Archive

06 February 2012, Volume 27 Issue 2 Previous Issue    Next Issue

---

For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

The predictive value of flow-mediated vasodilation on therapeutic efficacy of midorine hydrochloride for vasovagal syncope in children.　 2012, 27(2): 102-105.  Abstract ( )   Objective　To investigate the predictive value of flow-mediated vasodilation （FMD） of brachial artery on therapeutic efficacy of midorine hydrochloride for vasovagal syncope （VVS） in children. Methods　Twenty-four children with unexplained syncope underwent head-up tilt test and were diagnosed with VVS. All the patients received FMD detection and midodrine hydrochloride treatment. The patients were followed up in clinics after one month of treatment and repeated FMD detection was performed. After three months the patients were followed up by telephone. Twenty-four patients were followed up for 10～18 months，with a mean of （14.5±2.3） months. The recurrence of syncope at the end of followed-up was used to evaluate the therapeutic efficacy. ROC curve was used to explore the predictive value of FMD. Results　For 24 patients，FMD was reduced after one month treatment of midodrine hydrochloride ［（11.07±3.11）% vs （7.64±1.81）%，P < 0.001］ without any change in resting heart rate，resting systolic arterial pressure and baseline brachial artery diameters. During the follow-up period，5 patients had recurrence of syncope. The effective rate of midodrine hydrochloride was 79.2%. There were no significant differences in resting heart rate，resting systolic arterial pressure and baseline brachial artery diameters before treatment between the patients with different therapeutic response. FMD in patients with good therapeutic efficacy was significantly higher than that with poor therapeutic efficacy ［（11.93±2.83）% vs （7.80±1.63）%，P = 0.005］. ROC curve on predictive value of FMD showed that area under curve was 0.895 with a 95% confidence interval of 0.22～0.49，and a FMD of 8.85% as cutting value produced both high sensitivity （90%） and specificity （80%） to predict efficacy of midodrine hydrochloride for treating VVS. Conclusion　FMD can be considered as an indicator for selecting midorine hydrochloride as a treatment for VVS in children. FMD of 8.85% taken as a cut-off value produces both high sensitivity and specificity.

Select

Radiofrequency catheter ablation therapy for atrioventricular reentrant tachycardia combined with  Ebstein’s anomaly. 2012, 27(2): 106-108.  Abstract ( )   Objective    To investigate the effectiveness， safety and influencing factors of radiofrequency catheter ablation for atrioventricular reentrant tachycardia combined with Ebstein’s anomaly. Methods    Clinical data of 8 patients diagnosed with Ebstein’s anomaly combined with atrioventricular reentrant tachycardia，who received radiofrequency catheter ablation in our hospital between Jan 2009 and Jun 2011，were retrospectively analyzed， including electrocardiographic presentation， numbers and lo-cations of accessory pathways， mapping strategies and therapeutic effects. Results    Pre-operative electrocardiograms showed dominant preexcitation in 5 patients， incessant preexcitation in 1 and no obvious preexcitation in the other 2 patients. Nine accessory pathways were detected by electrophysiological study，including 5 located at right posterior wall， 2 at right mid-septum and the remaining 2 at right posterior septum. Totally 8 accessory pathways（88.9%） were successfully ablated. A posterior septal pathway was unsuccessfully ablated due to difficulty for the ablating catheter tip to adhere closely to the tricuspid ring. Swartz sheaths were used for 4 patients due to unstability of catheter tip while intending to adhere to target site. Five patients received corrective operation for Ebstein’s anomaly after ablation. Conclusion    Accessory pathways complicated by Ebstein’s anomaly are usually located at right posterior wall and right posterior septum. It is safe and effective for children with Ebstein’s anomaly complicated by atrioventricular reentrant tachycardia to be treated by radiofrequency catheter ablation before surgical correction of cardiac structural anomaly.It is more reliable and effective to map VA fusion during ventricular pacing or tachycardia than to map AV fusion during sinus rhythm.

