[TWO SCHOOL-AGED CASES OF FRUIT GIBBERELLIN-REGULATED PROTEIN ALLERGY WHICH NEED INDIVIDUAL REMOVAL STRATEGY IN SCHOOL LUNCH].

Gibberellin-regulated protein (GRP) is a newly discovered allergen in systemic fruit allergies. The kind of fruits which cause allergy is extensive as GRP is universally included in plants. Two children with GRP allergy were reported. Case 1: A 6-year-old boy experienced anaphylaxis while running after school lunch, which included canned peaches. A skin prick test (SPT) and blood examination suggested that he had peach GRP allergy. Six months and three years later, he experienced a similar episode after eating apple and citrus flesh, respectively. Case 2: An 11-year-old boy experienced anaphylaxis while running after consuming canned peaches during school lunch. A SPT implied that he had peach GRP allergy. However, a similar episode occurred after eating strawberry flesh 18 months later.Patients with GRP allergy often have one or more allergies to fruits other than peaches, as in these cases, and relevant fruits differ depending on the case. Particularly, clinicians should recognize that apple and citrus fruits are frequently included in school lunches as fruit flesh and as flavoring or seasoning in ready-made sauces or dressings. Therefore, an appropriate removal strategy should be considered in school lunches depending on each case of GRP allergy.

Eosinophilic granuloma of bone: two case reports.

Eosinophilic granuloma (EG) is a benign, self-limiting disorder that usually involves a single bone. However, there is a growing evidence that the clinical picture of EG is protean. We report two cases with EG that showed rare presentations. Case 1: A 14-year-old girl complained of headache in the left parietal region for several days. The initial examination was normal. During the next three weeks, her headache was progressive and she noticed a tender swelling on her head. Cranial computed tomography (CT) revealed an osteolytic lesion on the left parietal bone. On magnetic resonance imaging (MRI), the lesion corresponded to a tumor that arose from the intradiploic region, and showed both extracranial and epidural extension. She underwent tumor resection and a diagnosis of EG was made on pathological examination. An immunohistochemical study with Ki-67 suggested accelerated growth of the tumor cells. Case 2: A 1.9-year-old boy suddenly complained of a pain in the back and soon had difficulty in walking without help. Several days later, he became unable to sit or walk. On examination, he had spastic paraplegia in addition to painful swelling on the back. A myelogram showed a block just below the T2 vertebra. Chest CT scanning disclosed that a tumor lying posterior to the T2 vertebra was causing marked cord compression and destruction of the posterior elements of the spine. The tumor extended at T1-T3 vertebral levels. He underwent tumor resection and recovered neurological ability. EG should be considered as a differential diagnosis for patients with osteolytic lesions who exhibit aggressive clinical features.

Examination of severe, hospital acquired infections affecting extremely low birthweight (ELBW) infants.

PURPOSE: A nationwide questionnaire survey was carried out in 77 major neonatal intensive care unit (NICU) facilities in Japan. The survey investigated severe, hospital acquired infections occurring in extremely low birthweight (ELBW) infants at each institution. METHODS: The nationwide questionnaire survey involved 77 major NICU facilities and ELBW infants born in 1996. The actual status of severe infection in these infants was investigated. RESULTS: Replies were obtained from 57 of the 77 facilities that were sent a questionnaire (74% recovery). During the survey period, the total number of patients hospitalized in 57 facilities was 13697, of which there were 836 ELBW infants. During this period, severe infection occurred in 126 of the ELBW infants. Of those, 98 who developed delayed infection (72 h or more after birth) on the basis of the date of onset were investigated. Methicillin-resistant staphylococcus aureus (MRSA) was the most common organism found, (38 infants, 38.8%), followed by Pseudomonas (10 infants, 10.2%) and Candida (8 infants, 8.2%). Septicemia was present in 67 patients (68.4%), while pneumonia and gastrointestinal complications were found in 15 patients (15.3%). With respect to therapy, the selection of antibiotics varied between facilities. Vancomycin (VCM) was used in 31 cases (31.6%) because MRSA was the most common organism. VCM was used from the early stage of treatment in as many as 20 infants (20.4%). Fifty-eight infants survived (59.2%), 28 infants died (28.6%), and 12 subsequentially had obvious complications (12.2%). CONCLUSION: It was confirmed that severe, hospital acquired infections caused by MRSA are still a significant problem in many institutions. Despite active prevention and treatment, the incidence of severe, hospital acquired infection has not decreased and the prognosis has not improved. Considering the inadequacy of the medical care environment in Japan, it seems impossible to solve these problems at present.