PURPOSE: The neuophils contribute as an important defence mechanism against bacterial infection. In neonates with infection, not only the number of neutrophils are decreased due to inhibited production but also phagocytic function is impaired resulting in high mortality rate. The purpose of this study is to establish the effectiveness of exogenous granulocyte-macrophage colony-stimulating factor (GM-CSF) in infected neonates by comparing the serum levels of GM-CSF and various hematologic paratmeters in non-infected and infected neonates. METHODS: The study included 50 neonates without infection and 23 neonates with infection who were admitted to neonatal intensive care unit of Chungnam National University Hospital in between May 1998 and February 1999. The total number of white blood cell (WBC) counts, absolute granulocyte counts (AGC) and the serum GM-CSF concentration at birth were measured in non-infected neonates and they were stratified according to birth weight and gestational age. The total number of WBC counts, AGC and the serum GM-CSF concentration at postnatal 7th and 14th day were measured and compared with that of infected neonate's. Neonates with infection were divided either to receive exogenous GM-CSF & antibiotics or antibiotics only; The total number of WBC counts, AGC and the serum GM-CSF concentration at post-treatment 2nd and 7th day were measured and compared. RESULTS: Decreased total number of WBC counts, AGC and the serum GM-CSF concentration at birth were observed with lower birth weight and gestational age. In infected neonates, the total number of WBC counts, AGC and the serum GM-CSF concentration increased more when compared with that of non-infected neonates. Tendency towards increased total number of WBC counts, AGC and the serum GM-CSF concentration were observed after exogenous GM-CSF treatment. CONCLUSION: We recommend the use of GM-CSF in neonates with infection, especially those without increasing total WBC counts, and absolute granulocyte count as a norrnal physiological response.
Anti-Bacterial Agents ; Bacterial Infections ; Birth Weight ; Chungcheongnam-do ; Gestational Age ; Granulocyte-Macrophage Colony-Stimulating Factor ; Granulocytes* ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Leukocytes ; Macrophages* ; Mortality ; Neutrophils ; Parturition

Respiratory distress syndrome of preterm infants remains a significant cause of morbidyty and mortality. Early, just after birth, prediction and recognition of RDS is so important. The precision and reliability of the stable microbubble test (SMR)and shake test as a predictor of respiratory distress syndrome were studied. A 110-neonate who was born at Chungnam National University Hospital between November 1991 to September 1992was selected randomely and studied. The results were as follows; 1) Among the 110 neonates, 13 cases were noticed as RDS. 2) Among the 13 infants with RDS, SMR results were zero and very weak in 11 cases, weak in 2 cases. Of the 97 infants with Non-RDS, 9 cases were weak, 88cases were medium and strong, positive predictive value and negative predictive value was 100%, 98% respectively. 3) Of the 13 infants with RDS, Shake test result were negative in 8 cases, 1+in 1 case, 2+in 1 case and 4+in 3 case. Of the 97 infants with Non-RDS, 3 cases were negative, 9 cases were 1+, 9cases were 2+ and 63 cases were 4+, positive predictive value and negative predictive value was 72.7%, 9 However, frequent relapses and severe side effects caused by such therapy necessitate development of a more specific and effective therapeutic regimen.Recently, a T cell derived cytokine, interleukin 4 (IL-4)is being recognized as a major cytokine up-regulating IgE production and response, while interferon- (IFN- )counteracts IL-4 actions to down-regulate the IL-4 induced IgE response. Hence, the present study is aimed to investigate the role of IL-4 in MCNS. Using freshly isol 4.9% respectively. We conclude that the rapidity, simplicity and reliability of the stable microbubble test is more useful as a bedside procedure in identifying of predicting the infants who are likely to develop RDS than shake test.
Chungcheongnam-do ; Humans ; Immunoglobulin E ; Infant ; Infant, Newborn ; Infant, Premature ; Interleukin-4 ; Microbubbles* ; Mortality ; Parturition ; Recurrence

No abstract available.

