A case of relapsing Kawasaki disease and review of the literature.

A review of the literature was carried out on the occasion of one case of Kawasaki disease in a small infant aged 3 months which relapsed 17 years later. Kawasaki disease is of unknown aetiology and mainly affects children under 5 years of age. It is manifested as a necrotizing vasculitis with aneurysms of the coronary arteries and the proximal medium size arteries. One hundred and fifteen thousand cases have been reported up to the present date, an incidence of 6-11/100,000 children. The evidence of coronary aneurysms range from 20-30%, while peripheral aneurysms are rare. Eighteen cases of peripheral ischemia have been reported in the international literature. The diagnosis is clinical and treatment remains symptomatic (anti-inflammatory and anticoagulant). Thrombolytic and anticoagulant management is applied in acute heart attack, and surgical bypass in chronic ischemia. Reversion of the aneurysms is observed in 60% of the cases, while relapse of the disease is possible years or decades later. Death is due to thrombosis of the coronary or rupture of the coronary or distal aneurysm. For this reason, regular fellow-up of the patients is recommended, according to the guidelines for long-term management of patients with Kawasaki disease.

Superiority of dobutamine over dopamine for augmentation of cardiac output in patients with chronic low output cardiac failure.

Dobutamine is a newly developed catecholamine reported to have minimal direct vascular effects relative to its inotropic activity and to have less chronotropic and arrhythmogenic properties than other catecholamines used in the treatment of low output states. In this study, the acute hemodynamic effects of dobutamine were compared to those of dopamine in 13 patients with chronic low output cardiac failure. At dosages adjusted to achieve similar increments in cardiac output, dobutamine reduced left ventricular filling pressure (LVEP) from 24 +/- 2 mm Hg (SEM) to 17+/- 2 mm Hg, while dopamine increased LVEP to 30 +/- 3 mm Hg and in six patients caused arterial O2 saturation to fall below 90%. This poor response to dopamine was probably the result of its vasoconstrictive effects and illustrates the potential advantages of using a cardioselective agent such as dobutamine when the desired goal of therapy is to improve ventricular function by direct inotropic stimulation.