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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.116, No.10, October 2012
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Original Article
Title
Differences of Controller Therapy for Asthmatic Children between Pediatricians at Hospitals, Pediatricians in Clinics and Internal Medicine Doctors in Clinics
Author
Mitsuhiko Nambu1)10)11)12) Norio Kurumatani2)10) Yukihiro Ohya3)10)11)12) Toshio Katsunuma4)10)11)12) Makoto Kameda5)10)11)12) Tatsuo Sakamoto6)10)11)12) Katsushi Miura7)10)11)12) Yuhei Hamasaki8)11)12) and Naomi Kondo9)11)12)
1)Department of Pediatrics, Tenri Hospital
2)Department of Community Health and Epidemiology, Nara Medical University, School of Medicine
3)Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development
4)Department of Pediatrics, Jikei University Daisan Hospital
5)Department of Pediatrics, Osaka Prefectural Hospital Organization, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases
6)Department of Pediatrics, Nagoya University Graduate School of Medicine
7)Department of General Pediatrics, Miyagi Children's Hospital
8)Department of Pediatrics, Faculty of Medicine, Saga University
9)Department of Pediatrics, Graduate School of Medicine, Gifu University
10)Asthma Questionnaire Working Group
11)Committee of Japanese Pediatric Guideline for the Treatment and Management of Asthma 2012
12)Japanese Society of Pediatric Allergy and Clinical Immunology
Abstract
A questionnaire-based survey was conducted in order to study the spread of the Japanese Pediatric Guidelines for the Treatment and Management of Asthma (JPGL) in Japan and the usage of controller medications for asthma children. The questionnaire was sent by mail to 1,000 pediatricians who were working at hospitals, 1,000 pediatricians who were working in clinics, and 1,000 internal medicine doctors who were working in clinics; the numbers of valid responses were 445, 531, and 269, respectively. The Japan Pediatric Society and the Japan Physicians Association supported this study and selected the members randomly.
Almost all pediatricians but not enough internal medicine doctors had the JPGL; only a little more than half of internal medicine doctors who had followed up some asthma children had JPGL. Controller therapy for intermittent, mild persistent, and moderate persistent asthma of less than 2 years, 2 to 5 years, and more than 5 years of age was asked of those doctors who had followed up some patients. Leukotriene receptor antagonists were generally most frequently selected. On the other hand, patch β2 stimulants were selected for intermittent and mild persistent asthma by many doctors, but less by doctors who had been interested in allergies. The combination medicine of inhaled corticosteroids and inhaled long acting β2 stimulants was selected for mild and moderate persistent asthma of more than 5 years of age by many doctors, and the combination medicine was selected by more than half of internal medicine doctors for moderate persistent asthma. The doctors who had been interested in allergies selected inhaled corticosteroids and combination medicine more than those doctors who had not been particularly interested in allergies. We need to encourage doctors, especially those who are not specially interested in allergies, to utilize the guidelines for the treatment and management of childhood asthma.
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Original Article
Title
Staphylococcus, One of the Indigenous Bacteria in the Oral Cavity, Plays a Major Role in the Pathogenesis of Pediatric Infective Endocarditis
Author
Kei Yamamoto1) Hideaki Ueda2) and Seiyou Yasui2)
1)Department of General Pediatrics, Kanagawa Children's Medical Center
2)Department of Cardiology, Kanagawa Children's Medical Center
Abstract
We retrospectively reviewed the medical histories of 37 pediatric patients admitted to our hospital between April 1985 and November 2009 for the treatment of infective endocarditis (IE). These patients, who were diagnosed with IE on the basis of the modified Duke criteria, were divided into two groups-an early group (n=16, admitted between 1985 and 1999) and a later group (n=21, admitted between 2000 and 2009). We compared the backgrounds, diagnosis, complications, causative pathogens, and clinical outcomes between the groups.
The major pathogen identified in the early group belonged to the genus Streptococcus, except Streptococcus pneumoniae, (n=8), whereas those identified in the later group belonged to the genus Staphylococcus (n=11). Moreover, Streptococci, except S. pneumoniae, were identified as the major pathogen in only two cases in the later group (p=0.009). Disease background and outcome were not significantly different between the two groups.
For 30 years, Staphylococci have been identified as the causative agents of IE in children in the United States, and this shift in causative agents from Streptococci to Staphylococci was observed in Japan after 2000.
