bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous Near Closure of Coronary Artery Fistula: Doppler Echocardiographic Findings
Authors: Tomita Hideshi , Sawada Yoko , Nagata Nobuo , Chiba Shunzo
Published: October 2007

A 1‐year‐old girl was diagnosed as having a fistula between the left coronary artery and the right ventricle by selective coronary angiography. The left to right shunt ratio was 38%. At a second angiography, the fistula was markedly diminished in size. Turbulent flow was detected throughout the cardiac cycle in the left coronary artery and during systole in the right ventricle by Doppler echocardiography on the first visit. At 3 years of age the systolic component of the left to right shunt flow in the left coronary artery and the right ventricle was reduced in size. Doppler echocardiography proved useful in observing the natural history of this coronary artery fistula.
Clinical Features of Enteric Adenovirus Infection in Infants
Authors: Shinozaki Tatsuhiko , Fujita Yasuko , Araki Kazuko , Tajima Takeshi , Kobayashi Masaaki , Abe Toshiaki
Published: October 2007

During the period December 1984 to October 1988, adenoviruses (Ads) were isolated on 119 occasions (1.6%) from stool samples of patients with gastroenteritis. By DNA restriction analysis, 85 enteric adenoviruses (EAds) were identified. Sixty‐seven patients with these infections were studied, of whom 18 had Ad40, 30 had Ad41 and 19 had untyped Ad infections. The incidence of Ad infection was high in children between 6 and 11 months of age. The illness was characterized by watery diarrhea (whitish in one third of patients), continuing for a mean of 4.5 days, and vomiting, which occurred more often in patients with EAds than in other types of infection. Diarrhea, fever and vomiting were seen significantly more frequently in patients with Ad40 than in Ad41 infection. Diarrhea and vomiting were also seen significantly more frequently in patients with EAds than in Ads infection. Diarrhea, fever and vomiting were observed more frequently in patients with rotavirus than EAds infection.
Host Responses and Neuroendocrinological Changes in Pyrexia in Childhood
Authors: Inamo Yasuji , Takeuchi Shigeo , Okuni Masahiko
Published: October 2007

Host responses and neuroendocrinological changes during pyrexia in childhood were studied. Serum IL‐β could not be detected in most subjects either during pyrexia or in afebrile periods. IL‐β was detected in two cases, increasing during pyrexia and decreasing during the afebrile period. Plasma ACTH increased during pyrexia, but this was not statistically significant. Serum Cortisol during pyrexia increased to around twice the normal value, and many subjects showed a high level of arginine vasopressin. The subjects, who did not develop dehydration, showed a decrease in serum osmolality and serum sodium during the pyrexia period. Serum Fe and Zn decreased, but serum Cu increased during both periods. It could not be confirmed that IL‐1 activates the hypothalamic‐pituitary‐adrenal axis during pyrexia. It is concluded that AVP is important in the control of fever and the maintenance of homeostasis of body fluid during pyrexia.
Surfactant Apoprotein A (SP‐A) in Tracheal Aspirates of Newborn Infants with RDS
Authors: Eguchi Hideshi , Koyama Norihisa , Tanaka Taihei , Kamiya Kenji , Ogawa Yunosuke
Published: October 2007

Human pulmonary surfactant contains four groups of apoproteins, SP‐A, B, C and D. We determined the concentration of SP‐A in the tracheal aspirate of newborn infants by a two‐site simultaneous immunoassay with monoclonal antibodies, and used this assay to assess changes in surfactant in various clinical situations. SP‐A concentrations were standardized per milligram of albumin in the aspirate. The ratio of SP‐A/albumin (µg/mg) in tracheal aspirates of 18 preterm infants with respiratory distress syndrome (RDS), in which samples were obtained within 12 hours of birth, was significantly lower (0.2 ± 0.1/µg/mg, mean ± S.D.) compared to a group of 20 non‐RDS preterm infants of similar gestational age (15.8±7.4µg/mg) (p<0.05). None of the RDS infants had a SP‐A/albumin ratio above l/µg/mg within 12 hours of birth, but the ratio exceeded 5µg/mg in all samples from non‐RDS infants. The SP‐A/albumin ratio significantly increased, however, at 48 to 72 hours after birth in infants with RDS (15.7 ± 9.5µg/mg). During the recovery phase of RDS, no difference was evident in the SP‐A/albumin ratio in babies treated with artificial surfactant compared to those not treated.
Factors Affecting Transcutaneous Bilirubin Measurement: Effect of Daylight
Authors: Yamauchi Yoshitada , Yamanouchi Itsuro
Published: October 2007

The purpose of this study was to determine whether daylight might affect the accuracy and reliability of TcB measurement at the forehead and sternum. One hundred and seven full‐term newborn infants were divided into two groups. Babies in group I (N = 59) were kept near the window which was sometimes directly exposed to daylight, and babies in group II (N = 48) were kept on the door side of the room which had no direct daylight, during the first week of life. The result indicates that daylight is one of the significant factors affecting TcB measurement at the forehead, contributing to poor correlation between TcB reading at the forehead and serum bilirubin concentrations. We suggest the necessity of obtaining TcB readings at the forehead and sternum, at least, in order to improve the accuracy and reliability of such measurements in infants.
Neuronal Differentiation of Ewing's Sarcoma Induced by Cholera Toxin B and Bromodeoxyuridine—Establishment of Ewing's Sarcoma Cell Line and Histochemical Study—
Authors: Ohta Shigeru , Suzuki Atsushi , Shimada Morimi , Kosuga Mayumi , Taga Takashi , Sugiura Yasuo , Iwai Muneo , Miyahira Yoshimitsu , Okabe Hidetoshi , Suzuki Shigeo , Kasahara Yoshitaka
Published: October 2007

