In Japan, the leading cause of death for children over 1 year old is injury, and for children aged 0-14, drowning is the second leading cause of death. The purpose of the present study was to describe the epidemiological factors of drownings and near-drownings among Japanese children and to ascertain whether there are characteristic patterns for different age groups.Epidemiologic data was obtained by questionnaire. A total of 604 cases of submersion injuries were reported from 49 hospitals located in 22 Japanese prefectures. In the present paper, victims of drowning (n = 134) and near-drowning with permanent severe brain damage ( n = 5 I) and those of near-drowning with intact survival or mild impairment (n = 4 19) were investigated. Preschool-aged children, especially toddlers, are at the greatest risk of drowning and near-drowning, and for children over 2 years of age, boys have three times greater risk than girls. The bathtub is the most common place of submersion injuries in Japan, especially for children under 4 years of age. The important risk factors for the victims who died or were severely impaired were associated with duration of submersion and necessity of emergency cardiopulmonary resuscitation on arrival at hospital. Abstract Key wordsbathtub drownings, childhood drownings and near-drownings, childhood injury.In Japan, the mortality rate for children is decreasing every year due to recent advances in medical technology and improvement in sanitation. According to the Ministry of Health and Welfare statistical year book (1990), the overall death rate per 100 000 children is 44.8 for those aged 1-4; 18.7 for those aged 5-9; and 14.7 for the 10-14 year age group. The death rate from injuries was 13.7 for children aged 1-4; 7.1 for those aged 5-9; and 3.8 for those aged 10-14.' In Japan, injuries cause approximately 32.2% of all deaths of children aged 1-4; 43.7% for ages 5-9, and 30.5% for ages IO-14.Accidents are the leading cause of deaths in children and there are nearly 2000 victims yearly. Next to motor vehicle trauma, drowning is the most prevalent type of injury causing death in children aged 0-14. It is the most common cause for children aged 0-4.The purpose of the present study was to investigate the epidemiological factors, such as age, sex, season, site of submersion and outcome of drowning and near-drowning in childhood, and to formulate preventive strategies for Correspondence: Ryuzo Mizuta MD, Department of Pediatrics, Kyoto Second Red Cross Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602, Japan. IS Frisby ML, Hill H. A community's response to childhood drownings. Crit. Care Nurs. Clin. North Am. 1991; 3 373-9. 16 Leach SC. Continuing care for the near-drowning child, Crit. Cure Nurs. C h North Am. I 99 I ; 3: 30% 1 7. I7 Rivara FP. Traumatic deaths of children in the United States: Currently available prevention strategies. Pediclrrics 1985; 75: 18 Pearn JH, Wong RYK, Brown J el al. Drowning and neardrowning involving children: A fiveyear total population study from the city and county of ...
Since July 1973, the authors began developing a mass screening system using a VMA (vanilmandelic acid) spot test on 6‐to‐7 month‐old infants for early detection of neuroblastoma in Kyoto city, Japan. Using this method, six infants with this tumor were discovered; five of the six infants were cured, and one is under treatment. These patients showed a favorable prognosis on early diagnosis. in this article, 57 neuroblastoma patients from the Department of Pediatrics, Kyoto Prefectural University of Medicine, treated during the last 20 years, from July 1962 to June 1982, are evaluated. Since the mass screening program has run smoothly since July 1974, clinical findings are compared between 35 neuroblastoma cases before mass screening from the 12‐year period from July 1962 to June 1974 and 22 cases after mass screening, during the 8‐year period from July 1974 to June 1982. Before mass screening, only 20% (7/35) of the patients were discovered with neuroblastoma younger than 12 months of age and 68.6% were older than 2 years of age. After mass screening, 54.6% (12/22) of the patients were younger than 12 months of age and only 31.8% (7/22) were older than 2 years of age. Before mass screening, 17.1% (6/35) survived with five of the six surviving patients being younger than 12 months of age at the time of diagnosis; 72.7% (16/22) of the patients detected after mass screening are living now. Eleven of the 16 patients have already been cured, and the remaining 5 patients are presently undergoing treatment. A marked improvement of their prognoses is dependent on the early detection of this tumor by mass screening. To date, using the VMA spot test for early detection in infancy is convenient and effective for improvement of its prognosis.
We have been following a male case of congenital sodium diarrhea (CNaD), who had a distended abdomen, passed watery stools with high sodium concentration, and showed metabolic acidosis in the first week of life. He also showed hyponatremia, low urine sodium, high serum aldosterone and high renin activity, Other possible causes of secretory diarrhea were ruled out. The initial effective treatment was oral supplements of water and electrolytes lost in the fecal fluid: with this he gained weight, and hyponatremia and metabolic acidosis were corrected. Loperamide hydrochloride was administered to increase intestinal absorption of sodium, as the serum prostaglandin was high. Watery diarrhea then improved, but as he passed stools, we stopped and postponed the treatment for a while; the stools then became watery again. Although diarrhea has persisted, he has not shown any abnormalities in growth or psychomotor development for the first two Years of life.
The maturation of embryonal neural crest cells is thought to be regulated in part by the milieu into which these cells migrate. Neuroblastoma (NB) is a tumor of very early childhood that is thought to arise in association with the arrested differentiation of embryonal neural crest cells. In culture, neuroblastoma tumor cells differentiate in the presence of retinoic acid, which is also known to influence extracellular matrix protein synthesis. We have cultured neuroblastoma cells on laminin (LN) and fibronectin (FN) substrata to examine the role of extracellular matrix in retinoic acid (RA)-induced differentiation of these tumor cells. These proteins caused morphologic changes in NB cells indistinguishable from those caused by RA. Antiserum to each of these proteins blocked the effects induced by the corresponding protein, but neither antiserum affected the action of RA. Despite the induction of a neuronal morphologic change, matrix proteins did not alter the proliferation of NB cells. These results indicate that LN and FN modulate the differentiation of NB cells without inducing growth arrest and that RA-induced differentiation does not require these matrix proteins.
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