Kou Ichihashi

The use of intravenous immunoglobulin in Miller Fisher syndrome

We report a patient with Miller Fisher syndrome who was treated with an intravenous high-dose of immunoglobulin. This syndrome is considered to be a benign variety of acute inflammatory demyelinating polyneuropathy (Guillain-Barré syndrome). However, there have been several reports of the need for ventilatory support and a few cases have had a fatal outcome. We observed a case of progressive Miller Fisher syndrome in a 3-year-old boy. Following 2 episodes of apnea lasting about 50 s each, he was treated with intravenous immunoglobulin (400 mg/kg/day) for 5 consecutive days. His respiratory state, general muscle strength, truncal ataxia and emotional state improved remarkably after this therapy.

Prenatal MRI in a fetus with a giant neck hemangioma: a case report

We report a fetus with a giant neck hemangioma which was examined by MRI in utero. The initial diagnosis was made by ultrasonography. The sonolucent aspect of the mass, together with the presence of pulsating Doppler flow signals, was highly suggestive of a fetal hemangioma. In late pregnancy, fetal MRI revealed the location, size and characteristics of the neck tumor. Following prenatal corticosteroid treatment and premature delivery of the pregnancy due to fetal cardiac failure, the newborn received angiography and coil embolization of the tumor vessels. Despite vigorous treatments, the newborn died 12 h after birth. Evaluation of a fetal neck hemangioma by MRI is recommended late in pregnancy for precise information on the tumor and adjacent organs since the image is valuable for planning optimal perinatal treatment. Copyright

Utility of a Doppler-derived index combining systolic and diastolic performance (Tei index) for detecting hypoxic cardiac damage in newborns

Abstract The purpose of this study was to assess cardiac function of newborns with mild asphyxia by a Doppler-derived index combining systolic and diastolic performance (Tei index). We studied 20 preterm infants with mild asphyxia. A control group consisted of 20 gestational age-matched preterm infants without asphyxia. Echocardiograms were performed during the fourth and seventh days after birth. Peak velocities of an early filling wave (E) and an atrial contraction wave (A) were measured from the mitral inflow velocity profile and the ratio of peak E to A was calculated. Ejection time was measured from the left ventricular outflow Doppler signal. The sum of isovolumetric times was obtained by subtracting the ejection time from the interval between cessation and onset of mitral inflow. The index was the sum of isovolumetric times divided by ejection time. Ejection fraction was also calculated. The ratio of peak E to A and ejection fraction were the same in both groups. The myocardial performance index in patients with asphyxia was higher than that in patients without asphyxia. We concluded that patients with mild asphyxia have a mild cardiac dysfunction and this change can be detected by a myocardial performance index.

Difference between left and right lateral ventricular sizes in neonates.

The objective of this study is to determine the causes of asymmetry of the lateral ventricles in neonates. We also studied the effect of head position and the relationship of body weight at birth in regard to lateral ventricular size. Eligible for inclusion in this study were 60 neonatal infants whose gestational age was 33.1+/-3.5 weeks and whose birth weight was 1793+/-613 g. Ultrasonographic examinations were performed at the first and the second weeks after birth. In parasagittal and coronal scans through the posterior horn of the lateral ventricle, the lateral ventricle was traced and its area was measured. We found no significant variation of ventricular size in relation to body weight at birth. The left ventricular size was larger than the right one. The difference of the left and right ventricular sizes was partially effected by head position. The ratio of left to right lateral ventricular sizes showed a very wide distribution. We considered that ventricular asymmetry is not pathological, but due to individual differences.

Inhalation of nebulized nitroglycerin in dogs with experimental pulmonary hypertension induced by U46619

Abstract Background: Pulmonary hypertension (PH) causes mortality in some congenital and acquired heart and lung diseases. However, inhalation of NO gas requires complicated and expensive instruments and elaborate preparations to avoid toxic gas administration. We tested the effectiveness and safety of inhaled nebulized nitroglycerin (Neb‐NTG) in dogs with experimental PH.

Cerebral and Abdominal Arterial Hemodynamics in Preterm Infants with Patent Ductus Arteriosus

Using Doppler echocardiography we evaluated the effect of ductal shunt flow on the cerebral and abdominal arterial blood flow in 25 preterm infants. Eligible for inclusion in this study were healthy preterm newborn infants. They were divided into two groups based on their gestational age: group A, 33‐36 weeks (15 infants) and group B, 28–32 weeks (10 infants). Two‐dimensional Doppler echocardiograms were obtained in each infant during the first 8 hours of life and repeated every 6–12 hours until no ductal shunt flow could be detected. Flow in the ductus arteriosus, the basilar artery and the coeliac artery were examined. Closure of the ductus arteriosus occurred significantly later(p< 0.05) in group B than in group A. Pulsatility indices of flow in the basilar and coeliac arteries were high when the ductus was patent, decreasing to a fixed level with closure. This study suggests that a shunt of the patent ductus arteriosus (PDA) adversely influences the cerebral and abdominal blood flow in preterm infants.

Changes in ventricular and muscle volumes of neonates

Abstract Background: To examine the changes in cardiac ventricular and muscle volumes in neonates, echocardiography was performed in 25 normal neonates at 3–5 and 30–35 days after birth.

Expression of cellular retinoic acid binding protein in the developing nervous system of mouse embryo

The expression of cellular retinoic acid binding protein, CRABP, in developing mouse embryos was immunohistochemically analyzed. Differentiating young neurons and neuronal fibers in the myelencephalon, metencephalon, mesencephalon and spinal cord in 10.5- and 12.5-day embryos showed intense expression of CRABP, but undifferentiated cells in the neural tube did not. Neural tissue in 16.5-day embryos expressed less amount of binding protein than the tissues of the younger stages. These expressions of CRABP suggest that retinoic acid participates in neurogenesis at early developmental stages via expression of cellular retinoic acid binding protein.

Change in cardiac diastolic function in neonates.

SummaryIn this study we used Doppler echocardiography to examine changes in ventricular diastolic function in neonates. Echocardiograms were performed in 25 healthy neonates at 1–6 days (2.7±1.6 days) and at 25–35 days (29.4±3.3 days) after birth. Ventricular inflow velocity curves were recorded using the pulsed-Doppler method. Peak velocities (peak E, A), mean velocities (mean E, A), times (time E, A), and diastolic velocity-time integrals (area E, A) were measured during both early ventricular filling and atrial systole. The acceleration time of the wave during early ventricular filling was also measured. Peak E and A and mean E and A in both ventricles increased at 1 month after birth. Acceleration times in both ventricles were short-ened. The ratio of area E to A in both ventricles and of peak E to A in the left ventricle did not change at 1 month after birth. Only the ratio of peak E to A in the right ventricle increased. The ratio of peak E to (area E + area A), which is thought to be a load-independent index, increased in both ventricles. The authors concluded that ventricular relaxation appears to increase in both ventricles, 1 month after birth, and that changes in diastolic function occur even in neonates.

Autonomic function in Kawasaki disease with myocardial infarction: usefulness of monitoring heart rate variability.

Background : Despite anticoagulant therapy, many patients with Kawasaki disease and giant coronary artery aneurysm develop myocardial infarction. These patients have a high risk of sudden death, but the etiology is not clear. We studied autonomic function and the possibility of malignant ventricular arrhythmia through heart rate variability.