Evaluation of screening with urine dipsticks and renal ultrasonography for 3-year-olds in Chiba City over 30 years

BACKGROUND

Urinary screening for 3-year-olds cannot adequately detect congenital anomalies of the kidney and urinary tract (CAKUT).

METHODS

Urinary screening for 3-year-olds was investigated over 30 years. Dipsticks for proteinuria, hematuria, glycosuria, leukocyturia, and nitrite at first screening, and dipsticks, urinary sediments, and renal ultrasonography at second screening were performed. Screening results were evaluated.

RESULTS

The positive rates of proteinuria, hematuria, leukocyturia, and nitrite relative to 218,831 children at the first screening were 1.0%, 4.6%, 2.3%, and 0.88%, respectively. Thirty-seven glomerular disease, 122 CAKUT, and 5 urological disease cases were found. We detected 6 stage 3-4 chronic kidney disease (CKD) and 3 end-stage kidney disease cases, including 3 CAKUT, comprising 2 bilateral renal hypoplasia and 1 vesicoureteral reflux (VUR), and 6 glomerular diseases, comprising 4 focal segmental glomerulosclerosis and 2 Alport syndrome. The positive rates relative to 218,831 children and CKD detection rates for each tentative diagnosis of mild hematuria, severe hematuria, proteinuria and hematuria, proteinuria, and suspected urinary tract infection were 1.4% and 0.67%, 0.11% and 3.7%, 0.01% and 28.6%, 0.02% and 45.0%, and 0.08% and 9.7%, respectively. Among 14 VUR cases with significant bacteriuria, 13 were found by leukocyturia, 12 had grade ≥ IV VUR, and 10 had severe renal scars.

CONCLUSIONS

Nine stage 3-5 CKD cases comprising 3 CAKUT and 6 glomerular disease were found by urinary screening of 3-year-olds among 218,831 children. The combination of urine dipsticks including leukocyturia at the first screening and ultrasonography at the second screening appeared useful.

Demographic, clinical characteristics and treatment outcomes of immune-complex membranoproliferative glomerulonephritis and C3 glomerulonephritis in Japan: A retrospective analysis of data from the Japan Renal Biopsy Registry

The reclassification of membranoproliferative glomerulonephritis (MPGN) into immune-complex MPGN (IC-MPGN) and C3 glomerulopathy (C3G) based on immunofluorescence findings in kidney biopsies has provided insights into these two distinct diseases. C3G is further classified into dense deposit disease and C3 glomerulonephritis (C3GN) based on electron micrographic findings. Although these diseases have poor outcomes, limited Japanese literature confined to small, single-center cohorts exist on these diseases. We retrospectively analyzed 81 patients with MPGN type I and III from 15 hospitals in the Japan Renal Biopsy Registry to compare demographic, clinical characteristics and treatment outcomes of patients with IC-MPGN to those with C3GN. Of the 81 patients reviewed by immunofluorescence findings in kidney biopsies, 67 patients had IC-MPGN and 14 patients had C3GN. Age at diagnosis and systolic and diastolic pressure were higher and proteinuria and impaired renal function were significantly more prevalent in patients with IC-MPGN than those with C3GN. About 80% of the patients in both groups were treated with immunosuppressive therapy. At last follow-up (median 4.8 years), complete remission rate of proteinuria was significantly higher in patients with C3GN (64.3%) than in those with IC-MPGN (29.9%; P = 0.015). The renal survival rate was lower in patients with IC-MPGN when compared to C3GN (73.1% vs. 100%; log-rank, P = 0.031). Systolic blood pressure and renal function at baseline were independent predictors of progression to end-stage kidney disease. The overall prognosis of patients with C3GN is more favorable than for patients with IC-MPGN.

Clinical characteristics of HNF1B-related disorders in a Japanese population

BACKGROUND

Hepatocyte nuclear factor 1β (HNF1B), located on chromosome 17q12, causes renal cysts and diabetes syndrome (RCAD). Moreover, various phenotypes related to congenital anomalies of the kidney and urinary tract (CAKUT) or Bartter-like electrolyte abnormalities can be caused by HNF1B variants. In addition, 17q12 deletion syndrome presents with multi-system disorders, as well as RCAD. As HNF1B mutations are associated with different phenotypes and genotype-phenotype relationships remain unclear, here, we extensively studied these mutations in Japan.

METHODS

We performed genetic screening of RCAD, CAKUT, and Bartter-like syndrome cases. Heterozygous variants or whole-gene deletions in HNF1B were detected in 33 cases (19 and 14, respectively). All deletion cases were diagnosed as 17q12 deletion syndrome, confirmed by multiplex ligation probe amplification and/or array comparative genomic hybridization. A retrospective review of clinical data was also conducted.

