PURPOSE: This study was performed to investigate the effectiveness and safety of the prophylactic administration method of surfactant, followed by rapid extubation to nasal CPAP (nCPAP) in very preterm infants. METHODS: Thirty-three preterm infants with 24-29 weeks gestational age (GA) were treated with the method of prophylactic administration of surfactant by a brief intubation within 15 minutes after birth and rapid extubation to nCPAP for the treatment of respiratory distress. The variables and complications related to oxygen therapy and mechanical ventilation (MV) were compared with those of 24 historical control infants with comparable GA, treated with the rescue surfactant administration with prolonged MV for the respiratory distress syndrome (RDS). RESULTS: Prophylactic surfactant with nCPAP did not reduce the total durations of oxygen therapy and MV, compared with the rescue surfactant with MV (P=0.622 P=122, respectively). The incidence of death and BPD at 36 weeks postmenstrual age (PMA) and other complications related to oxygen therapy and MV were not increased in the infants treated with prophylactic surfactant with nCPAP despite the lower GA and birth weight. In the subgroup analysis for infants with 27-29 weeks of GA, the total duration of MV tended to decrease in infants treated with prophylactic surfactant with nCPAP (Odd ratio, 0.93, 95% Confidence interval, 0.87, 1.00, P=0.051). CONCLUSION: Prophylactic surfactant administration followed by rapid extubation to nCPAP tended to reduce the duration of MV in infants with GA of 27-29 weeks, compared with the rescue surfactant administration with prolonged MV for RDS.
Birth Weight ; Continuous Positive Airway Pressure ; Gestational Age ; Humans ; Incidence ; Infant ; Infant, Newborn ; Infant, Premature ; Intubation ; Oxygen ; Parturition ; Respiration, Artificial

BACKGROUND: Laparoscopic gynecologic surgery is a standard procedure today for its small skin incision and short hospital admission stay. However pneumoperitoneum (PP) and Trendelenberg position induce adverse effects in hemodynamics and pulmonary gas exchange. The purpose of this study is to evaluate the effects of propofol compared with enflurane for pulmonary gas exchange in the Trendelenberg position and pneumoperitoneum. METHODS: Twenty women were randomly allocated to either the enflurane (n = 10) or propofol (n = 10) with fentanyl-N2O/O2 anesthesia. PaCO2, PaO2, PETCO2 were checked at pre-PP, 10 min after PP, 30 min after PP, and 10 min after CO2 deflation. In addition the Vd/Vt ratio was calculated according to the Bohr equation. Vital sign and peak airway pressure were checked at each stage. RESULTS: PaCO2 and PETCO2 increased and PaO2 decreased significantly during PP in both groups. Vd/Vt increased significantly in the enflurane group at 30 min after PP. Peak airway pressure increased significantly in both groups. Blood preassure and heart rate were not changed significantly. All of the parameters were not significantly different between groups. CONCLSIONS: Propofol compared with enflurane did not show any advantage in gas exchange during gynecologic laparoscopic surgery under Trendelenberg position and PP.
Anesthesia* ; Enflurane* ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy* ; Pneumoperitoneum ; Propofol* ; Pulmonary Gas Exchange ; Skin ; Vital Signs

No Abstract Available.
Lower Extremity* ; Varicose Veins*

Heterotopic brain tissue is a developmental anomaly of neurogenic origin with no malignant potential, and is usually present around the nose of children and infants. So it has been called nasal glioma. But, even more rarely, heterotopic glial tissue may be found in various sites other than nasal cavity, such as the ethmoidal sinus, palate, tonsillar area, pharynx, ear, subcutaneous tissue, lung, and female genital tract. We experienced a more unusual case of a polypoid heterotopic brain tissue in the soft palate in a 3-year-old boy. The mass was microscopically reminiscent of "gliosis" of the central nervous system and interestingly contained choroid plexus focally. The glial nature of the lesion was confirmed by glial fibrillary acidic protein immunostain.
Brain* ; Central Nervous System ; Child ; Child, Preschool ; Choroid Plexus ; Ear ; Female ; Glial Fibrillary Acidic Protein ; Glioma ; Humans ; Infant ; Lung ; Male ; Nasal Cavity ; Nose ; Palate ; Palate, Soft* ; Pharynx ; Subcutaneous Tissue

