No abstract available.
Humans ; Infant, Very Low Birth Weight* ; Critical Care*

PURPOSE: Antenatal steroid(ANS) therapy in premature infants is an effective therapeutic strategy in reducing the incidence of respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, and patent ductus arteriosus. For premature infants to gain improved survival, adequate weight loss during early postnatal days and maintenance of electrolyte balance is important, however, it is uncertain that ANS affect them. We hypothesized that ANS augment fluid and electrolyte balance and dinical outcome of very low birth weight(VLBW) who had received restricted fluid regimen. METHODS: Mechanically ventilated VLBW infants who survived over 30 days were selected. We reviewed medical records to compare weight loss, urine output, electrolyte concentration, blood pressure during five days of life and clinical outcome between premature infants who received ANS(n=15) and who were not(n=58). RESULTS: Gestational age, birth weight were similar between two groups. Volume of administered fluid, urine output, and initial weight loss during first five days of life were similar, however, weight loss on postnatal day five were lower in study group than control group(p=.039). Blood pressure, serum sodium concentration, serum potassium concentration, and urine specific gravity were similar between two groups. Incidence of respiratory distress syndrome was lower in study group(20%) than control group(48%)(p=.041), however, incidence of sepsis were greater in study group(33%) than control group(7%)(p=.029). CONDUSION: ANS did not affect fluid and electrolyte balance of very low birth weight(VLBW) infants who had received restricted fluid regimen. ANS decreased the incidence of respiratory distress syndrome in this population, however, increased the incidence of sepsis.
Birth Weight ; Blood Pressure ; Ductus Arteriosus, Patent ; Enterocolitis, Necrotizing ; Gestational Age ; Hemorrhage ; Humans ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Premature ; Medical Records ; Parturition ; Potassium ; Sepsis ; Sodium ; Specific Gravity ; Water-Electrolyte Balance* ; Weight Loss

Although prenatal and neonatal intensive care in recent years improved survival of infants, the risk of cerebral palsy (CP) in infants with perinatal asphyxia persisted. Screening criteria for risk factors of cerebral palsy and delayed development (DD) in term infants with perinatal asphyxia are required so that early diagnosis and rehabilitation and physical therapy could decrease the neurologic complications and maximize quality of life. To identify the risk factors of CP and DD in infants with perinatal asphyxia, we undertook a case-control study of 25 infants with perinatal asphyxia (5 min Apgar score below 6). At one year follow-up, 12 infants developed CP and DD and 13 control infants showed normal development. Risk factors associated with an increased risk of CP and DD were the number of abortion (p=0. 031), history of neonatal seizure (p=0.021), hypoxic ischemic encephalopathy (p=0.046), and poor response to resuscitation immediately after birth (p=0.017). In term infants with perinatal asphyxia, the risk factors of CP and DD were increased number of abortion, history of neonatal seizure, and hypoxic ischemic encephalopathy and poor response to resuscutation. Thus infants with these risk factors should be carefully followed up after hospital discharge and further extensive and prospective study in term infants with perinatal asphyxia could elucidate possible mechanisms related to cerebral palsy and delayed development.
Apgar Score ; Asphyxia* ; Case-Control Studies ; Cerebral Palsy* ; Early Diagnosis ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal ; Mass Screening ; Parturition ; Quality of Life ; Rehabilitation ; Resuscitation ; Risk Factors* ; Seizures

We report a case of colonic metastasis from ovarian cancer presented as an intraluminal fungating mass mimicking primary colon cancer 8 years after surgery for ovarian cancer. A 70-year-old woman presented with constipation. She had undergone an extended total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian papillary serous cystadenocarcinoma 8 years earlier. Colonoscopy showed a large fungating mass 10 cm from the anal verge that was suspected to be colorectal cancer. A computed tomography scan showed a bulky intraluminal fungating mass in the rectosigmoid junction. After a lower anterior resection and a pathologic diagnosis, a diagnosis of a papillary serous adenocarcinoma due to metastasis from an ovarian tumor was made for this patient.
Adenocarcinoma ; Aged ; Colon* ; Colonic Neoplasms ; Colonoscopy ; Colorectal Neoplasms ; Constipation ; Cystadenocarcinoma, Serous ; Diagnosis ; Female ; Humans ; Hysterectomy ; Neoplasm Metastasis* ; Ovarian Neoplasms*

