PURPOSE: Parenteral nutrition is given to infants who tempararily cannot take oral feeding adequately. A lipid emulsion is added to the parenteral to supply essential fatty acids. In neonatal sepsis, elastase from azuropilic granules of the neutrophils is released and rapidly bound to alpha1-Proteinase Inhibitor(alpha1-PI). The lipid emulsion has been noted to markedly inhibit chemotaxis of neutrophils, so we to measured the levels of Elastase-alpha1-Proteinase Inhibitor(E-alpha1-PI) complex to evaluate the effect of intralipid infusions on the neutrophil in newborns with sepsis. METHODS: This study evaluated 8 patients with neonatal sepsis and 12 normal newborns. We measured E-alpha1-PI complex levels in the serum of these patients by ELISA methods. RESULTS: Before infusion with lipid solution, patients with neonatal sepsis had significantly increased levels of E-alpha1-PI complex in comparison with those of vaginally delivered normal newborns. E-alpha1-PI complex levels were significantly decreased after lipid infusions of 0.5g/kg per day, but there was no further significant decrease with higher doses of the infusate. CONCLUSION: We observed the suppression neutrophil elastase levels by lipid infusions in newborn with sepsis. These results suggest that there were no appropriate chemotatic effects of neutrophil in newborn with sepsis. Therefore, we considered whether the lipid infusion was stopped if the newborn with sepsis was infused parenteral nutrition with intralipid.
Chemotaxis ; Enzyme-Linked Immunosorbent Assay ; Fatty Acids, Essential ; Humans ; Infant ; Infant, Newborn* ; Leukocyte Elastase ; Neutrophils ; Pancreatic Elastase* ; Parenteral Nutrition ; Sepsis

PURPOSE: This study was designed to investigate the clinical effects of Newfactan in the treatment of moderate to severe respiratory distress syndrome. METHODS: There were enrolled 20 preterm infants who were diagnosed as grade III or grade IV respiratory distress syndrome at Kosin University Gospel Hospital from July 1997 to May 2000. All of these preterm infants were treated for rescue. To investigate the improvement of respiratory parameters we used FiO2, MAP, a/APO2 ratio, OI. RESULTS: Newfactan was administered to the patients at 7.2+/-7.4 hours (range 1.5- 32) after birth and 7 cases (35%) were administered one dose, 8 (40%) were administered two doses and 5 (25%) were administered three doses. The dose interval from first to second dose was 9.2+/-12.3 hours (range 5-46). The dose interval from second to third dose was 27.6+/-5.4 hours (range 21-35). The need of FiO2 showed decreased tendency especially between 4 to 6 hour after administration (P<0.05). PaCO2 and OI were decreased and a/APO2 ratio was increased after administration (P<0.05). MAP was not changed statistically (P>0.05). There were 41 complications and outcomes including PDA, sepsis, pneumothorax, intraventricular hemorrhage, BPD, ROP, and necrotizing enterocolitis. CONCLUSION: The clinical effects of Newfactan in the treatment of grade III or grade IV respiratory distress syndrome were significant in improving FiO2, PaCO2, a/APO2 ratio and OI.
Enterocolitis, Necrotizing ; Hemorrhage ; Humans ; Infant, Newborn ; Infant, Premature ; Parturition ; Pneumothorax ; Sepsis

BACKGROUND: Recently, an acquired resistance to vancomycin in enterococci has become a serious clinical problem. For the prevention of further propagation of vancomycin-resistant enterococci (VRE), epidemiological study of the infection is essential, but studies on the VRE infection are rare in Korea. We conducted an analysis of the epidemiology of a VRE outbreak in a neonatal intensive care unit (NICU) to clear up the route of propagation of the VRE. METHODS: Vancomycin-resistant Enterococcus faecium (VREFM) strains were isolated from urine specimens of seven patients, rectal swabs from seven patients, and three skin swabs from two patients in the Kosin Medical Center neonatal intensive care unit, Pusan, Korea. Antimicrobial susceptibilities were tested by a disk diffusion method and agar dilution method. Genotypes of vancomycin-resistance were determined by PCR and SmaI-digested genomic enterococcal DNAs were analyzed by pulsed-field gel electrophoresis. RESULTS: All of the 17 strains of VREFM were resistant to ampicillin, vancomycin, and teicoplanin and they showed the same genotype (vanA). SmaI-digested genomic DNAs of seven strains isolated from urine were typed as I (1), II (1), IIIb (4), and IV (1). Three strains from skin swabs were I (2) and II (1). Six strains from rectal swabs were I (2), II (1), and IIIa (3). Genomic DNA typing of one isolate from a rectal swab failed. Each genomic DNA type of VREFM strains isolated from skin swabs of two patients were the same with those from urine specimens as I and II, respectively. CONCLUSIONS: This study suggests that VRE strains colonized in the intestines can cause infections after skin colonizing and can be transmitted/propagated to other people through skin contact. In conclusion, it is important for the prevention of the dissemination of VRE that controls for patients' skin hygiene, as well as hand washing by medical persons, be put in place.
Agar ; Ampicillin ; Busan ; Colon ; Diffusion ; DNA ; DNA Fingerprinting ; Electrophoresis, Gel, Pulsed-Field ; Enterococcus faecium ; Epidemiologic Studies ; Epidemiology ; Genotype ; Hand Disinfection ; Humans ; Hygiene ; Infant, Newborn ; Intensive Care, Neonatal* ; Intestines ; Korea ; Molecular Epidemiology* ; Polymerase Chain Reaction ; Skin ; Teicoplanin ; Vancomycin

