White color stool in rotavirus infection

1) Watery stool of an infant with Roravirus's gastroenteritis(Vomiting & diarrhea) .
------- Stool colour is white-yellow, which is specific for Roravirus infection,
-------- since infection induce the reduction of bile excretion.

2) red colored ones are fragments of undigested carrot

3) Rapid test for rotavirus and adenovirus: red line show
--- the detection of rotavirus.

                   

------------------------
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.

Electron micrograph of Rotavirus. Bar indicate 100nm.

Dr. Maria-Lucia Rácz, Institute of Biomedical Sciences

University of São Paulo. Visual collection of American 

Society for Microbiology

❑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, MD
-------------------------------  keijihagiwara@gmail.com
-------------------------------  Kami-Ube Pediatric Clinic,
----------------------------- --1-20-2 Tokiwadai, Ube 755-0097, Japan.

Dr. Kanehiro Takaki and vitamin B1 deficiency

Japanese rice: right is the polished rice(Bran, outer layer of rice,

which contain vitamin B1, E , are removed)

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

Kanehiro Takaki（高木兼寛 in Japanese） and beriberi

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

1)  Below are excepts from the book "Arthur Kornberg: For the love of

enzymes. The odyssey of a biochemist. Harvard University Press. 1991."

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

Japanese naval records of deaths from beriberi

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

Year               Diet               Total navy            Deaths from

                                             personnel                beriberi

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

1880(M13)     Rice diet          4,956-------------1,725

1881(M14)----Rice diet          4,641-------------1,165

1882(M15)----Rice diet          4,769-------------1,929

1883(M16)  -  Rice diet          5,346                     -1,236

1884(M17) Change to new diet  5,638                  718

1885(M18)----New diet--------6,918                        41

1886(M19)     New diet--------8,475                          3

1887(M20)     New diet--------9,106                          0

1888(M21)     New diet          9,184                          0

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

One hundred year ago, epidemics of beriberi(vitamine B1, or thiamine deficiency)

were destroying the Japanese navy. More than half of a crew, after a few weeks at

sea, would become weak, listless, and paralyzed and would succumb to profound

weight loss, liver disease, and heart failure.

Barely twenty-five years after Perry's visit, Japan had replaced Samurai swordsmen

with a navy that would soon challenge one of the mightiest of the West.  But unlike

Western sailors, the Japanese were peculiarly vulnerable to beriberi despite the best

hygiene and the finest rice money could buy; the kernels, having been separated

from the ugly husks, were polished free of the protective silvery skins consumed

by the population at home.

It struck one K. Takaki, a ship doctor, that the Japanese had copied every detail of

British naval equipment and operations excepts for rations, and so he designed this

crucial experiment: the crew of 300 of one vessel on a long cruise was fed the

polished rice diet, while the crew of another was given the unappetizing fare of

British seaman: oatmeal, vegetables, fish, meat, and condensed milk.

Of those fed with rice, two-thirds contracted beriberi; the sailors fed the strange

British diet all remained hale and hearty. The dramatic effects of changing to a new

ration are preserved in Japanese naval records(see Table). Although Dr.Takaki could

not explain the causal relationship between diet and beriberi, to knowledgeable

microbiologists in Japan and Europe these was only one interpretation: the polished

rice rations must have been infected.

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

2)  Dr. Takagi's effort of diet change was resulted in the dramatic decrease of
----vitamin B1 deficiency in Navy .  In Russo-Japanese war(1904-1905), Japanese 
----navy completely defeated the Russian Bultic Fleet in the Battle of Tsushima(Sea 
----of Japan Naval Battle).

----But not the diet change in Army were done. At that times,  medical community 
----, especially, doctors in Army believed that a bacteria is the cause of disease.  
----In fact, researchers of Tokyo Imperial college of Medicine insisted that we
--- found the beriberi's bacteria.


----During the Japanese Army Campaigns in Manchuria, China,  so many soldier were------
----suffering from Beriberi.  The vitamin B1 deficiency killed more soldiers than that
----of fighting itself.

3) Dr. Takagi also founded Ji-Kei University School of Medicine and nursing school
----at Tokyo. He studied the Medicine at St Thomas' Hospital in London and learned 
-    the pragmatic approach to the disease.


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

Drinks for acute gastroenteritis(vomiting & diarrhea) in children

OS-1: A solution for vomiting & diarrhea
----------- see→  Otsuka Pharmaceutical Factory , Inc.   

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

Oral rehydration solution

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

Oral Rehydration Solution(ORS) was first developed for infant diarrhea 

(acute gastroenteritis) in developing countries.  

  see → http://en.wikipedia.org/wiki/Oral_rehydration_therapy#cite_note-14

The key point is  that absorption of water in intestine is associated 

with Na and glucose.

Oral Rehydration Solution( for example, OS-1 ) for children in developed 

countries contain lower concentration of Na & Cl than that of  ORS(WHO). 

