Pediatric knowledge was not fully learned by seven-year program medical students of pediatrics major in first five years,so two years of postgraduate was the key period for culturing their pediatric specialty.Students of seven-year program were characterized by strong theoretical knowledge but poor pediatric clinic knowledge,therefore,pediatric clinic teaching should emphasize on basic knowledge and skills,avoid dwelling on specific details at early stage,pay attention to their communicative ability with children and their relatives,combine theory with clinic practice and teach from surface to point.Meanwhile,we aimed at changing them into pediatric doctor through cultivating their clinic skills and scientific research ability.

Cavernous transformation of portal vein accounts for about 40％ in children portal hypertension.Compared with other causes of portal hypertension disease cavernous transformation of portal vein presents early age of disease onset,high risk of bleeding and normal liver function.Because the pathology is relatively simple and most children have no other diseases,so a reasonable treatment of the disease has decisive significance.The current concept for diagnosis and treatment of the disease is different between home and abroad,Controlling upper gastrointestinal bleeding is the main purpose in out country.Reliving hypersplenism,improving liver blood supply and quality of life are much important abroad,The article aims to summarize latest foreign literature to introduce latest research for the disease abroad.

ObjectiveTo observe the effect of portal blood flow on rat's liver with prehepatic portal hypertension.MethodsSixty-six male Wistar rats were randomly divided into five groups:partial portal vein transfixation group( A,n =20),hepatic artery transfixation after partial portal veins transfixation group( B,n =20),hepatic artery transfixation group (C,n =10),SO group( D,n =10 ),hepatic artery and partial portal vein transfixation group ( E,n =6 ).The mortality as well as the biochemical examination wereobserved at the 12th week after operation.Then the density of the microvascular in portal area and proliferating cell nuclear antigen expression of intro-hepatic bile duct epithelium were determined by immunohistochemical staining method.The ultra microstructure changes of hepatocytes were observed under transmission electron microscope.Results Biochemical examination,including glutamic-oxa-lacetic transaminase,glutamic-pyruvic transaminase and total protein,showed no significant differences anong all groups (P ＞0.05) at the 12th week after operation.Glutamie-oxalacetic transaminase in group A,in group B,in group C and in group D are (132.69±21.03) U/L,(154.40±28.73) U/L,(125.84±26.60) U/L,(134.02±18.42) U/L; glutamic- pyruvic transaminase in group A,in group B,in group C and in group Dare (39.33±8.62) U/L,(44.84 t9.47)U/L,(40.41±8.04) U/L,(38.47±7.29) U/L.Compared with groups C and D,the mortality rate (group A 20％ ; group B 25％),and the microvascular number in portal area increased obviously in group B and A(P ＜0.05).The proliferating cell nuclear antigen expressions of intra-hepatic bile duct epithelium increased significantly in group B (mean optical density 0.345±0.027 compared with the rest groups mean optical density in group A,in group C and in group D are 0.264 ± 0.015,0.258±0.022,0.249±0.021 ) ( P ＜ 0.01 ) ; fat accumulation in the hepatocytes and mitochondria vacuolization were observed under transmission electron microscopic in group A and group B.ConclusionsThe portohepatic collateral circulation still has its significance in liver blood supply of prehepatio portal hypertensive rat; the epithelium of intra-hepatic bile duct was mildly damaged and the microvascular number in hepatic portal area increased as well as the fat accumulated in hepatocytes of prehepatic portal hypertensive rat; if the hepatic artery blood supply is lost,these changes would become more obviously.

The mode of action of V-type organophosphate poisons on acetylcholinesterase has been studied. It shows that the leaving group of V-type poisons is dialkylamino-ethyl-thio radical,and the phosphonyla-ting site on the enzyme molecule is similar to that of the G-type poison soman, as shown by the competition experiments.

Objective To retrospectively analyze the therapeutic effect of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to cavernous transformation of portal vein (CTPV).Methods Retrospectively analyzed 30 cases of children with CTPV admitted by Beijing Children's Hospital in General Surgery Department from Jan.2005 to Dec.2012,and evaluated the clinical efficacy of ligaturing pericardial blood vessel combined splenectomy for treating children with gastrointestinal bleeding and hypersplenism secondary to CTPV.Results All of 30 cases admitted operation without serious complication.All children admitted follow-up from 6 to 60 months.Seven cases of 22 patients with gastrointestinal bleeding relapsed bleeding post operation and were cured by conservative treatment.Four cases of 7 relapsing bleeding children had NSAID.All cases of 8 children with simple hypersplenism suggested normal results of blood routine post operation,2 children occurred bloody stools who were cured by conservative treatment.None of patients had serious infection correlating with splenectomy.The size of spleen of patients with gastrointestinal bleeding is larger than patients with simple hypersplenism.Conclusions (1) Ligaturing pericardial blood vessel combined splenectomy is a good choice for children with gastrointestinal bleeding and hypersplenism secondary to CTPV.(2) NSAID may increase the recurrence rate of gastrointestinal bleeding post operation.(3) There may be a negative correlation between the size of spleen and the risk of gastrointestinal bleeding for children with CTPV.

