UROLITHIASIS IN AUSTRALIAN ABORIGINAL CHILDREN

Thirty-six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty-five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.     

Children's stories of hope: moving toward an expanded understanding of the world children live in

This qualitative study that allowed children to be the dominant voice examined children's stories of hope. Twenty-nine kindergarten children through to third graders were interviewed using familiar school items: story board, pictures, puppets, and so on. One elementary school, located in a large southwestern metropolitan city, was selected for this study. Data was coded and prominent themes emerged illustrating that children are much more moral than many adults give them credit for. Approximately one-half of the stories shared focused not on the children's wants or “hopes”, but on others - classmates, friends, family, or extended relatives. The findings support research that highlights the issues of care, concern, and compassion that are a priority for young children.     

腹腔镜胆囊切除术开展初期质量控制的临床研究

目的探讨如何控制腹腔镜胆囊切除术（LC）开展初期的并发症及中转率。方法制定八条质量控制措施，总结分析568例LC临床资料。结果并发症6例，仅占1．2％，中转手术8例，中转率仅1．6％。结论在开展LC初期只要加强质量控制，完全可以避开高并发症、高中转率这种所谓的自然规律。     

Respiratory atopic disease, Ascaris-immunoglobulin E and tuberculin testing in urban South African children

BACKGROUND: Epidemiological relation of intestinal helminth infection and atopic disease, both associated with a T-helper (Th) 2 immune response, is controversial, as it has been reported that helminth infection may either suppress or pre-dispose to atopic disease. This relation has not been tested in an area with a high burden of Mycobacterium tuberculosis (MTB) infection, a known Th1-stimulating infection. OBJECTIVE: To study the association of intestinal helminth infection and atopic disease in a community where helminth infection is endemic and MTB infection is high. METHODS: Three-hundred and fifty-nine randomly selected children aged 6-14 years from a poor urban suburb were tested with allergy questionnaire, skin prick test (SPT) to common aeroallergens, Ascaris-specific IgE (Ascaris-sIgE), fecal examination for pathogenic intestinal helminths and tuberculin skin testing (TST). Histamine bronchoprovocation was tested in the group of children aged 10 years and older. RESULTS: were corrected for demographic variables, socioeconomic status, parental allergy, environmental tobacco smoke (ETS) exposure in the household, recent anthelminthic treatment and for clustering in the sampling unit. Results Ascaris-sIgE was elevated in 48% of children, Ascaris eggs were found in 15% and TST was positive in 53%. Children with elevated Ascaris-sIgE had significantly increased risk of positive SPT to aeroallergens, particularly house dust mite, atopic asthma (ever and recent), atopic rhinitis (ever and recent) and increased atopy-related bronchial hyper-responsiveness. In children with negative TST (<10 mm), elevated Ascaris-sIgE was associated with significantly increased risk of atopic symptoms (adjusted odds ratio (OR(adj)) 6.5; 95% confidence interval (CI) 1.9-22.4), whereas in those with positive TST (>/=10 mm) this association disappeared (OR(adj) 0.96; 95% CI 0.4-2.8). CONCLUSIONS: These results suggest that immune response to Ascaris (Ascaris-sIgE) may be a risk factor of atopic disease in populations exposed to mild Ascaris infection and that MTB infection may be protective against this risk, probably by stimulation of anti-inflammatory networks.     

双炔失碳酯或丙睾配伍dl-15甲基PGF_(2α)抗早孕的临床比较

本文报告65例双炔失碳酯配伍d1-15甲基PGF_(2α)(以下简称PG)抗早孕结果并与33例丙睾配伍PG抗早孕结果进行比较。结果显示,双炔失碳酯组完全流产59例,占90%;不全流产3例,占5%;失败3例,占5%;总有效率95%。丙睾组完全流产27例,占82%;不全流产6例,占18%;总有效率100%。两组总有效率无显著差异;完全流产率无显著差异;但不全流产率有明显差异(P<0.05)。药流后点滴出血天数,双炔失碳酯组平均为8.1±5.0天;丙睾组平均为18.9±19.1天;两组有明显差别(P<0.05)。双炔失碳酯经阴道给药后无一例发生心、肝、肾功能变化。     

One-year follow-up of the outcome of a randomized controlled trial of a home-based intervention programme for children with autism and developmental delay and their families

Introduction There is debate about the type and intensity of early childhood intervention that is most helpful for children with developmental problems. The aim of the study was to determine whether a home‐based programme provided over 12 months resulted in sustained improvement in development and behaviour 12 months after the intervention ceased. The characteristics of the children and families who benefited most from the intervention were also studied. Method Randomized controlled trial. Participants A total of 59 children, aged 3–5 years, attending two early childhood intervention centres in Melbourne, Australia. Intervention Half of the subjects received an additional home‐based programme consisting of 40 weekly visits. Main outcome measures Bayley Scales of Infant Development and Wechsler Preschool and Primary Scale of Intelligence Revised, Preschool Behaviour Checklist, Bayley Behaviour Rating Scale and Behaviour Screening Questionnaire. All tests administered pre‐intervention, following the intervention and 12 months later. Secondary outcome measures Family stress, support and empowerment. Results Fifty‐four children completed the assessments 12 months after conclusion of the intervention. Compared with the control group, improvement in aspects of cognitive development in the children who received the extra intervention was sustained 1 year later (P= 0.007) while significant behavioural differences post intervention were not. Analyses of the data by the Reliable Change Index indicated improvement of clinical significance occurred in non‐verbal areas. In contrast to the control group who deteriorated, language skills in the intervention group remained stable. Improvements were significantly associated with higher stress in the families. Conclusion Improvements following the provision of a home‐based programme to preschool children with developmental disabilities were sustained 1 year later. Children from highly stressed families appeared to benefit most, reinforcing the importance of involving families in early childhood intervention programmes.     

Childhood convulsive status epilepticus: epidemiology, management and outcome

Convulsive status epilepticus (CSE) in childhood is a medical emergency and its aetiology and outcome mean that it should be studied separately from adult CSE. The incidence in developed countries is between 17 and 23/100,000 with a higher incidence in younger children. Febrile CSE is the commonest single group with a good prognosis in sharp distinction to CSE related to central nervous system infections which have a high mortality. The aim of treatment is to intervene at 5 min and studies indicate that intravenous (i.v.) lorazepam may be a better first-line treatment than rectal diazepam and i.v. phenytoin a better second-line treatment than rectal paraldehyde. An epidemiological study strongly supports the development of prehospital treatment with buccal midazolam becoming a widely used but unlicensed option in the community. More than two doses of benzodiazepines increase the rate of respiratory depression without obvious benefit. The 1 year recurrence rate is 17% and the hospital mortality is about 3%.     

脑梗死后早发性癫(癎)发作临床特点分析

目的:探讨脑梗死(CI)后早发性癫癎发作(EES)的临床特点。方法:对2643例确诊为CI患者的临床资料进行回顾性研究。结果:CI后EES的发生率为4.58%,女性高于男性(P<0.05);婴幼儿及未成年人高于成年人(P<0.01)和老年人(P<0.01);累及皮质的发生率高于未累及皮质的(P<0.01);EES作为CI首发症状者占49.59%,24h内出现者占76.03%,1周内出现者占94.21%,仅有5.79%在第2周出现;局灶性发作占65.29%,全面性发作占34.71%;给予AEDs治疗发作均可控制,伴有EES的患者病死率高于不伴有者(P<0.05)。结论:CI后EES较为常见,女性多于男性,未成年人的发生率高于成年人及老年人,与梗死部位有关,以局灶性发作为主,抗癫癎治疗有效,临床预后较差。