PURPOSE: To compare respiratory and clinical outcomes between the currently used strategy of Intubation, Surfactant, Extubation (InSurE) and nasal continuous positive airway pressure (NCPAP) and the alternative strategy of InSurE and nasal intermittent positive pressure ventilation (NIPPV) for the initial treatment of respiratory distress syndrome (RDS) in preterm newborns < or =32 weeks. METHODS: Twenty-six comparable preterm infants with RDS were included in the study; 13 were randomized to NCPAP and 13 to NIPPV. In both groups, the InSurE procedure consisted of intubation, surfactant instillation and 2 h positive pressure ventilation followed by extubation, after which spontaneously breathing newborns were placed on NCPAP or NIPPV. RESULTS: There were no differences in demographic characteristics or cardiorespiratory status among preterm infants enrolled in the study. The reinutation rate was lower among the infants treated with NIPPV than among those on NCPAP (8% vs. 46%, P<0.05) and the rate of aminophylline use between 4 and 7 days of age of was lower in the NIPPV group compared to the NCPAP group (8% vs. 30%, P<0.05). In addition, "InSurE with NIPPV" significantly reduced the overall duration of endotracheal ventilation and shortened the time to first feed compared to "InSurE with NCPAP". CONCLUSION: "InSurE with NIPPV" displayed therapeutic benefits as the initial treatment of preterm RDS when compared with the currently used ventilator strategy, "InSurE with NCPAP" by preventing re-intubation and shortening the duration of endotracheal ventilation.
Aminophylline ; Continuous Positive Airway Pressure* ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intermittent Positive-Pressure Ventilation* ; Intubation ; Pilot Projects* ; Positive-Pressure Respiration ; Prospective Studies* ; Respiration ; Ventilation ; Ventilators, Mechanical

The objective of this investigation was to evaluate the influence of gestational age at exposure on the prenatal effects of gamma-radiation. Pregnant ICR mice were exposed to a single dose of 2.0 Gy gamma-radiation at a gestational 2.5 to 15.5 days post-coitus (p.c.). The animals were sacrificed on day 18 of gestation and the fetuses were examined for mortality, growth retardation, change in head size and any other morphological abnormalities. The only demonstrable effect of irradiation during the preimplantation period was an increase in prenatal mortality. Resorptions were maximal on post-exposure day 2.5 after conception. The pre-implantation irradiated embryos which survived did not show any major fetal abnormalities. Small head, growth retardation, cleft palate, dilatation of the cerebral ventricle, dilatation of the renal pelvis and abnormalities of the extremities and tail were prominent after exposure during the organogenesis period, especially on day 11.5 of gestation. Our results indicate that the late period of organogenesis in the mouse is a particularly sensitive phase in terms of the development of the brain, skull and extremities.
Abnormalities, Radiation-Induced/*pathology ; Animals ; Bone and Bones/abnormalities/radiation effects ; Female ; Fetal Death ; *Gamma Rays ; *Gestational Age ; Mice ; Mice, Inbred ICR ; Pregnancy ; Pregnancy, Animal/*radiation effects ; Prenatal Exposure Delayed Effects

The Na(+)-Ca2+ exchange transport operating in outward mode has been suggested to cause Ca2+ entry during reperfusion or reoxygenation, exchanging extracellular Ca2+ for intracellular Na+ that has accumulated during ischemia or cardioplegia. During cardioplegia, however, an increase in Ca2+ entry via this mechanism can be decreased due to increased intracellular H+ activity and a decrease in cellular ATP content. In this study giant excised cardiac sarcolemmal membrane patch clamp technique was employed to investigate the effect of cytosolic pH change on the Na(+)-Ca2+ exchanger, excluding the effect of ATP, in guinea pig cardiac myocytes. The outward Na(+)-dependent current, which has a characteristics of Hill equation, was decreased as pH was decreased in the range of 7.5-6.5. The current density generated by the Na(+)-Ca2+ exchange transport was 56.6 +/- 4.4 pA/pF (Mean +/- S.E.M.) at pH 7.2 and decreased to 42.9 +/- 3.0 pA/pF at pH 6.9. These results imply that Na(+)-Ca2+ exchange transport, operating in a reverse mode during cardioplegia, decreases due to increased intracellular H+, and further suggest that consequent intracellular Na+ accumulation is one of aggravating factors for Ca2+ influx during reoxygenation or reperfusion.
Acidosis/*metabolism ; Animal ; Calcium/*metabolism ; Electric Conductivity ; Guinea Pigs ; Heart Ventricle/metabolism ; Hydrogen-Ion Concentration ; Ion Transport ; Myocardium/*metabolism ; Sodium/*metabolism ; Sodium-Hydrogen Antiporter/physiology ; Support, Non-U.S. Gov't