Select

The clinical evaluation of transcatheter closure of ventricular septal defects with special appearance using the Amplatzer duct occluder Ⅱ. 2012, 27(2): 109-111.  Abstract ( )   Objective To evaluate the techniques and results of transcatheter closure of ventricular septal defects with special appearance using the new Amplatzer duct occluder Ⅱ（ADO-Ⅱ）. Methods　Two patients were included in the study，one female， 6 years old， perimembranous ventricular septal defect（pmVSD） with a conspicuous aneurysm-like formation and a cauliflower appearance；the other was male， 5 years old， muscular VSD（mVSD）；it was difficult to close with VSD occluder and then it was decided to use the new ADO-Ⅱ. After the ateriovenous loop was constructed， the left retention flanges were released in ascending aorta. If no residual shunt was found and the positionwas good with aortic angiogram and echocardiogram， ADO-Ⅱ was released eventually. Taking echocardiogram and electrocardiogram one day after procedure， and the patients were discharged from hospital 5 days later，with aspirin orally （3～5 mg/kg/d） taken in follow-up. Results　In patient 1 with pmVSD after a left ventricular angiogram， the defect was with a conspicuous aneurysm-like formation and a cauliflower appearance， multiple exit holes on the right side of the defect， the largest size of holes was about 2.3 mm， and the size of inlet on the left side was 7.6 mm， the distance from the aortic valve was 6.1 mm. 7F sheath was unable to be delivered across the hole through arteriovenous loop and the VSD was closed with a 5F delivery sheath and ”6×4” ADO-Ⅱ eventually， trivial tricuspid regurgitation existed by TTE after procedure. In patient 2 with mVSD， the size of hole on the left side was 6.3 mm and that of the right side was 2 mm， the distance from aortic valve was 16 mm. It was a smaller tunnel-like defect， with an oblique course toward the inlet septum. The defect was successful closedly with 4F sheath and “4×4” ADO-Ⅱ. The results of EKG were normal after the procedure. Conclusion　Transcatheter closure of VSD with special appearance using Amplatzer duct occluder Ⅱ is a good alternative selection when it is difficult to close with VSD occluder. It is a feasible， safe and effective method with few complications.

Select

Accelerated idioventricular rhythm after percutaneous transcatheter closure of ventricular septal defect in children.　 2012, 27(2): 112-114.  Abstract ( )   Objective　To summarize incidence rate，clinical significance and mechanism of accelerated idioventricular rhythm （AIVR） after transcatheter closure of ventricular septal defect（VSD） in children. Methods　From Oct.2002 to May 2011，1179 children with VSD underwent percutaneous transcatheter closure. All patients received electrocardiogram and 24h dynamic electrocardiogram after transcatheter closure. Totally 1392 outpatients that received 24 h dynamic electrocardiogram examination and 988 children with ASD who underwent transcatheter closure were assigned as two control groups.The difference of AIVR incidence rate was compared between VSD transcatheter closure group and control groups. Seventeen cases developed AIVR after transcatheter closure of VSD，but no one had subjective symptoms.Nine cases  were treated with methylprednisolone，albumin and creatine phosphate sodium and the other 8 cases had no therapy.All the 17 children with AIVR received follow-up study. Results　The incidence rate of AIVR in transcatheter VSD closure group was higher than in control groups.Based on the first-month holter monitoring electrocardiogram，all the 17 AIVR cases after transcatheter VSD closure recovered to normal，whether they receive treatment or not.And in the follow-up study，there were no adverse medical events. Conclusion　AIVR incidence with transcatheter closure of VSD is higher than other patients.The mechanism of AIVR is closely related to the procedure of transcathter VSD closure.AIVR after transcatheter VSD closure is a benign arrhythmia that perhaps needs not treat ment.

Select

Clinical evaluation of right ventricular function in children with ventricular septal defect complicated by pulmonary artery hypertension.  2012, 27(2): 115-119.  Abstract ( )   Objective    Discuss the value of TDI， STI and serum BNP in evaluating right ventricular function in children with VSD complicated by pulmonary artery hypertension （PAH）. Methods    A total of 68 children with VSD and 24 age-matched healthy children were involved in this research. The patients were divided into mild（n=23）， moderate（n=21） and severe（n=24） groups according to pulmonary artery pressure. Two-dimensional standard apical four-chamber image of consecutive three cardiac cycles were preserved by GE Vivid 7 to obtain GLS and GLSR. PW-TDI of tricuspid annulus motion curve was recorded to measure Sa，IVA and Tei. Tricuspid annulus plane systolic excursion（TAPSE） was measured through M-mode echocardiography.BNP was detected by ELIASA. Results    （1） Tricuspid annulus IVA and TAPSE decreased with the increase of PAH， but Tei index increased with the PAH（P < 0.01）.The three parameters had significant difference except those between control group and mild group. Sa had significant difference except that between control group and mild group， moderate and severe group. （2） GLS and GLSR decreased with the increase of  PAH；GLS had statistically significant difference between the groups. GLSR had significant difference except that between control group and mild group， moderate and severe group. （3）Serum BNP increased in accordance with PAH and had significant difference between the groups. （4）BNP and Tei index correlated better with NYHA. Conclusion    TDI and STI parameters can reflect the right ventricular function of children with VSD complicated by pulmonary hypertension. BNP and Tei index correlate  with NYHA better. BNP and GLS can reflect mild impair of the right ventricle.

