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

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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. 

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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

Starting the Swine N1H1 vaccine for child

Photo ---------- Two type of Swine flu vaccine(10ml vial and 1.0ml vial)

, made by KAKETSUKEN, The chemo-Sero-Therapeutic Research Institute,

Today(November 21th, 2009), I start to shot the Swine flu vaccine for 41 child

with two groups;

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

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

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

Japan. On 16th November, I had received 10 vials(one bottle contain 10ml)

of the Swine flu(A,N1H1) vaccine from local health authority of Yamaguchi

prefecture.

※The charge of vaccine(National-wide rates): first (3,600 yen), second (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(1~5 year old only),

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

E-mai: 1) keijihagiwara@gmail.com

2) keiji-hagiwara@umin.ac.jp

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Sweet potato

Today, I harvest the sweet potatoes (a variety name：鳴門金時）
in my small garden. You may need to dig deeper around 1 m.
I miss to cut some of them with hoe.

Tamiflu and a chinese herb（八角）

Chinese star anise fruits (Chinese: 八角, pinyin: bājiǎo ) is the traditional herb

of the Chinese cooking.

It is the starting material of anti-influenza virus drug Oseltamivir (trade name=

Tamiflu). see ⇒ http://en.wikipedia.org/wiki/Tamiflu

The shikimic acid is extracted from the seeds of star anise in a ten-stage process.

Then, Tamiflu is chemically synthesized(at least 14 steps are necessary) from it.

Thirteen grams of star anise make 1.3 grams of shikimic acid, which can be

made into 10 capsules(oseltamivir 75 mg/ capsule, for treatment of one Pearson).

Star anise is grown in four provinces in China and harvested between March

and May. It is also produced in Lang Son province, Vietnam.

Any questions: write to keijihagiwara@gmail.com

Swine flu( 12-year-old)

Two records of 12-year-old boy with Swine flu, who were treated with Relenza.

In these cases, excellent effect of Relenza.

Relenza is a type of oral inhalation drug for influenza A, B, or swine H1N1influenza

virus infections.　see → http://www.gsk.com/products/prescription-medicines/relenza.htm

Any questions: write to keijihagiwara@gmail.com

Swine flu( 6-year-old)

October 25th. At evening, started fever.

|||||||| ------ Rapid test: influenza-A(+).

|||||||| ------ prescribed Tamiflu dry syrup & acetaminophen granules.

||||||| ---------------- A record of body temperature: 6-year-old. Arrow indicate Tamiflu

||||||| dry syrup intake.

Any questions: keijihagiwara@gmail.com

Swine flu (2-year-old)

Last week, The Swine flu have been spreading among the elementary school

children in Ube（宇部）. It's late start, since Ube city is situated far from the

big city, such as Fukuoka（福岡） or Hiroshima（広島）.

View Larger Map

October 27th. 2-year-old. mother noticed fever at mid-night.

||||| ------- 28th. came to my clinic.

||||| -------------- Rapid test : influenza-A(+)

||||| -------------- prescribed Tamiflu dry syrup, cough syrup & acetaminophen.

|||||||| --------------- Tamiflu dry syrup( a powder for oral suspension )

||||||||| ---------------- arrow indicate Tamiflu intake.

Any questions: write to keijihagiwara@gmail.com

Swine N1H1 influenza Vaccine

---------------- Vaccine for Swine H1N1 influenza virus

October 20th, Swine flu vaccine for health professionals (doctor & nurses)

delivered to my clinic. One vial's cost is 2,937 yen(29.37 $, 1$=100yen).

Of course pay myself.

You can see the influenza trend in Japan

→ http://www.google.org/flutrends/intl/en_us/jp/

Any questions: write to keijihagiwara@gmail.com

RS virus infection(1 year & 6 month old; pneumonia)

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

Case presentation: 1 year and 6-month-old boy.

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

He had been taken thyroid hormone for congenital hypothyroidism.

Dec.6th. start fever and cough.

|||||||||||| 8th. came to my Clinic. prescribed Erythromicin and cough-syrup.

||||||||||||10th. high fever and developed severe coughing with stridor.

|||||||||||| ------- Moist & dry rales audible in both lower lungs.

|||||||||||| ------- WBC 5,700/micro-L, CRP(++)

------- Rapid test for RS-virus(+).

Chest X-ray showed bilateral infiltrations(+).

||||||||||| ------------- referred to University Hospital.

RS(Respiratory syncytial) virus is one of the major agents, which cause

, common cold, bronchiolitis or pneumonia from late autumn~ winter~spring in infant.

        ➔ http://keiji-hagiwara.blogspot.com/2009/03/rs-virus-infection-in-infant-1.html

        ➔ Lean about RS virus infection : http://www.cdc.gov/rsv/

For preventing the disease, monoclonal antibody to RS virus(Synagis)

should be given every months during autumn to spring, to high-risk babies

such as the low-birth-weight infants or with congenital heart disease or

respiratory problems.

The costs of Synagis is high. At present, public Health insurance cover the

cost in infants at risk, but not "normal infants" in Japan.

Any questions: write to keijihagiwara@gmail.com