Doug Brunk

Bruises that occur in nonmobile infants, those over soft tissue areas, and those that carry the imprint of the implement used or multiple bruises of uniform shape could be signs of physical abuse.

That is the key conclusion from the first-ever systematic attempt to answer the question “what patterns of bruising in childhood are diagnostic or suggestive of abuse?”

For the study, Sabine Maguire, M.B., and associates at Cardiff (Wales) University examined 23 studies on the topic that were published in the medical literature from 1951 to 2004 (Arch. Dis. Child. 2005;90:182-6).

They ranked the study by design and definition of abuse used and excluded review articles, expert opinion, single-case reports, and studies that failed to define abuse and addressed medical conditions that predispose children to bruising.

The investigators found that bruises in nonabused children tend to be 10-15 mm in size, sustained over bony prominences, and located on the front of the body, typically the result of a fall. The prevalence of bruising in babies who are not independently mobile is less than 1%. “Around 17% of infants who are crawling or cruising have bruises, whereas the majority of preschool and school-age children have accidental bruises,” they wrote.

They listed the following patterns of bruising that suggest physical abuse: bruising in children who are not independently mobile; bruising in babies; bruises that are seen away from bony prominences; bruises to the face, back, abdomen, arms, buttocks, ears, and hands; multiple bruises in clusters; multiple bruises of uniform shape; and bruises that carry the imprint of the implement used or a ligature.

“When interpreting the significance of any bruising, it is essential to evaluate the full clinical and social picture and note the developmental level of the child,” they said. “All bruising must be interpreted in the context of the explanation given.”

In a related study, the same investigators searched the medical literature to determine if it is possible to tell the age of a bruise in a child (Arch. Dis. Child. 2005;90:187-9). Dr. Maguire and associates identified 167 studies but only used three in their assessment. It was concluded that it is not currently possible to “accurately age a bruise from clinical assessment. Any clinician who offers a definitive estimate of the age of a bruise with the naked eye is doing so without adequate published evidence.”

Bruises that occur in nonmobile infants, those over soft tissue areas, and those that carry the imprint of the implement used or multiple bruises of uniform shape could be signs of physical abuse.

That is the key conclusion from the first-ever systematic attempt to answer the question “what patterns of bruising in childhood are diagnostic or suggestive of abuse?”

For the study, Sabine Maguire, M.B., and associates at Cardiff (Wales) University examined 23 studies on the topic that were published in the medical literature from 1951 to 2004 (Arch. Dis. Child. 2005;90:182-6).

They ranked the study by design and definition of abuse used and excluded review articles, expert opinion, single-case reports, and studies that failed to define abuse and addressed medical conditions that predispose children to bruising.

The investigators found that bruises in nonabused children tend to be 10-15 mm in size, sustained over bony prominences, and located on the front of the body, typically the result of a fall. The prevalence of bruising in babies who are not independently mobile is less than 1%. “Around 17% of infants who are crawling or cruising have bruises, whereas the majority of preschool and school-age children have accidental bruises,” they wrote.

They listed the following patterns of bruising that suggest physical abuse: bruising in children who are not independently mobile; bruising in babies; bruises that are seen away from bony prominences; bruises to the face, back, abdomen, arms, buttocks, ears, and hands; multiple bruises in clusters; multiple bruises of uniform shape; and bruises that carry the imprint of the implement used or a ligature.

“When interpreting the significance of any bruising, it is essential to evaluate the full clinical and social picture and note the developmental level of the child,” they said. “All bruising must be interpreted in the context of the explanation given.”

In a related study, the same investigators searched the medical literature to determine if it is possible to tell the age of a bruise in a child (Arch. Dis. Child. 2005;90:187-9). Dr. Maguire and associates identified 167 studies but only used three in their assessment. It was concluded that it is not currently possible to “accurately age a bruise from clinical assessment. Any clinician who offers a definitive estimate of the age of a bruise with the naked eye is doing so without adequate published evidence.”

Bruises that occur in nonmobile infants, those over soft tissue areas, and those that carry the imprint of the implement used or multiple bruises of uniform shape could be signs of physical abuse.

That is the key conclusion from the first-ever systematic attempt to answer the question “what patterns of bruising in childhood are diagnostic or suggestive of abuse?”

For the study, Sabine Maguire, M.B., and associates at Cardiff (Wales) University examined 23 studies on the topic that were published in the medical literature from 1951 to 2004 (Arch. Dis. Child. 2005;90:182-6).

They ranked the study by design and definition of abuse used and excluded review articles, expert opinion, single-case reports, and studies that failed to define abuse and addressed medical conditions that predispose children to bruising.

The investigators found that bruises in nonabused children tend to be 10-15 mm in size, sustained over bony prominences, and located on the front of the body, typically the result of a fall. The prevalence of bruising in babies who are not independently mobile is less than 1%. “Around 17% of infants who are crawling or cruising have bruises, whereas the majority of preschool and school-age children have accidental bruises,” they wrote.

They listed the following patterns of bruising that suggest physical abuse: bruising in children who are not independently mobile; bruising in babies; bruises that are seen away from bony prominences; bruises to the face, back, abdomen, arms, buttocks, ears, and hands; multiple bruises in clusters; multiple bruises of uniform shape; and bruises that carry the imprint of the implement used or a ligature.

“When interpreting the significance of any bruising, it is essential to evaluate the full clinical and social picture and note the developmental level of the child,” they said. “All bruising must be interpreted in the context of the explanation given.”

In a related study, the same investigators searched the medical literature to determine if it is possible to tell the age of a bruise in a child (Arch. Dis. Child. 2005;90:187-9). Dr. Maguire and associates identified 167 studies but only used three in their assessment. It was concluded that it is not currently possible to “accurately age a bruise from clinical assessment. Any clinician who offers a definitive estimate of the age of a bruise with the naked eye is doing so without adequate published evidence.”

SAN DIEGO — Only 15% of melanomas are extracutaneous, but you can easily miss these lesions if you don't keep them in mind during routine skin exams, Terence O'Grady, M.D., said at a melanoma update sponsored by the Scripps Clinic.

The most commonly affected sites for extracutaneous melanoma include the ocular or juxtacutaneous mucosal membranes. (See box.)

“It's easy to miss very small lesions in these places, especially if you don't have really good light in your office,” said Dr. O'Grady, a dermatologist with the departments of medicine and pathology at the University of California, San Diego. “You need to take your time to look at least in these areas.”

He begins routine skin exams by inspecting the patient's scalp and working his way down to the feet. Starting at the scalp “can be a problem in patients with really thick hair, but if you pick through the hair like you're looking for nits, you can examine the entire scalp surface,” he said. “A lot of times, atypical pigmented lesions are present on the scalp. In fact, it's probably more common to have atypical nevi there than to have common nevi.”

