PURPOSE: The purpose of this study was to evaluate the effect of amino acid mixtures on incidence and severity of total parenteral nutrition associated-cholestasis(PNAC) in very low birth weight infants. METHODS: Retrospective review of 63 very low birth weight infants(birth weight < or =1,500 g) who received total parenteral nutrition(TPN) in our neonatal intensive care unit from January 2000 to December 2004 was performed. Patients were divided into 2 groups : Group I(n=32, Jan 2000-Jun 2002) and Group II(n=31, Jul 2002-Dec 2004), where infants in Group II received taurine and glutamic acid-rich amino acid mixtures. PNAC was defined as serum direct bilirubin(DB) level greater than 2.0 mg/dL. The incidence and severity of PNAC were compared between these groups. RESULTS: The incidence of PNAC was significantly lower in Group II than in Group I(21.9% vs 6.5%, P<0.148). Maximum and mean DB levels were also significantly lower in Group II(P<0.05). CONCLUSION: The incidence and severity of PNAC in very low birth weight infants may be reduced with different composition of amino acid mixtures in TPN. Further prospective randomized controlled studies are needed to determine an ideal composition of acid mixtures to prevent the development of PNAC.
Cholestasis* ; Humans ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Intensive Care, Neonatal ; Parenteral Nutrition, Total ; Retrospective Studies ; Taurine

PURPOSE: To compare ocular biometry and refractive results measured using conventional applanation ultrasonography and 3 different optical interferometries, Lenstar LS900(R), AL-Scan(R) and OA-2000(R). METHODS: The biometries of 31 cataractous eyes were measured using ultrasonography, Lenstar LS900(R), AL-Scan(R) or OA-2000(R). The axial length, anterior chamber depth and keratometry were measured. The SRK/T formula was used to calculate intraocular lens power. Two months after cataract surgery, the refractive outcome was determined and results from the 4 different biometry methods were compared. RESULTS: Axial lengths were 23.39 +/- 0.95 mm, 23.42 +/- 0.98 mm, 23.43 +/- 0.98 mm and 23.44 +/- 0.98 mm measured using ultrasonography, Lenstar LS900(R), AL-Scan(R) and OA-2000(R), respectively with no statistically significant differences observed (p = 0.996). The anterior chamber depth and keratometry were 3.14 +/- 0.41 mm, 3.10 +/- 0.38 mm and 3.13 +/- 0.39 mm (p = 0.936) and 44.41 +/- 1.52 D, 44.54 +/- 1.57 D and 44.44 +/- 1.52 D (p = 0.937) for Lenstar LS900(R), AL-Scan(R) and OA-2000(R) respectively. There were no statistically significant differences between the 3 optical devices. The mean absolute error of the 4 different devices were not statistically significant (p = 0.722). CONCLUSIONS: The ocular biometric measurements and prediction of postoperative refraction using ultrasonography, Lenstar LS900(R), AL-Scan(R) or OA-2000(R) showed no significant differences.
Anterior Chamber ; Biometry ; Cataract ; Interferometry* ; Lenses, Intraocular ; Optical Devices ; Refractive Errors ; Ultrasonography*

OBJECTIVES: Our purpose was to determine the efficacy of maternal corticosteroid therapy in the prevention of neonatal respiratory distress syndrome. STUDY DESIGN: The data in this study was taken from 136 women who participated in prematurity prevention programs at two hospital. Of 136 women who were delivered at 25 to 34 weeks, 68 received dexamethasone and 68 did not. 'I'he frequency and relative risk of adverse outcomes, including repiratory distress syndrome, necrotizing enterocolitis, neonatal sepsis and maternal infection wcre compared by means of univariate techniques. RESULT: When dexamethansone was administered, there was a lower incidence of respiratory distress syndrome at between 30 to 32 weeks gestation (relative risk of treatment group vs control group=0.425, p<0.05) and there was no statistical difference between 24 to 26 weeks (relative risk of treatment group vs control group=0.833, p>0.05). I'here was no statistical difference between 33 weeks to 34 weeks (relative risk of treatment group vs control group=0.782, p>0.05). 'I'here was no statistical significance in the incidence of maternal infection, neonatal sepsis or necrotizing enterocolitis (p=0.808, p=0.698, p=0.559). CONCLUSION: Dexamethasone appears to significantly reduce neonatal respiratory distress syndrome at between 30 and 32 weeks gestation.
Dexamethasone ; Enterocolitis, Necrotizing ; Female ; Humans ; Incidence ; Pregnancy ; Respiratory Distress Syndrome, Newborn* ; Sepsis

