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06 February 2010, Volume 25 Issue 02 Previous Issue    Next Issue

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A review of clinical treatment of 12 children with severe influenza A （H1N1）.　　 WANG Ying， BIAN Feng-zhi， DENG Kun. 2010, 25(02): 124.  Abstract ( )   Objective　To investigate the clinical features and treatment of influenza A （H1N1） in children. Methods　Clinical data of 12 children with severe influenza A （H1N1） were analyzed retrospectively. Results　12 patients were all fever onset， of whom， 9 were respiratory symtom onset and with sore throat， cough， expectoration and other flu-like symptoms； 1 case was with diarrhea of digestive symptom onset and 1 case was neurological symptom onset； 2 patients were with obvious asthmatic suffocation and dyspnea； 3 children were heard with coarse rales and wet rales in both lungs， and 2 cases were heard with wheezing sound. Besides， the white blood cells（WBC）count in 12 patients showed that 4 cases were with high WBC count， while 3 low； neutral category of WBC： 4 cases increased， 4 reduced；lymphocyte ratio： 4 cases were high， 2 cases low； platelet count： 1 case reduced， and 1 increased. ALT of 6 cases increased， AST of 7 cases increased， LDH of 7 cases increased， CK of 7 cases increased and CK-MB in 3 cases increased. With the patients’ condition improved，WBC， liver function and myocardial enzymes returned to the normal level. Conclusion　The symptoms of patients with severe influenza A （H1N1） are all respiratory tract onset and the main target organs are the lungs， often  associated with bacterial and mycoplasmal infection，and with the emergence of various complications involving multiple-organ dysfunction. The conditions of children with neurological symptom onset in particular progress rapidly and they are in greater danger.

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Neurologic complications associated with 2009 influenza A （H1N1） infection in children. TANG Zheng-zhen, HE Yan-xia, ZHENG Yue-jie, YANG Wei-guo, DENG Ji-kui, SONG Ping 2010, 25(02): 129.  Abstract ( )   Objective　To describe the clinical characteristics of neurologic complications associated with 2009 influenza A （H1N1） infection in children.   Methods　A prospective study of 150 children confirmed 2009 influenza A （H1N1） infection in Shenzhen Children Hospital from November 4, 2009, to January 19, 2010 was conducted. The clinical features and outcome of the patients with neurologic complications were analyzed. Results　The incidence rate of neurologic complications associated with 2009 influenza A （H1N1） infection was 14% of the hospitalized patients. 18（85.7%） patients were diagnosed as encephalopathy，2（9.5%） patients were diagnosed as seizures，1（4.7%） patient was diagnosed as encephalitis. 14 were male, 7 were female； the median age was 5 years. 12（57%） patients were admitted to an ICU, 6（28.5%） required mechanical  ntilation. 17（80.9%） patients were fully recovered and discharged, three （14%） died from severe encephalopathy. Conclusion　The incidence rate of neurologic complications associated with 2009 influenza was high, severe encephalopathy canlead to death. This result should attract a great deal of attention as 2009 influenza A （H1N1） pandemic continues.

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Atrioventricular block after transcatheter closure of secundum atrial septal defects using Amplatzer septal occluder in children. LI Jun-jie，LI Yu-fen，ZHANG Zhi-wei，QIAN Ming-yang. 2010, 25(02): 132.  Abstract ( )   Objective　To determine the incidence， risk factors， prevention and treatment of AVB associated with ASD transcatheter closure using ASO in children. Methods　A total of 450 patients underwent transcatheter ASD closure using ASO from March 1998 to December 2005 in our institution. The median age was 6.3 years （ranging from 2.3 to 14 years） and the median weight was 17.4 kg （ranging from 9 to 44 kg）. Electrocardiographic tracings before procedure and at follow-up visits were reviewed. The risk factors， prevention and treatments of the AVB were analyzed. Results　Fourteen patients developed various AVB （3.1%）， including first degree AVB in 6， second degree AVB in 4 and third degree AVB in 4 patients. All AVBs occurred one to two days after transcatheter occlusure of the ASD. Among 14 patients， new-onset AVBs were found in 12 patients and aggravation of preexisting AVBs was noted in 2 patients. The larger device （ 24±2 vs 19±3mm， P < 0.001） and smaller age（4.3±1.4 vs 7.6±2.3 years，P ＝0.03）were two risk factors for AVB. Corticosteroid was routinely used for all patients with AVB and removal of the device was implemented for 4 patients with third degree AVB. A vast majority of cases resolved or improved spontaneously，with no recurrence at short-term follow-up. Conclusions　AVB remains the severe complication after interventional catheterization for ASDs using ASO. The larger device and smaller age can be associated with the development of AVB. Selection of the proper ASO may be the most effective measure to prevent AVB after transcatheter closure of ASDs for small children. Most of all AVBs can resume within a short time by giving medical or surgery intervention as soon as possible.

