Diagnosis and management of Kawasaki Disease

Article Abstract:

Kawasaki disease (mucocutaneous lymph node syndrome) usually affects young children, causing fever, inflammation of the mucous membranes of the mouth, ''strawberry tongue,'' rash, and other symptoms. It may involve the heart, causing narrowing of the coronary arteries and myocardial infarction (heart attack) occurring months or years after the initial illness. A genetic predisposition may be involved. Kawasaki disease is more common among Asians, and peaks in incidence between December and May. Mortality is highest among children under two years of age. The symptoms, including cardiovascular features, are described. Half of the patients with coronary aneurysms (dilations of the walls of the coronary arteries, which bring blood to the heart) have no complications, but large aneurysms (affecting about 5 percent of patients) frequently lead to blockage of the coronary arteries and heart attacks, and in extreme cases, death. In one survey of patients who had died of Kawasaki disease, half died within two months of the acute illness, but 20 percent died more than a year later. Treatment of the disease includes aspirin therapy, which relieves symptoms but may not be effective against coronary aneurysm. Gamma globulin therapy may be effective in preventing coronary aneurysms, and has been found to cause no serious complications. In cases of severe coronary artery involvement, coronary artery bypass grafts may be required. Balloon angioplasty and clot-dissolving therapy have had limited success. Long-term treatment for patients with varying degrees of complications is discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Kawasaki disease, Kawasaki syndrome

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Newer tests for the diagnosis of renovascular disease

Article Abstract:

Magnetic resonance imaging (MRI) and Doppler ultrasonography may be effective methods for diagnosis of renovascular hypertension. Renovascular hypertension (RVH) is a disorder that is often caused by renal artery stenosis (RAS), or narrowing of an artery that supplies blood to a kidney. A survey of the medical literature found that MRI and Doppler ultrasonography are both sensitive methods for detecting RAS. Both are noninvasive procedures that allow anatomical detection of the narrowing of a renal artery. A set of standard guidelines has not been established for the use of these methods for the diagnosis of RAS. The captopril test and captopril renography may also be effective noninvasive tests for diagnosing RAS. These tests involve the use of the drug captopril to detect metabolic changes, such as a drop in blood pressure, in patients with suspected RAS. Tests that have been used traditionally to detect RVH often have had low sensitivity. Some have also involved the use of substances that could cause kidney damage.

Magnetic resonance imaging, Doppler ultrasonography, Renovascular hypertension, Captopril

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The value of the forced expiratory time in the physical diagnosis of obstructive airways disease

Article Abstract:

Measurement of forced expiratory time (FET) may be an effective method for the diagnosis of obstructive airways disease (OAD). OAD is a chronic lung disease. FET was measured by the same physician in 384 patients and compared to spirometry. Spirometry is measurement of the breathing capacity of the lungs. A FET with a cutoff value of six seconds correctly diagnosed the most patients with OAD. The use of a FET with a cutoff value of six seconds was most sensitive for the diagnosis of patients over 60 years old. Pairs of physicians measured FET with a cutoff value of six seconds in 98 patients. A significant level of agreement was found between measurements of FET made by different physicians.

Usage, Measurement, Lung diseases, Obstructive, Chronic obstructive lung disease, Respiration, Pulmonary function tests

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