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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.119, No.11, November 2015
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Original Article
Title
Diagnosis, Treatment and Prognosis of Fetal Ventriculomegaly
Author
Ikumi Hori Hiroko Ueda Yoko Nakajima Koichi Ito Takeshi Endo Ayako Hattori Tokio Sugiura Rika Nagasaki Takenori Kato Naoki Ando Tetsuya Ito and Shinji Saitoh
Department of Pediatrics and Neonatology, Graduate School of Medical Sciences, Nagoya City University
Abstract
Fetal ventriculomegaly is usually diagnosed by ultrasonography. Because the causes of fetal ventriculomegaly are variable, the management and outcomes basically relied on the underlying diseases. Forty patients were diagnosed with fetal ventriculomegaly in our hospital between 2004 and 2013. Prenatal examination, diagnosis, postnatal management and outcome were studied retrospectively. Four cases (10%; three cases of congenital cytomegalovirus infection and one case of congenital metabolic disorder) were treated medically. These cases showed significantly smaller head circumference than those in both surgical treatment and nonintervention groups. Ventriculo-peritoneal shunt operation was performed in 14 cases (35%). These cases showed significantly larger head circumference than those in both medical treatment and nonintervention groups. Twenty-two cases were diagnosed or predicted with underlying diseases prenatally, and 19 of these cases were diagnosed by magnetic resonance imaging. Six infants (15%) died within 1 year. Early treatment offers the possibility of improved prognosis in cases of congenital cytomegalovirus infection and congenital metabolic disorder. In conclusion, it is important to exam cytomegalovirus infection postnatally and take a family history carefully in cases of patients showing not significantly enlarged head circumstances.
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Original Article
Title
Epilepsy Developing in Children with Attention-deficit/Hyperactivity Disorder After OROS Methylphenidate Treatment
Author
Masayuki Tanaka Noriko Kinoshita and Daisuke Yoshida
Department of Pediatrics, National Hospital Organization, Higashi-Ohmi General Medical Center
Abstract
We conducted a retrospective review of medical records of attention-deficit/hyperactivity disorder (ADHD) patients without epilepsy before receiving OROS methylphenidate (MPH) treatment to investigate the prevalence of seizure onset. We examined age, sex, duration of OROS-MPH treatment, the number of patients who discontinued OROS-MPH treatment in less than 6 months, epileptiform EEG discharges, and seizure onset. We examined 142 ADHD cases, including 127 males and 15 females, of patients who received OROS-MPH in the pediatric department of National Hospital Organization, Higashi-Ohmi General Medical Center, during the period between January 2008 and March 2015. Age at first treatment ranged from 6 to 14 years, and prescription period ranged from 1 to 69 months. Twenty-seven patients stopped receiving treatment within less than 6 months. Of the 102 patients without epileptiform EEG discharges, none had epileptic seizures. Of the 13 patients with epileptic EEG abnormalities, one patient with Rolandic discharges had epileptic seizures. One patient without EEG before OROS-MPH use experienced epileptic seizures after 5 years of treatment.
Two cases with epilepsy had no recurrent seizures after OROS-MPH discontinuation. However, they were retreated with OROS-MPH because antiepileptic drugs had no effect on their behavioral problems. They had no seizures while using both antiepileptic drugs and OROS-MPH. The prevalence of epilepsy in our study was 1.74%.
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Original Article
Title
Fraction of Exhaled Nitric Oxide after β2-agonist Inhalation during Childhood Asthma Attacks
Author
Yutaka Takahashi Mai Itoh Keisuke Iwamoto Yukiyo Oshima Syuntaro Tsumagari Noriko Yanazume Mitsuru Nawate Mikio Yoshioka and Takaaki Shikano
Department of Pediatrics, KKR Sapporo Medical Center
Abstract
Inhalations of β2-agonist were given to 34 childhood asthma patients who were brought to our hospital because of asthma attacks, and fractions of exhaled nitric oxide (FeNO) levels were determined before and after inhalations. Simultaneously, pulmonary function was determined in 15 of the 34 patients. FeNO was increased in 26 (76.4%) of the 34, showing significant increase from 53.1± 27.7 ppb before inhalations to 62.4± 31.7 ppb (+9.3± 13.7 ppb) after inhalations (p< 0.0001). The rate of change in FeNO did not correlate with that in peak expiratory flow (R=0.39, p=0.795), whereas it showed significantly positive correlations with the rates of changes in FEV1% (R=0.765, p=0.002). Attention is required for evaluations of FeNO, since low FeNO levels may ensue possibly from narrowing of the peripheral airway during asthma attacks.
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Original Article
Title
Serological Pertussis Infection in Healthcare Workers in Pediatric Medical Institutions: A Prospective Longitudinal Study
Author
Kenji Okada1) Masaaki Tanaka2) and Minoru Soh3)
1)Section of Pediatrics, Department of Medicine, Division of Oral & Medical Management, Fukuoka Dental College
2)Tanaka Pediatrics Clinic
3)Soh Pediatrics Clinic
Abstract
Prevalence of serological pertussis infection among healthcare workers in pediatric medical institutions was investigated in a prospective longitudinal study. Pertussis infection rate, assessed with significant increase in PT antibody titer, was low. However, the protective antibody positive rate was as low as 28.3%, indicating high susceptibility to pertussis infection. To prevent pediatric healthcare workers from becoming a source of infection, in particular for pertussis vaccine naï ve children less than 3 months old, immunization against pertussis should be performed as done in many other foreign countries.
