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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.119, No.9, September 2015
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Review
Title
Risk Factors for Fall-related Oropharyngeal Injuries in Pediatric Patients
Author
Satoshi Tsuji1) Masahiro Nozawa1) Naho Nishimura2) and Takeo Fujiwara3)
1)Pediatric Emergency Medicine and Transport Services, National Research Institute for Child Health and Development
2)Critical Care Medicine, National Research Institute for Child Health and Development
3)Department of Social Medicine, National Research Institute for Child Health and Development
Abstract
Background: Few studies have examined the risk factors for pediatric injury in Japan. The present study was undertaken to examine risk factors for pediatric oropharyngeal trauma associated with falls.
Subjects and methods: Retrospective chart reviews of pediatric patients aged < 16 years admitted to our emergency department with fall-related oropharyngeal injuries were conducted during 2012. Cases involving > 1-m falls, bicycle accidents, traffic accidents, and injury during school exercise were excluded. Age, sex, injury time, injury mechanism, injury site, treatment method, and treatment outcome were evaluated.
Results: In total, 171 patients (64% male; median age, 26 months) were divided into 2 groups: direct injury around the mandible and lips (simple injury group, n=128) and oropharyngeal injury involving a foreign body (foreign body injury group, n=43). All patients in the simple injury group were discharged home and followed up for 10 days. In the foreign body injury group, 13 patients underwent head computed tomography, 2 underwent surgical repair under general anesthesia, and 3 were admitted to the pediatric intensive care unit. Eleven patients were hospitalized for as long as 20 days.
Discussion: Patients in the foreign body injury group sustained more severe injury during 7:00 pm to 9:00 pm than did patients in the simple injury group (p< 0.05). A total of 75% of children in the foreign body injury group sustained toothbrush injuries that required intervention and prevention.
Conclusion: An injury prevention program designed for pediatric nighttime toothbrush use is recommended in Japan.
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Original Article
Title
Relationship between Lateral Ventricle Areas on Cranial MRI in Very Low Birth Weight Infants at NICU Discharge and Developmental Outcome at 3 Years
Author
Shin Fujiwara Rie Fukuhara Satoshi Hada Hirotaka Kihara Ryo Furukawa Sayaka Imai and Hisako Kataoka
Department of Neonatology, Hiroshima Prefectural Hospital
Abstract
Objective: We investigated the association between lateral ventricle area on cranial magnetic resonance imaging (MRI) at the time of neonatal intensive care unit (NICU) discharge and mental deviation quotient (DQ) according to the Kyoto Scale of Psychological Development at age 3 years. Patients and Methods: This study included 82 infants with a birth weight< 1,500 g who were managed in our hospital's NICU starting at their birth between January 2006 and March 2010. The lateral ventricles and brain metrics were measured on three sections from T2-weighted cranial MRI at the time of NICU discharge. We investigated the association between these measures and DQ for the three areas of the Kyoto Scale of Psychological Development at age 3 years. Results: The lateral ventricle areas were not associated with the brain metrics, gestational age, or head circumference at the time of MRI. Multivariate analysis adjusted for perinatal and neonatal predictors showed that only the posterior lateral ventricle area was predictive of a postural-motor DQ< 85. A posterior lateral ventricle area≥250 mm2 had 50% sensitivity and 86% specificity for a postural-motor DQ< 85. Conclusions: The posterior lateral ventricle area may be a useful tool for predicting motor function at age 3 years.
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Original Article
Title
Eight Cases with Vascular Rings and a PA Sling Who Underwent Surgery
Author
Tomohiro Nawa1) Masato Yokozawa1) Tsutomu Wada1) Keiji Haseyama1) Motoki Takamuro1) Ai Kasuga2) Norihisa Horita2) Kinya Hatakeyama2) and Hiroyuki Tsutsumi2)
1)Department of Cardiology, Hokkaido Medical Center for Child Health and Rehabilitation
2)Department of Pediatrics, Sapporo Medical University School of Medicine
Abstract
Congenital vascular rings with a pulmonary artery (PA) sling, which results from abnormal development of the branchial arch system and pulmonary artery, may cause tracheoesophageal compression. We reviewed 8 patients with vascular rings and a PA sling who underwent surgery in our center. Symptomatic cases had either stridor persisting from birth or early infancy, or a history of recurrent bronchitis or dysphagia. Subclinical cases were diagnosed during fetal ultrasound screening or an examination for possible associated congenital heart disease. Multi-detector row computed tomography (MDCT) was useful in confirming the diagnosis; at MDCT examination, the presence of a dimple, ligament and abnormal configuration of the descending aorta were important features leading to the diagnosis. After surgery, most symptomatic patients immediately improved; however, in cases complicated by tracheal malacia and stenosis, symptoms could be prolonged after operation. In patients with right aortic arch and aberrant left subclavian artery, compressive symptoms do not generally develop unless accompanied with Kommerell's diverticulum or retroesophageal aortic arch, when sings of compression may occur. Preoperative bronchial fiberoscopy is desirable, because it helps evaluate the potential for postoperative complications such as tracheal malacia and stenosis.
