小儿胃电图230例临床应用分析

本文报道230例胃肠道疾病患儿的胃电图临床检测结果,并对小儿胃炎、胃炎伴节律紊乱、胃节律紊乱综合征胃电图的频率、幅值进行了讨论;对患儿与健康小儿的胃电图、小儿胃炎与成人胃炎的胃电图参数进行了比较;同时对胃电图诊断的胃炎与胃镜诊断的胃炎和病理诊断的胃炎进行了对照及统计学处理。     

胃电图在新生儿中的应用

胃电图是一种经体表电极记录胃电的方法,是一种无创性检查,对于评估胃肠动力功能较为有效。胃电图的操作简单,无并发症,对于脆弱的新生儿,特别是早产儿尤为适用。该技术在成年人和儿童中作为一种胃肠动力功能的检查工具已经得到了广泛的认可和应用,但在新生儿中的应用尚刚刚起步。新生儿的测量方法和参数特点与成年人相比有很大不同。作为一种功能性的检查,胃电图尚不能诊断器质性疾病,但可以用于监测早产儿的胃电生理成熟度,评价胃食管反流和喂养不耐受等胃肠动力紊乱疾病的胃肠功能、胃肠动力学的疗效及不同喂养方法的效果等。     

小儿慢性胃炎内镜表现与病理组织学改变的相关性研究

目的 探讨小儿慢性胃炎内镜表现与胃黏膜病理组织学改变的关系.方法 回顾性分析2003年1月至2007年3月浙江省金华市中心医院收治的213例患儿胃镜下8种主要表现;按慢性炎症、炎症活动性、萎缩、肠化生、异型增生、黏膜糜烂6种类型进行病理评价,研究内镜表现和病理诊断的相关性.结果 胃镜诊断慢性浅表性胃炎(CSG)207例,慢性萎缩性胃炎(CAG)6例.213例均送病理学检查,病理诊断CSG196例,轻度CAG11例,正常胃黏膜6例.胃镜与病理学诊断CSG和CAG总符合率分别为91.08%和93.89%.胃镜诊断CSG的镜下主要表现为黏膜充血水肿和红白相间,以红为主,对病理CSG的诊断灵敏度分别为86.22%和81.12%,特异度为47.06%(P<0.05);CAG的胃镜诊断对病理的诊断灵敏度为18.18%,特异度为98.01%(P<0.05).结论 儿童CSG胃镜下主要表现对病理CSG的诊断灵敏度较高,具明显的相关性,而CAG的胃镜诊断对病理CAG的诊断灵敏度较低.     

988例儿童骨髓细胞形态学诊断结果分析

目的　 探讨儿童骨髓细胞形态学特点与临床初步诊断的关系。方法 　将2 0 0 0年～ 2 0 0 2年我院门诊及住院部送检的 988例儿童骨髓穿刺合格标本 ,进行细胞形态检查与细胞化学染色 ,结合临床表现作出实验室骨髓细胞学诊断。结果 　对骨髓细胞形态学结果与特点进行总结与分析 ,发现与骨髓细胞学诊断结果符合率最高的疾病分别是 :原发性血小板减少性紫癜 (ITP)占 90 .1% ;急性淋巴性白血病 (ALL)占 82 .5 % ;缺铁性贫血 (IDA)占 92 .0 %。结论 　骨髓细胞形态学检验对小儿血液病诊断有重要参考价值。     

儿童上消化道疾病与幽门螺杆菌感染关系探讨

小儿胃镜的应用为儿童上消化道疾病的诊断提供了直观而准确的手段,幽门螺杆菌（Helicobacter pylori,H．pylori）与消化道疾病关系的发现也为儿童上消化道疾病的病因研究提供了新的思路。为探讨两者的关系,现将我院393例儿童胃镜及H．pylori检查结果分析如下。     

关节镜在儿童关节疾病诊治中的作用

为了探讨关节镜在儿童关节疾病诊断和治疗中的价值。对３０例（３２个关节）诊断不明，短期保守治疗无效的关节病患儿，行关节镜检查及相应的镜下手术。术前根据临床和常规辅助检查结果作出临床诊断，关节镜所见结合病理检查得出最后诊断。术后定期随访观察疗效。临床诊断与最后诊断的符合率仅为４８％，镜下手术对多种疾病有效，术后平均随访２年３个月，优良率达８１％，无一例出现并发症。关节镜检查可显著提高儿童关节疾病的早期诊断率，镜下手术具有创伤小、并发症少及恢复快等优点，是儿童关节疾病较为理想的早期诊断和外科治疗手段。     

