PURPOSE: Intraventricular hemorrhage(IVH) is a major risk factor for neurodevelop- mental handicap in very low birth weight infant. So we carried out to determine the efficacy of indomethacin in reducing the incidence of intraventricular heorrhage in very low birth weight infant. METHODS: A prospective, random trial was carried out to determine the efficacy of indomethacin in preventing intraventricular hemorrhage. A total of 46 infants of less than 1500g birth weight admitted to NICU of IL Sin Christian Hospital from August 1995 to June 1997 were analyzed. Randomly, 23 infants were given indomethacin and 23 infants were not given as control group. Serial cranial ultrasound examination was performed. RESULTS: There were no differences in the birth weight, gestational age, sex, Apgar score, blood pressure, intake and output within the first 3 days between the indornethacin and control groups. Of 23 infants given indomethacin, four had germinal matrix or intraventricular hemorrhage, in comparison with 10 of 23 control infants(P=0.045). CONCLUSION: Prophylactic indomethacin lowers the incidence of IVH in very low birth weight infants.
Apgar Score ; Birth Weight ; Blood Pressure ; Gestational Age ; Hemorrhage* ; Humans ; Incidence ; Indomethacin* ; Infant ; Infant, Very Low Birth Weight ; Prospective Studies ; Risk Factors ; Ultrasonography

No abstract available.
Lung*

No abstract available.

PURPOSE: To evaluate effectiveness of oblique approach under biplane fluoroscopic guidance in transthoracic fine needle aspiration biopsy. MATERIALS AND METHODS: Fourteen consecutive patients underwent transthoracic fine needle aspiration biopsy for subcarinal lesions. Subcarina was the only accessible biopsy site in 13 patients. Subcarinal biopsy was performed to determine the presence of metastasis in an enlarged subcarinal lymph node in the remaining one patient. Before biopsy, we evaluated the size and location of the lesion on preliminary plain chest X-ray film and CT scan. Under dual projection fluoroscopic guidence, biopsy was performed through right posterior intercostal space with the patient prone by using oblique approach. On 15 degree LAO projection the needle was directed to the area anterior to the spine and advanced to the line extending through the posterior wall of the main bronchus. RESULTS: Cytologic diagnosis was made in 12 out of 14 patients(accuracy 85.7%). The final diagnosis consisted of 5 squamous cell carcinoma, 5 small cell carcinoma, 1 adenocarcinoma and 1 adenosquamous carcinoma. Pneumothorax developed in 2 patients(14%) and was managed by chest tube drainage. Mild hemoptysis was observed in 2. CONCLUSION: Transthoracic fine needle aspiration biopsy using oblique approach under biplane fluoroscopic guidance is a relatively safe and sensitive method for the histologic diagnosis of subcarinal lesion.
Adenocarcinoma ; Biopsy* ; Biopsy, Fine-Needle* ; Bronchi ; Carcinoma, Adenosquamous ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Tubes ; Diagnosis ; Drainage ; Hemoptysis ; Humans ; Lymph Nodes ; Needles ; Neoplasm Metastasis ; Pneumothorax ; Spine ; Thorax ; Tomography, X-Ray Computed ; X-Ray Film

