Immunogenicity and reactogenicity of a novel hexavalent DTPa-HBV-IPV/Hib vaccine compared to separate concomitant injections of DTPa-IPV/Hib and HBV vaccines,when administered according to a 3, 5 and 11 month vaccination schedule

In an open randomised trial, 312 eligible infants were enrolled to receive either a single injection of the hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio/ Haemophilus influenzae b (DTPa-HBV-IPV/Hib) vaccine, or concomitant injections of commercial DTPa-IPV/Hib and HBV vaccines (comparator). Vaccines were administered at 3, 5 and 11 months of age. The statistical approach for non-inferiority showed that the DTPa-HBV-IPV/Hib vaccine was at least as immunogenic as the comparator vaccines in terms of immunogenicity of all antigens 1 month after the 2nd dose. Non-inferiority criteria were also met immediately before and 1 month after the 3rd dose for all antigens except poliovirus type 3 prior to the 3rd dose. The majority of subjects were seroprotected against diphtheria, tetanus, polyribosyl-ribitol-phosphate, hepatitis B and poliovirus after the 2nd dose and maintained seroprotective antibody levels until the 3rd dose. A marked difference was observed in anti-HBs antibody geometric mean antibody concentrations (GMCs) at 1 month after the 2nd dose (higher GMCs in DTPa-HBV-IPV/Hib group). Reactogenicity (incidence of solicited local and general symptoms) was similar between the two study groups and no vaccine-related serious adverse events occurred. CONCLUSION: the new diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio/ Haemophilus influenzae b vaccine administered at 3, 5 and 11 months of age was safe and at least as immunogenic as the comparator vaccines thus providing an effective and more comfortable option for this infant vaccination schedule.     

Feeding,growth, and biochemical studies in very low birthweight infants.

Fifty infants of gestational age 28 to 32 weeks and birthweight less than 1501 g were reviewed on the expected date of delivery and at conceptional ages of 4, 8, and 12 months. All infants were at home by the expected delivery date, were fed on demand, and weighed regularly. On the expected delivery date and at 4 months, the amounts of formula milk and weaning food accepted were recorded; energy and protein intakes were calculated; and serum sodium, potassium, urea, protein, and osmolality were measured. The birthweight of these infants ranged between the 3rd and 75th centiles (on average about the 20th) but at the expected delivery date was, on average, below the 3rd centile. Infants who had been weaned in the first 4 months after the expected delivery date (n = 26) had similar energy and protein intakes and similar biochemical indices to those weaned later (n = 24). They achieved catch up growth (below 3rd to 10-25th centile) by 1 year, irrespective of the time of weaning and without any differences in metabolic ''stress''.     

胃镜下球囊扩张治疗小儿溃疡性幽门狭窄

目的探讨溃疡性幽门狭窄形成持久性(外科性)幽门梗阻的新的治疗方法。方法对10例幽门口(管)溃疡并狭窄患儿,在静脉复合麻醉下,通过胃镜直视用CRE三级扩张食管球囊行幽门扩张,观察术后腹痛、黑便、呕吐的发生,同时随访术后3、6、9、12个月恢复饮食种类、幽门大小、体重、身高情况。结果总有效率达100%,6～9个月复查胃镜和随访,幽门直径≥12mm,5例可进食普食,4例可进食软饭;8例患儿生长发育赶上同龄儿,占80%。结论CRE三级食管球囊行幽门扩张治疗溃疡性幽门性狭窄,该方法操作简单、效果确切、安全性好。     

The influence of valproic acid treatment on hair and serum zinc levels and serum biotinidase activity

Some of the side effects that develop during long-term valproic acid (VPA) treatment are similar to symptoms of zinc and partial biotinidase deficiencies. This situation suggests an association between these side effects and biotinidase and/or zinc deficiencies. In 32 pediatric patients (22 females, 10 males) receiving VPA treatment, hair and serum zinc levels and serum biotinidase activity (BA) were measured prior to and in the 3rd and 6th months of treatment. Also, serum VPA levels were measured in the 3rd and 6th months of treatment. The mean serum and hair zinc levels were found to be reduced in the 3rd and 6th months of treatment as compared with the pre-treatment values, while the mean serum BA was lower than the pre-treatment values in the 3rd month of treatment, but returned to initial values in the 6th month of treatment. In the 3rd and 6th months of treatment, patients complaining about hair loss had lower hair and serum zinc levels and serum BA but greater mean serum VPA than those who did not. However, the differences between parameters were not statistically significant. Our findings suggest that hair loss in patients can be attributed to zinc and BA depletion within the first 3 months, and to zinc depletion only by the 6th month.     

