[Exchange transfusions in sepsis after the pediatric open heart surgery].

We experienced 2 cases of septic children after open heart surgery. Both of them recovered by using exchange blood transfusion technique. We use irradiated and dialysed fresh blood for exchange blood transfusion. After this procedure, they recovered from sepsis, as the datas improving, white blood cell reduced from 19,700 +/- 3,710 to 8,200 +/- 2,360, CRP reduced from 5.46 +/- 1.65 to 1.89 +/- 0.70, T-Bil reduced from 7.61 +/- 2.66 to 3.02 +/- 0.89, and BUN reduced from 525.92 +/- 6.64 to 19.76 +/- 5.34. Furthermore, blood pressure and urine volume were stable between exchange blood transfusion, although after open heart surgery. Therefore this procedure has benefits for the compromised, septic patients, performed open heart surgery, because of its stability of the circulating circumstances. And using the irradiated and dialysed fresh blood provides stable condition eventhough under high dose catecholamine use.

[The trend of childhood bacterial meningitis in Japan (1997.7-2000.6)].

We surveyed the epidemiology of purulent meningitis in pediatrics for 3 years between July 1997 and June 2000 in Japan and obtained the following results. The number of cases of purulent meningitis was 428, which was equivalent of 1.1-1.7 children out of 1,000 hospitalized those in pediatrics per year. The age-distribution for the infections was the highest under 1 year of age and it decreased as the age increased. Under 1 year of age, the highest distribution was observed in one month of age and under 1 month of age, the highest distribution was observed in 7 days of or younger ages. Haemophilus influenzae was the most common pathogen causing the infections, followed by Streptococcus pneumoniae, group B streptococcus, and Escherichia coli. Relationship between causing pathogens and age-distribution was as follows: group B streptococcus and E. coli were major pathogens under 4 months of age and H. influenzae and S. pneumoniae were major pathogens over 3 months of age. Susceptibility tests performed at each facility demonstrated that 25.3% of H. influenzae isolates and 38.7% of S. pneumoniae isolates were drug-resistant. Analysis of resistant genes for H. influenzae and S. pneumoniae isolates, which were stored and sent, demonstrated higher rates of resistance than those observed in susceptibility tests. These results suggest that the increase in insufficient efficacy of usual treatment with combination of ampicillin and cefotaxime is predictable against the infections. Therefore, the treatment for the infections should be reconsidered.

[A curative report of multiple organ dysfunction syndrome and disseminated intravascular coagulation due to methicillin-resistant Staphylococcus aureus caused mediastinitis after cardiac surgery].

We experienced a curative case, who was a fifty nine-year old man suffered from multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC) due to Methicillin-resistant Staphylococcus aureus (MRSA) caused-mediastinitis following cardiac surgery against atrial septal defect (ASD) and tricuspid regurgitation. We successfully treated him with mediastinal irrigations by a large quantities of physiological saline containing 1% Povidone iodine (PI) and MRSA sensitive antibiotics as well as artificial supports such as plasma pheresis and hemodialysis against failure organs. It may be due to the prompt treatment with mediastinal irrigation and well timed dosage of sensitive antibiotics against the origin of sepsis that such a serious patient like this case could be recovered from MODS and DIC. In addition, it may be very effective to irrigate with 1% PI against MRSA-caused-mediastinitis.

Congenital dislocation of the knee. Its pathologic features and treatment.

Arthrograms and operative findings of 19 patients with 26 congenital dislocations of the knee (CDK) were reviewed to clarify the pathologic features, methods of treatment, and the optimum treatment for the patient with multiple joint deformities. The fundamental pathologic features in CDK involved a shortening of the quadriceps femoris tendon, a tight anterior articular capsule, and hypoplasia of the suprapatellar bursa. Valgus deformity of the knee, which was observed in half of the patients, was caused by the fragility of the medial components of the knee. This fragility was attributable to the forward displacement of the tibial insertion of the medial components. Arthrograms served as effective indicators when evaluating the pathologic features and determining the applicability of surgical therapy. There were limits to conservative therapy that were dependent on the extent of the pathologic changes. In extremely refractory patients with arthrogryposis multiplex congenita (AMC), an elimination of genu recurvatum and an improved range of movement could be obtained by the use of surgery. The valgus deformity was significantly reduced by invasive treatment that reinforced the fragile inner components. Experience with nine patients with multiple lower-limb joint deformities indicates that the knee dislocation should be treated before any of the other deformities.

[Statistical survey of prosthetic restorations--fixed and removable prosthesis].

