Case report of bronchial Dieulafoy disease in children / 中华实用儿科临床杂志

The clinical data of a child with bronchial Dieulafoy disease treated in Wuhan Children′s Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, was analyzed retrospectively.The patient was a 9-month-old boy, who was admitted to hospital due to " intermittent hematemesis vomiting blood for 6 hours" . Chest CT suggested ground-glass opacity in both lungs.Electronic bronchoscopy showed that the neoplasm bulged into the lumen at the opening of the right inferior lobar bronchus, and fresh blood oozed from the basal segment of the neoplasm during the operation.Bronchial arteriography and transcatheter bronchial artery embolization were performed due to recurrent hemoptysis, during which the patient was diagnosed with bronchial arterial vascular malformation and finally diagnosed with bronchial Dieulafoy disease after consulting the relevant literatures.The disease is infrequent and characterized by rupture hemorrhage of bronchial submucosal malformed artery, the etiology and pathogenesis of which are still unclear, and it may be related to congenital vascular malformation in children.Bronchoscopy for hemoptysis of unknown cause in children should be performed with caution.If small and smooth protruded nodular lesions are seen under the bronchoscope, the bronchial Dieulafoy disease should be considered, and the lesions should not be touched too much or subjected to biopsy blindly.Fatal massive hemorrhage can be avoided by bronchial arteriography and bronchial artery embolization.

Comparisonbetweencomplicationsandrecurrenceofdifferentinterventionalmethods inthetreatmentofbenignesophagealstenosisinchildren / 实用放射学杂志

Objective Toinvestigatetheinterventionaltreatmentmethodsofbenignesophagealstenosisinchildren,includingballoondilation, stentimplantationandcontinuousballoondilation.Methods 42casesofesophagealstenosisdiagnosedbybariumexaminationinour hospitalfromJanuary2010toJune2017.Accordingtothetreatmentmethods,theyweredividedintoballoondilationgroup(13cases),stent implantationgroup (11cases),continuousballoondilationgroup (18cases),andthecomplicationsandrecurrenceratesofthree methodswerecompared.Results Balloonorstentsweresuccessfullyplacedorremovedinallcases,andtheclinicalsymptomswere significantlyimproved.Therewerenoseriouscomplicationssuchasruptureofesophagus,perforationandmassivehemorrhageI.nballoondilation group,restenosisoccurredin10cases3to10monthsafteroperation,withcomplicationsrateof76.9% andrecurrencerateof76.9%. Instentimplantationgroup,sentfallingoffordisplacedoccurredin4casesandrestenosisin4cases,withthecomplicationsrateof 72.7% andrecurrencerateof36.3%.Incontinuousballoondilationgroup,therewere2casesofballoondescendingand4casesof restenosis,withcomplicationsrateof33.3% andrecurrencerateof22.2%.Comparingthecomplication,theballoondilationgroup>thestentimplantationgroup(χ2=0.056,P>0.05),thestentimplantationgroup>thecontinuousballoondilationgroup(χ2=4.243, P<0 .05 ),the balloon dilation group>the continuous balloon dilation group (χ2=5 .743 ,P<0 .05 ).Co m paring the recurrence rate ,the balloondilationgroup>thestentimplantationgroup(χ2=4.033,P<0.05),thestentimplanationgroup>thecontinuousballoondilationgroup (χ2=0.684,P>0.05),theballoondilationgroup>thecontinuousballoondilationgroup(χ2=9.120,P<0.05).Conclusion There aredifferentincidenceofcomplicationsandrecurrenceinthreemethods,andthecontinuousballoondilationissimplerandlesscomplicationsand recurrencethantheothertwomethods.Itcanbethefirstchoiceforinterventionaltreatmentofesophagealstenosis.

