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To determine whether changes in ECGs correlated with abnormalities in echocardiograms in children with acute and convalescent Kawasaki syndrome, we undertook a retrospective analysis of 44 patients examined during the first 2 weeks of illness and followed for at least 6 months, 31 for longer than 1 year. We analyzed 360 ECGs, 282 echocardiograms, and clinical status. Results of echocardiography showed 18 children with myocardial dysfunction, pericardial effusion, and/or coronary arterial abnormalities (41%); 26 children had no abnormalities. All 18 of the former and all but 10 of the latter had abnormalities on serial ECGs that normalized on recovery. Thirty-four of 44 patients (77%) had ECG abnormalities. These abnormalities were most prevalent in the first month: 68% appeared in the first week, about 50% in the second to fourth weeks, 16% at 2 months, and 10% at 3 months. The type of ECG change did not predict the type of echocardiographic abnormality, except that low voltage of QRS was found only with pericardial effusion. The most frequent early changes were in T waves, which were flattened in 28 (64%). Later 12 patients had high, peaked, abnormal T waves. Prolonged PR interval occurred in 13 patients, seven of whom had echocardiographic abnormalities. Of six with prolonged QT interval, four had abnormal echocardiograms. The possibility of having an abnormal echocardiogram increased with the number of ECG changes: from 0 risk with no change to 37% for one, 47% for two, 80% for three, and 100% for four changes in serial ECGs. Both ECGs and echocardiograms are important in early and subsequent evaluation of these patients. Inasmuch as the ECGs showed abnormalities in 77% whereas echocardiograms showed changes in 41%, we believe that serial ECGs in comparison with prior tracings offer the more sensitive noninvasive indicator of pancarditis in young children during acute and convalescent Kawasaki syndrome.

Many drugs with which to treat reversible obstructive airway disease are available. Beta-adrenergic aerosols are the first line of defense; these are followed, when necessary, by either timed-release theophylline or oral beta-adrenergics. Often, a combination of these drugs must be used to achieve effective relief of symptoms. Once-daily theophylline preparations can be extremely effective in patients who need regular medication and in whom gastrointestinal upset or compliance is a problem. In patients who have frequent setbacks, occasional courses of tapered doses of steroid are necessary. When oral steroids are necessary regularly, the physician should consider using an aerosol corticosteroid, cromolyn sodium, or both. These drugs can be used daily with relative safety. However, only a small amount (ie, no more than 12%) of an inhaled medication reaches the lungs. In selected patients, regular doses of cromolyn sodium are used for prophylaxis and may preclude the need for theophylline or oral beta-adrenergics, which can have deleterious effects in adults and children. Cromolyn sodium is most effective if used before exercise or exposure to animals. Research is continuing on more effective and longer-acting beta-adrenergic aerosols and oral preparations.

Vaccinia virus was irradiated in vacuo with low-voltage electrons of restricted ranges. It was found that the pock-forming ability of the virus was not decreased after bombardment with electrons penetrating 100 A beneath the virus surface. There was very slight reduction in titer with large doses of electrons penetrating 330 A, but a sudden marked drop in infectivity occurred after exposure to electrons penetrating 500 to 700 A. Electrons of higher energies, including those capable of penetrating the virus particle completely, did not produce significant further fall in infectivity titer. It is concluded that a highly radiation-sensitive unit essential for pock formation is situated 500 to 700 A beneath the surface of the virus particle, possibly in the form of a shell. The relation of this finding to the known structure of the virus and to other radiation data on the dimensions of the infectious unit is discussed.