A new method for objectively evaluating childhood nocturnal cough.

OBJECTIVE: Cough is so common that the best method for evaluating nocturnal cough in children is required. METHODS: We developed a cough monitoring system by evaluating 50 child volunteers, and validated the cough monitor in 20 samples from 10 children with cough overnight. Coughs were recorded using a video camera and digital sound recording. At the same time, our system with microphone and accelerometer was used. The number of coughs in each eight hour video-audio recording was counted manually by three trained observers, and all cough data were printed out and the defined cough events, using both these printed-out data and video-audio recordings, were then calculated by three observers. RESULTS: The cough monitoring system demonstrated excellent agreement between the number of coughs counted by volunteers, and those counted by cough monitoring system (sensitivity 98.8%, specificity 97.8%). Also, there was significant agreement in the counts of coughs between the video-audio method and our system (P < 0.0001), and between the defined cough events and our system (P < 0.0001). CONCLUSIONS: Our method demonstrated well agreement with the video-audio recording method in children, and is considered to be highly useful for the objective monitoring of overnight cough in children with respiratory diseases.

Consistently high levels of exhaled nitric oxide in children with asthma.

BACKGROUND: Exhaled nitric oxide (eNO) levels in children are unstable because they are regulated by many potent factors. The purpose of the current study was to evaluate the reliability of eNO levels between a long interval and other lung functions in normal and asthmatic children. METHODS: Eighty-three elementary school children (aged 11-12 years; male : female, 39 : 44) participated in this study. Lung function, airway resistance and eNO levels were measured twice: the first measurement was in autumn 2007, and the second was one year later. RESULTS: There were 62 non-asthmatic control children (male : female, 31 : 31) and 21 asthmatic children (male : female, 8 : 13). In both the first and the second examination, the levels of eNO in children with asthma were higher than those in children without asthma. The parameters of lung function and the respiratory resistance in children without asthma showed a good correlation between the results of the first and second examinations. The eNO level in non-asthmatic children showed a good correlation between the two. On the other hand, the peripheral airway parameters of lung function and the respiratory resistance in children with asthma were not correlated between the first and the second examinations. The eNO level in these patients was well correlated between the two examinations. CONCLUSIONS: These data suggest that the eNO level showed good reproducibility in children with and without asthma. The eNO level is therefore considered to be a useful marker for reproducibly evaluating a subject's airway condition.

A prognostic value of neuron-specific enolase in cerebrospinal fluid of acute cerebellar ataxia.

We examined 16 patients with acute cerebellar ataxia (ACA) to determine whether clinical manifestations or laboratory findings could predict the prognosis of ACA. We divided the patients into two groups: a benign group of patients whose cerebellar symptoms completely disappeared within 21 days (9 patients), and a prolonged group of patients whose cerebellar symptoms persisted for more than 22 days (7 patients). The two groups were compared on the basis of demographic and clinical characteristics, and laboratory variables. The cerebellar symptoms did not differ significantly between the two groups, except in duration. The level of neuron-specific enolase (NSE) in the cerebrospinal fluid (CSF) of the prolonged group was significantly higher than that of the benign group (p < 0.01); other parameters, including protein and cell count in the CSF, were not significantly different. The results suggest that the NSE level in CSF is of prognostic value in ACA.

A case of accidental ingestion of a salbutamol sulfate inhalant, Venetlin®.

Pediatricians examine increasing numbers of children with bronchial asthma every year. In Japan, medical institutions can provide standardized therapies according to the Japanese Pediatric Guideline for the Treatment and Management of Asthma 2005. Inhalation therapy is highly beneficial, and a substantial proportion of patients choose to purchase inhalators and practice inhalation therapy at home. Recently, we experienced a case of accidental ingestion of a salbutamol sulfate inhalant by a non-asthmatic child, which reminded us anew of the importance of managing the medicines for asthma. We also recognized the need to educate patients and their families on the knowledge of these medicines. In this report, we analyze the case and discuss measures that pediatricians can implement to avoid accidental inhalant ingestion by children.

Renovascular hypertension due to bilateral renal artery stenosis treated with stent implantation in a 12-year old girl.

