Ming-Chih Lin

Epidemiologic features of Kawasaki disease in acute stages in Taiwan, 1997–2010: Effect of different case definitions in claims data analysis

Background Kawasaki disease is the leading cause of pediatric acquired cardiac disease in many industrialized countries. The aim of this study was to estimate the incidence of Kawasaki disease in acute stages in Taiwan, by linking the diagnosis code to medication and comparing the differences in epidemiological features with those of previous reports that used the diagnosis code alone. Methods We searched the National Health Insurance Research Database from 1997 to 2010. For the International Classification of Diseases, Ninth Revision (ICD‐9) set, all inpatients with a main diagnosis of Kawasaki disease (ICD‐9, 446.1) were retrieved. For the ICD‐9 + intravenous immunoglobulin (IVIG) set, Kawasaki disease in acute stages was defined as the disease stages requiring IVIG. The epidemiologic features were calculated and compared by both methods. Results The incidence rates for children under 5 years ranged from 21.5 to 68.5 per 100,000 person‐years (average 49.1) for the ICD‐9 + IVIG set and from 48.5 to 82.8 per 100,000 person‐years (average 74.9) for the ICD‐9 set. Significant discrepancy in peak season estimation occurred in summer. The 5‐year recurrence rate was 1.1% for the ICD‐9 + IVIG set and 4.5% for the ICD‐9 set. The coronary complication rates were around 7.24% (ICD‐9 + IVIG) and 6.48% (ICD‐9). Conclusion Discrepancies occurred when different case definitions were used in claims data analysis. Previous reports might have overestimated the incidence, recurrence rate, and complication rate in older children. The new method might slightly underestimate them. The true incidence might lie in between.

Comparative effectiveness of intravenous immunoglobulin for children with Kawasaki disease: a nationwide cohort study.

Introduction Different immunoglobulin manufacturing processes may influence its effectiveness for Kawasaki disease. However, nationwide studies with longitudinal follow-up are still lacking. The aim of this study was to evaluate the comparative effectiveness of immunoglobulin preparations from a nationwide perspective. Materials and Methods This is a nationwide retrospective cohort study with a new user design. Data came from the National Health Insurance Research Database of Taiwan. From 1997 to 2008, children under 2 years old who received immunoglobulin therapy for the first time under the main diagnosis of Kawasaki disease were enrolled. The manufacturing processes were divided into β-propiolactonation, acidification and those containing IgA. The endpoints were immunoglobulin non-responsiveness, acute aneurysm, prolonged use of anti-platelets or anti-coagulants, and recurrence. Results In total, 3830 children were enrolled. β-propiolactonation had a relative risk of 1.45 (95% CI 1.08∼1.94) of immunoglobulin non-responsiveness, however, the relative risks for acidification and containing IgA were non-significant. For acute aneurysms, acidification had a relative risk of 1.49 (95% CI 1.17∼1.90), however the relative risks for β-propiolactonation and containing IgA were non-significant. For prolonged use of anti-platelets or anti-coagulants, β-propiolactonation had a relative risk of 1.44 (95% CI 1.18∼1.76), and acidification protected against them both with a relative risk of 0.82 (95% CI 0.69∼0.97), whereas the relative risk for containing IgA was non-significant. For recurrence, all three factors were non-significant. Conclusions The effectiveness of immunoglobulin may differ among different manufacturing processes. β-propiolactonation had a higher risk of treatment failure and prolonged use of anti-platelets or anti-coagulants. Acidification may increase the risk of acute coronary aneurysms.

A novel hybrid therapy for pulmonary atresia with intact ventricular septum

There exists some controversy over how to treat patients of pulmonary atresia with intact ventricular septum: transcatheter or open chest. Each has certain drawbacks. We describe a novel hybrid approach which has the advantages of both methods.

Combined Transcatheter Closure of Atrial Septal Defect and Patent Ductus Arteriosus: Report of Two Cases

Atrial septal defect (ASD) and patent ductus arteriosus (PDA) are common congenital heart defects and usually isolate. The combination of these two defects is infrequent. Nowadays, both defects are amenable to transcatheter closure, without surgery. However, both defects by transcather closure was rarely reported. Here we report that two children with ASD and PDA benefited from combined interventional therapy using the Amplatzer septal occluder for the ASD and Gianturco coils for the PDA. Based on our limited experience, closing the PDA before the ASD may be a better option.

Precordial thump in a newborn with refractory supraventricular tachycardia and cardiovascular collapse after amiodarone administration.

About half of patients with ITP may develop hemorrhagic complications. Petechiae, purpura, epistaxis, gingival bleeding, and menorrhagia are common manifestations in patients with ITP. However, serious hemorrhagic complications are uncommon and the incidence of fatal bleeding is approximately 5% throughout a lifetime [4]. Patients with platelet counts of less than 10 000/ml develop major bleeding, including intracranial hemorrhage, hematuria, and gastrointestinal bleeding. However, adult gynecologic manifestations are very rare. Initial management of acute ITP is based on the severity of thrombocytopenia and bleeding. Medical treatment is initiated with intravenous methylprednisolone combined with immunoglobulin if a patient has a platelet count of less than 30 000/ml [5]. Intravenous anti-D and recombinant factor VIIa infusion can be provided as additional alternative therapies. However, platelet transfusion may be necessary for emergency intervention or surgery. The initial goal of treatment is to accomplish a hemostatic platelet count.

