Katsushi Miura

Study of Liver Function in Infants with Atopic Dermatitis Using the 13C-Methacetin Breath Test

Serum glutamic-oxaloacetic transaminase (GOT) levels were determined in 214 infants (133 males and 81 females) with atopic dermatitis during their first visit to the Department of Allergy, National Childrens Hospital, Tokyo, Japan. Compared with the normal hospital range, their levels were found to be significantly higher, a tendency which was more conspicuous in lower age groups. We carried out a 13C-methacetin breath test (MBT), administering the stable-isotope-labeled compound to 11 children with higher serum GOT values and 5 within the normal range to investigate hepatic metabolism of methacetin in infants with atopic dermatitis. 13C-methacetin was given orally, and the 13CO2 level in the breath was determined immediately before and after administration, by mass spectrometry. Compared to the normal controls, the atopic infants demonstrated significantly lower 13CO2 peak excretion and delayed peak time. The clearance rate of 13CO2 was also decreased. These results suggest some relationship between atopic dermatitis and liver function in infants.

Acute Heart Failure Due to Midaortic Occlusion as the Initial Manifestation of Takayasu Arteritis

An afebrile 8-year-old Japanese girl was referred with hypotensive shock and respiratory distress. She presented with a cough of 1-week duration followed by lethargy, dyspnea, and anuria, with which she was admitted to a previous hospital. She was intubated and given intravenous catecholamines, which did not improve her symptoms. Then, she was transferred to our hospital. Physical examination revealed a right arm blood pressure of 128/64 mm Hg and a left arm blood pressure of 94/56 mm Hg while on 4.6 μg/kg per min of dopamine and dobutamine. However, no blood pressure was obtained in the lower limbs. The heart sounds were distant with no murmur audible. Coarse crackles were prominent in both lungs. Laboratory data showed the following values: creatine kinase of …

Care of children with allergic diseases following major disasters.

To the Editor, On March 11, 2011, a massive earthquake of magnitude 9.0 struck the Tohoku region of Japan. More than 18,000 people have been reported dead or missing, and many others have been forced to live in evacuation centers. Children are particularly vulnerable in such disasters, especially those with allergic diseases. Immediately following the disaster, to determine the condition of children with allergic diseases in the affected areas, the Japanese Society of Pediatric Allergy and Clinical Immunology (JSPACI) established a network of physicians in the affected areas, pediatric allergists throughout Japan, and private organizations engaging in support activities in the affected areas. Children and their parents and guardians had experienced various difficulties immediately after the disaster. For example, at regional evacuation centers, there was a lack of understanding regarding food allergies. Government officials told parents attempting to check the ingredient labels of the food products being distributed that ‘Children with food allergies should not eat relief food supplies because they are at high risk’. Others were warned that ‘During this time of emergency, children cannot afford to avoid foods because of allergy’. To improve the quality of life of children with allergic diseases and their parents, the JSPACI created the ‘Manual for Dealing with Allergy Ailments in Children during Disasters’. Allergic diseases covered include asthma, atopic dermatitis, and food allergies, and the manual consists of three parts: one for patients and their families, one for refugees evacuated from an affected area, and one for government administrative personnel. During weeks in which this manual was developed, many detailed opinions and proposals were obtained from physicians in the affected areas and patient advocacy groups. This collaboration between physicians and patient advocacy groups enabled the creation of a practical manual. While the effect of this manual will be investigated in future studies, favorable responses have already been obtained. The English version of the manual is available online (1). Major disasters can occur at any time in any part of the world. We hope that this manual will help ensure that children with allergic diseases who survive disasters but are subsequently forced to evacuate do not suffer because of a lack of understanding or poor disease control. Finally, we would like to express our sincere gratitude to all our friends worldwide who have kindly offered words of encouragement to those affected by the disaster in Japan.