异位胃黏膜显像诊断梅克尔憩室的价值

目的探讨99mTcO4-异位胃黏膜显像鉴别梅克尔憩室的临床价值。方法对25例不明原因消化道出血患儿进行99mTcO4-异位胃黏膜显像,腹部出现局限性放射性异常浓聚灶,诊断为梅克尔憩室。结果3例显像为阳性,经手术和病理证实为梅克尔憩室。22例经其他辅助检查确诊为其他原因引起消化道出血。其在诊断梅克尔憩室中具有很高灵敏度、准确性和特异性。结论异位胃黏膜显像简单易行、安全、无创伤,可作为小儿消化道出血鉴别诊断的首选影像学检查。     

99TcmO4-异位胃黏膜显像诊断小儿梅克尔憩室并出血的价值

目的 评价99TcmO4-异位胃黏膜显像诊断小儿梅克尔憩室的价值.方法 对有便血史、临床疑诊为梅克尔憩室的43例患儿行99TcmO4-异位胃黏膜显像.显像前禁饮食4 h以上,静脉注射99TcmO4-(111～185 MBq)后立即动态及30 min、1 h、2 h静态采集图像.23例患儿行小肠造影.将99TCmO4-显像结果与小肠造影结果及临床最终诊断结果进行对比、评价、分析.结果 43例患儿中99TcmO4-异位胃黏膜显像阳性且核医学医师诊断为梅克尔憩室27例,其中术后病理证实为梅克尔憩室26例,肠重复畸形1例.阴性16例中3例为梅克尔憩室,13 例非梅克尔憩室.诊断灵敏度为89.7%,特异性为92.9 %,阳性预测值为96.3%.阳性病例影像多表现为动态影像上与胃同时或稍晚出现异常核素浓聚灶,多位于右腹股沟区,呈圆形或类圆形,随时间延长渐增浓;静态影像上仍可见该浓聚灶,随时间延长其位置、形态、大小变化不大.99TcmO4-异位胃黏膜显像与小肠造影比较,诊断灵敏度(χ2=3.08,P>0.05)、特异性(χ2=0.28,P>0.05)差异均无统计学意义.结论 99TcmO4-异位胃黏膜显像诊断梅克尔憩室灵敏度、特异性高,无创、安全、简便且无痛苦,应作为诊断梅克尔憩室并出血的首选影像学方法.     

放射性核素显像诊断儿童小肠重复畸形并出血

目的 探讨高锝酸盐(99mTcO4-)腹部显像诊断小儿小肠重复畸形并出血的影像特征及其意义.方法 检查当日禁食水,年龄小或不能配合者予镇静剂(苯巴比妥0.1 g/支,3 mg/kg,肌注).静脉注入99mTcO4-(7.4～11.1 MBq/kg),以脐为中心进行采集,每5 min采集一帧前位或后位图像,每帧计数500 K,显像至60 min,个别病例显像至120 min.结果 放射性核素显像诊断为消化道重复畸形患儿9例,其中5例为小肠重复畸形,3例为梅克尔憩室,1例为空肠系膜海绵状血管瘤,均经手术病理检查证实.其显像阳性特征为注射显像剂5 min,在胃显像同时见腹部局限性异常放射性浓聚,部位以脐周最多见,其次是腹下区及左右腹股沟区.浓聚区内放射性分布不均,范围大小不等,位置相对固定,形状各异,60 min不消失.结论 小肠重复畸形在99mTcO4-异位胃黏膜显像中,有特征性影像学表现.放射性核素显像诊断小儿消化道重复畸形简便、有效,可为手术治疗提供重要诊断依据.     

异位胃粘膜显像对小儿消化道出血的诊断价值

高锝酸盐（^99mTcO4^-）异位胃黏膜显像对胃粘膜异位症具有独特的诊断价值，该方法简单、无创、准确性高。已广泛应用于临床。本文对近4年来38例高锝酸盐异位胃黏膜显像阳性的Meckel’s憩室和肠重复畸形患儿的临床特征、显像结果进行分析。并与手术结果和病理诊断进行比较。     

