PURPOSE: Factors affecting the response to surfactant replacement therapy are considered as types of surfactant, and strategies of treatment including prophylactic vs rescue therapy, single vs multiple doses, methods of mechanical ventilation, and modes of surfactant delivery. Among those factors, response to surfactant replacement therapy according to the modes of surfactant delivery was rarely studied in the world. In preterm infants with RDS, we studied the efficacy and adverse effects of surfactant replacernent therapy according to the differences in the modes of surfactant delivery. METHOD: Preterm infant weighing 500-2,500g with RDS who required assisted ventilation were divided into two groups. One group is as follows five fractional doses with five positional changes after removal from ventilator by feeding tube technique. The other group is as follows; two fractional doses with two positional changes by side-port adaptor technique. Of the 30 infants enrolled, 15 were randomly assigned to each group. We compared the respiratory indices, chest radiologic response, clinical outcome after surfactant replacement, and adverse effects during dosing procedure. RESULT: There were no diffrences of patient profile between two groups. There were significant improvernent in FiO2, a/APO2, MAP, OI, and chest radiologic response following surfactant replacement therapy in both groups. No significant differences were noted in the adverse effects during dosing procedure and incidence of complication. CONCLUSION: In initial phase of RDS treatment with surfactant replacement therapy, two fractional doses with two positional changes by side-port adaptor technique improve respiratory indices, radiologic response without dernonstrable harmful effects as five fractional doses with five positional changes after removal from ventilator by feeding tube technique, however two fractional dosing procedure is more recommendable because of #more simple and convenient procedure.
Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Respiration, Artificial ; Thorax ; Ventilation ; Ventilators, Mechanical

We analyzed neurodevelopmental outcome data of 36 selected studies. Data of individual studies were pooled by birth weight group: <800g, <1.000g, <1.500g and by time period of birth year: Period I (pre-intensive care era), 1960-67:Period II (beginning period of intensive care), 1968-76: and Period III (established period of intensive care), 1977-87. In all weight groups, survival and intact outcome rates based on live birth have progressively improved over the three period. The major neurodevelopmental handicap rate of the <1,500g decreased in Period III vs. Period I and Period II (66,70, and 45 per 1,000 live births in I, II, and III, respectively). However, the major handicap rate in the <800g and the <1,000g live births increased: in the <800g, from 48 per 1,000 live births in Period II to 101 in Period III and, in the <1000g, from 28 per 1,000 live births in Period I to 67 in Period II and 73 in Period III. Increases in major handicap rate in two lower weight groups were predominantly the effect of increasing number of survivors over these periods and had little to do with the change in handicap rates in the survivors. In the <1,500g, the magnitude of reduction in handicap rate in the survivors was sufficient to overwhelm the effect of increased survival, resulting in a reduction in the number of major handicapped children. We conclude that based on the currently avaiable reports, neonatal intensive care has provided very low birth weight infants with a reduction in mortality, an increase in intact outcome, and decrease in the number of major neurodevelopmentally handicapped children. We try to estimate the trend of major neurodevelopmental handicap and intactoutcome of infants with birth weights <1,500g in Korea and speculate that major handicap rate have progressively increased over the three period in spite of increase in intact outcome.
Birth Weight ; Disabled Children ; Humans ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal* ; Korea ; Live Birth ; Mortality ; Parturition ; Survivors