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Case Report
Title
A Neonate with Infantile Fibrosarcoma Mimicking Cavernous Hemangioma
Author
Ikuko Kubokawa1) Akira Hayakawa1) Kousuke Nishida1) Satoshi Hirase1) Nobuyuki Yamamoto1) Takeshi Mori1) Oshi Tokuda2) Masaaki Ueda2) and Kazumoto Iijima1)
1)Department of Pediatrics, Kobe University Graduate School of Medicine
2)Department of Pediatrics, Toyooka Public Hospital
Abstract
Clinical and radiologic diagnosis of infantile fibrosarcoma is often a challenging problem because of similarities with hemangiomas and vascular malformations. We report a male neonate who had a large infantile fibrosarcoma that was initially believed to be a cavernous hemangioma. At birth, a hen's egg-sized mass was noted on his right lower leg. He was observed because cavernous hemangioma was suspected, however, the mass increased rapidly. At 11 days old, he was referred to our hospital for β-blocker treatment. The mass was red-violet in color, fist-sized and hard, which decreased mobility of the mass. A biopsy was performed immediately because rapid growth is atypical of hemangiomas and vascular malformations. After biopsy, the neonate was treated with a β-blocker for the diagnosis and therapy of the suspected hemangioma. However, the tumor grew rapidly and reached 10 cm in diameter. In addition, serum calcium concentration remarkably elevated. At 17 days old, biopsy findings showed non-rhabdomyosarcomatous soft-tissue sarcoma, which forced the performance of an emergency hip disarticulation.
Histopathological examination of the tumor showed tight and diffuse proliferation of spindle cells. The ETV6-NTRK3 fusion product was identified by RT-PCR, confirming the diagnosis of infantile fibrosarcoma.
Early diagnosis is required for infantile fibrosarcoma as it sometimes progresses to a life-threatening condition because of rapid growth, bleeding and hypercalcemia. Although biopsies are likely to be avoided in cases of hemangiomas and vascular malformations because of the danger of bleeding, it is important to consider and perform a biopsy if the presentation and clinical course are atypical.
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Case Report
Title
A Case of Acute Respiratory Distress and Flaccid Paralysis Associated with Enterovirus D68
Author
Keiji Yonekura1) Yasutaka Shiraishi2) Reiko Tsuda1) Eriko Okajima1) Masaki Kojima1) Keiichi Hara1) Yasuhiko Sera1) Youichiro Kaneko1) and Shinichiro Miyagawa1)
1)Department of Pediatrics, National Hospital Organization KURE Medical Center
2)Department of Pediatrics, Hiroshima City Funairi Citizens Hospital
Abstract
During the period of August thru September 2014, enterovirus D68 (EV-D68) circulated in North America. Severe respiratory illness and acute flaccid paralysis with anterior myelitis were reported in EV-D68 positive cases.
We report the case of a 5-year-old girl in Japan who developed acute flaccid paralysis after acute respiratory distress supported by a mechanical ventilator. Intravenous immunoglobulin and pulse therapy with methylprednisone were not effective for the paralysis. The flaccid paralysis has remained unchanged up to now. EV-D68 was identified in her tracheal secretions.
EV-D68 infection could be an important differential diagnosis for acute respiratory distress and flaccid paralysis with unknown etiology. As such, in Japan, it is important to pay attention to any EV-D68 outbreak trends.
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Case Report
Title
Recurrent Pneumoparotitis with Pneumomediastinum
Author
Yoshimitsu Osawa Mari Kaneko Yoko Takano and Shozo Maeda
Isesaki Municipal Hosptal
Abstract
We report the case of an 11-year-old boy with pneumoparotitis complicated by pneumomediastinum. He had cyclic vomiting syndrome and migraine. He complained of swelling and pain in his mandible and neck after coughing and suppression of vomiting. Chest and neck radiography revealed pneumomediastinum and subcutaneous emphysema, and he was admitted to our hospital. Further, computed tomography (CT) revealed pneumoparotitis, and therefore a diagnosis of pneumomediastinum and pneumoparotitis was made. Parotid swelling and pain reduced after bed rest and antibiotic administration. However, after approximately 1 year, pneumoparotitis recurred after suppression of vomiting.
The patient had no history of respiratory tract disease, such as asthma, or trauma. Therefore we assume that the pneumomediastinum, subcutaneous emphysema and pneumoparotitis were caused by elevation in oral pressure due to suppression of vomiting.
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Case Report
Title
A Case of Toxic Shock Syndrome with Serious Rhabdomyolysis
Author
Akio Kato1) Masahiro Noda1) Takumi Kobayashi1) Kunihiro Oba1) Masayuki Kokaji1) Makoto Kuroda2) Makiko Saito3) Masashi Mizuguchi3) and Jun Abe4)
1)Department of Pediatrics, Showa General Hospital
2)Department of Pathogen Genomics, National Institute of Infectious Disease Pathogen Genome Analysis Research Center
3)Department of Developmental Medical Sciences, The University of Tokyo
4)Division of Allergy, Department of Allergy&Immunology, National Center for Child Health and Development
Abstract
There are several reports that some cases of toxic shock syndrome (TSS) presented symptoms similar to Kawasaki disease. We encountered a 13-year-old boy with TSS who had Kawasaki disease-like symptoms, and developed shock and multiple organ failure.
The boy was admitted to our hospital because of fever, bulbar conjunctival hyperemia, and erythema of hands and feet. Severe watery diarrhea appeared several hours after admission. He developed hypotension, loss of consciousness, renal failure and multiple organ dysfunctions with DIC. Then he was moved to the ICU.
Treatment with large doses of γ-globulin, steroid pulse therapy, hypothermia therapy, blood filtration dialysis and cytokine apheresis was started. On the second day of illness, he developed severe swelling of his lower legs and his serum CK level elevated to 583,000 IU/l which we diagnosed as compartment syndrome due to rhabdomyolysis. Urgent relaxation incisions were performed.
His condition improved after these supportive therapies. Atrophy of the tibialis anterior remained but he became able to walk by himself. Finally, he was discharged on the 51st day of hospitalization without neurologic complications.
In this case, it was very difficult to diagnose his symptoms as TSS or Kawasaki disease. We diagnosed TSS because the TSST-1 producing staphylococcus was identified from stool culture. In addition, a heat unstable type gene polymorphism was detected, which is considered to be a precipitating factor of severity in TSS.
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