Teiichi Oda

Epidemiologic Application of Pulsed-Field Gel Electrophoresis to an Outbreak of Campylobacter fetus Meningitis in a Neonatal Intensive Care Unit

An outbreak of nosocomial Campylobacter fetus meningitis occurred in a neonatal intensive care unit (NICU). Eight C. fetus strains were isolated from 4 infants with meningitis, the mother of the index patient and 2 infants who were asymptomatic intestinal carriers. The pulsed-field gel electrophoresis (PFGE) pattern with the restriction endonucleases Smal and Sall were found to be identical for the nosocomial C. fetus isolates, but the patterns were different from those of sporadic strains. These nosocomial strains were strongly suspected to be a single strain. The finding revealed that the index patient was infected by the mother, and that the outbreak developed from this patient by cross-infection. This is the first confirmed nosocomial C. fetus meningitis outbreak spread by cross-infection in a NICU.

Anti‐verocytotoxin (VT)1, VT2 and VT2c antibodies in commercial intravenous immune globulins in Japan

Verocytotoxin-producing Escherichia coli (VTEC), which is also called enterohemorrhagic E. coli, is the most important cause of hemolytic uremic syndrome (HUS).’ Verocytotoxin (VT) is also referred to as Shiga-like toxin (SLT).* The precise mechanism by which VTEC infection causes HUS has not been fully elucidated but is thought to be related to the secondary effects of systemically absorbed VT. It has been suggested that the first step is injury to endothelial cells of the glomerulocapillaries of the kidney by VT. In order to determine whether commercial intravenous immune globulin (IVIG) available in Japan has a potentially beneficial effect on Japanese HUS patients, we checked the antibodies to three VT types (VT1, VT2 and VT2c) in the WIG.

Scimitar syndrome with an accessory diaphragm and an absent right superior vena cava

An 8-year-old boy with scimitar syndrome, an accessory diaphragm and an absent right superior vena cava, underwent surgery on March 28, 1983. The scimitar vein was separated from an accessory diaphragm and cut just above the right diaphragm where the vein penetrated. The vein was re-implanted into the right lateral portion of the right atrium and a tunnel was made between the atrial septal defect created in the septum and the site of the implanted vein. The accessory diaphragm was not removed because of the lack of compression on the right lung. At cardiopulmonary bypass, venous cannulae were inserted into the persistent left superior vena cava and inferior vena cava. Because of the absence of the right superior vena cava, the right atrium was not fixed by both cavae so that there was difficulty in intracardiac maneuvers. The patient is doing well 32 months after this treatment.

CARNITINE DEPLETION DURING TOTAL PARENTERAL NUTRITION DESPITE ORAL L-CARNITINE SUPPLEMENTATION

Carnitine (CAR) plays an important role in the β‐oxidation of fatty acids. Less attention, however, has been paid to CAR compared to other nutrients even in total parenteral nutrition (TPN). To examine CAR metabolism during TPN and the effect of simultaneous oral L‐CAR supplementation on CAR levels, the blood CAR level was measured in a 3‐year‐old boy receiving long‐term TPN because of short bowel syndrome. Both the total and acyl CAR in the serum were evaluated under various nutritional conditions including oral supplementation of L‐CAR. Low CAR concentrations were observed especially when lipid containing TPN regimens were in place. Oral L‐CAR supplementation was not sufficient to restore the low CAR levels in the present index patient even when the dose was increased to 120 mg/kg in accordance with the result of the L‐CAR absorption test that revealed poor intestinal absorption of this nutrient. Moreover, a markedly low CAR level was measured during the onset of sepsis in the patient, and the blood CAR was depleted when lipid metabolism was activated by lipid loading or sepsis. To date, the late effects of CAR depletion on child growth have not been well examined. It is recommended that the blood CAR level be maintained at normal levels before any prominent manifestations of the deficiency have developed. The intravenous administration of CAR appears to be necessary to supply a sufficient amount of CAR for patients with severe malabsorption.

Indirect hemagglutination assay for antibodies to Escherichia coli lipopolysaccharides O157, O111 and O26 in patients with hemolytic uremic syndrome

We examined sera from 10 patients with hemolytic uremic syndrome (HUS) and 51 controls, with and without diarrhea, for antibodies to Escherichia coli lipopolysaccharides (LPS) O157, O111 and O26 using the indirect hemagglutination (IHA) assay. A significant rise (to a titer of ≥ 2560) in IHA antibody to O157 LPS was detected in eight of the 10 HUS patients, to O111 in two patients, one of whom showed concomitantly an antibody rise to O157, but to O26 in no patients. The IHA titers fell rapidly after the acute phase of the illness. Of the control sera 15 (29.4%) non‐specifically agglutinated uncoated sheep red blood cells (SRBC) at a titer of ≥80, six (3.9%) at ≥320 and the maximum was 640. In spite of the relatively low level of non‐specific agglutination the IHA appeared to be a useful screening method to identify verotoxin‐producing E. coli infections at the early stage of HUS because the titers were clearly higher than non‐specific agglutination and the assay is easy to perform and gives results quickly. Artificial carriers are being considered for use in place of SRBC to diminish the non‐specific hemagglutination.

