PURPOSE: The aim of this study was to evaluate the effect of inhaled nitric oxide(iNO) on gas exchange, hemodynamics and pulmonary inflammation in newborn piglets with E. coli induced septic lung. METHODS: Twenty three instrumented and ventilated piglets were randomized into three groups: CON(n=6), PCON(n=9), and PNO(n=8). In the piglets of the PCON and PNO groups, E. coli septic lung was induced by endotracheal instillation of E. coli. Ten ppm iNO was given continuously in the PNO group after endotracheal instillation of E. coli. All animals were mechanically ventilated for six hour with a peak inspiratory pressure of 30 cmH2O, frequency of 25 breaths/min, FiO2 1.0 and a positive end-expiratory pressure of 4 cmH2O. All measurements were made at one hour intervals during the experiment. At the end of the experiment, lung tissue was harvested for the analysis of myeloperoxidase activity, indicative of lung inflammation. RESULTS: All piglets with pulmonary instillation of E. coli developed E. coli sepsis. Piglets in the PCON group developed progresseve pulmonry hypertension, hypoxemia and hypercarbia compared to the CON group due to increased pulmonary vascular resistance, intrapulmonary shunt fraction and physiologic dead space fraction. iNO did not reverse pulmonary hypertension in the PNO group. However iNO significantly improved oxygenation, which was attributed to marked improvement of venous admixture and partial attenuation of increase in dead space fraction. Increased myeloperoxidase activity in PCON compared to CON was significantly attenuated in PNO. CONCLUSION: iNO improves oxygenation and lung inflammation in newborn piglets with E. coli induced septic lung.
Animals ; Anoxia ; Escherichia coli* ; Escherichia* ; Hemodynamics* ; Humans ; Hypertension ; Hypertension, Pulmonary ; Infant, Newborn* ; Lung* ; Nitric Oxide* ; Oxygen ; Peroxidase ; Pneumonia* ; Positive-Pressure Respiration ; Sepsis ; Vascular Resistance

According to the reports, the prevalence of anti-HCV is about 1%. In past, the results of the prevalence of HBs Ag & HBs Ab in the patients of Hansen's disease were reported. But we don't know about that of anti-HCV. So we study about the prevalence of serum anti-HCV of 60 patients & PALS of Hansen's disease. And we test about Alk. Phosp., ALT, AST, Gtlc HBs Ag & HBs Ab. 1. The prevalence of anti-HCV is 8.33%. It is higher than past reports(about 1-2%). 2. The prevalence of HBs Ag is 3.4% & that of HBs Ab is 36.3%. 3. Because of the high prevalence of anti-HCV in the patients of Hansen's disease & PALS, we think that more studies are need about it.
Hepacivirus* ; Hepatitis C Antibodies* ; Hepatitis C* ; Hepatitis* ; Humans ; Leprosy ; Prevalence

To evaluate the predictive values of oxygenation index (OI), arterial-alveolar oxygen tension ratio (a/APO)2, and alveolar-arterial oxygen gradient ((A-a)DO2) for early recognition of responsiveness to high frequency oscillatory ventilation (HFOV) in very low birth weight infants with respiratory distress syndrome (RDS), 23 infants who received HFOV treatment for severe RDS after failing to be improved with conventional mechanical ventilation from July 1995 to February 1998 were included. Twelve infants survived with HFOV (Responder group), while 11 infants could not maintain oxygenation with HFOV and died (Non-responder group). Clinical record (of each patient) were retrospectively reviewed and compared with the respiratory indices. Mean (A-a)DO2 was significantly lower in the responder group than in the non-responder group at 2 hr after HFOV (p=0.024), and the difference was more remarkable at 6 hr (p=0.005). Death in the patient with (A-a)DO2 over 350 at 2 hr after HFOV therapy was 100% in sensitivity and 80% in specificity. The earliest significant difference of mean a/APO2 between two groups was noted at 6 hr after HFOV treatment (p=0.019). OI showed no significant differences between two groups. In summary, (A-a)DO2 was the most effective and sensitive respiratory index for predicting the responsiveness to HFOV in infants with severe RDS providing due as early as 2 hr.
Comparative Study ; High-Frequency Ventilation* ; Human ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Oxygen/blood ; Predictive Value of Tests ; Prognosis ; Pulmonary Gas Exchange* ; Respiratory Distress Syndrome/therapy* ; Respiratory Distress Syndrome/mortality ; Respiratory Distress Syndrome/diagnosis* ; Retrospective Studies ; Sensitivity and Specificity ; Treatment Outcome

