PURPOSE: A retrospective study was undertaken to test the hypothesis that febrile neonates, who have bacterial infections, can be accurately predicted early by diagnostic criteria. METHODS: We conducted a retrospective study of 152 infants, 28 days or less of age, whose rectal temperature was at least 38degrees C. Past history, family history, finding on physical examinations and results of CBC, urinalysis, lumbar puncture, CRP, and cultures of blood, urine and CSF were recorded. The diagnostic criteria for bacterial infection were : presence of identifiable fever focus(skin, soft tissue, bone, joint, eyes, ears), presence of maternal risk factors(malnutrition, fever, infection, premature rupture of membrane) & neonatal risk factors(prematurity, SGA), unhealthy condition at physical examinations, neutrophil index(immature neutrophil count/total neutrophil count ratio)> OR =0.15 and CRP> OR =2.0mg/dL, urinalysis-> OR =5 WBC/high-power field, absence of upper respiratory tract illness in parent and contact people. Febrile neonates who meet any of the diagnostic criteria were considered as high risk for bacterial infection. RESULTS: The overall incidence of bacterial infections in the 152 febrile neonates was 13.8%(21 neonates) with urinary tract infections in 8 neonates, bacteremia in 8 neonates and meningitis in 5 neonates. Only 1 neonate, who was classified as low risk for bacterial infection, was identified with a bacterial urinary tract infection. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic criteria were 95.2, 92.4, 66.7 and 99.2%, respectively. CONCLUSION: These data show the ability of diagnostic criteria to identify neonates with bacterial infection. Febrile neonates who meet the diagnostic criteria must be treated intensively and those who do not meet the diagnostic criteria can be carefully managed as inpatients or outpatients without administering antimicrobial agents, avoiding iatrogenic complications.
Anti-Infective Agents ; Bacteremia ; Bacterial Infections* ; Bone and Bones ; Fever ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Inpatients ; Joints ; Meningitis ; Neutrophils ; Outpatients ; Parents ; Physical Examination ; Respiratory System ; Retrospective Studies ; Rupture ; Sensitivity and Specificity ; Spinal Puncture ; Urinalysis ; Urinary Tract Infections

PURPOSE: There have been high rates of false positive and recall in neonatal screening test using the cut-off points set by the manufacturing company. So, it is necessary to re-evaluate the cut-off values to minimize the false positive rates. METHODS: We collected capillary blood in dry filter paper from 996 healthy neonates on the third day in cases of normal vaginal delivery or the fifth day in cases of Cesarean section. The levels of phenylalanine, galactose, 17-hydroxyprogesterone and branched-chain amino acids were measured using enzyme immunoassay. The results were compared with the original cut-off points set by the manufacturing company. RESULTS: The original cut-off points of four substances were 4.0mg/dL, 7.5mg/dL, 35ng/mL, and 8.0mg/dL, respectively, so that false-positive rates were 0.4, 1.6, 3.93, and 0.001%, respectively. When we set the cut-off point at 99.7 percentile using the data from healthy neonates, they should be 4.0mg/dL, 9.2mg/dL, 54.3ng/mL, and 8.0mg/dL, respectively. CONCLUSION: The false-positive and recall rates were higher in galactosemia and congenital adrenal hyperplasia when using the original cut-off points, suggesting that it would be reasonable to modify the cut-off point at 99.7 percentile after measuring those substances from enough of healthy neonates.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital ; Amino Acids, Branched-Chain ; Capillaries ; Cesarean Section ; Female ; Galactose ; Galactosemias ; Humans ; Immunoenzyme Techniques ; Infant, Newborn ; Metabolism, Inborn Errors* ; Neonatal Screening* ; Phenylalanine ; Pregnancy

PURPOSE: The mechanism of hypoxic damage is mainly intracellular influx of calcium ions through the glutamate ionotropic receptor. This study was performed to determine alterations in distribution and expression of kainate receptor subunits after 1 hour of moderate hypoxia in the newborn piglet brain, as in a condition of mild to moderate perinatal hypoxic-ischemic encephalopathy. METHODS: Ten newborn piglets were ventilated at PaO2 over 80mmHg for 30min. Thereafter, the control group(n=5) was ventilated with 21% oxygen, and hypoxic group(n=5) with 6% oxygen at PaO2 below 25mmHg for 1 hour. Concentrations of protein, ATP and phosphocreatine were determined. The proteins were immunostained with anti-rat GluR6/7 and anti-rat KA2 antibody. RESULTS: Hypoxia(PaO2 20+/-1mmHg) and acidosis(pH 7.06+/-0.09) developed significantly in the hypoxic group compared to the control group(PaO2 104+/-4mmHg, pH 7.44+/-0.03, respectively, P<0.01). The concentrations of ATP(2.84+/-1.28micromol/kg brain, P<0.05) and phosphocreatine(0.78+/-1.07micromol/kg brain, P<0.001) were reduced compared to the control group(5.04+/-0.25micromol/kg brain, 4.03+/-0.31micromol/kg brain, respectively). The protein contents of GluR6/7 subunits were ordered; cerebral cortex>hippocampus, thalamus, hypothalamus>basal ganglia, cerebellum>white matter, and KA2 subunits were ordered : hippocampus, basal ganglia>cerebral cortex>thalamus, cerebellum>hypothalamus, white matter. The distribution of the subunits between the hypoxic group and control group were similar. CONCLUSION: Cerebral cortex, hippocampus and basal ganglia may be the most vulnerable to excitotoxic injury. Kainate receptor subunits did not change after 1 hour of moderate hypoxia.
Adenosine Triphosphate ; Anoxia ; Basal Ganglia ; Brain* ; Calcium ; Cerebral Cortex ; Ganglia ; Glutamic Acid ; Hippocampus ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain ; Infant, Newborn* ; Ions ; Oxygen ; Phosphocreatine ; Receptors, Kainic Acid ; Thalamus