RESULTS

Most cases had morphological abnormalities in the renal-urinary tract system. Diabetes developed in 12 cases (38.7%). Hyperuricemia and hypomagnesemia were associated with six (19.3%) and 13 cases (41.9%), respectively. Pancreatic malformations were detected in seven cases (22.6%). Ten patients (32.3%) had liver abnormalities. Estimated glomerular filtration rates were significantly lower in the patients with heterozygous variants compared to those in patients harboring the deletion (median 37.6 vs 58.8 ml/min/1.73 m²; p = 0.0091).

CONCLUSION

We present the clinical characteristics of HNF1B-related disorders. To predict renal prognosis and complications, accurate genetic diagnosis is important. Genetic testing for HNF1B mutations should be considered for patients with renal malformations, especially when associated with other organ involvement.

A case report of mediastinal seminoma arising after renal transplantation

Recipients of organ transplantation on immunosuppressive medications are at increased risk for developing de novo malignancies, including skin cancer, Kaposi's sarcoma, in situ carcinomas of the uterine cervix, anogenital cancers, renal cell carcinoma, and post-transplant lymphoproliferative disorders (PTLD). However, there are few case reports of germ cell tumors after organ transplantation. There are some case reports of testicular seminoma, but not mediastinal seminoma. This case report is the first description of a mediastinal seminoma that developed de novo 28 months after renal transplantation and that was initially diagnosed as PTLD. To improve outcomes of organ transplant recipients, it is important to report rare cases of malignancies arising while on immunosuppressive medications. When we detect mediastinal tumor arising after organ transplantation while on immunosuppressive therapy, diseases other than PTLD should be considered in the differential diagnosis.

Indication of electron neutrino appearance from an accelerator-produced off-axis muon neutrino beam

The T2K experiment observes indications of ν(μ) → ν(e) appearance in data accumulated with 1.43×10(20) protons on target. Six events pass all selection criteria at the far detector. In a three-flavor neutrino oscillation scenario with |Δm(23)(2)| = 2.4×10(-3)  eV(2), sin(2)2θ(23) = 1 and sin(2)2θ(13) = 0, the expected number of such events is 1.5±0.3(syst). Under this hypothesis, the probability to observe six or more candidate events is 7×10(-3), equivalent to 2.5σ significance. At 90% C.L., the data are consistent with 0.03(0.04) < sin(2)2θ(13) < 0.28(0.34) for δ(CP) = 0 and a normal (inverted) hierarchy.

Effects of genistein and herbimycin, tyrosine kinase inhibitors, on catecholamine release in bovine adrenal chromaffin cells

1 The effects of genistein and herbimycin, tyrosine kinase inhibitors, on catecholamine (CA) release were examined in bovine adrenal chromaffin cells. 2 In intact cells, genistein (10-100 microm) and herbimycin (3-30 microm) inhibited CA release induced by acetylcholine (ACh; 100 microm) or the nicotinic receptor stimulant 1,1-dimethyl-4-phenyl-piperazinium (DMPP; 10 microm), but did not affect CA release induced by high K+ (40 mm). 3 Genistein and herbimycin inhibited (45)Ca2+ uptake induced by ACh (100 microm). 4 Neither genistein nor herbimycin affected [(3)H]nicotine binding with nicotinic receptors. 5 In beta-escin-permeabilized cells, neither genistein nor herbimycin affected CA release induced by Ca2+ (1 microm). 6 These results suggest that protein tyrosine kinase plays the facilitatory role in the regulation of CA release induced by nicotinic receptor stimulation in stimulus-secretion coupling of bovine adrenal chromaffin cells.

Large-scale gene expression profiles, differentially represented in osteoarthritic synovium of the knee joint using cDNA microarray technology

Osteoarthritis (OA) is one of the most common age-related chronic disorders of articular cartilage, joints and bone tissue. Diagnosis of OA commonly depends on clinical and radiographic findings. However, changes in cartilage associated with the early stage of OA cannot be detected using radiographs, because significant cartilage degeneration must occur before radiographic findings show alterations of the appearance of cartilage. To identify new biomarkers of OA, we analysed gene expression profiles of synovium from 43 patients with OA, ten patients with rheumatoid arthritis (RA), and eight non-OA/non-RA patients using a novel cDNA microarray chip. We identified 21 genes with simultaneous significant differences in expression between OA and non-OA/non-RA groups and between OA and RA groups. Linear discriminant analysis showed that the three groups could be well separated using those 21 genes. Statistical analysis also revealed that several of the 21 genes were associated with disease progression and clinical presentation. The graphical modelling method indicated that some of the 21 genes are significantly associated with a particular clinical presentation, suggesting biological relationships among those genes. This is the first report of the use of cDNA microarray technology to create large-scale gene expression profiles differentially expressed in situ in OA synovium of the knee joint.