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A study of heart rate variability in children with neurally mediated syncope. CHEN Li， CHEN Jian-jun， TANG Chao-shu， DU Jun-bao. JIN Hong-fang. 2010, 25(02): 136.  Abstract ( )   Objective　To discuss the variation of parameters of heart rate variability  in neurally mediated syncope （NMS） in children.  Methods　Twenty-nine children with NMS （11 males and 18 females， mean age 12.4±2.2 yrs） who came from Peking University First Hospital from April 2007 to March 2008，were included in the study. The hemodynamic patterns of NMS were detected. All patients experienced 24 hours of Holter monitoring. Parameters of heart rate variability in children with NMS were analyzed. SPSS 10.0 software was used for the statistical analysis of these data. Results　There was no significant difference in SDNN between that of NMS group and normal value （P > 0.05）. The SDNNi and rMSSD in NMS group increased by 19.21% and 54.07%， respectively （P < 0.05）. The pNN50 and triangular index were not significantly different between NMS group and normal value （P > 0.05）.  Conclusion　There is autonomic nerve adjustment imbalance in children with NMS.

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Association between TIM-1 -1454 locus polymorphism and Henoch-Schonlein purpura in children. HUANG Na， LU Ling， YUAN Li-ping. 2010, 25(02): 139.  Abstract ( )   Objective　To assess the genetic association between the TIM-1 gene promoter region -1454G/A polymorphism and HSP in children. Methods　Genomic DNA was extracted from the peripheral leukocytes of 143 patients with HSP and 178 normal children by polymerase chain reaction-restriction fragment length polymorphism analysis and gene sequencing technology； calculate genotype and allele frequencies； analyze the relationship was found between comparison groups. Results　No significant differences in allele or genotype distribution between patients and controls. However， a significant increased frequency of allele G in -1454G/A loci was found in patients with HSP who developed renal manifestation， compared to patients without renal involvement （OR = 2.375， 95% CI = 1.168～4.830， P < 0.05）， and the genotype distibution also showed statistically significant difference （P < 0.05）. Conclusion　Although there is no association between TIM-1 -1454 SNP and HSP， this study suggest that TIM-1 -1454 SNP might be associated with susceptibility to the development of renal manifestation in patients with HSP.

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One-year follow-up study for mycoplasma pneumoniae pneumonia with pulmonary atelectasis complications. ZHANG Yong-ming，LIU Xiu-yun，JIANG Zai-fang. 2010, 25(02): 143.  Abstract ( )   Objective　To study the reversal of atelectasis during the recovery of mycoplasma pneumoniae pneumonia and determine the therapeutical time of fiber-optical bronchoscope-assisted washing treatment. To recognize the incidence of bronchiolitis obliterans. Methods 　Totally 109 cases of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication had been selected from 1166 patients who were treated in Beijing Pediatric Hospital between May 2006 and May 2007. After telephone appointments and parental authorizations， all pediatric patients were examined with HRCT and/or with pulmonary function after an interval of 1.0 to 1.4 years. Results　（1） The incidence of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication in hospitalized patients was 10.03%. （2） Reversal of atelectasis during recovery: one-year follow-up study showed that 23 patients have been identified with abnormal lung appearance by using HRCT imaging in 36 cases of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication， corresponding to a rate of 63.9%. The abnormalities were as follows： appearances of “mosaics” （9 cases）， bronchiectasis （12 cases）， thickened bronchial walls （11 cases）， decreased pulmonary vascularity （2 cases）， smaller tubercles and tree-in-bud patterns （3 cases）， mucus clots （1 case） ， unilateral hyperlucent lung （1 case） and rope-shaped atelectasis areas （10 cases）. （3） There was a significant difference in the therapeutically effect of fiber-optical bronchoscope-assisted washing treatment between the group within 20 days and more than 20 days of illness （P < 0.05）. （4） Analysis of the pulmonary functions in 27 cases showed that the pulmonary function was still abnormal with obstruction of ventilation function in 16 cases， complexed/mixed ventilation functional obstructions with blocking as primary obstacle in 1 case.（5） The incidence of bronchiolitis obliterans was 25% （9/36） in our study.Conclusion　The incidence of pediatric mycoplasma pneumoniae pneumonia with pulmonary atelectasis complication in hospitalized patients is 10.03%； the follow-up study shows that the sequelae of the mycoplasma pneumoniae pneumonia is mainly bronchiectasis and/or bronchitis obliterans； early application of the fiber-optical bronchoscope-assisted washing treatment may reduce the sequelae of the mycoplasma pneumoniae pneumonia； this one-year follow-up study also shows that the pulmonary function is still abnormal with obstruction of ventilation function in some patients.

