PURPOSE: Conventional indomethacin therapy(0.2mg/kg every 12 hours for three doses) has been used for closure of PDA. The effect of prolonged low dose of indomethacin therapy(0.1mg/kg daily for six days)had been reported in foreign country but, nothing had been reported in our country. So we attempted this study to examine effects of these two methods. METHODS: Forty one infants with PDA of prematurity from January 1992 to July 1995 who were admitted in NICU of Il Sin Christian Hospital were included. 27 of these infants received conventional dose of indomethacin therapy and 14 received prolonged low dose of indomethacin therapy, and we examined with closure rate and complication etc. RESULTS: 1) Closure of PDA was observed in 15(55.6%) and relapse was 3(11.1%) in conventional dose therapy group. In prolonged low dose therapy group, closure was 8(57.1%) and relapse was none. 2) Intraventricular hemorrhage was observed in 20(74.1%), 6(42.9%) and gastrointestinal tract bleeding was 6(22.2%), 13(92.2%) in each group. There was statistically significant between the two groups(p<0.05). 3) The rise of serum BUN, creatinine was observed in 9(33.3%), 6(46.2%), bleeding tendency was 9(33.3%), 8(57.1%), necrotizing enterocolitis was 2(7.4%), 0 and retinopathy of prematurity was 8(29.6%), 3(21.4%) in each group.But there was not statistically significant correlation between the two groups. 4) The development of sepsis and broncopulmonary dysplasia was slightly more in prolonged low dose therapy group. 5) The reduction of urine output was observed in 11(40.7%), 2(14.3%) in each group but, absolute oliguria was not observed in both groups. CONCLUSIONS: Though the closure rate of PDA was similar in both groups, prolonged low dose indomethacin therapy can be recommanded with its effectiveness on preventing the relapse of PDA and the accurrence of necrotizing enterocolitis.
Creatinine ; Enterocolitis, Necrotizing ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Indomethacin* ; Infant ; Oliguria ; Recurrence ; Retinopathy of Prematurity ; Sepsis

PURPOSE: To compare the effect of breast milk containing fortifier with preterm formula on bone mineral metabolism in premature infants, we evaluated the state of bone mineralization, biochemical alteration and the frequency of rickets during the first five months of life. METHODS: Fourteen fortified breast milk-fed infants and eleven preterm formula-fed infants who were born at Il-Sin Christian Hospital from August, 1996 through July, 1997, were studied. The breast milk-fed group received human milk fortifier. The intake of Ca, P, Mg, protein, and fat was calculated at one month of age. Birth weight and weight at one, two and five months of age were measured. Serum Ca, P, alkaline phosphatase and 25-hydroxyvitamine D were measured at one month of age, and the wrist received X-ray examinations monthly. Total body bone mineral content was measured by Dual energy X-ray absorptiometry (Lunar WI) at two and five months of age. RESULTS: The two groups were similar in birth weight, gestational age, and weight at one, two and five months of age. Enteral Ca, P, protein, Mg, and fat intake, and urinary excretion of Ca, P were similar among the two groups. Serum Ca, P, ALP and 25-hydroxyvitamin D were not different. Occurrence of rickets and bone mineral content were similar among the two groups. CONCLUSION: Fortified breast milk-fed infants and preterm formula-fed infants showed no difference in total body bone mineral content and occurrence of rickets. Ultimately, we could enhance the advantage of breast milk fed to premature infants by adding fortifier.
Absorptiometry, Photon ; Alkaline Phosphatase ; Birth Weight ; Bone Density ; Breast ; Calcification, Physiologic ; Gestational Age ; Humans* ; Infant ; Infant, Newborn ; Infant, Premature ; Metabolism* ; Milk, Human* ; Rickets* ; Wrist

Citrullinemia is an inborn error of urea cycle metabolism caused by deficiency of arginosuccinate synthetase. It is characterized by hyperammonemia and high citrulline level in serum, CSF and urine. The clinical symptoms include vomiting, lethargy, seizure, coma and ultimately death if hyperammonemia is not controlled. We report a case of 9- day old male with citrullinemia who was initially treated with sodium benzoate during acute stage followed by gradual weaning to discontinuation. Hyperammonemia was well controlled by low protein milk diet and arginine.
Arginine* ; Citrulline ; Citrullinemia* ; Coma ; Diet* ; Humans ; Hyperammonemia ; Lethargy ; Ligases ; Male ; Metabolism ; Milk ; Seizures ; Sodium Benzoate ; Urea ; Vomiting ; Weaning

