No abstract available.

No Abstract available.
Enterocolitis, Necrotizing* ; Heart Defects, Congenital* ; Humans ; Infant, Newborn* ; Nutritional Support*

A 34-year-old female with a history of advanced pulmonary sarcoidosis and right-sided heart failure presented with chronic, postprandial right upper quadrant pain, and weight loss. Endoscopic biliary drainage was deemed to be the most appropriate therapeutic option for her chronic cholecystitis. Endoscopic retrograde cholangiopancreatography utilizing the SpyGlass cholangioscopy system allowed us to access the cystic duct through which the gallbladder was ultimately decompressed, via biliary stent placement and gallstone irrigation. This is the first report of SpyScope assisted placement of fully covered self-expandable metal biliary stents into the cystic duct enabling definitive treatment of symptomatic chronic cholecystitis and cholelithiasis without cholecystectomy.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cholecystitis ; Cholelithiasis ; Cystic Duct ; Drainage ; Female ; Gallbladder ; Gallstones ; Heart Failure ; Humans ; Sarcoidosis, Pulmonary ; Stents ; Weight Loss

No abstract available.

OBJECTIVE: To systematically review previous studies and to assess, via a subgroup meta-analysis, the combined odds ratio (OR) of prognostic factors affecting the success of miniscrew implants (MIs) inserted into the buccal posterior region. METHODS: Three electronic searches that were limited to articles on clinical human studies using MIs that were published in English prior to March 2015 were conducted. The outcome measure was the success of MIs. Patient factors included age, sex, and jaw of insertion (maxilla vs. mandible), while the MI factors included length and diameter. A meta-analysis was performed on 17 individual studies. The quality of each study was assessed for non-randomized studies and quantified using the Newcastle-Ottawa Scale. The meta-analysis outcome was a combined OR. Subgroup and sensitivity analyses based on the study design, study quality, and sample size of miniscrews implanted were performed. RESULTS: Significantly higher success rates were revealed for MIs inserted in the maxilla, for patients ≥ 20 years of age, and for long MIs (≥ 8 mm) and MIs with a large diameter (> 1.4 mm). All subgroups acquired homogeneity, and the combined OR of the prospective studies (OR, 3.67; 95% confidence interval [CI], 2.10-6.44) was significantly higher in the maxilla than that in the retrospective studies (OR, 2.10; 95% CI, 1.60-2.74). CONCLUSIONS: When a treatment plan is made, these risk factors, i.e. jaw of insertion, age, MI length, and MI diameter, should be taken into account, while sex is not critical to the success of MIs.
Humans ; Jaw ; Maxilla ; Odds Ratio ; Outcome Assessment (Health Care) ; Prospective Studies ; Retrospective Studies ; Risk Factors ; Sample Size

Methicillin-resistant Staphylococcus aureus is composed of 80% of isolated Staphylococcus aureus in intensive care units and has become a threat to critically ill population including neonates not only in Korea. A key to success in eradicating MRSA infection within neonatal intensive care unit involves formulating an infection control guideline that is sustainable under the support of senior leader and day to day leader. When decolonization is done with mupirocin, judicious use of mupirocin should be done due to prevalance of mupirocin resistant MRSA strains found in Korea especially in the community hospitals. Implementing an effective infection control strategies to eradicate MRSA among neonatal population in Korea must include medical facilities in the community.
Critical Illness ; Hospitals, Community ; Humans ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care, Neonatal ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Mupirocin ; Staphylococcus aureus

Neonatal infections are frequent complications of neonates receiving intensive care unit. In particular, large cohort study has suggested that neonatal infections among extremely low birth weight infants are associated with poor neurodevelopmental and growth outcomes in early childhood. This review article will focus on the rational use of empirical antibiotics/antifungal therapy for early and late onset sepsis/fungemia, duration of antibiotic treatment, highlight clinically relevant aspects of the antibiotics commonly used in the treatment of sepsis, antibiotics requiring therapeutic dose monitoring, and management of antibiotic-resistant infection in the neonate.
Anti-Bacterial Agents ; Cohort Studies ; Drug Monitoring ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care Units ; Sepsis

