No abstract available.
Breast* ; Female ; Lactation* ; Milk, Human*

In the figure 3, designation of severity of bronchopulmonary dysplasia (BPD) was misprinted. Open bars (white) represent severe BPD, not mild BPD. Closed bars (Black) represent mild BPD, not severe BPD. Gray bars in the middle represent moderate BPD without change.

A 49-year-old Caucasian male patient suffered from fever general weakness and diffuse hair loss on the scalp for 3 days. Skin lesions showed erythematous scaly patches with pustules and erosions on the lower extremities and perianal region, and multiple ulcerations on the labial mucoas. A complete blood cell count revealed thrombocytopenia and leukopenia, which gradually worsened day after day (platelet: 29, 000/mm², WBC: 1,000/mm³). Candida albicans was isolated from the lesions of the oral cavity and lower extremities. Twelve days prior to the visit, he had taken etretinate Tegison®) P.O.25mg/day, prednisolone P.O. 50mg1dy and methotrexate P.O. 15mg/day for 5 days for the treatment of psoriasis. We presume that these adverse reactions may be synergistic adverse reactions, probably due to methotrexate and etretinate in consideration of the patient's history.
Acitretin* ; Blood Cell Count ; Candida albicans ; Etretinate* ; Fever ; Hair ; Humans ; Leukopenia ; Lower Extremity ; Male ; Methotrexate* ; Middle Aged ; Mouth ; Prednisolone ; Psoriasis* ; Scalp ; Skin ; Thrombocytopenia ; Ulcer

PURPOSE: We tested the hypothesis that preterm infants who develop bronchopulmonary dysplasia (BPD) have higher concentration of serum tumor necrosis factor-alpha (TNF-alpha) within 8 hours after birth than those who do not. METHODS: Serum and tracheal aspirate (TA) TNF-alpha concentrations were measured by enzyme-linked immunosorbent assay in the thirty-four preterm infants born before 32 weeks of gestation. Multiple logistic regression analysis was done. RESULTS: Median concentrations of both serum and TA TNF-alpha were higher in BPD group than in non BPD group [serum TNF-alpha, 214.52 pg/mL (84.20-244.20) versus 100.07 pg/mL (78.43-225.52), P=0.037],[TA TNF-alpha, 13.12 pg/mL (10.43-64.67) versus 11.58 pg/ mL (9.76-58.53), P=0.038]. After making adjustments for the effects of gestational age at birth, 5 minute Apgar score less than 7 and histologic chorioamnionitis, only serum TNF-alpha concentration was independently significant [P=0.045 Odds ratio, 1.381 95% confidence interval, 1.007-1.895]. The diagnostic indices of TNF-alpha (cutoff, 97.1 pg/mL) as a predictor of development of BPD were: sensitivity of 85.7%, specificity of 38.5%, positive predictive value of 69.2%, negative predictive value of 62.5% (P=0.037). CONCLUSION: Increased serum TNF-alpha concentration within 8 hours after birth may be a significant risk factor of later development of BPD.
Apgar Score ; Bronchopulmonary Dysplasia* ; Chorioamnionitis ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Premature ; Logistic Models ; Odds Ratio ; Parturition ; Pregnancy ; Risk Factors ; Sensitivity and Specificity ; Tumor Necrosis Factor-alpha*

OBJECTIVE: To determine whether gene expressions of VEGF and PlGF are different between the human placenta of normal and abnormal pregnancy. METHODS: Placenta was collected at each trimester of normal pregnancy, missed abortion, intrauterine growth retardation and pre-eclampsia. Total RNA was extracted from placenta. Reverse transcription-polymerase chain reaction(RT-PCR) was performed using VEGF and PlGF primer. RESULTS: VEGF121, VEGF165 and VEGF189 were identified in normal pregnancy and missed abortion. In two cases of four IUGR and one case of three pre-eclampsia, four of isoforms (VEGF121, VEGF145, VEGF165, and VEGF189) were identified. The intensity of signal was strongest for VEGF165 in all cases. PlGF131 and PlGF152 were identified in all cases. However, the signal intensities of VEGF121, VEGF165, VEGF189, PlGF131 and PlGF152 were not different according to the gestational age. They were also not different between normal pregnancy and abnormal pregnancy. CONCLUSION: VEGF and PlGF were not only expressed at placenta but also overexpressed in part of IUGR and pre-eclampsia. The results suggest that VEGF may play a role in the induction of angiogenesis of placenta in normal pregnancy and its production may be increased under the hypoxic condition.
Abortion, Missed ; Female ; Fetal Growth Retardation ; Gene Expression* ; Gestational Age ; Humans* ; Placenta* ; Pre-Eclampsia ; Pregnancy ; Protein Isoforms ; RNA ; Vascular Endothelial Growth Factor A

