PURPOSE: The surfactant dysfunction may play an important role in meconium aspiration syndrome (MAS). We aim to evaluate the effect of surfactant lavage in the treatment of term infants with MAS. METHODS: The medical records of 15 neonates with severe MAS admitted at Yongdong Severance Hospital from 2005 to 2007 were reviewed and analyzed. Seven infants with severe MAS necessitating mechanical ventilation underwent tracheobronchial lavage with 20 mL/kg of diluted (5.3 mg phospholipid/mL) surfactant saline suspension (Newfactan(R)). Data regarding clinical outcomes was assessed by comparison with 8 control infants with equally severe MAS retrospectively. RESULTS: In the lavage group, radiological improvement was evident after 6 hours of treatment. The duration of artificial ventilation and duration of hospital day were also significantly shorten in the lavage group compared with the control group. The mean oxygen index, mean ventilation index improved significantly within the first 6 hours after treatment. No differences were found in the incidence of major complications and mortality between the two groups. CONCLUSION: The surfactant lavage seems to be an effective and safe method for treatment of severe MAS. A multicenter, large scaled randomized controlled trial is needed for further study.
Bronchoalveolar Lavage ; Humans ; Incidence ; Infant ; Infant, Newborn ; Meconium ; Meconium Aspiration Syndrome ; Medical Records ; Oxygen ; Pulmonary Surfactants ; Respiration, Artificial ; Therapeutic Irrigation ; Ventilation

PURPOSE: Inflammation plays a potential role in the pathogenesis of bronchopulmonary dysplasia (BPD). Strategies for preventing BPD include respiratory management, antioxidants, nutritional treatment, and others such as anti-inflammatory agents. We aimed to assess the safety, tolerability, and efficacy of montelukast (MK), a cysteinyl leukotriene 1 receptor antagonist, as an add-on therapy in BPD. METHODS: In addition to currently available standard measures such as oxygen supplementation, bronchodilators, nutritional support, and/or diuretics, montelukast was administered to 15 preterm infants with BPD. MK was given orally (1 mg/kg/d) for a mean period of 12 weeks. We compared safety and efficacy parameters with historical controls. RESULTS: All 15 patients survived, and no differences were found in the incidence of adverse reactions between the 2 groups. The ventilation index was significantly improved after 2 weeks in MK group compared with historical controls. There were no significant differences in other respiratory parameters (MAP, oxygen dependency, and ventilator dependency) between the groups, but the MK group showed trends of greater improvement. CONCLUSION: Administration of MK 1 mg/kg/d was well tolerated in preterm BPD patients as an add-on therapy. We demonstrated that after 2 weeks of MK administration of 1 mg/kg/d, MK had beneficial therapeutic effects on BPD patients as an add-on to the standard therapy. Further multicenter randomized controlled clinical trials are needed to confirm the efficacy and safety of MK as a useful supplement to standard therapy for BPD patients.
Acetates ; Anti-Inflammatory Agents ; Antioxidants ; Bronchodilator Agents ; Bronchopulmonary Dysplasia ; Dependency (Psychology) ; Diuretics ; Humans ; Incidence ; Infant, Newborn ; Infant, Premature ; Inflammation ; Nutritional Support ; Oxygen ; Quinolines ; Ventilation ; Ventilators, Mechanical

Most of the gastric outlet obstruction symptoms like vomiting and abdominal distension were caused by congenital anatomical abnormality in a neonate. Abnormal structures associated with congenital gastric outlet obstruction have been categorized by its site and extent of obstruction. We report one case of persisting vomiting in a premature infant caused by serosal fibrous band in gastric outlet lesion, excluded from the category of congenital gastric outlet obstruction.
Fibrosis ; Gastric Outlet Obstruction* ; Humans ; Infant, Newborn ; Infant, Premature ; Vomiting

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.
Anesthesia ; Anesthesia, Spinal* ; Arthroplasty ; Blood Pressure ; Ephedrine* ; Femoral Neck Fractures ; Heart Rate ; Hip ; Humans ; Hypertension ; Hypotension* ; Incidence ; Injections, Intramuscular ; Needles ; Tetracaine

This study was designed to compare the efficacy of an ephedrine intramuscular injection with crystalloidadministration for the prevention of hypotension during spinal anesthesia in geriatric patients undergoing hip fracture surgery. Twenty-seven ASA II patients scheduled for the .arthroplasty of femoral neck fracture under spinal anesthesia were randomly allocated to receive either 15 ml/kg of Ringer's lactated solution (crystalloid group) or an ephedrine intramuscular injection (ephedrine group). Spinal anesthesia was performed in a lateral decubitus position. According to the patient's height, 10-12 mg of hyperbaric 0,5% tetracaine was injected through a 23-25 gauge spinal needle at the L3-4 or L4-5 interspace. Patients in crystalloid group received Ringer's lactated solution 15 mVkg, over 20 minutes before spinal anesthesia. Patients in the ephedrine group were injectede 30 mg of ephedrine I.M immediately after spinal anesthesia. The incidence of hypotension was 8/12 (66%) in the crystalloid group and 6/15 (40%) in the ephedrine group (p<0.01). There was no significant difference between the groups in the level of anesthesia or heart rate, and hypertension did not occur in either group. The result of this study suggests that the intramuscular injection of ephedrine may be more effective than crystalloid infusion for the prophylaxis of hypotension associated with spinal anesthesia in geriatric patients.
Anesthesia ; Anesthesia, Spinal* ; Arthroplasty ; Blood Pressure ; Ephedrine* ; Femoral Neck Fractures ; Heart Rate ; Hip ; Humans ; Hypertension ; Hypotension* ; Incidence ; Injections, Intramuscular ; Needles ; Tetracaine

