• Clinical and Experimental Pediatrics
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• v.48 no.4
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• pp.438-442
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• 2005

Kawasaki disease is an acute febrile vasculitis that occurs predominantly in young children under 5-years-old. The patients present generally with a high spiking fever that is unresponsive to antibiotics and lasts for more than five days at least. Prolonged fever has been shown to be a risk factor in the development of coronary artery disease. It seems to be certain that infectious agents are associated with the pathogenesis of Kawasaki disease. The differential diagnosis of Kawasaki disease must rule out infectious diseases including scarlet fever, toxic shock syndrome, measles, and so on. This is very important for adequate treatment and prevention of cardiac complications of Kawasaki disease. We experienced a 25-month-old boy who had high fever and pneumonic consolidation in the right middle and lower lobe of the lung that was considered as mycoplasma pneumonia on admission and developed coronary artery aneurysmal dilatation during treatment with roxythromycin.

• Clinical and Experimental Pediatrics
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• v.58 no.10
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• pp.369-373
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• 2015

Purpose: In 2004, the American Heart Association (AHA) had published an algorithm for the diagnosis of incomplete Kawasaki disease (KD). The aim of the present study was to investigate characteristics of supplemental laboratory criteria in this algorithm. Methods: We retrospectively examined the medical records of 355 patients with KD who were treated with intravenous immunoglobulin (IVIG) during the acute phase of the disease. Laboratory data were obtained before the initial IVIG administration and up to 10 days after fever onset. In 106 patients, laboratory testing was performed more than twice. Results: The AHA supplemental laboratory criteria were fulfilled in 90 patients (25.4%), and the frequency of laboratory examination (odds ratio [OR], 1.981; 95% confidence interval [CI], 1.391-2.821; P<0.001) was a significant predictor of it. The fulfillment of AHA supplemental laboratory criteria was significantly associated with refractoriness to the initial IVIG administration (OR, 2.388; 95% CI, 1.182-4.826; P=0.013) and dilatation of coronary arteries (OR, 2.776; 95% CI, 1.519-5.074; P=0.001). Conclusion: Repeated laboratory testing increased the rate of fulfillment of the AHA supplemental laboratory criteria in children with KD.

• Clinical and Experimental Pediatrics
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• v.62 no.4
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• pp.138-143
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• 2019

Purpose: Prognostic factors of coronary aneurysms in Kawasaki disease have been investigated in many studies. The aim of this study was to identify risk factors associated with early and late coronary artery outcomes in treated patients with Kawasaki disease. Methods: A total of 392 patients diagnosed with Kawasaki disease from January 2012 to December 2015 in Pusan National University Children's Hospital were retrospectively selected as subjects of the present study to determine risk factors for coronary aneurysms and persistence of coronary aneurysms after a 1-year follow-up. Results: Coronary aneurysms were detected in 30 of 392 patients within 1 month after the occurrence of Kawasaki disease. Coronary aneurysms persisted in 5 of 30 patients after a 1-year follow-up. A long duration of fever (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.06-2.02; P=0.018) and high platelet count (adjusted OR, 1.00; 95% CI, 1.00-1.01; P=0.009) were found to be independent factors to predict the development of coronary aneurysms in the early phase. Initial coronary severity (adjusted OR, 46.0; 95% CI, 2.01-1047.80; P=0.016) and a high white blood cell count (adjusted OR, 1.17; 95% CI, 1.01-1.36; P=0.028) were found to be significant factors for the persistence of late coronary aneurysms in univariate analysis. However, no significant factors were found in multivariate analysis. Conclusion: These data are from early and late follow-up of coronary aneurysms in our unit. Further studies are needed to determine the mechanisms involved in the disappearance of coronary aneurysms and related factors.

• Korean journal of dermatology
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• v.56 no.9
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• pp.568-569
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• 2018

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.415-417
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• 2002

Images of microcalcification specks showed large variation in conventional radiographs of phantoms which are approved for mammography image quality standard by the American College of Radiology (ACR). This kind of variation is not appropriate for image quality standards because the number of specks are visually counted in images and that number is important in image quality evaluation. Our study using synchrotron radiation (SR) imaging revealed the overlapping of micro-sized air bubble(s) to some specks, and also the structural deformation or crackings. Eight phantoms approved by ACR from two different makers and an air-bubble phantom were examined. SR imaging was performed at a synchrotron radiation facility, SPring-8, in Japan. The image-detector was a fluorescent-screen optical-lens coupling system using a CCD camera with a spatial resolution of 6 $\square$m. Objects when imaged with longer sample-to-detector distance show edge enhancement due to a difference in refraction indices, that is refraction enhancement. Refraction-enhanced SR images revealed that some of specks carried foreign objects, which were proven to be air. In phantoms provided by one maker, attaching/overlapping airs were observed for 62 out of 150 specks (41%) , with a higher incidence for the smallest specks. A speck becomes hardly visible in a conventional radiograph when air(s) overlaps the majority part of a speck, though depending on the size of the air-inclusion and on its configuration. Those airs might have been adsorbed on a speck surface before being embedded and then introduced into the matrix together with specks. Our study using SR imaging has clearly shown the nature of defects in some mammography phantoms which seriously degrade the quality as an image standard.