An Ewing's sarcoma (ES) cell line was established from a metastatic bone marrow specimen in a patient with advanced disease, and some histochemical characteristics were investigated by neuronal differentiation induced with cholera toxin B (CTB) and bromodeoxyuridine (BrdU). Neuronal differentiation was investigated by the expression of neurofilament and Leu‐7, and glial differentiation was observed by expression of S‐100 protein. Neurofilament (NF) and Leu‐7 were positive in ES cells and these were expressed more intensively by induction with CTB than with BrdU. There was no expression of S‐100 protein in untreated or differentiated ES cells. ES cells became differentiated to neuronal cells with CTB and BrdU, but it was not observed, that ES cells had the potential to differentiate to glial cells. It appears that ES is of more primitive neural origin than neuroblastoma, primitive neuroectodermal tumors and other related neural tumors.
Human Herpesvirus 6 (HHV‐6) Infection and Exanthem Subitum in Thailand
Authors: Balachandra Kruavon , Bowonkiratikachorn Piyaporn , Poovijit Boonsri , Thattiyaphong Aree , Jayavasu Chuinrudee , Wasi Chantapong , Takahashi Michiaki , Yamanishi Koichi
Published: October 2007

Of 50 patients in Thailand suspected clinically of having exanthem subitum, 31 (62%) were serodiagnosed as HHV‐6 infection. Sixteen strains of HHV‐6 from 31 patients (52%) whose antibody titers had converted during convalescence were isolated during the acute phase. The disease occurred in infants from 3 months to 1 year of age and most frequently at age 4‐6 months. Antibody only to HHV‐6 converted in 23 of 50 patients (46%), and seroconversion to HHV‐6 and dengue virus was observed in 7 patients (14%), and to HHV‐6 and Coxsackie B virus in 1 case (2%). In the 23 patients in whom seroconversion only to HHV‐6 was observed, all had fever and rash which appeared after subsidence of the fever. Lymphadenopathy and relative lymphocytosis were recognized, associated with diarrhea, vomiting, running nose, cough and hepatomegaly. Febrile convulsions were seen in some cases. All patients recovered completely within a week.
Dysmorphology in Children with Congenital Metabolic Disorders
Authors: Méhes Károly
Published: October 2007

The prevalence of minor morphological aberrations was evaluated in 54 children with various congenital metabolic disorders. Similarly to major malformations, minor malformations were not more common in the patients than in our control population. The dysmorphic appearance of some of the affected children was caused by minor variants that arose after organogenesis.
Mucopolysaccharidosis VI (Maroteaux‐Lamy Syndrome) with Hearing Impairment and Pupillary Membrane Remnants
Authors: Shigematsu Yosuke , Hori Chikahide , Nakai Akio , Kuriyama Masanori , Kikawa Yoshiharu , Konishi Yukuo , Sudo Masakatsu , Konishi Kaoru
Published: October 2007

A Japanese boy aged 13 months was referred to us because thickened ribs had been observed on a chest X‐ray taken during a respiratory infection. Mucopolysaccharidosis type VI (MPS VI) was diagnosed based on urinary glycosaminoglycan analysis and low activity of arylsulfatase B in peripheral leukocytes. He had mild pupillary membrane remnants, but no corneal opacities. The auditory brainstem response revealed moderate hearing impairment, which may have caused his subnormal DQ score of 85 at the age of 19 months. Although MPS VI is characterized by normal intellectual development with normal hearing in early infancy, it is important to examine for hearing loss, especially when an infant with this disease shows developmental delay.
Infectious Complications in Childhood Leukemia
Authors: Hirotsu Takuo , Akatsuka Jun‐ichi
Published: October 2007

Since children with acute leukemia have prolonged periods of severe neutropenia due to the disease itself or its intensive chemotherapy, they often develop life‐threatening infectious complications. A protected environment and prophylactic antibiotics for patients with severe neutropenia have been shown to decrease the incidence of infectious morbidity. In spite of the high mortality rate of infections, on the other hand, their diagnosis is not well established because the percentage of microbiological detectability by blood culture is low. The differentiation of infections may be possible by using some supplementary measures and particular laboratory parameters. Febrile neutropenic patients with leukemia should promptly receive empiric treatment with combinations of two or three broad‐spectrum antibiotics that are bactericidal and synergistic toward the presumed pathogens, or with antifungal drugs if patients are resistant to antibiotics, as well as supportive measures such as granulocyte transfusion, intravenous gamma‐globulin and granulocyte colony‐stimulating factor.
Late Effects of Childhood Acute Leukemia and Its Treatment
Authors: Yamamoto Masao , Fukunaga Yoshitaka , Tsukimoto Ichiroh , Bessho Fumio , Akatsuka Jun‐ichi , Hosoya Ryohta , Nakazawa Shinpei , Sakurai Minoru , Ueda Kazuhiro , Miyazaki Sumio , Yokoyama Masaru , Mugishima Hideo , Nishimura Kohzoh
Published: October 2007

Late effects of childhood acute leukemia and its treatment were studied in 766 patients (684 ALL, 73 ANLL, and 9 others) in Japan who had remained in remission for more than 1 year after their first complete remission. Delayed adverse sequelae involve a wide variety of organs and their functions. Short stature was present in 2.61%, obesity in 3.79%, abnormalities of growth hormone secretion in 1.5%, delayed secondary sex characteristics in 1.5% of males and 0.6% of females, motor disturbances in 1.17%, sensory disturbances in 0.91%, intellectual and learning disabilities in 2.48%, abnormal findings in routine neurologic examinations in 1.31%, EEG abnormalities in 4.30%, brain CT abnormalities in 5.09% and cardiac dysfunction in 1.07%. Various other disorders were seen in 20 patients. Many of these delayed adverse sequelae are caused by or related to central nervous system prophylaxis and systemic combination chemotherapy. The results suggest that it is needed to improve therapeutic methods through the stratification of patients by risk factors and detailed analysis of prognostic factors. Moreover it is important to render medical and psychosocial support to long‐term survivors of childhood leukemia through interactions between the patient, parents and medical staff.
Caroli's Disease: Scintigraphic and Radiographic Findings
Authors: Nishida Naoki , Takemoto Tatsuya , Yamamoto Chihiro , Sugimoto Tateo , Kuge Masaharu
Published: October 2007

