儿童癫持续状态病因诊断的评估

癫持续状态(SE)是儿科常见的神经系统危重症之一,其病因复杂。50 a来人们一直在研究SE发生的原因,如中枢神经系统感染、急性脑缺氧损伤、代谢性因素、药物、毒物中毒等与SE的关系已明确,但部分SE患者并无明显病因,提示在SE发生过程中尚有其他病因。若潜在的病因不解除,会对患儿抢救造成困难。因此临床医师应当在第一时间进行儿童SE病因诊断的评估。实用儿科临床杂志,2012,27(10):792-794     

Hematuria in children.

Hematuria is the most common sign of renal lesions in childhood. Most common renal causes are glomerulonephritis, Alport's syndrome and IgA mesangiopathy. Urological and systemic causes are less frequently seen. Diagnostic approach focuses on the clinical presentation of hematuria: gross or microscopic, and accompanying signs or symptoms. Monosymptomatic hematuria causes are variable in each age group. Prognosis of cases with hematuria depends upon the cause.     

Knee pain in children

Knee pain is common in children, particular during adolescence. A detailed history and clinical examination often will identify the likely cause. Health care professionals looking after children and young people should be aware of the common causes of knee pain and red flags which are a feature of more sinister causes. Common causes of knee pain include patellofemoral problems, apophysitis such as Osgood Schlatter's disease and Sinding-Larsen-Johansson Syndrome, osteochondritis dissecans, trauma, rheumatological causes such as juvenile idiopathic arthritis, and infective causes as such septic arthritis and osteomyelitis. Malignancy must be excluded when there are red flag signs. Non-accidental injury and referred pain from the hip if not considered, can be easily missed. This review offers practical advice regarding the assessment of knee pain.     

儿童肝脏酶学异常328例病因分析

目的探讨儿童肝脏酶学异常的病因。 方法对2001年11月至2004年10月以肝脏酶学异常为主要原因,收住复旦大学附属儿科医院的328例患儿通过查阅病历进行回顾性分析。 结果328例患儿中52例(15.9%)未能明确病因,38例存在肝脏酶学异常重叠性疾病(11.6%)。引起儿童肝脏酶学异常的前6位疾病(有重叠)分别为巨细胞病毒(CMV)肝炎(156例)、乙型病毒性肝炎(46例)、甲型病毒性肝炎(30例)、胆管闭锁(30例)、肝豆状核变性(12例)、糖原累积病(12例);CMV肝炎是1岁以下儿童肝脏酶学异常最常见的病因,3岁以上儿童肝脏酶学异常以甲、乙型病毒性肝炎为主。 结论儿童肝脏酶学异常的病因多种多样,仍需深入研究;以CMV肝炎为首因的婴儿肝病综合征及以甲、乙型病毒性肝炎为主的病毒性肝炎是儿童肝脏酶学异常的主要病因,加强上述疾病的防治具有重要意义。     

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目的探讨儿童肝脏酶学异常的病因。方法对2001年11月至2004年10月以肝脏酶学异常为主要原因,收住复旦大学附属儿科医院的328例患儿通过查阅病历进行回顾性分析。结果328例患儿中52例(15.9%)未能明确病因,38例存在肝脏酶学异常重叠性疾病(11.6%)。引起儿童肝脏酶学异常的前6位疾病(有重叠)分别为巨细胞病毒(CMV)肝炎(156例)、乙型病毒性肝炎(46例)、甲型病毒性肝炎(30例)、胆管闭锁(30例)、肝豆状核变性(12例)、糖原累积病(12例);CMV肝炎是1岁以下儿童肝脏酶学异常最常见的病因,3岁以上儿童肝脏酶学异常以甲、乙型病毒性肝炎为主。结论儿童肝脏酶学异常的病因多种多样,仍需深入研究;以CMV肝炎为首因的婴儿肝病综合征及以甲、乙型病毒性肝炎为主的病毒性肝炎是儿童肝脏酶学异常的主要病因,加强上述疾病的防治具有重要意义。     

Renal and endocrine hypertension. A review

Historical prospectives of hypertension studies are introduced. The pathophysiology of hypertension, renin-angiotensin-aldosterone system, urea-angiotensin interactions, and essential hypertension are reviewed. The causes of secondary hypertension, especially the renovascular and endocrine causes in the child, neonate and post-transplant patients are discussed. Comments are made on the medical costs of diagnostic work-up. Treatment for hypertension is summarized.     

