Recto-vestibular disruption defect resulted from the malpractice in the treatment of the acquired recto-vestibular fistula in infants

AIM： TO explore the pathogenesis of the rectovestibular disruption （RVD） defect and to recommend a successful repair, and prevention of it. METHODS： Clinical records of 15 girls, age ranged from 3 to 15 （median, 7.5） years, with acquired rectovestibular fistula （RVF） mistreated before were retrospectively reviewed. All of them presented an abnormal appearance of perineum and were suffering from some degree of fecal incontinence, and those were graded Ⅲ to IV by Li Zheng＇s Score. Repair of anal sphincters and reconstruction of perineum body and skin by anterior perineal rectoanoplasty were performed in all cases. RESULTS： Operation in all cases was successful. The perin.eum looked practically normal and fecal continence score rose up to VI by Li Zheng＇s Score. CONCLUSION： The conventional treatment for anal fistula, lay-open or string-treatment, should be considered as malpractice of RVF, and certainly leads to the RVD defect, and the anterior perineal rectoanoplasty could cure it satisfactorily.

Diagnostic value of maximal-outer-diameter and maximal-mural-thickness in use of ultrasound for acute appendicitis in children

MM： To evaluate the maximal-outer-diameter （MOD） and the maximal-mural-thickness （MMT） of the appendix in children with acute appendicitis and to determine their optimal cut-off values to diagnose acute appendicitis.METHODS： In total, 164 appendixes from 160 children between 1 and 17 years old （84 males, 76 females; mean age, 7.38 years） were examined by high-resolution abdominal ultrasound for acute abdominal pain and the suspicion of acute appendicitis. We measured the MOD and the MMT at the thickest point of the appendix. Patients were categorized into two groups according to their medical records： patients who had surgery （surgical appendix group） and patients who did not have surgery （non-surgical appendix group）. Data were analyzed by MedCalc v.9.3. The rank sum test （Mann-Whitney test） was used to evaluate the difference in the MOD and the MMT between the two groups. ROC curve analysis was used to determine the optimal cut-off value of the MOD and the MMT on diagnosis of acute appendicitis.RESULTS： There were 121 appendixes （73.8%） in the non-surgical appendix group and 43 appendixes （26.2%） in the surgical appendix group. The median MOD differed significantly between the two groups （0.37 cm vs 0.76 cm, P〈 0.0001）, and the median MMT also differed （0.15 cm vs 0.33 cm, P 〈 0.0001）. The optimal cut-off value of the MOD and the MMT for diagnosis of acute appendicitis in children was 〉 0.57 cm （sensitivity 95.4%, specificity 93.4%） and 〉 0.22 cm （sensitivity 90.7%, specificity 79.3%）, respectively.CONCLUSION： The MOD and the MMT are reliable criteria to diagnose acute appendicitis in children. An MOD 〉 0.57 cm and an MMT 〉 0.22 cm are the optimal criteria.

Matrix metalloproteinases in the restorative proctocolectomy pouch of pediatric ulcerative colitis

AIM:To investigate matrix metalloproteinases(MMPs) and their tissue inhibitors(TIMPs) in pouch mucosa of pediatric onset ulcerative colitis(UC).METHODS:In this cross-sectional study,28 patients with pediatric onset UC underwent ileal pouch biopsy 13 years(median) after proctocolectomy.Expression of MMPs-3,-7,-8,-9,-12 and-26 and TIMPs-1,-2 and-3 in samples was examined using immunohistochemichal methods,and another biopsy was used to evaluate the grade of histological inflammation.Two investigators independently graded the immunohistochemical specimens in a semiquantitative fashion,using a scale marking staining intensity as follows:0 = less than 20 positive cells;1 = 20-50 positive cells;2 = 50-200 positive cells;3 = over 20 positive cells.Fecal calprotectin and blood inflammatory markers [serum C-reactive protein(CRP) and erythrocyte sedimentation rate] were determined during a follow-up visit to examine correlations between these markers and the expression of MMPs and TIMPs.RESULTS:Of the 28 patients with pediatric onset UC,nine had not experienced pouchitis,whereas thirteen reported a single episode,and six had recurrent pouchitis(≥ 4 episodes).At the time of the study,six patients required metronidazole.In all of the others,the most recent episode of pouchitis had occurred over one month earlier,and none were on antibiotics.Only four samples depicted no sign of inflammation,and these were all from patients who had not had pouchitis.Two samples were too small to determine the grade of inflammation,but both had suffered pouchitis,the other recurrent.No sample depicted signs of colonic metaplasia.Most pouch samples showed expression of epithelial(e) and stromal(s) MMP-3(e,n = 22;s,n = 20),MMP-7(e,n = 28;s,n = 27),MMP-12(e,n = 20;s,n =24),TIMP-2(e,n = 23;s,n = 23) and MMP-3(e,n = 23;s,n = 28) but MMP-8(e,n = 0;s,n = 1),MMP-9(e,n = 0;s,n = 9) and MMP-26(e,n = 0;s,n = 3) and TIMP-1(n = 0,both) were lacking.In samples with low grade of inflammatory activity,the epithelial MMP-3 and MMP-7 expression was increased(r =-0.614 and r =-0.472,respectively,P < 0.05 in both).MMPs and TIMPs did not correlate with the markers of inflammation,fecal calprotectin,erythrocyte sedimentation rate,or CRP,with the exception of patients with low fecal calprotectin(< 100 μg/g) in whom a higher expression of epithelial MMP-7 was found no differences in MMPor TIMP-profiles were seen in patients with a history of pouchitis compared to ones with no such episodes.Anastomosis with either straight ileoanal anastomosis or ileoanal anastomosis with J-pouch did depict differences in MMP-or TIMP-expression.CONCLUSION:The expression of MMPs pediatric UC pouch in the long-term shares characteristics with inflammatory bowel disease,but inflammation cannot be classified as a reactivation of the disease.