The perforator based flap has been used successfully as a pedicle or free flap and has gained popularity in clinical use. Although Lipo-PGE1 effect on survival rate of musculocutaneous flap is good, but effect on survival rate of perforator based flap is not well known. Therefore, the purpose of this study is to find pharmacological delay effect by using Lipo-PGE1 in abdominal skin perforator flap of rats. Thirty Sprague- Dawley rats were divided into 3 groups. Perforator flaps were designed in rectangular shape, sized 3x7cm to 4x8 cm on abdomen. Flap incision was made deeply enough to the panniculus carnosus, from lateral to medial side and we found four musculocutaneous perforators at each side. Right second cranial perforator was saved, and the others were electrocauterizied. The experimental groups included group I(control): no procedure before the flap elevation; group II(surgical delay): right second cranial perforator was saved, one week before the flap elevation, the others cauterizied. But left four perforators were not injuried.; Group III(pharmacological delay): before the flap elevation, Lipo-PGE1(0.5microgram) was given intraperitoneally for 5 days. On the seventh day after operation, the results were evaluated and compared in terms of flap survival area, vessel counts by Hematoxylin-Eosin stain and Vascular Endothelial Growth Factor (VEGF) protein expression by Western blot. The results were as followings. First, The mean percentages of the flap survival area in Group II(83.75+/-11.07%) and Group III(76.95+/-11.99%) were significantly higher than that in Group I(44.06+/-15.29%)(p<0.05). Second, The vessel counts of Group II(4.4+/-0.84) and Group III(4.3+/-0.82) were significantly higher than that of Group I(2.0+/-0.67) significantly(p<0.05) Third, The VEGF expression is increased in two experimental groups than that of control group. In conclusion, the use of Lipo-PGE1 could increase flap survival area in rat skin perforator flap model, as likely as surgical delay. This phenomenon is thought to be due to choke vessel dilatation and new vessel formation. Therefore, we expect that Lipo-PGE1 can increase rate of flap survivability in perforator based flap as well as that of musculocutaneous flap, only short term use.
Abdomen ; Alprostadil* ; Animals ; Blotting, Western ; Dilatation ; Free Tissue Flaps ; Myocutaneous Flap ; Perforator Flap ; Rats* ; Skin* ; Survival Rate ; Vascular Endothelial Growth Factor A

BACKGROUN: Many studies have shown that diabetes mellitus does not modify the clinical features and treatment outcomes. However, to our knowledge, those surveys for clinical features and treatment outcomes in pulmonary tuberculosis with diabetics were performed 15 years ago and have not been confirmed by more recent reports. Therefore, the purpose of this study is to investigate the effect of diabetes mellitus on microbiologic findings in far advanced stage of pulmonary tuberculosis and so to make some suggestions for the management of pulmonary tuberculosis with diabetes mellitus. METHODS: This study population was composed of 47 patients with far advanced stage of culture-proven pulmonary tuberculosis hospitalized in our department from 2000 through 2002. None of patients was intractable. Patients were divided into 4 groups; group1;nondiabetics with initial treatment, group2;diabetics with initial treatment, group3;nondiabetics with retreatment, group4; diabetics with retreatment. Treatment regimens were individualized on the basis of susceptibility results. A retrospective review of the records of all 47 patients with pulmonary tuberculosis and diabetes mellitus was carried out. The clinical features, bacteriologic, radiographic findings and treatment outcomes were compared among 4 groups. RESULTS: Time to negative conversion of AFB in sputum smear was significantly increased in diabetics group than nondiabetics, but time to negative conversion of AFB in sputum culture was not significant. Also time to negative conversion of AFB in sputum smear or culture was not affected by treatment pattern. The effect of antituberculosis medication significantly delayed response in diabetics with retreatment and resistance rate was higher in diabetics or retreatment. Time to negative conversion of AFB in sputum smear was related to cavitary size in radiographic findings, but time to negative conversion of AFB in sputum culture was related to drug sensitivity. Natural course of cavity on radiographic findings after antituberculosis therapy was not significant. CONCLUSION: It seems that diabetes mellitus does not affect bacteriological negative conversion rates except negative conversion rate of AFB in sputum smear, which chiefly related to cavitary size, in far advanced stage of pulmonary tuberculosis. Therefore, because the presence of AFB in sputum smear after 5th months of therapy is not necessarily a treatment failure in far advanced stage of pulmonary tuberculosis with diabetics, any decision regarding prologation or change in therapy maybe required based on the results of culture and drug susceptibility tests.
Bacteriology ; Diabetes Mellitus* ; Humans ; Retreatment ; Retrospective Studies ; Sputum ; Treatment Failure ; Treatment Outcome ; Tuberculosis, Pulmonary*

