炎琥宁注射剂治疗小儿手足口病130例疗效观察

目的观察炎琥宁注射剂治疗小儿手足口病的临床疗效。方法将260例手足口病患儿按病例单双号法分成两组,每组各130例。两组病例均同时伍用头孢哌酮舒坦钠控制感染,在此基础上对照组给予利巴韦林10～15mg/(kg·d),加入5%葡萄糖注射液100mL中静脉滴注,每日1次;观察组给予炎琥宁注射剂5～10mg/(kg·d),加入5%葡萄糖注射液100mL中静脉滴注,每日1次。两组疗程均为5～7d。观察两组患儿治疗后体温恢复时间、皮疹、疱疹消退时间及总有效率。结果 1个疗程结束后观察组总有效率96%(128/130),对照组78%(110/130),两组比较差异有统计学意义(P<0.05);两组治疗过程中无副反应发生。结论炎琥宁注射剂治疗小儿手足口病具疗程短、显效快,值得临床应用。     

强力宁治疗急性黄疸型肝炎116例

我院1988年以来采用强力宁治疗116例小儿急性黄疸型肝炎，取得满意疗效，现报告如下。全部病例均符合1984年全国病毒性肝炎会议诊断标准。没治疗和对照组各116例。治疗组男80例，女36例，年龄2～12岁；对照组男84例，女32例，年龄1．5～12岁。始疗组谷丙转氨酶（GPT）为330．70±34．60U；对照组为314．30±43．27U。上述数据两组有可比性。治疗组用强力宁40～60ml加入5％葡萄糖250～400ml内，每日1次静滴，疗程2周。对照组内加三磷酸腺着20mg、辅酶A50u静滴。此外两组每日口服维生素及肌注维丙胺，每周复查GPT一次疗程结束后GPT降为正…     

促肝细胞生长素治疗婴儿肝炎综合征

目的探讨促肝细胞生长素治疗婴儿肝炎综合征的临床疗效及安全性。方法选择2002年3月～2003年2月住院的婴儿肝炎综合征患儿61例,静脉滴注促肝细胞生长素,进行前瞻性研究;选取2001年3月～2002年2月住院的婴儿肝炎综合征患儿54例为对照组,治疗2周后观察患儿总胆红素(TBIL)、ALT、AST等,判断药物疗效。结果疗程结束后婴儿肝炎综合征治疗组TBIL、ALT下降明显,优于对照组(P<0.05);治疗组和对照组总有效率分别为78 69%和61.11%,治疗组优于对照组(P<0.05)。结论促肝细胞生长素有助婴儿肝炎综合征肝功能恢复,无明显不良反应。     

痰热清注射液佐治小儿呼吸道感染60例

目的观察痰热清注射液佐治小儿呼吸道感染的疗效。方法将呼吸道感染的患儿118例随机分为治疗组和对照组.治疗组静注痰热清注射液0.5-10mL/(kg·d),1次/d.疗程3-7d;对照组给予鱼腥草注射液1.0-1.5mL/(kg·d),1次/d,疗程3-7d。两组均同时使用头孢他啶。结果治疗组与对照组治愈分别为34例、29例;显效分别为15例、18例;有效分别为9例、8例;无效分别为2例、3例,两组总有效率分别为96.67%、97.83%.经统计学处理无显著差异(u=0.620P=0.535)。且未发现有皮疹、寒颤、发热、点滴局部疼痛等不良反应。结论痰热清注射液佐治小儿呼吸道感染疗效确切.可与鱼腥草注射液达到同等临床疗效,为临床治疗小儿呼吸道感染提供了一种新的治疗药物。     

复方丹参注射液治疗新生儿硬肿症102例疗效观察

目的 观察复方丹参注射液治疗新生儿硬肿症的疗效。方法 治疗组102例，在综合治疗的基础上同时结合复方丹参注射液2ml加入10％葡萄糖液20ml静滴，每日1次，连用5～10天。并与对照组50例给予综合治疗相比较。结果 治疗组治愈率75％，死亡率25％；对照组治愈率54％，病死率46％。两组疗效对比，治疗组的治愈率明显高于对照组。结论 复方丹参注射液治疗新生儿硬肿症疗效显著，不仅可以提高治愈率，而且可以缩短病程，并且无副作用。     

痰热清注射液治疗小儿急性支气管炎45例临床观察

目的 观察痰热清注射液治疗小儿急性支气管炎的临床疗效。方法 将小儿急性支气管炎患者90例随机分为治疗组与对照组，两组分别静脉给予痰热清注射液和双黄连注射液，静脉滴注，每日1次，疗程为7～10天。结果 治疗组总疗效优于对照组，治疗组在退热方面优于对照组。结论 痰热清注射液治疗小儿急性支气管炎疗效确切。     

肝素超声雾化吸入治疗毛细支气管炎61例报告

我科于1993年1月～6月收治毛细支气管炎96例,随机分为肝素雾化吸入组61例和对照组35例,两组治疗前临床表现基本相似。治疗组用肝素20mg加入20ml生理盐水稀释后雾化吸入,每日2次,疗程5～7天。结果显效42例(69％),有效15例(24.5％),无效4例(6.5％),总有效率为93.5％,与对照组比较,P<0.05。目前研究倾向认为该病     