Caroli's disease is a rare congenital anomaly of the liver. Since new diagnostic techniques for the evaluation of hepatic disease have been introduced, the number of reported cases of Caroli's disease has been gradually increasing. This report describes the case of a 13 year old girl with nausea, vomiting, fever and hepatomegaly. The diagnosis of Caroli's disease was established by ultrasonography and CT scan. The complications and management are discussed. The important points in management are to relieve symptoms and to conduct regular examinations by ultrasonography for the early detection of hepatobiliary carcinoma.
Prader‐Willi Syndrome with del(15)(q1l, q13) Associated with Hepatoblastoma
Authors: Hashizume Kohei , Nakajo Toshio , Kawarasaki Hideo , Iwanaka Tadashi , Kanamori Yutaka , Tanaka Kiyoshi , Utuki Tadahito , Mishina Jun , Watanabe Toyoko
Published: October 2007

A case of Prader‐Willi syndrome who later developed hepatoblastoma is reported. Prader‐Willi syndrome was suspected because of hypotonia, hypopigmentation, and undescended testes when he was a newborn infant. The diagnosis was confirmed by chromosome analysis, which showed 46XY del(15)(qll, ql3). When he was 1 year 4 months old, a liver tumor and high serum AFP were found. At operation a large tumor arising from the caudate lobe was found and the tumor was totally resected. After completion of the hepatectomy, he developed circulatory collapse of unknown cause and died shortly after the operation. Histopathologic examination revealed that the tumor was composed of two components, well differentiated cells and poorly differentiated cells. The well differentiated part did not dominate the poorly differentiated part, so it was diagnosed as poorly differentiated hepatoblastoma. This is the first reported case of Prader‐Willi syndrome with a pediatric malignant tumor.
Congenital Hydrocolpos Combined with Unilateral Renal Agenesis
Authors: Tsukahara Hirokazu , Fujimoto Iwao , Hiraoka Masahiro , Nakashima Tetsuo , Hayashi Nobushige , Ishii Yasushi , Sudo Masakatsu
Published: October 2007

Herein we report an infantile case of congenital hydrocolpos combined with left renal agenesis which presented with an abnormal mass protruding from the vaginal introitus. The diagnosis was made shortly after birth by ultrasonography and confirmed by other radiologic diagnostic methods. This case highlights the value of ultrasonography in diagnosing hydrocolpos and determining the coexistence of renal anomalies.
Kawasaki Disease and Epstein‐Barr Virus
Authors: Kikuta Hideaki , Matsumoto Shuzo , Osato Toyoro
Published: October 2007

We report the results of virological (serological and molecular biological) studies of Epstein‐Barr virus (EBV) in patients with Kawasaki disease (KD). Forty‐nine (86%) of 57 Kawasaki disease patients and 15 (68%) of 22 patients with recurrent Kawasaki disease had serological evidence of primary Epstein‐Barr virus infection during the first month after the onset of their disease based on the results of a sensitive method of detecting antibody to viral capsid antigen (VCA). The serological response to EBV was significantly low and transient. EBV sequences were identified directly in peripheral blood mononuclear cell (PBMC) DNA samples from 23 (56%) of 41 KD patients within 2 weeks after onset by means of the polymerase chain reaction (PCR). EBV sequences were also detected in 10 (83%) of 12 repeatedly tested KD patients within 3 months after onset. In contrast, only 7 (18%) of 40 control DNA samples were PCR‐positive. These virological studies indicate that an unusual EBV‐cell interaction may occur in KD.
Leukotriene B4 and Kawasaki Disease
Authors: Hamasaki Yuhei , Miyazaki Sumio
Published: October 2007

The role of LTB4 in Kawasaki disease as a chemo‐attractant and immunomodulator is reviewed through our own experience and reports by other invenstigators. In our experiment using 19 patients, we measured calcium ionophore‐stimulated LTB4 synthesis in PMNs obtained in three different stages of the illness (acute, convalescent and recovered phases). LTB4 synthesis was significantly increased in the convalescent phase of the illness. Other investigators showed increased serum‐LTB4 concentration in acute as well as convalescent phases, suggesting that LTB4 participated in the inflammatory process of Kawasaki disease as an inflammatory mediator and immunomodulator. However, no difference was found in LTB4 synthetic activity in PMNs in any phases of the illness between the patients with and without coronary lesions, which indicated that LTB4 was not a parameter of coronary aneurysm formation. Therapeutic use of high‐dose γ‐globulin showed a tendency to decreased LTB4 synthesis in PMNs, although it is not conclusive.
Inhibitory Effects of High Doses of Intravenous γ‐Globulin on Platelet Interaction with the Vessel Wall in Kawasaki Disease
Authors: Inagaki Minoru , Yamada Kaneo
Published: October 2007

