Campylobacter colitis: a common infectious form of acute colitis

A case of acute ulcerating colitis due toCampylobacter fetus is presented. The radiographic and endoscopic findings are indistinguishable from those of idiopathic acute ulcerative colitis. The clinical and bacteriological data relating to Campylobacter are discussed.     

抗结核药物致伪膜性肠炎八例诊治分析

伪膜性肠炎（Pseudomembraneous colitis,PMC）是一种主要发生于结肠,亦可累及小肠的急性黏膜坏死和纤维素渗出性炎症,黏膜表面覆有黄白或黄绿色伪膜,多为应用抗生素后导致肠道菌群失调,难辨梭状芽胞杆菌大量繁殖,产生毒素而致病[1-3].以往报道该病多因细菌感染使用抗生素所致,鲜见服用抗结核药物出现伪膜性肠炎的报道.2010年6月至2013年10月,我院共收治抗结核药物导致伪膜性肠炎患者8例,现将其临床特征及诊治过程分析如下.     

Redo pull-through in Hirschsprung's [corrected] disease for obstructive symptoms due to residual aganglionosis and transition zone bowel

Background

Reoperations in Hirschsprung disease may be required for residual aganglionosis or transition-zone bowel found at the distal pull-through. We aimed to review the management of patients who had this complication and offer suggestions on how to avoid it.

Methods

Ninety-three patients with Hirschsprung disease were referred to our institution with recurrent problems after a pull-through done elsewhere. All required reoperations with a variety of indications, and of these, 25 had residual aganglionosis/transition-zone histology. This was the only indication for redo in 16 children.

Results

Children (range, 2-17 years) presented 6 to 66 months after the initial pull-through. The predominant symptoms were enterocolitis (n = 9 [56%]), constipation (n = 7 [44%]), failure to thrive (n = 5 [31%]), and impaction (n = 4 [25%]). The rectal biopsy performed as part of their post pull-through work up showed hypertrophic nerves (n = 16), absent ganglion cells (n = 6), and normal ganglion cells (n = 10). The original frozen-section biopsy, determining the level of the pull-through, only sampled the seromuscular layer in 3 children, leading to misdiagnosis. Reoperations involved a transanal resection (n = 15) and a posterior sagittal approach (n = 1). In all cases, obstructive symptoms were resolved, and no patient has had recurrent enterocolitis.

Conclusion

Patients' post pull-through with recurrent obstructive symptoms may have residual aganglionosis or transition-zone bowel. Reoperation can result in the resolution of these symptoms. A full-thickness biopsy at the time of the initial pull-through to include the mucosa and submucosa may increase the possibility of identifying hypertrophic nerves.     

Prevalence of head deformities in preterm infants at term equivalent age

Introduction

Due to a rising number of head deformities in healthy newborns, there has been an increasing interest in nonsynostotic head deformities in children over recent years. Although preterm infants are more likely to have anomalous head shapes than term newborns, there is limited data available on early prevalence of head deformities in preterm infants.

Aims

The purposes of the present study were to acquire quantitative data on head shape of preterm infants at Term Equivalent Age (TEA), to determine the prevalence of symmetrical and asymmetrical head deformities and to identify possible risk factors.

Methods

In a cross-sectional study design, Cranial Vault Asymmetry Index (CVAI) and Cranial Index (CI) calculated from routine head-scans with a non-invasive laser shape digitizer were recorded and categorized in type and severity of deformation for three different groups of gestational age. Perinatal and postnatal patient data was tested for possible associations.

Results

Scans of 195 infants were included in the study. CVAI at TEA was higher in very preterm (4.1%) compared to term and late preterm infants. Prevalence of deformational plagiocephaly was 38% in very preterm infants. CI was lower in very (71.4%) and late (77.2%) preterm infants compared to term infants (80.0%). Compared to term babies (11%), a large number of very (73%) and late (28%) preterm infants exhibited dolichocephaly at TEA.

Discussion

Prevalence of symmetrical and asymmetrical head deformities in preterm infants is high at TEA. Interventions are required to prevent head deformities in preterm infants during the initial hospital stay.     

大黄对新生鼠坏死性小肠结肠炎模型肠损伤的防治作用

目的：评价大黄对新生儿坏死性小肠结肠炎（NEC）的保护作用，通过检测肠黏膜组织匀浆中血小板活化因子（platelet-activating factor。PAF）及肿瘤坏死因子（tumornecrosis factor-α，TNF-α）的含量，探讨大黄的保护作用是否与降低肠组织PAF、TNF-α浓度有关，为应用大黄防治NEC提供科学依据。方法：选用新生2d龄SD大鼠30只随机分为A组（NEC模型＋大黄煎剂）、B组（NEC模型＋生理盐水）、C组（正常对照）3组，均行母乳喂养。制模成功后A组连喂3d大黄煎剂，B组喂等量生理盐水，5d后所有新生鼠处死，取肠组织作病理评分检查，并检测肠组织中PAF、TNF-α含量。结果：A组肠组织病理损伤程度轻，病理评分低于B组（P〈0．01）。A组PAF、TNF-α含量低于B组，差异有非常显著性（P〈0．01）。结论：大黄煎液对新生鼠NEC有非常显著的防治作用，能明显减轻缺氧肠组织的损伤程度，下调炎性细胞因子水平。因其价廉易得，且已经在新生几临床有广泛应用，故可作为临床防治NEC的新手段。[著者文摘]     

Hirschsprung’s disease: 13 years’ experience in 112 patients from a single institution

Although Hirschsprung’s disease is curable, a low mortality and a certain morbidity have been described by several authors. We will present our experience with the treatment of Hirschsprung’s disease at Gaslini Children’s Hospital. All patients who underwent a pull-through procedure since January 1993 were included. Data were obtained from a comprehensive questionnaire and from the revision of the notes. The results were subsequently described and compared with regard to age and length of aganglionosis. A total of 151 patients underwent a pull-through. One hundred and twelve of these patients completed the forms and were reviewed. Eighty patients had a classic form, 22 an ultralong. Complications occurred in 28 patients (25%). Postoperative enterocolitis was complained by 25 patients (13% colonic and 59% ultralong forms) and constipation by 15 (equally distributed). Excellent to good continence was experienced by 84% of patients with classic forms and by 68% of patients with ultralong forms. A clear improving trend during growth was evident for patients with ultralong forms. Psychological self-acceptance, patients’ perspective and cosmetic results proved to be significantly better for patients with classic forms of the disease. Our study confirmed the complications and long-term sequelae that patients with Hirschsprung’s can experience. Early diagnosis can minimise morbidity and mortality and prompt and adequate treatment can reduce the incidence of postoperative complications. The parents should be acknowledged regarding the progressive improvements of function that patients gain during growth, particularly in case of ultralong forms, thus strengthening the need for continuative care and close follow-up.     

早产极低出生体重儿肠道菌群变化与坏死性小肠结肠炎的相关性

目的:探讨早产极低出生体重儿（VLBWI）坏死性小肠结肠炎（NEC）发生前肠道菌群结构特征变化。方法:采用前瞻性巢式病例对照研究。将2018年4月20日至11月20日生后24 h内收住苏州大学附属儿童医院或苏州市立医院新生儿重症监护病房（NICU）且出生体重<1 500 g、出生胎龄<35周的46例早产VLBWI作为研...