Clinical Features of Atypical Kawasaki Disease

PURPOSE: To identify clinical and laboratory features of atypical Kawasaki disease(KD), and to develop criteria for early diagnosis of atypical KD patients. METHODS: All patients with KD treated at our hospital from January 1998 to June 2000 were reviewed retrospectively. RESULTS: Among a total of 167 patients, 28(16.8%) were atypical KD of which seven(25%) were infants. Among the five cardinal symptoms, oral mucosal change(96.4%) occurred most frequently, followed by conjuntivitis(57.1%) and rash(46.4%). Most notable laboratory findings were anemia, and increased erythrocyte sedementation rate(ESR) or C-reactive protein(CRP). Coronary artery abnormalities developed in seven(25.8%) atypical KD patients, compared with 14.4% in typical KD patients. We considered oral mucosal change as major criterion, and conjunctivitis, rash, hematocrit 30 mm/hr or CRP >3.1 mg/dL as minor criteria. Proposed modification in diagnostic criteria for atypical KD include fever of >or=5 days;major criterion+>or=2 minor criteria, or fever of >or=5 days+4 minor criteria. CONCLUSION: The modified diagnostic criteria has yielded a sensitivity 89.3%. Our diagnostic criteria may be used for early diagnosis of atypical KD.

Usefulness of Low Risk Criteria for Serious Bacterial Infection Among Febrile Infants Younger than Three Months of Age

PURPOSE: A retrospective study was undertaken to evaluate the usefulness of low risk criteria for identifying febrile infants younger than three months unlikely to have serious bacterial infection. METHODS: We conducted a retrospective study of 527 infants younger than three month with a axillary temperature >or=37.4degrees C. If they met the following all four criteria, appear well, WBC 5,000-20,000/mm3, urine stick WBC(-) and nitrite(-), CSF WBC <10/mm3, they were considered at low risk for serious bacterial infection(SBI). SBI was defined as a positive culture of urine, blood, or cerebrospinal fluid. The sensitivity, specificity, negative predictive value and positive predictive value of the low risk criteria were calculated. RESULTS: Of 527 febrile infants, 110(21.0%) had serious bacterial infections. The 2.7% who met the low risk criteria had SBI and negative predictive value was 97.3%. SBI was diagnosed in 103 infants(38.6%) who didn't meet the low risk criteria including urinary tract infection(78.6%), most commonly, bacteremia(16.5%), bacterial meningitis(8.7%), Salmonella gastroenteritis(1%), osteomyelitis(1%), septic arthritis of hip joint(1%). There were no differences in the sensitivity and negative predictive value according to the monthly-age-group. CONCLUSION: This low risk criteria to identify infants unlikely to have SBI early is available, however low risk infants must be carefully observed.

Assessment of Afterload by Doppler Aortic Flow Velocity Measur ement / 대한흉부외과학회지

BACKGROUND: Afterload as well as myocardial contractil ity is an important factor for the adequacy of circulation after cardiac surgery . To noninvasively assess alterations in afterload, we evaluated the changes in aortic blood velocity waveform. MATERIAL AND METHOD: Ascending aortic blood flow was measured by continuous wave Doppler echocardiography befo re and after afterload manipulation in eight open-chest dogs. Nitroprusside was administered singly and simultaneously with epinephrine in various combinations. Left atrial pressure as an index of preload was maintained by saline administra tion. RESULT: The infusion of nitrop russide produced dose-dependent decreases in blood pressure and index of systemi c vascular resistance(ISVR) (all p<0.05 vs baseline), which was associated with increases in peak velocity(PV), mean acceleration(MA) and minute distance, and w ith a decrease in acceleration time(all p<0.05 vs baseline). ISVR obtained durin g nitroprusside infusion had a better correlation with both PV(r=-0.60, p=0.001) and MA(r=-0.52, p=0.003) than with velocity time integral(VTI) or the Doppler t ime intervals. The combined infusion of nitroprusside and epinephrine, unless IS VR was elevated, produced synergistic effects on PV, MA and VTI, but these Doppl er indexes tended to diminish with an elevation in afterload. CONCLUSION: Doppler measuremen t of PV and MA in the ascending aorta may be used to noninvasively assess change s in afterload.

