早产儿肠穿孔的手术治疗:肠吻合术与造瘘术的对比

Background:Traditionally,a stoma is established after resection of perforated or necrotic intestine for isolated intestinal perforation (IIP) and necrotizing enterocolitis (NEC).We compared the outcome of resection and anastomosis (RA) with stoma formation (RS). Methods:Sixty-eight neonates undergoing laparotomy for IIP (n=20),NEC(n=43),and indeterminate cause (n=5) were reviewed retrospectively. Intestinal resection was followed by either anastomosis or stoma. The primary outcome measure was the frequency of anastomosis-and stoma-related complications. Results:The median gestational age (GA) was 28.5 weeks and birth weight (BW)-was 940 g. Thirty-seven neonates had RA (NEC 22,IIP 14,1 unknown),28 RS (NEC 21,IIP 6,1 unknown),and 3 laparotomy only. Twenty-five neonates died postoperatively. The mean ± SD GA of those who survived was 30 ± 4.5 weeks and those who died was 27.2 ± 3.5 weeks (P=0.008). The mean BW for those that survived was 1440.5 ± 865.1 g and those who died was 827.7 ± 385.1 g (P=0.002). There was no statistically significant difference between the RA and RS groups for GA (P=0.93),BW(P=0.4),general complications (P=0.96),anastomosis and stoma complications (P=0.48),and deaths (P=0.42). Conclusions:RA,rather than stoma,is an acceptable option in the surgical management of preterm neonates with IIP or NEC.

视乳头黑色素细胞瘤的OCT研究

Optic disc melanocytoma is a well-known clinical entity occurring as a deeply pigmented lesion on the optic nerve head. A 40-year-old man with a pigmented lesion overlying the left optic disc was evaluated with optical coherence tomography. The single high reflectance band from the anterior edge of the disc lesion with optical back shadowing behind on optical coherence tomography helped to pinpoint the diagnosis of the lesion as optic disc melanocytoma. Quantitative assessment of the mass with optical coherence tomography for its growth did not show any increase in size horizontally or vertically after 6 months. Optical coherence tomography is useful for obtaining the exact measurements of the mass lesion and may be used as a tool to follow the progress and growth pattern of the lesion.

个体化家庭治疗书面计划控制中度持续性哮喘的疗效研究:一项随机化的临床对照试验

Abstract Abstract Background: The management of childhood asthma necessitates a comprehensive approach including pharmacological treatment as well as education about self-evaluation and home management of the condition. Aim: To evaluate the efficacy of adding an individualized written home-manage-ment plan in the control of moderate persistent asthma. Methods: Children with moderate persistent asthma were randomized to receive either an individualized written home-management plan or no plan, in addition to standard asthma therapy including education. They were followed up with serial measurement of outcome variables. Results: Children receiving an individualized written home-manage-ment plan had fewer acute asthma events, fewer lost school days, lower symptom score and less nocturnal awakening than those who did not receive a written plan. Conclusion: The addition of a written individualized home-management plan improves overall control in children with moderate persistent asthma.

1例甲状腺毒症患儿治疗过程中所伴发的低钙血症

A 2-mo-old infant born to a mother with Graves’disease and having symptoms of thyrotoxicosis was started on antithyroid drugs.Life-threatening hypocalcaemia requiring high-dose calcium infusions developed 1 mo after starting therapy.Serum alkaline phosphatase and paratharmone levels were elevated.This communication may serve to alert treating physicians about this rare complication in infants with thyrotoxicosis after initiation of antithyroid therapy.Conclusion:Severe hypocalcaemia may follow initiation of antithyroid therapy in infants with thyrotoxicosis.

脓胸患儿胸膜腔内注入链激酶的随机对照试验

目的:对于严重的脓胸患儿,可从肋间导管将药物注入到胸膜腔内,本文对比胸膜腔内注入链激酶与注入安慰剂的疗效差异。方法:收集病情大于5期的脓胸患儿病例,利用肋间引流法进行胸膜腔内药物注入,根据注入成分不同,分为链激酶组(n=19)

与肺结核成年患者有家庭接触的儿童中结核感染传播的发生率和危险因子

Aims: To study the prevalence of tuberculosis infection among children in hous ehold contact with adults having pulmonary tuberculosis, and identify the possib le risk factors. Methods: Children under the age of 5 years who were in househol d contact with 200 consecutive adults with pulmonary tuberculosis underwent tube rculin skin testing. Transverse induration of greater than 10 mm was defined as positive tuberculin test suggestive of tubercular infection. Infected children u nderwent chest radiography and analysis of gastric lavage fluid or induced sputu m for detection of acid fast bacilli. Results: Tuberculin test was positive in 9 5 of 281 contacts (33.8%), of which 65 were contacts of sputum positive patient s, while 30 were contacts of sputum negative patients. Nine of these children we re diagnosed as having tuberculosis based on clinical features and/or recovery o f acid fast bacilli; seven were in contact with sputum positive adults. The impo rtant risk factors for transmission of infection were younger age, severe malnut rition, absence of BCG vaccination, contact with an adult who was sputum positiv e, and exposure to environmental tobacco smoke. Conclusion: The prevalence of tu berculosis infection and clinical disease among children in household contact wi th adult patients is higher than in the general population, and risk is signific antly increased by contact with sputum positive adults.

