Infantile spasms. A retrospective study of 105 cases.

This paper is a summary of our observations on 105 cases of infantile spasms. The age of onset was around six months after birth, but the patients came for treatment mainly about one year after onset. Fever of unknown cause, asphyxia, birth injury, infection of the central nervous system, tuberous sclerosis, phenylketonuria and recent immunization etc. were complained. Clinically, it is characterized by head nodding, mental retardation, myoclonic jerks and various neurologic deficits. EEG findings showed classical or modified arrythmia or other epileptiform patterns. About one third of 22 cases examined had abnormal brain stem auditory evoked potentials. Among 42 patients who underwent CT scanning before ACTH treatment, 18 were normal and 7 abnormal; during ACTH treatment 3 normal and 4 abnormal; after completion of treatment, 4 normal and 6 abnormal, suggesting no further atrophy of the brain. Examination of trace elements of the hair by particle-induced X-ray emission (PIXE) method in 23 patients revealed a significant difference in lead, calcium and zinc contents between patients and 101 controls, but no statistical difference in iron and copper contents between the two groups. Sodium valproate, prednisone and ACTH appear to be effective in the treatment of infantile spasms. Eight patients fully recovered, and they can go to school without difficulty. Many patients derived various degrees of improvement to the satisfaction of their parents. Two patients were still amented and often attacked by myoclonus. The effects, side effects of these drugs, and the possible pathogenesis were discussed.

     

某儿童医院10年临床报告细菌性痢疾的流行病学特征

目的探讨细菌性痢疾(以下简称菌痢)近10年流行特点。方法对10年来收集的全院各科上报的菌痢进行回顾性分析。结果1993-2002年报告菌痢10861例,占传染病报告总数的62.92%,传染科门诊量占全院门诊百分比的年变化为8.54%～4.33%;菌痢发病占传染科门诊的年比率变化为1.05%～3.45%;<1岁、1～3岁、4～6岁、7～9岁、≥10岁5个年龄组,各组之间菌痢检出率差异有统计学意义,1～3岁组检出率最高;细菌性痢疾每年4月检出率开始上升,8月达最高,11月检出率恢复到上升前水平;不同性别的儿童检出率差异有统计学意义,男童明显高于女童。结论细菌性痢疾检出年龄特点为婴幼儿最高,随年龄增长,发病逐渐减少;发病高峰季节向春秋季扩展。     

膝交叉韧带重建术的护理配合

随着社会经济的不断发展，由于交通及运动损伤引起的膝关节损伤目趋增多。交叉韧带是维持膝关节稳定的重要结构，韧带的断裂会引起关节不稳，若时间长会发展成创伤性关节炎，严重影响病人的工作与生活。膝交叉韧带重建术，尤其在关节镜监视下重建是近年来发展起来的一项新技术，通过手术能有效地恢复关节的稳定与功能，但手术的效果优劣在很大程度上取决于手术技术及术中医护配合的好坏。2000年7月-2003年7月，我院共行膝交叉韧带重建术236例，现将护理配合报告如下。     

亚低温治疗颅脑损伤延长翻身间隔时间与压疮关系的研究

[目的]探讨颅脑损伤病人应用亚低温治疗仪时具体间隔多长时间翻身不发生压疮.[方法]随机选择45例颅脑损伤应用亚低温治疗的病人,采取3 h后开始翻身,侧卧位时每次均为1 h,以后平卧位时间每次逐渐递增1/2 h.[结果]在应用亚低温治疗期间除3例病人在不同时段内发生轻微紫色冻伤外,所有病例均未发生压疮,平均翻身间隔时间为11.31 h,应用单样本统计学处理,有统计学意义(t=8.867,P<0.005).[结论]颅脑损伤病人在使用亚低温治疗过程中翻身间隔时间可以延长至8 h不发生压疮.     

Bone growth patterns in Chinese children and adolescents: a 6-year follow-up study provides evidence for sexual dimorphism and tracking

Summary We prospectively examined bone growth patterns in 894 children aged 6–17 years at the baseline visit, with a 6-year follow-up. Results show bone “tracking” over a six-year interval and sexual dimorphism of bone attained levels and timing of peak bone growth. Our findings underscore childhood and adolescence as critical periods for building bone and developing gender differences. Introduction Bone growth patterns were prospectively examined in 894 Chinese children (496 males), aged 6–17 yrs, from a population-based twin cohort. Whole-body bone area (BA), bone mineral content (BMC), and bone mineral density (BMD) were measured by DEXA at baseline and a 6-yr follow-up. Methods Graphic smoothing plots and generalized estimating equations were used to model bone attained levels, growth, and “tracking”. Results Attained levels of BMC and BA increased curvilinearly with age. Male attained levels were higher than females after age ∼15 yr, but BMD was lower between 13–17 yrs (Tanner stage I to IV). In both genders, peak BMC and BMD growth lagged ∼2 yrs behind peak BA growth, which lagged 2 yrs behind peak height growth. Peak bone growth occurred 1–3 yrs later in males. Over the 6-yr follow-up, all bone measurements “tracked”, but “shifting” across ranks also occurred, and baseline tertile ranking influenced bone growth. Females with early menarche had higher attained levels than females with late menarche at age 12–13 yrs. Conclusion Our findings confirm and expand previous studies on peak bone growth conducted in Caucasian cohorts, particularly sexually dimorphic and maturational effects. The significant “tracking” of bone measurements in this 6-yr follow-up study underscores the importance that osteoporosis prevention should begin in childhood and adolescence. Fengxiu Ouyang and Binyan Wang contributed equally to this article. Source(s) of support: This study is supported in part by grant R01 HD049059, R01 HL0864619 and R01 AR045651 from the National Institute of Health and by the Food Allergy Project.     