PURPOSE: This study was carried out to elucidate the effects of nitric oxide synthase(NOS) inhibitor, NG-monomethyl-L-arginine(L-NMMA) and nitric oxide precursor, L-arginine(L-Arg) on cerebral hemodynamics and energy metabolism during reoxygenation-reperfusion(RR) after hypoxia-ischemia(HI) in newborn piglets. METHODS: Twenty-eight newborn piglets were divided into 4 groups; Sham normal control(NC), experimental control(EC), L-NMMA(HI & RR with L-NMMA), and L-Arg(HI & RR with L-Arg) groups. HI was induced by occlusion of bilateral common carotid arteries and simultaneously breathing with 8 percent oxygen for 30 mins, and followed RR by release of carotid occlusion and normoxic ventilation for one hour. All groups were monitored with cerebral hemodynamics and cytochrome aa3 (Cyt aa3) using near infrared spectroscopy(NIRS). Na+, K(+)-ATPase activity, lipid peroxidation products, and tissue high energy phosphate levels were determined biochemically in the cerebral cortex. RESULTS: In experimental groups, mean arterial blood pressure, PaO2, and pH decreased, and base excess and blood lactate level increased after HI compared to NC group(P<0.05). These variables subsequently returned to baseline after RR except pH. There were no differences among the experimental groups. In NIRS, oxidized hemoglobin(HbO2) decreased and hemoglobin(Hb) increased during HI(P<0.05) but returned to base line immediately after RR; 40 min after RR, the HbO2 had decreased significantly compared to NC group(P<0.05). Changes of Cyt aa3 decreased significantly compared to NC after HI and recovered at the end of the experiment. Significantly reduced cerebral cortical cell membrane Na+, K(+)-ATPase activity and increased lipid peroxidation products(P<0.05) were not improved with L-NMMA or L-Arg. CONCLUSION: These findings suggest that NO is not involved in the mechanism of HI and RR brain damage during the early acute phase of RR.
Anoxia ; Arginine* ; Arterial Pressure ; Brain ; Carotid Artery, Common ; Cell Membrane ; Cerebral Cortex ; Electron Transport Complex IV ; Energy Metabolism* ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypoxia-Ischemia, Brain* ; Infant, Newborn* ; Ischemia ; Lactic Acid ; Lipid Peroxidation ; Nitric Oxide ; omega-N-Methylarginine* ; Oxygen ; Perfusion ; Respiration ; Ventilation

PURPOSE: The aim of this study was to investigate the incidence and contributing factors of nonoliguric hyperkalemia in extremely low birth weight infants (ELBW) within 96 hours after birth in very low birth weight infants. METHODS: The incidence of non-oliguric hyperkalemia and difference of clinical feature between hyperkalemic (>or=7.0 mEq/L) and normokalemic (<7.0 mEq/L) groups were determined by reviewing medical records of 35 extremely low birth weight infants admitted in Samsung Medical Center between Jan. 2001 to Dec. 2001. We analyzed the serum levels of sodium, potassium, fluid intake, urine output, blood gas analysis values, and other factors that influenced serum electrolytes. RESULTS: Among 35 ELBW infants, 11 (31%) was hyperkalemia developed and 4 infants (36%) was associated with cardiac arrythmia. The incidence and onset time of hyperkalemia showed inverse correlation with birth weight and gestational age. Perinatal complications and serum levels of sodium, fluid intake, hourly urine output, and other blood gas analysis were no different in both groups. Dopamine administrations, UAC insertion rate, ICH incidence and base deficit were significantly increased in hyperkalemic group. CONCLUSION: Non-oliguric hyperkalemia is a frequent complication of ELBW infant. Serum potassium should be monitored closely to avoid life threatening cardiac arrhythmia in these infants.
Arrhythmias, Cardiac ; Birth Weight ; Blood Gas Analysis ; Dopamine ; Electrolytes ; Gestational Age ; Humans ; Hyperkalemia* ; Incidence ; Infant* ; Infant, Low Birth Weight* ; Infant, Newborn ; Infant, Very Low Birth Weight ; Medical Records ; Parturition ; Potassium ; Sodium