印度中部的甲真菌病:临床病因的联系性

Background. Onychomycosis is mainly caused by dermatophytes, but yeasts and nondermatophyte molds have also been implicated, giving rise to diverse clinical presentations. The etiological agents of the disease may show geographic variation. The aim of the present study was to isolate the causative pathogens and to determine the various clinical patterns of onychomycosis in central India. Methods. The study population comprised 90 patients with onychomycosis. Nail samples were collected for direct microscopic examination and culture. Clinical patternswere noted and correlatedwith causative pathogens. Results. The male: female ratio was 3:1 and the mean age was 29.40 ±13.61 years. Fingernails were involved in 60%, toenails in 26.67%and both fingernails and toenails in 13.34%of the 90 patients. The clinical types noted were distolateral subungual onychomycosis (64.44%), total dystrophic onychomycosis (17.78%), proximal subungual onychomycosis with paronychia (12.2%), proximal subungual onychomycosiswith-out paronychia (4.44%) and superficial white onychomycosis (1.11%). Dermatophyteswere themost common pathogens isolated, being found in 24 patients (26.36%) [Tricophyton rubrum (23.07%), Tricophyton verrucosum(2.22%) and Epidermophyton floccosum (1.11%)], followed by Candida albicans, which was found in 22 patients (24.27%). Thirty-six (39.58%) nondermatophyte molds were isolaled from 29 patients. Of these 29 cases, six were associated with Tricophyton rubrum, which was considered the primary pathogen. Conclusions. Distolateral subungual onychomycosis was the most common clinical presentation; however, total dystrophic onychomycosis and proximal subungual onychomycosiswere not uncommonin this part of India. Tricophyton rubrum and Candida albicans were the major pathogens. The clinicoetiologic correlation revealed that a single pathogen could give rise to more than one clinical type. 2004 The International Society of Dermatology.

高脂血症患者中术前他汀类药物治疗与经皮冠状动脉介入术后所发生的院内并发症之间的关系

We investigated whether the observed protective effect of hyperlipidemia is stronger in patients who take statins and, if so, whether that effect is likely due to patient characteristics associated with statin use. In-hospital complications and long-term outcomes of patients with hyperlipidemia(cholesterol level ≥240 mg/dl) undergoing percutaneous coronary interventions(PCI) on statins(group Ia, n=2,052) and not on statins(group Ib, n=1,650) were compared with 726 patients with lower cholesterol levels(group Ⅱ). Despite a higher prevalence of co-morbidities and worse angiographic characteristics in patients with hyperlipidemia, patients in group Ia had significantly lower in-hospital mortality(0%vs 2%in the other 2 groups, p< 0.001), a lower increase in the postprocedure creatine kinase-MB fraction(14%vs 27%in group Ib and 28%in group Ⅱ, p< 0.001), and fewer PCI complications(15%vs 30%in groups Ib and Ⅱ, p< 0.001). After adjustment, patients in group Ia had a significant decrease in complications(odds ratio 0.72, 95%confidence interval 0.65 to 0.92, p=0.009). In contrast, those in group Ib had outcomes similar to those of patients with lower cholesterol. After application of propensity analysis to adjust for the likelihood of receiving statins based on clinical, angiographic, and procedural characteristics, group Ia had fewer in-hospital complications(odds ratio 0.75, 95%confidence interval 0.62 to 0.90, p=0.002) and lower in-hospital mortality(odds ratio 0.32, 95%confidence interval 0.12 to 0.84, p= 0.021). After successful PCI, overall survival after dismissal and survival free of myocardial infarction and target vessel revascularization were similar. In conclusion, hyperlipidemia per se is not associated with lower in-hospital complications after PCI. The benefit is largely limited to patients on statin treatment.

竖式还纳口成形术:治疗腹裂畸形时的肠坏死的方法

Silo pouch formation is a standard procedure to prevent compartment syndrome in gastroschisis. Intestinal complications such as perforation and volvulus can occur and their management can be perplexing. We present three such patients in which we formed a stoma through the silo pouch owing to these complications. Creation of stoma through the silo is a novel, safe temporizing technique to decompress the bowel while delayed reduction continues. Subsequently, when the baby and the bowel improve, the stoma can be closed.