PURPOSE: To evaluate the sonographic findings and detection rate of ductal carcinoma in situ (DCIS) and to compare the results with mammographic findings. MATERIALS AND METHODS: Of 134 patients with pathologically proven DCIS, 47 patients (48 breasts) who underwent sonography before surgery were included. Twenty-seven patients were asymptomatic, while 20 experienced symptoms. Whether a lesion was present, and the nature of the related sonographic finding were analyzed retrospectively. When a mass was identified by means of sonography, it was evaluated in terms of its shape, margin, echogenicity, associated microcalcifications, and intervening echogenic lines. RESULTS: Sonography detected 39/48 cases of DCIS (81%). In 24 cases, detection was based only on the presence of the mass, while in nine cases this depended on additional findings alone [periductal thickening (n=6); micronodules (n=3)]. In three cases the presence of microcalcifications alone was sufficient for detection and in the other three cases, detection was based on the presence of microcalcifications as well as on additional findings [periductal thickening (n=2); micronodules (n=1)]. Thirteen lesions (54 %) were irregular in shape, while 11 (46 %) were oval or lobulated. The margins of 17 lesions (71 %) were ill-defined, and in 18(75 %), echogenicity was slightly hypoechoic. CONCLUSION: Sonography showed that for masses identified as DCIS, the most common findings were an ill-defined margin, irregular shape, and mild hypoechogenicity. Microcalcifications were identified in 13 of 48 breasts (27%), while in some cases intervening echogenic lines and microcalcifications were the only finding. For early detection of DCIS, mammography together with sonography may be helpful.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Mammography ; Retrospective Studies ; Ultrasonography*

PURPOSE: To assess the effect of gestational age and illness severity, and the effect of antenatal exposure to magnesium sulfate, glucocorticoids, and antibiotics, on the timing of the first stool in preterm infants. METHODS: Medical records of all preterm infants admitted to the neonatal ward at Kangnam Sacred Heart Hospital between March 1998 and August 1998 were reviewed. We studied the time of the first stool in 55 infants. RESULTS: The median age of the infant at the time of first stool was 18 hours, and 90% of the infants passed stool by 50 hours. Both the gestational age and the illness severity, as measured by the score for neonatal acute physiology(SNAP), correlated significantly with the timing of the first stool(r=0.47 and P<0.001 for SNAP; r=0.29 and P<0.05 for gestational age). An analysis of covariance showed that the relationship between SNAP and the timing of the first stool was significant even after adjustment for gestational age(P<0.01), but the relationship between the gestational age and the timing of the first stool was not significant after adjustment for SNAP (P=0.14). Antenatal exposure to magnesium sulfate for tocolysis, glucocorticoids for enhancing fetal lung maturity, and antibiotics, had no effect on the timing of the first stool. CONCLUSION: Delayed passage of first stool is a function of illness severity, not of gestational immaturity. Antenatal exposure to magnisium sulfate, dexamethasone, and antibiotics, does not affect the timing of first stool in premature infants.
Anti-Bacterial Agents ; Dexamethasone ; Gestational Age ; Glucocorticoids ; Heart ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Lung ; Magnesium Sulfate ; Medical Records ; Tocolysis

PURPOSE: The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. MATERIALS AND METHODS: Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as "4"("suspicious abnormality") and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. RESULTS: The pathologic outcome of these 113 lesions was as follows: infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0 %(9/113); ADH(atypical ductal hyperplasia), 5.3 % (6/113); DEH(ductal epithelial hyperplasia), 1.8 %(2/113); ductectasia, 0.9 %(1/113), FCD(fibrocystic change), 27 .4 %(31/113); fibroadenoma, 7.1 %(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1 % (8/113); other pathology, 15.0 %(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2 %), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1% ). CONCLUSION: Because category 4 lesions account for about 25.7 % of all breast malignancies, mammographic lesions in this category ("suspicious abnormality")should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed.
Biopsy ; Breast* ; Carcinoma, Ductal ; Fibroadenoma ; Fibrosis ; Humans ; Pathology

