Koji Sameshima

Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy.

Background: Among typical patients with Kawasaki disease (KD), a few KD patients present with only fever and cervical lymphadenopathy at admission (KDL). These patients have a significant risk for misdiagnosis, delay in treatment for KD, and development of coronary artery abnormalities. Therefore, the development of an easy tool for early diagnosis in these patients is desirable.

Patients diagnosed with Kawasaki disease before the fifth day of illness have a higher risk of coronary artery aneurysm

Background : A fever lasting for at least 5 days is an essential characteristic of the original diagnostic criteria ofKawasaki disease (KD). However, it is not difficult for an experienced physician to confirm the diagnosis of KD before the fifth day offever. The aim of this study is to investigate the effect of intravenous gamma globulin therapy (IVGG) in KD initiated before the fifth day of illness.

Twenty-five types of T-cell receptor Vβ family repertoire in patients with Kawasaki syndrome

Abstract Recently, a possible relationship between Kawasaki syndrome (KS) and superantigen has been discussed since the report of selective expansion of specific Vβ family in the acute phase of KS. To further investigate the relationship between KS and superantigens, we examined 25 types of T-cell receptor Vβ family repertoire in patients with KS using the reverse transcription polymerase chain reaction. This is the first attempt to examine all of 25 Vβ families in KS. A non radioisotope method was used to quantify mRNA so that the experiment was safer, simpler, and faster. An expression index (EI) for each Vβ was defined as: (the amount of each Vβ mRNA)/(the sum of all Vβ mRNA) × 100. Ten patients with KS and ten normal children were studied. The Vβ9 and Vβ15 of acute phase of KS showed both significantly lower mean EI and significantly higher frequency of a decreased EI value as compared with control children. Selective expansion of the Vβ family in the patients with KS was not observed. Although highly increased EIs were observed in various Vβs, their frequency was not statistically significant. The pattern of increased Vβs did not show the specific pattern that indicates a particular superantigen. Conclusion In Kawasaki syndrome non-radioisotope method for analysing Vβ mRNA is useful in cases where many samples have to be handled. The depletion of Vβ9 and Vβ15 or highly increased expression index in the acute phase of Kawasaki syndrome might suggest a relationship to superantigens.

9p Deletion and distal 9q duplication due to a paternal pericentric inversion 9(p22q32)

SummaryA female infant with 46,XX,rec(9), dup q,inv(9)(p22q32)pat is presented. She had a duplication from 9q32 to qter and a deletion from 9q22 to 9pter. Phenotypical abnormalities observed corresponded with features noted in cases with distal dup (9q), while pathognomonic features of del(9p) syndrome were not observed.

What are parents of obese children concerned about in their children

We retrospectively examined the issues that concern parents of obese children to determine the most effective means of motivating them to seek treatment for obesity in their children.

Surgical Results of Lumber Fusion in Hemodialysis Patients

今回，透析患者に対する腰椎固定手術についてその手術成績と問題点について検討した．対象は，2002～2008年に手術を行った30例（男性15例，女性15例）であった．手術時年齢は52～72歳（平均61.8歳），透析歴は6ヶ月～31年（平均13年6ヶ月）であった．術前診断は，破壊性脊椎関節症（DSA）12例，腰椎変性すべり症10例，腰部脊柱管狭窄症4例，腰椎椎間板ヘルニア3例，分離すべり症1例であった．手術方法はPLF 24例，PLF+PLIF 4例，前方固定術2例であった．結果，JOAスコアの改善率50％以上が22例（73.3％）であったが，合併症による死亡が2例（6.7％）あった．透析患者に対する腰椎固定手術は合併症が多く，透析医，麻酔医との連携と十分なインフォームドコンセントが重要である．

