PURPOSE: High flow rate (FR) and pressure limit (PL) strategy with time-cycled pressure-limited (TCPL) ventilator is employed routinely in the neonates. Theoretical basis of this strategy is the two-compartment theory that the lung with acute respiratory failure consists of units with different compliance and resistance. But such constant pressure strategy has the risk of ventilator induced lung injury. We compared the ventilatory indices and clinical outcomes of two different strategies, high FR-constant pressure and low FR-constant FR in the ventilator care of the neonates with acute respiratory failure. METHODS: For the neonates born in our hospital and treated with mechanical ventilation from March to August in 1997, two different ventilator strategies were employed randomly with flow control ventilator. In the high-FR group, the FR was fixed at 10 L/ min and the PL was adjusted according to the arterial blood gas analysis (ABGA) results. In the low-FR group, the FR was adjusted to 10 mL/kg of tidal volume. Sixty neonates were enrolled, 32 in high-FR and 28 in low-FR group. Ventilatory indices and clinical outcomes were statistically cornpared in the two groups. RESULTS: Perinatal factors were not different in the two groups. Initial ventilator settings, ABGA results and ventilatory indices were not different. The tidal volume, fraction of inspired oxygen, peak inspired pressure and oxygenation index were higher and dynamic compliance was lower in the high-FR group compared to the low-FR group after 3 to 72 hours of ventilator care. In clinical outcomes, incidences of pulmonary interstitial emphysema, pneumothorax and chronic lung disease were significantly lower in the low-FR group. CONCLUSION: Low-FR with constant FR strategy resulted in better clinical outcomes in the ventilator care of neonates. We conclude that constant FR strategy prevents damage of the better compliant lung units and decreases the incidence of acute and chronic complications of ventilator care.
Blood Gas Analysis ; Compliance ; Emphysema ; Humans ; Incidence ; Infant, Newborn* ; Lung ; Lung Diseases ; Oxygen ; Pneumothorax ; Respiration, Artificial ; Respiratory Insufficiency* ; Tidal Volume ; Ventilator-Induced Lung Injury ; Ventilators, Mechanical

No abstract available.
Laparoscopy* ; Ureter*

Phacomatosis pigmentovascularis (PPV) is a rare syndrome characterized by concurrent nevus flammeus (capillary malformation) and pigmentary nevus. According to current research, the major pathophysiologic mechanism in PPV is venous dysplasia with resultant compensatory collateral channels and venous hypertension. Arterial involvement is rare. We herein report our experience on renovascular hypertension, intermittent claudication, and severe rhabdomyolysis due to diffuse stenosis of multiple arteries in a patient with PPV type IIb associated with SWS.
Arteries ; Constriction, Pathologic ; Humans ; Hypertension ; Hypertension, Renovascular ; Intermittent Claudication ; Intracranial Aneurysm ; Neurocutaneous Syndromes* ; Nevus ; Port-Wine Stain ; Rhabdomyolysis* ; Sturge-Weber Syndrome* ; Vascular Diseases

BACKGROUND: Various tools for the acute response system (ARS) predict and prevent acute deterioration in pediatric patients. However, detailed criteria have not been clarified. Thus we evaluated the effectiveness of bradycardia as a single parameter in pediatric ARS. METHODS: This retrospective study included patients who had visited a tertiary care children's hospital from January 2012 to June 2013, in whom ARS was activated because of bradycardia. Patient's medical records were reviewed for clinical characteristics, cardiologic evaluations, and reversible causes that affect heart rate. RESULTS: Of 271 cases, 261 (96%) had ARS activation by bradycardia alone with favorable outcomes. Evaluations and interventions were performed in 165 (64.5%) and 13 cases (6.6%) respectively. All patients in whom ARS was activated owing to bradycardia and another criteria underwent evaluation, unlike those with bradycardia alone (100.0% vs. 63.2%, p = 0.016). Electrocardiograms were evaluated in 233 (86%) cases: arrhythmias were due to borderline QT prolongation and atrioventricular block (1st and 2nd-degree) in 25 cases (9.2%). Bradycardia-related causes were reversible in 202 patients (74.5%). Specific causes were different in departments at admission. Patients admitted to the hemato-oncology department required ARS activation during the night (69.3%, p = 0.03), those to the endocrinology department required ARS activation because of medication (72.4%, p < 0.001), and those to the gastroenterology department had low body mass indexes (32%, p = 0.01). CONCLUSIONS: Using bradycardia alone in pediatric ARS is not useful, because of its low specificity and poor predictive ability for deterioration. However, bradycardia can be applied to ARS concurrently with other parameters.
Arrhythmias, Cardiac ; Atrioventricular Block ; Body Mass Index ; Bradycardia* ; Electrocardiography ; Endocrinology ; Gastroenterology ; Heart Arrest ; Heart Rate ; Hospital Rapid Response Team ; Humans ; Medical Records ; Pediatrics ; Retrospective Studies ; Sensitivity and Specificity ; Tertiary Healthcare