Clinical effects of high‐dose γ‐globulin therapy in Kawasaki disease have been evaluated from the viewpoints of its inhibitory effects on platelet adhesion and thrombus formation on the vessel wall. Platelet adhesion to the subendothelium is the first step of thrombosis as well as platelet interaction with the vessel wall, which can be observed experimentally by Baumgartner's method. Twelve patients with Kawasaki disease treated with intact intravenous γ‐globulin (IVGG) showed decreased platelet adhesion in contrast to ten patients treated with only aspirin (ASA) or flurbiprofen (FP). Addition of intact IVGG to normal blood in Baumgartner's method also resulted in decreasing platelet adhesion and thrombus formation; however, other pepsin‐treated IVGG caused enhanced platelet adhesion and thrombus formation. Moreover, pretreatments of the vessel wall with both types of IVGG showed effects similar to those of addition. In conclusion, high‐dose therapy with intact IVGG has inhibitory effects on platelet adhesion and thrombus formation. Although the mechanism of the effects is not yet clear, some competitive inhibition between intact IgG and adhesive protein such as von Willebrand factor is suggested, and Fc receptors of the platelet membrane and Fab and Fc receptors of the subendothelium of the vessel wall may have some role in the interaction.
Effect of Serum pH on Bilirubin‐Protein Binding
Authors: Yeung C.Y. , Lee FT. , Wong H.N.
Published: October 2007

Progressive increase of the serum pH upon standing and storage in different conditions is documented. Bilirubin albumin titration studies were performed on serum of different pH by Sephadex gel filtration and horseradish peroxidase oxidation methods. Results showed that different pH produced different titration curves and that more reproducible and consistent results were obtained with the peroxidase oxidation titration method. Addition of HC1 and CO2 to the serum also produced different bilirubin‐protein titration results. For blirubin albumin binding studies, we suggest to adjust the pH to 7.4 with CO2 to obtain clinically meaningful data.
Human Erythropoietin in Children Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Hisano Satoshi , Kaku Yoshitsugu , Ueda Kohji , Onoyama Kaoru
Published: October 2007

The effect of intravenous recombinant human erythropoietin (rHuEPO) by two different dosage regimes was evaluated in 12 anemic children on continuous ambulatory peritoneal dialysis (CAPD). Eight patients (group A) were treated once a week at a mean dose of 89U/kg for 24 weeks. The other four patients (group B) were treated three times a week at a mean dose of 260 U/kg for 8 weeks, and then once a week at a mean dose of 88 U/kg for the next 16 weeks. In group A, the hematocrit (Ht) increased gradually and significantly from 19.9 ± 2.1% to 28.7 ± 1.5% at the 24th week, while in group B, it rapidly increased from 17.9 ± 2.5% to 30.2 ± 4.3% at the 8th week, and thereafter was maintained at a level of approximately 30%. However, there was no significant difference in the Ht between the two groups. In two of the four patients in group B, blood pressure increased from 136/87 mmHg to 168/102 mmHg and from 106/70 mmHg to 132/92 mmHg, at the 4th and the 8th weeks respectively, related to a rapid rise of the Ht. Neither antibody to rHuEPO nor other sides effect were evident. Gradual improvement of anemia by once‐a‐week intravenous administration of rHuEPO is advantageous for the quality of life in children on CAPD.
Prophylaxis of Vitamin K Deficiency in Infancy
Authors: Nakagawa Tsuneo , Yazawa Takeshi , Watanabe Kazuyoshi
Published: October 2007

A prospective study was performed in Okazaki, Japan, to attempt to establish a more effective system of prophylaxis for vitamin K deficiency in infancy (VKDI). During the first year, a Normotest (Hepaplastintest) was performed in all infants at one week and at one month of age. Two mg of vitamin K was administered orally to those whose Normotest values were below 40%. i.e., the non‐prophylactic administration of vitamin K (NPVK). During the second year of the study, all newborn infants received prophylactic vitamin K (PVK) within 24 hours of birth and at one week of age. The dosage was repeated at one month of age depending on the Normotest value. A total of 7,059 infants, comprising 93.3% of the live births in the city of Okazaki, were enrolled in this study. Data from 5,431 of these infants were used in the analysis of the results. In the NPVK group, 20 of the 2,791 infants had Normotest values below 40% at one month of age while 20 of the 2,640 in the PVK group had low values despite the prophylactic administration of vitamin K. Considering the prevalence of low Normotest values (40%) at one month of age and the predicted Normotest values, it was concluded that the month of birth (June September), the age of the mother (21–29 years), the birth order (first‐born) and male sex are risk factors for vitamin K deficiency in infancy.
Estrogen Therapy in Turner's Syndrome
Authors: Cutler Gordon B. , Ross Judith Levine
Published: October 2007

Girls with Turner's sydrome are born short, grow slowly, and usually fail to enter puberty spontaneously and to undergo a pubertal growth spurt. The goal of estrogen therapy is to correct estrogen deficiency in a manner that optimizes height potential, permits attainment of normal bone mass, and provides appropriate feminization with minimal risk of adverse effects. The issues to be resolved include the age at which treatment should be begun, the preparation, route of administration, and dosage to be given, the effect on concurrent growth hormone administration, the rate of dose increase during treatment, the timing and nature of progestin administration, and the total duration of treatment. The available data suggest that treatment should be initiated between the ages of 12 and 14 years. The dose‐response relationship between growth rate and estrogen dose is biphasic. Optimal growth stimulation for ethinyl estradiol occurs at approximately 100 ng/kg body weight per day, which is below the dose that produces full feminization. Although suboptimal doses of estrogen and growth hormone appear to have additive effects, estrogen causes only a minor increase in the short‐term growth response to an optimal dose of growth hormone. The long‐term effects of estrogen combined with growth hormone are unknown. In the absence of data concerning the outcome of different dose schedules, we treat for 2 years at 100 ng/kg/day of ethinyl estradiol, then double the dose annually until menstruation, at which time cyclic monthly progestin therapy is added (medroxyprogesterone acetate 10 mg daily from days 16 to 25). The importance of estrogen in maintaining normal bone mass suggests that treatment should be lifelong. Current research in our clinic is assessing the long‐term effect on adult height of ultra‐low‐dose treatment (25 to 50 ng/kg/day of ethinyl estradiol) during the childhood years (ages 5 to 11), alone or in conjunction with supplemental growth hormone.
Growth Hormone Secretory Status in Patients with Turner Syndrome
Authors: Zhang Dao‐Hua , Yano Koichi , Itoh Yoshiya , Mitamura Ryou , Suzuki Naoki , Okuno Akimasa
Published: October 2007

