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<p><b>OBJECTIVE</b>To analyze the efficacy of percutaneous endoscopic gastrostomy (PEG) in pediatric patients.</p><p><b>METHOD</b>From October 2011 to October 2014, children in the gastrointestinal ward of Guangzhou Women and Children's Medical Center received PEG or jejunal tube PEG(JET-PEG). The success rate, operation time were recorded. The changes of their weight, enteral nutrition calories and the incidence of pneumonia before and after the first 6 months of operation were compared. Follow-up was conducted until October 2014, the recent and long term complications, the length of indwelling time, the replacement or removal of the tube were recorded, the patients swallowing function or the primary disease's outcomes were observed.</p><p><b>RESULT</b>Of the 13 cases, 10 were male, 3 were female, their average age was 2 years (range 1.8 months-9 years). We performed PEG for 12 of the patients who had congenital craniofacial problems that led to feeding difficulties or recurrent cough and pneumonia (6/12), or neurological disorders (6/12) with inability to swallow, and in one case JET-PEG was performed, this child suffered from chronic intestinal pseudo-obstruction with vomiting and abdominal distension. The gastrostomy was successful in all the patients through one operation, the average operation time of PEG was (25 ± 3) minutes, JET-PEG was 60 minutes. One local skin infection was noted, no long-term complication occurred. In the first 6 months after operation, all the patients gained weight((5.5-30.5) kg postoperation vs. (3.0-30.0) kg preoperation), and 12 cases' enteral nutrition calories increased (from (209-502) to(272-543) kJ/(kg·d)), the incidence of pneumonia decreased in the children who had recurrent pneumonia before the operation (from (0-1.5) to (0-0.16) per month). Until October 2014, their average length of gastric tube indwelling time was 17.8 months (range 4-36 months). In 4 cases PEG tube was removed when they could eat completely independently, the other 9 needed enteral vein nutrition via PEG tube or jejunal tube, in 3 of them balloon type gastric fistula tube was applied. Two of the 13 cases who had cleft palate received stomatological operations when their weight grew to meet the standard.</p><p><b>CONCLUSION</b>PEG and JET-PEG are safe and effective method for enteric nutrition feeding in pediatrics, the technique causes minimal trauma and has rapid postoperative recovery, few complications, good aesthetic appearances and simple nursing, it can significantly improve their nutritional status and quality of life.</p>
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Child , Child, Preschool , Female , Humans , Infant , Male , Enteral Nutrition , Methods , Gastrostomy , Incidence , Nervous System Diseases , Therapeutics , Pneumonia , TherapeuticsABSTRACT
To discuss clinical diagnosis and treatment of cow’s milk protein allergy and cow’s milk protein-induced FPIES (food protein induced enterocolitis syndrome). Methods We retrospectively analyzed clinical data of one infant with milk protein allergy-induced FPIES. Results A 67 days old female on mixed breast and formula feeding developed recurrent diarrhea, abdominal distension, vomiting, mucousy and bloody stools, feeding dififculty, anemia, and failure to thrive since 2 weeks after birth. Laboratory studies showed anemia, increased CRP level and elevation of peripheral white blood count and eosinophil proportion. Milk-speciifc IgE was negative. She was previously hospitalized 4 times, all with admitting diagnosis of“necrotizing enterocolitis”. We treated her with milk protein elimination for 4 weeks and all symptoms were resolved. Milk protein re-challenge test was positive, consistent with clinical features of cow’s milk protein allergy-induced infant FPIES. Conclusions Cow’s milk protein allergy and cow’s milk protein-induced FPIES can present with non-speciifc and variable clinical symptoms and signs, and should be considered in the differential diagnosis.
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<p><b>OBJECTIVE</b>To evaluate the efficacy of endoscopic balloon dilatation, stenting and surgery in treating corrosive esophageal stricture of children.</p><p><b>METHOD</b>We retrospectively analyzed the management of 31 children who were treated with endoscopic balloon dilatation, stenting or gastric tube esophagoplasty because of corrosive esophageal stricture between August 2005 and December 2012. Dysphagia was graded into 4 grades according to Stooler grading methods. The efficacy was divided into 3 grades which were very effective, effective and ineffective according to the improvement of dysphagia.</p><p><b>RESULT</b>Among 31 children with corrosive esophageal stricture, in 22 children the problem was caused by alkali, in 9 by acid; 23 children had long-segment stricture and 8 had short-segment stricture. The number (rates) of cases in whom the endoscopic balloon dilatation was very effective, effective, and ineffective were 12 (38.7%) , 7 (22.6%) , 12 (38.7%) , respectively. The number of cases in whom stenting was effective or ineffective was 1 and 3, respectively. The gastric tube esophagoplasty was very effective and effective in 8 and 2 cases, respectively. Total rates of very effective, effective, and ineffective of 3 treatments were 64.5%, 29%, 6.5% respectively. The efficacy of endoscopic balloon dilatation was better in short-segment stricture and bigger caliber stricture, the efficacy was not so good for other types of strictures. The efficacy of balloon dilatation was not related with the nature of substances (either alkaline or acidic). Compared with very effective group, the ineffective group with longer course of disease before dilatation (t = -2.091, P = 0.048) , smaller stricture calibre (t = 2.855, P = 0.009) , longer stricture segment (t = -3.405, P = 0.003) and longer dilatation time (t = -2.103, P = 0.047) , had statistical significance.</p><p><b>CONCLUSION</b>Endoscopic balloon dilatation was the preferred treatment for corrosive esophageal stricture of children. The efficacy was better in shorter course of disease, short-segment stricture and bigger caliber stricture, for other situations the efficacy was not so good. The efficacy of balloon dilatation was not related with the nature of substances.Stent or surgery can be considered if efficacy of balloon dilatation was not so good.Gastric tube esophagoplasty is an effective treatment for complicated corrosive esophageal stricture.</p>
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Child , Child, Preschool , Female , Humans , Infant , Male , Burns, Chemical , Therapeutics , Deglutition Disorders , General Surgery , Therapeutics , Dilatation , Methods , Esophageal Stenosis , General Surgery , Therapeutics , Gastroscopy , Retrospective Studies , Stents , Treatment OutcomeABSTRACT
