Quick Search
  Home Journal Information Current Issue Past Issues Services Contact Us  
Vol 3, No 2
Vol 3, No 2 May 2007 ISSN 1708-8569
 
Editorial
Special communication
Review articles
Original articles
Case report
Correspondence
   
Editorial:
Lead poisoning in Chinese children: risk factors and preventive measures
  Yao-Hua Dai, Zhao-Yang Fan
 
  [Abstract] [Full Text] [PDF]  
Special communication:
Improvement of resuscitation techniques for neonatal asphyxia
  Xiao-Yu Zhu, Qian-Shen Zhang
 
  [Abstract] [Full Text] [PDF]  
Review articles:
Renal tubular acidosis in childhood
  James C. M. Chan, Fernando Santos
  Increased knowledge on the genetics, the pathophysiology, the natural history and the treatment of renal tubular acidosis (RTA) has begun to clarify this often confusing field. To help pediatricians better acquainted with the physiological and genetic basis of the various types of RTA, to facilitate early diagnosis and treatment with the ultimate aim of preventing the significant growth failure and chronic kidney failure of undiagnosed and untreated patients with RTA, we reviewed new data on the mechanisms of growth retardation in patients with RTA. RTA should be included in the differential diagnosis of a child with growth failure, rickets and metabolic acidosis. The diagnostic work-up and treatment are succinctly presented in this review.

Key words: renal tubular acidosis; growth retardation; chronic kidney failure; nephrocalcinosis; nephrolithiasis

World J Pediatr 2007;3(2):92-97

  [Abstract] [Full Text] [PDF]  
Current diagnosis and management of children with vasovagal syncope
  Cheng Wang, Hui-Fen Zheng
  Background: Vasovagal syncope (VVS) is the most common type of syncope and a wide variety of stimuli can trigger this reflex. The morbidity is high in children with VVS. The aim of this review is to describe the diagnosis and treatment of children with VVS.

Data sources: Related articles in PUBMED and CNKI in the last decade were reviewed. The data on the diagnosis and management of VVS were extracted and analyzed.

Results: The diagnosis of children with VVS includes basic method (inquiring history of syncope and physical examination), head-up tilt table test (baseline head-up tilt test, sublingual nitroglycerin tilt test and isoproterenol head-up tilt test), and standing test. The therapy includes education, behavior modification, training, standing training, oral fluid therapy, pharmacological treatment (beta blockers, fludrocortisone, alpha agonists, selective serotonin re-uptake inhibitors and captopril), and permanent use of pacemaker.

Conclusions: Basic method (inquiring history of syncope and physical examination) is most important. Sublingual nitroglycerin tilt test is recommended in the diagnosis of VVS. Education, behavior modification, training, standing training, and oral fluid therapy are effective in preventing VVS, but the effect of all medicines needs to be further investigated.

Key words: vasovagal syncope; head-up tilt test; children; diagnosis; therapy

World J Pediatr 2007;3(2):98-103

  [Abstract] [Full Text] [PDF]  
Total parenteral nutrition-induced liver dysfunction: evidence and pathogenesis
  Xiao-Gang Hui, Yutaka Hayashi
  Background: Total parenteral nutrition (TPN) is known to be life-saving in patients with intestinal failure. But long-term TPN-related complications especially liver dysfunction have been the focus of studies. In this article, we address the evidence of TPN-induced liver lesions and the pathogenesis of these lesions.

Data sources: The articles about the relationship between TPN and liver function were retrieved from PubMed database.

Results: Varied injuries to the liver are induced clinically and experimentally by progressive deterioration after a longer period of TPN infusion. The mechanisms of cholestasis and fibrosis in pathological changes include alteration of trace elements in hepatocytes, metabolic disturbance of fatty acid, calorie overload, lithocholate effect, sepsis, etc. The administration route of TPN is excluded from the pathogenesis of liver disease, and light infusion should be avoided.