异位胃粘膜显像对小儿消化道出血的诊断价值

高锝酸盐(99 mTcO4-)异位胃黏膜显像对胃粘膜异位症具有独特的诊断价值,该方法简单、无创、准确性高,已广泛应用于临床。本文对近4年来38例高锝酸盐异位胃黏膜显像阳性的Meckel’s憩室和肠重复畸形患儿的临床特征、显像结果进行分析,并与手术结果和病理诊断进行比较。1资料与方法1·1资料1999年1月~2003年8月因便血或腹痛怀疑存在异位胃黏膜症而行高锝酸盐异位胃黏膜显像呈阳性表现的患儿38例。其中男25例,女13例,年龄22 d~14岁。男女比例为1·92:1。绝大多数患儿有便血的临床表现(36/38),可为暗红色(17/38)、鲜红色(12/38),也可为黑色(7/…     

核素扫描诊断小儿消化道出血的临床研究

高锝酸钠(^99TcO4ˉ)核索扫描为简单、易行、无刨伤的检查方法,检测异位胃黏膜准确性高,已广泛应用于临床。笔者对近10多年来44例^99TcO4ˉ核素扫描阳性的Meckel‘s憩室和肠重复畸形患儿的临床特征、显像结果进行分析．并与手术结果和病理诊断进行比较,现将结果报道如下。     

儿童梅克尔憩室的诊断及并发症的临床分析

目的总结儿童梅克尔憩室(MD)的临床诊断及并发症的诊治要点,为临床合理治疗提供参考。方法回顾性分析98例儿童梅克尔憩室的临床特点及辅助检查结果,总结其对于准确诊断梅克尔憩室的价值及并发症的诊治情况。结果 198例梅克尔憩室患儿,男性76例,女性22例,男女比例约为3.5∶1,并发症包括梅克尔憩室引起的便血、肠梗阻、炎症等,以便血最常见(58/98,59.18%)。251例患儿术前行99TcmO-4检查,其中43例提示为异位胃黏膜,检出率为84.31%;84例术前行腹部超声检查,其中37例考虑梅克尔憩室,检出率为44.05%,经卡方检验,放射性核素与超声对MD患者检查结果有统计学差异(χ~2=5.852,P=0.02)。358例以便血为主要表现的患儿中,42例术前共同行了放射性核素检查和超声检查,阳性发现率分别为80.95%和66.67%。经卡方检验,放射性核素与超声对MD伴便血患儿检查结果无统计学差异(χ~2=2.217,P=0.14)。结论 MD临床表现缺乏特异性,以并发便血最多,超声在诊断MD伴便血中有较高的特异性,联合放射性核素检查可提高检出率;对于MD伴炎症及肠梗阻的患儿,急诊超声对其各种并发症的检出及判断具有较高的诊断符合率,有利于减少急腹症的误诊。     

儿童梅克尔憩室出血的病因和治疗

目的 探讨梅克尔憩室出血的病因及外科治疗。方法 回顾性分析我院1995年1月～2003年1月收治19倒梅克尔憩室出血的临床资料。结果 剖腹手术5例，其中行憩室楔状切除术2倒，憩室、肠切除术3倒；腹腔镜下憩室切除术14倒，其中腹腔内憩室切除术10倒，腹腔镜辅助下腹腔外切除术4倒。血抗幽门螺杆菌(Hp)抗体检查5倒，均阴性。憩室内均检出异位胃黏膜。溃疡、出血部位在憩室内小肠黏膜处12倒，异位胃黏膜处2例，术后均痊愈。结论 憩室出血因异位胃黏膜所致，与Hp感染无关；溃疡、出血部位多在憩室内小肠黏膜处；腹腔镜手术或开腹手术应根据憩室形态、异位胃黏膜分布及炎症波及范围选择术式。     

以急腹症为表现的小儿梅克尔憩室

目的 回顾分析以急腹症为主要表现的小儿梅克尔憩室的临床特点和诊治经验,以提高疗效,防止误诊、漏诊.方法 回顾性分析2005年7月至2011年8月我科经治并经手术确诊的30例梅克尔憩室患儿的临床资料,包括主要症状、体征以及术前诊断过程和手术探查所见以及具体手术方法,其中7例为急性肠梗阻、消化道穿孔和憩室炎、腹膜炎等急腹症表现.结果 30例患儿均因不同并发症求治,其中以消化道出血为主要表现者20例,以长期反复发作腹痛为表现者3例,以急性憩室炎、消化道穿孔以及急性进行性肠梗阻为主要症状者7例,术中见梅克尔憩室均发生在距回盲部50 ～ 100 cm的小肠系膜对侧缘,憩室基底部直径大小基本与局部肠管的直径相当,但合并闭袢性肠梗阻者长径明显大且有黏连索带存在形成勒卡.病理检查梅克尔憩室的组织结构与末端回肠相同,有18例见异位组织,异位胃黏膜15例,异位胰腺迷生3例,憩室内衬均为小肠黏膜,镜下可见有炎症、出血、溃疡、坏死等病理变化.本组患儿手术行病变切除并一期肠吻合后均痊愈.结论 以急腹症为主要表现的小儿梅克尔憩室的患儿以小年龄组为主,术前确诊难度大,发病凶险且进展快速,治疗则以手术为主,病灶切除并一期肠吻合均可痊愈.     

