A Kawasaki disease (KD) survey, 4th nationwide survey was performed retrospectively to evaluate the morbidity and mortality of KD during 1994KD during -2000 in Taiwan. This study was the continuation of past three surveillances since 1976, when the first case appeared. A specially designed questionnaire was sent to all the major hospitals, with 100 or more beds, to collect the number of patients encountered in each hospital, data with identification numbers (ID), sex, age, coronary lesions. The total number of KD cases (1994-2000; nϭ4892) and incidents were also increased in this survey (year 2000 ϭ 53.33 ) with two out breaks in 1996 and 1998. Annual incidence were calculated on mid year population of less than 5 years of age. Male to female ratio was 1.7:1 and still showed constant male (n ϭ 3079) dominant ratio. The patients below 2, 2 to 4 and above 4 years were 57%, 27% and 16% respectively. 84% cases (n ϭ 4118) were below 4 years of age. Highest number of cases were reported by northern provinces (nϭ2142) then followed by south (nϭ1401) which was same as the previous survey. Early coronary artery dilatation was noted in 1329 cases ( 27.18%). Fatality rate has come down to 0.06% (nϭ3) when compared to 0.4 and 0.2% in the previous surveillance. Increasing numbers of patients with peaks, every 2-3 years suggested the possibility of unknown infectious agents playing the role in etiology. The present day advances could not decrease the prevalence rate but improved long-term outcomes significantly. Objective. The objective of the study is to describe recent epidemiological patterns of Kawasaki disease in China and to make a comparison between China and Japan.Methods. The survey form and diagnostic guideline of Kawasaki disease that had been approved by the Kawasaki Disease Research Committee were sent to all pediatric departments of county hospitals and urban medical centers where pediatric beds existed in Jiangsu (197 hospitals), Shannxi (150 hospitals), Guangdong (156 hospitals) provinces and Beijing City (39 hospitals). A retrospective survey was carried out and all of the hospitalized patients during a 5-years-period had been included into this research.Results. The total number of recorded cases during the 5-years-period was 2127. The incidence rates for per 100,000 children younger than 5 years of age were 1.85 in Jiangsu, 2.34 in Shan'xi, 24.4 in Beijing and 5.93 in Guangdong. The male:female ratio was from 1.70 to 2.23 . The peak of age at onset was 1 to 2 years old. The disease occurred more frequently in spring and summer, with the lower incidence in autumn and early winter. Patients who developed cardiac sequalae accounted for 13.6%, 14%, 21.5% and 30% in Jiangsu, Shan'xi, Beijing and Guangdong respectively. Fatality rate was 0.2% Objective: The Hong Kong Kawasaki disease Study Group (HKKDSG) has started surveillance on patients diagnosed to have Kawasaki Disease (KD) in Hong Kong since 1993 with the purpose of collecting incidence data, reviewing the characteristics of KD and analyzing the epidemio...

The prevalence of hypertension in Hong Kong Chinese adolescents is 1.44%. The current study shows high waist circumference is a predictor of hypertension in adolescents, while increased physical activity is a protective factor. Incorporating waist circumference into screening protocols may increase the sensitivity of cardiovascular risk stratification. Healthcare providers should be strong advocates helping to prevent obesity and promote physical activity in adolescents and children.

Severe acute respiratory syndrome (SARS) is an emerging infectious disease. After the appearance of an index patient in Hong Kong in February 2003, SARS outbreaks occurred rapidly in hospitals and spread to the community. The aim of this retrospective study is to evaluate the effectiveness of a triage policy and risk-stratified infection control measures in preventing nosocomial SARS infection among paediatric healthcare workers (HCWs) at the Prince of Wales Hospital, a general hospital to which children with SARS are referred in Hong Kong. The acute paediatric wards were stratified into three areas: (1) ultra high-risk area, (2) high-risk area and (3) moderate-risk area according to different risk levels of nosocomial SARS transmission. The implementation of different levels of infection control precautions was guided by this risk stratification strategy. Between 13 March and 23 June, 38 patients with probable and suspected SARS, 90 patients with non-SARS pneumonia, and 510 patients without pneumonia were admitted into our unit. All probable SARS cases were isolated in negative-pressure rooms. Twenty-six HCWs worked in the ultra high-risk area caring for SARS patients and 88 HCWs managed non-SARS patients in other ward areas. None of the HCWs developed clinical features suggestive of SARS. In addition, there was no nosocomial spread of SARS-associated coronavirus to other patients or visitors during this period. In conclusion, stringent infection control precautions, appropriate triage and prompt isolation of potential SARS patients may have contributed to a lack of nosocomial spread and HCW acquisition of SARS in our unit.