清开灵注射液治疗小儿急性上呼吸道感染疗效观察

目的比较清开灵注射液与病毒唑对小儿急性上呼吸道感染的疗效。方法将139例急性上呼吸道感染的患儿随机分为治疗组(清开灵组68例)和对照组(病毒唑组71例)。2组对症治疗相同,治疗组给予静脉滴注清开灵注射液0.8mL/(kg·d),1次/d,3~5d为1个疗程,对照组给予静脉滴注病毒唑10~15mg/(kg·d),溶于5%~10%葡萄糖液中,1次/d,3~5d为1个疗程。结果治疗组总有效率为92.6%,对照组为77.5%。2组比较差异显著(P<0.01)。结论清开灵注射液治疗小儿急性上呼吸道感染,可显著缩短病程及缓解症状,优于病毒唑注射液,未发现明显副作用。     

钙剂持续静滴治疗婴儿手足搐搦症45例疗效观察

目的比较钙剂持续静滴与钙剂间断静滴治疗婴儿手足搐搦症的效果.方法治疗组用10%葡萄糖酸钙5ml/(kg*d),用10%葡萄糖150ml稀释,每分钟2～3滴/公斤体重,疗程3～5天,对照Ⅰ组10%葡萄糖酸钙每次10ml,用10%葡萄糖20ml稀释,30分钟内静滴,每日1次;对照Ⅱ组剂量同对照Ⅰ组,每日2次,两对照组疗程7～10天.结果治疗组治疗后1,3天血钙达正常水平,与对照组比较,P均＜0.01;尿钙测定三组无明显差异,P＞0.05;临床症状3天内控制者治疗组占88.9%,对照Ⅰ组45.0%、对照Ⅱ组50.0%,P＜0.01.结论钙剂持续静滴治疗婴儿手足搐搦症疗效显著.     

丹参、维生素C治疗过敏性紫癜20例临床观察

我科自1991年12月以来,应用丹参和维生素C治疗20例过敏性紫癜,总有效率为90％,另20例应用激素的对照组则为75％。丹参注射液6～10ml/d置葡萄糖液250ml中静滴,维生素C2.0g/d静注;激素组用强的松1～2mg/kg·d,分3次口服,两组分别以14天为一疗程,实验证明丹参能抗过敏及稳定肥大细胞膜,抑制脱颗粒和介质的释放及降低IgE的产生并有提高C_3及IgG作用,故丹参对变态反应的第一、二阶段均有良好的阻抑作用;其次     

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.     

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.     

How well are we doing? – Metabolic control in patients with diabetes

OBJECTIVE: To compare the present level of metabolic control in children and adolescents with insulin-dependent diabetes mellitus (IDDM) attending Brisbane paediatric diabetes clinics with published overseas data. METHODOLOGY: Blood HbA1c concentrations, population characteristics, current treatment practices and short-term complications were recorded in all patients, aged 19 years and under, attending the diabetes clinics of the two Brisbane Children's Hospitals or the private practice of one of the authors (MJT) in the first quarter of 1998. RESULTS: Two hundred and sixty-eight patients were assessed (M/F 142/126). Ages ranged from 1 to 19 years (mean 11. 2 years); duration of IDDM was 0-16 years (mean 4.4 years); and 141 (53%) were pubertal. Of those aged less than 13 years, only 4% had more than two injections daily. Insulin doses (U/kg/day) rose with increasing age. Larger doses were required in regimens involving more than two injections per day than those involving one to two injections per day. Ketoacidosis or severe hypoglycaemia in the last 3 months were reported in eight (2.7%) and 17 (6.3%) of patients, respectively. Mean HbA1c (+/- SD) was 8.6 +/- 1.4% (range 5.2-14.0%), with 33% of children having a HbA1c concentration < 8%. HbA1c concentrations were significantly related (P < 0.05) to insulin dose and to duration of diabetes, but not to severe hypoglycaemia, ketoacidosis, age, frequency of injections, or number of clinic visits per year. Mean HbA1c concentration was significantly higher (P < 0.05) in those children in puberty (8.7 +/- 1.5%) than in those not in puberty (8.5 +/- 1.2%). CONCLUSION: Only 33% of patients had a HbA1C concentration less than 8% and 6.3% had a severe hypoglycaemic episode in the 3 months. These results are similar to published overseas data.     

MAINTENANCE OF DIFFERENTIATED FUNCTION OF THE SURFACTANT SYSTEM IN HUMAN FETAL LUNG TYPE II EPITHELIAL CELLS CULTURED ON PLASTIC

We report a simplified culture system for human fetal lung type II cells that maintains surfactant expression. Type II cells isolated from explant cultures of hormone-treated lungs (18-22 wk gestation) by collagenase + trypsin digestion were cultured on plastic for 4 days in serum-free medium containing dexamethasone (Dex, 10 nM) + 8-bromo-cAMP (0.1 mM) + isobutylmethylxanthine (0.1 mM) or were untreated (control). Surfactant protein (SP) mRNAs decreased markedly in control cells between days 1 and 4 of culture, but mRNA levels were high in treated cells on day 4 (SP-A, SP-B, SP-C, SP-D; 600%, 100%, 85%, 130% of day 0 content, respectively) . Dex or cAMP alone increased SP-B, SP-C, and SP-D mRNAs and together had additive effects. The greatest increase in SP-A mRNA occurred with cAMP alone. Treated cells processed pro-SP-B and pro-SP-C proteins to mature forms and had a higher rate of phosphatidylcholine (PC) synthesis (2-fold) and higher saturation of PC (~34% versus 27%) than controls. Only treated cells maintained secretagogue-responsive phospholipid synthesis. By electron microscopy, the treated cells retained lamellar bodies and extensive microvilli. We conclude that Dex and cAMP additively stimulate expression of surfactant components in isolated fetal type II cells, providing a simplified culture system for investigation of surfactant-related, and perhaps other, type II cell functions.