Guillain-Barré syndrome in a local area in Japan, 2006-2015: an epidemiological and clinical study of 108 patients.

BACKGROUND AND PURPOSE: Many epidemiological studies of Guillain-Barré syndrome (GBS) and Fisher syndrome (FS) have been conducted in Europe and America. In contrast, epidemiological studies are rare in Asia where the GBS subtypes differ from those in Western countries. This study was undertaken to clarify the incidence of GBS and FS in a local area in Japan as well as their seasonal trends. METHOD: Seventy-one GBS and 37 FS patients were recorded from 2006 to 2015 in an area of approximately 1.5 million inhabitants in Japan. The incidence, seasonal trends and clinical features of GBS and FS were examined. RESULTS: The incidence rate of GBS was 0.42 cases per 100 000 person-years and that of FS was 0.22 cases per 100 000 person-years. The incidence of GBS increased with age and FS affected predominantly patients aged from 45 to 64 years old. There was some seasonal clustering of acute motor axonal neuropathy (AMAN) and FS in spring and summer, but it was not significant. AMAN and FS patients had a high frequency of preceding infection (AMAN, 68% gastrointestinal infection; FS, 65% upper respiratory infection). Antecedent respiratory infection was significantly associated with FS as an outcome. Serum antibodies to ganglioside GM1 were detected in 71% of AMAN patients and antibodies to GQ1b were detected in 81% of FS patients. CONCLUSIONS: Our study offers evidence of a lower incidence of GBS and a higher incidence of FS in a local area in Japan than in Western countries.

Strict red blood cell transfusion guideline reduces the need for transfusions in very-low-birthweight infants in the first 4 weeks of life: a multicentre trial.

BACKGROUND AND OBJECTIVES: Very-low-birthweight infants are among the most heavily transfused patients. The objective of this study was to verify if the introduction of a strict guideline would reduce the need for red blood cell transfusions in the first 4 weeks of life in these neonates. MATERIALS AND METHODS: This was a multicentre prospective study of two cohorts of very-low-birthweight infants transfused in accordance with the recommendations of a neonatologist (Phase 1) or according to previously published guidelines (Phase 2). RESULTS: In the first 28 days of life, 102 patients (68.5%) in Phase 1 and 117 (59.7%) in Phase 2 were transfused. The number of transfusions was 1.9 +/- 2.0 in Phase 1 and 1.4 +/- 1.6 in Phase 2 (P = 0.01). After adjusting for gestational age, blood loss and the presence of respiratory distress syndrome, the strict guideline reduced the number of transfusions in 17.6% (IC 95%-30.5% to -2.6%). CONCLUSIONS: The strict guideline was effective in reducing erythrocyte transfusions in very-low-birthweight infants.

Meningoencefalitis bacteriana en pediatría / Bacterial meningoencephalitis in pediatrics

La menigoencefalitis bacteriana es una patología que ha aumentado su incidencia en los últimos años. Se ha realizado un estudio prospectivo, previa elaboración de un protocolo para determinar la incidencia de esta patología, germen causal, clínica tratamiento, secuelas y mortalidad. En el Servicio de Pediatría del Hospital Central SSFP, durante el período de 1985-1988 se hospitalizaron 3604 pacientes, de los cuales 670 (18.5%) correspondieron a la Unidad de Cuidados Intensivos Pediátricos, diagnosticándose dentro del segundo grupo 20 casos de meningoencefalitis bacteriana, lo que equivalen al 2.9% de los pacientes intensivos. De los 20 casos analizados, se aislaron ocho de Neisseria meningitidis seis casos con Heamophyllus influenzae, uno con E. coli y en cinco no se aisló germen causal. En el grupo estudiado: 16 pacientes fueron de sexo masculino, 4 de sexo femenino. El grupo etario más afectado fue el de lactantes (40%). Entre los síntomas y signos comunes estuvieron: fiebre, vómitos, irritebilidad y signos meníngeos. El tratamiento antibiótico fue doble y la mortalidad alcanzó el 15% de los casos estudiados. Se enfatiza la necesidad de un diagnóstico etiológico rápido y el inicio de un tratamiento adecuado y oportuno para evitar secuelas posteriores y disminuir la mortalidad por esta patología