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Catecholamine-associated cardiomyopathies caused by neuroblastoma have rarely been reported. We are reporting 2 cases of neuroblastoma associated with hypertension and severe cardiomyopathic changes in different extremes. One case was dilated cardiomyopathy with heart failure, and the other showed echocardiographic features simulating hypertrophic obstructive cardiomyopathy. Both girls had high levels of urine catecholamines on presentation. Anthracycline group of chemotherapy was avoided. Chemotherapy and tumor resection resulted in successful normalization of blood pressure and regression of cardiomyopathic changes. Blood pressure and cardiomyopathic changes should be monitored not only at presentation, but also during the treatment for neuroblastoma.

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We report the use of oral sildenafil in a 5-month-old preterm infant with severe bronchopulmonary dysplasia and pulmonary arterial hypertension refractory to inhaled nitric oxide treatment, maximal ventilatory support and conventional vasodilator therapy. Sildenafil was prepared as a liquid suspension by the method of trituration and administered via an orogastric tube to the patient. Forty-eight hours after sildenafil treatment, echocardiography revealed that the tricuspid incompetence was substantially diminished and the contractility of both ventricles improved, indicating a marked reduction in pulmonary arterial pressure. Oral sildenafil treatment was continued for 6 months until complete resolution of pulmonary arterial hypertension, and oxygen supplement was weaned off. There was no adverse effect during the treatment period. Oral sildenafil may be useful in reducing pulmonary vascular resistance and can be considered for treatment of severe pulmonary arterial hypertension secondary to bronchopulmonary dysplasia.

We report on a child with Kawasaki disease complicated by the development of a giant coronary artery aneurysm (CAA) progressing to rupture, successfully resuscitated and treated by emergency coronary artery bypass.A 5-year-old boy was initially treated for lymphadenitis by a general practitioner; however, the fever persisted and he developed conjunctival injection, skin rash and cracked lips. He was then treated for Kawasaki disease with intravenous immunoglobulins (400 mg/kg per day) on the 9th day of illness for 3 consecutive days; fever subsided, but an echocardiography on day 13 revealed a grossly dilated right coronary artery and he was transferred to our hospital for further management. He was afebrile on admission and echocardiography revealed a giant right CAA measuring 18.6 mm in maximal diameter with a huge thrombus obliterating nearly the whole lumen (Fig. 1). The left coronary artery was also uniformly dilated; the platelet count was 1110·10 9 /l and the ESR was 143 mm/h. In view of the high risk of complete coronary occlusion, he was heparinised together with administration of aspirin and warfarin. Abciximab was also given because of the severe thrombocytosis. The platelet count dropped to 786·10 9 /l on the following day and the ESR dropped to 35 mm/h on the 4th day after admission. However, fever recurred on the 7th day with elevated ESR and persistently high platelet count. Therefore intravenous immunoglobulin (1 g/kg) was administrated again and he became afebrile afterwards. Nevertheless, the right CAA continued to enlarge, measuring 30 mm at its maximal diameter on MRI at 4 weeks (Fig. 2).After discussion with cardiothoracic surgeons, coronary arterial bypass surgery was deemed necessary to prevent the imminent rupture. Unfortunately, the day before surgery, he suddenly collapsed in the ward during a temper tantrum. Immediate echocardiography and pericardiocentesis confirmed cardiac tamponade with blood. He was resuscitated and a pericardial window was created urgently at the bedside. He was successfully revived and rushed to the operating theatre, where a right CAA rupture was confirmed and emergency coronary artery bypass surgery was performed utilising the left saphenous vein as the graft. Post-operative inotropic support was weaned off within 36 h. He was extubated 2 days after surgery. Right ventricular function normalised within 1 month. He has remained well 6 months thereafter, receiving only aspirin for persistent left coronary artery dilatation.Giant CAA occurs in 0.5%-1% of patients with Kawasaki disease with a fatality rate of 4% [3,6]. Risk factors for the development of a giant CAA during the acute phase of Kawasaki disease are not entirely clear. However, late start of intravenous immunoglobulin administration and the requirement of additional doses of immunoglobulin to control fever have been shown to be important risk factors, which are probably exemplified in this case. Abciximab, a platelet glycoprotein IIb/ IIIa receptor inhibitor, which has been increasingly investigated for...