Two Cases of Cervical Disc Hernia after Anterior Fusion

We successfully treated two patients with cervical disc hernia after anterior fusion. Case 1 was a 50-year-old woman. In 1991 she underwent anterior cervical fusion after being diagnosed with cervical disc hernia (CDH) at another hospital and postoperative course was good. Ten years later, due to numbness of both hands and finger elaborate movement disorder developed, and she visited our hospital for checkup. Cervical disc herinia was noted at the proximal adjacent level of the previous fusion level in magnetic resonance imaging (MRI), for which we performed anterior cervical fusion again. Postoperatively, numbness of the arms and elaborate movement disorder improved. Her Japan Orthopedic Association(JOA) score improved 16 points from 12 points.Case 2 was a 60-year-old man. In 1993 he underwent anterior cervical fusion after being diagnosed with CDH and ossification of the posterior longitudinal ligament. Eight years later, he visited our hospital again for checkup due to numbness of both arms and urine leak. We recognized CDH at the proximal adjacent level of the previous fusion level in MRI for which we performed front fusion again. Postoperatively, spastic paralysis improved. JOA score also improved 12 points from 10 points and he was able to return to work.

Maternal Antibody for TSST-1 may Inhibit the Kawasaki Syndrome in Infants under 6 Month of Age

The etiology of Kawasaki syndrome (KS) is still unknown. The symptoms of KS suggest a possible relationship between KS and super-antigen(s) (SA). The infrequent occurrence of KS in early infants may be due to passive maternal antibody. So, we investigated the antibody titers for SAs in the early infants with KS. Patients and Methods: Fifteen KS patients under 6 months of age (before gammaglobulin therapy), 8 their mothers, and 2 mothers of other KS patients under 6 months of age were used for this study. Twenty-two infants under 6 months of age and 40 normal adult volunteers were also used as the controls. Antibody titers for SAs (SPEC, SPEA, TSST-1, SEB) were measured by enzyme-linked immunosorbent assay. A titer over the average value +2sd of the control was considered to be high. Results: The average titers for SPEC and SPEA were not different between KS and control. In the titers for TSST-1 and SEB, KS patients showed higher titers than did control (TSST-1; 0.482±0.531 vs. 0.191±0.244, SEB; 0.326±0.525 vs. 0.252±0.322), however, they were not significantly different. The ratio of high TSST-1 titer in KS was significantly higher than that in control (33% vs. 5%, p=0.031). The average TSST-1 titer of the mothers was significantly lower than that of control adults (0.101±0.165 vs. 0.447±0.485, p=0.021). In the 8 infant-mother pair, 6 infants showed a higher TSST-1 titer than that of their respective mothers. Conclusions: In KS patients under 6 months of age, TSST-1 may be related to KS, and maternal antibody for TSST-1 may inhibit the KS. Further examination is necessary to elucidate the etiology of KS.The etiology of Kawasaki syndrome (KS) is still unknown. The symptoms of KS suggest a possible relationship between KS and super-antigen(s) (SA). The infrequent occurrence of KS in early infants may be due to passive maternal antibody. So, we investigated the antibody titers for SAs in the early infants with KS. Patients and Methods: Fifteen KS patients under 6 months of age (before gammaglobulin therapy), 8 their mothers, and 2 mothers of other KS patients under 6 months of age were used for this study. Twenty-two infants under 6 months of age and 40 normal adult volunteers were also used as the controls. Antibody titers for SAs (SPEC, SPEA, TSST-1, SEB) were measured by enzyme-linked immunosorbent assay. A titer over the average value +2sd of the control was considered to be high. Results: The average titers for SPEC and SPEA were not different between KS and control. In the titers for TSST-1 and SEB, KS patients showed higher titers than did control (TSST-1; 0.482±0.531 vs. 0.191±0.244, SEB; 0.326±0.525 vs. 0.252±0.322), however, they were not significantly different. The ratio of high TSST-1 titer in KS was significantly higher than that in control (33% vs. 5%, p=0.031). The average TSST-1 titer of the mothers was significantly lower than that of control adults (0.101±0.165 vs. 0.447±0.485, p=0.021). In the 8 infant-mother pair, 6 infants showed a higher TSST-1 titer than that of their respective mothers. Conclusions: In KS patients under 6 months of age, TSST-1 may be related to KS, and maternal antibody for TSST-1 may inhibit the KS. Further examination is necessary to elucidate the etiology of KS.