Relationship between Maturation of the Skin and Electrical Skin Resistance

ABSTRACT: In 16 newborn infants (24 6-39 wk 6 days 830-3390g) at ages between 0-70 days, the skins electrical resistance was measured. Over 30 min we sequentially measured direct current resistance between two skin electrodes placed on the abdomen. The resistance was found to be low in very premature infants with gestation ages of 30 wk or less. It increased with both gestational age and postnatal age. In these infants, the resistance measured at 30 min during the first 4 days of life (3.4 ± 0.3 KΩ; mean ± SD) was significantly less than that found at 20-70 days (8.8 ± 1.2 kΩ; p<0.001). The relationship between the infants electrical skin resistance (y) and the gestational age (x) best fit the exponential formula: y = 7.42 -e0.24x- 10-4 + 2.74. This formula shows that the electrical skin resistance increases exponentially during the last trimester. The measurement of electrical skin resistance is a quantitative method that can be utilized to evaluate the gestational age of infants.

A Case of Bilateral Renal Dysplasia with Dandy-Walker Syndrome and Tapetoretinal Degeneration

We treated a 5 year and 9 month old Japanese boy, with symptoms of congenital blindness due to tapetoretinal degeneration and Dandy‐Walker syndrome who died of renal insufficiency. The autopsy findings of the kidney revealed bilateral dysplasia with cysts. These findings were compared to similar abnormalities occurring simultaneously in the eye, brain and kidney (oculocerebro‐renal syndrome) which has been considered as a new syndrome.

Impedance Pneumography in Newborn Infants; Correlation between Tidal Volume and Thoracic Impedance Variations and Detection of Abnormality of Pleural Cavity

nrmH.O tween AZ and the tidal volume in premature infants was evaluated. In 10 premature infants who were not suffering from respiratory distress and ventilated with tidal volume below 15 ml, a linear relationship was found between AZ and the tidal volume. We recorded AZ and the tidal volume simultaneously in an infant with RDS who received mechanical ventilation. Even in this severely ill state A 2 and the tidal volume were well correlated with each other as shown in FIG. I. We recorded right and left AZ simultaneously (AZR, ~ Z L ) in patients with pneumothorax and chylothorax. AZ recorded from the thorax with pneumothorax or chylothorax were sharply minimised, and when pneumothorax or chylothorax were aspirated the laterality was disappeared. Therefore, it is possible to detect an abnormality of pleural cavity by monitoring right and left AZ simultaneously FIG. 11. w lOsec

A Case of Prader‐Willi Syndrome with Pickwickian Syndrome

11-year-old female was reported. She had typical signs and symptoms of Prader-Willi syndrome. She showed diminished fetal activity during the last trimester, and hypotonia and poor activity during her neonatal stage. The hypotonia improved slowly by 4 months of age. Her behavioral development was moderately delayed. Rapid weight gain began at 4 years of age. Mental deficiency (1. Q. 36) prohibited her going to normal school class. At age 11, she was admitted to the Fukuoka University Hospital at first time, complaining of marked obesity and mental retardation. She had a body weight of 68.2kg (standard: 36.9kg) and rather short stature. She showed most of the feature of Prader-Willi syndrome, i.e., narrow bifrontal diameter, strabismus, almond-shaped eyes, fish mouth and enamel hypoplasia of teeth. Four months later, after the discharge, she had somnolence, dyspnea and cyanosis with signs of congestive heart failure and readmitted. On this time, she had marked cardiomegaly and pulmonary congestion on X-ray film, marked hypoxemia with hypercapnia, low vital capacity and right axis deviation on electrocardiogram. Echocardiogram revealed a marked increase of right ventricular dimension and a decreased left ventricular ejection fraction. Mechanocardiogram also showed decreased right and left ventricular contractilities. It was inferred that she had an alveolar hypoventilation from pulmonary function studies. After disappearance of congestive heart failure by administration of digitalis and diuretics, low caloric diet was begun, and she lost 5 kg of body weight. After that, her arterial blood gas improved to almost normal, cardiomegaly disappeared and cardiac function normalized. We concluded that she had signs of Pickwickian syndrome with congestive heart failure as a result of massive obesity induced from Prader -Willi syndrome.