Tomoharu Akiba

Prediction of Peak Pulmonary Artery Pressure by Continuous-Wave Doppler Echocardiography in Infants and Children

SummaryContinuous-wave Doppler echocardiography was used to estimate peak pulmonary artery (PA) pressure in 104 infants and children, aged 4 days to 16 years, with normal hearts (control group) and 43, aged 29 days to 13 years, with various kinds of heart disease (patient group). The Doppler transducer was directed toward the right ventricular outflow tract and angled until the maximal velocity signal was reached. Doppler velocity time intervals were measured as follows: acceleration time (AT), from the onset to the peak of the velocity curve; and ejection time (ET), from the onset to the termination of the velocity curve. In the control group, AT corrected through dividing by the RR interval of the electrocardiogram (ATc), and AT/ET by dividing by the square root of the RR interval (AT/ETc), were independent of body surface area. In the patient group, peak PA pressure had a significant inverse correlation with both ATc (r=-0.78) and AT/ETc (r=-0.87). Thus, AT/ETc derived from continuous-wave Doppler echocardiography is a good quantitative predictor of peak PA pressure in infants and children.

Terminal deletion of chromosome 10q: clinical features and literature review.

Key words chromosome 10q, deletion.

A case of pericardial hemangioma with consumption coagulopathy cured by radiotherapy.

An infantile case of pericardial hemangioma with large pericardial effusion and consumption coagulopathy is described. This is the first reported case of pericardial hemangioma cured by radiotherapy.

Estimation of Right Ventricular Pressure in Children by Thallium-201 Myocardial Imaging Using Single-Photon Emission Computed Tomography

Thallium-201 myocardial imaging using single-photon emission computed tomography was performed to estimate right ventricular (RV) systolic pressure in 34 children (aged 4.1 to 16.1 years, mean 7.9 +/- 2.9). Acquisition of the images was performed using a semicircular arc of 180 degrees. On a short-axis slice, a line drawn perpendicular to the ventricular septum so as to cross the RV free wall showing maximum uptake was defined as the region of interest. Thallium-201 counts in regions of interest over both RV and left ventricular (LV) free walls were measured. The ratio of RV-to-LV peak thallium-201 counts was compared with RV peak systolic pressure and the ratio of RV-to-LV peak systolic pressure measured at cardiac catheterization. Both RV peak systolic pressure and the ratio of RV-to-LV peak systolic pressure correlated well with the ratio of RV-to-LV peak thallium-201 counts (r = 0.95 and 0.96, respectively). The ratio of RV-to-LV peak thallium-201 counts greater than or equal to 0.45 could predict RV pressure overloading with a sensitivity of 92%, and a specificity of 88%. Thus, the quantitative analysis of thallium-201 myocardial imaging using single-photon emission computed tomography permits the noninvasive and accurate estimation of RV systolic pressure in children.

Right and left ventricular function assessed by regional wall motion analysis in patients with tetralogy of Fallot

We studied pre- and postoperative regional right and left ventricular wall motion and global ejection fraction in 18 patients with tetralogy of Fallot who had successful repair, and compared these values to those of patients with a history of Kawasaki disease as controls. Right ventricular ejection fraction was significantly lower in the preoperative group (52 +/- 4%) than that in the control group (57 +/- 4%), and that in the postoperative state (49 +/- 4%) was significantly lower than those in the control and preoperative groups. Left ventricular ejection fraction was significantly lower in the preoperative group (56 +/- 7%) than that in the control group (61 +/- 5%), while that in the postoperative state (64 +/- 6%) was significantly higher than those in the control and preoperative groups. Regional ventricular wall motion analysis revealed that shortening fractions in the tricuspid valve region were reduced in the preoperative patients and were persistent even after successful repair; those in the right ventricular outflow tract region were decreased after the correction. Regional left ventricular wall motion showed that shortening fractions in the anterolateral region were improved after the correction. We conclude that right ventricular dysfunction was present in the preoperative patients with tetralogy of Fallot and was persistent even after total correction.