胃镜直视下球囊扩张术治疗小儿食管狭窄

目的 探讨胃镜直视下球囊扩张治疗小儿食管狭窄的安全性和有效性.方法 12例食管狭窄患儿,其中食管闭锁术后吻合口狭窄7例、先天性食管狭窄3例、腐蚀性炎性狭窄2例,年龄5～59个月,在静脉复合麻醉和气管插管下,通过胃镜直视用控制辐射状扩张(CRE)三级扩张球囊行食管狭窄扩张.观察术后腹痛、黑便、呕吐的发生,同时随访术后3～12个月恢复饮食种类,狭窄口大小、营养情况.结果 12例共进行22次扩张,19次成功,3次术后出现并发症,扩张成功率为86%.12例中,3例扩张失败,9例扩张成功、症状改善,有效率为75%.扩张前狭窄口直径2～8 nun,3～12个月后复查胃镜和随访,狭窄口直径9～13mm,8例可进食固体食物、营养状况改善.结论 CRE三级食管球囊行食管狭窄扩张治疗,操作简单、效果确切,食道闭锁术后吻合口狭窄的扩张效果较好.     

婴儿夜晚睡眠模式发展的前瞻性研究

目的 了解婴儿生后第1 年夜晚睡眠模式的发展规律.方法 采用非侵入性的睡眠监测仪Actiwatch 监测50 名在重庆市妇幼保健院出生的健康足月新生儿的12 项婴儿夜晚睡眠参数.监测时间为生后第10 天、28 天,以及2、3、4、5、6、9、12 月龄的第1 个星期二,每次连续监测60 h.采用二水平混合效应模型进行统计学分析.结果 22 名男童和25 名女童完成了为期1 年的纵向随访.从生后第10 天到12 月龄,夜间入睡潜伏期3 月龄时降低了48%,6 月龄时降低了83%;夜晚睡眠效率从66% 增加到87%;夜晚睡眠总时间从416 min 增加到517 min;夜晚最长连续睡眠时间从197 min 增加到327 min.夜晚睡眠效率、夜晚睡眠总时间和夜晚最长连续睡眠时间均随年龄增大呈增长趋势(PPP结论 婴儿夜晚睡眠模式在生后前半年,尤其生后3 个月内发展迅速.婴儿期部分睡眠参数与性别有关.     

儿童双侧肾母细胞瘤手术治疗的探讨

目的 总结探讨儿童双侧肾母细胞瘤综合治疗的疗效及随访结果。方法 回顾性分析我院白1998年8月至2010年8月手术治疗的双侧肾母细胞瘤患儿临床资料。结果 7例双侧肾母细胞瘤中,男性患儿3例,女性患儿4例,发病年龄最大21个月,最小6个月,平均年龄( 12.71±4.89)个月。临床表现腹部肿块7例(7/7),血尿1例(1/6),贫血2例(2/6),4(4/7)例活检明确病理经术前化疗后手术,3例先手术后化疗,1例化疗2个疗程疾病进展,家属放弃治疗后死亡,5例结束整个疗程随访中,4例带瘤生存,1例随访7个月后残余肿瘤病灶消失,随访时间最长10年,最短10个月,1例术后化疗中,2年存活率85.7％。结论 儿童双侧肾母细胞瘤通过手术、化疗及放疗综合治疗,可以带瘤生存。     

Recovery of Natural Killer Cells After Chemotherapy for Childhood Acute Lymphoblastic Leukemia and Solid Tumors

Recovery of natural killer (NK) cells after cessation of chemotherapy for childhood acute lymphoblastic leukemia (ALL) and solid tumors was investigated in 25 children aged 3 to 18 years. The numbers of CD3-CD56+, CD16+, and CD8-CD57+ cells in peripheral blood were analyzed with monoclonal antibodies and flow cytometry at 0, 1, 3, 6, 9, and 12 months after discontinuation of therapy. The CD3-CD56+ and CD16+ cell counts of ALL patients (n = 14) were below the mean -1SD values of controls at cessation but normalized within one month due to a rapid 2.1 and 4.5 fold increase, respectively. The CD8-CD57+ cell count of ALL patients was normal compared to controls at cessation. In solid tumor patients (n = 11), the counts of all NK cell phenotypes studied were of normal amount compared to controls at cessation and no vigorous increase occurred after the therapy. NK cell function was determined by killing K 562 target cells in five patients. In the two standard risk ALL patients tested, the activity was still low at 5 months after therapy. In contrast, the function was normal at 1 month (Wilms' tumor), 3 months (Mb Hodgkin's) and 6 months (Burkitt lymphoma). In conclusion, NK cell counts were decreased compared to controls during therapy for ALL, but recovered rapidly afterwards. In spite of normal counts, NK cell function may be impaired for several months. The number and function of NK cells is less affected in solid tumor patients. These differences may reflect the milder immunosuppressive effect of interval cytostatic medication in solid tumor patients when compared to the more intensive continuous therapy in ALL patients. © 1995 Wi1ey-Liss, Inc.     