Dr. O'Grady also makes it a point to examine the nail beds and the interdigital folds. “These are unusual places to find melanoma lesions, but you can find them,” he said. “One thing I always try to do is have the patient take off their shoes and socks so I can look at the bottom of their feet. That's an important part of the exam.”

Metastatic melanoma is more common in extracutaneous locations, so if you see a pigmented lesion in one of these sites, “consider it a primary melanoma only if you can rule out all possibility of metastasis,” he said. “Sometimes this is difficult or impossible. For example, if a pigmented lesion was removed 10 years ago with no histologic exam, it's going to be hard to prove that this is not a metastasis but is, rather, a primary lesion.”

Ocular lesions comprise about 80% of all extracutaneous melanoma. Pigmented lesions of the eye are the most common. “These will be just like nevi you find in other places, so if you see a nevus on the eyelid, it may be just a nevus and nothing more,” he noted. “If you see pigmentation on the conjunctiva or on the sclera, it may be just a normal melanosis, or it could be a junctional nevus, or it could be something more sinister.”

Part of his routine skin exam involves folding the eyelids to look into the fornices of the conjunctiva, where pigmented lesions, are almost universally something bad. “Those definitely need to be biopsied.” However, Dr. O'Grady added that an ophthalmologist might be referred to because most physicians are not trained to look at ocular lesions.

Another ocular lesion, primary acquired melanosis, can have anything from what looks like melanoma in situ to something as innocuous as hyperpigmentation. “So it doesn't necessarily have to be melanocytic.”

Primary acquired melanosis that involves the limbus is highly suggestive of malignant melanoma. “What's interesting is that you can also see primary acquired melanosis on the conjunctiva that shows extension of lentigo maligna from eyelid skin,” he added.

Poor prognostic indicators of ocular lesions include tumor thickness, pagetoid spread, and involvement of the cornea, episclera, palpebral conjunctiva, or fornix. Sometimes ophthalmologists can successfully treat affected eyes without surgical removal.

The vulva is the next most common site of extracutaneous melanoma, making up about 7% of all cases and typically occurs after menopause, usually discovered late, most commonly on the glabrous skin of the labia minora. Prognosis is grim, with a 5-year survival rate of 47%.

Many cases are amelanotic and resemble discharge or bleeding, “so many of these patients are treated for inflammatory conditions or infectious etiologies before a biopsy is performed,” Dr. O'Grady said.

“What's interesting is that some cases have been diagnosed on Pap smear,” he said. “They actually get the Pap smear back as melanoma cells.”

Estimated Frequency

Eye (78.9%)

Vulva (7.2%)

Soft tissues (2.5%)

Anorectum (2.3%)

Vagina (2.1%)

Upper respiratory tract (1.6%)

Gums and mouth (1.2%)

GI tract (0.7%)

Lung, lip, penis, genitourinary tract, nasopharynx (all less than 0.5%)

Source: Dr. O'Grady

SAN DIEGO — Only 15% of melanomas are extracutaneous, but you can easily miss these lesions if you don't keep them in mind during routine skin exams, Terence O'Grady, M.D., said at a melanoma update sponsored by the Scripps Clinic.

The most commonly affected sites for extracutaneous melanoma include the ocular or juxtacutaneous mucosal membranes. (See box.)

“It's easy to miss very small lesions in these places, especially if you don't have really good light in your office,” said Dr. O'Grady, a dermatologist with the departments of medicine and pathology at the University of California, San Diego. “You need to take your time to look at least in these areas.”

He begins routine skin exams by inspecting the patient's scalp and working his way down to the feet. Starting at the scalp “can be a problem in patients with really thick hair, but if you pick through the hair like you're looking for nits, you can examine the entire scalp surface,” he said. “A lot of times, atypical pigmented lesions are present on the scalp. In fact, it's probably more common to have atypical nevi there than to have common nevi.”

Dr. O'Grady also makes it a point to examine the nail beds and the interdigital folds. “These are unusual places to find melanoma lesions, but you can find them,” he said. “One thing I always try to do is have the patient take off their shoes and socks so I can look at the bottom of their feet. That's an important part of the exam.”

Metastatic melanoma is more common in extracutaneous locations, so if you see a pigmented lesion in one of these sites, “consider it a primary melanoma only if you can rule out all possibility of metastasis,” he said. “Sometimes this is difficult or impossible. For example, if a pigmented lesion was removed 10 years ago with no histologic exam, it's going to be hard to prove that this is not a metastasis but is, rather, a primary lesion.”

Ocular lesions comprise about 80% of all extracutaneous melanoma. Pigmented lesions of the eye are the most common. “These will be just like nevi you find in other places, so if you see a nevus on the eyelid, it may be just a nevus and nothing more,” he noted. “If you see pigmentation on the conjunctiva or on the sclera, it may be just a normal melanosis, or it could be a junctional nevus, or it could be something more sinister.”

Part of his routine skin exam involves folding the eyelids to look into the fornices of the conjunctiva, where pigmented lesions, are almost universally something bad. “Those definitely need to be biopsied.” However, Dr. O'Grady added that an ophthalmologist might be referred to because most physicians are not trained to look at ocular lesions.

Another ocular lesion, primary acquired melanosis, can have anything from what looks like melanoma in situ to something as innocuous as hyperpigmentation. “So it doesn't necessarily have to be melanocytic.”

Primary acquired melanosis that involves the limbus is highly suggestive of malignant melanoma. “What's interesting is that you can also see primary acquired melanosis on the conjunctiva that shows extension of lentigo maligna from eyelid skin,” he added.

Poor prognostic indicators of ocular lesions include tumor thickness, pagetoid spread, and involvement of the cornea, episclera, palpebral conjunctiva, or fornix. Sometimes ophthalmologists can successfully treat affected eyes without surgical removal.

The vulva is the next most common site of extracutaneous melanoma, making up about 7% of all cases and typically occurs after menopause, usually discovered late, most commonly on the glabrous skin of the labia minora. Prognosis is grim, with a 5-year survival rate of 47%.

Many cases are amelanotic and resemble discharge or bleeding, “so many of these patients are treated for inflammatory conditions or infectious etiologies before a biopsy is performed,” Dr. O'Grady said.

“What's interesting is that some cases have been diagnosed on Pap smear,” he said. “They actually get the Pap smear back as melanoma cells.”

Estimated Frequency

Eye (78.9%)

Vulva (7.2%)

Soft tissues (2.5%)

Anorectum (2.3%)

Vagina (2.1%)

Upper respiratory tract (1.6%)

Gums and mouth (1.2%)

GI tract (0.7%)

Lung, lip, penis, genitourinary tract, nasopharynx (all less than 0.5%)

Source: Dr. O'Grady

SAN DIEGO — Only 15% of melanomas are extracutaneous, but you can easily miss these lesions if you don't keep them in mind during routine skin exams, Terence O'Grady, M.D., said at a melanoma update sponsored by the Scripps Clinic.