The growth hormone (GH) secretory capacities in patients with Turner syndrome aged 5.1–15.9 years and those with constitutional short stature (CSS) aged 5.2–14.2 years were evaluated by pharmacological and physiological means. The GH response to hypoglycemia in the patients with Turner syndrome was lower than that in the patients with CSS. However, the GH response to arginine was not significantly different between the two patient groups. For the physiological test, the integrated concentration of GH (ICGH), the number of episodic peaks and their mean height were evaluated using blood obtained from the patients every 20 minutes for a period of 24 hours. The ICGH and the mean height of the episodic peaks in the patients with Turner syndrome were significantly lower than those in the CSS patients during the night but not during the day. Negative correlation between the bone age and the night‐time values of ICGH was observed in the patients with Turner syndrome. Such correlation was not observed in the CSS patients. The patients with CSS showed a significant day‐night difference in the ICGH and the mean height of the episodic peaks, but the patients with Turner syndrome did not show any significant day‐night difference in either the ICGH or the mean height of episodic peaks. In conclusion, the GH secretory capacity in patients with Turner syndrome is lower than that in CSS patients.
Epidemiological Studies on Measles in Karachi, Pakistan‐Mothers' Knowledge, Attitude and Beliefs about Measles and Measles Vaccine
Authors: Isomura Shin , Ahmed Akhtar , Dure‐Samin Akram , Mubina Agboatwalla , Takasu Toshiaki
Published: October 2007

In order to gather information on the factors affecting the spread of measles vaccine in Pakistan, 287 mothers living in Karachi were interviewed concerning their knowledge, attitude and beliefs about measles and measles vaccine. Measles had been highly prevalent, mainly among infants between 9 and 18 months of age. The severity of the illness and the frequency of complications were well known and the importance of immunizations was well recognized. In traditional combined families grandparents had made the decision to take children for immunization, but many mothers had begun to feel that they were responsible for participation in the programme. The vaccine acceptance rate had increased sharply in recent years, primarily due to local health educators' activities and mass media such as TV programmes. The present findings confirm the importance of continuous effort toward promotion of primary health care by collaboration of motivated mothers and community health workers.
Brain Biopsy in Herpes Simplex Encephalitis
Authors: Fishman Marvin A.
Published: October 2007

Routine brain biopsy is often recommended in all patients suspected of having herpes simplex encephalitis (HSE). This approach is based upon the lack of ability to make the diagnosis of HSE on clinical grounds, the need to exclude other diseases for which there is specific therapy, and to stop empiric therapies. Acyclovir is a relatively safe, effective antiviral agent with little toxicity as currently used to treat HSE. Thus this is not a problem. Careful review of alternate diagnoses established at brain biopsy reveals few for which biopsy is the only and best way of making the diagnosis. Thus empiric therapy with acyclovir should be considered in some children in whom all appropriate diagnostic techniques fail to establish specifically treatable diseases. Early detection of HSV antigen in CSF may provide a non‐invasive means of early diagnosis in the future.
Neuropathology of HTLV‐I‐Associated Myelopathy—A Report of Two Autopsy Cases—
Authors: Izumo Shuji , Ijichi Toshiharu , Higuchi Itsuro , Tashiro Alicia , Takahashi Kohichi , Osame Mitsuhiro
Published: October 2007

A neuropathological analysis was performed in two autopsy cases of HTLV‐I‐associated myelopathy. The thoracic spinal cords were most severely affected and the histopathological findings consisted of mononuclear cell infiltration, marked destruction of myelin and axons and astrocytic gliosis. More than half the infiltrated cells were positive for pan‐T cell marker; B cells were sparse in the parenchyma and subarachnoid spaces. CD4 and CD8 positive cells were found in the early stages of the lesions. CD8, however, predominated over CD4 in the other stages. It appeared that a chronic inflammatory process had started at the middle to lower thoracic cord and had extended gradually in both directions. The middle thoracic spinal cord is known to have the poorest blood supply, and the horizontal distribution of inflammatory cells at this region correlated with the most distal supply of the anterior spinal artery.
Childhood Neurocysticercosis‐Epidemiology, Diagnosis and Course
Authors: Kalra V. , Sethi A.
Published: October 2007

Neurocysticercosis was diagnosed in 0.89% of children enrolled in our Child Neurology Clinic in the years 1979 to 1990. The commonest presenting symptom was seizures (90%) followed by raised intracranial pressure (44%). CT scans revealed a variety of lesions including low and high attenuation cysts, periventricular edema, hydrocephalus and calcification. ELISA was useful in substantiating the diagnosis in almost 70% of cases. Only 18 patients who had active disease merited treatment with praziquantel. The clinical and CT response was good. Follow‐up revealed spontaneous quiescence in many patients with inactive disease.
Neuroradiological Findings in Glutaric Aciduria Type I: Report of Four Japanese Patients
Authors: Nagasawa Hiroyuki , Yamaguchi Seiji , Suzuki Yasuyuki , Kobayashi Masanori , Wada Yoshiro , Shikura Keiko , Shimao Satoshi , Okada Toshio , Orii Tadao
Published: October 2007