PURPOSE: Acute diverticulitis of the right colon is not rare in Korea and the clinical presentation is indistin guishable from acute appendicitis. Cecal diverticulitis has led to a controversy in the management of disease. METHODS: Thirty-one cases of acute cecal diverticulitis who underwent operation for suspected acute appendicitis were reviewed retrospectively from January 1995 to December 1998. RESULTS: There were 17 men & 14 women. Ages ranged from 9 to 69 (mean: 37.5) years. All patients presented with signs and symptoms as acute appendicitis. All patients were explored through a transverse incision in the right lower quadrant under the impression of acute appendicitis. An appendectomy and drainage was performed in 13 patients, and resection of the lesion was performed in 18 patients (12 ileocecal resection, one partial cecectomy including appendix, one partial cecectomy and an appendectomy, 4 diverticulectomy and appendectomy), depending on the location of diverticulitis, severity of inflammation, and surgeon. Staples (TA(R), GIA(R)) were used in all cecal resection cases except for diverticulectomy. Five complications were observed, 3 in cecal resection cases (one wound seroma, one wound infection and one bleeding), and 2 in appendectomy and drainage cases (two wound infections). There was no postoperative mortality. The average length of the postoperative stay was 10.2 days in the drainage group and 8.8 days in the cecal resection group. Two recurrences were observed. One was the patient who had diverticulectomy performed. The other was a patient who had had appendectomy and drainage. CONCLUSION: We concluded that the preferred surgical management of an acute cecal diverticulitis operated for a presumed acute appendicitis is cecectomy using staples depending on its location and severity of inflammation. It was safe, relatively easy to do through the same incision, and could be a definitive treatment.
Appendectomy* ; Appendicitis ; Appendix ; Colon ; Diverticulitis* ; Drainage ; Female ; Humans ; Inflammation ; Korea ; Male ; Mortality ; Recurrence ; Retrospective Studies ; Seroma ; Wound Infection ; Wounds and Injuries

We report a rescently experienced case with atypical radiologic manifestation of solid and papillary epithelial neoplasm of the pancreas in a 37 years old female patient. The tumor had heavy calcification on its capsule wall and septa. Instead of the usual encapsulated lesion with partly solid and partly cystic-hemorrhagic components, the lesion consisted of numerous fine cavitations containing air without fluid component except focal abscess fluid.
Abscess ; Female ; Humans ; Neoplasms, Glandular and Epithelial* ; Pancreas* ; Pancrelipase*

PURPOSE: Neutrophils are central to the defences against bacterial infection, and in neonates the number of neutrophils are decreased due to inhibited production and phagocytic function. This induces high mortality rates in infants suffering from neonatal sepsis. Exogenous GM-CSF can increase the number of neutrophils and improve the phagocytic function. To establish the most cost effective dose of exogenous granulocyte-macrophage colony-stimulating factor in infected neonates, we divided infected patients into two groups. The serum level of granulocyte-macrophage colony stimulating factor, white blood cell count and absolute granulocyte count were compared. METHODS: This study included 22 infants with infection, admitted to the neonatal intensive care unit of Chungnam National University Hospital, between February 1998 and September 1999. Infected infants were divided into two treatment groups with exogenous GM-CSF 3 microgram/kg/day & 10 microgram/kg/day. The total WBC count, the absolute granulocyte count and the serum GM-CSF concentration of peripheral blood before use of GM-CSF, and those of 2nd, 5th and 7th day after use were compared. RESULTS: In 3 microgram/kg/day group, WBC count and the absolute granulocyte count and the serum GM-CSF concentration reached a peak after the 2nd injection of GM-CSF. In 10 microgram/kg/day group, the WBC count and the absolute granulocyte count increased gradually until 7th day. There was tendency for the total WBC counts, the absolute granulocyte count and the serum GM-CSF concentration of peripheral blood in 10 microgram/kg group to increase more than those of 3 microgram/kg group, after exogenous GM-CSF treatment. CONCLUSION: In neonates, we propose the exogenous GM-CSF treatment 10 microgram/kg/day as being more effective than 3 microgram/kg/day protocol, which is one of the safest and most effective methods to increase the total WBC count, the absolute granulocyte count and the serum GM-CSF concentration of peripheral blood.
Bacterial Infections ; Chungcheongnam-do ; Colony-Stimulating Factors ; Granulocyte-Macrophage Colony-Stimulating Factor* ; Granulocytes ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Leukocyte Count ; Leukocytes ; Mortality ; Neutrophils ; Sepsis

