[Case of fanconi syndrome positive for anti-M2 antibodies revealed by severe hypokalemia and multiple bone fracture]

A 38-year-old female developed pain in the right leg in 2006. In 2007, the diagnosis of femoral head necrosis was made based on MR images, and femoral head prosthetic replacement was performed. In April 2009, she visited a local hospital for low back pain, and was referred to our department due to electrolyte abnormalities on hemanalysis. Since marked hypokalemia (K=2.5 mEq/L), hypophosphatemia, hyperchloric metabolic acidosis, proteinuria, and urinary blood sugar suggested Fanconi syndrome, she was admitted for close examination. Bone survey showed a marked decrease in the amount of bone particularly in the four limbs and fracture at the proximal 1/3 of the left ulnar bone. In the lumbar spine, scoliosis and vertebral deformity were observed. Since impaired P re-absorption and unselected aminoaciduria and osteomalacia were also present, the diagnosis of Fanconi syndrome was made. On admission, ventricular tachycardia developed due to hypokalemia, requiring immediate electrolyte correction. For differentiation from acquired Fanconi syndrome, various examinations were performed. No apparent cause was found except for the positive antimitochondrial antibody-M2 (anti-M2). In this case, no data suggested liver dysfunction, and subsequent liver biopsy also showed no significant pathological findings pointing to PBC. We encountered a patient with Fanconi syndrome positive for anti-M2. This case may attract interest, particularly in the mechanism of nephropathy due to anti-M2, and therefore, this case is reported with a literature review.

Effect of formula thickened with reduced concentration of locust bean gum on gastroesophageal reflux

AIM

Previous studies showed that HL-350, a formula thickened with a reduced concentration of locust bean gum, decreased frequent regurgitation in 4-month old infants with reflux. In this study, we investigated the effect of HL-350 in younger infants.

METHODS

We studied 20 infants less than 2 months old who had three or more episodes of regurgitation or vomiting per day. Ten infants (group A) were fed with HL-350 for the first week, and with control milk, HL-00, for the following week. The other 10 infants (group B) were fed in reverse order. Mothers recorded number of regurgitation episodes, feeding volume and time and number of bowel movements. To evaluate gastric emptying we measured antral cross sectional areas ultrasonographically at various time points after feeding.

RESULTS

The median number of regurgitation episodes decreased significantly with feeding of HL-350 (2.3/day) compared to feeding with control milk (5.2/day) (p = 0.00048). No significant difference was evident in feeding volume and time, body weight gain, or gastric emptying rate between HL-350 and control milk.

CONCLUSION

HL-350 decreased the number of regurgitation episodes without affecting gastric emptying delay in very young infants with recurrent vomiting.

Plasmapheresis in fulminant acute disseminated encephalomyelitis

We report an 11-year-old girl with acute disseminated encephalomyelitis (ADEM) who developed respiratory failure and coma despite the use of corticosteroid and intravenous immunoglobulin. We performed plasmapheresis four times, which improved her level of consciousness, hyperesthesia, external ophthalmoplegia and muscle weakness, and led to the normalization of brain and spinal cord MRI. Plasmapheresis might be an effective treatment in cases of fulminant ADEM.

[The relation between the severity of bronchial asthma and the treatment points in children]

The treatment points and score for definition of the asthma severity were initially introduced in the guideline for pediatric asthma treatment and management on 1998. We studied the relationship between the severity of clinical symptoms for children with bronchial asthma and the treatment points from July 1998 to November 1999 in our hospital. One hundred twenty five patients (one to 15 years of age, 77 boys and 48 girls) were retrospectively investigated. The treatment points and scores were associated with the clinical symptom score. However, there was no relationship in some patients. In order to define the severity of bronchial asthma, we should investigate not only the severity in terms of the clinical symptoms; the number and degree of asthma attacks, but also the treatment points and score. Furthermore, we should pay attention to the seasonal variation of the treatment points.

A study on more than 20 years of postoperative follow-up in pediatric surgical cases

There have been very few postoperative follow-up studies from the aspect of philosophical anthropology in the field of pediatric surgery. Fifty patients who underwent surgery either during the neonatal period or infancy and have been receiving medical treatment or consultation for more than 20 years in Juntendo University Hospital and Katsunan Hospital, were investigated from the aspect of philosophical anthropology. During adolescence or young adulthood, 52% of the patients were suffering from their medical problems. Forty percent of patients were bullied by their peers during their elementary school age due to various medical problems. As patients became adolescents or young adults, 20% of them started to feel that others were prejudiced against them or they were discriminated against when going to school or looking for a job. About 30% of patients who were of elementary school age and of adolescent or adult age, were introverted and short-tempered. Eighteen percent of the patients who were of elementary school age and adolescent or young adult age, were not satisfied with their family, particularly their parents, because of their medical problems. When patients became adults, 40% were not satisfied with their own society, particularly with others in their working place. More than 80% of patients who were of preschool age were shielded from their medical problems by their parents. As they became older, their parents were not always able to cover up their medical problems, but understanding school teachers and their elders were able to shield some of patients from social ridicule. By learning the results of this study, it is important for pediatric surgeons to minimize postoperative medical problems, giving proper surgery and postoperative care. Pediatric surgeons should become very supportive medical doctors to patients who suffer from postoperative medical problems.