We examined neuroradiological computerized tomography (CT) findings and the clinical course of four Japanese children with glutaric aciduria type I (GA1) whose enzyme activity of glutaryl‐CoA dehydrogenase was undetectable. Brain CT in all cases examined showed low density white matter, fluid collection in bilateral frontotemporal regions (particularly surrounding the Sylvian fissures), enlargement of the lateral ventricles and slight atrophy of the basal ganglia. Although these findings seemed to be characteristic for GA1, they were unlikely to be more extended, at least over 2 years after infancy. The low density white matter was observed more evidently in the neonatal or early infantile periods than in later periods. The degree of enlargement of fissures in bilateral frontotemporal regions about the Sylvian fissures appeared to correlate with the severity of symptoms such as dystonia or choreo‐athetosis. Magnetic resonance images (MRI) in one case showed bilateral linear‐shaped low intensity in areas of the external capsules and putamen on a Tl‐weighted image. These CT and MRI findings, as well as clinical symptoms such as choreoathetosis or dystonia, may suggest that metabolic abnormalities in GA1, such as glutaconate, are toxic to the extrapyramidal tract system in the central nervous system, and that the clinical symptoms of the patients are attributable to atrophy of basal ganglia. Brain CT may be useful in diagnosis and evaluation of the clinical course of GA1 patients.
Methacholine Inhalation Challenge in Children with Idiopathic Chest Pain
Authors: Izumi Nobuo , Haneda Noriyuki , Mori Chuzo
Published: October 2007

Bronchial reactivity to inhaled methacholine (MCH) was evaluated in 32 patients with ‘idiopathic’ chest pain. Each pain was recurrent in nature. The incidence of cases with a provocative concentration causing a 20% fall in the forced expiratory volume in 1 sec (PC20) of 10 mg/ml or less was 62.5% (20 cases), while it was only 11.1% (three cases) in 27 healthy controls. Seventeen patients had no personal history of allergic diseases, elevated serum lgE level or positive house dust mite‐specific IgE antibody. Among these 17, eight (47.1%) had a PC20 of 10 mg/ml or less, the incidence of which was also higher than that of the healthy controls. During the challenge, eight patients complained of chest pain similar to that experienced before. The present results indicate that bronchial hyper‐reactivity is an important cause of ‘idiopathic’ chest pain. Patients with unexplained chest pain should be considered for inhalation challenge.
Spinal Arachnoid Cyst in a Newborn Infant
Authors: Hashimoto Kazuhiro , Hashimoto Motoya , Homma Satoshi , Ohsone Yoshiteru , Hasegawa Hisaya , Takei Jiro , Kida Yoshikazu , Takeuchi Yutaka , Ohba Minako
Published: October 2007

A male infant was born with asphyxia following a prolonged breech delivery at 39 weeks of gestation. He had a chylohemothorax from birth. Soon after birth he exhibited flaccid paraplegia with an absence of deep tendon reflexes in the lower extremities. At 17 days of age, magnetic resonance imaging (MRI) disclosed a hypodense area in the thoracic cord between C7 and Th4 in T,‐weighted images, and spinal sonography revealed an echo‐free space compressing the spinal cord in the same region observed with MRI. A spinal cyst was removed surgically at 24 days of age. The cyst was confirmed by pathology to be a true arachnoid cyst between C7 and Th4. The cause of this cyst may have been a spinal cord injury during the perinatal period.
Surfactant Replacement Therapy in Premature Babies with Respiratory Distress Syndrome: Factors Affecting the Response to Surfactant and Comparison of Outcome from 1982–86 and 1987–91
Authors: Konishi Mineo , Chida Shoichi , Shimada Senji , Kasai Takeo , Murakami Yoichi , Cho Kazutoshi , Fujii Yutaka , Maeta Haruo , Fujiwara Tetsuro
Published: October 2007

The impact of surfactant therapy on chronic lung disease remains uncertain. During the past decade (1982–91), over 300 babies with respiratory distress syndrome (RDS) weighing 501–2,500 g at birth were consecutively treated with surfactant‐TA at our neonatal intensive care unit. Data on 95 RDS babies treated in the first 5 year period (Period 1, 1982–86) were compared with those on 158 RDS babies treated in the second 5 year period (Period 2, 1987–91). Overall respiratory improvement was better in Period 2 than in Period 1. In Period 2, surfactant therapy converted 98% of the babies with moderate/severe RDS to those with ‘near normal’ lung by 72 hr post‐treatment. In Period 2, 95% of the surfactant‐treated babies weighing 501–1,750 g at birth survived, 97% of which required no supplemental oxygen at 40 weeks corrected gestational age. Increased survival rate in the surfactant‐treated babies during the past decade has not been followed by a parallel increase in chronic lung disease. The severity of the initial pulmonary disease per se was not the significant risk factor for chronic lung disease. Several other variables affecting the response to surfactant therapy and outcome have been identified by stepwise logistic regression analysis and include factors related to perinatal events such as birth asphyxia and infection, and other complications of prematurity.
Pulmonary Surfactant Apoprotein‐A in Neonates with Different Respiratory Disorders
Authors: Nagai Hiroshi , Ogawa Yunosuke , Eguchi Hideshi , Kamiya Kenji , Koyama Norihisa , Tanaka Taihei , Takasaki Jiro , Takada Eiko , Ohama Yoichi , Kaneko Koji , Yoshida Naoko
Published: October 2007

A serial determination of pulmonary surfactant apoprotein‐A (SP‐A) was made on tracheal aspirates from seven intubated infants with different types of respiratory failure in the first week of life. A two‐site immunoassay with monoclonal antibodies was adopted to determine the SP‐A concentration. The concentrations of albumin in the same samples were also assayed, and these data were expressed as the ratio of SP‐A to albumin (SP‐A/albumin ratio), and evaluated against clinical data such as the arterial‐alveolar oxygen tension ratio (a/APO2) or ventilatory index. In infants with respiratory distress syndrome, the SP‐A/ albumin ratio was initially low, and increased gradually in the first few days of life with the improvement of a/APO2 and ventilatory index. The complication of pulmonary hemorrhage due to patent ductus arteriosus (PDA) resulted in a temporary decrease in the ratio. The infant with transient tachypnea of the newborn showed higher concentration from the first day of life and, in the course of PDA without pulmonary hemorrhage, the ratio did not decrease. The cases of congenital pneumonia showed the SP‐A/albumin ratio remaining low while the infection was evident.