               Na          K            Cl       citric acid----   glucose  (mmol/L)

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

WHO    75~90 --   20        65~80       10              75~111      

-ORS 

OS-1       50   -      20          50    ---       0                100

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

Any questions:  write to Keiji Hagiwara, MD                          

                             keijihagiwara@gmail.com

Tulips in Keukenhof

In 17th century, "Tulip mania "was occurred in Netherlands. 

A new variety, rare type, tulip bulb were trade with high prices. 

In addition, future market accelate the bulb prices.

Keukenhof, Netherlands

Keukenhof is world's largest tulip garden, where is located southwest of
Amsterdam. → http://www.keukenhof.com/

Below, photos taken April 25, 1987.
1)Dutch woman is taller than any other Europeans.

2)Various types of Tulips and so many types of flowers

3) inside of garden

4) Near Keukenhof. myself and 3rd son.
    Blooming so many tulips !

4) Amaryllis in the front of my clinic;
Two bulbs of Amaryllis were purchased in Keukenhof garden of Holland

in 1987, when I studied at Universite Catholique de Louvain in Brussels.

Its bulbs produce child, grandchilds and so on ------

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

An epidemic of Swine Flu in children at Ube-Onoda area

In Ube city, an epidemic of swine flu was started among elementary school pupils

(aged 10~12 year old), and then spread to older or younger ages. The peak was 48 week((November.23~29,2009).

1) Influenza case is defined as positive in Flu symptoms & rapid influenza antigen test.  

----all reported cases, except for very few cases of B(+),  is A(+)positive and were not 

---- confirmed by PCR.

2) Cases are reported from pediatricians of Clinics and Hospitals in Ube-Onoda area,

----(Total pop.= 210,000. less than15 year old=29,000) Yamaguchi, Japan.

3) week 40 (Sep.28~Oct.4, 2009)
               week 41 (Oct.5 ~ Oct.11)
               week 42 (0ct.12~Oct. 18)
               week 43 (Oct.19~Oct.25)
               week 44(Oct.26~Nov.1 )
               week 45(Nov.2~Nov.8)
               week 46(Nov.9~Nov.15)
               week 47(Nov.16~Nov.22)
               week 48(Nov.23~Nov.29)
               week 49(Nov.30~Dec.6)
               week 50(Dec.7~ Dec.13)
               week 51(Dec.14~Dec.20)
               week 52(Dec.21~Dec.27, 2009)
               week 53(Dec.28~Jan.3, 2010)


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

View Larger Map

Snow in Ube city

Today, light snow(3~5cm) in Ube city. The snow at road is melting.
Below photo is my clinic at am 9:00. 

View Larger Map
Any questions: write to       keijihagiwara@gmail.com
                                            Keiji Hagiwara, MD
                                            Kami-Ube Pediatric Clinic,
                                            Ube 755-0097, Japan.

The injection technique of Swine influenza vaccine

In Japan, Swine flu vaccine is made by

1)The Kitasato Institute Reseach Center for Biologicals  
    → http://www.kitasato.ac.jp/rcb/eng/index.html

2)The chemo-Sero-Therapeutic Research Institute 

        → http://www.biken.or.jp/english/index.html

and other companies.

For more infomation, Please ask the companies.

The injection technique of vaccine;
1) Inject into subcutaneously, not intra-muscularly in Japan.
     Other vaccines(DaPT, Measles & Rubella, Varicella, Mumps,
      Japanese encephalitis ) are also administered via the same route .
2) The site of vaccine injection is upper arm(skin just above 
    Triceps brachii muscle, avoid the radial nerve), not thigh or 
     buttock.

------------------------   from Wikipedia(http://en.wikipedia.org/wiki/Triceps_brachii_muscle)

3) Use the 27 gauge needle(for the tubelculin test) .
4) Before injection, vaccine liquid( 4 ℃) is warmed up to room temperature.
     Cold liquid will triger the pain reaction.
5) Inject slowly. Rapid injection also induces pain.

subcutaneous injection of Swine Flu vaccine(1)

subcutaneous injection of Swine Flu vaccine(2)

subcutaneous injection of Swine Flu vaccine(3)

In USA, swine(2009 N1H1) influenza vaccine is administered via intra-
muscular route, or by intra-nasal spray(may be the same in Europe).

　intramuscular Flu vaccination in the left shoulder muscle

    (from the website of Centers for Disease Control and Prevention

      ➞ http://www.cdc.gov/  )

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

Mongolian spot

Mongolian spots are most common among newborn or infant of Mongolian,
Japanese, Korean, Chinese, Polynesian, Micronesian, native American,
and east African.

A Mongolian spot (Dermal melanocytosis) is a birthmark and usually
disappears 6 year old ~ puberty.

The most common color is light dark blue, light blue-gray, or deep brown.
it appear usually in the lumbosacral area and/or other any parts of body.

☆ Mongolian spot is diffent from "blue spots " such as
            → Nevus Ota (http://www.cosmetic-medicine.jp/english/zukan/nevus-ota/index.htm)

       or → Nevus Ito(http://emedicine.medscape.com/article/1058580-overview)


1)  4 month old boy:

2) 7-month-old boy:

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

First shrine visit of the New Year 2010

|||||||||||||||||||||A happy New Year 2010 !