PURPOSE: Thymic size can be affected by glucocorticoids which promotes surfactant synthesis in preterm infants. We assessed the hypothesis that the fetal lung maturity in preterm infant correlates with the size of the thymus detected at birth on the routine chest radiograph. We also searched for a possible relationships between thymus size, respiratory distress syndrome (RDS), and the cord blood cortisol level. METHODS: The cardiothymic/thoracic ratios (CT/T) within 6 hours after birth and cord blood cortisol levels were measured in 42 preterm infants admitted to the neonatal intensive care unit of Seoul National University Children's Hospital from June 2002 to December 2003. Multiple linear regression analyses were done to assess the relationships between the CT/T, the perinatal events and the cord blood cortisol levels. The receiver operation characteristic curve analysis was done to evaluate the CT/T in the prediction of RDS. RESULTS: 8 infants (19.0%) developed RDS. The CT/T positively correlated with the birth weight, but not with the gestational age. The CT/T were significantly larger and the cord blood cortisol levels were significantly lower in the preterm infants with RDS than in those without RDS. The cord blood cortisol levels were negatively correlated with the CT/T. The birth weight and RDS were all independently associated with the CT/T. The CT/T less than 0.37 identified infants with RDS with 87.5% sensitivity and 61.8% specificity. CONCLUSION: The larger thymus at birth can be used to identify RDS. The lower cord blood cortisol level may be associated with the larger thymus in RDS.
Birth Weight ; Fetal Blood* ; Gestational Age ; Glucocorticoids ; Humans ; Hydrocortisone* ; Infant ; Infant, Newborn ; Infant, Premature* ; Intensive Care, Neonatal ; Linear Models ; Lung ; Parturition ; Radiography, Thoracic ; Sensitivity and Specificity ; Seoul ; Thymus Gland*

The effect of fentanyl and nalbuphine used as analgesics in balanced anesthesia were evaluated in 60 full term parturients, ASA physical status class I or II, sheduled for elective cesarean section. They were injected intramusculary with 0.2 mg of glycopyrrolate 30 minutes to one hour prior to the induction of anesthesia. Four mg/kg of thiopental sodium and one mg/kg of succinylcholine were administered intravenously for the induction and endotracheal intubation. Anesthesia was maintained with 66% of nitrous oxide in oxygen until delivery. Following the intravenous injection of 4 mg-vecuronium, controlled ventilation was applied to maintain at PCO1 30 to 40 mmHg. Immediately after clamping of the umbilical cord, 3 ug/kg of fentanyl(F group) or 0.3 mg/kg of nalbuphine(N group) with 5 mg of droperidol were administered. In the F group, the systolic and diastolic blood pressures at three minutes after fentanyl were significantly lower than those during the preinduction period and during recovery room stay. The systolic BP in the preinduction period was significantly higher than those of three minutes after nalbuphine, and the diastolic BP at the preinduction period was also higher than those of three minutes after nalbuphine and during recovery room stay. Heart rates were significantly increased three minutes after nalbuphine than at recovery room. The blood presures and heart rates were not significantly different between the two groups. The time intervals from the end of the operation to the first analgesics were significantly longer in the N group(mean 11.3 hours) in contrast to the F group(mean 6.9 hours). There were a few complications such as nausea, headache, dizziness, somnolence and euphoria. The incidences of awareness was 13.3 and 6.7% in the F and N group, respectively. We concluded that the balanced anesthetic technique using nalbuphine with droperidol nuder the inhalation of 66%-nitrous oxide resulted in a satisfactory anesthesia for cesarean seetion with good postoperative analgesia.
Analgesia ; Analgesics ; Anesthesia ; Anesthetics ; Balanced Anesthesia* ; Cesarean Section* ; Constriction ; Dizziness ; Droperidol ; Euphoria ; Female ; Fentanyl* ; Glycopyrrolate ; Headache ; Heart Rate ; Incidence ; Inhalation ; Injections, Intravenous ; Intubation, Intratracheal ; Nalbuphine* ; Nausea ; Nitrous Oxide ; Oxygen ; Pregnancy ; Recovery Room ; Succinylcholine ; Thiopental ; Umbilical Cord ; Ventilation

