Clinical factors causing hyperbilirubinemia in patients with Kawasaki disease / 소아과

PURPOSE: Hyperbilirubinemia, jaundice and gallbladder hydrops are unusual manifestations of Kawasaki disease (KD). In this case, abdominal pain, anorexia and abdominal distension may follow eventfully. We reviewed the clinical and laboratory data to investigate the causative factors of hyperbilirubinemia in patients with KD. METHODS: Two-hundred eighty two children diagnosed and hospitalized with KD were identified by searching patients' charts. Cases were included in the study if diagnosed between January 1997 and December 2004. We reviewed clinical data, age, sex, duration from the onset of fever to admission and duration from start of treatment to defervescence. Clinical and laboratory data were compared between normal (A) and hyperbilirubinemia (B) groups. RESULTS: Thirteen patients (4.6 percent) showed hyperbilirubinemia. In the hyperbilirubinemia group, age and initial ALT value were higher than group A (P=0.003, 0.018 respectively). Duration from the onset of fever to admission and age were relative risk factors in hyperbilirubinemia (P=0.007, 0.003 respectively) in patients with KD. CONCLUSION: Shorter duration from the onset of fever to admission and older age group were relative risk factors of hyperbilirubinemia in patients with KD.

Clinical significance of follow-up laboratory tests, performed at 6 weeks after the onset of Kawasaki disease / 소아과

PURPOSE: Low dose aspirin is used due to its antiplatelet effect for the subacute phase of Kawasaki disease(KD). It is usually used for 6-8 weeks, then various hematologic laboratory tests and follow up echocardiography for evaluating coronary abnormalities are performed. Our review investigated the usefulness of various follow up laboratory tests performed at 6 weeks after the onset of KD. METHODS: Two hundred eighty-two children diagnosed and hospitalized with KD were identified by reviewing patient's charts. Cases which were diagnosed between January 1997 and December 2004 were included in this study. We reviewed laboratory data including leukocytes, platelet counts, antistreptolysin O(ASO), erythrocyte sedimentation rate(ESR), C-reactive protein(CRP), aspartate aminotransferase(AST), alanine aminotransferase(ALT), urinalysis, and echocardiograms performed at admission and 6 weeks after the onset of KD. Paired t-test and Fisher's exact test, as well as logistic regression tests, were used for the statistical analysis. RESULTS: At 6th week data, ESR and CRP were still elevated in 35(12.4 percent) and 12(4.3 percent) patients, respectively. Sterile pyuria were all normalized. But, 36 patients(12.8 percent) showed thrombocytosis, 22(7.8 percent) elevated AST, 15(5.3 percent) leukocytosis, and 6(2.1 percent) coronary abnormalities. Coronary abnormalities at the 6th week were only shown in patients with initial abnormalites. Younger age and initial thrombocytosis were risk factors for thrombocytosis at the 6th week. CONCLUSION: All children with initial coronary abonormalites should have an echocardiogram at 6 weeks after the onset of fever. In view of case-effectiveness, additional echocardiographic studies are justified only if abnormalities are present at admission. ESR, CRP, and urinalysis performed at the 6 weeks after onset of KD is not significant for clinical information of progression. Platelet count should be estimated at 6th week for a judgement of continuous antiplatelet therapy.

Renal Anomalies in Neonates with Isolated Preauricular Tags / 소아과

PURPOSE: The aim of this study was to determine the role of renal ultrasonography in neonates with isolated preauricular tags. METHODS: We performed a retrospective study of 10,997 newborn infants delivered from January 1995 to June 2003 in Wonkwang University Hospital. Nineteen newborns born with isolated preauricular tags were assessed for renal anomalies by performing renal ultrasonography within one week after birth. The study group was compared with a control group of 25 healthy neonates without preauricular tags during the same period, also using renal ultrasonography. RESULTS: Preauricular tags were detected in 19 of 10,997(0.17%) neonates; 57.9% were found on the right side. Renal anomalies in neonates with isolated preauricular tags were detected in four infants (21.1%); this incidence was higher, but was not significant, compared with the control group. Types of anomalies were mild hydronephrosis of grade 1(3 cases) and 2(1 case) which were normalized within one year. CONCLUSION: Routine renal ultrasonography is not recommended for newborn infant with isolated preauricular tags.

The Clinical and Laboratory Features of Kawasaki Disease with Nonresponsibility to the Acute Antiinflammatory Treatment

PURPOSE: To assess the clinical features and laboratory findings in Kawasaki patients with nonresponsibility to the acute antiinflammatory treatment, and identify the risk factors for the nonresponsibility, we reviewed the medical records of patients with Kawasaki disease. METHODS: A retrospective study of 177 patients with Kawasaki disease at Wonkwang University Medical Center from June, 1997 to June, 2002, was performed. High dose intravenous immune globulin(IVIG) and aspirin were all used for the initial acute antiinflammatory treatment. Two groups, group A(n=19) of initial nonresponders and group B(n=158) of initial responders were compared clinically and laboratorically. RESULTS: Nineteen(10.7%) of 177 patients hardly responded to the initial antiinflammatory treatment. Patients with failure to respond to initial treatment(group A) did not differ from the control group in terms of age, sex, WBC count, coronary abnormalities, and evidence of pyuria. Compared with initial responders(group B), the patients who were retreated(group A) had a significantly shorter fever- admission interval(P=0.041), and a higher level of both AST/ALT(P=0.011) and ASO titier(P=0.000). CONCLUSION: Among Kawasaki disease patients studied, retreatment group with initial nonresponders had significantly shorter fever-admission interval, and higher both AST/ALT level and ASO titer, than the initial response group.