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Clinical comparison of autoimmune hepatitis and drug-induced liver disease in children and review of literature. XU San-qing， LIU Yan，FANG Feng， et al. 2010, 25(02): 147.  Abstract ( )   Objective　To compare the pathogenesis， clinical characteristics and prognosis of  autoimmune hepatitis and drug-induced liver disease in children through case reports and literature review in order to improve the recognition of such diseases . Methods　Analyze retrospectively and compare the causes， clinical manifestations， laboratory results， treatment protocols and prognosis of 3 inpatients with autoimmune hepatitis and 5 inpatients with drug-induced liver disease， combined with literature review.  Results　For three patients with autoimmune hepatitis，there existed illness history of 6 months to 3 years， moderate to severe hepatosplenomegaly， elevated IgG levels and positive autoantibodies in serum， hepatic hydropic degeneration and interstitial and portal inflammatory cells infiltration in hepatic histopathologic lesions， good reaction to glucocorticosteroid treatment； but for five patients with drug-induced liver disease， there existed use of drugs to induce liver disease， illness history of 3 to 20 days， mild to moderate hepatosplenomegaly in four cases， ALT more than 1000 U/L in acute phases in three cases， elevated serum IgG levels in two cases， negative autoantibodies， recovery after expectant treatment in four cases， good reaction to glucocorticosteroid treatment in one case with cholestatic liver disease. Conclusion　When confronted with the patients with acute or chronic severe liver diseases， clinicians should put the emphasis on the investigation of drugs to induce liver disease and the examination of liver function， IgG， autoantibodies and hepatic histopathologic lesions，in order to clarify the diagnosis of autoimmune hepatitis or drug-induced liver disease，if infectious， metabolic and other causes are excluded. Early and correct treatment will be beneficial to the recovery of such diseases and avoidance of irreversible liver damage.

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Curative effects of six patients with tumor cell of retinoblastoma found in cerebrospinal fluid. WANG Yi-zhuo，HUANG Dong-sheng，SHI JI-tong，ZHANG Wei-ling，ZHAO Jun-yang，LI Song-f 2010, 25(02): 150.  Abstract ( )   Department of Pediatrics，Beijing Tongren Hospital affiliated to Capital University，Beijing 100730，China Abstract：Objectives　To evaluate the effects of CTV （carboplatin，Teniposide Vincristine） chemotherapy and intrathecal chemotherapy in children with tumor cell of retinoblastoma in cerebrospinal fluid. Methods　Totally 256 cases who were clinically diagnosed with retinoblastoma in our hospital were studied， 6 of them who had tumor cells in their cerebrospinal fluid before treatment were given 6～9 cycles of CTV（Carboplatine、Teniposide and Vincristine）chemotherapy and 8～10 times of intrathecal chemotherapy； meanwhile， focal therapy was performed. Follow-up was between 12 to 20 months. Results　All patients had completed the therapy， up to now condition stable； recheck the cerebrospinal fluid didn't show the tumor cell. Conclusion　System chemotherapy together with intrathecal chemotherapy is effective for children with tumor cell of retinoblastoma found in cerebrospinal fluid. However， more patients with longer follow-up are needed to confirm these results.