Riedel's thyroiditis is an extremely rare disease that is difficult to diagnose correctly using preoperative diagnostic tools because it can mimic malignant neoplasm or the fibrous variant of Hashimoto thyroiditis during preoperative physical, radiologic, and pathologic examination. We describe here a rare case of Riedel's thyroiditis in an elderly patient and its radiologic characteristics.
Aged ; Hashimoto Disease ; Humans ; Hydrazines ; Magnetic Resonance Imaging ; Positron-Emission Tomography ; Rare Diseases ; Thyroid Gland ; Thyroiditis ; Tomography, X-Ray Computed

OBJECTIVE: Infants of diabetic mothers have higher incidence of congenital malformations compared with those of non-diabetic mothers. We investigated the usefulness of prenatal level II or "targeted" ultrasonography (TUS) as a diagnostic tool to identify congenital abnormalities in infants of diabetic mothers. METHODS: We retrospectively reviewed the medical records of 218 mothers diagnosed as pregestational or gestational diabetes in whom prenatal TUS was performed in Asan Medical Center between 2004 and 2009. The prenatal TUS findings were compared with the congenital abnormalities found in the infants (n=226) of the diabetic mothers by physical examination and ultrasonography (including echocardiography). Maternal risk factors associated with congenital anomalies were also investigated. RESULTS: The incidence of congenital anomalies was 14.2% (n=32) in prenatal TUS and 15.5% (n=35) postnatally, respectively. Only 7 cases (3.6%) out of the 194 infants with normal prenatal TUS findings were found to have congenital abnormalities diagnosed postnatally. All of the abnormalities in these 7 infants could be detected or suspected by physical examination after birth. Maternal fasting glucose level >120 mg/dL and insulin therapy were significant risk factors for predicting congenital abnormalities in infants of diabetic mothers. CONCLUSION: Prenatal TUS performed by experienced obstetricians had a good reliability in the diagnosis of congenital anomalies in infants of diabetic mothers. Need for universal screening of ultrasound or echocardiography in these infants should be questioned especially in the cases in which prenatal TUS was performed.
Collodion ; Congenital Abnormalities ; Diabetes, Gestational ; Echocardiography ; Fasting ; Female ; Glucose ; Humans ; Incidence ; Infant ; Insulin ; Mass Screening ; Medical Records ; Mothers ; Parturition ; Physical Examination ; Pregnancy ; Retrospective Studies ; Risk Factors ; Ultrasonography, Prenatal

PURPOSE: To determine the clinical manifestations and outcomes of patients with tracheoesophageal fistula (TEF) and esophageal atresia (EA) born at a single neonatal intensive care unit. METHODS: A retrospective analysis was conducted for 97 patients with confirmed TEF and EA who were admitted to the neonatal intensive care unit between 1990 and 2007. RESULTS: The rate of prenatal diagnosis was 12%. The average gestational age and birth weight were 37(+2) weeks and 2.5+/-0.7 kg, respectively. Thirty-one infants were born prematurely (32%). Type C was the most common. The mean gap between the proximal and distal esophagus was 2 cm. Esophago-esophagostomy was performed in 72 patients at a mean age of 4 days after birth; gastrostomy or duodenostomy were performed in 8 patients. Forty patients exhibited vertebral, anorectal, cardiac, tracheoesophageal, renal, limb (VACTERL) association with at least 2 combined anomalies, and cardiac anomaly was the most common. The most common post-operative complications were esophageal stricture followed by gastroesophageal reflux. Balloon dilatation was performed for 1.3 times in 26 patients at a mean age of 3 months. The mortality and morbidity rates were 24% and 67%, respectively, and the most common cause of death was sepsis. The weight of approximately 40% patients was below the 10th percentile at 2 years of age. CONCLUSION: Mortality and morbidity rates of patients with TEF and EA are high as compared to those of infants with other neonatal surgical diseases. Further efforts must be taken to reduce mortality and morbidity and improve growth retardation.
Anal Canal ; Birth Weight ; Cause of Death ; Dilatation ; Duodenostomy ; Esophageal Atresia ; Esophageal Stenosis ; Esophagus ; Extremities ; Gastroesophageal Reflux ; Gastrostomy ; Gestational Age ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Intensive Care, Neonatal ; Kidney ; Limb Deformities, Congenital ; Prenatal Diagnosis ; Retrospective Studies ; Sepsis ; Spine ; Trachea ; Tracheoesophageal Fistula

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.
Achievement ; Bottle Feeding ; Bronchopulmonary Dysplasia ; Enteral Nutrition ; Gastroesophageal Reflux ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Length of Stay ; Parturition ; Retrospective Studies