Muerte cerebral; experiencia en la UCI pediátrica HC. SSFP (Unidad de Cuidados Intensivos Pediátricos del Hospital Central del Servicio de Sanidad de las Fuerzas Policiales / Brain death; experience in the pediatric intensive Care Unit from the Hospital Central del Servicio de Sanidad de las Fuerzas Policiales

El concepto de Muerte Cerebral es equivalente a muerte del paciente. En la Unidad de Cuidados Intensivos Pediátricos del Hospital central del Servicio de Sanidad de las Fuerzas Policiales se elaboró un protocolo para diagnosticar este estado basado en los criterios clínicos modificados de Minnesota (Cabieses, F.) Tronco encefálico muerto. El paciente debe estar en coma irreversible, sin respuesta a ningún estímulo nociceptivo. El diagnóstico debe ser realizado por un Pediatra y un Neurólogo que no estén a cargo del paciente; luego de establecido el deceso, se comunicará a los padres del niño. esta es experiencia en tres casos con diagnóstico de Muerte Cerebral dejando planteada la posibilidad de utilización de órganos y tejidos para trasplante de acuerdo con la legislación vigente

Trisodium nitriloacetate monohydrate: promoting effect in urinary bladder carcinogenesis in rats treated with N-butyl-N-(4-hydroxybutyl)nitrosamine.

The effect of trisodium nitrilotriacetate monohydrate [(Na3NTA X H2O) CAS: 18662-53-8] on development of urinary bladder tumors in rats initiated with N-butyl-N-(4-hydroxybutyl)nitrosamine [(BBN) CAS: 3817-11-6] was studied. Twenty-one male inbred W rats 6 weeks of age were given drinking water containing 500 ppm of BBN for 4 weeks and then put on diet containing 10,000 ppm of Na3NTA X H2O for 28 weeks. Na3NTA X H2O promoted the development of urinary bladder tumors in rats treated with BBN. The incidences of papilloma and transitional cell carcinomas in the urinary bladder were 90% (18/20) and 25% (4/20), respectively, in rats treated with BBN and then Na3NTA X H2O and 0 in those treated with BBN or Na3NTA X H2O alone. The incidence of papillary or nodular hyperplasia in week 32 was 100% (20/20) in rats treated with BBN and then Na3NTA X H2O and 61% (13/21) in rats treated with BBN only.

Effect of propylthiouracil on the thyroid tumorigenesis induced by N-bis(2-hydroxypropyl)nitrosamine in rats.

The effect of 0.15% propylthiouracil (PTU) on thyroid tumorigenesis was studied in male Wistar rats given a single i.p. injection of 280 mg of N-bis(-2-hydroxypropyl)nitrosamine (DHPN) per 100 g body weight. The mean weights of the thyroid of rats treated with DHPN followed by PTU and with PTU alone were significantly higher than those of rats treated with DHPN only and control rats. The incidences of follicular adenoma at the end of week 20 of the experiment were 100% (21/21) in rats treated with DHPN followed by PTU, and 19% (4/21) in rats given DHPN alone. Papillary adenoma was observed in one rat treated with DHPN followed by PTU. The incidence of follicular carcinomas with invasive growth into the capsule, adipose tissues or blood vessels was 52% (11/21) in rats given DHPN and then PTU. No papillary carcinomas or solid tumors were found in any rats. Rats given PTU alone and untreated rats had no thyroid tumors. The serum concentration of T4 in rats treated with PTU alone was significantly lower than that in the control group. The serum concentration of T4 in rats treated with DHPN followed by PTU was slightly, but not significantly, lower than that in control rats. The serum concentrations of T3 in rats treated with DHPN followed by PTU, DHPN alone and PTU alone were also slightly, but not significantly, lower than that in controls.