Pyomyositis is a primary bacterial infection of the skeletal muscles. Although infection can affect any skeletal muscle, the large muscle groups such as the quadriceps or gluteal muscles are most often the focus of this disease, and most commonly the inflammation is focal, involving a single muscle. The mechanism of pyomyositis is poorly understood. The local mechanical trauma at the time of an incidental bacteremia is frequently postulated as a mechanism that could explain the high incidence of the disease in tropical areas and its male preponderance. Staphylococcus aureus is the most common organism responsible for pyomyositis. Mycobacterium tuberculosis primarily affects the lungs, and the prevalence of active pulmonary tuberculosis co-existing with musculoskeletal tuberculosis has been about 30 percent. We report here on a case of an otherwise healthy 17-month-old girl, who had tuberculous pyomyositis at the upper arm after the hepatitis A vaccination with no evidence of any coexistent active tuberculosis.
Arm ; Bacteremia ; Bacterial Infections ; Female ; Hepatitis A ; Humans ; Incidence ; Infant ; Inflammation ; Lung ; Male ; Muscle, Skeletal ; Muscles ; Mycobacterium tuberculosis* ; Mycobacterium* ; Prevalence ; Pyomyositis* ; Staphylococcus aureus ; Tuberculosis ; Tuberculosis, Pulmonary ; Vaccination

Posttransplant diabetes mellitus, a complication due to corticosteroids and the calcineurin inhibitors, cyclosporine and tacrolimus, is commonly regarded as a form of type 2 diabetes mellitus. Diabetes ketoacidosis, which requires relative insulin deficiency to impair fatty acid metabolism, is a complication of type 1 diabetes mellitus. We report two patients who presented with diabetic ketoacidosis after kidney transplantation. Two patients presented with severe hyperglycemia, significant ketosis and metabolic acidosis of variable severity. One patient was treated with a cyclosporine-based regimen, and the other with a tacrolimus-based regimen. Both were found to have moderate to high serum levels of calcineurin inhibitors on presentation. Our experience suggests that post-transplant diabetes mellitus, in association with calcineurin inhibitor, may result in ketoacidosis either secondary to relative beta cell dysfunction, peripheral insulin resistance, or a combination of the two effects. Post transplant diabetes mellitus can be an atypical form of adult-onset diabetes with features of both type 1 and type 2 diabetes mellitus.
Acidosis ; Adrenal Cortex Hormones ; Calcineurin ; Cyclosporine ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Hyperglycemia ; Insulin ; Insulin Resistance ; Ketosis ; Kidney Transplantation ; Metabolism ; Tacrolimus

Posttransplant diabetes mellitus, a complication due to corticosteroids and the calcineurin inhibitors, cyclosporine and tacrolimus, is commonly regarded as a form of type 2 diabetes mellitus. Diabetes ketoacidosis, which requires relative insulin deficiency to impair fatty acid metabolism, is a complication of type 1 diabetes mellitus. We report two patients who presented with diabetic ketoacidosis after kidney transplantation. Two patients presented with severe hyperglycemia, significant ketosis and metabolic acidosis of variable severity. One patient was treated with a cyclosporine-based regimen, and the other with a tacrolimus-based regimen. Both were found to have moderate to high serum levels of calcineurin inhibitors on presentation. Our experience suggests that post-transplant diabetes mellitus, in association with calcineurin inhibitor, may result in ketoacidosis either secondary to relative beta cell dysfunction, peripheral insulin resistance, or a combination of the two effects. Post transplant diabetes mellitus can be an atypical form of adult-onset diabetes with features of both type 1 and type 2 diabetes mellitus.
Acidosis ; Adrenal Cortex Hormones ; Calcineurin ; Cyclosporine ; Diabetes Mellitus ; Diabetes Mellitus, Type 1 ; Diabetes Mellitus, Type 2 ; Diabetic Ketoacidosis ; Humans ; Hyperglycemia ; Insulin ; Insulin Resistance ; Ketosis ; Kidney Transplantation ; Metabolism ; Tacrolimus

BACKGOUND: On-line hemodiafiltration (HDF) is a technique that relies on the re-injection of pyrogen-free substitution fluid obtained by cold filtration of dialysate. Therefore, safety of this therapy depends on the quality of dialysate and, mainly, on the integrity of the ultrafilters employed. Paired hemodiafiltration (PHF) is a new technique where re-infusion takes place inside the dialyzer by means of dialysate backfiltration. METHODS: To assess safety and feasibility, we carried out prospective cross-over trial comparing PHF with hemodialysis (HD) in five stable HD patients RESULTS: All PHF sessions were well tolerated. No pyrogenic reactions were observed during the study period. No significant difference was found in the incidence of intradialytic hypotension. PHF led to significantly higher small and middle molecule clearance than HD. The reduction rates of urea, creatinine and beta2-M were significantly higher in PHF than in HD, while no difference was found for phosphate. The serum beta2-M levels fell progressively from the HD value of 29 mg/L to 17 mg/L at the end of 3 months's PHF treatment. CONCLUSION: In conclusion, PHF is a feasible and safe convective therapy to increase beta2-M removal compared with HD. Long-term, prospective multicenter clinical studies are mandatory to assess the clinical outcome of this new on-line technique of HDF.
Creatinine ; Filtration ; Hemodiafiltration* ; Humans ; Hypotension ; Incidence ; Prospective Studies ; Renal Dialysis ; Urea

