Mid-Cervical Malignant Pleomorphic Adenoma Prsenting With Upper Airway Obstruction.

The case of a 1 year and 6 months old girl with pleomorphic adenoma arising from the upper middle part of the neck is reported. Although the tumor invaded the hyoid bone, it was removed completely and symptoms of upper airway obstruction disappeared. We suspect it may have originated from thyroglossal duct structures.     

儿童气道梗阻

儿童气道梗阻的病因包括外来压迫和腔内梗阻。其临床表现多非特异性,部分与哮喘和慢性支气管炎重叠,尤其合并先天性心脏病时,伴发的呼吸道症状常掩盖了气道自身病变,故较难识别。因此,对反复或持续呼吸道感染、肺不张、粗糙咳嗽、严重喘鸣、吸入性胸骨凹陷、活动耐量降低、呼吸困难、窒息或有长期插管史且不能用其他原因解释的患儿应高度怀疑气道梗阻。纤维支气管镜检是诊断气道梗阻的一线筛查方法,三维CT和MRI血管造影适用于腔外梗阻,尤其是血管来源气道受压者的评估。有明显呼吸道症状、中等或严重程度的气道梗阻者一经诊断应尽早手术治疗,以降低并发症和病死率。术后持续的气道梗阻与残余压迫、继发性气道管壁软化或气管自身缺损有关。支架植入仅适用于全身状况较差、不能耐受手术或心血管畸形纠治术后长期插管的气道梗阻者。     

小儿上尿路结石梗阻致急性肾衰的手术治疗

目的 探讨小儿上尿路结石梗阻造成急性肾衰的病理生理。分析手术治疗的临床疗效。方法 先行利尿合剂冲击疗法或经皮肾穿刺置管引流,改善垂危状况后手术取石解除梗阻。结果 对７４例患儿的６２个肾、１９根输尿管、３个膀胱切开取石。６７例获痊愈、７例死亡。结论 应用于成人的手术方法也同样适用于小儿。手术解除一侧梗阻即可逆转全身情况,对侧择期手术肾功能并未发现代偿性减退或丧失。     

Airway Obstruction in a Child with Esophageal Achalasia

A 13-year-old Japanese boy who had respiratory symptoms and had been treated as a case of chronic bronchitis was found by us to have esophageal achalasia. He had complained of cough for one year and a half, and pulmonary function studies showed severe airway obstruction. The chest radiogram showed the trachea compressed by the dilated esophagus. After operation, the symptoms disappeared and marked improvement was found in the flow-volume curve. Esophageal achalasia should be considered as one of the differential diagnoses of airway obstructive disease.     

Approach to a Child with Lower Airway Obstruction and Bronchiolitis

Lower airway obstruction can occur at the level of trachea, bronchi or bronchioles. It is characterized clinically by wheeze and hyperinflated chest, apart from other signs of respiratory distress. Common causes include bronchiolitis, asthma, pneumonia, laryngotracheo-bronchitis, congenital malformations and foreign body inhalation. Bronchiolitis usually occurs in children aged 2 months to 2 years. It is most commonly caused by respiratory syncytial virus infection. The diagnosis is mainly clinical, and investigations have a very limited role. Humidified oxygen and supportive therapy are the mainstays of treatment. A trial of inhaled epinephrine or parenteral steroids may be considered for non-responders. It is usually associated with good outcome.     

急性上呼吸道感染的合理用药

急性上呼吸道感染约90%是由病毒引起,仅少数(约10%)是由细菌、支原体或衣原体引起.目前,我国在治疗上呼吸道感染上存在着极不合理的用药情况.北京某儿童医院冬季门诊上呼吸道感染患儿的处方,抗生素使用率达95%.众所周知,抗生素对病毒感染是无效的,且有多种不良反应.滥用抗生素,不仅浪费大量钱财,而且严重危害儿童健康.应提高诊治水平,针对病因治疗,不要盲目用药;目前西医对病毒性上呼吸道感染并无好的治疗方法 ,我国中医中药却有很好的疗效.因此,大力发扬中医中药治疗、纠正滥用抗生素是当先医务界亟待推广的方针.     

Common Acute Upper Extremity Injuries In Sports

Familiarity with anatomical differences in the pediatric patient is necessary to properly identify and treat the variety of upper extremity musculoskeletal injuries encountered in the ED. The many unique characteristics of pediatric bone, the presence of physes, and degree of skeletal maturity all pose a challenge for the emergency physician's ability to diagnose and treat pediatric orthopedic injuries. The somewhat subtle findings both on physical and radiographic examination of many serious pediatric orthopedic injuries further complicate the evaluation process. The treatment of upper extremity injuries in children and young athletes requires heightened vigilance for classic mechanisms of injury, a thorough systematic approach to the orthopedic examination, and a broad knowledge of various injury patterns and treatments. With experience, the emergency or primary care physician will enjoy the challenge of caring for acute traumatic sports-related upper extremity injuries in children.     