The treatment of retinoblastoma with four-drug regimen including Cisplatin, Etoposide, vincristine, and cyclophosphamide

Over an 11-year period, 59 patients (83 eyes) were treated with four-drug chemotherapy (cisplatin, etoposide, cyclophosphamide, and vincristine) at Hacettepe University, Departments of Ophthalmology and Pediatric Oncology. We evaluated the clinical features, treatment modalities, and outcome of these patients with a median follow-up of 55 months (range 9-130 months). Enucleation was performed as a first-line treatment for 30 eyes due to iris neovascularization and neovascular glaucoma, tumor in the anterior chamber regardless of the tumor stage, and for the patients with the Reese-Ellsworth (RE) group Vb. Chemotherapy was given regardless of tumor stages according to the RE groups in all 59 patients (83 eyes). Fifty-three eyes were treated with chemoreduction (CRD) and focal treatment. The rates of globe preservation were 87% for bilateral tumors and 35% for unilateral tumors in the CRD group. The 5-year overall (OS) and enucleation-free survival (EnFS) was 86.9% and 40%, respectively, for the whole group. At 3rd year, ocular survival rate for the eyes with vitreal or subretinal seeding was 58% and without seeding was 66% (P = .78). Seeding or subretinal collection may not indicate poor prognosis under intensive chemotherapy. The intensive four-drug chemotherapy protocol might have satisfactory results in the retinoblastoma (RBL) patients.     

Megestrol acetate treatment of growth failure in children infected with human immunodeficiency virus

OBJECTIVE: To evaluate the effect of megestrol acetate on weight gain and linear growth in human immunodeficiency virus-infected children with growth failure. METHODS: All human immunodeficiency virus-infected children with growth failure treated with megestrol acetate at our institution were evaluated retrospectively. Weight, height, and weight:height ratio were documented from 6 months before initiation of megestrol acetate until 6 months after treatment was discontinued. Measurements were corrected for age and sex by conversion to z-scores. Incremental growth was determined before, during, and after treatment. The potential effects of CD4+ T-lymphocyte count and percentage, antiretroviral therapy, and intercurrent illnesses on growth were evaluated. RESULTS: Nineteen patients were treated with a total of 27 courses of megestrol acetate. The median duration of therapy was 7 months (range, 3 to 11 months), and the median megestrol acetate dose was 7.91 mg/kg/day (range, 4.06 to 8.56 mg/kg/day). From 6 months and 3 months before treatment to the onset of therapy, median changes in weight z-scores were -.27 and -.15, respectively. During megestrol acetate treatment, median changes in weight z-scores were +.29 after 1 month of therapy, +.40 after 3 months, and +.57 after 6 months. After megestrol acetate therapy was discontinued, poor weight gain and weight loss resumed. Median 6-month growth velocities for weight were less than the 10th percentile before megestrol acetate, greater than the 97th percentile during treatment, and less than the 3rd percentile after treatment was discontinued. Megestrol acetate therapy was not associated with changes in linear growth. Antiretroviral therapy, CD4+ T-lymphocyte count or percentage, or intercurrent illnesses were not associated with statistically significant differences in response to megestrol acetate therapy. CONCLUSIONS: Megestrol acetate treatment of growth failure in pediatric human immunodeficiency virus disease is associated with weight gain, without affecting linear growth.     

What is a normal rate of weight gain in infancy?

