儿童急性鼻窦炎并发眶壁骨膜下脓肿

目的探讨儿童急性鼻窦炎并发眶壁骨膜下脓肿的临床特征及治疗方法的选择。方法回顾分析武汉大学人民医院耳鼻咽喉-头颈外科1996年6月至2005年10月收治的35例5~12岁儿童急性鼻窦炎并发眶壁骨膜下脓肿的临床表现、CT扫描特征和不同治疗效果。结果13例(37.1%)仅通过药物控制感染,22例(62.8%)行鼻内窥镜下眶壁骨膜下脓肿引流。比较药物治疗组和鼻内窥镜下脓肿引流组的疗效:前者无视力下降,后者有9例视力下降;前者2例结膜水肿,后者14例;前者5例眼球移位,后者17例;前者无眼内压增加者,后者13例;前者无眼球活动受限,后者14例;CT显示前者脓肿宽明显小于后者(0.21 cmvs 1.35 cm)。结论对视力下降、眼球移位、眼球活动受限、眼内压>20 mmHg、脓肿宽>4 mm的儿童,应行鼻内窥镜下眶壁骨膜下脓肿切开引流术。     

Orbital complications of acute sinusitis

Orbital complications of sinusitis may occur either by spread along the venous system or by direct extension of infection between contiguous structures. The association between sinusitis and inflammation of the orbits has been known for centuries. But in the post antibiotic era there is a marked decline in the number of case reports in the literature. This paper presents 10 cases of sinusitis who had orbital complications. The classification of this disease complex as given by Chandler helps in planning the treatment. Groups I and II respond very well to antibiotics but in groups III, IV, V surgical intervention is necessary. Early identification and aggressive therapy reduces the morbidity of this disease.     

慢性阻塞性肺疾病的十年回顾

慢性阻塞性肺疾病(COPD)是一种常见的呼吸系统疾病,随着疾病的进展将会严重影响患者的工作和生活,甚至导致死亡,因此目前本病日益受到重视.现简要回顾过去10年间有关COPD的几个问题.     

The management of female infertility by tubal microsurgical reconstruction: A ten year review

The outcome of 368 consecutive tubal microsurgical operations excluding reversal of sterilizations, over a ten year period at the Rotunda Hospital, is presented. One hundred and ten conceptions resulted giving a pregnancy rate of 29.9% per procedure. The ‘take home baby rate’ was 24.2%, with miscarriage and ectopic pregnancy rates of 2.7% and 3% respectively.     

The epidemiology of trypanosomiasis in Rumphi district,Malawi: a ten year retrospective study

Background

Human African Trypanosomiasis (HAT) is caused by two species of the tsetse fly vectored protozoan hemoflagellates belonging to Trypanosma brucei, namely T.b gambiense which predominates in Western Africa and follows a chronic disease course and T.b rhodensiense which is more prevalent in Southern and Eastern Africa, Malawi included, and follows a more acute and aggressive disease course. Previous studies in the Democratic Republic of Congo, Angola, Uganda and Sudan have demonstrated that the prevalence rates of T.b rhodensiense infection have reached epidemic proportions.

Objectives

To describe the epidemiology of Trypanosomiasis in Rumphi District over the past ten years.

Methodology

A total of 163 records from January 2000 to December 2006 were retrospectively studied.

Results

There were more males than females (121 vs. 40) with the 20 – 29 years age bracket having the highest number of cases (26.3%, n=160). Stage 2 HAT was the commonest stage at presentation (58.2%, n=158) with the patients in the same being 3.5 times more likely to die than those with stage 1 HAT. Case fatality rates for late and early stage disease were 21.5% (n = 92) and 7.2% (n = 66) respectively with 84.6% having been cured (n=162). Convulsions were associated with fatal disease outcome and the majority of cases (97.2%, n=103) lived within 5 kilometres of the Vwaza game reserve boundary.

Conclusion

More men have been infected than women, with a high involvement in the 20 – 29 age brackets. A dramatic increase with active case finding indicates a high under-detection of the disease with late stage HAT being predominant at presentation. Though it has been found that cases with late stage disease have an increased likelihood of dying compared to those in early stage HAT, the high proportion of successful treatment indicates that the disease still carries a high degree of favourable outcome with treatment. It has also been demonstrated in this study that more than 95% of trypanosomiasis cases live within 5 km of game reserve boundary. Disease interventions should be implemented in areas within 5km of marshland game reserve boundary as priority areas.     