Refractory Ventricular Tachycardia in a Long QT Syndrome Child Successfully Controlled by Left Cardiac Sympathetic Denervation

Long QT syndrome is a congenital disorder accompanied by a high incidence of sudden cardiac death. β-adrenergic blockade is the therapy of choice, and it is successful in 75-80% of patients. However, for those in whom refractory arrhythmia or cardiac events are not prevented by medication, the literature suggests that left cardiac sympathetic denervation may be useful. Here we present a girl 20 months of age with refractory ventricular tachycardia due to long QT syndrome successfully treated by left cardiac sympathetic denervation. There was no significant complication.

Spontaneous closure of patent ductus arteriosus after an episode of Kawasaki disease: a case report

IntroductionKawasaki disease is regarded as systemic vasculitis. Many experts believe that not only coronary arteries but also other small arteries are involved during the period of systemic inflammation. However, the evidence to support this point view is limited.Case presentationWe report the case of a one-year-four-month-old Taiwanese girl whose patent ductus arteriosus was incidentally found during an episode of Kawasaki disease. The ductus closed spontaneously after the acute phase of Kawasaki disease.ConclusionsIn this patient, the patent ductus arteriosus may have closed spontaneously after Kawasaki disease due to its involvement in the generalized vasculitis that this disease incurs. This would support the theory that the vasculitis of Kawasaki disease is limited not only to coronary arteries but also to all medium- sized arteries.

Spontaneous Regression of a Large Ductus Arteriosus Aneurysm in a Neonate

1 a 2 n “ R 3 L t d s hrough screening echocardiography, a ductus arteriosus aneurysm was found in a 3-day-old male neonate with a gestational age of 40 weeks and a birth ody weight of 3120 g. The pulmonary opening of the anurysm was 0.21 cm. The multi-detector row computed toography (MDCT) at the age of 5 days clearly delineated the arge aneurysm with the maximal diameter of 1.5 cm, which as compressing the left pulmonary artery ( Figure, A and C ecause he was asymptomatic and had no significant murmur, e was discharged without any treatment. Follow-up echoardiography at the age of 1 month showed that the pulmoary opening of ductus arteriosus was spontaneously closed. DCT at the age of 9 months showed that the aneurysm was ell thrombosed with rim calcification ( Figure, B and D) he left pulmonary artery became bigger, without significant bstruction. The patient thrived without any symptoms. Neonatal echocardiographic screening in our series igure. Volume-rendering images of MDCT show A, a large ductus arteriosus neurysm in a neonate at the age of 5 days and B, thrombosed aneurysm with rim alcification (arrowheads) at the age of 9 months. Oblique sagittal images show , the aneurysm filled with contrast medium and compressing the left pulmonary rtery at the age of 5 days. D, The left pulmonary artery became bigger and the rganized thrombus was identified as the low-attenuation area within the calcified im (arrowheads) at the age of 9 months. AAO, Ascending aorta; DA, ductus neurysm; DAO, descending aorta; LPA, left pulmonary artery; MPA, main ulmonary artery; RV, right ventricle.

Stent implantation for a totally occluded right coronary artery in a six-year-old boy after Kawasaki disease: a case report.

IntroductionCoronary stenting has previously been considered to be less feasible in children under 12 years old due to the limitation of vascular access. We report the case of a six-year-old boy who successfully underwent stent implantation for his totally occluded right coronary artery.Case presentationA Taiwanese boy aged six years and nine months old was found to have giant aneurysms after an acute episode of Kawasaki disease. An angiography revealed that his middle right coronary artery was totally occluded. A 0.014-inch guidewire was advanced to cross the totally occluded site. After pre-dilating the middle portion of his right coronary artery with a 1.5 mm balloon, stenting of his right coronary artery was accomplished using a 2.5 × 28 mm and a 2.5 × 18 mm bare metal stent. A final angiography demonstrated no residual stenosis or dissection.ConclusionCoronary stenting could be a therapeutic option for children as young as six years old. Close follow-up is mandatory because the long-term outcome is still unclear, especially in a small child.

Does Weekly Change of the Ventilator Circuit Really Matter in Preventing Ventilator Associated Pneumonia

Introduction: Health-care associated pneumonia is the leading cause of death in patients with hospital acquired infections, and ventilator associated pneumonia (VAP) is an important part of this. The hygiene of ventilator tubing is considered to be a risk factor; however, the frequency of the need to change the ventilator circuit is controversial. The aim of this study was to determine if it was beneficial to change it weekly rather than the current policy of routine change when the sputum culture turned positive. Patients and Methods: This was a retrospective cohort study and the data were gathered from a medical center from November 2007 to December 2008. All patients under eighteen years of age who underwent ventilator support were enrolled. Demographic data were retrieved from charts and a review of nursing records. The diagnosis of ventilator associated pneumonia (VAP) was determined by the hospital infection control committee. In one group, the ventilator circuit was changed weekly and, in the reference group, it was changed when the sputum culture turned positive. Results: There were 848 person-days in the weekly change group, and 850 person-days in the reference group. The incidence of VAP was 5.9 per 1000 person-days with weekly change and 3.8 per 1000 person-days in the reference group RR=1.71 (95% CI 0.41-7.12, P=0.46). Conclusion: Routine weekly change of the ventilator circuit had no significant effect on the prevention of VAP. Tubing should still be changed once it is contaminated. Further prospective and larger scale studies are needed to determine the optimal interval for changing circuits.