Re-treatment regimens for acute stage of Kawasaki disease patients who failed to respond to initial intravenous immunoglobulin therapy: Analysis from the 17th nationwide survey

BACKGROUND: Current regimens for re-treatment of patients with Kawasaki disease who failed to respond to the initial intravenous immunoglobulin (IVIG) therapy are still uncertain. The purpose of this study is to reveal what regimens were used as the initial therapy and re-treatment for acute stage of Kawasaki disease in the current Japanese medical setting. METHODS: The 17th nationwide survey on Kawasaki disease covered patients whose onset was in 2001 and 2002. In questionnaires sent to all hospitals with a bed capacity of 100 or more and a pediatric department, several questions related to therapeutic regimens for Kawasaki disease were posed. The authors observed the proportions of hospitals that had regimens for patients who failed to respond to the initial therapy. RESULTS: Among those hospitals that responded to the survey, 1052 (64.1%) reported that at least one patient with Kawasaki disease visited the hospital. Among these 1052 hospitals, 73.3% had a regimen to administer 30-39 mg/kg per day of oral aspirin with initial IVIG. The proportion of hospitals that used 1 g/kg per day of IVIG for 2 days was the largest among the options for the initial treatment. For those patients who fail to respond to the initial therapy, 464 hospitals (44.1%) reported that their pediatricians would use additional IVIG only. The number of hospitals that planned to administer high-dose IVIG and ulinastatin was 185 (17.6%). The number of hospitals having regimens of additional IVIG and steroids was 54 (5.1%). CONCLUSIONS: The current status of the treatment for patients with Kawasaki disease not responding to the initial IVIG therapy in Japan was revealed. A randomized trial of a large sample is needed to ascertain the effectiveness of several options for re-treating Kawasaki disease.     

Use of sonographic elastography of the masseter muscles for optimizing massage pressure: a preliminary study

Summary  To examine the stiffness of the masseter muscle using sonographic elastography and to investigate its relationship with the most comfortable massage pressure in the healthy volunteers. In 16 healthy volunteers (10 men and 6 women), the Masseter Stiffness Index (MSI) was measured using EUB-7000 real-time tissue elastography. They underwent massages at three kinds of pressures using the Oral Rehabilitation Robot (WAO-1). A subjective evaluation regarding the comfort of each massage was recorded on the visual analogue scale. Elastography was also performed in two patients with temporomandibular joint dysfunction with the myofascial pain. The mean MSI of the right and left muscles in the healthy volunteers were 0·85 ± 0·44 and 0·74 ± 0·35 respectively. There was no significant difference between the right and left MSI in the healthy volunteers. The MSI was related to massage pressure at which the healthy men felt most comfortable. The two temporomandibular disorder patients had a large laterality in the MSI. The MSI was related to the most comfortable massage pressure in the healthy men. The MSI can be one index for determining the massage pressure.     

Histological evaluation of alveolar ridge augmentation using injectable calcium phosphate bone cement in dogs

Summary  Alveolar ridge augmentation is an important procedure to restore tooth loss. Several types of graft materials have been used for augmenting the alveolar ridge. An injectable calcium phosphate cement (CPC) has been applied to periodontal bone defects and has shown favourable results. Thus, this CPC may work as an effective graft material for alveolar ridge augmentation. The aim of this study was to evaluate the effectiveness of the CPC for large-scaled (about 7 × 8 × 6 mm) ridge augmentation in dogs. Alveolar ridge defects were created bilaterally in the maxilla of six beagle dogs. The CPC was applied to one of the bilateral maxillary defects. The untreated defect on the contralateral side served as control. The animals were sacrificed at 6 months after surgery and decalcified histological specimens of the alveolar ridge were prepared histometrically and evaluated under a light microscope. Newly formed and reconstructed alveolar ridges covering the CPC were observed in all experimental sites. In the control sites, only slight newly bone formation was observed. Histomorphometrical analysis indicated that the CPC grafted group exhibited significantly ( P  = 0·0001) increased area and height in new bone formation compared with those of the control group. The results indicate that the CPC appears to be an effective material for alveolar ridge augmentation and may act as a space maintainer to conduct new bone formation.     

Identification of intrahepatic lymphocyte subpopulations in patients with drug-induced allergic hepatitis

Intrahepatic lymphocyte subpopulations were studied in eight cases of drug-induced allergic hepatitis (DIAH) by the immunoenzymatic technique using monospecific T cell antibodies and other reagents. In peripheral blood, the CD4: CD8 ratio in DIAH was higher than that in normal controls. In liver tissue, CD8 positive lymphocytes were predominant, and these cells were attached to the surface of hepatocytes. Leu 7, CD4 and CD11 positive lymphocytes were scarce and were not attached to hepatocytes. HLA-class I was displayed on the cell membrane of hepatocytes. These results suggest that cytotoxic T cells, which are CD8 positive, CD4 negative and CD11 negative, may play an important role in the pathogenesis of liver cell injury in patients with DIAH.     

Calcium and silicon from bioactive glass concerned with formation of nodules in periodontal-ligament fibroblasts in vitro

summary Previously, the authors reported that bioactive glass promoted formation of nodules in cultured periodontal-ligament fibroblasts and high concentrations of calcium and silicon were detected in the culture medium. Herein, the effects of bioactive glass, calcium alone and calcium and silicon for formation of nodules on the periodontal-ligament fibroblasts are examined. The cells were cultured with bioactive glass, without bioactive glass, calcium and silicon, with calcium alone and with calcium and silicon. The ceil growth, alkaline-phosphatase activity, amount of pro-collagen type I and the number of nodules were measured periodically until the 21st day. The cell growth rate with calcium and silicon was the highest, however the rate with bioactive glass and calcium alone were similar to that without them. The alkaline-phosphatase activity and the amount of pro-collagen showed peaks at the 11th day. At the peak, the alkaline-phosphatase activity with bioactive glass or calcium and silicon, and the pro-collagen with bioactive glass was higher than without them. The number of nodules with bioactive glass, calcium alone or calcium and silicon was greater than without them. These findings suggested that the combination of calcium and silicon released from bioactive glass was concerned with the formation of nodules on the periodontal-ligament cells.     

Intraoperative cardiovascular collapse in an infant with Arnold-Chiari malformation

We report a case of an infant with a diagnosis of Arnold-Chiari malformation who developed acute cardiovascular collapse during posterior fossa decompression surgery. Haemodynamic manifestations were hypotension and bigeminy characterized by resistance to conventional resuscitation. The aetiology was considered to be due to brainstem compression exerted to control surgical bleeding from an inadvertently lacerated sinus at an unusual site, the rim of the foramen magnum. Restoration of blood pressure and disappearance of arrhythmia immediately followed removal of the brainstem compression rather than volume or pharmacological resuscitation.