SUNY Downstate Medical Center

Helicopter sight seeing, near United Nation Buildings.

SUNY Downstate Medical Center, Brooklyn, New York

Kings Country Hospital Center, Brooklyn, New York

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

Vanderbilt University Medical Center

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Downtown of Nashville, from hotel window. Photo; taken September 1995

Vanderbilt University campus is located a few km West-South from downtown.

The bronze stature of the shipping and rail magnate "Commodore" 

Cornelius Vanderbilt, who provided Vanderbilt its initial $1 million endowment.

Vanderbilt University Medical Center

Dr. Ouchi and me

A party in the campus.

A football match.

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

Minimum Inhibitory Concentration( MIC test)

MIC test:Tube method

MIC test: Micro titer method

-------- from the homepage of Antimicrobial Test Laboratories

MIC(Minimum inhibitory concentration) is the lowest concentration(μg/ml) of an
antibiotics that inhibit the growth of a bacteria.

A bacteria are culturing in wells or tubes, while an serial dilution of an antibiotics are
adding each tubes or wells for overnight. Cloudy tubes or wells indicate the growth
of bacteria. Clear wells or tubes indicate the inhibition of a Bactria's growth.


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

Kirby-Bauer antibiotic testing (disk diffusion)

Staphylococcus aureus

Left：Aztreonam disc(30μg/ml).

Right：Vancomycin disc(30μg/ml)

--------Dr. Mizuno, Clinical Laboratory, Yamaguchi University School of Medicine

Kirby-Bauer antibiotic testing (disk diffusion) is a test for determine which antibiotics
is susceptible to a bacteria. A bacteria(Staphylococcus aureus) are grown on agar
plates, while the small discs(containing antibiotics: Aztreonam or Vancomycin) are
placing for overnight. Clear zone indicate the inhibition of a bacteria's growth.

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

Flu vaccine (2010~11)

This year's flu vaccine contain 3 strains of influenza viruses.

1) influenza virus strains included:
ーーーーーーー A strains: A / California / 7 / 2009 (H1N1)
ーーーーーーー-ーーーー A / Victoria / 210/2009 (H3N2)
ーーーーーーー B strains: B / Brisbane / 60/2008

2) Number of vaccination: 1-year-old-----under 13-year-old: twice (1~4 weeks apart)
ーーーーーー-------ー---ー 13 years or older : once.

3) Cost: 1st: 3,600 yen, 2nd: 2,550 yen


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

Exanthema subitum( Roseola)

Clinical course of Roseola (Exanthama subitum)

---------------------------------------
Roseola= Exanthema subitum
---------------------------------------
This disease may suffer 2/3 of the Japanese child.

Etiology: human herpes virus - 6.

EM image : x 25,000(Dr. Kazuto Yamaguchi,Department of Animal

Experiment, Yamaguchi University School of Medicine)

Age: 3 months to 3 years (frequently 7 months~ 1.5 years)

Clinical course:

||||||||||||||||||1) high fever(39~40℃) last for 3~5 days.
||||||||||||||||||||||| but child 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.


Complication:
|||||||||||||||1) febrile convulsion
|||||||||||||||2) encephalitis (rare)

Questions ? -------  write to keijihagiwara@gmail.com

Pinwheel

Pinwheel: a windmill toy

Windmill in Kinderdijk

blowing a pinwheel

While children is blowing a pinwheel toy （風車 Kaza-guruma in Japanese),
you may easy to hear the sound of the bronchi or lung.

From autumn to winter, the infant and toddler often suffer from wheezing
(Asthmatic) bronchitis. Using windmill toe, you never miss.

Any question: write to Keiji Hagiwara, M.D.
                                   Kami-Ube Pediatric Clinic
                                   keijihagiwara@gmail.com

Polio vaccine

Oral polio vaccine

(a) Period in Ube city: September 01 ~ October 15
(b) Subject of oral polio vaccine: (1)  3-month-old ~ 7.5-year-old
ーーー        ーーーーーーー     ー   (2)  Born in 1975 ~ 52
(c) Number of dose: 2 doses.


Any Questions :
Keiji Hagiwara, MD
1-20-2, Tokiwadai,
Ube 755-0097, Yamaguchi
E-mail: keijihagiwara@gmail.com

Vaccine injection technique: Japan-US differences

-------- from the homepage of CDC

Two types of vaccine injection techniques ( Intramuscular or subcutaneously) 
are routinely used In United States.

----------  Intramuscular   :  Influenza, Haemophilus influenzae, Pneumococcal, -----------------------------------                    DTaP, Hepatitis-B, Hepatitis-A.

---------- Subcutaneously:  IPV(Polio), MMR, Varicella

In Japan, all vaccines are administered by subcutaneously.

Any questions ?

--------------- write to Keiji Hagiwara.  keijihagiwara@gmail.com

Morning glory

This summer is two hot. The flower of Morning glories are opening in early morning
and are fading at late morning, taken at a.m.9:00, as you can see the following photos.

Morning glory

Morning glories begin to blooming in the fence of my clinic.

Morning glory

Morning glory＝朝顔（日本語）＝牽牛（中文）.
The flower usually opens in the morning and closes in the afternoon.
It was first introduced to Japan by the Japanese mission to China in 
early 8th centuries as a drug (The seeds contain alkaloids and use as 
a laxative).

Fireworks in Ube city

Time: 2010 July 24. Saturday  pm 8:00~9:00
Taken Photos from near-side of the faculty of Engineering, Yamaguchi University

Korle Bu Teaching Hospital, University of Ghana Medical School (2)

Time: 1987.11.10
Place: Korle Bu Teaching Hospital, University of Ghana Medical School.

1) From the top of the ward

2) in the ward. From left; Dr. Nakano, Dr. Archampong and the attaché of 

    Japanese embassy.

3) The recovery room

4) the consultation room for children

Pediatric consultation

measuring of the body weight of infant

Korle Bu Teaching Hospital. University of Ghana Medical School(1)

Time: 1987.11.10
Place: Korle Bu Teaching Hospital. University of Ghana Medical School

The entrance of Korle Bu Teaching Hospital. 

University of Ghana Medical School

Korle Bu Teaching Hospital

Dr. Archampong(Dean of Medical school) and nurses

Accra, Ghana

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Stay period : November 8~11, 1987.
Place : Accra, Capital, Republic of Ghana

To enter Ghana, be required the certification of yellow fever vaccine.



WHO recommendation:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yellow Fever
Country requirement: a yellow fever vaccination certificate is required from all travellers 

over 9 months of age.

Malaria
Malaria risk due predominantly to P. falciparum exists throughout the year in the 

whole country. Resistance to chloroquine and sulfadoxine-pyrimethamine reported.
Recommended prevention: Mosquito bite prevention plus atovaquone-proguanil 

chemoprophylaxis doxycycline or mefloquine (select according to reported resistance pattern)

Rabies
Rabies risk: High risk. pre-exposure immunization recommended for travellers and other 

people for whom contact with domestic animals particularly dogs and other rabiesvectors is likely.

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

before the arrival to Kotoka International Airport

in the street of Accra

Marriot hotel. noisy room conditioner.