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06 June 2009, Volume 24 Issue 06 Previous Issue    Next Issue

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Analysis of misdiagnosis of anomalous origin of left coronary artery from pulmonary artery with cardiomegaly in infants and children. WANG Shu-Shui-a, Li-Yu-Fen-a, Jian-Meng-Yang-a, Bo-　Wei-a, Huang-Mei-Ping-b, Li-　Gong-a, Xu-Yan-Mei-a, Li-Jiang-Lin-a, Zhang-Zhi-Wei-a, Chen-Xin-Xin-c, Peng-　Jian-c 2009, 24(06): 450.  Abstract ( )   Abstract： Objective　To analyze the experience of misdiagnosis of anomalous origin of left coronary artery from pulmonary artery （ALCAPA） with cardiomegaly in infants and children. Methods　A total of twenty-two infants and children with ALCAPA and secondum cardiomegaly who had once been misdiagnosed from 1996 to 2009 were analyzed retrospectively. The examination included electrocardiography， chest X-ray， echocardiography， computed tomography and angiographies.Totally 21 patients underwent cardiac operation. Results　In cases of infants， 6 were misdiagnosed with endocardial fibroelastosis， 3 with dilated cardiomyopathy， and one with congenital mitral valve prolapse. In cases of children， 4 were misdiagnosed with dilated cardiomyopathy， 3 with endocardial fibroelastosis， 2 with congenital mitral valve prolapse， 1 with right coronary artery fistula， 1 with Kawasaki disease and 1 with patent ductus arteriosus. The diagnoses of ALCAPA were confirmed by cardiac surgery in 21 cases. Conclusion　The cases with ALCAPA and secondum cardiomegaly are easily misdiagnosed with endocardial fibroelastosis， dilated cardiomyopathy， congenital mitral valve prolapse and coronary artery fistula. It is important to carefully identify the origin of left coronary in echocardiography and computed tomography， and this can differentiate ALCAPA from other diseases.

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Acute bilirubin encephalopathy：MRI features and their correlation with prognosis. SHANG Hang-Lu-a, LIANG Zhi-Jiang-b, CHEN 　Wei-c, YAN Zhi-Han-c, LIANG Chi-Dan-a, ZHANG Zi-Yang-b, CHEN 　Xiang-a, WANG Xiao-Tong-a 2009, 24(06): 455.  Abstract ( )   Abstract:Objective　To study the MRI features in acute bilirubin encephalopathy and to determine their correlation with prognosis . Methods　The MR imagings in 11 cases of acute bilirubin encephalopathy were retrospectively studied， which were compared with 6 healthy neonates. Results　Eight out of 11 cases of acute bilirubin encephalopathy demostrated symmetric，high-intensity signal in the the globus pallidus on T1-weighted imaging； no lesions were detected on T2WI. Three cases of acute bilirubin encephalopathy with abnormal initial MRI findings had final diagnosis as athetoid cerebral palsy and demonstrated a signal switch from hypersignal in the globus pallidus on T1WI to hypersignal on T2WI. One case with abnormal initial MRI and 1 case with normal initial MRI of acute bilirubin encephalopathy displayed normal followed-up neurological development. Conclusion　The bilateral，symmetric，high-intensity signal in the globus pallidus on T1WI is probably characteristic MRI findings of acute bilirubin encephalopathy； however， it does not correlate with long-term prognosis.

