Impact of transcatheter closure of atrial septal defects on cardiac function.

PURPOSE: The purpose of this study was to investigate the effects of transcatheter closure of atrial septal defects (ASD) on left ventricular function. METHODS: Conventional and three-dimensional echocardiographic methods (3D) were performed in 20 patients who underwent ASD closure. Diastolic and systolic volumes (LVVd and LVVs) and ejection fractions (EF) were determined by 3D methods. Doppler and tissue Doppler indices were also measured before and 1 day after the procedure. We determined the predictors of patients with a mitral early Doppler/tissue Doppler velocity ratio (E/E') ≥8 after closure. RESULTS: Ejection fraction decreased (from 70 ± 8 to 63 ± 8%, p = 0.005) after the procedure because of an equivalent increase in LVVs and LVVd maintaining the same cardiac output. Among the echocardiographic variables before ASD closure that correlated with E/E' after closure, the receiver operating characteristic curve of E' gave the largest area under the curve with E' of 12.2 cm/s as the best predictor of patients with E/E' ≥8 after ASD closure. CONCLUSION: Atrial septal defect closure decreased EF on the surface, thereby maintaining the same stroke volume and cardiac output. Patients with diastolic dysfunction before closure might have a higher risk of developing congestive heart failure after ASD closure.

Increase of child car seat temperature in cars parked in the outpatient parking lot.

BACKGROUND: A guideline for the safe use of child car seats (CS) was published by the Japan Pediatric Society in 2008. There have been few studies of the increase of temperature of a CS in parked cars. The aim of this study was to determine the change in the temperature of the CS in cars parked in full sun. METHODS: The temperature of CS was measured during summer (July and August) in 2006, 2007, and 2008. The CS used in this study (n= 50) were for children (≤ 6 years old) who were taken by car to Sugimura Children's Medical Clinic. Temperatures were only measured on sunny days. Measurements were performed from 09.00 to 17.00 hours. Thermochron (Thermochron i-Button: G type, Maxim Integrated Products, CA, USA) was used to measure the temperatures. The maximum temperatures of CS were compared in time at the clinic, taking into consideration seat colors, and car colors. RESULTS: Of the 50 cars, three cars were excluded due to being in the shade while the temperature was measured. A total of 47 cars were used for this study. The temperature of the CS ranged from 38.0 to 65.5°C (47.8 ± 5.8°C). Eighteen CS (38.3%) reached a temperature of 50°C or above. The maximum temperature of the 13.00-15.00-hours group was significantly higher than that of the 09.00-11.00-hours group (P= 0.035). The CS temperatures in the black car group were significantly higher than those of the white car group (P= 0.013). CONCLUSION: CS may become very hot while a car is parked in sun, especially if the car and the CS are black, so the CS should be cooled before a young child is placed in it. Guardians of small children should be aware of this risk.

Association between the frequency of disposable diaper changing and urinary tract infection in infants.

BACKGROUND: Often diapers are not changed after infants pass urine. AIM: To define the association between the frequency of changing diapers and urinary tract infection (UTI) in infants. METHODS: Urine samples were tested in 131 infants (aged from 2 months to 2.5 years) who had a temperature > or =38 degrees C. The authors investigated the number of times diapers were changed daily. A total of 128 infants, excluding 3 cases, were divided into 2 groups: group A, without UTI (n = 96); group B, with UTI (n = 32). The number of times diapers were changed was compared between the groups. RESULTS: In group A and group B, the number of times diapers were changed daily were 7.5 +/- 1.4 and 4.7 +/- 1.4, respectively. The number of times diapers were changed was significantly lower (P < .0001) in group B than in group A. CONCLUSIONS: Among infants wearing disposable diapers, there is an increased risk of UTI as the frequency of changing diapers decreases.

Relation of the Timing of Onset of Rhinitis and Cough to Asthma Attack in Children.

If the risk of progression to asthma could be predicted in patients with rhinitis, prevention of asthma might become possible. The purpose of this study was to clarify the relationship between the duration of rhinitis symptoms and acute asthma attacks in children with a history of asthma who were not on treatment for asthma. In 94 children with a history of asthma who were asymptomatic after completing asthma treatment, we investigated the onset and duration of nasal discharge and cough related to allergic rhinitis. Then the children were followed up for 2 weeks and were classified into either an asthma attack group (Group A) or non-asthma group(Group B). A total of 78 subjects were evaluated after 16 were excluded. The duration of nasal discharge was significantly shorter in Group A than in Group B (5.5±1.9 days vs. 10.4±3.1 days, P<0.0001). The interval between the onset of cough and nasal discharge was -1.0±3.1 days in Group A and -5.7±4.1 days in Group B (P<0.0001). The risk of progression to asthma attack may be higher when the onset of cough precedes nasal discharge or when nasal discharge has a short duration and cough shows an early onset. These results may provide assistance when selecting patients for early anti-allergy therapy from among those presenting with upper respiratory tract symptoms.

