婴儿肠旋转不良影像学检查的探讨

目的:探讨婴儿肠旋转不良影像学检查的价值.方法:回顾性分析41例经手术证实的婴儿肠旋转不良患者的病例资料.所有病例均摄腹部平片,16例行钡剂灌肠,18例行钡餐检查.结果:腹部平片显示十二指肠部分性梗阻32例,双泡征13例,小肠低位梗阻并腹腔积液3例,未见明显异常3例.钡剂灌肠显示阑尾位于右上腹10例,右中腹1例,左上腹4例,1例位置正常;与手术中记录的阑尾位置比较,诊断符合率较低(28.6%,4/14).钡餐检查显示十二指肠水平段及其近端扩张、梗阻,扩张远端呈鼠尾状改变6例,其中2例显示为完全性梗阻;十二指肠空肠曲位置异常11例;十二指肠螺旋型下降13例;空肠位于右侧腹9例,位置正常1例.结论:在肠旋转不良影像学检查中,腹部平片能提供肠道气体的异常信息,可作为本病的首诊检查方法;钡剂灌肠虽然可显示阑尾位置异常,但诊断准确性低,胃肠钡餐检查可显示十二指肠的位置和形态,是确诊本病的较好影像学方法.     

腹腔镜食管裂孔疝修补术的初步探讨

目的探讨腹腔镜食管裂孔疝修补和胃底折叠术（Toupet手术）治疗食管裂孔疝的临床效果。方法 2009年1月～2010年5月,21例患者行腹腔镜食管裂孔疝（Ⅰ型9例,Ⅱ型4例,Ⅲ型6例,Ⅳ型2例）修补,采用单纯缝合膈肌脚,补片完全缝合,补片缝合加钉合等方法修补食管裂孔疝,并同期行部分胃底折叠术。结果本组患者手术均获成功,手术时间85～170min。无中转开腹及死亡病例。术后平均住院7d。术后随访1～16个月,20例临床症状完全消失,1例改善不明显,无明确复发病例。结论腹腔镜食管裂孔疝修补和胃底折叠术安全有效,应根据患者情况采用个体化的修补方式。     

Simultaneous acute splenic sequestration and transient aplastic crisis in children with sickle cell disease

Acute splenic sequestration crisis (ASSC) is a hematological emergency in young children with sickle cell disease (SCD), characterized by worsening anemia and splenomegaly, usually with reticulocytosis and thrombocytopenia. Transient aplastic crisis (TAC) due to parvovirus B19 infection occurs in older children with SCD, and typically manifests as worsening anemia with reticulocytopenia and no splenomegaly. Five older children with SCD (4 HbSC, 1 HbSS on hydroxyurea) developed ASSC concurrent with TAC and had a severe clinical course. Our cases suggest that older children with SCD and acute parvovirus infection should be monitored closely for splenomegaly and multi‐system dysfunction. Pediatr Blood Cancer 2009;53:479–481. © 2009 Wiley‐Liss, Inc.     

多排螺旋CT对儿童主动脉缩窄的诊断价值

目的 探讨多排螺旋CT以其后处理图像对儿童主动脉缩窄的诊断价值.方法 临床怀疑为主动脉缩窄的患者26例,平均年龄7.5 个月(5天～4岁),进行多排螺旋CT增强扫描.对所有病例的CT轴位图像按需要进行多平面重组及容积再现、最大密度投影.结果 26例患儿顺利完成MDCT成像检查,均确诊为主动脉缩窄,其中11例主动脉弓发育不良,CT诊断与手术结果相一致.主动脉靶重建直观地显示主动脉缩窄的部位及程度.结论 MDCT是一种有用的无创伤性检查方法,结合二维与三维图像有助于主动脉缩窄的诊断以及治疗方案的制定.     

小脑扁桃体下疝畸形合并脑室扩张的外科治疗

目的 探讨小脑扁桃体下疝畸形合并脑室扩张的手术方法及其效果。方法 回顾性分析20例小脑扁桃体下疝畸形合并脑室扩张病人的临床资料,全部病例均采用后正中入路小骨窗枕下减压加自体筋膜减张缝合术。结果 全部病例术后MRI显示延颈髓压迫解除、枕大池形态恢复;术后20例病人均获得随访,平均随访24个月,2例症状完全消失,12例症状明显改善,5例症状无明显改变,1例症状加重;20例病人脑室大小均未见明显改变,无脑室扩张加重病例。结论 脑室扩张是小脑扁桃体下疝畸形先天畸形的一部分,而不是由于枕大孔区梗阻造成的梗阻性脑积水;小脑扁桃体下疝畸形合并脑室扩张患者颅内压多正常,在行枕下减压术前一般不需要行脑室外引流术,后正中入路小骨窗枕下减压术可取得良好效果,术后未发现有脑室进行性扩大或颅内压增高的现象。     

Nebivolol Effects on Nitric Oxide Levels,Blood Pressure,and Renal Function in Kidney Transplant Patients

In hypertensive kidney transplant recipients, the effects of nebivolol vs metoprolol on nitric oxide (NO) blood level, estimated glomerular filtration rate (eGFR), and blood pressure (BP) have not been previously reported. In a 12‐month prospective, randomized, open‐label, active‐comparator trial, hypertensive kidney transplant recipients were treated with nebivolol (n=15) or metoprolol (n=15). Twenty‐nine patients (nebivolol [n=14], metoprolol [n=15]) completed the trial. The primary endpoint was change in blood NO level after 12 months of treatment. Secondary endpoints were changes in eGFR, BP, and number of antihypertensive drug classes used. After 12 months of treatment, least squares mean change in plasma NO level in the nebivolol kidney transplant recipient group younger than 50 years was higher by 68.19% (99.17% confidence interval [CI], 13.02–123.36), 69.54% (99.17% CI, 12.71–126.37), and 66.80% (99.17% CI, 12.95–120.64) compared with the metoprolol group younger than 50 years, the metoprolol group 50 years and older, and the nebivolol group 50 years and older, respectively. The baseline to month 12 change in mean arterial BP, eGFR, and number of antihypertensive drug classes used was not significantly different between the treatment groups. In hypertensive kidney transplant recipients, nebivolol use in patients younger than 50 years increased blood NO.     

A telephone survey of parental attitudes and behaviours regarding teenage drinking

Background  

Irish teenagers demonstrate high rates of drunkenness and there has been a progressive fall in age of first drinking in recent decades. International research indicates that parents exert substantial influence over their teenager's drinking. We sought to determine the attitudes and behaviours of Irish parents towards drinking by their adolescent children.