PURPOSE: Late-onset hypotension in preterm infants is not a rare condition. Late circulatory collapse due to adrenal insufficiency (AI) is one of the major causes of late-onset hypotension. We assessed the incidence and causes of late-onset hypotension. We also compared the clinical findings according to the presence of AI. METHODS: In total, 244 preterm infants with a gestational age < or =32 weeks and who were admitted to the neonatal intensive care unit (NICU) of Seoul National University Boramae Hospital and Seoul National University Hospital from January 2009 to April 2011 were included. Clinical findings were analyzed retrospectively. RESULTS: Forty-four infants (18%) suffered from late-onset hypotension. Hydrocortisone was administered to 30 infants (68.2%) and AI occurred in 16 infants (36.4%). Cesarean section, sepsis before hypotension, and gastrointestinal surgery were independently associated with late-onset hypotension. Intrauterine growth retardation (IUGR) was less frequent in the hydrocortisone-treated group than in infants not treated with hydrocortisone. The AI group had fewer IUGR infants, and the duration of hospitalization was shorter in the AI group than in infants who were not administered hydrocortisone. Blood pressure tended to normalize more quickly in the AI group, however, the difference was not significant. CONCLUSION: AI was a major cause of late-onset hypotension, and the use of hydrocortisone shortened the length of hospitalization.
Adrenal Insufficiency ; Blood Pressure ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gestational Age ; Hospitalization ; Humans ; Hydrocortisone ; Hypotension ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Pregnancy ; Sepsis ; Shock

The thalamus, located between the cerebrum and midbrain, is a nuclear complex connected to the cerebral cortex that influences motor skills, cognition, and mood. The thalamus is composed of 50-60 nuclei and can be divided into four areas according to vascular supply. In addition, it can be divided into five areas according to function. Many studies have reported on a thalamic infarction causing motor or sensory changes, but few have reported on behavioral and executive aspects of the ophthalmoplegia of the thalamus. This study reports a rare case of a paramedian thalamus infarction affecting the dorsomedial area of the thalamus, manifesting as oculomotor nerve palsy, an abnormal behavioral change, and executive dysfunction. This special case is presented with a review of the anatomical basis and function of the thalamus.
Cerebral Cortex ; Cerebrum ; Cognition ; Executive Function ; Infarction* ; Mesencephalon ; Motor Skills ; Oculomotor Nerve Diseases ; Ophthalmoplegia ; Thalamus

A nationwide survey was conducted to determine the incidence of bronchopulmonary dysplasia (BPD) in Korea and the intercenter differences in survival and BPD rates among preterm infants. Questionnaires were sent to all registered neonatal intensive care units (NICUs). The questionnaires inquired about the survival and BPD rates of very low birth weight (VLBW, < 1,500 g) infants who had been admitted to each NICU from 2007 to 2008. BPD was defined as requiring oxygen at 36 weeks' postmenstrual age. Almost all level III NICUs replied. During the study period, 3,841 VLBW infants were born in the NICUs that responded to the survey. The survival rate was 81% and the BPD rate was 18%. Combined outcome of BPD or death rate was 37%. The BPD rate and combined outcome of BPD or death rate varied considerably from 5% to 50% and 11% to 73%, respectively across the centers. There was no significant correlation between the survival rate and the BPD rate across the centers. In conclusion, the incidence of BPD among VLBW infants in Korea during the study period was 18%, and a considerable intercenter difference in BPD rates was noted.
Anti-Inflammatory Agents/therapeutic use ; Bronchopulmonary Dysplasia/drug therapy/*epidemiology/mortality ; Demography ; Dexamethasone/therapeutic use ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Questionnaires ; Republic of Korea/epidemiology ; Survival Rate

Pregnancy with liver cirrhosis and/or portal hypertension is uncommon. Additionally, pregnancy in young women who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis is extremely rare. Esophageal variceal rupture, fatal hemorrhage and epidural hematoma must be considered during the management of such patients. This is a case of epidural analgesia for labor in a patient who previously underwent splenorenal shunt operation for portal hypertension due to liver cirrhosis.
Analgesia, Epidural* ; Female ; Hematoma ; Hemorrhage ; Humans ; Hypertension, Portal ; Liver Cirrhosis* ; Liver* ; Pregnancy ; Rupture ; Splenorenal Shunt, Surgical*

Aortic valve replacement with aortic allograft has been considered a treatment of choice for aortic valve disease secondary to bacterial endocarditis because of its good hemodynamic performance and higher resistance to infection. The aortic root replacement technique might be superior to the subcoronary allograft implantation technique with regard to aortic regurgitation. A 46 years old male patient had acute aortic regurgitation with progressing heart failure secondary to acute bacterial endocarditis. The patient underwent emergent aortic root replacement using 20 mm aortic allograft. At operation, right coronary cusp perforation and heavy calcification of commissure between right and left coronary cusp were observed. The patient recovered well and postoperative echocardiography demonstrated no aortic regurgitation. Inflammatory signs were subsided after 8 weeks of antibiotics therapy. Medically uncontrolled acute bacterial endocarditis was treated successfully by aortic root replacement using aortic homograft.
Allografts* ; Anti-Bacterial Agents ; Aortic Valve ; Aortic Valve Insufficiency ; Echocardiography ; Endocarditis, Bacterial* ; Heart Failure ; Hemodynamics ; Humans ; Male ; Middle Aged ; Transplantation, Autologous