OBJECTIVE: To determine the differences in water balance between preterm small for gestational age (SGA) and appropriate for gestational age(AGA) infants, we compared the difference in initial physiologic weight loss during the first five days of life and studied associated factors influencing the initial physiologic weight loss in preterm SGA and AGA infants. METHODS: We retrospectively analyzed water and electrolyte balance in 51 preterm low birth weight infants of whom 20 were preterm SGA infants(gestational age, 30.4+/-1.6weeks:birth weight, 970+/-180g) and 31 preterm AGA infants(30+/-1.7 weeks:1437+/-276g) matched by gestation. RESULTS: The percent weight loss was significantly lower in SGA than in AGA infants(p=0.01). The percent weight loss on the fifth day of life were 12.1+/-5.3% in SGA and 15.8+/-4.3% in AGA infants, respectively(p=<0.01). SGA infants had significantly lower urine output on the second and third day of life compared to AGA infants. Diuresis started on the second day of life in AGA infants and on the fifth day of life in SGA infants. CONCLUSION: The initial physiologic weight loss in SGA infants occurred in a smaller degree compared with AGA infants. This was associated with lower urine volume and the delay in onset of diuresis in SGA infants. These differences in water balance in SGA and AGA infants should be considered in the management of preterm low birth weight infants on mechanical ventilation.
Body Weight Changes* ; Body Weight* ; Diuresis ; Gestational Age ; Humans ; Infant* ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Respiration, Artificial ; Retrospective Studies ; Water-Electrolyte Balance ; Weight Loss

PURPOSE: Aortic thrombus is a rare but serious complication in neonates, usually associated with central vessel catheterization. Currently treatment of asymptomatic aortic thrombus in preterm infants is controversial. We evaluated effects of urokinase in preterm infants with aortic thrombi. METHODS: We studied 12 preterm infants in whom umbilical arterial catheterizations were performed and subsequently aortic thrombi were detected. In six patients bolus doses of urokinase 4, 400 IU/kg were injected, followed by continuous infusions of 4, 400 IU/kg/hr. The mean duration of urokinase use was 11 days (6-13 days). The other six patients who did not receive urokinase served as controls. The two groups were compared for changes in the size of thrombi. RESULTS: The initial sizes of aortic thrombi upon detection were similar, although the diagnoses were made earlier in urokinase group than in controls. The days to 50% reduction in size of thrombi were significantly shorter in urokinase group, as were the days to complete resolution. One infant in urokinase group and 2 infants in control group had persistent aortic thrombi up to 90 days of follow-up. Intracranial hemorrhage and disseminated intravascular coagulopathy were absent in all 12 cases. CONCLUSION: Urokinase administration could be an effective therapy for preterm neonates with aortic thrombi. It significantly reduces the size of the thrombus and shortens the days to complete resolution.
Catheterization ; Catheters ; Diagnosis ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Infant, Premature* ; Intracranial Hemorrhages ; Thrombosis* ; Urokinase-Type Plasminogen Activator*

PURPOSE: Pulmonary interstitial emphysema (PIE) is a common and serious complication of mechanical ventilation in infants with hyaline membrane disease. This abnormal collection of gases has two basic roentgenographic features; linear and cyst-like radiolucencies. High positive inspiratory pressure was found to be the most significant parameter associated with development of fatal pulmonary interstitial emphysema. Without prompt conservative management such as lowering peak inspiratory pressure, PIE often progress to a pneumothorax with increased mortality. We studied the incidence and risk factors of PIE and associated risk factors which progress to pneumothorax in mechanically ventilated infants with hyaline membrane disease. METHODS: We reviewed retrospectively the charts of infants who had been admitted to the neonatal intensive care unit between Jan. 1990 and Mar. 1995. A hundred and two infants who were diagnosed as hyaline membrane disease and mechanically ventilated were included in the study. Analysis of clinical characteristics and ventilator parameters were made. Chest radiographs were reviewed for hyaline membrane disease, PIE, pneumothorax by a pediatric radiologist without knowledge of their clinical course. RESULTS: 1) We observed PIE in 14 of 102 infants (13.7%) of which 11 infants progressed to develop pneumothorax. 2) Low gestational age, low apgar score and high peak inspiratory pressure were the factors significantly associated with development of PIE. 3) PIE was frequently located bilaterally (52%), distributed on whole lung parenchyme (92%). Sizes of radiolucency were variable including blebs. 4) Early onset PIE and failure to promptly lower peak inspiratory pressure were the associated risk factors for development of pneumothorax. 5) Pneumothorax developed within a mean 7.5 hours after apperance of PIE. Right side pneumothorax was more frequent (67%). Mortality increased to 73% with development of pneumothorax in PIE. CONCLUSIONS: Early diagnosis of PIE and prompt lowering of peak inspiratory pressure should be emphasized to improve the survival and outcome of mechanically ventilated hyaline membrane diasease infants.
Apgar Score ; Blister ; Early Diagnosis ; Emphysema* ; Gases ; Gestational Age ; Humans ; Hyalin* ; Hyaline Membrane Disease* ; Incidence ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Lung ; Membranes ; Mortality ; Pneumothorax ; Radiography, Thoracic ; Respiration, Artificial ; Retrospective Studies ; Risk Factors* ; Ventilators, Mechanical