No abstract available.
Female ; Granulosa Cells* ; Interferon-alpha* ; Rodentia*

PURPOSE: Antenatal dexamethasone administration is associated with a significant lowering respiratory distress syndrome (RDS) incidence, but can increase neonatal infection. Ambroxol has been accepted as an alternative treatment to dexamethasone and is of at least equal efficacy but without adverse reaction. The aim of this study was to evaluate the effectiveness of ambroxol versus dexamethasone in RDS incidence and neonatal infection. METHODS: In this study, 30 infants, who received prenatal dexamethasone therapy, were compared retrospectively to 19 infants who received prenatal ambroxol therapy and 45 infants who received placebo during 28 to 34 weeks' of gestation. RESULTS: RDS incidence was comparable in both the dexamethasone (10.0%) and ambroxol (10.5%) groups but higer in the control group (26.6%). The puerperal infection rate in the mothers of these infants was 33.3% in the dexamethasone group, 10.5% in the ambroxol group and 20.0% in the control group. Neonatal infection in the 28 days following delivery was 56.6% in the dexamethasone group, 26.3% in the ambroxol group and 26.6% in the control group. Neonatal infection rate of the dexamethasone group was higher than ambroxol and control groups (P<0.05). When premature rupture of membrane was controlled, the sepsis rate (<28 days) was significantly lower in the ambroxol group than in the dexamethasone group (P<0.05), but puerperal infection and sepsis (<7 days) were not significantly different. CONCLUSOIN: Ambroxol was as effective as the dexamethasone in reducing the RDS incidence. Neonatal and puerperal infection were significantly higher in the dexamethasone group than in the ambroxol group.
Ambroxol* ; Dexamethasone* ; Humans ; Incidence ; Infant ; Membranes ; Mothers ; Pregnancy ; Puerperal Infection ; Retrospective Studies ; Rupture ; Sepsis

Pagets disease is a chronic skeletal disease of middle and later life, beginning insidiously and characterized by progressive structural changes and typical deformities occuring in the long bones, pelvis, and cranium. The occurence of Pagets disease is extremely rare in Korea. We have experienced a case of Pagets disease of bone in 67 year-old female affecting mainly the ilium and skull, and we report the case with brief review of the literatures.
Congenital Abnormalities ; Female ; Humans ; Ilium ; Korea ; Pelvis ; Skull

Nonunion of the distal humerus is rare and diffcult to treat. It presents to surgeon a double challenge : to obtain bony union of the nonunion and to preserve the mobility of the joint. Six patients who had been treated for a nonunion of the distal humerus at National Medical Center from 1980 to 1988 were reviewed. Three of them were extraarticular and the rests were intraarticular fractures. Two had been open fractures. Five had been associated with nerve injury. Senile osteoporosis was noted in two. Four had been initially treated by 0/R and I/F; one, by irrigation, debriment and traction, followed by 0/R and I/F. The average time from the initial treatment to the treatment of nonunion was 20 months, ranging 3 to 44 months. The type of nonunion was reactive in one and nonreactive in five. All patients had pain, instability and limited motion of the elbow. Four who had perfomed surgical treatment for the nonunion were successful in obtaining bony union. Two who had not performed the operation were supported with the elbow brace to relieve the pain and prevent the progression of the deformity. At follw-up(average 21.6 months, ranging 5 to 39 months), functional end result was good in one; fair in four; poor in one, according to the functional rating system of Jupiter et al. In spite of success in union, the functional disability was major long-term problem. The probable causes of nonunion in our cases were unsatisfactory C/R and insufficient immobilization time, incomplete 0/R and inadequate I/F, insufficient postoperative immobilization time, senile osteoporosis, underlying systemic disease, and focal infection in fracture site.
Braces ; Congenital Abnormalities ; Elbow ; Focal Infection ; Fractures, Open ; Humans ; Humerus ; Immobilization ; Intra-Articular Fractures ; Joints ; Jupiter ; Osteoporosis ; Traction

Isolated ACTH deficiency is a uncommon disorder causing secondary adrenocortical insufficiency. Less than 200 cases have been reported in the world. The major clinical manifestations are hypoglycemia, weight loss, hypotension, anemia, weakness, nausea, inability to excrete water load, and hyponatremia. A 56-year-old male was admitted because of weakness, fatigue, nausea and vomiting. He was pallor and not associated with hyperpigmentation. The basal plasma ACTH and cortisol levels were 8.30 pg/ml and 0.6 ug/dl. The serum cortisol did not response to rapid ACTH stimulation test. On combined pituitary stimulation test, the cortisol did not response to insulin-induced hypoglycemia. Other anterior pituitary hormones showed normal responses except elevated prolactin level. Six months after glucocorticoid replacement therapy, the elevated basal prolactin level returned to normal. Brain MRI did not show any anatomic abnormalities of the sellar and suprasella area. We report a case of isolated ACTH deficiency accompanied by hyperprolactineia, which respond to glucocorticoid replacement therapy.
Adrenal Insufficiency ; Adrenocorticotropic Hormone* ; Anemia ; Brain ; Fatigue ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hyperprolactinemia* ; Hypoglycemia ; Hyponatremia ; Hypotension ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Nausea ; Pallor ; Pituitary Hormones, Anterior ; Plasma ; Prolactin ; Vomiting ; Water ; Weight Loss

