Tohju Ichimura

Thyroid function in children with nephrotic syndrome

The thyroid function of seven children with untreated nephrotic syndrome who had a normal serum creatinine concentration was compared with that of the same patients in remission and age-matched controls. There was a significant decrease in serum thyroxine (T4), tri-iodothyronine (T3) and thyroid-binding globulin (TBG) concentrations in untreated nephrotic children compared with the same patients in remission and age-matched controls. Most values for serum free T4, free T3 and thyroid-stimulating hormone (TSH) in the patients with nephrosis were within the normal range. However, the mean serum free T4 and free T3 concentrations were significantly (P<0.05) lower in the untreated patients than in the same patients in remission, and the mean serum TSH concentrations were significantly (P<0.05) higher in the untreated patients than in the same patients in remission. There were massive urinary losses of T4, T3, TBG. free T4 and free T3 in the untreated nephrotic children compared with the same patients in remission and age-matched controls. The daily urinary protein excretion showed a positive correlation with the urinary T4, T3, free T4, free T3 and TBG excretion. Furthermore, the urinary protein excretion showed a negative correlation with the serum T4, T3, free T4, free T3 and TBG levels. There was a negative correlation between serum albumin and serum TSH. These findings provide evidence of mild hypothyroidism in children with untreated nephrotic syndrome, partly because of losses of T4, T3, free T4, free T3 and TBG into the urine.

Long lasting smooth muscle relaxation by a novel PACAP analogue in guinea-pig and primate airways in vitro

1 We compared the relaxant effect of pituitary adenylate cyclase activating peptide (PACAP) 1–27 with that of a newly developed PACAP 1–27 analogue, [Arg15,20,21Leu17]‐PACAP‐Gly‐Lys‐Arg‐NH2, in the guinea‐pig trachea and primate bronchi in vitro (n=4–5). 2 In the guinea‐pig trachea precontracted by a submaximally effective carbachol concentration (0.1 μM), cumulative administration of PACAP 1–27 and the β2‐adrenoceptor agonist salbutamol (3 nM–3 μM) caused significant and concentration‐dependent smooth muscle relaxation, with salbutamol being approximately one log‐step more potent in this model. However, in primate bronchi precontracted by carbachol (0.1 μM), cumulative administration of PACAP 1–27 and salbutamol caused concentration‐dependent smooth muscle relaxation with very similar potencies and maximum relaxant effects. 3 In the guinea‐pig trachea, non‐cumulative administration of the PACAP 1–27 analogue and the original PACAP 1–27 (0.3–3 μM) caused concentration‐dependent relaxation with a very similar maximum relaxant effect and potency. However, the onset and offset of action was markedly slower for the PACAP 1–27 analogue than for the original PACAP 1–27 (>90% versus <10% of peak relaxation remaining 6 h after administration). Separate experiments confirmed that the PACAP 1–27 analogue also caused significant relaxation with slower onset and offset of action than did the original PACAP 1–27 in primate bronchi. 4 Peptidase inhibition by captopril (10 μM) and phosphoramidon (1 μM) significantly increased the maximum relaxant effect and duration of action of PACAP 1–27 but not of the PACAP 1–27 analogue, during the 3 h of observation in the guinea‐pig trachea. 5 We conclude that [Arg15,20,21Leu17]‐PACAP‐Gly‐Lys‐Arg‐NH2 produces significant, concentration‐dependent and sustained airway smooth muscle relaxation in vitro. The sustained relaxant effect is due, at least in part, to the PACAP 1–27 analogue being less susceptible to cleavage by peptidases than the original peptide PACAP 1–27.

Chronic respiratory failure after acquired cytomegalovirus infection in a very low birthweight infant.

The case of a female infant who developed chronic respiratory failure after an acquired cytomegalovirus (CMV) infection is presented here. She was a very low birthweight (VLBW) infant and was free from oxygen supplement until 2 months after birth. Interstitial pneumonia occurred at 2 months of age, and her respiratory condition gradually deteriorated. A chest roentgenogram at 4 months revealed hyperinflation and reticular shadow, similar to that of severe chronic lung disease (CLD) in preterm infants. She was mechanically ventilated because of progressive respiratory deterioration, and oxygen dependency continued for 5 months after extubation. There are several previous reports of CMV pneumonia in term neonates or infants. However, there appears to be no published report on the pulmonary sequelae of CMV pneumonia in VLBW infants. The present case seems to indicate that acquired CMV pneumonia in VLBW infants causes chronic respiratory failure even when mechanical ventilation is not administered, and this respiratory failure is very similar to CLD in clinical symptoms and chest roentgenogram.

