Proper positioning of pulmonary artery catheter and predicting distal migration of it during cardiopulmonary bypass is important for the prevention of perioperative complication of pulmonary artery rupture. The authors therefore examined the insertion length of pulmonary artery catheter via right internal jugular vein at which catheter tip was advanced to the most proximal position where pulmonary capillary wedge pressure could be obtained. And also the distal migration is measured by comparing the difference between prebypass and postbypass corrected length. Just before bypass, pulmonary artery catheter was arbitrarily receded 5cm for the prevention of spontaneous distal migration and wedging. The subjects were 47 patients who underwent open heart surgery (valve replacement, coronary artery bypass graft) during the period of November, 1992 through April, 1993. The results were as follows. 1) The insertion length of pulmonary artery catheter from skin to the right ventricle inlet, pulmonary artery inlet and pulmonary capillary wedge position were 26.5+/-3.0 cm, 36.8+/-4.9 cm and 46.1+/-5.7 cm respectively. 2) There were no significant statistical correlations between insertion lengths and patient constitutions such as body weight and height(r=0.144, r=0.032). 3) Locations of catheter tips were distributed to the 0.9+/-3.1 cm left to the spinous process, 1.9+/-1.6 cm inferior to the carina ; mostly LLQ of the lung field(51%). 4) During cardiopulmonary bypass, pulmonary artery catheter tips were migrated distally in 93.6% of the cases and the migration lengths were 2.7+/-2.0 cm. 5) There were no major perioperative complications caused by pulmonary artery catheterization. These results suggest that 5 cm withdrawal of pulmonary axtery catheter just before cardiopulmonary bypass can prevent the fatal complication of pulmonary artery rupture owing to its spontaneous distal migration.
Bays ; Body Weight ; Capillaries ; Cardiopulmonary Bypass ; Catheterization, Swan-Ganz ; Catheters* ; Constitution and Bylaws ; Coronary Artery Bypass ; Extracorporeal Circulation* ; Heart Ventricles ; Humans ; Jugular Veins ; Lung ; Pulmonary Artery* ; Pulmonary Wedge Pressure ; Rupture ; Skin ; Thoracic Surgery

PURPOSE: Recently, vancomycin-resistant enterococci (VRE) have become one of the major nosocomial pathogens in Korea. However, there have been few studies on the epidemiology of VRE colonization among neonates. In this study, we investigated the prevalence of VRE colonization, risk factors for VRE, and how to control the spread of VRE infection in the Neonatal Intensive Care Unit (NICU) of Pusan National University Hospital (PNUH). METHODS: We retrospectively reviewed medical records of 192 neonates who were admitted to the NICU of PNUH from March 2006 to March 2007. Surveillance cultures from rectal swabs for detecting VRE were obtained weekly during the study period. We analyzed the prevalence of VRE and various risk factors. RESULTS: The rate of VRE colonization among NICU patients was 25% (48/192). Thirty five of these VRE colonized patients were transferred to the NICU from other local hospitals. Compared with the non-VRE group, the risk factors associated with VRE colonization were lower birth weight, congenital heart disease, applied mechanical ventilation, use of a central venous catheter, chest tubing, a history of surgery, and use of antibiotics. CONCLUSION: VRE colonization among patients admitted to the NICU is rapidly increasing. Monitoring and managing premature neonates from the beginning of the birth process, avoiding many invasive procedures, avoiding antibiotics such as vancomycin and third generation cephalosporin are important for preventing the emergence and spread of VRE colonization in the NICU.
Anti-Bacterial Agents ; Birth Weight ; Central Venous Catheters ; Colon ; Heart Diseases ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Korea ; Medical Records ; Parturition ; Prevalence ; Respiration, Artificial ; Retrospective Studies ; Risk Factors ; Thorax ; Vancomycin ; Vancomycin Resistance

No abstract available.
Busan* ; Eclampsia* ; Female ; Pregnancy ; Singing*

PURPOSE: To evaluate the effect of parenteral nutrition in early neonatal period on bone mineralization at the time of reaching 2 kg body weight in premature infants, bone mineral density(BMD) in infants who received long-term parenteral nutrition in the early neonatal period was measured and compared with infants who received enteral nutrition only. METHODS: Twenty low birth weight infants(those weighing 2 kg or less) were investigated in the Neonatal Intensive Care Units of Pusan National University Hospital between May 2000 and April 2001. Twelve infants received oral nutrition with preterm formula after birth(group A). Eight infants were supported with parenteral nutrition and intensive management in the early neonatal period due to respiratory distress syndrome and after a while they were also fed with preterm formula(group B). We measured the BMD of the whole body of all 20 infants using at the time reaching 2 kg body weight. RESULTS: The mean value of the BMD of total infants was 0.610+/-0.003 g/cm2. The BMD of group A and B was 0.615+/-0.002 g/cm2 and 0.603+/-0.006 g/cm2, respectively. There was no significant differences in the BMD between the two groups. CONCLUSION: Low birth weight infants who received appropriate nutritional supports such as total parenteral nutrition and preterm formula could achieve a catch-up in bone mineralization compared with the infants who were fed with preterm formula only and who had similar postconceptional age and weight.
Body Weight* ; Busan ; Calcification, Physiologic* ; Enteral Nutrition ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature* ; Intensive Care Units, Neonatal ; Nutritional Support ; Parenteral Nutrition* ; Parenteral Nutrition, Total

BACKGROUND: Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to f ind out the ideal timing of operation. METHOD: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by x2-test. RESULTS: Eighty one point two percent were men and 18.8% women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.1(range, 0 to 9). Patients were treated properatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group, Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. CONCLUSION: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.
Drug Therapy* ; Female ; Follow-Up Studies ; Humans ; Male ; Mycobacterium tuberculosis ; Recurrence ; Retrospective Studies ; Treatment Failure ; Tuberculosis, Pulmonary*

PURPOSE: The optimal timing and the consequences of dexamethasone therapy in chronic lung disease remain unknown. The purpose of this study was to determine whether early dexamethasone therapy would reduce the incidence of chronic lung disease and to determine the adverse effects and complications of prematurity associated with such therapy. METHODS: Twenty neonates with hyaline membrane disease(dexamethasone n=10, placebo n=10) of less than 32 weeks of gestation at Ewha Womens University Mokdong Hospital were enrolled. Infants were randomized to receive either early dexamethasone or placebo within 12 hours after birth for three days at 10 day intervals until postconceptional age was 36 weeks. RESULTS: There were no significant differences in the incidence of chronic lung disease, duration of the ventilator therapy, O2 therapy and the duration of admission in the NICU. Retinopathy of prematurity and periventricular leukomalacia were more common in the dexamethasone-treated group(P< 0.05). There were no different in other complications between two groups. CONCLUSION: This study suggests that dexamethasone treatment in extreme low birth weight premature infants may be discouraged. And the duration of treatment and total dosage of dexamethasone should be reevaluated.
Dexamethasone* ; Female ; Humans ; Hyalin ; Incidence ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; Lung Diseases* ; Lung* ; Membranes ; Parturition ; Pregnancy ; Retinopathy of Prematurity ; Ventilators, Mechanical