Systemic complications of acute glomerulonephritis in Nigerian children

This study was undertaken to: (i) determine the prevalence, pattern and outcome of systemic complications of acute glomerulonephritis (AGN), and (ii) evaluate some clinicolaboratory features of the disease in Nigerian children. Clinical and laboratory records of consecutive cases of AGN seen over a period of 3 years in our unit, were prospectively entered into nephrology record forms and later analysed. Some of the analysed data included age, sex, blood pressure, types of systemic complication, haematocrit, plasma electrolytes, urea, creatinine, protein and albumin. Fractional excretion of filtered sodium (FeNa, %) and 24-hours urinary protein concentration data were also analysed. Majority of the patients (18/29) were under 6 years of age, with peak age incidence of 3 years. The hospital incidence of AGN and prevalence of systemic complications were 10 new cases per year and 41.38%, respectively. Heart failure (HF) and acute renal failure (ARF) were sole systemic complications in 7 and 2 AGN patients, respectively. Three patients had double systemic complications: one each of hypertensive encephalopathy (HTE)+HF, HTE+ARF and ARF+HF. Ten of 29 patients (34.48%) had nephrotic range proteinuria. None of the AGN patients except those with ARF had FeNa >1%, plasma bicarbonate <15 mmol/l, urea 225 mmol/l and creatinine 2400 mmol/l. Two of the patients died: one each of ARF and ARF+HF, giving a case fatality and mortality rate of 6.90% and 0.08%, respectively. ARF is clearly the principal risk factor for mortality in our AGN patients. Its early detection and aggressive but purposive management which must include dialysis, will certainly improve outcome in AGN cases complicated by ARF.     

Synopsis of non-communicable diseases in children admitted to the paediatric ward of the university of Nigeria teaching hospital (UNTH) Enugu,Nigeria: A ten year review

Background:

Non-communicable diseases are increasing worldwide due to rapidly changing lifestyles and socio-economic status. It is contributing significantly to the global burden of diseases.

Objective:

To determine the pattern of non-communicable diseases in children admitted into the Paediatrics ward in a tertiary health centre in Enugu.

Materials and Methods:

A review of admissions into the Paediatrics ward of the University of Nigeria Teaching Hospital Enugu, between January 1999 and December 2008 was done using the registry of admission and discharge.

Results:

The age range of patients admitted during the period was 2 months to 18 years (mean 5.27 ± 5.42 years). There were 1173 (59.6%) males and 796 (40.4%) females. Disorders of the haematological system accounted for 514 (23.3%) of the non-communicable diseases among the admissions, malignancies accounted for 424 (19.2%) among the admissions, whereas the renal, central nervous, and cardiovascular systems were involved in 282 (12.8%), 274 (12.4%), and 241 (10.9%) patients, respectively. There were 274 (12.4%) deaths and 1667 (75.5%) discharges while 38 (1.7%) were discharged against medical advice. Data on 221(10.2%) of the patients were reported missing. Malignancies contributed to 75 (27.3%) of the deaths, haematological disorders accounted for 44 (16%) whereas renal disorders and nutritional disorders contributed to 43 (15.7%) and 41 (15%) of the deaths, respectively.

Conclusion:

Non-communicable diseases affect children in our environment and contribute to morbidity and mortality in children. Strategies to prevent these diseases should be encouraged in order to avert the challenges of double burden of the diseases in children.     

眶内异物继发眶尖综合征1例报告并文献回顾

目的 报道眶内异物继发眶尖综合征1例,并通过文献复习分析总结我国此类型患者的临床特点.方法 1例43岁男性患者,因眼部外伤导致眶内异物来本院就诊,确诊为眶内异物继发眶尖综合征,并予急诊行手术取出异物、眼眶减压,术后予止血、降眶压及激素治疗.结果 国内报道中眶尖综合征共17例(含本例),其中男15例,女2例.其中8例为感...     

儿童慢性鼻窦炎分级治疗探讨

目的 探讨儿童慢性鼻窦炎不同分型采用分级治疗方法的合理性及优越性。方法 对192例病儿根据病情及检查不同从轻到重分为3型,Ⅰ型97例,Ⅱ型58例,ⅢI型37例,针对不同分型制定1-3级治疗方案对病儿进行施治。结果 Ⅰ型患儿采用一级治疗方案,有效率91%;Ⅱ型患儿采用二级治疗方案,有效率88%;Ⅲ型患儿采用三级治疗方案,有效率92%,总有效率90%。结论 不同类型鼻窦炎患儿采用分级治疗,使治疗方案逐渐加强,从一般的药物保守治疗、辅助治疗至功能性鼻窦内窥镜手术治疗（FESS）,体现出了个性化治疗,针对性强、效果好,具有一定临床参考价值。     