Coincidental occurrence of the renal cell carcinoma and renal angiomyolipoma in the same kidney is exceedingly rare, and it is usually presented as separated masses or nodules in cage of its occurrence. However, our case which has occurred in a 37-year-old-man without any stigmata of tuberous sclerosis is different because the angiomyolipoma and renal cell carcinoma are admixed in the same mass. To our knowledge, only 2 cases or combination of this tumors have been reported previously.
Angiomyolipoma* ; Carcinoma, Renal Cell* ; Christianity ; Kidney* ; Tuberous Sclerosis

BACKGROUND: Early surgical ligation of patent ductus arteriosus which has a significant hemodynamics and contraindications to the indomethacin therapy is a safe and effective therapeutic modality in premature infants. MATERIAL AND METHOD: From January 1995 to May 2000, 50 premature infants were diagnosed to have patent ductus arteriosus in Kosin University Hospital. There were 22 infants with asymptomatic PDA(Group I) and 28 infants with hemodynamically significant PDA which were treated with indomethacin(Group II, n=5) and surgical ligation(Group III, n=23). Group III had one or more contraindications to indomethacin therapy. Surgical ligation was done in the neonatal intensive care unit. This study is to compare the effects of surgical ligation and indomethacin therapy in premature infant with hemodynamically significant PDA. RESULT: Gestational age(week)and birth weight (g) were shorter and lesser in Group III(29.6 2.1, 1435 431.0) than in Group I(32.1 2.1, 1731 450.9), II(32 1.0, 1830 165.5) significantly(p<0.05), Age at the time of treatment (day) was not different in Group II(8.6 5.5) and III(7.3 4.4)(p<0.05), but body weight at the time of treatment(g) was lesser in Group III(1211 22.4) than Group II (1670 43.6) significantly(p<0.05). Survival rate(%) was higher in Group II(100) than Group III(73.9) significantly(p<0.05). The main causes of deaths were septicemia(5 cases), intracerebral hemorrhage(2), bronchopulmonary dysplasia(2), septic shock(1), and pneumothorax(1), which were not related to the operation. CONCLUSION: Early surgical ligation of hemodynamically significant PDA was a very effective therapeutic modality, and was thought to be safely applicable to the premature infant with contraindication to the indomethacin therapy and the extremely low birth weight.
Birth Weight ; Body Weight ; Cause of Death ; Ductus Arteriosus, Patent* ; Hemodynamics ; Humans ; Indomethacin ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Ligation*

Hypercarbia is a potential complication during laparoscopic surgery. However, is more likely to occur in extraperitoneal surgery than in intraperitoneal surgery because insufflated CO2 gas can diffuse easily into the surrounding tissues. We report the anesthetic course and complications encountered during endoscopic harvesting of a saphenous vein with CO2 insufflation in coronary artery bypass surgery. Although the surgery was successful, the patient developed signs and symptom of CO2 absorption: tachycardia, hypertension, hypercarbia and acidosis. Possible mechanisms are presented, along with a discussion of the prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, care must be taken to monitor the CO2 insufflation pressure, perform a routine examination and palpation of the chest wall, use of N2O with caution, increase the level of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.
Absorption ; Acidosis ; Coronary Artery Bypass* ; Coronary Vessels* ; Diagnosis ; Endoscopy ; Humans ; Hypertension ; Insufflation ; Laparoscopy ; Palpation ; Saphenous Vein* ; Subcutaneous Emphysema ; Tachycardia ; Thoracic Wall ; Ventilation