Differential effects of FK506 and cyclosporin A on catecholamine release from bovine adrenal chromaffin cells

1 The effects of the immunosuppressants, tacrolimus (FK506) and cyclosporin A (CsA), on catecholamine (CA) release were examined in cultured bovine adrenal chromaffin cells. 2 In intact cells, FK506 (1-30 microM) inhibited CA release stimulated by acetylcholine (ACh; 100 microM), 1,1-dimethyl-4-phenyl-piperazinium (DMPP, 10 microM) or high K+ (40 mM). CsA (1-30 microM) had a little inhibitory effect on the ACh- or DMPP-stimulated CA release, whereas it enhanced the high K(+)-stimulated CA release. 3 In beta-escin-permeabilized cells, FK506 inhibited CA release stimulated by Ca2+ (1 and 10 microM) in the presence and absence of MgATP (2 mM). CsA induced CA release under Ca(2+)-free condition and enhanced the Ca(2+)-stimulated CA release in the presence and absence of MgATP. 4 It is known that the Ca(2+)-dependent exocytosis involves at least two distinct steps, ATP-requiring priming stage and ATP-independent fusion step in adrenal chromaffin cells. Therefore, it is suggested that FK506 inhibits the Ca(2+)-dependent exocytosis probably at the fusion step whereas CsA induces CA release from bovine adrenal chromaffin cells.

Differential secretion of adrenaline and noradrenaline in response to various secretagogues from bovine chromaffin cells

1. Differential secretion of adrenaline (Adr) and noradrenaline (NA) in response to various secretagogues was studied in bovine adrenal chromaffin cells. 2. Acetylcholine (ACh; 3-300 mumol/L), 1,1-dimethyl-4-phenyl-piperazinum (DMPP; 1-100 mumol/L), high K+ (20-60 mmol/L), calcimycin (1-100 mumol/L), histamine (0.3-30 mumol/L) and angiotensin (Ang)II (0.3-30 mumol/L) induced the secretion of a 1.3-2-fold greater percentage of NA stores than Adr stores in intact cells. 3. In beta-escin-permeabilized cells, Ca2+ (0.1-30 mumol/L) induced a greater secretion of Adr and NA in the presence of MgATP (2 mmol/L) than in the absence of MgATP. The percentage of NA secreted was 1.4- and 1.5-fold greater than that of Adr in the presence and absence of MgATP, respectively. 4. The ATP-independent phase of the Ca(2+)-dependent exocytosis is thought to be associated with the final step that ultimately leads to fusion, while the ATP-dependent phase is thought to be associated with the vesicle priming reaction. Therefore, the preferential secretion of NA in response to ACh, DMPP, high K+, calcimycin, histamine and AngII may be due, at least in part, to the greater effectiveness of Ca2+ in producing exocytosis in NA-containing cells.

Sclerosing encapsulating peritonitis in pediatric peritoneal dialysis patients

The aim of this study was to define the incidence and characteristics of sclerosing encapsulating peritonitis (SEP) in pediatric peritoneal dialysis (PD) patients in Japan. A questionnaire was sent to all dialysis units with at least two pediatric PD patients. Among 687 patients registered, 11 cases (1.6%) of SEP were diagnosed. The mean age of patients with SEP at the start of PD was 9.7+/-3.6 years and at SEP diagnosis, 19.1+/-3.8 years. All patients had undergone PD for more than 5 years, and the mean PD duration was 9.6+/-3.3 years. SEP was diagnosed in 6.6% and 12% of patients dialyzed for >5 years and >8 years, respectively. The incidence of peritonitis among patients with SEP was not different from that among the Japanese pediatric registry. All patients had virtually no residual urine volume and 9 had impaired peritoneal ultrafiltration. Peritoneal calcification was the most-frequent radiological finding. Peritoneal biopsy was performed in 7 patients and confirmed sclerotic peritonitis in all. Ten patients transferred to hemodialysis, and only 1 patient underwent surgery. Three patients died. We recommend that patients on PD for more than 5 years who have impaired peritoneal ultrafiltration or peritoneal calcification should be carefully managed as presumptive cases of SEP.

