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25 June 2005, Volume 20 Issue 06 Previous Issue    Next Issue
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The role of transesophageal echocardiography in children with congenital heart disease during perioperative period． Ma Xiaojing,Liang Xuecun,Huang Guoying 2005, 20(06): 334-336 .  Abstract ( )   Abstract Objective To evaluate the utility of transesophageal echocardiography (TEE) for surgical and interventional repairs in children with congenital heart disease (CHD) and its safety as well.Methods 317 patients with CHD underwent TEE examinations at the age of 2 months~17 years and 6 months(mean 4.7 ears).HP/SONOS2500 ultrasonic instrument with transesophageal biplane probe of 5.5~7.5MHz was used to perform TEE under general anesthesia.Results Compared with preoperative transthoracic echocardiography(TTE),TEE had new findings or made revision of the diagnoses in 51 cases(16.1%) before operations,which led to the changes of surgical or interventional precedure in 25 cases(7.9%).TEE had found residual problems or evolving situations in 57 cases(18.0%) after operations,which led to a second immediate surgical intervention in 8 cases(2.5%).There were no detectable complications due to TEE in all cases.Conclusion TEE is valuable in providing meaningful preoperative emendations or additions and finding residual problems after operations. The technique is safe in children.

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The mannose binding lectin serum levels and mutation on the 54 code of MBL in the children with recurrent respiratory tract infections. Wang Mo,Li Qiu，Wang Xiaogang 2005, 20(06): 337-339 .  Abstract ( )   Abstract Objective To detect the mannosebinding lectin (MBL) serum levels and the mutation on code 54 of MBL in children with recurrent respiratory tract infections(RRTI),and to find the relationship between MBL serum levels and recurrent respiratory tract infections(RRTI).Methods To detect the serum MBL level of 238 normal people and 65 children with RRTI through the methods of enzymelinked immunoadsordent assay,then compare the immune data(IgG,IgA,IgM,C3,C4) of 11 children with low serum MBL level and compare the rate of the mutation on code 54 through the methods of polymerase chain reaction(PCR)restriction fragment length polymorphism (RFLP) with 55 normal children.Results The rate of low serum MBL level in the children with RRTI was higher than that in the normal population(χ2=6.96,P<0.05),the same went for the frequency of mutation of code 54 (P<0.05).RRTI caused by low serum MBL level occurred mostly among children under 2 years of age,and the rate of respiratory tract infection in the individuals with MBL level under 100μg/L was more than that in children with levels ranged from 100μg/L to 200μg/L (P<0.05),and was associated with reverse chang of serum levels of C3,C4(P<0.05).Conclusion Under 2 years of age,the children with the low serum MBL levels caused by mutation on MBL54 show the susceptivity to IRRTI,and the low serum MBL level is parallel to high serum levels of C3，C4，and the lower the level the more possible infection.

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The activation of nuclear factorKappa B in kidney tissue in children with primary nephrotic syndrome and its relationship with pathological changes and urine protein excretion. Zhao Hongyang,Sun Ruopeng,Zhen Junhui et al. 2005, 20(06): 340-341 .  Abstract ( )   Abstract Objective To study activation of transcription factor NFKappa B(NF-κB) and its role in regulating the expression of inflammatory mediators involved in pathogenesis of primary nephrotic syndrome (PNS).Methods To explore the role of NF-κB in the pathogenesis of PNS in children,and its significance for pathological changes as well as 24hour urine protein excretion,we examined NF-κB activity in glomeruli and tubular tissues by twostep immunohistochemical staining from the kidney biopsy specimen of 51 children with PNS,and from 5 patients after renal operation.Results We found that NF-κB activity significantly increased both in MCD and NMCD children compared with the controls,and the activation of NF-κB in MCD was different from that of NMCD;there was also statistical difference of NF-κB activity between mild,moderate,severe MsPGN and the controls Additionally,positive correlation was observed between NF-κB activity of glomeruli and renal tubules and 24hour urine protein excretion.Conclusion These results suggested that the upregulated activation of NF-κB in glomerular and tubular tissues of children with PNS is related to severity,pathological changes and urine protein excretion,and involved in the pathogenesis of PNS.

