Takuma Miura

Prevalence and persistence of a novel DNA TT virus (TTV) infection in Japanese haemophiliacs.

To clarify the clinical implication of a newly discovered ‘TT virus (TTV)’, we assayed TTV DNA in sera from 50 haemophiliacs by a seminested‐PCR. TTV DNA was detected in 75% (35/50), which was a much higher prevalence than for HBV (HBc‐Ab), HCV RNA, or HGV RNA. In particular, TTV DNA was found in 44.4% (4/8) of patients who had been treated only with virally inactivated factor VIII concentrates. Elevated ALT levels were observed in patients with HCV RNA and TTV DNA; however, the elevation in TTV DNA was obtained from patients co‐infected with HCV RNA (62.9%, 22/35). There was no significant difference in ALT levels between TTV DNA‐positive and DNA‐negative in patients without HCV RNA. 85.3% (35/41) of TTV DNA‐positive sera in 1990 were again positive for TTV DNA in 1995. These findings suggest that many haemophiliacs have been infected with TTV. Although TTV infection was not associated with serum ALT elevation, persistent TTV infection may contribute to cryptogenic hepatic failure in haemophiliacs.

Theophylline-induced convulsions in children with epilepsy.

To the Editor. In Japan, theophylline is widely used as a basic bronchodilator in asthmatic children and other patients with severe cough. However, many recent papers have reported that theophylline induces convulsions.1–3 Therefore, we retrospectively investigated theophylline-induced convulsions in epileptic children. In our outpatient clinic, 143 epileptic patients are receiving anti-epileptic drugs. Among them, 43 had previously received theophylline and 16 of these …

A Nationwide Survey of Newly Diagnosed Childhood Idiopathic Thrombocytopenic Purpura in Japan

Background We evaluated the clinical pictures, outcome for childhood idiopathic thrombocytopenic purpura (ITP) and the trends of the choice of management for childhood ITP in Japan. Method Every year, questionnaires were sent to all institutions that employ the active members of the Japanese Society of Pediatric Hematology. The questionnaires included age, sex, date of diagnosis, platelet count at diagnosis, the presence or absence of antecedent infection, hemorrhagic symptoms, initial management, and the outcome of all patients newly diagnosed with ITP. Results A total of 986 newly diagnosed as ITP patients were reported between January 2000 and December 2005. The occurrence of ITP peaked in boys less than 1 year of age, and at 1 year of age in girls. The male-to-female ratio was 1.24:1. Wet purpura was observed in more than half of the patients with platelet counts of <10,000/μL. The initial treatment varied among the patients with different platelet counts at diagnosis; most of the patients with platelet counts <20,000/μL received intravenous immunoglobulin or oral corticosteroids. Conversely, cases without any aggressive treatment increased to a larger degree in patients with ≥20,000/μL of platelet. Conclusions These findings indicate that overall compliance to the Japanese guideline is considered to be relatively good in Japan.

Isolated central nervous system (CNS) relapse in a case of childhood systemic anaplastic large cell lymphoma without initial CNS involvement.

Central nervous system (CNS) involvement in cases of anaplastic large cell lymphoma (ALCL) has been described only rarely. The authors describe an 11-year-old girl with ALCL who developed isolated CNS relapse but had no CNS disease at initial diagnosis and had received CNS-prophylactic treatment. The patient achieved a second remission following intensive treatment of the relapse and continues to be in remission at the time of writing. This case serves to emphasize that isolated CNS relapse without detectable initial CNS involvement can arise even after CNS-prophylactic treatment in pediatric ALCL cases.

Rectal mucosal prolapse syndrome and a bidet

During the past 10 years, many people in Japan have begun to use bidets for rectal washing after defecation. These devices not only clean but also stimulate the area surrounding the anus, and make defecation easier. For this reason, some Japanese people make it a habit to use bidets after defecation. Recently the authors encountered a patient with rectal mucosal prolapse syndrome associated with overuse of a bidet.