Lack of Ca2+- and ATP-dependent priming stage in caffeine-induced exocytosis in bovine adrenal chromaffin cells: comparison with Ca2+

1. Caffeine (20-40 mM) secreted catecholamines from beta-escin-permeabilized bovine adrenal chromaffin cells in the presence or absence of 2 mM MgATP. The caffeine-induced catecholamine secretion in the presence of MgATP was to the same extent as that in the absence of MgATP. 2. Ca2+ (0.1-10 microM) induced a significantly greater secretion of catecholamines in the presence of MgATP than in the absence of MgATP. 3. ML-9 (100 microM) and ML-7 (100 microM), myosin light chain kinase inhibitors, and W-7 (100 microM) and trifluoperazine (TFP; 30 microM), calmodulin antagonists, inhibited the Ca2+-induced catecholamine secretion in the presence of MgATP but not in the absence of MgATP. They did not inhibit the caffeine-induced catecholamine secretion in the presence of MgATP. 4. The ATP-independent phase in Ca2+-dependent exocytosis is thought to be associated with the final step that ultimately leads to fusion, while the ATP-dependent phase is thought to be associated with a vesicle priming reaction. Therefore, these results suggest that the ATP-requiring priming stage is lacking in the process of caffeine-induced exocytosis in bovine adrenal chromaffin cells.

Myosin light chain kinase inhibitors and calmodulin antagonist inhibit Ca(2+)- and ATP-dependent catecholamine secretion from bovine adrenal chromaffin cells

We have used stage-specific assays for ATP-dependent priming and for Ca(2+)-activated triggering in the absence of ATP to examine the effects of myosin light chain kinase (MLCK) inhibitors, ML-9 and ML-7, and calmodulin antagonists, W-7 and trifluoperazine (TFP), on regulated exocytosis in beta-escin-permeabilized bovine adrenal chromaffin cells. Ca2+ (0.1-30 microM) induced a significantly greater secretion of catecholamines in the presence of MgATP (2 mM) than in the absence of MgATP. ML-9 (30 and 100 microM), ML-7 (30 and 100 microM), W-7 (30 and 100 microM) and TFP (10 and 30 microM) inhibited the Ca(2+)-induced catecholamine secretion in the presence of MgATP, but did not affect the catecholamine response to Ca2+ in the absence of MgATP. In intact cells all these compounds inhibited catecholamine secretion in responses to acetylcholine (100 microM) and high K+ (40 mM). The results obtained in permeabilized cells suggest that the calmodulin-MLCK system plays an essential role in the ATP-requiring priming stage but not in the Ca2(+)-triggered fusion step in the exocytotic process in bovine adrenal chromaffin cells.

Urologic abnormalities in Menkes' kinky hair disease: report of three cases

Menkes' kinky hair disease is a rare congenital disorder of copper metabolism with X-linked recessive inheritance. It is well known that it is frequently associated with urologic abnormalities. The authors experienced three such cases, but each of them was different. Multiple bladder diverticula, right vesico-ureteral reflux, and right hydronephrosis were noted on the first baby boy. In the second case, hematomas in the left kidney, pelvis, ureter and the adipose capsule, which were thought to be the abnormality of vessels, were noted in the neonatal period. In the third body, multiple bladder diverticular were noted at the age of 1 year. One year, 10 months later, a spontaneous rupture at the huge diverticulum occurred.

The effects of sevoflurane on contractile and electrophysiologic properties in isolated guinea pig papillary muscles

We examined, in guinea pig papillary muscles, whether the negative inotropic effect of sevoflurane is due to the depression of the influx of extracellular Ca2+ or to inhibition of the availability of intracellularly stored Ca2+. Sevoflurane decreased action potential duration and contractile force in a concentration-dependent fashion in normally polarized guinea pig papillary muscles. Sevoflurane produced a depression of contractile force with different rates or patterns of stimulation in the rested state and at low stimulation frequencies. In a potentiated state, sevoflurane did not depress contractile forces. Although sevoflurane decreased action potential duration and contractile force in a concentration-dependent fashion in normal Tyrode's solution, in high K+ Tyrode's solution, it caused a depression of contractile force without a shortening of action potential duration. Sevoflurane also depressed contractile force in normal and high K+ Tyrode's solution with ryanodine 1 microM. Our results suggest that in myocardial contractile force the negative inotropic effect of sevoflurane might be caused by depression of transsarcolemmal Ca2+ influx, accompanied by shortening of the action potential duration.