Conclusions: TPN may lead to liver dysfunction, but the causes are multifactorial. The authentic factor is unknown although progresses have been made in this field. Since conspicuous lesions are confined in the mesenchyma, further studies should concentrate on the relationship between Ito cells and TPN administration. The significant step toward the gene expression profiling of TPN-supplied liver is to elucidate the real etiologies.Key words: total parenteral nutrition; liver dysfunction; pathogenesis

World J Pediatr 2007;3(2):104-109

  [Abstract] [Full Text] [PDF]  
Imatinib mesylate, a new drug for chronic myeloid leukemia in pediatric patients
  Vasantha Thavaraj, Rachna Seth
  Background: Imatinib mesylate (IM) is the greatest drug discovered in the past three decades. It is one of the new agents which have the potential to decrease therapy-related morbidities for patients with chronic myeloid leukemia (CML). As a tyrosine kinase inhibitor and a potential targeted model therapy, IM works through competitive inhibition of the ATP binding site of tyrosine kinase Bcr-Abl, the aberrantly expressed and constitutes active gene product of t(9;22) Philadelphia chromosome translocation.

Data sources: All literatures were from Pubmed and full text articles.

Results: IM induces major cytogenetic response in 60% of cases in chronic phase of CML and complete hematological response in 95%. IM can be used as the fist line treatment of CML. If the treatment is not successful within a year of treatment, the patient should be advised for marrow transplant. IM is also used in CML patients who are intolerant to interferon or have failed to interferon therapy. IM can induce high rates of cytogenetic and hematological responses in children in whom interferon treatment has failed. The hematologic toxic effects of IM are manageable.

Conclusions: IM plays a role in the treatment of CML both in adults and children. Usage of the agent a waits further elaboration of molecular biology of different cancers and specific targeted therapy.

 Key words:  imatinib mesylate; chronic myeloid leukemia; childhood cancers; chronic leukemia

World J Pediatr 2007;3(2):110-114

  [Abstract] [Full Text] [PDF]  
Original articles:
Differentiation of neuroblastoma cells induced by nerve growth factor gene transfection
  Qian Dong, Qiang Gao, Hong-Ting Lu, Li-Rong Sun, Lin Hou, Yu Cheng
  Background: Neuroblastoma (NB) is a very common childhood malignant tumor with considerable morbidity and mortality. Nevertheless, some cases can disappear spontaneously and be induced to differentiate into mature cells in vitro. It may be a potential treatment method to induce NB cells to differentiate into mature cells. This study was undertaken to observe the differentiation of neuroblastoma cell line transfected with nerve growth factor (NGF) gene and investigate the role of NGF in the differentiation.

Methods: Tumor specimens of NB patients were collected for primary cell culture and the cells were separated and purified to be cell line as a cell model. The plasmid containing NGF gene was transfected into NB cells mediated by liposome. Morphological changes were observed under a phase-contrast microscope. Cell proliferation was determined by the MTT method and mitosis index.

Results: The expression of NGF was higher after gene transfection, the cell proliferation was inhibited and morphological changes occurred. Total RNA separated by agrose gel electrophoresis resulted in clear 28s and 18s, indicating that RNA quality was good. RT-PCR products about 726 bp, matching NGF size, indicated that NB cells can express a certain amount of NGF, and the expression was increased after NGF gene transfection. Forty-eight hours after NGF gene transfection, morphodifferentiation presented like neurodendrite and axons, which were similar to mature ganglion cells.

Conclusions: The established NB cell line is an induced type (type N). The transgenic NB cells can highly express NGF, which can inhibit proliferation and induce differentiation.

Key words: NGF; transfection; neuroblastoma; cell line; differentiation

World J Pediatr 2007;3(2):115-120

  [Abstract] [Full Text] [PDF]  
Correlation of brain natriuretic peptide with hyponatremia in newborn infants with hypoxia ischemic encephalopathy
  Wei Zhang, Xia Yu, Qing-Pin Fu, Ting-Yan Liao, Cheng-Zhong Liu, Xiao-Ling Li, Min Zhai, Xian-Qing Li
  Background: This study was undertaken to investi-gate the correlation between blood levels of brain natriuretic peptide (BNP) and hyponatremia in hypoxic-ischemic encephalopathy (HIE) of newborn infants. The mechanism by which BNP and hyponatremia involved in the pathogenesis of HIE was also investigated. 