This study was performed to elucidate the mechanism of improved oxygenation after surfactant replacement therapy in respiratory distress syndrome (RDS) of the newborn infants. In 26 newborns with RDS, end tidal-CO2 tension (PetCO2), arterial blood gas analysis and pulmonary function tests were measured at baseline, 30 min, 2 hr and 6 hr after surfactant administration. The changes in dead space/tidal volume ratio (VD/VT ratio=(PaCO2-PetCO2)/PaCO2), oxygenation index and arterial-alveolar partial pressure difference for oxygen ((A-a)DO2) were elucidated and correlated with pulmonary mechanics. Oxygenation index and (A-a)DO2 improved, and VD/VT ratio decreased progressively after surfactant administration, becoming significantly different from the baseline at 30 min and thereafter with administration of surfactant. Pulmonary mechanics did not change significantly during the observation period. VD/VT ratio showed close correlation with OI and (A-a)DO2, but not with pulmonary mechanics. These results suggest that decreased physiologic dead space resulting from the recruitment of atelectatic alveoli rather than improvement in pulmonary mechanics is primarily responsible for the improved oxygenation after surfactant therapy in the RDS of newborn.
Airway Resistance ; Human ; Infant, Newborn ; Lung/physiopathology* ; Lung Compliance ; Pulmonary Gas Exchange ; Pulmonary Surfactants/therapeutic use* ; Respiratory Dead Space* ; Respiratory Distress Syndrome/physiopathology ; Respiratory Distress Syndrome/drug therapy* ; Tidal Volume*

We evaluated the effects of a combined therapy of pre-blockade endogenous nitric oxide synthase (NOS) with N-nitro-L-arginine methyl ester (L-NAME) and continuous inhaled NO (iNO) on the gas exchange and hemodynamics of Escherichia coli pneumonia and sepsis in newborn piglets. Seven to ten day old ventilated newborn piglets were randomized into 5 groups: control, E. coli pneumonia control, pneumonia with iNO 10 ppm, pneumonia pre-treated with L-NAME 10 mg/kg, and pneumonia with the combined therapy of L-NAME pretreatment and iNO. E. coli pneumonia was induced via intratracheal instillation of Escherichia coli, which resulted in progressively decreased cardiac index and oxygen tension; increased pulmonary vascular resistance index (PVRI), intrapulmonary shunting, and developed septicemia at the end of 6 hr experiment. iNO ameliorated the progressive hypoxemia and intrapulmonary shunting without affecting the PVRI. Only two of 8 animals with L-NAMEpretreated pneumonia survived. Whereas when iNO was added to infected animals with L-NAME pretreatment, the progressive hypoxemia was abolished as a result of a decrease in intrapulmonary shunting without reverse of the high PVRI and systemic vascular resistance index induced by the L-NAME injection. This result suggests that a NOS blockade may be a possible supportive option for oxygenation by iNO treatment in neonatal Gram-negative bacterial pneumonia and sepsis.
Treatment Outcome ; Swine ; Survival Rate ; Sepsis/diagnosis/drug therapy/physiopathology ; Pulmonary Gas Exchange/*drug effects ; Premedication/*methods ; Pneumonia, Bacterial/diagnosis/*drug therapy/physiopathology ; Oxygen Consumption/*drug effects ; Nitric Oxide Synthase/antagonists & inhibitors ; Nitric Oxide/*administration & dosage ; NG-Nitroarginine Methyl Ester/*administration & dosage ; Injections, Intravenous ; Escherichia coli Infections/diagnosis/*drug therapy/physiopathology ; Drug Therapy, Combination ; Animals, Newborn ; Animals ; Administration, Inhalation

