偏头痛患儿的大脑血流动力学变化

目的　研究偏头痛患儿的脑动脉血流动力学改变 ,探讨其在小儿偏头痛发生中的作用。方法　应用经颅多普勒 (TCD)技术 ,检测 90例 7～ 14岁头痛间歇期的偏头痛患儿和 80例健康同龄儿童脑动脉血管血流动力学指标。结果　 90例偏头痛患儿中脑动脉血流动力学异常者 77例 (86 % ) ,其中 6 0例 (6 7% )流速增快 ,9例 (10 % )减慢 ,与对照组相比 ,差异具有显著性 (P <0 0 1) ;90例中 2 3例 (2 6 % )存在双侧同名动脉血流速度不对称 ,其中伴有血流速度异常者15例 ,血流速度正常者 8例 ,差异具有显著性 (P <0 0 1)。结论　脑动脉血流动力学因素异常改变 ,在小儿偏头痛的发生中具有重要作用。尤其值得注意的是 ,双侧同名动脉流速不对称的改变 ,在小儿偏头痛的发生中同样可能起着重要的作用。     

雷公藤多苷治疗儿童肾病综合征的机制探讨

目的 :探讨雷公藤多苷在治疗儿童肾病综合征中的作用及其机制。　方法 :对 16年来在我科住院明确病理类型的 5 5 0例中 10 5例肾病综合征患儿 ,在激素逐渐减量的同时用雷公藤多苷 ( 1m g/ kg· d- 1 )治疗。　结果 :81例肾病综合征获得缓解 ,总缓解率达 77.1% ,其中 MCNS( 2 4例 )、Ms PGN ( 46例 )、MPGN ( 17例 )、MN ( 13例 )和FSGS( 5例 )的缓解率分别为 91.7%、89.1%、76 .5 %、38.5 %和 0 % ,FSGS效果最差 ;14例改善 ,10例无效。　结论 :由于病理类型不同疗效相差较大 ,临床上对激素治疗无效或耐药的肾病综合征患儿 ,应及时行肾活检以明确病理诊断 ,对病理类型为 MCNS和 Ms PGN者可单用雷公藤多苷治疗 ,以避免长期应用激素的不良反应 ,这是治疗儿童肾病综合征的有效方法之一     

Effect of regular training on the anthropometric parameters and urine steroids in childhood

The changes in the anthropometric data and urine steroid metabolites caused by regular training in children in two age groups (11 and 14 years old) were investigated. The skinfolds of older girls participating in regular athletic, swimming or soccer training were thinner compared with age-matched control groups (P < 0.01) and their body mass and constitution were lower (P < 0.05). In the other groups no significant differences were observable in the anthropometric parameters. The trained children in all groups had significantly higher exercise times on the cycle ergometer (P < 0.01, in young boysP < 0.05). The strength of their hands was lower in three trained groups: in younger boys (P < 0.05), in younger girls (P < 0.01) and in older girls (right handP < 0.01, left handP < 0.05). The urinary excretion of androsterone (P < 0.02), 11-ketopregnanetriol (P < 0.01) and pregnenetriol (P < 0.02) was decreased in the older trained girls; pregnenetriol was increased in younger boys (P < 0.05). Urinary excretion of cortisol metabolites was increased in trained boys [in younger boys: tetrahydrocorticosterone (P < 0.05) and 20-hydroxycortisol (P < 0.05); in older boys allotetrahydrocortisol (P < 0.02), cortisol (P < 0.05) and 20-hydroxycortisol (P < 0.05)]. There were no significant differences in the younger girls. In the trained older girls urinary excretion of cortisol metabolites was decreased: tetrahydrocortisone (P < 0.02), allotetrahydrocorticosterone (P < 0.01), tetrahydrocortisol (P < 0.05), -cortolone (P < 0.01), cortisol (P < 0.02), 6-hydroxycortisol (P < 0.01) and 20-hydroxycortisol (P < 0.05). A multivariate analysis of the data from the trained groups and sedentary, age-matched control groups showed that regular training has a significant effect on steroid excretion.     

Competencies and problems reported by parents of Greek and American children,ages 6–11

This study compared parent-reported competencies and behavioral/emotional problems in demographically-matched samples of Greek and American children, ages 6–11. Parents of 356 children of each nationality completed the Child Behavior Checklist (CBCL). Competence scores were higher for American children, except on Academic Competence, where scores were higher for Greek children. Greek scores were significantly higher than American scores on the Withdrawn, Anxious/Depressed, Attention Problems, Delinquent Behavior, Aggressive Behavior, Internalizing, Externalizing, and Total Problem scales. On the Anxious/Depressed syndrome, nationality accounted for 14% of the variance. There were few main effects for sex and age and fewer interactions. The higher problem scores in the Greek sample were partly due to the tendency of Greek parents to use extreme item scores. When items were scored present v. absent, Greek scores were higher only on Withdrawn, Anxious/Depressed, Internalizing, and Total Problems, while American scores were higher on Somatic Complaints and Thought Problems. Nationality differences in rates of referral for mental health services and sample differences in exclusion criteria for prior mental health services may have contributed to differences in problem scores. Results are compared to findings from other cross-cultural studies.

