Transient low level of IgG3 induced by sepsis

Staphylococcus aureus sepsis developed in a 14 year old girl. Immunological evaluation revealed low level of IgG3, although total IgG level was normal. The level of IgG3 increased gradually along with the recovery from sepsis. Immunoglobulin replacement therapy might have been useful in this patient, even though the total immunoglobulin level was within normal limits.     

Phase II Study of Mitoxantrone in Patients With Non-Small Cell Lung Cancer

A phase II study of mitoxantrone was performed in 24 patientswith non-small cell lung cancer (NSCLC). Mitoxantrone was administeredby intravenous drip infusion of 12 mg/m² every three weeks.There were no responders among the 21 evaluable patients includingfive patients without prior therapy. The major hematologicaltoxic effect was leukocytopenia. Thrombocytopenia and decreasein hemoglobin were slight. A change in the electrocardiogramwas observed in one patient and one patient experienced cardiogenicshock. Mitoxantrone is not acceptable for the treatment of NSCLC becauseof its low antitumor activity, and careful observation is neededfor administration of this agent to patients with pre-existingrisk factors, such as prior anthracycline exposure, mediastinalradiation or underlying cardiovascular disease.     

Moyamoya disease associated with bilateral renal artery stenosis

Recent research has suggested that an association exists between moyamoya disease and fibromuscular dysplasia which involves systemic vessels, including renal arteries. We report a 3 year old girl with moyamoya disease associated with bilateral renal artery stenosis. This case may support the common etiology of these two clinical conditions. To our knowledge this is the youngest case of moyamoya disease associated with bilateral renal artery stenosis.     

Infectious diseases in African children

Present status and problems of infectious diseases in African children are detailed. The Department of Paediatrics, Mie University School of Medicine has 10 years' experience of international medical cooperation with African countries. At present, the department is participating in two projects in Ghana and Zambia. The activities have been carried out in the field of priority infectious diseases in African children. Major infectious diseases in Africa are malaria, diarrhoeal diseases, acute respiratory infections and some specific parasitic diseases. Human immunodeficiency virus infection has also become a threat to the health and survival of children in Africa. To reduce morbidity and mortality due to these diseases, primary health care activity may be an effective and economical measure. Japan is expected to make further technological and economical contributions to the control of the infectious diseases in developing countries. Japanese paediatricians should be aware of the condition of child health in developing countries and consider what can be done to help.     

Morphological and molecular changes in denture‐supporting tissues under persistent mechanical stress in rats

Summary The purpose of this study was to determine the effects of mechanical compression on the palatal mucosa using an experimental palatal base. The palatal base was either pressed onto (stress group) or not pressed onto (fit group) rat palatal mucosa. Blood flow was measured and the animals were sacrificed 6–72 h later for analysis. The expression of heat shock protein 70 (HSP70), vascular endothelial growth factor (VEGF) and proliferation cell nuclear antigen (PCNA) was characterized by immunohistochemical staining. For morphometric analysis, connective tissues were divided into bone side and epithelial side tissues. The ratio of PCNA‐positive cells (PCNA score) was calculated, and the expressions of mRNA encoding HSP70 and VEGF was evaluated. Whereas blood flow in the stress group showed ischaemia, none was found in the fit group. Proliferation cell nuclear antigen scores on the bone side were higher than on the epithelial side in the stress group (P < 0·05). Heat shock protein 70‐ and VEGF‐positive cells were observed under compression conditions, particularly in the periosteum. In the stress group, the expressions of mRNA encoding HSP70 and VEGF were highest at 12 h (P < 0·05). These results suggest that mechanical compression of the palatal plate induces ischaemia, and that cells in the underlying denture‐supporting tissue, which includes the periosteum, synthesize HSP70 and VEGF to maintain homeostasis under these conditions.     

Change in the post-discharge destinations from a senile dementia therapy ward in Japan: the second report

Background: The new long‐term care insurance (LTCI) system, known as Kaigo‐Hoken, was implemented in April 2000. We previously reported a change in the type of destination after discharge from a senile dementia therapy ward (named the Midori ward) following implementation of the LTCI system at Fukuoka Prefectural Onga Hospital during the period from 1 April 1999 to 31 March 2001 in Psychogeriatrics (2003; 3 : 104–108). We subsequently investigated the type of destination after discharge from the Midori ward at Fukuoka Prefectural Onga Hospital during the period from 1 April 2001 to 31 March 2002. Methods: We used data from a total of 320 discharged inpatients with dementia who fulfilled the criteria according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM‐IV) for dementia of the Alzheimer's type, vascular dementia and other types of dementia. We compared the period from 1 April 1999 to 31 March 2000 before the LTCI implementation and the periods from 1 April 2000 to 31 March 2001 and 1 April 2001 to 31 March 2002 after the LTCI implementation. The type of destination after discharge and the place of origin of the inpatients before admission were classified into one of the following groups: (i) nursing home or geriatric care facility group; (ii) hospitalization group; (iii) home group; and (iv) death group. Results: No significant change was evident when the subjects’ post‐discharge destinations were compared or when the subjects’ pre‐admission residences and post‐discharge destinations were compared. These results were similar to our previous report which appeared in Psychogeriatrics (2003; 3 : 104–108). Conclusion: While the LTCI system has become more widely used, it is still necessary to analyze each case and provide the care that encourages people with dementia in senile dementia therapy wards to return to their homes under the LTCI system.     

The Protective Effect of 2-Mercapto-Ethane Sulfonate (MESNA) on Hemorrhagic Cystitis Induced by High-Dose Ifosfamide Treatment Tested by a Randomized Crossover Trial

High-dose ifosfamide (one or two courses of 6 g/m²) with orwithout mesna was administered to 13 patients with advancednon-small cell lung cancer. The protective effect of 2-mercapto-ethanesulfonate (mesna) against the urotoxic side effects inducedby ifosfamide was examined by a randomized crossover trial.A significant reduction in the incidence of hematuria was observedin the patients receiving mesna. Macroscopic hematuria was observedin only one patient who received treatment with mesna versusseven patients treated with ifosfamide alone. Other symptoms,such as frequency and dysuria, tended to be diminished in thepatients receiving mesna, although the difference was not statisticallysignificant. Our results suggest that mesna is effective inpreventing or diminishing ifosfamide-induced hemorrhagic cystitis.Concomitant use of mesna should allow the administration ofa high dose of ifosfamide although more extensive studies areneeded to define the optimal dose and schedule of administrationof mesna to prevent or attenuate the hemorrhagic cystitis.     

Clonal and non-clonal karyotypically abnormal cells in haemophagocytic lymphohistiocytosis

We studied chromosomes in bone marrow (BM) or peripheral blood cells of nine patients with haemophagocytic lymphohistiocytosis (HLH); three of them had a family history of HLH and four others underwent concurrent Epstein-Barr virus (EBV) infection. In addition to a large population of normal mitotic cells, karyotypically abnormal clonal cells were found in two patients, abnormal clonal cells and a nonclonal (single) abnormal cell in one, and nonclonal abnormal cells in three. All the six patients with chromosome abnormalities died of progressive disease; one of them also had EBV infection and EBV-associated clonal proliferation. Two of three patients with EBV infection and only normal mitotic cells in BM completely recovered from the disease.
Although HLH did not show histological and/or haema-tological evidence of a neoplastic disease, clonal chromosome abnormalities and the fatal clinical outcome found in some of the patients suggest that the disease may be heterogenous and include malignancy. HLH patients with karyotypically abnormal clonal cells in BM should warrant more intensive chemotherapy than that presently being applied to them and should be considered as candidates for BM transplantation.