Video-fluoroscopic study of swallowing in children with neurodevelopmental disorders

BACKGROUND: Children with neurodevelopmental disorders can have feeding problems. Malnutrition and recurrent aspiration pneumonia can increase the risk of morbidity and mortality. Video-fluoroscopic study of swallowing (VFSS) is essential in understanding the pathological mechanisms involved during swallowing. METHODS: The aim of the present study was to assess the role of VFSS in assessment and management of four children with various neurodevelopmental disorders in a multidisciplinary feeding team. We describe the team approach, with the participation of child neurologist, radiologist with the rehabilitation team including the speech therapist, occupational therapist and dietician, in the assessment and plan of management. RESULTS: Video-fluoroscopic study of swallowing had been useful in assessing the type of swallowing problems with treatment goals targeted to the basic underlying pathophysiological mechanism. CONCLUSION: A child neurologist should be involved in the multidisciplinary oromotor rehabilitation program for neurologically impaired children with feeding problems.     

Histological findings after angioplasty using conventional balloon, radiofrequency thermal balloon, and stent for experimental aortic coarctation

Abstract Background : Use of balloon angioplasty or stent implantation has been reported to be effective in relieving coarctation of the aorta. However, restenosis frequently occurs after balloon angioplasty for native aortic coarctation in small infants, and sometimes develops after stent implantation because of vessel growth. The causes of restenosis remain uncertain. The purpose of this study was to assess the histologic differences in vascular responses to angioplasty using conventional balloon, radiofrequency thermal balloon (RFTB), or stent for experimental aortic coarctation. Methods : The authors surgically created an aortic coarctation model using 14 puppies. Angioplasty using conventional balloon, RFTB, or stent was performed 1 month after the initial operation. At the acute or chronic phase after angioplasty, the animals were killed and histologic studies were performed. Results : More vascular injuries were noted in the specimens from animals undergoing conventional angioplasty than in those with RFTB or stent. However, neointimal hyperplasia was seen more often after RFTB or stent because of the proliferation of smooth muscle cells from the tunica media, caused by secretion of growth factors. Apoptosis reached a peak 1?2 weeks after angioplasty, regardless of the type of intervention. Conclusions : The authors conclude that angioplasty with RFTB or stent can provide relatively small injuries in the vessel wall for aortic coarctation, but care must be taken to prevent restenosis caused by intimal hyperplasia, because neointima hyperplasia is more frequent after RFTB or stent.     

多胎妊娠晚期1胎死亡后的期待疗法

目的 探讨多胎妊娠晚期l胎死亡后期待疗法的价值。方法 回顾性分析1997年1月至2002年12月住院分娩多胎孕妇344例，分析19例多胎妊娠晚期l胎死亡的临床处理。结果 19例多胎妊娠晚期l胎死亡后的存活胎儿在临床观察、超声、胎心监护及实验室检查监测下，期待1～8周均成活并分娩，母体凝血功能未发现异常。结论 在严密监测下，无产科并发症的多胎妊娠晚期l胎死亡后的活胎可以期待，从而降低成活胎儿的病死率。     

第一产程异常胎心监护图形与新生儿结局的关系

目的　探讨第一产程异常胎心监护图形与新生儿结局的关系。方法　回顾分析 2 0 0 2年 8月至 2 0 0 3年 6月在我院足月单胎头位分娩产妇 ,第一产程中胎心率 (FHR)异常图形 2 1 7例 (观察组 )和FHR正常图形的2 6 9例 (对照组 )的临床资料。结果　第一产程异常FHR图形的发生率为 4 4 7% ,常见类型为轻度变异减速(6 4 5 % )、基线变异减弱 (2 1 6 % )和轻度心动过速 (1 2 0 % )。晚期减速、基线变异减弱和重度变异减速是导致新生儿窒息的危险因素。观察组羊水过少 (5 1 % )、脐带缠绕 (2 2 6 % )、羊水粪染 (1 0 6 % )、新生儿窒息 (6 5 % )、新生儿转入NICU(1 0 1 % )的发生率和剖宫产率 (31 8% )明显高于对照组 (P <0 0 5 )。结论　第一产程异常FHR图形的发生率较高 ,其中晚期减速、基线变异减弱、重度变异减速与新生儿窒息的发生相关 ,其他图形可在严密监护下继续试产     

62例双侧脑挫裂伤双侧开颅手术治疗分析

目的:总结62例双侧脑挫裂伤的临床特点、CT检查和手术治疗.方法:对62例双侧脑挫裂伤患者的手术治疗进行回顾性分析.结果:均行CT检查,以额颞叶脑挫裂伤多见,多并发外伤性蛛网膜下腔出血、硬膜下血肿和脑内血肿.病例全部行双侧开颅手术,其中双侧开颅手术手术一次的治愈率、致残率、病死率分别为75.0%、12.5%、12.5%;手术两次的治愈率、致残率、病死率分别为31.6%、21.0%和47.4%.手术一次组的治愈率高于手术两次组、病死率低于手术两次组,有显著性差异(P＜0.05),而致残率无显著性差异(P＞0.05).结论:双侧脑挫裂伤有其一定的临床特点,对该病的演变与发展做出早期预判、掌握手术指征,及时行一次性双侧开颅手术治疗是预后的关键.     