PURPOSE: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radiographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR underwent contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-enhancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approximately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated. RESULTS: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagnosis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to occur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-enhanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the detection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%. CONCLUSION: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive values; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.
Berlin ; Catheters ; Child* ; Diagnosis ; Gravitation ; Humans ; Microbubbles ; Radiation, Ionizing ; Sensitivity and Specificity ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Tract ; Vesico-Ureteral Reflux*

PURPOSE: To compare the incidence and clinical characteristics of infants with atypical CLD and those with classic BPD among premature infants less than 32 weeks' gestation. METHODS: Clinical data was collected retrospectively from the 256 premature infants less than 32 weeks' gestation and their mothers during 3-year study period. RESULTS: Among 212 preterm infants less than 32 weeks' gestation who survived to 28 days of life, 19 (9%) had atypical CLD and 38 (17.9%) had classic BPD. Atypical CLD infants were significantly heavier and more mature than classic BPD infants (mean birth weights, 1,100+/-294 g vs 915+/-225 g; and mean gestational age, 26.9+/-1.6 weeks vs 21.1+/-1.3 weeks). Duration of ventilator therapy and oxygen inhalation within 28 days of age were shorter in atypical CLD infants than in classic BPD infants (mean duration of ventilator therapy, 16.3+/-6.9 days vs 27+/-6.8 days; and mean duration of oxygen inhalation, 25.5+/-13.5 days vs 53.8+/-39 days). Oxygen dependency in atypical CLD infants showed bimodal pattern, decreasing gradually to 3-week after birth and upturning to peak at about 5-week after birth. Comparing the respiratory indices between classic BPD and aypical CLD, FiO2 at day 2,7, and 10, and oxygen index at day 2, and 10 were significant in classic BPD, but MAP were not. Considering the birth weight, MAP per birth weight, and modified oxygen index showed more apparent differencies between the two groups. CONCLUSION: 35.5% of total CLD were atypical CLD and showed bimodal pattern in oxygen dependency. Atypical CLD infants were significantly heavier and more mature than classic BPD infants.
Birth Weight ; Bronchopulmonary Dysplasia ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature* ; Inhalation ; Lung Diseases* ; Lung* ; Mothers ; Oxygen ; Parturition ; Pregnancy ; Retrospective Studies ; Ventilators, Mechanical

In our previous study, we have demonstrated that peak inspiratory pressure over birth weight (PIP/kg) and mean airway pressure over birth weight (MAP/kg) were more significant risk factors for the development of neonatal chronic lung disease (CLD) than PIP and MAP. We aimed to develop a scoring method using the modified respiratory variables (SMUMRV) to predict CLD at early postnatal period. From 1997 to 1999, a retrospective review was performed for 197 infants <1,500 g for the development of the SMUMRV based on statistical analysis. From 2000 to 2001, calculated scores on day 4, 7 and 10 of life were obtained prospectively for 107 infants <1,500 g. Predictive values and the area under the receiver operator characteristic curve (AUC) were determined and compared with the result of the previous regression model. Gestational age, birth weight, 5 min Apgar score, PIP/kg at 12 hr of age, fractional inspired oxygen (FiO2), MAP/kg, modified oxygenation index and ventilatory mode were selected as parameters of SMUMRV. No significant differences of AUCs were found between the SMUMRV and the Yoder model. It is likely that our scoring method provides reliable values for predicting the development of CLD in very low birth weight infants.
Analysis of Variance ; Birth Weight ; Chronic Disease ; Comparative Study ; Female ; Humans ; Infant, Newborn ; Lung Diseases/*diagnosis ; Male ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Respiratory Function Tests/*methods ; Retrospective Studies ; Sensitivity and Specificity ; Time Factors