The most commonly affected sites for extracutaneous melanoma include the ocular or juxtacutaneous mucosal membranes. (See box.)

“It's easy to miss very small lesions in these places, especially if you don't have really good light in your office,” said Dr. O'Grady, a dermatologist with the departments of medicine and pathology at the University of California, San Diego. “You need to take your time to look at least in these areas.”

He begins routine skin exams by inspecting the patient's scalp and working his way down to the feet. Starting at the scalp “can be a problem in patients with really thick hair, but if you pick through the hair like you're looking for nits, you can examine the entire scalp surface,” he said. “A lot of times, atypical pigmented lesions are present on the scalp. In fact, it's probably more common to have atypical nevi there than to have common nevi.”

Dr. O'Grady also makes it a point to examine the nail beds and the interdigital folds. “These are unusual places to find melanoma lesions, but you can find them,” he said. “One thing I always try to do is have the patient take off their shoes and socks so I can look at the bottom of their feet. That's an important part of the exam.”

Metastatic melanoma is more common in extracutaneous locations, so if you see a pigmented lesion in one of these sites, “consider it a primary melanoma only if you can rule out all possibility of metastasis,” he said. “Sometimes this is difficult or impossible. For example, if a pigmented lesion was removed 10 years ago with no histologic exam, it's going to be hard to prove that this is not a metastasis but is, rather, a primary lesion.”

Ocular lesions comprise about 80% of all extracutaneous melanoma. Pigmented lesions of the eye are the most common. “These will be just like nevi you find in other places, so if you see a nevus on the eyelid, it may be just a nevus and nothing more,” he noted. “If you see pigmentation on the conjunctiva or on the sclera, it may be just a normal melanosis, or it could be a junctional nevus, or it could be something more sinister.”

Part of his routine skin exam involves folding the eyelids to look into the fornices of the conjunctiva, where pigmented lesions, are almost universally something bad. “Those definitely need to be biopsied.” However, Dr. O'Grady added that an ophthalmologist might be referred to because most physicians are not trained to look at ocular lesions.

Another ocular lesion, primary acquired melanosis, can have anything from what looks like melanoma in situ to something as innocuous as hyperpigmentation. “So it doesn't necessarily have to be melanocytic.”

Primary acquired melanosis that involves the limbus is highly suggestive of malignant melanoma. “What's interesting is that you can also see primary acquired melanosis on the conjunctiva that shows extension of lentigo maligna from eyelid skin,” he added.

Poor prognostic indicators of ocular lesions include tumor thickness, pagetoid spread, and involvement of the cornea, episclera, palpebral conjunctiva, or fornix. Sometimes ophthalmologists can successfully treat affected eyes without surgical removal.

The vulva is the next most common site of extracutaneous melanoma, making up about 7% of all cases and typically occurs after menopause, usually discovered late, most commonly on the glabrous skin of the labia minora. Prognosis is grim, with a 5-year survival rate of 47%.

Many cases are amelanotic and resemble discharge or bleeding, “so many of these patients are treated for inflammatory conditions or infectious etiologies before a biopsy is performed,” Dr. O'Grady said.

“What's interesting is that some cases have been diagnosed on Pap smear,” he said. “They actually get the Pap smear back as melanoma cells.”

Estimated Frequency

Eye (78.9%)

Vulva (7.2%)

Soft tissues (2.5%)

Anorectum (2.3%)

Vagina (2.1%)

Upper respiratory tract (1.6%)

Gums and mouth (1.2%)

GI tract (0.7%)

Lung, lip, penis, genitourinary tract, nasopharynx (all less than 0.5%)

Source: Dr. O'Grady

SAN DIEGO — Health-related quality of life in adolescents and young adults with Kawasaki disease is excellent regardless of coronary sequelae, according to results from a large cross-sectional study of Japanese patients presented at an international Kawasaki disease symposium.

Hiromi Muta, M.D., and his colleagues received 246 completed Medical Outcome Study Short Form 36 surveys from Japanese patients aged at least 16 years who had been diagnosed with Kawasaki disease and had undergone coronary angiography or two-dimensional echocardiography.

The investigators divided respondents into three groups: those with normal coronary measurements on angiography or echocardiography, those who had had aneurysms, and those who had experienced episodes of ischemia. The investigators observed no differences in health-related quality of life among patients in all Kawasaki disease groups compared with the normal Japanese population after adjusting for age and gender, Dr. Muta said at the symposium, sponsored by the American Heart Association.

However, 29% of Kawasaki disease patients reported cigarette use and 12% were overweight (a body mass index of 25 kg/m2 or more), which only accelerates their risk.

“Long-term follow-up is necessary, since the risk of arteriosclerosis increases with age,” he said.

SAN DIEGO — Health-related quality of life in adolescents and young adults with Kawasaki disease is excellent regardless of coronary sequelae, according to results from a large cross-sectional study of Japanese patients presented at an international Kawasaki disease symposium.

Hiromi Muta, M.D., and his colleagues received 246 completed Medical Outcome Study Short Form 36 surveys from Japanese patients aged at least 16 years who had been diagnosed with Kawasaki disease and had undergone coronary angiography or two-dimensional echocardiography.

The investigators divided respondents into three groups: those with normal coronary measurements on angiography or echocardiography, those who had had aneurysms, and those who had experienced episodes of ischemia. The investigators observed no differences in health-related quality of life among patients in all Kawasaki disease groups compared with the normal Japanese population after adjusting for age and gender, Dr. Muta said at the symposium, sponsored by the American Heart Association.

However, 29% of Kawasaki disease patients reported cigarette use and 12% were overweight (a body mass index of 25 kg/m2 or more), which only accelerates their risk.

“Long-term follow-up is necessary, since the risk of arteriosclerosis increases with age,” he said.

SAN DIEGO — Health-related quality of life in adolescents and young adults with Kawasaki disease is excellent regardless of coronary sequelae, according to results from a large cross-sectional study of Japanese patients presented at an international Kawasaki disease symposium.

Hiromi Muta, M.D., and his colleagues received 246 completed Medical Outcome Study Short Form 36 surveys from Japanese patients aged at least 16 years who had been diagnosed with Kawasaki disease and had undergone coronary angiography or two-dimensional echocardiography.

The investigators divided respondents into three groups: those with normal coronary measurements on angiography or echocardiography, those who had had aneurysms, and those who had experienced episodes of ischemia. The investigators observed no differences in health-related quality of life among patients in all Kawasaki disease groups compared with the normal Japanese population after adjusting for age and gender, Dr. Muta said at the symposium, sponsored by the American Heart Association.

However, 29% of Kawasaki disease patients reported cigarette use and 12% were overweight (a body mass index of 25 kg/m2 or more), which only accelerates their risk.

