Primary IgA Glomerulonephritis and Schonlein-Henoch Purpura Nephritis: Clinicopathological and Immunohistological Characteristics

A comparative analysis on clinicopathological and immunohistologicalcharacteristics was performed of 205 cases with primary IgAnephritis and 35 with Schönlein-Henoch purpura nephritis(purpura nephritis). Diagnostic criteria for primary IgA nephritiswere set out so that IgA was either the most prominent immunoglobulinor, at least, equal to IgG and/or IgM, if present, irrespectiveof mesangial or peripheral localization. In primary IgA nephritis,one half of the cases were discovered by asymptomatic proteinuria,and one-third presented recurrent upper respiratory tract infectionand gross hematuria, one-fourth abdominal pain and a few casesjoint pain, while purpura nephritis was associated with a significantlyhigher incidence of such systemic symptoms as abdominal andjoint pains, in addition to purpura. Both diseases shared atendency toward conspicuous hematuria in contrast to the modestproteinuria, with normal renal function in three-fourths totwo-thirds. Moreover, four of 35 with purpura nephritis showedpreceding proteinuria and had been regarded as primary IgA nephritisuntil purpura appeared. The glomerular pathology had a commonfeature in that there was frequent occurrence of mesangial proliferativeand focal and segmental lesions. The immunohistology in thetwo diseases was indistinguishable with regard to the glomerularimmunoglobulins and mediators, whether purpura was present orabsent. Thus, we propose a unifying concept that, by analogywith SLE, primary IgA nephritis may be regarded as ‘sinelupo,’ lying on one side of the nosological spectrum withless systemic symptoms, whereas purpura nephritis may occupythe other side with more systemic aspects. Furthermore, we confirmedthe epimembranous granular deposition of IgA in both diseasesas the most characteristic morphological expression of circulatingimmune complexes.     

Tobacco use among Japanese schoolchildren: results from preliminary study of Japan adolescent smoking survey (JASS)

Over the past two decades many studies have shown associationsbetween smoking and increased health problems. Smoking amongchildren is especially a major public health concern. Preventingyoung people from developing a smoking habit is an importantgoal for school health education. In Japan, it is difficult to collect accurate data regardingadolescent smoking behaviour, because in Japan smoking underthe age of 20 is prohibited by law. Therefore, a large surveyof smoking habits of young Japanese people was overdue. Numeroussurveys have been carried out since the late 1970s, but thesehave been limited in sample size or geographic area. The Japan Adolescent Smoking Survey (JASS) is probably the largestnumerical survey of smoking behaviour and opinions of schoolchildrenever carried out in Japan. Here the authors show the preliminaryresults of JASS. The goals of the JASS study are to standardize the method ofmeasurement in the smoking behaviour of young children. We believeit is now possible to compare national and international smokingrates of young people, and further, to develop and evaluateteaching methods about smoking for schoolchildren on the basisof this standardization. This report presents the tobacco use among schoolchildren inJapan.     

Serum Lipids in Patients With Carcinoma and Benign Diseases of the Breast

The serum levels of total triacylglycerol, cholesterol and phospholipidsin 121 patients with breast carcinoma, 61 patients with benignbreast diseases and 145 healthy females were studied especiallyin relation to their alteration by aging. At all age levels the patients with breast carcinoma had significantlyhigher concentrations of serum triacylglycerol than those withbenign breast diseases. In carcinoma patients a gradual increasein the levels of serum cholesterol was observed with age, showingthe same tendency as healthy females. Increases in serum phospholipidswere observed with age in patients with carcinoma and benigndiseases of the breast but were not statistically significantin comparison with those of healthy controls.     

Herpes zoster in a normal child after varicella vaccination

A healthy 5 year old girl developed herpes zoster in the dermatome supplied by the ophthalmic branch of the fifth cranial nerve 40 months after varicella vaccination. She was admitted to our hospital because of high fever and painful vesicular lesions over the left side of her forehead. She was treated successfully with systemic and topical acyclovir without developing herpetic keratoconjunctivitis. Our acute and convalescent phase evaluations showed that non-specific cellular and humoral immunity was normal. This is the fourth case of herpes zoster developing in an immunocompetent child following vaccination. Unlike the previously reported cases, our patient required hospitalization mainly to prevent ocular involvement. The issue concerning whether the universal introduction of varicella vaccination of normal children will reduce the incidence of the subsequent occurrence of herpes zoster must await further studies involving longer follow-up periods.     

