Acta paediatrica Taiwanica = Taiwan er ke yi xue hui za zhi最新文献

Background: To evaluate the efficacy of prednisolone sodium phosphate oral solution plus inhaled procaterol in the treatment of acute asthma in children.

Methods: Forty-three patients aged 6 to 12 years with an acute exacerbation of asthma were double-blind randomized into one of two treatment groups in a 1:1 ratio:1) prednisolone oral solution +placebo tablets + procaterol MDI or 2) prednisolone tablets +placebo oral solution + procaterol MDI, all given three times daily for 7 days. Peak expiratory flow rate (PEFR), 24-hour reflective asthma symptom scores, spirometry and pulmonary index score (PIS) were recorded before and after treatment. Net changes in PEFR, symptom score, PIS, Forced Expiratory Volume in the first second (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow between 25 and 75 percent of the forced vital capacity (FEF(25-75%)) (before and after treatment) and global assessment by the investigator and the subjects or their parents were analyzed.

Results: The two groups were statistically similar at baseline values of these parameters. After a 7-day course of treatment, the net change of PEFR before and after treatment was significantly improved in both groups, but there was no significant difference in the net change of PEFR between the two groups (57.27+/-31.44 L/min vs. 54.29 +/-30.04 L/min, difference 2.99 +/-30.76 L/min, mean +/-SD, P=0.752). The net change in PIS and total symptom score did not differ between the two groups (P=0.091 and 0.827, respectively). Similarly, the FEV1, FEV1/FVC and FEF25-75% all improved with either treatment, and neither group was significantly superior to the other group (P=0.162, 0.48 and 0.081, respectively). Global assessment by the investigator and the subjects or their parents at the end of study indicated an essentially comparable result.

Conclusions: Prednisolone sodium phosphate oral solution plus inhaled procaterol is as efficacious as prednisolone tablets plus inhaled procaterol in the management of acute asthma in children.

Background: Several studies showed some chronic idiopathic thrombocytopenic purpura (ITP) patients with complete platelet recovery after Helicobacter pylori (H. pylori) eradication and cited the cause of persistent thrombocytopenia as inability to eradicate H. pylori. So we studied H. pylori infection status in pediatric ITP patients at diagnosis and address whether such infection played a role in the development of childhood ITP.

Methods: We compared H. pylori infection status by stool H. pylori antigen test of an ITP group including 32 childhood ITP patients at diagnosis from September 2004 to June 2006 and a control group including 30 unselected patients with no history of thrombocytopenia seen consecutively with clinical manifestations of pharyngotonsillitis, bronchitis, or bronchopneumonia in our ward during a one-month span. We further analyzed parameters between H. pylori infection-positive (H. pylori(+)) and H. pylori infection-negative (H. pylori(-)) childhood ITP patients.

Results: The H. pylori-positive (H. pylori(+)) rate was 19% in the study group and 17% in the control group, with not statistically significant difference. As for the characteristics and treatment response about H. pylori status, they were also not statistically different. Although the ratio of chronic ITP cases showed higher tendency in H. pylori(+) patients (2/6) than the H. pylori(-) ones (3/26), it was not statistically significant.

Conclusions: It seems that H. pylori infection played a minor role in the development of childhood ITP in this small-scale study. A large-scale study is necessary to further confirm the relationship between H. pylori infection and the development of childhood ITP.

Cardiovascular disease (CVD) is a major cause of death in pediatric patients with chronic kidney disease (CKD). Both types of traditional and CKD-related risk factors for CVD are prevalent in children with CKD. Many of these factors are associated with endothelial dysfunction (ED) and nitric oxide (NO) deficiency. ED with NO deficiency is both a cause and consequence of CKD. Hence, ED links CVD to pediatric CKD because ED plays a major role in the development of CVD. This review discusses how the risk factors for CVD contribute to ED and NO deficiency, leading to CVD in pediatric CKD. With early detection of ED by new non-invasive methods and restoration of NO bioavailability through different therapeutic approaches, the morbidity and mortality of CVD in pediatric CKD patients can be reduced.

Background: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients.

Methods: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone.

Results: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscopic surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days.

Conclusions: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.

Pheochromocytoma in children shows much worse complications than that in the adult patients. An 11-year-old girl was transferred to our emergency room after suffering from headache, dizziness, cold sweating and palpitation for 3 days. Severe hypertension, remarkable blood pressure fluctuation between 260/160 and 65/50 mmHg, decrease of cardiac contractility, as well as abnormal electrocardiogram findings including ST-T segment elevation and QT interval prolongation were noted soon after admission. Later, a 4x4.5x2.5 cm tumor in the right adrenal gland area was found by computed axial tomogram study. Assessment of the urine catecholamine metabolites showed high levels of vanillylmandelic acid, normetanephrine and norepinephrine indicating an active adrenal pheochromocytoma produced mainly norepinephrine. Although several antihypertensive drugs were used, ventricular tachycardia and Torsade de pointe still occurred on her for 3 times, each was preceded by a period of blood pressure fluctuation and burst out concomitantly at the peak of a hypertension crisis. From this case, we found that when the specific alpha-blocker like phenoxybenzamine or phentolamine was not available to us, labetalol by continuous intravenous infusion was the only effective drug to protect the patient from attacks of hypertensive crisis and ventricular tachycardia. Her right adrenal gland was resected smoothly when BP was well under control. Histological examination showed the adrenal medulla was full of pheochromocytoma cells.

Background: The pathoetiology and outcomes of intussusception in older children are different from those in young children. This study aims to investigate the characteristics and outcomes of intussusception in children older than 5 years in a tertiary referring hospital.

Methods: A retrospective review of patients aged older than five years having received a postoperative or roentgenographic diagnosis of intussusception between 1988 and 2005 was conducted. The clinical presentations, diagnostic and treatment methods, and outcomes of all cases were reviewed.

Results: A total of 12 cases were recorded. They were eight males and four females, with a median age of 7.6 years (range 5.0-11.1 years). Four (33.3%) children had symptoms lasting more than one week before a prompt diagnosis was made. The most commonly encountered symptom was abdominal pain (100%), followed by nausea/vomiting (75.0%). Recurrent intussusception occurred in 33% of cases. Abdominal sonogram identified intussusceptum in all patients when this procedure was performed. Six patients were treated operatively. Lead lesions including two malignant lymphomas, one Meckel diverticulum, and one colon polyp were found in 4 cases. Three of the four lead points were diagnosed and treated by colonoscopy preoperatively. Complications after operations were adhesive ileus (33.3%) and recurrent intussusception (16.7%). All patients remained well, including those who had lead points identified after prompt treatments.

Conclusions: Intussusception in older children presents a higher frequency of persistent symptoms, lead points, and recurrence. Pediatricians need to be aware of the etiology and treatment options for intussusception in older children.