Once upon a time in ------

In 1975, I graduated Yamaguchi University School of Medicine. 5 members of

our class, Tsukahara, Kanehara, Hagihara, Imaizumi and Koyama chose the
Pediatrics, Yamaguchi University School of Medicine.

Before the graduation of medical school, Tsukahara and I passed the medical
portion of ECFMG (the test of the certificate for foreign medical students who
would like training at hospital in USA), but we both failed the English portion.

After graduation, we tried again the English test but failed. However, we never
gave up to go to America.

In 1985, I had a chance to go to abroad, Brussels, Belgium. I missed the chance
of studying in USA, but Tsukahara did it; John Hopkins Medical Center for
studying genetics in 1987 and again, Montana State University in 1995.

Tsukahara wrote a lots of papers in the subjects of human genetics and human
malformation syndrome., but I choose one.------- Tsukahara M. et al. : Bartonella
henselae infection from dog. Lancet 352(9141)1682, 1998.

Cat-scratch disease is caused by a Bacteria, named Bartonella henselae, which is
transmitted by cats. He showed the first time that dogs also transmit this bacteria
to human.

After the graduation of medical school, for nearly 20 years, I had been worked
with him in the department of Pediatrics,Yamaguchi University School of Medicine.

Thukahara will forever live in my mind.

April　2009.
in the season of cherry blossom.
Keiji Hagiwara, M.D.
---------------------------------------------------------------------------------------------------------------

Photo) September 28th, 1986. a restraint at  Brugge, Belgium. 

--------Tsukahara and my 3rd son. Before attending the conference 

--------of Human Genetics in West Berlin, he came to Brussels, 

--------where I studied at Louvain.

Photo) Back is a canal of Brugge, Belgium. Tsukahara, my 3 sons and myself.

Photo) In the street of Brugge, Belgium. my wife, three sons and Tsukahara.

Photo) 10th February, 1978. Nara city. Tsukahara speaking at my wedding.

Photo) At my wedding. Right: Professor Shunzou Konishi, the former President --------

--------- of Yamaguchi University and the director of the Department of Pediatrics, --------------------------------------Yamaguchi University School of Medicine, Ube, Japan.

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

---------------------------  ↑ myself ------------------　    ---↑ Tsukahara
Photo) June 6th, 1993. Members of Pediatric ward of Yamaguchi University 
           --------Hospital went to Space World in Kita-Kyushu.

----------------------------------------↑ myself-----↑Tsukahara
Photo) 1989? 　Pediatric ward moved to new building.

--------------------------------------↑小西教授 ↑義保 ↑砂川 ↑ 篠原

----------        --------------------------------------------------↑今泉                    ↑金原
Photo) Summer 1975. The staff of Pediatric ward of Yamaguchi University
            Hospital (Head: Prof. Shunzou Konishi), in a beach at Hofu city.

---------------------------↑今泉　　　　↑金原　　↑守口　　　　　　　↑myself　　　　　

ーーーーーーーーーーー↑金子↑ 平岡

----------------             -----↑ myself ------------------        ------------　Tsukahara ↑

A snap photo

 7th March, 2009. from left; Miss Yamaguchi, myself & Dr.M. Miyasaka

(Immunology Frontier Research Center, Osaka University).

Atopic dermatitis(2 year old)

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

Atopic dermatitis( 2-year-old )

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

Here a typical case of Atopic dermatitis.

2-year-old boy. Skin rash appear in face, neck, trunk, arm and leg.

Only show the photos of hand, thigh and foot.

------------------------ Red, irritated, raised rash at left thigh.

Lab. data):

|||||||| Serum IgE 356 iu/L.

|||||||| white blood cells 15,800/mm3. Eosinophil 9%.

|||||||| Allergen test for egg white (+4/6), cow milk( +4/6), ovomucoid(+3/6),

|||||||| ----------wheat(+2/6) , dogs(+3/6), cat( 0/6), mites(o/6), house dusts(0/6).

-------------------------- Left foot: He frequently have been scratched the skin

-------------------------- and worsen the dermatitis------ negative feedback.