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Original Article
Title
Outbreak of Human Metapneumovirus Infection in a Hospital Ward for Patients with Severe Motor and Intellectual Disabilities
Author
Kazuya Goto1) Kazuhide Imai1) Naomi Uemura1) Misako Hiramatsu1) and Nobuyuki Hamada2)
1)Division of Pediatrics, Nishibeppu National Hospital
2)Division of Infectious Diseases, Department of Infectious Medicine, Kurume University School of Medicine
Abstract
A mass infection of human metapneumovirus (hMPV) occurred in a ward for patients with severe motor and intellectual disabilities (SMID) over a 5-week period from June to August of 2009. Twenty-three patients developed a fever, and two of them were positive for hMPV which was detected by reverse transcription-polymerase chain reaction (RT-PCR) from a throat swab. An antibody titer of hMPV was also measured by the fluorescent antibody technique, and 10 cases were diagnosed to have an hMPV infection. Ten of 21 cases, excluding 2 cases in which an infection was ruled out, were diagnosed to have pneumonia. Respiratory failure was observed in 2 of these cases in which endotracheal intubation as well as intrapulmonary percussion ventilation (IPV) were carried out. The cause of the mass infection in this case was probably due to environmental factors such as the structure of the ward, the quantity of treatment and daily care, or difficulty in obtaining permanent immunity to hMPV. Patients with SMID are believed to be a group at risk for the mass occurrence of hMPV infection with possible advanced severity. Therefore, the early diagnosis of a mass respiratory tract infection is necessary to prevent further infection and administer appropriate treatment, while carefully keeping the possibility of hMPV infection in mind.
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Original Article
Title
Clinical Study of a Positive Rate in Meckel Diverticulum Scintigraphy
Author
Akiko Yamamoto1) Teruichiro Kitaoka1) Takanobu Maekawa1) Toshihiko Kakiuchi2) Akira Ishiguro1) and Hirokazu Sakai1)
1)Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development
2)Division of Gastroenterology, National Center for Child Health and Development
Abstract
The true positive yield for Meckel daiverticulum scintigraphy should be accessed to assure efficient diagnosis and avoid unnecessary radiation exposure. We analyzed the clinical presentation of 52 patients who underwent Meckel diverticulum scintigraphy at the National Center for Child Health and Development between 2002 and 2010. The median age of the patients was 5 years and 2 months and the male-to-female ratio was 8: 5. The most common clinical sign to prompt the consideration of scintigraphy was unknown hematochezia (n=39), followed by intussusception (n=10) and others (n=3). Among the 52 patients who underwent scintigraphy, 5 demonstrated uptake; 4 had hematochezia and 1 had intussusception. The hematochezias were extensive. Ectopic gastric mucosa was identified in all 5 patients. In the 39 patients with hematochezia of unknown origine, those with Meckel diverticulum were significantly older than the others (median age: 8 years and 9 months vs. 1 year and 1 month; p=0.016). Our results suggest that age is an important factor to consider when deciding on the use of Meckel diverticulum scintigraphy in patients with extensive hematochezia.
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Original Article
Title
Nine Cases of Acute Epiglottitis in Children
Author
Teruyoshi Kurosawa Satoko Yanagihara Hiroshi Sakakibara and Toshiro Terakawa
Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center
Abstract
In Japan, most cases of acute epiglottitis in children are due to Haemophilus influenzae type b infection. Although definitive diagnosis and appropriate treatment can presumably lead to complete recovery, often the clinical course leads to unexpected outcomes and can be fatal. Airway management is critical for healthy survival of the patient. In this regard, intubation under inhalation anesthesia by a skilled person should be considered, except in emergency cases.
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Original Article
Title
Pulmonary Outcomes and Risk Factors in Extremely Low-birth-weight Infants in Late Infancy
Author
Akihiro Hoshino Takanari Fujii Yoshifusa Abe Ryoko Ishikawa Madoka Aizawa Junya Iwasaki Katsumi Mizuno and Kazuo Itabashi
Department of Pediatrics, Showa University School of Medicine
Abstract
Objective: The objective of this study was to clarify the pulmonary outcomes and risk factors in extremely low-birth-weight infants (ELBWIs) in late infancy.
Methods: We retrospectively reviewed hospital records of 69 ELBWIs who were born in the past 10 years and visited our hospital until 3 years of age.
