31 October, 2008

Drinks for vomiting & diarrhea in child

Photo:  A solution for vomiting & diarrhea 
             ( Otsuka Pharmaceutical Factory , Inc.  )     

Photo:  It's components .

Oral rehydration solution
Oral Rehydration Solution(ORS) was first developed for 
infant diarrhea in developing countries.  

The key point is  that absorption of water in intestine is 
associated with Na and glucose.

               Na          K            Cl       citric acid   glucose  (mmol/L)
WHO    75~90 --   20        65~80       10              75~111      

OS-1       50   -      20          50           0                100

Any questions:  write to Keiji Hagiwara, MD                          

30 October, 2008

Breast swelling in newborn baby

Photo:  Breast enlargement and a little milk in Newborn baby.
Some newborn baby, who care by breast feeding, may swelling 
of her breast and a little milk. 

This is caused by mother's milk which contain a hormone. 
Do not worry !   This swelling will subside naturally.

Any questions:  write to Keiji Hagiwara, MD                         

29 October, 2008

Vomiting & diarrhea due to Rotavirus

Photo 1) Electron micrograph of Rotavirus .   Bar indicate 100nm.
                Visual collection of American Society for Microbology 

Photo 2) Watery stool of an infant.  Stool colour is white-yellow.                   
               Right panel show the Rapid antigen test for Rotavirus         
               & Adenoviruses.  Agglutination is noted in rota virus.

Rotavirus infection
❑Symptoms:  fever and frequent vomiting, follow watery diarrhea.

❑Rotaviruses:  5 antigenic groups(A,B,C,D, E). group A
          (6 serotypes) are major causes infantile vomiting & diarrhea.
❑Transmission:  fecal-oral route
❑incubation periods: 1-3 days
❑Treatment:   Oral rehydration solution or parenteral fluids 
                        are given to correct dehydration.

❑Prevention:   live attenuated vaccine(given by mouth).
                        not available in Japan.

Any questions, write to Keiji Hagiwara, M.D.
                                 E-mail: keijihagiwara@gmail.com

Chicken pox vaccine

Photo: Chicken pox vaccine( from The Research Foundation

1) What is Chicken pox ?  
    see → http://keiji-hagiwara.blogspot.com/2008/07/chickenpox.html

2) Chicken pox vaccine was first developed by Dr.Michiaki
   The Oka strain of varicella-zoster virus isolated from vesicles 
  of a 3-year-old boy with typical Varicella was serially passaged 
  11 times in human embryonic lungs cells and 12 times in guinea
  pig embryo cells, and further passaged in human diploid cells
  several times.

Any questions:  write to Keiji Hagiwara, MD                    

28 October, 2008

Umbilical hernia in infant

Photo: umbilical hernia in infant.
Umbilical hernia is notice at neonatal period and gradually
bigger and bigger during infancy.

Don't worry !

Up to 1~ 1.5 year, it is naturally dissolved.

In the case of inguinal hernia, some baby need the operation.
some baby have tighten the neck of hernia and the intestine
can not go back to abdomen.

Any questions: write to Keiji Hagiwara, MD

Belches in newborn infant

newborn 16-day-old.  distention of intestine due to air injections

 Photo: 1 month old neonate. X-Ray show the distention
---------of stomach due to excessive ingestion of Air.
-------- ( note the thymus shadow of upper lung)

Figure) A method to induce belches .

The neonate frequently drink airs during breast or bottle feeding
and have difficulty in belches. So after feeding, Please induce belches 

Any questions: write to Keiji Hagiwara, MD


X-Ray system in Pediatric practice

Photo)  X-Ray system in my Clinic---made by SHIMADZU              
             corporation. Her right hand hold the protector for
             preventing the radiation to reproductive systems 
             of child.

X-Ray system 
Is it necessary to have a X-Ray apparatus in Pediatric Primary 
Care Clinic ?    If doctor is well trained and good experiences, 
the answer is NO.

It is difficult to take good X-Rays in child. For instance, Chest
X-Ray is shot at deep inspiration phase. But child can not hold 
the respiration.  So by chance. 

The point to take a good X-Ray is the fixation of child's body 
by mother or father and a staff.  At least two persons are
needed to fix an infant.

In 1895, Wilhelm Röntgen discovered X-Ray. Then one year 
later, Umejiro Shimadzu assumed the name of his father, 
Genzo Shimadzu, the founder of SHIMAZU Co.and in 
cooperation with his younger brother, succeeded taking 
roentgenograms for the first time in Japan. 

Any questions:  write to Keiji Hagiwara, MD                          

A case of pneumonia in infant

Figure 1) Body temperatures recorded by parent.
Photo 2) Chest X-Ray; 2-year-old. (53 kV, 250mA, 20ms, 150cm)

a case of pneumonia
2 year old, female

26th July. first visit:
|||||||||||||||||| Fever started at morning.
|||||||||||||||||| pm3:00 came to Clinic. No sighs. prescribed antibiotics
|||||||||||||||||| and antipyretic.
28th . 2nd visit:
||||||||||||||||| fever(-) and cough appeared.
||||||||||||||||| No special findings/prescribed cefatrizine and anti-cough
||||||||||||||||| medicines.
30th .third visit:
|||||||||||||||| high fever(+) and become worse coughing at night
|||||||||||||||| and early morning.
|||||||||||||||| Throat & tonsil: not reddish.
|||||||||||||||| Respiratory sounds diminished at right upper lung.
|||||||||||||||| X-Ray showed the consolidation of right upper lung.
|||||||||||||||| WBC 6,600/mm3, C-reactive protein (+)
||||||||||||||| Rapid test for Respiratory syncytial virus : I forgot !