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Effect of high dose vitamin C on flow mediated vasodilation of brachial artery in acute phase of Kawasaki disease. Sun Dongming,Wang Hongwei,Shi Hong et al. 2005, 20(06): 342-344 .  Abstract ( )   Abstract Objective To observe the effect of high dose vitamin C on flow mediated vasodilation(FMD) of brachial artery in acute phase of Kawasaki disease(KD) and investigate whether high dose vitamin C could improve vascular endothelial dysfunction in KD.Methods Using high resolution vascular ultrasound,we measured FMD of the brachial artery of 36 patients who were admitted to our hospital from Jan.2001 to Dec.2002. in acute phase of KD and 15 matched healthy subjects as controls.Studies were performed before and after intravenous infusion of high dose vitamin C (200mg/kg，max≤4g) or placebo in KD group.Results The FMD of the brachial artery in KD group was significantly lower than that in the control group (3.55±3.00% vs 10.34±4.29%，P<0.001).Intravenous infusion of vitamin C significantly increase the FMD of the brachial artery in 18 KD patients (6.97±2.93% vs 3.51±2.01%，P<0.01),while after administration of placebo in the other 18 patients,there was no significantly increased in the FMD(4.12±2.21% vs 3.75±3.00%，P>0.05).Conclusion Intravenous infusion of high dose vitamin C can increase the FMD of the brachial artery,and it can improve vascular endothelial dysfunction in KD.

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Analysis of the factors and pathogens of complicated upper urinary tract infection in children. Cheng Ling,Xu Hong,Zhou Lijun. 2005, 20(06): 345-347 .  Abstract ( )   Abstract Objective To investigate the factors and resistance of the pathogens of complicated upper urinary tract infection (UTI) in children.Methods Distribution and resistance of pathogens,complicated factors in 178 urinary culturepositive UTI patients hospitalized from 1999 to 2004 were analyzed.Results Infants with complicated upper UTI accounted for 46.6%.Among the complicated factors,vesicoureteric reflux (VUR) accounted for 61.8%,and 37 of 40 children with venal scar had VUR.E.coli in the complicated upper UTI accounted for 33% of all the pathogens,which was significantly lower than in simple upper UTI (P<0.001)However,Klebsiella and Pseudomonas aeruginosa accounted for 15.8% and 8.1% respectively,which were significantly higher than in simple upper UTI (5.6% and 2.4% respectively,P<0.01 and 0.05 respectively).Nearly 28% of the Gram negative bacilli were the ESBLs producing strain,most of which were E.coli.Gram negative bacilli had a high resistance rate towards not only the penicillin uncombined with the betalactamases inhibitors but also the first,second and third generations of cephalosporins.Furthermore,the multicross resistance of the ESBLs strains was even more serious.Conclusion The complicated upper UTI is predominant in infants and VUR induces complicated upper UTI and renal scar.E.coli is still the major pathogen,while the proportion of Klebsiella,Pseudomonas aeruginosa are significantly increasing.The pathogens have high drugresistance and the ESBLs producing strains have serious multiresistance.