No abstract available.
Mucous Membrane* ; Prolapse* ; Vitelline Duct*

PURPOSE: The vancomycin dosage regimen is regularly modified according to the patient's glomerular filtration rate (GFR). In the present study, we aimed to assess the usefulness of serum cystatin C (Cys-C) concentration, compared with serum creatinine (SCr) concentration, for predicting vancomycin clearance (CLvcm) in neonates. METHODS: We retrospectively analyzed the laboratory data of 50 term neonates who were admitted to the neonatal intensive care unit and received intravenous vancomycin, and assessed the pharmacokinetic profiles. Creatinine clearance (CLcr) and GFR based on Cys-C (GFRcys-c) were estimated using the Schwartz and Larsson formulas, respectively. RESULTS: The mean CLvcm (+/-standard deviation) was 74.52+/-31.17 L/hr, the volume of distribution of vancomycin was 0.67+/-0.14 L, and vancomycin half-life was 9.16+/-17.42 hours. The SCr was 0.46+/-0.25 mg/dL and serum Cys-C was 1.43+/-0.34 mg/L. The peak and trough concentrations of vancomycin were 24.65+/-14.84 and 8.10+/-5.35 mcg/mL, respectively. The calculated GFR based on serum creatinine concentration (GFR-Cr) and GFRcys-c were 70.2+/-9.45 and 63.6+/-30.18 mL/min, respectively. The correlation constant for CLvcm and the reciprocal of Cys-C (0.479, P=0.001) was significantly higher than that for CLvcm and the reciprocal of SCr (0.286, P=0.044). GFRcys-c was strongly correlated with CLvcm (P=0.001), and the correlation constant was significantly higher than that for CLvcm and CLcr (0.496, P=0.001). Linear regression analysis showed that only GFRcys-c was independently and positively correlated with CLvcm (F=41.9, P<0.001). CONCLUSION: The use of serum Cys-C as a marker of CLvcm could be beneficial for more reliable predictions of serum vancomycin concentrations, particularly in neonates.
Creatinine ; Cystatin C* ; Glomerular Filtration Rate ; Half-Life ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Linear Models ; Retrospective Studies ; Vancomycin*

We report a case of a goblet-cell carcinoid tumor of the appendix which metastasized to the peritoneum and was treated by using cytoreductive surgery (CRS) with intraperitoneal chemotherapy. A 47-year-old male presented with chronic constipation and was diagnosed as having a rectal adenocarcinoma with a signet-ring-cell component under colonoscopy. Computed tomography suggested peritoneal metastases with diffuse nodular parietal peritoneal thickening of the entire abdomen and focal invasion of the upper rectum by a seeding mass. CRS with intraperitoneal chemotherapy was done under the diagnosis of a rectal adenocarcinoma with peritoneal metastases. The pathologic diagnosis was a goblet-cell carcinoid tumor of the appendix with peritoneal metastasis. The histological discrepancy between a peritoneal metastatic mass and a rectal mass was due to the mixed histological pattern of a goblet-cell carcinoid tumor. A metastatic mass may not share identical immunohistochemical characteristics from its origin. This histologic discrepancy necessitates caution in diagnosing a distant metastasis of a goblet-cell carcinoid tumor.
Abdomen ; Adenocarcinoma ; Appendix ; Carcinoid Tumor* ; Colonoscopy ; Constipation ; Diagnosis ; Drug Therapy* ; Goblet Cells ; Humans ; Infusions, Parenteral ; Male ; Middle Aged ; Neoplasm Metastasis ; Peritoneal Neoplasms ; Peritoneum ; Rabeprazole ; Rectum

OK-432 (picibanil) is an inactivated preparation of Streptococcus pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.
Chest Tubes ; Chylothorax ; Drainage ; Edema ; Humans ; Hydrops Fetalis ; Infant ; Infant, Newborn ; Infant, Premature ; Picibanil ; Pleural Effusion ; Pleurodesis ; Pregnancy ; Recurrence ; Streptococcus pyogenes