“Long-term follow-up is necessary, since the risk of arteriosclerosis increases with age,” he said.

SAN DIEGO — Preliminary results from an ongoing surveillance of Kawasaki disease in the United States suggest that no unusual increases in cases occurred between 1998 and 2003, Ryan Maddox reported in a poster session at an international Kawasaki disease symposium.

“For the most part, the findings were consistent with those of previous studies and in line with what we'd expect,” Mr. Maddox, an epidemiologist with the division of viral and rickettsial diseases at the Centers for Disease Control and Prevention, Atlanta, told Family Practice News. “We're not seeing more cases reported, which is a good sign.”

He pointed out that while the study involved patients in 29 states, 80% of the data came from clinicians in just four states: California, Illinois, Michigan, and Virginia. “Obviously, we can't make a claim about [nationwide] incidence based on that,” he said, but added that a new case reporting form was available was available online (www.cdc.gov\ncidod\diseases\kawasaki\index.htm

Between 1998 and 2003, 1,854 cases of Kawasaki disease were reported, which represents an estimated 10% of Kawasaki disease patients nationwide. Most patients (79.9%) were younger than 5 years, and 59.8% were boys.

Nearly all the patients (99%) were hospitalized for their disease, and 97.8% received intravenous immunoglobulin. Coronary artery abnormalities were reported in 14.7% of patients, which is higher than the 10.3% reported in a surveillance study conducted between 1991 and 1993. Reasons for this increase may have to do with improved ways to detect coronary artery abnormalities since the earlier study.

“It appears that [the prevalence of] aneurysms remained fairly constant over this period,” Mr. Maddox said. “However, [coronary] dilatations have been increasing. That's something that can be picked up through echo testing, which may be better at detecting these dilatations [than before.] That could account for at least some of the increase we're seeing.”

The investigators also observed that 23.2% of patients had illness onset in February or March, while 12.4% had onset in August or September. Some suggest Kawasaki disease could caused by a virus, which could explain the increased prevalence during February and March.

SAN DIEGO — Preliminary results from an ongoing surveillance of Kawasaki disease in the United States suggest that no unusual increases in cases occurred between 1998 and 2003, Ryan Maddox reported in a poster session at an international Kawasaki disease symposium.

“For the most part, the findings were consistent with those of previous studies and in line with what we'd expect,” Mr. Maddox, an epidemiologist with the division of viral and rickettsial diseases at the Centers for Disease Control and Prevention, Atlanta, told Family Practice News. “We're not seeing more cases reported, which is a good sign.”

He pointed out that while the study involved patients in 29 states, 80% of the data came from clinicians in just four states: California, Illinois, Michigan, and Virginia. “Obviously, we can't make a claim about [nationwide] incidence based on that,” he said, but added that a new case reporting form was available was available online (www.cdc.gov\ncidod\diseases\kawasaki\index.htm

Between 1998 and 2003, 1,854 cases of Kawasaki disease were reported, which represents an estimated 10% of Kawasaki disease patients nationwide. Most patients (79.9%) were younger than 5 years, and 59.8% were boys.

Nearly all the patients (99%) were hospitalized for their disease, and 97.8% received intravenous immunoglobulin. Coronary artery abnormalities were reported in 14.7% of patients, which is higher than the 10.3% reported in a surveillance study conducted between 1991 and 1993. Reasons for this increase may have to do with improved ways to detect coronary artery abnormalities since the earlier study.

“It appears that [the prevalence of] aneurysms remained fairly constant over this period,” Mr. Maddox said. “However, [coronary] dilatations have been increasing. That's something that can be picked up through echo testing, which may be better at detecting these dilatations [than before.] That could account for at least some of the increase we're seeing.”

The investigators also observed that 23.2% of patients had illness onset in February or March, while 12.4% had onset in August or September. Some suggest Kawasaki disease could caused by a virus, which could explain the increased prevalence during February and March.

SAN DIEGO — Preliminary results from an ongoing surveillance of Kawasaki disease in the United States suggest that no unusual increases in cases occurred between 1998 and 2003, Ryan Maddox reported in a poster session at an international Kawasaki disease symposium.

“For the most part, the findings were consistent with those of previous studies and in line with what we'd expect,” Mr. Maddox, an epidemiologist with the division of viral and rickettsial diseases at the Centers for Disease Control and Prevention, Atlanta, told Family Practice News. “We're not seeing more cases reported, which is a good sign.”

He pointed out that while the study involved patients in 29 states, 80% of the data came from clinicians in just four states: California, Illinois, Michigan, and Virginia. “Obviously, we can't make a claim about [nationwide] incidence based on that,” he said, but added that a new case reporting form was available was available online (www.cdc.gov\ncidod\diseases\kawasaki\index.htm

Between 1998 and 2003, 1,854 cases of Kawasaki disease were reported, which represents an estimated 10% of Kawasaki disease patients nationwide. Most patients (79.9%) were younger than 5 years, and 59.8% were boys.

Nearly all the patients (99%) were hospitalized for their disease, and 97.8% received intravenous immunoglobulin. Coronary artery abnormalities were reported in 14.7% of patients, which is higher than the 10.3% reported in a surveillance study conducted between 1991 and 1993. Reasons for this increase may have to do with improved ways to detect coronary artery abnormalities since the earlier study.

“It appears that [the prevalence of] aneurysms remained fairly constant over this period,” Mr. Maddox said. “However, [coronary] dilatations have been increasing. That's something that can be picked up through echo testing, which may be better at detecting these dilatations [than before.] That could account for at least some of the increase we're seeing.”

The investigators also observed that 23.2% of patients had illness onset in February or March, while 12.4% had onset in August or September. Some suggest Kawasaki disease could caused by a virus, which could explain the increased prevalence during February and March.

SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.

Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told FAMILY PRACTICE NEWS.

The findings suggest systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.

Dr. McCrindle said that he was surprised by the findings, which conflict with similar reports from Japanese investigators.

“The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children], meaning that even normal is abnormal.”

Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. A group of 60 normal controls matched for age and gender.

The investigators performed a cardiovascular risk assessment of all participants, including questions about smoking and smoke exposure, family history of cardiovascular disease, and attitudes and practices regarding physical activity. Patients completed a food frequency questionnaire and were asked to recall food they'd consumed in the last 3 days; they also underwent detailed height and weight measurements, fasting blood work, a fasting lipid profile, and urinalysis. Systemic arterial endothelial function was obtained assessing brachial artery reactivity (BAR).

The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.

In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.

The lab results showed no differences between the two groups in terms of total cholesterol; HDL; LDL; apolipoproteins A1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.

However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.

“Based on these results, we conclude that systemic arterial endothelial dysfunction does not appear to be present after Kawasaki disease.”

SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.

Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told FAMILY PRACTICE NEWS.

The findings suggest systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.