胃镜结肠镜联合诊断儿童小肠淋巴管扩张症(附3例报告)

目的探讨胃镜-结肠镜联合对儿童小肠淋巴管扩张症(IL)的诊断价值。方法针对2010年1月至2012年6月3例经重庆医科大学附属儿童医院院胃镜-结肠镜联合检查、最终确诊IL病例,回顾性分析其临床表现、辅助检查、以及内镜下和组织病理特点。结果对3例疑诊IL患儿,安全、快速实施胃镜空肠输入段及结肠镜回肠末段检查,镜下所见并经病理组织活检证实小肠淋巴管扩张;结合其临床表现及其他辅助检查,顺利诊断儿童原发性小肠淋巴管(PIL)患者2例、继发性小肠淋巴管扩张症(SIL)1例。结论胃镜(必要时联合结肠镜)术、结合组织病理学检查,足以作为诊断儿童IL首选常规手段,具有安全、经济、高效的优点,尤其适用于小年龄儿童患者。     

140例先天性心脏病诊断方法对比分析

本文对140例先天性心脏病的诊断方法进行了对比分析,临床诊断的符合率达88.6%,指出临床诊断应仔细查体并重视心电图及胸片的分析研究;心导管诊断与手术诊断完全符合率达91.3%,加上部分符合率可达97.3%,说明了心导管及心血管造影仍不失为先心病诊断及手术治疗提供准确的血流动力学及异常通道情况的一种重要检查方法,但本文10例心导管检查与手术结果不符,咎其原因为对临床和血氧资料的分析不够深入造成,从而发现,由本文证实的左向右分流的病例,在相应部位均有一个以上的血样血氧饱和度在80%以上,故应指出,在判断分流病例时,除上下两心腔血氧饱和度平均值之差符合诊断标准外,还须有一个以上部位的血氧饱和度在80%以上,诊断才比较可靠;心脏超声心动图检查与手术结果相比,M 型超声符合率为88.8%,B 型超声符合率为94.9%,M 型和 B 型相比,后者加上声学造影及多普勒技术应用,远优于前者,一例临床和心导管检查均未发现的单心房和2例心导管及心血管造影均未发现的三房心由 B 型超声确诊。因此,随着经验的积累和技术的不断改进,非侵入性诊断手段将会更加完善、准确。     

424例儿童阴囊内疾病的超声诊断分析

目的探讨超声在儿童阴囊内疾病诊断中的价值。方法回顾性分析424例（498侧）阴囊疾病患儿行二维黑白超声、二维彩色多谱勒和能量多谱勒超声检查的结果。其中338侧病变器官经手术及病理检查证实,其他经CT、激素测定或经抗菌治疗和随访疗效证实。结果单侧病变350例;双侧病变74例,患病阴囊共498侧。疾病性质：隐睾120例,其中30例为双侧,诊断符合率达92％;鞘膜积液122例,其中双侧16例,诊断符合率100％（包括阴囊鞘膜积液80侧;精索鞘膜积液58侧）;睾丸和附睾炎症50例,其中双侧18例,合并阴囊脓肿10例,诊断符合率94．1％;睾丸附睾鞘内扭转16例,诊断符合率93．75％;附件扭转56例,诊断符合率92．8％;睾丸损伤16例,诊断符合率93．75％;精索静脉曲张8例,诊断符合率100％;睾丸胚胎性肿瘤16例,诊断符合率93．75％。睾丸细石症10例,均为双侧,诊断符合率100％。结论儿童阴囊内疾病种类繁多,表现各异,大多进展快,情况急,及时诊断与预后密切相关,超声对阴囊内疾病的定性和定位诊断具有较高的准确性,可作为首选诊断方法。     

988例儿童骨髓细胞形态学诊断结果分析

目的 探讨儿童骨髓细胞形态学特点与临床初步诊断的关系。方法 将2000年～2002年我院门诊及住院部送检的988例儿童骨髓穿刺合格标本，进行细胞形态检查与细胞化学染色，结合临床表现作出实验室骨髓细胞学诊断。结果 对骨髓细胞形态学结果与特点进行总结与分析，发现与骨髓细胞学诊断结果符合率最高的疾病分别是：原发性血小板减少性紫癜(ITP)占90．1％；急性淋巴性白血病(ALL)占82．5％；缺铁性贫血(IDA)占92．O％。结论 骨髓细胞形态学检验对小儿血液病诊断有重要参考价值。     

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.     

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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     

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   

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.     

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.     

Overcoming surfactant inhibition with polymers

Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.     

Understanding infant formula

The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.