Double Target Method (Double Marker-Guided Extrathoracic Introducer Insertion)

Incidence of damage to pacemaker and implantable cardioverter defibrillator leads is an emerging problem that should be prevented. The extrathoracic venipuncture approach has been suggested as a technique for venous access to avoid the problem. This report describes the method of double marker-guided venipuncture of extrathoracic subclavian and/or axillary vein. This approach achieves definite, safe, and speedy extrathoracic venipuncture and may be especially suitable for multiple lead placement for cardiac resynchronization therapy. (PACE 2004; 27[Pt. I]:818–820)     

Clinical Application of Left Ventricular Assist Devices

In Japan, 32 patients have had application of monoventricular and biventricular assist devices during the past three years. Five of the 32 patients treated by the Fall of 1986 have successfully achieved long-term survival. In this paper we describe our experience with the Tomasu and Pierce VAD in a total of four and two patients, respectively. Four of the six patients could be successfully weaned from the VAD and two of them were long-term survivors. Nonsynchronizing pumping of the VADs was effective, as well as synchronizing pumping. Anticoagulant therapy is highly recommended during the use of the VAD although there was no significant incidence of thromboembolism or thrombus in the devices in this clinical series.     

Evolutionary aspects of positioning and identification of vertebrate limbs

Emerging developmental studies contribute to our understanding of vertebrate evolution because changes in the developmental process and the genes responsible for such changes provide a unique way for evaluating the evolution of morphology. Endoskeletal limbs, the locomotor organs that are unique to vertebrates, are a popular model system in the fields of palaeontology and phylogeny because their structure is highly visible and their bony pattern is easily preserved in the fossil records. Similarly, limb development has long served as an excellent model system for studying vertebrate pattern formation. In this review, the evolution of vertebrate limb development is examined in the light of the latest knowledge, viewpoints and hypotheses.     

Systemic sclerosis in children: A national retrospective survey in Japan

A retrospective questionnaire survey of pediatric departments, for childhood collagen disease from 1985 to 1994 was used to clarify the clinical features of scleroderma in Japan. In the primary survey, 0.9% of the children with a rheumatic condition had scleroderma. Answers to this questionnaire were received on 18 (localized 9; systemic 9) patients from 15 institutions. In order to examine systemic sclerosis (SSc), seven cases of SSc in Japanese articles during the same period as the questionnaire were added to these answers and compared to the Japanese epidemic study investigated by Fukuyama in 1974. There were 16 children, seven boys and nine girls, with SSc during the 10-year period in Japan. The mean age of onset of symptoms was 8.0 ± 2.8 years and the age at diagnosis was 10.1 ± 3.0 years. Eighty percent of children had Raynaud's phenomenon at the onset of SSc, and skin and musculoskeletal involvement was highly recognized during the course of the disease. Atrophy of the frenulum linguae and lung fibrosis were commonly seen in SSc. In serological studies, 80% of children have antinuclear antibodies and approximately 50% of patients have anti-Scl-70 (topoisomelase I) antibodies at the onset and during the course of childhood SSc. The prognosis is poor, as remission occurred in only one child. The clinical symptoms and examination of serological autoimmune antibodies were supportive of an early diagnosis of SSc. When compared to the previous national survey of children with SSc, the present results showed that the male-to-female ratio was reduced, the age at onset was low, the positive incidence of serological autoimmune antibodies elevated, and the usage of vasodilators and nonsteroid anti-inflammatory drugs (NSAID) increased, with corticosteroids decreased. But, the positive percentage of clinical symptoms were not changed in both studies. For a complete retrospective nationwide epidemic survey carried out on children with scleroderma, especially SSc, it is important to include dermatology departments.