PURPOSE: Feeding desaturation is a common problem among preterm infants which can result in prolonged hospital stays, long-term feeding difficulties and growth delay. The purpose of this study was to identify the characteristics of premature infants with feeding desaturation and to examine the effect of orocutaneous stimulation on oral feeding. METHODS: During the first phase of this study, 125 extremely low birth weight infants were reviewed retrospectively. Characteristics between infants with feeding desaturation (n=34) and those without feeding desaturation (n=91) were examined. During the second phase, 29 infants recruited from March, 2009 to May, 2010 were subjected to orocutaneous stimulation. The results of orocutaneous stimulation were compared to a control group (n=81). RESULTS: The first phase of the study revealed that extremely low birth weight infants with feeding desaturation were significantly lower in gestational ages at birth, and had lower 5 minute apgar scores, more gastroesophageal refluxes and bronchopulmonary dysplasia. Infants without feeding desaturation reached full enteral feeding significantly earlier and showed shorter duration of hospital stay. At the second phase, infants in the intervention group showed shorter days to achieve initiation of bottle feeding, shorter days in achievement of full bottle feeding, last episodes of feeding desaturation and length of hospital stay compared to the control group of similar characteristics. CONCLUSION: Orocutaneous stimulation among extremely low birth weight infants results in earlier achievement of full bottle feedings without episodes of feeding desaturation hence shortens the length of hospital stay.
Achievement ; Bottle Feeding ; Bronchopulmonary Dysplasia ; Enteral Nutrition ; Gastroesophageal Reflux ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Length of Stay ; Parturition ; Retrospective Studies

OBJECTIVE: To evaluate the effect of custom molded foot orthosis without heel lift in scoliosis patients who had different pelvic height caused by inequality of RCSPA (resting calcaneal stance position angle). METHOD: We retrospectively reviewed the medical data of all patients who had been prescribed custom molded foot orthosis without heel lift in our institution from 2005 to 2009 and chose 38 scoliosis patients with Cobb's angle (> or =10degrees) and different pelvic height (> or =5 mm) caused by inequality of RCSPA (> or =2degrees). Radiologic findings of whole spine AP and RCSPA were measured pre and post treatment and compared. RESULTS: Twenty two females and sixteen males were included in this study. Their mean age was 7.76+/-3.72 years. Their mean period of wearing orthosis was 14.11+/-3.25 months. Initial average Cobb's angle of 13.18+/-3.16degrees were reduced to 7.42+/-3.45degrees (p<0.001). Initial difference of height between right and left iliac crest of 0.87+/-0.26 cm reduced to 0.55+/-0.28 cm (p<0.01) and angle of pelvic inequality of 3.98+/-1.55degrees reduced to 2.54+/-1.27degrees (p<0.05). Initial difference of RCSPA between right and left of 3.69+/-1.54degrees decreased to 1.69+/-1.54degrees (p<0.01). Each parameter has significantly reduced 12 months after the wearing of the custom molded foot orthosis in scoliosis patients whose age was 9 or below, whose Cobb's angle at 15degrees or lower. CONCLUSION: The custom molded foot orthosis without heel lift was effective for scoliosis patients, who had different pelvic height caused by inequality of RCSPA.
Child ; Female ; Foot ; Foot Orthoses ; Fungi ; Heel ; Humans ; Male ; Orthotic Devices ; Retrospective Studies ; Scoliosis ; Socioeconomic Factors ; Spine

PURPOSE: Hearing loss is one of the common birth defects in humans, with a reported prevalence of 1-3 per 1000 newborns. We investigated the incidence of hearing loss and evaluated the use of neonatal hearing screening test in neonatal intensive care unit (NICU) graduates who are at greater risk for hearing loss than normal newborns. METHODS: The neonates admitted to the NICU of Asan Medical Center from 1 March, 2003 to 30 March, 2008 who were available for follow-up were included. Those who failed the first auditory brainstem response prior to discharge were retested with the stapedial reflex test, auditory brainstem response and tympanometry in the Otolaryngology department. RESULTS: Of 2,137 neonates, 2,000 (93.5%) neonates were tested prior to discharge. Sixty-seven neonates (3.4%) failed the first newborn hearing screening test. Of 67 infants, 52 infants were retested for a second hearing test. Excluding 10 infants (19.2%) who were lost during follow-up, 16 infants were confirmed to have hearing impairment of which 12 and 4 infants had unilateral and bilateral hearing loss, respectively. Of 16 infants, 5 did not meet the criteria set by the Korean National Health Insurance Corporation. CONCLUSION: The prevalence of hearing impairment in NICU graduates is about 0.8%, excluding those who were lost for follow up, necessitating a systemic and effective hearing assessment program among these high risk infants and more generous national insurance coverage.
Acoustic Impedance Tests ; Congenital Abnormalities ; Evoked Potentials, Auditory, Brain Stem ; Follow-Up Studies ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Tests ; Humans ; Incidence ; Infant ; Infant, Newborn ; Insurance Coverage ; Intensive Care, Neonatal ; Mass Screening ; National Health Programs ; Otolaryngology ; Prevalence ; Reflex

