ObjectiveTo analysis the causes of infant spasm (IS) and provide a theoretical basis for clinical diagnosis and treatment. MethodsCollected the clinical data of 116 IS cases in our hospital from May 2011 to December 2013, which conform to the diagnostic standard, and analysis its causes. ResultsIn the116 cases we collected, symptomatic IS is primarily for 78 cases (67.24%); the onset age of symptomatic IS within 6 months was 76.39% (55/72), higher than the rates of symptomatic IS beyond 6 months 52.27% (23/44) (P=0.007); The pathogenic factor in symptomatic IS, prenatal accounted for 48.72%, intrapartum factors accounted for 34.62%; for sexually transmitted diseases accounted for 47.44%, venereal disease accounted for 52.56%. In 78 cases of symptomatic IS, gender has no relation with its pathogenic factors; the onset age within 6 months of antepartum and intrapartum factor is significantly higher than the rates of symptomatic IS beyond 6 months (89.09% VS 69.57%); distribution between urban and rural areas and its pathogenic factors is related, prenatal factors of urban IS significantly lower than which in rural areas (38.30% VS 64.51%), intrapartum factor IS significantly higher than the rural IS (44.68% VS 19.35%). ConclusionThe cause of the IS given priority to with symptomatic, IS in the majority with, and prenatal or developmental factors in the higher flight in symptomatic, and the smaller of the onset age antepartum and intrapartum factor becomes more apparent, prenatal factors in the rural areas is higher than which in the unban areas, but intrapartum factor in the unban areas is higher than which in the rural areas. Magnetic resonance imaging (MRI) still plays an important role in etiology diagnosis.
ObjectiveTo probe the clinical features and the characteristics of radiography and electroencephalogram (EEG) of tuberous sclerosis complex(TSC) in children with epilepsy. MethodsThe clinical data of the TSC cases with epilepsy were collected from inpatients in Jiangxi Children's Hospital from Jan. 2013 to Oct. 2015. ResultsAmong the 26 cases, 21 cases(21/26, 80.77%) involved abnormalities of the skin. Of these patients, there were 10 cases with hypomelanotic macules, 7 cases with café au lait spots and 4 cases with facial angiofibromas. There were no significant difference among the different age groups. In addition, there were 8 cases (8/26, 30.77%) with spasm seizures, of whom 3 cases had partial seizure, 10 cases (10/26, 38.46%) with complex partial seizure, 5 cases(5/26, 19.23%) with secondary generalized seizure, 2 cases(2/26, 7.69%) with tonic-clonic seizure and one case with Lennox-Gastaut syndrom(1/26, 3.85%). The average onset age of the epileptic spasms group were younger than those of the other epilepsy groups (t=2.143, P=0.042). EEG monitoring demonstrated hypsarrhythmia in 7 cases (7/26, 26.92%) in the interictal EEG, focal epileptic discharges in 11 cases (11/26, 42.31%), multifocal discharges in 5 cases, the slow background activity in 2 cases and the normal EEG in one case. Cranial imaging demonstrated subependymal nodules (SEN) in 25 cases(25/26, 96.15%) was the most common. ConclusionThe clinical manifestations and seizure types of TSC in children, especially in infants and young children, were diverse and age-dependent. It was very important to improve understanding of the clinical features and related risks of TSC at various ages, which was helpful to diagnose TSC early.
目的比较全层连续缝合法和分层缝合法在急诊腹部手术中的切口愈合效果。 方法将符合纳入标准的急诊腹部手术患者随机分为全层缝合组和分层缝合组，比较2组患者的切口愈合效果。 结果全层缝合组的关腹时间短于分层缝合组（P=0.000），但在切口液化发生率、切口感染发生率、总切口并发症发生率、切口愈合及术后住院时间方面，2组的差异均无统计学意义（P＞0.05）。26例细菌培养结果为阳性（全层缝合组10例，分层缝合组16例）的患者中，致病菌主要为大肠埃希菌（11例）和铜绿假单胞菌（7例）。 结论相较于分层缝合法，急诊腹部手术中采用全层缝合法既不增加切口并发症的发生率，又节省手术时间，对于危重患者具有重要的意义。
ObjectiveTo optimize the therapy protocols of high dose prednisone combined with topiramate (TPM) in children with infantile spasms (IS). MethodsSixty cases were collected in our hospital from September 2012 to September 2013 and randomly divided into two groups(n=30) and followed-up for more than 6 months.The spasms were assesses by video-electroencephalogram (VEEG) monitoring including awake and asleep states before treatment, after two weeks of therapy and the end of the courses respectively.And the Gessel developmental quotient (DQ) scores were performed before treatment and after six months of therapy. ResultsFor the unresponders to high dose prednisone in one week of therapy, there were 46.67%and 60.00% in test group higher than 31.25% and 37.50% in control group respectively in 2 week and in the end of treatment.And the rate of complete resolution of hypsarrhythmia in the test group was 46.67% and 60.00% higher than 25.00% and 37.50% in control group respectively in 2 week and in the end of treatment.But there were no statistical significances between two groups(P >0.05).The incidence of side effects(83.33% vs. 80.00%) and the relapse rate(39.14% vs. 40.00%), were not statistically significant between two groups(P >0.05).The responsive rates for the cases with the lead time within 2 months higher than beyond 2 months in two groups respectively in 2 weeks and in the end of treatment. ConclusionsThe protocol of the test group was superior to that of the control group.The responsive rates of children within 2 months of lead time were higher than beyond 2 months, which indicates that early diagnosis and early treatment would improve efficacy and have an important influence on the prognosis of IS.
ObjectiveTo analyze the clinical data of 5 cases of congenital hyperinsulinemia with sizures as the initial symptoms. MethodsRisk factors in perinatal period, clinical manifestation, laboratory examination, treatment and follow-up visits of 5 cases of congenital hyperinsulinemia with sizures as the initial symptoms were analyzed retrospectively, who were admitted to Department of Neurology of Jiangxi Children's Hospital from July 2012 to August 2016. Results5 children were all male. The onset time varied from 3 to 9 mouths old. All the cases presented seizures as the main clinical manifestations, persistent hypoglycemia, hyperinsulinemia, low free fatty acid and hypoketonemia. During follow-up, treatment with diazoxide and dietary therapy was effective in 3 cases, pure dietary therapy ineffective in 2 cases. 3 cases manifested as acute symptomic seizures, 2 cases as remote symptomic epilepsy. During follow-up, 1 cases showed normal intelligence, 3 cases developmental delay, and 1 case dropout. ConclusionMost of the infants with congenital hyperinsulinemia presented seizures as initial symptoms. Severe hypoglycemia and long duration would damage brain, and early management may significantly improve the prognosis. The early diagnosis can be made by measuring fasting blood glucose, insulin, free fatty acid and, plasma β-hydroxybutyric acid, C peptide and so on. The majority of children were effective by diazoxide.