gakkaizashi


THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY

Vol.119, No.10, October 2015


Original Article
1. Temperature Change and Viral Titer of Varicella Vaccine during Distribution and Storage
Case Report
1. A Case of Hypoxic Gas Inhalation Therapy in an Extremely Low Birth Weight Infant with Congenital Heart Disease
2. SPINK1 Gene Mutation Showing Recurrent Acute Pancreatitis
3. Pneumatosis Cystoides Intestinalis in a Patient with Systemic Juvenile Idiopathic Arthritis with a Literature Review
4. Laundry Detergent Pod Ingestion: An Emergency Case Report in a 7-month-old Infant


Original Article
Title
Temperature Change and Viral Titer of Varicella Vaccine during Distribution and Storage
Author
Takao Ozaki1) Naoko Nishimura1) Toshiaki Ihara2) Takuji Kumagai3) Koichi Baba4) Takao Nagai5) Tetsushi Yoshikawa6) and Yoshizo Asano6)
1)Department of Pediatrics, Konan Kosei Hospital
2)Department of Pediatrics, National Mie Hospital
3)Kumagai Pediatric Clinic
4)Baba Pediatric Clinic
5)Nagai Pediatric Clinic
6)Department of Pediatrics, Fujita Health University
Abstract
Because varicella-zoster virus is heat-labile, we were concerned that temperature changes during distribution and storage could reduce the viral titer of varicella vaccine. We held a review conference on vaccine distribution and conducted annual surveys during 2008-2013 to investigate temperature changes during distribution and storage of varicella vaccine as well as the viral titer. We now report the results of the final survey (2013) and summarize all the survey results.
The 2013 survey was conducted nationwide at 6 medical institutions. To investigate temperature changes during vaccine distribution and storage, an automatic temperature recorder was attached to 10 vials purchased by a standard distribution method. The vials were kept cold with dry ice when collected (5 on delivery to institutions and 5 after 1 month of storage), and the viral titer (plaque-forming units (PFU)/dose) was measured in all vials.
The vials were kept at an appropriate temperature (≤5°C) during shipping to the 4 distribution agents and delivery to the institutions, and at the institutions (4 stored vials refrigerated and 2 at 5°C). The mean titer was 31,000 PFU/dose on delivery and 29,200 PFU/dose after 1 month of storage; both were higher than the biological products standard (≥1,000 PFU/dose). These results were consistent with those of 5 previous surveys (2008-2012), revealing no temperature problems during distribution or storage of varicella vaccine and no titer decrease.




Case Report
Title
A Case of Hypoxic Gas Inhalation Therapy in an Extremely Low Birth Weight Infant with Congenital Heart Disease
Author
Yoshikazu Otsubo1) Taro Kanbe1) Hiroya Ushinohama2) Eriko Ozono1) Kazuhiko Hashimoto1) Chiharu Yuasa1) You Hamaguchi1) Takuya Hayashida1) Hirofumi Fukunaga1) and Muneichiro Sumi1)
1)Department of Pediatrics, Sasebo City General Hospital
2)Department of Pediatric Cardiology, Fukuoka Children's Hospital
Abstract
In preoperative management of neonates with congenital heart disease with increased pulmonary blood flow, inhalation therapy with hypoxic gas using a nitrogen gas mixture (N2 inhalation therapy) reduces the flow by raising pulmonary vascular resistance, thereby maintaining the systemic circulation. However, many aspects of cerebral hemodynamics during N2 inhalation therapy remain unknown. Most notably, there are few reports on the impact of long-term N2 inhalation therapy on the central nervous system in extremely low birth weight (ELBW) infants.
We encountered an ELBW infant (gestational age 31 weeks 6 days; weight 778 g) with congenital heart disease associated with increased pulmonary blood flow (double outlet right ventricle), given N2 inhalation therapy until the weight reached a level allowing pulmonary artery banding (PAB). While this therapy was applied, the cerebral tissue oxygenation index was continuously measured using near-infrared spectroscopy in order to prevent hypoxia-induced brain damage. We also assessed cerebral blood flow measured by brain echography and changes in the estimated pulmonary to systemic flow ratio (Qp/Qs) determined by echocardiography. N2 inhalation therapy was applied for 49 days starting at age 20 days, and PAB was performed at age 69 days. While the patient is currently awaiting radical operation, development equivalent to corrected age in months was observed at 10 months after treatment, and no central nervous system sequelae have been detected by head magnetic resonance imaging and electroencephalography. We herein report our examination of the actual impact of N2 inhalation therapy and fluctuations in various monitoring parameters.




