发性遗尿症患儿的随机平行对照研究

目的 对去氨加压素(DDAVP)治疗无效的、晨尿渗透浓度正常的原发性遗尿（PNE）患儿,以托特罗定为基础叠加槐杞黄颗粒和心理行为干预,寻求最佳治疗方案。方法 对DDAVP治疗无效的PNE门诊患儿经过 1个月的药物洗脱期,以区组随机方法分为3组：西药组（托特罗定）、中西药组（托特罗定+槐杞黄颗粒）和联合组（托特罗定+槐杞黄颗粒+心理行为干预）行平行随机对照试验,入组时依据患儿及其家长回忆的月遗尿次数视为基线遗尿次数,在治疗结束时（近期）和治疗结束后3个月（远期）评估疗效并行意向性分析。结果 符合纳入排除标准的234例PNE患儿进入本文分析,3组各78例,3组间年龄、性别和基线遗尿次数差异均无统计学意义（P均>0.05）;近期和远期总有效率,联合组和中西药组均好于西药组,差异有统计学意义（P分别为0.017和<0.001）;近期总有效率,联合组与中西药组差异无统计学意义（P>0.05）,远期总有效率,联合组与中西药组差异有统计学意义（P＝0.005）,联合组近期和远期得到1例有益结果需要治疗PNE人数（NNT）分别为6.5（95％CI：3.7～25.3）和2.4（95％CI：1.8～3.6）,中西药组远期NNT为和4.6(95％CI:2.7～15.2)。结论 托特罗定+槐杞黄颗粒+心理行为干预2.4例DDAVP治疗无效的晨尿渗透浓度正常的PNE患儿在远期疗效上有1例有效,而且置信区间很窄,对这一结果信心很大。     

消炎痛治疗儿童白日尿频

儿童白日尿频(DUFC)也称儿童神经性尿频,首次报道于1979年,以尿频、尿急和体检、尿液检验及培养无异常为特点,病因未明,抗生素治疗无效,针灸可改善症状。本文收集3～10岁DUF-C患儿30例,5岁以及5岁以下25人,男性17例(56.7％),每日排尿20～40次,典型者由于连续排尿而尿量减少,10滴～10ml/次,治疗前症状持续时间为0.5～12个月,多数1～3个月,均无烦渴或心理障碍,所有患者体检、血常规及空腹血糖浓     

不稳定膀胱症

不稳定膀胱(unstable bladder)又称持续性婴儿膀胱,是一种功能性排尿障碍,临床表现为尿频、尿急、尿失禁和夜间遗尿等。其发生机理是由于膀胱充盈期逼尿肌不自主收缩。此症并不少见,国内据文建国和童尔昌报告,在12岁以下正常儿童中,这种逼尿肌不自主收缩的检出率高达11.5％。此症     

感觉统合训练治疗儿童学习障碍的临床观察

目的探讨感觉统合训练对儿童学习障碍的治疗效果。方法将90例学习障碍的儿童分成两组,训练组和对照组各45例。对训练组儿童进行感觉统合训练,每次训练90分钟,隔日一次,共三个月;对照组不采用任何治疗。结果训练组学习障碍儿童的学习成绩有明显的提高。结论感觉统合训练是治疗儿童学习障碍的有效方法。     

儿童排尿功能障碍的研究进展

儿童排尿功能障碍临床多见, 临床表现有尿频、尿急、尿痛、排尿延迟、尿失禁和遗尿症等。可仅有一种症状, 也可多种临床表现同时存在, 且与排便功能障碍密切相关。如得不到及时诊断和治疗, 除影响生活质量外, 常引起肾脏功能损害, 甚至危及生命。因此, 应重视小儿排尿功能障碍的诊治。     

支气管哮喘儿童气质特征分析及临床干预研究

目的 探讨支气管哮喘(哮喘)儿童的气质特征以及气质干预在哮喘儿童的临床应用.方法 采用中国学龄前儿童气质量表对157例哮喘儿童进行测试,分析哮喘儿童气质特征.哮喘组儿童随机分为干预组(76例)和对照组(81例),干预组根据气质类型进行心理干预,比较2组儿童哮喘症状评分的变化.结果 哮喘组儿童的气质类型依次为中间偏麻烦型26.1%、中间偏平易型20.4%、发动缓慢型19.7%、平易型17.8%和麻烦型15.9%.哮喘组患儿中麻烦型、中间偏麻烦型、中间偏平易型比例较高,而发动缓慢型、平易型所占比例较低.哮喘干预组和对照组儿童初诊时日间症状计分和夜间症状计分差异无显著性(P=0.211,P=0.314);治疗2周后,两组日间和夜间症状计分均有明显下降,其中干预组低于对照组,差异有显著性(P=0.014,P=0.000);治疗12周后,日间和夜间症状计分继续下降,两组间差异无显著性(P=0.077,P=0.119).结论 儿童哮喘与气质特征关系密切;根据气质特征分析结果对哮喘儿童进行行为干预,可以有效改善患儿的日同和夜间哮喘症状计分,使患儿症状尽快得到控制.     

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.     

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.     

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.