Predictors of acute complications in children with type 1 diabetes

CONTEXT: Diabetic ketoacidosis and severe hypoglycemia are acute complications of type 1 diabetes that are related, respectively, to insufficient or excessive insulin treatment. However, little is known about additional modifiable risk factors. OBJECTIVE: To examine the incidence of ketoacidosis and severe hypoglycemia in children with diabetes and to determine the factors that predict these complications. DESIGN, SETTING, AND PARTICIPANTS: A cohort of 1243 children from infancy to age 19 years with type 1 diabetes who resided in the Denver, Colo, metropolitan area were followed up prospectively for 3994 person-years from January 1, 1996, through December 31, 2000. MAIN OUTCOME MEASURES: Incidence of ketoacidosis leading to hospital admission or emergency department visit and severe hypoglycemia (loss of consciousness, seizure, or hospital admission or emergency department visit). RESULTS: The incidence of ketoacidosis was 8 per 100 person-years and increased with age in girls (4 per 100 person-years in < 7; 8 in 7-12; and 12 in > or =13 years; P<.001 for trend). In multivariate analyses, sex-adjusted and stratified by age (<13 vs > or =13 years), the risk of ketoacidosis in younger children increased with higher hemoglobin A(1c) (HbA(1c)) (relative risk [RR], 1.68 per 1% increase; 95% confidence interval [CI], 1.45-1.94) and higher reported insulin dose (RR, 1.40 per 0.2 U/kg per day; 95% CI, 1.20-1.64). In older children, the risk of ketoacidosis increased with higher HbA(1c) (RR, 1.43; 95% CI, 1.30-1.58), higher reported insulin dose (RR, 1.13; 95% CI, 1.02-1.25), underinsurance (RR, 2.18; 95% CI, 1.65-2.95), and presence of psychiatric disorders (for boys, RR, 1.59; 95% CI, 0.96-2.65; for girls, RR, 3.22; 95% CI, 2.25-4.61). The incidence of severe hypoglycemia was 19 per 100 person-years (P<.001 for trend) and decreased with age in girls (24 per 100 patient-years in < 7, 19 in 7-12, and 14 in > or =13 years). In younger children, the risk of severe hypoglycemia increased with diabetes duration (RR, 1.39 per 5 years; 95% CI, 1.16-1.69) and underinsurance (RR, 1.33; 95% CI, 1.08-1.65). In older children, the risk of severe hypoglycemia increased with duration (RR, 1.34; 95% CI, 1.25-1.51), underinsurance (RR, 1.42; 95% CI, 1.11-1.81), lower HbA(1c) (RR, 1.22; 95% CI, 1.12-1.32), and presence of psychiatric disorders (RR, 1.56; 95% CI, 1.23-1.98). Eighty percent of episodes occurred among the 20% of children who had recurrent events. CONCLUSIONS: Some children with diabetes remain at high risk for ketoacidosis and severe hypoglycemia. Age- and sex-specific incidence patterns suggest that ketoacidosis is a challenge in adolescent girls while severe hypoglycemia continues to affect disproportionally the youngest patients and boys of all ages. The pattern of modifiable risk factors indicates that underinsured children and those with psychiatric disorders or at the extremes of the HbA(1c) distribution should be targeted for specific interventions.     

Neck abscess: five year retrospective review of Hospital University Kebangsaan Malaysia experience

The most commonly involved space was the parapharyngeal and superficial anterior triangle followed by submandibular, retropharyngeal, posterior triangle and submental spaces respectively. Thirty-three percent of patients had diabetes mellitus as a predisposing factor. More than half of them had no known aetiological cause for the neck abscess. We encountered one mortality in an elderly patient with diabetes who succumbed to overwhelming septicaemia despite early abscess drainage and intensive medical treatment.     

A review of neurological complications in AIDS

Involvement of the central nervous system is now being recognized as an important aspect of HIV infection. Acting as a sanctuary site, it may pose problems to effective therapeutic strategies. HIV-induced AIDS dementia complex is the commonest mode of presentation. Other causes include opportunistic infections and, more infrequently, malignancies. The precise diagnosis is often difficult to make and requires the judicious use of the CT scan. Treatment has been disappointing and is characterized by frequent relapses.     

Microbiology of acute sinusitis in Mexican patients

Acute bacterial sinusitis is a common disorder affecting children and adults. We performed a study to assess the bacteriology of acute sinusitis in a community hospital in Mexico City. Patients with an acute exacerbation of persistent sinusitis or acute sinusitis were enrolled. Aspiration of sinus secretions was performed and aspirates were sent for culture. All patients received antibiotic treatment for the infection based on microbiologic sensitivity reports. Follow-up consultation included endoscopy and a computed tomography scan of paranasal sinuses to assess response to treatment. A total of 110 patients were enrolled for evaluation. Forty nine percent of patients were women; median age was 31 years. A total of 136 cultures were recovered for analysis. Twenty seven percent of cultures were negative. Isolated organisms were Haemophilus influenzae (26%), Moraxella catarrhalis (15%), Streptococcus pneumoniae (14%), methicillin-sensitive Staphylococcus aureus (7%), enterobacteriaceae (6%), Pseudomonas aeruginosa (2%) and miscellaneous (3%). Twenty eight percent of H. influenzae strains were resistant to ampicillin. Penicillin-sensitive S. pneumoniae (PSSP) and penicillin-intermediate-resistant S. pneumoniae (PISP) accounted for 21% and 79% of the S. pneumoniae strains, respectively. H. influenzae was the most common isolated organism. About 55% of those isolates were found in patients <18 years old and only 25% were resistant to ampicillin. Sinus endoscopy continues to be a useful diagnostic tool in addition to imaging studies in sinus infection and should be pursued by the clinician whenever feasible.