Newborn with congenital arteriovenous fistulas of the abdominal wall complicated by a ductus arteriosus aneurysm

A case of congestive heart failure in a neonate resulting from a congenital abdominal arteriovenous fistula is described; an aneurysm of the ductus arteriosus was also found in the patient. Abdominal aortography was performed and demonstrated dilated feeding arteries, including the hypogastric arteries, which communicated with a dilated umbilical vein. Ligation of the feeding arteries and the umbilical vein led to resolution of the heart failure. Transient liver dysfunction occurred, however. Symptoms improved dramatically upon removal of the ligature from the umbilical vein. Although there is one previous report of an arteriovenous fistula involving the umbilical vein, we know of no prior report of a congenital arteriovenous fistula in association with a ductus arteriosus aneurysm.

Comparison of cardiovascular responses to airway management: fiberoptic intubation using a new adapter, laryngeal mask insertion, or conventional laryngoscopic intubation

STUDY OBJECTIVES

To evaluate the circulatory effects of fiberoptic intubation with a newly developed mask adapter and to compare these effects with those obtained with a conventional laryngoscope and laryngeal mask airway with general anesthesia.

DESIGN

Randomized study.

SETTING

Operating room at a university hospital.

PATIENTS

30 ASA physical status I adult patients scheduled for minor elective surgery.

INTERVENTIONS

A Macintosh laryngoscope was used for intubation in Group L (n = 10), a fiberoptic bronchoscope with newly developed mask adapter was used in Group FI (n = 10), and a laryngeal mask airway was used in Group LMA (n = 10). Anesthesia was induced with thiamylal, fentanyl, and vecuronium. Patients were manually ventilated for 4 minutes with sevoflurane. Then their tracheas were intubated with a laryngoscope or fiberoptic bronchoscope, or a laryngeal mask airway was inserted.

MEASUREMENTS AND MAIN RESULTS

Blood pressure (BP) and heart rate (HR) were measured continuously. After intubation, the magnitude of change of both BP and HR was greatest in Group L, next highest in Group FI, and lowest in Group LMA.

CONCLUSION

Fiberoptic intubation with general anesthesia using the newly developed mask adapter offers an advantage over the standard laryngoscope for patients in whom pressor response of intubation is potentially hazardous.

New operative method for tracheal compression in congenital heart disease

A new technique is described for repairing tracheal compression caused by ascending aorta associated with corrected transposition of the great arteries and pulmonary atresia in a 113-day-old infant. Surgical repair for the tracheal compression was accomplished by suspending the pericardium around the aortic arch to the underside of the sternum. This method seems to be useful for some patients with tracheal compression caused by the ascending aorta.

Serum and urine inorganic fluoride levels following prolonged low-dose sevoflurane anesthesia combined with epidural block

STUDY OBJECTIVES

To determine whether serum and urine inorganic fluoride levels with prolonged (more than 7 hours) low-dose (0.8 to 2.0 vol %) sevoflurane anesthesia plus epidural anesthesia were increased as compared with isoflurane anesthesia plus epidural anesthesia. To measure the urine tubular enzymes N-acetyl-beta-glucosaminidase (NAG), alpha 1-microglobulin (alpha 1-M), and beta 2-microglobulin (beta 2-M) for renal tubular injury in both groups.

DESIGN

Randomized, prospective study.

SETTING

University hospital.

PATIENTS

15 ASA physical status I and II adults (7 males, 8 females) who were scheduled for prolonged laparotomy (lasting 9.5 to 10.2 hours) with general anesthesia.

MEASUREMENTS AND MAIN RESULTS

Epidural anesthesia was administered before induction of general anesthesia. General anesthesia was induced with thiamylal administered intravenously (IV), and the trachea was intubated following administration of vecuronium IV. It was maintained with either sevoflurane or isoflurane in nitrous oxide and oxygen. Standard monitoring was used in all patients. Serum and urine inorganic fluoride and urine tubular enzymes were measured periodically. Serum inorganic fluoride was 54 mumol/L at 4.3 minimum alveolar concentration (MAC) hours of sevoflurane; the peak level for isoflurane was 8 mumol/L at the same MAC hours. Sevoflurane also increased urine inorganic fluoride excretion to 96 mumol/hr 8 hours. NAG excretion started to increase after inhalation of either sevoflurane or isoflurane. alpha 1-M and beta 2-M excretion increased markedly postoperatively. Even though fluoride levels and tubular enzymes were high, there was no evidence of postoperative renal dysfunction.

CONCLUSIONS

There was no increase in urinary enzymes, which are indicators of tubular injury, specific to sevoflurane. There was no postoperative renal dysfunction, as indicated by unchanged serum creatinine and blood urea nitrogen levels.

