贫血皮肤黄染咳嗽头晕

第一次查房主治医师查房,入院20h。住院医师汇报病史。患儿,女,10岁,因面色黄、乏力20d,咳嗽7d入院。患儿于入院前20d无明显诱因出现面色黄、乏力偶伴头晕,无发热、皮疹、腹痛、腹泻、心慌、胸闷等症状。入院前7d,患儿出现轻微咳嗽,无咳痰。入院前3d,患儿面色黄明显,仍咳嗽,以夜间为主,咳黄色痰,到当地医院就诊,给予泰力特、竹沥水,治疗无效,来我院就诊。查血常规WBC6·3×109/L,Hb65g/L,RBC2·07×1012/L,PLT79×109/L;胸片双肺纹理粗重,双肺下叶见点片状阴影,左肺叶下少许积液。门诊以“贫血原因待查”收入院。既往体健。否认肝炎、…     

咳嗽、气促、肝脏肿大

第一次查房主治医师查房,入院第1天。住院医师汇报病史。患儿，男，18d，因“咳嗽2d”入院。     

反复咳嗽伴气促

主治医师查房：入院16h。住院医师汇报病史。患儿，女，14岁，因反复咳嗽近4个月余，伴气促入院。患儿于4个月前开始咳嗽，干咳为主，无明显发热、头痛、胸痛、呕吐、腹泻等症状。起病后去当地医院就诊，给予阿莫西林、甘草合剂等处理，病情略好转，但不久症状又加重，并出现活动时气急，消瘦，但饮食及精神状态尚可。于3个月前来本院，     

呼吸困难 声嘶

第一次查房主治医师查房,入院后12h。 住院医师汇报病史。患儿,男,4岁。因“反复呼吸困难2周伴声嘶”入院。患儿于2周前无明显诱因下出现气促,表现为安静时呼吸加快,呼吸费力,略有声嘶,无发热。至当地医院就诊,拟诊“急性喉-气管-支气管肺炎,喉梗阻Ⅲ度”。     

喘息 呼吸困难

第一次查房 主治医师,入PICU后1h内。住院医师患儿,男,1岁,因咳嗽、气喘伴发热2d急诊入院。体温波动于38．5℃左右。外院予13服头孢克洛2d,发热无好转,咳嗽及喘息加重,伴声嘶,无明显犬吠样咳嗽。既往有两次支气管肺炎病史。查体：T39℃,R60次／min,HR160次／min,BP80／60mmHg（1mmHg=0．133kPa）,SpO2 90％（未吸氧）,体质量10kg。神志清,     

反复腹胀 呕吐 腹泻

第一次查房主治医师查房,入院后第3天。住院医师汇报病史。患儿,女,1岁3个月,主因“反复腹胀、呕吐1年余,加重伴稀便1月余”收住我院ICU。患儿于入院前1年余（即生后3个月）因发热、咳嗽诊断为“肺炎”,体温37—38℃,进而出现腹胀,表现为腹部膨隆,     

反复咳嗽、阵发性脐周疼痛

病例摘要 患儿，女，10岁，因反复咳嗽伴阵发性脐周疼痛6d入院。患儿于6d前无明显诱因出现咳嗽，流涕不适，无发热、咳痰、咽痛不适，伴脐周阵发性疼痛，疼痛能耐受，无放射性疼痛，伴呕吐，2～3次／d，非喷射性，呕吐物为胃内容物，不含胆汁及咖啡样物，在外院静脉滴注药物治疗（具体治疗方案不详），咳嗽缓解，仍反复腹痛、呕吐。     

儿童气管内错构瘤1例

患儿,女,10岁,因间断咳嗽气喘2年,加重10d入院。2年前患儿受凉后开始出现咳嗽伴有气喘,经抗感染治疗后可缓解,但此后易反复发作,曾数次因“支气管肺炎”、“支气管哮喘”等住院治疗。10d前患儿再次出现咳嗽伴有气喘,并出现进行性呼吸困难,端坐呼吸,不能平躺,在当地治疗无好转后     

第129例——间断咳嗽、喘息10个月

病历摘要患儿女，l岁4个月，主因“间断咳嗽喘息10个月”入院。患儿于入院前10个月无明显诱因出现流涕、咳嗽，伴轻度喘息，于当地诊所抗感染治疗两周后症状缓解。其后4个月，每间隔20d左右，咳嗽，喘息发作约1周，夜间入睡后及进食、哭闹时加重，喘息不重，有痰，难咯出，可平卧，无憋气、发绀、呛咳及发热，     

咳嗽变异性哮喘误诊1例分析

咳嗽变异性哮喘(eough variant asthma,CVA)又称过敏性咳嗽，是一种特殊类型的哮喘，发病机制是因气道高反应性所致。特点为咳嗽反复发作1个月以上，以夜间或清晨为重，干咳为痰，临床无感染征象或经长期抗生素无效，使用支气管扩张剂咳嗽发作缓解。笔者遇到1例曾误诊数月，现报告如下。     

