Clinical Study of Typical and Atypical Kawasaki Diseases

PURPOSE: Atypical patients of Kawasaki Disease (KD) are now discovered with increasing frequency. The goal of this study is to help diagnose and treat KD by comparing of clinical characteristics between typical and atypical KD. METHODS: We performed a retrospective analysis of 82 patients with typical or atypical KD from January 1993 to March 1997. RESULTS: Out of the 82 patients, 49 cases were diagnosed as having typical KD, while there were 33 cases of atypical KD. The mean age was 31.4 months and 25.5 months respectively. The rate of prevalence in the changes of extremities, polymorphous exanthema, and cervical lymphadenopathy was greater in typical KD than atypical KD. The number of patients with various combinations of the principal symptoms among the 33 atypical cases were 18. Mean duration of fever was 6.2 days in typical cases and 5.8 days in atypical cases. The most common clinical findings were cough and rhinorrhea in both groups and the most common disease was pneumonia CRP was significantly elevated in patients with typical KD than atypical cases. Coronary artery dilatations were confirmed by 2-D echo in 7 (19.4%) of 36 tested typical cases, while 2 (9.1%) of 22 tested atypical cases. Patients were treated with aspirin and high-doses of IV gamma-globulin. CONCLUSION: Atypical KD was characterized by the infrequent appearance of rash, cervical lymphadenopathy, changes of hands and feet. We thought that there wasn't a strong association between atypical KD and coronary involvement.

A Study on the Serum Level of Phenytoin after Intravenous Administration of Loading Dose

PURPOSE: Phenytoin is effectively and widely used drug for the treatment of status epilepticus and patient with ongoing seizure by intravenous infusion. It is generally recommended to maintain serum concentration above 10microgram/ml for the sustained effective anticonvulsant effect. This study was designed to know the optimal time to begin oral maintenance therapy after initial intravenous infusion. METHODS: Total 17 patients with status epilepticus and ongoing seizure who were admitted to the pediatric department of Han Yang University during the period from July 1993 to September 1995 were enrolled in this study and serum level was monitored at 2, 6 and 12 hours after the intravenous phenytoin infusion of loading dose, 20mg/kg of body weight by enzyme multiplict immunoassay technic. Student t-test was used for statistical analysis and P value below 0.05 interpreted as statistically significant. RESULTS: 1) The subjects were 5 boys and 12 girls, average age was 7.6 years old and age distribution was from 3 months to 15 years old. 2) The serum concentration ranged from 9.42microgram/ml to 43.98microgram/ml (24.04+/-8.97microgram/ml) after 2 hours, 8.82microgram/ml to 33.95microgram/ml (18.62+/-6.43microgram/ml) after 6 hours, and 7.20microgram/ml to 31.38microgram/ml (14.97+/-6.58microgram/ml) after 12 hours. 3) There was no significant differences of average serum concentration and the decline of serum concentration by time between patients over and below 2 years of age and both sexes. 4) The average decrease in serum phenytoin concentration per hour was 0.91microgram/ml. 5) The average maintenance duration of therapeutic serum level after initial infusion of loading dose was 22.4 hours. CONCLUSIONS: The average maintenance duration of therapeutic serum level after initial infusion of loading dose was 22.4 hours, hence it would be appropriate to administer maintenance dose of phenytoin if the serum level at 2 hours after loading dose is satisfactory.

The Changing Patterns of Microorganisms and Results of Antiobiotic Susceptibility Tests from the NICU

PURPOSE: Results of bacterial cultures and susceptibility tests in the neonatal period have shown changes according to the year they were reported, and the increase in pathogenic organisms has become a topic of great interest. This study was carried out to determine the trend in the occurrence of microorganisms and susceptibility testing results conducted on neonates from the newborns hospitalized in the NICU at Hanyang University Hospital during the past 1- years. METHODS: The laboratory data of microorganisms isolated by culture of various specimens from the NICU from January, 1986 to December, 1995 were retrospectively analyzed. The study period was divided in two 5-year periods. RESULTS: 1) The total number of neonates in the first half was 6,392, and 8,364 in the second half. Of these, positive blood cultures were observed in 62(1.0%) and 166(2.0%), respectively. Isolation from other specimens totalled 834(450 in the first half and 384 in the second). 2) There was a total of 13 specimens other than blood, from which bacteria were isolated. There 380 urine specimens and 20 umbilical secretions in the first half and 167 bronchial secretion and 101 umbilical secretions in the second. 3) The microorganisms cultured in the first half included 215 Gram positive, 232 Gram negative organisms, and 3 fungi. Common organisms included 119 cases of E. coli(26.4%), 66 cases of MSSA(14.7%) and 64 cases of CNS(14.2%). In the second half, there were 182(47.4%) Gram positive, 192(50.0%) Gram negative organisms, and 10(2.6%) fungi. The most common organisms were MRSA(123 cases, 32%), E. cloacase(56 cases, 14.6%), CNS(29 cases, 7.6%), and Klebsiella (29 cases, 7.6%). 4) There were a decrease in organisms susceptible to Oxacillin, Gentamicin, Cephalothin, and Ampicillin in the second half. CONCLUSIONS: The changes in the NICU during the past 10 years include a great increase in MRSA, Enterobacter, and Candida, reflecting the increasing trend of nosocomial infections. Furthermore, there was an increase in resistance to Oxacillin and Gentamicin while there was good susceptibility to Vancomycin and Chloramphenicol even in the second half.

Relationship of Insulin like Growth Factor I with Pharmacologically Stimulated Growth Hormone Secretion in Growth Hormone Deficient Children

No abstract available.