[Kawasaki disease: recent findings in etiology, pathogenesis and therapy]. / Malattia di Kawasaki: recenti acquisizioni in eziologia, patogenesi e terapia.

The number of cases of Kawasaki disease increases in Japan. The aetiology is still unknown but epidemiological studies suggest an infectious aetiology in spite that no specific microorganism has been implicated; it must be, probably present a hereditary predisposition connected with HLA subtypes. Many investigators reported an increase in the antibody level against several agents, among which bacteria and virus. Recently they found that aberrant regulation of T- and B-cells functions was associated with initiation of such antibody production, that in the majority of cases is self-limiting. The effectiveness of high- and low-doses of salicylates, given always associated with steroids, only up to fifteen days of illness, and Intravenous Gamma Globulin (IVGG), is also discussed.

[Cardiologic aspects of Kawasaki's disease]. / Aspetti cardiologici della malattia di Kawasaki.

Both immediate and long-term prognosis of Kawasaki's disease (K. D.) are due to cardiac involvement and, particularly, to coronary artery aneurysms formation. Of 19 cases that we studied, age ranging between 7 months and 8 years, 18 has been followed clinically and with echocardiographic procedure. In 1 case (10 years old), which underwent a triple bypass surgical operation due to the presence of multiple aneurysms, diagnosis was made retrospectively. In 2 of 19 cases (10.52%) coronary artery aneurysms were present. One case showed aneurysm's partial regression two years later. In 10 of 18 cases (55.5%) clinical evidence of cardiac compromise was present, whereas in no patient ECG alterations occurred at all. Our data prove the poor benefit of clinical approach and ECG interpretation in K. D., whereas we believe that echocardiographic study is the best method in early identification of aneurysms.

Kaposi's sarcoma following corticosteroid treatment for temporal arteritis--a case report.

After three months of corticosteroid treatment, a sixty-nine-year-old man, suffering from temporal arteritis, developed a Kaposi's sarcoma (KS) initially located on the left ankle and subsequently spread over both feet and hands. Laboratory data showed a deficiency of both humoral and cellular immunity and constant positivity in the tests for cytomegalovirus. The onset of KS during corticosteroid treatment of temporal arteritis is an extremely rare occurrence, this case being only the second one reported in the literature. In our case the development of this neoplasm can be related to an immunodeficiency that led to a deficit in the immunological surveillance, along with an activation of oncogenic viruses.

[Kawasaki's disease. 3 problems: incomplete clinical forms, steroid treatment, low doses of aspirin]. / Malattia di Kawasaki. Tre problemi: le forme cliniche incomplete, il trattamento steroideo, le basse dosi di aspirina.

After a brief review of the recent literature and the description of the clinical and echocardiographic follow-up of 9 cases observed from 1976 to 1985, the authors stress the relative importance to recognize patients who do not fulfill the classic criteria for the diagnosis of Kawasaki disease, in order to treat with antiaggregants those affected by coronary aneurysms. Moreover they discuss the beneficial effects of steroids, in association with salicylates, given only in the first two weeks of disease when the production and deposit of immunocomplexes and the release of lysosomal enzymes from macrophage cells occur. Finally the authors point out that the treatment with low doses of salicylates selectively acting on thromboxane A2 and not on Pgl2, as shown in experimental studies, remains to be confirmed by clinical trials.