反复咳嗽、喘憋

主治医师查房:入院第一天。住院医师　汇报病史。患儿4个月,男,以反复咳嗽、喘憋10d ,加重2d为主诉入院。患儿10d前始咳嗽,伴气管发出“咝咝”声,活动后明显。于病后第3天到当地医院,确诊为“毛细支气管炎”。给予青霉素80万u、双黄连5ml、地塞米松2mg ,日1次,静脉点滴。3d后咳喘明显好转,停用地塞米松。2d后,于入院前2天喘憋又加重,鼻塞,气管及咽喉部有痰咳不出,来我院就诊。病来无发热,食佳,有时呛奶,不吐沫,二便正常,睡眠略差。既往1个月时有轻微湿疹史,无咳喘史。足月正常产,出生体重3 4kg ,母乳喂养,生长发育正常。家族中无反复咳喘史…     

Clinical significance of cough and wheeze in the diagnosis of asthma

OBJECTIVES: (1) To determine the prevalence of cough, wheeze, and breathlessness, both as single symptoms and in combination, in primary schoolchildren and their relation to doctor diagnosed asthma. (2) To identify in areas with different levels of dust pollution whether questionnaire reported 'cough alone' (without wheeze or breathlessness) had similar risk factors to the questionnaire reported triad of 'cough, wheeze, and breathlessness'. SUBJECTS AND METHODS: Two cross sectional community surveys of primary schoolchildren (5-11 years) were performed in 1991 and 1993. Parent completed questionnaires related to socioeconomic and respiratory factors were distributed through 15 schools in three areas of Merseyside, one of which had a relatively high level of dust pollution. Data were analysed to determine the prevalence of different respiratory symptom patterns. Univariate and multiple logistic regressions were used to investigate the associations between respiratory symptom profiles and potential risk factors. RESULTS: The proportions of completed questionnaires that were returned were similarly high in both surveys, 92% in 1991 (1872 of 2035) and 87% in 1993 (3746 of 4288). The proportions of children with different respiratory symptom patterns were similar in the two surveys: in 1991, asymptomatic children 70.1% (1109 of 1583), those with cough alone 8.9% (141 of 1583), and children with the symptom triad of cough, wheeze, and breathlessness 8.3% (132 of 1583); the figures for 1993 were 69.5% (2144 of 3083), 9.2% (284 of 3083), and 7.3% (224 of 3083) respectively. The prevalence of doctor diagnosed asthma increased from 17.4% in 1991 to 22.1% in 1993. The symptom of cough alone was associated with going to school in an area of increased air pollution. The symptom triad of cough, wheeze, and breathlessness was associated with reported allergies, familial history of atopy and preterm birth. In 1991, of children with the symptom of cough alone one in eight were diagnosed asthmatic; twice as many doctors made the diagnosis on this basis in 1993. CONCLUSION: The respiratory symptom of cough alone and cough, wheeze, and breathlessness represent clinical responses to different specific risk factors. Cough alone was associated with the environmental factors of school in the dust exposed zone and dampness in the home, whereas cough, wheeze, and breathlessness related to allergic history and preterm birth, and may be the best surrogate of asthma. Diagnosis of asthma on the basis of cough alone partly explains the increased prevalence of doctor diagnosed asthma, especially in dust polluted areas.     

反复咳嗽伴气促

主治医师查房 :入院 16h住院医师　汇报病史。患儿 ,女 ,14岁 ,因反复咳嗽近4个月余 ,伴气促入院。患儿于 4个月前开始咳嗽 ,干咳为主 ,无明显发热、头痛、胸痛、呕吐、腹泻等症状。起病后去当地医院就诊 ,给予阿莫西林、甘草合剂等处理 ,病情略好转 ,但不久症状又加重 ,并出现活动时气急 ,消瘦 ,但饮食及精神状态尚可。于 3个月前来本院 ,门诊查血常规WBC10 8× 10 9/L ,N 0 5 9,RBC 375× 10 9/L ,Hb 12 6 g/L ;CRP16mg/L ;X胸片右侧胸腔中等量积液 ,左侧少许胸膜反应 ;收住院治疗。入院查体 :神清 ,面色略苍白 ,气促 ,安静时无…     

Clinical significance of cough and wheeze in the diagnosis of asthma.