PURPOSE: The peak incidence of disseminated intravascular coagulation(DIC) in the pediatric age group is in the neonatal period. The objective was to determine the early diagnostic laboratory tests of DIC in newborn infants. METHODS: 46 neonates with DIC, admitted between January 1995 and November 1998 in NICU of Chungnarn National University Hospital, were compared with 49 newborn infants in control group. We checked platelet counts, PT, aPTT, FDP, fibrinogen and AT III in both groups. We defined abnormality of laboratory tests of DIC as values which outranged 2 S.D. of control group means. In DIC group, serial laboratory tests were performed in 35 patients. RESULTS: Symptoms or signs suggestive of DIC were abdominal distension(40%), bleeding(35%), apnea(15%), and lethargy(15%). The incidence of infection was 65%, and the incidence of keeping endotracheal tube, arterial line, umbilical venous catheterization, TPN and asphyxia was about 40%. Sensitivity of laboratory tests was as follows: fibrinogen was 63%, platelet count 59%, aPTT 49%. And specificity was 100% for FDP, 96% for platelet count, and 93% for fibrinogen. 22 patients showed at least one of the initially normal values changed to abnormal during follow up tests. The percentage of transition was 83% for fibrinogen and 64% for platelet count. In DIC group, 34 patients (74%) improved, but 12(26%) died. CONCLUSION: This study suggests that the most reliable initial diagnostic laboratory tests in DIC are fibrinogen and platelet counts.
Asphyxia ; Catheterization ; Catheters ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Fibrinogen ; Follow-Up Studies ; Humans ; Incidence ; Infant, Newborn* ; Platelet Count ; Reference Values ; Sensitivity and Specificity ; Vascular Access Devices

PURPOSE: Prediction of developmental outcome after perinatal asphyxia is important but difficult. The objective was to evaluate the relationship of perinatal risk factors and neonatal complications with Bayley Scales of Infant Development II (BSID-II) scores in asphyxiated newborns. METHODS: Forty asphyxiated infants, admitted between January and December 1997, were studied at a mean corrected age of 12.7 months. Perinatal risk factors, neonatal complications and developmental outcome were evaluated. Subjects were classified by BSID-II scores: 23 infants with normal development [Mental Developmental Index(MDI) and Psychomotor Developmental Index(PDI) > or =85] in Group 1, and 17 with delayed outcome(MDI or PDI<85) in Group 2 [Group2A: 10 infants with mild delay(MDI and PDI > or =70), and Group2B 7 with significant delay(MDI or PDI < or =70)]. RESULTS: MDI and PDI in Groups 1 and 2 were 98.97.0 and 108.4+/-10.1 vs. 79.3+/-16.2 and 79.5+/-22.6, respectively. MDI and PDI of Groups 2A and 2B were 85.7+/-11.4 and 94.215.7 vs.8.4 and 58.6+/-11.0, respectively. There were no significant differences in Apgar score, fetal deceleration, seizure, meconium aspiration, pH, BE, pCO2, LDH, CPK, CPK isoenzymes, EE(and brain ultrasonographic findings between Groups 1 and 2. But ultrasonographic findings were significantly different between Groups 1 and 2B. CONCLUSION: There was no significant difference of perinatal risk factors or neonatal complications between normal and delayed developmental groups by Bayley scales in asphyxiated newborns.
Apgar Score ; Asphyxia ; Brain ; Child ; Child Development ; Deceleration ; Humans ; Hydrogen-Ion Concentration ; Infant ; Infant, Newborn* ; Isoenzymes ; Meconium Aspiration Syndrome ; Risk Factors* ; Seizures ; Weights and Measures*

We present a case of onychogryphosis of both great toe nails associated with onychomycosis of all toe nails occurring in a 90-year-old female patient. She also had senile dementia. Affected nail plates were thickened, increased in length, and curved like the horn of a ram. The nail plates were removed surgically form the nail bed. Direct microscopic examination revealed many hyphae with potassium hydroxide. Trichophyton rnbrum was isolated from the culture in Sabouraud glucose agar media. On histopathologic examination, we found many hyphae in the nail plate. We suggest an onychomycosis as one of the causes of onychogryphosis.
Agar ; Aged, 80 and over ; Alzheimer Disease ; Animals ; Female ; Glucose ; Horns ; Humans ; Hyphae ; Onychomycosis* ; Potassium ; Toes ; Trichophyton

No abstract available.
Encephalitis* ; Prognosis*