基底核钙化30例

目的探讨儿童基底核钙化(BGC)的相关疾病、主要病因和临床特点。方法对CT和检查发现的30例儿童BGC的临床资料进行回顾性分析,总结儿童BGC的临床表现、影像学特点。结果多种因素、疾病与儿童BGC相关,如甲状旁腺功能减退、宫内感染和缺氧、癫、外伤后腔隙性脑梗死等。临床主要表现为抽搐、精神运动发育迟缓、肢体运动障碍等。CT上表现为基底核区局限性点状钙化。结论儿童BGC的临床表现多样。对头颅CT发现的BGC儿童进一步确诊病因,未能确诊病因的BGC儿童应加强随访。     

Common complaints with cardiac implications in children

Chest pain, palpitations, and dizziness are not infrequent complaints in the office of a primary care physician. Historical events and physical findings can lead to a more accurate determination of cardiac causes of these symptoms. Electrocardiogram and chest radiographs are two additional tests most often helpful in determining cardiac causes of symptoms.     

Childhood injuries in the United States. Mortality, Morbidity, and cost

National estimates of the mortality, morbidity, and cost of childhood injuries are presented by specific causes. Motor vehicle-related injuries, homicide, and suicide are the leading causes of childhood injury deaths. Falls and sports-related injuries are the leading causes of hospitalizations and emergency department visits. We estimate that unintentional childhood injuries cost the nation $7.5 billion in 1982. The highest direct costs per year for unintentional injuries are attributable to falls, sports, and motor vehicle occupant injuries, while the highest indirect costs are related to motor vehicle occupant injuries, pedestrian injuries, and drowning. Injury accounts for 78% of the total fatalities among late adolescents (age 15 to 19 years), the pediatric age group at highest risk for injury mortality. A stronger federal and state commitment is needed to prevent childhood injury.     

婴儿胆汁淤积症的病因研究进展

婴儿胆汁淤积症是一类多因素引起的以高胆红素血症为临床特点的综合征,病因谱广泛,包括感染、中毒、肝内外胆管发育异常及遗传代谢缺陷等.感染、胆道闭锁患儿占胆汁淤积症患儿半数以上,除了常见病因,citrin缺陷症、Alagille综合征、进行性家族性胆汁淤积症等新病因不断被认识,这些疾病临床症状与胆道闭锁相似,预后及治疗各不...     

Anterior urethral valves

Posterior urethral valves (PUV) are the most frequent cause of obstructive uropathy in boys. Rarer causes of obstructive uropathy include bladder diverticulae, meatal stenosis and urethral or bladder stones. Anterior urethral valves are rare causes of urinary obstruction in boys and are ten times less frequent than PUV in the literature(1-6). This paper highlights our experience with 5 patients with anterior urethral valves.     

Acquired coronary disease in children: the role of multimodality imaging

Coronary sequelae of Kawasaki disease, post-surgical coronary lesions and cardiac allograft vasculopathy are the main causes of acquired coronary pathology in childhood. Surveillance and timely recognition of coronary problems in children who are at risk of ischemic events are imperative and noninvasive imaging is increasingly utilized for these purposes. Herein, we summarize the causes of acquired coronary disease in children and discuss the role of various imaging techniques that are available to establish the diagnosis and guide management.     

Altered mental status

Altered mental status is a sign of serious neurologic or systemic disease. The physician must rapidly assess the depth of coma and risk of intracranial hypertension, then determine the etiology and prescribe appropriate management. This is no small task, considering the variety and multitude of illnesses that may present with altered mental status. The etiologies can be broken down into structural and medical causes. The structural causes more frequently affect the brainstem centers adjacent to the ascending reticular activating system that are responsible for pupillary response and oculocephalic reflexes. Medical causes generally spare these structures. Management of structural lesions requires prompt diagnosis and neurosurgical input. Medical etiologies are protean and treatment is often supportive.     