These data suggest that the SP‐A/albumin ratio of the tracheal aspirate can be used for the quantitative and qualitative evaluation of endogenous pulmonary surfactant in newborn infants with different respiratory disorders.
Postnatal Growth Curves of Very Low Birthweight Japanese Infants
Authors: Itabashi Kazuo , Takeuchi Toshio , Okuyama Kazuo , Kuriya Norikazu , Ohtani Yasuyo
Published: October 2007

To construct standard growth curves for Japanese infants of very low birthweight, longitudinal data provided by 47 neonatal centers in Japan were reviewed. Data were collected on the growth of infants admitted to those units during 1986 and 1987 and who survived beyond 3 years of age. A total of 379 singleton infants, who were free of neurological sequelae and appropriate for gestational age, were enrolled. Those whose birthweights were more than 600 g and less than 1,500 g were grouped into nine weight categories separated by increments of 100 g. Data on the increase in weight and head circumference were compiled and analyzed until more than half the infants in each weight category had been discharged from each site. Growth curves of bodyweight and head circumference in the nine groups were constructed using polynomial regression analysis to define the curve of best fit. With increasing prematurity, significant trends of greater weight loss (P < 0.05), longer time to reach the lowest weight (P < 0.01) and a longer time to regain birthweight (P < 0.01) were observed. In addition, there was a significantly higher incidence of chronic lung disease in such groups (P < 0.0001). Growth curves were characterized by the average clinical profiles in each of the nine groups. We believe that these data will be useful in evaluating the growth of very low birthweight infants being cared for in modern neonatal intensive care units in Japan.
Oxygen and Reduced Umbilical Blood Flow Trigger the First Breath of Human Neonates
Authors: Togari Hajime , Sobajima Hisanori , Suzuki Shigesumi
Published: October 2007

The mechanism triggering the first breath of human neonates is still unclear. In order to investigate the role of oxygen and umbilical blood flow in the onset of the first breath, a total of 20 rat and rabbit fetuses were studied. AH five rat fetuses delivered in a nitrogen chamber did not commence breathing of their own accord, whereas all five rabbit fetuses delivered in oxygenated fluorocarbon fluid commenced their own breathing, suggesting that contact with oxygen rather than release from submergence is more crucial in the initiation of the first breath.
Effect of Mean Airway Pressure on Bronchial Mucosal Blood Flow in Rabbits with Oleic Acid‐induced Injury
Authors: Mizuno Katsumi , Itabashi Kazuo , Okuyama Kazuo
Published: October 2007

The effects of mean airway pressure (MAP) on bronchial mucosal blood flow at the carina in nine anesthetized adult rabbits undergoing high frequency ventilation were studied. The animals were given oleic acid to diminish lung compliance and to exclude the influences of increasing MAP on systemic venous return. Mucosal blood flow decreased significantly when MAP exceeded 14 cmH2O. Mucosal blood velocity tended to decrease as higher levels of MAP were applied. Mucosal blood volume decreased significantly when MAP exceeded 20 cmH2O. Hemodynamics, arterial blood gas values and pH were not changed significantly. Our data demonstrate that bronchial mucosal blood flow decreases at high levels of MAP even if cardiac output remains constant. Hence this decrease of bronchial mucosal blood flow may be due to the transmission of pressure to submocosal bronchial capillaries.
[13C] Breath Test of Medium‐chain Triglycerides and Oligosaccharides in Neonates
Authors: Hoshi Jun , Nishida Hiroshi , Yasui Masato , Ohishi Masaya , Takahashi Maoto
Published: October 2007

It is suitable to examine the utilization of carbohydrates and fats using stable isotope‐labelled substrates in neonates because of their non‐radioactivity. Administering medium‐chain triglycerides (MCT) and oligosaccharides is of use in enteral nutrition for a patient with a limited water intake such as a neonate. In this study, the oxidation of MCT and maltose administered orally as an energy supplement in neonates has been examined using a stable isotope‐labelled breath test. Five normal term neonates and five growing preterm infants were given [13C]‐trioctanoin orally and three growing preterm infants were given [13C]‐glucose and [13C]‐maltose orally. The [13C] enrichment in carbon dioxide was analyzed by isotope ratio mass spectrometry, and oxidation rates over 6 hr and 12 hr respectively, were calculated. The oxidation rates for [13C]‐octanoin after 6 hr were 46.2 ± 3.6% in preterm infants and 53.5 ± 13.8% in normal neonates, respectively (no significant difference), and 58.4 ± 9.4% and 52.8 ± 6.0% for [13C]‐glucose and [13C]‐maltose, respectively (not significant). The results demonstrate that orally administered MCT and maltose are oxidized sufficiently in preterm infants.
Comparative efficacy of cefixime and ampicillin‐sulbactam in shigellosis in children
Authors: Helvaci Mehmet , BektaŞLar Dilber , ÖZkaya Buket , Yaprak IŞIn , Umurtak Bahar , ErtuǦRul Ayda
Published: October 2007