Feasibility of treating hyperfibrinogenemia with intermittently administered batroxobin in patients with ischemic stroke/transient ischemic attack for secondary prevention.

This study evaluated the safety and efficacy of batroxobin in treating hyperfibrinogenemia for secondary stroke prevention. Patients with ischemic stroke or transient ischemic attack (TIA) were measured for plasma fibrinogen levels. Selected participants had concomitant hyperfibrinogenemia (plasma fibrinogen > or = 3.0 g/l). Patients enrolled between 1 July 2003 and 31 December 2004 were treated with batroxobin; patients enrolled between 1 January 2002 and 30 June 2003 were treated without batroxobin. Batroxobin was administered intermittently via intravenous injection at 3-monthly intervals. Patients in both groups were followed for 1 year. Any cerebrovascular events and suspected adverse events were recorded. In total, 112 ischemic stroke/TIA patients with concomitant hyperfibrinogenemia were enrolled, 52 being treated with batroxobin and 60 without batroxobin. Six patients (11.5%) with batroxobin and 16 patients (26.7%) without batroxobin had recurrent cerebral ischemic events during follow-up. Stroke/TIA recurrence in patients without batroxobin was higher than that in patients with batroxobin (P < 0.05). Two patients with batroxobin and two patients without batroxobin developed hemorrhagic stroke during follow-up. There were five deaths (9.6%) in the batroxobin group, and seven deaths (11.7%) in the nonbatroxobin group during follow-up (P > 0.05). Intermittent intravenous injection of batroxobin can efficiently reduce the risk for stroke/TIA recurrence in patients with concomitant hyperfibrinogenemia.     

Endoscopic pH monitoring for patients with suspected or refractory gastroesophageal reflux disease.

BACKGROUND: Wireless pH studies can offer prolonged pH monitoring, which may potentially facilitate the diagnosis and management of patients with gastroesophageal reflux disease (GERD). The aim of the present study was to evaluate the detection rate of abnormal esophageal acid exposure using prolonged pH monitoring in patients with suspected or refractory GERD symptoms. METHODS: Patients undergoing prolonged ambulatory pH studies for the evaluation of GERD-related symptoms were assessed. Patients with a known diagnosis of GERD were tested on medical therapy, while patients with suspected GERD were tested off therapy. The wireless pH capsules were placed during upper endoscopy 6 cm above the squamocolumnar junction. RESULTS: One hundred ninety-one patients underwent a total of 198 pH studies. Fifty ambulatory pH studies (25%) were excluded from the analysis: 27 patients (14%) had insufficient data capture (less than 18 h on at least one day of monitoring), 15 patients had premature capsule release (7%), seven were repeat studies (3.5%) and one had intolerable pain requiring capsule removal (0.5%). There were 115 patients undergoing pH studies who were off medication, and 33 patients were on therapy. For the two groups of patients, results were as follows: 32 (28%) and 22 (67%) patients with normal studies on both days; 58 (50%) and five (15%) patients with abnormal studies on both days; 18 (16%) and three (9%) patients with abnormal studies on day 1 only; and seven (6%) and three (9%) patients with abnormal studies on day 2 only, respectively. CONCLUSIONS: Prolonged 48 h pH monitoring can detect more abnormal esophageal acid exposure but is associated with a significant rate of incomplete studies.     

护士对护理记录理解的偏差及对策

一般护理记录单是住院病历的一部分，根据卫生部、中医药管理局公布的《病历书写基本规范》（试行）的规定，一般护理记录的定义是：护士根据医嘱和病情对一般病人住院期间护理过程的客观记录，内容包括病人姓名、记录日期和时间、病情观察、护理措施和效果、护士签名。现将护士在一般护理书写中存在认识上的理解偏差分析如下。     

抗凝剂对AFU活性的影响

α-L-岩藻糖苷酶（AFU），是一种溶酶体酸性水解酶，广泛分布于机体组织细胞一血液和体液内，参与含岩藻糖基的糖蛋白、糖脂的分解代谢。血清AFU测定对原发性肝癌诊断的阳性率在64％～84％之间，特异性在90％左右。AFU以其对检出小肝癌的高敏感性，对预报肝硬变并发肝癌的高特异性，和与AFP测定的良好互补性，而越来越被公认为是肝癌诊断、随访和肝硬变监护的不可或缺的手段。许多文献都主张联合检测AFU和AFP活性，对肝癌高发人群的筛查和肝癌的早期诊断有重要意义。笔者在一次偶然机会中，因几位门诊体检人员的血清标本不够而采用EDTA-K，抗凝的血浆测定AFU活性，发现这几个标本AFU结果均明显增高。为了验证是否因EDTA-K：抗凝剂的影响，笔者专门做了以下实验，现将结果报道如下。