急性阑尾炎、小肠粪石性肠梗阻并发肠外瘘1例

1临床资料患者,女,13岁,因转移性右下腹痛42h入院。查体:腹软,无胃肠型蠕动波,肝脾未及,墨非氏征(-),未扪及包块,右下腹肌紧张,压痛,反跳痛明显,无移动性浊音,肠鸣音3～5次/分,无气过水声和金属音。血常规检查WBC15.6×109,中性粒细胞0.92,B超检查阑尾区可探及一索条状低密度影     

持续气道正压通气治疗新生儿急性呼吸衰竭

目的探讨持续气道正压通气(CPAP)治疗新生儿急性呼吸衰竭56例疗效。方法在传统治疗基础上对56例急性呼吸衰竭新生儿采用CPAP辅助治疗,根据临床表现及血气变化,调节CPAP的压力、流量及氧浓度。结果所有患儿上机6 h后临床症状缓解,pa(O2)上升,平均使用时间28 h,与上机前比较有显著差异(P<0.05)。结论使用CPAP治疗新生儿急性呼吸衰竭效果显著。     

白三烯受体拮抗剂抑制小鼠急性哮喘呼吸道炎症的研究

目的应用白三烯受体1拮抗剂孟鲁斯特(montelukast,MK)治疗小鼠急性哮喘呼吸道炎症,探讨MK对白细胞介素-5(IL-5)和嗜酸性粒细胞趋化因子(eotaxin)表达及血清总IgE水平的影响。方法卵清蛋白(OVA)致敏并激发Balb/c小鼠建立急性哮喘模型。静脉予MK(25 mg/kg)或Saline 3 d。瑞氏染色观察小鼠支气管肺泡灌洗液(BALF)炎症细胞,酶联免疫吸附法(ELISA)检测肺组织、BALF和血清IL-5和eotaxin及血清总IgE水平。半定量逆转录聚合酶链式反应(RT-PCR)检测IL-5和eotaxin的mRNA表达。液相色谱方法检测血MK水平。结果OVA激发后24 h,MK组BALF白细胞总数、嗜中性和嗜酸性粒细胞(EOS)分别为(26.0±18.9)×107/L(、5.92±8.09)×107/L和(0.74±0.88)×107/L,较Saline组相应数明显减少(P均<0.05)。EOS减少达80%以上。MK组BALF和肺组织IL-5分别为(48.52±14.45)ng/L和(27.40±9.62)ng/g蛋白,较Saline组相应值明显降低(P均<0.05);MK组血清IL-5和总IgE水平明显减低。MK组BALF中eotaxin水平也明显降低(P<0.05);MK组肺组织IL-5 mRNA显著降低,肺eotaxin及其mRNA水平无明显下降。结论MK可能通过抑制IL-5和IgE产生和分泌起抗炎作用。     

Coronary Blood Flow Changes in Acute Left Ventricular Obstruction in Anesthetized Dogs

Short term studies were carried out analyzing the degree of ischemia, based on coronary blood flow, associated with infravalvular obstruction in relation to increments in leftventricular peak systolic pressure overload. In these experiments a double lumen balloon catheter was placed in the infravalvular region of the left ventricle through the apex; the balloon was then inflated slowly with saline solution to make systolic pressure gradients between left ventricle and aorta gradually up to 60mmHg. There was an inverse relationship between coronary blood flow and the gradient between left ventricular peak systolicpressure(Plv )and aortic pressure (Pao ); when the Plv –Pao gradient was plotted as a function of coronary blood flow a linear regression slope with a value of -0.3 was obtained. At a maximal Plv –Pao gradient pressure of 60mmHg, coronary blood flow decreased 20%. When coronary blood flow was plotted as a function of PLV the linear regression slope was –0.4 and as a function of Pao the value for the slope was 0.79. (P 相似文献   

A Child Case of Acute Right Coronary Obstruction Due to Catheter-Induced Coronary Dissection:

We report on a 10-year-old child who suffered from acute right coronary obstruction due to catheter-induced coronary dissection. Immediate placement of a perfusion catheter into the obstructed right coronary artery and subsequent overnight reperfusion allowed successful recovery of the right coronary artery lumen without implantation of a stent. Follow-up angiography demonstrated spontaneous regression of the dissected coronary artery and normal right and left ventricular wall motion. The indication of stent implantation should be carefully determined in a child case of iatrogenic coronary dissection because stenting may induce coronary stenosis during growth.