An inclusive review of the tuberculosis measures including the tuberculosis prevention law is proposed, the discontinuation of the BCG re-vaccination and of the school examination is executed in the pediatrics department area in year 2003. Moreover, single time vaccination to the infant is basic, and the vaccination method is introduced direct BCG vaccination as a rule. The childhood tuberculosis measures are exactly in the turning point. A group and uniform correspondence to which we have executed is bad efficiency so far. A basic idea of the revision is to introduce an individual, emphatic correspondence by which a high risk and a dangerous group are valued, and to convert to efficient measures. We have to enhance the contact examination, to be thorough in chemoprophylaxis, to improve the quality of the medical treatment, ask to the medical institution consultation at the having symptom, and strenghen the system of the childhood tuberculosis surveillance.

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Objective evaluation of sleep apnea was performed in the respiratory disorders with snoring in children. It was aimed at 24 children (14 tonsillar hypertrophy and 10 allergic rhinitis) who make snores. At the time of sleep, evaluation of a respiratory obstacle by using the apnea monitor (Micro sleep model 97, Japan Eurotech Co.), equipped with posture, respiratory sound, breathing by nose and mouth, breathing by movement of rib and abdominal wall, the degree of oxygen saturation, and the monitor of heart rate before sleeping, and gazed at them by natural sleep. AHI (apnea-hypopnea index) was adapted as an index of sleep apnea. In results, most of apnea-hypopnea in a children with snoring was obstructive. By the tonsillar hypertrophy group, AHI was statistically high compared with the allergic rhinitis group. In children who were conducted tonsillectomy, the distinct improvement in AHI was observed as compared with before operation. We concluded that sleep apnea in children with allergic rhinitis is relatively mild, and AHI is an useful parameter for the evaluation of sleep apnea in children with snoring.

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We examined 66 patients aged 10 months to 12 years with lower respiratory tract infection during January 1999-Decenber 2000. All of them were diagnosed as acute Chlamydia pneumoniae infection by presence of positive serum IgM to Chlamydia pneumoniae. Serum IgG, IgA and IgM antibodies to Chlamydia pneumoniae were determined by an enzyme-linked immunosorbent assey (ELISA) test employing a Chlamydia pneumoniae outer membrand complex protein. Serum specimens for serologic testing were obtained at least twice, the intervals were longer than two weeks. No patient met the criteria for acute Chlamydia pneumoniae infection. We might underestimate the number of infection associated with Chlamydia pneumoniae in children, if specific IgM were not tested.

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We administered zanamivir by inhalation using a nebulizer to children with influenza virus infection during the 2001/02 season. The treatment was performed twice a day for a maximum of 5 days in inpatients and once a day for 2 days in outpatients with 5 mg of zanamivir each time in all of them. Their general conditions improved rapidly and no adverse events were observed. Statistical analysis, however, did not show a significant difference in efficacy among inpatients, outpatients and control groups; probably because of differences regarding their clinical characteristics or lack of dosage. Since children with influenza virus infection are at a risk of developing encephalitis or encephalopathy, zanamivir is thought to be suitable for pediatric patients diagnosed as having influenza, because it is highly safe and its effects are quick. Moreover, our method, that is inhalation using a nebulizer, is reliable and easy to perform even in infants. However, it is necessary to evaluate its efficacy and safety by an exact method.

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The upper airway obstruction by pharyngeal tumor is very rare in infants. We present a girl of neonate who showed inspiratory stridor, ingestion disoder and failure to gain weight. On otolaryngological examination, pediculate tumor existed on retropharynx. We resected the tumor at stalk under general anesthesia with intubation, because we worried that it was possible that the tumor suddenly impacted in inlet of larynx. The tumor was covered with normal mucosa and included chondral tissue. We wondered whether the tumor was a cervical rib that was a congenital anomaly.
Judging from a point of anatomical and embryological view, there is a possiblity that this is a case of cervical rib. When we differentiate the cause of neonatal respiratory disoder, we should consider a congenital tumor including cervical rib.

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A 13-year-old woman consulted our department complaining of severe weight loss, accompanied by her parents. A diagnosis of “anorexia nervosa” was speculated and she was admitted to our hospital on the day. Pneumomediastinum and subcutaneous emphysema were observed on chest Xray film and CT scan. Emphysema were thought to be caused by both increasing airway pressure due to strain and loss of elasticity of the alveolar tissue, which was believed to be caused by low nutritional state of the patient's anorexia nervosa. After two weeks rest, emphysema improved without special treatments. It is thought that pneumomediastinum is one of the important complications of anorexia nervosa.

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