Recently pediatricians take a more comprehensive approach to children with psychosomatic diseases by treating the child and the family as well.
The effectiveness of family therapy in well known today. The case reported here in the application of family therapy techniques to the mother of a 13-year old boy who had suffered from bronchial asthma attacks since he was 3 years old. Because of his recurrent and severe attacks, his mother became very nervous and anxious about the sick boy.
When an amelioration of symptoms was observed, his doctor decided to reduce the dosage of medicine and to persuade his mother that a smaller dosage was better for the boy. The mother, to the contrary, insisted that more and more medicine should be given.
The doctor advised her to consult a family therapist.
At first she refused that kind of counselling. Then the pediatrician/family therapist (author) used her out-patient clinic, applying family therapy techniques such as positive connotation, stable messages and so on.
Once her collaboration was obtained the pediatrician/therapist succeeded in controlling her anxiety about the drug reduction, the boy recovered from his bronchial asthma attacks even when the dosages were reduced.
Conclusion: It concluded that family therapy techniques are effective for anxious mothers in out-patient clinics.

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This is a case of a six year old girl who was admitted to the intensive care unit because of status asthmaticus with mediastinal and subcutaneous emphysema, bi-lateral pneumothorax and atelectasis.
During treatment in the ICU there was no communication with her surroundings. After moving from the ICU to a twin bed room her symptoms improved, but diffuse slow waves were seen temporally in the awake EEG.
As the causes of EEG abnormality, 1: hypoxia, 2: CO₂ narcosis, 3: sedatives used for intubation, 4: steroid, 5: neophylline or 6: ICU syndrome due to psychological anxiety can be considered, although there was no evidence of 1, 2, 3, 4 or 5 as mentioned above.
During the treatment for two weeks in the ICU, this patient suffered from stress and had psychological anxiety, then lost conversational ability.
After moving from the ICU to a twin room, these symptoms were improved.
Therefore, ICU syndrome is suspected to be the main cause of these symptoms and EEG abnormality.

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Two patients suffering juvenile rheumatoid arthritis (JRA) with the symptom of pericarditis who were found unresponsive to high doses of conventional oral steroid therapy, were theated with pulse therapy.
The first patient was admitted to the hospital again at the age of 6 11/12 due to the third recurrence. This patient, taking oral dose of prednisolone 2mg/kg daily, showed no improvement, but instead, he developed pericarditis on the 11th day after the treatment.
The second patient is a 14 year 11 month old girl who was admitted to the hospital due to muscle pain and pericarditis along with fever and rheumatoid rash, which lasted for two weeks prior to this admission. For both patients a large amount of pericardial effusion was revealed by echocardiogram. Development of cardiac tamponade was being feared and there were discussion on the indication of pericardiocentesis. Inorder to improve pericarditis and acute systemic symtoms both patients received conventional pulse therapy of methylprednisolone 30mg/kg/day intravenously for three consecutive days a week for three weeks.
From the first day of pulse therapy, the high fever declined. Pericardial effusion disappeared within the three weeks. The patients showed significantly better clinical responses. No side effects were observed during the pulse therapy except a slight moonface.
Pulse therapy is indicated when the patients are unresponsive to high doses of conventional oral steroid therapy or have a risk of cardiac dysfunction to be developed.

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Immunity is often influenced by anesthesia and operation, We investigated the peripheral lymphocyte subpopulation before and after general anesthesia. The lymphocyte subpopulation (CD3, CD4 and CD8) were measured in 29 children before the anesthesia and the day after, CD3, CD4 and CD8 positive lymphocyte decreased when patients had been taken the surgery operation for the anesthesia more than several hours. We also measured the peripheral lymphocyte subpopulation (Thy1.2, Lyt-2 and L3T4) in mice in order to clarify whether immunity was influenced by anesthesia or by operation. As the result, Thy1.2⁺ Lyt-2⁺ and L3T4⁺ lymphocyte decreased after anesthesia
These results suggested that the number of lymphocyte is mainly influenced by anesthesia.
Plasma histamine levels in patients also increased from 0.12±0.04ng/ml to 0.22±0.13ng/ml after intravenous injection of atoropine sulfate and pancuronium.

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An 8-year-old boy with IgA nephropathy, who is hypersensitive since infancy to many foods including hen's eggs, cow's milk and soy beans, has been studied. Specific IgE antibodies to these foods were detected in his serum. The patient has taken small amounts of milk and eggs, and hematuria was noticed when he was 7 years old. After admission to our study, he was given a diet completely free of egg and milk proteins, and the amount of protein and red blood cells in the urine decreased gradually without drug therapy. After oral provocation tests with hen egg white or cow's milk, an increase in the protein/creatine ratio of morning urine was noticed. However, specific IgA antibodies to either egg white or cow's milk proteins could not be detected in his serum by the immunablotting technique. In this case, ingestion of egg or milk was suspected to have increased the urinary protein/creatinine ratio by a mechanism other than that mediated by specific IgA antibodies to these food antigens.