竞争情报与医院战略管理整合研究新视角:应用模式

在深化医院改革的过程中,当今医院处在体制转轨的特殊时期,医院为求生存走向市场,走向竞争也是必然,如何把医院办好、做强是摆在每个医院管理人员面前不容忽视的问题。怎样打破制约医院发展不科学的管理模式,打破瓶颈,走出新路。提出竞争情报与战略管理整合的新思路,即应用模式的研究,为推进医院现代化管理的理论研究提供参考。     

发达地区新型农村合作医疗模式的探索--广州市番禺区新型农村合作医疗的实践

广州市番禺区农村合作医疗坚持了30多年从未间断,2003年,被列为全国新型农村合作医疗试点县以来,建立了发达地区新型农村合作医疗模式。探讨沿海经济发达地区新型农村合作医疗的成功经验、主要特点和存在问题。     

胫骨平台骨折的手术治疗及并发症防治探讨

目的对胫骨平台骨折治疗的临床结果进行分析,并对其相关并发症进行探讨,总结相关经验并提出有效预防措施.方法回顾性分析胫骨平台骨折手术患者74例,骨折类型按Schatzker分型,其中Ⅰ型10例,Ⅱ型15例,Ⅲ型11例,Ⅳ型10例,Ⅴ型12例,Ⅵ型16例.Ⅰ型骨折采用切开复位松质骨拉力螺钉固定,其他类型采用切开复位、钢板螺钉内固定,缺损塌陷处自体或同种异体骨植骨.并对术后并发症进行分析.结果74例获得随访,随访时间1~5 a,平均3.2 a,功能评价采用Hohl膝关节功能分级系统,临床结果优良率达90%,术后各种并发症18例,其中创伤性关节炎10例,关节强直2例,关节不稳4例,感染2例.结论手术内固定是治疗胫骨平台骨折的重要方法,术中解剖复位、牢固内固定、术前正确处理并发症及早期正确适当功能锻炼能有效预防术后并发症,提高手术效果.     

黄芪注射液加纳洛酮治疗急性脑出血53例

目的初步探讨黄芪注射液加纳洛酮治疗急性脑出血的临床疗效。方法分别采用黄芪注射液治疗方案(A组:51例)、纳洛酮治疗方案(B组:49例)、黄芪注射液加纳洛酮治疗方案(C组:53例),对153例急性脑出血患者进行治疗,并于入院后第7、14、28天分别进行血肿体积、水肿容积测量和临床神经功能缺损程度评分。结果入院后第7天三组血肿体积、水肿容积、临床神经功能缺损程度评分比较差异均无统计学意义(P>0.05);入院后第14天C组分别与A、B组比较,血肿体积、水肿容积均显著减小(P<0.05),但A与B比较差异无统计学意义(P>0.05),三组临床神经功能缺损程度评分比较差异无统计学意义(P>0.05);入院后第28天C组分别与A、B组比较,血肿体积、水肿容积、临床神经功能缺损程度评分均有显著减少(P<0.05)。结论黄芪注射液加纳洛酮治疗方案是一种治疗急性脑出血更有效、更安全的方法。     

Acute-onset nontraumatic paraplegia in childhood: fibrocartilaginous embolism or acute myelitis?

Fibrocartilaginous embolus causing acute spinal cord infarction is a rare cause of acute-onset paraplegia or quadriplegia. Few cases of survivors have been reported in the neurosurgical literature, with most reports involving post-mortem or biopsy findings. There is little information on MRI findings in such patients. We present the youngest patient ever reported, and discuss the important differences between fibrocartilaginous embolus and acute myelitis of childhood. A 6-year-old girl with a history of back pain presented with sudden-onset nontraumatic paraplegia, with a clinical anterior spinal artery syndrome. Initial MRI scan revealed intervertebral disc disease at L1–2 and an incidental thoracic syrinx, but no cause for her acute-onset paraplegia was identified. Cerebrospinal fluid and other investigations were all negative. Sequential MRI scans revealed development of spinal cord expansion from T10 to the conus medullaris, with increased cord signal in the anterior aspect of the spinal cord. The intervertebral disc disease was unchanged. The imaging and clinical findings were caused by fibrocartilaginous embolus, which meant there was no need for spinal cord biopsy. The report describes the clinical and imaging criteria for diagnosis of fibrocartilaginous embolus, highlighting the case for avoiding an unnecessary biopsy. The clinical pattern in the paediatric group is discussed, with features differentiating it from acute myelitis of childhood. Received: 4 January 2000