{"id":122,"date":"2007-02-19T13:09:00","date_gmt":"2007-02-19T12:09:00","guid":{"rendered":"http:\/\/resource.bmj.com\/bmj\/2007\/02\/19\/nejm-15-feb-2007\/"},"modified":"2007-02-19T13:09:00","modified_gmt":"2007-02-19T12:09:00","slug":"nejm-15-feb-2007","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmj\/2007\/02\/19\/nejm-15-feb-2007\/","title":{"rendered":"NEJM 15 Feb 2007"},"content":{"rendered":"

Kawasaki disease <\/a>is a disease with many characteristics you don\u2019t want a disease to have. It\u2019s so rare that you will not see it more than once in a GP lifetime, but so dangerous that you mustn\u2019t miss it; it picks out children at random, but often clusters; we don\u2019t know its cause, but it behaves as if it\u2019s an infection; it can cause coronary artery damage and death, either immediately or much later. For a good brief update, see p.659<\/a>. The study <\/a>here illustrates the extreme difficulty of making therapeutic progress in diseases like this: it shows that pulsed corticosteroid treatment does not improve the effect of the standard immunoglobulin therapy.<\/p>\n

<\/strong>Patients with chronic pancreatitis<\/a> <\/strong>lead uncomfortable, unpredictable lives, punctuated by periods of intense pain which can become almost continuous. Now that clever gastroenterologists can cannulate the pancreatic duct by endoscopy, <\/a>patients can sometimes have their distal pancreatic duct obstruction relieved in this manner: but more often not, as this study <\/a>illustrates. For most, pancreaticojejunostomy <\/a>(the modified Puestow procedure) is a better bet.<\/p>\n

<\/strong>I suspect that one of the reasons <\/strong>influenza immunisation<\/a> <\/strong>is so little used in infants and small children<\/a> <\/strong>is our reluctance to submit them to yet another series of injections. But this may be about to change with this US study, which shows that intranasal attenuated live flu vaccine<\/a> <\/strong>works better than the standard intramuscular inactivated vaccine. The study <\/a>involved 8,000 kids under 5 with no recent wheeze or severe asthma. I wonder how long it will be before, at all ages, the squirt replaces the prick.<\/p>\n","protected":false},"excerpt":{"rendered":"

Kawasaki disease is a disease with many characteristics you don\u2019t want a disease to have. It\u2019s so rare that you will not see it more than once in a GP lifetime, but so dangerous that you mustn\u2019t miss it; it picks out children at random, but often clusters; we don\u2019t know its cause, but it […]<\/p>\n

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