Thrombolytic Therapy and Long Term Follow-up Study in a Child with Kawasaki Disease Complicated by Giant Coronary Aneurysm with Thrombosis

The long-term clinical issues in Kawasaki disease are concerned with the coronary artery lesions that result in aneurysmal formation, thrombotic occlusion, progression to ischemic heart disease, and premature atherosclerosis. We here report a 3 month old infant with Kawasaki disease complicated by giant coronary aneurysm with thrombosis. After urokinase(10,000 IU/kg) and heparin(400 IU/kg) were injected for two days as thrombolytic agents, thrombi were successfully dissolved. Even though long-term oral anticoagulation with low-dose aspirin, dipyridamole and coumadin were administered, thrombosis of the left main coronary artery was slowly increased. five years later, coronary angiography showed nearly total occlusion of the left anterior descending artery and collaterals from the right posterior branch and radionuclide scan demonstrated complete reversible perfusion defect of several portions of the left ventricle.

Recurrence Rate of Febrile Seizures by Combining Risk Factors

PURPOSE: In previous studies, various risk factors for recurrent febrile seizures have been identified. But none of these risk factors alone could sufficiently discriminate children at high or low risk for recurrent seizures. Therefore, we tried to identify patients at high risk of recurrent febrile seizures by combining risk factors. METHODS: Two hundred and four children who had been admitted to our hospital from March, 1997 to July, 1999 with their first febrile seizures were enrolled in our study, and followed up over 2 years. We investigated the recurrence rate according to variables such as sex, age at first febrile seizure, family history of febrile seizures or epilepsy, type of the first seizure, neurologic abnormality and EEG abnormality. RESULTS: Family history of febrile seizures and age at first febrile seizure(or=12 months (no risk factor), 43.8%; the group with no family history and age or=12 months(one risk factor), 64.5%; group with family history and age <12 months(two risk factors), 90.4%. CONCLUSION: A correlation between numbers of risk factors and recurrence rate was present and the children with a family history of febrile seizures and a young age at onset(<12 months) were regarded as a high risk group of recurrence.