Cesko-Slovenska Pediatrie最新文献

The authors examined IgG sub-classes, using the ELISA method, in 35 patients with relapsing respiratory diseases and 27 children of a control group aged 3-15 years. In children with relapsing respiratory diseases without deficiency of the main immunoglobulin classes they found a statistically significantly reduced value in sub-class IgG2 (P < or = 0.01). The changes found in other sub-classes were not statistically significant. The authors draw attention to the fact that deficiency in IgG sub-classes should be considered in case of repeated respiratory infections caused by encapsulated microorganisms--H. influenzae, Str. pneumoniae--and also when reduced levels of IgG and IgA are found. However, even normal levels do not rule out deficiency.

The authors present their experience with orthopaedic surgical treatment of children with cerebral palsy. The paper is based on a group of 630 patients where they performed 1882 operations of the lower extremities in 1970-1992. The authors evaluate the long-term results in regularly checked 361 patients (205 boys and 156 girls), mostly with the spastic form of cerebral palsy, with regard to different types of affections which markedly influence the prognosis of surgery (monoparesis, hemiparesis, diparesis, triparesis, quadruparesis). The authors emphasize the primary importance of rehabilitation and team work where the orthopaedist's work is guided by efforts to make further rehabilitation training possible and to facilitate it. They consider surgery an integral part of comprehensive treatment of cerebral palsy which must be followed immediately by further rehabilitation. The authors emphasize the part played be the orthopaedic surgeon to prevent the genesis and development of deformities of the locomotor apparatus.

The justification of examinations by magnetic resonance and the results of visualization of cardiac and vascular structures in relation to the performed surgical operation were evaluated retrospectively in 24 children after surgery of congenital heart disease. Thirteen patients had an operation of coarctation or a double aortic arch and four had an operation of an anomaly of the branch of the pulmonary artery-its loop or atresia. Seven patients had operations, mostly complicated inborn heart disease, of the common arterial trunk and transposition of the large arteries with a conduit, tricuspidal atresia after Fontan's or Glenn's modified operation and ligature of an aortal aneurysm. At the time of examination the patients were 4 to 18 years old. Spin echo sequences obtained by basic reconstructions of T1 and possibly T2 weighted images on a 1.5 T Magnetom apparatus Siemens proved an excellent visualization in the area of the large arteries and the capacity of detailed visualization of cardiac structures, incl. changes of the vascular wall in relation to the performed operation. Magnetic resonance examinations provided accurate information on central anastomoses and conduits as well as on changes of the vascular lumen. The investigation confirmed that magnetic resonance is suitable for visualization of postoperative changes and findings of morphological structures in particular at sites of cardiovascular anastomoses where magnetic resonance supplements the visualization capacity of echocardiography and substitutes invasive examinations where only an angiographic examination is needed. In eight instances the examination was supplemented by invasive assessment of haemodynamic conditions.

In the period from 1990 to 1992 542 children aged 0-15 years were examined by the breath hydrogen test for abdominal pain and chronic nutritional disorder. The results of lactose tests were pathological in 107 children with abdominal pain and 95 with chronic nutritional disorder. The authors followed 107 children with abdominal pain and directed their attention to its relationship to lactose intolerance. It was confirmed to be the only cause of abdominal pain in twenty-six children (24.3%). In spite of the well known pathogenetic mechanism of lactose intolerance leading to abdominal pain and metheorism and loose stools, an atypical clinical course was observed in these patients. There were no complaints associated with the intake of milk in history, the abdominal pain being the leading symptom in all patients but four who had loose stools. There was an improvement of clinical symptoms after the low-lactose diet.

Chronic and recurrent abdominal pain are frequent diagnostic problems in school age and adolescent children. The authors examined the IgG antibodies to Helicobacter pylori using ELISA in a group of 91 children. Positive results were found in 20 children, i.e. 22%. All children positive for Helicobacter pylori antibodies underwent an endoscopic examination with bioptic sampling of the gastric and duodenal mucosa. Bioptic samples were examined histologically and Helicobacter pylori was identified microscopically and using urease tests and cultivation. All 20 children with antibodies to Helicobacter pylori had histological evidence of chronic gastritis in the gastric antrum and infection with Helicobacter pylori was found in 16 cases. Detection of Helicobacter pylori IgG antibodies is useful in the selection of patients for endoscopic examination of the stomach and duodenum. Endoscopy is relevant also where antibodies to Helicobacter pylori are negative and the characteristic picture of chronic disease of the upper gastrointestinal tract is present.

Bacteriological examination focused on the aerobic and anaerobic flora from ectomized tonsils in 17 patients with recurrent tonsillitis, in 8 patients with hypertrophy of the tonsils and 122 children with an adenoid vegetation confirmed microbial aetiology. In ectomized tonsils and adenoids aerobic gram-positive bacteria comprised most frequently staphylococci, and gram-negative bacteria H. influenzae. As to anaerobic gram-positive bacteria, they isolated most frequently peptostreptococci, and as to gram-negative ones B. fragilis from tonsils and Bacteroides sp. from adenoids. In the treatment of recurrent infections of the upper respiratory pathways it is important to use preferentially aminopenicillins combined with beta-lactamase inhibitors and lincosamides.