OBJECTIVES: (1) To determine the prevalence of cough, wheeze, and breathlessness, both as single symptoms and in combination, in primary schoolchildren and their relation to doctor diagnosed asthma. (2) To identify in areas with different levels of dust pollution whether questionnaire reported ''cough alone'' (without wheeze or breathlessness) had similar risk factors to the questionnaire reported triad of ''cough, wheeze, and breathlessness''. SUBJECTS AND METHODS: Two cross sectional community surveys of primary schoolchildren (5-11 years) were performed in 1991 and 1993. Parent completed questionnaires related to socioeconomic and respiratory factors were distributed through 15 schools in three areas of Merseyside, one of which had a relatively high level of dust pollution. Data were analysed to determine the prevalence of different respiratory symptom patterns. Univariate and multiple logistic regressions were used to investigate the associations between respiratory symptom profiles and potential risk factors. RESULTS: The proportions of completed questionnaires that were returned were similarly high in both surveys, 92% in 1991 (1872 of 2035) and 87% in 1993 (3746 of 4288). The proportions of children with different respiratory symptom patterns were similar in the two surveys: in 1991, asymptomatic children 70.1% (1109 of 1583), those with cough alone 8.9% (141 of 1583), and children with the symptom triad of cough, wheeze, and breathlessness 8.3% (132 of 1583); the figures for 1993 were 69.5% (2144 of 3083), 9.2% (284 of 3083), and 7.3% (224 of 3083) respectively. The prevalence of doctor diagnosed asthma increased from 17.4% in 1991 to 22.1% in 1993. The symptom of cough alone was associated with going to school in an area of increased air pollution. The symptom triad of cough, wheeze, and breathlessness was associated with reported allergies, familial history of atopy and preterm birth. In 1991, of children with the symptom of cough alone one in eight were diagnosed asthmatic; twice as many doctors made the diagnosis on this basis in 1993. CONCLUSION: The respiratory symptom of cough alone and cough, wheeze, and breathlessness represent clinical responses to different specific risk factors. Cough alone was associated with the environmental factors of school in the dust exposed zone and dampness in the home, whereas cough, wheeze, and breathlessness related to allergic history and preterm birth, and may be the best surrogate of asthma. Diagnosis of asthma on the basis of cough alone partly explains the increased prevalence of doctor diagnosed asthma, especially in dust polluted areas.     

The transient value of classifying preschool wheeze into episodic viral wheeze and multiple trigger wheeze

Background:  A recently proposed method for classifying preschool wheeze is to describe it as either episodic (viral) wheeze or multiple trigger wheeze. In research studies, phenotype is generally determined by retrospective questionnaire.
Aim:  To determine whether recently proposed phenotypes of preschool wheeze are stable over time.
Methods:  In all, 132 two to six-year-old children with doctor diagnosed asthma on maintenance inhaled corticosteroids were classified as having episodic (viral) wheeze or multiple trigger wheeze at a screening visit and then followed up at three-monthly intervals for a year. At each follow-up visit, standardized questionnaires were used to determine whether the subjects wheezed only with, or also in the absence of colds. Stability of the phenotypes was assessed at the end of the study.
Results:  Phenotype as determined by retrospective parental report at the start of the study was not predictive of phenotype during the study year. Phenotypic classification remained the same in 45.9% of children and altered in 54.1% of children.
Conclusion:  When children with preschool wheeze are classified into episodic (viral) wheeze or multiple trigger wheeze based on retrospective questionnaire, the classification is likely to change significantly within a 1-year period.     

Rhinovirus and preschool wheeze

Rhinovirus (RV) known as the common cold virus generally only causes a mild upper respiratory infection, but severe lower respiratory symptoms have been associated with RV infections especially in asthmatic individuals. Wheezing is a symptom of airway obstruction, and preschool children wheezing with RV have been associated with increased risk of asthma at school age. There are, however, conflicting opinions as to whether there are differences in response to RV infection or whether wheezing with RV reveals a preexisting impairment that promotes asthma mainly in predisposed children. The advent of molecular diagnostics to detect respiratory viruses has led to new insights into the role of RV infections. This review will discuss recent information concerning the role of RV as an important respiratory pathogen related to early onset wheeze and exacerbation of established asthma in preschool children.     

A multicentre randomized placebo-controlled double-blind study on the efficacy of Ketotifen in infants with chronic cough or wheeze

The efficacy of Ketotifen was examined in the treatment of 113 infants between 6 and 36 months of age presenting with a history of cough and/or wheeze in a multicentre randomized placebo-controlled double-blind study. A 4 week no-medication baseline phase preceded the 16 week treatment phase in which infants took 2.5 mL twice daily of either placebo or Ketotifen (0.5 mg) syrup; this was followed by a 4 week wash-out phase. Diary card evaluation was performed by the parent or guardian for the duration of the study and recorded wheeze and cough twice daily as well as medication used. The percentage of symptom-free days decreased significantly in both groups (P < 0.005) with placebo-treated infants experiencing significantly more symptom-free days compared with the Ketotifen group (P < 0.01), although this difference was never more than 10% in any 4 week treatment period. Symptom severity scores and use of beta-agonist medication were also less in the placebo-treated infants but did not reach statistical significance. This study was unable to show a therapeutic advantage of Ketotifen over placebo in this group of infants with chronic cough and/or wheeze and the apparent statistical advantage of placebo is not a clinically relevant finding.