BACKGROUND: Despite remarkable progress of understanding the pathophysiology and therapy of bronchial asthma, asthma morbidity and mortality are on the rise. Also hospitalization and attending rates of emergency department for asthma have been increasing gradually. We analyzed clinical characteristics and prognosis of patients who visited emergency room due to asthma attack in order to define clinical characteristics of these group of patients. METHOD: We reviewed 105 adult asthmatic patients who attended emergency department of Korea University Hospital between August 1995 and July 1996, retrospectively. RESULTS: 103 patients(56 female, 47 males, mean age : 48.6 years) attended-68 self referral, 18 practitioner referral and 17 OPD transfer- and 86 patients(83.5%) were admitted. Attending emergncy department was clearly more frequent in December(13.6%) and May(12.6%). Time lag between onset of asthmatic attack and arrival at the hospital was 14.2 15.5 hour and initial peak expiratory flow rate was 166.7 68.3L/min.(43.3% predicted) The commonest cause for visiting emergency room was aggravation of asthma due to upper respiratory tract infection in mild asthmatics. About half of them had history of previous ER visits. Their prognosis was not bad, but after discharge, about half of patients escaped from OPD follow-up. CONCLUSION: As a group they merit detailed attention and follow up arrangement. Clinician need to monitor and review the treatment plans, the medications, the patient's management technique, and the level of asthma control. For this group, plans for longer term treatment, including asthma education program and adjustment of overall treatment plan should be made.
Adult ; Asthma ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Korea ; Male ; Mortality ; Peak Expiratory Flow Rate ; Prognosis ; Referral and Consultation ; Respiratory Tract Infections ; Retrospective Studies ; United Nations

Using 3D ultrasound, bilateral chylothorax was diagnosed antenatally in the second trimester. Apparently stable, bilateral pleural effusion progressed rapidly to severe hydrops with facial edema during observation, and then we decided bilateral pleural-amniotic shunt operation. Here we present a case where drainage of pleural effusion by a double reverse pig tail stent made by ourself was achieved, although placement of the thoracoamniotic shunt resulted in near complete drainage of bilateral pleural effusion with normalization of intrathoracic anatomic relationships, subsequent resolution of fetal hydrops, but the ultimate outcome was unsuccessful due to the internalization of one catheter and unknown sudden death. We think that ongoing research is required to further evaluation about complications associated with this procedure, specifically failure of function due to obstruction, migration of the catheter,
Catheters ; Chylothorax* ; Death, Sudden ; Drainage ; Edema ; Female ; Humans ; Hydrops Fetalis ; Pleural Effusion ; Pregnancy ; Pregnancy Trimester, Second ; Stents ; Tail ; Ultrasonography

OBJECTIVE: A Clinical Study of Placenta P#revia done by cesarean section and the study of preterm delivery that is major cause of premature motality even thought expected managment of placente previa. METHODS: This study was evaluated for the clinical analysis on the 641 patients with placenta previa among total deliveries of 56,120 cases at the St. Mary and Holy Family hospital of Catholic University from Jan. 1,1989 to Dec.31,1997. RESULTS: The following results were obtained: 1. The total incidence of placenta previa was 1.14%. 2. The incidence of placenta previa increases with age. 3. Placenta previa has occurred more often in multipara(60.2%) than primipara(39.8%), and placenta previa has occurred more often in women who had experienced abortion(71.8%) than women who hadnt(28.2%). 4. The types of placenta previa distributed 326 cases of totalis(50.9%), 110 cases of partialis(17.2%), 99 cases of marginal(15.4%) and 106 cases of low lying placenta(16.4%). 5. The fetal presentation distributed 557 cases of vertex(86.9%), 49 cases of breech(7.6%), 28 cases of transverse lie(4.4%). 6. The types of uterine incision included 543 cases of low sepnent transverse incision(84.7%), 46 cases of classical incision(7.2%), 9 cases of inverted T incision and 43 cases of cesarean hysterectomy(6.7%). 7. Premature delivery of placenta previa prior to completion of 37 weeks was 186 cases(29.0%) and low birth infant less than 2,500gm was 128 cases(20.0%).and perinatal mortality rate was 28.0 per 1,000. 8. During delivery, 278 cases of placenta previa(43.4%) were transfused with mean 3.6 pints. Incidence of vaginal bleeding was 49.3% of placenta previa,mean admission day until delivery was about 5 day. CONCLUSION: there is a strong association between advancing age and incidence of placenta previa, and then. the risk increases with parity & the number of abortion. Considering the mean volume of blood loss more than 3 pints of blood should be prepared befor delivery.
Cesarean Section ; Deception ; Female ; Humans ; Incidence ; Infant ; Labor Presentation ; Parity ; Parturition ; Perinatal Mortality ; Placenta Previa* ; Placenta* ; Pregnancy ; Uterine Hemorrhage