This is a continued report on the statistical classification of the prosthetic restorations placed in the outpatients in the Tokyo Medical and Dental University Hospital. The data were collected from the laboratory records during the period of January to June of 1986. The results are summarized as follows: 1. Total of 419 bridges, consisting of nearly the same number in the maxillary and mandibular units, were fabricated. A wide variety of designs was observed for those not covered by the health insurance. 2. Approximately 83% of the 265 complete dentures were covered by the health insurance. The number of the maxillary units was slightly more than that of the mandibular units, which was similar to the data collected about 20 years ago. 3. Seven hundred and fifty-four partial dentures were placed and approximately 45% of these were covered by the health insurance. 4. Various designs were observed in the 'Konus-Kronen' type of prosthesis. They were assumed to be applied not only for the restoration of the edentulous areas, but also for the splinting of the remaining teeth. 5. Fixed bridges were placed in more than 90% of the cases with single tooth loss. However, partial dentures were more frequently used than the fixed bridges for the restoration of the two-tooth loss.

[Statistical survey of prosthetic restorations--outline and single crowns, cast cores and inlays].

This is a report on the statistical classification of the prosthetic restorations placed in out-patients of the Tokyo Medical and Dental University Hospital. The data were collected from the laboratory records during the period of January to June of 1986. The results are summarized as follows: 1. The total number of the prosthetic restorations placed in the outpatients were 7355, and 56% of these were covered by the health insurance. 2. Of the total restorations, 29.6% were cast cores, 18.2% were inlays and 17.2% were crowns. Post crowns, jacket crowns and partial veneer crowns were very few, being only 0.3%, 0.4% and 0.5%, respectively. 3. Approximately 50% of the prosthetic restorations were single crowns. 4. Compared to the record from about 20 years ago, the number as well as the ratio of the crowns including the facing crowns was approximately doubled. On the contrary, the number of jacket and post crowns has remarkably decreased. 5. With regard to the single anterior prosthetic restorations, the majority were the porcelain fused to metal crowns which were not popular 20 years ago.

[Experimental study on the etiology of pathogenesis of acetabular dysplasia in congenital dislocation of the hip].

In order to investigate the etiology of pathogenesis of congenital hip dislocation and acetabular dysplasia, experiments using fetuses of pregnant rabbits were conducted. The following findings were obtained. (1) Dislocation occurred in approximately 40% of total animals used. The earliest dislocation was seen 2 days after birth. (2) The hip dislocation could be relatively and easily generated by exogenous factors during the perinatal period, even without such primary cause, as hip joint dysplasia. The acetabular dysplasia could be generated secondarily to dislocation. (3) There was a difference in the cause of acetabular dysplasia between areas of the acetabulum with and without load. (4) The acetabular depth growth in the dislocated hip was more seriously impaired than the longitudinal and transverse diameters of the acetabular entrance. These results have indicated that endochondral ossification of the epiphyseal cartilage of the acetabulum in the dislocated hip was more markedly impaired than that of Y epiphyseal cartilage.

[Diagnostic imaging of pulmonary lymphangiomyomatosis; especially the correlation of CT finding and pathological finding].

CT findings of pulmonary lymphangiomyomatosis were composed of diffusely arranged reticular and cystic appearances with mildly increased density. These correlated with histological increased smooth muscle cells, emphysematous change and dilated lymph vessels.

[Clinico-pathological analysis of stage IIIa carcinoma of the cervix uteri].

We have reviewed cervical carcinoma IIIa cases treated at the University of Hirosaki Hospital from 1970 to 1984 and at the Metropolitan Komagome Hospital from 1975 to 1984. In this period, 32 cases were staged at IIIa, and this group accounts for less than 2% of all cervical cancer cases at these two institutions. The age of the 32 patients ranged from 33 to 86 years with a mean age of 66. In treatment methods, 3 cases were operated on and other cases were irradiated by a combination of intracavitary therapy and external beam therapy. The actuarial 5-year survival rate was 78.3%, and the relative 5-year survival rate was 86%. Our results suggest that FIGO stage IIIa carcinoma of the cervix has a much better prognosis than FIGO stage IIIb cervical cancer.

[Urinary kallikrein levels during pregnancy].

Whether to determine the urinary kallikrein (UKK) levels in the second trimester of pregnancy is valuable in predicting of gestosis, especially of hypertension, was studied using samples of urine obtained from 500 cases of pregnant women without gestosis, 50 pregnant women with gestosis and 50 cases of pregnancy with a variety of complications other than gestosis. The main results obtained were as follows: In normal pregnancy, UKK levels elevated with pregnancy for a peak in the first to the second trimester of pregnancy, tapering off thereafter. The UKK level was significantly lower in 20 pregnant women with gestosis especially in hypertensive type than in pregnant women without gestosis (p less than 0.001). Pregnant women with normal blood pressure who suffered no gestosis and had an extremely low UKK level, accounted for 9.8% of all pregnant women studied. This figure includes a large number of those who were in a high risk group for the onset of gestosis. From these findings, UKK was considered to be useful as one of the factors used in predicting the onset of hypertension in association with gestosis and we are now studying pregnant women in the 20th and 30th week of pregnancy in more detail.