Although thrombotic thrombocytopenic purpura (TTP) is rare, early diagnosis and treatment are important for decreasing the mortality rate. Acquired vitamin B12 deficiency is frequently overlooked because of its rarity in developed countries, particularly in children and adolescents. The hematological changes in vitamin B12 deficiency present as megaloblastic anemia, increased lactate dehydrogenase, vasoconstriction, increased platelet aggregation, and abnormal activation of the coagulation followed by microangiopathy as well as neutropenia and thrombocytopenia. We report herein the case of a 15-year-old girl who had been neglected, which might have caused pseudo-TTP through malnutrition, particularly vitamin B12 deficiency. When we encounter cases of TTP in children, clinicians must be aware of the possibility of malnutrition, particularly with vitamin B12 deficiency, even in developed countries, and investigate the cause of malnutrition including neglect.

Background: Nasal hyperresponsiveness is a common feature of allergic rhinitis, but the underlying mechanisms have yet to be elucidated. The effects of repeated antigen inhalation on the characteristics of histamine H₁ receptors and expression levels of heterotrimeric guanosine 5′-triphosphate-binding proteins in nasal mucosa were investigated to understand the mechanisms of the pathogenesis of nasal hyperresponsiveness in allergic rhinitis. Methods: Male Hartley guinea pigs were sensitized by the inhalation of dinitrophenylated ovalbumin antigen (10 mg of protein/ml) and repeatedly challenged by inhaling aerosolized dinitrophenylated ovalbumin antigen for 3 weeks. Twenty-four hours after the last antigen inhalation, in vivo nasal responsiveness to histamine was measured. [³H]Mepyramine binding assays and immunoblotting for α subunits of the G_q protein were also performed using membrane preparations of isolated nasal mucosae. Results: The histamine-induced increase in intranasal pressure was significantly augmented after repeated antigen challenge, indicating that nasal hyperresponsiveness was achieved. In saturation binding studies, no significant change was observed in the density and antagonist affinity of H₁ receptors in the hyperresponsive animals. On the other hand, the affinity of histamine for high-affinity agonist binding sites in the hyperresponsive group, measured by histamine competition binding studies, was much greater than that in control animals, and these results were affected by guanosine 5′-O-(3-thiotriphosphate) in both groups. Moreover, Gα_q levels in nasal mucosal homogenates were significantly increased after repeated antigen challenge. Conclusions: Elevated G protein levels in nasal mucosa might induce an increased binding affinity of histamine to its receptors, resulting in an augmented nasal response to histamine, that is, nasal hyperresponsiveness, in guinea pigs.

Trigonocephaly involves premature fusion of both the metopic suture and the sutures in the skull base. Surgical treatment by opening of the prematurely fused metopic suture and expansion of the anterior cranial base by creating “neosutures” was used to treat three children with trigonocephaly . The combi nation of lateral canthal advancement and radical forehead remodeling achieved excellent results . These procedures can also prevent the development of midface hypoplasia such as hypotelorism . The two younger patients, aged 0 and 6 months, achieved rapid bone growth in the defects and normaliza tion of intercanthal and interpupillary distances. The older patient, aged 8 years, retained some skull defects at follow-up.The optimal age for surgery is 3-6 months, which allows good cosmetic results and minimizes visual repercussions with relatively low perioperative risks.

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The purpose of this study is to demonstrate the localization and distribution of keratin-positive cells (KPC) in the various pathological types of prostatic cancer, and to investigate the correlation between the basal cell and KPC. The localization of keratin was immunohistochemically investigated in 20 benign prostatic hyperplasia (BPH) and 33 human prostatic adenocarcinomas by the indirect immunoperoxidase technique, using anti human keratin rabbit serum on frozen sections. In BPH, strongly positive staining for keratin was detected in the cytoplasm of basal cells. Glandular epithelial cells were positive. In the cancer sections, no KPC was observed in all 6 cases of the large acinar type, all 10 cases of the small acinar type and all 12 cases of the column and cord type. On the other hand, KPC remained around the cancer cell populations in all 10 cases of the cribriform type. In the fused gland type, KPC was localized in 3 of 9 cases and in the medullary type 3 of 7 cases. If KPC was regarded as the marker of the basal cell as shown in BPH, it would be speculated that the absence of KPC occurred in some type of prostatic cancer showed the disappearance of basal cell. That is, KPC could not be detected in large acinar, small acinar and column and cord type, while KPC remained completely or partially in the cribriform, fused gland and medullary type. These histochemical alteration would suggest the different degree of malignancy in the various histological type of prostatic cancer.