Select

Relationship of long-term blood transfusion， iron chelation therapy with iron overload in 51 children with beta-thalassaemia major.  2012, 27(2): 120-123.  Abstract ( )   Objective    To explore the relationship of long-term blood transfusion， iron chelation therapy with iron overload in the patients with beta-thalassaemia major. Methods    The serum ferritin （SF）， liver function， renal function， myocardial enzyme， ultrasonograph of liver and spleen， blood glucose and urine glucose were detected in the patients with beta-thalassaemia major in “Friends of thalassemia” and “Service team for thalassemia in Shenzhen” with regular long-term blood transfusion and iron chelation therapy in three months. Left ventricular ejection fraction（LVEF）， myocardial， liver， pancreas and pituitary MR imaging T2* were performed on 51 patients of them. The51 patients were divided into 3 groups. 10 cases with sufficient dose DFO and sufficient dose DFP iron chelation treatment group （sufficient dose joint group）； 31 cases with insufficient DFO and DFP iron chelation treatment group （insufficient joint group）； 10 cases with sufficient dose DFX iron chelation treatment group （DFX group）. Results    There was no difference in myocardial T2*，pituitary T2*，LVEF in every group.（P > 0.05）. Liver T2* in sufficient dose joint group was higher than that in insufficient joint group （P < 0.05）. Liver T2*， pancreas T2*， and pituitary T2*in DFX group was significantly higher than that in the other two groups （P < 0.05）. SF in sufficient dose joint group was significantly lower than that in insufficient joint group（P < 0.05）， SF in DFX group was significantly lower than that in the other two groups（P < 0.05）. Liver T2* and pancreas T2*in C group were significantly lower than those in A and B groups （P < 0.05）.There was myocardial iron overload in 11 of 51cases （21.6%）， and there was liver iron overload in 43 of 51 cases （84.3%）. SF had no correlation with myocardial T2*（r = 0.254，P > 0.05）， and there was moderate negative correlation with liver T2*（r = 0.558，P < 0.01）. Conclusion    The sufficient dose DFO with DFP treatment， and the DFX treatment can effectively reduce SF，compared with that of insufficient DFO with DFP treatment. All iron chelation therapy can alleviate myocardial iron overload.

Select

Risk factors of acute idiopathic thrombocytopenic purpura developing into chronic idiopathic thrombocytopenic purpura.　 2012, 27(2): 124-126.  Abstract ( )   Objectives　To investigate the risk factors for children with acute idiopathic thrombocytopenic purpura（AITP） developing into chronic idiopathic thrombocytopenic purpura （CITP）.  Methods　A total of 138 patients with AITP from May 2006 to April 2010 in the First Affiliated Hospital of Guangxi Medical University were Selected and telephoned for retrospective analysis. The 16 related factors，including clinical presentation，laboratory tests and treatment programs，were performed single case-control study. For those significant single factors，multi-factor non-conditional Logistic regression analysis was used to find meaningful factors. Results　The main influencing factors were the onset-to-treatment time，O Rh （D） + type blood，treatment with gamma globulin and platelets increasing to normal time. The age of onset，early treatment with platelets，platelets beginning-to-pick-up time，gender，with or without the precursor dominant infection，pretreatment platelet count，mean platelet volume，mean platelet distribution coefficient，the number of bone marrow megakaryocytes，and the number of immature megakaryocytes，the number of particle-type giant cells and naive lymphocytes were irrelavant factors. Conclusion　The key to improving the diagnosis includes early treatment，and early treatment with large dose of gamma globulin treatment. The high-risk factors to chronic include lateness of platelet recovery to normal and O Rh （D） + blood （relative to A and B blood type）.

Select

Clinical and pathological analysis of children with asymptomatic abnormal findings in urinalysis. 2012, 27(2): 127-129.  Abstract ( )   Objective　To investigate the relationship between clinical characteristics and renal pathological types. Methods　Renal biopsies were performed on 172 children. The patient’s history，physical examination，routine biochemical tests，including immunological analyses [immunoglobulin，complement，renal function，liver function，hepatitis virus markers]，kidney ultrasound，Doppler ultrasonography and routine urine cultures were obtained to exclude urinary tract infection，urinary calculi，renal tumor and secondary glomerulonephritis. Apart from light microscopy of the urine sediment，phase-contrast microscopy was also performed for the detection of dysmorphic erythrocytes. Results　In 172 children who were investigated，149 cases（86.6%） had isolated haematuria （IH），7 cases（4.1%） had isolated proteinuria （IP） and 16 cases（9.3%） had combined haematuria and proteinuria （CHP）. In total of 172 patients，minor abnormalities were in 66.9% cases；focal segmental glomerulosclerosis （FSGS） was in 12.8% cases；IgA nephropathy was in 7.6% cases；focal glomerulosclerosis（FGS） was in 6.4% cases；Thin basement membrane nephropathy （TBMN） was diagnosed in 2.3% cases. While in patients with CHP，minor abnormalities were in 31.3% cases；IgA nephropathy was diagnosed in 50% cases. In patients with gross haematuria，minor abnormalities were in 56.3% cases and FSGS was diagnosed in 25% cases. Conclusion　A school urine screening program can detect chronic renal disease in its early stage. A regular follow-up for those children with microhematuria is certainly warranted. Renal biopsy is recommended to those children with combined hematuria and proteinuria and massive haematuria.