Methods: The blood levels of BNP and natrium were measured in the HIE and the control groups at the 3, 7 and 14 days of age respectively. The HIE group was divided into two subgroups as hyponatremia group (22 HIE newborn infants with hyponatremia) and normal natrium level group (52 HIE infants with normal natrium level). There were 18 non-HIE newborn infants with normal natrium level in the control group. All parameters were compared among the three groups at the aforementioned age periods.

Results: The blood BNP level of infants with HIE aged 3 days was higher than that of the control group (P<0.01). At 7 days of age, there was no significant difference between the HIE group with normal blood natrium and the control group. But the BNP level in the hyponatremia group was higher than that in the normal blood natrium group (P<0.01). The blood natrium level decreased significantly in the hyponatremia group at the three age periods (P<0.01). The neonatal behavioral neurological assessment showed a significant difference between the two HIE groups as well as between the three different age periods in the hyponatremia group. There was a negative correlation between BNP level and blood natrium level at each age period in the hyponatremia group.

Conclusion: BNP may be involved in hyponatremia in newborn infants with HIE, and may play an important role in the pathogenesis of HIE directly or induced by hyponatremia.

Key words: newborn infants; hypoxic-ischemic encephalopathy; hyponatremia; brain natriuretic peptide; neonatal behavioral neurological assessment

World J Pediatr 2007;3(2):121-124

  [Abstract] [Full Text] [PDF]  
Cardiovascular reserve ability and exercise capacity on bicycle ergometer exercise stress test in children with ventricular premature beat
  Zheng-Hai Qu, Zi-Pu Li
  Background: This study was undertaken to evaluate the cardiovascular reserve ability and exercise capacity on bicycle ergometer exercise stress test to determine the effect of anti-arrhythmic therapy in children with ventricular premature beat (VPB).

Methods: Ruled out those with organic cardiac disease by physical examination, echocardiography and myocardial enzyme analysis, 123 children with VPB (aged 2-17 years) were included in this study. Fifty patients were treated with anti-arrhythmic drugs (treatment group), and 73 patients were not treated with any anti-arrhythmic drugs (non-treatment group). Their heart rate, systolic pressure, diastolic pressure and total work capacity were determined by bicycle ergometer stress test.

Results: VPB disappeared in 22 patients (44%) of the treatment group and 31 patients (42.5%) of the non-treatment group. Seventeen patients in the treatment group and 22 patients in the non-treatment group underwent the bicycle ergometer exercise stress test. Compared with normal children, these patients showed no significant difference in heart rate, systolic pressure, diastolic pressure, and reserve indexes (F=3.18-4.98, P>0.05). The total work capacity was of no significant difference among the subgroups (F=3.16, P>0.05).

Conclusions: There is no relationship between anti-arrhythmic therapy and natural disappearance of VPB. VPB without organic cardiac abnormality does not influence children's heart function and exercise capacity. Exercise test is essential to patients with VPB.

Key words: ventricular premature beat; cardiovascular reserve; heart rate; blood pressure; exercise test; work capacity

World J Pediatr 2007;3(2):125-128

  [Abstract] [Full Text] [PDF]  
Human herpesvirus detection and species identification with PCR-RFLP and ELISA: a comparative study
  Guan-Ping Dong, Shi-Qiang Shang, Li-Zhong Du, Xi-Lin Yu, Ya-Ping Xu, Xiu-Jing Wu
  Background: This study was undertaken to establish a restriction endonulease pattern which could detect and differentiate four major human herpesviruses by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP), and to compare PCR-RFLP with enzyme-linked immunosorbent assay (ELISA) in diagnosing herpesvirus infection.

Methods: A pair of primers was designed to amplify herpes simplex virus type 1 and 2 (HSV-1/-2), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). At last, we used the PCR-RFLP technique to differentiate four different herpesviruses. Meanwhile, 75 clinical blood specimens from infants of suspected viral infection and 38 blood specimens from healthy children were evaluated for herpesviruses DNA by PCR-RFLP or virus-specific IgM antibody detection by ELISA.