BACKGROUND: Sirtuin 1 (SIRT1) and deleted in breast cancer 1 (DBC1) are known as tumor suppressor or promoter genes. This may be due to their diverse functions and interaction with other proteins. Gastric adenocarcinoma is one of the most common malignancies, but little is known about its carcinogenesis. Therefore, we investigated the association of immunohistochemical expression of SIRT1, DBC1, p53, and beta-catenin and their variable clinicopathological characteristics. METHODS: We obtained samples from 452 patients who underwent gastrectomy. Tissue microarray blocks were constructed and immonohistochemical staining was performed. RESULTS: Expression of DBC1 and SIRT1 was associated with lower histologic grade, intestinal type of Lauren classification, and lower pT (p<0.001) and pN stage (DBC1, p=0.002; SIRT1, p<0.001). Association between absence of lymphatic invasion, and SIRT1 (p=0.001) and DBC1 (p=0.004) was observed. Cytoplasmic beta-catenin expression was associated with lower histologic grade, pT, pN, tumor-node-metastasis (TNM) stage, DBC1 (p<0.001), and SIRT1 (p=0.001). Expression of SIRT1 and DBC1 was not associated with p53 (p=0.063 and p=0.060). DBC1 was an independent good prognostic factor in multivariate analysis (p=0.012). CONCLUSIONS: SIRC1 and DBC1 can be considered to be good prognostic factors in gastric adenocarcinoma.
Adenocarcinoma ; beta Catenin ; Breast Neoplasms ; Cytoplasm ; Gastrectomy ; Humans ; Multivariate Analysis ; Proteins ; Sirtuin 1 ; Stomach ; Tumor Suppressor Proteins

No abstract available.
Adenoma, Pleomorphic ; Palate

BACKGROUND: Overexpression of heat shock protein 70 (HSP70) has been observed in many types of cancer including gastric adenocarcinomas, although the exact role of HSP70 in carcinogenesis remains unclear. METHODS: The study analyzed a total of 458 radical gastrectomy specimens which were immunohistochemically stained with HSP70, p53, and Ki-67 antibodies. RESULTS: The study determined that the expression of HSP70 was significantly increased in early gastric cancer (EGC) compared to advanced gastric cancer (p<0.001). The HSP70 expression was correlated with well-differentiated tumor type, intestinal type of Lauren classification and the lower pT and pN stage. Negative expression of Ki-67 and p53 expression was associated with poor prognosis. The study did not find any correlation between HSP70 and p53 expression. The study determined that HSP70 expression in the EGC subgroup was associated with a poor prognosis (p=0.009), as well as negative Ki-67 expression (p=0.006), but was not associated with p53. Based on multivariate analysis, HSP70 expression (p=0.024), negative expression of Ki-67, invasion depth and lymph node metastasis were determined to be independent prognostic markers. CONCLUSIONS: HSP70 is expressed in the early stages of gastric adenocarcinoma. In EGC, HSP70 is a poor independent prognostic marker and is correlated with a low proliferation index.
Adenocarcinoma ; Gastrectomy ; Heat-Shock Proteins ; Hot Temperature ; HSP70 Heat-Shock Proteins ; Ki-67 Antigen ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Prognosis ; Stomach Neoplasms

Peripheral nerve block has frequently been used as an alternative to epidural analgesia for postoperative pain control in patients undergoing total knee replacement. However, there are few reports demonstrating that the combination of femoral and sciatic nerve blocks (FSNBs) can provide adequate analgesia and muscle relaxation during total knee replacement. We experienced a case of successful FSNBs for a total knee replacement in a 66 year-old female patient who had a previous cancelled surgery due to a failed tracheal intubation followed by a difficult mask ventilation for 50 minutes, 3 days before these blocks. FSNBs were performed with 50 ml of 1.5% mepivacaine because she had conditions precluding neuraxial blocks including a long distance from the skin to the epidural space related to a high body mass index and nonpalpable lumbar spinous processes. This case suggests that FSNBs can provide a good alternative anesthetic method for total knee replacement.
Analgesia ; Analgesia, Epidural ; Arthroplasty, Replacement, Knee ; Body Mass Index ; Epidural Space ; Female ; Femoral Nerve ; Humans ; Intubation ; Masks ; Mepivacaine ; Muscle Relaxation ; Nerve Block ; Pain, Postoperative ; Peripheral Nerves ; Sciatic Nerve ; Skin ; Ventilation