Thoracoamniotic shunting for fetal pleural effusions with hydrops

OBJECTIVE: The purpose of this study was to evaluate perinatal outcome after thoracoamniotic shunting for fetal pleural effusions with hydrops. STUDY DESIGN: This was a retrospective study. RESULTS: Shunting was performed immediately after diagnosis and was successful in all 54 of the cases that were attempted. There were 7 pregnancy terminations, 9 in utero deaths, and 38 live births, of which 7 children died in the neonatal period and 31 children survived. Among the liveborn infants, 27 infants were delivered preterm (71%), of whom 7 infants (15%) had preterm premature rupture of membranes and 4 infants (8.5%) had chorioamnionitis. Perinatal death (23/54 infants; 43%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (9 cases). All 31 survivors had chylothorax; for 28 of the survivors, the chylothorax was primary, and for 3 survivors, the chylothorax was the result of right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome. CONCLUSION: After the shunting, pleural effusion with hydrops has a 57% survival rate; premature delivery is the leading source of morbidity.     

Is ultrasound really helpful in the detection of rib fractures?

OBJECTIVE: To determine the usefulness of ultrasound in the detection of rib fractures. PATIENTS AND METHODS: A prospective study was performed over a 3-month period. Patients presenting with a high clinical suspicion of rib fracture(s) to the Accident and Emergency Department were referred for radiological work-up with a PA chest radiograph, an oblique rib view and a chest ultrasound. Associated lesions, e.g. pleural effusion, splenic laceration and pneumothorax were recorded. RESULTS: Fourteen patients were radiologically assessed. The mean patient age was 31 years (range 16-55 years) and the M:F ratio 3.7:1 (11 men and 3 women). Ten patients displayed a total of 15 broken ribs. Chest radiography detected 11, oblique rib views 13 and ultrasound 14 broken ribs. Ultrasound findings included discontinuity of cortical alignment in 12 fractures, an acoustic linear edge shadow in nine and a reverberation artifact in six. Concordance with plain film findings, and especially oblique rib views, was good, though better when the rib fractures fragments were markedly displaced. One splenic laceration was detected with an associated small pleural effusion. There were no pneumothoraces. The average time of ultrasound examination was 13 min. CONCLUSION: Ultrasound does not significantly increase the detection rate of rib fractures, may be uncomfortable for the patient and is too time-consuming to justify its routine use to detect rib fractures.     

胸腔积液应用中心静脉导管引流的观察及护理

目的 观察中心静脉导管在胸腔积液引流中的应用与疗效。方法 实验组42例采用中心静脉导管进行引流与对照组38例采用单一胸腔穿刺治疗的临床疗效对比观察。结果 实验组在平均住院天数、平均住院费用明显低于对照组；在患者及家属的满意度方面明显高于对照组；而在患者疼痛，出现胸膜反应的例数，平均穿刺的次数等方面明显低于对照组（p〈0．05和p〈0．01）。结论 中心静脉导管在胸腔积液引流中的疗效令人满意。     

Low dose bromocriptine-induced pleural effusion and pleuropulmonary fibrosis

We describe a parkinsonian patient who developed a slight asymptomatic pleural effusion during prolonged therapy with low dose bromocriptine (BCR) in addition to levodopa, following prior treatment with CQA 206–291. A moderate increase of BCR dosage prompted a severe pleuropulmonary inflammatory reaction with polyclonal activation and elevated serum liver enzymes, which normalized following withdrawal of the drug. The clinical syndrome and close relation to BCR treatment are in keeping with a diagnosis of BCR-related pleuropulmonary fibrosis (PPF). Features of this case are compared with previous reports on dopamine (DA) agonist-related PPF. This case supports earlier suggestions of polyclonal activation in DA agonist-related PPF and suggests hepatic involvement and dose dependency.     

中心静脉导管和传统胸腔闭式引流治疗创伤性血胸的对照研究

目的 评价应用中心静脉导管行胸腔闭式引流治疗创伤性血胸的有效性、安全性.方法 2003年1月至2007年5月期间浙江大学医学院附属第二医院急诊中心收治的299例创伤性血胸患者按入院日期的单、双号分为导管组(n=156)、胸管组(n=143).导管组从B超定位点按Seldinger法,穿刺置入一次性单腔中心静脉导管,末端接引流袋;传统胸管常规置入,末端接水封瓶.比较两组患者置管的操作时间、治疗成功率、严重并发症发生率、术后镇痛药使用率、手术伤口愈合时间、伤121感染发生率,再对两组中治疗成功的患者,进一步比较其留管时间、相关费用.应用SPSS 13.0软件系统,率的比较采用X2检验,计量资料的比较采用t检验,以P<0.05为差异具有统计学意义.结果 导管组的操作时间、术后镇痛药使用率、手术伤口愈合时间、伤口感染发生率明显低于胸管组(P<0.05),但两组患者的治疗成功率、严重并发症发生率差异无统计学意义(P>0.05).两组中治疗成功的患者,其留管时间、相关费用差异无统计学意义(P>0.05).结论 中心静脉导管引流胸腔积血和传统胸管一样安全、有效,且操作简单、创伤小,较传统胸管更易为医患双方接受.     

