Detection of ectopic gastric mucosa using 99mTc pertechnetate: review of the literature

Technetium-99m (^99mTc) pertechnetate scintigraphy in a child with acute gastrointestinal bleeding of unknown origin suggests ectopic gastric mucosa caused by Meckel’s diverticulum or gastrointestinal duplication cysts. Our objective was to define the patterns of scintigraphic findings likely to be encountered in patients with ectopic gastric mucosa with illustrative cases and to review the literature. Fifty children (age 1 year to 14 years) were evaluated for ectopic gastric mucosa using ^99mTc pertechnetate scintigraphy. Functioning ectopic gastric mucosa was detected in eight patients with Meckel’s diverticula and three patients with bowel duplication. Three patients showed atypical findings on scintigraphy which were perforated appendix, calyceal stasis, and regional enteritis. Ectopic functioning gastric mucosa in Meckel’s diverticulum is visualized simultaneously with the stomach, whereas in intestinal duplications tracer activity can be visualized in the dynamic sequence or before gastric tracer visualization in an irregular pattern. A variety of scintigraphic patterns can be found in patients with ectopic gastric mucosa undergoing ^99mTc pertechnetate scintigraphy depending on the location and size of the ectopic tissue. Also, acquisition of delayed images is useful when the initial images are equivocal in children.     

A retrospective study of surgery and reirradiation for recurrent ependymoma

PURPOSE: To report disease control for patients with recurrent ependymoma (EP) treated with surgery and a second course of radiation therapy (RT(2)). PATIENTS AND METHODS: Thirty-eight pediatric patients (median age, 2.7 years) with initially localized EP at the time of definitive RT underwent a second course of RT after local (n = 21), metastatic (n = 13), or combined (n = 4) failure. Reirradiation included radiosurgery (n = 6), focal fractionated reirradiation (n = 13), or craniospinal irradiation (CSI; n = 19). RESULTS: Initial time to failure was 16 months, and median age at second treatment was 4.8 years. Radiosurgery resulted in significant brainstem toxicity and one death (median dose, 18 Gy). Progression-free survival ratio was greater than unity for 4 of 6 patients; there was one long-term survivor. Three of 13 patients treated using focal fractionated reirradiation (median combined dose, 111.6 Gy) experienced metastasis. The CSI was administered to 12 patients with metastatic failure, 3 patients with local failure, and 4 patients with combined failure. The 4-year event-free survival rate was 53% +/- 20% for 12 patients with metastatic failure treated with CSI. Failure after CSI was observed in 1 of 3 patients with a history of local failure and 3 of 4 patients with a history of combined failure. CONCLUSION: Patients with locally recurrent EP experience durable local tumor control, but remain at risk of metastasis. Patients with metastatic EP failure may receive salvage therapy that includes a component of CSI. Durability of disease control and long-term effects from this approach require further follow-up.     

Cross-sectional and longitudinal associations between TV viewing and girls' body mass index, overweight status, and percentage of body fat

OBJECTIVE: To assess cross-sectional and longitudinal relations between television (TV) viewing and girls' body mass index (BMI), weight status, and percentage of body fat. STUDY DESIGN: Participants included 169 girls who were measured at ages 7, 9, and 11 years. Height and weight were measured and used to calculate girls' BMI and to classify their weight status. Girls' percentage of body fat was assessed with the use of dual-energy x-ray absorptiometry. Mothers reported the hours per day that girls watched TV on a typical day. RESULTS: No significant cross-sectional associations were identified. Results from longitudinal analyses showed that in comparison to girls who never exceeded the American Academy of Pediatrics TV viewing recommendations (ie, watched 相似文献   

Systematic Review and Metaanalysis of Statins for Heterozygous Familial Hypercholesterolemia in Children: Evaluation of Cholesterol Changes and Side Effects

Heterozygous familial hypercholesterolemia (heFH) affects 1 in 500 individuals. Evidence supports the low-density lipoprotein (LDL)-lowering effect of statins for adults with heFH. However, there are concerns regarding the treatment children with heFH. By performing a systematic review and metaanalysis of the published literature, this study aimed to evaluate the efficacy and safety of statins used for children with heFH. A systematic review was performed by searching multiple medical databases and citations to identify reports of randomized controlled trials of statins used to treat children with heFH. The trials were retrieved, reviewed, and subjected to metaanalysis. The search yielded 2,174 titles. Of the 63 studies retrieved and reviewed, 56 were excluded, 7 were included in the systematic review, and 4 were included in the metaanalysis. Significant heterogeneity was detected. The metaanalysis showed significant LDL lowering, high-density lipoprotein (HDL) cholesterol elevation, and increases in height and weight with statins. The metaanalysis could not be performed for many side effects of statins, but individual trials showed no significant side effects. Quality assessment showed methodologic concerns, with potential for bias. For example, six trials analyzed statin effects without intention to treat despite such a stated intention. Metaanalysis shows significant LDL lowering with statin treatment. Further studies, including epidemiologic and multicenter studies, are required.     

