肺结核合并糖尿病46例临床分析

目的总结肺结核合并糖尿病的诊断、临床表现、治疗方案及转归预后。方法回顾性总结本院收治的46例肺结核合并糖尿病患者的临床症状、X线表现、实验室检查、治疗和转归预后,并结合文献进行回顾性分析。结果本组46例空洞发生率高(占82.61%),痰菌阳性率高(占73.91%);病灶吸收好转率为80.43%;痰菌阴转率为71.74%;血糖控制明显下降。结论肺结核合并糖尿病患者需早期诊断,采取有效的抗结核化疗的同时有效控制血糖,能到达控制结核、糖尿病的目的,这是治疗的关键。

Pentoxifylline in hepatopulmonary syndrome

AIM： To determine the effects of pentoxifylline （PTX） on clinical manifestations and evaluate arterial blood gas data in hepatopulmonary syndrome （HPS） in chil- dren. METHODS： In a pilot study of 10 children with chronic liver disease, who had HPS, 20 mg/kg/d PTX was ad- ministered for 3 mo. Clinical data and arterial blood gas parameters were evaluated at baseline, the end of the treatment period, and 3 mo after drug discontinuation. RESULTS： Six patients could tolerate PTX, while four patients experienced complications, Among patients who could tolerate PTX, there was a significant increase in arterial oxygen pressure （PaO2） （P = 0,02） and oxy- gen saturation （Sa02） （P = 0.04） and alveolar-arterial oxygen gradient （P = 0.02） after 3 mo of treatment. Significant decreases in Pa02 （P = 0.02） and alveolararterial oxygen gradient （P = 0.02） were also seen after drug discontinuation. CONCLUSION： PTX may improve PaO2, Sa02 and alve- olar-arterial oxygen gradient in the early stage of HPS.

Comparison between preadolescent and adolescent patients with high-grade osteosarcoma in China

Objective:The aim of this study was to assess the differences in clinical appearance and prognosis of osteosarcoma between preadolescent and adolescent in Chinese patients and investigate whether age at diagnosis is a prognostic indicator.Methods:Between May 2002 and May 2009,ninety-six children with high-grade osteosarcoma treated at our institute were stratified according to the age of 10.There were 19 preadolescents(≤ 10 years) and 77 adolescents(10 years < age ≤ 19 years),and their medical records were reviewed and compared using Fisher exact tests.Overall survival and disease-free survival was estimated by Kaplan-Meier methods and compared using log-rank tests.The prognostic significance of the various factors on survival was examined by Cox regression analysis.Results:There were no significant differences in terms of Karnofsky Performance Status(KPS) score,Enneking stage,tumor location,histologic type,pathologic fracture,tumor necrosis rate,tumor size,relapse and frequencies of adjuvant chemotherapy between the two groups.A high proportion of preadolescent patients was treated with amputation(78.9% vs.44.2%;P = 0.01).The 5-year survival of the preadolescent and adolescent groups was(38 ± 14)% and(33 ± 10)%,and the 2-year disease free survival for each group was(45 ± 12)% and(44.4 ± 6.3)%,respectively.Our study showed that age did not have any statistical significance for survival(P = 0.803).Univariate analysis indicated that KPS score;frequencies of adjuvant chemotherapy,tumor size and relapse were significantly related to overall survival.Multivariate Cox regression analysis revealed that both frequencies of adjuvant chemotherapy and relapse were independently prognostic factors for survival.Conclusion:Clinical characteristics and survival between the preadolescents and adolescents with osteosarcoma in China were compatible.So we suggested that there did not need to treat preadolescents patients by alternative and/or aggressive therapies compared with adolescent patients.

Analysis of genotypes and phenotypes in Chinese children with tuberous sclerosis complex

Tuberous sclerosis complex(TSC) is a neurocutaneous syndrome with serious clinical presentations, an autosomal dominant genetic disorder involving multiple organs and systems. We retrospectively investigated the clinical manifestations and genotypes of 20 Chinese children with TSC to enable informed diagnostic and surveillance recommendations in China. A retrospective analysis of clinical manifestations in 20 children(7.00±5.30 years old) with TSC was conducted. A genetic testing of the genes TSC1 and TSC2 was performed in 14 children.The earliest manifestations of TSC were skin lesions(80% of patients) and seizures(75%). Fourteen of the children presented with retinal hamartomas, and 2 of these underwent eye enucleation at other hospitals through misdiagnosis. On magnetic resonance imaging, 18 children exhibited subependymal nodules, and 16 ones showed cortical nodules. 5 cases of non-renal hamartomas, 5 cases of multiple renal cysts, and 5 cases of cardiac rhabdomyomas were observed.The genotyping of TSC1 and TSC2 in 14 children revealed 11 with mutations in TSC2, 2 with mutations in TSC1, and no mutations of either gene in one patient. Eight of these observed mutations are reported here in for the first time. The illness presentations of the TSC2-mutated patients were more severe than that of patients carrying TSC1 mutations.There were differences in the mutations of TSC genes in Chinese children from those reported in other countries. The described clinical characteristics and genotyping will help pediatric neurologists to understand, diagnosis, and treat TSC.

Clinical and pathological analysis on Traditional Chinese Medicine syndromes in children with immunoglobulin A nephropathy

OBJECTIVE:To evaluate the common Traditional Chinese Medicine(TCM) syndromes and analyze their relationship to clinical and pathological manifestations in children with IgAnephropathy.METHODS:Forty five children diagnosed as having primary IgA nephropathy by renal biopsy for the first time were enrolled in this trial,and their TCM syndromes were evaluated and the distribution of TCM syndromes was observed.All the sick children were growed? according to clinical manifestations and pathological damages,and the differences in TCM syndromes were compared between the groups.RESULTS:The first 5 TCM symptoms were common cold,hyperhidrosis,red dry throat,dark yellow urine and lassitude.In the acute nephritis group,edema and aching pain in loin and knees were significant(P=0.021 and P=0.000).In the severe pathological damage group,edema was obvious(P= 0.004),and 24 h urinary protein was positively correlated with edema(P=0.015) while negatively with common cold(P=0,007).The score of mesangial cell proliferation was correlated with edema,red dry throat and common cold(P=0.006,0.013 and 0.029 respectively).The score of segmental pathological change was positively correlated with edema(P=0.039).CONCLUSION:Common cold,hyperhidrosis,red dry throat,dark yellow urine,lassitude and other symptoms of qi deficiency of the spleen and lung mainly seen in children with IgA nephropathy may bear a close relationship to clinical manifestations and pathological damages.