Injuries of school-aged children in Japan: Causes and costs

Injuries of school-aged children were presented from several data sources. About 80000 schools, from nurseries to upper secondary schools, operate in Japan and are attended by 24.3 million students. About 97% of these young people are insured by the insurance system of the School Safety Division of the National Stadium and School Health Center of Japan. Annual injuries and illnesses total 1.08 million, 1039 cases being impedimentary and 191 causing death. The average incidence of injury and illness is 4.6%, a rate that has been increasing every year since 1960. The activity at the time of injury, the impairment incurred, and the part of the body injured differ with the type of school and depend mainly on the developmental stage of the child. Minor injuries occur at the rate of about 47 cases in elementary schools and 14 in lower secondary schools versus one benefit-applied injury at a school safety center. The cost of injuries under the control of schools totaled US$124 million per year in 1990. The average amount of benefits per injured student per month was US$63.     

Childhood injuries in Japan

Approximately 2000 children aged between 0 and 14 years die annually of accidents and their sequelae in Japan. Moreover, accidents and their sequelae are the leading cause of death in the 1–4 year, 5–9 year and 10–14 year age groups. Accidental drowning and traffic accidents account for 2/3 of all such deaths. Measures for preventing injury in these age groups are clearly necessary, since the mortality rate due to accidents and their sequelae in children 0 to 4 years old is higher in Japan than in European countries. It is considered that the lives of 824 infants aged between 0 and 4 years might be saved annually in Japan if the mortality rate could be reduced to a level comparable to that in Sweden by accident prevention and control. Therefore, a systematic approach for prevention of childhood injury is a high priority in Japan.     

Generation and Characterization of Monoclonal Antibodies Specific to Surface Antigens of Human Trophoblast Cells

PROBLEM : To generate and utilize specific monoclonal antibodies for routine fetal cell isolation from the maternal circulation. METHODS : Monoclonal antibodies specific to human trophoblast cell surface antigens were generated and characterized. After cell fusion, antibodies secreted by hybridomas were screened by enzyme-linked immunosorbent assay and immunohistochemical assays. RESULTS : By using cultured BeWo choriocarcinoma cells or the membrane fraction of human placenta as the immunogen, seven (BW-108, 110, 123, 124, HP-15, 16 and 17) antibodies specific to the surface antigens of trophoblast were produced. They were shown to have little cross-reactivity to other human tissues. Among the antibodies raised against human sperm, HSA-10 was also found to cross-react with human trophoblast, but not detected in other tissues. When immobilized to magnetic beads, these antibodies were shown to react only with BeWo cells in suspension, but not blood cells and ovarian carcinoma cell line, OC-3-VGH. CONCLUSION : Therefore, these antibodies may have potential application in fetal trophoblast cell isolation from the maternal circulation for prenatal genetic diagnosis.     

Retroperitoneal lymph node dissection in patients with interaortocaval lymph node metastases of transitional cell carcinoma of the urinary tract

Three patients suffered from renal pelvic, ureteral and bladder cancers that were treated with both standard surgical treatments and two adjuvant cycles of cisplatin-based combination chemotherapy. Metastases of interaortocaval lymph nodes were detected in all patients between 9 and 33 months from the surgery for primary lesions. All patients received three cycles of cisplatin-based combination chemotherapy and retroperitoneal lymph node dissection (RPLND). The chemotherapy achieved partial response (62-98%). Two patients with viable cancer cells died with hepatic metastases; the first 15 months and the second 25 months from the date of diagnosis of distant lymph node metastasis. The third patient, who had no viable cancer cells, remains alive and disease-free 36 months later. Therefore, RPLND after chemotherapy provides prognostic information that helps to define patients who might benefit from additional systemic chemotherapy.     

Para-Aortic Nodal Irradiation in the Treatment of Carcinoma of the Uterine Cervix: A Report of 22 Cases

Twenty-two patients with previously untreated carcinoma of theuterine cervix were treated by para-aortic nodal irradiationfor the macroscopical metas-tases found at the operation withor without pathological confirmation, at the National CancerCenter Hospital from 1962 to 1980. The irradiation was givenwith 6 MeV X rays. Total doses ranged from 42 to 99 with anaverage of 69 in Time Dose Fractionation factors. All of thepatients died of the tumor within 42 months. The initial siteof relapse was intrapelvic for two patients, extrapelvic for18, and both intra- and extrapelvic for two. Of 12 patientsupon whom autopsies were performed, only one of the patientswho had multiple metastatic tumors of less than i cm in maximumdiameter had the tumor controlled in the irradiated region.     

Long-term ventilator-assisted children in Japan: A national survey

Owing to improved technology and care for patients who need mechanical ventilation, the quality of life as well as the prognosis for long-term ventilator-assisted patients has improved significantly in recent years. However, the increased number of these patients has raised economic, ethical and medical problems. In order to assess the magnitude of these problems, we conducted the first nationwide survey on the status of long-term ventilator-assisted children in Japan. Questionnaires were mailed to 2524 pediatric departments at hospitals in Japan with more than 100 beds. At the time of the survey, 282 hospitals had 567 patients who had been ventilated for more than a month. Among these patients, 434 were younger than 20 years and had been ventilated for more than 3 months. The most common basic disorders were: various myopathies (n = 65), hypoxicischemic encephalopathy (n = 60), spinal muscular atrophy type 1 (Werdnig-Hoffmann disease, n = 55), chronic lung disorders of prematurity (n = 21), Ondine's curse (n = 22), drowning (n = 17) and congenital heart diseases (n = 16). Of these 434 patients, only 61 were ventilated at home. Although home care was considered suitable for chronic ventilator patients by many pediatricians who responded to the survey, its realization has been hampered by the lack of a system and regulations to support it. The fact that many pediatricians in Japan have actively prolonged the life of Werdnig-Hoffmann patients, from whom aggressive life saving measures have been withheld in most Western countries, has raised ethical as well as medical issues.     

Dysplasia of the Uterine Cervix

In order to evaluate the significance of dysplasia lesions ofthe uterine cervix, 6,587 cervical biopsies in the five yearsfrom 1974 to 1978 were reviewed. The average age at the timeof diagnosis was: dysplasia, 44.4 years; carcinoma in situ,48.7 years; microinvasive carcinoma, 50.9 years; invasive carcinoma,56.6 years. This group consisted of 653 cases of dysplasia,194 of carcinoma in situ, 75 of microinvasive carcinoma, and536 of invasive carcinoma. On the basis of follow-up studiesof 166 dysplasia patients, the lesions of nine (5.4%) of thesepatients progressed to in situ carcinoma. These nine patientswere kept under observation for periods varying between 12 and41 months. These findings, in addition to the similar distributionof dysplasia and carcinoma in situ on the cervix, suggest thatdysplasia is a stepping stone to carcinoma.