大きな地図で見る

Today, I went to the first shrine visit by car. But, Traffic congestion due to
many people visit the shrine " Kotozaki Hachimanguo(琴崎八幡宮)" in
Ube city. I gave up, return to my home and then by walking.

During the first~third January, we Japanese visit to Shrine for worship.
People pray to God for their wishes and good future. I am not so religious,
but, ------ I went to ------ . " God helps those who help themselves ".

P.S; The shrine said that from January 1 to 3, 186,000 people(Pop. of
        Ube city: 178,000) visited the shrine.

Any questions: write to ------------  keijihagiwara@gmail.com

2009 N1H1 influenza vaccination for children under way

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

2009 N1H1 influenza vaccine

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

I have been administering the Swine flu vaccine for child with following groups;

The order of priority;

------ i) The child with underlying disease (Bronchial asthma et ct.)

------ ii) 1~ 5 year old with "normal child".

------ iii) elementary school pupils, grade I ~ III ,

------ iv) mother or care taker who have infants less than 1 year old( Dec. 4th ~~ )

------ v) elementary school pupils, grade IV~ VI, ( Dec. 4th ~~ )

The distribution of Swine flu vaccine to Hospitals and Clinics is too slow in Japan.

※ The charge of vaccine(National-wide rates): first shot (3,600 yen)

-----------------------------------------------------------second shot (2,550 yen)

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

Age ----------------------------The dosage of vaccine

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

1~ 5 -year- old---------------0.2ml x 2 times (apart 1~4 weeks)

6~12 -year-old---------------0.3ml x 2 times (apart 1~4 weeks)

13 year old > ----------------0.5ml x 2 times (apart 1~4 weeks)

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

If you wish to be vaccination for your child with above mentioned category,

please call to reservation (Tel : 0836-29-1155).


Thank you,

Keiji Hagiwara, MD

Kami-Ube Pediatric Clinic,

1-20-2 Tokiwadai, Ube 755-0097

Tel: 0836-29-1155

Fax:0836-29-1156
Any questions: write to E-mail: keijihagiwara@gmail.com

Automatic blood cell counter

I purchase the new automatic blood cell counter. because the breakdown
of the former machine, which worked for 12 years.

--------------------------------LC-660(not sold in USA), HORIBA, Ltd.
　　　　　　　　　              　→ http://www.horiba.com/us/en/
Using 10 micro-litter whole blood, you can measure WBC, RBC,
Hgb,HcT, Platelet and the percentages of lymphocyte, monocyte,
and granulocyte. it take only one minute.

Any questions: write to keijihagiwara@gmail.com

Roseola(= Exanthema subitum)

~~~~~~~~~~~~~~~~~~~~~~
Roseola(= Exanthema subitum)
~~~~~~~~~~~~~~~~~~~~~~

【Case 1. One-year-old baby】
||||||||||||||||||||||||||||The body temperature in this case is not so high.

||||||||||||||||Usually, the rash of Roseola is unclear one. This case is relatively
||||||||||||||||clear cut one, look like the initial stage of " Measles" rash.
||||||||||||||||The low resolution of Blog's Photography is not suitable to show
||||||||||||||||skin eruption.

------------------------------------------------------------------------------------
【Case 2.  9-month-old boy】
||||||||||||||||||||||A fever chart: good record !
||||||||||||||||||||||His mother described that skin eruption appear from
||||||||||||||||||||||abdomen→ back|→ face→ hand & foot.

~~~~~~~~~~~~~~~~~~~~~~
Roseola(= Exanthema subitum)
~~~~~~~~~~~~~~~~~~~~~~
◎Ages: 6-month-old ~ 1.5-year-old
◎Etiology: human herpes virus 6, and 7(rare) and less frequently Enteroviruses.

Electron-microscopy of HHV-6(x 25,000), Dr. Kazuto Yamaguchi,

Department of Animal Experiment, Yamaguchi University School of Medicine.

◎Ethinic: Roseola is very common in Japanese infant, 2/3 infants suffer
|||||||||||||from this condition. Asian infants (Chinese, Korean ) may suffer
|||||||||||||similar frequency.
◎Clinical course:
|||||||||||||||||1) High fever(39~40℃) last for 3~5 days. but infant do not
||||||||||||||||||||seem very sick.
|||||||||||||||||2) no cough, no runny nose( frequently, loose or watery stool) .
|||||||||||||||||3) a fever subside, then a red rash appear in body.
||||||||||||||||||||The type of rash is variable; Rubella like, Measles like, or
||||||||||||||||||||diffuse pink rash. Rash disappear in several days.
➞    The skin eruption of Roseola is unclear one and many different types.
|||||||||||Sometimes mother will not notice ----- so carefully observe the baby
|||||||||||skin. This is one reason why Roseola's frequency is different among ethnic
|||||||||||groups or nations.
◎Complication:
|||||||||||||||1) febrile convulsion
|||||||||||||||2) encephalitis (rare)

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