脐部两孔腹腔镜结合ECT诊治小儿小肠出血

目的 总结脐部两孔L腹腔镜结合ECT(emission computed tomography,ECT)在小儿小肠出血诊断和治疗中的应用经验.方法 我院2004年1月至2010年12月共收治167例消化道出血患儿,其中72例患儿反复便血患儿进行99m锝酸盐(99mTc)显像检查,均行腹腔镜探查术.结果 72例中59例ECT阳性患儿均经腹腔镜探查及病理证实,其中47例梅克尔憩室,9例小肠重复畸形,3例为血管瘤;13例ECT阴性患儿7例经手术及病理证实为梅克尔憩室,2例为肠重复畸形,1例蓝色橡皮疱痣综合征,2例为过敏性紫癜导致的肠道出血,1例未见器质性病变.以上患儿均治愈,术后随访3个月至6年未见出血.结论 ECT检查可作为小肠出血的首选无创检查.脐部两孔腹腔镜结合ECT检查对小儿小肠出血不仅可以提高诊断率,而且又具有治疗价值,切口美观,创伤小,并可减少开腹探查的盲目性及创伤性.     

Allergic factors associated with the development of asthma and the influence of cetirizine in a double-blind, randomised, placebo-controlled trial: First results of ETA®

There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC^® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.     

Resurgence of measles in Singapore: profile of hospital cases

OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

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孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%～5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相     

EXCITING NEW TREATMENT APPROACHES FOR PATHYPHYSIOLOGIC MECHANISMS OF SICKLE CELL DISEASE

During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.     

Infiltrations of Epstein-Barr virus-carrying cells in granular lymphocyte-proliferative disorders corresponding to chronic active Epstein-Barr virus infection

A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.     

LUTEINIZING HORMONE RECEPTOR MUTATIONS IN DISORDERS OF SEXUAL DEVELOPMENT AND CANCER

Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.     

A profile of respiratory symptoms in urban and rural South Australian school children

This report describes the cross-sectional analyses of data from the first year of a longitudinal study using questionnaire and respiratory function data over a 5 year period from a sample of rural South Australian school children. The cumulative or lifetime prevalences of respiratory symptoms were estimated in 825 rural and 1261 urban school children aged between 5 and 15 years in order to determine if the prevalence rates differed between rural and urban school children. The study found the overall cumulative prevalence of asthma and/or wheezy breathing (AWB) to be 24.1% in the rural school children compared to 27.6% in the urban school children. Most children developed AWB symptoms before the age of 7 years, with 20% reporting moderately severe symptoms and 10% having more than one attack per fortnight. The cumulative prevalence of bronchitis, loose/rattly cough (BLRC) differed significantly between the rural school children (34.1%) and urban school children (47.9%). The BLRC symptoms preceded the development of AWB in many cases. Urban school children also reported a higher prevalence of atopic conditions.     

Personality profiles and heart rate variability (vagal tone) in children with recurrent abdominal pain

The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.     

Hauttemperaturen verschiedener Körperoberflächenareale des Rumpfes bei Säuglingen

Summary In two groups of infants (3–53 weeks old) skin temperatures were controlled in different areas of the trunk—i.e.: regions of sternum, lungs, heart, liver, spleen, kidneys—at different room-temperatures (group I: 21–25°C; group II: 29–32°C). Rectal temperatures of some probands in both groups also had been controlled simultaneously. A definite change in the reaction to heat was proofed in different periods of the first year of life. In higher environmental temperatures the skin temperature was almost constant at every controll-point of the skin, even in older infants. In lower environmental temperatures the skin temperatures lowered continuously with age till 7. to 9. moth. From 10. to 12. month the lowering of skin temperature discontinued. The rectal temperatures were relatively constant in all infants. Only in infants from 7. to 12. month, whose skin temperatures were controlled in lower as well as in higher environmental temperatures, a tendency to higher rectal temperatures was proofed in warmer environmental temperatures.The significance of these results is discussed.

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Untersuchungen mit Unterstützung durch die Deutsche Forschungsgemeinschaft.