[A case of thoracic aortic aneurysm associated with atypical coarctation and kinking of the aortic arch]

The aneurysm associated with atypical coarctation and kinking of the aortic arch is rare. Authors experienced such a case and performed operation using bypass technique as below. A 17-year-old male admitted to the authors' hospital to undergo operation of the enlarging thoracic aneurysm. He was observed from his childhood diagnosed as the coarctation and kinking of the aortic arch. The chest X-ray films showed a mass shadow in the left superior mediastinum. It had been also diagnosed as having a small post-stenotic dilation of aortic arch. Recently the mass on the X-ray enlarged. He was diagnosed as an aneurysm located on aortic arch using MR-imaging and aortogram. The aneurysmectomy was performed because of the possibility of the aneurysmal rupture. Under the general anesthesia, extra-anatomical bypass was made between ascending aorta and descending aorta, and another one between the bypass and left common carotid like as T-shape, because the proximal aneurysm was very near located on the origin of left common carotid. The aneurysm was excised and woven Dacron graft was implanted. The post-operative course was uneventful. This case suggests the necessity of deliberate clinical observation using roentgenography for a case of kinking of the aortic arch.

[A case report of cor triatriatum benefit of MRI for preoperative diagnosis and surgical method]

Cor triatriatum is uncommon in all congenital heart diseases. It is a malformation resulting in a separation of the left atrium or right atrium into two chambers due to a congenitally abnormal diaphragm. We wish to present a case of cor triatriatum in which MRI was found most useful for preoperative diagnosis and surgical procedure. A 2-year-old girl was transferred to us for severe pulmonary congestion as shown on chest X-ray. Echocardiography showed abnormal diaphragm in the left atrium. MRI demonstrated clearly the relationship between left pulmonary vein and the abnormal diaphragm. Therefore we should preoperatively determine type I A according to the Lucas and Schmidt's classification. Cardiac catheterization showed moderate pulmonary hypertension and confirmed cor triatriatum. The resection of the abnormal diaphragm was performed under extracorporeal circulation with moderate hypothermia. The postoperative course was uneventful. MRI is a very useful non-invasive technique in making a diagnosis and in choosing the appropriate surgical procedure for cor triatriatum.

[A case of tetralogy of Fallot associated with isolation of a subclavian artery and partial DiGeorge syndrome]

A month old girl was referred to our hospital for heart murmur and congestive heart failure. After the UCG and angiography, clinical diagnosis was tetralogy of Fallot, right aortic arch, isolation of left subclavian artery (Victorica type I), and a patent ductus arteriosus that originated from left subclavian artery. The direction of blood flow in the patent ductus arteriosus was from a subclavian artery to pulmonary artery, so she was in the condition of pulmonary over flow and appeared congestive heart failure, although she associated with tetralogy of Fallot. With intraoperative and postoperative examinations, we diagnosed the association of partial DiGeorge syndrome. Isolation of subclavian artery is uncommon, but this anomaly was classified by Victorica. Embryology of this anomaly was explained with hypothesis of double arch system. We had seen no reports of DiGeorge syndrome associated with isolation of a subclavian artery. But DiGeorge Syndrome is hypoplasia of branchiogenic organs, and subclavian arteries is differentiated from brachial arteries. So we supposed that this two lesions have the possibility of combination.

Inotropic and electrophysiologic effects of propofol and thiamylal in isolated papillary muscles of the guinea pig and the rat

We compared the inotropic and electrophysiologic effects of propofol and thiamylal in isolated papillary muscles of the guinea pig and rat. Propofol applied in clinical 10% intralipid emulsion showed concentration-dependent negative inotropic effects, accompanied by decreased action potential duration, in the guinea pig. Intralipid alone had no effect. Although thiamylal showed a concentration-dependent depression similar to propofol in the guinea pig, depolarization of resting membrane potential was seen at 0.1 and 0.3 mM, and a slight prolongation of action potential duration at 90% repolarization at 0.1 mM, and then a decrease of action potential duration at 0.3 mM. In rat papillary muscles, propofol did not produce any depression of contractile force, whereas thiamylal produced a concentration-dependent negative inotropic effect. The important findings observed in the action potential in rat papillary muscles were the modest shortening of action potential duration after propofol application, and the significant decrease of resting membrane potential and the significant prolongation of action potential duration caused by thiamylal. Both propofol and thiamylal depressed slow action potentials and contractile force in guinea pig papillary muscles depolarized by 25 mM K+ solution. In conclusion, the negative inotropic effects of propofol and thiamylal might be caused by inhibition of trans-sarcolemmal Ca2+ influx accompanied by shortening of action potential duration in guinea pig papillary muscles. The action potential of thiamylal might be affected by the suppression of K+ current in guinea pig and rat papillary muscles that was never observed in the propofol-treated tissue.

