ABSTRACT. Objective. Acute Kawasaki disease can result in the development of large coronary artery aneurysms that may persist. Abciximab, a platelet glycoprotein IIb/IIIa receptor inhibitor, is associated with resolution of thrombi and vascular remodeling in adults with acute coronary syndromes. The purpose of this study was to compare changes in aneurysm diameter at early follow-up in patients who had Kawasaki disease and received abciximab in addition to standard therapy with those who were treated with standard therapy alone.Methods. Patients with Kawasaki disease and large aneurysms were divided into 2 groups on the basis of acute therapy: 1) abciximab in addition to standard therapy and 2) standard therapy alone. Echocardiograms were reviewed for coronary aneurysms (lumen diameter 1.5 times that of the adjacent vessel). Maximum aneurysm diameter was determined during the acute/subacute phase of Kawasaki disease (<6 weeks) and at early follow-up (4 -6 months). Regression of the aneurysm was defined as a decrease in lumen diameter, and resolution was defined as normalization of the vessel.Results. Six patients had 20 aneurysms in the abciximab group, and 9 patients had 30 aneurysms in the standard therapy group. Early follow-up data were available for 19 of the 20 aneurysms in the abciximab group and 19 of the 30 aneurysms in the standard therapy group. Patients who were treated with abciximab demonstrated greater regression in aneurysm size at early follow-up than patients who were treated with standard therapy alone (percentage decrease: 41 ؎ 19% vs 17 ؎ 27%). In the abciximab group, 68% (13 of 19) of aneurysms resolved at early follow-up compared with 35% (7 of 19) in the standard therapy group.Conclusions. Patients who were treated with abciximab demonstrated greater regression in aneurysm diameter at early follow-up than patients who received standard therapy alone. These findings suggest that treatment with abciximab may promote vascular remodeling in this population and warrants further study. Pediatrics 2002;109(1). URL: http://www.pediatrics.org/ cgi/content/full/109/1/e4; Kawasaki disease, coronary artery abnormalities, abciximab.

PurposeLumbar puncture (LP) is a routine procedure performed on infants < 90 days for diagnostic evaluation of suspected meningitis or seizures. Occasionally the initial attempt fails to yield a sample of cerebral spinal fluid for diagnostic testing, leading to management dilemmas with incomplete information. At Primary Children's Medical Center (PCMC), patients who have a failed LP are frequently referred for imaging assistance with either ultrasound or fluoroscopy success of LP, length of stay (LOS), and cost of hospitalization.MethodsTo identify patients less than 90 days of age who were referred to interventional radiology for LP after at least one failed previous attempt, PCMC's radiology database was queried, from August 2002 through July 2005. Patient medical records were subsequently reviewed. PCMC's administrative database was queried for the same time period to establish a control group of all hospitalized infants < 90 days with a successful LP. Wilcoxon rank sum tests were performed to compare LOS and cost of hospitalization for patients who had a successful LP with radiological intervention, compared to the control group. Median and interquartile ranges (IQR) are presented. All statistical analyses were performed using SAS v 9.12 (Carey, NC).Results1,547 patients had a successful LP performed during hospitalization, from 08/2002-07/2005. 62 patients (4%) were evaluated for imaging-assisted LP after a failed previous attempt. The ultimate success rate in radiology was 95.2%. 7 patients underwent ultrasound of the thecal sac with no LP attempt secondary to identification of limited fluid below the conus; re-evaluation with ultrasound resulted in success of LP in all 7 patients. Median LOS for the imaging assisted group was longer compared to the control group [70 (IQR 54-117) hrs vs 42 (IQR 57-92) hrs p = .003]. Median cost of hospitalization for the imaging=assisted group was higher compared to the control group [$4,799 (IQR $3,643-$7,271) vs $3,731 ($2,843-$6,364), p = .002].ConclusionsImaging assistance with either ultrasound or fluoroscopy yields a high success rate for LP in patients that had a previously failed attempt. However, LOS and cost of hospitalization are significantly higher. System-based analysis identifying the contributors, both clinical and technological, to LOS and cost will facilitate standardized intervention strategies to more efficiently manage patients < 90 days with a previously failed LP.