Severe abdominal infections in neutropenic patients

Abdominal infections are an important cause of morbidity and mortality in neutropenic patients. We present a retrospective series of 16 patients, mostly with acute leukemia, who developed severe abdominal infections during chemotherapy-induced neutropenia between 1991 and 1997. The frequency among patients with acute leukemia was 2.35% (13 of 553). Thirteen patients presented with enterocolitis and 3 patients presented with cholecystitis. Eight patients died. Bacteremia was present in 6 patients, 4 patients suffered from proven or strongly suspected fungal infections, and 1 patient suffered from cytomegalovirus infection. Early surgical management was required in a patient with intestinal obstruction, whereas other patients could be managed conservatively. Two patients with acute cholecystitis were treated with antibiotics until the end of neutropenia and then were resected. Severe abdominal infections in neutropenic patients, which are often fatal, were caused by nonbacterial microorganisms in one-fourth of the cases and could be managed conservatively in most instances.     

Intracolonic use of vancomycin for treatment ofClostridium difficile colitis in a patient with a diverted colon

Clostridium difficile-associated pseudomembranous colitis (PMC) is a common affliction of postoperative patients. Risk factors include antibiotic therapy, recent surgery, and hospitalization (1,2,3). We present a case of PMC in a diverted colon and its treatment using vancomycin enemas.     

先天性巨结肠术后发生小肠结肠炎的高危因素

目的：分析先天性巨结肠术后发生小肠结肠炎的高危因素。方法：1991年1月－1999年6月行先天性巨结肠根治手术155例,获随访141例,进行10个相关因素调查,包括非手术因素和手术因素。结果：34例发生不同程度小肠结肠炎（24％）,吻合口狭窄或瘘和肠梗阻是术后发生小肠结肠炎的高危因素,术前患小肠结肠炎是术后发生小肠结肠炎的另一危险因素。沁肠结肠炎患儿上呼吸道或肺部感染增加一倍。结论：术后小肠结肠炎是肠道梗阻和肠粘膜抵抗力降低共同作用的结果,避免和解除梗阻因素的同时改善患儿肠道粘膜功能是降低该并发症发生并使其疗效有显著性改善的新途径。     

The impact of Down’s syndrome on the immediate and long-term outcomes of children with Hirschsprung’s disease

Hirschsprung’s disease (HD) in Down’s syndrome (DS) patients is stated to have a worse outcome than HD alone. In our study we reviewed the immediate and long-term outcomes of these children and questioned whether DS should influence the operative management. Data were collected on all children with HD (including total colonic aganglionosis), between January 1990 and December 2000. They were divided into two groups based on the presence or absence of Trisomy 21 and compared retrospectively. In this time period we treated 173 children with HD; 17 of these had DS. Both the groups were comparable in their mean gestational age, birth weight and presentation except that the DS group had a significantly higher overall incidence of pre and/or postoperative enterocolitis. A tota1 of 164 children underwent a Swenson pull-through and 9 had a Soave’s procedure. Follow-up ranged from 1 to 10 years. Continence assessed using the Wingspread scoring system in children over the age of 4 years showed no significant difference. Although children with both HD and DS are predisposed to complications and required a more cautious management, long-term outcome in terms of continence was not significantly worse than in HD alone. Thus the co-existence of DS should not influence the decision to offer these children and their parents the choice of definitive repair.     

新生儿坏死性小肠结肠炎62例疗效观察

目的:探讨62例新生儿坏死性小肠结肠炎(NEC)的诊治与疗效。方法:62例中早产儿及足月未成熟儿32例,足月儿30例。手术10例,其中肠切除肠吻合4例,肠造瘘6例;52例行保守治疗。本组病例均在综合治疗的基础上给予静脉高营养(TPN)疗法。TPN液经周围静脉输入。应用TPN时间为6～30d。在实验室监测情况下用TPN。结果:治愈56例,治愈率为90.3％。死亡6例,占9.7％。结论:新生儿NEC应早期诊断,在综合治疗的基础上应用TPN疗效满意。     

缺血再灌注对于胎鼠小肠组织神经降压素的影响

目的 研究缺血再灌注对于有胎鼠小肠组织神经降压素（ＮＴ）的影响,旨在探讨小肠组织ＮＴ含量的降低是在坏死性小肠炎的发要理中起着一定的作用。方法 ５７只胎鼠随机分为两组;假手术组１３只;缺血再灌注组４４只,缺血再灌注组再分为１组３４只,缺血时间分别为５ｍｉｎ、１０ｍｉｎ、２０ｍｉｎ,再灌注时间均为５ｍｉｎ。再灌注Ⅱ组２１只,缺血时间均为１０ｍｉｎ,再灌时间分别为５ｍｉｎ、２０ｍｉｎ,采用放射免疫的方法     

Necrotising enterocolitis and neonatal sepsis: A literature review

Necrotising Enterocolitis is a common infection and medical emergency effecting susceptible premature and low birth weight infants, cared for within Neonatal Intensive Care Units (NICU). Characteristics of the disease include fever, abdominal distention, bilious vomits and aspirates, poor enteral feeding and blood present in stool. Without prompt management, the risk of ischemia and necrosis of the infant bowel is high, leading to the likely development of Short Bowel Syndrome (SBS). Medical management of the disease includes gut rest, intravenous antibiotic and fluid resuscitation if symptoms of hypovolaemic shock are present, with surgical interventions required when bowel necrosis becomes irreversible. Neonatal nurses have an important role in early detection of the disease among at risk infants, preventing extensive and life-long bowel damage occurring among these infants. However, due to the ongoing and chronic nature of the disease, the skills of paediatric nurses are required when the baby develops SBS after extensive surgery.     

新生儿坏死性小肠结肠炎发病机制研究进展

新生儿坏死性小肠结肠炎是新生儿常见的急性肠道炎症性坏死性疾病,其发病机制尚未完全明确,该研究从未成熟肠道生长因子水平、肠道介质对微循环的影响、多种因素所致肠道菌群异常定植、感染、喂养方式、遗传易感性及输血、脐静脉置管医疗行为等方面对NEC发病机制进展进行阐述,为临床诊疗提供依据。     

腹部X线和彩超对新生儿坏死性小肠结肠炎诊断的研究

目的研究新生儿坏死性小肠结肠炎（NEC）腹部X线和彩超的表现,提高对NEC的早期诊断。方法对2008年1月至2012年12月,我院确诊的40例NEC患者的腹部X线和彩超做回顾性分析。结果与单纯应用腹部X线或彩超对NEC的诊断相比,联合应用腹部X线和彩超可以明显提高对NEC的诊断率（P〈0．05）。结论联合应用腹部X线和彩超可以提高对临床疑为NEC的早期诊断。