Dr. McCrindle said that he was surprised by the findings, which conflict with similar reports from Japanese investigators.

“The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children], meaning that even normal is abnormal.”

Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. A group of 60 normal controls matched for age and gender.

The investigators performed a cardiovascular risk assessment of all participants, including questions about smoking and smoke exposure, family history of cardiovascular disease, and attitudes and practices regarding physical activity. Patients completed a food frequency questionnaire and were asked to recall food they'd consumed in the last 3 days; they also underwent detailed height and weight measurements, fasting blood work, a fasting lipid profile, and urinalysis. Systemic arterial endothelial function was obtained assessing brachial artery reactivity (BAR).

The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.

In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.

The lab results showed no differences between the two groups in terms of total cholesterol; HDL; LDL; apolipoproteins A1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.

However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.

“Based on these results, we conclude that systemic arterial endothelial dysfunction does not appear to be present after Kawasaki disease.”

SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.

Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told FAMILY PRACTICE NEWS.

The findings suggest systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.

Dr. McCrindle said that he was surprised by the findings, which conflict with similar reports from Japanese investigators.

“The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children], meaning that even normal is abnormal.”

Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. A group of 60 normal controls matched for age and gender.

The investigators performed a cardiovascular risk assessment of all participants, including questions about smoking and smoke exposure, family history of cardiovascular disease, and attitudes and practices regarding physical activity. Patients completed a food frequency questionnaire and were asked to recall food they'd consumed in the last 3 days; they also underwent detailed height and weight measurements, fasting blood work, a fasting lipid profile, and urinalysis. Systemic arterial endothelial function was obtained assessing brachial artery reactivity (BAR).

The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.

In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.

The lab results showed no differences between the two groups in terms of total cholesterol; HDL; LDL; apolipoproteins A1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.

However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.

“Based on these results, we conclude that systemic arterial endothelial dysfunction does not appear to be present after Kawasaki disease.”

SAN DIEGO — Use of memantine in patients with moderate to severe Alzheimer's disease significantly reduced their behavioral disturbances and psychiatric symptoms, compared with placebo, Jeffrey L. Cummings, M.D., reported in a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

“We think this represents an important, newly recognized benefit for the use of memantine in patients with Alzheimer's disease,” Dr. Cummings, director of the University of California, Los Angeles, Alzheimer's Disease Research Center, said in an interview. “The question we posed was, does a drug like memantine, which is used for cognitive improvement, have any effect on agitation? What we saw was that in several analyses—whether we looked at week 12 or week 24, whether we looked at patients who were asymptomatic at baseline or symptomatic at baseline—memantine reduced agitation.”

For the 24-week study, Dr. Cummings and his associates randomized 403 patients at 37 clinical centers who had moderate to severe Alzheimer's disease to receive either memantine 10 mg b.i.d. or placebo. The memantine was titrated up weekly in 5-mg increments from a starting dose of 5 mg/day during week 1 to 20 mg/day at week 4. All patients remained on donepezil throughout the study.

The investigators used the Neuropsychiatric Inventory (NPI) to assess behavioral symptoms at baseline, week 12, and week 24.

Of the 403 community-dwelling patients, 202 received memantine and 201 received placebo. The mean age of study participants was 76 years, and 65% were female. Most (91%) were white.

When compared with patients in the placebo group at 12 weeks, those in the memantine group had significant improvements on the NPI domains of agitation/aggression (-0.4 vs. 0.2), irritability/lability (-0.4 vs. 0.1), and appetite/eating change (-0.4 vs. 0.1), where a negative value denotes improvement and a positive value signifies worsening of symptoms. Improvements in all of these NPI domains remained statistically significant at 24 weeks.

“I was surprised by the magnitude and consistency of the effect,” Dr. Cummings told CLINICAL NEUROLOGY NEWS.

The investigators also observed that in patients who were asymptomatic at baseline, memantine treatment resulted in significantly less emergence of agitation/aggression and appetite/eating changes by week 24, compared with those on placebo.

According to Dr. Cummings, this is the first study to look at the effect of memantine on behavior in Alzheimer's disease.

Forest Laboratories Inc., manufacturer of memantine, supported the study.

SAN DIEGO — Use of memantine in patients with moderate to severe Alzheimer's disease significantly reduced their behavioral disturbances and psychiatric symptoms, compared with placebo, Jeffrey L. Cummings, M.D., reported in a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

“We think this represents an important, newly recognized benefit for the use of memantine in patients with Alzheimer's disease,” Dr. Cummings, director of the University of California, Los Angeles, Alzheimer's Disease Research Center, said in an interview. “The question we posed was, does a drug like memantine, which is used for cognitive improvement, have any effect on agitation? What we saw was that in several analyses—whether we looked at week 12 or week 24, whether we looked at patients who were asymptomatic at baseline or symptomatic at baseline—memantine reduced agitation.”

For the 24-week study, Dr. Cummings and his associates randomized 403 patients at 37 clinical centers who had moderate to severe Alzheimer's disease to receive either memantine 10 mg b.i.d. or placebo. The memantine was titrated up weekly in 5-mg increments from a starting dose of 5 mg/day during week 1 to 20 mg/day at week 4. All patients remained on donepezil throughout the study.

The investigators used the Neuropsychiatric Inventory (NPI) to assess behavioral symptoms at baseline, week 12, and week 24.

Of the 403 community-dwelling patients, 202 received memantine and 201 received placebo. The mean age of study participants was 76 years, and 65% were female. Most (91%) were white.

When compared with patients in the placebo group at 12 weeks, those in the memantine group had significant improvements on the NPI domains of agitation/aggression (-0.4 vs. 0.2), irritability/lability (-0.4 vs. 0.1), and appetite/eating change (-0.4 vs. 0.1), where a negative value denotes improvement and a positive value signifies worsening of symptoms. Improvements in all of these NPI domains remained statistically significant at 24 weeks.

“I was surprised by the magnitude and consistency of the effect,” Dr. Cummings told CLINICAL NEUROLOGY NEWS.

The investigators also observed that in patients who were asymptomatic at baseline, memantine treatment resulted in significantly less emergence of agitation/aggression and appetite/eating changes by week 24, compared with those on placebo.

According to Dr. Cummings, this is the first study to look at the effect of memantine on behavior in Alzheimer's disease.

Forest Laboratories Inc., manufacturer of memantine, supported the study.

SAN DIEGO — Use of memantine in patients with moderate to severe Alzheimer's disease significantly reduced their behavioral disturbances and psychiatric symptoms, compared with placebo, Jeffrey L. Cummings, M.D., reported in a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

“We think this represents an important, newly recognized benefit for the use of memantine in patients with Alzheimer's disease,” Dr. Cummings, director of the University of California, Los Angeles, Alzheimer's Disease Research Center, said in an interview. “The question we posed was, does a drug like memantine, which is used for cognitive improvement, have any effect on agitation? What we saw was that in several analyses—whether we looked at week 12 or week 24, whether we looked at patients who were asymptomatic at baseline or symptomatic at baseline—memantine reduced agitation.”