The authers report a case of chondroid chordoma in the cavernous sinus. The chondroid chordoma is an uncommon variant of typical chordoma(0.2% of intracranial tumors) and reported usual locations of the chondroid chordoma are clival, parasellar, intrasellar, temporal region, other skull base and extracranial areas. Reported cases of this tumor arising in the cavernous sinus is very rare. We report a case of cavernous sinus chondroid chordoma presenting with clinical symptoms by hemorrhage.
Cavernous Sinus* ; Chordoma* ; Hemorrhage ; Skull Base

No abstract available.
Herpes Simplex* ; Simplexvirus*

Purpose: This study aimed to evaluate current morbidity rates following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer and peritoneal metastasis. Methods: A total of 42 patients who underwent CRS and HIPEC for colorectal cancer with peritoneal metastasis at a single tertiary referral center between January 2022 and December 2022 were included. Perioperative outcomes and postoperative complications were prospectively assessed. Results: The mean peritoneal cancer index (PCI) was 16.0. The distribution of PCI scores was as follows: <10, 33.3%; 10– 19, 26.2%; and ≥ 20, 40.5%. Completeness of the cytoreduction (CCR) scores were as follows: 57.1% of patients achieved CCR-0, 16.7% achieved CCR-1, 7.1% achieved CCR-2, and 19.0% achieved CCR-3. The mean operation time was 9.1 hours, and the median hospital stay was 17.0 days. Postoperative complications occurred within 30 days in 47.6% of cases and between 30 and 60 days in 11.9% of cases. Reoperation within 30 days was required in 5 cases, and 1 patient died within 30 days. The most common complications were pleural effusion (5 patients), anastomosis site leakage (3 patients), and pneumonia (3 patients). Patients with higher PCI scores were more likely to experience complications (P = 0.038). Conclusion Although CRS and HIPEC are still associated with high morbidity and mortality compared to other colorectal surgeries, outcomes have improved with increased experience. These results suggest that the procedure is becoming a more acceptable treatment option over time.

Purpose: This study aimed to evaluate current morbidity rates following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer and peritoneal metastasis. Methods: A total of 42 patients who underwent CRS and HIPEC for colorectal cancer with peritoneal metastasis at a single tertiary referral center between January 2022 and December 2022 were included. Perioperative outcomes and postoperative complications were prospectively assessed. Results: The mean peritoneal cancer index (PCI) was 16.0. The distribution of PCI scores was as follows: <10, 33.3%; 10– 19, 26.2%; and ≥ 20, 40.5%. Completeness of the cytoreduction (CCR) scores were as follows: 57.1% of patients achieved CCR-0, 16.7% achieved CCR-1, 7.1% achieved CCR-2, and 19.0% achieved CCR-3. The mean operation time was 9.1 hours, and the median hospital stay was 17.0 days. Postoperative complications occurred within 30 days in 47.6% of cases and between 30 and 60 days in 11.9% of cases. Reoperation within 30 days was required in 5 cases, and 1 patient died within 30 days. The most common complications were pleural effusion (5 patients), anastomosis site leakage (3 patients), and pneumonia (3 patients). Patients with higher PCI scores were more likely to experience complications (P = 0.038). Conclusion Although CRS and HIPEC are still associated with high morbidity and mortality compared to other colorectal surgeries, outcomes have improved with increased experience. These results suggest that the procedure is becoming a more acceptable treatment option over time.