Uterine artery embolization was introduced to arrest post-partum hemorrhage 20 years ago. It has also been used to control severe hemorrhage from uterine gestational trophoblast tumors, carcinoma of the uterus, uterine arteriovenous malformations, and cases of pelvic trauma. More recently, transcatheter uterine artery embolization is a new treatment for uterine leiomyoma. A 33-year old married woman with 2 children had a history of heavy pelvic pain and pressure. Ultrasound and MRI investigation showed a bulky 12 x 10cm submucosal myoma in right lower uterine segment. The both uterine artery embolization was performed via a bilateral femoral artery. We present a case in which successful embolization of the uterine arteries in a woman with submucosal myoma resulted in a subsequent transcervical expulsion of large pieces of the dominant fibroid after 3 month of treatment with a brief review.
Adult ; Arteriovenous Malformations ; Child ; Female ; Femoral Artery ; Hemorrhage ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Myoma* ; Pelvic Pain ; Trophoblastic Neoplasms ; Ultrasonography ; Uterine Artery Embolization* ; Uterine Artery* ; Uterus

Giant congenital melanocytic nevi are very rare skin lesions with an estimated prevalence of 1 in 20,000 live births, and have high risk of malignant melanoma development and leptomeningeal melanocytosis. Hence, its early and exact diagnosis in the neonatal period is important and essential. Only seven cases of giant congenital melanocytic nevi have been reported in Korea, of which none of the cases were associated with hemangioma. Herein, the authors describe a case of giant congenital melanocytic nevi with huge hemangioma with the pathologic findings that exhibited benign and provide a literature review.
Hemangioma ; Humans ; Infant, Newborn ; Korea ; Live Birth ; Melanoma ; Nevus, Pigmented ; Prevalence ; Skin

OBJECTIVE: Since the management of pregnancy is gestational age dependent, accurate knowledge of the dating of gestational age is essential. The gestational age calculation system(GACS) was made to get a precise informations of exact gestational age of pregnant mothers. METHODS: Using the personal computer and Microsoft Visual Basic soft ware, the GACS program was made to meet obstetrician's desire. This program is designed and embodied to calculate gestational age controlling many variables such as last menstrual period(LMP), expectant date of confinement(EDC), gestational age on the calculating date, ultrasonographical gestational age, and conceptional date. RESULTS: The accurate gestational age was displayed by GACS according to various input data. The work sheet of whole gestational age can be printed by GACS. CONCLUSION: The GACS is a tool to calculate gestational age of pregnant mothers precisely. This can be used very conveniently and informatively by obstetric clinicians. We recommend this program for the members of perinatologists and obstetricians.
Gestational Age* ; Humans ; Microcomputers* ; Mothers ; Pregnancy

Cytoplasmic Cu/Zn superoxide dismutase (SOD1) is an antioxidant enzyme that converts superoxide to hydrogen peroxide in cells. Its spatial distribution matches that of superoxide production, allowing it to protect cells from oxidative stress. SOD1 deficiencies result in embryonic lethality and a wide range of pathologies in mice, but little is known about normal SOD1 protein expression in developing embryos. In this study, the expression pattern of SOD1 was investigated in post-implantation mouse embryos and extraembryonic tissues, including placenta, using Western blotting and immunohistochemical analyses. SOD1 was detected in embryos and extraembryonic tissues from embryonic day (ED) 8.5 to 18.5. The signal in embryos was observed at the lowest level on ED 9.5-11.5, and the highest level on ED 17.5-18.5, while levels remained constant in the surrounding extraembryonic tissues during all developmental stages examined. Immunohistochemical analysis of SOD1 expression on ED 13.5-18.5 revealed its ubiquitous distribution throughout developing organs. In particular, high levels of SOD1 expression were observed in the ependymal epithelium of the choroid plexus, ganglia, sensory cells of the olfactory and vestibulocochlear epithelia, blood cells and vessels, hepatocytes and hematopoietic cells of the liver, lymph nodes, osteogenic tissues, and skin. Thus, SOD1 is highly expressed at late stages of embryonic development in a cell- and tissue-specific manner, and can function as an important antioxidant enzyme during organogenesis in mouse embryos.
Animals ; Cerebral Cortex/embryology/enzymology ; Copulation ; Cytoplasm/*enzymology ; Embryonic Development/*physiology ; Female ; Immunohistochemistry ; Lung/embryology/enzymology ; Male ; Mice ; Mice, Inbred ICR ; Organogenesis/*physiology ; Pregnancy ; Stomach/embryology/enzymology ; Superoxide Dismutase/deficiency/genetics/*metabolism