Community‐acquired pneumonia in children: what’s old? What’s new?

Community‐acquired pneumonia (CAP) still remains a significant cause for childhood morbidity worldwide. Streptococcus pneumoniae is the most important causative agent at all ages. Respiratory syncytial virus is common in young children, and Mycoplasma pneumoniae in schoolchildren. Paediatric CAP is universally treated with antibiotics; amoxicillin is the drug of choice for presumably pneumococcal and a macrolide for presumably atypical bacterial cases. Because of globally increased resistances, macrolides are not safety for pneumococcal CAP. At present, available prospective research data on the epidemiology of paediatric CAP in western countries are from 1970s to 1980s; correspondingly, data on bacterial aetiology are mainly from 1980s to 1990s. Current concepts on pneumococcal aetiology are mostly based on poorly validated antibody assays. Most data on clinical characteristics in children’s CAP, as well as on antibiotic treatment come from developing countries, thus not being directly applicable in western communities. Recent viral studies have revealed the role of rhinoviruses, metapneumovirus and bocavirus in the aetiology of paediatric CAP. This review critically summarizes the available data on epidemiology, aetiology, clinical presentation, treatment and outcome of CAP in children, with special focus on the newest microbial findings, the age and applicability of the data and the need of new studies.     

咽喉反流与儿童分泌性中耳炎

咽喉反流是指胃内容物反流到食管上括约肌水平。分泌性中耳炎是儿童常见的疾病,可导致儿童听力损失和语言发育迟缓。近10年的研究支持咽喉反流与分泌性中耳炎有关系,但是咽喉反流引起分泌性中耳炎的确切病因机制尚未十分明确。本文对近期有关咽喉反流与儿童分泌性中耳炎相关性的文献进行检索与回顾,总结咽喉反流与儿童分泌性中耳炎相关性的最新进展。     

Toll样受体4信号途径在大鼠中耳积液中的表达

目的探讨Toll样受体4（Toll like receptor 4,TLR4）信号途径在中耳积液大鼠的作用机制。方法采用听泡内注入纤维蛋白封闭剂和脂多糖制作大鼠中耳积液模型。分别于3、5、7、9、11、13天处死大鼠,每次5只。取中耳黏膜检测TLR4、诱生型一氧化氮合酶（inducible nitric oxide synthase,iNOS）、白细胞介素8（interleukin-8,IL-8）mRNA的表达;免疫组化检测核因子κB（nuclear factor kappa B,NF-κB）表达情况。结果对照组中耳黏膜内有少量的TLR4、iNOS和IL-8mRNA的表达,中耳积液时表达量明显增高（P〈0.05）。免疫组化检测显示大鼠中耳黏膜内NF-κBp65的表达在中耳积液时明显提高。结论中耳积液时TLR4表达明显升高,并伴有NF-κB活化,促进下游IL-8等的表达,可能是引发大鼠分泌性中耳炎的机制之一。     

经皮胸膜活检对胸腔积液病因诊断的价值

目的：探讨经皮胸膜活检对胸腔积液病因诊断的价值和安全性。方法回顾性分析86例胸腔积液行闭式胸膜活检患者的临床资料。结果经皮胸膜活检成功率为95.3%,直接明确病因诊断的共57例,确诊率为66.3%,其中结核性胸膜炎阳性率为91.3%,恶性胸腔积液的阳性率48.4%,发生胸膜反应3例,气胸1例。结论经皮胸膜活检操作简单、易行、创伤小、安全、阳性率高,对胸腔积液的诊断具有较高价值。     

胸膜纤维板剥脱术在慢性结核性脓胸中的应用效果及安全性分析

目的探讨胸膜纤维板剥脱术在慢性结核性脓胸中的应用效果及安全性。方法选取本院2008年7月～2013年12月手术救治的58例慢性结核性脓胸患者作为研究对象,所有患者术前均给予抗结核及抗感染治疗,以胸膜纤维板剥脱术作为手术方式,术后持续治疗,增强呼吸功能锻炼,有效促使肺不张。结果58例慢性结核性脓胸患者手术均顺利完成,术中出血量为（700±45）ml。经胸膜纤维板剥脱术治疗后,患者脓腔消失,病情改善较佳．无死亡病例;术后未发生肺漏气、肺不张、感染、出血等并发症。病情完全改善者50例（86．2％）,病情好转者6例（10．3％）．脓胸复发者2例（3．5％）。结论胸膜纤维板剥脱术治疗慢性结核性脓胸患者的效果显著,可有效改善患者的肺功能,与抗结核等相关治疗相结合,可降低复发率,提高患者的生存质量。