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Follow-up study of 237 children with mental retardation of 0～6 years old from 2004 to 2007 in Beijing.　 LIANG Ai-Min-1, Chen-Xin-Xin-1, Shao-Cui-Xia-2, Wu-Yang-Hua-1, Zhang-Xiu-Ling-1, Zhang-Zhi-Xiang-3, WANG Feng-Zhi-1, An-Hui-Qing-1, Bian-　Yang-3, Li-　Yong-2, Shi-Ji-Liang-2, Qu-Cheng-Yi-4 2009, 24(06): 459.  Abstract ( )   Abstract：Objective　To study the situation and characteristic of  270 mental retardation children（MR） who were diagnosed during 0～6 years old， in 2004’ program， and provide the data for government to make policy. Methods　Gesell developmental diagnosis schedule， China- Wechsler Intelligence Scale for Children （WISC）， S-M adaptive Behavior Scales， research by clues were adopted in study. Altogether 237 MR children were followed up and they completed all measurement. Results　Totally 124（52.32%） children were excluded from MR and 113（47.68%） were still diagnosed with MR in 237 children who were diagnosed in 2004. In 113 MR children， 40.71% of them were mild， 59.29% severe. The result of Binary logistic showed that the high DQ in personal-social and adaptive areas， being educated， being considered by their parents to have a good future or to be normal， were factors improving the developmental result of MR. Conclusion　The development of MR children diagnosed by DQ during 0～6 years old is changeable， and is affected by many factors. The concept of “developmental delay” is more suitable than MR. During 0～6 years old， the developmental surveillance system is more useful than a cross survey for MR study.

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The research of the ultrasound bone measurement of school-age children. XIONG 　Fei, YANG Su-Fei, TUN 　Na, TUN Kang-Min 2009, 24(06): 462.  Abstract ( )   Abstract：Objective　To evaluate the application of a new quantitative ultrasound system which is used to monitor bone mineral density of school-age children. Methods　A total of 1750 subjects were examined，aged from 6 to 13 years old. The speed of sound （SOS） was measured in all subjects，and the growth and the degree of the sex maturity were also measured. Ultimately，the relationships between SOS and the index were investigated. Results　All subjects’nutritional status was good . The SOS increased with the age， but among the boys and the girls，the age phase of rapid increas was not the same . The SOS increased with the maturity of sex. There were positive relationships between height、weight and the SOS （r = 0.2599、0.2743，P < 0.05）. In the 10～12-year old girl group，the SOS of obesity was higher than that of normal weight （ t = 2.94、2.48，P < 0.05）. As shown by stepwise regression analyses， height was the most important factor which affected the SOS（F = 11.63，P < 0.05）. Conclusion　The result of quantitative ultrasound has well consistency with the bone density， which is examined by DXA. The quantitative ultrasound can be used to estimate the growth of bone in children.

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The application of bronchoscopy to the diagnosis and therapy of diseases with repeatedly coughing and wheezing.　 SHU Chun-Mei-1, Cao-　Ling-1, Yuan-　Yi-1, Guan-Xiao-Li-1, Liu-Xi-Cheng-2 2009, 24(06): 466.  Abstract ( )   Abstract：Objectives　To investigate the diagnostic and therapeutic value of bronchoscopy in children with recurrent cough and wheezing. Methods　A total of 244 children with recurrent coughing and wheezing for more than one month were chosen for bronchoscopy. The clinical data were analyzed retrospectively. Results　Among 149 cases， the most common findings were bronchitis （88 cases）， bronchial aperture dropsy， inflammatory narrowness and sputum blocking （12 cases）， indicating that the leading cause was the infection， followed by congenital tracheobronchial anomalies，　 which occurred in 22 cases. accounting for 14.8%of all cases; The third cause was the foreign body in the airway（21 cases ），accounting for 14.1%.In 46 cases with pneumonias and atelectasis， blocking in the airway by infection was the primary cause. After syringed and clamped treatment， most cases recovered.In the 49 cases diagnosed as“children asthma”，85.7% were bronchitis. Conclusion　The bronchoscopy can be of significant help for diagnosis and therapy of diseases with repeatedly coughing and wheezing.