We studied the effects of chronic hyperoxia (>95% oxygen for 14 days) in change of body weight, wet to dry lung weight ratio, and morphologic changes of lung tissue compared with that of room air (21% oxygen for 14 days) in Sprague-Dawley neonatal rat pups. The results were as follows: 1) In neonatal rat pups exposed to room air (normoxia group), body weight of initial 3 days of neonatal rat pups was 9.18 0.18g, and body weights of developing rat pups exposed to room air for 7, 10, 14 days were 14.07 1.90, 17.00 2.09, 23.07 1.93g respectively. In neonatal rat pups exposed to hyperoxia (hyperoxia group), body weight of initial 3 days of neonatal rat pups was 9.35 0.80 g, and body weights of developing rat pups exposed to hyperoxia for 7, 10, 14 days were 11.06 1.31, 12.64 1.77, 15,41 1.65 g respectively. These results suggest that changes of body weight in developing rat pups were stunted significantly in the hyperoxia group compared with normoxia group during 14days-experiment (p<0.01). 2) No appreciable difference of wet to dry lung weight ratio was noted at initial 3 days of neonatal rat pups between normoxia group and hyperoxia group, but considerably increased wet to dry lung weight ratio was noted significantly at 7 days of exposure in the hyperoxia group compared with the normoxia group (p<0.05). The difference of wet to dry lung weight ratio was not significant at 10, 14 days of exposure between normoxia group and hyperoxia group. These results suggested that relative water content of wet lung was at a peak at 7 days of exposure in hyperoxia group. 3) The lung from developing rat pups exposed to room air for 7 days had many small alveoli and numerous septal buds. However, in the lung from developing rat pups exposed to hyperoxia for 7 days, presence of pink staining material within the lumen of the air spaces (proteinaceous edema fluid) and increased interstitial cellularity due to infiltration by macrophages and neutrophils was observed, and these findings suggested acute exudative lung injury. 4) In most lungs from developing rat pups exposed to room air for 14 days, much increased alveolarization including the secondary septal bud formation was observed. However, in most lungs from developing rat pups exposed to hypeoxia for 14 days, increased septal and interstitial cellularity and thickness and interstitial fibrosis were observed significantly compared with normoxia group (p<0.01). In conclusion we could make a experimental animal model which had similar histopathologic finding of bronchopulmonary dysplasia in human infant and this model will be useful for research of pathogenesis of bronchopulmonary dysplasia.
Animals ; Body Weight ; Bronchopulmonary Dysplasia ; Edema ; Fibrosis ; Humans ; Hyperoxia* ; Infant ; Infant, Newborn ; Lung Injury ; Lung* ; Macrophages ; Models, Animal ; Neutrophils ; Oxygen ; Pulmonary Edema ; Rats* ; Rats, Sprague-Dawley

No abstract available.
Humans ; Infant, Newborn*

Volkmanns ischemic contracture, despite a relatively small incidence, is one of the most devastating complications following a limb injury. The orthopedic surgeon must be equipped to recognize and effectively treat this complication. Recently the authors have managed 3 cases with V.I.C. with the following results. 1) The etiology showed CO poisoning, arterial injury, wringer injury around the elbow in each case. 2) The method of surgical treatment depended upon deformities and functional loss of individual patient. 3) The end results seemed to be proportionate to the previous deformities and functional less. 4) Early postoperative passive exercises of the digits seemed to be helpful in restoring further range of motion.
Congenital Abnormalities ; Elbow ; Exercise ; Extremities ; Humans ; Incidence ; Ischemic Contracture ; Methods ; Orthopedics ; Poisoning ; Range of Motion, Articular ; Upper Extremity

In several pathologic conditions of the joints, it is rather frequent to find a swollen joint. The authors performed an analysis of the joint fluid proteins from 20 cases of rheumatoid arthrit is and 20 normal Kore an adults with the object of evaluating the significance of it s clinical application. The study was done with Beckman Model R System, Durrum type cell, and scanned with Model RB Analytrol. Scheicher and Schuell 2043-A paper was used with diethyl barbituric acid-sodium diethyl barbituratebuffer, pH 8.6, ionic strenght 0.075 and stianed with 0.1% bromphenol blue. The results obtained were as follows: 1) The amount of total protein was significantly increased with average of 4.80 + 1.249gm% in comparison with 2.34 + 0.553gm% in normal group. 2) Albumin fraction showed the average of 41.86 + 6.219% in comparison with 64.85 + 5.288% in normal group. 3) Alpha 2 globulin fraction disclosed the average of 10.19 + 3.379% in comparison with 4.24 + 1.158% in normal group, which was significantly increased one. 4) Gammaglobulin fraction was also significantly elevated with the average of 21.51 + 8.942% in comparison with 11.70 + 1.923% in normal group. 5) There was noted a decreased A/G ratio, the average of 0.74 + 0.196, in comparison with 1.911 + 0.430 in normal group.
Adult ; Arthritis, Rheumatoid ; Bromphenol Blue ; Humans ; Hydrogen-Ion Concentration ; Joints