Results: The products of four human herpesviruses after PCR amplification varied from 510 bp to 592 bp and allowed characterization of herpesvirus type with restriction endonulease analysis. Among the 75 specimens, 23 (30.7%) were shown positive by PCR including 13 for CMV, 4 for EBV, 5 for HSV-2, and 1 for HSV-1 after restriction enzyme digestion with BamHI and BstUI, whereas 10 (13.3%) were detected positive by ELISA. All ELISA-positive specimens were likewise positive by PCR. Thirteen of 65 ELISA-negative specimens were tested positive by PCR.

Conclusion: The PCR-RFLP technique is more specific, sensitive, rapid and accurate than ELISA in diagnosing herpesvirus infection.

Key words: herpesvirus; polymerase chain reaction; restriction fragment length; polymorphism; ELISA

World J Pediatr 2007;3(2):129-133

  [Abstract] [Full Text] [PDF]  
Surgical anatomy of the pelvis as a basis for pull-through procedures in Hirschsprung's disease
  S. Berger, M. Schweizer, P. Schweizer
  Background: The basis for successful pull-through procedures in patients with Hirschsprung's disease is a detailed knowledge of the anatomy of the pelvis. The currently most utilized pull-through techniques were reviewed with regard to their impact on the anatomy of different regions of the pelvis. The findings were analyzed as to advantages and disadvantages of the respective procedures.

Methods: The anatomy of the pelvis was studied in three children by post mortem examination. The study was approved by the institutional ethics committee.

Results: The study confirmed five anatomical regions of the pelvis of surgical importance which should be considered when planning and performing a pull-through procedure. It could be shown that the fascial coating of the rectum plays an important role in an adequate pull-through procedure.

Conclusions: The type of complications that may be expected and the prognosis of a pull-through procedure is influenced by the given anatomical conditions of the pelvis. Thus, an adequate procedure should respect the anatomical characteristics of the five surgically important anatomical regions of the pelvis.

Key words: Hirschsprung's disease; pull-through operation; pelvic anatomy

World J Pediatr 2007;3(2):134-139

  [Abstract] [Full Text] [PDF]  
Pathologic changes in pulmonary arteries of infants with complex congenital heart defect with diminished pulmonary blood flow but without aortopulmonary collateral arteries
  Xiao-Tong Zhang, Ying-Long Liu, Ying-Mao Ruan, Cun-Tao Yu, Lei Liu
   

Background: To evaluate the development of small pulmonary arteries of infants with complex congenital heart defect (CHD) with diminished pulmonary blood flow but without aortopulmonary collateral arteries, we compared the imaging data including diameter of the central pulmonary artery, McGoon ratio and pulmonary artery index (PAI), which were obtained by echocardiography and cardioangiography before operation.

Methods: Biopsy specimens were obtained from 46 infants suffering from complex CHD with diminished pulmonary blood flow but without aortopulmonary collateral arteries from January 2002 to September 2004. The infants were at their age of 6-36 months. They had undergone echocardiography and cardioangiography examinations. Autopsy specimens were obtained from 5 infants, aged 4-18 months, who died of non-cardiovascular diseases and served as normal controls. The tissue was fixed with buffered formalin, and routinely prepared by impregnated in wax. Tissue sections were stained with hematoxylin-eosin, Weigert's elastic stain counter-stained with van Gieson. Three parameters including percentage of media thickness (MT%), percentage of media section area (MS%) and numbers of small arterial per square centimeter (APSC) were obtained by morphologic quantitative analysis using a computer image processor. The diameters of the left pulmonary artery (LPA) and the right pulmonary artery (RPA) were measured by echocardiography and cardioangiography. The McGoon ratio and PAI were calculated according to the results of cardioangiography.

Results: There was no significant difference in MT% and MS% between the normal control group and the experimental group. The mean value was 11.44% and 18.34% in the normal control group. The mean value of APSC was significantly different between the two groups (408.58/cm2 and 217.15/cm2 respectively). The diameters of the main pulmonary artery (MPA), LPA and RPA measured echocardiographically were not correlated with pathological data (P>0.05). The diameters of the LPA and MPA (r=0.61, P=0.01), of the RPA and MPA (r=0.48, P=0.01), and of the RPA and LPA (r=0.57, P=0.01) were positively correlated. But the diameters of the LPA, RPA and MPA were not correlated with pathological parameters. The diameters of the LPA and RPA were positively correlated (r=0.378, P=0.015) as shown by cardioangiography. The McGoon ratio and PAI calculated by cardioangiography were correlated with APSC (r=0.51, P=0.001 and r=0.448, P=0.004).