Treatment of rectal prolapse in children with cow milk injection sclerotherapy:30-year experience

AIM:To evaluate the role and our experience of injecti-on sclerotherapy with cow milk in the treatment of rectal prolapse in children. METHODS:In the last 30 years (1976-2006) we made 100 injections of sclerotherapy with cow milk in 86 chil-dren. In this study we included children who failed to respond to conservative treatment and we perform ope-rative treatment. RESULTS:In our study we included 86 children and in all of the patients we perform cow milk injection sclerot-herapy. In 95.3% (82 children) of patients sclerotherapy was successful. In 4 (4.7%) patients we had recurrent rectal prolapse where we performed operative treatment. Below 4 years we had 62 children (72%) and 24 older children (28%). In children who needed operative trea-tment we performed Thiersch operation and without any complications. CONCLUSION:Injection sclerotherapy with cow milk for treatment rectal prolapse in children is a simple and effective treatment for rectal prolapse with minimal com-plications.

Change in the body temperature of healthy term infant over the first 72 hours of life

Objective: To determine the range of body temperature in a group of healthy Chinese term neonates over the first 72 hours of life and to assess the influence of body weight, gestational age and route of delivery. Method: All 200 consecutive cases of neonates delivered at our hospital from March to August 2001 were included in this retrospective study. Temperatures were measured immediately after delivery, after 30 minutes, 1 hour, 2 hours, 8 hours and 15 hours and on the 2nd and 3rd day. Axillary temperatures ranging from 36.5 篊 to 37 篊 were regarded as normal. No cases of maternal fever or systemic infection of the newborns were discovered. All infants were discharged in good general condition. Results: The mean rectal temperature at birth was 37.19 篊. The lowest average temperature was reached at 1 hour after delivery (36.54 篊) with a significant difference between natural delivery (36.48 篊) and section (36.59 篊) (P<0.05). Temperature subsequently rose to 36.70 篊 at 8 hours and 36.78 篊 at 15 hours (P<0.05). Hypothermia was seen in 51.8% and hypothermia in 42.5% of the patients. On the 3rd day after delivery, 96% of all temperatures were in the normal range. A significant relation was found between hypothermia and both low birth weight (P<0.001) and low gestational age (P<0.05). Conclusion: The ref-erence range presently used did not include all physiological temperatures in the first 72 hours of life. Considering other factors, such as birth weight, route of delivery, gestational age and body temperature on the 2nd and 3rd day of life, may help to correctly assess the significance of temperatures beyond the reference range.

Thirty-six Cases of Infantile Proctoptosis Treated by Extremely Shallow Puncture

Proctoptosis, a disease of downward displacement of the anal canal, rectal mucosa, rectum or partial sigmoid colon, is known as prolapse of the rectum in TCM, which is frequently seen in the weak and thin babies or children of 2-4 years old. The author treated 36 cases of infantile proctoptosis by using extremely shallow puncture in the acupuncture techniques from Aug. 1995 to Dec. 1998 and obtained satisfactory results as reported in the following.……

Fitting and evaluation of height-diameter models for Alnus japonica in La Trinidad, Benguet, Philippines

The study was conducted to develop height-diameter at breast height(HT-DBH) models for Alnus japonica in La Trinidad, Benguet,Philippines and evaluate their predictive capability.The six widely used nonlinear growth models that were selected in this study were the ChapmanRichards, Schnute, Modified logistic, Korf/Lundqvist,Weibull and Exponential. A total of 208 Alnus japonica trees were measured using standard diameter tape for DBH(1.3 m above the ground) and Vertex and transponder was used for the total height measurement. The performance of the developed models were evaluated using the fit statistics including coefficient of determination(R^2), root mean square error(RMSE), mean bias(ē), absolute mean difference(AMD), and Akaike Information Criterion(AIC). The lack-of-fit statistics was also performed for further evaluation of the performance of the models.Based on the evaluation criteria, all six models were able to determine the DBH-height relationships and fitted the data well. Using the rank analysis, the Weibull HT-DBH model had the best performance among the six commonly used nonlinear growth models. The results of this study will help forest managers especially in La Trinidad, Benguet to easily predict the total height using the Weibull model for Alnus japonica utilizing the DBH as the predicting variable.