For the 24-week study, Dr. Cummings and his associates randomized 403 patients at 37 clinical centers who had moderate to severe Alzheimer's disease to receive either memantine 10 mg b.i.d. or placebo. The memantine was titrated up weekly in 5-mg increments from a starting dose of 5 mg/day during week 1 to 20 mg/day at week 4. All patients remained on donepezil throughout the study.

The investigators used the Neuropsychiatric Inventory (NPI) to assess behavioral symptoms at baseline, week 12, and week 24.

Of the 403 community-dwelling patients, 202 received memantine and 201 received placebo. The mean age of study participants was 76 years, and 65% were female. Most (91%) were white.

When compared with patients in the placebo group at 12 weeks, those in the memantine group had significant improvements on the NPI domains of agitation/aggression (-0.4 vs. 0.2), irritability/lability (-0.4 vs. 0.1), and appetite/eating change (-0.4 vs. 0.1), where a negative value denotes improvement and a positive value signifies worsening of symptoms. Improvements in all of these NPI domains remained statistically significant at 24 weeks.

“I was surprised by the magnitude and consistency of the effect,” Dr. Cummings told CLINICAL NEUROLOGY NEWS.

The investigators also observed that in patients who were asymptomatic at baseline, memantine treatment resulted in significantly less emergence of agitation/aggression and appetite/eating changes by week 24, compared with those on placebo.

According to Dr. Cummings, this is the first study to look at the effect of memantine on behavior in Alzheimer's disease.

Forest Laboratories Inc., manufacturer of memantine, supported the study.

SAN DIEGO — Donepezil is safe and effective in African Americans with mild to moderate Alzheimer's disease, a 12-week open-label study demonstrated.

The finding is important because African Americans are underrepresented in clinical trials even though they have a higher risk for Alzheimer's disease, compared with whites, Patrick Griffith, M.D., said during a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

This trial uses the Fuld Object Memory Evaluation (FOME), a culturally unbiased evaluation of memory. “The test has been validated in African Americans, and it operates independent of educational level or [social background],” Dr. Griffith, chief of the division of neurology at Morehouse School of Medicine, Atlanta, said in an interview. “It relies on touch and vision. We may have a measuring tool for future clinical trials that will avoid previous reports of educational or cultural bias.”

He added that the FOME was designed for elders who may have problems with hearing or attention.

Dr. Griffith and his associates enrolled 125 community-dwelling African Americans aged 51-98 from 30 sites in the United States with a clinical diagnosis of mild to moderate Alzheimer's disease and Mini-Mental State Examination (MMSE) scores of 10-26. The patients received donepezil (Aricept) 5 mg/day at the conclusion of their baseline visit; the dose was increased to 10 mg/day after 4 weeks—according to clinician judgment.

At weeks 4, 8, and 12, the investigators administered the FOME, the MMSE, and the Clinician Interview-Based Impression of Change with Caregiver Input (CIBIC-plus).

Patients demonstrated significant improvement on the FOME storage and retrieval scores, the MMSE scores, and the CIBIC-plus scores during 12 weeks of therapy.

The most common treatment-emergent adverse events were diarrhea, hypertension, and urinary tract infection, and the incidences were similar to those reported previously in patients with mild to moderate Alzheimer's. Lab results were unremarkable.

Pfizer Inc., donepezil's maker, supported the study.

SAN DIEGO — Donepezil is safe and effective in African Americans with mild to moderate Alzheimer's disease, a 12-week open-label study demonstrated.

The finding is important because African Americans are underrepresented in clinical trials even though they have a higher risk for Alzheimer's disease, compared with whites, Patrick Griffith, M.D., said during a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

This trial uses the Fuld Object Memory Evaluation (FOME), a culturally unbiased evaluation of memory. “The test has been validated in African Americans, and it operates independent of educational level or [social background],” Dr. Griffith, chief of the division of neurology at Morehouse School of Medicine, Atlanta, said in an interview. “It relies on touch and vision. We may have a measuring tool for future clinical trials that will avoid previous reports of educational or cultural bias.”

He added that the FOME was designed for elders who may have problems with hearing or attention.

Dr. Griffith and his associates enrolled 125 community-dwelling African Americans aged 51-98 from 30 sites in the United States with a clinical diagnosis of mild to moderate Alzheimer's disease and Mini-Mental State Examination (MMSE) scores of 10-26. The patients received donepezil (Aricept) 5 mg/day at the conclusion of their baseline visit; the dose was increased to 10 mg/day after 4 weeks—according to clinician judgment.

At weeks 4, 8, and 12, the investigators administered the FOME, the MMSE, and the Clinician Interview-Based Impression of Change with Caregiver Input (CIBIC-plus).

Patients demonstrated significant improvement on the FOME storage and retrieval scores, the MMSE scores, and the CIBIC-plus scores during 12 weeks of therapy.

The most common treatment-emergent adverse events were diarrhea, hypertension, and urinary tract infection, and the incidences were similar to those reported previously in patients with mild to moderate Alzheimer's. Lab results were unremarkable.

Pfizer Inc., donepezil's maker, supported the study.

SAN DIEGO — Donepezil is safe and effective in African Americans with mild to moderate Alzheimer's disease, a 12-week open-label study demonstrated.

The finding is important because African Americans are underrepresented in clinical trials even though they have a higher risk for Alzheimer's disease, compared with whites, Patrick Griffith, M.D., said during a poster session at the annual meeting of the American Association for Geriatric Psychiatry.

This trial uses the Fuld Object Memory Evaluation (FOME), a culturally unbiased evaluation of memory. “The test has been validated in African Americans, and it operates independent of educational level or [social background],” Dr. Griffith, chief of the division of neurology at Morehouse School of Medicine, Atlanta, said in an interview. “It relies on touch and vision. We may have a measuring tool for future clinical trials that will avoid previous reports of educational or cultural bias.”

He added that the FOME was designed for elders who may have problems with hearing or attention.

Dr. Griffith and his associates enrolled 125 community-dwelling African Americans aged 51-98 from 30 sites in the United States with a clinical diagnosis of mild to moderate Alzheimer's disease and Mini-Mental State Examination (MMSE) scores of 10-26. The patients received donepezil (Aricept) 5 mg/day at the conclusion of their baseline visit; the dose was increased to 10 mg/day after 4 weeks—according to clinician judgment.

At weeks 4, 8, and 12, the investigators administered the FOME, the MMSE, and the Clinician Interview-Based Impression of Change with Caregiver Input (CIBIC-plus).

