BCG is the oldest and most widely used vaccine at presentin the WHO Expanded Programme on Immunization. In a recent meta-analysis, the protective efficacy of BCG in trial was 51% and in the case-control studies 50%. There has been as yet no controlled prospective trial on the efficacy of revaccination. The recent WHO statement does not recommend BCG revaccination. BCG is ne of the vaccines with rare adverse reactions. Lymphadenitis are the most frequent side effects. Disseminated fatal BCG infection is rare. The risk-benefits of a BCG vaccination programme have to be assessed strictly.

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Comprehensive treatment, including pharmacotherapy, physiotherapy, guidance as to swallowing exercise, and surgical treatment, was given to the children with recurrent respiratory infections accompanied with gastroesophageal reflux (GER) or swallowing incoordination, and the effect of the treatment was investigated.
The subjects were 14 children, the outpatients or inpatients of Gunma Children's Medical Center, who were suffering from recurrent respiratory infections accompanied with GER or swallowing incoordination. Of these cases, 7 were accompanied only with GER, 3 were accompanied only with swallowing incoordination, and the remaining 4 cases were accompanied with both of them. Diagnoses were made based on the results of upper gastrointestinal series, fiberoptic laryngoscopy, gastroesophageal scintigraphy, 24-hours pH monitoring, measurement of esophageal pressure, gastroesophageal endoscopy. As to the treatment of swallowing incoordination, the training of eating exercise was carried out after due consideration of the way of eating, the menus of meals, etc. for each case, by doctors, nurses, physiotherapists and dietitians. To the family of each patient, guidance was actively given by means of newly prepared pamphlets and other materials. As to the treatment of GER, postural therapy, as well as pharmacotherapy using antacids, drugs for improving the digestive tract function, etc. were conducted. To the refractory cases, surgical treatment was given.
The frequency of recurrence of recurrent respiratory infections has decreased in 13 of the 14 cases. For the treatment of recurrent respiratory infections accompanied with GER or swallowing incoordination, it was considered to be necessary to establish a comprehensive treatment system including doctors, nurses, physiotherapists and dietitians.

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Serum levels of a high molecular weight circulating antigen KL-6, detected by means of a sandwich assay using a monoclonal antibody, had been proved to be a useful marker in monitoring the activity of interstitial lung diseases in adult. However, clinical use of KL-6 in pediatric patients had not been reported. We investigated a series of101children (1mo.-16yr., median 6yr.) who underwent blood testing at our hospital for any reason, except for a respiratory disease, and 40 full term healthy neonates as reference sample groups. The reference interval determined for children was83.7-249.9U/ml (median 149.0U/ml), which was significantly lower than the adult values reported elsewhere. Sex and age difference was not observed. Neither the WBC count nor the CRP value was associated with KL-6levels. But, the serum LDH had a weak positive correlation with KL-6levels. The KL-6levels in neonates were significantly lower than in children. The reference interval determined for neonates was 50.8-226.3U/ml (median 107.2U/ml). Difference with sex, gestational age, route of delivery, birth weight, and the timing of blood sampling was not observed.

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We report a case of pulmonary infarction in 19-year-old girl and review 18 Japanese pediatric cases previously reported over16years from 1983 to 1999. We summarize the clinical manifestations of pulmonary infarction in the 19 Japanese cases.
A 19-year-old girl was admitted to Kiryu Kousei General Hospital because of high fever and left lower limb edema. She had single ventricle and single atrium, and was treated with Blalock-Taussing Shunt procedure at 2 years old. At 19 years old, the patient suffered from sepsis of Peptococcus magnus after trauma. We treated her with aspirin, antibiotics, cardiac stimulant, and diuretics. Her condition did not improve with any of these treatment, and suddenly she developed dyspnea, and had cardiac arrest occurred. Diagnosis of pulmonary infarction was made. The patient died at 7 days after the onset of this infection.
All Japanese children with pulmonary infarction had underlying diseases including congenital heart disease (plus pulmonary hypertension), trauma (including operations), collagen diseases, coagulopathy, infections, and tumor. We should consider that we treat Japanese children who had those risk factors for thromboembolism with anticoagulant therapy

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Objective: To study the relationship between the airborne fungi andallergic asthma in children.
Methods: Airborna fungi were isolated and identified by using gravitational precipitation method (sheet glass and culture plate of exposure) determination. Fungal allergen skin tests were performed on 345 children with bronchial asthma. Fungal immunotherapywas given to children who showed positive reaction on the skin tests.
Results: Observation of 35, 746 grain of airborne fungi spores and 1, 188 grain of fungi spores for one year revealed the following species of fungi: Ustilaginales, Aternaria uredinales, Cladosporium cladosporioides, Cladosporium pithomyces, Cladosporium macrocarpum, Aspergillus niger, Aspergillus versicolor and Aspergillus fumigatus. Thirty-nine (45.9%) of 85 (41.5%) of 260 older children with asthma were positive for the skin tests; total positive rate was 42.6%. Eighty-one in 108 cases of asthma completed fungal immunotherapy. Total effective rate was 88.9%.
Conclusion: The airborne fungi are important sensitization allergenfor inducing asthma in children. Fungal immunotherapy is an effective therapeutic method of asthma associated with fungi.

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