Steroid pulse therapy was useful to reduce the fever duration and medical costs for patients with Kawasaki disease. Steroid pulse therapy and additional IVIG treatment were not significantly different in terms of preventing the development of coronary artery aneurysm.
Intravenous immunoglobulin (IVIG) treatmentresistant patients are high risk of developing coronary artery lesions with Kawasaki disease. The IVIG-responsive (Group A; n ϭ 6) and IVIG-resistant patients (Group B) were predicted before starting the initial treatment using the Egami scoring system and randomly allocated as a single-IVIG treatment group (group B1; n ϭ 6) or as a IVIG-plus-methylprednisolone (IVMP) combined therapy group (group B2; n ϭ 5). We investigated the transcript abundance in the leukocytes of those patients using a microarray analysis. Five patients in group A and one patient in group B1 responded to initial IVIG treatment. All group B2 patients responded to IVIG-plus-IVMP combined therapy. Before performing these treatments, those transcripts related to IVIG resistance and to the development of coronary artery lesions, such as IL1R, IL18R, oncostatin M, suppressor of cytokine signaling-3, S100A12 protein, carcinoembryonic antigenrelated cell adhesion molecule-1, matrix metallopeptidase-9, and polycythemia rubra vera-1, were more abundant in group B patients in comparison with group A patients. Moreover, those transcripts in group B2 patients were more profoundly and broadly suppressed than group B1 patients after treatment. This study elucidated the molecular mechanism of the effectiveness of IVIG-plus-IVMP combined therapy. (Pediatr Res 66: 577-584, 2009)
To assess the clinical manifestation of kerosene pneumonia, we studied20cases with accidental ingestion of kerosene, admitted to the Department of Pediatrics, Kitasato University Hospital in these15years from1983to1998.All cases were divided into two groups by presence of the positive radiological findings on chest X-ray on admission. Eight patients showed some positive radiological findings, and the remaining cases (n=12) did not have abnormal findings on chest X-ray. We compared several points between these two groups as follows,(1) clinical symptoms on admission,(2) results of arterial blood gas analysis,(3) the time which took from ingestion to confirmation of positive radiological findings,(4) 133Xe ventilation scintigraphy and (5) treatment options.There were no significant differences on clinical symptoms on admission nor results of arterial blood gas analysis between these two groups. In5cases, secondary chemical pneumonia appeared over 12 hours after kerosene ingestion. In2cases, 133Xe ventilation scintigraphy revealed impaired lung function after resolution of clinical symptoms and chest X-ray findings.These results suggest that closed observation in the hospital and sequencial radiological evaluation are necessary in the cases of accidental ingestion of kerosene. And functional evaluation, e.g., 133Xe ventilation scintigraphy, is important after resolution of clinical symptoms and chest X-ray findings.
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