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Dexamethasone and IFN-γ on the function of TH1/TH2 in children with lower respiratory tract infections. Li Guihua,Zhang Huijuan. 2005, 20(06): 348-350 .  Abstract ( )   Abstract Objective To observe the effect of dexamethasone and IFNγ on the function of TH1/TH2 in lower respiratory tract infections.Methods Sixty patients with lower respiratory tract infections were divided randomly into 2 groups:group I with dexamethasone treatment,group II with IFN-γ treatment.Normal group of 15 cases was as control.Serum levels of IgE,IFNγ and IL4 were detected before and after treatment.Results Compared with normal control,there was significant difference in the serum level of IgE,IFN-γ,IL-4,IFN-γ/IL-4 in group Ⅰ and group ,P<0.001.There was no difference in the serum level of IgE,IFNγ,IL4,IFNγ/IL4 between group I and group Ⅱ before treatment(P>0.05).But there was significant difference after treatment(P<0.001).After being followed up for 12 months,3 cases suffered from asthma in group Ⅰ,10 cases in group Ⅱ.There were outstanding meanings by square examination,P<0.05.Conclusion In patients with lower respiratory tract infections,the serum level of IgE rises.Humoral immunity is relatively increased and cell immunity decreased.So the TH1/TH2 is out of balance.With the treatment of dexamethasone,the body’s immune system is suppressed.In short time,the infection and asthma can be controlled,but TH1/TH2 can’t change after treatment.IFN-γ can interfere the duplication of virus,increase the level of IFN-γ in body,furthermore it can strengthen the cell immune function,lower cell immunologial answer of TH2 and recover the balance of TH1/TH2 The followup suggests IFN-γ has an important meaning in preventing infant asthma.

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Clinical characteristics and prognosis of lead poisoning encephalopathy in infants. Zhu Pingzhao,Liu Gangqian,Li Songyi 2005, 20(06): 351-353 .  Abstract ( )   Abstract Objective Study the clinical characteristics and prognosis of lead poisoning encephalopathy.Methods We reviewed and analyzed the clinical data and the results of the 26 cases of lead poisoning encephalopathy.Results All the 26 cases had frequen convulsion,accompanied by disturbance of consciousness and above middle pitch of anemia.Among the 26 cases vomit ting was found in 23 cases,diarrhea in 21 cases,fever in 11 cases,live swelling in 5 cases.Supplemental examination:before treatment,the average of blood lead level was 8.486μmol/L，urine lead level was 3.598μmol/L,Hb was lower than 90g/ L,the lowest being 5g/L.The blood calcium was all lower than 1.86 mmol/ L,the lowest being 1.03 mmol/L.Protein of cerebrospinal fluid in all cases was over normal.Myocardial enzyme of 22 cases was over normal,suggesting myocardials injured obviously.Only 1 case was found ventricle system expanding lightly in CT/MRI.All cases had no death after treatment of driving lead.The 12month followup result suggested that second epilepsy was found in 4 cases and cerebral palsy in 4 cases.Conclusion The lead poisoning encephalopathy is the most serious type of the lead poisoning,and prognosis is not good. The patient of convulsion with unknown reason,and no fever,should be checked the bloodlead for early diagnosis in order to prevent from leaking diagnosis.

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Comparative study on two different ways of hydration and alkalization in the treatment of childhood acute lymphoblastic leukemia with highdose methotrexate. Liu Ansheng,Xue Huiliang,Wang Yaoping. 2005, 20(06): 354-356 .  Abstract ( )

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Primary repair of tetralogy of Fallot:an analysis of risk factors for early postoperative death in 152 patients. Zhang Chen,Liu Yuyang,Sheng Feng 2005, 20(06): 357-359 .  Abstract ( )   Abstract Objective To identify risk factors associated with early postoperative death in patients undergoing primary repair of tetralogy of Fallot (TOF).Methods 27 preoperative and intraoperative variables potentially predictive of early postoperative death of 152 patients,who underwent primary repair of TOF between April 1995 and March 2004 at the Cardiovascular Center of Children's Hospital of Fudan University,were analyzed in a univariate and multivariate manner.Results Univariate analysis demonstrated a significant association between early postoperative death and the following variables: weight at the time of surgery,age for cyanosis to be present,SaO2,AO/MPA,McGoon ratio,Nakata index,Qp/Qs,(Qs-eQp)/Qs,multiple aortopulmonary collateral arteries and transannular patching. In the multivariate model only AO/MPA and McGoon ratio were associated with early postoperative death.Conclusion Pulmonary artery hypoplasia is the most important risk factor for early postoperative death after primary repair of TOF.Multiple risk factors should be considered when the choice of patients for the procedure is made.