儿童后尿道损伤的诊断与治疗

目的　探讨儿童后尿道损伤更为有效的诊治方法和并发症的防治。方法　回顾性总结分析 1990年 4月～ 2 0 0 3年 12月四川大学华西医院收治的 5 5例儿童后尿道损伤的临床资料 ,38例( 6 9.0 % )获得 6个月～ 14年 (平均 6年 4个月 )的随访。结果　本组几乎均为陈旧性后尿道损伤。尿道狭窄组 10例行尿道带管扩张 ,7例治愈 ,3例改行尿道拖入吻合术 ;尿道闭锁组 ,采用后尿道拖入吻合术 2 9例 ,近期成功率 10 0 % ,远期结果 ,排尿欠通畅 3例 ,部分性尿失禁 4例 ,反复发生附睾炎 2例 ,阳痿 2例 ;经耻骨后尿道成形术 14例 ,近期成功率 86 % ,远期结果 ,排尿困难 2例 ,排尿欠通畅 2例 ,不完全性尿失禁 2例 ,附睾炎 1例 ,阳萎 1例 ;3例阴囊中缝皮瓣拖入间置术中 ,2例发生间置尿道狭窄 ;2例经会阴尿道吻合术疗效满意。结论　尿道狭窄经恰当处理后会有良好的效果 ;经会阴后尿道拖入吻合术在儿童后尿道闭锁的治疗中效果满意 ,经耻骨后尿道吻合术更适用于较复杂的后尿道闭锁治疗 ;我们赞同儿童后尿道断裂伤后早期即时的耻骨上膀胱造瘘 ,延期尿道修复手术的观点     

Congenital posterior urethral obstruction: re-do fulguration

In patients with congenital posterior urethral obstruction, transurethral fulguration (TUF) is usually the treatment of choice if the patient is in a stable condition. However, few papers have described the proportion of patients who need further fulguration. We reviewed 83 boys with a congenital obstructive posterior urethral membrane (COPUM) to assess the role of re-do fulguration, as judged by prospective video recordings. Between December 1990 and March 2000, 83 boys (aged from newborn to 15 years) underwent cystourethroscopy for investigation of a urethral anomaly and were found to have a COPUM. TUF was performed endoscopically with a hook diathermy electrode. Two to 3 months later boys who had cauterisation had a further urethroscopy and diathermy as required. Of the 83 membranous lesions in the posterior urethra, 38 were considered severe, 20 moderate, and 21 minor. Four patients had inadequate data to be properly classified. Eighteen (47.4%) of the 38 patients who had a severe obstructive membrane equired further endoscopic intervention to obliterate residual membrane elements. As over 45% of patients who had a severe obstructing membrane needed further fulguration, it is important to follow patients carefully and to repeat the cystourethroscopy.     

Fetal urinary bladder rupture and urinary ascites secondary to posterior urethral valves. A case report.

Megacystis is a typical prenatal sonographic finding in cases of lower urinary tract obstruction. Urinary bladder perforation represents a rare complication in this condition. We report on a boy with in utero bladder perforation and urinary ascites secondary to posterior urethral valves. The pre- and postnatal therapy is described and the current literature is reviewed.     

Pemphigus vulgaris in childhood. A case report

An 11-year-old girl with vesicles and eroded lesions on her oral mucosa and tongue was diagnosed as having pemphigus vulgaris. The diagnosis was confirmed by histopathologic and immunofluorescence studies. The patient was successfully treated with methylprednisolone and azathioprine. After two months maintenance therapy was started. She is still taking methylprednisolone and azathioprine as maintenance therapy and no recurrence has been observed.     

Congenital scaphoid megalourethra associated with posterior urethral valves

Megalourethra is a very rare mesenchymal congenital anomaly and its association with posterior urethral valves is still rarer. We hereby present such a rare combination and discuss its etiopatho-genesis Accepted: 16 June 1998     

Congenital posterior urethral obstruction: the historical perspective

The currently accepted interpretation of urethral anatomy and pathology in boys is based on studies from the first half of this century, most notably from Hugh Hampton Young and his colleagues. The studies that led to Young's conclusions and the developments in the management allow for reinterpretation, particularly with the advent of prenatal diagnosis and video-endoscopic recording technology.     

Transient pseudohypoaldosteronism secondary to posterior urethral valves--a case report and review of the literature.

In transient pseudohypoaldosteronism (TPHA), renal tubular resistance to aldosterone is thought to be secondary to renal disease. We report a case of TPHA caused by posterior urethral valves associated with urinary tract infection and review 62 cases previously reported. The infant presented with unspecific signs of vomiting and dehydration, so that pyloric stenosis was first suspected. Laboratory data and retroperitoneal sonography led to the diagnosis TPHA. This case illustrates that urine culture and renal ultrasonography should be performed in any infant with electrolyte disturbances to exclude infection or obstructive uropathy.     

Congenital cysts of the pancreas. A case report

The authors report a clinical case of congenital cyst of the pancreas occurred in a female aged 15 months. They stress how this pathology is particularly rare in pediatric age (only 22 cases in the literature) and how it is extremely difficult to formulate a preoperative diagnosis. The young patient was in good general condition with an enormous abdominal tumefaction and without alterations of hematochemical markers. Echographic and tomographic patterns led to four diagnostic hypotheses: a) mesenteric cyst; b) left ovarian cyst or compound ovarian tumor; c) intestinal duplication; d) pancreatic cyst. Only after surgery a correct diagnosis was formulated (on the basis of the topographic position and the intracystic content of amylase and lipase) and a complete resolution of this pathology was obtained. Surgery therefore has the double function of formulating a correct diagnosis and allowing the complete resolution of this pathology. The complete surgical removal of the mass, in view of the benignity of this lesion, is the therapeutic goal.     

Monoclonal B-cell lymphocytosis in early childhood. A case report

A case is reported of a 12-year-old girl with a benign course of a lymphocytosis through years associated with splenomegaly. The lymphocytes simultaneously expressed a monoclonal B-cell phenotype of IgM-kappa and a mature T-antigen using the monoclonal OKT1 antibody. Due to her stable condition, no treatment was required. The immunological results suggest the possibility of an early childhood B-cell chronic lymphoid leukemia.     

Congenital toxoplasmosis in a 15 day-old infant. A case report

A case congenital toxoplasmosis in a 15-day old infant was reported, citing the difficulties encountered in establishing the diagnosis due to the wide range of the disease's clinical spectrum. Congenital toxoplasmosis was suspected after finding hydrocephalus, cerebral calcification, and chorioretinitis. Serology tests with the ELISA technique were highly positive for antibodies against IgG, whereas anti-IgM was negative. The patient died before the second serological analysis was done. The final diagnosis of congenital toxoplasmosis was eventually established at autopsy, based on the detection of T. gondii in the brain, testicular, liver, spleen and striated muscle tissues.     

儿童血汗症1例报告

No abstract available

     

小儿红斑性肢痛症1例

患儿,女,3岁,因双足疼痛2d于2 0 0 3年3月9日入院。患儿于入院前2d无明显诱因出现双足剧烈疼痛,啼哭不止。睡觉时因双足放入被中疼痛加重,迫使双足暴露在被外;抬高双足或冷敷疼痛减轻。病程中无发热,无其他关节肿痛。查体:发育正常,心肺未见异常,四肢关节无红肿、变形,足背血管