Tracheal tube cuff damage usually requires tube replacement; however, in patients with a difficult airway, tube exchange can pose significant risks. We report a case in which cuff damage was successfully managed using an automatic cuff pressure controller. 　The patient was a man in his 70s who was scheduled for posterior decompression and fusion for cervical spondylotic myelopathy while wearing an external spinal fixation device. Awake nasotracheal intubation was performed using a flexible bronchoscope, during which cuff damage was identified. The tracheal tube was exchanged with a Tube Exchanger® but cuff damage recurred, requiring a second exchange using the same method. Although no cuff leak was observed immediately afterward, a gradual decrease in tidal volume developed after repositioning the patient to the prone position. Because the cuff leak was relatively minor, an automatic cuff pressure controller was connected, which maintained tidal volume without further decreases and allowed completion of the surgery. In situations where tube exchange carries high risk, an automatic cuff pressure controller may serve as a temporary rescue measure for cuff damage. The cause of cuff damage in this case was considered to be a nasal septal spur combined with the relatively large tube size.

Guardians' perceptions of the oral food challenge (OFC) test with 1-day hospitalization have not yet been investigated. In this study, a questionnaire survey on the OFC test was distributed to guardians of children who underwent the test for food allergies with 1-day or overnight hospitalization between April 2015 and May 2016. Patients who underwent the test at other hospitals and those with incomplete responses were excluded. A total of 164 patientguardian pairs were included in this study, and the valid response rate was 68% (112/164). Among negative aspects of OFC with overnight hospitalization, the response “visiting the next day” was the most frequent at 74%(83 guardians) and was significantly more frequent than the responses “anxiety at night,” “consultation and questions the next day are possible,” and “observation time is long” (all p<0.01). Among the positive aspects of OFC with 1-day hospitalization, the response “no next-day visit” was the most frequent at 87%(97 guardians) and was significantly more frequent than the responses “relief at night,” “cannot go to work the next day,” and “observation time is short” (all p<0.01). Among the negative aspects of OFC with 1-day hospitalization, the response “anxiety at night” was the most frequent at 45% (50 guardians) and was significantly more frequent than the responses “no next-day visit,” “cannot go to work the next day,” and “observation time is short”（p<0.01, each). The number of patients whose child underwent the OFC test with 1-day hospitalization was significantly higher than that with overnight hospitalization (87 guardians [78%] vs.8 guardians [7%] , p<0.01). These results suggested that majority of the guardians preferred that OFC be performed with 1-day hospitalization because there was no need to visit the hospital again the next day. However, many guardians had anxiety at night in OFC with 1-day hospitalization.

　　In Japan, few reports have discussed adverse events and safety after simultaneous vaccination during infancy. The purpose of this study was to elucidate adverse events after simultaneous vaccination of inactivated vaccines in infants in comparison with those after single vaccination. Selected for this study were infants aged ≥2 months who received subcutaneous injections of inactivated vaccines between July 2012 and June 2013. These subjects were divided into two groups: a single-vaccination group (46 subjects) and simultaneous-vaccination group (42 subjects). The presence or absence of severe adverse events that required hospitalization was investigated. We also checked up on subject background and systemic [fever (transitional and highest body temperature)] and local (dermatological, respiratory, gastrointestinal, neurological, and other organs’ symptoms) adverse events. Questionnaires to investigate if adverse events occurred during one week after simultaneous vaccination, questionnaires were distributed to the parents of all the subjects. “We performed vaccination in 162 subjects, and the collect rate of questionnaires was 57% (97/162).” The percentage of effective answers to the questionnaire survey was 91% (88/97). Among simultaneous-vaccination group subjects, 14 (32%) received Haemophilus influenzae type b (Hib) + 7-valent pneumococcal vaccine (PCV7) and 12 (27%) received Hib + PCV7 + Diphtheria-Pertussis-Tetanus vaccine. No subject developed severe adverse events that required hospitalization. The body temperatures taken on the day following the injection in the simultaneous-vaccination group were significantly higher than those in the single-vaccination group (p=0.049). However, the incidence of other systemic and local adverse events in the simultaneous-vaccination group was not significantly different from that in the single-vaccination group. Compared with single vaccination, simultaneous vaccination of inactivated vaccines in infants resulted in a significant rise in body temperature on the day following vaccination; however, no severe adverse events occurred.

　　The use of adrenaline autoinjectors is generally contraindicated in children weighing less than 15kg. However, their use may be beneficial in life-threatening situations. Here we report the case of a 2-year-old boy who weighed less than 15kg and had a history of 3 episodes of milk-induced anaphylaxis. He was prescribed an adrenaline autoinjector following parental consent. The boy experienced coughing, hives, dyspnea, hoarseness, and reduced consciousness after accidentally consuming dairy products during a family trip. His mother used the adrenaline autoinjector because the family was far from an emergency hospital. The patient’s condition was resolved and he was subsequently transported by ambulance to an emergency center and hospitalized. An antihistamine and a corticosteroid were administered to treat a persistent localized hives. No biphasic reaction was observed, and he was discharged the next day in good condition. An adrenaline autoinjector was effective for the emergency treatment of anaphylaxis in a child weighing less than 15kg. It is important to report such cases to accumulate and provide more information on the utility of adrenaline autoinjectors in children.