OBJECTIVE: Bacteroides fragilis is the most frequently isolated anaerobes in tissue of intraabdominal infection, particularly in intraabdominal sepsis or abscess. In acute experimental model with an intraabdominal infection, the response to B. fragilis is characterized by infiltration of neutrophils and monocytes. To understand the pathogenesis of B. fragilis infection, it is important to explore the mechanism for inflammatory signals such as chemokines induced by this bacteria. The goal of this study was to determine whether peritoneal monocytes or fibroblasts surrounding with intraabdominal abscess induced by B. fragilis could express chemokines such as monocyte chemotactic protein-1 (MCP-1) or macrophage inflammatory protein-1a (MIP-1a). METHODS: 1) After C57BL/6 mice were intraperitoneally inoculated with abscess-inducing agents containing B. fragilis, RNA was extracted from the intraperitoneal tissues of the mice using Ottawa sand and the guanidinium thiocyanate-phenol-chloroform method in 3 days later. 2) After C57BL/6 mouse peritoneal monocytes were infected with B. fragilis for 1, 4 and 9 hours, cellular RNA was extracted from the cells. 3) Fibroblasts isolated from intraabdominal abscess nodules induced by B. fragilis infection were growth in tissue culture for 3 to 4 weeks. After the fibroblasts were stimulated with IL-1alpha (0.1-10 ng/ml) or TNFalpha (0.1-10 ng/ml) for 24 hours, total cellular RNA was extracted. MCP-1 or MIP-1alpha mRNA expression was assessed using RTPCR. MCP-1 or MIP-1alpha proteins in cluture supernatants or tissue extracts were also measured by ELISA. RESULTS: 1) MCP-1 or MIP-1alpha mRNA was highly expressed in peritoneal tissue of C57BL/6 mice bearing with intraabdominal abscess induced by B. fragilis. 2) Expression of MCP-1 mRNA increased at 9 hours in mouse peritoneal monocytes infected with B. fragilis. MIP-1alpha mRNA was initially expressed and perisisted in the monocytes infected with B. fragilis for 9 hours. MCP-1 or MIP-1alpha proteins was also parallel to the expression of those chemokines. 3) The fibroblasts isolated from intraabdominal abscess nodules by B. fragilis infection constitutively expressed MCP-1, MIP-1alpha, production in the fibroblasts was significantly upregulated in response to proinflammatory cytokines produced in the monocytes, including IL-1alpha and TNFalpha, but MCP-1 production were not. The normal fibroblasts from uninfected mice didnot show significant production of MCP-1 or MIP-1a in response to IL-1a or TNFalpha. CONCLUSION: These results suggest that peritoneal monocytes and fibroblasts surrounding with abscesses induced by B. fragilis produce MCP-1 or MIP-1a. Furthermore, it could be extrapolated that those effects may play a role in the formation of intraabdominal abscess nodules.
Abscess* ; Animals ; Bacteria ; Bacteroides fragilis* ; Bacteroides* ; Chemokine CCL2* ; Chemokine CCL3 ; Chemokines ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Fibroblasts ; Guanidine ; Intraabdominal Infections ; Macrophages* ; Mice ; Models, Theoretical ; Monocytes* ; Neutrophils ; RNA ; RNA, Messenger ; Sepsis ; Silicon Dioxide ; Tissue Extracts ; Tumor Necrosis Factor-alpha