The clinical efficacy of ultraselective intravascular embolization combined with local sclerotherapy in the treatment of large hemangioma in children / 实用放射学杂志

Objective To study the clinical efficacy and complications of ultraselective endovascular embolization combined with local sclerotherapy in the treatment of large hemangioma in children,to provide a better choice for the treatment.Methods 85 cases of large hemangioma in our department in the last three years were analyzed retrospectively.Patients were divided into two groups according to the treatment:the simple treatment group (33 cases),ultraselective endovascular embolization,and the combination treatment group (52 cases),ultraselective endovascular embolization combined with local sclerotherapy or local sclerotherapy after endovascular embolization.The total effective rate and the incidence of complications between two groups were compared,and the patients were followed up for 3 months to 1.5 years.Results 85 cases of large hemangioma were successfully treated by simple ultraselective endovascular embolization or combined treatment.A total of 75 cases were treated effectively (complete cure,partial cure,condition improved)and 10 cases were ineffective and no recurrence or tumor enlargement in the follow-up .In the total effective rate,the combination treatment group [96.2% (50/52)]was superior to the simple treatment group [75.8% (25/33)](χ2=6.245,P=0.012 ).There was no significant difference in the complete cure rate between the two groups (χ2=1.561,P=0.212 ).The complication rate in the simple treatment group was slightly higher than that in the combined treatment group:36.4% (12/33)vs 32.7% (17/52)(χ2=0.064,P=0.996).Conclusion The total effective rate of ultraselective endovascular embolization combined with local sclerotherapy in the treatment of large hemangioma in children is better than simple endovascular embolization,and less complications,safely treatment and less trauma.It can be used as the first choice for treatment of large hemangioma.

Analysis of the efficacy of superselective intravascular embolization in the treatment of large hemangioma in children / 中华放射学杂志

Objective To evaluate the clinical efficacy of superselective intravascular embolization in the treatment of large hemangiomas in children,and to provide a reliable basis for the clinical treatment and to predict prognosis.Methods The clinical and imaging data of 85 children with large hemangiomas who underwent superselective angiography and embolization were collected in our hospital from January 2015 to January 2018,and followed up for 3 months to 1.5 years.According to the DSA angiography of the hemangioma [artery origin,artery number,arterio-venous fistula(AVF)],and combined with age,tumor size and the selection and compatibility of embolization materials.Using the chi-square test to analyze these indicators.Results Analysis of the clinical efficacy indicators,was shown as the following:(1) Artery origin:The total effectiveness rate of single and mixed sources was 95.3％ (61/64),66.7％ (14/21) respectively.The difference was statistically significant (x2=0.688,P＜0.05).(2) Feeding artery number:The total effectiveness rate of 1 branch,2 branches and ≥3 branches was (3/3),(25/27)and (47/55) respectively.The difference was statistically significant (x2=1.944,P＜0.05).(3) Presence of fistula(AVF):The total effectiveness rate of AVF and without AVF was 36.4％ (4/11) and (95.9％,71/74) respectively.The difference was statistically significant (x2=0.806,P＜0.05).Other influencing factors including:(1)Age:the recurrence rate of patients≤5 months and＞5 months was 33.3％ (6/18) and 20.9％ (14/67)respectively.There was no significant difference (x2=1.220,P＞0.05);(2)Tumor size:The recurrence rate of φ≤80 mm and φ＞80 mm was 25.5％(13/51)and 32.4％(11/34) respectively.There was no significant difference (x2=0.474,P＞0.05).(3) Selection and compatibility of embolization materials:The recurrence rate of Lipiodol + bleomycin and gelatin sponge +bleomycin was 27.0％ (10/37) and 31.3％ (15/48) respectively.There was no significant difference (x2=0.179,P＞0.05).Conclusions The clinical efficacy of superselective intravascular embolization in the treatment of large hemangioma in children was influenced by:artery origin(mixed sources),artery number (≥3 branches),AVF,age tumor size,selection and compatibility of embolic materials.

Analysis on monitoring results of antibody levels after 4-vaccine inoculation among healthy children in Guangshui City during 2013 / 国际检验医学杂志