Vertebral osteomyelitis and paravertebral abscess due to Salmonella oranienburg in a child.

distinct clinical manifestations can develop, including acute gastroenteritis, bacteremia, extraintestinal focal infections or asymptomatic infections.1 Focal suppurative infections in salmonellosis may occur almost anywhere, but the Salmonella organism is a rare pathogen of osteomyelitis in children and has been reported to account for only 2% of infections.2 The main target bone in Salmonella osteomyelitis is unknown but, in general, the vertebra is rarely infected in the pediatric age group.2 Salmonellosis, a wellknown complication in children with sickle cell disease,3 is seldom appreciated as a cause of osteomyelitis in those without predisposing disorders.4–7 In the present study, we describe a previously healthy child who developed thoracic vertebral osteomyelitis and paravertebral abscess due to Salmonella oranienburg. From our review of the literature, we believe ours to be the first reported case of a child with Salmonella vertebral osteomyelitis associated with paravertebral abscess due to Salmonella oranienburg.

Re-emergence of echovirus type 13 infections in 2002 in Yamagata, Japan

OBJECTIVES To analyze the prevalence of echovirus type 13 (Echo13) in Yamagata, Japan. METHODS Virus isolation was performed from 6514 clinical specimens using six cell lines between January 1999 and December 2002. We also carried out a seroepidemiological study against Echo13, using 234 serum samples collected in 2001. RESULTS In 2002, we isolated a total of 50 Echo13 strains, which had not been detected from 1981 until 2001 in Japan. The antibody positive rate was higher (57.2-62.0%) in subjects 50 years or over than in those under 50 years (0-14.4%). CONCLUSIONS Serological study suggested that Echo13 had been present in Yamagata until around 1960, at which time the antibody positive persons were exposed to Echo13 in their childhood. Furthermore, results of virus isolation demonstrated that Echo13 re-emerged in around 2002 after a hiatus of several decades.

Campylobacter coli bacteremia in an 11‐year‐old boy

Campylobacter infections predominantly cause intestinal illnesses and rarely produce bacteremia. Campylobacter bacteremia occurs mostly in malnourished children or patients with chronic, debilitating illnesses or immunodeficiency.1 The most common species of Campylobacter causing bacteremia is C. jejuni, however C. coli is rare.1–8 We describe herein a previously healthy child with bacteremia due to C. coli.

Contracted form of endocardial fibroelastosis in two siblings

two forms: dilated and contracted.1 The left ventricular cavity is enlarged in the dilated form, whereas it is normal or small in the contracted form. Several investigators have reported the dilated form of endocardial fibroelastosis occurring siblings.2,3 In contrast, to our knowledge, only one report of a familial occurrence of the contracted form has been previously published.4 We describe two siblings with the contracted form of endocardial fibroelastosis.

Left and right ventricular volume characteristics in tetralogy of Fallot and their relationship to arterial oxygen saturation and age.

Left (LV) and right ventricular (RV) volume characteristics in 43 patients with tetralogy of Fallot (TOF) undergoing no prior surgical intervention, aged 3–50 months, were evaluated. The control group consisted of 45 patients with Kawasaki disease without cardiac lesions, aged 12–82 months. The TOF patients were divided into four groups: those having arterial oxygen saturation < 80% with an age at the time of study < 18 months (group 1a) or with that ≧ 18 months (group 1b), and those with arterial oxygen saturation ≧ 80% with an age < 18 months (group 2a) or with that ≧ 18 months (group 2b). The results were compared with those in control subjects. In group 1a, each of LV end‐diastolic volume (EDV), LV ejection fraction (EF), RVEDV and RVEF was reduced. In group 1b, LVEDV, LVEF and RVEF were decreased. In groups 2a and 2b, RVEF alone was depressed. From these results, the severity of hypoxemia was an important risk factor for ventricular dysfunctions. No influence of age on the volume characteristics was found. The investigations suggested that patients with TOF having an arterial oxygen saturation < 80% are probably candidates for early surgical intervention.