BCG vaccine

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BCG vaccine in Japan

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In 1967, the injection method of Bacillus Calmette et Guérin(BCG)  

vaccine was changed from intradermal injection into 18-needles

-press method in Japan.  I don't know the real reason. Probably, 

this method is remained less skin scars at injection site.

       → http://en.wikipedia.org/wiki/Bacillus_Calmette-Guérin

----------------------------------Photo:   brown ampule contain Freezed dry BCG vaccine,  

---------------------------------------------Right; 9-needles device.

BCG vaccine was originally produced by French researchers, 

Drs. Calmette and Guérin in Pasteur institute. They attenuated 

Mycobacterium bovis by sequential passage of cultures.

In 1934, Dr. Kiyoshi Shiga (http://en.wikipedia.org/wiki/Kiyoshi_Shiga

, the discoverer of shigella, the bacilluscausing dysentery )

 introduced this strain into Japan.

The side effect of Japan made-BCG vaccine(Tokyo 172 strain), 

such as subaxillary lymph node's swelling , is very few.

---------------------------------One month after BCG injection. 　
---------------------------------Note the small abscesses at inoculation sites. 


Any questions:  write to  keijihagiwara@gmail.com
--------------------------------Keiji Hagiwara, MD.
--------------------------------Kami-Ube Pediatric Clinic

C-reactive protein

Photo: Rapid Latex agglutination method for C-reactive protein

             concentration in Blood.

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C-reactive Protein

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C-Reactive protein is named for its property of precipitating with

the group-specific C polysaccharides of the cell wall of the

pneumococcus in the presence of Ca ions. It was discovered in

1941 by Dr. MacLeod and Avey.

    Acute phase protein

    M.Wt.                           : 110,000~ 144,000

    site of production       : liver

    Normal serum value :  less than 1.0 mg/100ml

    Increased in :   acute infections and inflammatory change 

                            or necrosis.

    measurement method:  precipitation with specific antiserum.

WBC count: past & present

Photo. 1) Automatic counter.

                   ACE Counter FLC-240A(11 year old), HORIBA. Ltd.

                 →　http://www.horiba.com/medical-diagnostics/

             You can measure to Leukocyte, Red blood cell, Hb, 

             Ht ; Platelet. using whole blood of 20 micro-litter.

Photo. ２) Neubauer Hemacytometer Photo.３) prick device, disposable plastic pipette 

                   and glass pipette

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Leukocyte count

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We, pediatricians frequently have been order to measure White

Blood Cells(leukocyte) and its differential, as described in the

clinical records of first human trial on penicillin.

→http://keiji-hagiwara.blogspot.com/2008/08/first-clinical-trials-of-penicillin.html

At present, the counting of white blood cell is very easy to do

, less than 5 minutes.  Doctors need no technician.

In the past, the enumeration of leukocyte was counting manually

using Hemacytometer under light microscope.

Manual determination of White Blood Cells :

1) a few micro-litter of whole blood were filled to the pipette.

2) diluted with stain solution, and squeeze gently several times.

3) charge Neubauer Hemacytometer with stained blood.

4) using 100x magnification, count leukocytes in the 4 corner

     squares( total: 16 corners), of the counting camber.

5) multiply number of leukocytes counted by 50 = Total WBC

     count. if 210 leukocytes are counted, total count is 210x50=

     10,500/cu mm.

Any questions:  write to Keiji Hagiwara, MD                          

                                            keijihagiwara@gmail.com

New York from air(3)

View Larger Map

photo 1) Queensborough Bridge(59th street Bridge).

right lower: Goldwater Memorial Hospital

photo 2) Long Island city.

Left: Queensborough Bridge.

Right: Kosciuszko Bridge across Newton Creek.

New York from air(2)

1)
Photo.2) The tall building in center is the Citicorp Center building.

Of note, the slanted top contains a huge block of concrete 

to keep the building from swaying in the wind. It was 

added after the tower was constructed in the 70's. 

It is called a Tuned Mass Damper.

3)

photo 4) Queensborough Bridge

Yew York from air(1)

Photo 1)
Photo 2)
Photo 3) Empire State Bild. (rt)
photo 4)

Photo 5) United Nations, September 1995.

Harvest Rice

Photo:  harvesting rice.  14th October,08.

In the back of my Clinic is a small cultivated field for rice.

An old couple harvest rice.  Usually, from September to

October is a time for harvesting rice in Yamaguchi Prefecture.

Cough or cold medicines

There are a variety of over-the-counter cough or cold medicines 

(syrup) for children are sold in Drug stores in Japan. Its taste and 

flavor are excellent if you drink, in spite of its contain bitter codeine.           

The ingredients of OTC cold medicine ;

------------------------------------------------------------------------

1) Cough suppressant: many contain codeine phosphate,                 

    and dl-methylephedorine or dextromethorohan HBr.

2) Anti-histamine: d- Chloropheniramine

3) Expectorant: guanethidine sulfate

4) Fever reducer: acetaminophen

5) Vitamins: B1, B2, C
6) Caffeine

-------------------------------------------------------------------------    

Usually, Pediatrician prescribe 1),2),3),4) with the various combination 

of its volume and ingredients, depending upon the child condition. 
But not use 5), 6).  

1) Be careful !   Please buy the child-resistant Safely caps. 

2) In mild cold case, it may OK to use OTC drugs. 

3) The cost of OTC cold drugs is expensive. 

We pediatricians prescribe more reasonable and effective cold medicines, 
but, Public Insurances regulate its cost too much lower.  I can’t accept 
this Japan Insurance Policy.  

Any questions: write to Keiji Hagiwara M.D.                                     

                          keijihagiwara@gmail.com 

Staphyloccal Scalded Skin Syndrome in child

Photo: bullae with clear fluid and the peeling of skin in toddler.

