Vascular permeability is one of the characteristics of vasculitis in Kawasaki disease (KD) and is closely related to indurative edema. Evaluating indurative edema may be useful for estimating the severity of KD. Indurative edema is correlated with resistance values in the limbs. Therefore, we evaluated the efficacy of resistance values in the limbs in KD patients, as measured by a multiple-frequency bioelectrical-impedance method, for estimating the severity of KD.
Patients and Methods:
In 38 patients with the acute phase of KD (before intravenous immunoglobulin treatment; IVIG), 32 with the sub-acute phase (after IVIG), and 49 controls, we measured resistance (impedance; IMP) in each child’s total body, forearm, and lower leg at frequencies of 0 and infinity (IMP-0 and IMP-∞, respectively) using MLT-550N (Sekisui ). Corrected Imp values (coIMP; Imp x limb’s cross-sectional area/ limb’s length) were also examined.
Results:
IMP values were not different among patients with the acute and sub-acute phases of KD and controls. However, coIMP values in the forearm of patients in the acute phase of KD were significantly higher than those of controls (coIMP-0 Ωcm: 197±50 vs. 164±35, P<0.001, coIMP-∞; 151±42 vs. 125±36, P=0.003). These values were decreased to 181±46 Ωcm for coIMP-0 and 144±44 Ωcm for coIMP-∞ at the sub-acute phase and were still significantly higher than those of controls. Values of coIMP in the lower leg showed similar changes to those in the forearm. The values of coIMP in the forearm of IVIG non-responders at the acute phase were higher than those of responders, but this difference was not significant.
Conclusion:
Values of co-IMP in the forearm might be useful for estimating the severity of KD.
A male neonate born at 33 weeks of gestation was orally administered caffeine from the 2nd to the 13th days of life for the management of apnoea of prematurity with several episodes of bradycardia. Paroxysmal bradycardia recurred at 23 days of age, indicating that the treatment was ineffective. A physical examination at 31 days of age revealed no hypothermia or other abnormalities. Laboratory findings at 35 days of age showed no abnormalities in the serum electrolyte, thyroid hormone, creatinine kinase, or troponin-I levels. The serum samples were also negative for Anti-SS-A and anti-SS-B antibodies. Other serum findings were as follows: epinephrine, 17 pg/mL (normal < 100 pg/mL); norepinephrine, 1205 pg/mL (normal < 450 pg/mL); and dopamine, 38 pg/mL (normal < 20 pg/mL). The urinary metanephrine-to-creatinine ratio was 2.06 (normal < 0.5). The chest radiography, echocardiography, brain magnetic resonance imaging and video electroencephalography findings were normal. His resting heart rate was 150-170 beats/
genital heart disease. In the present case, streams evaluated in 4D flow revealed insufficient mixing of oxygenated and deoxygenated blood, despite the presence of a large ASD. These findings were useful for the treatment strategy.
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