PURPOSE: There have been high rates of false positive and recall in neonatal screening test using the cut-off points set by the manufacturing company. So, it is necessary to re-evaluate the cut-off values to minimize the false positive rates. METHODS: We collected capillary blood in dry filter paper from 996 healthy neonates on the third day in cases of normal vaginal delivery or the fifth day in cases of Cesarean section. The levels of phenylalanine, galactose, 17-hydroxyprogesterone and branched-chain amino acids were measured using enzyme immunoassay. The results were compared with the original cut-off points set by the manufacturing company. RESULTS: The original cut-off points of four substances were 4.0mg/dL, 7.5mg/dL, 35ng/mL, and 8.0mg/dL, respectively, so that false-positive rates were 0.4, 1.6, 3.93, and 0.001%, respectively. When we set the cut-off point at 99.7 percentile using the data from healthy neonates, they should be 4.0mg/dL, 9.2mg/dL, 54.3ng/mL, and 8.0mg/dL, respectively. CONCLUSION: The false-positive and recall rates were higher in galactosemia and congenital adrenal hyperplasia when using the original cut-off points, suggesting that it would be reasonable to modify the cut-off point at 99.7 percentile after measuring those substances from enough of healthy neonates.
17-alpha-Hydroxyprogesterone ; Adrenal Hyperplasia, Congenital ; Amino Acids, Branched-Chain ; Capillaries ; Cesarean Section ; Female ; Galactose ; Galactosemias ; Humans ; Immunoenzyme Techniques ; Infant, Newborn ; Metabolism, Inborn Errors* ; Neonatal Screening* ; Phenylalanine ; Pregnancy

Mesenteric inflammatory pseudotumor in infants is a rare disease entity. To our knowledge, only scattered reports of this condition have appeared in the literature in English and there is no previously published report in Korean. We describe a case of mesenteric inflammatory pseudotumor in an infant. Ultrasonography revealed an inhomogeneous solid mass with hypervascularity, contrast-enhanced CT showed a large, inhomogeneous mass with ill defined hypo and hyperattenuated areas.
Granuloma, Plasma Cell ; Humans ; Infant* ; Rare Diseases ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: To evaluate the sonographic findings and detection rate of ductal carcinoma in situ (DCIS) and to compare the results with mammographic findings. MATERIALS AND METHODS: Of 134 patients with pathologically proven DCIS, 47 patients (48 breasts) who underwent sonography before surgery were included. Twenty-seven patients were asymptomatic, while 20 experienced symptoms. Whether a lesion was present, and the nature of the related sonographic finding were analyzed retrospectively. When a mass was identified by means of sonography, it was evaluated in terms of its shape, margin, echogenicity, associated microcalcifications, and intervening echogenic lines. RESULTS: Sonography detected 39/48 cases of DCIS (81%). In 24 cases, detection was based only on the presence of the mass, while in nine cases this depended on additional findings alone [periductal thickening (n=6); micronodules (n=3)]. In three cases the presence of microcalcifications alone was sufficient for detection and in the other three cases, detection was based on the presence of microcalcifications as well as on additional findings [periductal thickening (n=2); micronodules (n=1)]. Thirteen lesions (54 %) were irregular in shape, while 11 (46 %) were oval or lobulated. The margins of 17 lesions (71 %) were ill-defined, and in 18(75 %), echogenicity was slightly hypoechoic. CONCLUSION: Sonography showed that for masses identified as DCIS, the most common findings were an ill-defined margin, irregular shape, and mild hypoechogenicity. Microcalcifications were identified in 13 of 48 breasts (27%), while in some cases intervening echogenic lines and microcalcifications were the only finding. For early detection of DCIS, mammography together with sonography may be helpful.
Breast* ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Mammography ; Retrospective Studies ; Ultrasonography*

PURPOSE: This study was conducted to identify the association between emotional labor and job stress in bus drivers, as well as to propose management strategies for job stress. METHODS: The study was conducted in February 2013 and involved 182 bus drivers working in the Gyeonggi area. RESULTS: emotional labor was 9.5+/-2.34 on average, and job stress was higher than the median of the same indicator among Korea's workers in the areas of physical environment, job autonomy, and relationship conflicts. Factors that affected job stress was lower if the subjects' Higher values for emotional labor indicated a higher level of job stress. CONCLUSION: To reduce among drivers, the following measures are necessary: increase the comfort of the driver's seat within the vehicle, provide adequate rest between bus headways, provide comfortable in-house rest facilities, and establish physical training spaces to reduce musculoskeletal disorders as well as programs for reducing back pain. In addition, relationship conflicts may be relieved by increasing job autonomy as much as possible, by granting autonomous control of working hours and bus headways, as well as by banning long work hours. Moreover, various club activities, exercise programs, and counseling programs that workers can be involved in together may be beneficial. This study is significant in that it identified the relationship of the bus drivers' emotional labor and job stress, which has previously been ignored as a research topic. Through its results, this study provides baseline data for the preparation of management strategies that can address the job stress of bus drivers.