新生儿心肌病诊治进展

新生儿期的心肌病有不同于其他年龄组的特点。新生儿原发性心肌病主要有心内膜弹力纤维增生症、家族性肥厚型心肌病和心肌致密化不全。继发性心肌病病因主要包括心肌炎、心肌功能不全（围生期窒息和左冠状动脉起源异常等疾病所致）和代谢障碍。临床表现不典型,应重视病因诊断并进行综合治疗。     

体外循环下心脏术后发热的原因

体外循环下心脏术后发热作为一种临床常见并发症开始引起临床医师的关注.发热机制包括体液学说和神经学说.术后发热原因可简单分为非感染性发热和感染性发热.非感染性发热常见于炎性反应、自身免疫反应、药物及输血等.感染性发热常见于呼吸道感染、切口感染及血行感染等.现就体外循环下心脏术后的发热原因进行概述.     

重庆地区202例儿童慢性咳嗽的病因研究

目的 探讨儿童慢性咳嗽的病因构成。方法 对2015年5月至2017年11月于重庆医科大学附属儿童医院住院治疗的202例慢性咳嗽患儿的临床资料进行回顾性分析。结果 202例患儿的病因分布为：感染后咳嗽81例（40.1%）,咳嗽变异性哮喘71例（35.1%）,上气道咳嗽综合征43例（21.3%）,异物吸入3例（1.5%）,胃食管反流性咳嗽1例（0.5%）,多发性抽动症2例（1.0%）,先天性呼吸道疾病1例（0.5%）。119例（58.9%）慢性咳嗽是单病因所致,83例（41.1%）有多种病因。不同年龄组（< 1岁、1岁~、3岁~、6~14岁）和不同咳嗽性质组（湿咳、干咳）慢性咳嗽病因构成差异均有统计学意义（P < 0.01）。结论 儿童慢性咳嗽的前三位主要病因为：感染后咳嗽、咳嗽变异性哮喘和上气道咳嗽综合征;不同年龄阶段及不同咳嗽性质的患儿其慢性咳嗽的主要病因存在差异。     

An 11-Month-Old With Vomiting,Altered Mental Status,and Hypoventilation

Vomiting is a common pediatric complaint seen frequently in both pediatric and general emergency departments. Obstructive causes of vomiting are rare outside of the newborn period compared to more benign causes such as viral gastroenteritis. Timely recognition of these rarer causes of obstruction is essential for optimal care. This case highlights a severe presentation of chronic isolated vomiting caused by obstruction. It serves as a strong reminder to emergency care providers that obstruction can occur outside of the newborn period and, if unrecognized, can result in significant morbidity.     

Adolescent mortality in the city of Rio de Janeiro from 1981 to 1995: how many deaths could be prevented?

OBJECTIVE: This paper examines the main causes of mortality among adolescents ages 10 to 19 in the city of Rio de Janeiro with a focus on mortality prevention. METHODS: Mortality data from 1981 to 1995 were taken from the Mortality Information System of the Brazilian Ministry of Health. Age and sex specific mortality rates were calculated for the main causes of death covering three discrete time periods (1981-85, 1986-90 and 1991-95). RESULTS: Rates of homicides and fatal injuries by firearms have increased for adolescents of both sexes during the period studied. Among adolescent males the increase was from 46.5 /100,000 (between 1981 and 1985) to 105.8/100,000 (1991- 1995). Among adolescent females, mortality rates attributable to the same external causes presented a growth from 3.1/100,000 (1981-1985) to 7.8/ 100,000 (1991-1995). Geographic analysis indicates that the harbor area of the city and vicinities reflect higher indices of firearmsrelated deaths. For the same time period, non-external causes of death declined. Malignant neoplasias and pneumonia, the most frequent non-external causes of death, are decreasing. The rates of complications involving immune deficiencies have increased from nonexistent to 1.2 /100,000 during the last period (1991-1995) studied. CONCLUSION: The main causes of deaths among adolescents in the city of Rio de Janeiro are preventable. We propose that health professionals be attentive to this fact to prevent unnecessary deaths through health promotion.     

Secondary nocturnal enuresis

Secondary nocturnal enuresis accounts for about one quarter of patients with bed-wetting. Although a psychological cause is responsible in some children, various other causes are possible and should be considered. This article reviews the epidemiology, psychological and social impact, causes, investigation, management, and prognosis of secondary nocturnal enuresis.     

Dysmenorrhea and pelvic pain in adolescents.

Dysmenorrhea and pelvic pain are common complaints in the adolescent population. Although most cases are primary dysmenorrhea and easily treated with NSAIDs or OCPs, pathologic causes should be considered, especially in cases not responding to standard medical management. Endometriosis is the most common finding in teenagers who do not respond to this regimen, but müllerian anomalies and musculoskeletal causes must also be considered.