Trisodium nitrilotriacetate monohydrate: promoting effects on the development of renal tubular cell tumors in rats treated with N-ethyl-N-hydroxyethylnitrosamine.

The effect of trisodium nitrilotriacetate monohydrate [N,N-bis(carboxymethyl)glycine trisodium salt] (Na3NTA X H2O) on development of renal tubular cell tumors induced with N-ethyl-N-hydroxyethylnitrosamine [CAS:13147-25-6; 2-(ethylnitrosamino)-ethanol] (EHEN) was studied. Six-week-old male inbred W rats were given a diet containing 1,000 ppm of EHEN for 2 weeks and then a diet containing a high (10,000 ppm) or low (500 ppm) concentration of Na3NTA X H2O for 30 weeks. The rats were killed during week 32. The higher concentration of Na3NTA X H2O enhanced the development of renal tubular cell tumors and increased the number and size of tumors in rats treated with EHEN, but the lower concentration of Na3NTA X H2O did not. The incidence of renal tubular cell tumors in week 32 was 33% in rats treated with 1,000 ppm EHEN for 2 weeks, 100% in rats treated with 1,000 ppm EHEN for 2 weeks plus high Na3NTA X H2O diet for 30 weeks, and 39% in rats treated with 1,000 ppm EHEN for 2 weeks and then given low Na3NTA X H2O diet for 30 weeks. Numbers of atypical cell foci per kidney area (No./cm2) were 17.0 +/- 7.6 in rats treated with EHEN and high Na3NTA X H2O, 7.3 +/- 2.2 in rats treated with EHEN and low Na3NTA X H2O, 3.7 +/- 1.4 in rats treated with EHEN alone, and 1.0 +/- 2.4 in rats treated with high Na3NTA X H2O diet alone. Atypical cell foci retained a tubular pattern and consisted of basophilic cells with a large nucleus or clear cells with a small nucleus.

Basic lead acetate: promoting effect on the development of renal tubular cell tumors in rats treated with N-ethyl-N-hydroxyethylnitrosamine.

The development of renal tubular cell tumors by the end of experimental week 32 was studied in inbred Wistar male rats fed a diet containing 1,000 or 500 ppm N-ethyl-N-hydroxyethylnitrosamine (EHEN) for 2 weeks and then given 1,00 ppm basic lead acetate (LA) for 20 weeks. A low dose of LA enhanced the development of renal tubular cell tumors in rats treated with EHEN and increased the number and size of the tumors. The incidence of renal tubular cell tumors at the end of week 32 was 50% in rats treated with 1,000 ppm EHEN for 2 weeks and 100% in rats treated with 1,000 ppm EHEN for 2 weeks and then given 1,000 ppm LA for 20 weeks. The incidences of renal tumors of more than 3 mm in diameter were 70% in rats treated with 1,000 ppm EHEN plus LA and 0% in rats treated with EHEN or LA alone. The low dose of LA showed the enhancing effect of the development of renal tubular cell tumors in rats treated with a subthreshold dose of 500 ppm EHEN.

Promoting effects of phenobarbital and barbital on development of thyroid tumors in rats treated with N-bis(2-hydroxypropyl)nitrosamine.

Phenobarbital (PB) and barbital (BB) promoted the development of thyroid tumors in rats treated with a sub-effective dose of N-bis(2-hydroxypropyl)nitrosamine (DHPN) for thyroid tumorigenesis. Rats were given s.c. injections of 70 mg DHPN/100 g body weight once a week for 4 or 6 weeks with or without diet containing 500 p.p.m. PB or BB for the next 12 weeks. The incidences of thyroid tumors at the end of week 20 of the experiment were 66% in rats given DHPN for 4 weeks and then PB, 23% in rats given DHPN for 4 weeks and then BB, 100% in rats given DHPN for 6 weeks and then PB, 45% in rats given DHPN for 6 weeks and then BB, and 23% in rats given DHPN for 6 weeks. Rats given only DHPN for 4 weeks or only PB or BB had no thyroid tumors after 20 weeks.