Pediatric Inpatient Headache Therapy: What is Available

Status migrainosus is defined by the international classification of headache disorders (ICHD) criteria as a debilitating migraine lasting more then 72 hours. The epidemiology of status migrainosus is still unknown in adult and children, and frequently underdiagnosed. Children and adolescents often end up in the emergency room with an intractable headache that failed outpatient therapy. Six to seven percent of these children do not respond to acute infusion therapy and require hospitalization. It is imperative that more aggressive therapy is considered when patients are affected by a severe intractable headache to prevent further disability and returning the child to baseline activity. Multiple therapies are available for adults and children. Studies for acute therapy in the emergency room are available in adults and pediatric groups. Small studies are available for inpatient therapy in children and, along with available therapies for children and adolescents, are described in this review. A review of the literature shows growing evidence regarding the use of dihydroergotamine intravenously once patients are hospitalized. Effectiveness and safety have been proven in the last decades in adults and small studies in the pediatric populations.     

椎管内转移癌病人氨甲喋呤配伍高渗盐水硬膜外灌注治疗顽固性疼痛的临床探讨

１０例椎管内转移癌病人曾长期使用大剂量镇痛药难以奏效，而少数病例便采用硬膜外腔注射吗啡２～４ｍｇ疼痛缓解仅１ｈ。采用硬膜外腔灌注氨甲喋呤配伍高渗盐水，使抗癌药直接与肿瘤接触，几分钟内杀死癌细胞，加之高渗盐水能促使肿瘤和神经干脱水，肿瘤体积缩小和破坏，改善局部动脉缺血和组织水肿，从而减轻或消除肿瘤对神经根的压迫，缓解和消除神经痛。     

难治性便秘综合治疗及影响因素的评价

目的评价综合治疗对难治性便秘的疗效及影响因素。方法将84例难治性便秘分为非重叠组和重叠组。应用个体化综合治疗4周,观察便秘症状评分变化及总有效率,分析IC患者的重叠症状和心理障碍状态对疗效的影响。结果(1)84例便秘患者中,重叠组和非重叠组分别占40.5%和59.5%。(2)重叠组和非重叠组的总有效率分别为50.0%和78.0%(P<0.05)。(3)对37例IC患者的心理测试调查显示,59.4%(22/37)有心理障碍状态,重叠组和非重叠组伴有心理障碍状态对治疗的总有效率分别为4.8%和31.5%(P<0.05)。结论适合个体化的综合治疗使多数难治性便秘缓解症状,但伴有重叠症状,尤其心理障碍状态则影响疗效。     

Fifty- four infantile intractable diarrhea patients treated with integrated traditional chinese and western medicine

Ｉｎｆａｎｔｉｌｅｉｎｔｒａｃｔａｂｌｅｄｉａｒｒｈｅａ（ＩＩＤ）ｗａｓｕｓｕａｌｌｙｃｏｍｐｌｉｃａｔｅｄｗｉｔｈｍａｌｎｕｔｒｉｔｉｏｎ,ｇｒｏｗｔｈｒｅｔａｒｄａｔｉｏｎａｎｄｐｕｌｍｏｎａｒｙｉｎｆｅｃｔｉｏｎ,ｅｔｃ．Ｉｔｉｓｄｉｆｆｉｃｕｌｔｔｏｃｕｒｅ,ａｎｄｍｏｒｔａｌｉｔｙｉｓｒａｔｈｅｒｈｉｇｈ．ＴｈｅａｕｔｈｏｒｓｕｓｅｄｉｎｔｅｇｒａｔｅｄｔｒａｄｉｔｉｏｎａｌＣｈｉ ｎｅｓｅａｎｄｗｅｓｔｅｒｎｍｅｄｉｃｉｎｅｔｈｅｒａｐｙｔｏｔｒｅａｔｉｔ,ａｎｄｓａｔｉｓｆａｃｔｏ…     

植入性鞘内药物(吗啡)输注系统治疗顽固性疼痛的临床观察

目的:探讨植入性蛛网膜下腔(即鞘内)药物(吗啡)输注系统(implantedintrathecaldrugdeliverysystem,IDDS)在顽固性疼痛治疗中的临床意义。方法:对4例因顽固性疼痛(癌痛和非癌痛)、药物治疗无法缓解而实施植入性鞘内药物输注系统的病人进行临床效果评价。结果:筛选试验成功后,经过外科手术将IDDS植入体内,术后给予持续输注吗啡,经过剂量调整,镇痛效果较明显,副作用减轻。结论:通过IDDS将镇痛药物(吗啡)直接注入作用部位(脊髓和大脑),镇痛效果确切,同时避免了全身给药时的副反应,是针对顽固性疼痛(癌痛和非癌痛)的三阶梯治疗以外的一种有效方法。应用时应掌握适应症,并进行筛选试验确定治疗的有效性,并根据疼痛缓解程度和副作用进行剂量调整。     

联用托吡酯治疗难治性癫痫临床观察

目的:观察联用托吡酯(TPM)治疗难治性癫痫(IE)的疗效与安全性.方法:采用开放性试验的方法,对20例IE患者进行治疗,以加用TPM前3个月的月均发作频率为基数,并与加用TPM后3个月的稳定期月均发作频率进行比较,同时观察其不良反应.结果:联用TPM治疗IE,总有效率达到75.0%,显效率为55.0%,其中3例(15.0%)完全控制;不良反应发生率为30.0%,为一过性,主要涉及中枢神经系统,其中2例出现体重减轻.结论:联用TPM对IE有良好疗效,安全性好.     

子咳的辨析及临床意义

通过总结历代对“子咳”的论述及认识,阐明了“子咳”的病因病机,结合当今医学的研究进展,指出“子咳”产生的生理病理基础。结合临床提出“子咳”的辨证分型及治疗方法,并提供有效的治疗经验。指出并探究与“子咳”相关中医理论的重要性及对临床的指导意义。