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We studied the correlation between ages and the specific IgG₄ antibodies to Dermatophagoides pteronyssinus (Dp), egg-white, cow's milk, soybean in 66 children who had no allergic diseases. Thirty-nine boys and twenty-seven girls were studied. Their ages ranged from one month to 12 years old.
A few children had the specific IgG₄ antibody to Dp. Egg-white-specific IgG₄ antibody was detected in chidren after 5 months of age, and 75%-92% in those after 2 years old. Cow's milk-specific IgG₄ antibody was already present in early infancy, and was especially detected with high frequency in 3 to 4 years-old children. Soybean-specific IgG₄ antibody was produced in a few cases after 1 year old.
These results suggest that the antigen-specific IgG₄ antibodies are produced with high frequency in children who have had no allergic diseases.

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We report vitamin K deficiency in 3 infants with cow milk allergy receiving a casein hydrolysate milk (MA-1 milk^®). Low vitamin K content of casein hydrolysate milk was considered the cause of the vitamin K deficiency. Vitamin K prophylaxis is therefore necessary in infants receiving this milk.

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Effect of TE-031, a new macrolide antibiotic, on theophylline kinetics was studied in asthmatic children.
In the first study, 18 patients were taking sustained-release theophylline orally for 4 weeks, and TE-031 was given in a dose of 600mg/day for 7 days on the 3rd week of the study. Blood samples were collected at the same time (7:20 a.m. and 2 p.m.) on 8 days and 1 day prior to TE-031 administration, on the 3rd and 7th day after TE-031 administration and on the 7th day after the termination of TE-031. The mean serum theophylline concentration on the 7th day after administration was more significant than on other days (p<0.01).
In the second study, an investigation regarding the effect of TE-031 on intravenously given theophylline was carried out in three patients. Among these patients, one of them had a significantly prolonged theophylline half-life and her clearance decreased after TE-031 administration.
The results of these two studies indicate that TE-031 may affect the theophylline kinetics and its serum concentration. Patients receiving therapeutic doses of theophylline are at a considerably higher risk of theophylline toxicity if TE-031 is co-administered. Thus, it is advised to monitor theophylline concentration during administration of these two drugs together.

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Stimulative or inhibitory actions of arachidonic acid (AA) metabolites released from CB (cells recovered from broncho-alveolar lavage fluid) against antigen-induced contraction of guinea pig trachea were examined. Tracheal strips were stimulated with ovalbumin (OA) or OA+A23187 in the presence or absence of CB. Tracheal strips were deviled into 4 groups, depending on the difference of stimuli, (1) OA, (2) OA+A23187, (3) CB+OA, (4) CB+OA+A23187. Contraction of strips was expressed as a ratio to that induced by acetylcholine at 10^-4M.
Contractions induccd by OA, OA+A23187, CB+OA and CB+OA+A23187 were 1.11±0.05, 1.27±0.32, 1.43±0.20 and 0.55±0.15, respectively. when compared with that induced by OA, contractions induced by CB+OA+A23187 were reduced significantly. Contraction induced by CB+OA seemed to be enhanced, but not significantly. TXB₂ released into the incubation medium was measured by RIA and the concentrations in the groups of OA and OA+A23187 were lower than the detectable range. The concentrations in the groups of CB+OA and CB+OA+A23187 were 292 and 468pg/0.1ml, respectively.
Concentrations of 6keto-prostaglandin (PG) F1_α in the groups of CB+OA and CB+OA+A23187 were 29.00 and 39.25pg/0.1ml which were significantly higher than thet of OA. The results indicate that cells recovered from BALF, mainly macrophages, may play a regulatory role in the reaction of hypersensitivity of guinea pig trachea by synthesizing stimulative and inhibitory mediators of AA. TXA₂ may play an important role as a contractive mediator. PGE₂ and PGI₂ were determined to be produced in small amounts, but may not play as important a role as dilative mediators because of their productivity.

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HLA population study was performed in asthmatic children. The frequencies of HLA class I (A, B, C), II (DR, DQ, DRW) antigens were measured in the following groups. Forty-eight asthmatic children, aged 5-17 years, were diagnosed by clinical manifestation alone. Thirty-one asthmatic children, aged 5-16 years, were diagnosed by clinical manifestation and high serum level of DF-specific IgE antibody, Fifty-two healthy control group, aged 15-45 years, were documented by absence of symptoms, negative DF specific IgE antibody and negative DF skin test. Our results suggest no significant difference in the frequency of HLA antigen in the 3 groups.

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