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When using testosterone ointment as a treatment for microphallus, it should be borne in mind that this application has systemic effects.

Key wordsbreast-feeding, Japan, sunlight exposure, vitamin D deficiency rickets, vitamin D supplementation.Recent research in rickets in Japan has focused on hereditary rickets, that is, X-linked hypophosphatemic vitamin D resistant rickets 1 or vitamin D-dependent rickets. 2 It was speculated that the advent of vitamin D-fortified milk and enhanced sunlight exposure decreased the previously common incidence of vitamin D deficiency rickets. However, vitamin D deficiency rickets continues to be reported in USA due to dietary restrictions without the benefit of adequate sunlight exposure or vitamin D supplementation and/or prolonged breast-feeding in dark-skinned infants. 3 Vitamin D levels in human milk (approximately 4.5 IU/dL) are generally low in comparison with vitamin D-fortified milk (about 50 IU/dL). 4 Therefore, a uniform policy of vitamin D supplementation has recently been recommended for breastfed infants in the USA. 3 Nineteen patients of vitamin D deficiency rickets due to dietary restrictions and/or lack of sunlight exposure between 1995 and 2000 were reported in Japan. [5][6][7][8][9][10][11][12] We describe one case of vitamin D deficiency rickets in Tochigi, not due to dietary restriction, and review recent reports written in English on vitamin D deficiency rickets in Japan. [5][6][7][8][9][10][11][12]

Spinal epidural lipomatosis (SEL) in patients on steroid therapy may be explained by two hypotheses: (1) steroids induce SEL and (2) steroids cause the growth of a pre-existing SEL, especially in obese children. Steroid-induced SEL (SSEL) is rarely described in children, with only six cases reported elsewhere. However, we have already reported four nephrotic children with SSEL, including one child in another hospital, in addition to the six cases. We investigated the frequency of SSEL in 125 children with renal diseases treated with glucocorticoids in a single hospital over 16 years, and examined the risk factors in 62 patients with SSEL reported in the literature. When patients complained of symptoms at the early stage of SSEL, i.e., back pain or numbness, and patients were obese, we performed spinal magnetic resonance imaging (MRI). SSEL was detected in 5 of 125 children (4.0%). Of the 5 patients with SSEL, 3 had vertebral compression fractures, and all 5 patients were on methylprednisolone pulse therapy. Our study suggests that many more patients can be detected at the early stage of SSEL by performing spinal MRI for patients with early symptoms, obesity, and those who have received methylprednisolone pulse therapy.