No abstract available.
Angiocardiography* ; Heart Defects, Congenital*

No abstract available.
Child* ; Humans ; Peritoneal Dialysis, Continuous Ambulatory*

No abstract available.

The aim of our study was to investigate the differential effects of dexamethasone (DXM) and hydrocortisone (HCS) on somatic growth and postnatal lung development in a rat model of bronchopulmonary dysplasia (BPD). A rat model of BPD was induced by administering intra-amniotic lipopolysaccharide (LPS) and postnatal hyperoxia. The rats were treated with a 6-day (D1-D6) tapering course of DXM (starting dose 0.5 mg/kg/day), HCS (starting dose 2 mg/kg/day), or an equivalent volume of normal saline. DXM treatment in a rat model of BPD induced by LPS and hyperoxia was also associated with a more profound weight loss compared to control and LPS + O2 groups not exposed to corticosteroid, whereas HCS treatment affected body weight only slightly. Examination of lung morphology showed worse mean cord length in both LPS + O2 + DXM and LPS + O2 + HCS groups as compared to the LPS + O2 alone group, and the LPS + O2 + DXM group had thicker alveolar walls than the LPS + O2 group at day 14. The HCS treatment was not significantly associated with aberrant alveolar wall thickening and retarded somatic growth. The use of postnatal DXM or HCS in a rat model of BPD induced by intra-amniotic LPS and postnatal hyperoxia appeared detrimental to lung growth, but there was less effect in the case of HCS. These findings suggest that effect of HCS on somatic growth and pulmonary outcome may be better tolerated in neonates for preventing and/or treating BPD.
Amnion/drug effects ; Animals ; Animals, Newborn ; Anti-Inflammatory Agents/*pharmacology ; Dexamethasone/*pharmacology ; Disease Models, Animal ; Female ; Hydrocortisone/*pharmacology ; *Hyperoxia ; Lipopolysaccharides/toxicity ; Lung Diseases/*pathology ; Oxygen/metabolism ; Pulmonary Alveoli/*drug effects/growth & development/pathology ; Rats ; Rats, Sprague-Dawley

BACKGROUND: As a result of endoscopic development and diagnostic technical improvements, the detection rate of early gastric cancer (EGC) has been increased and the prognosis of patients has been improved with surgical treatment. The most important factor for the prognosis of patients with EGC is the presence of regional lymph node metastasis, whose incidence is approximately 3% in patients with intramucosal EGC and 20% in patients with submucosal EGC. Recently, endoscopic resection has become the modality of treatment widely accepted in well selected cases of EGC. We have reviewed the results of endoscopic resection of EGC during 10 years and follow-up. METHODS: Over a ten year period from 1989 to 1999, 47 EGCs were resected endoscopically and the mean age of patients was 62.6 +/- 9.5 years. Thirty-six cases were treated by endoscopic mucosal resection and 11 cases were treated by snare polypectomy. RESULTS: Thirty-five cases were defined as complete resection by pathologic study and 33 cases were enrolled in follow-up study group. During follow-up period, there were 6 cases of death which was not related to the original disease. The mean follow-up duration of the survival group was 36.5 +/- 25.7 months. Local recurrence was detected in 1 case and a new lesion developed on the other site in 1 case. CONCLUSION: It appeared that endoscopic resection is an effective therapeutic procedure for some cases of EGC.
Follow-Up Studies* ; Humans ; Incidence ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Recurrence ; SNARE Proteins ; Stomach Neoplasms*

