NEJM 15 Feb 2007

Kawasaki disease is a disease with many characteristics you don’t want a disease to have. It’s so rare that you will not see it more than once in a GP lifetime, but so dangerous that you mustn’t miss it; it picks out children at random, but often clusters; we don’t know its cause, but it behaves as if it’s an infection; it can cause coronary artery damage and death, either immediately or much later. For a good brief update, see p.659. The study 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.

Patients with chronic pancreatitis 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, patients can sometimes have their distal pancreatic duct obstruction relieved in this manner: but more often not, as this study illustrates. For most, pancreaticojejunostomy (the modified Puestow procedure) is a better bet.

I suspect that one of the reasons influenza immunisation is so little used in infants and small children 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 works better than the standard intramuscular inactivated vaccine. The study 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.