OBJECTIVETo summarize the reason and treatment of redo surgery in Hirschsprung disease for postoperative distension and constipation.

METHODSFrom January to December 2014, 35 patients with constipation and distention after pull-through done elsewhere were referred to our institution. The reasons procedures and outcomes of redo surgery were a retrospectively analyzed.

RESULTSThe indication of reoperation in 21 cases was pathological problems, including residual aganglionosis, retained transition zone bowel, and in 13 cases was anatomical problems, including retained dilated segment, obstructive Soave cuff. One case had both pathological and anatomical problems. Among them, 5 cases belonged to total colonic aganglionosis. All the cases received conservative treatment for about 6 months before reoperation. Five cases had enterostomy before redo pull through surgery. Thirty cases underwent Soave surgery with or without laparoscopy or laparotomy. Twenty-six cases underwent transabdominal Soave surgery, 3 cases transanal Soave surgery, 1 case transanal Soave surgery with laparoscopy. Other surgery included Ikeda surgery, excision of diaphragm or scar, and anoplasty. Postoperative complications were found in 3 patients. One had rectovesical fistula and was cured after operation. Two cases had anastomotic leakage and then underwent diverting ileostomy. Thirty-three cases had a mean follow-up of 59 months. During the follow-up, 32 cases had no distension and constipation. Two cases presented occasional dirty pants, 2 cases frequent soiling, 1 case daily soiling.

CONCLUSIONSReasons of distension and constipation in Hirschsprung's disease after surgery are pathological and anatomical problems. Operation procedure is chosen based on reasons. Transabdominal Soave surgery is safe and effective.

Anastomotic Leak ; Cicatrix ; Constipation ; Digestive System Surgical Procedures ; Hirschsprung Disease ; Humans ; Ileostomy ; Laparoscopy ; Laparotomy ; Postoperative Complications ; Postoperative Period ; Reoperation ; Retrospective Studies

Objective:To investigate the clinical features and treatment strategies of acute appendicitis in children with malignant tumors and neutropenia.Methods:This was a case series report.A retrospective review was conducted on the children with malignant tumors complicated by neutropenia, who were admitted to the Beijing Children′s Hospital, Capital Medical University between March 2007 and October 2023 due to acute appendicitis.The clinical data of the patients, including demographic characteristics, clinical manifestations, laboratory tests, and treatment strategies, were collected.The Fisher′s precision probability test was performed for group comparisons of count data.The t-test was performed for normally distributed measurement data, and the non-parametric rank-sum test for non-normally distributed measurement data. Results:Twenty-four patients were included in the study.The age of the patients was 4.3 (2.9, 4.3) years, and the male-to-female ratio was 7︰1.Acute lymphoblastic leukemia (75%) was the most common type of malignancy.The main clinical manifestations were fever (92%) and abdominal pain (75%).Six patients underwent surgical treatment (5 laparoscopic surgeries)(the surgical treatment group), and 18 patients received conservative treatment(the conservative treatment group).The proportion of patients with signs of localized or diffuse peritonitis was significantly higher in the surgical treatment group (83%) than in the conservative treatment group (25%)( P=0.007).The symptomatic relief time of acute appendicitis was significantly shorter in the surgical treatment group [(1.00±0.00) days] than in the conservative treatment group [(5.50±3.60) days]( t=-4.323, P=0.001).The length of hospital stay was significantly shorter in patients who underwent laparoscopic surgery [6.00 (2.00, 8.00) days] than in patients who received conservative treatment [9.50 (6.75, 20.50) days]( Z=-2.136, P=0.033).Acute appendicitis was cured in all patients, and there were no deaths during hospitalization. Conclusions:Both surgical and conservative treatments are safe and effective for acute appendicitis in children with malignant tumors and neutropenia.Surgical treatment can relieve the symptoms of acute appendicitis more quickly, and laparoscopic appendectomy can shorten the length of hospital stay.

Objective:To evaluate clinical characteristics and treatment of postoperative anastomotic stricture in pediatric congenital biliary dilatation patients.Methods:The clinical data of 24 children with postoperative anastomotic stricture from Apr 2012 to Oct 2019 in Beijing Children's Hospital was retrospectively analyzed.Results:There were 6 males and 18 females. Patients were divided into bile- leak group (BL, n=6) and non bile-leak group (NBL, n=18) based on whether there was anastomotic leakage after primary surgery. The main symptoms in BL group was persistent obstructive jaundice, and recurrent cholangitis in NBL group. Postoperative symptoms were first shown in an average of 7.0 months in BL group, compared to 59.0 months in NBL group, P<0.05. In BL group, 4 underwent redoing hepaticojejunostomy, 2 underwent anastomosis plasty. In NBL group, 3 underwent redoing hepaticojejunostomy, 15 did anastomosis plasty with multiple biliary stones found necessitating extraction. After reoperation, one patient had bile leakage, 2 patients had recurrent cholangitis within one-month, 21 patients had uneventful recovery. Five were found to have biliary stones in long-term follow-up. Conclusions:Biliary-enteric anastomotic leakage can cause stricture in postoperative patients of congenital biliary dilatation ,reoperation is necessary in symptomatic patients.