PURPOSE: The study assessed the effect of exogenous surfactant on oxygen and ventilator requirements and long-term prognosis of neonates with respiratory deterioration due to pulmonary hemorrhage. METHODS: From March 2007 to March 2011, neonates with respiratory deterioration due to pulmonary hemorrhage in Saint Mary's Hospital were identified from the database. Among 20 patients with pulmonary hemorrhage, 10 patients received surfactant therapy and the other 10 did not. We compared outcomes of these two groups. The primary outcome was changes in respiratory status following surfactant therapy, as reflected by oxygen index (OI), fractional inspired oxygen (FiO2) and mean airway pressure (MAP). Secondary outcomes were the duration of ventilation, nasal continuous positive airway pressure (NCPAP), oxygen inhalation days, progression to severe bronchopulmonary dysplasia or death, and retinopathy of prematurity, which required laser therapy. RESULTS: Surfactant treatment group had higher FiO2, MAP, and OI than the non-treatment group during pulmonary hemorrhage. But, there were no differences in FiO2, MAP, and OI after 2 hours of pulmonary hemorrhage between the two groups. There were no significant side effects during surfactant treatment in the surfactant treatment group. Surfactant treatment group had fewer ventilator days, NCPAP days (P<0.05) and a tendency towards shorter oxygen days than the non-treatment group (P=0.09). Also, the surfactant treatment group had less severe bronchopulmonary dysplasia (BPD) or death than the non-treatment group (10% vs. 70%, P<0.05). CONCLUSION: Exogenous surfactant appears to be a useful adjunctive therapy with neonates of severe respiratory deterioration due to pulmonary hemorrhage. Also, exogenous surfactant treatment dose not seen to be associated with any significant side effects during the therapy.
Bronchopulmonary Dysplasia ; Continuous Positive Airway Pressure ; Hemorrhage ; Humans ; Infant ; Infant, Newborn ; Inhalation ; Lung ; Oxygen ; Prognosis ; Pulmonary Surfactants ; Respiratory Insufficiency ; Retinopathy of Prematurity ; Saints ; Ventilation ; Ventilators, Mechanical

Primary cardiac tumors are rare, with a prevalence of 0.001–0.2%. Among such tumors, cardiac hemangioendotheliomas are some of the most uncommon. In Korea, there have been no reports of hemangioendothelioma occurring in the heart of infants. We herein report a case of an infant that was admitted to our medical center and presented with cough and a runny nose. The initial diagnosis was acute bronchiolitis. Cardiomegaly was observed on chest radiography. Echocardiography revealed a tumor measuring 3.5×4.0 cm in the right atrium. The infant was transferred to a tertiary medical center for tumor excision. The excised lesion was 3.8×3×3.2 cm in size, and biopsy confirmed a diagnosis of hemangioendothelioma. In this case report, we describe our experience with a rare case involving cardiac tumor in an infant with an upper respiratory tract infection.
Biopsy ; Bronchiolitis ; Cardiomegaly ; Cough ; Diagnosis ; Echocardiography ; Heart ; Heart Atria ; Heart Neoplasms ; Hemangioendothelioma ; Humans ; Infant ; Korea ; Nose ; Prevalence ; Radiography ; Respiratory Tract Infections ; Thorax ; Twins

