沐舒坦糖浆临床疗效随机对照研究

为观察口服沐舒坦糖浆对咳嗽痰多患儿的临床疗效。将120例1-12岁患儿随机分为沐舒坦糖浆组60例。急支糖浆组60例，疗程7天，结果显示沐舒坦糖浆服用第3天可使痰量减少，咳痰程度减轻，痰液性状转稀和咳嗽症状减轻，至第7天可使抗生素使用频率降低。临床症状综合改善率74.7%。总有效率71.6%。表明沐舒坦糖浆化痰祛痰止咳疗效可靠，具有良好的安全性和依从性。     

Relations Between Coercive Strategies and MMPI-2 Scale Elevations Among Women Survivors of Childhood Sexual Abuse

The relationship between coercion strategies used by perpetrators of childhood sexual abuse (CSA) and elevations of CSA survivors on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was investigated. Participants were 151 women survivors of CSA in outpatient treatment at a university-based community mental health center. Scores on the MMPI-2 clinical scales and the Keane posttraumatic stress disorder (PTSD) scale were examined. Main effects were found for promised or received rewards on several clinical scales and the PTSD scale of the MMPI-2, independent of the presence of force. Specifically, the presence of such rewards was associated with significantly higher levels of symptomatology on Paranoia (Pa), Psychasthenia (Pt), Schizophrenia (Sc), and PTSD (Pk). There were no main or interaction effects noted for the presence of actual or threatened force on any of the scales.     

Rhinosinusite chronique de l''enfant: évolution des concepts

The concept of chronic rhinosinusitis in children has been recently individualized. The diagnosis is based upon the clinical history. It may be part of a diffuse inflammatory disease of the respiratory tract. Allergic and environmental polluting factors are possibly involved and must be looked for. Drainage of the rhinopharynx and local steroids are usually the first line treatment. In case of failure, a CT-scan of the sinuses should be performed looking for an obstructive anomaly of the sinuses requiring functional endoscopic sinus surgery     

Posterior Laryngeal Clefts: Preliminary Report of a New Surgical Procedure Using Tibial Periosteum As an Interposition Graft

Objective: To present the preliminary results of a new surgical procedure for posterior laryngeal cleft repair. Design: Retrospective study in an academic tertiary care center. Method: The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with severe aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involvement but not further than the first six tracheal rings. Associated malformations included one VATER syndrome, one esophageal atresia, and one tracheoesophageal fistula. Surgery was performed under general anesthesia with nasotracheaI intubation. A vertical anterior laryngofissure was performed. The mucosal margins of the clefts were incised and then repaired in two layers with polyglactin sutures. The original feature of this procedure was the interposition of a small piece of tibial periosteum between the two layers. This fascia graft is known to be strong and resistant in cleft palate surgery. Main Outcome Measure: Clinical and endoscopic follow-up was used for evaluation of results. Results: The three patients had successful laryngeal repair at a mean follow-up of 6 months (range, 4-14 mo). Conclusion: The anterior laryngofissure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair. A longer follow-up is needed to confirm these preliminary results. A computed tomography scan study and a study on the rabbit are planned in order to evaluate the outcome of these periosteal grafts.     

Improving the quality of child health services: participatory action by providers.

OBJECTIVE: To test a quality improvement approach called COPE (Client-Oriented, Provider-Efficient services), for use in strengthening health systems and supporting Integrated Management of Child Health (IMCI) efforts. DESIGN: Pre- and post-intervention observations of client/provider interactions, facility audits, staff and client surveys, and focus groups to evaluate differences between eight COPE intervention and eight matched non-intervention facilities after a 15-month intervention in 2001. SETTING: Primary care clinics in Guinea and Kenya. STUDY PARTICIPANTS: Health care providers and child caregivers. INTERVENTIONS: Over 15 months, the intervention supported four COPE exercises at each intervention site, supported supervisor training in quality management, and organized minimal training in topics selected by site staff as areas where training was needed. MAIN OUTCOME MEASURES: Differences in staff's and child caregiver's knowledge, attitudes, and practices; differences in the quality of services provided. RESULTS: On almost every quality indicator (over 65 indicators), whether reported by staff, observed by evaluators, or reported by clients, the intervention sites performed statistically significantly better than control sites. INTERVENTION: sites were cleaner and more pleasant, with more respect and information for clients, and more privacy. Staff had better personal communication skills, better diagnostic skills, and prescribing practices and gave better home care instructions to carers. Clients in intervention sites were more informed and more satisfied, and their children had better immunization coverage than those in control sites. CONCLUSION: COPE is a simple process, yet our study confirms that it can have a very dramatic effect on the quality of services. This study demonstrated how all areas of quality can be addressed by empowering health care providers to take action by using COPE. We suggest that COPE can complement Integrated Management of Childhood Illness (IMCI) training and can help to achieve better health for children.     

儿童白血病合并暴发型水痘带状疱疹病毒感染临床分析

目的探讨白血病患儿合并水痘带状疱疹病毒感染的临床特点及防治措施.方法回顾性分析1995年1月～2003年2月某院收治的6例合并水痘带状疱疹病毒感染的白血病患儿病历情况.结果 6例患儿均有发热及典型皮损,其中4例为持续高热(39～40.4℃)达1周,皮疹均为全身性分布.6例患儿均治愈,无水痘并发症发生.结论白血病患儿合并水痘带状疱疹病毒感染多呈暴发性感染,临床症状较重,容易出现并发症,应采取积极有效的防治措施.大剂量静脉用免疫球蛋白联合抗病毒药物等综合治疗效果较好.