Case Report
Title
SPINK1 Gene Mutation Showing Recurrent Acute Pancreatitis
Author
Akio Honda1) Tomoko Nakagawa1) Masahiro Takeyama1) Mitsuyoshi Suzuki2) and Midori Shima1)
1)Department of Pediatrics, Nara Medical University
2)Department of Pediatrics, Juntendo University
Abstract
SPINK1 (serine protease inhibitor, Kazal type 1) gene mutations are seen in some patients with idiopathic acute pancreatitis; these mutations could be a risk factor for chronic pancreatitis and pancreatic cancer.
[Case] A 13-year-old girl with a history of acute pancreatitis 1 year previously developed abdominal pain, back pain, and vomiting. Pancreatic function test showed that the pancreatic enzyme levels were elevated and abdominal computed tomography scan showed diffuse swelling of the pancreas, which indicated a relapse of acute pancreatitis. She did not have any familial history nor any traumatic episodes. Autoimmune diseases and other infections were absent. Anatomical disorders of the pancreatic duct were not detected by magnetic resonance cholangiopancreatography. We continued restriction of fat and commenced oral protease inhibitor treatment after discharge. However, she had a relapse of pancreatitis 1 month later. Genetic analysis showed that she had N34S heterozygous mutation of SPINK1. We reinforced the restriction of fat and added bromhexine hydrochloride to her treatment regimen. However, the next month, she had a relapse of pancreatitis, which was the 4th episode in 2 years.
[Conclusion] Approximately 70% of acute pancreatitis patients with SPINK1 mutation have no familial history. Therefore, analyzing gene mutations of patients with juvenile or recurrent pancreatitis without familial episodes is warranted. Restriction of fat and drug therapy may be essential for preventing the recurrence of inflammation and progression to chronic pancreatitis, pancreatic cancer, and other complications, including diabetes mellitus.




Case Report
Title
Pneumatosis Cystoides Intestinalis in a Patient with Systemic Juvenile Idiopathic Arthritis with a Literature Review
Author
Mariko Takei1) Takashi Ishige1) Reiko Hatori1) Maiko Tatsuki1) Takeshi Tomomasa2) and Hirokazu Arakawa1)
1)Department of Pediatrics, Gunma University Graduate School of Medicine
2)PAL Children's Clinic
Abstract
We present a case of pneumatosis cystoides intestinalis, in a patient who developed intussusception during treatment for systemic juvenile idiopathic arthritis (sJIA). The patient was given a diagnosis of sJIA at 1 year 4 months; no gastrointestinal symptoms had been reported prior to diagnosis. After the diagnosis of sJIA, he was treated with steroids, followed by intravenous tocilizumab. He suddenly presented with ileal obstruction at 2 years 5 months, and we diagnosed pneumatosis cystoides intestinalis. The concomitant use of steroids and tocilizumab were considered risk factors for PCI. However, retrospective review of his abdominal CT scan, performed at the time of sJIA diagnosis before starting steroid therapy, showed a small pneumatosis in the intestinal wall. We therefore considered that sJIA in itself can become the cause of PCI without immunosuppressive therapy. The patient's intussusception was treated operatively, and the patient received 2 weeks treatment with hyperbaric oxygen therapy, after which no recurrence occurred.




Case Report
Title
Laundry Detergent Pod Ingestion: An Emergency Case Report in a 7-month-old Infant
Author
Kei Ikeda Makoto Morita Syunsuke Miwata Tomoyasu Noguchi Hirohide Tokunaga and Shinji Hasegawa
Department of Pediatrics, Nagoya Memorial Hospital
Abstract
Laundry detergent pods were introduced to the Japanese market in late April 2014.
In this report, we present the case of a 7-month-old boy who accidentally ingested a laundry detergent pod. He was referred twice to the emergency department of a hospital; however, he was diagnosed with no adverse effects and was advised to return home. Soon afterwards, while at home, he began to develop vomiting and dyspnea; thus, he was admitted to our hospital. As gastric lavage, repetitive suctions, and inhalation therapy did not alleviate his symptoms, he was transferred to a tertiary care pediatric hospital. There, he was treated with suction, inhalation, and antibiotics, and he recovered in six days without sequelae.
Clinicians, particularly pediatricians and emergency care physicians, should be informed of the danger of laundry detergent pod ingestion. Parents and caregivers of children who have ingested laundry detergent pods, should immediately contact medical institutions for appropriate management. Moreover, parents and caregivers should be educated on the potential risks associated with laundry detergent pod ingestion, the need for safe storage, and care in use.




Back number