OBJECTIVE: The objectives of this study were to obtain information on MIS levels in normal and RDS neonates and to investigate the relationship between the RDS prevalence and MIS level in preterm and term neonates. METHODS: Total 131 male neonates were selected randomly and they were consisted of 50 term normal neonates, 15 term neonates with RDS, 50 prematurely born normal neonates, and 16 prematurely born neonates with RDS. Total 131 female neonates were also selected like male neonates. The venous blood was collected from all subjects and measured the level of MIS using ELISA. The ANCOVA was conducted to evaluate any influence of adjusted value of gestational age and body weight on MIS level between normal neonates and neonates with RDS. RESULTS: 1) The MIS levels of female neonates were significantly lower than those of male neonates with no overlap. 2) The MIS levels of normal female neonates were not significantly different from those of female neonates with RDS. 3) There were significant negative relationships between MIS concentration and gestational age (r=-0.777, p<0.001), and birth weight(r=-0.728, p<0.001) in normal rnale neonates. 4) There were significant negative relationships between MIS concentration and gestational age (r=-0.726, p<0.001), and birth weight(r=-0.725, p<0.001) in male neonates with RDS. 5) After adjusting the value of gestational age, the MIS level of male neonates with RDS was significantly higher than that of normal male neonates(p<0.001). 6) After adjusting the value of body weight, the MIS level of male neonates with RDS was significantly higher than that of normal male neonates(p<0.001). CONCLUSION: Male neonates with RDS had higher MIS levels than normal male neonates of the same body weight or same calculated gestational age. The results of this study suggest that MIS may play a causative or important ancillary role in the sexual dimorphism that characterizes the neonatal RDS and may be used as a predictive marker of RDS in male neonates.
Anti-Mullerian Hormone* ; Body Weight ; Enzyme-Linked Immunosorbent Assay ; Female ; Gestational Age ; Humans ; Infant, Newborn* ; Male ; Parturition ; Prevalence

Hydrops fetalis is diagnosed when abnormal fluid collections are manifest in two or more fetal compartments, including abdominal ascites, pleural effusions, pericardial effusions, skin edema, polyhydroamniosis and placental edema. Although fetal hydrops was hystorically most commonly associated with Rh blood group isoimmunization, the availability of Rh immunoglobulin has increased the proportion of fetuses affected due to nonimmune etiologies. We have experienced a case of nonimmune hydrops fetalis at 32 weeks of gestation in a 27-year-old woman and reported that with brief review of related literatures.
Adult ; Ascites ; Edema ; Female ; Fetus ; Humans ; Hydrops Fetalis* ; Immunoglobulins ; Pericardial Effusion ; Pleural Effusion ; Pregnancy ; Skin

Left atrial wall calcification is frequently observed in patients with rheumatic valvular heart disease. However, massive left atrial wall calcification, so called porcelain or coconut atrium, with left atrium thrombi is very rare. Here, we describe the case of a 67-year-old male patient with porcelain atrium, recurrent left atrial thrombi, and a spontaneous axillary hematoma after mitral valve replacement and surgical thrombectomy due to rheumatic valvular heart disease. The patient underwent two valvular surgeries 20 years prior; therefore, we determined not to perform additional surgeries because of a high risk of morbidity, mortality, and the recurrence of atrial thrombi. The patient has been maintained on daily warfarin as an anti-thrombic therapy for more than 5 years without major embolic complications.
Aged ; Cocos ; Dental Porcelain ; Heart Atria ; Heart Valve Diseases ; Hematoma ; Humans ; Male ; Mitral Valve ; Recurrence ; Thrombectomy ; Thrombosis ; Warfarin

Left atrial wall calcification is frequently observed in patients with rheumatic valvular heart disease. However, massive left atrial wall calcification, so called porcelain or coconut atrium, with left atrium thrombi is very rare. Here, we describe the case of a 67-year-old male patient with porcelain atrium, recurrent left atrial thrombi, and a spontaneous axillary hematoma after mitral valve replacement and surgical thrombectomy due to rheumatic valvular heart disease. The patient underwent two valvular surgeries 20 years prior; therefore, we determined not to perform additional surgeries because of a high risk of morbidity, mortality, and the recurrence of atrial thrombi. The patient has been maintained on daily warfarin as an anti-thrombic therapy for more than 5 years without major embolic complications.
Aged ; Cocos ; Dental Porcelain ; Heart Atria ; Heart Valve Diseases ; Hematoma ; Humans ; Male ; Mitral Valve ; Recurrence ; Thrombectomy ; Thrombosis ; Warfarin

Malignant mixed mullerian tumor (MMMT) is a tumor in which carcinoma (an epithelial malignancy) is mixed with sarcoma (a nonepithelial malignancy). Extrauterine MMMTs are extremely rare, and only 32 cases are reported according to the literature. We experienced a case of primary peritoneal MMMT and repot with a brief review of literature.
Peritoneum* ; Sarcoma