PURPOSE: Retinopathy of prematurity(ROP) continues to be a serious problem in infants who survived with neonatal intensive care. Nevertheless, there is neither available data about the incidence of ROP which may be the basis of the epidemiology, nor analysis of the risk factors of ROP in Korea. The purpose of this retrospective study was to evaluate the incidence of ROP and to analyze perinatal risk factors of ROP. METHODS: The study population was inborn neonates of Seoul National University Hospital during the three-year period, from Jan. 1991 to Dec. 1993. The total number of infants was 5,764, and the incidence of ROP was evaluated according to gestational age and birthweight. Infants with birthweight under 1,500gram or with gestational age less than 33 weeks were involved in this study, in 168 of the 242 infants, their eyes were examined. Of these, 71 developed some degree of ROP, and 12 received cryotherapy. The comparisons of perinatal risk factors of ROP between the group with and without ROP, and in the group with ROP, between with and without cryotherapy have been made. RESULTS: 1) The cumulative incidence of ROP according to gestational age was 100% in less than 28 weeks, 96.0%, 80.4%, 66.7%, 57.3%, 44.1%, 32.2%, 23.1%, 15.8%, and 10.6% in less than 29, 30, 31, 32, 33, 34, 35, 36, and 37 weeks, respectively. 2) The cumulative incidence of ROP according to birthweight was 100% in under 750gram, 90.9%, 69.8%, 56.8%, 39.1%, 26.8%, 16.0%, and 9.9% in under 1,000gram, 1,250gram, 1,500gram, 1,750gram, 2,000gram, 2,250gram, and 2,500gram, respectively. 3) The perinatal risk factors which were statistically significant were gestational age, birthweight, Apgar score at 1 and 5 minutes, duration of hospitalization, ventilation and oxygen supply, number of transfusions, acidosis, hyperoxia, maximum fraction of inspired oxygen, maximum peak inspiratory pressure, maximum frequency, and the presence of pneumonia, apnea-bradycardia syndrome, intraventricular hemorrhage, sepsis, hypocalcemia, hyperglycemia, bronchopulmonary dysplasia, administration of aminophylline or furosemide. With linear logistic regression analysis, only gestational age (OR=0.930, 95% CI=0.887-0.975) and hyperoxia (OR=1.006, 95% CI=1.003-1.009) were proved to relate to the occurrence of ROP independently. CONCLUSIONS: ROP was developed in 44.1% of infants less than 33 weeks and in 56.8% of infants under 1,500gram and the occurrence of ROP was related significantly only to gestational age and hyperoxia.
Acidosis ; Aminophylline ; Apgar Score ; Bronchopulmonary Dysplasia ; Cryotherapy ; Epidemiology ; Furosemide ; Gestational Age ; Hemorrhage ; Hospitalization ; Humans ; Hyperglycemia ; Hyperoxia ; Hypocalcemia ; Incidence* ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Logistic Models ; Oxygen ; Pneumonia ; Retinopathy of Prematurity* ; Retrospective Studies ; Risk Factors* ; Seoul ; Sepsis ; Ventilation

There were many reports of longitudinal changes in the causative organisms of neonatal sepsis in Western countries but few in Asia. We aimed to study longitudinal trends in the epidemiology of neonatal sepsis at Seoul National University Children's Hospital (SNUCH), a tertiary center in Korea, and compared the results to previous studies of Western countries. The medical records of all of the neonates who were hospitalized at SNUCH from 1996 to 2005 with positive blood cultures were reviewed. We also compared the findings to previous 16-yr (1980-1995). One hundred and forty-nine organisms were identified in 147 episodes from 134 infants. In comparison with the previous 16-yr studies, there was a decrease in the number of Escherichia coli infections (16.2% vs 8.7%: odds ratio [OR] 0.495; 95% confidence interval [CI], 0.255-0.962; P = 0.035), but an increase in Staphylococcus aureus (16.6% vs 25.5%: OR 1.720; 95% CI, 1.043-2.839; P = 0.033) and fungal infections (3.3% vs 18.7%: OR 6.740; 95% CI, 2.981-15.239; P < 0.001), predominantly caused by Candida species. In conclusion, the incidence of sepsis caused by E. coli decreases, but S. aureus and fungal sepsis increases significantly. Compared with Western studies, the incidence of sepsis caused by S. aureus and fungus has remarkably increased.
*Hospitals ; Humans ; Infant ; Infant, Newborn ; Infant, Newborn, Diseases/*epidemiology/microbiology ; Intensive Care Units, Neonatal ; Longitudinal Studies ; Mycoses/epidemiology ; Republic of Korea/epidemiology ; Sepsis/*epidemiology/microbiology ; Staphylococcal Infections/epidemiology

PURPOSE: The survival rate of infants weighing less than 1,000 g at birth(extremely low birth weight infants, ELBWI) has increased due to recent advances in perinatal and neonatal intensive care. The purpose of this study was to evaluate the survival rates of ELBWI born at Seoul National University Hospital during the last six years. METHODS: A total of 99 infants were divided into three groups(period I : 2000 to 2001, period II: 2002 to 2003, period III: 2004 to 2005) based on date of birth. We compared the survival rate of ELBWI over the three periods, using CRIB II score for adjustment for clinical severity. RESULTS: Overall survival rate of ELBWI was 74.7 percent. The survival rate of ELBWI increased over the three periods(period I: 60.7 percent, period II : 73.3 percent, period III: 85.3 percent). The threshold of viability(defined as survival of at least 50 percent of infants) was 25 weeks of gestation and 600 g at birth. The birth weight-specific survival rates increased considerably over the three periods for infants < 750 g at birth(period I: 10 percent, period II: 46.2 percent, period III: 70.6 percent). The survival rates of ELBWI over the three periods increased much remarkably after adjustment for clinical severity by CRIB II score. CONCLUSION: In our institution, survival rates of ELBWI during the last six years continued to improve, particularly for infants weighing < 750 g at birth. This increase in survival rates was not associated with the clinical severity of ELBWI.
Humans ; Infant Equipment ; Infant* ; Infant, Extremely Low Birth Weight ; Infant, Low Birth Weight* ; Infant, Newborn ; Intensive Care, Neonatal ; Parturition ; Pregnancy ; Seoul ; Survival Rate*

