13Carbon mixed triglyceride breath test and pancreatic enzyme supplementation in cystic fibrosis

Children with cystic fibrosis have variable degrees of exocrine pancreatic insufficiency which, if untreated, is the main cause of fat malabsorption. The impact of pancreatic enzyme supplementation on fat digestion was measured in 41 children with cystic fibrosis, 11 healthy controls, and five children with mucosal diseases by a non-invasive test of intraluminal lipolysis using 13carbon (13C) labelled mixed triglyceride (1,3-distearyl, 2[13C] octanoyl glycerol). The children with cystic fibrosis without pancreatic supplements had a median (range) 13C cumulative percentage dose recovered over six hours (cPDR) of 3.1% (0-31.7), the controls 31.0% (21.8-41.1), and the subjects with mucosal disease 27.8% (19.7-32.5). In 23 subjects with cystic fibrosis the usual dose of pancreatic enzyme supplements increased the cPDR to a median of 23.9% (0-45.6), and twice the usual dose of enteric coated microspheres increased the cPDR to 31.1% (11.1-47.8). There was no significant difference between the median cPDR of normal controls and children with mucosal disease, but there was a highly significant difference between these groups and children with untreated cystic fibrosis. Thirteen children with cystic fibrosis had no 13C recovery in their breath without enzymes and 10 showed marked increases with regular enzymes. In eight children doubling the dose of enzymes caused no or minimal improvement. The mixed triglyceride breath test offers a simple, non-invasive way of assessing the need for pancreatic enzyme supplementation in children with cystic fibrosis and could be used to optimise treatment.     

Prolonged QT interval and cardiac arrhythmias in two neonates: sudden infant death syndrome in one case

Two neonates with arrhythmias and the long QT syndrome are described. The arrhythmias were detected in utero and both infants were apparently well after birth. The first infant, although well, had a bradycardia for the first 9 days of life. A normal heart rate was documented at 10 days but a prolonged QT interval was not appreciated on the ECG. He was discharged from hospital but died suddenly and unexpectedly 3 days later. A post-mortem examination failed to find a cause for his death which therefore fell into the category of the sudden infant death syndrome (SIDS). A retrospective analysis of the perinatal electrocardiogram showed a probable junctional rhythm with 2:1 conduction to the ventricle; the QT interval was prolonged at 0.52 seconds (QTC = 0.63). The second infant had a QT interval of 0.52 seconds (QTC = 0.54) and frequent ventricular premature beats on a 24-hour electrocardiogram. She was treated with propranolol and remains well 2 years later. Sudden infant death has often been described in the siblings of children with the long QT syndrome and one other report described a case of SIDS which was said to have had a prolonged QT interval on the perinatal ECG. This report, however, provides unquestionable evidence, in one case, of an association between the long QT syndrome and SIDS.     

Cardiac biopsy in childhood

Endomyocardial biopsy was attempted in 18 children aged 5 months to 15 years with 82% success. Biopsies obtained from 15 children were examined by light and electron microscope making positive morphological diagnoses in 3 cases. The biopsy findings were actively helpful in 7 other cases, which contrasts with experience in adult biopsy series. This is a low risk procedure which does not add to the hazards of cardiac catheterization in children.     

缺血性脑卒中患者阿司匹林抵抗现象及处理策略

阿司匹林作为缺血性脑血管病的一级和二级预防用药，广受关注。然而长期服用阿司匹林的患者仍会发生动脉血栓形成事件，因此本文就阿司匹林抵抗的概念、发生机制、检测方法、预防措施及其在缺血性脑血管病中的临床意义加以综述。     

音乐疗法在围手术期护理中的应用研究

目的：探讨音乐疗法在围手术期护理中的作用。方法：选择在我院实施局麻手术患者120例，随机分为观察组和对照组，两组均进行常规护理，观察组同时在术前、术中、术后收听自己喜欢的音乐。对两组焦虑水平、术中麻醉药用量和术后疼痛程度进行比较。结果：观察组术前SAS评分和焦虑发生率均明显低于对照组（P〈0．05），而术后两组无显著性差异（P〉0．05）；观察组术中咪唑安定使用量明显少于对照组（P〈0．05），利多卡因使用量也少于对照组，但无显著性差异（P〉0．05）；观察组术后疼痛分级明显低于对照组（P〈0．01）。结论：在同手术期护理中应用音乐疗法，可以减轻患者焦虑、减少麻醉药用量，缓解疼痛，促进康复。     

Dose-response effect of fetal cocaine exposure on newborn neurologic function

BACKGROUND: Studies of fetal cocaine exposure and newborn neurologic function have obtained conflicting results. Although some studies identify abnormalities, others find no differences between cocaine-exposed and cocaine-unexposed infants. To determine the effects of prenatal cocaine exposure on intrauterine growth and neurologic function in infants, we prospectively evaluated 253 infants shortly after birth. METHODS: Women who delivered a live singleton >36 weeks by dates were eligible for enrollment. Maternal exclusionary criteria were known parenteral drug use, alcoholism, and acquired immunodeficiency syndrome; infant exclusionary criteria were Apgar scores 相似文献   

Autopsy diagnosis of endemic burkitt lymphoma as the primary etiology of acute renal failure in children

Two cases of Burkitt lymphoma are reported who presented atypically with acute renal failure and significant proteinuria as initial features of the lymphoma. The cases underscore the need for high index of suspicion for Burkitt lymphoma in any child with rapidly enlarging kidneys and acute renal failure of obscured origin in parts of the world where Burkitt lymphoma is endemic.     

Quality and costs of family planning as elicited by an adolescent mystery client trial in Nigeria

Results are presented from a rural reproductive health project in Delta State of Nigeria. A baseline survey of Family Planning clients revealed that only 2 percent of adolescents were utilising the services. Therefore four adolescents, two males and two females posing as two couples, were used as mystery clients to assess providers response to adolescents, as well as the adolescent perspectives on the quality and costs of the family planning services in the clinics they visited. This was complemented with a participatory rural appraisal of the communities. The adolescent mystery clients reported that some providers were surprised to see them, were judgemental, and engaged them in religious counselling. The adolescents found the services unsatisfactory, but the costs were affordable. In the participatory rural appraisal, the communities found the cost of contraceptives affordable despite a recent price increase of 20-150% across the different contraceptives. Emerging practices that were detrimental to adolescent reproductive health were also discovered and innovative approaches for promoting access to reproductive health information by out-of-school adolescents through the use of artisan trade associations and home videos are suggested.