Objective To evaluate the efficacy and safety of composite milk clotting enzyme capsules in children with functional dyspepsia.Methods A multicenter,randomized,open-label clinical trial was carried out in 4Guangzhou hospitals during Feb.2012 to Mar.2013.Children with functional dyspepsia on basis of Rome Ⅲ criteria were enrolled and treated with composite milk clotting enzyme capsules.Total symptom score and drug-related adverse reactions were evaluated after one-week and two-week therapy.The treatment outcome were divided into very effective,fairly effective and ineffective according to the symptom score changes.Superiority test was done for effectiveness of the treatment based on efficacy difference by 10％ regarded as superiority.Results Two hundred and one children were enrolled.One hundred and ninety-six children completed the study as planned.After two-week therapy,better effective rate and total effective rate were 68.88％ and 87.76％,higher than those of one-week therapy (27.04％,76.02％) (U =2.935,P ＜ 0.05).The lower limits of 95 ％ confidence interval of difference in symptoms improve rate,better efficacy rate and symptom score decrease rate between two-week and one-week therapy were more than 10％,and two-week therapy was superior to one-week therapy.No significant drug-related adverse reaction was found during the study.Conclusions Composite milk clotting enzyme capsules can improve functional dyspepsia symptoms significantly.The effectiveness of two-week of treatment is better than that of one-week treatment.No obvious drug-related adverse reaction is observed.
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Objective To discuss the nursing intervention of Rey syndrome in children patients.so as to search effective nursing measures.Methods 12 children patients with Rey syndrome received comprehensive nursing treatment with reducing intracranial pressure and were under continuous close observation.Slightest changes were feeded back timely,then effective nursing measures were taken to stabilize their illness,patients also received dietary therapy,medication nursing and rehabilitation training,etc.Results All patients ameliorated after 3 to 7 days,and achieved clinical recovery after 20 to 30 days without sequelae.Conclusions Early diagnosis and correct effective nursing care can improve curative rate and avoid the occurrence of complications and sequelae.
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Objective To observe the levels of cAMP and adenylyl cyclase(AC) in hippocampus of mice with vascular dementia(VD) and the effect of Dihydroergocriptine(DHE),and to explore the molecular pathogenesis of VD.Methods The mice were subjected for ischemia-reperfusion three times on bilateral common carotid arteries by knots to establish models of VD and the changes of learning and memory were tested on d29/d30 after operation.DHE was administrated to another group of mice,which was taken as treatment group.The cAMP level was evaluated by the radioimmunoassay;AC mRNA positive neurons of hippocampus CA1 area were examined through in-situ hybridization.Results Compared with shamed-operation group,the learning and memory of model group was worse(P
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Objective To investigate the calcium signal transduction pathway in hippocampal neurons of mice with vascular dementia (VaD) and the intervention effect of dihydroergocriptine (DHE). Methods The mice were subjected for ischemia-reperfusion repeatedly on bilateral common carotid arteries by knots to establish the VaD models. Animals with sham-operation were taken as control group. The treating group was administered with DHE after the establishment of VaD model. The behavior changes were observed through the step-down avoidance test and water maze test on the 29th and 30th days after operation. The resting 〔Ca 2+〕 i level of hippocampal neurons was evaluated by laser scanning confocal microscopy. RT-PCR technique was used to measure mRNA expression of CaM an CaMPKⅡ in hippocampal neurons. Results The resting 〔Ca 2+〕 i level in model group(43.50?3.00) was significantly higher than those in the sham-operation group (25.50?3.50) (P
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Many complications occur in the early stage of post-orthotopic liver transplantation, six patients with or the ptopic liver transplantation, mainly contract hemorrhage,renal insufficience,acute host-vs-graftreaction,palmonary infectin,thoracic fluid and oral ulcer.We conclude in order to improver the postoperation survival of the patients it is very important to closely obere the change of patients and early recognize and deal with various complications on the basis of observing and nursing these patients
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Objective: To investigate the rate of post-stroke depression and psychosocial factors related to it, and to provide the direction and the basis for clinical nursing. Methods: 69 patients with stroke were assessed by Zung Self-rating Depression Scale and Type A Behavior Pattern Scale. Their sex, age, behavior type, marital condition, level of education, supportor of medical expenses were collected and analysed statistically. Results: The rate of post-stroke depression was 59.42%, and the rate in type A behavior group was higher than that in the other behavior groups(P
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Objective To study the effects of Hydergine on expression of N-methyl-D-aspartate receptors in hippocampus and actions of mice with ischemia-reperfusion injury.Methods 36 mice were randomly divided into model group,Hydergine group and sham-operated group. The models of ischemia-reperfusion injury were made by knotting bilateral common carotid arteries. The behavioral abnormalities were investigated by step-down test and water maze test, and the expressions of N-methyl-D-aspartate receptors in neurons of hippocampus were observed by immunohistochemistry technique. Results Compared with model group, the performance records of learning and memory in Hydergine group were better (all P
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Objective: To explore the relationship between post-stroke depression and coping style and social sustian for guiding psychological intervention.Methods: A control study was done in 78 patients with post-stroke depression and 65 patients with non-post-stroke depression by using Medical Coping Modes Questionnaire and Social Sustian Scale.Results: The score of confrontation was lower and that of resignation was significantly higher in depression group than in non-depression group(P