• Clinical and Experimental Pediatrics
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• v.45 no.8
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• pp.1048-1051
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• 2002

Toxic shock syndrome(TSS) is clinically similar to Kawasaki disease(KD) in that both of them are characterized by fever, desquamating rash and mucous membrane erythema. In contrast the main feature of TSS is hypotension, whereas the complication of KD is coronary vasculitis. We report an 8-year-old boy who fulfilled the crireria for TSS and KD. Initially he showed clinical features of TSS, so he was treated with intravenous antibiotics and supportive management. But the fever sustained, and the coronary aneurysm that is the main complication of Kawasaki disease was shown by echocardiogram on Day 14. He was treated with intravenous immunoglobulin twice and the fever subsided and general condition was improved.

• Journal of Cardiovascular Imaging
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• v.26 no.4
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• pp.238-246
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• 2018

BACKGROUND: Kawasaki disease (KD) sometimes presents with only fever and cervical lymphadenopathy before other clinical signs materialize. This lymphadenopathy-first-presenting Kawasaki disease (LKD) may be misdiagnosed as bacterial cervical lymphadenitis (BCL). We investigated characteristic imaging and clinical data for factors differentiating LKD from BCL. METHODS: We compared imaging, clinical, and laboratory data of patients with KD and BCL. We included patients admitted to a single tertiary center between January 2015 and July 2018. RESULTS: We evaluated data from 51 patients with LKD, 63 with BCL, and 218 with typical KD. Ultrasound imaging revealed multiple enlarged lymph nodes in both LKD and BCL patients. On the other hand, computed tomography (CT) showed more abscesses in patients with BCL. Patients with LKD were younger and showed higher systemic and hepatobiliary inflammatory markers and pyuria than BCL patients. In multivariable logistic regression, younger age and higher C-reactive protein (CRP) retained independent associations with LKD. A comparison of the echocardiographic findings in LKD and typical KD showed that patients with LKD did not have a higher incidence of coronary artery abnormalities (CAA). CONCLUSIONS: LKD patients tend to have no abscesses on CT and more elevated systemic hepatobiliary inflammatory markers and pyuria compared to BCL patients. The absence of abscess on CT, younger age, and elevated CRP were the most significant variables differentiating LKD from BCL. There was no difference in CAA between LKD and typical KD.

• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.251-255
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• 2009

Kawasaki disease is an acute systemic inflammatory disorder, the etiology of which has not yet been established. The clinical manifestations are non-specific and are common to many pediatric infectious and immunologic diseases. In 2 cases presenting fever, cervical lymphadenopathy, and retropharyngeal abscess-like lesions on the neck shown in a computerized tomography (CT) scan, the diagnosis of Kawasaki disease was delayed. The patients were not responsive to antibiotic therapy, and fluid collection was not found during retropharyngeal aspiration. They showed typical Kawasaki manifestations over time and atrioventricular valve regurgitation in the echocardiogram. A diagnosis of Kawasaki disease should be considered in similar cases of fever and cervical lymphadenopathy. A CT scan that shows a retropharyngeal abscess-like lesion on the neck can be a false positive finding, and other laboratory exams, including echocardiography, should be performed as early as possible to avoid unnecessary medical and surgical procedures.

• Proceedings of the Korean Society of Propulsion Engineers Conference
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• 2004.03a
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• pp.453-459
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• 2004

An axially staged combustor equipped with an LPP combustion system and CMC liner walls has been investigated for stable combustion and low NOx emissions for the ESPR project. Several fuel injectors were designed and manufactured for the LPP burner, and single sector combustor tests were conducted to evaluate fundamental combustion characteristics such as emissions, instabilities, auto-ignition, and flash back at typical operating conditions from idle to Mn 2.2 cruise. The latest test results showed that the LPP burner had a good potential for the low NOx target. It was also found that the NOx emission level was greatly affected by a distortion in the air flow velocity field upstream of the LPP burner due to the diffuser and fuel feed arm. The CMC material was investigated to apply for the high temperature and low NOx combustor. Annular combustor liner walls were manufactured with the CMC material, and they have been tested at low pressure conditions to evaluate the soundness of the material and the mounting and seal system. This paper reports the latest research activities on the LPP combustion system and CMC liner walls for the ESPR project.

• Pediatric Infection and Vaccine
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• v.23 no.1
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• pp.10-17
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• 2016

Purpose: The diagnosis of Kawasaki disease depends on clinical symptoms, which makes it difficult to diagnose early in patients with only cervical lymphadenopathy. The purpose of this study is to understand the clinical characteristics of cervical-lymph-node-first presentation of Kawasaki disease and compare them with those of typical Kawasaki disease. Methods: We surveyed 283 patients who were admitted to Hallym Sacred Heart Hospital and were diagnosed with Kawasaki disease from January 2012 to December 2014. The patients were divided into two groups: cervical-lymph-node-first presentation of Kawasaki disease (LKD, N=24) and typical Kawasaki disease (KD, N=259). The medical records were retrospectively reviewed. Results: The mean age of the LKD group was higher than that of the KD group (P=0.04). At admission, the LKD patients had on average 1.62 out of 5 symptoms, whereas the KD patients had 3.47. The time from fever to diagnosis and administration of IV immunoglobulin was longer in the LKD group than in the KD group (P<0.001). The mean C-reactive protein of the LKD group was higher than that of the KD group (P=0.01). There were no statistical differences in the presence of coronary artery complications between the two groups at two weeks or at two months after diagnosis (P=0.52, P=0.08). Conclusions: The Kawasaki disease patients with fever and cervical lymphadenopathy usually do not present obvious clinical symptoms, which makes it hard to diagnose in the early phase of disease. Clinician must pay attention when examining these patients.