Oscillometric Blood Pressure of Upper and Lower Extremities and Aortic Blood Flow Velocity in Neonates

PURPOSE: We studied the blood pressure difference between the upper and lower extremities in healthy newborn infants and the effect of isthmic narrowing of the aorta on making a possible difference. METHODS: The blood pressure was measured with an oscillometric blood pressure device from four extremities of 62 healthy infants aged 1-15 days. A Doppler echocardiography was performed for each infant to measure the aortic blood flow velocities in the ascending, just above and below the aortic arch isthmic narrowing. RESULTS: The blood pressure readings were as follow : right arm 69.7 (+/-7.5)/42.7(+/-7.2)mmHg, right calf 69.5(+/-6.1)/42.6(+/-6.3)mmHg, left arm 69.0(+/-7.3)/43.1(+/-6.3)mmHg, and left calf 68.9(+/-7.4)/42.9(+/-5.6)mmHg. The estimated pressure gradient between the ascending aorta and aorta below the isthmus was 2.4+/-1.3mmHg and between opposite sides of the isthmus was 1.2+/-0.8 mmHg. CONCLUSION: Unlike in childhood and adolescence, the blood pressure in the lower extremities of healthy newborn infants is not higher than in the upper extremities. But the isthmic narrowing of the aortic arch does not explain this phenomenon.

Recent Trend of Increasing Proportion of Interventional Catheterization in Congenital Heart Disease

PURPOSE: The proportion of interventional catheterization in congenital heart disease is being increased in Korea, especially in Sejong Heart Institute, so we performed statistical analysis on the cardiac catheterization cases. METHODS: Total 233 cases of congenital heart disease confirmed by cardiac catheterization at the Sejong Heart Institute between Jaunary 1995 and June 1995 were analyzed retrospectively. RESULTS: 1) The distribution of age has become more younger than that of previous reports that is, the proportion of the infant less than 1 year old was 34.8%. 2) The proportion of male sex was equal to that of female. TOF and TGA were observed predominantly in male patients, and PDA and UVH revealed female preponderance. 3) The relative frequencies of each individual congenital heart disease in order of frequency were as follows; TOF 37.3%, PDA 13.3%, VSD 8.2% and UVH 7.7%. 4) Among the 145 (62%) cases of hemodynamic study pre-operation and post-operation cases were 85 and 60 cases, respectively. The cases of interventional catheterization were 84 (36%), and those of endomyocardial biopsy were 4 (2%). 5) The frequencies of each interventional catheterization of 84 cases in order of frequency were as follows: defect closure 28 cases, balloon valvuloplasty 20 cases, balloon angioplasty 17 cases, coil embolization 15 cases, and balloon atrial septostomy 4 cases. 6) There were 2 cases of mortality associated with cardiac catheterization. CONCLUSIONS: The proportion of interventional catheterization in congenital heart disease is being increased in the Sejong Heart Institute, and this trend will spread to the other cardiac center in Korea.

Periventricular leukomalacia: Ultrasonographic findings, risk factors and neurological outcome

The thirty eight newborn infants with periventricular leukomalacia who were admitted to the neonatal intensive care unit of Gil General Hospital from March 1, 1988 to June 30, 1991, were investigated for ultrasonographic findings, risk factors and neurological outcome. The results were as follows: 1) There were 38 cases of PVL including 21 echogenic flarings and 17 cystic PVL's. 2) Mean birth weight was 2,250 gm and mean gestational age was 35 week. 3) Mean detection timing was 4th day in echogenic flarings and 18th day in cystic PVL's. 4) PVL's were located in the parietal region in 1 case and fronto-parieto-occipital in 3 cases. 5) Mean cyst size was 6 mm. 6) Multiple logistic regression analysis for the risk factors of PVL showed that low birth weight, apnea and seizure were the most significant contributing factors (p<0.05). 7) In the follow-up study of cystic PVL's, 7 cases showed improvement, 7 cases developed into multicystic encephalomalacia and 3 cases developed into atrophy. 8) Neurodevelopmental outcome of cystic PVL's showed nomal; 6.2%, minor neurodevelopmental defect; 43.8%, major neurodevelopmental defect; 31.2% and death; 18.8%. 9) Neurosonographic predictability for neurodevelopemental sequelae by cystic PVL's showed sensitivity; 63.6%%, specificity; 98.0%, positive predictive value; 92.8% and accuracy; 88.2%. 10) Major neurodevelopmental defect was more frequent, cyst size being larger and location being more extensive (p<0.05).

Primary endodermal sinus tumor of the common bile duct

No abstract available.

Three cases of Acute Transverse Myelitis

No abstract available.

A Case of Chronic Myelogenous Leukemia in a Child Treated in a Interferon

No abstract available.