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Background: We developed a tailored education program using a touch-screen computer for changing management behavior with asthmatic children and their caregivers. The purpose of this study was to examine the effect of the tailored education program., Methods: Caregivers including children with asthma were recruited during visits to a national children's hospital and those whose month-long asthma condition on the JPAC (Japanese Pediatric Asthma Program) score was 14 and below were included. Caregivers were randomized to the tailored education (intervention group) or non-tailored education (control group). The intervention group underwent a patient education program using a touch-screen computer, and they received tailored messages generated by a computer program. A research nurse and clinical psychologist used a computer-based resource to tailor the education messages and provided counseling using motivational interviewing for the caregivers including children with asthma. The control group received only a booklet on asthma., Results: Forty-seven subjects aged 1 to 6 years were enrolled. Forty-seven caregivers were randomized to the tailored education (n=22) or non-tailored education (n=25) group. The results of two-way ANOVA showed that interactions between groups were observed in the score of JPAC and asthma knowledge for preschool children whose asthma onset was within one year and a half. The main effects of time were observed in the total and subscale score of QOL (Quality of Life) and the total score of P-CASES (Parental Childhood Asthma's Self-efficacy Scale)., Conclusion: These findings indicate the benefit of a tailored education program to control symptoms in such caregivers.

This report describes the successful management of neurosurgical procedures with continuous infusion of recombinant factor IX (rFIX). A 1-year-old boy with severe hemophilia B was administered prophylactic therapy with rFIX after intracranial bleeding. We found the enlargement of an arachnoid cyst in a follow-up CT scan. He underwent marsupialization of the cyst under the continuous infusion of rFIX. FIX levels were examined in our hospital and the rFIX infusion rate was adjusted in an attempt to keep FIX levels above 90% intraoperatively, and 70% until his 7th post-operative day. We studied the pharmacokinetic profile of rFIX and found a half-time of 25 hours and mean in vivo recovery of 0.69 IU/dl/IU/kg. Reconstituted rFIX also retained at least 95% activity after 72 hours at room temperature. This is the first report of the perioperative management of a child undergoing a neurosurgical procedure under the continuous infusion of rFIX in Japan. Further studies are required before the routine use of this product for continuous infusion.

Background and Aims: Anaphylaxis is an acute multi-systemic and potentially fatal reaction, resulting from the exposure to antigens. There are few detailed reports of children with anaphylaxis. We studied the actual condition of an anaphylaxis including biphasic reaction., Methods: This is a retrospective case study of children presenting to the Emergency Department of the National Center for Child Health and Development with anaphylaxis between 2002 and 2010. Etiology, age, sex ratio, clinical features, and management were examined., Results: The median age of the patients was 36 months. Boys were predominant (63%). Seven cases developed anaphylactic shock, but all survived. As causes of anaphylaxis, food was identified in 85% of the patients, including eggs, dairy products and nuts, and drugs were identified in 3% of the patients. Initial symptoms consisted of mucocutaneous lesions (90%) and respiratory symptoms (71%). Epinephrine was given in 75 patients (22%). The biphasic anaphylactic reaction was observed in 3 out of the 340 cases (0.9%). In age, sex, grade and symptoms, there was no significant difference between patients with biphasic anaphylactic reaction and monophasic reaction., Conclusion: We clarified that the incidence of biphasic anaphylactic reaction was 0.9% in pediatric patients for the first time in Japan.

Diagnosis of multiple sclerosis (MS) is difficult when the lesion mimics glioma or cerebral enchephalitis. We report a case of pediatric MS initially suspected as brain stem glioma. An 11-year-old boy developed left foot joint pain followed by progressive symptoms such as left arm and leg weakness, dysarthria, paraplegia, and decreased level of consciousness. He subsequently developed respiratory distress requiring endotracheal intubation and mechanical ventilation. Magnetic resonance imaging showed a mass measuring 2 cm in the medulla oblongata. Although this mass was initially suspected as a glioma, the patient's acutely progressive disease course was not consistent with this diagnosis. Open biopsy revealed inflammation and demyelination, but no malignant cells were detected. He was treated with steroid pulse therapy, which showed dramatic effects. Nine months later, he developed another episode characterized by several neurological symptoms, and the diagnosis of MS was clinically confirmed. Open brain stem biopsy is technically demanding, but this case demonstrates that appropriate neurosurgical evaluation can play an important role in diagnosis by ruling out glioma and confirming MS.

We introduce a new method of external chest compression (ECC), an essential part of cardiopulmonary resuscitation, using a thumb and index finger method (TIFM) on infants, and compares, this with two standard methods of the two finger method (TFM) and the two-thumb encircling hands method (TTEM). Sixty trained PALS (Pediatric Advanced Life Support) providers were randomly assigned into three groups and provided one-rescuer ECC for a period of five continuous minutes. Results without coaching or feedback were recorded on a recording CPR simulator (Laerdal, Inc). ECC was performed according to the BLS recommendations of the International Liaison Committee on Resuscitation (ILCOR). The quality of ECC in the TFM group deviated considerably from guideline recommendations. The same parameters in the TTEM and new TIFM groups during this study were in accordance with the parameters recommended by the guidelines. Thus, our new TIFM technique of chest compression, in infants was shown to be better than the currently TFM, especially for achieving adequate compression depth and avoiding fatigue, and is equally as effective as the TTEM. We propose this new method (TIFM) should be considered as the method of choice in single rescuer situations.

Background: Recently, single shot spinal anesthesia using local anesthetic and opiate has been thought to be an ideal anesthetic method for cesarean section. For single shot spinal anesthesia, it is important to administer appropriate dose of drugs. However, optimal regimen for cesarean section in Japanese parturients has not been well studied., Methods: In the present study, the validity of standard regimen of single shot spinal anesthesia for cesarean section was evaluated retrospectively. In the reviewed five month period (from May 2007 to September 2007), there were 183 cases of cesarean section, and single shot spinal was adopted in 144 cases., Results: All of them were treated by the standard regimen (hyperbalic 0.5% bupivacaine 10 mg, fentanyl 25 microg, and morphine hydrochloride 0.1 mg). Among 144 cases, 139 cases (96.6%) required no additional pain relief until the delivery, and no parturient experienced critical adverse effects such as total spinal anesthesia., Conclusions: It is suggested that the studied regimen was valid for most of Japanese parturients.

For a parturient with breech presentation, an external cephalic version is sometimes done to enable vaginal delivery. Usually external cephalic version has been done without anesthesiologist's management. However there have been several reports indicating a benefit of anesthesia for external cephalic version. We report successful case of external cephalic version under combined spinal-epidural anesthesia followed by vaginal delivery.