Renovascular hypertension (RVH) in children is a relatively rare disease, but it is important in that it is a treatable condition when properly diagnosed. Percutaneous transluminal renal angioplasty (PTRA) with or without stenting is widely applied to adult patients with RVH. However, limited information is available as to PTRA with stenting in pediatric patients. We experienced a case of RVH in a 12-year-old girl, who had severe hypertension (180/110 mmHg). Bilateral renal artery stenosis was demonstrated by 3D-CT, MR angiography and selective renal arteriography. Renal function and plasma renin activity were normal. Angiotensin blockade was refrained for fear of functional deterioration of the kidney. Medical treatment with amlodipine insufficiently lowered the pressure to 140-160/80-100 mmHg, so we performed PTRA. Stenotic lesion and pressure gradient was still present after balloon angioplasty on both sides, prompting us to place LUMINEXX® stents on both renal arteries. Blood pressure dropped dramatically after the intervention. Amlodipine was discontinued, and then, enalapril and warfarin were administered to prevent neointima and thrombus formation. Her blood pressure and renal function was stable 18 months after PTRA. Oversized self-expanding stent such as LUMINEXX® stent could be used for renal artery stenting even in pediatric patients with RVH.

Spontaneous expectoration of bronchial foreign body: a case report.

A nine-year-old girl with mental retardation accidentally swallowed an axle of a toy car and was urgently hospitalized with the diagnosis of left bronchial foreign body. While various monitors were installed and removal of the foreign body by a ventilating rigid bronchoscope was in preparation, the patient suddenly coughed and vomited, with the foreign body found in the vomit. When examining infant cases of air way foreign body, attention tends to be focused on the diagnosis and treatment. However, patients are at risk of aggravating difficulty in breathing or suffocation as long as foreign bodies are present in the air way. It is important to monitor carefully for changes in the breathing and to prepare for unexpected events.

C1q nephropathy in a 2-year-old boy presenting with steroid resistant nephrotic syndrome.

We experienced a case of a 2-year-old boy, who presented with steroid resistant nephrotic syndrome, which developed insidiously. Renal biopsy revealed that he had focal and segmental glomerulosclerosis on light microscopy, dominant mesangial deposition of C1q by immunofluorescent staining, and electron dense deposits on electron microscopy, which are all compatible with C1q nephropathy. He had no clinical sign of any collagen diseases, including systemic lupus erythematodes. So, the diagnosis of C1q nephropathy was made. An intensive treatment by a combination of cyclosporine, prednisolone and methylprednisolone pulse therapy was successful in achieving remission and disappearance of proteinuria in this patient. Although he developed hypertension requiring calcium blocker and angiotensin converting enzyme inhibitor, his renal function stayed within normal limit for 3 years after the initiation of the treatment. The growth was well preserved during the 3 years of treatment with almost unchanged SD scores for height. He has delay in speech, which may not be associated with the etiology of his nephropathy, based on the absence of such association in the previous reports. C1q nephropathy is still a controversial clinical entity, so accumulation of the cases may help further understand the pathogenesis and clinical manifestation of C1q nephropathy.

Hyperaldosteronemia and hypogammaglobulinemia secondary to atopic dermatitis-induced exudation in an infant presenting with growth failure.

The present case is a 5-month-old female with atopic dermatitis who was brought to hospital for growth failure noted upon regular health examination. Laboratory examinations revealed hyponatremia, hyperkalemia, hypoproteinemia, hypogammaglobulinemia, elevated plasma renin activity and hyperaldosteronemia. Immune function was normal. Composition of the exudate collected from the skin lesions of atopic dermatitis was similar to that of plasma. Application of a steroid ointment improved the lesions as well as all laboratory values. These findings indicate that voluminous exudation caused by extensive atopic dermatitis can lead to hypotonic dehydration, electrolyte abnormalities, hypoproteinemia, hypogammaglobulinemia and, finally, to growth failure in infants. We conclude that intensive treatment is important for severe atopic dermatitis in infants to prevent serious complications.

Utility of virtual bronchoscopy in congenital tracheomalacia.

Utility of virtual bronchoscopy was evaluated in a case of congenital tracheomalacia by comparing virtual bronchoscopic images with those of fiberoptic bronchoscopy. Results indicate that virtual bronchoscopy is useful in diagnosing stationary lesions. However, its diagnostic value is inferior to that of fiberoptic bronchoscopy for mobile lesions, in that virtual bronchoscopy does not permit dynamic images. We recommend that the institutions, where fiberoptic bronchoscopy is available, should perform virtual bronchoscopy in parallel to explore its utility.

Feasibility of fiberoptic bronchoscopy for small infants including newborns.

In pediatric practice, the application of fiberoptic bronchoscopy (FBS) has been limited to infants and children, primarily because the caliber of the available fiberscopes was too large for application to small babies including newborns. Recently, fiberscopes with thinner calibers were generated, prompting application of FBS to newborn patients. In the recent five years, we have utilized narrow-caliber FBS at the Neonatal Intensive Care Unit of the Tokai University Hospital. Through 21 FBS applications on newborn patients for various indications, we conclude that given careful monitoring of the patient's systemic conditions and management of ventilation, FBS can be safely applied on small babies including newborn patients and facilitate treatment of the airway problems.