OBJECTIVE: To evaluate condylar head remodeling after mandibular set-back sagittal split ramus osteotomy (SSRO) with rigid fixation in skeletal class III deformities. The correlation between condylar head remodeling and condylar axis changes was determined using cone-beam computed tomography (CBCT) superimposition. METHODS: The CBCT data of 22 subjects (9 men and 13 women) who had undergone mandibular set-back SSRO with rigid fixation were analyzed. Changes in the condylar head measurements and the distribution of the signs of condylar head remodeling were evaluated by CBCT superimposition. RESULTS: The subjects showed inward rotation of the axial condylar angle; reduced condylar heights on the sagittal and coronal planes; and resorptive remodeling in the anterior and superior areas on the sagittal plane, superior and lateral areas on the coronal plane, and anterior-middle and anterior-lateral areas on the axial plane (p < 0.05). CONCLUSIONS: The CBCT superimposition method showed condylar head remodeling after mandibular set-back SSRO with rigid fixation. In skeletal class III patients, SSRO with rigid fixation resulted in rotation, diminution, and remodeling of the condylar head. However, these changes did not produce clinical signs or symptoms of temporomandibular disorders.
Axis, Cervical Vertebra ; Cone-Beam Computed Tomography ; Congenital Abnormalities ; Head ; Humans ; Male ; Methods ; Osteotomy, Sagittal Split Ramus* ; Temporomandibular Joint Disorders

OBJECTIVE: To evaluate the presurgical orthodontic tooth movement of mandibular teeth after dental decompensation for skeletal Class III deformities on the basis of vertical skeletal patterns. METHODS: This cohort was comprised of 62 patients who received presurgical orthodontic treatment. These patients were divided into 3 groups according to their vertical skeletal patterns. Changes in the positions of the mandibular central incisor, canine, premolar, and 1st molar after presurgical orthodontic treatment were measured using a cone-beam computed tomography (CBCT) superimposition method. RESULTS: The incisors moved forward after dental decompensation in all 3 groups. The canines in group I and the 1st premolars in groups I and III also moved forward. The incisors and canines were extruded in groups I and II. The 1st and 2nd premolars were also extruded in all groups. Vertical changes in the 1st premolars differed significantly between the groups. We also observed lateral movement of the canines in group III and of the 1st premolar, 2nd premolar, and 1st molar in all 3 groups (p < 0.05). CONCLUSIONS: Movement of the mandibular incisors and premolars resolved the dental compensation. The skeletal facial pattern did not affect the dental decompensation, except in the case of vertical changes of the 1st premolars.
Bicuspid ; Cohort Studies ; Compensation and Redress ; Cone-Beam Computed Tomography ; Congenital Abnormalities ; Humans ; Incisor ; Malocclusion ; Molar ; Tooth ; Tooth Movement