Glomerulonephritis with predominant paramesangial IgG deposition.

The new clinicopathological entity, Immunoglobin G (IgG)‐associated mesangial prollferative glomerulonephritls (GN), has been reported recently, but serial renal biopsies were not performed In the cases reported. The findings of three serial renal biopsies In a pediatrlc case with IgG‐associated GN and paramesangial deposits are reported. Microscopic hematuria was found Incidentally at the age of 8 years and the hematuria often worsened transiently during periods of upper respiratory infections. The patient was treated mainly with dipyrldamole. The third biopsy showed that both para‐mesangial hemispherical deposits and predominant mesan‐gial IgG deposits had increased, while mesangial cell proliferation had markedly decreased. These serial biopsy findings suggest that IgG‐associated GN with microscopic hematuria and slight proteinuria may be characterized by a relatively benign histoiogical and clinical course, as described in recent reports.

Breathing Patterns in Asthmatic Children During Attack

Breathing patterns in asthmatic children during attack were studied using multielectrode impedance pneumography. A great number of respiration patterns were analyzed by a personal computer. During severe attacks, a pattern of prolonged expiratory time was noted. Inspiratory time, however, did not change, regardless of the severity of the asthmatic attack. No remarkable changes in breathing patterns were recognized during mild attacks. It was, therefore, considered that breathing patterns remained essentially unchanged except in cases of severe asthmatic attacks.

Coffin-Siris syndrome: A case of an extremely low birthweight infant with severe kyphoscoliosis

A case of Coffin‐Siris syndrome in a male of extremely low birthweight with severe kyphoscoliosis is reported. His birthweight was 965 g, the lowest reported in the world for an infant with this syndrome. Coffin‐Siris syndrome is characterized by nail hypoplasia of the fingers and toes, eyebrow hypertrichosis, prominent lips and prenatal or postnatal growth retardation. He was the only case who was mechanically ventilated from birth because of birth asphyxia. He died at 12 days of age because of sepsis, a poor immune system as in other extremely low birthweight infants, and because he easily suffered from upper respiratory infection as a result of Coffin‐Siris syndrome.

Breathing Patterns During Sleep in Stable Asthmatic Children

Breathing patterns during sleep at night were studied in 15 asymptomatic asthmatic children and 11 nonasthmatic controls using impedance pneumography. Inspiratory time (TI), expiratory time (TE) and expiratory time/inspiratory time ratio (TE/TI) were used as the indices of breathing patterns. In the daytime, TI, TE and TE/TI, showed no significant differences between asthmatics and controls. During nocturnal sleep, TE and TE/TI increased significantly in the asthmatics compared with the value during daytime, while these values showed only a small variation overnight in the controls. TI showed no significant changes through the night in either the asthmatics and the controls. The results of this study indicate that the stable asthmatic children had abnormal breathing patterns during nocturnal sleep.

Saireito-induced cystitis in children: Two new cases and a review of the literature

We describe 2 children with sterile cystitis caused by Saireito, a traditional Chinese herbal medicine. A diagnosis of cystitis was made for 1 child at 8 months and for the other at 11 months after Saireito treatment for renal disease was initiated. Clinical symptoms were resolved 1 and 6 weeks after Saireito treatment was withdrawn. We also reviewed the first report written in the English language on 8 additional patients with Saireito-induced cystitis. We found that Saireito-induced cystitis occurred mainly in children and developed 6 months or more after Saireito treatment was initiated. The incidence is not uncommon, and the cause may be an allergic reaction, because eosinophilic cell infiltration was noted on histopathologic examination, and the challenge test was positive. We recommend that, when sterile cystitis develops during treatment with Saireito, Saireito should be immediately withdrawn.

Immunosuppressive factors in sera of children with non A, non B, hepatitis

It has been reported that sera of patients with acute phase of hepatitis B or other various diseases contain immunosuppressive factor(s). Today, the research of etiologic virus(es) has been tried about non-A, non B hepatitis. We used sera of six children with nonA, non B hepatitis and studied whether those contained immunosuppressive factor(s). Regarding to those factors, we researched firstly rosette inhibition factor (RIF) that suppressed rosette formation of T lymphocytes and sheep red blood cells, and secondly serum immunosuppressive factor (SIF) that suppressed mitogeninduced activation of lymphocytes. It was accepted that those sera contained both of RIF and SIF at high rates and, both factors disappeared with improvement of liver functions, When those sera were classified by the density ultracentrifugation separation method, RIF was present in the low density lipoprotein fraction (1.01 6 < d < 1.063) and, SIF in the lipoprotein deficient serum (d > 1.25). Therefore, the two factors would be different from each other.