Objective To understand the antibody levels after the inoculation of measles ,poliomyelitis ,epidemic encephalitis B and hepatitis B vaccines among healthy children aged 7 - < 13 years old in Guangshui City of Hubei province to provide the scientif ‐ic basis for formulating the immune prevention and control strategy and risk assessment in whole city .Methods 4 616 healthy chil‐dren aged 7 - < 13 years old were sampled from the whole city .The enzyme‐linked immunosorbent assays (ELISA) was used to de‐tect the 4‐antibody levels .Results The antibody positive rates of measles ,poliomyelitis ,epidemic encephalitis B and hepatitis B a‐mong healthy children aged 7 - < 13 years old in Guangshui City were 94 .41% ,93 .07% ,93 .78% and 68 .72% respectively .The protection levels of first three kinds of antibody reached more than 85% ;the positive rates had statistical difference among 4 kinds of antibody(χ2 = 1 987 .08 ,P = 0 .000) .The antibody positive rates of epidemic encephalitis B had no statistical difference among different age periods (χ2 = 10 .141 ,P= 0 .071) ;the antibody positive rates of measles ,poliomyelitis and hepatitis B had statistical difference among different age periods(χ2 = 40 .471 ,P = 0 .000 ;χ2 = 25 .174 ,P = 0 .000 ;χ2 = 283 .641 ,P = 0 .000) .The positive rates of 4 kinds of antibody had no statistical difference between different genders (χ2 = 0 .019 ,P= 0 .889 ;χ2 = 1 .017 ,P= 0 .313 ;χ2 = 0 .018 ,P= 0 .892 ;P= 0 .639 ,P= 0 .424) ;the antibody positive rates of measles ,poliomyelitis and epidemic encephalitis B had no statistical differences among 17 villages and towns in the whole city (χ2 = 0 .099 ,P= 1 .000 ;χ2 = 0 .117 ,P= 1 .000 ;χ2 = 0 .134 , P= 1 .000) ,while the antibody positive rate of hepatitis B had statistical difference among these villages and towns (χ2 = 186 .179 , P= 0 .001) .Conclusion The antibody levels of measles ,poliomyelitis and epidemic encephalitis B reach the protection rate ,but the antibody level of hepatitis B needs to be increased .The monitoring work should be continuously strengthened and the seeking missed inoculation and re‐inoculation work should be reinforced .

Interventional approaches to neonatal Kasabach-Merritt syndrome：method selection and therapeutic effectiveness / 中华放射学杂志

Objective To explore therapeutic effects of different interventional approaches to neonatal Kasabach-Merritt syndrome (K-MS) Methods A retrospective analysis of therapeutic effects of different interventional approaches to K-MS in 12 neonates from May 2010 to August 2014. All the patients received local treatment (n=5), chemoembolization (n=4) and combined local treatment and endovascular chemoembolization (n=3), respectively, depending on size, location and blood supply of K-MS. The K-MS patients with angioma measuring5 cm received local treatment, endovascular chemoembolization and combined local treatment and endovascular chemoembolization, respectively. The patients were categorized as cured, improved and clinical inefficient, respectively, based on therapeutic effect. The criteria for cured patients were: (1) angioma faded completely or mostly; (2) the platelet count stabilized within the normal range; (3)no recurrence for more than six months. The criteria for improved patients were: (1) angioma shrinked significantly; (2) the platelet stabilized within the normal range. The criteria for clinical inefficient patients were: (1) agioma no obviously shrinked, the platelet count has no improvement over 2 months after interventional approaches. Results All the 12 patients with K-MS were cured and had no complication. Of the 12 patients, 5 patients received local treatment had decreased localized tension and ecchymosis of hemangioma at the first day of therapy, were cured after 2 to 7 courses of therapy. Of the 4 patients received endovascular chemoembolization, 3 were cured after one course of treatment, 1 had recurrent disease one month later after one course of therapy and were cured after the second course of treatment.One had recurrent disease a month later after one course of treatment and were cured after the second course of treatment. Three received combined local treatment and endovascular chemoembolization, angioma shrinked significantly and increased platelet count after the first course of treatment, and 2 to 3 courses local treatment were combined, hemangioma faded and platelet count stabilized within the normal range after 2 to 3 courses of local treatment. Conclusions Interventional therapy is the most effective treatment of neonatal K-MS.There are different interventional approaches to optimize treatment of neonatal K-MS depending on sizes, location and blood supply of K-MS.

Modified continuous balloon dilatation substituting stenting in the treatment of benign esophageal stenosis in children / 中华放射学杂志