Chest wall reconstruction in a patient with Cantrell syndrome.

Cantrell syndrome is a very rare congenital anomaly with up to five features: a midline, upper abdominal wall abnormality, lower sternal defect, anterior diaphragmatic defect, diaphragmatic pericardial defect, and congenital abnormalities of the heart. This report describes our experience of performing a reconstruction of a chest wall defect in a Cantrell syndrome case with herniation of the heart. The patient was a 1-month-old female infant who received surgical patch repair of a ventricular septal defect (VSD) and atrial septal defect (ASD) at the Department of Cardiac Surgery. Subsequently, the patient underwent reconstruction at the second-stage surgery. A rhomboid skin flap with an inferior pedicle was used to close the defect. In this process the flap, including portions of the rectus abdominis muscles, was elevated and transferred into the defect. The sectioned ends of the divided pectoralis major muscles were sutured together to simultaneously reconstruct the muscles. It has been 2 years since the surgery, and the defect is covered with normal skin, and the protrusion of the heart from the chest wall and the externally visible pulsation have been resolved. The progress has been very good functionally and cosmetically.

Effect of oral sodium cromoglycate in 2 children with food-dependent exercise-induced anaphylaxis (FDEIA).

UNLABELLED: Food-dependent exercise-induced anaphylaxis (FDEIA) was prevented from recurring in 2 children by sodium cromoglycate (SCG) before intake of the causative food. CASE 1: A 14-year-old girl who had suffered recurrent symptoms of anaphylaxis when she exercised after lunch. Radioallergosorbent test (RAST) was 1.49 UA/mL for wheat. She was advised to take SCG before lunch. In 2007, she ate bread at lunchtime without taking SCG and developed anaphylaxis. After this, she always took SCG and did not develop anaphylaxis. CASE 2: A 9-year-old boy who had recurrent symptoms of anaphylaxis when he exercised after lunch. RAST was 0.46 UA/mL for wheat. He started taking SCG before lunch. In June 2008, he forgot to take SCG and ate fu (a food made from wheat). He exercised after lunch and developed anaphylaxis. Since then, he has always taken SCG and has not developed anaphylaxis. CONCLUSION: Our findings suggest that SCG prevents FDEIA caused by wheat allergy.

Improved antibody responses in infants less than 1 year old using intradermal influenza vaccination.

BACKGROUND: Antibody response to influenza vaccine is limited in early. Infants have poorer hemagglutination-inhibiting antibody responses than 12-month-old. Intradermal administration reportedly elicited immune responses similar to or better than a standard intramuscular dose. We hypothesized that intradermal injection could achieve a better response in infants than subcutaneous injection. METHODS: We randomized 34 healthy infants 6-12 months old to either intradermal immunization (0.1 ml of trivalent influenza vaccine containing at least 3 microg of hemagglutinin antigen per strain) or subcutaneous immunization (also 0.1 ml). Changes in hemagglutination inhibition titer were compared using Mann-Whitney U-test, changes in positivity rate, seroconversion, and seroprotection. Local and systemic adverse events were assessed. RESULTS: All 32 infants received both injections. Antibody titers on days at 42 after intradermal injection were significantly greater than subcutaneous injection (P=0.032 in A/New Caledonia (H1N1), 0.019 in A New York (H3N2) and 0.044 in B/Shanghai. Positive titers for A New York (H3N2) were attained significantly more often after intradermal (73.3%) than subcutaneous injection (23.5%) on day 28, and significantly more often 42 days after intradermal injection (93.3% for A/New Caledonia (H1N1) and 73.3% for B/Shanghai) than after subcutaneous injection. Positive rates for other stains were similar between groups on days 28 and 42. Seroconversion rates were similar between groups. Seroprotection on day 42 for A New York (H3N2) was significantly greater in the intradermal (86.7%) than in the subcutaneous group (35.3%). Seroprotection rates for other stains were similar. CONCLUSIONS: Intradermal administration to infants of two doses of influenza vaccine was more immunogenic than subcutaneous injection. Seroconversion and seroprotection rates remained insufficient. Further study of route, quantity, and frequency are needed to improve of responses in infants.