Conclusion: The developing extent of small pulmonary arteries is correlated with the central pulmonary artery of infants suffering from complex CHD with diminished pulmonary blood flow but without aortopulmonary collateral arteries.

Key words: congenital heart defect; pulmonary artery; oligemia; cardioangiography; infant

World J Pediatr 2007;3(2):140-145

  [Abstract] [Full Text] [PDF]  
Percutaneous nephrolithotomy using ureteroscope and pneumatic intracorporeal lithotripsy in the management of pediatric renal calculi
  Xiang Yan, Xiao-Gong Li, Wei-Dong Gan, Hong-Qian Guo
  Background: Percutaneous nephrolithotomy (PCNL) is widely performed in the treatment of kidney stones in children. The main risk of this therapy is hemorrhage that requires blood transfusion associated with an increased risk of kidney loss. This study was undertaken to assess the safety and efficacy of PCNL using ureteroscope and pneumatic intracorporeal lithotripsy in the treatment of pediatric renal calculi.

Methods: We studied 22 kidneys of 15 patients under 14 years who underwent PCNL in our hospital. The average age of these patients was 9.2 years (range 5-14 years). In 7 bilateral and 8 unilateral cases of 5 staghorn calculi, the average stone burden was 2.04 (0.9-4.5) cm. PCNL was performed with an X-ray-guided peripheral puncture. With a minimal dilatation of the urinary tract with ureteroscope and pneumatic intracorporeal lithotripsy, a staged approach was used for bilateral cases.

Results: Complete stone clearance was achieved in 20 of the 22 kidneys, giving an overall clearance rate of 91%. Mild fever (<39ºC, <2 days) was seen in 14 patients, whereas serious pyrexia was seen in 1. The decrease in the level of hemoglobin averaged 1.6 g/dl, but none of the patients required blood transfusion.

Conclusions: PCNL is a better treatment of choice for pediatric stone disease refractory to extracorporeal shock wave lithotripsy. To treat pediatric urolithiasis with PCNL using ureteroscope and pneumatic intracorporeal lithotripsy is safe and effective.

Key words: percutaneous nephrolithotomy; ureteroscope; pneumatic intracorporeal lithotripsy; children

World J Pediatr 2007;3(2):146-149

  [Abstract] [Full Text] [PDF]  
Case report:
Rectal atresia with rectourethral fistula: a rare anomaly
  Chien-Hsing Lee, Ming-Chih Chou, Hui-Min Yeh
  Background: Rectal atresia is an extremely rare anorectal malformation. We described a case of combined rectal atresia and rectourethral fistula.

Methods: The case was treated by a transverse loop colostomy after magnetic resonance imaging for confirming rectal atresia. He had anal dilation with a Hegar dilator at home and was readmitted to the hospital at age of 5 months for surgery. Distal colostography revealed a rectourethral fistula, and the gap between the two rectal pouches was 0.5 cm. The infant underwent a posterior sagittal repair.

Results: The infant was treated successfully after the fistula was excised and the continuity of the rectum was established by circumferential anatomosis. He is 2 years old now and passes stool daily.

Conclusion: Rectal atresia with rectourethral fistula can be treated successfully by a posterior sagittal approach.

Key words: rectal atresia; rectourethral fistula

World J Pediatr 2007;3(2):150-151

  [Abstract] [Full Text] [PDF]  
Correspondence:
Correspondence
  Kin-Sun Wong, Hui-Jin Chen
 
  [Abstract] [Full Text] [PDF]  
   
 
 
 
World Journal of Pediatric Surgery
roger vivier bags 美女 美女

Home  |  Journal Information  |  Current Issue  |  Past Issues  |  Journal Information  |  Contact Us
Children's Hospital, Zhejiang University School of Medicine, China
Copyright 2007  www.wjpch.com  All Rights Reserved Designed by eb