Results: Twenty-four infants (35%) had recurrent wheeze and 24 infants (35%) had lower respiratory tract infection. Twenty-two infants (32%) required rehospitalization for respiratory illnesses and 14 infants (20%) required rehospitalization for respiratory illnesses more than once. Six infants (9%) required mechanical ventilation for respiratory failure. Gestational age and chronic lung disease (CLD) were risk factors for recurrent wheeze. CLD found to be a risk factor for lower respiratory tract infection and rehospitalization for respiratory illnesses. Home oxygen therapy (HOT) was a risk factor for more than once rehospitalization, and tracheostomy was a risk factor for mechanical ventilation for respiratory failure.
Conclusions: ELBWIs may develop respiratory illnesses in late infancy. Because respiratory illnesses in infants who require HOT or tracheostomy more likely increase in severity, it is very important for these infants to prevent infection and manage respiratory illness carefully.
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Original Article
Title
Growth Hormone Treatment Was Effective in Increasing Height in 4 Patients with XLH Who Were Short Despite Phosphate and Vitamin D Therapy
Author
Tomoyasu Saito1)2) Masako Izawa3) Ryojun Takeda1) Makoto Yamada1) Masahiro Goto1) and Yukihiro Hasegawa1)
1)Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center
2)Department of Pediatrics, Matsudo City Hospital
3)Division of Endocrinology and Metabolism, Aichi Children's Health and Medical Center
Abstract
X-Linked hypophosphatemic rickets (XLH), caused by the PHEX gene mutation, is characterized by hypophosphatemia, rickets and impaired growth. Conventional therapy with oral vitamin D and phosphate has been shown to result in improved growth and resolution of the rickets. However, some patients remain unresponsive regarding short stature. The aim of this study is to show the beneficial effect of growth hormone treatment on height for those patients with a short stature despite failure conventional treatment. We investigated four patients with growth retardation (height SD range: -2.5--2.7 SD, age: 3.0-5.4 years) in spite of vitamin D and phosphate therapy. These patients, who were proven to have PHEX gene mutation, were treated with GH for 2.4 to 10.3 years. Their height became 1.4-2.7 SD greater than at the initiation of GH treatment. These results suggest that GH treatment combined with conventional therapy may increase short stature in patients with XLH.
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Original Article
Title
A Case of Mesenteric Abscess Formation Related with Yersinia pseudotuberculosis Infection
Author
Takashi Kumamoto1) Toshiyuki Maeda1) Tomohiro Ichimaru1) Katsuya Tashiro2) and Yuhei Hamasaki2)
1)Department of Pediatrics, Saga Prefectural Hospital Koseikan
2)Department of Pediatrics, Faculty of Medicine, Saga University
Abstract
Yersinia pseudotuberculosis (Yp) is known as one of the major pathogens of zoonosis, and sometimes causes gastroenteritis and mesenteric lymphadenitis in human. However, clinical features and epidemiological data about Yp infection in humans remain unclear because sensitive and practical diagnostic methods have not been established.
We treated a 13 year-old girl who had epilepsy as an underlying disease and had been given valporate. She was admitted to our hospital on day 3 because of high fever, erythema multiforme on the extremities and liver dysfunction associated with jaundice. We initially diagnosed her illness as acute cholangitis and treated her with tazobactam/piperacillin. After treatment with antibiotics, her symptoms subsided and she was discharged on day 17. But the following day, she complained of fever and right lower abdominal pain and returned to our hospital. Mesenteric lymphadenitis was diagnosed after her abdominal CT scan findings which revealed enlargement of mesenteric lymph nodes around the cecum. Immediate administration of ceftriaxone and gentamicin failed to alleviate her lymphadenitis, and lymph node necrosis was observed on a follow-up CT. After changing the antibiotics (meropenem and clindamycin), she fully recovered by day 45.
As Yp infection is sometimes associated with mesenteric lymphadenitis, we examined the antibody titers against Yp in her sera. The titer in the convalescent phase was significantly elevated composed to that in the acute phase (×20→×640) and we concluded that Yp was the causal pathogen in this case.
As far as we know, this is the first report of mesenteric abscess formation caused by Yp infection. In this report, we would like to emphasize that clinicians should be aware of the possibility of Yp infection in cases with mesenteric lymphadenitis.
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