Select

ppropriate range of arterial blood partial pressure of carbon dioxide in permissive hypercapnia ventilation.　 2012, 27(2): 130-133.  Abstract ( )   Objective　To study the appropriate range of arterial blood partial pressure of carbon dioxide （PaCO2） in permissive hypercapnia ventilation in the treatment of neonatal respiratory distress syndrome（NRDS）. Methods　From  Jan.2004 to Dec.2009 in Sanming First Hospital Affiliated to Fujian Medical University，90 cases of infants who were treated with mechanical ventilation were randomly divided into three groups： control group（PaCO2 range 35～45 mmHg）（1 mmHg = 0.133 kPa），treatmentⅠgroup（PaCO2 range 46～60 mmHg），treatment Ⅱgroup（PaCO2 range 61～75 mmHg）. Data relevant to the neonates were collected and analyzed ，including the ventilator’s parameter ，blood gas ，complications and therapeutic effectiveness. Results　Mean airway presure （MAP），inspiratory time （Ti） and peak inspiratory presure （PIP） in the treatment group were significantly lower than those in the control group respectively （P < 0.01）；fraction of inspiration O2（FiO2）was lower than that in the control group （P < 0.05）；respiratory rate（RR） was higher than that in the control group （P < 0.05）；pH in treatment group was lower than that in the control group （P < 0.05）；PaCO2 was significantly higher than that in the control group（P < 0.01）；PaCO2 in the treatmentⅠgroup was significantly lower than that in the treatment Ⅱ group （P < 0.01）； the incidence of ventilator associated lung injury （VALI） in treatment groups was lower than that in the control group （P < 0.05），and mechanical ventilation time was significantly lower than that in the control group （P < 0.01）；the therapeutic effectiveness was better than that of the control group （P < 0.05）. There were also no differences in the length of hospitalization ，incidence of intraventricular hemorrhage（IVH） and periventricular leukomalacia（PVL）（P > 0.05），but consequence of IVH in the control group and the treatment Ⅱ group was very serious. Conclusion　Permissive hypercapnia ventilation in the treatment of NRDS can markedly decrease the incidence of VALI and mechanical ventilation time，without affecting oxygenation，heart rate，blood pressure and without increasing the incidence of IVH and PVL；the therapeutic effectiveness is better than that of the conventional mechanical ventilation.Moderate range of PaCO2（46～60 mmHg） is appropriate because of slight IVH .

Select

Clinical，endoscopic and pathologic characteristics of food allergy inducing upper　gastrointestinal tract hemorrhage in 35 infants.　 2012, 27(2): 134-136.  Abstract ( )   Objective　To analyze the clinical manifestations，endoscopic features and histopathologic changes of food allergy inducing upper　gastrointestinal tract hemorrhage in infants in order to improve the level of dignosis. Methods　From Jun.2006 to Jul.2010 in Jiangxi Children’s Hospital，clinical manifestations，endoscopic features and pathologic changes in 35 infants who sufferred from allergic gastritis were collected and retrospectively analyzed. Results　All patients had haematemesis and mild or moderate anemia，among whom 19 cases were with high eosinophile granulocyte，6 cases with mild hypoproteinemia and 20 cases with high immunoglobin E level in serum；2 cases had positive antibody to H. pylori in serum. At the same time ，food allergen-specific immunoglobin G was detected，among which 2 milk-feeding infants were hypersensitive to milk，and 1 breast-feeding patient was hypersensitive to albumen/yolk，while the platelet counting，liver function and the blood clot test were normal. All the patients had erosive gastritis and multiple focus，among which 21 cases had multiple erosion mostly in fundus ventriculi and sinuses ventriculi and 14 cases in body and sinuses；3 cases had sinuses ventriculi and canalispyloricus edema，and 1 had esophagitis. All the 35 patients showed eosinophilia in gastric mucosa histopathologically，and recovered effectively after an elimination diet.  Conclusion　Food allergy inducing upper gastrointestinal tract hemorrhage in infants has no specific clinical symptoms；patients are mainly milk-feeding，hemorrhage of digestive tract is one of common manifestations，and gastric mucosal erosion is frequently seen under endoscope；elimination diet is the primary diagnostic and therapeutic method and gets favorable effect；pathological observation of gastric mucosa and eosinophile granulocyte counting contribute to the diagnosis .