Abstract Shigellosis is still an important health problem in developing and underdeveloped countries as it is resistance to commonly used antibiotics including ampicillin, trimethoprim‐sulfamethoxazole, chloramphenicol and tetracycline. Between May 1996 and October 1996, in a prospective randomized double‐blind trial, cefixime was compared with ampicillin‐sulbactam, both given orally for a period of 5 days, for the treatment of 80 children with acute bloody diarrhea. Forty patients were treated with a single‐dose (8 mg/kg per day) of cefixime and the other 40 patients were given three doses of 100 mg/kg per day of ampicillin‐sulbactam. After identification of Shigella organisms in stool specimens, nine patients in the cefixime receiving group and six patients in the ampicillin‐sulbactam receiving group were excluded from the study. Differences in average age, sex and weight between the cefixime and ampicillin‐sulbactam group were statistically meaningless (P > 0.05). Fever and bloody diarrhea were universal features. The efficacy of cefixime was found to be better than ampicillin‐sulbactam. Patients given cefixime had a shorter duration of fever (P<0.01), shorter duration to disappearance of blood in the stool (P<0.01), reduced time with diarrhea (P<0.01) and reduced hospitalization time during the 5 study days (P<0.01) than patients given ampicillin‐sulbactam. No adverse effects were observed in the two study groups. This controlled trial showed good efficacy with cefixime compared to ampicillin‐sulbactam in the treatment of shigellosis. Single‐dose daily oral therapy with cefixime also showed good tolerability. Cefixime should be considered as an alternative drug of choice for shigellosis in children.
Tyrosinemia type Mike disease: A possible manifestation of 3‐oxo‐Δ4‐steroid 5β‐reductase deficiency
Authors: Kimura Akihiko , Endo Fumio , Kagimoto Seiichi , Inoue Toshiro , Suzuki Mikako , Kurosawa Takao , Tohma Masahiko , Fujisawa Takuji , Kato Hirohisa
Published: October 2007

Abstract Background: It has been suggested that quantitative analysis of urinary bile acids may help to distinguish primary 3‐oxo‐δ4‐steroid 5β‐reductase deficiency from the excretion of 3‐oxo‐δ4 bile acids that occurs as a result of liver damage.

Methods: Urinary bile acids were quantitatively analyzed by gas chromatography‐mass spectrometry in four Japanese patients with severe neonatal cholestasis associated with hypertyrosinemia without urinary succinyl‐acetone (i.e. tyrosinemia type I‐like disease). These four patients represented sporadic cases.

Results: Large amounts of 3‐oxo‐δ4 bile acids were detected, which comprised greater than 80% of the total urinary bile acids. Small amounts of allo‐bile acids and primary bile acids were also detected, comprising less than 1% and 15% of the total urinary bile acids, respectively.

Conclusions: It was suspected that these four patients had a primary 3‐oxo‐δ4‐steroid 5β‐reductase deficiency. However, it is possible that some patients in this study may have had a secondary 3‐oxo‐δ4‐steroid 5β‐reductase deficiency, caused by idiopathic neonatal cholestatic liver failure.
Evaluation of left ventricular volume using automatic border detection in children: A comparison with conventional off‐line echocardiographic quantification
Authors: Hashimoto Ikuo , Ichida Fukiko , Miura Masayoshi , Okabe Takashi , Shimura Shouetsu , Uese Kei‐Ichiro , Hamamichi Yuji , Tsubata Shin‐Ichl , Miyawaki Toshio , Fukahara Kazuaki , Murakami Arata
Published: October 2007

Abstract Background: Evaluation of the clinical usefulness of the on‐line automatic border detection system for determination of left ventricular volume in children in comparison to the conventional off‐line method.

Methods: Eighty consecutive patients in whom clear images were obtained by two‐dimensional echocardiography were studied. Using the Hewlett‐Packard Sonos 2500 with a 3.5 or 5.5 Mhz phased array transducer, all patients were studied in the apical four‐chamber imaging plane for automatic border detection and apical four‐chamber and two‐chamber imaging planes for manual tracing. Left ventricular end‐diastolic and end‐systolic volumes were measured and compared using the bi‐plane Simpson method.

Results: Left ventricular end‐diastolic volumes obtained by automatic border detection correlated well but were slightly underestimated compared to those obtained by manual tracing (r= 0.98). Left ventricular end‐systolic volumes obtained by automatic border detection also correlated well with those obtained by manual tracing (r = 0.96). Left ventricular ejection fractions compared favorably. However, left ventricular volumes obtained using the classical Pombo M‐mode echocardiography showed poorer correlation with those obtained by manual tracing methods.

Conclusions: Automatic border detection is a promising method for real‐time estimation of left ventricular volume. In patients with good endocardial tracking, automatic border detection can be used for routine studies of cardiovascular disease, even in children.
Successful treatment of Wernicke's encephalopathy in a boy with acute mixed lineage leukemia
Authors: Onodera Norio , Nakahata Toru , Tanaka Hiroshi , Ito Ryosuke , Honda Takashi
Published: October 2007

Abstract A 12‐year‐old boy had been treated with multiagent chemotherapy for acute mixed lineage leukemia and with intravenous hyperalimentation due to persistent diarrhea and vomiting for 2 months. He suddenly complained of horizontal nystagmus and gait disturbance followed by oculomotor palsy and disorientation within a few days. Blood tests revealed low serum vitamin Bl and high serum pyruvate. Magnetic resonance imaging in T2‐weighted axial image revealed a high signal inside the bilateral thalami, mamillary bodies and periaquaductal gray matter. He was diagnosed as Wernicke's encephalopathy and successfully treated with vitamin Bl. Careful observation and adequate treatment are emphasized in the management of this preventable and curable disease.