PURPOSE: Chlamydia trachomatis is one of the most common sexually transmitted diseases and is also a cause of pneumonia in infants. Respiratory infections by respiratory viruses are also common for infants. The objectives of this study were to identify the clinical manifestations and to determine the prevalence of C. trachomatis respiratory infections and coinfections by respiratory viruses in infants younger than 6 months of age. METHODS: For this study, we enrolled 6 months or younger infants who were admitted to the Dankook University Hospital between January 2002 and July 2007, with respiratory symptoms. Nasopharyngeal aspirates or throat swabs were collected within s d of hospitalization and C. trachomatis was detected using polymerase chain reaction (PCR). Patients who tested positive underwent multiplex PCR for respiratory viruses. RESULTS: A total of 690 patients underwent chlamydial PCR testing and 36 (5.2%) had positive results. Of the 36, 28 (78%) were male; 30 were vaginally delivered. From the 36 patients positive for C. trachomatis, 26 underwent multiplex respiratory viral PCR; 12 were coinfected with viruses. Respiratory syncytial virus (RSV) was the most frequent pathogen that was detected in 6 patients. Increased C-reactive protein and fever were significant in patients coinfected with respiratory viruses. CONCLUSION: C. trachomatis can infected in infants delivered by cesarean section as well as in 6 months old or younger infants. Infant with C. trachomatis respiratory infections can also be coinfected with respiratory infection also coinfected with respiratory viruses. Further studies are needed to better understand the prevalence rates of the this infection and its coinfection rate with respiratory viruses.
C-Reactive Protein ; Cesarean Section ; Chlamydia ; Chlamydia trachomatis ; Coinfection ; Female ; Fever ; Hospitalization ; Humans ; Infant ; Multiplex Polymerase Chain Reaction ; Pharynx ; Pneumonia ; Polymerase Chain Reaction ; Pregnancy ; Prevalence ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Sexually Transmitted Diseases

BACKGROUND: The control of multidrug-resistant microorganisms (MDROs) is important in preventing healthcare-associated infections. We performed a survey to evaluate the current system for control of MDROs in general hospitals in Korea. METHODS: A questionnaire consisted of queries about infection control systems, personnel, antibiotic use monitoring systems, isolation and barrier precautions, and obstacles to and opinions about MDROs. The questionnaire was mailed to 145 hospitals with more than 300 beds in November 2005. RESULTS: One hundred and two of the 145 (70.3%) hospitals responded; 65.3% of the responded hospitals had antibiotics control programs and 96.0% of those had control programs for MDROs. Surveillance cultures for vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) were taken in 21.6% and 16.7% of the hospitals, respectively. Over 90% of the hospitals had guidelines with respect to wearing gloves, collecting infectious wastes, and cleaning the environment for MRSA and VRE, but less than a half of the hospitals had the same standard for extended-spectrum beta-lactamase-producing gram-negative bacteria and carbapenem-resistant gram-negative bacteria. Most hospitals recommended gowning when contamination or invasive procedures were anticipated, but for VRE patients, gowns were used more strictly whenever there was contact with MDROs. Major obstacles related to isolation of patients infected or colonized with MDROs were the cost for isolation rooms (37.3%), and proposed solutions were reimbursement from the medical insurance company (86.3%), construction of a nationwide management system (61.8%), and effort by individual hospitals (58.8%) for MDROs infection control. CONCLUSION: Most of the hospitals have adopted control programs, but more needs to be done. Further efforts, including periodic reporting of antibiotic resistance, sufficient cost reimbursement, and providing education and increased awareness are urgently needed.
Anti-Bacterial Agents ; Colon ; Drug Resistance, Microbial ; Education ; Enterococcus ; Gram-Negative Bacteria ; Hospitals, General* ; Humans ; Infection Control* ; Insurance ; Korea* ; Methicillin-Resistant Staphylococcus aureus ; Postal Service ; Surveys and Questionnaires