We have retrieved weights from the Child Health records of an annual cohort of 3418 full-term children, aged 18–30 months in order to define a lower limit of normality for weight gain for both clinical and research purposes. There was a strong tendency for children at the extremes of the distribution to move inwards towards the average: only 26% of those below the 3rd centile for weight at six weeks were still below it at one year. We describe a method based on conditional standards to correct for this "regression to the mean" and produce a measure of the discrepancy between a child's predicted and actual growth: the "thrive index". The value of the thrive index below which only a minority of children fell provided a lower threshold for normality. While most children below the 3rd centile for weight at 9–24 months of age also had subnormal weight gain, 41 % of those with subnormal weight gain had not fallen below the 3rd centile.     

脑白质损伤早产儿血清髓鞘碱性蛋白和S1OOB蛋白的变化及与预后的关系

目的 探讨脑白质损伤( periventricular leukomalacia,PVL)患儿血清髓鞘碱性蛋白(myelin basic protein,MBP)及S100B蛋门(S100B protein,S100B)的动态变化及其与患儿预后的关系.方法 对2007年11月至2008年7月我院住院的78例PVL早产儿(PVL组)和43例正常早产儿(正常对照组),分别在其生后第1、3、7、14天测定血清中MBP及S100B含量.30例正常早产儿及69例PVL患儿出院后每3个月随方1次,直至纠正胎龄至1岁,用Gesell发育量表测定其智力以及运动发育情况.结果 (1) PVL组患儿血清MBP于生后第1天升高[(7.61±1.78) μg/L]、第3天达峰值[( 14.53±3.12) μg/L],后随病情好转,逐渐降低;与正常对照组比较,PVL组患儿在生后第1、3、7、14天血清MBP水平均明显高于正常对照组(P＜0.05).(2) PVL组患儿血清S100B水平在生后第1、3、7天明显升高[(3.82±0.68),(4.41±0.91),(5.78±1.54) μg/L],第7天达峰值,与正常对照组比较,差异有统计学意义(P＜0.05);至生后第14天时,S100B明显降低,两组比较已无明显差异(P＞0.05).(3) PVL组患儿生后第7天血清S100B、MBP持续升高者,随访至1岁时其发育商比生后第7天血清S100B及MBP明显下降者落后;也明显落后于正常早产儿(P＜0.05).结论 PVL患儿生后血清MBP及S100B水平与病情严重程度相关.如患儿血清MBP及S100B持续升高超过7d,则发育商明显落后,预后不良.     

A study of attitudes of practising doctors to infant feeding

The attitudes of 264 practitioners towards infant feeding were studied between January and December 1972. Information was collected by questionnaire technique. Of the 264 respondents, 200 were qualified and 50 were interns undergoing training at the local Medical College in Jabalpur, India and 14 were licentiates. Most qualified practitioners recommended breast feeding up to 6-24 months. An increasing tendency to recommend breast feeding for shorter periods (6-12 months only) and not exclusively beyond 6 months was apparent among practitioners qualifying more recently, i.e., after 1965. The majority of the practitioners recommended that breast feeding be initiated within 12-48 hours after birth, but licentiates advocated beginning breast feeding on the 2nd and 3rd days. The majority of practitioners recommended delayed supplementation with milk. Most of them preferred cow's milk because of "easy digestibility." Only 1/5 of the qualified practitioners advocated introduction of mixed feeds by the 3rd month of age. Interns stated that breast feeding should be continued up to 12 months, not exclusively, but supplemented with milk and solid feeds. The majority felt that breast feeding should be started within 6 hours. The advice on feeding and nutrition provided by graduate practicing doctors to patients was unsatisfactory. The feeding advice was based on prevailing cultural practices and tradition and not on sound scientific principles. This was the result of cultural taboos and prejudices rather than a lack of information. There was a marked difference between the attitude of doctors graduating recently and those who graduated before 1966. This seems to be due to the recent emergence of pediatrics as a discipline in medical colleges and therefore of its improved teaching.     