-------------------------- 6 days after treatment.　

Any questions: write to Keiji Hagiwara, MD

keijihagiwara@gmail.com

Cherry blossams are in bloom

Cherry blossoms are now blooming in peak here.

Below are photos in Tokiwa park in Ube city, Yamaguchi.

　　　　　　　　　Tokiwa lake(man-made) in Tokiwa Park.

Herpangina

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

Herpangina

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

1) Season: Summer

2) Age: infant and toddlers

3) Course of illness:

fever and throat pain resolved few days or more longer.

Photo) Throat of Herpangina. Small vesicles appear in palate.

4) Etiology: Enterovirus

Photo) Electron-Micrograph of Enterovirus

------ Dr.Linda Stannard, University of Cape Town.

Any questions: write to Keiji Hagiwara, MD

keijihagiwara@gmail.com

Adenovirus infection in child (1-year-old & 6-year-old)

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

Adenovirus infection in child(2)

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

---------------- ☞ 1 year & 10 month-old girl:

|||||||||| April 5th 2004. fever & cough at morning.

|||||||||| 6th. came to Clinic. reddish white coated tonsil(+).

|||||||||| Rapid test for adenovirus(+).

|||||||||| 9th. fever fell down.

----------------- ☞ 6 year old girl (same patient as above).

|||||||||||||| But this time no so severe ----- may due to some immunity to adenovirus

|||||||||||||| March 4th, 2009. high fever & throat pain at evening. no cough.

|||||||||||||| Tonsil: red(+) pus(-).

|||||||||||||| adenovirus test (+).

|||||||||||||| March 7th. fever fell down.

1) Adenovirus: DNA virus. 47 serotype

-------- Dr. Linda Stannard, Department of Microbiology, University of Cape Town.

2) Season: winter ~ spring ~ early summer.

3) Age: 6 month old~ toddlers.

4) Transmission route: child to child.

||||||| ☞ close contact through droplets.

||||||| ☞ feces~oral route.

||||||| ------- Child with adenovirus infection have excreted its viruses in feces

|||||||-------  for long period( 2 weeks).

5) main site of infection: kindergarten.

6) incubation period: 2~14 days.

7) Type of diseases:

||||||| ☞ So many types of adenovirus have been circulating,

||||||| child may be 2, 3 or more times suffered from this virus.

||||||| But don't worry,your child gradually immune to this virus.

||||||| i) Pharingitis, Tonsillitis: common

||||||| ii) Acute bronchitis & pneumonia: infant, at risk in premature born baby.

||||||| iii) conjunctivitis & keratitis: common in summer.

||||||| iv) Acute gastroenteritis: serotypes 31, 40, 41.

||||||| v) Hemorrhagic cystitis: toddler ~ 10 year old.

||||||| vi) Pertussis(whooping cough ) like illness: rare.

Any questions: write to Keiji Hagiwara MD,

keijihagiwara@gmail.com

RS virus infection( 1-year & 7-month-old)

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

RS virus infection in infant

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

||||||||||||||| ☞ Case presentation:

|||||||||||||||| ------- 1 year 7 month-old boy (acute wheezing bronchitis).

||||||||||||| January 19th. started high fever & cough.

|||||||||||||||||||||||||||| 20th. severe cough with wheezing at night.

||||||||||||||||||||||||||||||||||||||| Rapid diagnostic test for RS virus(+).

|||||||||||||||| 25th. no fever. cough & wheezing continued.

|||||||||||||||| February 2th. still coughing.

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

Respiratory Syncytial(=RS) virus: RNA virus

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

------------ Linda Stannard, Department of Medical Microbiology, University of Cape Town.

2) Age: 6 month old ~ toddlers

3) Season: winter~ early spring.

4) Incubation period: 2~8 days

5) Transmission route: close contact with infected infants.

|||||||||||||||||||||||||||||||||||||||||||||droplets, aerosol inhalation.