Patients demonstrated significant improvement on the FOME storage and retrieval scores, the MMSE scores, and the CIBIC-plus scores during 12 weeks of therapy.

The most common treatment-emergent adverse events were diarrhea, hypertension, and urinary tract infection, and the incidences were similar to those reported previously in patients with mild to moderate Alzheimer's. Lab results were unremarkable.

Pfizer Inc., donepezil's maker, supported the study.

SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.

Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told RHEUMATOLOGY NEWS.

The findings suggest that systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.

Dr. McCrindle was surprised by the findings, which conflict with similar reports from Japanese investigators. “The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children],” he said at the symposium.

Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. They also enrolled a group of 60 normal controls matched for age and gender.

The investigators performed a cardiovascular risk assessment of all participants. Systemic arterial endothelial function was obtained to assess brachial artery reactivity (BAR).

The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.

In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.

The lab results showed no differences between the groups in total cholesterol; HDL; LDL; apolipoproteins A-1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.

However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.

SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.

Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told RHEUMATOLOGY NEWS.

The findings suggest that systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.

Dr. McCrindle was surprised by the findings, which conflict with similar reports from Japanese investigators. “The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children],” he said at the symposium.

Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. They also enrolled a group of 60 normal controls matched for age and gender.

The investigators performed a cardiovascular risk assessment of all participants. Systemic arterial endothelial function was obtained to assess brachial artery reactivity (BAR).

The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.

In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.

The lab results showed no differences between the groups in total cholesterol; HDL; LDL; apolipoproteins A-1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.

However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.

SAN DIEGO — Systemic arterial endothelial dysfunction was significantly related to higher levels of triglycerides and fasting blood glucose, but not to other cardiovascular risk factors in a long-term follow-up study of patients with Kawasaki disease, Brian W. McCrindle, M.D., reported at an international Kawasaki disease symposium.

Those particular factors “may be indicators of ongoing inflammation, which may be addressed by long-term aspirin use, antioxidant vitamins, or, in extreme cases, use of a statin,” Dr. McCrindle, a pediatric cardiologist at the Hospital for Sick Children, Toronto, told RHEUMATOLOGY NEWS.

The findings suggest that systemic arterial endothelial dysfunction is not present in the long term after Kawasaki disease and that brachial artery activity is not related to the degree of past or current coronary artery involvement.

Dr. McCrindle was surprised by the findings, which conflict with similar reports from Japanese investigators. “The difference may be in the control population used for comparison, with North American children being more sedentary, having poorer nutrition, and being more overweight [compared with Japanese children],” he said at the symposium.

Dr. McCrindle and his associates enrolled 52 patients, aged 10-20 years, who had their initial episode of Kawasaki disease between 1982 and 1998 and who had been followed for a mean of 11 years. They also enrolled a group of 60 normal controls matched for age and gender.

The investigators performed a cardiovascular risk assessment of all participants. Systemic arterial endothelial function was obtained to assess brachial artery reactivity (BAR).

The mean BAR dilatation in Kawasaki disease patients was 8.9%, which was not significantly different from the controls (9.4%), and was not related to any disease characteristic or measure of current or past coronary artery lesions.

In addition, the investigators observed no differences between the BAR of Kawasaki disease patients and that of controls in terms of age, gender, Tanner stage, skinfold thickness percentile, body mass index z score, physical activity levels of the patient or family members, or responses to the dietary assessment.

The lab results showed no differences between the groups in total cholesterol; HDL; LDL; apolipoproteins A-1, B, or E; lipoprotein (a); homocysteine or fibrinogen levels; or 24-hour microalbumin excretion.

However, decreased BAR in Kawasaki disease patients was significantly and independently related to higher triglyceride levels and higher fasting blood glucose levels.

SAN DIEGO — Cardiac abnormalities in patients with Kawasaki disease may appear well after their short-term treatment phase, even in those with no previous evidence of cardiac involvement, results from a follow-up study show.

The results “further support a need for long-term follow-up of all patients with Kawasaki disease,” Rosie Scuccimarri, M.D., reported at an international Kawasaki disease symposium. “Patients who have had normal echoes at 8 weeks should also have echocardiograms at least every 5 years.”

For the study, she and her associates contacted 221 patients who had been admitted to Montreal Children's Hospital with a diagnosis of Kawasaki disease during January 1985 to December 1999 and who were treated in the acute phase of their disease with intravenous immunoglobulin and low-dose aspirin. The aim was to conduct late follow-up echocardiographic evaluations, and of the 221 patients contacted, 159 participated in the study.

Patients identified as having echocardiographic abnormalities within 8 weeks of Kawasaki disease diagnosis or during later follow-up visits (38) were matched to those in which no prior abnormalities were detected (121). The mean age of disease diagnosis was 3 years, and the mean age at study visit was 11 years.

Of the 38 patients in whom abnormalities had been detected previously, 12 had coronary artery lesions, which translated into an incidence of 7.5% in the entire study group.

A coronary vessel was defined as abnormal if its diameter was greater than 3 mm in a child younger than 3 years, greater than 3.5 mm in a child aged 3-5 years, greater than 4 mm in a child aged 5-11 years, and greater than 5 mm in a child older than 11 years.

All 38 patients with abnormalities had complete resolution of their original abnormalities, but 8 (21%) had developed new pathology on long-term follow-up.

The investigators also observed that 7 of the 121 patients (6%) with normal echocardiograms on early follow-up had abnormal results on late follow-up, including one with a new coronary artery lesion.

“There was a significant interest by patients to participate [in the study],” noted Dr. Scuccimarri, a pediatric rheumatologist at McGill University Health Center, Montreal. “We were lucky enough to have patients who came [from] as far as Hong Kong, Western Canada, and the United States at their own expense.”

In another part of the study, a subgroup of 35 patients underwent a stress test using technetium-99m sestamibi (stress MIBI) with continuous ECG monitoring: 18 who had echocardiographic abnormalities at early or late follow-up and 17 who had no such abnormalities.

Among the 18 patients with abnormalities at early or late follow-up, 1 had an abnormal stress ECG, she said at the meeting, which was sponsored by the American Heart Association. Among those without evidence of abnormalities, one had an abnormal ECG, and one had an abnormal stress MIBI. She concluded that stress-MIBI testing and long-term follow-up “needs to be evaluated further.”

SAN DIEGO — Cardiac abnormalities in patients with Kawasaki disease may appear well after their short-term treatment phase, even in those with no previous evidence of cardiac involvement, results from a follow-up study show.

The results “further support a need for long-term follow-up of all patients with Kawasaki disease,” Rosie Scuccimarri, M.D., reported at an international Kawasaki disease symposium. “Patients who have had normal echoes at 8 weeks should also have echocardiograms at least every 5 years.”