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Zusammenfassung Diese Studie vergleicht die Fähigkeiten und Verhaltens- bzw. emotionalen Auffälligkeiten in demographisch parallelisierten Stichproben von griechischen und amerikanischen Kindern im Alter von 6-11 Jahren. Die Eltern von 356 Kindern der beiden Nationalitäten füllten die Child Behavior Checklist (CBCL) aus. Die Kompetenzwerte waren bei den amerikanischen Kindern mit Ausnahme der akademischen Fähigkeiten höher. Die griechischen Werte waren signifikant höher als die amerikanischen im Hinblick auf die Skalen Zurückhaltung, ängstlich/depressiv, Aufmerksamkeitsstörungen, delinquentes Verhalten, aggressives Verhalten, Internalisation, Externalisation und Gesamtauffälligkeiten. Im Hinblick auf das ängstlich/depressive Syndrom war die Nationalität für 14% der Varianz verantwortlich. Nur vereinzelt wurden Haupteffekte im Hinblick auf Geschlecht und Alter und eine geringere Anzahl Interaktionen festgestellt. Die höheren Problemwerte in der griechischen Stichprobe waren teilweise durch die Tendenz der griechischen Eltern bedingt, extreme Werte anzukreuzen. Bei den Items, die als vorhanden bzw. nicht vorhanden gewertet werden mußten, waren die griechischen Werte nur bei den Skalen Zurückhaltung, ängstlich/depressiv, Internalisation und Gesamtprobleme höher, während amerikanische Werte für die Skalen körperliche Beschwerden und Denkstörungen höher lagen. Nationalitätsunterschiede der Zuweisungsraten zu psychosozialen Diensten und Stichprobenunterschieden im Hinblick auf die Ausschlußkriterien für vorangegangene Inanspruchnahme psychosozialer Dienste könnten zu den unterschiedlichen Problemwerten beigetragen haben. Die Ergebnisse werden verglichen mit anderen transkulturellen Studien.

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Résumé Cette étude a comparé les compétences et les problèmes de comportement et affectifs rapportés par les parents d'un échantillon d'enfants grecs et américains âgés de 6 à 11 ans appariés démographiquement. Les parents de 356 enfants de chaque nationalité ont rempli la Child Behavior Checklist (CBCL). Les scores de compétence étaient plus élevés pour les enfants américains excepté pour la compétence scolaire pour laquelle les scores étaient plus élevés chez les enfants grecs. Les scores grecs étaient significativement plus hauts que les scores américains quant au retrait, l'anxiété-dépression, les problèmes d'attention, le comportement délinquant, le comportement agressif, les échelles d'internalisation, d'externalisation et de problèmes totaux. Pour le syndrome anxiodépressif, la nationalité intervenait pour une variance de 14%. Il y avait peu d'effets principaux en ce qui concerne le sexe et l'âge. Les scores de problèmes les plus élevés dans les échantillons grecs étaient en partie dûs à la tendance des parents grecs à utiliser des items extrêmes. Quand les items étaient cotés présents versus absents, les scores grecs étaient plus élevés seulement en ce qui concerne le retrait, l'anxiété-dépression, l'internalisation et les problèmes totaux tandis que les scores américains étaient plus hauts en ce qui concerne les plaintes somatiques et les problèmes de pensée. Les différences de nationalité en ce qui concerne les taux de référence à des services de santé mentale et les différences des échantillons dans les critères d'exclusion pour l'utilisation antérieure de services de santé mentale, peuvent avoir contribué aux différences dans les scores de problèmes. Les résultats sont comparés aux autres études transculturelles.

     

Cranial burst fracture in infants: acute recognition and management

In the past, the diagnosis of growing skull fracture or diastatic fracture has included a subset of injuries better referred to as cranial burst fracture. Cranial burst fracture, typically associated with severe injury in infants less than 1 year of age, is a closed, widely diastatic skull fracture accompanied by acute cerebral extrusion outside the calvarium. We treated 11 such infants at the LeBonheur Children's Medical Center and 2 at the Children's National Medical Center from January 1986 through December 1994. Infants ranged in age from 1 to 17 months, with an average age of 5.7 months. All presented with marked scalp swelling and a Glasgow Coma Scale score of 10 or less. Twelve had a history consistent with severe injury (motor vehicle accident, 7, abuse 5). The cause of injury in one patient remains unproven. Surgery (reduction of herniated cerebral tissue, repair of large dural laceration, and cranioplasty) was usually performed within 10 days of injury, a time period long enough to assure hemodynamic stability and resolution of acute cerebral swelling, yet sufficiently brief to avoid the chronic changes (scarring, parasitization of scalp vessels by damaged cortex) associated with a growing skull fracture. Prompt repair of cranial burst fracture may prevent ongoing brain injury such as has been neuropathologically demonstrated in patients with growing skull fracture. Magnetic resonance imaging establishes the diagnosis of cranial burst fracture in equivocal cases, rendering unnecessary a waiting period to see if scalp swelling resolves. Our experience, together with information in the neuropathological and neurosurgicla literature, suggests that cranial burst fracture is associated with severe trauma, requires expeditious treatment, and has been underdiagnosed in the past, leading to growing skull fracture, a condition requiring more extensive surgery.     

