Tsutomu Ohno

Development of myelination in the human fetal and infant cerebrum: A myelin basic protein immunohistochemical study

The early development of myelination was studied by means of myelin basic protein (MBP) and luxol fast blue (LFB) stainings of large sections of the cerebral hemispheres. Myelination first occurs in the globus pallidus, pallidothalamic fibers of the posterior internal capsule and the thalamus at 25 weeks, which may be related to the cellular maturation in the globus pallidus and thalamus. Then myelination is observed in the striatum, and precentral and postcentral gyri at 35 weeks, and the anterior internal capsule and optic radiation at 37 weeks. Immunoreactivity with MBP is observed earlier and more strongly in the early myelination period than that with LFB. Thus, MBP may play an important role in myelination and its delay. The macroscopic positivity as to MBP as well as LFB staining may be related to the development of high signal intensity observed in a T1-weighted magnetic resonance imaging, which was observed 1 to 3 months after the first microscopic appearance of myelin.

Neuropathologic study of newborns with prenatal-onset leukomalacia

The distribution of leukomalacia and glial fibrillary acidic protein (GFAP)-positive glial cells in prenatal- and postnatal-onset leukomalacia were compared and diagnosed histologically in 128 autopsied infants and the different pathogeneses were examined. Prenatal-onset leukomalacia was diagnosed in 12 of 71 still-births and neonates surviving less than 3 days (16.9%). All 4 preterm infants of less than 32 gestational weeks had widespread white matter necrosis and 4 of 5 term infants had focal necrosis. GFAP-positive glial cells were more increased in the deep and intermediate white matter in both forms of leukomalacia than in the controls, although in the subcortical white matter they were less increased in prenatal- than postnatal-onset leukomalacia. These differences may indicate different pathogeneses, including vascular maturity and causal factors, in prenatal- and postnatal-onset leukomalacia.

Successful transcutaneous arterial embolization of a giant hemangioma associated with high-output cardiac failure and Kasabach-Merritt syndrome in a neonate : A case report

Abstract We describe the case of a patient with a neonatal giant cutaneous hemangioma with high-output cardiac failure and Kasabach-Merritt syndrome and successfully treated with transcutaneous arterial embolization aimed at controlling severe congestive heart failure and consumption coagulopathy. A patient was admitted to the neonatal care unit on the first day of age because of a large hemangioma on his right lateral chest wall and respiratory distress, associated with cardiac failure resulting from arteriovenous shunting. On the second day of age the platelet count decreased to 5.7 × 104/μl and fibrinogen level was 85 mg/dl. The values of prothrombin time and activated partial thromboplastin time were prolonged. Intravenous predonisone therapy was started immediately, but bleeding tendency was getting worse and the evidence of congestive heart failure persisted. On the third day the patient then underwent embolization of feeding arteries with microcoils. The cardiac failure and thrombocytopenic coagulopathy had improved significantly without complications. We conclude that transcutaneous arterial embolization is an effective and safe treatment in this neonate and should be considered for the treatment of control high-output cardiac failure and coagulopathy in infants with hemangioma and Kasabach-Merritt syndrome.

Effects of albumin infusion therapy on total and unbound bilirubin values in term infants with intensive phototherapy

Background : The purpose of the present study was to evaluate the effect of intravenous albumin administration on the serum total and unbound bilirubin values in term non‐hemolytic hyperbilirubinemic neonates during intensive phototherapy.

Follow-up study of auditory brainstem responses in infants with high unbound bilirubin levels treated with albumin infusion therapy.

Background : Several authors reported that there was a close relationship between unbound bilirubin concentrations and abnormal results of auditory brainstem responses. Full‐term infants with high‐unbound bilirubin concentrations who were treated with human albumin were followed to evaluate their hearing abilities by using auditory brainstem responses.

Morbidity and mortality of infants born at the threshold of viability : Ten years' experience in a single neonatal intensive care unit, 1991-2000

Background: The purpose of the present paper was to evaluate the mortality and morbidity of infants born at 22–24 weeks gestation.

Sudden intractable respiratory failure in extremely low birth weight infants with H-type tracheoesophageal fistula.

Abstract A fatality from a tracheoesophageal fistula (TEF) in two extremely low birth weight infants is presented. The sudden onset of intractable respiratory failure accompanied by the absence of chest movement and breathing sounds was observed. The typical clinical symptoms were concealed because the infants required mechanical ventilation and nasogastric feedings. When ventilated infants with these symptoms are suspected of the diagnosis of TEF, prompt reintubation under the guidance of a flexible bronchoscopy may be life saving because the endotracheal tube passes through the fistulas into the esophagus with ease.

A newborn infant with lipoprotein glomerulopathy associated with congenital nephrotic syndrome

from the formation of thrombi of abnormal lipoproteins in the glomeruli.1–4 The etiology of the disease remains unknown, although apolipoprotein may have a role.5–7 The disease has been reported almost exclusively in adults in Japan.1,2 In the current report, we present a neonatal case of LPG manifested with a congenital nephrotic syndrome. To our knowledge, this is the youngest reported case of this disease.8,9

Intractable hypoglycemia following indomethacin therapy for patent ductus arteriosus.

described simultaneously the administration of indomethacin, a prostaglandin synthetase inhibitor, to produce pharmacological closure of the ductus arteriosus in symptomatic premature infants. The use of indomethacin has rapidly replaced surgical ligation as the primary therapy to close a patent ductus arteriosus (PDA). However, indomethacin therapy may induce several serious adverse effects, such as transient renal dysfunction, decreased platelet aggregation and gastrointestinal disturbances. Many decreased blood glucose values are speculated to be related to indomethacin therapy. There have been few literature reports of indomethacin-induced hypoglycemia.3,4 Studies in vitro and in vivo suggested that prostaglandins might participate in the regulation of insulin and glucagon secretion.3 However, the mechanism by which indomethacin induced a drop in the blood glucose level in the newborn is still unclear. In this report, we describe a premature infant with intractable hypoglycemia due to hyperinsulinemia following intravenous indomethacin therapy for PDA. This infant was successfully treated with hydrocortisone.

The effect of acetazolamide and carbon dioxide on cerebral hemodynamic changes on near-infrared spectroscopy in young rabbits

The changes of cerebral blood oxyhemoglobin (HbO2), deoxyhemoglobin (HbR), and total hemoglobin (tHb) induced by acetazolamide and CO2 loading on near-infrared spectroscopy (NIRS) were recorded. In anesthetized 2-week-old rabbits, acetazolamide (10 mg/kg i.v.) increased HbO2 and tHb, concomitant with an increase in tissue PCO2, and decreased HbR only at 5 and 10 min. CO2 loading significantly increased HbR and decreased HbO2, and after the termination of CO2 loading, tHb and HbO2 significantly increased and HbR decreased to nearly the baseline value. Thus, NIRS demonstrated cerebral hemodynamic responses as a function of vasomotor reactivity to acetazolamide as well as CO2 loading.