儿童非肾母细胞瘤肾脏肿瘤的临床治疗探讨

目的总结和探讨儿童非。肾母细胞瘤肾脏肿瘤的治疗方法。方法1998年7月至2010年7月我们共收治非肾母细胞瘤肾脏肿瘤患儿18例,其中男性14例,女性4例,年龄最大9岁,最小2个月,平均年龄（40．17±34．04）个月,术后病理诊断包括肾透明细胞肉瘤9例（9／18,50％）,肾横纹肌样瘤2例（2／18,11．1％）,肾癌2例（2／18,10．1％）,肾中胚层。肾瘤1例（1／18,5．56％）,后。肾间质瘤1例（1／18,5．56％）,后肾腺瘤1例（1／18,5．56％）,肾血管平滑肌脂肪瘤1例（1／18,5．56％）,肾原始神经外胚叶瘤1例（1／18,5．56％）。结果随访9例肾透明细胞肉瘤,8（8／9）例无瘤生存,最长随访时间5年,最短2个月,平均随访时间（24．56±17．27）个月,1例手术化疗后下腔静脉瘤栓残留水平至右心房入口,放弃治疗1．5年后死亡。2例肾横纹肌样瘤经手术、放疗及化疗,随访3年和4年均无瘤存活。2例。肾癌单纯手术切除,密切随访25个月、13个月无复发及转移。1例。肾原始神经外胚叶瘤经手术及化疗,随访16个月无瘤存活。1例肾中胚层肾瘤、1例后。肾间质瘤、1例后。肾腺瘤、1例肾血管平滑肌脂肪瘤均完整切除,现最长随访时间4年,最短1年,无一例复发。结论儿童非肾母细胞瘤肾脏肿瘤所占比例虽小,但临床鉴别诊断困难,病理诊断非常重要,手术、化疗及放疗综合治疗是诊治的首要选择。     

Development of body weight and height of small-for-gestational-age infants in relation to the degree of intrauterine retardation]

The increase of weight of 238 hypotrophic and 31 eutrophic newborns is analyzed and assigned to 4 clusters in the course of their first 21 months. It is compared with body weight curves by Prader. Cluster 1 Increase in weight about the 50th percentile Cluster 2 Increase in weight between the 50th and 3rd percentile Cluster 3 Increase in weight just below the 3rd percentile Cluster 4 Increase in weight clearly below the 3rd percentile More than a half of all hypotrophic newborns had a body weight below the 3rd percentile by Prader (cluster 3 and 4) on attaining the age of 21 months. The appearance of hypotrophy in the newborns is subdivided into 4 groups by means of gestational age and relative birthweight: Group 1 eutrophic and moderate hypotrophic (n = 77) Group 2 premature and moderate hypotrophic (n = 46) Group 3 eutrophic and distinct hypotrophic (n = 62) Group 4 premature and distinct hypotrophic (n = 53) We found that the increase of weight correspond to cluster 4 in 4% of group 1, in 22% of group 2, in 32% of group 3, and in 43% of group 4. At last the increase of body weight is hard influenced in the first 3 years of life by hypotrophy and degrees of maturity of the newborns.     

Childhood choroid plexus neoplasms

Fourteen children less than 2 years old with choroid plexus papilloma (CPP) were studied. Of these patients nine had the tumor in the lateral ventricles (LV), three in the fourth ventricle (4th V), one in the third ventricle (3rd V) and one in the third and left lateral ventricle (LLV). Ten cases showed benign CPP, three cases malignant CPP, and one case had a venous malformation of the choroid plexus (VMCP). Computed tomography (CT) was the best method for neuroradiological study, although a very small CPP in the 3rd V was not detected in an early study. Malignant and benign CPP can be differentiated with CT, especially if the study is performed with contrast media. Pneumoencephalography must be rejected because it is very dangerous and may be the cause of death in some cases. The follow-up of patients with CPP showed a poor prognosis, even after correctly removing the tumor and inserting a shunt.     

Successful antiangiogenic therapy of giant cell angioblastoma with interferon alfa 2b: report of 2 cases