天津市1999-2021年0~14岁儿童伤害死亡谱及城乡差异分析

目的 分析天津市0~14岁儿童伤害死亡谱的特征、变化情况及城乡差异。方法 1999-2021年天津市儿童伤害死亡数据来源于天津市全人口全死因监测数据库,计算不同亚组人群和主要伤害原因的构成比、粗死亡率和标化死亡率并比较城乡差异。采用Cochran-Armitage趋势检验分析死亡原因构成比的时间变化趋势。采用Joinpoint回归分析变化趋势,计算平均年变化百分比（AAPC）。伤害死亡风险的季节差异用死亡率比值及其95%CI表示。结果 1999-2021年,伤害是天津市0~14岁儿童的第3位死因。农村儿童死于医疗卫生机构的比例为31.08%,低于城市的37.82%。儿童伤害的总体标化死亡率呈下降趋势（AAPC=-5.54%,P<0.001）。溺水和道路交通伤害的标化死亡率在城市和农村地区呈下降趋势（P<0.001）。意外中毒的标化死亡率仅在农村地区呈下降趋势（AAPC=-8.09%,P<0.001）,在城市地区无明显变化趋势（P>0.05）。自杀标化死亡率在城市地区无明显变化趋势（P>0.05）,在10~14岁农村儿童中呈上升趋势（AAPC=4.58%）。跌倒/坠落标化死亡率在城市和农村地区均无明显变化趋势（P>0.05）。伤害死亡的总体风险和溺水死亡风险在城乡均为夏季最高;道路交通伤害在城市为秋季最高,在农村为夏季最高;意外中毒死亡风险在城乡均为冬季最高。结论 近年来天津市儿童伤害死亡情况得到明显改善。城市和农村地区的儿童伤害死亡水平仍存在较大差异,在未来政策制定中,应充分考虑缩小城乡差距。     

中、重度单纯性肥胖儿童血液流变学、心功能变化及二者相关性的研究

检测６０例中、重度学龄期单纯性肥胖儿童的血液流变学指标,以Ｍ超、Ｂ超、多普勒血流显像、多普勒组织显像等技术对心功能状况进行了全面检查。结果表明,与正常体重对照组相比,肥胖儿血液流变学各指标均有显著变化（Ｐ均＜０００１）,心脏的收缩和舒张功能均受累,血粘度的增加与心功能减低有明显的相关性。提示儿童期的单纯性肥胖已出现了血液流变学特性和心血管功能的异常,随着血粘度的增加,心功能渐减低,血液流变学特性的改变是单纯性肥胖症心血管系统功能受累的病理基础之一。     

小儿急性中毒77例临床分析及预防

本文对近 10年收治 77例急性中毒的患儿进行了回顾性分析。观察到 :年幼小儿、农村小儿发病率较高 ,因误服药物、鼠药的食物致急性中毒的患儿较多 ,死亡病例均因就诊太晚。提示 :对急性中毒必须早诊断、早治疗。并提出减少小儿意外中毒的关键应从预防着手     

Effective treatment of acute hyperkalaemia in childhood by short-term infusion of salbutamol

Hyperkalaemia is a lifethreatening emergency and infusion of glucose with insulin has so far been regarded as the standard treatment of choice. Recently the -2 stimulatory drug salbutamol has been shown to be an effective agent to treat hyperkalaemia by inducing a shift of potassium into the intracellular compartment. We treated 15 children aged 0.1–14 (mean 5.2) years suffering from acute hyperkalaemia (mean level 6.6±0.54, range 5.9–7.7 mmol/l) with a single infusion of salbutamol (5 g/kg over 15 min). Serum potassium concentrations decreased significantly within 30 min to levels of 5.74±0.53 and 4.92±0.53 mmol/l after 120 min (P<0.001, respectively). No side-effects occurred other than a slight increase in heart rate in 3 patients.Conclusion A single intravenous infusion of salbutamol at a dose of 5 g/kg is a highly effective treatment for hyperkalaemia with minimal clinical side-effects. The effect lasts for at least 120 min and may reverse hyperkalaemia in some patients without further interventions so that salbutamol seems justified as the first choice treatment for this condition in childhood.