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. We report a case of KD with acute respiratory distress syndrome (ARDS) after intravenous immunoglobulin (IVIG) infusion. Lung manifestations associated with KD have previously been reported in the literature. Although IVIG infusion is an effective therapy for acute KD, there are some reported complications related to IVIG infusion: hypotension, aseptic meningitis, acute renal failure, hemolytic anemia, etc. The case of KD reported here was treated with IVIG and aspirin. A few days after recovery from KD, the patient developed fever and maculopapular rash. A diagnosis of relapse KD was made and retreated with IVIG infusion. However, the patient developed ARDS four days after the second IVIG infusion. The patient recovered from ARDS after nine days of ICU care, which included high frequency oscillation ventilation with inhaled nitric oxide, steroid treatment and other supportive care.
Acute Kidney Injury ; Anemia, Hemolytic ; Aspirin ; Diagnosis ; Exanthema ; Fever ; High-Frequency Ventilation ; Humans ; Hypotension ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Lung ; Meningitis, Aseptic ; Mucocutaneous Lymph Node Syndrome* ; Nitric Oxide ; Recurrence ; Respiratory Distress Syndrome, Adult* ; Systemic Vasculitis

Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.
Brain ; Cerebral Infarction* ; Child ; Child, Preschool ; Decompressive Craniectomy ; Diagnosis ; Enoxaparin ; Humans ; Immunoglobulins ; Inflammation ; Levofloxacin ; Magnetic Resonance Imaging ; Male ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia, Mycoplasma* ; Stroke ; Thrombophilia ; Thrombosis ; Vasculitis

One of the common serious consequences of trauma to the temporal bone is facial nerve paralysis. Several attempts have been made to evaluate the relationship between the radiological findings and traumatic facial paralysis. These works have demonstrated the usefulness of high-resolution computed tomogrphy in assessment of facial nerve pathway. The authors tried to clarify the significant factors contributing to the facial nerve paralysis due to temporal petrous fractures clinically and radiologically including the high resolution CT findings. Fifty eight patients with 66 petrous fractures were reviewed in this context. Various clinical factors including hearing disturbance, CSF otorrhea demonstrating the objective traumatic evidences were reviewed. Plain X-ray findings and CT findings were reviewed as radiologic evidences. The radiologic factors were fracture evidence and wide fracture gap(more than 1mm) in plain film. Among CT findings, evidence for blood in middle ear, blood in mastoid air cells, ossicular disruption, fracture line compromising the facial nerve pathway from internal acoustic canal to mastoid portion and multiplicity of fracture lines were reviewed. These factors were analyzed statistically. In this study, it was found that traumatic bony involvement in facial nerve pathway did not necessarily mean facial paralysis. The most relavent factor contributing to the traumatic facial paralysis was multiple petrous fractures.
Acoustics ; Ear, Middle ; Facial Nerve ; Facial Paralysis* ; Hearing ; Humans ; Mastoid ; Paralysis ; Temporal Bone

Cervical spondylolytic spondylolisthesis is a rare congenital anomaly. It is often misunderstood as a result of trauma. However, most of them are congenital deformities.The vast majority of patients with radiographically proven cervical spondylolysis can be treated confidently with conservative measures. Cervical spondylolytic spondylolisthesis that cause symptoms requiring surgery is very rare. Surgical intervention should be reserved for those who fail non-operative management or exhibit neurologic compromise referable to an unstable spondylolytic defect. We report a case of cervical radiculopathy in a 45-year-old female patient who had been diagnosed with spondylolytic spondylolisthesis at the sixth verterba and treated with surgery.

No abstract available.
Kidney* ; Perfusion* ; Radionuclide Imaging*

No abstract available.
Wilms Tumor*