Induced moderate hypothermia for low cardiac output after pediatric cardiac surgery

Postoperative low cardiac output states are a major cause of postoperative mortality in infants and children following corrective cardiac surgery or congenital heart defects. Whole body hypothermia has been used since 2001 in the management of these low output states when they are refractory to conventional modes of therapy. From December 2001 to April 2006, 25 cases were included in this study. The median [range] age of patients was 36.6 months [1 mo-19 y] with a median weight of 12.2 kg [3.5-44 kg]. Following cooling, there was a decrease in heart rate [P < 0.001], an increase in mean arterial pressure [P < 0.001] and a decrease in mean arterial pressure [P < 0.001]. Significant increases in pH and urine output were also noticed, the increase in urine output being greater in the surviving group [P = 0.02]. A decrease in platelet count was occurred [P < 0.001] but WBC count remained unchanged [P = 0.18]. Fifteen of 25 patients survived to leave hospital. Induced hypothermia does not appear to be associated with any complications and after the failure of all conventional treatments, it seems likely that the technique may have been beneficial to outcome in some patients

[Prevalence of congenital heart defects in children with Down's syndrome in Imam Khomeini Hospital, Tehran]

The aim of this study was to investigate the prevalence of congenital heart defects in children with Down's syndrome in Imam Khomeini Hospital in a period of 2 years [2001-2002]. Based on their medical files and echocardiographies, 32 patients with Down's syndrome were evaluated during study. The cytogenetic analysis in these patients [19 males and 13 females] revealed that 29 cases [90.7%] had trisomy 21, 2 cases [6.2%] had translocation and only one case [3.1%] was mosaic. Family history for heart diseases was positive in 2 patients [6.2%]. The findings of echocardiography were as follow: endocardial cushion defect [ECD] in 16 cases [50%], ventricular septal defect [VSD] in 7 cases [21.8%], atrial septal defect [ASD] in 6 cases [18.7%], tetralogy of Fallot [TOF] in 2 cases [6.2%], patent ductus arteriousus [PDA] in one case [3.1%]. The diagnosis of congenital heart defects in children with Down's syndrome is crucial because treating them in due course results in dramatical decrease in the mortality and morbidity rates of these patients

[Recurrent Kawasaki diseases: a case report]

Kawasaki disease is a vasculitis with unknown cause, which is most commonly seen in children younger than 5 years old. The incidence of the disease is between 0.8-3% and male/female ratio is 1.37. Kawasaki is diagnosed basd on prolonged fever at least five days with four of five clinical criteria. Recurrent diseases occur in 1-3% of cases. Multiple recurrences have been reported rarely. We report on a 4-year-old boy that experienced three attacks of Kawasaki disease. All three clinical features were complete diseases and he was treated with IVIG. He was healthy after 6 months of follow up after the third recurrence. We report a case of multiple recurrent Kawasaki disease with coronary aneurysm in different portion. There was no adverse sequelae, after he is treated with IVIG