For the study, she and her associates contacted 221 patients who had been admitted to Montreal Children's Hospital with a diagnosis of Kawasaki disease during January 1985 to December 1999 and who were treated in the acute phase of their disease with intravenous immunoglobulin and low-dose aspirin. The aim was to conduct late follow-up echocardiographic evaluations, and of the 221 patients contacted, 159 participated in the study.

Patients identified as having echocardiographic abnormalities within 8 weeks of Kawasaki disease diagnosis or during later follow-up visits (38) were matched to those in which no prior abnormalities were detected (121). The mean age of disease diagnosis was 3 years, and the mean age at study visit was 11 years.

Of the 38 patients in whom abnormalities had been detected previously, 12 had coronary artery lesions, which translated into an incidence of 7.5% in the entire study group.

A coronary vessel was defined as abnormal if its diameter was greater than 3 mm in a child younger than 3 years, greater than 3.5 mm in a child aged 3-5 years, greater than 4 mm in a child aged 5-11 years, and greater than 5 mm in a child older than 11 years.

All 38 patients with abnormalities had complete resolution of their original abnormalities, but 8 (21%) had developed new pathology on long-term follow-up.

The investigators also observed that 7 of the 121 patients (6%) with normal echocardiograms on early follow-up had abnormal results on late follow-up, including one with a new coronary artery lesion.

“There was a significant interest by patients to participate [in the study],” noted Dr. Scuccimarri, a pediatric rheumatologist at McGill University Health Center, Montreal. “We were lucky enough to have patients who came [from] as far as Hong Kong, Western Canada, and the United States at their own expense.”

In another part of the study, a subgroup of 35 patients underwent a stress test using technetium-99m sestamibi (stress MIBI) with continuous ECG monitoring: 18 who had echocardiographic abnormalities at early or late follow-up and 17 who had no such abnormalities.

Among the 18 patients with abnormalities at early or late follow-up, 1 had an abnormal stress ECG, she said at the meeting, which was sponsored by the American Heart Association. Among those without evidence of abnormalities, one had an abnormal ECG, and one had an abnormal stress MIBI. She concluded that stress-MIBI testing and long-term follow-up “needs to be evaluated further.”

SAN DIEGO — Cardiac abnormalities in patients with Kawasaki disease may appear well after their short-term treatment phase, even in those with no previous evidence of cardiac involvement, results from a follow-up study show.

The results “further support a need for long-term follow-up of all patients with Kawasaki disease,” Rosie Scuccimarri, M.D., reported at an international Kawasaki disease symposium. “Patients who have had normal echoes at 8 weeks should also have echocardiograms at least every 5 years.”

For the study, she and her associates contacted 221 patients who had been admitted to Montreal Children's Hospital with a diagnosis of Kawasaki disease during January 1985 to December 1999 and who were treated in the acute phase of their disease with intravenous immunoglobulin and low-dose aspirin. The aim was to conduct late follow-up echocardiographic evaluations, and of the 221 patients contacted, 159 participated in the study.

Patients identified as having echocardiographic abnormalities within 8 weeks of Kawasaki disease diagnosis or during later follow-up visits (38) were matched to those in which no prior abnormalities were detected (121). The mean age of disease diagnosis was 3 years, and the mean age at study visit was 11 years.

Of the 38 patients in whom abnormalities had been detected previously, 12 had coronary artery lesions, which translated into an incidence of 7.5% in the entire study group.

A coronary vessel was defined as abnormal if its diameter was greater than 3 mm in a child younger than 3 years, greater than 3.5 mm in a child aged 3-5 years, greater than 4 mm in a child aged 5-11 years, and greater than 5 mm in a child older than 11 years.

All 38 patients with abnormalities had complete resolution of their original abnormalities, but 8 (21%) had developed new pathology on long-term follow-up.

The investigators also observed that 7 of the 121 patients (6%) with normal echocardiograms on early follow-up had abnormal results on late follow-up, including one with a new coronary artery lesion.

“There was a significant interest by patients to participate [in the study],” noted Dr. Scuccimarri, a pediatric rheumatologist at McGill University Health Center, Montreal. “We were lucky enough to have patients who came [from] as far as Hong Kong, Western Canada, and the United States at their own expense.”

In another part of the study, a subgroup of 35 patients underwent a stress test using technetium-99m sestamibi (stress MIBI) with continuous ECG monitoring: 18 who had echocardiographic abnormalities at early or late follow-up and 17 who had no such abnormalities.

Among the 18 patients with abnormalities at early or late follow-up, 1 had an abnormal stress ECG, she said at the meeting, which was sponsored by the American Heart Association. Among those without evidence of abnormalities, one had an abnormal ECG, and one had an abnormal stress MIBI. She concluded that stress-MIBI testing and long-term follow-up “needs to be evaluated further.”

SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

Although the exact cause of the association remains unclear, “iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology.

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

The investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had been transfused or were currently on a transfusion program. They also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two osteoporotic, two osteopenic).

Liver iron concentrations were higher among osteopenic females than their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia, Dr. Shah said.

SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

Although the exact cause of the association remains unclear, “iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology.

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

The investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had been transfused or were currently on a transfusion program. They also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two osteoporotic, two osteopenic).

Liver iron concentrations were higher among osteopenic females than their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia, Dr. Shah said.

SAN DIEGO — Nearly half of adults with sickle cell anemia have osteopenia, according to results from a small study.

Although the exact cause of the association remains unclear, “iron overloading from blood transfusion may be a relevant contributing factor, as liver iron was significantly greater in osteopenic than nonosteopenic patients,” Farrukh T. Shah, M.D., said in a poster session at the annual meeting of the American Society of Hematology.

Other potential contributory mechanisms based on previous clinical research include marrow expansion, bone infarction, delayed puberty from anemia, low vitamin D levels, iron chelation therapy, and hypogonadism.

The investigators performed dual-energy x-ray absorptiometry (DEXA) scans on 10 female and 7 male consecutive sickle cell disease patients who had been transfused or were currently on a transfusion program. They also assessed hypogonadism, vitamin D3, parathyroid hormone, serum ferritin, and hemoglobin levels, said Dr. Shah of the department of hematology at Whittington Hospital NHS Trust, London.

Among females in the study, six had osteopenia or osteoporosis in the spine; four had significant demineralization of the hip (two osteoporotic, two osteopenic).

Liver iron concentrations were higher among osteopenic females than their nonosteopenic counterparts; the levels of serum estradiol were not different between the two groups. No differences were seen between the two groups in terms of ferritin, units of blood transfused, parathyroid hormone, or vitamin D.

Among males, two had spinal osteopenia but none had osteopenia of the hip. Liver iron levels and serum ferritin levels were higher in the osteopenic males than in the nonosteopenic males. No differences were noted between the two groups in terms of serum testosterone, units of blood transfused, parathyroid hormone, or vitamin D.

Overall, 47% of the study participants had osteopenia, Dr. Shah said.