PURPOSE:To identify trends in causative bacterial organisms for neonatal sepsis and antimicrobial susceptibilities over 10 years in one neonatal intensive care unit. METHODS:We retrospectively reviewed the cases of culture-proven neonatal sepsis between January 1998 and December 2007. The 10-year period was divided into two phases (phase I, 1998-2002; phase II, 2003-2007) to distinguish the differences during the entire period. RESULTS:Total 350 episodes of neonatal sepsis were identified in 315 neonates. The common pathogens of early-onset sepsis were S. epidermidis, S. aureus, P. aeruginosa, and E. cloacae in phase I, and S. epidermidis and E. cloacae in phase II. In cases of late- onset sepsis, coagulase negative Staphylococcus, S. aureus, and K. pneumoniae were isolated frequently in both phases. The incidence of sepsis caused by multi-drug resistant organisms decreased with strict infection control. Gram positive organisms showed 0-20% susceptibility to penicillin, ampicillin, and cefotaxime in both phases. Sensitivity to amikacin for Enterobacter spp. increased, whereas P. aeruginosa showed decreased sensitivity in phase II. Between 50% and 60% of other gram negative bacteria, except P. aeruginosa, were susceptible to cefotaxime in phase II in contrast to phase I. Greater than 80% of gram negative bacteria were sensitive to imipenem except P. aeruginosa and ciprofloxacin in both phases. CONCLUSION:The trend in causative microorganisms and antimicrobial susceptibilities can be used as a guideline for selection of appropriate antibiotics. A particular attention should be paid to infection control, especially to reduce sepsis caused by multi-drug resistant organisms.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Cefotaxime ; Ciprofloxacin ; Cloaca ; Coagulase ; Enterobacter ; Gram-Negative Bacteria ; Humans ; Imipenem ; Incidence ; Infant, Newborn ; Infection Control ; Intensive Care, Neonatal ; Penicillins ; Pneumonia ; Retrospective Studies ; Sepsis ; Staphylococcus

PURPOSE: Death is an important problem for physicians and parents in neonatal intensive care unit. This study was intended to evaluate the mortality rate, causes of death, and the change of mortality rate by year for infants admitted to the neonatal intensive care unit. METHODS: We retrospectively surveyed the medical records of the infants who were admitted to the neonatal intensive care unit at Asan Medical Center and who died before discharge between 1998 and 2007. Gestational age, birth weight, gender, time to death and the underlying diseases related to the causes of infant deaths and obtained from the medical records and analyzed according to year. RESULTS: A total of 6,289 infants were admitted and 264 infants died during the study period. The overall mortality rate was 4.2%. For very low and extremely low birth weight infants, the mortality rate was 10.6% and 21.4%, respectively. There was no significant change in the mortality rate during the study period. Prematurity related complications and congenital anomalies were the conditions most frequently associated with death in the neonatal intensive care unit. of the infant deaths 37.1% occurred within the first week of life. CONCLUSION: Even though a remarkable improvement in neonatal intensive care has been achieved in recent years, the overall mortality rate has not changed. To reduce the mortality rate, it is important to control sepsis and prevent premature births. The first postnatal week is a critical period for deaths in the neonatal intensive care unit.
Birth Weight ; Cause of Death ; Critical Period (Psychology) ; Gestational Age ; Humans ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Intensive Care, Neonatal ; Medical Records ; Parents ; Premature Birth ; Retrospective Studies ; Sepsis

Congenital diaphragmatic hernia (CDH) with severe pulmonary hypoplasia is associated with significant mortality. Recently, several new therapeutic methods have been suggested, such as high- frequency oscillatory ventilation and inhaled nitric oxide. For hypoxemic respiratory failure unresponsive to these advanced medical treatment options, extracorporeal membrane oxygenation (ECMO) serves as the last potentially effective treatment. An understanding of the pathophysiology of pulmonary hypertension associated with CDH led to a strategy involving preoperative stabilization and delayed surgical intervention with ECMO. We describe four cases of ECMO, including the first report of ECMO for neonatal CDH in Korea.
Extracorporeal Membrane Oxygenation ; Hernia, Diaphragmatic ; Hypertension, Pulmonary ; Nitric Oxide ; Respiratory Insufficiency ; Ventilation