Purpose: This study aimed to evaluate current morbidity rates following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colorectal cancer and peritoneal metastasis. Methods: A total of 42 patients who underwent CRS and HIPEC for colorectal cancer with peritoneal metastasis at a single tertiary referral center between January 2022 and December 2022 were included. Perioperative outcomes and postoperative complications were prospectively assessed. Results: The mean peritoneal cancer index (PCI) was 16.0. The distribution of PCI scores was as follows: <10, 33.3%; 10– 19, 26.2%; and ≥ 20, 40.5%. Completeness of the cytoreduction (CCR) scores were as follows: 57.1% of patients achieved CCR-0, 16.7% achieved CCR-1, 7.1% achieved CCR-2, and 19.0% achieved CCR-3. The mean operation time was 9.1 hours, and the median hospital stay was 17.0 days. Postoperative complications occurred within 30 days in 47.6% of cases and between 30 and 60 days in 11.9% of cases. Reoperation within 30 days was required in 5 cases, and 1 patient died within 30 days. The most common complications were pleural effusion (5 patients), anastomosis site leakage (3 patients), and pneumonia (3 patients). Patients with higher PCI scores were more likely to experience complications (P = 0.038). Conclusion Although CRS and HIPEC are still associated with high morbidity and mortality compared to other colorectal surgeries, outcomes have improved with increased experience. These results suggest that the procedure is becoming a more acceptable treatment option over time.

PURPOSE: Functional loss of mismatch repair has been reported to be the reason for resistance to several chemotherapeutic drugs. The expressions of hMLH1 and hMSH2 were examined to assess whether they correlated with the biological behavior and the chemotherapeutic responsiveness in paflents with sporadic colon cancers. METHODS: Ninety-one patients with stage III primary colon cancer were included from the tumor registry of the Asan Medical Center, Seoul, Korea. All patients underwent a curative operation and postoperative chemotherapy with 5- fluorouracil and leucovorin for 6 cycles between 1993 and 1997. Immunohistochemical staining for hMLH1 and hMSH2 was performed using archival paraffin blocks. A positive expression was determined when unequivocal nuclear staining was identified in more than 10% of the cancer cells. The survival and the clinicopathologic variables regarding hMLH1 and hMSH2 expressions were assessed using the log-rank test and the Cox proportional regression method. RESULTS: Either hMLH1 or hMSH2 expression was lost in nine cases (9.9%). hMLH1 and hMSH2 expressions were significantly correlated with tumor invasion (P=0.012) and tumor differentiation (P=0.017). The disease-free survival did not differ with respect to hMLH1 and hMSH2 expressions. The number of metastatic lymph nodes and the preoperative serum CEA level were independent predictors of disease-free survival on a multivariate analysis. CONCLUSIONS: The loss of hMLH1 or hMSH2 expresscon appears to be involved in the differentiation of and the invasion by colon cancer. However, nether hMLH1 nor hMSH2 expression was correlated withthe 5-fluorouracil responsiveness.
Chungcheongnam-do ; Colon* ; Colonic Neoplasms* ; Disease-Free Survival ; DNA Mismatch Repair ; Drug Therapy ; Fluorouracil ; Humans ; Korea ; Leucovorin ; Lymph Nodes ; Microsatellite Instability ; Multivariate Analysis ; Paraffin ; Seoul

PURPOSE: This study evaluated the efficacy of neoadjuvant chemotherapy combining 5-flurouracil/folinic acid with irinotecan (FOLFIRI) in colorectal multiple liver metastases regardless of resectability. METHODS: Forty-four patients with multiple (at least two) colorectal liver metastases were enrolled at seven tertiary referral hospitals between May 2007 and September 2010. All patients received the FOLFIRI chemotherapeutic regimen. Response to chemotherapy was assessed after three cycles (6 weeks) and once more after six cycles (12 weeks) of treatment. RESULTS: Objective response was noted in 27 patients (61.4%) and 4 patients (9.1%) had progressive disease. Of 44 patients, 10 patients (22.7%) underwent curative surgery (R0 resection) and 34 patients did not receive R0 resection. Grades 3 to 4 hematological toxicity was noted in 12 patients (27.3%) and grades 3 to 4 nonhematologic toxicity was identified in 5 patients (11.4%). CONCLUSION: FOLFIRI chemotherapy as a neoadjuvant chemotherapy for multiple colorectal liver metastases regardless of resectability demonstrated the possibility of R0 resection, high rate of objective response, and tolerable toxicities in this study.
Camptothecin ; Colorectal Neoplasms ; Humans ; Liver ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Prospective Studies ; Tertiary Care Centers