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Самостоятельная работа с текстом Kawasaki Disease

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Kawasaki Disease

Description.Kawasaki disease (mucocutaneous lymph node syn­drome) is a children's illness characterized by fever, rash, swelling of the hands and feet, irritation and redness of the whites of the eyes, swollen lymph glands in the neck, and irritation and inflammation of the mouth, lips and throat. These immediate effects of Kawasaki disease are rarely serious: however, long-term heart complications result in some cases and can be seen as early as two weeks after onset of the disease.

Named after Dr. Tomisaku Kawasaki, a Japanese pediatrician, the disease has probably been in existence for a long time, but was not recognized as a separate entity until 1967. The incidence is higher in Japan than in any other country. In the United States it is more frequent among children of Asian-American background, but can occur in any racial or ethnic group. The disease is not common, and its incidence in the United States has not been determined. In recent years, it has tended to occur in localized outbreaks, most often in the late winter or spring, but is seen year-round. Kawasaki disease almost always affects children; most patients are under 5 years old, and the average age is about 2 years. Boys develop the illness almost twice as often as girls.

The heart may be affected in as many as one of five children who develop Kawasaki disease. Damage sometimes occurs to the blood vessels that supply the heart muscle (the coronary arteries) and to the heart muscle itself. A weakening of a coronary artery can result in an enlargement or swelling of the blood vessel wall ( an aneurism). Infants less than 1 year old are usually the most seriously ill and are at greatest risk for heart involvement.


The acute phase of Kawasaki disease commonly lasts 10 to 14 days or more. Most children recover fully. The likelihood of developing coronary artery disease later in life is not known, and remains the subject of medical investigation.

Cause.The cause of Kawasaki disease is unknown. It does not appear to be hereditary or contagious. Because the illness frequently occurs in outbreaks, an infectious agent (such as a virus) is likely the cause. It is very rare for more than one child in a family to develop Kawasaki disease.

Signs and Symptoms.Fever and irritability are often the first indications of the disease. Fever ranged from moderate (101° to 103° F) to high (above 104° F). The lymph glands in the neck may become swollen. A rash usually appears on the back, chest, and abdomen early in the illness; in infants it may develop in the groin. In some cases, the rash may spread to the face. The rash appears as poorly defined spots of various sizes, often bright red. Fever continues to rise and fall, sometimes for as long as 3 weeks.Bloodshot eyes (conjunctivitis) may develop, and the eyes can become sensitive to light.

The child's tongue may be coated, slightly swollen, and resemble the surface of a strawberry, sometimes referred to as "strawberry tongue". The lips may become red, dry, and cracked; the inside of the mouth may turn darker red than usual.

The palms of the hands and soles of the feet often become red, and hands and feet may swell. Occasionally, a stiff neck will develop. Abdominal pain and diarrhea occur in some children.

When the fever subsides, the rash and swollen lymph glands usually disappear. The skin around the toenails and fingernails often peels painlessly, usually during the second or third week of illness. The skin on the hands or feet may peel in large pieces.

The knees, hips, and ankles may become swollen and painful. Occasionally, joint pain and swelling persist after other symptoms have disappeared, but permanent joint damage does not occur. Lines or ridges on fingernails and toenails, formed during the illness, may be seen for weeks or months.

Diagnosis.The diagnosis of Kawasaki disease cannot be made by a single laboratory test or combination of tests. Physicians make the diagnosis after carefully examining a child, observing signs and symptoms, and eliminating the possibility of other diseases that are similar. Blood tests are used to detect mild anemia, an elevated white blood cell count, and an elevated sedimentation rate, indicating inflammation. A sharp increase in the number of platelets, a major clotting element in blood, may also be found.


Urine tests may reveal the presence of protein (albumin) and white blood cells. An irregular heartbeat and evidence of heart muscle involvement can be detected by electrocardiogram (ECG). An echo-cardiogram (or echo) is used to look for possible damage to the heart or to the coronary arteries that supply blood to the heart muscle. Other blood tests or diagnostic studies may be requested by the physician.

Complications.The possibility of heart and coronary artery involvement makes Kawasaki disease unpredictable, but these prob­lems usually are not serious and disappear with time. However, on occasion aneurisms of coronary or other arteries of the body can occur, and some may require medical or surgical treatment. Very rarely, complications may include heart attacks, which can be fatal.

Treatment.Kawasaki disease is frequently treated in the hospital, with a stay from a few days to a few weeks. Some children may receive care at home without hospitalization.

Since the cause of Kawasaki disease is unknown, no specific medication is available. Aspirin is often used to reduce fever, rash, joint inflammation, and pain, and to prevent formation of blood clots. Recent studies from Japan arid the United States suggest that another medication, intravenous gamma globulin, may decrease the risk of developing heart disease when given early in the illness. A major goal of treatment both in the hospital and at home is to make a child as comfortable as possible while the illness runs its course.

If tests reveal an aneurysm or other heart or blood vessel abnormality, repeated echocardiograms or other tests may be necessary for several years following recovery from Kawasaki disease. Almost all children return to completely normal activity after the acute phase of the illness.

Prevention.There is no known prevention for Kawasaki disease. Approximately one child in a hundred may develop the disease a second time. Parents should know that nothing they could have done would have prevented the disease.

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