BACKGROUND: Laparoscopic surgery is replacing conventional surgical techniques due to its many advantages. However the possibility of respiratory complications during CO2-induced pneumoperitoneum remain. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to mechanical ventilation in hypercapneic patients. This study investigated the effectiveness of TGI in reducing the PaCO2 level in hypercapneic patients during laparoscopic surgery without increasing the peak inspiratory pressure (PIP) and usefulness of a Univent tube(R) as a device for TGI. METHODS:Twenty-four patients who were scheduled to undergo gynecological laparoscopic surgery, were enrolled in this study. Anesthesia was induced and maintained with propofol, rocuronium and N2O-O2-sevoflurane. The suction port of the endobronchial blocker of the Univent tube(R) was used for the path of TGI. Data including the ABGA and respiratory parameters were measured three times, the pre-CO2 peritoneum (pre-CO2 pneumoperitoneum point, PCP), 15 min after CO2 peritoneum (after-CO2 pneumoperitoneum point, ACP) and after 15 min TGI (TGI point, TGIP). RESULTS: At ACP, the PaCO2 and PIP had increased more significantly than PCP. After TGI, the PaCO2 was decreased more significantly than ACP, but the PIP did not increased. CONCLUSIONS: TGI is a useful adjunct to mechanical ventilation in hypercapneic patients during laparoscopic surgery, and a univent tube(R) is an economic and convenient device for TGI.
Anesthesia ; Humans ; Insufflation* ; Laparoscopy* ; Peritoneum ; Pneumoperitoneum ; Propofol ; Respiration, Artificial ; Suction

OBJECTIVE: In this study, we aimed to examine the relationship between chin deviation and the positional and morphological features of the mandible and to determine the factors that contributed to chin deviation in individuals with a unilateral cleft lip and palate (UCLP). METHODS: Cone-beam computed tomography (CBCT) images of 28 adults with UCLP were analyzed in this study. Segmented three-dimensional temporomandibular fossa and mandible images were reconstructed, and angular, linear, and volumetric parameters were measured. RESULTS: For all 28 individuals, the chin was found to deviate to the cleft side by 1.59 mm. Moreover, among these 28 individuals, only 7 showed distinct (more than 4 mm) chin deviation, which was toward the cleft side. Compared to the non-cleft side, the mandibular body length, frontal ramal inclination, and vertical position of the condyle were lower and inclination of the temporomandibular fossa was steeper on the cleft side. Furthermore, the differences in inclination of the temporomandibular fossa, mandibular body length, ramus length, and condylar volume ratio (non-deviated/deviated) were positively correlated with chin deviation. CONCLUSIONS: UCLP individuals show mild chin deviation to the cleft side. Statistical differences were noted in the parameters that represented positional and morphological asymmetries of the mandible and temporomandibular fossa; however, these differences were too small to indicate clinical significance.
Adult ; Chin ; Cleft Lip ; Cone-Beam Computed Tomography ; Humans ; Mandible ; Palate

OBJECTIVE: To investigate skeletal and dental changes after application of a mandibular setback surgery-first orthodontic treatment approach in cases of skeletal Class III malocclusion. METHODS: A retrospective study of 34 patients (23 men, 11 women; mean age, 26.2 +/- 6.6 years) with skeletal Class III deformities, who underwent surgery-first orthodontic treatment, was conducted. Skeletal landmarks in the maxilla and mandible at three time points, pre-treatment (T0), immediate-postoperative (T1), and post-treatment (T2), were analyzed using cone-beam computed tomography (CBCT)-generated half-cephalograms. RESULTS: The significant T0 to T1 mandibular changes occurred -9.24 +/- 3.97 mm horizontally. From T1 to T2, the mandible tended to move forward 1.22 +/- 2.02 mm, while the condylar position (Cd to Po-perpendicular plane) shifted backward, and the coronoid process (Cp to FH plane) moved vertically. Between T1 and T2, the vertical dimension changed significantly (p < 0.05). Changes in the vertical dimension were significantly correlated to T1 to T2 changes in the Cd to Po-perpendicular plane (r = -0.671, p = 0.034), and in the Cp to FH plane (r = 0.733, p = 0.016), as well as to T0 to T1 changes in the Cp to Po-perpendicular plane (r = 0.758, p = 0.011). CONCLUSIONS: Greater alterations in the vertical dimension caused larger post-treatment (T2) stage skeletal changes. Studying the mandibular position in relation to the post-surgical vertical dimension emphasized the integral importance of vertical dimension control and proximal segment management to the success of surgery-first orthodontic treatment.
Cone-Beam Computed Tomography ; Congenital Abnormalities ; Female ; Humans ; Male ; Malocclusion ; Mandible ; Maxilla ; Retrospective Studies ; Vertical Dimension