Manometric assessment of idiopathic megarectum in constipated children

AIM: Chronic constipation is a frequent finding in children. In this age range, the concomitant occurrence of megarectum is not uncommon. However, the definition of megarectum is variable, and a few data exist for Italy.We studied anorectal manometric variables and sensation in a group of constipated children with megarectum defined by radiologic criteria. Data from this group were compared with those obtained in a similar group of children with recurrent abdominal pain.METHODS: Anorectal testing was carried out in both groups by standard manometric technique and rectal balloon expulsion test.RESULTS: Megarectum patients displayed discrete abnormalities of anorectal variables and sensation with respect to controls. In particular, the pelvic floor function appeared to be impaired in most patients.CONCLUSION: Constipated children with megarectum have abnormal anorectal function and sensation. These findings may be helpful for a better understanding of the pathophysiological basis of this condition.

ROLE OF ACULASER THERAPY IN CEREBRAL PALSY CHILDERN (INITIAL DATA & RESULTS)

A single, open and non-comparative study was conducted at Anwar Shah’s First C.P. & Paralysis Clinic and Research Center to evaluate the effects of Aculaser (acupoint-laser) Therapy for children suffering from cerebral palsy (CP) of various types. These children were further classified according to their major complaints. Analysis of the data indicated that 11 children with severe spasticity and stiffness all showed marked improvement (100% success rate); of the 8 children with epileptic fits, 6 patients had a significant reduction in the intensity, frequency and duration of epileptic fits, while the rest 2 cases showed no any improvement or aggravation (75% success rate); out of 5 children with cortical blindness, 2 cases showed complete recovery of vision and 3 had marked improvement (40% cure rate); out of 4 children with hearing difficulties, 2 showed marked improvement (50% success rate); out of 14 children with aphasis, 8 showed improvement (57% improvement rate). Results of this study show that Aculaser Therapy has a high improvement rate of CP children, not only improving the spasticity and stiffness but also the cortical blindness, epilepsy, deafness and speech.

越南《新刊南药神效十科应治》“小儿急惊”探析

越南文化是汉文化圈的重要组成部分,其传统医学受中医药学的影响颇深。通过对越南古医籍《新刊南药神效十科应治》卷九小儿科部分与中国医籍比较,可见其对小儿急惊的病机、症状、治则的认识深受我国宋代钱乙《小儿药证直诀》医学思想的影响,其所载方药主要引自《本草纲目》《普济方》等中国医籍。这种域外接受形式,扩大了中国医药在汉文化圈的影响力,拓展了中医药的应用范围,也促进了中医方药的域外流传和推广。

儿童突发性听力下降的临床特征分析

目的:探讨儿童突发性听力下降的临床特征和预后,指导临床诊断及治疗。方法:回顾分析12例(21耳)因突发性听力下降住院治疗的患儿临床资料。结果:12例患儿,单耳发病25%,双耳发病75%,发病时间平均为5.42d,伴耳鸣4例,眩晕5例;可能病因中,腮腺炎2例,明确的上呼吸道感染史6例,外伤史1例,使用耳毒性药物1例。颞骨CT发现大前庭水管5例。7耳(33.3%)重度听力损失,14耳(66.7%)极重度听力损失。治疗7d后痊愈6耳(28.6%),有效1耳(4.8%),总有效率为33.3%,无效14耳(66.7%)。5例14d时复查听力无改变。结论:对于儿童突发性听力下降需行影像学检查排除内耳畸形;小儿突发性听力下降多有明确的病因,且听力损失重,治疗效果欠佳。

Mechanism of peripheral blood mononuclear cell invasion by HBV on artificial immunization in newborns

OBJECTIVE: To study the effect and mechanism of the peripheral blood mononuclear cell (PBMC) invasion by HBV on artificial immunization in newborns. METHODS: Fifty-two newborns of HBsAg positive mothers were immunized with HBIG (hepatitis B immunoglobulin) and HBVac (hepatitis B vaccine) and were followed up for 7 months. The newborns' HBV-DNA in serum and in the PBMCs was detected with nested-PCR; anti-HBs was tested with solid phase radioimmunoassay (SP-RIA). PBMCs isolated from newborn peripheral blood were incubated in the presence of PHA or purified HBsAg. Interleukin-2 (IL-2) level in culture supernatants of activated cells was detected by ELISA. RESULTS: The failure rate of immunization was higher in infants with positive HBV-DNA in PBMCs than those with negative HBV-DNA (P