2002至2006年国家自然科学基金资助儿科学结题情况分析

目的 了解国家自然科学基金资助儿科学项目的完成情况和学科研究进展,客观公正地做好结题项目的绩效评估.方法 本文总结与分析了2002年至2006年度国家自然科学基金临床医学Ⅱ处资助儿科学各类项目结题完成情况,报道部分项目取得的重要研究成果和突出进展.结果 2002-2006年儿科学52项结题项目共发表文章420篇,平均8.1篇/项,科学引文索引(SCI)收录56篇,平均1.1篇/项,共培养博士后10人,博士102人,硕士109人;获省部级一等奖2项,二等奖2项;申请专利4项,获准专利1项.儿科学分支专业中的呼吸病学、肾脏病学、心血管病学等7个专业为结题项目主要涉及领域,取得了较大的研究进展.结论 2002-2006年儿科学52项结题项目在儿科学各专业、各资助项目类别间的分布及结题完成有一些差异;与其他的临床基础Ⅱ学科中某些学科相比还有一定的差距.结题项目总体完成情况较好,许多项目取得了研究成果,展示了国家自然科学基金在学科发展上的重要引领作用.     

小儿心脏术后早期合并呼吸道合胞病毒感染的影响和转归

目的 总结小儿心脏术后早期(<72 h)合并呼吸道合胞病毒(Respiratory Sncytial Virus,Rsv)感染对患儿术后病程的影响及其转归并分析总结治疗经验.方法回顾分析2005年5月至2008年5月浙江大学医学院附属儿童医院SICU收治的39名先天性心脏病(先心病)心内直视术后早期合并RSV感染的患儿的术后病程和转归.并1:1随机配对抽取同期收治的同年龄、同病种、无RSV感染的先心病心内直视后的39名患儿作为对照组.采取成组配对设计资料的t检验法比较两组患儿的呼吸机辅助通气时间、住ICU时间和住院时间;采取Fisher精确检验法检验二次插管率、无创辅助通气应用率以及术后常见并发症的发生率.再根据患儿年龄、先心病病种以及是否合并肺动脉高压进行分组比较.结果 两组患儿均痊愈出院.RSV感染显著延长患儿的呼吸机辅助通气时间、住ICU时间和住院时间,并增加术后肺不张的发生率(P<0.05).对年龄<6个月的患儿RSV感染不仅显著延长呼吸机辅助通气时间、住ICU时间和住院时间(P<0.05),还增加术后低心排综合征和合并感染的发生率(P=0.05);而对>24月的患儿无显著影响.对紫绀型先心病患儿显著延长其呼吸机辅助通气时间,住ICU时间和住院时间(P<0.05);对非紫绀型先心病患儿仅显著延长住ICU时间和住院时间(P均<0.05).对合并肺动脉高压患儿RSV感染不仅显著延长呼吸机辅助通气时间,住ICU时间和住院时间,还增加术后合并感染的发生率(P均<0.05);而对无肺动脉高压患儿仅延长住院时间(P<0.05).结论小儿心脏手术后早期合并RSV感染会对术后病程产生不良影响,尤其对小婴儿,紫绀型先心及合并肺动脉高压的患儿影响更大.早期诊断,采取有效的循环、呼吸支持结合抗病毒等综合治疗取得了较满意的治疗效果.     

Current issues in the management of acute bacterial sinusitis in children

OBJECTIVE: To review and summarize recent challenges in the microbiology and treatment of acute bacterial sinusitis (ABS), one of the most common infectious diseases in the pediatric community. METHODS: A review of recent medical literature from 1990 to 2006 was acquired using the National Library of Medicine's PUBMED database. RESULTS: Multiple mechanisms of penicillin resistance have been identified: porin channel blockage, beta-lactamase production, and changes in penicillin-binding proteins (PBPs). Other factors affecting treatment efficacy include the role of normal nasopharyngeal flora, such as alpha-streptococci. The more widely documented shift in the causative pathogens of acute otitis media (AOM) following the release of the heptavalent pneumococcal conjugate vaccine (PCV7) has also been documented in two studies of ABS in children. CONCLUSIONS: Treatment of ABS in children is complicated by a number of emerging changes in pathogen resistance patterns. These include beta-lactamase-negative ampicillin resistance (BLNAR) and multi-drug resistance, bacterial interference, and geographic data. These phenomena are likely to impact the treatment of URIs. Appropriate diagnosis and differentiation from viral sinusitis is essential prior to initiating therapy. Clinician education about these emerging issues remains an important strategy in diagnosing and treating ABS in children. This includes an understanding of known patient adherence to antibiotic therapy, such as taste, tolerability, dosing schedule, therapy duration, and patient preference. Clinicians should review judicious ABS treatment approaches that employ agents with documented efficacy against implicated pathogens.