[A case of the successful treatment of pulmonary artery pseudoaneurysm after PA banding]

Pulmonary artery pseudoaneurysm after PA banding is a rare complication and its mortality is very high. The authors successfully operated on this sort of lesion. To our knowledge, this is the first successful case in Japanese literature. The second of twins was found to be suffering asplenia, dextro cardia, TAPVC, atrioventricular septal defect, corrected TGA and PDA. On the 19th day of life, increasingly pulmonary congestion forced us to operate. We performed PDA ligation, correction of TAPVC, together with extrathoracically adjustable PA banding. 5 months following this operation, spike fever and swelling of anterior thorax were noted. PA angiography was performed, and it showed that the pulmonary artery had been cut through by the band and a pseudoaneurysm had developed. The PA banding was removed and an end-to-end anastomosis of the PA was performed using cardiopulmonary bypass and deep hypothermia with surface cooling. The diameter of the PA anastomosis was designed to be one half that of her aorta. Staphylococcus aureus was cultured from the specimen of the PA band. It was thought to have contributed to the development of this aneurysm. The post operative course was uneventful.

Recurrent perforations of viscus due to ventriculoperitoneal shunt in a hydrocephalic child

In this report, we describe the first case of recurrent perforations of viscus due to ventriculoperitoneal shunt for the treatment of hydrocephalus. Based on our own experience and a survey of literature, we suggest that perforation of the gastrointestinal tract should be suspected in patients with ventriculoperitoneal shunt, particularly when abdominal symptoms or ventriculitis are presented. To manage this complication, at the first perforation in the present case, a fibrin sealant was effective for closure of the perforated stomach wall. At the second perforation, when laparotomy was performed, we could not find any abnormality in the abdominal cavity except for a sheath and slight omental adhesions near it.

[The development of the Japanese Irrational Belief Test]

Japanese Irrational Belief Test (JIBT), a self-report type measure was developed as a means to aid the controlled clinical research on rational-emotive therapy. A five point scale questionnaire consisting of 107 items was administered to 211 Japanese university students, analyzed by factor analysis and item analysis, and seven scales of 10 items each were finally constructed. Seven scales measure the testee's beliefs on self expectation, problem avoidance, ethical blame, helplessness over inside, dependence, cooperativism and helplessness over outside. Coefficients of internal consistency of seven scales were 0.725 to 0.882. Both the JIBT and the STAI were administered to 208 normal subjects to examine their relationships, and the JIBT was also administered to 98 neurotic subjects to compare with the normal subjects. The results showed that for the normal subjects the beliefs on problem avoidance, helplessness over inside, dependence, cooperativism and helplessness over outside were highly correlated with anxious proneness, and statistically significant differences between the normal subjects and the neurotic subjects were found in the beliefs on self expectation, problem avoidance, helplessness over inside, dependence and helplessness over outside.

Nasal administration of salmon calcitonin for prevention of glucocorticoid-induced osteoporosis in children with nephrosis

To determine the effect of intranasal administration of salmon calcitonin on glucocorticoid-induced osteoporosis in children with nephrosis, we gave 100 U of calcitonin intranasally on alternate days with 1 alpha-hydroxyvitamin D3 to five children, 8 to 12 years of age, with frequently relapsing nephrosis. Four patients with osteoporosis, 10 to 14 years of age, were treated only with 1 alpha-hydroxyvitamin D3 and served as control subjects. Both groups were treated with an almost equal amount of glucocorticoids previously and during this study period. Bone mineral content of the spine was measured by a quantitative computed tomographic technique. The bone mineral content was preserved in both cortical and spongeous areas of the vertebrae during the 16-month period in the calcitonin-treated group but was decreased significantly in the control group. Urinary hydroxyproline and calcium excretion decreased significantly in the calcitonin-treated group. The serum calcium and phosphorus concentrations and the parathyroid function did not change significantly in either group. We conclude that calcitonin suppressed bone resorption and might be useful for the long-term treatment of osteoporosis, in combination with 1 alpha-hydroxyvitamin D3, in children with nephrosis requiring long-term glucocorticoid therapy.

