Clinical features of Enterococcus faecium meningitis in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To summarize the clinical features of Enterococcus faecium meningitis in children.</p><p><b>METHODS</b>The clinical data of nine children with Enterococcus faecium meningitis were analyzed.</p><p><b>RESULTS</b>In all the nine children, Enterococcus faecium was isolated from blood, cerebrospinal fluid, or peripherally inserted central catheters; 6 (67%) patients were neonates, 2 (22%) patients were younger than 6 months, and 1 (11%) patient was three years and four months of age. In those patients, 56% had high-risk factors before onset, which included intestinal infection, resettlement of drainage tube after surgery for hydrocephalus, skull fracture, perinatal maternal infection history, and catheter-related infection. The main symptoms were fever and poor response. In those patients, 22% had seizures; no child had meningeal irritation sign or disturbance of consciousness. The white blood cell count and level of C-reactive protein were normal or increased; the nucleated cell count in cerebrospinal fluid was normal or mildly elevated; the protein level was substantially elevated; the glucose level was decreased. The drug sensitivity test showed that bacteria were all sensitive to vancomycin and the vancomycin treatment was effective. Only one child had the complication of hydrocephalus.</p><p><b>CONCLUSIONS</b>Enterococcus faecium meningitis occurs mainly in neonates and infants. The patients have atypical clinical features. A high proportion of patients with Enterococcus faecium meningitis have high-risk factors. Enterococcus faecium is sensitive to vancomycin.</p>

Clinical and genetic features of early-onset progressive encephalopathy associated with NAXE gene mutations / 中国当代儿科杂志

Early-onset progressive encephalopathy is a lethal encephalopathy caused by NAXE gene mutations. This paper reports the clinical and genetic features of a patient with early-onset progressive encephalopathy. A 4-year-old boy admitted to the hospital had repeated walking instability and limb weakness for 2 years. The patient and his elder brother (already dead) had clinical onset at 2 years of age. Both of them showed symptoms such as strabismus, ataxia, reduced muscle tone, delayed development, and repeated respiratory failure after infection. The NAXE gene of the patient showed new compound heterozygous mutations, i.e., c.255 (exon 2) A>T from his mother and c.361 (exon 3) G>A from his father. The NAXE gene encodes an epimerase that is essential for the repair of cellular metabolites of NADHX and NADPHX. This disease is associated with a deficiency of the mitochondrial NAD(P)HX repair system. Patients usually have rapid disease progression. They are also quite likely to have respiratory failure immediately after infection.

Clinical application of laparoscopic spleen-preserving operation in traumatic spleen rupture / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the effect of laparoscopic spleen-preserving operation for traumatic spleen rupture.</p><p><b>METHODS</b>From 1997 to 2003, 15 cases of traumatic spleen rupture were treated with laparoscopic spleen-preserving operation in our hospital. Nine cases had operation history in the middle and lower abdomen. ZT binding, electrocoagulation, fibrin and gelfoam tamping and suture repairing were used in patients with spleen rupture of grade I and grade II. Combined hemostasis was used for spleen rupture of grade III.</p><p><b>RESULTS</b>All patients did not need laparotomy during operation and no postoperative bleeding occurred. They were all cured and followed up for 3-12 months. Determination of immunoglobulins after operation showed normal, and spleen ultrasonic examination, CT and body state evaluations were all satisfactory.</p><p><b>CONCLUSIONS</b>Laparoscopy in the management of spleen trauma can be used in confirmed diagnosis and in determining the degree of spleen injury. For patients with stable vital signs laparoscopic spleen-preserving operation can be used. The laparoscopic spleen-preserving operation is safe in the treatment of traumatic spleen rupture.</p>

Case-Control Study on Risk Factors in Children with Epilepsy / 实用儿科临床杂志

Objective To explore the risk factors in children with epilepsy and their effects on attack rate of epilepsy.Methods One hundred and sixty epilepsy patients(patient group,88 boys and 72 girls)and 150 healthy children(control group,72 boys and 78 girls)were selected.All children conformed epilepsy at the west China second hospital were consecutively included in the study for 6 months period.The range of age was from 1 month to 16 years[(7.0?4.7)years old] of patient group children.All children with epilepsy had no-causation seizure for more than twice time and were diagnosed by electroencephalogram.Neurologically normal children in same period,matched for age and sex,visiting the health care clinic were selected as controls.The range of age was from 2 month to 16 years [(6.3?4.5)years old] of control group children.The risk factors examined were febrile convulsions,head trauma,central nervous system infections,abnormal perinatal history,family history of epilepsy and parental consanguinity.The data of patients and controls were obtained from a questionnaire through personal interviews.Details on the patient,family history,and parental age at the time of childbirth were included.Medical records were then reviewed.According to the data type,the statistics were performed with ?2 test and the significance level was the P

Long-Term Effect of Topiramate Treatment on 24 Cases of Lennox-Gastaut Syndrome / 实用儿科临床杂志

Objective To explore the effect and adverse reaction of topiramate(TPM) on treating Lennox-Gastaut syndrome(LGS)(including therapeutic alliance or single ). Methods Twenty-four cases with LGS whose attacks could not be controlled by re-(gular) therapy were selected.TPM was gradually increased from low dosage till its showing effect or untolerant adverse reaction.Results Two cases were excluded because of adverse reaction and increase of attacks. The remained cases were followed up from 6 months to 15 months (average: 9 months). The total effective rate was 82.6%, 11 cases accounting for 45.8% free of attack. The tonic-clonic seizure reduced more than 50% accounting for 82.2%, the full control accounting for 66.7%. The myoclonic seizure reduced more than 50% accounting for 81.8%,the full control accounting for 58.8%.The atypical absence seizure reduced more than 50% accounting for 81.8%, the full control accounting for 63.6%. The maximum effect occurred about 2-40 weeks following TPM used, the dosage about 2-10 mg/(kg?d).The adverse reaction included anorexia (8 cases), language disorder (5 cases), drowsiness (4 cases), decrease of anamnesis (3 cases), weight loss or unchanged(3 cases), inattention (3 cases), depression (3 cases), mental bradypraxia (2 cases ), skin damage (1 case), stupor (1 case), gross hematuria(1 case).The hepatic and renal function were normal during therapy. Conclusion TPM is a new, broad-spectrum, effective and safe antiepileptics drug on treating LGS.

Clinical Significance of Abnormal Electroencephalogram Spindle Wave in Children / 实用儿科临床杂志

Objective To explore the clinical significance of abnormal spindle wave in the central nervous system.Methods Eighty-four cases of central nervous system disease were retrospectively analyzed.Results The attenuation and disappearance of electroencephalogram spindle wave cue marked brain structural damage, the region of abnormal electroencephalogram spindle wave was similar to that of brain computer tomography showing.Conclusion Abnormal electroencephalograph spindle wave always indicates intracranial disease, which may play an important role in the decisive diagnosis and the judgment of prognosis of the disease.