PURPOSE:Hypotension is common in extremely low birth weight infants (ELBWI) and the treatment becomes important as the survival rate of ELBWI is increasing. This study is to investigate frequency and etiologies of hypotension in ELBWI. METHODS:40 patients admitted to the NICU of Seoul National University Children's Hospital from September 2004 to June 2006 were included retrospectively. Definition of hypotension was 1) mean arterial blood pressure below 30 mmHg or below the gestational age, 2) decreased urine output or metabolic acidosis, and 3) use of inotropics. Hydrocortisone was used for inotrope-resistant hypotension. Clinical characteristics of patients with hypotension were compared with those of others without hypotension. RESULTS:Mean gestational age and mean birth weight of 40 patients was 26(+6)+/-2(+1) weeks and 787+/-149 g. 20 patients had hypotension. 17 events were within 1 week of postnatal age, 5 from 1 to 2 weeks, and 9 after 2 weeks. The etiologies of hypotension within 1 week were PDA in 12 cases, and bleeding in 4 cases. PDA, post-operative condition, adrenocortical insufficiency, and sepsis were the probable etiologies of hypotension after 2 weeks. Among 12 patients recieved hydrocortisone, 9 responded to hydrocortisone. Patients with hypotension were significantly low in gestational age and birth weight. Incidence of IVH and ROP were significantly high in patients with hypotension. CONCLUSIONS:Hypotension was frequent in ELBWI and the etiologies of hypotension were various according to postnatal ages. Significant proportion of hypotension was inotrope-resistant in ELBWI. Further studies about etiologies are in need with reference of this study.
Acidosis ; Arterial Pressure ; Birth Weight ; Gestational Age ; Hemorrhage ; Humans ; Hydrocortisone ; Hypotension* ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Retrospective Studies ; Seoul ; Sepsis ; Survival Rate

PURPOSE: The purpose of this study is to make a diagnostic classification and discuss a diagnostic strategy of floppy infants by investigating clinical, neurological, electrophysiological, and genetic analysis of infants admitted to intensive care units with the complaint of hypotonia. METHODS: A retrospective study was performed from Jan. 1993 to Dec. 2005 in neonatal and pediatric intensive care units of Seoul National University Children's Hospital. Clinical features and all tests related to hypotonia were investigated. RESULTS: There were 21 cases of floppy infants admitted to intensive care units. Final diagnosis was classified as centra (7 cases[33.3 percent]), peripheral (11 cases [52.4 percent]), and unspecified (3 cases [14.3 percent]). Among the central group, three patients were diagnosed as hypoxic ischemic encephalopathy, two patients as Prader-Willi syndrome, one patient as chromosomal disorder, and one patient as transient hypotonia. Among the peripheral group, four patients were diagnosed as myotubular myopathy, three patients as SMA type 1, two patients as congenital myotonic dystrophy, one patient as congenital muscular dystrophy, and one as unspecified motor-neuron disease. Motor power was above grade 3 on average, and deep tendon reflex was brisk in the central group. Among investigations, electromyography showed 66 percent sensitivity in the peripheral group, and muscle biopsy was all diagnostic in the peripheral group. Brain image was diagnostic in the central group, and Prader-Willi FISH or karyotyping was helpful in diagnosis in central group. Morbidity and mortality was more severe in the peripheral group CONCLUSION: Classification of diagnosis by clinical characteristics in this study, and application of investigations step by step, may provide an effective diagnostic strategy.
Biopsy ; Brain ; Chromosome Disorders ; Classification* ; Diagnosis ; Electromyography ; Humans ; Hypoxia-Ischemia, Brain ; Infant* ; Intensive Care Units ; Intensive Care Units, Pediatric* ; Karyotyping ; Mortality ; Muscle Hypotonia ; Muscular Dystrophies ; Myopathies, Structural, Congenital ; Myotonic Dystrophy ; Prader-Willi Syndrome ; Reflex, Stretch ; Retrospective Studies ; Seoul