We describe 2 cases of angioblastoma, a rare, destructive pediatric tumor, treated with interferon alfa 2b (IFNalpha2b). The first patient is a 10-month-old male who presented with an ulcerated palatal neoplasm that could not be completely resected. The second is a male neonate with a congenital tumor of the right hand that invaded the hypothenar eminence, destroying the fourth and fifth metacarpals. Biopsy in both patients was interpreted as giant cell angioblastoma. Angioblastoma is rare; there is only 1 reported case that necessitated amputation of an upper extremity, also initially recommended for our patient. Because there is little experience with chemotherapy, permission was granted to employ an antiangiogenic regimen of IFNalpha2b. The angiogenic protein, basic fibroblast growth factor (bFGF), was abnormally elevated in both patients. Both patients received IFNalpha2b. In the first child, it was used after incomplete resection, because biopsy-proven tumor was present at the margin and in the nasopharynx. Biopsies 15 months after initiation of IFN2alphab were negative for tumor. Therapy was stopped after 3 years. Eighteen months later, the patient remains disease-free. In the second child, IFNalpha2b was started after debridement of the ulcerated tumor. Over 11 months, the tumor completely regressed and there was bony regeneration of the metacarpals. The fifth digit was amputated because of damage to the metacarpophalangeal joint by the tumor. IFNalpha2b therapy was discontinued after 1 year of treatment, and the child remains disease-free 2 years and 8 months later. In conclusion, this report demonstrates that: 1) a bFGF-overexpressing low-grade tumor can respond to IFNalpha2b in a manner similar to life-threatening infantile hemangiomas, 2) urinary bFGF levels can help guide IFNalpha dosage in such patients, and 3) although bFGF-mediated tumor angiogenesis is inhibited by IFNalpha, physiologic angiogenesis seems to be unaffected.     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的　 探讨尿内皮素 (ET)、尿微量蛋白 (a1 M、TRF、Alb)在新生儿窒息肾脏损害中的意义。 方法 　窒息组在生后第 3天、第 7天采用放射免疫法测定尿ET ,同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。 结果 　发现窒息组第 3天尿ET含量明显高于对照组 (P <0 0 1)。且重度窒息组 >轻度窒息组 >对照组。第 7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组 ,但统计显示无明显差异 (P >0 0 5 )。尿微量蛋白 (a1 M、TRF、Alb)变化与尿ET呈正相关 (P <0 0 1)。 结论 　尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系     

伴有染色体1p36缺失的高危神经母细胞瘤自体造血干细胞移植巩固治疗的近期疗效分析

目的总结和分析伴有染色体1p36缺失的高危神经母细胞瘤(HR-NB)的临床特征,分析这些患儿经过自体造血干细胞移植巩固治疗后的近期疗效,为进一步提高HR-NB生存率提供参考依据。方法回顾性分析2014年4月-2016年4月,北京儿童医院血液肿瘤中心收治的HR-NB患儿的临床资料。HR-NB诊断标准、临床分期、治疗方案和疗效标准均根据北京儿童医院HR-NB方案(BCH-HR-NB-2007),入组患儿为同时伴有染色体1 p36缺失,且均经过系统治疗和随访的HR-NB。随访至2016年12月31日。结果入组患儿共11例(男4例,女7例),平均年龄43个月,临床分期均为INSS-Ⅳ。肿瘤原发于后纵隔3例,腹膜后或肾上腺8例。骨髓转移11例,骨骼转移10例,均为多发骨转移,远处淋巴结转移6例,肝脏等内脏转移5例,中枢转移2例。伴有N-myc基因扩增4例。全部患儿术前化疗4~5个疗程,回输干细胞计数为(2.62~10.68)×10~6/kg,中位随访时间14.9(9~32)个月。4例患儿复发或进展,其中1例停维甲酸3个月后骨髓复发,放弃治疗后死亡;另3例分别于干细胞回输后第3、5和6个月,维持治疗中肿瘤进展,2例放弃后死亡,1例仍在治疗中。余7例患儿处于肿瘤稳定状态。结论伴有染色体1 p36缺失的HR-NB患儿,骨髓和骨骼转移率极高,约1/3同时伴有N-myc基因扩增。自体造血干细胞移植巩固治疗后3~6个月内,仍然容易出现肿瘤进展。提示肿瘤恶性程度高,很容易进展或复发,在干细胞移植巩固治疗后维持治疗期间仍需要增加全身治疗的强度。     

小儿先天性中胚叶肾瘤

目的：探讨小儿先天性中胚叶肾瘤（ＣＭＮ）的临床特点、诊断及治疗。方法：近２０年间收治ＣＭＮ７例，男４例，女３例，年龄７个月～１０岁。术前均可扪及一腹部肿块，其中１例伴肉眼血尿，病变位于左侧４例，右侧３例。全部病例均接受了手术治疗，２例证实有肾门旁肿瘤转移，病理检查属平滑肌瘤型５例，细胞型２例，因术前及术中疑诊为Ｗｉｌｍ＇ｓ瘤而接受了不同疗程化疗。结果：除１例２个月龄患儿术后死于窒息外，余６例术后均随访，１例术中肿瘤破裂者术后８个月复发，化疗无效后再次手术已无瘤生存９年，余５例无瘤生存至今，最短５年，最长已１５年。结论：ＣＭＮ是一罕见的肾肿瘤，虽好发于新生儿及婴儿早期，但也可见于年长儿，其临床表现和病理改变虽有诸多特点，但有时仍难与Ｗｉｌｍ＇ｓ瘤区别，手术切除是治疗本病最有效的方法