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Niigata-shi, Japan

Kurabayashi T.,Niigata City General Hospital
Clinical calcium | Year: 2011

Calcium transfer from the mother to the fetus and neonate during pregnancy and lactation plays an extremely important role in the bone health of the mother and infant. Calcium aids in bone health through all ages but is especially crucial during pregnancy and lactation. Despite facing similar demands for calcium in pregnancy and puerperium, the maternal adaptations differ significantly between these two reproductive periods. Although the studies are underway to establish the conclusion, the changes in the structure and metabolism of bone and calcium during pregnancy and the early stage of postpartum are evaluated by investigating bone mineral density (BMD) , bone histomorphometry and bone markers of human or animal models. The bone resorption increased at the end of pregnancy and lactation, and the bone formation increases and the bone structure is almost recovered after cessation of lactating in postpartum. Vitamin D and parathyroid hormone-related protein (PTHrP) status especially becomes crucial for optimal maternal and fetal outcomes, fetal and neonatal skeletal growth, and maternal health in later life. Source


Watanabe T.,Niigata City General Hospital
Journal of Pediatric Biochemistry | Year: 2013

Kawasaki disease (KD) is an acute febrile vasculitis that predominantly affects children ≤ 5 years of age. The cause of KD remains unknown, but it is thought that the immune system is activated by an infectious trigger in a genetically susceptible host. Because KD is systemic vasculitis, multiple organ involvement can develop, including hyponatremia. Hyponatremia is common in patients with KD, occurring in 29%-70% of patients. Although hyponatremia is usually mild and asymptomatic in nearly all patients with KD, profound hyponatremia contributes to the development of central nervous system dysfunction in some patients. KD patients with hyponatremia have clinical and laboratory findings that are consistent with severe inflammation, including higher C-reactive protein levels and an increased incidence of coronary artery lesions. While the pathogenesis underlying the development of hyponatremia in KD is incompletely understood, several possible mechanisms have been proposed, including hypovolemic hyponatremia, the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ingestion of fluid that is hypo-osmolar relative to the fluid loss. Hypovolemic hyponatremia may be caused by gastrointestinal loss of fluid and sodium, and renal loss of fluid and sodium secondary to renal parenchymal injury and/or cytokine-induced renal tubular dysfunction. SIADH occurs in approximately 40% of KD patients with hyponatremia and may be a major cause of hyponatremia in KD. Although the pathogenesis underlying the development of SIADH in patients with KD is unclear, cerebral vasculitis or ADH secretion stimulated by cytokines, including interleukin (IL)-1β and IL-6, may contribute to the development of SIADH in patients with KD. © 2013-IOS Press and the authors. All rights reserved. Source


Takai K.,Niigata City General Hospital
Journal of clinical and experimental hematopathology : JCEH | Year: 2013

We report five cases that presented with high fever, anasarca, hepatosplenomegaly and severe thrombocytopenia with reticulin fibrosis of the bone marrow. The constellation of symptoms is not compatible with any known disease, and we had difficulty in diagnosis and treatment. The age distribution was from 47 to 56 years, and two men and three women were affected. Two patients needed hemodialysis because of renal dysfunction and oliguria with massive pleural effusion. Laboratory examinations showed normal immunoglobulin levels and no monoclonal protein. None of them showed diagnostic autoantibodies for any autoimmune diseases. Histological examination of the liver in three patients and spleen in two showed non-specific findings. Lymphadenopathy was tiny and lymph node biopsy was carried out in only one case. Histologically, paracortical hyperplasia with vascular proliferation and atrophic germinal centers resembling hyaline-vascular-type Castleman's disease or POEMS syndrome were detected. Without a definitive diagnosis, treatment was started with cyclophosphamide, hydroxydaunorubicin, vincristine and prednisolone (CHOP) regimen in one patient, semi-pulse therapy with methyl-predonisolone in three and cyclosporin A in three. Two patients achieved complete remission, two were steroid-dependent and the remaining one died of multiple organ failure. These findings suggest that this disease may be a novel clinical entity belonging to systemic inflammatory disorder with a background of immunological abnormality or a unique variant of multicentric Castleman's disease. [J Clin Exp Hematop 53(1): 63-68, 2013]. Source


Kurabayashi T.,Niigata City General Hospital
Clinical calcium | Year: 2010

Calcium transfer from the mother to the infant during pregnancy and lactation plays an extremely important role in the bone health of the mother and neonate. Calcium aids in bone health through all ages but is especially crucial during pregnancy and lactation. Changes in the structure and metabolism of bone during pregnancy and the early stage of postpartum are evaluated by investigating bone mineral density (BMD), bone histomorphometry and bone markers of human or animal models. The bone resorption increased at the end of pregnancy and lactation, and the bone formation increases and the bone structure is almost recovered after cessation of lactating in postpartum. Puerperal BMD remained static over the subsequent 5-10 years. If the women have a low BMD at this stage of their reproductive life, it tends not to improve over this time. Perhaps identification of this at-risk group may lead to effective interventions to reduce fracture risk in later life. Source


Watanabe T.,Niigata City General Hospital
Pediatric Nephrology | Year: 2011

Although the etiology of Henoch-Schönlein purpura (HSP) remains unclear, influenza vaccinations have been implicated as possible triggers for HSP. We describe four patients with HSP following influenza vaccinations which developed during the pandemic of influenza A (H1N1) 2009 and review the literature concerning HSP associated with this vaccine. HSP in patients developed in October and November, 2009. Four patients exhibited purpura, three patients complained of arthralgias, and one patient had both abdominal pains and renal involvement. Reviewing the literature, 11 patients with HSP following influenza vaccinations have been reported. Eight patients were children and five patients had past histories of immunologically mediated diseases including HSP, drug eruptions, and food allergy. While a favorable outcome was noted in most patients, one patient developed end-stage renal failure and another patient exhibited chronic glomerulonephritis. Although the precise reason for clustering of our patients with HSP following influenza vaccination was unclear, increasing use of the recent influenza vaccine associated with the pandemic of influenza A (H1N1) 2009 might explain this phenomenon. Because the incidence of HSP caused by influenza vaccination was very low, influenza vaccination should not be limited for this reason. However, caution may be required with its use in children with immunologically mediated diseases such as HSP. © 2010 IPNA. Source

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