------------ referred to Yamaguchi University Hospital.

Any questions, write to Keiji Hagiwara, M.D.
E-mail: keijihagiwara@gmail.com

25 October, 2008

Tokiwa park

Photo 1) Pericans in Tokiwa park are very friendly.
Photo 2) Tokiwa park :  → http://ww52.tiki.ne.jp/~zaiubetokiwa/index.html
Photo 3) White Swans in Tokiwa park. Black one is Austrarian Black Swan.

23 October, 2008

Butterfly Needle: old and new

Photo:   butterfly needles for Drip infusion. 

Upper one is old one, which is difficult to preserve several 
days, especially in infant and toddler.  

Lower one (new version available from Becton Dickinson)
is suitable to newborn and infant's Fluid infusion therapy 
for many days.

Nebulizer for Asthma attack: Old and New

Photo 1)  Ultrasonic Nebulizer 
                  Omron→ http://www.omron.com/
Photo. 2) Air compressor Nebulizer.   
         this one is made from Plastic, 
         not glass(frequently broken)

Nebulizer for Bronchial Asthma attack
Nebulizer solutions;

    (a)procaterol HCl(broncho-dilator)
        Intal® (cromoglicate Na)
   (b)procaterol HCl
         Bisolvon®(bromhexine HCl)
 # Do not mixture of Bisolvon ®and Intal® which form
     precipitates !

Any questions:  write to Keiji Hagiwara, MD                          

21 October, 2008

Hepatitis-B vaccine

Photo 1) Electron micrograph of hepatitis B virus.  
                     ( Linda Stannard, Department of Medical Microbiology,                      
                     University of Cape Town )

Photo 2) Hepatitis-B vaccine

If mother is positive of hepatitis-B surface antigen, especially
e-antigen(+),  administer the hepatitis-B vaccine and 
hepatitis-B immune globulin to child as following schedule.

            0 day :  hepatitis-B immune globulin
   2-month-old:  hepatitis-B immune globulin+ HB vaccine
   3-month-old:  HB vaccine
   5-month-old:  HB vaccine

MMR vaccine in Japan

Photo:  MMR vaccine( Measles-Mumps-Rubella combined) 
              stopped in April 1993 in Japan, since aseptic meningitis
               occurred among child who received this vaccine at a
               rate of 1/300~1/1200. At present, not available in Japan)

MMR vaccine  and aseptic meningitis
------------------------------------------ --

In April 1989, MMR(Measles-Mumps-Rubella) vaccine was 
introduced in Japan. and then its side effect were reported
more frequently year after year.  

The vaccine strains of Mumps viruses(Urabe Am9 strain)
caused meningitis.  In April 1993, Ministry of Health & Welfare 
decided to stop this vaccine. 

   The frequency of aseptic meningitis among child who
          received MMR vaccine in Yamaguchi prefecture.
       1989                  11/13,269            ( 1/1,206)
       1990                  14/ 7,510             ( 1/  578)
       1991                    8/ 5,728             ( 1/ 716)
       1992                   6/ 4,512              ( 1/ 752)

At present, Measles-Rubella vaccine administer at age 
1 year, and second dose of  age at 5-7 years.

Any questions:   write to Keiji Hagiwara, MD
--------------------------------Kami-Ube Pediatric Clinic,
--------------------------------1-20-2 Tokiwadai, Ube 755-0097, Japan
-------------------------------- keijihagiwara@gmail.com

Polio vaccine

Photo: oral polio vaccine, one vial contain 20 doses.

Polio vaccine

Oral polio vaccine(type I, II, III) is used in Japan.  The time for 
vaccination is Spring and Autumn.  
Polio virus infection;
     Incubation period:   7-21 days
     Transmission:   fecal-oral or oral-oral routes.
               i) low-grade fever and sore throat occurs in 4-8% 
                   of infections.
               ii) most infections in human are asymptomatic.
                   Limb paralysis occurs in approximately 
                  1 /1,000~2,000 infections

20 October, 2008

DaPT vaccine

Photo: DaPT vaccine ( from Takeda Pharmaceutical Compamy Ltd.)

Diphtheria, acellular Pertussis and Tetanus vaccine

Japan. The acellular or component pertussis vaccine have been few
side effects(Encephalopathy, fever, swelling of injection site ---- )
compare to that of whole cells vaccine.

The delay of introduction to other countries, was that it was difficult
to do the clinical vaccine control-study, since the prevalence of
whooping cough was low in Japan. Therefore, USA, Canada and
European countries independently conducted the control study of
this acellular pertussis vaccine and later proved its efficacy.

What is pertussis(whooping cough) ?

Any questions: write to keijihagiwara@gmail.com