ABSTRACT
Six patients with Kawasaki disease (KD) were treated with prednisolone (1 to 2 mg/kg/day) for 3 days (from days 10 to 12 after the onset of the illness) after apparently unsuccessful treatment with intravenous immunoglobulin (IVIG, 2 g/kg/dose and additional 1 g/kg/dose). Five patients responded immediately to the first course of prednisolone infusion. One patient failed to respond to the first course of prednisolone therapy, but he did respond to the second 3-day course of therapy. None of the patients demonstrated a further progression of coronary artery dilatation or any adverse effects. Standard-dose and short-term corticosteroid therapy therefore appears to be a safe and effective treatment for patients with IVIG-resistant KD.
Subject(s)
Drug Resistance , Immunoglobulins, Intravenous/administration & dosage , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Prednisolone/administration & dosage , Child , Child, Preschool , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Follow-Up Studies , Humans , Infant , Infusions, Intravenous , Male , Mucocutaneous Lymph Node Syndrome/immunology , Prospective Studies , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
We investigated changes in the Activities of Daily Living (ADL) of stroke patients in a convalescent rehabilitation ward and a general ward using a Functional Independent Measure (FIM). The subjects were 109 patients hospitalized for rehabilitation purposes at the Oyamada Memorial Spa Hospital. The change in FIM at the time of hospitalization and that at 1 week later was investigated in 81 patients in the convalescent rehabilitation group (CRG) and 28 patients in the control group (CG). In addition, the CRG was investigated again after one month. Intensive rehabilitation service based on ADL and worksheets was introduced in the CRG. On the other hand, these were not introduced in the CG. The total score of FIM increased significantly (p<0.01) in the first week after hospitalization in both groups. The FIM-gain after one week in the CRG was high. With regard to each item, a significant improvement was observed in patients' motor skills while eating, grooming, bathing, dressing the upper body, dressing the lower body, toilet, bladder management, transfer bed/chair, toilet and tub, and walking/wheelchair (11/13). Multiple regressions were used to assess the relationships between FIM-gain (one week, one month), age, rehabilitation intensity and other predictive variables. Better rehabilitation outcomes were observed in patients with lower level of dementia and high rehabilitation intensity. It was thought that planned rehabilitation based on ADL was effective in the CRG, and it was suggested that the CRG's system is effective in the rehabilitation of stroke patients.
Subject(s)
Activities of Daily Living , Cognition , Convalescence , Motor Skills , Stroke Rehabilitation , Aged , Humans , Rehabilitation Centers , Stroke/psychologyABSTRACT
To investigate the effect of high-dose intravenous immunoglobulin (IVIg) on neutrophil apoptosis in Kawasaki disease (KD), we studied the in vitro spontaneous and IVIg-induced apoptosis of neutrophils by analyzing a proportion of annexin V-positive cells and cells with fragmented DNA. The mean number of peripheral neutrophils in the post-IVIg phase decreased significantly (P < 0.01) compared with that in the pre-IVIg phase. The mean proportion of spontaneous apoptotic neutrophils in the post-IVIg phase was significantly higher (P < 0.01) than that in the pre-IVIg phase, and there was a significantly positive correlation (P < 0.01) with the reduction ratio of the circulating neutrophil counts from the pre-IVIg through the post-IVIg phases. IVIg induced a dose-dependent increase in the proportion of apoptotic neutrophils in the pre-IVIg phase. As a result, the present study demonstrated a novel action in which high-dose IVIg therapy decreased the number of circulating neutrophils by accelerating their apoptosis in KD.
