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A 7-year analysis of pediatric asthma in Tochigi was performed with the aim of improvement of future treatment.Self-administered questionnaires were completed by pediatric asthma patients and their parents who visited pediatric clinics or hospitals in Tochigi at the same period of year in 2002, 2006, and 2008. Changes in asthma symptoms and in the QOL of the patients and their parents were analyzed. Data on the background and treatment of the patients were obtained from doctors.The questionnaires were answered by 1487, 1058, and 1014 patients or parents in 2002, 2006, and 2008, respectively. The results showed significant increases in the use of ICS and LTRA (p0.001, for each.) and significant decreases in the use of theophylline, DSCG, and LABA (p0.001, for each.). Frequency of wheezing, cough and sputum were significantly reduced in all age groups (p0.01, for each.). There were significant reductions of frequency of wheezing in patients under 2 years old; in wheezing and cough in patients aged 2-5 years old; and in wheezing, cough and sputum in patients aged 6-15 years old (p0.05 for each.). The QOL of the patients and their parents was significantly improved in all age groups (p0.05 for each.).These findings suggest that increased use of anti-inflammatory agents such as LTRA and ICS have contributed to a reduction in asthma symptoms and an improvement in the QOL of the pediatric patients and their parents, but more widespread use of these agents are still needed for residual uncontrolled asthma patients.

The ratio of the peak transmitral velocity during early diastole (E) to the peak mitral valve annular velocity during early diastole (E') obtained by tissue Doppler imaging correlates with the left ventricular end-diastolic pressure in adults. However, the E/E' ratio has not been established in normal children. The purpose of this study was to assess the effect of age on the various tissue Doppler indices of ventricular diastolic function.The subjects in this study included 174 children with normal cardiac function. The left and right ventricular inflow velocities were recorded, and the peak of late diastolic flow velocities (A), E, and the ratio of E/A were determined. The following tissue Doppler indices were obtained: peak velocities of early and late diastolic mitral annulus in the left ventricular lateral wall (E'l and A'l) and in the interventricular septum (E'se and A'se) and those of the lateral tricuspid annulus in the right ventricle, E'r and A'r.The E'l and the E'se increased with age up to 5 years after birth, after which they became constant. The E'r was constant after birth. The E'l/A'l and E'se/A'se increased with age up to 5 years after birth, after which they became constant. The E'r/A'r was constant after birth. The Em/E'se and Em/E'l decreased with age up to 5 years after birth, after which they became constant. The Et/E'r was constant after birth.The age-related changes suggest age-related alterations in left ventricular diastolic function. Right ventricular diastolic function is constant after birth.

Medical practice after adolescence in child neurology was discussed. Major issues to be solved included; who should play major role in the practice, what medical facilities are available for inpatients, how medical networks are built in the community (especially for disabled patients), and which medical benefits were required to support patients after the cessation of support for childhood disorders. As child neurologists, we must decide whether we need training in adult neurology as an elective course or compulsory. All these considerations have to be solved by child neurologists for the benefit of maturing patients.