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Staphylococcal scalded skin syndrome in child

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SSSS arises mainly in the newborn infant, rarely in older child,

because they possess the antibody against the exfoliative toxin

A or B.

any questions: write to Keiji HaAgiwara, MD

keijihagiwara@gmail.com

Staphyloccal Scalded Skin Syndrome in mouse

Photo: SSSS in ddY mouse. Upper 2 mouses were subcutaneously injected
---------with different doses of the Staphylococcus aureus which were cultured 
---------from the SSSS patient. Lower one was the control(St. aureus, Cowan I )

----------(provided by Dr Hisanori Konishi, Department of Bacteriology, 
-----------Yamaguchi University School of Medicine)

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Staphylococcal scalded skin syndrome in mouse

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The disease is caused by strains of Staphylococcal aureus, which

produce exofoliative toxins(A or B), which absorbed, cause the

separation of cells within epidermis.

The Staphylococcal aureus, which isolated from the baby with

this disease, was cultured and then Mouse(ddY) was inoculated

subcutaneously with the its Staphylococci. A positive Nikolsky

sign(peeling of skin) indicate the epidermolytic activity or

presence of exfoliative toxins.

Any questions: write to Keiji Hagiwara, MD

------------------------------  keijihagiwara@gmail.com

Staphyloccal Scalded Skin Syndrome in newborn

Staphylococcal scalded skin syndrome in newborn baby;

reddishness around the neck skin and peeling(another case of this story).

Staphylococcus aureus in human skin

(Dr. Dennis Kunkel, Dennis Kunkel Microscopy, Inc. Kailua, HI )

----------------------------------------------------
Staphylococcal scalded skin syndrome
----------------------------------------------------

In early spring 1990, a newborn with staphylococcal scalded

skin syndrome (=SSSS) came to the Department of Pediatrics,

Yamaguchi University Hospital and subsequently another 2

babies came to the outpatient clinic. Those 3 babies were born

at maternity unit of University Hospital.

The staff of maternity unit had tried to control of this staphylo-

coccus infection. So the rooms, linen, curtains, gowns, and

floors were cleaned with a disinfectants and heavy hand

washings were ordered to the staffs . But the outbreak of SSSS

continued.

The Professor of Pediatrics asked me any idea to stop of this

outbreak. In that time, I didn't knew where and when staphylo-

coccus was transmitted to newborn baby ? I went to Library

and found one paper from Guy’s Hospital, London.

It described as follow;

We described two outbreaks of staphylococcal skin infection

among neonates, Aged from 3 to 16 dates, who were delivered

in the maternity unit at Guy’s Hospital. The first outbreak,

which included six babies, began in mid-February1986 and

lasted for a period of 10 days; second, began exactly 4 weeks

later, involved a further possible nine babies and resolved in

14 days. We wish to draw attention to the work that all of this

caused, the procedures used to identify the epidemic strain,

and to show how the two outbreaks were connected by

persistent nasal carriage by one member of hospital staff.

I showed this paper to the chief of the committee for Hospital

Infection Control. Then the committee conducted same method

as described by Guy's Hospital and succeeded to control this

outbreak.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

1990: A outbreak of neonatal SSSS in Maternity unit.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

(only show the cases which extensive bacterial examination

were done)

May 1990 : 2 cases

June: 1 case

July: 1 case

August: 3 cases

September: 3 cases -------- and no cases after.

# The carrier of our case: Staphylococcus aureus (MRSA and

produced exofoliative toxin) were isolated from nasal swabs

of 2 obstetrician.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

I thank you to Docters of Guy's Hospital of London.

Ref) Dancer SJ, Simmons SM, Poston SM, Noble WC,: Outbreak of

staphylococcal scalded skin syndrome among neonates.

Journal of Infection 16, 87-103,1988.

Any questions, write to Keiji Hagiwara, M.D.

E-mail: keijihagiwara@gmail.com

Health Center at Brooklyn, SUNY

1)Helicopter sightseeing: Queensborough Bridge. September 1995.

2) Health Science Center at Brooklyn, State University of

New York. September, 1995.

View Larger Map

3)Health Science Center at Brooklyn. SUNY.

4) Helicopter sightseeing over Queensboroug Bridge.
5) United Nations Building. We used Island helicopter service,

Heli-port was located near United Nations. I forgot the fee

of 90 $ ?

-----------------------------------------------------------------------------

then, We visited the Department of Pediatrics, Children's Medical

Center of Brooklyn, State University of New York.

Dr. Margaret Hammerschlag is a chief of department, a specialist

in Chlamydia pneumoniae infection in children, and the author of

the chapter " Chlamydia pneumoniae infection" in the textbook of

Pediatric Infectious Disease.

Her laboratory is to be said that the rate of Chlamydia pneumoniae's

isolation from patients is the best in the world. A Pediatrician from

the Kurume University school of Medicine was studied there.

We stayed 3 days in New York.

Vanderbilt University

View Larger Map
1) downtown in Nashville from the hotel, September 1995.
2) in the front of Vanderbilt Medical Center. September 1995.

Right: me , left : Dr. Ouchi
3) joined a party in Vanderbilt University Campus to eat a lunch.
4) Vanderbilt Stadium: watched a American Football game between

Vanderbilt Univ. team and ?? Univ. team.

5) the playing site for children in a shopping center at suburbs in Nashville.

-------------------------------------------------------------------------------------------------

We stayed 5 nights in San Francisco and moved to Vanderbilt University,

Nashville, where a colleague of my University studied there for the research

on Helicobacter Pylori.

I walked around the Hospital, Faculty of Medicine and Laboratory, and also

the University campus at random direction. It's good place for study I think.

Nashville is not noisy city, also gave me a good impression.