We evaluated the effects of a combined therapy of pre-blockade endogenous nitric oxide synthase (NOS) with N-nitro-L-arginine methyl ester (L-NAME) and continuous inhaled NO (iNO) on the gas exchange and hemodynamics of Escherichia coli pneumonia and sepsis in newborn piglets. Seven to ten day old ventilated newborn piglets were randomized into 5 groups: control, E. coli pneumonia control, pneumonia with iNO 10 ppm, pneumonia pre-treated with L-NAME 10 mg/kg, and pneumonia with the combined therapy of L-NAME pretreatment and iNO. E. coli pneumonia was induced via intratracheal instillation of Escherichia coli, which resulted in progressively decreased cardiac index and oxygen tension; increased pulmonary vascular resistance index (PVRI), intrapulmonary shunting, and developed septicemia at the end of 6 hr experiment. iNO ameliorated the progressive hypoxemia and intrapulmonary shunting without affecting the PVRI. Only two of 8 animals with L-NAMEpretreated pneumonia survived. Whereas when iNO was added to infected animals with L-NAME pretreatment, the progressive hypoxemia was abolished as a result of a decrease in intrapulmonary shunting without reverse of the high PVRI and systemic vascular resistance index induced by the L-NAME injection. This result suggests that a NOS blockade may be a possible supportive option for oxygenation by iNO treatment in neonatal Gram-negative bacterial pneumonia and sepsis.
Treatment Outcome ; Swine ; Survival Rate ; Sepsis/diagnosis/drug therapy/physiopathology ; Pulmonary Gas Exchange/*drug effects ; Premedication/*methods ; Pneumonia, Bacterial/diagnosis/*drug therapy/physiopathology ; Oxygen Consumption/*drug effects ; Nitric Oxide Synthase/antagonists & inhibitors ; Nitric Oxide/*administration & dosage ; NG-Nitroarginine Methyl Ester/*administration & dosage ; Injections, Intravenous ; Escherichia coli Infections/diagnosis/*drug therapy/physiopathology ; Drug Therapy, Combination ; Animals, Newborn ; Animals ; Administration, Inhalation

No abstract available.
Health Surveys* ; Smoke* ; Smoking*

Dexamethasone has been widely used in very low birth weight infants (VLBWI) weighing less than 1,500 g at birth for the prevention or treatment of chronic lung disease (CLD). Recently, however the use of dexamethasone is being reduced, as its association with abnormal neurodevelopmental outcome is known. On the other hand, there have been persistent concerns about the increased risk of CLD according to the reduction of postnatal dexamethasone use. Hence, we did a retrospective cohort study to delineate the change in the incidence of CLD according to the reduction of dexamethasone use in VLBWI. The medical records of 559 VLBWI admitted to neonatal intensive care unit at Samsung Medical Center between November 1994 and December 2002 were reviewed with a focus on the use of postnatal dexamethasone and the incidence of CLD. The use of postnatal dexamethasone has significantly decreased over the study period. Especially, the use of high-dose regimen has markedly decreased. The day when postnatal dexamethasone therapy was begun has also been significantly delayed. The incidence of CLD has significantly decreased over the same period. In conclusion, the incidence of CLD has not increased despite the decreased use of postnatal dexamethasone.
Chronic Disease ; Cohort Studies ; Dexamethasone/*therapeutic use ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; *Infant, Very Low Birth Weight ; Intensive Care Units, Neonatal ; Lung Diseases/*drug therapy/*epidemiology ; Male ; Retrospective Studies