Pediatrics international : official journal of the Japan Pediatric Society
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Thrombolytic therapy for coronary aneurysm thrombosis of Kawasaki disease (KD) includes antiplatelet and anticoagulants, i.v. coronary thrombolysis (IVCT), and i.c. thrombolysis (ICT). Therapeutic methods, drugs and doses vary among medical facilities. ⋯ In the present nationwide survey, thrombolytic therapy was more effective in cases of a shorter duration between thrombus formation and the start of treatment. It was found that many facilities used only IVCT for thrombus alone. Medications given to KD children did not cause serious hemorrhagic complications, unlike in adults. Although doses exceeded recommended levels in many cases, the only complications were nasal bleeding and fever.
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Comparative Study
Use of non-invasive total hemoglobin measurement as a screening tool for anemia in children.
Universal screening for anemia is important in children, but invasive blood sampling is required. A new device (Radical-7® Pulse CO-Oximeter™, Masimo, Irvine, CA, USA) now enables non-invasive hemoglobin concentration (SpHb) measurement to be done, but the usefulness of this device for anemia screening in children is unclear. The objective of this study was to compare SpHb with complete blood count (CBC) using a hematology analyzer (Microsemi® LC-667CRP; Fukuda Denshi, Tokyo, Japan). ⋯ The correlation of Radical-7® and Microsemi® was 0.602 (P < 0.0001). On Bland-Altman comparison, bias was -0.6 ± 1.1 g/dL. Even though further improvement is required, Radical-7® offers many possibilities in the context of primary screening.
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Several drugs, when used chronically in very preterm infants, are considered to be associated with the development of late-onset circulatory collapse (LCC), which can lead to neurodevelopmental impairment. Despite its clinical importance, conclusive risk factors for LCC have yet to be identified. The aim of the present study was to investigate the relationship between LCC and diuretics, methylxanthines, levothyroxine, and sodium chloride. ⋯ Methylxanthine use was significantly associated with LCC onset. Diuretics may have the ability to provoke LCC through sodium wasting, resulting in a negative balance of the electrolyte. The incidence of LCC could be lowered by paying particular attention to infants' sodium balance, and by aggressive methylxanthine treatment.
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Four patients with a thrombus in a coronary artery aneurysm due to Kawasaki disease (KD) were treated at our hospital between 1994 and 2009. All the cases were treated with intravenous coronary thrombolysis (IVCT) therapy and the cases with acute myocardial infarction were treated with additional intracoronary thrombolysis therapy. Although both thrombolytic therapies were effective, IVCT required more time than intracoronary thrombolysis to resolve the thrombus. We concluded that IVCT can be used as the first-line thrombolytic therapy for KD, except in cases with acute myocardial infarction.
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Reported herein is a coronary anomaly that occurred in a young adolescent athlete who presented with cardiopulmonary arrest. The patient was resuscitated and treated with therapeutic hypothermia. ⋯ Enhanced computed tomography of the heart indicated an anomalous left main coronary artery originating from the right coronary sinus and coursing between the aorta and the pulmonary artery. The patient underwent surgical intervention with coronary artery bypass grafting to prevent symptom recurrence.