[Studies on 145 cases of septicemia in infancy and childhood--especially on septicemic patients with malignant and hematological diseases]

Clinical and bacteriological data of 145 inpatients with septicemia, treated at the hospital of Chiba University School of Medicine from 1972 to 1987, were reviewed by dividing them into three stages. (stages I: 1972-76, stage II: 1978-82, stage III: 1983-87) Patients with underlying diseases have been increasing: 91.8% of the total patients in stage III. Among the patients with underlying diseases, malignant and hematological diseases occupied about 60%, and in the other diseases, congenital heart diseases have been increasing in number. As to the organisms isolated, gram positive bacteria have increased, while gram negative bacteria have decreased. In stage III, the rate of gram positive organisms and gram negative ones accounted for 43.1% and 41.2% of all the isolates from the septic patients with malignant & hematological diseases, respectively. In patients with malignant & hematological diseases, alpha-streptococcus, coagulase-negative staphylococcus, and Fusobacterium sp. have been increasing, whereas, Escherichia coli, Enterobacter sp., Klebsiella sp., and Pseudomonas aeruginosa decreasing. In patients with other underlying diseases, S. aureus, CNS, and non Fermenters have been increasing. Among the patients without underlying diseases, gram positive bacteria accounted for the major part. The decrease of gram negative organisms in patients with malignant and hematological diseases may partially depend on the introduction of polymixin B as the drug of gut decontamination. The outcome of septicemia in the patients with malignant & hematological diseases has been markedly improving through all the three stages. During stage III, episode mortality and case mortality rate proved to be 23% and 31%, respectively. The introduction of the third generation cephems has decreased the mortality rate for gram negative organisms and contributed to the improvement of the total prognosis. The prognosis was worst in the case of P. aeruginosa, showing a mortality rate of 50% during stage III. Coincidence rate of blood and other cultures have been largest in the case of P. aeruginosa, so, the drug sensitivity of the strain cultured from other sites is sometimes useful in the choice of antibiotics.

Primary intra-osseous carcinoma of the maxilla

An unusual case of maxillary carcinoma, diagnosed as a primary intra-osseous carcinoma, is reported. This was differentiated from primary carcinoma of the maxillary sinus on the basis of the radiographic findings and the patient's dental history.

[Clinical studies of sulbactam/cefoperazone therapy in pediatric bacterial infections]

Sulbactam/cefoperazone (SBT/CPZ) was administered intravenously to 9 patients with respiratory infections (H. influenzae 6 cases, pathogens unknown 3 cases), 2 patients with urinary tract infection (E. coli and C. freundii; both cases had VUR), and 1 patient with staphylococcal bacteremia. In these causative bacteria, 5 strains (H. influenzae 3, E. coli 1 and S. aureus 1) were beta-lactamase producers. Bacteriological efficacy (eradication rate) was complete (9/9, 100%) and clinical efficacy was also complete (12/12, 100%). In comparison with CPZ alone, MICs of SBT/CPZ against beta-lactamase producing bacteria were superior. Although mild side effect was observed in 1 case (eosinophilia), no other severe form of adverse reaction were encountered. It was concluded that SBT/CPZ was an useful antibiotic for the treatment of pediatric bacterial infections, especially caused by beta-lactamase (penicillinase) producing bacteria.

Chylothorax following Bochdalek herniorrhaphy in an infant

A case of chylothorax following Bochdalek herniorrhaphy in an infant is presented. To our knowledge, it is only the third case to be reported in the literature.

[Basic and clinical studies on cefmenoxime in pediatric field]

Cefmenoxime (CMX) is a newly developed cephalosporin. Basic and clinical studies on this drug was carried out and the results were as follows. 1. Serum level and urinary recovery A 7 years old male was administered 10 mg per kilogram of CMX by one shot intravenous injection. Serum levels were 23.3 micrograms/ml at the time of 15 minutes after injection, 12.0 micrograms/ml at 30 minutes, 3.9 micrograms/ml at 1 hour, 2.0 micrograms/ml at 2 hours, and 0.3 micrograms/ml at 4 hours. In this same patient, 6-hour urinary recovery was 54.7%. 2. Clinical evaluation and adverse reaction Thirty-seven patients (upper respiratory infection 4, pneumonia 20, pyothorax 1, purulent lymphadenitis 1, cellulitis 2, sepsis 1 and urinary tract infection 8) were treated with CMX in doses of 30 approximately 212 mg/kg divided 3 approximately 4 times per day for 1.5 approximately 21 days intravenously. The overall efficacy rate was 94.6%. As to adverse reaction, exanthema and drug fever were observed in 1 patient respectively. Abnormal laboratory data noted were eosinophilia in 2.3%, and elevation of serum transaminase in 9.8%.