PURPOSE: Pulmonary interstitial emphysema (PIE) is a common and serious complication of mechanical ventilation in infants with hyaline membrane disease. This abnormal collection of gases has two basic roentgenographic features; linear and cyst-like radiolucencies. High positive inspiratory pressure was found to be the most significant parameter associated with development of fatal pulmonary interstitial emphysema. Without prompt conservative management such as lowering peak inspiratory pressure, PIE often progress to a pneumothorax with increased mortality. We studied the incidence and risk factors of PIE and associated risk factors which progress to pneumothorax in mechanically ventilated infants with hyaline membrane disease. METHODS: We reviewed retrospectively the charts of infants who had been admitted to the neonatal intensive care unit between Jan. 1990 and Mar. 1995. A hundred and two infants who were diagnosed as hyaline membrane disease and mechanically ventilated were included in the study. Analysis of clinical characteristics and ventilator parameters were made. Chest radiographs were reviewed for hyaline membrane disease, PIE, pneumothorax by a pediatric radiologist without knowledge of their clinical course. RESULTS: 1) We observed PIE in 14 of 102 infants (13.7%) of which 11 infants progressed to develop pneumothorax. 2) Low gestational age, low apgar score and high peak inspiratory pressure were the factors significantly associated with development of PIE. 3) PIE was frequently located bilaterally (52%), distributed on whole lung parenchyme (92%). Sizes of radiolucency were variable including blebs. 4) Early onset PIE and failure to promptly lower peak inspiratory pressure were the associated risk factors for development of pneumothorax. 5) Pneumothorax developed within a mean 7.5 hours after apperance of PIE. Right side pneumothorax was more frequent (67%). Mortality increased to 73% with development of pneumothorax in PIE. CONCLUSIONS: Early diagnosis of PIE and prompt lowering of peak inspiratory pressure should be emphasized to improve the survival and outcome of mechanically ventilated hyaline membrane diasease infants.
Apgar Score ; Blister ; Early Diagnosis ; Emphysema* ; Gases ; Gestational Age ; Humans ; Hyalin* ; Hyaline Membrane Disease* ; Incidence ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Lung ; Membranes ; Mortality ; Pneumothorax ; Radiography, Thoracic ; Respiration, Artificial ; Retrospective Studies ; Risk Factors* ; Ventilators, Mechanical

This study examined the effects of custom nutrition education on dietary intakes and clinical parameters in patients diagnosed with iron deficiency anemia. A total of 34 patients visited the anemia clinic of Yeouido St. Mary's Hospital. Among these, only 16 patients were available for follow-ups. A follow-up was conducted by a clinical dietitian 2 months from the first nutrition education session. Patients were all women. For custom nutrition education, we investigated anthropometric data, dietary assessment (24 hr-recall, FFQ), and self-recognized anemic symptoms. Weight did not show a significant difference but hemoglobin, hematocrit (P<0.01), serum iron, and serum ferritin (P<0.05) were significantly increased after the nutrition education. Serum total iron binding capacity was significantly decreased (P<0.01). Self-recognized symptoms such as dizziness, fatigue (P<0.001), shortness of breath, headache (P<0.01), brittle nails, and sore tongue (P<0.05) were significantly improved. Daily intakes of protein (P<0.05), total iron (P<0.01), and animal iron (P<0.001) were significantly increased. A significantly negative correlation was observed between current serum iron and the intake of carbohydrates, fat, or phosphorus (P<0.05). But current serum ferritin showed a significantly positive correlation with the frequency of intake of meat, poultry, and fish. It could be concluded that the custom nutrition education might be effective on quality of diet as well as iron status and it might also improve the clinical parameters in patients diagnosed with the iron deficiency anemia.
Anemia ; Anemia, Iron-Deficiency ; Animals ; Carbohydrates ; Diet ; Dizziness ; Dyspnea ; Fatigue ; Female ; Ferritins ; Follow-Up Studies ; Headache ; Hematocrit ; Hemoglobins ; Humans ; Iron ; Meat ; Nails ; Phosphorus ; Poultry ; Tongue