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The clinical research of BCG vaccinated and unvaccinated in pediatric tuberculous meningitis. NIE Lin-Lin, JIE Yuan-Yuan, SHU Chao-Min 2009, 24(06): 469.  Abstract ( )   Abstract：Objective　To study the relationship of clinical features between vaccinated and unvaccinated children with tuberculous meningitis（TBM）. Methods　A total of 122 hospitalised children （54 vaccinated，68 unvaccinated） were enrolled，using the clinical data for a retrospective study. Results　The peak incidence of age was from 0 to 5 years （67.2%）；most children were in rural areas （72.1%）. The most common clinical stages were intermediated and advanced stages， the vaccinated children being fewer than the unvaccinated （38.9% VS 58.8%，P < 0.05）. The clinical prognosis of vaccinated children was better than unvaccinated （P < 0.05）. No significant clinical feature and hydrencephaly differences were seen. Conclusion　The incidence of advanced stage of TBM of BCG vaccinated children is lower than unvaccinated children， and children of BCG vaccinated have a better prognosis than unvaccinated children.

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Clinical features and outcome of pediatric liver transplantation. LIU 　Lei, LIU Yi-He, CHEN Zhong-Yang, WANG Xin-Jiang, XU Li-Xin, WANG 　Yu 2009, 24(06): 471.  Abstract ( )   Abstract：Objective　To investigate the clinical features and efficacy of pediatric liver transplantation. Methods　Analyze the clinical data of 15 children（age≤12yr） who underwent 18 liver transplantations from August 2000 to November 2007. We performed 10 reduced-size liver transplantations for 7 children before 2004， four split and four living related liver transplantations for 8 children after 2006. Immunosuppressants， antibiotics and anticoagulation were administered after operation. Results　The incidences of the complications following the operations were: acute rejection（20.0%）， infection（73.3%）biliary complications （33.3%）， hepatic artery thrombosis （20.0%）， and abdominal bleeding （13.3%）. Four children （26.7%） had to receive re-operations for abdominal infection or hemorrhage or thrombosis. Among them， one received second and one received third liver transplantation because of thrombosis， and the re-transplantation rate was 13.3%. Four recipients died （26.7%）， the rest 11 children enjoyed good liver function with a follow-up range from 13 months to 8 years and 4 months . Conclusion　Liver transplantation is an effective treatment for children with end-stage liver diseases. It’s critical to prevent and manage the complications.

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Clinical efficacy analysis of Linezolid in treatment of 40 children with infectious diseases . 　 YAN 　Yong-1, 2 , SUN 　Ji-2, WANG 　Wei-2, ZHANG 　Lei-2, ZHANG 　Jing-2 2009, 24(06): 474.  Abstract ( )   Abstract：Objective　To evaluate the clinical efficacy and safety of linezolid in the treatment of children with various kinds of infectious diseases composed mainly of respiratory infection. Methods  Forty hospitalized children with infectious diseases were enrolled from March to September in 2008. Based on bacterial culture results or clinical experience， efficacy of linezolid was evaluated by means of retrospective analysis in different underlying diseases， infection sites and pathogens. Results The clinical cure rate， significant rate and none effective rate of 40 children were 70%， 27.5% and 2.5% respectively. The overall effective rate was 97.5% and there was no significant statistical difference between the clinical cure rate of different underlying diseases and infection sites. Twenty-six resistant gram-positive strains were detected in 40 children with pathogen eradication rate of 96.2%. The Linezolid course， positive symptoms and signs disappearing time of group with incipient usage of linezolid in 17 cured cases were shorter than those of group with ineffective treatment of vancomycin changed by linezolid later in 11 cured cases （P < 0.05）. The positive signs disappearing and bacterium eradication time of he group with bacterium originated from pulmonary in 10 cases were also shorter than those of the group from other sites in 15 cases（P < 0.05）.  The main adverse reactions included diarrhea， skin rash and blood changes in 2 cases respectively and diarrhea plus skin rash in 1 case. Liver and renal function monitor shew no influence. Conclusion  Linezolid is active against resistant gram-positive infections including vancomycin resistant enterococci in children with high pathogen eradication rate. With high penetrativity in tissues and fast efficacy for pulmonary infections， linezolid was one of the recommended choices of treatment for severe cases with gram-positive infections and the other cases with inefficacy and allergy to vancomycin. With reversible side effects and good tolerance， linezolid-treated patients in long-term usage should take hemogram， liver and renal function monitor.