No abstract available.
Female ; Pregnancy ; Pregnancy Outcome* ; Pregnancy*

Scleroderma is rare disease of unknown etiology characterized by fibrosis of skin and internal organs such as lung, gastrointestinal tract, kidney, heart and so on. The association between scleroderma and malignancy has been a controversy during recent years. We report a 77-year old female who had scleroderma and squamous cell carcinoma of esophagus. She was diagnosed as esophageal carcinoma and then sclerotic skin change developed in both hands and feet 3 months later. We present this case with a review of literatures.
Aged ; Carcinoma, Squamous Cell ; Esophageal Neoplasms ; Esophagus ; Female ; Fibrosis ; Foot ; Gastrointestinal Tract ; Hand ; Heart ; Humans ; Kidney ; Lung ; Rare Diseases ; Skin

Isotretinoin is a known human teratogen that can cause multiple malformations. At present, women who conceive one cycle after discontinuing isotretinoin are told that their teratogenic risk is not higher than baseline. We present a case of both ear malformation in a newborn whose mother had taken isotretinoin for 2 years until one month prior to the time when she became pregnant. We suggest that further studies of pharmacokinetics and malformation of isotreinoin are needed.
Abnormalities, Drug-Induced/*diagnosis/*etiology/pathology ; Adult ; Female ; Humans ; Infant, Newborn ; Isotretinoin/*adverse effects ; Male ; Pregnancy ; *Prenatal Exposure Delayed Effects

BACKGROUND: Cefoxitin, a cephamycin-type antibiotic, is known to be superior to oxacillin in predicting the presence of mecA gene because it serves as a very potent inducer of mecA regulatory system. We used a cefoxitin disk diffusion methods for detection of methicillin-resistant Staphylococcus aureus (MRSA), and compared it with the conventional methods. METHODS: For 50 MRSA and 50 methicillin susceptible S. aureus confirmed by mecA and femA gene PCR, oxacillin, cefoxitin, and moxalactam disk diffusion methods, oxacillin and cefoxitin E-tests, Vitek 2 and Microscan Walkaway antibiotics susceptibility tests, and PBP2a latex agglutination test were performed. The sensitivity and specificity of each method were evaluated. RESULTS: The sensitivities of oxacillin disk diffusion method and E-test were 96%. The sensitivities of cefoxitin and moxalactam disk diffusion method, cefoxitin E-test, Vitek 2, Microscan Walkaway, PBP2a latex agglutination test were 100%. The specificities were 100% for all the methods used. CONCLUSIONS: It may be considered that both the cefoxitin- and moxalactam disk diffusion methods are effective and excellent screening methods for the detection of MRSA in clinical laboratory routinely.
Anti-Bacterial Agents ; Cefoxitin ; Diffusion ; Latex Fixation Tests ; Mass Screening ; Methicillin ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Moxalactam ; Oxacillin ; Polymerase Chain Reaction ; Sensitivity and Specificity

BACKGROUND: Peroxisome proliferator activated receptor-gamma (PPAR-gamma) is a nuclear receptor that regulate adipocyte differentiation and modulate intracellular insulin-signaling events. As such, PPARgamma is a candidate gene for several human disorders including obesity and type 2 diabetes mellitus. The objective of our study was to examine the relationship between genetic variation of PPARgamma2 and diabetes and obesity in Korean subjects. METHODS: We studied 99 subjects with type 2 diabetes mellitus, 128 obesity patients and 97 controls. Screening for mutation at codon 12 and 115 of PPARgamma2 were carried out by PCR-RFLP analyses. Statistical significance was evaluated by Chi-square test. RESULTS: The allele frequency of the Pro12Ala PPARgamma2 variant were 0.05 in controls, 0.06 in type 2 diabetes group, and 0.07 in obesity group (p=0.47). Pro115Gln variant were only proline homozygote in all groups. Genotype frequencies were also similar and conformed to expectations of the Hardy-Weinberg rule. The presence of PPARgamma2 gene variant was no associated with concentrations of total cholesterol, triglyceride, HDL-cholesterol, and also with fasting glucose. CONCLUSION: We concluded that the Pro12Ala and Pro115Gln PPARgamma2 missense mutation may not be associated with type 2 diabetes mellitus and obesity in Korean patients.
Adipocytes ; Cholesterol ; Codon ; Diabetes Mellitus, Type 2* ; Enzyme-Linked Immunosorbent Assay ; Fasting ; Gene Frequency ; Genetic Variation ; Genotype ; Glucose ; Homozygote ; Humans ; Liver Cirrhosis ; Mass Screening ; Mutation, Missense ; Obesity* ; Peroxisomes ; PPAR gamma* ; Proline ; Triglycerides