79 patients with suspected H.N.P. of lumbar vertebrae were studied from June 1983 to June 1986 who had had both metrizamide myelography and computed tomography. Comparative study of the findings from clinical examination, CT and myelography of them are as follows. l. In physical examination, S.L.R.T. was most common sign, 58 patient(73.4% of study group) showed positive in S.L.R.T.(30~70 range). Of these positive patients in S.L.R.T. 41.4% was the patients who were younger than 30 years of age and also had pressure sign of nerve root on CT and myelography. These group showed highest positive rate in S.L.R.T. 2. In CT and myelographic study, the most frequent occurence of H.N.P. were seen in L4–5, L5–S1, L3–4 in order and myelography showed higher positive rate in L4–5 intervertebral space while CT showed higher positive rate in LS–S1. 3. On CT, facet joint arthritis or stenosis were seen in 49.4% of the study group and 53.7% of computed tomographic positive patients of H.N.P. 4. Corresponding rate of positive sign of H.N.P. between CT and myelographic findings were seen 71 intervertebral spaces, which means 84.5% of 84 positive spaces on CT and 88.8% of 80 positive spaces on myelography. 5. In 49 intervertebral spaces clinical sign, CT and myelographic findings were all positive. In another words 58.3% of 84 positive intervertebral spaces on CT and 61.3% of 80 positive spaces on myelography showed all positive sign on clinical examentation, CT and myelography. 6. L5–Sl intervertebral spaces showed most controversial results in comparative study of CT and myelography. 7. 25 of 26 positive spaces on CT(96.2%) and 23 of 26 positive spaces of myelography(88.5%) were confirmed by operation and all 3 false-negative on myelography were found in L5–Sl intervertebral space. 8. Most diagnostic differences were seen in L5–S1, which has wider epidural space. CT showed higher sensitivity than myelography in this study. For its higher sensitivity and non-invasiveness CT is thought to be first recommendable method for diagnosis of H.N.P. and myelography is recommended as second best choice where diagnostic differences are seen.
Arthritis ; Constriction, Pathologic ; Diagnosis ; Epidural Space ; Humans ; Lumbar Vertebrae ; Methods ; Metrizamide ; Myelography ; Physical Examination ; Zygapophyseal Joint

No abstract available in English.
Calcaneus ; Clinical Study

NO abstract available.
Glomerulonephritis, IGA* ; Humans ; Immunoglobulin A* ; Lymphocytes* ; RNA, Messenger* ; Transforming Growth Factor beta

Over a continuous 4-year period, from January 1989 till December 1992, 7,100 infants were born in Department of Obstetrics and admitted to Nursery or Neonatal Intensive Care Unit of Department of Pediatrics of Seoul National University Children's Hospital. Among them, 126 cases were diagnosed as respiratory distress syndrome (RDS) of newborn. The total incidence of RDS among all the newborns (inborn) was 1.77%. And the incidence of RDS related to birth weight was 81.82% in infants of 500~749 g of birth weight, 68.57% in infants of 750~999 g of birth weight, 55.6% in infants of 1,000~1,249 g of birth weight, 35.71% in infants of 1,250~1,499 g of birth weight, 16.67% in infants of 1,500~1,749 g of birth weight, 9.82% in infants of 1,750~1,999 g of birth weight, 1.00%in infants of 2,000~2,249 g of birth weight, 1.29%in infants of 2,250~2,499 g of birth weight, and 0.08% in infants of more than 2,500 g of birth weight. Cumulative incidence of RDS related to birth weight was 81.82%in infants under 750 g of birth weight, 71.74% in infants under 1,000 g of birth weight, 62.39% in infants under 1,250 g of birth weight, 53.33% in infants under 1,500 g of birth weight, 39.85% in infants under 1,750 g of birth weight, 30.83% in infants under 2,000 g of birth weight, 20.42% in infants under 2,250 g of birth weight, and 13.70% in infants under 2,500 g of birth weight. The incidence of RDS related to gestational age was 83.33%, in infants under 25 weeks of gestation, 78.57% in infants at 25~26 weeks of gestation, 67.31% in infants at 27~28 weeks of gestation, 56.41%in infants at 29~30 weeks of gestation, 16.47% in infants at 31~32 weeks of gestation, 4.74% in infants at 33~34 weeks of gestation, 1.15% in infants at 35~36 weeks of gestation, and 0.05% in infants at more than 37 weeks of gestation. Cumulative incidence of RDS related to gestational age was 83.33% under 25 weeks of gestation, 80.00% under 27 weeks of gestation, 70.83% under 29 weeks of gestation, 63.33% under 31 weeks of gestation, 46.38% under 33 weeks of gestation, 27.76% under 35 weeks of gestation. Perinatal risk factors related to the incidence of RDS were analyzed by the multiple logistic regression statistical method in 595 infants, who were born under 37 weeks of gestation and under 2,500 g of birth weight in Seoul National University Hospital. The risk of RDS rose with decreasing gestational age (odds ratio=1.76, 95% CI=1.57, 1.99), with decreasing 5 minute Apgar score (odds ratio=1.23,95% CI=1.08, 1.40), while prolonged ruptrue of membranes of > 24 hours in the absence of maternal infection was highly protective (odds ratio=0.37, 95% CI=0.20, 0.70).
Apgar Score ; Birth Weight ; Gestational Age ; Humans ; Incidence* ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Logistic Models ; Membranes ; Nurseries ; Obstetrics ; Pediatrics ; Pregnancy ; Risk Factors* ; Seoul