A multiple primary malignant tumor is a disease mainly encountered in the of the older age groups. Attempts should be made to rule out a second primary malignant neoplasm in the elderly patients with unusual signs and symptoms. We encountered a case of a 67-year-old male with triple primary malignant tumors of the stomach, larynx, and lung. The patient had been treated with a subtotal gastrectomy for early gastric cancer in 1991 and a Laser laryngectomy for the laryngeal squamous cell carcinoma in 2003. In 2005, lung cancer was found with the biopsy revealing an adenosquamous carcinoma. Systemic chemotherapy was performed.
Aged ; Biopsy ; Carcinoma, Adenosquamous ; Carcinoma, Squamous Cell ; Drug Therapy ; Gastrectomy ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Larynx* ; Lung Neoplasms ; Lung* ; Male ; Stomach Neoplasms ; Stomach*

PURPOSE: To compare the accuracy of computed tomography (CT) with that of digital subtraction angiography (DSA) in predicting the resectability of Klatskin tumor on the basis of vascular invasion. MATERIALS AND METHODS: Twenty-five patients with Klatskin tumor who had undergone laparotomy were in-cluded in this study. In order to assess the surgical resectability of their tumors, the preoperative CT scans and DSA of these patients were retrospectively assessed in terms of vascular invasion. The criteria of unresectability were tumoral invasion of the proper hepatic artery or main portal vein, or simultaneous invasion of the hepatic artery on one side and the other side portal vein. RESULTS: Tumors were unresectable in 13 cases, and resectable in 12. CT and DSA predicted nine and three tumors as unresectable ones, respectively. The sensitivity, specificity, positive predictive value, negative predic-tive value and accuracy of CT in determining whether a tumor was unresectable were 61.5 %, 91.7%, 88.9 %, 6 8 .8 % and 76.0 %, respectively. For DSA, the respective figures were 23.1 %, 100 %, 100 %, 54.5 % and 6 0 .0 %. For the detection of vascular invasion without diameter change, CT was superior to DSA; for the evaluation of vascular anatomy, it was, however, less effective. CT failed to detect small hepatic metastasis (n=2), lymph node metastasis (n=1), variation of the bile duct (n=1), and the distal extent of tumor in the bile duct (n=1), factors which precluded surgical resection. CONCLUSION: CT is a reliable method for the detection of vascular invasion and tumor unresectability. For the detection of vascular anatomic variation, the combined use of CT and DSA would be helpful.
Anatomic Variation ; Angiography ; Angiography, Digital Subtraction* ; Bile Ducts ; Hepatic Artery ; Humans ; Klatskin's Tumor* ; Laparotomy ; Lymph Nodes ; Neoplasm Metastasis ; Portal Vein ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

OBJECTIVE: The change of claudin expressions, integral transmembrane proteins for tight junction, might be related to progression of cervical premalignancy or malignancy. The aim of this study was to verify the tendency of expressions of claudin-1 and -7 according to the progression of cervical pathology of uterus. METHODS: There were 162 tissues obtained at AA institute. 25 tissues were normal, 26 were cervical intraepithelial neoplasia (CIN) 1, 30 were CIN2, 44 were CIN3, 25 were microinvasive cervical carcinomas, and 12 were invasive squamous cervical carcinomas (ISCC). H and E and immunohistochemical staining were done. RESULTS: Among normal tissues, 52% showed no expression, 48% weak expressions at claudin-1, and 28% no expression, 56% weak expressions at claudin-7. Among CIN3, 20% showed weak expressions, 41% showed moderate expressions at claudin-1, and 14% weak expressions, 52% moderate expressions at claudin-7. Among ISCC, 42% showed moderate expressions, 50% strong expressions at claudin-1, and 33% moderate expressions, and 33% strong expressions at claudin-7. These data shows the increasing tendency of claudin-1 and claudin-7 expressions according to the severity of lesions (p<0.01). CONCLUSION: The expressions of claudin-1 and claudin-7 were increased more according to the progression of cervical lesions.
Carcinoma, Squamous Cell* ; Cervical Intraepithelial Neoplasia ; Claudin-1* ; Pathology ; Tight Junctions ; Uterus