PURPOSE: To investigate the clinical characteristics and the risk factors for mechanical ventilator treatment and incidence of complications in children admitted to an intensive care unit (ICU) with detected respiratory viruses. METHODS: Eighty-two patients who were detected respiratory viruses by multiplex real-time polymerase chain reaction from nasopharyngeal aspirates were enrolled among the 123 children admitted to ICU with acute respiratory manifestations during the study period from January 2006 to December 2012. RESULTS: Detection rate of respiratory viruses were 66% and 13 patients (16%) had two viruses isolated. The most common respiratory virus isolated was respiratory syncytial virus (RSV) (35%) followed by rhinovirus (19%), adenovirus (13%), parainfluenza virus (11%), influenza virus (11%), human metapneumovirus (6%), and human coronavirus (5%). Pneumonia (70%) was the most common clinical diagnosis. The mean age of patient with RSV infection was the youngest and with influenza virus infection was the oldest among other viruses infection (mean+/-standard deviation, 5.9+/-10.1 months vs. 51.0+/-26.1 months; P=0.01). Forty Patients (49%) who had the underlying diseases were not associated with incidence of mechanical ventilator treatment and complications. Bacterial coinfection with respiratory virus was the significant risk factor of mechanical ventilator care and incidence of complications (odds ratio [OR], 50.003; 95% confidence interval [CI], 3.955-632.144; P=0.003, and OR, 15,569; 95% CI, 1.803-134.452; P=0.013). CONCLUSION: The significant morbidity of pediatric patient admitted to ICU with respiratory virus infection (RVI) was associated with bacterial coinfection. Furthermore, multicenter study should be performed to investigate the epidemiology of RVI in pediatric patients admitted to ICU in domestic.
Adenoviridae ; Child* ; Coinfection ; Coronavirus ; Diagnosis ; Epidemiology ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Metapneumovirus ; Orthomyxoviridae ; Paramyxoviridae Infections ; Pneumonia ; Real-Time Polymerase Chain Reaction ; Respiratory Syncytial Viruses ; Rhinovirus ; Risk Factors ; Ventilators, Mechanical ; Viruses*

BACKGROUND: The dominant innervation of airway smooth muscle is parasympathetic fibers which are carried in the vagus nerve. Activation of these cholinergic nerves releases acetylcholine which binds to M3 muscarinic receptors on the smooth muscle causing bronchocontraction. Acetylcholine also feeds back onto neuronal M2 muscarinic receptors located on the postganglionic cholinergic nerves. Stimulation of these receptors further inhibits acetylcholine release, so these M2 muscarinic receptors act as autoreceptors. Loss of function of these M2 receptors, as it occres in animal models of hyperresponsiveness, leads to an increase in vagally mediated hyperresponsiveness. However, there are limited data pertaining to whether there are dysfunctions of these receptors in patients with asthma. The aim of this study is to determine whether there are dysfunction of M2 muscarinic receptors in asthmatic patients and difference of function of these receptors according to severity of asthma. METHODS: We studied twenty-seven patients with asthma who were registered at Pulmonology Division of Korea University Hospital. They all met asthma criteria of ATS. Of these patients, eleven patients were categorized as having mild asthma, eight patients moderate asthma and eight patients severe asthma according to severity by NAEPP Expert Panel Report 2(1997). All subjects were free of recent upper respiratory tract infection within 2 weeks and showed positive methacholine challenge test(PC 20<16mg/ml). Methacholine provocation tests performed twice on separate days allowing for an interval of one week. In the second test, pre-treatment with the M2 muscarinic receptor agonist pilocarpine(180µg) through inhalation was performed before the routine procedures. RESULTS: Eleven subjects with mild asthma and eight aubjects with moderate asthma showed significant increase of PC20 from 5.30±5.23mg/ml(mean±SD) to 20.82±22.56mg/ml(p=0.004) and from 2.79±1.5mg/ml to 4.67±3.53mg/ml(p=0.012) after pilocarpine inhalation, respectively. However, in the eight subjects with severe asthma significant increase of PC20 from 1.76±1.50mg/ml to 3.18±4.03mg/ml(p=0.161) after pilocarpine inhalation was not found. CONCLUSION: In subjects with mild and moderate asthma, function of M2 muscarinic receptors was normal, but there was a dysfunction of these receptors in subjects with severe asthma. These results suggest that function of M2 muscarinic receptors is different according to severity of asthma.
Acetylcholine ; Asthma ; Autoreceptors ; Humans ; Inhalation ; Korea ; Methacholine Chloride ; Models, Animal ; Muscle, Smooth ; Neurons* ; Pilocarpine ; Pulmonary Medicine ; Receptors, Muscarinic* ; Respiratory Tract Infections ; Vagus Nerve