Search PubMed⌕ Search

Biomedical subjects

A H Rowley

Publications and source records attributed to A H Rowley.

51 records · Page 3Linked to original sources
PubMed1987

Incomplete Kawasaki disease with coronary artery involvement.

We report four patients with Kawasaki disease in whom characteristic coronary artery abnormalities developed after illnesses that did not meet diagnostic criteria. An additional patient lacked a history of acute manifestations of Kawasaki disease, but severe Kawasaki-like arterial changes were noted at autopsy. Fever was present in four of the five patients, in three lasting from 7 to 14 days. Despite manifestation of few classic acute clinical features of Kawasaki disease, three of four patients had desquamation of the fingers and toes 10 to 14 days after onset of illness, and the fifth had desquamation several months prior to death. These patients were seen over a 2-year period during which 22 other children were seen with Kawasaki disease with coronary artery abnormalities. Thus, strict adherence to currently accepted criteria for diagnosis of Kawasaki disease may lead to failure to recognize incomplete forms of this illness, with potential sequelae of myocardial infarction or sudden death. This finding suggests that children with prolonged unexplained febrile illnesses, especially those associated with subsequent peripheral desquamation, should undergo echocardiography 3 to 4 weeks after onset of the illness. This practice would help to identify those patients with illnesses characterized by incomplete diagnostic criteria but in whom significant coronary abnormalities develop.

Coronary Aneurysm↗
PubMed1986

Does Kawasaki disease have a retroviral aetiology?

In 18 consecutive children with Kawasaki disease of recent onset, reverse transcriptase (RT) activity was studied in co-cultivated peripheral-blood-mononuclear-cell/lymphoblastoid-cell supernatants. 8 of 18 children, but only 1 of 18 controls, showed RT activity in one or more sample (p = 0.009). RT activity was identified in 14 of 226 samples from patients, but in only 1 of 167 from controls (p less than 0.01). The findings suggest that a retroviral agent may be casually related to Kawasaki disease.

Acute Disease↗
PubMed1986

Benztropine-induced acute dystonic reaction.

We report an unusual case of benztropine-induced acute dystonia and dyskinesia without findings of acute anticholinergic toxicity in a 20-month-old child. Laboratory analysis of blood, urine, and gastric contents demonstrated the presence of an atropinic compound and diphenhydramine only, suggesting the association of benztropine and acute dystonia. Effects of benztropine on neuronal uptake of dopamine may represent a possible mechanism for this unusual adverse effect.

Accidents↗
PubMed1986

The incubation period necessary for detection of bacteremia in immunocompetent children with fever. Implications for the clinician.

The authors determined the time required for blood cultures to be detected as positive for the common bacterial pathogens in immunocompetent infants and children with fever who had no apparent source of infection. Records of the bacteriology laboratory were reviewed retrospectively from 1981 to 1984 for blood cultures that were positive for Haemophilus influenzae type b, Streptococcus pneumoniae, Neisseria meningitidis, Salmonella species, and group B streptococcus. Blood culturing by a conventional technique and a radiometric method were compared sequentially. Only four (1.5%) of 268 specimens were detected as positive after the second day of incubation; in each case that detection of bacteremia was delayed there was an identified source of infection. For H. influenzae, but not S. pneumoniae, significantly more bacteremias were detected earlier by the radiometric method. Discontinuation of empiric antibiotic therapy in immunocompetent children with suspected bacteremia and without focal infection appears warranted when blood cultures have been sterile for at least 48 hours.

Anti-Bacterial Agents↗
PubMedDate not supplied

Angiogenesis in fatal acute Kawasaki disease coronary artery and myocardium.

Angiogenesis has been shown to be dysregulated in coronary artery (CA) aneurysms in the chronic phase of Kawasaki disease (KD). Neovascularization may occur in inflammatory-related vascular diseases because many angiogenesis mediators are secreted by inflammatory cells. We hypothesized that inflammation of the acute KD CA aneurysm could lead to dysregulation of angiogenesis mediators and subsequent neovascularization. To investigate this hypothesis, acute fatal KD cardiac tissues were immunostained for angiogenic inducers and inhibitors. Microvessel density was determined and the degree of inflammation assessed. Marked inflammation and angiogenesis were found in acute KD CA aneurysms and myocardium, with the highest microvessel density seen in patients who died 2-3 weeks after onset of the disease. Expression of proangiogenic proteins was higher than expression of inhibitors in KD CA aneurysms and myocardium. Angiogenesis mediators were localized to inflammatory cells in the myointima, adventitia, and myocardium. We conclude that significant neovascularization occurs in acute KD CA aneurysms and myocardium much sooner after onset of the disease than has been previously reported, that multiple angiogenesis factors are involved, and that dysregulation of angiogenesis likely contributes to KD vasculopathy.

Acute Disease↗
PubMedDate not supplied

Kawasaki syndrome.

Kawasaki syndrome is an acute self-limited illness of young children that may result in significant cardiovascular sequelae in 20% of patients. The etiology is unknown, but clinical and epidemiologic features strongly suggest an infectious etiology. The incidence of coronary artery abnormalities has been dramatically reduced by administration of intravenous gamma-globulin in the acute phase of illness. This paper reviews the clinical, laboratory, etiologic, epidemiologic, cardiovascular, pathologic, and therapeutic aspects of Kawasaki syndrome. Discovery of the etiology of this disorder will enable more specific diagnostic tests and therapies to be developed.

Child, Preschool↗