Cytomegalovirus (CMV) remains an important pathogen in organ transplant recipients, and ganciclovir has been the antiviral agent of choice both for prevention and treatment of CMV disease. Recently ganciclovir-resistant cytomegalovirus has been reported with increasing frequency in organ transplant recipient and is an emerging clinical problem in transplant recipients. Ganciclovir-resistant CMV infection has been associated with clinical progression of CMV disease and high mortality even with foscarnet therapy. We report here a case of disseminated ganciclovir-resistant CMV disease in a 34-year-old renal transplant recipient, who died of multiorgan failure despite treatment with both ganciclovir and foscarnet.
Adult ; Cytomegalovirus Infections* ; Cytomegalovirus* ; Foscarnet ; Ganciclovir ; Humans ; Kidney Transplantation* ; Mortality ; Transplantation ; Transplants

A substantial proportion of adrenal incidentalomas demonstrates subtle hormonal hypersecretion; however, adenomas that cosecrete aldosterone and cortisol are rare. We here report a case of an adrenal mass that was incidentally detected on a computed tomography scan in a 57-year-old man. The patient had a 10-year history of diabetes mellitus and a 5-year history of hypertension. Evaluation revealed hyperaldosteronemia with an elevated plasma aldosterone-to-renin ratio, hypokalemia, unsuppressed cortisol after dexamethasone administration, and elevated urinary free cortisol concentration. The appearance of the right adrenalectomy specimen indicated adrenal adenoma. Postoperatively, the blood glucose and blood pressure control improved and the urinary cortisol and aldosterone-to-renin ratio normalized. A complete endocrine evaluation in patients with incidentally discovered adrenal masses should be performed, even if the patient has a long-standing history of hypertension and diabetes, to avoid any postoperative adrenal crises.
Adenoma ; Adrenalectomy ; Adrenocortical Adenoma* ; Aldosterone* ; Blood Glucose ; Blood Pressure ; Dexamethasone ; Diabetes Mellitus ; Humans ; Hydrocortisone* ; Hyperaldosteronism ; Hypertension ; Hypokalemia ; Middle Aged ; Plasma

OBJECTIVES: Despite severe oligospermia, males with Y chromosome microdeletion can achieve conception through ICSI (Intracytoplasmic Sperm Injection). However, ICSI may not only result in the transmission of microdeletions but also the expansion of deletion to the offspring. The purpose of this study was to screen vertical transmission, expansion of microdeletions and de novo deletion in male fetuses conceived by ICSI. MATERIALS AND METHODS: A total of 32 ICSI treated patients with their 33 (a case of twin) male fetuses conceived by ICSI were used to make this study group. Sequence-tagged sites (STSs)-based PCR analyses were performed on genomic DNA isolated from peripheral blood of fathers and from the amniocytes of male fetuses. Ten primer pairs namely, sY134, sY138, MK5, sY152, sY147, sY254, sY255, SPGY1, sY269 and sY158 were used. The samples with deletions were verified at least three times. RESULTS: We detected a frequency of 12.5% (4 of the 32 patients) of microdeletions in ICSI patients. In 4 patients with detected deletions, two patients have proven deletions on single STS marker and their male fetuses have the identical deletion in this region. Another two patients have two and three deletions, but their male fetuses have more than 3 deletions which include deletions to their father's. Meanwhile, seven male fetuses, whose fathers were analyzed to have all 10 STS markers present, have deletions present in at least one or more of the markers. CONCLUSIONS: Although the majority of deletions on the Y chromosome are believed to arise de novo, in some cases a deletion has been transmitted from the fertile father to the infertile patient. In other cases the deletion was transmitted through ICSI treatment, it is likely that one sperm cell is injected through the oocyte's cytoplasm and fertilization can be obtained from spermatozoa. Our tests for deletion were determined by PCR and our results show that the ICSI treatment may lead to vertical transmission, expansion and de novo Y chromosome microdeletions in male fetuses. Because the sample group was relatively small, one should be cautious in analyzing these data. However, it is important to counsel infertile couples contemplating ICSI if the male carries Y chromosomal microdeletions.
Cytoplasm ; DNA ; Family Characteristics ; Fathers ; Fertilization ; Fetus* ; Humans ; Male* ; Oligospermia ; Polymerase Chain Reaction ; Sequence Tagged Sites ; Sperm Injections, Intracytoplasmic* ; Spermatozoa ; Y Chromosome*