Hypofibrinogenemia in a girl with Langerhans cell histiocytosis during etoposide and prednisolone therapy

A case of a girl with Langerhans cell histiocytosis who had hypofibrinogenemia during etoposide (VP‐16) and prednisolone therapy is described. A patient on a three times per week schedule of 100 mg/m2 etoposide in combination with 40 mg/m2 of prednisolone every day had hypofibrinogenemia of 90 mg/dL after 12 doses of etoposide. Hypofibrinogenemia improved after discontinuing the course of etoposide. The clinical course suggested that the combination of etoposide with prednisolone caused this side‐effect. Although the exact mechanism of toxicity of etoposide with prednisolone remains unknown, it is possible that the side‐effect might be due to reduced production of fibrinogen in the liver. Careful monitoring of fibrinogen is mandatory in patients receiving etoposide and prednisolone.

Intestinal obstruction and phenytoin intoxication

linemia associated with nodular lymphoid hyperplasia of the small intestine. Am. J. Med. 1966; 40: 78–87. 7 Chandra S. Benign nodular lymphoid hyperplasia of colon: A report of two cases. Indian J. Gastroenterol. 2003; 22: 145–6. 8 Costamagna G, Shah SK, Riccioni ME et al. A prospective trial comparing small bowel radiographs and video capsule endoscopy for suspected small bowel disease. Gastroenterology 2002; 123: 999–1005. 9 Iddan G, Meron G, Glukhovsky A et al. Wireless capsule endoscopy: The discomfort of internal gastrointestinal examination may soon be a thing of the past. Nature 2000; 405–17. 10 Byrne WJ, Jimenez JF, Euler AR et al. Lymphoid polyps (focal lymphoid hyperplasia) of the colon in children. Newsl. Am. Acad. Pediatr. 1982; 69: 598–600. 11 Mukhopadhyay S, Harbol T, Floyd FD et al. Polypoid nodular lymphoid hyperplasia of the terminal ileum. Arch. Pathol. Lab. Med. 2004; 128: 1186–7. 12 William JB, Jorge FJ, Arthur RE et al. Lymphoid polyposis (focal lymphoid hyperplasia) of the colon in children. Pediatrics 1982; 69: 598–600.

Interferon therapy for Japanese hemophiliacs with chronic hepatitis C

Eight Japanese hemophiliacs with chronic hepatitis C (CHC) received interferon (IFN) therapy and four of them (50%) responded completely. Non‐responders included 3 double‐infected patients: I with hepatitis B virus (HBV) and 2 with human immunodeficiency virus‐1 (HIV‐1). In one of the patients with HIV‐1 double infection, the absolute number of CD4* lymphocytes decreased during IFN therapy. These findings suggest that hemophiliac patients with CHC can respond well to IFN therapy, but in patients who are double‐infected with HBV and HIV‐1, the indication of IFN therapy should be considered seriously.

The level of granulocyte elastase (ELP) in children suffering from inflammatory diseases.

In order to study on the elastolysis and fibrinolysis in inflammatory process, the level of granulocyte elastase (ELP) was assayed in inflammatory diseases. The assay was carried out in children suffering from inflammatory diseases such as Kawasaki disease (MCLS), pneumonia, allergic purpura and others.ELP was extracted from granulocytes by 2mol/l KSCN and measured by using the artificial substrate, Suc-Ala-Tyr-Leu-Val-pNA. The biological activity was expressed as amidolytic activity per cell. The ELP activity of normal newborn babies was 9.0±3.1 nU/cell and it increased by age, attaining to the level of 16.1±5.8 nU/cell of normal adults. In MCLS, pneumonia and aseptic meningitis, the level of ELP decreased during the 2nd and 3rd weeks of illness, and it returned to the normal range up to the 4th or 5th week. On the other hand, the level of ELP was not reduced in upper respiratory diseases in which the inflammation was moderate. In allergic purpura, the level of ELP increased and returned to the normal range after the 5th week. Although the causes of the decreased level of ELP in inflammatory diseases are not clear, it can be suspected that ELP is released from granulocytes and consumed during inflammatory process.