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Kawasaki disease is a self-limiting acute vasculitis that affects small and medium-sized vessels, and is the most common cause of acquired heart disease in children in our environment. Up to 25% of untreated patients develop coronary aneurysms. It is suspected that an infectious agent may be the trigger of the disease, but the causative agent is still unknown. Based on the previous evidence, recommendations are proposed for the diagnosis, treatment of acute disease, and the long-term management of these patients, in order to unify criteria. The diagnosis must be quick, based on easy-to-use algorithms and with the support of complementary tests. This document includes the indication of available imaging techniques, as well as the planning of cardiological examinations based on the initial involvement. Intravenous immunoglobulin is the basis of the initial treatment. The role of corticosteroids is still controversial, but there are studies that support its use as adjuvant treatment. A multidisciplinary working group has developed a scheme with different treatment guidelines depending on the risk factors at diagnosis, the patient\'s clinical situation, and response to previous treatment, including indications for thromboprophylaxis in patients with coronary involvement. The stratification of risk for long-term treatment is essential, as well as the recommendations on the procedures based on the initial cardiological involvement and its progression. Patients with coronary aneurysms require continuous and uninterrupted cardiological monitoring for life.

The practice guideline for general practitioners (GPs) on polymyalgia rheumatica and temporal arteritis was published in February 2010 by the Dutch College of General Practitioners. This guideline provides GPs with recommendations for the diagnosis and treatment of polymyalgia rheumatica. After other disorders have been excluded, the diagnosis of \'polymyalgia rheumatica\' is made in patients over the age of 50 who have bilateral pain in the neck and shoulder girdle and/or hip girdle that has lasted for longer than 4 weeks, morning stiffness that lasts longer than 60 minutes and an ESR > 40 mm in the first hour. After the diagnosis is made treatment with prednisone or prednisolone 15 mg per day is started. This dosage is diminished very gradually according to a uniform treatment schedule during a period of 3 months, thereafter depending on the clinical course. The practice guideline pays attention to the diagnosis and management of temporal arteritis only when it occurs concurrently with polymyalgia rheumatica.

BACKGROUND: Arteritis and tubulitis, the diagnostic features of acute renal allograft rejection, are typically focal lesions. To avoid under-diagnosis, the Banff \'97 schema recommends the preparation of multiple slides, of which three should be stained with hematoxylin and eosin (H&E) and three with periodic acid-Schiff (PAS) or silver. In this study, we examine the validity of the Banff \'97 recommendations and determine how widely these recommendations are applied.
METHODS: We reviewed 52 consecutive renal transplant biopsy specimens showing both acute tubulointerstitial and vascular rejection. Arteritis was graded for each H&E slide, and tubulitis was graded for each H&E and PAS/silver. The handling of renal allograft biopsy specimens in the U.K. was determined by means of a questionnaire.
RESULTS: When two, as opposed to three, H&E slides were examined, arteritis was missed in 11.4% of cases; when only one H&E slide was examined, arteritis was missed in 33.3% of cases. When only one, as opposed to three, PAS/silver slide was examined, tubulitis was under-graded in 33.3% of cases. In the U.K., 40% of laboratories stain at least three slides with H&E, and 42% stain at least three slides with PAS/silver. Only 30% of laboratories conform to all the Banff guidelines for slide preparation.
CONCLUSIONS: There is likely to be significant under-diagnosis and under-grading of acute rejection if the Banff \'97 guidelines for slide preparation are not implemented. Most laboratories in the U.K. do not conform to these guidelines.

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