6) Site of infections: kindergarten, child care centers

7) Type of diseases:

||||||||||||||| i) upper respiratory infection: frequent

|||||||||||||| ii) wheezing bronchitis: infants

||||||||||||| iii) Acute bronchiolitis: apnea(holding respiration)

||||||||||||| iv) pneumonia:

8) Prevention: monoclonal antibody to RS virus(Trade name SYNAGIS)

------------------ , its high costs, is administered in one shot/month during winter

-------------------- for high risk baby  ☞ low-birth-weight infant, premature baby 
==============================or infant with congenital heart diseases.

Any questions: write to Keiji Hagiwara MD. keijihagiwara@gmail.com

Dr. Arthur Kornberg's comment on Penicillin

Dr. Arthur Kornberg and his family ---- from the book "For the love 

of enzymes: The odyssey of a Biochemist. Harvard University Press. 

1991.

Dr. Arthur Kornberg (1918-2007, who received the Nobel Prize

 of Physiology or Medicine in1959 and first done the chemical 

synthesis of a infectious phage, a virus of bacteria in 1967) wrote 

about penicillin.

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

  Penicillin and other antibiotics are the most dramatic 

therapeutic advance in medicine in my lifetime. When I was a 

student and intern before the advent of antibiotics, the 

treatment of lobar pneumonia was discouraging ineffective. 

One out of four patients died. Subacute bacterial endocarditis 

was invariably fatal. Rheumatic fever and acute nephritis 

were prevent.        

Many people know that antibiotic therapy was not discovered 

at bedsides nor even in a clinical pharmacology laboratory. 

Bullrings in Spain have a statures of Alexander Fleming, 

who in 1929 noticed the inhibition of bacterial growth around 

penicillin mold contaminated his Petri plate.        

The apotheosis of Fleming gored bullfighters is exaggerated 

because the practical use of the penicillin mold was not 

discovered by Fleming. It took Ernst Chain, a biochemist, 

and Howard Florey, a pathologist, to apply this knowledge 

ten years later to isolate penicillin and demonstrated its 

clinical utility.        

   There is much more to the penicillin story than that. 

Basic inquiries and findings essential to Fleming's discovery 

started at least fifty years earlier. Fleming would never have 

made his observation without the agar Petri plate. But, more 

important, he would never have understood what he saw on 

the plate were it not for the firm foundations of bacteriology 

and immunology.       

One might assume that Chain and Florey undertook the 

isolation of penicillin because of its possible clinical potential. 

Not at all. With the encouragement of Florey, Chain started 

his research on penicillin only because he was curious about 

the dissolution of bacterial walls by enzymes such as lysozyme. 

He thought penicillin was an enzyme too and wanted to 

understand the mechanism of its action. He surprised to find 

that penicillin was a molecule small enough to pass readily 

through the pores of a dialysis membrane which stopped 

passage of molecules as large as enzymes. 

Penicillin was not enzyme at all. This discovery immediately 

presented the possibility that penicillin, as a low-molecular-

weight compound, could be administered as a drug to animals. 

With the technique of freeze-drying, which had just become 

available, Chain was able to concentrate and preserve 

penicillin and then to prove its therapeutic efficacy.       

  Why were Chain and Florey so quickly to test their very 

crude penicillin preparations for clinical efficacy?  Their 

prompt decision was likely conditioned by the discovery in 

the mid-1930s that sulfonamides inhibit microbes and yet are 

not toxic to animals. 

Thus, an agent could selectively interrupt growth of microbes 

without affecting the animal host, and this observation gave 

Chain and Florey the confidence to test their penicillin prepa-

rations in infected mice.       

It may also explain why Fleming, ten years earlier, believing 

that only the host immune system could combat infections, 

regarded chemotherapy as implausible and so failed to test 

his crude penicillin preparations for therapeutic value. 

I choose penicillin as an example of the importance of basic 

research because its history is so recent and dramatic.   

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

Arthur Kornberg: For the love of enzymes: The Odyssey of a 

Biochemist. Harvard University Press. 1991.

Any questions:  write to Keiji Hagiwara, MD

                                      keijihagiwara@gmail.com