Objective To explore the feasibility of using the modified continuous balloon dilatation substituting the traditional membrane-covered stent in the treatment of benign esophageal stenosis in children.Methods A retrospective analysis of the clinical data of 25 cases with esophageal stenosis from January,2012 to February,2014 was conducted.Preoperative esophageal stenosis was confirmed by angiography,and the expansion of the stenosis segment was examined after 2-4 weeks postoperatively.According to the age and the location of the esophageal stricture,25 cases were classified into two groups.Twelve cases of group A without obvious contraindications were treated by continuous balloon dilatation,while 13 cases of group B with age of less than 3 years or upper esophageal stenosis,retrievable stent implantation was performed.All cases were followed up from 6 months to 2 years.Clinical symptoms,swallowing fluency and the degree of esophageal stricture were followed up at 1,3,and 6 months postoperatively,and the effect of treatment was evaluated.Results Two groups of patients were successfully treated,and the stents were removed successfully after 2-4 weeks.The average diameter of the stenosiswas significantly increased after treatment,swallowing was improved obviously,with no perforation,hematemesis and melena and other serious complications.The balloon moved down happened in one case,which was adjusted under perspective observation.One case in group A underwent colonic interposition for esophageal replacement because of recurrence of restenosis.The balloon dilatation was effective in 10 cases.In Group B,5 patients had stent migration or displacement,3 cases had recurrent esophageal stricture,and the treatment was effective in 5 cases.There was significant difference in complications between the group A and B (x2=5.23,P＜0.05).Conelusions Continuous balloon dilatation is a simple,effective procedure with fewer complications in the treatment of children with benign esophageal stenosis.In addition to stenting,it may be another ideal choice for benign esophageal stenosis in children.

Prevention and treatment of common complications after esophageal retrievable covered stent placement in children / 实用放射学杂志

Objective To explore risk factors,prevention and treatment of common complications of benign esophageal stenosis treated with the retrievable covered stents in children.Methods Fifteen cases,diagnosed as benign esophageal stenosis by barium esophagogram were treated with retrievable covered stents under fluoroscopy,Then the stents were removed after 2-3 weeks.The cases were followed-up and complications were observed.Results The stents were successful implanted in all cases.The diet was improved obviously after operation,and gradually transformed from liquid,semiliquid to normal feeding.At the same time,narrow section gradually expanded from 0.1-0.6 cm to 0.6-1.5 cm.Postoperative follow-up was in 1,2,3 weeks and 3 months.Main complications were stents shift in 5 cases,esophageal restenosis in 2 cases,esophageal-tracheal fistula in 1 case,postoperative dull pain behind sternum and foreign body sensation in 6 cases.Relevant preventions and treatments were performed based on different complications.Conclusion It should not be ignored that complications after covered stent placement are more in children than in adults,preventions and treatments should be taken positively.

The therapic effect of the combination of endovascular embolization and hormone in Kasabach-Merritt phenomenon / 中华放射学杂志

Objective To explore the therapic effect of the combination of endovascular embolization and clinical hormone in treatment of Kasabach-Merritt phenomenon (KMP),and analyze the advantages.Methods Six cases with KMP from May 2010 to June 2012 were retrospectively analyzed.All the patients underwent large dose hormone shock therapy after admission for 7-10 d.Subsequently,selective endovascular embolization was performed using Seldinger technique under general anesthesia Then,the hormone therapy was continued for 2 weeks after embolization.The platelet count and the effect were recorded.If the area of the tumor reduction is less than 50％,3-4 courses of local hardening treatment was conducted for the residual tumor.The local treatment used multipoint puncturing of the tumor and injection drugs under X-ray fluoroscopic monitoring until the tension of local vascular increased.Results On DSA,the lesions of all the 6 cases showed rich blood supply with a large number of hybrid distribution of tumor blood vessels.The lesions disappeared in 4 cases after 1-2 weeks combination therapy and no recurrence for 0.5-1.0 year follow-up.Two cases whose tumor reduced less than 50％ after combination therapy received local hardening treatment,and faded after 3-4 courses.The number of platelet for all patients kept normal and the spirit of the patients showed great improvement,the bleeding tendency and local soft tissue swelling was in remission.Subcutaneous blood stasis and petechiae disappeared.There were no serious adverse reaction and complications.Conclusion Combination therapy with endovascular embolization and clinical hormone for Kasabach-Merritt phenomenon has a good curative effect.

A case of Keutel syndrome in child (review the literature) / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#The purpose is to report a calcification of the cartilaginous of the tracheobronchial case in child, and to recognize the clinical and imaging features on Keutel syndrome.@*METHOD@#A comprehensive analysis of the clinical data and X-ray,CT. Some literatures involving some symptoms of this child were reviewed.@*RESULT@#This patient diagnosed with Keutel syndrome finally.@*CONCLUSION@#When we meet calcification of the cartilaginous of the tracheobronchial patient in clinic, it may be Keutel syndrome.