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Original Article
Title
A Survey of Medical Treatment for Cough in a Pediatric Outpatient Clinic
Author
Toshishige Inoue1) Kazuki Satoh2) and Hiroyuki Mochizuki3)
1)Department of Pediatrics, Sumitomo Hospital
2)Department of Pediatrics, NHO Shimoshizu Hospital
3)Department of Pediatrics, Tokai University
Abstract
Cough is one of the most familiar symptoms observed in outpatients. Interest concerning cough is recently increasing in pediatricians, and guidelines have been published. However, there are few epidemiological and clinical reports about pediatric cough in Japan. A study of children who visited pediatric outpatient clinics complaining of cough was carried out four times (February, May, August, November) in 2013. Patients complaining of cough accounted for about 30%of outpatients, and 75%of them were under 6 years of age. The main diseases causing cough were common cold (42.9%), bronchial asthma (27.4%), lower airway infection (26.6%), naso-sinusitis (13.6%) and croup syndrome (1.7%). Most patients visited the clinic within a few days after the start of the cough, and 84.1%within 7 days. The symptom of cough disappeared within two weeks in 63.1%of patients, and continued for more than 4 weeks in 4.1%. Expectorants were prescribed in more than 80%of patients and beta-2 agonists, anti-histamines, leukotriene receptor antagonists and anti-microbitics were frequently prescribed for patients who had cough irrespective of their diagnoses.
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Case Report
Title
Five Cases of Neonatal Ductus Arteriosus Aneurysm
Author
Akira Sato Syuhei Fujita Hiroyuki Higashiyama Takeshi Futatani Noboru Igarashi and Kiyoshi Hatasaki
Department of Pediatrics, Toyama Prefectural Central Hospital
Abstract
Ductus arteriosus aneurysm (DAA) has long been considered to be a rare and serious disease. In recent years, however, significant progress has been made in the field of echocardiography, and we have learned that most cases of DAA are asymptomatic and will eventually close naturally. We report on 5 cases of neonatal ductus arteriosus aneurysm, all of which were observed to resolve naturally and without intervention. As a general rule, the risk of complications increases with the size of the DAA, however, there have also been cases in which symptoms were present for small-diameter DAA, highlighting the importance of taking into account other risk factors such as a family history of connective tissue disease. This report shows the importance of carefully following up on the natural regression.
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Case Report
Title
An Adolescent with Infective Endocarditis of the Aortic Valve Managed by the Ross Procedure
Author
Ryo Takahashi Masato Kimura Eichiro Kawai Takehiko Ohnoki and Shigeo Kure
Department of Pediatrics, Tohoku University School of Medicine
Abstract
A previously healthy 16-year-old adolescent presented with intermittent fever and received antibiotics for 2 months. Although he had no history of a heart murmur, a murmur was noted during antibiotic therapy and follow up. On further examination at a general hospital, he was diagnosed with infectious endocarditis (IE) based on echocardiographic findings of aortic regurgitation (AR) with vegetation and the presence of Staphylococcus lugdunensis in the blood. He became afebrile after receiving intravenous penicillin G and gentamicin therapy but gradually developed heart failure due to progressive AR. He was then referred to our hospital to evaluate the indication for the Ross procedure to replace the aortic valve with a pulmonary autograft. The Ross procedure was performed as the patient had a congenital bicuspid aortic valve (CBAV) and the annulus of the valve had been destroyed by IE, which placed him at risk of ventricular septal perforation or atrioventricular block. Although histopathological examination revealed no pathogens or inflammatory cells on the aortic valve, 16S ribosomal RNA sequencing of the tissue showed high homology to S. lugdunensis. The postoperative course was uneventful and he received antibiotics for 6 weeks after confirmation of negative blood culture. CBAV, which has a relatively high prevalence, is a risk factor for IE. However, many patients with CBAV remain asymptomatic. For fever of unknown origin in young adults, it is important to consider the existence of asymptomatic congenital heart disease, such as CBAV, and to include IE in the differential diagnosis.
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Case Report
Title
A Case of Juvenile Polyposis Coli due to Chromosome 10q23 Deletion
Author
Keisuke Kunieda1)2) Takeshi Naito1) Jun Mori1) Takuto Naito1) Atsushi Fujiki1) Takuya Nakatani1) Yasutaka Morimoto2) Akihiro Toriie2) Yuri Etani3) and Hiroyuki Ishida1)
1)Department of Pediatrics, Matsushita Memorial Hospital
2)Department of Gastroenterology, Matsushita Memorial Hospital
3)Department of Gastroenterology and Endocrinology, Osaka Medical Center and Research Institute for Maternal and Child Health
Abstract
The loss of BMPR1A and PTEN genes predisposes individuals to juvenile polyposis. Patients with chromosome 10q23 deletion syndrome (OMIM #612242) present with juvenile polyposis due to a microdeletion that encompasses both BMPR1A and PTEN. Despite this established link, there are few case reports of chromosome 10q23 deletion syndrome. Therefore, the correlation between the genotype and phenotype remains unexplained. We report the case of a 23-month-old boy with chromosome 10q23 deletion syndrome who presented with the following clinical features: ventricular septal defect, macrocephaly with developmental delay from infancy, and juvenile polyposis from early childhood. The patient visited our hospital with a chief complaint of anemia and bloody stool, which prompted us to perform both a gastroscopy and colonoscopy. Upon completion of the procedures, we diagnosed juvenile polyposis coli. We also checked his karyotype by high resolution chromosome analysis, which showed 46, XY, del (10) (q23.2q23.32). Consequently, we concluded that chromosome 10q23 deletion including either BMPR1A or PTEN was associated with juvenile polyposis in our patient. Many papers have recently reported that juvenile polyposis harbors an increased risk of malignancy, although juvenile polyposis is usually hamartomatous. Our patient may have a high risk of malignant transformation since his juvenile polyp is characterized as partly adenomatous. In conclusion, after a diagnosis of juvenile polyposis, careful follow-up should be performed due to the increased risk of malignancy.
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