The higher prevalence of CALs in incomplete KD reflects difficulties in diagnosis and delays in treatment. More timely diagnosis and treatment of incomplete KD patients could further prevent the development of cardiac lesions.

Results: In multivariate analyses, patients aged younger than 1 year (OR compared with 1-2-year-olds = 6.57) and those older than 5 years (OR compared with 1-2-year-olds = 4.24), those who received additional intravenous immunoglobulin (IVIG) without the use of steroid (OR = 8.38) and those who received steroid administration with or without the additional use of IVIG (OR = 220.51 and 83.83, respectively), showed significantly higher OR for giant coronary aneurysms. As for IVIG therapy, the additional use of IVIG (OR = 14.84), total dosage of IVIG exceeding 2500 mg/kg (OR compared with 1500-2499 mg/kg = 12.26) and the duration of IVIG administration for more than 3 days (OR = 30.12), were found to significantly increase the risk of developing giant aneurysms in univariate analyses that were adjusted for sex and age. Conclusions:The observation of 53 patients with giant coronary aneurysms due to Kawasaki disease among those included in the nationwide survey presented some risk factors, together with considerations about the associated aneurysms.

Keywords:diffuse idiopathic skeletal hyperostosis, vertebral fracture, conservative treatment Spine Surg Relat Res 2019; 3(4): 401-403 dx.We present a case of vertebral fracture associated with diffuse idiopathic skeletal hyperostosis (DISH) treated by a successful conservative treatment. DISH-associated vertebral fracture is unstable like a long bone fracture and often leads to severe paralysis after displacement. Early surgical stabilization is recommended 1,2) ; however, 26.6% postoperative complications 2) , neurological deterioration 3) , and perioperative deaths 2-6) have been reported. Conservative treatment is selected in patients with surgical risk factors or delayed diagnosis 2) . However, detailed reports on conservative cases are lacking.A 63-year-old man experienced back pain after a fall. He had hypertension, diabetes, and hemodialysis for 3 years and had undergone coronary stent graft for angina pectoralis 1 year before. One month after the fall, he visited a clinic and was diagnosed with vertebral fracture, and posterior fusion surgery was recommended. However, he rejected surgery because he had not received any treatment for 1 month and experienced only slight back pain. Then, he visited our hospital.He could walk without aid or external fixation and showed no neurological deficit.Computed tomography (CT) 1 month after the fall revealed continuous ossification of the anterior longitudinal ligament (OALL) from T2 to L2, and it was broken at T7/ T8 ( Fig. 1-ab). On the right side, the fracture line ran through the T8 vertebral body horizontally via the T8 pedicle to the posterior wall of the lamina (Fig. 1-a). The T6-T8 spinous processes were fractured vertically ( Fig. 1-b). In the spinal canal, the yellow ligament ossified in the midposterior portion.It was diagnosed as DISH, not ankylosing spondylitis, as there was no history of low back pain and no inflammation finding in the blood examination and there was a large lumbar osteophyte. As there was no neurological deficit, he refused surgical treatment. Furthermore, he had many comorbidities; therefore, he was treated conservatively with thoracolumbar orthosis made with plastic and metal frame covering the chest to the iliac crest while performing standing activities about 4 to 12 hours per day. He came to our clinic every month for 5 months and after once for every 2 months, and CT evaluation was performed at 1, 2, 3, 5, 7, 11, 15 months after the injury, and plain X-ray was performed at 4, 9 months.Two months after the injury, back pain was reduced and he could recline on a tilted chairback. CT showed no fracture displacement. Three months after the injury, back pain while lying down resolved. Ventral callus formation ahead of OALL at T7/T8, sclerotic change in the T8 vertebral body, and callus formation around the spinous process were observed (Fig. 2-a). After 5 months, he experienced back pain only when lying on a hard floor. Ventral callus formation ahead of OALL had developed, and the fracture line in the posterior T8 vertebral body became...